Sometimes, when it comes to the anti-vaccine movement, I feel as though I’m bipolar. There are times when I’m incredibly depressed that pseudoscience and fear mongering are winning out, leaving our children vulnerable to infectious diseases not seen in decades and believing that it’s only a matter of time before we start seeing really major outbreaks. This mood tends to strike me when I see actual stories about plummeting vaccination rates and, well, small outbreaks of diseases associated with low vaccination rates and unvaccinated children.

There’s a condition in surgery known as a “sentinel”–or “herald”–bleed, which is generally associated with something called an aortoduodenal fistula, which is an abnormal communication between “big red” (the aorta) and the duodenum. One condition in which aortoduodenal fistulae occur is when there is synthetic graft material in the aorta behind the stomach, which is generally the case after an open repair of an abdominal aortic aneurysm. However, they can also occur after pancreatic surgery, such as the Whipple pancreaticoduodenectomy. In both cases, scarring and chronic inflammation lead to the abnormal connection. In the context of such fistulae, a “sentinel” bleed is generally a relatively small, self-limited upper GI bleed. The patient bleeds, then stops. Everything appears to have settled down. Then, usually hours although sometimes days later, the patient suffers a massive exsanguinating hemorrhage from the fistulae. There are other examples of herald bleeds. One arguably more common example is the herald bleed that occurs with the rupture of a cerebral aneurysm. The patient will complain of a sudden onset of the worst headache he’s ever had in his life, which will result in a workup. Often the CT will be negative, although a lumbar puncture will usually find blood in the cerebrospinal fluid. Then, when things appear to have settled down, the patient can suffer a massive subarachnoid hemorrhage that kills him or leaves him with permanent neurologic disability. Basically, the aneurysm will start with a small leak that seals itself off sometime before it ruptures and bleeds profusely.

The relatively small outbreaks, such as the measles outbreak in San Diego, could be viewed as being similar to sentinel bleeds, relatively small and self-limited. I fear the real outbreak, as well we all should. Thanks to the anti-vaccine movement, it’s a matter of time unless current trends reverse themselves. When I think about this, I become very depressed.

Sometimes, though, I feel a bit at the manic end of the bipolar spectrum. These feelings tend to occur when very bad news, of which there’s been more and more lately, strikes the anti-vaccine movement. Examples are much more common in the last year than before and include the fall of Andrew Wakefield. Also, happily, the media have been less and less sympathetic to the anti-vaccine movement, turning the narrative from that of plucky parents fighing The Man and the uncaring system to people who reject science when they don’t like it and whose irresponsibility endangers every children. We saw this in Chris Mooney’s Why Does the Vaccine/Autism Controversy Live On?, Amy Wallace’s An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All, and excellent exposes by Trine Tsouderos and Pat Callahan on the autism biomed movement and how dubious autism “treatments” based on anti-vaccine beliefs refuse to die. The result is that, over the last year, I definitely get the feeling that the tide has turned. Reporters see a good story in the anti-vaccine movement, but anti-vaccine parents are no longer invariably the sympathetic figures in that story. This is a good thing indeed!

Not surprisingly, seeing their glowing press coverage evaporate, the anti-vaccine movement has gotten a bit…well, frustrated. Signs of that frustration are evident in anti-vaccine zealots’ increasingly vicious attacks on those who have the temerity to point out that science is not on their side. Amy Wallace, for instance, was the victim of misogynistic attacks by J.B. Handley, while Steve Novella was at the receiving end of one of J.B. Handley’s rants. Perhaps the most spectacular meltdown came when the anti-vaccine crank blog Age of Autism posted a crudely Photoshopped image of Trine Tsouderos, Steve Novella, Paul Offit, Amy Wallace, and Thomas Insel sitting around a Thanksgiving table preparing to feast on a baby. Meanwhile, a steady stream of invective likens those who stand up to science to Nazis, Stalin, and all manner of evil.

Given this background, I wondered what to expect after the airing of a FRONTLINE episode The Vaccine War, which I reviewed the other day. I didn’t have long to wait. The chief spokescelebrity, Jenny McCarthy herself, weighed on–where else?–The Huffington Post with a little ditty called Frontline’s “The Vaccine War” Misses Half the Story. Not to be outdone, on the very same day, that pediatrician to the stars, consigliere to the anti-vaccine movement with serious anti-vaccine tendencies that he refuses to admit, Dr. Jay Gordon, weighed in with an outraged screed of his own entitled PBS Frontline on Autism Resorts to Pseudo-Documentary, Tabloid Journalism. Both are pathetic–woo-ful, if you will–whines, and the very fact that they were written suggests the impotence of the anti-vaccine movement in the face of science that passed them by at least five years ago.

Of the two, Dr. Gordon’s strikes me as the more pathetic. Here’s the reason. Take a look at the introduction:

Tonight PBS aired a show called “The Vaccine War.” I was interviewed at great length and in great depth about vaccines and my point of view and expressed my ambivalence about the polarization of this issue and the need for more calm reasoned discussion about the number one question that new parents have. I told Kate McMahon, the co-producer of the show, that there was a large group of doctors and others who cannot be dismissed with the facile label “anti-vaccine” because we still give vaccines and see a place for them in the practice of medicine but we do not agree with the current vaccine schedule nor the number of vaccines children receive all at one time.

A few days ago, Ms.McMahon emailed me to tell me that the decision had been made to omit my interview from the show. There would not be one word from me. She didn’t tell me that she had also omitted 100 percent of Dr. Robert Sears interview. And that any other comments from physicians supporting the parents on the show in their ambivalence about vaccines or their decision to refuse all vaccines would also be omitted.

Well, boo-hoo! Cry me a river. Surely someone as media-savvy as Dr. Gordon seems to be must realize that lots of interviews are taped for documentaries and that often, out of two hours of tape, nothing or only one sound bite will end up finding its way into the final documentary. It’s not malice. It’s not necessarily bias. It’s just the way it is. In fact, if Dr. Jay hasn’t learned anything since some of his more spectacular examples of foot-in-mouth disease, such as his invocation of the formaldehyde gambit or his utterly risible comparison of vaccine science to tobacco companies’ denialist tobacco science, McMahon may have done him a huge favor by cutting him from The Vaccine Wars. She saved Dr. Jay from an opportunity to dig himself in even deeper and make himself look even worse than he does now. Unfortunately, denied that opportunity for a national television audience, Dr. Jay tries to seize an opportunity to do so for a national blog audience with his open letter to McMahon. It is a highly target-rich environment, particularly his wounded sense of utter betrayal:

I trusted you by giving you two or three hours of my time for an interview and multiple background discussions. I expressed my heartfelt reservations about both vaccines and the polarizing of this issue into “pro-vaccine” and “anti-vaccine” camps. I told you that there was at least a third “camp.” There are many doctors and even more parents who would like a more judicious approach to immunization. Give vaccines later, slower and with an individualized approach as we do in every other area of medicine.

What did you create instead?

“The Vaccine War.”

A war. Not a discussion or a disagreement over facts and opinions, but a war. This show was unintelligent, dangerous and completely lacking in the balance that you promised me — and your viewers — when you produced and advertised this piece of biased unscientific journalism.

Project much, Dr. Jay? I wonder what I would find if I searched Age of Autism for wors like “war” and “battle” and other terms like that? Let’s see, there’s Are We Winning the Vaccine-Autism War?, complete with a picture of the Marines raising the American flag at Mount Suribachi on Iwo Jima. Then there’s AoA’s Kent Heckenlively opining, “The war has begun,” not to mention a whole section on AoA devoted to Parent Warriors. Heck, Jenny McCarthy herself called one of her autism books peddling nonsense vaccine-autism Mother Warriors, fer cryin’ out loud! From my perspective, it isn’t so much public health officials, physicians, and scientists who are viewing the vaccine-autism manufactroversy as a “war” and therefore crafting their rhetoric accordingly. It’s the anti-vaccine movement itself using martial language to describe the manufactroversy.

Remember how I’ve said on occasion before that I hate to be too harsh on Dr. Jay because he reacts like a whipped puppy when too much insolence, respectful or not-so-respectful, is applied? Well, this is what I mean, except that sometimes he reacts with wounded, righteous indignation. And when he gets righteously indignant, he becomes incoherent, at least when it comes to science, leading him to launch into a whole bunch of the same old scientifically ignorant blather that he has regaled us with so many times before in the past:

Autism. An epidemic caused by environmental triggers acting on genetic predisposition. The science is there and the evidence of harm is there. Proof will come over the next decade. The National Children’s Study will, perhaps by accident, become a prospective look at many children with and without vaccines. But we don’t have time to wait for the results of this twenty-one year research study: We know that certain pesticides cause cancer and we know that flame retardants in children’s pajamas are dangerous. We are cleaning up our air and water slowly and parents know which paint to buy and which to leave on the shelves when they paint their babies’ bedrooms.

The information parents and doctors don’t have is contained in the huge question mark about the number of vaccines, the way we vaccinate and the dramatic increase in autism, ADD/ADHD, childhood depression and more. We pretend to have proof of harm or proof of no harm when what we really have is a large series of very important unanswered questions.

Dr. Jay seems so confident when he proclaims autism an “epidemic” caused by environmental triggers acting on genetic disposition. Unfortunately for him, the evidence thus far doesn’t support such a sweeping statement. For one thing, as has been discussed time and time again, it is unlikely that the true prevalence of autism has increased as dramatically as the numbers make it appear. Diagnostic substitution and broadening of the diagnostic criteria have contributed, as has increased screening for autism. Whenever a condition or disease is screened for in a population, more of it will be found. Always. Be that as it may, there is considerable evidence that the true prevalence of autism and ASDs has not increased that dramatically, if it has increased at all. The “autism epidemic” is almost certainly mostly due to artifacts changes in awareness, diagnostic criteria, social implications. One dramatic indicator of this was a recent study that showed that the risk of being diagnosed with an autism spectrum disordercorrelates with social proximity to another family with a child with an ASD diagnosis, suggesting that the increase in ASD diagnoses is largely due to societal factors.

Note also how Dr. Jay is up to his old tricks again, comparing a questionable, probably nonexistent “epidemic” of autism to known diseases and known risk factors for harm, such as pesticides. He then likens vaccines to pesticides and flame retardants in children’s pajamas with utter confidence, the result being that he can fool the unwary into thinking that, wow, vaccines really must be dangerous. (Does anyone really believe Dr. Jay’s assurances that he is “not anti-vaccine” anymore? I sure don’t.) He then does the denialist do-si-do and spreads fear, uncertainty and doubt by, in essence, demanding proof of no harm. Science can never give proof of a negative. The best it can do is to estimate how likely a positive is, and in the case of vaccines and autism numerous studies have failed to find a correlation. Based on current data, the likelihood that Dr. Jay’s fevered, fear-filled fantasies of deadly vaccines causing autism is true is exceedingly low. Dr. Jay also points to a whole bunch of questions that–or so he claims–have not been answered. Too bad Dr. Jay didn’t mention just what those questions are. Maybe it’s because the questions have been asked and answered, but Dr. Jay didn’t like the answers. Scratch that. There’s no “maybe” about it.

The last part of Dr. Jay’s open letter is just plain embarrassing. Really. I was actually embarrassed for him when I read this:

I base everything I do on my reading of CDC and World Health Organization statistics about disease incidence in the United States and elsewhere. I base everything I do on having spent the past thirty years in pediatric practice watching tens of thousands of children get vaccines, not get vaccines and the differences I see.

Vaccines change children.

Most experts would argue that the changes are unequivocally good. My experience and three decades of observation and study tell me otherwise. Vaccines are neither all good–as this biased, miserable PBS treacle would have you believe–nor all bad as the strident anti-vaccine camp argues.

Note what Dr. Jay doesn’t say. He doesn’t say that he bases his practice on the actual science-based recommendations of the CDC regarding vaccines. That much is painfully obvious. If you don’t believe me, look at this Tweet he posted the other day:

@scott_hurst @lizettee My non-ASD son’s 5 yrs physical is coming up, do you recommend he get vaccinated? his brother has autism.Never.

That’s right. Dr. Jay just told a mother not to vaccinate her son without ASD because his brother has autism. There is zero science to support such a reckless and potentially dangerous recommendation, yet Dr. Jay makes it anyway because he somehow believes that siblings of children with autism have some sort of genetic “trigger” that vaccines will set off, thus causing autism. For shame, Dr. Jay! For shame! There is no excuse for a pediatrician to make such an irresponsible recommendation for a child, and, if Dr. Jay is making this recommendation on Twitter, just imagine to how many of his patients’ parents he is making the same irresponsible recommendation.

Also note how much Dr. Jay touts his 30 years of experience. Don’t get me wrong; experience can be a good thing. However, personal experience that doesn’t acknowledge current medical science becomes out of date, distorted by one’s own beliefs, and often devolves into dogma- and anecdote-based, rather than science-based, medicine, prone to confirmation bias (which is almost certainly what Dr. Jay is refusing to acknowledge in his stories of so much autistic regression after vaccines). I’ve gone over this problem with Dr. Jay before ad nauseam, both on this blog and in prolonged e-mail exchanges with Dr. Jay, who complains most piteously when I point out that he is not a scientist and that he himself points out that he doesn’t have any good scientific evidence to back up his fear of vaccines. Sorry, Dr. Jay. You’re a nice guy and all, but you spread misinformation–dangerous misinformation, particularly when you say things like this:

The way vaccines are manufactured and administered right now in 2010 makes vaccines and their ingredients part of the group of toxins which have led to a huge increase in childhood diseases including autism.

There’s only one word that describes such a statement: Bullshit. That’s what Dr. Jay is full of in this post. I had some nits to pick with FRONTLINE over this show, but not about the science. The producers got the science right, and they were also right not to give time to a pediatrician who values personal anecdotes over science and blithely gives out irresponsible advice over Twitter and sounds like a mad scientist in a B-movie ranting “I’ll show you all!” as he says, “The science is there and the evidence of harm is there. Proof will come over the next decade.” Except that neither the science nor evidence of harm is there.

Jenny McCarthy’s post is, believe it or not, even more brain dead. Since it quotes Dr. Jay and regurgitates the usual Generation Rescue talking points, I don’t know that I want to spend a lot of time on it, particularly given that it piteously echoes much of the same complaints of Dr. Jay about FRONTLINE special being so unfair and mean to Generation Rescue. From my perspective, FRONTLINE bent over backwards to be fair. Not once did it call out GR for being anti-vaccine; heck, it even called GR a group of “concerned parents,” ignoring the group’s history of anti-vaccine activism.

No, being unfair to Generation Rescue is not a problem that FRONTLINE had.

Perhaps most telling is this remark by McCarthy:

For those who’ve watched the show, you know that the Frontline producers broke their promise and presented our entire community’s position through my interview and just two other parents — Barbara Loe Fisher and J.B. Handley.

Where are the doctors and scientists who support our community and support the idea that vaccines may be a trigger for autism? In Frontline’s world, they don’t exist.

Imagine how much more credible the countless stories of children regressing into autism after vaccine appointments would be if a doctor were saying the same thing.

This comment strikingly echoes similar comments by Anne Dachel whining about FRONTLINE on the anti-vaccine propaganda blog Age of Autism:

The claims of parents were noted and dismissed on Frontline.

Not exactly. The claims of parents regarding causation were noted and dismissed based on scientific studies. The show itself gave parents ample time to discuss their non-science-based fears and beliefs about vaccines. Dachel then continues:

A growing number of parents say that vaccines can cause autism and that more studies need to be done. Frontline reported that the science is in. There’s no need for more research because multiple, large-scale studies from around the world have looked at the question and the answer is no.

Ten of thousands of parents report that their children were normally developing until they were vaccinated. They regressed and became autistic. Paul Offit, MD, Anthony Fauci, MD and Eric Fombonne, MD declared that regression following vaccinations is mere coincidence.

Not exactly. Drs. Offit, Fauci, and Fombonne didn’t “declare” regression to be “coincidence.” They merely pointed out that multiple large epidemiological studies have failed to find any evidence that autistic regression in temporal proximity to vaccination is not coincidence. There’s a difference. It’s subtle, I know, perhaps too subtle to penetrate the antiivaccine zealot’s brain. It means that no association has been found at the statistical power level of the studies done. That means it is possible that there might still be a small correlation in a small number of children. However, even given that possibility, there is no good evidence that the “trigger” now claimed by anti-vaccine activists exists, and, even if it did, that would be hugely different thing than the hysterical claims that vaccines have been the primary cause of the “autism epidemic” over the last 20 years. If it were true that vaccines were such a major cause, then the studies performed would almost certainly have found a correlation strong enough to cause an “epidemic” by now. The incredibly shrinking vaccine-autism hypothesis has been reduced to saying that maybe in a small number of children, just maybe, the odd vaccine reaction might, if the child has the genetic predisposition, trigger autism. Vaccines have gone from the bogeyman causing thousands upon thousands of cases of autism in normal children to something that, if you squint real hard and make up genetic predispositions for which there are no good data, you might be able to paint a tenuous connection. The null hypothesis has not been disproven; according to the best science currently available there is no correlation between vaccines and autism, and FRONTLINE was correct to hammer that point home again and again.

I did like one thing that Dachel said, though:

I think a better name for the show would have been, “The Anti-vaccine Movement: Misguided and Dangerous.”

That would have been an excellent title for the show, although I would have probably come up with something even more “insolent” if I were a FRONTLINE producer. Of course, that’s probably why I’m not a FRONTLINE producer.

These days, for the first time in years, I’m optimistic about vaccination. I get the distinct sense that the power and influence of the anti-vaccine movement has peaked. It’s crested and appears to be on the wane now. That doesn’t mean the movement can’t still do enormous mischief, nor does it mean that it is going away any time soon. After all, as long as there have been vaccines, there has been an anti-vaccine movement. What is encouraging is that increasingly the mainstream media is realizing that the anti-vaccine movement as embodied by Jenny McCarthy, J.B. Handley, Barbara Loe Fisher, and their ilk is made up of a bunch of cranks pushing pseudoscience. Some of them are even beginning to appreciate that a whole lot of autism “biomed” quackery produces a huge incentive for various “alt-med” practitioners to keep the myth that vaccine cause autism alive. And these are all good things. Unfortunately, I don’t know if they’ll be enough. If there’s one thing that the anti-vaccine movement has shown, it’s that it’s always ready to come back, and, even if the latest setbacks destroy its ability to mobilize a mass message, I fully expect that anti-vaccine sentiments will return one day.

Damn. My manic phase appears to be ending.

Comments

  1. #1 Prometheus
    May 5, 2010

    “Dr. Jay” prognosticates:

    “Polio will not return to the USA…”

    And this claim is based on…..? Polio was endemic in the US until the 1960’s, when a vaccine was discovered. Because of that vaccine, we have reached the point where there is no domestic polio in the US.

    However, because of irrational vaccine fears in other countries, the final eradication of polio from the planet has not yet happened. For that reason, we need to keep a large portion of our community immunised in order to prevent imported polio from spreading.

    Epidemics are – to quote a supporter of “Dr. Jay” – “simple”, in the sense that all you need is a large enough susceptible population in close enough contact to spread the disease among themselves. Once you have that, it’s like having a pile of wood soaked in petrol – all it needs is a spark.

    “Dr. Jay” continues his foretelling:

    “…measles will not overwhelm herd immunity…”

    And this claim is based on…? I can only suppose that “Dr. Jay” thinks that the innate immunity of the US population is radically different from that of the people in the UK, where they are currently having uncontained outbreaks of measles. However, the data supporting that sort of conclusion seems to be lacking.

    Measles (and mumps and rubella) are particularly nasty problems in public health because they are spread person-to-person by respiratory droplets and have a high infectivity. The only “up” side to them is that they generally leave their victims permanently immune (the major “down” sides being a case-fatality rate of 2 per 1000 [measles] an encephalitis rate of 1 per 1000 [measles], meningitis rate of 10% [mumps], etc.).

    Make no mistake, if there is a sufficiently large population of non-immune people in contact with each other, there will be an epidemic. If that population reaches the endemic threshold (generally thought to be about 250,000 people), measles will become endemic. Again.

    “Dr. Jay” is simply wrong.

    The prophesy continues with:

    “…pertussis is over- and under-diagnosed and the “epidemics” often are not what they seem.”

    I’m not sure exactly what “Dr. Jay” means by pertussis being both under- and over-diagnosed, but I can take a stab at it. Microbiologists know that many people carry Bordetella pertussis in their nose – this is known as asymptomatic carriage. So, if you do nasal cultures of a large group of people, you will “over-diagnose” pertussis (the disease) based on the mere presence of Bordetella pertussis (the bacteria).

    However, from a public health standpoint, much pertussis (the disease) is missed because [a] physicians aren’t used to thinking about it and often don’t recognise it in adults and older children and [b] people who have been vaccinated a long time ago will have a milder presentation of the disease.

    However, pertussis (the disease) in adults and older children (and the milder cases in vaccinated individuals) will still lead to Bordetella pertussis (the bacteria) being sprayed into the air and all over susceptible individuals, primarily infants who are too young to be vaccinated (and who are most likely to suffer respiratory compromise – i.e. suffocation – from pertussis).

    The epidemics of pertussis (the disease) haven’t materialised yet because there are still a lot of immune and partially immune people in the population and because Bordetella pertussis isn’t as contagious as, say, measles or influenza.

    However, as more and more people avoid getting their children (who are notorious for not covering their coughs or staying away from infants when they are ill) vaccinated against pertussis, we will see more and more very young infants in hospital with pertussis and dying from the disease. This may not reach true “epidemic” proportions, but that will not keep it from being a vaccine-preventable tragedy.

    “Dr. Jay” makes one final pronouncement:

    “We don’t need a rotavirus vaccine in America and should focus our efforts on making it affordable and available to the Third World.”

    An admirable sentiment, that. I might add that we also don’t need Porsches, California wines, DVD movies, deodorant, Nike running wear or Hollywood. However, if uncontrolled vomiting, simultaneous diarrhea, fever and dehydration are something that you’d like to avoid in youself or your children, then the rotavirus vaccine is certainly one of those “nice to have” things that make living in an industrialised nation more bearable.

    It also needs pointing out that selling rotavirus vaccines in wealthy, industrialised nations (like the US) helps to pay for the research needed to develop the rotavirus vaccine, which in turn makes it possible for the manufacturers to make the vaccine available to the “Third World” below cost.

    To put it bluntly, if the manufacturers couldn’t sell their product at a profit in the industrialised nations, they never would have devloped the rotavirus vaccine.

    It’s not pretty or “socially correct”, but it is the reality of the situation.

    In summary, “Dr. Jay” has made a lot of assertions about vaccines and epidemics, all of them demonstrably false. It strikes me as a bit of “whistling through the graveyard” – a brave face put on a deeper fear. Perhaps “Dr. Jay” fears that “the big one” (epidemic, not earthquake) will happen during his lifetime, leaving him humiliated, vilified and despised.

    I applaud his willingness to return over and over to this ‘blog (and, apparently, to my humble ‘blog) to take his medicine, but I begin to wonder if he’s learning what he needs to learn from these visits. Frankly, I don’t expect much scientific thinking from physicians, since that is not the thrust of their education, but “Dr. Jay” seems especially resistant to learning how to think scientifically, despite our best efforts.

    Let me leave with some advice for “Dr. Jay” from the 12-step community:

    “Keep coming back!”
    “Don’t leave before the miracle!”

    Maybe Orac could start a 12-step program for addiction to pseudo-scientific thinking…..?

    Prometheus

  2. #2 Todd W.
    May 5, 2010

    @Prometheus

    as more and more people avoid getting their children (who are notorious for not covering their coughs or staying away from infants when they are ill) vaccinated against pertussis

    Don’t forget boosters for adults. People need to remember that whether they got the pertussis vaccine or were infected with pertussis, their immunity will wear off. Infection with pertussis does not lead to life-long immunity.

  3. #3 Orac
    May 5, 2010

    A superb article:

    http://www.psychologytoday.com/blog/strange-tongue/201005/autism-the-numbers-dont-add

    You’re slipping, Dr. Jay, if you think that article is “superb.” (Or maybe you like it because he mentions you favorably.) You may, however, have inadvertently provided me with blog fodder for tomorrow, although I already have something I was thinking of blogging. Time will tell later tonight whether the mood strikes me to take this on. After all, I’ve taken on the same nonsense so many times that even I get tired sometimes.

  4. #4 Joseph
    May 5, 2010

    That Psychology Today article is full of nonsensical and incorrect statements. At pet peeve of mine:

    As for the numbers, we all know them–at least a twentyfold increase in a quarter-century. Sure, some of that increase is due to broadening definitions, to the inclusion of many milder cases plus some that would have been diagnosed as simply “retarded”. But if that was the only factor involved, the number of cases that would have been classified as autism in 1985 should have remained more or less constant until today. Have they? We don’t know. Moreover, rates in California started to rise steeply in 1988, six years before DSM IV broadened the definition.

    You see why that makes no sense at all?

  5. #5 Prometheus
    May 5, 2010

    Joseph,

    The assumption made in the Psychology Today article would be true only if nobody was ever re-evaluated following their early childhood.

    That would mean that if someone were diagnosed as “not autistic” (or, more simply, weren’t recognised as being autistic) in 1985, that no pediatrician, psychologist, psychiatrist, family practitioner, general practitioner, teacher, etc. could ever have them reclassified.

    Ever.

    Of course, that’s nonsense. Today, even adults are being newly diagnosed as autistic. It’s not that they recently developed autism, just that they had a different diagnosis (or none) and were belatedly recognised as being autistic.

    It’s this sort of poor grasp of statistics that causes people to make strange and illogical claims.

    Prometheus

  6. #6 D. C. Sessions
    May 5, 2010

    Today, even adults are being newly diagnosed as autistic. It’s not that they recently developed autism, just that they had a different diagnosis (or none) and were belatedly recognised as being autistic.

    Case in point being one of my children who (at 26) is finally developing social skills that most children have mastered by the time they’re ten.

  7. #7 Joseph
    May 5, 2010

    The assumption made in the Psychology Today article would be true only if nobody was ever re-evaluated following their early childhood.

    The statement in the Psychology Today article is a tad confusing and muddled, actually. The way I interpret it, I’d say the problem is not just that. (Young children also seem to get diagnosed more frequently as time goes by.)

    It’s like introducing a new product into the market, say, a hi-tech cellphone. Sales are not going to be stable the day after the cellphone is introduced. There’s going to be a curve of adoption (a diffusion of innovation curve, if you will.) This will look roughly exponential at first, and eventually it will level off. (Technically, it’s an S-curve — or roughly logistic — function if you’re talking about prevalence, and presumably quasi-gaussian if you’re talking about incidence rate of diagnoses.)

    Theoretically that’s how it should work, and from what I’ve seen in passive autism databases, this is roughly how it does work, at least so far.

    There are other issues, like the fact that not only criteria has changed, but also diagnostic tools. Presumably, the subjective view of psychiatrists about autism also evolves over time, even if DSM-IV doesn’t change.

  8. #8 T. Bruce McNeely
    May 5, 2010

    The author of this PT article appears to imply that the change in diagnostic criteria only occurs after they are listed in the DSM IV. Not true. In most cases, revisions to the DSM reflect current psychiatric practice, with the revised diagnostic criteria often being established in the literature years before they are listed in the DSM.
    The author is a linguist. This would not provide him with any expertise in evaluating vaccine safety or the diagnosis of autism.

  9. #9 Corina Becker
    May 5, 2010

    Is Dr. Jay still commenting? If so, I would like to remind him that he still has to prove to me that he’s sincere about the apology he offered me on LiveJournal.

    And since some people such as Dr. Jay like to rely on anecdotes for evidence, here’s a little story for you.

    I’m a Canadian adult, and our H1N1 vaccine contains the “dreaded” thimersol, which I received. Oh yeah, and I’m autistic. By the reasoning of vaccines-cause-autism myth, it would be reasonable if I regressed and became “more” autistic, right? Except… I didn’t. Still just as autistic as when I was born.

    ~Corina

  10. #10 Dangerous Bacon
    May 5, 2010

    Orac said: “You’re slipping, Dr. Jay”.

    I don’t understand how this is possible.

    Dr. Jay Gordon has descended so far into the promotion of antivaccination myths and pseudoscience, that the only way he could possibly slip further is if he was to go the whale.to route and embrace conspiracy theory as an explanation for why immunization is promoted as a benefit to public health.

    Oh, wait…Jay has already begun bizarre conspiracy-mongering (see comment #310).

    There’s no low ground left to which he can slip. Unless he follows the example of Dr. Buttar and other autism “healers” to rake in money from parents of autistic kids through useless and potentially dangerous treatments.

    Speaking of Dr. Buttar…guess who’s lining up with Jay Gordon to protest how his expert opinions were left off the Frontline program on vaccination?

    Birds of a feather…

  11. #11 maydijo
    May 5, 2010

    Another question for Dr Jay: If you had a client who was travelling with their children to an area of the world where measles or polio was a risk, would you suggest vaccination? If you had a client who went to the UK with an unvaccinated child, and that child contracted measles, and there were complications, what would your defense be when they sued you for malpractice for giving them such shitty advice?

  12. #12 D. C. Sessions
    May 5, 2010

    If you had a client who went to the UK with an unvaccinated child, and that child contracted measles, and there were complications, what would your defense be when they sued you for malpractice for giving them such shitty advice?

    “Thirty years of experience.”

    It’s the medical equivalent of “9-11!!!!!”

  13. #13 D. C. Sessions
    May 5, 2010

    May I propose the Jay Gordon drinking game?

    Every time Jay tells us “thirty years of experience” someone replies “DRINK!”

  14. #14 Travis
    May 6, 2010

    @363

    Can I apply this drinking rule retroactively? I just opened a bottle of Doppel-Hirsch and I would like to drink it as part of this game.

  15. #15 Matthew Cline
    May 6, 2010

    I like the “Chuck Norris facts” version of the idea:

    How did the ancient Egyptians build the pyramids?

    With Dr. Jay’s 30 years of medical experience.

  16. #16 T. Bruce McNeely
    May 6, 2010

    I’ll play the drinking game, but I’ll stick to water. I had better watch out for hyponatremia, though.

  17. #17 jim
    May 6, 2010

    Matthew: I like that. “Dr Jay has so much experience, diseases ask him for advice.”

  18. #18 MC
    May 6, 2010

    “Case in point being one of my children who (at 26) is finally developing social skills that most children have mastered by the time they’re ten.”

    Perhaps he could teach the fine people at the Age of Autism some social skills most people have mastered by the age of 10? They seem to be lacking in those.

  19. #19 monado
    May 7, 2010

    Are you kidding, Jay? Before pertussis vaccine, I went to camp for a week. A couple of days in, I came down with a cold. I learned how to sweep my glasses, flashlight, and kleenex box under me in my sleep so I could turn over in a sleeping bag. There were five others in my tent. And when I came home, my “cold” developed into whooping cough. At some times I coughed so hard I thought, indeed hoped, that I’d die and get it over with. I probably gave it to at least my tent-mates if not others.

  20. #20 monado
    May 7, 2010

    Todd and Robyn, children immunized now are getting less than 4% of the toxins that I got in the 60s. I posted a chart here.

    And I will remind trolls that when the U.S. government proposed reinstating the smallpox vaccine because of the slight possibility of germ warfare, Paul Offit opposed it because the smallpox vaccine has too many side effects. It’s not about automatically supporting vaccination; it’s about weighing the FACTS.

  21. #21 monado
    May 7, 2010

    Smallpox variolation preceded vaccination. The original prophylaxis observed by Lady Mary Wortley Montagu in the hareems of Turkey was done with serum from mild cases of smallpox. People chose the 10% chance of dying from variolation with a mild case over the 30% chance of dying from an average case. I believe that the practice spread to England and then was improved by Jenner when he noticed that dairymaids who had had cowpox seemed immune to smallpox. That’s where all the songs about meeting a beautiful milkmaid come from.

  22. #22 monado
    May 7, 2010

    Speaking of autoimmune disorders, I know two people who developed Type 1 diabetes after a “flu-like” and presumably viral illness. I hypothesize that the infection triggered an autoimmune reaction against their islets of Langerhans, leaving them dependent on insulin to prevent death. If scientists ever pin down the cause, I’d like a vaccination against that disease, please.

  23. #23 ...
    May 7, 2010

    Just to show how well Dr. Gordon learns, I will post an email he sent me almost five years ago (the all CAPS part is Dr. Gordon (fun, eh?), and so was the email verification required for the reply I sent, which I refused to participate with,.. oh well). By the way, take note how he deals with the question about the diphtheria outbreak in the former USSR states, he neglects to mention why they are “GONE”:

    >> Subject: vaccines
    >> Date: Thu, 09 Jun 2005 01:09:18 -0700
    >>
    >> Thanks for your comments.
    >>
    >> I will be more rigorous in constructing and publishing my posts.
    >>
    >> Most vaccines protect against illnesses American children can no longer
    >> contract
    >
    > Like measles and mumps?

    WELL, YES, AS YOU KNOW, MEASLES CASES NOW NUMBER 35 OR SO IN THE USA EACHYEAR. MUMPS SOMEWHAT MORE AT 200-300. BOTH DISEASES CAN PRODUCE SERIOUSCOMPLICATIONS BUT RARELY DO. WHEN THE INCIDENCE OF A DISEASE DROPS TO THESELOW LEVELS, THE RISK/BENEFIT ANALYSIS CHANGES.
    >
    > Pertussis? Chicken Pox?
    THE DPT IS A REASONABLE SHOT AND I GIVE IT TO THE MAJORITY OF KIDS IN MY PRACTICE. VARICELLA IS AN INNOCENT CHILDHOOD DISEASE WHICH WE HAVE NOWTRANSFERRED INTO ADULTHOOD. I TELL ALL FAMILIES TO EITHER GET THE DISEASEOR THE SHOT BY AGE TEN YEARS.
    >
    > Haemophilis influenza b?
    ALMOST GONE, AS YOU KNOW. I STARTED PRACTICE WHEN HIB WAS AROUND A LOT.NOW, AGAIN, THE RISK/BENEFIT ANALYSIS FAVORS LOOKING HARDER. I DO GIVE LOTSOF THESE SHOTS, THOUGH.

    > Tetanus?
    AGAIN, UNDER 50 CASES/YEAR INTO HE USA–PROBABLY OWED IN LARGE MEASURE TO VACCINATION BUT NOT COMPLETELY
    >
    > Kids in the US still get those… and they are only an airplane ride away.
    XENOPHOBIA DOES NOT SERVE THIS ARGUMENT WELL
    > Diptheria? (see what happened in Russia)
    GONE
    > Polio… So you don’t think anyone will fly in from Yemen or Indonesia to
    > the USA ever again?
    NO, I DO NOT THINK SO. AS YOU FAMILIARIZE YOURSELF WITH THE HISTORY OF POLIO, YOU CAN SEE THAT THERE HAS NOT BEEN WILD POLIO IN THE USA FOR OVER 25 YEARS AND THE LIKELIHOOD OF AN IMPORTED CASE BEING ACTIVE AND SPREADING IS NIL
    > The drop in hepatitis B was only after infants started to be vaccinated
    > against it.
    TRUE. BUT EACH PARENT HAS THE RIGHT TO DECIDE. THIS SHOT MAY BE OF GREAT BENEFIT TO PUBLIC HEALTH BUT OFFERS NO BENEFIT TO EACH INFANT
    >
    > This is a county in the USA, it lists the incidences of disease:
    > http://www.metrokc.gov/health/epilog/vol4505.htm … the only thing that is
    > missing from the present vaccine schedule is polio, diptheria and mumps —
    > all three of those are still occuring only an airplane ride away. Chicken
    > Pox is also not listed, but it is still occuring — and it does maim and
    > kill every year in the USA:
    > http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5223a3.htm> >
    > and must therefore be subject to different risk/benefit analyses
    >> that in other times or in other countries where these diseases are still
    >> endemic.
    >>
    >
    > Should this be done by lawyers or by health professionals? You should> perhaps speak to the public health folks in Indiana about that.

    DOCTORS AND PATIENTS TOGETHER AGAIN,

    THANKS FOR MAKING ME THINK HARDER.

    BEST, JAY GORDON

  24. #24 Sid Offit
    May 7, 2010

    @Prometheus

    Polio was endemic in the US until the 1960’s, when a vaccine was discovered.

    The polio vaccine was given the stamp of approval in 1955

  25. #25 Dangerous Bacon
    May 7, 2010

    Very good Sid, except it wasn’t “the polio vaccine” that was approved in 1955 – it was the Salk inactivated polio vaccine. From 1955-57, polio cases in the U.S. fell 85-90% due to that vaccine. Further reductions and eventual eradication of wild-type polio from the U.S. (in 1979) occurred after the introduction of Sabin’s oral polio vaccine in 1961.

    Timelines on vaccine introduction and major advances against vaccine-preventable diseases here.

  26. #26 Prometheus
    May 7, 2010

    “Sid Offit”,

    You are correct that the Salk inactivated vaccine was approved in 1955. However, there was a lag between the approval of the vaccine and the time when polio was no longer endemic. In addition, the Sabin vaccine not only made polio vaccination easier, it eliminated GI carriage of the virus.

    To be more clear, that sentence should read:

    “Polio was endemic in the US until the 1960’s when – as the result of vaccination – it was gradually eradicated.”

    In 1955 – the year the Salk vaccine was approved, there were 13,850 cases of paralytic polio; by 1960, this had dropped to 2,525. By 1966 – five years after the approval of the Sabin oral vaccine – that number had dropped to 106. From that point onward, the number of polio cases has continued to decline.

    I am encouraged to see “Sid Offit” acknowledging that the polio vaccine was what ended domestic polio in the US (and UK, Europe, etc.). That’s the first step in what I hope will be a many such steps toward reality and scientific thinking.

    Keep coming back, “Sid”.

    Prometheus

  27. #27 Dangerous Bacon
    May 8, 2010

    Orac (in comment #316, addressing Jay Gordon): “Perhaps the only two things that I may have convinced you of is chelation therapy for autism is quackery–and dangerous quackery at that–and that the “formaldehyde gambit” about vaccines is really, really dumb because formaldehyde is a natural byproduct of metabolism.”

    When did Jay’s supposed rejection of the “formaldehyde gambit” occur? It must have been really recent, because a “Q&A Interview”* featuring Jay on his website, dated 2/24/10 has Jay saying the following:

    “Right now we’re creating vaccines using ingredients that are cheap preservatives, but it could be done better. It means, let’s see if we can get the aluminum out of them. Let’s see if we can get the formaldehyde out of them.”

    Seems as if Jay is still pushing the idea that formaldehyde is a harmful ingredient in vaccines, in addition to other misinformation.

    *I don’t see any identification of who the “interviewer” is – sounds like Jay is talking to himself.

  28. #28 Sid Offit
    May 9, 2010

    @Dangerous Bacon and “Prometheus”

    Already down ~40 before the Salk vaccine, it’s hard to believe declines into 55-57…

    (From 1955-57, polio cases in the U.S. fell 85-90% due to that vaccine.)

    …were due to vaccination since the Cutter incident ruined the 1955 vaccination season and as vaccine enthusiast Arthur Allen states in Vaccines P205

    “By 1957, the National Foundation was having trouble getting people to vaccinate their children,” lamenting that, “… vaccine was gathering dust on warehouse shelves.”

  29. #29 SC (Salty Current)
    May 9, 2010

    When did Jay’s supposed rejection of the “formaldehyde gambit” occur? It must have been really recent, because a “Q&A Interview”* featuring Jay on his website, dated 2/24/10 has Jay saying the following:…

    Amazing! That’s exactly the language he used in 2008 and for which he was slammed here:

    http://scienceblogs.com/insolence/2008/07/dr_jay_gordon_pediatrician_to_the_stars.php

    Watch his bobbing and weaving in that comment thread:

    @ #100:

    So . . . drop the formaldehyde stuff? OK. Can I have the rest then?

    @ #157:

    And, by the way, I have learned from those of you on this board to stop using formaldehyde as an exemplar of the problems with vaccines. I still feel that even miniscule amounts of certain chemicals injected in multiple vaccines could be dangerous, but there are far better examples than formalin.

    @ #200:

    Orac, I did not say that the ‘formaldehyde gambit’ is stupid, as you put it. I merely think it’s not the best topic to argue about.

    Shameless.

  30. #30 Prometheus
    May 9, 2010

    From “Sid Offit”:

    “…it’s hard to believe…”

    It’s not about belief, it’s about the data.

    And before “Sid” goes on with the “whale.to” candard about “Polio was declining before the vaccine.”, here are the numbers for the years around the introduction of the Salk vaccine:

    1951 ….. 10,037
    1952 ….. 21,269
    1953 ….. 15,648
    1954 ….. 18,308
    1955 ….. 13,850 (Salk vaccine introduced)
    1956 …… 7,911
    1957 …… 2,499
    1958 …… 3,697
    1959 …… 6,289
    1960 …… 2,525
    1961 …….. 988 (Sabin vaccine introduced)
    1962 …….. 792
    1963 …….. 396
    1964 …….. 106
    1965 ……… 61

    [Note: prior to 1951, the CDC records combine paralytic and non-paralytic cases of polio – this may be the source of the “Polio was declining before the vaccine.” canard. The numbers above are for paralytic cases only, but the non-paralytic cases declined in parallel.]

    What’s harder to believe, that the Salk vaccine reduced the US incidence of polio by almost 82% in five years (1955 – 1960) or that “hygeine”, “sanitation” or “nutrition” in the US improved so much in the same time period that the incidence of polio dropped by 92% “naturally”?

    If you ask me, it takes more “belief” (i.e. willful suspension of reason and logic) to believe the latter.

    Really, how many times do we have to show “Sid” (and others of his ilk) the data about polio or measles or smallpox, etc.? How much mental contortion and fingers-in-the-ears-singing-la-la-la-I-can’t-hear-you! must it take to not see what is right before your eyes?

    That’s the difference between reality and fantasy – fantasy requires that you ignore the data.

    Prometheus

  31. #31 D. C. Sessions
    May 10, 2010

    Prometheus, you can find Sid’s 40% by comparing 1952 to 1955 and (as Sid did) counting 1955 as unvaccinated. If you recall the recent Canadian example, the antivaccination crowd has no problem with cherry-picking data to create the illusion of trends.

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