In the late 1990s, the respected British medical journal, The Lancet, published a report that linked vaccines to autism. This was met with a fusillade of objections from credible sources, followed by study after study that proved there was (and is) no association between vaccines and autism.
Nevertheless, the fuse on the already significant anti-vaccination movement was lit. And irresponsible commentary fed the fire. For instance, US Senator Rand Paul, a physician, told of a friend with a child who was vaccinated for measles, mumps and rubella, and then, presto, contracted autism.
Measles
In 2000, due to an aggressive public health campaign, measles was declared eradicated in the US, with a few cases being documented from unvaccinated US citizens who had traveled in countries with high rates of measles.
Measles can be much more than an irritating skin rash. It carries a death rate that is small (one or two per one thousand cases), but still results in serious complications such as pneumonia and encephalitis. In 2011, for instance, 40% of people with measles were hospitalized, almost all of them unvaccinated. In the last 10 years, the incidence of measles in the US has been as low as 18 per year and as high as 1,274, almost all of it in unvaccinated individuals. Worldwide, before 1963 (the year measles vaccines became widely available), there were 2.6 million deaths per year from measles. Since then, with widespread measles vaccination initiatives, the yearly mortality averages about 140,000. A two stage vaccination for measles results in a 97% protection rate against the disease.
Medical Reports Gone Astray
Recently, The Economist, a popular and highly regarded British magazine for lay people, published a piece by a health journalist entitled “Fake research is influencing medical care.” Without citing specific instances, the author points to studies that contain allegedly fabricated data, which then eventually find their way into “many, if not most,” clinical treatment guidelines for physicians. The writer also presents information that editors are slow, or even resistant, to correcting errors.
I think, or hope, that the import of the article is overstated, but I too am suspicious of a lot of the medical literature. When, while perusing a medical journal, I see the heading of an article that may interest me, I immediately look to see how the study was sponsored. If it was funded by a pharmaceutical company, I may not go any further. I know the proprietary interest drug companies have in finding that a medicine is safe and effective, and I understand how data can be fudged to fit the “right” conclusion. I also know that the authors of such studies are often compensated, or even employed, by the company manufacturing the product.
But even studies done by authors without “skin in the game” face great challenges in executing research with integrity. The gold standard for clinical studies is randomization, that is, study subjects have to agree, prospectively, to be assigned to either the intervention group or the placebo group. At the heart of this is “informed consent.” Patients are supposed to understand randomization, “blind” analysis of results, etc. Can someone in the throes of a heart attack really make an informed choice regarding entering a study that will randomize him/her to, say, cardiac angioplasty (i.e. opening heart arteries mechanically) versus the usual approach to care?
Unequivocal Fraud
It took 11 years, but The Lancet withdrew the study on autism, when fraud was conclusively proven. Mistakes, honest mistakes, occur in medical research all the time, and this is acceptable. Outright fraud is not acceptable, and the case of the autism publication is exhibit A for the harm such lies can do. The article is still at the root of much of the anti-vaccination movement, and it could be argued that the deceitful author is responsible for the loss of millions of lives.
Are you also leery of drugs with tons of advertising?
Yes! You can review two postings from last year that reveals my attitude on highly advertised, and worthless, drugs: May 28, 2022 on Prevagen and September 11, 2022 on Vitamin D.
Thanks for broaching this important topic Jim. Fraudulent research is abhorrent, no doubt, and can spread distrust of important and legitimate science, Science has unfortunately had its own versions of George Santos. But when one sees honest and diligent scientists such as Anthony Fauci attacked in the way he has been, it is clear that the animus is more than against spurious science. This is not new to human nature, is it? Take Galileo for instance….
However, science gets on thin ice when scientists are tempted to extrapolate or generalize results beyond what are scientifically warranted. Getting others, including both scientists in other areas and the lay public, to understand the nuances and limitations of scientific evidence is difficult and “boring”. Shorter sound bites that provide patt answers are better accepted and provide more positive feedback for a researcher, tempting some to go beyond their often admirable area of mastery into realms of less expertise.
And trying to obfuscate a scientific argument for the sake of public relations expediency, as did Dr. Fauci and other public health leaders early on in the COVID pandemic when the public was told that masking was not necessary (at least partially out of concern there would be a run on the limited supplies of masked needed by healthcare workers) can blow back on well intended recommendations.
Unfortunately science is always running behind the need for answers, putting pressure on scientists to fill the information gap. Those who venture beyond the limits of their research conclusions do so at their peril. But it is a tragedy when good information is available and is not used as it might because of prejudice, suspicion and ill will, as you point out, Jim.
Jim, thank you for us gain a better perspective on this complex topic. We hear the advice that we should “follow the science.” But it isn’t that simple.