Wednesday, June 27, 2007

Patrick Holford and Dr Andrew Wakefield's Discredited Findings: Part 1

Immunisation images, advertising and commemoration
Patrick Holford sent round an email last week in which he asked people to sign a petition in support of Dr Andrew Wakefield for his upcoming hearing before the General Medical Council in the UK. Patrick Holford hadn't signed the petition the last time that I looked (yesterday evening), nor is the petition solely about Wakefield. Nonetheless, Patrick Holford seized this opportunity to reproduce swathes of text from his own books where his claims and recommendations stand and fall with the reliability and accuracy of Wakefield's work: Was Dr. Andrew Wakefield Right About the Link Between Autism, the Gut, Allergy and the MMR Vaccine?. [Update Jan 2008: Patrick Holford's Concerns About the MMR Vaccine] He undertakes the task of providing a salient overview:
If you are not sure, then please read on to find out what we know about autism, the gut, vaccinations and what food has to do with it.
You will notice that Patrick Holford emphasises food allergies because he routinely recommends food allergy and intolerance tests, tests for nutritional deficiencies, hair mineral analysis, restrictive diets and mega-supplementation. However, he does rely upon Wakefield for the scientific underpinning of many of these entrepreneurial opportunities.
Dr Andrew Wakefield, in a now controversial study, published in the Lancet in February 1998, of 60 autistic children with gastrointestinal symptoms, found much greater incidences of intestinal lesions than in non-autistic children with similar digestive problems. Over 90 per cent of autistic children showed clinical evidence of chronic inflammation of the small and large intestine as a result of infection, at levels greater than six times that found in non-autistic children with inflammatory bowel disease [5].

Despite a concerted effort to discredit Wakefield's research, recent studies are confirming the link between autism, digestive problems, immune system abnormalities and the MMR vaccine. Wakefield's own research has shown that, in a group of 15 autistic children versus healthy children, there is clear evidence of immune dysfunction [6]. Three studies have shown measles antibodies in the central nervous system, with the potential to damage both brain and gut. [7;8;9]
Now, I know that there are times when Patrick Holford relies upon news reports rather than troubling to read the scientific papers so I recommend Brian Deer for a very readable summary of The MMR-autism scare and Wakefield's role in it.

Keen-eyed readers will have noticed that Patrick Holford refers to 60 children in the Feb. 1998 Lancet paper when there were 12 but he repeatedly has problems with reporting numbers accurately (and here) so we should overlook that. What we should not overlook is that this paper has been so discredited that it should be left to moulder in a quiet grave and referred to in hushed tones as an example of what can go horribly wrong in research and publication.

The Patients and Methods section of the Lancet paper claims:
12 children, consecutively referred to the department of paediatric gastroenterology with a history of a pervasive developmental disorder with loss of acquired skills and intestinal symptoms (diarrhoea, abdominal pain, bloating and food intolerance), were investigated.
However, most of these children were (through their parents) potential parties in a law-suit against vaccine manufacturers (by the publication of the paper 10 had Legal Aid to sue which meant that public funds were meeting their legal costs). Nor had Wakefield disclosed his conflict of interest arising from the substantial fees he would collect as an expert witness in the litigation that would rely upon his research findings (around £500,000); further, he did not disclose that he had patents for potentially competitive products.

Partly because of Wakefield and this paper, the rules of disclosure are very different now, in most journals. The money and the law-suit may seem murky, but what about the science?

Brian Deer's summary is an excellent guide to the goal-post shifting. Wakefield had claimed that 8 out of 12 [66.6%] of the children had received MMR within 14 days of symptoms and that the onset of symptoms was rapid and dramatic. However, expert witnesses who were recruited to confirm the MMR-autism link reported that the median time to the onset of symptoms among the children in the law-suit was 1.1 years, while Wakefield had claimed a median time of only 6.3 days.

So, the argument had to change. The emergence of autistic disorders after MMR wasn't rapid and dramatic, but delayed and insidious.

What about that scary-sounding ileal-lymphoid-nodular hyperplasia that so impresses Patrick Holford? Wasn't this a new, terrifying, malign finding that must mean something? Well, no. It turns out that the swelling of the glands, near the end of the small intestine and close to the appendix is a generally benign finding in children that has been known about for some time. It has nothing to do with inflammatory bowel disease.

But what about the autistic enterocolitis? Patrick Holford is concerned about the chronic inflammation that scourged the large and small intestines of the children in Wakefield's studies. He still refers to autistic enterocolitis in his books and articles; especially those promoting the need for a restrictive diet that should be supervised by one of his nutritional therapists who will also recommend a gut-healing programme and extensive supplementation. He also emphasises that the children have inflammation arising from infection because he is a staunch advocate of anti-fungal medications for children with these compromised guts.

Patrick Holford cleaves to his belief in this chronic inflammation despite the fact that Wakefield's colleagues have withdrawn their support for his research and retracted the publication on which Patrick Holford relies. Patrick Holford still promotes this idea although one of Wakefield's collaborators and co-authors, Walker-Smith, has admitted that most of the children did not show signs of inflammation and that there were no unusual findings in the children's colons.

So Patrick Holford still relies upon Wakefield's work although it has been known for some time that he was wrong about the rapid emergence of behavioural symptoms after MMR; wrong about the significance of ileal-nymphoid-nodular hyperplasia; and wrong about the autistic enterocolitis. Of course, many of Patrick Holford's recommendations for the treatment of autistic children and his remarkable claims that he can "bring them back" like so many latter-day Lazarus depends upon the validity of Wakefield's research.

But what about those measles antibodies in the cerebro-spinal fluid and the gut tissue of the children Wakefield examined? Whatever significant problems there may be with the rest of his work, surely this is the crux of the matter. That is Part 2.

But, for now, it may be worth pondering the idea of just what would make Patrick Holford give up his belief in the 'science' that underpins so much of his own treatment recommendations. What would make him update his many books and websites to at least acknowledge that this has gone far beyond "he says, she says" and it is now acknowledged that this science is discredited? So discredited that a lawyer for the US Govt. Health and Human Services Dept. recently made this remarkable comment in his concluding statements for the first part of the Autism Omnibus hearings in the US. The MMR-autism case has no plausible or verifiable science to support it.
It's at best speculation, idle speculation. Now, at worst--at worst--it's a contrivance. It's a contrivance that's been developed and articulated and promoted by its chief proponent, and that's Andrew Wakefield. He promoted it for financial gain. Either way it's not science.
pgs 28-9: Day 12 Transcript of Cedillo v. Secretary of Health and Human Services (pdf)
Mike Stanton of Action for Autism has some remarkably robust view on Patrick Holford and his opinions on vaccination, MMR, autism and treatments.

Related posts
Patrick Holford and Dr Andrew Wakefield's Discredited Findings: Part 2
Kevin Leitch on Andrew Wakefield and the death of the MMR debacle and Justice for Katie
Mike Stanton on Patrick Holford and his unusual views on vaccination, MMR and autism
Patrick Holford Claims Remarkable Benefits for Homeopathic Vaccinations
Dr Crippen on the remarkable cost-savings that Patrick Holford could offer the NHS: Pay £6.99 to say "no" to cancer
Holford Watch: Holford believes Secretin is "Worth considering" as an autism treatment; however, there is no evidence that this treatment is effective and
Holford is sceptical about off-label prescribing, but thinks that secretin for autism is "Worth considering"
Patrick Holford alias Doctor Knock aka Holt Senior

Image information: 1. Mass Vaccination Ouch!, 2. Double ouch, double vaccination, 3. Polio outbreak campaign, 4. 065 Norwich Historic Plaque (Green)

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