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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]This study will be a real example of fraud waste and abuse since there are already dozens of studies showing there is no link between vaccines and autism. [/quote]

The validity of these studies are in question. You cannot trust the manufacturers or those who directly financially benefit from the products to be able to do an unbiased study. [/quote]

https://pmc.ncbi.nlm.nih.gov/articles/PMC1124634/

No one serious is questioning the validity of those studies. At this point the only thing that we are sure doesn’t cause autism is the MMR vaccine.
- mother of a kid with autism[/quote]

I'm not an antivaxxer, but let me play devil's advocate: the study you cited describes itself as a "retrospective cohort study" (rather than a prospective, double-blind, placebo-controlled study like the kind you often see in the drug-approval process). It also seems like it doesn't test vaccinated vs. unvaccinated but instead tests kids who got one particular vaccine (MMR) against those who did not. You could imagine an RFK acolyte say, "show me a placebo-controlled test where some of the kids were vaccinated and the rest weren't." What's the answer to that? Is it that that study has already been done? Is it that it hasn't been done but it's not worth doing? Is it that that study could be informative but would be unethical? Is it that that's a good idea and we should do it if it'll allay concerns?[/quote]

It doesn’t appear that you are an expert in evidence based medicine. I don’t consider myself to be one either, but I did a residency in evidence based internal medicine at ucsf and there is way too much boring info I could spout about the merits and feasibility of different types of studies for different situations. I reviewed the “autism” link as a case study during my residency and I can tell you that many many smarter people than myself looked into it and agree that it’s a load of horses&$t and there is no need to squander more time or money on this. It deserves as much merit as the theory that has long prevented Pakistan from eradicating polio - that the polio vaccine was deployed by the CIA as a means to sterilize Muslim men. That theory resulted in 20k cases of polio a year in the 90’s.

And you can trust me, I’m an mit grad, and obviously a genius who is qualified to be an ATC. Actually only the first part is true. [/quote]

I'm the poster you responded to. Thanks for the civil and interesting response. You're 100% correct that I'm not an expert in evidence-based medicine (or any kind of medicine), and, not to belabor the point, I'm also not an antivaxxer. But I think your message hits the nail on the head with what I'm grappling with: there are (I assume) as you point out a lot of ways to design a study. I certainly haven't read the autism-vaccine studies, and I'm definitely not questioning their conclusions. But is a foreign retrospective study without a vaccine-free control group really the most rigorous study we have that exists? (I'm not saying it is; I don't know!) If it is (or is at least close to it), then asking for a more rigorous study strikes me as... somewhat less crazy than I might have assumed?

I get your point that smart people have looked at this and said this has been conclusively proven. I'm not disputing that. [/quote]

Here is a primer on evidence based medicine.

https://www.mwc.com.br/files/Williams%5BA769%5D%20-%20Understanding%20EBM.pdf

The PP who said it would be unethical to do the gold standard study, a double blind placebo controlled RCT, is correct. You cannot perform a double blind study in which half the babies are given placebo and half are given MMR for many reasons that I’m sure you understand. If you don’t, please reply and I will lay it out.

The loophole that doctors often used for this moral impasse, was to just pack their stuff and do the studies in developing countries in Africa, Asia, and the Caribbean, where people were not so fussy about medical malfeasance and informed consent. In India, a trial came under scrutiny because infants were being randomized between groups that got placebo vs a proven safe rotavirus vaccine.

The original Wakefield study looked at 8 children with GI symptoms from intestinal inflammation, who were diagnosed with autism 1 month after MMR vaccine, and concluded that there was a link between autism and vaccination. However, since autism diagnoses often occur at the same age that kids are vaccinated, it would be impossible not to see a coincidence. The Wakefield study is akin to showing that the second dose of MMR, typically given between ages 4-6, causes children’s front teeth to fall out and new ones to grow in their places.

You can read more about the flaws in the 8 person Wakefield study here

https://pmc.ncbi.nlm.nih.gov/articles/PMC2908388/

One of the best ways to study if there is a link between an exposure and an outcome is to do a cohort study - a study that follows a cohort of patients and follows them over time for certain outcomes. By keeping track of other variables like maternal age, paternal age, ethnicity, birth weight, gestational age, ses status, siblings with autism, environmental exposures, vaccinations, childhood illnesses etc, you can control for those variables and see if any of them show correlation with the outcome. There have been many cohort studies involving a total of well over 1 million children that show no correlation.

Also, there was a meta-analysis, which is the gold standard of looking at multiple studies and using data analysis to create more accurate conclusions and stronger evidence by pooling the number of patients and reducing the margin of error.

https://pubmed.ncbi.nlm.nih.gov/24814559/

Here is a list of cohort and case control studies

https://www.autismspeaks.org/do-vaccines-cause-autism

The sheer number of studies on this topic that have been done to allay irrational fears is already wasteful. We didn’t need so many studies when one involving 500k kids as opposed to 8 should have been sufficient.

Something is causing autism. It’s not vaccines. [/quote]

I'm the OP you responded to. I am familiar with all of-- and do not disagree with any of-- the arguments that you made. That said, I can also imagine a parent saying, "sure, but the approval of a new drug requires typically requires a prospective, randomized, blinded study design; I want that for my kid's shots." You can argue that the parent is wrong-- and, yeah, i get the ethical concerns--  but I think you'll agree that the merits of that view really boil down to a matter of values rather than cold hard science. [/quote]

I don’t think parents who are refusing vaccinations are familiar with the merits of random double blind placebo controlled studies vs single blind studies vs prospective cohort studies vs retrospective case control studies. If they were, they would understand. It’s just math. [b]The anti vax parents think that they are smarter than the 99.999% of physicians and epidemiologists[/b] who are advising them to vaccinate their kids based on decades of research and their tens of thousands of hours of study and clinical work. A randomized controlled trial will not convince them when even the unnecessary death of their own child won’t change their mind.

[/quote]

No, people don't think they are smarter. At all. (Please, PP, this kind of thinking does not help.) They just don't trust the authority figures that we trust - that we have good reason and knowledge enough to trust. And Trump, RFK Jr, Musk and others are willfully encouraging the further eroding of that trust. It is really tragic and hard to see a way out.

I agree with others that the US may need to feel the pain to believe it. I feel no schadenfreude at unvaxxed children dying of measles and am livid that innocent babies and the immunocompromised will be at risk. I just fear that that is the only experience that will turn around public sentiment.

Also, if the Trump administration has its way, and they privatize all the authorities that we have put our faith in, who will the rest of us trust? 
[/quote]

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