Respectful Insolence

Having gotten into the whole idea of blogging about peer-reviewed research yesterday and even using a spiffy new icon to denote that that’s what I’m doing, originally I had planned on looking up another interesting article or pulling one from my recent reading list and blogging about it. Then, realizing that Breast Cancer Awareness Month is over after today, I happened to come across an article that reminds me of something that’s appropriate for today, namely Halloween. Yes, it’s that mercury maven of mavens, that tireless crusader who thinks he found that the Amish don’t get autism and, steadfastly ignoring all other possibilities, such as lifestyle or genetics, concludes that it must be the vaccines, stupid.

Olmsted had disappeared for a while, apparently leaving his job at the UPI, only to resurface at Generation Rescue’s blog, Rescue Post, where he’s basically continued doing the same credulous and badly researched articles that he used to do at UPI for his Age of Autism series, only even more credulous and useless. Now, with the end of Breast Cancer Awareness month here, guess what?

He’s baaack.

Like Michael Myers of the Halloween series or Jason of the Friday the 13th series, not to mention like innumerable zombie or vampire films over the last several decades, just when you thought he was dead, Olmsted jumps out of the shadows to terrify people with half a brain or more with his amazing ability to use truly awful reasoning, amazing leaps to conclusions, and just plain bad science. This time is no different. This time, he’s trying to outdo Mike Adams in trying to make his antivaccination ramblings “relevant” by invoking Breast Cancer Awareness month and an article in TIME Magazine that I blogged about a couple of weeks ago in a particularly shameless way:

WASHINGTON, Oct. 29 — One big problem the autism community faces is lousy coverage by Big Media. Where is the curiosity and sense of urgency in the face of the soaring autism rate? Where is the willingness to challenge self-interested parties like the CDC and the AAP rather than rewriting their press releases and calling it a day?

This kind of coverage is not limited to autism, and it can be revealing to look at other illnesses and see the same kind of haphazard and just plain mediocre reporting. This is Breast Cancer Awareness Month, so let’s make it a case study.

Time Magazine’s Oct. 15 cover says, “Why Breast Cancer is Spreading Around the World.” You’d expect when you read the story to find out why, would you not? But the story itself is a mish-mash. Rather than focus in-depth on the question, the article offers touching but irrelevant anecdotes (so-and-so in China was recently diagnosed and might not have been a decade ago) and pointless diversions. “Of all the things that can determine a woman’s chances of surviving breast cancer, perhaps one of the most powerful is the simple matter of race.”

Well, that’s interesting and important, but it has zero to do with “why breast cancer is spreading around the world.” Time devotes only a couple of paragraphs to answering its cover question.

The press doesn’t show any “curiosity” about the autism “epidemic”? What planet is Olmstead living on? Over the last year, we’ve been bombarded by stories about autism, particularly the Autism Omnibus. Every time a major study about autism (or even related to autism) comes out, there’s a lot of press on it, the most recent example being the recent New England Journal of Medicine study that failed to find a risk between thimerosal-containing vaccines and neurodevelopmental disorders, with the promise that the study looking at autism will be released in 2008. No, the problem when it comes to autism is not lack of reporting, but rather bad reporting–like Olmsted’s. In reality, though, perhaps what irks Olmsted is more that, aside from credulous “mommies” like Jenny McCarthy and her enablers, the mainstream press slowly but surely seems finally to be getting the message that vaccines do not cause autism and that the “autism epidemic” is much more a function of better diagnosis and classification. Be that as it may, in retrospect, I’m kicking myself a bit. I should have realized that somewhere, somehow, some crank would misinterpret TIME Magazine‘s rather sloppy use of language in its headline or use it for their own nefarious purposes. In reality, breast cancer is not “spreading around the world.” It’s always been there. Even taking into account regional and ethnic variations in breast cancer susceptibility, it is still the most common cancer to afflict women all over the world. The reasons breast cancer seems to be more prevalent in many third world countries probably include:

  • Longer life. Before, women tended to die at an earlier age of other causes. Like most solid tumors, breast cancer is still primarily a disease of older women, and its incidence rises with age.
  • Westernized lifestyles. I’m not sure this is true, given that the risk due to these factors is probably far outweighed by family history and age.
  • Fewer children. This may be a factor, as having more children does lower the risk of breast cancer.

I tend to favor the first reason as a major cause, but one reason that is ignored is increased awareness. As hard as it is to believe, there are many places in the world where breast cancer has such a stigma to it that women deny it until it is too late often do not seek care, and the disease is not treated. When the woman dies of breast cancer, because of the stigma the cause is attributed to some other problem. This is such a problem that that First Lady Laura Bush recently went to Saudi Arabia to increase awareness. Often the reason is that religious or cultural proscriptions prevent women from going to mammography if the technician or radiologist is male or seeing a male doctor. Combine that with powerful cultural taboos about cancer, particularly breast cancer, that are strong enough that a husband will fear that no suitable man will marry his daughter if his wife is revealed to have breast cancer, and you can see how denial can keep the true rate of breast cancer artificially low. Lest you doubt the power of this taboo, I’ll just say that I have seen it in action in at least a couple of Egyptian patients. Their husbands didn’t even come to doctors appointments; in both cases it was the sons who came with them.

Olmsted, intrepid reporter that he thinks himself to be, concludes that there must be more going on:

In an unfortunate bit of timing for Time, a study came out the same week that raised the issue the magazine ignored – the environment. The Washington Post reported, “A new study has found a significant link between women’s exposure to DDT as young girls and the development of breast cancer later in life.

“The results are something of a surprise, researchers said, because several previous studies have found no link between cancer and the insecticide, which was widely used during the 1950s and ’60s but was banned in the United States in 1972.”

Now we’re back in familiar territory, aren’t we, fellow autism travelers? A whole host of flawed studies over many years found “no link” between DDT and breast cancer. Meanwhile, it’s banned here but used in developing countries, perhaps with unintended consequences for a whole generation.

You know where this is going, of course. Oh, yes, Olmsted, mercury maven that he is, is about to make the analogy between breast cancer and mercury and autism. But, before he does, what is this study to which he refers? It appears to be this one here.

In essence, this study was a rather small study (only 129 women). It was a case-control study using 129 matched pairs, where exposure to DDT was estimated by looking at serum samples that had been collected over 40 years ago. A five-fold increased risk of breast cancer was found in women with significant exposure DDT at an early age, as determined by these blood samples. Most previous studies have found no association between DDT exposure and breast cancer; so what makes this one different? It’s not clear yet. The strength of this study is that it measured levels of DDT metabolites in serum samples taken around the time of exposure. On the other hand, the weakness of hte study is that it doesn’t have that many patients, and it has only incomplete information about other risk factors, making it difficult to correct for them.

In other words, the study, although good for what it is, is only one study, and it’s presently an outlier. Its may be correct, but it needs to be confirmed, given that it comes to dramatically different conclusions than the bulk of previous studies designed to address this question. Not that that would stop Olmsted from riding this one study for all its’ worth and analogizing it to his favorite bugaboo, mercury and autism. All the other studies before this one must, to him, be “flawed,” with this study being The One True Study that “proves” a link. Keeping this in mind, it’s not surprising to see where Olmsted will go next, namely misrepresenting what the TIME Magazine article said:

What I want to point out is that DDT is one plausible factor in the rise of breast cancer around the world – a phenomenon Time basically attributes to eating too many cheeseburgers, having two kids instead of 10 and lazing around the office rather than picking cotton by hand.

Naturally, spurred on by this one finding, Olmsted couldn’t resist heading to Google:

Nor is DDT the only possible environmental factor ignored by Time. Spurred by the contrast between the Time article and the DDT study, I found dozens of Web sites and numerous studies that focus on an environmental component to breast cancer. To pick just one, Breast Cancer Action has a fact sheet on its Web site, www.bcaction.org, titled “What you should know about breast cancer and the environment.”

Because we all know that, if it’s on the Internet, it must be true.

Look, it’s certainly plausible that environmental factors contribute to breast cancer susceptibility, and there are plenty of studies implicating a variety of these factors. Indeed, Olmsted is wrong about the press ignoring such links. They’re a popular topic in the press. In essence, he’s attacking a strawman. Moreover, no one downplays such links, which are certainly worth studying, but only as far as the data takes us. Unfortunately, Olmsted doesn’t allow himself to be shackled by such petty issues:

What we have here, Luke, is a failure to communicate the full story of breast cancer risk by the most trusted magazine in America. And that is no aberration – Time after Time, so to speak, the major media outlets simply don’t do a very good job of delving into environmental factors that lead to a higher incidence of diseases and disorders.

Thus the analogy to autism. Once-over-lightly is what we’re getting from the folks who are supposed to be independently digging for the truth (the whole truth) themselves. We need to do a lot better than that, but more and more it looks like we’ll have to do it ourselves. And we will.

Of course, although you’ll never get Olmsted or any other mercury militia member or sympathizer to admit it, the invocation of “environmental” causes for autism is in fact a code for blaming vaccines, be it the mercury in the thimerosal preservative or the vaccines themselves. Never forget that. Never mind that there are now several large studies that have completely failed to find a link between either mercury and autism or vaccines in general and autism. He should also be careful in invoking the breast cancer example. Whatever effect environmental factors may have in the development of breast cancer, it’s pretty clear that, unlike the case of lung cancer, for example, the role of environmental factors in breast cancer is dwarfed by family history (i. e., genetics), followed by reproductive factors (age at menarche, age at menopause, age at first pregnancy, number of live births, etc.). Other factors, such as alcohol intake or diet, are much further down the list of risk factors, and environmental factors that might actually be linked with breast cancer (radiation to the chest, for example) apply to relatively few women. In this, comparing autism to breast cancer may not be such a bad comparison, but not in the way Olmsted intended.

It’s possible that environmental factors may contribute to the development of autism. These days most data point to a predominately genetic cause, but, as in the case of breast cancer, environmental factors are a hot area of research, given that it’s possible that as yet undetermined “environmental factors” may interact with a genetic predisposition to autism to produce the syndrome. Of course, that’s not what Olmsted is about, because the evidence thus far utterly fails to implicate the “environmental factor” that Olmsted is really interested in. Remember, everything about his previous history suggests that it’s all about the vaccines. His invocation of the breast cancer analogy is merely a disingenuous way of suggesting that the vaccine-autism link is still plausible, although you have to know his long history of antivaccination writings on the topic of vaccines and autism or mercury and autism to realize this. Now, like much of the mercury militia, he seems to be turning his attention away from vaccines somewhat and starting to invoke unspecified “environmental factors,” but it’s clear that he’s only being dragged away from blaming vaccines kicking and screaming.

Comments

  1. #1 isles
    October 31, 2007

    I think what bugs me the most about people like Olmsted is when they say things like “the press isn’t curious about the autism epidemic” when what’s really going on is that the press has figured out it’s a load of crap and has moved on. There’s just something so breathtakingly narcissistic about it – as if they can only see their worldview as the one true worldview.

    Come to think of it, doesn’t that pretty much describe a lack of “theory of mind,” which is supposed to be a cardinal feature of autism? That’s pretty funny.

  2. #2 Joseph
    October 31, 2007

    And there are a number of environmental factors associated with autism. There’s also a lot of money going into researching environmental factors. I fail to see Olmstead’s point.

  3. #3 jk
    October 31, 2007

    “. . .steadfastly ignoring all other possibilities, such as lifestyle or lifestyle. . .”

    Did you mean to type two “lifestyles?” Because I would have thought genes fit into the picture somewhere.

  4. #4 jre
    October 31, 2007

    Orac -
    Excellent post, as usual. If you move “in a particularly shameless way” to a point immediately after “invoking”, I think your meaning will be clearer.
    Speaking of shameless plugs, here is what I was able to dig up on the state of knowledge regarding DDT in 1972. It was then, and is now, suspected to cause cancer in humans — mostly because of its tumorogenicity in animals. A few epidemiological studies have shown some association between DDT exposure and human cancer, particularly pancreatic cancer, but never a strong effect — that’s why, 35 years later, it is still listed as a “suspected” human carcinogen. DDT was quite properly banned for agricultural use, and we may yet see a firm link between DDT and cancer, but the jury’s still out.
    Regarding thimerosal, though, the jury is definitely in, and the verdict is “not guilty”. Multiple well-designed studies have looked carefully for an effect, and found none. For Olmsted to pretend otherwise is disgraceful … but then, what else is new?

  5. #5 DLC
    October 31, 2007

    Unfortunately there are too many people out there who go by “common sense” or “mommy instinct.”
    The day after this http://www.aap.org/advocacy/releases/oct07autism.htm was published almost every news outlet carried the story.Unfortunately, as is typical of science reporting in the mainstream media, most reported it poorly. So, Olmstead saying that Autism isn’t getting the press coverage it deserves sounds to me like “My particular brand of autism quackery isn’t getting the coverage it deserves.”

  6. #6 iain
    November 1, 2007

    Orac,

    A bit OT, but I’d like to know whether you’ll be commenting on this ‘be thin to avoid cancer’ report that’s all over the news at the moment: http://www.dietandcancerreport.org/

    Some media reports are annoyingly skimpy on details (e.g. which cancers are involved) but the report seemingly makes several recommendations that I find a bit surprising, such as that it’s best to have a BMI at the low end of the ‘normal’ range. My immediate thought was that I needed someone more knowledgeable and better-qualified to dig behind the headlines and tell me (a) whether this report is being accurately represented in the media and (b) whether it’s the product of well-conducted research. Naturally you came to mind. (Why yes, I am flattering you in the hope that you’ll post something on this – is it working?)

  7. #7 dnr
    November 4, 2007

    Breast Cancer Awareness Month gives women a number of misleading messages, such as 1) A mammogram can prevent breast cancer. (This is false.) 2) A mammograms can early detect and lead to cure virtually every cancer. (false again. Most cancers are missed on the mammogram)

  8. #8 Orac
    November 4, 2007

    Oh really? What organization claims that mammograms prevent breast cancer or that mammorgrams can detect and lead to cure of every cancer?

    You’re also wrong; most cancers are not missed on mammography.

  9. #9 Online Cancer Guide Blog
    November 5, 2007

    A new type of mammogram equipment called full-field digital mammography has created mammogram to be the best method for diagnosing early breast cancer. As the traditional film-screen mammogram is limited in its ability to detect some cancers, extensive research has made to improve mammogram, thus, introduced full-field digital mammography.

  10. #10 dnr
    November 5, 2007

    Oh really? What organization claims that mammograms prevent breast cancer or that mammograms can detect and lead to cure of every cancer?

    The ACS and NCI support the discredited notion that mammograms “prevent” breast cancer. About 2/3 of women believe that annual mammograms will prevent beast cancer because of various advertising campaigns over the years.

    You’re also wrong; most cancers are not missed on mammography.

    The American College of Radiology says up to seventy per cent are missed.
    .

  11. #11 Orac
    November 5, 2007

    The ACS and NCI support the discredited notion that mammograms “prevent” breast cancer. About 2/3 of women believe that annual mammograms will prevent beast cancer because of various advertising campaigns over the years.

    Citations, please?

    The American College of Radiology says up to seventy per cent are missed.

    Citations from the peer-reviewed literature, please? (I suspect I know where you got that figure from, but let’s see if I’m right.)

    I might even get a blog post out of this.

  12. #13 MartinM
    November 5, 2007

    When citing the scientific literature, it helps to pick something which actually supports one’s claims. Where exactly does that study conclude that ‘most cancers are missed on the mammogram?’

  13. #14 dnr
    November 5, 2007

    Try looking at the references at the bottom of the link.

    What is your answer for Per Cent cancers missed by screening mammography? Zero?

  14. #15 MartinM
    November 5, 2007

    Try looking at the references at the bottom of the link.

    No. Do your own bloody research. Don’t make the claim until you’re able to back it up.

    What is your answer for Per Cent cancers missed by screening mammography? Zero?

    Idiotic strawmen will get you nowhere. No one has claimed that mammography is perfect. Indeed, I haven’t made any claims about mammograpy at all. You have, and it’s on you to a) support them or b) bugger off.

  15. #16 santorini
    November 5, 2007

    Idiotic strawmen will get you nowhere. No one has claimed that mammography is perfect. Indeed, I haven’t made any claims about mammograpy at all. You have, and it’s on you to a) support them or b) bugger off.

    Mammography misses cancers about 31 to 69 per cent of the time, depending on the conditions and setup of the study.

    Also, positive findings on mammograms lead to negative biopsies 4 out of 5 times. Some call this doing unnecessary procedures.

    50% of the time when cancer is found based on a mammogram finding, it is the nonagressive form that is clinically occult and would probably never cause disease. The other 50% ofthe time it is a real cancer,the agressive type.

    The American Cancer Society and Breast Cancer Awareness Month publicize annual mammography, but perform a disservice to the public because they do not honestly discuss these negatives. Women come away with the impression that the annual mamogram will prevent breast cancer. It doesnt.

    Most women are unaware of the false negative and false positive mammogram rates which lead to additional procedures which cause scarring, and emotional distress.

    Most women going for their annual mammogram are unaware that two of the large scale studies of screening mammography which were done in countries with universal health care (Canada and Sweden) showed no mortality benefit from screening mamography.

    This information is all heavily supported in medical literature.

  16. #17 MartinM
    November 6, 2007

    This information is all heavily supported in medical literature.

    And if you’d actually bothered to cite some of it, your contribution to this discussion would have been non-zero.

  17. #18 santorini
    November 6, 2007

    Bird RE, Wallace TW, Yankaskas BC. Analysis of cancers missed at screening mammography. Radiology 1992; 184:613-617.

    van Dijck JA, Verbeek AL, Hendriks JH, Holland R. The current detectability of breast cancer in a mammographic screening program. Cancer 1993; 72:1933-1938.[

    Ikeda DM, Andersson I, Wattsgard C, Janzon L, Linell F. Interval carcinomas in the Malmo mammographic screening trial: radiographic appearance and prognostic considerations. AJR Am J Roentgenol 1992; 159:287-294

    Feig SA. Role and evaluation of mammography and other imaging methods for breast cancer detection, diagnosis, and staging. Semin Nucl Med 1999; 29:3-15.

    DeGroote R, Rush BF, Jr, Milazzo J, Warden MJ, Rocko JM. Interval breast cancer: a more aggressive subset of breast neoplasias. Surgery 1983; 94:543-547.[

    Burrell HC, Sibbering DM, Wilson ARM, et al. Screening interval breast cancers: mammographic features and prognostic factors. Radiology 1996; 199:811-817

    Nodine CF, Kundel HL, Lauver SC, Toto LC. Nature of expertise in searching mammograms for breast masses. Acad
    Radiol 1996; 3:1000-1006

    Chan HP, Lo SCB, Sahiner B, Lam KL, Helvie MA. Computer-aided detection of mammographic microcalcifications: pattern recognition with an artificial neural network. Med Phys 1995; 22:1555-1567.

    Petrick N, Chan HP, Wei D, Sahiner B, Helvie MA, Adler DD. Automated detection of breast masses on mammograms using adaptive contrast enhancement and texture classification. Med Phys 1996; 23:1685-1696

    Nishikawa RM, Giger ML, Doi K, Vyborny CJ, Schmidt RA. Computer aided detection and diagnosis of masses and clustered microcalcifications from digital mammograms. In:

    Bowyer K, Astley S, eds. State of the art in digital mammographic image analysis. London, England: World Scientific, 1994; 82-102.

    Kallergi M, Carney GM, Gaviria J. Evaluating the performance of detection algorithms in digital mammography. Med Phys 1999; 26:267-275.

    Kegelmeyer WP, Jr, Pruneda JM, Bourland PD, Hillis A, Riggs MW, Nipper ML. Computer-aided mammographic screening for spiculated lesions. Radiology 1994; 191:331-337

    Davies DH, Dance DR. The automatic computer detection of subtle calcifications in radiographically dense breasts. Phys Med Biol 1992; 37:1385-1390.

    Ikeda DM, Birdwell RL, O’Shaughnessy KF, Sickles EA. Analysis of 172 subtle, undetected or non-recalled findings on prior “negative” mammograms in women with screening-detected breast cancers (abstr). Radiology 1999; 213(P):240.

    American College of Radiology. Breast imaging reporting and data system (BI-RADS) 3rd ed. Reston, Va: American College of Radiology, 1998.

    Harvey JA, Fajardo LL, Innis CA. Previous mammograms in patients with impalpable breast carcinoma: retrospective vs blinded interpretation. AJR Am J Roentgenol 1993; 161:1167-1172.

    Sickles EA. Mammographic features of 300 consecutive nonpalpable breast cancers. AJR Am J Roentgenol 1986; 146:661-663.

    Goergen SK, Evans J, Cohen GPB, MacMillan JH. Characteristics of breast carcinomas missed by screening radiologists. Radiology 1997; 204:131-135.

    Kopans DB. Breast imaging 2nd ed. Philadelphia, Pa: Lippincott-Raven, 1998; 247, 798.

    Bird RE. Professional quality assurance for mammographic screening programs (abstr). Radiology 1990; 177(P):587

    Tabar L, Fagerberg G, Duffy SW, Day NE, Gad A, Grontoft O. Update of the Swedish two-county program of mammographic screening for breast cancer. Radiol Clin North Am 1992; 30:187-210.

    Harris JR. Staging and natural history of breast cancer. In: Harris JR, Lippman ME, Morrow M, Osborne CK, eds. Diseases of the breast. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2000; 403-406.
    Ba

  18. #19 MartinM
    November 7, 2007

    Yes, well done, you can copy and paste the list of references I already told you I wasn’t going to dig through.

    Well, almost. You managed to cut off most of the last one.

    Given that you started off by citing a paper which supported none of your claims, I somehow doubt that each and every one of the references in that paper will turn out to be relevant. I doubt even more that you’ve read them.

    A quick glance at the first two abstracts reveals nothing of interest, and I’m not about to waste my time going through another 24 for the benefit of someone who can’t be bothered doing so themselves. The stupid thing here is that you might even be right; I haven’t argued at any point that your claims are wrong, merely that you’ve failed to make any sort of case whatsoever. Nor do you appear to be trying very hard to do so.

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