Get a load of this. David Kirby has rewritten and re-posted his story from Friday (June 20). The new June 21st story is entitled, CDC: Vaccine Study Used Flawed Methods. It starts with the following:

(NOTE: My original post on this topic mischaracterized the 2003 CDC vaccine investigation as an “Ecological Study,” which it was not. I am reposting this piece to reflect that information accurately, but also to point out that many of the weaknesses identified in the CDC’s data and methods apply to the published 2003 “retrospective cohort” study, as much as they do to any future “ecological” ones. I regret and apologize for the error.)

I hope I’m not getting a big ego, but I have a suspicion that Kirby read my post critiquing his story of yesterday, decided he had been confused about ecologic studies, and decided to create a new story. The damn problem is that Kirby’s new article is now even more confused and erroneous than the first one. The first sixteen paragraphs’s of Kirby’s new article are devoted to the Verstraeten et al. 2003 study that found no link between mercury in vaccines and autism, ADHD, speech delay or tics. Kirby claims that this study was a major issue in both the 2006 Report of the NIEHS Expert Panel and in the CDC Report responding to the NIEHS report.

So here’s some cutting and pasting from my previous post, to remind you of some of Kirby’s major misinterpretations of the NIEHS Report, expecially regarding the Verstraeten et al. 2003 study.

Nowhere in the 2006 report did the NIEHS panel conclude that the CDC’s 2003 thimerosal safety study was riddled with “several areas of weaknesses” that combined to “reduce the usefulness” of the study. In fact, in the NIEHS panel meeting that generated the 2006 report, the quality of the CDC’s 2003 thimerosal safety study was not even discussed. This can be seen clearly if you carefully read the NIEHS Report of the Expert Panel.

Earlier this week Epi Wonk had a long discussion with one of the Expert Panel Members (who adamantly insisted that he/she remain nameless), who confirmed three things for me:
(1) The purpose of the NIEHS Expert Panel was exactly as stated in the report:

It has been proposed that the Vaccine Safety Datalink could be used to look at the association between autistic disorder (AD) or autism spectrum disorders (ASD) by means of an ECOLOGIC ANALYSIS (emphasis mine) that would compare rates before and after the removal of thimerosal from most childhood vaccinations. To determine the feasibility and potential contribution and/or drawbacks of such a study, and to consider alternative study designs that could be conducted using the VSD database, the NIEHS convened a panel of experts…

(2) The quality of previous epidemiological studies of the association between thimerosal and autism was not discussed.
(3) The overall quality of the 2003 Verstraeten et al. study was not discussed. Indeed, in the section of the report in which the expert panel considered research panels other than ecologic analyses, which they did dismiss as riddled with several areas of weaknesses that combined to reduce the usefulness of ecologic studies, the expert panel “…recommended that further consideration be given to conducting an extension of the Verstraten study that would include additional years for follow up, would add more managed care organizations and reexamine the criteria for exclusion of births and/or take a sensitivity analyses approach to examining the impact of various exclusion criteria.”

And we still have these discrepancies between the new story and the actual CDC Report:

KIRBY: …the NIEHS had criticized CDC for failing to account for other mercury exposures, including maternal sources from flu shots and immune globulin, as well as mercury in food and the environment. CDC acknowledges this concern and recognizes this limitation, the Gerberding reply says.
ACTUAL QUOTE FROM CDC REPORT: NIEHS Finding: Difficulty in estimating cumulative exposure of child to organic mercury: The panel expressed concern that VSD adminstrative data or medical charts would not be accurate in recording or estimating a childs total mercury exposure from sources other than vaccines, such as diet, air and water. CDC Response: CDC acknowledges this concern and recognizes this limitation. In addition to administrative data and medical chart review, CDC has employed parent interviews to identify total cumulative mercury exposure from sources other than vaccines, such as diet. Often, however, parent recall, for events several years in the past, poses limitations as well.

KIRBY: “The NIEHS also questioned why CDC investigators eliminated 25% of the study population for a variety of reasons, even though this represented, “a susceptible population whose removal from the analysis might unintentionally reduce the ability to detect an effect of thimerosal.” This strict entry criteria would likely lead to an “under-ascertainment” of autism cases, the NIEHS reported. Again, this would have been an issue in the Verstraeten data. “CDC concurs,” Gerberding wrote, again noting that VSD data are “not appropriate for studying this vaccine safety topic. The data are intended for administrative purposes and may not be predictive of the outcomes studied.”
FACT: The NIEHS Expert Panel did not “question why CDC investigators eliminated 25% of the study population.” On the contrary, when discussing potential alternative designs (other than ecological studies), another possibility that generated support by the panel was an expansion of the VSD study published by Verstraten et al. The availability of several additional years of VSD data was seen as an opportunity to provide a more powerful test of any potential association between thimerosal and AD/ASD and would enable reconsideration of some aspects of the original study design (e.g., exclusion criteria) It was unclear to the panel what effect exclusion of low birth weight infants and those with congenital or severe perinatal disorders or born to mothers with serious medical problems of pregnancy had on the results of the Verstraeten et al. study; an expanded future study in which sensitivity analyses both including and excluding children with perinatal problems was recommended. The quote that begins with CDC concurs has no bearing on the Verstraeten et al. study, as implied by Kirby. Gerberding is responding to an NIEHS Expert Panel point about case ascertainment. Here is the entire quote from the CDC report: CDC responds: “CDC concurs with the recommendation that broader ICD-9 codes should be considered. The weakness further emphasizes why an ecological design is not appropriate for studying this vaccine safety topic using the VSD. The VSD data are intended adminstrative purposes and may not be predictive of the outcome studied. Because the outcomes have not been validated and considering the sensitivity of this issue, any VSD study of vaccines and autism, including a broader list of ICD-9 codes, would require chart review.”

Kirby ends his new article with the following postscript:
“This revised piece does raise two new questions, I think:
1) If the VSD is not necessarily appropriate to help determine the effect of reducing mercury levels in vaccines, are taxpayers getting their money’s worth?
2) If studies done in Denmark, Sweden and California were also “ecological” in nature, are they subject to some of the same weaknesses and limitations?”

Epi Wonk Response:
1) Neither the NEIHS Report nor the CDC Report state anywhere that the VSD is not appropriate to help determine the effect of reducing mercury levels in vaccines.
The relevant summary statements are:
(A) The NIEHS panel identified several serious problems that were judged to reduce the usefulness of an ecologic study design using the VSD to address the potential association between thimerosal and the risk of AD/ASD.
(B) “CDC concurs”, Dr. Gerberding wrote, “that conducting an ecologic analysis using VSD administrative data to address potential associations between thimerosal exposure and risk of ASD is not useful.”
(C) The NIEHS “panel identified several major strengths of the VSD to be: its ability to detect infrequent, vaccine-related adverse events of modest size; the possibility to supplement the MCO administrative data with reviews of medical records, interviews with parents and children, and additional diagnostic assessments; and the availability of demographic information about the MCO members.”
(D) “CDC agrees with the panels assessment of the strengths of the VSD Project to evaluate vaccine safety concerns. The VSD is a unique public-private collaboration that provides a model for the study of patient safety concerns by using individual-level data. In addition, CDC recognizes the tremendous value of the VSD as a national resource of expertise in vaccine safety research.

2) The NIEHS Expert Panel recommended that ecologic studies should not be done using the U.S. Vaccine Safety Datalink. Are completely different types of data from Denmark, Sweden, and California on which ecological analyses have been done subject to some of the same weaknesses and limitations? The answer is NO, but I suppose I’ll have to do a an entire instructional post on this for Mr. Kirby’s benefit.

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17 Responses to “David Kirby HuffPost, Take 2: My Original Story was Flawed, So Here’s A Second (”Corrected”) Story That’s Still Flawed, But I Hope I Can Snow You Under Again This Time…”  

  1. 1 Mary Parsons

    I hope I’m not getting a big ego, but I have a suspicion that Kirby read my post critiquing his story of yesterday, decided he had been confused about ecologic studies, and decided to create a new story. The damn problem is that Kirby’s new article is now even more confused and erroneous than the first one.

    It’s always disappointing when a student has their work returned to them with corrections, is advised to re-submit but fails to take full advantage of those corrections and hands in a dog’s breakfast that demonstrates a complete lack of understanding as to why the first round of corrections were necessary.

    I look forward to your educational post on the topic of appropriate data and ecological analysis.

  2. 2 EpiWonk

    @Mary Parsons: Unfortunately, Mr. Kirby has much more influence with Dean Huffington than Professor Epi Wonk does. A friend e-mailed me that comments containing any mention of “Epi Wonk” are banned from the above-mentioned HuffPost article’s comment area. I find this hard to believe. If it’s true, I don’t know whether to be flattered or angry.

  3. 3 Heraclides

    @EpiWonk: If true, you’re apparently not the only one blocked from posting—seems Orac is too (he mentioned this in the comments in one of his blogs very recently).

    My own views are that its perfectly fine to remove people that are clearly spamming or posting inflammatory or offensive material and the like, as many blogs clearly do, but it seems a mite inconsistent to react to a particular person (or people) as David obviously has, then ban references to them! (In this, I mean not just reacting to you, but others too.)

  4. 4 EpiWonk

    @Heraclides: I agree with you, but I don’t think I can do anything to influence Huffington Post policy on this.

  5. 5 daedalus2u

    When a publication limits comments not solely to eliminate spam, derogatory and defamatory content, and limits comments content to only that it agrees with, that publication isn’t doing journalism; it is doing one sided advocacy.

  6. 6 Mary Parsons

    I don’t know whether to be flattered or angry.

    Absolutely flattered. When you retired, did you have any expectation that you would become so very potent and dangerous a force that even mention of your name would be forbidden? And to do that from such a recent start in the blogosphere. Goodness, you will be one of the shiniest stars in the med blogging firmament if this continues.

    Seriously, you write about such matters so persuasively that I am looking to fill an obvious gap in my education. I confess to browsing various courses to see if feasible for me to investigate epidemiology and to brush up and refresh my knowledge of statistics (which is sadly out of date).

  7. 7 Joseph

    A friend e-mailed me that comments containing any mention of “Epi Wonk” are banned from the above-mentioned HuffPost article’s comment area. I find this hard to believe.

    I don’t.

  8. 8 qchan63

    I don’t find it hard to believe either. Witness what happened last year when the author of the book “Unstrange Minds” posted a comment to one of Kirby’s Huffpost pieces under a pseudonym. Kirby, who apparently could see (and maybe still can?) commenters’ underlying email addresses, chose to blab the author’s real identity in a separate Web forum.

    After this behavior was made known to the people who run Huffpost, Kirby apparently was compelled to issue the following apology:

    Dear List members

    I have been informed by the editors of the Huffington Post that it is against the rules to reveal the identity of people who post comments on the blog.

    I was not aware of that rule.

    I apologize to Huffpost and, particularly, to Dr. Grinker, for the violation. Please do not attempt to contact him directly. He made his comment in the full belief that his identity would not be revealed, and we all need to respect that decision.

    Again, my apologies to everyone.

    David

    (Autism Diva has a good account of the full episode at http://autismdiva.blogspot.com/2007/07/california-autism-epidemic-gold-rush.html )

    Leaving aside the questionable assertion that Kirby had NO IDEA it was wrong to reveal anonymous commenters’ identities, that little kerfuffle would seem to make it clear there’s lots of opportunity for comment monitoring and control over at Arianna’s site.

  9. 9 Uncle Dave

    daedalus2 is quite right.

    People seem concerned about the integrity of science yet
    this writer (Kirby) demonstrates a more chilling
    indictment of journalistic integrity.

    Again, if the facts are misrepresented Huffington
    editor Roy Sekoff ain’t much of a Editor either.

    Note when you search Kirby on Huffington Post, Vacuum bags
    come up. Coincidence?

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