Archive | November, 2009

Age of Autism: misquotes Story Landis…jumps to unsupported conclusion

2 Nov

When the Age of Autism reported on a note written by Story Landis, they added a word that dramatically colored what was said. I am left wondering why would AoA make such an clearly detectable misquote? Read on and you will see what I mean.

Take a look at the piece titled “Dr. Story Landis: Autism not a multi-symptom disease but a money making scheme?“. That whole “money making scheme” part is what got people riled up. But is it really supported by what was said?

Here’s a little screenshot of the Age of Autism blog post, if you don’t want to click through to their site:

Segment of post about Story Landis

Segment of post about Story Landis

I know this seems redundant, but here is what they quote Dr. Landis as saying:

“I wonder if Lyn Redwood is pushing autism as a multi-symptom disorder in order to feed into vaccine injury awards.”

Emphasis added by me.

Why add emphasis, you might ask? Because “awards” is not in what Dr. Landis wrote in that first line. Go ahead and check. Here’s the note, as downloaded from the of the Age of Autism blog.

“I wonder if Lyn Redwood is pushing autism as multisystem disorder to feed into vaccine injury?

It is the second line that mentions awards:

Would be a good justification for looking at vaccine injured kids who have gotten awards.

The insertion isn’t a simple mistake–it is made twice in the same blog post. Here is the second place the mistake was made:

How could Landis imply that families are “trying to make” autism into a total body disease in order “to feed into vaccine injury awards.”

Neither section in the “quotes” is accurate. “Trying to make” isn’t in what Dr. Landis wrote, and, as we have just seen, “feed into vaccine injury awards” isn’t either.

Without the word “awards” added the meaning that the Age of Autism blog post tries to convey, heck, the title of the blog post–that Dr. Landis was speculating that this was a “money making scheme”–is unsupported.

Let’s dive into this a bit deeper. David Kirby, blogger at the Age of Autism and at the Huffington post did a very strange thing. In his piece he gets the correct quote from the note, doesn’t mention the mistake made at the age of autism, but still pushes the Age of Autism interpretation:

To many parents, it seemed that Dr. Landis suspected Redwood of “pushing” the study of these multisystem problems merely to boost the number of autism cases filed in vaccine court (the Vaccine Injury Compensation Program), and to increase their chances for victory. Judging by the comments on Age of Autism, those parents were profoundly offended by the implications of that interpretation.

I’m curious as to how Mr. Kirby came to the conclusion that Dr. Landis’ note was “merely to boost the number of autism cases filed in vaccine court” and “to increase their chances for victory”. Dr. Landis didn’t mention the court, the chances of victory…or even “awards” in the context that would support Mr. Kirby’s interpretation.

I’d be curious as to whether Mr. Kirby pointed out the mistakes to the Age of Autism blogger in question.

A casual observer might find it odd how Mr. Kirby corrected the quote and yet persisted in pushing (yes, I’ll use the term pushing) the interpretation based on the misquote. The same casual observer would find it especially odd, since Mr. Kirby was the one to publicly disclose Dr. Landis’ explanation of her comment:

The other part of my note addressed the fact that it is important for autism researchers to study the children who have been most profoundly affected by their response to vaccines. That in no way mitigates my sincere apology to the families who interpreted my note to be uncaring and disrespectful.

“The other part of my note” being “Would be a good justification for looking at vaccine injured kids who have gotten awards.”

If you can look at the quote fresh, consider this interpretation–the first sentence, “I wonder if Lyn Redwood is pushing autism as multisystem disorder to feed into vaccine injury?” is discussing the if autism as a multisystem disorder would feed into the *idea* of autism as a vaccine injury. The assertion that her comment referred to vaccine injury “awards” is at best speculation and, at worst, a pretty clear misquote. I could speculate on the motives of the Age of Autism blogger, but haven’t we just seen how dangerous it is to speculate on motives with little information?

note: I made some small edits for clarity shortly after publishing this.

Evaluation of Immunization Rates and Safety Among Children with Inborn Errors of Metabolism

2 Nov

Ever since the Hannah Poling case became public, and especially give the way in which David Kirby has presented the case, there has been a question of whether vaccines can cause regressions in children with inborn errors of metabolism (mitochondrial disorders are a subset of these).

I discussed one very recent paper Fever Plus Mitochondrial Disease Could Be Risk Factors for Autistic Regression. Commenter and LBRB blogger Joseph made the very correct observation then:

I’d say it’s potentially interesting, but limited. In order to tell that something is a risk factor, you need a case-control study.

More specifically, can self-selection bias be discounted in this study?

It is encouraging to see that such studies into this question are being staged. Here is the abstract from a study presented 2009 Infectious Diseases Society of America titled, Evaluation of Immunization Rates and Safety Among Children with Inborn Errors of Metabolism.

Abstract

Background: Children with metabolic disorders are a potential high-risk group for vaccine-preventable diseases. Despite recommendations that they receive all routine immunizations, information regarding both immunization rates and safety data within this population is lacking.
Methods: Using Northern California Kaiser Permanente’s (NCKP) integrated electronic medical record, we identified children up to age 18 years who had an inborn error of metabolism (IEM) from 1990 to 2007. We assessed immunization rates among a subset of infants with IEM born at NCKP who were members until age 3 years matched to healthy infants (1:20), comparing both immunizations received by age 2 years and timing for receipt of vaccines. We next separately assessed for adverse events after immunization by using self-controlled analyses among all children up to age 18 years with an IEM who received at least 1 vaccine at any time, comparing emergency room visits and hospitalizations during post-vaccine days 0-30 to post-vaccine days 31-60.
Results: We identified 79 infants with IEM who were born and remained a member of NCKP at age 3 years. Compared to 1580 matched controls, there was no difference in the proportion of children with IEM up to date for vaccines at 2 years, nor was there any delayed receipt of recommended vaccines during the first year. We also preliminarily identified 322 children with IEM who received any vaccine. Preliminary analysis in this group did not detect an increase in emergency room visits [rate ratio (RR) 0.83, 95% confidence interval (CI) 0.60, 1.14] or hospitalizations (RR 1.1, 95% CI 0.9, 1.4) during the 30 days after vaccination compared to post-vaccine days 31-60.
Conclusion: Children with metabolic diseases in this cohort were vaccinated at rates comparable to healthy children. Although sample size is a limitation, preliminary evidence does not suggest an association between vaccination and an increased risk for serious adverse events.

Emphasis added.

A news story on the subject quoted the session chair where the study was presented:

“These findings are very reassuring,” said Larry Pickering, MD, National Immunization Program, Centers for Disease Control and Prevention, and Emory University, Atlanta, Georgia, who moderated the session at which the study was presented.

“Most of us who take care of kids with inborn errors of metabolism think vaccination is one of the best interventions we can offer them,” he said. “They are at increased risk for devastating complications, even death, from the diseases that the vaccines prevent.”

This is reassuring. Preliminary, yes. I can already see the criticisms, both legitimate and otherwise, that will be levied against this study. but potentially very reassuring. Vaccines are one of the front line interventions in protecting people with mitochondrial disorders.

Let’s see if I can predict the criticisms:

1) not peer reviewed
2) many authors received grant money from vaccine manufacturers.
3) the sample size is small (79 infants)
4) the number of infants with mitochondrial disorders is even smaller (7)
5) it would be good to see a comparison of hospitalizations in the months previous to immunizations (if possible)
6) the time spanned by the study covers a large change in the immunization schedule. The sample size of infants immunized in the current schedule is likely to be rather small.

The sample size is small, but it would be interesting to see if the prevalence of metabolic disorders has increased over this time span. But, as autism has shown us, the correlation=causation arguments can be shaky at best.

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