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Dr. Jay Gordon and me: Random encounters with an apologist for the antivaccine movement

27452983Although he doesn’t detest me nearly as much as antivaccine honcho and founder of Generation Rescue J. B. Handley does, Santa Monica celebrity pediatrician Dr. Jay Gordon doesn’t like me very much at all.

Actually, I’m not sure whether that’s entirely true or not, but Dr. Gordon sure doesn’t like it when I criticize him for his antivaccine rhetoric. He affects an oh-so-wounded posture and self-righteously assures me that he is not “anti-vaccine” and that it is “beneath me” to use such rhetoric against him. Whether such rhetoric is “beneath me” or not, however, I’ve never quite understood why Dr. Gordon gets so upset at when I describe him as “anti-vaccine.” After all, his words are frequently apologetics for the anti-vaccine movement, and his actions frequently give it aid and comfort. After all, he is Jenny McCarthy‘s son Evan’s pediatrician, and as a result of that connection he has been giving speeches to antivaccine rallies, such as the “Green Our Vaccines” rally in Washington, D.C. in June. (He is the man in the sunglasses behind Jim Carrey in the picture at the top of this post by me.) After all, he has been palling around with luminaries of the antivaccine movement, such as Jenny McCarthy and her boyfriend Jim Carrey, the aforementioned J. B. Handley, Robert F. Kennedy, Jr., Boyd Haley, and numerous others at events like the “Green Our Vaccines” rally.

But, above all, over the last three or four years, Dr. Gordon has become the go-to pediatrician that the media seemingly always wants to interview when a vaccine “skeptic” with an MD after his name is required to provide the “balance” that journalists worship above all else, even when that “balance” gives undue credence to pseudoscientific nonsense. He clearly relishes that role, too, most infamously on his appearance with Jenny McCarthy on Larry King Live!, in which McCarthy shouted down pro-vaccine physicians and yelled “Bullshit!” (as if she who yells the loudest and is the most foul-mouthed wins the debate) and as evidenced by his appearances on certain antivaccination mailing lists, from which messages are occasionally forwarded to me.

What else am I supposed to think, except that Dr. Jay is at the very least an apologist for the antivaccine fringe, if not a card-carrying member himself?

Unfortunately, Dr. Gordon strikes me as being mostly a nice guy. I say “unfortunately” because it would be much easier to be as harsh on him as his promotion of antivaccine pseudoscience deserves if he were not. He also clearly believes that he is right based on the evidence. Based on science and clinical evidence, he most definitely is not. Recently, I had decided more or less to lay off him for a while, so as to avoid the wounded cries that invariably accompany valid charges that he is an apologist for the antivaccine fringe. Also, I felt kind of bad beating up on him so regularly and thought that perhaps a respite was in order. Then I found out that Dr. Gordon wrote the foreword to Jenny McCarthy’s new antivaccine and pro-autism quackery book, Mother Warriors: A Nation of Parents Healing Autism Against All Odds. Then, one of my readers actually took the time to transcribe Dr. Gordon’s foreword and e-mail it to me.

I read it, and I was appalled.

That foreword demonstrates that Dr. Gordon has firmly allied himself with the antivaccine camp (more later). What I still can’t figure out is: Why? So, at the risk of provoking another self-righteous wail from Dr. Gordon that he really, truly isn’t “antivaccine,” I thought I’d explore a bit about his views, why they are so wrong, and why I reluctantly had to come to the conclusion that, even if Dr. Gordon does not see himself as “antivaccine,” he has clearly allied himself with the radical antivaccine movement and become one of its chief apologists, in the United States at least. My primary purpose in writing this is not to take another swipe at Dr. Gordon (although that is unavoidable), but rather to try to coax him back to science and, failing that, to inform SBM readers why his arguments are fallacious.

Dr. Gordon and me: Three years and going strong

I first “met” Dr. Gordon online in 2005, which is, as I’ve pointed out before, when I first encountered the die-hard antivaccine movement. Indeed, my first encounter with Dr. Gordon was shortly after my discovery of thsi movement and my rather wide-eyed and innocent dive into the online fray. I also noticed him when I noticed, a mere three weeks after its going live, that The Huffington Post had become a bastion of antivaccine pseudoscience, a position that it has maintained to the present day. Mixed right in among posts written by such mercury militia antivaccine apologists such as David Kirby, Robert F. Kennedy, Jr., there was Dr. Jay Gordon. Ever since then, the two of us have intermittently sparred about vaccines in various online locales. Months will go by with no contact, and then suddenly Dr. Gordon will write or say something that provokes a debunking, and there’s a kerfluffle, after which there is silence for months. Usually, Dr. Gordon is unhappy that most of the time I have criticized him under a pseudonym. Having seen his foreword in Jenny McCarthy’s book, I decided that now was an opportune time to take that excuse away from him and see if he will answer evidence- and science-based criticisms if he can’t complain about my anonymity.

One thing that has become clear to me over the last three years is that Dr. Gordon, like virtually all advocates of pseudoscience, does not realize or accept that he is a advocating pseudoscience. Indeed, he thinks he’s a scientist, but, alas, he makes arguments that are most unscientific. For instance, in e-mail exchanges, he has argued that anecdotal evidence from his own practice and his own observations, coupled with his own reading, have convinced him that vaccines cause autism. Never mind the science that finds no plausible mechanism by which mercury in vaccines or vaccines themselves might result in autism and the multiple large epidemiological studies powered to find even small correlations between mercury and autism or vaccines and autism that have failed to support the claim that vaccines cause or contribute to the development of autism in infants. Dr. Gordon trusts his clinical experience above that. He also thinks that David Kirby’s book Evidence of Harm is “meticulously researched and a great read” and that Robert F. Kennedy, Jr.’s infamous Deadly Immunity essay is “important.” (It wasn’t.) Such is the level of Dr. Gordon’s understanding of science. Dr. Gordon also wrote in 2005:

Mercury in vaccines causes autism and other brain injury. The IOM twisted the facts to suit the CDC and the vaccine industry.

No, it doesn’t, and no it didn’t.

To demonstrate why Dr. Gordon is not a reliable or credible source of vaccine information, I would like to discuss a recent interview and then conclude with a discussion of his foreword to Mother Warriors.

Dr. Gordon and formaldehyde

Early this summer, around the time of that Amanda Peet made her controversial statements defending vaccines, once again Dr. Gordon demonstrated his skill with anti-vaccine talking points in this interview with Cookie Magazine. It was painful for me to read such misinformation coming straight from the mouth of a fellow physician. Indeed, it was even worse than listening to Dr. Michael Egnor spew creationist nonsense hither and yon, because at least for Dr. Egnor evolution is not part of his area of expertise. I don’t know about you, but I always thought that vaccines were a key area of expertise for pediatricians. In the case of Dr. Gordon, however, you’d never know it from the data-free, anecdote-filled nonsense he spouted in this interview. For example, listen to his response to a question about why he buys into the “too many, too soon” mantra and advocates “staggering” vaccines:

I think the immune system, like every other system of the body, matures slowly, and that it can better tolerate viral infection at older ages and better tolerate one virus at a time. The other thing is that vaccines all contain other ingredients. They contain aluminum, they contain tiny bits of formalin [an aqueous solution of formaldahyde]. So I recommend waiting as long as parents are comfortable, and vaccinating very, very slowly. I also ask parents to wait at least six months before the first vaccine. I prefer to wait a year.

Formaldehyde? Aluminum? Oh, my goodness! Toxins! I could not believe a physician was parroting the “toxin” gambit about vaccines. That’s arguably the single most scientifically ignorant rhetorical gambit antivaccinationists use, and Dr. Gordon appears to have bought into it. Did Dr. Gordon skip pharmacology class in medical school?

Of course, Dr. Gordon, showing that even physicians can be prone to putting too much stock in testimonials and anecdotes over science and epidemiology, points out cases of regression he’s seen after vaccination, and argues:

Now, many people would argue that vaccines are only for the better. I would say that there’s no free lunch; it is lovely to be immune to whooping cough, but if I have to diminish your health a little bit to do that, I have to hesitate. Integrity demands that I tell you other parts of the story: I saw one child who developed seizures two days after her two-month appointment, and she didn’t get any shots. It’s true that the onset of autism often coincides with the time that kids are getting their shots. But the vast majority of times that I see a temporal relationship, I’m assuming it’s not a coincidence.

Assuming? Note that Dr. Gordon cannot produce a single scientific study to support his beliefs. Not one. In fact, I once replied to one of his e-mails chastising me for referring to him as “anti-vaccine.” In my response, I pointed out that I had seen snippets of his videos posted to YouTube and his own website as well as a video of his speech to the “Green Our Vaccines” rally:

Note how Dr. Gordon states that he bases his conclusions that vaccines probably cause more harm than good on “over 30 years” of his own experience and above all (emphasis mine) “listening to you,” meaning the audience of antivaccinationists whom he is addressing. It never occurs to him that, as he became more famous in antivaccination circles, more and more parents would seek him out, creating a self-reinforcing echo chamber effect impervious to outside information and the overwhelming mass of data not consistent with his belief that vaccines cause autism and various neurological conditions, not to mention diabetes and others. I also can’t help but ask what planet he comes from that he can claim with a straight face that doctors do not discuss potential risks of vaccination with parents and then blame doctors for not warning parents that vaccines can cause autism when there is no good evidence upon which to base such a warning.In response, I asked Dr. Gordon pointedly but politely if he could provide me with citations for scientific studies in the peer-reviewed literature that support what he said in those videos, what he said in this interview, and, most importantly, at the “Green Our Vaccines” rally, most of which was nothing more than testimonials. Dr. Gordon never got back to me with the references or a coherent discussion of the science that leads him to make such conclusions. I’ve periodically tweaked him about that ever since, and I plan to continue to do so, but wonder if he’ll get back to me now. While I wait, I’ll point out that Dr. Gordon continues to spread misinformation about the MMR virus, like:

It’s a live-virus vaccine. A live-virus vaccine, in order to work, creates a little bit of an infection. And when you get measles, you get it through your nose and your throat, [which triggers a very specific immune response.] When we inject measles, we are bypassing that system and going right into the bloodstream. And we’re finding that yes, there can be some impact on the intestinal tract and to the brain from the measles vaccine. And it’s a vaccine of almost no benefit to American children, one by one. Now, in terms of public health, I don’t want to be the guy who said, “Boy, this vaccine stinks.” It doesn’t stink. It works very, very well. The reason we don’t have measles in America is because the vaccine works great. But sit down, please. Let’s talk about the fact that your cousin and your other cousin both have autism. Or that your son has some questionable neurological issues, he seems to be speaking or walking a little later. I don’t want to mess with him.

Number one: The measles vaccine is not of “almost no benefit to American children.” It keeps measles at bay, and the resurgence of measles that we have seen in the U.K. and are now seeing in the U.S., thanks to decreased levels of vaccination due to fearmongering about the MMR vaccine shows how little it would take for herd immunity to fail. Number two: There is zero scientifically sound evidence that the MMR causes autism or other neurodevelopmental disorders–or even “autistic enterocolitis.” None. All we have is Andrew Wakefield’s litigation-driven and incompetent “research,” research so badly done that his co-authors almost all disavowed it when its deficiencies came to light. That Dr. Gordon apparently continues to believe that shoddy pseudoscience concerns me greatly.

It gets worse. Gordon repeated the usual misinformation about mercury in flu vaccines and even mentioned a 7-year-old getting a tetanus booster with mercury in it. It makes me wonder if he served as an uncredited background consultant for Steve Wilson, so similar is his patter to the misinformation served up by that “investigative journalist.” Most children do not get the flu vaccine, especially not under two years of age, and, even as the use of the flu vaccine is encouraged, flu vaccines containing more than trace amounts of thimerosal are increasingly uncommon because of low demand. It is likely that the marketplace will soon render them all but extinct, except for adults (Indeed, the flu shot I got a couple of weeks ago contained not only thimerosal but formaldehyde!) Also, children don’t suddenly get autism at age 7 after getting a vaccine. The bottom line is that children’s exposure to thimerosal from vaccines is lower than it has been since the 1980s and is continuing to decline, but there’s no sign of a significant decline in autism diagnoses. None. That’s about as bulletproof epidemiological evidence as there is showing no correlation between the two. Not that this stops Dr. Gordon:

Right now we’re creating vaccines using ingredients that are cheap preservatives, but it could be done better. It means, let’s see if we can get the aluminum out of them. Let’s see if we can get the formaldehyde out of them. Let’s see if we can produce them in a way that makes a little more sense for safety.

Aluminum is not a preservative. It is an adjuvant. It’s there to make the vaccine produce a stronger immune response and thus make the vaccine work better. It’s an integral component of what makes the vaccine work. There’s also no evidence it has anything to do with autism or any other neurodevelopmental or immunological disorder. Of course, now that the mercury is gone from nearly all vaccines routinely given to children under two and multiple epidemiological studies have exonerated mercury in vaccines as a cause of autism, we all know that aluminum is becoming the new mercury for antivaccinationists. Never mind that aluminum has been used for 80 years and has an exemplary safety record.

Also, I know formaldehyde a convenient scary-sounding chemical used in the vaccine manufacturing process that antivaccinationists like to point to, but by the time the finished vaccine is made, there’s nothing more than a trace amount in any vaccine. Dr. Gordon breathes more formaldehyde sitting in an L.A. traffic jam in his Lexus than is in any vaccine. The plastic products and varnishes in your house produce more. In fact, the human body makes far more formaldehyde than is in any vaccine, as described here:

The average quantity of formaldehyde to which a young infant could be exposed at one time may be as high as 0.2 mg (see table below). This quantity of formaldehyde is considered to be safe for two reasons. First, formaldehyde is essential in human metabolism and is required for the synthesis of DNA and amino acids (the building blocks of protein). Therefore, all humans have detectable quantities of natural formaldehyde in their circulation (about 2.5 ug of formaldehyde per ml of blood). Assuming an average weight of a 2-month-old of 5 kg and an average blood volume of 85 ml per kg, the total quantity of formaldehyde found in an infant’s circulation would be about 1.1 mg — a value at least five-fold greater than that to which an infant would be exposed in vaccines. Second, quantities of formaldehyde at least 600 — fold greater than that contained in vaccines have been given safely to animals.

I’ve tried to point out to Dr. Gordon these facts, and, at least as far as I can tell, he’s no longer playing the formaldehyde gambit, which gives me hope that he is educable. However, if you want to know what Dr. Gordon thinks of vacccines, he finished up with this tidbit:

I think that the public health benefits to vaccinating are grossly overstated. I think that if we spent as much time telling people to breastfeed or to quit eating cheese and ice cream, we’d save more lives than we save with the polio vaccine.

That’s right. Dr. Gordon seems to be arguing that breast feeding and keeping cheese out of the diet will prevent the spread of infectious diseases better than vaccines. Funny, but Europeans eat lots more cheese than Americans, and they don’t seem to be any less healthy than we are. On the other hand, per capita U.S. cheese consumption has been rising since the 1980s. Hey, I have an idea! Maybe it’s maternal cheese consumption, not vaccines, that causes autism! In the meantime, we can have a whole bunch of svelte, otherwise healthy kids suffering from vaccine-preventable diseases. In actuality, Dr. Gordon has a point that decreasing obesity and encouraging breast feeding would increase infant health in the U.S. However, his comparing vaccination unfavorably to these other public health measures reveals his true agenda. It’s possible to encourage breast feeding and a more healthy diet without denigrating the known benefits of vaccines. Dr. Gordon chooses to denigrate them. Indeed, his attitude towards vaccines can apparently be summed up by what he said in a comment:

I gave a half dozen vaccines today. I gave some reluctantly but respected parents’ wishes to vaccinate.

I found it most telling that Dr. Gordon said that he “reluctantly” gave some vaccines because he “respected parents’ wishes to vaccinate.” Why, if Dr. Gordon is not “anti-vaccine,” was he “reluctant” to give these children appropriate vaccines? What is there to be reluctant about? It certainly sounds to me as though Dr. Gordon tried to persuade some parents not to provide their children with standard vaccines.

And then there’s Dr. Gordon writing in the foreword to Jenny McCarthy’s new book, which is what pushed me to write this post.

A panoply of antivaccine fallacies on display

In Jenny McCarthy’s latest book, Mother Warriors: A Nation of Parents Healing Autism Against All Odds, McCarthy blames her son Evan’s autism on vaccines and claims to have “cured” his autism with so-called “biomedical interventions. If past internet exchanges with Dr. Gordon are any indication, one could expect that this foreword would be replete with pseudoscience and “brave maverick doctor” posturing. Aside from completely unsupported claims of fact like, “Vaccines can cause autism,” and “hyperbaric oxygen works,” to assertions of “tremendous increase in autism,” Dr. Gordon has indeed laid out quite a spread of logical fallacies and pseudoscience in his foreword. Indeed, Dr. Gordon doesn’t waste any time when it comes to deploying logical fallacies. In fact he begins right from paragraph one:

The AAP and the Centers for Disease Control and Prevention (CDC) are filled with doctors who not only don’t believe the ideas in this book but actively ridicule them and spend a lot of money trying to disprove the causes and treatments so well presented when Jenny Mccarthy and others in the cure-autism community speak and write.

Unfortunately, ridicule neither validates nor invalidates a claim. The AAP and the CDC may well have doctors who ridicule the ideas in Jenny’s book, but that they ridicule such claims does not make those doctors incorrect, nor does their ridicule validate such claims. In fact, what Dr. Gordon appears to be doing is combining a whine about being ridiculed with the Galileo gambit, in which those “brave maverick doctors” are implicitly likened to Galileo, who was persecuted for his science because it conflicted with the reigning paradigms of the time. It’s an invalid comparison, as Michael Shermer writes in his book Why People Believe Weird Things:

For every Galileo shown the instruments of torture for advocating scientific truth, there are a thousand (or ten thousand) unknowns whose ‘truths’ never pass scientific muster with other scientists. The scientific community cannot be expected to test every fanstastic claim that comes along, especially when so many are logically inconsistent.

Or, more succinctly:

They laughed at Copernicus. They laughed at the Wright brothers. Yes, well, they also laughed at the Marx Brothers. Being laughed at does not mean you are right.

Thus, being laughed at does not mean that Dr. Gordon is correct. Sometimes, as in this case, ridicule is a completely appropriate response to what a person says or promotes. What makes Dr. Gordon’s critics and the critics of the antivaccination movement correct from a scientific standpoint is that current science supports them and does not support Jenny McCarthy and the movement whose celebrity face she has become. In addition, Dr. Gordon is one to talk about ridicule. After all, what is he doing in his foreword but ridiculing the AAP, CDC, and any who have the temerity to point out that science does not support Jenny McCarthy’s ridiculous (and I chose that word intentionally) claims? He has also frequently ridiculed Dr. Paul Offit in various online exchanges, leading me to think of the old Usenet retort: “Pot. Kettle. Black.”

Not that that stops Dr. Gordon from making a couple of assertions of what he considers to be fact. Indeed, Dr. Gordon states baldly:

Vaccines can cause autism.

Of course, Dr. Gordon offers not one whit of scientific evidence to support this claim. He has never been able to provide a coherent scientific argument for why he believes this claim to be true. Instead, he simply makes it as though it were self-evident. It’s not, and there is no good scientific evidence that vaccines can cause autism. When challenged to provide support for this sort of assertion, Dr. Gordon is invariably flummoxed, usually retreating back to his “clinical experience” garnished with logical fallacies, more of which are discussed below. His stating that “vaccines can cause autism” in this way suggests that no specific scientific support or mechanism for autism causation will be offered in the book that follows. Readers will need to chalk this up to the following format of fallacious logic, “X is true. The evidence for this claim is that X is true.”

Dr. Gordon also sees the issue of “biomedical interventions” for autism as a false dichotomy:

Diet and supplements and other alternatives to doing nothing can lead to recovery from autism. Period.

“Period”? Wow, that’s pretty definitive! (Putting the word “period” after an assertion is always great for convincing people.) It’s also fallacious.

The implication would seem to be that “biomedical” interventions, such as gluten-free diets, chelation therapy, and other woo and “doing nothing” are the only choices. They are not, but pseudoscientists pushing the vaccine-autism link and “biomedical” treatments for autism desperately want parents to believe that these are the only two choices. Although “recovery” certainly isn’t clearly defined by Dr. Gordon, parents can focus on education and social skills without getting into the expense of unnecessary supplements, restrictive diets, or other alternative medicine at all. Although some may not, many parents who focus on education and social skills for will see “improvement” as a result.

There is a false premise under this fallacy as well, and that is that autism is a condition of developmental stasis and that any development observed must be due to whatever intervention the parent is making. It is not; autism is a condition of developmental delay. Autistic children can and do develop, sometimes dramatically–occasionally even dramatically enough to lose their diagnosis of autistic spectrum disorder. Indeed, there’s huge variability in the development of autistic children as well, not to mention variability in the developmental course of a single child, with periods of apparently little progress intermingled with periods of rapid development. Morever, there is a great deal of expectation effect in parents’ reporting of the results of their interventions, along with a lot of confirmation bias.

For these reasons, and many more, it is impossible to conclude with any scientific validity that any “biomedical” intervention “works” in “improving” autistic symptoms without controlled randomized trials as evidence showing it does. Anecdotal experience and “personal clinical experience” (favored by Dr. Gordon) do not constitute sound scientific evidence, no matter how much Dr. Gordon would like to persuade you that they do. After all, physicians believed for hundreds of years that bloodletting was an effective treatment for a wide variety of conditions based on “personal clinical experience” and anecdotes.

Of course, no foreword to a book about pseudoscience would be complete without blaming physicians for something they haven’t done:

We doctors need to stop deceiving our patients into thinking that immunizations are “free.” Every medical intervention costs the body something, and we have a legal and moral obligation to tell parents.

Above all else, physicians also have a legal and moral obligation to be accurate in boiling down the best scientific evidence for a medical intervention, and claiming that vaccines might cause autism based on no good scientific evidence that they can or do is simply not accurate. Most doctors would not agree to a statement claiming that “we doctors are deceiving our patients into thinking that immunizations are free.” Doctors do consider the contraindications before administering any injection – that alone conveys knowledge that all medical procedures are not “free.” Immunization requires a risk/benefit analysis, as do all medical interventions. But, of course, Dr. Gordon doesn’t see it quite that way. Instead, he sees dark conspiracies everywhere:

The official position of the American Academy of Pediatrics may be the same as my personal position, but they are far too involved with the pharmaceutical industry to actually do anything but pay lip service to an open discussion. The CDC and the AAP are filled with doctors whose research, speaking engagements, and travel are often funded by the manufacturers of vaccines. Many of these same doctors are paid consultants, and some later go to work full-time for the pharmaceutical industry.

Again, this is a gambit beloved of advocats of pseudocience: The Pharma Shill Gambit. Indeed, Dr. Gordon has on at least one occasion tried out this particular gambit on me in e-mails demanding to know if I receive renumeration from pharmaceutical companies. Dr. Jay seemed most disappointed to learn that I do not. Also, as his history demonstrates, Dr. Gordon’s also rather quick to pull out the pharma shill gambit as well to preemptively slime those who might refute antivaccination and pro-quackery nonsense, after which he retreats to the “oh, sorry, I spoke too soon and really didn’t mean it” ploy.

Of course, ties to and support from the pharmaceutical industry exist, and they should be watched and carefully considered as potential conflicts of interest. However, research funding simply being connected to vaccine manufacturers, does not automatically invalidate science. Poor data, statistics, experimental methodology, and lack of reproducibility invalidate science. Sure there’s room for added transparency in any such arrangement where industry is involved with, or even produces some of the science, but Dr. Gordon’s apparent belief in a vast conspiracy hell-bent on making truckloads of money, no matter how many children are supposedly harmed, goes beyond the pale.

Still, Dr. Gordon is apparently smart enough to realize that beating the dead “autism = mercury poisoning” horse will not help his flailing arguments against vaccines, and so he quickly changes the subject:

Yes, most vaccines have much less mercury, but wait until the evidence against aluminum in vaccines becomes common knowledge. The body of research regarding aluminum’s harm to human cells already contains hundreds of articles.

Of course, Gordon isn’t about to make any scientific connection to autism with the aluminum. He can’t, because there isn’t. Nor can he make any connection between aluminum and any measurable harm to infant health. Again, he can’t, because there isn’t, at least not from the doses of aluminum used as adjuvants in vaccines. In reality, this is nothing more than a variation of the deceptive and downright “toxin” gambit, one that Dr. Gordon has credulously repeated in the past. Again, now that mercury has been cleared as a potential cause of autism by several very large epidemiological studies, for the antivaccine movement aluminum has become the new mercury. So, being utterly unable to make a coherent case that aluminum adjuvants in vaccines cause harm, Dr. Gordon next resorts to even more fallacious logic and science:

Like many of you and like some of my colleagues, I’m extremely concerned about what has caused the tremendous increase in autism and related disorders over the past decade. The presumption that doctors are much better at diagnosis is absurd and unscientific. (I know that I’m not 400 or 800 percent smarter than I was years ago.)

If ever there were a straw man argument, this is it. This one, better known as the “better diagnosis” straw man, seeks to imply that any increases in autism prevalence cannot just be explained by “better diagnosis”–and therefore there must really be an autism epidemic. The problem for Dr. Gordon is that absolutely no one–I repeat, no one–is making such an argument, except as a straw man argument to slap down, as Dr. Gordon does with gusto. In reality, this particular straw man is an intellectual crutch, and an ineffective one at that, for those who don’t have the slightest idea how to address the real arguments of those who state (correctly so far), that there is no evidence of any autism epidemic. The real arguments are much more substantial than a simple, “doctors are better at diagnosis.” Read up on the changing definition of autism, broadening of diagnostic criteria, diagnostic substitution, increased awareness and recognition, and the influence of access to services, for more information.

Dr. Gordon also likes to indulge in special pleading:

Last but far from least, we have to support and reinforce the intelligent and fiercely held hope these parents of children with autism have. Doctors have to acknowledge and help research the therapies that lead to recovery from autism, recovery brought on by therapies long ignored by the AAP and others. Dairy-free, gluten-free, sugar-free diets have succeeded far too many times for any doctor to claim that they’re not “evidence-based.”

That’s a pretty bold implication, asserting with such confidence that there are dietary therapies that lead to recovery from autism. It’s also not true that such claimed therapies have been ignored. They may not have had all the attention some true believers would like, but there is in fact research on the subject. Unfortunately, for Dr. Gordon’s assertion, the evidence that gluten-free diets improve autistic symptoms is much like the evidence for most “alternative” medical interventions. Smaller, unrandomized, uncontrolled (or poorly controlled) trials suggest a therapeutic effect, but the better designed the trial the more likely it is to show no effect distinguishable from that of a placebo.

Let’s set that aside for the moment though. Is there more to Dr. Gordon’s unscientific assertion that diets have succeeded far too many times for any doctor to claim that they’re not “evidence-based”? Perhaps he’ll present some scientific evidence in support of his claim.

Or not:

Evidence doesn’t spring just from medical studies funded by drug companies and supervised by MDs and researchers on their payrolls.

Brilliant! Not only is this a classic straw man argument, but the pharma shill gambit is woven seamlessly into it! Alas for poor Dr. Gordon, no one, and I mean no one, is claiming that evidence can only spring “just” from medical studies “funded by drug companies and supervised by MDs and researchers on their payrolls.” That doesn’t mean satisfactory evidence can come from just anywhere though. So, where does Dr. Gordon suggest we look for this evidence? Surprise, surprise! It’s not from scientists!

It’s from The People, man:

Evidence can come from the hundreds of families and doctors who have watched children with autism get better and even fully recover from the symptoms that have kept them from mainstream education and social opportunities. This is hard evidence and to deny it is specious reasoning and bad science.

Unfortunately, anecdotes from hundreds of families and doctors, do not represent “hard” evidence. Dr. Gordon’s apparent acceptance of anecdote is not “good science.” Rather, it is not science at all. In the critically thinking world, to which Dr. Gordon is apparently an outsider, acceptance of anecdote as scientific “evidence” is called “believing.” The very reason that science-based medicine is so important is because humans are prone to find patterns where none exist, especially when looking at small numbers and limited information. Such pattern finding ability probably had a survival advantage in the past, but it leaves humans with cognitive quirks that lead us frequently to attribute causation when none exists. Dr. Novella wrote an excellent discussion of the proper role of anecdotal evidence in science-based medicine. I suggest that Dr. Gordon read it.

Dr. Gordon’s argument is nothing more than argumentum ad populum, also known as an appeal to popularity. The observation that supposedly hundreds of families and doctors have watched children with autism get better and even fully recover from the symptoms is very close to meaningless. It wouldn’t matter if there were thousands of families and doctors with the claim. A large number of believers doesn’t equate to truth of the conclusion. There are hundreds, if not thousands, of people who have claimed to have seen Bigfoot. Does this mean that Bigfoot is real? There are hundreds, if not thousands, of people who claim to have been abducted by aliens and subjected to various experiments. According to Dr. Gordon’s apparent logic, he should answer, “evidence can come from the hundreds of outdoorsmen and others who have seen Bigfoot” that Bigfoot exists or “evidence can come from hundreds of people who have been abducted by aliens” that aliens are visiting Earth and abducting people. Many other examples come to mind: Belief in ghosts, psychics, astrology. Many, many people believe in these things and have believed in these things for millennia. Does that mean they are real or that they work?

In Conclusion

Boiled down to its essence, Dr. Gordon’s entire foreword says very little about autism, or Jenny McCarthy’s understanding of the subject. It appears to be little more than an indictment of vaccines in general, and a fallacy-filled presentation of “science doesn’t have all the answers” and “vaccines did it.” Sadly, it’s also of a piece with his previous writing, public appearances, and online activity since at least 2005. Indeed, Dr. Gordon’s entire public career says very little about autism, although it does say that he is clearly deeply “skeptical” of vaccines based on his own “clinical experience” rather than scientific evidence and well-conducted epidemiological studies. Based on excessive use of fallacious logic, our lesson from this foreword from Dr. Gordon can be summed up thusly, “complete pseudoscience probably follows.” I can’t say for sure that it does because I haven’t read the book, but, given Jenny McCarthy’s track record I’d be shocked if such were not the case. (I’d actually read McCarthy’s book, except that I really, really don’t want to buy the book, because morally I cannot abide the thought of contributing to Jenny McCarthy’s income.)

Finally, I really wish that Dr. Gordon had not debased himself so far in writing this foreword. To throw his own words back at him, writing such a chapter is beneath him. After all, Dr. Gordon seems like a nice enough guy. Unfortunately, he appears to have become too enamored of the hero status he’s been given by the anti-vaccine contingent and his time in the limelight with the celebrity mother of his patient Evan. Of more concern to me is this: Given that McCarthy’s book seems to argue that biomedical interventions can cure autism, Dr. Gordon’s stamp of approval in the form of his foreword makes me wonder whether he prescribes the woo described therein. After all, if Dr. Gordon believes that these biomedical bits of woo that Jenny McCarthy has advocated in her most recent book and in her previous book help “recover” autistic children, than why wouldn’t he recommend them to his patients? If he really believes they work, then ethics would demand that he do so. In actuality, I really, really hope that Dr. Gordon doesn’t use such treatments in his practice. In the end, because Dr. Gordon strikes me as a nice enough guy whose general credulity and lack of scientific acumen has led him down a disturbingly wrong path, I keep hoping against hope he’ll eventually see the light. However, his having penned such a brain dead, fallacy-filled introduction to a brain dead, fallacy-filled book advocating dangerous quackery does not make me optimistic that this will ever happen. It’s just the latest example of his apologia for antivaccinationist pseudoscience. Dr. Gordon can proclaim to high heaven that he really, truly is not “antivaccine,” but that doesn’t make it so. His words and actions belie his denials, and it is quite accurate to conclude that, at the very least, he is an apologist for the antivaccine movement.

More’s the pity.

Note: Special thanks to Dad of Cameron over at Autism Street, for contributing to parts of this post.

Posted in: Neuroscience/Mental Health, Public Health, Science and the Media, Vaccines

Leave a Comment (121) ↓

121 thoughts on “Dr. Jay Gordon and me: Random encounters with an apologist for the antivaccine movement

  1. Ranson says:

    A spectacular and comprehensive read, as always, Dr. Gorski. You wrap up many of the usual antivaccine arguments comprehensively. One could almost use this as a primer for debating the subject.

  2. Owen says:

    Yes, excellent, like Ranson says.

    Just one thing though…

    “Dr. Gordon seems to be arguing that breast feeding and keeping cheese out of the diet will prevent the spread of infectious diseases better than vaccines.”

    You may have more information that backs up this point, but on the quote you gave he’s talking about heart disease and such-like, not infectious diseases. That seems fairly obvious, so am I missing something?

    (There’s enough to complain about without giving him wiggle room to avoid your main points.)

  3. Michelle B says:

    I agree with Ranson. Will use this article as reference in dealings with sloppy thinkers like Gordon (who does not seem nice but creepy to me–sloppy thinkers like Gordon and his creepy celebrity crew stay stuck in their erroneous viewpoint because of their enabling each other to stay stuck).

    The ‘we are not anti-vaccines’ ploy is disgustingly transparent revealing their intellectual dishonesty and lack of scientific understanding. Why can’t they just admit the truth, that they are anti-reality.

  4. Michelle B says:

    I agree with Owen’s point. I think Gordon sloppily mixed up types of diseases. And also seemed to have arbitrarily decided that since polio is not very prevalent (wonder why?), combating heart disease is more important to prevent so stop with the wasteful vaccinations already! (sarcasm).

  5. David Gorski says:

    Alright, it was lame attempt at sarcastic humor that apparently didn’t quite fly. I’m wondering if having associated with Dr. Crislip is starting to rub off on me, only I don’t quite have his talent for it. However, in my defense, I’d point out that breast feeding does provide humoral immunity to infants; it just isn’t enough to prevent many vaccine-preventable diseases.

    My main point is that Dr. Gordon promotes diet and fighting obesity as a means of denigrating the public health benefit of vaccines. He assumes that because the polio vaccine has reduced polio incidence to very low levels that the vaccine is no longer of benefit, not seeming to realize that if polio vaccination rates were to fall polio would almost certainly return, just as the measles has returned in areas of the country where MMR vaccination uptake has fallen below her immunity. Again, Dr. Gordon poo-poos the public health benefits of vaccines. Moreover, he neglects the suffering that polio causes in the form of paralysis and other complications, which affect far more polio victims than the disease actually kills.

  6. overshoot says:

    Will use this article as reference in dealings with sloppy thinkers like Gordon (who does not seem nice but creepy to me

    $HERSELF and I have settled on describing him as “smarmy.”

  7. overshoot says:

    I’d point out that breast feeding does provide humoral immunity to infants; it just isn’t enough to prevent many vaccine-preventable diseases.

    Well, sort of. In the case of endemic diseases that a mother encounters frequently (and thus give her sky-high antibody titers) and that an infant will likely encounter before the maternally conferred immunity wears off, then the child may acquire natural immunity without a severe (or perhaps even noticeable) case of the disease.

    IMNAASOEWIO [1], this is the historical mechanism that kept polio a minor disease and likely mitigated other non-epidemic diseases. I really don’t see that going back to the conditions that enabled polio to be a pervasive disease are desirable, though.

    Of course these little distinctions seem to be lost on the antivac crowd.

    [1] In My Not At All Scientific Or Even Well-Informed Opinion

  8. Matt says:

    Here’s the cheese quote in context with the question. It’ from his interview with Cookie Magazine, on vaccines:

    How do you reconcile the notion of not vaccinating with the public health benefit that you mentioned earlier?

    I think that the public health benefits to vaccinating are grossly overstated. I think that if we spent as much time telling people to breastfeed or to quit eating cheese and ice cream, we’d save more lives than we save with the polio vaccine.

    If he’s talking about heart disease, why? Given the question why?

    First, I would challenge the assumption–I think the Polio vaccine has saved a lot of lives. If we stopped vaccinating against Polio, we would see a lot of deaths and disability. Sure, if one doctor doesn’t give the vaccine, the protection everyone else offers means he could get away with it. That’s not what he’s saying though.

    Even the, it’s a poor argument. A good diet may save more adults than, say, treating appendicitis saves kids. Do we stop treating the kids?

  9. Zoo Knudsen says:

    So at what point does he stop being considered a nice guy considering he is blatantly spouting unfounded “expert” opinion that will, if it hasn’t already, directly lead to increased morbidity and mortality in the pediatric population?

  10. David Gorski says:

    A good diet may save more adults than, say, treating appendicitis saves kids. Do we stop treating the kids?

    Damn. That’s the retort I should have come up with to Dr. Jay’s nonsense. I may steal it if I ever update this post for use elsewhere in the future. :-)

  11. Harriet Hall says:

    The term media whore comes to mind.

    Gordon joins a long line of doctors from Andrew Weil to Christiane Northrup who have misused the prestige of their MD degrees to spread unsupported beliefs.

  12. overshoot says:

    The term media whore comes to mind.

    In all seriousness, Doctor, I think you do sex workers a disservice.

    The woman who makes herself available on a fee-for-service basis is at least honest about the business she’s in. Those who (naming no names) represent themselves to the public and the courts as somehow objective experts don’t deserve even that much respect.

  13. Fifi says:

    I think it may be worth looking into just how involved Big Vita/Supp is in the anti-vaccine movement. The reason why cheese and ice-cream are mentioned is because dairy is one of the things that woo nutritionists who push detox claim is toxic. The whole “food is toxic take huge doses of supplements instead” thing is a sales pitch of Big Vita/Supp and seems to be a large part of the actual motivating force behind the anti-vax push (follow the money trail of who profits by spreading disinformation about vaccines and, in the case of autism, it’s Big Vita/Supp and chelation clinics).

  14. James Fox says:

    Excellent again Dr G

    All the antivax folk seem to posses the most interesting combination of delusions, conspiracy theories and an inordinate sense self importance. Clearly not a good combination.

    You mentioned one of the Autism woo cures of a gluten free diet in your post. I’m often hearing from people in the media and friends that they are “gluten intolerant”. I’ve generally been a bit dubious about this as its sounded a lot like the multiple toxin sensitivity garbage. And I’ve never heard it mentioned by someone who has a credible or scientific background or read a reasonable science/evidence based article giving an explanation. Any good links to some science based information either explaining or debunking this “condition” ?

  15. weing says:

    Let me get this straight. This Dr Gordon thinks vaccines cause autism and booger eating gives you medical insight that is missed by doctors and makes you an instant authority on vaccines and autism?

  16. Joe says:

    weingon 20 Oct 2008 at 4:18 pm wrote “Let me get this straight. This Dr Gordon thinks vaccines cause autism and booger eating gives you medical insight that is missed by doctors and makes you an instant authority on vaccines and autism?”

    Let me get this straight- do you have a problem with that?

  17. bcorden says:

    Just a point:
    You say
    “Most children do not get the flu vaccine, especially not under two years of age, and, even as the use of the flu vaccine is encouraged, flu vaccines containing more than trace amounts of thimerosal are increasingly uncommon because of low demand.”

    Actually, we went from giving influenza to high risk kids over six months, to all kids six to 24 months, to all kids six months to 5 years; to all kids six months to 18 years.

    http://www.medpagetoday.com/InfectiousDisease/URItheFlu/11065
    “The new age recommendation for routine annual flu immunization covers children from five to 18. Just two years ago, the CDC raised the age recommendation from 24 months to 59 months. Before that, a 2004 recommendation had been for immunization for children six months to 24 months. ”

    thats why I gave a dozen flu shots today and will give 40 tomorrow in our “flu clinic”

    And, they are Hg Free!! (not that I care)

    Dr. C.

  18. weing says:

    Joe,
    Yes, I do have a problem with that and feel like hitting my head against a wall. I could have saved myself many years of financial hardship and grueling studying to get through medical school and residency. Why didn’t I think of just eating my boogers to make me an expert like Jenny? Stupid! Stupid! Stupid me!

  19. Ranson says:

    @ James Fox

    The closest thing I’ve heard is that some autistic kids with conditions like Celiac disease seem to have a worse time of it because of the symptoms of the disease. For kids with issues communicating and expressing themselves, a disorder that causes serious bowel discomfort and fatigue can only make them miserable, because they have a harer time explaining the discomfort. If/when something like celiac is discovered and treated in someone on the spectrum, I can believe that there might be some improvement due to the reduction or elimination of stress related to the disease. I’ve seen at least one poster on another blog mention this series of events in relation to his/her child, so it isn’t a completely implausible idea.

  20. I go away for one weekend, and this is what I miss! Gordon really makes me want to pound my head into the keyboard, simply because I don’t understand how he can hold the opinion he does in the face of so much evidence that autism is genetic, that it is not the vaccines and never was, and that Jenny’s pet cause is bringing a resurgence of deadly infectious diseases to this country! Moreover, he is helping her to publicize the extremely damaging idea that autistic people are broken and need to be fixed in order to be considered humans with very real feelings whose self-esteem can be damaged by tripe like this! Gah!!!!!

  21. Calli Arcale says:

    Ranson, my family has lots of learning disorders (including a couple of autism-spectrum cases and a lot of ADHD cases) *and* carries the gene for celiac sprue. We know because my cousin was unfortunate enough to inherit it from both of her parents. Interestingly, she has no learning disorders. So from a sample size of one, I’d say there’s no association between celiac sprue and autism. Of course, the detox folks will just say that she’s avoided autism merely because she’s not been permitted any gluten since the age of six months. (She has it bad; she was hospitalized after her first taste of solid foods.) Or they’ll say that ah-ha, the genes obviously correspond, even if all of the traits of both don’t always appear together! But of course the truth is that a sample of one generally means bupkis for epidemiology.

  22. Ranson says:

    @Calli Arcale

    I apologize if I left the impression that I felt the conditions were associated — that is not the case. What I intended to get across was that a condition such as celiac could possibly be an added stressor to an autistic individual. Since such a source of stress may not be readily apparent and the individual may not be easily able to communicate about it, the spectrum disorder may appear “worse” due to the added suffering. I was positing that a removal of the stressor (i.e. a diet change) could appear to cause an “improvement”, when it would really be more of a return to the baseline of the actual condition.

    I think this kind of correlation could account for some of the anecdotes regarding diet as a “cure” — there is sure to be some overlap of the populations of those on the spectrum and those with disorders related to food. If someone attempts a diet change that happens to relieve the digestive-type stress, it’s easy to see where a “correlation/causation” fallacy could appear.

  23. Fifi says:

    I think that anecdotes about behavioral changes accompanying dietary changes are quite probably accurate in a lot of cases. Not because a healthy diet *causes* things like autism or true ADD but because really poor diets and malnutrition cause all kinds of health and learning problems even for neurotypical kids. If a kid isn’t neurotypical and already has additional challenges which lead to frustration and acting out, then a poor diet will really acerbate this and make their condition seem even worse. (Add in parents who lack skills to manage frustration themselves so don’t have the tools to offer their kids, and it’s just one big ball of dysfunction with lots of threads that lead to a central cause.) Plus autistic kids can get fixated on only eating certain things which may not be healthy for them (just like non-autistic kids, it’s just that autistic kids tend to be harder for parents to manage). Kids that drink coke or other high sugar beverages as their primary liquid and eat junk food all the time (this includes pre-prepared foods that many people eat which aren’t very healthy but they mistakenly think are due to advertising and poor nutritional education) are clearly going to benefit from eating properly and be better behaved whether they have a learning disability or not.

    As for the gluten connection, anyone who has to cut gluten out of their diet has to be quite conscious of what they’re eating and it removes a whole range of fat, sugar and additive laden foods that people commonly feed to their children in North America. It also means that a parent will need to be much more conscious of feeding their child a nutritionally balanced diet and they can’t rely upon pre-prepared foods in the same way. So instead of hot dogs on white bread and burgers, or fried fish, kids get fed lots of whole grain rice, veggies and healthy food (Dr Gordon seems to be a promoting a vegan diet – which seems like a lot of additional work for a mother of an autistic child since it’s difficult enough to maintain adequate, let alone optimum, nutrition for an adult with a vegan diet). I’ll be interested to see if the food extremists give up whole grain rice now that it’s been shown to contain arsenic? (Particularly rice grown in the USA due to many cotton fields which contain arsenic from cotton production being converted to rice production, with the rice then picking up the arsenic from the soil. It’s ironic to note that many gluten-free products are made with rice and rice bran so that parents who put their autistic kids on gluten-free diets and use rice products as a substitute – as many people commonly do – may well be actually be feeding their kids food that’s got extra environmental arsenic in it!)

    It’s pretty clear that the majority of American adults can’t feed themselves in an informed and healthy manner so it’s hardly a surprise that they feed their children the same thing they’ve been sold as being “normal” food. The amount of money that goes into trying to entice children to pressure their parents into buying junk food is pretty phenomenal. Like adults, if you remove the junk food and tv it’s amazing how much healthier, more social and conscientious kids become ;-)

  24. BisserR says:

    Dear Dr. Gorski,

    You attitude is unnecessary. You are causing more harm to the vaccine program than you realize.

    The mere term ‘antivaccine’ is confrontational and does not promote constructive dialog. You certainly wouldn’t be happy to be described as ‘pro-vaccine injury’, ‘pro-mercury’ or ‘pro-aluminum’. Parents who choose not to vaccinate their children are doing the best they can. They have valid concerns about safety which could be addressed by improving vaccines and conducting proper studies. Namecalling and treating people as duffs does not help anyone.

    Best,
    Bisser

  25. passionlessDrone says:

    Hi Ranson & FiFi -

    You might be interested in knowing that several researchers have found that children with autism generate IG responses at increased levels than their undiagnosed peers for common dietary proteins found in wheat and/or milk.

    http://foa.sagepub.com/cgi/content/abstract/23/3/176
    http://aut.sagepub.com/cgi/content/abstract/10/2/189
    http://content.karger.com/ProdukteDB/produkte.asp?Doi=65416
    http://www.ncbi.nlm.nih.gov/pubmed/15870662

    This doesn’t mean diet causes, or cures autism, but clearly there is something going on there. My son develops eczema and loose stools any time he is exposed to wheat or dairy; often times this is accompanied by poorer behavior.

    - pD

  26. David Gorski says:

    The mere term ‘antivaccine’ is confrontational and does not promote constructive dialog. You certainly wouldn’t be happy to be described as ‘pro-vaccine injury’, ‘pro-mercury’ or ‘pro-aluminum’. Parents who choose not to vaccinate their children are doing the best they can. They have valid concerns about safety which could be addressed by improving vaccines and conducting proper studies. Namecalling and treating people as duffs does not help

    Yes, the term “antivaccine” is confrontational–intentionally so. Unapologetically so, in fact.

    It’s also accurate. Remember, I’m not talking about you (at least as far as I can tell thus far) or parents who have concerns and questions. I’m talking about parents and supporters who have decided that vaccines cause autism (period!) and that they will not vaccinate their children. I’m talking about people who run organizations opposed to the very concept of mandatory vaccination who use pseudoscience, misinformation, and fearmongering to promote their agenda. These are people to whom, evidence be damned, it is always about the vaccines. These are the people who use the brilliantly Orwellian slogan “Green Our Vaccines.” Ask them exactly what it would take to make vaccines “green enough” or “safe enough” that they would vaccinate their children, and they can’t tell you. I’ve written about this extensively before and why I consider the whole “we’re not ‘antivaccine,’ we’re pro-safe vaccine’” to be an obvious dodge:

    http://www.sciencebasedmedicine.org/?p=139

    I’ve also “thanked” Jenny McCarthy for her role in promoting the resurgence of measles in the U.S.:

    http://www.sciencebasedmedicine.org/?p=194

    But back to our points. No one–I repeat, no one–is against “safer” vaccines. Here’s the problem. Vaccines do not cause the conditions and problems that are attributed to them by antivaccinationists, but what antivaccinationists mean by “safer” is “vaccines that don’t cause autism.” Unfortunately for them, multiple large studies powered to detect even weak correlations have failed to find any correlation between mercury-containing vaccines and autism or vaccines in general and autism, despite Dr. Gordon’s “feeling” and “belief” that “vaccines can cause autism.” It’s scientifically impossible ever to completely prove a negative, but the best scientific evidence out there strongly supports the contention that the odds that vaccines cause the health problems attributed to them is exceedingly small. Not zero, but exceedingly small.

    In light of that data, the unrelenting barrage of claims that vaccines cause autism, neurological problems, and many other conditions and diseases is based on no good evidence. Worse, no evidence is ever enough for antivaccine activists. Whenever more studies are done that exonerate vaccines as a cause of autism, they either move the goalposts or dismiss the studies. A beautiful example of this is David Kirby, who in 2005 said that if autism rates didn’t start dropping by the end of 2005, it would be a huge blow to the thimerosal hypothesis. (Remember, thimerosal was removed from most childhood vaccines at the end of 2001.) 2005 and 2006 came and went with no decline, and then it was “by 2007.” 2007 came and went with no decline, and now Kirby’s saying 2011. No study or group of studies is ever convincing.

    No, this goes far beyond parents who are concerned. You’ll find that I’m happy to discuss what I know with such parents in a nonconfrontational way. When it comes to Jenny McCarthy, J.B. Handley, Barbara Loe Fisher, and–sorry to say–probably Dr. Gordon, they are beyond persuading, and the gloves come off. To get you thinking about the issues involved, consider these questions:

    1. What ingredients, specifically, are “dangerous” in vaccines? What is the scientific evidence that they are?
    2. What, specifically, does “Green Our Vaccines” mean?
    3. What, specifically, would it take to convince you that vaccines do not cause autism? (No vague generalities, please.)
    4. I gather from your statement about parents who haven’t vaccinated their children that you are one of them. (Apologies if I’m incorrect.) If I’m correct, then what evidence, specifically, would it take to convince you that vaccines are safe and to vaccinate your child.

    Finally, if you want to call me “pro-mercury” or “pro-aluminum,” go right ahead. I have a thick skin. What’s so bad about aluminum, anyway, other than that, now that thimerosal has largely been exonerated as a cause of autism, aluminum has become the new mercury? Yes, mercury is toxic, but the dose makes the poison, and at the doses given there is no evidence that thimerosal is dangerous or harmful. Ditto the aluminum salts used as adjuvants in vaccines. Think of it this way. One of the most deadly toxins known to humans is the botulinum toxin. Yet, physicians inject botulinum toxin (a.k.a. Botox) into people’s faces to smooth out wrinkles.

    The dose makes the poison.

  27. Militant Agnostic says:

    Whenever I hear someone Like Jay Gordon extolling the values of anecdotal evidence, I trot out my favourite example of a worthless anecdote (although you don’t hear it much lately) – “My Aunt/Grandomther/Father etc smoked a pack a day and lived to be 90, therefore smoking doesn’t cause cancer”

    When I commented with this example at Respectful Insolence, I noticed he had no comeback to that although responded to commects above and below mine. I also noticed he hasn’t come over here – I assume he can play the “bunch of meanies” persecution card better at RI.

    During my career in well test analysis in the oil and gas industry, I have encountered a lot of people telling me things based on their experience that contradict the laws of physics and/or do not match at all what I have observed. Confirmation bias is very powerful.

    I find it ironic that people who think that their recollection of their personal experience should trump the knowledge of experts in the field who have applied the scientific method to much larger quantities of data call those experts arrogant.

  28. passionlessDrone says:

    LOL!

    The dose makes the poison.

    “My Aunt/Grandomther/Father etc smoked a pack a day and lived to be 90, therefore smoking doesn’t cause cancer”

    It turns out, that unless your end points are lethality, the dose does NOT always make the poison. The notion that dose is the only important factor is a phrase with only slightly more utility than “Green Our Vaccines”.

    If we look to autism science, in fact, we find that in animal models, researchers were able to create behavioral changes, as well as distinct physiological differences by keeping the same dose, but modifying the timing of the dose.

    http://jpet.aspetjournals.org/cgi/reprint/jpet.107.121483v1

    Animals given the agent at 2-5 days after birth develop abnormal behavior patterns and activated microglia observed in autism. Animals given the agent at 11 – 14 days after birth do not develop either. Same dose. Different result.

    The discussion about about vaccines and the association of chronic complications is full of these over simplifications. It is a shame.

    - pD

  29. David Gorski says:

    The problem with your argument is that no one has ever convincingly shown that the dose of thimerosal received in vaccines at the times that the vaccines were routinely given causes autism–or that it is even correlated with a detectably increased risk of autism. You’re putting the cart before the horse. Before it’s reasonable to start going on and on about “timing,” there should exist some evidence that there is a correlation between thimerosal-containing vaccines and autism. There ain’t. I also note that the article you referenced looks at rats. There is no particularly good rodent model of autism. In fact, there is no really good animal model of autism, period (I can’t resist taking after our friend Dr. Jay). Indeed, the “similarities” to autism listed in the paper you cite seem are quite tenuous and involve a lot of handwaving. The closest thing to such a model is this, and note that the behavioral traits described are clearly different from the behavioral traits described in the rat model.

    The genetic model of autism:

    Dr. Powell studied the genetically altered mice and found that, when examined in behavioral tests that may reflect key signs of autism, they showed decreased social interaction with other mice; other traits, such as anxiety, coordination and pain sensitivity, were unaffected. These social interaction deficits, Dr. Powell says, are hallmark features of human autism. In addition, the mice showed enhanced spatial learning abilities, which may resemble the enhanced cognitive abilities in autistic savants (people who have a severe developmental or mental handicap as well as extraordinary mental abilities).

    The rat model of autism you referenced:

    In behavioral tests, animals treated with terbutaline on PN 2 to 5 showed consistent patterns of hyper-reactivity to novelty and aversive stimuli when assessed in a novel open field, as well as in the acoustic startle response test.

    There’s no doubt we need a good, valid animal model for autism. Whether or not the genetic mouse model is represents just such a model or not remains to be clarified, but it appears likely to be more valid and useful than the model you cite. That’s not to say that the rat study isn’t interesting; it is, actually. I’m just not sure it’s as relevant to autism in humans as the authors apparently believe it to be.

    So, yes, timing as well as dose can make a difference in some drugs, but the mercury militia has failed to show that the the dose and timing of thimerosal-containing vaccines lead to a detectably increased risk of autism. Ditto vaccines in general. In the absence of such evidence, your speculation is just that–speculation, and not very convincing speculation, either.

  30. Fifi says:

    PD – It will certainly be interesting to see what the results of studies will be regarding diet and autism since only minimal studies that have been done and they point in both directions at this point. Clearly diet does effect development and behavior in children, whether there’s connection between gluten and/or diary intolerance and autism is unproven at this point. The key is to do studies to discover the reality rather than relying upon parent’s observations (which are biased and unreliable for the obvious reasons, including parents of autistic children being targets for an unregulated industry that’s not required to operate within the same ethical guidelines as medicine and science, a fact that many lay people don’t understand and which – combined with the challenges, hopes and fears that come with having an autistic child – can make parents of autistic children very easy marks for con men and women who pretend to really care and spend time “caring for” the people they con as a means to conjure trust and create an intimate and emotional relationship….until the wallet runs dry, of course).

    http://www.sciencedaily.com/releases/2007/05/070501115240.htm

    To throw in my own anecdote – none of the people I know who are gluten intolerant (one happens to be a scientist) are autistic or autistic spectrum, and conversely none of the people I know with Aspergers are gluten intolerant. This, of course, means nothing other than I know these people and proves nothing regarding autism and food intolerances.

  31. Fifi says:

    It’s quite obvious why and how parents of autistic children get sucked into quackery and want to believe and why it’s easy for con men and women to take advantage of the parents of autistic children and use their hope and grief to manipulate them. What’s less obvious sometimes is what’s feeding the roots of the tree of quackery and where the ideas that are being promoted and hostility to medicine and science actually comes from, and how these ideas have gotten so much traction despite being contradicted by the evidence. Really the parents and movie stars are just sugary frosting intended to make the message attractive not the public and aren’t the actual source of the message – and often they have been conned too and are true believers, hence being passionate “warriors” that are actually pawns in other people’s games where the endpoint is power and profit. In many ways, going into “battle” against these parents and public figures is a bad communications strategy (not only ineffective but actually harmful to science and medicine vis a vis public perception).

    This blog does a good job of following the trail of crumbs back to the gingerbread house where they were first half baked with a dash of pseudoscience and a whole heap of well spun sugary magic to make the pseudomedicine go down.

    http://leftbrainrightbrain.co.uk/?p=463

  32. passionlessDrone says:

    Hi David Gorski –

    The problem with your argument is that no one has ever convincingly shown that the dose of thimerosal received in vaccines at the times that the vaccines were routinely given causes autism–or that it is even correlated with a detectably increased risk of autism.

    In the first place, you don’t seem to have any idea of what my argument is. I do not believe that thimerosal is the cause of an explosion of autism. Does this help clear things up?

    But this does nothing to change my belief that these conversations nearly always fall back on positions that soundbyte well, but fail to take into consideration the complexity of what is being discussed. Unfortunately, the studies being performed seem to suffer from the same problems.

    For starters, I think that the focus on thimerosal is a huge, gross over simplification of exactly the type that makes most of these discussions all bluster, but rarely any substance. There is a lot going on during vaccination; including a lot that remains poorly understood. Given we have studies with one particular ingredient has little meaning other than information on one particular ingredient. If the purpose of vaccination was to inject children with mercury, then the studies concerning thimerosal would speak much more clearly towards the vaccination program as whole, but this is not the case.

    The closest thing to such a model is this, and note that the behavioral traits described are clearly different from the behavioral traits described in the rat model.

    What about the very distinct physiological changes found in the animals that have also been found in autism, though? In my opinion this is more telling than abnormal behaviors.

    I’d agree that behavioral analysis is poor modeling at modeling autism, but our options are limited there.

    Whether or not the genetic mouse model is represents just such a model or not remains to be clarified, but it appears likely to be more valid and useful than the model you cite.

    What, if any, physiological similarities were found in the animals in this model?

    Ditto vaccines in general.

    Completely unsubstantiated. There are no studies comparing cohorts who got vaccinated versus those that did not unless we are willing to accept gross over simplifications. Studying the MMR rates tell us very little about the impact of decreasing the age of DTAP, or Hib vaccination. Studying thimerosal levels tells us very little about the chances of initiating auto immune dysfunction.

    In the absence of such evidence, your speculation is just that–speculation, and not very convincing speculation, either.

    You have made up an argument, placed it in my mouth, and slam dunked it. What, precisely, did I speculate?

    - pD

  33. Fifi says:

    BisserR – “The mere term ‘antivaccine’ is confrontational and does not promote constructive dialog. You certainly wouldn’t be happy to be described as ‘pro-vaccine injury’, ‘pro-mercury’ or ‘pro-aluminum’. Parents who choose not to vaccinate their children are doing the best they can. They have valid concerns about safety which could be addressed by improving vaccines and conducting proper studies. Namecalling and treating people as duffs does not help anyone.”

    Interesting that you should “tut-tut” over that while the whole anti-vax movement is trying to distance themselves from being anti-vaccination now that there’s substantial evidence to contradict the claims that mercury in vaccines causes autism. That’s why the meme has been modified to “green vaccines” and it’s no longer mercury being blamed but the process of vaccination itself. It really makes no difference to the anti-medicine “movement” (which is what the root and true target of the anti-vax movement as supported by Big Vita/Supp who want to push their product as the answer to autism). The target isn’t vaccines, it’s medicine and science since they’re the only things getting in the way of selling their products to more people. The very idea of a “green” vaccine is stupid if you think about it even for a second and is merely marketing speak, in fact it’s a wonderful example of “greenwashing” (trying to sell something as being environmentally friendly when it’s not, like Shell’s “we’re environmentalists” ads!).

    Many “proper studies” have been done and there’s good evidence that there’s no link between thimeserol in vaccines and autism. Now those who make their living from being anti-vax have had to shift the goalposts (yay, that means science scored a goal ;-) ) Since, by coincidence, autism starts to more obviously manifest around the time kids get vaccinated that’s too good a “proof” to use to con parents into buying woo to give up! (Con men and women always engage people’s tendency to believe that seeing is believing as a means of “proving” their con, that’s why the appearance of being science not magical thinking is so important to Big Vita/Pharma and their distributors.) Hence the shift to marketing the idea of “green vaccines” and the pretense by anti-vax believers that it was never about mercury in vaccines. If you keep in mind that it’s really just about selling supplements and vitamins, and generally trying to keep people from engaging in reality based and critical thinking (and, instead, keeping them agitated and emotional so they can’t think clearly and rationally), it all really makes quite a bit of sense in terms of messaging. (The message being the fundamental idea you want to get across that may not be what appears to be the message on the surface.)

  34. David Gorski says:

    What about the very distinct physiological changes found in the animals that have also been found in autism, though? In my opinion this is more telling than abnormal behaviors.

    No, it’s not, because the connection between “neuroinflammation” and autism is tenuous at best. Seeing our exchange here, a colleague tells me that you’ve been informed on other blogs of the multiple shortcomings of this study (for example, on Kristina Chew’s blog), particularly in relating the animal model used to autism, but that you’ve ignored them. I could list the additional reasons why this study doesn’t have very much to say about the pathogenesis of autism, if you like.

    As for your bit about the “unvaccinated” versus “vaccinated,” you do realize that such a study is potentially both unethical and definitely incredibly difficult, hard to justify without some stronger evidence. Prometheus described well why your argument doesn’t hold water:

    http://photoninthedarkness.com/?p=100
    http://photoninthedarkness.com/?p=121

  35. BisserR says:

    “multiple large studies powered to detect even weak correlations have failed to find any correlation between mercury-containing vaccines and autism or vaccines in general and autism”

    I don’t believe this to be the case. There are a number of observational studies, but these typically compare different types of vaccines or vaccination schedules, or compare different periods (say before and after removal of thimerosal). Aside from the fact that observational studies have severe limitations by design, I am not aware of any comparison between groups of “fully vaccinated” (as per AAP recommendation) and never vaccinated children.

    What would be the requirements for a good study? First consider sample size. Assume that one third of autism cases are due to vaccinations and that the autism rate among vaccinated children is 0.6% (6 in 1000), while the autism rate among unvaccinated children would be 0.4% (4 in 1000). As study with error level 5% and power 95% would require 26,917 vaccinated and 26,917 unvaccinated children (here is a sample size calculator ). Further, we would need to do a randomized, double-blind study with a sufficient follow-up time for reliable diagnosis. This could be achieved by randomizing children at birth and withholding vaccines for the “unvaccinated” group until age 5, at which time each child is evaluated for autism by an expert blind to the vaccine/placibo randomization.

    1. What ingredients, specifically, are “dangerous” in vaccines? What is the scientific evidence that they are?

    Individual incredients are not so important as is the vaccine as a whole. Possible interaction between vaccines and giving multiple vaccines are also a concern. The only way to put the issue to rest is to study multiple vaccines within the context of the current immunization schedule promoted by AAP.

    2. What, specifically, does “Green Our Vaccines” mean?

    I have no idea what the march organizers had in mind.

    3. What, specifically, would it take to convince you that vaccines do not cause autism? (No vague generalities, please.)

    A double-blind randomized study of the magnitutde that I describe above will likely suffice. Of course, if the result is borderline (e.g. a p-value of 0.062 is obtained) it would be reasonable to believe that there is a vaccination contribution to autism, but this contribution accounts for less than 1/3 of all cases.

    4. I gather from your statement about parents who haven’t vaccinated their children that you are one of them. (Apologies if I’m incorrect.) If I’m correct, then what evidence, specifically, would it take to convince you that vaccines are safe and to vaccinate your child.

    Yes, I am one of them. If a study like the one I describe above is followed for multiple points (not just autism but also SIDS, ADD, ADHD etc.) and all come negative, I would be pretty convinced in vaccination safety. Also, comparing the rates of preventable disease in the two groups would provide a reliable measure of vaccine efficacy.

  36. Fifi says:

    BisserR – Since you’re not happy with the research that’s been conducted so far because you don’t consider it rigorous or extensive enough, what’s the rigorous and extensive scientific data that is the basis of your belief that vaccines are dangerous for your child’s health and may cause autism? And if it’s not based on scientific studies, what is your decison not to vaccinate your child based upon and where did you get your information?

  37. BisserR says:

    Fifi – My decision to stop vaccinating my children (I did vaccinate my two sons initially, my daughter was never vaccinated) was based on anectodes and warnings from other parents, as well as observations and records of possible vaccine reactions in my oldest son. After I looked into the issue I found that the data is insufficient to support the safety claims of the CDC and AAP. I thus decided to err on the side of safety and postpone vaccinations indefinitely.

  38. David Gorski says:

    BisserR

    You do realize, of course, that the trial you propose is completely unethical and would never–let me repeat this for emphasis, never, ever, ever–be approved by an IRB (institutional review board, the committee that each institution must constitute to protect the rights of human subjects in clinical research). Nor should it ever be.

    Why unethical? Because it is considered doing harm to withhold vaccines that protect against infectious disease from a child. It is true that in evidence-based medicine (and, for the most part, in science-based medicine) the randomized clinical trial is considered the highest form of evidence. However, it is not always ethical or practical to do a randomized, double-blinded, placebo-controlled clinical trial. This is one such case, because leaving children unprotected against infectious disease for at least five years would be doing harm, because the completely predictable result would be an increased incidence of such diseases in the unvaccinated control group.

    When randomized clinical trials cannot be done due to ethical concerns, that doesn’t mean we can’t produce very reliable evidence. It just takes more work and more studies to make up for it. Huge epidemiological studies, when properly designed and controlled for confounding factors, can be very close to being as good, and we have exactly that showing no correlation between either thimerosal-containing vaccines or vaccines according to the routine vaccination schedule showing no detectable correlation between vaccines and autism. From Paul Offit’s Autism’s False Prophets using the example of thimerosal:

    Natural measles infection occasionally causes the number of platelets…to decrease…Measles vaccine also can cause temporary thrombocytopenia, albeit rarely, in about one of every 25,000 vaccinated children. Investigators unearthed this rare problem with measles vaccine using a series of powerful epidemiological studies. In 1976, public health officials in the United states, fearing that an unusual outbreak of influenza among soldiers at Fort Dix (New Jersey) signaled the start of the next influenza pandemic, immunized millions of Americans with what was called the swine flu vaccine. Unfortunately, some people immunized with the vaccine developed a rare form of paralysis called Guillian-Barré syndrome. Epidemiological studies showed that the vaccine was the cause. One of every 100,000 people who got swine flu vaccine–400 people among 40 million—had been afflicted.

    Problems caused by vaccines as rare as one in 10,000, one in 25,000, or one in 100,000 have been readily detected by epidemiological studies. If autism a disease that affects one of every 150 American children, was caused by thimerosal, epidemiological studies would have detected it. Indeed, if thimerosal in vaccines accounted for only 1% of autism—one in 15,000—epidemiological studies would have found it. Instead, after examining the records of hundreds of thousands of children, investigators in both North America and Europe couldn’t find any evidence of a relationship between thimerosal and autism. It wasn’t that their studies were poorly designed or that they had been part of a vast international conspiracy to hide the truth. They couldn’t find a relationship because it wasn’t there to be found.

    No correlation between the MMR or vaccination in general and autism has been found, either.

    Again, Prometheus gives an excellent primer on these issues in the following two posts, one of which I see from the comments you have read:

    http://photoninthedarkness.com/?p=121
    http://photoninthedarkness.com/?p=100

  39. James Fox says:

    @BisserR
    To err on the side of safety from a known risk benefit ration seems to me would involve vaccinating your child against the known adverse health effects of preventable communicable diseases.

  40. BisserR says:

    James Fox – My daughter will be 4 next year, has never been vaccinated and has never been seriously sick. Vaccines are given to healthy children who, for the most part, don’t need them.

    David Gorski – I am aware that there are plenty of practical and political reasons that make such a study impossible. But the reasons of why such study cannot be done are not a substitute for its results. We have to admit that our evidence is limited, be it for very good reasons.

    Paul Offit overstates the evidence that we have, just like you did in your earlier comment. I understand the political urge to do so in the name of preserving the immunization program, but political considerations are no substitute for sound data. His claim that epidemiological studies would have detected 1% increase in autism due to thimerosal is utterly ridiculous.

  41. David Gorski says:

    No, it’s not “political” reasons. It’s ethical reasons. The study you propose is unethical. Period.

    Dr. Offit does not overstate our level of certainty that vaccines do not cause autism. Epidemiological studies carried out carefully can be quite powerful for detecting correlations. In fact, a bit too powerful, as false positives tend to be more likely than false negatives.

    What you’re doing is painfully obvious, though. You’ve decided you don’t like vaccines, for whatever reason. Consequently you now set the bar for evidence that would convince you that vaccines are safe at a level that you know can never be reached ethically or practically. It’s a very convenient ploy, because you know it’s ethically impossible ever to provide the evidence it would take to “convince” you that vaccines are “safe enough” for you and do not cause autism. Very clever, but very obvious to anyone with some knowledge of clinical trial design.

  42. HCN says:

    BisserR said “My daughter will be 4 next year, has never been vaccinated and has never been seriously sick.”

    That is until there is a failure in herd immunity. That has happened several times this past year with measles, it happens all the time with pertussis. While your daughter is old enough that pertussis will just be like a very nasty cold and not kill her like it does do about dozen American babies each… measles, mumps, diphtheria, tetanus, etc are not so nice.

    “Vaccines are given to healthy children who, for the most part, don’t need them.”

    So how do you know that nice school where you daughter may soon attend possibly full of folks just like you will not have someone travel and then bring back measles… just like what happened in a San Diego charter school? Do you have some kind of pre-cognitive ability to determine exactly how long the herd immunity you depend on will not be breached?

    (ignoring the fact that there is no herd immunity for tetanus, which is rare but not unlikely, and not pleasant even for the nine or less out of ten that survive)

  43. Harriet Hall says:

    BisserR,

    You are absoutely right: your daughter doesn’t need the vaccines because she is not at risk of catching those diseases. The safest thing right now is not to vaccinate her and not put her at risk of ANY complications from vaccines.

    You are right, but your attitude is short-sighted and selfish. Short-sighted because later in life your daughter may be exposed to those diseases; a classmate may bring measles back from a vacation trip. Your attempt to protect your daughter today may put her at risk tomorrow.

    Selfish because you are depending on other people to keep those diseases out of your community by vaccinating their children. You are getting a free ride.

    If enough people do what you’re doing, the herd immunity drops, the diseases come back into the community, and everyone suffers the consequences. This is not opinion or speculation, but a simple statement of what has happened over and over in various countries.

    Your desire to protect your child is laudable, but it is tragically misguided and it is endangering us all.

  44. BisserR says:

    How much data do we need to detect 1% increase in autism due to thimerosal? Hit the sample size calculator again. If we have two populations with frequencies 100 in 15,000 and 99 in 15,000, respectively, we need to sample 32,089,895 individuals from each of them to obtain 5% A type error and 5% B type error for detecting this difference. Do we have high-quality, clean epidemiological data on more than 60 million children to reach the certainlty that Dr. Offit is talking about? As I said earlier, his claim is utterly absurd.

    Surely, you could postulate some statistical model to get some extra power, but then your conclusions would depend on your model assumptions being true, and they never are. Moreover, the 1% difference that we are trying to catch will require a massive amount of data and data entry problems (which exists in every real data set) will make your study highly questionable.

    There is no free ride. No matter what data, what models, and how many studies were done on this, Dr. Offit’s claim stands out as ridiculously absurd.

    You may consider this ‘ethical’, but when I hear such claims from somebody who advocates “good science”, as Dr. Offit does, I smell a rat. I dont see such claims as a reassuring statement of vaccination safety.

  45. David Gorski says:

    You may consider this ‘ethical’, but when I hear such claims from somebody who advocates “good science”, as Dr. Offit does, I smell a rat.

    We all know what’s coming next here, don’t we?

  46. HCN says:

    BisserR said “How much data do we need to detect 1% increase in autism due to thimerosal? …. Do we have high-quality, clean epidemiological data on more than 60 million children to reach the certainlty that Dr. Offit is talking about?”

    For a country with a population of 300 million, asking for data on that fraction of the population is impractical, expensive and unnecessary. And ridiculous, considering (from the Wiki page on “Demographics_of_the_United_States”) that there are only about 83 million children between age 0 to 19 in the United States.

    I would suggest you crack open a basic book on statistics, though in the mean time there is this:
    http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=137461 … or much simplified here:
    http://en.wikipedia.org/wiki/Sample_size

    Just to let you know that the thimerosal in vaccine studies have been done in the USA, Canada, UK, Denmark and possibly a couple of other countries. The number of children involved were a more than adequate to conclude that thimerosal has no causal relationship to autism (the same goes for the MMR, which never even contained thimerosal).

    Also, I know nothing will change your mind, but you could show some effort in learning and engaging with the subject by actually reading Dr. Offit’s book (it should be available in you local library).

  47. RationalJen says:

    Bisser said:

    This could be achieved by randomizing children at birth and withholding vaccines for the “unvaccinated” group until age 5, at which time each child is evaluated for autism by an expert blind to the vaccine/placibo randomization.

    The MDs on this blog have patiently tried to explain to you why that’s unrealistic, and you simply refuse to listen. I’m not going to be as polite. As the parent of a 3 year old, let me be blunt – f*** you! There’s no way I’d put my child at risk of contracting a vaccine-preventable disease just so you could move on to the next excuse for not vaccinating your child. Not only are you ethically challenged, you’re the poster child for irresponsible parenting.

    I know you probably feel like I’m being “confrontational,” and I’m fine with that. When a parent rejects the science-based evidence that vaccines are safe and effective in favor of “anecdotes and warnings from other parents, as well as observations and records of possible vaccine reactions,” that parent is guilty of sloppy-thinking and deserves to be called out for it.

    You then commented that you looked into the issue and found insufficient data to support safety and efficacy claims of vaccination. If you didn’t find the data, you didn’t look very hard. Then again, you weren’t really trying, were you? That’s called confirmation bias – you decided what the answer was and ignored any disconfirming evidence. Common form of self-delusion and inexcusable when it puts a child’s health at risk.

    Vaccines don’t cause autism. They don’t overwhelm a kid’s immune system – in fact, they pose less of a challenge than a case of strep throat. They do prevent the very real misery of diseases like mumps, measles, chickenpox, pertussis, influenza, etc.

    If you don’t like being called an anti-vaxxer, then quit acting like one.

  48. HCN says:

    Rational Jen said “Then again, you weren’t really trying, were you? That’s called confirmation bias – you decided what the answer was and ignored any disconfirming evidence. Common form of self-delusion and inexcusable when it puts a child’s health at risk.”

    “Lies, damned lies and statistics”… http://en.wikipedia.org/wiki/Statistical_deception … and for required reading I would suggest “How to Lie With Statistics” by Darrell Huff. Both are interesting reading, and anyone who knows the basics of real statistics knows how to find the fraud and blustering.

    The reason I mention this is because the username sounded familiar. I did a bit of checking, and found:
    http://photoninthedarkness.com/?p=150#comment-18432

    He was trying the same tactic, but not to the silly extremes.

    Dr. RationalJen your assessment of his attitude is right on target.

  49. BisserR says:

    HCN, RationalJen – MDs have never been too good with statistics. ‘Ethical’ considerations are not a substitute for statistical calculations. It appears you guys just won’t admit that Paul Offit makes an absurd claim, one that is not based on evidence but on wishful thinking. He pulls this 1% number without any justification.

    Can anyone write out the logic that yielded the 1% number? List the studies, the sample size, the assumptions and calculate the power. Don’t just throw general formulas or statements about ethics, but provide concrete calculations that help justify this particular statement. Anyone?

  50. David Gorski says:

    ‘Ethical’ considerations are not a substitute for statistical calculations.

    Statistical considerations don’t matter if the study proposed is completely unethical, as the study you proposed was. If it can’t be done because leaving thousands of children unprotected against various vaccine-preventable infectious diseases (again, as you proposed) is completely unethical, then doing the statistical calculations for such a study is pointless. You propose intentionally leaving thousands of babies unvaccinated in the name of a clinical trial studying a hypothesis that has an incredibly low prior probability.

    I reluctantly have to conclude that RationalJen has you pegged spot-on, especially given your putting the word “ethical” in quotation marks, which indicates to me that you don’t believe the consideration that rules out your proposed study is indeed ethical. I hate to say it, because I like to give every commenter here at SBM the benefit of the doubt, but your comments have led me to this conclusion. Sooner or later, all antivaccinationists reveal their true colors. In any case, you appear to be an antivaccinationist who has set the bar for evidence that would convince you vaccines don’t cause autism so high that no evidence achievable in the real world could possibly convince you. Very convenient.

    And now very obvious.

    You may now commence in emulating Dr. Gordon by whining that you “really, truly aren’t anti-vaccine” but really “pro-safe vaccine.” If you like, you can then make insinuations that I’m somehow in the pay of big pharma.

  51. Owen says:

    For the avoidance of doubt, can someone explain what’s wrong with Bisser’s question:

    “How much data do we need to detect 1% increase in autism due to thimerosal? …. Do we have high-quality, clean epidemiological data on more than 60 million children to reach the certainlty that Dr. Offit is talking about?”

    So far the responses have been along the lines of “do you know how hard it is to get that kind of data???”. I’d rather hear something like “we can attain that level of certainty using techniques that aren’t covered by your power calculator, and here they are”.

    This Offit chap makes what sounds like a very strong claim: “Indeed, if thimerosal in vaccines accounted for only 1% of autism—one in 15,000—epidemiological studies would have found it.” Where does his certainty come from, if the “gold standard” tests haven’t been done? Has Bisser just done his sample-size calculation wrong, or misapplied the technique, or what?

  52. Fifi says:

    BisserR – I’m curious, who did the observation and gathered the records that led you to believe that your son would possibly have problems with vaccines?

  53. Fifi says:

    BisserR – It seems a bit silly to rely upon herd immunity when one is busy eroding herd immunity. For your children’s safety I wouldn’t rely upon herd immunity at this moment in time since it’s already weakened and will get increasingly weaker. Of course, if you keep your kids in a sterile “safe” environment away from other kids then unfortunately they won’t get the needed interaction with normal germs to build up a normal immune system. Do you intend to home school or will your kids be in the general population?

  54. BisserR says:

    David, The ethics of the study I propose depends on one’s prior beliefs in the safety and efficacy of vaccines. I have opted not to immunize my children, which shows that my beliefs at this time are different than yours. Such a study would be ethical from my perspective, but I realize this is not a widely shared opinion.

    I find the ‘anti-vaccine’ or ‘pro-safe vaccine’ labels rather silly. This is just a play of words trying to create impression of evil or righteousness. The real issue is to evaluate vaccine safety and efficacy in an objective manner. Using such phrases purposefully injects emotion in the debate, which I see as counterproductive. This was exactly the point of my original (first) comment on this blog. And this is why I have no use of the ‘big pharma’ silliness either. You are who you are and I belive you are sincere in what you write.

    The eradication of polio was an amazing success and this example makes a general anti-vaccine attitude rather foolish. This doesn’t mean a general pro-vaccine attitude is very smart either. Vaccines can be beneficial in some circumstances and harmful in others. All the emotion injected in this debate has made it very difficult to separate fact from fiction and sound data from hyperbola.

    I cringe when I hear people like Dr. Offit throw out silly stements like “epidemiology would have detected even 1 in 15,000 increase” or “you can safely administer 10,000 vaccines” and yet try to argue for “good science”. Credibility is important and defending vaccines at any cost in all cases has caused more harm than good to the vaccination program.

  55. Diane Henry says:

    Haven’t read this entire thread, so apologies if this is repeated info…

    In Autism’s False Prohpets, Dr. Offit notes that the rotavirus vaccine licensed in 1998 caused intussusception in “about one of every 10,000 babies who got it.”

    –also–

    “Measles vacccine also can cause temporary thrombocytopenia, albeit rarely, in about one of every 25,000 vaccinated children. Investigators unearthed this rare problem with measles vaccine using a series of powerful epidemiological studies.”

    So if epidemiology can find these problems, it would have found an autism/thimerosol link. But of course, thimerosol has been in removed from most vaccines now, and yet autism diagnosis rates haven’t gone down in any way.

  56. Fifi says:

    Diane Henry – That’s why the anti-vax movement (which seems to be a front for Big Vita/Supp) is changing the meme from “mercury causes autism” to “green your vaccines” – it’s a much more marketable meme that appears “positive” rather than “anti” (that’s why they’ve changed the script to saying they don’t want to get rid of vaccines, just make them 100% safe). Of course, there is no such thing as 100% safe in any aspect of life so this is a false and unattainable goal. What we have is the ability to choose and minimize our risks – I suspect many parents who are anti-vax thing they’re reducing risk. The thing is, they’re not actually considering the very real dangers of childhood illnesses and are relying upon herd immunity (it’s kind of silly to assume you’re the only one not vaccinating your kids or to rely upon others to keep your child safe, particularly since they could pick up an illness from adults as well as other kids). Without vaccines kids are certainly much less than 100% safe, particularly since anti-vaxers are likely to hang around with other anti-vaxers whose kids aren’t immune, and I’d think would be less likely to get appropriate medical treatment if their kid did get an illness and one of the complications arose…since, just like vaccines, childhood illnesses can have complications that lead to brain damage the risk of brain damage from not vaccinating one’s child is rarely calculated when people look at the statistics gathered by the medical community regarding vaccine safety, the risk of brain damage is one of the reasons vaccines were created!

  57. David Gorski says:

    David, The ethics of the study I propose depends on one’s prior beliefs in the safety and efficacy of vaccines.

    The proposed study is unethical by any reasonable standard of medical ethics. In fact, in terms of ethics it would be at least as bad as this study:

    http://www.sciencebasedmedicine.org/?p=82

    Even if the prior estimated probability that the hypothesis of your proposed trial (that vaccines cause or contribute to autism and neurodevelopmental disorders) based on what we already know were not so incredibly low, that would only elevate the ethics of it to extremely dubious rather than totally unethical.

    One of the principles of clinical trial ethics under the Helsinki Declaration and others is that, for a clinical trial to be ethical, current knowledge should be sufficiently uncertain that scientists have no strong reason to believe that one group in a trial will do better or worse than the other. Thus, for such a study even to approach being considered ethical, current data would have to indicate a high enough likelihood that vaccines cause autism and all the nasty things you think they cause to balance out the known harm that will come to the children in the control group who will come down with infections such as pertussis, Hib, and others that could have been prevented had they been vaccinated.

    Given the multiple epidemiological studies that have failed to find even a hint of such a correlation, there’s no way a reasonable medical ethicist could conclude, based on existing science, that the risk of harm due to participating in the trial would be roughly equal for both experimental groups. That’s because it isn’t. The unvaccinated group would suffer measurable harm in the form of subjects who become ill who did not have to. There could even be deaths.

    But, then, you know that, and you know that, because such a trial will never be done (because it should never be done), you will always be able to have what seems to those without a knowledge of clinical trial ethics a seemingly reasonable justification for your anti-vaccine views by holding that study up as the one thing that would convince you that vaccines are safe and don’t cause autism. Your “I want a randomized, double-blinded study” ploy is a classic ploy of the antivaccine movement. I’ve seen it played many, many times before.

  58. daedalus2u says:

    Those are very strange, incongruous, and one might even say hypocritical standards of evidence. I would say an example of a situation where fools rush in where angels fear to tread.

    All the health professionals on this board, and virtually all health professionals in the health profession consider it unethical to not vaccinate children. This judgment is based on the complete totality of research on vaccines that has ever been done.

    You have decided on the basis of a few anecdotes by a few non-medical people you are acquainted with, that vaccinating children is unethical, and demand impossible studies to disprove your unfounded belief.

    If 1 in 10,000 cases of autism were “caused” by vaccines (a hypothetical which I don’t think is correct), that means out of 1.5 million children vaccinated, 1 in 150 (or 10,000) will become autistic due to something else and 1 will become autistic via vaccines. If those 1.5 million children were not vaccinated and got the diseases “naturally”, about 1500 of them would die from measles.

    You (and I don’t doubt many of the anti-vaxers) may prefer a dead child to an autistic child. Those of us living in the real world don’t.

  59. passionlessDrone says:

    Hi David Gorski –

    No, it’s not, because the connection between “neuroinflammation” and autism is tenuous at best.

    Well, we not only have the Vargas study in regards to activated microglia, but also at least one study showing sharply elevated tnf alpha in the CNS. Do you have any studies you can post wherein neural inflammation was searched for, but not found in autism?

    Based on the fact that you did not respond, my assumption is that the genetic model of autism in the mouse you described earlier has zero physiological characteristics previously observed in autism, as opposed to any. Plenty of tenuousness to go around, it would seem.

    Seeing our exchange here, a colleague tells me that you’ve been informed on other blogs of the multiple shortcomings of this study (for example, on Kristina Chew’s blog), particularly in relating the animal model used to autism, but that you’ve ignored them. I could list the additional reasons why this study doesn’t have very much to say about the pathogenesis of autism, if you like.

    LOL! Your colleague like has assigned my decision to ignore them to an incorrect motive. I am, however, interested in knowing why you feel neuroinflammation is not important to autism.

    In any case, I’m not here to prove that vaccines cause autism so much as to point out that the proclomations that science has settled the issue to be very much overstated, and seemingly based on a series of very poor assumptions. I advocate for additional research; though I have not seen you advocate against this precisely, it is a common theme I run into. Do you believe we should be performing additional research on vaccines and chronic conditions, including autism?

    As for your bit about the “unvaccinated” versus “vaccinated,” you do realize that such a study is potentially both unethical and definitely incredibly difficult, hard to justify without some stronger evidence.

    Well, first we go from (supposedly) having evidence that ‘vaccines in general’ have been studied in autism, to an argument that such an analysis is not ethical and impossible. Now that is what I call changing the goalposts!

    Without a study of vaccinated / unvaccinated populations, I’m curious what, exactly what you would constitute strong enough evidence to reverse your stance on performing such an analysis? How might we accumulate more information as to stronger evidence without analyzing the two cohorts? This is a genuine question.

    The other thing I love about this is the argument is that it ignores the reality that as we type, there are dozens, if not hundreds of new vaccines under development. Will there ever be a time which we might consider evaluating their side effects in a controlled fashion? The logical conclusion from the ethics argument would seem to be that there is not. Perhaps there is a cut off that I have not had yet described to me.

    - pD

  60. DanaUllman says:

    It was once unethical to not bloodlet patients. Heck, the “Lancet” even named itself after the instrument used in bloodletting.

    It was once unethical for a physician to consult with a homeopathic doctor or to treat a homeopathic patient! Joseph Barnes, MD, the Surgeon General of the U.S. in the Lincoln administration, was even reprimanded for treating the Secretary of State, William Seward, who was stabbed on the night of Lincoln’s assassination. Barnes’ “crime” was that he treated a homeopathic patient.

    What is today’s medicine is tomorrow’s quackery…this isn’t a prediction; it is a fact of history.

    Ironically, physicians today assert that modern medicine has finally become “scientific,” though they have been making this same assertion for 150 years. Any student of medical history sees through this arrogance.

  61. BisserR says:

    Diane Henry wrote:

    “So if epidemiology can find these problems, it would have found an autism/thimerosol link.”

    Lovely argument, because it actually closely follows the logic of Paul Offit. This is the type of reasoning he might call ‘good science’… if it supports the ‘right’ conclusion.

    Looking at the rotavirus vaccine and intussusception, here is the background rate estimate of intussusception from the NEJM article “Intussusception among Infants Given an Oral Rotavirus Vaccine”

    “The background incidence rates of intussusception according to month of age were derived from data on cases with a confirmed diagnosis recorded by the Vaccine Safety Datalink project from 1991 to 1997. The annualized incidence of intussusception in this data base was 34.2 cases per 100,000 child-years.”

    We see that intussusception is extremely rare. Further in the article they say

    “Three to 14 days after vaccination with RRV-TV, the adjusted odds ratio was 10.6 (95 percent confidence interval, 5.7 to 19.6).”

    The odds of intussusception incresed about 10 times after vaccination. Here is a picture of the temporal association between intussusception and vaccination time from the same article (<a href=”http://content.nejm.org/cgi/content/full/344/8/564/F1″ Figure 1 ).

    This example is very different from the “1% of autism – 1 in 15,000″ that Paul Offit speculates about. I believe he has profound lack of understanding about statistical testing, specifically about the fact that statistical tests compare odds, not absolute numbers. If epidemiology could detect such small shifts in incidence as he suggests we would certainly have better prevalence estimates for autism.

  62. BisserR says:

    That link didn’t work. I wish I could edit my comment to fix it. Here it is again.

    <a href=”http://content.nejm.org/cgi/content/full/344/8/564/F1″ Figure 1

  63. BisserR says:

    That link didn’t work. I wish I could edit my comment to fix it. Here it is again.

    Figure 1

  64. Fifi says:

    BisserR – I suspect my earlier question got lost so I’ll repost :-)

    Could you share who did the observation and gathered the records that led you to believe that your son would possibly have problems with vaccines?

    Also, are you planning on home schooling your kids? Or are you relying upon herd immunity to protect them from childhood diseases and their possible complications like brain damage?

  65. Fifi says:

    BisserR – I’m curious, would you infect your child on purpose with a disease like chicken pox or mumps so that he or she has immunity later in life? Or would you avoid your children coming into contact with childhood diseases that vaccinations can now protect against?

  66. David Gorski says:

    Without a study of vaccinated / unvaccinated populations, I’m curious what, exactly what you would constitute strong enough evidence to reverse your stance on performing such an analysis?

    A well-designed, adequately powered epidemiological analysis that finds a correlation between vaccination and autism that is detectable above the random noise would be a start. (There ain’t no such beast, and it’s not for lack of studies or trying.)

    Actually, come to think of it, it would take considerably more than that. Remember, we’re talking about a trial that would expose thousands of children to an increased risk of infectious disease because they are not vaccinated. To justify placing so many children at risk for the sake of a clinical trial, there must be compelling evidence to think that vaccinating might pose at least an equal risk that would justify.

    That evidence doesn’t exist. Neither does a scientific or ethical rationale to justify such a trial.

  67. BisserR says:

    Fifi – The observations came from my wife’s meticulous daily records and some strange incidents that I remembered. There are 3 incidents which I suspect were vaccine reactions.
    - getting very sick with high fever about 3-5 days after immunization (recorded by temperature readings and photos with the title “worst sickness of his life” by my wife)
    - troubled, desparate, prolonged, laud crying within 36 hours after vaccination (from my own memory during a trip we took immediately after vaccinating)
    - falling deep into sleep in very unusual circumstances and becoming limp to an extend I had never seen before or since (from my own memory during the same trip)

    I have no proof that these were indeed vaccine reactions and even less proof that they were in any way connected with his subsequent autism diagnosis. Looking into the possible cause of these incidents gave me the first clue that vaccine reactions are poorly understood and rarely recorded.

    The anecdotes that I refered to are mostly stories from other parents about similar reactions shortly after vaccination, sometimes followed by severe developmental regression, which were dismissed by their pediatricians as mere conincidence unrelated to vaccines or to autism. In some cases the pediatricians themselfs had suggested a vaccine reaction, only to retract this as problems worsened. It was this attitude, about which I kept hearing from other parents, that convinced me that if there is some connection between these possible vaccine reactions and autism the data wouldn’t be there to prove it, because pediatricians make their records under the assumption that no such connection exists.

    All my children are in school and at this point I have no plans to home school. I haven’t thought about purposedly exposing my children to chicken pox and/or mumps. I know some people do it.

  68. Fifi says:

    BisserR – So you have one child who is partially vaccinated and one who isn’t at all? How did your wife know what to look for when observing your child who did get vaccinated? And what was she looking for?

  69. Fifi says:

    Do you want your children to get chicken pox and mumps while they’re still young or are you taking the route of just avoiding situations where they may get sick? Or is it just a matter of whatever happens happens and you’re just not thinking about the consequences of them not being vaccinated or acquiring natural immunity?

  70. Fifi says:

    My apologies, you wrote out what your wife observed and I just wasn’t paying attention. Like you say, it could just as easily have nothing to do with the vaccination so, while I can see why a parent may jump to conclusions, as you note there’s little evidence and a lot of rooom to impose what one wants to believe on this anecdote or what one actually sees when they observe their child. This is just the kind of situation that does tend to make parents leap to conclusions – particularly if they feel there’s a threat to their baby being “normal” or harmed. It’s much harder to wrap one’s head around the dangers of not vaccinating one’s child – particularly since the really horrible things that can happen tend to be in the future not immediate (which people who believe vaccines cause autism believe vaccines to be).

  71. BisserR says:

    Fifi – I have two children who are partially vaccinated (to different degree) and one who was never unvaccinated. Ironically, the one who had the most vaccinations is severely autistic, the other partially vaccinated child is mildly autistic, the unvaccinated one is neurotypical. No statistical significance here, just another anecdote :)

    I have not yet decided about getting them in contact with chicken pox or mumps so they can build immunity. If I do it will be at age 8 or so. We are not there yet, so I will research the pro and cons more carefully when the time comes.

  72. BisserR says:

    “It’s much harder to wrap one’s head around the dangers of not vaccinating one’s child – particularly since the really horrible things that can happen tend to be in the future not immediate (which people who believe vaccines cause autism believe vaccines to be).”

    This is exactly true. Vaccination is certain and immediate if you decide to do it, while a particular vaccine preventable disease may be quite unlikely during the child’s lifetime. Even if such disease were to occur it will frequently pass without complications, so no big deal. Thus vaccines are a medical intervetion attempting to prevent something that may or may not happen, while the risk of a vaccine reaction in contrast is present immediately. “First do no harm” comes to mind and has been my guiding principle in this case. Physicians can be easily biased to overreact to the danger of preventable disease because they see all the sick children, especially when complications arise, but not so much the healthy ones.

  73. Fifi says:

    “Unvaccinated”? Sorry, I don’t understand what you mean.

    Oh, so you have two autistic spectrum children? Yep, just more anecdotes – I could share some too since I worked with autistic kids as a volunteer ages ago back in the 70s, have a friend with an autistic child and know loads of adults who aren’t neurotypical (mainly Aspergers). Are they all boys?

    Do you worry about what may happen to your kids if they contract these diseases as adults or now? I ask because if they’ve shown themselves to be sensitive to a vaccine which is much milder than the actual full blown disease then the likelihood of complications from contracting the disease seems higher (though I’d appreciate being corrected by Dr Novella if this isn’t the case!) Certainly contracting any of these illnesses as an adult carries a much higher risk than childhood infection.

  74. Fifi says:

    Oh, I guess you meant to say “never vaccinated” or “unvaccinated” – you confused me with never unvaccinated! (I’ve got a horrible feverish flu today so not so quick! :-)

  75. Fifi says:

    Are you kids with autism just going to normal schools or ones that provide them extra help? Do the schools know they aren’t vaccinated?

  76. BisserR says:

    Fifi – No, the little one who was never vaccinated (this was a typo before) is a girl, the older two are boys. Since girls are less likely to be autistic it gives you a good reason to discount this particular anecdote and tell everybody what a misguided “jumping to conclusions” parent I am :)

  77. Fifi says:

    Oh not so unlikely – in fact it’s increasingly likely that adults contract childhood diseases due to not being properly vaccinated, particularly since there’s so much international travel and immigration today. Are you depending on herd immunity to protect your child?

  78. BisserR says:

    Fifi – Yes, the schools have vaccination records and I have signed waiver forms. The big one is in special ed (2nd grade), the second one is in regular kindergarden with an aid, the girl is in private preschool.

  79. Fifi says:

    BisserR – I have no interest in “telling everyone you’re a jumping to conclusions parent”, I’m merely interested in how you’re making your choices and what they’re based upon. Clearly you had a process for coming to your conclusion, I’m just curious as to what it is. Like I said, I have a friend who has an autistic son so I do understand just how hard and frustating it can be depending on the severity of a child’s autism.

    Actually, I don’t ask because it’s necessarily less likely a girl will be autistic but because female autism often goes undiagnosed for a variety of reasons – the main one being that girls are innately more capable socially so can fake it better than boys. If both your sons are autistic, I’d suggest that it might be in your daughter’s best interests to get her properly tested by someone who’s knowledgable about how autism manifests in girls. You may actually be overlooking autism in your girl and leaving her at a disadvantage because the autism doesn’t manifest in the same way as it does for boys. Since there indications that autism may well be genetic or have a genetic component, you may be falsely assuming your daughter is okay because you attribute your son’s autism to getting vaccinated and autism manifests differently in girls. It would be a shame if your daughter had to struggle in isolation and silence simply because of an erroneous conclusion and because girls present differently. Certainly – back to anecodotes here – the reports from autistic women who only discover their own autism when their child is diagnosed indicate that girls who don’t get diagnosed and the help they need carry quite a heavy burden.

  80. Fifi says:

    Thanks for the school info, I was curious as to how schools handle this.

  81. passionlessDrone says:

    Hi David Gorski -

    A well-designed, adequately powered epidemiological analysis that finds a correlation between vaccination and autism that is detectable above the random noise would be a start. (There ain’t no such beast, and it’s not for lack of studies or trying.)

    This sounds like the study I am lobbying for, as opposed to the studies that have already been done. (?)

    Well, listen, I’ve been trying to find a study those that takes into consideration one population actually getting fewer vaccinations than the other, with the exception of MMR studies, I simply cannot find one. Can you post some links to a study showing a differential reception of Hep B, or Hib, or Polio, or Dtap, or , Pneumococcal, or Rotavirus, or Influenza? No matter how many times I ask people this question, for some curious reason, I just don’t get a response; even when that have just insisted such studies exist. If there is no lack of studies trying, why not post a few for me, here?

    Actually, come to think of it, it would take considerably more than that. Remember, we’re talking about a trial that would expose thousands of children to an increased risk of infectious disease because they are not vaccinated. To justify placing so many children at risk for the sake of a clinical trial, there must be compelling evidence to think that vaccinating might pose at least an equal risk that would justify.

    Well, while there would be bias involved in a study that used participants who had already made the choice not to be vaccinated, we wouldn’t have to worry about the ethical choices those people had made. There are confounds in any study, what is to keep us from taking advantage of this existing population to learn something?

    That evidence doesn’t exist. Neither does a scientific or ethical rationale to justify such a trial.

    Hm. What if we had evidence that children with autism were more likely to react more strongly to the triggering of an immune response via vaccination? Would this qualify as scientific rationale to you?

    Take a look at this study, from researchers at Yale, recently published in Pediatrics:

    “Macrophage migration inhibitory factor and autism spectrum disorders”

    http://www.ncbi.nlm.nih.gov/pubmed/18676531?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

    This is pretty nifty stuff. It turns out, children with autism were found to have increased levels of a factor that increases expression of toll like receptors, one of the fundamental biological components of how aluminum based adjuvants initiate an immune response during vaccination. Genetic analysis revealed that modifications to the promoter region of the gene is associated with an autism diagnosis. What’s more, there is a positive correlation between ciculating levels of this chemical and autism severity.

    Go figure; applied research showing an assocation between the expression of components at the heart of vaccine functionality and autism severity.

    All of our thimerosal studies and autism would be completely blind to this association; triggering toll like receptors is the reason for the vaccine, the presence of absence of the oft studied preservative would be completely irrelavant. Speaking of appropriately powered epidemiology, the analysis of a single vaccine (i.e., MMR) in the sequence of the current schedule would have a very difficult time identifying this connection; by the time the MMR was provided children have had their toll like receptors stimulated many, many times by previous vaccinations.

    Perhaps you have some compelling evidence that you’d like to share as to why this is not something worth investigating?

    - pD

  82. DanaUllman says:

    Actually, I am worried about children who get vaccinated and who then assume that this vaccination lasts a lifetime (it rarely does). I am worried that these children will become adults and will then get mumps, measles, or whatever later in life.

    This is akin to the “green revolution” of yesteryear where farms then become addicted to fertilizer and pesticides.

    I personally would have preferred to have my own son get exposed to mumps and measles (he did get exposed to chickenpox…which lasted around 2 days and was given homeopathic Rhus tox 30C, that’s poison ivy, which one of the common medicines for chickenpox).

    I had hoped to get him exposed to mumps and measles so that he would have lifelong immunity, but I simply could not find them. Such exposure is particularly helpful to girls because when they become mothers, their breastmilk is more likely to have antibodies to these infections, while vaccinated mothers have considerably less antibodies to these diseases. A more serious problem with these diseases is when neonates get them, and because of this, it is best for girls to get the natural disease.

    One note here is that several studies have noted that simply giving vitamin A to kids with measles reduces complication rate significantly…but heck, vitamin A is too cheap for any company to promote adequately, as compared with the profit margin in vaccines.

    On a lighter note…
    When I was a kid, my father (a pediatrician and professor at UCLA) brought me to a patient’s home, a young girl. He encouraged me to play with her, and then, to “seal the deal,” he encouraged me to kiss her. Yeah, it worked…and I got the measles. I learned at an early age that when you kiss girls, you get diseases.

  83. BisserR says:

    Fifi – Thanks for the concern. My daughter is fine. I know autism quite well and there are also a number of specialists who visit us regularly to work with my sons. I do worry that she might carry a dangerous gene, but her abilities to converse, to catch details in communication and people’s mood, to make friends and to discover the world in every sense leave no room for concern.

  84. passionlessDrone says:

    Hello friends -

    I have theorized a study that allows us to investigate the effect of added immunizations without putting anyone in danger. Well, that’s not entirely true, in my opinion, but that is the beautiful part.

    Here is how it works:

    1) Get a large cohort of pregnant women/infants. Say 40,000.
    2) Split them into two groups, a regular schedule group, and a heavy schedule group. Each child gets four vaccinations for each disease at each visit; in one group, three of four shots are fillted with saline. In the other group, all four shots are the vaccine.
    3) Repeat application of vaccines as per standard schedule.
    4) Evaluate after ten years for neurological outcomes or other impacts.

    With this we are able to achieve many things that are deemed ‘impossible’ in conducting a vaccinated / unvaccinated study:

    1) True double blinding. Doctors, psychiatric evaluators, parents and children will not know which group they are in. This powerful source of bias is removed.
    2) True randomization.
    3) True placebo.
    4) Highly matched cohorts for sex, race, socioeconomic status, or other factors.
    5) No added risk for the development of nasty diseases; everyone is getting at least the regular schedule.

    Here is the hilarious part; there is no reason, absolutely no reason that the people who would have us believe the vaccine schedule to be completely safe to oppose this on safety grounds. They are quite clearly on record as stating that a child could easily handle 10,000 immunizations simultaneously. What possible danger could come from giving them four Hep B shots at once? One does wonder how many people who type so vigorously in defense of the schedule would actually sign their own infants up for such a study.

    David Gorski, would you voluntee your child for such a study? Surely, you, of all people, feel there would be nothing to fear from it.

    - pD

  85. Prometheus says:

    Bisser R makes a strong argument that the statistical power of the research and epidemiologic studies done so far on thimerosal and autism can’t show a 1% increase in autism due to thimerosal. Leaving aside his use of a 5% beta error (50% is more common in scientific studies) to inflate the numbers, he is mathematically correct.

    What Bisser R may not have noticed is that there was a large, rather uncontrolled and completely convincing “study” of thimerosal and autism done on the entire US child population, starting in 2001.

    I refer, of course, to the removal of thimerosal from childhood vaccines.

    Now, people may wish to quibble that the thimerosal hasn’t been completely removed – it has only been reduced to “trace” amounts (less than 1% of that in vaccines that used thimerosal as a preservative). Of course, some conspiracy theorists will argue that it wasn’t removed at all, but there’s no point in going down <i.that path.

    However, no matter if you say “removed” or “reduced by over 99%”, the amount of thimerosal that children receive in vaccines dropped dramatically between 2001 and 2002 [please spare me the "it was never removed from the shelves" canard - vaccines have expiry dates, and a survey showed that they were largely gone by 2003].

    Given that, we should have seen a reduction in autism rates by now, even if thimerosal caused only 1% of al autism. [Hint: we haven't]

    Now, I’m sure that the next move by Bisser R will be to show how hard it is to detect a 1% drop in autism rates due to the “noise” in the data – said “data” being largely rubbish, as I have said on numerous occasions.

    That being said, we should take a moment to look back on how the now-ridiculous notion that thimerosal in vaccines could cause autism got its start….

    That’s right! It was the dramatic rise in autism prevalence that started some under-educated but over-imaginative individuals speculating that it had to be something in the vaccines that was causing this “epidemic” of autism.

    You’ll note that none of these early “thimerosal-causes-autism” proponents ever said anything like “Thimerosal causes a few percent of the autism in the US.” Nope, they went full canvas jacket right out of the chute and claimed that thimerosal in the vaccines was THE cause of autism.

    Period. Full stop. Nothing follows.

    Now, I’ll let Dr. Offit explain his reasoning for the claim that the epidemiological studies could have detected if 1% of autism was caused by thimerosal. But frankly, that’s just a distraction, a red herring used by Bisser R to put us off the scent.

    The real issue is that Bisser R thinks vaccines are more dangerous than the diseases they were developed to prevent.

    That’s the issue – not whether Dr. Offit’s numbers work out correctly or whether vaccines could be safer or could be made with fewer (or no) “toxins” (however that is defined). Perhaps vaccines could be “safer”, but nobody wants to develop a safer MMR vaccine or DTaP vaccine because there is no profit in childhood vaccines.

    There, I’ve said it.

    Ask yourself, how much profit can “Big Pharma” make if they sell the bulk of their childhood vaccines to state and federal agencies that conspire (excuse me, “cooperate”) to get the lowest price? Have any of you “Big-Pharma-is-harming-our-children-for-profit” spittle-sprayers have actually looked at the price for a dose of MMR or DTaP?

    In fact, the drugs and medical supplies used to diagnose and treat even a modest case of measles are far more profitable to “Big Pharma” and the hospitals. Not to mention that your pediatrician gets about $10 for vaccinating a child (if they clear any money at all) but could (and would) charge hundred to thousands of dollars to diagnose, treat, admit, etc. a single child for measles.

    And let’s not even think about the potential for profit from a case of polio, diphtheria or tetanus.

    No, if “Big Pharma” or “doctors” are giving vaccines to make a profit, they are financial idiots. The big bucks are in treating disease, not preventing it.

    Bisser R shows his true ignorance (and true anti-vax street cred) when he says:

    “Vaccines are given to healthy children who, for the most part, don’t need them.:

    Even today, even in the US, the risk of death or permanent injury from a single vaccine-preventable disorder – measles – exceeds the documented risk of death or permanent injury from the vaccine. And measles is still relatively tame compared to the really bad actors like polio, diphtheria and tetanus.

    This risk:benefit ratio is already tipping even further in favor of vaccination because of parents like Bisser R who have decided that the social contract of vaccination does not apply to them.

    Leaving aside the societal issues of vaccination – which seem beyond the ken of the narcissistic anti-vaxers – the point of vaccinating healthy children is to keep them healthy. If you don’t vaccinate your children, you are relying on other people – a large percentage of other people – to take the “risks” that you are unwilling to take.

    There’s a word in biology for an organism that takes advantage of the risks, work or resources of another organism – parasite.

    I have no problem with parents who don’t vaccinate their chidlren for legitimate medical reasons – that’s why we have collective immunity (I don’t like the term “herd immunity”, since we aren’t herd animals). I also have little problem with those who don’t vaccinate for sincere religious reasons.

    I also don’t have a serious problem with the vaccine parasites. Parasites have a role in ecosystems and they probably have a role in society. In this case, it may be serve as a warning to others – a “cautionary tale”. All I ask is that they “own” what they are – parasites on the risks taken by other people.

    Bisser R also seems to think that his unvaccinated children will be at no significant risk of death or injury – he seems to be unaware of the way infectious diseases work. The fact that he felt compelled to mention that his unvaccinated child is rarely (or was it “never”) ill speaks to his ignorance on the matter.

    We don’t vaccinate against “all illness” – we vaccinate against diseases that can kill and cripple. Those diseases – fortunately – are few in number. Until recently, they were also exceedingly rare in the US and UK.

    They’re not so rare, anymore.

    Thanks to the parasites.

    Prometheus

  86. HCN says:

    pD said “David Gorski, would you voluntee your child for such a study? Surely, you, of all people, feel there would be nothing to fear from it. ”

    I would absolutely NOT volunteer a child for such a study. There is a very real possibility of the 20000 children getting placebo to end up getting pertussis, Hib, rotavirus and even measles.

    Looking at my county’s Public Health newsletter:
    http://www.kingcounty.gov/healthservices/health/communicable/epilog/~/media/health/publichealth/documents/epilog/vol4809.ashx … there have been eight cases of pertussis in August (over 50 for the year so far), and over 80 cases of chronic HepB (that is usually in children) in August (and yes, there is a large Asian population in this area, and it can be passed by saliva), and over 600 this year (or through August) In addition to this year there being a couple cases of Hib… and in the state there were over a dozen cases of measles (not this county). If you do a search for measles at that site you will find that every year there is a measles alert due to a traveler coming in to the airport.

    Those infections happened most often the now smaller percentage of people who were not vaccinated (especially the eight kids of one family who contracted measles at a church function… in our county… where three had to be hospitalized). Now imagine what would happen if you had a bunch of kids who were not vaccinated and did not know they were not vaccinated when an infection like measles makes the rounds. When measles was brought to Grant County a couple of kids in local private schools got measles, they could at least tell the other unvaccinated kids to stay home. How do you do that to the placebo group?

    Do you really think that would pass a human subjects safety review? To see some of the stuff involved check this:
    http://depts.washington.edu/clinres/clinicaltrialshandbook/4human.html (you should also click to the Human Subject Division homepage at, since I am at a URL limit… just click on one of the many links to it in that document).

    Usually they check to see that the medication or procedure would not harm the subject… but in this case it looks like NOT using a medical procedure that has been shown in many large epidemiological studies to be safe would expose the children to risk of diseases that are shown to cause severe harm.

    Also, you are asking for a very expensive (ten years!) study, when there have been several good studies showing that there is no casual link between vaccines and autism. The cost and time are not worth the very real risk to children. The money and time is better spent dealing with real medical issues of these children (eg: seizures), working towards real therapies and accommodations (like the Experimental Education Unit located next to the Montlake Cut behind the medical center, a real preschool and kindergarten with SLPs, OT/PTs, psychologists, teachers and others).

  87. David Gorski says:

    David Gorski, would you voluntee your child for such a study? Surely, you, of all people, feel there would be nothing to fear from it.

    No, because, again, this study would be almost as unethical as the originally proposed study. The reason is that there is no scientific justification to expose thousands of children to a four-fold increase in the dose of common childhood vaccines. Even though the risk of injury due to vaccines is very, very small, increasing the dose of vaccines could only increase that risk with no corresponding benefit due to the increase. In other words, it’s all increased risk, however small, for no benefit.

    In fact, your study would be even more unethical if there were a strong scientific basis to suspect that “more vaccines = more autism” because the potential for harm in the “more vaccines” group would be even greater–again, with no prospect of benefit.

    You really have a lot to learn about clinical trial ethics.

  88. HCN says:

    Oh, sorry, I mis-read pD’s study. Something about the saline. I admit I was wrong.

    Still it would be expensive, for no good reason.

    By the way, at least one of my kids has been in a long term study that was under the watchful eye fo the Human Subject Division, http://www.washington.edu/research/hsd/index.php … lots of paperwork.

    It was a study of the psychological health and well being of children starting middle school, then going through middles school. They did get an additional grant to interview the students and parents when they entered high school.

    Getting and keeping grant money is a big deal to the researchers.

    I got a notice from then that they got a grant to study these children as they transition to high school graduates. They started to interview the randomly chosen students (not enough money to interview all the available subjects) last summer. My kid did not get chosen. They would really love to get a grant to interview these kids after they graduate from high school (it is http://depts.washington.edu/pathways/page2.html ).

    Truthfully, if I were an entity in charge of giving out grant money I would think that project would be more productive than chasing after a mythical vaccine/autism link.

  89. BisserR says:

    Prometheus – Great post! As always, I love your writing style.

    My unjustified attention to the “1% of autism” statement of Dr. Paul Offit was not because I believe thimerosal causes a significant number of autism cases. I just seized on it as illustration showing how people who advocate “good science” don’t mind throwing out absurd statements when they feel it promotes their agenda. But you already knew that, didn’t you?

    Prometheus wrote:

    “Even today, even in the US, the risk of death or permanent injury from a single vaccine-preventable disorder – measles – exceeds the documented risk of death or permanent injury from the vaccine.”

    Looking at the measles update from the CDC at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5733a1.htm we see that

    “During January 1–July 31, 2008, 131 measles cases were reported to CDC from 15 states and the District of Columbia (DC): Illinois (32 cases), New York (27), Washington (19), Arizona (14), California (14), Wisconsin (seven), Hawaii (five), Michigan (four), Arkansas (two), and DC, Georgia, Louisiana, Missouri, New Mexico, Pennsylvania, and Virginia (one each). Seven measles outbreaks (i.e., three or more cases linked in time or place) accounted for 106 (81%) of the cases. Fifteen of the patients (11%) were hospitalized, including four children aged <15 months. No deaths were reported.”

    131 measles cases in the US, no deaths and quite likely no permanent injuries for the first 7 months of 2008. The risks here seem rather small.

    Let’s look at vaccine injuries. The best I could find were the 20 year aggregated data from the Vaccine Injury Compensation Program at http://www.hrsa.gov/Vaccinecompensation/statistics_report.htm

    We have over 900 claims for measles or MMR vaccine, of which 71 are for deaths and over 300 have led to compensation. The risks here seem higher.

    I know, parasites and herd immunity… bring it on.

  90. Owen says:

    >>> Go figure; applied research showing an assocation between the expression of components at the heart of vaccine functionality and autism severity.

    [...]

    Perhaps you have some compelling evidence that you’d like to share as to why this is not something worth investigating? <<<

    That seems like a fair question. Anybody got an answer?

  91. Owen says:

    >>> I’ll let Dr. Offit explain his reasoning for the claim that the epidemiological studies could have detected if 1% of autism was caused by thimerosal. But frankly, that’s just a distraction, a red herring used by Bisser R to put us off the scent. <<<

    Bisser may well be using this as a smokescreen, but I’m not.

    I’ve had both my children vaccinated. I’m not anti-vaccine.

    But I do expect positions to be backed up with arguments and evidence. I don’t really doubt that someone *can* explain where Offit gets his confidence. But I haven’t see anyone try yet, perhaps because they feel Bisser is being disingenuous.

    Well, I’m don’t *think* I’m being disingenuous. I have no ulterior motive that I’m aware of. So, please, can someone explain it to me, and, no doubt, to the lurkers here who are interested too?

  92. Owen says:

    >>> (Bisser) 131 measles cases in the US, no deaths and quite likely no permanent injuries for the first 7 months of 2008. The risks here seem rather small.

    [...]

    We have over 900 claims for measles or MMR vaccine, of which 71 are for deaths and over 300 have led to compensation [*]. The risks here seem higher. <<<

    You are aware, of course, that that’s exactly what *should* happen? If the vaccines are doing their job, then the fact that they are not entirely without risk means that they will in fact cause more problems than outbreaks of the disease will (in a well-vaccinated population).

    Okay, you might argue, that’s fine for the population. But I’m not a population, I’m an individual, and what’s good for the population at any given moment might not be best for me. To whit: if the rest of the population is well-vaccinated, then it’s not in my interest to vaccinate my children. That way, they get the benefit of everyone else’s herd immunity without facing the (small, but very real) risks of vaccination.

    Fair enough. That’s a very real issue. My responsibility is to *my* children, not to anyone else’s and I can empathise with someone making that decision.

    However, it doesn’t scale, and ultimately leads to the collapse of herd-immunity if everyone makes the same cost-benefit analysis. That then leaves my children in a worse position: there’s no herd-immunity, and they haven’t got their own vaccinations to fall back on.

    So, my position is this: even taking my own, narrow self-interest into account, it’s *still* more sensible to vaccinate than not.

  93. Owen says:

    Forgot to include this footnote in the last comment:

    [*] I understand the bar for compensation claims is set fairly low. Vaguely plausible temporal relationships are enough: there’s no need to prove causation to get compensation.

  94. passionlessDrone says:

    Hi David Gorski –

    No, because, again, this study would be almost as unethical as the originally proposed study. The reason is that there is no scientific justification to expose thousands of children to a four-fold increase in the dose of common childhood vaccines. Even though the risk of injury due to vaccines is very, very small, increasing the dose of vaccines could only increase that risk with no corresponding benefit due to the increase. In other words, it’s all increased risk, however small, for no benefit.

    Well, I can think of some benifits:

    1) You could finally shut Jenny McCarthy up. [Truth be told, that wouldn't bother me so much.]

    2) You would be able to provide me with at least one study comparing something approaching full vaccine loads to something else, as opposed to just saying they exist, but not posting anything.

    3) The treatment group would be less likely to be under-responders who fail to develop immunity. We would, in a sense, be giving them extra protection. If I am not mistaken, it is this phenomena that has given rise to increasing the number of shots for things like DTAP; increasing the number of children who get full protection; if you keep on tapping those toll like receptors, eventually the body figures out the signature and generates a memory.

    This is actually getting pretty funny. We know that some number of children don’t generate immunity with one jab; why not increase our chances that they develop immunity by giving them four, or eight? Think of it as an super duper booster. Or is there some magical formula wherein a X% failure to develop immunity is AOK? If there is, can you let me in on it? If not, why shouldn’t we be shooting for closer to 99.9% immunity? One way to keep on increasing our rates of immunity, for sure, is to keep on stimulating the immune system.

    Another thing that is funny about this argument is that you don’t seem very concerned about mandatory influenza vaccines in some areas, even though they’ve been shown to be no better than placebo for some age groups. Isn’t this an increase in risk for absolutely no benifit? Do you think that we should be mandating influenza vaccine for children less than 2 in New Jersey? You are aware it has been shown ineffective in that age group, are you not? Why isn’t that program an example of exactly what you claim to have a problem with; more risk for no benifit?

    In fact, your study would be even more unethical if there were a strong scientific basis to suspect that “more vaccines = more autism” because the potential for harm in the “more vaccines” group would be even greater–again, with no prospect of benefit.

    But what about all that fancy ciphering that Dr. Offit has showing that a child can receive ten thousand vaccines? I’m really confused; either he was off by a factor of thousands, or our increase of risk is absolutely miniscule. What about the prospect of benifit of achieving even higher rates of immunity in the children in the treatment group? You aren’t advocating that a 99% immunity level, as opposed to 98% isn’t benificial, are you? With all these parasites running around, that one percent could lead to dozens of fewer cases of measles in this country!

    You really have a lot to learn about clinical trial ethics.

    LOL! ROFL! I love it. The implicit argument being made here is that it is impossible to ever study the vaccine schedule. We can defeat measles and chicken pox (and next, shingles!). We can put a man on the moon. We can bail out wall street. But actually testing a series of agents we give to four million children a year is just too darn difficult.

    We are doomed.

    - pD

    ps – I like that fancy quote thing you can perform. What’s the trick?

  95. Owen says:

    >>> The implicit argument being made here is that it is impossible to ever study the vaccine schedule. <<<

    Er, no, not quite.

    The argument is you can’t study the vaccine schedule *using this technique* (gold-standard double-blind randomized blah blah).

  96. BisserR says:

    ——————————————————————————
    “Macrophage migration inhibitory factor and autism spectrum disorders”

    http://www.ncbi.nlm.nih.gov/pubmed/18676531?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

    This is pretty nifty stuff. It turns out, children with autism were found to have increased levels of a factor that increases expression of toll like receptors, one of the fundamental biological components of how aluminum based adjuvants initiate an immune response during vaccination. Genetic analysis revealed that modifications to the promoter region of the gene is associated with an autism diagnosis. What’s more, there is a positive correlation between ciculating levels of this chemical and autism severity.

    Go figure; applied research showing an assocation between the expression of components at the heart of vaccine functionality and autism severity. ”
    ——————————————————————————

    Very interesting reading. The data is quite preliminary and any connection to vaccines is highly speculative, though not unreasonable. A larger sample to look at MIF levels in plasma would be nice. They only had 10 probands and there was high variation in the data. If the relationship is confirmed, a study MIF levels before and after vaccination might be worth the money (or is this already studied? please send me a link if you are aware of such research). Also, does anyone know of other environmental factors that could influence MIF levels?

    The genetic link is also interesting. A sample of people with high risk CATT variants could form a very interesting study group.

  97. BisserR says:

    By the way, increased MIF levels are also present in asthma, artrithis and some other autoimmune conditions, as well as in other diseases, e.g. gastric cancer:
    http://www.springerlink.com/content/yu7730j4m7206j12/

  98. passionlessDrone says:

    Hi Owen –

    Er, no, not quite.

    The argument is you can’t study the vaccine schedule *using this technique* (gold-standard double-blind randomized blah blah).

    Fair enough, bu what I cannot figure out is, what technique is available for studying the vaccine schedule? Is there one? This is a genuine question.

    The argument is made that only the existing schedule has an adequate mix of benifits (well established), and risks to be applied to any child. But I argue that we only understand one half of that ratio; the benifits. No one seems to be able to tell me how we can efficiently gauge the risks without making slews of assumptions that ultimately dilute our ability to reach meaningful conclusions.

    Existing research have involved studying components in isolation and incrementally adding insults without analyzing the cumulative results. It is a slopshod application of the scientific method, instead of a rigorous one.

    Here is an example that I find particularly alarming:

    http://www.ncbi.nlm.nih.gov/pubmed/18843097?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

    Researchers found that if they stratified Hepatitis B vaccine by manufacturer a much stronger relationship between vaccination and MS was observed. All previous studies (except another by this group, where this potential relationship was identified) have made the assumption that all Hepatitis B vaccines could be grouped together. No doubt this lead to simpler modeling ability, but it is a wild over simplification. Does anyone disagree?

    Treating all vaccine types as interchangeable when conducting research did absolutely nothing to actually reduce risk of MS; just our ability to detect the trend appropriately. In the meantime, millions or tens of millions of doses of this particular vaccine have been given, all the while talking heads proclaim up and down that the vaccine schedule has been proven safe.

    In case you were wondering, diagnosis of MS has increased substantially over the past twenty years. Oh well.

    There are other assumptions made in a wide range of studies evaluating vaccines and chronic outcomes that affect our ability to understand the impact of our policies. I would discuss them if anyone wishes.

    I am only advocating we find a method to have a more concise understanding of the actions we are taking. I find it incredibly frustruating that no one seems to have any ideas other than to glibly tell me that while my ideas are unethical, or unpractical they have nothing better than to stay the course.

    - pD

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