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Autism and Vaccines: Responding to Poling and Kirby

In response to my NeuroLogica blog post on Monday, David Kirby wrote a response in the Huffington Post and Dr. Jon Poling (father of Hannah Poling) wrote an open letter to me, placed in the comment section and posted at Age of Autism. It seems only polite that I respond to their kind attention.The primary focus of my original post (which I further developed yesterday) was that the media is focusing too much attention on what celebrities and politicians are saying about the controversy surrounding the discredited notion that vaccines are a significant cause of autism. Over the past year Jenny McCarthy (now joined by her boyfriend Jim Carrey) has become the major spokesperson for a movement that, at its core, is anti-vaccine and is dedicated to the scientific opinion that vaccines are toxic and cause autism. Recently actress Amanda Peet joined the fray, professing her belief that vaccines are safe, are not associated with autism, and that parents who do not vaccinate their children are “parasites” for depending on other parents who do. (She later apologized for that remark, calling it “divisive”.)

While I appreciate Amanda Peet’s support, I feel strongly that scientific questions should be handled by the scientific community. Celebrities are great when they support causes – but when they second guess the scientific community and decide to advocate for their own scientific conclusions, they are more likely to cause harm than good.In that post I also took David Kirby to task for criticizing Amanda Peet, saying that her position is against the “medical establishment.” Kirby used a very dubious chain of logic to come to that conclusion – relying heavily on the opinions of politicians and ambiguous cases and failing utterly to make the case that the medical establishment, or any consensus of scientific medical opinion, finds any credibility in the supposed link between autism and vaccines.

My Involvement with this Issue

Before I respond directly to Kirby and Poling I want to review my personal involvement with this controversy. Not because it is relevant (only the scientific evidence is relevant) but because my critics often try to make it relevant, usually by making false assumptions about me. So I want to just set the record straight, satisfy any curiosity, and also make this my formal disclosure of any potential conflicts.

I am an academic neurologist in the clinical educator tract at the Yale University School of Medicine. I am an adult neurologist (not a neurosurgeon) with specialties in general neurology and neuromuscular disease. My duties are primarily teaching and clinical with some clinical research thrown in.

I do not participate in autism treatment, diagnosis, or research. I am not affiliated in any way with the Yale Child Study Center or autism research at Yale. I do not speak for Yale or autism research at Yale in any regards. I do not prescribe or research vaccines. I do not work for or have any financial interest in any pharmaceutical company or any corporation that has a vested interest in the vaccine program. I have never worked for the government or any regulatory agency. I am not involved in any legal cases involving autism or vaccines.

My first involvement with this controversy was several years ago when I was invited to write a review article for the New Haven Advocate. This was an outgrowth of what I consider to be my primary academic activity – educating the public about science and science-based medicine. This is something I have been doing for over a decade, starting with the New England Skeptical Society, a non-profit educational organization I started with some colleagues to promote science and reason. My activities have evolved over the years and now include a popular science podcast (the Skeptics Guide to the Universe) and this blog.

After several months of reading and literature review, I decided that at that time (2005) the evidence did not support a link between vaccines in general, the MMR vaccine specifically, or thimerosal in vaccines with autism or any neurodegenerative disorder. I did not begin my investigation with that conclusion. My goal was to accurately reflect the current state of the scientific evidence. As an outspoken scientific skeptic, my reputation is not based upon any particular scientific conclusion. Rather it is based upon dedication to the process of science – using valid logic and fairly accounting for all available evidence.

So for me the only thing that mattered was getting the science right. If I honestly thought the evidence supported a link between vaccines and autism I would have promoted that conclusion. This would have actually worked out much better for me and my career – becoming an early advocate for a minority and highly controversial position that I thought was correct and would eventually be vindicated would have worked very well for me. As it turns out I supported the boring consensus position and was largely ignored outside of skeptical circles. Oh well.

David Kirby

In 2005, as part of my research, I read David Kirby’s book, Evidence of Harm, in which he promoted the conclusion the thimerosal probably does cause autism and that the government is essentially engaged in a cover up of this fact. This conclusion was premised in part on the belief that we are in the midst of a true autism epidemic – that true autism rates are increasing rapidly (the evidence, however, supports the conclusion that the apparent increase is due largely to an expanded diagnosis and increased surveillance). At the time I also interviewed David Kirby for several hours by phone. We both agreed that our respective positions were destined for a definitive test – for thimerosal had been removed by the beginning of 2002 from all vaccines in the routine child vaccine schedule. If thimerosal were a significant cause of autism then autism rates should plummet by 2007. If not then they would continue to rise until they plateau at the true rate. Well, it’s 2008 and autism diagnosis rates have continued to rise without a blip. This fact alone rules out thimerosal as a significant contributor to autism rates (as always – really just as a point of logic – an effect too small to be detected by the available data cannot be ruled out).

David Kirby, however, refused to admit the undeniable implications of this data. He has since moved on to other hypotheses linking vaccines and autism- just as speculative and lacking in data.

In my recent blog post I criticized Kirby for his recent Huffington Post piece – specifically that he is desperately trying to portray the public controversy over an alleged association between vaccines and autism as a legitimate scientific controversy. Yet to make his case he cites politicians and regulators – not scientists. Further he cites the fact that the IACC (the Interagency Autism Coordinating Committee) expressed interest in exploring the vaccine-autism issue. But it turns out this interest came from Lynn Redwood – a member of Safe Minds, a group promoting the idea of a link between vaccines and autism. She was included to give voice to this minority opinion. Now Kirby is using that politically-motivated inclusion to argue that scientists are taking the controversy seriously.

Kirby now takes this self-referential strategy one step further. First he writes:

I write my Huffington Post blogs in order to spark debate and commentary from other quarters about what has become — like it or not — the biggest medical controversy of our time: the potential link between vaccine ingredients and autism.

In that sense, my last piece, “Amanda Peet vs. the Medical Establishment,” has done its job.

Reaction was predictably swift and furious to this opinion essay — and that’s what blogs are: this is not news reporting.

Let me dissect this a bit. He is saying that the purpose of his blog entry was not to report or inform, but to spark debate and commentary. Does that mean we are not meant to trust the information in his blogs? Are they intended only to provoke and not inform? While I agree that blogs are largely opinion pieces, the distinction from reporting is not clean. Often blogs will report news or summarize evidence. Opinions are often based upon a factual premise – you cannot then hide from misinformation and poor facts by claiming it’s all just opinion.

Kirby is also claiming that the autism-vaccine question is the “biggest medical controversy of our time.” I disagree, but I am also not sure how to objectively measure such a thing. As a side note – notice how he wrote: “potential link between vaccine ingredients and autism” – vaccine ingredients. Without ever admitting defeat on the thimerosal issue, he has quietly shifted his claim over to “vaccine ingredients”. What ingredients are those, I wonder?

What Kirby is primarily doing here is exactly the same thing that the Discovery Institute (an anti-evolution group) tries to do with intelligent design (ID) and evolution. They promote the idea of a scientific controversy of evolution and ID where none exists. They then use propaganda and political mechanisms to create a public and political controversy. They then present the public controversy they manufactured as if it were a scientific controversy, and then scream for academic freedom to “teach the controversy.” Meanwhile they desperately claim that there must be something wrong with evolution or else why would there be such a controversy.

Kirby and the anti-vaccination crowd have created a false controversy over vaccines and autism. They then promote this controversy as if it were a legitimate scientific controversy. They then demand that their claims be investigated, that they are represented on the IACC, and they sue the government over alleged vaccine injury – and claim that the resultant controversy they manufactured is evidence for a legitimate scientific controversy and that they should therefore be taken seriously. There must be something to this controversy we manufactured because there’s a controversy – it’s nothing more than an elaborate and deceptive self-fulfilling prophesy.

Kirby is now using a strategy also familiar to the ID crowd – say something scientifically outrageous, and then use the backlash of scientific outrage to say – well at least I got them talking about it and taking the controversy seriously. Mission accomplished. It’s just more self-fulfillment.

What is lacking in the case of ID and the anti-vaccination movement is an actual scientific controversy, or reliable scientific evidence to challenge the current consensus of opinion.

For further self-reference, Kirby writes:

Now, Hannah’s father, Dr. Jon Poling, a respected neurologist and clinical assistant professor of the Department of Neurology, Medical College of Georgia, has responded to Dr. Novella, including his, “criticizing the journalism of Mr. David Kirby.”

A copy of Dr. Poling’s letter to Dr. Novella is posted at what ABC News.com called “the popular blog, Age of Autism.”

It makes for some good reading, from deep inside the medical establishment!

It is misleading for Kirby to refer to Dr. Jon Poling as being “deep inside the medical establishment.” Sure, he is a neurologist, but he is hardly a disinterested expert. He is, as Kirby points out, Hannah’s father. This means that he was involved in suing the vaccine compensation program on the claim that vaccines triggered his daughter’s neurological condition. In this case he is acting more as a member of the anti-vaccine movement than the medical establishment.

For the record, I don’t think it’s accurate to characterize me as part of the medical establishment either. As I pointed out above, I am not involved in autism research or any organization dealing with autism or vaccines. I am simply an individual academic educator distilling this information for the public. But this is a small and not very relevant point.

Also Kirby might be just being facetious, as he claimed he was in his original post about the “medical establishment.” That gives him the ability to make his point – the medical establishment is fighting amongst itself over this real controversy – without being held accountable to the details.

Dr. Jon Poling

Dr. Poling has published an open letter (his second to me) on the Age of Autism website – a site dedicated to the failed mercury hypothesis of autism. He begins:

Your assertion that the scientific question of Autism etiology belongs to the medical community rather than Hollywood Stars is correct. I also agree that Hollywood opinions are more likely to be broadcast to millions because of their position in the media. This heightened awareness is nothing but a positive thing for the million families struggling with this difficult, and all too common, disorder. Jenny McCarthy is an Autism Mom looking for answers and rattling some cages—good for her. Amanda Peet is a new mom who believes in the importance of vaccines to protect her baby—good for her too. Don’t attack the moms, listen to them.

Heightened awareness is not always a positive thing, if it’s awareness of misinformation. What Jenny McCarthy has done is spread demonstrable misinformation (like the false claim that vaccines contain antifreeze) which has served to confuse the public. Unscientific propaganda distracts from real science and real solutions. Misinformed parents, hoping for answers, have been lured by false claims of the so-called “mercury militia” to risky and likely ineffective treatments, like chelation therapy. Hysteria over vaccines has lead to increasing numbers of parents choosing not to vaccinate their children – with resultant outbreaks of preventable diseases, like measles. This threatens herd immunity – which means that vulnerable populations, and even the vaccinated, are at increased risk (because vaccines are not 100% effective).

Dr. Poling is saying, essentially, that public misinformation, risky and ineffective treatments, false hope, and unnecessary outbreaks of preventable disease is all good – as long as it raises awareness.

He then tries to defend McCarthy, and criticize me, with the mommy gambit. This was tried before by RFK Jr. who tried to deflect skepticism towards the dubious claims of the mercury militia as an “attack on mothers.” McCarthy’s status as a mom, even of a child who may have autism, does not exempt her opinions from scrutiny, and does not remove from her the obligation to use her celebrity status responsibly.

He continues:

In criticizing the journalism of Mr. David Kirby, you wrote:

“He refers again to the Hannah Poling case, a girl with a mitochondrial disorder who developed a neurodegenerative disorder with “features of autism” after getting a fever from vaccines.”

Actually—Hannah has diagnoses of DSM-IV Autism (by JHU/KKI psychology) and mitochondrial disorder (by two metabolic experts). The only ‘degeneration’ that occurred (along with 6mos of total growth failure) after 18mos of NORMAL development followed vaccination and nothing else! Of course, any ‘scientist’ can obviously point out that temporal correlation in a single case never proves causation. Rule number one of pediatrics though is “LISTEN TO THE MOM.” Are 10s of thousands of autism moms over the last decade suffering from mass hysteria induced by Hollywood? Not likely.

I was quoting the summary of the case in the Autism Omnibus decision – “features of autism.” I am still not convinced that Hannah Poling has a condition on the autism spectrum, as opposed to a broader neurological disorder that has features that overlap with autism – enough to meet some of the DSM-IV criteria. The case report also listed many symptoms that are not symptoms of autism. But as even Dr. Poling admits, this is part of the problem of trying to reach any reliable conclusion from a single case.

Dr. Poling emphasizes that his daughter had “NORMAL” development until 18 months of age. Assuming this is true, that only means the she had a regressive neurological disorder – nothing exotic or unusual there. Many neurological disorders known to be genetic are regressive – children develop normally for a while and then lose ground. This by itself is not evidence for any sort of trigger, such as vaccines.

He then reiterates his mommy gambit non sequitur, this time presuming to preach to me about clinical wisdom. Listening to mothers (and all family members, for that matter) is about information gathering – not about scientific conclusions. Parents know their children and are sensitive to changes – but that does not mean they are equipped to scientifically interpret them. Any good clinician listens to patients and family members – but also knows that there is a huge tendency to over-report. This is because people do not instinctively know what information is important and what is coincidence, they have a tendency to see patterns even where they don’t exist, and they report a great deal of misleading or just unrelated information. It’s the clinician’s job to sort through that – to find the signal in the noise. Dr. Poling is telling me to listen to the noise.

He then finishes with a straw man – that the only alternative explanation is that 10′s of thousands (not sure how he came by that number or what specifically he is referring to) of moms are suffering from mass hysteria. The true alternative hypothesis – the one actually favored by the scientific consensus – is that the observation of mothers (and fathers, for that matter, but I guess fathers are not as emotionally appealing as mothers) is accurate, the mistake is in assuming causation from correlation. Autism is frequently diagnosed around the age that many vaccines are given. This does not mean that vaccines cause autism. We need controlled or epidemiological data to test that hypothesis – and the evidence strongly suggests that the correlation is coincidence – not causation.

Dr. Poling then writes (again quoting me):

“This special case – which is not a case of autism being caused by toxins in vaccines – says nothing about the broader vaccine-autism debate.”

The only thing unique about my little girl’s case is the level of medical documentation—5 to 20% of patients with ASDs have mitochondrial dysfunction. Many other cases where mitochondrial testing is WNL is because “we never looked” not because the testing would be “within normal limits.” Most mitochondrial experts will tell you that the dots of autism and mitochondrial disorders are strongly connected.

Dr. Poling is saying that his daughter’s case is not unique – that it is typical and therefore is does say something about a broader vaccine-autism connection. Hannah Poling’s history has many features that are not typical of autism – like a history of otitis media with frequent fevers, seizures, and what sounds like a rare encephalitis that probably did result from vaccines. Even if we put her mitochondrial mutation aside – this is not a typical case of autism.

Dr. Poling also makes specific claims about the association of autism and mitochondria – which is not surprising as this is now one of the favored hypotheses of the anti-vaccine crowd, now that their mercury hypothesis has failed. He does not reference his “5-20%” figure for autistic children with mitochondrial dysfunction. The highest figure I could find was 7.2%. I admit I am not familiar enough with this literature to know for sure if there is other published data showing it is more prevalent, but reviews of the literature give figures more in the 5% range.

But more important than the exact figure is what it means. Right now the answer is that no one knows. Autism is not a single disease, it is a complex of diseases with various causes. It may be that one of those causes is mitochondrial dysfunction. The anti-vaccine crowd are now seizing upon this to argue that vaccines are triggering autism in a population made susceptible by mitochondrial dysfunction. But this is pure speculation – a hypothesis, not something that can be concluded from any data. It is also possible that some forms of mitochondrial dysfunction cause autism without a trigger, or that there are a host of environmental triggers. Perhaps any fever can trigger regression, and therefore vaccines may even have a protective role by decreasing overall infections. Maybe we should be vaccinating children with mitochondrial diseases more, not less.

Much is unknown, but at present there is no evidence (beyond two isolated cases of which I am aware, Hannah Poling being one) that links vaccines to mitochondrial dysfunction and autism.

About the case he writes:

“The case was settled (not judged in Poling’s favor, but settled) because both sides realized it was a special case that could not be extrapolated to other vaccine-autism cases.”

The case was not settled, it was conceded by medical representatives of Sec HHS. We are obviously pleased with the HHS decision to concede our case, but we had NOTHING to do with the concession. This was a unilateral decision from HHS (recall that HHS is the respondent, rather than the vaccine maker, as manufacturers have blanket liability protection afforded by the Vaccine Injury Program established in 1986) I will not speculate on the obvious question—why concede? Hannah’s case was positioned to set precedent as a test case in the Omnibus Autism Proceedings for potentially thousands of other cases.

OK – I’m not a lawyer and I don’t want to get caught up in legal jargon. This is also not a normal court of law, so I am not sure if “settled” even applies to such hearings. I was referring to the fact that the case was removed as a test case – it was not decided as a test case. The HSS agreed that “compensation was appropriate” – they specifically did not concede, as Dr. Poling implies, that vaccines were actually responsible for Hannah Poling’s autism. What the HHS did not do was rule that this case sets a precedent for any other case. It seems that Dr. Poling is suggesting that the Autism Omnibus cheated – they removed a case they knew would set a precedent they apparently did not want. But wasn’t the whole point of the test cases to be test cases?

My interpretation (and that of many others) of the HHS ruling was that the Hannah Poling case is too complex and unique to be a test case, but because there is so much uncertainty they erred on the side of compensation – without conceding that vaccines caused autism in this case.

He continues:

With regard to the science of Autism, I have no argument with the assertion that a single case does not prove causation of a generalized autism-vaccine link. What the case does illustrate though is a more subtle point that many physicians cannot or do not want to comprehend (ostensibly because vaccines are too important to even question). Autism is a heterogeneous disorder defined by behavioral criteria and having multiple causes. Epidemiological studies which have not found a link between autism and aspects of vaccination do not consider the concept of autism subgroups. Indeed, in a heterogeneous disorder like Autism, subgroups may indeed be ‘vaccine-injured’ but the effect is diluted out in the larger population (improperly powered study due to inability to calculate effect size with unknown susceptible subpopulation).

At least we agree that this one case cannot prove a causation between vaccines an autism. But isn’t that the whole question? Trying to rescue the conclusion he appears to want, Dr. Poling then pulls the “you can’t handle the truth” gambit. I really love this one – yeah, if vaccines are causing harm I (as an academic neurologist with no direct ties to vaccines at all) want to just hide my head in the sand. Please, Dr. Poling, spare us your condescension. Apparently what I cannot admit is that: “Autism is a heterogeneous disorder defined by behavioral criteria and having multiple causes.” Gee, that sounds familiar – where have I encountered that concept before.

Well, a year ago I wrote in a blog entry on autism:

First it needs to be understood that ASD is likely not a single disease but rather a groups of diseases possibly with various underlying causes.

Again – I am not an autism expert. I am just distilling the consensus of opinion of experts – who seem to have no problem recognizing that autism is a group of disorders, not a single disorder. I don’t expect Dr. Poling to have read every blog entry I have ever written on autism, but if I easily gleaned that from the autism literature, why didn’t he. It seems he was just assuming whatever was convenient for him to assume about his fellow physicians.

His next statement is technically true – that studies designed to look for an effect in an entire population may not be powered to find those effects in a much smaller subgroup. But I have been reading the literature long enough to recognize this as a juicy post-hoc rationalization. In other words – this is what proponents always say after the evidence doesn’t support their contentions. It’s true – but it doesn’t mean there is an effect in a subgroup – it just means we cannot rule out effects that are smaller than the data is capable of showing. This is universally true – by itself it does not rescue data from being negative. At best it means that you can generate a new hypothesis (a subgroup effect) after the old one has been rejected (no effect in the entire group). But all you have now is an untested hypothesis – speculation, not evidence.

After some more speculation, Dr. Poling descends further into condescension:

Definition: Autism is a heterogeneous systemic disorder with primary neuropsychiatric manifestations due to complex genetic and gene-environmental interactions likely affecting synaptic plasticity early in childhood development. This new theory of Autism is rapidly replacing the ‘old guard’ dictum that Autism is a genetically predetermined developmental brain disorder of synaptic formation/pruning that is set in motion prenatally. By the ‘10 year rule of science,’ your time is about up!

Time is up for what, exactly? Is Dr. Poling assuming that I am part of some alleged “old guard” that doesn’t recognize that genes interact with their environment. Does he forget that I am a neurologist, like he (we even went to the same medical school). I treat ALS – guess what is the leading hypothesis of the causes of ALS (which, like autism, is a group of diseases with various causes) – that it is a complex interaction of genetics and environment. What about multiple sclerosis – a complex interaction of environment and genetic predisposition. I have not been in neurology long enough to remember a time when this was not the leading hypothesis as to the cause of many neurological disorders.

Genetic phenotypes interact with their environment – sure. The question is, what is the relative contribution from genes and environment, and what is the interaction. This is a question that autism researchers have asked themselves (even though they cannot comprehend such things, according to Dr. Poling). For example there have been twin studies that specifically ask what the relative contribution of genes and environment is to the risk of developing autism. The conclusion of this one study is: “Genetic structural equation modeling showed that the overlap between AQ and WB and SOC was mainly due to genetic effects.” This means when they looked at twins and non-twin siblings, shared genetics was more of a predictor of overlapping autism traits than shared environment.

This is hardly the final word, and yes this is a very complex topic that requires further research. Subgroup analysis – sure, sounds good. My point is that researchers are asking the very question Dr. Polings suggests they are not, and also that the evidence is pointing in the direction of strong genetic influences in autism. I have no problem with researchers exploring hypotheses about specific environmental triggers of specific genetic abnormalities in subgroups of autism – research away. I would not even be surprised if such research yielded fruit.

My position, rather, is that we cannot conclude from current evidence that there is a specific causal link between vaccines and autism. Further, any such potential link is likely to only be relevant to a minority of autism cases as existing evidence rules out a moderate or larger association between vaccines and autism. Finally – none of this rescues the thimerosal hypothesis as the explanation for an autism epidemic. Dr. Poling admits that they are now nibbling around the edges of autism – not proposing a possible explanation for a major cause of autism. The fact that there was no measurable effect on the incidence of autism after the removal of thimerosal rules out a significant effect for thimerosal by any mechanism.

This includes the article that Dr. Poling references on altered calcium homeostasis. He says that in the discussion the authors speculate about thimerosal as a possible trigger. This type of speculation does not derive from the data – it’s just speculation. Further, as I just pointed out, it doesn’t matter what mechanism is proposed for an effect from thimerosal, the data already rules out a significant effect.

He concludes:

Thank-you Dr. Novella and his band of skeptics for continuing the debate.

No problem, Dr. Poling. Me and my merry band of skeptics will now return to Sherwood Forest. In all seriousness – more skepticism is exactly what Dr. Poling and his side need. Skepticism is just good science.

It’s interesting that Dr. Poling finishes with Kirby’s debate gambit – as if the debate justifies it’s own existence. At least that brings this discussion full circle.

Conclusion

Existing evidence supports the conclusion that autism spectrum disorder – while a collection of disorders of differing causes, is dominantly genetic. There is no evidence to support vaccines or thimerosal as a significant contributor to autism. Proponents of an autism-vaccine link have been steadily retreating from negative data falsifying their claim. They are now focusing on small subgroups of autism with possible genetic and environmental factors – but at present have nothing more than speculation to implicate vaccines even in this drastically reduced role.

Meanwhile there are groups and individuals presenting to the public unsubstantiated claims that vaccines are unsafe and cause autism. These unproven claims are leading some parents to unproven and dubious therapies. It is also leading some parents to forgo immunization, threatening herd immunity and already resulting in outbreaks on preventable diseases.

David Kirby and Dr. Poling want the debate to continue – and not just in the laboratory and the clinic, among scientists who can parse the subtleties of the data – but in public where fear-mongering and misinformation are easy to spread. According to them, it’s all good.

________________________

This entry has been cross-posted at NeuroLogica blog

Posted in: Neuroscience/Mental Health, Public Health, Vaccines

Leave a Comment (64) ↓

64 thoughts on “Autism and Vaccines: Responding to Poling and Kirby

  1. Richard says:

    I would just like to add my voice in praise of Amanda Peet. I can understand your concerns about the influence of celebrity opinions on the public, but she is our ally and needs our support. Let’s work with her.

  2. overshoot says:

    He then finishes with a straw man – that the only alternative explanation is that 10’s of thousands (not sure how he came by that number or what specifically he is referring to) of mom’s are suffering from mass hysteria. The true alternative hypothesis – the one actually favored by the scientific consensus – is that the observation of mothers (and fathers, for that matter, but I guess fathers are not as emotionally appealing as mothers) is accurate, the mistake is in assuming causation from correlation. Autism is frequently diagnosed around the age that many vaccines are given. This does not mean that vaccines cause autism. We need controlled or epidemiological data to test that hypothesis – and the evidence strongly suggests that the correlation is coincidence – not causation.

    Back in the 19th century, John Langdon Haydon Down (yes, that Dr. Down) described many cases of what would be today called autism, in his detailed and methodical manner. Among them he noted a distinct subtype that would today be recognized as “regressive autism,” and in earlier days as changelings. Lacking a vaccination schedule to pin it on in those days, mothers instead related the change in their children to the “second teething.”

    So it would seem that we have multiple sets of mothers’ wisdom in conflict here. Is it the Fair Folk, teething, mercury, or something else that causes this in their children?

  3. overshoot says:

    Epidemiological studies which have not found a link between autism and aspects of vaccination do not consider the concept of autism subgroups.

    Since some of those epidemiological studies have been whole-population studies, there are only two ways that subgrouping could change the conclusion:

    1) The supposedly vulnerable subgroups are so small that they cannot be detected by comparing outcomes for millions of subject, or
    2) There are offsetting subgroups for whom vaccination is protective, yielding a net de minimis result.

    In either case the risk/benefit relationship for decision makers is the same: vaccination poses no net risk to children. Whether it might be possible to identify either extremely rare or offsetting groups is interesting but moot.

  4. Kev says:

    overshoot: point 1) in your comment seems to be the new strategy of the Petitioners in the ongoing Autism Omnibus – in direct contrast to the all the years of woe-talk regarding the mythical Autism Epidemic.

  5. overshoot says:

    Kev:

    overshoot: point 1) in your comment seems to be the new strategy of the Petitioners in the ongoing Autism Omnibus – in direct contrast to the all the years of woe-talk regarding the mythical Autism Epidemic.

    So it’s a lottery. This is news?

    The way that vaccine court works, it’s not dependent on how common something is. Once you establish that 1 per thousand autism cases might have been caused by a vaccine, all thousand are in a position to collect (or at least their lawyers and experts are) on the grounds that any one of them might have been hit by the golden BB.

    Reversing the funnel, the kind of rhetoric we see here uses the (claimed, at most) hundreds of kids since the early 90s as the Horrible Risk that parents must avoid by making sure that their children aren’t exposed to those Nasty Nasty Vaccine Toxins.

  6. TsuDhoNimh says:

    “I found that the history was somewhat of the following. Their early months of babyhood were perfectly uneventful; there had been nothing to cause the slightest anxiety; intelligence had dawned in the accustomed way, when, first dentition proceeding, a change had come over the aspect of the child. Its look had lost its wonted brightness; it took less notice of those around it; many of its movements became rhythmical and automatic, and with or without convulsions there was a cessation of the increasing intelligence which had marked its early career; anxiety was felt on account of the deferred speech, still more from the lessened responsiveness to all the endearments of its friends”

    On Some of the Mental Affections of Children and Youth. J. Langdon Down. 1887

    *********
    Now if that isn’t a description of regressive autism …what is?

  7. DLC says:

    A nice couple of articles, Dr. Novella, thanks for posting them.
    As for David Kirby: what he gets out of “stirring the pot” isn’t “truth” or scientific advancement, but more instances of seeing his name in print. I don’t think it matters to him if it’s Autism or Rickets he was writing about, so long as it got his name on somebody’s front page (or even page 5).

  8. anniepema says:

    Paternal age causes a great deal of autism and early childhood schizophrenia (autism) this is non familial. Vaccines aggravate mitochondrial disorders. Sperm stem cells accumulate mutations with age and exposures to toxins and there is plenty of research for the last 50 years on various aspects of this subject. http://how-old-is-too-old.blogspot.com/

  9. autism360 says:

    Defending mercury in vaccines is a battle only for fools.I have no respect for anyone who will defend injecting toxic metals into infants.Get smart defend the kids not hazardous waste.

  10. autism360 – your statement is misdirection and a non sequitur. I am just relating what the scientific evidence says. If the science says there is no evidence that thimerosal in vaccines has caused any harm – that is not defending a toxic metal – it’s reporting the scientific evidence.

    Second – the best way to defend children is with the best scientific evidence, so that we can know what the right thing to do is. What about all of those children who suffered needlessly from preventable diseases, or who died from worthless chelation therapy. By your logic you are not interested in defending those children.

    We are arguing about the best way to interpret the scientific evidence so that we can do what is best for children and everyone. You just pulled a cheap ploy in a failed attempt to take the moral high ground.

  11. Fifi says:

    overshoot – “Among them he noted a distinct subtype that would today be recognized as “regressive autism,” and in earlier days as changelings.”

    Thanks overshoot, I have a particular interest in the intersection of medicine and mythology – and where our mythological beliefs come from. The myth of changelings does indeed fit very well with autism. Did you come across this idea somewhere or did you just put two and two together?

  12. davlin says:

    “Dr. Poling is saying that his daughter’s case is not unique – that it is typical and therefore is does say something about a broader vaccine-autism connection. Hannah Poling’s history has many features that are not typical of autism – like a history of otitis media with frequent fevers, seizures, and what sounds like a rare encephalitis that probably did result from vaccines. Even if we put her mitochondrial mutation aside – this is not a typical case of autism.”

    This article really pointed out the danger of the so-called “objective observer”. It points out a need to honestly and fully investigate autism further and listen to more parents. What Dr Poling has said is absolutely true – Anna Poling’s history is actually like many with regressive autism, right down to the repeat ear infections, frequent fevers and seizures. It is actually quite common to hear of these symptoms coming in a the same time as the regressive behaviour.

    And most in the community are not “anti-vaccine” at all, rather they are “safe-vaccine”, though it may be convenient to dispense of their experiences by labelling them as such.

    Obviously, no pertinent discussion will be gleaned here…time to move on…

  13. David Gorski says:

    And most in the community are not “anti-vaccine” at all, rather they are “safe-vaccine”, though it may be convenient to dispense of their experiences by labelling them as such.

    Perhaps you should tell that to those whipping up the hysteria against vaccines. They aren’t listening.

    Actually, the “pro-safe vaccine” gambit is just that–a gambit. Antivaccinationists know that being perceived as anti-vaccine is a bad thing–as well it should be. However, if you want to determine whether someone who claims to be “pro-safe” vaccine really is that, ask this:

    1. What specific evidence would it take to convince you that vaccines are safe?

    2. What is an acceptable level of risk/complications for vaccination?

    Antivaccinationists have real problems with the two questions above. They have trouble with #1 because in reality no evidence will convince them that vaccines are safe. Also, frequently, they will answer #2 with: 100% safe. When I hear that, I know I’m dealing with an anti-vaccinationist because there is no such thing as 100% safe anything. Every medical intervention is a balancing of risks and benefits, and we do things every day that are far less beneficial and far more risky than being vaccinated. (Driving a car, for example.) Antivaccinationists cannot or will not understand that.

    Take a look at this to see how “not anti-vaccine” the “Green Our Vaccines” movement is.

  14. kac says:

    Interesting information about 19th century parents saying that teething was going on when their children regressed into what would today be considered Autism. Back in the 19th century teething powder had mercury in it.

  15. overshoot says:

    Fifi:

    Thanks overshoot, I have a particular interest in the intersection of medicine and mythology – and where our mythological beliefs come from. The myth of changelings does indeed fit very well with autism. Did you come across this idea somewhere or did you just put two and two together?

    I certainly can’t take credit. The similarity between regressive autism and the tales of changelings has been around since before they started blaming vaccines for autism; I recall someone citing it (and it was old then) back in misc.kids before misc.kids.health was chartered. Must have been early 90s.

    DejaGoogle News might have something.

  16. overshoot says:

    Interesting information about 19th century parents saying that teething was going on when their children regressed into what would today be considered Autism. Back in the 19th century teething powder had mercury in it.

    In the 20th century teething powder had mercury in it, but the use of mercuric chloride is later than Dr. Down’s work and much later than other accounts. Interestingly, there does not seem to have been a drop in autism subsequent to the elimination of mercury in OTC preparations.

    For instance, Augustus Lamb was a fine example. Son of Caroline and William Lamb, Lord Melborne — later Prime Minister of England. That was the early 19th Century and there’s quite a bit in the journals and biographies of the famous Lord which recounts Augustus’ regression and later life in detail.

  17. davlin says:

    Actually, I am just as concerned about hyper pro-vaccine individuals as I am about the anti-vaccine – and now the suggestion that anyone pro-safe vaccine is suspect underlines that fact. I know several doctors who are actually afraid to speak up about what they have witnessed. They thought the first episode was a “coincidence”, and then it happens again and at a differnt time-line. The establishment maintains the staus quo, you know? Doctors meetings where concerns about temporal associations are spoken of then routinely dismissed to avoid controversy and to protect “the numbers and vaccine schedule”. How is this a good thing? And the fact is that Big Pharma is protected and continually markets and woos doctors who don’t always have the time to ensure thay are harnessing all information on relevent medical interventions.

    From what I understand, the first rule of thumb is to do no harm. If ignoring correlations (and I am talking specifically regressive autism here), and rewriting childrens’ histories is acceptable, then we are not talking relevent, progressive medicine. Vaccines are not just for the “greater good”, and we need to acknowldge that when something goes wrong (and it does in some cases), we need to support the consequences, but more importantly, we need to mitigate the damage. Saying nothing is 100% safe is accurate but does not absolve us our obligation to fix damage we have inflicted unintentionally.

    No one is comfortable with the idea of collateral damage, but dismissing it by quoting literature when you haven’t actually witnessed it or lived with it doesn’t further the positive attributes of vaccines.

  18. daedalus2u says:

    It was mercurous chloride (HgCl) or calomel not mercuric chloride (HgCl2) also called corrosive sublimate. HgCl2 was used but at considerably lower doses that HgCl.

    Many teething powders had a grain of HgCl per dose. That is 65,000 micrograms of HgCl, or 55,000 micrograms of mercury.

    One company sold over 30 million doses in one year containing 65,000 micrograms of calomel per dose.

    Over 1000 children died from pink disease from mercury containing OTC drugs.

    Many millions of children received many thousands of times more mercury from teething powders than any child ever received from vaccinations.

  19. savants says:

    “with autistic features” is NOT autism. Many conditions have autistic features. Only 50% of the savants I have followed have Autistic Disorder; the other half have MR, traumatic brain injury or even fronto-temporal dementia. Many of those have ‘autistic features’ (mannerisms, sterotyped movements,
    habits etc) but autistic features as SYMPTOMS are different from AUTISM as a disorder. The Poling decision only conclued there was an encephalopapy with “autistic features” That term has been morphed by Kirby and others into “autism” (Many blind children, normal except for visual impairment, have ‘autistic features’ and it is important to consider that in differential diagnosis of those children),

    Elsewhere in medicine such ____like circumstances are not unusual. For example patients with fronto-temporal dementia (Pick’s) have many ‘alzheimer-like’ symptoms; but it is not alzheimer’s disorder. And some patients on certain anti-psychotics have ‘parkinson-like’ symptoms; but it is not
    Parkinson’s disease. And many conditions can produce dementia; but they are not all Alzheimer’s.

    The beginning of wisdom is to call things by their right names.
    In that regard ‘with autistic features’ is NOT autistic disorder and we need to be careful not to morph those terms together.

    And yes, Dr. Down did describe clear cases of late onset or regressive autism. He mentioned that this often occurred at the time of the ‘second dentition’. But even he was careful to indicate that such an association may have been only temporal in nature. He also named these cases “developmental” retardation, a term a century later WE use to describe this category of cases now. And, he commented on the special head findings in this developmental retardation group, also an interesting finding with the head size research currently underway.

    I’ve been involved in autism epidemiology and other research for 50+ years and I have been at it so long that I had the opportunity to learn from Dr. Kanner himself when he was a visiting professor at UW-Hospitals in Madison Wisconsin during my training. Autism is a group of disorders (as is mental retardation) with a final common path we call autism. Some cases represent an interaction between genes and environment (with epigenetics as the mechanism). I recently posted my paper on Common Sense Autism on the savant syndrome web site at http://www.savantsydrome.com in the articles section. It echoes many of the concerns expressed above, particularly the morphing of autistic symptoms into autism; the ever expanding diagnostic spectrum and ‘epidemic’ of cases; and the fact that autism is group of disorders, not a disorder with only one cause.

  20. kac says:

    Isn’t there any easy way to solve this debate once and for all. Have a study with a vaccinated group and an unvaccinated group. If vaccines don’t play a role in Autism , then both should have the same rate.

    A reporter went to the Amish community , who don’t vaccinate, and found , I think 3 cases of Autism. 2 were adopted and vaccinated and 1 lived near a coal burning plant. The “scientific community” found this info not reliable because the Amish are considered a homogenous group .

    If anyone knows of a study that has been done using a vaccinated group against an unvaccinated group let me know.

    All I know is that there is a fight in Congress to get this research done. Why ?

  21. Harriet Hall says:

    “Have a study with a vaccinated group and an unvaccinated group”

    I don’t think you can do that. It would be unethical to deny children the protection of vaccines and it would endanger others in the community by reducing herd immunity.

    There are things science simply can’t do: like randomizing people and making half of them smoke and making the other half not smoke all their lives. Nevertheless, we were able to determine that smoking was harmful by other means.

  22. kac says:

    I’m pretty sure you could find unvaccinated children in this country or some where else in the world.

    In fact Homefirst medical services outside of Chicago has about 35,000 children who aren’t vaccinated because of religious beliefs.

    I keep hearing everyone use “herd immunity” as the reason parents need to vaccinate their children. If they don’t then they are considered ” parasites”. If herd immunity is so important why aren’t adults required to keep up with their vaccinations. Majority of adults had their last vaccinations done when they were children or teenagers. Vaccines last about 10 years if you are lucky.Do diseases only attack children and bypass adults ? Don’t you need 90% of the population to be vaccinated to have herd immunity. Why aren’t adults included in herd immunity. Aren’t there millions of undocumented workers in this country, who aren’t current with their vaccines. Why are parents of Autistic children vilified for questioning vaccines and called parasites if they choose not vaccinate.

  23. davlin says:

    PKU and conjenital rhubella are known contributors causes of autism. When we know the underlying mechanism we rename it and title it with the addition of “autistic traits/characteristics”. The fact is we do not know the underlying mechanism of most cases of autism, nor do we fully understand its covergence on any path. Most research can truly account for a small percentage of any particular subtype. Neither of the two “causes” above mean a definative diagnosis – you can prevent rhubella, and a positive diagnosis of PKU at birth can establish a dietary regiment to prevent secondary issues such as autism.

    I have noticed a general lack of many camps in the research and advocacy realms to merge and openly discuss throughly any of this. Most mantain loyalty to their research/ideology and view anything else with a very narrow view finder. Research that verifies their point of view is lauded while research that challenges preconceived, dated or specific ideas are held to closer inspection and vilified.

    The fact remains – anyone claiming to know the genesis or true nature of autism is suspect. They don’t. Rather than the whole, all we have are fractions, so a discussion of the nuances of whether someone has autism or whether they have autistic traits gives a false sense of a certain knowledge base of autism we don’t really have.

  24. durvit says:

    A US study reported a 20% incidence of whooping cough infection in adults with a persistent cough. [1] Earlier this year Dr. Nayer Khazeni advised adults to be vaccinated against whooping cough: Vaccine News You Need in the San Franciso Chronicle.

    The new tetanus/diphtheria vaccine also vaccinates against whooping cough. This resurging infection in adults can cause cough severe enough to crack ribs or induce vomiting, and may last months.

    Depending on home circumstances, this might also lessen the likelihood of transmission to very young children and the setting up of secondary cases.

    Increasingly, adults are being advised to have booster shots, both for their own benefit and that of others.

    [1] Wright SW, Edwards KM, Decker MD, Zeldin MH. Pertussis infection in adults with persistent cough. JAMA. 1995 Apr 5;273(13):1044-6.

  25. davlin says:

    “Have a study with a vaccinated group and an unvaccinated group”

    This can be done easily. It has been loosly researched with the Amish and can certainly be done in more depth. Preliminary research had their (Amish) autism figure as extremely low compared to the general population.

  26. kac says:

    “adults are being ADVISED to have boosters of dpt”

    Children are MANDATED by the state to be vaccinated or they aren’t allowed in schools.

    If herd immunity is so important why aren’t adults MANDATED to keep up with their vaccinations. Why aren’t they denied employment if they aren’t fully vaccinated. Again, why is it only school age children required to vaccinate?

  27. Harriet Hall says:

    “why aren’t adults required to keep up with their vaccinations.”

    Most childhood vaccinations provide lifelong immunity. There is no need for adults to get boosters of anything but tetanus. And we are now recommending one tetanus booster include pertussis.

  28. kac says:

    Having the disease naturally = life long immunity

    vaccination= usually 10 years or unknown

    I had the MMR as a child by the time I was 21 I was no longer immuned

  29. HCN says:

    autism360 said “Defending mercury in vaccines is a battle only for fools.I have no respect for anyone who will defend injecting toxic metals into infants.”

    So do you think these are better toxins for babies: tetanospasmin, tetanolysin, diphtheria toxin and pertussis toxin ?

    I would love to see where is it shows that the level of thimerosal (about 0.0 micrograms) in the DTaP vaccine is more toxic than the above toxins which are produced by the actual bacteria.

    Oh, overshoot… I remember some posts on “changelings” in autism many years ago. But now I can’t find them, except mostly in alt.autism.support:
    http://groups.google.com/groups/search?hl=en&q=autism+changeling+&qt_s=Search

  30. The Amish data is worthless – it was a very sloppy phone survey. The Amish, in fact, do vaccinate and do get autism.

    You can compare vaccinated and unvaccinated children, as well as pre-vaccine and post-vaccine incidents. The CDC does this The date so far is negative, but I think next year they will be publishing data specifically on autism.

    The point is, though, that you cannot randomize – you cannot randomly assign children to not be vaccinated.

  31. David Gorski says:

    Steve, the Amish study wasn’t even a phone survey. It was just the sloppy “research” of a single antivaccinationist reporter named Dan Olmsted:

    http://autism-news-beat.com/?p=29
    http://photoninthedarkness.com/?p=69

    As for phone surveys, Generation Rescue once did a hilariously inept “experiment” (really nothing more than a phone survey) that was so badly designed and poorly carried out as to boggle the mind. Meanwhile, J. B. Handley was too dumb to realize that the survey, taken at its face value, actually suggested a protective effect against autism by vaccines in some groups. (No, it didn’t really show that, because it was worthless and didn’t really show anything, but the end data itself did seem to suggest that being fully vaccinated was protective against autism compared to being “partially vaccinated.”)

    See:

    http://photoninthedarkness.com/?p=99
    http://leftbrainrightbrain.co.uk/?p=567
    http://scienceblogs.com/insolence/2007/06/fun_with_phone_surveys.php

    As for your point about how you “cannot” randomize children not to be vaccinated, actually you can. It’s just that it would be horrifically unethical to do so and, fortunately, against the law. :-)

  32. savants says:

    The fact that we don’t know the cause of autism doesn’t mean it cannot be diagnosed in an appropriate manner in specific cases that do meet established criteria with a typical history and certain clinical findings. What is problematic is failing to distinguish between “autistic-like” traits and behaviors and “autism” as a disorder and morphing them together ‘as if’ they are the same condition clinically and causally. We don’t know the cause of Alzheimer’s yet there is such a condition and the diagnosis is appropriate in certain cases. Yet not every person with “Alzheimer-like” (dementia) symptoms has that disorder but from a research point of view, if we are ever to find out the cause of Alzheimer’s disorder, we will need to make that distinction in our research. Same with autistic disorder. The more conditions and ever broadening criteria we include loosely in the ‘spectrum’ (for whatever worthy reasons) the less specificity that diagnosis carries and the less the research yield with respect to definitive causes and then targeted treatment which (like PKU) is the ultimate objective.

  33. Harriet Hall says:

    kac said,

    “Having the disease naturally = life long immunity. vaccination= usually 10 years or unknown”

    That is simply not true. Where did you get that information? It sounds like some of the propaganda we find on anti-vaccination websites.

    “I had the MMR as a child by the time I was 21 I was no longer immuned”

    How did you determine that you were no longer immune?

  34. durvit says:

    Kac wrote:

    Having the disease naturally = life long immunity. vaccination= usually 10 years or unknown

    Harnden et al [1] reported that their analysis revealed that “neither infection nor immunisation results in lifelong immunity” for whooping cough. However, they found that prior immunisation resulted in attenuated clinical features.

    [1] Harnden A, Grant C, Harrison T, Perera R, Brueggemann AB, Mayon-White R, Mant D. Whooping cough in school age children with persistent cough: prospective cohort study in primary care. BMJ. 2006 Jul 22;333(7560):174-7.

  35. Harriet Hall says:

    The only thing I know of that wanes in 10 years is immunity to tetanus: hence the recommendation for all adults to get tetanus boosters every ten years. Incidentally, tetanus is not a communicable disease like MMR, polio, etc. so herd immunity doesn’t apply.

  36. kac says:

    While pregnant, blood work came back that I no longer had immunity to the measles, mumps or rubella. In fact most of my friends and relatives found out while pregnant that they had lost immunity to various diseases they had been immunized against.

    I have never heard that vaccines = life long immunity. I heard for example if you had the chicken pox as a child you are immuned to for life. Thats why when there were active chicken pox around it was all right to be around children who had it ,if you had already had it. Same with measles.

  37. kim spencer says:

    you are so very kind to try and protect poor little parents like me from dubious treatments. i would like to think that i am smart enough to know that if i research and try a treatment and it leads to improvement in my child, that i am barking up the right tree, thank you.
    dr. poling has said on cnn that he never would have believed this was happening if it had not happened to him/his child. dr. healy says she believed the status quo until she went and looked for herself. a huge percentage of autism parents (including me) were exactly like amanda peet with beautiful normal 18-month-olds potentially spouting the value of vaccination who over the next year or so realized they were in serious trouble as far as the health of their vaccinated children were concerned. how sad for all of us that we believed what you believe and ended up where we are today…with seriously sick children that no one will help us pay to help, and then find that the scourge of the earth treatments, ones that ameliorate the kind of damage vaccines can incur, are the ones that make the difference.
    i can’t wait til this is all over and you all realize the damage you have had a hand in perpetuating.

  38. Harriet Hall says:

    “i would like to think that i am smart enough to know that if i research and try a treatment and it leads to improvement in my child, that i am barking up the right tree, thank you.”

    We would all like to think that. Some of us realize that we are subject to human foibles and may be misled. Austistic children tend to improve over time, and it is easy to give credit where it isn’t due.

    A physician friend of mine has 2 autistic children. He and his physician wife had researched everything they could find and had put the kids on a special diet. It seemed to be working, and they were very pleased. Then one day my friend found out that his wife had discontinued the diet without telling him, and he hadn’t noticed any difference. He realized how easily he could be fooled. We all can.

  39. overshoot says:

    I heard for example if you had the chicken pox as a child you are immuned to for life.

    Actually, if you had chicken pox as a child you are infected for life. Herpes zoster sets up housekeeping in nerve roots for a continuing low-grade infection. Stress or age can reduce your resistance and up she rises. It’s called shingles.

    You can have the shingles, I’ll vote for the vaccine.

    Thats why when there were active chicken pox around it was all right to be around children who had it ,if you had already had it. Same with measles.

    Rechallenge keeps a lot of immunities going. IMHO that’s not a sufficient reason to go back to endemic polio, measles, diphtheria, smallpox, etc. Since quite a few of these diseases have no nonhuman hosts, I prefer the smallpox solution: eradication. Once there isn’t any wild polio or measles on Earth, we can have the best of all worlds: no vaccines and no disease either.

    However, that solution seems to bother the Friends of Endangered Microorganisms such as David Kirby.

  40. overshoot says:

    a huge percentage of autism parents (including me) were exactly like amanda peet with beautiful normal 18-month-olds potentially spouting the value of vaccination who over the next year or so realized they were in serious trouble as far as the health of their vaccinated children were concerned.

    I’m sure that it’s nice for you to blame vaccines for what happened, but what comfort do you have for those like Augustus Lamb who was never vaccinated and had the same regression at the same age?

  41. Harriet Hall says:

    Measles vaccine is considered to be 95% (range 90-98%) effective at preventing measles after one dose, and 99% effective after two doses.
    The duration of vaccine-induced immunity is believed to be lifelong in most vaccine recipients. A small proportion (<5%) may lose protection after several years.

    In a study of pregant women, (9.4%) women were susceptible to rubella, (16.5%) to rubeola, and (16.3%) to mumps. (32.6%) were susceptible to at least 1 virus, whereas only (1.7%) were susceptible to all 3. In that study, 3/4 of the women couldn’t remember if they had had the recommended boosters. Having received a booster (in childhood) predicted immunity to all 3 viral components of the MMR vaccine in adulthood.

  42. kim,

    I am a trained clinician and scientist and I would not be compelled by my own anecdotal experience. I know that just because a treatment seems to work that doesn’t mean that it does. We need controlled studies. Millions of people over the years have sworn by fake treatments that we know did not work or were even harmful – you just cannot tell.

    All we want is to know what really works. And we have very compelling and logical reasons for not trusting anecdotes. We have 100 years of medical history behind this position and well-developed opinions about the placebo effect, confirmation bias, the need to control for confounding factors, etc. We are clinicians and scientists, with families and children of our own.

    What we are trying to do here is simply share our analysis, our experience, and out opinions with the public and engage in discussion. Because that is how science works – that’s how it progresses – by critical analysis and productive discussion.

    And yet – ALL we have received from those who blame vaccines for autism is personal attacks, accusations, and utterly arrogant and mean-spirited dismissiveness. Read the comments over at Age of Autism in response to this entry. They accuse us of being evil, stupid, closed-minded, and in the pocket of “Big Pharma”. They think we hate children and attack mothers. We are just trying to understand the scientific evidence, and they are attacking us with conspiracy mongering and hateful diatribes.

    Like you just expressed, they are absolutely convinced that they are right and will be vindicated, and they are just waiting for the opportunity to gloat.

    And yet they are perplexed that we are not anxious to engage with them and take them seriously.

    The mind boggles.

  43. kac says:

    obviously, vaccines don’t work the same for everyone. Why is it that someone can get vaccinated against the same disease several times and still show no immunity. Why is it that someone can get vaccinated to a disease and when exposed to that disease still get the disease, While some people who get vaccinated never get the disease.

    Is it so far fetched to think that some children who receive vaccines have an adverse reaction and develop Autism. Thousands of parents have the same story.

    In medicine you can have 2 people with the same cancer getting the same treatment. One survives the other dies. You can have 2 people who smoke the same amount of cigarettes for same amount of time . One develops cancer the other doesn’t. The same can be said for the use of antibiotics, some people have reactions to antibiotics , others don’t. Obviously genetics play a part in all of these situations. How come it is so far fetched to think vaccines are not “one size fits all” . That the genetic make up of an individual can influence how they handle all of the vaccines.

  44. kac says:

    I’ve had the chicken pox and shingles, so I know how they feel. My son has Autism. I ‘d gladly trade his Autism for a bout of chicken pox or shingles any day.

  45. Harriet Hall says:

    “Is it so far fetched to think that some children who receive vaccines have an adverse reaction and develop Autism. Thousands of parents have the same story.”

    It’s not far-fetched, it just “could” be wrong. The only way to find out is with good science.

    Let’s say a study shows no correlation between vaccine and autism. By your argument, some of those children could be genetically susceptible and vaccines might have caused their autism anyway. But if we don’t see a statistical correlation, that would mean that an equal number of children were genetically protected from autism by vaccines. If “one size doesn’t fit all” how are we to know which size fits which?

    In cancer, if one person survives and the other dies, we still had to treat both of them the best we knew how, because we didn’t have any way of knowing which one would die.

  46. overshoot says:

    All we want is to know what really works. And we have very compelling and logical reasons for not trusting anecdotes. We have 100 years of medical history behind this position and well-developed opinions about the placebo effect, confirmation bias, the need to control for confounding factors, etc. We are clinicians and scientists, with families and children of our own.

    100 years? Sir, you grossly understate the case.

    We have millennia of written history of medicine, and a very great deal of it was accepted for centuries at a stretch as being effective. Today, those same practices are recognized by scientist and sectarian alike as at best useless and often harmful or even lethal.

    How, then, did they persist for such a long time? I sometimes imagine a woomeister reintroducing the exact same “medicine” that was taught in European medical schools in 1780 as the newest greatest thing. I fear that he would be wildly successful, with no end of testimonials to the wonders performed.

  47. overshoot says:

    I’ve had the chicken pox and shingles, so I know how they feel. My son has Autism. I ‘d gladly trade his Autism for a bout of chicken pox or shingles any day.

    Ah, but is that choice actually available to you?

    Wishing won’t make it so; it either is or it isn’t — and the best available information strongly suggests that it isn’t.

  48. Harriet Hall says:

    “I’ve had the chicken pox and shingles, so I know how they feel. My son has Autism. I ‘d gladly trade his Autism for a bout of chicken pox or shingles any day.”

    If your unvaccinated child had died of chickenpox pneumonia or encephalitis, you might feel differently. And chickenpox is only one of many vaccines, arguably one of the least important.

  49. kac says:

    No, unfortunately that choice isn’t available to me. How I wish it were.

    Statistically, the chances of my child dying from the chicken pox, measles or any of the diseases we vaccinate are low compared to 1-150 children developing Autism, or should I say 1-94 boys developing Autism. At it’s peak polio was 1-4000 . I would still take the gamble and have my child exposed to those diseases then deal with Autism.

    My child statistically has a higher chance of dying in a car accident then from any of those diseases and I still drive him places.

  50. HCN says:

    Though there is one problem with your statistics:

    There is no real evidence that the vaccines have anything to do with autism.

    Plus the 1 in 150 includes the entire spectrum of autism, from full Kanners without speech to very high functioning Asperger’s that go to college, get jobs and function fairly well.

  51. kac says:

    I think you are wrong. The 1-150 is for the diagnosis of Autism, not including PDD or Aspergers.

    There still isn’t real evidence that vaccines don’t cause evidence either.

  52. David Gorski says:

    I think you are wrong. The 1-150 is for the diagnosis of Autism, not including PDD or Aspergers.

    You can “think” whatever you like, but what you “think” is completely incorrect.

    The 1 in 150 figure is for all diagnoses of autism, Asperger’s, autistic spectrum disorders, and pervasive developmental disorders, not otherwise specified. It’s for the entire spectrum from nonverbal, stimming, flapping kids to kids with mild cases of Asperger’s who end up going to college and living normal lives.

  53. David Gorski says:

    My child statistically has a higher chance of dying in a car accident then from any of those diseases and I still drive him places.

    That argument doesn’t support not vaccinating. The risk to your child of having a harmful vaccine reaction is many orders of magnitude smaller than the risk of dying in a car accident; so by your own rationale it makes no sense not to vaccinate.

    You seem to have a case of the inability to judge relative risks. I discussed this very issue here (scroll to the heading “The Perfect Solution Fallacy”).

  54. HCN says:

    kac said “There still isn’t real evidence that vaccines don’t cause evidence either.”

    Ah, yeah… right. Actually there is lots of studies covering several countries and hundreds of thousands of children that show now relationship. Here, this is only on the MMR:
    http://www.immunize.org/catg.d/p4026.pdf … and a bunch of stuff on thimerosal:
    http://www.immunize.org/thimerosal/experts.asp

    And, no I am not wrong on what constitutes the 1 in 150 number. It is only certain groups that bandy about that number, yet reject the high functioning autistics as “not really being autistic”.

    This is an anecdote: Before the days of vaccines it was commone for a family to lose not one, but multiple children to disease. My grandmother was from a family of five children, only three made it to adulthood… and that was not that long ago.

    For what it is worth, my interest is having a health impaired kid who is severely learning disabled. Because of seizures (before any vaccine) he had to rely on herd immunity for production from pertussis. At that time our county was having a pertussis epidemic. Thanks anti-vax guys!

    Oh, as a bonus, he did get hospitalized multiple times for croup, and was severely ill with chicken pox (vaccine came out a year later).

  55. HCN says:

    A couple of things you might read about that 1 in 150:
    http://www.unstrange.com/essay.html

    and http://www.unstrange.com/dsm1.html

    I highly recommend that you read the book.

  56. Overshoot – I was talking about scientific medicine – 100 years, 150 tops. Prior to that we had philosophy-based medicine – ideas were not systematically and scientifically tested. That is how they survived so long .

  57. overshoot says:

    Overshoot – I was talking about scientific medicine – 100 years, 150 tops. Prior to that we had philosophy-based medicine – ideas were not systematically and scientifically tested. That is how they survived so long .d you come across this idea somewhere or did you just put two and two together?

    My very point. You were pointing out the ways that we can fool ourselves and citing a century or so of efforts [1] to work around the problem. I was pointing out that we have millennia of evidence for the problem that science is designed to overcome.

    [1] I will quibble with the total timeframe. Practices have not been monotonic; the sixteenth century had some very good systematic work including that of Paré and Fracastoro. Much of it went out the window for two hundred years as Europe obsessed over authority.

  58. durvit says:

    On the general point of bias and anecdotes. Lindner has put together a good overview of the impact of bias on trials of interventions and why it is essential that there are rigorous controls in place: Clinical attrition due to biased preclinical assessments of potential efficacy (pdf) [1]. Extending rigorous controls to preclinical trials will result in greater failures at that stage but will improve the rigorous assessment and confidence in results of whatever survives the later trials.

    As Drs Novella, Gorski and Hall have said, anecote misleads, that is why we need rigorous trials. Dr Fombonne recently testified at the latest Autism Omnibus (written up by Ms Clark for anyone who doesn’t want to work through the transcripts). Fombonne described a randomised clinical trial of a treatment that involved a language based intervention to improve communication skills in young children with autism.

    [I]t’s an intervention that everybody likes, eh and when we did the trial we had all the impression that it was actually achieving some positive results. The parents were happy and were convinced that the methods were showing some efficacy, and we did too.
    But as we did the study well we didn’t analyze the data before the data were finally collected and when we broke the blind and looked at the results and there is no difference between the two groups—which is breaking my heart, in some ways—but this also shows that our experience as clinicians and as parents can be misleading.

    As pointed out in the comments to Ms Clark’s post, either both groups stagnated (unlikely, because both the parents and clinicians were pleased) or the children in the waiting list control group made similar language gains to the group that had the intervention. Which tends to confirm the maxim: that autism is a condition associated with developmental delay, NOT stasis.

    [1] Lindner, MD. Clinical attrition due to biased preclinical assessments of potential efficacy. Pharmacology & Therapeutics 115 (2007) 148–175.

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