If there’s one thing about the anti-vaccine movement, it’s all about the ad hominem attack. Failing to win on science, clinical trials, epidemiology, and other objective evidence, with few exceptions, anti-vaccine propagandists fall back on attacking the person instead of the evidence. For example, as I’ve noted numerous times, Paul Offit has been the subject of unrelenting attacks from Generation Rescue and other anti-vaccine groups, having been dubbed “Dr. Proffit” and accused of being so in the pocket of big pharma that he’ll do and say anything for it. I personally have been accused by Jake Crosby of a conflict of interest that isn’t, based on conspiracy mongering and an utterly brain dead argument (which is much like every other argument Jake likes to make on this issue). Steve Novella, Paul Offit, Amy Wallace, Trine Tsouderos, and others were portrayed as cannibals sitting down to a Thanksgiving feast of baby. Meanwhile, anti-vaccine luminaries invoke the pharma shill gambit with abandon and try their best to smear journalists who write about how anti-vaccine views are endangering herd immunity, journalists such as Trine Tsouderos, Amy Wallace, Chris Mooney, and Seth Mnookin, to name a few.

Sometimes, however, for whatever reason karma, fate, God, or whatever you want to call it smiles on anti-vaccine activists, dropping a story into their laps that allow them to indulge the worst of their tendencies towards ad hominem attacks and seem superficially credible. So it was about a year ago when an financial fraud investigation was being undertaken in the case of Poul Thorsen, a Danish investigator who had contributed to two large Danish studies, one of which failed to find an association between the MMR and autism in the immediate wake of Andrew Wakefield’s falsified data suggesting such an assocation and one of which failed to find an association between mercury in the thimerosal preservative in vaccines and an increased incidence of autism. At the time longstanding anti-vaccine propagandist Robert F. Kennedy, Jr. tore into Thorsen with abandon before he was even indicted or charged (he was only under investigation at the time) as though, even if he actually did commit fraud, such fraud invalidated the two large studies regarding MMR and autism and thimerosal and autism with which he had been involved. Did it?

To find out, let’s hop into our SBM TARDIS and go back in time about a year, in order to see the genesis of this manufactorversy that AoA is currently flogging. Let’s look at the case of Danish investigator Poul Thorsen as it developed.

Thorsen in 2010: Robert F. Kennedy, Jr. parties like it’s 2005

It was back in March 2010. Andrew Wakefield had just had his 1998 Lancet paper retracted by the editors in the wake of his having lost his medical license in the U.K. as a result of his research misconduct. Just when times seemed darkest for those who promote the scientifically discredited notion that vaccines cause autism, a miracle occurred! So great was the miracle that it enticed Robert F. Kennedy, Jr., who for quite some time before had actually been pretty quiet about vaccine/autism issues, to let himself be pulled out of storage, dusted off, and sent once again to tilt at mercury windmills. Not unsurprisingly, he reappeared on that bastion of anti-vaccine pseudoscience, The Huffington Post, and the title of his post was Central Figure in CDC Vaccine Cover-Up Absconds With $2M. In what appeared to be a coordinated attack, the anti-vaccine group Generation Rescue‘s blog Age of Autism was promoting RFK, Jr.’s article and adding a few of its own with titles such as Poul Thorsen’s Mutating Resume by the not-so-dynamic duo of Mark Blaxill and Dan Olmsted and NBC 11 Atlanta Reports: Vaccine Researcher Flees with $2M, featuring this news report:

These were among the earliest reports about Poul Thorsen. So what was going on? Let’s look at RFK’s article and how he started it:

A central figure behind the Center for Disease Control’s (CDC) claims disputing the link between vaccines and autism and other neurological disorders has disappeared after officials discovered massive fraud involving the theft of millions in taxpayer dollars. Danish police are investigating Dr. Poul Thorsen, who has vanished along with almost $2 million that he had supposedly spent on research.

Thorsen was a leading member of a Danish research group that wrote several key studies supporting CDC’s claims that the MMR vaccine and mercury-laden vaccines were safe for children. Thorsen’s 2003 Danish study reported a 20-fold increase in autism in Denmark after that country banned mercury based preservatives in its vaccines. His study concluded that mercury could therefore not be the culprit behind the autism epidemic.

But was Thorsen really the driving force behind the Danish vaccine-autism studies that the anti-vaccine movement hates so much? I had been paying close attention to the vaccine-mercury-autism manufactroversy for nearly five years then, and I had never heard of him, although I had heard of one of his coauthors. If Thorsen was so important to the pro-vaccine movement, you wouldn’t have known it from the two studies that the mercury militia was hoping to discredit by turning up its propaganda machine to 11 about Thorsen’s possible criminal behavior. Those papers were:

• Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, Thorsen P, Olsen J, Melbye M. A population-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med. 2002 Nov 7;347(19):1477-82.
• Madsen KM, Lauritsen MB, Pedersen CB, Thorsen P, Plesner AM, Andersen PH, Mortensen PB. Thimerosal and the occurrence of autism: negative ecological evidence from Danish population-based data. Pediatrics. 2003 Sep;112(3 Pt 1):604-6.

It is the Pediatrics paper that the mercury militia appeared to be concentrating mostly on because it directly deals with thimerosal in vaccines. But look at the citations above for both papers anyway. Do you notice something? Look where Thorsen’s name is in the list of authors in both studies. Notice that it is not first, nor is it last. This is important because author order matters in scientific and medical studies. In straight science studies, the two most important authors are usually the first author and the last author. The last author is usually the senior author in whose laboratory the work was done, while the first author is the person whose project the work represents and who was the primary author of the manuscript. In medical papers, as in Pediatrics or NEJM, the author list usually signifies the relative contribution of each author to the article, the first being the most important and the last being the least important. In both types of articles, there is always designated one author who is the corresponding author. In scientific papers, the corresponding author is almost always the last author; in medical papers it is usually the first author. The corresponding author is responsible for answering inquiries about the study and, way back in the age before PDF files, used to be the author to contact to request reprints. Not only that, the corresponding author is generally considered to be the primary author for the paper.

Notice something else?

That’s right. Poul Thorsen was not the first author for either of these studies. He was not the last author, either. He was not the corresponding author; that would be Kreesten M. Madsen, MD, who was corresponding author on both the NEJM and Pediatrics papers. As it turns out, Thorsen was safely ensconced in the middle of the pack of co-authors. That’s why, when RFK, Jr. referred to the Pediatrics study as “Thorsen’s study,” he had to be either grossly ignorant or intentionally misleading (Take your pick.) Anyone who knows anything about how the scientific literature works would be able to spot that immediately just by looking at the abstracts of these articles. Trust me, if studies this large really were Thorsen’s babies his name would not have been relegated to fourth or sixth on the list of authors. Basically, Thorsen’s position in the author lists of these two papers indicated that, whatever leadership position he may have held at Aarhus University and in its vaccine studies group, he clearly was not the primary contributor for these studies.

Not that that stopped the mercury militia from going out of its way to paint him as such, referring to him as a “central figure.” At the time, I had to tip my hat to RFK, Jr. his language throughout his article is truly Orwellian, a propaganda masterpiece of prestidigitation of language and innuendo. Here are just a few examples of perfectly loaded phrases sprinkled throughout the article, all designed to suggest concealment and conspiracy:

• …”built a research empire…”
• “…failed to disclose…”
• “…has disappeared…”
• “…damning e-mails surfaced…”
• “…culprit behind…”
• “…leading independent scientists have accused CDC of concealing the clear link between the dramatic increases in mercury-laced child vaccinations.”
• “…safe to inject young children with mercury…”
• “…CDC officials intent on fraudulently cherry picking…”

RFK, Jr. also parroted anti-vaccine talking points about the study that were hoary back when David Kirby first published the mercury militia Bible, Evidence of Harm, talking points like:

His study has long been criticized as fraudulent since it failed to disclose that the increase was an artifact of new mandates requiring, for the first time, that autism cases be reported on the national registry. This new law and the opening of a clinic dedicated to autism treatment in Copenhagen accounted for the sudden rise in reported cases rather than, as Thorsen seemed to suggest, the removal of mercury from vaccines. Despite this obvious chicanery, CDC has long touted the study as the principal proof that mercury-laced vaccines are safe for infants and young children. Mainstream media, particularly the New York Times, has relied on this study as the basis for its public assurances that it is safe to inject young children with mercury — a potent neurotoxin — at concentrations hundreds of times over the U.S. safety limits.

Notice how RFK Jr. really, really wanted you to believe that the Danish studies are the primary foundation upon which the science exonerating MMR and thimerosal-containing vaccines as a cause of autism rests, the be-all and end-all of the epidemiology studying thimerosal-containing vaccines, when in fact there are multiple studies and lines of evidence, of which the Danish studies are but a part. Also notice how he conflated a study’s being weak with its being fraudulent. The two are entirely different concepts, and it is entirely possible for a study to be poorly designed and executed without even a whiff of fraud. Be that as it may, the Danish studies, although they have weaknesses inherent in a retrospective design, are actually pretty darned good studies. As I said before, RFK’s whine in the passage above is the parroting of a hoary criticism of the Danish studies cribbed straight from anti-vaccine sites. The criticism goes like this. Anti-vaccine propagandists argue that because, beginning in 1994, outpatient records were used in addition to inpatient records for case ascertainment in Denmark for purposes of these studies, the whole set of studies must be crap. As Steve Novella pointed out, this change was not chicanery, and in fact Madsen et al tried to test whether the change in case reporting by doing this was significant. Here is a quote from Madsen et al:

In additional analyses we examined data using inpatients only. This was done to elucidate the contribution of the outpatient registration to the change in incidence. The same trend with an increase in the incidence rates from 1990 until the end of the study period was seen.

In other words, Madsen et al considered the possibility that adding outpatient records to inpatient records beginning in 1994 might change the results. They tested for that possibility and determined that the addition of outpatient cases did not change the trend of increasing autism diagnoses. Again, RFK, Jr. was either grossly ignorant of the facts or consciously distorting. (Take your pick–again.) The same was true of J.B. Handley when he repeated the same misinformation, and and of Ginger Taylor when she also repeated the same fallacious argument.

Here’s what was going on. In the wake of debacle the implosion of Andrew Wakefield represented, the anti-vaccine movement needed a distraction—badly—and they needed it fast. It would have been even better if the distraction were one that they could spin to make it look as though there were some dark corruption at the heart of the vaccine science. Like manna from heaven, about a year ago Dr. Thorsen’s case dropped seemingly from the sky. Never mind that it makes absolutely no difference to the science exonerating vaccines or thimerosal in vaccines as a cause of autism whether Thorsen is a criminal and thief or not. It was convenient propaganda, even though there is abundant evidence that Thorsen was not a major player in the Pediatrics and NEJM publications reporting the Danish studies.

Fast forward to 2011: The indictment of Poul Thorsen for fraud

As we have seen, in the wake of the commencement of an investigation of Poul Thorsen for fraud and embezzlement of CDC grant money, it was not surprising that the anti-vaccine movement struggled mightily to elevate him to being the prime mover and shaker of the Danish studies. The reason was obvious: They wanted to discredit “inconvenient” studies that did not support their belief that mercury in vaccines causes autism. It was an ad hominem attack, plain and simple, because the primary argument was not against the data or the studies, but against the man. It’s a form of poisoning the well or guilt by association. It’s the same thing as if I were to point to physicians who have defrauded Medicare or insurance companies and argue that all science-based medicine is thus somehow suspect. Unfortunately, this sort of tactic frequently works–which is why propagandists without moral qualms about smearing their opponents frequently use it.

It’s also why, when I saw this article a couple of weeks ago, I knew that it wouldn’t be long before Age of Autism and other anti-vaccine minions would be swarming. After all, in January the BMJ had published the rest of Brian Deer’s expose of Andrew Wakefield’s research fraud, showing his actions to be even worse than we had suspected. The anti-vaccine movement needed another distraction, and the indictment of Poul Thorsen was a convenient one, which is why it wasn’t long before the anti-vaccine blog Age of Autism was on the case after Thorsen had been indicted. Since then, Thorsen has been a regular feature on AoA (up to and including today’s post) and other anti-vaccine blogs and websites. You’ll see why from this news report:

A Danish man was indicted Wednesday on charges of wire fraud and money laundering for allegedly concocting a scheme to steal more than $1 million in autism research money from the Atlanta-based Centers for Disease Control and Prevention.

The indictment charges Poul Thorsen, 49, with 13 counts of wire fraud and nine counts of money laundering. The wire fraud counts each carry a maximum of 20 years in prison and the money laundering counts each carry a maximum of 10 years in prison, with a fine of up to $250,000 for each count.

The federal government also seeks forfeiture of all property derived from the alleged offenses, including an Atlanta residence, two cars and a Harley-Davidson motorcycle.

This is how Thorsen is now accused of having done it:

Once in Denmark, THORSEN allegedly began stealing the grant money by submitting fraudulent documents to have expenses supposedly related to the Danish studies be paid with the grant money. He provided the documents to the Danish government, and to Aarhus University and Odense University Hospital, where scientists performed research under the grant. From February 2004 through June 2008, THORSEN allegedly submitted over a dozen fraudulent invoices, purportedly signed by a laboratory section chief at the CDC, for reimbursement of expenses that THORSEN claimed were incurred in connection with the CDC grant. The invoices falsely claimed that a CDC laboratory had performed work and was owed grant money. Based on these invoices, Aarhus University, where THORSEN also held a faculty position, transferred hundreds of thousands of dollars to bank accounts held at the CDC Federal Credit Union in Atlanta, accounts which Aarhus University believed belonged to the CDC. In truth, the CDC Federal Credit Union accounts were personal accounts held by THORSEN. After the money was transferred, THORSEN allegedly withdrew it for his own personal use, buying a home in Atlanta, a Harley Davidson motorcycle, and Audi and Honda vehicles, and obtaining numerous cashier’s checks, from the fraud proceeds. THORSEN allegedly absconded with over $1 million from the scheme.

If Thorsen is convicted, I have no problem saying unequivocally that he should go to prison for a long time. As was pointed out in this Reuters story about the indictment, research dollars are a precious commodity. In fact, with the recent budget battles and cuts in Washington, government research grants haven’t been this hard to come by for 20 years, and there’s no sign of improvement in the situation in sight; it will likely be several years before things get better, if they ever get better at all. So, I’m as angry as anyone to see a researcher abuse research funds by, if the indictment is correct, buying a home and a Harley-Davidson motorcycle. Of course, having had to deal with the bureaucracy at my university and cancer institute that oversees my grants, I really don’t understand how it is even possible to buy a house and a Harley using grant funds. Every major expenditure (for me, at least) is closely tracked and matched to the approved budget. I can’t even envision how, even if I wanted to try to misuse large sums of my grant funds, I could even find a way to do it. I really can’t. To me, if Thorsen really did abuse his research funds this way, it points to a serious accounting and oversight problem in his university that allowed such chicanery to occur.

Be that as it may, reading between the lines I do find one bit of information that might explain some things about the Danish studies. Madsen was the first and corresponding author, but it’s pointed out that Thorsen became principal investigator of the CDC grant in 2002. That doesn’t help AoA at all, though. I went and looked up the two articles again and noticed something interesting that I hadn’t really paid attention to before.

The NEJM article lists its funding sources as:

Supported by grants from the Danish National Research Foundation; the National Vaccine Program Office and National Immunization Program, Centers for Disease Control and Prevention; and the National Alliance for Autism Research.

This article was, however, published in November 2002. Given that it takes months, sometimes even a year or more, for a manuscript to go from submission to publication, this work had almost certainly been completed and was in the publication pipeline before Thorsen took over as principal investigator of the CDC grant. The Pediatrics paper, which was published after Thorsen went back to Denmark, lists its funding thusly:

The activities of the Danish Epidemiology Science Centre and the National Centre for Register-Based Research are funded by a grant from the Danish National Research Foundation. This study was supported by the Stanley Medical Research Institute. No funding sources were involved in the study design.

That’s right. The Pediatrics thimerosal study was not even funded by the CDC! Even if it were, given that large epidemiological studies take years to carry out, it probably was in the last leg of its analysis when Thorsen showed up anyway. Even worse for the “guilt by association” crowd, all of the fraudulent charges to the grant are alleged to have occurred between 2004 and 2008, as described above–well after the Danish studies were published.

Of course, none of this stops AoA from opining:

We have written several articles about Dr. Poul Thorsen (4th from the left in the back row with his CDC colleagues), whose research known as “The Danish Study” is quoted extensively to “debunk” the autism vaccine connection. The mainstream media was silent when he disappeared. Here are some of the posts we’ve run on the topic along with today’s article in the Atlanta Bizjournals below. Will they give Thorsen “the Wakefield treatment” now, or have they been given their marching orders to look the other way?

Of course, not noted by the author is that Thorsen has already been treated far more harshly than Wakefield ever was! He’s been indicted on criminal charges; all that happened to Wakefield is that he was struck off the register of licensed UK physicians, and then only after a ridiculously long (two and a half year) hearing by the British General Medical Council. He just had a couple of his papers retracted, the most prominent of which being the Lancet paper from 1998 for which strong evidence was found that he had falsified data. In the meantime, he had moved to Texas to make big bucks applying his woo to autistic children, at least until the scandal led even his friends kick him out of the practice. Thorsen faces decades in prison if convicted of these crimes. My guess right now is that Thorsen is praying for “the Wakefield treatment.” It was so much less harsh than what he faces if he is convicted of defrauding the federal government. My other guess is that Thorsen would gladly take the “Wakefield treatment” over the possibility of 20+ years in a federal prison.

Not long after AoA, the anti-vaccine group Autism Action Network (formerly known as A-CHAMP) also piled on. If you read this “action alert,” you’ll notice the clever linking of Thorsen’s indictment for defrauding the federal government of research funds with baseless criticism of the two main Danish studies that provide strong epidemiological evidence that failed to find a link between the MMR vaccine and autism or thimerosal in vaccines and autism. It doesn’t matter that Thorsen’s alleged fraud didn’t even occur until at least a year after the publication of the thimerosal study.

Then, of course, the anti-vaccine group Safeminds had to weigh in with its own press release. Sallie Bernard, unfazed by reality and science, stares bravely into the abyss that was once what little credibility she has, and insists that “many biological studies support a link between mercury and autism, but these Danish studies have been used to suppress further research into thimerosal. With clear evidence of Dr. Thorsen’s lack of ethics, it is imperative to reopen this investigation.” And there you have it, the clearest and most honest statement of the intent of the anti-vaccine movement. In essence, all they want is any excuse they can find to try to demand “more studies,” even as the hypothesis that vaccines cause autism continues to pine for the fjords. Like Polly, however, it is still an ex-hypothesis, while, like Frankenstein, Bernard thinks she can infuse life into the dead. (I do so love to mix metaphors when it suits my purpose.) However, instead of using electricity from lightening Bernard uses nonsense like this:

In addition, internal emails obtained via FOIA document discussion between the Danish researchers and Thornsen which acknowledge that the studies did not include the latest data from 2001 where the incidence and prevalence of autism was declining which would be supportive of a vaccine connection. The emails also include requests from Thornsen to CDC asking that the agency write letters to the journal Pediatrics encouraging them to publish the research after it had been rejected by other journals. A top CDC official complied with the request sending a letter to the editor of the journal supporting the publication of the study which they called a “strong piece of evidence that thimerosal is not linked to autism”.

The latter accusation above is just plain silly, as this link shows. Basically, it’s a letter of support from the CDC for the Danish thimerosal article, and there’s nothing there in any way incriminating. I do find it odd, however, that clearly the second page of the letter is missing, which makes me wonder why that is. The e-mails already say who signed the letter. As for the e-mails about the data from 2001, it’s impossible to tell exactly what the correspondents are saying. There are only two brief e-mails, and much text is redacted with black marker, that consist of an exchange between Marlene Lauritsen, who’s second author on the paper, and Kreesten Madsen, the first author. It’s cryptically mentioned that the incidence and prevalence are “still decreasing in 2001,” but the sentence immediately following it is redacted. Most of Madsen’s reply to this e-mail is also redacted.

In other words, the e-mails tell us little or nothing. More importantly, as Sullivan has shown by listing the studies rejecting the vaccine-autism hypothesis on which Thorsen is a co-author, you could eliminate every study with which Thorsen was associated, and the literature refuting the hypothesis is only reduced slightly.

Finally, of all the reactions to the study, there is one that made me laugh out loud when I read it. I’m talking about Katie Wright:

Who would make serious health care decisions based upon the work of a thief and a fraud.

Come on CDC, you cannot be serious.

Given that Wright and the many AoA followers have routinely made health care decisions based upon the work of Andrew Wakefield, who, while not a thief, was clearly a scientific fraud, I posit that Wright owes me a new irony meter. She blew mine up again–melted that sucker into a pool of gurgling plastic, rubber, and copper wire so that it’s now sputtering pathetically on my desk. Yet Wright and her fellow travelers defend Wakefield to the death metaphorically speaking, with J.B. Handley, for example, even going so far in this weekend’s New York Times Magazine as to liken him to “Nelson Mandela and Jesus Christ rolled up into one” and Michelle Guppy, coordinator of the Houston Autism Disability Network, darkly threatening a reporter, “Be nice to him [Wakefield], or we will hurt you.”

Double standard? You be the judge.

Conclusion

To a certain extent, I understand the assertion of “once a cheat, always a cheat.” I understand that the lead author (Madsen) and Thorsen’s other co-investigators might now want to check over Thorsen’s contribution to the two papers (as relatively small as it appears to be compared to the other authors), even for the paper whose work was not funded by the CDC at all and therefore has zero financial dependency on the CDC. That’s normal caution. However, normal caution is most definitely not what these attacks by Safeminds and AoA are about. They’re about the denialist technique of spreading FUD (fear, uncertainty, and doubt) about vaccines. Let’s just put it this way. Let’s say the anti-vaccine movement’s wet dream about Thorsen came true and it was somehow discovered that his science was also falsified and that, further, his fraud was enough to call the conclusions of every study for which Thorsen was a co-author in doubt. Even in that highly unlikely scenario, in which both studies were somehow completely discredited as a result of Thorsen’s financial chicanery with grant funds, it would not be nearly enough for scientists to call into question the scientific consensus that neither the MMR nor thimerosal are associated with an increased risk for autism. The reason is that there’s so much other evidence that is consistent with the Danish studies and similarly shows that neither the MMR nor thimerosal in vaccines is associated with autism.

What AoA, Safeminds, and other denialists refuse to understand is that science is rarely, if ever, a matter of a scientific consensus being based on one study, two studies, or a handful of studies. A scientific consensus is based on examining all the evidence from all relevant studies, deciding which studies are most methodologically powerful, and then synthesizing it all into a conclusion. Contrast this to how the anti-vaccine movement treats its “brave maverick doctors” like Andrew Wakefield, Mark Geier, Rashid Buttar, et al, and the difference between real science and anti-vaccine pseudoscience couldn’t be clearer.

ADDENDUM: I can’t resist pointing you to a hilariously misguided attack against me that proves once again that, for the anti-vaccine activists, it’s all about the ad hominem. Clifford Miller, a.k.a. ChildHealthSafety, was apparently unhappy that in the comments of Seth Mnookin’s post complaining about J.B. Handley’s attacking him solely based on his having once been a heroin addict, an addiction that Seth managed to beat, I dared to criticize J.B. for an ad hominem attack. In response, Miller fired off a counterattack. Not only was he unhappy about a post of mine that was over a year old, but he regurgitated Jake Crosby’s fallacious pharma shill gambit that used against me last summer.

Thank you, Mr. Miller, for a hearty chuckle and for, in your utterly irony challenged manner, proving my point about the anti-vaccine movement and ad hominem attacks better than I ever could.