Rodier on Bernard et al. and environmental causes of autism

25 May

The idea that mercury poisoning causes autism was first put forward in a paper by Sally Bernard and others entitled Autism: a novel form of mercury poisoning.

This was published in a journal called Medical Hypotheses. As you might tell from the title, Medical Hypotheses presents hypotheses-not proven ideas. The journal has no peer review process. Instead, they basically print “…will publish radical ideas, so long as they are coherent and clearly expressed”. If you write well and pay to publish, it will likely get in. Keep that in mind with any paper from “Medical Hypotheses”.

In this paper, the put forth the hypothesis that mercury causes autism. To support this idea, they compare the symptoms of autism and mercury intoxication.

In the Autism Omnibus Proceedings, Dr. Patricia Rodier spoke on specifically the Bernard paper. Dr. Rodier has a unique position in the United States, and likely the world: she is an expert on both mercury poisoning and autism. Below is a rough transcription based on the audio recording of that testimony.

She starts out by stating that she has many criticism of the Bernard paper. She also mentioned a response to that paper had already been published by Nelson and Bauman. That paper is worth reading, and it’s free on the Pediatrics website.

Dr. Rodier then discusses the comparisons made between mercury poisoning and autism, based on her experience with both. If you want the short version: there is no comparison.

First, many of the symptoms or characteristics that are discussed in the Bernard paper are not specific to either autism or mercury poisoning. These include, nausea, vomiting, irritability and temper tantrums. Basically, these are things that happen for all of us at times.

Other symptoms are common across many disabilities: mental retardation, depression and abnormal gait. Again, these are not specific to either autism or mercury poisoning.

Almost all the symptoms used for mercury poisoning are taken from “Mad Hatter’s” disease: the result of a very high exposure to inorganic mercury vapor. Only a few symptoms listed were from ethyl mercury exposure. Since the exposure from vaccines is due to ethyl mercury (thimerosal breaks down to ethyl mercury) that would be the valid comparison.

Dr. Rodier, in her testimony, then discussed how the Bernard paper doesn’t actually do what it purports to do. The comparison isn’t valid since the actual symptoms of autism and mercury poisoning do not match up in a comparison.

She then goes on to discuss many of the comparisons made by Bernard, et al., and show that the comparisons are not valid.

1. Under psychiatric disturbances, the paper discusses depression, flat affect, depressive traits, mood swings, impaired face recognition

1a. Depression is a symptom of acrodynia. This is an exposure to inorganic mercury, not ethyl mercury. While some, possibly many, autistics suffer from depression, it is not a characteristic of autism.

1b. Mood swings are a characteristic of Mad Hatters disease. Again, this is not an autism symptom or characteristic.

1c. Flat affect is a diagnostic trait for autism but not mercury poisoning . Also, this is the opposite of mood swings, a characteristic of mercury poisoning noted in ii, above.

1d. Impaired face recognition occurs in autism, but hasn’t even been tested in any kind of mercury poisoning.

So, in this first group of four: there is no overlap for the above 4 ‘symptoms’. If it happens in mercury poisoning, it doesn’t happen in autism and vice versa.

2. Under speech and language deficits, the paper describes:
2a. Verbalizing and word retrieval. This is a problem is observed in Mad Hatters disease but not autism. But, this is compared to ecololia and word use and pragmatic errors. These never happen in mercury poisoning. It is an autism trait.
3. Again under psychiatric disturbances, the paper lists “Lacks eye contact”, and “impaired vision” under mercury toxicity, compared to “problems with joint attention” as the ‘similar’ autism trait
3a. “lacks eye contact” is a symptom of autism, but not of mercury poisoning. Likewise, impaired visual fixation is a symptom of methyl mercury poisoning-the brain control of the eye muscles are impaired which doesn’t allow you to fixate on something-but is not a symptom of autism. Joint attention has nothing to do with vision. It is not a feature of any kind of mercury poisoning. It is a social impairment, not a vision issue.

4) Under CNS structure, they compare “progressive microcephaly” for mercury poisoning with “progressive microcephaly and macrocephaly” for autism.
4a. progressive microcephally is given as a symptom of mercury poisoning. The idea of ‘progressive’ is incorrect here. Also, microcephaly is a sign of methyl mercury toxicity prenatally, not postnatal exposure. Children are born with it.
4b. Progressive macrocephally is a sign of autism. However, it has never been reported in mercury poisoning.

5) Under Neurochemistry, they list “Causes demyelinating neuropathy” under mercury poisoning.

5a. Demyelinating nerorpathy results from a chronic exposure to inorganic mercury. It is not reported in autism.

5b) They list “demyelination in brain” as a characteristic of autism, but no one has ever listed this in autism and the reference doesn’t address it.

Dr. Rodier posed the question: since the authors are trying to show a connection between thimerosal containing vaccines and autism, why don’t they compare autism and ethyl mercury poisoning? Keep in mind, there are various forms of mercury (ethyl and methyl being two types of organic mercury). In their comparison, Bernard et al. have picked from ethyl, methyl and inorganic mercury symptoms. Dr. Rodier suggest the reason they didn’t stick to purely ethyl mercury symptoms because “It doesn’t make a good story”.

1) For example, in a paper by Zhang , 41 people were exposed to ethyl mercury from tainted rice. They knew dose from how much rice they ingested. The authors documented the symptoms. Doses varied from mild to death.

1a) The three most comment symptoms documented by Zhang were:

1a.i) Muscle Weakness

1a.ii) Loss of appetite

1a.iii) Dizziness

Dr. Rodier notes that “those don’t sound much like autism”.

1b) The next 10 symptoms listed by Zhang are

1b.i) nausea

1b.ii) abdominal pain and diarrhea

1b.iii) fever

1b.iv) numbness of the extreminties

1b.v) peresthesia and ataxia

1b.vi) vomiting

1b.vii) thirst

1b.viii) unsteady gait

1b.ix) ringing in the ears

1b.x) headache

Dr. Rodier: again, none of these sound like any of the symptoms of autism that are used in diagnosis.

Dr. Rodier stresses at this point: there is really no correspondence between the symptoms of ethyl mercury poisoning and autism

The government’s attorney asked: the current hypothesis is that low levels of inorganic mercury cause oxidative stress or an inflammatory process which cause autism. Does that make sense? Dr. Rodier answered quite directly, “no”. In the opinion of that autism and mercury poisoning expert, the logic does not work.

She went on to point out that scientists try to disprove hypotheses, not just find support for their given hypothesis. (author’s note here: this is quite true. You need to test a hypothesis and make sure it doesn’t fail, not just collect the evidence that implies it is correct).

She points out that there is one piece of evidence that completely refutes the Bernard et al. hypothesis. There have been autopsy studies performed on people with acute ethyl mercury poisoning. While they indeed had high levels of organic mercury after the ethyl mercury was gone, these people recovered from the mercury toxicity symptoms after the ethyl mercury was gone and the had inorganic mercury was left.

This was the end of the discussion on the Bernard paper and mercury. It is pretty clear when an expert in both fields-mercury toxicity and autism-speaks on the comparison. Compare this to the authors who wrote the paper. Of the three, only one had a background in medicine. That is Lyndelle Redwood, a nurse. None of them are researchers, none experts in either autism or mercury poisoning.

From the above it is pretty clear: the hypothesis put forth by Bernard et al. was a poorly formed and is definitely incorrect.

In the Omnibus Proceeding, the discussion then moved away from mercury directly and into the question of environmental causes of autism. The question was posed: when does autism begin? The answer was that it almost always is determined pre birth.

This led to a discussion of known environmental factors that lead to autism. Dr. Rodier listed them and listed when the exposure has to occur to result in autism.

The known environmental causes are: Rubella, thalidomide, valproic acid, ethanol, misoprostol. All are involved during gestation. The timing of exposure to increase autism risk is:

1) Rubella (German measles): before the 9th week

2) Thalidamide: week 3 and 4

3) Valproic acid: week 3 and 4

4) Ethanol: week 3-5

5) Misoprostol: week 6

She noted that tuberous sclerosis is an example of autistic symptoms developing after birth as the tumors progress.

Terbutaline has been brought up a number of times by the plaintiffs (petitioners) in the Omnibus as an example of an environmental cause of autism. The question was raised as to why Dr. Rodier didn’t discuss this. She described that it is not an environmental cause study, but a genetic study.

Twin pairs were studied. Some were exposed to terbutaline and some were not. They compared the concordance: the rate of one twin having autism if the other did not. No significant increase was found in general in this study. So, the authors looked at a smaller subset, and still found no increase. Then, they looked only at male twins, where no autistic siblings were present in the family. In that case only, they found a significant effect.

Dr. Rodier goes on to discuss that even interpreting this part is difficult because we don’t know if the increased risk was due to the terbutaline, or the fact that the children were at risk of being born early (terbutaline is given to prevent premature delivery).

The judge (Special Master in this court) asked if this was because without the terbutaline the children would not have survived to be born. Dr. Rodier agreed and pointed out that the interpretation the plaintiffs are supplying is further confused because low birth weight is also an increased risk factor. This is from a very recent paper in Pediatrics. Since the turbutaline twins were low birth weight, that could be a factor in the increased autism risk found.

The plaintiffs lawyers have been using a study on rats as an example of a post-natal environmental exposure. The government lawyer asked if this was a valid interpretation. Could this be used to suggest a post-natal exposure could cause autism in humans? Dr. Rodier answered that this is not valid. Newborn rats are more developmentally immature than newborn humans. Newborn rats have closed eyes, no hair, and in other ways are very much more developmentally like prenatal humans. The study would compare better to late-gestation humans.

There was much more in her testimony, but that gets even farther away from the Bernard paper, so we can end this discussion here and let others pick up the rest of her testimony.

12 Responses to “Rodier on Bernard et al. and environmental causes of autism”

  1. kristina May 26, 2008 at 00:47 #

    The Bernard et al. paper has all the trappings, and the shortcomings, of an undergraduate (freshman) compare and contrast paper. The basic problem is that, as you note here, the terms of comparison (autism and Mad Hatters disease) are not the two things that should be compared. I have to look at the paper again: As I recall, a portion of it contains a chart listing “symptoms of autism” and “symptoms of mercury” in paired columns. This is a deceptive presentation, as it is set up to highlight simple similarities (which, as Dr. Rodier noted, as not accurate in many cases) and to iron out any differences.

    The whole conceptual point of Bernard et al. is to make(force) these comparisons, rather than to accurately consider the conditions discussed. It’s the study that launched a thousand incorrect notions about autism.

  2. Sullivan May 26, 2008 at 01:16 #

    thanks Kristina–

    I think that the Bernard paper is definitely an attempt to force a comparison that didn’t (and still doesn’t) exist.

    I’ll point out that the above presentation is pretty dry. I thought that keeping the commentary level low was important in relating what Dr. Rodier had to say in response to this historically important paper. Historically important and scientifically incorrect paper.

    People traveled far and spent a lot of money to hear about autism ‘science’ at a convention this week. A lot of it is debunked in the testimony at the Omnibus.

  3. Ms. Clark May 26, 2008 at 01:20 #

    Thanks, Sullivan. One thing that kind of cracked me up was the term, “progressive microcephaly.” I guess the authors of this paper were suggesting that if your kid gets a few micrograms of ethyl mercury from thimerosal that his or her head will begin to shrink. Though I suppose it could mean that the baby’s head would just cease to grow while his or her body continued to grow. Doesn’t sound very typical of autism.

    I think it’s odd that the “Bernard” paper was written by Albert Enayati. In the book, “Evidence of Harm,” it says that he offered to paper to anyone who would pay to get it in to Medical Hyp, and whoever paid for it would get to put his or her name as lead author….

    hmmmm.

  4. Ms. Clark May 26, 2008 at 01:28 #

    Just a note, Dr. Rodier gave her credentials at the very end of day 9 (May 22), but the main part of her testimony is day 10, May 23. There won’t be a “Day 11″ since that would be Monday, a holiday. They’ll start with recordings that will be labeled, “Day 12″ on Tuesday, apparently.

  5. Sullivan May 26, 2008 at 01:40 #

    I want to add another observation: it is often implied by those pushing the autism/mercury hypothesis that mainstream researchers have ‘dismissed’ the idea. This suggests that a thorough analysis has not been considered.

    When you have a single person like Dr. Rodier who has experience in both autism and mercury poisoning who can bring that expertise to the question, those arguments fail.

    The Omnibus has demonstrated very clearly that it is the mercury crowd that has not only the shallow background expertise, but is also doing the minimal effort needed to gather data to support the hypothesis.

    Dr. Rodier echoed the sentiments of Dr. Johnson who stated that the first step in testing a new hypothesis is to try to disprove it. If there is a simple test that can disprove a hypothesis, it can save many years of fruitless effort. Dr. Rodier suggested that the simple test that discredits the thimerosal/autism theory is exactly on of Dr. Aposhian’s (toxicologist for the petitioner) favorite stories: the story of the family that ate the tainted pork in New Mexico. The symptoms of ethyl mercury poisoning went away as the ethyl mercury was removed from the system. People who regress with autism after thimerosal containing vaccines do not improve as the ethyl mercury is converted to inorganic mercury. Therefore, those with regressive autism after TCV’s are not suffering from ethyl-mercury poisoning.

    Dr. Mumper exemplified this trait as well. She relied heavily on the Hornig study to form her view of vaccine injury autism. However, even in preparing for the Omnibus, she hadn’t read the Berman paper which demonstrated that Hornig’s results can not be replicated (even with 10x the mercury exposure).

    The arm-chair epidemiologists David Kirby and the Geiers are also very guilty of this. They used the CDDS data to support the idea of an epidemic, but didn’t look deep enough into the data to test if the hypothesis was valid. They didn’t check how the data compared by region or by ethnicity (to name only a couple of ‘sanity’ checks).

    It is beyond sad that parents and would be autism-medical-practitioners go to conventions and listen to supposed experts without rebuttal. In a real scientific conference, these ‘experts’ would be subject to tough questions by the scientific ‘peers’. Instead, 50 year old data on duck brains is passed off as profound and relevant to autism.

    The best and the brightest of the scientists promoting vaccine-injury-autism are being tested and they are failing.

  6. culvercitycynic May 26, 2008 at 01:41 #

    Thanks very much for this Sullivan.

  7. Sullivan May 26, 2008 at 02:06 #

    I think it’s odd that the “Bernard” paper was written by Albert Enayati. In the book, “Evidence of Harm,” it says that he offered to paper to anyone who would pay to get it in to Medical Hyp, and whoever paid for it would get to put his or her name as lead author….

    In preparing this, I called up the paper again. As I read it, there were some strange abbreviations and phrasings.

    As an example, “HgP” for mercury poisoning google hgp mercury poisoning and you get almost 12,000 hits. Add -autism and 11,000 of the hits disappear. Almost all of the hits are based on this paper.

    It struck me that someone was trying to shave the paper down. So, I scrolled to the end of the paper and, lo and behold, it ends at exactly the page break. If correct (and I would welcome a hypothesis breaking test) this means that the authors likely got the proofs and saw that they had only a little bit of text on what would have been the 11th published page. By shaving it down, they saved 10% on the page charges.

    Just an untestable hypothesis. But, it was an honest observation on my part as I read the paper.

  8. Phil Schwarz May 26, 2008 at 05:03 #

    The Bernard (Enayati?) paper is destined to go down in the history of autism in the company of “The Empty Fortress”: as a wrong turn that sets true progress and betterment of the lives of autistic people back untold numbers of years.

  9. isles May 26, 2008 at 05:37 #

    It sounds like if the authors of the Bernard paper were comparing two animals, they would say, “Two eyes? Present in both! Hair? Present in both! Four legs? Present in both! These are obviously the same animal!” When they were actually looking at a gerbil and a yak.

    It also sounds like Dr. Rodier did a magnificent job debunking this POS “study.”

  10. Sullivan May 26, 2008 at 05:43 #

    Yeah,

    “It sounds like if the authors of the Bernard paper were comparing two animals, they would say, “Two eyes? Present in both! Hair? Present in both! Four legs? Present in both! These are obviously the same animal!” When they were actually looking at a gerbil and a yak.”

    except one was a gerbil an the other was a fish. Some of the comparisons were just that bad.

    A real comparison shows that they are not the same.

    It was pretty clear that Dr. Rodier has been eager to debunk this since she first read it.

Trackbacks/Pingbacks

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