The ScienceBlogs Book Club

I want to thank all of you who took the time to read the book and comment. Many of you had kind things to say about the writing and content, clearly understanding what I was trying to do and why I did it. I’ll try and answer as many questions that were directed at me as I can, writing a blog entry every morning.

I’ll start with the easier questions.

We tried to get companies that publish audio books interested in this book, but were unsuccessful.

All of my royalties from the sale of this book will be donated to the Center for Autism Research at Children’s Hospital of Philadelphia. I have found the director of the center, Bob Schultz, to be a careful, thoughtful investigator. But this isn’t set in stone. I’m open to other suggestions.

I wrote the chapters introducing Wakefield and thimerosal without providing any evidence to refute those theories because that was the way it played out in the press and to the public. I thought that this would give the reader a better sense of what really happened during the early stages of the controversy.

Many bloggers continue to question whether mercury in vaccines causes autism. Given the amount of information available to refute this claim, I find this astounding:

First, prior to its removal from vaccines in the spring of 2001, it was possible that children less than 6 months of age could receive as much as 187.5 micrograms of ethylmercury in thimerosal. But because mercury is part of the earth’s surface, and is contained in our water, that wouldn’t have been their only source of mercury. A typical breast fed child would receive about 360 micrograms of environmental mercury, methylmercury. Because environmental mercury is eliminated from the body 10 times more slowly than the ethylmercury in thimerosal, it is much more likely to accumulate.

Second, six epidemiological studies consistently showed that children receiving thimerosal-containing vaccines were not at greater risk for autism than children receiving lesser quantities of thimerosal or no thimerosal in vaccines.

Third, within months of thimerosal’s removal from vaccines in 2001, the quantity of ethylmercury to which young infants were exposed dropped from 187.5 micrograms to 0 micrograms, without any appreciable decline in the incidence of autism. No single-dose vial of vaccine given to young children currently contains thimerosal.

Fourth, the signs of symptoms of mercury toxicity, as described in a wonderful article by Karin Nelson and Margaret Baumann referenced in the book, are distinct from autism. So it never made sense that mercury would cause autism.

Fifth, the reason that the American Academy of Pediatrics pushed to remove mercury quickly from vaccines is that there were not studies in place showing that the quantity of thimerosal in vaccines didn’t cause subtle signs of mercury poisoning. But no longer. The study by William Thompson and coworkers at the CDC answered that question. Thompson carefully defined mercury exposures before and after birth in about 1,000 children then prospectively performed more than 40 neurodevelopmental and psychological tests. Again, no differences in children exposed to greater or lesser quantities of mercury in vaccines. So thimerosal didn’t cause even subtle signs of mercury poisoning. Given that young children were exposed to more mercury from their environment than from vaccines, the results of Thompson’s study weren’t surprising.

So the epidemiological, ecological, and biological studies were all consistent.

A couple of bloggers praised the book for its tone, that I never appeared to get angry at the false prophets described in the book. The reason for that is that I’m not the father of a child with autism. If I were, I would have been quite angry. Angry because I think that the anti-vaccine forces have taken the autism story hostage. And angry that because of their influence, the media almost never carries stories about the real cause or causes of autism. In the July 11, 2008 issue of SCIENCE, Jim Sutcliffe summarizes the functions of the 30 or so genes that have now been associated with autism. A pattern is clearly emerging. Those genes code for proteins that involve the neurological synapse or proteins that are important in endocytoplasmic trafficking in neuronal cells. These kinds of studies might well lead to therapies that could modify the disorder. But you never hear about them. Never. Rather, we hear about how Jenny McCarthy treats autism by focusing on the gut–anti-fungals, elimination diets, etc. The media is perfectly willing to mislead parents for ratings. Shameful.

Comments

#1 Kev
October 2, 2008

“The media is perfectly willing to mislead parents for ratings. Shameful”

They do and it is. There are a cadre of reporters who want to publish accurately but beyond that we have to deal with the Dan Olmsted’s and Sharyl Attkisson’s. Its no surprise that the resistance to the autism/antivax grew from bloggers reporting on the science, given that aside from this small cadre of reporters no one else was interested.
#2 John Rummel
October 2, 2008

I’m hesitate to offer this, but I’m sure it’s been said before:

You note in the final chapter that the NIH, CDC, etc. organs of scientific medicine were largely silent while the antivacs were having a field day in the press…

Is it time for the scientific big guns to hire PR firms to help them manage the media? It’s distasteful to me, as a science advocate, to say that, but is that where we’re at now?
#3 Esther
October 2, 2008

*sigh* I can’t wait to get my copy and hope that this book club won’t be over by then…except that it was sent (apparently) not via airmail. And I’m not in the US.
#4 Kev
October 2, 2008

“Is it time for the scientific big guns to hire PR firms to help them manage the media? It’s distasteful to me, as a science advocate, to say that, but is that where we’re at now?”

YES!

I understand your distaste but things are getting very, very serious. The anti-vaxxers are experts at this. You need to be too.
#5 mollishka
October 2, 2008

So if thimerosal is no longer in vaccines, what is used as the preservative? Or are all vaccines now single-use?

And science can barely get enough money to do science. Where are we supposed to get money for PR firms?
#6 Brian Scott
October 2, 2008

Hi Paul Offit –

I’ll admit that I haven’t read your book, but I do find myself very skeptical of the claim that science has conclusively proven no link between autism and vaccinations. What bothers me, is that to date, the existing science has only studies specific components of the vaccine schedule. The existing suite of studies are comprised of investigations into particular ingredients, or particular vaccines; but this does nothing to answer the question of earlier insults, or other ingredients.

An analogy that I feel appropriate is if everyone smoked fourteen brands of cigarettes; we have many studies of people that smoked thirteen brands of cigarettes, and likewise we have studies of people that have smoked no tar cigarettes. But we have no studies for people that haven’t smoked. If I am mistaken, and such a study in regards to vaccines has been undertaken, I would appreciate it if you could provide a link.

It is as if, because no one can think of a mechanism by which a more aggressive vaccine schedule could cause autism, there is no reason to study it in its entirety. With so much unknown about autism, the idea that because a specific ingredient is no longer in vaccines, or a specific vaccine has been shown not to be associated, the remaining schedule or ingredients must also be safe seems to be extremely poorly reasoned.

Consider the very recent finding that Tylenol use drastically increases the risk of developing asthma, despite having been approved for decades. This doesn�t mean there was a conspiracy, or negligence; just that because no one could conceive such a seemingly beneficial, transient action could raise the risk of developing a chronic health problem. Imagine where we might be had Tylenol been mandated to every infant in the country periodically? And in fact, many doctors told their parents to give their child this drug before and after vaccinations to help reduce fevers.

I�d provide an example of how, I believe, getting the influenza vaccine during pregnancy can raise the likelihood that the child will develop neurological disorders. I am not providing links, in hopes of preventing this post from getting hung up in spam blockers. Someone of your expertise can easily find the references I am detailing below.

1) It is widely accepted that children born to mothers pregnant during years of particularly virulent flu seasons, are more likely to develop neurological disorders; specifically schizophrenia has been identified in several large studies.

2) Recent researchers have found that in animal models, abnormal behaviors can be achieved in offspring by stimulating an immune response in the mother at a critical timeframe, without actually exposing the animal to the disease itself. In particular, I would recommend �Maternal immune activation alters fetal brain development through interleukin-6� wherein researchers found that a single injection of interleukin 6 is able to create offspring with behavioral differences. Knockout mice were immune to this effect.

3) Influenza vaccines have been shown to create significant increases in interleukin 6. See �Effect of influenza vaccine on markers of inflammation and lipid profile� wherein researchers observed significant elevations in cytokines after an influenza vaccination. This is, after all, what the vaccine is designed to do.

Again, we seemingly have a situation where the notion that maternal immune response, as opposed to the virus itself, could be causing the problem is completely novel; and yet, we are finding the opposite to be true only after tens of millions of inoculations have been given to pregnant women. I see striking similarities in the failure to evaluate long term impacts in flu shots and the vaccine schedule as a whole; because we cannot conceive of a mechanism of action, one must not be present.

Please, please understand that I by no means advocating that vaccines are not effective at preventing disease and saving lives. I am only stating that I do not think we can effectively gauge the true risks of the current vaccination schedule without quality evaluations.

I am curious if you feel that such a is necessary or not; and if not, is there anything you can say as to my concerns?

Thank you for you time.

Brian Scott
#7 Joseph
October 2, 2008

I’ll admit that I haven’t read your book, but I do find myself very skeptical of the claim that science has conclusively proven no link between autism and vaccinations.

I can tell you haven’t read the book, Brian. Towards the end Dr. Offit explains how it’s not really possible to conclusively prove a negative.

Let’s say a study finds the risk ratio of autism from thimerosal is 1.0 with 95% CI 0.99 to 1.01. There’s still a chance of a small real risk between 1.0 to 1.01 (not considering the 5% chance that the real risk is outside the confidence interval).

It’s kind of like trying to prove that reindeer can’t fly. You can’t prove it conclusively, but there’s no reason to believe they do fly.

Studies like Thompson et al. (2007) are amazingly consistent with the null hypothesis. The most reasonable conclusion is that the null hypothesis is true.

Certainly, the notion that there’s an “autism epidemic” caused by thimerosal is completely falsified, and can’t be taken seriously any more.

Your other point is that not all ingredients have been studied. This is true. But consider again a study like Thompson et al. (2007) that looks at thimerosal exposure. Is it reasonable to suppose that children with higher vaccine exposure got more thimerosal in the 1990s? I think that’s a reasonable assumption. So even though the whole schedule hasn’t been tested, there are reasonably good proxies on that.
#8 Brian Scott
October 2, 2008

Hi Joseph -

Your point proving no link is well taken. What if, instead, the question were phrased, ‘I have yet to see a study that conclusively shows no increased risk for developing autism with the current schedule’?

As far as flying reindeers, we have too much oversimplification in this type of disucssion already; you would equate evaluation of if something had wings or not with our very imperfect understanding of a developing infants immune system and the effect of earlier and combined stimulations on said system without a good evaluation.

Please understand that I am not questioning the specific preservative which has gotten so much attention. I want to be clear on this point.

Is it reasonable to suppose that children with higher vaccine exposure got more thimerosal in the 1990s? I think that’s a reasonable assumption. So even though the whole schedule hasn’t been tested, there are reasonably good proxies on that.

As long as we are comfortable basing national health policies on proxies and reasonable assumptions, your point has limited validity. Would such a proxy be valid at determining if the age at which a child had an immune stimulation was influential in outcomes? Would such a proxy be useful if we found that different types of vaccines protecting against the same diseases had been shown to have different effects on physiology seemingly unrelated to creating an immune memory?

In any case, this is a superb illustration of my primary point; because we cannot think of a way it could be possible, reasonable assumptions and proxies are all that is needed to have complete confidence.

Brian
#9 truth bot
October 2, 2008

Is it commonly recommended that mothers be vaccinated when pregnant? That doesn’t seem to make a lot of sense. But if it is ever recommended, wouldn’t the small risk of developmental problems be less than the same risk to the fetus from a full blown infection? The body generally reacts more vigorously (immunologically speaking) with a real virus, versus select viral antigens present in vaccines.
#10 Kristina
October 2, 2008

“Hostage” is an apt way to describe how the anti-vaccinationists have affected what gets said about autism in the mass media—-potentially tragically, as they themselves are not able to see that they’ve become imprisoned by their own theories.
#11 Calli Arcale
October 2, 2008

Your point proving no link is well taken. What if, instead, the question were phrased, ‘I have yet to see a study that conclusively shows no increased risk for developing autism with the current schedule’?

Closest I can think of is the studies which have shown no significant change in the autism rate regardless of the vaccine schedule. That is, if you look at first-world countries with different vaccine schedules, the autism rate is similar. (I specify “first-world” because third-world countries aren’t a reliable source of data on autism and other neurological disorders. Too many of their residents have far more pressing concerns, like getting more than four meals a week and not dying of malaria, to worry much at all about accurately diagnosing neurodevelopmental problems — or even seeing a doctor at all in their lives.)

There isn’t an ethical way to experimentally test whether or not vaccines cause autism. You’d have to deny vaccines to a randomly selected group, and given the known benefits of vaccines (to say nothing of the public health imperative) this would be constitute deliberately denying a person proper health care, and would be grossly unethical. I suppose it might be done in the third world; occasionally, such studies do get done. It’s useful from a scientific standpoint, but pretty horrific from a human rights standpoint. So we must content ourselves with the initial clinical trials (where a new vaccine is compared not against placebo but against the existing vaccine schedule) and proxies such as Joseph described above. These can be effective if you have enough numbers, and fortunately with mass vaccination programs, we *have* enough numbers. You’d never get a hundred million people in a clinical trial, but you get a hundred million people taking the vaccine. That’s also how subtle adverse effects of other drugs (like Tylenol) are discovered as well — through millions of people using them day to day and their physicians reporting any adverse effects that occur. Do we end up making guinea pigs of ourselves? To some extent, but I don’t think that’s avoidable. Not unless we wish to deny ourselves lifesaving medications. We have to be willing to accept *some* risk. The tricky part is in properly evaluating that risk.
#12 Joseph
October 2, 2008

As long as we are comfortable basing national health policies on proxies and reasonable assumptions, your point has limited validity. Would such a proxy be valid at determining if the age at which a child had an immune stimulation was influential in outcomes? Would such a proxy be useful if we found that different types of vaccines protecting against the same diseases had been shown to have different effects on physiology seemingly unrelated to creating an immune memory?

But you see, health policies are not based on this, but on tests of the safety of vaccines that are outside of the autism-vaccine controversy. The reason these thimerosal and MMR studies were carried out was because there were hypotheses floating around, which had no real basis in reality. So now that these hypotheses have been discredited, there are still people who think it might be something else about vaccines. The rationale for this? The same testimonial-based rationale that made people look into thimerosal and MMR, nothing more. Is it possible to study a hypothesized vaccine connection in a more detailed way? Sure. But why? Is there a point when you’ll stop? Anti-vaxers will never be satisfied, regardless of what is found. Research money is not infinite. Priorities need to be defined. Why spend money in what is clearly a blind alley that has been visited before? Why is there more merit in studying the connection between vaccines and autism vs. say, the connection between wi-fi stations and autism, or a million of other arbitrary things?
#13 Brian Scott
October 2, 2008

Hi Callie Arcale -

There isn’t an ethical way to experimentally test whether or not vaccines cause autism. You’d have to deny vaccines to a randomly selected group, and given the known benefits of vaccines (to say nothing of the public health imperative) this would be constitute deliberately denying a person proper health care, and would be grossly unethical.

But there is already a population which has or is not getting vaccinated by their own volition; we need not worry about the ethical problems with health choices they have chosen to make. A growing subset of these people, be they correct or not, already have a child with autism; they should be more likely to have additional children on the spectrum. There is selection bias to be dealt with in this instance.

We have to be willing to accept *some* risk. The tricky part is in properly evaluating that risk.

We are in agreement!

Brian
#14 M2
October 2, 2008

Maybe one reason the “vaccines cause autism” story has resonated with the media and public is that we have a lot of examples of big businesses using “science” to obscure the health risks of their products. Tobacco companies did this for decades to “prove” that cigarette smoke was not harmful. (Or at least create doubt and controversy about the real science that showed just how dangerous smoking really is.) Same with asbestos companies, lead, industrial dyes, and lots of other chemicals. Most recently, we have Vioxx. Merck knew it increased the risk of heart attacks, but attempted to cover it up.

With all these archetypal stories, it makes sense that people think vaccines could be another example of big corporations putting their profits before people’s health. So the question is, how do we differentiate the vaccine story from these examples of corporate greed? How do we show that the science demonstrating vaccine safety is real and trustworthy, especially to an audience of non-scientists?

One thought I keep returning to: the truth will out. No corporation has a monopoly on reality. They can use “science” to manipulate public opinion and legal regulation, but ultimately that is only a delaying tactic. At this point, everyone knows that cigarettes are bad for you because the overwhelming amount of independent scientific evidence has pointed to that truth. With vaccines, the overwhelming amount of independent scientific evidence has pointed to their safety. The fact is, if “Big Pharma” were trying to conceal dangerous side effects, it would have come out a long time ago. To suggest that they have successfully hidden any vaccine risks at this point is to posit the existence of a conspiracy on a scale more massive than anything ever seen in this world. It’s not even remotely plausible. I know that won’t stop conspiracy theorist nuts from believing it, but I think it’s worth pointing out to more rational people.

Recommended reading for extra credit:
Doubt Is Their Product by David Michaels
#15 Chris H.
October 2, 2008

Brian Scott said “But there is already a population which has or is not getting vaccinated by their own volition; we need not worry about the ethical problems with health choices they have chosen to make.”

Read the Prologue, page xv… it details when Dr. Offit experince at CHOP in 1991. There was a measles outbreak there, and it centered around a religious group that did not vaccinate its children. Seven children of that group died from measles.

Really, you should actually read the book. Especially Chapter 6. It is not that difficult to read, and it is not too terribly long.

Sorry, I know you guys are trying to be helpful. But you should not be explaining in detail here what is clearly explained in the book, and with lots more detail.
#16 Brian Scott
October 2, 2008

Hi Joseph -

Is there a point when you’ll stop? Anti-vaxers will never be satisfied, regardless of what is found.

Gross over simplification.

Why spend money in what is clearly a blind alley that has been visited before?

Your presumption that this is a blind alley is based soley on your definition of reasonably valid assumptions and the usefulness of proxies.

Why is there more merit in studying the connection between vaccines and autism vs. say, the connection between wi-fi stations and autism, or a million of other arbitrary things?

The decision is not arbitrary, but rather, based on the fact that there has been an explosion of auto immune related disorders at the same time we have initiated a series of drastic immune stimulations at earlier and earlier times in an infants life. While the true level, if any, of a rise in autism can be debated as to diagnostic shifting or better awareness; what cannot be denied is that there is a clear auto immune component to the physiology of autism.

Likewise, the increase in other auto immune conditions like asthma, allergies, and type 1 diabetes have risen dramatically in the same time frame.

We have been tinkering with a system that was designed by evolution over millions of years, the stimulatory effects largely based on the actions of chemicals whose mechanism of action is only very recently becoming understood. Despite the fact that we have seen dramatic increases of chronic diseases associated with that system, we are told that reasonable assumptions are the best we can do in terms of analysis; and in fact, dollars could be spent better elsewhere.

Brian
#17 Joseph
October 2, 2008

But there is already a population which has or is not getting vaccinated by their own volition; we need not worry about the ethical problems with health choices they have chosen to make.

This study would be retrospective, and the populations are very likely to be inequivalent. There are many confounds at play.

Putting the matter to rest would require a randomized double-blind study. That’s the best possible methodology, but it would be unethical. Even then, many such studies would be needed, and even if all come back negative, you’d still have anti-vaxers who don’t care about the science. It’s happened before.

There has to be a good reason to study things. At this point there’s frankly no merit whatsoever to the beliefs of the anti-vaxers.
#18 Joseph
October 2, 2008

Your presumption that this is a blind alley is based soley on your definition of reasonably valid assumptions and the usefulness of proxies.

In part, I do think that if some thing about vaccines had to do with neurological outcomes, large individual-level thimerosal studies like Thompson et al. (2007) would’ve detected it. But I also think it’s a blind alley because of a track record of failure in the part of those who have proposed these types of hypotheses. We’re dealing with a hypothesis that is pushed, frankly, because people are trying to get money out of the vaccine injury compensation system. I can sympathize with parents of disabled children who are trying to ensure financial security for themselves, but this doesn’t make it right.

The decision is not arbitrary, but rather, based on the fact that there has been an explosion of auto immune related disorders at the same time we have initiated a series of drastic immune stimulations at earlier and earlier times in an infants life. While the true level, if any, of a rise in autism can be debated as to diagnostic shifting or better awareness; what cannot be denied is that there is a clear auto immune component to the physiology of autism.

Likewise, the increase in other auto immune conditions like asthma, allergies, and type 1 diabetes have risen dramatically in the same time frame.

Even if it were true that autism is an auto-immune disorder (which is not even close to established) there’s no evidence whatsoever that vaccines are associated with auto-immune disorders. What is the rationale here? That vaccines have to do with the immune system and so do auto-immune diseases? Is that the connection? Maybe cell phones cause autism. It has been suggested that cell phones cause brain tumors. Brain tumors have to do with the brain. Autism has to do with the brain as well. There you go.
#19 Kathryn
October 2, 2008

Dr. Offit:

Thank you so much for answering my previous question. I have another…

I am thoroughly convinced by the epidemiologic evidence that neither MMR nor thimerosol are associated with an increased risk of autism. But as the mother of an 8-month old who is up to date on all his immunizations, I can also relate to the fleeting doubt and fear that I’ve experienced every time the pediatrician is about to inject a syringe of “unknown” material into my son. I know what the studies have shown, and I don’t need to worry about mercury anymore, but could there be something else we haven’t studied yet? Another vaccine contaminant, or simply the practice of administering up to six immunizations at once to a 10-lb child? I’m not sure how this would be done observationally, but have there been any epidemiologic evaluations (other than ecologic studies) of the current vaccine schedule to rule out characteristics OTHER than thimerosol/MMR? I understand that anti-vaxxers will always find some other vaccine component to blame (aluminum, etc), and I don’t want to fall into that camp – but I would like to be able to address these concerns with data.

Thank you for your time and thoughtfulness in addressing our questions.
#20 David W.
October 2, 2008

Offit, I thank you for publishing this book.

I received one of the 50 copies Scienceblogs was giving away. I’m an adult autistic. I’m tired of the claims about the autism-vaccine link. I’ve read the studies that delved into the matter. I was not familiar with the history behind it. Your book was very enlightening to me. I didn’t realize how complex the history of the matter is. I thought it was due to poor science education.
#21 Ms. Clark
October 2, 2008

I’d like to add something to the discussion of this question: “Is it time for the scientific big guns to hire PR firms to help them manage the media? It’s distasteful to me, as a science advocate, to say that, but is that where we’re at now?”

Part of the reason that the autism vaccine hysteria took off is due to the able help of “scientific big guns” like Dr. David Amaral of UC Davis and Craig Newschaffer (I think that’s the right spelling). There were fairly well known researchers at the beginning of the “vaccine caused autism epidemic” who jumped on the wagon and yelled, “giddiyap” to the team of horses.

Why? Well, Dr. Eric Fombonne has said it in public a few times, basically there are researchers who act like “research whores” and will do ANYTHING for a research buck, including saying things like, “wellll, we don’t KNOW, but maybe thimerosal COULD cause autism, and GOSH it sure does look like we are about to be DESTROYED by that autism epidemic. Maybe we could STOP it or something if you built us a brand new INSTITUTE or something and kept sending hundreds of thousands of DOLLARS our way or something…”

Dr. Offit is very generous to Mady Hornig and Dr. Richard Deth in his book. These people sold out me and my ASD child for a buck. Their careers were nothing and heading into more nothing until they decided to play hero to the wealthy mercury parents. To me, it looks like they absolutely knew they were producing fake science, junk science for the litigant parents and selling autistic children into the reality of getting EDTA (caustic stuff) put into their rectums in the form of “chelating suppositories”… not to mention having this and other stuff put into their mouths and veins.

There’s a laundry list of these amoral researchers. I’d like to see them all pilloried, but then I tend to be angry about children being tormented and medically tortured by or because of fools who are making money. That would include most of the researchers at the MIND Institute.
#22 Ms. Clark
October 2, 2008

Clarification: Dr. Fombonne doesn’t use the term “research whores.” What he said was that some researchers jokingly told him to stop arguing against the existence of an “autism epidemic” because the “epidemic” meant money in the bank for those researchers.

Many published autism research papers that I have read over the past few years include statements in the introduction or conclusion along the lines of, “We and our funding body know that the United States is about to be destroyed by a tidal wave of horrible little autistic children, so we were funded (and want to continue to be funded) to find out if X has contributed to this probably never-ending nightmare that will destroy life as we know it IF WE don’t find a way to end it.”
#23 David W.
October 2, 2008

Edit to my comment at #20:

“Offit, I thank you for publishing this book.”

Correction: “Offit, I thank you for writing this book, and donating the proceeds to more effective autism research.”
#24 Brian Scott
October 2, 2008

Hi Joseph –

This study would be retrospective, and the populations are very likely to be inequivalent. There are many confounds at play.

The same can be said of the same studies exhonerating particular ingredients or components of the vaccine schedule. Verasteen does not suffer from similar confounds? Denmark?

Maybe cell phones cause autism. It has been suggested that cell phones cause brain tumors. Brain tumors have to do with the brain. Autism has to do with the brain as well. There you go.

And again here we go with the gross over simplifications. Anyone looking for a reason why the science needs better PR need look no further than your comments.

Brian

Brian
#25 otoness
October 2, 2008

Dr Offit’s book is damned good. He writes like a man who sees the truth, but who cannot understand very well why others cannot. He gives a sermonette on the scientific method, points to the role of religion and superstition in our lives, but this is not very satisfactory. Chapter 10, Science and Society is the weakest of the book. Perhaps other bloggers can suggest improvements to his approach. My inclination is to look at other science pathologies and ask what maintains them. For example, take a look at Saks et al Science 309, 892 (2005) “The Coming Paradigm Shift in Forensic Science”. That so many people are in jeopardy of imprisonment and death because of jackass “science” is shocking. Offit appears to declare Cold Fusion dead, but like a zombie it lives on in the hearts and minds of some very tenacious scientists: Beaudette, Charles, Excess Heat: Why Cold Fusion Research Prevailed(Oak Grove Press 2002). How are these examples different, the same? What other examples can you suggest? Is there a science of comparative science pathologies?
otoness
#26 AtheistAcolyte
October 2, 2008

The same can be said of the same studies exhonerating particular ingredients or components of the vaccine schedule. Verasteen does not suffer from similar confounds? Denmark?

Not sure I understand what confounds are similar. I believe Denmark was prospective, selecting the children and then following them through the thimerosal changeover. If not, then there is a prospective birth cohort study in the UK which does not support the thimerosal association.
#27 Joseph
October 2, 2008

The same can be said of the same studies exhonerating particular ingredients or components of the vaccine schedule. Verasteen does not suffer from similar confounds? Denmark?

Of course there’s confounding in Verstraeten et al. Dr. Offit discusses this in the book. For example, I understand they controlled for a healthcare bias, i.e. parents who don’t vaccinate might also not seek psychiatric services. A more important confound there is that during the early 1990s, thimerosal exposure increased. Of course, the prevalence of diagnosed autism by birth year also increased during that time — it has always been increasing for that matter. So you need to control for coincidental trends. If I recall correctly, they stratified by year, which is an imperfect way to control for this, but it’s better than nothing.

There are “studies” that don’t have even the most basic control for confounding, and these are the studies that do find an association, not surprisingly. I’m referring to studies by the Geiers, of course — there’s nothing else published at that level of quality.

A vaccined vs. unvaccinated population study might be confounded in more complicated ways, I imagine. You have to look harder for children who are completely unvaccinated, so you could end up with a population that is very different from the norm. For example, you’ll find many unvaccinated kids among the siblings of autistic children – perhaps a reason why Generation Rescue’s survey found ASD to be more common among unvaccinated children than vaccinated ones.
#28 mandydax
October 2, 2008

I was wondering; what, if any, plausible and ethical therapies have been tested or proposed for the more severe cases of autism? The mention of synapses got me thinking about drug therapies for other synaptic related disorders like depression. For instance, I take Lexapro to help with my social anxiety, and one of the common symptoms of autism seems to be extreme introversion. There are a lot of potential side effects (including sexual dysfunction, which could make it a bad idea in prepubescents) from SRIs and the like, but it has me curious if anything along these lines has been proposed or studied (maybe in adult autistics)? Surely it’s not a cure, but a treatment might make life easier for the children and their parents.
#29 The Perky Skeptic
October 2, 2008

I am grateful to Dr. Offit for having written this book, and for having endured the hate-filled mudslinging of the antivax crowd.

You, sir, are doing amazing work, and THANK YOU for donating the profits from this book to good research on autism! I say this as a mother of an Asperger child, and as someone who has many, many symptoms of being on the spectrum myself. I see in my son a clear-as-day blending of mine and my husband’s traits, and have been following the genetic research on autism avidly. I’m looking forward to seeing more done, so that we can better understand our own neurodiversity.
#30 PalMD
October 2, 2008

Dr. Offit:

Thank you so much for answering my previous question. I have another…

Kathryn, if you’d be so kind to indulge me, I can answer some of these questions.

I am thoroughly convinced by the epidemiologic evidence that neither MMR nor thimerosol are associated with an increased risk of autism. But as the mother of an 8-month old who is up to date on all his immunizations, I can also relate to the fleeting doubt and fear that I’ve experienced every time the pediatrician is about to inject a syringe of “unknown” material into my son. I know what the studies have shown, and I don’t need to worry about mercury anymore, but could there be something else we haven’t studied yet? Another vaccine contaminant, or simply the practice of administering up to six immunizations at once to a 10-lb child? I’m not sure how this would be done observationally, but have there been any epidemiologic evaluations (other than ecologic studies) of the current vaccine schedule to rule out characteristics OTHER than thimerosol/MMR? I understand that anti-vaxxers will always find some other vaccine component to blame (aluminum, etc), and I don’t want to fall into that camp – but I would like to be able to address these concerns with data.

The best way to study the question is to look at children who have gotten the standard vaccine schedule, as that would expose them to all possible components. The answer thus far has been a resounding SAFE. Not only that, but the small risk of known reactions to vaccines is much, much, much lower than the risk of the diseases the vaccines prevent. The emotional argument that “but it’s all those shots in my baby” is much less compelling than “OMG, my baby could get POLIO/whooping cough/etc.”
#31 The Perky Skeptic
October 2, 2008

One more question for Dr. Offit– You need any more volunteers for testing the rotavirus vaccine? ‘Cause I’d like to sign up for that one!
#32 lurker
October 2, 2008

All of my royalties from the sale of this book will be donated to the Center for Autism Research at Children’s Hospital of Philadelphia. I have found the director of the center, Bob Schultz, to be a careful, thoughtful investigator. But this isn’t set in stone. I’m open to other suggestions.

May I suggest Laurent Mottron MD,PhD at the rivi�re-des-prairies hospital in Montreal whose group work in perception and deliver some very good studies (many of which are downloadable here: http://psych.wisc.edu/lang/autism-research.html).

The reason I recommend his group is because we work on the strength (or qualities) of autistics and I believe that researching on the strength is a better way to help autistics improve their outcome instead (in other word, it’s natural for us to use our strength to succeed).

disclaimer: I work for the group as well as being a client of Dr. Mottron.
#33 Kathryn
October 2, 2008

The best way to study the question is to look at children who have gotten the standard vaccine schedule, as that would expose them to all possible components. The answer thus far has been a resounding SAFE.

Thanks for addressing my question, PalMD — can you please point me in the direction of a study specifically designed to compare the outcomes of kids who have adhered to the standard vaccine schedule to kids on a delayed schedule or no schedule at all? The reason my child is vaccinated is that I did weight the risk of an adverse vaccine reaction against the risk of HepB/polio/pertussis/etc, not to mention my responsibility to my community to preserve herd immunity, and immunizations won. But I’d still like to see the data that shows that kids receiving multiple vaccinations at once are the same down the road as kids who are on a delayed schedule, or a schedule where only one vax is received per visit. Does this research exist?
#34 Epi Wonk
October 3, 2008

Hi. I’m a retired epidemiologist who worked as a branch chief at CDC and as professor of perinatal and pediatric epi at a children’s hospital, med school, and school of public health.

I think this is perhaps the most important book related to science for a “popular readership” in a long time. I’m hoping that many Americans (and Brits) read it.

Dr. Offit,
I agree with otoness that much more thinking has to go into the issue of Science and Society (discussed in Chapter 10), so that lack of understanding of science doesn’t produce more anti-vaccinationists in the future. In a recent article, Dr. Michael Fitzpatrick said: “[The] problem starts at the top, among scientists who share the loss of confidence and authority that afflicts the elite of contemporary society… Senior scientists must take up their responsibility to explain and defend science in public, and to set their own house in order by tackling fraud [and]exposing junk science.” It seems to me that — besides yourself — very few senior scientists have stepped forward and confronted the anti-vaccinationist movement. Indeed, offhand I can’t think of any. I wonder if you have any comments on this.
#35 Epi Wonk
October 3, 2008

Regarding my previous comment: Apologies to Steven Novella, Orac, and the numerous other senior science bloggers who have consistently taken on the anti-vaccine movement.
#36 Inquisitive Raven
October 3, 2008

#28: This has nothing to with Offit’s book, but I’ve also been reading a book about neuroplasticity. In one chapter there’s a discussion of infant brain development, and a particular nerve growth factor’s impact on it. It is hypothesized that white noise might be the environmental trigger for a child already genetically pre-disposed to develop autism. This idea appears to have some empirical support, but I don’t know enough to really evaluate it.
#37 TheProbe
October 3, 2008

Epi Wonk,I read your blog a few times a week and have always been impressed with how you deconstruct bad science with surgical precision. I have learned a lot from you.

If one sits back and reads the articles and responses to this book club (kudos to the book club!) one can see that this is just the thing that can counter the purveyors of infectious disease, disability and death.

Perhaps the powers at ScienceBlogs can collect these articles and comments and consolidate them in a website. With the proper work, the site can be at the top of Google.
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#38 Phil Schwarz
October 5, 2008

“We tried to get companies that publish audio books interested in this book, but were unsuccessful.”

Perhaps worth a retry, once the successful sales pattern of the book has had a chance to establish itself?
#39 muhabbet
March 25, 2009

thanks..
#40 düzce haber
December 15, 2010

One more question for Dr. Offit– You need any more volunteers for testing the rotavirus vaccine? ‘Cause I’d like to sign up for that one…