Brian Deer is the investigative journalist who has spent years building a case that Andrew Wakefield’s original Lancet paper alleging a connection between the MMR vaccine and an autism-GI disorder syndrome was not only bad science, it was fraud motivated by greed. In part two of his BMJ series detailing the results of his investigation, Deer follows the money, showing that Wakefield stood to make millions from a monovalent replacement vaccine as well as testing for his proposed new GI disorder. For those interested in the details – read the BMJ article. In short Deer builds a convincing case that Wakefield created a fraudulent study designed to generate fear regarding the MMR vaccine that he would then exploit to make millions. Meanwhile he was also paid over a million dollars by trial lawyers to build a case against the MMR vaccine.

What I want to write about today is a recent blog post by Brian Deer in which he accuses the medical establishment of circling the wagons (at least initially) around Wakefield. Deer specifically cites Ben Goldacre and Paul Offit as examples of physicians who were unwilling to accuse Wakefield of fraud. Deer writes:

But a Philadelphia-based commentator was not impressed by the BMJ’s intervention. “It doesn’t matter that [Wakefield] was fraudulent,” Dr Paul Offit, a vaccine inventor and author in Pennsylvania, was quoted in the Philadelphia Inquirer the next day as saying. “It only matters that he was wrong.”

I wasn’t surprised. From his establishment vantage-point, this was the third time Dr Offit had popped up to opine on the issue. Twice previously he’d been quoted as saying that my findings were “irrelevant” (although he’d been happy enough to use them in his books). Science had spoken, his argument went. There was no link between the vaccine and autism. It was experts like him who should rule on this matter, he seemed to imply, not some oik reporter nailing the guilty men.

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For those “shruggies” who still cling to the naive notion that there is no harm in worthless medicine, we have an update on promotion of homeopathic products for the prevention of malaria in sub saharan Africa. The General Pharmaceutical Council (GPhC) of the UK decided to drop their investigation of complaints against pharmacies that were recommending worthless treatments instead of proven and effective drugs for malaria prophylaxis.

Homeopathy is a prescientific philosophy-based system of treatment whose central ideas have been long discredited. Preparations are diluted to the point that there is essentially no active ingredients left behind, and so they are literally nothing but sugar pills or placebos. What’s more, there has been extensive clinical studies of homeopathy, most of it useless, but the well-controlled trials show that homeopathy does not work – for anything.

I did a literature search for homeopathic studies with malaria, and found one animal study published in the journal Homeopathy. The methods are pretty sparse, but there is no indication of blinding, and in any case the study is in mice, not people. Despite the highly preliminary nature of this one study, the authors conclude:

Although the mechanism of action is unknown, these agents would be good candidates as alternative or complementary medications in the treatment of malaria.

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Recent studies demonstrate that babies 12-18 months old have similar activity in their brains in response to spoken words as do adults, a fact that tells us a lot about the development of language function.

In the typical adult brain language function is primarily carried out in highly specialized parts of the brain – Wernicke’s area (in the dominant, usually left, superior temporal lobe) processes words into concepts and concepts into words, while Broca’s area (in the dominant posterior-inferior frontal lobe) controls speech output. The two areas are connected by the arcuate fasciculus and are fed by both auditory and visual input. Taken as a whole this part of the brain functions as the language cortex. A stroke or other damage to this area in an adult results in loss of one ore more aspects of speech, depending on the extent of damage.

Damage to this part of the brain in babies, however, does not have the same effect. When such children grow up they are able to develop essentially normal language function. There are two prevailing theories to explain this. The first is that language function is more widely distributed in infants than in adults, perhaps also involving the same structures on the non-dominant side of the brain. As the brain matures language function becomes confined to the primary language cortex.

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The Journal of Personality and Social Psychology plans to publish a series of 9 experiments by Daryl Bem that purport to show evidence for precognition. This has sparked a heated discussion among psychologists and other scientists – mainly is it appropriate to publish such studies in a respected peer-reviewed journal and what are the true implications of these studies? I actually think the discussion can be very constructive, but it also entails the risk of the encroachment of pseudoscience into genuine science.

Peer-Review

Before I delve into these 9 studies and what I think about them, let me explore one of the key controversies – should these studies be published in a peer-reviewed journal? This question comes up frequently, and there are always two camps: The case in favor of publication states that it is necessary to provoke discussion and exploration. Put the data out there, and then let the community tear it apart.

The other side holds that the peer-reviewed literature holds a special place that should be reserved only for studies that meet certain rigorous criteria, and the entire enterprise is diminished if nonsense is allowed through the gates. Once the debate is over, the controversial paper will forever be part of the scientific record and can be referenced by those looking to build a case for a nonsensical and false idea.

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In 1998 Andrew Wakefield and 12 coauthors published a now infamous paper in the Lancet alleging a connection between regressive autism and nonspecific colitis (bowel inflammation). They also reported a “strong temporal association” between this alleged new syndrome and injection with the MMR vaccine. The study was based upon 12 case reports of children with this apparent syndrome. It sparked fears regarding the MMR vaccine specifically, and vaccines in general, that spread initially through the UK but then around the world, including the US. The result was a surge in the anti-vaccine movement, declining vaccine compliance – and in some communities low enough to reduce herd immunity resulting in outbreaks of vaccine-preventable diseases, like measles and whooping cough.

In early 2010 the Lancet finally retracted the paper, citing ethical concerns, and later that year the General Medical Council found that Wakefield had acted unethically. He was eventually struck off and now is self-employed in the US – professionally disgraced but he remains unrepentant and a martyr and hero of the anti-vaccine movement. Like many cranks, Wakefield hides behind a veil of accusations of conspiracies and persecution.

Despite his downfall, the damage had already been done. During this time journalist Brian Deer relentlessly investigated Wakefield and the Lancet paper. The chilling result of this investigation is now detailed in a BMJ paper (the first in a series).

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It seems that for every established science there is an ideological group who is motivated to deny it. Denialism is a thriving pseudoscience and affects any issue with the slightest political or social implications. Sometimes, even easily verifiable facts can be denied, as people seem willing to make up their own facts as needed.

Denialists have an easy job – to spread doubt and confusion. It is far easier to muddy the waters with subtle distortions and logical fallacies than it is to set the record straight. Even when every bit of misinformation is countered, the general public is often left with the sense that the topic is controversial or uncertain. If denial is in line with a group’s ideology, then even the suggestion of doubt may be enough to reject solid science.

We see this when it comes to the effectiveness of vaccines, the evolution of life on earth, and anthropogenic global warming. A recent Pew poll shows that the campaign of global warming denial has been fairly successful – while the science becomes more solid around the consensus that the earth is warming and humans are contributing to this, the public is becoming less convinced.

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In our advertising we stated that Power Balance wristbands improved your strength, balance and flexibility.

We admit that there is no credible scientific evidence that supports our claims and therefore we engaged in misleading conduct in breach of s52 of the Trade Practices Act 1974.

If you feel you have been misled by our promotions, we wish to unreservedly apologise and offer a full refund.

This is an impressive skeptical victory. One of the self-proclaimed missions of the skeptical movement (such as it is) is consumer protection. Skeptics value truth and reason, and often we will correct a misconception just for the sake of doing so. But often misinformation has a nefarious purpose – to support an ideology, or just to sell something. Deliberately using misinformation in order to create a demand for a product or service is known as fraud.

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In a recent New York Times article, Abigail Zuger takes a crack at the diet wars, and does a reasonable job. There are many points left to be made, however.

The question is, essentially, how to maintain a healthful and desired weight. In broad brushstrokes, the variable are – how many calories people consume, what kind of calories are consumed (the proportion of macronutrients – fat, protein, and carbohydrates) and how much people exercise. These are the (allegedly) controllable variables. The variable we cannot control is our genetics, which largely determines our inherent metabolism and hormonal function.

Different people have different interpretations of the evidence. There are also countless popular diets that don’t even attempt to square with the evidence, but I will largely ignore them for this post.

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