As you may have noticed, I've fallen into a groove (or, depending on your point of view, a rut) writing about anti-vaccine lunacy. The reason is simple. While I was busy going nuts over Bill Maher's receiving the Richard Dawkins Award, the anti-vaccine movement has been busy, and there are some things I need to address that had backed up while I was distracted. There's one more thing I need to address before I move on to other topics.
Over the last couple of months, I've noticed something about the anti-vaccine movement. Specifically, I've noticed that the mavens of pseudoscience that make up the movement seem to have turned their sights with a vengeance on the Hepatitis B vaccine. The reason for this, I believe, is fairly obvious. The fact that the Hep B vaccine is administered shortly after birth seems somehow to enrage the anti-vaccine movement more than just about any other vaccine. Moreover, given that, aside from maternal-child transmission when the mother is infected, hepatitis B is usually only contracted through either bloodborne contact (the sharing of needles, the administration of contaminated blood) or sexual activity, it's very easy for anti-vaccinationists to make a superficially plausible argument that it's not a necessary vaccine, even though there are reasonable rationales for giving it to infants. The image of sticking a needle into a newborn infant trumps that, though, at least for the anti-vaccine movement. Indeed, just the other day, the anti-vaccine crank groups the National Vaccine Information Center (NVIC), Talk About Curing Autism (TACA), and the anti-vaccine crank blog Age of Autism posted a call for the elimination of hepatitis B vaccination for newborns:
Washington, DC - National Vaccine Information Center and Talk About Curing Autism are calling on President Obama to order the immediate suspension of the Centers for Disease Control and Prevention recommendation of the birth dose of the Hepatitis B vaccine after two recent studies linking the Hepatitis B vaccine to functional brain damage in U.S. male newborns and infant primates. In a related development today, the United States Department of Health and Human Services, including the Health Resources and Services Administration and Centers for Disease Control and Prevention, announced that 1 in every 91 children are now diagnosed with an autism spectrum disorder as reported in the November 2009 issue of Pediatrics. Previous data released by the CDC indicated a prevalence of 1 in every 150 children affected by the disorder.
Note how AoA so cleverly interposed the latest information about autism prevalence with its call to eliminate the birth dose of the hepatitis B vaccine. Very clever. By doing so, it linked the two in readers' minds, as if one had something to do with the other. Meanwhile, David Kirby is up to his usual nonsense. At the heart of this are two studies, one a restrospective study in humans and the other a study in monkeys, both of which the anti-vaccine movement is promoting as slam dunk evidence that the hepatitis B vaccine is causing all sorts of horrific problems. Taking both of them on in one post is too much, even for my logorrheic tendencies. So I'll deal first with the monkey study and then, either later this week or sometime next week, deal with the human study.
The reason I start with the monkey study is because, so confident are the anti-vaccinationists of the study that they've placed the accepted manuscript on the Thoughtful House website (PDF).The study has also been posted on the anti-vaccine blog Age of Autism (PDF). That means that you can read it for yourself. (Thanks, Thoughtful House and Age of Autism!) The study is entitled Delayed Acquisition of Neonatal Reflexes in newborn Primates receiving A Thimerosal-containing HepatitiS B Vaccine: influence of gestational age and Birth weight, and it's by a cast of characters that we've met before, including the pseudoscientist who launched thousands of cases of MMR in the U.K. through his shoddy science, being in the pocket of trial lawyers, and possibly even scientific fraud. Then there's also Laura Hewitson. We've seen her before as the author of a couple of abstracts that I dissected in gory detail last year. Suffice it to say that, not only was the science shoddy, but massive conflicts of interest were not disclosed. The only difference this time around is that the conflicts of interest were disclosed. No doubt this was in response to all the criticism last year.
In fact, let's look at the conflicts of interest first:
Prior to 2005, CS and AJW acted as paid experts in MMR-related litigation on behalf of the plaintiff.LH has a child who is a petitioner in the National Vaccine Injury Compensation Program. For this reason, LH was not involved in any data collection or statistical analyses to preclude the possibility of a perceived conflict of interest.
It's hard not to retort that LH (Laura Hewitson) is the frikkin' first author! She designed and coordinated the study! She's also the corresponding author, which presumably means that she wrote the manuscript, or at least the bulk of it. There is not just the appearance of a conflict of interest; there is a conflict of interest, a massive conflict of interest. The same is the case with Andrew Wakefield. In fact, if I were to use the same criteria that Age of Autism did when it automatically labeled any study with any pharmaceutical company underwriting whatsoever as hopelessly biased in its Fourteen Studies website, I could stop right here and dismiss this study as so hopelessly the result of a conflict of interest that I don't even need to analyze it.
Fortunately, unlike anti-vaccine cranks, that's not how I roll. I did, however, have a hearty laugh at AoA's attempt to justify the blatant conflict of interest thusly:
One likely tactic of critics of the study will include attempts to nullify the evidence based on the alleged bias of those involved. For one, the study is privately funded and acknowledges some well known autism advocates as financial contributors. These include the Johnson family (Jane Johnson is co-author of Changing the Course of Autism, a member of the Board of Directors of Thoughtful House and Director of Defeat Autism Now!), SafeMinds, the Autism Research Institute and Elizabeth Birt. Although all of these groups make clear their research interest is vaccine safety, they are frequently attacked for being "anti-vaccine", an epithet that will almost certainly be hurled again here.
If the shoe fits...
However, even more amusing was this:
The most aggressive attacks, however, will likely be reserved for the study authors. The basis of these attacks is best anticipated by the following conflict of interest disclosure in the published paper.
After which Blaxill quotes the conflict of interest statement from the paper that I reproduced above. Isn't the hypocrisy breathtaking? In Fourteen Studies, AoA and Generation Rescue slimed every investigator who received a penny of money from a pharmaceutical company or any governmental public health agency. In fact, Generation Rescu defined conflicts of interest this way:
We considered a scientist employed by a vaccine maker or a study sponsored by a vaccine maker to have the highest degree of conflict, with a public health organization (like the CDC) to be the second-worst.
Based on some of the things that Generation Rescue said about those "Fourteen Studies," it also appeared to define the mere fact of being funded through grants from the CDC, NIH, American Academy of Pediatrics, or even the Canadian Institutes for Health Research as being a hopeless conflict of interest. Scientists who have had NIH grants (such as myself) or grants from any of these other organizations know just how ridiculous considering that particular funding source to be a horrific conflict of interest is. The bottom line is obvious. It's a "conflict of interest" only if Generation Rescue says it's a "conflict of interest." Words apparently mean exactly what Generation Rescue says they mean, no more, no less. Another way of putting it is that it's only a conflict of interest if the funding source happens to be an organization Generation Rescue hates. Accepting funding from a pharmaceutical company? It's a conflict of interest. No doubt about it. Such COIs need to be reported, and--guess what?--they usually are. But, to Mark Blaxill and the Age of Autism, being one of the complainants in the Autism Omnibus and being funded by organizations whose purpose is to demonstrate that vaccines somehow cause autism and other neurodevelopmental problems? Well, that's not a conflict of interest to anti-vaccinationists because they see themselves on the side of angels and think that they could never, ever have their objectivity affected by the funding source, having an autistic child, or being part of a legal action for "vaccine injury," which, by the way, might be helped by scientific evidence showing that vaccines can cause autism or neurodevelopmental disorders. One notes that one of the things the previous monkey study published as an abstract by Hewitson and Wakefield got dinged for in the blogosphere was that no conflicts of interest were reported. Poor Mark seems really peeved at the criticism Hewitson justly received for that little ethical lapse last year.
On to the study.The first thing I always look at whenever reading any study is a simple question: What is the hypothesis being tested? This is the closest I could find:
Here we examine, in a prospective, controlled, observer-blinded study, the development of neonatal reflexes in infant rhesus macaques after a single dose of Th-containing HB vaccine given within 24 hours of birth, following the US childhood immunization schedule (1991-1999). The rhesus macaque is used in preclinical vaccine neurotoxicity testing and displays complex earlyneurobehavioral and developmental processes that are well characterized (reviewed by [7]).
Of course, to anyone who's been involved in dealing with the anti-vaccine movement, one thing that's very clear is that the subtext behind this is the unsinkable rubber duck of a belief among the anti-vaccine movement that, somehow, someway, either vaccines or mercury in vaccines causes autism. An inconvenient fact is that there has been no thimerosal in early childhood vaccines other than the flu vaccine since late 2001, but that doesn't stop the anti-vaccine movement. I suspect that the reviewers of this article were probably blissfully ignorant of this context and concentrated solely on the methodology. Had they known, no doubt they would have asked some uncomfortable questions in their reviews. Of course, they would have no way of knowing that this study is in fact more of a propaganda tool than anything else. One thing that needs to be emphasized is that there really is no good primate model of autism, at least not that I'm aware of. That's why Wakefield et al resorted to looking at infant reflexes.
Another question that needs to be asked. Why did the investigators look at thimerosal-containing hepatitis B vaccination? There's no thimerosal in the hepatitis B vaccine anymore and hasn't been since 2001. In fact, if you read the methods section of the paper, you'll see that Hewitson et al added thimerosal to Recombivax HB (Merck) in order to recreate that thimerosal feeling from the 1990s. Why would they do that? Especially since the authors state in the conclusion that the study design "was not able to determine whether it was the vaccine per se, the exposure to thimerosal, or a combination of both, that caused these effects." More on near the end of this piece.
Before I get to the effects observed, let's just consider something else. When I read this study, there was something that set my skeptical antennae twitching fiercely. Remember the abstracts I discussed last year? Let's take a trip down memory lane and read what I wrote back then:
What first leaps to mind in looking at the study is that there are 13 monkeys in the "vaccine" group and only three in the control group. No explanation is given for why there are such unequal numbers. Similarly, there is no mention of how the monkeys were assigned to one group or the other (randomization, anyone?), whether the experimenters were blinded to experimental group and which shots were vaccine or placebo, whether the monkeys were weight- and age-matched, or any of a number of other controls that careful researchers would do. Right off the bat, from the small numbers (particularly with only three monkeys in the control group), I can say that the study almost certainly doesn't have the statistical power to find much of anything with confidence.
Now, let's look at how many monkeys in this study: Thirteen receiving the hepatitis B vaccine plus added thimerosal. Well, now, doesn't that seem rather...coincidental? There were also three animals receiving no injection and four receiving a saline placebo. Sound familiar? Well, there were three controls receiving no injection and four receiving saline placebo. Why do I bring this up? Remember, the abstract from last year described monkeys as undergoing the "entire vaccination schedule." Remember how it was described that the vaccinated monkeys "exhibited autism-like symptoms":
The first research project to examine effects of the total vaccine load received by children in the 1990s has found autism-like signs and symptoms in infant monkeys vaccinated the same way. The study's principal investigator, Laura Hewitson from the University of Pittsburgh, reports developmental delays, behavior problems and brain changes in macaque monkeys that mimic "certain neurological abnormalities of autism."
The findings are being reported Friday and Saturday at a major international autism conference in London.
Although couched in scientific language, Hewitson's findings are explosive. They suggest, for the first time, that our closest animal cousins develop characteristics of autism when subjected to the same immunizations - such as the MMR shot -- and vaccine formulations - such as the mercury preservative thimerosal -- that American children received when autism diagnoses exploded in the 1990s.
Given the similarity of the description of the study described in the manuscript, in which hepatitis B vaccine was even spiked with thimerosal in order to mimick the vaccine schedule of the 1990s (given that hepatitis B vaccine no longer containes thimerosal) and the previously reported abstract, in which the entire vaccine schedule of the 1990s was supposedly mimicked, it does make me wonder. Could it be that the results being reported derived from observations made on the same monkeys? In other words, could it be that the investigators gave the monkeys the hepatitis B vaccine after birth, tested their various reflexes early in their lives, and then continued with their "simulated" vaccination schedule in order to produce the rest of the observations reported last year? Inquiring minds want to know! After all, the current study only goes out for 14 days after birth.
Indeed, one wonders if, stung by the criticisms of inadequate controls, the investigators added additional controls and kept the same group of 13 monkeys as the "vaccinated group." Maybe they didn't, but the similarity between the numbers of monkeys used in the abstract last year and the numbers of monkeys used in this study sure do raise an eyebrow. This is especially true given that in several of the analyses, the investigators pool the four monkeys receiving the saline control and the three receiving no injection for purposes of calculating means. Could it be that the investigators simply added a few monkeys after the experiment hda been started (or even after the original 16 monkeys had already undergone the entire "vaccination schedule"? Again, inquiring minds want to know! Could it be that, in order to beef up their apparent statistical power to detect differences in these various reflexes, some additional monkeys had to be added? Or was this done in response to reviewers' concerns. If that's the case, then when were these additional monkeys studied? How long after the original group. Mark Blaxill brags that the person who measured the monkeys' reflexes was trained by an expert until her results had a high concordance with those of experts, but if there were a several month delay between when she measured the first group of monkeys and then the additional controls, it's not too hard to imagine that she got better and thus more able to detect subtle differences in the reflexes. Again, the similarities between the designs of the studies described in the IMFAR abstracts last year and this study sure make me wonder if perhaps Hewitson and Wakefield are perhaps "minimizing" the use of animals. Of course, normally using as few monkeys as possible would normally be a good thing, but if that's what they're doing, why not report the entire study? Are they planning on having it come out in dribs and drabs, in other words posting several papers of what we call the "MPU" or "minimal publishable unit"?
In any case, in this particular MPU, what did Hewitson and Wakefield find? Not much, actually, the triumphant crowing of Mark Blaxill at AoA notwithstanding. Basically, Hewitson and Wakefield reported that three of thirteen reflexes were delayed, specifically the root reflex was delayed by one day; the suck reflex by nearly two days, and the snout reflex, also by nearly two days. There also appeared to be a confounding factor in that monkeys with lower gestational age (GA). For example, the authors state:
In general,as GA increased animals reached criterion earlier whereas animals of lower GA were relatively delayed. This effect was only significant when exposure was taken into account.
I really have to wonder whether in a larger group of unvaccinated monkeys, the correlation with these reflexes with gestational age would reach significance without taking the hepatitis B vaccine into account. Given such small numbers, I always wonder about any sort of multivariate analysis. Also, in this paper, these reflexes are ranked from 0 (absent) to 3 (the highest possible score). The time to criteria was defined as the time to reach the highest possible score. Again, given the small numbers and the correlation between gestational age and reaching these milestones, I really have to wonder if the results in this study, although statistically significant, are really behaviorally or biologically significant. If there's one thing my mentors always taught me, it's that statistically significant doesn't necessarily mean significant.
Personally, I'm not all that impressed. One reason is that, even if the study shows what the authors claim it shows, so what? They haven't shown evidence of long-lasting neurological impact, and they certainly haven't shown any evidence that the hepatitis B vaccine causes autism, even though you know that's the subtext of what they are arguing. Moreover, the numbers are really small. Another reason is that no statistical justification is given for pooling the no vaccine group with the saline placebo group. Whenever I see this, I become very suspicious of a post hoc combining of data. A good rule of thumb is that it's usually a bit questionable to combine groups like this. Presumably the reason why two control groups were done was to determine if simply the pain of giving an injection may have had any affects on these neurodevelopmental parameters, a scientifically legitimate reason. But, again, it really makes me wonder that the investigators pooled the data, apparently post hoc. The only reason to do that is to convert three groups to two groups and to add statistical power to the control group. You can be quite sure that, had there been a statistically significant difference between the "vaccinated" group and the saline placebo group and between the "vaccinated" group and the uninjected group, no pooling of data would have been done. Count on it. The results would have been reported un--shall we say?--massaged.
It's also rather instructive to look at the original IMFAR abstract, which reported:
Kaplan-Meier survival analyses revealed significant differences between exposed and unexposed animals, with delayed acquisition of root, suck, clasp hand, and clasp foot reflexes. Interaction models examined possible relationships between time-to-acquisition of reflexes, exposure, [3C]DPN binding, and volume. Statistically significant interactions between exposure and time-to-acquisition of reflex on overall levels of binding at T1 and T2 were observed for all 18 reflexes. For all but one (snout), this involved a mean increase in time-to-acquisition of the reflex for exposed animals.
It's interesting to note that the looked at 18 reflexes then but only reported 13 now. Why did they drop five? In this one, there were more "significant" differences in the old group, and only two of the reflexes appeared to be consistent between the two studies. Again, is the experiment reported in this paper a true repeat of the studies in the IMFAR abstracts, or is it simply an "extended" version of the prior study?
I think you know which one I suspect. I also think that this study was a horrible waste of primates, and I can't believe the University of Pittsburgh's IACUC was thinking when it approved this study.
On a different note, I wonder about the ostensible justification for this study:
Since Th[imerosal]-containing vaccines, including the neonatal HB vaccine, continue to be used routinely in developing countries [3], continued safety testing is important, particularly for premature and low-birth-weight neonates.
If the authors are so concerned with developing countries, why on earth did they emulate the U.S. vaccination schedule? Why did they use monovalent hepatitis B vaccine, when few countries other than the U.S. do? Most developing countries use a tetravalent, pentavalent, or hexavalent vaccine containing multiple other antigens, such as diphtheria, tetanus, pertussis, IPV, Hib, and HepB antigens. The hepatitis B vaccine, if given at all, usually isn't given until at least six weeks of age as part of existing vaccine programs. So, when you come right down to it, this study isn't even looking at what it claims to be looking at or following the rationale that its authors claim. If it were, it would not be following the U.S. vaccination schedule. In reality, it looks very much as though this study is custom-designed to sow doubt and fear about the birth dose of hepatitis B vaccine in the United States. That, and it's almost certainly going to be used as ammunition for legal action and lawsuits. Just wait.
It also may be another objective here. I note that anti-vaccine groups like TACA funded this study, which certainly cost at least $100,000 to do, probably considerably more. They would not have invested the money if they didn't expect a payoff. Here's what I think may be going on. Like all good denialists, they want material to sow doubt about the science they deny. Small preliminary studies in general have a fairly high likelihood of producing false positive results; so funding such studies is likely to produce at least some apparent "hits," such as this one. Because such studies are small and preliminary, they can't really settle anything, and the anti-vaccine movement knows it. So anti-vaccine groups like TACA and Generation Rescue will use the results of such small studies as justification for claiming that vaccines are not safe and that money is needed to do bigger studies. They'll then get such larger studies funded through the NIH. In the meantime, they'll point to such NIH-funded studies as "evidence" that there is a scientific controversy and milk them for all they're worth until the larger studies come back negative, as they almost always do.
It's a very hard strategy to counter, and, unfortunately, it just might work.
REFERENCE:
Hewitson, L., Houser, L., Stott, C., Sackett, G., Tomko, J., Atwood, D., Blue, L., White, E., & Wakefield, A. (2009). Delayed Acquisition of Neonatal Reflexes in newborn Primates receiving A Thimerosal-containing HepatitiS B Vaccine: influence of gestational age and Birth weight NeuroToxicology DOI: 10.1016/j.neuro.2009.09.008
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I think the "too many too soon" idea has run its course, and that's why they are focusing their efforts on the birth dose of the HepB vaccine now. We seem to be witnessing an inflection point in the movement.
Now, I'm going to go right ahead and say that this particular study smells like fraud. (Wakefield? Fraud? Nah...) It's unlikely they discarded the first study presented at IMFAR, and carried out a second study with another 13 monkeys. They added 4 monkeys post-hoc in order to alter the results, why else? Why would it matter if the observers are blinded if there are separate observations carried out post-hoc? Monkey business indeed.
Thanks, Orac. I requested that you review this study so that I would have ammo to refute it if any woo-oriented friends bring it up. I found the conflicts of interest pretty amusing in my own first read, but was wondering about their explanation of the small numbers as typical in primate studies, as the animals are so expensive. You don't address this directly, although you pretty well discredit the small numbers for other reasons and decry the waste of primates.
Why do people who completely discredit science to begin with, try so hard to (mis)use it for their own purposes? It seems hypocritical at best and criminal at worst.
Thanks! I was hoping you would put your two cents in on this study. I quickly glanced through it and I detected the same concerns you did. I don't have experience in epidemiology/clinical research and I was very reassured that despite my limited knowledge I was on the right track.
Wait...seek funding from a corrupt government organization that is part of the conspiracy and funded "bogus" studies that show there is no connection between vaccines and autism?
I'd love to see the numbers for the placebo vaccine vs not vaccinated at all. Also, LOL at calculating a 95% confidence interval for an n of 13, why not just state the whole range?
Poor monkeys.
The people funding this "study" (and I have no doubt that the bulk of the funding for this came from the Johnson & Johnson family) have no interest in real research whatsoever. Their aim is to merely to distract everyone, pure and simple. Sadly, it's working.
@ Jen: "Their aim is to merely to distract everyone, pure and simple."
I'd ask what J&J was trying to distract people from but I am all too aware of your idee fixe that acetominophen is the root of all evil.
I doubt that's what J&J had in mind. I do feel sorry for the monkeys, though. Being put to use for shoddy science is a shame.
Having a family member with HepB, or being around children with Hep B is a risk factor ... no sex or needles required!
Am J Epidemiol. 1977 Feb;105(2):118-22.
Epidemiology of hepatitis B in two Alaska communities.
"Families containing an individual with HBsAg had significantly higher infection prevalence than those without an antigen carrier. Larger households had higher proportions of infected members than smaller households. The data suggest that efficient transmission of hepatitis B virus occurs within the household setting in these villages by other than classically established parenteral routes."
Transmission of hepatitis B virus to classroom contacts of mentally retarded carriers. JAMA. 1985 Dec 13;254(22):3190-5
"staff and pupils with a history of classroom exposure to a hepatitis B virus carrier had significantly increased prevalences of hepatitis B virus infection (13.4%, odds ratio = 1.9; 9.3%, odds ratio = 2.5, respectively). Similarly, yearly seroconversion rates of 1.3% and 0.67% indicate that staff and, to a lesser extent, pupils are at increased risk of infection."
Meryl Dorey had this study up on her blog. I left a comment to direct people here, but I doubt it'll get approved.
I would think that the files of the IACUC would fall under public records laws, which would be a quick way to find out whether this is the same 13 monkeys or if it's another twelve monkeys plus Bruce Willis.
If indeed this is scheduled as a paper dribble, that IACUC paperwork would tell much of the tale.
When I first read this study, I wondered why none of the monkeys were given thimerosal-free vaccines. I think you may be right, Orac, that the 13 monkeys in this study were probably the same 13 monkeys that were used in the previous study.
I also wonder how this study design made it past the IACUC. I suspect that it will also be used by PETA/PCRM as an example of "useless" animal research. Unfortunately, in this case they would have a point.
"I also wonder how this study design made it past the IACUC. I suspect that it will also be used by PETA/PCRM as an example of "useless" animal research. Unfortunately, in this case they would have a point."
I fear you might be right. The vision of anti-vaxers and anti-vivs slugging it out in a kind of crank death match would be appealing were it not for the fact that those who are likely to suffer most from such an exchange are the real scientists caught in the middle.
There's no need to be insulting. Just because monkeys can't talk is no cause to degrade them to Bruce's level.
I agree the saline and no vaccination groups are very suspicious for "monkey business" because they never justified the two groups, and did not analyze them as distinct groups. W
Another problem. They analyzed 13 outcome variables, and did not adjust p values for multiple comparisons.
According to the methods, the animals were tested daily. Statistics were based on time to event analysis. One would expect the Kaplan-Meier plots to tick down only at daily intervals. In the paper, K-M plots sometimes show multiple down-ticks within a 1 day interval. If they tested once daily, how could events happen in intervals more discrete than once per day? I am not a statistician, but this seems very odd.
wholly father - YES! I was wondering about the multiple ticks per day as well!
I decided to read over the preprint before reading Orac's analysis or the comments, and the study design / randomization issue was what jumped out at me as well. From the preprint:
When I read that, I thought "What?" It sounds like they're saying that all members of a given peer group got the same treatment. I.e., they all got Th-HepB, or they all got saline, or they all got no injection. If so, that's certainly consistent with the speculation here about some animals being added at the end.
It also suggests that even if the saline group was studied relatively contemporaneously with the Th-HepB group, there was still a temporal segregation. What if some deleterious event occured in the nursery during the period that the saline group was being cared for and tested.
If my interpretation is correct, I find it very curious that they would choose that design. Why not include at least one saline or no-injection animal in each peer group? With their apparent design, there's no way to discriminate between possible vaccine-related effects and uncontrolled time-related variables.
Also, I agree with others that the two different control groups is bizarre. Even if three additional controls were 'added later,' why not give them saline injections as well?
Something seems to be missing here. Normally, I would be loathe the suggest anything deliberately untoward, but given that there's good reason to suspect AJW of previous misconduct, I can't help but wonder.
Note - please ignore the numbers 19, 20, 21, & 22 in the text I quoted above. They are line numbers from the preprint, and should have been edited out.
And in fact, I did edit the text to eliminate line breaks, and those numbers weren't visible at the time. I'm not sure why they appeared in the final post. Apologies to the board!
"Another question that needs to be asked. Why did the investigators look at thimerosal-containing hepatitis B vaccination? There's no thimerosal in the hepatitis B vaccine anymore and hasn't been since 2001."
[and]
"If the authors are so concerned with developing countries, why on earth did they emulate the U.S. vaccination schedule? Why did they use monovalent hepatitis B vaccine, when few countries other than the U.S. do? "
Because, if your kid's case in in front of the Vaccine Court and you don't want to get summarily tossed like the MMR cases did, and if you're hoping to create some doubt like in Hannah Poling's case so a settlement may be offered, you need to come up with "a study" that you can hang your hat on. That you are the first author is of little consequence -- unless someone starts reading the fine print and disclaimers.
So they did a study with the old type of vaccinations that used to include Thimerosal to show that Thimerosal in vaccines is responsible for the increase in autism since thimerosal was removed from vaccines.
And because of flaws in the study, the study doesn't even show an increase in autism due to the vaccines used in the study.
Well, I'm convinced.
Even if the study was well designed and executed (which it is not), and even if the study conclusively showed delayed development of survival reflexes (which it does not), it is still a very, very, very long leap to conclude that vaccines and or Thimerisol are responsible for increased autism rates in humans.
A few interesting points:
[1] These "survival" reflexes (called "primitive reflexes" in humans) are present at birth in human infants - their absence would be noted by any competent pediatrician.
[2] Absence or delayed appearance of "primitive reflexes" is not a feature of autism.
Prometheus
SBM's down again.
Damn, you guys need to find another host.
Indeed, persistance of primitive reflexes appears to garner more anecdotal reports from people with autism than abscence.
Huh. I see that SBM just changed hosts two months ago.
Bad luck, or altie sabotage?
There are no accidents, man.
I too disapprove of this needless waste of primates. Given that there are widely disparate rates of HepB vaccination around the world isn't this a candidate for the much vaunted vax/unvax study that is called for by anti-vaxxers.
Looking at their tables and graphs and their statistics section, I see no evidence they have corrected for multiple comparisons. From inspection, it would seem that their "significant" results are most likely just artefacts of multiple comparisons.
t's interesting to note that the looked at 18 reflexes then but only reported 13 now. Why did they drop five?
This is a really telling piece of information to me. The study states that it used the Brazelton assesment scale, which seems to have 18 reflex and 28 behavioral items. I don't know what is on the Brazelton assesment, but, from tables 1 and 2 in the paper, if you separate left and right on the relfexes listed as left and right in figure 1, you get 18 (actually clasping isn't separated into hand and foot or left and right in table 1, but it is separated into had and foot in table 2).
So it could be that they combined categories where convenient to make the stats work their way. I'm guessing that table 1 came from the previous version and table 2 is new to this version.
I am impressed that so many people read the whole study.
I saw that it is 40 pages - 40 pages of Andrew Wakefield and his co-conspirators. I considered that this might lead to a life of self-destructive behavior. If 40 pages of Wakefield is not extreme masochism, what is?
Then I considered the opposite problem. There might be some sort of Stockholm Syndrome from spending so much time reading his words. What if they actually began to appear almost reasonable? What if I started to see his writing as approaching coherent, but I couldn't get an emergency prescription of a fast-acting anti-psychotic?
Nah! I'll wait for the movie. I imagine something along the lines of The Thimerosal Man of Alcatraz - only with Gilbert Gottfried in the lead role. He's saying, I'm ready for my close up? I think that they specialize in that close up shot in prison. A heartwarming tale, just in time for the holidays. Or is it a tailwarming . . .
Maybe next year.
(As a computer engineer, none of my research involves humans or animals, so please forgive my ignorance on this topic.)
Can we at least send a question/complaint/warning to the IACUC at the University of Pittsburgh School of Medicine and/or the University of Washington? Ask them which group(s) approved the study, for the paperwork (if available), and/or at least whether it was two studies as suspected?
If they had to submit separate paperwork for a follow-on that involved just one group of four, how did they describe it? A study that just provides a (very small) control group and no experiment is something I'd hope they'd at least question strongly.
What does "allocated... on a semi-random basis" mean? Either it's truly random or it's not. Failure to adhere to randomization should be described in detail.
As for thimerosal, if they wanted to examine the effects of that component, the study shouldn't have used HepB vaccine at all: it should have studied saline control vs saline + thimerosol (at the appropriate dose). Good experimental design involves narrowing the study to the suspected agent.
I could go on. But I'll settle on the issue of surrogate endpoints. They measured something of questionable clinical relevance. In humans, autism is not necessarily associated with abnormal reflexes. There's no link given between the time to acquisition of reflexes and any particular human condition.
The rationale is obviously bunk. As Orac notes, most non-US countries use multivalent vaccines. If there are any using mono-valent vaccines with thimerosal, why not import that?
Second, the paper notes the APGAR scores of the monkeys were taken. No mention is made of APGAR scores or if there is any correlation between those scores and the delays they are supposedly measuring. That would seem to be a key bit of information.
The timing of when the 4 extra controls were tested is also key. Adding them in after the study was basically concluded would be something worth noting in the manuscript and something worth rejecting the paper over.
The rationale is obviously bunk. As Orac notes, most non-US countries use multivalent vaccines. If there are any using mono-valent vaccines with thimerosal, why not import that?
Second, the paper notes the APGAR scores of the monkeys were taken. No mention is made of APGAR scores or if there is any correlation between those scores and the delays they are supposedly measuring. That would seem to be a key bit of information.
The timing of when the 4 extra controls were tested is also key. Adding them in after the study was basically concluded would be something worth noting in the manuscript and something worth rejecting the paper over.
What does "allocated... on a semi-random basis" mean? Either it's truly random or it's not. Failure to adhere to randomization should be described in detail.
They could be applying a randomization within each peer group. Say, in each 4 animals, 2 are controls and 2 are experiment.
They could be applying a randomization within each peer group. Say, in each 4 animals, 2 are controls and 2 are experiment.
Sullivan, true, although their group numbers preclude them from doing this. They also put animals in either exposed or unexposed peer groups, which also precludes them from randomising this way. They also have the question of the 4 animals which seemed to be added post hoc.
I bet the claims about blinding and randomization were also added post-hoc, after the critiques of the IMFAR abstract last year. I usually don't presume fraud a priori, but I have to make an exception with certain anti-vaxers (namely, Wakefield and the Geiers.)
"A needless waste of primates" - "The rhesus macaque is used in preclinical vaccine neurotoxicity testing and displays complex early neurobehavioral and developmental processes that are well characterized (reviewed by [7])." - in other words, they develop analogously to humans - that's why they're used......aren't there any checks in place to stop such hideous travesties taking place? I happen to think that these studies are immoral - (please note, I do not say they are not expedient - for humans, only that they are not ethically correct) which I realise is a minority view here, but even those who do not agree with this position are surely horrified that sentient beings are available to these quacks?
The conflict of interest statement was interesting for another reason. Originally, Wakefield never disclosed any conflicts of interest - in a whole string of papers - right up till Brian Deer exposed him.
After being exposed, he used to say in a string of papers that he was an "expert to the court" - making it look like he was an independent adviser to the judge. Which, of course, was a lie.
Now, with the heat really on him, the journal has forced a new statement out of him: that he was an expert to the plaintiffs.
Ahh... now why didn't he say that in 1998, I wonder?
Having read the above comments and the paper in Neurotoxicology I agree with the points made by Orac, Sullivan and Science Momabout the dubious way the treatment and control groups (particularly the controls) have been assigned. I get the clear impression that they were always going to get a particular result no matter what the actual data indicated.
Another thing I was struck by was the unusual detail they go into when discussing some aspects of the experimental design, such as the training given to those conducting the tests, while they then leave out or discuss in a very vague way such as how exactly the study and control groups are divided up (semi-random??). When reading it I thought "The lady doth protest too much, methinks.", it seems to me that it was written with the intention of convincing journalists and other commentators rather than providing scientists a meaningful study that they could follow up on.
Anyway it's good to see this being challanged. Research using monkeys is crucial to progress in several areas of medicine, but that doesn't mean that scientists needn't voice their concerns about the scientific validity or ethical justification for a particular study when the occasion demands it.
THANK YOU! As the mother of a child with a neurological disorder that severely impacts his communication skills* I am subjected to a constant stream of anti-vaccine rubbish. I am, of course, interested in any REAL research about what may have caused my sonâs problems and how I might solve them so I read the stuff I get but donât always have the tools at my disposal to evaluate it properly. Your complete and clear analysis is much appreciated!
*PS Depending on who you talk to my sonâs issues put him âon the spectrumâ but the definition, prevalence, growth, or lack of growth in the number of autism cases is a whole ânother can of worms â perhaps we can get into that another time..
Tell me about it, AutismMom! I have a kid who had a seizure disorder as an infant, plus more seizures due to an illness (now vaccine preventable). Just getting a diagnosis nineteen years ago was an adventure, and then it kept changing. Except I kept being told "he is not autistic"... until he was in high school when the psychologist said "I think he might have autism".
Add that some really un-fun health issues. sigh
The paper itself is well dissected by Orac and the posters above. I have one more foundational question:
How on earth can the demonstrably fraudulent Andrew Wakefield get any paper published in any journal with an impact factor above zero?
Stop giving column inches to this sociopath!
Meat Robot,
That is the key question. I think Neurotoxicology should be investigated for corruption, and boycotted out of existence if this paper is not retracted.
@Chris
"Except I kept being told 'he is not autistic'... until he was in high school when the psychologist said 'I think he might have autism'."
Someone calling themselves bensmyson will have a go at you for that, like the piece of shit had a go at me for being one of those autistic people who did not get diagnosed as a child (back in the 60s and 70s), and called me a fucking Munchausen - whilst protesting that s/he was not out to be provocative and offensive. Calls him/herself a Christian, too. If that sort of behaviour is Christian, I'll gladly become a Satanist - every Satanist I have ever encountered has been a far more compassionate person than that piece of crap.
If BMS does have a go at you, as far as I'm concerned, you can feel free to be as nasty as you like back to them. And I'll be happy to support that.
Slightly off topic but the withdrawal of a vaccine in Australia this year (2010) for killing people was put in the BMJ. No mention of mercury or not. But despite the rhetoric of removing mercury I am 95 per cent certain these vaccines do contain full amounts of mercury brain destroying toxins.
Do you want to boycott the BMJ out of existence too?
Slightly on topic was that in this SMALL sample EVERY single animal vaccinated with mercury endured a brain expansion at least 10 per cent above those unvaccinated and often DOUBLE this amount.
What kind of things go on when brains EXPLODE in size?
Even after a 15 round heavy weight bout an expansion of this size would merit HOSPITAL treatment for winner or loser alike.
Also slightly off topic
Cars, planes et al are often RECALLED because they cause accidents.
Some recalls are not URGENT and others are.
Does this mean people who campaign for action on faults are guilty of being anti car or anti plane?
In any reasonable society issues of SAFETY need addressing.
Slightly ON TOPIC:
The death of more than a million infants after vaccines has YET to be addressed.
Orac has long since argued that mercury is out of infants vaccines.
The fact that infants still DIE SUDDENLY after mercury vaccines at age 2 or less shows this promise WAS illusory.
For anyone who cares to read VERY OLD research. A flu vaccine is TOXIC (more than 50 per cent with added mercury) even when diluted 100 fold. This in a world where flu vaccines can be and are made to be NON TOXIC when at the required strength to be used SAFELY.
@John Fryer
Except you seemed to miss a few things:
1) The increase in amygdala volume in the vaccinated group was not statistically significant.
2) The decrease in amygdala volume in the unvaccinated group was huge and contrary to another study by Payne, et al., showing that normal macaque development is that the amygdala increases in volume, suggesting that either the methods in Hewitson, et al., were flawed, the 2 macaques were abnormal or the data was faked.
3) The control group consisted of 2. Two. Pray, tell, how does one achieve any sort of significance with only 2 in a group?
The evidence of a causal connection to any deaths has yet to be presented.
Citation needed that a) infants under age 2 receive mercury-containing vaccines, b) that infants under 2 die suddenly after such vaccines and c) that there is a causal connection, rather than merely temporal.
Huh? Flu vaccines are toxic, but they aren't toxic? At any rate, got a citation to support whatever claim you're making here? And it would be advised that you use current research, rather than "VERY OLD" research, since science has more than likely moved on since then.
Based on what information do you come up with this number? Please be specific. Gut feelings are not going to be accepted as a valid answer. Also, citations are your friends. If you are going to talk about a paper the least you can do is say what paper it is.
Why would anyone do that? If they were publishing crap articles that should not have gotten through peer review because of many, many problems with the research conducted, maybe one should do that.
If they use really bad science, then sure they should be criticized, maybe even called anti-plane etc. The problem with anti-vax people is not that they criticize vaccines it is that they do it in a dishonest way, promote lies about vaccines and continue to push theories that have been tested and discredited. Those at AoA and elsewere really are against vaccines, they are not looking to make anything safer and have shown this over and over.
Citation needed. Where did you get these numbers? Even if a million died after getting vaccines do you have some data to show it was the vaccines that did it?
Also, are you arguing that vaccines still contain mercury? Or that vaccines are just unsafe with or without mercury? It is hard to tell what you actually mean though considering you go on about mercury earlier on it seems that is your concern. Lets just assume your million infants dying after vaccines number is correct. If you take the mercury out and a million still die then it would seem the mercury was not responsible for those deaths. It is not evidence that mercury is still in the vaccines. If you want to show that get some of the vaccines and get the tested.
John Fryer Chemist:
First off, there is a thread about the new paper that she managed to cobble together out of the same old data set. You might want to check it out. Short version: she's trying to sell normal growth as autistic symptoms, and severe brain abnormalities as normal. I mean, who seriously believes brains are supposed to *shrink*? It's only by claiming that that Hewitson is able to claim any kind of abnormality in the vaccinated group.
Secondly, with your random all-caps, you make me think of the late, great net-kook Robert E McElwaine. "UN-altered REPRODUCTION and DISSEMINATION of this IMPORTANT Information is ENCOURAGED, ESPECIALLY to COMPUTER BULLETIN BOARDS."
Travis:
Mr. Fryer got that data from where he gets all his information: his imagination. He just makes stuff up. He actually claimed that there are no children under age two vaccinated in Japan. It took multiple postings of the Japanese pediatric vaccine schedule to get him to stop that nonsense claim.
Chris,
I figured it was probably that, but I was curious if there was some woo-ful source he was using. What tread was that claim made in? I do not remember it, then again I read a lot of the threads here and cannot remember every poster.
See here (and I mis-remembered it, he said âJapan did stop their vaccines in the first year of life.â).
Note how AoA so cleverly interposed the latest information about autism prevalence with its call to eliminate the birth dose of the hepatitis B vaccine. Very clever.
Yes! Clever indeed.
We do not officially know why autism, non existent almost, until recently, now strikes at 1 child in 100 or so.
The hit rate for Sudden Unexpected Death peaked at around 1 child in 1 000 and has fallen to about 4 times more rare, although of course infinitely higher than in years gone by.
The patterns are not evident with changing mortality and illness patterns but in any event the infectious illnesses suffered for short periods of time are now being replaced by neurological illness and sudden death not seen before.
It is pointless lamenting the 20 per cent or less that forego their MMR vaccine when about 20 years ago few people indeed took advantage of this vaccine. Today the illness and death from measles is low in First World countries.
Given that officially there is NO KNOWN REASON for sudden death and autism that does not give us the right to increase the number of dangerous vaccines given to infants.
Everybody acknowledges RISK from vaccines and everybody ACCEPTS the much higher risk from repeat vaccines.
The fact that nobody wants to admit vaccines as a cause or contribution to malady and death must not allow the mantra of vaccinations to go forward and advance both in number and repeats without looking at the problems of such a policy. Why the need for many times more vaccines than a few years earlier?
For me, too many vaccines, too early with adjuvants of doubtful safety make it certain that we are indeed going down the road where maybe old infectious illnesses are on the wane but we are exchanging now one death in ten years for a population and now risking one death per thousand, one lost mind per hundred and one neurological problem long term for one in three children. Something is clearly wrong.
If this price is not at the cost of vaccines alone then we have sugar substitutes known to toxic as well as new foodstuffs claimed to be as safe as the old but somehow managing to strike dead any pestiferous animal or fungi that attempts to deflect that plant from becoming a super plant.
For me the worst option is the actual option.
We have sudden death, we have autism, we have nervous disorders. But we have no clue as to why we have these maladies we never used to have in such numbers.
And while changing ways of life make comparisons with yesterday impossible we see the amongst the First World countries USA fall from first in health to last in health in a few decades.
We may not all accept the role of toxic vaccines as causing toxic problems but no one can deny some vaccines are still toxic to humans even when diluted a hundredfold.
If vaccines are causing harm, then those given first in life will strike us down the hardest. The cry by many that vaccines CANNOT cause autism is often with the quote that their child was like this at birth. Flu vaccines given before birth with mercury and vaccines given at birth hardly justify this assertion as admitting or denying vaccine harm.
And then there is the known toxic quality of vaccines when safer ones exist. There is the known anaphylactic effect long proved fact that modern doctors are not even aware of except to suggest more vaccines, drugs etc to ward off natures repulsion of foreign matter entering a body.
Even without admitting humans err we cannot be complacent with children born or becoming permanently dependent on others to survive.
And the bottom line is that anyone who contributes to the death or illness of children is guilty of a CRIME. You cannot on one hand say no vaccines means a CRIME when the vaccine itself may cause more deaths and illness than it saves.
My own experience with TB vaccine is good but it has to be said that after a hundred years or so of use the rate worldwide is HIGHER than ever. Polio never was as bad to all as the publicity leads us to believe and often polio is recognised as an illness that causes no known problems.
The bottom line again is the body is adapted to fight of infection and usually fails only when overwhelmed by TOXIC chemicals. Toxic mercury is causing autism today and toxic chemicals caused polio to change from benign to dangerous in the 40's when DDT was sprayed liberally onto anything moving.
Not one reference, not one shred of evidence to back up any of the claims made, and it does not even address the questions put to him. As far as John seems to be concerned this is not a forum for discussion, this is a place to pontificate.
If I actually used a killfile this would be a plonking moment.
blah, blah, blah, goes John Fryer. Lots of statements and no evidence. Like the fact that vaccines protect against SIDS:
Look at what Mr. Fryer says:
Actually, Mr. Fryer, since diseases actually cause more deaths than vaccines (and it is well documented), then you are guilty of a crime by spreading lies about vaccines.
Now, either get back on your meds and go away, or post some real evidence.
False. We know that autism was never "non existent almost." It was just unrecognized. The evidence does not indicate any actual increase in incidence.
Citation for "infinitely higher than in years gone by." Correcting for the fact that infant mortality from other causes has been drastically reduced from "years gone by."
Indeed, infectious diseases were often only suffered for short periods of time - then they killed the sufferer. Also, "not seen before" does not imply "wasn't there before".
Because of vaccination! Yet children are once again dying from measles in the UK, thanks primarily to Wakefield.
The fact that they prevent disease, however, does - since the diseases in question are far more dangerous than the vaccines.
Because they prevent much greater risks from the actual diseases. Is this really so hard to understand?
Because we can prevent many more diseases with vaccination now.
If it's "certain" and "clearly wrong" you should be readily able to provide actual evidence for it.
Huh?
Actually we do. We've always had them and just not recognized them as such.
Citation needed.
Define "toxic" please. If you mean that adverse reactions occur, yes. Nobody denies that. However, the risk of said adverse reactions is many times less than the risk of the diseases they prevent.
Pure assumption.
The cry that "vaccines CANNOT cause autism" is not given by anyone. What IS said is that the evidence demonstrates that they do not. Because it does.
No, the evidence does.
Which safer ones would that be? With citations to the safety studies.
The possibility of anaphylaxis is well known by modern doctors. Again, the risk is outweighed by the benefits of preventing disease.
Nobody I know of is so complacent. Everyone would love to prevent or cure such, but nobody knows how.
Indeed - AoA, Wakefield, McCarthy, et al are all attempted mass murderers.
Fortunately we don't have to rely on "may". The evidence demonstrates that vaccines do not cause even a tiny fraction of the death and illness they prevent.
Tell that to the parents of the children paralyzed or killed by polio. Not paralyzing or killing EVERY victim doesn't justify your dismissal.
Because, of course, people were killed by disease so much less often hundreds or thousands of years ago.
Evidence needed.
Hi Scott
You claim that autism has not risen in numbers but that only we know today can recognise this syndrome.
If you genuionely believe this it is difficult to argue with you.
The CDC themselves have impressive graphs showing the rise in autism cases.
Common sense should tell us as from my own limited knowledge I have neighbours with children that may be called autistic but in any event shout out, can't talk or look after themselves and for another one is now in an institution.
15 years ago I was unaware of this syndrome except for a name.
We cannot be certain the condition is not as old as mankind but my theory with many others of a mercury causation would mean we could expect old cases.
The significant changes is that organomercury is very very toxic and is bit by bit being injected into younger and younger people.
3 months was the first age in the UK 30 years ago.
15 years ago this was reduced to 2 months.
USA is ahead in that they commenced to inject mercury at birth in 1991.
What is the effect of all this?
Who knows in the world of blame something else but whether old or recent ANY mercury vaccine comes out as TOXIC by any standard test and the CDC knows this.
@John Fryer Chemist: What happened, John? Get tired of having your a** handed to you in the other thread? You keep babbling the same old stupid lines and lies.
I'll give him credit: his rant this morning (4:45 AM? Does he sleep? Or is he in Europe?) really toned down on the all-capitalized words that have normally been his forte (and a pretty good sign of crank status).
Seriously, Mr. Fryer (Al)chemist - you could use basic HTML tags to emphasize your key words differently, like this, or this, or this. Although I suppose if you wrote like this too much you would just generate the same effect as RANDOM shout words THAT sporADICALLY appear.
Oh, and you really ought to provide evidence for the following statement:
Ah, the underline tag doesn't work. Too bad.
Where is this other thread Mi Dawn? Are you talking about the LB/RB thread? I would be curious to read more from this genius.
False. They show the rise in autism diagnoses. A very different thing.
Also false. Quite the opposite, in fact - all evidence demonstrates them to be quite safe. If you wish to claim otherwise, do so with EVIDENCE, not unsupported rantings.
Not a single other word in your most recent post has any meaning or relevance.
Hi, Kristen. Mr Fryer was quite busy on a RI thread...
Too much vaccine/autism monkey business for me to be involved in--but apparently not Laura Hewitson
But apparently he got tired of us asking for CITATIONS, PLEASE on that thread. Calli Arcale, Scott, Pablo, etc were all marvelous; I only popped in and out as programs were running at work and for a while once I got home from work until I got busy around the house.
Missed this comment at first. My son was not "like this at birth". We didn't start seeing signs of autism until he went to preschool and we were told to take him out because there was something "wrong".
That doesn't mean he wasn't autistic from birth. It was just the point where the differences between him and neuro-typical children became obvious.
I don't know what happened that resulted in his autism. I just know that arguing about vaccines is distracting from the true issues at hand. Can vaccines cause autism? It is highly unlikely considering the research that has already been done. Time to move on and try to find real reasons and real solutions.
Anti-vaxers slow progress and cause unneeded worry and unnecessary disease.
Thanks Mi Dawn. That was around the time I was dealing with assorted idiopathic barfing and wasn't online much. Time to go back and take a look (yes, this is what I do for fun).
John Fryer Chemist:
I haven't the time for a point-by-point right now, but I'll address this one.
You said this as part of your response to people pointing out that autism is not a recent phenomenon. (You had claimed it went from nonexistent to 1 in 100.) Your response indicates precisely what I suspected -- because you had not heard of autism 16 years ago, you believe it did not exist. This is the hallmark of a person who is not an independent thinker, who is shockingly incurious, and who is intellectually lazy. You are not interested in learning; your knowledge is based entirely upon what you have encountered in life.
That's a very limited way to experience the world. You really should get out more.
Autism is definitely more than 15 years old; the fact that you hadn't heard of it is partly due to the fact that neurological disorders used to be a taboo subject in polite society and partly due to your own incurious nature.
I have a brother who is on the spectrum. He is 26, and was receiving services from the school district under the autism rubric 20 years ago, when he started kindergarten. I do remember my grandfather, a very traditional sort of fellow, not wanting to be seen in public with him. Once my brother improved the point where he is now a functioning adult, my grandfather became proud of him, and they had a good relationship. But it was not unusual, even a quarter century ago, for the mentally disabled to be kept in the shadows and not often seen in public.
One of the more famous autistics is Temple Grandin. She was born in 1947, and diagnosed at the age of three. The word "autism" is even older, coined in 1910, and taking its modern meaning in 1938, and becoming a medical diagnosis in 1943. (Note: very few psychological or neurological diagnoses are older than that. It is a comparatively young field.) The oldest well-documented case dates to 1747, though the term "autism" did not yet exist. Going back further, there are case reports generally attributed to supernatural forces which a modern reader can recognize as probably autism.
The condition has been around for a very long time. It has been observed in the unvaccinated. (Even a Generation Rescue telephone survey found examples, though the study was so poorly designed it could do little more than say "both vaccinated and unvaccinated autistics exist".) There is no dose-response effect between autism and number of vaccines (demonstrated in several studies). Removal of thimerosal did not affect autism prevalence. Regional correlations are more significant, though it is unclear whether this is due to genes (families do tend to cluster geographically), pollution (which often clusters geographically), social effects of things like urbanization, better surveillance and consequently fewer undiagnosed cases in some areas, or what.
Another interesting thing: rates of autism have climbed at a rate which mirrors the decline of mental retardation. It is not proven that there is a causal link between the two, but the close correlation is compelling enough that one must at least consider the possibility that the condition has not increased at all -- we've just started calling things by different names.
Me, I have a suspicion that something about our modern, Western lifestyle makes the symptoms more obvious, or harder to cope with. This would explain Somalis coming to America and suddenly learning that their children have autism. Perhaps it would not have been so obvious in Somalia as in an unfamiliar country with strange customs and an extremely data-rich lifestyle. I don't know how that would be tested, but it's an interesting idea.