Once more for the record, I like David. I tried very hard to get to see him in London last time he was over and we’d arranged to meet up for a drink but due to my family situation it wasn’t to be. However, I cannot let that stop me from recalling that we have very differing views on a wide range of things to do with autism and vaccines.
I have noticed of late a tendency for David’s HuffPo blog posts to be more than usually full of ‘if’ ‘maybe’ ‘might’ etc. However his skill as a writer buries these ambiguities and makes them appear certainties. I’m not even sure its a concious thing for David. His need to write well sometimes (I think) obscures a clinical need for precision in such delicate areas as he and I write in.
With that in mind, I recalled a post of his from November 2008 entitled ‘Tom Daschle: Friend to Many Autism Families’ in which he describes Mr Daschle thusly:
By nominating Tom Daschle to head up the Department, President Elect Obama has selected a man who has demonstrated an unflinching willingness to question vaccine safety, and to fight for the rights of those people who believe they have been, or may be, seriously injured by certain vaccinations.
I think David might’ve been trying to insinuate that Tom Daschle’s nomination was good for the autism/antivaccine community. Certainly however, as with the autism/antivaccine’s belief that RFK Jr would be appointed by Obama, this nomination might not be quite what that community is expecting. As blogged by Orac today, Daschle’s true feelings on vaccinations were spelt out by the man himself:
Immunization is probably as — as sound an investment as we can make in good health. I can’t imagine that we could do any better than ensure that every — every child is immunized, and that we understand the importance of — of broad-based immunization and the tremendous good health that can come from it.
Following that, David made a fairly innocuous presentation from a US Army scientist look much more sinister than it actually was. He claimed that the army listed autism as a possible ‘health effect’ of mercury/thiomersal. It turned out that that was not actually the case.
Dr. Centeno’s presentation, entititled ‘Mercury Poisoning: A Clinical and Toxicological Perspective,’ did mention Thimerosal. However, its inclusion was specifically intended to point out that although there has been some speculation about a potential association between Thimerosal and Autism, currently there is no data or science to support such a claim. Neither the AFIP nor Dr. Centeno have been involved in or conducted research on Autism.
After that was the recent debacle when David mixed up Change.org and Change.gov – the latter being a website of Obama. The former a privately owned enterprise for at least the last 2 years. David thought (and committed to a blog post) that Obama had hired pro-neurodiversity bloggers and he imagined a conversation Obama might have with an autism parent:
It is hard to imagine the President one day saying…“I do not think we should devote resources to finding out what happened to your [autistic child]. I do not believe there is anything we can do to help him, and it is not desirable to even try.
This post made me sad and angry. I thought better of David than that. To say that any of us who do not believe vaccines cause autism do not think it is desirable to help our autistic children is massively insulting. I hope someday David can maybe spend a bit of time with parents who don’t think vaccines caused their child’s autism and see for himself how we help our kids. And maybe an apology might be forthcoming also.
David’s latest faux pas is regarding the latest MIND institute study. In a post entitled ‘UC Davis Study: Autism is Environmental (Can We Move On Now?)’ David says:
Autism is predominantly an environmentally acquired disease, the study seems to conclude. Its meteoric rise, at least in California, cannot possibly be attributed to that shopworn mantra we still hear everyday, incredibly, from far too many public health officials: It’s due to better diagnosing and counting.
The autism epidemic is real, and it is not caused by genes alone: You cannot have a genetic epidemic. It really is time that we, as a society, accept that cold, hard truth.
Here’s the full conclusion:
Autism incidence in California shows no sign yet of plateauing. Younger ages at diagnosis, differential migration, changes
in diagnostic criteria, and inclusion of milder cases do not fully explain the observed increases. Other artifacts have yet to be quantified, and as a result, the extent to which the continued rise represents a true increase in the occurrence of autism remains unclear.
Lets look at that last again:
…the extent to which the continued rise represents a true increase in the occurrence of autism remains unclear.
And yet David seems to to think its crystal clear. The paper itself also contains some direct and fairly easy-to-check errors. For example:
The inclusion of milder cases has been suggested as an explanation for the increase in autism. Neither Asperger’s
syndrome nor “pervasive developmental disorders not otherwise specified” qualify under the category of autism in the DDS system.
Here is what DDS passed on to me in Summer of 2007. I promised not to attribute the quote to an individual so I won’t, but you can email DDS yourselves and ask them.
The current CDER was written in 1978 and updated in 1986, which is why the language is so out of date ( e.g., Residual Autism). California has clinicians in the field who are, of course, using modern criteria in their assessments but then they have to go backwards and try to fit those kids into the 1986 CDER. So you are going to have Aspergers kids, PDD-NOS kids in both categories 1 and 2. Categories 1 and 2 are called ‘Autism.’ But because there are so many clinicians, using lots of different techniques for evaluation, there is a lot of inconsistency and enrollment figures should not be misused as epidemiological data.
Hertz-Picciotto might also be interested in a quote from Rita Eagle PhD of the California Dept. of Developmental Services (DDS) to Journal of Autism and Developmental Disorders, Vol. 34, No. 1, February 2004:
To many clinicians, it appears that more and more children who, in the past, would never have been referred to the regional centers for example, bright but anxious and slightly socially inept kids with average or better IQs and children who, in the past, had been or would have been diagnosed as ADHD, OCD, ODD, anxiety disorder, learning disabilities, psychotic, and so forth are now being diagnosed wit high-functioning autism and/or Asperger syndrome and referred to the regional centers for services.
Truth is that a lot of Hertz-Picciotto 2009 is simply wrong. For an extensive overview of why, please read Joseph’s technical takedown from which I’ll quote his conclusion:
H-P et al. is a surprisingly poor paper. It does not produce any new data in order to support its two main results. It makes an apples-to-oranges comparison between a Finnish epidemiological study and California DDS ascertainment over time. It tells us the obvious about “milder” cases. In the end, I don’t think this is an improvement over the 2002 MIND Institute report to the California Legislature. In fact, it could very well be worse.
The way H-P et al. have gone about trying to show there’s a real rise in autism incidence over time is not a very good way to go about doing things, in my view. There are other ways. For example, I’ve suggested trying to replicate Lotter (1967) in detail. This would not be as easily challenged.
David closes his latest error prone piece with:
But the sooner our best minds in science and medicine come to grips with the fact that these poor, hapless kids have been exposed to the wrong environmental toxins and/or infectious agents at the wrong time, the sooner we can find out how to best treat what really ails them.
This is a prime example of bad science leading the media. David has reported on a paper that has made fairly bad errors and taken them at their word. Sadly, this sort of thing will only continue as long as institutions like MIND (controlled by a man who is dedicated to proving vaccines cause autism) churn out error strewn papers.
Left Brain Right Brain 
Thanks for linking, Kev.
After I wrote my post, I thought of a much simpler way to explain the problem with H-P et al.
It’s this: They completely ignore awareness as a factor. They look at diagnostic criteria, access, age of diagnosis, etc., but they completely leave out what could very well be the single most important factor in the rise of autism diagnoses: awareness.
You wouldn’t know it from the conclusions, but the researchers do admit that awareness is something they don’t account for toward the end of the paper.
In an epidemiological screening, awareness is not really a factor. But in a database like California DDS, awareness is supremely important. (This also goes to my opinion that the comparison of California DDS to a Finnish epi study is apples-and-oranges).
Let me put it this way. Imagine there’s zero awareness. It doesn’t matter what criteria is in place, there won’t be any diagnoses.
A mistake like .org and .gov would be embarrassing, even for a baby blogger like me.
For someone who claims to be a journalist, it’s pretty damning.
He could probably get a job whipping up weather or Diana stories for the Daily Express.
I think “controlled” is likely not accurate. The gentleman I believe you are referring to doesn’t even have an office or phone at the MIND Institute.
I like Dr. H-P, actually. I would love to sit down with her and discuss this paper since I have some major issues with it, though.
A journalist would be so ashamed at the trail of wrongness highlighted in this post, he or she would, at the very least, show some sign of contrition.
David Kirby? Not so much. Barreling ahead! Who cares about accuracy when you answer to a fratboy ideologue?
“Why is David Kirby grasping at straws?”
Um, because as a journalist, he’s a hack with a busted rep, and couldn’t get a job with any decent mag or paper, but has found plenty of rubes in the “autism community”? Anyway, that’s my guess.
Where’s my comment?
Like Joseph, I was immediately struck by the absence of any consideration of diagnostic awareness when I read the abstract of the paper hyped by David Kirby.
When I bought my first new car some years ago, I suddenly noted that there were a great many white Honda Accords just like mine on the roads within a few miles of my home in Davis, California. Using reasoning like that demonstrated in the latest paper from the MIND Institute, I concluded that a sudden influx of white Hondas from outside of California couldn’t explain that phenomenon, and I could not believe that I was now accepting “pale beige” or “light grey or silver” as “white”; similarly, I doubted that I would have classified the cars I was noticing as white Honda Civics or Mazdas in years past: the diagnostic criteria were unchanged. I don’t claim any special insight here: Clearly this must have occurred to Hertz-Picciotto et al. as well as to Mr.Kirby.
Hi everyone –
Awareness is a factor; but I’m struggling to see how you can effeciently empiricize increased awareness? How could we model it in such that we could have confidence that all of the increased awareness was correctly accounted for?
In other words, lets say that the authors pushed in something about increased awareness, but still came away with values indicating a true rise in autism. How could the study be constructed such that we couldn’t just wonder if the increased awareness wasn’t factored in well enough, and that is why an increase may still be an artifact of other factors?
– pD
Good question. You can look at rates of diagnosis and compare them with a screening that uses the same criteria that was supposed to be in place to diagnose.
One problem with H-P et al. is that they assume the criteria in place for the 1990 birth year cohort would’ve been Kanner’s criteria. That’s by age 5, so we’re talking up to 1995.
Clearly, there must have been low awareness in the early 1990s, but the criteria was not necessarily old, so the prevalence was not terribly low.
You can look at a date earlier than 1990 and then you might see much lower awareness, older criteria and so forth, which would completely change the results.
In fact, even though they don’t consider awareness, if you use a more liberal estimate for the difference between DSM-IV and older criteria, H-P et al. would have explained *all* of the rise, as I demonstrate here.
But again, the whole thing is a dubious exercise in comparing apples and oranges.
It’s silly, really, to think there’s a precise number like 2.2 that describes the difference between DSM-IV criteria and older criteria. It’s not just because of statistical error. There’s obviously subjectivity involved in such studies. We can’t assume that the way researchers interpret DSM-IV now is exactly the same way they interpreted it in 2000. We can’t assume that different diagnosticians interpret the criteria in the same way, much less diagnosticians in different countries.
The more I look at H-P et al. the more I come away thinking it’s a shockingly naive analysis.
Hi As a person with an autism child I take it you are seriously interested in finding why your child is not normal?
Exposure to mercury does not just have to be vaccine related but can be from any number of environmental exposures from living near power stations spewing out mercury etc etc limitless almost.
Many people are challenging and finding mercury as the cause of autism and improving the situation.
The problem for me is it cost 50 cents to vaccinate and tens of thousands to get all that neurotixn out afterwards with most of the money going to the pockets of the polluters.
12 million kids in USA permanently neurologically harmed means if you look for money you may get 1 dime if the money is shared out evenly.
The best way is vaccinate carefully and save an awful lot of money as well as the health of your child.
Hi Joseph –
In fact, even though they don’t consider awareness, if you use a more liberal estimate for the difference between DSM-IV and older criteria, H-P et al. would have explained all of the rise, as I demonstrate here.
Interesting stuff; but I still get the feeling that everyone is pretty much stabbing in the dark.
I took a very brief look at Williams 2006, the meta study you reference that would explain all of the increase if we used their metadata. In their own limitation set, they acknowledge that awareness could not be accounted for in the studies they used.
Qualitative influences on prevalence such as awareness of autism in each population could not be included.
It would seem the meta analysis did not take awareness into account either. This generates rather strange problem though; if we were to use the meta data study as you propose, and accept its data as valid, we’d have to come to the conclusion that increased awareness was not impacting increases at all!
Of course, that’s assuming the remainder of the numbers the H-P used were valid, which you don’t. I think the whole thing is still just too murky to come to good conclusions either way. With DSM-V coming out, this isn’t likely to get better anytime soon.
– pD
As a direct reply to the question “Why is David Kirby grasping at straws?”, I suggest that the reasons are laid out very clearly in a succinct new review in Clinical Infectious Diseases in which Drs Gerber and Offit summarize the epidemiological evidence that refutes the vaccines-cause-autism story.
The article is available (free) from the journal here:
http://www.journals.uchicago.edu/doi/pdf/10.1086/596476
One more thing: David Kirby asked in his January 8, 2008 Huffington Post autism-related article “Can we move on now?” Unfortunately, Mr. Kirby seems to be having a hard time letting go: He wrote, “It is illogical for us to oppose the study of, say, mercury exposures and autism, because it might somehow implicate thimerosal, and by extension, vaccines.”
Yes, it’s past time to move on. Here’s the conclusion of the CID article cited above:
“Twenty epidemiologic studies have shown that neither thimerosal nor MMR vaccine causes autism. These studies have been performed in several countries by many different investigators who have employed a multitude of epidemiologic and statistical methods. The large size of the studied populationshas afforded a level of statistical power sufficient to detect even rare associations. These studies, in concert with the biological implausibility that vaccines overwhelm a child’s immune system,have effectively dismissed the notion that vaccines cause autism. Further studies on the cause or causes of autism should focus on more-promising leads. (My emphasis.)
Hello friends –
I’ve been thinking a bit more about ‘increased awareness’, but it just seems like an cumbersome phrase, and one with increasingly little utility.
Specifically, I’m trying to figure out why we wouldn’t be able to measure the results of increased awareness through more easily accessible components.
For example, I believe as the argument goes, as ‘awareness’ of autism increased, so did the number of diagnosis; i.e., your physician and school now understand what autism is, and you are therefore more likely to get a diagnosis; as opposed to the other options, another diagnosis, or no diagnosis at all. If my understanding is incorrect, the remainder of my post is of little value; please correct me.
Now, what struck me was that aren’t the results of more awareness included in things that can be measured for in a much more reliable manner? For example, if you had autism twenty years ago, but your physician wasn’t aware of it; you got a diagnosis of MR or schizophrenia. But we have much more reliable ways of tracking diagnostic substitution. Likewise, if you had PDD-NOS twenty years ago, and received no diagnosis, don’t we ways to analyze the effect of relaxed diagnostic criteria?
Are there other ways that less awareness could result in fewer autism diagnosis that doesn’t get captured by studying substitution or expanded criteria? What are they?
– pD
If you mean am I interested in finding out why my child is autistic then the answer is both yes and no. In terms of research priorities, I think ‘no’. I am much more interested in things that might actually help. In terms of an interest in science I think ‘yes’. In the same why I’m interested in dark matter and string theory. Absolutely fascinating but of no relevance to my everyday life.
Yes, so I keep hearing. However, when I ask to see the published case studies everyone goes very quiet. Do you people realise that with a few decent case studies published in top notch peer reviewed journals you could very quickly make your beliefs an actual new paradigm? Why has this never been done?
You’re putting the cart well and truly before the horse. If you want legal injury money you first have to establish legal injury. In other words, you need to prove vaccines cause autism.
Sure, but that part has to do with impact of criteria alone, not considering awareness. So H-P et al. says the impact of criteria alone is 2.2-fold. Williams et al. (2006) says it’s 3.6. That seemingly small difference is non-trivial when you do the H-P et al. calculation.
In reality I don’t think there’s any study with ideal methodology as far as determining the impact of criteria changes.
I think they should set out to do an exhaustive screening on a specific population using different sets of criteria. It’s probably tricky to faithfully replicate criteria used in the past, though. Lorna Wing is still around and might help design a replication of Lotter (1967).
Why on earth would you think better of him than that?
Orac, it is called projection. The attempt to emulate another person’s thinking by imputing your own thinking/motives onto their actions.
It works both ways, Kirby projects that people not in his camp don’t care about autistic children and people outside of his camp project that people in Kirby’s camp do care about autistic children.
–Friedrich Nietzsche
Well, before now I can’t remember him making such crass statements as the one he made saying parents who don’t think vaccines cause autism don’t want their kids to ‘get better’. He usually stays away from such silliness.
I think David K is just one of those writers who is writing too quickly, pushes “send” without carefully proofing, and then winds up having to recant. He’s done that a number of times (so have I, so I sympathize!). Problem is, of course, that he is a Major Voice in the Autism Community – and he’s writing for HuffP. As a result, people listen.
Joseph’s commentary is helpful… but I have to say that as a non-statistician I find it very hard indeed to really compare Joseph’s #’s to the MIND #’s and KNOW who is right and who is wrong.
I did call the folks at DDS in CA, and spoke to a lovely ass’t chief who could answer NONE of my questions. He just didn’t know whether kids with PDD or AS would be turned away at the door, or how they would be evaluated. He certainly couldn’t answer the question “how the heck would anyone know whether a developmentally delayed 2 year old would or would not be able to live and work independently at the age of 21?!”
Sigh. As always, more questions than answers!
Best,
Lisa (www.autism.about.com)
He might be a major voice in the false Autism Advocate Community, but not in the autism community.
And oh, how I do lament the lack of professionalism in writers who do not proofread their submissions. (Nawt, it just makes their point very much more open to critical thinking.)
Lisa, the main criticism doesn’t have to do with numbers or statistics. It’s conceptual. For example, do you think using that Finnish epidemiological study to make inferences about how California DDS works makes sense? One is active, the other is passive. One only looks at a specific population of intellectually disabled children. The other is open to anyone.
Do you think the impact of awareness is insignificant?
Would the artifacts in the study subsume diagnostic substitution? This is non-obvious.
In my latest post (the Comment section) I go over all the issues in the paper that I know of. Yes, some are about statistics.
Joseph – as I understand it, the idea was to focus specifically on growth or lack of growth of a cohort of individuals who are, by definition, among the more profoundly impacted by autism.
People with AS and PDD (in theory) are not provided with services through the CA DDS – because their symptoms are supposedly too mild to qualify.
Thus, again in theory, changes in awareness and diagnostic criteria should have been relatively unimportant for this group. After all, they would all have such profound symptoms that they would be obvious to anyone!
Even granted that the criteria HAVE changed somewhat, and SOME individuals with PDD and AS are accepted, there are obviously plenty of people with autism diagnoses in CA who are “too high functioning” to meet DDS criteria.
Thus, logically, if the number of people served by the DDS has grown exponentially, it SHOULD be the case that the number of people with profound symptoms has increased – if not exponentially, at least significantly.
If the number of people with those symptoms has increased significantly, there must be a reason.
If the number really and truly has increased, then there must be some new artifact in the universe that is causing that increase.
And I think that’s basically the point that’s being made.
I do remain skeptical. Your logic, and Kev’s – and my own – tell me that the DDS has not remained an unchanging variable, and that the researchers have exaggerated their claims. But setting aside the idea of an “epidemic,” is it not possible that there has been some significant increase in the number of people with diagnosable classic autism? If not – why not?
Lisa
That’s a mistaken assumption, Lisa. The issue is not whether they were identified by someone as being disabled. The issue is whether they were identified and given an “autism” label, and then registered with California DDS. That’s not the same thing at all.
That’s basically the difference with an exhaustive epidemiological screening. In the screening, they supposedly look at all potential cases, diagnosed and undiagnosed. With California DSS, it’s more passive.
Additionally, as Kev and many others will probably tell you, it’s not true that California DDS only has “severe” clients. Yes, there are restrictions on admission, but (1) it’s well known that children with Asperger’s and PDD-NOS do get into the system – the authors don’t exactly deny this; (2) The vast majority of autistics in California DDS at the moment do not have mental retardation – i.e. they are “high functioning” according to the official definition of the term. This wasn’t always so. Why is that?
If you look at the number of autistics with a mental retardation assessment, for example, yes, it has increased, but not “exponentially.” Now, is it unusual that it has increased? Not necessarily. They might have been always there, receiving services, except without an “autism” evaluation.
Take a look at Shah et al. (1982) to see how that might work. (Note the year and the fact that it’s an adult study).
Hi Kev
A few decent case studies in top notch medical journals?
It is impossible to get any research article in your so called top notch journals simply because it would mean one more nail in the coffin for mercury vaccines and hopefully the abandonment of mercury in vaccines.
Pichichero publishes at an average rate of one paper every two weeks in top notch medical journals.
How does he do this?
If you look at some data on mercury he did for one paper it would take a dozen scientists about 6 months or so to get these figures on hundreds of animals.
He does two papers a month and ALL are acceptable to these top notch medical journals.
I just ask WHY?
One answer comes from Mark and David Geier who just wanted to point out that Pichero gets his funding from just about every vaccine company.
It took the Geiers 7 months to get a simple letter published.
Pichichero gets PAPERS published every other week and many are his own personal work on subjects vast wide and broad.
The message that your results gives is the limiting factor and no one would get a paper published easily unless it was CERTAIN and important for immediate health reasons and was at the same time double checked by the Pichichero’s of this world.
One example was way back when they discovered putting mutagenic additives to 1 month babies night ware was NOT a good idea. Professor Bruce Ames checked out their work and of course meant another year went by when kids were exposed to HARM.
Hauntingly this additive was ALSO like mercury a nerve destroying agent.
Anybody understand what John Fryer is trying to say? Not sure I do, though he has the Geiers in there and seems to think they’re genuine researchers so maybe confusion is his norm.
John, the Geiers don’t do real research because the real stuff isn’t much use in castrating small children.
John’s basically saying its all a big conspiracy. Which of course is twaddle but it makes him feel better and provides the lazy minded an ongoing excellent excuse.
There are some fascinating points in time on this article but I don’t know if I see all of them heart to heart. There’s some validity but I will take hold opinion until I look into it further. Good article , thanks and we would like extra! Added to FeedBurner as well