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Jenny McCarthy and the law of unintended consequences

19 Oct

This video explains a consequence of Jenny McCarthy’s self-serving appearance on Oprah. The mom who made the video uses text to explain how she and her son listened to Jenny that day rave about how Warrior Mothers “fix” their autistic children. The boy deduces from this that since he is autistic and has a mother that perhaps his mother has already “fixed” him or maybe she will “fix” him in the future.

The mom realized that it wasn’t good for her son to see himself as a broken thing, or as a fixer-upper not quite good enough as is. The mom says she has decided to be a different kind of Mother Warrior now. She will continue to make sure her son gets the skills he needs to do the best he can. She will be one that fights for acceptance of her son and her family as they are.

I’m fighting for my son to be the best he can be…without being made to feel like there is something wrong with him being the way he is.

I would say this was an example of the law of inintended consequences. Jenny “Look at ME!” McCarthy’s statements are so often over-the-top, so shallow and ill-informed and so often self-contradictory. (What is it that cured Evan Asher this week? Diflucan for a raging yeast infection or just a few simple changes in diet and a few vitamins?) I believe she and her air-headed supporters can only make so many extreme and unethical comments about children in the national media before it starts to sink in to normal people that children are being spoken of abusively. I hope there will be a huge backlash because of Jenny’s exploitative, exhibitionist, anti-acceptance, anti-truth, anti-kindness, anti-child, anti-public-health putsch. I hope that backlash brings people to a point where they take a stand, visibly, and make declarations firmly on the side of autistic people as the mom who made this video did.

Thanks, Dinah M., for pointing out the video.

Sunday Solutions – No. 5

19 Oct

Another review rather than tutorial this week. This time its an idea that seems really stupid – until you actually need and use it, and then its invaluable.

Simply Checklists does exactly what it sounds like, it provides a well thought out set of checklists for just about every situation you may need one for – from getting married, to baby sitter information to stocking a first aid kit.

Now you’re probably thinking (like I did the first time I saw it) – this is stupid, who needs this? But believe me, when you’re trying to get organised and you realise you’ve forgotten a key piece of the puzzle, this site will help you.

Now, this site doesn’t help with _autism_ checklists but it does help you take care of everything else, leaving you free to concentrate on the needs of the autistic person in your life (even if that person happens to be you). And of course, nothing is stopping us, the autism community, from maybe creating our own version of this site.

McCain courts the autism vote

16 Oct

If you watched the U.S. presidential debates tonight, you heard the “A” word a few times. Yep, Autism.

Senator McCain, who tripped up early in the campaign by giving credence to the thimerosal debate (and, yes, tripped up is accurate since he backed away fast from that stance), is courting the Autism community’s vote.

In discussing his running mate’s credentials to be president (should Mr. McCain for some reason stop being president), Mr. McCain stated:

She’ll be my partner. She understands reform. And, by the way, she also understands special-needs families. She understands that autism is on the rise, that we’ve got to find out what’s causing it, and we’ve got to reach out to these families, and help them, and give them the help they need as they raise these very special needs children.

She understands that better than almost any American that I know. I’m proud of her.

I wish Mr. McCain had more contact over time with the disability community. “She understands that better than almost any American I know”…I guess since she has a child with special needs and a young relative with autism, she has some experience, but wouldn’t it be nice if Senator McCain knew someone in the autism research community? (a guy can dream, can’t he?)

Actually, I really liked the way Senator Obama brought this back to one of his themes in his reply:

I do want to just point out that autism, for example, or other special needs will require some additional funding, if we’re going to get serious in terms of research. That is something that every family that advocates on behalf of disabled children talk about.

And if we have an across-the-board spending freeze, we’re not going to be able to do it. That’s an example of, I think, the kind of use of the scalpel that we want to make sure that we’re funding some of those programs.

For those who didn’t watch, there was discusssion earlier in the debate about a Senator McCain’s proposal for a spending freeze. Senator Obama made the point clear: cut smart, not blindly.

That said, I also liked how Senator Obama brought in the entire disability community. Yes, it was still child focused, but he did talk about “other special needs”.

I like how he sees research as a priority.

Senator McCain later stated:

And I just said to you earlier, town hall meeting after town hall meeting, parents come with kids, children — precious children who have autism. Sarah Palin knows about that better than most. And we’ll find and we’ll spend the money, research, to find the cause of autism. And we’ll care for these young children. And all Americans will open their wallets and their hearts to do so.

I wonder how many autistic adults were in his audiences? I wonder how many people with other disabilities (or family members with other disabilities) were in the audience.

Senator McCain may have thought that he was winning my vote, but he just lost it. Yes, disability issues, especially autism, play a role in my choice. But, this looks too much like pandering to the vaccine-autism crowd while doing the politician’s two-step around the sticky details.

I.e. it was “let’s use code words about the epidemic and vaccines to gather votes”.

I really hope I am wrong, but that was my read.

Senator Obama’s response really did speak to me, though. Focusing on funding research–and research for other conditions besides autism–spoke to goals that match mine, rather than an attempt to buy my vote.

The Los Angeles Times has a full transcript of the debate already.

Also, AutismStreet gathers his thoughts and types faster than I. There is a good treatment of this subject there.

here’s a taste:

She understands that autism is on the rise? Really? Can she clearly convey the distinction between more diagnoses, and an actual increase in prevalence? Does she understand diagnostic substitution? What about the broadening criteria and the changes in the very definition of autism? Does she really understand this? Or, is McCain pandering and simply parroting anti-vaccination and anti-autism advocate fundraisers’ “autism epidemic” rhetoric?

[added material]

I want to repeat: I really hope I am wrong about Senator McCain. Even if he loses the presidential bid, he is a Senator and someone we need to help in the probable lean years ahead–and beyond.

The Truth About Andrew Wakefield

14 Oct

Regular readers will know that an eminent UK scientist writes the occasional guest blog piece for LB/RB. Here is his piece in the wake of the the Lipkin/Hornig study and the amusing claim that it vindicates Wakefield. Enjoy – Kev.

A scientist who has followed the Wakefield saga from the start sets the record straight.

According to recent newspaper reports Andrew Wakefield is planning to publish his account of the MMR/autism controversy next year, under the title The Lesser Truth. He is currently facing charges of gross professional misconduct at the General Medical Council (the case is expected to conclude in April 2009). Meanwhile, Wakefield and his supporters continue to claim that his research is valid and continue to smear the investigative journalist Brian Deer who exposed the conflicts of interest and dubious ethics – as well as the junk science – behind the claims of a link between MMR and autism. But it was Wakefield who was obliged to back down in court from his libel allegations against Deer. Wakefield was unable to contradict Deer’s claim that he has been “unremittingly evasive and dishonest in an effort to cover up his wrong-doing”.

Here are some truths about Wakefield and his research that may not find their way into The Lesser Truth:

Wakefield was never a respected researcher. His first foray into the Lancet was a controversial paper in 1989 saying that Crohn’s disease was due to problems in the blood supply to the gut (vasculitis). But this was wrong. In the early 1990s he was funded by pharmaceutical companies for research along the same lines, mostly in animal models, and produced a series of low-impact, forgettable, papers.

Wakefield first courted notoriety in 1993 when he claimed to have identified measles virus in Crohn’s disease gut tissue. Coincidently, measles virus can cause vasculitis so it is easy to understand how, from 1989 onwards, Wakefield had to find measles in Crohn’s. We now know this result was not possible: there is no measles virus in Crohn’s disease and the antibodies Wakefield used were not specific for measles either. In Wakefield’s own lab, a good molecular biologist, Nicholas Chadwick, could not find measles in Crohn’s by sensitive molecular techniques. However, Wakefield said he could find measles, using crude techniques using flawed reagents. Suppressing data which ruins your hypothesis is scientific fraud.

In February 1996 Wakefield cooked up the idea that MMR was involved in autism with the solicitor Richard Barr and parent activist Rosemary Kessick. He wrote a research protocol to get into the children’s colons to look for measles virus and gut damage, and applied to the Legal Aid Board for £55K.

By October 1996, the Royal Free team had scoped enough children to provide Wakefield with tissue samples so that his technician could look for measles virus in the guts of autistic children by immunohistochemistry. This was clearly research, without clinical or ethical justification.

By spring/summer 1997 Wakefield had enough cases and enough creative data for his story. He believed that autistic children had gut inflammation and most importantly, he believed that he had discovered the cause – measles virus persisting in the gut from MMR. Wakefield first tried to get this study published in Nature but it was rejected.

Towards the end of 1997 he sent an abstract of this work to be presented at Digestive Diseases Week in the USA in May 1998. He also submitted two papers to the Lancet. The first was accepted and published as the now notorious February 1998 Lancet paper. The second, the study claiming to have identified measles virus in the gut by immunohistochemistry, was rejected. To see Wakefield’s pictures of measles virus in the guts of autistic children go here (slides 37 and 38). The second paper was never published and has now mysteriously disappeared, although Wakefield showed it all over North America for years.

In 2000, Wakefield published a larger series on “autistic enterocolitis”, the new disease he claimed to have identified (Wakefield et al 2000 Enterocolitis in children with developmental disorders. American Journal of Gastroenterology 95: 2285-95). Analysis of the data in this paper has revealed that it was a scam: autistic children do not have a chronic inflammatory bowel disease. Normal findings in children were called pathology, pathological results were re-examined and sexed up, and new abnormalities were manufactured, all to make it appear that these children had gut inflammation (MacDonald TT, Domizio P. Autistic enterocolitis; is it a histopathological entity? Histopathology. 2007 Feb;50(3):371-9).

As the litigation in the UK began to heat up around 2000, the defendants (the MMR manufacturers) started to ask simple questions, such as, where is the paper which shows measles in the gut of autistic children? This was part of the MMR/autism story that was rejected by Nature and the Lancet. Who knows why Wakefield never published it? Maybe he realised it was junk since at the same time his identification of measles virus in Crohn’s disease had unravelled. Maybe he knew that the experts for the defence had looked at the data and the methodology and shown it was junk.

Wakefield now hooked up with Dublin pathologist John O’Leary. O’Leary was supposedly an expert in an unsound and discarded methodology called in cell PCR, which he claimed allowed him to amplify measles genetic material in tissue samples, in this case, from the guts of children with autism, and identify its cellular location. He also set up PCR techniques to amplify measles from samples of gut. The O’Leary lab’s studies of Wakefield’s gut biopsy specimens were published in another notorious paper (Uhlmann et al. Potential viral pathogenic mechanism for new variant inflammatory bowel disease. J Clinical Path: Mol Pathol 2002;55: 84-90).

In his testimony to the Omnibus Autism proceedings in Washington in summer 2007, London-based molecular biologist Professor Stephen Bustin showed the utter incompetence of O’Leary and his lab. He revealed the fact that a result was called positive if the sample contained measles virus but no DNA (a biological impossibility). He also revealed that if they analysed the same autistic sample 6 times and got a positive once, the patient was deemed to be positive, even though they were also getting positive measles results out of samples of pure water.

It seems that O’Leary has belatedly seen the error of his ways: in the recently published Hornig study, his lab – in common with other labs in the USA – failed to find measles in samples from autistic children (Hornig et al 2008 Lack of association between measles virus vaccine and autism with enteropathy: a case-control study. PLOS One 3(9):e3140). The attempts by Wakefield and his acolytes to claim that the Hornig study vindicates the Uhlmann paper are preposterous. Distancing himself from Wakefield as fast as is possible for any man of 20 stone, O’Leary cleaned up his lab and did things properly.

A review of the career of Andrew Wakefield is a trawl through the underbelly of science. Wakefield did not do experiments to seek the truth – he did experiments to confirm his own beliefs. He produced junk science for over a decade and did immense damage to patients with Crohn’s disease, and autistic children and their parents. Hopefully the GMC will nail the charlatan, and show some sympathy for the Royal Free clinicians who thought Wakefield was honest. The Andy Wakefield show has now moved to the USA where he can get the attention he craves and he can play the role of the selfless seeker of truth whom the establishment had to silence. Being a victim is a good career move for him. It will help Thoughtful House sell junk therapies for autism to desperate parents and allow Andy to live in a really big house, where he can entertain his showbiz friends. He really wanted to be a famous scientist, but he was rubbish at that, so he had to become (in)famous by other means.

A pediatrician’s bill of rights

13 Oct

Since the publication of Dr. Offit’s Autism’s False Prophets, there has been the first signs of a pediatric fight back to the unending anti-vaccinationism of Team McCarrey et al. I did my best to encourage that feeling with my posts on the recent Science Blogs Bookclub discussion of Autism’s False Prophets where I made it (hopefully) clear that it was perfectly OK to loudly disagree with the caricature of the poor, pity-me autism parent if what they were espousing was clearly and obviously in contrast with international public health. I also made it clear (again, hopefully) that doctors and scientists need to get public and loud with their message. If that means hiring PR firms – so be it. But other options are to blog, to comment on other blogs, to write books, to write op-ed pieces.

I think I detected amongst the comments of the posts that Dr Offit, Orac, Kristina and myself made the signs of a scientific community ready to start fighting back. I really hope so.

Someone else who needs a mention is Ben Godlacre. His book ‘Bad Science‘ is my current read (thank you kindly benefactor 🙂 ) and I intend to give it a decent review when I’m finished. But its bloody good. I’ve already learnt things that had eluded me about the importance of random selection in science – if you’re a parent and want to find out how bad science can affect many things (including our choices to vaccinate) then you need to read it. Its good to see Ben taking his challenge to bad science up a notch.

Today, I read a page that underlined to me more than anything else that paediatricians – particularly members of the AAP – are fed up of being maligned as tools of ‘big pharma’, are fed up of being attacked, are fed up of being painted as being part of some giant conspiracy. They’re fighting back.

Given the crisis that pediatricians face in vaccine management, Cohen has devised a Pediatrician’s Bill of Rights that defends specific freedoms he feels are being trampled. These rights include:
• The right to refuse a vaccine refuser, under certain conditions
• The right not to split, delay, or miss shots, or deviate from standard community pediatric practice
• The right to ignore vaccine agendas and dictums that go against core pediatric scientific beliefs
• The right to practice the pediatric profession without interference from interest groups
• The right to promote the science of public health (including routine childhood immunization) without fear of retribution from anti-science groups
• The right to change policies and practices on childhood immunization based on newly validated research at any time
• The right to refrain from offering durable goods and vaccines to patients when acquisitions and overhead costs exceed contractually agreed-upon payments, and when good-faith negotiations fail to provide injunctive relief.

Good for them. This isn’t only a fight about autism, its about public health and no matter how many self-appointed ‘editors’ like to think otherwise, when it comes to the science and medicine of public health, the effects of vaccines and their bearing on autism, they know jack shit compared to a doctor. Please – listen to doctors about medical matters. Not super-rich organisations led by people who can’t recall from one interview to the next if their child is recovered or not. There is no conspiracy. Doctors don’t hate you. They don’t want to hurt you.

Sunday Solution – No.4 plus update

12 Oct

No PDF to download this week. Instead I want to post my own review after I saw one from Mashable today about the excellent Savvy Auntie website.

As the name suggests Savvy Auntie is a way to keep Aunties (and grandmas, grandads, uncles, cousins, friends – not to mention parents) very firmly in the loop as to what is cool for kids in terms of presents and gifts. You can sort by price, age, colour – even personality!

However, these are not the best bits of the site. the absolute best bits are the Social Web (Web 2.0 for you Old Skoolers) aspects of the site. They have given all users the ability to ask actual parents about the toy in question – quite reassuring. So you as a user can leave reviews, star products, recommend toys for particular sections such as the Special Needs section. There are also forums, blogs etc if you really want to get involved.

Savvy Auntie is basically Amazon for toys/gifts – but an Amazon that is organised, nicely laid out and easy to navigate. Its going to grow so getting in now will reap you dividends.

Now – a minor update. Left Brain/Right Brain has its own Twitter account but now for you radicals who don’t Tweet but do use something else, we’re there too – so if you use Meemi, Pownce, Gozub, Plurk, Identica, Rejaw or Hi5 search for user ‘lbrainrbrain’ and you’ll get our updates too.

Age of Autism use appalling scare tactics

11 Oct

In a recent post, the Age of Autism highlight the death of a baby girl where MMR was found to be a contributing cause. The US government settled with the parents, which is exactly what they should have done. The vaccine was at fault and this child died as a result.

But of course the anti-vaccinationists at AoA can’t leave it at that. They say:

God rest her little soul and comfort her parents, who tried to do right by her and ended up losing her. No, we don’t want to see children dying of preventable childhood diseases, don’t bother us with that canard. We also don’t want to see an ounce of prevention turn into a pound of death.

An ounce of prevention and a pound of death.

Lets establish a few facts shall we? The fact that children are dying right now of vaccine preventable diseases is no canard. Two have died in the UK since 2006 of measles. 345,000 died worldwide of measles in 2005. To belittle and dismiss the deaths of these people – mostly children – as ‘a canard’ is nothing short of evil. Using this little girls deaths to get a cheap shot in at a vaccine that has helped bring about a drop in worldwide deaths from 873,000 in 1999 to 345,000 less than a decade later goes beyond cynical to almost pathological.

What needs to happen for these people to see what it is they are promoting? Should we transport those 345,000 deaths from some dusty locale far, far away to New York? Atlanta? Washington DC? Manchester? Edinburgh? Would it seem real enough then to these soccer moms and weak men desperate to please their Mother Warriors? Would they still be burbling on about an ounce of prevention?

Lets have a look at the VAERS database for 2006. The year Madyson Williams received her MMR shot. According to VAERS there were 22 incidents involving ‘death’ and ‘MMR’. One of these reports stated:

the rpt stated info was recv as “hearsay” through small town grapevine

Another:

The reporter stated “a little girl up the street died after an allergic reaction to MMR.”

Another:

The consumer reported that she “heard of a patient who died after the second MMR shot.”

Another:

Information has been received from a consumer concerning her neighbor’s son who on an unspecified date was vaccinated with a dose of MMR II (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3). On an unspecified date, post vaccination, the patient developed autism and eventually jumped in a lake and died…….The reporter refused to provide information beyond what was on the VAERS form . The reporter refused to provide the name and telephone number of the actual parents of the child.

There is a type of person who seems to feel it necessary to make everything – everything – about them. I hate vaccines therefore ‘my neighbours son’ died of them. I hate vaccines therefore ‘a little girl up the street’ died from them. the AoA article shows exactly the same casual disregard for human life in pursuance of their agenda. Disgusting and immoral.

Too many falsehoods, too often

11 Oct

ResearchBlogging.orgThere are a number of falsehoods used in the vaccine-rejectionist arsenal. One, which we’ve discussed recently, is the idea that vaccine preventable diseases are in reality “not that bad.” Another is that deaths from vaccine preventable diseases were decreasing before vaccines were introduced, implying that the vaccines are getting credit for something that was already happening. Another is that somehow we are “overvaccinating” and that we can go back to an earlier schedule and be just fine. Another is that we vaccinate children too young.

We all know the current catch phrases. And that’s what they are, slogans, catch phrases…the efforts of marketing rather than science.

But, let’s take a look at a paper that covers a number of these falsehoods at once. This is an older paper, from 1994. The paper is National Trends in Haemophilus influenzae Meningitis Mortality and Hospitalization Among Children, 1980 through 1991.

As you can imagine, they were looking at the reduction in deaths and hospitalizations from meningitis caused by Haemophilus influenzae. This is what the Hib vaccine protects against. The first Hib vaccine licensed in the U.S. came out in 1985. However, it didn’t work for children >18 months of age, and had only moderate effectiveness for older children. A more effective vaccine was licensed in 1987 for children >18 months, and in 1990 for children >2 months.

Bottom line, good protection against Hib meningitis came to the U.S. in 1987.

So, if this actually worked, we should see trends changing about that time. Take a look at Figure 1 from the paper. (click to enlarge)

U.S. Hib deaths by year 1980 to 1991

The top trend is for Hib induced meningitis. The other two datasets are for Streptococcus pneumoniae and Neisseria meningitidis induced meningitis.

Note that the mortality was dropping with time before the introduction of the vaccine. Deaths declined by 40% from 1980 to 1987 (a span of 8 years) for Hib meningitis (with similar big drops in the other types). Dang. Good job, docs! But, that’s only part of the story. Take a look at what happens after 1988. Hib meningitis deaths drop at a much faster rate. After the introduction of the vaccine, Hib meningitis deaths dropped 90% in only 4 years.

But, you don’t have to geek out like me on the numbers, just look at that trend–in 4 years, Hib meningitis went from the highest cause of meningitis deaths, to tied with the lowest in this comparison.

That’s the sort of data that the mercury-causes-autism crowd were expecting to see in the autism rates starting a couple of years ago. (but, I digress…)

Note that there isn’t a change in the trends for the non Hib versions of meningitis graphed. It’s about as clear as data can get–introduce the vaccines, fewer people die. Note that the hospitalization rate is about 15x higher than the death rate. So, a lot of kids ended up in the hospital. I have to admit, I didn’t realize how really nasty this disease is. If about 1 in 15 of the people who go to the hospital die…well, dang, thank god there’s a vaccine.

I can already hear the response–but, why do we have to be so “aggressive” in giving these vaccines to such young children? Take a look at figure 3 from the paper.

Hib meningitis deaths for infants and young children 1980-1991

They broke the data down to infants (younger than 1 year old) and children 1-4 years old. Notice that the trend is the same for both age groups. More importantly, notice that the death rate is about 5x larger for the youngest children.

Yes, five times higher. But, protecting these young children is “aggressive”. If that’s aggressive, thank god for aggressive.

You may be wondering what prompted this little excursion to a paper from the 1990’s. Well, take another look at the citation:

Kenneth C. Schoendorf, John L. Kiely, William G. Adams and Jay D. Wenger (1994). National Trends in Haemophilus influenzae Meningitis Mortality and Hospitalization Among Children, 1980 through 1991 Pediatrics, 93 (4), 663-668

Note that one author, John L. Kiely? He recently wrote an Op-Ed for the Atlanta Journal Constitution on the importance of the MMR vaccine. Or, you may know him as EpiWonk.

But, to summarize:

Go back to the 1980 vaccine schedule? Had they not added Hib, thousands of kids would have died in the last 20 years. Many more would have suffered permanent injury.

We give too many vaccines? Based on what? Can we just do without the Hib?

Vaccines given too young? A 5x higher mortality rate for the youngest. Where’s the sense in delaying protection?

Vaccine preventable disease were becoming more manageable, so vaccines weren’t really doing anything. I guess if you believe in levitating dolphins, that argument works. For everyone else, the data are clear: vaccines work. They work well.

Autism and allergies

8 Oct

ResearchBlogging.orgAllergies are often a topic of discussion in the autism community. Much of the alternative- medicine approach works from the point of acting on allergies. I saw this paper and found it interesting, but wasn’t going to blog it until the PETA campaign (Got Autism) came up using the proposed sensitivity of autistics to casein.

The paper is Atopic features in early childhood autism, by B. Bakkaloglu, B. Anlar, F.Y. Anlar, F. Oktem, B. Pehlivantürk, F. Una, C. Ozbesler, and B. Gökler. As you might guess from the author list, this isn’t a U.S. or western European group. They are from Turkey. I have no reason to doubt the group’s quality, but that fact, together with the fact that the sample size is relatively small (30 autistic and 30 controls), suggests to me that this isn’t going to be the final word on this subject.

That said, the paper looks for allergic hypersensitivity (atopy) in a group of children with autism.

Here’s the abstract:

BACKGROUND: Autism is a developmental disorder of unknown etiology. Sensitivity to dietary and environmental antigens has been considered in its pathogenesis.

AIM: To examine immediate hypersensitivity in early childhood autism.

METHODS: We investigated 30 autistic children (23 boys, seven girls 2-4 years old) for atopic history, serum IgG, IgA, IgM, IgE levels, and skin prick tests (SPT) with 12 common antigens.

RESULTS: Nine/30 autistic children (30%) and 1/39 (2.5%) age-matched neurological controls from the same hospital had a family history suggestive of atopy (p<0.005). No patient in the autism and 28% in control group had symptoms of respiratory allergy (wheezing or asthma) (p<0.005), and 6/30 (20%) autistic vs. 7/39 (17%) control children had history suggesting other allergic disorders (p=ns). Eleven/23 (47.8%) autistic children had at least one positive skin test, similar to age-matched population controls. Serum IgG, IgA, and IgM levels were within age-appropriate limits. Serum IgE was elevated in four patients (13.3%). Specific IgE levels were negative in four cases with multiple SPT positivity.

CONCLUSIONS: This study suggests allergic features based on history, skin tests, and serum IgE levels are not frequent in young autistic children despite family history. This discrepancy between predisposition and manifestation might imply immunological factors or environmental condition

That gives away the punch-line: they don’t see a correlation between allergic features and autism. It’s still worth looking a bit closer at the paper.

They recognize that autism is a broad spectrum, so they attempted to look at a group that was fairly similar:

Many studies examined hypersensitivity or intolerance to environmental and food antigens in autism: however, their interpretation and comparison may be difficult due to methodological differences or anecdotal nature of the information. In addition, autistic spectrum disorders are a mixed group: inclusion of patients of various ages and clinical phenotypes can cause discrepancies, which we intended to avoid by studying newly diagnosed cases with idiopathic childhood autism in a narrow age range.

The study looked at very young children, ages 2-4. Autism was measured by a CARS test. Autistic children had scores from 33-50, with a median of 44.5. Since a score of 30-36.5 is considered “mild/moderate” autism, these data indicates that the children were largely in the “severe” range.

They found that 30% of the autistic children had familial history of atopy, compared with only 2.5% of the control children. However, autoimmune disease was not present in high numbers in the parents. Those two facts are interesting on their own, and if that was the end of the study, I wouldn’t be surprised if it popped up in autism discussion forums. But, another interesting finding is that the atopy is not found in the autistic children.

The questionnaire for allergic symptoms indicated familial atopy in 30% of autistic children and 2.5% of hospital controls (p<0.005) (Table 1). Taken together, 3/30 children of the autism group (10%) and 15/39 of the hospital controls (61%) had a score of at least 1 (p<0.005), and the rate of reported allergic symptoms was 6/30 vs. 7/39 (p:ns). Groups did not differ significantly in early-life environmental factors likely to affect allergic state: area of residence, day care attendance, breast feeding, and birth order. Parental autoimmune disease was present in two autism (vitiligo, psoriasis) and one control case (arthritis) (p:ns). CARS scores of the autism group were 33–50, mean 43.6, and median 44.5.

But, given that my interest level was higher due to the PETA ads using the proposed casein sensitivity of autistics, I wanted to see what sensitivities they found:

Of total 276 skin tests applied, 27 (9.7%) were positive, most commonly against aspergillus and grass antigens, followed by cat fur and D. farinae. Eleven/23 (47.8%) of children who received skin tests had a positive result with at least one antigen and five of them, with multiple antigens. House dust mite sensitivity was seen in three (13%), pollen, five (21.7%), and mold, in six (26%) children.

Serum IgG, IgA, and IgM were within age-appropriate limits according to laboratory standards. Serum IgE was elevated in 4/30 cases (13.3%), all associated with allergic symptoms in the patient or in a family member, or SPT positivity. Antigen-specific IgE tests done in four out of five children with multiple SPT positivity were negative.

So, mold (aspergillus), grass, cat fur and dust mites (D. farinae) were the top. Not casein, not gluten.

Again, do I think this is the last word on autism and allergies? No. But, I do think it is a good example of newer studies than, say, PETA’s reliance on a 1995 paper.

PETA appears to have wanted just enough data to justify their billboard. I join many in the blogging community who found the use of people with autism–the misuse, I should say–abhorrent. Kev has already responded in his own way. It took me a while to find my own, rather obscure, method of response.

I am grateful that the billboard has been pulled. I would hope that PETA would issue an apology as well. I’m not holding my breath.

B BAKKALOGLU, B ANLAR, F ANLAR, F OKTEM, B PEHLIVANTURK, F UNAL, C OZBESLER, B GOKLER (2008). Atopic features in early childhood autism European Journal of Paediatric Neurology, 12 (6), 476-479 DOI: 10.1016/j.ejpn.2007.12.008

Kirby launches torpedo at Verstraeten, sinks Geier

8 Oct

The thimerosal/autism study by Thomas Verstraeten is one of the big targets for those with the vaccines/mercury cause autism agenda. For what it’s worth, Autism’s False Prophets goes into the history of the Verstraeten study and clearly explains the history of that study.  Not surprisingly, the answer is somewhat different than you might find in, say, Evidence of Harm.

In his recent briefing on Capital Hill,  David Kirby took another jab at the Verstraeten study. He tried to assert that (a) the NIEHS claimed that the Vaccine Safety Datalink was unusable for autism studies and that (b) the CDC agreed. He was incorrect, and, luckily, a staffer caught Kirby at it.

Mr. Kirby is trying to explain his actions in a blog post in which he posts an open letter to that congressional staffer.

Let’s consider something here: the congressional staffer, an M.D., knew enough about the subject to catch David Kirby misquoting the NIEHS. I wouldn’t have been quick enough on my feet to catch the misquote.  Now, David Kirby wants to educate this gentleman. Frankly, the information should be flowing the other way. If Mr. Kirby had shown himself open to such education, say when EpiWonk made it abundantly clear (twice) what Mr. Kirby’s mistakes were, perhaps it would be worth the staffer’s time to discuss this with Mr. Kirby. That said, let’s take a look at Mr. Kirby’s letter.

In regards to Mr. Kirby’s misquotes, he has recently “clarified” his position.  He is writing to the Doctor who corrected him in his briefing here:

As you rightly pointed out (and as I concurred that day) I omitted an important detail in regards to Dr. Gerberdings’s letter to the Committee. I regret that, and never meant to mislead people in the room.

It was a rather artless sin of omission.

I think the lesson for me here is that, when you try to cram a two hour presentation into 25 minutes, it is wise to not include very complicated and, as you put it, “somewhat arcane” details that are difficult to explain in such a short period of time. In retrospect, I probably should have focused solely on the NIEHS report itself, and left the Gerberding letter out of the presentation entirely.

Mr. Kiby iscorrect, it is a confusing situation.  There are two documents–an NIEHS report and Dr. Gerberding’s response for the CDC. But, does that excuse misquoting the head of the CDC in his legislative briefing?

Here’s what David Kirby in his capital hill briefing “quoted” the NIEHS report as saying:

NIH: “We identified several areas of weakness that were judged to reduce the usefulness of the VSD for addressing the potential association between exposure to thimerosal and risk of ASD.”

That isn’t in either the NIEHS report or Dr. Gerberding’s response.  Here’s what Dr. Gerberding actually agreed to:

The panel identified several serious problems that were judged to reduce the usefulness of an ecologic study design using the VSD to address the potential association between thimerosal and the risk of AD/ASD.

Emphasis is mine.  But, we’ve already discussed that: Dr. Gerberding didn’t claim that the VSD has reduced usefulness in addressing the thimerosal/autism question. It made a claim that the ecological studies using the VSD had limitations. But, the recipient of Mr. Kirby’s letter would know that.

Back to Mr. Kirby’s open letter: David Kirby is now presenting his own interpretation of the NIEHS report, in place of Dr. Gerberding’s.

As I interpret things, the panel concluded that the database itself suffered from several weaknesses and limitations, which in turn reduced its usefulness for studies of autism risks from thimerosal (ie, Verstraeten) AND ALSO reduced the feasibility of future studies (ie, ecological ones) that are based on data collected within the VSD.

As EpiWonk aptly pointed out, Mr Kirby’s assertion is not the case. The NIEHS panel suggested a number of possible studies on autism using the VSD.  From the NIEHS report:

An alternate future study design that was viewed positively among panel members was a study of a high risk population, defined, in this instance, as siblings of individuals diagnosed with AD/ASD. A sibling cohort from the VSD would allow comparison of AD/ASD risk in siblings as a function of their thimerosal exposure through vaccination and the sample size would lend itself to supplemental data collection. A related study design based on sib-pairs or sets could be used to address discordant ASD/AD status in relation to thimerosal exposures. Another possibility that generated support by the panel was an expansion of the VSD study published by Verstraten et al (2004). The availability of several additional years of VSD data was seen as an opportunity to provide a more powerful test of any potential association between thimerosal and AD/ASD and would enable reconsideration of some aspects of the original study design (e.g., exclusion criteria). A related idea was to conduct a VSD retrospective cohort study using California-based MCOs linked with the California DDS, which would improve the diagnostic data and provide more complete ascertainment. For each of these designs, the ability to link medical records from mothers with those of their children was deemed critical.

As this reader interprets things, NIEHS seems to find that there is quite a bit of value in the VSD for studying autism, including an expansion of the Verstraeten study.

EpiWonk made the point first, but how can the NIEHS say that Verstraeten study design is not a good and that future use of the VSD is not useful, while at the same time suggest expanding Verstraeten?

The bottom line is that there are limitations to using the VSD alone in ecological studies of autism. One can overcome these limitations by going to chart reviews and other methods–as used in Verstraeten et al. and, more importantly, by VSD studies ongoing at CDC (one of which looks at autism).  As noted by Dr. Gerberding:

The VSD currently has a number of priority studies underway to address a range of important immunization safety questions, none of which utilize an ecologic study design. Instead, these current studies, including one study evaluating associations between thimerosal-containing
vaccines and autism, all evaluate individual-level data. This typically involves the review of individual medical charts to confirm the vaccines each individual received as well as the outcomes being studied. Studies using individual rather than group data provide stronger scientific evidence.

Mr. Kirby seems to be neglecting the fact that the CDC’s ongoing study (and the Verstraeten study) is not soley dependent on the VSD for the data.  He seems to be arguing that since the VSD, as a single data source, has limitations, the CDC can’t use it for any study. It’s like saying,

But, let’s take a closer look at what this says….and what Mr. Kirby is saying: The VSD on it’s own is not a good source of data to look at the thimerosal/autism question.

Now, anyone remember all the consternation that has been created by the fact that the VSD is not open to just any outside researcher?  Why should the VSD be opened to, say, Mark and David Geier?  Could they do the individual level data collection needed to make a VSD study valuable?

Apparently not. Recall this study by the Heather Young and the Geiers: Thimerosal exposure in infants and neurodevelopmental disorders: An assessment of computerized medical records in the Vaccine Safety Datalink

This was a study paid for by the petitioners in the Omnibus proceding.   It, on it’s own, was bad enough that EpiWonk disassembled it.  Twice.

The recent Heather Young/Geier paper didn’t look at individual level data.  Any future study by the Geiers almost certainly wouldn’t as well.  Given the argument by the NIEHS, Dr. Gerberding…and David Kirby, the above study and any proposed study by the Geiers on the VSD would be useless.

Some how I doubt Mr. Kirby will make statements confirming that. But, I can’t see how he could hold any other opinion, given the arguments he, himself, has made.

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