Parents: ADHD drugs don’t work

If you want to start an argument, try telling a parent – any parent – how to raise their kids. So I'm going to preface this by saying that I'm just trying to make parents aware of something that might concern them. One of the most controversial issues among parents of school-age children today is the shockingly large number of children who are being treated with drugs to control their behavior, especially those children who have been diagnosed with attention-deficit hyperactivity disorder (ADHD). Now it appears that these drugs simply don’t work, except in the short term. The results of a scientific study reported this past week showed that long-term use of drugs to children with ADHD doesn’t provide any benefit over behavioral therapy. Not only that, but children who took medication ended up, on average, one inch shorter than children who didn’t. That’s right: ADHD drugs stunt children’s growth.

This seems to be rather shockingly bad news for the ADHD drug manufacturers. The news was reported on the front page of the Washington Post and in many other media outlets. The study, an 8-year followup of the Multimodal Treatment Study of Children With ADHD (MTA), was reported in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP). The study divided children into 4 groups: medication (M), behavior therapy (B), both treatments (M+B), or no treatment. The authors of the study had reported in 1999 – with great fanfare – that children who received drugs (M and M+B) did better than children who only had therapy (B) after 14 months and at 2 years followup. In other words, over the short term, the drugs seemed to work. As the Washington Post reported: “Because children given drugs alone appeared to do about as well as those treated with both drugs and talk therapy, the study skewed treatment in the direction of medication.”

However, over longer time periods, the drugs (including Adderall and Concerta, two of the most commonly prescribed drugs for ADHD) didn’t help at all – and they stunted growth. Children who took ADHD drugs for 3 years or longer were an average of one inch shorter than children who didn’t take drugs. The study looked at “grades earned in school, arrests, psychiatric hospitalizations, [and] other clinically relevant outcomes,” and found no differences in children given drugs compared to children given only behavioral therapy.

What should be even more disturbing is that this isn’t really news at all – it was reported two years ago, in 2007. The same authors reported then, in a 3-year followup study, that “treatment groups did not differ significantly on any measure at 36 months.” In other words, the benefits of drugs disappeared by 3 years after treatment started. Some of the scientists involved have downplayed these results, but one, William Pelham, was quoted in the Post saying his colleagues are “embarrassed to say they were wrong and we led the whole field astray.”

Another scientists leading the study, Peter Jensen, shot back that Pelham was biased against drugs. However, Jensen has been pushing drug therapy quite publicly for years. In the press release from the National Institute of Mental Health after the 2007 report, he said that “medication can make a long-term difference for some children if it's continued with optimal intensity.” This despite the fact that the 2007 results indicated that medication was not providing any benefit over behavior therapy, results that appear even stronger now. In contrast, William Pelham was already saying in 2007 that ADHD drugs were “all risk and no reward.”

It’s worth noting also that NIMH heavily promoted the initial results of this study back in 2000, and its website still states that “combination treatments as well as medication-management alone are both significantly superior to intensive behavioral treatments and routine community treatments in reducing ADHD symptoms.”

Reporter and blogger Maggie Mahar tried to draw attention to the story in 2007, but the U.S. media simply didn’t pick up on the story. Mahar also pointed out that “drug manufacturers have a serious interest in keeping the U.S. discussion on ADHD married to the medical-disease model.”

All of this made me wonder if Peter Jensen, who seems determined to continue to support the use of drugs to treat ADHD, might have ties to pharmaceutical companies. It took me only a few minutes to discover that he has received funding or grants from: UCB-Pharma, Cephalon, Novartis, McNeil Consumer & Specialty Pharmaceuticals, and Janssen Pharmaceutica. I found confirmation of these ties here. Novartis and UCB-Pharma are manufacturers of ADHD drugs (Ritalin or methylphenidate), and Cephalon makes Provigil, which they attempted to promote as an ADHD drug for years until the FDA rejected it.

Far too many of our children – primarily boys, who are diagnosed with ADHD 3-4 times more often than girls – are being medicated for ADHD. There is ongoing controversy, which I won’t get into here, over whether ADHD is grossly overdiagnosed. Whether ADHD is correctly diagnosed or not, though, it now seems clear that putting children on drug therapy might cause them long-term harm (stunting their growth) while only providing temporary, short-term changes in behavior.

Washington Post shines light on waste at NCCAM

Science reporter David Brown at The Washington Post wrote an excellent article today entitled "Critics Object to 'Pseudoscience' Center," which focused on my efforts - and the efforts of others, notably bloggers at Science-Based Medicine - to eliminate the funding for NIH's National Center for Complementary and Alternative Medicine (NCCAM). You can read the article here (requires login, but it's free).

I'm quoted in the beginning of the article, which also makes reference to my proposal to de-fund NCCAM, posted on Change.gov in January. Brown also reports that NCCAM is getting a boost of $31 million in its budget this year, thanks to the recently-passed stimulus bill in Congress. That's on top of an overall NIH portfolio of $300 million dedicated to "alternative medicine", which includes $122M for NCCAM and $122M for OCCAM.

NCCAM was created initially by Senator Tom Harkin, who continues to push it. In a hearing just a couple of weeks ago, he stated

"One of the purposes when we drafted that legislation in 1992 . . . was to investigate and validate alternative approaches. Quite frankly, I must say it's fallen short. I think quite frankly that in this center, and previously in the office before it, most of its focus has been on disproving things, rather than seeking out and proving things."

Brown quoted this in his article and also paraphrased my response that this shows how badly Harkin understands science. Science doesn't set out to "investigate and validate" - it just investigates, and sometimes the results are negative. That's precisely what has happened with every well-done study of many of the pseudoscientific claims that NCCAM supports, including energy healing (see my previous blog post), acupuncture, homeopathy, magnet therapy, Ayurveda, qi, and others.

In an effort to achieve balance, Brown also interviewed a leading naturopath, Carlo Calabrese, who was formerly on NCCAM's advisory board. Calabrese seems to concede - oddly - that his practices might be no better than placebo treatment, but he argues "What can be done to generate a better placebo? Why isn't that an interesting and valid area of investigation?" How telling: he thinks that even if the methods are just placebos, they still deserve funding. He doesn't seem to see the problems inherent in lying to patients - which is exactly what you're doing if you give them a treatment that you know is a fake.

Kudos to David Brown, and to the Washington Post, for shining some light on the use of NIH funds to support pseudoscience.

Healing Touch for cancer (thanks, NCCAM!)

I was looking at recent grants made by NCCAM, and found a project that just started last year: R15AT003591, “Use of Energy Biofield Therapy for the Treatment of Cancer and GVHD”, from the Univ. of Nevada-Reno, led by Alice Running in their nursing school, and co-directed by Lisbeth Welniak of UC Davis. It’s a 3-year award, and the first year was for $210,688, so I’m estimating the total cost at roughly $630,000. That's a nice chunk of change. But what the heck is "energy biofield therapy"?

Well, NCCAM supports a variety of pseudoscientific practices in the “energy therapy” category, including this study. Running and Welniak plan to look specifically at two methods, Reiki and “Healing Touch”, to see if they can (1) cure cancer and (2) reduce the likelihood of immune rejection (graft versus host disease, or GVHD) of transplated tissues or cells. Really? Remarkable.

First, a very quick look at the two “therapies” proposed by Running and Welniak. Healing Touch is another name for “Therapeutic Touch,” a technique that is little more than magical thinking, but that is very popular (unfortunately) among many nurses and nurse-training programs (including, obviously, the PI of this study, Alice Running). Basically, the claim is that a Healing Touch practitioner (let’s call this person a “healer”) can wave her hands over the patient, manipulate the patient’s “energy field” (an invisible field, undetectable by any known technology), and heal all sorts of illnesses, relieve pain, etc. During a session, the healer doesn’t even touch the patient.

This is all complete nonsense, of course. Therapeutic Touch (and Healing Touch) were most famously debunked in a 1998 article in the Journal of the American Medical Association (Rosa L, Rosa E, Sarner L, Barrett S. A Close Look at Therapeutic Touch. JAMA 279:1005-1010, 1998), using an experiment designed by Emily Rosa, a 4th-grade student at the time. The results have been summarized in many places:

“Emily was able to recruit 21 experienced TT practitioners for her experiment. The TTP's were allowed to "feel" Emily's hands prior to the test, and choose which one they felt the strongest energy radiating from. With the TTP seated behind the screen, Emily then placed her hand over one of the TTP's hands. After 20 trials, these experienced TTP's, some of whom had even published articles on TT, could only sense Emily's hand correctly 44% of the time. By chance alone, they should have guessed correctly 50% of the time. Clearly, except in their own mind, they were not sensing an energy field.”

If TT was debunked 10+ years ago, why is this obvious pseudoscience still being funded by NCCAM? The leaders of this new study claim (with no evidence) that “The mental ability of a being, whether conscious or not, to influence physical parameters especially those linked to stress and inflammatory pathways has become more evident in recent years.” Ah, I see. It's "evident" to someone - presumably Running and Welniak.

Unfortunately, there is big money behind Healing Touch. Programs such as this one - http://www.healingtouchprogram.com - have sold certification classes to over 100,000 nurses (so they claim), making this a multi-million dollar industry with many “experts” who aren’t likely to admit that they are frauds (or that they’ve been made to look like fools). This is despite the fact that websites promoting Healing Touch proudly admit that "many of the techniques used in energy therapies come from practices in shamanistic and Asian traditions with thousands of years of use." That's right, these techniques were used by shamans. Sounds trustworthy to me.

Reiki, by the way, is pretty much the same thing, only with different mumbo-jumbo surrounding it. The Reiki “therapist is supposed to direct their energy into the client to promote the body's self healing” and some Reiki instructors even claim that Reiki can heal genetic disorders.

Oh, and I should mention: this NCCAM study will look at mice. That’s right, they will use Healing Touch to try to cure cancer in mice. As they describe it: “we will determine the limits of Healing Touch to reduce tumor growth and symptoms of graft vs. Host disease in murine models.”

What seems to be going on is that Running believes in this nonsense, and she has recruited Welniak – a scientist at another institution who has published legitimate work on GVHD in mice, and doesn’t seem to have published anything relating to pseudoscience before – to provide cancerous mice for her study. The two of them submitted a proposal to NCCAM, and now they have NIH funding. But by participating, Welniak is lending her scientific reputation to this nonsense, and seriously tarnishing it in the process.

I can’t imagine a better use for $630,000 of taxpayer-provided NIH funds, can you?

Alcohol and cancer: should we all stop drinking?

This past week, stories on the front page of many newspapers reported that women who drink alcohol in any amount have a significantly greater risk of cancer, especially breast cancer. “Even moderate drinking affects women's cancer risk” read the headline in The Guardian (London).

Is this true, or is this another case where the media (and the scientists talking to the media) are over-hyping their results? The only way to find out is to read the article reporting these results, carefully, and look at their actual numbers, which I did. What I learned was that the lowest risk of cancer was found in women who drank 3-6 glasses of wine per week. Surprised? Read on.

The news stories said that the risk was greater whether you drank red wine, white wine, or any other kind of alcohol. The journal itself issued a press release titled “Million Women Study Shows Even Moderate Alcohol Consumption Associated with Increased Cancer Risk” and it also quoted an editorial appearing in the same issue, which said that “There is no level of alcohol consumption that can be considered safe.”

Wow. Scary stuff. My wife read the front-page story and decided that same day not to drink a glass of wine with dinner. But what is the real risk here? Should you stop drinking wine?

First, here’s how they reported risk: they computed the increase in relative risk for each additional 10 grams of alcohol per day, where 10 grams is approximately the alcohol contained in 1 glass (125 ml) of wine. (125 ml is exactly 1/6 of a bottle, so if you get 6 glasses from a bottle, you’re having a standard glass.)

The article reported a 12% increase in relative risk of breast cancer from each additional glass of wine per day. (That's true - but read on.) The study involved very large numbers, over 1 million women, which means that this increase was statistically quite significant. But they don’t report the absolute risk – only relative risk. Fortunately the article provides the raw numbers, so I’ve computed absolute risk here.

The women were divided into “non-drinkers”, who reported drinking less than one glass of wine per week (24% of the participants), light drinkers who drank 1-2 glasses per week (29% of the participants), and three other groups based on weekly consumption of alcohol, as I show in the table below. The number of cases of cancer was measured an average of 7.2 years later, so what the study really measured was the likelihood that a woman would get some type of cancer over a 7-year period. The average age of the women at the beginning of the study was 55.

Here are the key numbers from the study:

Group	Number of women	Total cancers	Breast cancers
Non-drinkers	306760	17416	6409
1-2 drinks/week	371453	19307	7841
3-6 drinks	293891	15183	6642
7-14 drinks	240894	12838	5672
>14 drinks	67292	4031	1816

Now, here is what they didn’t report: absolute risk. As you can see from the table below, the difference in absolute risk of any type of cancer, or of breast cancer, is very, very small for light to moderate drinkers:

Absolute cancer risk in the JNCI study

               Any cancer(%)   breast cancer (%)
Non-drinkers       5.68             2.09
1-2 drinks/week    5.20             2.11
3-6 drinks         5.17             2.26
7-14 drinks        5.33             2.35
>14 drinks         5.99             2.70

Perhaps the first thing to notice is that light drinkers – 1-2 drinks per week – had a LOWER risk of cancer than non-drinkers. Thus it seems that eliminating all alcohol might not be a good idea. The authors of the study, though, had a different theory: they explained that some nondrinkers might have eliminated alcohol due to an existing medical problem, and therefore that this group might be less healthy than the others. Therefore they excluded this group from their analysis, and used the “light drinkers” (1-2 drinks per week) as the baseline group. The increased risk is entirely based on comparisons to this group.

Next, notice that the risk of breast cancer in women who drink 3-6 glasses of wine per week rises from 2.11% to 2.26%. That’s a 7% increase in relative risk, but the absolute risk is very small in either case. Also, the risk from all types of cancer actually decreases, from 5.20% to 5.17%, and in fact this figure (5.17%) represents the lowest overall cancer risk in the study. So it appears that the quote from the editorial above, that “there is no level of alcohol consumption that can be considered safe,” is simply not supported by the data. (The editorial was written by two scientists from NIH, M. Lauer and P. Sorlie.)

Third, let’s look at the risk for women who drink 7-14 glasses of wine per week. This is 1-2 glasses with dinner every night – still fairly moderate. As compared to the very light drinkers, risk of breast cancer increased from 2.11% to 2.35%. That’s an increase in relative risk of 11% – this is what the study reported – but an 11% increase sounds a lot more scary than an 0.24% increase. The overall cancer risk in this group increased by just 0.13%, which even in relative risk is only 2.5%. The reason for the smaller overall cancer risk is that the risk for some cancers actually went down with increasing alcohol consumption.

The article, while generally well written, does make a glaring overstatement in its conclusions, one that the editors and reviewers should never have let stand. It is this: “regular consumption of low to moderate amounts of alcohol by women increases the risk of cancers of the upper aerodigestive tract, rectum, liver, and breast.” That is not correct. The study showed an association between increasing alcohol consumption and cancer, but correlation does not necessarily imply causation. The authors should have written that increasing one’s consumption of alcohol is associated with increased risk – not that it “increases the risk.” They didn’t prove that, nor did they offer a mechanism that would explain it.

So: what the study really found was that the healthiest women drink 1-2 glasses of wine per week, or 3-6 glasses per week, depending on how you read the numbers. Emphasizing relative risk, as the authors and the journal editors did, overstates the real risk. The commentaries also conveniently neglected to point out that nondrinkers were excluded from the analysis.

As for me, I just bought a couple of bottles of wine yesterday. I think I'll open one tonight.

Anti-vaccine pseudoscientist Jay Gordon

After the vaccine court decision (discussed in my last post), there have been predictable reactions from many anti-vaccine activists, some claiming that “more study is needed,” others claiming bias, and of course conspiracy theories. One of the most prominent anti-vaccinationists is Jay Gordon, who is Jenny McCarthy’s kid’s doctor, and who has enjoyed a huge amount of publicity by going on TV repeatedly as the vaccine “skeptic”. He employs a variety of logical fallacies to argue, again and again, that vaccines cause autism. What is also remarkable about this guy is that he protests, over and over, that he is not anti-vaccine.

Come on.

Gordon’s latest act is an article in the Huffington Post, which has been a haven for anti-vaccine nonsense, titled “The Vaccine Court was Wrong.” In this ridiculous article, he trots out the usual arguments. First, he says “they should have insisted on further studies to assist in the decision-making process.” Huh? The courts don’t decide what scientific studies should be done. They review the evidence presented to them. The plaintiffs chose 3 cases from among thousands – the best cases they could find, presumably – and presented their evidence. They failed up and down the line to show that vaccines have any link whatsoever to autism. They also failed to show that thimerosal (the preservative that used to be present in some childhood vaccines) has any link to autism. Furthermore, they failed to show any plausible mechanism for how vaccines might cause autism.

Multiple large epidemiological studies have failed to show any link. But Dr. Jay still insists we need “further studies.”

Next, let’s deal with the question of Jay Gordon’s incompetence as a scientist. In a second recent post (last week) by Gordon, he claimed bluntly:

“Let me state very simply, vaccines can cause autism.”

Gordon provides no evidence for this statement – he just declares it to be true. One of the responses on the HuffPost site got him riled up: a commenter said:

“Dr. Jay is not a scientist…. I see no peer-reviewed publications in his biography, no additional training in biomedical research, and no specific expertise in vaccine science. He has no more credibility in telling you that vaccines are unsafe than I, a computer programmer, do.”

This really got Gordon upset. Here’s his reply:

“Actually, I am a scientist. After high school, I continued my education and trained for twelve years in medical science. Subsequent to that, I have observed thousands of children and families and kept records about their health. That, [blogger id], is science.”

Hang on while I get back on my chair. The inanity of that statement floored me for a minute. Let’s see: if I take courses in anatomy, physiology, etc., can I claim to be a doctor? What about that, Dr. Jay? The problem is, taking medical school courses doesn’t make you a scientist – it exposes you to science, true, but in your case you didn’t seem to learn the methods of science, just the facts (presumably).

But even more misguided is Gordon’s claim that his observations (however numerous) trump controlled epidemiological studies. Scientists know all too well how much bias can affect observations: that’s why we do controlled, blinded studies. Gordon seems to think that his experience overrides any number of scientific studies. This is the antithesis of science. If Gordon understood science (he doesn’t), then he would know that subjective experience and beliefs don’t form a valid basis for conclusions. You can use observations to form hypotheses, but then you must test them. In the case of the autism-vaccine hypothesis, it has been tested, repeatedly, and has failed. Real scientists have accepted these results and moved ahead to try to determine the true causes of autism, instead of clinging to failed hypotheses.

Here I have to give a big shout-out to Orac over at Respectful Insolence for his latest post in which he picks apart Gordon’s arguments decisively, and provides a lesson on why Gordon is not only not a scientist, but is one of the most damaging anti-vaccinationists circulating today.

Finally, Gordon also wrote this week that “private industry is once again duping the FDA, doctors and the public. “ There it is – the conspiracy theory. Not that he has any evidence of this – he doesn’t. In fact, most of the large studies showing no link between vaccines and autism (the ones I’ve read) were publicly funded, and run by scientists who had no financial interest in the outcome. In contrast, Dr. Jay is doing very well financially selling his DVD and books where he warns parents about the dangers of vaccines. In fact, his website is a shameless collection of self-promotional materials (I refuse to post a link here) and advertisements asking you to buy his “must-see DVD” (I’m not making that up) and book. So who’s really making money on this pseudoscience?

One final shout-out to Steven Novella for his clear explanation of some of the sloppy thinking and logical fallacies behind Gordon’s arguments. If only people would read Orac and Novella instead of Gordon!

Special court rules that vaccines are not linked to autism

This story is all over the news - it's on the front page of today's Washington Post, in fact, which I was delighted to see - so I won't say much, but I just wanted to make note of it. It's particularly telling in light of last weekend's news - discussed in my previous blog entry - that Andrew Wakefield falsified some of the data in his 1998 paper claiming that MMR vaccines were linked to autism.

The special "vaccine court" ruled yesterday, in three separate cases, each of which was testing a different strategy for claiming that vaccines cause autism, that there was no evidence that vaccines caused autism in any of the cases. The judges rule against the notion that MMR vaccine causes autism, and against the notion that thimerosal used as a preservative in vaccines causes autism, and against the notion that some combination of vaccines and thimerosal causes autism.

I just wanted to quote one of the judges, George Hastings. Not only did he rule that the vaccine-autism hypothesis was "very wrong," but he also wrote:

"Unfortunately, the Cedillos have been misled by physicians who are guilty, in my view, of gross medical misjudgment."

I'd like to think that any doctor who is telling parents that vaccines might cause autism would read this and then look again at the scientific evidence. One more quote from Judge Hastings:

"...the evidence was overwhelmingly contrary to the petitioners’ contentions. The expert witnesses presented by the respondent were far better qualified, far more experienced, and far more persuasive than the petitioners’ experts, concerning most of the key points. The numerous medical studies concerning these issues, performed by medical scientists worldwide, have come down strongly against the petitioners’ contentions. Considering all of the evidence, I found that the petitioners have failed to demonstrate that thimerosal-containing vaccines can contribute to causing immune dysfunction, or that the MMR vaccine can contribute to causing either autism or gastrointestinal dysfunction."

I hope that these cases, and the publicity today, will reassure many parents that they needn't worry when giving vaccines to their children. The far greater worry is that previously-controlled diseases such as measles will make a comeback, as is already happening.

For more details on the recent ruling and other analysis, I recommend the Holford Watch blog here, and Steven Novella's Neurologica blog entry, here. A good explanation of the vaccine court is here.

Autism, vaccines, and Andrew Wakefield’s fraudulent claims

A new article in the Sunday Times of London by investigative reporter Brian Deer reveals new details about the original study claiming that the MMR vaccine causes autism. This now-infamous study, published in The Lancent by Andrew Wakefield and colleagues in 1998, involved just 12 children, all of whom were autistic. It turned out that the children were all recruited to the study – not a random sample, despite the paper’s claims – by Wakefield and a lawyer whom he partnered with, as part of an effort by Wakefield to build a legal case allowing him to make pots of money by suing vaccine manufacturers. And Wakefield also had filed for a patent on a “safer” vaccine that he was ready to offer as soon as he “proved” that MMR wasn’t safe.

The latest article reveals that Wakefield “changed and misreported results in his research, creating the appearance of a possible link with autism, a Sunday Times investigation has found.” Some of this data was revealed earlier, but Brian Deer has dug deeper and found even more troubling information. Not only were the patients recruited to the study by a lawyer seeking to sue vaccine makers, but the data were manipulated (see the details in this extended article) in ways that seriously altered the findings. Several of the children, for example, showed signs of autism before receiving the vaccine, as was revealed in their medical records. The Lancet study reported that all the children showed the first signs of autism after getting the vaccine. Another example: Wakefield reported on biopsies of the colon for all the children, saying that the biopsies were abnormal. This indicated what he claimed was a new syndrome, where measles particles in the vaccine inflamed the colon, causing a “leaky gut”, through which “toxins” somehow made their way to the brain. Subsequent research has shown no evidence of this, and Wakefield has never identified any specific toxins (nor has anyone else).

Well, it turns out that Wakefield altered the biopsy data too. The paper concluded that 11 of the 12 children had “uniform” intestinal changes that they called “nonspecific colitis”. The hospital pathologists, however, “concluded that they were not uniform but varied and unexceptional.” Wakefield’s team met and reviewed the reports, and decided to stick with their original findings anyway.

Wakefield sees himself as a persecuted hero, or at least that’s what he says. Last summer he compared himself to Vaclav Havel, the playwright and political activist who later became President of the Czech Republic. Orac calls this “the Galileo Gambit” – a tactic where you invoke the name of a famous scientist whose theories were initially rejected, only later to be confirmed, as a defense of your own beliefs. The implication is that you’re just like them – in this case, Wakefield is suggesting that he’s just like Vaclav Havel, who stood up to Communism and repression in his native country.

Sorry, Andrew, you’re no Vaclav Havel – not even close. Havel wasn’t trying to file lawsuits to pad his own pockets. One of the most damning pieces of evidence is a document uncovered by Brian Deer that reveals that in 1996 – two years before the infamous MMR-vaccine paper, Wakefield and his lawyer associated filed documents seeking funds from the UK Legal Aid board for this:

“to seek evidence which will be acceptable in a court of law of the causative connection between either the mumps, measles and rubella vaccine or the measles/rubella vaccine and certain conditions which have been reported with considerable frequency by families who are seeking compensation.”

In other words, Wakefield was looking for evidence that he could use to sue vaccine makers. This is one of the most elementary errors one can make in a scientific study, the confirmation bias problem: you decide in advance what you want to find, and then you interpret all the evidence in a way that supports your pre-conceived notions. In Wakefield’s case, this also conveniently profited his own bank accounts: he earned £435,643 (as reported by Brian Deer) through his work with lawyers.

For 10 years now, scientists and the media have treated Andrew Wakefield with respect. He’s done countless interviews and presented himself in the media as he likes to be seen, and meanwhile scientists have spent millions of dollars and years of effort trying to replicate his findings. All the scientific results have shown the same thing: that there is no link between the MMR vaccine and autism. These years of research could have been devoted to productive research on autism, trying to find the real causes, rather than chasing false hypotheses.

There are only two explanations I can think of for Wakefield’s continuing insistence that he’s right: either he’s incompetent or he’s a fraud. ( Orac calls him an "antivaccination loon" - a bit strong, but justified. David Gorski at Science-based medicine calls him a scientific fraud.) I’ve seen his interviews and he really seems to believe what he’s saying, so my conclusion is that he’s incompetent. Rather than treat Wakefield with respect, we all (journalists included!) show be showing outrage over the damage he’s causing to public health. Because there’s no mistake about that: vaccination rates have fallen, many children have gotten sick as a result, and some children have died. That’s a very real cost, and a tragic one.