Respectful Insolence

At least Eli Stone was good for one thing

ResearchBlogging.orgI did not watch Eli Stone last Thursday.

I didn’t really need to, given that prerelease descriptions made it clear that the show’s pilot episode was nothing more than a load of antivaccination propaganda. Indeed, it was so bad that the American Academy of Pediatrics actually took the step of drafting a public letter to ABC asking it either to can the show or run a disclaimer stating that science does not support the contention in Eli Stone that mercury in vaccines is a major cause of autism. In response, David Kirby, the Energizer Bunny of the mercury militia, posted a predictable screed accusing the AAP of trying to “censor” ABC, a truly hilarious proposition, given that ABC and its parent company Disney probably spend more in a day than the entire yearly budget of the AAP–and it has the airwaves as well. Equally predictably the “luminaries” of the mercury militia lapped it up, gloating that ABC’s running the show was some sort of victory.

In other words, things played out pretty much as I expected them to.

From perusing a copy of the show’s script that was sent to me, I can see that perhaps the worst thing about Eli Stone is not the antivaccinationist crap in its pilot. It’s rather that Stone, who starts out in the stereotypical way as a greedy bastard who defends large corporations for huge sums of money but then has a revelation that leads him to become some sort of modern day “prophet” who is fighting against his former corporate masters for the little guy. What appears to be an overarching theme of the show is an argument for faith over reason. Indeed, that seems to be the crux of Stone’s argument against the vaccine manufacturer he is suing for having caused his client’s autism. In the pilot, “faith” that thimerosal in vaccines causes autism won out over the science that shows that it does not to the tune of a $5.2 million award to the autistic child. Lovely message. Perhaps murderers nailed by forensic CSI-style science could start using that argument: “Your honor, I know that science shows me to be guilty as sin, but you can never really know for sure. Have faith that I didn’t do it.” Yeah, that’d fly real well.

One consequence of Eli Stone that I didn’t even come close to foreseeing was that the AAP decided to release early a study that demonstrates the ethyl mercury in thimerosal used in vaccines is excreted far more rapidly than methyl mercury, the organic form of mercury that is most commonly used as a standard (mainly because far more about its pharmacokinetics in humans is known). According to the press release:

New research from the University of Rochester suggests that infants’ bodies expel the thimerosal mercury much faster than once thought – thereby leaving little chance for a progressive building up of the toxic metal. This debunks the myth, believed by some parents and some pediatricians, that the gauntlet of thimerosal-containing shots many infants received in the 1990s – when the average number of vaccines kids received increased sharply – had put them at risk for developmental disorders.

“Thimerosal has been used for decades, but the surge in vaccinations caused fear that possible accumulations of ethyl mercury, the kind in thimerosal, might exceed safe levels – at least, when based on the stringent risk guidelines applied to its better-understood chemical cousin, methyl mercury, which is associated with eating fish,” said Michael Pichichero, M.D., professor of Microbiology/Immunology, Pediatrics and Medicine at the University of Rochester and the study’s main author.

But scientists are learning that the two mercury species actually behave quite differently. In fact, the body rids the kind found in thimerosal more that 10 times faster than it removes the kind one might encounter in a Friday night fish fry.

Now, on to the study itself. The reason I didn’t blog about this last week, when the press release was made, is that I didn’t have access to the study itself until this weekend, and I always like to read the study itself whenever possible before blogging about it. First, here’s a little background. There are two primary forms of organic mercury that people absorb. There’s methyl mercury, which is the sort that is most commonly absorbed from the diet, and there’s ethyl mercury, which is the form found in thimerosal. An ethyl group has one extra carbon in its hydrocarbon, with two carbon units rather than the one that is found in methyl mercury. But is this relatively small difference enough to affect how the two are handled by the body? Until fairly recently, scientists tended to extrapolate from data on methyl mercury when discussing ethyl mercury, but this study by Michael E. Pichichero, MD of the University of Rochester, entitled Mercury Levels in Newborns and Infants After Receipt of Thimerosal-Containing Vaccines, looked specifically at ethyl mercury levels in a large number of infants.

This study was a followup study to an older pilot study published in 2002 in the Lancet in which thimerosal elimination was studied in 40 infants. Pichichero et al found that thimerosal-containing vaccines (TCVs) did not elevate mercury levels in the blood above levels considered safe and that mercury was rapidly eliminated from the stools. This new study expands on these observations by increasing the number of infants to 216 and looking at three different ages: Newborns (Group 1), 2 month olds (Group 2), and 6 month olds (Group 3). Each cohort received the vaccinations recommended for its age. Because thimerosal is no longer used in most childhood vaccines in the U.S. and Europe, the study was done in Argentina, with blood samples taken before standard, routine recommended vaccination and then at different time points after vaccination. In order to minimize the number of needlesticks, babies only had one blood draw after vaccination, done at different times for different infants. The results were then pooled, and a one compartment first order pharmacokinetics model was applied to the pooled data, taking into account age and weight. In addition, urine and stool samples were also analyzed for mercury, although there were a few children who were unable to contribute an adequate blood sample for mercury determination. Both methyl and ethyl mercury were measured, as was inorganic mercury, to try to differentiate sources whenever possible.

The findings of the study can be summarized as follows:

  1. Mercury was measured in the vaccines themselves, and the mercury detected was consistent with the amount stated by the manufacturers and that the mercury in vaccines was exclusively ethyl mercury.
  2. The highest levels of mercury in blood were detected in the first samples obtained after vaccination (ie, at 12 hours after vaccination in the newborn group and at 24 hours after vaccination in the 2- and 6-month-old groups).
  3. Regardless of age group, mercury levels were relatively low, with the highest level detected being 8.0 ng/mL in a newborn 12 hours after receiving the birth dose of HBV vaccine that contained 32.5 μg of mercury, suggesting a low risk for any sort of mercury-related toxicity, particularly taking into account how rapidly the mercury is eliminated.
  4. The halflife of mercury in the blood after administration of TCVs ranged from 2.0 days (2 month olds) to 3.7 days (newborns).
  5. Mercury was detected in virtually all stool samples tested and increased significantly after vaccination in all 3 groups. Mercury was detected in stools throughout all the sampling time points and fell slowlly towards normal. This pattern is consistent with the liver eliminating the mercury. However, how much of the mercury was eliminated this way could not be precisely calculated because 24 hour collections were not done.
  6. Mercury was nearly undetectable in urine in all samples. Because mercury can be toxic to the kidneys, a blood marker for kidney damage was also measured. It was not elevated, indicating no damage.

The bottom line is that the elimination of ethyl mercury is much faster than that of methyl mercury ingested orally (a half life of 2-4 days compared with a half life of 44 days, respectively). At the very least this observation means that basing toxicity estimates for thimerosal in vaccines on toxicity estimates based on the body’s elimination of methyl mercury is scientifically inappropriate. It also suggests that it is highly unlikely that mercury from vaccines accumulates to cause any sort of toxicity, much less autism (the symptoms of which are not consistent with mercury toxicity anyway). It does not, as the authors point out, directly assess the toxicity of ethyl mercury, but it does provide highly useful information for estimating the risk based on standard dosages, at least in countries that still use TCVs. It is also consistent with a recent study in infant monkeys, which found a similar result and a lower distribution of mercury in the brain when compared with methyl mercury. As the press release states:

To illustrate, researchers cite that infants in the 6-month-old group – who, in their lifetimes, had encountered more total ethyl mercury that any other group studied – still had the same pre-vaccination blood-mercury levels before their checkups as most 2-month-olds had before theirs. This suggests that, before each round of shots, the mercury has plenty of time to be cleared.

Finally, there was a rather interesting side observation made. Some methyl mercury was detected in all of the samples, despite the fact that infants are not commonly fed fish or fish-based products in Argentina. The amount of methyl mercury ranged from 1% to 50% of the total organic mercury measured, which suggests that environmental exposure is likely to be a more significant source of long term mercury exposure than any vaccine regimen currently in use.

This study is yet another nail in the coffin of the “TCVs cause autism” claim made with such fanfare a few years ago by the mercury militia. It suggests that, not only do the epidemiological data fail to support any such link, but that even science as basic as pharmacokinetics fails to support a link.

Of course, antivaccinationists are not pleased with this study, both because it was released early to combat the lies on Eli Stone but also because it comes hot on the heels of the large California study that became the latest in the line of large epidemiological studies that failed to find a link between TCVs and autism. Indeed, antivaccinationist and prominent member of the mercury militia, Barbara Loe Fisher, swings and misses trying to cast doubt on the study:

Here is what all the fuss is about (for today at least): Pichichero claims his study of about 200 babies and children, who were injected with vaccines containing ethyl mercury (thimerosal), showed that measurable mercury levels in the blood of the children were gone within 3.7 days. This, says Pichichero, is much quicker than the average 44 days it takes for methyl mercury (found in fish) to be undetectable in the blood. Ergo, he says, exposure to thimerosal does not cause brain damage or autism!

A straw man argument. The study states explicitly that it does not say that, only that this pharmacokinetic information is useful in estimating risk, which, based on how fast mercury is eliminated, appears to be low. Worse, Fisher is too scientifically illiterate to know what a half life is. Here’s a clue, Barbara: A half life of 3.7 days does not mean that the mercury was gone in 3.7 days. It means that half of it was. Then, in another 3.7 days, half again was gone, leaving 25% of the original amount, and so on until mercury levels fall to the point where they are indistinguishable from zero. Geez, learn a bit of science or at least read the press release, whose author was kind enough to explain what a half life is! Having just demonstrated her scientific ignorance, Fisher continues:

Not so fast, says Thomas Burbacher, M.D., a scientist who studies the biological effects of ethyl mercury on primates. “Just because it came out of the blood doesn’t mean it is excreted from the body. It could have gone to the brain. In primates, you actually get more mercury in the brain after exposure to ethyl mercury than with methyl mercury – it has an easier time crossing the blood brain barrier.” HERE.

Another straw man. Although what Burbacher says is technically true, Fisher and Burbacher forget to notice that the Pichichero study did look at urine and stool and found a considerable amount of mercury in the stool, strongly suggesting that the stool is the primary means of elimination. True, the stool studies were not sufficiently rigorous to account for all of the mercury elimination. It was acknowledged in the study that it’s possible that a two-compartment pharmacokinetic model, in which the ethyl mercury enters the blood and then is taken up in tissues, has not been ruled out. However, while in the process of doing the definitive study that will answer the question of whether all the mercury is excreted in the feces, Pichichero, citing the monkey study that shows no significant accumulation in the brain, retorts:

“There is a direct relationship between the amount of mercury in the blood — and how long it stays in the blood — and the ability of mercury to get into the brain to produce developmental problems,” he says. “We did not prove there was not deposition of mercury in other parts of the body, but we prove that the half-life of ethyl mercury from thimerosal is low, excretion is high, and the kidneys — an organ very sensitive to the effects of mercury — were not damaged.”

Again, Fisher has no clue what she’s talking about and Burbacher is just pulling a rationalization out of his nether regions. The bottom line is that the hypothesis that mercury in TCVs causes autism somehow has been extensively investigated by both epidemiological studies, clinical studies, and basic science. It has been found not to be consistent with the evidence. Unfortunately, antivaccinationists like Barbara Loe Fisher can’t let go and just admit that they were wrong.

REFERENCE:
Pichichero, M.E., Gentile, A., Giglio, N., Umido, V., Clarkson, T., Cernichiari, E., Zareba, G., Gotelli, C., Gotelli, M., Yan, L., Treanor, J. (2008). Mercury Levels in Newborns and Infants After Receipt of Thimerosal-Containing Vaccines. PEDIATRICS, 121(2), e208-e214. DOI: 10.1542/peds.2006-3363

Comments

  1. #1 TheProbe
    February 4, 2008

    Mercury was measured in the vaccines themselves, and the mercury detected was consistent with the amount stated by the manufacturers and that the mercury in vaccines was exclusively methyl mercury.

    Methyl or ethyl?

  2. #2 Kathleen Seidel
    February 4, 2008

    Thanks very much for this clear, readable summary.

    That said — I believe you’ve made a typographic error. After you refer to:
    “a study that demonstrates the ethyl mercury in thimerosal used in vaccines is excreted far more rapidly than methyl mercury,”
    you state:
    “Mercury was measured in the vaccines themselves, and the mercury detected was consistent with the amount stated by the manufacturers and that the mercury in vaccines was exclusively methyl mercury.”

  3. #3 Wendy
    February 4, 2008

    I thought it was interesting that there was an editorial in the New York Times reporting the AAP’s concern and arguing, basically, that people should recognize that the show is fiction, that there was nothing even approaching reputable science to be found in the story. Basically, they encouraged people to make their vaccination decisions based on science, not fiction.

  4. #4 John Fryer
    February 4, 2008

    Very well put Orac but its propaganda. You can’t prove a negative, so until you find the cause its all propaganda.
    The levels found are high enough to destroy brain cells and from other results it indicates this destructive level is reached in the brains. Mercury in the brain does not leave in 2 days or even 2 months!
    Humans are very resilient – the survival of the fittest – so choosing fit and healthy people to see if there are problems? Poor science?
    Surely if you want to prove the most toxic non radioactive element is destroying brains you choose those already harmed in the womb or at day one from GMO mercury vaccine?

    Or is the exercise to tell the world the most deadly toxic element is a food and nourisher of the brain cells?

    Propaganda!

  5. #5 Bronze Dog
    February 4, 2008

    Oh, my dear Ed, that’s concentrated woo.

    The levels found are high enough to destroy brain cells and from other results it indicates this destructive level is reached in the brains.

    Citation, please.

    Mercury in the brain does not leave in 2 days or even 2 months!

    Sounds like a rather extraordinary claim, especially since it’s coupled with word games. Define “mercury” as you’re using it. Why are so few of you willing to do even that?

    Humans are very resilient – the survival of the fittest – so choosing fit and healthy people to see if there are problems? Poor science?

    That’s either a lot of non-sequiturs, or are you asking why the didn’t use “poor excreters?” I haven’t seen any evidence the latter exist, or that they’re relevant.

    Surely if you want to prove the most toxic non radioactive element is destroying brains you choose those already harmed in the womb or at day one from GMO mercury vaccine?

    1. I’m pretty sure the “most toxic non-radioactive element” is an outright lie. Show me a citation.

    2. This isn’t really about elemental mercury, so that’s kind of moot anyway.

    3. Why focus on elements as a group, instead of chemicals in general? You know that there are plenty of compounds that are much, much, much more toxic than mercury. Playing games with words, again, I suspect.

    So, John, will you provide evidence, or will my pointing out of your propaganda tactics hold?

  6. #6 Calli Arcale
    February 4, 2008

    I strongly suspect that the element chlorine is more toxic than the element mercury. Yet chloride salts are essential to life. Strange thing, chemistry. It doesn’t support hyperbole very well.

  7. #7 pbaroco
    February 4, 2008

    I have a new hero, and the name is Bronze Dog… Way to police the silly comments.

  8. #8 Racter
    February 4, 2008

    Botulin, the toxin produced by the bacterium Clostridium botulinum has a median lethal dose of one nanogram per kilogram.

  9. #9 wfjag
    February 4, 2008

    Bronze — I think what John was doing is known as sarcasm. (At lease I hope that’s what he was doing).

  10. #10 wfjag
    February 4, 2008

    Bronze — I think what John was doing is known as “sarcasm”. (At least, I hope that’s what he was doing).

  11. #11 isles
    February 4, 2008

    wfjag – Sadly, no, I don’t think so. John Fryer is a well-known antivaccination extremist.

  12. #12 Dangerous Bacon
    February 4, 2008

    Slightly off-topic – but the N.Y. Times ran an op-ed piece yesterday on Don Imus and his “redemption” for comments about the Rutgers womens’ basketball team.

    The article mentioned that one of the sponsors of Imus’ radio show (which includes continued idiotic attacks on vaccination and false warnings about mercury dangers) is a New Jersey hospital.

    Orac – any idea which N.J. hospital is disgracing itself by sponsoring Imus? They deserve a bout of national embarassment.

  13. #13 Chad
    February 4, 2008

    At first I thought Mr. Fryer was being sarcastic, but after reading that comment a few times I now think he’s just stupid.

  14. #14 sirhcton
    February 4, 2008

    Well, Boyd Haley says all you mercury-causes-autism deniers are just wrong! Just read http://www.kentucky.com/211/story/307394.html to find out. You cannot get any higher publishing authority than your local newspaper, even if they do not refer to any studies supporting Haley’s contention.

  15. #15 daedalus2u
    February 4, 2008

    Bacon, that wouldn’t be a NJ mental hospital would it? Advertising on Imus could then be categorized as a public service announcement. Outreach to the population most in need of their services.

  16. #16 Mike Kilpatrick
    February 5, 2008

    I’m an ex-scientist (long story) and long term skeptic and full on atheist, but I’m a little conflicted around this issue. I watched Eli Stone and I actually found it to be entertaining, despite the obvious errors and non-science. (Oh, and at least it did have a disclaimer of sorts at the end.)

    I actually watched it because I wanted to be outraged by it, but I simply wasn’t. It was just mildly entertaining television.

    And I’m not sure a reading of previews and the scripts is able to do it justice. While I agree with most of what the esteemed author writes here, I think it’s wrong to criticise something without having even watched it.

    I found that behaviour wrong when people tried to get the Jerry Springer Opera banned from the BBC without having seen it, and the same for the episode of South Park featuring the Bloody Mary. It would be two-faced of me to accept it because it happens to be something I agree on.

    Of course I would have preferred there to be some accuracy around the premise of vaccines, but there are so many good programmes out there that require the suspension of belief (and science) to enjoy. Like Star Trek and all the spin offs, Firefly, Heroes, Alias, Life on Mars. In fact, most of the television I enjoy.

    I also disagree that it was “propaganda”. The issue was a vehicle for the main character to rediscover someone from the past and turn 180 degrees around as a person. Okay, not a great, or well chosen, vehicle but you get my point.

    Perhaps I’m over-simplifying here, but are people really going to take their science information from a fictional programme? Especially in a programme in which the main character believed George Michael was singing in his living room?

    Surely the release of more studies that conclusively prove that mercury in vaccines isn’t a cause of autism is more than enough to combat fiction. Okay, maybe I’m going too far. :-)

  17. #17 Skeptical Cat
    February 5, 2008

    are people really going to take their science information from a fictional programme?

    Yes.

    And it doesn’t happen like you suggest. Only the most deluded watch a bad TV drama and think it is real.

    However, people will watch the show, not think too much about it and then a few days or weeks later when someone mentions vaccines or autism they’ll say, “Hey, don’t vaccines cause autism?”

    And they will assume it’s true because they remember hearing it somewhere. That’s the sad fact about the way human memory tends to work.

  18. #18 Calli Arcale
    February 5, 2008

    It’s not even subconscious sometimes. Even those who remember that they heard it on Eli Stone will think “Hey, those TV shows are researched. The events are fictional, but it’s a drama meant to imitate life, so stuff like that should be real, right?” It’s not that they think it’s non-fiction; it’s that the show represents itself as fiction based on reality. Heck, even science fiction and fantasy do that, if they’re any good.

    People watched “Armageddon” and, despite knowing that it’s science fiction and not meant to be taken seriously, came away thinking that nukes would solve the problem of an asteroid bigger than 1 Ceres about to impact the Earth in just a few hours. Which is utter poppycock, of course. It’s really interesting how much basic science information among the general public is based on what they’ve seen in popular science fiction films — despite the full knowledge of all audience members that they’re not real, and require the suspension of disbelief.

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