The anti-vaccine community has been in a tizzy lately over a supposed "CDC whistleblower", Dr. William W. Thompson, who, according to them, revealed fraud at the United States Centers for Disease Control and Prevention (CDC). To bolster their claim, they point to a new study from one of their own, Brian S. Hooker, that purports to show evidence of an increased risk of autism among African American boys who receive their first MMR vaccine late. However, the claims appear to be hollow and unfounded, and so they have chosen to rely on emotional arguments that may sound convincing to those who are not familiar with the issues and people involved. In a truly egregious fashion, they have erroneously and cynically compared this whole thing to the Tuskegee syphilis study, and equated the CDC with Adolf Hitler, Josef Stalin and Pol Pot, combined.
With that in mind, here is a brief FAQ for parents, news media and others to help them understand what the claims are and what the evidence actually says. The questions below have been raised or implied by anti-vaccine activists. Hopefully, this will prevent inaccurate reporting and help parents feel reassured about the MMR vaccine.
Did the CDC commit fraud?
A small group of vocal activists claim that the CDC committed fraud by intentionally covering up data. This group, which blames vaccines for a wide range of problems, offers no evidence in support of this claim. The closest they come is pointing to a statement released by a CDC researcher, William W. Thompson, in which he mentions a scientific disagreement over what data to publish in a 2004 paper on which he was an author ("Age at first measles-mumps-rubella vaccination in children with autism and school-matched control subjects: a population-based study in metropolitan Atlanta"). The study examined the age of first MMR vaccination and autism but found no association. While one could read into Thompson's statement an implication of wrongdoing, he does not allege any fraud either on his part nor on the part of the rest of the team associated with the 2004 paper. Even though his statement makes no mention of fraud, some people who wish to scare people about vaccines and make others distrust the CDC point to his statement as evidence of fraud.
Did the CDC hide data from the public?
No. The data set used by the CDC in the 2004 paper has always been available to qualified researchers. Instructions on how to access this data are available on the CDC web site.
Did the CDC cover up a finding that the MMR vaccine is linked to autism?
From the facts that are known at this time, the CDC does not appear to have covered up anything. In 2004, the CDC conducted a study examined children with autism (cases) and those who don’t have autism (controls), then looked at the age of MMR vaccination to see if cases were more likely to have been immunized at a certain age than controls. While no clear association was discovered, they did notice that there was an odd finding that more cases than controls were vaccinated later than 24 months of age but before 36 months of age. To see if this apparent association was real, they gathered more information from state birth certificate records for all study subjects that had a Georgia birth certificate. This additional information allowed them to see if there might have been some other factor (e.g., birth weight, parents’ age, mother’s education level, etc.) that might have been responsible for the strange finding. Once the researchers controlled for these additional factors, the anomaly disappeared, meaning that there was no connection between MMR vaccination and autism. The published paper included the results of the birth certificate analysis by race and age at first MMR vaccination, but did not include a racial comparison from the larger group for age at first vaccination, because racial information was not available for all subjects, and that strange finding from the larger group was not reliable. Furthermore, as the subgroup analysis showed, that initial finding was wrong. In response to the noise from the anti-vaccine movement, the CDC released a statement in support of their original study.
Did CDC lie when they said they got more information from birth certificate records?
No. Many anti-vaccine activists, including Brian Hooker, have stated that the birth certificates do not contain the information the CDC researchers stated they obtained from them (birth weight, mother's education, etc.). While the birth certificates that parents receive have limited information, a more complete worksheet (PDF) is completed by the hospital staff and kept on file with the state. The information on the Georgia state birth worksheet is similar to the U.S. Standard Certificate of Live Birth (PDF). These complete birth records have information on birth weight, whether the birth was premature or at term, if the baby was a twin/triplet/etc., the mother's education level, and so on. The CDC researchers used these complete birth certificate records in their 2004 study. More information on the standard birth worksheet, including revisions, can be found on the CDC's National Vital Statistics System web site.
Did CDC use the birth certificate requirement to exclude African Americans from the study?
No. An early claim among anti-vaccine activists was that the CDC researchers only required birth certificates for African American children in their study so they could exclude them from the birth certificate subgroup analysis. This, so the claim goes, was so they could hide an association between MMR vaccine and autism among African American boys. But the researchers used birth certificates for all of the children in their study. This is illustrated in Table 2 from the 2004 study (reproduced here for commentary):
Click to enlarge.
From: DeStefano, et al. (2004). "Age at First Measles-Mumps-Rubella
Vaccination in Children With Autism and School-Matched
Control Subjects: A Population-Based Study in Metropolitan Atlanta"
The birth certificate requirement was not used to suppress data on African Americans. This anti-vaccine claim appears to have been made specifically to exploit race and stir up fear and anger in the African American population.
Was the decision to use birth certificates arbitrary and irrelevant?
No. As the authors of the 2004 study note (emphasis added):
Among case and control children whose records we were able to match with Georgia birth certificate files, we performed a subanalysis to evaluate possible confounding by differences in birth and maternal characteristics.
The full study population data showed a possible association between age of first MMR and autism, but the data did not contain information that may have pointed to other causes of that association. The birth records did have that information, and allowed the researchers to discover that the MMR was not associated with autism.
Did a new study find that there is an increased risk of autism in African American boys?
A study ("Measles-mumps-rubella vaccination timing and autism among young african american boys: a reanalysis of CDC data") published in August 2014 in the journal Translational Neurodegeneration by Brian S. Hooker did conclude that there was an increased risk of autism in African American boys who were given their first MMR vaccine between 24 and 31 months of age (Hooker cut off at 31 months, rather than 36 months as in the CDC study, because, after excluding low birth weight infants, there were "insufficient cases" at 36 months; the subgroup he analyzed is different than in the CDC's study). His study also found that there was no association between MMR and autism at other ages, nor was there any association for African American girls nor for children of any other racial category. However, his results regarding African American boys are almost certainly wrong.
The original 2004 study by the CDC was what is called a case-control study. (A case-control study takes two matched groups, one with a condition and one without, and looks to see how likely or frequently they were exposed to a potential risk factor. It can suggest associations, but usually doesn't prove causation.) The data for that study was collected with the case-control design in mind. Hooker's study appears to be a cohort study, which is a completely different type of study design, yet he used the same CDC data set that was designed for a case-control study. (A cohort study starts with people who do not have the disease of interest, then follows them to see if different levels of exposure to a suspected risk factor increases the risk of the disease or condition of interest.) Using data designed for use in one type of study design in a study with a completely different design can introduce errors into the analysis. Hooker then used an inappropriate statistical analysis (either Pearson's chi-squared test, as mentioned in the Methods, or Fisher's exact test, as noted in the tables) to analyze the data. This type of test ignores variables that can skew results, as well as making a small signal seem very large. Hooker admitted in a presentation at an anti-vaccine conference (around the 17:00 mark) on August 29, 2014 that he used a very simple technique, that "simplicity is elegance", and that he prefers to do simple things rather than intellectually challenging things. However, elegant does not mean correct; his "simple" analysis ignored confounding variables. Another shortcoming of the study is that Hooker does not report the number of individuals included in his subgroup analyses. The size of the groups matters. The smaller the group, the more likely a finding is due to chance. Since publication, the journal has withdrawn Hooker's study due to concerns about the validity of its conclusions as well as possible conflicts of interest that were not disclosed by Hooker or the peer reviewers who reviewed the study.
Who is Brian Hooker?
Brian S. Hooker is the father of an autistic child. He has a degree in biochemistry, but has no formal training in statistics or epidemiology, nor is he trained in any field pertinent to the study of vaccines or autism (e.g., immunology, vaccinology, childhood development, developmental psychology, etc.). Hooker has an open case claiming vaccine injury for his son before the Vaccine Court. He is also a board member of an anti-vaccine organization called Focus Autism. Focus Autism is the organization that funded Hooker's study. Hooker is also ideologically opposed to vaccines and the CDC, as evidenced by an email he sent to former director of the CDC, Julie Gerberding, in which he wrote, "I would personally urge you to review the Book of Matthew 18:6 and consider your own responsibility to all children of the U.S. including my own son." The referenced Bible passage reads (King James Version):
But whoso shall offend one of these little ones which believe in me, it were better for him that a millstone were hanged about his neck, and that he were drowned in the depth of the sea.
What do you mean by undisclosed "conflicts of interest"?
Authors of scientific articles are supposed to provide a clear statement of any conflicts of interest that might bias their results. The purpose is to make the reader aware of what might influence the author's conclusions regarding the data and findings they are reporting. In his study, Brian Hooker only disclosed that he “has been involved in vaccine/biologic litigation". The statement implies that he is not currently involved in litigation related to vaccines. In reality, Hooker has an active case before the Vaccine Court in which he is suing the government for what he claims is his son's vaccine-induced autism. He stands to benefit from studies that find a connection between vaccines and autism. He also fails to disclose that he is a board member of the anti-vaccine organization Focus Autism, which funded the study.
The journal in which Hooker published his study, Translational Neurodegeneration, allows authors to submit suggestions for possible reviewers. These reviewers ought to be experts in the relevant fields and should not have strong personal or business ties to the study authors. The journal may choose to use the reviewers suggested by the authors, or they might pick researchers who have published papers previously in the same journal on the same or related subject. We do not know who the reviewers were, but there are some likely candidates, none of whom are qualified to act as peer reviewers and have numerous conflicts of interest, including working relationships with Hooker.
Did Hooker's study prove Andrew Wakefield right?
No, it did not. Andrew Wakefield has long advocated the belief that the MMR vaccine causes autism. If we ignore all of the flaws in Hooker's 2014 study and assume that his findings are accurate, Hooker's study shows that the MMR is not associated with autism. In other words, Hooker's study, if it is accurate, proves Andrew Wakefield (and much of the anti-vaccine movement) wrong. The only group in which Hooker found an association (and even that association is not proof of causation) was among African American boys who got the MMR vaccine late (between 24 and 31 months). But, as noted above, Hooker's study was quite flawed and so his findings are very likely incorrect.
The Bottom Line
Despite much noise being made by the small, yet incredibly vocal, anti-vaccine community, there is no evidence of fraud on the part of the CDC, nor is there convincing evidence of any cover-up. Brian S. Hooker's study contains a number of flaws leading to a spurious, and biologically implausible, conclusion. In fact, the quality of the study is such that the journal that published it withdrew it pending further investigation, citing serious concerns about the validity and potential conflicts of interest. This entire issue is, in reality, much ado about nothing. It is just another example of anti-vaccine activists doing bad science to put your children at greater risk of harm, all because they cannot accept their own children as they are.
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Further Reading:
Posts discussing Hooker's allegations, excluding anti-vaccine sources
Timeline
August 8, 2014: Hooker paper published online
August 18, 2014: Focus Autism Press Release published online
August 18, 2014: Andrew Wakefield's Autism Media Channel Video Alleging a CDC Whistleblower published online
August 22, 2014: Andrew Wakefield's Autism Media Channel Video Naming William W. Thompson as "The CDC Whistleblower" published online
August 22, 2014: Orac Knows at Respectful Insolence - Brian Hooker proves Andrew Wakefield wrong about vaccines and autism
August 22, 2014: Reuben Gaines at The Poxes Blog - Andrew Jeremy Wakefield plays video director while African-American Babies die, or something
August 23, 2014: Ren at Epidemiological - Directed Acyclic Graphs and the MMR vaccine doesn’t cause autism
August 24, 2014: Liz Ditz at I Speak of Dreams - L'affaire CDC-MMR: Hooker, Wakefield, and Focus Autism Accuse African-American Senior CDC Researcher of Being A Race Traitor
August 25, 2014: Orac Knows at Respectful Insolence - The central conspiracy theory of the antivaccine movement
August 25,2014: David Gorski MD at Science Based Medicine - Did a high ranking whistleblower really reveal that the CDC covered up proof that vaccines cause autism in African-American boys?
August 25, 2014: Todd W. at Harpocrates Speaks - Andrew Wakefield Tortures History
August 25, 2014: Michael Simpson at Skeptical Raptor - Great CDC Coverup–suppressing evidence that MMR vaccines cause autism? (cross-posted at Daily Kos
August 26, 2014: Orac Knows at Respectful Insolence - Hey, where is everybody? The “CDC whistleblower” manufactroversy continues apace
August 26 2014: Sullivan (Matt Carey) at LeftBrainRightBrain - Autism, Atlanta, MMR: serious questions and also how Brian Hooker and Andrew Wakefield are causing damage to the autism communties
August 26 2014: Lisa Lightner at Grounded Parents - The CDC vaccines/autism/coverup theory {spoiler alert-it’s not true!}
August 26, 2014: Reuben Gaines at The Poxes Blog - How to end a scientist’s career with some fancy editing
August 26, 2014: Anti-Vaccine Group The Thinking Mom's Revolution Hosts a #CDCWhistleblower Twitter Party
August 27, 2014: Karoli Kuns at Crooks and Liars - Rob Schneider's Anti-Vax Crusade Now Enters Alex Jones Territory
August 27 2014: Sullivan (Matt Carey) at LeftBrainRightBrain Autism - Discussions of the recent MMR/autism paper (and why the study isn’t what the author wants you to believe it is)
August 27, 2014: Orac Knows at Respectful Insolence - The CDC “whistleblower” manufactroversy: Twitter parties and another “bombshell” e-mail
August 27, 2014: Phil Plait at Bad Astronomy, Slate - No, There Still Is No Connection Between Vaccines and Autism
August 27, 2014: Todd W. at Harpocrates Speaks - Anti-vaccine Activists Throw Twitter Tantrum
August 27, 2014, in the morning: The Journal Translational Neurodegeneration removes Hooker's paper from the public domain
August 27 2014: Sullivan (Matt Carey) at LeftBrainRightBrain Autism - The Brian Hooker article “…has been removed from the public domain because of serious concerns about the validity of its conclusions”
August 27, 2014: Adam Marcus at Retraction Watch - Journal takes down autism-vaccine paper pending investigation
August 27, 2014: Reuben Gaines at The Poxes Blog - Even the bottom-feeding journals seem to have some sense
August 27, 2014, at approximately 2:30 pm, PDT, attorneys for William W. Thompson, the CDC employee, publish Thompson's statement
August 27, 2014: Ren at Epidemiological - Dr. Brian S. Hooker gets the Andrew Wakefield treatment
August 27, 2014: Debra Goldschmidt, CNN - Journal questions validity of autism and vaccine study
August 28, 2014: Sullivan at LeftbrainRightBrain - Andrew Wakefield betrays another “whistleblower” with Brian Hooker helping
August 28, 2014: Reuben Gaines at The Poxes Blog - Autism is not death, unless you want it to be
August 28, 2014: Todd W. at Harpocrates Speaks - CDC Whistleblower William Thompson Breaks Silence
August 28, 2014: Orac at Respectful Insolence - A bad day for antivaccinationists: A possible retraction, and the “CDC whistleblower” issues a statement
Posts discussing Hooker's allegations from anti-vaccine sources
Timeline
August 8, 2014: Hooker paper published online
August 18, 2014: Focus Autism Press Release published online
August 18, 2014: Andrew Wakefield's Autism Media Channel Video Alleging a CDC Whistleblower published online
August 18, 2014: Jake Crosby at Autism Investigated - CDC Whistleblower Reveals Yet More Research Fraud
August 19, 2014: Age of Autism at Age of Autism - Whistleblower Says CDC Knew in 2003 of Higher Autism Rate Among African-American Boys Receiving MMR Shot Earlier Than 36 Months
August 20, 2014: Mike Adams at Natural News - Vaccine bombshell: CDC whistleblower reveals cover-up linking MMR vaccines to autism in African-Americans
August 20, 2014: Age of Autism at Age of Autism - Senior Government Scientist Breaks 13 Years' Silence on CDC's Vaccine-autism Fraud
August 20, 2014: Jon Rappoport at Jon Rappoport's Blog Breaking - Breaking: MMR vaccine, autism, CDC coverup
August 21, 2014: Jon Rappoport at Jon Rappoport's Blog - Vaccine-autism connection: US Congressman stonewalled by the CDC
August 21, 2014: Jon Rappoport at Jon Rappoport's Blog - Advice for the secret CDC vaccine whistleblower
August 21, 2014: Mike Adams at Natural News - CDC refuses to turn over documents to Congress: Evidence linking MMR vaccines to autism intentionally withheld from investigators
August 22, 2014: Ethan Huff at Natural News - CDC whistleblower confesses to publishing fraudulent data to obfuscate link between vaccines and autism
August 22, 2014: metamars at My Firedog Lake - CDC refuses to turn over documents to Congress showing MMR vaccines caused autism in black children (note: metamars' blog post, not an official Firedoglake post)
August 22, 2014: Andrew Wakefield's Autism Media Channel Video Naming William W. Thompson as "The CDC Whistleblower" published online
August 22, 2014: Jon Rappoport at Jon Rappoport's Blog - CDC whistleblower revealed: William Thompson
August 22, 2014: Jon Rappoport at Jon Rappoport's Blog -
August 22, 2014: Jon Rappaport at Jon Rappaport's Blog - Breaking: CDC whistleblower Thompson in grave danger now
August 22, 2014: at TMR at Thinking Moms' Revolution - CDC Whistleblower William Thompson Blows the Lid on Malfeasance and Fraud at the CDC
August 22, 2014: Jake Crosby at Autism Investigated - Andrew Wakefield Betrays CDC Whistleblower
August 23, 2014: Inquisitr - CDC Whistleblower’s Claims Cause Uproar In Autism Community
August 24, 2014: Jon Rappoport at Jon Rappoport's Blog - CNN iReport on CDC whistleblower spreads like wildfire, then censored
August 24, 2014: Jon Rappaport at Jon Rappaport's Blog - Rob Schneider says he has smoking gun on CDC vaccine-autism
August 24, 2014: Sally Colletti, Examiner - Autism and The CDC: Now What?
August 25, 2014: Kent Heckenlively, Age of Autism - A Break in the Wall - William W. Thompson
August 25, 2014: Ethan Huff at Natural News - CDC whistleblower exposes massive autism cover-up perpetrated by government agency
August 25, 2014: Mike Adams at Natural News - CDC whistleblower's secret letter to Gerberding released by Natural News as mainstream media desperately censors explosive story
August 25, 2014: Mike Adams at Natural News - CNN caught red handed covering up CDC medical genocide of African-American babies
August 25, 2014: Zorro at Thinking Moms' Revolution - Stop Calling Us Crazy: Autism, MMR, and Institutional Gaslighting
August 25, 2014: Megan Heimer at Living Whole - CDC Whistleblower Comes Out and They All Play Dead
August 25, 2014: Age of Autism at Age of Autism - Rob Schneider Demands Answers on CDC MMR Fraud
August 25, 2014: Jon Rappoport at Jon Rappoport's Blog - CDC vaccine-autism fraud: what victory looks like
August 25, 2014: Jon Rappoport at Activist Post - CDC whistleblower, watch out; here come the mothers">
August 25, 2014: Kelly Brogan at Kelly Brogan MD - CDC: You’re Fired. Autism Coverup Exposed
August 25, 2014: Patrick "Tim" Bolen at the Bolen Report - The CDC Whistleblower... The Story Mainstream Media Doesn't Want To Run...
August 26, 2014: JB Handley at Age of Autism - Knock-out Blow Needed: Dr. Thompson Must Speak Out on MMR African American Autism Connection
August 26, 2014: John Stone at Age of Autism - CDC Frauds: Connections Between the DeStefano Paper and the Thorsen Affair
August 26, 2014: Celia Farber, Epoch Times - Whistleblower Reveals CDC Knowingly Put Children at Risk of Autism, Media Remains Silent (Video)
August 26, 2014: Jon Rappoport at Jon Rappoport's Blog - CDC whistleblower is just the tip of the iceberg
August 26, 2014: Mike Adams at Natural News - EXCLUSIVE: Bombshell email from CDC whistleblower reveals criminality of vaccine cover-up as far back as 2002
August 26, 2014: Age of Autism at Age of Autism - CDC Whistleblower on Thimerosal in Pregnant Women (note: video interview with Brian Hooker, not William W. Thompson)
August 26, 2014, in the evening: Anti-vaccine Activists at The Thinking Moms' Revolution Host a #CDCWhistleblower Twitter Party
August 27, 2014: "Bobby Dee" at Gianelloni Family - Erased by a Birth Certificate
August 27, 2014: John Stone, Age of Autism - The CDC: the Detective Agency Which Could Never Find Anything
August 27, 2014: Anne Dachel, Age of Autism - CDC Whistleblower Story: Danke to Franchi
August 27, 2014: Marcella Piper-Terry, at Age of Autism - CDC Whistleblower and Probability of Post-MMR Autism Diagnosis
August 27, 2014: Ethan Huff at Natural News - Congressman Posey discusses autism, vaccines and lack of CDC transparency in interview with Dr. Brian Hooker
August 27, 2014: Mike Adams at Natural News - Media conspiracy to bury CDC whistleblower story protects vaccine makers at the expense of human life
August 27, 2014: Jon Rappoport at Jon Rappoport's Blog - Update: CDC whistleblower in touch with members of Congress
August 27, 2014, in the morning: The Journal Translational Neurodegeneration removes Hooker's paper from the public domain
August 27, 2014: Mike Adams at Natural News - Scientific journal censors Brian Hooker's analysis of CDC vaccine data; the Church of Science orders 'burning of books'
August 27, 2014: Sayer Ji at GreenMedInfo - CDC Autism/Vaccine Coverup Extends to Media and Journals
August 27, 2014: Age of Autism at Age of Autism - Translational Neurodegeneration Removes Vaccination Timing Article
August 27, 2014, at approximately 2:30 pm, PDT, attorneys for William W. Thompson, the CDC employee, publish Thompson's statement
August 27, 2014: Age of Autism at Age of Autism - Statement from William Thompson, RE Pediatrics MMR African American Males Data
August 27, 2014: Mike Adams at Natural News - BREAKING: CDC whistleblower confesses to MMR vaccine research fraud in historic public statement
August 27, 2014: Jake Crosby at Autism Investigated - Whistleblower Confirms Wakefield Outed Him Without Permission
August 27, 2014: Sayer Ji at GreenMedInfo - CNN Publishes Story Denying Vaccine-Autism Link
August 27, 2014: The Event Chronicle at The Event Chronicle - CDC Whistleblower confesses to MMR vaccine research fraud in historic public statement
August 28, 2014: Celia Farber, Epoch Times - Vaccinegate: CDC Whistleblower Admits Claims of Data Fixing Were True, Complains at Being Recorded and Outed
August 28, 2014: Dan Olmstead at Age of Autism - Our Story So Far: Both MMR & Mercury-Laced Vaccines Cause Autism
August 28, 2014: "Bobby Dee" guest posting at Living Whole - The CDC Whistleblower Press Release: Interpreted
Other links
Full text of Hooker's paper: Transl Neurodegener. 2014 Aug 8;3:16. doi: 10.1186/2047-9158-3-16. eCollection 2014. Measles-mumps-rubella vaccination timing and autism among young african american boys: a reanalysis of CDC data.
Statement of Concern from publishers of Hooker's paper.
Full text of the Focus Autism press release
CDC Position statement on 2004 Destefano paper
Snopes.com: http://www.snopes.com/medical/disease/cdcwhistleblower.asp