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Autism Onset and the Vaccine Schedule – Revisited

This week on Science-Based Medicine I wrote an article about a new study looking at the onset of autism symptoms, showing that most children who will later be diagnosed with autism will show clear signs of autism at 12 months of age, but not 6 months. This is an interesting study that sheds light on the natural course of autism. I also discussed the implications of this study for the claim that autism is caused by vaccines.

Unfortunately, I made a statement that is simply wrong. I wrote:

Many children are diagnosed between the age of 2 and 3, during the height of the childhood vaccine schedule.

First, this was a vague statement – not quantitative, and was sloppily written, giving a different impression from the one I intended. I make these kinds of errors from time to time – that is one of the perils of daily blogging about technical topics, and posting blogs without editorial or peer-review. Most blog readers understand this, and typically I will simply clarify my prose or correct mistakes when they are pointed out.

However, since I often write about topics that interest dedicated ideologues who seek to sow anti-science and confusion, sometimes these errors open the door for the flame warriors. That is what happened in this case.

J.B. Handley, writing at Age of Autism, saw my error as a way to demonize me before his enthralled mobs – and he dives into his task with gusto – although without much care or attention to detail himself, as we will see. Handley also is clearly not interested in what the science actually says, only in grabbing a propaganda opportunity.

First, to clarify the facts, here is the childhood vaccine schedule from the CDC. As we can see, the majority of vaccines are given prior to the age of 2, many in fact at or before 12 months. While “height” is a vague term, it is certainly inaccurate in this case. Before I explore this issue further, however, let me address the other factual claim made in that statement.

I wrote that “many children are diagnosed between the ages of 2 and 3. About this statement Handley writes:

Firstly, the last time I checked, the average age of diagnosis for a child with autism was somewhere between 3-4 years of age, not 2-3.

In fact, the average age of diagnosis is 3.1 years (although to be fair other studies give the average at 3.6  – there is some regional variation).  This is “somewhere between 3-4 years of age” but Handley’s point is still incorrect. I did not write that the average age was between 2 and 3 but that many children are diagnosed between 2 and 3, which is certainly true if the average age at diagnosis is 3.1. In his exuberance, Handley simply got this wrong.

I don’t expect him to make a correction, however. The last time he attacked me, he make a rather amateurish mistake, confusing incidence and prevalence, and used his error as the basis of his criticism. He never admitted or commented in any way on his gross error.

But onto the substance of his latest attack. The point that I was trying to make, which I did in fact clarify later in my post, is that when parents attempt to date the onset of their child’s autism they typically will date the onset later than the true onset. As we now know, from multiple studies, true clinical onset (biological onset is likely earlier) is between 6 and 12 months. Parents may not notice this onset until much later, and formal diagnosis is later still. This diagnosis happens within the childhood vaccination schedule, so it is likely that parents will have some recent vaccine to point to when looking for factors that seem to correlate with the onset of autism.

That was my point – a point that I and many others have made previously. By pushing earlier the true clinical onset of autism this study adds to evidence against the involvement of later vaccines. It is true that many vaccine are given in the first year of life, and of course this study by itself does not let all vaccines off the hook – nor did I say that it does.

But I did discuss one vaccine in particular – the MMR vaccine. MMR has received more attention than any other vaccine as a potential cause of autism, thanks to the now-discredited work of Andrew Wakefield. The first dose of MMR is given at a minimum of 12 months of age, with the second dose being given between 4 and 6 years. Certainly this study is relevant to the claim that MMR is a significant cause of autism

There is much evidence to support the conclusion that there is no correlation between MMR and autism. It should be obvious that this study is further evidence against a correlation. If most children with autism show signs by 12 months, then a vaccine which is not given prior to 12 months cannot be to blame. This was not obvious to Handley, however. He wrote:

In fact, between the ages of 2 and 3, children receive all of 2 vaccines, accounting for 5.5% of the vaccines they receive, while a full 70%, including MMR, come in their first 12 months of life, perfectly matching the time when this new study reported the beginning of a regression into autism!

Wrong, Handley. The MMR does not come “in their first 12 months of life.” At the very earliest it comes AT 12 months, which obviously cannot be responsible for symptoms that are present by 12 months. Maybe Handley was just sloppy in his choice of words (but it is odd that he went out of his way to mention MMR by name). Or maybe he is guilty of all the things of which he falsely accused me. This is certainly the same kind of error I made, although more specific. My error was inadvertent and I have readily admitted my mistake and am taking great pains to correct it. Let’s see how Handley responds when this error is pointed out to him.

The bottom line is that this study does in fact add to the body of evidence against an association between MMR and autism, because of the timing of the onset of autism.

Handley also takes exception to my point that parents may not accurately observe and remember when the onset of their child’s symptoms were. He makes one obvious point – that onset is not a moment in time but a process. I agree – but never implied otherwise. But even for diseases and disorders of insidious onset, there usually is a relatively brief period of time when the patient or family member really notices it – and that is when they date the onset.

I have the experience of actually seeing and diagnosing patients, reviewing their histories and comparing them to documented evidence in some cases. So I, like other experienced clinicians, understand this phenomenon well. For example, I see many patients with dementia, like Alzheimer’s disease, and they or their family will often date the onset of symptoms at a point in time some months prior to presentation, often anchored to a specific event (a phenomenon actually known as “anchoring”). But when I probe for specific details, it is apparent that there were signs of dementia for 1-2 years prior to the family’s dating of the onset. Or, I may have the benefit of a documented exam or history, clearly showing onset prior to the memory of those giving the history.

Handley seems naive to all of this, and rather he is content to grossly mischaracterize my point as calling parents “dumb,” which, of course, I never did. This is because Handley’s purpose, in my opinion, is not to meaningfully explore the evidence, but to demonize scientists and physicians with whom he disagrees. Read the comments to his blog and you will see that his attempts at demonizing me and others are quite successful in the echochamber of his followers. He wrote:

Further, this notion by Novella that we parents are “telescoping” is simply the ridiculous introduction of a new and confusing term to try and explain away the chorus of tens of thousands of parents all screaming the same thing about what happened to their kids.

The authors of this study itself applied the concept of “telescoping” or dating autism onset as more recent that it really was. I simply used their term, which they in turn took from the literature. It is a well-described concept, not invented by me or this study’s authors – people remember events in the past as being more recent than they actually were. For Handley’s purposes, however, he wants to characterize a well-known and scientifically established psychological phenomenon as being equivalent to calling people stupid, or spinning reality.

I also showed that this phenomenon is absolutely relevant to the question of vaccines and autism, using the Cedillo case as an example. The Cedillos believed that their child acquired autism after receiving the MMR vaccine. However, home movies reviewed in the court case brought before the Autism Omnibus shows signs of autism in the first year – prior to the first MMR vaccine.

Further, Handley is now trying to argue that this new study supports a correlation between vaccines and autism. In fact, it does nothing of the sort. It does all but eliminate MMR, varicella, and Hep A as having any potential role in autism, as these vaccines all come after the onset of autism in most cases. Handley, if he were being intellectually honest, should admit this, but he doesn’t, and very dishonestly implies that MMR specifically is still a potential cause.

Average age of diagnosis of autism is about 3.1 years of age, and when that was the best information we had to go on the anti-vax movement argued that this showed a correlation with vaccines. Then clinical studies showed that the diagnosis could be reliably made between age 2-3 years of age, but that’s OK, that still correlates with vaccines. Now we know the age of clinical onset is between 6 and 12 months, and Handley is saying this still correlates with the vaccine schedule.

Since the HepB is given at birth, and other vaccines at 1-3 months, moving the diagnosis of autism up even further would still correlate with some vaccines. Since Handley is willing to blame any vaccines, regardless of type (live virus or otherwise) and ingredients (thimerosal or not) no age of onset would disprove his cherished vaccine hypothesis.

There is also nothing about the vaccine hypothesis that led anyone in the anti-vaccine camp to predict that the true age of onset of autism is earlier than it is being diagnosed, and certainly not to within 6-12 months of age. So Handley is just retrofitting – declaring whatever evidence there is as supporting his position.

Finally, Handley pulls the “pharma shill” gambit on me as part of his smear campaign. He trots out an accusation he has made before, portraying my association with the ACSH as being sinister. As I have already explained, my association with the ACSH is limited to me agreeing to advise them on areas of my expertise. That’s it. I have, in fact, performed zero work for them. I have had no contact with them, other than them sending me their public material, and I have never received any kind of remuneration from ACSH. I have corrected Handley on this before, so I know that he knows what he is writing is wrong, and he has failed to correct his errors.

Further my associations with the pharmaceutical industry are minimal – a couple lectures and consultations for nominal fees years ago (and nothing ever to do with vaccines). I have never received a dime from any company to express an opinion on a scientific topic, or write a particular blog or article. I suppose that Handley believes my many hours of work producing podcasts and blogs and promoting science and skepticism is all an elaborate smokescreen for shilling for industry, all without receiving a dime for my efforts, which makes me the worst shill ever.

Actually, I don’t suppose that at all. Rather I think that Handley knows that what he is writing is pure BS, especially since I have called him on it before, and openly challenged him to produce a shred of evidence to support his false accusations. But Handley knows the narrative of the anti-vaccination movement – everyone who denies that vaccines are evil are themselves evil shills for even more evil industry.

Conclusion

In the end, all that matters is the science, which clearly shows that there is no association between vaccines and autism. This one study has minimal implications for an alleged connection, except that it clears the most often implicated vaccine – MMR. It also supports other evidence that the onset of autism is earlier than many parents observe and much earlier than formal diagnosis, which calls into question any casual observations about the timing of onset to any potential triggers.

In my first article on this topic I was sloppy in that one sentence about the vaccine schedule – an error I have now corrected. But that error did not affect the relevant points I made in the rest of the article, which I have also amplified here.

J.B. Handley thinks he has scored some points for his side by jumping on my error, but he has only shown himself, once again, to be a propagandist with no regard for science, accuracy, or even common decency.

Posted in: Science and Medicine, Vaccines

Leave a Comment (57) ↓

57 thoughts on “Autism Onset and the Vaccine Schedule – Revisited

  1. David Gorski says:

    None of this is surprising to those of us who’ve dealt with J.B. before. Of course, one wonders what happened to all of those anecdotes about children in whom “the light went out of their eyes” right after vaccination. Invariably these children are between 1 and 3 years old. I thought those were the stories that were the “smoking gun” that “proved” vaccines cause autism. It would look as though, in his fervor to move the goalposts, J.B. is backing away from even those stories.

  2. windriven says:

    Hadley and their ilk have missed the mark. With clinical onset marked at 6-12 months of age it is obvious that the REAL culprit is the transition to solid foods. Big Vax is innocent! It is time to attack Big BabyFood. Gerber had better bulk up its legal department. I understand that Andrew Wakefield has a peer-reviewed study coming out in the July Mad Magazine that indisputably proves a link between Gerber and the Illuminati.

  3. rork says:

    “that is one of the perils of daily blogging about technical topics, and posting blogs without editorial or peer-review”

    Might want to change that situation.

  4. rork – we are considering options. It should be noted, that many bloggers here blog once a week or two weeks, which is much more tolerable. David and I contribute to other blogs, so we are much more under time pressure.

    But even then, the rate of errors like this is very low – as a percentage or even total number. And when they crop up, we rapidly correct them.

    We also do some pre-posting review, but it is ad hoc, not uniform. As we expand our resources, however, we may incorporate more uniform editorial review.

  5. KathyO says:

    This is because Handley’s purpose, in my opinion, is not to meaningfully explore the evidence, but to demonize scientists and physicians with whom he disagrees.

    Exactly. If someone is interested in the truth, then no matter how passionate they are, they concede at least an occasional error.

    @ windriven

    No, not baby food, clearly autism onset correlates with learning to walk. I think the problem is Big Baby Shoe.

  6. Fifi says:

    Dr Novella, I agree with KathyO wholeheartedly. Being able to concede and openly acknowledge an error (in communication or facts) is fundamental not only to honest communication but also to good science. Black/white thinking and rigid ideological positions are the domain of religion/political ideologies and not science or reality-based thinking. Science evolves, what we know and our understanding of reality changes as we learn and understand more, ideologies or ideological positions don’t because they’re impervious to reality. We do science and the complexity of the real world a disservice and set it up to fail in the public eye when we promote science or medicine in the same way ideologues promote their ideas. That’s why I find blogs like Dr Lipson and Dr Jones’ more recent ones so constructive in terms of explaining and representing SBM to the public (and ultimately more effect at communicating the reality of SBM and why it’s different than ideology based alternative medicine).

  7. Fifi says:

    Dr Gorski – Well according the Canadian Minister of Science & Technology (a retired chiropractor) evolution has something to do with running shoes and sidewalks so you may well be onto something here! ;-)

  8. daedalus2u says:

    Blogs are ideally suited to post publishing review. Yes, all people make mistakes. Writers who are interested in disseminating information will always correct those mistakes and learn from them.

    Readers should always be looking for mistakes, and should always consider that even the most reliable sources may have trivial errors, especially when first published.

    I think having the example of errors being found and corrected shows a better example of how real science and real scientific communication is and should be done.

  9. Fifi says:

    Dr Novella, I forgot to add that I appreciate you addressing your own error in this blog too rather than simply glossing over it. The answer to both simplistic ideological/magical thinking or the faux complexity of pseudoscience isn’t to be simplistic or arrogant about superior knowledge or ideological ourselves, it’s to acknowledge complexity and uncertainty and to reveal to people that they are nothing to be afraid of and that science is a tool for understanding reality and the universe. Science and reality based thinking can allow us to live in the world as well as humanly possible and they don’t negate appreciating the mysteries of being alive and human, in fact they enhance them. It’s why Carl Sagan was such a wonderful champion of science and so popular.

  10. Skeptico says:

    Let’s see if I’ve got this straight. Anti-vaccine groups have been saying for years that they know vaccines cause autism, because parents saw signs of autism at age 3-4, just after vaccines given at age 3-4. This has just been confirmed because we now know that autism actually first appears at 12 months, just after vaccines given at 12 months.

    Did I miss anything?

  11. wales says:

    What a lot of wordiness to parse out the differences between “3 yrs 1 mo” vs. “3 yrs 6 mo” and “within the first 12 mos” vs. “12 mos or so”. The study authors themselves noted “recent prospective studies suggest that signs of autism emerge over the first year or so of life” note “first year or so”.

    Anyhow, the retroactive attention to detail is odd after a the initial gross misstatement of fact regarding the immunization schedule, something a 12 year old could have verified in 10 seconds via google. After all, the immunization schedule is not “highly technical” information, any parent knows that most vaccination occurs in the first year.

    Yes editorial and internal peer review is a great idea, it would greatly improve the credibility of this site. And more research citations to support posts that often amount to personal opinion essays. Bias creeps in everywhere and there is no substitute for readers reviewing primary sources themselves.

  12. Esattezza says:

    I agree with the points you have made, but just want to point out that age of diagnosis is probably not the most helpful of statistics in this case (though admittedly the easiest to track down). For example, when my cousin was diagnosed, it took eight months to diagnosis from the time my aunt made the first doctor’s appointment because it had become clear to her that something was wrong. This may be the extreme case (I don’t know, I don’t have those stats on hand), but any way you look at it, the process must take time. As far as I can tell, this doesn’t really change the argument, but I thought it was worth considering.

  13. Esattezza says:

    “Anyhow, the retroactive attention to detail is odd after a the initial gross misstatement of fact regarding the immunization schedule, something a 12 year old could have verified in 10 seconds via google. After all, the immunization schedule is not “highly technical” information, any parent knows that most vaccination occurs in the first year.”

    @ wales

    Stop trolling. Dr. Novella corrected his mistake and you bash him. If he hadn’t, you’d have bashed him for that.

  14. daniel says:

    It’s funny to read JB Handley and the way he tries to write in a way like Orac.

    They don’t understand science, so they do cargo cult science. They don’t understand insolence, so they do cargo cult insolence.

    I’m sure they are sitting around flummoxed. “But, we used the phrase ‘burning stupid,’ that means we are right, doesn’t it?”

  15. wales says:

    esattezza: afix your “trolling” label where you like. As an erstwhile reader of this site I am interested in improving it. My point remains valid, whether or not you personally agree. I’m sure Dr. Novella appreciates your sympathetic support.

  16. BKsea says:

    AHA! Steven Novella was wrong. That proves vaccines cause autism. It also proves the Earth is flat, 9/11 was an inisde job and AGW is a hoax. Your evil overlords must be very disappointed that you destroyed all of their evil conspiracies with one sentence.

  17. Skeptico says:

    Wales:

    As an erstwhile reader of this site I am interested in improving it.

    Um, you do know what “erstwhile” means, yes?

  18. wales says:

    why yes I do, I had decided after reading the Novella and Tuteur posts of yesterday that I would stop reading this blog. I may change my mind if steps are taken to improve the quality.

  19. Esattezza says:

    Wales, what is that point exactly? That the authors here should be infallible? Even professional journalists must sometimes post corrections.

    As far as my trolling “label”: your response the Steve’s correction of his error was snarky and designed to get a rise out of the other readers of this site (as you must admit language like “a 12 year old could do it” is designed to do) this is pretty much the definition of trolling And so I bow out of this line of conversation before I further fall victim to it.

    As far as the rest of your statement, I too am committed to improving the quality of posts on this site and agree that a peer-review/editing process would be beneficial to catch mistakes like this and that more primary citations are always a plus. On the whole, though, I think the SBM does a good job of it.

    As you point out, some of the posts are more opinion essay than pure reporting, but who says that’s never allowed on this blog? Personally, I like reading such entries, as it gives me insight into the personal biases of the author that I keep in mind while reading their other posts. Yes, bias is everywhere, but better when freely admitted. (For example, my personal biases related to this post are that vaccines don’t cause autism and that SBM authors tend to be more reliable, fact-based, and genuine than AoA authors. Does my agreeing with SBM’s description of the autism issue color that second opinion somewhat? Yes. Do I still examine the facts that each group provides? Yes.)

  20. Chris Lamb says:

    I read:

    Steve just hates the “community” and want’s to harm things important to the “community” and is a shill for corporates interests who are enemies of the “community”.

    Has that kool-aid got vodka in it?

  21. Esattezza says:

    Also, as point of interest, wales, you said: “I had decided after reading the Novella and Tuteur posts of yesterday that I would stop reading this blog. I may change my mind if steps are taken to improve the quality.” Out of curiosity, what blogs do you read that provide information up to your exacting standards? I’m always looking for something new.

  22. Fifi says:

    Unfortunately, SBM now has its own cargo cult blogger too! That said, the quality of other (unfortunately less frequent) bloggers who really do actually do SBM blogging makes it still worth visiting. (And, well, it’s just as much fun to point out the illogic and sensationalism of a cargo cult blogger here as it is one who promotes ideology under the pretense of science elsewhere. Though, of course, having a cargo cult blogger here does much more harm to SBM for all the obvious reasons.)

  23. wales says:

    Esattezza: Since you asked, I generally don’t read blogs. For the topics of science and medicine, I prefer primary sources of information. This blog initially attracted me because of sbm’s practice of citing references. While opinions can be entertaining and sometimes educational, for me they are only of value in conjunction with reference sources, especially on complex subjects such as medicine and science. Perhaps it’s just a difference of opinion as to the usefulness of this blog. For example, yesterday Tuteur repeatedly dismissed legitimate academic paper citations as “meaningless” and “someone’s opinion”, requesting “data” while providing no “data” or citations herself. I learned more by reading the papers she dismissed than I did from the blog post.

    I disagree with the claim that “stand alone” citations are meaningless without an accompanying analysis and argument. I often skim sbm posts and comments looking for reference citations. But then I view this purpose of this blog as an educational one, not as a debating venue. While cyber debates can occasionally be enlightening, without reference sources they often (usually?) degenerate into cyber soap boxes.

  24. EricG says:

    Dr. G

    Speaking of bare feet, what then, is your impression of this:

    http://www.youtube.com/watch?v=7jrnj-7YKZE

    obviously the claims are far more grounded in reality in data…

  25. BillyJoe says:

    wales said:

    “I had decided after reading the Novella and Tuteur posts of yesterday that I would stop reading this blog”

    You are throwing the baby out with the bathwater.

    As a matter of interest, when I read “at the height of the vaccine schedule” I intended to post a correction. But, after reading the rest of his post, I reinterpreted that sentence and decided that it wasn’t exactly wrong. There’s no doubt that it could have been written better though.

    Meanwhile at AOA, they’re shifting towards blaming the DTP vaccines given in the first six months, citing MMR and all the other vaccines as only a further aggravations of the basic damage caused by DPT.

    I won’t throw the baby out with the bathwater, but the eels are definitely going.

  26. Science Mom says:

    It is rather typical Handley to slather over what is a relatively benign error. One that was quickly corrected and ironically, is not a quality that AoA, or the like possesses.

    It is flattering though; such a trivial mistake has been used to distract from the entire Wakefield/Thoughtful House debacle.

    SM

  27. David Gorski says:

    I had decided after reading the Novella and Tuteur posts of yesterday that I would stop reading this blog. I may change my mind if steps are taken to improve the quality.

    Needless to say, I’m devastated…not.

    I also predict that you will be back.

  28. David Gorski says:

    It is flattering though; such a trivial mistake has been used to distract from the entire Wakefield/Thoughtful House debacle.

    Actually, the last time I checked, AoA still hadn’t addressed the Wakefield resignation. But I think I will when my turn to blog here rolls around on Monday. :-)

  29. squirrelelite says:

    Wales @ 2:58:

    I like going to the primary sources of information whenever I can, too. Unfortunately, most of the primary sources for medical information are journals which restrict access to the summary level unless you pay a subscription fee.

    What is your favorite open (no-fee) source for access to primary sources of medical information?

  30. rosemary says:

    Wales, “For the topics of science and medicine, I prefer primary sources of information.”

    Since when? When I first noticed you commenting you were citing articles in the NYTs. I’ve never yet met a scientist or MD who considers a newspaper article a primary source.

    Wales, “While opinions can be entertaining and sometimes educational, for me they are only of value in conjunction with reference sources, especially on complex subjects such as medicine and science.”

    While bloggers and commenters may frequently give references, references on any particular complex subject, especially in science or medicine, have to be individually evaluated and also viewed in context of all the available evidence. It certainly isn’t easy and it is very time consuming which obviously gives someone with expertise in a field a very good head start when it comes to writing about a topic in his field. Unlike others, he doesn’t have to review a lot of material before starting because he has already reviewed most of it.

    When bloggers write about topics that they are not experts in, we can expect errors. Hopefully, they or readers catch them and correct them. However, if one expects people to only blog or comment on topics which they know throughly or to completely research a topic before writing about it, I think one is being very unrealistic. IMO, people who follow blogs should know and accept these as limitations of the media.

    Wales, “Perhaps it’s just a difference of opinion as to the usefulness of this blog. For example, yesterday Tuteur repeatedly dismissed legitimate academic paper citations as ‘meaningless’ and ‘someone’s opinion’,”

    I may be wrong, but you give me the impression that anything you think comes from a “prestigious” source is “legitimate”, to be taken at face value without any regard to the type of studies reported, whether or not they were observational, epidemiological, RCTs, etc and without any regard as to how they line up with the entire body of evidence.

  31. wales says:

    rosemary, you are wrong.

  32. wales says:

    PS Rosemary, the NYT article provided links to primary sources, as I pointed out in my original comments.

  33. wales says:

    And to those who asked me about “free” sources of medical journal articles, as you undoubtedly know they are rare. However a full subscription is not always required, and many journals sell access per article (often for as low as $15). I also occasionally peruse my local university medical school library for textbooks and journals.

  34. squirrelelite says:

    Yes, wales, they are rare.

    Unfortunately, I cannot afford $15 an article to look for useful information as a background for commenting on a blog. So, I stick to what seem to be the best available free material on the web.

    I also find blog posts by those who do have access to such materials to be a useful, informative and educational resource.

    Unfortunately, AoA and J B Handley don’t meet that criterion.

  35. BillyJoe says:

    wales,

    I think the whole point of reading blogs written by experts in the field is to find out stuff that would otherwise take you a whole week of research.

    Mistakes are made, of course, so scanning the commentary also becomes necessary, but this is still less time consuming than reading all the primary sources. (I have done it on the odd occasion on a topic of special interest, but I also have to work for a living).

    The trick is finding bloggers who you can trust – as long as you don’t trust them absolutely.

    And, again, I didn’t much wrong with Steven Novella’s post other than poor choice of words.

  36. Zoe237 says:

    “Mistakes are made, of course, so scanning the commentary also becomes necessary, but this is still less time consuming than reading all the primary sources. (I have done it on the odd occasion on a topic of special interest, but I also have to work for a living).”

    Exactly!

    There are some free medical journals out there, like “Pediatrics” and “British Medical Journal.” How they make money I don’t know. But yes, one can get them from the library if you’re really dedicated.

    A brief peer review seems like a good idea on this website, to prevent any more Handley orgasms. Still, the imperfections of blogging literature are part of the fun.

  37. BillyJoe says:

    I have submitted the following question on JB Handley’s article:

    “Just to be clear…

    Do we all agree with the following statement:

    The MMR vaccine cannot be the cause of Austism because it is given at or after 12 months of age whereas symptoms of Autism commence before 12 months of age.

    That, at least, is what the article referenced by Steven Novella seems to be saying.”

    It is awaiting moderation.

  38. Danio says:

    Hey BillyJoe,
    Todd W., a regular commenter on Respectful Insolence, has established a blog expressly for posting comments that are lost in ‘moderation’ limbo at Age of Autism. The blog’s called ‘Silenced by Age of Autism’ and can be found here, just in case you’d like to cross-post this or future comments.

  39. BillyJoe says:

    Thanks.
    …though I’m not sure how long to wait for it not to appear before posting it on that site.

  40. Adam_Y says:

    PS Rosemary, the NYT article provided links to primary sources, as I pointed out in my original comments.

    Ooo come on stop being so pompous. You probably aren’t even able to interpret those sources correctly.

  41. The Blind Watchmaker says:

    “Since Handley is willing to blame any vaccines, regardless of type (live virus or otherwise) and ingredients (thimerosal or not) no age of onset would disprove his cherished vaccine hypothesis.”

    Unfortunately for now, the claim that any vaccine at any time increases the risk of autism remains unfalsifiable because..”No studies have compared the incidence of autism in vaccinated, unvaccinated, or alternatively vaccinated children (i.e., schedules that spread out vaccines, avoid combination vaccines, or include only select vaccines). These studies would be difficult to perform because of the likely differences among these 3 groups in health care seeking behavior and the ethics of experimentally studying children who have not received vaccines.”

    http://www.journals.uchicago.edu/doi/full/10.1086/596476?cookieSet=1#h5

    I guess this is as far back as the goalpost goes for now.

  42. rosemary says:

    Wales, “And to those who asked me about “free” sources of medical journal articles, as you undoubtedly know they are rare. However a full subscription is not always required, and many journals sell access per article (often for as low as $15). I also occasionally peruse my local university medical school library for textbooks and journals.”

    Hospitals in the US have medical libraries where you can read the journals they subscribe to as well as the reference books they carry and you can make copies of the material you find there for nominal fees. The librarians can order articles from journals they don’t subscribe to but there can be a fee for that.

    In my experience librarians have gone out of their way to get articles for me for free. That means finding them in a library from which they themselves can get them without charge. Libraries at different institutions seem to form groups that subscribe to different journals so that they can share the articles in them with others in their group. Now a lot is done electronically.

    Does anyone off hand have any idea of the average number of articles one has to read to accurately review a common topic? I doubt it. My guess would be that the number will vary greatly by topic, but my guess would be that it often reaches dozens if not hundreds and the only way to accurately review an entire topic is to review all the material, no picking and choosing what to buy and what not. That gets pretty expensive if you have to buy a lot of articles. It is also very time consuming. The other way to review a topic is to read a review published in a reputable journal or textbook. Actually, even if I do a review myself, I always want to speak to an expert with practical experience too to see if I’ve missed something.

  43. BillyJoe says:

    My post was published but only one person responded, but not in a meaningful way. Unfortunately, some misinformed sceptic said something stupid about the thiomersol having been removed from the MMR vaccine and they are all over him like a rash. Embarrassing.

  44. Esattezza says:

    Rosemary: “Does anyone off hand have any idea of the average number of articles one has to read to accurately review a common topic? I doubt it. My guess would be that the number will vary greatly by topic, but my guess would be that it often reaches dozens if not hundreds and the only way to accurately review an entire topic is to review all the material, no picking and choosing what to buy and what not.”

    Let me put it this way… I have friends in their third and fourth years of graduate work to get their PhDs in biomedical sciences and their “papers to read” pile tends to hover at being about 8 inches high, even though I know they read daily. Granted, some of these papers are being read for their methods, but my point stands.

  45. Danio says:

    @BillyJoe:
    Not in a meaningful way? She quoted Mother Warrior Jenny McCarthy at you, man! Pearls of wisdom from the grand dame of the antivax movement, bringing all the gravitas of a Strawberry Alarm Clock lyric. Oh, my sides still ache.

    So, to sum up: babies are injected with mercury (a neurotoxin!) for the first twelve months of life then they get the MMR, which does ‘even more damage’. [The nature of this damage is unspecified, but Jenny McCarthy hints darkly that the live rubella virus in the MMR causes autism]. And to convince you of this, you should read the testimony of Vasken Aposhian who testified for the petitioners in the Cedillo Vaccine Injury case which…they lost.

    Crystal clear, no?

  46. BillyJoe says:

    Couldn’t have said it better myself, Danio. :)

  47. daedalus2u says:

    One of the most characteristic attributes of autism is the number of minicolumns in the brain. That number is fixed during the first trimester in utero. A vaccine after the infant is born cannot increase that number.

  48. BillyJoe says:

    “One of the most characteristic attributes of autism is the number of minicolumns in the brain. That number is fixed during the first trimester in utero. A vaccine after the infant is born cannot increase that number.”

    If you are confident that that excludes a postnatal cause for ASD, why don’t you post it on the site. Make sure though, those posters over there are not ignorant and can spot a error from 6 meters away (well, even when there isn’t one, but it helps if you don’t have one, otherwise you are dead meat)

  49. rosemary says:

    Esattezza, “Let me put it this way… I have friends in their third and fourth years of graduate work to get their PhDs in biomedical sciences and their “papers to read” pile tends to hover at being about 8 inches high, even though I know they read daily. Granted, some of these papers are being read for their methods, but my point stands.”

    Thanks Esattezza. You put it beautifully. It is something that the segment of the general public who thinks that with a PC and Internet access they can know as much as the professionals really has to hear repeatedly.

    The public also has to know that a lot of what is published is preliminary and may not turn out to be accurate and that some preliminary work which may turn out to be very important takes a long time to get published although people in the field often know about it before then. One example from the topic I am familiar with is laser therapy for argyria. I’m not pulling files to check facts for a comment on a blog. I’m just doing this from memory. Derms all over the US have being doing it for about 10 years. I know because they and their patients have told me about it and given me the specifics such as which lasers they are using. They have been saying ever since they started that they were going to publish very soon. To date there is just one published article and it is not from the US. In the published study the patients were lost to followup. In the US they have not been and they are finding that the procedure, as a lot of us expected, is not permanent. I could go on but don’t have time. My point is that you can’t just pull some studies off the Internet, even if you get the entire articles not just abstracts, read them and be certain that you really know the topic. It just isn’t that simple.

  50. Wow, daedalus2u… because of your comment, I googled “autism minicolumns brain” and have been awash in the interesting details! I had heard of research being done on brain structural differences, but I never knew the vocabulary surrounding the structural differences that had been observed (well, except for “cranial circumference,” but that was only the tip of the proverbial iceberg).

    So, thanks! I never would have known what the heck a minicolumn was otherwise! :)

    Regarding our family’s own observations of autism onset, we observed our son was different from other babies as early as… birth! :) But we didn’t get around to having him tested for any anomalies until he was 4 years old. Why not? Because– I quote– “He’s perfectly normal! I was doing the same things at his age.” *retrospective facepalm*

  51. trrll says:

    I think that Dr. Novella oversold the finding a bit, even though it is worthy of discussion in terms of yielding insight into autism. There is already plenty of evidence that “regression” is not indicative of an acute insult. For example children with Rett syndrome, which has a well characterized genetic cause, typically exhibit regression, and there are certainly accounts of unvaccinated children being diagnosed with autism around the time when most children get their shots. None of this has ever carried any weight with the antivax crowd.

    But this won’t carry any weight with the anti-vaxxers, because they are already convinced that it is the vaccines. The details don’t matter, and we’ve already seen that the narrative can shift wildly, so long as it ends up with the finger being pointed at vaccination. They’ll just conclude that perhaps the child had some kind of a “risk factor” to begin with, or else the damage was done by the early vaccines but not recognized, and the later vaccination was the “straw that breaks the camels back” and made the autism worse.

  52. Geekoid says:

    If he knowingly makes false claims about you, isn’t that libel?

  53. geolith says:

    Beth’s Blog discusses a kerfuffle involving Pepsi, a celebrity and social media.

    http://beth.typepad.com/beths_blog/2010/02/pepsi-charity-contest-learning-from-mistakes-and-level-playing-fields.html

    The clip ends with a quote from Clay Shirky that seems quite applicable to Dr. Novella’s lapse: “failing informatively.” I also liked the term “public learning…”

    …”The New York Times published an article called “Pepsi Trips Over Its Own Submission Rules” which describes what happened:

    The tiny charity currently atop the rankings in one category of the contest accidentally got a little help from Pepsi itself. Materials submitted by the Joyful Heart Foundation, a charity started by Mariska Hargitay, one of the stars of “Law & Order: Special Victims Unit,” to help victims of sexual assault, were updated by the staff at Pepsi after the submission deadline, which is against the contest rules.

    That upset some of the contestants who wondered whether Pepsi was doing favors for a celebrity. “I can’t edit my own submission, so how did she do it?” said one contestant, who insisted on anonymity because he did not want to jeopardize his chances of winning.

    Did Pepsi stonewall and ignore it as we have seen happen with previous online contests?

    No.

    Pepsi has embraced a learning as you go approach when it comes to social media and the art of public learning. Mistakes and stumbles happen and as Chris Brogan recommends you need to apologize and learn. And now we have a real-life example with the Pepsi Refresh Contest making a mistake by not following its own rules, but moving swiftly to acknowledge it, fix it, and move on. This is what Clay Shirky calls failing informatively.”

    - On a grander scale, as an interesting post on Mind Hacks points out, mistakes can be part of striving towards a greater good.

    “I’ve just read a funny and insightful interview with neuroscientist Vincent Walsh from last November’s Current Biology that’s full of over-caffeinated anecdotes and understated wisdom.

    …What has been your biggest mistake in science?

    Oh, I haven’t even begun to peak on mistakes. I have so many more to give. I make mistakes all the time. In fact, I can’t think of any of my most rewarding papers for which I wouldn’t either interpret the data differently now or start/end with a different theoretical perspective.

    If you’re still being right about the same shit you were right about 20 years ago, then something tells me you’re either not thinking or you’re just moving papers as product.

    The whole point of intellectual activity is to come to new conclusions. I don’t see how one can think and keep coming up with the same conclusion, unless it’s really dull stuff.

    It’s almost our job to be wrong. How can you not make mistakes if you’re reaching for something? I don’t understand people who are proud of never having made one.”

    http://www.mindhacks.com/blog/2010/02/on_riding_the_mistak.html

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