The Facts In The Case Of Dr. Andrew Wakefield | Hacker News Reader

The Facts In The Case Of Dr. Andrew Wakefield

tallguywrites.livejournal.com

86 points_zhqs44 comments

Rather than merely putting this whole unpleasantness behind us and moving on, I think the medical establishment (Doctors in particular) needs to take a serious look at why the public was so ready to distrust them and assume the worst.

Medicine in this country is a rotten business. Hospitals have shoddy billing practices, routinely gouging their patients ($5 for a single Tylenol) and giving them vague, indecipherable bills. Doctors engage in protectionism, limiting the supply of doctors by restricting the accreditation of medical schools, ensuring that they earn more than their counterparts in any other developed nation by at least a factor of 2. Practicing physicians are also if not outright in bed with, then certainly far too close to the drug companies. I went to see a dermatologist a few years ago, and in the waiting with me and the other patients were two attractive pharmaceutical reps waiting to see the Doctor who owned the office. Doctors need to realize that trust must be earned, and can easily be lost. As of late, they haven't been doing a whole lot to deserve it. Until the medical establishment cleans up its act, you can expect many more debacles like this one to occur.

...routinely gouging their patients ($5 for a single Tylenol)...

Items like this quickly vanish from your bill when you tell the hospital you don't have insurance. It's the insurance companies they are trying to gouge, not the patients.

I think it is silly how people are so quick to blame the doctors and the hospitals, when the prices are set by the insurance companies 90% of the time. Where is the public outcry that insurance companies are price gouging and making millions off of denying sick people treatment.

What evidence do you have that the insurance companies are price gouging? FYI, insurance companies have very low profit margins.

Try the congressional committee tasked with investigating Insurance company profits prior to the latest health care bill which was really just insurance regulation.

Low profit margins compared to what exactly? Is it right for any company to make a profit off of the suffering of another human being?

Try a PR event created by politicians seeking soundbites and justification to expand their authority?

As for whether it is right for any company to profit off the suffering of another human being, absolutely not. It's also not right for people to do so. That's why I hate those doctors, nurses and EMTs, always profiting from other people's suffering.

You are right I should have been more specific insurance companies profit by denying you access to life saving treatments, doctors, et al, profit from giving you life saving treatments. Clearly those are exactly the same thing and you are completely correct. Clearly.

A much simpler theory that explains why the public doesn't trust public health pronouncements is that people have been both crying wolf in the doctor's name and declaring various unsafe things safe in doctor's names for a very long time now. The corruption of the doctor down the street may be a hobbyhorse of yours but I don't think that's what most people are thinking of when they consider a public health question; they're thinking about the fact that eggs are a mortal menace, then good for you, then eat the white but not the yolk, then eat the yolk but not the white, then good for you again, then a mortal menace, then good for you again. Then take that and multiply it across numerous issues.

Medical journalism's credibility is pretty low. (Although whether it is lower than journalism's in general I don't know... that's a high bar, or perhaps rather a low bar, to meet. And I don't mean that sarcastically, I mean that measured public trust in journalism is extremely low and sinking.) I don't think that has much to do with the stuff you talk about, which is not widely recognized.

Except that doctor was in the UK working for the NHS.

I've never heard of anyone feeling that they were ripped off financially by a doctor in the UK, so that doesn't explain the problem.

Upvote for this. The reason people are so quick to distrust real life-saving medical advice (e.g., about vaccinations) is because the medical world spouts with implied certainty so much garbage that later turns out to be false--nutritional advice being the most obvious example.

could you give a more specific example?

http://news.ycombinator.com/item?id=1332954

When you talk about "the medical world," do you mean popular news reporting on medical topics? Populars news is frequently wrong or sensational (or both) about science news. A small study about fat absorption becomes "What doctors are saying about your diet - more details at 11."

That's not the fault of "the medical world." News orgs are no better prepared to disseminate accurate medical news than they are accurate news about computers and tech.

Much of the bad nutrition advice of the past few generations (e.g., the food pyramid, "good" vs. "bad" fats, etc.) was regularly propagated by family physicians. That is the very definition of most people's interaction with the medical world.

All of the things in your second paragraph are true enough of U.S. medicine, but not so much in the U.K., where there was just as much (or more) public acceptance of the vaccine-autism link.

Doctors engage in protectionism, limiting the supply of doctors by restricting the accreditation of medical schools

You might want to check the number of physicians per capita in a lot of different countries

http://www.dartmouth.edu/~mss/data%20analysis/Volume%20I%20p...

(the first listed source has a good discussion of methodology)

http://www.forbes.com/2009/07/02/health-care-costs-opinions-...

(the second source gets into a lot of related issues)

http://www.nationmaster.com/graph/hea_phy_per_1000_peo-physi...

(the third source shows data reported to the United Nations by national governments, some of which I find implausible)

http://www.infoplease.com/ipa/A0934558.html

(the fourth source shows extreme cases from the U.N. data)

and look at their mortality and morbidity statistics

http://en.wikipedia.org/wiki/List_of_countries_by_life_expec...

http://en.wikipedia.org/wiki/Mortality_rate

http://www.who.int/whosis/whostat/2010/en/index.html

to see how much that matters in cross-national comparisons.

Some comments about the recent medical insurance reform bill in Congress suggest that differences between the United States and other countries in health outcomes have more to do with population lifestyle differences than with medical-care differences.

http://www.washingtonpost.com/wp-dyn/content/article/2007/08...

http://www.granttribune.com/index.php?option=com_content&...

http://www.cardiologytoday.com/view.aspx?rID=64007

for a critique of useless medical interventions.

The reason some members of the public are so ready to distrust them is because many members of the public are conspiracy-theorizing morons. They can clean up billing practices as much as they want, it won't do anything to convince the tin foil hat crowd who will distrust them solely on the basis of the doctors' rightful authority.

In the case of vaccines you'd have to believe that nearly the entire medical profession was willing to kill children just to keep profits on one particular vaccine, instead of just the one ethically challenged doctor: Andrew Wakefield.

My favorite site on the subject: http://www.jennymccarthybodycount.com/Jenny_McCarthy_Body_Co...

This is absolutely fantastic. The sooner we put this vaccine/autism bullshit to rest the better.

Don't you see the wider message on the last page?

This destined to happen again, since journalists don't fact check, don't have relevant expertise and the press favour sensationalism over accuracy.

Yes, and nifty cartoons like this are a great tool to make the truth more accessible to people.

(On a side note we as a public get the press we deserve. If decent investigative reporting got more readers than Brad and Angelina On The Rocks!!! we might get more of it done.)

The last page is very poignant. "Is this too much to ask?" My fear that it might be. A cynic would suggest that a newspaper's primary responsibility is not to report the news accurately to its readers but to make as much money as possible for its shareholders. It does this by selling as many papers as possible. Fact checking, expertise and accuracy are only useful when they help to sell papers.

newspapers sell their reader demographic to advertisers. The actual news is an annoyance and in the past quite a costly one, which is why they are now happy just quoting twitter/blogs and cut out anyone with real journalism skills.

Very good point. I find it interesting, however, that they're pursuing a strategy that will eventually render them irrelevant.

And as importantly the pressure to sell paper copies leading to more and more sensationalist stories with no regard to the future beyond the next pay cheque.

There's a lot of hate here for Wakefield's paper (much deserved) and for mainstream journalists (also much deserved), but the fact that it got published in the supposedly prestigious and rigorously peer-reviewed Lancet goes by nearly unmentioned.

Journalists notoriously screw up their interpretations of scientific papers, but that doesn't seem to be the case here -- they accurately reported what was published in the Lancet. The problem was that it was published in such a journal at all -- once that cat was out of the bag, the rumor had all the credibility it needed.

Surely you noticed the part of the article where Wakefield falsified data? That the paper he submitted to the Lancet was at odds with the actual clinical records at the hospital? And the fact that his damning financial connection was not disclosed to the journal?

What is the journal supposed to do? They certainly couldn't have predicted that a tiny 12-person study would blow up in the way it has. In the end, they retracted the paper, which is exactly how it should have worked. Sometimes bad papers get published--peer review can't catch everything.

I noticed the part where Wakefield falsified data, as well as the part where the author criticized his sample size and methodology... so why didn't the journal's peer review process notice it? I find it hard to believe they couldn't predict that a study concluding that a poorly-understood but prevalent disease among children was caused by universal vaccination wouldn't be big news. Why would the journal even consider publishing an article making claims as big as Wakefield's on the basis of a dozen study participants?

The "in the end" where they retracted the paper was like six months ago, right?

> so why didn't the journal's peer review process notice it?

Because peer review, like every other human endeavor, is not perfect?

> I find it hard to believe they couldn't predict that a study concluding that a poorly-understood but prevalent disease among children was caused by universal vaccination wouldn't be big news.

But the study did not conclude that. The paper stated "we did not prove an association between measles, mumps, and rubella vaccine and the syndrome described". It reported interviews with the parents talking about MMR, but did not conclude that itself. The conclusion was more about the relationship between gastrointestinal issues and autism (also false, but less obviously so).

No decent scientist would draw a sweeping conclusion like "autism is caused by universal vaccination" from this study. One study--especially one so small, with no controls and no randomization--does not demonstrate causation no matter how significant the correlation. The Lancet study (false, but still subtle enough) was misinterpreted due to Wakefield's spin machine and a gullible media.

And to be honest, I have no idea why they didn't retract sooner. I do hold them at fault for that.

Actually the mainstream press went beyond what was in the Lancet article, relying too much on spin supplied by Wakefield in press conferences. And that is noted in the cartoon submitted here on HN, as it has been noted by several critics of Wakefield's role in stirring up phony controversy on vaccines.

http://www.sciencebasedmedicine.org/?p=3660

"Even though the study itself used the typical careful and relatively neutral language that we all expect from scientists, Wakefield himself was not nearly so circumspect. In a press conference announcing the Lancet study, he said:

"'He told journalists it was a "moral issue" and he could no longer support the continued use of the three-in-one jab for measles, mumps and rubella.

"'"Urgent further research is needed to determine whether MMR may give rise to this complication in a small number of people," Dr Wakefield said at the time.

"'And so began one of the most contentious health stories of this generation.'

"Wakefield’s Lancet paper, even interpreted as sympathetically as possible, concluded nothing that justified such language."

Just yesterday I saw a child in a local park who clearly had measles. It was a pretty rare sight not long ago, but in the part of London where I live it's trendy to not vaccinate your children.

That's like saying it's trendy to sexually abuse your children. These are real diseases that actually kill people. Appalling.

Just out of curiosity, how do you "clearly" detect measles?

Lumbar punctures for children in a study designed to strengthen a bogus lawsuit? Yikes! That makes me angrier at the parents that volunteered(/were paid for) their kids' participation than at the doctor. Though still pretty angry at him, too.

Ben Goldacre on badscience.net has a lot to say on this sibject, including a new related post today. http://www.badscience.net/2010/05/a-staggeringly-weak-interv...

So hard to still like Jim Carrey. He was great in "I love you Phil Morris".

He's an actor, not a scientific advisor.

He really believes this. The problem is that there is a bunch of people who readily believe his medical advice over what a certified doctor would give.

Most certified doctor's aren't really doing much different than Jim Carey- they have just chosen the CDC as their trusted source instead of the anecdotes that Jim Carrey uses. So I would say people are choosing anecdotes over their country's public health recommendations.

I think not trusting public health recommendations is a good thing given that they are often not based on sound science. But unfortunately people are turning to anecdotes instead of critically evaluating the evidence of both sides.

you seriously think that a man who has made millions as a professional liar (actor) is just as good as a army of public health officials who are dedicated to improving the lives of everyone?

I think not trusting public health recommendations is a good thing given that they are often not based on sound science.

Where is your critical evaluation of your own statement? Where is your proof for attacking a entire profession?

My point is that neither an actor, doctor, or government agency is a good source of information: you have to look at the sources they are using (and determine if they are accurately portraying the sources).

The only really good public health recommendation I can think of is to wash your hands. Read the book Good Calorie, Bad Calorie if you want to learn how dietary public health recommendations are not at all based on good science.

In the best case scenario our public health recommendations have generally distracted us from the truth. I would probably get heavily down-voted for discussing the worst case.

But wouldn't you then be trusting a book?

No, trusting scientific sources. If you see someone (including an author) correctly interpreting scientific studies (and not cherry-picking them) then you can think about trusting their arguments.

Still, you have to trust the book's author did not cherry-pick studies in order to make his case for selling the book. This may go against his economic interests.

That's a hard pill to swallow.

You don't need to put trust into any one book. Of course it would be foolish to look at just one book or just books from one point of view on a subject. If you look at the evidence from different sources site it will become apparent who is cherry-picking and mis-interpreting. Maybe everybody is, and you make up your own mind.

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