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"Wakefield's article linking MMR vaccine and autism was fraudulent."

Wow. If the allegations referred to in this British Medical Journal editorial are true -- that scientist Andrew Wakefield, who was being paid by law firms who wanted to sue vaccine companies, deliberately manufactured data linking vaccines to autism  -- then Wakefield has blood on his hands.

Count me in among the mothers who (back in 2000 when my first child was born) chose to vaccinate on a delayed and modified schedule in part because of the doubts engendered by reports like Wakefield's 1998 paper in the respected British journal Lancet. 

It has been suggested for a long time that the preponderance of the evidence since Wakefield's report tended to refute the alleged vaccine-autism connection, and I had come  to believe that it was in error -- one of those common dead-end pathways in scientific research.  Eventually, the paper was even retracted, as does happen sometimes when there prove to be mistakes.   I no longer had a concern about vaccines and autism specifically.  I hadn't been following the story closely since then, and so I wasn't expecting a finding of fraud.

Full disclosure:  I'm still unhappy with vaccines that have a fetal-tissue connection.  I still prefer to give kids one vaccine at a time the first time they get one, so that the cause of any reaction can be known.   I'm supportive of religious- and philosophical-exemption laws.  And I am aware of the concerns about vaccine reactions of other kinds, and am understanding of the nervousness with which many parents approach them, as well as being generally sympathetic with a low-medical-intervention and individual- rather than population-focused medicine.  

But this?  Outright falsification of medical data that affected vaccination decisions (and possibly disease outbreaks) in several countries, as well as influencing the direction of autism research?  

I can't figure out whether I'm outraged more as a mother or as a scientist.

(Knowing me, probably as a scientist.)

Mainstream-type folks often like to characterize alternative-type folks as crackpots.  Homeschoolers know this.  Home-birth mamas know this.  Mothers who practice extended breastfeeding know this.  Consumers of alternative medicine of all kinds know this.  People who source some of their food outside the mainstream production/processing industry know this.  Hey, religious people know this.  It's annoying to see experts whose knowledgeable advice you rely on, referred to as crackpots, or evil.

It's even more annoying when some of the  "experts" DO turn out to be  crackpots, or evil, or both.

Chemistry blogger Derek Lowe weighs in:

The 1998 paper that linked MMR vaccination with autism has had a long way to fall. It made, of course, a huge media sensation, and energized the whole vaccination/autism controversy that still (in spite of evidence) goes on. But it didn't look very robust from the start, scientifically. And over the years it's gone from "Really needs shoring up" to "hasn't been reproduced" to "looks like there's something wrong with it" to "main conclusions retracted" to the final, lowest level: outright fraud.

Here's a good history of the whole affair in the BMJ. And here's the first part of a series of articles by Brian Deer, the journalist who dug into the study and found how fraudulent it really was. Not one of the 12 cases in Wakefield's original study hold up; the data were manipulated in every single one to make it fit his hypothesis. His hypothesis that he was getting grant money for. His hypothesis that he was already planning lawsuits around, before the study even started.

His hypothesis, I might add, that has led to completely unnecessary suffering among the unvaccinated children this scare has produced over the years, and has diverted enormous amounts of time, energy, and money away from useful study of autism. This sort of deliberate action is really hard to contemplate, as a reasonable human being - it's like some sort of massive campaign to persuade people to throw bricks through the windows of ambulances.

In a better world, we'd be getting expressions of sorrow and contrition from all the celebrities and others who've profited from this business. But that's not going to happen, is it?

Don't hold your breath.

Amen, sister.

Jamie schools the world in her latest post at Light and Momentary.

Here are two things you might like to know about the study published Monday in Pediatrics. 

1. The authors do not say anywhere that mothers are not trying hard enough. No one needs to read about this study and then run through the reasons why she stopped breastfeeding to make sure they're good enough. You in the pink shirt over there, relax. It's not about whether you suffered enough, not at all.
2. It's all about the fact that modest differences add up to big numbers in large populations. Because of the magnitude of the potential savings, the authors call for improved support and infrastructure for breastfeeding mothers.

Most of the blogosphere buzz about this article has focused on its calculation that six months of exclusive breastfeeding by 90% of mothers would save more than 900 children's lives as well as $13 billion annually. We can't have those kind of breastfeeding rates without paid maternity leave, people are saying, so what's your point, Dr. Bartick?

But they're not just talking about Breastopia in this article. The authors present a range of numbers, and the 90% values have gotten all the press because big numbers make big headlines. No one seems to be talking about the more attainable outcomes: if we could just hit the Healthy People 2010 targets, we would save still save billions annually (billions as in 2.2, but still, billions, plural) and 142 children's lives. Those are reachable goals: they specify that 75% of babies will begin breastfeeding -- a single attempt counts -- and 50% of babies will still be receiving some human milk -- even a tiny fraction of their intake -- at six months old.

We don't need to reform the whole maternity leave system to save lives and dollars. (Not that I'd complain if anyone wanted to tackle the vexed issue of maternity leave in the US.) Here are some things we do need...

Read the whole thing.

Keep your hands off my family's Sudafed.

From Reason.com (h/t Radley Balko's excellent The Agitator), the latest update on the policy issue that was recently voted "Policy Issue Most Likely To Turn Bearing Blog Into A Flaming Libertarian Site Devoted to Deregulation:"

 The Wall Street Journal reports that "a nationwide resurgence in illegal methamphetamine labs" has caused state and federal legislators to re-examine the effectiveness of the Sudafed crackdown. They plan to do what prohibitionists always do in the face of failure: double down—in this case by requiring prescriptions for a cheap, safe, effective decongestant that not long ago was readily available in convenience stores across the land. That requirement will force doctors to police Americans' pseudoephedrine consumption...

Yes, you heard it:  the feds (and some states; Oregon's already done it) want to turn Sudafed into a prescription-only drug, not because of safety concerns, but because making it difficult for us to get it has not worked to stop methamphetamine production, and even less to stop methamphetamine use.

Leaving aside the ridiculously bad timing of such an endeavor (we already spend HOW MUCH on health care?  And you want to turn an effective self-treatment option, a well-beloved one measured in the dollars spent on pseudoephedrine every year, into one that requires a doctor's visit?  Perhaps an emergency room visit, for the uninsured?)....

...aw, what the hell, I've ranted about this before, here's my post from 2007 about the stupid guidelines on children's "cold medications" that don't distinguish among the several different compounds commonly sold as "cold medications."

And can I just add to the comments on the Reason website...

"have you ever tried to breastfeed a baby who has a terrible head cold and can't breathe through her nose? It's awful. Bleeding awful, both for you and the baby. An effective decongestant can mean the difference between a sick baby who can't easily take in her only source of fluid and nutrition, and a baby who can do it easily. Believe me, saline spray does NOT do the trick.

(disclaimer: nursing mothers should be cautious taking decongestants because of anecdotal evidence that in some women it compromises milk supply)"

Shaken baby syndrome: bogus?

Brief but interesting article, with links, by Radley Balko on the changing medical consensus (and the lag in the legal consensus) about "shaken baby syndrome," or SBS.  Some of the points raised:

• Symptoms that prosecutors have argued are proof of SBS are now known to occur because of other causes, including falls, infections, and reactions to vaccinations.
• Doctors used to think that classic SBS symptoms presented immediately after shaking, so that the person who was with the child when it died was certain to be guilty of manslaughter or even murder.  New research shows that the symptoms may take 3 days to set in.
• New research also shows that shaking without an accompanying head injury produces less serious bleeding than was previously believed.
• "I shook the baby to try to wake him up" has been taken as evidence of guilt.

I'm interested in the lag between scientific findings and their acceptance in other circles -- legal circles being one or the most important.  Balko notes:

In other words, there are almost certainly a significant number of innocent people in prison today who were wrongly convicted of shaking a baby to death. The problem is that there are also likely a number of guilty people who, nevertheless, shouldn't have been convicted on the basis of science-based testimony we now know to be false. The task will be convincing both the courts and the public to risk freeing actual child killers in order to free the innocent people convicted with flawed medical testimony...

This whole controversy speaks to a fundamental tension between science and law. Science moves along a slow trajectory from inquiry toward certainty. While the courts have been eager to embrace new science—particularly forensic science—at the trial level, they're reluctant to revisit those cases when the science changes.

Very interesting, especially for every parent who's ever worried that taking the baby to the emergency room after a fall might get him accused of child abuse...

Yet another piece of evidence.

From Katie Allison Granju:  "New research:  Lack of breastfeeding doubles risk of SIDS."

Hopefully, if the information gets out and is really internalized by pediatricians, this will help convince many on-the-fence mothers, and those who struggle with difficulties getting breastfeeding started, to hang in there at least for the window of time that's most important for SIDS prevention:  four to six months after birth.

By the way, in case you were wondering, "Didn't we know that already?", the new study appears to demonstrate causality, not just correlation.  

Someone please relieve my mild irritation.

So they're pulling all the infants' cough and cold medications.  It'll be the children's formulations next; the days of liquid cold medicines may soon be over.

The news articles on the subject have all been driving me crazy.  Take a look at this article from the Associated Press, or this one from the New York Times.   (What I heard on NPR this afternoon wasn't any better.)  Patterns of misuse, "the medicines don't help," deaths after taking antihistamines and decongestants...  what's missing from these stories?

I'll tell you what's missing.  None of these stories mention the words dextromethorphan, pseudoephedrine, phenylephrine, guaifenesin, or diphenhydramine.  These are the common active ingredients (besides acetominophen and ibuprofen) that appear in various combinations in "cough and cold medicines."  None of these stories tell you which active ingredients are implicated in overdoses.  None of these stories tell you whether all of these active ingredients have been found to be ineffective in children, or whether it's just some of them. 

I was reading this story to Mark and his answer was, "If they are claiming that pseudoephedrine doesn't relieve symptoms, they're on crack."   No kidding.  I could believe that of dextromethorphan or guaifenesin or phenylephrine, but not pseudoephedrine.  My second child, Milo, was a "lungy" baby.  Every time he caught a cold, it sounded like pertussis.  Half a dozen times in his first year I sat up with him, keeping him upright so his breathing wasn't strangled-sounding.   What helped?  Children's pseudoephedrine.  Nothing else.  And it helped a lot.  So I was startled to read that several of the withdrawn medications are formulations of pseudoephedrine alone.  Taken with the news articles it seemed to imply that pseudoephedrine is no better than a placebo.  This hasn't squared with our experience.  It is a pretty damn good placebo.

I am not one to confuse "data" with the plural of "anecdote," but neither do I confuse AP or NYT writers with peer reviewers, so I dug briefly around and discovered that indeed, pseudoephedrine has never been shown ineffective in children.  It has been shown effective in adults and has never been studied in children:

The best studied oral agent in adults, both as a single and combination ingredient, is pseudoephedrine. It is most commonly taken to relieve congestion and rhinorrhea associated with upper respiratory infections (URIs). The majority of the evidence from adult studies...do support a modest reduction of signs and symptoms associated with URIs reported both subjectively and objectively, with single doses of the drug. Notably, however, there is limited evidence supporting multiple doses over the course of an illness as well as an absence of supportive pediatric data. ^...

The few pediatric studies that have been conducted have failed to document beneficial effects of any of the compounds studied. Two studies evaluated oral antihistamine-decongestant combinations and found them no better than saline placebo ( Hutton N, et al. J Pediatr.1991 ;118:125 -130[Medline] ; Clemens C, et al. J Pediatr.1997 ;130:463 -466[Medline] ). Two others found no beneficial effects of topical phenylephrine ( Bollag U, et al. Helv Paediat Acta.1984 ;39:341 -345[Medline] ; Turner RB, et al. Pediatr Infect Dis J.1996 ;15:621 -624[Medline] ). Notably, none of these pediatric investigations studied drugs containing pseudoephedrine.

[Emphasis mine.]  In other words, phenylephrine doesn't work -- apparently -- but no one can yet say that of pseudoephedrine.

OK, so if nobody has shown that pseudoephrine doesn't work in children, then why are they pulling it?!?  It's getting lumped in with all the other cough-n-cold stuff.  In the absence of evidence to the contrary, why can't I as a parent make the choice to use what we've seen works really well?

I have two theories.

One theory is that there are a lot of people who would like to see pseudoephedrine disappear completely, because then it would get a lot harder to make meth.  It's already behind the counter for that reason (which is annoying enough).

The other theory is that this is another case of The Government Thinks The American People Can't Handle Complicated Instructions.

I suspect that this is for the same sort of reason that they decided to make the food pyramid nice and friendly by labeling all fats equally bad for you, which any lipid chemist can tell you is an outright falsehood.  It was easier for the government to say "Dietary fat's bad!  Avoid it!" then to lay out the truth:  (a) artificial trans fats are bad and (b) saturated fats appear to raise blood cholesterol and (c) medium-chain fatty acids, saturated or not, have beneficial effects and (d) polyunsaturated fats raise the good cholesterol... so we got the simple, wrong version.

Now all of a sudden, all cough and cold remedies are unhelpful.    That is SOOOO much easier than developing better labeling, or rectifying the overdose-waiting-to-happen situation in which "children's liquid suspensions" are less concentrated than "infant's drops" formulations, or -- heaven forbid! -- actually using long scary words like "dextromethorphan" in a news story.

UPDATE.  I am particularly interested in comparing attitudes about pseudoephedrine to acetaminophen, i.e. "Tylenol," which in my mind is a valuable comparison because it is very frequently given to children and is extremely dangerous in overdose; it'll destroy your liver pretty quickly.

Pseudoephedrine has been involved in at least three infant deaths, according to this 2005 link from the CDC.  One infant got a double dose of pseudoephedrine because he was given two medications that both contained pseudoephedrine as well as, apparently, carbinoxamine, dextromethorphan, and acetominophen.  The other two had been given, respectively, pseudoephedrine and carbinoxamine; and pseudoephedrine, dextromethorphan, and acetominophen.  Hard to say which drug caused each death; the coroners blamed "cough and cold medication."

What about acetominophen?

This annual report from the American Association of Poison Control Centers is chock full of interesting information.  (I love poison control centers.  They are one of the few "healthcare agencies" that actually dispense useful and accurate information to the public.  Wonder why they don't seem to be worried someone will sue them?)  In 2005, analgesics were implicated in more "exposures" of children under 6 than were cough and cold medications.  This does not, of course, mean they were the most toxic.  Analgesics (e.g., acetominophen) are also the most common cause of adult exposures and the category that is most commonly associated with poisoning death in all categories -- 696 cases in 2005, vs. 18 cases that involved cold and cough medications.  They are, I'll bet, the most common stuff in the medicine cabinet, which undoubtedly increases the risk that someone will poison themselves with them.

It is sobering to get to the table in the back -- page 29 in the .pdf, about 831 in the page numbering -- and see the long, long list of acetominophen deaths, including many suicides.  (Yes, it doesn't mean that acetominophen is more dangerous.  It probably only means that it's more common.  Is it hundreds of times more common?)    Scroll down to page 61/863 and look at the list of poisonings from cough and cold medications.  It is a hell of a lot shorter.

I wish the articles would clarify the several different issues -- overdose risks from combining products that have ingredients in common, overdose of single products, deaths from taking recommended doses, and balancing these risks against taking medicines that do show benefits vs. medicines that are shown not to work.

AAP says: Put the baby in your room.

The American Academy of Pediatrics (AAP) has revised their infant sleep recommendations for the prevention of sudden infant death syndrome (SIDS).   Notably:

...there is growing evidence that room sharing (infant sleeping in a crib in parent’s bedroom) is associated with a reduced risk of SIDS. The AAP recommends a separate but proximate sleeping environment.

In other words, while it still recommends cribs, the AAP now recommends that babies sleep in the same room as their parents.  I applaud this recommendation, which makes sense on many levels.  Because their waking will be heard sooner, babies will cry less and suffer less.  Perhaps breastfeeding will become well-established for more newborns, so that fewer mothers will have problems that drive them to give up nursing.

Our family cosleeps.   The benefits to us of co-sleeping are apparent, and the risk of SIDS is small (and not at all, to my knowledge, studied in exclusively co-sleeping families --- most of the data comes from families who occasionally co-sleep).  I personally recommend it to every nonsmoking parent who asks me. 

But I am still pleased by the new AAP recommendations.    Because they are palatable to the average American, they stand a good chance of becoming the new norm in nighttime baby care --- I mean, there is a good chance that the typical newborn will move from the nursery down the hall to the crib a few feet away.  That's a tremendous gain in mother-baby closeness.

Here is another interesting statement.  I had no idea that this research even existed:

Research now indicates an association between pacifier use and a reduced risk of SIDS, which is why the revised statement recommends the use of pacifiers at nap time and bedtime throughout the first year of life. The evidence that pacifier use inhibits breastfeeding or causes later dental complications is not compelling enough to discredit the recommendation. However, it is recommended that pacifier introduction for breastfed infants be delayed until one month of age to ensure that breastfeeding is firmly established. In addition, if the infant refuses the pacifier, it should not be forced.

Fascinating!  Why do you suppose that a pacifier should reduce the risk of SIDS?  Does suckling stimulate breathing, or keep the airway open?  Well, my night nursers have always nursed so much when they were small...

I'm pleased to see that they recommend waiting until breastfeeding is firmly established.  Do you suppose that this part will be noticed, or will pediatricians just start telling parents, "Use a pacifier.  It lowers the risk of SIDS."  I hope that they remember that pacifiers do cause problems.

The rest of the recommendations are not very much changed.  One part I disagree with has to do with avoiding flat-head: 

Avoid development of positional plagiocephaly (flat back of head): Encourage “tummy time.” * Avoid having the infant spend excessive time in car-seat carriers and “bouncers.”

Parents certainly should avoid putting the baby too much in car-seat carriers and bouncers, but the solution isn't "tummy time" (which is a pleasant-sounding euphemism for "leaving the infant awake face down on the floor"), it's carrying the baby, in arms or a soft carrier.  Get a sling and use it.  Better yet, get several.  (Here or here are good places to start.)   

All in all, pretty good, but --- as usual --- there's a general lack of perspective.  We should care about total infant mortality, not just SIDS.  And morbidity too:  good quality breastfeeding prevents so many problems that it's hard to see why it's not a higher priority than SIDS.  For a while, a major disposable-diaper manufacturer printed diapers with the "Back to Sleep" slogan.  Nobody printed "Having trouble breastfeeding?  Before you give up, dial 1-800-LALECHE."

Possibility the first:  The unexpected, unexplained nature of SIDS scares people more than other causes of infant death and illnesses.  Possibility the second:  Nobody stands to lose a lot of money if people decide to do what's best for their babies when it comes to sleep.

UPDATE:  Of course, if you look for it on Google News, the headlines are all about the benefits of cribs and pacifiers.  Not about the benefits of putting your child in your room, which is surely the change that has the most significant impact on standard U. S. parenting practices.

UPDATE AGAIN:  Dumbest headline award goes to the Washington Post, for this gem:

To cut crib deaths, separate beds are urged for babies

Think about it.

"Parents have lost touch with the notion that these charts are guidelines, not rules."

Doctors too, apparently.  Well, it's about time someone pointed this out:

It turns out most advice parents get about weaning infants onto solid foods — even from pediatricians — is more myth than science.

That's right, rice cereal may not be the best first food. Peanut butter doesn't have to wait until after the first birthday. Offering fruits before vegetables won't breed a sweet tooth. And strong spices? Bring 'em on....

"Parents have lost touch with the notion that these charts are guides, not rules," says Rachel Brandeis, a spokeswoman for the American Dietetic Association. "Babies start with a very clean palate and it's your job to mold it."...

The difference is cultural, not scientific, says Dr. Jatinder Bhatia, a member of the American Academy of Pediatrics' nutrition committee who says the American approach suffers from a Western bias that fails to reflect the nation's ethnic diversity.

Yep.  I remember well, before I became a mother, sitting at lunch with some other graduate students and postdocs.  One, an Italian man, had brought his wife and baby son, maybe seven months old.  When the food came, the Italian woman pulled the "baby food" from her purse:  a whole, raw tomato.  I was shocked!  But that baby chowed down!  I remembered that, and never bothered with prepared baby food for our kids.

Thanks to Danna for the link.

Let's not judge sex-ed effectiveness on teen pregnancy alone.

Tom at Family Scholars Blog writes:

Given that everyone wants to reduce teen pregnancy, why can’t we just agree to go with what has been shown to work? Increasingly, I see earmarked funds for abstinence-only education as financial handouts to the Bush Administration’s social conservative base. To be sure, I don’t support throwing condoms at kids. Comprehensive sex-ed programs that don’t work should not be supported, either. But there has been a fair amount of research as to what works. We should use this knowledge. Believe me, if there was any convincing evidence that abstinence-only programs worked, I’d support them.

With the caveat that parents should be able to expect transparency and some degree of control over the curriculum presented to their own children, public policy should definitely throw its weight behind programs that are proven to further public goals.  And reducing teenage pregnancy is indeed a laudable public-health goal.

I have two questions for Tom about the specific programs that are shown to reduce teenage pregnancy:

1. Are these same programs also proven to reduce rates of sexually transmitted infections among teenagers? Surely this is an equally laudable public-health goal.
2. How do these programs affect the age of onset of sexual behavior, compared to other programs? Surely delaying the onset of sexual behavior is also a laudable goal, if perhaps not as urgent (from a public health standpoint) as reducing teen pregnancies and STIs.

It isn’t self-evident that the programs that best reduce teenage pregnancy are the same programs that best reduce STI rates, because these different results are produced by different behavior sets.   A decrease in teen pregnancy could be caused by increased use of oral or injectable contraceptives, neither of which offers any protection whatsoever against STIs.  And even condoms are not very effective against the transmission of human papilloma virus (HPV) or herpes, both of which have lifelong consequences.

Nor is it self-evident that declines in teen pregnancy correspond to children waiting longer before becoming sexually active.  Perhaps they are substituting oral and anal intercourse for vaginal intercourse.  Perhaps they are using contraceptives more frequently.  These do not protect against emotional entanglements too complex for their maturity level.

So I’m curious if one class of programs is effective in all three of these areas. Teen pregnancy isn’t the only measure worth studying.

Cosleeping and SIDS: Comments

My initial judgment of the article that I summarized below, purporting to show a connection between cosleeping and SIDS, is that the research methods appear sound (although I want to run it by an epidemiologist friend of mine).    The conclusions that are based on the research also appear sound, with some caveats.

The FOX News story captured most of the details, much better than I usually expect from science reporting.

Worth pointing out:

• The researchers recommend that all babies sleep in the parents' room.   If parents smoke, putting baby to sleep in a separate room increases the risk of SIDS.
• The study did NOT show that it was risky to cosleep with a baby older than 11 weeks.
• 5 of the 46 SIDS babies reported as having shared a bed in the last sleep were actually found dead in a crib or "moses basket."
• Bed sharing here is defined as having shared the bed on a single occasion---in the case of SIDS babies, during the "last sleep" before being found dead, and in the case of control babies, in the night before the interview.  Only 13 babies in the SIDS group and 13 babies in the control group regularly slept in the parental bed.  The rest---110 babies in the SIDS group and 240 babies in the control group---regularly slept somewhere else.

I think the most important point for new parents is the last.  When  "continuum-concept" adherents or "attachment-parenting"  proponents (the best-known of which is Dr. William Sears)  speak of co-sleeping, we are referring to  a baby's sleeping every night in the parental bed, with parents, from birth. 

The question "Should we co-sleep, or not?" means, for most of us, "Should my baby always sleep in my bed, or should he never sleep in my bed?"  It does not mean, "Should my baby sleep in my bed tonight?"   

Yet the latter is really the question that the study purports to answer.

Those of us who regularly co-sleep are really only interested in twenty-six of the studied babies, thirteen who died and thirteen who did not; or, perhaps, thirty-nine of the studied babies, thirteen who died and their twenty-six associated controls.   Is this a large enough sample to evaluate the risk of regularly co-sleeping?  Were there confounding factors?

One missing piece of information is necessary to gain perspective.  This site claims that the rate of SIDS in Scotland is about 0.7 per 1000 births (70 per 100,000).  52,537 babies were born in Scotland in 2001.  The 123 SIDS deaths were spread out over 53 months. Let us suppose for the sake of argument that the percentages shown by the study are accurate measures of the population, that the control group is representative of the whole population with respect to sleeping practices, and that the birth rate was flat at 52,537/year (big assumptions---this is just for the sake of argument).  Then, for every 100,000 babies born in Scotland:

- 4,943 reportedly regularly sleep with parents.  95,057 don't.

- 70 die of SIDS.  99,930 don't.

- 7 babies (70 x percent of all SIDS babies who sleep with parents) regularly sleep with their parents and die of SIDS.  4,936 babies regularly sleep with their parents and don't die of SIDS.

- 63 babies do not regularly sleep with their parents and die of SIDS.  94,994 babies do not regularly sleep with their parents and do not die of SIDS. 

- Chance of dying from SIDS if baby regularly sleeps with parents:  7/4,943=0.14% (14 in 10,000).  Chance of dying from SIDS if baby does not regularly sleep with parents:  63/99,930=0.063% (6 in 10,000).   

Perspective:  Odds that the baby will not die of SIDS if you co-sleep regularly:  99.86%.  Putting the baby in a crib every night improves those odds to 99.94%.   

We co-sleepers do it because we perceive benefits:  more sleep, easier breastfeeding, and a closer relationship with our kids.  Is the slight improvement in the odds worth the loss of those benefits?  It's a question that the report did not cover.

Let's extrapolate more wildly from the tiny data set of regular cosleepers, just to see what happens on a per-night basis.   If the extrapolation were, by some amazing coincidence, representative of the population, this would allow us to answer separately questions relevant to "Should I take my baby into my bed tonight?" and "Should I always cosleep or should I never cosleep?"

- On a given night, 19,011 babies per 100,000 births are in bed with their parents.  Assume that all those who normally sleep with their parents are among them. (This may not be valid.)  Then, at most, on a given night, 14,068 babies who do not normally sleep with their parents are in bed with them. 

Out of 100,000 births, then:  26 babies are in their parents' bed at some time during a sleep session in which they die.  (Only 23 of them actually die in the bed.)  It is reasonable to suppose that 7 of these are the ones that died who regularly slept in the parents' bed.  So 19 babies who do not regularly sleep in their parents' bed die during a sleep session that takes place at least partly in their parents' bed. 

123 deaths over 1590 days:  0.08 SIDS deaths on a given night over the course of the study in Scotland.  If it is true that the SIDS rate is 70/100,000 = 123/175,714 over the course of the study, then on a given night in Scotland,   0.08/175,714 babies die, or 46 per hundred million (not that there are that many babies in Scotland). 

SO.  Out of a theoretical one hundred million babies in Scotland:

On a given night, 14,068,000 who don't usually sleep with their parents are in bed with their parents.  4,943,000 are in bed with their parents as usual.  80,988,000 are, as usual, not in bed with their parents.  On that night, 46 babies die of SIDS.  Twelve were babies who don't usually sleep with their parents, but that night, were in bed with their parents.  Five were babies who were in bed with their parents as usual.  The other 29 were not in bed with their parents. 

Risk of a baby who always sleeps with you dying of SIDS tonight:  10 in 10 million.

Risk of a baby who doesn't usually sleep with you dying of SIDS tonight if you don't put him in your bed:  4 in 10 million. 

Risk of a baby who doesn't usually sleep with you dying of SIDS tonight if you do put him in your bed:  9 in 10 million.

So yes, the very tiny risk of death is highest for regular co-sleepers and lowest for regularly separate sleepers---though the data set is perhaps too small to make this conclusion.