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 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.

  2. #2 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.

  3. #3 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.

  4. #4 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?

  5. #5 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.

  6. #6 D. C. Sessions
    June 19, 2009

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

    The paying customer is always right.

  7. #7 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?

  8. #8 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

  9. #9 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.

  10. #10 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?

  11. #11 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)

  12. #12 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.

  13. #13 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

  14. #14 Joseph
    June 19, 2009

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

  15. #15 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.

  16. #16 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.

  17. #17 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.

  18. #18 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

  19. #19 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?

  20. #20 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?

  21. #21 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.

  22. #22 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.

  23. #23 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.

  24. #24 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!

  25. #25 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.

  26. #26 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?

  27. #27 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?

  28. #28 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.

  29. #29 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.

  30. #30 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.

  31. #31 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.

  32. #32 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?

  33. #33 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

  34. #34 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.

  35. #35 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.

  36. #36 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

  37. #37 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?

  38. #38 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?

  39. #39 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…

  40. #40 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

  41. #41 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?

  42. #42 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.

  43. #43 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.

  44. #44 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.

  45. #45 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.

  46. #46 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?

  47. #47 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?

  48. #48 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?

  49. #49 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.

  50. #50 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?

  51. #51 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.

  52. #52 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!

  53. #53 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.

  54. #54 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.

  55. #55 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.

  56. #57 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.

  57. #58 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

  58. #59 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

  59. #60 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.)

  60. #61 D. C. Sessions
    June 20, 2009

    HCN, I’m blushing.

    Besides, the garden is mostly $HERSELF’s work.

  61. #62 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

  62. #63 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?

  63. #64 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.

  64. #65 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

  65. #66 LW
    June 20, 2009

    Measles infection is beneficial? Sadly, I must have missed the link. Could you please repost it?

  66. #67 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

  67. #68 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?

  68. #69 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?

  69. #70 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.

  70. #71 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

  71. #72 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

  72. #73 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.

  73. #74 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?

  74. #75 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.

  75. #76 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.

  76. #77 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.

  77. #78 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!

  78. #79 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?

  79. #80 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.

  80. #81 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

  81. #82 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.

  82. #83 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.

  83. #84 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

  84. #85 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.

  85. #86 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.

  86. #87 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…

  87. #88 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

  88. #89 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

  89. #90 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

  90. #91 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.

  91. #92 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.

  92. #93 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.

  93. #94 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.

  94. #95 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.

  95. #96 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”.

  96. #97 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.

  97. #98 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

  98. #99 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.

  99. #100 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?

  100. #101 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).

  101. #102 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..

  102. #103 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

  103. #104 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.

  104. #105 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.

  105. #106 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.”

  106. #107 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.

  107. #108 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

  108. #109 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.

  109. #110 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.

  110. #111 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.

  111. #112 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?

  112. #113 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.

  113. #114 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.

  114. #115 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.

  115. #116 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.

  116. #117 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.

  117. #118 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?

  118. #119 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.

  119. #120 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.

  120. #121 Militant Agnostic
    June 21, 2009

    To parody Barry Goldwater

    Big meaniness in defense of public health is no vice.

  121. #122 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”.

  122. #123 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

  123. #124 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.

  124. #125 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

  125. #126 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?

  126. #127 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

  127. #128 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.

  128. #129 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.

  129. #130 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.

  130. #131 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

  131. #132 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.

  132. #133 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.

  133. #134 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.

  134. #135 kathleen
    June 21, 2009

    Thank you kwombles!

  135. #136 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

  136. #137 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.

  137. #138 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…”

  138. #139 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.

  139. #140 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.

  140. #141 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.

  141. #142 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.

  142. #143 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

  143. #144 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.

  144. #145 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.

  145. #146 kathleen
    June 22, 2009

    I revamped my profile-no anonymity for me!

  146. #147 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.

  147. #148 kathleen
    June 22, 2009

    oops-thanks for the edit…my third child was diagnosed last week. Thanks, I’ll go fix that!

  148. #149 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.

  149. #150 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!

  150. #151 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

  151. #152 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

  152. #153 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.

  153. #154 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?

  154. #155 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.

  155. #156 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.

  156. #157 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.

  157. #158 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.

  158. #159 K (not the K from the druid thread, BTW)
    June 23, 2009

    It will take courage.

    Or a big fat lawsuit.

  159. #160 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.

  160. #161 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’.

  161. #162 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

  162. #163 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

  163. #164 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.

  164. #165 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.

  165. #166 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

  166. #167 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

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