Sunday, March 01, 2009

SACRIFICE

The other day, Age of Autism posted an item about a recent article in Pediatric News. AoA labeled the article as “irony.” I have a few other descriptive terms for it, but the bounds of civility precludes their use here.

The Pediatric News article, by Dr. Barbara Howard, addresses the ongoing struggle many physicians have in convincing us that “all is well,” despite all that we have seen and learned.

Specifically, Dr. Howard is trying to give advice to her peers as to how they can regain a semblance of credibility as they attempt to tell us about the “abundance of research disputing the connection between vaccines and autism,” when at the same time the mainstream medical profession “still can’t fully explain to parents or even [themselves] why rates of autism are increasing at a rapid clip.”

Dr. Howard’s willingness to accept the conclusions from that “abundance of research,” without truly looking at how those conclusions were reached, is typical of the intellectual laziness that permeates not just medicine but other professions as well. In the legal field, we used to refer to such practitioners as being “head note citers.” Those were the guys who, when writing a brief, cited certain cases for points that were abbreviated in a “head note” inserted by editors from the legal publishing house. Yet when the judicial decision itself was read, it became crystal clear that the case was being wrongly cited. That’s how lawyers lose credibility with their audience (the court).

A similar loss of credibility occurs when doctors tell us that the potential connection we worry about was disproven by the Danish studies, in which the criteria for inclusion in the populations studied changed between the two groups being compared. And how can we believe in their professional judgment when they tell us that the Verstraeten study ¬⎯ which we know showed a link that was later lost after the Simpsonwood conference radically altered the parameters of the study, resulting in what the authors termed a “neutral” result neither proving nor disproving a connection ⎯ likewise stands as concrete evidence that there are no safety concerns.

Hey, I’m still convincible. All it would take is a little honest talk from a doctor armed with enough real science to refute the questions that have been raised. But what do I know. I’m just one of those lay persons Dr. Howard referred to when she wrote:
If their concerns are based on faulty logic or scientific confusion, remember that their theory could make perfect sense if you hadn’t studied microbiology, immunology, physiology, and metabolism, not to mention statistics.

There you have it: the irony. Once again, we’re subjected to the myth that the only people feeding this issue are the uneducated parents who really don’t understand science. Like so many others, Dr. Howard completely ignores the work of Boyd Haley, Jill James, Thomas Burbacher, and so many others. Although those scientists have not necessarily proven a definite connection, their work has raised serious questions to which mainstream medicine has not yet given any answers. And unlike the “abundance of research” Dr. Howard and others rely on, the work giving rise to those questions is in the nature of microbiology, immunology, physiology, and metabolism. What Dr. Howard relies on consists primarily on epidemiology: i.e., statistical analyses that often fall victim to the accounting principle of GIGI ⎯ garbage in, garbage out.

I don’t question Dr. Howard’s sincerity. My problem with her, and others like her, is that they are willing to use flawed logic and compromised science to prop up a program they believe in with the best of intentions. Dr. Howard’s motivation is obvious in her advice to the profession:
Finally, if we’re being perfectly honest here, we must admit to ourselves that we have a covert agenda when it comes to vaccines.

Vaccination protects individual children, but its real value is in mediating risks across populations.

Are we really prepared to tell Mr. and Mrs. Johnson that we do care about Susan, but we also have an obligation and a responsibility to consider societal benefits and risks in an ever-increasing ripple effect from our office door to the neighborhood, the community, the state, the nation, and the world?

This is the same crap we’ve heard from Paul Offit and his ilk over the years. But every time we hear them say something, it’s only hinted at. Their belief in the concept of “herd immunity” (a theory based upon the inherent unreliability of vaccines) is so strong that they feel the sacrifice of a statistically small set of children is acceptable to ensure a relatively small percentage decrease in the incidence of some diseases. That’s what they believe, but convincing us that our children may be part of a sacrifice is not easy. It’s far easier to give us the false reassurance that our fears are unfounded.

Sometimes I think these mainstream physicians picked up their sense of morality from Star Trek. Like many, I wiped away some moisture form my eyes at the end of Star Trek 2: The Wrath of Khan, when Spock sacrificed himself for his shipmates. That sacrifice was based on his logical conclusion that the needs of the many outweigh the needs of the few, or the one. That’s an awfully easy maxim to believe in when you aren’t the one or the few, or the one. But even more to the point, what made Spock’s sacrifice noble was that he willingly took it on. Our kids didn’t volunteer to be sacrificial lambs. There’s nothing noble about their sacrifice other than the courage with which they and their parents get through each day.

If the theory of herd immunity is sound ⎯ and that’s a might big “if” ⎯ I certainly understand that there are other parents who could just as easily say that I am suggesting their children be put at risk of being sacrificed. There are no easy answers to the question of whose needs are more important. To reach the correct answer, we need an honest dialog. Dr. Howard, however, thinks that is too difficult:
One of our many arguments in favor of vaccines has to do with the balancing of weighted risks and benefits, according to statistical models.

There’s a big disconnect here, because people in general, and even doctors, are not particularly good at making decisions when we’re given information in SAT-like formulas. (“This vaccine would reduce your chances of getting disease x by a certain percentage; disease x carries this percentage risk of serious sequelae or death; the vaccine carries this percentage risk of serious sequelae or death.”)

Try us doc. We’re really not as dumb as you think. We can have an honest discussion of the risks of not vaccinating, including the risk to other kids in society. But before we can have that discussion, you need to be willing to acknowledge that there just may be a potential for serious sequelae from not just a particular vaccine, but from rigid adherence to the recommended vaccination schedule. At the very least, you need to acknowledge that there is an open question needing further study. And that’s the hard part, isn’t it?

1 Comments:

Blogger EdR77203 said...

I have always marveled at the statistical analysis of the scientists. (I hate to muddy the word with their types.) How can you do a statistical measure of the mercury in shots or the MMR vaccine and claim that these statistical tests prove that there is no relationship between autism and vaccines. That was not what the tests were designed for. I also don't understand why they get vitriolic, sarcastic, patronizing and insulting when anyone suggests that the statistical test for a relationship between autism and vaccines should involve a control group.

How much statistical knowledge does it take to recognize that the Danish study was flawed? If the rate of autism rose with the decline of mercury then that says one of two things - a little mercury makes for fewer autism cases or what they should have realized, that their data got contaminated by some other factor, namely bad collection techniques.

The scientists have to use statistics because repeatable measurements like those done by Haley show that claims that mercury is okay for autistic children (or anyone else) is absurd. Instead, the scientists prefer to quote a 1937 study done by Eli Lilly that infers that a 200 pound man can safely take an injection of 2 grams based on rabbit studies. Offit actually does say that in his "False Prophets" book.

And then there is my favorite saying "Post hoc ergo propter hoc" that they say because there have been so many reports of fever, a change in demeanor, listlessness and then a plunge into autism, not caring that there is more to the MO than it occurred right after the vaccination.

I too can be convinced, but I am not looking for evidence of harm. I am just looking for evidence of this being taken seriously.

3/1/09, 10:55 PM  

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