The piece below is from the blog justthevax, where it ran as “Independent” the Wakefield way (really something for the fail blog). I like this piece because, frankly, I wish I had done it. Catherina takes a look at the exact claims made by Dr. Wakefield’s supporters and shows that they are clearly false.
“Independent” the Wakefield way (really something for the fail blog).
One of the claims that keeps reappearing in the comments sections under articles covering the GMC ruling on Andrew Wakefield and colleagues is that
The key finding (chronic colitis found in ASD children) of Dr. Wakefield’s early case report published in The Lancet in 1998 HAS been independently confirmed by medical researchers in five different countries.
That is a very significant claim. After all, independent confirmation of a recent finding, would make the validity of a finding more likely, and if 6 independent laboratories found the same gut changes in autistic children, then then likelihood that this was a) a fluke or b) made up by Andrew Wakefield would be drastically reduced.
Finally, one of those commenters has posted those ‘independent confirmations’ – so I thought it might be worth having a look at them.
Krigsman, A. (Assistant Professor of Pediatrics, New York University School of Medicine Director of Gastroenterology Services), et al.,Ileocolonoscopy in Children with Autistic spectrum Disorder and Chronic Gastrointestinal symptoms. Autism Insights 2010:2 1-11.
Gonzalez, L., et al., Endoscopic and Histological Characteristics of the Digestive Mucosa in Autistic Children with gastro-Intestinal Symptoms. Arch Venez Pueric Pediatr, 2005;69:19-25.
Balzola, F., et al., Panenteric IBD-like disease in a patient with regressive autism shown for the first time by wireless capsule enteroscopy: Another piece in the jig-saw of the gut-brain syndrome? American Journal of Gastroenterology, 2005. 100(4): p. 979-981.
Balzola, F., et al., Autistic enterocolitis: Confirmation of a new infammatory bowel disease in an Italian cohort of patients. Gastroenterology 2005;128(Suppl. 2);A-303.
Galiatsatos, P., et al., Autistic enterocolitis: Fact or fiction. Canadian Journal of Gastroenterology. 2009;23:95-98.
Let’s look at number 1, Krigsman et al. The name sounds vaguely familiar. In fact, anyone who has read a little about the MMR-autism affair will know Arthur Krigsman as the clinical director of Thoughtful House, which happens to be the same Texas Clinic out of which Andrew Wakefield practises. One editor of “Autism Insight”, the journal in which this “independent confirmation” was published, is Andrew Wakefield (another one the senior author of the study, Carol Stott). Gosh, I bet peer review was harsh for this one.
Gonzales et al, number 2, has been published in “Arch Venez Pueric Pediatr” which stands for Archivos Venezolanos de Puericultura y Pediatría. It was a bit tricky to get my hands on the paper, especially since the citation was not quite right, but I did manage and was not surprised to find that indeed the authors cannot replicate Wakefield’s 1998 “findings” of a distinct autistic enterocolitis, although they do report a higher incidence of gastrointestinal problems in their autistic group.
Balzola et al, number 3, is a case report of one adult autistic patient with inflammed bowel.
Similarly, Balzola et al, number 4, is a meeting abstract (if anyone has access, could they email me that abstract, please) that never saw the light of day as a peer reviewed study.
Finally, number 5, Galiatsatos et al., is a case report, featuring two adult patients with gastrointestinal problems and an ASD diagnosis. The authors call for “more investigations” in their discussion.
So what do we have here? Three (3) genuinely published cases of autistic adults who had consulted a doctor for gastrointestinal problems and were found to have gastrointestinal problems. One conference report from April 2005 that has not gone through peer review and has not appeared in a real journal in the 5 years since the conference. One real study looking at over 50 autistic children which does not confirm Wakefield’s findings. And finally, one study by Wakefield’s buddies in a freshly founded journal run by Andrew Wakefield and his buddies, to say that their buddy Andy was really right all along – how is that for “independent” confirmation?!
Left Brain Right Brain 
It’s strange that discussion of ASD and gastrointestinal issues frequently involves the idea that the existence of gastrointestinal problems in individuals with ASD somehow supports Wakefield’s failed hypothesis. Of course that is not at all the case. It’s useful to recall Wakefield’s hypothesis, which some of Wakefield’s fans may not clearly understand since it was was not explicitly stated in the recently-withdrawn Lancet article.
Most of you already know the background: Wakefield suggested that inflammatory bowel disease (IBD), Crohn’s disease, and ulcerative colitis were caused by chronic infection with measles virus—and, of course, because the nonspecific reagents he used to test for measles virus consistently produced false-positive reactions, Wakefield was repeatedly wrong. Then he took this a step further: “Following an incomplete immune response to an attenuated virus challenge early in life, or indeed less often a wild type infection, measles virus collects in the wall of the gut . . . [ASD] in children is associated with measles, mumps and rubella exercises (MMR) vaccination. . . [and produces] lesions in the gut indicative of the problems which arise in IBD and Crohn’s disease.” Clearly, Wakefield believed that ASD was related not merely to gastrointestinal problems in children with ASD, but to gastrointestinal problems that arose as a specific consequence of a chronic inflammatory response to chronic infection with an attenuated (vaccine) strain of the measles virus. [From Wakefield’s patent application available at http://briandeer.com/wakefield/vaccine-patent.htm%5D Again, as Bustin and others have demonstrated, Wakefield was tripped up by the false-positive reactions produced in his notably nonspecific tests.
Thus, Wakefield’s hypothesis was that chronic inflammation due to chronic measles infection was the instrument responsible for ASD: the measles-induced inflammation lead to increased permeability of the gut wall such that unspecified dietary toxicants (“neurotoxic opiod peptides”) moved towards the brain, crossed the blood-brain barrier, and produced the symptoms of ASD. [http://www3.interscience.wiley.com/cgi-bin/fulltext/120709186/PDFSTART] Yet again, Wakefield was wrong.
So what of it if some individuals with ASD do have GI issues? Clearly, the ONLY forms of GI disturbance that would be consistent with Wakefield’s idea would be those which arise from chronic infection with measles virus, and there’s simply no reason to believe that such infections are a factor in ASD. It doesn’t matter how many individuals with ASD have GI problems—Wakefield’s still wrong.
Brian,
it would be amazing if no autistics had GI issues. Autism isn’t a shield for GI concerns.
What I find interesting is that Dr. Wakefield and his supporters don’t use Hornig et al. as one of their references. There are a number (25, I think) if kids with autism and GI disorders serious enough to warrant colenoscopies.
There is even a child with a positive test for measles virus. Two, actually, one control and one autistic kid. Both also had inflammation–but not of the sort that Dr. Wakefield claims is so common.
Unfortunately Hornig et al. don’t go into the details of the GI complaints of the children in their study.
But,
And whenever any tells me how ethical Wakefield and the others were, consider this: They had to pick kids they did not think had Crohn’s disease or ulcerative colitis because it was a minor amount of inflammation they were looking for. Of the 12 kids, after the tests, none of them were diagnosed as having Crohn’s or UC.
The same is true for Krigsman’s study of 143 consecutive colonoscopies of autistic kids — none of them had Crohn’s or UC.
Just to show that there are limits, Wakefield has been dropped from the editorial board of Autism Insights. Krigsman is still on the board.
As Walker-Smith and Murch try to distance themselves from Wakefield, Wakefield tries to shift the blame to Dr Thores. See http://mmrlawyers.blogspot.com/2010/04/wakefield-tries-to-shift-blame.html
I am still not really sure where the ND movement stands on this issue.I think this question gets to the very heart of what is and is not “autism’.As I have said on my blog,there are far too many people who have been diagnosed as having “autism”,that should not,and a lot of these people have gastrointestinal disease.This includes both my sister and I,who are 40,and 49 years old respectively.We have both autism diagnoses,GI disease,and the same mysterious medical problems.In spite of what David Kirby
says.
“If it seems like most of the people you know with autism are 22 or younger, that’s because most people diagnosed with autism were born after 1987.”
My mother,has a lifelong history of similar GI disease,as well.So do a lot of the mothers of children who supposedly “became autistic” after the MMR vaccines,a fact that is often overlooked.
The problem is,that,most of the research into GI disease in autism has been done by people with a well defined antivaccine agenda,and seem to view their studies as a way to prove this,other than a few exceptions like Tim Buie,at Massachusettes General,who clearly see GI disease in autism as a real problem unrelated to vaccines.Dr.Buie,unlike Thoughtful House,has included autistics over the age of 40 in his studies.
The Krigsman study is just more pseudoscience has come out of TH to prove the same old vaccines cause GI disease BS.One might have hoped there would have been some sort of backlash,against anybody associated with TH from publishing any more such “studies”,and most reputable journals would not have allowed this,but this may not be the case.
“sheldon101
April 23rd, 2010
02:16:58
And whenever any tells me how ethical Wakefield and the others were, consider this: They had to pick kids they did not think had Crohn’s disease or ulcerative colitis because it was a minor amount of inflammation they were looking for. Of the 12 kids, after the tests, none of them were diagnosed as having Crohn’s or UC.”
Or other medical conditions in addition to GI disease for that matter,and that may be important.
I am finally getting the workup I should have gotten many years ago,and my new doctor has many issues on the table to try and figure out the cause of my GI disease.Unlike Wakefield,Krigsman, (Or maybe even someone like Dr.Buie,I don’t know.)This doctor has put my autism completely aside,and is looking at it in the context of my other medical problems.He is looking at my lifelong history of lung infection,and is wondering if I don’t have either cystic fibrosis,or gastrointestinal tuberculosis,secondary to an undiagnosed primary immune disease.These are the first two of many things I will be tested for.The other hospital I went to was not willing to see me as anything other than someone with an autism,or psychiatric diagnosis,first and foremost,and this may be a big problem here.
The TB theory is unrealistic,by the way.
If we can find the cause of the GI disease in my family,it is very likely this might lead us to the cause in everyone,but to prove this exists,you do need to look beyond those who had the MMR vaccines.GI disease,definitely “autistic enterocolitis” a la Wakefield ? I don’t think so.
David Kirby worded that pretty carefully, BTW, and I don’t think many people would disagree with it. (Although, technically, we don’t really know if autistic adults have gotten diagnoses en masse. It’s likely most haven’t.)
I suppose Kirby inadvertently neglected to summarize it this way: “If it seems like most of the people you know with autism are 22 or younger, that’s because most people diagnosed with autism were born after [the DSM-III-R was published in] 1987.”