January 7, 2011

Wakefield And The Autism Fraud-- The Other Part Of The Story

madoff.JPG
get it?


Does the MMR vaccine cause autism?  Merely writing those words guarantees the google crawler is going to summon the trolls.  But it's a legitimate question, not legitimate in that it is true but legitimate in that since someone says it does, we should all be interested in finding out one way or another.

Short version: a paper in 1998 with more authors than test subjects observes that previously normal kids developed autism after the MMR vaccine.  Back and forth, the science is questioned, 10 of the authors renounce the study and Lancet ultimately retracts the study.

However, a new analysis finds that Wakefield wasn't just wrong, but he probably faked the study.

From AP:

The analysis [by Deer] found that despite the claim in Wakefield's paper that the 12 children studied were normal until they had the MMR shot, five had previously documented developmental problems. Deer also found that all the cases were somehow misrepresented when he compared data from medical records and the children's parents.
The obvious outrage is how this guy frauded all of us, and may have inadvertently/on purpose caused thousands of kids to not get the MMR vaccine.

But there are two other problems that should also generate outrage, or at least bafflement.

First, it's 2011.  The paper was written in 1998.  How long does it take to look over the primary source data? 

Which brings us to the next, larger problem: the people who finally reviewed Wakefield's paper, scrutinized the primary sources, and went and talked to the parents was not a team of neurologists or 3 new peer reviewers, but a journalist

That's who we have fact checking our science.

This journalist did what all of medicine did not do for a decade: email 12 people.


II.

Hold on: as we now already knew for years, Wakefield wrote this paper in order to support a lawsuit against the vaccine manufacturers.  In 1998.  There were several other Illness v. Vaccine civil cases as well.

No?

Let me spell it out for you: in these gigantic cases with millions of dollars at stake and every possible resource imaginable-- Wakefield himself got $500k-- no one in the legal community thought to verify the science either.  They just trusted the expert witnesses, who, of course, never read a primary source on anything-- always review articles and books.  All that money hinging on, essentially, the word of Wakefield, and no one bothered to check his work.

Think about this when you meet with your public defender.

III.

I get it: Wakefield's evil.  A Big Legal shill who faked the data to enhance his testimony and own profits.  He probably thought-- and this is in fact what happened-- that it would be a small enough study that no doctor would care about it, but he could use it in court to say "there is evidence to support the notion that..."  And, indeed, no one read that paper until 2 years later, when Wakefield pressed his luck by writing more articles citing that study.

We should "extradite him to Britain to face fraud charges," said some article somewhere.

Whatever.  If you want to be cattle and moo with the herd, fine: blame Wakefield.  But Wakefield didn't do this, Wakefield is a product of this.  It's like blaming Bernie Madoff for the banking crisis.  He's guilty, but he isn't the cause of the problem, he's the result of the problem.

You scientists have created a system that trusts, implicitly, the word of every scientist-- except if he is getting paid by Pharma, of course (as everyone knows, NIH and university funds do not influence results.)  If he says the patient had a -7 on a scale, then it was -7, end of story. "Well, we have to trust the researcher a little bit, otherwise the whole architecture falls apart."  Exactly.   Why then do you not trust bankers that way?  If a banker lies he goes to jail. Are there any penalties for making up a study?  Do you seriously believe that scientists have less reason to nudge the numbers than bankers do? 

Then, you'll engage in serious academic disputes about whether MMRM is better than LOCF for analyzing a double blind study-- you'll assert that double blind trials are the gold standard!-   when you all know that 75% of the time we can tell if it's placebo or drug.  When you title the paper, "A Double Blind, Placebo Controlled Trial of---" you are lying.

And why wouldn't you?  The system is set up for you to lie.

Why, in the internet age, is the primary data not part of the paper? 

Peer Review is a joke-- why do you call it that?  They're not my peers, they're my close friends or my mortal enemies depending on my/my department's relationship with the editor; and they're not reviewing it, they're writing asinine, self-important comments that will never be noted after publication.

Why doesn't it change?  The answer is precisely in what Wakefield did: he wrote a tiny paper that he hoped would not be scrutinized (or even read.)  He just wanted to be able to say he wrote it, he wrote it not for science but for himself.  Now pick up any journal.  How many articles within are not for clinicians to act on, they're to put on a CV, get a promotion, get a grant, establish a name.  That's why we have ten million journals, none of which anyone reads, ever.

Fortunately enough good science gets done, loudly, powerfully, that medicine moves forward.  But the amazement shouldn't be that Wakefield's study was a fraud, the amazement should be why we haven't discovered hundreds of studies that are frauds.

I'll save you the meta-analysis: it's because we don't have enough journalists.

----

From 2009:

MMR Vaccine Finally Cleared Of Assault

Autism And The MMR Vaccine: Bait And Switch, For Profit
 







Comments

Only one quibble: name one ... (Below threshold)

January 7, 2011 1:56 AM | Posted by Max: | Reply

Only one quibble: name one banker that got sent to jail. (Madoff was not a banker, he was a fund manager.)

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Well, how can it be that me... (Below threshold)

January 7, 2011 2:06 AM | Posted by Stephen R. Diamond: | Reply

Well, how can it be that medicine marches on, when scientists are in the same moral position as hypothetical bankers who suffer no punishment for fraud? To the extent that it amazes you that medicine marches on, its continuing to march on casts doubt on your premise: that scientists yield as readily as bankers to economic opportunities; or that it's as easy in science as in finance to get away with fraud, despite the limitations of the results-confirmation process.

The difference between bankers and scientists is that bankers are in it solely for the money, whereas scientists are in it mainly for recognition, and in general recognition is a far weaker motive than money. It is worth more to a banker to get away with fraud than it is for the scientist.

The difference in supervision is that money can often be stolen without anyone's else's assistance, scientists work in groups and employ numerous assistants, so it almost requires a conspiracy theory to allege fraud. Yes, it happened in this vaccination/autism study, but one instance doesn't make an argument. If there's a danger of false reporting in science, it lies with highly esteemed scientists (Cyril Burt comes to mind). This case may be an outlier that journalists would, naturally, pursued.

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A journalist can pick up th... (Below threshold)

January 7, 2011 2:11 AM | Posted by Jim: | Reply

A journalist can pick up the phone and call the twelve sets of parents. A scientist would see this endeavor considered to be a follow-up study by an IRB that requires a detailed application be submitted, complete with rationale and scripted questions that must be adhered to.

This may not refute what you're saying so much as demonstrate the mechanism by which it is enforced.

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"Do you seriously believe t... (Below threshold)

January 7, 2011 3:00 AM | Posted by randy: | Reply

"Do you seriously believe that scientists have less reason to nudge the numbers than bankers do?"

Good point. My first reaction is "of course they have less reason, about $5-$100 million more reasons." But the latest experimental economics seem to say that wealth is relative, and so even if scientist don't make $100 million bonuses, they're not competing with the bankers but with other scientists/doctors/academics. I suppose their motivations are just as strong, even with less cocaine.

I would still like to see the bankers marched into the streets and gunned down.

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"$5-$100 million more"...i ... (Below threshold)

January 7, 2011 3:02 AM | Posted by randy: | Reply

"$5-$100 million more"...i meant "fewer". i need drugs to balance out the beer.

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For the longest time I wish... (Below threshold)

January 7, 2011 4:51 AM | Posted by Anon: | Reply

For the longest time I wished I could have blamed it on the vaccine but the truth is he was born that way.

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Here's a good questi... (Below threshold)

January 7, 2011 5:42 AM | Posted by Anonymous: | Reply


Here's a good question:
Why should we believe the journalist?
He's saying the study is fraudulent, he figured it out... but why the hell should I believe him? For all I know, this douchebag is frauding us about uncovering a fraud (which seems a whole lot more likely than the over the top scandal he claims to have discovered). Is anyone checking HIS facts, making sure he's not misrepresenting things?


As for why we don't regulate academics and research the way we do banking records, the reason is we sort of assume a natural competition amongst researchers... if scientist A is trying to figure out cancer, scientist B and C are competing with him for funding. If scientist A is a faker, a scammer, makes crap up, sooner or later it will catch up to him because he has competitors (not to mention eventually it will be discovered his intellectual products are totally useless).
With money its a bit different as competition is not always there - money is money, after all, if you have a pile of it in front of you, just steal it. The people in the bank literally have the money in their lap, all they need to do is take it, so we have to be extra sure they don't take it.

The other reason we don't regulate academics is we assume such people are benevolent and have a genuine pursuit of knowledge and progress motivating them, i.e. we are ignorant that research is a product just like a car stereo, it can be faked and sold to a rube, it can be stolen and sold on the black market.

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"Why should we believe the ... (Below threshold)

January 7, 2011 6:51 AM | Posted by Anonymous: | Reply

"Why should we believe the journalist?"

One hopes a serious journal has a team of fact checkers, who spend considerable time double-checking everything the journalist writes. Unfortunately sometimes they just call people to make sure their names are spelled correctly, but one also hopes the BMJ has a higher standart than most other journals.

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Ok, lookie what got publish... (Below threshold)

January 7, 2011 8:22 AM | Posted by ATraveller: | Reply

Ok, lookie what got published the next day:

Scientists fear MMR link to autism

I'm actually impressed by the speed of that. Of course, they are apparantly citing old data, that has never been published, but never mind that. "Scientist fear" ought to do the trick, and keep the debate alive for a long, long time.

Well played.

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dailymail is a rag... I wou... (Below threshold)

January 7, 2011 8:48 AM | Posted by geg: | Reply

dailymail is a rag... I wouldn't take it too seriously

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Spot on. I have family and ... (Below threshold)

January 7, 2011 9:27 AM | Posted by medsvstherapy: | Reply

Spot on. I have family and friends that go on and on about evil banks. Well, like everything else, they are ostensibly regulated. So, regulation failed. Yes, banks are evil. So, regulate them. BP is evil - so regulate deep-water drilling. And then we can benefit from the evil ones striving to do their evil, but under our check.

A side note abt peer review:
"Peer Review is a joke." I am reviewing an article for a Psychiatry journal right now. It involves evaluating some symptom groups upon presentation for dx and tx. Where did these ppl come from? How do ppl in general end up in this tx setting? Are any court-mandated? Who refers? Are they self-referred? What is their funding / health ins profile?--are they all Medi-wildcard? I will put this in my review. The authors will either have to say 1. they don't know, 2. actual info, or 3. fake the data.

I am not doing counselign with kids now. But child counselors ALWAYS want to know if there is anything litigious going on - because we want to know if we are a pawn in a divorce case. So, we ask.

Peer review here will make the authors of the under-review article commit a bit further to making things transparent - giving more of a context in which to place these data. If Wakefield had been asked to do this, it would have forced him to either solidify the false story more, or hint at the truth - and the story would have been a bit more easy to unravel.

Yet, my little anecdote is just a side-note.

I totally agree that the big issue is NOT that there is a scoundrel out there - there ALWAYS will be; the issue is that Lancet fostered the scoundrel, and was fairly powerless to check it.

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The difference between b... (Below threshold)

January 7, 2011 9:35 AM | Posted, in reply to Stephen R. Diamond's comment, by Reader: | Reply

The difference between bankers and scientists is that bankers are in it solely for the money, whereas scientists are in it mainly for recognition, and in general recognition is a far weaker motive than money. It is worth more to a banker to get away with fraud than it is for the scientist.
Only because you're assuming it's solely for recognition. If the studies don't turn out the way the funding source(s) wanted, the next study doesn't get funded. Pfizer tells Astra-Zeneca that Dr. Schmoe isn't interested in producing results and...guess he should have played along better. The monetary stakes aren't as high for researchers, but instead of greed you're dealing with desperation.

For example, the JUPITER trial was recently revealed to be excessively flawed. And it wasn't just a bunch of guys looking for recognition - this study was supposed to put the final nail in the coffin of the "are statins really necessary?" debate. And it did, after a lot of dishonest data, and the researchers made plenty of money and their continued funding was guaranteed. Except now we know it was a load of baloney and statins are damn near next to useless for anyone but older men with previous cardiac events. Pretty unfortunate for all those otherwise-healthy middle-aged housewives now taking a pill daily because of slightly elevated cholesterol...

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Questioning the motives of ... (Below threshold)

January 7, 2011 9:47 AM | Posted by Gary: | Reply

Questioning the motives of global-warming researchers ultimately, somehow, ends in accusations of racism. The Left--cut from a superior cloth--are exempted from normal human qualities such as greed, envy, and preferences for others similar to themselves. We should trust scientists and academics with blind religious faith, as they are the new righteous ones.

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I don't know what the solut... (Below threshold)

January 7, 2011 10:07 AM | Posted by R. Kevin Hill: | Reply

I don't know what the solution is, but the problem isn't confined to the sciences. I recently read a Cambridge University Press biography of a historical figure in which a claim of some importance about an act of the figure was made, supported by a 19th century document describing an interview with a witness of the event. Just for giggles, with some difficulty I got the document myself (an 1896 magazine article in German) and read it, and it simply reported no such event at all. I don't think peer review is completely worthless, but this sort of thing happens all the time.

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The junk that makes it into... (Below threshold)

January 7, 2011 10:23 AM | Posted, in reply to R. Kevin Hill's comment, by Reader: | Reply

The junk that makes it into textbooks and other educational materials never ceases to amaze. I read a redaction from a publishing house, for a religious textbook, in which they included information provided by Scientologists (but no other source) on a "controversy" surrounding the religion. The house said that upon further review, yada yada. Fact checking simply interferes with the business' ability to make money, so it isn't done.

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I think you are missing som... (Below threshold)

January 7, 2011 10:48 AM | Posted by Andres: | Reply

I think you are missing some important facts. There have been countless studies done since this one was published, that conclusively showed that MMR (and other vaccines) do not cause Autism.

This does not stop people from believing that MMR vaccines, and other vaccines increase the risk of autism. There has been a concerted effort by many groups, including Wakefield, to push the autism link as fact. For reasons that I cannot comprehend.

The way science is done is not broken. Essentially when someone finds something new, different, or novel, they publish it, and other labs / researchers will then attempt to corroborate the studies findings. Unless other groups can corroborate the results the scientific community won't accept it as fact.

The way science is reported on, however, is indeed problematic. News outlets love taking preliminary results, hopeful results, results that show something new / scary, and report it as fact. The reporters might not comprehend completely that they are preliminary results, or fully understand the science underlining the issue. It doesn't stop them from reporting it as the next big thing.

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"it's because we don't have... (Below threshold)

January 7, 2011 10:53 AM | Posted by Phanatic: | Reply

"it's because we don't have enough journalists."

Right. Journalists like this:

http://www.dailymail.co.uk/news/article-388051/Scientists-fear-MMR-link-autism.html

[quote]Now a team from the Wake Forest University School of Medicine in North Carolina are examining 275 children with regressive autism and bowel disease - and of the 82 tested so far, 70 prove positive for the measles virus.

Last night the team's leader, Dr Stephen Walker, said: 'Of the handful of results we have in so far, all are vaccine strain and none are wild measles.

'This research proves that in the gastrointestinal tract of a number of children who have been diagnosed with regressive autism, there is evidence of measles virus.

'What it means is that the study done earlier by Dr Wakefield and published in 1998 is correct.[/quote]

No, what it means is that of 82 kids who have a)autism and b) bowel disease, 70 tested positive for the measles virus. Did they have autism before they were vaccinated? Did they have bowel disease before they were vaccinated? If you tested 82 kids who have autism *or* bowel disease, but not both, how many would test positive for the measles virus? If you tested 82 kids who have *neither* autism nor bowel disease, how many would test positive for the measles virus?

Journalists.

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Avid reader here. What you... (Below threshold)

January 7, 2011 12:19 PM | Posted by CriminalDefense: | Reply

Avid reader here. What you say about junk science is a huge problem of trial law practice, and it is downright SCARY what is acceptable "expert witness" fodder. "Rape nurses," child psychologists, therapists and social workers pull out psuedo-science and make conclusions they can't back up when pressed. Most jurors take what they say as gospel and even a lot of judges' eyes glaze over once things get technical.

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Andres - It's not just the ... (Below threshold)

January 7, 2011 12:24 PM | Posted, in reply to Andres's comment, by Anonymous: | Reply

Andres - It's not just the way the news is reported. It's rather fashionable for people in medical science to blame journalists for bad science reporting. While it's true that reporters hold some responsibility and there's a world full of bad science journalism out there (and non-science journalists writing about things they don't really understand), very often some of the bullshit/hype starts with the PR departments of universities and the scientists themselves. More hype means a higher profile for the university and potentially more funding.

That said, the anti-vaccine movement has been highly media driven because they've used the Scientology model (a lot of pseudoscience/pseudomedicine and the supplement industry have links to Scientology). This involves getting a celebrity to be a spokesperson to get media attention as part of the disinfo efforts. Really the anti-vaccine hysteria is mainly about selling desperate parents "alternative treatments"...ideology may be used to sell it but the main motive is profit, as always.

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First, in the present scien... (Below threshold)

January 7, 2011 12:36 PM | Posted, in reply to Stephen R. Diamond's comment, by Anonymous: | Reply

First, in the present scientific climate, medicine, like the rest of science, marches on mostly to the extent that it is driven by money.

Second, money is an extremely POOR motivator--it's only a good motivator on tasks that require minimal cognitive processing. This means that the current system has held scientific discovery back for quite a while--science has succeded, where it has, in spite of itself.

Third, many researchers that work in "teams" often work independently, and the opportunities--from data collection to data analysis and publication--for fraud are abundant.

Science holds no more truth than anything else in our lives, yet it is regarded in high esteem. In this day and age, the scientific community spends more time mentally masturbating and clamoring for status than providing results that better society.

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I am more than a little dis... (Below threshold)

January 7, 2011 12:54 PM | Posted by Dean Esmay: | Reply

I am more than a little disappointed that there are commenters here who suggest that money doesn't influence or potentially corrupt scientists. Or that they aren't competing for money.

Within the current peer review process, they are absolutely, positively, very nearly 100% of the time, competing with each other for money. Not just as individuals, but as teams.

Whipping out the word "conspiracy" is a quick and easy way to dodge the unassailable fact that they are in fact competing for money. And sometimes, it may be "small" amounts (in the tens of thousands of dollars), which all by itself is problematic. But in certain academic areas, they're competing for millions, tens of millions, and in a few elite cases, even billions of dollars.

What this creates is what anyone in basic text on ethical business or good government practice will tell you is a conflict of interest. Researchers are, all too frequently, no longer truly economically disinterested. Money is on the line.

In the case of some elite researchers, it's very large amounts of cash. In others, it may be "small," but it's big enough that there's a conflict of interest.

In a staggering number of cases, if you do not produce results, you and your whole team will lose your jobs. You have a mortgage, you have kids, and if you aren't producing results, you may be losing your job. You are thus under the same pressure as any schmoe in any career to produce or go find work at McDonald's.

This is why a simply staggering amount of science cannot be trusted. You have an inherent conflict of interest that has grown up around the peer review process that the peer review process has never been updated to address. The current peer review process doesn't just work for PAPERS, it also determines WHETHER OR NOT YOU KEEP DRAWING YOUR PAYCHECK.

Generations ago scientists could count on tenure to protect them from conflicts of interest and from being unafraid to pursue their research wherever it took them. Now tenure, too, depends on you not rocking the boat to get there, and takes decades to achieve, working under people who are frequently making very good money and won't take you on as a grad student or postdoc if you are a boat-rocker or you dare question the status quo they are invested in.

"Conspiracy" doesn't begin to describe it. The proper term is conflict of interest, and there is no reason--none, zero, zip--to believe that scientists are any more immune to the problems causes by conflict of interest than people in any other field: banking, real estate, stock trading, law, auto sales, auto repair, or any other endeavor at all.

Until the peer review system is changed to reduce or eliminate the inherent bias caused by conflict of interest, we can confidently predict that there will be tons of worthless science, and quite a bit of it never uncovered because the entire system is structured to prevent it from being exposed.

The Atlantic published a phenomenal piece not long ago on the stunning work of Dr. John Ioannidis and his team of dedicated researchers has shown, time and time again, that a simply staggering amount of medical research is simply worthless, and, worse, that research which has already been proven bogus, even restracted, still gets cited over and over again and used as proof for things in a simply staggering amount of other papers. The entire field is riddled through it. I strongly recommend this to you and your readers:

Lies, Damned Lies, and Medical Science:
http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/8269/

This should be a clarion call for reform. And the general public should be interested in this because so much of this research is being funded using TAXPAYER MONEY.

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The journalists are too bus... (Below threshold)

January 7, 2011 1:46 PM | Posted by Nadia: | Reply

The journalists are too busy posting pictures of Kim Kardashian with a camel toe -- no one gives a crap about vaccines and drugs. Pass the sertraline and stare at Jenny McCarthy's boobs as she testifies how her son miraculously came out of autism.

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<a href="http://www.nature.... (Below threshold)

January 7, 2011 2:21 PM | Posted by Anonymous: | Reply

http://www.nature.com/embor/journal/v8/n5/full/7400970.html

This is an interesting study that claims at least 10,000 articles should have been retracted from PubMed. The number of actual retractions is 596!

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But... Didn't we know this ... (Below threshold)

January 7, 2011 2:29 PM | Posted by Isaac: | Reply

But... Didn't we know this two years ago when The Times ran their article and The Lancet pulled the original study? Slow news day for WebMD/non-medical media or am I missing something?

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Did Hell just freeze over? ... (Below threshold)

January 7, 2011 4:36 PM | Posted by RC: | Reply

Did Hell just freeze over? I mean, you're actually defending journalism?

I suppose you've never held either science or journalism in very much esteem, but I wouldn't have guessed you would show a preference for the latter.

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It is like Gary Taubes book... (Below threshold)

January 7, 2011 10:14 PM | Posted by LUCCHESE: | Reply

It is like Gary Taubes book Good Calories, Bad Calories. He is a science journalist and a lot of people dismiss him for this because apparently it takes a medical degree to look through diet studies and determine if any mistakes were made.

And it all basically boils down to a widely known fact: carbs (the bad insulin spiking ones) make you fat.

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Top Ten Legal Drugs Linked ... (Below threshold)

January 8, 2011 1:05 AM | Posted by TR: | Reply

Top Ten Legal Drugs Linked to Violence

http://www.theonion.com/articles/new-huckleberry-finn-edited-for-language,18745/?utm_source=morenews

Do a post on these drugs/risks/problems w study?

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Top Ten Legal Drugs Linked ... (Below threshold)

January 8, 2011 1:05 AM | Posted by TR: | Reply

Top Ten Legal Drugs Linked to Violence

http://healthland.time.com/2011/01/07/top-ten-legal-drugs-linked-to-violence/

Do a post on these drugs/risks/problems w study?

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Taubes is a good example.</... (Below threshold)

January 8, 2011 1:23 AM | Posted by Anonymous: | Reply

Taubes is a good example.

Obesity research is a great example.

Obesity research is driven down the wrong path over and over again, because the reality of things grossly conflicts with the funding. The reality is that the obesity epidemic began circa 1970, which correlates to women entering the workforce and american citizens making a dietary shift toward an extremely high sugar, high carbohydrate, convenience food diet. Frozen TV dinners and take out food which are unfathomably and unnaturally high in sugar and carbohydrate and low in protein became normal dietary fare. The most genetically vulnerable among us fattened first; but eventually we all fattened as generations of prenatal exposure to hyperinsulinemia/hyperglycemia/hyperleptinemia programs the fetus toward ever deteriorating metabolic control. Each generation is fatter and more diabetic than the previous because your mothers sky high insulin (as well as elevated sugar and leptin) fucks the fetus up for life. This is well demonstrated in animals and any layman can see each generation of his family is fatter earlier and becomes diabetic at an earlier age than the previous ones.

The root cause of all of this is GROTESQUE amounts of sugar in the diet, as well as starchy carbohydrate. We drink gigantic slurpies and king size candy bars and we eat takeaway because women no longer cook meals because women work. It's not women's fault at all, but it is evident that the shift of women entering the workforce changed our dietary practices, which in turn triggered the present obesity/diabetes epidemic we are now dealing with.

In spite of the fact this is all obvious and the evidence is clear (common non-genetic obesity is always caused by hyperinsulinemia with or without hyperglycemia; obesity is not possible without insulin excess; certain foods are much more insulinogenic than others), mainstream obesity research resists investigating this angle as if it were like holocaust revisionism.

Why?

Because junk food is huge business. NO one wants to hear 100 calorie packs and weight watchers and all that shit is part of the problem, because that cuts profits. If you go to a supermarket, 90% of what is marketed to fat people to help them, diabetics as well, is actually terrible for them.

Miracle cures for obesity is also big business. No one wants to hear that atkins was pretty much fucking right; people want to hear that there is a new pill or a new surgery which will magically erase obesity forever. It's never going to happen. Obesity is not a disease, obesity is a physiological result of hundreds of genes which err certain humans toward being hyperresponsive to seasonal changes - a very sophisticated hibernation response. Recently modernized hunter gatherers and humans whos genetics herald from the northern parts of the world evolved to respond to high carbohydrate intake as a sign of impending winter, and metabolism responds accordingly (think: seroquel or any AAP, all of which cause obesity/diabetes/infertility via triggering a quasi hibernation response). Dopamine, melatonin, the sympathetic nervous system via light exposure all regulate the hibernation response in animals. It is the same in humans. If you block dopamine in an animal or in a human it exhibits signs of hibernation. Carbohydrate, in some humans, works like that, as a trigger for hibernation... as some humans come from environments/have genes which evolved in environments where there were large seasonal shifts in carbohydrate availability.

For some humans, massive slurpies from 7-11 are like big doses of seroquel. It triggers a genetic code which promotes hibernation, thus the accrual of body fat, insulin resistance/glucose intolerance, elevated blood sugars, torpor/apathy/"innatentive ADD"/hypersomnia (downregulation of dopamine receptors occurs during obesity, in response to carbohydrate, and it helps promote the hibernation adaptation... this is rapidly reversed by glucose restriction and food restriction).

There will never be a "pill" to cure this, because WE ARE this. It would be like curing humanity. There is no way to stop it, it is too much of our physiology, it is a normal healthy evolutionarily adaptive cluster of traits, a tendency. All we can do, and all we should do, is work with our genetics and stop triggering an artificial hibernation - bright light in the morning, low glucose intakes, low psychiatric med intakes (which block dopamine/augment serotonin, which blocks dopamine as a secondary action) all will prevent the metabolic mayhem of year round hibernation. High dopamine, high light, low dietary sugar/carbohydrate - this is the key to resolving an abnormal/excessive hibernation response.

But you know what, no one gives a shit, because this isn't profitable.

So take your zoloft, eat your high sugar low calorie diet food, go to the gym every day until you need orthopedic surgery, keep sleeping too little, keep your abnormal light exposure patterns. No money to be made in reality.

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Follow the money whenever y... (Below threshold)

January 8, 2011 8:13 AM | Posted by GT: | Reply

Follow the money whenever you want to know the truth of something.

Even if researchers are motivated by the most noblest of ideal, they have to eat and put a roof over their heads too.

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Disclosure: I am a profess... (Below threshold)

January 8, 2011 8:46 AM | Posted by bobby: | Reply

Disclosure: I am a professional, practicing scientist. More disclosure: I work for a global pharmaceutical company.

The peer-review process is not broken, it works as well as can be expected, and peer-review does not exist in the vast majority of fields in which information is disclosed to the public. In general scientists trust one another, and it is very rare to see medical records altered and 13 people conspire to fake data. I am amazed that the Wake Forest bozo cited above in the Daily Mail chose to conduct a press conference rather than put his data through the peer review process and disclose only published results. That is a huge no-no in the scientific world. If we allowed scientists to go right to the press with every still-warm result from the lab, well, that's how you get all the fake "neutriceuticals" out there. Mix that with a financial incentive, and you have a board-certified dermatologist who is dissatisfied with $300K a year and resorts to pushing something called "hydroxyderm" and 488 nm laser dermablation on her patients, counting on the well-studied placebo effect and associated "testimonials."
So there is LOTS of quack science out there in the popular press. The peer-review process and respected journals like the Lancet are there to improve the quality of the information that gets released, as well as they can. But, as with banking, in the face of a determined and credentialed individual with malicious intent, regulations and procedures are just not enough.

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I'm not sure you take this ... (Below threshold)

January 8, 2011 10:22 AM | Posted by 300baud: | Reply

I'm not sure you take this one deep enough, Alone.

One of the reasons that we don't get more good journalism is that readers don't much want good journalism. Sure, a lot of people say they want it, but how many put money down? How many will read it instead of the reams of gossip, sports reporting, and poltics covered like gossip or sports?

And in medicine, of course, people always want the next miracle cure. They want to know how to live forever by eating this or taking that. They want novelty and surprise and things to be scared of more than they want solid, sober, carefully tested advice that is probably kind of boring. Not everybody, sure, but enough so that ad-supported media is going to go after them, first. Just like everybody puts the candy bars next to the cash register rather than fruits and vegetables.

But why do people act like they want that stuff? And given that you're an expert on what goes on in people's heads, what can we do to change that?

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There really is a pi... (Below threshold)

January 8, 2011 12:19 PM | Posted by Anonymous: | Reply


There really is a pill for everything. It's called cyanide.

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Bernard Lawrence Madoff is ... (Below threshold)

January 8, 2011 12:50 PM | Posted by Anonymous: | Reply

Bernard Lawrence Madoff is a piece of shit, of epic proportions. What is truly amazing is that if the bottom had never fallen out, this pig would have been celebrated as a great capitalist. For instance, he served on the boards of universities and provided hundreds of thousands of dollars to political candidates.

Plus, this scandal illustrated what anybody with an IQ over 80 knew, i.e. that the SEC is another bloated, USELESS federal agency.

It is also very telling that more swine were not sent to prison.

http://thirdtierreality.blogspot.com/

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Ever wonder what happened t... (Below threshold)

January 8, 2011 2:02 PM | Posted by Reverend Nathaniel Killjoy, Esq.: | Reply

Ever wonder what happened to all those bullshit papers you had to write for college? "Cheers: A Post-Modernist Reinterpretation of the American Homunculus qua Zeitgeist," et al. Not like you had a strong opinion on the exact shape of the bar in Cheers, or how that molded American discourse. You just had to write a paper, so you popped some Adderall and cranked it out before the deadline. More bullshit to put on your CV.

I have had this fear - I am currently in college - that this bullshit never really ends. No one really knows what the fuck they're doing.

Seems that I'm mostly right.

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Understand the McWhiffle ec... (Below threshold)

January 8, 2011 2:10 PM | Posted by The Good Reverend Killjoy: | Reply

Understand the McWhiffle economy and you understand the world. The business of America is process. And we all do just enough to get by.

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Gary wrote: "Questioning th... (Below threshold)

January 8, 2011 2:24 PM | Posted, in reply to Gary's comment, by Jasmine: | Reply

Gary wrote: "Questioning the motives of global-warming researchers ultimately, somehow, ends in accusations of racism."

Gary, I'm glad someone else thought of global warming when they read this! The article asks: "Why, in the internet age, is the primary data not part of the paper?" If you recall the leaked "Climategate" e-mails, they're all about the leading researchers in climate science fighting tooth and nail to keep their data and algorithms from public scrutiny, even to the extent of defying Freedom of Information Act requests. And mainstream journalism has never bothered to ask any real questions about it, even though this research is used to justify trillion-dollar changes in the world's economy.

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How relevant was his paper?... (Below threshold)

January 8, 2011 2:49 PM | Posted by Anonymous: | Reply

How relevant was his paper? How many citations did it receive before the story broke loose?

There are plenty of papers that get published that no one cites. The research was done (or not, in Wakefield's case), but isn't important enough to generate more research. Part of the process.

There's also the issue that if the study was published in 98, the data was originally gathered when, in 93? You're talking about 20 year old data, again, probably not relevant.

I wouldn't go about exonerating journalists. Because one broke a story doesn't pardon the dozens if not hundreds of others that sensationalize science to sell magazines.

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I can't believe you didn't ... (Below threshold)

January 8, 2011 4:05 PM | Posted by FJWalker: | Reply

I can't believe you didn't mention a possible reason being that people want desperately to believe that a vaccine causes autism and not the emotional life/health/interpersonal relationship of the parents?

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Scientists are not idiots a... (Below threshold)

January 9, 2011 11:45 AM | Posted by titmouse: | Reply

Scientists are not idiots about conflicts of interest.

Replication of results by independent parties is our best control against fraud.

Everyone in this thread pimping, "science is no better than other ways of knowing stuff": please kill yourselves.

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Yes, because "slurpies from... (Below threshold)

January 9, 2011 2:57 PM | Posted by syntaxfree: | Reply

Yes, because "slurpies from 7-11" function as an H1-antagonist for Stupid Americans. And besides, all psychiatric medications (other than slurpies from 7-11 apparently) work the same: "augment serotonin", so hey -- it's not like there are industries that profit from people exercising their bodies, right? Screw capitalism.

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You know, I love to hate jo... (Below threshold)

January 9, 2011 4:11 PM | Posted by Termm: | Reply

You know, I love to hate journalists. You have to use that word loosely, in this day and age. I don't consider many (news)people on Fox or CNN to be actual journalists, but rather pseudojournalists, or actors. Anyway, I must commend this fine man or woman who broke the story about this being a BLATANTLY false, almost maliciously published study. Wakefield, shame on you. Heaping amounts of guilt and shame on you. And to EVERY SCIENTIST who has ever cited that study, or worked in the field of vaccines or autism... well, you're ****ing up.

See: The 10 year cell-phone cancer study where the researchers decided the results were "inconclusive", even though there were data points which suggested cell phones caused cancer and other data points which showed it had absolutely no effect. Good thing those scientists wanted to publish accurate information instead of cuddle up with whichever groups wanted a spin one way or the other.

I hope this kind of story is the exception rather than the trend, but it's scary either way.

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You could say it requires a... (Below threshold)

January 9, 2011 10:49 PM | Posted, in reply to Stephen R. Diamond's comment, by Anonymous: | Reply

You could say it requires a culture. China?

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Hello syntaxfree, my uneduc... (Below threshold)

January 10, 2011 5:34 AM | Posted, in reply to syntaxfree's comment, by Anonymous: | Reply

Hello syntaxfree, my uneducated friend.

In people with the genetic potential to become obese, glucose causes a downregulation of dopamine receptors which promotes the hibernation state. Part of the hibernation preparation state involves weight gain, which if never terminating/unnaturally chronically activated turns into obesity. This paucity of dopamine sensitivity is rapidly corrected upon glucose restriction/calorie restriction.

In people who take psychiatric medicine, an artificial hibernation state is triggered by the chemical blockade of dopamine receptors. H1 receptor antagonism is NOT why seroquel makes you fat, that's why seroquel makes you hungry a few minutes after you take it. It is mainly the dopamine block in antipsychotics that causes weight gain. The symptoms / side effects of antipsychotics are redundant with seasonal adaptation - hypersomnia, weight gain, elevated glucose, decreased fertility.

In hibernating animals, dopamine (with melatonin, on which it exists on an axis, as well as SNS activity) regulate the hibernation response. In hibernating animals, bromocriptine - a d2 receptor agonist - can block seasonal adaptation/hibernation.

No, I never claimed that all psychiatric medications augment serotonin. However, serotonin reuptake inhibitors are extremely common psychiatric meds that people take for no good reason at all, and this unnatural augmenting of serotonin results in a secondary dopamine suppression, thus mild antipsychotic like effects. That's why wellbutrin is often added to decrease SSRI side effects (numbness/apathy/sexual apathy and dysfunction/hunger/weight gain) - wellbutrin helps dopamine suppression.
Usually only crazy people take seroquel, and there aren't many crazy people out there...however ALL sorts of normal people are on paxil for no good reason.

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Furthermore, functional dop... (Below threshold)

January 10, 2011 5:49 AM | Posted by Anonymous: | Reply

Furthermore, functional dopamine receptor (d2) down regulation is fundamental to the hibernation process in mammals. The fact that obesity / weight gain involves, requires, functional dopamine receptor downregulation offers evidence obesity is pathophysiologically related to hibernation. It is obvious to anyone with a brain who has read the evidence and thought about it for a few minutes, but this is big news for the rest of the world who think obesity is caused by being a lazy fat slob (rather than laziness, if it occurs, being secondary to the physiological processes resulting in excess body fat accrual).

http://www.jneurosci.org/cgi/reprint/7/9/2732.pdf

In hibernating animals, decreased dopamine sensitivity occurs by a decreased degridation of DA (result->low HVA levels), which triggers functional/physiologic low dopamine sensitivity, which is part of the process that allows the animal to prepare for and enter hibernation (eating a shitton, moving little, gaining body fat, running higher glucose, suppressing the reproductive functions of the body). Sounds like all the fat people I know.

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Well well-- bad vaccines, b... (Below threshold)

January 10, 2011 7:16 AM | Posted by Anonymous: | Reply

Well well-- bad vaccines, bad "doctors", bad "social sciences", bad journalists and finally, bad big pharma.

Pick one or follow the money. You will end up with a bad "banker".

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I think every parent knows ... (Below threshold)

January 10, 2011 4:53 PM | Posted by Lorne Marr: | Reply

I think every parent knows his or her child better than the government or researchers and when they see the damage a vaccine may cause to their child they will never use it.

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A bad human. The flaws of ... (Below threshold)

January 10, 2011 10:52 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

A bad human. The flaws of our society are not problems with our system, it is almost as good and responsive as any system ever devised. The flaws are inherent in ourselves. Human greed, pride, and foolishness.

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True Religion Jeans (“true ... (Below threshold)

January 11, 2011 5:06 AM | Posted by True religion jeans: | Reply

True Religion Jeans (“true faith” cowboy) is a famous brand found by Jeffery and Kym. Jeans and music accounted for most of the location of their lives. The true religion jeans are designed with a stylish and fashionable look that can match with your outfit perfectly and you will feel very relaxed and comfortable by wearing it. Now, you can get it at cheap price on the true religion jeans sale.com
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I have a question perhaps o... (Below threshold)

January 11, 2011 6:32 AM | Posted by possum: | Reply

I have a question perhaps one of you clever doctors can help. Those morbidly obese people who can't leave their homes, who is feeding them? If they cannot leave the house and in some cases the bed, who is giving them all this food? If they are unable to work due to their size, who is paying for all the food they are gorging? Surely at any point the caregiver can say OK, lardass, no more burgers for you, here's a bowl of carrots. What is a bed-ridden person going to do? Has anyone done some some research on the role of co-dependents, enablers and other "loved ones" in keeping the obese as fat as they are?

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Well the evidence suggests ... (Below threshold)

January 12, 2011 12:59 AM | Posted, in reply to possum's comment, by Anonymous: | Reply

Well the evidence suggests that family members of these people are so used to using food to make their bed bound relative happy, that it is impossible for them to truly accept that feeding them is the worst thing they can do. It's like, the bed bound obese person's whole life revolves around food (as their brain has been fucked up so that food is their one and only pleasure due to dopamine receptor downregulation combined with the consequences of immobility)... and the family are trained to feed them on cue.

I work in healthcare and I have seen some wacky things from family members, not just with obese people but diabetics and other sick people. Often times the family is unable to accept medical reality and they just bring the foods that are comforting, evne if that food is literally poison to their loved one. Humans are simple animals slightly more sophisticated than monkeys, its hard for them to understand stuff like "All that baked pasty shit will just contribute to hyperglycemia that will destroy your fathers eyes, kidneys, blood vessels, feet and legs. You are killing your father bringing this shit in every single day". All they know is it makes pops happy and it makes them feel happy so they do it. People are extremely simple.

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Oh and i thought of soemthi... (Below threshold)

January 12, 2011 1:20 AM | Posted by Anonymous: | Reply

Oh and i thought of soemthing else related to this discussion...

Dopamine regulates core body temperature. Dopamine binding to dopamine receptors reduces body temp. This further supports dopamines role in seasonal adaptation - dopamine is dominant during spring and summer, helps keep body temp in range (more dopamine signalling, lower temp). During the cold months when animals enter some degree of hibernation, dopamine binding decreases and body temp is not suppressed (as this function is no longer needed).

Hard antipsychotics can trigger a condition called neuroleptic malignant syndrome for this reason - when the dopamine receptors are artificially blocked by medication like the older antipsychotics do, one is prone to develop critically high core body temp which can result in rhabdomylosis and death.

Our genes were selected to create an organic machine that is fit for the environments similar to the ones which selected the genes. Dopamine is a major, major neurohormone that controls seasonal adaptation (along with many others). The side effects of medications, mood and thought disorders in general, are often related to otherwise adaptive seasonal adaptation traits. If you have a patient who becomes psychotic and manic in spring, depressed and torporous in november, you can help this patient by manipulating his or her light exposure patterns (less during mania, more during depression). Or, alternatively, you could just BLOCK all of their dopamine receptors, that will work too, but they will turn into a fat hibernating animal and you are breaking the system in the long run. Just saying.

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"Hard antipsychotics can tr... (Below threshold)

January 12, 2011 5:03 AM | Posted by syntaxfree: | Reply

"Hard antipsychotics can trigger a condition called neuroleptic malignant syndrome for this reason"

What is a _soft_ antipsychotic? Lithium? Chamomille tea?

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Again for my uneducated fri... (Below threshold)

January 12, 2011 4:29 PM | Posted, in reply to syntaxfree's comment, by Anonymous: | Reply

Again for my uneducated friend, antipsychotics are divided into two categories: typical and atypical. When one speaks of a hard antipsychotic they are referring to the typical ones, where there is literally a hard block of the dopamine receptor. THe atypical antipsychotics, on the other hand, have sort of an off/on block and so are far less likely to produce terrible side effects like tardive diskinesia. TD is caused by the hard block of the dopamine receptor secondary to old antipsychotics, leading to compensatory dopamine receptor upregulation in certain areas of the brain. THe signs and symptoms of TD are paradoxically dopamine mediated - dopamine regulates spontaneous facial gestures, spontaneous tongue movements, dopamine receptor binding causes this to happen. In a person with TD their dopamine receptor milieu is permanently damaged so that they basically dart their tongue around and make weird faces all day. This is less of a consequence with the atypical antipsychotics.

Lithium may be classified as an antipsychotic, but it is not, in the sense that lithium does not block serotonin/dopamine receptors... however lithium can be used as an antipsychotic in people who have manic psychosis. Manic psychosis is related to disregulation of the circadian clock and lithium corrects that. It also augments inhibitory neurotransmitters like an antiepileptic and some evidence suggests mood disorders like mania are vaguely seizure like events (unstable brain energy leading to mood episode). But primarily lithium works in manic depressive disorder by affecting circadian clock.

Chamomile tea is a mild OTC relaxing agent and has zero relationship to antipsychotics.

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> This journalist did what ... (Below threshold)

January 14, 2011 5:31 PM | Posted by gwern: | Reply

> This journalist did what all of medicine did not do for a decade: email 12 people.

Not hardly. The paper didn't come with names and emails attached, after all.

From http://www.bmj.com/content/342/bmj.c5347.full

> "“Well I can’t really comment,” he said. “You really touch on an area which I don’t think should be debated like this. And I think these parents are wrong to discuss such details, where you could be put in a position of having a lot of medical details and then try to match it with this, because it is a confidential matter.”
>
> It was not merely medically confidential, it was also legally protected: a double screen against public scrutiny. But responding to my first MMR reports, in the Sunday Times in February 2004,31 the GMC decided to investigate the cases and requisitioned the children’s records.32
>
> The regulator’s main focus was whether the research was ethical. Mine was whether it was true. So as a five member disciplinary panel33 trawled through the records, with five Queen’s counsel34 and three defendant doctors,35 I compared them with what was published in the journal.36"

Those pesky laws and ethics!

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Why trust the journalist? S... (Below threshold)

January 15, 2011 9:14 AM | Posted, in reply to Anonymous's comment, by DaveGeek: | Reply

Why trust the journalist? Simple, if he's lying odds are he and his publisher are going to get sued for defamation of character. Particularly since his article was pretty specific, pointed and well-known. The legal team of the news organ publishing this journalist's finding is going to demand that he have incontrovertible proof before they would publish this. Clearly unlike those who published Wakefield's "findings".

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In line with Dave's comment... (Below threshold)

January 15, 2011 9:43 AM | Posted by gwern: | Reply

In line with Dave's comment, I would point out that England is infamous for its libel laws. If Wakefield thought he had a leg to stand on, it would be quite profitable for him to sue.

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It's official: most studies... (Below threshold)

January 18, 2011 1:20 AM | Posted by bs footprint: | Reply

It's official: most studies are flawed/biased. Best to ignore most of them, says Dr. John Ionnidis:

"Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science."

Lies, Damned Lies, and Medical Science

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Apparently the Lancet actua... (Below threshold)

January 18, 2011 9:34 AM | Posted by Sean: | Reply

Apparently the Lancet actually retracted the article in 2004, not 2011...

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So, if some random fraud ma... (Below threshold)

January 18, 2011 3:44 PM | Posted by P.T. Barnum: | Reply

So, if some random fraud made a study of something, and claimed something, then that makes the claim CERTAINLY WRONG. In fact, IT PROVES THAT THE CLAIM IS WRONG.

Interesting. Completely non-scientific, and bordering on insane, but heh, you got where you want to be.

Also, the actually scientist with actual studies say it was Multi-dose vials... not multi-germ vaccines, but multi-dose vials containing thimerosal that caused autism.

But of course, we have entered dangerous ground if we discuss the "enemies" actual position, instead of a straw-man.

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Wakefield actually ran away... (Below threshold)

January 18, 2011 5:20 PM | Posted, in reply to gwern's comment, by Anonymous: | Reply

Wakefield actually ran away to America when this blew up in his face. At first he was working at some anti-vaxers clinic in the US but they booted him too because they didn't want to be associated with the bad publicity.

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"It is worth more to a b... (Below threshold)

January 20, 2011 12:26 AM | Posted, in reply to Stephen R. Diamond's comment, by bobby b: | Reply

"It is worth more to a banker to get away with fraud than it is for the scientist."
- - -

Dissent.

A banker steals money and is temporarily rich, and then the money gets spent and it's gone, and while the banker may still have the fur-lined sink he bought with that gob of money, he's no longer rich and his life goes back to sucking whatever eggs he was sucking before, because his purchase of the fur-lined sink has provided no transformational energy to his life.

A scientist fakes a study and "solves" an important medical question, and her name is put forth in bold print in the magazines her friends and enemies and creditors read, and her name becomes regularly invoked by lesser scientists as one of the Citations of the Gods - in short, she becomes a Name, an Ancestor, One Of The Founding Fathers - whatever title she and her competitors use to signify that you've really made it!

All in all, I'd say the scientists value the fruits of fraud more than the bankers do. Money's primary influence on human life occurs in its absence.

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A scientist fakes ... (Below threshold)

January 20, 2011 9:34 PM | Posted, in reply to bobby b's comment, by Anonymous: | Reply

A scientist fakes a study and "solves" an important medical question, and her name is put forth in bold print in the magazines her friends and enemies and creditors read, and her name becomes regularly invoked by lesser scientists as one of the Citations of the Gods - in short, she becomes a Name, an Ancestor, One Of The Founding Fathers - whatever title she and her competitors use to signify that you've really made it!
Good point, that. But fraud ('faking it') seems like a foolish way to achieve the goal (a form of immortality) since it'll be found out eventually... won't it?
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If a banker lies he goes... (Below threshold)

January 31, 2011 1:13 AM | Posted by bobn: | Reply

If a banker lies he goes to jail.

Which country do you live in? Nobody has gone to jail for the biggest swindle in human history. Paulsen, Blankfein, Prince, Dimon, Fuld, Thain, Mozilo, - every damn one of them walks free to this day.

Madoff was an absolute piker compared to these guys.

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"I'll save you the meta-ana... (Below threshold)

March 30, 2011 2:44 PM | Posted by T. K.: | Reply

"I'll save you the meta-analysis: it's because we don't have enough journalists."
Wrong...
The correct answer is:
"I'll save you the meta-analysis: it's because we don't have enough GOOD journalists WITH DECENT SCIENTIFIC KNOWLEDGE."

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yes!and for cipes ... (Below threshold)

April 9, 2011 5:30 AM | Posted, in reply to ATraveller's comment, by kay: | Reply

yes!

and for cipes sakes, when is it going to be acknowledged that autism is a behavioral diagnosis, not a medical diagnosis. Good luck narrowing any cause down if your not going to be more special than "autism"

Why don't we try to find *one cause* for fatigue? It's absurd

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"you'll assert that double ... (Below threshold)

February 19, 2014 3:58 AM | Posted by HGJ: | Reply

"you'll assert that double blind trials are the gold standard!- when you all know that 75% of the time we can tell if it's placebo or drug. When you title the paper, "A Double Blind, Placebo Controlled Trial of---" you are lying."

There are a few problems with the study you cite here:

1). The study targeted people with OCD and depression, people naturally inclined toward pessimism. Is it any wonder that most of them guessed they were given the placebo?

2). Frankly, I'd imagine that most genuinely ill people in a similar position would, if asked, guess that they'd been given a placebo. It's a win-win for them. If they say placebo and they're right, they win, and if they say placebo and they're wrong that means they were getting real medicine so they still win.

Also, even if double-blind studies are inherently flawed, what's the alternative?

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