Warning: capitalism can damage your health

Deaths rose sharply in communist countries that rushed to privatise. Does that prove economic `shock therapy' kills? Or was it that the statistics rapidly became more honest in such countries? You would have to be naive to believe Communist statistics and old habits die hard

For a communist nation wishing to show off its capitalist credentials, mass privatisation was a killer move. Literally. In Russia, when the sell-off of state-owned companies was at its height, the death rate of working adults rose by 18 per cent and the life expectancy dropped by nearly five years. Men of working age, suddenly bereft of both employment and the healthcare that frequently accompanies it, found themselves greeting the Grim Reaper well ahead of schedule, sometimes having downed a bottle or two of aftershave.

This is, in caricature, the controversial thesis offered by David Stuckler, Lawrence King and Martin McKee, in The Lancet recently. The scientists - Dr Stuckler and Dr King are sociologists at Oxford and Cambridge respectively, and McKee is Professor of European Public Health at the London School of Hygiene and Tropical Medicine - claim that hasty mass privatisation in several former Eastern bloc and Soviet states coincides convincingly with a spike in their death rates. They speculate the main link between the two is unemployment, a well established cause of ill health and stress, as well as a trigger for life-shortening behaviour, such as binge drinking.

The study has ignited an intriguing, and sometimes ill-tempered, debate about how swiftly - or slowly - a fledgeling economy should emerge from its chrysalis. In their analysis, the researchers gently wag a finger at Jeffrey Sachs, the world-famous economist and advocate of "shock therapy" - the sudden lifting of price controls and subsidies, coupled with the flogging off of state companies and assets - to catapult countries irreversibly into capitalism. "The need to accelerate privatisation is the paramount economic policy issue facing Eastern Europe," the economist once wrote.

Unsurprisingly, Professor Sachs is none too keen to have up to a million communist corpses piled at his door. He counters that the link between privatisation and deaths is "zero"; that a rise in dangerous drinking among Russians was due not to unemployment but to the abandonment of an anti-alcohol campaign; and that the notoriously poor Soviet diet must bear some blame. It's a peculiar choice, that last one, for the cerebral professor: short of adulteration with poison, diet cannot explain sudden changes in death rates.

As well as pointing this out, the academics retort that "the countries Professor Sachs cites as successes (in terms of their transition to free-market economies) were only successful because they did not follow his advice".

It's not so much velvet glove, this spat, as boxing glove, and it looks like going the full ten rounds. At the very least, we should admit the possibility that shock therapy has hit the ropes. and why it matters. Because China and India are poised to sell off many of their state-owned enterprises in the hope of ascending to the top of the economic heap. Stop and think about it. Two of the most populous nations on earth are heading down the path of capitalism, and there is half-decent evidence that the way this path is travelled could spell the difference between life and death for millions.

Dr Stuckler and Professor McKee say their paper is about epidemiology, not ideology. Their aim was to peer deeper into the high human price paid for the death of communism in Europe, a fact that is not in dispute. Unicef estimates it caused three million premature deaths. The United Nations calculates that ten million men disappeared during the transition. Life expectancy dropped in many affected countries (for Russian men, who especially suffered, it fell from 64 to 58 between 1991 and 1994). Unemployment and hazardous drinking (including the consumption of spirits and even aftershave) were found to be serious factors.

But why did some countries, such as Russia and Kazakhstan, suffer steeper rises in their death rate than other countries going through similar turmoil, such as Slovenia? Dr Stuckler et al decided to try to put numbers and a timeline to a hunch: that the way market reforms were carried out might be the key. As the authors summarise: "Any disruption to the established social order creates high levels of social stress." Anecdotally, the countries that sprinted to capitalism appeared to suffer most; those that cantered emerged relatively unscathed.

They defined "mass privatisation" as the transfer of at least 25 per cent of large, state-owned enterprises to the private sector within two years. On average, the countries with mass privatisation programmes saw the death rate for adult men (aged between 15 and 59) rise by 13 per cent; in total, it represented nearly a million extra deaths. Across the five worst countries, which included Russia and Kazakhstan, the average death rate shot up by 42 per cent for a short period in the early nineties.

Other countries, such as Croatia and Slovenia, which dismantled the machinery of communism more slowly, did not see such a dramatic rise. Also, those countries where people belonged to social networks such as the Church, or trade unions were less badly affected; interestingly, it is this aspect that the authors regard as their key breakthrough.

"The Poles came out well (from communism)," Professor McKee told me. "Why? Because they meet each other at Mass every Sunday."

The authors speculate that those countries undergoing shock therapy unwittingly swept safety nets away with the old order. Many Russians lived in "one-company towns"; when the companies and jobs disappeared, so did healthcare, childcare and the social hub.

The Economist has lambasted the paper and the research has provoked a torrent of invective in the blogosphere. But what should matter more is whether the paper represents decent science; here, we must note the opinion of Professor Sir Michael Marmot, perhaps the biggest name in the field of how social circumstances affect health: "With all the caveats, Stuckler and colleagues' study is relevant beyond Eastern Europe..."

The paper has been wrongly viewed by outsiders as an ideologically motivated attack on capitalism; its authors have fallen victim to an occupational hazard of social science. "We are not stark raving Leninists," sighs Professor McKee, who confesses to being flabbergasted at the critics. Of course capitalism is a good thing, he says, but we should pursue it with human welfare - as well as political and economic considerations - in mind. Privatising at a prudent pace, while ensuring the jobless have social support, is the ideal scenario.

China and India are embracing free markets. China alone has a population of 1.4 billion, roughly ten times that of Russia. If there is an inkling of truth in the analysis, then "shock therapy" could jeopardise tens of millions of lives. And there's nothing therapeutic about that.

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MMR-autism scare: the truth is out at last

The `vaccine court' in the United States, and its excellent expert witnesses, have finally slain and buried MMR junk science.

`To conclude that Colten's condition was the result of his MMR vaccine, an objective observer would have to emulate Lewis Carroll's White Queen and be able to believe six impossible (or, at least, highly improbable) things before breakfast. The families of children with autistic spectrum disorders have waited in vain for adequate evidence to support the autism-MMR hypothesis. Although I have the deepest sympathy for families like Colten's, struggling emotionally and financially to find answers about ASD's [Autistic Spectrum Disorders] causes, and reliable therapies to treat ASD's symptoms, I must decide Colten's case on the evidence before me. That evidence does not establish an adequate factual basis from which to conclude that Colten's condition was caused by his vaccines.'

Denise K Vowell, 12 February 2009, Special Master, US Court of Federal Claims. Petitioners: Kathryn and Joseph Snyder (parents of Colten).Respondent: Secretary of Health and Human Services

`I feel a deep sympathy and admiration for the Cedillo family. And I have no doubt that the families of countless other autistic children, families that cope every day with the tremendous challenges of caring for autistic children, are similarly deserving of sympathy and admiration. However, I must decide this case not on sentiment, but by analysing the evidence. Congress designed the [vaccine injury compensation] programme to compensate only families of those individuals whose injuries or deaths can be linked causally. to a listed vaccination. In this case the evidence advanced by the petitioners has fallen far short of demonstrating such a link.'

George L Hastings, 12 February 2009, Special Master, US Court of Federal Claims. Petitioners: Theresa and Michael Cedillo (parents of Michelle). Respondent: Secretary of Health and Human Services

`The Hazlehursts' experience as parents of an autistic child, as described during the evidentiary hearing in this case, has been a very difficult one. The undersigned is moved as a person and as a parent by the Hazlehursts' account and again extends to the Hazlehursts very sincere sympathy for the challenges they face with Yates. The undersigned's charge, however, does not permit decision-making on the basis of sentiment but rather requires a careful legal analysis of the evidence.

`The parties have submitted a wealth of evidence and have presented the testimony of a number of experts who have extensive clinical and research experience in the particular areas of interest in this case. Having carefully and fully considered the evidence, the undersigned concludes that the combination of the thimerosal-containing vaccines and the MMR vaccine are not causal factors in the development of autism. The weight of the presented evidence that is scientifically reliable and methodologically sound does not support petitioners' claim. Petitioners have failed to establish entitlement to compensation under the Vaccine Act.'

Patricia E Campbell-Smith, 12 February 2009, Special Master, US Court of Federal Claims. Petitioners: Rolf and Angela Hazlehurst (parents of William Yates). Respondent: Secretary of Health and Human Services

In 2007 federal judges were appointed as `special masters' in three test cases selected from the families of more than 5,000 children claiming compensation on the grounds that a combination of vaccines containing the mercury-based preservative thimerosal in the first year of life and the measles, mumps and rubella (MMR) vaccine after 12 months, caused them to develop autism and related health problems.

The first case in the `Omnibus Autism Proceedings' - that of Michelle Cedillo - was heard by George L Hastings in Washington, DC in June 2007; the second - that of William Yates Hazlehurst - by Patricia E Campbell-Smith in Charlotte, North Carolina in October 2007; the third - that of Colten Snyder - by Denise K Vowell in Orlando, Florida in November 2007. On 12 February, in simultaneously published judgments, all three judges rejected claims that vaccines caused autism in these children (1).

The special masters' concluding summaries, quoted above, are sympathetic, judicious and categorical. The full judgments, amounting to nearly 700 pages of text, are of exceptional interest to anybody concerned to establish the truth in this long-running controversy.

A tribute to American justice

Andrew Wakefield, the former Royal Free Hospital researcher who launched the MMR-autism scare more than a decade ago, and is now based in a private autism treatment clinic in Texas, told a local TV station last week that he believes that this issue `can't be resolved in the courts of law' (2). In general, I am inclined to agree with Dr Wakefield that law courts are not the best places in which to deal with matters of controversy in science. Yet, on the particular issues at stake in the `Omnibus Autism Proceedings', the legal forum offers some advantages.

Though assemblies set up to evaluate claims of vaccine-autism links, by the Medical Research Council in the UK, or the Institute of Medicine in the USA, have sought to involve parents and other lay interests, the terms of discussion have generally been set by scientists and medical authorities. By contrast, the expert witnesses in the vaccine courts are obliged to present their evidence to judges who have no particular scientific expertise: the standard is that of the intelligent, objective, observer.

Parents who attribute their children's autism to vaccines often claim that they - and the scientists and doctors who support their conviction - have been denied a public hearing. The vaccine courts allowed their voices, and those of their legal representatives and supportive experts, to be heard and to be interrogated. The scientific issues, though complex, can be resolved in these cases into a basic question that can be decided by a competent judge: does the evidence support the claim that this vaccine (or combination of vaccines) caused autism in this child? It is also worth recalling the precedent of the exemplary judgment made in relation to claims against the whooping cough (pertussis) vaccine in England more than 20 years ago (3).

In each of the three test cases, the special masters heard statements from lawyers for the petitioners (the children's families) and from those representing the respondent (the US health department). They heard evidence from the parents and from expert witnesses called by the parents and those called by the health authorities; witnesses were subjected to cross examination by rival lawyers. The special masters reviewed documents submitted by both sides, including scientific papers and medical reports relating to the three children. They carefully and conscientiously evaluated the evidence and, by a process documented in detail in the judgments, came to their conclusions. By contrast with the proceedings currently underway at the General Medical Council in London, the US vaccine courts offer a process that is transparent, democratic and scrupulously fair and efficient, a tribute to the superiority of the American legal system (4).

A number of aspects of the vaccine court's judgments merit further discussion. The first is the most important, but also the most familiar - the scientific issue of whether vaccines cause autism. The second is the questions raised by the court about the quality of the scientific and medical advice received by the petitioners, and, implicitly, by parents of autistic children more widely who identify with the anti-vaccine and associated biomedical treatment campaigns. The court also raised serious concerns about the activities of three key figures in this controversy - Andrew Wakefield (who did not appear in person but whose work was extensively discussed), the paediatric gastroenterologist Arthur Krigsman and the general practitioner Jeffrey Bradstreet. Both Krigsman and Bradstreet are close collaborators with Wakefield and both appeared in these test cases as expert witnesses and consulting physicians. Both are prominent figures in the Defeat Autism Now! network of practitioners who provide `unorthodox biomedical interventions' for children with autism.

`Bad science'

`Doctor Fombonne summed up the body of scientific research into ASD's [autistic spectrum disorders] causes and the petitioners' TCV-MMR vaccine hypothesis, saying the possibility that some children are genetically predisposed to abnormal reactions to TCVs [thimerosal-containing vaccines] and the MMR vaccine so as to cause autism was less likely than the possibility of the earth being the center of the solar system. His statement is an exaggeration of the evidence (or lack thereof), but is a concise and pithy expression of the general scientific disapproval of petitioners' theories.' (5)

`Sadly, the petitioners in this litigation have been the victims of bad science, conducted to support litigation rather than to advance medical and scientific understanding of ASD'. (6)

We need not dwell here on the scientific basis of claims that autism may be caused by mercury or MMR vaccines: for a comprehensive review see my new book and Paul Offit's account (7). Let us simply present the conclusions drawn by special master Denise Vowell in the Colten Snyder case (which are similar to those in the other cases). `After careful consideration of all of the evidence', Vowell found that `it was abundantly clear that petitioners' theories of causation were speculative and unpersuasive' (8). In particular, petitioners:

a) `could not reliably demonstrate the presence of measles virus in Colten's central nervous system' (this was `because of pervasive quality control problems at a now-defunct laboratory' - of which more below);

b) `failed to establish that measles virus can cause autism or that it did so in Colten';

c) `failed to demonstrate that amount of ethylmercury in TCVs [thimerosal-containing vaccines] causes immune system suppression or dysregulation';

d) `failed to show that Colten's immune system was dysregulated'.

Vowell also dismissed the concept of `autistic enterocolitis', an inflammatory bowel condition that provides a hypothetical link between MMR and autism, as `speculative and unsupported by the weight of evidence' (9).

Bad scientists

`Respondents' experts were far more qualified, better supported by the weight of scientific research and authority, and simply more persuasive on nearly every point in contention.' (10)

The gulf in relevant expertise and experience between the rival expert witnesses is a recurring theme in the vaccine court judgments. The special masters exposed several instances of `resume padding' among the parents' experts and of illegitimate claims to academic status and authorship of published papers. They noted that one of these experts had become a professional expert witness after retiring from clinical practice 17 years ago. By contrast, the experts challenging vaccine-autism links were highly qualified and highly experienced in the relevant disciplines.

While noting their concerns about the parents' experts' CVs, the special masters emphasised that their judgment was not merely based on the experts' academic authority, but also on their performances in court. All three commented that whereas they found the respondent's witnesses in general to be knowledgeable, well-informed and credible, the parents' experts tended to be ineffectual and unpersuasive. Special master Patricia Campbell-Smith, who presided in the Hazlehurst case, emphasised that the respondent's witnesses were more persuasive because their evidence was `well supported by medical literature and significant clinical experience' (11). She observed that they were `careful in matters of degree', that they offered `specific, detailed criticisms' of rival evidence `explaining carefully' why they considered it was not reliable. By contrast, petitioners' witnesses were `not as disciplined. where differences mattered'. When it came to the interpretation of scientific papers, they gave `greater weight to speculative conclusions' than even the authors of these papers, they used `carefully selected sentences' taken out of context and relied on `scientifically flawed and unreliable articles'.

Take, for example, the contrast between Jean Ronel-Corbier, a paediatric neurologist who treats autistic children, but has no record of academic publications or professional distinction, and Diane Griffin, a virologist with a long record of publication and an international reputation. Both, like most of the expert witnesses, appeared in all three cases. Vowell found Ronel-Corbier to be `earnest and sincere' but considered that his opinions were `heavily laced with generalities, speculation and beliefs largely unsupported by evidence' (12). Hastings agreed that he was `sincere but not reliable'; he appeared `unfamiliar with the medical literature' and was `willing to give opinions on causation on very scant evidence' (13). Vowell found that Griffin was, `despite her inexperience' in court, a `model witness' whose testimony was `careful, reasoned and responsive' (14). She offered `appropriately qualified opinions' and as a result was `compelling and completely convincing'. Campbell-Smith considered Griffin `highly credible and knowledgeable'.

The gulf in academic and professional standards between the rival experts in these cases is not the result of the petitioners' difficulty in persuading high quality scientists and doctors to testify on their behalf. It reflects the fact that the bad science of the vaccine-autism campaign is not supported by reputable scientists and doctors in the relevant disciplines. It is a great misfortune that, over the past decade, thousands of parents of autistic children, on both sides of the Atlantic, have come under the influence of the plausible purveyors of the junk science of the vaccine-autism campaign (15). The great value of the Omnibus Autism Proceedings has been in exposing the work of these shady practitioners to the scrutiny of serious scientists.....

More HERE