Curse you, Mark and David Geier.
I'm getting tired of having to subject my scientific and critical thinking skills to the assaults on science and reason that you routinely publish in dubious journals to use as weapons in your apparently never-ending crusade to extract as much money as possible out of vaccine manufacturers and the Vaccine Injury Compensation Program. Dissecting your pseudoscientific claims causes me pain, not so much that I'm driven to take a hiatus from blogging, as Matt was by Kent Hovind's creationism, but almost.
I had hoped to let this cup pass, given how much I've written on the topic lately, but, thanks to mentions by Clark, RW, and Tara, I find myself feeling obligated to comment.
Yes, Mark and David Geier, that father-son team of dumpster-diving pseudoscientists and promoters of chelation and chemical castration as treatments for autism dedicated to "proving" that mercury in vaccines causes autism, no matter how much they need to torture the data to do it, are at it again.
This time around, they've published an allegedly scientific paper entitled Early Downward Trends in Neurodevelopmental Disorders Following Removal of Thimerosal- Containing Vaccines, published (where else?) in that repository of dubious medical science, The Journal of American Physicians and Surgeons. This paper purports to show that autism rates have started to dip since early 2003, when the last lots of thimerosal-containing childhood vaccines expired, the point after which, with the exception of some flu vaccines, for all intents and purposes no child in the U.S. has received thimerosal-containing vaccines. If true, such an observation would represent compelling evidence for the thimerosal-autism hypothesis. Not surprisingly, loony sources like WorldNut Daily and Vox Day (to whom I administered a blog slapdown a few months ago when he uncritically parroted Dan Olmsted's credulous reporting on a poorly documented population that is claimed not to have been vaccinated and to have very low rates of autism) have trumpeted the Geiers' study as "proof" that mercury in vaccines causes autism).
It's no such thing.
What it is, in actuality, is yet another example of the Geiers mining the Vaccine Adverse Events Reporting System (VAERS) database for purposes for which it was never designed and misusing the California Department of Developmental Services (CDDS) database similarly. First, off, as I pointed out extensively before, the VAERS database is designed only as an early warning system for reporting adverse events thought to be due to vaccines. It is not designed to track the incidence or prevalence of vaccine complications. One reason is that anyone can make entries into it, not just medical professionals, and the results are only checked in the most perfunctory way. For example, as Jim Laidler described before, it takes entering something like a claim that a vaccine turned one into The Incredible Hulk in order to get the staff there to question the entry. Worse, as I described before, the database has been corrupted by litigation, with a dramatic increase of entries linked to litigation claiming that thimerosal caused the plaintiff's child's autism. As for appropriate uses of the VAERS database, here's what it says right on the VAERS information page:
VAERS data are derived from a passive surveillance system and represent unverified [emphasis mine] reports of health events, both minor and serious, that occur after vaccination.
While some events reported to VAERS are truly caused by vaccines, others may be related to an underlying disease or condition, to drugs being taken concurrently, or may occur by chance shortly after a vaccine was administered.
Therefore, VAERS collects data on any adverse event following vaccination, be it coincidental or truly caused by a vaccine. The report of an adverse event to VAERS is not documentation that a vaccine caused the event.
The bottom line is that the VAERS database is not a reliable source to determine autism prevalence or incidence, period. It's too prone to being affected by scares, like the recent hype over mercury supposedly causing autism, and even outright manipulation, and its entries aren't even examined by medical professionals in sufficient detail to determine whether adverse events reported were or could be reasonably inferred to have resulted from vaccines. Of course, that never stopped the Geiers from diving into that database again and again and again, all without acknowledging the shortcomings of this database. And it actually wouldn't be all too surprising if reports of autism attributed to vaccines in the VAERS database did indeed fall after 2003, given that it was widely publicized that thimerosal was removed from nearly all childhood vaccines around that time, making it less likely after then that parents would attribute their children's autism to vaccines.
But what about the CDDS? It could be a source of determining whether autism rates are indeed rising, at least in California. There's just one problem. To do that properly, one has to look at new diagnoses. However, the CDDS database reports total cases (both new and old) every month. As Citizen Cain pointed out while criticizing David Kirby's misinterpretation of the California numbers last year:
Rather, the California Department of Developmental Services reports on the total number of people with autism registered to receive services. Kirby derives an estimate of children who enter the system in 2004, for instance, by subtracting the total number of cases within the system at end of 2003 from the total number of cases in the system at the end of 2004. Kirby calls the change in total cases "new autism diagnoses," which it is not.
However, as has been pointed out by Interverbal and Citizen Cain, the CDDS does record some other data that might be useful, such as age. Thus, although the purpose of this database is not to measure the incidence of developmental conditions like autism and mental retardation, in the case of autism one could get perhaps get a rough idea of the incidence of autism by looking at the cohort from 3-5 years of age over time, as this is the age range at which autism is most commonly first diagnosed. Of course, a number of potential sources of bias and error need to be kept in mind, as Interverbal described in detail, but one might get some useful information if one did the proper analysis and qualified it with the limitations of the database, a rough estimate of autism rates over time. Too bad that is not what the Geiers did.
So what did the Geiers do? I quote their paper:
The total new number of autism reports received by the CDDS from 36 consecutive reporting quarters (from that starting on January 24, 1994, through that ending on January 6, 2003), and for 15 consecutive reporting quarters (from that starting on January 3, 2002, through that ending on October 4, 2005) were analyzed.
Bzzzt! Wrong answer. (In fact, if you look at the graph on Figure 3, the Geiers even make the mistake of labeling what they are plotting as new cases of autism.) In fact, when correctly analyzed, the California data show new cases of autism in the 3-5 year old cohort continuing to rise.
Even if the data from these databases were more useful for determining the incidence of autism, the way the Geiers did their analysis is utterly laughable. Here's what they did. (Any statisticians, please chime in here.) Basically, they plotted the data as cases against time period by quarter and then used a statistics package to do linear regression of the data from 1994 to the end of 2002 and then to do it again from the beginning of 2002 until October 2005. They then compared the slopes of the two lines derived from linear regression for each graph and concluded that the slope of the line after 2002 had changed from positive (increasing) to negative (decreasing).
Geez, couldn't these guys at least have bothered to hire a biostatistician? (Certainly no statistician is listed in the authors, just Mark and David Geier.) If they had, they would have found out that doing interrupted time series analysis is fraught with difficulty, and that the appropriate way to look at such effects over time is not by simplistically comparing slopes before and after a time point, but rather by using one of these techniques, depending upon the specific question and data. Also, choosing the end of 2002 is a bit of a stretch; after all, autism is most commonly diagnosed between ages 3-5, which means that around now is the period in which we should start to see a dramatic drop in autism rates if mercury in vaccines is truly the cause of autism. But it's still even worse than that, so bad that it's funny. Basically, what the Geiers have done is to take contiguous data and make up trendlines to "prove a point," even if the data don't support it, and it's hard not to note that the r-squared value of the latter data is very much lower than the r-squared for the earlier data, meaning a much poorer fit to the linear regression. Indeed, Bartholemew Cubbins has made a useful video to show you why this is an invalid statistical technique, and Autism Diva has described it. In addition, they use the Kruskal-Wallis statistic to compare trend lines, but the K-W statistic is generally not used for that purpose. Rather, it is a nonparametric (to be used for non-Gaussian distributions) to compare the medians of three or more unpaired groups, not two slopes, one before and one after a time point. I may not be a statistician, but even I know that. This is freshman-level statistics.
Finally, let's take a look at the journal in which this "study" was published, namely The Journal of American Physicians and Surgeons (JAPS). Those of you out there who are physicians or scientists, I encourage you to browse its back issues on its website to see what kind of articles this journal publishes. For example, in the very same issue as the Geiers' paper, there are three articles casting doubt on the concept of the "shaken baby syndrome." (Blaming "shaken baby syndrome" on a vaccine reaction is how baby killer Alan Yurko got off, and he was aided and abetted by Dr. Mohammed Al-Bayati, he of the HIV/AIDS denialist fame.) Indeed, there seem to be many such articles scattered among the issues available on the JAPS website. There's also a "case study" of treating Herpes Zoster with vitamin C. In other issues, JAPS has published articles supporting a link between abortion and breast cancer; an article on the "medical dangers of homosexuality" (which also claimed that homosexuals who tried to change to heterosexuality "often succeed in doing so"); and an antifluoridation article; an anti-illegal immigrant screed referring to their "stealthy assault on medicine," blaming them for bringing disease to the U.S., and demanding that we close our borders; and an article decrying evidence-based medicine.
The journal is a rag. Given the low scientific quality of the articles it publishes, it's hard for me to conclude anything other than that its claim of "peer review" is a sham. Indeed, I recently became aware that JAPS is, as Terry Kopel described it:
The Journal of American Physicians and Surgeons seems to be little more than a conservative publication gussied up with a medical spin. A look at the references in the illegal-alien report, written by Madeleine Pelner Cosman--a "medical lawyer" whose previous claim to fame appears to be a book on medieval cooking but who has also written an article for a group called Jews For The Preservation of Firearms Ownership--is chock full of hardline conservative cites, including books by Michelle Malkin and former WND writer (and Slantie winner) Jon Dougherty and articles by Phyllis Schlafly and Tom DeWeese.
Indeed, JAPS is so dubious that it isn't even indexed in the Medline database. Even the speculative and often dubious vanity journal Medical Hypotheses is so indexed. (How it managed that, I still can't figure out.) Just from perusing its back issues, one should be able to see that the group that publishes JAPS, the Association of American Physicians and Surgeons has an agenda, and that that agenda is anti-homosexual, anti-abortion, and against mandatory vaccination.
No wonder Vox Day is so quick to cite a study from this journal so uncritically.
The bottom line is that this study by the Geiers does not show what it claims to show because (1) it uses reporting databases for purposes for which they were not designed and for which the agencies maintaining them don't recommend; (2) one of these databases consists mainly of unverified reports of adverse events or diseases that the parent or doctor attribute to vaccines, whether correctly or incorrectly; (3) the authors use such mind-bogglingly simplistic statistical techniques to analyze the data that no conclusion can be made, certainly not the one they claim to make; (4) the investigators, Mark and David Geier, have a track record of abusing science and medicine, even to the point of proposing chemical castration as a treatment for autism in order to "increase the efficacy of chelation therapy"; and (5) the journal in which the findings are published is run by an organization that is expressly antivaccination. Could mercury from thimerosal in vaccines be a major cause of autism? I suppose it's possible, but certainly this study doesn't support such a link. Nor do any of the studies by the Geiers, most of which are published in JAPS and other not-so-reputable journals.
Given the fast pace of developments on mercury/autism front, as I was writing this I had to wonder what was happening to produce so much bullshit at such a rapid rate over the last couple of weeks. Then I noticed something. David Kirby's Evidence of Harm, the book published about a year ago that fanned the flames of this trumped up controversy, ultimately leading to Robert F. Kennedy, Jr.'s mendacious Salon.com article in June, has just come out in paperback. Could all this new activity by the Geiers and RFK, Jr. have anything to do with this?
Nahhh. Couldn't be.
Hopefully, I won't have to blog on this topic again for a while. I feel dirty after having had to dive into the bowels of the Geiers' bad science and quack treatments for autism and RFK, Jr.'s distortions and logical fallacies so many times in a mere week and a half. Given so much bad science, I fear the impact on my science and critical thinking skills if I have to read any more of the Geiers' papers without at least a rest to let my brain recover. (Even worse, writing this rebuttal distracted me from the Oscars.)
Time for a shower.
Some previous posts on this topic:
NOTE: Due to a serious spam attack on this article, trackbacks and comments have been turned off.
You claim lawyers have inflated the numbers in the database. That should make it more difficult for the Geier's to show a decrease. So, using your logic, there must be more of a reduction than they were able to show.
You call the statistics simplistic. We're not dealing with the Daily Racing Form. It's just kids who are autistic and kids who are not, nothing complicated about it.
Arguments ad hominem to knock the Geier's and the publication indicate you are just clutching at straws.
There was more evidence of improved children posted on EOHarm yesterday. That evidence just keeps increasing. Have you picked out a new pseudonym to hide behind when you have to eat your words?
Interesting how you picked up on a minor and speculative part of my overall argument that could be discarded without affecting its validity (the speculation about lawyers and lawsuits) and then misrepresented it, rather than addressing the meat of my arguments: the incorrect use of these two databases and the simplistic and incorrect statistical analysis.
No surprise there.
Just as I was not surprised when you admitted chelation was the proper treatment for mercury poisoning but maintained it isn't indicated in autism in spite of the fact that kids are improving with it.
Autistic or not autistic does not require complicated statistical analysis. Simple does not equate to simplistic.
Beautiful takedown. No stone unturned.
I remember the first time I ever submitted a research article as a first-author. I was terrified. What if I did something wrong? What if I was missing something obvious? What if someone came along and used a different technique and completely invalidated what I did? In the end I had to simply accept that someday someone might poke holes in the work, but not today.
Why don't the Geiers, and people like them, worry about this?
There is no way that any respectable scientist read their manuscript and encouraged them to publish it. And the sad news is that the hopes of parents are being pinned to this garbage because they're being told that it's peer-reviewed, so it's fact.
"Autistic or not autistic does not require complicated statistical analysis. Simple does not equate to simplistic."
Then what you're saying is that the Geiers shouldn't have put this garbage into press?
I fully understand that dumpster diving is not your goal in life, but, you do it so well! :)
I spent a good portion of last night reading up on the Geiers. They are very scary people, as they have the aura of credibility about them. They are amongst charlatans-turned-expert witnesses.
These critters have a pattern. They take their degrees and then set up either a corporations (e.g. Boyd Haley) or a not-for-profit (e.g. Peter Breggin) to lend an aura of validty to themselves. The damage that they do is immeasurable.
What has to be done is to set up a national database where defense attorneys can find information on them, and use that information in a suppression hearing to have their evidence and testimony not admitted. Often, that is all the plaintiffs have going for them. After a while, these cases will form a comprehensive body of evidence which can be used over and over.
I'm a statistics-trained person, and I can't even begin to describe how disgusted I am at the supposed analysis in this paper.
It doesn't take a lot of work to debunk this on mathematical/statistical grounds. While I
Cubbins video is OK, it misses the key point about what's wrong with the analysis. It isn't just that you can massage data to create the kinds of regression lines that you want. This is true, but for someone who isn't mathematically trained, watching that video doesn't provide enough information. His sample set _does_ have a key point where the data direction changes - the trend in the sample data _does_ reverse, and looking at that, on the basis of what he says in his video, you could make the argument that the two line solution is a more accurate representation of the data that the single line - he doesn't make clear *why* splitting the data like that is wrong.
Here's the key, fundamental issue: when you're doing statistical analysis, you don't get to look and the data and choose a split point. What the Geiers did is to look at the data, and find the best point for splitting the dataset to create the result they wanted. There is no justification for choosing that point except that it's the point tat produces the result that they, a priori, decided they wanted to produce.
Time trend analysis is extremely tricky to do - but the most important thing in getting it right is doing it in a way that eliminates the ability of the analysis to be biased in the direction of a particular a priori conclusion. (In general, you do that not to screen out cheaters, but to ensure that whatever correlation you're demonstrating is real, not just an accidental correlation created by the human ability to notice patterns. It's very easy for a human being to see patterns, even where there aren't
Redo the Geiers analysis using any decent time-trend analysis technique - even a trivial one like doing multiple overlapping three-year regressions (i.e., plot the data from '92 to '95, '93 to '96, '94 to '97, etc) and you'll find that that nice clean break point in the data doesn't really exist - you'll get a series of trend lines with different slopes, without any clear break in slope or correlation.
So - to sum up the problem in one brief sentence: in statistical time analysis, you do not get to pick break points in the time sequence by looking at the data and choosing the break point that is most favorable to your desired conclusion.
Sorry, but you're wrong about that.
If you're looking at a database containing un-reviewed reports, and the claim is that people are adding reports in order to bolster a lawsuit, then what you would expect is for the pattern of reports to match a time-trend predicted by any changes related to the causal relationship charged in the lawsuits.
If you're talking about something like this autism debate, where the lawyers are claiming that mercury in thimerasol is the cause of autism, then you'd expect to see a trend of increasing claims up to the point where thimerasol was removed from the vaccines, followed by an immediate reversal.
That is, *exactly* the trend that the Geiers claim to have discovered.
If you were seeing a *real* change in the data, then you would expect to see a *slowing* of the increase trend as thimerasol-containing vaccines were gradually replaced with non-thimerasol versions, leading to a descrease leading towards a decrease. You would *not* expect a sharp inflection point, but a gradual shift.
*And*, given that autism generally isn't diagnosed immediately, but after several years, you would expect that the trend line wouldn't shift instantly at the point of the vaccine switchover, but with a lag of several years.
An immediate inflection just doesn't make sense. But since the immediate inflection is
a *created* phenomenon, by cherry picking the data, it doesn't matter - there isn't a real inflection point, which you can see by analyzing the data yourself using a valid time-trend technique.
Is there a thimerasol relationship to autism? I'll be honest - I don't know. I'm very skeptical, but I don't know. But this purported relationship shown by the Geiers is just shoddy math - it's using human bias to select datasets that reflect a pre-selected
conclusion, without regard for whether the data actually really matches the conclusion that they want. This conclusion does not match what you would really predict for an thimerasol-autism relationship.
"It's just kids who are autistic and kids who are not, nothing complicated about it."
It is simply astounding that Fore Sam can find the button for posting comments.
Fore Sam said: Just as I was not surprised when you admitted chelation was the proper treatment for mercury poisoning but maintained it isn't indicated in autism in spite of the fact that kids are improving with it.
Chelation can be the appropriate treatment in cases of real heavy metal toxicity such as lead poisoning, it can help to remove some of the heavy metal but it can not repair damage caused by heavy metal poisoning and does nothing to increase IQ for victims of real heavy metal poisoning. Since autism is not heavy metal poisoning, and there is very little evidence to suggest that it is, chelation is not an appropriate treatment for autism. Your favorite 'chelation agent', alpha-lipoic acid, does not effectively bind and 'chelate' mercury allowing it to be excreted as an ALA-Hg compound. In fact there are a few studies to suggest that it enhances Hg toxicity and increases intracellular Hg levels.
Simple does not equate to simplistic.
Sometimes it does.
It would be interesting to see how many parents who are chelating their autistic kids have a)heavy metals toxicity lab results from a) real labs, ie: not DDI, et al. and b)those toxicity results were obtained with out chelator provocation and interepreted by a board-certified toxicologist.
You brought up the lawyers but you forgot to consider the statute of limitations and the affect that mey have on the numbers. You also don't know how many people did not report to VAERS that should have. Frankly, I don't see how anyone can claim a valid result from looking at VAERS.
To me, the only numbers that are useful are the fact that 76% of people reporting to the Autism Research Institute observed improvement with chelation. You also have the fact that thimerosal containing vaccines are still on shelves with expiration dates of 2008 and the flu shot and tetanus shot still have mercury which muddies the waters in trying to analyze any of this. You won't have your answers until all the mercury has been out of vaccines for 6 years and you can get accurate numbers from the schools. Our politicians have been bribed to prevent that from happening.
Here's a nice, comprehensive few paragraphs on the limitations of VAERS data from a discussion of the Geiers' article, "Neurodevelopmental disorders after thimerosal-containing vaccines" in Parker et al., Thimerosal-Containing Vaccines and Autistic Spectrum Disorder: A Critical Review of Published Original Data (Pediatrics Vol. 114 No. 3 September 2004, pp. 793-804):
"We identified multiple methodologic concerns regarding this article. The key outcome measure, calculation and comparison of AE (adverse event) incidence for thimerosal-exposed and unexposed infants, requires accurate and unbiased assessment of the numerator (children with defined AEs) and denominator (exposure/no exposure to thimerosal-containing DTaP) for the 2 groups. Several factors contribute to substantial inaccuracy in the numerator of AEs. VAERS is a passive reporting system that is monitored by the Centers for Disease Control and Prevention (CDC) and the FDA and to which anyoneâhealth care provider, vaccinee, or parentâmay report an AE after vaccination. Although the authors postulated complete reporting of AEs by stating that "all adverse reactions are to be reported to the VAERS database as required by US law," in fact, reporting is mandated only for events included in the "injury table" of the National Vaccine Injury Compensation Program; ASDs and NDDs potentially associated with diphtheria, tetanus, whole-cell pertussis (DTP)/DTaP or thimerosal exposure are not mandated. Moreover, for these and other adverse reactions, substantial underreporting occurs. Underreporting is particularly common for events that are not in the compensation program, for events that are not defined by a specific diagnostic test, or when the temporal relationship with vaccination is not well defined, both of which apply to the conditions evaluated in this study. In addition, events in VAERS are classified on the basis of a reported diagnosis or a coder's interpretation of symptoms/signs included in a comment field. Diagnoses are not validated. The authors do not report which diagnosis or symptom terms they abstracted from the VAERS database or how they dealt with diagnostic overlap or incomplete records. This is particularly troubling because the disorders reported have a long differential diagnosis and because the mean age reported for children with autism (1.7 Â± 1.1 year) is below the age at which a reliable diagnosis of that disorder is made. Demonstrating the statistical fragility of analysis of this database, if only 1 child who has autism and did not receive thimerosal-containing DTaP were misclassified into the thimerosal group or if 1 such child were not reported to the VAERS system, then the reported risk ratio would be reduced by half and the P value would be >.05."
"In addition, several biases may have led to differential reporting of events in children who received DTaP vaccines that did or did not contain thimerosal as a preservative affecting the ability to compare relative reporting rates. In a setting of incomplete reporting, if parents or providers, either of whom can report to VAERS, are aware of a possible link between thimerosal exposure and NDDs, then reporting by either group may be greater among those who have been exposed ("reporting bias"). This bias also may have affected description of symptoms and had an impact on how events were coded. "Diagnostic bias," with providers more likely to diagnose autism or other NDDs among children who were exposed to thimerosal, also may have occurred. Because of FDA concern and subsequent recommendations by the American Academy of Pediatrics and the US Public Health Service for precautionary thimerosal removal in July 1999, with associated media interest, there was a substantial risk that these biases occurred in a study that includes AEs reported through 2000. VAERS data show markedly increased reporting of autism during the second half of 1999 and 2000, consistent with reporting bias."
"An additional problem affecting numerator data is the inability to define accurately total thimerosal exposure in children with reported AEs. VAERS reports include only the vaccine type and manufacturers for the visit associated with the AE and within 4 weeks before that date. It is not possible to define whether a child received thimerosal-containing or -free DTaP vaccine at previous visits or other vaccines that may or may not have included this preservative. As NDD risk was hypothesized by the authors to be related to the total thimerosal exposure rather than only thimerosal in DTaP, the inability to define that exposure represents a significant limitation."
" he doesn't make clear *why* splitting the data like that is wrong. "
Thanks MarkCC - he's right, I struggle with scientific depth versus time/file size and I tend not to use a hammer to drive home points.
I appreciate the depth and intensity that this pathetic attempt at swaying public opinion, otherwise known as the Geier family paper, is being analyzed and publicized. I'm convinced that people will benefit by this commentary.
I wonder if Kathleen's autistic child was reported to the VAERS database. How many others were not reported before anyone knew they had a case against the vaccine manufacturers? I say the decrease is much more marked than can be gleaned from VAERS.
Any "medical" or "scientific" paper which has a book of the Old Testament listed as a serious reference (i.e., the Lerman paper) has lost what little credibility it may have started with in my eyes.
VAERS: Custom-made by lawyers who believe autism is caused by thimerosal to prove that autism is caused by thimerosal.
Perhaps if you directed some of your "skepticism" at the pharmaceutical industry, you wouldn't be so wound up about these insignificant people. Conflict of interest, much?
Great article Orac. This piece (along with MarkCCâs excellent comments) should be the reference rebuttal to the ridiculous Geiersâ paper that no doubt we will be hearing about again and again in the future. Consider it bookmarked.
And what about that âEvidence-Based Guidelines: Not Recommendedâ JAPS paper? To quote the paper: âEBGs [Evidence Based Guidelines] are irresponsible, and should not be recommended.â Hilarious.
You should know it is not ad hominem when you also refute the arguments (as Orac did) as well as question the integrity of the source.
I have had a look at the Journal of American Physicians and Surgeons, and -- doggies! This thing is way below trash.
In fact, reading the book reviews (try it if you have a strong constitution) I got a very strong sense of deja vu.
Where have I read tendentious, ideological crap purporting to be scientific? Ah, yes -- 21st Century Science and Technology, published by Lyndon LaRouche. On internal evidence alone, I'd say that JAPS is likely to be the house organ for the LaRouchies or someone similar. Does anyone out there know more about JAPS and its publishers?
1. What does the pharma industry have to do with the complete and utter sloth of the autism-mercury advocates?
2. I apply skepticism equally, whenever I can. The whole pharma thing is just an off-topic red herring that distracts from the advocates' lack of evidence, and is often used as an excuse for that lack of evidence, as well as a tool for immunization against counter-evidence.
3. I get wound up by just about anyone who tells not-true statements about serious medical issues. Especially if they promise a magic bullet cure.
Skeptico; Knocking the Geier's with his opinion of their reputation and doing the same with the magazine is ad hominem. These things do not address their argument.
The "sloth" of the autism-mercury advocates is curing children. Your pals in Pharma continue to poison babies.
You should be wound up about Orac telling us that chelation cures mercury poisoning but won't help autism in spite of evidence that it does cure autism. You can't worm your way around that fact no matter how much you try.
Fore Sam says:
Sam, if that was all Orac did then you might have a point. But that is not all he did. He also explained exactly why the Geier's work is total crap. That does not make it an ad hominem. Ad hominem is not just a fancy Latin word for an 'insult'.
Re: Skeptico; Knocking the Geier's with his opinion of their reputation and doing the same with the magazine is ad hominem. These things do not address their argument.
You must have problems with reading comprehension. A very small portion of Oracâs 2,500 word article was devoted to âKnocking the Geier's with his opinion of their reputationâ. The majority of it was explaining the errors in their methodology.
Ad hominem is:
It is only ad hominem if you only criticize the source and donât address the arguments presented. If you demolish the arguments, it cannot be ad hominem â adding an additional criticism of the source cannot possibly invalidate the arguments that refute the sourceâs position.
Misunderstanding and misusing the ad hominem fallacy the way you just did is a common novice mistake.
Fore Sam says:
So you would predict that there will be a huge down-swing in new autism diagnoses over the next couple years in the U.S.?
If not, why not?
I would also note that you need not necessarily be critical of the "man" for it to be an ad hom. For instance, "Sue is too smart to be wrong here.", is also a type of ad hominem fallacy, except in reverse.
Wouldnât that be argument from authority?
It has always seemed to me that argument from authority is ad hominem reversed.
Yeah, I don't think there's a big difference between a positive ad hominem and an argument to authority.
Re ad hominem, I think it is a valid technique to criticise the opponent even without adressing the actual argument if your critique is concerning the credibility of the other. (I also think that the argument from authority should be renamed to argument from false authority - wasn't there a post on PT a while ago?).
In other words, it is not an ad hominem if I cast doubt on the reliability of a source, as long as I have facts and not insults. And the history of the Geiers, their vested interests are facts.
Didn't somebody say: "A statement of fact cannot be insolent"?
Of course, this carries not as much weight as dealing with the actual argument, but IMHO it is not off-limits.
Could all this new activity by the Geiers and RFK, Jr. have anything to do with this?
It could have something to do with the fact that Special Master George Hastings forced the plaintiffs in the U.S. Court of Claims Omnibus Autism proceedings to name their experts. They filed their designation on February 14, 2006. Mark R. Geier, MD, is one of them, and he is going to have to pass muster as an expert qualified to testify about the causal relationship between vaccines and autism. Some published papers on the subject would help. (I guess a blog post by RFK Jr. doesn't do much, though.)
The claimants are still asking for additional time to produce their experts' reports. Some citable papers are going to have to materialize before they do this. The January 31, 2006 request for an extension of time is supported by a letter from Mark Geier, MD, citing problems with the VSD database as the reason he won't be able to complete his analysis anytime this year.
Anyway it's possible that this flurry of activity is litigation related.
Docket of the proceedings is here:
What I really want to know, is where JAPS came up with the "peers" for the peer review. The Geiers are quite - err - unique.
I don't think a downswing will be as large as it should be since TCV's are still on shelves.
and what excuse are you going to come up with when there are no thimerosal containing vaccines on the market anymore (like in Denmark) and the incidence of autism is still not plummeting? I wish the mercury blamers would make their minds up. First, the "very secret" Simpsonwood minutes are supposed to show that the effects of thimerosal are highly dose dependent with the most severe effects in the highest dose group, next on, the puny little dose in the flu shot that some children may or may not get are supposed to be enough to keep autism rates high?! Has anyone looked into how many doses of thimerosal containing flu vaccine have been given to under 3 year olds in the last 5 years?
Someone looked into flu shots in old folks and figured out that if they got the flu shot 5 years in a row it increased their chances for Alzheimer's. I don't think they've been given to kids long enough to do a similar study.
that "someone" was Fudenberg and that statement belongs in the same dumpster the Geiers have been digging in...
Wrong, John. That is a myth that has been propagated by antivaxers after Hugh Fudenberg made that claim in a talk he gave in 1997. There is not a single scientific study that supports it. In fact, there is preliminary evidence that vaccines can protect against Alzheimers. I've already written about the origin of that myth.
Fore Sam said:Someone looked into flu shots in old folks and figured out that if they got the flu shot 5 years in a row it increased their chances for Alzheimer's.
I guess you know that you'll be expected to produce a reference for that ridiculous statement. Could the 'someone' possibly be your hero Boyd Haley?
The "sloth" of the autism-mercury advocates is curing children. Your pals in Pharma continue to poison babies.
Repeating an untrue statement doesn't make it true: Your sloth is refusing to do more than parrot that quack line over and over. Try showing me the data and you'll win me over. You know what it takes, but you still refuse to do that very simple act.
And stop using the depraved "Obtain disapproval" propaganda technique. I have no ties with Pharma, just like I have no ties with the MiB, the illuminati, Israel, Palistine, the Communist Party, or Al Queda. Guilt by imaginary association was a beloved tactic in the Red Scare.
You should be wound up about Orac telling us that chelation cures mercury poisoning but won't help autism in spite of evidence that it does cure autism. You can't worm your way around that fact no matter how much you try.
What evidence? That unverifiable, uncontrolled, unblinded just-so story you've drawn unsupported conclusions from that you refuse to answer fundamental questions about?
As someone who believes there is a vaccine/autism link, I think it's great to have people engage in these discussions even if they are finding fault with studies that attempt to prove a link. But I have always found it frustrating that these critiques are so one-sided. Orac and friends, why do you assume that the studies produced by the CDC are correct? If you're going to stand up and declare that there is no link between vaccines and autism, don't you have to investigate the claims of the CDC with the same vigor that you investigate the work of the Geier's? Have you ever reviewed the CDC study that was published in Pediatrics? Below is an excerpt from Sander Greenland, Professor of Epidemiology at UCLA, who
submitted expert testimony to the Vaccine court on January 31, 2006. The full report can be found here:
His concerns with the CDC study follow:
Whether justified or not, deep suspicions have arisen regarding the published CDC report (Verstraeten, 2003) from the VSD database, due to a series of events that preceded publication (among them, changes in data,
methods and results that occurred between the initial unpublished analysis from early 2000 and the 2003 publication, including exclusion of data from a
large HMO; move of the lead author to Glaxo Smith Klein; and refusals to provide access to the data). Further analyses of the data by independent parties would address concerns that the published results had been manipulated to conceal thimerosal effects.
Regardless of their origin, the published VSD study did have many questionable aspects of analysis that may have obscured effects, if any effects were present. Most of these problems were pointed out by Dr. Harland
Austin at the Omnibus Hearing in September 2004, and I can corroborate his testimony. Of great concern to me is the failure to pool results across the HMOs. As Dr. Austin stated, pooling is standard practice, and should be
done using sound techniques. Instead, the published VSD study used a very small HMO C (Pilgrim) to "validate" findings from the much larger HMO B (Kaiser) and A (Puget Sound), which as Dr. Austin noted, is not good practice
because it has extremely low power (is very likely to miss effects, compared to correct pooling methods). The published results from HMOs A and B also employed questionable restrictions on the comparison children, to
clinic or emergency-room attendees, which further reduces power. The authors of the published study also excluded comparisons when the case total was less than 50, on the grounds of "power considerations." This is a fallacious
reason for exclusion, because all power considerations after data are collected can be addressed by examining the confidence intervals for the comparison; the latter show what effect sizes cannot be reasonably excluded, based on
In addition to having serious analytic problems as just enumerated, the published VSD study did not employ births beyond 1998, and did not fully justify exclusion of data from all the other VSD HMOs. The use of births in
subsequent years would further enhance the power to detect effects, if any are present, as would use of data from other VSD HMOs as appropriate.
Thus, a new analysis of the VSD database addressing the analytic problems of the published analysis, and incorporating as much data from subsequent years and
other HMOs as feasible and justifiable, would both allay concerns about impropriety of the 2003 publication, and provide considerable additional scientific information.
My hero is Bobby Orr (bow) but, for this, Haley will do.
Just because we parents don't bother conducting scientific studies while we cure our kids doesn't mean what we have to say is false. You and your pals here wouldn't dare contact all of us to do those studies because you're afraid of what you'll find. Then Orac would have to eat his words about chelation not curing autism even though he says it cures mercury poisoning. It's nice to know, however, that he agrees with Andy Cutler on that.
Just because you parents believe you are curing your kids doesn't mean what you have to say is true. You and your pals donât dare to look at the studies because you're afraid of what you'll find. Then you would have to eat your words about chelation curing autism.
Hey, this is much easier than having to provide evidence.
Just because we parents don't bother conducting scientific studies while we cure our kids doesn't mean what we have to say is false.
True, but it does mean that you're not gathering good evidence.
You and your pals here wouldn't dare contact all of us to do those studies because you're afraid of what you'll find.
So, then, why do I keep asking direct links to those studies? And why do you not provide them?
Then Orac would have to eat his words about chelation not curing autism even though he says it cures mercury poisoning.
Hey, I've had to risk eating my words before. And if thimerosal causes autism, I'd want to know right away. But you won't give me any evidence, despite months of requests. You're even tight-lipped about your "Ace of Trumps" anecdote, and why I should accept it over replicable studies designed to filter out bias and alternative explanations.
It's nice to know, however, that he agrees with Andy Cutler on that.
Don't know who that is, don't particularly care, but I smell more guilt by association.
Nice to see you have a sense of humor.
Studies paid for by people who want to disprove the connection don't bother me since my kid keeps improving inspite of that "junk science". The day will come when I'll be out golfing with my formerly autistic son and you guys will still be trying to tell people chelation won't work. The problem with that is that, after we get enough of our kids cured, we'll probably be able to file malpractice suits against doctors who keep giving patients this bad information.
Dumpster Diving Duo and Sham Peer Review
Can it get any worse for the vaccine litigants?
Oh, come on, Best.
Don't you know autistic people improve without any biomedical intervention?
Really. It's a delay, not a freeze.
It puzzles me that the incidence of autism is so gender biased. How come boys are getting so many more vaccinations than girls?
Orac, a biostatistician did take a look at the data. He (sort of) reaches similar conclusions.
Well, well. Here's to keeping an open mind and following the data wherever it leads. I don't have a "dog in the fight", as Wade Rankin would say, so it really doesn't effect me personally if autism = mercury or not. (Though I would be forced to eat a considerable amount of crow myself.)
Fore Sam: For the love of Gaia, please stop the broken record routine of trying to force these scientists, doctors, mathematicians, etc. to accept that in the past few years, a few hundred autistic kids seem to have had their symptoms abate, partially or totally, due to chelation. You are just a dumb, irrational, and delusional parent thowing your money away on chelation and golf. Shut up already!
1. Natural improvement. Your silence on your observation controls suggests that you've done nothing to eliminate that explanation.
2. Proper testing protocols reduce or eliminate bias in studies. A blinded liar doesn't know which results to manipulate. With independant replication, it gets harder and harder each time. Oh, and appeal to motivation. If you have a problem with the studies, debate their contents, not the motives that exist in your unfalsifiable Illuminati conspiracy hypothesis.
Well, what do you expect? We can't change our minds if you and your ilk
1) Don't bother trying to understand or even acknowledge our objections to your shoddy "evidence".
2) Continue to rely on insinuation and innuendo and other forms of political trickery, rather than scientific data to convince us. (Is this a good time to mention that I think propaganda tactics are a form of barbarism?)
3) Implicitly minimize scientific data gathering as some ivory tower concept, even though it's not much different than what intelligent children do in "puzzle dungeons" in the Legend of Zelda series instead of flipping random switches until they get the result they want. If you want to bring in blinding, think Pepsi Challenge.
I'll shut up when the scientists stop lying.
Have you ever met any of our kids?
No. That's why I'm relying on you for information. Why won't you give me your observational protocols? How'd you control against natural improvement?
You'd have to lock the kid in a cage to do that. I could show you one that was. He's in an institution. If you're in New Hampshire, give me a call. You can stop by and meet Sam and look at old videos.
PS2 Said: I don't have a "dog in the fight", as Wade Rankin would say, so it really doesn't effect me personally if autism = mercury or not.
Unless selling supplements and bogus chelation agents counts. Woof!
My son has made tremendous progress since we started treating him biomedically. About a week after we started chelation my son started to mimic speech. We started it over the summer, a couple of weeks before school started back up for him. As soon as we came back, his teachers told us that he is now ready to start going to a regular preschool with a shadow for 2 half days/week. Our therapists regularly tell us that the kids who do the diet and other treatments do better than the children who don't. None of this is scientific and I don't expect to sway anyone on this list but you seemed interested. The good news is that there is a chelation study underway so hopefully we'll all have some better answers soon.
I know I want to see as many studies as possible. My son used to be in obvious stomach pain. He would lean over objects to put pressure on his abdomen. Since starting the Specific Carbohydrate Diet (SCD) that has gone away. I would love to know what caused his discomfort and what about the diet made it go away. I would love to know when I could safely re-introduce some of those carbs that I took away from him.
You may not like the way Fore Sam goes about making these arguments but try to put yourself in his position or in my position. I have seen my child get better as a result of following the DAN protocol. My sons therapists can't believe how far he has come in such a short time. Yet I don't have enough scientific proof to convince someone like you. I'm fine with that but it can be very hard to read the opinions of people who claim that chelation doesn't help autism and that mercury or vaccines in general can't possibly have anything to do with autism.
I made a post last night asking the obviously intelligent people on this list to look at both sides of the argument and critique the CDC as carefully as they critique the Geier's. Hopefully that will happen.
I am glad your son is doing so much better. I am sure that is a big relief! Unfortunately, we cannot step aside and see how your son would have behaved without the diet in a parallel universe. Humans tend to interpret a temporal sequence of events as causal (i.e. the earlier event triggering the later). My son had a particularly difficult phase as a 2 year old. He used less of his vocabulary, whined a lot, threw tantrums. One Thursday, he got his second MMR shot. By the following weekend, he had stopped whining altogether, went through a true language explosion; soon afterwards, he started potty training. Now, I would be tempted to attribute that to the MMR (naw, not really), but it was just time for him to come around, because countless children, irrespective of vaccination status, go through their "terrible twos" and come out of them again.
I am sure the diet is not the only intervention that your son got. Maybe it was just time for him to come around...
So, you think my kid just wasn't ready to come around for about 7 years stagnating in infant behavior? Maybe it will be time for you to come around soon.
Thanks, it is a big relief. Now that he is communicating so well his biggest issue is stimming. The stimming was always there, although it may be worse since starting chelation, but we weren't real concerned by it in the past since we were too busy praying for him to speak.
You make a good point regarding your own child and it's why I made the point that I knew my story wouldn't convince anyone on a chat board like this.
Can I ask a stupid question? Can someone explain the difference in Figure 1 vs Figure 5 from Interverbal's blog where he critiques the Cali numbers?
Killer (do you have a name?)
isn't stimming more the environment's problem? I recently had a women in my (university) class who was rocking from side to side and once I got over the notion that I was boring her, it really wasn't an issue.
I wasn't talking to you, really, but since you ask - I understand your son doesn't like golf. What sport does he like?
I may be guilty of using the word "stim" to describe multiple things. Some of the behaviors I'm referring to might best be described as OCD. For example, he used to be infatuated with vacuums. When it was on, he would follow it around, run back & forth around it with his head down & teeth slightly clenched while making noises. It's also very difficult to get his attention while this was happening. Even if the object is "off" or if it's out of sight (say in a closet) he would sit in front of the closet and obsess/stim for an endless amount of time if you let him. Once he gained speech, he would talk about it all day if you let him. The objects that he focuses on change over time but the way he acts around them tend to be the same.
Re: VAERS and the Geiers -
"Biomedical" treatment organizations like "Defeat Autism Now!" (DAN!) have been advocating since at least 1997 that their members:
[a] Report their autistic children to the VAERS as "vaccine-injured".
[b] Report the autistic children of their friends and relatives to the VAERS as "vaccine-injured".
VAERS allows people to report "vaccine injuries" that occured to people who are not even family members. If you look at the database (available on-line), you will see that a very large number have been filed (often in large "blocks") by law firms. Another fairly large group is filed by relatives other than the parents.
So, when the Geiers find "vaccine-injured" autistic children in the VAERS database, this is indicative of exactly this - that the database has been contaminated by spurious reports.
The fact that thimerosal-related reports of autism have decreased since thimerosal was removed from all children's vaccines (except - if you want to be strict - the influenza vaccine) is also no indicator of real autism trends. It makes it ridiculous to claim that thimerosal caused a child's autism if they never could have gotten any - doesn't it?
The Geiers' "dumpster-diving" in the VAERS database is no more "proof" that thimerosal causes autism than finding Easter eggs at an Easter egg hunt is "proof" of the Easter Bunny.
You asked earlier about whether or not the other side is criqued as strongly. I have not analyzed the CDC papers that you mentioned. I'll freely admit that I am not a stats person--I have a basic understanding that I gleened from various math classes and what's been emphasized in medical school, but that's about it.
That being said, let me share some of what I've observed in terms of how scientific papers are used in the medical world. First of all, the papers that are published in a scientific journal are peer-reviewed. That is, the authors submit a paper, and a group of physicians critically analyze their methods and their findings and even more importantly, their interpretations of their findings and determine that all of them follow logic, without errors. If it passes that, it is published, if not, it is sent back to the authors with a list of what the paper needs in order to be published and the authors start over again. (Orac, you've gone through the process, so if I'm wrong, please correct me!) These are considered to be more scientific, and therefore, more accurate in their findings because it has gone through a system of judgement, than those published in the independant journals, such as the Journal of American Physicians and Surgeons which virtually anybody could submit to, claiming a fact without any system of validating the reported results.
However, just because an article is peer-reviewed and accepted for publication doesn't mean that it's free from errors--nor does that mean that it is accepted as "truth." For virtually every discpline that I've worked with, there has been a meeting called "Journal Club" held at least once a month, where an article is selected and carefully critiqued. Did the researchers select patients evenly and equally represented for their trials? Did they have adequate number of people in their trial (a report on one or two patients with a disease that show improvement is much less convincing than having 20,000 people enrolled with a significant improvement)? Are there biases that are evident in how they are presenting their findings? Did they control and adjust for outside influences? Are their results significant, as in, if another population of patients were selected, would we see similar results? And so forth. Often, the consensus at the end is that the paper is weak, and that the recommendations/outcomes reported are not accurate enough to be implemented into every day practice.
The same kind of cirticisms happen more than just in a localized meeting at the hospital. Every journal also includes a "Letters to the Editor" section where other researchers/physicians write in and describe the failings that they noted. It attepts to be a system of critique and analysis at every level--whether it always succeeds as that is another matter for another day. :)
you have to imagine me sitting here with a big wide smile, because I know a couple of boys who are just like that (and a psychologist once claimed all little boys act a bit like that). I sympathise that it can irritate the heck out of everyone else when one person in the family will not talk about anything apart from the "obsession of the week" to the point where no "normal" family activities seem possible. The "idiosyncratic interests" are a clear indication that your son is a "typical" child with (I am guessing) Asperger.
As a random thought, I don't know what your therapist suggests, but have you tried to put your son's interests to use? If he is into rainforest frogs this week - he can check out a book in the library, if he cooperates in family task x.
to pick up on that thought - I generally find that children (whether neurotypical or not) cooperate best when their feelings (and quirks) are (positively) acknowledged. I remember when I was visiting my friend whose son is on the spectrum and I needed to use the family computer for an hour of work, but that happened to be the same computer that he had his new game on. So while I was trying to concentrate on my work, he was standing next to me going on and on and on and on about the features of his new game and he would not stop. I told him I needed only an hour, so he decided to wait, dropped into the chair next to me and went on and on and on and on about his game. Then I turned to him and said: "I realize I am blocking *your* computer and you really, really want to play your new game and show it to me. It is really exciting for you and you can't wait." Happy nods, because I *finally* get it. Then I continued: "I need to concentrate on this piece of work right now and I can't do that when I hear you talk about your game, because it distracts me and the more you talk, the longer it is going to be before I am done and we get to your game." So he sighed, turned around and for the next hour, sat outside the room on the stairs and went on about his game, just to himself. Then we played together for a bit. So in the end, everyone was happy - he was happy that I understood him and acknowledged his feelings, I was happy because he left me alone and I could work. Although he doesn't seem to notice that his obsessions go on everyone's nerves, I am sure he gets the negative vibes and that must be very frustrating.
His mom and teacher approach school in a similar, encouraging, way. Yes, they know he really really wants to do fractions and yes, he can do them if the regular school work is done first. He does very well in a conventional school now, although it really bugs his mum that her son will only do the absolute minimum of the required school work and then turn to his "real interests".
That's not ASD specific, I find this approach works for *any* child; what is more important, it works for the adults, too, because when you empathise with the child, instead of feeling mostly annoyed, your whole attitude is more positive. I feel much less stressed and a lot less "naggy" when I remember to approach my children in this way (and it doesn't always work and I don't always remember it, sigh).
Stopping my ramble now...
Couldn't post this yesterday, for technical reasons of some sort:
From Fore Sam:
Uh, are you on acid? The easiest way to control against natural improvement is to use a placebo control group. Since I have little reason to believe you did that, I think we can safely say that you haven't eliminated natural improvement as a possibility, unless you did some other method I'm not aware of.
Possible post-hoc fallacy: Just because something happened after you put him on the diet doesn't mean that it happened because you put him on the diet.
In your position, I'd be looking for evidence before making anecdotal claims, or at least asking if anyone knows of better evidence. Until there's good evidence, there's nothing worth discussing.
I'm a bit curious how that'll go myself. Imagine some mistakes will be found, but I doubt it'll be nearly as bad as the Geiers' stuff.
Julia, Bronze Dog,
Regarding my request for critiques of the CDC and other such reports.... My frustration stems from the following. Today, the mainstream believes that the evidence does not support a link between vaccines & autism largely based on the IOM report in 2004. In the IOM study, they made their decision on 5 or 6 epidemiological reports from the US, Sweden, UK & Denmark (I think 3 of the reports came from Denmark). I think it was a big mistake for the IOM to ONLY look at epidemiology. Included in the IOM report is a statement that epidemiology may not be sufficient to determine whether a small percentage of children were adversely affected by vaccines. There was clinical data & biological studies available for them to review but they declined to do this. So evidence from people like Mady Hornig, Richard Deth, Boyd Haley and others was not even considered. DAN doctors who have treated thousands of autistic children and possess clinical data were also not even considered.
The US epidemiological study, led by Thomas Verstraeten, of GSK, is a "neutral" study according to Verstraeten. This is because they initially found a correlation in a large HMO (we only know this because of documents obtained via FOIA) but there was no correlation found in a much smaller HMO, and after several revisions. I would love for MarkCC to hear from MarkCC on this one, but I digress. So to summarize, even though the initial results showed a huge correlation (you can see those documents & SafeMinds analysis of it here: http://www.safeminds.org/Generation%20Zero%20Syn.pdf and here: http://www.safeminds.org/Generation%20Zero%20Pres.pdf) and even though the lead author wrote a letter to Pediatrics, which was published, claiming the study was neutral - the IOM somehow found the study to show no association.
The Danish & Swedish studies are so obviously flawed I have a hard time comprehending how they manage to still be recognized. Here are quotes from Evidence of Harm regarding those studies:
"In Sweden, autism rates continued to climb after thimerosal was removed from pediatric vaccines in 1993, according to the report. But the study only counted autism cases diagnosed in a hospital setting. Autism
is almost always diagnosed in doctors' offices or clinics, not in hospitals. Few parents rush their child to an emergency room if they stop talking."
"The Danish results were riddled with even more problems than the Swedish ones, however. Even the authors admitted that they "may have spuriously increased the apparent number of autism cases." As in Sweden, they had counted only inpatient cases, at least from 1983 to 1994. Then
in 1995, for reasons that went unexplained, the researchers began including outpatient cases as well. "Changes over time in the rates of diagnosis of autism-like disorders in inpatient versus outpatient settings may have affected the ascertainment of cases," the authors said. The second flaw was that prior to 1992, the data did not include cases diagnosed in a busy clinic in Copenhagen, where 20% of all Danish cases were
diagnosed. By adding in these previously excluded cases, the authors found a spike in rates in 1992, the same year that mercury was removed from vaccines. A third change in methodology occurred midway through the study. In 1993, Denmark had updated its psychiatric diagnostic codes and
adopted new diagnoses for autism-related disorders. Government workers conducted training seminars with clinicians in order to promote the new coding system. This campaign "may have stimulated reporting of autism cases (as well as other health outcomes)."
So the IOM relied on a "neutral" US epidemiological study and flawed European epidemiological studies to not only state that there was no link - they had the balls to state that the evidence was so strong that we should simply stop looking at vaccines altogether. Mind you, their report also points out the limitations in epidemiology when it comes to finding a small percentage of the population that may have been harmed.
Sweden has a very different medical system from the US. Basically ALL medical care gets administered through hospitals and clinics. Health care is free for everyone through the clinics and very few people go private. My friend's son, who did get his Asperger diagnosis in Sweden, goes to a hospital for primary care. Therefore, the data are very valid and likely to include most autism cases.
As for Denmark - why would you see a "spike" in a year that thimerosal is removed from vaccines, when clearly, you would expect any change in an infant immunzation schedule to take at least 3, probably 5 years to become apparent in an autism statistic (if there was a connection).
The excerpt I quoted regarding Sweden is implying that cases diagnosed in clinics would not be included which you seem to agree would be significant.
Regarding Denmark, you're right, you wouldn't expect to see an increase in autism in the year thimerosal was removed. That resulted solely from changes in the test criteria.
Some other things I forget to mention in my last post.
The CDC has refused to allow access to the VSD so that their results can be replicated. They may have also committed a crime by destroying datasets.
no, I don't agree. I am a native German speaker and I use hospital and clinic synonymously. So hospital = clinic, meaning, the vast majority of autism cases in Sweden would be diagnosed in the hospital, not in a private practise. I can run that by my friend in Sweden, though, but I clearly remember how irritated she was when they moved there and found that primary care was admistered through hospitals rather than smaller settings.
Actually, in Germany, most autism cases would probably be diagnosed in collaboration with the next university hospital.
Nice try, but no. The IOM duly considered the papers of Haley, Horning, Holmes, Bradstreet, et al. - and found them to be mostly non-contributory to the topic. The fact that a half-dozen large, population-based studies with different methdology all came to the same conclusion is a pretty damning indictment of the thimerosal-autism theory.
Flaws of said studies aside, the big thing to remember is that places where thimerosal has been removed from vaccines for many years still have autism rates comparable to the United States. Nobody to date has been able to explain that.
That's your opinion. Frankly, I'm getting tired of this argument. You're willing to ignore the flaws of the studies to prove your point but you don't seem to consider the possibility that the flaw in the study altered the result. Besides, there are a lot of differences when comparing the US vaccine program to that of Denmark or Sweden. The most important study by the IOM should have been the one conducted in its own country. And that one was declared neutral by the author and the FOIA documents show a tremendous correlation and now we're not allowed to see the data. Why do you so blindly put your trust in that?
Back to the IOM report (just when I thought I was out, they pull me back in!). Can someone help me understand what I'm reading? So we all know that the IOM said there was no link and we shouldn't ever look at vaccines again. But if you look past the executive summary there is some conflicting information. On page 167 http://fermat.nap.edu/books/030909237X/html/167.html
"The committee concludes that although the hypothesis that exposure to thimerosal-containing vaccines could be associated with neurodevelopmental disorders is not established ... the hypothesis is biologically plausible."
"The committee also concludes that the evidence is inadequate to accept or reject a causal relationship between thimerosal exposures from childhood vaccines and the neurodevelopmental disorders of autism, ADHD, and speech or language delay."
"The committee recommends the use of the thimerosal-free DTaP, Hib, and hepatitis B vaccines in the United States, despite the fact that there might be remaining supplies of thimerosal-containing vaccine available." (Orac, this one might be very interesting for you considering all the yelling you did at RFK Jr for his wicked ways in pointing out how the CDC exposed our children unnessarily to thimerosal)
"The committee recommends that full consideration be given by appropriate professional societies and government agencies to removing thimerosal from vaccines administered to infants, children, or pregnant women in the United States."
On page 168: http://fermat.nap.edu/books/030909237X/html/168.html
"The committee recommends case-control studies examining the potential link between neurodevelopmental disorders and thimerosal-containing vaccines."
"The committee recommends further analysis of neurodevelopmental disorders in cohorts of children who did not receive thimerosal-containing doses as part of a clinical trial of DTaP vaccine."
"The committee recommends conducting epidemiological studies that compare the incidence and prevalence of neurodevelopmental disorders before and after the removal of thimerosal from vaccines."
"The committee recommends research on how children, including those diagnosed with neurodevelopmental disorders, metabolize and excrete metals--particularly mercury."
"The committee recommends continued research on theoretical modeling of ethylmercury exposures, including the incremental burden of thimerosal with background mercury exposure from other sources."
"The committee recommends careful, rigorous, and scientific investigations of chelation when used in children with neurodevelopmental disorders, especially autism."
Some interesting info on page 174 regarding the polio vaccine http://fermat.nap.edu/books/030909237X/html/174.html
"The committee concludes that the biological evidence is strong that SV40 is a transforming virus."
"The committee concludes that the biological evidence is moderate that SV40 exposure could lead to cancer in humans under natural conditions."
"The committee concludes that the biological evidence is moderate that SV40 exposure from the polio vaccine is related to SV40 infection in humans."
No, the CDC has not refused access to the VSD. They have a specific (from what I can tell), application requirements, these include IRB approval from the various Kaisers who supply the information.
There is private information in those data sets that must be protected.
It might be a lengthy and hard process. That is okay, it is worth it to have an ethically intact study.
You said "Can I ask a stupid question? Can someone explain the difference in Figure 1 vs Figure 5 from Interverbal's blog where he critiques the Cali numbers? "
I am Interverbal, so I can certainly explain that. I am sorry that I didn't see your question until now.
Figure 1. is a prevalence rate of autism per 10,000 children. In 2005 that prevalence rate is 35 autistic kids per 10,000 kids. I used the CDDS data and US census projections to calculate that rate. The method is explained in the Methods section of that post.
Prevalence is simply a snapshot of all how many total persons there are in a certain group at a given time.
Figure 5. are the raw number of "new cases" (more on that later) in the given years.
You might call this "incidence" which is the number of new cases, in a given amount of time.
However, we can not call this incidence just as we can't call these data "new cases". The CDDS is a service agency. That is their mission, everything else is secondary. When I talked to them, they explained that...well...stuff happens. A kid might services starting in August, but maybe his paperwork won't be all cut and dry until that December or even March. Also, there is the issue of voluntary nature of the system.
The CDDS has a formal document were they state this:
I do statistics, regression analysis specifically, for a living. If we were to really do a test like this we'd want to test a linear trend model with vs. a spline model. We'd then test to see if the spline model is the better model using an F-test. This paper does none of this and should have been rejected on grounds such as that.
Your point about total cases is also quite valid. Total cases is not the same as new cases and pretending that such an identity exists should have also lead to rejection of the paper.
All in all, this is simply crap.
Killer, way to completely ignore the point.
Why is the rate of autism the same in the US, the UK, Denmark, Japan, Germany, and many other countries, even though they have widely differing immunization schedules, as you yourself admit?
I know what I think the answer is. What's yours?
I don't know that the rate of autism is the same in all of those countries. Seems to me no one is really sure what the rate of autism is in the US, let alone in those other countries.
I know you may slam me but when you are hurting as much as I am its not a big deal.
You see I am the Dad of a beautiful blond hair, blue eye 6 year old little boy that is autistic. Imagine hearing your child said at 17 months old "bye bye baby" and that would be the last words he would say for two years. Imagine asking your wife what she wants for Christmas and she said "to hear my baby say I love you" after this you are hurting pretty bad. I know it could be worst he could be fighting cancer etc.
What if we (the parents that think mercury can cause autism) are right. Even if there is a 1% chance we are right. The Government make parents buy new car seats every few years because car seats sold in 1999 no longer meet 2006 Government regulation at a cost of about $75.00 to $100.00 and somehow the CDC said $2.35 more for a mercury free shot is to much. It would have cost us about $61.10 to have had all of my child shots mercury free. So far we have spent about $100,000.00 in the past 4 years on speech therapy, tutors, special diets, Doctor, supplements, extra employee because my wife is not able to help me with my business any more, etc. Not counting the buckets of tears me and my wife have cried. Do we have to be 100% sure that mercury can cause autism before we remove it or 50% or 25% what is the percentage?
If we are wrong we will cost parents $2.35 to $61.10, if the CDC is wrong it will cost parents hundreds of thousands, and this country BILLIONS.
Ask your self why is the CDC fighting so hard to keep mercury in vaccines (by the way I know the CDC says mercury has been removed from all vaccines except the flu shots but if you will listen very close the CDC says all mercury has been removed has a preservative what the CDC will not tell you is mercury is still in most vaccines as a sterlizing agent) knowing that California removed mercury from there vaccines a few years ago and now autism has drop 22%. There is a pediatrician group in Chicago that has about 30,000 to 35,000 children that has not been vaccinated with NO reports of autism. I feel like if we can get all mercury out of vaccines and the autism rate drops dramaticly then and maybe only then will the CDC stop denying the mercury autism link.
Ten years ago my son's school had no autistic children, today there are about 32, are we to believe that 10 years ago these children were not talking, hand flapping, almost constantly spinning, banging their heads, having total melt downs and no teacher notice. I now know what autism is, in all my years of school I never saw a autistic child.
I'm not anti-vaccines but I am anti-mercury.
P.S. According to mercury/Thimerosal M.S.D.S it is known to cause cancer too.
What if aliens really were responsible for the pyramids? The problem with "what ifs" is that anyone can make one up. Dire consequences in someone's imagination should not guide our judgement.
Jeff, if I were you, I wouldn't rely on your memory. Memories are easily altered by present experiences.
I'd also like to see the source of your California data.
what about Denmark that has not been using thimerosal in their vaccines for over 10 years and a similar incidence of ASD as other countries?
I'd like to see a reference for the notion that thimerosal is still contained in US vaccines as a "sterilising agent".
I did have several schoolmates with ASD, one of whom it was generally known (because we were told to tolerate his pencil twirling and tipptoeing) and at least two in my class (one boy and one girl) whom I know now almost certainly fitted the Asperger diagnosis. I have a good amount of friends and collegues who are on the spectrum (40 year olds, undiagnosed), some of their children are on the spectrum, too (diagnosed, which is how the parents realised about themselves).
There is not 22% drop in autism in California. In fact the numbers in California are still increasing. The "drop" is in the number of folks who (may be) weren't receiving services for autism the previous quarter, but are in the new quarter.
Also, if memory serves that 22% comes from one, Rick Rollens. Rick uses all the age groups to calculate his data. So the 3-5 year olds are being lumped in the with the 62-99 years olds. This is a mistake as it looks like diagnostic reassignment in the older ages happens all the time. Certainly there is growth at all age groups every quarter.
The FamilyFirst group out of Chicago, was investigated by the reporter Dan Olmstead. He just asked a few people in that group. He didn't go door to door asking. He didn't actually check that those families didn't receive vaccines. In fact the FamilyFirst folks admit that the families might get them from other pediatricians (If you carefully read the article).
I know teachers who say that all the new autistic kids were just the same sorts of kids they have seen before in different categories a few years ago (Not kidding). So whose anecdotal evidence is better....
It has been really great to read the posts in response to the vaccine article and the questions that remain. As a mom to a child with autism, an educator and the child of an educator in the Special Ed field for 40 plus years both at the university and public school level, I would like to add my 2 cents. From my experience and the experience of my parent, children with autism were not as numerous in the past as they are today. Perhaps there were some who were mis-diagnosed, but not enough to explain the increase we see now. We will have to agree to disagree on that point. Speaking as a parent, what I do know is that any research done concerning possible causes of autism are welcomed. I'm not a scientist and I don't know if vaccines contribute to a tendency to trigger autism or not. If there is any connection, I hope that definitive answers can be determined to avoid future children going through some of the pain that not being 'normal'can cause. Don't think that I haven't agonized over the 'what if's' -- what if my taking my son to get vaccinated made a difference in his developing autism? What if I didn't get him vaccinated and he did get one of the awful diseases we want to protect our children from? Who knows, and it's putting the horse after the cart at this point. Knowing what may contribute to some children developing autism will not help my son now, but it could help others. We wouldn't change our son for our sakes for anything, but if not having autism would make his life happier, we'd welcome a way to erase the effects of autism. Many of you seem to know much more about the studies conducted and the science behind them than I will ever know. I do hope that scientists will continue to look for causes and answers. Maybe this was a flawed study, maybe not, but its good that it's getting discussion. I also hope that ways to lessen the severity of autism will continue to be investigated, so that a safe and humane treatment can be found. In short, thanks to you all for thinking about autism. That's a way to lead to further advances and more understanding for those on the spectrum.
MKB: Your personal experience isn't something to go on. One problem is the change in definition, as well as increase awareness. Autistics used to be labelled as "retarded" in some cases.
But you're quite right about the need for more research. We just have to make sure the research meets scientific standards, since it's all too easy to manufacture a scare, even accidentally.
MKB said: " What if I didn't get him vaccinated and he did get one of the awful diseases we want to protect our children from? "
Two weeks after my son got the MMR he had a horrible seizure which required a trip to the ER by ambulance. Since then he has had a severe speech disability. Think it was the vaccine?
Hmmmm... actually he was dehydrated because of a nasty gastrointestinal bug. One that may or may not have been prevented by the new rotavirus vaccine.
You talk about "research". I would like to point you to several places where research IS being done. Several years ago one of my other children spent a morning being a test subject for one of those listed in the Autism Research Network (his reactions to actions by the evaluator, like pretending to hurt herself, were used to see how a "normal" preschooler would behave). Check out those links... one may be near you where you can get more informatio.
Bronze Dog - I agree that my personal experience isn't something to go on, I was referring to the previous poster. I assume his is not either.
And - HCN ,I too agree, I don't know, that's the entire point, I thought. Thanks for the info though.
I would like to address several of the things you wrote so that you can scour them for merit.
You wrote "We will have to agree to disagree on that point."
I appreciate that you have this respect for those of us who do not agree that there is an increase in autism. The feeling of respect is certainly mutual.
You wrote "Perhaps there were some who were mis-diagnosed, but not enough to explain the increase we see now"
Gernsbacher et al. (2005) argue that there are three reasons that there are more autistic kids (and adults) now as opposed to days gone by. These are new categories, broader definitions, and better diagnostic tests, that were not available until the mid 90s. We know from Fombonne (2001) that 3/4 ( By my count it actually higher, but he was being conservative) of the autism spectrum is not Autistic Disorder, but another sub type. This is not primarily an issue of mis-diagnosis, but of those categories not being in existence before 1994 and the advent of DSM-IV.
In addition Jick et al. (2006) show that there is another cause of increase due to broader advertisement of autism. Via correlation in that study, we could could conclude that Dr. Andrew Wakefield causes autism.
You also write "I hope that definitive answers can be determined to avoid future children going through some of the pain that not being 'normal' can cause."
A question about "cause" in that sentence. Is it the "difference" that causes the pain or is it the way some people act towards those who are different?
And when we have our answer to the above, which should we cure?
Personally, I look foreword to the day when kids who are different are not seen a "train wrecks" or a "plague" in the words of certain autism "advocates".
Thanks for the numbers. I appreciate that you have the data to back up your assertions. I do know that the definitions have become more broad and that does impact the numbers of those diagnosed. Does this alone make the difference in the increase, as I said, I do not know. It's good that you do.
I could not agree with you more on hopes that in the future children on the spectrum deemed 'different' are not seen as described. If you read, I love my son dearly and his differences are what make him who he is. The pain is caused by those who do not appreciate his unique way of interacting with the world. I would cure those who do not understand autism first and that is what I try to do daily, professionally and as a parent. And whether we like it or not, being different and not being accepted does cause one pain at a certain level.
Geez - I just wanted to say that I thought it was really great that what appeared to be intelligent people were discussing this issue. That's all! I'm not saying anyone is wrong or that I know the answers. Just thanks for making it important enough to discuss it.
You wrote: You see I am the Dad of a beautiful blond hair, blue eye 6 year old little boy that is autistic. Imagine hearing your child said at 17 months old "bye bye baby" and that would be the last words he would say for two years.
I can very well imagine this, everything else you've brought up, and more. None of it's easy, I know, but none of is evidence that thimerosal is or was ever involved. On the outside chance that it is a problem, and because there is considerable concern, it has been removed from most vaccines. It seemed prudent so it was removed, for the most part. If you think the very trace amounts that might make it in to the final product are sufficient to keep autism rates at current levels you are wrong.
I understand what it's like to believe in something and I understand what it's like to be wrong. Check out my first blog entry on the subject.
I am neither pro or anti-mercury. I'm for quality autism research and I am very much in favor of truth. Two things you won't get from the Geiers.
I want to say that I came into this discussion with the assumption that you are a fantastic parent to your child. That is an assumption is very much intact.
I also truly appreciate that you shared your conclusion. I truly want to hear your comments, critiques, and opinions.
Although, you should know, that a lot of us to spend time here are skeptics and that we tend to be very critical.
It is a little stressful to fly with a group like this, but it is usually worthwhile in the end.
You write "Just thanks for making it important enough to discuss it."
For my part thank you, and thanks also to Orac who wrote this post. You might find this link to autism bloggers of use as well: http://www.autism-hub.co.uk/
I'm still a little confused by your 5th chart. So are you saying that the "raw" numbers of new 3-5 year olds is decreasing?
Regarding the reasons why there are more autistic children today than in the past...
I tend to lump all of those arguments into 2 categories:
1. Children who would have previously been diagnosed as something other than ASD are now being diagnosed as ASD. This could occur for the various reasons that you state.
2. Children who previously would have no diagnosis today qualify for an ASD diagnosis. Again, I think you would argue this could occur for some of the reasons you state above.
Personally, I don't buy either of these arguments. If the first one was valid we would be able to see it in the historical data. Suppose in 2006 there were 10 autistic children and 2 mentally retarded (assuming this is the misdiagnosis you believe would have been given in the past) children the population was 100. So the rate of ASD + MR would be 12%. I would expect the 12% number to be constant over the past 50 or 100 years but perhaps we would see 10 MR children & 2 ASD children in 1950. Does that example make sense?
I don't buy the 2nd argument either. The ASD children I know stand out. For your argument to be valid those children would not have been noticed. And 50 years ago these children would not be getting special services like ABA so I assume they would not have made as much progress as the ASD children today and would have been even more noticeable. I don't know what Fonbonne's argument is regarding the 75% of autistic children that aren't really autistic. Can you elaborate on that? Regarding the widening of the diagnostic criteria, do you know exactly what changed? I thought it was something like instead of needing 6 traits to qualify as ASD it got lowered to something like 5. But I admittedly don't know the details and would be interested to learn about that.
Killer, you are thinking of something like this:
J Autism Dev Disord. 2002 Jun;32(3):207-15.
The changing prevalence of autism in California.
Croen LA, Grether JK, Hoogstrate J, Selvin S.
We conducted a population-based study of eight successive California births cohorts to examine the degree to which improvements in detection and changes in diagnosis contribute to the observed increase in autism prevalence. Children born in 1987-1994 who had autism were identified from the statewide agency responsible for coordinating services for individuals with developmental disabilities. To evaluate the role of diagnostic substitution, trends in prevalence of mental retardation without autism were also investigated. A total of 5038 children with full syndrome autism were identified from 4,590,333 California births, a prevalence of 11.0 per 10,000. During the study period, prevalence increased from 5.8 to 14.9 per 10,000, for an absolute change of 9.1 per 10,000. The pattern of increase was not influenced by maternal age, race/ethnicity, education, child gender, or plurality. During the same period, the prevalence of mental retardation without autism decreased from 28.8 to 19.5 per 10,000, for an absolute change of 9.3 per 10,000. These data suggest that improvements in detection and changes in diagnosis account for the observed increase in autism; whether there has also been a true increase in incidence is not known.
"I'm still a little confused by your 5th chart. So are you saying that the "raw" numbers of new 3-5 year olds is decreasing?"
Correct, however, we can not call the apparent new 3-4 year olds, "new" according to the CDDS.
You wrote "Suppose in 2006 there were 10 autistic children and 2 mentally retarded (assuming this is the misdiagnosis you believe would have been given in the past) children the population was 100. So the rate of ASD + MR would be 12%. I would expect the 12% number to be constant over the past 50 or 100 years but perhaps we would see 10 MR children & 2 ASD children in 1950. Does that example make sense?"
It makes perfect sense, but it is still fallacious. It assumes that MR, is the only category that fed into the present ASD. Eagle (2003) and Gernsbacher, Dawson, & Goldsmith (2005) suggest very clearly that there is shifting from other categories. The previous authors also give a good blow by blow of the criteria change.
Also, I am sure that I would not want to calculate my ASD-MR rates by adding ASD to MR. A better way is to calculate the rate of MR within a specific ASD. Then you could see what the rate of MR was doing. For Autistic Disorder, the rate of MR is dropping (Fombonne, 2003). And no surpise as the criteria were revised in 1994, 1980, and there were at least 3 research definitions before that.
Further, ASD is compromised of 5 subtypes. They are Autistic Disorder, Aspergers Disorder, Pervasive Developmental Disorder-Not Otherwise Specified, Rett's Disorder, and Childhood Disentegrative Disorder.
These have very different histories and points of "discovery". However 4 out the five categories didn't exist in the DSM before 1987 and 1994 (when it was revised). They weren't included as part of the ASD before then. The were not part of the epidemiology. One subtype PPD-NOS is the vast bulk of the present ASD. It is at least 75%. (Fombonne, 2001 and Fombonne, 2003). What I am saying is 75% of the spectrum is due to the addition of PDD-NOS in 1987. That is history.....
You wrote "The ASD children I know stand out. For your argument to be valid those children would not have been noticed"
Sir, I have helped do diagnosis. It is pretty hard to diagnose the kids who are Aspergers or PDD-NOS and sometimes even Autistic Disorder. I have flat out been wrong sometimes and was shown to be so by formal diagnostics. Also, my all time favourite study, involves well tenured special educators, being shown a video of a class and being told that one young man was ADHD in the class, they started labeling all his ADHD behavior.....He was not ADHD. We are not always the diagnosticians we think we are....
"And 50 years ago these children would not be getting special services like ABA so I assume they would not have made as much progress as the ASD children today"
Eaves and Ho (2004) show there is no meaningful difference between those who receive ABA and those who didn't in a single geographical area of Canada in their descriptive study. However, that study is not a controlled trial, but is merely descriptive. It could be that the ABA folks in that area of Canada get kids who have greater deficits. The authors also do not adequately define ABA.
Sallows & Grupner (2005) randomly assign autistic kids to two groups. An in clinic ABA group and a at home ABA group. There were no meaningful difference between the groups, so they combined them and averaged 47% of kids in their program being able to enter maintream Kindergartern. This number exactly replicates Lovaas (1987) without the use of spanking, so it is rather more ethical. However, Sallows & Grupner did not have a no-treatment control group. I have heard that at one time they did and that there was no difference between the no-treatment group and the treatment groups at the halfway point of this study. I can not verify that however.
Behavior analysts have over 1000 autism focused, controlled single-case designs that are published. We can clearly show that our treatment caused a change in the targeted behavior. However, we can't say that those kids would never have gained those skills by themselves. To state such, would be to make a logical fallacy called a "false equation".
My email in katahajime74(at)hotmail (dot)com. I would be happy to provide those studies.
Have you seen Mark Blaxill's response to that study? Apparently, the author's of the study you provided reversed their findings when challenged. Here is the abstract.
Study Fails To Establish Diagnostic Substitution as a Factor in Increased Rate of Autism
Mark F. Blaxill, M.B.A.
In a recent article in Pharmacotherapy,1 Drs. Jick and Kaye claim that increasing rates of autism in the United Kingdom can be explained by changing diagnostic practices. They cited a related study from California,2 which used a similar argument, but they failed to mention that the authors of that study reversed their finding3 when their argument was challenged.4
I have seen Blaxill's response, but I have not seen any "reversal" by Croen - do you have the reference?
"It assumes that MR, is the only category that fed into the present ASD."
If there are categories in addition to MR then just add it in. So instead of the rate of MR + ASD being constant over time you should be able to see that MR + Disorder n + Disorder n + 1, etc.. + ASD has been constant over the last 50 or 100 years.
"Also, I am sure that I would not want to calculate my ASD-MR rates by adding ASD to MR. A better way is to calculate the rate of MR within a specific ASD. Then you could see what the rate of MR was doing. For Autistic Disorder, the rate of MR is dropping "
I'm not sure what you mean by this. Are you saying that it used to be common for ASD children to also be diagnosed as MR and that it is now less common? Why wouldn't you add ASD to MR? I don't see how else you could claim a diagnosis shift.
"These have very different histories and points of "discovery". However 4 out the five categories didn't exist in the DSM before 1987 and 1994 (when it was revised). They weren't included as part of the ASD before then. The were not part of the epidemiology. One subtype PPD-NOS is the vast bulk of the present ASD. It is at least 75%. (Fombonne, 2001 and Fombonne, 2003). What I am saying is 75% of the spectrum is due to the addition of PDD-NOS in 1987."
But doesn't California have data on full blown autism? Even if you restrict it just to that, haven't the numbers risen dramatically?
"Sir, I have helped do diagnosis. It is pretty hard to diagnose the kids who are Aspergers or PDD-NOS and sometimes even Autistic Disorder. I have flat out been wrong sometimes and was shown to be so by formal diagnostics."
Is it hard for you to make the distinction between ASD, PDD and Asperger's or are you saying children who fit any of these categories may sometimes be diagnosed as neurotypical? My son was diagnosed as moderately autistic. I really don't care about the diagnosis because I feel it is just a label but my therapists tell me that my son would probably be diagnosed as PDD today. As much progress as my son has made - and I can't tell you how proud I am of him - but I can't imagine a professional telling me that he is neurotypical after spending at least 30 minutes with him.
I don't even have access to see the full comment by Blaxill. Can you post it here if you have access to it?
"If there are categories in addition to MR then just add it in. So instead of the rate of MR + ASD being constant over time you should be able to see that MR + Disorder n + Disorder n + 1, etc.. + ASD has been constant over the last 50 or 100 years."
This won't work for the CDDS. They don't have all the categories we need to see this. This works somewhat better for the IDEA data, but is still not perfect even when adjusted for population increase. Also, as I said before we can only go back to the 1966 for a rate of Autistic Disorder. You would have to do door to door type desriptive epidemiology to establish this.
"I'm not sure what you mean by this. Are you saying that it used to be common for ASD children to also be diagnosed as MR and that it is now less common? Why wouldn't you add ASD to MR? I don't see how else you could claim a diagnosis shift."
Correct. You wouldn't add ASD to MR rate to get a percent. You say 12%, but that 12% is not based on any concept. There is no 88% of something else.
"But doesn't California have data on full blown autism? Even if you restrict it just to that, haven't the numbers risen dramatically?"
It did, then in July 2003, the CDDS added further restrictions. And sure enough, we see a drop in September 2003.
"Is it hard for you to make the distinction between ASD, PDD and Asperger's or are you saying children who fit any of these categories may sometimes be diagnosed as neurotypical?"
It can be very hard. PDD-NOS and Autistic Disorder can be a real challenge depending on the kid. Yes, these kids can (and are) mistaken for typically developing persons.
"My son was diagnosed as moderately autistic. I really don't care about the diagnosis because I feel it is just a label but my therapists tell me that my son would probably be diagnosed as PDD today. As much progress as my son has made - and I can't tell you how proud I am of him - but I can't imagine a professional telling me that he is neurotypical after spending at least 30 minutes with him."
I am glad that you are proud of your son. I am sure that you and he, have have a great time doing different activities and learning.
Your therapist is probably right about re-diagnosis, depending on where you live. Some diagnosticians will change Autistic Disorder to Aspergers Disorder or PDD-NOS if a child makes a lot of progress. I disagree with that practice however. One Of the little guys I worked with picked up a considerable IQ gain in two years and was re-diagnosed a la the logic of the diagnostician.
Also, Blaxill et al. (2003) correctly note that there is not perfect correspondence between Autism and MR, but discount the fact that a great deal of it can. Also, Blaxill et al, use the median age of diagnosis to compute how many persons Croen et al may have missed. The median, is certainly not the right statistic to use in this case. They should have used the mean, or a trimmed mean if they were worried about outliers.
I just read Blaxill's full comments and Croen's response to it. The summary you posted from Croen's study is clearly not correct. So you don't have to take my word for it, here are some quotes from Croen responding to Blaxill:
Blaxill et al. correctly point out that age patterns of enrollment in this service system may be substantially different for autism and idiopathic MR and that truncated follow-up for children born during the more recent study years might differentially affect the observed trends in prevalence of these two disorders over the study period. That is, not only did we underascertain autism in the later
years (which we acknowledged), but we may have underascertained MR to a substantially greater degree
(which we did not acknowledge)."
"Diagnostic substitution does not appear to account
for the increased trend in autism prevalence we
observed in our original analysis because the probability
of becoming a DDS client for MR by age 4 remained
relatively constant over the study period, while
the probability of becoming a DDS client for autism
by age 4 increased steadily from about 2/10,000 births
in 1987 to about 10/10,000 births in 1994, a nearly
five-fold increase (Fig. 1, Table I)."
"We agree with Blaxill et al. that the slight degree of diagnostic substitution we observed in these samples would not explain the dramatic increase in the probability of becoming a DDS client for autism by age 4."
Jonathan, You seem to rely heavily on the work of Eric Fombonne. To quote Blaxill's response: "In your editorial commentary, Eric Fombonne praises the study, and claims
"Croen et al. carefully analyzed the California dataset. We disagree."
I wonder how Fombonne could make a comment like that when the Croen study was so obviously flawed. I guess I should just expect this by now given the roar of approval generated by the Verstraeten study & the Danish study.
I think it would be perfectly fine to only go back as far as 1966 to prove diagnostic substitution. I don't understand all of the reasons you provide, but I certainly accept your point that it will be difficult to do this. But I think it would be possible to do. I think the reason it hasn't been done is because the data does not support diagnostic substition. So without diagnostic substitution you're left with the argument of ASD children today would have gone unnoticed in the past. Your stories about it being hard to diagnose aside, I think this is a pretty weak argument.
If you want to argue that vaccines or mercury doesn't cause autism, that's fine. But to say the numbers aren't really increasing is not supported by anything scientific, at least nothing that I've seen here.
Speaking of mercury, have you seen the Texas study by counties that showed an increase in autism the closer a county was located to mercury emitting power plants?
do you have the link to the Croen response? Thanks.
I have the response as a .pdf file. It's only a couple of pages so I could paste it here but the formatting wouldn't be great and there are a couple of charts that can't be saved here. If you give me your email address I can send it to you. Also, please call me KillerJabs - the killer reference is starting to make me uncomfortable.
You wrote "I think the reason it hasn't been done is because the data does not support diagnostic substition."
I would say that this is rather for hardship of doing such a study. It would be a lot of work, even in a relatively small geographical study. That sort of detailed epidemiology is rare in any field of study.
It was done in Chakrabarti & Fombonne (2005) and to an extent in Honda et al. (2005). But these were for far younger ages. However, the merit of these studies is that they show a no change of autism for two birth cohorts, from the early to late 90s (the period where there is supposedly a major increase).
You wrote "If you want to argue that vaccines or mercury doesn't cause autism, that's fine. But to say the numbers aren't really increasing is not supported by anything scientific, at least nothing that I've seen here."
Chakrabarti & Fombonne (2005) refutes what you just said. It is both excellently conducted/controlled and shows that there is no increase between two cohorts of kids, one cohort born in the early 90s and one born in the late 90s, the period spanning the supposedly greatest increase.
You wrote "Speaking of mercury, have you seen the Texas study by counties that showed an increase in autism the closer a county was located to mercury emitting power plants?"
Yes, and I have rather specific problems with it. The source data, the IDEA Texas data, does not control for the 6 threats to random and systematic error, so these are threats to the accuracy fo this study. Not surprisngly, problems occur.The IDEA Texas data is descrepant from the epidemiology is term of racial percentages (which should be even, but is not) and in number (should be much higher) and in definition (not the same as the DSM-IV). And let us not forget that assignment to the IDEA service category is not the same as a diagnosis (Laidler, 2005).
Then there is the non causa, pro causa reasoning (correlation is not causation). His might well be better explained by urban vs rural differences, which is something we repeatedly seen in the epidemiology (Fombonne, 2003). It might be tempting to say "that is because of the power plants", but that would be ad hoc reasoning. We don't know, why there is this difference. We haven't isolated the variable. I suspect this has more to do with the availability of diagnosticians than power plants though.
Also, re this logic, I could ask why isn't there a decrease in autism? After all, the whole country was basically powered by coal burning plants in days gone by.
Re the IDEA data one can explain why Oregon has the highest rate (apparently) out of any State compared to Washington which is notably lower. Certainly not California with its famous smog from various powerplants.
Ditto for Minesota which is second highest, and which doesn't have more powerplants than Michigan. And then we add in the quite mercury polluted Great lakes (I grew up at the tip of Lake Erie). No one is supposed to eat fish more than once a month (we were told often in school) as the Walleye eat the perch and the perch hung out by the powerplant just on the mainland (I grew up on an island) and were high in (you guessed it!) mercury. I actually calculatd our autism rate, it is 55 per 10,000, just under the famous 60 per 10,000 (but well within the confidence intervals).
In fact the only real way Orgeon and Minnesota are alike is their exceedingly loose autism criteria for IDEA services. http://www.autism-watch.org/general/edu.shtml
Also, this blog post has some good information:
Also, Bertrand et al. (2001) were CDC authors who were called in 1999 to check out the high rate of autism in Brick Township, NJ. They confirmed the high rate of autism (within confidence intervals of 60 per 10,000), but found no significant environmental toxins. They were very thorough as I understand it.
"I would say that this is rather for hardship of doing such a study. It would be a lot of work, even in a relatively small geographical study. That sort of detailed epidemiology is rare in any field of study."
I strongly disagree with you on this one. Our government has tremendous resources. If they could do a study that would essentially prove that the rate of autism has been constant for the last 50 years, that there is no epidemic, that vaccines couldn't possibly cause autism they would do this study. I think they would do it so fast your head would spin. You say this epidemiology is rare but didn't Croen just recently attempt to do it? It just needs to be done honestly and accurately.
You say it was done by Fombonne in 2005 but diagnostic substition does not seem to be part of their study. Can you send me a link to the study? And didn't the rate of autism start increasing in the late 80's and early 90's? I think their study would be much more credible if they included something like the early to mid 80's. If the numbers were stable from the early 80's and onwards in the area they studied I suspect they would have included that in their study.
"Also, re this logic, I could ask why isn't there a decrease in autism? After all, the whole country was basically powered by coal burning plants in days gone by."
Do you have data on the amount of mercury emitted by power plants over time? You seem to be implying that it is decreasing. You may be right but I'd like to see data to support that. Also, even if the yearly emissions is decreasing - and I don't know that it is - the cumulative amount of mercury would still be increasing. Right?
Regarding the article by Rita Eagle who is claiming that diagnostic substitution is responsible for the increase in autism. Like I state above, if she is correct and children previously diagnosed as OCD are now diagnosed as autistic you would see that in the data. The clinical anecdotes she is relying on mean nothing.
"I strongly disagree with you on this one. Our government has tremendous resources. If they could do a study that would essentially prove that the rate of autism has been constant for the last 50 years, that there is no epidemic, that vaccines couldn't possibly cause autism they would do this study." I think they would do it so fast your head would spin."
When we invoke an explanation that comes after the fact and in the absence of evidence it is called "ad hoc" reasoning and it considered a logical fallacy. Up to you whether you will use this rationale.
You wrote "You say this epidemiology is rare but didn't Croen just recently attempt to do it? It just needs to be done honestly and accurately."
No, Croen et al. (2001) looked at pre-set data, that is uncontrolled for poor precision, sampling error, variability in measurement, selection bias, information bias, and confounding. These are the exact same issues that are present in Blaxill et al. response. Neither succeeded in that regard. This is not comparable to Chakrabarti & Fombonne (2005) which controlled for the above.
"You say it was done by Fombonne in 2005 but diagnostic substition does not seem to be part of their study. Can you send me a link to the study? And didn't the rate of autism start increasing in the late 80's and early 90's? I think their study would be much more credible if they included something like the early to mid 80's. If the numbers were stable from the early 80's and onwards in the area they studied I suspect they would have included that in their study."
Chakrabarti & Fombonne (2005) http://ajp.psychiatryonline.org/cgi/content/full/162/6/1133
make the new categories + altered criteria + better diagnsotic tools in mid 90s + more awareness, tenable as they rule out a change in autism prevalence in the 90s.
They showed that the prevalence rate was the same between birth cohorts at the point where we should expect to see the biggest change. The rate was not exactly the same (it went up in the 2005 version) but the rates were well within the confidence intervals.
They show a prevalence rate that didn't change (contrary to what we would predict via the DDS and IDEA data). This is (in fact) the exact same rate as has been found in the US and the Japan, and (I have heard the data should be out soon) Canada.
Also, remember these authors were screening pre-school aged children at the time of study. If you wanted them to study kids born in 1988, then you would need a time machine to tell them to screen them in 1993.
Also, the first spike occurred in 1987 which coincided with the DSM-III-R and the famous Lovaas (1987) study. It was high and stable for a year or two, then it dropped until 1992, when it spiked again and then dropped, and then spiked again in 1997. Then it dropped until 1999. The descriptive epidemiology has behaved like this in the years post 2000 as well. Its is not cyclical, though the ranges are too random.
You wrote "Do you have data on the amount of mercury emitted by power plants over time? You seem to be implying that it is decreasing. You may be right but I'd like to see data to support that. Also, even if the yearly emissions is decreasing - and I don't know that it is - the cumulative amount of mercury would still be increasing. Right?"
As you like http://en.wikipedia.org/wiki/Image:Mercury_fremont_ice_core.png
You write "Regarding the article by Rita Eagle who is claiming that diagnostic substitution is responsible for the increase in autism. Like I state above, if she is correct and children previously diagnosed as OCD are now diagnosed as autistic you would see that in the data. The clinical anecdotes she is relying on mean nothing."
No, they mean something rather specific. They are a testable hypothesis that can be potentially disproven, so they are a scientific hypothesis.
However, one would have to go out and do the epidemiology. You can not produce a refutation to her statment via the CDDS or IDEA data neither of which records the relevant data.
"When we invoke an explanation that comes after the fact and in the absence of evidence it is called "ad hoc" reasoning and it considered a logical fallacy. Up to you whether you will use this rationale."
I have read the CDC Simpsonwood & the IOM transcripts. There is a great deal of evidence that these people did not want to see an adverse outcome. The CDC are the people who created the vaccine schedule and essentially made it a mandate. Do you disagree that these people would want to exonerate vaccines? If you don't see that I have some bridges that I'd like to sell to you.
"No, Croen et al. (2001) looked at pre-set data, that is uncontrolled for poor precision, sampling error, variability in measurement, selection bias, information bias, and confounding. These are the exact same issues that are present in Blaxill et al. response."
I would be very interested to hear your opinion of the CDC Verstraeten study.
"They showed that the prevalence rate was the same between birth cohorts at the point where we should expect to see the biggest change."
I think our definitions of where we should expect to see the biggest change are a bit different. In the US the vaccine schedule changed in the late 80's and early 90's. The rate of autism increased dramatically from the mid 80's to the mid 90's. That is the point where I expect to see the biggest change. If there was a study that showed the prevalence rate was actually the same in 1985 as compared to 1995 now that would be something. I'm assuming the vaccine schedule change happened around the same time in the UK. So even if the Fombonne study was performed with all of the i's dotted and the t's crossed, I'm not getting why it's important. You say it refutes my claim that there are no studies to prove the numbers aren't increasing. I don't see it that way at all.
"No, they mean something rather specific. They are a testable hypothesis that can be potentially disproven, so they are a scientific hypothesis."
"However, one would have to go out and do the epidemiology. You can not produce a refutation to her statment via the CDDS or IDEA data neither of which records the relevant data."
If someone wants to argue that the increase is due to diagnostic substitution then there should be a study to support it. It would have to go back before the 1987 spike and show how the numbers pre-1987 are actually the same as what we are seeing today due to diagnostic substitution. That's all I'm saying. The Croen study doesn't do it and the Fombonne study doesn't either, although I'll accept your endorsement that their study is well done and scientifically valid. In the absence of such a study I really don't see how you can continue arguing that the increase is not real.
"As you like http://en.wikipedia.org/wiki/Image:Mercury_fremont_ice_core.png"
So please help me understand what I'm looking at. Is that the amount of mercury emitted each year? I'm assuming it's not a running total. I have no idea what happens to the mercury after it's produced. How long does it remain in the environment as a harmful toxin? What I'm getting at is, even if the yearly emissions have dropped recently is there more of a mercury burden today than there was 10 years ago?
Interesting website and insight into another world-view... Reflections from one who feels we are playing "Whack a Mole".
Related to the above... "The E.C.H.O. Foundation will be offering FREE consultations for a minumum dontion of $50.00"
There seems to be some altered world view that equates "FREE" with a minimum "donation."
Apparently, you failed to see my response to Jim. Detective Laidler failed to notice a difference in our email addresses. Not that it matters, but I'm not the person Jim mentions in that email. But I'm certainly touched to see that you are thinking about me. Now if you wouldn't mind staying focused on the subject...
You wrote "I have read the CDC Simpsonwood & the IOM transcripts. There is a great deal of evidence that these people did not want to see an adverse outcome. The CDC are the people who created the vaccine schedule and essentially made it a mandate. Do you disagree that these people would want to exonerate vaccines?."
I have also read those transcripts, there is nothing in them that is outside of a bog standard discussion of
interpretation. I am involved in a large correlational study (not about autism or any medical issue) at the moment. The sort of discussion looks pretty typical to me for a correlation study.
I have no problem admitting that the CDC and the IOM have a conflict of interest in this case. There is no problem if we simply state this fact. However, to say that they have lied due to this fact (and in the absense of evidence) is no different than any other sort of bog standard conspiracy theory.
You wrote "I would be very interested to hear your opinion of the CDC Verstraeten study."
You write "I think our definitions of where we should expect to see the biggest change are a bit different. In the US the vaccine schedule changed in the late 80's and early 90's. The rate of autism increased dramatically from the mid 80's to the mid 90's. That is the point where I expect to see the biggest change."
Noted, but that is not what we see.
"If there was a study that showed the prevalence rate was actually the same in 1985 as compared to 1995 now that would be something. I'm assuming the vaccine schedule change happened around the same time in the UK. So even if the Fombonne study was performed with all of the i's dotted and the t's crossed, I'm not getting why it's important. You say it refutes my claim that there are no studies to prove the numbers aren't increasing. I don't see it that way at all."
Is that all it will take? There are all sorts of studies within a few points of each other over ten years between the 80s and 90s. Heck, I can find the same prevalence in 1997 and 1983 via two studies.
Chakrabarti & Fombonne show that the prevalence rate among pre-schoolers didn't increase over the 90s. This shows that the numbers didn't change during the 90s. This rather directly refutes your statement.
"If someone wants to argue that the increase is due to diagnostic substitution then there should be a study to support it. It would have to go back before the 1987 spike and show how the numbers pre-1987 are actually the same as what we are seeing today due to diagnostic substitution. That's all I'm saying. The Croen study doesn't do it and the Fombonne study doesn't either, although I'll accept your endorsement that their study is well done and scientifically valid. In the absence of such a study I really don't see how you can continue arguing that the increase is not real."
The meaningful change happens in the 90s, and years post 2000. You have no big time icnreases, if that is taken away.
What you could conclude if those years are taken away is that there was a spike in 1987 followee by a dip in 1989. So, no epidemicthat way either.
"So please help me understand what I'm looking at. Is that the amount of mercury emitted each year? I'm assuming it's not a running total. I have no idea what happens to the mercury after it's produced. How long does it remain in the environment as a harmful toxin? What I'm getting at is, even if the yearly emissions have dropped recently is there more of a mercury burden today than there was 10 years ago?"
Yes, that is amount of mercury in the atmosphere in a given year. If we refer to this chart than we see major spikes (following major volcanic activity) always go down to more normal rate the next year. So, yes, there is less mercury today compared to ten years ago.
Now for some history:
All the major spikes in that graph (they are blue) are volcanic. Remember, these were very sigificant events. Mt. St. Helens errupted with the force of 500 Hiroshima sized atomic bombs. Krakatau, caused such a bang that it made water slosh in the English channel on the other side of planet.
The most powerful of these was Tambora. It caused the "year without summer" or "eighteen hundred and froze to death" due to the ash from its erruption. It probably also helped usher in the marked cold during the 1800s which has been called a "little ice age". Lord Byron wrote that year "I had a dream, which was not all a dream. The bright sun was extinguish'd, and the stars did wander"
I thought it was the mercury (thimerosal) in the 'Killer Jabs' in question but if you want to blame autism on mercury from coal fired power plants, let's review a few details.
In issuing the Clean Air Mercury Rule this past March, the Bush administration hoped to ease health concerns about mercury from coal-fired power plants. The White House enacted a "cap and trade" approach to reduce emissions of the element nationwide by about 20 percent in five years and 70 percent by 2018. In formulating its rule, the administration noted that power plants emit only 48 tons of the metal every year--just a small fraction of the total amount of mercury in the atmosphere. Mandating further emission cuts, it argued, would not solve the problem of human exposure to the neurotoxin.
"We don't think there will be any hot spots." The hot-spot standoff arises from big gaps in mercury science, according to environmental researchers, and the lack of comprehensive data on mercury deposition means that a consensus about emissions control will not likely emerge soon.
Theoretically, mercury should pref-erentially rain down in areas near to power plants. But attempts to determine the fallout have proved incomplete. For instance, the Mercury Deposition Network, which measures the metal in rainwater in many parts of the country, does not account for mercury particulates that settle dry onto vegetation, a form of deposition that could be equal to the wet variety, according to Oak Ridge National Laboratory scientist Steve Lindberg.
[...]And just because a region receives above-average deposition doesn't mean that it will have high levels of methyl mercury, the form that builds up in long-lived predatory fish such as trout, pike, tuna and swordfish. "The areas with the most problems may not have the highest levels of deposition," explains mercury expert David Krabbenhoft of the U.S. Geological Survey branch office in Middleton, Wis. Indeed,
[...]Scientists hope that this information and other advances may resolve the hot-spot debate and demonstrate the wisdom or folly of the administration's approach to mercury regulation.
killerjabs: "Not that it matters, but I'm not the person Jim mentions in that email. "
Then get a more creative nickname.
"I have no problem admitting that the CDC and the IOM have a conflict of interest in this case. There is no problem if we simply state this fact. However, to say that they have lied due to this fact (and in the absense of evidence) is no different than any other sort of bog standard conspiracy theory."
I happen to believe that members of the CDC were not honest during the Verstraeten study. But that's not the point I was trying to make. I'm simply stating that given their obvious conflict of interest if given a choice they would greatly prefer to see vaccines proven to have no association with thimerosal. I'm not trying to convince you that they lied to do so. Just stating that an association would be an unpopular conclusion to the people that created the schedule. And if diagnostic substition could be proven to account for the increase in autism, which would restore public confidence in vaccines, I believe the CDC would do the study.
I'm referring to the VSD study. It's the US epidemiological study that the IOM partly relied on to announce their conclusion of no association - even though the details of their report that I pointed out earlier seem to indicate otherwise. It's the one where the Relative Risk of autism decreases from over 7 down to 0 over 5 iterations and over 4 years.
"Noted, but that is not what we see."
I'm confused. The rate of autism in the 80's was something like 1-2 per 10,000 and didn't it jump to something like 1 in 500 in the 90's?
"Is that all it will take? There are all sorts of studies within a few points of each other over ten years between the 80s and 90s. Heck, I can find the same prevalence in 1997 and 1983 via two studies."
Where are those studies from? Are you able to apply whatever was learned from those two studies to the increasing rates all over the US? For example, if Croen was right about MR or if Eagle was right about OCD diagnostic substitution then it should explain the increase in California, in Georgia, in NJ, etc... We should be able to apply their argument to any of the areas that have had an exponential growth in autism and at least for the diagnostic substitution argument it should be provable by data analysis. When I start seeing valid studies of places like California that clearly show that diagnostic substitution was responsible for a large percentage of the increase I'll take it seriously. Until that happens your only argument is increased awareness and better diagnosis. And I'm not arguing that those things haven't contributed to the numbers.
"So, yes, there is less mercury today compared to ten years ago."
You may be right but here's some info from the Tennessee Valley Authority on mercury emissions that somewhat contradicts what you are saying: http://www.tva.gov/environment/air/ontheair/merc_emis.htm#anchor3
Mercury is a global problem to which re-emissions from past activities contribute.
Once released into the environment, the cycling of mercury is very complex and not well understood. Mercury never breaks down into another element; it always remains as mercury. Mercury is a volatile, heavy metal, and, as such, can be re-emitted into the atmosphere from land and water surfaces repeatedly after its initial release into the environment. Estimates of the magnitude of re-emission are very difficult to quantify. But there is no disputing that re-emission is a major source of total modern-day mercury emissions. Consequently, much of the mercury circulating through today's environment is mercury that was released decades or centuries ago, when mercury was commonly used in many industrial, commercial, and residential products and processes.
"I thought it was the mercury (thimerosal) in the 'Killer Jabs' in question but if you want to blame autism on mercury from coal fired power plants, let's review a few details."
I wasn't blaming autism on mercury from power plants. I agree with the AAP that mercury from power plants is dangerous to people. I also think it's hypocritical for the AAP to sue to reduce mercury exposure from power plants while they fight to keep it in vaccines. Unfortunately the pediatrician who was on this list avoided that question.
You write "I'm confused. The rate of autism in the 80's was something like 1-2 per 10,000 and didn't it jump to something like 1 in 500 in the 90's?"
No, it was just over ten for the whole ASD in the 80s. In fact the prevalence has never been 1 per 10,000 except for two studies studying just Autistic Disorder (one in the 70s and one in the 80s) that used similar and highly restrictive criteria. Those studies contradicted other studies of that period and are outside of their confidence intervals. One used Kanner's criteria and one used Rutter's.
You write "Where are those studies from? Are you able to apply whatever was learned from those two studies to the increasing rates all over the US?"
Sweden and Norway. US specific autism epidemiology was scarce during the 80s and 90s, also there was no autism IDEA or CDDS data yet, in the 80s as well. The Swedish study applied rather nicely as it is within confidence intervals (but higher) than the two US studies from the period. In other words, the Swedish study from 1983 is higher than the US study in 1989. Also, Japan and Canada had rates almost 80-90% higher than the US during the same years.
You write "For example, if Croen was right about MR or if Eagle was right about OCD diagnostic substitution then it should explain the increase in California, in Georgia, in NJ, etc... We should be able to apply their argument to any of the areas that have had an exponential growth in autism and at least for the diagnostic substitution argument it should be provable by data analysis. When I start seeing valid studies of places like California that clearly show that diagnostic substitution was responsible for a large percentage of the increase I'll take it seriously. Until that happens your only argument is increased awareness and better diagnosis. And I'm not arguing that those things haven't contributed to the numbers."
Diagnostic substitution is a possible mechanism, but is still theory. What is not theoretical is the autism prevalence never changed in the 90s, that is established science, and will require well controlled contradictory science to disprove it.
You quoted "Mercury is a global problem to which re-emissions from past activities contribute.
Once released into the environment, the cycling of mercury is very complex and not well understood. Mercury never breaks down into another element; it always remains as mercury. Mercury is a volatile, heavy metal, and, as such, can be re-emitted into the atmosphere from land and water surfaces repeatedly after its initial release into the environment. Estimates of the magnitude of re-emission are very difficult to quantify. But there is no disputing that re-emission is a major source of total modern-day mercury emissions. Consequently, much of the mercury circulating through today's environment is mercury that was released decades or centuries ago, when mercury was commonly used in many industrial, commercial, and residential products and processes."
Yes, but that does not contradict what I say. It just states that it never goes away (true enough) that is not same as saying that it will be perpetually atmosphere bound. Yellowstone National Park is the site of Superplume volcano which erupts cataclysmically every 600,000 years or so, the last one occurred 630,000 years ago (yeah, it is due) and blew a 60 mile gap in the Gallatins mountain range. Several erruptions before that it achieved a scale 2,500 to 8,000 times more powerful than Mt. St. Helens. The most recent superplume eruption was at Toba in Sumatra 74,000 years ago, it was followed by at least 6 years of volcanic winter (we know from the ice cores) and probably contributed to health of the last ice age.
I imagine humans came pretty close to checking out from the outgassing alone in that time. The mercury would have poisoned plants and animals as well in that period. However, as one can see from the ice cores chart, these spikes don't last.
Okay, I just re-read Verstraeten et al (2003).
Verstraeten is a massive study that uses HMO VSD data.
There are a number of problems concerning threats to precision within it.
Precision issues: Some of the age ranges (26 months) are little young, still appropriate, but a little young and just below the mean age of daignosis, maybe those cohirst shouldot have been included. The authors also note there are some differences between HMOs. That is a problem.
Also, some of the disorders they looked at were ill defined. What is an emotional disturbance? How is it quantified and defined? They don't explain.
Also, some of the dates they selected a priori are a bit abitrary.
Also, I hear tell that the CDC has lost this data. The authors need to find it or consider retracting the study.
The authors themselves take a reasonable view in their conclusion, although they find a non-correlation they encourage other studies on this matter. I think that is quite fair. Their results are justified by their statistical analysis however, which is at odds with claims of the Geiers.
"No, it was just over ten for the whole ASD in the 80s. In fact the prevalence has never been 1 per 10,000 except for two studies studying just Autistic Disorder (one in the 70s and one in the 80s) that used similar and highly restrictive criteria. Those studies contradicted other studies of that period and are outside of their confidence intervals. One used Kanner's criteria and one used Rutter's."
"What is not theoretical is the autism prevalence never changed in the 90s, that is established science, and will require well controlled contradictory science to disprove it."
Here is a link to a paper published by Mark Blaxill that looks at multiple autism papers over the years. It seems to show that autism in the US started to increase in the
late 80's and kept on increasing through the 90's.
I appreciate you reading the Verstaeten study. This study is probably one of the primary reasons why parents like me distrust the CDC. If the study truly showed a non-correlation, why would they "lose" the data making it impossible for replication? Here is a link to a SafeMinds analysis of the study: http://www.safeminds.org/research/library/VSD_SafeMinds_critique.pdf Even though you found faults with the study I suspect it is much worse than you think.
As I stated above, the Danish studies are equally disturbing. Here are SafeMinds analysis of those studies:
Forgot to post the link to the Blaxill study: http://www.safeminds.org/research/library/The-Question-of-Time-Trends-i…
Just popping for a moment with a couple of questions to ponder the quality and type of research being used here:
What exactly are Blaxill's qualifications? Where did he go to medical school?
Is he more or less qualified than the Geiers?
The VAERS is a collection of anecdotes. The plural of anecdote is NOT data. What it can do is point to a direction of legitimate study. It is also biased, with the help of those who actually pay the Geiers, personal injury lawyers. This has been pointed out, but it seems to get lost in a pile of rhetoric.
So are the Geiers and Blaxill doing real science or are the doing Armdhair Science?
You obviously knew the answer before you asked the question, but no, Mark Blaxill did not go to medical school. He has an MBA, I believe from Harvard. I didn't realize one needed to go to medical school to become qualified to perform statistical analysis of epidemiology. His critique of Croen was certainly right on - even Croen agreed.
Why you seek to compare him to the Geier's is beyond me. It seems childish, like your remark to me to be more creative with my nicknames. Ironically, if you looked at the resume of the elder Geier you may actually find the qualifications you seek.
The SafeMinds links that I provided above have nothing to do with VAERS so I'm not sure why you mentioned it. You really show your true colors by focusing on the Geier's conflict of interest as a result of their testimonies regarding adverse vaccine reactions. WHAT ABOUT THE CONFLICTS OF INTEREST IN THE STUDIES THAT YOU SO DEARLY HOLD UP AS PROOF OF NO LINK? The CDC sets the vaccine schedule and tests for its safety. The vaccine industry was involved in the VSD study. It is no different than asking the tobacco industry to study the safety of cigarettes. The Danish studies were conducted by Danish vaccine makers. These are the studies that the IOM used to make their decision. I suggest you think about these conflicts of interest before you go slamming the Geier's in the future.
I do not consider the Danish studies valid, however, I would never want my name next to these SafeMinds reports as they make inferences about those authors honesty. SafeMinds, does this again and again and again. It erodes their credibility. They should stick to the supportable points. I lost my respect for that organization some time ago for this reason.
Thanks for the SafeMinds critique. They note several of the precision errors I noticed and one that I missed. However, I am sorry to say that I was not very impressed. In this critique they are making very fundamental claims about the honesty of the authors. They should have stuck to their major points. It would have been more effective, instead they water this down with inferences and not unsupported conclusions. That was foolish of them.
I am going to tear into this:
They circle a quote in red "as we expect a bias towards the null". Okay, that is not as uncommon as one might think. It increases the odds of what is called a type II error (beta) which is to accept the null hypothesis when we should reject it. There are ways it can be adjusted for.
The authors of the critique have made some claims of what these data actually show in their re-analysis. Okay, so what dates did they modify and why? Also, where are their formulae and graphs? I want to see these. They should be included, why aren't they? Maybe a few less quotes and a few more data calculations would be nice.
Finally their inferences about the CDC's deliberate manipulation of data, is not supported by their quotes or by their data (from what I can tell).
Moving on to Blaxill's report on the changing prevalence over the years. Hey! He gets the prevalence for Autistic Disorder in the 70s correct. That is better than just about all his peers. However, he flubs recognizing that the PDDs have changed as well. So, he is comparing apples and trilobites. That is just in the Abstract.
So what is the mean of all the PDD studies from the 70s through the 90s? Okay, well 70s = 13.7; 80s = 8.5; and 90s = 13.75. So, in thirty years we have a grand total change in the PDD's of (.05). You have to wait until the years post 1999 to see the real change.
Okay, so in general Blaxill produces a genuine solid article in terms of his review of literature (it is actually very good). Then he gets to his conclusion and here he is making conclusions that are not supported by his lit review. He does not supply evidence for what he concludes.
One more comment on the SafeMinds VSD critique - The link I provided above (http://www.safeminds.org/research/library/VSD_SafeMinds_critique.pdf) was produced before the VSD Generation Zero documents were obtained via the Freedom of Information Act (FOIA). Generation Zero is the first cut at the data attempted by Verstraeten. What he found in that first pass, before all the changes occured, is pretty shocking (Relative risk of autism in the high exposure group was as high as 11 times the risk in the zero exposure group). Here is the SafeMinds critique of Generation Zero:
Not quite. Statens Serums Institut has no real reason to cover up a link between vaccines and diseases, as explained in the link.
KillerJabs keep up the good work! The ignorance here is troubling.
Once again SafeMinds leaps to unsupported conclusions. How in the heck did they conclude that the words of Verstraeten = coverup?
I really appreciate your honesty.
I have mixed feelings regarding your comments about SafeMinds' statements about the authors honesty. Scientifically speaking, you're absolutely correct. But the changes that the authors made to the study, the quotes that tell us what they were saying about it and the fact that they have "lost" their datasets tells me that there should be an investigation. There was recently talk of a Senate investigation so it may still happen but who knows. But I do see your point. And I agree it would be good to see how SafeMinds came to their conclusions.
Regarding no support for the CDC manipulation of data by SafeMinds - Have you read the Generation Zero critique? The relative risk for autism decreases from 11 to 0 by the time the study is published. The "you can push I can pull" quote seems directly related to their ability to decrease the statistical significance of an adverse effect. If there was no data manipulation, why is the final report so different than the early generations? I think we both agree that the VSD study contains numerous errors. You have an issue with SafeMinds inferring that these errors were intentional data manipulation to produce the results that they wanted. That's fine and I'm not inclined to argue that with you. The point is that this study and those Danish studies were used by the IOM to reach a conclusion of no association. I find it very odd that the IOM was unable to discover the problems with these studies as you were so easily able to do. How could the IOM look at these studies and be so sure there is no link to make them declare we should focus on more promising avenues of research? It's mind boggling.
I can't speak to your questions about the PDD's in Blaxill's study. Are you able to submit comments to it since I believe it is published? Perhaps you can get Blaxill to give you a reply.
"Once again SafeMinds leaps to unsupported conclusions. How in the heck did they conclude that the words of Verstraeten = coverup?"
I tried to cover this general topic above. It's not just one set of words by Verstraeten. It's a lot of things taken together. But regardless of whether you believe there has been a coverup, there have been terrible errors in these studies which were used as input by the IOM to make a very important decision regarding vaccines & autism.
Blaxill was published in 2004 and is now probably out of range for comments.
I do not agree with the IOM conclusion that no more research should be done on this issue. However, I do agree with the IOM that the evidence does at this time does not support a thimerosal connection.
The quote "You can push I can pull" seems to be a warning to be careful in designing the correlational design. It is easy to accidently upset the data.
Fair enough for now.
What gets me is that nobody's called jabs on her(?) attempt to change the subject off the issue of expanded criteria.
Because in all the statistics showing increased numbers - someone like me is in them.
But I've got Asperger's, and I can pass rather effectively, at that.
I technically got assistance from the college I go to - specifically, they allowed me to register for classes early. The one I'll be going to for my PhD isn't, to my knowledge, aware of my diagnosis.
And yet, if people were using Pennsylvania instead of California for the autism prevalence stats, I would be in them - and I would have been a "new case" about five years ago!
Meanwhile, my sister has a dual diagnosis - MR and autism. You think she would have gotten an autism diagnosis a few decades ago? I don't - I think she would have had an MR diagnosis and that's it.
But she still has the MR diagnosis... which leads back to why tracking the percentage of MR+autism is meaningless.
What you have to look at there is the percentage of people with one diagnosis who also have the other diagnosis. And the percentage of people with ASD diagnoses who also have MR diagnoses has been going down - but the percentage of MR diagnoses in the general population has been holding pretty steady.
The way I see it, there's two possible explanations. Either autism has been getting less severe over time (in which case we don't need to worry! given enough time, everyone will be autistic, but nobody will be affected by it), or ... well, the criteria have been expanding so that people who used to not be considered autistic now are.
(Remember, that 1 in 166 stat includes Asperger's and PDD-NOS as well as autism.)
1. The original VSD data is available. That is a fallacy that continues to be perpetrated by SafeMinds - there were datasets that were destroyed, but those were the Geiers' datasets. Even if for some reason said datasets were destroyed, how hard would it be to get new data and run the same analysis?
2. The FDA tests vaccines for safety, not the CDC. The CDC only makes vaccine schedule recommendations that individual states can choose to adopt. The notion that the "vaccine industry" was involved with the VSD study is a pretty big stretch.
3. The idea that the relative autism risk changed during the course of the VSD study is nothing dramatic. The CDC has said on numerous occasions that the initial analyses of the data involved flawed datasets (duplicate and incomplete records, for example) and also had numerous potential confounders as well. The obvious question, as Johnathan points out, is whether the precision errors invalidate the study. I don't believe that to be the case.
Regarding the VSD study you said:
"The authors themselves take a reasonable view in their conclusion, although they find a non-correlation they encourage other studies on this matter. I think that is quite fair."
But did you know the lead author in the study is on record calling the study neutral, not a negative, non-correlation as most people assume. Here is a link to Verstraeten's letter to Pediatrics where he discusses this: http://pediatrics.aappublications.org/cgi/content/full/113/4/932
"Not quite. Statens Serums Institut has no real reason to cover up a link between vaccines and diseases, as explained in the link."
That link states right up front that there are no issues with the methodology of the Danish studies. Have you actually looked at the critiques of those studies? I posted them. Jonathan looked at them and decided that they are not valid.
You say Statens Serums Institut has no real reason to cover up a link between vaccines and diseases. Isn't the fact that they generate revenue from the sale of vaccines a real reason? Surely you have to see that as a conflict of interest. If not, I'd be interested to hear why not.
"Blaxill was published in 2004 and is now probably out of range for comments."
I will try to get in touch with him about this although I can't guarantee a response.
"I do not agree with the IOM conclusion that no more research should be done on this issue. However, I do agree with the IOM that the evidence does at this time does not support a thimerosal connection."
Stating the evidence does not support a thimerosal connection is a very strong statement when 3/5 (2 Danish, 1 American) of the epidemiological studies are not valid (Danish) or are neutral studies (VSD). A statement that the evidence was inadequate to accept or reject a causal relationship would have made more sense in my opinion.
"The quote "You can push I can pull" seems to be a warning to be careful in designing the correlational design. It is easy to accidently upset the data."
Jonathan, I think you could make a strong case that Dr. Philip Rhodes goes out of his way to change the methodology in order to change an unpopular result. First, he gets rid of the low mercury exposure group and the group of children with the highest mercury exposure. He acknowledges that the highest mercury exposure group has an unusually high percentage of outcomes. This makes no sense to me. If the purpose of the study is to look at the effect of thimerosal wouldn't you want to compare the highest thimerosal exposure to the lowest?
Then he adds children back into the pool who were initially excluded based on prematurity exclusion codes. The Safe Minds critique states this strategy adds "noise" to the study and reduces the strength of the signal. Here is Dr. Philip Rhodes' quote on this topic:
"Now I take all those kids that Tom has excluded based on prematurity exclusion codes and throw them in. At one month I think there is some argument that is overdoing it. Throwing them all back in. I think there is a clear argument that is going too far, but that further brings things down."
So he acknowledges a clear argument against doing what he does. But he does it anyway because it further reduces the signal. Then the push/pull quote:
"So you can push, I can pull. But there has been substantial movement from this very highly significant result down to a fairly marginal result."
It seems to me that Dr. Rhodes made changes to the methodology that he knew were inappropriate in order to reduce a highly significant result.
I haven't tried to change the subject off of expanded criteria. Lots of things are getting discussed simultaneously.
1. The VSD study done by the CDC should be allowed to be replicated by independent researchers. Without the datasets, that will be nearly impossible.
2. The CDC uses the VSD database as a way to find adverse reactions and test for vaccine safety.
3. You are certainly entitled to read all of the VSD critiques and conclude the study to be valid. But even if it's valid, according to the lead author it is only a neutral study.
Some great news to share with everyone!
Congress enacted legislation aimed at investigating the link between thimerosal and autism. Looks like we may just get an independent review of the VSD after all!
Here is a link to the letter Congress sent to the National Institute of Environmental Health Services (NIEHS):
Yes, I know Verstraeten, called the study neutral, I may have even mentioned that here somewhere, (or not).
It has been 6-7 (if memory serves) years since Rimland and company came out with their original paper outlining the possibility of mercury etiology of autism. In that time where are the necessary and formalized proofs which should be collected?
I am talking about the stuff beyond anecdote and film footage; that is stuff I can turn on the television and watch as some evangelist does faith healing.
A great way to do religion is summarized by the clichÃ© "Absence of evidence, is not evidence of absence", however, it is a poor way to do science.
So, I re-assert my statement "I do agree with the IOM that the evidence does at this time does not support a thimerosal connection." Remember, the 4 studies you name, were not he only ones talked about by the IOM and there have been more since.
I don't know enough about Dr. Rhodes decision to make a supportable statement either way about it. Please tell me more.
However, it is definitely not clear that he is trying to obscure anything.
I am neutral to the fact that Congress enacted legislation to allow better access to the VSD. It a good thing if allows good researchers more access to the VSD. It is a bad thing if the access will be so open that patient confidentiality will be endangered (Congresses, track record with protecting privacy hasn't been stellar these past few years).
I am willing to wait and see, but my gut tells me I am about to see more bog standard fallacious science from the Geiers.
Here is a link to several studies that support a vaccine/mercury autism link: http://www.generationrescue.org/evidence_reports.html
"So, I re-assert my statement "I do agree with the IOM that the evidence does at this time does not support a thimerosal connection." Remember, the 4 studies you name, were not he only ones talked about by the IOM"
Here is a direct quote from the IOM report discussing how they came to their conclusion (http://fermat.nap.edu/books/030909237X/html/6.html)
Epidemiological studies examining TCVs and autism, including three controlled observational studies (Hviid et al., 2003; Miller, 2004; Verstraeten et al., 2003) and two uncontrolled observational studies (Madsen et al., 2003; Stehr-Green et al., 2003), consistently provided evidence of no association between TCVs and autism, despite the fact that these studies utilized different methods and examined different populations (in Sweden, Denmark, the United States, and the United Kingdom). Other studies reported findings of an association. These include two ecological studies4 (Geier and Geier, 2003a, 2004a), three studies using passive reporting data (Geier and Geier, 2003a,b,d) one unpublished study using Vaccine Safety Datalink (VSD) data (Geier and Geier, 2004b,c), and one
unpublished uncontrolled study (Blaxill, 2001). However, the studies by Geier and Geier cited above have serious methodological flaws and their analytic methods were nontransparent, making their results uninterpretable, and therefore noncontributory with respect to causality (see text for full discussion). The study by Blaxill is uninformative with respect to causality because of its methodological limitations. Thus, based on this body of evidence, the committee concludes that the evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism.
So the IOM made their decision on the invalid Danish studies, a neutral US study, and the Swedish & UK study. The Swedish study makes some of the same errors as the Danish study but we haven't focused too much on that. The UK study was never really critiqued by Safe Minds so I can't really speak to that one. Even if you want to count that one as evidence against a link, I still don't see how that single study could supply enough weight to make a statement like this. Remember, Verstaeten called the US study neutral because the first, large HMO showed a statistical link between thimerosal and autism while the smaller HMO did not show a link. So if you have 2 or 3 studies that don't show a link and one study that does show a link I don't see how they could make such a strong statement.
I made contact with Mark Blaxill and have some responses to your comments.
"On the question of the changing definition of PDDs, the ONLY thing that has changed has been the inclusion of Asperger's Syndrome in the PDDs. Everything else has changed and the DSM IV was designed to TIGHTEN the definition. I make this point pretty clearly in both the review and the presentation. So the apples and oranges criticism is unfair."
"My main argument is this. If you want to argue that the reported increases are an artifact, that's a STRONG, very aggressive hypothesis. It should be subjected to rigorous testing. The hypothesis (and it's three main variants: diagnostic oversight, diagnostic substitution and diagnostic expansion) fails every test."
"Regarding the means, sounds like he's quoting rates based on dates of publication, a classic error I point out in my article."
"As to the question about the VSD critique, not sure what they're talking about. I put lots of charts and clear labels in there. We don't have access to any of the VSD calculations or raw data, so the only thing one can critique is the output. And that's impossible to do definitively without access to the underlying data."
"one point I neglected to make in my time trends discussion is that the study by Byrd et al (looking at the CA populations) was an important falsification of the "diagnostic expansion" hypothesis. Autism populations born in the 80s and 90s met diagnostic criteria in exactly the same way, which is not consistent with the claim of doctors doling out "easy" diagnosis of autism"
Jonathan, regarding the VSD questions here are links to the CDC documents that Mark presumably uses to create his critique. Perhaps this will help to answer some of your questions. There is actually quite a bit of information at the Safe Minds site. You may want to poke around.
I have seen that GR research list many a time. I don't think they are a good list of proofs. There are good critiques for each. I will critique them very briefly by number. I have read every single one of these articles (they are not all research).
1. This is not research.
2. This means nothing by itself.
3. There seven threats to internal validity, this study fails to control for every single one.
4. Looks good, but doesn't answer to what extent and for hoe long.
5. The GR statement exceeds what this study states.
6. Dr. Hornig's statement about "autistic behavior" in her mice is absurd.
7. Okay, but I don't understand why Dr. Focuses on autistic disorder instead of Retts, which requires behavioral regression and is known to be related to RNA methylation.
8. This is contradicted by large amount of rsearch.
9. The Geier's had their IRB approval yanked over this.
10. Newschaffer is using the IDEA, which is just as poor a data source as the CDDS.
11. So, does a lot else.
12. The controls in this study had highly elevated levels of mercury. Not very intuitive.
13. Same as # 11
14. There is problems with selection and assignment in this study.
15. Texas sharpshooting at its finest.
16. But a link between autoimmune and ethylmercury is not enough by itself.
18. This is a review of literature, not an empirical study.
19. Blaxill et al use the median, to calculate the error range of Croen et al. That was not a good idea.
20. This isn't a study.
21.We already spoke about this.
22. Not a study
23. Not a study
24.Not refereed and not controlled
25. Not a study
26.Not a study
The novel form of mercury poisoning crew needs to offer real evidence. Reports to congress are not going to cut it. Observational biology research in terms of pointing out that thimerosal can damage nerve cells (so does alcohol) is not going to cut it. Half hearted and uncontrolled measures of chelation or specific diet is not going to cut it. Correlation using the VAERS, CDDS, and IDEA (or some other uncontrolled data set) is not going to cut it.
They will need full on, well controlled descriptive epidemiology, and controlled trials of chelation. Then they will convince the doubters and naysayers. Nothing else will cut it.
Certainly the MMR is out of the picture as a cause of increase thanks to Honda et al (2005). So, that is one down. Right now the best science on the issue is either neutral or against. And so at least one more time I will state "I do agree with the IOM that the evidence does at this time does not support a thimerosal connection". Maybe that will change if the researchers advocating this theory get their act together and do a well controlled study. I am still waiting.
Those studies may not be perfect, but taken together they are a growing body of evidence for an association. You say Burbacher's research means nothing by itself, but it does squash the popular myth that ethyl mercury is harmless b/c it quickly leaves the body. I would think that this study would be enough evidence for the CDC & AAP to take thimerosal out of vaccines.
You say in #12 that it is not intuitive for the controls to have highly elevated levels of mercury. Are you sure that the controls had highly elevated levels? They were high relative to the autistic group but I don't recall reading that they were highly elevated levels. The notion that autistic children are not able to excrete heavy metals supports the reduced glutathione findings by Jill James. I did a hair test to check for mercury on myself, my wife and my son (before starting the DAN protocol) back when Greenpeace? was doing these tests on the cheap to gather data. My wife and I were excreting normal amounts of mercury while my son was not excreting enough to even register on the test.
There is a chelation study underway. I look forward to it as well. Regarding epidemiology, hopefully this new Congressional directive will help to product that. In the meantime, we have the Generation Zero versions of the Verstraeten VSD study.
I do not agree that the MMR is out of the picture due to the Honda study.
Not to keep harping on this point, but the IOM made their statement based on the 5 epidemiological studies in the US, Denmark, Sweden & the UK. Those studies hardly qualify as good science.
"Certainly the MMR is out of the picture as a cause of increase thanks to Honda et al (2005). So, that is one down".
It's out of the picture? So, that is one down? Are you joking? One study and your through thinking about it? That's how it works for your side, right? Typical.
Actually there have been more than 17 studies on MMR showing its effectiveness and safety. The Honda was just the most recent.
Which should have been more than enough to counter the ONE study that was bought and paid for by lawyers, used test subjects provided by the lawyers (his clients), published in the Lancet... and later had all but a couple of its authors retract. But the effect of that "scare study" is that mumps is running rampant in the UK, and measles is making a comeback.
By the way, the MMR vaccine has been used in the USA since the early 1970's and has never contained thimerosal. During a time of low vaccine coverage between 1989 and 1991 over 120 people in the USA died from complications of the actual disease of measles (and at least 90% had NEVER been vaccinated with the MMR).
A list of the MMR studies and autism can be found here:
MMR and Autism Studies... and it has not even been updated to include the Honda study.
Do you have anything more substantial than claims without evidence?
You said: You say Burbacher's research means nothing by itself, but it does squash the popular myth that ethyl mercury is harmless b/c it quickly leaves the body.
There was never any question that some mercury from vaccines finds it way in to the brain, just as some mercury from other sources like fish does as well. Burbacher found that less mercury from thimerosal gets into the brain compared to methylmercury but there were no changes in brain structure like those found in children with autism and Burbacher did not report an toxic effects. I'm not saying it's a good thing, no body wants mercury in their brain, but the study does nothing to show that thimerosal is able to cause autism. Just because it was detectable using highly sensitive assays does not mean it reached levels know to be toxic.
You said: The notion that autistic children are not able to excrete heavy metals supports the reduced glutathione findings by Jill James.
How so? If you believe one to be true, one may appear to support the other but it's just as likely, maybe more likely, both are wrong.
You said: I did a hair test to check for mercury on myself, my wife and my son (before starting the DAN protocol) back when Greenpeace? was doing these tests on the cheap to gather data. My wife and I were excreting normal amounts of mercury while my son was not excreting enough to even register on the test.
Isn't it possible, and also more likely, that your son has less mercury intake and exposure than you and your wife and that he excretes less because he has less to excrete or less is deposited on his hair from environmental sources?
Speaking of Greenpeace:
"We examined several possible sources [of mercury], including dental amalgams and flu vaccines," said Patch. "We found little relationship between these sources and higher-than-average levels. But we did find a very strong relationship between fish consumption and elevated mercury."
"By the way, the MMR vaccine has been used in the USA since the early 1970's and has never contained thimerosal".
I know that, HCN. The point is that the possibility is still there that a baby who has an immature or non-functioning immune system (such as one which is compromised due to thimerosal-containing vaccs) the weakened "live virus" can cause horrific effects. Deal with and stop the denial.
Thanks for contacting Mt. Blaxill and sharing my thoughts and then his thoughts, which I have some comments on.
Mr. Blaxill writes "On the question of the changing definition of PDDs, the ONLY thing that has changed has been the inclusion of Asperger's Syndrome in the PDDs. Everything else has changed and the DSM IV was designed to TIGHTEN the definition. I make this point pretty clearly in both the review and the presentation. So the apples and oranges criticism is unfair.""
In 1980 in the DSM-III there were three categories Infantile Autism, Atypical Pervasive Developmental Disorder, and Childhood Onset Pervasive Developmental Disorder. ATDD was changed to PDD-NOS in the DSM-III-R in 1987.
In 1994 in DSM-IV, there was Autistic Disorder (loosened, not tightened from Infantile Autism), PDD-NOS (with fresh new modification from the last version, in fact Volkmar et al (2000) write that the changes were so broad that in field trials of the new criteria they over-identified by 75%. They reverted to the original DSM-III-R wording (but not criteria).
DSM-IV also added Asperger's Disorder, whose rate is not well established in descriptive epidemiology and which might be low 1-2 per 10,000 or quite high 30+ per 10,000.
Also they added Rett's Disorder which is stable in prevalence at 3.8 per 10,000 girls and Childhood Disintegrative Disorder which seems to be stable at .2 per 10,000. However, Rett's is seldom included in autism epidemiology and CDD is so small and stable as to be negligible on this issue.
A major change in general from the DSM-III to DSM-IV was the employment of more objective language. I note that "objective" does not equal "greater restriction per se", but "more easily agreed upon by two or more independent observers"
I will assume that this what Mr. Blaxill meant by "tighten", (And hopefully he will correct this if it is wrong) as these criteria changes certainly do not reflect an attempt to diagnose less persons with Autistic Disorder, Aspergers, or PDD-NOS. Incidentally, I am not the first to argue this, that would be Gernsbacher et al (2005) and to an extent Fombonne (2003).
So with this in mind, I re-assert my comment that Mr. Blaxill compared apples and oranges (or Trilobites, as I said).
"My main argument is this. If you want to argue that the reported increases are an artifact, that's a STRONG, very aggressive hypothesis. It should be subjected to rigorous testing. The hypothesis (and it's three main variants: diagnostic oversight, diagnostic substitution and diagnostic expansion) fails every test."
I strongly agree with Mr. Blaxill that this position must be tested. It also must be potentially disprovable. However, we disagree greatly that this theory has ever been shown to fail "every test". Mr. Blaxills re-analysis of Croen et al. (2002) is still using a database (CDDS) which is uncontrolled for random and systematic error and is unlikely to yield reliable data for either Dr. Croen or Mr. Blaxill. In addition, the MIND study for California legislature is logically flawed and was excellently taken to pieces by Dr. Gernsbacher and company. That study was never peer reviewed as well and I assure you, I would have loved the chance to critique it where it was published.
"Regarding the means, sounds like he's quoting rates based on dates of publication, a classic error I point out in my article."
I did take steps to make sure that the studies I quotes were conducted within a few years of date of publication. One must allow for certain publication time. His criticism therefore does not apply in this case.
"As to the question about the VSD critique, not sure what they're talking about. I put lots of charts and clear labels in there. We don't have access to any of the VSD calculations or raw data, so the only thing one can critique is the output. And that's impossible to do definitively without access to the underlying data."
I still have no idea how Mr.Blaxill achieved his conclusion in the re-analyzing of the Verstraeten studies.
"one point I neglected to make in my time trends discussion is that the study by Byrd et al (looking at the CA populations) was an important falsification of the "diagnostic expansion" hypothesis. Autism populations born in the 80s and 90s met diagnostic criteria in exactly the same way, which is not consistent with the claim of doctors doling out "easy" diagnosis of autism"
I comment on this un-refereed study above. The underlying logic of this study, is flawed.
Killerjabs, I have taken a great deal of time to read the SafeMinds site, I have read and read and read, including thr articles you provided (which I re-read) I still don't think Mr. Blaxill's critique is very transparent and I still have no idea how he came to his some of his conclusions.
There is more than one study that shows gastrointestinal disorders in children with autism, although I don't know that they associate it with the MMR. Here are the studies I'm referring to: http://www.chem.cmu.edu/wakefield/bio.html
Regarding the Honda study, there are critiques of it by Wakefield and Yazbak. Here are links to those:
While searching around for the Honda study I found some claims that Eric Fombonne is a paid consultant for Aventis Pasteur in some legal proceeding brought against AP by parents of autistic children. Please tell me this isn't true! If Fombonne is guilty of the same crime as the Geier's that will be very telling.
Re the Dr, Holmes study. I can't imgaine anyone could offer a better critique, than Autism Diva (and she addresses your question to boot!) http://autismdiva.blogspot.com/2005/12/dr-amy-holmes-was-just-trying-to…
Remember a pile of poolry controlled studies does not equal "growing body of evidence", it equals a "pile of bad studies".
I note the better controlled studies can be taken to mean a lot of things.
I was thrilled to hear about the new chelation study back in September. Then I found out that a Naturopathic Center is responcible for it and I nearly choked. It isn't even out yet, but it already looks bad. Search "Autism Street" and go to that blog to read about Dad of Camerons critique of it. Jeeze, it is not even done yet and there are already problems with it.
You wrote "I do not agree that the MMR is out of the picture due to the Honda study."
(shrugs) As you like....
You wrote "Not to keep harping on this point, but the IOM made their statement based on the 5 epidemiological studies in the US, Denmark, Sweden & the UK. Those studies hardly qualify as good science."
A "dicto simplicitar" (sweeping generalization) isn't going to do the trick. Offer a critique of those studies to show how they are flawed.
Hi Joe Citizen,
(sigh) Golly, I am easily trolled.
Okay, I'll bite.
"Are you joking?"
"One study and your through thinking about it?"
"That's how it works for your side, right? Typical."
If you have some science for us please present it, we are waiting patiently.
"The point is that the possibility is still there that a baby who has an immature or non-functioning immune system (such as one which is compromised due to thimerosal-containing vaccs) the weakened "live virus" can cause horrific effects"
Maybe, I mean, we can't prove it never happen. Of course the same is true for space aliens and psychics. However, we can't seem to replicate Dr. Wakefield's work, and then the epidemiology doesn't support him either. Honda et al, is just the most recent work (why I quoted it).
"Deal with and stop the denial."
I assure you, that some enthymeme isn't going to do the trick.
Now, if you have real data or a real argument, present it. Or not, as you like....but if not, I will not discuss this with you...More simply said: Don't waste my time.
"However, we can't seem to replicate Dr. Wakefield's work".
Wrong... Krigsman did back in 2002. Where have you been?
the Wakefield critique of the Honda paper is absolutely inadequate. Basically, Wakefield states that Japanese children continue to receive all three vaccines. This is wrong. In an email communication with Dr. Honda (with me, but verifiable in the literature) he states that only about 50% of all Japanese children receive the rubella vaccine (I am guessing all girls) and only about 30% receive the mumps vaccine. Therefore, the percentage of Japanese children who receive all three vaccines will be very low, especially among boys.
However, others have failed in that replication, including a team at the research center I belong to. I have mentioned this before on this thread. Were you paying attention?
Ideally, we look for replication via well controlled studies when we try to prove a finding. Then again, Wakefield et al (1998) was not well controlled in the first place as is pointed out by the rejoinders to it in the Lancet.
Fombonne did consult with Aventis Pastuer in the case intiated by those parents sueing Aventis Pastuer.
I don't blame him, I understand those parents were abusing epidemiology.
I'll attempt to get a reply from Mark Blaxill but like before I can't make any promises. Before I contact him, I'd like to go over a couple of things with you - mostly for my own understanding.
Regarding the time trends... I was under the impression that the California data is limited to "full blown autism" or autistic disorder. That it does not include PDD, Asperger Syndrome and others. Is my assumption correct?
I see that you and Mark disagree regarding the change in diagnostic codes. Mark seems to think that at one point there was a "tightening" (he indicates that his 59th reference supports this statement) while you seem to think otherwise. I will ask Mark about this. But can you describe for me the details of the criteria change from DSM III to IIIR in the 80's to DSM IV in the 90's? But please limit the conversation to the change in the way "full blown autism" was diagnosed. So for example, if it was easier to be diagnosed as autistic in 1987 as compared to 1980 and easier in 1994 as compared to 1987 please describe the characteristics that were required in 1987 but not required in 1994.
You seem to imply that the California data is not valid because it is uncontrolled. Can you please describe what this means in layman terms? What exactly is wrong with it?
Also, on page 12 of Mark's Time Trend paper, he produces charts for the UK and the US which comprise 19 surverys. The CDDS only accounts for one of those surveys. Do you have issues with the other 18 surveys? Mark's analysis find an increasing rate of autism for both countries. Do you disagree with his analysis? If yes, why? His approach makes sense to me (although I'm admittedly not an expert). Here is his approach:
An alternative approach is to synthesize evidence from
autism surveys using the following methods:
â¢ Analyze surveys from a single country separately instead
of grouping separate regions together.
â¢ Use the most common measure of disease frequency:
â¢ Compare prevalence reports based on birth dates of
children in the survey population, not the publication
â¢ Highlight differences in diagnoses, distinguishing (using
DSM-IV nomenclature) autistic disorder from PDDNOS
and Asperger's syndrome.
â¢ Identify all possible sources of bias resulting from specific
survey design choices.
"I did take steps to make sure that the studies I quotes were conducted within a few years of date of publication. One must allow for certain publication time. His criticism therefore does not apply in this case."
I'm not positive that his criticism does not apply in this case. This is what Mark says on this topic on page 8:
"Relying on the date of publication can obscure large
differences in the study populations observed. For example,
three Scandinavian studies published in a three-year period
used markedly different populations: a Swedish study published in 1997 measured the prevalence of autism in a 3- to 6-year-old population born from 1988 through 199193; another Swedish study published two years later, in 1999, focused on 7-year-olds who were born in 1985, several years
before the children in the first group85; while a Norwegian
study published between the two covered a wide range of
age cohorts and measured prevalence rates going back as far
In addition, combining surveys from locations as widely
separated as Yokohama, California, and Goteburg greatly
increases the potential for non-comparability. None of the
three meta-analyses chose surveys based on country groupings, therefore risking the introduction of confounding environmental factors that are geographically specific."
It was for these reasons that Mark seems to favor the US & UK studies that were all published since 1999.
"I still have no idea how Mr.Blaxill achieved his conclusion in the re-analyzing of the Verstraeten studies. "
Can you be more specific? Which conclusions are you unable to account for? Having these details will hopefully enable me to get answers from Mark with less back & forth emails.
I read Autism Diva's blog on the Holmes study. When I have all of your questions for Mark I will add this to the list since Mark was a contributing author for this study. Someone named Narthan commented on Autism Diva's blog and raised some interesting points about her analysis:
"It seems like your analysis is comparing across the results of two different studies. This isn't always fair. The studies were done on different days by different hands. The McDowell paper used cold vapor atomic fluorescence spectroscopy to measure mercury content. I'm not sure what method Holmes used, but even if it was the same method, It was certainly done on a different instrument. The size and composition of the samples were different."
I think Narthan makes some really good points. My personal feeling is that I would like to see more studies on this topic.
"I was thrilled to hear about the new chelation study back in September. Then I found out that a Naturopathic Center is responcible for it and I nearly choked. It isn't even out yet, but it already looks bad. Search "Autism Street" and go to that blog to read about Dad of Camerons critique of it. Jeeze, it is not even done yet and there are already problems with it."
Nearly choked just from finding out a Naturopathic Center is running the study? Guess you don't wait too long to form an opinion. Reminds me of the self fulfilling prophecy I learned about in Sociology 101. And to think you're the most open minded person I've run into from "your side."
I read Dad of Cameron's critique. Honestly, I'm not that impressed with it. Someone on his blog made a point that there should be non autistic children included in the study as a control, particularly during the phase 1 chelation challenge test. I forget who made this point but I absolutely agree with him. The study author did point out that they have prior chelation challenge data to use as a comparison but I would also prefer to see non autistic children in this study. That being said, I understand that this is a first of its kind study and some of the questions asked by Dad of Cameron may not have established answers. But that is exactly why we need the study.
"Not to keep harping on this point, but the IOM made their statement based on the 5 epidemiological studies in the US, Denmark, Sweden & the UK. Those studies hardly qualify as good science."
"A "dicto simplicitar" (sweeping generalization) isn't going to do the trick. Offer a critique of those studies to show how they are flawed."
Haven't we already covered these? Here is a quote from you on the Danish studies:
"I do not consider the Danish studies valid"
Here are your quotes on the VSD study:
"There are a number of problems concerning threats to precision within it."
"Precision issues: Some of the age ranges (26 months) are little young, still appropriate, but a little young and just below the mean age of daignosis, maybe those cohirst shouldot have been included. The authors also note there are some differences between HMOs. That is a problem."
"Also, some of the disorders they looked at were ill defined. What is an emotional disturbance? How is it quantified and defined? They don't explain."
"Also, some of the dates they selected a priori are a bit abitrary."
"Also, I hear tell that the CDC has lost this data. The authors need to find it or consider retracting the study."
The Swedish study makes the same error as the Danish study when it only counts inpatient diagnoses at first and then starts counting the outpatient diagnoses midway through the test.
The UK study has not been critiqued by Safe Minds and at this point it may never be. Mark Blaxill did say at one point that this study suffers from a fatal flawed called multicollinearity but I have no more detail other than that. Even if I concede the UK study as valid, after you disregard the Danish & Swedish studies you're left with 2 studies against a link (UK & 2nd HMO from VSD) and 1 for a link (1st HMO from VSD). That hardly seems like enough evidence for the IOM to rule the way they did.
I posted a 2nd link to a critique of the Honda study. One of the problems it pointed out was that one of the authors in that study had a large conflict of interest. Have you read that? I believe it is written by Yazbak.
Regarding Fombonne's work with AP, how is that conflict of interest any different than what the Geier's did?
Did Fombonne, in his early work, believe that the rate of autism was increasing?
Can you send a link to the study you reference by your research lab that what unable to replicate the findings of Wakefield?
What is your opinion on the original Wakefield study? Do people that don't believe it think that he made up the diagnosis? Were those children really healthy with no gastro disorder? I may be wrong, but clinical research seems a little more cut and dry as compared to epidemiological research.
yes, I have read Yazbak as well. Similar points apply. The perceive COI is constructed. The mumps strain used is irrelevant, as least if you follow the usual "multiple virus" exposure idea.
As for rubella vaccination, I find Terada the much more thorough analysis: http://www.nih.go.jp/JJID/56/81.html
The other point I wanted to bring up is this notion that as long as someone can prove with epidemiology that the MMR doesn't cause autism then it must be safe. Correct me if I'm wrong, but I didn't think Wakefield ever stated that the MMR caused autism. I thought he just said it needed to be researched. The point that seems to get lost in all this is that there are some very sick children. Whether or not the MMR caused those children to be autistic shouldn't be the end of the discussion - at least in my opinion. Jonathan's argument that Wakefield's results haven't been replicated elsewhere seems like the more crucial argument against Wakefield.
Here is a link to a new study with mice that links Thimerosal With Immune System Dysfunction
This latest study again begs the question - why are we still using thimerosal in vaccines?
An interesting snippet I came across today. Can anyone confirm that the ppb numbers are correct?
Is a trace amount of mercury in a vaccine really hazardous?
Â§ Mercury is so toxic even in tiny amounts that the EPA safety limit for mercury in drinking water is 2 ppb (parts per billion). A liquid with 200 ppb is considered hazardous waste. A vaccine with "just" trace amounts of mercury contains up to 2000 ppb of mercury. Spilling a 1/10 tsp. vial of vaccine with even trace amounts of mercury would require a Haz-mat team to clean it up.
Â§ A flu vaccine contains 50,000 ppb of mercury
Â§ New research on thimerosal showed that even at the nanomolar level (parts per billion), brain cells were destroyed.
(Thimerosal induces neuronal cell apoptosis by causing cytochrome c and apoptosis-inducing factor release from mitochondria. Yel L, Brown LE, Su K, Gollapudi S, Gupta S. Immunology/Medicine, C240 Med Sci I, University of California)
Â§ "No one knows what dose of mercury, if any, from vaccines is safe... We can say there is no evidence of harm, but the truth is - no one has looked."
Neil Halsey, director of the Johns Hopkins Institute for Vaccine Safety, 1999
Just to get the conversions straight: One ppb is the same as 1 gram of mercury in one billion grams of water, or 1 gram of mercury in one million litres of water, which is the same as 1 microgram mercury per liter of water (or a water based solution). So, if a flu shot with a total of 25 micrograms of mercury has 50000 ppb of mercury, it has a volume of 0.5 ml, which seems about right.
Can you give me a citation which shows that liquids over 200 ppb of mercury are considered hazardous waste?
Many things contain mercury. Breast milk is a good example. Multiple studies in Taiwan, Sweden and Germany have found that the concentration of mercury in breast milk ranged from about 0.25 to 20 micrograms per litre. Similarly, reconstituted infant formula contained 0.4 to 2.5 micrograms of mercury per litre.
J Toxicol Environ Health A. 2005 Oct 22;68(20):1713-69
If an infant drinks a litre of breast milk per day, then they are receiving 0.25 to 20 micrograms of mercury (mostly in the form of methyl mercury) per day, and 91 to 7300 micrograms of mercury in one year. That sort of puts the vaccine amount into some perspective, doesn't it?
OK, I found a citation for 200 ppb for mercury content in solid waste here.
Not so sure that applies to waste water, though.
Thanks for providing the conversion data. Regarding the mercury in breastmilk and your question about perspective...
One big difference is that your breastmilk example is a small exposure over a long period of time whereas the vaccine example is a very large exposure all at one time. Parents who believe thimerosal is a problem would argue that a bolus dose is more dangerous than the exposure you describe.
But the children who drank milk from mothers with the higher level of mercury did have a bolus dose, day in and day out approximately equal to one flu shot per day (20 micrograms per day, approximately equal to 25 micrograms per flu shot). One litre per day is probably a low estimate for the amount of milk consumed by a child who is only breast-feeding. One flu shot, or maybe two or three flu shots per day!!!!!
I think this brings up a good point, which was raised on the other thread, or maybe further up this thread. Under the hypothesis of autism=mercury poisoning, some children are supposed to be unable to excrete mercury. So unable to excrete mercury that they are permanently poisoned by something in the range of 150 micrograms of mercury from their shots. Why then are they able to excrete the continuous doses of mercury they ingest each and every day? Even the children who are formula fed get at least 0.4 micrograms of mercury per day, 146 micrograms per year. Shouldn't all that mercury be accumulating, and accumulating over the years, eventually causing acute signs of mercury poisoning, leading eventually to death? Remember that mercury is present at low levels in many foods as well, not just in fish.
Before I answer you points, I would like to say that I do not claim an open mind or even see an open mind as a virtue. You see, I have no idea what an "open mind" even means. That said, I do greatly value fairness and objectivity.
With this in mind consider my horror, when I learned that an important study is being conducted by a school of thought known for deviations into quackery. Doesn't mean the study will be poor, but it does push warning buttons to me.
The CDDS provides services for Autistic Disorder, but as of August 2003, the Lantermen Act revision implemented a more restrictive criteria. In fact the first big drop is not until Sept 2003, just after the law change. This confounds the Geier's point of change which is Jan 2003, as seen in my graph http://photos1.blogger.com/blogger/346/1599/1600/CDDS.4.jpg
I don't think it is possible to improve upon the comparison of the DSM autism criteria than Gernsbacher et al have already done http://www.autcom.org/Epidemic.pdf
which should take you to the article which is not long and is an easy read).
If you would like more than this let me know.
Mark quotes Volkmar et al. (1997) as his reference, whereas I have quoted Volkmar et al. (2000) as a proof. Volkmar (sorry if you know this) is the guy at Yale who we have to thank for the PPD definitions, more or less. I am not sure how to resolve this one. Mr. Blaxill's comments are welcome to me, as are his criticisms, and I am appreciative that he has taken the time to do so.
By "uncontrolled" I mean "notably, open to error". To control for an error, we assume that it will be present before we do the study and add measures that will allow us to identify such an error. A second and rather poor way is to use ad hoc reasoning to try to explain the error away, after the study is done, based on the argument that the error really wasn't a problem in this case. I have seen this work for only one study (Lovaas, 1987)
In epidemiological research there are 4 kinds of errors that are of concern.
External validity is the concept of how well an experiment holds up in other experiments which are similar (in some manner) to the first study. This is an issue in this study as descriptive epidemiology must replicate the Geier's finding.
Internal validity is the extent to which we know that the independent variable caused the change in the dependent variable. Not an issue in this case unless someone claims this as proof that thimerosal caused autism, then we can see to what extent the 7 threats of this sort are controlled for (hint; none of them).
The final two are random and systematic error. These really require a more technical explanation. These require a more lengthy explanation to do them justice. I offer a detailed discussion of all this on my blog in the discussion section near the bottom (long, but worth it, I hope)
Re the date of study, you wrote "I'm not positive that his criticism does not apply in this case. This is what Mark says on this topic on page 8:"
In this case, one must verify the accuracy of their suspicion and read the date of the studies were actually conducted, I will hold you to that sir.
One must be careful not to reject findings from other areas merely because they are from other areas. To do so, is potentially illogical. The UK and the US are somewhat comparable, but not totally. The UK only has Thimerosal in one childhood vaccine. The amount of Thimerosal their children receive is not comparable, yet they have the same rate for the spectrum. I note that Mr. Blaxill chooses to compare these.
However, Japan has the same rate for Autistic Disorder as both the US and the UK. As you note, Mr. Blaxill does not describe the epi from Japan.
Further I only consider 8 studies from the US & UK valid post 1999. I disagree with Mr. Blaxill, over the validity of several of the studies he opts to include. In addition Mr. Blaxill's study pre-cluded several important 2005 studies which suggest that the prevalence rate never increased during the 90s. He needs a full fledged controlled epi study at this point to disprove this.
I would like to understand why Mr. Blaxill justifies a statistically significant finding with the expression "meets standard for legal causality" and does not temper this with an explanation of what correlation actually is scientifically/logically.
Re multicollinearity and the UK study. I believe I understand what Mr. Blaxill means, but I will not comment unless he formally mentions this (and I can see this in context.)
I agree with your conclusion re the Holmes study needing to replicated.
Re my comment on sweeping generalizations of the IOM report you write "Haven't we already covered these? Here is a quote from you on the Danish studies:"
We have discussed the Danish studies, but not the others per se. So, my answer is "no we have not".
I think that answers you points. Let me know if not.
Let's repeat this one more time.
The only childhood vaccine that contains thimerosal is the flu vaccine. And even that vaccine has a thimerosal-free version that will cover the vast majority (if not all) children under the age of 2 and pregnant women that are likely to be vaccinated. Because flu vaccines are not mandated for school or daycare entry, vaccine uptake is still nominal.
Continue to yammer about thimerosal being in vaccines is a total red herring. If you want to discuss the possibility that thimerosal had a role in neurological disorders IN THE PAST, then fine, but the main purpose of that will be to help trial lawyers and litigants pursue their case against drug companies.
"But the children who drank milk from mothers with the higher level of mercury did have a bolus dose, day in and day out approximately equal to one flu shot per day (20 micrograms per day, approximately equal to 25 micrograms per flu shot)."
The assumption that breast milk contains 20 mcg seems high. What was the mean? Here is a link to a study I found that says the worldwide mean for mercury in breastmilk was 2.7 ppb. http://www.nrdc.org/breastmilk/chem13.asp
You're also attempting to compare methyl mercury via breastmilk to ethyl mercury via injection and there isn't enough data to make the comparison. Burbacher may have been the first to compare the two and he readily admits more research is needed. Also, thimerosal is not the only ingredient in vaccines which further complicates an attempt to compare it to breastmilk exposure. Antigens such as aluminum could certainly make things worse. Or what about the combination of exposure via vaccines plus exposures to methyl mercury like you point out.
The link that I referenced mentioned a study that reminded me a little of the Holmes study. Here is an abstract:
In one recent study of mercury exposure, breast-fed infants tended to have higher residues of mercury detectable in their hair. The infants with higher hair mercury levels also had improved neurological development, including faster progression to sitting, creeping, and standing. Because mercury is known to affect neurological development adversely, the faster development in infants with higher mercury levels was attributed to the benefits of breastfeeding. Thus any possible adverse effects of mercury in breast milk were overcome by the advantages of breastfeeding
Grandjean, P., P. Weihe, and R. White. Milestone Development in Infants Exposed to Methylmercury from Human Milk, NeuroToxicology 1995; 16(1): p. 27-34.
"I don't think it is possible to improve upon the comparison of the DSM autism criteria than Gernsbacher et al have already done http://www.autcom.org/Epidemic.pdf
which should take you to the article which is not long and is an easy read). If you would like more than this let me know."
That study is not really about the changing DSM criteria. It's an argument against an epidemic that uses DSM to support the argument. It doesn't seem to have any mention of the DSM change in 1987. Instead it focuses solely on the change from 1980 to 1994. So if you have an unbiased source you can point me to that would describe the changes from 1980 to 1987 to 1994 please let me know. If you don't have one handy I can look around for it.
Thanks for the epidemiological explanations. It was very helpful.
"In this case, one must verify the accuracy of their suspicion and read the date of the studies were actually conducted, I will hold you to that sir."
"Further I only consider 8 studies from the US & UK valid post 1999. I disagree with Mr. Blaxill, over the validity of several of the studies he opts to include. In addition Mr. Blaxill's study pre-cluded several important 2005 studies which suggest that the prevalence rate never increased during the 90s. He needs a full fledged controlled epi study at this point to disprove this."
What are the 8 valid studies?
"We have discussed the Danish studies, but not the others per se. So, my answer is "no we have not". "
Didn't we cover the VSD? If it's a neutral study how can it possibly be counted as evidence against an association?
"I think that answers you points. Let me know if not."
You never answered my question regarding Fombonne's conflict of interest. Why is it acceptable when people on the other side of the argument are immediately discredited due to their involvement in lawsuits? I also asked if Fombonne's opinion regarding autism & epidemic changed over time. Where his conclusions different in his early studies?
"The only childhood vaccine that contains thimerosal is the flu vaccine."
That is not true. Other vaccines have "trace" amounts of thimerosal which contain up to 2000 ppb of ethyl mercury.
"And even that vaccine has a thimerosal-free version that will cover the vast majority (if not all) children under the age of 2 and pregnant women that are likely to be vaccinated."
"Because flu vaccines are not mandated for school or daycare entry, vaccine uptake is still nominal."
Is this your opinion or fact? My experience is if a doctor recommends it, it gets done.
"Continue to yammer about thimerosal being in vaccines is a total red herring. If you want to discuss the possibility that thimerosal had a role in neurological disorders IN THE PAST, then fine, but the main purpose of that will be to help trial lawyers and litigants pursue their case against drug companies."
Oh really? Do you have an autistic child? My guess is no because I have a hard time envisioning a parent of an autistic child speaking that way. My "yammering" as you so eloquently describe it is because I want the truth about my son's condition. I want that truth so that mainstream medicine can get off their a## and start working on a cure for him and every other sick child. If thimerosal did cause harm and the CDC sat back and allowed more children to receive it, even though there were alternatives (see RFK Jr article) then they should be treated as criminals. I place more blame with them then with the drug companies although Merck's actions in not reporting their concerns in 1991 is equally disgusting.
Point #1: Other than the flu vaccine, most vaccines contain thimerosal in such minute quantities that they are not believed to be biologically significant. (<1 mcg)
Point #2: According to the CDC (yes, THAT CDC) approximately half of children under 2 and about 1/8 of pregnant women get the flu shot. If you do the math you'll see that the number of doses of thimerosal-free vaccine made available this past year would likely cover that population, as long as they were distributed properly. So yes, flu vaccine uptake is relatively nominal in those age groups even with the CDC's recommendation. This is all on the CDC's website if you look for it.
Point #3: It is none of your business whether I have an autistic child or not, which is another attempt by you to change the topic. The harsh reality is that even if mercury was to blame for your child's condition (which I doubt) there's not a whole lot that can be done at this point. It's unlikely that removing the mercury will improve your child's condition. And thimerosal has been removed in large part from vaccines with little noticable change to autism rates. So the only reason to actively pursue bogus legislation and put out rather useless studies is to bolster the omnibus proceedings in vaccine court and/or pave the way for civil lawsuits against drug companies. Very little of what is being done will actually help children get better.
"Point #1: Other than the flu vaccine, most vaccines contain thimerosal in such minute quantities that they are not believed to be biologically significant."
How do we know that 2000 ppb of ethyl mercury is not biologically significant? There are no studies that would tell you that.
"Point #2" - Is that statement from the CDC based on historical data? They only recently changed their recommendations so the percentage of children and pregnant women getting the vaccine today, and tomorrow, could be higher. And your argument is based on the fact that the vaccines get distributed properly.
You brought the topic of lawsuits up, not me.
"The harsh reality is that even if mercury was to blame for your child's condition (which I doubt) there's not a whole lot that can be done at this point. It's unlikely that removing the mercury will improve your child's condition."
Based on what science? Have scientists really focused on finding ways to repair mercury damage? And what if mercury damage is just one aspect? What if there are immune disorders? Is there also no hope for that condition? You're opinions mean little to me.
"And thimerosal has been removed in large part from vaccines with little noticable change to autism rates. So the only reason to actively pursue bogus legislation and put out rather useless studies is to bolster the omnibus proceedings in vaccine court and/or pave the way for civil lawsuits against drug companies. Very little of what is being done will actually help children get better."
It is still in vaccines in the US although I admit it is reduced. But there are no scientific studies to show that the amount of thimerosal still in vaccines is safe. And what about other countries? I guess 3rd world countries don't count in your opinion. They still receive thimerosal. Isn't that a reason to continue the research? And if it turns out that vaccines have caused autism in some children, who are you to say that those families aren't entitled to compensation? You really have a lot of nerve making statements like this.
Jabs, you continually miss the point.
Thiomersal was in vaccines for decades.
Then you people claim there was an "epidemic" when the amount of thiomersal went up.
Then it went down, and you're claiming that ANY thiomersal causes it.
You cannot have it both ways.
"Then you people claim there was an "epidemic" when the amount of thiomersal went up."
The age that children received vaccinations also decreased.
"Then it went down, and you're claiming that ANY thiomersal causes it."
Actually, I'm just claiming that ANY thimerosal is bad and it shouldn't be in vaccines.
I'm optimistic that the studies that can answer these questions are going to occur sooner rather than later. Our politician's are finally starting to get it.
Rep. Carolyn Maloney (D-NY), who will unveil a bill to provide for a new study of vaccinated and unvaccinated populations of American children.
Data from this relatively simple study could settle once and for all the question of a link between vaccines and autism, ADD, ADHD and other disorders. Rep. Maloney will also discuss the Federal bill to ban thimerosal in vaccines, which she co-sponsors with Rep. Dave Weldon (R-FL), and a possible Congressional move to empanel a new committee of the Institute of Medicine that would consider new evidence to support the link.
Senator Lieberman followed up his letter to the NIEHS http://www.a-champ.org/Congressionalletter2-22-06.html by stating today on Imus that if "they don't do this study, then congress is going to mandate it."
You wrote "That study is not really about the changing DSM criteria. It's an argument against an epidemic that uses DSM to support the argument. It doesn't seem to have any mention of the DSM change in 1987. Instead it focuses solely on the change from 1980 to 1994. So if you have an unbiased source you can point me to that would describe the changes from 1980 to 1987 to 1994 please let me know. If you don't have one handy I can look around for it."
In that sense, no, I can not. There will always be some bias in some direction. However, none of those authors have a conflict of interest in the study I gave you.
The merit of that article is that it is a very easy read, meant partly for non technical persons. A more thorough and slightly more technical article comes straight from the horse's mouth (the second author is the one to thank for the PDD definitions in the DSMs) http://www.cpa-apc.org/Publications/Archives/CJP/2003/september/tidmars…
You wrote "What are the 8 valid studies?"
These are the 9 (sorry, forgot one) descriptive epidemiologic studies. This is not counting the etiologic autism epidemiology or the meta-analytic descriptive epidemiology.
Bertrand, J., Mars, A., Boyle, C., Bove, F., Yeargin-Allsop, M., & Decoufle, P.
(2001). Pediatrics, 108, 1155-161.
Chakrabarti, S., & Fombonne, E. (2001). Pervasive developmental disorders in preschool children. Journal of the American Medical Association, 285,
Chakrabarti, S., Fombonne, E., (2005). Pervasive developmental disorders in preschool children: confirmation of high prevalence. American Journal of
Psychiatry, 162(6), 1133-1141.
Fombonne, E., Simmons, H., Ford, T., Meltzer, H., Goodman, R. (2001). Prevalence of pervasive developmental disorders in the British national survey of child mental health. Journal of the American Academy of Child & Adolescent Psychiatry 40, 820-827.
Jick, H., Beach, K.J., Kaye, J. A. (2006) Incidence of autism over time. Epidemiology, 17(1), 120-121.
Kielinen, M., Linna, S. L., & Moilanen, I. (2000). Autism in Northern Finland. European Child and Adolescent Psychiatry, 9, 162-167.
Magnusson, P., & Saemundsen, E. (2001). Prevalence of autism in Iceland. Journal of Autism & Developmental Disorders 31: 153-163.
Yeargin-Allsopp, M., Rice, C., Karapurka, T., Doernberg, N., Boyle, C., Murphy, C. (2003). Prevalence of autism in a US metropolitan area. Journal of the American Medical Association, 289, 49-89.
Honda, H., Shimizu, Y., Imai, M., & Nitto, Y. (2005). Cumulative incidence of childhood autism: a total population study of better accuracy and precision. Developmental Medicine And Child Neurology. 47(1), 10-8.
Didn't we cover the VSD? If it's a neutral study how can it possibly be counted as evidence against an association?
Correct, but there are yet more studies to be looked at from that report. Further, although the Danish studies are out and the Verstraten study is neutral (and flawed), the science has not been static since that point. Some of the best research against the vaccine link have only come out in the last year or so.
You wrote "You never answered my question regarding Fombonne's conflict of interest. Why is it acceptable when people on the other side of the argument are immediately discredited due to their involvement in lawsuits? I also asked if Fombonne's opinion regarding autism & epidemic changed over time. Where his conclusions different in his early studies?"
My apologies, I will rectify that now. It is not acceptable for anyone's research to be discredited due to their involvement in litagation. I do not discredit the Geier's work for this reason.
Dr. Fombonne, has revised his opinion on the prevalence of autism. He placed it lower in his reviews during the earliest years post 2000. He has not changed his opinion on "why" there is a rise.
Please note my name change from KillerJabs to David H.
I read some of the Tidmarsh paper. I'm still unsure of the net effect of the changes that occured in the DSM between 1980, 1987 & 1994. The Tidmarsh paper supports the claim that the criteria was loosened between 1980 & 1987.
"With these changes in criteria, the DSM-III-R became overly inclusive, created false-positive diagnoses, and differed widely from the criteria set down in the ICD-10 (13)."
But it does seem like things were tightened between 1987 & 1994.
"Because it was critical that future research should compare different populations, it was necessary to align the DSM and ICD classifications. To achieve this, a literature review, a reanalysis of existing data, and a large multicentre international field trial were undertaken."
"Studies using ICD-10 criteria showed that they correlated well with expert clinical diagnoses (14). The DSM-IV classification system kept the research and clinical
criteria together but brought criteria into line with the ICD-10 and included the other PDDs (15). Hence, the 2 systems' descriptions of the different disorders are now close (Table 1)."
But then there are other statements that at first glance seem somewhat contradictory to the above quotes:
"Problems still exist with the DSM-IV system. The criteria are less stringent than the ICD-10 research criteria and are therefore more inclusive. Among the disorders, autistic disorder is the most clearly defined, while AD and PDD NOS are less so."
It's not clear to me how the ICD-10 research criteria is related to DSM III, DSM III R & DSM IV.
Of those 9 valid studies, do all of them support the theory that there has not been an epidemic of autism?
"Some of the best research against the vaccine link have only come out in the last year or so. "
Is this the Fombonne study? Are there others? Is all of this research epidemiology to determine prevalence rates?
"Dr. Fombonne, has revised his opinion on the prevalence of autism. He placed it lower in his reviews during the earliest years post 2000. He has not changed his opinion on "why" there is a rise."
What year did Fombonne do his consulting for Aventis Pasteur?
Do you have a list of the studies you believe refute the vaccine/autism link? It would be great if you could generate a list similar to what is provided on Generation Rescue. A link to the report (preferably a place that didn't require a fee to read it) and an abstract describing why the report refutes the link.
Hi David H.,
Things were not tightened from the DSM-III-R to the DSM-IV, but they were brought into closer alignment with the ICD-10 (1990). I would argue this was done rather poorly as there is still major differences in categorization between them.
Search "ICD-10 AND autism". You shold be able to find a page for purposes of comparison to DSM-IV categories (which are also easy to find on the web).
In the last year or so we have gained Chakrabarti and Fombonne (2005). This is direct evidence that the rate of autism never went up in the 90s. It also found the same rate the PDDs as the CDC authors found for the US in 1999 (Bertrand et al., 2001). This is within confidence intervals of another CDC study 2002 from Yeargin-Allsop et al. (2003). It also is the same as the Autistic Disorder prevalence in Japan (Honda et al., 2005). It is also within the confidence intervals other studies I named as well.
Jick et al (2006) have added a study (I have some concerns in terms of systematic error) study on incidence in autism. They have a particularly interesting effect of a correlation of Wakefield's 1998 study and a spike in autism. This adds some (correlational) evidence that popularization of autism has an effect on diagnosis.
All of these studies are descriptive epidemiology that addressed prevalence of Autistic Disorder or the PDDs. The Chakrabarti study had a meta-analytic component in that 2 studies (Chakrabarti & Fombonne, 2001 and 2005) done in the same way, with the samecriteria, in the exact same geographical location found no difference of prevalence.
Dr. Fombonne consulted in a law case in 2001, if memory serves (I stand to be corrected on this).
The list you asked for will require some time for me to assemble and to "quality control" it as well. I am already over my head with reviewing research for two blog projects and writing articles for 2 real journals, and conducting a large correlational design project (not about autism), and then doing homework. Give me 3-4 weeks and I promise I will do this and post it on my blog.
In the Chakrabarti and Fombonne (2005) study, what years were the children born in that they studied? I know you gave dates of 1992-1995 for the early part of the study and then a date in the later 90's for the 2nd part. But it wasn't clear to me if those were birth years, date of diagnosis or something else entirely.
Thanks for taking the to do with the study summarization.
I answered this on my site as well just now. The birth years were 92-95 and 96-98.
The "thimerosal caused an autism epidemic" theory suggests that the rise in autism occurred after the vaccine schedule was changed. In the UK, the change occurred in 1990. This change increased early exposure to thimerosal. So if the theory is correct, the number of autistic children would have started to increase somewhere around 1990.
The Fombonne study you cite finds that the prevalence was constant in children born between 1992-1995 and with children born between 1996-1998. In my opinion, this study does nothing to refute the theory that the change in the vaccine schedule in 1990 caused an increase in autism in the UK. To do so, I think the authors would have to do a third study - post thimerosal removal.
One of the talking points is that the "epidemic" didn't happen over night even in the presence of the Thimerosal change. There was a gradual increase or so we might see by Newschaffer's use of IDEA data. Of course, by the CDDS and Epidemiologic stats don't really show such an increase until the years post 1999. Although the first big spike (there are a number and they are short lived) in the epi was in published in 1987.
I would be surpised if we don't see another study from Fombonne on this subject in the future.
I'm looking at some charts of the California data at the Adventures in Autism blog. Here's a link: http://adventuresinautism.blogspot.com/2006_01_01_adventuresinautism_ar…
You say that the CDDS doesn't really show an increase until post 1999. But I'm not seeing that in these charts. The data only goes as far back as 1994. But from 1994 up to 2002 I see a fairly significant increase.
Ginger at Adventures in Autism and I had quite the discussion some time ago when her work first came out. We are also on cooperative terms and have shared some data to help each other in our analyses.
I have problems with Ginger's analysis (as she is aware)for several reasons, mostly, in that she is using all the ages in her graph, not just the 3-5 cohort. This is the same error Mr. Rollens makes (and continues to do so despite being told to not do this). Ginger on the other hand, said she will modify her technique, when she was told that this was a problem. Also, my data goes back to June 1992, as seen by visiting my site.
I just visited your site http://interverbal.blogspot.com/2006/02/review-of-the-use-of-california…. The first chart on that page titled "Autism Prevalence Rate: Across Quarters, per 10,000 Children Ages 3-5" also seems to show that the numbers that the numbers were increasing in the early 90's. I think I see what you're referring to. The increase that occurs somewhere around 2000 (hard to tell exactly on the graph) does seem to be increasing at a faster pace as compared to the early 90's. But we still see the numbers quadruple (~4 per 10K in 1992 to ~16 per 10K in 2000) which is a large increase in 8 years.
Since I don't have access to the Fombonne study, other than the abstract, can you explain how they gathered the data? For example, did they just summarize existing data (like the CDDS) or did they actually survey the entire community themselves and assign a diagnosis of autism based on whether the subject met the criteria?
I was focusing on incidence rather than prevalence, sorry for not specifying.
The prevalence of 3-5 years olds in the CDDS is still increasing increasing, even now.
The article you are after is found in full at:
I was looking at an older post from you in which you briefly commented on each of the reports/studies posted at Generation Rescue. The 3rd study, is the chelation study of autistic children & some controls. To me, a study like this appears to be much simpler than some of the large epidemiological studies we have discussed. You say it violated every rule and I'd be interested in hearing more about that. I guess this type of study seems a little more black and white to me, as compared to say the VSD study. So I'm curious to hear what the authors did wrong and how those errors could have invalidated the study.
Word on the street is that a similar type of study was recently conducted with results similar to the Bradstreet study. I haven't seen this new study yet but hopefully it will be released shortly.
Hi David H.
Correct, I did indeed say that the Bradstreet study failed to control for threats to internal validity. However, this is inaccurate as this study (Case-Control) is a form of descriptive research rather than experimental (internal validity threats are less applicable here).This study actually fails to control for random and systematic error.
The reference of these children to the researchers' center, leaves this open to bias. This may favor a subset of children who are not truly representative of the autistic population.
The same problem exists with the controls who were children who were referred to the center. This potentially leaves this open to Texas Sharpshooting. The authors should have offered some form of control for this.
The most significant problem (on many levels) is the 221 autistic kids and the 18 controls. These are not comparable groups. Dr. Geier (if no one else) should have known this).
The Central Limit Theorem, states that two samples can be meaningfully compared in terms of significance testing, if both samples have above 30 members (this theorem isn't always true). This study flunks that general rule. Since the smaller sample is only 8% of the larger sample, this is pretty huge problem.