Respectful Insolence

Pity poor David Kirby.

Nearly three years ago now, he published his now-infamous Evidence of Harm: Mercury in Vaccines and the Autism Epidemic, A Medical Mystery. Hooking up with the most vocal of the mercury militia, his book blamed mercury in vaccines as the major cause of autism. Unfortunately for Kirby, time has not been kind to him. Although he still manages to retain his rock star status among the antivaccination glitterati, each successive study failing to find a link between thimerosal-containing vaccines (TCVs) and autism put another nail in the coffin of Kirby’s relevance, to the point where a year ago he was reduced to blaming mercury in pollution from China and from the teeth of corpses being cremated in California as the reasons for the continued increase in autism prevalence in the California Department of Developmental Services database reported a mere three weeks ago. Of course, Kirby’s smart enough to know that blaming mercury in vaccines for autism was a hypothesis that made a very powerful prediction that could be tested. That prediction, of course, was that the removal of thimerosal from vaccines should lead to a relatively rapid decrease in the rate of autism in children born after the removal. It’s been nearly six years since the last lots of TCVs expired and went out of circulation, and we’re still waiting for that decrease (or even a decrease in the rate of increase), leaving Kirby and other members of the mercury militia to–shall we say?–diversify their concept of what causes autism beyond just mercury. Naturally, antivaccinationists piled on, trying to find a flaw in the CDDS study. They mostly failed, and I always suspected that Kirby was too clever to join his less deft fellow travelers who keep sticking their fingers in their ears and saying that it really, truly is the mercury. Really.

Instead, Kirby is trying a new tack. Whereas before it was all about the mercury, now he’s branching out into becoming openly antivaccinationist.

Last week, I expressed some of my usual not-so-Respectful Insolence at the producers of an ABC television show whose pilot is set to air on Thursday night. The pilot episode of the show, Eli Stone, is chock-full of antivaccination propaganda, so much so that the New York Times, in a rare piece of good science reporting that refused to play the “report both sides judge neither” game, told it like it was and pointed out that there was no scientific evidence supporting a link between thimerosal-containing vaccines (TCVs) and autism and pointed out that the show made it look as though there was still a real scientific controversy about this issue when there really isn’t. In response, the American Academy of Pediatrics (AAP) has done what such groups should do when faced with an idiotic television show that spreads lies likely to scare parents about vaccines. It’s written an open letter to Disney and ABC, scheduled to be made public this afternoon, asking that the show be pulled or, at the very least, that a disclaimer stating that “”no scientific link exists between vaccines and autism” be run. (I’ve seen the letter but won’t quote it extensively it before it is released.) Kirby has responded in his usual smarmy manner on–where else–that propaganda wing for the antivaccination movement, that bastion of apologists for the mercury militia, namely The Huffington Post:

I share the AAP’s concern that parents should not be driven away from protecting their children from dangerous, even deadly diseases. But parents are far too smart to base such an important decision as immunization on the “content of the episode” of a single drama on broadcast television.

In fact, if I were Dr. Jenkins, I would be far more concerned about real news happening in the real world – events that not only suggest the possibility of some sort of link between mercury, vaccines and autism, but might alarm parents more than any fictional account written for ratings-grabbing mass entertainment.

If I were Dr. Jenkins, instead of fretting over a fake family engaged in a mock trial held in a make-believe court on some LA soundstage, I would be up at night wondering why the Federal Government recently conceded a real vaccine-autism lawsuit in a real court and will soon pay a real (taxpayer-funded) settlement to a real American family and a very real child with autism.

Apparently Kirby, who claims to be a reporter, didn’t bother to look into this. Luckily Kathleen Seidel (whose Neurodiversity blog is essential reading) set Kirby straight in the comments:

An award has been approved to the petitioners in Poling v. HHS because this autistic child experienced a compensable vaccine reaction. This does not mean that a vaccine reaction caused the Poling child to become autistic, or that thimerosal caused harm. Vaccine reactions happen; the NVICP exists so that individuals and families can obtain fair compensation without incurring the expense generally associated with civil litigation. There are ca. 5,000 autism cases pending in Vaccine Court, and it is likely that some of these autistic children will be found to have suffered from vaccine reactions. As for the supposedly “secretive action” of the court in “sealing” the records of the case — filings in NVICP proceedings are only made available to the Special Master and the parties to the case. Even though transcripts for the first three test case hearings were made available to the public, this was an exception to SOP, made with the consent of the families involved. You will find that if you try to download any other case documents from the docket sheet at http://ecf.cofc.uscourts.gov, you will not be allowed to do so. So, if you want to see the records, why don’t you ask the Poling family to share them with you, instead of insisting that the Special Masters violate NVICP policy.

Poor Kirby, buddy that he is with the antivaccination movement, I wonder why he didn’t think of this simple action. Isn’t that what a real reporter would do? But David Kirby hasn’t been a real reporter in quite a long time, if he ever really was. As if this isn’t enough, though, Kirby has to crank the stupid up to 11:

If I were the AAP, or ABC for that matter, I would feel downright silly stating that “no scientific link exists,” so soon after the Journal of Child Neurology published a study titled, “Blood Levels of Mercury Are Related to Diagnosis of Autism: A Reanalysis of an Important Data Set.” I would also worry about parental reaction to learning that researchers had done due diligence and reanalyzed data from a prior, hugely influential study that (erroneously) found zero connection between mercury levels and autism.

Instead of trying to silence the fictional words of “Eli Stone” co-creators Greg Berlanti and Marc Guggenheim, I would pay closer attention to the real words of Journal authors M. Catherine DeSoto and Robert Hitlan, who found a major flaw in the original study that found no link. In fact, they concluded, “a significant relation does exist between the blood levels of mercury and diagnosis of an autism spectrum disorder,” and that “hair sample analysis results offer some support for the idea that persons with autism may be less efficient … at eliminating mercury from the blood,” something that proponents of the mercury-autism hypothesis have long contended.

Silly Kirby. I can’t believe he’s citing that paper. It’s the same paper that Representative Dan Burton (R-Indiana) tried to ram down the Special Masters’ throats and that Deirdre Imus gloated about as “evidence” that mercury causes autism that is being “ignored.” In reality, the DeSoto and Hitlan paper is nothing more than a bit of post hoc statistical fiddling with the dataset of study by Ip et al on hair and blood mercury levels in autistic children compared to non-autistic controls to create a “statistically significant difference” between hair and blood mercury levels in the autistic and non-autistic groups. For all the attention given to DeSoto and Hitlan by the mercury militia and that their sycophants trumpeting their reanalysis of the data as if it were God Himself delivering the proof from on high that mercury causes autism give to this dataset, you’d think it was the California Department of Developmental Services database or the dataset used in the recent New England Journal of Medicine study that failed to find a relationship between thimerosal-containing vaccines and adverse neurodevelopmental events.

It wasn’t. It was a decent study, but certainly nothing earth-shattering. If it weren’t for the mercury militia, it would have long ago faded into the mass of other workman-like but not outstanding studies that make up the bulk of the biomedical literature.

Dad of Cameron and Interverbal have teamed up to analyze the Hitlan and DeSoto study. Suffice it to say, Hitlan and DeSoto used some rather dubious assumptions (for example, assuming that the data must go in one direction), leading them to choose a statistical test for their reanalysis that was probably not appropriate. They also cited some rather dubious papers to support their analysis. In response, Hitlan and DeSoto in essence went ballistic, so much so that they published a highly indignant FAQ about their study. It’s rather interesting reading, if only for the self-righteous defense of citing articles in Medical Hypotheses. In any case, D’oC and Interverbal have responded to the FAQ in not one, but three, parts (part one, part two, part three). Prometheus has also weighed in. Suffice it to say, they all leave Hitlan and DeSoto not looking so good.

Finally, here’s the favorite gambit of antivaccinationists trying to argue in the face of all this evidence otherwise that it really, truly the mercury:

Another study, freshly out of Harvard, likewise shows a potential link between mercury and the autopsied brains of young people with autism. The American Journal of Biochemistry and Biotechnology reports that a marker for oxidative stress was 68.9% higher in autistic brain issue than controls (a statistically significant result), while mercury levels were 68.2% higher.

And though the mercury results did not quite reach statistical significance (probably due to the small number of autistic brains studied: 9), the authors cautioned that, “However, there was a positive correlation between (oxidative stress and mercury levels),” meaning the two might be associated.

I noted a couple of things. First, this journal does not appear to be yet indexed by Medline. Probably this is because it’s a new journal, with only one year worth of issues. New journals are frequently hard-up for papers, and frequently will ask for submissions, leading to some less-than-stellar publications. It’s tough to get a journal off the ground. Of course, that doesn’t mean that this paper isn’t worthwhile, so I perused it. It seems to be a bit of a hodge-podge. For instance, the authors included a toxicity curve of methyl mercury on a cultured human glioma cell line for no apparent reason, as it didn’t really seem to relate to anything else in the paper. In fact, the numbers are all over the place, with huge error bars, making it hard to conclude much of anything. The authors claim that mercury levels are higher in autistic brains, but it was not statistically significant. Of note, the authors did not present a p-value for this that I could see; they just say that the difference was not statistically significant. There’s a big difference between a p-value of, say, 0.07 (almost statistically significant) and a p-value of, say, 0.50 (nowhere near statistically significant). I found this particularly odd, given that they presented these values separately in their own table. Another problem is that the brain tissue was harvested an average of 15.5 hours after death for the controls and 21.6 hours for autistics. Although this wouldn’t make a difference for measuring a metal, like mercury, I have to wonder what it means for the measurement of markers of oxidative stress. Another curious thing about the paper is that the “money figure,” where it is shown that the level of 3-NT, a marker of oxidative stress, is higher in autistic brain homogenates, includes only nine of the controls (there were ten controls total) and six of the autistics (there were a total of nine). No reason is given. What happened to the values for the other control and the three other autistic brains? Suffice it to say that this paper wasn’t particularly convincing, particularly in light of the much stronger epidemiological evidence that emphatically fails to find a linkage between mercury and autism.

Finally, Kirby abandons mercury completely and lets his true antivaccination flag fly:

Finally, if part of my AAP job description was to ensure that every American child is vaccinated as early and often as possible, I would be hugely apprehensive, not about a new courtroom drama, but rather about a dramatic new study soon to appear in the Journal of Allergy and Clinical Immunology.

In the article, “Delay in DPT vaccination is associated with a reduced risk of childhood asthma,” Anita Kozyrskyj, an asthma researcher at the University of Manitoba, and other scientists combed the medical records of 14,000 children born in Manitoba in 1995 (when many Canadian shots still contained mercury, by the way).

They found that children who received the DPT (diphtheria, pertussis and tetanus) vaccine at two months of age were 2.63 times more likely to develop asthma (at a rate of 13.9%) than children who were not given the shot until after four months of age (5.9%). “We’re thinking that maybe if you delay this allergic response until a bit later, the child’s immune system is more developed and maybe you’re not seeing this effect,” Kozyrskyj told the Winnipeg Free Press, which just broke the story.

First of all, the Winnipeg Free Press article is an execrable bit of “present both sides” journalism, full of quotes from parents who blame vaccines for their children’s asthma and no one questioning whether this is true. The problem, of course, is this is a retrospective study. Because it’s an E-pub ahead of print, I was unable to get a hold of it from home last night, but one thing that can be said is that retrospective studies have to be very carefully designed to control for confounding factors. One big confoundign factor that comes to mind that I don’t see mentioned in the abstract is why the vaccines were delayed. Was it because of lower socioeconomic status? Was it because of a rural surrounding, where getting to doctors in a timely fashion is difficult? Was it because the child was ill around the time the vaccine is normally given, resulting in a delay? Perhaps it was:

Overall, nearly 12 per cent of the children who received at least four doses of DPT had asthma. The majority of children who had asthma lived in urban areas and were predominantly male.

Gee, you don’t think the pollution in the urban environment and the exposure to pollution might have something to do with asthma, do you? I’m guessing the paper itself mentions this possibility and tried to take it into account, but I can’t check until I can get a hold of the paper. Naturally, such a possibility would not even occur to Kirby, who apparently only read Winnipeg Free Press article. In any case, it’s just one article, and, as far as I could tell from some PubMed searches, the only one to have looked at this specific question. It would require replication and extension to be believed. Moreover, delaying vaccination is not without its cost, as Kozyrskyj pointed out in the article that Japan recommended children under 10 months not be vaccinated between 1975 and 1988, and the country saw a spike in the number of childhood cases of whooping cough.

Kirby then launches into a beautiful example of a “correlation does not necessarily mean causation” fallacy coupled with “if this, then that” innuendo and a ludicrous accusation against the AAP of censorchip. It’s all so mind-numbingly idiotic that even now I stand in brain-fried awe at it:

Even more importantly, if too-early vaccination causes asthma in some kids, could the practice cause other disorders? There is absolutely nothing to link this vaccine study to autism, of course. But consider the following:

1) Many asthma cases have been linked to autoimmunity. The same with autism.
2) Childhood asthma has been dramatically increasing for two decades. The same with autism.
3) Most of the children with asthma in the vaccine study were boys. The same with autism.

Any way you look at it, this study is hardly reassuring news to parents who are about to vaccinate their kids (though think how comforting it would be to allow them to delay this shot by two months). Medicine and the media constantly tell us that all vaccines are safe for all children. When parents try to jive that information with studies that imply the opposite, their faith and trust in public health and the immunization program begin to take a nosedive, along with vaccination rates.

It’s not just the broadcast of fiction out of ABC that might drive parents away from immunization. It is the negation of fact out of the AAP as well. And if unvaccinated children get sick, will the esteemed Academy also “bear responsibility,” or just heap it all upon the network?

ABC executives could cave in and cancel the broadcast, but I don’t think they will. And even if America’s pediatricians manage to successfully censor fiction and crush artistic freedom, they will never be able to stifle the facts.

“Crush artistic freedom”? Get a grip, Kirby. The AAP just wrote a letter expressing free speech! In any case, I’m half tempted to reply to his three “gotchas” above with: Internet usage has risen dramatically in the last two decades. The same with autism and asthma. Therefore Internet usage causes asthma and autism. It’s so obvious, isn’t it?

In Kirby-world, that’s what passes for argument: Studies that are either cherry-picked or not particularly relevant coupled with conspiracy-mongering and non causa pro causa. No wonder he’s becoming increasingly irrelevant, except to the antivaccinationists who showed up in the comments of his article to shower him with praise for his “brave” stand. To them, Kirby is a god smiting the dreaded vaccine infidel.

But, no, believe him when he says he isn’t antivaccine.

Comments

  1. #1 Septimus Fortherestofus
    January 28, 2008

    No doubt:
    For instance, the authors included a toxicity curve of methyl mercury on a cultured human glioma cell line for no apparent reason, as it didn’t really seem to relate to anything else in the paper. In fact, the numbers are all over the place, with huge error bars, making it hard to conclude much of anything. The authors claim that mercury levels are higher in autistic brains, but it was not statistically significant. Of note, the authors did not present a p-value for this that I could see; they just say that the difference was not statistically significant.

    When reading that paper, I was blown away by the highly concentrated unprofessionalism of the whole thing. I was left wondering if these people had enough pride to be embarrassed by their effort. I suppose it’s possible they don’t know just how bad it sucks.

  2. #2 Estellea
    January 28, 2008

    I think you covered the Kirby piece with the appropriate contempt and your usual adeptness so I will venture into the criticism of the AAP attempt to censor the ‘Eli Stone’ episode. I say let the show go on; any parents that would be swayed into not vaccinating their child would be the same ones that plop their children in front of the television for 10+ hours/day, shove formula and fast food down their gullets and take medical advice ala Jenny McCarthy (i.e. the lowest common denominator). Sit back and let evolution take its course; harsh, I know, but we just have to face the fact that some children are doomed by simple virtue (or vice) by the parents that they have.

  3. #3 Freddy the Pig
    January 28, 2008

    Estellea – unfortunatley, the dame parents will probably home school theri kids and give them abstinence only sex education, so they will reproduce early.

    Kirby is claiming that provoking the immune system early causes childred to devleop asthma. This files in the face of studies showing that asthma is more common in first borns than in younger siblings and a study showing that children who live with a dog in their first year are less likely to develop asthma.

  4. #4 Dangerous Bacon
    January 28, 2008

    “Sit back and let evolution take its course; harsh, I know, but we just have to face the fact that some children are doomed by simple virtue (or vice) by the parents that they have.”

    Even if we could in good conscience consign these children to a greater risk of disease because of their parents’ ignorance, we could not overlook the risk to everyone else from the diseases these unvaccinated kids introduce into the population.

    This is everybody’s problem.

  5. #5 vlad
    January 28, 2008

    “Sit back and let evolution take its course; harsh, I know, but we just have to face the fact that some children are doomed by simple virtue (or vice) by the parents that they have.” I’m all for this approach but for 2 things. The idiots not vaccinating will poke holes in herd immunity which endangers the children of not nuts bag parents. When the children of the anti vax nuts get sick we all have to pay for it. No hospital will (or legally can) turn a person away if the are in need of critical care. Now since I see a strong correlation between Anti-vax and “Natural Healing” I doubt these people would have medical insurance, hoodia is not covered by Harvard Pilgrim.

  6. #6 Rod Clark
    January 28, 2008

    One of my favorite authors, Norman Mailer used to post on Huffington Post, and they’ve been very critical of the Bush regime. So I’ve always been in favor of HP, but why they allow Kirby to continue posting there is beyond me.

  7. #7 Estellea
    January 28, 2008

    I think we may be addressing 2 types of parents. There are those that I alluded to and the others that won’t take their children to physicians let alone (gasp) have them vaccinated regardless of a fictional piece of television rubbish. Censoring this show will only draw more attention to it as evidenced by the mere attempt to do so.

    I don’t know what some of you may be proposing but I would fear a tremendous backlash should vaccinations become patently mandatory, no exemptions. I wholly agree with and understand the fears of breaks in herd immunity for certain diseases and it is most unfortunate that children will be victimized for their parents’ ignorant decisions. Instead, look at the programs in Scandinavian countries where vaccines are not mandatory but voluntary uptake is superb.

    It is irresponsible, to put it mildly, for the writers of ‘Eli Stone’ to sensationalize and erroneously portray the fictional autism-mercury link. Perhaps someone with a more finely tuned moral compass will give equal time to a prime-time show about the ramifications of a measles outbreak among a cluster of unvaccinated children or congenital rubella syndrome. One can hope.

  8. #8 daedalus2u
    January 28, 2008

    There are a number of problems with this paper. First, if you notice, the mercury levels measured are in picoMoles/g. The mercury levels in their in vitro tests are in microMolar, or (assuming a density of 1), nanoMoles/g.

    The mercury species they used, MeHgOH is lipid soluble and does partition into lipids (MeHgCl has a k of about 1.7, MeHgOH should be similar). So lipid membranes present no barrier to it. Once inside a cell it can attach to thiols with an equilibrium constant of about 10^10. The plates they used had only 5,000 cells per well but they added MeHgOH to a final concentration of 2-4 microMolar.

    What the final concentration in the cells in vitro is unknown. It is likely considerably greater than the 2-4 nanoMoles/g of media.

    In soil, mercury partitions onto the soil particles (likely into bacterial biomass) with partition coefficients of ~10^3-10^4. A lot of the variability may relate to the amount of microbial biomass vs. inert mineral particles (which tend not to adsorb much mercury).

    In the limit (large volume of media per cell), we can estimate the mercury level in the cells as ~10^3-10^4 times the solution concentration. This could easily exceed 10 microMoles/g or a million times higher than what was observed in the brain samples (which are only cells, so that measurement is a true mercury concentration per gram of cell).

    http://www.ncbi.nlm.nih.gov/pubmed/9253168?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    http://www.ncbi.nlm.nih.gov/pubmed/11380179?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1

    Their “viability assay” (not exactly sure which one they are using) actually measures the reduction of tetrazolium to formazan which is usually mediated by mitochondrial dehydrogenaases. If one assumed that cells were either 100% killed or 100% unaffected (an unlikely circumstance), then the measurement might reflect “viability”. If mitochondrial respiration were impaired by X%, such as by mercury poisoning enzymes containing thiols or sulfur clusters, then ??? Usually the assay

    http://www.promega.com/tbs/tb163/tb163.html

    http://www.promega.com/applications/cellprolif/productprofiles/celltiter96AQ.htm

    uses absorbance at 490 nM, not 570 nM. Is the difference reported due to sloppy writing or sloppy labwork or both?

    (disclaimer: I am working in autism research and favor the low NO hypothesis of ASDs. I see low NO in both the causation and maintenance of ASD symptoms, and I feel causation and maintenance are separable (to some extent discussed in my blog). A low NO state is a state of oxidative stress and a state of oxidative stress is a low NO state. They are indistinguishable, inseparable, and inextricably linked. A state of oxidative stress cannot and will not be changed by antioxidant supplements.)

  9. #9 Skeptico
    January 28, 2008

    Re: “…but why they allow Kirby to continue posting there is beyond me”

    Remember, Arianna Huffington is a good friend of anti-vaccination idiot Bill Maher.

  10. #10 isles
    January 28, 2008

    Another thing on the asthma study – without looking at an actual copy (which I don’t think is even available yet), the kids in that study were given the old DTP vaccine, which was known to be more reactogenic than today’s DTaP – that’s why the switch was made, duh.

    I think Orac’s point about possible confounding is more likely to explain whatever association was found, but this underscores the point that its findings don’t apply to vaccines today. Not that a little thing like reality would stop the likes of David Kirby.

  11. #11 Coin
    January 28, 2008

    Remember, Arianna Huffington is a good friend of anti-vaccination idiot Bill Maher.

    The Huffington Post has a really large and occasionally ridiculous group of people contributing. It’s perhaps not entirely reasonable to interpret inclusion of an author on Huffington Post as explicit endorsement of their message– and in fact it’s impossible to do this in all cases, since there are occasional instances of the Huffington Post running authors who are more or less diametrically opposed. For example, they have Sam Harris AND Deepak Chopra posting there…

    This said, it is bothersome that the Huffington Post is probably the most high-profile outlet still giving Kirby a platform at this point, and there does seem to be a very consistent pattern over there of endorsing fringe health stuff.

  12. #12 DLC
    January 28, 2008

    The overwhelming weight of evidence is against Mr Kirby, but he continues to sound the alarm, when there’s no fire.
    No fire? not even a wisp of smoke. The thimerosol containing vaccine hypothesis was tenuous at best and now has been shown to be non-existant. Perhaps Mr Kirby needs more NO in his gas mixture. . .

  13. #13 Orac
    January 28, 2008

    The Huffington Post has been a hotbed of antivaccination craziness since its very inception in 2005, as I documented here in a post written a mere two weeks after HuffPo debuted, including a mention of a brain dead screed by David Kirby at the height of the popularity of his book.

  14. #14 Coin
    January 28, 2008

    Ah, wow. I hadn’t realized the Kirby/Huffington thing had been going on so long.

  15. #15 JakeR
    January 28, 2008

    “Instead, Kirby is trying a new tact.”

    I don’t know if Kirby has any tact at all, but the word you wanted is tack, as a sailboat takes a new tack, moving so that the wind comes from the opposite side of the vessel.

  16. #16 Mark
    January 28, 2008

    DLC, I assume you mean N2O? N2O is nitrous oxide. NO would kill him.

    Oh, wait…

  17. #17 Orac
    January 28, 2008

    I don’t know if Kirby has any tact at all, but the word you wanted is tack, as a sailboat takes a new tack, moving so that the wind comes from the opposite side of the vessel.

    New Rule:

    Typo/grammar/spelling comments are exceedingly lame and henceforth will be deleted with extreme prejudice–after I fix the mistake, of course.

  18. #18 daedalus2u
    January 28, 2008

    Actually NO would make him smarter and less delusional if he could deliver it in exactly the correct way (which is exceedingly difficult).

    NO is non-toxic even at 500 ppm. But in air it tends to form NO2 (rapidly) which is toxic at 5 ppm.

  19. #19 Kathleen Seidel
    January 28, 2008

    Orac, thanks for memorializing last night’s epistolary labors. For a while I was wondering whether my comment to Huffpo would ever see the light of day; whereas a half-dozen adulatory comments submitted after mine were approved, mine took a few hours to show up on the page. Methinks the lack of praise triggered some kind of Huffpo — or Kirby — policy.

    Kirby’s references to “censorship” bespeak a total failure to comprehend the nature of true censorship. True censorship is something that governments do; true censorship requires police power for its enforcement. Censors can get you thrown in the slammer. The kind of “censorship” that Kirby and his pals are kvetching about is nothing but the exercise of free speech by people who hold opinions with which they disagree.

  20. #20 Schwartz
    January 28, 2008

    It would appear that the AAP has not learned the hard lessons repeated by the Catholic church on several occasions. Protesting something in the media results in a lot higher level of visibility and attracts far more attention.

    The proponents of the show and the message could not have come up with a better mechanism to guarantee widespread exposure if they tried.

  21. #21 daedalus2u
    January 28, 2008

    No Schwartz, the APP has nothing to hide. Vaccines do not cause autism. Vaccines never did cause autism. The APP never did anything, and it never tried to cover up anything regarding vaccines, mercury and/or autism (unlike the Catholic Church covering up priests raping children).

    The APP is trying to save children’s lives by protecting their parents from reckless frauds shouting “fire” and trying to cause a stampede away from vaccines. If Kirby and the other frauds succeed with their lies, children will die from diseases that could have been prevented.

    I wonder if ABC will be sued when children are harmed by not being vaccinated? Or if children are harmed because there is insufficient herd immunity? Unless they have disclaimers at every commercial break, I predict there will be a lawsuit if anyone in the US gets a disease that could have been prevented by one of these vaccines. It will be an easy win for the plaintiff. There is no shortage of real experts who will all testify as to the safety of vaccines and the importance of herd immunity. Who will ABC trot out? Kirby? Geier? The actor who had a vision?

    When Oprah talked about mad cow and the beef markets fell, she got sued. When people actually die from what ABC does (with all the warning they have), I predict it will bankrupt ABC.

  22. #22 Ian Musgrave
    January 28, 2008

    Regarding the paper American Journal of Biochemistry and Biotechnology 4 (2): 73-84, 2008

    Orac wrote:

    Of note, the authors did not present a p-value for this that I could see; they just say that the difference was not statistically significant.

    You are right, they did not quote a P-value, but I was able to calculate one from their data. I got a P value pf 0.21, not exactly a near miss. The P value I calculated for the 3-NT data was 0.045, which is the P value the authors reported (3-nitrotyrosine being their marker of oxidative stress).

    However, this P-value is what you get from an unpaired t-test. They claim the data were analysed by ANOVA, but you can’t do ANOVA on the two sample tests that they present. Which brings me to the data distributions. The data is treated as if it is normally distributed, but the Age and Post Mortem Interval are clearly gamma distributions, and the appropriate evaluation is median (with some sort of range eg interquartile range). Given that the wrong data format is assigned to the Age and PMI, and given the raw range values presented for the 3-NT values (there are no raw values), is 3.91 to 333.03 pmol g^-1 of tissue in the autistic subjects and 13.69 to 49.04 pmol g^-1 of tissue in controls, I strongly suspect that these are gamma-distributed as well. Thus t-tests (or ANOVA) are not the appropriate statistical tests in this case. A proper non-parametric statistical test would very likely show no significant difference.

    Also, as Orac points out, although there were 10 control subjects and 9 autistic subjects, the means and statistical tests were done on only 9 control subjects and 6 autistic subjects (this is true for 3-NT, mercury and selenium). Why (and which) subjects were excluded (and if the same subjects were excluded in each analysis) is not reported in the paper at all, although for the mercury data the range is given for all subjects. I though perhaps they excluded all subjects whose PMI was greater than 24 hours, but that would give an n of 5 for the autistic group and n of 10 for the controls. So I am at a loss to understand why they excluded certain groups.

    This brings me to the correlation between 3-NT and mercury, claimed to be r=0.796 with p=0013 (there appears to be a missing decimal point), there is no n value, and no original graph, so it is not possible to evaluate this. I presume it is all subjects lumped together (not invalid), but with low subject numbers this might be very sensitive to outliers, so it is hard to interpret these results.

    At the very most, all one can say from this study is that oxidative stress may be higher in autistic subjects (which is not altogether unexpected). There is no evidence of mercury involvement. I’ll write to the authors and see if I can clear this up.

  23. #23 Schwartz
    January 29, 2008

    Daedelus2u,

    You’re missing the point. If the objective is to stop the message (whether it is incorrect or not doesn’t matter), then doing this will not meet their objective at all. It will just call more attention to the message, and broaden the audience wider than it would ever have been.

    If they had done nothing, a much smaller number of people watching the pilot and maybe people reading blogs would have seen it — and those people reading the blogs are already likely watching it with a well entrenched opinion on the matter.

  24. #24 Just Saying
    January 29, 2008

    The “antivaccination glitterati” ? Shouldn’t that be the “antivaccination ignorati” ? ;)

  25. #25 TheProbe
    January 29, 2008

    The proper term for these people is anti-vaccination liar sociopaths. They hate living children.

    As foir schwarts, the objective is to provide accurate information. Stopping the “message” is what the anti-vaccination liar sociopaths would love to have, since it adds to their “fact base”.

  26. #26 daedalus2u
    January 29, 2008

    There are a lot of possible mechanisms that lead to nitrotyrosine formation. There is considerable thought that this is a natural control mechanism because under conditions of hypoxia proteins are nitrated and then denitrated when the hypoxia is removed.

    http://ajpheart.physiology.org/cgi/content/full/286/1/H30

    This article has a diagram of the mitochondrial respiration chain.

    A better version of the diagram is in this later paper

    http://www.biochemsoctrans.org/bst/033/1399/bst0331399.htm

    which shows more of which proteins are nitrated and how that fits into the control system of mitochondria (that would be complexly).

  27. #27 mark's tails
    January 29, 2008

    I have seen the JACI article mentioned. In their discussion they write that they controlled for factors such as socioeconomic status, infections and other potentially confounding variables but it made no difference. However, the one thing that can also make a difference, and they even mention in their results section is that most of the kids with asthma were from an urban environment and were male. Given this data why then didn’t the authors check their data with location; urban vs rural which is also strongly correlated with incidence of asthma and may be a possible reason for delayed vaccination as well.

    They do mention that the whole pertussis vaccine is no longer used and write:
    “It is premature to make recommendations until these findings have been confirmed with the DaPT vaccine, and the benefits of altering immunization schedules need to be weighed against the
    risks.”

  28. #28 mark's tails
    January 29, 2008

    A caveat to the above comment. I have seen the article because I am an AAAAI member. The article is listed on PubMed and is available as an ePub on the JACI website.

  29. #29 John B.
    January 29, 2008

    I do not understand why so-called journalists like David Kirby and Dan Olmsted rant about things without conducting interviews! It must mean that they don’t want other opinions getting in the way of theirs. Kirby can no longer be taken seriously as a journalist.

  30. #30 John Best
    January 29, 2008

    I’m surprised that, through all of this rhetoric trying to deny the truth, nobody mentioned the wonderful results Dr Geier is obtaining by removing mercury from kids’ brains and watching them get better.

    One would think that a doctor who writes this junk would make some note of that information that is proving useful to brain damaged kids. It is all about doing what’s best for the kids, isn’t it?

  31. #31 TheProbe
    January 29, 2008

    John B. said: “Kirby can no longer be taken seriously as a journalist.”

    Agreed. In fact, considering how bad they have consistently been, I see no reason to expect that their prior works were much better. I suspect that they were far less scrutinized because they were far less controversial.

  32. #32 Prometheus
    January 29, 2008

    “I’m surprised that, through all of this rhetoric trying to deny the truth, nobody mentioned the wonderful results Dr Geier is obtaining by removing mercury from kids’ brains and watching them get better.”

    I’d love to mention his results – he published a study back in December 2006 in which 11 “children with ASDs” were given DMSA and Lupron. There was no control group, so we’ll never know if these kids got any better than they would have without the risk of side effects from these drugs.

    Yes, their “scores” improved. No, we have no idea how much they would have improved without intervention. Ergo, the study is useless, except as a way to justify the Geiers’ rather dubious “combination therpapy”.

    For what it’s worth, I’d love for someone to find a treatment that helps autistic people, even if it is Dr. Geier. Unfortunately, he doesn’t seem inclined to do the work that need to be done to show that his “therapy” actually works better than placebo (or even simply doing nothing).

    Surely, Dr. Geier knows how to do a proper study, doesn’t he? So, why doesn’t he do one? Why is he wasting his time and the patients’ time (and their parents’ money) doing “studies” that show nothing?

    I wonder.

    Prometheus

  33. #33 Lucas McCarty
    January 29, 2008

    Yes the sample size would be small, but it really wouldn’t have been hard for Geier to put at least a control group.

    Why doesn’t he Mr Best? Why don’t all the quacks? The truth is that *Autistics develop anyway* and this has been reported from the very beginning. The myth of developmental stasis has nothing to support it.

  34. #34 TheProbe
    January 29, 2008

    John Best blathered: “I’m surprised that, through all of this rhetoric trying to deny the truth, nobody mentioned the wonderful results Dr Geier is obtaining by removing mercury from kids’ brains and watching them get better.”

    Why would anyone who knows about science do that? As Prometheus and Lucas pointed out, Geier’s “studies” are seriously flawed, and provide no useful information.

    As Kathleen Seidel’s expose on the Geier’s dubious treatments and practices showed, there is no reason to believe that the Geiers’ treatment does anything except expose kids to potential dangers due to the nature of the drugs used, and possible side effects.

    “One would think that a doctor who writes this junk would make some note of that information that is proving useful to brain damaged kids. It is all about doing what’s best for the kids, isn’t it?”

    Strange you say that it is for the kids, when you promote every single quack treatment, some of which are quite dangerous.

  35. #35 Elaine
    January 29, 2008

    I really like the expression “cranking the stupid up to 11″.
    What bothers me is how the autism-vaccine myth seems to have permeated popular consciousness. Most people seem to at least heard something about it. Not everyone will believe it, but not everyone will question it either.

  36. #36 John Best
    January 29, 2008

    Guys,
    Again with the “studies” bit. The studies can wait. Curing the kids is most important.

    All Mrs Seidel did was avoid the fact that kids are being helped, agree with corrupt judges, mumble about irrelevant business dealings and try to tell us that it was possible to chemically castrate anyone who had not yet reached puberty. Pretty comical when you put it all together.

    Those who disagree with stasis must disagree with the medical profession who still tells us there is no cure for autism. Of course, the people in institutions who are adults but still behave like two year olds are our proof that the medical profession was right about that before the brilliant Dr Holmes discovered the cure.

    Probe, The only treatment I promote is chelation so please don’t accuse me of promoting anything else.

  37. #37 Prometheus
    January 30, 2008

    John – again with the dodge!

    The studies are needed to show that this “treatment” is actually working. That way, we will know if the risk of administering DMSA (which has been shown to decrease intellectual performance with prolonged use) and Lupron (which has its own constellation of side-effects, many of which are serious) is worthwhile.

    Remember secretin? Everybody thought that it was helping autistic kids. Bernie Rimland confidently opined that 70% of kids were showing improvement.

    Yet, when it was studied – by a company that stood to gain a bunch of bucks if it “worked” for autism – it was no better than placebo.

    Secretin, by the way, has a much lower incidence of side effects than Lupron.

    John also confuses the fact that autism – to date – is incurable with the myth of stasis. Although autism has no “cure” (and is, therefore, “incurable”), all autistic children continue to develop and “improve”, even without treatment.

    If John Best thinks that all autistic adults “…behave like two year olds…”, perhaps he should take a look at Temple Grandin and Teresa Binstock. He should at least be able to admit that they are autistic adults, even if he wishes to deny the existence of all others.

    Of course, you never find something if you don’t look.

    Prometheus

  38. #38 Joseph
    January 30, 2008

    Dr. Adams’ study is methodologically better than the Geiers’ but it’s not published yet. The control group got 1 round of DMSA and 6 rounds of placebo. The experimental group got 7 rounds of DMSA. Although both groups improved in various scores (as does the group in Geier’s study) there was no statistically significant difference between the groups, and this is what counts.

    John, DMSA does nothing for autism. It’s a waste of time, and potentially dangerous.

  39. #39 Ian Musgrave
    January 31, 2008

    As I noted in my post above, I emailed the lead author of the American Journal of Biochemistry and Biotechnology 4 (2): 73-84, 2008 paper, politely inquiring as to the exclulsion criteria for the subjects. I still have not heard back, I will let you know if I hear anything.

  40. #40 EdSmith
    February 1, 2008

    I came to this discussion as an uninvolved reader. I understand science, hypothesis testing, sampling, and P-values. When the mercury-autism connection doubters resort to name-calling, generalization and personal attacks they diminish their scientific arguments.

    If their science is sound, they should not have to resort to name-calling to make their points. If they use name-calling to increase readership, they are entertainers, not scientists.

    Those willing to explore possibilities of a mercury-autism connection appear more rational in this debate because they address specific points. They do not use rash generalizations and they seem to make better use of data.

    The mercury-autism connection doubters can choose to use science or entertainment to make their points. If they are scientists, or wish to use science, they should have no need to use entertainment and personal bashing. Unfortunately, they use it a great deal– making their “science” highly suspect.

  41. #41 Orac
    February 1, 2008

    The mercury-autism connection doubters can choose to use science or entertainment to make their points. If they are scientists, or wish to use science, they should have no need to use entertainment and personal bashing. Unfortunately, they use it a great deal– making their “science” highly suspect.

    So you’re basically saying that you evaluate scientific arguments based on whether or not you like the rhetorical tactics of either side. That certainly appears to be what you’re saying. Excellent reasoning! Just because you don’t like the side you’re clearly sympathetic with being subject to a bit of mockery, you try to use that as a reason to cast doubt on the science. I wonder if you say the same things about supporters of evolution subjecting creationists to mockery for their antiscience beliefs.

    The reason we resort to mockery is because the targets are so richly deserving of mockery. Despite “tsunamis” of evidence from well-designed scientific studies that there is no detectable link between thimerosal-containing vaccines (or vaccines in general, for that matter), and autism, they still soldier on, convinced as ever that it must be the mercury or the vaccines. When antivaccinationists are so immune to reason and continue to promote pseudoscience that is dangerous to our children, outrage and mockery are not inappropriate responses.

    Besides, whether you’re aware of it or not, I’ve discussed the science showing why thimerosal in vaccines does not cause autism (nor do vaccines in general) and the really bad science being marshalled by the mercury militia to try to show that it does in nauseating detail many, many, many times on this blog. That you haven’t read my numerous serious posts on the topic is not my problem

    The bottom line is that the “mercury causes autism” hypothesis is scientifically dead as a doornail. Dead, dead, dead. I’m hoping the huge CDC study to be published next year on the subject will be the final nail in its coffin, but given that the last couple of recent studies should have been the final nail, I’m not optimistic. The mercury militia is driven by ideology and conspiracy-mongering, not science.

  42. #42 daedalus2u
    February 1, 2008

    Everyone with half a brain or even 1/10 of a brain has already accepted that autism is unrelated to mercury. What you have left are the “dead enders”, some delusional cranks and the fraudulent quacks who are trying to get money out of the parents they have tricked.

    What I think will turn the tide is when the data from these two studies are put together.

    The Faroe Islands mercury studies where they looked at cord blood mercury, umbilical cord mercury, maternal blood mercury and maternal hair mercury for over 1,000 consecutive births. They also have retested many of these same individuals for mercury and have intelligence testing on many of them too.

    http://www.ncbi.nlm.nih.gov/pubmed/16647838?ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    http://www.ehponline.org/members/2005/7842/7842.html

    http://www.ncbi.nlm.nih.gov/pubmed/10430235?ordinalpos=55&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    The Faroe Islands Autism study

    http://www.ncbi.nlm.nih.gov/pubmed/17029020?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    The two studies overlap. The autism study reports data by year of birth, and in the year where the mercury tested cohort was born there were ~1400 births and 5 cases of autism.

    There were over 750 children with cord blood mercury levels above 65 nM/L. There were over 250 with cord blood mercury levels above 200 nM/L. There were at most 5 cases of autism (perhaps fewer) in these children highly exposed to mercury in utero.

    In the DeSoto reanalysis of the Ip et al data, the highest mercury levels measured in single individuals, individuals that were considered to be “outliers” were less than 65 nM/L.

    The Faroe Islands studies have more individuals with measured mercury levels by multiple “gold standard” techniques than all other autism studies put together.

    It is probably safe to say that the mercury levels in the Faroe Island children are likely higher than all of the mercury levels in all of the Autism Omnibus plaintiffs. But with only 5 cases of autism.

    How can mercury cause autism if many hundreds of children can be exposed to such high levels and not get autism? Easy, it can’t. Autism has nothing to do with mercury exposure.

  43. #43 Dev
    February 29, 2008

    While I see a lot of generalizations here made on the basis of study methodology, what I don’t see is direct experience with any attempts to use biochemical approaches to heal an autistic kid. Elimination diets, for example, or treatments for yeast. Antioxidants, minerals or probiotics. Or, chelation. Do you think the parents doing this are really all just delusional?

    I am reminded of a study in England on the question of whether various kind of food colorings provoke hyperactive behavior in kids. Years, no decades of study on this question have been done, hyperactivity being measured by batteries of tests and psychological observations. Results were always equivocal. Finally, someone thought to do all the testing, but in addition asked the parents whether they thought that their kid had been given a drink with the coloring or not. Guess what? The parents could tell, just by observing the behavior of their child.

    What kind of fundamental disrespect denies the experience of a parent with their child? I mean, who the hell do you people think you are? And yes, I have taught at and attended the best universities on this planet, and this kind of fundamental arrogance still makes me sick.

    Now, I’ve seen dozens of hair tests of autistic kids before, during and after chelation. Guess what? The hair mercury either starts high and goes down, or starts low, increases as the kid apparently starts to excrete, and then comes down. And it all happens in parallel with the alleviation of symptoms. If any of you cared to look, you would be able to find the same, and even talk to the parents whose children going through this process.

    But no, that would be getting your hands dirty.

  44. #44 Orac
    February 29, 2008

    While I see a lot of generalizations here made on the basis of study methodology, what I don’t see is direct experience with any attempts to use biochemical approaches to heal an autistic kid. Elimination diets, for example, or treatments for yeast. Antioxidants, minerals or probiotics. Or, chelation. Do you think the parents doing this are really all just delusional?

    [...]

    What kind of fundamental disrespect denies the experience of a parent with their child? I mean, who the hell do you people think you are? And yes, I have taught at and attended the best universities on this planet, and this kind of fundamental arrogance still makes me sick.

    It has nothing to do with arrogance. In fact, it’s quite the opposite. I don’t view parents as “delusional,” just human. They saw what they saw, but, because of human quirks in thinking and the fallibility of human memory, draw the wrong conclusions from it. Testimonial and anecdotal evidence, particularly when there is a close emotional relationship, are among the most unreliable forms of evidence. It has nothing to do with being “delusional”; it has everything to do with the quirks and defects in human reasoning that make us very susceptible to confusing correlation with causation. Steve Novella has posted a very good discussion of the reasons why anecdotes are so unreliable and why it is so easy for us humans to come to the wrong conclusions from them. Indeed, the very reason physicians and scientists developed over time the concept of the randomized double blind trial is because physicians are just as susceptible to these problems with reasoning as any other human being. Consequently, noting that anecdotes are in general very poor evidence and requiring randomized clinical trials whenever possible is in fact humility, the recognition that physicians, too, are just as susceptible, if not more so, to the same fallibilities, quirks, and errors in thinking that everyone else is.

    Pointing out that anecdotes are not good evidence of cause and effect does not deny or denigrate the experiences of parents or the love parents have for their children. What it says is that many parents have, as humans are prone to do, drawn scientifically incorrect conclusions from their experiences and observations of their children.

    As for the “dozens of hair tests of autistic kids,” have you systematically examined your results in a statistically rigorous manner? Have you done your measurements in a blinded fashion? If not, I would submit that you are very likely experiencing a case of confirmation bias. I know you won’t like hearing this, but there’s a good chance it’s true.

    Lastly, in all too many cases, yes, there are parents who think they know a lot about the science of autism but whose knowledge is a mile wide and an inch deep. Attending the University of Google (as Jenny McCarthy apparently did), is not enough, nor is reading papers that show what one wants to see while ignoring the mass of literature that does not. There’s a reason becoming an M.D. takes four years and getting a Ph.D. usually takes longer, leaving aside the years of postgraduate training required. No doubt you will see that as an example of my supposed “arrogance,” but it’s the difference between a superficial understanding of how science works and recognizing all complexities and difficulties of designing any sort of therapy for a human condition or disease. It also makes it harder (although, unfortunately, by no means hard enough) to let one slip into pseudoscience.

  45. #45 Dev
    February 29, 2008

    -you are very likely experiencing a case of confirmation bias

    And how would you know that? It’s already been admitted on this page that there are no decent studies done on treatment.

    -It has nothing to do with arrogance.

    Not only is it arrogance, but it’s so pervasive and so profound that you can’t even begin to discern it. You should read what you just wrote. You’ve given me a sermon. No doubt one that was given to you and that clearly produced a hypnotic trance. And now it’s all just sooo clear. No one ever knew anything before your exalted methodology came along. Or if they did it was some kind of primitive version, or simply random chance that what they came up with happened to work.

    The world is much bigger than you know. The way you wield the cudgel of your religion, backed by the power of your empire, is sowing enormous animosity. Not just in your own back yard, but throughout the world as you prosecute your colonization, both mental and physical.

    But I know – you’ll just shrug your shoulders and keep behaving as you are, firmly believing that I’m … just being perverse.

    You think this will go on forever. That’s your confirmation bias.

  46. #46 Seth Roberts
    February 29, 2008

    What you call “anecdotes” might more neutrally be called single observations. Scientific papers are based on collections of single observations. It is not so obvious as you say that collections of single observations — which is what Dev is referring to — are worthless.

    In the case of parents with autistic kids who’ve gotten better after chelation, the whole collection of observations consists of more than just one X happened then Y happened (where X = chelation and Y = improvement). Almost always, parents have tried other things that didn’t work. Chelation therapy isn’t easy; they try other things first. For each child, the set of observations is that several events (treatments) were followed by no improvement, and then a later event (chelation) was followed by improvement. When this sequence of events happens for dozens of children — as Dev is saying — it is obviously very meaningful. Novella lists a series of alternative explanations (e.g., placebo effect) for a single observation — e.g., a single observation that chelation therapy was followed by improvement. When the whole dataset — repeated examples where various other therapies did not work but chelation did — is considered, these alternative explantions become implausible. For example, the placebo explanation does not explain why the previous therapies did not work. They too were expected/hoped to work. Regression to the mean is implausible because the problem (autism) was stable for a long time before the improvement. “Most illness are self-limiting” — that is, they go away. Autism doesn’t. And so on. None of Novella’s alternative explanations do a good job of explaining the whole set of observations that Dev refers to.

  47. #47 Orac
    February 29, 2008

    And now it’s all just sooo clear. No one ever knew anything before your exalted methodology came along. Or if they did it was some kind of primitive version, or simply random chance that what they came up with happened to work.

    Dev,

    Well, actually, a lot of what people thought they “knew” before science was indeed wrong. I’ll give examples. For hundreds, if not thousands, of years it was believed on the basis of anecdotal experience that bloodletting was good for all sorts of ailments. We now know that, with very few exceptions, it isn’t and is often harmful. For hundreds of years, it was thought that inducing purging with metals like cadmium, antimony, or even mercury was therapeutic for a wide variety of conditions, again based on anecdotes and tradition. We now know none of these things work. In fact, it was because such treatments were often more harmful than anything else that homeopathy, which is nothing more than giving a placebo (water), initially appeared to be superior. It was because doing nothing was better than all too many treatments of the day. Another example is that for who knows how many years before that right up until the present day in some societies, people believed that religious rituals or sacrifices to gods could cure disease. These things don’t work either.

    So, yes, Dev. Before the formalization of randomized trials and scientific medicine, what we thought we knew about medicine was indeed actually very poor indeed. There were a few exceptions, of course, because some therapies have such an obvious effect that randomized trials aren’t truly necessary. In surgery, such an example is operating to stop exsanguinating hemorrhage versus not operating. Few things in medicine, however, are that clear, and certainly the question of whether “biomedical treatments” do anything for autism isn’t one of them.

    Finally, as far your charge of “arrogance,” that’s a common charge designed to put advocates of scientific medicine on the defensive, as is the claim that science is a “religion.” Given that you’re getting increasingly histrionic in your attacks, I see no reason to remain quite as sedate as I have before. Instead, I will direct you to a few links that describe quite well your rhetorical gambit:

    Arrogant
    Science is just another religion!
    Is science just another religion?
    You’re just mean!

    Finally, when it comes to true arrogance, think about this: Who’s more arrogant, the one who recognizes his or her human fallibilities and designs an entire system of observation and hypothesis that has as one of its key elements methodology intended to minimize the impact of those fallibilities, biases, and deficiencies in identifying causation or the person who refuses to recognize that humans are fallible, story-telling beings who are easily led in the wrong direction, particularly through their tendency to confuse correlation with causation, and, in essence, says that he or she knows without all those safeguards?

    Pot. Kettle. Black.

    Seth,

    You make an error common in describing anecdotal medicine that Steve Novella actually specifically dealt with in his post, although you probably don’t see it because you appear to be laboring under a common misconception about autism. The error is in his discussion of trying multiple therapies, until they find one that “works” while the others didn’t. Indeed, many parents have. However, even if one tries multiple therapies that do nothing, in the case of a condition that improves one of them will appear to be effective because its use will coincide with the improvement. Contrary to what seems to be the prevailing belief among many advocates of so-called “biomedical interventions,” most autistic children do improve and develop. It’s a condition of developmental delay, not developmental stasis. Indeed, a small but not insignificant percentage of children with a diagnosis of autism or ASD will develop to the point where they go “off the spectrum” and no longer meet the criteria for an ASD diagnosis. This is with no intervention at all. Prometheus explains this phenomenon quite well here, along with how these anecdotes can easily get passed around with the discounting or ignoring of negative anecdotes (confirmation bias again) and develop into groupthink:

    Testimonials: Listening to People’s Stories
    Finding truffles among the clods
    Myths and legends of autism, part II

    Contrary to your claim, Dr. Novella’s observations do apply quite well to Dev’s anecdotes. As for the number of anecdotes, as I like to say, the plural of “anecdotes” is not “data.” To demonstrate that these so-called “biomedical interventions” do anything positive to impact symptoms of autism, a randomized, double-blind trial is truly needed. To produce convincing data, that trial would have to show that the “biomedical interventions” resulted in faster development and a decrease in autistic behaviors and symptoms above and beyond that of the control group.

  48. #48 Dev
    March 1, 2008

    Idiocy is not restricted to any historical age, nor is resistance to it.

    Now look, I’ve been as thoroughly trained in science as you. I simply didn’t think it was the end of the story. I know, it looks “humble” to you, submitting yourself as you do to your methodological god. Only, I don’t think yours is the only way to discover the truth. It’s only when you are confronted with someone standing outside of your limited conception of how to engage in inquiry that your arrogance becomes manifest. Locked in it as you are, you can’t see it. You are it. Now while my perspective has a historical and cultural breadth, you don’t really have to go all that far. Just walk over to a neighboring department. You’ll find carefully worked out methodologies that can be used for inquiry, in some cases even into questions of medical relevance. But what would that mean to you? It would mean that people like you, as you are now, would stomp all over you. You’d no longer be accepted, nor gain the perks of your position. What you don’t see, is how much bigger the world is from over here.

  49. #49 Hey Zeus is my homeboy
    March 1, 2008

    Just walk over to a neighboring department.

    Dev means the Department of Mysteries on Level 9 of the Ministry of Magic.

    The scientific process is tried and true. “Opening” one’s mind to magical thinking doesn’t mean one is improving one’s science.

    Love the “I’m trained in science” bit – truly hilarious.

  50. #50 Orac
    March 1, 2008

    Now look, I’ve been as thoroughly trained in science as you.

    What you’ve written in these posts thus far gives me good reason to seriously doubt that.

  51. #51 notmercury
    March 1, 2008

    Seth Sayeth: “Almost always, parents have tried other things that didn’t work. Chelation therapy isn’t easy; they try other things first. For each child, the set of observations is that several events (treatments) were followed by no improvement, and then a later event (chelation) was followed by improvement.”

    I’ve heard similar anecdotes, excuse me “single observations”, before regarding things like Secretin and methylB-12 injections. Nothing else worked until they tried x or y and then they saw great improvement. Sometimes anecdote will inspire a well designed study or two, in the case of Secretin patents and clinical trials, but the results are often disappointing.

    Jim Adams tried to set up a study on the efficacy of chelation but the results are less than spectacular, from what I hear. Too bad he is unlikely to publish his results and the NIMH chelation trial may never get off the ground.

    The parents who claim to see improvement with chelation rarely report immediate results, how can they when chelation is a gradual process, and some report minor improvements after years and years of chelation. If they weren’t convinced that mercury or other metals were to blame, why would anyone stick with something like that for so very long? Why would a parent claim that chelation is beneficial when their child is still quite autistic after years of chelation therapy? Faith or bias? You decide.

  52. #52 Robster, FCD
    March 1, 2008

    And we can’t forget the expense or risks of chelation. Wouldn’t it be nice to know, via scientific study, that the improvements were actually tied to chelation, and not to the passage of time?

  53. #53 Craig
    March 3, 2008

    And who are you? Who do you work for? You’ve helped the parents of autistic children how? At least he is trying to find an answer, while you and the rest of the medical community do everything you can to cover it up. Thanks, I think I know where to place my skepticism.

  54. #54 Craig
    March 3, 2008

    And who are you? Who do you work for? You’ve helped the parents of autistic children how? At least he is trying to find an answer, while you and the rest of the medical community do everything you can to cover it up. Thanks, I think I know where to place my skepticism.

  55. #55 Robster, FCD
    March 3, 2008

    Craig, Kirby may be trying to help, but his actual actions are hurtful to the public, and by leading parents of autistic children to often dangerous, and always expensive and wasteful treatments, he certainly isn’t helping anybody.