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Felaktigheter om Andrew Wakefield et al.

SvD hade en artikel av Henrik Ennart om bl.a. forskaren Andrew Wakefield den 1 dec 2018. Wakefield är den brittiske läkare (gastroenterolog) som var en av författarna till en artikel i The Lancet om en studie där man undersökt MPR-vaccinet och dess eventuella samband med tjocktarmsinflammation och vissa utvecklingsstörningar, t.ex. autismspektrumtillstånd. Studien beskylldes för diverse oegentligheter, artikeln drogs tillbaka och Wakefield fråntogs sin läkarlicens.

Andrew Wakefields gärning i stort kan jag inte uttala mig om, men det går att uttala sig om just den artikel i The Lancet det gäller. Det cirkulerar en mängd felaktigheter om tillbakadragandet och vad artikeln egentligen säger.

T.o.m. Folkhälsomyndigheten spred dessa felaktigheter, men tog sedermera bort dessa från sin webbplats. Tidigare på Folkhälsomyndighetens sida om MPR-vaccin fanns två avdelningar: ”7. Varför har MPR-vaccin misstänkts för att orsaka autism?” och ”8. Varför drogs Wakefields artikel tillbaka?”

Nu finns bara ett kortare stycke på den webbsidan: ”7. Varför har MPR-vaccin misstänkts för att orsaka autism?”, där Wakefield inte längre nämns.

Det som stod på Folkhälsomyndighetens sida har säkert bidragit till att många journalister skrivit felaktigheter i frågan. När det gäller Henrik Ennarts artikel, så tar jag här bara upp det som handlar om Wakefield.

 

SvD 1 december 2018.

 

1) Artikeln var inte skriven av Wakefield ensam; han hade av 12 medförfattare: S H Murch, A Anthony, J Linnell, D M Casson, M Malik, M Berelowitz, A P Dhillon, M A Thomson, P Harvey, A Valentine, S E Davies och J A Walker-Smith. Artikeln heter ”Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children”.

2) Artikeln drogs inte tillbaka efter två år utan efter 12 år. Den finns fortfarande att läsa, men med texten RETRACTED i rött över sidorna.

3) Artikeln i The Lancet hävdade inte att det fanns ett ”samband mellan vaccinationer och autism samt tarmsjukdomen IBS.” IBS nämns inte, utan vad man talar om är ”non-specific colitis”, alltså ospecificerad grovtarmsinflammation.

De 13 författarna var mycket försiktiga när det gällde att dra några slutsatser om samband och skrev uttryckligen i Discussion-delen av artikeln:

We did not prove an association between measles, mumps and rubella vaccine and the syndrome described. Virological studies are underway that may help to resolve this issue.

If there is a causal link between measles, mumps and rubella vaccine and this syndrome, a rising incidence might be anticipated after the introduction of this vaccine in the UK in 1988. Published evidence is inadequate to show whether there is a change in incidence or a link with measles, mumps and rubella vaccine.

4) Detta att Wakefields medförfattare drog tillbaka sitt stöd stämmer inte. 2004 publicerades i The Lancet något som rubricerades ”Retraction of an interpretation”, där 10 av medförfattarna tar avstånd från just den tolkning som Ennart och många andra gjort, man tar alltså inte avstånd från vad artikeln säger utan från ”the interpretation placed upon these findings”:

We wish to make it clear that in this paper no causal link was established between MMR vaccine and autism as the data were insufficient. However, the possibility of such a link was raised and consequent events have had major implications for public health. In view of this, we consider now is the appropriate time that we should together formally retract the interpretation placed upon these findings in the paper, according to precedent.

Såvitt jag förstått ville inte Wakefield medverka i denna ”retraction”, eftersom han tyckte att man redan i artikeln tydligt angivit att sambandet inte bevisats och att ytterligare forskning behövs.

Intressant nog friades en av medförfattarna, John Walker Smith, 2012 av High Court som helt avfärdade GMC:s (General Medical Councils) anklagelser. Man kan tycka att även Wakefield borde ha friats genom detta, men tydligen skulle han ha behövt driva ett eget mål men hade inte råd med detta.

The Independent skrev om saken (7 mars 2012):

In May 2010, Prof Walker-Smith lost his licence to practise along with Dr Andrew Wakefield who was at the centre of the MMR research.
A GMC fitness to practise panel found both men guilty of misconduct over the way the research was conducted.
Its verdict followed 217 days of deliberation, making it the longest disciplinary case in the GMC’s 152-year history.
Today the GMC suffered a serious blow when Mr Justice Mitting, sitting in London, ruled the verdict and the decision to strike off could not stand.
The judge criticised the disciplinary panel’s ”inadequate and superficial reasoning and, in a number of instances, a wrong conclusion”.
The judge said: ”It would be a misfortune if this were to happen again.”

Sheldon Saul Hendler (1936–2012)

Någon gång vid mitten av 1990-talet köpte jag en bok av den amerikanske läkaren Sheldon Saul Hendler, ”The Doctor’s Vitamin and Mineral Encyclopedia”. Jag hade hört mycket gott om den, och när jag nu fick ett eget exemplar, så kunde jag konstatera att den faktiskt var väldigt användbar. Mycket av det man köper i hälsokostaffärer granskade han för och emot och jämförde med vilka eventuella vetenskapliga studier som gjorts som kunde belägga den ena eller andra åsikten.

Senare köpte jag också hans ”PDR for Nutritional Supplements” (skriven tillsammans med David Rorvik), en betydligt större bok, dock begränsad till kosttillskott, här togs t.ex. inte örtmediciner upp.

Idag tyckte jag det var dags att kolla om det möjligen kommit någon ny intressant bok av Hendler och upptäckte när jag googlade att han tyvärr avlidit 2012 (se runa).

Jag upptäckte också något jag inte haft en aning om; att han var musiker – jazztrumpetare. Och att han skrivit musiken till Jacob Bronowskis TV-serie från 1973, ”The Ascent of Man”. Bara detta var ett märkligt sammanträffande. Den serien betydde mycket för mig, och jag har sedan läst några böcker av vetenskapshistorikern Bronowski. Jag brukar gärna citera vad Bronowski skrev om vikten av att sätta sig in i vetenskapliga spörsmål: ”The world today is made, it is powered by science; and for any man to abdicate an interest in science is to walk with open eyes towards slavery.”

Tillbaka till Hendler. Han höll också vetenskapens fana högt. Han var definitivt ingen flummare, fast han tog vitaminterapier och örtmediciner på allvar.

Hendler tog en Ph.D i biokemi vid Columbia University i New York, och senare studerade han vid University of California i San Diego samt vid Salk Institute, där han bl.a medverkade vid viktiga fynd om nukleosomens struktur (ett protein som DNA-molekyler slingrar sig runt och som har med genuttryck att göra). Han var också med i gruppen som upptäckte en ny hudsjukdom, elastoderma 1985 (se New England Journal of Medicine). I San Diego blev han också medicine doktor.

More on trigger points & muscle lumps

In 2003 I published a book about mercury poisoning from dental amalgam, fibromyalgia and the role in society of scientific research. It was built upon my own experiences as chronically ill. The print version is available in Swedish only, but there is a version in English available on line as a 131 page PDF.

After the book was published, I also uploaded a few web pages with further comments on these topics, but those were in Swedish only. I believe, however, that especially one of those texts, concerning muscle lumps, should reach also non-Swedish readers. I have therefore translated it into English. Read more »

Is illegal tobacco more dangerous than legal?

When I wrote about the tobacco industry and its mafia methods the other day (in Swedish) I had missed an ad that was published in Swedish daily Svenska Dagbladet on December 7. Advertisers are the Swedish Tobacco Manufacturer’s Association and an association for Swedish Stores & Fast Food.

The main message appears on the facsimile above: ”Illegal tobacco causes organized crime”, designed so that it resembles a warning on a cigarette packet.

An interesting attempt by an industry with very little goodwill to try to improve its image somewhat by pointing the finger at a branch of the same industry, which in some respects is even worse than themselves.

The products of the pirates and their business practices are perhaps a bit worse than those in the official channels, but you should be aware that they operate in a market that is created and maintained through decades by exactly the so-called legal tobacco industry. This has been done by systematically hiding the known dangers regarding tobacco harm.

The ad contains four statements:

* Those who sell illegal tobacco ignore age limits and market to young people.

* 2 billion Swedish crowns are being withheld from the state since pirated tobacco is tax free.

* Criminal activities are financed through the enormous profits from illegal tobacco.

* Pirated [counterfeit] cigarettes may have higher rates of various substances than is allowed as expressed in the approved limit values.

They try to make it sound as if only the illegal businesses focus on the young. But that is not true. Remember when Austria Tabak some years ago arranged special smoke parties for young people in Sweden, where they had the opportunity to buy cheap cigarettes. As late as the mid-1990s there were still tobacco advertisements that clearly aimed at the youth. Today, product placement in movies obviously aims at a young audience. And, as is well known, all of a suddden people smoke a lot again in TV serials.

I ask Pascal Diethelm about this. Diethelm is a well-known health activist at OxyGenève in Switzerland, who was one of the two sued in the so-called Rylander affair a few years ago.

– The ad in the Swedish dailies is a smokescreen to distract the attention away from the real problem, Diethelm says, namely the fact that the main suppliers of illegal tobacco trade are the cigarette companies themselves. It could be that less than 1% of the traffic is related to the pirates, but the industry uses them to mask the fact that the rest comes from them – except for counterfeit cigarettes, which mostly come from China, and which represent an increasing, but still small, share of the illegal market.

– Intergovernmental negotiations are underway for the elaboration of a protocol on illicit tobacco trade, and the tobacco industry is trying everywhere to preempt that future protocol by concluding separate agreements (with loopholes) with each country at the local level – perhaps this is what they are trying to do in Sweden.

When it comes to the talk about higher rates of various harmful substances in illicit cigarettes, Pascal Diethelm says that this is a myth, which has two purposes – as a scare tactic and to pass the message that regular cigarettes are safer, which is known not to be true.

Pingad på Intressant.

Scientific fraud must be investigated – also in Sweden!

In Swedish magazine Axess (No 2/2008) I have an article about how important it is that Sweden finally gets an impartial institution that may investigate science fraud. Other Nordic countries have such agencies – while Sweden turns a blind eye to a lot of irregularities that should be classified as either science fraud or scientific misconduct. There is presently a proposal in parliament suggesting the founding of a committee on scientific misconduct. This would at least be a start, therefore it is worth supporting. It is far from an ideal solution, but better than what we have now.

The line of argument in my article is based on a case I have followed for several years, the case of Swedish professor Ragnar Rylander, tobacco researcher who on the one hand, had a series of public health assignments (e.g. scientific advisor to the Swedish National Board of Health and Welfare), and on the other, was secretly working as a consultant to the tobacco industry. In that capacity he helped to keep secret such research results that could adversely affect the industry’s business. He also assisted in withholding incriminating documents concerning these affairs from the prosecutors in the major trials against the tobacco industry that took place in the USA in the 1990s.

Read the whole article in English translation from my archive!

Pingad på Intressant.

CT scans may affect children’s learning

A group of Swedish scientists at the Karoliska Institute and Harvard School of Public Health have found that CT scanning in children could affect their later learning abilities. The British Medical Journal presents the study thus:

Receiving low doses of ionising radiation to the head in infancy may impair the developing brain and affect intellectual development. Hall and colleagues (p 19) studied 3094 men from Sweden who had received radiotherapy for cutaneous hemangioma before the age of 18 months. They analysed military records reporting the men’s intellectual capacity at age 18 or 19 and found that exposure to doses of radiation greater than 100 mGy, the equivalent of a computed tomography scan, was negatively correlated with high school attendance and learning ability assessed by cognitive tests. The authors call for re-evaluating the use of computed tomography for minor head injuries in infants.

The full text of the article Per Hall, Hans-Olov Adami, Dimitrios Trichopoulos, Nancy L Pedersen, Pagona Lagiou, Anders Ekbom, Martin Ingvar, Marie Lundell & Fredrik Granath, ”Effect of low doses of ionising radiation in infancy on cognitive function in adulthood: Swedish population based cohort study”, BMJ 2004;328:19 (3 January) is available at the BMJ web site. The study has already received some criticism at the Rapid Responses section.

Pingad på Intressant.

Microwave ovens and wireless networks

Jim Geier reports in an article at Wi-Fi Planet, Dueling with Microwave Ovens, about his experiments, which show how radiation from microwave ovens might interfere with wireless local computer networks, so-called WLAN’s. From a health point of view this seems to indicate that our microwave permeated environment not only includes radiation from cordless phones, cell phones, burgler alarms etc., but also leakage from microwave ovens, short in duration maybe but still adding to the total exposure. A quotation from the article:

A more realistic distance from the microwave is from one of the break tables, which is about eight feet away from the microwave. At this range, I reran the throughput tests, resulting in 178pps. This still equates to around a 75 percent decrease, something that would likely make users unhappy. […]
I also repeated the tests down the hall about 20 feet away with the microwave running and still experienced fairly sluggish responses. In fact, throughput from there was still only 260pps. Obviously, the microwave was making the WLAN crawl at surprisingly great distances from the microwave.

Pingad på Intressant.

The Rylander affair – at a glance

29 March 2001: The two anti-tobacco organizations CIPRET-Genève and OxyGenève publish their press release titled ”Geneva, platform of a scientific fraud without precedent”, where professor Rylander’s connections with the tobacco industry are pointed out. They also demand that the Geneva University must investigate the matter.

30 March 2001: An investigation is initiated by the rectorate of the Geneva University.

20 April 2001: Ragnar Rylander sues Pascal Diethelm and Jean-Charles Rielle, representatives of the two anti-tobacco organizations, for defamation on three points: for having claimed that Rylander was secretly employed by the tobacco industry, that he was one of the most highly paid of the industry’s consultants, and that he was responsible for a scientific fraud without precedent.

29 June 2001-24 maj 2002: The first trial in the Geneva Police Court. Diethelm and Rielle try to prove that their allegations are correct and thus do not constitute defamation.

6 November 2001: The rectorate of the university of Geneva presents its investigation: The context in which Rylander has chosen to work does not ”seem innocent in all respects”.

24 May 2002: The verdict in the first trial: The court agrees with the defendants on one point, that Rylander was secretly employed, but the claim that he was one of the most higly paid consultants and that he was guilty of scientific fraud could not be proved. Rielle and Diethelm are imposed a fine of 4,000 CHF each. They appeal.

September 2002: The Geneva University continues the investigation in the light of new facts presented during the trial. On December 20, the university representatives acknowledge that they might even reassess professor Rylander’s research results and communicate this to the scientific community, if necessary.

13 January 2003: The second verdict. The Cantonal Appeal Court in Geneva establishes the verdict of the Police Court. However, of the two counts from the earlier trial, now only one remains: the question of a scientific fraud without precedent. It was found that the defendants had proved that Rylander was one of the most highly paid of the industry’s consultants. The fine is lowered to 1,000 CHF. Rielle and Diethelm appeal again.

17 April 2003 (published May 28): The Supreme Court of Switzerland (Tribunale Fédérale) annuls the judgment of January 13, as being ”incomprehensible” and ”arbitrary”, and refers the case back to the cantonal court.

15 December 2003: The Court of Justice of the canton of Geneva publishes its verdict, where Rielle and Diethelm are completely freed of all charges, and professor Rylander’s work at the Geneva University is charecterized as a ”scientific fraud without precedent”. (Read also this blog entry!)

null

Read more:

Philip Morris assigned secret grants to Swedish professor” (Dagens Forskning [Today’s Science] no 12, 10-11 June 2002) (English, also available in Swedish.)
Ragnar Rylander has willingly offered his services” (Dagens Forskning [Today’s Science] no 16, 26-27/8 2002) (English, also available in Swedish.)
Extensive information in French at the Prevention web site.

Pingad på Intressant.

Rylander affair: ”fraud without precedent”

The affair in Geneva concerning the Swedish scientist Ragnar Rylander and his secret connections with the tobacco industry – an affair which has been going on for almost three years – possibly reached its final ruling on December 15th. The Criminal Division of the Court of Justice of the canton of Geneva published its verdict of acquittal in the trial, where professor Rylander sued two representatives of the anti-tobacco organizations CIPRET-Genève and OxyGenève, Jean-Charles Rielle and Pascal Diethelm, for defamation. They were now completely freed of all charges. The lawsuit was brought on because of what they said at their web site ”Prevention”, that professor Rylander had manipulated his studies to suit his covert financier, and that Geneva because of this was the platform for a ”scientific fraud without precedent”.

Two verdicts from 2002 and 2003, where the defendants were found guilty, were appealed and in May 2003 the Swiss Federal Tribunal found the last verdict ”incomprehensible” and referred it back to the Geneva judges who now in their December verdict actually use the same phrasing as was used in the original text that Rielle and Diethelm were sued for:

Geneva has indeed been the platform of a scientific fraud without precedent in the sense that Ragnar Rylander has acted in his capacity of associate professor at the University, taking advantage of its influence and reputation and not hesitating to put science at the service of money, in disregard of the mission entrusted to this public institution, which consists in particular in the dissemination of culture founded on scientific knowledge and in raising awareness of the responsibility that teachers assume towards society. (Page 22 in the verdict.)

(Genève a bien été la plate-forme d’une fraude scientifique sans précédent dans la mesure où Ragnar Rylander a agi en sa qualité de professeur associé de l’Université, profitant de son rayonnement et n’hésitant pas à mettre la science au service de l’argent, au mépris de la mission confiée à cet établissement de droit public qui consiste en particulier à diffuser une culture fondée sur les connaissances scientifiques et à faire prendre conscience de la responsabilité que les enseignants assument envers la société.)

The court puts it rather bluntly that Rylander has lied about his collaboration with the tobacco industry:

Ragnar Rylander has said only a very small part of the truth – the sponsoring by the tobacco industry of the two symposia of 1974 and 1983 – while remaining silent on all the rest, namely, in particular, his role within the INBIFO research laboratory, his permanent links with the lawyers of Philip Morris and the fact that his articles were regularly submitted to Philip Morris before being published. (Page 21 in the verdict.)

(Or, Ragnar Rylander n’a dit qu’une toute petite part de la vérité – le sponsoring par l’industrie du tabac des deux symposiums de 1974 et 1983 – en taisant tout le reste, soit en particulier son rôle au sein du laboratoire de recherches INBIFO, ses liens permanents avec les avocats de Philip Morris et le fait que ses écrits étaient régulièrement soumis à Philip Morris avant d’être publiés.)

You may read the entire verdict (in French) at http://www.prevention.ch/ryju151203.htm

The University of Geneva has an investigation going on regarding Rylander’s research, but the University of Gothenburg has hitherto not found an investigation a necessary measure. On December 18th, however, the Swedish radio (”Vetenskapsnyheterna”) reported that the dean at the medical faculty at the University of Gothenburg, Staffan Eden, now will initiate an investigation in order to form a new policy.

Swedish readers may read a recent interview with professor Rylander in Göteborgs-Posten, December 17th.

See also ”The Rylander affair – at a glance”.

Pingad på Intressant.

Pfizer’s cover-up on antihypertensive drugs

Recently the Swedish Television (November 11th) as well as the PBS television network (November 13th, as a follow-up on their Frontline program ”Dangerous Prescription”) reported about the ALLHAT project, a comparative study of antihypertensive drugs, led by professor Curt Furberg of Wake Forest University School of Medicine in North Carolina.

The ALLHAT study (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) found that old-fashioned diuretica such as chlorthalidone, was at least as good for lowering high blood pressure as alpha-blockers such as doxazosin. There is also a link to a possible increased risk of congestive heart failure, heart attack and stroke with doxazosin – probably not as much a side-effect as a matter of lack of effect on these conditions.

The ALLHAT study was presented in an article in JAMA almost a year ago: The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group, ”Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic”, JAMA, December 18, 2002—Vol 288, No. 23 2981-2997. It is available as a PDF file at the ALLHAT site or here. The authors conclude:

Thiazide-type diuretics are superior in preventing 1 or more major forms of CVD [cardio-vascular disease] and are less expensive. They should be preferred for first-step antihypertensive therapy.

The ALLHAT study was terminated prematurely since the research team did not want to jeopardize the participating patients’ health by giving them a drug that the team suspected did not provide the best remedy. The drug company Pfizer, who manufactures a doxazosin drug called Cardura (in Sweden the trade mark is Alfadil), started a counter campaign. But the company had also to face a lawsuit from a patient who had taken Cardura. In this trial a lot of internal Pfizer documents were disclosed to the public. Here we can read, among other things, the survey that a PR firm executed in order to check whether doctors were aware of the critique against Cardura or not. Thus they would be able to customize their ”damage control” letters to physicians of different medical specialties. See this PDF at the FDA website, pages 104-106.

Björn Dahlöf, a Swedish scientist and consultant to the drug industry, claimed in the Swedish TV program ”Uppdrag granskning” that the JAMA article had never been peer-reviewed, something he later admitted was not true. There has obviously been attempts not only to discredit Furberg, but also to stop doctors from listening to his lectures. At a conference in Anaheim, California, in the spring 2000, the drug company organized a sight seeing tour for some of the doctors at precisely the time when Furberg was about to deliver his lecture. In the TV program Furberg says that this was hardly a coincidence. And it was not. The confidential Pfizer documents from the trial, now at display at the FDA web site, prove that this in fact was a deliberate measure. Karole M. Oleksey, of the Cardura marketing team, with special responsibility for Spain and Italy, writes in an e-mail on March 16, 2000 (page 109 in the PDF):

I saw Loris and Alessandro here at the ACC this morning at the ALLHAT presentation. I am sure they will fill you in on the presentation of the results. The good news is that they were quite brilliant in sending their key physicians to sightsee rather than hear Curt Furberg slam Pfizer once again!

This is not surprising since drug companies have acted in similar ways before at conferences, for instance by marking journalists man-to-man to keep them from talking to certain scientists with unwanted views. See for instance my article ”Consensus and canaries” footnote no 69.

A mini-interview (in English) with Curt Furberg about his and the study group’s findings is available at the ESI Special Topics Web site.

The PBS writes about Furberg as a follow-up on the program ”Dangerous Prescription”:

”If you eliminated all the ACE inhibitors and calcium antagonists [calcium channel blockers] for the first-line treatment of hypertension,” says Furberg, and if patients were put on diuretics, ”we would avert maybe 60,000 events per year – 60,000 heart failures or strokes. These are devastating complications. So, if you want to know what has happened over the past five years, we’ll you can multiply by five. So we’re talking about a large number of people who unnecessarily have suffered these events because we didn’t have the knowledge we have today.” (See Andrew Liebman’s ”Producer’s notebook”)

For Swedish readers there is an article on Furberg at the Svenska Dagbladet web site, published November 16th, titled ”Läkemedelsindustrins fiende nummer ett” (”The drug industry’s enemy number one”). On the web is also a written article from the Swedish television accompanying their program ”Uppdrag granskning” (November 11th), titled ”Dolda fakta om blodtrycksmedicin” (”Hidden facts about antihypertensive drugs”).

Pingad på Intressant.