2019 · Annals of Internal Medicine
Measles, Mumps, Rubella Vaccination and Autism
Verdict
UNSCIENTIFIC
Neither the paradigm nor the study inside it passes. The verdict is unscientific.
1·Study methodology · inside the paradigm
UNSCIENTIFIC
Does not follow the scientific method within Psychiatric Model.
2·Paradigm · Psychiatric Model
UNSCIENTIFIC
Fails the tests. The worse layer decides.
How the verdict is decided
The verdict grades both layers: the paradigm this study assumes, and how the study was carried out inside it. Both must be scientific for the whole thing to be scientific. A clean method inside an unscientific paradigm is unscientific. An unscientific method inside a better paradigm is unscientific. A split on either layer is mixed. The worse layer decides.
1·Study methodology
Did this study test its claim with methods that are independent, falsifiable, and non-circular?
UNSCIENTIFIC
This study claims that MMR vaccination does not increase autism risk, trigger autism in susceptible children, or cause autism cases to cluster after vaccination. All three tests fail.
Independently Verifiable
Fail
The researchers turned five psychiatrist-assigned code categories into autism cases without directly observing the children's behavior.
Falsifiable
Fail
An increased raw diagnosis rate after MMR could be discounted as confounding through the study's risk-score adjustment.
Non-Circular
Fail
They fitted the autism risk score to the cohort's diagnoses, then used it to adjust and subdivide comparisons of those same diagnoses.
Why
They linked vaccination reports for 657,461 children to entries in the Danish Psychiatric Central Register. Psychiatrists had assigned those entries under diagnostic criteria; the researchers counted five code categories as autism. They reviewed no individual charts and did not observe behavior. Next, they used diagnoses in the complete cohort to fit a score from eight birth and parental characteristics. That score defined risk groups and adjusted the comparison of the same diagnoses. A higher raw diagnosis rate could therefore be treated as confounding rather than accepted against the claim. They reported an adjusted comparison of 0.93 as evidence that MMR vaccination does not increase autism risk.
2·Paradigm · Psychiatric Model
Does the framework this study assumes pass the three tests?
UNSCIENTIFIC
Independently Verifiable
Fail
The psychiatric criteria behind this register's five code categories turn observable behavior into a diagnosis of autism.
Falsifiable
Fail
Cases that contradict a narrow autism pattern can remain autism cases under the register's atypical and unspecified categories.
Non-Circular
Fail
Psychiatric criteria generate the register's diagnoses, which then serve as evidence of the condition those criteria defined.
Why
Children's speech, movements, and interactions can be observed without accepting a psychiatric framework. The framework adds rules about which combinations identify autism. Here, those rules supplied both the outcome and the sibling-history variable. A vaccination-associated increase could challenge the vaccination claim without challenging the psychiatric definition. Children who do not fit a narrow pattern can still receive atypical or unspecified diagnoses, both included in this study. Psychiatrists apply the criteria to create diagnostic entries. Researchers then count those entries as instances of the condition the criteria defined. Agreement with that classification does not independently establish that its five categories identify one condition.
From the study
Child psychiatrists diagnose and assign diagnostic codes for this register, which contains information from psychiatric hospitals and psychiatric wards (inpatients and outpatients in the study period).
We defined our main study outcome of autism as a diagnosis of any of these autism spectrum disorders.
The autism risk score was derived in the complete study cohort by fitting a proportional hazards model of autism risk with attained age as underlying time-scale comprising the preselected variables as covariates.
For fully adjusted models, the baseline hazard function was stratified on birth year, sex, other childhood vaccines received, sibling history of autism and autism risk score (in deciles).