Anatomy of a Failure: Why This Latest Vaccine-Autism Paper is Dead Wrong

[u/Pr0veIt]

https://theunbiasedscipod.substack.com/p/anatomy-of-a-failure-why-this-latest?r=tzw65&utm_medium=ios&fbclid=PAZXh0bgNhZW0CMTEAAaYbpw_4lOFqImjSJ1F93F4X5yLV3ZpCvIWKfuPX6CA43X-0kHSk_bx5HJE_aem_dMRkxQRZtNFzMO-Z6dLUAQ&triedRedirect=true

The “study” being examined in this article has been shared here at least three times in the last 24hrs. It has blatant funding bias but also a myriad of methodological problems. This article does a great job of breaking those down.

[u/ComedianCommercial46]

I work in healthcare data but I also have a severely autistic 8-year-old, so naturally I’m intrigued with both the study as well as Dr. Steier's rebuttal. I have some genuine questions to understand her argument against the article. I just want to make sure I understand the assertions correctly.

1. **Problem #2: Medical Visits and Documentation**

   - She states that “children with more medical visits are naturally more likely to have documented vaccines and developmental diagnoses. The authors fail to address this fundamental confounding factor.”

     - Is she saying that in the Medicaid population, there’s a chance that patients with few or no actual vaccinations have a larger chance for their records to be inaccurate (not showing ANY or not enough vaccinations) than for patients with several or more vaccines? Just trying to understand the argument here. It is considered fraud to bill for the wrong codes so, while, yes, it needs to be validated, I can’t understand where there would be even a moderate chance that kids with few visits for vaccines would have less accurate billing records than kids with lots of vaccinations. I know that was only one part of the assertion, the other part being the developmental diagnoses.

1. **Vaccines Given Through Other Programs**

   - “…missing vaccines given through other programs (including Vaccines for Children), providers, or states…”

     - Is this to say that Medicaid billing information does not show vaccines that were given in other programs? I assume this to be at least partially correct, but working in healthcare data analytics, I am always surprised at how much data IS included in claims.

     - Is the implication here that there are unpredictable patterns where children with high levels of vaccines on Medicaid could have different diagnoses than children with lower levels of vaccines on Medicaid who received most of their vaccines elsewhere?

[u/ComedianCommercial46 → u/ComedianCommercial46]

1. **Data Tracking and Specific Vaccines**

   - “…they lack individual data through DEVEXI to track children across multiple visits using unique identifiers, while simultaneously admitting they lack individual-level data on specific vaccines.”

     - Why can’t both of these be true? The charge code for a vaccine doesn’t necessarily indicate what disease the vaccine is for. Knowing how many vaccines a patient has is different than knowing what a patient is vaccinated for.

1. **Problem #3: Early Diagnoses**

   - “their approach misses early diagnoses entirely.”

     - Again, honest question here, but in billing, it doesn’t matter WHEN the diagnosis occurred, it still goes out on the claim. If a 9-year-old comes in for their annual well-child check, the claim will show an autism diagnosis, even if it was diagnosed 8 years earlier.

1. **Problem #4: Temporal Analysis**

   - “Even basic temporal analysis could reveal whether apparent associations held steady or were artifacts of changing diagnostic practices.”

     - Is she saying that if patients were diagnosed earlier on in the study they should have the same rate of autism as patients diagnosed later on in the study, after correcting for diagnosis trends/changes? I would agree to that, but does that matter, if they are comparing unvaccinated to vaccinated? Wouldn’t the diagnosis trends impact both groups the same, or is she thinking that maybe patients who have had vaccines are more likely to get tested?

     - If I’m understanding correctly, she is alluding to parents of kids with autism cutting off vaccines. So, if the study were to have looked at the temporal nature of the vaccine date and the diagnosis date, there could be some bias toward autistics having FEWER vaccines, not more. I agree, they should have looked at this, but if anything, it would likely have made an even stronger case, unless I’m not understanding her argument.