The New Vaccine-Autism Study

You may have heard of Brandolini's law:

"The amount of energy needed to refute bullshit is an order of magnitude bigger than that needed to produce it."

Don't take that phrase "order of magnitude" too seriously. The point is that it's often easier to spread hogwash than to clean it up.

For example, yesterday, Children's Health Defense, the non-profit group led by RFK Jr., reported the following "breaking" news:

The new paper supposedly refutes studies such as one published in The Lancet last May; according to that study, vaccines have saved roughly 154 million lives since 1974.

However, the new paper wasn't "published" (e.g., in a peer-reviewed journal). It was posted to a website.

The author, Denis Rancourt, is not an "all-cause mortality expert". He's a physicist. (Or, I should say, he was a physicist. In 2009, he was fired from University of Ottawa for insubordination. In 2014, he lost a libel suit based in part on a blog post in which he referred to a colleague as a "house n–".)

Brandolini's law in action. I haven't even finished the first sentence of this report, and already I've spent 5 minutes fact-checking misstatements about the credibility of the paper's author and venue.

The paper itself is a mishmash of distorted data, unsubstantiated conspiracy theories, conceptual mumbo-jumbo, and statements that raise questions about Denis Rancourt's sanity. I don't know how hard he worked on it, but it would take considerable effort to fully refute all the bullshit contained therein. I may do that in a future newsletter.

Meanwhile, my focus this week is on another new study from the anti-vaccination camp, one that attempts to revive the thoroughly-debunked claim that childhood vaccines are dangerous.

This study, published one week ago today, has already been celebrated by Children's Health Defense and other like-minded organizations and individuals, and so we can expect it to fuel the growing mistrust of vaccines in the U.S. We need to push back.

I'm going to dive right into the study, then surprise you (maybe) with some details about the people responsible for its publication.

The new study

Pretend for a moment you were browsing the internet and came across this study. You know nothing about the authors, the funders, the journal, or anything else outside of the article itself.

At first glance, it might seem like you've stumbled onto an authentic scientific publication. The masthead looks professional; the study is described as peer-reviewed.

As you read the study, you'd also find that the details are fairly easy to grasp.

The sample consisted of 47,155 nine-year-olds in Florida who'd been enrolled in Medicaid since birth. 42,032 of these children had been vaccinated, 5,123 had not. Some children in each group had been diagnosed with one or more neurodevelopmental disorders. These NDDs include autism (ASD) as well as learning disorders, tic disorders, hyperkinetic disorder, epilepsy/seizures, and encephalopathy.

Here are the three main findings:

• 28.7% of vaccinated children, but only 11% of the unvaccinated ones, had at least one NDD.

• Among children born prematurely, 39.9% of those who got vaccinated, but only 15.7% of the unvaccinated group, had at least one NDD.

• The more vaccinations children had by age 5, the higher the rates of autism.

The takeaway: Vaccines are dangerous. They cause damage to young children's brains. You can't argue with the data, right?

Wrong.

Look closely, and the evidence falls apart more readily than snowflakes on a child's tongue.

1. Healthcare utilization bias.

Let's assume we can trust the findings. In other words, assume that vaccine status and NDD rates truly are correlated. It doesn't follow that vaccines cause NDDs.

Ask yourself: Which parents don't get their kids vaccinated?

Studies suggest that these parents are less likely to visit mainstream health care providers for other services too. Perhaps their access to health care is limited; perhaps they just don't trust the system. Either way, if they have children with NDDs, these kids are less likely to be diagnosed.

In contrast, parents who get their children vaccinated are also bringing them to health care providers more frequently, thereby making it more likely that NDDs are spotted.

This illustrates the well-known "healthcare utilization bias". Even if we trust that there's a vaccine-NDD correlation, we can't assume that vaccines are causing NDDs. Rather, among families who utilize health care the most, kids are more likely to get vaccinated and to be diagnosed with an NDD.

In fact, if we dig deeper, it becomes clear the data can't be trusted in the first place.

Let's dig.

2. Shifting base rates.

The sample consisted of children who were 9 years old at some point between 1999 and 2011.

During this time period, rates of neurodevelopmental disorders ­­– particularly autism spectrum disorder – increased nationwide owing to more intensive screening as well as expansion of the diagnostic criteria (most notably through the release of the DSM-IV-TR in 2000).

The researchers failed to make any adjustment for this increase in population-wide rates of NDDs.

This can be viewed as an extension of the healthcare utilization bias: Kids who get vaccinated are seeing health care providers more frequently, and those providers happen to be identifying more cases of autism than they used to.

The researchers could've determined how badly their findings are undermined by healthcare utilization bias and shifting base rates. They had the data; they simply chose not to run the analyses.

3. Confounds.

The researchers also failed to control for a variety of known contributors to NDDs, including family history. We have no way of determining whether the vaccinated group differs from the unvaccinated group in other ways that contribute to the development of NDDs.

Simply put, a reputable epidemiological study would do so much more by way of controlling for potential confounds.

4. Causal confusion.

The researchers claim that vaccines cause NDDs. Obviously this claim depends on vaccination taking place first.

One of the most bizarre – and suspicious – aspects of the study is that the researchers provide no information on when children got vaccinated, or when they received an NDD diagnosis. All we know is that by age 9, kids either had or hadn't received vaccines, and they either had or hadn't been diagnosed.

As a result, some children may have received an NDD diagnosis before their first vaccination. Obviously their data shouldn't count as evidence that vaccines cause NDDs. The jab that Tony gets at age 5 doesn't retroactively cause him to develop autism at age 4.

Here too, the researchers had the data but simply chose not to examine it.

(They did run one analysis relating total number of vaccines received by age 5 to NDD rates, but this still doesn't address the problem. Some kids may have received an NDD diagnosis before their first vaccination, or between the first and second ones, and so on. It's suspicious too that the researchers' only dose-response analysis was done under this single, apparently arbitrary condition.)

5. Flawed classification.

Children were classified as "vaccinated" or "unvaccinated" on the basis of Medicaid billing records. This approach is inaccurate.

(a) The unvaccinated group almost surely included some kids who received vaccines from sources other than Medicaid.

(b) Florida law doesn't require providers to report vaccines to Medicaid – another reason some vaccinated children may have been classified as unvaccinated.

(c) Children were labeled "vaccinated" even if their Medicaid records only indicated a single vaccine-related visit. A child who received the Hepatitis B vaccine at birth but nothing else, for instance, would be lumped together with children who received a routine schedule of more than a dozen vaccines over a period of years.

The researchers don't explain why vaccines in general would be expected to cause NDDs. By treating, say, the Hepatitis B, rabies, and MMR vaccines as interchangeable, they undermine the rationale for doing the study in the first place.

I can't emphasize enough how shoddy and suspicious it is to lump children together in a single "vaccinated" group, no matter how many vaccines they had, and then link vaccination to NDDs without consideration of when the vaccines and diagnoses were received.

Bottom line

Judged on its own merits, the study fails miserably. It provides no credible evidence that vaccination increases children's risk of NDDs.

I've only described the flaws I felt I could briefly summarize; there are many more, including some technical ones (e.g., lack of sensitivity analyses) that would guarantee students an F in Epidemiology 101.

Conflict of interest

The Conflict of Interest section of the paper contains the following statement:

"The authors declare no conflict of interest."

Concretely speaking, this is untrue, as the research was funded by the National Vaccine Information Center, a non-profit (with no governmental affiliation) that has an ugly history of anti-vaccine propaganda and misinformation.

I'll revisit the conflict of interest issue after briefly introducing the cast of characters behind this study.

The lead author

Anthony Mawson, the lead author, worked for Jackson State University from 2001 through 2022. He's currently president of the Chalfont Research Institute, a non-profit organization with no website, though it does have a physical address: 5359 Briarfield Road, Jackson MS, 39211. Here, courtesy of Google Maps, is Dr. Mawson's research institute:

Notice the hammock on the left where, presumably, much of the key research is conducted.

Mawson was the lead author of a 2017 vaccine study that was retracted twice by different journals, then posted online to a disreputable pay for play outlet.

(Retraction is a big deal. Scientific papers aren't retracted simply because of errors, bad methodology, or weird findings. They're retracted when the data are so deeply flawed and/or fraudulent that nothing, including corrections, could restore even minimal credibility.)

The "journal"

Science, Public Health Policy and the Law is not an academic journal but rather a WordPress blog pretending to be a "high-impact" journal.

James Lyons-Weiler helped found this "journal", continues to serve as Editor-in-Chief, and is listed as Reviewing Editor on the new study. Lyons-Weiler openly acknowledges that the journal is a bottom-feeder, noting for instance that

"Unlike other journals, we consider submissions that may have been wrongfully retracted"

This reminds me of a little market I used to visit when I lived in Hangzhou, China. At this market you could buy stuff made by "Clavin Klien" and "Praba" – in other words, products that had so many typos and other flaws, they weren't even good enough to be sold as fake versions of the real brands (though most shoppers would still recognize them as forgeries).

Analogously, Science, Public Health Policy and the Law publishes studies that are so obviously untrustworthy, even legitimate journals that air bad research won't publish them. And, as you've probably gathered, ideology drives the science. Here's Lyons-Weiler in 2018:

"[A]s currently formulated, vaccines are filthy, nasty vials of toxic sludge that every American citizen and parent should be able to refuse for any reason"

Lyons-Weiler is also founder of IPAK-EDU, an organization listed as the journal's publisher that offers, among other things, an online vaccine course taught by a self-described engineer and software developer.

But here's the punchline: Lyons-Weiler, along with every single member of his journal's editorial board, work in some capacity for Children's Health Defense, the non-profit famous for RFK Jr.'s leadership and for spreading anti-vaccination misinformation. (A few members of the editorial board simply have no expertise; the rest have had papers retracted, medical licenses revoked, or other penalties indicative of guilt beyond mere association with RFK Jr.)

Conflict of Interest?

Remember how the authors declared no conflict of interest? In a sense, that's accurate. The authors, their editors, their funders, and other supporters are of one mind that vaccines are harmful, and that it is acceptable to distort scientific evidence and propagate outrageous bullshit in order to prove the point.

Final thoughts

Hundreds of studies attest to the safety of vaccines currently in use, and it's clear from some of these studies that neither vaccines nor vaccine ingredients cause autism and other NDDs. (Drs. Andrea Love and Katie Suleta provide a concise summary, with hyperlinks, here.)

Adverse events do occur in rare cases, as with any other medical treatment, but the vaccines are not generally dangerous, and by any public health metric the benefits vastly exceed the risks.

Brandolini's law reminds us that we need to choose our battles. There aren't enough hours in the day to refute all the bullshit around vaccination and other evidence-based health practices.

And yet we should try. Watching RFK Jr.'s confirmation hearings, I was struck by his inability to distinguish Medicare and Medicaid. He confused the two yesterday, more than once, and he continued to struggle today.

Call it carelessness if you will, but this broad-span confusion contrasts sharply with the onslaught of highly specific misinformation that RFK Jr. and those who've worked for him, including Anthony Mawson and James Lyons-Weiler, continue to disseminate.

We have to push back. If you have concerns about RFK Jr. being confirmed as HHS secretary, reach out to your Senators. If you're a doctor, consider signing this opposition letter. But remember too that whether or not RFK Jr. is confirmed as HHS secretary, he's likely to continue supporting some of the worst and most dangerous distortions of scientific data, including the study I've shared with you here. We need to stay vigilant too.

Vaccines are generally safe and effective. Have a peek at the data here, here, or here, and share with others. If someone mentions the new study, refer them here or to this newsletter.

Thanks for reading!