Discovering that your child has an autism spectrum disorder is a frightful experience; it happened to one of my oldest friends. First you’re happily and optimistically watching your child develop like any other excited parent – and then you’re watching your child regress and the gap between him and normal kids his age inexorably widen. You wonder what’s going on inside his mind; you worry about his care should something happen to you; and as he gets older you worry about how people will react to him when he passes puberty and non-standard behaviour becomes more scary than cute. With the number of diagnoses growing – the US Centers for Disease Control puts the rate at about 1 in 150 children; the advocacy organisation Autism Speaks says 1 in 110 – small wonder that terrified parents grasp at anything that looks like it might be a cure or a preventive measure. The coincidence of timing – MMR is administered at roughly the same age at which children begin displaying the symptoms of autism disorder – means that vaccines seem an entirely plausible cause.

Wakefield’s paper, which studied a sample of only 12 children, provided a plausible and simple answer: vaccines. That was helpful for Wakefield, who had a second career as a plaintiff’s expert in autism litigation. You can see the temptation: vaccines, unlike genetics, have manufacturers who can be sued. as Forbes has a nice piece on this type of conflict of interest, and proposes that academic journals should include opposition-side expert witnesses in the peer review panel for any author who has acted as an expert witness in litigation.

In the more than ten years since its publication, Wakefield’s paper has spawned an entire movement of anti-vaccinists. Utterly predictably, once-vanishing “childhood” diseases are on the rise, bringing back all the dangerous complications doctors invented vaccines to eradicate in the first place. There are the inevitable celebrities, most notably Jenny McCarthy. And, since everyone loves a good conspiracy theory, the sad thing is that retracting the paper merely fuels the martyred conviction of anti-vaccine groups that Big Pharma has won again.

In this situation, no one has won. The Lancet‘s reputation is damaged. Wakefield is likely to lose his licence to practise medicine. Children have died of diseases like whooping cough that were so long gone doctors don’t even recognise the symptoms. Despite lowered vaccination rates the number of autism cases continues to rise. And parents of autistic children are still desperate and frightened.

Tony Blair’s government must take some of the blame. The UK has sometimes backed invasive and expensive legislation on the basis that “If it saves the life of just one child…” But in this particular case, despite public loss of confidence after BSE, Blair basically told parents with concerns to shove it, take the vaccine, and shut up. He was, we now know, scientifically right, but he was culturally wrong. A more painstaking approach might have meant less rejection of the government’s backing of the MMR vaccine.

When I started The Skeptic the big topics we were concerned about tended to be psychic fraud. That stuff is small fry. It may be annoying that people believe in astrology or believe in the physical effects created by the occasional washed-up stage magician, but you don’t die of that kind of gullibility. The big stuff is science fraud, especially because while the scientific process can undo the damage and rebuild the truth, the consequences for innocent bystanders often can’t be undone.

Wendy M. Grossman, http://www.pelicancrossing.net

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Through the miracle of the Internet, I spent part of this afternoon sitting at my desk watching live video from the House of Commons Science and Technology Sub-Committee as they debated the question above. The detail of the witnesses: Rt Hon Mike O’Brien QC MP, Minister of State, and Professor David Harper CBE, Chief Scientist, Department of Health, and Professor Kent Woods, Chief Executive, Medicines and Healthcare Products Regulatory Agency.

The main justification for including homeopathy appears to be its popularity: 10 percent of the population use these remedies. (By this logic, smoking should be included on the NHS!)

One of the committee members asked about the disparity in the rules, in that homeopaths don’t have to prove the efficacy of their remedies, but the manufacturers of vitamin supplements do.

Some other interesting questions were raised. Is it acceptable for a doctor who knows that a homeopathic remedy has no effect other than the placebo effect to dispense these remedies to patients on the basis that they might work. Should he be required to disclose to the patient his knowledge that they are no better than placebos? Most patients would probably resent this kind of “paternalistic deception”.

Besides, the minister said later, it’s “illiberal” to refuse people treatments they believe are working. He drew a distinction between efficacy (evidentially proven) and effectiveness (helps patients). Some numbers: 88 PCTs do not provide homeopathy, 26 do in exceptional cases; 31 do. (I think those hastily scribbled numbers are right.) NICE does not consider the evidence base sufficient to assess these remedies.

There seems to have been some (now sadly typical) trouble over the consultation on the subject of introducing rules for homeopathy, in that although it was opposed by several eminent medical bodies the recommendation that eventually reached the minister was that there was widespread support. Professor Campbell replied that the debate is about homeopathy, but there were few objections to the scheme itself. The committee asked him to make the consultation testimony public. “This is a homeopathic medicinal product used within the homeopathic tradition” is the wording on the label; what does this mean to the “average man in the street”? Doesn’t it imply the stuff, you know, works? (I’m paraphrasing; the questioner managed the most polite version of “Isn’t this a lie to the public?” that I’ve ever heard.)

I can’t answer that personally, but I can recount the argument I had recently with an American friend. It went like this:

“The Royal Family uses homeopathy and look how long they live!”

“The Royal Family is one of the richest families in the world, and besides homeopathy they use all the best medical care their money can buy.”

“They do?”

Homeopathy isn’t harmful in and of itself. Its wider effects – a lack of care for evidence and the truth, diverting people from medicine that works (it has been recommended as an anti-malarial drug), and the promotion of general ignorance – are harmful.

(Ben Goldacre also featured in a previous session, of which a webcast can be seen here.)

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I met him once, when Lewis Jones did an interview with him for The Skeptic. Seeing him was the same kind of mind-blowing experience that seeing Randi for the first time was. He *looked* like a guru; he performed the miracles that India’s gurus use to attract followers; and then he explained exactly what he’d done like Agatha Christie. Simply brilliant.

The thing that has always stuck in my mind from the interview was that he said that debunking miracles was very important in India because miracles are how religions/religious leaders sell themselves (with the implication that once they have sold themselves all kinds of exploitation become possible). This seems to me an important point to keep in mind when someone asks, “What harm can it do if people believe…?”

The Times did a pretty intelligent writeup of his work in 2003: http://www.timesonline.co.uk/tol/life_and_style/article1152564.ece

And the BBC here, in 2004: http://news.bbc.co.uk/1/hi/programmes/this_world/3813469.stm

Premanand took a lot of risk in trenchantly opposing gurus he believed to be fraudulent. I hope among his many admierers are some who can carry on his work.

Wendy Grossman www.pelicancrossing.net

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