BMJ: Article on Ben Goldacre and responses (Autsim/MMR/Wakefield)

[Guest guest]

Can only get an extract - anyone have whole article?

Also below the following extract are the BMJ responses.

http://www.bmj.com/cgi/content/extract/337/oct01_3/a1856

Published 1 October 2008, doi:10.1136/bmj.a1856

Cite this as: BMJ 2008;337:a1856

Views & Reviews

Review of the Week

Becoming Ben

, director, Ovations Chronic Disease Initiative

richardswsmith@...

Ben Goldacre’s book assembles an impressive array

of villains who deal in bad science, finds

The first 150 words of the

<http://www.bmj.com/cgi/content/full/337/oct01_3/a1856>full

text of this article appear below.

We’re lucky to have Ben Goldacre, and maybe as a

result of his book we’ll have more people like

him. He is fighting what sometimes seems like a

one man battle against a tide of pseudoscience

and an army of quacks. His main weapons are his

weekly column in the Guardian newspaper, an

impressive website (www.badscience.net), and now

this book, which aims " to teach good science by examining the bad. "

Luckily Goldacre, a practising doctor, has all

that’s needed for the battle: a solid

understanding of epidemiology, statistics, and

public health; a fluid, engaging way of writing,

although with a weakness for bad jokes; a gift

for using the web effectively; a taste for glory;

a thick skin; good lawyers; and seemingly

boundless energy (he tells us in passing about his childhood hyperactivity).

The good lawyers are necessary because Goldacre

is regularly threatened with libel actions and

even . . .

[<http://www.bmj.com/cgi/content/full/337/oct01_3/a1856>Full

text of this article]

http://www.bmj.com/cgi/eletters/337/oct01_3/a1856

The MMR story is not complete 8 October 2008

<http://www.bmj.com/cgi/eletters/337/oct01_3/a1856#202946>

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Stone,

none

London N22

Send response to journal:

<http://www.bmj.com/cgi/eletter-submit/337/oct01_3/a1856?title=Re%3A+The+MMR+sto\

ry+is+not+complete>Re:

The MMR story is not complete

I should like to ask [1] how it

could be that Ben Goldacre's account of the MMR

story is complete when it has been made virtually

impossible, particularly in this country, for

those on one side of the debate to present their

case, not least because proponents of MMR safety

blank all criticisms? Meanwhile, and for long

time the media - so far from supporting or giving

space to Wakefield - have been largely intimidated into silence.

As it is Goldacre has never answered the

challenge of the fundamental flaws in the

epidemiology of MMR and autism, as, for instance,

I set out for him in my Rapid Response of 21

September 2007 [2], citing four studies he had

used in his pivotal award winning polemic 'Never

Mind the Facts', published in the Guardian in

December 2003 [3]. Three of the studies, I

pointed out, were found when reviewed by Cochrane

to be seriously deficient. In fact none of the

six autism studies reviewed by Cochrane was

judged to be of low risk of bias (and these were

supposed to be the best). Cochrane demonstrated

its own bias by suggesting that the absence of

evidence for safety should be balanced against

the need to eradicate the diseases, [4] [5] stating in conclusion:

" The design and reporting of safety outcomes in

MMR vaccine studies, both pre- and

post-marketing, are largely inadequate. The

evidence of adverse events following immunisation

with MMR cannot be separated from its role in

preventing the target diseases. " [4]

Moreover, it is less than certain that even if

the epidemiology had been better conducted than

it has been whether it would have necessarily

given a clear answer regarding Wakefield's

hypothesis. Almost unreported in this country the

former head of the National Institutes of Health,

Bernardine Healy, told CBS news earlier this year

that the Institute of Medicine Review of 2003/4

had been over-dependent on epidemiology, and that

in order to properly research the autism/vaccine

issue you would have to look at medical subgroups

(as, indeed, Wakefield had been doing)[6].

Also, almost unreported in this country has been

the publication of the Hornig study [7], the

first study to even half heartedly replicate the

Uhlmann study of 2002, which layed out Wakefield

and O'Leary's initial laboratory findings [8].

While the rhetoric surrounding the publication of

the Hornig study has trumpeted in the US the

final eclipse of the Wakefield hypothesis the

interior detail suggests anything but (perhaps

why we have heard so little of it so far in this country).

In the first place the study confirms the

consistency of O'Leary's results with two most

higly rated labs in the US. Secondly, while the

study only had five cases which of the Wakefield

pheno-type it confirmed two positive results for

measles virus RNA from ileal samples, across all

three laboratories - one from the autistic group

and one from the control group, all of which had

gut pathology (and all cases having MMR). The

study does not tell us whether symptoms in two

cases developed pre or post vaccination, though

it would certainly bolster their case for " lack

of association " if it was pre. And so far from

disputing the results Uhlmann in the discussion it states:

" Our results differ with reports noting MV RNA in

ileal biopsies of 75% of ASD vs. 6% of control

children [10], [41]. Discrepancies are unlikely

to represent differences in experimental

technique because similar primer and probe

sequences, cycling conditions and instruments

were employed in this and earlier reports;

furthermore, one of the three laboratories

participating in this study performed the assays

described in earlier reports. Other factors to

consider include differences in patient age, sex,

origin (Europe vs. North America), GI disease,

recency of MMR vaccine administration at time of

biopsy, and methods for confirming

neuropsychiatric status in cases and controls.

Participation in the current study required

confirmation in cases of the presence of an AUT

diagnosis and exclusion in controls of AUT or

other developmental disturbances. "

Another reason why we might find this troubling

in this country is that study confirms the

appropriateness of the kind of investigation for

which Drs Wakefield, - and Murch are

presently on trial at the General Medical

Council. Not only is this a terrible injustice to

the doctors - irrespective of whether the

hypothesis is correct or not - but it has

effectively infringed the rights of autistic

children in this country who are now widely being

denied appropriate medical support, as the

National Autistic Society has warned [9].

[1] , 'Becoming Ben', BMJ 1 October

2008, http://www.bmj.com/cgi/content/full/337/oct01_3/a1856

[2] Stone 'Re: Restrictions on hospitality

apply to doctors and journalists', BMJ Rapid

Responses http://www.bmj.com/cgi/eletters/335/7618/480#176662

[3] Ben Goldacre, 'Never mind the facts',

Guardian 11 December 2003:

http://www.guardian.co.uk/life/feature/story/0,,1103958,00.html

[4] V Demicheli, T Jefferson, A Rivetti, D

Price,[Review] 'Vaccines for measles, mumps and

rubella in children', Cochrane (Wiley 2005),

http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004407/frame.html

[5] Clifford G , 'Questions on the

Independence and Reliability of Cochrane Reviews,

with a Focus on Measles-Mumps-Rubella Vaccine',

http://www.jpands.org/vol11no4/millerc.pdf

[6] CBS News,'Leading doctor: vaccines-autism

worth study',

http://www.cbsnews.com/stories/2008/05/12/cbsnews_investigates/main4086809.shtml

[7] Mady Hornig, Briese, Buie,

Margaret L. Bauman, Lauwers, Ulrike

Siemetzki, Hummel, A. Rota,

J. Bellini, J. O'Leary, Orla Sheils, Errol

Alden, Larry Pickering, W. Ian Lipkin, 'Lack of

Association between Measles Virus Vaccine and

Autism with Enteropathy: A Case-Control Study',

published 4 September 2008,

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0003140#s3

[8] V Uhlmann, C M , O Sheils, L

Pilkington, I Silva, A Killalea, S B Murch, J

-, M Thomson, A J Wakefield, and J J

O'Leary, 'Potential viral pathogenic mechanism

for new variant inflammatory bowel disease',

Molecular Pathology, Mol Pathol. 2002 April;

55(2): 84–90,

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed & pubmedid=1195095\

5

[9] NAS, 'General Medical Council hearing against

Dr Wakefield', http://www.nas.org.uk/nas/jsp/polopoly.jsp?d=459 & a=13952

" The National Autistic Society (NAS) is keenly

aware of the concerns of parents surrounding

suggested links between autism and the MMR

vaccine. The charity is concerned that the GMC

hearing, and surrounding media coverage, will

create further confusion and make it even more

difficult for parents to access appropriate medical advice for their children.

" It is particularly important that this case is

not allowed to increase the lack of sympathy that

some parents of children with autism have

encountered from health professionals,

particularly on suspected gut and bowel problems.

Parents have reported to the NAS that in some

cases their concerns have been dismissed as

hysteria following previous publicity around the

MMR vaccine. It is crucial that health

professionals listen to parents' concerns and

respect their views as the experts on their individual children.

" There is an urgent need for further,

authoritative research into the causes of autism,

to improve our understanding of the condition, to

respond to parents' concerns and to enable us to

ensure that there are appropriate services and

support in place to meet people's needs. "

Competing interests: Autistic son

Becoming Ben. 10 October 2008

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Bill Welsh,

President

ATT clinic, 29A Stafford street, Edinburgh EH3 7BJ

Send response to journal:

<http://www.bmj.com/cgi/eletter-submit/337/oct01_3/a1856?title=Re%3A+Becoming+Be\

n.>Re:

Becoming Ben.

The MMR “debacle” as Ben Goldacre describes it is

far from over. " The blame " does not lie with

“hundreds of journalists” etc, it lies fairly and

squarely with a highly politicised health system

that discourages dissent from within its own

ranks, that combined with a greed philosophy that

has enveloped a once fine profession. It may be

of interest to BMJ readers to learn of some of

the glowing descriptive terms used at the ongoing

GMC trial of Dr Wakefield et al, with regard to

their scientific research: “excellent”, “robust

and rigorous”, “revolutionary”, “watertight”,

“clinical observation backed up by good science”,

etc, etc. I could go on but when I tell you that

these quotes are from prosecution witnesses you

will realise how far off the mark ‘Becoming’ Ben

is in his attacks on the witness of thousands of

parents. And that is what the MMR debate has

become, a battle between ordinary citizens whose

children face 70 years of mental handicap and

pain, and people like Goldacre. This is no longer

about good science or bad science, the science

debate was over when the editor of the Lancet,

Horton, recently conceded re Wakefield’s

paper, and I quote: 'The essential clinical

findings remain unchallenged as far as their

accuracy is concerned'. Perhaps Horton can

encourage Goldacre “to a deeper understanding of this complex issue”.

Competing interests: Grandfather of an autistic boy.

The Dawn of McScience 10 October 2008

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Mark Struthers,

General Practitioner

Bedfordshire, UK

Send response to journal:

<http://www.bmj.com/cgi/eletter-submit/337/oct01_3/a1856?title=Re%3A+The+Dawn+of\

+McScience>Re:

The Dawn of McScience

The sun has set on honest, independent science

whose primary goal is the discovery of truth. I

don’t know when the sun went down, but like

Horton, I do know that a new era has dawned.

Of course, Dr Horton, present esteemed editor of

The Lancet, described the enlightenment of this

new dawn in his book on the MMR crisis. [1] In

the third chapter, Horton eloquently describes

how, with the colonization of science, the

traditional norms of disinterested inquiry and

free expression of opinion have been given up to

the harvest of huge revenues from the global

wellness industry. He tells us that “subtle yet

insidious changes to the rules of engagement

between science and commerce are causing

incalculable injury to society, as well as to

science.” And in the description, Horton subtly

implies that Wakefield, apparently

burdened with enormous financial conflicts of

interest in his researches into the possible

causes of autism and childhood bowel disease, was

an important marker of this malignant process.

We will all remember that Wakefield and

paediatricians Professors - and Murch

are currently being tried by the GMC, a trial

that will last nearly two years at a cost to the

ordinary doctor of millions of pounds.

Wakefield, who dared to question the

rights of the vaccine- industrial-complex has recently said,

“It is not a question of not vaccinating. I’m not

against vaccinations. I don’t know for sure

vaccines cause autism but I suspect they do. The

opposition just states categorically it does not.

But they don’t know either.” [2]

By apparently invoking the good offices of the

new corporate science, Ben Goldacre can sneer

“unattractively” at the idea of a possible link

between autism, bowel disease and vaccines, particularly the MMR.

[1] The Dawn of McScience. Horton. 3rd

Chapter, MMR Science & Fiction, Exploring the

Vaccine Crisis. Granta Books 2004.

[2] Autism Doc claims government led witch hunt

against him. Phil Doherty, Sunday Sun. Sep 28

2008. http://www.sundaysun.co.uk/news/north-

east-news/2008/09/28/autism-doc-claims-government-led-witch-hunt-against-

him-79310-21915131/

Competing interests: None declared

--------------------------------------------------------

Sheri Nakken, former R.N., MA, Hahnemannian Homeopath

Vaccination Information & Choice Network, Nevada City CA & Wales UK

Vaccines - http://www.wellwithin1.com/vaccine.htm

Vaccine Dangers & Homeopathy Online/email courses - next classes Sept 10, 2008