Respectful Insolence

Here we go again.

You may have noticed that I’ve been laying off that repository of quackery, autism pseudoscience, and anti-vaccine nonsense, The Huffington Post. I assure you, it’s not because things have gotten much better there. Oh, sure, occasionally someone will try to post something resembling science and rationality, but it’s impossible for so few to overcome so much history and so much woo. Indeed, even when someone tries, he can’t help but be sucked into the morass of pseudoscience that is HuffPo. For example, Dr. Harvey Karp (the same guy who went toe-to-toe with Dr. Jay Gordon–more on him later–on The Doctors and humiliated him) recently wrote what was for the most part a decent post taking on the myth that vaccines cause autism. Unfortunately, he couldn’t resist prefacing his post with this:

If a foreign government were suspected of doing something that caused brain problems to 1/166 American children our nation would immediately and vigorously respond…and even go to war! Well, our children are under a mysterious assault that is causing 1/166 to develop autism. And, we must band together and immediately and vigorously make the correction of this problem a true national priority.

This is the sort of risibly hyperbolic warlike rhetoric that would not be out of place on the happy home for autism quackery, Age of Autism or even on the home page of Generation Rescue. The reason is that such rhetoric clearly implies that Dr. Karp accepts the “autism epidemic” fear mongering at face value. Think about it: What could be this “mysterious assault” that’s supposedly making so many of our children autistic? It couldn’t possibly be, as, for the most part, what the scientific consensus currently believes it is, could it? It couldn’t possibly be a combination of increased awareness and diagnostic substitution, which is what most of the evidence thus far supports as the cause for the huge increase in incidence of autism over the last 20 years or so. Indeed, prominent autism researcher Simon Baron-Cohen put it very well in an e-mail to Age of Autism (although I have no idea why he is bothering to try to set the cranks there straight):

I think many children in the old days were overlooked and that we are getting much closer to the true rate in the population these days. In that sense, the fact that more cases are being diagnosed could be seen as an achievement, that we are getting much better at identifying such children. If some note of alarm was needed, perhaps it should be over all those individuals who were missed in the old days, and who are now being better recognized.

Which leads Dr. Karp to opine:

In this 3-part blog, I’d like to discuss in detail the reasons why shots are very safe – and super important – and to present some fresh ideas about a more likely cause of autism: an invisible soup of toxins we’re exposed to every day…endocrine disrupting chemicals (EDCs).

Gee, I wonder if that’s what Mark and David Geier were thinking when they came up with their Lupron protocol. Or maybe he’s making wild extrapolations from Dr. Baron-Cohen’s “extra male” hypothesis regarding the pathogenesis of autism. Either way, combine the apocalyptic rhetoric about an autism epidemic with this bit about “endocrine disrupters,” and it sounds like the whole “oh, no it’s the toxins!!!” gambit, only without the “toxins” coming from vaccines. I really hope that Dr. Karp has some decent evidence to support his “endocrine disrupting chemicals” idea for autism pathogenesis, because I’m not aware of any. Maybe he can educate me, but his rhetoric leaves me worried that, after a good start defending vaccines against the sort of anti-vaccine nonsense that HuffPo is reviled for, he may descend into a different kind of pseudoscience. We’ll see.

Which brings me to an old friend of the blog, Dr. Jay Gordon, and his latest foray into anti-vaccine propaganda is also on–where else?–The Huffington Post. The reason is that Dr. Gordon uses Dr. Karp’s post as a jumping-off point for a post of his very own entitled, appropriately enough, Autism and Toxins. Suffice it to say, it lives down to what we’ve come to expect from Dr. Jay over the last four years.

Before I dive in, though, I do feel a bit reticent about being too harsh on Dr. Jay. Don’t get me wrong; I no longer buy his protestations that he is not “anti-vaccine.” I accept that Dr. Jay believes he is not antivaccine, but his words so routinely belie his denials that I’ve come to believe that he really is deluding himself. What’s more bothersome is that Dr. Jay is generally a nice guy. He’s also just so pathetic when criticized, putting his head down and his tail between his legs like a puppy who’s being yelled at or smacked. In doing so, he inevitably retreats into his usual armamentarium of logical fallacies, appeals to his “personal clinical experience” and anecdotes, all the while whining about just how horribly mean I and my readers are to him. Unfortunately, he seems utterly incapable of accepting that he really does bring a lot of it on himself. Naturally, Dr. Jay starts out with a nod to the guy who so thoroughly and politely smacked him down on The Doctors before heading into a science-free assertion:

Dr. Harvey Karp has just written an excellent blog beginning to discuss the role environmental toxins play in causing autism. I agree that the huge rise in autism is real, and not just related to better diagnosis or reclassification of mental illness. Autism is most likely caused by a genetic predisposition and an environmental “trigger.”

This is called argument by assertion. Dr. Jay simply asserts that the rise in autism can’t be accounted for by better diagnosis or reclassification of “mental illness,” seemingly failing to understand that autism is not a mental illness per se; it’s a neurodevelopmental disorder. He wants you to believe his assertion, not because he can present any scientific evidence to support it, but rather because…well, he’s Dr. Jay and he said it. In other words, it’s the logical fallacy known as an argument from authority. In any case, there is copious evidence that there is a significant genetic component to autism. There may even be an environmental component. However, there is no good evidence for an environmental “trigger.” Indeed, an environmental “trigger” is, in anti-vaccine-speak, virtually always a code word for vaccines.

And Dr. Jay proves me right by going straight for the conspiracy theory ad hominem attacks:

Studies showing that vaccines and their many constituents do not contribute to this problem are flawed, filled with specious reasoning and, for the most part funded by the pharmaceutical industry. Even articles in reputable medical journals are often written by doctors with an economic interest in continuing the vaccination program’s status quo. This does not invalidate all of these studies but it certainly makes them suspect and a poor foundation for an argument excluding vaccines from the list of environmental influences on the increase in autism in America and elsewhere.

Of course, Dr. Jay is utterly incapable of pointing out a single example of “specious reasoning.’ Certainly, he can’t provide a single valid scientific criticism of any of the studies that hasn’t been written by the anti-vaccine movement for him to regurgitate. Indeed, he does exactly that in saying that the Danish study data are “misused by all and interpreted to suit one’s needs.” Never mind that he is full of crap on this one. I won’t go into details because Steve Novella has already discussed the fallacious attacks on the Danish study. Here’s a hint, too, Dr. Gordon: Citing antivaccine crank websites like Vaccination Liberation Info in support of your arguments doesn’t do much for your reputation. Indeed, have you ever heard of Scopie’s Law? It goes something like this:

In any discussion involving science or medicine, citing Whale.to as a credible source loses you the argument immediately..and gets you laughed out of the room.

Perhaps I should enshrine Orac’s law:

In any discussion involving vaccines, citing Vaccine Liberation Info (or JABS, or Generation Rescue, etc.) as a credible source loses you the argument immediately..and gets you laughed out of the room.

Of course, I suppose I should be grateful that Dr. Gordon hasn’t pulled out the truly idiotic analogy between the vaccine industry and the tobacco industry that he has used in the past. Perhaps he learned something from the slapdowns he received over that one, much as he doesn’t appear to use the “formaldehyde gambit” anymore after receiving a heaping’ helpin’ of much-deserved not-so-Respectful Insolence for it. Too bad he apparently didn’t tell Jim Carrey; it might have spared him from looking about a stupid as stupid can be a couple of months ago.

Still, despite the routine spewing of talking points straight from the anti-vaccine movement, Dr. Gordon continues to insist that he’s “not anti-vaccine.” Indeed, he gets so, so indignant whenever anyone calls him anti-vaccine, as Steve Novella and I have both reluctantly felt compelled to do at various times. No doubt he’ll do the same now. However, he does have an excuse:

The facile dismissal of those of us calling for safer vaccinations and scrutiny of the current vaccine schedule is not scientifically based and polarizes the discussion. Perhaps most importantly, this dismissal is insulting to the thousands of parents and families who aver that their children have been harmed by vaccines. There are extremists choosing to ignore the facts in all vaccine/autism camps. I am not one of them.

Asking that cars be manufactured with more attention to safety and that driving is best when done safely does not make one “anti-car” or anti-driving. Asking for safer vaccinations and more judicious use of those we have does not make me or anyone else “anti-vaccine.”

First off, the call for “safer” vaccines is a sham. Maybe Dr. Gordon believes it, though. So let’s test it. Dr. Gordon, if you read this, I hereby challenge you to answer some simple questions:

  • You say you want safer vaccines. OK then, please, define for us exactly what you would define as “safe enough.” Be very specific. What rate of complications for which vaccines would be “safe enough”? What rates of various infectious diseases against which these vaccines protect would be acceptable in order to balance the risk-beneifit ratios. Please justify your conclusions with reasoning and citations of appropriate peer-reviewed scientific papers.
  • You castigate vaccines for having “toxins.” You’ve apparently backed off on formaldehyde, accepting that it’s a normal byproduct of human metabolism and that a baby makes more formaldehyde in a single day than is contained in the entire vaccine schedule. However, what “toxins” would you remove? Be specific, and provide evidence that these “toxins” actually cause harm.
  • What specific evidence would it take for you to accept that vaccines are safe relative to the risk of disease and to start recommending that your patients vaccinate other than “reluctantly.”

I’ve yet to see you answer these questions. All I’ve seen is your dodging them and dancing around them, engaging in evidence-free rants and the copious use of the pharma shill gambit. Here’s a hint, Dr. Jay: Even if everything you said were true, it would be the science that matters more than anything else. Funding sources matter; they should make us a bit more skeptical. But in the end it’s the experimental design, data, statistical methodology, and data analysis that matter more.

As for that lame gambit about its not being “anti-car” to call for safer automobiles, well, that’s not what anti-vaccine advocates like yourself do. In fact, if a “car safety advocate” said that she would not use a car, ever (as Jenny McCarthy said she wouldn’t vaccinate again, ever, if she were to have another child); spreads misinformation and pseudoscience about cars, all designed to make them seem enormously more dangerous than they really are; can’t provide anything but bad studies and bad science to back up her viewpoint; and, no matter what, always blamed the car for virtually every problem, well, then, yes, I’d say such a “car safety advocate” was anti-car.

See the analogy to the anti-vaccine movement, for which you’ve become an apologist, if not a card-carrying member?

Finally, I like the way Dr. Gordon plays the poor abused mother card, as though questioning anti-vaccine propaganda is being “insulting” to mothers. I’ll repeat yet again that correlation does not necessarily equal causation, and the plural of “anecdote” is not “data.” Once again, we humans are very prone to seeing patterns, whether there is a pattern or not. It’s not “insulting” to point this out. Indeed, we scientists understand that we are just as prone to these cognitive quirks and shortcomings as anyone else. That’s why we don’t trust testimonials and anecdotes, except as hypothesis generating tools, and that’s why the scientific method is so important. It’s a way of preventing our biases, cognitive shortcomings, and tendency to confuse correlation with causation from leading us astray. Indeed, Dr. Karp put it fairly well:

In fact, one of the scariest characteristics of autism is that it can suddenly afflict a child who seems developmentally normal. But, is it possible that this sudden problem right after shots is just a coincidence? Absolutely, yes! Every day, serious and amazing things occur, purely by chance. Think of it this way, in a large country like the US, a one-in-a-million coincidence happens 300 times a day.

Approximately 24,000 children are diagnosed with autism every year and in about 1/3 of those cases (8000/year…150/w) normally developing kids show abrupt deterioration (so called “regressive” autism). Regression usually appears between a child’s 1st and 3rd birthdays, a period during which they get shots 4 separate times. Do the calculations and you quickly realize that, every year, over 600 children will spiral into autism during the four 1-week periods that follow these 4 shot visits… just by pure, utter, random chance.

Such a high chance of coincidence means that a parent who hears about 4-5 toddlers (or even 4-500 toddlers) who worsen after shots may easily be fooled into assuming that the cause of the autism was the shots…but they would be jumping to a totally false conclusion.

I say “fairly well” because, if one looks carefully at most cases of “regressive” autism, signs of autism can almost always be identified well before the “regression” occurs. In that context, “seems” is a good word, because parents often miss the subtle early signs of autism. Surely Dr. Karp must know that. He also must know that vaccines are blamed for autism if regression occurs up to a month after vaccination, sometimes even longer, meaning that his estimates are, if anything, quite low. I also have no idea where Dr. Karp got his “one in a million coincidences” happening “300 times a day.” I can only assume he’s simply taking the approximate population of the U.S. (300 million) and dividing by one in a million. However, there’s no reason to assume a “one in a million” occurrence will happen once a day. It’s sloppy reasoning that undermines the rest of his argument. In any case, epidemiological studies have looked assiduously for evidence that children regress into autism in temporal proximity to vaccination at a rate that is greater than what would be expected by random chance alone or that there is a correlation in general between vaccination and autism. They’ve failed to find even a whiff of such an association.

Be that as it may, I realize that Dr. Gordon can’t seem to understand that confusing correlation with causation is incredibly easy even when two events are not causally related, despite its having been explained to him time and time again. He seems to think that he is above it all and that he could never, ever be led astray by his personal experience:

I have been in practice thirty years and watched thousands of children get shots, not get shots, develop autism or remain developmentally “neurotypical.” I have no proof that vaccines cause autism and would be very excited to have my large group of extremely healthy mostly unvaccinated children studied someday. It would be disingenuous to imply that non-vaccination might not lead to an increased incidence in vaccine-preventable illness. It would be equally disingenuous to state that this possibility poses a great threat to America’s children. The risks of vaccinating the way we do now exceeds the benefits of this vaccine program. “Scientists” who suggest that experienced doctors ignore their eyes and ears are wrong. Detractors who say that we should ignore parents who are certain that vaccines caused their children’s autism are wrong and often quite mean-spirited.

That’s right; we’re “mean-spirited” for suggesting that human cognition is fallable.

I suppose it’s also “mean-spirited” to point out that I’ve seldom seen so many bad arguments packed into a single paragraph. While admitting that he has “no proof” that vaccines cause autism and admitting that decreasing vaccination rates could very well lead to outbreaks vaccine-preventable diseases, Dr. Gordon makes the utterly false conclusion that such a possibility would not pose a threat to our children. How on earth he comes to that conclusion, I have no idea, but come to it he does. What about Hemophilus influenza type b? Remember that nasty bug, Dr. Jay? Twenty years ago, it was the scourge of pediatrics, causing invasive disease in 1 in 200 children under the age of 5. Of these, one half to two-thirds developed meningitis, with a mortality rate of 5% and rate of permanent brain damage of 30%. It is a truly nasty bug. Then a vaccine was developed in the late 1980s, and by the late 1990s Hib had virtually disappeared. Indeed, younger pediatricians in practice now have never seen a case of Hib meningitis. Apparently Dr. Jay thinks that it wouldn’t be a big deal if we stopped vaccinating against Hib. Instead, he would willingly subject our children to real risks of outbreaks of vaccine-preventable diseases in order to protect against a hypothetical risk that vaccines cause autism, a hypothetical risk that multiple large, well-designed studies have failed to validate, having failed to find even a hint of a wisp of a correlation between either thimerosal and autism or vaccines and autism.

One of the interesting things that came out of Dr. Jay’s tap dancing, however, is his admission that he apparently doesn’t vaccinate large numbers of his patients (“my large group of extremely healthy mostly unvaccinated children”). I’d be very curious to know what percentage of Dr. Jay’s patient population is unvaccinated and whether it was because he didn’t think they needed to be. Of course, Dr. Jay is lionized in anti-vaccine circles; so he probably attracts parents who don’t want to vaccinate, and, because he shares their vastly inflated, evidence-free view of how “dangerous” vaccines are, he validates their beliefs and doesn’t challenge their fears of vaccines. He, as he himself puts it, “doesn’t give a lot of vaccines” and “vaccinates reluctantly” when parents insist on having their child vaccinated. Characteristically, Dr. Jay also deploys the logical fallacy of an argument from ignorance:

Dr. Karp, if you are going to talk and blog about kitchen cleaners, furniture polish, pesticides and other toxins, how can you possibly ignore the 30-40 injections of potentially risky material we give children in their first 24 months of life? There is absolutely no proof that these shots are as safe the makers say they are and certainly no proof that new combinations of vaccines and hastily created shots are safe enough for our children.

And there is absolutely no proof that there isn’t a celestial teapot circling the sun between the earth and Mars. A better example of argumentum ad ignorantiam I am hard-pressed to remember.

Oh, I’m sorry, I’m just being so very, very mean. Or insolent. Or both. Or whatever. I’m sorry; I just can’t help myself when I encounter so many logical fallacies, abuses of science, and just plain bad arguments in such a short article. In any case, Dr. Gordon is full of crap yet again. Vaccines are continually tested for safety, and each new vaccine is tested against the background of the current vaccine schedule. Perhaps Dr. Jay requires a colon cleanse to remove the accumulated toxins from so much crap. They’re affecting his reasoning ability. Oh, wait. Sorry. Strike that. I’m being mean again. I must try to be nice, just like Dr. Gordon.

That’s because Dr. Gordon is so much nicer than I am. He is never, ever mean as he blithely dismisses all the scientists who have worked on studies that have failed to validate the concept that vaccines cause autism as hopeless pharma shills in the thrall of the filthy lucre poured upon them by vaccine manufacturers and labeling commenters here as being paid by big pharma to post comments refuting anti-vaccine pseudoscience. When he slanders vaccine manufacturers by likening them to tobacco companies pushing a dangerous product through pseudoscience, marketing, and the denial of epidemiology, Dr. Jay’s not being mean. He’s just telling it like it is.

Because only Dr. Jay is allowed to insult others or use harsh arguments in favor of his position. That’s just being a truth teller. When others do it, they’re just plain mean and nasty. Like me.

Dr. Jay finishes with a flourish:

It remains very possible that changing the way we manufacture vaccines and being more selective in our use of them may have huge public health benefits. It would be unscientific and immoral to ignore these more difficult possibilities in favor of the easier answers in Dr. Karp’s post. We can save more children if just think harder

Again, what Dr. Jay is advocating is definitely a “more difficult.” Unfortunately for him, it’s also a “more difficult possibility” with completely unproven benefits, no evidence to suggest that there would be benefits, and a well-known down side of decreasing the rates of vaccination and thus endangering herd immunity. There is no logical or reasonable rationale for taking Dr. Jay’s advice, given that there is no science behind it. At least, Dr. Jay is utterly incapable of articulating a scientific rationale for his position. All he can offer is conspiracy mongering; the pharma shill gambit; logical fallacies such as special pleading, arguments from ignorance, appeals to popularity, and arguments from authority ; and reliance on anecdotal evidence. In other words, Dr. Jay can offer no compelling reasons to support his view. But, then, what do I know? I’m just a big, contemptuous meanie who hates mothers. (For how I’ve dealt with such charges before, Dr. Jay might be amused to read my response to Robert F. Kennedy, Jr., who made in essence the same charge against skeptics who have the temerity to point out that there is no good scientific evidence linking vaccines to autism. It’s one of my more entertaining posts, if I do say so myself.)

But back to my being a big meanie. No doubt Dr. Gordon will soon show up soon all wounded and insulted that I (or others, like Steve Novella, whose post I urge Dr. Jay to read) would ever accuse him of being “anti-vaccine.” Again, I believe him when he says he he is “not anti-vaccine” to the point that I accept that Dr. Jay believes himself not to be anti-vaccine. The problem is, his actions and words belie his denials. He doesn’t vaccinate many of the children in his practice, is proud of his contingent of unvaccinated patients, and pops up frequently in the media castigating vaccines as being riddled with “toxins” and various other evil humors, sometimes even speaking in front of anti-vaccine rallies like last year’s “Green Our Vaccines” rally. It’s still not too late for Dr. Jay, however. As I always say, if you don’t want to be seen as “anti-vaccine,” then stop repeating science- and evidence-free, logical fallacy-ridden talking points that feature prominently on the websites of pseudoscience-boosting and anti-vaccine websites and blogs, such as Whale.to, Age of Autism, Generation Rescue, or Vaccine Liberation Info. Oh, and learn a bit of science.

Maybe I should have restrained myself from adding that last sentence. I wouldn’t want to be accused of being mean and nasty, now would I?

ADDITIONAL COMMENTARY:

Hey, fake autism experts—put up, or shut up!

Comments

  1. #1 Joseph
    June 16, 2009

    Simple question for Dr. Jay: How many different children have you seen, and out of these, how many have an ASD diagnosis that you are aware of?

  2. #2 Mu
    June 16, 2009

    I wonder, has there ever been an vaccine preventable disease outbreak centered around a physician’s office? His policies seem to invite a disaster in the long run, especially since he’s specialized in affluent clientele more likely to have traveled into areas where exposure to measles etc is likely.

  3. #3 Brandon
    June 16, 2009

    Even The Onion is getting in on the vaccination action.

  4. #4 KWombles
    June 16, 2009

    Careful, Orac, or you may be accused of being a rambling, deranged word twister as I have recently been. :-)

    If Dr Jay is anything like those main anti-vaccination commenters over at Huff, using their own words to point out their fallacies and absurdities leads to you being called just that. And we know he’s just like that.

    I’m crying bucketloads of tears over that, I can tell you.

  5. #5 SLC
    June 16, 2009

    I think that Dr. Orac is being far to nice to dangerous whackjobs like “Dr.” Gordon.

  6. #6 skeptiquette
    June 16, 2009

    A couple of points.

    1. Orac, you must have missed my post from the Bob Sear’s Thread. (not that I would expect you to read every post)

    I posted a citation to a recent study which DOES NOT show that ‘diagnostic substitution’ and “diagnostic drift” are actually responsible for the autism “epidemic”. You should probably read it if you are going to continue arguing from the standpoint have taken thus far.

    Grether JK, Rosen NJ, Smith KS, Croen LA. Investigation of Shifts in Autism Reporting in the California Department of Developmental Services. J Autism Dev Disord. 2009 May 29. [Epub ahead of print]

    2. Did you ever think that making vaccines more individualized would actually INCREASE herd immunity? and DECREASE risk from both side effects and the diseases they are to prevent against?

    It’s pretty simple concept and a goal envisaged by the top vaccinologists in the country. As much as you seem to love the “one size fits all” protocol, it (and your knowledge surrounding vaccines and autism) is, well, pretty antiquated and not consistent with the knowledge and technology we have gained in the new millenium. Keep fighting the good fight though, you really seem to be making progress!

    I will touch on two ways that changing the schedule and the specific makeup of the vaccines will increase herd immunity.

    Understanding the specific mechanisms at play during routine vaccinations and how they interplay with specific genetic makeups will allow the physician to screen infants and decide whether the vaccine will be efficacious, and/or have the potential for side effects.

    First, this type of approach would probably allay the fears of all but the most staunch anti-vaccinationists, thus increasing vaccine uptake, overall.

    Second, developing vaccines that are geared for the individual is where vaccinology/vaccinomics are going. Oh noez we have to givup r precious: teh one size fits all !11!11!. This will actually increase HERD IMMUNITY, because making vaccines that when administered actually confer immunity to the INDIVIDUAL, bolster herd immunity.

    Obviously, most if not all here are aware that vaccines don’t work for everyone and therefore we need a 90%-95% uptake to establish herd immunity (these are the numbers I generally see in the literature). This high uptake requirement is partially due to the fact that vaccines don’t confer immunity to all who partake in the program.

    So for more reasons than one, stomping on the idea that we should individualize the vaccine schedule and actual vaccines, is HURTING herd immunity.

    Here are a few journal articles you should pick up and read, you know, to bring you into this millenium:

    1. Personalized vaccines: the emerging field of vaccinomics

    2. Trends affecting the future of vaccine development and delivery: The role of demographics, regulatory science, the anti-vaccine movement, and vaccinomics.

    3. Adversomics: the emerging field of vaccine adverse event immunogenetics.

    4. Application of pharmacogenomics to vaccines

    5. Vaccine immunogenetics: bedside to bench to population

    6. Heterogeneity in vaccine immune response: the role of immunogenetics and the emerging field of vaccinomics

    7. Pharmacology, vaccinomics, and the second golden age of vaccinology

    Congratulations on being completely unaware that your stance contributes to the waning of herd immunity

    Here is an easy question for you guys:

    If you are not part of the solution you are part of the ???

  7. #7 Calli Arcale
    June 16, 2009

    And there is absolutely no proof that there isn’t a celestial teapot circling the sun between the earth and Mars. A better example of argumentum ad ignorantiam I am hard-pressed to remember.

    A celestial teapot at the Sun-Earth L3 point would be more interesting — that spot is never visible from Earth. Spoooky!

    The Nibiru crowd use a similar argument all the time to say that Nibiru must exist because nobody’s proved it doesn’t. Oh, and the Babylonians talked about it, and Sitchin was RIGHT!!!! and it’s going to come and kill us all in 2002…wait, 2004…um….2012? Oh, and here’s a picture of Io to make you think I’ve seen it with a telescope. (Seriously, there are people who make this sort of claim.)

    Dr Gordon remains completely and utterly unsurprising. You really should not be surprised that he keeps repeating the same arguments. He knows they work to keep his client base coming back in. I suspect that’s all he really cares about.

  8. #8 ababa
    June 16, 2009

    Mu said: I wonder, has there ever been an vaccine preventable disease outbreak centered around a physician’s office? His policies seem to invite a disaster in the long run, especially since he’s specialized in affluent clientele more likely to have traveled into areas where exposure to measles etc is likely.

    Around here, the anti-vaxers keep a master list of “no-vax” friendly doctors or at least ones that don’t give them too much trouble. Of course they all talk big about putting their foot down on the forums, but you can tell that most of them just switch pediatricians until they find one that doesn’t resist them.

    A few of these doctors on that list have found out about it and quickly changed their vaccination policy. They weren’t too happy to have some Mom raise a stink because they were on the list she printed out but still recommended they vaccinate their children. Apparently the threat of showing up on the evening news in case of a vaccine preventable disease outbreak was just a little too risky for them. Can you see the headlines now?

    “Measles Outbreak Centered Around Local Pediatrician”

  9. #9 Joseph
    June 16, 2009

    I posted a citation to a recent study which DOES NOT show that ‘diagnostic substitution’ and “diagnostic drift” are actually responsible for the autism “epidemic”. You should probably read it if you are going to continue arguing from the standpoint have taken thus far.

    That’s from California. I haven’t found the time to read that study, and I should. But I can note that:

    1) If you look in Shattuck’s paper, California was one of a handful of states that didn’t follow the pattern of diagnostic substitution he found.

    2) In California DDS, the vast majority of the increase in the autism caseload is due to children with no mental retardation.

    3) In IDEA data, we see that there has not been a decline in MR as a ‘primary disability’ in California. However, the aggregate of all special education categories has been stable, and specific learning disability has had significant decline. See this analysis at Autism Street.

    Or to summarize, diagnostic substitution is not necessarily from MR only.

  10. #10 D. C. Sessions
    June 16, 2009

    I’m sure that Dr. Jay would appreciate the extra business if every parent in LA County whose child had a cough, fever, and Koplik’s spots came to his office for a walk-in. He’s busy, so they might have to spend a long time in the waiting room.

  11. #11 Terrie
    June 16, 2009

    “If you’re not part of the solution, you’re part of the precipitate.”

  12. #12 Happeh
    June 16, 2009

    “What could be this “mysterious assault” that’s supposedly making so many of our children autistic?”

    (1) Denying the reality of the Yin part of the body.

    (2) Encouraging your young to do things that kill the Yin part of the body.

    (3) Failing in your adult duty to train your young to build the Yin part of their body.

    Stop fighting me. Come to the playground by me, look at the Asian children, look at the other children, then look at the general physical appearance of each group. The outwardly visible physical differences you see in each group explains a large part of autism.

    Calling me a troll angers me Orac. If you go to that playground you will see exactly what I am talking about. Stop telling people that what I say is not true, do your job as a medical man, and raise your children to be healthy and strong with accurate medical knowledge.

    Don’t sell them ADHD drugs that give them sudden cardiac arrest. Teach them about the Yin part of the body and how to exercise it.

  13. #13 zer0
    June 16, 2009

    “If you’re not part of the solution, you’re part of the precipitate.”

    Pure Win

  14. #14 Tyro
    June 16, 2009

    Only somewhat tangential, the Onion’s News & Views has a piece on Vaccines with the blunt headline “Vaccine Rejectors Put Kids at Risk”: http://www.theonion.com/content/amvo/vaccine_rejectors_put_kids_at_risk?utm_source=onion_rss_daily

  15. #15 DrFrank
    June 16, 2009

    You know, skeptiquette, it’s technically possible to make valid points without also sounding like your head is lodged firmly up your own arse.

  16. #16 Dave
    June 16, 2009

    skeptiquette asks: “If you are not part of the solution you are part of the ???”.

    Answer: precipitate.

  17. #17 DLC
    June 16, 2009

    But . . . Dr Jay trumps your reality with his own!
    What good is your science compared to Dr Jay Gordon’s anecdotes ! It doesn’t matter where the studies came from or who did them, as long as they don’t back up Dr Jay Gordon, they’re suspect!
    So… why the hell bother with all this science business when all we need is Dr Jay Gordon ?
    [/rant]

  18. #18 Stu
    June 16, 2009

    Happeh, you’re not a troll — just completely, utterly, clinically bug-fuck insane.

  19. #19 Leslie
    June 16, 2009

    Just curious – with all these unvaccinated kids out there, has anyone ever investigated the incidence of autism among them? And what do the parents blame in that case – nebulous “toxins” in the atmosphere?

  20. #20 notmercury
    June 16, 2009

    skeptiquette:

    Congratulations on being completely unaware that your stance contributes to the waning of herd immunity

    Maybe you are working on developing individualized vaccines, who knows. Obviously you view yourself as part of the solution, not the problem, right? OK, convince me. What are you doing to help and how can you be sure that your efforts aren’t creating more problems for autistic children and adults?

    Here is an easy question for you guys:

    If you are not part of the solution you are part of the ???

    a)Whole

    b)Evil Doers

    c)80′s supergroup ABBA

    d)Illuminati

    e)Reaction

  21. #21 Mu
    June 16, 2009

    The question comes up ever so often. It has been looked at, but never in a true controlled sense of a rigorous trial. This is mainly due to ethical problems of “can’t be worse than the standard of care” (can’t randomize the non-vaccine group)and of sheer numbers. Prometheus had a nice analysis of how many unvaccinated kids you’d have to investigate to find a significant result, and the numbers are just not there, even with all of Jenny’s efforts.
    One “study”, a survey done by the anti-vax groups, actually found less autism in the vaccinated group than in the unvaccinated. They don’t quote that one too often.

  22. #22 Joseph
    June 16, 2009

    Just curious – with all these unvaccinated kids out there, has anyone ever investigated the incidence of autism among them?

    According to information gathered by Jenny McCarthy’s autism organization, Generation Rescue, 3.7% of all completely unvaccinated children have an ASD diagnosis (or 6 times what was found by the most recent CDC phone survey.) GR has never provided a satisfactory explanation as to what they attribute this rate to.

  23. #23 t_p_hamilton
    June 16, 2009

    “If you’re not part of the solution, you’re a homeopathic medicine.”

  24. #24 E.V.
    June 16, 2009

    If you are not part of the solution you are part of the ???

    Umm, lessee…. I know! How about “false dichotomy?”

  25. #25 Agoraphobic Kleptomaniac
    June 16, 2009

    @Happeh:

    Stop fighting me. Come to the playground by me, look at the Asian children, look at the other children,

    Happeh is now invading children’s playgrounds trying to teach them about their Yin?

    Should the authorities be notified?

    @Skeptiquette:
    Individualized vaccines questions:
    1) Cost? This sort of testing seems very expensive.
    2) Do you mean individualized dosing or individualized schedule? You imply both…

    Obviously, most if not all here are aware that vaccines don’t work for everyone and therefore we need a 90%-95% uptake to establish herd immunity … This high uptake requirement is partially due to the fact that vaccines don’t confer immunity to all who partake in the program.

    I have no hard data against this, but it sounds wrong. Does anyone have the reason why 95% of people need to be immunized for herd immunity?

    Thanks.

  26. #26 ababa
    June 16, 2009

    Leslie,
    When confronted with the fact that by not vaccinating the only thing it buys is vulnerability to disease and has no affect on the incidence of autism, antivaxers go crazy blaming everything from the tooth fairy to mercury fillings in the parents. They invent numbers and use creative math to explain it away. The parents that were conned into believing the nonsense wind up blaming themselves for “failing” at parenting. Here is a link to a thread on sMothering on just exactly that (note all of the creative blame game going on):

    http://www.mothering.com/discussions/showthread.php?t=1077468

    This is a widely dismissed group that AoA and GR like to pretend does not exist. One of the editors of AoA, Kim Stagliano, supposedly has three autistic daughters, one of them is completely unvaccinated. Every time the subject comes up over there it is moderated out of existence.

  27. #27 James Sweet
    June 16, 2009

    This “vaccinomics” thing sounds interesting, but from what I can see, the sum total of publicly available information on the subject seems to be one research paper (I haven’t read it, but the abstract makes the paper sound rather… abstract), a Mayo Clinic podcast, an empty wiki and an empty blog.

    That would be great if individualized vaccines could increase immunity and cut back on side-effects. But uh… what does that have to do with Orac’s post? One can hardly blame Orac for not giving an obligatory nod to what appears to be a speculative new idea at best. And I don’t think he said anything that would directly rule out individualized vaccines…

    Put it this way: It is a far cry from Bob Sears pitching alternative vaccination schedules with absolutely no supporting evidence except that the CDC schedule is scary, vs. researchers from the Mayo clinic writing about a possible future development in the field.

  28. #28 Mu
    June 16, 2009

    AK, the 90+% vaccination for herd immunity comes from the likelihood of an outbreak spreading. A single kid with measles probably comes into contact with a number of other kids before it’s isolated, for example the 10 kids in it’s daycare group. If 19 of 20 kids are successfully vaccinated, most likely no second kid will be infected, and the case stays a single episode. If your numbers go down significantly below that, you will get a chain infection and a localized outbreak.

  29. #29 James Sweet
    June 16, 2009

    @Agoraphobic Kleptomaniac: The minimum compliance rate to achieve effective herd immunity varies from disease to disease, and I’m not sure how high quality the data is for each disease… probably some are well-studied in this way, others are not. (though I am only guessing)

    Anyway, the rule of thumb is that in order to avoid the risk of an outbreak, you need about 90-95% compliance (again, depending on the disease). I don’t have a source handy, but I’m sure you can find one if you look.

    Nobody is saying the world explodes if compliance falls to 89.9%, and nobody is saying that the disease will be instantly eradicated if compliance hits 90.1%. It’s just a general target.

  30. #30 Orac
    June 16, 2009

    Skeptiquette (@6) appears to be trying to impress me with overwhelming knowledge. Of course, I’m quite aware of various genomic (or other “-omic” approaches) to understanding disease and predict responses to therapy. After all, I run a program, a large section of which is dedicated to systems biology and oncogenomics and have been interested in such approaches for at least a decade now.

    Which is why I’m not impressed by Skeptiquette’s snark. Nice try though. She might convince me that her snark is more than just hot air if she can tell me

    1. How does one identify a genomic signature?
    2. How does one validate a genomic signature?
    3. What is the absolute requirement in any validation study of a genomic signature?

    And Joseph beat me to the comments about the article she cited.

    Granted, Skeptiquette may well have given Dr. Jay a lifeline to use if and when he decides to show up here to whine about his treatment, because I’m quite sure that Dr. Jay has little clue how genomic and proteomic approaches work and what their powers and limitations are and even more sure that he had nothing of the sort in mind when he advocated vaccinating “smarter.” However, that doesn’t help his argument. You see, genomic approaches are very, very complex. Moreover, once a genomic signature is identified that is thought to be predictive to, say, prognosis (as in cancer) or response to therapy–or even response to vaccines–it takes years to validate it in clinical trials. In other words, now, on the ground, as a matter of public health all this fancy new technology is not going to help now. Maybe ten years from now (less if we’re lucky), but not right now. Who knows? These approaches might even improve herd immunity many years in the future.

    Right now, herd immunity depends on having as high a percentage of the population vaccinated as possible. Yes, right now, herd immunity depends upon the “one size fits all” approach (which really isn’t “one size fits all,” given that there are contraindications to various vaccines in the schedule that need to be taken into account). What Dr. Jay is proposing is putting the cart before the horse; i.e., cutting back drastically on vaccines based on an evidence-free faith that they somehow cause or contribute to autism. Right now he is saying that we accept a known risk (the resurgence of vaccine-preventable infectious diseases in order to obviate an unknown, unproven, and most likely nonexistent risk (that vaccines cause autism). He is not advocating “vaccinating smarter” (although that’s a catchy way of putting it). He’s advocating not vaccinating much, if at all, based on the fear of an almost certainly nonexistent complication of vaccines.

    Another word about genomics approaches. They’re very tricky and difficult to get right. Indeed, I’ve written about this before as far as systems biology goes:

    http://scienceblogs.com/insolence/2007/03/the_individualization_of_medical_treatme_1.php

    In any case, I remember around the turn of the millennium (since Skeptiquette mentioned it). Cancer journals were rife with various genomic signatures that were going to revolutionize oncology. Very few did, and only one (the Oncotype DX) has thus far made it into widespread clinical use in the U.S, although I have no doubt that more are coming.

    In other words, all this talk of “vaccinomics,” pharmacogenetics, and immunogenetics is all well and good, but it’s nowhere ready for prime time yet, and until it is clinically validated, bringing it up is nothing more than a smokescreen to justify anti-vaccine fears.

  31. #31 Zar
    June 16, 2009

    Gordon complaining about “meanness” sounds a lot like Heidi Montag complaining about Al Roker’s hard-hitting interview style.

    @happeh

    Come to the playground by me, look at the Asian children, look at the other children, then look at the general physical appearance of each group.

    Yes, because of course all Asian-Americans are totally in on eastern medicine and acupuncture and use Ancient Chinese Secret instead of modern medicine. (They’re also know kung fu. All of them.) They are all interested in “Yin” a Chinese philosophical concept, even if they are Korean or Japanese. Because they are all alike. They are all so wise and the women are so submissive and feminine and lotus blossom sex goddesses who dressed in kimonos will massage your baka gaijin roundeye feet while you listen to her uncle Charlie Chan use ancient Chinese proverb to solve mysteries. Also, she’s really good at math. Just as all American Indians are shamans who transform into wolves and/or eagles, live in teepees and communicate with smoke signals (no use white man’s telephone) while wearing feathers and loincloths and stand at the edge of roads and cry at the litter, and all latinos make tacos while salsa dancing (because they’re all Mexican, you know) and show their fiery latin tempers while dispensing no-nonsense, down-to-earth wisdom and having wild crazy passionate sex, and black people are amazing dancers who can freestyle rap.

    You racist. You fucking racist. If you would actually talk to one of those mysterious Yellow People on the playground, you might find out that Asian kids have neurological problems too. And most of them don’t give a flying fuck about yin.

  32. #32 PalMD
    June 16, 2009

    Orac, stop using all that fancy science. It’s not fair!

  33. #33 kathleen
    June 16, 2009

    I have just about fucking had it with happeh-Oh I guess my kids are ignoring their yin? I’ll get on it straight away…perhaps we ought to add “yin” enhancement to vaccines? Happeh-you ARE a troll and exceptionally insulting.

  34. #34 trrll
    June 16, 2009

    Did you ever think that making vaccines more individualized would actually INCREASE herd immunity? and DECREASE risk from both side effects and the diseases they are to prevent against?

    It’s pretty simple concept and a goal envisaged by the top vaccinologists in the country. As much as you seem to love the “one size fits all” protocol, it (and your knowledge surrounding vaccines and autism) is, well, pretty antiquated and not consistent with the knowledge and technology we have gained in the new millenium. Keep fighting the good fight though, you really seem to be making progress!

    It seems like you don’t understand what is meant by “individualized” treatment. What it does not mean is individual doctors arbitrarily experimenting on their patients based upon blind guessing. Individualized treatment means carrying out controlled studies to identify the specific genetic and other factors that influence the risk and efficacy of a treatment, and carrying out further studies to identify what changes in treatment produce better outcomes.

    Numerous controlled studies show that the current vaccination schedule is both effective and associated with a very, very low risk of adverse effects. When one departs from the validated schedule, one is effectively carrying out an uncontrolled experiment on one’s own patients. It is far more likely that the result will be increased risk than that it will be reduced risk.

  35. #35 Joseph
    June 16, 2009

    Stop fighting me. Come to the playground by me, look at the Asian children, look at the other children, then look at the general physical appearance of each group.

    FYI, Happeh – The prevalence of PDD in Japan is 1.81%. See Kawamura et al. (2008). (I do believe they confused “incidence” with prevalence in this paper. Incidence would normally be much lower, depending on the cohort, and the units should be “per year” or something.)

  36. #36 Tsu Dho Nimh
    June 16, 2009

    If a foreign government were suspected of doing something that caused brain problems to 1/166 American children our nation would immediately and vigorously respond…and even go to war!

    If a toy hospitalized 1 in 5 children that played with it, leaft some of them brain damaged, deaf or blind, and killed 1 in a thousand … what would the good doctor recommend? An all-out campaign to get the toy off the market? One would hope so.

    And the “toy” is measles.

  37. #37 Dianne
    June 16, 2009

    If a foreign government were suspected of doing something that caused brain problems to 1/166 American children our nation would immediately and vigorously respond…and even go to war!

    I don’t know…I’d like to think that our government would look carefully at the evidence associated with such an accusation, consider whether the evidence suggested that the accusation merited more than a good laugh (it probably wouldn’t), and (if by some wild chance the accusation looked like it might be true) engage in diplomatic negotiations with the country in question before taking the drastic and irrevokable step of starting a war. Then I look at Bush’s venture in Iraq…

  38. #38 MartinM
    June 16, 2009

    If you are not part of the solution you are part of the ???

    People who say things like “if you’re not part of the solution, you’re part of the problem” are, themselves, part of the problem.

  39. #39 KeithB
    June 16, 2009

    Dr Jay wrote:
    “Even articles in reputable medical journals are often written by doctors with an economic interest in continuing the vaccination program’s status quo. ”

    I think we *all* have an economic interest in preserving the status quo. Giving people the polio vaccine has *got* to cost society a lot less than supporting a bunch of folks in iron lungs for thirty years!

  40. #41 Anthro
    June 16, 2009

    Zar and Kathleen,

    Please don’t bother getting upset at Happeh–he is certifiably insane. Take one look at his site and you will know this. Alas, he is only to be pitied. I wish he would quit posting, but I just skip his posts now.

    Also, Zar, I enjoyed your rant, but it will fall on deaf ears in the case of Happeh–he is quite delusional and probably can’t even process your points.

  41. #42 Uncle Glenny
    June 16, 2009

    If a foreign government were suspected of doing something that caused brain problems to 1/166 American children our nation would immediately and vigorously respond…and even go to war!

    If a foreign government were to kill 1/166 of a population, and 200,000 people were killed, that would indicate a population of over 33 million. Oh! That’s more than the population of Iraq! War, indeed.

    (Sorry.)

    Orac, on the “300 a day” line, that seems well in line with common expressions of frequency, e.g., “nnn women are diagnosed with breast cancer every day”, “Since Obama was elected, a wingnut head explodes every 8 seconds.” I wouldn’t count that against him in that context. Otherwise, heh…

  42. #43 Matthew Cline
    June 16, 2009

    @Zar:

    They are all interested in “Yin” a Chinese philosophical concept, even if they are Korean or Japanese.

    According to Happeh, the various non-Chinese Asian nationalities have a different system with different names that basically amounts to the same thing as Yin Yang, or they encode their knowledge of it into statues/paintings/legends/myths rather than talk about it openly and directly, or they’re keeping it a secret from the rest of the world. (At least, I think that that’s his position)

    If you would actually talk to one of those mysterious Yellow People on the playground, you might find out that Asian kids have neurological problems too. And most of them don’t give a flying fuck about yin.

    According to Happeh, if an average white parent went up and talked to an Asian parent in a playground, the Asian would be able to tell that the white person would be incredulous (or worse) at the idea of the Yin Yang Theory. This would give the conversation’s atmosphere (at best) a strained quality. In order to avoid that, the Asian will avoid talking about the Yin Yang theory to the white parent, because Asians are just that polite. Therefore, the only way for the average white person to gain any insight into Asian parenting techniques is to carefully observe them.

    @Happeh:

    1) The people at places like Age of Autism and Generation Rescue think that the actual rate of autism increased dramatically in the 1990′s (and maybe is still increasing). If you agree, what do you think changed in the 1990′s that caused a problem with Yin?

    2) How can you tell the difference between Asian parents who follow the Yin Yang theory versus “Westernized” Asians who no longer follow it?

    3) Elsewhere, you’ve said that blacks and Hispanics have their own version of the Yin Yang Theory. Why not watch them and their children at the playgrounds? Why only watch the Asians?

    4) I’ve ever only seen you talk about Yin in relation to health problems? Is it just that I’ve never seen you talk about the types of health problems where Yang is involved? Or when you talk about Yin in relation to health problems is it just a shorthand for “Yin and/or Yang”?

  43. #44 Dangerous Bacon
    June 16, 2009

    Orac: “He wants you to believe his assertion, not because he can present any scientific evidence to support it, but rather because…well, he’s Dr. Jay and he said it. In other words, it’s the logical fallacy known as an argument from authority.”

    Hey, he’s an FAAP and gets the magazine and decal and insurance come-ons and everything. Betcha _you’re_not an FAAP.

    When Dr. Jay shows up here to whine about insults directed at his wilful ignorance* (while simultaneously avoiding the three important questions Orac has directed to him), here’s another question for him to duck: In posing as the standard-bearer for parents who’ve been led to believe that vaccines caused their kids’ autism, don’t you feel any remorse for insulting the intelligence and concerns of the vastly greater number of parents who believe in vaccines and utilize them to protect their children from disease, disability and death?

    *in case Dr. Jay wants to further update his website, “Willful Ignorance” would make a nice title as counterpoint to “Respectful Insolence”.

  44. #45 daedalus2u
    June 16, 2009

    Vaccines tuned to a specific person’s genome is what they used to call vaporware. A fictitous perfect (and yet undeveloped) product used to deny market share to an existing good product.

  45. #46 MI Dawn
    June 16, 2009

    @Dangerous Bacon: Thankfully, I don’t believe Orac is a FAAP. Few oncologic breast surgeon/researchers are fellows in the American Academy of Pediatrics. I’d rather worry about one who was…

    Personally, I’m less concerned about what group my doctor is a member/fellow of, and what he knows about the care he provides, the continuing education he attends, and how he listens to me. (Please note: “he” used only because Orac and Dr Jay are both male. I am very well aware of female health care providers!)

  46. #47 kathleen
    June 16, 2009

    Anthro-you are quite right..it is just that sometimes happeh is like an annoying scab that you just have to pick at-even though you know it will cause an infection.

  47. #48 passionlessDrone
    June 16, 2009

    Hello friends –

    I was thinking about some related topics the other night, and thought I’d throw them to the skeptics to see what happened.

    I’m generally in favor of a vaccinated / unvaccinated study, but this might be simply too problematic a goal in the short to medium term for a variety of reasons. I would like to mention, however, that no one seemed concerned about health care seeking biases when the study came out showing that skipping a DTP vaccination resulted in a far greater risk of catching pertussis.

    With a mind towards developing safer vaccines, and concurrently learning more, what about some more studies on how vaccines are affecting the immune system up and above measurements of antibody recognition? What about some studies that attempted to incorporate a time dependent parameter? Such studies need not be concerned with autism per se; but could still give us insight as to potential interactions between vaccination and the immunological findings in autism, as well as a host of other auto immune disorders which we seem to have gotten so much better at detecting in the past twenty years.

    For example, plenty of children miss their regular two month well visit check for one reason or another; parent forgot, they were travelling, flat tire, whatever. What if we were to evaluate cytokine profiles of children coming in for their first vaccines at their four month appointment with children who received their two month vaccines on schedule? Likewise, children whose parents have decided to adopt a spaced out schedule could have their cytokine profiles compared. Or children who receive combination vaccines instead of their single shot equivalents.

    Why might this be useful information? A consistent finding in the autism population is a dysregulated immune response. Likewise, we have several recent animal studies that indicate that early life immune responses can lead to lifelong alterations to the immune response in affected animals; oftentimes in a time dependent manner.

    A common argument made is that such a relationship between vaccines and consequent immune modifications is impossible among the background noise of thousands of daily bacterial and viral exposures. Unfortunately, in the relatively limited suite of studies that measure immunological profiles other than antibodiy production in vaccination, we seem to have evidence to invalidate this assertion.

    Modulation of the infant immune responses by the first pertussis vaccine administrations

    Many efforts are currently made to prepare combined vaccines against most infectious pathogens, that may be administered early in life to protect infants against infectious diseases as early as possible. However, little is known about the general immune modulation induced by early vaccination. Here, we have analyzed the cytokine secretion profiles of two groups of 6-month-old infants having received as primary immunization either a whole-cell (Pw) or an acellular (Pa) pertussis vaccine in a tetravalent formulation of pertussis-tetanus-diphtheria-poliomyelitis vaccines. Both groups of infants secreted IFN-gamma in response to the Bordetella pertussis antigens filamentous haemagglutinin and pertussis toxin, and this response was correlated with antigen-specific IL-12p70 secretion, indicating that both pertussis vaccines induced Th1 cytokines. However, Pa recipients also developed a strong Th2-type cytokine response to the B. pertussis antigens, as noted previously. In addition, they induced Th2-type cytokines to the co-administrated antigen tetanus toxoïd, as well as to the food antigen beta-lactoglobulin. Furthermore, the general cytokine profile of the Pa recipients was strongly Th2-skewed at 6 months, as indicated by the cytokines induced by the mitogen phytohaemagglutinin. These data demonstrate that the cytokine profile of 6-month-old infants is influenced by the type of formulation of the pertussis vaccine they received at 2, 3 and 4 months of life. Large prospective studies would be warranted to evaluate the possible long-term consequences of this early modulation of the cytokine responses in infants.

    Cytokine profile after rubella vaccine inoculation: evidence of the immunosuppressive effect of vaccination

    CONCLUSIONS: Our data indicate that the vaccination with live attenuated rubella vaccine results in moderate but sustained immune disturbance. The signs of immunosuppression, including defective lymphocyte response to mitogene and impaired cytokine production, may persist for at least 1 month after vaccination.

    Cytokine profile and level of antibodies after administration of split-vaccine against influenza to adults

    Analysis of antibody titers 21 days after vaccination compared with baseline levels revealed high immunogenicity of vaccine in terms of mean geometric titers increase as well as sufficient levels of seroprotection and seroconversion. Study of cytokine profile showed absence of significant changes of IFN-gamma, TNF-alpha, IL-2, IL-4 levels and considerable variability of IL-6 and IL-8 baseline levels as well as their dynamics after vaccination. Direct correlation between IL-6 and IL-8 levels was observed during whole period post-immunization.

    Note, I’m not proposing the ‘overloaded immune system’ strawman in regards to possible links to autism, but a more subtle alteration of immune functioning that may persist in certain genetically and/or environmentally predisposed individuals. Clearly, alterations lasting up to two months have been observed, and up to a month in adult populations. If anyone has some studies of common childhood vaccines that show a lack of changes in cytokine profiles after administration, I’d love to see them.

    Learning more about the immunological impact of vaccinations is a worthwhile effort of increasing our basic knowledge set, regardless of if any of the findings are of use in applying towards the surge in autoimmune disorders we may or may not be experiencing.

    - pD

  48. #49 Dangerous Bacon
    June 16, 2009

    “@Dangerous Bacon: Thankfully, I don’t believe Orac is a FAAP. Few oncologic breast surgeon/researchers are fellows in the American Academy of Pediatrics.”

    Yeah, and he doesn’t feel the need to impress us with his membership in a specialty society where only the most basic educational requirements apply and membership is guaranteed if you pay the dues.

    But I suppose I should lay off belaboring Dr. Jay’s pitiful attempts to augment his credibility, and stick to skewering his nutty ideas and lame attempts at ad hominems.

  49. #50 Happeh
    June 16, 2009

    Orac you coward. Don’t think I did not see your post. I know you are here and read my post.

    Stop acting like you have a vagina. You wrote a hit piece on me. You challenged me. I am here to take up the challenge.

    Oh wait! Maybe I should ask a question first? Does Orac really have a vagina? I mean is Orac a female in real life?

    That would explain his weak behavior.
    ——–

    Agoraphobic – “Happeh is now invading children’s playgrounds trying to teach them about their Yin?

    Should the authorities be notified?”

    I made a bet with myself that some piece of filth would say this. Congratulations Agoraphobic. You win.

    Anybody that knows Agoraphobic should watch their children around him. People that can ruminate publicly about child anything probably fantasize about it. That is why they make the response they do.

    If Agoraphobic didn’t fantasize about children, he would have made some other comment.
    ——-

    Zar – “You racist. You fucking racist.”

    Sorry. Many people before you have tried the “accuse of racism” gambit before. It doesn’t work because it is stupid. Only cattle fall for it.

    ————

    Kathleen – “I have just about fucking had it with happeh-Oh I guess my kids are ignoring their yin? Happeh-you ARE a troll and exceptionally insulting.”

    This is an example of a western female. Publicly saying “fucking had it” to a total stranger.

    You are not a woman. You think you are a man because the people who control your society are destroying the female motherly womanly aspect of women to destroy the society. The people who control your society are training you and the other females to be men.

    You are one of their success cases.

  50. #51 Enkidu
    June 16, 2009

    @ababa

    WOW that thread is full of crazy. The only word to describe those moms is paranoid…

  51. #52 Happeh
    June 16, 2009

    I wish the thinking people talked more. It is not pleasant to read the low thinkers rants, knowing that the high thinkers are sitting their watching because they do not want to be involved. I think the high thinkers should help me with the low thinkers, but everyone has the right to do what they want.

    For you high thinkers sitting there watching quietly? Since you are the more intelligent, there is more liklihood you will be able to understand me.

    I have created something for you to think about. The creation involves human evolution. Something I know scientists love to talk and think about. If you have some brains, you will be thinking about this for a long time. If you have a lot of brains and figure it out immediately, it will change your life.

    http://www.happehtheory.com/OracPicture02.png

    I made the picture big enough for the child like readers of Orac’s blog. For some reason big pictures seem to get thru where small print requiring thinking does not.

    Be warned. I mean really big picture. 1400 X 1000 or so. Don’t be surprised if it takes awhile to load depending on your internet connection.

    If you are intelligent, this will challenge your intelligence. Please don’t let the low thinkers, the haters, or Orac, tell you what to do and determine your intellectual future, by heeding their advice to ignore me.

    You will gain nothing by obeying them. You will only hurt yourself.

  52. #53 BA
    June 16, 2009

    Happoe is mad, don’t make happoe angry, you wouldn’t like happoe when happoe is angry.

  53. #54 JMG
    June 16, 2009

    Great post as usual, Orac, but I really have to comment regarding:
    If you have a lot of brains and figure it out immediately, it will change your life.

    Really? Really. You cut up some picture in paint, and made some half-baked remarks, ergo evolution is false. And you think this has any meaning, to anyone, at all. Really.

  54. #55 K
    June 16, 2009

    Re: the posts talking about unvax kids and autism, sort of related… I just heard an explanation for this in one family’s experience…

    I recently heard a mom at a seminar stand up and say she has 3 children who are “severely autistic.” First is fully vaccinated, 2nd is partially vaccinated, 3rd is completely UNvaccinated.

    She said Dr. Wackfield himself found vaccine-strain measles virus in the gut and esophagus of all three of her children. She explained the unvax child had “caught” it from the vaccinated one by sharing drinks, etc…

    The room was full of physicians. Not one person challenged her. I wanted to ask her what she had to pay to get this evaluation by Wackfield, and how she could possibly believe anything he “found” given his questionable scientific history, but I knew it would be a waste of everyone’s time.

    To argue with a man who has renounced the use and authority of reason is like administering medicine to the dead.
    -Thomas Paine

  55. #56 David M.
    June 16, 2009

    Dear Woo Dude:

    Glad to see you are still ringing that same old bell that autism is actually caused by genetics and that the huge spike in the last 20 years is due to better diagnosis. Also, glad to see you are breaking new ground on your blog by going after AofA and the Huff Post.

    (Excuse me, I just yawned for some reason.)

    Anywhoo, did you happen to catch the big study that just came out that basically shot down the belief that major mental illness is caused by genetics.

    Dude, it was in all the papers and on the internets. I know you were probably busy watching Oprah or making fun of Jenny’s hairdo or something so I am including a bit of some of the coverage so you can catch up and maybe do a fresh blog on ACTUAL medical news. (That would be cool, man)

    From an article in Forbes:

    “A giant new study found that one of the few genes widely thought to boost depression risk under stressful circumstances actually does nothing to cause the disease…The null findings provide a sobering illustration of just how difficult it will be to find genes that boost risk of major mental disorders such as schizophrenia, depression and bipolar disorder. Numerous risk genes that have been touted in small initial studies haven’t been confirmed by larger studies. The hope is that finding genes that cause psychiatric disorders will lead to a new generation of personalized medicines, or at least tools to pinpoint patients at risk. But for now, that seems far off.”

    Wow that is interesting, talking one scientist to another. Don’t you think, Woo Dude. Dude?

    Now, it wouldn’t be prudent to conclude that maybe genetics has nothing to do with mental health problems, like…wait for it…autism. But kinda makes you think. If this genetics thing has just been disproved in mental illness than maybe everyone is wasting their time saying that autism is genetic. Maybe they should look elsewhere.

    (WAIT – I’m sorry, I cannot make a conclusion like that without full scientific study. I cannot say that something is true unless there is a range of scientific studies to support this. My bad, Woo Dude.)

    (Long Pause, clouds rolling by, birds chirping)

    Hey if I can’t say something is true unless there is a full scientific study behind it then how can anyone say that the 36 vaccines given to children in the US don’t cause autism. Those 36 vaccines have never been tested. Sure two have but not all 36.

    Hey Woo Dude, I think you should look into all this after you finish watching Oprah tomorrow.

    I will check back when I get back from the lab.

  56. #57 Mu
    June 16, 2009

    But that’s great news, I don’t understand why Wakefield doesn’t publish it. If the vaccine strain is transmitted directly from human to human we don’t need to worry about herd immunity anymore, it will be self propagating.

  57. #58 HCN
    June 17, 2009

    David M. said “Anywhoo, did you happen to catch the big study that just came out that basically shot down the belief that major mental illness is caused by genetics..”

    Instead of being incredibly annoying to the point of aggravating stupidity, why don’t you provide the journal, title, author and dates of the paper or PubMed link to the study in question? Forbes is not a science publication.

  58. #59 Orac
    June 17, 2009

    Glad to see you are still ringing that same old bell that autism is actually caused by genetics and that the huge spike in the last 20 years is due to better diagnosis. Also, glad to see you are breaking new ground on your blog by going after AofA and the Huff Post.

    (Excuse me, I just yawned for some reason.)

    Several thousand readers a day would disagree with you. However, argumentum ad populum aside, no one’s forcing you to read my stuff. Don’t like it? Find it boring? It’s no skin off my nose; don’t read it.

    Anywhoo, did you happen to catch the big study that just came out that basically shot down the belief that major mental illness is caused by genetics.

    I’m with HCN on this one. Not only didn’t you supply the link even to the Forbes article (which, as HCN points out, is not a science journal), but you didn’t supply a link to the peer-reviewed scientific article that reported the results. If you really want me (or anyone else) to go to the trouble to read the study, you should do us the common courtesy of supplying a PubMed link or at least a citation including the authors, journal, title, and year of the publication.

    In any case, even from the brief excerpt you provided, the study hardly sounds as though it “shot down the belief that major mental illness is caused by genetics.” No single study could do that, anyway.

  59. #60 HCN
    June 17, 2009

    David M., since we have had to deal with real mental illness in our extended family (schizophrenia, which effects 1 out of 100, even more than autism!), I don’t find you humorous. Especially since one of my children is now showing signs of the same illness.

    So put up, or shut up. Or at least stop acting like an idiot.

  60. #61 Skemono
    June 17, 2009

    Since I doubt David M. would put up and supply us with a study to read, I went to Forbes.com to see whether I could find the article in question, and the study referred to. I tried searching for “autism”, which was my first mistake, because the article David touts says nothing about autism. The original scientific paper that the Forbes article discusses appears to be this.

    But anyways, when searching for what Forbes says about autism, I found this:

    Studies of autism in twins encouraged scientists to look for a hereditary explanation. Today the strongest evidence supports a genetic theory, most likely with an additional environmental factor that interacts with the risk genes. In a study to be published later this year by Baron-Cohen and a former graduate student, Bhismadev Chakrabarti, the authors identify nine genes as being associated with autistic traits.

    Yeah, that’s devastating to Orac’s case here.

  61. #62 Matthew Cline
    June 17, 2009

    @Happeh:

    Since Orac doesn’t want people responding to you here in his blog, I’ve left my latest response to you at your own blog.

  62. #63 sad
    June 17, 2009

    My Challenge to you Pro-Vaxers:

    In a few weeks, most likely the fast-tracked, no trials, no controlled studies, H1N1 vaccine will be available. I would like you ALL to go and get that vaccine and post a photo of it as well as a signed affidavit from a doctor that you have gotten the vax.

    Ok, now off with you all on your little assignment.

  63. #64 Happeh
    June 17, 2009

    Orac is a rude individual who talks nasty about other people behind their back. Then when those people show up on Orac’s doorstep to have a discussion with Orac about his nastiness, Orac runs away and hides.

  64. #65 Matthew Cline
    June 17, 2009

    @K:

    She said Dr. Wackfield himself found vaccine-strain measles virus in the gut and esophagus of all three of her children. She explained the unvax child had “caught” it from the vaccinated one by sharing drinks, etc…

    I wonder if any anti-vaxers who never vaccinated their kids will ever try to sue vaccine manufacturers for making live attenuated virus vaccines. Or maybe even sue parents who used attenuated vaccines. Would suits like that have to go through the Vaccine court? (Assuming they weren’t thrown of court out by a judge before the suit even got started)

  65. #66 idlemind
    June 17, 2009

    Wow, Happeh, paranoid much? Of course, it’s all about you.

    Given that it’s now about 5am in his time zone, I suspect Orac has been asleep whilst you’ve been ranting.

  66. #67 Orac
    June 17, 2009

    Orac is a rude individual who talks nasty about other people behind their back. Then when those people show up on Orac’s doorstep to have a discussion with Orac about his nastiness, Orac runs away and hides.

    More like: Orac is bored with you, Happeh. To tears. You were amusing for a while, but no more.

  67. #68 D. C. Sessions
    June 17, 2009

    Orac is bored with you, Happeh. To tears. You were amusing for a while, but no more.

    Word of the day: extinction.

  68. #69 Joseph
    June 17, 2009

    I would like to mention, however, that no one seemed concerned about health care seeking biases when the study came out showing that skipping a DTP vaccination resulted in a far greater risk of catching pertussis.

    @pD: There are a couple reasons for that: (1) The odds ratio was, you know, 23; (2) It’s entirely plausible and expected.

  69. #70 Vindaloo
    June 17, 2009

    Between happeh and David M. the crazy, the bigotry, and the idiocy runs rampant in this thread.

    Does David M realize just how stupid this makes him sound:

    Hey if I can’t say something is true unless there is a full scientific study behind it then how can anyone say that the 36 vaccines given to children in the US don’t cause autism.

    The real problem is that there is no full scientific study proving that werewolves don’t cause autism. Was there a full moon when David M posted?

  70. #71 Joseph
    June 17, 2009

    Now, it wouldn’t be prudent to conclude that maybe genetics has nothing to do with mental health problems, like…wait for it…autism.

    Prudent? How so? In order to rule out genetics, you’d need a pretty good alternative explanation for the results of twin studies, sibling studies, and parental age studies.

  71. #72 Orac
    June 17, 2009

    @pD: There are a couple reasons for that: (1) The odds ratio was, you know, 23; (2) It’s entirely plausible and expected.

    Indeed. And the authors took the possibility into account, concluding that, whatever effect there might be was small compared to a RR=23:

    http://scienceblogs.com/insolence/2009/05/one_more_time_vaccine_refusal_endangers.php

  72. #73 passionlessDrone
    June 17, 2009

    Hi Joseph –

    But the odds ratio wasn’t known until after the analysis was complete. Many times, I’ve had people tell me that the healthcare bias choice is such a huge confounding effect that there is no point in performing a vaccinated / unvaccinated study in the first place; we’d never be able to place any confidence in the numbers.

    I would agree that an increased risk based on skipping the vaccine would be completely expected.

    - pD

  73. #74 Joseph
    June 17, 2009

    Many times, I’ve had people tell me that the healthcare bias choice is such a huge confounding effect that there is no point in performing a vaccinated / unvaccinated study in the first place; we’d never be able to place any confidence in the numbers.

    The study would not have ideal methodology, so whatever the results, there could always be reasonable doubt. But if the RR is 23, and the confidence interval is not insanely huge, that’s different.

    The thing with the unvaccinated vs. vaccinated study is that in order to find a good number of completely unvaccinated children, it would have to be a US-wide study. US states vary considerably in their vaccine uptake, and they also vary considerably in, say, their autism counts in special education.

    One expensive way to control for this is to blindly screen all children for ASD, instead of relying on existing diagnoses. There are confounds that would be difficult to control for, though (e.g. genetics.)

  74. #75 Scott
    June 17, 2009

    Anywhoo, did you happen to catch the big study that just came out that basically shot down the belief that major mental illness is caused by genetics.

    A giant new study found that one of the few genes widely thought to boost depression risk under stressful circumstances actually does nothing to cause the disease

    Besides the points that have already been made, I’d like to point out the complete illogic on display here. “One particular gene apparently doesn’t increase the risk of depression after all” has somehow turned into “no mental illness has a genetic link”. And that’s not even going into the question of whether or not autism is properly described as a mental illness in the first place!

  75. #76 Robin Levett
    June 17, 2009
  76. #77 Dangerous Bacon
    June 17, 2009

    I’ll have to read that study about vaccine(s) supposedly altering immune function for the worse (at least temporarily). Have to wonder, though – if stimulating the immune system in kids with relatively small amounts of antigen in vaccines is so bad, what’s the consequence of a full-blown assault on the immune system through a succession of vaccine-preventable diseases, with vastly greater amounts of wild-type antigen? Seems like your cytokines would really get walloped in that case.

    But of course, disease and death are “natural”.

    (senses a giant hook coming in from the wings to snag happeh off the stage).

  77. #78 David M.
    June 17, 2009

    Back from the lab and see that many on this site can’t do searches on Google News. (And I thought this was a high tech crowd. My bad.)

    Anywhoo, here is the link to the NYT story on the big study I talked about. Very interesting. Even on the home page of the NYT.com

    http://www.nytimes.com/2009/06/17/science/17depress.html?hp

    And Orac as for your site and its popularity…Well, let me put it this way. McDonald’s sells a lot of hamburgers every day, but that doesn’t mean they make the best hamburgers.

  78. #79 Orac
    June 17, 2009

    I never said my popularity did necessarily indicated quality (although in this one case it actually does). However, what my popularity does mean that I really don’t care if someone like you doesn’t like me or not or if you find my writing educational or entertaining or not. Actually, come to think of it, even if I still had the traffic level I originally had when I started this blog (i.e., very little), I probably wouldn’t care if someone like you likes me or not or if you find my writing educational or entertaining. I’m just that crotchety.

    As for your article, my goodness, you make a huge extrapolation from one study! One gene thought to be involved in depression didn’t pan out; so you conclude that mental illness has no genetic basis. Scott’s right.

  79. #80 Scott
    June 17, 2009

    It’s even worse than I thought! The article doesn’t even say what he claims it does.

    The new report, by several of the most prominent researchers in the field, does not imply that interactions between genes and life experience are trivial; they are almost certainly fundamental, experts agree.

    But it does suggest that nailing down those factors in a precise way is far more difficult than scientists believed even a few years ago, and that the original finding could have been due to chance.

    So we’ve got citing a newspaper article to as saying something which it directly contradicts, grossly overgeneralizing that, and then claiming that it somehow completely dismisses a mountain of high-quality studies. Truly, the crazy is strong with this one.

  80. #81 Joseph
    June 17, 2009

    @David M: You seem to be the only one here who does not see the utter lack of logic in your argument. The fact that a gene has been found to not be associated with depression after all is not evidence that depression does not have a genetic component. The heritability of conditions is not measured by how successful scientists are at finding alleles that associate with them. (Incidentally, Jake Crosby often makes the same reasoning mistake.)

    It’s also completely irrelevant to autism. There’s nothing to suggest that if one psychiatric condition is heritable, all must be heritable, or the other way around.

  81. #82 Robin Levett
    June 17, 2009

    @David M #77:

    How’s that reading in Nature going?

  82. #83 daedalus2u
    June 17, 2009

    I have a question for Dr Jay about comment censorship moderation when you writes something for HufPo. Who decides and using what criteria whether a comment is accepted or censored rejected?

    I understand that is a simple question that the HufPo overlords may not allow you to answer because it would reflect on the reliability and objectivity of HufPo as a news source.

  83. #84 Jay Gordon, MD, FAAP
    June 17, 2009

    Real science lives, breathes and changes. It accepts that today’s ideas and hypotheses might be cast out and disproved tomorrow. Your science, as you so aptly put it, ORAC, is just “crotchety.”

    This morning’s hike ended with a nice conversation with my nearly-89-year-old friend John, a geology professor Emeritus at UCLA. He reminded me, “The best geologist is the one who has seen the most rocks.”

    All of you here have little except numbers, nastiness and no real experience or wisdom to back up your sterile beliefs. Get away from the keyboard and have a look at the problems in the pediatric community. You’ll see why some of us are willing to support yet-unproven hypotheses, weather your viscious ad hominem opprobrium and move on to try to help children. You just sit there and quote hidebound old numbers. Shame on you for being so narrow-minded.

    Best,

    Jay

  84. #85 Vindaloo
    June 17, 2009

    David M. – your water closet isn’t considered by scientists to be a lab of repute.

    A little help for you – snark is warranted when you’re right… you’re not.

  85. #86 dedicated lurker
    June 17, 2009

    I know a woman who has triplets, all unvaccinated. She has a nephew who died six months or so after his MMR and she and his mother blame the vaccine. (I don’t know if there’s even a remote chance of this, because I know nothing about how he specifically died.) She decided to forgo vaccines after that. She has four vaccinated children.

    Guess which three all have autism.

    All the vaccinated ones seem to be doing fine. She refuses to accept the diagnosis of one of the triplets and screams it’s just prematurity despite the fact the kid’s almost four. One of the triplets was hospitalized for pertussis. She still won’t vaccinate and still thinks they cause autism.

  86. #87 Scott
    June 17, 2009

    Real science lives, breathes and changes. It accepts that today’s ideas and hypotheses might be cast out and disproved tomorrow.

    Yet when YOUR ideas are disproved, you cling to them even more tightly, refusing to even consider that you might *gasp* actually be fallible! Who it it that’s narrow-minded again?

  87. #88 Joseph
    June 17, 2009

    Real science lives, breathes and changes. It accepts that today’s ideas and hypotheses might be cast out and disproved tomorrow.

    Exactly, Dr. Jay. A good example is the thimerosal hypothesis. It was studied. Precautions were taken even in the absence of evidence. Predictions were made, which subsequently failed.

    Have you moved on from that hypothesis, Dr. Jay, as “real science” is supposed to do? Or perhaps the following applies to you:

    Shame on you for being so narrow-minded.

  88. #89 KeithB
    June 17, 2009

    What does your friend think of Steve Austin? He has seen a lot of rocks.

  89. #90 Joseph
    June 17, 2009

    Also, why should Dr. Jay’s personal experience in pediatrics be more relevant in terms of knowledge of autism epidemiology than that of, say, an autism expert like Simon Baron-Cohen or Lorna Wing, or an autism epidemiologist like Eric Fombonne, or an anthropologist like Roy Richard Grinker who has traveled around the world to study the issue?

  90. #91 Scientizzle
    June 17, 2009

    Dr. Gordon @ 83:

    …some of us are willing to support yet-unproven hypotheses…Shame on you for being so narrow-minded.

    Orac and others are narrow minded because they refuse to accept unproven hypotheses? Dr. Gordon, how did you get a medical degree without even studying science? This is a mind-numbingly stupid statement.

    I have a hypothesis: the activities of anti-vaccine enablers like Dr. Gordon are directly contributing to greater suffering and death via preventable communicable disease. There is some data to support this hypothesis, but it’s not proven, I suppose. Would Dr. Gordon be narrow-minded if he refused to accept this hypothesis?

  91. #92 LibraryGuy
    June 17, 2009

    Dr. Jay: “You’ll see why some of us are willing to support yet-unproven hypotheses…”
    And treat children accordingly? Now that’s scary.

  92. #93 Happeh
    June 17, 2009

    Orac – “More like: Orac is bored with you, Happeh. To tears. You were amusing for a while, but no more.”

    Keep trying to obfuscate Orac.

    Orac attacked Happeh for no reason other than maliciousness. Happeh did nothing to Orac to provoke Orac’s assault.

    When Happeh knocked on Orac’s door to have a talk with him about the bad stuff Orac said, Orac locked the door and ran for his mommy.

    Don’t try to change the story Orac. You are not bored. You are sucking on Momma’s teat and crying in fear.

  93. #94 UnHappeh
    June 17, 2009

    Happeh no like Orac. Orac mean. Only smart people understand Happeh. Happeh speak in third person needlessly. Now Happeh make thinly-veiled allusions to racial superiority and won’t hold back on blatant sexism.

    Fools! Happeh will show you all! Happeh is invincible!

  94. #95 KeithB
    June 17, 2009

    Happeh is Zathras. This explain much. But at least there is symmetry.

  95. #96 Orac
    June 17, 2009

    Ha! That made me laugh so much that I decided to leave my response to Dr. Jay’s comment above for later on today or sometime tonight…

  96. #97 passionlessDrone
    June 17, 2009

    Hi Dangerous Bacon -

    Have to wonder, though – if stimulating the immune system in kids with relatively small amounts of antigen in vaccines is so bad, what’s the consequence of a full-blown assault on the immune system through a succession of vaccine-preventable diseases, with vastly greater amounts of wild-type antigen? Seems like your cytokines would really get walloped in that case.

    This is true. But several animal studies on early life immune activation indicate that there is a time dependent effect; animals challenged during certain time periods show persistent modifications to immune functioning, behaviors, or stress response whereas animals challenged later in life do not show the same changes.

    For examples see:

    Early-life immune challenge: defining a critical window for effects on adult responses to immune challenge.

    Neonatal immune challenge exacerbates experimental colitis in adult rats: potential role for TNF-alpha

    Postnatal Inflammation Increases Seizure Susceptibility in Adult Rats

    All of these studies have been published in the past few years; there are many, many others on the effect of early life immune activation that show striking differences into adulthood, but do not have concurrent animals which received treatments during different timeframes.

    Very, very few children in the past had Hib, diptheria, tetanus, pertussis, polio, rotavirus, and hepatitis b in their second month of life; these days the chances that we’ve initiated an immune response to these diseases by that timeframe hovers well over 90%. I’m not certain we are clever enough to tinker around with the immune system during this timeframe without having unintended consequences.

    Even if we accept that the innate immune response is less robust in vaccination that wild infection, that still doesn’t mean we understand the impact up and above not getting the disease. Considering the fact that our particular subset of children have been shown to generate much more robust innate immune responses than their non diagnosed peers, making assumptions of no effect strikes me as intellectually lazy.

    Also, it isn’t just about counting antigens; wild antigens don’t come alongside alum to insure a robust immune response.

    - pD

  97. #98 passionlessDrone
    June 17, 2009

    Hi Joseph -

    I agree with what you have written.

    One way that we may be able to identify children who are unvaccinated may be to start by look for kids that have been admitted for pertussis. This, of course, would potentially introduce other confounds, but perfect is the enemy of good.

    - pD

  98. #99 Dangerous Bacon
    June 17, 2009

    Dr. Jay, FAAP says: “You’ll see why some of us are willing to support yet-unproven hypotheses, weather your viscious (sic) ad hominem opprobrium and move on to try to help children. You just sit there and quote hidebound old numbers.”

    Dear Dr. Jay, you’re ignoring content again to complain about “opprobrium” and unspecified “hidebound old numbers”. Where are your responses to Orac’s questions (see above), summarized as follows:

    “You say you want safer vaccines. OK then, please, define for us exactly what you would define as “safe enough.” Be very specific…You castigate vaccines for having “toxins.”…what “toxins” would you remove? Be specific, and provide evidence that these “toxins” actually cause harm.
    What specific evidence would it take for you to accept that vaccines are safe relative to the risk of disease and to start recommending that your patients vaccinate other than “reluctantly.”"

    And I’d like an answer to my question: if we are (as you claim) insulting parents of autistic children who blame vaccines, aren’t you insulting the far greater number of parents who believe in protecting their kids with vaccines and don’t buy into your fearmongering? Don’t those parents deserve your respect?

    And what aspect of your training led you to put absolute faith in anecdotes rather than “hidebound old numbers”? When I was in medical school we had at least some exposure to means of critical thinking and analyzing published research. Did your school fail you in this regard? Did they teach you to prescribe drugs and utilize treatments on the basis of testimonials, or did you develop this conviction through your 30 years of practice?

    C’mon Dr. Jay, here’s your chance to rise above ad hominems and participate in an actual informative and science-based debate.

  99. #100 l'asperge
    June 17, 2009

    “You’ll see why some of us are willing to support yet-unproven hypotheses, weather your vicious ad hominem opprobrium..”

    It’s called “taking one for the team.” Negative peer review is the price of admission to your loopy social circle. You’ve sold out, doc. Deal with it.

  100. #101 Karl Withakay
    June 17, 2009

    “The best geologist is the one who has seen the most rocks.”

    And this is true because it has a folksy sound to it and an 89 year old geologist said it?

    I submit that that statement is invalid in the first place, argument by authority, argument by assertion, and applying it to anything other than geology is essentially an argument by analogy, and therefore not logical support for your position.

    Stephen Hawking hasn’t spent very much time behind telescopes, so I guess he can’t have too much worth saying about cosmology as compared to Phil Plait. (With all due respect to the awesome Bad Astronomer.)

  101. #102 D. C. Sessions
    June 17, 2009

    All right, I think Jay has won me over. Parent’s really are the ultimate authority on the diagnosis and treatment of their children. Jenny really is right about the cause and treatment of Evan’s autism, for instance.

    “Mommy instinct” trumps all the studies in the world.

    I’d write more, but my neighbor is going to need help beating out the demons which caused her daughter’s diabetes. Maybe later.

  102. #103 Stu
    June 17, 2009

    No D.C., it’s only FAAPs with thousands of years of experience like Jay that know best I think.

    (Am I the only one continuously amused by FAAP? I cannot help but hearing a loud, long, cartoonish farting noise).

  103. #104 Travis
    June 17, 2009

    Stu, you are amused in a much better way than I am. It always makes me think about masturbation. Sure, normally one only uses one ‘a’ but it is close enough.

  104. #105 Stu
    June 17, 2009

    Oh great Travis…

    Maybe it is better to keep these things to oneself.

    FAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAP!

  105. #106 howzbayou
    June 17, 2009

    Actually “fap” is used in Japanese manga as an onomatopoetic word for the sound of male masturbation.

    Think — “OOF!” “EEGAH!” “FAP! FAP! FAP”

  106. #107 anon
    June 17, 2009

    I’m not certain we are clever enough to tinker around with the immune system during this timeframe without having unintended consequences.

    Neither am I pD. It’s well established that the infant immune response in animal models is easily aggravated. While extrapolation from animals/rodents to humans has its own limitations, it is certainly worthwhile to determine (or at least care) if human infants are being stimulated to damaging degrees.

  107. #108 Dedj
    June 17, 2009

    A quick analysis of the publication history of Dr Jay’s alledged friend indicates that he has clearly spent a lot of time literally ‘in the field’. However, he has also backed this up with analysis, time in the lab, time spent number crunching, and time at the shelves, always relating his findings to theory.

    He is, in essence, the very worst person Jay could quote in his defence.

    I’m sure One Click, JABS, AoA and the rest will be glad to hear that Dr Jay thinks thier posistion is unproven.

  108. #109 RJ
    June 17, 2009

    “it is certainly worthwhile to determine (or at least care) if human infants are being stimulated to damaging degrees. ”

    And what would you expect to see/measure if the immune system is stimulated to damaging degrees?

    Also, do you think vaccines (your topic of ‘concern’) stimulate to damaging degrees more so than diseases? Why would you think this?

  109. #110 IAMB
    June 17, 2009

    @ Travis #104

    Thank the FSM… I thought it was just me for a moment there…

  110. #111 passionlessDrone
    June 17, 2009

    Hi RJ –

    And what would you expect to see/measure if the immune system is stimulated to damaging degrees?

    Well, what about cytokine profile measurments that I described in post 48 for a start? Whether or not this is ‘damaging’ would be difficult to determine with this type of study; but at least we’d be learning more.

    Children who showed markedly different levels of cytokines post vaccination (if there were any) could be followed to evaluate for subsequent development of autoimmune disorders, seizure disorders, or autism. When financially feasible, children with polymorphisms common to autism (or autoimmune disorders) and immunological function (i.e., MIF, HLA-###, PTGS2, etc) could be compared with children without these polymorphisms to determine the difference in innate immune response.

    This type of study would provide us with basic knowledge about the immunological effect of vaccination up and above antibody generation. Don’t you think this would be valuable information to have?

    Also, do you think vaccines (your topic of ‘concern’) stimulate to damaging degrees more so than diseases? Why would you think this?

    There is a possible time dependent effect that this question does not address. See my post at # 97 for some studies wherein researchers have identified differential effects based on the timing of an insult and consequent immune or behavorial changes into adulthood.

    Likewise, our well meaning efforts to move the age of measles vaccination up to 9 months a while ago revealed that while you could generate an immune response at earlier ages; it did not come without consequences, much higher rates of morbidity were reported, and some subsets of children were found to have profoundly altered regulatory cell populations two years after early life, ‘high titer’ vaccinations. The infant immune system is a lot different than that of an adult, or an older child; we ignore this realty at our peril.

    - pD

  111. #112 notmercury
    June 18, 2009

    Hi pD, I thought you might enjoy reading this.

    http://jop.sagepub.com/cgi/content/abstract/23/5/567

    Is OCD an immune disorder or are immune differences an effect of OCD?

  112. #113 Joseph
    June 18, 2009
  113. #114 RJ
    June 18, 2009

    pD,

    Cytokine profiles will not tell you much. Cytokines profiles are expected to vary after vaccination (that’s part of the immune system doing what it is supposed to do, the way it does it) but establishing a correlation with variations within among specific cytokines and adverse events is not going to tell you much. I can tell you, from first had experience, that cytokine profiles vary widely among individuals, as do the kinetics. What you suggest might be a worthy project for a graduate student, but for use in a public health setting, costing thousands of dollars per patient, it isn’t going to provide any useful information. If my experience is worth anything, my team and I (like many at hundred of companies around the world) look at cytokine/chemokine expression following immune insult on a daily basis. There is no way we could make rhyme or reason out of a snap-shot profile of any one or large selection of Cyto/chemokines and disorders down the line. They do not equate.

    As for your second portion…I guess I just disagree. Citing specific instances that were identified in large-scale studies, and then falling back and making a generalization with other ramifications is not the way I would see it. The main differences between the infant and adult immune system is experience…the changes that have ensued in the adult are a consequence of exposures over time. The functions of the innate immune system are very much alike, however, it is the status of acquired immunity that is significantly different. The whole point of immunizations is to provide similar exposures to the infant, which is primed and anticipating the infections it has to deal with on a constant basis, without causing the diseases themselves. Basically, directing the infant immune system toward the same state as an adult in a safer manner.

    Hope this is food for thought.

  114. #115 Jay Gordon, MD, FAAP
    June 18, 2009

    Thank you all for elevating this conversation beyond a discussion of the safety of children into the realm of bodily function noises. Too cool.

    Best,

    Jay

  115. #116 RJ
    June 18, 2009

    “Thank you all for elevating this conversation beyond a discussion of the safety of children into the realm of bodily function noises. Too cool.”

    You’re welcome, phony. I suppose I shouldn’t be courteous and answer someones question then, is that right? The topic was profiling potential markers to see if a correlation could be determined, a process that (in theory) could be beneficial for children. But, I think your 3rd-grade level response just goes to reinforce what most of us here have known all along…you are not Jay Gordon. But, hey! If this little fantasy is what keeps your little wiener hard, then have at it spanky!

  116. #117 passionlessDrone
    June 18, 2009

    Hi notmercury & Jospeh –

    Great stuff. Thank you for the links.

    Detangling the causal nature of immune dysregulation in neurological disorders is difficult; but we do seem to keep on finding similar properties in a variety of conditions.

    However, I think that you run the risk of greatly over simplifying the the breadth of immune related findings in regards to autism by simpy pointing out that other neurological conditions share immune abnormalities.

    For example, this paper,

    http://pediatrics.aappublications.org/cgi/content/abstract/122/2/e438?rss=1

    tells us that having polymorphisms known to be associated with other inflammatory autoimmune disorders is associated with a risk of autism. Unless we can posit a mechanism by which having autism can cause you to have a specific polymorphism, the direction of this relationship seems pretty clear. Furthermore, as circulating levels of the end product increased, so too, does the severity of autistic behavior by several measures. The substance in question, macrophage migration inhibitory factor, is a known upregulator of the toll like receptors and the consequent innate immune response; this would seem to be very much in line with what we have observed concerning the increased robustness of the innate immune response in the autism population compared to the non autism population. By several avenues, having an increased innate immune response has been associated with autism.

    But what can also be seen is that the same relationship appears if we look from the direction of resolving the immune response as well. For example, this paper:

    http://www.ncbi.nlm.nih.gov/pubmed/18762342?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

    tells us that having decreased levels of TGF-Beta1 is associated with autism, and in this instance, as levels decrease, autistic behaviors are more severe. Animals who have tgf-beta1 blocked quickly develop autoimmune inflammatory conditions, and immunomo-regulatory effects of TGF-Beta1 have been shown clinically in several studies.

    So it seems that having problems regulating inflammation; either with an increased response, or a decreased ability to resolve that response are associated with autism. Do either of you (or anyone else) have any ideas on mechanisms by which having autism could cause these types of findings that leaves our observations of altered immune function as a bystander side effect, as opposed to a contributing factor?

    Speaking more directly towards the question of OCD, it just so happens, having known promoter genes responsible for increased production of tnf alpha is associated with an OCD diagnosis:

    http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T0G-4SYTCCJ-3&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=d6c928c64a6e64006a7fd2a5e3e56161

    It would seem that, at least in part, a predisposition towards an more robust inflammatory response heightens your risk of OCD. The same allele is associated with a diagnosis of schizophrenia:

    http://www.nature.com/mp/journal/v6/n1/full/4000815a.html

    I’m sure there are others. Please consider the magnitude of the coincidence necessary for these findings all to be spurious, and indeed, an altered immune response and association of alleles was simply a byproduct in all of these cases. (That particular polymorphism has been evaluated for in one study that I know of in autism with no associations found.)

    Finally, I’m not at all opposed to the idea that other components of having autism, especially the highly altered stress response, could interact with the immune system resulting in a feedback loop capable of causing problems. We have a growing body of research showing that physiological stress and immune function are tightly coupled and capable of synergistic effects. Certainly OCD and PTSD would seem to make sense logically here.

    It is well and good to point out the complexities of the interactions between behavior and immune function; in fact, it is precisely that large block of unknown interactions that causes me so much concern over the fact that our existing studies bypass the commonalities of all vaccinations and instead focus on a single vaccine, or a single vaccine ingredient, and armed with this tiny slice of analysis, we have declared there is no relationship. But acknowledging this complexity does nothing to make our existing research concerning vaccination more detailed.

    - pD

  117. #118 Pablo
    June 18, 2009

    Wow, Dr. Jay has taken his ball and run again? Or is this just another trying to hide behind the “someone was mean to me” curtain as an excuse for not addressing anything of substance?

    BTW, recall I told you all a couple of weeks ago that Dr. Gordon has no interest in science, and he again demonstrates that. I love the approach this time, in the “Science has the possibility of being wrong, so we can’t ever assume it is right” line.

    As for the “the best geologist has seen the most rocks” nonsense, can we apply it to other things, too? “The best chemist has seen the most chemicals”?

  118. #119 James Sweet
    June 18, 2009

    The best electrician has seen the most sparks.

    The best blogger has seen the most trolls.

    The best nutritionist has eaten the most food.

    The best pediatrician is the youngest one.

    The best physicist is the one who is most physical.

    The best football player is the one who owns the most footballs.

    The best author is the one who has written the most/longest books.

    The best meteorologist is the one whose seen the most meteors.

    The best president is the one whose run the most countries.

    The best spouse is the one whose been married the most times.

    The best lawyer is the one who has committed the most crimes.

    The best prison warden is the one with the most prisoners.

    Hey, this is actually kindof fun!

  119. #120 James Sweet
    June 18, 2009

    Argh, excuse my inappropriate use of “whose”.

    The best grammar nazi is the one who has made the most grammatical mistakes!

  120. #121 Joseph
    June 18, 2009

    BTW, how many “rocks” is that? That’s basically what I asked in the first comment in the thread. We don’t even know how many different patients Dr. Jay has seen during his long career, and we don’t know how many of them have an ASD diagnosis that he’s aware of. If we knew these figures, we could begin to understand where he’s coming from. Then again, it’s possible Dr. Jay hasn’t even checked his own records in order to form his personal opinion. Plus, he might have been quite busy with the DVDs, the books and the talks.

  121. #122 passionlessDrone
    June 18, 2009

    Hi RJ –

    I find your response quite interesting.

    Cytokine profiles will not tell you much. Cytokines profiles are expected to vary after vaccination (that’s part of the immune system doing what it is supposed to do, the way it does it) but establishing a correlation with variations within among specific cytokines and adverse events is not going to tell you much. I can tell you, from first had experience, that cytokine profiles vary widely among individuals, as do the kinetics. What you suggest might be a worthy project for a graduate student, but for use in a public health setting, costing thousands of dollars per patient, it isn’t going to provide any useful information. If my experience is worth anything, my team and I (like many at hundred of companies around the world) look at cytokine/chemokine expression following immune insult on a daily basis. There is no way we could make rhyme or reason out of a snap-shot profile of any one or large selection of Cyto/chemokines and disorders down the line. They do not equate.

    That cytokine profiles vary widely among individuals isn’t suprizing to me; but I’d be curious as to why you would feel that the significant differences found among the autism population (or other neurological disorders) aren’t of interest? Or is the bigger problem identifying an association over time after a particular insult due to the accumulation of random noise? My thoughts were along the lines that, one way or the other infants who go on to have an autism diagnosis generally wind up with different cytokine profiles and levels of response than their non diagnosed peers; given that, why not see if we could detect when such abnormalities show up, and if these different profiles were associated temporally with vaccination. The cost factor is admittedly very problematic right now.

    As for your second portion…I guess I just disagree. Citing specific instances that were identified in large-scale studies, and then falling back and making a generalization with other ramifications is not the way I would see it.

    Hm. Well, I think the only generalization I was trying to make is that vaccines are capable of causing persistent modulations to the immune system in areas other than antibody recoginition, and as such, the idea that we can’t be having other impacts is problematic to defend in the absence of more complete analysis. I wasn’t trying to state evidence of harm so much as a relative lack of no harm. I will have to try to be more clear.

    The main differences between the infant and adult immune system is experience…the changes that have ensued in the adult are a consequence of exposures over time. The functions of the innate immune system are very much alike, however, it is the status of acquired immunity that is significantly different. The whole point of immunizations is to provide similar exposures to the infant, which is primed and anticipating the infections it has to deal with on a constant basis, without causing the diseases themselves. Basically, directing the infant immune system toward the same state as an adult in a safer manner.

    Well, I’m certainly not involved with evaluating cytokine expression following immune insult on a daily basis; but I’ve read several papers lately that indicate that we have lots to learn about the developing immune system up and above the status of acquired immunity. For example:

    The “window of susceptibility” for inflammation in the immature central nervous system is characterized by a leaky blood brain barrier and the local expression of inflammatory chemokines

    Innate immunity of the human newborn is polarized toward a high ratio of IL-6/TNF-alpha production in vitro and in vivo

    Innate immunity of the human newborn: distinct cytokine responses to LPS and other Toll-like receptor agonists

    The comparative immunotoxicity of five selected compounds following developmental or adult exposure.

    Maybe I’m misreading these (?), or the authors are off base; but several seem to describe much different immune responses in newborns in areas other than the eventual acquisition of immunity; including cytokine profiles and production. When I couple this kind of finding with some of the animal studies that indicate a robust immune response during critical windows can lead to lifelong immune system alterations; including evidence that anti-inflammatory agents can nullify long term effects, I run into problems with the idea that we can have confidence of the absence of subtle, difficult to detect changes as a result of vaccination in a subset of infants.

    Maybe even with findings like this, you still don’t feel there is a sufficient difference between the developing immune response and the adult immune response. (?)

    Hope this is food for thought.

    I appreciate your response. Thank you.

    - pD

  122. #123 RJ
    June 18, 2009

    “I’d be curious as to why you would feel that the significant differences found among the autism population (or other neurological disorders) aren’t of interest? ”

    I suppose they are, but when dealing with stress-responses, we cannot dwell on mere antigen stimuli as a driver. It’s OK to consider, but likely a dead end. There are too many factors involved with eliciting stress responses (hormones, UV/radiation, osmotic conditions, pattern-recognition receptor signaling, feedback loops, DNA damage, many more)and then when one is upregulated, it feeds into several others. Eventually, the cascade can get very convoluted. I would suggest considering the chicken and egg scenario for you thoughts…the cytokine levels can be upregulated because they are autistic (not that they are autistic because of cytokine levels). Social stresses result in the differential levels of these markers, not that these markers are some driver of their condition.

    “Maybe I’m misreading these (?), or the authors are off base; but several seem to describe much different immune responses in newborns in areas other than the eventual acquisition of immunity; including cytokine profiles and production. ”

    No, not off base, but what they are describing is an innate immune system that has all the working components and is working with the acquired immune system to mature. Maybe it’s me, but I think it is obvious that there would be difference between the two, just as if you were to try and have a conversation with each, the adult would make more sense while the other would communicate on a more primitive level…learning is still occurring. But the point is, the same fundamental frame work is there. Again, getting back to your focus, cytokine expression…it is going to differ between the two because the infant is still dealing with all of the other microbial interactions that an adult has already dealt with (and has the memory and relationships in place).

    I think to be succinct, the papers you’ve listed should be thought of as pieces to the puzzle that describe the learning and development of the infant immune system and that by taking some of these as evidence that there are difference, therefore, we must treat them differently is unwarranted. It would be better to look at it as in a whole-systems approach and not dwell on any particular piece. The fact remains, the infant is dealing with a constant bombardment of microbial interactions (many of them are pathogens) and by dealing with them, over time, to mature to a state we’d call the adult immune system. And again, looping back to immunizations, the point is that we bypass disease so that these individuals can gain that immunity and continue to develop accordingly. I think anyone would be had-pressed to convince me that giving children these diseases so that they can gain immunity “naturally” is a better option. It doesn’t make any sense whatsoever. (I’d be happy to look at the lists of the pro’s and con’s of each). The fact is, the longer it takes for a child to be immunized, the greater the chance they will become infected and have the disease. Times are good right now in the U.S. so we don’t need to shit egg-rolls, but given the fact that we are globalizing and cramming more and more people on to this little rock, those odds are changing.

    Enjoy the rest of your day.

  123. #124 Jay Gordon, MD, FAAP
    June 18, 2009

    RJ–

    The comment was directed at the responses above yours. (Read them.)

    Your post was great. As I’ve mentioned before, I learn a helluva lot reading your posts, pD’s and others. I just have a lot of trouble with the hair trigger tempers and nastiness directed towards me. My skin’s getting thicker because in no way do I believe that I have the only answer to the issue of vaccines and autoimmune disease. I’m very happy to listen and learn.

    Best,

    Jay

  124. #125 Prometheus
    June 18, 2009

    Dr. Jay rants again:

    Real science lives, breathes and changes. It accepts that today’s ideas and hypotheses might be cast out and disproved tomorrow. Your science, as you so aptly put it, ORAC, is just “crotchety.”

    Dr. Jay feels that asking for data, studies and all that is just too “old fashioned” and “crochety”. We should all just accept what Dr. Jay says because he has experience, wisdom and all that jazz. Everything, that is, except an understanding of the relevant biology and a grasp of statistics. And data – he doesn’t have that, either.

    Yes, today’s ideas and hypotheses might be cast out tomorrow – or they might not. However, in the absence of data to the contrary, it makes little sense to ignore the data we have today simply because it might be contradicted tomorrow.

    This morning’s hike ended with a nice conversation with my nearly-89-year-old friend John, a geology professor Emeritus at UCLA. He reminded me, “The best geologist is the one who has seen the most rocks.”

    Nice and folksy. What I gleaned from that amusing aphorism is that we should be getting our information about autism from people who research and treat autism, not an out-of-touch pediatrician-to-the-stars with a Messiah complex. Good call, Dr. Jay.

    All of you here have little except numbers, nastiness and no real experience or wisdom to back up your sterile beliefs.

    So, Dr. Jay admits that we who disagree with him have the data – even if he refuses to admit that many of us have the “experience” and “wisdom” to back it up. Strange – isn’t this the man who puts so much stock in “mommy wisdom”? Does “mommy wisdom” only count when he agrees with it? Is Dr. Jay really that patriarchal?

    Get away from the keyboard and have a look at the problems in the pediatric community.

    Is Dr. Jay referring to the spreading influence of magical thinking and unsupported hypotheses? He should get away from the keyboard and into the bathroom – he could see one of “the problems in the pediatric community” in the mirror.

    You’ll see why some of us are willing to support yet-unproven hypotheses, weather your viscious ad hominem opprobrium and move on to try to help children.

    Ah, yes – the “we’re just trying to help the children” gambit. Sorry, Dr. Jay, but giving bad advice to parents and using unsupported treatments for autism isn’t “helping the children”. It’s probably the exact opposite.

    Your hypotheses, Dr. Jay, aren’t just “unproven”, they’re unsupported – and many of them have been “disproven”. You need data to support hypotheses, Dr. Jay – not “wisdom” and not “vast clinical experience”.

    Doctors for centuries used bleeding as a general cure-all based in their “wisdom” and “vast clinical experience”. It wasn’t until people started looking at data – numbers – that they realized that bleeding was worse than useless.

    You just sit there and quote hidebound old numbers. Shame on you for being so narrow-minded.

    Yeah! Shame on us for saying “The data don’t support your claims, Dr. Jay.” After all, there are other ways of knowing and many other worlds than this, right? We should be more accepting of magical thinking, fantasy-based medicine and wish-fulfillment as alternatives to science.

    And why should we abandon what the data tell us and follow Dr. Jay? Ipse dixit – “He, himself, said it”. After all, Dr. Jay has no “hidebound old numbers” to show us, just his “wisdom” and “experience”. He knows because he knows. His wisdom is infallible because he has never found himself to be wrong.

    Well, Dr. Jay, you’re welcome to live in your little fantasy world where everyone who disagrees with you is “narrow-minded” and “hurtful” and “mean”. In reality, most people have been trying to reach you inside the wall of self-deception you have built.

    Wake up and smell the coffee, Dr. Jay. It’s not too late to switch to the winning side.

    Prometheus

  125. #126 Dangerous Bacon
    June 18, 2009

    Dr. Jay sez: “I’m very happy to listen and learn.”

    But not to respond to Orac’s highly relevant questions, which might convince us there’s something to your rhetoric besides “I have 30 years of experience” and “No one knows children better than their parents”.

  126. #127 Jay Gordon, MD, FAAP
    June 18, 2009

    In between patients . . .

    I respect and learn from all your opinions and from the studies and factual information your present. I also understand your passion in defending the scientific method and in attacking those of us who adhere to opinions without sufficient science. As I mentioned earlier, I wish the tone of the discourse were less angry and bitter.

    Best,

    Jay

  127. #128 D. C. Sessions
    June 18, 2009

    I’m very happy to listen and learn

    “… as long as I’m listening to flattery and the learning doesn’t contradict what I already believe.”

  128. #129 Mu
    June 18, 2009

    Dr. Jay, the biggest issue most of us science types have with your crowd is the moving goal posts.
    You have a hypothesis: Vaccines contribute to autism.
    Give us a target, what does it take to validate or disprove this hypothesis to YOUR satisfaction. Feel free to put down any target, just give us one you are will to be measured up to.

  129. #130 D. C. Sessions
    June 18, 2009

    As I mentioned earlier, I wish the tone of the discourse were less angry and bitter.

    Which is no doubt why you call us pharma shills and ignore the polite on-topic material.

  130. #131 Dangerous Bacon
    June 18, 2009

    “I also understand your passion in defending the scientific method”

    “…although I don’t believe in it myself.”

  131. #132 Jay Gordon, MD, FAAP
    June 18, 2009

    Mu, good point. Give me a little time to think of something more specific than what I’ve said before.

    D.C. Sessions. You are correct. My apologies for implying that the group here shills. I believe you when you say you don’t. And, to say it again, I will be more judicious in my public statements owed to what I’ve absorbed here.

    Bacon, yes, I do.

    Best,

    Jay

  132. #133 D. C. Sessions
    June 18, 2009

    I believe you when you say you don’t.

    If you’d been paying attention, you might have noticed that I never denied shilling. I don’t even deny shilling on MHA.

    I do, however, have a truly amazing offer for anyone who thinks I do — they could make a cool $5000 real easy. Just match that sum in escrow and have a forensic accountant go over my financial records. If I’m getting anything from a pharmaceutical company (other than the stuff I pay for) then the money’s theirs and I pay the accountant.

    Of course, if they’re wrong

  133. #134 James Sweet
    June 18, 2009

    I wish the tone of the discourse were less angry and bitter.

    FWIW, Dr. Jay, I agree with this wish… even when sometimes I am the one using an angry/bitter tone.

    It can be very difficult sometimes when confronted with someone who obstinately clings to untrue information (I’m not talking about you, and I’m not not talking about you, I’m just talking in the abstract). For example, the other night I was challenging a group of anti-vaxers, and since I was in unfriendly territory, I knew it was imperative that I keep my cool and present the information I had in a calm and compassionate manner.

    But when the presenter at this meeting stated the old lie about their being antifreeze in vaccines, I lost control of my tone and said, “That’s not true, it is a myth and a lie” in an icily bitter tone. I wish I would have kept my composure and simply told them that antifreeze is ethylene glycol, which is not the same as beta-propiolactone. I would have been much more effective if I had done that. But I was just so shocked they would pull out such a blatant untruth that I lost control of my emotions.

    Folks, Dr. Jay is right about this part of it. One word you hear thrown around a lot when people talk about what drove them away from conventional medicine is “bullying”. I think what unfortunately happens a lot of the time is that new parents here some ridiculous anti-vax propaganda (like the anti-freeze thing), but they don’t have the tools to evaluate its veracity, so they ask their doctor, and their doctor responds in a hostile and/or dismissive manner. Next thing you know, you’ve got a new convert to woo.

    I’m as guilty as everyone else on this point, but nonetheless I think this is one point where we would be wise to heed Dr. Jay’s advice: When you are talking to an anti-vaxer, try your best to remain calm and be civil.

  134. #135 Orac
    June 18, 2009

    You are correct. My apologies for implying that the group here shills. I believe you when you say you don’t. And, to say it again, I will be more judicious in my public statements owed to what I’ve absorbed here. Bacon, yes, I do.

    Dr. Jay, you’ll have to forgive me if I don’t believe you. I’ve heard you, chastened after the skeptical beatdown you receive in the comments here, promise that you will, really and truly, be more “judicious” in your public comments. Indeed, if you like, I can pull up a couple of examples that are fairly recent. Now, don’t get me wrong. I’m not accusing you of lying. I think that, right now anyway, you are sincere and really do mean what you say.

    Unfortunately, history belies your good intentions that exist right now. Sadly, your unscientific beliefs and conspiracy mongering about the government and big pharma seem to be so deeply ingrained that, sooner or later, you always relapse. This has been your pattern over the last four years, since our first blogopsheric encounter. You can’t seem to help yourself. I’ve tried to help to educate you through calm, dispassionate science; through sarcastic “tough love”; and through shock and awe. None of it seems to work or to take. You remain utterly convinced that your personal experience is right and science is wrong, your protestations that you are not “anti-vaccine” not withstanding. Sorry if that’s harsh, but the truth sometimes hurts.

    Indeed, your little rant on HuffPo, the one that “inspired” this particular blog post whose comment thread has been going on so long, was a relapse after the last time you promised to be more “judicious” in your rhetoric. I fully expect that, a week or a month or a few months hence, you will be repeating the same ridiculous nonsense about how vaccine manufacturers are like tobacco companies and how none of the numerous studies that failed to find a link between vaccines and autism can be trusted because they were funded by big pharma. (Actually, only some of them were funded by big pharma.) Even sooner, I predict, you’ll be touting your “30 years of clinical experience” over science, clinical trials, and epidemiology that show that there is no detectable link between vaccines and autism. You’ll start trotting out variations of the “toxin” gambit (albeit without mentioning formaldehyde–you at least appear to have learned that much) before too long. And if you don’t do it here, you’ll keep doing it in front of the mothers of your patients who lionize you for your anti-vaccine apologia and your willingness–no, eagerness–to indulge their overblown fears.

    You just can’t seem to help yourself. I really hope I’m wrong this time, but I don’t think that I am. Perhaps my pointing out your frequent promise to be more circumspect about the science and your equally frequent breaking of those promises will keep you on the straight and narrow this time for a longer period of time before something happens to cause you to release another round of vaccine psuedoscience.

    But, then again, that’s the big meanie in me talking.

  135. #136 Dangerous Bacon
    June 18, 2009

    James Sweet: “I’m as guilty as everyone else on this point, but nonetheless I think this is one point where we would be wise to heed Dr. Jay’s advice: When you are talking to an anti-vaxer, try your best to remain calm and be civil.”

    To respond to _you_, since you seem to be sincere on this point:

    Most of us have no difficulty in being polite while disagreeing with people who have doubts and worries about vaccination, including parents who want the best for their kids but have been led astray by antivax lies and misinformation. It’s much harder maintaining civility when confronted by hardcore antivaxers who have no interest in entertaining opposing ideas, particularly those who spew insults while simultaneously griping about how mean their opponents are.
    I know a pediatrician who debates this issue online. He takes pains with parents who have antivaccination views, working with them to minimize fears and gradually gain their acceptance of the value of immunization. And from what I know of my colleagues, there’s a lot of calm and respectful lobbying done on this score.
    Even in the comment section of this blog, if someone asks an honest (if misguided) question about vaccination, they will generally get civil and informative answers. Abusive hardcore antivaxers who have no interest in rational debate are much less likely to get gentle treatment.

    So it goes.

  136. #137 Jay Gordon, MD, FAAP
    June 19, 2009

    pD and RJ and Bacon–

    I have a question: As I read your more recent comments, you seem to be saying very clearly that we can’t expect an baby’s/immature immune system to respond to either illness or vaccination in the same way an adult/mature immune system does.

    One of the points I make to parents is that I think vaccines given later and one at a time might make the vaccination process safer. Do you agree or am I misreading your comments?

    Thanks.

    Jay

  137. #138 Jay Gordon, MD, FAAP
    June 19, 2009

    For example, this paper,
    http://pediatrics.aappublications.org/cgi/content/abstract/122/2/e438?rss=1
    tells us that having polymorphisms known to be associated with other inflammatory autoimmune disorders is associated with a risk of autism.

    It is well and good to point out the complexities of the interactions between behavior and immune function; in fact, it is precisely that large block of unknown interactions that causes me so much concern over the fact that our existing studies bypass the commonalities of all vaccinations and instead focus on a single vaccine, or a single vaccine ingredient, and armed with this tiny slice of analysis, we have declared there is no relationship. But acknowledging this complexity does nothing to make our existing research concerning vaccination more detailed

    pD, Bacon, RJ if you have the time to exchange email I’d really love to hear more about the sub-discussion among the three of you without raising the ire or showing disrespect for the other posters here. Thanks.

    jay@drjaygordon.com

    Jay

  138. #139 Chris
    June 19, 2009

    Dr. Gordon:

    One of the points I make to parents is that I think vaccines given later and one at a time might make the vaccination process safer.

    What is your evidence? How does it protect them from the diseases?

    Right now, many babies who suffer the most from pertussis (like the case in Australia recently where the month old little girl died) are those who are too young to be vaccinated, delaying past two months may cause even more infant deaths. Where is the advantage?

    What about tetanus? It is everywhere. Henry David Thoreau’s brother died from tetanus from a razor cut. Many new parents are very diligent about using the itty bitty clippers to trim the baby’s teeny tiny fingernails… what if they transmit tetanus?

    What about rotavirus? Why would it be safer for a two month old to get rotavirus versus a six month old?

    When is it safer to get Hib?

    The outbreak in San Diego showed that children too young to get the MMR were very vulnerable when a kid with measled cae to the doctor’s office. How would your schedule prevent those kinds of outbreaks?

    Again, I ask, please post the evidence that counters the statement I found here, which says:

    Each year, top disease experts and doctors who care for children work together to decide what to recommend that will best protect U.S. children from diseases. The schedule is evaluated each year based on the most recent scientific data available. Changes are announced in January, if needed. The schedule is approved by the American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the American Academy of Family Physicians.

  139. #140 Jay Gordon, MD, FAAP
    June 19, 2009

    Chris–

    I’m not sure. That’s why I asked the question.

    I agree: Herd immunity protects very young children from pertussis but I believe that the way we vaccinate and the disdain for parents who just want to talk a little more about vaccines is leading to a loss of confidence in the entire process. Yes, yes, I know that I am part of that problem and usually not part of the solution. Irony or all ironies. Don’t you wonder why I’m here? I really do want to absorb some science at a higher level than I own right now.

    Tetanus is not “everywhere.” It’s in Africa and other parts of the globe while we in the USA have a few dozen cases/year. I would like to see more effective tetanus vaccination there.

    Rotavirus vaccination also belongs in other countries. Even if there is only a small risk associated with this vaccine it’s not worth it.

    HIB, thanks to vaccination, has almost disappeared from America. Now it’s time to consider more selective use of that and some other shots. No, I don’t have a precise alternative to the current schedule but I can tell you that it’s not the best we could do.

    Best,

    Jay

  140. #141 HCN
    June 19, 2009

    My kid ended up in the hospital with rotavirus! Trust me I would have had him take the vaccine (especially since I also got it). How dare you claim it is elsewhere!

    Also, as a gardener, I am reminded every year that tetanus is just a scratch or bug bit away. It is not just in Africa. Okay, I did a quick Google search and this was the first hit for “tetanus USA”:
    w w w .cdc.gov/mmwr/preview/mmwrhtml/ss5203a1.htm … “During 1998–2000, an average of 43 cases of tetanus was reported annually;”

    How many more would we have if we did not vaccinate? Just the fact there are few dozen in the USA means it does happen on this continent!

    Wait, Hib is almost gone?! Did you miss this the kid who died in Minnesota, and the child who needed protection from herd immunity:
    scienceblogs.com/insolence/2009/01/more_disease_and_death_among_the_unvaccinated.php … “Five Minnesota children have grown sick — and one of them died — from a germ that can cause meningitis, causing U.S. health officials to warn of the importance of a common childhood vaccine.”

    Plus, I just head Paul Offit on a podcast w w w . cispimmunize.org/soundadvice/poffit_transcript.pdf… that says “I mean we’ve had — in Philadelphia in the last couple of months — we’ve had six cases of Hib meningitis and three deaths because parents were afraid that vaccines were doing more harm than good.”

    You keep putting “FAAP” behind your name, do you actually read the journal?

  141. #142 Jay Gordon, MD, FAAP
    June 19, 2009

    HCN–

    If the scientists posting here won’t tolerate my unscientific anecdotal posts, they would be pretty hypocritical not to attack your notes above. Rotavirus is very treatable in the United States and the vaccine should be used elsewhere.

    Quoting Dr. Offit should easily fit into the same category of my–foolishly–posting something from whale.to: accurate or not, the inherent bias of these two sources invalidates their being quotable.

    Jay

  142. #143 Orac
    June 19, 2009

    Quoting Dr. Offit should easily fit into the same category of my–foolishly–posting something from whale.to: accurate or not, the inherent bias of these two sources invalidates their being quotable.

    Nice try, Dr. Jay, trying to equate the views of a well-known vaccine scientist with those espoused on the uber-crank website Whale.to. Still, pretty transparent. Can you do better?

  143. #144 daedalus2u
    June 19, 2009

    Dr Jay, are you that completely ignorant about tetanus? Tetanus is not a communicable disease. There is no herd immunity to tetanus because the organism that causes tetanus is very widespread in the environment. People catch it when they have a wound that is infected by dirt, not from other people.

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

    How can you in good conscience advise your patients about the risks of tetanus when you are so ignorant about it? Comparing Dr Paul Offit to whale.to? WTF? If you are unable to distinguish them, the fault lies in your ignorance.

  144. #145 James Sweet
    June 19, 2009

    @dangerous bacon: That is great work that your pediatrician friend is doing! More people need to take that approach. The problem right now is that the anti-vaxers are taking it to the streets, one-on-one, and pro-vax is only just starting to do that. I hope his work is successful!

    I agree with you that even here, most of the time the vitriol is reserved for the hardcore anti-vaxers… I’m just saying that 1) that’s not always the case, and so it never hurts to be reminded to take it easy on people who might have simply been misled; and 2) getting all up on it with the hardcore folks is fun, but doesn’t really accomplish anything.

    Regarding the comment about how I suspect some people unnecessarily come away from their pediatricians feeling bullied, I am just basing that on my personal experience trying to keep a few concerned parents I know from turning to the dark side. Maybe it’s not a widespread problem at all.

    Or maybe there’s no way around it: One interesting moment from the anti-vax meeting I recently attended was when one of the hardcore said that the pro-vax people were always using “fear-based” arguments. I asked her why she said it was “fear-based” when pro-vax people talk about the harm done by childhood diseases, but when anti-vax people talk about autism and vaccine reactions then it is just “sharing information” or “telling all sides”. Heh, she actually stumbled on that one for about ten seconds before she managed a coherent answer. Her assertion was that pro-vax people say that there “will” be an epidemic, but anti-vax people just say that your kid “might” get autism.. which is a cop-out if I’ve ever heard one.

    So maybe it really isn’t possible, maybe the people who come away feeling “bullied” were already lost to the dark side and any way of presenting information that contradicts their beliefs would be perceived as mean-spirited. I don’t know. I do think that it never hurts to remind ourselves to be civil, though — even to people who don’t deserve it.

    (And I say this as someone who fails to uphold that standard… that again and again and again. :)

  145. #146 Jay Gordon, MD, FAAP
    June 19, 2009

    Paul Offit and sites like whale.to have such well-known and such overwhelming bias that references to them can be ignored by the “other” side. Even when they’re “right” they’re easy to ignore.

    I know that C. tetani bacteria are not just in Africa and that the disease is not communicable . . . but, there are very few cases in America and hundreds of thousands of fatal cases in Africa. It doesn’t take much thought to realize we should focus on getting the vaccines and the education to countries whose population is actually threatened by the disease.

    James Sweet . . . the simple concepts here are that everybody deserves a civil response and that pediatricians and others actually do use fear as a primary lever to convince parents to vaccinate.

    Best,

    Jay

  146. #147 Joseph
    June 19, 2009

    Whale.to is not just “biased.” It’s a site that posts garbage and nonsense routinely. This is why it can never be taken seriously. Hence, Scopie’s Law.

  147. #148 Orac
    June 19, 2009

    Dr. Jay, do you really realize just how crazy the content on Whale.to is? See this post by me for an example, with multiple links:

    http://scienceblogs.com/insolence/2008/06/the_nuttiness_that_is_whaleto.php/

    My post includes links to articles on Whale.to with titles like:

    Cloudbusters and black lines
    6 TBs in a circle (Healing Black lines)
    Ghostly resident in Crieff shop
    Noxious earth energies and their influence on human beings
    Mind control hardware (Did you know that CPR equipment is part of the plot?)
    The vaccination hoax and Holocaust
    Genocide via vaccination
    Holy Hand Grenade (not of Antioch, I hasten to add).
    Crystal & water charging
    Cell phone/GSM/PCS (aka DEATH TOWERS), TETRA, HAARP, GWEN, & Power lines
    Asian tsunami was nuke
    Medical (Allopathic) Mind Control
    Mammography Hoax
    Atheism, Forbidden Archeology & The Darwinian Evolution Hoax

    Please. Go to my post and browse some of these topics on Whale.to.

    Really, Dr. Jay. You’ve gone off the deep end with your comparing Paul Offit to Whale.to. Whatever you may think of Paul Offit, no matter how much you disagree with him, there is no reasonable way you can make an argument that what he says is on the order of the thousands of web pages of nonsense.

    The only “civil” way I can comment on your comparison is to say that I really hope that you were simply ignorant of just how full of conspiracy theories, pseudoscience, lies, and general craziness Whale.to is full of. If you were aware of it, then your slander of Paul Offit is an example of the very “incivility” that you chastise me for and I call: Pot. Kettle. Black.

  148. #149 kathleen
    June 19, 2009

    I have been trying to follow this thread for a bit. I am not a scientist-but I am doing my best.I am going to throw my two cents in for what it is worth-call it a parental anecdote(they seem to be the basis of much of vaccine debate)-the kind that is never written about..Having three of my kids on the spectrum has been an adventure-my third child was diagnosed with aspergers just last week. My other two have P.d.d. (nos) and autism. My second child being the most severly affected by autism. Having been through diagnosis before-I was very worried when he was born. I didn’t know what caused autism-I had heard that perhaps vaccines were the culpret-I was scared. My second child did not typically develop-he had both great and fine motor delays and he did not speak-did not babble…although he could scream. With my second child-I staggered his vaccines. He did not receive his MMR until he was three years old. Two weeks later, he spoke his first word.By using my anecdote-my experience, I could say that the MMR was beneficial in overcoming speech delay. I could take that coincidence and make a theory.Silly as it may be..
    My kids were born with autism. That statement does not make me popular in the anti-vax community. By saying they were born that way-well then I can’t blame vaccines…and if I can’t call my kids “vaccine injured”-well then DAN protocols and all the other stupid woo crap is not for me. I mean how can you “recover” or “cure” a child who was not injured..There is a lot of money being made-and I don’t think it is by big pharma. Dr. Jay-As a parent I would NEVER entrust the care of my child with you. For the simple reason that you support Jenny McCarthy-who uses her son as a prop..because of your into in Warrior mothers”..because that kind of crap preys on parents fears..you say you are not anti-vax..and I say guilty by association.

  149. #150 Joseph
    June 19, 2009

    Yes, Dr. Jay’s argument is shockingly illogical. If bias were sufficient to discount someone’s argument, rational discussion would be impossible, since everyone has some bias one way or another.

    For that matter, I can’t see any reason why Dr. Offit has more bias than, say, Dr. Jay himself, or Jenny McCarthy or Jon Poling or David Kirby or Dan Olmsted.

  150. #151 paul offit
    June 19, 2009

    Dr. Gordon. Just out of curiosity, what is my inherent bias? That I think vaccines work. That I think vaccines are safe. Both of these notions are supported by data. And I would argue that being the co-inventor of a vaccine is also not a bias. Rather, the process of taking a vaccine from the lab to the bedside was enormously informative. And although I list my patent as a “conflict of interest,” I am not conflicted. I review data (now as a working group member on several ACIP committees) and make recommendations based on those data. Nothing conflicts with this.

  151. #152 James Sweet
    June 19, 2009

    James Sweet . . . the simple concepts here are that everybody deserves a civil response and that pediatricians and others actually do use fear as a primary lever to convince parents to vaccinate.

    Okay, Dr. Jay, I’ll challenge you to answer the question I mentioned in my previous post: How come when pediatricians say, “If you don’t vaccinate, your child could get a dangerous infectious disease”, that is “us[ing] fear as a primary lever…. but when folks like you say, “If you do vaccinate, your child could get autism” — a proposition that you yourself admit is an “unproven hypothesis” — then that is just providing information?

    What is the distinguishing factor that makes one “fear-based” and the other not? I’d really like to know…

  152. #153 Orac
    June 19, 2009

    Easy. It’s “fear-based” if Dr. Jay doesn’t agree with it. If he does agree with it, it’s “providing information.”

  153. #154 RJ
    June 19, 2009

    Is anyone else here but me entertaining the idea that it’s not Dr. Jay Gordon (the pediatrician to the stars) that is posting? I see too many obvious errors and disconnects in his postings and just don’t buy it.

  154. #155 AutismNewsBeat
    June 19, 2009

    …pediatricians and others actually do use fear as a primary lever to convince parents to vaccinate.

    Do doctors use fear to convince patients to quit smoking and lose weight? Do pediatricians use fear to convince parents to use car infant seats, or that their kids wear a helmet when riding a bike? When you talk to your adolescent patients about street drugs and promiscuous sex, do you warn them of the consequences of such risky behavior? If so, are you not leveraging fear?

  155. #156 James Sweet
    June 19, 2009

    And as Dr. Offit points out, the difference between “biased” and “unbiased” is whether you agree with the anti-vaxers.

    I was told by an anti-vaxer that I had been “given a lot of one-sided information”… which was an odd thing to say considering that I already knew most of the anti-vax arguments she was trying to present. Um. So I suppose I knew the anti-vax “information” without having actually heard it before??

    Actually, I shouldn’t be so glib. There is a very simple explanation for why the anti-vaxers say the other side is “fear-based” and “biased”, and unfortunately it’s not very funny…

  156. #157 RJ
    June 19, 2009

    “pD and RJ and Bacon–

    I have a question: As I read your more recent comments, you seem to be saying very clearly that we can’t expect an baby’s/immature immune system to respond to either illness or vaccination in the same way an adult/mature immune system does.

    One of the points I make to parents is that I think vaccines given later and one at a time might make the vaccination process safer. Do you agree or am I misreading your comments?”

    Yes, you misread my comments. Completely misread.

    My comments stated that most immune functions, particularly those related to innate immunity, are alike. The main differences stem from the status of elements involved in acquired immunity. All waiting does is generate a larger window of opportunity for a child to become infected, leaving the infant immune system to be more naive, so to speak (acquired immunity is learning through exposure). Immunizations closes those window by exposing the immune system to something that looks like the disease antigen(s) but does not cause the disease, thereby reducing the risk and ‘educating’ or driving the immune system to a mature state.

    I have seen nothing to date that suggests that waiting makes the immunization process safer. Nothing. I have seen plenty of data that shows that the longer it takes to vaccinate the child, the greater the chance of infection. And, as a result, infections often lead to complications and problems, a situation that is clearly not safer.

  157. #158 K
    June 19, 2009

    Dr. Jay said:

    I know that C. tetani bacteria are not just in Africa and that the disease is not communicable . . . but, there are very few cases in America and hundreds of thousands of fatal cases in Africa.

    and

    Tetanus is not “everywhere.”

    Honestly, these kinds of comments, especially coming from a physician, boggle the mind.

    I took a brief foray into Jenny McCarthy’s alma mater, University of Google, and every single site I visited indicated that tetanus spores are everywhere, or any place there is soil, animals, and humans. It’s such a basic fact, even most google sites got it right. (I didn’t check them all.)

    But technically, I guess you could be right–I don’t know if there are tetanus spores on the Moon or Mars, etc.. But planet Earth is loaded with them.

    Why do you suppose we have so little fatal tetanus in the US?
    Because we vaccinate. Doh. We’ve been vaccinating for tetanus routinely since the 1940s.
    And when a person gets tetanus, do you know what kind of treatment is needed?
    The only treatment, really, is supportive. And we have the capability and level of medical care in this country to provide that supportive treatment, resulting in fewer fatalities. But sometimes, even that isn’t going to save you. Vaccination is highly effective and better than being in the ICU on a vent any day.

    As for hib disease… Do you not understand the concept of herd immunity? Do you not realize Hib disease is not eradicated and never will be, if you continue to spout such nonsense? And until you present a valid plan for “selective vaccination”, your idea is meaningless. It is anyway, but if you presented an actual plan that has a chance of working, it would show you’ve got some data to support this idea.

    I would rather vaccinate my infant for rotavirus any day than have him hospitalized on IV fluids and other meds and exposed to the constant risk of some other nosocomial infection. Just because we can treat it, doesn’t mean that is the better option.

    Seriously, as a physician, you scare me.

  158. #159 Rogue Medic
    June 19, 2009

    Dr. Offit,

    Dr. Gordon. Just out of curiosity, what is my inherent bias? That I think vaccines work. That I think vaccines are safe. Both of these notions are supported by data. And I would argue that being the co-inventor of a vaccine is also not a bias. Rather, the process of taking a vaccine from the lab to the bedside was enormously informative. And although I list my patent as a “conflict of interest,” I am not conflicted. I review data (now as a working group member on several ACIP committees) and make recommendations based on those data. Nothing conflicts with this.

    There is a lot of misunderstanding of conflict of interest. We should not be using that term, but instead using potential conflict of interest.

    As you point out, those involved in anything derive many benefits that they are able to pass on to others. These benefits come from being closely involved with work on what is being investigated. They come from the development of expertise.

    This involvement should not be seen as a justification to prohibit contribution to a debate, but the opposite. This involvement means that you have a lot to contribute to the debate. Expertise is what is needed.

    This is in contrast to someone who is ill informed and travels the country making speeches about imaginary dangers. Dangers that have no scientific basis. Someone who is only an expert at misrepresentation. That unethical behavior, and many other questionable behaviors, is more likely to be a true conflict of interest, not just a potential conflict of interest.

  159. #160 daedalus2u
    June 19, 2009

    Dr Jay, the reason (and the only reason) why there are few cases of tetanus in the US is because of vaccination. Essentially all cases of tetanus in the US (and in the world) are in individuals who are unvaccinated. Comparing incidence rates in the US population (many of whom are vaccinated) is completely useless in estimating the risk for an unvaccinated individual. What causes the low incidence in the US is high rates of vaccination, not living in the US.

    This is one of the dangers of having personal experience trump science. It is very easy to equate correlation with causation and make mistakes like this.

    Telling patients they don’t need to vaccinate for tetanus because the incidence in the US is low is dangerous misinformation. If one of your patients does get tetanus be sure your malpractice insurance will cover it.

  160. #161 Matt
    June 19, 2009

    Dr. Jay,

    Do you really not see the difference between an opinion based on decades of research versus a crank who puts together a website?

  161. #162 Jay Gordon, MD, FAAP
    June 19, 2009

    The only “civil” way I can comment on your comparison is to say that I really hope that you were simply ignorant of just how full of conspiracy theories, pseudoscience, lies, and general craziness Whale.to is full of. If you were aware of it, then your slander of Paul Offit is an example of the very “incivility” that you chastise me for and I call: Pot. Kettle. Black.
    Posted by: Orac | June 19, 2009 9:43 AM

    Orac, good call. No, I was not aware of all the “craziness” on whale.to and end up there when I turn down Elsevier’s kind offer to pay $30 every time I want to look at an article. I think I have been correctly and even civilly chastened from in any way linking to that site in the future. Thanks.

    Paul, for decades your research, writing and speaking have been funded by the pharmaceutical industry. You have never revealed–and need never reveal–the amount of money you made from the rotavirus vaccine but I think that this all creates a conflict of interest when you discuss and promote vaccination. I have never doubted your sincerity nor your honesty. I have been intemperate at times and, by the way so have you and Jim and others, and I have apologized for this. I don’t view this as a “potential” conflict of interest. It is a real conflict.

    There is no “slander” intended, Orac, just a simple statement that a person who has dedicated his life to vaccines is far from unbiased.

    RJ, thanks. It still looks like you, pD and others are saying that we must consider the immune system’s responses at various ages and be aware of how little we know.

    As for the comments about my ignorance: Yes, I have gaps in my knowledge base and will keep coming back here to fill some them. I have taken care of a lot of patients and that counts for something. Your persistence in attacking my reliance on observation and experience will not discourage me.

    Just one more time, being unpleasant and abusive diminishes the value of the conversation for everyone here. Stop it.

    Best,

    Jay

  162. #163 Pablo
    June 19, 2009

    As you point out, those involved in anything derive many benefits that they are able to pass on to others. These benefits come from being closely involved with work on what is being investigated. They come from the development of expertise.

    In terms of the “conflict of interest,” it can be something like this:

    Does person X support vaccination because they work in “Big Pharma” or do they work in “Big Pharma” because they support vaccination and want to help to make it better?

    I know people who have chosen to work in the cancer treatment industry because they have had loved ones die from cancer, and made it their lives goal to try to find a cure. Do we dismiss what they have to contribute because they work for a pharmaceutical company? Heck, even if they were to promote that company’s product, it STILL might not be a conflict of interest. In one case I know, the reason the guy works for the company he does is because he believes they have the best chance at solving the cancer problem.

    He is not a company shill. The company is instead the vehicle that he uses to advance his agenda.

    I don’t understand the objection to Paul Offit. Here is a guy who has actually one out and done what McCarthy and the others are clammoring for: improved our vaccines. So why are they complaining about it? Oh, because he is unwilling to throw out the whole system.

    It’s odd, it almost seems like Offit would be MORE welcomed by that crowd if he crowed that the current vaccines were evil and HIS vaccine was a safer, more effective alternative. How much would they be complaining about his conflict of interest then? I mean, if the chelation whackos can get away with it…

  163. #164 a-non
    June 19, 2009

    I find it fascinating that Dr. Gordon has not applied the same rules about “conflict of interest” to folks like Andrew Wakefield or the Geiers as he does to Paul Offit. At least we know Paul Offit’s competing interests. His work on vaccines and relationships with pharmaceutical companies are not exactly state secrets.

    It took investigative journalists and a medical inquiry board investigation to find Andrew Wakefield’s “conflicts of interest”. At the time he was warning parents against the MMR shot, he was 1) working with trial lawyers to prove the shot was harmful and 2) applying for a patent for a single-dose measles vaccine.

    Applying Dr. Gordon’s standards, I would suggest that Andrew Wakefield is no more reliable as an authority on vaccines as Paul Offit or whale.to.

  164. #165 skeptyk
    June 19, 2009

    Dear Dr. Jay,

    Well, that did not take too long. In #135, Orac predicts that soon enough you would backslide into injudicious rhetoric, and at #145, you jump the couch.

    Don’t you wonder why I’m here? I really do want to absorb some science at a higher level than I own right now.

    Maybe you should consider all the vastiness of science you have access to, via libraries, journals, colleagues, etc. You wouldn’t be the first to use Orac’s comment threads to learn something, but your failure to engage the most basic questions from comments over the past few months make me wonder at your commitment to knowledge.

    Contrasting your repeated claims to want to learn from folks here (as long as they adhere to your persnickity standards of politeness) with the evidence (from your own words here and at HuffPo and elsewhere) of your actual medical practice and patient education…well, it makes my head spin. I don’t know whether your narcissism is pathological or just pathetic. BTW, that’s not an ad hominem fallacy there.

    Tetanus is not “everywhere.” It’s in Africa and other parts of the globe while we in the USA have a few dozen cases/year. I would like to see more effective tetanus vaccination there.

    Okay, maybe you have some neurological quirks that makes it hard to grok meaning, and maybe you really thought that he was speaking of the disease rather than the pathogen. I will give you the benefit of the doubt, but make the point that your tendency to misinterpret and then shoot out an answer like this may be why Jim Carrey can blithely say such stupid things as that we don’t need tetanus vaccine. In a soundbite world, people hear your throwaway remarks, not your later corrections, alas.

    Rotavirus vaccination also belongs in other countries. Even if there is only a small risk associated with this vaccine it’s not worth it.
    HIB, thanks to vaccination, has almost disappeared from America. Now it’s time to consider more selective use of that and some other shots.

    Now, Dr. Jay, as pediatrician to jetsetters, you do know they sit in jets and travel and airports full of people going to and from other countries. I work with folks who spend their vacations providing surgery and other procedures in Haiti. I have friends and relatives practicing medicine in South Africa, Tanzania, Sweden, India… My point, of course, is that our world is effectively borderless when it comes to contagious diseases. Widespread vaccination rates in the US don’t give you and your more-likely-to-travel rich clients an ethical out for putting the rest of your clients, and children worldwide, at risk for VPDs.

    Once again, we are breathless with anticipation at how you defend your argument for “more selective”, and “judicious” use of HiB and “some other” shots.

    No, I don’t have a precise alternative to the current schedule…

    and yet! you only reluctantly give vaccinations to only some of your patients, and then, only to appease their parents. Which, if you really believe these shots are so dangerous, would be very unethical. Once again, your actions and arguments are so discombobulated that I wonder if your narcissism is pathology because, even if you do not perceive any problem, it leads to real harm to others.

    Love and air-kisses,

    Skeptyk, who has the mommy-instincts to vaccinate her children.

  165. #166 Pablo
    June 19, 2009

    The bigger problem is that Gordon doesn’t apply the “conflict of interest” gambit to HIMSELF. He has a huge financial stake in his anti-vax stance, which gives him lots of self-promotion opportunities. With this, he can raise his public stature, which begets more opportunities.

    Sadly, Jay Gordon was actually fairly well-known for his breast feeding promotion activities. However, that only made him well-known among pediatricians, and didn’t give him a lot of exposure in the general public. Now he has used an anti-vax position to further elevate his celebrity status.

    From any objective analysis, he has all the characteristics of a publicity hound, causing a huge conflict of interest.

    Now, I don’t discount Jay Gordon for that reason. There are plenty of reasons he is full of it. But if the anti-vaxxers want to open the topic of “conflict of interest,” then it has to include folks like Jay Gordon and Bob Sears.

  166. #167 Tsu Dho Nimh
    June 19, 2009

    Dr Jay –
    Once again you are saying that blanket immunization is not a good idea because of the low incidence of certain diseases. You apparently select which vaccines to give, and alter the schedule based on your perception of the relative risks of disease versus vaccine.

    But you are not answering these questions, about the children in the USA. Africa has its own problems, and like the food for starving children in China I heard about at the dinner table when I was a child, not using a vaccine here doesn’t miraculously make what you are not using here appear over there to save a kid’s life.

    1 – How many children hospitalized, permanently damaged, or dead from HiB are acceptable to you?

    2 – How many babies hospitalized or dead from rotavirus are acceptable to you?

    3 – How many children hospitalized, permanently damaged, or dead from pertussis are acceptable to you?

    4 – How many children hospitalized, permanently damaged, or dead from diphtheria are acceptable to you?

    5 – How many children hospitalized, permanently damaged, or dead from tetanus are acceptable to you?

    6 – How would you adjust the current vaccination schedule to attain these numbers?

    7 – And, where the hell are the hospitals going to find room for the ones who need hospitalization, IV fluids, respirators, anti-serums, and other interventions to save their lives? Hospital planning for the last couple of generations has not included vaccine-preventable diseases in their factors.

  167. #168 Matt
    June 19, 2009

    And as Dr. Offit points out, the difference between “biased” and “unbiased” is whether you agree with the anti-vaxers.

    Similar to the “open mind” argument. If you believe in the vaccines-cause-autism idea, you have an open mind. If you don’t, your mind is closed.

    Pretty easy. Much easier than actually thinking.

  168. #169 Jen
    June 19, 2009

    “Dr. Gordon. Just out of curiosity, what is my inherent bias? That I think vaccines work. That I think vaccines are safe. Both of these notions are supported by data.”

    Do you think they’re safe when administered in conjunction with acetaminophen? And if so, where is that data?

  169. #170 Jay Gordon, MD, FAAP
    June 19, 2009

    I find it fascinating that Dr. Gordon has not applied the same rules about “conflict of interest” to folks like Andrew Wakefield or the Geiers as he does to Paul Offit. At least we know Paul Offit’s competing interests. His work on vaccines and relationships with pharmaceutical companies are not exactly state secrets.

    I do apply those same standards. I think that Dr. Wakefield’s conflicts and the Geiers’ lessen the impact of what they say and I feel the same about Paul Offit. Bob Sears, of course. And, yes, as you imply, if I begin speaking or writing from only one point of view–for profit–I have a conflict of interest, too.

    So you think the best way to help is to polarize and insult? Have fun.

    Why is it so damn hard for you to talk instead of shouting?

    I had an epiphany this morning, and I’ll be as brief as I can: All of this is real to me and theoretical to you. By that I mean that I’ll see and treat more families affected by autism in one week than you’ll know in a lifetime. I have to face families in pain, financial distress and more. You can theorize about how many cases of HIB are OK . . .

    What would you say to a family who have two fully-vaccinated children with autism, a family history of autoimmune disease, the knowledge that autism is thought to be a neuroimmune disorder and are trying to decide how and when to vaccinate their third child? I have conversations like that every single day of my life. Would you counsel the usual vaccine schedule for them because you’re certain there’s no connection between vaccines and autism? Would you consider that this family may have a predisposition to vaccine/medeication sensitivity. Science . . .

    What I bring to this discussion is experience and curiosity. I have learned more about the cytokine system the past days than in the past ten years. (Of course, zero was an easy number to exceed.) People like Tsu Dho Nimh (clever?) ask inane questions. No one has ever bothered to ask me why I believe what I believe or whether there’s some common ground in this debate. I anticipate rude responses but posit this in the hope that there might actually be one or two of you who know what I mean.

    Best,

    Jay

  170. #171 Orac
    June 19, 2009

    I had an epiphany this morning, and I’ll be as brief as I can: All of
    this is real to me and theoretical to you. By that I mean that I’ll
    see and treat more families affected by autism in one week than you’ll
    know in a lifetime. I have to face families in pain, financial
    distress and more. You can theorize about how many cases of HIB are OK

    OK, I’ll bite. How many patients with autism/ASD do you see and treat in a typical week?

  171. #172 Orac
    June 19, 2009

    I had an epiphany this morning, and I’ll be as brief as I can: All of
    this is real to me and theoretical to you. By that I mean that I’ll
    see and treat more families affected by autism in one week than you’ll
    know in a lifetime. I have to face families in pain, financial
    distress and more. You can theorize about how many cases of HIB are OK

    OK, I’ll bite. How many patients with autism/ASD do you see and treat in a typical week?

  172. #173 FreeSpeaker
    June 19, 2009

    Dr. Jay:

    Paul, for decades your research, writing and speaking have been funded by the pharmaceutical industry. You have never revealed–and need never reveal–the amount of money you made from the rotavirus vaccine but I think that this all creates a conflict of interest when you discuss and promote vaccination. I have never doubted your sincerity nor your honesty.

    Let’s see…Dr. Offit has a conflict of interest, but is honest….is that a homeopathic conflict of interest, one where there is no dishonesty left?

    Reading Dr. Jay…I am so confused….Back to AFP for a second read….

  173. #174 Joseph
    June 19, 2009

    Applying Dr. Gordon’s standards, I would suggest that Andrew Wakefield is no more reliable as an authority on vaccines as Paul Offit or whale.to.

    Wakefield is no more reliable than whale.to, that’s for sure. But Wakefield most likely is guilty of scientific fraud. He can’t be compared to Dr. Offit by any stretch of the imagination.

  174. #175 Dedj
    June 19, 2009

    “No one has ever bothered to ask me why I believe what I believe”

    Total and absolute nonsense and you know it. You have been directly challenged on this several times over the past few months.

    You have been asked multiple questions that explicitly relate to your beliefs. You have thus far failed to competantly respond to a single one, except to answer with blithe assertions that you are somehow more experienced than the people that write the professional literature that you convieniently ignore in favour of your own agenda.

    It’s time for you to stop pretending that you are being treated unfairly and start answering the questions put to you. You are being treated the way you are because of your lack of professionalism, arrogance and blithe slanderous claims.

    Stop talking about your experience, the existance and validity of which is under extreme doubt, and start ponying up some evidence.

    We don’t care if you SAY you walk the walk, at the moment, your statements do not match up with your entirely self-alledged experience.

  175. #176 D. C. Sessions
    June 19, 2009

    Dr. Gordon:

    I know that C. tetani bacteria are not just in Africa and that the disease is not communicable . . . but, there are very few cases in America and hundreds of thousands of fatal cases in Africa. It doesn’t take much thought to realize we should focus on getting the vaccines and the education to countries whose population is actually threatened by the disease.

    So your quantitative analysis tells you that there aren’t enough deaths from tetanus in the USA to justify vaccination. Please, by all means, disclose to the rest of us what the correct level of tetanus deaths in the USA might be. How many deaths a year do you need before vaccination becomes desirable?

    What means do you propose for getting that death count into the desired range? A “bang-bang” control system, where we simply stop vaccinating until some target number of deaths occur in a year, followed by vaccinating everyone until the body count is below the desired level again?

    Maybe we should draw lots at birth to determine which babies get tetanus vaccine and which don’t.

    Alternately, we could mix unlabeled placebo doses into the vaccine supply, adjusting the proportion of real and bogus doses to achieve the desired number of deaths. In that case, what would be the proper relationship between deaths [or more properly, epsilon(deaths)] to get a good control function? Given the first-order integrating nature of the system, would you advise using a PID algorithm?

    I’m sure that there are other mechanisms that could be used (I’m just an engineer who does control systems from time to time.) There are certainly more sophisticated control algorithms that could be used for any of the mechanisms; I’ve just described two of the simplest.

    Finally, it would help a great deal if you could disclose your research into the actual quantitative risks and benefits of tetanus vaccination which lead to these calculations. For some reason the ACIP seems to have missed them.

  176. #177 dguller
    June 19, 2009

    Dr. Jay,

    Just because you feel the urgency of dealing with families whose children have autism does not imply that your judgement about what counts as good treatment is valid. Physicians in the 18th century felt the urgency of many diseases in their patients, and they firmly believed that cupping and bloodletting was helpful, based upon their personal experiences and their need to believe that they were helping their patients. However, once the data was looked at objectively, their practices were found to actually be harming more patients than helping them.

    I think that what is so frustrating here about your comments is that you really do not seem to understand that your personal experiences do not automatically trump scientific data simply because you feel a great deal of emotional salience in this issue. If anything, the more emotional you are about this issue, the more likely you will engage in fallacies of emotional reasoning, especially with the need to reduce cognitive dissonance.

    I’ll give you an example. I recently bought a Hyundai Sonata, because it received excellent ratings and the statistics showed that it is a reliable automobile. Now, mine turned out to be a lemon. That made me upset and emotional, since I spent money, and I didn’t like feeling like an idiot for wasting money. It would have been easy for me to tell everyone I knew not to get a Hyundai, because they suck. However, that would put my personal experience at odds with the statistical evidence that, in fact, most cars are reliable and there are inevitably — by chance — going to be lemons, and I was unlucky enough to get one. It would have been emotionally satisfying, but logically fallacious, to put my personal experience over and over the objective facts.

    I believe that there is a similar case here with you. No-one doubts your personal experiences, just like no-one doubts that my — sadly — car sucks. However, it is what you INFER from your genuine experiences that results in the problems and critiques, especially when it is distorted by emotional reasoning. That is why it is more important to put personal anecdotes aside when they grossly conflict with objective scientific evidence. There are better odds that what we infer from our personal experiences is wrong rather than all the objective science being wrong when done right.

    Any thougths?

  177. #178 Pete D
    June 19, 2009

    “What would you say to a family who have two fully-vaccinated children with autism, a family history of autoimmune disease, the knowledge that autism is thought to be a neuroimmune disorder and are trying to decide how and when to vaccinate their third child?”

    I asked my wife (MD in IM/peds, FAAP) about this and she looked at me like I was an idiot. I daresay she might look at you the same way, Jay. Thanks for making her job harder, dick.

  178. #179 skeptyk
    June 19, 2009

    “All of this is real to me and theoretical to you.”
    Oh, fer pete’s sake, Jay, are you the only person who lives in the real world seeing real people with real illnesses, real financial distress, etcetera? All about you…again? Do the rest of us here have to list our personal criteria as patients, parents of patients, professionals caring for patients and so on for YOU to think we have anything cogent to the discussion? Don’t trip over your big, important self on your way to the science.

  179. #180 Pablo
    June 19, 2009

    “What would you say to a family who have two fully-vaccinated children with autism, a family history of autoimmune disease, the knowledge that autism is thought to be a neuroimmune disorder and are trying to decide how and when to vaccinate their third child?”

    To be more explicit than Pete D, it was this statement that made me know for sure that I wouldn’t want Dr. Gordon any where near my children as a pediatrician.

    I want a doctor who will provide me with good medical advice, and NOT facilitate my fears of the Bogeyman.

    To answer the question, I think Pete D’s wife would suggest that he say the same thing he would to the parents who come in with two UNVACCINATED autistic children, and are contemplating what to do with the third (he knows full well, of course, that autism rates in unvaccinated children are the same (to be conservative) as those for vaccinated kids).

  180. #181 Joseph
    June 19, 2009

    By that I mean that I’ll see and treat more families affected by autism in one week than you’ll know in a lifetime. I have to face families in pain, financial distress and more.

    Ok, we got some numbers. This means you see at least 2 autistic children a week.

    At a prevalence of 1%, you’d have to be seeing about 200 children a week total, or 40 children every day Monday through Friday.

    The prevalence of 1% is not really valid, though, because that’s a prevalence you’d expect to see as the result of a very thorough epidemiological screening. You probably see children who are diagnosed through normal channels.

    I see you practice in Santa Monica, California. According to data I have from the California Department of Developmental Services (DDS) from 2006, the LA County area would’ve had a 3-5 administrative prevalence of about 0.55%. It could be a bit higher now.

    If I were to use this figure, though, it would mean that you see 364 children a week, or 52 children a day.

    I suppose it’s possible you are that busy. A more reasonable guess is that you’re seeing way too many children of anti-vaxers, due to your fame, and very few if any autistic children of non-anti-vaxers. Hence, you’re suffering from confirmation bias, and this explains much of your personal-experience-derived beliefs.

    (I might also note that some of us here live with autistic children every day, and not just see families of autistic children on occasion, which we also do – like in school activities.)

  181. #182 James Sweet
    June 19, 2009

    What would you say to a family who have two fully-vaccinated children with autism…

    Well, if you add in that they believe the vaccines caused the autism, then I don’t know what I would say. I would want to explain to them in the kindest way possible that they were mistaken, that there was no link between vaccines and autism… but I don’t know if I’d be able to do it.

    However, I would answer you the same way if you asked, “How would you tell a patient he/she had cancer?” or “How would you tell a pregnant woman that her fetus didn’t have kidneys and couldn’t survive outside the womb?” I’d have a really hard time with that, too.

    This is one reason why I am a software developer and not a doctor. Thank god it’s not my job to have to tell people something they really don’t want to hear.

    That is the job of a doctor, however.

  182. #183 Pablo
    June 19, 2009

    Do the rest of us here have to list our personal criteria as patients, parents of patients, professionals caring for patients and so on for YOU to think we have anything cogent to the discussion? Don’t trip over your big, important self on your way to the science.

    The curious aspect of Gordon is that he claims you need to be a practicing pediatrician, apparently, to have a valid opinion on the matter. Yet, 99.9% of the Fellows of the AAP and the rest of pediatricians in the country maintain the CDC/AAP guidelines, many of whom do it adamantly (far many more than those who are refusers). So what does he say to them? Does he stand up at a vaccine talk at an AAP conference and tell the audience that he doesn’t accept their conclusions because he is a working pediatrician and lives in the real world?

    He’d be laughed out of the room and dismissed as a kook. Not all that different from how he is viewed here, in fact.

  183. #184 Broken Link
    June 19, 2009

    Dr. Jay wrote: Orac, good call. No, I was not aware of all the “craziness” on whale.to and end up there when I turn down Elsevier’s kind offer to pay $30 every time I want to look at an article. I think I have been correctly and even civilly chastened from in any way linking to that site in the future. Thanks.
    ____

    Dr. Jay, I have a serious suggestion for you. You seem to be interested in learning. Here’s a way in which you can read about the science connecting autism and vaccines for free. I’d highly recommend that you take some time and seriously, carefully and with an open mind, read through the Omnibus proceedings regarding Michelle Cedillo. The transcripts are here in PDF form:

    ftp://autism.uscfc.uscourts.gov/autism/cedillo.html

    I’ve done so, and it put to rest that absolutely last vestiges of doubt in my mind that autism is connected with vaccines. If you read it, you will find that the Cedillos were treated with the utmost respect, and that their witnesses were given every opportunity to make their best case possible. Yet, I concluded, the Special Masters concluded, and I think you will conclude as well, that this was not even a close case. It’s not difficult reading, but it does require a certain amount of persistence and a willingness to learn. Please give it a try.

  184. #185 James Sweet
    June 19, 2009

    And you know what, if a family already had two kids develop autism at some point after being vaccinated, and they were so terrified they didn’t want to vaccinate the third, I am not going to judge them. I think they’d be making an incorrect decision in terms of risk/benefit, but goddamn, that’s a tough situation, and if in a rare case like that they decide to make an irrational choice, you know, I’m not going to put them down.

    After all, practically speaking, if the only people who didn’t vaccinate their kids were people who already had >=2 autistic children, compliance rates would be much higher than they are now…. right?

    So you know what, if you want to tell that family that no scientific evidence supports a link between vaccines and autism, but that you will accept their decision either way, I don’t actually have a major problem with that.

    What I have a major problem with is feeding misinformation to the public at large that causes fear in people who haven’t even had anything happen to them yet. To draw an analogy: It’s one thing if someone being afraid of heights because they saw a loved one fall off a cliff. On the other hand, if someone is afraid of heights because their therapist encouraged them to be terrified of falling… well, that’s professional misconduct.

  185. #186 James Sweet
    June 19, 2009

    And just to be clear, my last post does not mean I’m saying it’s okay to be afraid of vaccines if you think your kid has had a reaction… or even if your kid really did have a reaction.

    I have a friend who had a pretty severe reaction to the pertussis vaccine when she was a kid. It says on her chart now in big red letters, “NO PERTUSSIS VACCINE”. I can’t remember the details of the story, but I guess she had a bad fever for a few days, stuff like that.

    And you know what? Her mother, who is an RN, is still doggedly pro-vaccine. So is my friend. They both understand that while there are risks to vaccines (nobody ever said there weren’t) that the risks of not getting vaccinated are far greater. Unless I suppose you are going to “hide in the herd”, in which case you are just a selfish asshole.

  186. #187 Pablo
    June 19, 2009

    Let’s think of an anology (doomed to fail, of course)

    Dr. Gordon gets a visit from a family who is suffering through their third child this month to have the chicken pox. They ask him if they can get some antibiotics, because a friend of theirs told them that their daughter had the chicken pox and the doctor gave her antibiotics and she got better.** Now, Dr. Gordon knows full well that antibiotics are not a treatment for a viral disease like the chicken pox, and, moreover, overprescription of antibiotics paticularly for virus infection, is discouraged by all medical organizations.

    So what should Dr. Gordon do? Should he discuss with them how antibiotics are not a proper treatment for chicken pox, and the information they have been given is somehow mistaken.** Or should he validate the parents’ mistaken beliefs and tell them he will give them some antibiotics?

    The implication in his scenerio is that he will chose to enable them.

    **In fact, the doctor DID give the friend’s daughter antibiotics, but because she had developed a bacterial infection because she scratched too much. It was an infection so bad, that she needed treatment. The friends did not convey that information to the parents in this case, and therefore mislead them into drawing the wrong conclusion.

    How’s that?

  187. #188 D. C. Sessions
    June 19, 2009

    I had an epiphany this morning, and I’ll be as brief as I can: All of this is real to me and theoretical to you. By that I mean that I’ll see and treat more families affected by autism in one week than you’ll know in a lifetime. I have to face families in pain, financial distress and more.

    Ah, yes. Nobody knows the trouble Jay Gordon has seen. Nobody knows his sorrows. The narcissistic appeal to his own authority.

    It’s all theoretical to us (except for Paul Offit, who can be discounted for other reasons). We should pay no attention to Mark Crislip (he an infectious disease specialist, not a paediatrician so ignore him.) Oh, and except for the other practicing paediatricians who post here. Especially those practicing paediatricians who post here and have autistic spectrum children of their own; they’re really biased.

    You can theorize about how many cases of HIB are OK . . .

    Hey, I don’t theorize about it at all. I take your expert word on the subject. For some reason you don’t want the rest of the world to know that one — all we have from you is that there isn’t enough HiB currently in the USA so it’s necessary to take steps to increase the number of cases.

    We’re just trying to help by asking what the target rate is. You’re in charge here, Doc. How many do you want to die this year?

  188. #189 RJ
    June 19, 2009

    Wow, Jake Crosby at AoA has written a very revealing piece (sarcasm alert!). Apparently, THEE scientist responsible for many of those horrible vaccines that saved children’s lives was the culprit behind a controversial plot, which resulted in the import of African Green Monkeys (which apparently had HIV and not SIV, I dunno, ask him). Well, I don’t want to spoil it for you…but it looks like Jake has finally let the cat out of the bag! Yup! Vaccines and the inventors are responsible for AIDS…heck, even cancer! My favorite comment is from the walking tool-shed Mark Blaxill who wants to let everyone know (although not confirmed) that the mass experiments carried out on Africans using the polio vaccine could very well be where ‘AIDS’ (not HIV) comes from. Man, those guys at AoA are such supper sleuth journalists!

  189. #190 James Sweet
    June 19, 2009

    Good analogy, Pablo.

    Sadly, if the parents were determined enough they could surely find a doctor to prescribe them the antibiotics anyway..

  190. #191 Karma is a bitch
    June 19, 2009

    “What would you say to a family who have two fully-vaccinated children with autism…”

    Jay, I have a good answer (I think). Pretend your defending yourself in court. What would you say to the jury…

    Given your well documented position you will undoubtedly be named in malpractice suits when VPD deaths rates increase. There must be people out there that will cite you (and others) as the reason they didn’t vaccinate their kids. The problem is, despite your advice, some of these kids went on to “develop” autism anyway, and all subsequently died from a VPD. At that point these parents (and a larger segment of society) may actually want some answers.

    In the courtroom you must outline your train of thought, supported with credible scientific evidence. Saying “believe me,I’m a practicing doctor” and walking away won’t suffice. Saying that “show me vaccines don’t cause autism” and walking away won’t suffice.

    You’ll be forced to either prove your case,(that the benefit of not vaccinating or “selectively vacinating” outweighs the risk of VPD), or be discraced.

    Can you provide at least a rough outline of what you would say? I’m not attacking you, I want to learn too. Unless you can better articulate your point, I really do think you are in some trouble here with this whole “I just know” thing. You better get your act together, it may be too late already.

  191. #192 D. C. Sessions
    June 19, 2009

    Sadly, if the parents were determined enough they could surely find a doctor to prescribe them the antibiotics anyway..

    And that being the case, their Brave Maverick Doctor does the Brave Maverick Doctor thing: knowing that they’re going to get antibiotics from somebody, it’s better that they get them from him instead of changing paediatricians to some quack, so he writes the scrip.

    Remember: the paying customer is always right.

  192. #193 kathleen
    June 19, 2009

    ” I have to face families in pain and financial distress..”
    I know of a few families facing financial distress because they are paying huge amounts of money to have chelation and home Hbot systems. They spend this money because they believe that their children ahve been “vaccine injured” and famous people have told them that these things will “recover” or “cure” them. I guess one way to relieve the financial burden from these patients were if a doctor were to tell them that these therapies are unproven-and that they shouldn’t waste their money..

  193. #194 Dangerous Bacon
    June 19, 2009

    Dr. Jay: “No, I was not aware of all the “craziness” on whale.to and end up there when I turn down Elsevier’s kind offer to pay $30 every time I want to look at an article. I think I have been correctly and even civilly chastened from in any way linking to that site in the future.”

    Does this chastening extend to no longer accepting whale.to’s offerings as as reliable? Or just to posting the links here?
    Oddly enough, I don’t have to pay $30 for journal articles online – many are free through widely accessible links, plus I get a much greater number free through my hospital’s medical library system. All it takes is being on the medical staff and looking up articles via the online library section. I’d bet you have the same potential for access through hospital affiliation(s), if you choose to use it.

    Dr. Jay: “pD and RJ and Bacon–

    I have a question: As I read your more recent comments, you seem to be saying very clearly that we can’t expect an baby’s/immature immune system to respond to either illness or vaccination in the same way an adult/mature immune system does.

    One of the points I make to parents is that I think vaccines given later and one at a time might make the vaccination process safer. Do you agree or am I misreading your comments?”

    I thought I posted a response to this earlier, but it seems to have gotten eaten. No, you misread my comments as well. All I said about the cytokine theory was that I wondered how any “derangements” in immune function secondary to vaccination compared with what effects occur when the immune system is hit with a far greater antigenic stimulus from actual diseases. I said nothing about infants’ immune systems relative to those of adults. Have _you_ considered the relative damage caused by full-blown infectious disease relative to vaccination? Surely in your 30 years of practice you’ve had some opportunity to see the harm inflicted in myriad ways on children by serious, potentially crippling and even fatal infectious diseases.

    RJ said: “Is anyone else here but me entertaining the idea that it’s not Dr. Jay Gordon (the pediatrician to the stars) that is posting? I see too many obvious errors and disconnects in his postings and just don’t buy it.”

    I’ve wondered about that here in the past, for similar reasons, mainly disbelief that an experienced working pediatrician could be so utterly misinformed and dangerously wrong. But recently on this site, I criticized the Dr. Jay commenter for flirting with AIDS denialism and promoting quacky alternative therapies for HIV, with the result that the section on HIV vanished from Dr. Jay Gordon’s website. So there’s a pretty good inference that “our” Dr. Jay is the real article.

    More’s the pity.

  194. #195 RJ
    June 19, 2009

    Dangerous Bacon: “So there’s a pretty good inference that “our” Dr. Jay is the real article.”

    Wow, that’ scarry! This guy is allowed to practice medicine? Seriously, the shit I’ve read that he’s posted is what I would a college freshman to write. His understanding of the most fundamental concepts is completely absent.

    One thing I do have to say for the man, he knows how to advertise to his target demographic (drumming up business). “No one knows your child better than you do”. That will get the narcissistic elite into his office. And to blog on HuffPo and $ell books instead of publish in reputable journals…I think that says it all.

  195. #196 Tsu Dho Nimh
    June 19, 2009

    Dr Jay says, “the knowledge that autism is thought to be a neuroimmune disorder” …. whose knowledge? Links to published research please?

    Last I heard, autism research was tending to a disordered development of something called microcolumns which develop in the fetal brain in the 6th week or so of pregnancy.

    And I really want to know – since you are opposed to the practice of vaccinating all children who don’t have medical contraindications because the vaccine preventable diseases are at a “low level” and you believe the risk/benefit balance is on the side of not vaccinating – how many cases of specific diseases do you feel are acceptable?

  196. #197 Jay Gordon, MD, FAAP
    June 19, 2009

    Again, between patients on an amazingly busy day . . .

    Tsu, I don’t have any answer whatsoever for your question. None. I do think that we don’t know enough to continue to “adjust” a baby’s immune system repeatedly nor do we know enough to figure out what happens when you eradicate measles from the planet. Maybe we need a low level of certain organisms to keep others in check. I don’t know and you certainly don’t know what happens when we eradicate an organism which has lived with humans for millennia. Measles is good for you? I didn’t say that. I am saying that it’s existence might be more important than we think.

    Pablo, 99.9% of pediatricians do not follow AAP/CDC vaccination guidelines. I’ll address the rest of your concerns after work.

    Broken Link, thanks. I’ll look.

    Orac, only three children this week more than ten last week. I see about 60-70 children/week. Most of my practice involves well child care of neurotypical children but I see families whose doctors don’t want to take care of children with autism and they end up here. I am not an expert in autism treatment but, believe it or not!–sometimes I’m the best they’ve got. I refer them for conventional care (OT, PT, speech and more) and I support their use of HBOT, chelation and other alternatives. (I’m the best they can find??? Yes. Sad but true.)

    Jay

  197. #198 HCN
    June 19, 2009

    Dr. Jay said “What would you say to a family who have two fully-vaccinated children with autism, a family history of autoimmune disease, the knowledge that autism is thought to be a neuroimmune disorder and are trying to decide how and when to vaccinate their third child?”

    Almost sixteen years ago I sat in the pediatric neurologist’s office when my second son’s language delay was discussed. His older brother had, and still has, a severe speech disorder. I was just pregnant with child #3.

    He told us that the speech and language issues were most likely genetic.

    You see, unlike you: he was using both the science, real research and his experience (one of his daughters had a language disorder).

    Also, the child with the most severe issues was the least vaccinated. His history of seizures was a contraindication for pertussis vaccination. That has since been remedied and received his first pertussis vaccine with a Tdap at age eighteen.

    My younger son (fully vaccinated, first of the three to get the Hib vaccine) did grow out of the language degree. He just graduated from high school with honors. My daughter (also fully vaccinated, and the first of the three to get the HepB vaccine) is doing well, and has an affinity for language (she thinks Japanese is “easy”).

    The oldest one has ended up rushed to the hospital by ambulance due to rotavirus. All three have had chicken pox (the youngest when she was six months old). Trust me, I would rather had them risk the very minor risk of those vaccines versus the effects of those diseases. Especially since I was transporting the boys to a total of five speech/language therapy sessions per week (2 for one kid, 3 for the other).

    You are really going to have to work very hard to tell me that the cost of the ambulance, IV fluids, and the rest of the hospital costs did not bring more money to “Big Pharma” than a cost of a rotavirus vaccine. Not to mention the stress and anxiety to our family.

    Oh, and you said “Orac, good call. No, I was not aware of all the “craziness” on whale.to and end up there when I turn down Elsevier’s kind offer to pay $30 every time I want to look at an article.”

    I thought as an “FAAP” you were a fully paid up member of the American Academy of Pediatrics and did not have to pay $30 per article.

    Also, there are these places all over Southern California: they are called libraries. Many of these libraries subscribe to places where you can access the papers for free. And as a resident of the State of California you should have access to any of the state supported medical school libraries, like UCLA. Just this past week I walked into the Engineering Library at my local public university and saw “Guest, no login required” terminals available for looking up papers (though mostly patent searches).

  198. #199 kathleen
    June 19, 2009

    “whose doctors don’t want to take care of children with autism”
    Are these doctors being reported? That makes absolutely no sense…Unless of course it is the parents that won’t go to these doctors because they don’t like what they have to say..vaccines don’t cause autism…chelation and Hbot are unproven myths…that children continue to grow and develop…even autistic ones-without the use of silly treatments..The best that they can find??? Or is it perhaps the only one they can find to feed them what they want to hear.

    and I will reiterate..Perhaps you wouldn’t be dealing with watching the financial distress of your patients families if you didn’t support chelating-Hbot-and all the other such unsupported ridiculously expensive nonsense.

  199. #200 ababa
    June 19, 2009

    Jay Gordaon said: and I support their use of HBOT, chelation and other alternatives.

    Regardless of what you believe about vaccines, you know full well chelation in particular is nonsense and potentially dangerous for treatment. Even if you have your doubts about vaccines I would hope you would at least steer desperate parents away from expensive treatments that can do nothing other than make things worse. You know that thimerosol was a red herring, and even if it weren’t how could it help a child born in the last 8 years?

    You should be ashamed of yourself for “supporting” that.

  200. #201 RJ
    June 19, 2009

    “You are really going to have to work very hard to tell me that the cost of the ambulance, IV fluids, and the rest of the hospital costs did not bring more money to “Big Pharma” than a cost of a rotavirus vaccine. Not to mention the stress and anxiety to our family.”

    Excellent point HCN! Very well said.

  201. #202 Joseph
    June 19, 2009

    Dr. Jay is probably well known among the anti-vax autism parents in Santa Monica. He probably sees many of their kids. He probably often hears their stories of how they had a normal child, who was vaccinated, and then got diagnosed with autism. These types of stories are notoriously unreliable as documented by Lingam et al. (2003). Parents changed their recollection of events after Wakefield. The common claim that children were perfectly normal before vaccination was also challenged in the Omnibus trial.

    But that’s basically what it is. Confirmation bias day in and day out.

  202. #203 bob
    June 19, 2009

    Jay: You support chelation therapy for autism? So, you DIRECTLY encourage the deaths of your patients, in addition to INDIRECTLY doing so via your antivax garbage? Despicable.

  203. #204 Scientizzle
    June 19, 2009

    Dr. Gordon @ 197:

    I support [my patients'] use of HBOT, chelation and other alternatives.

    Why? Serious question. Why?

    I’ll grant that the minimal research done regarding HBOT treatment for autism suggests it may be effective (big caveat: only one clinical study of any quality completed thus far, and 8 of 11 authors derive revenue from hyperbaric treatment; PMID: 19284641)…

    But chelation therapy? Really?! Chelation therapy has no demonstrable efficacy in the treatment of autism and many demonstrable dangers.

    How do you justify support for chelation therapy? Do you attempt to talk these parents out of a decidedly unproven and dangerous modality?

  204. #205 D. C. Sessions
    June 19, 2009

    TDN:

    And I really want to know – since you are opposed to the practice of vaccinating all children who don’t have medical contraindications because the vaccine preventable diseases are at a “low level” and you believe the risk/benefit balance is on the side of not vaccinating – how many cases of specific diseases do you feel are acceptable?

    Dr. Gordon:

    Tsu, I don’t have any answer whatsoever for your question. None. I do think that we don’t know enough to continue to “adjust” a baby’s immune system repeatedly nor do we know enough to figure out what happens when you eradicate measles from the planet. Maybe we need a low level of certain organisms to keep others in check. I don’t know and you certainly don’t know what happens when we eradicate an organism which has lived with humans for millennia. Measles is good for you? I didn’t say that. I am saying that it’s existence might be more important than we think.

    Of all the mealy-mouthed, sanctimonious, cowardly lames I’ve seen here and elsewhere this takes the cake.

    Dr. Gordon comes on television and tells parents that they should take the known risks of HiB, of pertussis, of tetanus, of measles, of freaking SPSE, of diphtheria …

    When asked for how he comes to this conclusion, he cites the low levels (thanks to vaccination) of morbidity and mortality from these diseases in the USA, so that vaccination should be avoided until they rise to some optimal level — but won’t tell us what that optimal level is.

    When pressed for how he comes to these conclusions, he pulls the “Trust me, I’m the Doctor here!” schtick. And when pressed some more, his answer is …

    (wait for it)

    A terminal case of the Precautionary Principle: since our knowledge isn’t perfect, we don’t dare eradicate smallpox or measles or polio! What the PhysioProf!?!?!?

    So tell us, Dr. Gordon: is this the sum of your vast medical expertise, that we are supposed to put ahead of all other authorities so that we willingly accept going back to the diseases I grew up with: that you don’t know, and therefore we shouldn’t?

    Hey, we also don’t know all of the possible consequences of insulin or bronchodilators — so maybe you should change the way you treat diabetics or asthmatics, too.

  205. #206 D. C. Sessions
    June 19, 2009

    You should be ashamed of yourself for “supporting” that.

    The paying customer is always right.

  206. #207 RJ
    June 19, 2009

    ” I don’t know and you certainly don’t know what happens when we eradicate an organism which has lived with humans for millennia. Measles is good for you? I didn’t say that. I am saying that it’s existence might be more important than we think.”

    So, let me get this straight…we need to put children in HBO chambers, chelate them, feed them who-knows-what supplements, and whatever other unfounded/untested therapies there are…to ‘fix’ them because these people aren’t neurotypical, but we need to consider the moral ramifications of eliminating pathogens (some of which are not living things anyway) by advocating the abandonment of medicines greatest success story? Did I get that right?

  207. #208 Jay Gordon, MD, FAAP
    June 19, 2009

    Of all the mealy-mouthed, sanctimonious, cowardly lames I’ve seen here and elsewhere this takes the cake.

    My last patient, a four-year-old, called me a poopoohead. You two would get along well, D.C.

    Seriously, you know exactly what the consequences would be to total eradication of measles? What about total eradication of lactobacillus? Sanctimonious is as sanctimonious does. We scientists (yes, me too!!) know so much less than we think we do. We should tread much more lightly and speak more quietly. (Yes, you too.)

    Best,

    Jay

  208. #209 RJ
    June 19, 2009

    “Seriously, you know exactly what the consequences would be to total eradication of measles? What about total eradication of lactobacillus?”

    Two different things. One is a virus (non-living, parasite, pathogen) while the other is a bacterium (living, commensal/symbiotic organism, beneficial).

    I would say you are comparing apples and oranges, but it would be more accurate to say you are comparing apples and a rock.

  209. #210 kathleen
    June 19, 2009

    At least 10 people in the past hour have asked how you could support chelation and Hbot…and yet you still don’t answer…you only answer when someone calls you a name..Your four year old patient called you a poopoo head..perhaps they are right?

  210. #211 Dangerous Bacon
    June 19, 2009

    Dr. Jay: “I don’t know and you certainly don’t know what happens when we eradicate an organism which has lived with humans for millennia. Measles is good for you? I didn’t say that. I am saying that it’s existence might be more important than we think.”

    Omigod, we’ve eradicated (or nearly so) such diseases as typhus, plague, smallpox, yellow fever…no wonder Johnny can’t read!!!

    You know, to answer Dr. Jay’s query earlier “Why am I here?” – I see tje unnerving possibility of a sinister answer, exemplified in the more than 200 comments on this one article alone. One could speculate that Orac gets paid by the comment through the ScienceBlogs people (under the table by Big Pharma as well?). Could Dr. Jay actually be Orac’s shill, posting nonsensical tripe to stir up the masses to comment, thus filling Orac’s bank account with filthy lucre?!? And might Dr. Jay get a cut of these vast sums of money? I’m gonna write whale.to and Mike Adams, and demand they expose whatever there is here to expose, or at least make up something alarming.

    Anyway, to help set a comment record (and allegedly provide bucks for Orac) I propose we support Dr. Jay’s distinguished record of publication by giving him ideas for his next volume (working title: “Dr. Jay’s Big Bad Book of Vaccines”). Proposed chapter titles: 1) I Had An Epiphany Today 2) Scientists Are Meanies With Boring Numbers 3) Jenny Smiled At Me Today! 4) More Epiphanies 5) The Plural of Compassion Is Data 6) All My Nasty Abusive Critics Should FOAD

    Other ideas? (i.e. lots of photos of Jenny; Dr. Jay, not so much)

  211. #212 D. C. Sessions
    June 19, 2009

    My last patient, a four-year-old, called me a poopoohead. You two would get along well, D.C.

    Dr. Gordon, narcissism has its limits. Please note the difference between calling your statement lame (which is manifestly is) and calling you lame — which would be a comparison to Greg House and totally inappropriate.

    Seriously, you know exactly what the consequences would be to total eradication of measles? What about total eradication of lactobacillus? Sanctimonious is as sanctimonious does. We scientists (yes, me too!!) know so much less than we think we do. We should tread much more lightly and speak more quietly. (Yes, you too.)

    Please apply the argumentum ad ignoratum and the precautionary principle to the rest of your practice, Doctor. Do you know all of the consequences of using insulin or bronchodilators? By your reasoning (quoted) you shouldn’t use them. Or, for that matter, any other medical intervention.

    And do you really know all of the consequences of that microwave oven [1]? How about the shaving cream, deodorant, and soap you use?

    You can never be too careful, after all.

    [1] John Scudamore will tell you things that will ensure that you never microwave anything ever again.

  212. #213 Jay Gordon, MD, FAAP
    June 19, 2009

    Kathleen, this is the busiest day in months in my office. A patient cancelled at the last minute (did one of you call her??) so I have a little time.

    Chelation therapy has been used in pediatrics and other specialties for decades. It is a safe proven treatment. In my opinion, it’s not a proven “cure” for autism but can lower the level of certain metals in the blood. This could make a difference ig cognitive processes if one’s lead, mercury or arsenic level were too high. Unproven but, anecdotally efficacious.

    Hyperbaric oxygen therapy evaluation has recently been published as possibly improved symptoms in autism. It has been used for other medical reasons for a long time. It’s safe. Much more research needs to be done.

    http://www.websciences.org/cftemplate/NAPS/archives/indiv.cfm?ID=20061272

    Best,

    Jay

  213. #214 Joseph
    June 19, 2009

    @Dr. Jay: What is your opinion about the total eradication of autism?

  214. #215 D. C. Sessions
    June 19, 2009

    Could Dr. Jay actually be Orac’s shill, posting nonsensical tripe to stir up the masses to comment, thus filling Orac’s bank account with filthy lucre?!?

    DB, I think you’ve crossed the line with that one.

    While not everyone likes haggis and menudo, they are undeniably at least worth something. You owe them an apology.

  215. #216 Joseph
    June 19, 2009

    In my opinion, it’s not a proven “cure” for autism but can lower the level of certain metals in the blood. This could make a difference ig cognitive processes if one’s lead, mercury or arsenic level were too high. Unproven but, anecdotally efficacious.

    That’s incorrect, and you really should study this subject a little more, because it’s a non-trivial thing to be recommending chelation. Even in cases of low level lead intoxication, chelation doesn’t appear to help at all in regaining cognitive ability. In the absence of poisoning, it may even cause brain damage, according to a rat model.

    Additionally, chelation for real heavy metal poisoning is a treatment that lasts perhaps several months tops. I don’t know what you tell your patients, but many parents of autistic children try chelation for several years. It’s not clear what sort of long-term damage to your kidneys could result from this.

    Finally, Dr. James Adams carried out a randomized trial of chelation, and he was really hoping it would work. Years have passed, and the study is not published yet, that I know of. But I’ve read his presentations. There were no significant between-group differences in outcome. The kids on chelation had more adverse effects, but I’m not sure about statistical significance on that.

  216. #217 D. C. Sessions
    June 19, 2009

    Chelation therapy has been used in pediatrics and other specialties for decades. It is a safe proven treatment.

    You should tell that to Abubakar Tariq Nadama.

    In my opinion, it’s not a proven “cure” for autism but can lower the level of certain metals in the blood.

    Metals such as calcium.

  217. #218 Jay Gordon, MD, FAAP
    June 19, 2009

    Joseph, great question. I have wiped your sarcasm off my monitor and will answer, anyway.

    Autism spectrum disorders are very difficult on families and on the children and teens themselves. As you know, there’s a school of thought in the autism community proposing that we leave these kids and families alone and stop judging autism as a “disease.” I think the majority of affected families would like medical support and help.

    HCN, as you well know, a lot of journal articles are not available for free. Yes, I could go to the library.

    Chelation therapy is not risk free.

    Best,

    Jay

  218. #219 bob
    June 19, 2009

    Jay, about chelation and autism: “Unproven but, anecdotally efficacious.” One can find anecdotes about virtually ANYTHING on the internet. How do you decide which treatments are *sufficiently* anecdotally efficacious? Or do you also encourage bloodletting, per the anecdotal evidence for four humours based therapies?

  219. #220 kathleen
    June 19, 2009

    I would like to know exactly how this heavy metal toxicity is being diagnosed. And where. There are dangers to chelation(kidney failure/brain damage)..and it is unproven in the treatment of autism. My kids have also “improved”-as they continue to develop-they have had no such treatments. Could it anecdotally be because these children are developing and chelation is coincidental? Chelation is also very expensive-as is Hbot therapy…you spoke of the financial distress of your patients..If they are distressed-why would you support them in choosing very expensive treatments…”anecdotally efficacious” treatments?

  220. #221 D. C. Sessions
    June 19, 2009

    Chelation therapy is not risk free.

    But apparently has a better risk/benefit profile than vaccination, even in light of the Precautionary Principle.

    Do, please, share the research that supports these conclusions.

  221. #222 Joseph
    June 19, 2009

    I have wiped your sarcasm off my monitor and will answer, anyway.

    It was a serious question, and you didn’t really answer it.

  222. #223 gaiainc
    June 19, 2009

    Having just read through the past 100+ posts, I am left with two thoughts. One is that the only way I would let Dr. Gordon near my son is if he was the last one on earth and my son had no one else to turn to for medical care, which includes me since I am a family physician. Even then I hesitate because a lot of what I’ve read makes me facepalm and after a while, that hurts. I’m particularly flabbergasted that he supports chelation. Words fail me.

    The second is that Dr. Gordon doesn’t seem to admit patients in the hospital or care for them there. Every fall/winter/sometimes into spring our service admits a whole lot kids with rotavirus. This year it may have been a little better given that the rotavirus vaccine was coming out (THANK YOU, Dr. Offit), and I’m hoping this year we will also see fewer cases. However, I’m not going to hold my breath.

    Hmmm… on second thought, maybe I’ll just have to educate my son so that he can treat himself and bypass Dr. Gordon completely.

  223. #224 bob
    June 19, 2009

    He already told us about the “research,” DC: his personal anecdotes, and anecdotes other people tell him.

    I sure hope that friend of a friend of his who woke up in a hotel room tub full of ice with his kidney stolen is doing okay!

  224. #225 Jen
    June 19, 2009

    Just an update in case anyone is interested…

    I’m sure many of you remember my son’s horrific story as told in the “we support Dr. Andrew Wakefield?” thread from February.

    Dr. Krigsman scoped my son a few days days ago, and lo and behold…much damage was found in his poor intestinal tract. GE erosions and erythema, eosinophilic esophagitis, and lymphonodular hyperplasia in the duodenum and terminal ileum. Biopsies and pillcam results are pending. It’s no wonder he became so violent…that sort of pain and not being able to tell anyone would drive anyone crazy. I shudder when I think about how much pain he must have been in, and “modern” medicine’s “solution” to the problem was to explain his aggressive and self-injurious behaviors away as a hormonal change, treat it with powerful and often dangerous antipsychotic medications, and possibly institutionalization. I am FURIOUS.

    At least I have some answers though, and he can begin the healing process.

    I am more convinced than ever that Tylenol is responsible for this mess.

    Eosinophilic esophagitis and LNH are common findings in those with food allergies. (Remember that my son’s regression coincided around the time he was given multiple doses of Tylenol, which I will say ONCE AGAIN is increasingly being found to be linked with allergies and asthma.)

    (Why do I seem to be the only one who is pissed about this?)

    So, go ahead and continue to bicker back and forth amongst yourselves about whether or not vaccines cause autism. I’m sure Johnson and Johnson is most grateful to all of you for diverting attention away from them.

  225. #226 LW
    June 19, 2009

    Quoth Dr. Gordon:

    As for the comments about my ignorance: Yes, I have gaps in my knowledge base and will keep coming back here to fill some them.

    Does anyone besides me find it profoundly disturbing that a pediatrician, who gives real life-or-death medical advice to real living human beings, is hanging out here to fill the gaps in his knowledge base? I really enjoy Orac’s posts and (most of) the comments that follow, but surely there are continuing medical education programs that would relieve ignorance about the prevalence of the organism that causes tetanus, or the actual medical indications for chelation, or the existing research on causes of autism.

    Don’t doctors have to go through continuing education? Or are they allowed to go along treating patients based on their “experience” while their medical education gets more and more out of date?

  226. #227 D. C. Sessions
    June 19, 2009

    Having just read through the past 100+ posts, I am left with two thoughts. One is that the only way I would let Dr. Gordon near my son is if he was the last one on earth and my son had no one else to turn to for medical care, which includes me since I am a family physician. Even then I hesitate because a lot of what I’ve read makes me facepalm and after a while, that hurts.

    You obviously Just Don’t Understand. All of this is real to him and theoretical to you:

    I had an epiphany this morning, and I’ll be as brief as I can: All of this is real to me and theoretical to you. By that I mean that I’ll see and treat more families affected by autism in one week than you’ll know in a lifetime. I have to face families in pain, financial distress and more. You can theorize about how many cases of HIB are OK . . .

    See? Whether it’s OK for your son to get invasive HiB is just a matter of theorizing. Much more important are concerns regarding the dangers of a world without measles and polio, which is a terrifying prospect that requires us to keep them in circulation.

    And we probably should reintroduce smallpox, too — it’s been with us for millennia, and who knows what harm we might have done by eliminating it?

  227. #228 Scientizzle
    June 19, 2009

    I’m gobsmacked by Dr. Gordon’s promotion of chelation therapy. I suggest he does a MEDLINE search for “chelation therapy autism” and note that there are NO (zero, zip, nada) trials that support the off-label use of chelating agents for autism, but several reports of the dangers of this modality.

    Moving on the use of HBOT treatment for autism…Dr. Gordon gets minus points for citing Med Hypotheses to support a claim. Let me help, though: in comment #204 I stated:

    I’ll grant that the minimal research done regarding HBOT treatment for autism suggests it may be effective (big caveat: only one clinical study of any quality completed thus far, and 8 of 11 authors derive revenue from hyperbaric treatment; PMID: 19284641)…

    Read the study–it’s an actual randomized, double-blind, controlled clinical trial (the only one you’ll find; 62 subjects). Then, liberally apply that conflict of interest metric that allows you to discount the likes of Dr. Paul Offit to this trial.

  228. #229 D. C. Sessions
    June 19, 2009

    Does anyone besides me find it profoundly disturbing that a pediatrician, who gives real life-or-death medical advice to real living human beings, is hanging out here to fill the gaps in his knowledge base?

    Not even remotely as much as the fact that he’s discouraging parents from providing their children with proven life-saving preventive measures based on nothing more than night terrors about the the possibility that there might be some unknown downside to a world without smallpox, measles, polio, etc.

    However, what really bothers me is that he’s so lacking in the ability to critically consider his own prejudices that even when fallacies, illogic, and self-contradictions are pointed out to him he just cranks up the self-justification. That degree of inability to admit that he might be wrong (never mind actual self-criticism) in someone entrusted with the lives of children?

    Shudder.

  229. #230 Joseph
    June 19, 2009

    Dr. Krigsman scoped my son a few days days ago

    Dr. Krigsman is the medical director of Thoughtful House. He’s a colleague of Wakefield’s, basically. He’s the only researcher in the world who alleges to have reproduced Wakefield’s work (though I don’t think this is published anywhere.)

    Check out Krigsman’s testimony in Cedillo. It’s well worth reading.

    Now, is it possible that Krigsman really found what he claimed to find? I guess so. But I’m also very skeptical. I doubt that any child seen by Krigsman gets a negative result.

    If I were in this situation, I’d get a second opinion from an independent non-woo gastroenterologist.

  230. #231 Jen
    June 19, 2009

    “Check out Krigsman’s testimony in Cedillo. It’s well worth reading.”

    I’ve already read Dr. Krigsman’s testimony in the Cedillo hearings. I don’t agree with him that MMR is causing autism. I also don’t agree with YOU that the increase in autism is due to “better diagnosing” or an “increase in internet hosts.”

    “If I were in this situation, I’d get a second opinion from an independent non-woo gastroenterologist.”

    Actually, the first gastroenterologist we took him to wrote a nice letter to our insurance company, requesting that Dr. Krigsman be the one to perform the procedure, since he felt that Dr. Krigsman was eminently more qualified to treat my son.

    Believe whatever you like about Dr. Krigsman; you will anyway, despite anything I write. I, however, am eternally grateful to this man for giving my son his quality of life back.

  231. #232 Joseph
    June 19, 2009

    I, however, am eternally grateful to this man for giving my son his quality of life back.

    I thought he saw your son a few days ago.

    I also don’t agree with YOU that the increase in autism is due to “better diagnosing” or an “increase in internet hosts.”

    Not that I said exactly that, but what do you base your opinion on? Evidently, I’m interested in this particular argument. Is there anything new you can contribute?

  232. #233 Jay Gordon, MD, FAAP
    June 19, 2009

    D.C. Sessions, chelation, like every other medical intervention, has risks. In certain circumstances, the benefits exceed the risks. I think this is true for autism. Others disagree. Yes, I think that chelation might have a better risk/benefit profile than the current vaccine schedule but that’s not the point: If you have conditions which might be treated with chelation we’re not comparing vaccines and chelation we’re comparing chelation versus non-chelation. (You knew that.)

    Joseph, my apologies. Yes, I think we should continue to look hard for the causes of autism spectrum disorders and eradicate these disorders.

    Bob, silly question.

    Kathleen, yes, I think some children get better while undergoing certain treatments and not because of them. Studies are underway to discern which of the therapies actually work.

    Gaiainc, I have a breastfeeding practice. I have admitted no more than three or four children with rotavirus in the past thirty years. I have never given a vaccine against rotavirus. Comparing vaccination to breastfeeding protection is fun. Thanks for offering me the opportunity. I have been a pediatrician for thirty years (Have I mentioned that before?) and practice in a demanding community, in hospitals with extremely high standards in a state that is more than willing to call doctors to task for misdeeds. Check my record. If I were under-admitting or misdiagnosing rotavirus (HIB, pertussis, et cetera) I would not be around to talk with you. I last saw a case of bacterial meningitis in 1982 or 1983. A couple years ago a teenager in my practice was diagnosed with meningococcal meningitis, properly treated and survived with no sequelae. I last saw invasive HIB disease in the 1980s. I see children with pertussoid coughs every few months. Because many of my patients have not received any vaccines, I can get a definitive answer by drawing blood and measuring antibody titers. I see laboratory proven pertussis perhaps once or twice/year. I hospitalized a child for whooping cough in the 1980s and once in the 1990s. Again, both did well. I hate pertussis and would love a single antigen, single dose vaccine. I have none. This, obviously is the vaccine I favor the most although I tell all of my patients that they can’t go into their teenage years without varicella immunity. I recommend hepatitis vaccination for higher risk teens and adults and have given the meningococcal vaccination to quite a few kids heading for college. No matter what the polio data show (1700 cases/6,000,000,000 people) most of my families heading for India prefer to get the vaccine than go without.

    LW, don’t underestimate the brain power on this site. I’m guessing that you could use this page and the topic of cytokines as a quiz which 90% of doctors would fail. The prevalence of C. tetani? No, I don’t need help with that topic.

    D.C. Sessions, again, your bitterness is overwhelming your ability to contribute anything but insults. I’m sorry for having offended you so deeply. Many of your past posts have helped. Nothing you’ve written here is that great.

    Best,

    Jay

  233. #234 kathleen
    June 19, 2009

    @jen-I think that what people are saying is that no matter what, it appears that Dr.Krigsman will find something wrong..I am sorry for the struggle that both you and your boy are going through. I do hope that you get some answers and find some peace.

  234. #235 bob
    June 19, 2009

    Jay: Silly question? All you’re offering is anecdotes, so I asked how you discriminate among all the anecdotes you receive. I suppose your answer is “arbitrarily,” then? Or do you only listen to the ones that support your preconceived notions? That’d be my guess, since that (confirmation bias) would be just one more example of you fallacious thinking.

    As I said over on PalMD’s blog: You’d be a laughingstock if you weren’t so dangerous. Please stop contributing to innocent peoples’ needless deaths.

  235. #236 Jay Gordon, MD, FAAP
    June 19, 2009

    Bob,

    I just went back and reread all your posts here to see if I could the meaningful question you’re referring to. I couldn’t.

    Yes, I strongly prefer to cite literature which agrees with my biases. I don’t ignore the other literature or other ideas, but I don’t discriminate arbitrarily. I’ve learned a lot and changed the way I practice based on new research and ideas. I’m also very willing to participate in spirited discussions.

    What do you do for living, Bob? Just curious.

    By the way, I’m starting to doubt that the person posting now is the real “D.C. Sessions.”

    Best,

    Jay

  236. #237 Matthew Cline
    June 19, 2009

    … nor do we know enough to figure out what happens when you eradicate measles from the planet.

    So, then, has smallpox been eliminated for long enough that we know that there’s no downside to it being gone? Or would the Precautionary Principle say that we should use the smallpox we have in labs to reintroduce it into the wild? If the fact that we have it in labs, and thus can reintroduce it into the wild at any time if a problem is discovered, means that we don’t have to reintroduce it right now, then couldn’t we eliminate measles from the wild and keep samples of it at secure locations so we can reintroduce it if it’s found that eliminating wild measles is a bad idea?

    Also, what about the polio-vaccine scare that happened in Nigeria? Do you think that it was good thing, since it threw a wrench into the plans of polio being eliminated from the wild?

  237. #238 kathleen
    June 19, 2009

    “I think that some children get better while undergoing certain treatments and not because of them”
    So once again, why do you support parents using them..as they are extremely costly-and as of yet there is no proof that they work. There are however significant risks. Why?

  238. #239 Joseph
    June 19, 2009

    Yes, I think we should continue to look hard for the causes of autism spectrum disorders and eradicate these disorders.

    So, in your view, Dr. Jay, it’s a good idea to let viruses such as measles exist in the world to some extent, but the existence of people who happen to be autistic really can’t be tolerated. Because, truly, why should the world put up with a group of people characterized by well known impairments, but also all-consuming interests, enhanced logical consistency (De Martino et al. 2008), bird-of-prey-like visual acuity (Ashwin et al. 2009), a block design peak (Shah & Frith 1993), imperviousness to misleading prior context (Ropar & Mitchell 2002), and high prevalence of outstanding skills (Howlin et al. 2009)? What could possibly be gained by keeping such a group of people around? The viruses, on the other hand…

  239. #240 Jay Gordon, MD, FAAP
    June 19, 2009

    Matthew, no I don’t favor reintroduction of smallpox and I favor polio vaccination against polio in Nigeria.

    Kathleen, I think that the risks to chelation are overstated (data, please gentlemen and ladies!!) and that HBOT also is a low risk intervention. As for the money involved, you better than almost anyone here should know that taking care of child with autism using conventional means is very expensive. I don’t think that unconventional therapies greatly increase that expense and may decrease the cost in the long run.

    Best,

    Jay

  240. #241 Tsu Dho Nimh
    June 19, 2009

    Jay said: Maybe we need a low level of certain organisms to keep others in check. I don’t know and you certainly don’t know what happens when we eradicate an organism which has lived with humans for millennia.

    OMG!!!! Smallpox was finally eradicated in 1980 … and autism rates began to skyrocket!

    Since we can’t be sure that the eradication of smallpox isn’t causing the epidemic, should we bring it back? Maybe it’s necessary?

  241. #242 Jen
    June 19, 2009

    “I thought he saw your son a few days ago.”

    I said that he *scoped* him a few days ago. We started the process with Dr. Krigsman a few months ago, back when all of the behavior problems began. It was then that he was prescribed the elemental formula, (which he responded positively to immediately) and the lengthy process of gathering the needed specimens began. We ran into some snags with our insurance (HMO…long story) and the anesthesiologist expressed some concerns regarding his heart, so he also needed a cardiac evaluation done since he has a history of running some funky heart rhythms, otherwise it would have been done sooner.

    “Is there anything new you can contribute?”

    Uh, no. (Not without revealing personal information, anyway)I think I’ve been pretty consistent in my belief that Tylenol is a dangerous drug that should be used much more cautiously in pregnant women and young children, if not withdrawn from the market entirely. At the very least, it should only be sold by prescription. A warning label alerting consumers of the possibility of developing allergies and asthma would be nice, too, since, you know, there is evidence of that, and lots of it.

    Hey, a girl can dream…Starry-eyed idealist that I am, I’d like to see a reduction in the incidence of chronically ill children, as well as ensuring that children are safely vaccinated.

    Unfortunately, as long as the belief persists that vaccines cause autism, none of those things are going to happen.

  242. #243 D. C. Sessions
    June 19, 2009

    D.C. Sessions, again, your bitterness is overwhelming your ability to contribute anything but insults.

    I’m not at all bitter, Dr.Gordon — I’m contemptuous. In part because you’re not even clever enough to disguise the fact that you’re ducking and weaving in a bathetic attempt to avoid dealing with the issues that I contribute.

    I daresay that you’re the only one here who hasn’t noticed that; certainly several have commented on the fact.

  243. #244 kathleen
    June 19, 2009

    Jay, you didn’t answer my question. Why would you support ANY therapy that is not proven-especially expensive therapy.

    And to be quite honest-As I mentioned before three of my four kids are on the spectrum. With the exception of my insurance not fully covering a few diagnostic tests (neurological-brain scans) and initial evaluation..I have paid hardly anything out of pocket. Through Child development services and the dept. of education..I have received both speech and O.T. My children were diagnosed on different levels-from high functioning to low. And although I can not speak for my three year old yet, both of my boys have developed and progressed. They are both considered high functioning now.(I hate the terminology-but it works for this discussion)So I am not sure what you are referring to as to cost.

  244. #245 Rogue Medic
    June 19, 2009

    I am confused by all of this criticism of FAAP.

    Using the abbreviation after his name suggests that he has met the minimum standards to do so. The AAP is not, as far as I know, a disreputable organization. We should not be criticizing all who use this abbreviation after their name, just because we do not think highly of Dr. Gordon.

    I also do not see anything on the AAP site that supports Dr. Gordon’s anti-science, anti-vaccine statements. I expect that AAP members support vaccination much more than the general population. Unlike Dr. Gordon, their position is probably based on science, rather than anecdote.

  245. #246 Matthew Cline
    June 19, 2009

    Matthew, no I don’t favor reintroduction of smallpox and I favor polio vaccination against polio in Nigeria.

    So:

    1) Why is the elimination of measles from the wild a problem if we can store the measles virus in labs and then reintroduce it to the wild later later if there’s a problem?

    2) If it weren’t for the polio-vaccine scares, we’d be well on way towards completely eliminating polio from the wild, so I assume you think that eliminating polio is a good thing. Why worry about the possible unknown results of eliminating measles, but not polio? Is it that the severity of an unknown result from eliminating an infectious disease is at most X, where X is worse than measles, but polio is worse than X? If so, how do you put an upper cap on X? The point you made about measles is that we don’t know what could happen from fully eliminating a particular infectious disease, so how can we know the upper limit to the severity of these unknown risks? If there’s some other logic behind deciding that the unknown risk of eliminating polio is worth it but the unknown risk of eliminating measles isn’t, then please explain.

    3) Do you think that enough time has passed since smallpox has been eliminated from the wild that we know for sure that any unintended consequences of that elimination are worth it? If so, how do you know that enough time has passed to shake out any unknown effects, and that it isn’t possible for there to be any unknown effects that manifest as more time goes by?

    Or do you think that smallpox is so bad that no unknown risk from eliminating it could possibly be as bad as the disease itself? If the latter, since the risk is unknown, how do you make that judgment call?

  246. #247 kathleen
    June 19, 2009

    From what I understand Chelation is only FDA approved for accute heavy metal poisoning. Who does your testing-and where? As for citing that chelation can be dangerous-Abubakar Tariq Nadama. Or isn’t the death of one child serious enough?

  247. #248 bob
    June 19, 2009

    Jay: You couldn’t find my “meaningful question”? It seems that your reading comprehension is as poor as your overall comprehension of science and evidence.

    Here it is (copy-pasted directly from one of my posts above): How do you decide which treatments are *sufficiently* anecdotally efficacious?

    You still haven’t answered this, and I’m not the only one addressing this issue. Why are your anecdotes better than anybody else’s anecdotes? Why are they better than the scientific evidence you disparaged above?

    And (not that it’s relevant, or any of your business) I am a graduate student. Full disclosure: my research advisor has NIH grants. Guess I’m a Big Vaccine shill, then, huh?

  248. #249 D. C. Sessions
    June 19, 2009

    By the way, I’m starting to doubt that the person posting now is the real “D.C. Sessions.”

    Is this a variant on the Pharma Shill Gambit?

    Easy enough to find out. You can look up any of my Usenet posts and contact the domain admin. His phone number is in the domain registration records.

    Or for that matter, I’m in the phone book.

  249. #250 HCN
    June 19, 2009

    Dr. Gordon said “Gaiainc, I have a breastfeeding practice. I have admitted no more than three or four children with rotavirus in the past thirty years. I have never given a vaccine against rotavirus. Comparing vaccination to breastfeeding protection is fun.”

    I am calling foul on your anecdote, and record keeping.

    My son was fourteen months old and still being breastfed on demand when he was rushed to the hospital with rotavirus. He was actually eating some real food, and interacting with other children in a playgroup situation. He could have gotten the virus by transfer from a surface (toy, carpet) to his hand, and then his mouth. The fact he drank juice from a cup, and ate real food is immaterial.

    Maternal antibodies are only good for about six months. As a member of FAAP you should know this. My daughter got chicken pox when she was only six months old, and this was when her only form of nourishment was breastmilk. And yes, I did breastfeed until at least age two, and introduced foods and just let them choose. You wanna make something of that?

  250. #251 AutismNewsBeat
    June 19, 2009

    Pablo, 99.9% of pediatricians do not follow AAP/CDC vaccination guidelines. I’ll address the rest of your concerns after work.

    Do you have any data to back this up? The one study I’ve found is How Do Physicians Immunize Their Own Children? Differences Among Pediatricians and Nonpediatricians, 2005;116;e623-e633 Pediatrics. A survey of 2,070 Swiss physicians found that 93 percent agree with the official schedule, and would apply it on their own children. Pediatricians were more likely to follow the official recommendations than non-pediatricians.

  251. #252 HCN
    June 19, 2009

    Crud! I forgot! I also got the infection! I had to borrow some of his cloth diapers (hey! I was the super uber natural mom, breastfeeding, fresh homemade baby food and cloth diapers!) to stuff in my pants because it was hard to get to the facilities fast enough!

  252. #253 HCN
    June 19, 2009

    Dr. Gordon said (and I only noticed it after it was quoted): “By the way, I’m starting to doubt that the person posting now is the real “D.C. Sessions.”"

    Um, I have seen no variation in style or content in any D.C. Sessions posting since encountering him on Usenet almost a decade ago. He is what he is: a doctorate level electrical/computer engineer father of at least one now adult ADHD child who lives in Arizona, and is a volunteer medical tech on the ski slopes and is scary smart, wise and should never be dismissed. And what makes it even better: he is a gardener. Definitely someone I admire, respect and would not mind hanging out with.

  253. #254 Jay Gordon, MD, FAAP
    June 19, 2009

    HCN, I’m calling foul on your calling me a liar. That’s part if the pact here, isn’t it? No matter how severely one disagrees, the truth is the most important currency. Maternal antibodies are good for as long as a child is breastfeeding and breast milk has anti-rotaviral factors which protect babies:

    The compound, called lactadherin, is manufactured in the breast and doesn’t break down in the baby’s stomach. Instead, it mimics natural carbohydrates found along the child’s intestinal walls. The rotavirus mistakenly identifies lactadherin as this home-grown carbohydrate and latches onto it in order to anchor itself in the gut. Both lactadherin and the bound virus are then flushed out of the child’s system, says David S. Newburg, a biochemist at Harvard Medical School in Boston and coauthor of the study, which appeared in the April 18 Lancet.

    Researchers tracked 200 breast-fed infants in Mexico City, documenting any cases of diarrhea and taking regular blood and stool samples to check for rotavirus; infections. Of 31 babies with the infections, 15 had diarrhea and 16 had no symptoms. Breast milk consumed by the asymptomatic infants had higher quantities of lactadherin, indicating that the carbohydrate effectively suppresses the symptoms of viral infection
    and that some women make more of it than others.

    Breast milk contains other complex carbohydrates that may protect against disease-causing organisms, says study coauthor Ardythe L. Morrow, an epidemiologist at Eastern Virginia Medical School in Norfolk. “A lot of work is going into that area,” she adds.

    If further tests prove lactadherin can prevent diarrhea effectively on its own, researchers may be able to develop a synthetic version for treating the disease, Newburg said.

  254. #255 HCN
    June 20, 2009

    I did not call you a liar. I said your record keeping stinks.

    This is what I wrote (okay, James Sweet, this is the value of allowing cut and paste!):
    “I am calling foul on your anecdote, and record keeping.”

    Plus, whatever you post does not count unless accompanied with the cites to the pertinent literature. I live less than two miles from a medical school library so I can access most medical literature without paying a fee.

    Until tomorrow, Good Night. I am going to go watch some Babylon 5 DVDs from the library.

  255. #257 D. C. Sessions
    June 20, 2009

    I favor polio vaccination against polio in Nigeria.

    OK, the game of “20 questions” continues. Apparently the polio rate in Nigeria is higher than optimal, and that in the United States is lower.

    We’re still trying to get an answer on how many cases of polio in the USA are required to justify vaccination.

    Then we can move on to HiB.

  256. #258 Jay Gordon, MD, FAAP
    June 20, 2009

    HCN, breastfeeding does not prevent all illnesses including chickenpox. It does, however, exert a very strong protective effect against rotavirus.

    Rogue Medic, yes most members of the AAP are very strong supporters of vaccination but, AutismBeat, I was responding to Pablo’s comment that “99.9% of the Fellows of the AAP and the rest of pediatricians in the country maintain the CDC/AAP guidelines.” As usual, I have nothing to dispute your “93%” except my personal contact with my colleagues. Most of them adhere quite closely to AAP guidelines but deviate when they need to for medical or parental preference reasons.

    The comment about “the real D.C. Sessions” was a joke. Kinda’ like recurrent comments that I couldn’t be the real “Jay Gordon.”

    Best,

    Jay

  257. #259 Prometheus
    June 20, 2009

    Dr. Jay hypothesizes:

    Seriously, you know exactly what the consequences would be to total eradication of measles? What about total eradication of lactobacillus?

    Note: measles is a virus, most likely acquired by humans in the past 10+ thousand years from cattle, which have a similar viral disease known as rinderpest. Lactobacillus is a commensal bacteria found in the intestines and vaginas of most mammals. It has probably been with us since the evolution of mammals over 100 million years ago.

    Comparing a (relatively) recently acquired pathogenic virus to an ancient commensal bacteria shows the weakness of Dr. Jay’s “hypothesis”. The fact that other pathogenic viruses have either been completely eliminated (smallpox) or rendered nearly so in limited areas (yellow fever and polio in the US) shows that there is a precedent for eliminating pathogenic viruses without removing any “check” on worse diseases.

    Dr. Jay goes on to say:

    Sanctimonious is as sanctimonious does. We scientists (yes, me too!!) know so much less than we think we do.

    Dr. Jay may be a passable pediatrician – I don’t dispute that. However, he is as much a “scientist” as the guys on “Ghostbusters”. His constant refrain about how his “wisdom” and “experience” are better than “hidebound numbers” are in direct contrast to how real scientists work.

    Some physicians are scientists – our host, for example – but most physicians are not. This doesn’t keep them from being good physicians, but it does keep them from doing (and sometimes understanding) science.

    Real scientists know the literature and history of their field well enough to know the limits of their knowledge. This is why some excellent scientists have made fools of themselves when they wander into another field and claim to have found “the truth” (Linus Pauling comes to mind). Real scientists know their limits and stay within them.

    That there are some exceptions to this maxim merely shows that people who call themselves scientists are human and subject to human failings, just as there are ministers who prey on their “flock” and attorneys who imbezzle from their clients. They may call themselves scientists, ministers and lawyers, but they have stopped being scientists, ministers and lawyers.

    The words of “Dean Yeager” from the film Ghostbusters seems to fit here:

    Your theories are the worst kind of popular tripe, your methods are sloppy and your conclusions are highly questionable. You are a poor scientist, Dr. Jay.

    In fact, I’d go so far as to say that Dr. Jay is no scientist, at least as science has been practiced for the past 100 years. This doesn’t prevent him from being a fine pediatrician (there may be other things preventing that), but he is not a scientist and it is ludicrous for him to claim to be one after all the times he has claimed that his “wisdom” and “experience” trump the data.

    Prometheus

  258. #260 K
    June 20, 2009

    OMG.
    I cannot believe what I am reading.

    I last saw a case of bacterial meningitis in 1982 or 1983.

    Then you are damn lucky. I know of two meningococcal meningitis deaths in previously completely healthy teens in our state in the last 4 months.

    A couple years ago a teenager in my practice was diagnosed with meningococcal meningitis, properly treated and survived with no sequelae.

    Then that kid was damn lucky. Even with “proper” treatment, this disease can be rapidly fatal. Do you think those kids who have suffered permanent sequalae or died in the hospital simply did not receive the appropriate treatment? I hope you know better, but I seriously have to wonder.

    I last saw invasive HIB disease in the 1980s.

    Coincidentally, that was right around the time the vaccine for Hib disease became available. Hmmm…

    I see children with pertussoid coughs every few months. Because many of my patients have not received any vaccines, I can get a definitive answer by drawing blood and measuring antibody titers. I see laboratory proven pertussis perhaps once or twice/year.

    Dr. Gordon, for future reference, serology is not considered reliable for pertussis testing . You should be getting an NP swab for culture.
    Pink Book Page 201-202
    cdc.gov/vaccines, look under publications. (Hotel computer won’t let me link.)

  259. #261 D. C. Sessions
    June 20, 2009

    HCN, I’m blushing.

    Besides, the garden is mostly $HERSELF’s work.

  260. #262 Jay Gordon, MD, FAAP
    June 20, 2009

    NP swabs are not accurate. Too many things can obscure or mimic B. pertussis growth. Detection of pertussis antibodies–or the absence thereof–is far more accurate.

    I’m not lucky. I just told you, I have a breastfed incredibly healthy practice. I might add that my families’ nutritional status is superb, they don’t smoke, and they are far healthier than average. Most of the babies in my practice are nursed for one to three years. They get sick less often.

    Yes, the HIB vaccine stopped most invasive HIB disease. And, yes, prompt diagnosis and treatment of meningitis decreases the chance of sequelae. You can read that without my tossing citations your way.

    The point I was making about Lactobacillus and measles is simple: we don’t know very much about what happens when we tamper with human ecology. Bacterial or viral.

    Jay

  261. #263 bob
    June 20, 2009

    For crying out loud, can you *please* stop arguing from ignorance! Lest I trigger your persecution complex (and we all know that does have quite the hair trigger), note that I am *not* calling you ignorant.

    What I am saying is that the point you are trying to make (“we don’t know very much about what happens when we tamper with human ecology”) is not a point at all! Do you understand this or not?

  262. #264 Matthew Cline
    June 20, 2009

    The point I was making about Lactobacillus and measles is simple: we don’t know very much about what happens when we tamper with human ecology. Bacterial or viral.

    Then shouldn’t we put a halt to the attempt to eradicate polio from the wild, in case it screws something up? Maybe the absence of small-pox is causing irreparable damage to the ecology even as we speak. And if measles is somehow necessary to the ecosystem, we can just keep the measles virus in storage at multiple locations and reintroduce it into the wild if eliminating turns out to have been a bad idea.

  263. #265 Jay Gordon, MD, FAAP
    June 20, 2009

    Matthew, please let me know when you’re willing to leave this sub-topic.

    I think that the eradication of small pox and polio are good ideas. Measles infection is beneficial to individual humans but creates enough morbidity and mortality to give anyone pause. I’m not going to post that link again.

    I just don’t share your certainty about vaccination being unequivocally good. Or bad.

    Jay

  264. #266 LW
    June 20, 2009

    Measles infection is beneficial? Sadly, I must have missed the link. Could you please repost it?

  265. #267 Jay Gordon, MD, FAAP
    June 20, 2009

    OK. Question for the group: Can you send me to sites or articles you respect delineating the dangers of chelation? I know it’s well-known “woo” to you all, but I’m really interested in learning more about the potential problems. I’ve done a decent Google search and found usual about Kerry/Abubakar and so on. I know the risk of using a calcium-free solution. Is there more?

    Thanks.

    Jay

  266. #268 Matthew Cline
    June 20, 2009

    Measles infection is beneficial to individual humans but creates enough morbidity and mortality to give anyone pause. I’m not going to post that link again.

    If you’d said that measles has a known plus side that makes entirely eradicating it a bad idea, then I would have said that I’d have to read up on that (and I do say so now). If what you were trying to say is that we don’t know what long term changes would happen to the human ecology if we eliminated this known plus side, then you should have chosen your words more carefully, since it read like you were saying that measles might have an unknown plus side, which would also apply to polio.

    Also, if you claim that getting measles is in general beneficial, do you recommend that parents use “measles parties” to expose their children to measles, after first making sure that their pediatrician is competent enough to prevent any permanent damage if the child suffers severely from the infection? In which case you’d recommend that parents only vaccinate their children against measles if their child is so sickly that they’d likely have a really severe reaction to a full blown case of the measles?

    And that reminds me of a previous question about your use of medical indications in order to give vaccinations “judiciously”. By that, do you mean that you give vaccinations unless there’s a contraindication? Or that the default is not vaccinating, and you only give them if there’s an indication that the child needs it? If the later, what are the indications that a child is in need of a particular vaccination? Are these (non-contra) indications something you could find in the normal medical literature, or are they something that you’ve developed through your clinical experience?

  267. #269 Tsu Dho Nimh
    June 20, 2009

    Jay said, “Maternal antibodies are good for as long as a child is breastfeeding, which is overstating the case. The mother can only pass along the antibodies that she has. For example the best way to prevent neonatal tetanus is to vaccinate pre-reproductuive age girls so that they will have the antibodies to pass to the baby (transplacentally, in this case). If the mother is not immune to a disease, the child gets no antibody protection unless there is a non-specific protective effect.

    Of 31 babies with the infections, 15 had diarrhea and 16 had no symptoms. Breast milk consumed by the asymptomatic infants had higher quantities of lactadherin, indicating that the carbohydrate effectively suppresses the symptoms of viral infection and that some women make more of it than others.

    OK … so you are evidently willing to settle for something that is only 50% effective in preventing a disease. How do you propose protecting those infants whose mums (for physical or economic reasons) can’t breastfeed? And how will you spot those mums who do not make a protective amount of lactadherin so you can arrange protection for their infants?

    Measles infection is beneficial to individual humans … oh really? If so, how do we know which ones will benefit, and which ones will end up with complications?

  268. #270 daedalus2u
    June 20, 2009

    Dr Jay, this paper shows that chelating rats without heavy metal poisoning leads to long lasting adverse mental effects.

    Succimer Chelation Improves Learning, Attention, and Arousal Regulation in Lead-Exposed Rats but Produces Lasting Cognitive Impairment in the Absence of Lead Exposure

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17384765

    This paper is available for free, there is no excuse for you to not get it and read it. In case you have trouble understanding why I cited it, the absence of lead exposure is equivalent to the absence of mercury exposure. Children without toxic levels of mercury (in real tests, not provoked) would be expected to experience long lasting cognitive impairment from chelation treatment.

  269. #271 AutismNewsBeat
    June 20, 2009

    In November, 2008, the journal Neurotoxicology released an “e-publication” of an article that casts further doubt on the efficacy and safety of chelating children with autism.

    Rush T, Hjelmhaug J, Lobner D. Effects of chelators on mercury, iron, and lead neurotoxicity in cortical culture. Neurotoxicology. 2008 Nov 5. [Epub ahead of print]

    In this study, the authors used primary cortical cell cultures to study the effectiveness of several chelators commonly used to treat “heavy metal poisoning”: calcium disodium ethylenediaminetetraacetate (CaNa(2)EDTA), D-penicillamine (DPA), 2,3 dimercaptopropane-1-sulfonate (DMPS), and dimercaptosuccinic acid (DMSA). All but DPA have been widely used to “treat” autistic children.

    They treated the primary cortical cell cultures with four metal “toxicants”: inorganic mercury (HgCl2), methylmercury, ethylmercury (thimerosal!), lead (PbCl2) and iron (Fe-citrate) and then with one of the four chelators (and one control group that received the metals but no chelator). Their results may surprise some people.

    DPA performed the worst of all, providing no protection and actually increasing the toxicity of inorganic mercury, thimerosal and iron. EDTA reduced the toxicity of inorganic mercury but “caused a severe potentiation” of iron toxicity.

    Both DMPS and DMSA reduced inorganic mercury toxicity but increased the toxicity of thimerosal and iron. DMPS (but not DMSA) increased the toxicity of lead.

    Now, these aren’t the results we have been led to expect. [Note: potential understatement of the year candidate]

    If this had been the only study to suggest that chelation was potentially dangerous, I would be willing to shrug it off. After all, it is in cell culture, which is a questionable analogue for the intact organism. However, there have been two other studies looking at living organisms that have results consistent with the findings of Rush et al.

    Much more at:

    http://photoninthedarkness.com/?p=157

  270. #272 Orac
    June 20, 2009

    Seriously, you know exactly what the consequences would be to total
    eradication of measles? What about total eradication of lactobacillus?
    Sanctimonious is as sanctimonious does. We scientists (yes, me too!!)
    know so much less than we think we do. We should tread much more
    lightly and speak more quietly. (Yes, you too.)

    Geez. I leave the blog alone for 16+ hours (I try very hard not to look at the blog on Friday and Saturday nights, and yesterday I was away even longer than usual because, well, I got a new iPhone 3G S and just had to play with it until it was set up to my liking). What happens when I’m gone? The comment section goes wild, with you in the thick of it.

    Dr. Jay, you are using what is known as the logical fallacy of “argument from ignorance.” In essence, you are saying that, because we don’t know exactly what would happen if measles were eradicated, that there must be a horrible down side to its eradication that no one has contemplated. Here’s the problem. You are advocating taking a known risk with known consequences (not vaccinating for measles, leading to measles outbreaks) for an unknown risk with no science to suggest that it would even be a risk. In any case, as has been pointed out, measles is a virus. It is not even clear that it is “alive.” (Didn’t they discuss the differences between viruses and bacteria in your science classes and how it’s somewhat controversial whether to consider viruses a form of life, given that they have no metabolism and can only reproduce by hijacking the machinery of the cells of an organism?)

    In any case, let’s do a little thought experiment. What do you

  271. #273 Orac
    June 20, 2009

    HCN, as you well know, a lot of journal articles are not available for
    free. Yes, I could go to the library.

    I thought you were clinical faculty at UCLA. Don’t you have online access through UCLA to whatever journals it subscribes to?

    In any case, if you find an article on PubMed, that you want, e-mail me and I’ll send it if my library carries the journal.

  272. #274 Orac
    June 20, 2009

    Kathleen, I think that the risks to chelation are overstated (data,
    please gentlemen and ladies!!) and that HBOT also is a low risk
    intervention.

    You are aware of a recent incident in which an HBOT chamber caught fire, aren’t you?

  273. #275 Orac
    June 20, 2009

    HCN, I’m calling foul on your calling me a liar.

    You weren’t called a liar. Your record-keeping and memory were what was being called into question.

    Dr. Jay, you seem a bit defensive. Even when someone is not using an ad hominem but rather criticizing what you say, you are very quick to try to paint it as an ad hominem. It’s a convenient excuse for dodging inconvenient questions, but there is a difference between a real ad hominem and strong criticism of what you assert.

  274. #276 Orac
    June 20, 2009

    The words of “Dean Yeager” from the film Ghostbusters seems to fit
    here:

    Your theories are the worst kind of popular tripe, your methods are
    sloppy and your conclusions are highly questionable. You are a poor
    scientist, Dr. Jay.

    In fact, I’d go so far as to say that Dr. Jay is no scientist, at least
    as science has been practiced for the past 100 years. This doesn’t
    prevent him from being a fine pediatrician (there may be other things
    preventing that), but he is not a scientist and it is ludicrous for him
    to claim to be one after all the times he has claimed that his “wisdom”
    and “experience” trump the data.

    Sadly, this is exactly what I’ve tried, both on this blog and in private e-mail exchanges, to educate Dr. Jay about. He is not a scientist, but fancies himself one. A real scientist, however, would not elevate “personal clinical experience” and anecdotes from an echo chamber practice in which he has, as the “vaccine skeptic” pediatrician, attracted large numbers of children whose parents are deathly afraid of vaccination or outright against it, fearing that it causes autism and all manner of other problems.

    I’ve tried time and time again, on this blog and in private e-mail exchanges, to show Dr. Jay just how easy it is for human beings to fool themselves into incorrect conclusions by confusing correlation with causation, through selective memory and confirmation bias, by observing the placebo effect and regression to the mean without any control group, etc. He simply cannot accept that, and that is why he is not a scientist. A good scientist knows, above all, that he is just as prone to these lapses in critical thinking and to personal bias as any other human being, and it is the scientific method, as imperfect as it can be, that minimizes the effects of these biases and cognitive quirks. That applies to you and me, as well as anyone else. The difference between a scientist and a nonscientist like Dr. Gordon is that a scientist knows his limitations, which are imposed on him by how the human brain works. Dr. Jay either does not know his limitations or refuses to accept them.

  275. #277 Orac
    June 20, 2009

    I’m not lucky. I just told you, I have a breastfed incredibly healthy practice. I might add that my families’ nutritional status is superb, they don’t smoke, and they are far healthier than average. Most of the babies in my practice are nursed for one to three years. They get sick less often.

    So, by your own admission, your practice is nowhere near representative of the population at large. You cater to wealthy, pampered families, who also, by the way, benefit from herd immunity, in essence being free-riders, as Janet Stemwedel put it:

    http://scienceblogs.com/ethicsandscience/2009/06/vaccine_refuseniks_are_free-ri.php

    (If you haven’t already, I urge you to read the above post. It’s highly relevant to you and your practice.)

    So, given that you have admitted that the population that makes up your practice is very different from the typical population of children, then tell me: How can your “personal clinical experience” be applicable to everyone, given how narrow it is.

  276. #278 James Sweet
    June 20, 2009
    Seriously, you know exactly what the consequences would be to total eradication of measles? What about total eradication of lactobacillus?

    Dr. Jay, you are using what is known as the logical fallacy of “argument from ignorance.” In essence, you are saying that, because we don’t know exactly what would happen if measles were eradicated, that there must be a horrible down side to its eradication that no one has contemplated.

    Oh, snap, I just figured out Dr. Jay’s entire rationale here. It’s actually quite sound: You see, we all know that if we stop vaccinating, a number of children will die from preventable diseases. But do we really know the consequences of saving those children’s lives? Maybe one of them was going to grow up to be the next Hitler and kill six million people!

    We should tread carefully and just let them die. Otherwise, we might be responsible for another Holocaust!

  277. #279 AutismNewsBeat
    June 20, 2009

    We should tread carefully and just let them die. Otherwise, we might be responsible for another Holocaust!

    Can we blame vaccines for Britney Spears?

  278. #280 kathleen
    June 20, 2009

    http://www.asatonline.org/resources/treatments/chelation.htm

    Here is what I could find. Jay, you still haven’t answered any of my questions…1-how can you support people seeking treatments that can be dangerous are unproven and very costly.
    2)I answered your question on how autism has affected my family financially-you still haven’t answered mine-why are your patients financially distressed..and if they are-once again…why would you support them in getting costly treatments (that even you yourself have said) that are not proven to work. 3) How is heavy metal toxicity being diagnosed? and where? You keep saying one thing and then later reverse your opinion on what you said..you are not making sense. please answer my questions.

  279. #281 Jay Gordon, MD, FAAP
    June 20, 2009

    Thanks for the above responses to my question. I’ll continue my chelation education today and get back to you. I’ll also look into remote access to UCLA’s medical library.

    Pertussis:

    http://query.nytimes.com/gst/fullpage.html?sec=health&res=9501E7DB1F30F931A15752C0A9619C8B63&fta=y&pagewanted=all

    Measles:

    http://pediatrics.aappublications.org/cgi/content/abstract/123/3/771

    I’ll reread everything above but there’s not much new up there. In spite of not knowing the consequences, I’d like to see zero cases of HIB and polio.

    Have a great Saturday!

    Jay

  280. #282 Dangerous Bacon
    June 20, 2009

    Rogue Medic: “I am confused by all of this criticism of FAAP.

    Using the abbreviation after his name suggests that he has met the minimum standards to do so. The AAP is not, as far as I know, a disreputable organization. We should not be criticizing all who use this abbreviation after their name, just because we do not think highly of Dr. Gordon.”

    We’re not criticizing the AAP. We’re making fun of Dr. Gordon for parading the letters “FAAP” after almost every comment he makes, as though being a Fellow of the American Academy of Pediatrics was some sort of gold shield that implies special qualifications on his part. It does not – it only means that he is board certified in pediatrics, like zillions of other specialists who passed standard board exams, and pays his dues to the AAP.
    The AAP is indeed a fine organization, but not one that shares Dr. Gordon’s misguided views on vaccination. In fact, the AAP maintains a good database on vaccination and works to educate people on the value of immunization:

    http://www.cispimmunize.org/

    The AAP has also recently posted a summary of all the evidence debunking an autism-vaccine connection, complete with summaries and links to a bevy of research studies on the issue. In addition to hanging out here to fill his knowledge base gaps, Dr. Gordon is well advised to study that article and the research contained within.

    http://www.cispimmunize.org/Vaccine%20Studies.pdf

    Dr. Gordon is not alone in his style of self-promotion. I’ve noticed that other MDs who espouse fringe views often lard their postings and CVs with references to memberships and certificates that are irrelevant to their claims or are minor designations that do not speak to their qualifications. In one case, an MD who’s tangled with Orac referenced his certificate for passing general exams _during medical school training_. Since the exams in question are a necessary prequisite for graduation and getting an M.D. degree, it’s superfluous for an M.D. to cite them, and actually rather embarassing to boot. But if you’re on shaky scientific ground and want to impress the general public, I can see why one would want to trot out these “qualifications” as frequently as possible.

    Of course, if one descends further down the rabbit hole into outright quackery, the temptation arises to pad one’s CV even further. We see quacks obtaining correspondence school degrees or flat out buying diplomas from phony schools. Having all that framed paper impresses the marks.

  281. #283 Do'C
    June 20, 2009

    Jay Gordon MD, FAAP, IBCLC writes:

    “[...chelation, like every other medical intervention, has risks. In certain circumstances, the benefits exceed the risks. I think this is true for autism.]“

    Jay, you ignorant (attention) slut.

    If your “thinking” about this as true for autism is based on any science whatsoever, you’ll have absolutely no problem with communicating the following to readers here:

    1. Please provide scientific evidence that autistic children have more heavy metals in the brain or body in the first place, and that chelation would even be indicated. If you believe the “poor excretor” hypothesis, please provide definitive scientific evidence of inability to excrete heavy metals in autistic children.

    - You’ll need to include appropriate scientific evidence with published reference ranges and supporting normative studies for heavy metal toxicity testing methodology for ASD children.

    2. Please provide definitive scientific evidence that current chelators cross the blood brain barrier, and that current chelators actually remove heavy metals from the brain.

    3. Please provide definitive scientific evidence that any neurological damage caused by heavy metals would be reversible in autistic children.

    - Also, please comment on the possibilities and probabilities of redistribution of heavy metals into the brain.

    4. Please support, with appropriate scientific evidence, the notion that heavy metals even playing a role in autism is not just a baseless assumption (e.g. complete nonsense/ignorance/idiocy), as is that removal equals reversal or impact on core features of autism.

    That’s really only 4 major points, shouldn’t take you more than twenty minutes.

  282. #284 Pablo
    June 20, 2009

    Geez. I leave the blog alone for 16+ hours (I try very hard not to look at the blog on Friday and Saturday nights, and yesterday I was away even longer than usual because, well, I got a new iPhone 3G S and just had to play with it until it was set up to my liking).

    I get the impression you had other things going on yesterday, too, that kept you occupied earlier in the afternoon.

    Dangerous Bacon: I have seen the same effect in the veterinarian world. When I look at conference programs and the invited speakers, most of the vets are just listed as “DVM,” or maybe even just “Dr. XXX” despite the fact that most are vet school faculty, and many are even distinguished professors. Yet, they are completely understated in their titles. But inevitably it the accupuncture and other sCAM artists that have the whole list of acronyms after their name. It wreaks of self-promotion, with the air of superiority. But as I mentioned, those who actually earned it are less likely to advertise.

    One last comment: I was feeding the baby yesterday, and unfortunately didn’t realize that the topic of “Medical Myths” was being covered on Dr Radio (Sirius 114/XM 119). I only caught the last 15 minutes or so, during which they were talking about autism/vaccines. I don’t know how long that discussion was going on, but if I had known I would have called in with some comment or another (I regularly call Dr Radio). Oh well. Nonetheless, once again Dr Radio does it well, focusing on science based reality and not worrying about crap like insisting on having opposing views. Contrast that with that stupid Doctors show on TV

  283. #285 LW
    June 20, 2009

    “…chelation, like every other medical intervention, has risks. In certain circumstances, the benefits exceed the risks. I think this is true for autism.”

    How can Dr. Gordon possibly know whether the benefits exceed the risks when he is relying on commenters here to help him find out what the risks are?

    Can you send me to sites or articles you respect delineating the dangers of chelation? I know it’s well-known “woo” to you all, but I’m really interested in learning more about the potential problems.

  284. #286 Joseph
    June 20, 2009

    chelation, like every other medical intervention, has risks. In certain circumstances, the benefits exceed the risks.

    Does anyone else find it amazing that Dr. Jay thinks this way, and yet he discourages vaccination, but recommends chelation therapy for autism? It’s like Dr. Jay does exactly the opposite of what the science says in regards to risk vs. benefit.

  285. #287 kathleen
    June 20, 2009

    I find it amazing that he has contradicted himself a number of times-and when called on it…blithely goes about spouting more silliness…with an “aww shucks, I’m just a simple doctor” attitude. I’m still waiting for him to answer just one of my questions..I fear I’ll be waiting a very long time…

  286. #288 PalMD
    June 20, 2009

    From the PharmaShillCenter CDC:

    Serologic testing for pertussis is available in some areas but is not standardized and, therefore, should not be relied on as a criterion for laboratory confirmation.

    http://www.cdc.gov/ncphi/disss/nndss/casedef/pertussis_current.htm

  287. #289 Mike Stanton
    June 20, 2009

    Dr Gordon, you wrote
    Autism spectrum disorders are very difficult on families and on the children and teens themselves. As you know, there’s a school of thought in the autism community proposing that we leave these kids and families alone and stop judging autism as a “disease.” I think the majority of affected families would like medical support and help.

    This statement misrepresents the views of those of us who argue that it may be more beneficial to autistic people if autism was not regarded as a disease. Diseases require prevention and cure. (Hmm… a vaccine to prevent autism. I wonder how would that run in Santa Monica?) But if, as seems likely on the basis of the research published to date, autism is the result of neuroanatomical differences that occur in early pregnancy and subsequent atypical neurological development or “different wiring,” it is hard to see how that could be cured. Because autism is a spectrum condition of extreme heterogeneity genetic research is also unlikely to offer tests that could be used to inform genetic counselling and preimplantation genetic diagnosis, or to reliably support prenatal diagnosis and prevention by abortion.

    The absence of any prospect of prevention or cure in the medium term is not sufficient reason to reject the medical model in relation to autism. It could be argued that autism is an incurable disease and palliative care is in order. Your own view seems to be that ameliorative care is possible using therapies like chelation and hyperbaric oxygen. More traditional practitioners may reject those methods in preference for psychotropic medications and behavioural therapies. But you are united in locating the source of symptomatic evidence for autism within the subject and directing your therapeutic efforts at that source.

    Those of us who favour the social model of disability do not deny that autistic children and adults sometimes experience extreme difficulties in their lives. Nor do we deny that these difficulties should be addressed. But much of the distress and suffering experenced by autistic people and their families is the result of societal factors. The “I Exist” campaign by autistic adults in conjunction with the National Autistic Society has persuaded the UK government that many of the difficulties faced by autistic adults are “curable” by changes in government policy towards the provision of services and support. Our previous “Make Schools Make Sense” campaign made a similar point in relation to education.

    Rejecting the medical model of autism does not mean ignoring the needs of autistic people or denying them support. Nor do we reject all medical interventions out of hand. But we do expect the highest standards of scientific and ethical rigour to precede the implementation of any treatment for autism. If only these treatments were as rigourously tested for safety and efficacy as are vaccines, for example.

    FYI
    I am a special education teacher and derive part of my income from writing and lecturing on autism. I have an adult son with Aspergers Syndrome

  288. #290 Jay
    June 20, 2009

    Environ Health Perspect. 2007 February; 115(2): 201–209.
    Published online 2006 October 30. doi: 10.1289/ehp.9263. PMCID: PMC1831518
    Copyright This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article’s original DOI
    Research
    Succimer Chelation Improves Learning, Attention, and Arousal Regulation in Lead-Exposed Rats but Produces Lasting Cognitive Impairment in the Absence of Lead Exposure
    Diane E. Stangle,1 Donald R. Smith,2 Stephane A. Beaudin,3 Myla S. Strawderman,3 David A. Levitsky,1,3 and Barbara J. Strupp1

    Conclusions
    These are the first data, to our knowledge, to show that treatment with any chelating agent can alleviate cognitive deficits due to Pb exposure. These findings suggest that it may be possible to identify a succimer treatment protocol that improves cognitive outcomes in Pb-exposed children. However, they also suggest that succimer treatment should be strongly discouraged for children who do not have elevated tissue levels of Pb or other heavy metals.

    Thank you, daealus2u for this article. If a child has demonstrated lead or other heavy metal exposure, it concludes that chelation is effective. Obviously, no one would suggest chelation for a child with normal levels of lead or other metals.

    AutismNewsBeat, thank you, also. The site you’ve directed me to is Prometheus’ site and many of the same people commenting here can be found over there. The discussion is interesting.

    No, my practice is not representative of the population at large. My families are healthier, eat better, breastfeed longer, don’t smoke and more. They also vaccinate very sparingly if at all. The public health implications cannot be ignored. For all these factors.

    Kathleen, everything I’m learning here might reshape my thoughts about chelation. The long history of chelation for metal poisoning and it’s excellent safety record may have colored my thoughts a little. Yes, I know about the death of which you speak. Families affected by autism need as much help and support as I can give them. I know of places where chelation is free but that’s not the issue. These families may decide to allocate their resources in ways which are none of my or your business. If a treatment is effective insurance should cover it. For chelation, that effectiveness is not proven to the satisfaction of anyone else here, obviously.

    Dangerous Bacon, offensive and inaccurate as usual. I have no mail order degrees nor affiliations. Your comments add nothing except unpleasantness. I’m genuinely interested in this discussion. Are you?

    Do’C thanks for your comments. Answer the four points yourself please. Answer either in the positive or negative. I have a question: Do you think I’m lying or hiding something when I say I’d like to learn more about chelation? Do you think that any of the MDs here have not prescribed a medication for “off label” usage without 100% proof of efficacy or safety? Do you think that any surgeon on this site has not performed surgery in an innovative way as the situation and optimal patient benefit demanded without 100% proof of safety or efficacy? Doctors, care to answer those questions. Orac?

    Joseph, I think that chelation could be effective and seems safe. That’s all.

    PalMD, that twelve-year-old CDC note is out of date. The WHO guidelines are better:
    http://www.who.int/immunization_monitoring/diseases/pertussis_surveillance/en/index.html The bias is usually in favor of diagnosing the disease. I’m not saying that’s wrong but it does seem to often the case. What do your lab people say at your hospitals?

    Mike Stanton, thank you. I’m not sure if you’re saying you favor behavioral therapies over unproven therapies like chelation and HBOT but I will tell you that behavioral therapy after proper diagnosis is my preference.

    I will, just this once, use fewer initials.

    Best,

    Jay

  289. #291 Pete D
    June 20, 2009

    All – Dr. Jay has got to be the most ignorant pediatrician I have ever heard. Every peds doc in our little backwoods town subscribes to UpToDate, Prescriber’s Letter, or some other information resource to satisfy some of their CME credits. UpToDate does an extensive literature review on just about any topic and gives summaries of the relevant papers. Our small town docs also have access to tons of journals through our local community hospital and the health system that owns it.

    If he can’t find information relevant to objectively inform his opinion on vaccination, chelation, or strategies for dealing with autism it is solely from willful ignorance. It’s kind of sad, because the docs in town here are very straightforward about these matters with their patients and try as best they can to steer them in the right direction by going to the primary literature.

    ” Kinda’ like recurrent comments that I couldn’t be the real “Jay Gordon.” ” No, more like you couldn’t be a real doctor, dick.

  290. #292 Tsu Dho Nimh
    June 20, 2009

    Jay said, Obviously, no one would suggest chelation for a child with normal levels of lead or other metals.

    Here’s how it works: By using an oral chelator for a “provoked” test, collecting a urine sample over a short span, and comparing the results to those in children whose heavy metals screening was done with a 24-hour unprovoked test, the docs who want to chelate can usually get a result high enough to scare the parents.

    It’s akin to making a patient run around the block a few times, immediately taking their pulse, comparing it to a resting heart rate and treating the patient for tachycardia.

    A scam, and a profitable one for the docs and their favorite labs.

  291. #293 Matthew Cline
    June 20, 2009

    @Jay:

    In spite of not knowing the consequences, I’d like to see zero cases of HIB and polio.

    Are you saying this

    1) to make it absolutely, positively clear that you support the eradication of HiB and polio, and

    2) the only reason that you oppose the elimination of measles is because catching it has a known benefit?

    If so, you mentioning the possible unknown risks of eliminating a communicable disease from the wild makes your message less than clear. If, on the other hand, the unknown risks of eliminating measles factors into your opposition to eliminating measles, then I’m not going to drop the discussion of how you go about evaluating these unknown risks.

    Also, how is HiB going to be eliminated from the wild if the HiB vaccine is only administered “judiciously”?

    No, my practice is not representative of the population at large. My families are healthier, eat better, breastfeed longer, don’t smoke and more. They also vaccinate very sparingly if at all. The public health implications cannot be ignored. For all these factors. [emphasis added]

    So, then, you’re saying that your practice is proof that children don’t need to be vaccinated in order to keep them healthy? Or, at least, the children of affluent parents don’t need vaccinations; I know that you’ve been part of at least one effort to get millions of doses of vaccines to children in third-world countries.

  292. #294 HCN
    June 20, 2009

    Dr. Jay said “No, my practice is not representative of the population at large. My families are healthier, eat better, breastfeed longer, don’t smoke and more.”

    So it would seem you do not accept children who are adopted, since infants who are adopted do not have a chance to breastfeed.

    You probably also do not accept children whose mothers who have medical conditions that prevent breastfeeding. Things like anatomical issues with the nipple, or having conditions that require medication that would cause issues if their child had breastmilk, or worse have an infection that could be passed through breastmilk like HIV or hepatitis B, C or D.

    (We’ll go on the assumption you had no idea that the late Christine Maggione was HIV positive. Though I imagine you have copies of sMothering in your waiting room and must have seen the picture of her with the big crossed circle of “AZT” on her belly, which contained the yet unborn late Eliza Jane. See http://www.sciencebasedmedicine.org/?p=328 for a refresher of the rag’s cover.)

    Wait, mothers who cannot breastfeed was covered in the “are healthier”, so no families with mothers requiring medications to keep them alive. Perhaps you also exclude all families with genetic conditions like being carriers of or actually having sickle cell, type 1 diabetes, Long Q syndrome, real celiac disease and a number of other genetic conditions.

    It sounds a bit close to eugenics. Especially when you wonder if measles is actually “good” for humans; “let only the strong survive.” Perhaps you believe these two boys deserved being permanently disabled by measles, because they were obviously not healthy enough:
    http://www.timesonline.co.uk/tol/news/uk/article1055533.ece

    For a refresher: my oldest had seizures as a newborn (didn’t wait until he was over two like one of your patients, even though his mother claims it was the MMR give over a year before!), and has a severe genetic heart condition. I don’t particularly like people who claim that one of my three children is not healthy enough, and therefore not worthy enough to deserve life.

    Oh, and let us not forget what the “and more” is about: Dr. Gordon does not deal with health insurance. It is a cash only practice, so the parents of his little patients have to have real money.

  293. #295 Joseph
    June 20, 2009

    Jay said, Obviously, no one would suggest chelation for a child with normal levels of lead or other metals.

    Here’s how it works: By using an oral chelator for a “provoked” test, collecting a urine sample over a short span, and comparing the results to those in children whose heavy metals screening was done with a 24-hour unprovoked test, the docs who want to chelate can usually get a result high enough to scare the parents.

    This Quackwatch page documents the scam in detail.

  294. #296 Matthew Cline
    June 20, 2009

    @HCN:

    So it would seem you do not accept children who are adopted, since infants who are adopted do not have a chance to breastfeed.

    You probably also do not accept children whose mothers who have medical conditions that prevent breastfeeding.

    Saying that the mothers of the children he sees breastfeed longer doesn’t imply that he rejects children whose mothers can’t breastfeed. If a pediatrician accepts children regardless of the ability of their mothers to breastfeed, but among those who can breastfeed encourages them to do so for as long as possible, then saying “my families breastfeed longer” is just shorthand for “my families who are capable of breastfeeding do so longer”.

  295. #297 Dedj
    June 20, 2009

    “Mike Stanton, thank you. I’m not sure if you’re saying you favor behavioral therapies over unproven therapies like chelation and HBOT but I will tell you that behavioral therapy after proper diagnosis is my preference.”

    Why on earth are you thanking Mike Stanton?

    He was pretty much correcting your initial assertion that those who do not regard autism as a ‘disease’ wish to ‘leave people with autism alone’. You pretty much asserted that those who do not view autism as a disease do not think there is anything that can be done with people with autism – which, if you are talking about the ND movement is a totally inaccurate statement based on the vocations and academic work of those most prominent in the ND movement.

    He’s just publically pointed out that you’re an ignoramous, and you’re thanking him?!? WTF? Did you even understand a word he wrote?

    In addition:

    “Dangerous Bacon, offensive and inaccurate as usual. I have no mail order degrees nor affiliations. Your comments add nothing except unpleasantness. I’m genuinely interested in this discussion. Are you?”

    Except you DO in fact constantly refer to yourself as FAAP accredited, a totally worthless endevour as FAAP accreditaton adds nothing to your status or arguement. It is rather curious that as soon as this is pointed out to you that you pretend to drop the FAAP business without any explanation.

    If you’re going to pretend to be a high status figure like Dr Jay Gordon, at least make it convincing. I’m sure the real Dr Gordon will be less than happy that you’re making him out to be such a fool.

  296. #298 kathleen
    June 20, 2009

    Jay, you STILL DID NOT ANSWER MY QUESTION!! I am not going back over 200 plus posts..but will if you need me to.
    1) It WAS YOU who discussed dealing with families in financial distress.(how hard it was for you)-you also implied that I (because of having three children on the spectrum)of all people should be aware of these financial burdens. I then explained that-No, there really wasn’t much at all-and could you please explain. Now you are saying it is neither my or your business? If you make a statement-BACK IT UP! If you change your mind-say so.2) I asked how you could support these financially burdened people in seeking treatment that is unproven and unsafe. Now you tell me-sometimes it is free-but it is none of your business how they decide to pursue treatment? WTF??? YOU ARE THEIR DOCTOR-so what is it? Do you support it or not? You say “if a treatment is effective insurance should cover it” Insurance doesn’t cover it-you know that-you support it (chelation)-and at the same time take no responsibility for any of it. Then you go on to say-in the same post no less..”I think chelation could be effective and seems safe”

    If I ever had a doctor recommend a therapy to me on the basis of “could be effective and SEEMS safe..I would run-very quickly out the door.
    You know Jay-if you want to be anti-vax, fine..if you want to be pro chelation, pro Hbot-fine. Pick a side-please. You keep contradicting yourself and I find it astounding..

    “A man is never more truthful than when he acknowledges himself a liar” Mark Twain

  297. #299 HCN
    June 20, 2009

    Matthew Cline said “Saying that the mothers of the children he sees breastfeed longer doesn’t imply that he rejects children whose mothers can’t breastfeed.”

    Fair enough, but I was also thinking about this before I checked it this afternoon. I was going on a previous statement made by him (you’ll note and other challenged him on how well maternal antibodies protect babies… especially since one of my kids did end up in the hospital with rotavirus; implication being that is was my fault):
    Dr. Gordon said “Gaiainc, I have a breastfeeding practice.”

    I took that to mean that he only has patients who have been breastfed. It just happened that I checked this blog only after his latest bit.

  298. #300 daedalus2u
    June 20, 2009

    No Dr Jay, that paper only talks about lead poisoning, and only in rats. It is silent with respect to mercury, and what mercury levels are appropriate for which treatments. What that paper found was cognitive declines due solely to chelation. When you refer patients out for chelation, have you diagnosed them with heavy metal poisoning? You do test your patients for heavy metals before you refer them out for chelation don’t you? What is your cut-off for recommending chelation for mercury?

    Maybe you should put a link to that paper on your website, so that parents can appreciate there are downsides to needless chelation?

  299. #301 Dangerous Bacon
    June 20, 2009

    Jay sez: “Dangerous Bacon, offensive and inaccurate as usual. I have no mail order degrees nor affiliations. Your comments add nothing except unpleasantness. I’m genuinely interested in this discussion. Are you?”

    Yes, and I am capable of comprehending what others post and not misrepresenting their remarks. I did not suggest you had mail order degrees. What I did say was that you boast affiliation with a specialty society (the American Academy of Pediatrics) that does not signify any special knowledge or ability beyond simply being board certified (something which describes the vast majority of specialists in this country), in addition to the fact that the AAP is pro-vaccination. Did you bother reading any of the AAP links I provided, including those detailing the large body of research debunking an autism-vaccination connection? It would be a better use of your time than dodging and ducking in comments on this site.

    “I will, just this once, use fewer initials.”

    Best,

    Jay”

    Now Jay, you’re going to make me feel guilty – as if I’d taken away Linus’ blanket. Go ahead, promote yourself with any initials you want – but for variety’s sake, use something different once in awhile. Maybe Jay Gordon, M.D., M.E., S.D.L.C. (Master of Epiphanies, Super-Duper Lactation Consultant).

  300. #302 kathleen
    June 20, 2009

    @ daedalus2u I have asked him those same questions about 5 different times..How does he test for heavy metal toxicity and very importantly-what lab does he use…so far all I hear are crickets..

  301. #303 Jay Gordon, MD, FAAP
    June 21, 2009

    Pete D, I am happy to learn from the people at this web site. I also read everything from NEJM and Lancet to WebMD for their perspective. Very rude comment.

    Tsu, why are the results from “provocation” not the “real” results and the unprovoked results are? From what I’ve read there’s validity to revealing the provoked levels of metals. You’re saying this is wrong. Why?

    Matthew Cline, I’d like to see these diseases eradicated. Unlike you, I’m not sure that these are always great ideas. There are examples in other biological areas of eradication of one thing leading to pathological overgrowth of another. All of my patients are not affluent but all of them are educated. They make their own decisions about their own children. They take public health into account as they make these decisions and make the choices they think are the best. Thank you for noting my shorthand on “breastfeeding families.”

    HCN, much of my work is pro bonoor for reduced fees. None of your business, by the way. I have not dealt with insurance companies since 1984. Your posts are degenerating. Take a short break. You have had a tough life and deserve compassion. I care for families who’ve adopted babies, fostered babies, have breastfeeding problems, need “medication to stay alive” (very few medication are incompatible with breastfeeding) and the misinformation you’re giving here about hepatitis is dangerous. Ignorant and dangerous. This most recent post is just a rant.

    HCN, I can’t believe you interpreted anything I said to imply that your child’s rotavirus hospitalization was your fault.

    Dedj, it’s hard to read the nearly 300 posts above yours, I admit, but you’ve pretty much repeated what others have thrown onto the table. Mike Stanton and I might agree that behavioral therapy, speech therapy, occupational therapy and other conventional therapies have been shown to be effective in improving the quality of life of ASD kids. They should be tried first in preference to unproven modalities. If Mr. Stanton was not saying that, I’m sure he’ll correct me soon.

    Kathleen, I am not anti-vaccination. I am not “pro-HBOT” nor “pro-chelation.” Both of these methods of treatment look safe to me and I have seen them appear to effective. Perhaps, unlike you, I’m capable of listening to others and learning. I do not have a deep, deep commitment to chelation or HBOT. I do have a deep commitment to vaccinating as safely as possible. I have an ever deeper commitment to trying to figure out that the hell has gone wrong over the past 20 years. I do not test for metal toxicity. I have seen many reports from the labs who do. I have also seen elevated mercury and lead levels which were done at labs like UCLA, CSMC and elsewhere. What’s your point?

    Daedalus2u, the paper speaks to both sides of the issue: chelation benefits rats with high lead levels and harms those without. I need to learn more about provocation. Working on that.

    Bacon, cute post. The FAAP is not meaningless. I had to sit for written and oral boards. I also obtained an IBCLC credential but allowed it to lapse.

    Have a wonderful Father’s Day!

    Best,

    Jay

  302. #304 Tsu Dho Nimh, BS, MT(ASCP)
    June 21, 2009

    Jay asked, “Tsu, why are the results from “provocation” not the “real” results and the unprovoked results are? From what I’ve read there’s validity to revealing the provoked levels of metals. You’re saying this is wrong. Why?

    Now you are on my turf – those initials after my name are the result of 5 years of college and clinical study. Lab Tests R Us.

    Look at the lab results image here:
    http://www.quackwatch.com/01QuackeryRelatedTopics/Tests/urine_toxic.html

    The report states that the specimen was obtained after patient was given a “provoking agent,” but the reference range is based on non-provoked tests.

    They are comparing urine samples collected under condition “X” with a reference range collected under condition “F” … comparing apples to oranges, as it were. It’s akin to making a patient run around the block a few times, taking their pulse, comparing it to the range for normal resting heart rates and treating the patient for tachycardia. Now do you understand?

    If you wanted to create a valid provoked heavy metals excretion test, you would have to baseline the test by administering a chelating agent and collecting urine from a fairly large number of non-autistic children to get the reference range. That runs into all kinds of problems, because each chelating agent needs its own baseline, and the size and age of the patient have to be figured into the equation.

    24-hour collections (empty bladder in the AM and discard pee, note the time, collect all pee for next 24 hours, trying to empty the bladder and include the urine at the same time as the discarded urine at the start point) are the “gold standard” for pee tests because they compensate for the astounding variations in concentration the kidneys can create. Shorter collection periods, even if you try to compensate with creatine measurements, aren’t as consistent.

  303. #305 Joseph
    June 21, 2009

    Tsu, why are the results from “provocation” not the “real” results and the unprovoked results are?

    In internet lingo, you’re a n00b, Dr. Jay.

  304. #306 HCN
    June 21, 2009

    Dr. Gordon said “HCN, I can’t believe you interpreted anything I said to imply that your child’s rotavirus hospitalization was your fault.”

    I told you my kid ended up in the hospital due to rotavirus. A family physician, Gaiainc, replied that they admit kids to the hospital with rotavirus.

    You replied that you don’t because you are a “breastfeeding practice”, stating that breastfeeding is protective against illness like rotavirus. You further noted that your practice was of “healthier” kids who get better food.

    Hence, since I had a kid get sick, it was my fault.

    (even though I breastfed as long as possible, he self weaned just a month or so before… he liked to drink and walk around, much easier with a sippy cup, made him all his food (not only am I an organic gardener, I am a kick-ass cook, I even make my own salt-free chicken and beef glace de viande), and used cloth diapers — as crunchy as most of the sMothering crowd, but keeping up with regular medical care including all allowed vaccines, and anti-seizure meds… which he also was weaned off of before the illness)

    I am glad that you do not discriminate against those who cannot breastfeed. There was a woman in my mommy/baby group who could not because of a very serious health issue that made her pregnancy high risk. So I have no time for the types like at sMothering who rail against those who do not breastfeed. Your wording made it sound like you were just like them.

    Perhaps you should be more careful with your wording.

    Especially with the notion that perhaps the measles virus has some kind of benefit, or that chelation has benefit, or that information on the relative risks of vaccines versus disease requires more work than you are willing to spend to get.

    You will note that I am not the only parent you have offended. You have also offended others by not answering their questions.

    I agree with Joseph’s description of you: “In internet lingo, you’re a n00b, Dr. Jay.”

  305. #307 Matthew Cline
    June 21, 2009

    @HCN:

    even though I breastfed as long as possible, he self weaned just a month or so before…

    So I have no time for the types like at sMothering who rail against those who do not breastfeed.

    Do they advocate that a baby who self-weans be denied all solid foods so as to force them back into breast-feeding? I know that there’s some “boob nazis” who will do that.

  306. #308 Jay Gordon, MD, FAAP
    June 21, 2009

    Tsu do Nimh, thank you. I understand this issue much better than I ever have. The provocation values are then used with the reference values from non-provoked levels. That’s not a very honest thing to do, is it?

    Joseph, I have gone to your blog site. Yes, I am truly a Newbie in discussions of chelation, provoked versus unprovoked measurements and more. I have been too much of a “single issue candidate” and I’m trying to change that.

    HCN, it sounds like you’re past the point of accepting an apology for my wording. I apologize one more time, anyway.

    Best,

    Jay

  307. #309 Mike Stanton
    June 21, 2009

    Dr Gordon wrote
    Mike Stanton and I might agree that behavioral therapy, speech therapy, occupational therapy and other conventional therapies have been shown to be effective in improving the quality of life of ASD kids. They should be tried first in preference to unproven modalities. If Mr. Stanton was not saying that, I’m sure he’ll correct me soon.

    If he did not understand me the first time I see little point in correcting him. The null hypothesis is that Dr Gordon and I are in complete disagreement on the scientific and ethical framework for treating autism. I have yet to see any evidence to the contrary.

  308. #310 Jen
    June 21, 2009

    “I have an ever deeper commitment to trying to figure out that the hell has gone wrong over the past 20 years.”

    Dr. Gordon,
    I might suggest that you look very carefully at the accumulating evidence that is linking acetaminophen to asthma and allergies…you might see some similarities wrt to autism.

    Dr. Rosemary Waring’s research on sulfation deficits in autistic children might interest you as well. It may also offer some clues as to why children with ADHD respond favorably to the Feingold diet.

    Then consider that the increase in all of these diagnoses seems to coincide with the timing of aspirin’s link to Reye’s Syndrome.

  309. #311 DebinOz
    June 21, 2009

    As the parent of a son with ASD, and as someone with a PhD in epidemiology from UCB, I am totally excited with a study that has just started:

    http://www.dor.kaiser.org/external/Home_Default.aspx

    I used to work here, and I can assure you that this research will be well done, unbiased and relatively applicable to the entire population. Kaiser DOR, as part of a large HMO (for the non-USA reader) has research access to people’s charts from before birth to the grave.

    Quiz: Read the design and come up with hypotheses they can and cannot answer.

  310. #312 Pablo
    June 21, 2009

    So it would seem you do not accept children who are adopted, since infants who are adopted do not have a chance to breastfeed.

    You probably also do not accept children whose mothers who have medical conditions that prevent breastfeeding. Things like anatomical issues with the nipple, or having conditions that require medication that would cause issues if their child had breastmilk, or worse have an infection that could be passed through breastmilk like HIV or hepatitis B, C or D.

    He practices in blinkin Santa Monica!!!! Of course his patients are “healthier than average.” The correlation between health and wealth is well established. He’d like to believe it is because of him?

  311. #313 Dedj
    June 21, 2009

    “They should be tried first in preference to unproven modalities. If Mr. Stanton was not saying that, I’m sure he’ll correct me soon”

    He was saying that, after a fashion, but that wasn’t the main gist of his post, as anyone can tell from the first sentence. Mike has subsequently replied to confirm that you did not understand his post or focus correctly.

    You’re an amazing piece of work Jay. You’ve managed to turn a post where the person is clearly slapping you on the wrist for something you’ve said, into a post where they’re discussing something that their post mentioned only in passing and not until late in the second paragraph.

    Mike told you where you were wrong, you did not answer, in fact the idea that there was even a challenge went totally over your head.

    It’s no wonder your attempts at answers fail so badly, when it’s clear you have neither the knowledge nor experience to even understand the questions. Of course, the alternative is that you’re deliberately avoiding doing anything that might damage your own ego.

    Neither option looks good on you, the real Dr Gordon will be furious to find out that you’re making him out to be such an arse. You’re best off quitting now before he finds out and takes action against you.

  312. #314 kathleen
    June 21, 2009

    “Perhaps unlike you, I’m capable of listening to others and learning.”…”Whats your point?”

    I read everyone of your posts very carefully. As a parent of autistic children, I have a vested interest in autism/autism research/therapies etc. So I will go over a few posts.
    #170-”All of this is real to me and theoretical to you.” You also went on to say that you see more autistic people in one week than any of us will see in a lifetime. That is beyond arrogant and just plain wrong. “I have to face families in pain financial distress and more” I asked you what you meant by financial distress. #197-you spoke of having patients with autism-you were all they had because other Dr.’s didn’t want to treat kids with autism. You also went on to say that you supported the parents use of chelation and Hbot.I was perplexed by this and suggested that parents chose not to go to other Dr.’s because they did not tell them what they wanted to hear. Mainly that vaccines were safe and chelation and Hbot were very expensive-unproven and unsafe. I also asked you in referring to #170-how, when you knew your patients were financially distressed-you could support unproven and unsafe and expensive treatments. #213 you called chelation and Hbot “unproven but anecdotally efficacious” I commented that children continue to develop-that maybe development was taking place at the time of these therapies-and that this development might be coincidental. #233 “some children get better while undergoing certain treatments and not because of them” I asked you if there is no proof and it was all anecdotal-how could you support this-especially as you mentioned facing parents in financial distress-and these treatments are costly. #240 “you better than almost anyone here should know that taking care of a child with autism using conventional means is very expensive” You went on to equate using chelation and Hbot as being similar in cost. I countered with how much it cost my family to raise three children who were on very different ends of the spectrum. I explained what my out of pocket costs were and what services I received. I asked you to explain what exactly the financial distress for these families was. I couldn’t understand it.#290 you told me that it was neither your or my business how a family decides to spend money for treatment. That if treatment was effective than insurance should cover it.I countered with the fact that insurance doesn’t cover it-because it was not proven. I asked again how you can support treatment that was unproven-especially when it was expensive treatment. You didn’t answer my question. You danced around it.You were the one who was describing how hard it was to face these families in their pain and financial distress. You.
    In saying you support a families choice to try chelation and other therapies-that means you support those therapies.
    You say that you don’t test for heavy metals. How then do your patients have the lab work done? Or did you just mean that you personally don’t do the tests? You asked me what my point was. You have contradicted yourself in a number of places. I’m just saying pick a side and stick to it. You talk about being capable of listening..but are you capable of hearing…there is a big difference.

  313. #315 Jen
    June 21, 2009

    Quiz: Read the design and come up with hypotheses they can and cannot answer.

    Deb, I am also very excited about this study. I will be watching this very closely.

  314. #316 Pete D
    June 21, 2009

    “I also read everything from NEJM and Lancet to WebMD for their perspective.” You should try to read past the table of contents and look at the information contained within them. There would then be no dilemma in your mind as to what to tell your patients with autistic, vaccinated children upon their hesitation to vaccinate another. Dick.

  315. #317 HCN
    June 21, 2009

    Dr. Gordon said “HCN, it sounds like you’re past the point of accepting an apology for my wording. I apologize one more time, anyway.”

    Apologies only work if you learn from your mistakes and stop the offending behavior. One way to do that is to read and comprehend what Kathleen wrote above in #314, which ends with “You talk about being capable of listening..but are you capable of hearing…there is a big difference.”

    By the way, here is a way to keep up with the literature and to get CME credits, listen to the podcasts that discuss infectious disease and other things:
    http://www.pusware.com/ … which is geared towards medical care practitioners.

    I personally enjoy his podcasts geared to the lay audience:
    http://www.quackcast.com/

    Download them to your mp3 player of choice and enjoy them while you ride the escalator and walk the beach.

  316. #318 Dangerous Bacon
    June 21, 2009

    Still waiting for Jay to answer Orac’s questions from the initial posting (not to mention all the subsequent ones he’s evaded).

    Jay: “The FAAP is not meaningless. I had to sit for written and oral boards.”

    The AAP requires passage of special board exams in order for applicants to qualify as a FAAP? Really? Care to document this?

  317. #319 Orac
    June 21, 2009

    Matthew Cline, I?d like to see these diseases eradicated. Unlike
    you, I’m not sure that these are always great ideas. There are
    examples in other biological areas of eradication of one thing leading
    to pathological overgrowth of another.

    Examples, please? More importantly, why do you think that the potential adverse consequences of eradicating measles would be worse than allowing the measles to remain or even be endemic at a low level? Or even: Why do you think that the potential adverse consequences of eradicating measles would be such that we should even hesitate to pursue a policy of total eradication? Once again, you are arguing from ignorance: We don’t fully know the consequences of measles eradication; so there must be something really bad about it that we don’t understand yet. Some science, man! From what scientific basis do you derive this fear?

    HCN, much of my work is pro bonoor for reduced fees. None of your
    business, by the way. I have not dealt with insurance companies since 1984.

    Ah, that explains a lot, Dr. Jay. Indeed, I had long suspected as much.

    To me, it sounds as though you run quite the nice boutique practice, not taking insurance and requiring parents, if they want to come to you, to pay you themselves and then, if they are not among your rich celebrity clients, try to get out-of-network reimbursement from their insurance companies. No wonder you can’t afford to challenge the parents of your patients when they demand pseudoscience or refuse vaccination. They might go elsewhere, where they don’t have to pay cash themselves up front and then worry about getting the insurance company to reimburse them for 80% or less, given that insurance companies tend not to reimburse fully for elective out-of-network care. Some insurance companies don’t reimburse for elective out-of-network care at all.

    I can also see how you might, in that echo chamber world of yours, come to think that your patients are so much healthier than everyone else. They may indeed be, but how do you know? Against what metrics do you measure? Do you keep statistics and compare them to the statistics of a comparable aged population that is less fortunate? Or is this just a case of memory, which, as we all know, tends to be prone to selective remembering and especially confirmation bias, the tendency to remember things that confirm our biases and to forget things that go against them. Again, this is not–I repeat, not–to call you a liar. Rather, it’s simply to point out to you yet again that, without hard numbers and objective evidence, your memory and impression of how your patients do are just as prone to confirmation bias and confusing correlation with causation as any human being’s.

    In any case, assuming your patients are indeed so much healthier than average, it’s almost certainly because their parents are, for the most part, very well off and dedicated to various healthy practices. They can then leech off the herd immunity provided by the rest of the “average” population who actually do vaccinate but may not have the resources to do all the other things. Unfortunately, there’s a lot of pseudoscience and woo that “latches on” to good health practices. The antivaccine movement is among such woo. So is the “biomedical” movement.

  318. #320 Orac
    June 21, 2009

    Joseph, I have gone to your blog site. Yes, I am truly a Newbie in
    discussions of chelation, provoked versus unprovoked measurements and
    more. I have been too much of a “single issue candidate” and I’m
    trying to change that.

    Dr. Jay, would it be too “mean” or “nasty” to suggest that you should educate yourself first about such issues before speaking publicly about them or telling parents it’s OK to chelate and that the risks do not outweigh the benefits?

    Just a thought.

  319. #321 Militant Agnostic
    June 21, 2009

    To parody Barry Goldwater

    Big meaniness in defense of public health is no vice.

  320. #322 Do'C
    June 21, 2009

    In response to @283, Jay Gordon MD, FAAP, IBCLC writes:

    Do’C thanks for your comments. Answer the four points yourself please. Answer either in the positive or negative.

    ** EPIC FAIL **

    Dr. Jay, you made the statement…

    [...chelation, like every other medical intervention, has risks. In certain circumstances, the benefits exceed the risks. I think this is true for autism.]

    You bring the scientfic support! I provided you with a framework of points that would allow you create a coherent and relevant response, in scientific terms, with respect to chelation as a beneficial treatment for autism. Your response is a crystal clear demonstration of the lack of any scientific foundation (so far) for your “thinking”.

    I’ll answer your completely irrelevant questions.

    I have a question: Do you think I’m lying or hiding something when I say I’d like to learn more about chelation?

    No. If I thought you were lying about something, I’d call you on it. I think Hanlon’s Razor may apply in this case.

    Do you think that any of the MDs here have not prescribed a medication for “off label” usage without 100% proof of efficacy or safety?

    No, but I’d be willing to bet that they don’t share your completely unsupported “thinking” that the benefits of chelation exceed the risks for autism. Be careful Dr. Jay, you seem to be gunning for the Tu Quoque fallacy here.

    Do you think that any surgeon on this site has not performed surgery in an innovative way as the situation and optimal patient benefit demanded without 100% proof of safety or efficacy? Doctors, care to answer those questions. Orac?

    Chelation as a treatment for autism (let alone iterating that the benefits exceed the risk for autism), is not innovative surgery. Equivocation and implied Tu Quoque fallacy aside, your questions are so irrelevant, it’s hard to see them as little more than a weak attempt to change the subject.

    Now go back and get to work – you have lots of unaswered questions and unsupported points in this thread. Some child’s health may depend someday on your ability understand the implications of your apparent ignorance on the subject. To maintain your honesty, you’ll need to be able to support your position with some, at a minimum, decent science . Otherwise, the only position you should have is, “You know, I really don’t have the first clue about chelation (let alone chelation for autism), let me refer you to an appropriate board-certified toxicologist”.

  321. #323 Mike Stanton
    June 21, 2009

    Hi Dedj,

    You are too generous to Dr Gordon. He is not even right “after a fashion” when, referring to evidence based therapies he suggests that we agree that, “They should be tried first in preference to unproven modalities.”

    This statement of Dr Gordon’s can only be taken to mean that “unproven modalities” like chelation and HBOT should be tried second if evidenced based therapies do not work. But he knows that I reject unproven modalities as quackery. My very first blog post in 2005 stated that

    To subject children to treatment of questionable benefit and unquantifiable risk, because of a hypothetical possibility that their autism might have some connection with a biomedical disorder, is unacceptable. As such, chelation should be roundly condemned as a therapeutic intervention.

    The only change I would make today is that it is now beyond question that there is no benefit from chelation as a treatment for autism. Ditto HBOT, Lupron, special diets, megadoses of vitamins, secretin, anti-fungal medication or even homeopathic secretin. Yes, there are parents who give it to their children.

    The recommended daily dose is three drops of the remedy in a little water twice a day. The doses should not be given immediately before or after brushing the child’s teeth, because the mint in toothpaste can prevent the remedy from working.

    Tony Pinkus, managing director of Ainsworths, the homeopathic pharmacy that pioneered the development of this new secretin remedy in the UK, says: “One advantage of the homeopathic solution to the secretin problem is that the remedy does not introduce any synthetic substance into the body.”

    Exactly. And they have the nerve to call the website that publishes this nonsense “whatreallyworks.co.uk”

    Perhaps even Dr Gordon can agree that neither the unproven modalities of homeopathy nor the anecdotal evidence in their favour are worth a dime

  322. #324 skeptyk
    June 21, 2009

    Orac sez to Jay: I can also see how you might, in that echo chamber world of yours, come to think that your patients are so much healthier than everyone else.

    I am sure that Dr. Jay has lots of wealthy, classist parents who tell him and themselves that they are so much healthier than everyone else. It is a pervasive elitism which leads to such comments as these from Christine Maggiore (she was speaking here in 2005 of her daughter, who died of AIDS after the HIV+ Christine refused to use ARVs during pregnancy, and also breastfed):

    “Why our child — so appreciated, so held, so carefully nurtured — and not one ignored, abused or abandoned?” she wrote. “How come what we offered was not enough to keep her here when children with far less — impatient distracted parents, a small apartment on a busy street, extended day care, Oscar Mayer Lunchables — will happily stay?”

    There is breathtaking classism and contempt displayed all over the sMothering.com forums. Arthur Allen met many parents with similar attitudes when he was researching his book Vaccine. Alas, parents of children with autism find the loudest, proudest mouths in the support groups are quite often these same judgmental, selfish, priveleged parents.

  323. #325 K
    June 21, 2009

    Sigh.

    Dr. Gordon posted:

    PalMD, that twelve-year-old CDC note is out of date. The WHO guidelines are better:
    http://www.who.int/immunization_monitoring/diseases/pertussis_surveillance/en/index.html The bias is usually in favor of diagnosing the disease. I’m not saying that’s wrong but it does seem to often the case. What do your lab people say at your hospitals?

    Dr. Gordon,
    CDC also has a Surveillance Manual available for your use, both free and online. You should check it out. It was just updated in August 2008.

    On pertussis testing…
    It’s too much to copy and paste so here’s the link: http://www.cdc.gov/vaccines/pubs/surv-manual/chpt10-pertussis.htm

    An excerpt: At this time, positive serology results from a private laboratory are not confirmatory for the purpose of reporting. A single-point serologic assay has been validated at the Massachusetts state public health laboratory for persons aged 11 years or older and is used for clinical diagnosis and reporting in that state only.

    I don’t know what hospital lab people tell PalMD (and he probably would still consider it anecdotal only), but I know state epidemiologists in two different states, and they both labor tirelessly to get providers to “STOP with the serology for pertussis already! Do an NP swab!”

    As for bias in testing, if anything, pertussis is under-tested and under-reported.
    Much easier to simply precribe the Z-pak, right?
    http://www.ncbi.nlm.nih.gov/pubmed/15876918
    http://www.medscape.com/viewarticle/552159_3

  324. #326 Broken Link
    June 21, 2009

    Dr. Jay,

    I know I’m coming late to this – sorry, a busy weekend.

    Others have sent you very important reasons why chelation should not be considered for children who do not test positive for severe lead poisoning. Here’s one more reason.

    There is a series of studies that looked at children with real, moderately high, blood levels of lead (20 and 44 microg/dL). Those children were treated with DMSA chelation, and while their lead levels dropped faster than untreated children, their cognitive performance did not improve more than the placebo group. Indeed, there was some evidence that chelation could impair cognition. And as a consequence, it is no longer recommended that children with these moderate levels of lead in their blood be treated by chelation.

    http://pediatrics.aappublications.org/cgi/content/full/110/4/787

    Of course, children with autism do not have high levels of mercury in their blood. So, the rationale for treatment is very skimpy indeed. You’ve already admitted that it is unethical to use a provoked heavy metal urine test. Are you Dr. Jay, still willing to risk impaired cognition in the children for whom you endorse chelation?

  325. #327 Jay Gordon, MD, FAAP
    June 21, 2009

    Broken Link–

    Thanks for the information. This discussion has changed my thoughts about chelation. Do’C, yes, back to work.

    Best,

    Jay

  326. #328 KWombles
    June 21, 2009

    Dr. Gordon,

    Since you’ve changed your mind on chelation, you’ll be prominently displaying on your website that you no longer consider chelation to be a therapy that parents with children with autism should consider and you will refuse to administer it? In addition, you’ll be using your Huff blogger status and your newfound knowledge, right, to create a new article on why chelation is not something that should be used and you’ll post it to Huff sometime this week, right? It seems the only reasonable thing to do.

    And really, could your website be any more narcissistic? You are a panderer. I suppose that’s fine for your rich client base, but I want a pediatrician who knows what he’s doing, does the necessary literature review in frigging medical journals and makes evidence-based decisions where possible. And exercises some restraint where there isn’t clear science. And admits when he’s out on a limb and arms me with the necessary tools to come to a decision together about treatment for my children.

    You can do better and you should. If you had any self-respect, you’d spend some time reading all of the relevant literature on vaccines and on autism before you shamelessly tool yourself out with Jenny McCarthy.

    I feel better now. Thanks.

  327. #329 Dangerous Bacon
    June 21, 2009

    Jay: “Thanks for the information. This discussion has changed my thoughts about chelation.”

    More importantly, has it changed your _practice_ with regards to chelation. When parents tell you they are going to use chelation therapy for autistic children, including in circumstances where there is no valid reason to believe there’s any heavy metal toxicity, will you just nod and say that yes, you understand there’s anecdotal evidence that it helps – or will you take on the role of a _doctor_ and advise them that this is useless and even hazardous treatment?

    Jay: “It would be disingenuous to imply that non-vaccination might not lead to an increased incidence in vaccine-preventable illness.”

    Is this the sort of word play you engage in with your patients, or are you honest with them about the risks they are putting their kids and other people’s kids at by not vaccinating?

    yes, Jay goes back to work now, treating patients in the real world, saving lives via anecdotes, eschewing nasty old science with its numbers. Except for the numbers that really matter. All those with cash up front, step right in.

  328. #330 kathleen
    June 21, 2009

    But wait!! Jay!! You still didn’t answer my questions..Jay? Jay?…darn, I guess he just didn’t hear me.

  329. #331 Jay Gordon, MD, FAAP
    June 21, 2009

    Kathleen–

    Honestly, I’m not sure which of your questions I haven’t answered. Unless a family is really wealthy, taking care of a child with autism is financially stressful. I support treatments which help or might help a child. Admittedly some of these treatments are not proven and cost money. The families make decisions, as you know. My guidance of them will change because of what I’ve learned here.

    Tests for heavy metal toxicity may not be as accurate or honest as I thought they were before I was directed to reading and research I had not seen before. Do you understand that one of the purposes of these discussions is to exchange ideas? Have you read everything there is to read about the things you post about?? Hell, yes, I wish I knew more. Why on earth would anybody here think it’s a good idea to criticize someone for listening and learning? There is no reason to be nasty just because you are anonymous on this site. Completely 100% anonymous and therefore courageous in your abusive and insulting language. You would never speak this way in real life.

    Jay

  330. #332 KWombles
    June 21, 2009

    Dr. Gordon,

    Kathleen is not anonymous. Click on her name and it takes you to her blog. Heck, for that matter, click on mine and it takes you to my blog, where I link to my website and offer my credentials (I know, just a lowly adjunct instructor of psychology and English, but hey, what are you going to do?).

    Kathleen was not nasty to you (I’m not sure you know what nasty is if you think this was– try being called a baby killer by an anti-vaxxer because I support vaccinationm that’s nasty).

    I would respectfully submit, sir, that I want my pediatrician learning from medical journals, conferences, opportunities for continuing education, from other doctors with more experience, etc. Not from a blog, for all that I bow in deference to Orac’s wisdom.

    And, Dr. Gordon, I guarantee you I’d speak exactly the way I do online in person. One of the privileges in being mother to three on the spectrum who speak their minds is that it has decidedly rubbed off.

    Oh, and I have never been financially stressed because of my children’s autism. It’s called ponying up and doing the hard work, working with the school system to get the services they can provide and then spending all my spare time, close to forty plus hours per week working one on one with each my children to improve their eye contact, their compliance, their social skills, to reduce their stimming behaviors in situations where those behaviors get in the way. Not a penny required except for that spent buying textbooks second hand on ABA and cognitive behavioral therapy and autism. Just bucketloads of time, effort, and sheer determination to help them achieve their potential.

    It doesn’t go unnoticed you answered none of my comments to you.

    I do applaud that you wish to learn more. You should have done that BEFORE you went out on the circuit with Jenny.

  331. #333 Scientizzle
    June 21, 2009

    Dr. Gordon,

    I have been one of the voices critical of you in this thread and others. This post won’t be one of those.

    You have chosen to intellectually engage in an environment in which passionate advocacy can slip into hostility. This is to your credit.

    You have also stated a couple of times in recent days that your opinions regarding various aspects of the wide-ranging vaccine-autism conflict have shifted due to your interactions here. As a specific example, just a few comments above you state this discussion has changed my thoughts about chelation. If this is true (and I’m prepared to beleive you are genuinely reconsidering past stances on the basis of new data) and if it manifests itself in corresponding changes in your practice, I think that this small victory should be recognized and commended.

    I hope you continue to respond to the intellectual challenges posed in this forum.

  332. #334 kathleen
    June 21, 2009

    Jay, read post #314. Those are my questions. No, I may not be a famous doctor-I don’t even play one on t.v. I do however provide a link to my own blog. If you think that I don’t speak this way in real life…go visit my blog.
    Now you think that I am abusive…did I call you a dick? nope. Did I call you uneducated.? nope. I just called you on your fence sitting.
    I am far from wealthy-yet I still don’t understand the financial strain that you speak of. Simple question-I’ve asked it at least five times…you haven’t answered. Instead you get defensive. Remember you are the one who brought the topic up in the first place
    I most assuredly understand the exchange of ideas-what scares me is that you have been in the practice of medicine for thirty odd years and it took this post to make you question how you have been directing your patients? In other words you are saying that you supported families in choosing chelation and other therapies (your words) without thoroughly researching these therapies first?
    “Have you read everything there is to read about the things you post about?” On my own blog-yes. If it has to do with a treatment for my child-yes. They are my children That is my job. If there is something that I don’t understand-I discuss it with my doctor. That is his job. My doctor would NEVER direct me towards a treatment or course of therapy he did not fully understand or support. He is also humble enough to say he doesn’t know-when he doesn’t know.
    Jay-get over yourself. You are not a victim-more like a volunteer.

  333. #335 kathleen
    June 21, 2009

    Thank you kwombles!

  334. #336 Jay Gordon, MD, FAAP
    June 22, 2009

    Stupid! I wrote a really wonderful post and just lost it trying to solve Kathleen’s anonymity by clicking on her name while I was in the midst of writing. You live in the USA, Kathleen. I have discovered that fact

    Kim Wombles is not anonymous.

    Both of you have very personal experience with ASD.

    Kim, take education wherever you can get it. Scientific journals or here. I respect what you do and I respect the attitude you have regarding ASD families. Children and parents. You and have Kathleen have some pretty mediocre social skills, though. You are just as unpleasant on your home court as you are here.

    Kathleen, you are boring. Repetitious, rude, insulting and boring. Perseveration and speaking louder don’t make your ideas more interesting.

    I’m very happy you’ve not felt the financial strain of dealing with autism. Most of the patients I see are not wealthy enough to have skipped that aspect of caring for their children.

    Some of the people here have spent their lives in disciplines other than mine and I am learning a lot from them. What a jerk I am for admitting that and subjecting myself to your witty remarks about my changing my opinions because I acquire new knowledge and perspectives.

    Scientizzle, every time I thank someone I get my head handed to me again, but, thanks for understanding what I’m doing here. We all have core beliefs but there certainly details which can shift around.

    Good Night, All!

    Jay

  335. #337 colmcq
    June 22, 2009

    I respect anyone that cab take new ideas on board and change their opinion: “only I wise man changes his ideas”
    as confuscious once said.

  336. #338 James Sweet
    June 22, 2009

    You know Jay-if you want to be anti-vax, fine..if you want to be pro chelation, pro Hbot-fine. Pick a side-please. You keep contradicting yourself and I find it astounding..

    This is how the anti-vaxers operate, though… “We don’t want to tell anyone what to do. We are entirely neutral. We just provide information, and want everyone to make up their own mind. Also, vaccines are evil, they will give your children autism, they contain antifreeze and human fetuses, and I would never, ever, ever, ever let any of my kids get vaccinated. Oh, but we’re not like those nasty doctors who use ‘fear as their primary lever’. You can do whatever you want…”

  337. #339 kathleen
    June 22, 2009

    I must have hit a nerve! I find it fascinating that of all the criticism, name calling(boy, you were called some names,though not by me)-you chose to vent it all out on me. I asked you questions-you didn’t answer them-you didn’t, you know it. Turning the tables and somehow acting like the brave martyr..neither works nor suits you. As for your criticism of me- Ridicule is a shield, not a weapon.

  338. #340 Pete D
    June 22, 2009

    I’m glad this has been a good education for you Jay. Please make sure to stop by when you are studying for your next board exam.

  339. #341 Pablo
    June 22, 2009

    respect anyone that cab take new ideas on board and change their opinion: “only I wise man changes his ideas”

    While a willingness to learn is indeed a worthwhile trait, I still don’t have a lot of respect for a pediatrician who gets totally schooled by a blog discussion. Moreover, I have no respect for someone who can, on one hand dismiss the use of vaccines because “there’s no proof they are safe” while at the same time will use chelation because “there’s no evidence it’s dangerous,” especially when he admits that he doesn’t even know about the studies that have been done with chelation.

  340. #342 Dangerous Bacon
    June 22, 2009

    There’s a relatively simple way for Dr. Jay to demonstrate that he’s had a sincere change of heart on chelation therapy.

    He can add a posting on his website detailing his new knowledge of the risks and unproven benefit of chelation therapy for autism. This would go partway towards balancing out the non/anti-science that’s up on the site now, including blaming vaccines for autism.

  341. #343 KWombles
    June 22, 2009

    Dr. Jay,

    This isn’t a popularity contest, and Countering Age of Autism isn’t about warm fuzzies. Go to Detritus, at kwombles.blogspot.com for that. Countering is exactly that; standing up against the incredible horseshit AoA puts out day after day. There is no pleasant way to state to someone that not only is the information being dispensed wrong, it is engangering public safety, and it is putting forth a completely bogus perspective on what autism is. I have no need to be pleasant to people who villify me for standing up to speak out against them. Trust me, I started on this road providing evidence in a neutral, objective, and even soft-hearted manner and in return was attacked, called a baby-killer, called pro-autism, called a deranged word twister, etc. I’ve got me a fine thick skin and these words, coming from the likes of the folks who’re saying it, well, it makes me no nevermind, if you ken me? Just as your post full of puffed up moral outrage and the need to tell me my social skills are “mediocre” at the same time you name call Kathleen doesn’t much bother me either.

    I suggest you get a thicker skin or get out of the limelight. You don’t get to align yourself with a segment of the autistic community that sees their children as vaccine damaged goods, as soulless shadows, and then offer them treatments to recover their children that have no known efficacy and get a blank check on that one. You want to educate yourself on what researchers actually know about autism, then pick up the nearly 1500 page Handbook of Autism and Pervasive Developmental Disorders 3rd edition, Coleman’s (2005) The Neurology of Autism, and Bauman & Kemper’s The Neurobiology of Autism.

    And I said in my first post, my three children have taught me that being genuine at all times comes in handy. You’ll always know exactly where you stand with me, and isn’t that a lovely thing?

    So, you’ll be fixing your website to reflect your updated knowledge, right? I’ll be the first to offer you kudos for it and for writing a new blog for Huff stating categorically that you’ve realized you were wrong about a lot of the autism/vaccine controversy.

    Cheers.

    Kim

  342. #344 Scott
    June 22, 2009

    It’s also worth mentioning that Dr. Jay, AoA, et al are actively HAMPERING effective research into improving vaccine efficacy, reducing adverse reactions, getting a handle on what the causes of autism are, and devising appropriate treatments. Diverting scarce research funding and attention tends to do that.

  343. #345 Pablo
    June 22, 2009

    So, you’ll be fixing your website to reflect your updated knowledge, right? I’ll be the first to offer you kudos for it and for writing a new blog for Huff stating categorically that you’ve realized you were wrong about a lot of the autism/vaccine controversy.

    And then be sure to mention it to Jenny.

  344. #346 kathleen
    June 22, 2009

    I revamped my profile-no anonymity for me!

  345. #347 Pablo
    June 22, 2009

    Kathleen

    1) There is a typo in your header “tired off” instead of “tired of”

    2) How many kids do you have on the spectrum? Here, and in your profile you say three. In your header, you say two.

  346. #348 kathleen
    June 22, 2009

    oops-thanks for the edit…my third child was diagnosed last week. Thanks, I’ll go fix that!

  347. #349 Karl Withtakay
    June 22, 2009

    “Thanks for the information. This discussion has changed my thoughts about chelation. Do’C, yes, back to work.”

    “Tests for heavy metal toxicity may not be as accurate or honest as I thought they were before I was directed to reading and research I had not seen before”

    But has this new learning given you pause to reconsider your fundamental approach or the weight you give your “in the trenches experience” over scientific evidence?

    “do you understand that one of the purposes of these discussions is to exchange ideas? Have you read everything there is to read about the things you post about?? Hell, yes, I wish I knew more. Why on earth would anybody here think it’s a good idea to criticize someone for listening and learning? There is no reason to be nasty just because you are anonymous on this site.”

    I don’t criticize people for listening and learning; I criticize people when they speak authoritatively on a subject and make recommendations before doing the learning part.

    I criticize people who are so confident of their own observational and cognitive powers that they go with their gut first, and then check into the science to make sure they got it right (or at least find out what all the fuss is about), and then only alter the individual aspect they find they may have gotten wrong without going back to the drawing board to review the foundation of their empirically derived position.

  348. #350 Jen
    June 22, 2009

    “It’s also worth mentioning that Dr. Jay, AoA, et al are actively HAMPERING effective research into improving vaccine efficacy, reducing adverse reactions, getting a handle on what the causes of autism are, and devising appropriate treatments.”

    Precisely!

  349. #351 Prometheus
    June 22, 2009

    Dr. Jay – if you would like some information on the potential dangers of chelation, I would suggest the following articles:

    Graziano, et al (1992), Controlled study of meso-2,3-dimercaptosuccinic acid for the management of childhood lead intoxication. J. Pediatr. 1992 Jan;120(1):133-9

    [This article establishes DMSA as both safer and more effective than EDTA for lead intoxication.]

    Aposhian HV, et al (1995). Mobilization of heavy metals by newer, therapeutically useful chelating agents. Toxicology. 1995 Mar 31;97(1-3):23-38.

    Keith RL, et al (1997). Utilization of renal slices to evaluate the efficacy of chelating agents for removing mercury from the kidney. Toxicology. 1997 Jan 15;116(1-3):67-75.

    [These articles show that EDTA is not effective in chelating mercury]

    Dietrich KN, et al (2004). Effect of Chelation Therapy on the Neuropsychological and Behavioral Development of Lead-Exposed Children After School Entry Pediatrics. Jul;114(1):19-26. (http://pediatrics.aappublications.org/cgi/content/full/114/1/19)

    [This article showed a puzzling result - children with LOW lead levels showed a cognitive DECLINE after treatment with DMSA]

    Stangle DE, et al (2007). Succimer chelation improves learning, attention, and arousal regulation in lead-exposed rats but produces lasting cognitive impairment in the absence of lead exposure. Environ Health Perspect. 2007 Feb;115(2):201-9. Epub 2006 Oct 30. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1831518&blobtype=pdf )

    [This article shows that giving DMSA to rats that were not "heavy metal toxic" led to lower congnitive abilities. explaining the "puzzling result" in the Dietrich et al article.]

    Although it would have been better to ask for this information before recommending chelation to parents, better late than never.

    Prometheus

  350. #352 Jay Gordon, MD, FAAP
    June 22, 2009

    One week and 350 comments ago, I responded to Orac’s post about my HuffPo post. I’m not sure how long it would take to read all these comments at one sitting, but I’ve done that at least twice. I have done the best I can to answer dozens of question and asked some reasonable questions of my own. No one–including Orac–has responded well to my question about doctors using medicines “off label” or performing surgery in an innovative unproven way for a patient who needed it. Chelation therapy is used “off label” for treating autism and is a long way from being found either completely effective or completely ineffective in spite of the half dozen studies quoted here. The studies and anecdotes citing dangers of chelation are not conclusive at all and I’m surprised someone here hasn’t noticed that.

    I do not recommend chelation as first line therapy but I continue to support parents who have chosen it. Your perseverating about certain aspects of this discussion doesn’t help. When presented with facts, I can change my opinions. Thanks for the above Prometheus. I really wish more of you understood what it’s like to care for a hundred families who are otherwise unsupported by the insurance industry and by doctors. Kathleen, I’ll never know what your situation is like and, again, I’m sorry for offending you.

    Best,

    Jay

  351. #353 Mike Stanton
    June 22, 2009

    In reply to Dr Gordon’s remarks to Kathleen

    I’m very happy you’ve not felt the financial strain of dealing with autism. Most of the patients I see are not wealthy enough to have skipped that aspect of caring for their children.

    One of the problems with autism is the Fear, Uncertainty and Dread (FUD) that has been generated by those who paint it as a public health disaster and a “devastating disorder” that is so terrible that parents are encouraged to pursue desperate remedies because, whatever the consequnce, nothing could be worse than having an autistic child.

    When physicians buy into the FUD it is a simple matter for them to recommend all manner of probably ineffective and possibly dangerous treatments, many of which are very expensive. Even if they have their doubts they may be unwilling to gainsay parents who are under a lot of pressure to follow this path. In our case relatives kept sending us press cuttings of the latest miracle cure. As I wrote elsewhere

    Of course, friends and relatives are always hearing about miracle cures and interventions. These are usually very expensive and only obtainable on the other side of the globe. So, why aren’t you mortgaging your other children’s college fund and your pension to cure your child? Don’t you love him enough? Or perhaps he is not really that autistic? Grrrr!

    One of the reasons that parents like myself and I suspect, maybe Kathleen, have not been reduced to penury by our children’s autism is that we were too poor in the first place to even consider the expensive and unproven remedies. 20,000 dollars a year for ABA? 200 dollars for a 30 minute phone consultation with a DAN! practitioner who will sell me expensive and unnecessary tests before placing my child on an equally expensive regime of supplements and off-label medications? Forget it!

    We made do with what the public health and education services had to offer. It wasn’t perfect. it wasn’t easy. But we have had a positive outcome for our son. This did not always seem likely. And I can understand physicians desire to help when they see a family in distress. I invite Dr Gordon to read a lecture I delivered a few years ago. He may find this passage helpful.

    It is often the case that, rather than trying to normalize their behaviour, we would do better to teach autistic people that their normality is different to ours. Then, instead of telling them to change all the time because we are right and they are wrong, we could teach them strategies to understand us and make allowances for our behaviour.

    I think this view of autism could be quite attractive to psychologists and psychiatrists working in the health service. Instead of seeking to pathologize the behaviour of autistic people they would be freed to celebrate the positive aspects of autism and share this with parents who naturally want to love and value their child despite their difficulties. There is a lot of discussion about the need to mourn the loss of your ‘normal’ child and your hopes and expectations for him while you adjust to having an ‘abnormal child’ after diagnosis. It may be that what we really mourn is the lost opportunity for celebration. Autism appears to have taken this away from us and from our child. As Matthew once said to me,

    “I’m sorry, Dad. I wish I could have been the boy you never had.”

    Take the autistic child. Restore his self esteem and teach him to take pride in himself. Educate his parents in the best ways to raise him and teach them coping strategies for the challenges he will present. Counsel the brothers and sisters and teach them how to draw strength rather than weakness from their autistic sibling. You may not have a cure. But there are ample opportunities for you to heal.

  352. #354 Tsu Dho Nimh, BS, MT(ASCP)
    June 22, 2009

    Jay said, “I do not recommend chelation as first line therapy but I continue to support parents who have chosen it.

    Even if the lab tests that purportedly show an “elevated” level of mercury are not valid because they are comparing urine levels in provoked (with chelator given) autistic kids against non-provoked (no chelator given) normal kids?

    You said you understood. In post #308, you said, Tsu do Nimh, thank you. I understand this issue much better than I ever have. The provocation values are then used with the reference values from non-provoked levels. That’s not a very honest thing to do, is it?

    It’s definitely dishonest … it’s bogus, it’s lying, and it’s being used to enrich the doctors who sell the chelating medicines, ointments and whatever.

    If you can say that you understand the tests are dishonest, how can you still support parents who are chelating their child? Shouldn’t you inform them that they have been misled by a faulty testing protocol and have the kid tested by a real lab, maybe the one at UCLA, using the “gold standard” of heavy metals testing – the blood test?

  353. #355 Orac
    June 22, 2009

    No one–including Orac–has responded well to my question about doctors using medicines “off label” or performing surgery in an innovative unproven way for a patient who needed it.  Chelation therapy is used “off label” for treating autism and is a long way from being found either completely effective or completely ineffective in spite of the half dozen studies quoted here. The studies and anecdotes citing dangers of chelation are not conclusive at all and I’m surprised someone here hasn’t noticed that.

    I’ve written about using various surgical procedures in “innovative” ways before:

    http://scienceblogs.com/insolence/2007/02/surgical_research_tinkering_versus_innov_1.php

    http://scienceblogs.com/insolence/2008/05/when_popularity_outpaces_science_in_surg.php

    However, your analogy is very, very bad, and here’s why.

    Off-label use of medications can sometimes be justified if there is a valid scientific reason to think that the medicine might work for the off-label indication being used. That can most definitely not be said for chelation therapy, for which there is no compelling scientific rationale to think that it would do anything for autism. For one thing, most chelation agents don’t cross the blood-brain barrier. For another thing, there is no evidence that mercury or other heavy metal toxicity causes autism. There’s no good evidence that autistic children have higher levels of mercury or other metals other than highly dubious lab tests ordered by–let’s be blunt–quacks. Nor is there any science to lead us to suspect that, even if metal toxiciity did cause autism, that the changes or damage to the neurons isn’t permanent, in which case removing the heavy metals would do nothing. Finally, there is the issue of clinical efficacy. In brief, there is no evidence that chelation therapy does anything for autism other than testimonials and anecdotes, which, as we’ve pointed out time and time again, are very often misleading.

    No, Dr. Jay. Chelation therapy most definitely does not qualify as a legitimate, scientifically justifiable off-label use of a drug.

  354. #356 Dangerous Bacon
    June 23, 2009

    Jay: “I do not recommend chelation as first line therapy but I continue to support parents who have chosen it.”

    Tsu: “If you can say that you understand the tests are dishonest, how can you still support parents who are chelating their child? Shouldn’t you inform them that they have been misled by a faulty testing protocol and have the kid tested by a real lab, maybe the one at UCLA, using the “gold standard” of heavy metals testing – the blood test?”

    Tsu, a big part of the problem here is that Jay is hung up on what he perceives as a non-patriarchal model of practicing medicine, where (in his case) the physician “listens to the parents” and above all is supportive of whatever they choose to do (it helps that he has the same mindset that anecdotes and testimonials are as good as, if not better than scientific evidence).

    Jay thinks this is a valid and compassionate model for medicine. But he is essentially abdicating a key role of the physician – to educate the patient (or parents of the patient) and convince them of the validity of what evidence-based medicine has taught us about optimum medical care. He needs to do this even if the course to be recommended is not the popular one among his coterie of parents/fans.

    The other side of the coin, of course, is that once you’ve sold yourself and others on being the maverick who challenges the Establishment/Big Pharma/Cold-Hearted Ivory Tower Scientists, it’s a big comedown to have to concede that the mainstream view is correct after all.

    Which is why it will take more than applied reading here or elsewhere for Jay to change his medical practice as it applies to such things as vaccination, autism and chelation.

    It will take courage.

  355. #357 KWombles
    June 23, 2009

    Dangerous Bacon,

    That was very well said.

    I don’t expect nor want my physician to write me whatever prescription I think I want. I want him to practice medicine, help me figure out what’s wrong and what the limitations of medicine are in my case. If current medical science shows no effective medication, then I want that truth and a physician strong enough in his ethics to not base his career on giving me what I want whether it will help me or not. I want a physician who practices medicine ethically and responsibly.

    And I want one who doesn’t cast himself as the victim in a heated exchange on a blog. Persecution complexes are not attractive nor indicative of a physician with the backbone to make the hard decisions medicine often involves.

  356. #358 D. C. Sessions
    June 23, 2009

    Jay thinks this is a valid and compassionate model for medicine. But he is essentially abdicating a key role of the physician – to educate the patient (or parents of the patient) and convince them of the validity of what evidence-based medicine has taught us about optimum medical care. He needs to do this even if the course to be recommended is not the popular one among his coterie of parents/fans.

    That’s a very charitable view of our Dr. Gordon, but it’s at best incomplete.

    If Dr. Gordon were just a moral coward who abdicates his responsibility as the expert medical authority, then he wouldn’t (as he puts it) “reluctantly” vaccinate only if “parents insist.” That’s not a rejection of the “patriarchal” role.

  357. #359 K (not the K from the druid thread, BTW)
    June 23, 2009

    It will take courage.

    Or a big fat lawsuit.

  358. #360 Mu
    June 23, 2009

    Odd, if you’re a doc known to write generous prescriptions for pain killers, you’re in big trouble. If you’re known to write generous prescriptions on off-label use for parents to poison their kids with you’re home free and make lots of money.

  359. #361 DebinOz
    June 23, 2009

    I’m thinking that it’s about time that ‘Law and Order’ took this scenario on (kid with autism being subjected to terrible and ineffective therapy), thereby changing public perception. After all, they have debunked weird rebirthing (kid suffocates in blanket) and dodgy supplement issues (kid dies).

    Damn, I feel like I have hit rock bottom as an epidemiologist! Still, the public doesn’t read medical journals, but they love ‘Law and Order’.

  360. #362 Pablo
    June 23, 2009

    I’m thinking that it’s about time that ‘Law and Order’ took this scenario on (kid with autism being subjected to terrible and ineffective therapy), thereby changing public perception. After all, they have debunked weird rebirthing (kid suffocates in blanket) and dodgy supplement issues (kid dies).

    I’m thinking it’s about time Orac closed this post and started a new one. It’s really getting tough on the browser (sorry, I know the retort of “get a decent browser” but IE is still the most popular browser being used, and so webpages have to be compatible with it).

    I recommend a new thread: List the pediatricians you know personally who are pro-vaccine. See the comments in the Onion post.

    Maybe I will do this over at JREF

  361. #363 passionlessDrone
    June 23, 2009

    Hi RJ –

    Too much traffic here and getting involved in all of it just requires too much of my time so I bailed for a while. I was enjoying our discussion, however. Are you still there?

    I would suggest considering the chicken and egg scenario for you thoughts…the cytokine levels can be upregulated because they are autistic (not that they are autistic because of cytokine levels). Social stresses result in the differential levels of these markers, not that these markers are some driver of their condition.

    This is certainly possible, and again, especially in the case of psychological stressors I’m inclined to agree with you that feedback loops do seem likely.

    But what then, are we to make of studies such as the MIF study in Pediatrics? This is an immune regulator shown again and again to be highly associated with a variety of inflammatory autoimmune conditions; psychological stress isn’t giving these children the upregulating polymorphisms. The genetic association could be random, even though it was found in two geographically distinct populations, but we’d also need to find a reason why MIF levels correlated to autistic behavior severity. I guess I’m having a difficult time reconciling with the idea that in autism the findings of increased MIF might be spurious after it has been found to be associated so strongly with other autoimmune conditions; especially if the only evidence that this might be the case are arguments along the line of the uncertain nature of autism or other neurological conditions.

    I’d make an identical argument with the TGF-Beta1 study where decreases were found to be associated with autism, and again, correlate with severity. TGF-Beta1 has plenty of other functions, but a major one is immunomodulatory; do we have any evidence other than complexity that the mechanism behind an association to autism isn’t through immunological modification?

    I’m not basing my opinions on these two studies alone; there are many others, but this format makes it cumbersome to go into all of them in detail. We have several papers on differential generation of cytokines by several stimulants, again in the direction of creating more pro-inflammatory cytokines than control patients. We have an increasing body of evidence that some of the same inflammatory cytokines can be causative agents in the pathogenesis of seizures, a condition of very high comorbodity rates in the autism population.

    I think to be succinct, the papers you’ve listed should be thought of as pieces to the puzzle that describe the learning and development of the infant immune system and that by taking some of these as evidence that there are difference, therefore, we must treat them differently is unwarranted. It would be better to look at it as in a whole-systems approach and not dwell on any particular piece.

    Fair enough to a point. But we do already treat them differently; this is why, for example, the high titers measles vaccine effort was abandonded even though it had the potential to save some children by granting immunity at an earlier age. The question, to my mind is, do we know enough to be confident we are treating them differently enough? I guess we just have different answers to this question.

    And insisting on taking the whole system approach, we leave ourselves vulnerable to not evaluating findings; if I understand you correctly. (Please forgive me if I don’t). For example, we have three studies showing distinctly pro-inflammatory cytokines profiles in the brain or CSF and/or activated microglia in the autism population; though I do not beleive any of them showed more classic signs of adaptive autoimmune damage or associated T-cell infiltration. I’d think this is important information, just because the adaptive system doesn’t appear to be involved doesn’t mean it isn’t important to figure out what is going on here.

    The fact remains, the infant is dealing with a constant bombardment of microbial interactions (many of them are pathogens) and by dealing with them, over time, to mature to a state we’d call the adult immune system. And again, looping back to immunizations, the point is that we bypass disease so that these individuals can gain that immunity and continue to develop accordingly. I think anyone would be had-pressed to convince me that giving children these diseases so that they can gain immunity “naturally” is a better option. It doesn’t make any sense whatsoever. (I’d be happy to look at the lists of the pro’s and con’s of each). The fact is, the longer it takes for a child to be immunized, the greater the chance they will become infected and have the disease.

    I am generally agreement with what you’ve said here. I’m not going to make most of the arguments you are against here, except perhaps in highly specific cases that quickly devolve into minutia.

    It seems like there is one known, and several unknowns.

    We know that a disturbance of immune homeostasis is a feature of autism by many measurements; including but certainly not limited to, different expression of inflammatory cytokines.

    We don’t know if this immune dysregulation is causative in autism or not, though I believe we have several lines of evidence that it may be in some children. Unfortunately, this is a very difficult knot to detangle, and frequently the quality of debate on this point merely inovles pointing out that other poorly understood conditions also appear to have immune disturbances, as if this is proof that autism is not immune mediated.

    We also do not know if vaccination is capable of disturbing the immune systems homeostasis in ways that have been observed in autism. Unfortunately, to my mind, this is largely a result of a relative dearth of study on the finer details of the effect of vaccination up and above the eventual triggering of adaptive immunity. We do have many studies in the animal realm that tell us that simply triggering the immune system during development is capable of causing long term immune system changes, as well as behavioral abnormalities. Because we have no studies that effectively compare children that received no vaccinations (or very few) to children who did not, any effect from this type of force is unknown to us.

    I was just trying to think of ways that we might be able to indirectly tell if vaccination was capable of causing some of the immune dysregulation we see in autism. I guess I’ll have to work on some other ideas.

    I am interested in your thoughts.

    - pD

    ps –

    Times are good right now in the U.S. so we don’t need to shit egg-rolls, but given the fact that we are globalizing and cramming more and more people on to this little rock, those odds are changing.

    You should check this site out: http://lifeboat.com/ex/main

  362. #364 D. C. Sessions
    June 23, 2009

    I’m thinking it’s about time Orac closed this post and started a new one. It’s really getting tough on the browser (sorry, I know the retort of “get a decent browser” but IE is still the most popular browser being used, and so webpages have to be compatible with it).

    Don’t blame the site — this page still loads for me in less than a second.

    ScienceBlogs may have server-capacity issues, but that seems to affect even the simplest pages. As far as I can tell, when a page takes forever to load it’s the embedded ads that do it, not the text content.

  363. #365 Pablo
    June 23, 2009

    Don’t blame the site — this page still loads for me in less than a second.

    ScienceBlogs may have server-capacity issues, but that seems to affect even the simplest pages. As far as I can tell, when a page takes forever to load it’s the embedded ads that do it, not the text content.

    No, the text content is making a difference, too, because other (short) threads are not as bad.

    But even if that were not the case, even the long text thread is a killer on the mobile.

  364. #366 skeptiquette
    June 24, 2009

    Cytokine profiles will not tell you much. Cytokines profiles are expected to vary after vaccination (that’s part of the immune system doing what it is supposed to do, the way it does it).

    RJ,

    Yes, indeed you are correct cytokine profiles are supposed to vary after vaccination, but has it occurred to you that an abberant response or regulation of the response could be elicited due to genetic polymorphisms, epigenetic influences, intestinal micro flora composition, nutritional status, stress status, sleep status, metabolic status, etc.? This abberant response could contribute to the pathology and neurobiology of autism.

    I think that the evidence points in such a way that we should consider the bystander effects in susceptible individuals much more carefully.

    When you consider any and all obut establishing a correlation with variations within among specific cytokines and adverse events is not going to tell you much. I can tell you, from first had experience, that cytokine profiles vary widely among individuals, as do the kinetics.

    The first sentence here is pretty botched, are you trying to say that finding a relationship between the profile of one or many cytokines and adverse events is a wasted effort. I think that proposing that certain cytokine profiles, I.e. subclinical elevation of proinflammatory cytokines, are related to many behavioural changes is quite logical based on the evidence that has accumulated thus far. The study of psychoneuroimmunology has come a long way in the past ten years, as well as our understanding of the innate immune system. You are aware that the most typical immunoadjuvant, alum, is a potent activator of the NALP3 inflammasome, which is the protein scaffolding responsible for activating the pro form of IL-1B. How can you be so sure that this potent activation doesn’t go awry in certain susceptible individuals?

    What you suggest might be a worthy project for a graduate student, but for use in a public health setting, costing thousands of dollars per patient, it isn’t going to provide any useful information. If my experience is worth anything, my team and I (like many at hundred of companies around the world) look at cytokine/chemokine expression following immune insult on a daily basis. There is no way we could make rhyme or reason out of a snap-shot profile of any one or large selection of Cyto/chemokines and disorders down the line. They do not equate.

    A worthy project for a graduate student, are you serious?? As you can tell I couldn’t disagree with this attitude any more. For one, understanding more about the response to vaccines, in particular the innate immune response is of the utmost importance, since this is such a broad program we really need to use the technology we have to investigate bystander effects. Two, scientific inquiry into vaccine response with a commitment to understanding how inter individual variation dictates that reponse will not only produce safer more effective vaccines, but it will quell fear and increase uptake, all of which will be beneficial to public health . I have to fully agree with pD here, cataloguing baseline cytokine levels before and after a vaccine event would be of paramount importance. It surprises me that an animal model hasn’t been developed to examine this.

    I have to ask, what kind of company do you work for? Why are you looking at cytokine and chemokine responses to immune insults, I.e. what hypotheses are you testing? Regarding you and your team making rhyme or reason out of cytokine profiles and disorders down the line, is this something that you are studying, read about, or are you making an uninformed assumption?

    for your second portion…I guess I just disagree. Citing specific instances that were identified in large-scale studies, and then falling back and making a generalization with other ramifications is not the way I would see it. The main differences between the infant and adult immune system is experience…the changes that have ensued in the adult are a consequence of exposures over time. The functions of the innate immune system are very much alike, however, it is the status of acquired immunity that is significantly different. The whole point of immunizations is to provide similar exposures to the infant, which is primed and anticipating the infections it has to deal with on a constant basis, without causing the diseases themselves. Basically, directing the infant immune system toward the same state as an adult in a safer manner.
    Hope this is food for thought.

    This last paragraph makes me believe you are having a difficult time following the argument put forth, as the paragraph is a complete non sequitir. Anyways, I think we know the general objective of vaccines, no need to reiterate that point. The argument is that there is a very real possibility that vaccines are a part of the autism puzzle for a subgroup of susceptible individuals, by way of eliciting an innate immune response that is either abnormally upregulated or not adequately down regulated, the end result being a subclinical expression of proinflammatory cytokines, which impact the developing CNS.

    As pD has stated, an important correlation between MIF and children with autism was recently discovered. MIF has a multitude of functions, one being to reprogram the macrophage apoptosis patterns, effectively prolonging its activation phase. It also mitigates the effects of glucocorticoids, hormones responsible for keeping the innate immune response in check. Recent findings regarding a metabolic endophenotype are also interesting in the context of innate immune activation and regulation. The finding that children with autism have reduced levels of GSH and a lower ratio of GSH:GSSG is critical to understanding dysregulated immune function. This essential peptide plays a prominent role in regulating ROS, which play a critical role in activating the innate immune system. (particularly the NALP3 inflammasome). Lower GSH levels also affect the methionine cycle, resulting in lower levels of circulating SAM the main methyl donor for DNA methylation. It has been hypothesized that this results in a general state of hypomethylation, which critically impacts genetic expression. For example, normally the dna encoding the Interferon gene is heavily methylated in infants (here is one known difference between newborns and adults, or even toddlers for that matter) to reduce access to transcription factors, thereby suppressing its transcription.

    I would recommend a recent volume in Immunology and Allergy Clinics of North America, the May volume is incredibly interesting and quite relevant to this discussion.
    Immunol Allergy Clin North Am. 2009 May;29(2)
    Here is the table of contents:

    xiii-xiv Foreword

    Alam R Preface

    Freund GG “The Blood-Brain Barrier in Psychoneuroimmunology”

    Banks WA “Molecular Aspects of Fever and Hyperthermia”

    Roth J “Cytokine, Sickness Behavior, and Depression”

    Dantzer R “Hypothalamo-Pituitary-Adrenocortical Axis, Glucocorticoids, and Neurologic Disease”

    Doczy EJ “Social Interactions, Stress, and Immunity

    Avitsur R “Sleep and Psychoneuroimmunology

    Opp MR “Depression and Immunity: Inflammation and Depressive Symptoms in Multiple Sclerosis”

    Gold SM “Age and Neuroinflammation: A Lifetime of Psychoneuroimmune Consequences

    Godbout JP “Psychoneuroimmune Implications of Type 2 Diabetes: Redux

    O’Connor JC “Psychoneuroimmunology of Stroke

    Skinner R “Exercise, Inflammation, and Innate Immunity

  365. #367 passionlessDrone
    June 25, 2009

    Hi Skeptiquette –

    The finding that children with autism have reduced levels of GSH and a lower ratio of GSH:GSSG is critical to understanding dysregulated immune function. This essential peptide plays a prominent role in regulating ROS, which play a critical role in activating the innate immune system. (particularly the NALP3 inflammasome).

    I hand’t put these pieces together yet; that is really quite fascinating.

    Lower GSH levels also affect the methionine cycle, resulting in lower levels of circulating SAM the main methyl donor for DNA methylation. It has been hypothesized that this results in a general state of hypomethylation, which critically impacts genetic expression. For example, normally the dna encoding the Interferon gene is heavily methylated in infants (here is one known difference between newborns and adults, or even toddlers for that matter) to reduce access to transcription factors, thereby suppressing its transcription.

    Do you have any references for this? Not that I doubt you, but just in the interest of increasing the time I can do some reading by reducing the number of things to sort through. And again, a very interesting point.

    I’ve recently read a few papers regarding the effect of early life seizures that implicate the innate immune response as a causative factor in resultant neuroimmune and behavioral outcomes that have parallels in the autism realm that may also be of interest to this discussion.

    Enhanced microglial activation and proinflammatory cytokine upregulation are linked to increased susceptibility to seizures and neurologic injury in a ‘two-hit’ seizure model.

    and

    Glial activation links early-life seizures and long-term neurologic dysfunction: evidence using a small molecule inhibitor of proinflammatory cytokine upregulation

    The authors report that increased microglial activation, pro-inflammatory cytokines, and chemokines as a result of early life seizures; with particular increases in animals that had two induced seizures when compared to other groups. Up and above an acknowledged high prevelance of seiuzres in the autism population, these same immunological markers have been found in post mortem studies of the brains of persons with autism. Administration of an anti inflammatory agent after initial seizure resulted in decreases of these measures as well as behavioral improvements compared to animals who did not receive anti inflammatory treatments; indicating that it was the resultant immune response that was responsible for long term changes.

    Why might this be of interest to a discussion of the potential for vaccines to cause changes in infants up and above pathogen recognition?

    Well, for one, we know that having a seizure during the first year of life is associated with a future diagnosis of autism. Secondly, we have a growing body of evidence that cytokines are capable of causing seizures or increased seizure succeptibility, and some of these same cytokines, such as IL-1Beta and tnf-alpha, have been shown to be created in much higher quantities by blood from children with autism ,in vitro, in response to a variety of stimulating factors, including LPS. In at least one instance, we have experimental evidence that an increase in seizure succeptibility due to tnf-alpha is time dependent, such that effects are only visible if the stimulus occurs in a specific timeframe.

    To come full circle, our open question might be, are vaccines capable of generating an increase of inflammatory cytokines at levels that have been observed to be associated with seizure onset in individuals that are genetically, epi-genetically, and/or environmentally predisposed to respond with an extremely vigorous innate immune response? This might be a good candidate for another graduate student.

    In rare cases febrile seizures are a known side effect of vaccination; including the Pro-Quad debacle as a shining illustration of how much we have to learn about what we are doing. Speaking of which, I’d imagine it might be of particular interest to get a glimpse of cytokine generation profiles pre/post Pro-Quad / standalone MMR + Chicken Pox vaccination to see if this was a possible component towards the increase in seizures associated with this vaccine. A more sublte question to answer might be finding a way to detangle if cytokines surges insufficient to cause visible seizures are none the less capable of generating the type of neuroimmune differences found in the studies above. In other words, is a full fledged seizure necessary for neuroimmune modifications to occur?

    - pD