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In 1998, an article was published in the Lancet
that followed the cases of 12 children with developmental regression and gastro-intestinal symptoms
such as diarrhea or stomach pain
9 of these children had autism
and 8 of the 9 had parents who thought that the symptoms of their autism had developed after the vaccine for measles, mumps and rubella, or the MMR vaccine, was administrated
This was not a randomized control trial nor even a scientific study. It was merely a description of a small group of children.
To be honest, it's difficult to imagine that this study could get published in the Lancet today
but based on the belief of the parents of those 8 children, a frenzy of fear about vaccines and autism was ensued for more than a decade
that's the topic of this week's Healthcare Triage
let's me start with some caveats
I'm a pediatrician and a health services researcher
I see kids with autism, I treat kids with autism
I've even been part of funding NIH research to improve the ways we screen for and diagnose autism in children
it's a real condition that is increasing in prevalence and has a significant impact on children and families accross the world
I do not deny in any way that we need to do more about autism
but it has nothing to do with vaccines
and every dollar that we waste on that topic is a dollar we can't spend on important researcher treatment to help children with autism and their families
the initial article I mentioned in the Lancet was not a study
it had no real statistics and proved no association or causation
but it caused so much concern that it lead ta a whole bunch of real studies to combat it
just one year later in 1999 a study was published in the same journal
no difference was seen in the age of diagnosis for those who did and did not receive vaccines
that meant that either there was no association between MMR and autism or that it was too weak an association to be detected, even in a larger sample of children
some were unimpressed, they still were concerned
in 2001, a study was published in the Journal of the American Medical Association that looked at data on over 10,000 kindergarteners born in California from 1980 to 1994
the incidence of autism over that time increased from 44 per 100,000 births to 208 per 100,000 births
that's a 373% increase
MMR coverage, on the other hand, rose from 72% to 82%, a relative rise of only 14%
it was determined in the study that the relatively small increase in MMR could not possibly be responsible for the huge increase seen in autism
the next year, in 2002, a study was published in the New England Journal of Medicine that followed all children born in Denmark from 1991 to 1998
they obtained data on over 537,000 children, born in those years
they could find no association between the development of autism and the age of vaccination, the time since vaccination or even the date of vaccination
that same year, a similar study was published in the Journal of Pediatrics
it followed over 535,000 children in Finland, born between 1982 and 1986
it too could find no association between the MMR vaccine and autism
in 2004, the Lancet published another study, which matched 1294 kids with autism against 4469 kids without it
they found no relationship between the MMR vaccine and autism
in 2004, 10 of the 12 authors of that first Lancet paper retracted the supposition that the MMR vaccine could cause autism
this kind of thing is unbelievably rare in the medical litterature
an 11th author could not be contacted before the retraction
only one researcher, the main one in fact, held firm
for the record, that researcher is no longer licensed to practice medicine in the United Kingdom
in 2005, a systematic review, or study of studies, examining the effectiveness and unintended effects of the MMR vaccine, was published in the Cochrane Collaboration
they identified 31 studies which met the criteria for their review
after a thorough investigation, even though the MMR can be associated with a number of side-effects or other issues, there was no evidence for an association between the vaccine and autism
and in 2012 they updated their work
this time, the research they found included 5 randomized control trials, 1 controlled trial, 27 cohort studies
17 case control studies, 5 time series trials, 1 case cross-over trial, 2 ecological studies, and 6 self controlled case series studies
all of these together involved 14,700,000 children
and in all that data they could find no link between vaccines and autism
because there is no link
and another study, no manner how many times you ask for one, isn't going to overcome this massive amount of data
humans try to make sense of the world by seeing patterns
when they see a disease or condition that tends to appear around a time a child is a year or so old, as autism does
then that is also the age when kids get particular shots, they want to put those things together
parents watch their kids more carefully after the get shots
sometimes they pick up on symptoms then
but just because two things happen at the same times doesn't mean that one caused the other
this is why we need careful scientific studies
and as I have outlined here, they have been many many such studies that have failed to find any real evidence to support the hypothesis that vaccines cause autism
don't tell me it's the mercury in thimerosal that's to blame, there has been no thimerosal in infant vaccines since 2003 and autism hasn't disappeared in the last decade
this was all because of one paper, a decade and a half ago, that described the beliefs of the parents of 8 children with autism
and that's what makes the next part in this all the more tragic
in 2011, the British Medical Journal released an article which described in detail how that 1999 Lancet paper wasn't just junk science, it was a lie
it described how the main author, the only one who still supports its findings
changed the records, changed the stories, and changed the numbers to create the appearance of an association where none existed
the journalist who wrote the BMJ article tracked down the patients in the study and showed how none of these stories or information matched up to what was published in the final paper
he found that there were discrepancies as to wether the children actually had regressive autism
he found that there were falsifications and other symptoms that were alleged to cause the autism
he even discovered that dates had been changed
although the Lancet paper alleged that 8 of the 12 patients reported symptoms days after the MMR vaccine, the BMJ investigation confirmed that for almost all of these children, that wasn't the case
and if that wasn't bad enough, it turned out that all of the patients had been recruted by anti-MMR campaigners
this study was also commissioned and paid for by a group that planned litigation against the vaccine manufacturers
the British Medical Journal called the original Lancet paper a "fraud"
it's easy to become cynical about people's loss of trust and understanding in science to the point that you think it's unlikely that we will ever be able to convince some people that the MMR vaccine is safe
that's a tragedy in and on itself
it's easy to believe that the perpetrator of this fraud would not suffer the repercussions he deserves
many still continue to lionize him and believe him to be a victim of some powerful cabal
it's hard for me to be dispassionate about those who abuse the trust people give physicians
I get even more riled up when someone violates the rules of ethical science
I think it's likely that children have not been given an MMR vaccine because of this fraud
I think it's likely that children have gotten sick because of this fraud
I think it's likely some children have died
I hope we can find some way to change that in the future
this episode of Healthcare Triage is supported by audible.com, a leading provider of premium digital spoken audio information and entertainment on the Internet
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we recommend the signal and the noise by Nate Silver, which explains the analysis of data and statistics in an entertaining and informative manner
it's great! you should go listen to it now
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