David Kirby/Arthur Allen Debate Part III

24 Jan

“It’s understood that Hollywood sells Californication”
~ Red Hot Chilli Peppers

In this section I want to look at Kirby’s presentation regarding what he terms as the first of seven skeptical rebuttals to the autism/thiomersal hypothesis. He says that skeptics say:

Hmm. Not really. I think most people are agreed that autism is a ‘mix’ of genes and environment. However, this is a popular and recurring strawman from the anti-thiomersal hypothesisers – that thiomersal and environment are interchangeable. They’re not. Maybe ice cream is the environmental trigger for autism. What science _is_ pretty sure about however, is that thiomersal (i.e. one _possible_ environmental ‘trigger’) is _not_ in the frame. So straight away we can see the Kirby is proceeding from a misleading position. If his argument is so strong, why does he feel the need to do this I wonder?

However, the point Kirby is (misleadingly) making is to try and push the idea of there having been an epidemic. Lets see how he does this.

(A lot of the next section has been amply covered by Mike – I won’t repeat his work)

NB: The years Kirby refers to here are between 1988 – 1992.

Guess what else happened around that time?

In 1987, one year before the time period Kirby is talking about, the DSM (III-R) was published. This was a revision to the previously published (1980) DSM (III). Here’s what the DSM (III) criteria was for what it called ‘Diagnostic criteria for Infantile Autism’- this is in full by the way:

A. Onset before 30 months of age

B. Pervasive lack of responsiveness to other people (autism)

C. Gross deficits in language development

D. If speech is present, peculiar speech patterns such as immediate and delayed echolalia, metaphorical language, pronominal reversal.

E. Bizarre responses to various aspects of the environment, e.g., resistance to change, peculiar interest in or attachments to animate or inanimate objects.

F. Absence of delusions, hallucinations, loosening of associations, and incoherence as in Schizophrenia.

So that is the sole and only reference for autism in 1980. Next up, this is the 1987 revision – DSM (III-R):

Diagnostic Criteria for Autistic Disorder

At least eight of the following sixteen items are present, these to include at least two items from A, one from B, and one from C.

A. Qualitative impairment in reciprocal social interaction (the examples within parentheses are arranged so that those first listed are more likely to apply to younger or more disabled, and the later ones, to older or less disabled) as manifested by the following:

1.Marked lack of awareness of the existence or feelings of others (for example, treats a person as if that person were a piece of furniture; does not notice another person’s distress; apparently has no concept of the need of others for privacy);

2. No or abnormal seeking of comfort at times of distress (for example, does not come for comfort even when ill, hurt, or tired; seeks comfort in a stereotyped way, for example, says “cheese, cheese, cheese” whenever hurt);

3. No or impaired imitation (for example, does not wave bye-bye; does not copy parent’s domestic activities; mechanical imitation of others’ actions out of context);

4. No or abnormal social play (for example, does not actively participate in simple games; refers solitary play activities; involves other children in play only as mechanical aids); and

5. Gross impairment in ability to make peer friendships (for example, no interest in making peer friendships despite interest in making fiends, demonstrates lack of understanding of conventions of social interaction, for example, reads phone book to uninterested peer.

B. Qualitative impairment in verbal and nonverbal communication and in imaginative activity, (the numbered items are arranged so that those first listed are more likely to apply to younger or more disabled, and the later ones, to older or less disabled) as manifested by the following:

1. No mode of communication, such as: communicative babbling, facial expression, gesture, mime, or spoken language;

2. Markedly abnormal nonverbal communication, as in the use of eye-to-eye gaze, facial expression, body posture, or gestures to initiate or modulate social interaction (for example, does not anticipate being held, stiffens when held, does not look at the person or smile when making a social approach, does not greet parents or visitors, has a fixed stare in social situations);

3. Absence of imaginative activity, such as play-acting of adult roles, fantasy character or animals; lack of interest in stories about imaginary events;

4. Marked abnormalities in the production of speech, including volume, pitch, stress, rate, rhythm, and intonation (for example, monotonous tone, question-like melody, or high pitch);

5. Marked abnormalities in the form or content of speech, including stereotyped and repetitive use of speech (for example, immediate echolalia or mechanical repetition of a television commercial); use of “you” when “I” is meant (for example, using “You want cookie?” to mean “I want a cookie”); idiosyncratic use of words or phrases (for example, “Go on green riding” to mean “I want to go on the swing”); or frequent irrelevant remarks (for example, starts talking about train schedules during a conversation about ports); and

6. Marked impairment in the ability to initiate or sustain a conversation with others, despite adequate speech (for example, indulging in lengthy monologues on one subject regardless of interjections from others);

C. Markedly restricted repertoire of activities and interests as manifested by the following:

1. Stereotyped body movements (for example, hand flicking or twisting, spinning, head-banging, complex whole-body movements);

2. Persistent preoccupation with parts of objects (for example, sniffing or smelling objects, repetitive feeling of texture of materials, spinning wheels of toy cars) or attachment to unusual objects (for example, insists on carrying around a piece of string);

3. Marked distress over changes in trivial aspects of environment (for example, when a vase is moved from usual position);

4. Unreasonable insistence on following routines in precise detail (for example, insisting that exactly the same route always be followed when shopping);

5. Markedly restricted range of interests and a preoccupation with one narrow interest, e.g., interested only in lining up objects, in amassing facts about meteorology, or in pretending to be a fantasy character.

D. Onset during infancy or early childhood

Specify if childhood onset (after 36 months of age)

Slight difference huh? Of key importance – in 1980 we only had ‘infantile autism’. In 1987, we had ‘autistic disorder’.

The DSM (III-R) is a quantum leap in diagnostic precision (far from perfect of course and as we all know the DSM (IV) came along in 1994 and the DSM (IV-R) came along in 2000) but surely it is blindingly obvious what a massively more accurate and precise set of criteria must mean – better recognition. More diagnosis.

Now Kirby says that this increase ties in to the ‘spike in mercury in vaccines’ over the same time period. Could be. But lets _also_ not forget that – as Kirby says in this debate – you need clinical science to support a clinical idea such as thiomersal causing autism.

Nine years now and there is _not one_ paper that even suggests that the symptoms of autism can be attributed to thiomersal (or MMR, or both together come to that). Nine years. In terms of science this hypothesis has four papers that might be considered of publishable quality. One shows that if you take a strain of mice known for aggressiveness and severely overdose them with thiomersal then they get more aggressive. Another shows that if you take a control group high in mercury levels and compare them with new born babies then the babies will look like poor excretors of mercury. The third shows that ethyl mercury and methyl mercury cannot be used to represent each other. The last one shows that thimerosal might cause methionine synthase dysfunction (MSD) – a condition that bears no resemblance to autism.

So here we are with the thiomersal hypothesis resting squarely and solely on epidemiology. Once upon a time, Kirby said CDDS epidemiology was ‘the gold standard’ – now he says its not enough. However, make no mistake. Epidemiology is all this hypothesis has.

So what is the state of this epidemiology? Is it of good quality? Well, no. As Mike has shown (see link above) Kirby’s presentation numbers are awful. As I have shown, his opinion of CDDS fluctuates depending on whether the numbers work for him or not and as Jospeh has shown, his new source is equally as badly reported on as his initial take on CDDS was.

Another example of the epidemiology not only not working for Kirby but being actively manipulated is this:

Have a close look at that graph. Remember in the previous slide Kirby said that the biggest increase in thiomersal was between 1988 and 1992. Take a close look at the dates in _this_ slide. They start in 1993. That’s pretty misleading Mr Kirby. Tut-tut-tut.

Also in this slide I want you to notice that according to this data that Kirby is using, the numbers are continuing to climb in 2001, 2002 and 2003. However, we know from a recently discovered CDC set of meeting minutes that according to a survey, in September 2001, only 5.6%1 of _all vaccines_ contained thiomersal. By Feb 2002, only 1.9% of _all vaccines_ contained thiomersal.

So apparently, Mr Kirby is happy to use data from two sources that shows an increasing amount of autism. CDDS and IDEA data. Both show climbing autism against a backdrop of miniscule amounts of mercury in the general population.

Danger, Will Robinson. Does not compute.

(More Californication to come soon….stay tuned…)

107 Responses to “David Kirby/Arthur Allen Debate Part III”

  1. Friend in California January 31, 2007 at 05:07 #

    Bill –
    Believe me, I understand. This is one area I have not researched, but last time I did a quick reference check, our chances of having another autistic child is anywhere from 5-12% (I don’t really know who produced these #’s or whether they are verifiable).
    My wife and I talked very seriously and at length about whether or not this was a good idea. Bottom line is, we are hoping, fervently, that our new son is not autistic. I hate to put it so blatantly, but there it is. It also occurred to us that, in the case that autism is present in our youngest boy, he may be much more profoundly affected than his brother. All this was thought about carefully, and we decided to ahve another child anyway. The reason is that we love our kids and what they bring to our lives, and we felt another child (the last one we will have) would somehow “complete” our family. This is an intensely personal decision, and I would never try to convince anyone else that they should do the same. We are nervous that our baby may be autistic – just think about the lifelong impact that situation would have on our middle child – but once one realizes that “autism” does not equate to “tragedy”, it makes one’s decision less tied to emotional baggage.
    Look, all of us NT parents set out with a vision in mind of what parenthood will be like – I’m talking about school plays, soccer practice, “the talk” (birds and bees), prom, first day at University and driving away wondering how son/daughter will handle it, etc, ad infinitum. And those of us who are parents of autistic children realize very quickly that the landscape of predictability has changed rather suddenly. And my wife and I certainly went through an intense grief stage. But now that we are watching Jason’s personality develop, and through exposing ourselves to the writings (and I mean only the writings – I have yet to meet in person an adult diagnosed with autism) to autistic adults, we are learning that there is more to this than the pamphlet stated that was given to us the day of diagnosis at the Children’s Hospital.
    I respect and empathize with your decision, Bill, and the good news is you already have two healthy (I hope) daughters to share your life with and create some memories, and I think that’s great.
    I said at the beginning of this comment that we are hoping our new baby is not autistic, and this is an honest, true statement. But the bottom line is, nothing can take away the value of our newest family member – “the littlest Dionne” as we call him – including autism and the obvious difficulties its presence can cause in our family.

  2. margaret January 31, 2007 at 13:18 #

    Hi Friend in California,

    Congratualtions on the birth of your son. I had no other children after my son who developed autism. I think it would have driven me crazy to be constantly looking for “signs” of the presence of autism or lack there of.

    I am surprised that you state a preference for a non-autistic child. I’m puzzled by that.

    I know why I wouldn’t want another child with autis. It’s because what my son’s autism is like. He doesn’t talk, although he understands sign and has a quite a bit receptive language, unless it is something he has had no prior experience with a situation. He has never been real good at expressive language. That is the most frustrating part for me, and him I suppose. Also, my son is eleven and his tantrums arent as manageable as a five year olds. That’s your ASD son’s age, right? Plus your boy speaks, what a relief that must be to you. I think spoken language makes all the difference in the world. Hey, at five we stil had an optomistic outlook for my son’s future. Realistically, a lot of that optimism has faded. He also has some persist immune issues and other health problems. When he has a “flare up” of a physical problem he doesn’t know how to relay that information to us. Obviously we rush him to the doctor and try to figure out what the problem is- sometimes we are successful, sometimes we are not. When he is not feeling good (of course we are guessing he does not feel good) he resorts to self-injurious behaviors, such as head-banging and hand-biting. it’s heartbreaking to watch him do this. Really awful for us, we feel so helpless- can’t imagine what it is like for him?

    Anyways, I think you are brave to utilize the recommended vaccine schedule.

    I’m still unsure what caused my child’s autism and if we had another baby besides watching, waiting and worrying about autism; I also couldn’t feel confident in fully vaccinating my new baby.That would be a whole other source of worry and fear. Besides, there are many more recommended shots then when my son was a baby. Just the shear amount is worrisome. And, any child could have a vaccine reaction- we do agree that is a real possibility, even if it is a slim one.

    I do wish you and your wife luck with the new baby, and I hope everyone in your family is healthy, happy and enjoying life to the fullest.

  3. Friend in California January 31, 2007 at 15:40 #

    Thanks for the well-wishes, Margaret. I do understand where you are coming from, but I think your stated fear of vaccines is simply a persistence of concern caused by faulty arguments that resulted from bad science that was motivated, in part, by financial considerations on the part of groups of lawyers, treatment sellers, and conspiracy theorists. Iknow why you feel this way, as I was in the same boat not even 6 months ago. I also acknowledge that many kids are more profoundly affected than my son is, and that the possibility is real that our new baby could also fall into this category (although likely not).
    It should not surprise anyone that we would wish for an NT baby – we are not ignorant of the difficulties autism will present in my son’s life, and we fully acknowledge that a totally healthy, totally unaffected child has fewer obstacles to happiness and prosperity. This is in no way a “knock” on autistic people, it is just a simple ackowledgement that autistic people have more challenges to overcome in our society than NT’s. In actuality, there are a number of other circumstances which would create even more of a difficulty than autism would, and – surprise! – we hope our son does not experience any of those either.
    As parents, we will do everything we can to protect, care for, nurture, and promote the prosperity of our children, regardless of any and every circumstance. At the same time, we reserve the right to hope for the “path of least resistance” to our kids’ happiness.
    Other specific points:
    “And, any child could have a vaccine reaction- we do agree that is a real possibility, even if it is a slim one.”
    Yes, no doubt, but the science would indicate that a vaccine reaction does not result in autism.
    “Plus your boy speaks, what a relief that must be to you.”
    Yes, although I think it is more of a relief for him than us. But keep in mind, while he is verbal, he is not conversational .. yet. He can communicate his needs, but not have an unstructured exchange with us. Example: If I ask “What did you do at school today?” – no response. If I ask “Did you have a good day at school today?” he will answer “yes” (always yes, never no). Most of his speech is echolalic, although we are seeing steady improvement over time and I think he will end up to be 100% verbal.
    Look , our son has the full range of issues associated with autism, he meets each and every diagnostic criterion. He is fortunate in that very few of these criteria manifest themselves in the most profound way, but he certainly has his challenges.
    None of this changes the fact that we made the decision to have another child, knowing the likelihood was higher in our family than in an unaffected family, because we take the view that we would rather have another autistic child, if that’s what happens, than no more children at all.

  4. anonimouse January 31, 2007 at 16:16 #

    Margaret,

    There is virtually no evidence that an increase in the number of vaccines is related in any way to autism. You should see some kind of correlation between the rate of autism and vaccines given if that was the case. To date no such correlation (unless you consider the most distorted of mercury-autism analyses) exists.

  5. margaret January 31, 2007 at 17:01 #

    Thank you FIC or your reply.

    If I was you I would really look into a verbal behavior approach to teaching language. Your son sounds like a good candidate for turning his echolalia into conversational speech. Living in California there is probably a good chance his school may use this approach. I have seen first hand many children become conversational using their techniques. I can provide more info if you are interested.

    Animouse,

    I hear what you are saying. I am still concerned and fearful. As I stated in my first post, it is the number of vaccines that concerns me. No study has looked at all the combinations a child may receive today. Did you hear about a 5 in one vaccine the FDA is considering? It’s a one size fits all vaccine schedule. We have no way of knowing how individuals handle that. Also, my son was on lot’s of antbiotics, took tons of tylenol and motrin and prescription cough meds because he was sick all the time. How does that factor in to the aggressive vaccine schedule? I’m sorry I don’t have as much faith in epidemiology as you do. Please forgive me, I’m still concerned.

  6. anonimouse January 31, 2007 at 21:21 #

    No study has looked at all the combinations a child may receive today. Did you hear about a 5 in one vaccine the FDA is considering? It’s a one size fits all vaccine schedule. We have no way of knowing how individuals handle that.

    This is a fallacy I often hear about vaccines – that they’re “never” tested in combination with other vaccines.

    In Phase III trials which involve thousands of subjects (including many with assorted health problems), children have to continue to receive the “standard” of care. That means they’re vaccinated as per the regular schedule. While that won’t cover every case, that should give one a good idea of whether adding a new vaccine to the mix adds any additional problems.

    And these subjects are monitored over a fairly significant period of time. Most anti-vaxers will tell you it’s just a few days or weeks – the reality is that it’s more like a year. And all vaccines are routinely monitored post-licensure for adverse affects.

    As to the 5-in-1 vaccine, I believe it’s already in use. Anytime you can effectively combine multiple antigens into one shot, that’s a good thing. It means one less jab, one less exposure to adjuvants, etc, etc.

    The problem is that anti-vaxers have thrown out the same arguments over and over again that the lie becomes the truth. They can tell you thimerosal hasn’t been tested yet was used in vaccines for generations without incident. They can say vaccines aren’t tested for safety when they are. They can claim that vaccines cause all sorts of awful things like SIDS or Type 1 diabetes without any tangible proof to make their case.

  7. HN January 31, 2007 at 23:59 #

    Add to what anonimouse said:

    The study I posted way upthread was taking databases from three HMOs. One can assume that all the kids got the normal amount of pain meds along with vaccinations… and possibly antibiotics when they got ear infections, etc, etc.

    Fortunately, the whole paper and not just the abstract is accessible just by clicking the link I provided.

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