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The Alleged Autism Epidemic

It is without controversy that the number of autism diagnoses being made is on the rise. In 1991 there were about 6 cases per 10,000 births, and in 2001 there were about 42. This number continues to rise at about the same rate.

The cause of this rise, however, is very controversial. There are basically two schools of thought: 1 – that true autism rates are on the rise, and 2 – that the measured rise is an artifact of increased surveillance and a broadening of the definition. I wrote previously about this very controversy, in which I concluded that the expanded diagnosis hypothesis is much better supported by the evidence.

Now, a new study published last week in the journal Epidemiology is being presented by proponents of the epidemic hypothesis as support for their view. A closer look, however, reveals that this study does not support the epidemic hypothesis and adds little to the overall literature on this question.

Background

Prior studies generally support the contention that autism rates are rising due to changes in diagnosis and surveillance. (see my list of references below) For example, Taylor, after reviewing the evidence, wrote in 2006:

The recorded prevalence of autism has increased considerably in recent years. This reflects greater recognition, with changes in diagnostic practice associated with more trained diagnosticians; broadening of diagnostic criteria to include a spectrum of disorder; a greater willingness by parents and educationalists to accept the label (in part because of entitlement to services); and better recording systems, among other factors. (Taylor 2006)

Also, in an excellent review of this question, Gernbacher, Dawson, and Goldsmith pointed out that the DSM-III, the diagnostic manual for mental disorders published in 1980, required six specific criteria for the diagnosis of autism, while the 1994 DSM-IV had 16 less-specific criteria, out of which any 8 would qualify for the diagnosis. They further pointed to the increased practice of giving autism as an additional diagnosis to individuals who were also diagnosed with mental retardation or Down’s syndrome, for example.

In that same article the authors critically analyze a study looking at the same data as the current study, the MIND Institute of California. They conclude:

In this article we have detailed three reasons why some laypersons mistakenly believe that there is an autism epidemic. They are unaware of the purposeful broadening of diagnostic criteria, coupled with deliberately greater public awareness; they accept the unwarranted conclusions of the M.I.N.D. Institute study; and they fail to realize that autism was not even an IDEA reporting category until the early 1990s and incremental increases will most likely continue until the schools are identifying and serving the number of children identified in epidemiological studies.

They are referring to the fact that careful epidemiological studies indicate that the true incidence of autism is higher than what is being reported by service centers in the various states, and there is great disparity among the states. The numbers of diagnoses made by these centers is approaching the probable true number, following increased surveillance, changes in reporting methods, and a significant broadening of the diagnosis. There is therefore no reason to conclude that the true number of autism cases is increasing.

This is a fascinating epidemiological question – and one with huge implications. If autism rates are truly static, that would be compatible with the majority opinion that autism is dominantly a genetic disorder. If there is a true dramatic rise in the incidence of autism, then that strongly suggests an environmental cause or trigger.

As an aside, we need to avoid the false dichotomy of genetic vs environmental. Even if autism is dominantly genetic, as the evidence suggests, the effects of gene products ultimately interact with the environment. Complex genetic disorders, such as a neurodevelopmental disorder, are going to have environmental influences.

A “trigger”, on the other hand,  means that the genes just set the stage, but the disorder does not manifest unless the environment pulls the trigger. This could be an infection, toxin, coexisting disease, or (for neurodevelopmental disorders) the social and cultural environment.

For further background on this discussion I should also mention that at present the majority opinion is that the epidemiological evidence does not demonstrate a true rise in autism rates, but a small true rise could be hiding in the data and has not been ruled out.

I take pains to make these points because critics of the mainstream opinion often attack oversimplified straw men, while scientists working on this question tend to have and express appropriately nuanced opinions.

The UC Davis Study

This new epidemiological study, which must be put into the context of all the other studies on this question, looked at the California database of autistic children. They wanted to specifically test the “increased surveillance and diagnostic range” hypothesis, so they looked at autism rates by age. They found that younger age at diagnosis only accounts for a 12% increase in the diagnostic rates. Meanwhile, autism diagnosis rates have increased by 500-600% since 1991.

They then controlled for two further specific variables. First they eliminated all children who were not born in California. This was meant to eliminate children who were brought into California in order to receive services. They also looked at the severity of the symptoms and concluded that the “inclusion of milder cases” resulted in a 56% increase in diagnoses. So in total they could explain only about a 68% increase in autism diagnosis, which is about 10% of the total increase.

They conclude:

Autism incidence in California shows no sign yet of plateauing. Younger ages at diagnosis, differential migration, changes in diagnostic criteria, and inclusion of milder cases do not fully explain the observed increases. Other artifacts have yet to be quantified, and as a result, the extent to which the continued rise represents a true increase in the occurrence of autism remains unclear.

And yet in the press release for this study lead author Irva Hertz-Picciotto is quoted as saying:

“It’s time to start looking for the environmental culprits responsible for the remarkable increase in the rate of autism in California,”

The disconnect between the appropriately conservative conclusion in her paper and her statements to the media is interesting. This probably reflects the fact that peer-reviewed papers have to pass tight scrutiny, and so she could not get away with over-interpreting her results. But to the media she let her true biases be known.

The key to putting this study into context is the phrase “other artifacts”. This study did not control for all possible artifacts resulting in higher diagnosis rates. Specifically, it did not address surveillance, which is likely the dominant factor. It also did not control for shifting diagnosis, diagnostic substitution, and dual-diagnosis. In other words, 20 years ago a child may have been diagnosed with a non-specific speech disorder, and today they would be diagnosed with autism. This specific form of diagnostic substitution was found by Bishop in 2008.

Another factor is that physicians, teachers, and parents have increased awareness not only of the symptoms but of the autistic label. How many parents who notice that their child is socially withdrawn are going to seek out services or medical attention?

This study did nothing to assess these potentially huge factors. So what this study really did was account for 10% of the increase in autism diagnosis. But it did not show anything about the other 90%, nor rule out the leading contenders for diagnostic artifact.

The Vaccine Connection

Of course, the anti-vaccine crowd can be counted on to grab hold of this study, cherry pick it from the other studies whose conclusions they don’t like, and overinterpret the results.  David Kirby has already done so over at the Huffington Post. He wrote a piece last week titled: UC DAVIS STUDY: “Autism is Environmental” (Can We Move On Now?) He wants to declare premature victory and “move on,” even when, officially, the study authors had to admit that the question is “unclear.”

He writes:

Autism is predominantly an environmentally acquired disease, the study seems to conclude. Its meteoric rise, at least in California, cannot possibly be attributed to that shopworn mantra we still hear everyday, incredibly, from far too many public health officials: It’s due to better diagnosing and counting.

Compare that to the actual conclusions of the study.  I wonder if Kirby read past the press release.

And, of course, Kirby wants to bring this all back to vaccines.

 (It is important to keep in mind that almost every child born in 2000 would have received many vaccines that contained the mercury preservative thimerosal, which was not completely phased out of most – but not all – childhood vaccines until at least 2003.)

Even if it were ultimately found that autism rates are truly rising, and that this rise was due to an environment factors – vaccines would still be a very poor candidate.  There is already sufficient independent evidence against a significant link between vaccines and autism. If vaccines were causing a 5-6 fold increase in autism that would be a huge signal the studies to date would have picked up.

Also, Kirby fails to mention that the same database used in this latest study is the one that showed that after thimerosal was removed from the childhood vaccine schedule autism rates continued to rise without any change – pretty much destroying the thimerosal hypothesis he clings to.

As usual the most mindless aspect of Kirby’s commentary is his casual and self-serving assumption of moral and intellectual superiority, even over dedicated medical researchers. He writes:

Now, it’s always been easier and more reassuring to tell ourselves that autism was almost purely genetic, that it was always with us at the rate of 1 in 90 men (1 in 60 in New Jersey) and that, gee, weren’t doctors doing a great job these days of recognizing and diagnosis this disorder.

This pathetic groupthink has helped create hugely lopsided funding priorities in autism, where genetic studies get lavishly funded, while environmental ones are lucky to even pick up the dollar scraps left behind.

It is cheap and easy to portray and hard-won consensus built upon years of research and evidence as “groupthink.” Also, Kirby appears to have insufficient familiarity with the real world or medical research to understand that grants are not earned and careers not made by following the herd. There are many researchers tackling these tough questions from many angles and perspectives. Young researchers hoping to find a niche for themselves are more likely to question dominant beliefs.

In fact, while I disagree with Hertz-Picciotto in her bottom line interpretation of the evidence, I think it is a very healthy thing for researchers with a minority opinion to challenge the majority. This happens all the time. But, of course, the burden is on her to make her case.

Kirby insists that the scientific mainstream disagrees with him, not because maybe they understand the research better, but because they are afraid of the truth. They want to avoid any research that could ultimately point back to vaccines. But this is just conspiracy-mongering self-righteous nonsense.  And it is a huge non-sequitur.

The notion that scientists disagree with someone because scientists are generally unimaginative and afraid of the truth is huge red flag. This is the mantra of the crank.

Conclusion

This latest study is interesting, but was too limited in scope to significantly alter the evidence as a whole. I would not be surprised if some small portion of the increase in autism diagnoses were due to environmental factors. But I don’t think current evidence lends much support to this notion either. The current state of evidence strongly suggests that the dominant reason for the increase in numbers is due to changes in diagnostic behavior.

There are many similar epidemiological questions in the world of medicine. I am content to let the chips fall where they may, and will gladly alter my opinion as new evidence comes in. The same does not appear to be true for the Kirby’s of the world. The autism question in particular is mired in a fake controversy promulgated by an ideological anti-vaccine movement that causes no end of mischief.

___________________________________

References:

Hertz-Picciotto, Irva a,b; Delwiche, Lora a. The Rise in Autism and the Role of Age at Diagnosis. Epidemiology. 20(1):84-90, January 2009.

Bishop DV, Whitehouse AJ, Watt HJ, Line EA. Autism and diagnostic substitution: evidence from a study of adults with a history of developmental language disorder. Dev Med Child Neurol. 2008 Mar 31

Chakrabarti S, Fombonne E. Pervasive developmental disorders in preschool children: confirmation of high prevalence. Am J Psychiatry. 2005 Jun;162(6):1133-41.

Fombonne E. Epidemiology of autistic disorder and other pervasive developmental disorders. J Clin Psychiatry. 2005;66 Suppl 10:3-8.Click here to read

Jick H, Kaye JA. Epidemiology and possible causes of autism. Pharmacotherapy. 2003 Dec;23(12):1524-30.

Rutter M. Incidence of autism spectrum disorders: changes over time and their meaning. Acta Paediatr. 2005 Jan;94(1):2-15.Click here to read

Paul T. Shattuck. The Contribution of Diagnostic Substitution to the Growing Administrative Prevalence of Autism in US Special Education. PEDIATRICS Vol. 117 No. 4 April 2006, pp. 1028-1037

Taylor B. Vaccines and the changing epidemiology of autism. Child Care Health Dev. 2006 Sep;32(5):511-9.Click here to read

Morton Ann Gernsbacher, Michelle Dawson, and H. Hill Goldsmith, Three Reasons Not to Believe in
an Autism Epidemic
; Current Directions in Psychological Science. 2005 14(2)

Posted in: Neuroscience/Mental Health, Vaccines

Leave a Comment (45) ↓

45 thoughts on “The Alleged Autism Epidemic

  1. Skip says:

    If the study corrected for people who were not born in CA, did it also correct for people who were born in CA but moved out of the state?

  2. Anne says:

    For the past six years, Dr. Hertz-Picciotto has been running the NIH and FDA funded CHARGE Study (Childhood Autism Risk from Genetics and the Environment), defined on her M.I.N.D. Institute page as “the largest epidemiologic study of confirmed cases of autism to date, and the first major investigation of environmental factors and gene-environment interactions in this disorder.” It’s possible she has a bias in favor of such studies being conducted.

  3. tralala says:

    Hi there–longtime fan and absolute first-time commenter, here. I made the mistake of hopping over the Huffington Post piece; the comments are sickening. Just so you know.

  4. qetzal says:

    Skip,

    No, but the authors argue that was unlikely to have a significant effect. From the paper:

    Our birth cohort analysis assumed that out-migration was independent of whether a child developed autism. If out-migration were differential, the population incidence rates or cumulative incidence proportions could be slightly under- or overestimated. In either case, out-migration would not have affected overall trends unless the differential also varied substantially over time. Domestic out-migration from California is low—about 1.4% per year among children aged 0 to 10 years.

    By the way, the full text of the paper is available here. (Hat tip to Jennifer, commenting at Greg Laden’s Blog.)

  5. madder says:

    “This study did not control for all possible artifacts resulting in higher diagnosis rates. Specifically, it did not address surveillance, which is likely the dominant factor. It also did not control for shifting diagnosis, diagnostic substitution, and dual-diagnosis.”

    Ummm, okay. Given that the purpose of this paper was to examine the relative contributions of environment and diagnostic artifacts to the increase in autism diagnoses, how in the everlasting hell did they leave out these artifacts?

    I’m not an epidemiologist, and these would be the first things I would look for. Oh, wait….

    “[P]eer-reviewed papers have to pass tight scrutiny, and so [Hertz-Picciotto] could not get away with over-interpreting her results. But to the media she let her true biases be known.”

    Ah, yes; now I hear the dulcet tones of someone wearing out the bearings on her personal hobby-horse. Apparently the peer-review scrutiny wasn’t anywhere near tight enough.

  6. Karl Withakay says:

    Repost of my comment on this post over on NeuroLogica:

    Another thing the “autism is environmental” zealots seem to be overlooking is that if autism truly is on the rise, then the cause of autism must also be on a corresponding/proportional rise as well. If every year, the number of individuals in a given age group increases by X %, there should be a corresponding/proportional increase in the cause/trigger of autism, otherwise, you would expect the numbers to level off when the cause/trigger levels off.

    One thing that could explain the continued rise in autism diagnoses rather well is the firestorm effect related to increased surveillance and diagnostic substitution, etc. In a firestorm, the heat from the fire heats the air around the fire, which then rises due to its lower density. This brings in fresh air, which fans the fire, causing it to burn hotter, heating the surrounding air more, causing it to rise and bring it new fresh air even faster in a run away effect- a firestorm feeding on itself.

    Autism has perhaps become a firestorm diagnosis.

  7. jonny_eh says:

    Karl, I definitely buy into that argument. Also, the antivaxers ‘fan the flames’ by encouraging parents to get their children tested for autism even if they only have a remote suspicion that they may be autistic. This only helps to increase the rate of autism diagnosis.

  8. maus says:

    Funny how those parents who were talking about their AMAZING indigo children ( http://skepdic.com/indigo.html ) are now blaming vaccination and everything else in the world for their newly diagnosed “autistic” children who were encouraged to act out and develop behavioral problems…

    Not that this is true in all cases, or that they speak for the whole of sufferers, but this crowd is definitely the worst, loudest, and most counterproductive organized group, they’ve set their own children back in adulthood and now they want to make bad decisions for the rest of us.

  9. It’s true, maus. And what truly boggles my mind is how, when they thought their children were amazing to begin with, now that they’ve been diagnosed ASD they… no longer think they’re amazing? Well, that’s not only sad, that’s reprehensible.

    Kids (and adults) with autism are COOL!!! They really are amazing people. I’ve never met a kid with autism that I didn’t utterly adore once I got to know him/her. It makes me SICK that these parents seem not to be loving their children for who they are.

  10. Calli Arcale says:

    Sometimes, when I’m feeling particularly irked by these people, I wonder if it isn’t a relatively benign form of Munchausen’s Syndrome by Proxy. One way or another, they want their children to be special so they can be special too.

  11. storkdok says:

    Calli, I don’t think one could say MBP has a benign form, having seen it as a resident. There have been a number of mothers of autistics who have been accused of MBP, and the few I know of are not anti-vaxers. MBP and autism is kind of a holdover from the days when autism was “known” to be caused by “refrigerator mothers”. It is putting the blame on the mother.

    I really don’t think the anti-vaxers want to be “special” or have “special” children. In reading Michael Fitzpatrick’s “Defeating Autism: A Damaging Delusion”, I think he nails it on the head in the chapter “Angry Parents”. He describes “parents who become involved in the biomedical movement seem to get stuck at the stage of anger (Kubler-Ross grief stages, page 38).”

    “Parents are entitled to feel sadness and anger when their child is diagnosed as autistic, but in time they need to stop railing at the world and direct their energies into strategies that will benefit their child and their families. Campaigns that channel parents’ energies into the pursuit of wonder cures, or into futile confrontations with doctors, scientists and other professionals, or into litigation over vaccines, offer illusory hopes – and targets for blame and recrimination. At best they divert and dissipate already over-stretched parental energies; at worst they encourage an enduring rage that is likely to compound family difficulties, to intensify isolation and lead ultimately to demoralisation. (page 38)”

    Dr. Novella, thank you for writing this. I hadn’t seen this new article yet.

  12. It’s a shame. We never went through the stages of grief when B got ASD diagnosed. I felt exactly the way this blogger felt, only she’s more erudite than I’m feeling atm and I’ll just link her magnificent post instead! :) The stages she identifies in her own experience are 1. Relief, 2. Validation, 3. Momentum, and 4. Cameraderie. These stages might be more common in people who are more aware of their basic weirdness. ;) “Oh, wow, it’s genetic! Who knew?”

  13. I meant, it’s a shame that so many folks get stuck in their anger, like Storkdok mentioned.

  14. storkdok says:

    Perky, I also did not dwell on these stages of grief. I never got stuck in anger, I moved on very quickly to the “let’s learn what can help my son learn” phase, accepting him and his autism.

    I think there are people that no matter what kind of a diagnosis they or their loved ones receive, will be resilient and move on, looking for the positives in life. I’ve had patient’s dying from cancer who have the most positive attitude towards life I’ve ever seen. Then there are those who become mired in anger and grief when life is not perfect. They lash out at the world and everyone around them, destroying their relationships.

    I choose not to blame. I choose to see the positive side of life. I choose to find educational methods that help my son and to advocate vigorously for him. I choose to enjoy my son and his quirkiness, his newest obsession in all things NASA, which is pretty cool. ;0)

  15. Fifi says:

    Perky – “These stages might be more common in people who are more aware of their basic weirdness. “Oh, wow, it’s genetic! Who knew?”

    Good point. Those of us who accept the weird and wonderful diversity of being human (and accept and are interested in our own genetic quirks) don’t see difference and diversity as being a negative. Nothing against the neurotypical but they can be kinda boring! ;-)

  16. Fifi says:

    storkdock – It’s been suggested that the “refrigerator mothers” idea may have partially emerged because the mothers of autistic kids are more likely to be autistic or ASD themselves (so less snuggly and more rational/logical in general). We’re discovering that autism occurs in girls but is much harder to diagnose (mainly because girls have more ability to compensate for their social disadvantage). I’ve heard a lot of stories (once again anecdotal) about mothers who recognized their own autism once their child had been diagnosed. I can see how this may have led to the (incorrect) idea that it was behavior that created the autism, not genes (though blaming mothers was also popular at the time so not to be ruled out!).

  17. Calli Arcale says:

    “Calli, I don’t think one could say MBP has a benign form, having seen it as a resident.”

    I know. I said “relatively benign” to distinguish these mothers from the ones who surreptitiously inject their children with toxic substances or slip poisons into their food in order to induce symptoms.

    I did not mean to imply that what these mothers do is completely benign. In some cases, their zeal to “cure” their children’s autism (real or imagined) leads them to seek or perform quite drastic therapies on their children, usually with no basis in science. Chelation therapy is the most notorious, and possibly the most dangerous, of these, but less hazardous quack treatments are also harmful to the child. Even the stupid diets are risk without benefit, to say nothing of the overuse of antifungals to treat nonexistent yeast infections, sometimes diagnosed by nothing more complicated than the mother noting that the child “acts yeasty” (to use Jenny McCarthy’s phraseology).

    And for any mothers of autistic children, I also do not mean to imply that all mothers of autistic children are like this. Some are, and unfortunately they are so vocal and so attention-seeking (by their nature) that they threaten to dominate the discussion on autism, which is very unfortunate.

  18. Calli Arcale says:

    Addendum:
    “I really don’t think the anti-vaxers want to be “special” or have “special” children.”

    I think you’re right that most are stuck in the anger stage. But I wasn’t limiting to the anti-vaxers. I was thinking more about the Indigo Child thing (which certainly indicates a desire for one’s child to be special). But it would also explain some parents’ constant search for new therapies, and inability to accept their child’s autism. Many may be stuck in the anger stage of grieving, as you say (though as Perky Skeptic points out, many parents don’t grieve at all over the diagnosis), but I have a feeling that the most whacko of them are not in this category — particularly Jenny McCarthy, who was totally into the Indigo Child thing, but ditched it abruptly when the autism thing came along. For her, I really think it’s all about attention.

    Note: someone wanting their child to be special may not be consciously aware of their own emotional bias. They may just be wanting people to notice the uniqueness of their child, and then letting that desire get completely out of hand. Sort of like “Topper” on the Dilbert strip, combined with the natural parental instinct to imagine the worst.

  19. daedalus2u says:

    There are also the Harry Harlow results on socially isolated monkeys. Monkeys that were isolated from birth (even from their mothers) did end up with symptoms that the researchers characterized as “autistic”, profound withdrawal, rocking, self-injury, profound vulnerability to bullying by NT monkeys (they would be killed if not for experimenter intervention), and some “savant” abilities (in cognitive areas not related to social behaviors). Children subjected to serious neglect do have increased ASD symptoms.

    I see ASDs as a complete spectrum, where there can be movement on that spectrum throughout life. To some extent, social isolation at any age is going to make one less socially adept. Not doing anything for a period of time will reduce facility at it.

    I think the reason that some people are unable to tolerate their children being on the spectrum relates to communication via theory of mind stuff.

    http://en.wikipedia.org/wiki/Uncanny_valley

    My hypothesis as to why people with ASDs are so vulnerable to bullying relates to this. I have mentioned it before, but I think that when people meet, they do a Turing Test using their “theory of mind”, to see if the person is closely enough related to them for them to communicate and cooperate. If the error rate is too high, then xenophobia is triggered. I think that is the mechanism behind the uncanny valley effect. Xenophobia can be triggered either by the communication being off (different culture, different language, different body language), or by the “theory of mind” being off (person with an ASD).

    I think this is why people with ASDs become magnets for bullying by their peers and even by adults. I think that is why the social monkeys bullied the isolated monkeys in the Harlow experiments.

    My speculation is that when a child invokes xenophobia in their parent that some parents can’t deal with it except by displacing that xenophobia onto something else, the pharmaceutical industry, vaccines, autism, anything but their child.

  20. storkdok says:

    Calli, I’m pretty sure that the phrase “attention whore” was made for Jenny McCarthy. She does get a lot of secondary gain from her son’s autism, or whatever she calls it, indigo, etc. ;0)

  21. sdtech says:

    Steven, you said “There are many similar epidemiological questions in the world of medicine. I am content to let the chips fall where they may, and will gladly alter my opinion as new evidence comes in. The same does not appear to be true for the Kirby’s of the world.”

    The implication of this is that ironclad evidence of harm is imperative before approval of the “Kirby’s of the world.” But does the motto “first do no harm” apply only when one has ironclad evidence of harm? Where is the criticism for the lack of evidence of vaccine safety? How exactly does one justify the concept of 4 million newborns each year in this country treated as guinea pigs?

  22. jody says:

    You who keep thinking that the science is in, your right. And it’s not good for the CDC’s EX DIR. This is the latest about the CDC ‘s science “As questionable as the US thimerosal study was, “it was an improvement on other studies, including the two in Denmark, both of which had serious weaknesses in their designs,” Dr. Irva Hertz-Picciotto, Professor of Public Health at UC Davis Medical School and Chair of the NIEHS panel, told reporter Dan Olmsted at UPI.That leaves very little for the CDC to go on in terms of proving that thimerosal and autism are not associated in any way”. “CDC Director Dr. Julie Gerberding has delivered a potentially explosive report to the powerful House Appropriations Committee, in which she admits to a startling string of errors in the design and methods used in the CDC’s landmark 2003 study that found no link between mercury in vaccines and autism, ADHD, speech delay or tics.Gerberding was responding to a highly critical 2006 report from the National Institute of Environmental Health Sciences (NIEHS), which concluded that the CDC’s flagship thimerosal safety study was riddled with “several areas of weaknesses” that combined to “reduce the usefulness” of the study”. This is the Dir. of the CDC ‘s response to the allegations that their flag ship studies were fatally flawed according to congress and the NEIHS “CDC concurs,” Dr. Gerberding wrote in an undated mea culpa to Congress, (provided to me through a Capital Hill staffer)

    That leaves them with nothing left! Nothing!!!!!!

    This is the CDC Dir. admitting that they have no science left to refute the autism thimerosal connection, but give them some more time an they will produce good quality studies. I believe when they were first warned the autism rate was 1 in 10,000 they chose to ignore the warning, and every piece of research that they done in their words was well designed robust studies. We are learning that they were useless. So I guess we can say at the least, The Dir. of the CDC was incompatant, and at the worse the Dir. was involved in a criminal cover up. But I believe we have given them long enough time to investigate themselves I’m afraid if we give them anymore time we won’t have any children left. 1 in 82 from 1 in 10,000 we should have the same penalties that China has, they put people to death when they are this incompatant.

  23. HCN says:

    Jody moaned “This is the CDC Dir. admitting that they have no science left to refute the autism thimerosal connection, but give them some more time an they will produce good quality studies. ”

    So what? The present pediatric schedule includes vaccines that are now ALL available without thimerosal.

    And yet, autism rates increase while the total number of children diagnosed with disabilities stays the same.

    It does not matter how you interpret an interview of the author the the study being analyzed in this blog posting, especially one by a former journalist (who is no longer a journalist for a reason, and I doubt he would care for the punishment for incompetence in China). The science has been done ad nauseum in several different countries, and the answer is still the same: there is no casual link between vaccines and autism.

    That is a dead issue. It is time to concentrate on the real issues. Those are educational supports, medical supports and most important: support for the transition between school and employment.

  24. David Gorski says:

    Re: the recent Hertz-Picciotto study, which I presume you are alluding to.

    Jody,

    Please see:

    http://www.theness.com/neurologicablog/?p=454

    http://autismnaturalvariation.blogspot.com/2009/01/mind-institutes-second-attempt-more-of.html

    http://autismnaturalvariation.blogspot.com/2009/01/some-facts-of-interest-about-numbers.html

    http://autismnaturalvariation.blogspot.com/2009/01/age-of-diagnosis-analysis-is-also-wrong.html

    The bottom line is that the exposure of children in the U.S. to thimerosal in vaccines has fallen to very close to zero, down from its high in 1999-2000. That happened at the end of 2001. If mercury or thimerosal had anything significant to do with autism, a marked decline in new autism diagnoses in children born after 2001 would have been noticed by now. There has been no such decline.

    Quite simply, you are wrong on the science:

    http://www.sciencebasedmedicine.org/?p=14
    http://www.sciencebasedmedicine.org/?p=9
    http://www.sciencebasedmedicine.org/?p=139
    http://www.sciencebasedmedicine.org/?p=289

    http://www.sciencebasedmedicine.org/?cat=36
    http://www.sciencebasedmedicine.org/?p=194

    But thanks for showing me that Dr. Hertz-Picciotto is clearly biased.

  25. jody says:

    I like how you guys say it’s been removed I will let a more qualified person speak me Dr. Engley

    His toxicity studies of mercurials in human tissue culture revealed the mercurials were extremely toxic for human cells and the Thimerosal — the most active, toxic down to the nanogram. The amounts of mercury have gone down “but vaccines still have 100 times that amount when they are in preservative free and reduced thimerosal.

    Explain this
    1 # pregnant women are receiving a flu shot containing Thimerosal

    The MSDS states that preg. women should not be exposed to their product.

    2 # children 6 mos. to 2 yrs are at risk for complications of the flu and need the flu vaccine Dr. gerberding Dir. CDC said.
    The current research at that time was children 6 mos. to 2 yrs get absolutely no benefit from the inactivated flu vaccine except that of a placebo effect.

    My answer to it’s out and we still see autism rising, so it can’t be the thimerosal. Is it was just shifted to the child even earlier
    with the warnings from the simpson wood meeting that you would not want to go any earlier or you would see more outcomes AKA add, adhd, speech delay and autism,( Domestic terrorism ) she Dr. Gerberding did that for two reasons so people like you could say it’s out and we still see autism rising, so it can’t be the thimerosal. And so the numbers would not fall so rapidly.

    3 # we are always told that there is nothing more dangerous in
    children’s vaccines than lemon juice.

    In fact in children’s vaccines was thimerosal, and when it turns into inorganic mercury in the brain of the child. It is the most damaging to the mitochondria and that is by it’s self. Now It’s
    a well known fact that as a catalyst aluminum was used in children’s vaccines My question is If the MSDS says under
    reactivity data aluminum is mentioned and for a good reason
    because mercury and aluminum react violently together with the production of heat. What is something that reacts violently doing in children’s vaccines???

    4 # If this next statement is true then what what are they worried about???

    The CDC put out a Press release that the Vaccine schedule is and always has been flexible.

    This is what someone on an article said about the vacc. schedule.

    Kelly Zachrich, executive director.
    “Parents are actually coming in with a schedule of when they want their children to be vaccinated,” in some cases, even from their doctor, Zachrich said. The schedule does not follow the standard of care set by the Centers for Disease Control and Prevention’s Advisory Committee on Immunizations. When the CDC found out that multiple vaccines maybe responsible for mitochondria dysfunction with autism like symptoms. And the question was asked could we be damaging our children with to many vaccines at one time. They the CDC put out a Press release that the Vaccine schedule is and always has been flexible, so what is the problem, Kelly Zachrich, executive director. of Super Shot Inc., the largest provider of childhood vaccines in the county.

    It doe’s appear he was lying the next statements prove it, also
    it tells how sick and greedy these individuals are that sanction vaccines.

    Seems here they are caught in another lie, read down below on just how flexible they really were at the time of the IOM meeting.

    This below is from the IOM meeting minutes.

    Dr. Stratton: “We said this before you got here, and I think we said this yesterday, the point of no return, the line we will not cross in public policy is to pull the vaccine, change the schedule. We could say it is time to revisit this but we will never recommend that level. Even recommending research is recommendations for policy. We wouldn’t say compensate, we wouldn’t say pull the vaccine, we wouldn’t say stop the program.”

    So what I get by this statement We wouldn’t say compensate is that the vaccine compensation program is a cruel joke on parents of vaccine damaged children.

    If this is true then why bother with a vaccine compensation program??

    Dad of Colton a severely vaccine damaged child that was mercury poisoned by the standard of care set by the Centers for Disease Control and Prevention’s Advisory Committee on Immunizations.

    Why shouldn’t these people be put on trial for wilfully poisoning children???

  26. HCN says:

    Lots of words, but no real evidence.

    Most recent paper by FB Engley found on PubMed is:
    : J Ind Microbiol. 1995 Jan;14(1):21-5.Links
    Comparison of Dey and Engley (D/E) neutralizing medium to Letheen medium and standard methods medium for recovery of Staphylococcus aureus from sanitized surfaces.Dey BP, Engley FB Jr

    and

  27. HCN says:

    oops in wrong button… and:
    J Sterile Serv Manage. 1987 Jun;5(1):18-9.Links
    Disinfection & chemical decontamination methods.Engley FB Jr.

    and:
    Appl Environ Microbiol. 1983 May;45(5):1533-7. Links
    Methodology for recovery of chemically treated Staphylococcus aureus with neutralizing medium.Dey BP, Engley FB Jr.

    Also, if there is still thimerosal in vaccines, why did Burbacher have to ADD thimerosal to vaccines in his study? Why did he not use the actual vaccines with thimerosal if they were so easily available?

    I would suggest you start reading the real science and avoid certain webpages. Or at least read this page with an open mind.

  28. jody says:

    AMA paid for blue ribbon panel study on thimerosal from 1943
    back when the AMA had integrity “Dr. Frank Engley is a retired chairman and professor of Microbiology at the University of Missouri.
    He served on various committees and panels and has consulted for the CDC, NASA, the FDA, and EPA. He did some of the first research on the toxicity of thimerosal.**
    It should be noted that this article was published in the January
    1948 issue of the Journal of the American Medical Association
    ## It should be noted that this article was published in 1950 in the Annals of the New York Academy of Sciences this man was somebody not armchair quarterbacks like you guys. He has since past on but he left with a clear conscience unlike you guys.

    Heck guys this is in two Journals wonder why you did not know this.

    Maybe we should be asking the AMA why they don’t come forward on this important subject and save the children.
    After all it was their money that paid for the study.
    It seems greed runs ramped in the AMA and they care little or not at all, for little children.

    The reason they are fighting this so hard is that they ignored two very strong warnings one from 1948 and another from 1982
    and now the damage is to wide spread and severe
    hence this statement from Dr. Engley QUOTE”if they had followed through on our 82 report the vaccines would have been freed of thimerosal and all this autism they tell me would not have occurred” (They makes you wonder who all knows)

    This was taken from the actual report “It is clear from this research supported by a grant from the American
    Medical Association that Thimerosal is neither efficacious nor safe, and should be removed as a preservative in prescription biologics and pharmaceutical products, as well as from topical over-the-counter products such as Butt-Balm that have Thimerosal present in their formulations as an active ingredient.” Just before this courageous researcher died he set the record straight, another quote from Dr. Engley and probably the most important of all that truly shows how the CDC, FDA, AAP, IOM, and the NIH, all were asleep at the switch for decades. And even to present, QUOTE”if they had followed through on our 82 report the vaccines would have been freed of thimerosal and all this autism they tell me would not have occurred” My son was born in 1990 if they had listened to the report and followed through my son would be playing football in school instead he is being babysitted in school with the mental capacity of a about a two yr old thanks CDC FDA AAP IOM you truly are serving the people well NOT!!!!! Who was this courageous researcher that apparently loved children, here are the credentials of this great man Dr.Frank Engley studied thimerosal as far back as 1942. Dr. Engley is responsible for the 4 year School of Medicine at the University of Missouri. He has consulted for the CDC, IOM, NASA, FDA, EPA, CIA, AAMI, USP, Armed Forces Epidemiological boards, Army, Navy, Air Force as well as Director of research grants and training grants for NIH. Engley Served on the Council of the NIH Institute of Allergy and Infectious Disease and a consultant on many Epidemiological Boards too many to list. Dr. Engley has been a visiting Professor in over 40 foreign countries medical schools. He has produced films, written text books, Laboratory Manuals, over 100 publications, served on editorial boards for numerous scientific journals and periodicals, including four American, two British and one German. Engley is certified by the American Board of Micro Biology and served as the Chair of the Laboratory of American Public Health Association. He has been listed in American Men and Women of Science, Who’s Who in America, Who’s Who in American Education, Who’s Who among Consultants and Who’s Who in the World. His toxicity studies of mercurials in human tissue culture revealed the mercurials were extremely toxic for human cells and the Thimerosal — the most active, toxic down to the nanogram. The amounts of mercury have gone down but vaccines still have 100 times that amount when they are in preservative free and reduced thimerosal vaccines. Now who do we listen to ? a man who is nearing the end of his life and has nothing to gain, or Paul Offit vaccine sales man extraordinaire with a vacc. patent that he will not even disclose how much money he has made off the broken bodies of little children.

  29. sdtech says:

    David Gorski, you said “The bottom line is that the exposure of children in the U.S. to thimerosal in vaccines has fallen to very close to zero, down from its high in 1999-2000. That happened at the end of 2001.”

    Please look at the June 18, 2003 FDA letter that states that vaccines may contain “trace amounts of mercury, less than 1 microgram, from thimerosal as a residual from the manfucturing process” See http://www.safeminds.org/pressroom/press_releases/2005-03-07-FDA-to-Weldon-Thimerosal-Content-7-18-031.pdf

    One microgram of thimerosal contains 1.489 quadrillion atoms of mercury which is not a trace by any means.

    Also please look at the current statement by the Center for the Evaluation of Risks to Human Reproduction. “With the exception of inactivated influenza vaccines, none of the vaccines routinely recommended for children 6 years and younger currently contain thimerosal as a preservative (FDA 2005). Some of those vaccines still contain trace amounts of thimerosal that is added during their manufacture…Limited supplies of thimerosal-free or thimerosal-reduced influenza vaccines are available for use in children and pregnant women and the FDA is working with manufacturers to increase those supplies in the future.” See http://cerhr.niehs.nih.gov/common/thimerosal.html .

    The science is complete to the point where continued use of Thimerosal in vaccines for pregnant women and children is unconscionable. Mercury kills neurons.

  30. daedalus2u says:

    Interesting that you bring up the date of 1948.

    That was a time when mercury containing teething powders were routinely given to infants. The normal dose was 65,000 micrograms of mercurous chloride per dose. Many millions of doses each containing 65,000 micrograms HgCl were sold per year, with one company selling 30 million doses.

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=10645305

    Many millions of infants were given many thousands of times more mercury via teething powder than any child has ever received from vaccines.

    In 1948 in England and Wales, 70 children died from pink disease. We now know that pink disease was mercury poisoning.

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=14821416

    1947 was a worse year, 104 children died of pink disease. How many children have gotten pink disease from vaccines? The answer is none. How many of those children died from mercury poisoning due to vaccines? The answer is none.

    Many millions of children were given enough mercury that over a thousand children died of mercury poisoning. Where is the great epidemic of autism from the 1920’s, 1930’s, 1940’s and 1950’s?. What basis is there for connecting autism to mercury exposure? None at all. It is just a convenient boogeyman; a boogeyman to use to scam money from gullible parents and to try and scam the vaccine compensation court.

  31. Harriet Hall says:

    Jody said,

    Now who do we listen to ? a man who is nearing the end of his life and has nothing to gain, or Paul Offit vaccine sales man extraordinaire with a vacc. patent that he will not even disclose how much money he has made off the broken bodies of little children.

    Our decision to listen to someone should not be based on whether he is an authority, whether he is nearing the end of his life (what difference should that make?), or whether he stands to gain anything, but only on whether he has convincing evidence to support his claims.

    One thing I go by in deciding whether to listen to someone is whether he dispassionately presents the facts or uses inflammatory language like “broken bodies of little children.”

    Incidentally, Offitt has disclosed that the patent belongs to his institution, not to him personally, and that he has not made money from it.

  32. daedalus2u says:

    jody, in case you didn’t read the second reference carefully, pink disease in the years 1947 plus 1948 killed 174 children. All other causes killed 585. In other words, 23% of child deaths during that time were from mercury poisoning.

  33. HCN says:

    Jody, you are still writing lots of words but not giving us any real evidence.

    Some notes:

    1) Dr. Novella is questioning if there has been a real increase in the numbers of autism. He provided references, those are what are listed at the end of the article.

    2) Dr. Engley oldest paper published in an indexed journal was over twenty years ago. If he wrote anything about the availability vaccines with thimerosal, it is not indexed at PubMed. As far as we know he may have just been stating an opinion. It does not matter how distinguished he was, he did not do a real study nor publish the results.

    3) There is no real scientific evidence that vaccines have anything to do with autism, at least by credible scientists. You need to exclude anything written in a “If you pay us we will print it” journal like Medical Hypothesis, and anything which was financed by lawyers (like anything by Geier or Wakefield). It is a dead issue, and is taking money and effort away from the real issues. These issues affect all of us with disabled children, those children that need support in education, medical issues and the transition from school to employment.

    4) If there was still thimerosal in the vaccines why did Sallie Bernard ask for help in locating “older DTaP” vaccines in 2001? See:
    http://onibasu.com/archives/am/27456.html … “A group of university-based researchers needs several vials of the older
    DTaP vaccine formulations which contained thimerosal for a legitimate research study. If anyone knows an MD who might have some of these vaccines or knows where to get them, please email me privately.

    Thank you.

    Sallie Bernard
    Executive Director
    Safe Minds”

    That researcher was Burbacher, and he had to add thimerosal to the vaccines for his study because he could not find any older vaccines with thimerosal.

    5) On the wayback machine are the minutes of a meeting which discussed a survey done on the availability of thimerosal containing vaccines. An inventory of available vaccines in a county was taken in 2002, and it was found that the number with thimerosal was down to less than 2%. It has been reproduced in other sites, but archive of the original is still available:
    http://web.archive.org/web/20041210131810/http://www.cdc.gov/nip/ACIP/minutes/acip-min-feb02.doc … it says …:

    “Mr. Dean Mason presented a chart of the thimerosal-containing vaccines/toxoids in the pediatric schedule and under the C.D.C. contract (not all of which are licensed in the U.S.). N.I.P. estimated the amount of thimerosal in provider vaccine inventories in a survey conducted September 20, 2001 to February 20, 2002. The targets were a convenience sample of providers getting site visits from public health officials across the country. Inventory counts were done of all refrigerators for D.T.a.P., Hib, and hep B pediatric vaccines. The thimerosal classification was based on the lot number information, which was verified by the manufacturers.

    “In September 2001, 225 sites were canvassed, and 447 by February 2002. The decline in thimerosal-containing vaccine went from 5.6 percent to 1.9%, from 33,500 doses out of 63,600; to 2,796 doses out of 149,147. These were delineated by D.T.a.P., D.T.P., Hib, hep B-Hib, and hep B. Hep B rose from 4.95 percent to 7.5%; the proportion that is pediatric (10 microgram) versus adolescent versus adult (5 microgram) still requires evaluation. However, the N.I.P. thinks that most of it is pediatric.

    “During the visits, the providers were surveyed about thimerosal-containing vaccines in their inventories. Of the 447 interviews, 83.5 percent reported no thimerosal-containing vaccines in stock at any time since October 2001. Only 25.3% said they were aware of the “voluntary exchange programs” implemented by G.S.K. and Merck to replace the thimerosal-preservative vaccines with thimerosal-free ones. Only 2.9 percent had exchanged vaccines, with the following reasons given: unaware of the program, no thimerosal-containing vaccines in inventory; not worth the effort; will exchange after expiration.

    “The N.I.P.’s conclusions were that:

     The amount of thimerosal-preservative containing pediatric vaccines in provider inventories is small and continues to decrease.
     Thimerosal-containing pediatric vaccine inventories are almost totally comprised of hep B and D.T.a.P./Hib (91%), and the latter is only licensed for dose 4.
     Less than 1 percent of all D.T.a.P. vaccines inventoried in provider offices contained thimerosal. One way to accelerate that stock depletion could be to offer a systematic exchange program.”

    Please read what Dr. Novella more carefully, and look at the references. An anecdotal evidence of the changing diagnostic criteria is my son. He is now an adult. He has never been formally diagnosed with autism (the pediatric neurologist kept saying he was NOT autistic because he was a happy social child), but during his last year of high school the psychologist mentioned that if he were ten years younger he would have been classified as autistic.

    If you feel what Dr. Novella wrote is untrue, please present the real scientific evidence. I would suggest you not use the one that is the subject of this blog article.

    Also learn what constitutes real evidence versus opinion. You need to have an open mind when you read the papers, and learn to figure out if a person is actually qualified to speak on the subject. For instance do not take medical advice from a lawyer, actress or journalist.

  34. sdtech says:

    HCN, you wrote “There is no real scientific evidence that vaccines have anything to do with autism, at least by credible scientists.”

    Look at graph 3 on page 15 of the Thimerosal VSD Study dated 2/29/2000. It is marked “Confidential – Do Not Copy or Release” and was obtained using the Freedom of Information Act.

    http://www.nomercury.org/science/documents/ThimerosalVSDstudy_2-29-00.pdf

    You see a relative risk of 2.48 for mercury exposure of 75 micrograms from Thimerosal at 3 months

  35. sdtech says:

    HCN, I am sorry to hear about your son’s possible diagnosis. I don’t know if this is helpful but I respectfully suggest the book “Changing the Course of Autism” by Bryan Jepson.

  36. HCN says:

    sdtech, random websites do not count as real evidence, and that site is dated year 2000. Granted I did give two anecdotal sources that there has been very little thimerosal in vaccines since 2002.

    The science has been done in several countries and the results are:
    1) Autism rates have not really gone up. The diagnosis has gone up, and that is a completely different thing (read what Dr. Novella wrote, again).
    2) Vaccines have not been shown to be a cause of autism (again, several studies in several countries… including those where thimerosal used started to be restricted in 1992).

    Did you not notice that my son is now an ADULT?!! Did you notice that he has never been diagnosed with autism, even though he would be had he been ten years younger?

    This does not give me much faith in your reading ability, so I will not be taking any reading suggestions from you.

    I also stopped reading self-serving books since reading this idiot book which was just a book long advertisement: http://www.amazon.com/What-About-Your-Brain-injured-Child/dp/0757001866/

    I looked at that book you recommended, and it is also an unscientific self-serving book (ooh, look co-authored by Katie Wright! Ugh). And it about using the DAN! stuff… oh, yeah! That gives me lots of confidence, NOT! Especially after Roy Kerry became a DAN! doctor after he executed a five year old boy through needless and incompetent chelation (and don’t go giving the excuse that it was the “wrong” drug, because it was the ONLY think Kerry ever stocked or used).

    I take medical and neurodevelopmental advice only from qualified people. Those included my son’s pediatric neurologist, his cardiologist and the several therapists he saw during his ten years of speech therapy, and the very qualified special education professionals who worked with him from the time he was three years old and now while he is in community college with disability supports. This obviously excludes you.

  37. sdtech says:

    HCN, you said “random websites do not count as real evidence.”

    This is Dr. Verstraeten’s data from the CDC from 2000.

    As for the rest–you are the best advocate for your child and you’re entitled to tell me off.

  38. HCN says:

    And that is still OLD stuff. So what? It was his first paper, which was taken apart very severely and after he took the actual peer critism and fixed it, the effect went away. See the more recent 2004 paper here:
    http://pediatrics.aappublications.org/cgi/content/full/112/5/1039

  39. jody says:

    Harriet Hall

    His words It was like winning the lottery Paul Offit

  40. Harriet Hall says:

    Jody,

    What was like winning the lottery? What was the context of Offit’s statement? I can imagine him saying the achievement of an effective vaccine to help children was as valuable a prize to him as winning the lottery would be for most people. You claimed that Offit made money from the broken bodies of children and you have not presented any evidence to support that claim.

  41. sdtech says:

    HCN, you said “It was his first paper, which was taken apart very severely and after he took the actual peer critism and fixed it, the effect went away. See the more recent 2004 paper here:
    http://pediatrics.aappublications.org/cgi/content/full/112/5/1039 .”

    First, look at this report (2003).

    It says “In the first phase of our study, we observed an association between thimerosal exposure and some of the neurodevelopmental disorders screened, most notably between
    cumulative thimerosal exposure by 3 and 7 months of age and speech and language disorders at 1 HMO, and also an association between cumulative thimerosal exposure by 3 months of age in 1 HMO and tic disorder.”

    Second, look at Verstraeten’s letter (2004) at http://pediatrics.aappublications.org/cgi/content/full/113/4/932 . He says “The CDC screening study of thimerosal-containing vaccines was perceived at first as a positive study that found an association between thimerosal and some neurodevelopmental outcomes.”

    Third, note that he refers to one group of kids that show a significant risk and another from “Health Organization C” that does not. That means that for the two studies, ½ of the total shows risk and the other ½ does not show risk. ½ + 0 does not equal zero, it equals ½. That is not a “neutral” or “null” result.

    So to be clear, it is incorrect to say there is “no evidence” of harm. There is.

    One quantification of the change in risk of harm to children can be done by comparing the Autism Spectrum Disorder (ASD) rates between the years 1967 and 1983 of 3.4 per 10,000 and the CDC rate of 1 per 150 children in 2002 and then using an annual birth rate of 4 million children per year in this country.

    This calculates out to an increase of 25,307 more children each year with ASD! And the odds ratio is 19.7 – so that would say kids today have a 19.7 greater odds at getting autism than kids 25 years ago!

    Finally looking at the 2003 Verstraeten report, it says “The biological plausibility of the small doses of ethylmercury present in vaccines leading to increased risks of neurodevelopmental disorders is uncertain. The effect of organic Hg on neurologic development has been the focus of several studies. [References]5, 7, 22.”

    It is biologically plausible and there is evidence of harm.

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