Friday, July 27, 2007

Prof. Mawson on Andrew Wakefield: Why Do His Views Need Consideration?

kitten snarls, not want decafDr Crippen has posted a Letter from America. However, it is not a gentle insightful reprint of a favourite Alistair Cooke but a letter from a US epidemiologist, Prof. Anthony R. Mawson. Mawson writes to offer his opinion on Prof. Trisha Greenhalgh's critical analysis of the Wakefield et al. study that was published in The Lancet in 1998. [I shall address these criticisms in another post although I suspect that the comments will deal with these matters in some detail.]

Mawson is a staunch supporter of Dr Andrew Wakefield. Although we may disagree on the quality of Wakefield's research and its significance, I do think it is admirable that Mawson has not only written this supportive letter to the most widely-read medical blog in the UK, but he may also have signed the Nigel Thomas petition that has gained the reputation as being in support of Wakefield and his research. I have emailed Mawson to ask him to confirm that he is currently signatory 2054 and maybe even 3529 (the numbers may be subject to change). If he confirms one or other of those signatures, then I shall discuss the supportive comments that he left there in another post.

Dr. Crippen tells us that:
Professor Mawson’s views need consideration.
He doesn't tell us why he thinks this, although he does then offer a potted summary of Mawson's current positions. However, it is not clear to me why Dr Crippen believes that any of these are more relevant than the opinion of most other commentators. There seems to be some potential for confusion about Mawson's qualifications. Dr RJ makes a robust comment that explores Mawson's reproof to Prof Greehalgh. In passing, he remarks:
Perhaps Professor Mawson hasn't kept up with his continuing medical education?
Having consulted Mawson's CV and various other sources, it's my understanding that he is not an MD or medical doctor. The CV lists an MPH or Masters in Public Health. His alma mater for this offers a 45-credit hour curriculum for this course although I don't know if the requirements were different when he took it. The MPH programme focuses on the
application of management concepts in the public health sector to protect and improve the health of the community. The MPH program consists of a 45-credit hour curriculum, which focus on management at the operating level.
The DrPH seems to be a Doctor of Public Health but it is clear that this is not a PhD programme: in UK terms this seems to resemble an MPhil. Mawson does not list a PhD in any subject. His CV states:
Dr. Mawson obtained his bachelor’s degree in sociology and psychology from McGill University, Canada, his MA degree in sociology from the University of Essex, UK, and both MPH and DrPH degrees in epidemiology from Tulane University’s School of Public Health and Tropical Medicine, New Orleans. He was also a post-graduate student at the London School of Economics and Political Science.
[Edited: 14:00] As several commenters to that letter have pointed out, but Dr RJ summarises:
Prof Mawson is an epidemiologist. He is not a medical doctor, not a virologist, not a pathologist, not an immunologist, not a gastroenterologist and not an autism researcher. There is nothing in Professor Mawsons CV that makes me think that he is qualified to hold an opinion on this paper any more than, say, a nuclear physicist with an interest in the topic.
I fail to understand what added value an epidemiologist without a record of research into autism, MMR, or the prevalence/incidence of paediatric gut-issues brings to a discussion of the appropriate design study for a case-series of 12 children, selected according to criteria that were mostly related to participation in a legal case.

Dr Crippen is notoriously scathing towards the value of PhDs and other higher degrees when nurses comment that they have them. What would his attitude be to those BAs and MAs in sociology and psychology, or the MPH or DrPH if a nurse were to report that s/he had them and was using them as a basis to claim academic credibility or excellence for Wakefield's work? Just why are Mawson's qualifications more relevant and why do they make his opinions more deserving of consideration?

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Anonymous Anonymous said...

Do you know what an epidemiologist is by any chance?

6:34 pm  
Blogger Shinga said...

Reasonable range of definitions of epidemiology - help yourself.

8:20 pm  
Anonymous Anonymous said...

I'm aware of them. I'm an epidemiologist. It seemed like you had missed the point. Epidemiologists understand, teach and advise on study design. The original Wakefield paper was a case-series. End of.

11:34 pm  
Blogger Shinga said...

I rather suspected you were...

All epidemiologists?

You've looked through the comments at the original Letter from America? If you think that the point at issue is simply whether or not this was a case-series (and there is valid disagreement over whether it is prospective or retrospective) then it seems that you may have missed the point. End of - to use your distinctive phrase that is so reassuring as to your typical level of discourse.

9:43 am  
Blogger John said...

Would Dr Mawson be/have been a close colleague of Prof. Fombonne during his McGill days? The latter has invested a great deal of his professional standing on there being no link between MMR and autism.

3:49 pm  
Blogger Shinga said...

Interesting speculation, John. If they did overlap, it doesn't seem if there was a transfer of knowledge/expertise/views on the matter of MMR, autism, vaccines, paediatric gut issues etc.

3:54 pm  
Anonymous Anonymous said...

This is my answer to Dr RJ on the 'Letter from America' blog, which for some mysterious reason does not reproduce on the page:

Thank you Dr RJ

Anonymous gave me an answer conditional on his/her view of the problem. It was not a direct answer, it was an oblique answer. What you have done, however, is to assert something, not demonstrate it. I have an autistic son who by and large thrives physically. I am well aware that this is a different case from X round the corner who was one of Wakefield's 1998 subjects. X, apart from being cognitively impaired has been chronically ill with a gastro-intestinal disorder since MMR 13 years ago. It seems to me to be risible, being well acquainted with X and his extreme problems, to claim that this is a simple case of constipation, or that he should not have had a colonoscopy on the principle that he was autistic, and therefore did not inflammatory bowel disease.

As soon as Wakefield started to look at such cases he became the object of official opprobrium and disdain. He simply had to be wrong, completely out of order etc.

If you visit MMR the Facts NHS website you will see in question and answer form the following advice in question and answer format:

Q: "My son had a sever reaction to the first MMR jab. Does this mean that he is well protected from these diseases, or is a second dose still necessary?"

A: "If a child has responded to all the components of the vaccine the first time, he will not have a problem being exposed to the viruses again. It's like any one of us who is already immune meeting someone with the disease - the infection can't get established.

"If he hasn't made protection to all three diseases after the first time, then he would still be susceptible to those natural infections, and still needs the 2nd dose.

"Reactions after the 2nd dose are essentially the same as after the 1st dose, but if they do occur they are even rarer. There are no new side effects after the 2nd dose that do not occur after the 1st dose. The advice is therefore that it is safe for your child to have the 2nd dose in order that he is properly protected."

It is not unreasonable to point out that apart from being unsafe and unethical, this advice skews the evidence base: there is no follow and any parent who protests that their child has been irrevocably altered will be dismissed out of hand. We should be asking, if the system is so excellent where are the yellow cards, the monitoring, the investigation, the practices of ethical medicine?

I do not pretend to have all the answers, but I do know that the present system in relation to vaccine is one of ruthless assertion and denial, and is therefore inherently unsafe.

John Stone

11:23 am  
Blogger Shinga said...

You do seem to be awfully fond of posting your opinion around the place and affecting to win all sorts of intellectual and moral jousts such that you are a champion in your own world, though...

Case series point? Walker-Smith's statement that the bowel findings had not clinical significance. Chadwick and Bustin's testimony that dismantles any claim that there were positive findings of measles virus in biological samples?

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