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Quick Q&A with APC study lead author

26 Aug

I recently blogged about a study that linked APC dysfunction with autism and learning disability. Two questions interested me so I wrote to lead author Michele Jacob to ask them.

Hi Dr Jacob,

My name is Kevin Leitch, I own and edit a popular blog on autism and am also father to an autistic daughter.

I found your recent study very interesting and had questions that I’d like to ask you and hopefully you’d give me permission to discuss your answer on the blog?

My questions are –

1) is there any set of circumstance in which APC dysfunction can occur ‘in the wild’ e.g. could a child be given something that then ‘turned’ them into an autistic person by negatively affecting APC function?

2) If there *is* , is there a way that this dysfunction might be reversed or at least modified somewhat?

My own take on this is that the answer to both questions would be ‘no’ but I have no understanding of APC function and a laymans understanding of genes in general.

Many thanks in advance for both your fascinating study and any time you can offer me in answering my questions.

She responded:

Hi Kevin,

Thanks for discussing our work in your blog. I am delighted our work interests you.

I think the short answer to both questions is no. The only way to cause APC dysfunction is via gene mutations. It’s function can be modified, enhanced or reduced, by signaling events in cells, but these changes are not large enough to have effects on behavior.

Loss of function mutations in the APC gene are inherited or occur sporadically. The symptoms associated with the sporadic mutations will depend on the cell type. APC is present in all cells of the body and it has several functions that are critical at different stages of development.

My lab is continuing to define the role of APC in the nervous system. Our goal is to define changes caused by APC dysfunction that lead to learning deficits and autistic-like behaviors.

Hope this information clears up your questions.

My best regards to you and your daughter.

So why did I ask these questions? Well, its been my experience that the antivax crowd leap on any science that seems to have an outcome that is linked to autism, to either trash it or link vaccines to it. I’m hoping Dr Jacob’s answers lead away from the possibility of linking autism to vaccines via APC dysfunction.

Review of the Introduction of Age of Autism – the book.

23 Aug

So begins the Olmsted/Blaxill upcoming book ‘Age of Autism’.

…instead of taking Kanner’s word for it, [we decided] to learn about these previously anonymous families ourselves. We took clues from his extensive case descriptions and started uncovering the identities of the original families. Time and again, we connected the occupations of the parents to plausible toxic exposures and especially to a new mercury compound first used in the 1930s as a disinfectant for seeds, a treatment for lumber, and a preservative in vaccines. Yes, the parents’ professions were clues— but not to their obsessions or their marriages or their parenting or their genetic oddities; instead, they pointed to a strikingly consistent pattern of familial exposures to the same toxic substance.

(emphasis authors, inserts mine)

This is the paragraph that sets the authors hypothesis out. When we look at it carefully, we can see exactly what its purpose is – its purpose is to fit a set of preconceived ideas that revolve around one central disproven hypothesis – that mercury in vaccines (thiomersal/thimerosal) causes autism.

I haven’t yet read the rest of the book but I’m pretty sure what I’m going to find. To talk about that now would just be conjecture however, so lets stick to what we have here.

According to Olmsted and Blaxill, syphilis treatment, hysteria, mental illness and a variety of modern illnesses are all caused by mercury. I’m very much looking forward to reading this section too. Olmsted & Blaxill use Pink disease (a definite form of mercury poisoning which looks nothing like autism to ‘justify’ the inclusion of these illnesses in the Introduction.

Blaxill and Omsted detail how they went on to meet “Donald T.” one of Kanner’s original cases:

By any mea sure, he has fared astonishingly well. President of his college fraternity and later the Forest Kiwanis Club, a pillar of his Presbyterian church, he had a long career at the local bank, plays a competitive game of golf, and regularly travels the world. We learned how “Donald T.” went from being the first unmistakable case of autism to the first unmistakable case of recovery.

So on one hand we have the doom and gloom of Pink disease (a foreshadow of autism according to Blaxill & Olmsted) which killed hundreds and then actual autism which doesn’t seem that bad. I’ll be very interested to see how Blaxill & Olmsted narrate Donald T.’s ‘recovery’…or could it have been that Donald T. was in fact one of the first cases of autism who also either moved ‘off the spectrum’ (as a certain percentage of autistic people do) or…y’know…he simply progressed as he got older. My guess is that Blaxill & Olmsted will reveal that Donald T. had some kind of miraculous exposure to a chelating agent or multi vitamins or some form of extreme biomed. Lets see.

The whole Introduction is about 6,000 words long. I can’t possibly attempt to review the whole thing and I won’t attempt to review the whole book either. These are the sections of the Intro that caught my eye particularly. Maybe others who have access to the Intro will tackle more. One thing you can be sure of, LBRB will be here to catch and expose the errors.

LBRB on Facebook

22 Aug

I finally got around to creating a ‘Fan’ page on Facebook for LBRB as an alternative to the Networked Blog. I do understand theres an unofficial page floating around but please consider this the official LBRB page.

Also please take the time to click the ‘like’ box (below on the right) to add to the number of fans LBRB has (currently…erm…1…me)

Communicating Effectively About Vaccines

4 Aug

A new study is looking at how messages regarding vaccines are assimilated by the US public.

Immunization rates continue to be high but concerns about vaccine safety are increasing. Current communication methods do not appear to lead to more comfort with vaccines, making it more important than ever that state and territorial public health agencies, charged with promoting, monitoring and tracking vaccine use, understand the growing reluctance among parents and guardians to fully vaccinate their children and identify effective messages about the benefits of vaccines.

According to this report 5% of all respondents mentioned autism-related concerns and above average amount of people designated the statement:

Vaccines can cause serious health problems like…autism

‘convincing’.

and the conclusion states:

…Current communication methods based on scientific research do not appear to lead to more comfort with vaccines…

Reading this blog post one would tend to think it was a bad report for vaccines. Far from it, its wholly positive, which one will gather if one reads the whole thing. However, the aspect of the report I’m particularly concerned with (autism) shows that there is a growing trend of belief and a shrinking trend of science in what leads a parent to make up their mind. And apparently autism plays a relatively large percentage in that decision making process.

So what do we do about that? The science is clear that vaccines don’t cause autism but the US public seem to be ignoring such science. What else is there available that we can use? Because take note, we in the autism community have an obligation to society as much as they do to us. Their obligation is to do right by autistic people. Our obligation is continue to fight the idea that vaccines cause autism. If we do not then the public will believe that *all* parents of autistic people and autistic people themselves believe that vaccines cause autism – thats a very dangerous place to be.

OSR#1

30 Jun

My own contribution is here, with less science and more snark:

Please leave your comments there or here, it doesn’t matter.

Urine test for autism? Hmmm

4 Jun

Following on from Lisa Jo’s well placed concerns about this study,I also have a few. Namely the references. Not being scientifically qualified to tackle the meat of the paper I look straight at what the researcher uses to support his ideas. So far I’ve found these references the authors base their paper on:

1) Kidd, P. M. Autism, an extreme challenge to integrative medicine. Part: 1: The knowledge base. Altern. Med. Rev. 2002, 7 (4), 292–316.

2) Ashwood, P.; Anthony, A.; Pellicer, A. A.; Torrente, F.; Walker-Smith, J. A.; Wakefield, A. J. Intestinal lymphocyte populations in children with regressive autism: evidence for extensive mucosal immunopathology. J. Clin. Immunol. 2003, 23 (6), 504–17.

3) Bolte, E. R. Autism and Clostridium tetani. Med. Hypotheses 1998, 51 (2), 133–44

4) James, S. J.; Cutler, P.; Melnyk, S.; Jernigan, S.; Janak, L.; Gaylor, D. W.; Neubrander, J. A. Metabolic biomarkers of increased oxidative stress and impaired methylation capacity in children with autism. Am. J. Clin. Nutr. 2004, 80 (6), 1611–7

At the very least, relying on studies from Alternative Medical Review, studies co-authored by Andrew Wakefield, studies from Medical Hypothesis and studies co-authored by Jim Neubrander should give rise to questions over the credibility of this paper. Is it enough to scupper it? Of course not. But when we take Lisa Jo’s questions into the bargain – that autism does not always, if ever, have a distinct GI component, I have to wonder about this paper.

Addressing the ‘too many too soon’ hypothesis

3 Jun

Regular readers may be aware that I blogged about a study recently that demonstrated the early stages of tackling the ‘too many too soon’ hypothesis. It came in for some fierce criticism in the comment section so I wrote to the lead author to get his thoughts. What follows is his answer to me via email:

Reviewing your blog, there are two related criticisms of our study.

First, I must clarify the conflict of interest comment. Though less relevant in my mind, it addresses the other limitations noted by your readers. This study was completely unfunded – not by any pharmaceutical company, not by the CDC. We did this all in our free time because of a simple non-financial “conflict” – as infectious disease physicians we take care of children who suffer needlessly from vaccine preventable diseases. This clarification of funding leads to point 2 – because we
did not have millions of dollars at our disposal we chose to use pre-existing data to address a common parental concern for which we could not find any evidence-based talking points.

This strategy had significant benefits – once we had the idea for this study we got right to work and did not have to wait 7-10 years to see what the outcomes might be. However, as we acknowledge in the discussion (and your readers point out), the use of pre-existing data also introduces limitations. We did not have control over which outcomes were tested, nor which children were included or excluded from the original study.

Nevertheless, I believe this study was accepted for publication in an academic medical journal because it offers a unique methodology that may be used to study the effects of delayed vaccination on any outcome of choice, whether it be the incidence of vaccine-preventable diseases or the proposed vaccine side effect du jour. Unfortunately, I do not have the resources to perform these studies myself.

A separate question – which is really a critique of the original NEJM study (with which I was not involved) and not ours per se – is why the authors chose to exclude the children they did. In the time since you e-mailed be I believe “Luna_the_cat” has explained this fairly clearly. Basically, the original study excluded children with brain injuries that would not have been related to vaccination (except for a few – pneumococcal and haemophilus influenza meningitis which vaccines PREVENT) and this seemed reasonable in the initial study. Furthermore, the majority of these exclusion criteria are prenatal or congenital diagnoses that would have predated vaccination anyway.

Finally, regarding lack of “controls”. This was not a “vaccinated versus unvaccinated” study, nor was it intended to be. It was designed to address the “too many too soon” hypothesis. Our “controls” were those children in the cohort who received fewer vaccines later during the first year of life. In this case the “exposure” was timely vaccine receipt – which was never associated with any adverse neurodevelopmental outcomes.

Blocking immunisation

2 Jun

The rise of a public anti-vaccine movement in the US is partly to blame for blocking effective immunisations according to the AAP today.

A story on WebMD says that the

…rise of a public anti-vaccination movement that uses the Internet as well as standard media outlets to promote its position, which is “wholly unsupported by any scientific evidence” linking vaccines with autism and other childhood conditions.

is at least partly to blame for ensuring that ‘pockets’ of unimmunised children exist throughout the US. Other reasons given include problems with cost.

Read the whole story at Web MD (@WebMd).

Andrew Wakefield – as succesful an author as researcher

2 Jun

Andrew Wakefields supporters were hoping his new book would be a bestseller. That ain’t going to happen given how much a publishing insider revealed to me how many he has actually sold:

He sold a total of 1017 copies. Top sales 157 copies in NYC. 46 in LA, 43 in Atlanta (perhaps CDC people wanted to see what he said?!), 38 in Boston, 24 in Chicago, 18 in Seatlle and 17 copies in his hometown of Austin

Ouch. It’ll be interesting to see how well the book does as interest in it fades. Or maybe ‘well’ isn’t the right word.

Anne Dachel, Age of Autism Editor, makes remarkable claim

27 May

I was browsing the comments section of a seemingly innocuous story about autism – that early intervention might not be the universal panacea once thought – when I came across a comment from Anne Dachel, one of the leading ‘thinkers’ and editors behind the online anti-vaccine blog Age of Autism.

…I think a disorder that was unheard of 25 years ago…

I had to read it a couple of times to make sure I was seeing it right – I was – Anne Dachel believes autism was unheard of prior to 1985.

To say this is a remarkable claim is being overly fair to Dachel. Its one of those claims that is regularly made by the Age of Autism team that leaves one’s jaw on one’s chest with the sheer audacity of either its boldness or stupidity. It reminds one of John Best’s claim that autism was unheard of in China prior to 1999. Another rampant piece of stupidity.

As previously noted, Dachel writes for Age of Autism. I’ll leave you to form your own conclusions as to the accuracy of their blogging based on their Editors own bizarre beliefs about autism.