NOTE: This post, which is related to a discussion of Dr. Paul Offit's Book Autism's False Prophets, originally appeared over at The ScienceBlogs Book Club. However, now that the book club for this particular book has concluded, I am free to repost it here for those who may not have seen it and to archive it as one of my own posts. Besides, I know the antivaxers are more likely to see it here...
On Friday, while discussing what is perhaps the aspect of Autism's False Prophets that is at the same time the most important set of observations (namely, how the media and government miscommunicate science and how the public seems hardwired to misunderstand science) and its most glaring omission (namely, suggestions how to overcome this problem), I talked about "framing" or how we could potentially represent the current science on vaccines in a compelling way that will be persuasive to the bulk of concerned parents. We know that hard core antivaccinationist parents will not be persuaded by virtually anything we say, but they are relatively small in number. It may not seem that way, given how noisy they are and how effective they've become at propaganda and media manipulation, but they are. Far more numerous are parents who hear the alarming rhetoric of antivaccinationists and wonder if maybe there's anything to it all. They are the target audience.
In response, I got an e-mail from someone who wishes to remain anonymous. I will paraphrase what he said to some extent, because I don't want to risk "outing" him, but one some carefully selected excerpts should be safe:
We are in trouble on this issue because we see it as a scientific issue, and if we just line up the science, people will be reasonable and decide that we are right and Jenny McCarthy is wrong.
I see his point there. It's really no different than, for example, the evolution/creationism culture war. Evolutionary biologists know that the evidence is so overwhelmingly on the side of the theory of evolution and against creationism or its bastard offspring "intellgent design" creationism that they do tend to live under the delusion that, if the public were just informed of the science and the evidence, they would come to the reasonable conclusion: namely, that evolution represents the best theory of the origins of life that science has to offer, and creationism is without foundation in science. However, this attitude neglects the influence of fundamentalist religious beliefs, which are in direct opposition to the science of evolution and lead fundamentalists to reject evolution in spite of the overwhelming evidence in favor of it. When it comes to the whole issue of vaccines and autism, the evidence is nearly as overwhelming against the claim that vaccines or mercury in vaccines causes autism. So, a reasonable scientist thinks, just showing the overwhelming evidence that fails to support the hypothesis that vaccines cause autism should bring reasonable parents around. However, it can be argued, that viewpoint neglects the overwhelming emotional attachment parents have to their children, the malign effect of antivaccinationist propaganda which tells them that their child was somehow damaged and somebody must be made to pay, and the normal human cognitive quirks that make us seek patterns and be fast to see correlation as causation. I can see that.
My commenter then described a seminar about risk communication that he had attended and one presentation in particular. In this presentation it was described what's important to people under "low concern" and "high concern" conditions. The presentation
showed two pie charts, on what determines credibility under "low concern" conditions (expertise and credentials are what matters) and under "high concern" conditions - and under the latter, it's not expertise/credentials, but empathy and caring, and the big collective "we" are not good at that. I have great respect for Paul Offit (who, by the way, writes more books than I read - well, almost) but he is wrong on what we need to do to deal with this.
Instead of being clearer that vaccines don't cause autism, we need to not overstate what we know (lots of studies have looked at MMR and thimerosal, and no evidence that either of them are a cause of autism at the population level).
I'm not entirely sure I see where scientists are "overstating" what they know, but more on that later. He then cited two posts by Peter Sandman:
Thimerosal, autism, and misleading toward the truth
Does taking the thimerosal out of vaccines reassure people or scare them?
From these he boiled down Peter Sandman's message thusly:
...we need to stop gloating when we say that. We should express regret - because, if thimerosal had caused autism, well, we'd be through it by now. We would have had a tough couple of years, but we'd have vaccines without thimerosal by now and families who felt like their families were being torn apart by the stresses of dealing with a severely affected child would have have been spared that.
While there are some interesting and potentially useful suggestions in the links above, I have to strenuously disagree with this last sentiment. Strenuously. I will agree that gloating and rubbing antivaccinationists' face in the exoneration of thimerosal as a cause of autism is not a good idea as far as communication of science and risk go (and, remember, I'm not a risk communicator; so I frequently lapse in this area, especially when it comes to Generation Rescue and Jenny McCarthy), but Sandman is taking it too far to the other extreme. There is nothing to be sorry for, and I find it strange that he would castigate scientists for supposedly "exaggerating" the science exonerating vaccines (something I also disagree that scientists do) and then tell us to exaggerate "sorrow" that a nonexistent risk believed by the public was found to be without a foundation in science. What's there to be sorry about, other than at the money and effort being wasted chasing a failed hypothesis long after it's was known with a high degree of confidence not to be valid? I fail to see how that would help or mitigate the damage already done. In fact, if I were a parent concerned about vaccines causing autism, I would find such an statement even more condescending and insulting to my intelligence than anything Paul Offit's been accused of. But that's just me, I suppose. Or maybe not. In any case, I would frame it more like, "This is great news. Now we can move on to other, more promising areas of research."
Which is what scientists have been trying to do, but antivaccinationists won't let them.
The other thing that I really detest in Sandman's posts is his flagrant use of false equivalences:
The article you refer to is "Mistrust rises with autism rate," by Anita Manning (USA Today, July 7, 2005). The article reviews the unending controversy between vaccination opponents, who charge that there has been a cover-up of evidence suggesting a link between thimerosal and autism, and vaccination proponents, who claim that the evidence of any such link is extremely weak and almost certainly false. (Thimerosal is a form of mercury that has been widely used to keep vaccines sterile.)
The latest wrinkle in this controversy came with an article by Robert F. Kennedy Jr. focusing on a June 2000 meeting of scientists and public health officials at the Simpsonwood Conference Center near Atlanta. Kennedy wrote that transcripts of the Simpsonwood meeting show the cover-up in action; vaccination supporters retort that the evidence discussed at the meeting was nowhere near persuasive enough to justify serious concern.
My key point is that both sides are right.
Jody Lanard and I first used the phrase "misleading toward the truth" to describe USDA risk communications about mad cow disease. People (including scientists) who believe they are right on the merits tend to withhold information that they fear might lead others to an erroneous conclusion. On vaccination safety, maybe proponents are 85% right. That's not good enough for them, and too often they are less than candid about the other 15%. (Some of this is the sort of "conspiracy" the recent Kennedy/Simpsonwood kerfuffle is all about; some of it is more basic, like not bothering to mention that mercury is a poison in a disquisition the main thrust of which is the safety of thimerosal.) Leave aside whether or not this is dishonorable; it is demonstrably unwise. In a porous democracy like the U.S., the other 15% inevitably comes out - and the reluctance of proponents to acknowledge it makes it look much more compelling than it deserves.
Suppose the vaccination case isn't 85% right but 99% right. All the more reason to be candid about that other one percent. The stronger your case actually is, the more foolish you are to try to make it look even stronger than it is.
And:
Public health professionals claim that the weight of the scientific evidence shows that thimerosal does not cause autism. Critics claim that the public health profession is covering up the portion of the evidence that shows otherwise. Although I'm not qualified to assess either claim definitively, my strong impression is that both claims are true. (See for example my discussion of the June 2000 Simpsonwood Conference in the Guestbook entry linked above.)
That is, I think that the experts have solid grounds for concluding that thimerosal in pediatric vaccines is very unlikely to be responsible for the surge in autism diagnoses. And I think that once they reached that conclusion the experts have too often sought to reassure the public by overstating their degree of certainty, and have tried to ignore or discredit the evidence (a lot of anecdotal evidence plus a few studies) that suggested there might be something to the relationship after all. That's what I mean by "misleading toward the truth."
Overstating a mostly valid conclusion and hiding the small amount of contrary evidence is an incredibly common (and tempting) mistake. It is most common (and tempting) when people are upset, when you want to calm them down, and when all you have to work with is a pile of studies that didn't find the effect they were looking for, plus a handful that might have found something. The evidence is maybe 85% on your side, but you're afraid that acknowledging the other 15% might prolong the debate you're trying to quell. So you suppress the 15%.
Sandman may know public relations, but he's clueless about the science. Both sides are not, nor were they, "right." The antivaccinationist side relied on conspiracy-mongering and quote-mining to create the legend of Simpsonwood as a place where the CDC plotted to hide the evidence that mercury in vaccines was the main cause of the "autism epidemic." Indeed, it's not 85% correct or even 99% correct to state that science has failed to find a link between thimerosal and autism. It's more like 99.9999% right. Moreover, Sandman fails to present a single bit of evidence that, regarding thimerosal at least, the FDA, CDC, or vaccine proponents have been less than honest. He just asserts it as though it's true. It's also a total distortion that scientists don't mention that mercury is a poison. They do, and I do. I have. So does Dr. Offit; indeed he says explicitly in the book that it is and even devotes a section of the chapter Mercury Falling to explaining why the dose makes the poison and why, at the doses used in vaccines, mercury is not toxic and that, contrary to the claims of antivaccine activists, even if mercury were toxic at the levels used the symptoms of mercury poisoning do not resemble the symptoms of autism. Dr. Offit hammers that point home over and over, and discusses why it is impossible to avoid mercury:
Because everyone drinks water, everyone has small amounts of methylmercury in their blood, urine, and hair. A typical breast-fed child will ingest almost 400 mcg of methylmercury during the first six months of life. That's more than twice the amount of mercury than was ever contained in all the vaccines combined. And because the type of mercury in breast milk (methylmercury) is excreted from the body much more slowlly than that contained in vaccines (ethylmercury), breast milk mercury is more likely to accumulate. This doesn't mean that breast milk is dangerous, or that infant formula is dangerous, or that water is dangerous. Not at all. It means only that anyone who lives on the planet will consume small amounts of mercury all the time. During legislative hearings to ban mercury-containing vaccines, some politicians have stood up and said: "I have zero tolerance for mercury." This kind of statement makes for a great sound bite. But because mercury is an inescapable part of our environment, politicians with zero tolerance for it are going to have to move to another planet.
I get the feeling that Sandman is attacking a gigantic straw man argument here, leading him to conclude:
The core problem for vaccination proponents, in short, isn't that your critics exaggerate and distort. That's true, but it's not your core problem. Your core problem is that you also exaggerate and distort - and feel justified in doing so because you are (mostly) in the right, and don't notice that it keeps backfiring on you. Or to put it a bit differently, your core problem isn't that the public doesn't trust you. That's increasingly true too, but it's not your core problem. Your problem is that you don't trust the public.
And, worst of all:
My best guess is that vaccination proponents are "lying" (exaggerating and distorting) on behalf of the truth. That's why I wish they'd stop.
That's right. Sandman is accusing scientists like Paul Offit of lying in the name of defending vaccines. Of course, he can't point to a single lie. Not one documented lie told by the CDC or other vaccine proponents to parents. Certainly he can't point to one when it comes to thimerosal. In fact, the worst he can point to is a bit of a nonsequitur, namely a problem with the oral polio vaccine in Africa where, given the superstition and Islamic fundamentalists ready to jump at such problems, being reluctant to tell everything right away about a vaccine problem is somewhat understandable.
Sandman's complaint is nothing more than a tu quoque fallacy writ large, and it's a huge exaggeration. Antivaccinationists peddle outrageously false information and pseudoscience in a constant barrage of misinformation, exaggeration, cherry-picked data, and quote-mining on blogs like Age of Autism, while othe occasional vaccine proponent who may not be circumspect enough in not expressing too high a degree of certainty for Sandman's judgment is to him equivalent to the tsunami of misinformation that comes from the antivaccine side. (Apparently, though, it's OK for Sandman to "exaggerate and distort" while castigating scientists for "exaggerating and distorting" because he knows he's in the right in his criticism.) In fact, it's so wrong-headed that I have a hard time reading it without getting angry. Again, Sandman gives no specifics in the thimerosal controversy where vaccine proponents exaggerate and distort. He repeats the same essential message again in his later post, again bringing up the same straw men again and again not being able to give a single example, other than polio vaccine use in Nigeria, for which he castigated health officials for not acknowledging a very small risk of polio due to attenuated live virus polio vaccine. The only point he makes that I can sort of agree with is that if your position is 99% correct, at least acknowledging the other 1% is wise. However, I would also counter that there must come a certain level of certainty where acknowledging the "other side" gives pseudoscience an unjustified and undue appearance of validity. If you're 99.999999% correct, are you obligated to acknowledge the other 0.0000001%, just to be "conciliatory"? Are evolutionists obligated to acknowledge creationist pseudoscience just to be "conciliatory"?
Then we come back to the exactly the same problem that Dr. Offit and I have described and why what Sandman says is a straw man: Scientists do couch their conclusions with "error bars," so to speak. That's a major problem in communcation, in fact. They do do exactly what Sandman decries them for supposedly not doing: Stating that, to the best of our knowledge, there is no association between thimerosal and autism and that multiple studies have failed to find a link but then qualifying it to point out that we can never completely prove a negative or that in a small number of susceptible individuals there might still be a possibility. That's the very nature of how science works, especially in epidemiology: It can never completely prove a negative. Unfortunately, when scientists do acknowledge even the tiniest degree of uncertaint, antivaccine activists take that crack in the door and jump right on through: "See, see! There is a controversy! There might be a chance that vaccines do cause autism!"
I'm not saying that everything Sandman says is on that level of dubiousness. Certainly, I actually agree with him on this advice:
- Attribute the change to the power of opposition groups. By far the easiest way to establish that a new precaution isn't hypocritical is to concede that it's a response to pressure. "If you're so sure thimerosal is safe, why are you removing it?" "Because our critics won that fight!"
- Explain the practicality of the decision. Whether it's a genuine risk or not, a vaccine that significant numbers of people fear to take (or to let their children take) isn't an effective vaccine. You're not just deferring to your critics; you're deferring to reality.
Exactly. Simply say: The antivaccinationists won that battle, and given how much fear they were provoking among parents banning thimerosal was the most practical way to blunt that fear.
Sandman is certainly correct in saying that science communicators would do well to be more empathetic, even giving some suggestions how to do it. However, his "sorry" gambit strikes me as far more condescending and paternalistic than telling it like it is and doing our best to make parents understand that we empathize with their difficulties. As we all realize, raising an autistic child is an incredibly difficult task, and I have grave doubts if I could ever manage it, for example. However, Sandman dresses up the simple message that given current science the chances that vaccines or mercury cause or contribute to autism but that we understand why at the individual level parents might believe they do in a whole load of false equivalences and advice that might make sense in the case of a scientific question whose anser is less clear-cut, but it's advice that falls apart when it comes to defending science against pseudoscience.
ADDENDUM: I didn't see this before, but it's been pointed out to me that Peter Sandman has a rather infamous reputation among P.R. men, having done damage control for some of the largest corporations in the world. See:
- Sourcewatch: Peter Sandman
- Advice on Making Nice: Peter Sandman Plots to Make You a Winner
- Sandman's Cagey Tactics
- Some Clients of Peter Sandman
- Mining PR Exec Lauds Peter Sandman
- Sorry is the hardest word for AWB
Interesting.
I always thought the framing debate fairly easy to understand: Nisbet and Mooney had a good, sensible idea, but then began taking too far, to the point of attacking seemingly-effective outreach efforts that they didn't like. Others were initially skeptical, but might have been won round had Nisbet and Mooney not begun advocating censorship by attacking people like PZ that didn't frame in the exact way they wanted them to.
There are some people who believe that laypersons can't comprehend complexity (i.e., are stupid), so health information should be presented in black and white, instead of shades of gray. I don't happen to agree with that. For instance, overweight and obesity have many adverse effects (e.g., higher risk of developing heart disease and certain cancers). However, the human body is complex and there are many things we do not understand yet. Some studies have found what could be considered positive effects from obesity and overweight (e.g., lower risk of osteoporosis, better prognosis in people who already have heart disease). I have seen people become outraged that such studies are published and reported in the media, because the mere suggestion that being overweight may not be all bad will "confuse" the public. I deplore that attitude. Rather, why not have a rational discussion about the scientific merits? After all, it's not as if this were the only case of something having both positive and negative effects. For example, estrogen in women protects against heart disease and osteoporosis but increases breast cancer risk.
Likewise, when a negative study of ezetimibe's effect on atherosclerosis was published, some leading cardiologists worried that if people were told that ezetimibe was not effective, they might turn away from statins. Ditto when the SEAS study linked ezetimibe to a higher risk of cancer.
There should be more spelling out of what the conspiracy involved would entail. People will believe that big pharma and the government are out to get them, but most find it difficult to believe that their personal physician, whom they've known for years would willingly inject them, much less, themselves and their (the doctor's) children with a toxic substance for the benefit of Big Pharma.
Also, an idea I considered doing, someone should consider creating an oral history along the lines of Studs Terkel's Good War or Working on life in America or even globally before the advent of mass vaccination.
Hmmm... what about the other .0000009%? Why have you left them out of the conversation? :-)
I am so Wise is so wise
I think this the best way and the sooner the better before the people who remember the bad old days are gone. Most people have forgotten or never knew what things were like befor vaccinations were available for polio, tetanus, pertussis, measles etc.
One thing some Autistic self-advocates on the web often talk about is the utter lack of ethics experts have when they encounter Autism. Peter Sandman is a friggin brilliant example.
Does he have any idea the consequences of being apologetic or sorry for such people would bring about for Autistics, who are completely barred from taking part in the public debate about themselves? Fake or real remorse for failing to discover evidence for Thimerosal causing Autism feels like being kicked while you are down, because it is precisely batshit lies like it which are a barrier to adults trying to seek help.
We're on a runaway bus steered by a few hysterical parents and a lot of unscrupulous charlatans and when authorative persons say we shouldn't be beating and pushing very hard to the front to seize back control of the wheel, they should be forced to confront the realities we have to.
Peter Sandman can afford to be very gentle and empathic towards them, in the same way we can all be towards a petty thief, until we're bleeding to death and they're running away with our stuff.
I still think he has a point about some things being glossed over in your favour. Orac is particularly bad about it. Many times he tries to say that if something is subclinical, it is insignificant. Is reduced IQ bad? Obviously. Is it a disorder? No.
Also, I checked after the post I previously made on the subject, and it's true that thimerosal cannot be fairly considered plain old mercury - i.e. an uncompounded mercury ion. It's a lot worse. No one knows how much worse, but glossing over uncertainty is almost as bad as glossing over something that weakens your position.
It's still glossing over, however good your intentions. So Sandaman is more right than you say.
hariss Kol:
Is it just me, or do those last two phrases directly contradict each other? If we don't have any basis to say how much worse thimerosal is than elemental mercury, then we can't possibly have any basis to say that it's worse at all.
Can you please restate your point in words that make sense together? Thanks!
Mithrandir: It's just you. Just because noone has any accurate numbers doesn't mean you can't make an argument on it. I'm not saying it neccessarily in *enough* worse to be important. But it's possible, so my point is a valid one : this is an example of glossing over.
A more obvious example is dimethylmercury. It's obviously a lot worse than inorganic mercury, but you can't really say how much.
I'm not arguing that thimerosal is dangerous, I'm saying Orac and friends have done the sort of thing that sandman says they have. Orac is denying it.
And sodium chloride cannot fairly be considered plain old sodium - i.e. an uncompounded sodium atom. It's a lot worse. No one knows how much worse, but glossing over uncertainty is almost as bad as glossing over something that weakens your position.
Ban sodium chloride now!
Also, natural cures, Big Pharma, etc. etc.
Where, specifically, have I said that if something is subclinical it is insignificant? Be specific, please, and provide at least one or two examples.
Well, simple logic says, if thimerosal is responsible for autism then incidence should go down if we remove it. If not, then the original limit was lower than the minimal effect dose. Simple.
I sometimes wonder, how these antivaccinationists can even cross the street...
Orac said "Where, specifically, have I said that if something is subclinical it is insignificant?"
I think "subclinical" is someone's new buzz word, and I really don't think it means what they think it does.
Subclinical means "We are sorry for pulling the rug out on you spreading disparaging and baseless fears about Autistic people to push your agenda and deny them a say."
Well, seeing as we're all allowed opinions on what words must mean now, that was mine.
I find Sandman's implied attitude toward autistic-spectrum peopleto be of a similar ilk to that of the Jenny McCarthy crowd. They're both dehumanizing ASD people to support their agendas, and they're both reprehensible.
I agree that the the overwhelming emotional attachment parents have to their children is a major hurdle to overcome but it is precisely that attachment I have for my autistic child that makes me do research and consult experts who know what they're talking about so I don't unwittingly harm him by subjecting him to pseudoscientific treatments.
People who (intentionally or not) prey on parents vulnerabilities and fears piss me off.
is this where I'm supposed to say that none of this would even matter if we did an even halfway decent job of science education in the school system?
Because then people would understand things like probabilities and how to read studies and whatnot...
*sigh*
I think the people who say its safe to inject infants with organic mercury are the ones who believe in creationism and the ones who realize that mercury and the volumes of research that prove its a neurotoxin are more inline with evolutionists, not the other way around.
CanadianChick is correct that we need to do a better kob teaching science in our schools (at all levels). However, I'm not sure that will "cure" the problem of scientific agnosia.
Part of the problem, to be sure, is that most children finish high school (and often even college) thinking that science is simply the memorization of millions of facts. This leads to the "average" person thinking that if they can memorize a number of "sciency" facts, that they will become the equivalent of a "scientist". Thus we have the phenomenon of "Google PhD's" and the confusion of "research" (looking things up in the library or on the Internet) with "research" (forming hypotheses, testing those hypotheses experimentally and revising or reformulating the hypotheses according to the data).
We also have to deal with a more pervasive problem in the human psyche itself. For hundreds of thousands (if not millions) of years, our ancestors used their "intuition" and "gut feelings" to survive in a hostile world. The scientific method has been around - at best - only a few centuries. As we have seen - time and time again - this primordal attachment to the "hunch" and "common sense" can easily overwhelm even decades of scientific education and training, if it is allowed to (see: Linus Pauling, Boyd Haley, etc.).
What we need to do is somehow erase the idea of "common wisdom" - the idea that the intuition and opinion of the "average" person (i.e. the person uneducated and untrained in science) in a scientific field is equal (or, some argue superior) to the knowledge of a person who is educated and experienced in that field.
Another aspect of this is the need to convince the public (and the scientific community, as well) that expertise in one field (chemistry, for instance) doesn't automatically translate into expertise in every other field of science.
Oh, and we need to caution the public (and the medical community) that physicians are not neccessarily scientists (most are not).
Prometheus
"I think the people who say its safe to inject infants with organic mercury are the ones who believe in creationism and the ones who realize that mercury and the volumes of research that prove its a neurotoxin are more inline with evolutionists, not the other way around."
Why? The key-mark of many lay-creationists is to know just enough science to think their viewpoint is right (2nd law of Thermodynamics etc etc) whereas your average lay-evolutionist tends to know the same science, plus just enough to know that the creationist view is a bit dubious.
This is exactly parallel to the lay-antivax view where they (you) know just enough to know mercury is a neurotoxin, but not so much that they know it's the compound, dose and exposure that count - as with all the other 'chemicals and toxins' people are exposed to everyday.
Milly wrote:
Strawman. NOBODY is saying that mercury isn't toxic. What part of "the dose makes the poison" do you not understand?
~David D.G.
Lucas McCarty wrote, above:
One thing some Autistic self-advocates on the web often talk about is the utter lack of ethics experts have when they encounter Autism. Peter Sandman is a friggin brilliant example.
Here is an excerpt from same comment I made in the book club, since you are discussing it again here:
I heard Sandman at a recent conference, and he used [the example of inappropriate gloating that Wakefield was wrong].
He said something like, "Have you ever thought how great it would have been if Wakefield had turned out right? We could have disaggregated the MMR vaccine and given the components at different times, and voila, far less autism. Thus -- we should express sorrow that Wakefield turned out wrong, becuase if he'd been right, we could have done something to prevent so many future cases of autism."
He wasn't saying to apologize; he was saying we should feel and convey sadness that Wakefield was wrong.
Just a paraphrase, but I think I'm close to what he said.
Think about it: If Wakefield had been right, we would have found a major preventable cause of autism. The fact that he turned out wrong? We shouldn't be so cheerful about that.
By the way, I just looked at a link Orac cites above, "Sorry is the hardest word for AWB". No wonder the guy is infamous among PR men: He advocates admitting corporate guilt when the corporation is guilty! He must be REALLY infamous among corporate lawyers. Orac, did you actually read that article, or did you just post the link?
Prometheus, what you're describing would be my ideal of teaching science properly.
I mean, if you're someone like I was who really enjoyed biology then learning about the number of ATPs created from each molecule of glucose is great. Lots of interesting facts that ultimately do little to increase your ability to recognize bullshit.
(and I'm not saying that SHOULDN'T be taught - not at all)
But I think real science education should encompass all those things that you describe - understanding the scientific method, being able to critically assess claims, recognizing the difference between real research and having a Goggle degree, developing a well-honed sense of skepticism, etc...
Of course, I think all education should encompass a lot of that stuff, but then what would we do with all the sociology and English lit professors?
(says the accountant as she runs away)
Grace, is the ethical problem there really so hard to see?
Peter Sandman expresses no concern for the way Wakefield conducted research, no concern for those most affected by it and the kind of good intentions which pave the road to hell for others.
There's also a neat 'successful' Rain-Mouse study I could go on about. Yes, that study was really brilliant for Autistic people.
In fact, there are hundreds of successful studies concerning Autism, each more or less contributing to a general social climate where we can't go anywhere for help most of the time, to be eligible for that help if we can get it means we have to accept a version of reality which says the world is better off without us completely and it should be our ultimate goal to become or seem non-Autistic. Living is a superficial hobby.
Peter Sandman didn't seem to realise that the tradgedy wasn't that Wakefield failed, the tradgedy was that he was allowed to do the study at all, with many cheerleaders and zero scrutiny. Like those many others, it was a study that began with the premise that Autistics are not welcome anywhere and resources should not be spent on understanding Autism, what Autism can teach about the human condition in general and certainly not spent on accomidating Autistics so we can function in society as Autistics. All those resources must be spent on chasing the rainbow with the cause and cure for Autism at the end of it, before science has even a neophyte level of understanding about what Autism actually is.
Lucas, I think I see your position a little better now. Thanks for responding to my comment above.
You wrote that Wakefield's study "was a study that began with the premise that Autistics are not welcome anywhere and resources should not be spent on understanding Autism, what Autism can teach about the human condition in general and certainly not spent on accomidating Autistics so we can function in society as Autistics."
That seems true. Wakefield, in his pathetic way, was interested in investigating possible causes of autism, with the implied goal of finding ways to prevent autism.
So, from the point of view of constituents whose goal is not the reduction of the number of autistic children, "cause and cure" studies are a waste -- regardless of whether they are poorly-designed and misleadingly-interpreted studies like Wakefield's, or excellent studies that are accepted by mainstream scientists.
I think you are asserting that the "cause and cure" constituents are getting resources you think would be better spent on understanding "what autism is."
This is a legitimate argument from the "anti-cause and cure" constituency, if I may call it that. While I agree that it is important that researchers learn more about "what autism is," and "what Autism can teach about the human condition", it is also understandable that parents of severely autistic children are far more interested in "cures" for their children, and how to prevent other children from becoming severely autistic.
Am I closer to getting what you mean?
What is 'severely Autistic'?
Last week I wasn't able to drink; the sensory stress was too powerful. I had to just hold water in my mouth for hours while it slowly found it's own way to somewhere useful and thirst-quenching.
Today I finished building a PC in record time with no mistakes, it worked on first boot-up and I know every exact component of it. I know every IRQ address and I/O port, even though I'm still unsure exactly what they are. I was disappointed that the motherboard didn't support dual-channel memory, giving me an elitist sensation that whilst the machine was fine for the office job it was assigned to, it was never going to be good enough for me.
Those who wish to cure Autism will say the first one is closer to 'severe Autism' and the second one is closer to 'mild Autism' because the first one is a difficult challenge whilst the second is useful quirkiness. But how exactly do they know this? Where did they learn it? Is there a book of divine revelation which says so or is this something they were told by an expert? Does their infallable parental instinct tell them? My opinion is that they are both 'severe Autism', but the real difference between *me* and *them* is that I know I can't be sure of this.
In the my early years on the internet when I first encountered such people, I discovered after drinking many of my own tears that expressing such simple doubts singled me out; they thought them so strange that it obviously must be a symptom of the horrid condition which has so set me back in life. I later found out apparently 'normal' people have these doubts too and that these doubts are normal. If they're able to identify simple doubt as error and then attribute that error to the label I, a complete stranger carries, what are they like with their Autistic children everyday?
Finding out what Autism is is the most important thing we could know at this point and it's precisely the thing which those vicious and heartless people keep trying to stop. They already *know* what it is, they've told researchers what it is, why would the researchers possibly look into it unless they thought these few parents were *lying* or even *deluded*? These are very powerful and emotive rhetorical deterrents given out.
If you research about Autism, it is presumed you are looking for something to override the Truth as they have told it. When what should be really happening is that if you are researching a Cause and Cure, it should be presumed you have an agenda from which you think you can profit. Not a huge presumption either when we look at how many Causes and Cures have been declared and profited from and hilariously and I really mean that, we should be in hysterics over each Cause+Cure study that falls flat on it's face, not sorry, apologetic or whatever: Autism is still here to stay.
Hi Orac,
It's been a while since I've dropped by for a visit, so I thought I'd say "Hi!" (if you're trying to place the name, I'm the guy that used to write Capitalist Pig vs. Socialist Swine).
Also, I wanted to toss in my two cents into this discussion. It seems to me that the root of a number of problems, such as the evolution/creationism debate and the silliness about vaccines and autism, is that science literacy is terrible.
I don't think the issue is that scientists, doctors, etc. do a bad job talking to laypeople. I don't even think that the popular media is to blame, I don't think they're as bad insofar as distorting or sensationalizing their reports about scientific matters.
It just seems that people just don't understand scientific reasoning (or any sort of analytical reasoning for that matter). While I'm not a product of the US educational system, from observing my students it seems that what they've learned is how to memorize trivia. They don't understand how to weigh evidence.
That being the case, I can understand why people so credulously accept the dumb stuff that's being peddled by conspiracy theorists and the religious right. I think until there's some fundamental change in the educational system, it will always be an up-hill struggle to inform people regarding scientific matters (and a whole host of other things).
There is indeed a parallel to be drawn, but not the one that you think. The people who espouse creationism are overwhelmingly not biologists. It is extraordinarily rare to encounter a biologist who does not accept evolution (in my entire career, I don't think I've met even one), because evolution is an invaluable tool--it is very hard to do worthwhile research in biology without taking evolution into account. Similarly, the people who think that all that they need to know about mercury is that it is a "neurotoxin" are not pharmacologists, toxicologists, or doctors. Anybody in any of these professions has to know that "dose makes the poison," and that some of the most toxic elements on earth are harmless or even essential in the proper doses or the correct chemical combinations. Almost without exception, they vaccinate their own children, and like Orac do not bat an eye about taking a vaccine that is protected from bacterial contamination with thimerosal. And they've studied advanced biology, so very few of them believe in creationism
Dose makes the poison? Old thinking. How about timing makes the poison (think lead). Have any of you advanced scientists ever tested a vaccine vial for mercury? The concentration is 50,000 ug/l, assuming they are formulated correctly. Mercury is measured and monitored using ug/l as the units. The vaccine vial contains 250 times more mercury than what the EPA classifies as hazardous waste. They administered 500 ul of this poison, 12 times, into infants. You folks are really dense!
Poopsey said "Dose makes the poison? Old thinking. How about timing makes the poison (think lead)."
Okay, how does that make any sense? Lead is dangerous even if you are older. As for the EPA level, did you read page 64 of the book being discussed?
How about you just tell what evidence is that the vaccines (which no longer have thimerosal, and the ones that NEVER had thimerosal) are worse than the diseases. Since I am just a lowly engineer and mom of a disabled kid, I am not one of those "advanced scientist", so you can give me an education as to what science you really have.
To be specific, I want to know what scientific evidence you have that the DTaP is worse than diphtheria, tetanus and pertussis. This should not include anecdotes, news stories, random websites (especially if they have a link to hire lawyers, like the NVIC website) and random books. I want papers that I can find in my local medical school library.
Poopsey said:
Yeah, how dense? You should try to avoid vague terms like "really dense" when you can express density with a ug/l value. Try to concentrate and be specific, otherwise it's meaningless.
When skeptics question the validity of something because of it's age, it's usually because there is a good reason to be concerned about it's age and this is explained very clearly when they bring it up.
But here we just got a 'it is old therefore crap' arguement about dose = poison and no explaination for why.
"Old thinking" is of course just crank-speak for "evidence based science." The cranks would have you believe that it has never before occurred to scientists that the toxic effects of a substance might change with age, but in reality it is a well-established and extensively-studied phenomenon. And guess what--even though sensitivity may vary, it remains true that "dose makes the poison"--there is still a threshold dose below which the supposed "toxin" is effectively harmless.
If you'd actually read Dr. Offit's book, you wouldn't have embarrassed yourself by parroting these long-discredited crank claims. Of course, if you actually knew anything at all about biology, you'd have been able to figure it out for yourself, because the units are obviously wrong. For example, you cannot express a dose in units of concentration--this is an elementary error. A dose is given in terms of an amount of a substance, so the correct units would have to be something like ug or maybe ug/kg body weight. You can give the same dose in a higher concentration just by mixing it up in a smaller volume of solution, but that does not increase its effect on the body.
Moreover, the EPA guidelines are for methyl mercury, which has been shown to be eliminated more slowly, and thus to have a greater risk of accumulating in the body than the ethyl mercury that is in thimerosal. The "hazardous waste" argument is even more idiotic. For example, as a scientist, I can tell you that it would be a violation of regulations for me to dispose of a bottle of vodka by pouring it down the drain in my lab. That concentration of alcohol is considered "hazardous waste."
EPA exposure limits are based on the assumption of daily exposure--that is, they try to figure out what amount of a substance is so tiny that it can reasonably be concluded to be safe to be exposed to that amount every day, day in and day out. Comparing the amount in a single dose of vaccine to an every-day limit is apples and oranges--it simply does not make sense.
"Moreover, the EPA guidelines are for methyl mercury, which has been shown to be eliminated more slowly, and thus to have a greater risk of accumulating in the body than the ethyl mercury that is in thimerosal".
For starters, the EPA hazardous waste guidelines are for total mercury. Methyl mercury does not de-methylate as quickly as ethyl mercury due to a much stronger bond. That's why it stays around and is recirculated in the body. Ethyl mercury rapidly clears the blood and enters the brain where it is converted to Hg++ to a much higher degree than methyl mercury. This form remains trapped and causes the damage in the brain. Because of this unstable bond, ethyl mercury is much more toxic to the brain than methyl mercury.
"For example, as a scientist, I can tell you that it would be a violation of regulations for me to dispose of a bottle of vodka by pouring it down the drain in my lab. That concentration of alcohol is considered "hazardous waste."
Ethanol is not monitored as an EPA toxic characteristic parameter.
"EPA exposure limits are based on the assumption of daily exposure."
Waste, classified as hazardous by the EPA's Toxic Characteristic Leachate Procedure (TCLP), is considered unsafe for any exposure thus it is managed as hazardous waste.
You really don't know what you are talking about trrll.
Except that Trrll is correct and if you don't cherry-pick and fabricate stuff, it's pretty obvious.
So exactly how does mercury-induced brain damage cause enhanced perceptual functioning, higher fluid intelligence and atypically large vocabulary development among the vast majority of the constituents alleged to be affected by it?
How are their incidence levels remarkably unaffected by the very large drop in mercury exposure they've had in the last couple of years?
Again, if you had read Offit's book, you wouldn't have made such a nonsensical claim. It is not possible to make a guideline for "total" mercury, because toxicity depends upon the chemical form. So EPA's guidelines are based upon what is known about methyl mercury, which is the most toxic form.
But since, unlike ethyl mercury, it is eliminated slowly, it has plenty of time to do that. There is no evidence that ethyl mercury is more toxic to than methyl mercury. Indeed, as reported in Dr. Offit's book, animals given high doses of ethyl mercury do not show symptoms of mercury poisoning, nor are mercury poisoning symptoms seen in humans administered doses 10,000 times greater than that in vaccines. If ethyl mercury demethylated fast enough to compensate for its rapid elimination from the body, then toxic effects should have been observed. They weren't.
Nevertheless, it is classified as a hazardous waste under EPA regulations, and my institution would be subject to large fines for unlicensed disposal of hazardous waste if I were to pour ethanol down the drain.
The very fact that EPA lists acceptable concentration limits for these substances shows that it is not true that they are considered unsafe for "any" exposure. Note that these regulations are intended to apply to concentrations present in industrial effluent, not individual doses of medications. It would indeed be a problem if some industry were dumping thousands of gallons of thimerosal into a river every day, for example, thereby causing local residents to ingest mercury in water and fish on an ongoing basis.
Many regulations that do not make sense from the standpoint of the typical levels of exposure encountered in common usage or medical practice do make sense in the context of the industrial uses which the EPA regulations are designed to regulate. In reality, of course, nobody would be placed at risk if I were to pour a few milliliters of ethanol down the drain (although I would still be subject to thousands of dollars in fines if caught at it by the EPA). I could serve it to you at a party, and the only ill effect you would be likely to experience would be a hangover. But if I were dumping thousands of gallons of ethanol into the sewer, it would be a potential fire hazard.
In fact, many widely used medications are classified as "hazardous waste" under OSHA regulations. So comparing concentrations of substances in drugs to "hazardous waste" trigger concentrations intended to regulate levels of chemicals in massive quantities of industrial waste being released on an ongoing basis into rivers and streams is fundamentally a dishonest rhetorical tactic designed to fool people who don't understand what EPA and OSHA regulations are ultimately intended to control--namely, ongoing, day-in-day-out exposure of the public to chemicals.
"So exactly how does mercury-induced brain damage cause enhanced perceptual functioning, higher fluid intelligence and atypically large vocabulary development among the vast majority of the constituents alleged to be affected by it?
If this is your sick way of describing one of these ill kids diagnosed as autistic Lucas you don't have a clue.
"How are their incidence levels remarkably unaffected by the very large drop in mercury exposure they've had in the last couple of years?"
Geez Lucas, I think your hero Dr.Profit says that autism rates havn't changed at all. They have always been steady. Better diagnosis. Change in criteria. Diagnostic substitution. So what do you mean by your statement? You can't have it both ways.
Maggy, please produce real evidence for your claims. Show us the actual factual evidence that vaccines are a cause of autism, especially in regard to the MMR (which never had thimerosal). Just remember that whatever data you give us must be available for review at any good medical library (though it should not be a "you pay us, we will print" journals like Medical Hypothesis).
By the way, last I checked Dr. Offit was not making the claim of better diagnosis, change in criteria etc. Those are observations from people like Dr. Paul Shattuck, http://pediatrics.aappublications.org/cgi/content/full/117/4/1028), Dr. R.R. Grinker (an anthropologist, he wrote a book called "Unstrange Minds, he was profiled in Offit's book, his website includes changes in the DSM, http://unstrange.com/dsm1.html), there is also Dr. Jim Laidler who has written some essays on the different autism criteria in certain states, I am at my URL limit but you can find them at autism-watch DOT org (you can also read about his experience as part of the DAN! network and the waffle experience with his autistic son)... and then there were these studies:
Dev Med Child Neurol. 2008 May;50(5):341-5. Epub 2008 Mar 31.
Autism and diagnostic substitution: evidence from a study of adults with a history of developmental language disorder.Bishop DV, Whitehouse AJ, Watt HJ, Line EA.
J Autism Dev Disord. 2008 Jul;38(6):1036-46. Epub 2007 Nov 2.
Trends in autism prevalence: diagnostic substitution revisited.Coo H, Ouellette-Kuntz H, Lloyd JE, Kasmara L, Holden JJ, Lewis ME.
Pediatrics. 2006 Apr;117(4):1436-7.
Investigating diagnostic substitution and autism prevalence trends.Newschaffer CJ.
Arch Pediatr Adolesc Med. 2003 Jul;157(7):622-7.
Analysis of prevalence trends of autism spectrum disorder in Minnesota.Gurney JG, Fritz MS, Ness KK, Sievers P, Newschaffer CJ, Shapiro EG.
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.
Evidence always speaks louder than insults.
The URLs I posted included the trailing '),'... sorry, they are:
http://pediatrics.aappublications.org/cgi/content/full/117/4/1028
and
http://unstrange.com/dsm1.html
My apologies.
Though plugging autism-watch into a browser URL box will bring up the page with Dr. Laidler's essays (I just checked it with both Firefox and Explorer).
Perhaps you should read Dr. Offit's book, and find out what he actually says.
The one thing that everybody agrees upon is that autism incidence has not decreased. And that includes countries in which thimerosal use has been eliminated or greatly curtailed. Advocates of the mercury hypothesis predicted that reduction in thimerosal use would lead to a big decrease in autism. It never happened.
Which was my exact point Maggy: Autism incidence is not at all affected by mercury exposure and never has been. I was challenging you to explain how this can be the case if mercury had anything to do with it, like what DAN and Generation Rescue claimed, before they started switching it for other scary sounding chemicals.
Do your research; most Autistics are not children, most can talk with a large vocabulary, most demonstrate perceptual strengths not possessed by non-Autistic people and their intelligence scores in non-verbal fluid intelligence tests is often above average. These are the ones accounting for the increase in detected incidence since the 80s. They are not broken things rubbing shit on the walls in institutions once they become adults.
My teen age child can't speak, has an IQ in the forties, can't read or write, runs into traffic if not restrained, performs at a 2 year old level, grabs peoples glasses, pulls hair, throws food, has seizures, doesn't sleep, has constipation with grapefruit-sized blockage (verified by x-ray), has chronic sinus infections, has precocious puberty, has no understanding of water or other dangers and doesn't recognize me or anyone from her family. This is what Offit and you people are defending as something good? You're evil!
I do feel for your son's difficulties and how it affects your family (I know about seizures, my son had seizures as an infant, and later while sick with a now vaccine preventable disease). But your anecdote really does not in anyway show that vaccines have any connection to autism.
Again, I ask... if you have any real scientific evidence that the DTaP is worse than diphtheria, tetanus and pertussis, please present it. The same goes for the MMR's relative risk compared to measles, mumps and malaria (a vaccine that has been around since 1971 and never contained thimerosal).
It would be nice if you provided some actual evidence that you have even read the book under discussion. Tell us how you would interpret the meeting described on page 64, or the discussion on epidemiological studies that start on page 110, or the interpretation of "the dose makes the poison" starting on page 114 (and the water examples a page later), the description of product fraud on page 144, or on the relevance of the joke on page 211.
Does your son also hit you hard in the head so you can't tell the difference between him and the majority of diagnosed teens and adults that make up the so-called 'hidden horde' the mercury militia claims is proof of vaccines causing Autism?
Does it blur your vision, so when you read the DSM description of Autism you somehow see 'sinus infections', 'hair-pulling' and 'constipation' written on the page when it isn't?
You're a hidious troll that doesn't care about the consequences of your actions and words on the lives of others. No one should have any empathy for you because you're incapable of having empathy for anyone with an ASD diagnosis. Perhaps if your son is Autistic this is just poetic justice; you're making the world a hostile place for Autistics so anything you can suffer at his hands is just and well-deserved.
I've given up on trying reason and evidence. HCN and the rest should do the same; hysterical anti-vaxxers will lie and distort, to themselves, each other and the public. The only thing left is to point out the devastating result their behaviour produces and then compounds. Help for Autistic people will never materialise because time and energy will be wasted on irresponsible campaigns of misinformation and research into causes and cures for something no one even understands. Rather than research into understanding it, there is and will continue to be disasterously misleading speculation constantly contradicted by the results study subjects give and behaviours they demonstrate which are disregarded or distorted by biased observers.
It's gone on for decades and will go on for decades longer if the shrill voices don't shut up and let someone sane take the wheel on their runaway bus.
Lucas McCarty said "I've given up on trying reason and evidence. HCN and the rest should do the same; "
I understand, but I cannot stop trying reason and evidence because there are others who read these blogs. Many of them are undecided, and/or are being bombarded by the one side of the issue. I think I did manage to persuade someone who was getting all her information from parenting forums:
http://www.theness.com/neurologicablog/?p=372#comment-5588
I agree that Maggy cannot be reasoned with, but there are others who can reason reading this blog. They can see that her confrontational style of spewing insults but offering no constructive information is indicative of what kind of substance she has offer in this discussion: none.
Autism is simply a term from the psychiatric DSM-IV manual. It's nothing but a smokescreen. It provides an alibi for the drug companies who added mercury to vaccines at levels 250 times higher than hazardous waste levels (based on toxicity characteristics). It provides an alibi for the CDC, FDA, the American Academy of Pediatrics and the other drug company cronies who are responsible for the safety of our children. It provides an alibi for the people who administered this poison. It provides an alibi for health insurance companies so they don't have to pay for treatment for these sick kids. It provides an alibi for psychiatrists so they can force powerfull anti-psychotic drugs on these kids who are already terribly confused.
There will never be an identifiable cause for autism. There are though 11 published papers which identify the underlying medical condition of autism as neuroinflammatory disease. My favorite is ' Neuroglial activation and Neuroinflammation in the Brain of Patients with Autism'. This was published by John Hopkins University. Now, do you want to debate whether mercury, a known neurotoxin, added to childhood vaccines at levels 250 times higher than what the EPA identifies as hazardous waste, causes neuroinflammatory disease? Do you want to debate whether brain damaged kids behave in a way so that some psychiatrist can label them as somewhere on the 'spectrum'?
Obviously, Pete, your ability to READ has suffered a lot under whatever toxins are up to date at the moment.
So once more, slowly, just for you:
There - is - no - mercury - in - vaccines. They - removed - it - some - time - ago. The - MMR - vaccine - has - NEVER - contained - mercury.
That should even get through to your completely distorted brain. I don't even mention the harder stuff - the fact that your assumptions are utter BS and the reasons for that is something you would ignore anyway.
Pete is just repeating the "talking points" of the "thimerosal vaccines-cause-autism" promoters. I doubt that he has thought about the implications of what he is saying at all - he is letting other people do the thinking for him, as do most of the people caught up in the hate-mongering of Big Autism.
Seriously, do you think Pete and others of his ilk even understand the fact the the MMR vaccine never had mercury in it? Do you think they can grasp the concept that live virus vaccines would be destroyed by adding mercury? No. They are just repeating what they've been told.
When the "thimerosal-causes-autism" movement got started, there was mercury - in the form of thimerosal - in some vaccines given to children....in the US, but not in the UK or Canada or Denmark or.....you get the idea.
When it was pointed out that these countries had also experienced a rapid rise in autism prevalence, rather than saying, "Oops, my bad - it's probably not the thimerosal in vaccines.", they screamed that the researchers were "biased", "corrupt" or even part of a "conspiracy".
Some years after thimerosal was removed from children's vaccines in the US - and the autism prevalence kept climbing without a pause - the "thimerosal-causes-autism" crowd had another opportunity to "do the right thing" and admit their mistake. They could have just stopped screaming and walked away - nobody was going to rub their noses in it and make them go on "Good Morning America" to admit their mistake.
Instead, they screamed that the thimerosal-containing vaccines were "still on the shelves" - despite the fact that they would have been past their expiry date AND at least one study showed that they were gone. They also screamed that "thimerosal is still used in vaccine manufacture" - despite the fact that the amount of thimerosal getting into vaccines was less than 0.1% of the amount that in the older thimerosal-containing vaccines.
When that strategy started to look ridiculous - even to the TV news reporters - they switched tactics. Instead of blaming thimerosal, they went after the vague "toxins" in vaccines - without bothering to specify which "toxins" they meant. They became the "green our vaccines" movement without ever explaining the sudden shift to their followers.
Of course, a few of the less media-savvy members of the "thimerosal vaccines-cause-autism" group let themselves get pinned down to one or more specific "toxins", including the now-infamous "anti-freeze" (ethylene glycol), which was never in vaccines (although its sound-alike distant cousine polyethylene glycol is in some vaccines) and formaldehyde, which is present in amounts below those found in a ripe apple.
No, being part of the "thimerosal vaccines-cause-autism" movement means never having to say you're sorry. Or wrong. It also apparently means never having to think about what you are saying, since Big Autism is right there, supplying the script and the talking points.
Like Orac - and most, if not all, of the anti-pseudoscience 'bloggers - I don't have any expectation of "reaching" people like Pete. You can't reason someone out of a position or opinion that they didn't reason themselves into. No, I'm just hoping that some of the people watching this "debate" will see how impoverished the reasoning of the "thimerosal vaccines-cause-autism" argument is and decide to think for themselves.
Prometheus
OK you morons. Go to the John Hopkins Institute for Vaccine Safety site and count for yourselves the 11 vaccines that still contain 50,000 parts per billion of mercury. How many times can you repeat the same lie that "mercury has been out of vaccines for years". I never once mentioned the MMR vaccine. How can we have a discussion if you deny basic facts.
http://www.vaccinesafety.edu/thi-table.htm
Pete, none of those are pediatric vaccines (for example, the standard is DTaP not DTwP).
Also, there is no real evidence that thimerosal is a contributing factor in autism, nor that the always thimerosal-free MMR is a factor in autism. You would know this if you had read and understood the book under discussion.
If you have real scientific evidence to the contrary to that presented in Chapter 6, please present it. Remember it has to be real evidence in a paper I can find in my local medical library. No anecdotes, no websites (especially those run by lawyers, or shilling for lawyers like NVIC) and no books... just real papers like:
Mercury, Vaccines, And Autism: One Controversy, Three Histories
Author: Baker JP
Source: American Journal of Public Health, February 2008;98(2): 244-253
and
Early Thimerosal Exposure and Neuropsychological Outcomes at 7 to 10 Years
Authors: Thompson WW, Price C, Goodson B, et al; Vaccine Safety Datalink Team
Source: N Engl J Med, Sep 27, 2007; 357(13):1281-1292