As for the case to that Goldacre is in the pocket of the drug companies I personally believe (as you may have guessed by now I am more than not in the favour of Goldacre) that this is not the case. Goldacre is frequently critical of drugs companies, both on rebranding drugs and on thier fudging of scientific data.

Also what interesting here is that Goldacre is by definition a sceptic, so he is used to approaching a new idea with the view that it is wrong. MMR is actually case for him arguing the opposite, but for me I believe him to be correct, but I still defineately find your argument compelling on what is a foggy issue.

What baffles me about this discussion is why the ‘alternative medicine’ industry is so keen to support Andrew Wakefield who was a perfectly ordinary doctor and (not-very-good) scientist.

Good point David. It epitomises in many ways the whole crux of this debate, not just about MMR but about homeopathy as well: it’s this question over what to give strength and weight to in the evidence hierarchy and what is and is not “valid” evidence, which I’ve addressed elsewhere and will continue to address in forthcoming posts.

As for your implied question, I can’t speak for the “industry” bit, not least because as a collective noun it implies a degree of coherence, cohesion and focus that simply doesn’t exist, but I can try to explain how I and many of my colleagues look at this issue.

Not only was there nothing in the least alternative about him, but he also had a string vested interest in the outcome of his work because of his patents on the single vaccines, just the sort of thing that you always (and quite rightly) criticise.

This would be a good point IF Andrew Wakefield’s research was all there was to it, but it’s a fact that there are over 1000 sets of parents who can demonstrate a remarkable consistency in circumstances leading up to the diagnosis of autism in their children. Some of these parents are scientists like yourself, some physicians, and they’re a long way from being stupid. They know what they observed. They’ve got medical records, “before” and “after” videotapes, challenge/dechallenge/rechallenge data, all sorts of corroborating evidence. But nobody seems to want to hear this. The entire medical profession seem to deny the very possibility. Government don’t want to know either. As far as medical science (though medical science alone) is concerned, all these careful observations with their independent corroboration, documentation and testing of the hypothesis are just “anecdotal evidence” and hence, so the dogma goes, totally “invalid”.

Then one man pops his head over the ramparts of what’s looking increasingly like Fortress Biomedicine and says “wait a minute …” It doesn’t matter who he is. Andrew Wakefield gets support not because he’s Andrew Wakefield, with or without whatever qualifications, abilities and interests he may or may not possess, and which may or may not affect the validity of his research, but because he’s been someone willing to take this seriously, do some research and risk his reputation to spearhead a movement giving a voice to the many people who know beyond all reasonable doubt (at least in legal terms) that their children’s condition had some causal connection with the administration of this vaccine. So the bottom line is that discrediting Wakefield is no more than shooting the messenger.

The reason so many CAM practitioners support his efforts is because we end up working with so many of these children: not just the autistic ones, but all manner of children who’ve never been well since a routine vaccination. Why? Because GPs tell the parents it’s nothing to do with the vaccine, that any association is all in their imagination, and there’s nothing they can do about it anyway. What are these parents to do? Where do they turn? What choices do they have when nobody in “conventional” medicine will listen to them? So some turn to CAM practitioners because a) they’ve no involvement in any vaccination programme so no investment in denying any causal link, b) they have a lot more confidence in the value of case history as evidence, and c) they might, even though their therapies don’t meet conventional standards of “proof”, be able to help their children. And CAM practitioners, because they take account of the aetiology of the case and give it significant weight in their choice of treatment, have frequently confirmed to their own satisfaction from the response that there’s good reason to support the parents’ in their suspicions.

Of course they’re perfectly aware they have no rigorous scientific proof, but there’s no rule which says they can’t form a provisional hypothesis on the basis of their own observations and assessment and support calls for more thorough research on a possible link.

It looks very much to me like the parents of MMR-damaged children are saying “Look! We’ve seen black swans! Here’s our independently verified observation records. Here’s a video of them.” while medical science says “That’s not evidence. All swans are white”. It then sets out to “prove” it on its terms. It examines a few swan populations, produces a few rather flawed studies (including a couple on Danish swan populations where the primary suspect for the black swan gene has been absent from the gene pool since 1992, but where, unaccounted for in the latter study, the whole basis for recording black swan sightings changed around the same time) and continues to state categorically that there can be no possibility of black swans. And all despite the fact that this hypothesis is, by its nature (per Popper), unverifiable.

Raise the drawbridge! Lower the portcullis! Stuff that genie back in the bottle and get Pandora to sit on the lid! Vaccination is the sacred pox-ridden cow of biomedicine. We have to keep the faith regardless of the gathering flocks of black swans swimming about in the castle moat. Regardless of the fact that we’ve never tested the cumulative and combined effect of ever increasing numbers of childhood vaccinations administered within a short space of time to immature and vulnerable immune systems. Regardless of the explosion in conditions featuring dysfunctional immune response that have developed concurrently in highly vaccinated populations. Regardless of the number of conventional physicians expressing their own doubts about the safety of vaccines. Regardless of the countries who have taken precautionary measures and changed their policies to delay childhood vaccinations until the immune system has had more chance to mature. We have to close ranks, have to present a united front, because any admission of a connection will produce so many claims for compensation it will have punitive financial implications for our governments (not, of course, the pharmaceutical industry because they made sure they got themselves a get-out clause).

I salute your personal commitment to financial independence from the pharmaceutical industry, David. I’m not so sure about your ideological independence though, or the quality of your science. There are just far too many pieces to this jigsaw puzzle that haven’t been examined yet and too many dead canaries in the coal-mine to be ignored or dismissed as “invalid”.

Not only was there nothing in the least alternative about him, but he also had a string vested interest in the outcome of his work because of his patents on the single vaccines, just the sort of thing that you always (and quite rightly) criticise.

And before anyone says anything, I have never taken a penny from the pharmaceutical industry for my research. I value my independence too much to do that.

The fact that the patient has been largely symptom-free for a period of 2 years with just one major flare-up in that time is atypical for the normal disease pattern, particularly as apparently evidenced in this patient by her experience prior to homeopathy.

However, with the (very notable) caveat that it’s very hard to judge from case reports, from my personal opinion and perspective, I’d be looking for a better reaction to the prescription than has been shown here. The condition seems to be being held in abeyance but there’s little evidence of real cure. The susceptibility to succumbing to this symptom complex when under stress, though reduced, still appears to be present. The necessity for the frequency of repetition and the use of different remedies for limited totalities of symptoms would ring warning bells for me and have me going back to re-analyse the case. From the symptoms described, I think one major candidate has possibly been left out of consideration, and that’s Bambusa arundinacea — bamboo. But I could be completely wrong here — that’s just what hit me when I read it.

laughingmysocksoff, I linked to the original article in my blog post so you have no excuse for not reading it. In fact you were willing to discuss in detail my interpretation of the article, now it turns out you hadn’t read it at all. How can you consider yourself capable of critical thought if you aren’t prepared to do background reading before venturing an opinion.

Mea culpa, Gimpy. You’re right, I’ve no excuse on that one. I’ve been remiss in not examining the original. Doesn’t mean I’m not capable of critical thought, but that I’m also capable of shooting my mouth off when hard pressed for time. Can’t guarantee it won’t happen again, but I’ll do my best to make sure it doesn’t. I’ll now go study it, and let you know what I think. OK?

Interesting that you acknowledge that the Crohn’s disease report doesn’t provide you with enough evidence to make up your mind. The FoH are touting it as successful treatment and even issued a press release to publicise it. It’s rather lax of them to claim successful treatment if other homeopaths, such as yourself, have doubts.

Gimpy I said your reporting of the Crohn’s disease case doesn’t provide me with enough information to make up my mind. I haven’t seen the publication yet.

No laughingmysocksoff, M has a very good point. This is a critical phrase: cases for which its suitable. Can you tell before or after the remedy was given which cases were suitable? If you say after, we will be laughing all Christmas.

But if you say before, how can you tell which is which? Are there only a small group of real homeopaths who get it right every time.

The process is in many ways no different to making a biomedical diagnosis. It’s pattern-matching. And nobody gets it right first time every time because the pattern isn’t always clear, just as in biomedical diagnosis.

You assess the symptoms of the entire state of the individual as you’ve been able to gather from the interview, correlate those with remedies that have been demonstrated to exhibit those patterns and decide which has the balance of probability. In some cases, the remedy required is crystal clear. You give it, and the reaction is equally strong and clear. And in just about every instance where this is the case, then the indicated remedy does exactly what you expect it to first time every time.

Many cases though don’t exhibit such a clear picture, particularly where there’s chronic disease of many years’ standing. Even in a 90 minute interview, it’s not always possible to gather enough of the right kind of information. Where differentiation between remedy states might hinge on, say, the quality of pains (eg. burning vs stabbing) then you’re not going to get the information you need if the patient says I don’t know, it just hurts. A number of remedies may rank equally in relation to the information you have to hand and the differences between them can be subtle, so you then need to decide which to prescribe first. In these instances, you might have to give a remedy, then judge the reaction to it to either confirm or eliminate it from the list of likely contenders.

This is also no different to biomedical practice where a drug for a given condition might prove unsuitable for the patient and need to be changed to a different one. You can’t always tell in advance what will work, but that doesn’t mean you’re not prescribing on clear principles and replicable data.