SafeMinds

A climate scientist becomes a denialist arguing vaccine pseudoscience

oracknows — Tue, 10 Mar 2015 05:30:59 +0000

A climate scientist becomes a denialist arguing vaccine pseudoscience

The human mind is amazing in its ability to compartmentalize. Many are the times when I've come across people who seem reasonable in every other way but who cling tightly to one form of pseudoscience or another. On the other hand, as I've noticed time and time again, people whose minds have a proclivity for pseudoscience tend not to limit themselves to just one form of pseudoscience. Indeed, my surgical and skeptical bud Mark Hoofnagle coined a term for this latter phenomenon, namely "crank magnetism." It's basically a pithy term to describe how people who are into one form of pseudoscience or crankery are often into other forms. Think Alex Jones. Think Mike Adams. Think the many antivaccine activists that I've discussed over the years. The list goes on.

Such were the thoughts going through my mind as I encountered this remarkable bit of compartmentalization from a climate scientist named Cynthia Nevison, Ph.D. posted on that website of the antivaccine group SafeMinds and entitled This Climate Change Researcher Weighs in on the Use of “Science” to Ridicule Parents who Question Vaccines. It's a near prefect example of someone who is correct about one area of science but has a major blind spot regarding other science, particularly vaccines. We've met Nevison before spreading antivaccine misinformation, and now she's back to do it again. It's not surprising, given that she is a board member of SafeMinds. Unfortunately (for her), her arguments have not improved since the last time I encountered her. If anything, they're worse:

In 1988 Edward S. Herman and Noam Chomsky wrote a book, Manufacturing Consent: The Political Economy of the Mass Media, which describes how the media tend to present information from government sources as unquestioned truth while marginalizing dissenting opinions and effectively controlling the terms of the debate.
Herman and Chomsky’s astute observations are as applicable today as they were 27 years ago. The media have painted a largely black and white picture in which sensible, science-minded parents give their children the recommended 37 vaccine doses by age 18 months while irrational and uneducated parents balk at this regime.

In the majority of mainstream articles in newspapers, magazines, and on-line sites, one is either for vaccines or against them. The possibility of a middle ground is not acknowledged.

Here we go again: The fallacy of the golden mean, also known as the argument to moderation. It's a fallacy because it assumes that the best solution to a disagreement, that the best answer, must lie somewhere between the two positions. That might be a reasonable viewpoint to take when the arguments are political, but when the arguments are scientific or medical, quite often that is not the case. In fact, quite often, the answer is not somewhere between the extremes. It is the "extreme" supported by science. Surely Nevison must realize that based on her role as a climate scientist. Climate science has been under near-constant attack by anthropogenic global climate change denialists for a long time now, just as vaccines have been under attack by antivaccinationists since even before Andrew Wakefield first published his dubious case series in The Lancet linking the MMR vaccine to autistic bowel complaints, a case series that in the popular press was promoted, again, thanks to Andrew Wakefield, as evidence that the MMR vaccine caused autism. That paper was retracted due to Wakefield's scientific fraud, but the myth remains.

Certainly, Nevison does her best to feed the myth. her post is a collection of long-debunked (and easily debunked) antivaccine tropes so brain dead that she ought to be ashamed of herself. If, for instance, some FOX News pundit or some anthropogenic global climate change denialist spouted tropes this bad about climate science, Nevison would likely wax indignant, wroth even, and attack the denialists making the pseudoscientific arguments against climate change.

So let's take a look at her claims. They are pretty much the usual combination of non sequiturs, confusing correlation with causation, and bad science. For example, here's the first non sequitur:

1) The most pressing health problem facing American children today is not measles, but rather the rise in chronic immune system and neurological disorders. Asthma currently affects 9.3% of American children, 25-30% have allergies, more than 10% have ADHD, and over 2% of boys have autism.

American parents should not be mocked for wanting to protect their children from developing these chronic, sometimes debilitating, and often lifelong health conditions. Parents’ concerns for their children’s health and safety is grounded in data, not hype.

Of course, American parents are not being "mocked" for wanting to protect their children from these chronic conditions. Here's the problem. Nevison's underlying assumption is that vaccines are responsible for the prevalence of these conditions and that therefore being antivaccine is the same thing as protecting children from these conditions. It is not. We know from numerous studies that vaccines do not cause any of these conditions, particularly autism, a question that has been studied over and over and over not because there is compelling scientific question but because antivaccine activists like Nevison have been so persistent in promoting vaccine pseudoscience. Any "mockery" directed at antivaccinationists is in response to their well-documented promotion of ideas that, from a scientific standpoint, are so utterly ridiculous and devoid of supporting evidence that mockery is the most appropriate response.

Rather like the ideas being regurgitated by Nevison in this article.

Speaking of ideas worthy of ridicule, remember how Bill Maher tried to argue that "questioning" vaccines is not the same thing as questioning climate science. Remember how wrong he was? Nevison makes essentially the same bad argument, which is, as Gunnery Sgt. Hartman might put it, equally worthless.

See what I mean:

2) It is inappropriate to conflate climate change denial and concerns over vaccine safety as comparable examples of the rejection of science. (The fact that resistance to genetically modified foods is increasingly being cited as another example of the rejection of science raises questions about who is really behind this type of argument, but that is a discussion for another day.)

Why are so many parents questioning the official information coming from the mainstream media about autism and its potential link to vaccines? Are their fears based on facts or on emotion?

No, it is entirely appropriate to conflate climate change denial and antivaccine talking points (such as the nonsense that Nevison lays down, as being equally worthless antiscience nonsense. Ditto rejection of genetically modified organisms (GMOs). In fact, if you doubt me, you might want to check out what that paragon of crank magnetism, Mike Adams, has written about this, for example, in an article entitled Same delusional people who say vaccines are safe also insist GMOs, glyphosate, aspartame, mercury and radiation are safe, too. The whole idea behind the post, in typical Mike Adams hyper-caffeinated prose, is that not only are skeptics and scientists who point out that science doesn't support the fear mongering against vaccines and GMO "delusional" but that they are dangerous. Amusingly, Adams is also an anthropogenic global climate change denialist, as evidenced by multiple articles on his site (e.g. Global warming data FAKED by government to fit climate change fictions and Global warming debunked: NASA report verifies carbon dioxide actually cools atmosphere).

Nevison bases her argument on five "facts":

Autism is caused by improper brain synapse formation
Empirical data shows autism is on the rise
Autism is caused by environmental triggers but the government continues to spend most of its money searching for the elusive “autism gene”
The increase in the number of childhood vaccines correlates with the increase in autism
Asking whether our packed vaccine schedule might be a trigger for autism is a scientifically plausible question that is not equivalent to climate change denial:

"Fact #1" is possibly true. "Fact #2" is actually arguable. Yes, the apparent prevalence of autism is on the rise, but, as has been explained many times, both by myself and others, it's not at all clear if the "true" prevalence of autism has increased. Rather, a combination of factors, including broadening of the diagnostic criteria back in the mid 1990s, along with increased awareness and screening, have contributed to the apparent increase in autism prevalence through diagnostic substitution and other factors. If there has been a real increase in autism prevalence, it is almost certainly very small, contrary to cries of "autism epidemic" or "autism tsunami" from antivaccinationists like, yes, the board of directors at SafeMinds, including Nevison.

As for autism environmental "triggers," Nevison's argument references a SafeMinds article (hardly a reliable source), which references two studies, a recent Swiss study that concluded that autism exhibits slightly more than 50% heritability of autism and autism spectrum disorders and a Stanford study that estimated autism/ASD heritability to be around 38%. Of course, note the assumption Nevison makes. If there is an environmental component to autism and ASDs that's important, it must be the vaccines. Indeed she makes it explicit:

Further, to the extent that the NIH admits that autism is rising, it blames illogical things like air pollution (despite the fact that U.S. air quality has improved over the past few decades). Are genetics and air pollution appropriate scientific research priorities for a condition that took off sharply in the late 1980s?

In that case, as I so often like to point out, it would be equally "logical" to examine organic food. Seriously, do I have to bring up this graph again:

Why isn't Nevison demanding studies to determine if organic food is an environmental cause of autism? Or let me use another of my favorite examples. Internet use took off, beginning in the early 1990s and correlating with the beginning of the "autism epidemic." Why isn't Nevison demanding studies on this? The answer is obvious. It's because "environmental causes" of autism is code among antivaccine activists for "vaccines." Whenever you hear "environment" coming from someone like Nevison, substitute the word "vaccines," because to antivaccine activists, it’s the vaccines. It always was the vaccines. It always will be the vaccines. To them, there really is only one "environmental cause" of autism that matters: Vaccines. Never mind that scientists have been looking for evidence of a link between vaccines and autism and produced in the process copious evidence that there is none that they can be detected.

Nevison has an answer for that as well, riffing off her outrage that anyone would compare being antivaccine to being a climate change denier:

The media present climate change denial and concerns that vaccines can cause autism as comparable examples of scientific ignorance. However, evidence for climate change comes from thousands of studies across a wide range of scientific disciplines, from ecology to oceanography to paleogeology. This evidence is rooted in fundamental principles of physics and chemistry involving the absorption of energy by greenhouse gases, and is supported by thousands of ground-based, satellite-based and ice-core derived records from around the world that have documented trends in vital Earth properties such as temperature, rainfall, snow depth, polar ice extent, and atmospheric chemical composition. In contrast, the evidence refuting a vaccine-autism link is based more or less entirely on a limited number of studies from just one scientific discipline, epidemiology, which is rooted in statistical correlations that do not and cannot address underlying biological mechanisms. Further, some of those epidemiological studies originally showed significant associations between autism risk and thimerosal (Verstraeten, 2003) and receipt of the MMR before age 3 (DeStefano, 2004), but were manipulated to make those associations go away. CDC senior scientist Dr. Bill Thompson, who has now become a whistleblower, has publicly stated that he was involved in research fraud on a key MMR study. Thompson’s admission provides evidence that parental concerns about giving MMR too early may not be irrational after all, yet the mainstream media has barely reported on his allegations. They also have not reported that two scientists at Merck are suing the company for exaggerated claims over the efficacy of the mumps portion of the MMR vaccine, falsifying data sets, and destroying evidence.

Epidemiology cannot address underlying biological mechanisms? Tell that to Sir Richard Doll and all the other epidemiologists who figured out that smoking tobacco products causes lung cancer! Let's just put it this way, to make it simple enough for even Nevison to understand, given that she is now trashing a discipline that she clearly does not understand. There has never been a randomized trial that shows that cigarette smoking causes cancer. There have only been epidemiological studies. There will only be epidemiological studies because they are the forms of studies that can be done ethically to address this question. Moreover, it is using the same epidemiological methodologies that have been used to identify smoking tobacco as a cause of lung cancer that epidemiologists have failed to find a correlation between vaccines and autism. One notes that that last bit about the MMR is nothing more than a rehash of Brian Hooker's painfully incompetent "reanalysis" of a single epidemiological study that created the "CDC whistleblower" (a.k.a. the #CDCwhistleblower) manufactroversy.

As for Nevison's point about "multiple disciplines" verifying climate change theory, in her eagerness to focus on a single discipline that she doesn't respect (epidemiology), she forgets that there are many studies from many other disciplines, such as neuroscience, immunology, chemistry, biology, and the like that address the plausibility of a vaccine-autism link and fail to find plausibility. In any case, it's rather blatant how Nevison likes to disparage the epidemiology that fails to find a link between vaccines and autism in contrast to "many disciplines" all converging on the same conclusion about global climate change when it suits her (i.e., to attack the negative studies) but latches on to a single study when it can be incompetently twisted to show a seemingly positive result. (Indeed, the reanalysis of that study was so bad that even a new journal ended up retracting it.) Seriously, if Destefano et al (the study to which Nevison refers) were ever found to be completely invalid, it would not change the scientific consensus that vaccines do not cause autism any more than removing one study would invalidate the scientific consensus that human activity is a major contributor to global climate change.

Let's just put it this way. Hooker himself has discussed how he reanalyzed the DeStefano et al dataset using a “very, very simple statistical technique” and brags that to him in statistics “simplicity is elegance.” He then follows up by saying that he’s “not really that smart” and therefore “likes easy things rather than much more intellectually challenging things.” So he did the “simplest, most straightforward analysis.”

Here’s a hint: In statistics, the simplest analysis is often not the correct analysis, and, boy, was this the case for Hooker’s reanalysis of the DeStefano et al dataset. Nevison, I'm sure, understands that using "simple" techniques isn't always the best in climate science. That's why those climate models she studies are complex. The same is true of epidemiology, but in her ignorance Nevison buys a "simple" analysis. None of this stops Nevison from ranting more about the comparison:

The conflation of vaccine safety concerns with climate change denial is a cynical and scientifically misleading tactic that seems hypocritical when one recalls that the media for many years helped perpetuate the idea that climate change science was highly uncertain, even “bogus.” The media’s biased portrayal of the issue in years past helped enable inaction on important steps, such as building a clean energy economy, that could have begun decades ago and spared our children and grandchildren some of the burden they now face in coping with future climate disruption.

Of course, the difference here is that the media started out enabling antivaccine viewpoints that Nevison likes. They did it for years. Only over the last five years or so are the media actually getting the vaccine/autism story much more correct than they did before. Now that that's happening, Nevison doesn't like it.

It's ironic in the extreme that someone like Nevison, who belongs to a discipline whose legitimacy and science have been questioned by denialists using intellectually dishonest tactics would use exactly the same sorts of intellectually dishonest tactics used by antivaccinationists to attack epidemiology and vaccine science. Truly, the human mind compartmentalizes.

Or Nevison is just an obvious hypocrite. Take your pick. Either way, she's a clueless denialist.

oracknows Tue, 03/10/2015 - 01:30

Categories

Environment

It’s ironic in the extreme that someone like Nevison, who belongs to a discipline whose legitimacy and science have been questioned by denialists using intellectually dishonest tactics would use exactly the same sorts of intellectually dishonest tactics used by antivaccinationists to attack epidemiology and vaccine science.

Yes. There's something a bit off about it. Does she maybe have an autistic child? Or niece or nephew?
I find it all very...off.

The number of people willing to cherry pick what science they support never ceases to amaze me.

I find it interesting that the anti vaxxers continually bring up the number of vaccines as if our immune systems cannot handle them and cause allergies and asthma, while the actual hypothesis that is out there is that we may have cleaned up our environment too much, and our immune systems may be misbehaving because they are not being properly stimulated when we are young. That is, to me, an interesting contrast.

My mother is a great example of this. My youngest brother (now 25) is autistic (on the higher functioning end, but definitely not AS as he had significant language and developmental delays) and she believes whole hog in autism bio-med quackery, the autism-vaccine link (my brother "regressed" after receiving the MMR), the "autism epidemic," and the toxins gambit. I could probably write a novel on the psychological underpinnings of her belief.

My mother will post stuff from Mike Adams, then 5 minutes later post an article referencing James Inhofe's snowball throwing show on the Senate floor with a comment expressing frustration that such an "anti-science" climate change denialist is in a leadership position in our government. She'll post a ridiculous article from one of the autism bio-med crank blogs claiming that measles is no big whoop, then an hour later decry some state legislature's efforts to teach intelligent design in schools. The power of this particular blind spot is so intense it prohibits any self-awareness.

OMG almost puked in my mouth when I saw Manufacturing Consent used in this way - actually this is a reference I have used *often*, to combat conspiracy theorists since it offers a paradigm of so-called "media control" that requires no conscious planning and orchestration by our elites - it happens almost automatically. IN fact, the very philosophical approach of Chomsky/Herman, the *systemic* view, is completely at odds with a tradition conspiracy theory bent towards finding bad *individuals* and blaming changes on the actions of these few. I offer it as a way that CTers can come to understand propaganda and the media in way that might lead them away from their CT world - when I post about it, I am secretly hoping this is a gateway drug that will help erode some of their understanding...

....and now this... Was I a fool? Probably. Everything can be bent for "the cause", this book included... For it sounds like a complete misreading of their thesis, and I'm sad they had to misuse Chomsky (who is on the record forcefully discrediting CTs on 9/11 and the more cartoon-like understanding of "media control) and Herman to service this "propaganda" piece of their own.

There has never been a double blind study of the link between CO2 emissions and planetary temperatures.

It is interesting that in the three countries I have lived in (across Europe) these antivaccine tropes are not yet in the minds of people at all. There is plenty of pseudoscience, such as various miraculous cancer cures (not including the Gerson therapy, but including the "alkaline diet", "paleo" and various locally developed supplements that are supposedly the cure that is purposely hidden by doctors). But this antivaccine bullshit is completely new, and only recently entering discussion topics, for now it is usually laughed off.
It is interesting to see that elsewhere this is treated as a kind of "science" and it is a hot topic seriously being discussed. It would be very informative to write a piece about pseudoscience across the world, with examples of the main focus of quacks in different countries and continents. Perhaps it would be eye-opening to see that something thought to be ridiculous in the US is taken seriously e.g. in India, maybe allowing some reflection about one's own beliefs in a cure.

@6: Perhaps a "globally warmed" vs. "un-globally warmed" study is in order?

Yes, yes, selective science is a thing. Were it not we'd be building nuclear power plants to combat climate change.

Cause and effect: When car manufactioners removed the dimmer switch from the left side of our cars's floorboard in thew '60s, it left our left foot idle. This in turn modified the functioning of the right side of our brain, which in turn, along with eliminating public prayer from our schools, caused a malfunction therein resulting in a tremendous growth, in the past 50 years of STUPID in our society.

@ Esther:

Please fill us in: what countries were those?

Although she cites it, apparently Nevison either never read or read but failed to understand Verstraeten's 2003 publciation (PMID: 14595043)

Rather than finding evidence of "significant associations between autism risk and thimerosal" Verstraeten instead found "In no analyses were significant increased risks found for autism or attention-deficit disorder" and "No consistent significant associations were found between TCVs and neurodevelopmental outcomes."

[NB: 'TCVs' is an abbreviation for "thimerosal containing vaccines"]

re environmental vs genetic causes of autism:

http://www.bbc.co.uk/news/health-31713147

She MUST have an autistic child and simply not be able to accept that it just happens sometimes. The need to know why such a thing befalls people who have everything else going for them is right up there with the need to answer, “why are we here?” with a god delusion.

The most pressing health problem facing American children today is not measles, but rather the rise in chronic immune system and neurological disorders.

A bit of provax JAQing off here,because I am not an immunologist.

Putting aside autism for a minute,has there been many studies that refute the frequent antivax claim wild infections like measles strengthen the immune system?That these infections can actually lead to (auto)immune disorders? Or is this something that hasn't been studied in the past,because of the widespread use of vaccines?

There seems to be a few.The at least are two areas where this has been studied,that I have been able to find.One is the connection of viruses like rubella to Type 1 Diabetes.

http://cdn.intechopen.com/pdfs-wm/38932.pdf

The other is how wild measles can lead to longterm immunosuppression.

See here for example.
http://jid.oxfordjournals.org/content/184/1/1.long

These studies have mostly been out of Africa,where vaccines are still lacking,but I suspect doctors and researchers will much more opportunity to study this phenomenon in the future,here in the first world.

I hope she gets fired or stripped of her credentials. Better no climate scientists than ones who can be easily attacked or already in the gateway of pseudo science. Bet she turns into a climate change denialist in five years or less.

My brother was diagnosed with PDD-NOS in 1991, at around 26 months (he was barely talking, zero social interaction, self-stimulating bx, unbelievable tantrums, etc). My mother initially felt a lot of guilt and blamed herself for his disability, I remember that time really clearly (I am 10 years older than this brother) as including lots of crying spells from her... I believe that the vaccine-autism link (and later, the whole autism bio-med movement/woo) gave her a reprieve from the shame she was previously heaping upon herself - inappropriately, of course. She seems unable to accept the idea that sometimes, things like this happen for no good reason - so if she were to let go of the "stolen child" hypothesis, she'd have to go back to blaming herself.

Without any research into Ms. Nevison’s background and only informed by what I have read here and at Safe Minds, I am tempted to offer a very speculative association of thought, lacking any evidence:

The results from her basic field of study, and by implication her work, has been attacked by large business interests generating bad, misleading information, denying that they might be causing damage. Other large business interests are saying that vaccines, etc. are safe, so they, too, are probably denying damage to us and our children. Basically, big business lied before, so they are doing it now. If someone close to her has autism, this could be an influence. Her association with Safe Minds is not helping. My grandmother might have said she has made poor choices in her companions.

I now turn off the speculation channel and return to my simple, mundane life.

Sirhcton: Or she might be being bribed into discrediting herself. Stranger things have happened in America.

Oh thank heavens for NaturalHealth365 and their unrelenting willingness to spread FUD: http://vaccineworldsummit.com/

Mercifully, none of these nuts seem to turn up in real life.

@Esther

Unfortunately, pseudoscience asshattery has made inroads into many countries in Europe.

German is in the midst of a large measles outbreak, fueled largely by folks who refuse vaccines because of a fear of autism, etc.

Oh for pete's sake. She *opens* with the "recommended 37 doses by 18 months" malarkey, making it obvious he doesn't even know what *is* recommended, since you can only arrive at the scary number of 37 doses through some serious fudging of what you're counting as a "dose". I count a maximum of 26 doses, assumign the kid gets three influenza doses in, and gets Hep A on the earlier end of the recommended timeframe.

So excuse me, but I already know she's just parroting crap she got off an antivax website ,and didn't take the time to properly examine. I don't have to read any further to know that, becuase the ONLY way you can reach the conclusion that we give our kids 37 doses routinely is if you've been lied to. So if he can't even be bothered to google "CDC recommendations", the *first result* of which is the actual CDC recommendations, I honestly don't think she's worth listening to at all.

I'm sure she's just feeling sensitive because antivaxxers do get lumped in with climate change denialists. But there's good reason for that comparison, as Orac beautifully explains, and in fact a lot of them really are the same people. And she's just stepped in the evidence. That she can't smell the quality of what she's stepped in shows I'm not really convinced I can trust her on climate change either.

Just for fun, I looked up Nevison's two papers on autism. The first is from 2014 and it attempts to compare the increased rates of autism with the environmental factors she discusses above. As she says, many of those factors are going down, except two, the amount of glyphosate applied to GMO corn and soybean crops and cumulative amounts of aluminum adjuvant in vaccines. OMG, this is as crazy as Orac's comparison with organic foods or internet use. Here's the reference for this paper:

Nevison, C. D. (2014). A comparison of temporal trends in united states autism prevalence to trends in suspected environmental factors. Environmental Health : A Global Access Science Source, 13, 73. doi:http://dx.doi.org/10.1186/1476-069X-13-73

By the way,so far this paper has been cited 3 times and one is coauthored by Nevison.

Here's that reference:
Bilbo, S. D., Nevison, C. D., & Parker, W. (2015). A model for the induction of autism in the ecosystem of the human body: The anatomy of a modern pandemic? Microbial Ecology in Health and Disease, 26, 26253. doi:10.3402/mehd.v26.26253 [doi]

I have yet to read this paper but I couldn't help laughing at this: "The most compelling argument that autism is a modern pandemic is based on a simple deduction: since modern culture has led to immune system dysfunction, and since immune dysfunction is a hallmark of autism, then autism is a result of modern culture."
Here's the rest of the paragraph: "With as much as 40% of the population affected by allergies or autoimmune conditions, no debate exists regarding the well-documented rise of immune dysfunction in modern society. However, the association between autism and immune dysfunction merits review."

In their conclusion (subheaded as "the best way to determine if autism is a preventable, inflammation-associated pandemic is to see if autism can be prevented", lol) their magic fairyland ideas include this: "However, the nature of autism can be resolved decisively by conducting one experiment – Remove potential triggers for autism, normalize immune function in the human population, and monitor the levels of cognitive disease."

I'll try to read these better later, but if Nevison (as a climate scientist) ever said that the best way to resolve the nature of climate change was to conduct an experiment to remove all of the potential triggers for climate change, normalize the global climate and monitor the levels for change, wouldn't she be laughed off the planet?

A bit OT, but still somewhat vaccine-related:

Speaking of Google-searching, here is a little article about the recent initiative by the guys from Google to try to sort search results a little more by accuraccy of content rather than by popularity:

http://www.thisweekintomorrow.com/vol-2-no-19-1-trust-and-the-truth-acc…

Dear Jenny and Mikey got a mention as examples of an internet search going badly.

I am also not surprised that she is anti-GMO considering she cites Chomsky. This position and even tend to be more political than scientific.

Aluminum salt-based adjuvants have been used for decades....long before the supposed link to the increase in autism.

So, what's their point again?

By the way, I had posted a comment with a link to this post at SafeMinds. It posted as is; no obvious notice about moderation and now, guess what? it's gone.

I just posted another, let's see how long that remains. Anyone else here comment there?

Something else I found today and wanted to share here. This time, it's clearly related to the topic of vaccine and autism.

It's a little piece written on Feb 6 by a woman on the spectrum. It's title: I’m Autistic, And Believe Me, It’s A Lot Better Than Measles.

The part which caught me the most:

Someone who refuses to vaccinate their children because they’re afraid of autism has made the decision that people like me are the worst possible thing that can happen to their family, and they’re putting everyone at risk because of it. I’ve been told by some anti-vaxxers that they don’t mean my brand of autism; they mean non-verbal autism, or as they are so fond of calling it, “profound autism.” I’m not about to take any solace in the idea that they’re willing to make exceptions for autistic people who can perform as neurotypical, or at least pose as little annoyance to neurotypicals as possible. That just means that I will cease to be of any value to these people if I am no longer able to pass as one of them, and that they see no value and no humanity in anyone who communicates or behaves differently from them. Tell me again who has the empathy problem?

@Lawence #26

Aluminum salt-based adjuvants have been used for decades….long before the supposed link to the increase in autism.

So, what’s their point again

My understanding, after perusing the linked article (link in #23), is that it regards the "cumulative amount of postnatal aluminum adjuvant administered to U.S. children by 18 months of age" which has gone up considerably over the past few decades.
Link to figure from linked paper.
http://www.ehjournal.net/content/13/1/73/figure/F5

She also appropriate caveated the paper with these words at the beginning of the final section:

"Correspondence between temporal trends in autism and environmental factors is a useful method for identifying possible triggers of autism to help focus future research. However, it must be emphasized that the correlation in temporal trends between autism and PBDEs, cumulative aluminum adjuvants, and glyphosate shown here is not proof of causation, especially given the ecological nature of this study, in which the exposure data were aggregated at the group level"

The fact that resistance to genetically modified foods is increasingly being cited as another example of the rejection of science raises questions about who is really behind this type of argument, but that is a discussion for another day

No, no, let's discuss it now. Who is the mysterious shadowy force behind the curtains of history who invented and is using the "science-rejectionist" comparison to discredit the speakers of truth?
Tell us more about the conspiracy; put it in writing before it is too late. I will not be able to sleep until I know.

It's surprising that she didn't mention this study paid for by her own organization.

@Beth #29

The problem is that the "cumulative" amount of aluminum adjuvant is irrelevant because it doesn't accumulate in the body - it is eliminated in the urine Furthermore, the rise in bloodstream aluminum after i.m injection of aluminum adjuvants is so small in relation to normal levels that it couldn't even be measured until modern radiolabeling techniques were developed.

@Roger Kulp #15

has there been many studies that refute the frequent antivax claim wild infections like measles strengthen the immune system?

This is a difficult question to answer because the whole idea of "strengthening" the immune system is vague to the point of meaninglessness. The immune system comprises many different pathways, some of which are antagonistic to one another - if one is up-regulated, the other is down regulated. To give a concrete albeit over-simplified example, if you "strengthen" the inflammatory response too much, you get damage to the host, which is why there are mechanisms such as regulatory T cells in place to down-regulate inflammation. On the other hand, if the Tregs get out of control, you get immune suppression and decreased ability to fight of certain kinds of infections. In short, and again over-simplifying a bit, it is more important for the immune system to be "balanced" than "strong."

Nevison sounds pretty much like the chunderheads one meets at dailykos.com, except that dkos attracts gangs of ill tempered flying monkeys that scream and throw stuff to drown out the point. One of them counter attacked your correlation diagram of autism/organic food with a fairy tale about people watching other children die of autism so naturally they turn to wholesome organic food for protection.

The Herman and Chomsky story is a nice touch, for that kind of thing comes up over and over and over again. The loon makes a great noise in drawing attention to some bit of malfeasance, thirty or fifty or seventy years ago, then sits back and smirks - safely in the assurance that Team Loon with interpret this true incident as proof positive that some kind of skulduggery MUST be taking place in the specific time and specific place that he is alleging. Which annoys me, personally, because we all know that bad things have happened and that bad things will happen again: the question, to be decided on facts and evidence, is whether the specific bad action alleged is in fact taking place in the manner alleged. Anything else is conspiracy theory and proof by accusation.

@Sarah #29

Thank you for the additional information, but I wasn't making any claims regarding the “cumulative” amount of aluminum adjuvant and autism. I was responding to Lawrence about why Dr. Nevison had examined the correlation.

I did not find the linked study particularly helpful though. It only gives the abstract which states "The in vitro dissolution and in vivo absorption studies indicate that aluminum-containing adjuvants which are administered intramuscularly are dissolved by alpha-hydroxycarboxylic acids in interstitial fluid, absorbed into the blood, distributed to tissues, and eliminated in the urine." It also references tests performed on rabbits.

Are there any studies showing that human babies are able to eliminate the aluminum they receive in vaccines at the rate that would be predicted by the results this study? What is the variability and is there any danger to children who are not able to eliminate the aluminum as expected?

@Denice: Hungary, UK, Ireland. I am not saying it is nonexistent in these countries, just that other pseudoscience is the main focus of quacks.
@Darwy: indeed, a bunch of people in Germany have "embraced" the antivaccine movement, also in Germany and Austria homeopathy is very commonly used and is often prescribed by GPs.

So Beth, what was the real point of her paper then?

She's addressing two things here; one, that the rise in autism is real and two, that the rise cannot be due environmental pollutants whose levels have trending down (however, she didn't rule out if the levels remaining might still have the effects she's looking at). Then she correlates the rise in autism two things she doesn't like that have increased (she doesn't mention the organic foods Orac does though).
I don't think she does a good job with the second part, I need to look closer at the first.

My quick take on her first premise: she says that even if autism was not properly diagnosed in young children that those children would surely have been properly diagnosed by the time they were 18 (to be counted among the IDEA data she used) when diagnostics were improved. But I think that is a big assumption to make.

I'd like to see a more thorough appraisal of this paper. I'm not sure I'm qualified for that. I'm flagging it for future citations to see who refers to it later.

Beth( #34), you asked Sarah an interesting question. What do you think? Do you really think such experiments can be done on babies. Would you volunteer your baby for such a study.

Can you point to any studies that show that we are sure that the cyanide compounds in apple seeds (surely ending up in applesauce and juice) can be detoxified by infants? Again, I doubt such studies have been done, but we accept that those compounds can be metabolized just fine.

If you guys are interested, in Hungary the following things are popular that may not be known elsewhere:
- deuterium-depleted water as a cancer cure
- wheat germ extract, amino-acids, a mix of mushrooms in respective supplements as cancer cures
- anti-candida diet
- aloe vera (supposedly cures everything)

In UK:
- osteopathy (it has a different meaning than in the US)
- "Ukrain" (chelidonium majus) as cancer cure
- remedial face and jaw alignment (don't even ask)

Just for fun, I looked up Nevison’s two papers on autism. The first is from 2014 and it attempts to compare the increased rates of autism with the environmental factors she discusses above. As she says, many of those factors are going down, except two, the amount of glyphosate applied to GMO corn and soybean crops and cumulative amounts of aluminum adjuvant in vaccines.

Like Seneff, Nevison uses the IDEA client base as a proxy for autism prevalence. Unlike Seneff, she is at least aware of the problem that IDEA did not exist until 1975, and provided a strong incentive for assigning a disability to a child so they can receive funding, so naturally the numbers increased rapidly in the first few decades of its existence.

Nevison's argument is that the search for genetic causes of autism is misguided (since the heretability is less than 100%) so she looks to the environment instead, and comes up with various plausible-sounding mechanisms by which environmental toxins could affect neural development. All fair enough. Then she assembles a line-up of environmental toxins.

One of them is mercury... her analysis shows that thimerosal does *not* fit the hypothesis, but she is reluctant to let it off the hook and performs a little Distraction Dance about "maternal flu vaccinations" and "possible confounders", to avoid accepting her own logic. And as Orac noted above, she is willing to forget her paper and return -- in the way of dogs and vomit -- to the myth that "Thimerosal causes autism but scientists suppressed the story".

Anyway, she sets out to test the idea that "environmental toxins can drive a rise in autism", and she ends up proving that a long list of potent environmental toxins *don't* drive autism rates (because recent down-turns in toxin exposure do not match the autism data). Evidently those plausible-sounding mechanisms are not happening.
At that stage, the parsimonious conclusion would be that "environmental exposures are not a factor, and the two possibilities not yet excluded are merely false positives."

Unless, of course, you are already committed to the idea that vaccines are to blame.

Genetics and autism - there is a fairly strong heritability component. 38-50% is not a trivial number. Almost no disease are 100% heritable - a few are most autosomal dominant, but for autism that up to 50% heritability factor is pretty high. The problem the anti-vax crowd want to find the smoking gun. The latest research I read is that autism genetics isn't pointing to a single smoking gun gene but rather to an increase in SNPs (on certain chromosomes in particular) that appear to be a driving force behind development of autism. I am doubting one gene will ever by identified conclusively but this research is quite intriguing. It also helps explain the link between older parents and an increase in autism among children (particularly fathers) as an increase in errors in the chromosomes carried by sperm. Unfortunately not much we can do about it.
For aluminum, as either the or one of the most common elements in the earths crust, it is literally everywhere and we consume lots of it daily. The body eliminates aluminum just fine. If an infant couldn't (for some reason) eliminate aluminum (which they are also exposed to daily) then I don't think they would last too long.

It also references tests performed on rabbits. Are there any studies showing that human babies are able to eliminate the aluminum they receive in vaccines at the rate that would be predicted by the results this study?

You could try this (PDF).* Once again, though, we're back to comparisons with parenteral nutrition. Vaccines just aren't in the ballpark.

* Or, more generally, here.

Your argument about the ability of epidemiologic studies to rule convincingly establish that vaccines do not contribute to autism or other neurodevelopmental disorders is not quite accurate. From the Institute of Medicine's 2011 report on vaccine safety: “Epidemiologic analyses are usually unable to detect an increased or decreased risk that is small, unless the study population is very large or the difference between the groups (e.g., vaccinated vs. unvaccinated) at risk is very high (e.g., smoking increases the risk of lung cancer by at least 10-fold). Epidemiologic analyses also cannot identify with certainty which individual in a population at risk will develop a given condition. These studies also can fail to detect risks that affect a small subset of the population. (p. 50)”

The fact that several epidemiologic observational studies have shown no correlation between MMR / other vaccines and autism does not on its own lead to a clear conclusion that "Vaccines do not cause autism." That is playing fast and loose with the word "cause." Such a conclusion assumes: (1) that what we call autism has one single cause and (2) that finding no average correlation between vaccination and autism diagnosis at the population level means clearly establishes that such a correlation could not exist for small vulnerable subgroups. Both of those assumptions are likely false.

Also, the comparison with epi studies on the tobacco and lung-cancer link is specious because in that case the epi studies showed a strong correlation and in this case the best epi studies showed no association.

@Narad

Thanks for the links. They were fascinating, albeit it did take some effort to understand them. I think they simply reinforce the point that I think Dr. N is making - what little we know about the effect of aluminum injected into infants isn't particularly encouraging regarding the safely of that particular ingredient in vaccines.

For example,

" Maternal dietary exposure to excessive amounts of aluminium during gestation and lactation resulted in neurobehavioural abnormalities in mouse offspring"

"Little is known about the impact of aluminium-containing antacids in human pregnancy and lactation."

"Modest evidence of an effect exists for reproductive toxicity following oral exposure, for neurological toxicity following either oral or injection exposure, and for bone toxicity following injection exposure. "

- all of this would support the idea that vaccines with aluminum given to pregnant women might negatively affect the child.

"From animal studies and the clear association of aluminium exposure and DAE, it is clear that high levels of aluminium in CNS can lead to neurotoxicity." - this does not make me sanguine about the safety of aluminum in vaccines either. There will always be variation in how well different individuals will process these chemicals. We know that vaccines can cause serious adverse effects in some rare cases, presumably they are genetically more susceptible to something in the vaccine. It's not beyond possibility that even Al levels that don't exceed the MRL might adversely affect a small proportion of the population. 1 in a million maybe?

The other article, which specifically looked at the aluminum exposure to infants via vaccines concludes with "The body burden associated with dietary uptake from either breast milk or formula during the first several months of life and from semisolid food during the remainder of that first year is estimated to reach approximately 0.1 mg. This value is lower than the estimated body burden of approximately 4 mg that would result from consuming aluminum at a rate equal to the MRL of 2 mg/kg per day. The body burden attributable to vaccines may be expected to fall between the two except for a period of a few days following individual vaccinations."

In the body of the paper, they mention ". Table 1 identifies
the range of aluminum content for relevant injections
by age, and the vaccination curve in Fig. 1 applies to the
maximum aluminum doses. That curve is below the MRL [Minimal risk level (MRL)] and above the dietary intake curves, and shows spikes on the injection day followed by rapid elimination during the first few days. Overlaps occur between the MRL and vaccine curves during the first 1–3 days postinjection."

This means that there are times when vaccines will cause a spike in the level of aluminum in their body above what is considered 'safe' or below the minimum risk level. The graph shows this quite clearly.

Sorry I can't edit. Please ignore the next to last paragraph above. That was an accident.

The problem the anti-vax crowd want to find the smoking gun.

I'd say it's closer to a wholesale reliance on "the elusive 'autism gene'" as caricature. The irony is that the very same boneheads for whom regular genetics is Too Complicated, thus leaving them with nothing but weird spluttering, are perfectly happy to turn to babbling about epigenetics.

“The most compelling argument that autism is a modern pandemic is based on a simple deduction: since modern culture has led to immune system dysfunction, and since immune dysfunction is a hallmark of autism, then autism is a result of modern culture.”

There's a major [citation needed] in that sentence. I'm not an autism expert by any means, but I thought that autism was defined as a class of inappropriate ("abnormal") responses to many kinds of stimuli. IOW, more neurological than immunological. Is there any evidence, other than Google University, that autism is actually correlated with immune disorders?

“the best way to determine if autism is a preventable, inflammation-associated pandemic is to see if autism can be prevented”

Circular reasoning is circular.

This means that there are times when vaccines will cause a spike in the level of aluminum in their body above what is considered ‘safe’ or below the minimum risk level.

I suggest that you attend more closely to the portion of the text where MRLs are introduced (section 4.5), in particular, the units. The beginning of section 5 might help, as well.

IOW, more neurological than immunological. Is there any evidence, other than Google University, that autism is actually correlated with immune disorders?

I recall a Portland friend waving about a meme on Facebook stating that scientists have discovered that inflammation is the cause of depression. So I was kind of going, "I doubt the etiology is that simple," and poked around a bit to find the actual studies involved. In short, yeah, it's not that simple - about a third of people with clinical depression have higher-than-average levels of inflammation, although it's 45% in people with treatment-resistant depression. Thing is, a third of people with depression have lower-than-average levels of inflammation, and treatment with anti-inflammatory agents could make them worse.

In any case, what annoyed me about the meme was pretty much the sloppy associations in evidence when it comes to the whole "gluten-gut-inflammation-allergy-yadda-yadda" "theory" of autism. I'm just waiting now for one or more friends to start yakking about how it's the evil chemicals and gluten that make people depressed (by way of inflammation, natch) and Big Pharma is duping people into taking antidepressants instead of going on a paleo diet or whatever-the-f*** and the inevitable stabby feelings that will result.

As regards autism: I am having a hard time finding any credible sources linking it to inflammation, let alone allergies or, obviously, aluminum. This might not mean, necessarily, that there is no correlation, just that, while running a search, so far all I am seeing is pages and pages of biomed BS.

Is there any evidence, other than Google University, that autism is actually correlated with immune disorders?

With the caveat that this is an unfiltered search, yah, it's been attracting a fair amount of attention lately.*

Not of the "ZOMG epidemic of lump-of-things-that-vaguely-involve-the-immune-system!!1!" variety, mind you.

* I'm reminded of one AoA commenter who was on about "getting rid of microglia" or something.

@KWill:

Give me a break. While it is true that epidemiological studies can never 100% prove a negative, when enough well-designed studies all point in the same direction, the difference between failing to find a correlation between vaccines and autism and concluding that, to the best of our ability to detect, vaccines do not cause autism. Some of these studies are pretty darned big, too, for instance a study from Montreal looking at nearly 28,000 children. A more recent systematic review than the 2011 IOM report (which, BTW, did not find associations between serious adverse events and vaccines) concluded that "there is strong evidence that MMR vaccine is not associated with autism" and "we found evidence that some vaccines are associated with serious AEs; however, these events are extremely rare and must be weighed against the protective benefits that vaccines provide."

It's not as though I haven't heard this sort of nonsense that you're laying down before.

That is playing fast and loose with the word “cause.” Such a conclusion assumes: (1) that what we call autism has one single cause and

We know that there isn't a single cause of autism so nice fat strawman there.

(2) that finding no average correlation between vaccination and autism diagnosis at the population level means clearly establishes that such a correlation could not exist for small vulnerable subgroups. Both of those assumptions are likely false.

Argumentum ad Healy again. The very crux of Nevison's argument that vaccines are somehow the main/majority/only cause of autism is just what you are trying to argue against. Why don't you describe these elusive "vulnerable subgroups" and how vaccines have cause their autism.

The Spudd predicted this: "I believe vaccines cause autism and climate change is a hoax."

http://thespudd.com/i-believe-vaccines-cause-autism-and-climate-change-…

Such a conclusion assumes: (1) that what we call autism has one single cause

Autism can have a number of causes.
Vaccines are not among those causes.
What part of this is so difficult?

@ JP:

Believe it or not, some woo-meisters attribute nearly all ills to which flesh is heir to inflammation ( e.g. PRN). Ingesting meat, dairy, baked goods, alcohol, processed food, corn, cooked foods, non-organic, GMOs, sugars, omega 6 oils etc causes inflammation.

Of course, drinking green juices and using dried, powdered vegetables and fruits with handfuls of supplements can cure that easily.

@Denice:

Oh, I believe it. I am personally acquainted with some folks of this sort, although they are probably not so extreme as PRN.

Also, you forgot fluoride. Not that it actually causes inflammation, but hey, what're facts good for? (Portlanders are evidently quite concerned about their precious bodily fluids.)

@ Beth

Sorry, I forget not everyone's computer is on a University network. Narad's references are more relevant, anyways. It seems as if you're obsessing over a tiny, purely theoretical risk that aluminum adjuvants may cause injury, while ignoring the fact that there's no evidence that they actually do and plenty of evidence that they don't. Sure, everyone's susceptibility to toxins is different, but that doesn't mean, for example, that the fact that water is toxic in large amounts means that its plausible to think that some small subset of people could be killed by a glass of water. So I guess the real question is, what would it take to convince you that aluminum adjuvants are safe (for a reasonable definition of the word "safe"?)

@NARAD:

This means that there are times when vaccines will cause a spike in the level of aluminum in their body above what is considered ‘safe’ or below the minimum risk level.
I suggest that you attend more closely to the portion of the text where MRLs are introduced (section 4.5), in particular, the units. The beginning of section 5 might help, as well.

From section 4.5: " The agency used this end point in developing an oral MRL, or dose which is expected to be safe for human exposure."

From section 5: The MRL curves in Fig. 1 are based on low and average weight infants consuming aluminum at an amount equivalent to the MRL each day starting from birth

What did you think I needed to attend to? If you feel my statement was in error, could you explain why?

My apologies for the poor editing.

@KWill:

You have to keep in mind that the driving force behind the idea that vaccines cause autism is that fact that both autism diagnoses and the number of vaccines in the pediatric schedule increased around the late 80s/early 90s. The entire hypothesis relies on the assumption that a) the increase in diagnoses was due to a genuine increase in incidence, and b) vaccines are responsible for most, if not all, of the increase. Ignoring the first assumption (which is also probably not true), if vaccines were responsible for even a tiny fraction of the increase in autism diagnoses, they'd have to be causing autism in an appreciable fraction of kids - certainly more than 1 in 12,000, which is the number of cases of intussusception which epidemiological studies were able to attribute to the RotaShield vaccine.

Sarah A: "You have to keep in mind that the driving force behind the idea that vaccines cause autism is that fact that both autism diagnoses and the number of vaccines in the pediatric schedule increased around the late 80s/early 90s"

Don't forget the DSM IV in 1994. I was assured in 1991 that my non-verbal three year old did not have autism because he smiled, laughed and followed verbal instructions, did not qualify under DSM III.

Last week he qualified as high functioning autism under both DSM IV and DSM V.

@Yvette#52:

The Spudd did indeed predict it, but only by seconds (figuratively):

http://business.financialpost.com/2015/01/09/lawrence-solomon-fantasies…

The Professional Ignoramus does it again.

@Sarah "It seems as if you’re obsessing over a tiny, purely theoretical risk that aluminum adjuvants may cause injury, while ignoring the fact that there’s no evidence that they actually do and plenty of evidence that they don’t. "

I think that the plausibility of risk to infants is there. I don't know what that risk is, but my reading of these papers is that it increases with the number of vaccines given at one time. What I'm trying to say is that I think the parents who are concerned about these things have a legitimate cause for concern. Spacing out the shots may indeed make a difference for the small percentage of children that are more sensitive to Al.

As for convincing me the current schedule is the safest, you needn't bother. I'm a grandmother now. I don't have to make these decisions for anyone but myself at this point.

It's parents of young children that need to be convinced. If they are intelligent and research the issue and this is what they find, I cannot blame them for not being reassured about the safety of vaccines.

As for your analogy with a glass of water, I don't think it's particularly applicable. Among other findings was that the toxicity of aluminum varied with how it was acquired - orally and by injection differ significantly. Apropo to your water example, I can state that air is not a problem when it is swallowed even in large amounts, but it's deadly if even a small amount is injected.

My understanding, after perusing the linked article (link in #23), is that it regards the “cumulative amount of postnatal aluminum adjuvant administered to U.S. children by 18 months of age” which has gone up considerably over the past few decades.
http://www.ehjournal.net/content/13/1/73/figure/F5

So Nevison's hypothesis predicts a six-fold leap in autism incidence between children born in 1988 and those born in 1989, matching the change in adjuvants in recommended vaccines. With smaller but still dramatic jumps for the years 1998-1999 and 2003-2004, then reaching a plateau and staying there.

Her evidence contradicts her predictions conclusively.

@Orac: Ceteris parabus, the sample size of an epidemiological study is not directly relevant to its ability to detect rare causal associations among vulnerable subgroups. The coefficients reported in epidemiological studies are averages. In the presence of heterogeneity that is not explicitly modeled, it is well known that those averages are often biased. Check out the work of Christopher Winship, Yue Xie, or more recently Jennie Brand if you'd like to learn more about estimating causal effects in the presence of heterogeneity.

Could you link the more recent review that you reference? The 2012 Cochrane Library report concludes that the evidence was insufficient to draw conclusions about whether there is a causal association between the MMR vaccine and autism, as well as several other disorders: "We could assess no significant association between MMR immunisation and the following conditions: autism, asthma, leukaemia, hay fever, type 1 diabetes, gait disturbance, Crohn's disease, demyelinating diseases, or bacterial or viral infections. The methodological quality of many of the included studies made it difficult to generalise their results."
Their summary conclusion states: “The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate."

Careful reading of the report linked above makes it clear that if there are adverse effects of vaccines, they affect a very small proportion of the population. But we do not have sufficient evidence to move away from the position that vaccines may be associated with the adverse outcomes listed above for some individuals. In epi, average estimated causal effects (or their absence) do not always equal causal effects in specific individuals. In the presence of unmodeled heterogeneity, average risk (or its absence) isn't even average risk because that heterogeneity can seriously bias the estimates. IOM and Cochrane appear to understand this. I'm happy to provide links and explain more if you would like more info.

@Sarah: Thanks for the info. I think it is important to clarify what one means by the claim "Vaccines cause autism." I'm sure you are right that some people believe that 100% of cases of autism (or even 75% or 50% are caused by vaccination). People believe all sorts of crazy things as I am sure all of you who are most engaged in this debate with extreme anti-vaxxers know better than I. The IOM and Cochrane report that I discussed aren't really addressing that question--they are referring to whether vaccines are causally associated at any non-zero magnitude with particular adverse outcomes--not that they are THE cause of these outcomes. This hypothesis does not rest on the assumptions that you mentioned. In other words, the idea that vaccines might be linked to particular adverse outcomes in some cases does not require the incidence of those adverse outcomes to have increased over time in parallel to some changes in the vaccine.

Could you link the more recent review that you reference? The 2012 Cochrane Library report concludes that the evidence was insufficient to draw conclusions about whether there is a causal association between the MMR vaccine and autism, as well as several other disorders: “We could assess no significant association between MMR immunisation and the following conditions: autism, asthma, leukaemia, hay fever, type 1 diabetes, gait disturbance, Crohn’s disease, demyelinating diseases, or bacterial or viral infections. The methodological quality of many of the included studies made it difficult to generalise their results.”
Their summary conclusion states: “The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate.”

Why stop here? Shouldn't you have also included, "Currently, this is the only review covering both effectiveness and safety issues of MMR vaccines. In agreement with results from other studies and reviews a significant association between autism and MMR exposure was not found. The study of Wakefield (Wakefield 1998), linking MMR vaccination with autism, has been recently fully retracted (The Editors of The Lancet 2010) as Dr. Wakefield has been found guilty of ethical, medical and scientific misconduct in the publication of the paper; many other authors have moreover demonstrated that his data were fraudulent (Flaherty 2011)."

And, "Existing evidence on the safety and effectiveness of MMR vaccine supports current policies of mass immunisation aimed at global measles eradication and in order to reduce morbidity and mortality associated with mumps and rubella."

Vaccine safety monitoring should constantly strive to improve surveillance and standardisation, you won't get any argument there. But where you will get push back is trying to raise the spectre of "vulnerable subpopulations" without defining who or how re: autism. And do you really want to make the argument that they might exist therefore end vaccine programmes until every "vulnerable subpopulation" is identified? You might want to give some thought to what you are trying to advance before coming off as a smarmy ponce under the guise of "just being reasonable".

Hmmm, what about my child who was born in 1976 and was diagnosed with intellectual and physical impairments and "autistic-like" behavior (not autism), under the DSM II Diagnostic Criteria?

Prior to the passage of PL 94-142 (1975) millions of disabled children were "exempt" from attending school and hundreds of thousands of children were not provided appropriate special education services:

http://www2.ed.gov/about/offices/list/osers/idea35/history/index_pg10.h…

The reason why there are no case studies that link vaccines, the ingredients in vaccines, the spacing/timing of vaccines and the onset of autism...or allergies, or immune disorders, or diabetes...is because.....

vaccines.do.not.cause.those.disorders.period.

What did you think I needed to attend to?

One more time:

I suggest that you attend more closely to the portion of the text where MRLs are introduced (section 4.5), in particular, the units.

Ceteris parabus [], the sample size of an epidemiological study is not directly relevant to its ability to detect rare causal associations among vulnerable subgroups.

All what things being equal?

Ding ding ding ding ding ding ding!

The Guardian reports on an Australian study with the refreshingly frank headline:

Homeopathy not effective for treating any condition, Australian report finds

@Beth: the MRL number was derived by taking an amount that showed no effect in rats, and for safety dividing that by 3 because humans aren't rats, then for EXTRA safety dividing again by ten -- here alreadycompensating for the fact that some people may be particularly bad at getting rid of aluminum -- to get a daily oral consumption rate of 2mg/kg.

The MRL curve shows the amount of aluminum that would have accumulated in an infant's body if they daily consumed 2mg/kg of aluminum; according to the chart (note the logarithmic scale on the left axis) a two month old would have built up to .7mg, a year old up to 4 mg. By comparison, the highest spike from vaccination is 1.6 mg at 2 months. So, yes, for 2-3 days, a two-month old's body will contain more aluminum from a vaccination than if they had daily orally consumed an amount that has been doubly compensated for safety.

A fairly small two month old weighs 4kg. A fairly small 1 year old weighs 8 kg. On the day of the shots, vaccinations could give a two month old with normal aluminum consumption .4 mg of aluminum per kilo of kid. The 1 year old with a year's worth of daily consumption of the MRL would have .5 mg of aluminum per kilo of kid. I personally don't find that troubling at all.

@ScienceMom: "And do you really want to make the argument that they might exist therefore end vaccine programmes until every “vulnerable subpopulation” is identified?"

I absolutely did not make this argument. My point is only about risk of adverse effects while vaccine policy should (and does) balance average population risk of adverse effects with average population benefit of protection from infectious disease. On that count, the science is clear that the benefits of vaccination to the population and to the majority of individuals far outweigh the costs. But especially since this is a science blog, I think it is important that we be honest about the state of the scientific evidence on risks of serious adverse effects of vaccines. I'm not cherry picking citations here--these are very large systematic reviews from the IOM and Cochrane written by teams of experts who reviewed hundreds of studies.

The public dialogue on vaccine safety sometimes implies that the science clearly shows that vaccine X could not have contributed to adverse effect Y for any child. All I'm saying is that for the 135 vaccine adverse event pairs that IOM 2011 reviewed and for the adverse outcomes mentioned by Cochrane with respect to MMR, that absolutist position on vaccine safety is not scientifically justified, at least according to two of the most respected unbiased sources of scientific knowledge on health and medicine.

@Beth
"I think that the plausibility of risk to infants is there. "

Based on what? Your lacking understanding of dosage? You should work on that (an on your massively flawed analogies as well)!

On that count, the science is clear that the benefits of vaccination to the population and to the majority of individuals far outweigh the costs. But especially since this is a science blog, I think it is important that we be honest about the state of the scientific evidence on risks of serious adverse effects of vaccines.

And being a science blog which you might not have taken the time to peruse, I guessed you missed the thousands of comments and scores of posts which clearly discuss the types and risks of vaccine associated adverse events.

I’m not cherry picking citations here–these are very large systematic reviews from the IOM and Cochrane written by teams of experts who reviewed hundreds of studies.

You're cherry-picking quotes; I also quoted from the 2012 Cochrane MMR review. You also seem to be operating under the assumption that we Luddites don't seem familiar with the Cochrane Collaboration and the IOM.

The public dialogue on vaccine safety sometimes implies that the science clearly shows that vaccine X could not have contributed to adverse effect Y for any child.

Another strawman.

All I’m saying is that for the 135 vaccine adverse event pairs that IOM 2011 reviewed and for the adverse outcomes mentioned by Cochrane with respect to MMR, that absolutist position on vaccine safety is not scientifically justified, at least according to two of the most respected unbiased sources of scientific knowledge on health and medicine.

That does not seem to be all you're saying or rather implying. Don't you think all of this is known already? Read the post, Nevison's position is absurd and that's what is being discussed. Are you here to defend it? Don't hold back, nothing you have just stated is at odds with what we already know so what is it you really wish to say?

@ScienceMom: If I came across as attacking this blog or this post, that was not my intention. Although I reread my comments and they don't seem to be antagonistic to me. As I mentioned in the first sentence of my first comment, I was only addressing one specific point in the post. I wrote: "Your argument about the ability of epidemiologic studies to rule (sic) convincingly establish that vaccines do not contribute to autism or other neurodevelopmental disorders is not quite accurate."

Clarifying that point was my only intention. I don't dispute the value of this post or the legitimacy of questioning Nevinson's claims.

It seems to me that the value that this blog and its participants place on scientific evidence is a huge contribution. I share those values and assumed that my point would be taken in the spirit of open scientific dialogue and in ensuring that the science is communicated as accurately as possible. Ultimately, it sounds as if you agree with my basic argument, so I'm not sure what the problem is. It would be totally understandable if the degree and number of extreme anti-science crackpots that you likely have to deal with here contributes to some degree of defensiveness and annoyance at those who offer honest critiques that seem to challenge some basic assumptions.

I think there is much to be gained in having a civilized non-defensive discussion like real scientists who are open to new information/interpretations. Much of the value of science lies in the recognition and acceptance of uncertainty. If these views are not welcome here, though, I'm happy to leave you to it.

@Emma

Thanks for the additional explanation, but I am aware of how safety margins are computed. I don't see that your explanation invalidates my assessment.

@Narad - If you have a point to make, feel free to do so explicitly. Otherwise I'm going to assume that your objection to my statement was invalid rather than read through that section one more time and try to discern why you think it was incorrect.

'the evidence refuting a vaccine-autism link'
inherently implies that such a link exists.....

#75 Kwill,

The point you are making does get the hackles up on this blog.

You can swear up and down that you are in complete agreement about the physical reality, and about desirable public policy, but presenting this particular epistemological critique somehow brands you as 'the enemy'.

I attribute it pretty much to the hammer/nail phenomenon; if you have spent a long time with a narrow focus using a narrow set of tools, there is a natural defensiveness when a broader perspective intrudes.

So, I would agree with one point Nevison makes, which is that climate science is quite different from what is being discussed here. Much more complexity of technique and reasoning.

And I don't think Exxon, the Koch brothers, et al, are funding the anti-vax disinformation campaign with hundreds of millions of dollars, so the noble warriors here are hardly the Spartans at Thermopylae they seem to fashion themselves.

Are there any studies showing that human babies are able to eliminate the aluminum they receive in vaccines at the rate that would be predicted by the results this study?

Eell, they don't see to have any trouble eliminating the far greater amounts of aluminum they're exposed to from drinking breast milk or formula: over the first 6 months of life an infant could be exposed to a maximum of 2.5 mg of aluminum as the result of routine immunizations.

During those same 6 months it would be exposed to 10 mgs of aluminum if it's breast feeding; if receiving formula instead we're talking about a 40 mgs of aluminum, and as much as 120 mgs if it's receiving a soy-based formula.

"‘the evidence refuting a vaccine-autism link’
inherently implies that such a link exists….."

To the exact same same extent, I guess, that "the evidence refuting the occurrence of a catastrophic global flood as depicted in Genesis" implies that such a flood actually occurred, I suppose.

Which is to say, not at all.

@ #80: Exactly...

Her epidemiological argument is a big strawman. She is attacking evidence that does not exist. There is no evidence refuting the vaccine-autism link because no link exists.

You’re cherry-picking quotes; I also quoted from the 2012 Cochrane MMR review. You also seem to be operating under the assumption that we Luddites don’t seem familiar with the Cochrane Collaboration and the IOM.

Yep. I daresay I (and we) are far more familiar with the evidence than Kwill. There also comes a point when listing all the qualifications on the evidence yet again becomes very repetitive. I suppose that's a hazard of having been a blogger for a decade and having blogged this topic hundreds, if not thousands, of times over those years. I realize that most newbies don't go back and read old posts and each post has to stand on its own. On the other hand, too much repetition bores regulars and, far more importantly, there also comes a point when the failure to find a correlation despite having tried so hard is pretty compelling evidence that there almost certainly isn't one.

Indeed, I've come to find the saying that "absence of evidence is not evidence of absence" to be painfully trite and simplistic. Whether this saying is true or not depends very heavilly upon how hard you've actually looked. If, in fact, if we've looked very hard for evidence that vaccines are associated with autism and failed to find it (and we have, for nearly two decades now), then absence of evidence does become pretty compelling evidence of absence. It's never 100%, because epidemiology can never really 100% prove a negative. However, it does eventually reach a point that, for all practical intents and purposes, the negative has been proven as well as it feasibly can be with the scientific tools at hand and that, barring the unlikely appearance of new and unexpected evidence it becomes unreasonable to argue otherwise.

We are at that point with vaccines and autism in terms of epidemiology.

As for Kwill's near flouncing away:

I think there is much to be gained in having a civilized non-defensive discussion like real scientists who are open to new information/interpretations. Much of the value of science lies in the recognition and acceptance of uncertainty. If these views are not welcome here, though, I’m happy to leave you to it.

So present your evidence. So far, all I've seen are cherry picked quotes from a couple of reviews that don't really refute what's been written, all coupled with borderline concern trolling. I'm with Science Mom here when she says:

That does not seem to be all you’re saying or rather implying. Don’t you think all of this is known already? Read the post, Nevison’s position is absurd and that’s what is being discussed. Are you here to defend it? Don’t hold back, nothing you have just stated is at odds with what we already know so what is it you really wish to say?

Or, let's just put it this way. This isn't the my first time around the block, nor is Kwill the first apparent newbie who's shown up in the comments all sanctimoniously self-righteous about how I (and my commenters) are supposedly "rigid" and "unscientific" and don't adequately "acknowledge uncertainty" based on a reading of a single post. As the 11th Doctor so famously put it in his first appearance, there have been so many before.

To be honest, the longer I blog about this topic, the less obligated I feel to include long disclaimers about the "uncertainty" in the findings because more and more the evidence fails to support a vaccine-autism link, to the point where practically and functionally it is possible to say with a high degree of certainty that vaccines do not cause autism. I used to bend over backwards to repetitively include those disclaimers in every post. No longer, because the evidence has reached the point where I feel such disclaimers are no longer necessary, if they ever were, and, again, they become very repetitive for my regular readers, not to mention me as the writer.

@Orac: Point taken. I get that there is an insider-outsider dynamic here and I fully admit to being an outsider who does not have knowledge of the history of this blog. I absolutely do not question that you have more knowledge about vaccines than I do and I apologize if I sounded sanctimonious. But as a social scientist and demographer who conducts epidemiologic research on population health and teaches graduate and undergraduate statistics (although, admittedly, you have no way of knowing that), I thought that my observations about some of the limits of causal modeling in epidemiologic research, particularly in the presence of heterogeneity might be useful. I tried to look through previous posts and comments and didn't see that this issue as well as the IOM and Cochrane perspectives on it had been addressed previously but maybe i missed it.

I have great respect for your goal of promoting science and quelling anti- and psuedo-scientific misinformation. I can only imagine the perfectly understandable frustration that comes along with that battle. It seems my comments are distracting from that goal so I'll bow out.

If you are so inclined, though, I wonder if you could further indulge me and clarify one thing about your position re the IOM and Cochrane conclusions on vaccine safety and I'll accept that as the last word:

The IOM report, in particular, appears to me to be a very careful, exhaustive (and scientifically beautiful) assessment of the state of scientific knowledge on vaccine safety that thoroughly considers not only the number and/size of studies on this issue but more importantly their quality, strengths and limitations. They agree with you that we have reached the point where the evidence favors rejecting a causal association of MMR vaccine with autism, even while recognizing that this conclusion doesn't address possible vulnerabilities in small subpopulations. Yet for 135 of the vaccine-adverse event pairs they examine (some of which are pretty serious chronic conditions), they do not reach this conclusion and instead conclude that the evidence is insufficient to reject or fail to reject a hypothesis of no causal association. They say that for most of the pairs they examine, we just don't know.

I respect your expertise here and if you'll indulge me, I really want to know what you think about this. Am I missing something or does this conclusion suggest that there is a lot we don't know about potential adverse effects of vaccines (excluding autism). I'm just honestly curious and I'd love to be able to ignore this conclusion and move on. I'll accept whatever answer you have and leave you all to your important work.

One problem I have is people, in general, leaps people take from that idea that there might be one kid in all of America who was affected in this way because we can never prove that there cannot be that one kid with some particular combination of rare sensitivities.

A skip and a hop later and we've leaped to

Something so extremely rare that happens at a level so low it is unlikely you will ever detect it and this disease is becoming so very common we have to find something to blame that happens to almost all kids as we, in general as humans, love to find the one true cause to rule them and demonize the heck out of it.

Krill: "But as a social scientist and demographer who conducts epidemiologic research on population health and teaches graduate and undergraduate statistics (although, admittedly, you have no way of knowing that), I thought that my observations about some of the limits of causal modeling in epidemiologic research, particularly in the presence of heterogeneity might be useful."

This looks oddly familiar. I think I saw someone use the same arguments and claim to be a social scientist at the Science Based Medicine blog, but with a different username.

I can't find it. But it is familiar enough, that the ploy has been tried a few times.

The thing is that Wakefield did a fraudulent study on "the" MMR. Except the UK had introduced three different versions in 1988, and removed two in1992 due to the mumps component. Plus Wakefield had an American who had been given an MMR version that had been use since 1978.

So could someone clear up which MMR is supposed to cause autism. And if it the American version, where is the evidence dated before 1990 it caused autism to sore during the 1980s?

I just have to add by way of apology: As further evidence that I am an outsider (and probably also evidence that I am an old-fogey Luddite), I previously had no idea that a "concern troll" was a thing. Upon further investigation, ouch. I guess I can understand if my comments came off that way.

In my defense, I can only say that I am pro-vaccination, a zealous advocate for science, and very supportive of what you are doing here. I just have a question about the IOM and Cochrane conclusions on vaccine safety / the epidemiologic evidence and I honestly want to know--without antagonizing you--what the participants (and author) of what seems to be a high quality science-minded blog think about this. Maybe no one agrees but it did not seem to me to be an entirely crazy or illegitimate point/question, given the sources (IOM and Cochrane). But, again, if raising the question or the way I did it was some sort of violation of the comment etiquette please accept my apologies.

On the aluminum question, we know (from unfortunate contamination of parenteral feeding solutions) that even adults and babies with impaired kidney function can excrete vastly more aluminum than is present in any vaccine. People taking aluminum-based antacids absorb and excrete literally thousands of times more aluminum that is present in a vaccine. The blood concentrations that cause neurological problems are hundreds of times higher than those seen post vaccination. In fact the amount of aluminum absorbed from the injection site each day is very similar to that absorbed from food, water and air each and every day.

As for the vaccine-autism link, the only plausible mechanism I have seen proposed is the immune stimulation and fever that vaccination can cause. It seems to me that if this led to autism we should have seen a massive fall in autism since hardly any children go through the childhood infections that almost all children experienced just a few decades ago. It seems extremely implausible to me that a measles vaccine could cause autism when measles did not.

@Narad – If you have a point to make, feel free to do so explicitly.

You introduced the statement with "ceteris paribus." What are the other things that are supposed to be equal?

For that matter, how was sample size "not directly relevant" to getting here and thence to here in the case of Pandemrix and narcolepsy?

@Narad ?????

I'm have no idea what you are talking about or what point you are attempting to make. You indicated my understanding of a particular outcome from one of the papers you linked earlier was lacking, but I have yet to figure out why. If you can't explain why my statement was incorrect, I'm not going to take your criticism seriously.

And what does the sample size on two additional papers that I've not seen before have to do with the previous discussion?

I’m have no idea what you are talking about or what point you are attempting to make.

MRLs are measured in milligrams per kilogram per day. A one- or two-day excursion above the curve is meaningless.

And what does the sample size on two additional papers that I’ve not seen before have to do with the previous discussion?

I wasn't replying to you. That's why I quoted Kwill.

@Narad: I think you are confused. I am not the one who wrote the following: "@Narad – If you have a point to make, feel free to do so explicitly." I believe that is a quote from Becky.

Also, my point about sample size had nothing to do with a discussion about Pandemrix and narcolepsy or vaccine adjuvants but may be relevant to your discussion with Becky.

*Beth* not Becky.

Yet for 135 of the vaccine-adverse event pairs they examine (some of which are pretty serious chronic conditions), they do not reach this conclusion and instead conclude that the evidence is insufficient to reject or fail to reject a hypothesis of no causal association. They say that for most of the pairs they examine, we just don’t know.

It is a reasonable and honest position to take. And you will find here that advocating for vaccines while acknowledging there are risks and serious adverse events do occur; these are not mutually exclusive positions. If we knew everything science would stop right?

I just have to add by way of apology: As further evidence that I am an outsider (and probably also evidence that I am an old-fogey Luddite), I previously had no idea that a “concern troll” was a thing. Upon further investigation, ouch. I guess I can understand if my comments came off that way.

I don't think that anyone is losing sleep over your comments so don't fret but it's nice to see that you have self-awareness. This isn't a journal club or academic blog per se so the conversation tends to be more casual. There are no insiders, unless of course you count the minions so please stick around. I for one think you can add to the conversation here.

MRLs are measured in milligrams per kilogram per day.

Yes.

A one- or two-day excursion above the curve is meaningless.

And you know this because....?

@Narad: I think you are confused. I am not the one who wrote the following: “@Narad – If you have a point to make, feel free to do so explicitly.”

Ah, I did screw that up, sorry.

Also, my point about sample size had nothing to do with a discussion about Pandemrix and narcolepsy or vaccine adjuvants

The statement was that "the sample size of an epidemiological study is not directly relevant to its ability to detect rare causal associations among vulnerable subgroups." Unless one excludes analysis of postmarketing surveillance data from "epidemiological study," I'm not seeing how the two are orthogonal.

And, again, all what other things being equal?

I suppose that a very large study that excludes (or under-represents) a vulnerable subgroup would not find those rare causal associations in those selfsame vulnerable subgroups. Or, to put it another way, just because a study was large doesn't mean it was necessarily comprehensive. Is that what was meant?

I would think it would be impossible to find rare causal associations without a large sample size, but then, I am not an epidemiologist nor do I play one on TV.

I suppose that a very large study that excludes (or under-represents) a vulnerable subgroup would not find those rare causal associations in those selfsame vulnerable subgroups.

Part of the problem and why I objected to raising the spectre of "vulnerable subgroups" is that the term itself is so meaningless. Who are these "vulnerable subgroups" and what "vulnerability" do they possess that make them "vulnerable" to vaccine reactions?

@Science Mom,

Who are these “vulnerable subgroups” and what “vulnerability” do they possess that make them “vulnerable” to vaccine reactions?

I think that's an excellent question. I've occasionally asked what test one might perform besides vaccination to determine whether someone is particularly vulnerable to a vaccine-related injury. I've not gotten a good answer to date, but I think it's a valid question.

Beth @96: I think (and I might be off) that the confusion about the amount of Al is that the MRL is discussing a *chronic* exposure (how much an infant can eat every single day for a year. what you are describing in a vaccination with an alum adjuvant is an *acute* exposure, which usually has a much higher safety threshold because it is a single event.

Yes, that one shot might be more Al than you get through feeding, but since it isn't repeated tomorrow and the day after, your body has plenty of resources to get rid of it.

I hope that answers your question.

Who are these “vulnerable subgroups” and what “vulnerability” do they possess that make them “vulnerable” to vaccine reactions?

To be fair, this is an entirely plausible scenario...ultra-rare genetic variation could cause severe, yet vanishingly rare adverse events. Even though this subgroup is small, it's still a subgroup.

I’ve occasionally asked what test one might perform besides vaccination to determine whether someone is particularly vulnerable to a vaccine-related injury. I’ve not gotten a good answer to date

If there are well-known genetic underpinnings of the vaccine reaction, it would be easy to genotype the causal variant(s) to help guide treatment, similar to current efforts to use genomic data to reduce adverse drug events driven by genetic heterogeneity. Again though, this would only work for rare, severe vaccine reactions driven by a small number of rare yet high-effect-size alleles.

AdamG

If there are well-known genetic underpinnings of the vaccine reaction, it would be easy to genotype the causal variant(s) to help guide treatment, similar to current efforts to use genomic data to reduce adverse drug events driven by genetic heterogeneity.

I entirely agree with you. To rephrase my question, then, it becomes: what is the test we can do to determine whether someone has a predisposition to being harmed by a vaccine, and how do you know that?"

And frankly, that's an important question. If we had some test to say "you shouldn't immunize this person against chicken pox because the vaccine would be as bad as or worse than the disease", it would be a valuable advancement to medical science. In my opinion.

To rephrase my question, then, it becomes: what is the test we can do to determine whether someone has a predisposition to being harmed by a vaccine, and how do you know that?”

This is an area of active research. Here's a good place to start:
http://www.sciencedirect.com/science/article/pii/S104366181400139X

A one- or two-day excursion above the curve is meaningless.

And you know this because….?

Because MRLs come with a very substantial safety factor - usually 100-fold, but often higher.

Apropo to your water example, I can state that air is not a problem when it is swallowed even in large amounts, but it’s deadly if even a small amount is injected.

This is a quite meaningless example, because the impact of air injected is entirely physical and has nothing to do with toxicity.

@AdamG - that's great, I'll be happy to see the eventual results.

In all honesty, though, the original ASIA (Steve Howe, Carl Palmer, John Wetton, and Geoff Downes) was better than the various other ASIAs (even when they replaced John Wetton with Greg Freakin' Lake).

@Esther
– anti-candida diet
– aloe vera (supposedly cures everything)

The other bits of quackery you mentioned aren't familiar to me (although no doubt someone out there in the US is into them) but those two are extremely common. You can find information and supplies for both of them at any health food store or Whole Foods (fancy grocery store chain with a focus on 'natural'). Quite a lot of places will put aloe vera in your smoothie as well.

shows spikes on the injection day followed by rapid elimination during the first few days. Overlaps occur between the MRL and vaccine curves during the first 1–3 days postinjection.”
This means that there are times when vaccines will cause a spike in the level of aluminum in their body above what is considered ‘safe’ or below the minimum risk level. The graph shows this quite clearly.

Figure 1 in Keith et al. is a *hypothetical* curve for aluminium. It assumes that all the aluminium-hydroxide adjuvant becomes biologically available the moment it's injected (by analogy with Priest's trials with soluble aluminium citrate) and is then eliminated according to a power law.

But the whole point of an adjuvant is that it *doesn't* immediately disperse through the bloodstream. It hangs around the location of the injection, winding up the immune response, shouting "Let's you and him fight!" to white cells. So those spikes are a complete kettle of red herrings.

lilady@67

I wish I knew more about your son,and the problems your son had.I suspect they were chromosomal or metabolic.

As you know,I am older than he was,and I had my first diagnosis of autism,and other stuff,but I do not know what,in 1971.I was reevaluated and rediagnosed as an adult.

I don't know where your son went to school,but where I went to school,in Baltimore County,Maryland,all elementary and junior high schools had multigrade special education classrooms in the regular schools,This was in the late 1960s to mid 1970s.I had autism,and multiple learning disabilities,but none involving speech.For a number of years in school,I went back and forth between "regular ed" and special ed classes in the same school building.

I also have a lifelong history of medical issues that are probably as complicated as any your son had to deal with.I was lucky.I had a mother who cared enough to keep me out of an institution or group home.I lived with her until her death almost three years ago.I survived a few close calls with death,to get to where I could take full benefit from all of the remarkable advances we have seen in autism medicine in the 21st Century.

Make no mistake about it, the advances are there,especially in the areas of immune and mitochondrial/metabolic disorders.I now have at least three distinct metabolic diagnoses,and am working my way towards a diagnosis of what is likely,a rare or unique type of mitochondrial disorder.I am working with a couple of the top specialists in mitochondrial and metabolic autism.Treating these disorders has allowed me to live on my own.

Krebiozen @88

It is well accepted by doctors familiar with mitochondrial autism,that fever can trigger regression when there is underlying metabolic and mitochondrial disease.Any fever.Vaccine induced or wild.The mitochondria do not care.Once more this proves the antivaxers wrong when they say wild infections make kids,or adults,stronger.Not just one regression,but over and over again,unless the underlying mitochondrial disease,or IEMs are treated.And not only regression,but other problems as well,be they medical problems,or things like vision or hearing loss as well as autistic regression.This was the case with me well into adulthood.

It really too bad this blog is so bogged down with fighting the antivaxers,and cannot spend any time covering these advances,but that's what we have bloggers like Paul Whiteley,in the UK for.

What is even sadder,is that antivax parents don't abandon their antivax beliefs*,and start exploring these avenues for their children.It is not easy to get a diagnosis of some of these emerging immune or metabolic disorders.It involves work,and lots of tests.Some of which may have been only available through clinical trials,but the results are so much more rewarding than following the antivax path.

*This includes the belief their kids were "perfect" before vaccines.Most of these diseases are related to family history.

One of the complications of the immune system is that unlike pretty much every other system, there are cells that do a random reassortment of part of their DNA. This is one mechanism that allows us to generate so many different immunoglobulin types. Dreier discovered this at Cal Tech about half a century ago. This would potentially complicate testing for rare immunological conditions resulting from the existence of a particular antibody. It would be hard to predict how identical twins would turn out in this kind of testing, but they won't automatically show the same distribution of antibodies since the rearrangements are somatic.

As an aside, I think that the fringy resort to "weakening the immune system" as an explanation for all things that are as yet unexplained is unscientific and unlikely. What the fringe has going for it is that the immune system is complex and involves many opposing and balancing activities (as another commenter pointed out), so it is hard to refute a statement as vague as "weakening the immune system."

One other point that is fairly minor unless you are the medical examiner working on a particular kind of murder case. As one famous ME wrote in a book describing his career, the injection of air into a vein is not necessarily immediately fatal after a small amount of air is injected. It might take more, depending on luck and the particular victim. I can't remember which book I read this in, but I did read it. Scuba divers get air bubbles in their blood routinely upon ascent. You need to avoid an excess bubble load.

To be fair, this is an entirely plausible scenario…ultra-rare genetic variation could cause severe, yet vanishingly rare adverse events. Even though this subgroup is small, it’s still a subgroup.

Absolutely Eric however the anti-vaxxers just love putting this cart before the horse. We must first establish the genomic and proteonomic characteristics of these "vulnerable subgroups" before understanding any potential vulnerability to an adverse vaccine reaction.

If there are well-known genetic underpinnings of the vaccine reaction, it would be easy to genotype the causal variant(s) to help guide treatment, similar to current efforts to use genomic data to reduce adverse drug events driven by genetic heterogeneity. Again though, this would only work for rare, severe vaccine reactions driven by a small number of rare yet high-effect-size alleles.

An example would be those with mitochondrial gene defects. Once diagnosed even they are vaccinated albeit differently than the general population. The "vulnerable subgroups" are often used as shields or swords by anti-vaxx groups without so much as an understanding of what they are even invoking.

This is an area of active research. Here’s a good place to start:
http://www.sciencedirect.com/science/article/pii/S104366181400139X

Ooof, not a good example. Shoenfield has developed, shall we say, a rather active imagination with regards to autoimmune vaccine reactions and ASIA specifically.

@Beth #62 etc

Aluminum isn't a food, but neither is it some strange artificial substance.
It is the most common metal in the Earth's crust, so there's aluminum in organic oatmeal, broccoli, pure seawater and in playground dirt.

One of the complications of the immune system is that unlike pretty much every other system, there are cells that do a random reassortment of part of their DNA.

I'm rather fond of ERV's take.

An example would be those with mitochondrial gene defects. Once diagnosed even they are vaccinated albeit differently than the general population.

How so?

@Science Mom and @AdamG: Thanks so much for addressing my question and for the dialogue more generally. All great points.

@Mephistopheles O'Brien(#98): "I suppose that a very large study that excludes (or under-represents) a vulnerable subgroup would not find those rare causal associations in those selfsame vulnerable subgroups."

Although that is true, it is not even necessary that the vulnerable subgroup be excluded from the study for the rare causal associations to be obscured. If the rare vulnerable subgroup is small in the sample relative to the nonvulnerable subgroup who is not negatively affected (or who may even be positively affected by vaccination), that subgroup's contribution to the overall average coefficient estimate will be very small and undetected. Even if you had census data on the whole U.S. population that included vaccination history and all medical diagnoses, if the adverse effect was rare and you didn't know where to look for it, it would likely not show up. Of course, you can detect it if you explicit model it (i.e. in cohort studies, test the interaction between vulnerability X and vaccination) in predicting adverse outcome Y.. But you have to know what the vulnerability is and where to look and it has to be measured in your data. That is very difficult (currently impossible?) for outcomes like autism in which the etiology is not completely understood and therefore the vulnerabilities are not (all) known. All of this is complicated even more if the outcome of interest is caused by multiple factors so that only some of those with vulnerability X who are vaccinated will be diagnosed with the problem.

In sum, it's true that having a big enough sample is a necessary precondition to even getting some of those in a theoretical "vulnerable subgroup" in the sample, but a large sample is not at all sufficient for being able to detect negative causal effects in that vulnerable subgroup if one does not know where to look.

It sounds as if from what others have said that this "vulnerable sugroup" language is a tactic used by anti-vaxxers and, as @ScienceMom notes, this is putting the cart before the horse. I absolutely agree that just because there may be small vulnerable subgroups that we have not identified and therefore there may be small adverse outcomes that would not have been detected in the research to date, that does not mean that these subgroups even exist and all and it is certainly no justification for undermining national vaccination programs or changing recommendations. In my mind, all it means is that there is more we can learn about potential adverse effects of vaccines and we need to do more research (a trope among scientists, I realize--we always want more research!).

But--and this is question, not an assertion---doesn't this also mean that there is no scientific justification for saying to any individual parent (without knowing more about the specific case), "The science is clear that vaccines did not contribute to your child's autism?" To be clear, I'm not saying anyone here has ever said that but I think there are examples of this language in the larger public dialogue. And, I'll add that I'm simply asking the question and I'm not asserting this as fact. I know that may be perceived as an inflammatory statement and I'm very open to hearing it if you think the answer is no and/or the question is irrelevant.

doesn’t this also mean that there is no scientific justification for saying to any individual parent (without knowing more about the specific case), “The science is clear that vaccines did not contribute to your child’s autism?”

It doesn't mean that.
The link between vaccines and autism has been looked at. One meta-analysis used over 14 million individuals. No correlation was found. In a sample size that huge, if there was a susceptible subgroup, even if it was 1 in 1000 autistics, it would have been detected.
We have looked for the possible correlation exhaustively. There comes a point where absence of evidence has to be regarded as evidence of absence. The "susceptible subgroup" has reached that point.

Narad,

Quite a lot of places will put aloe vera in your smoothie as well.

I came across NCCAM's page on aloe vera recently. I was surprised to see that in 2002 the FDA required all OTC aloe vera laxatives to be removed from the market because of a lack of evidence for safety. Also, ingested aloe vera causes cancer in rats when given for long periods and has been linked to acute hepatitis (though not very convincingly), and topical aloe vera may inhibit healing of deep surgical wounds. So much for it being a panacea! I'll pass on the smoothie, thanks.

Kwill

But–and this is question, not an assertion—doesn’t this also mean that there is no scientific justification for saying to any individual parent (without knowing more about the specific case), “The science is clear that vaccines did not contribute to your child’s autism?”

If the epidemiological evidence was all that was available I would agree, but it isn't. For example, we have a lot of evidence that autism starts long before any vaccines are given - the only known causes of autism are congenital rubella syndrome and the use of some anticonvulsant drugs during a very specific window of pregnancy. There is also the evidence from twin studies that strongly suggests a large genetic component to autism.

Incidentally, the idea that vaccines can cause encephalopathy has been challenged.

How so

How are they vaccinated differently? According to this, http://www.sciencedirect.com/science/article/pii/S1096719208002035 most are given the recommended schedule however my interwebz meanderings have indicated that mito paediatric patients are often vaccinated fully but "selectively", as in one jab at a time.

@JulianFrost: Thanks for the input. But you have to think about what a correlation is. It is a statistical average. Averages can and often do obscure a great deal of heterogeneity. In statistics, this is called the "tyranny of the mean" or the "tyranny of averages." Here is a completely unrelated example from my own research. There is this longstanding correlation between marriage (vs. being unmarried) and better health. It's a pretty large positive association and hundreds of observational studies have observed this in both cross-sectional and longitudinal studies. I've done some of those studies myself. Then I found my research showing up in policy justifications for programs that advocated moving welfare money to programs that would promote marriage among low-income single mothers (the rationale being, they won't need welfare and they'll be healthier and happier if they marry). But whether this average benefit of (later) marriage would apply to single mothers specifically is an empirical question that no one had looked at. We got an NIH grant to look at this in a longitudinal cohort study that had data on >12,000 adults over a period of 30 years. What we found, and are continuing to find, is that that average benefit of marriage just doesn't apply to single mothers. And for some (African American single mothers who had a birth prior to age 24), later marriage is actually linked to worse health outcomes. We can't prove causality with observational data of course but use propensity score models and quasi-experimental methods to get close than just a regular correlation would).

The point is that 50 years of research on the links between marriage and better health hadn't detected this negative effect in this subpopulation because it wasn't looking for it. This average positive correlation was observed in the same data that we used and it was still positive and strong even though those single mothers were in the sample. Again, if the vulnerable subgroup is small relative to the nonvulnerable group, It just doesn't show up unless you model it explicitly. The fact that there are some in the sample for whom the marriage-->health correlation is negative was obscured by the fact that the overall average correlation is positive (because most people who marry had not had a nonmarital birth and weren't in the "vulnerable subgroup). This would be no different if the study had a sample of 1 million. Beyond having a random sample of sufficient size to even include the vulnerable subgroup, increasing the overall sample size does not itself increase the probability of detecting an adverse effect as long as the size of the vulnerable subgroup is small relative to the total population.

Obviously, this is a very different example than that of vaccines because not marrying really doesn't harm the population and not vaccinating does. That's why it would be crazy to suggest we have policies requiring people to marry but it is completely justified to have policies requiring people to vaccinate. Still, the underlying statistical reasoning regarding the tyrrany of averages is the same. Correlations do not give you any information about the presence of vulnerable subgroups. The size of the standard deviation/confidence intervals can give you a hint but it still doesn't tell you where to look to find a potential vulnerability. For that you need information about the etiology of the disease in question and you need to have measures of those vulnerabilities in your data.

@Krebiozen: That makes sense, thanks. And I'm sure you know more about the state of the science on the causes of autism than I do. My limited understanding of epigenetics is that even phenotypes with a strong genetic component can result from an interaction with non-genetic factors to influence gene expression. But maybe this has been ruled out in the case of autism. Again, I'm sure you all know more about this.

Also, re when autism starts--this seems an important point. Is the conclusion that we're pretty sure that all/most cases of what is classified as autism have some identifiable genetic or other physiological characteristic at birth that those who are not later diagnosed with autism do not have? If that's the case, I agree that would be strong evidence against a contributing role of vaccines.

#116 Kwill,

The answer is that it depends, and sometimes people can be sloppy in their reasoning or language-- and it's difficult to sort out which.

For example, the commenter at #119 Krebiozen has previously replied to one questioner in a manner that contradicts his current claim

"If the epidemiological evidence was all that was available I would agree".

(Perhaps his understanding has matured since then.)

So, yes, “The science is clear that vaccines did not contribute to your child’s autism." is a perfectly good answer if the scientific consensus is clearly articulated: "Vaccines do not contribute to autism."

The problem arises, in my humble opinion concerning science communication, when we fail to make clear the entire knowledge construct that leads to the conclusion. So, you get the 'absence of evidence' response-- which is not surprising if you are offering nothing more than some handwaving with probabilities.

Kwill:

Averages can and often do obscure a great deal of heterogeneity.

As I mentioned above, that meta-analysis looked at over 14 million people. At that level the sensitivity is mindblowing, so any heterogeneity, like the previously hypothesised susceptible subgroup would STILL have been detected.
Finally, for someone who claims to not be JAQing off, you're behaving suspiciously like someone who is.

I recall a Portland friend waving about a meme on Facebook stating that scientists have discovered that inflammation is the cause of depression. So I was kind of going, “I doubt the etiology is that simple,” and poked around a bit to find the actual studies involved. In short, yeah, it’s not that simple – about a third of people with clinical depression have higher-than-average levels of inflammation, although it’s 45% in people with treatment-resistant depression. Thing is, a third of people with depression have lower-than-average levels of inflammation, and treatment with anti-inflammatory agents could make them worse.

Somewhat off-topic, but fwiw: There's also quite a lot of research suggesting that inflammation is (in some sense) "the cause" of psychosis -- ie, it appears to play a part in the pathophysiology of schizophrenia, bipolar disorder, etc.

I didn't know it was potentially implicated in treatment-resistant depression. And -- as you so very rightly say -- even what little is known about the etiology of serious mental illness is not that simple. (Bio-psycho-social; genetic predisposition; and so on).

But I have to say: At least in the abstract, it actually makes more sense than none that it would be.

^^That doesn't mean that it's remotely reasonable to say that vaccines (or any of the other, assorted, usual suspects in the "it's-environmental!" line-up) cause any of those disorders, though.

Lest it needs saying.

zebra,

For example, the commenter at #119 Krebiozen has previously replied to one questioner in a manner that contradicts his current claim
“If the epidemiological evidence was all that was available I would agree”.
(Perhaps his understanding has matured since then.)

De enlighten me. Where precisely have I suggested that the epidemiological evidence alone is sufficient to categorically state that vaccines never cause autism?

Or even, "do enlighten me".

@JustaTech #101

Yes, that one shot might be more Al than you get through feeding, but since it isn’t repeated tomorrow and the day after, your body has plenty of resources to get rid of it.I hope that answers your question.

Thank you for your response. My understanding of the paper in question is that it converted amounts with respect to ingestion and injection in order to make the direct comparison. The question I asked had to do with how can we know those spikes above the MRL caused by vaccines are not going to cause problems for the individual. I’m afraid your response does not answer that question.

@ChrisP #105

Because MRLs come with a very substantial safety factor – usually 100-fold, but often higher.

100 fold - could you give a source for this? In engineering, a 6 sigma safety margin is common, which is a similar concept but a very different way of computing it.

I would agree that there is no evidence that such spikes are going to be harmful. But that is not the same as concluding they are safe. It means it falls into the ‘we can’t be sure’ category.

@Spectator #113 – One of the papers linked earlier that I read and have been discussing makes clear that there is a large difference in outcomes between AL that is ingested and AL that is injected. Very little of ingested AL is absorbed into the body. It is also well-established as a neurotoxin.

The question I asked had to do with how can we know those spikes above the MRL caused by vaccines are not going to cause problems for the individual. I’m afraid your response does not answer that question.

Because kidneys. And here is an updated version of Keith et al. which does a better job (in my opinion) of modelling IM Al kinetics. http://www.ncbi.nlm.nih.gov/pubmed/22001122

The question I asked had to do with how can we know those spikes above the MRL caused by vaccines are not going to cause problems for the individual. I’m afraid your response does not answer that question.

Because it doesn't spike above the minimum risk level for single exposure. And it is one.

In order for it to be above the MRL for daily exposure, the individual would have to be vaccinated daily.

@Beth --

In the event that the distinction still isn't clear:

You know how you can have an ice cream sundae every now and again without gaining weight, even though if you ate three ice cream sundaes every day you would?

Same thing.

Beth,

The question I asked had to do with how can we know those spikes above the MRL caused by vaccines are not going to cause problems for the individual. I’m afraid your response does not answer that question.

There are no spikes above the MRL, as Herr Doktor Bimler explained at #108. They assume that all the aluminum in the vaccine is absorbed immediately, which does not happen. The entire point of an aluminum adjuvant is that it is not absorbed for a long period.

We know, from experience with aluminum contaminating IV feeds, and kidney dialysis fluids, that aluminum doesn't cause problems unless blood levels are maintained of greater than 60 micrograms per liter. We can measure large spikes in blood aluminum after patients are given aluminum-containing antacids, which can result in up to 80 micrograms per kg body weight per day (5,600 micrograms per day in a 70 kg adult) being absorbed, which is rapidly excreted by the kidneys.

Compare a single dose of less than 1,000 micrograms in a vaccine injected intramuscularly where it dissolves slowly over a period of weeks, leaching into the blood at a rate of less than 0.4 micrograms per kg per day. When you consider that the normal range for blood aluminum is up to 6 micrograms per liter, and that we absorb up to 0.5 micrograms per kilogram per day from foods (that's 2 micrograms per day in a 4 kg baby), 0.4 micrograms per day is negligible. As has been pointed out, the increase in blood aluminum after vaccination is barely measurable.

In summary, we have a large excess capacity for excreting aluminum, and the tiny amounts in vaccines are simply too tiny to be of any concern.

^ "blood levels are maintained at greater than 60 micrograms per liter"

@Julian Frost: I think this is the study you are referencing: http://www.sciencedirect.com/science/article/pii/S0264410X14006367 and I agree that it is a valuable meta-analysis. It shows that in the combined sample from 5 case-control studies and 5 cohort studies, there is absolutely no significant average correlation of vaccination generally, vaccination with MMR specifically or thimerosal exposure with ASD or autism. It may not be relevant except to demonstrate this this may not be the study you are talking about: the combined sample size is 1,256,407 so correct me if I have the wrong study.

However, this study does not address or in any way disprove my point about the inability of the average to provide information about whether there are adverse effects in vulnerable subgroups. You note that, "In a sample size that huge, if there was a susceptible subgroup, even if it was 1 in 1000 autistics, it would have been detected." What would a correlation coefficient (or, in this case, odds ratio) that detected the adverse effect in the susceptible subroup look like? Are you saying that if vaccination contributed to the autism of 1 out of 1000 autistic children but did not contribute to the autism of 999 out of 1000 autistic children, then the meta analysis would have revealed a significantly greater odds of autism among the vaccinated compared to the non-vaccinated (rather than the nonsignificant odds ratios that it did produce). I'm sorry and I don't want to sound like I am attacking you because you seem to think that I have some sort of anti-vaxx agenda here, but I don't know how else to say it: That is not how odds ratios or correlations work even in very big samples. If you don't believe me, I'll quote the IOM again because, come on, it's the IOM! Don't we trust the IOM? See especially the last sentence “Epidemiologic analyses are usually unable to detect an increased or decreased risk that is small, unless the study population is very large or the difference between the groups (e.g., vaccinated vs. unvaccinated) at risk is very high (e.g., smoking increases the risk of lung cancer by at least 10-fold). Epidemiologic analyses also cannot identify with certainty which individual in a population at risk will develop a given condition. These studies also can fail to detect risks that affect a small subset of the population. (p. 50)”

If you are interested, here is a fairly detailed statistical explanation: http://www.ssc.wisc.edu/soc/faculty/pages/docs/elwert/Elwert%20Winship%…
All of this gets at the well-known problem in epidemologic research that population risk is not the same as individual risk and it is a fallacy to assume that it is. What's more, even the population average estimates (such as the nonsignificant odds ratios in the vaccine autism meta-analysis) can be biased in the presence of heterogeneity that is explicitly unmodeled (i.e. if the association is different in some subpopulation than it is in the rest of the population) as the Ellwood and Winship paper above shows. Believe me, as someone who conducts epidemiologic observational research, I don't like this any more than you do.

Here is another discussion and demonstration of the issue: http://www.jstor.org/discover/10.2307/2531765?sid=21106095850763&uid=2&…

and here:
http://www.biostat.harvard.edu/robins/prob-caus-89.pdf

I don't know what else to say about this other than this is a well-documented and well-known issue that is the subject of a substantial body of research. As someone who works in a field in which epidemiologic grant proposals get reviewed by experimental and clinical scientists, I get reminded of these limitations all the time. I only say this by way of explaining why it may seem like common knowledge to me but I understand if it is not common knowledge more generally. I'll add that I just think it's an important point to make in this group and for other science-minded folks to understand. My intent is not to prove you wrong personally.

On the positive side, there are methodological advances that appear to improve on the ability to modelling stochastic individual risk in epidemiologic studies but these are pretty new and not widely implemented.

Regarding this: "Finally, for someone who claims to not be JAQing off, you’re behaving suspiciously like someone who is." I'm trying my best here to make my point about the limits of epidemiologic research for detecting potential adverse effects in small subgroups be clear that this point in no way should undermine confidence in or the scientific justification for vaccination policy, which is clearly and undeniably beneficial to the population. If you'd like to tell me how to do this more effectively without raising your suspicion, I am happy to comply.

Can iask which paper you linked to suggesting different outcomes? All I'm finding your link @29 which doesn't indicate such.

There actually isn't a significant difference in outcome for ingested dietary aluminum versus adjuvant aluminum delivered by IM injection: while only a less of the total dietary aluminum you're exposed to is abosrbed in the gut compared to the total adjuvant aluminum you're exposed to by IM injection, in both cases once absorbed distribution to tissues and organs is essentially identical and in both cases the absorbed aluminum is effectively eliminated (see, for example, PMID:9302736).

As for aluminum being a neurotoxin, not at exposure levels achievable as a consequence of routine childhood vaccination. Always important to remember that it's the dose that makes the poison.

@Ann #130

Because it doesn’t spike above the minimum risk level for single exposure. And it is one.
In order for it to be above the MRL for daily exposure, the individual would have to be vaccinated daily.

This does not jive with my understanding of fig 1 in the paper linked by NARAD in #41. It plots the aluminum body burden contributions form diet and vaccines relative to the MRL level intake. Since days is the parameter shown by the x-axis, it seems to me that MRL shown is for a daily basis and clearly shows a spike above the MRL at slightly before 100 days old. If you don’t think this is the case, could you explain why my understanding is incorrect? Perhaps you could link to a paper that provides the MRL for a single exposure and compares that with the body burden contribution for vaccines showing that no spikes above the MRL occur?

@Krebozen #132

There are no spikes above the MRL, as Herr Doktor Bimler explained at #108. They assume that all the aluminum in the vaccine is absorbed immediately, which does not happen.

This is not true. In fact, they give the exact formula they use (equation 1) in their paper to compute the body burden from injections.
@JGC #135

Can I ask which paper you linked to suggesting different outcomes?

It was linked by NARAD in #41. “HUMAN HEALTH RISK ASSESSMENT FOR ALUMINIUM, ALUMINIUM OXIDE, AND ALUMINIUM HYDROXIDE
Daniel Krewski,1,2 Robert A Yokel,3 Evert Nieboer,4 David Borchelt,5 Joshua Cohen,6 Jean Harry,7 Sam Kacew,2,8Joan Lindsay,9 Amal M Mahfouz,10 and Virginie Rondeau11
It states (bolding mine): “Regardless of the duration of exposure, the toxicity attributed to aluminium is dependent upon the physiochemical properties (solubility, pH, bioavailability, etc.), type of aluminium preparation, route of administration, and physiological status (presence of renal dysfunction). “

Kwill,

this study does not address or in any way disprove my point about the inability of the average to provide information about whether there are adverse effects in vulnerable subgroups.</blockquote.
As previously mentioned

1 in 12,000 [was the rate of] intussusception which epidemiological studies were able to attribute to the RotaShield vaccine.

My point was in a sample size that large, if there was a susceptible subgroup, even one of less than 0.1%, there would have been a detectable difference, and the epidemiologists would have drilled down and investigated, and identified said susceptible subgroup.

Epidemiologic analyses also cannot identify with certainty which individual in a population at risk will develop a given condition. These studies also can fail to detect risks that affect a small subset of the population.

True, but they're not talking about a sample of literally millions.

Beth,

"There are no spikes above the MRL, as Herr Doktor Bimler explained at #108. They assume that all the aluminum in the vaccine is absorbed immediately, which does not happen."
This is not true. In fact, they give the exact formula they use (equation 1) in their paper to compute the body burden from injections.

They explicitly state, "Uptake following injections is taken as 100%". The point is that body burden isn't really relevant to toxicity, it's bioavailability that is important. If I have a milligram of insoluble aluminum hydroxide sitting at an injection site in my triceps slowly dissolving into my interstitial fluid, it isn't elevating my blood levels and causing neurotoxicity.

Perhaps it's your use of the word "outcomes" that's confusing me. The only unique outcome I see the paper note associated with an IM versus parenteral route of adminsitration macrophagic myofasciitis at teh site of injection, which it notes is only observed with excessively high exposures to alluminum adjuvants--and which, according to the WHO from an epidemiological perspective, has (with few exceptions) only been observed in France. Even in France we're talking of about 200 cases in total.

@Krebiozen #138 - You are correct. I missed that phrase. What uptake rate should they have used?

@JGC - By 'outcomes' I was referring to the toxicity of the dose. A specific dose ingested orally could be non-toxic while the same amount injected could be dangerous.

@Julian Frost: Thanks, really! The clarification that you are talking about the RotaShield study helps a lot. I admit I hadn't previously seen the rotavirus study so I took a close look and it appears we are talking about different research designs / statistical calculations (in the rotavirus study and the vaccine-autism meta-analysis) http://journals.lww.com/pidj/Abstract/2001/04000/Population_based_study…

One reason the rotavirus vaccine study was able to calculate a predicted risk of 1 in 11,073 children, I think, is that they had complete data from 10 managed care organizations. From the study: "The main advantage of the study was that the MCOs had known denominators of vaccinated and unvaccinated infants, allowing calculation of incidence rates and attributable risks of intussusception." The other factor is that they also had a very large number of unvaccinated children, perhaps because they were only looking at one specific type of vaccine--Rotashield. Only 56,000 children out of 463,000 in the study received this vaccine so 407,000 were in the "unvaccinated" group. This allowed them to calculate an estimate of how many cases of intussusception occurred in vaccinated children and compare that to how many cases occurred in unvaccinated children. That's basically how they come up with the 1 in 12,000 "vaccine attributable risk."

It's not entirely clear to me why the vaccine-autism meta analysis that we discussed did not attempt to calculate a similar vaccine-attributable risk. Is the problem that there aren't enough unvaccinated children with autism to power such an estimate? For this vaccine attributable risk calculation, I totally, agree having a bigger sample would be important. Is even the 1,256,000 in the meta-analysis not sufficient? This seems like an important question. Does anyone know of studies that have calculated vaccine "attributable risk" for autism, specifically? If not, why not?

Whatever the reason, the vaccine-autism meta-analysis does not incorporate these denominators of vaccinated and unvaccinated children and therefore it does not present any calculations of individual vaccine-attributable risk similar to the rotovirus study. All they present are average odds-ratios which cannot pick up sources of heterogeneity in the effects unless you know where to look.

Thanks again, though, for pointing me to this study and the vaccine attributable risk calculation. I'm going to poke around in the literature out of curiosity and I'll be sure and share if I find a similar study on vaccine attributable risk for other outcomes outcomes.

Beth,

What uptake rate should they have used?

Yokel and McNamara estimate 0.07–0.4 µg/kg/day, based on Flarend's work on rabbits. Basing this on rabbits and not humans isn't ideal, but mammalian muscle physiology is very similar, and I think it's a fair assumption that uptake rates will be similar. That is supported by the barely measurable increase in blood aluminum levels after vaccination, at least 100 times lower than the levels required to cause toxicity. Remember that we are talking about very low quantities of aluminum; a milligram of aluminum isn't very much - a drop of water weighs about 50 milligrams.

macrophagic myofasciitis at teh site of injection, which it notes ... only been observed in France.

Has *anyone* reported it outside of Gherardi's group of aluminium alarmists?
Keith &c are droll about nationality as a risk factor: "observed primarily in immune-compromised Frenchmen".

I didn't see anyone mention that Nevison only publishes in open-access journals and doesn't note her affiliation and obvious COI of Safeminds. While not enough for a retraction, it does show she's hiding it or is horribly sloppy.

Also, get rid of the two concern trolls.

Nevison only publishes in open-access journals

Is that relevant? Nothing wrong with OA journals per se. "Environmental Health" is from BiomedCentral (and ultimately part of the Springer group), while "Microbial Ecology in Health and Disease" is part of the Taylor & Francis group

I've published two articles in PLoS ONE; so I don't think publishing in open access journals is a bad thing.

100 fold – could you give a source for this?

Leaving aside the fact that, as noted, this is a red herring, the total uncertainty factor for the ATSDR intermediate-duration* MRL to convert from the murine LOAEL is 300 (PDF). Note that this is the 2008 version, not the 1999 version used by Keith et al., which hinges on a different Golub paper.

* There is no acute MRL.

^ LOAEL NOAEL (PDF)

@JayK
"Also, get rid of the two concern trolls."

I think that was directed at me. I just have to say after looking more into this "concern troll" phenomenon, it strikes me as an entirely appropriate critique in ideological or political discussions but problematic for legitimate scientific inquiry. I guess I misjudged the primary focus of this blog (or at least some of its participants) in assuming it was scientific rather than ideological. I'll just leave you with this from rational-wiki.

"The danger, of course, is that not everyone with a concern is a concern troll - and not every concern is unreasonable. In environments of genuine groupthink, applying the concern troll label may serve as a means of enforcing conformity and punishing (or silencing) dissent. And even without actual groupthink in play, many Internet posters find dismissing an argument much quicker and easier than evaluating it. In addition, the term "concern troll" focuses not on what the person is actually saying, but on some alleged agenda. Thus, if misused, it is the perfect refuge for someone who has no counter to the actual argument: simply ignore the points made, allege some other position, and then accuse the other person of lying if they deny that that is what they're really saying. It's a combination of straw man and argumentum ad hominem: make up something to attack, and ignore their actual points on the basis that since the points were made by someone acting in bad faith, they need not be addressed."

#149 KWill,

First, your contribution has been extremely useful to me at least-- I brought up this same (statistical) issue in a previous post, but I don't have your background and was unable to provide the (quality) references you did. It is absurd for anyone to suggest that you are a troll; if you are, you are better than any I have seen, and I can't wait for you to spring your trap.

I would, though, observe that your style is perhaps overly solicitous, and *that* is often a red flag for concern trolling or "Just A Question". Me, I come right out and say 'hey this is wrong'-- I get called arrogant and stuff like that but only the not-too-bright ones think I'm concern trolling. Of course, I can't say that a good scientific debate inevitably follows, because the defensiveness and chimp-troop behavior still manifests itself-- you should realize that many of these people are here simply to pile on some pretty sad characters from the anti-vax camp.

As I pointed out in my original comment, it doesn't matter how many times you demonstrate that you agree about the fundamentals of the topic-- they cannot concede any even marginally critical point.

Anyway, thanks again for a couple of good bookmarks, and I wish you better luck finding an interlocutor at your own level to engage with. I continue to believe that there are unbiased lurkers who learn from honest discussions-- I am one at least in many cases.

@Krebiozen #142

Thanks for answering my question. That does make sense.

@Zebra: Thanks, I appreciate it. I admit ignorance to some of the more esoteric rules of online engagement and default to being polite and respectful but I see how that has pitfalls too.

FWIW, I was seeking a scientific discussion that is divorced from the vitriol and ideology that is so prevalent on this issue (from both sides) and it seems this is not the place for that discussion. When the response to a presentation of the core conclusions of two summative statements from the most unbiased sources of the published scientific consensus (the IOM and Cochrane Library reports) on vaccine safety is that I must be a cherry-picking concern troll, that is clear evidence that this group (or t least some of its individual members) is more interested in ideological groupthink than an open and honest scientific discussion.

There's nothing inherently wrong with having an ideological anti-vaxx crusade, I guess, but when you do it under the guise of a "science blog" but then refuse to engage with the science, all I can say is that is very very bad for science.

The other thing you may want to consider if you want to actually do something about the threat of less than 100% vaccination rates rather than just bemoaning all the idiots who don't understand science: Look at the research which shows that >50% of respondents in a nationally representative study indicated that they have concerns about vaccine safety. Most of those people currently vaccinate and most aren't extreme anti-vaxx nutjobs. But if your response to them is something along the lines of "the science is clear and vaccines are perfectly safe for your child" and "you are suspiciously anti-science if you question the scientific consensus on this (although it is some other scientific consensus that exists somewhere other than in the publications of the IOM and Cochrane. In other words, if your response is "your concerns are ridiculous and get out of my face," then you stand to be as much as part of the problem of falling vaccination rates (by pushing some of that very large group of concerned/questioning but currently vaxxing parents into the other camp) as your apparent enemy is.

This is coming a little late, but it is unfortunate to see someone who appears to be good about being skeptical of some areas of science have such an anti-science attitude regarding climate change. Real science requires predictions of theories to match reality. Unfortunately many poorly informed people seem completely unaware that climate models do *not* meet this very basic requirement well enough to be taken seriously.

Unfortunately many folks don't know about about computer modeling and physics and math to grasp that the climate research field is very much a work in progress despite the attempt by "true believers" to pretend it is akin to a religious certainty where heretics who dare to question the faithful should be denounced as "deniers" to avoid needing to confront rational objections. If someone created a computer system that claimed to be able to predict the temperature one year from today to within a degree, or the dow jones average one year from today to within one point, then people would expect that such extraordinary claims would be backed by extraordinary evidence. Yet gullible true believers hear that supposed "scientists" claim models based on sparse data make long term projections and oddly blindly accept it.

Nobel laureate physicist Richard Feynman gave a lecture (transcripts are around the net) on "cargo cult science" which follow the superficial trappings of science but lack the crucial ability to be sufficiently skeptical of their own conclusions. This happens because science is a human process which can become temporarily dysfunctional. The theory of paradigm shifts acknowledges this human element, recognizing that even well intentioned fields have become temporarily stuck on a certain way of looking at the world and resist contrary viewpoints for too long until the old guard leaves the field or outsiders manage to step in and question things. Unfortunately in this case the PR war seems to be won by those who pretend their "science" can't be critiqued. They scream bloody murder at the thought their standard of certainty should be the same as say a field like particle physics... but then get away among some with pretending that they should nevertheless be granted as much credibility as those physicists, and surprisingly some otherwise skeptical people who know little about the field fall for the scam.

CommonSense (ha, ha), please go over to Greg Laden's Blog or to Stoat and spout your rubbish there. They need some fresh meat and you'll be perfect.

Unfortunately many folks don’t know about about computer modeling and physics and math

You're doubly in the wrong place, then, honeybunch. Take Julian's advice and go pontificate where it's on topic.

re: Julian & Narad's comments.

Those are of course typical of the sort of emotional rants that junk scientists give when challenged, since they can't respond with simple evidence and logic since their case isn't based on that. The very basic complaint against junk science claims is usually that tests indicate their claims don't match reality. The results of climate models don't match reality well enough. Some might appear to when cherry picked, but that isn't good enough, it'd be like basing a design of an aircraft on equations that *sometimes* seem to sort of work if you pick the right way of looking at it.

Unfortunately the field is complicated so you people within it can make complicated arguments that obfuscate the simple reality that we simply don't know enough about many of the processes involved to model them accurately. There are many good researchers in the field I'm sure, but the final claims are the results of complex climate models produced by a comparatively small number of people that people are blindly trusting. There are people that try to claim they can magically know what future climate will do without those models, but that isn't science since there are complex feedback interactions that need to be modeled quantitatively to even have the slightest ability to try to claim to know something about the future.

The very fact that there is debate within the field over how to explain a "pause", and that they can't yet agree on how to explain it, should clue people in to the fact that it is a work in progress. They need to be able to explain it to even attempt to claim they have credible models, and those models then need to demonstrate that they match reality. Instead people try to claim certainty that somehow they know what the future holds, despite the fact they haven't yet completed working models. Just as with alternative medicine, they invent lots of excuses for why they shouldn't be held to the same standards of evidence as other fields, or why their predictions should be trusted despite a lack of understanding of many things and despite the lack of credible evidence.

Different models are tweaked to get similar results.. despite having internally different physics. Many climate scientists have tried to claim for 25 years or so, even with vastly less data and understanding of the physical systems. They certainly didn't know enough to have a credible science based claim for their assertions back then, and even if they have more data now.. they still don't even if they obfuscate things enough so many people fall for the scam. Its like the same games that alternative medicine folks play with their complex theories they twist to match whatever results, non-falsifiable in essence since people don't require their results to match realty well enough. They don't have sufficient models of uncertainty and reliability of these complex models with sparse uncertain data and calculations with limited numerical accuracy and approximations due to it being of course a sparse model that can't model everything. They aren't validated the way models in other fields are. Given limited historical data, it is too easy for them to wind up calibrating the models against reality.. and then using the same data to test with (sometimes indirectly by having tweaked models so they are in the same ballpark as other models.. which have been tweaked to match the real data).

Common Sense, Respectful Insolence deals with quackery, pareidola and the logical fallacies that lead us to embrace the two. Greg Laden's Blog and Stoat both deal with climate science and climate change denialism. Please go there.

Common sense, let's assume for the sake of argument that although all models predict continued rise in global mean temperatures and a rising sea level, computer modeling of the likely outcomes of climate change needs improvement to allow us to accurately predict how rapidly GMT will rise and how the Maldives, Kiribati, Tuvalu etc. will dissappear beneath the waves.

This doesn't argue that global warming is not occurring and a genuine concern, that anthropogenic factors are not a principle contributor to the observed rise in global mean temperature, or that the adverse consequences we already see occurring as the result of climate change are not do not demand we take what action we can to reduce human contributions to rising GMT.

Oh, goody. Common Sense is an anthropogenic climate change denialist. I wonder if he's figured out yet that climate science denialists are about as welcome here as antivaccinationists, creationists, and quacks because they are cut from the same cloth.

Re Common Sense

Common Sense repeats the big lie that there has been a "pause" in the increase in global temperatures. The apparent pause is due to the result in 1998 which was an inordinately hot year due to a very strong El Nino condition. This is an outlier. When the result of 1998 is deleted, the "pause" disappears. Of course, the big lie continues to be propagated by the deniers like Common Sense.

Orac:

Science requires theories to match reality, just like the junk science you critique which doesn't stand up to testing *neither does climate research*. Yet true believers like you emotionally defend it because I suspect you have fallen for the "argument by authority" that supposedly it is "real science". I very much doubt you could make any sort of coherent defense of why you believe in climate change that doesn't rely on merely deferring to the authority of those you are trusting without skeptically examining their work. It would be like reading a homeopath make a claim and then blindly trusting it because they published it in a "journal".

It is unfortunate that you have this backwards. As far as I can tell you are skeptical about some things, but a "true believer" regarding climate change, *you* and the string of posters above you on this page engaging in mere disparaging rants remind me very much of the sort of junk scientists you usually critique. I'm sure you have seen people who know little about medical science being duped by alternative medicine. Unfortunately you and others like you seem to fail to consider the possibility that you know little about climate research and are the one that has fallen for a scam.

As someone who has read "real science" and looked into climate science.. it is difficult to believe anyone who knows much about science who actually looks into it takes the alarmist claims seriously. It requires a lack of understanding of how real science and modelling is done (on the part of the climate researchers), which allows people to be misled by climate researchers that obfuscate the basic problem that their theories do not yet match reality.

"Common Sense", it is obvious you have only read the title of this article.

As someone who has done mathematical modeling of dynamic structures, I can say with authority: you do not have a clue. Go away, you annoying flea.

And again instead of someone making a coherent argument, we get "go away you annoying flea" and an attempt at argument by authority. Yet again: in real science, theories need to make predictions that match reality before they are taken seriously. In junk science, there are all sorts of rationalizations as to why we should believe their claims despite that. In this case, just as religions denounce anyone who dares to question as a "heretic", with climate research those who dare questioned are labelled "deniers" and told to shut up and not annoy the true believers.

Climate science puts on the trappings of science, without being held to the same standards of evidence as other sciences. It is truly surprising how many otherwise skeptical people fall for it. I suspect it may be partly because it involves lots of math and physics that goes over the head of many from other fields, all the details obfuscate consideration of the simple issues such as: do the predictions match reality and are uncertainty and error factors properly accounted for within any claims.

Those who have objections to questioning a theory whose predictions don't yet match reality should question why they shouldn't be viewed as the ones who are "anti-science". Many here rightly complain about junk scientists whose theories don't match reality yet who still try to persuade people to believe them. (and anyone with the least bit of scientific skepticism and curiosity can easily find discussions about the models not matching reality with a bit of searching... and should guard against the obfuscations used to rationalize believing in them anyway by some of the less skeptical sites, unfortunately those who don't know much about the topic might easily fall for the excuses if they aren't careful apparently).

re: " it is obvious you have only read the title of this article."

Oh, and contrary to that unjustified claim, I read the article. The author seems to find it odd that a climate researcher might fall prey to junk science, whereas I don't find it at all surprising, especially given the culture in Boulder. There are many good scientists in Boulder, but in addition it is a hotbed of alternative medicine and other junk scientists. With a huge pot of money coming here for climate research, many who have doubts are scared to raise them, especially given some of the high profile alarmists nearby. There is for instance the noted alarmist Kevin Trenberth who famously tried to change the "null hypothesis" for the field. He decided climate alarmists no longer needed to actually prove their case but should be declared victorious by default, his beliefs cast in stone as if handed down from on high, and assumed to be "true" by default, unless proven otherwise.

Those are of course typical of the sort of emotional rants that junk scientists give when challenged, since they can’t respond with simple evidence and logic since their case isn’t based on that.

OK, what part of the v₂ bending mode of CO₂ and line broadening do you not understand?

Yawn, clueless clown is now boring.

Climate science puts on the trappings of science, without being held to the same standards of evidence as other sciences. It is truly surprising how many otherwise skeptical people fall for it.

I take it you similarly discard this sort of nonsense as merely having "the trappings of science."

Unfortunately you and others like you seem to fail to consider the possibility that you know little about climate research

Project much? One might note that you've failed to display the slightest trace of the knowledge of "computer modeling and physics and math" that you started out bemoaning the lack of here. Instead, you're just repeating bland complaints about models and the failure of everyone to recognize your keen insight.

How do you feel about solar system ephemerides? How would compare them with this bit of, erm, "analysis"?

They don’t have sufficient models of uncertainty and reliability of these complex models with sparse uncertain data and calculations with limited numerical accuracy and approximations due to it being of course a sparse model that can’t model everything. They aren’t validated the way models in other fields are. Given limited historical data, it is too easy for them to wind up calibrating the models against reality.. and then using the same data to test with (sometimes indirectly by having tweaked models so they are in the same ballpark as other models.. which have been tweaked to match the real data).

I mean, it must be awfully premature to start spending millions of dollars to put things at so-called "Lagrangian points." Drug design by simulating molecular dynamics? Are you krayzee? There's no telling what that stuff might do.

Yawn, clueless clown is now boring.

I know. We need a more creative, entertaining variety of climate science denialist.

Common Sense,

As someone who has read “real science” and looked into climate science.. it is difficult to believe anyone who knows much about science who actually looks into it takes the alarmist claims seriously. It requires a lack of understanding of how real science and modelling is done (on the part of the climate researchers), which allows people to be misled by climate researchers that obfuscate the basic problem that their theories do not yet match reality.

I have read a lot about climate science, including a lot of the denialist stuff. I find it difficult to believe anyone who has the slightest understanding of the science involved takes the denialist claims seriously. There is no doubt at all that our planet is warming, and very little doubt that humans are largely to blame. Current climate modeling is remarkably accurate, particularly when looking at temperature changes over the past century.

please go over to Greg Laden’s Blog or to Stoat and spout your rubbish there.

^^ That's pretty fun advice, CommonSense.

I was allowed to deny all manner of things there; Just don't mention Eric Holdren's *sterilants in the water* veiws as coauthored in Ecoscience (1977) as that seems to have gotten me banned (either that, or the Chew,Chew Baby cartoon clip I gave to hilight stereotypical cannibalism).

orac:

re: "clueless clown is now boring"

You seem to have lost sight of the guide post that claims in science need to be tested against reality, no matter what excuses people try to make to get away with avoiding that which are oddly given a pass by folks like you who confuse the label of "science" with real science.

What is boring is the inability of you to exhibit any signs of ability to be skeptical about the subject. You and the others behave exactly like alternative medicine adherents in your defense of theories that don't yet match reality, You and the other posters here act exactly like junk scientists who react emotionally to skeptics daring to question the topic. Just like many fans of alternative medicine in the public don't know enough about science to productively question some alternative practitioners, and get snowed by their explanations, you exhibit the same behavior regarding climate research. This is a complex phenomenon they are trying to model, and extraordinary claims to have done so require extraordinary proof, not gullible acceptance.

It is truly astonishing that folks that so many people who likely know little about physics or modeling are so vehement in their defense of claims they can't fully assess merely because others claim to be "scientists". I'm sure some homeopaths who claim to have done scientific research convince some in the public who don't know about science that self-labeling their views as "science" makes them so.

Common sense, you're speaking as if the climate models predicting the consequences of rising GMT have not been tested against reality. Why?

What is boring is the inability of you to exhibit any signs of ability to be skeptical about the subject.

Skepticism in the absence of credible evidence arguing that climate change isn't occurring, or that human activities have not been and are not now a significant contributor to the observed rise in global mean temperature, is hard to justify. Surely you're not saying we must be skeptical climate change is occurring simply for the sake of skepticism alone?

Regarding extraordinary claims requiring extraordinary proof, what claims regarding climate change and the likely outcome of continued rising GMT do you beleive are extraordinary, or that are not adequately supported by the current available evidence? Be specific.

It is truly astonishing that folks that so many people who likely know little about physics or modeling are so vehement in their defense of claims they can’t fully assess merely because others claim to be “scientists”.

Strangely, you keep saying this while providing no evidence whatever that would cause one to suspect that you know anything about either.

C'mon, walk everyone through the v₂ mode.

100 Quatloos that CommonSense also advocates for Men's Rights and human biodiversity.

@Orac - Thanks for admitting epidemiology cannot prove a negative.
Tons of epidemiology can't do no better at not-proving a negative, as you illogically claim here.
If that were true (I know you need it to be), then whoever has the money to produce the largest studies, no matter how skewed, would be creating "the truth", no matter how false.

@Orac - In your original post you again fall back on diagnostic substitution, while admitting autism diagnoses have increased... lol. How many bases are we trying to cover.
In your ridiculous graph you pretend that the correlation of increasing organic food consumption and increasing autism suggests there is a link... but what you don't mention, and with "good" reason, is that organic foods have never been proved-to-cause or linked-to-causing neurological injury/death, physiological injury/death, or immunological injury/death... as vaccines have.

That's according to the Vaccine Injury Table and the MMR package insert.
Vaccine Injury Table -
http://www.hrsa.gov/vaccinecompensation/vaccinetable.html
MMR package insert -
http://www.merck.com/product/usa/pi_circulars/m/mmr_ii/mmr_ii_pi.pdf

Let's have it Orac... where is your evidence that organic foods cause neurological, physiological or immunological injury/death?
Microwave use and cell phones increased in the same time period... while mandatory vaccinations tripled... many of those vaccines had/HAVE 250 X the EPA safe level of oral ingestion of mercury/kg body weight... injected all at once into infants and toddlers... THAT was on par with eating organic foods, as you, Orac, imply with your organic graph?
Your graph is pretty organic, I have to admit, in that it's major characteristic is stank!

Nothing like being straightforward about the health and welfare of kids... and nothing like being straightforward can't not be expected from the naysayers on this page, including the leader of the pack.

@Chris - Again you use your child's developmental problems as if that gives you some expertise or authority in this matter.
If anything, your completely subjective situation eliminates your voice from logically and unemotionally contributing on this issue... especially when taking such nonsensical positions and making obviously fraudulent statements.

Let's take comment #60 - You claim that high-functioning autism was a diagnosis in the DSM-IV.
No. The DSM-IV did not cover or propose an autism spectrum.
In the DSM-IV autism was ONE diagnosis out of 5 categories, those five categories came under under Pervasive Developmental Disorders.
High-functioning autism was never a diagnosis in ANY DSM until the 2013 DSM-5, which I haven't yet read.
But the final draft did not have "High functioning Autism" as a spectrum diagnosis, per say.
But it appeared that would be the way in the new world of the DSM-5, in conversations I had with APA personnel.

The DSM-IV narrowed the definition of autism because the DSM-III allowed for too many false positives. That was one of the DSM-III problems acknowledged by the APA when holding conferences to create the DSM-IV.

That you publicly claim your child has a developmental disability loses its impact when you destroy your own credibility by creating and then repeating easily exposed "mistakes".
If I was the father of a child with autism I would have supported references for everything I was talking about, 100% of the time.
YOU Chris, I have exposed as not merely ill-informed, but obstinate in the face of overwhelming evidence, refusing to back down from any post... much like the leader of the pack you are a member of.

As Always,
For the protection of children,
In the interests of truth and science,
Michael Polidori

Polidori, you are still an idiot... and a cyber stalker.

"That’s according to the Vaccine Injury Table and the MMR package insert.
Vaccine Injury Table "

So what is the ratio of compensated claims versus vaccine doses?

"MMR package insert –"

You still don't get that lawyer written CYA bits are not scientific citations.

First, I am not anti-vaccine, as Chris, and some others commenting here, have stated many times in other blogs.

Herd immunity is the only way we can partially protect kids and adults who CANNOT be vaccinated from common childhood diseases (people w/ genetic or acquired PERMANENT immune impairments).

Herd immunity also protects kids and adults who are temporarily immune compromised through drugs or cancer treatments (Chemo, Enbrel, Remicade, Nasonex, Flonase, Humira... and dozens more).

Even if vaccinated, people undergoing treatments that impair immunity can be overwhelmed by a live-vaccine booster or wild strain infection (Nasonex package insert warns patients to notify their doctor if they are exposed to measles, but don't detail if it's wild strain, direct vaccination or contact with a recently vaccinated person).
Persons with temporary immune impairment or no previous exposure can be infected by someone who was recently vaccinated with a live virus or bacteria (MMR package insert)

Herd immunity partially protects those who choose not to vaccinate.

Herd immunity partially protects those whose immune systems don't react to vaccines (In the MMR package insert, Mumps effectiveness ranges from 95% to 65%, in MERCK'S clinical studies!!).

@Chris - Chris wants to ignore the package inserts, because (he claims) they are written by lawyers.
A package insert is a contractual agreement, and therefore must be reviewed and edited by lawyers... as ALL contractual agreements are.
This includes car/phone/appliance/service warranties, food ingredients labels, rental contracts... is Chris implying that ALL contracts contain false/fraudulent information or exaggerations?

The warnings precautions and contraindications are created by doctors and research scientists.
Lawyers make sure the document is worded properly, protecting their clients in accordance with the law.
This doesn't include LYING/EXAGGERATING in the document.
Creating a false document also creates legal liability.

Chris' argument falls flat on it's face EVERY time he uses it, and he uses it a lot.

Chris also seems to have abandoned his claim that high-functioning autism was a diagnosis in the DSM-IV.

He's also not questioning my statement that the DSM-IV NARROWED the definition of autism, because the DSM-collaborators stated the DSM-III led to false positives.

Yet Chris takes up his leader's banner, defending Orac's deceptive/ridiculous graph correlating organic foods and autism.
Gorski/Orac PRETENDS that claiming vaccines are correlated to autism is as ridiculous as claiming organic foods are correlated to autism.
But vaccines are proved to injure the brains, bodies and immunity of kids and adults, while organic foods never do.

@Chris - Chris now admits vaccines cause injury and death, but says the number of compensated claims is small.
This deception implies the number of ACTUAL injuries and deaths caused by vaccines is small (the WRONG implication he wants readers to draw).

But Chris again ignores the fact that there is NO ACTIVE SURVEILLANCE SYSTEM in the USA.

NO ONE knows how many injuries and deaths are caused by vaccines every year.
So Chris implying that the cases compensated at the NVIP are the limit of how many vaccine injuries and deaths happen each year is a horrible deception.

But at least Chris has now admitted that "safe" vaccines do injure and kill.

Also Chris, regarding your implication that I am stalking you by commenting on your posts -
If you don't want to have a conversation about these issues, then stop falsely/fraudulently/deceptively PUBLICLY commenting on the issues I have knowledge about.
Especially these issues about children's health, vaccines' adverse events and adverse reactions and conflicts involving drug company profits (paying for the damage vaccines are known and proved to cause).

I have been researching/blogging about these issues long before you started attacking and personally insulting me.

As Always,
For the protection of children,
In the interests of truth and science,
Michael Polidori

I forgot to mention a couple of things... but I will only post ONE here, now.

Those kids Chris ADMITS were injured and killed and were compensated by the NVIP?...
THEY are the ones that should not have been vaccinated...
The ones that have been partially protected by herd immunity...
The reason we need to create complete science-based screening criteria... so we find those kids BEFORE we vaccinate them.

We need to enforce screening using current package inserts, until new ones are created.

MERCK clearly states in the pamphlet that parents/guardians/patients must be told of all the precautions/warnings/contraindications/adverse-events/adverse-reactions - EVERY TIME ANYONE IS VACCINATED.

Reviewing those 11 pages and answering the multiple questions that would bring up would take a large amount of time.
NO HEALTHCARE PROVIDER properly uses the 11 pages of the MMR package insert when they administer an MMR vaccine.
They should. It's the only way we have right now to identify kids susceptible to vaccine injury.

Ironically, the kids and adults that are injured or killed by vaccinations are the same people who should have been partially protected by herd immunity.

About 10% of us should not receive live vaccinations.
The CDC/FDA/Merck all admit that 10% of us have chronic cell-mediated immune issues, which makes live pathogen vaccinations very risky.

As Always,
For the protection of children,
In the interests of truth and science,
Michael Polidori

THIS IS A CORRECTED REPEAT OF THE ABOVE COMMENT -

Those kids Chris ADMITS were injured and killed and were compensated by the NVIP?...
THEY are the ones that should not have been vaccinated...
The ones that should have been partially protected by herd immunity...
The reason we need to create complete science-based screening criteria... so we find the kids at risk of being injured by vaccines BEFORE we vaccinate them.

We need to enforce screening, using current package inserts, until new ones are created.

MERCK clearly states in the pamphlet that parents/guardians/patients MUST be told of all the precautions/warnings/contraindications/adverse-events/adverse-reactions - EVERY TIME ANYONE IS VACCINATED.

Reviewing those 11 pages, and answering dozens of questions that would bring up, would take a large amount of time.
NO HEALTHCARE PROVIDER has that kind of time and thereby NO HEALTHCARE PROVIDER properly screens, using the 11 pages of the MMR package insert.
They should. It's the only way we have right now to identify kids susceptible to vaccine injury.

Ironically, the kids and adults that are injured or killed by vaccinations are the same people who should have been partially protected by herd immunity.
Those are the same ones who are injured or killed by wild virus strains.

About 10% of us should not receive live vaccinations.
The CDC/FDA/Merck all admit that 10% of us have chronic cell-mediated immune issues, which makes live pathogen vaccinations very risky.

As Always,
For the protection of children,
In the interests of truth and science,
Michael Polidori

But Chris again ignores the fact that there is NO ACTIVE SURVEILLANCE SYSTEM in the USA.

Your claim there is no all-caps ACTIVE SURVEILLANCE SYSTEM in teh USA is false, however: you're forgetting the Vaccine Safety Datalink, which monitors 9.2 million people annually in 8 geographically diverse US health care organizations. (PMID:21502252)

NO HEALTHCARE PROVIDER properly uses the 11 pages of the MMR package insert when they administer an MMR vaccine.

Which may be an argument that health care providers should more effectively inform their patients prior to adminstering a vaccine but is in no sense an argument that routine chiildhood vaccination is neither appropriately safe nor effective.

Agreed?

Is Polidori still cyber stalking me? I usually ignore his idiocy. He has been told multiple times that package inserts are not scientific citations, so he is obviously unable to learn with his welded shut skull.

Yvette:

The Spudd predicted this: “I believe vaccines cause autism and climate change is a hoax.”

From The Spudd link:

"Published on January 2, 2015"

From the Mike Adams nonsense:

"Friday, August 15, 2014"

Don't mistake observation for prediction.

The antivaccine movement resurrects the zombie that is the “autism epidemic” (2014 edition)

oracknows — Mon, 31 Mar 2014 01:30:09 +0000

The antivaccine movement resurrects the zombie that is the “autism epidemic” (2014 edition)

As I just mentioned a week ago, there used to be a time when I dreaded Autism Awareness Month, which begins tomorrow. The reason was simple. Several years ago to perhaps as recently as three years ago, I could always count on a flurry of stories about autism towards the end of March and the beginning of April about autism. That in and of itself isn't bad. Sometimes the stories were actually informative and useful. However, in variably there would be a flurry of truly aggravating stories in which the reporter, either through laziness, lack of ideas, or the desire to add some spice and controversy to his story, would cover the "vaccine angle." Invariably, the reporter would either fall for the "false balance" fallacy, in which advocates of antivaccine pseudoscience like Barbara Loe Fisher, Jenny McCarthy, J. B. Handley, Dr. Jay Gordon, and others would be interviewed in the same story as though they expressed a viewpoint that was equally valid as that of real scientists like Paul Offit, representatives of the CDC, and the like. Even if the view that there is no good evidence that vaccines are associated with an increased risk of autism were forcefully expressed, the impression left behind would be that there was actually a scientific debate when there is not. Sometimes, antivaccine-sympathetic reporters would simply write antivaccine stories.

So in general, April was a lousy time for anyone who could think critically about autism and/or vaccines, but a good time for blog fodder well suited to a bit of "Insolence." All good things come with a price, I guess.

I could also count on the antivaccine movement to go out of its way to try to implicate vaccines as a cause of the "autism" epidemic, taking advantage of the increased media interest that exists every year around this time. Examples abound, such as five years ago when Generation Rescue issued its misinformation-laden "Fourteen Studies" website, to be followed by a propaganda tour by Jenny McCarthy and her then-boyfriend Jim Carrey visiting various media outlets to promote the antivaccine message. Sometimes Fire Marshall Bill would produce antivaccine editorials so brain meltingly dumb that it's hard to believe someone with two neurons to rub together could have produced them.

Fortunately, over the last three or four years, the media have become noticeably—and appropriately—much more dismissive of antivaccine pseudoscience. This seems to have occurred in the wake of Andrew Wakefield's humiliation at being struck off (i.e., had his medical license revoked) in the U.K. and then having his infamous 1998 case series that started the fear mongering over a nonexistent link between the MMR vaccine and autism retracted by The Lancet based on evidence that he committed scientific fraud.

The antivaccine movement aside, there remains a temptation among scientists and government agencies to release the results of new studies having anything to do with autism either during the last week of March or the first week of April, all, of course, to take advantage of the publicity of Autism Awareness Month. So it was last week, when beginning on Thursday I sensed a disturbance in the antivaccine crankosphere force, with the antivaccine blog Age of Autism rerunning various posts by Mark "Not A Doctor, Not A Scientist" Blaxill and other AoA denizens from 2009. The reasons were obvious. The CDC was going to release the latest autism prevalence data on Thursday. The antivaccine crankosphere has been busily spinning those numbers since Thursday, which means it's time to address those numbers here. I had planned on doing it Friday, but then Dr. Bob Sears had to go and lay a major turd of whininess upon Facebook, necessitating a heapin' helpin' of Insolence. Never let it be said, though, that I don't come back to important topics, even after being distracted like Dug the Dog.

Autism prevalence in the United States, 2014

The CDC's latest autism prevalence numbers was published in the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (MMWR) in a report entitled Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010. This is the sixth survey reported from data gathered from the Autism and Developmental Disabilities Monitoring (ADDM) Network. The ADDM is an active surveillance system in the US designed to provide estimates of the prevalence of autism and autism spectrum disorders (ASDs), as well as other characteristics, of children aged eight years whose parents live in eleven ADDM sites.

The goals of the ADDM are:

To obtain as complete a count as possible of the number of children with ASD in multiple surveillance areas.
To report comparable population-based ASD prevalence estimates from different sites every 2 years and to evaluate how these estimates are changing over time. To study whether autism is more common among some groups of children than among others.
To provide descriptive data on the population of children with ASD.

The concept is simple; unfortunately the implementation is not. The report describes how surveillance is conducted at ADDM sites:

ADDM surveillance is conducted in two phases. The first phase consists of screening and abstracting comprehensive evaluations performed by professional providers in the community. Multiple data sources for these evaluations include general pediatric health clinics and specialized programs for children with developmental disabilities. In addition, most ADDM Network sites also review and abstract records of children receiving special education services in public schools. The second phase involves review of all abstracted evaluations by trained clinicians to determine ASD surveillance case status. A child meets the surveillance case definition for ASD if a comprehensive evaluation of that child completed by a qualified professional describes behaviors consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria for any of the following conditions: autistic disorder, pervasive developmental disorder–not otherwise specified (including atypical autism), or Asperger disorder. This report provides updated prevalence estimates for ASD from the 2010 surveillance year. In addition to prevalence estimates, characteristics of the population of children with ASD are described.

Why did the investigators choose age 8 as the benchmark, the age at which they would examine prevalence? As is explained later in the report, it's because the baseline ASD prevalence study conducted by the CDC's Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP) in 2003 demonstrated that this is the age of peak prevalence. How can that be? The authors of that study speculated that it was possible at the time that the lower rates in 9- and 10-year olds might have reflected the use of narrower diagnostic criteria for autism before the DSM-IV and the increased availability of educational and health services for children with autism in the 1990s. More specifically, prevalence rates in that study between the ages of 5 and 8 didn't significantly vary from each other; so the investigators chose the oldest age in that range, in order to capture the highest prevalence rate. To that, I also wonder whether, as I pointed out multiple times before, the observation that some children lose their ASD diagnosis as they grow and develop had anything to do with it. Be that as it may, this is the system, and that's how the estimates come about.

Last time the CDC reported these numbers, which was in 2012, they found that autism prevalence was 1 in 88. The antivaccine movement went wild. This time, in 2014, the CDC estimates that 14.7 per 1,000 eight year olds (1 in 68) have a diagnosis of an ASD. As Autism-News-Beat points out, this new estimate is 30% higher than the estimate from 2012. (It should be noted that this prevalence number comes from 2010 data.) It's hard not to mention at this point that it's very hard to blame this increase on vaccines given the stability of vaccination rates overall in the US. Let's just put it this way: The increase in prevalence numbers is not a compelling piece of evidence that vaccines are the cause of an "autism epidemic," no matter how much antivaccinationists try to convince you otherwise.

So what could be going on?

Making sense of the numbers becomes easier if you start looking at more than just the overall number of 1 in 68, or even the estimate that 1 in 42 boys and one in 189 girls living in ADDM Network communities were identified as having ASD in 2010. After all, we've known for a long time that boys are considerably more likely to be diagnosed with an ASD than are girls, and these numbers confirm that. So let's look at more of the details:

Non-Hispanic white children were approximately 30% more likely to be identified with ASD than non-Hispanic black children and were almost 50% more likely to be identified with ASD than Hispanic children. Among the seven sites with sufficient data on intellectual ability, 31% of children with ASD were classified as having IQ scores in the range of intellectual disability (IQ ≤70), 23% in the borderline range (IQ = 71–85), and 46% in the average or above average range of intellectual ability (IQ >85). The proportion of children classified in the range of intellectual disability differed by race/ethnicity. Approximately 48% of non-Hispanic black children with ASD were classified in the range of intellectual disability compared with 38% of Hispanic children and 25% of non-Hispanic white children. The median age of earliest known ASD diagnosis was 53 months and did not differ significantly by sex or race/ethnicity.

Next, if you look at Table 2 in the CDC report, you'll find a huge variation in the prevalence reported, ranging from 5.7 per 1,000 in Alabama (1 in 175) to 21.9 per 1,000 in New Jersey (1 in 46). Here are the data summarized in a graph:

I noticed something about this graph immediately. Look at the colors of the data points. either dark or light. The dark-colored points represent sites that relied primarily on data from healthcare sources, while the light-colored points represent sources that had access to educational records throughout all or most of their surveillance area? Why is that important? Simple: Notice how all the sites that only relied on data from healthcare sources (Alabama, Wisconsin, Colorado, and Missouri) report prevalence rates below the prevalence rate for all the sites combined. Only one (Missouri) had error bars that encompassed the overall prevalence rate for the entire ADDM Network. Now notice that the sites that had access to educational records (Georgia, Arkansas, Arizona, Maryland, North Carolina, Utah, and New Jersey) all reported prevalence rates that were either at or above the overall prevalence for the network. To me this is a red flag that at least some of the variability in the autism prevalence numbers has to do with the intensity of surveillance and the intensity of screening in various states. Frequently, this is mischaracterized dismissively by antivaccinationists as a huge straw man they like to call "increased awareness," but in reality it's a lot more than that, as I'll discuss later. In the meantime, let's move on.

Another red flag indicating that much of what is driving the changes in autism prevalence numbers is likely to be something other than biology is the wide disparity between autism prevalence as diagnosed in non-Hispanic Caucasians and in African-Americans as apposed to the much lower prevalence as diagnosed in Hispanics. Indeed, non-Hispanic white children were approximately 30% more likely to be identified with ASD than non-Hispanic black children and were almost 50% more likely to be identified with ASD than Hispanic children. This sort of disparity is far more likely to be due to differences in screening and diagnoses than to biology. Now couple this with observations in the report regarding ASD diagnoses as related to diagnoses of intellectual disability. The authors noted that in previous reports, from 2002 to 2008, the greatest increases in ASD prevalence were noted in Hispanic children, non-Hispanic black children, and children without co-occurring intellectual disability. The first two suggest that Hispanic and non-Hispanic black children are likely to be "catching up" with Caucasian children in terms of access to diagnostic services, while the increases in children without intellectual disability is interpreted thusly:

The much higher prevalence of ASD without co-occurring intellectual disability among white children appears to explain much of the variation in ASD prevalence estimates between different racial/ethnic groups. Among white children, the prevalence of ASD without intellectual disability was nearly double the prevalence among either black children or Hispanic children (OR = 1.8, p<0.01 for both comparisons). Conversely, the prevalence of ASD with co-occurring intellectual disability was similar among white children and Hispanic children but significantly higher among black children than among both of these groups. This suggests that in these seven sites, the significant white-to-black and white-to-Hispanic prevalence ratios were primarily driven by higher prevalence of ASD without intellectual disability among white children, and the significant black-to-Hispanic prevalence ratio was primarily driven by higher prevalence of ASD with co-occurring intellectual disability among black children.

In other words, more children without intellectual disability are being diagnosed with ASD. In the past, these children likely would not have been diagnosed with ASD—or with anything at all. Now they are being diagnosed. As Emily Willingham put it:

From the data, it looks like a lot of sociocultural factors enter into the values. Given the huge variability from site to site and the ethnic differences, recognition and service availability are probably factors. Dr. Boyle referred repeatedly to the evolution of our understanding of autism and used the large percentage of children included in these values who have average to above-average intelligence as an example of that. Unlike numbers from a decade ago, these values include children who previously might not have been recognized as autistic.

And Rachel Dornhelm:

For one thing, the prevalence seems to vary in different communities and among children of different races. The CDC found white children are far more likely to be identified with autism, even though scientists don’t believe the rates are truly different between whites, Hispanics or blacks.

That means that the discrepancy lies in the diagnosis and services available in different communities.

This is very likely true. As was pointed out in the analysis posted at the Thinking Person's Guide to Autism, Richard Grinker studied ASD prevalence rates in South Korea and estimated that 1 in 38 children had ASDs there. In a news report about the study, Grinker pointed out that the reason the rates he found were so high was likely because in-person evaluations were performed for any child suspected of having an ASD and two-thirds of the cases of ASD identified in the study were "in mainstream schools, unrecognized, untreated." If the estimates in the South Korean study are more accurate, prevalence rates for ASDs, which are clearly still underdiagnosed, can be expected to continue to increase for some time, until they finally level off at somewhere approximating the "true" prevalence rate. The study's message, according to autism researcher Bennett Leventhal, is that "if you really go look carefully among all children everywhere, you find that things are far more common than you previously expected." This is true not just of ASDs, but of pretty much every medical condition that has ever been screened for. If you don't look for it, you won't find it. If you do, you will, often at a much higher rate than you would ever have guessed.

I like to go back to an example I use time and time again. I use it time and time again because it's about as good an example as I can find. Antivaccinationists like to use the argument that increased diagnosis and screening alone can't explain such a large increase in a "genetic" disease. Thus, to them, autism can't possibly be due to a genetic condition. Rather, it must be due to "environment"—cough, cough, vaccines, cough cough. However, as I believe to be worth repeating, they are quite wrong in the premise behind their argument. I'm referring to the example of ductal carcinoma in situ (DCIS), a premalignant precursor of breast cancer, whose incidence has risen at least 16-fold since the 1970s, almost all because of the introduction of mammographic screening.

Another example is hypertension. Before the 1920s doctors didn't routinely measure systolic/diastolic blood pressure ratios; so there were few, if any, cases of hypertension because doctors weren't looking for it and didn't know how to easily measure it. Even over the last decade, prevalence of hypertension has increased (for instance, in Canada). Perhaps a better marker for hypertension diagnoses is the percentage of adults who have been prescribed antihypertensive medications, which has skyrocketed since 1950. Of course, over that time, the definition of what constituted "hypertension" has changed markedly, to lower and lower diastolic and systolic pressures. Amusingly, various denialists lambaste such broadening of diagnostic criteria to claim that hypertension is an "engineered" epidemic, while denialists of another stripe (antivaccinationists) take advantage of the broadening of the diagnostic criteria for autism/ASDs in the 1990s to link the entirely predictable increase in ASD prevalence to their favorite bogeyman, vaccines.

Once again, definitions of medical conditions matter. They can have a huge influence on prevalence rates observed. Moreover, if you don't look for something, you won't find it, and if you do look for something, you will find a lot more of it than you expected. It is quite possible that that is what's happening with autism, but such a narrative doesn't fit into the vaccine-autism idea. The antivaccine movement needs an increasing apparent autism prevalence.

The antivaccine movement reacts

Predictably, based on the intense "preparation" by blogs like AoA, I wasn't surprised to see that the antivaccine movement was ready to pull out the same sorts of histrionic reactions to this CDC report as it did to the CDC report two years ago. Predictably, SafeMinds denied that, well, I'll let SafeMinds say it:

Katie Weisman of SafeMinds stated, “Broader criteria and awareness cannot account for this magnitude of increase. The federal government continues to spend millions of dollars ineffectively and ‘potentially duplicatively’ according to a recent GAO report. We need to identify environmental triggers for autism, prevent them, and develop effective treatments.”

Never forget that in anti-vaccine-speak, "environmental triggers" is a code word for vaccines. Weisman is also attacking a straw man, which is the straw man I alluded to earlier. The issue goes far beyond "broader criteria and awareness." It involves both broader criteria and intensity of screening for developmental disorders, including ASDs. "Awareness" is too vague a term. Specifically, what likely accounts for the increased prevalence of ASDs includes a combination of broader diagnostic criteria, diagnostic substitution (i.e., conditions that formerly weren't diagnosed as ASDs now fall under the the diagnosis of an ASD), and increased screening and concomitant availability of services.

If you don't believe me when I say that "environmental triggers" is a code term for "vaccines," just take a look at SafeMinds' followup, Top Ten Things to Know about the CDC Report on Autism Prevalence. It's a mix of self-reported weaknesses of the CDC report, such as the point that the ADDM sites were not selected to be representative of the US population and that ADDM sites change over time, making direct comparisons over time problematic. Of course, one can't help but note that SafeMinds has no trouble assuming that the comparison between 2012 and 2014 (or 2010 and 2014) is perfectly valid, that autism prevalence really has increased 30% over two years, and that the difference couldn't possibly be influenced by differences in ADDM sites. In any case, here come the antivaccine points:

Inaccurate Information Regarding Thimerosal Exposure: Thimerosal was not completely removed from vaccines in 2002. The concerns regarding the use of mercury (thimerosal) in infant vaccines surfaced in July of 1999 and it took several years for manufactures to alter their production process to remove or reduce thimerosal content. Vaccines that were being made during these transition years that contained thimerosal continued to be released with 2 year expiration dates, which means children in this report were still receiving thimerosal containing vaccines. Infants in high risk categories were also recommended to receive flu vaccines with mercury starting at 6 months of age and annually thereafter. In addition, the CDC Advisory Committee for Immunization Practices recommends that all pregnant women receive flu vaccines during pregnancy of which the vast majority contained mercury. The fetus accumulates mercury at higher levels than the mother and exposure to mercury during pregnancy is documented to cause neurological harm. Therefore it is impossible to report that there is no association between mercury in vaccines and autism prevalence.

The problem, of course, is that this study never said anything at all about thimerosal and autism. That's not what it was designed to do. We have plenty of other studies that did look at that question to tell us that thimerosal in vaccines is not associated with autism. Nice straw man, though.

Of course, if it's not thimerosal in vaccines, it must be the vaccines themselves, right? At least, so sayeth SafeMinds:

Given that the ADDM researchers had access to medical records, a valuable opportunity to evaluate immunizations, adverse reactions, and the development of autism has been ignored. We have had two decades of lost opportunities, which shows no sign of changing. The paper states,” Other topics of interest focus on socioeconomic indicators as well as perinatal risk factors such as timing of conception, weight gain during pregnancy, parental age, and interpregnancy interval.” The CDC failed to mention the many other factors which studies are showing increases autism risk, including air pollution, pesticides, proximity to toxic release sites, and medications such as acetaminophen and anti-depressants. While the CDC/HHS continue to tell the public that there is no link between vaccine injury (and exposure to mercury) and the onset of autism, a study conducted by EBCALA[3] and published in the peer-reviewed Pace Law Review confirmed that the government has compensated at least 83 families in the Vaccine Injury Compensation Program whose child suffered a vaccine induced brain injury resulting in the onset of autism.

In other words, SafeMinds is criticizing the CDC for not examining the hypothesis that they want the CDC to examine, a hypothesis that has been thoroughly discredited, citing a highly dubious "study" by a lawyer about legal claims whose conclusions were easily refuted and which was unethically carried out without institutional review board approval.

Meanwhile, AoA ramped up the nonsense with a series of truly brain dead Facebook memes. Arguably the dumbest of them all is one in which superimposed over a picture of a highly disgusted looking older doctor is this one:

The stupid, it burns with a thermonuclear flare. Or maybe like one of those supernovas on Cosmos. Either way, it burns.

To this, I reply, using my own specialty as an example: How could doctors in the 1970s have missed so many cases of DCIS? How could doctors in the 1950s have thought that the best treatment for breast cancer was a radical mastectomy? How could doctors in the 1960s not have realized how useful chemotherapy was for certain cancers? Medical science advances. The way I treat breast cancer now is actually significantly different than what I did 15 years ago, and how I treat it as my career is near to winding up in 15 years will likely be significantly different from how I do it now. The same is increasingly true of how it is diagnosed and characterized, given the rapid development of molecular medicine techniques being used to characterize tumors. Compared to 15 years ago when they did, today most women don't have all the lymph nodes under their arms removed. Lots of them have chemotherapy first instead of after surgery. We do fewer mastectomies. There are new, targeted therapies. We can predict better who does and doesn't need chemotherapy. For instance, as recently as ten years ago, a lot of women with node-negative estrogen receptor-positive cancers got chemotherapy based solely on the size of their tumors. Now, thanks to a 21-gene assay, we can much more accurately separate the women with such tumors not likely to benefit from chemotherapy from those who are and treat each accordingly.

My god, man! Those oncologists ten years ago must have been a bunch of idiots to have subjected so many women so unlikely to benefit to such toxic chemotherapy!

See what I'm getting at?

It has nothing to do with pediatricians from 20 years ago being "a bunch of idiots." It's just that our understanding of autism and ASDs has improved and evolved, as is the case with many medical conditions. Lots of what I learned in medical school 26 years ago is now obsolete. Lots of what I learned in residency 18 years ago is obsolete. Lots of what I learned in fellowship 15 years ago is now obsolete. Medical science advances and evolves, and physicians have to be continually learning to evolve with it.

Contrary to the hysteria over the numbers coming from the antivaccine crowd and, I should add, the rather clueless reporting that I've seen that stops at mentioning the 30% increase in ASD prevalence over two years and doesn't delve into the nuances, these numbers do not represent a crisis. They do not represent evidence in support of a link between vaccines in autism. They don't even really suggest a link between environment and autism. That's not what this study was intended to do. What they do mean is that medicine is getting better at defining what autism is and diagnosing it and that there is still a ways to go, particularly in underserved communities and among underserved minorities. That's why I agree with Shannon Des Roches Rosa. It's time to keep calm and think critically, something antivaccinationists are unable to do as they make ridiculous charges and demand that "autism epidemic deniers" be fired, as though any of them could have done anything:

Against such ignorance, the gods themselves strive in vain, as they say.

Now I just wonder if in 2016, I'll have to do another post entitled Autism prevalence: Now estimated to be one in [insert next CDC report's number here], and the antivaccine movement goes wild.

oracknows Sun, 03/30/2014 - 21:30