OK, I’ve just read a second lengthy document that Robert F. Kennedy Jr. and his fellow travelers say is proof of a CDC/IOM cover-up, and I’ve found it is nothing of the kind. In fact it quite strongly shows the opposite.
First, a refresher. Kennedy wrote a scare piece linking thimerosal to autism, stating that a CDC meeting had spent days covering up a supposed link. I wrote a piece showing how Kennedy’s article was totally dishonest, and my conclusion was later confirmed and expanded upon by Majikthise. Kennedy also claimed in his article that the Institute of Medicine (IOM) had been paid by the CDC to further bury this so-called link, and presented several (un-sourced) quotes to support this claim. The IOM’s president replied that the quotes were taken out of context, and denied that they were part of any cover up. I reported on this, stating that Kennedy should offer evidence (with cites) of the original quotes (in context) and evidence of the “paid cover-up” that he so scandalously alleged. He hasn’t done so, as far as I am aware.
My post generated several comments, including several from a poster calling himself “Critical Thinker”, who did manage to find the transcript that contained the Kennedy IOM quotes. He challenged me:
Here is a link to the full IOM report. Read this document. Then tell me how I can possibly believe that the CDC did not want the IOM to find a link (Note by Skeptico: presumably he means “find no link”) and that the IOM had not already made up their mind BEFORE the study started that they would find no link between thimerosal and autism. Explain to me how these quotes are taken out of context as the IOM president would like us to believe. Here are some specific quotes that I find most concerning:
Page 32 Dr. Kaback:
"We have got a dragon by the tail here. At the end of the line, what we know is -- and I agree -- that the more negative that presentation is, the less likely people are to use vaccination, immunization, and we know what the results of that will be.
We are kind of caught in a trap. How we work out way out of the trap, I think, is the charge."
Page 34 (Note: actually page 33) Dr. McCormick:
"I am wondering, if we take this dual perspective, we may address more of the parent concerns, perhaps developing a better message if we think about what comes down the stream as opposed to CDC, which wants us to declare, well, these things are pretty safe on a population basis."
Page 72 (Note: actually page 74) Dr. Stratton:
"We said this before you got here, and I think we said this yesterday. The point of no return, the line we will not cross in public policy is pull the vaccine, change the schedule.
We could say it is time to revisit this, but we would never recommend that level. Even recommending research is recommendations for policy.
We wouldn't say compensate, we wouldn't say pull the vaccine, we wouldn't say stop the program."
Page 95 (Note: actually page 97) Dr. McCormick:
"What I am trying to get at is, do we want to simply, on our gut, say looking at the significance of the wild disease that you are protecting, and the seriousness and potential association with the vaccine - because we are not ever going to come down that it is a true side effect - is that going to be sufficient for you to judge public health impact?"
These did appear to be the quotes Kennedy was using. So I read the full transcript and the following is what I find those quotes to really mean, in context.
NOTE: I have shown the portion of the quotes that Kennedy included, highlighted in yellow. I believe that makes it clearer which bits Kennedy included and which bits he left out. It should be easier this way, for you to make your own mind up as to whether the bits Kennedy missed out (ie the non-highlighted text), alters the meaning. All additional bold is mine.
Page 32 Dr. Kaback:
The first quote is preceded by a lengthy discussion on how most people are bad at understanding statistics and determining relative risks (several anecdotes are recounted). There is a discussion about how there are always risks to anything, and that sometimes one risk trades off against another, and that people have to make decisions about these trade-offs. Finally, there is the recognition that, in reality, doctors only have a little time (1.6 or 1.7 minutes are quoted), to explain these factors to their patients. Then we have this:
It (the doctors’ explanation) all has to be done in 1.6 minutes in a way that they can make a – I will come back another time and give you a nice anecdote about informed decision making.
That, of course, is threaded through all our vocabularies, this great notion of informed choices that patients make.
We need to think a lot about that. We have got a dragon by the tail here. At the end of the line, what we know is -- and I agree -- that the more negative that presentation is, the less likely people are to use vaccination, immunization, and we know what the results of that will be.
We are kind of caught in a trap. How we work out way out of the trap, I think, is the charge. It does have a kinetic component.
That’s why I think we can’t sit two years to do it. (Snip)
Of course, we live in a 24-hour-a-day seven-day-a-week media blitz on our public. They are always looking for things to fill up the time and the newspapers with. This makes a great story. So, we have a big job.
They are talking about how people don’t understand statistics, and how it might be difficult to explain certain findings, and how difficult this job will be.
Page 33: Dr. McCormick
Following immediately from the above is:
I took away actually an issue that we may have to confront, and that is actually the definition of what we mean by safety.
It is safety on a population basis, but it is also safety for the individual child.
I am wondering, if we take this dual perspective, we may address more of the parent concerns, perhaps developing a better message if we think about what comes down the stream as opposed to CDC, which wants us to declare, well, these things are pretty safe on a population basis.
This is a discussion of the need of parents to know if a vaccine is safe for their individual child compared with the CDC’s requirement to know safety for the whole population. McCormick is proposing the committee additionally considers the parents’ concerns about the health of their individual children, instead of just safety for the whole population.
The whole flap around this quote is the wording “wants us to declare, well, these things are pretty safe”. She means, the CDC wants to know if they are safe. Seriously, the conspiracy believers need to grow up a little – it’s obvious what she means when you read the whole transcript.
Page 73: Dr. Stratton:
There is a discussion about just what the CDC wants to know from the IOM, with the conclusion being that the CDC primarily wants to know if there really is a causative link (ie doesn’t want to “whitewash” anything).
Dr. Stratton
I think there are two things we absolutely have to do and there is no doubt about it. We have to give them your best judgment of the causality assessment.
Exactly how you define that… you can decide.
This committee has to make a causality assessment. That is clear, and they have to recommend action, inaction, you know, how much action in some sense.
How you get from one to the other is your judgment. They have made suggestions for the things that you might want to consider. But we must give them a causality assessment.
Dr. Goodman:
… when you say action, how are you defining action? How far down the line are you defining actions?
(Snip)
Dr. Stratton:
We said this before you got here, and I think we said this yesterday. The point of no return, the line we will not cross in public policy is pull the vaccine, change the schedule.
We could say it is time to revisit this, but we would never recommend that level. Even recommending research is recommendations for policy.
We wouldn't say compensate, we wouldn't say pull the vaccine, we wouldn't say stop the program.
It really is very clear from the above that nothing is being buried. In fact, the key piece of information the CDC wants is, is there a causative relationship? Stratton is saying that they must say if the vaccine is dangerous – they must “make a causality assessment”. But Stratton is saying this committee draws the line at policy – whether or not the vaccine must be pulled. And this is confirmed by an earlier quote (that Kennedy ignored), from page 16:
Ms. Davis: So our recommendations can then influence public policy, but we will not be specifically recommending that they follow them.
Dr. Stratton: Right. When CDC and I talked about sort of how far we would go, and the president of the IOM and I spoke about the project, it is clear that it is not the purview of this committee
(Snip)
We would never say that something should be covered, something should be pulled, some schedule should be changed, but just suggest the evidence is sufficient that they themselves take a look at it.
“Suggest the evidence is sufficient” – hardly a group who had “already made up their mind BEFORE the study started that they would find no link”. Anyone who concentrates on “the line we will not cross in public policy is pull the vaccine” and ignores “they must say if the vaccine is dangerous “is just not reading the transcript with an honest desire to ascertain the intent of the committee.
Page 97 Dr. McCormick
What I am trying to get at is, do we want to simply, on our gut, say looking at the significance of the wild disease that you are protecting, and the seriousness and potential association with the vaccine - because we are not ever going to come down that it is a true side effect - is that going to be sufficient for you to judge public health impact?
This quote comes in the middle of a long discussion about risks of disease verses possible risks of vaccines, and severity of symptoms, and how you would grade such things. It’s hard to be sure exactly what McCormick means, but I think she is saying that it is unlikely they will be able to prove a causative link with 100% certainty. Then she says, remembering that the disease and autism are both serious conditions, would being less than 100% sure of a link be sufficient to make a public health judgment. In other words, she is not whitewashing a potential bad outcome; she is suggesting that a less than 100% certainty of a link could still be reported as a bad outcome: the opposite of what the conspiracy believers want to think. I’ve read this section about 20 times now and that’s the only explanation that makes sense. None of the other discussion even hints that a decision has been made by the committee; in fact, they are discussing how to quantify their results. It’s probably just a bit of careless language (in a meeting lasting a whole day, remember – did you ever have a bunch of conspiracy nuts with preconceived beliefs analyzing your every word for a whole day?), and in any case, even if I am wrong, taking this one quote out of 199 pages and suggesting it means the decision had already been made, is frankly absurd.
The rest of the transcript shows a group of people discussing: how to do the studies; how to prioritize; who would be the best people to get involved; how to educate the public about the outcome; how to define association v. causality; the difficulty of diagnosing autism; how to evaluate data. Nothing on how to “whitewash” anything, as Kennedy alleges.
But that’ not it. In fact, I saved the best for last.
Walt Wants
I found the “Walt wants” quote. In the Salon article, Kennedy writes:
According to transcripts of the meeting, the committee's chief staffer, Kathleen Stratton, predicted that the IOM would conclude that the evidence was "inadequate to accept or reject a causal relation" between thimerosal and autism. That, she added, was the result "Walt wants" -- a reference to Dr. Walter Orenstein, director of the National Immunization Program for the CDC.
This is probably the most disgraceful piece of out-of-context quote mining of the whole sorry piece. The following is the actual quote from Dr. Stratton, starting on page 123, with the only actual words quoted by Kennedy in yellow highlighter as before, and my bold:
What Walt said to us, and I know they are worried about, I mean, he said to us, saying something is category two, which means what Mike is calling category four, vaccine safety called category two inadequate to accept or reject a causal relation.
What he said is, telling me that it is still a category two isn’t enough to tell me what to do.
(Snip)
What Walt has said is, just telling me it is here isn’t enough. That is where he started to call what he wants, what everybody wants in the vaccine safety field is, break this one out for me. I am just telling you that is what they say.
First, you may notice that “Walt wants” doesn’t appear at all – that is a manufactured quote. For the sake of this discussion though, I'll accept "what he wants". ("He" being Walt.) More to the point, it is very clear from reading the whole thing that what Walt “wants” is to know if there is a causal relationship. Sheesh - it's right there in the actual words actually used by Stratton: “inadequate to accept or reject a causal relation [...] isn't enough..” Isn't enough! "He wants the IOM to “tell [him] what to do”. So, very clearly, Walt is not dictating to the IOM what the conclusion should be, as Kennedy alleges. It is the exact opposite. Walt clearly “wants” the IOM to break it out so it is clear if the vaccine is dangerous or not. He says: “inadequate to accept or reject” "isn't enough." He wants to know yes or no if it is dangerous or not.
Some In Context Quotes
Having said all that, now it’s time for some representative, not out of context quotes, that demonstrate the integrity of this committee:
Page 15 Dr. McCormick
…we could potentially come up with , there isn’t evidence for this one way or another, keep going full court press, or there is so much evidence to support this adverse reaction, pull the vaccine.
Page 73 Dr. Stratton
I think there are two things that we absolutely have to do and there is no doubt about it. We have to give them your best judgment of the causality assessment.
Page 83 Dr. Shaywitz
I wonder if we are just over-complicating the question that CDC is asking us. They really want to know – it is a complicated enough question for us scientifically.
They really want to know the causality of – they want to know about adverse effects.
Page 84 Dr. Kaback
…the real goal of this thing is to provide the public – not the CDC and not the congress, but the public – with a reasonable basis upon which to make decisions about immunization.
Hardly people covering anything up is it? Or, to paraphrase, read those quotes and tell me how I can possibly believe that the CDC wanted the IOM to whitewash a link and that the IOM had already made up their mind BEFORE the study started. Do tell.
OK, that’s it. Enough! The conspiracy believers have taken their best shot – and that was your best shot – and neither document quoted by Kennedy shows any conspiracy or cover-up. And frankly, taking a few out-of-context quotes from a 199 page transcript as proof of a conspiracy is pretty stupid anyway, but when the transcript reveals a group of honest scientists trying, with integrity, to grapple a difficult problem, it gets beyond stupid and is just thoroughly dishonest. It’s pathetic, frankly. If there really was a cover up, wouldn’t they have something better than this?
No more. Don’t bother throwing down a url linking to a huge .pdf with a couple of dodgy quotes in it and expecting me to read it. That’s over now.