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Online discussions discussing the recent CDC data “reanalysis” story

1 Sep

Educator/writer Liz Ditz often keeps a running summary of online discussions of trending topics. Below are some of her links. They are a few days old, but this gives you a starting place in case you wish to read multiple sources.

Posts discussing Hooker’s allegations, excluding anti-vaccine sources .

Timeline

August 8, 2014: Hooker paper published online

August 18, 2014: Focus Autism Press Release published online

August 18, 2014: Andrew Wakefield’s Autism Media Channel Video Alleging a CDC Whistleblower published online

August 22, 2014: Andrew Wakefield’s Autism Media Channel Video Naming William W. Thompson as “The CDC Whistleblower ” published online

  1. August 22, 2014,  Orac Knows at Respectful Insolence:  Brian Hooker proves Andrew Wakefield wrong about vaccines and autism

    Of course, the key finding in Brian Hooker’s paper is that Wakefield was wrong. Indeed, in this video, Wakefield even admits that he was mostly wrong about MMR and autism. Let that sink in again. He admits that he was mostly wrong about MMR and autism. OK, he says we were “partially right,” but the flip side of that is that he must have been mostly wrong.

  2. August 22, 2014, Reuben Gaines at The Poxes Blog: Andrew Jeremy Wakefield plays video director while African-American Babies die, or something

    Hooker is wrong in his assertions because the DeStefano paper did not leave out African-American children on purpose. Children were excluded from the analysis because of very legitimate and scientific reasons. They either were not the right age, did not have autism but some other neurodevelopment disorder, or were born outside of Georgia. Even if they were tossed into the analysis, DeStefano et al used a statistical analysis that took into account things like birth weight and mother’s age when analysing the data. They wanted to make sure that what they were seeing was most likely because of the MMR vaccine and not because of some other factor associated with autism.

  3. August 23, 2014,  Ren at Epidemiological: Directed Acyclic Graphs and the MMR vaccine doesn’t cause autism.

    I’m very skeptical that Dr. Hooker’s simplified statistical approach can be better than DeStefano et al’s approach of conditional logistic regression. Conditional logistic regression has the advantage of being able to control for a multitude of confounders and effect modifiers.

  4. August 24, 2014, Liz Ditz at I Speak of Dreams: L’affaire CDC-MMR: Hooker, Wakefield, and Focus Autism Accuse African-American Senior CDC Researcher of Being A Race Traitor

    According to Hooker, Wakefield, and Focus Autism, a respected senior African-American physician-researcher is a race traitor and a mass murderer.

  5. August 25, 2014, Orac Knows at Respectful Insolence: The central conspiracy theory of the antivaccine movement 

    I can imagine three main possibilities for what happened. The first possibility from what I know is that Thompson had some sort of disagreement with his co-investigators, made the incredibly stupid—yes, stupid—decision to unburden himself to Brian Hooker, who, he must have known or should have known, is an antivaccine crank associated with Andrew Wakefield, and is now paying the price for that decision… The second possibility is that Thompson wanted to correct something Hooker was doing with the data and somehow let himself be drawn into saying things that could easily be taken out of context. The third, and (I hope) much less likely, possibility is that Thompson’s gone off the deep end and gone antivaccine.

  6. August 25,2014, David Gorski MD at Science Based Medicine: Did a high ranking whistleblower really reveal that the CDC covered up proof that vaccines cause autism in African-American boys?

    “What [Hooker] has done, apparently, is found grist for a perfect conspiracy theory to demonize the CDC, play the race card in a truly despicable fashion, and cast fear, uncertainty, and doubt about the CDC vaccination program, knowing that most of the white antivaccine activists who support hate the CDC so much that they won’t notice that even Hooker’s reanalysis doesn’t support their belief that vaccines caused the autism in their children. Meanwhile, there is no evidence, at least none, submitted by the antivaccine propagandists flogging this conspiracy theory, that there really was a CDC conspiracy to hide anything.

  7. August 25, 2014, ToddW at Harpocrates Speaks, Andrew Wakefield Tortures History

    I want to focus on some statements made by one Andrew Wakefield, the British doctor who committed scientific fraud, resulting in the full retraction of his 1998 case series study on MMR and the stripping of his medical license. Wakefield boldly added himself to the list of not only torturing science, but now adds to his accomplishments torturing history and ethics (granted, we already knew he was ethically challenged). You see, in his videos (here and here) about the alleged “whistleblower”, William Thompson,Wakefield compared the purported “cover-up” to the Tuskegee syphilis debacle. It’s a false comparison used simply to inflame people and claim the race card.

  8. August 25, 2014, Michael Simpson at Skeptical Raptor, Great CDC Coverup–suppressing evidence that MMR vaccines cause autism? cross-posted at at Daily Kos

    It’s clear what’s happening here. Thompson, through sheer ignorance or total incompetence may have had a conversation with Hooker. Given the fact that the antivaccination gang lacks any serious scientific evidence supporting their dogma that vaccines cause autism, they jump on anything, however tenuous, that makes it appear that all of the evidence that refutes their dogma should be thrown in the garbage.

  9. August 26, 2014, Orac Knows at Respectful Insolence: Hey, where is everybody? The “CDC whistleblower” manufactroversy continues apace

    Here it is, Tuesday already, and the antivaccine underground is still on full mental jacket alert over the biggest story the antivaccine movement has seen in a while. Fortunately, it’s a story that’s been largely ignored by the mainstream media, which tells me that maybe, just maybe, the mainstream media has figured out that it shouldn’t give undue credence to cranks.

  10. August 26 2014, Sullivan (Matt Carey) at LeftBrainRightBrain Autism, Atlanta, MMR: serious questions and also how Brian Hooker and Andrew Wakefield are causing damage to the autism communties

    A study relying largely on a small group of subjects (about 20) with the conclusion that more work is needed. Sounds vaguely familiar. And, as we will see, Mr. Hooker has teamed up with Andrew Wakefield to put out a video where they jump past the whole this indicates more research is needed through this is absolute evidence of MMR causing autism directly to the CDC are engaging in a racist experiment sacrificing children to autism. It’s like the events around Mr. Wakefield’s 1997 Lancet paper cranked up to 11.

  11. August 26 2014,Lisa Lightner at Grounded Parents: the CDC vaccines/autism/coverup theory {spoiler alert-it’s not true!}

    a friend, a friend that I consider to be intelligent and reasonable….first posted a link to a CNN article. Correction–it’s iCNN…which is VERY different. ANYONE can post ANYTHING there. You can, really. It’s a crowdsourcing platform. Shame on you CNN for whoring out your name for page views. Because this is what happens–people will post just about anything…..

    I wish we knew the causes of autism, I really do. But vaccines ain’t it.

    Fear sells, don’t buy it.

  12. August 26, 2014, Reuben Gaines at The Poxes Blog: How to end a scientist’s career with some fancy editing

    As much as the anti-vaccine activists have been demanding that Dr. Thompson come out into the open and make some sort of a statement, no one seems to demand that Andrew Jeremy Wakefield and his team publish the entire recorded conversation between Brian Hooker and Dr. Thompson. All we get are lies and innuendo. We have operatives like Ginger Taylor writing on Twitter that CDC deliberately didn’t look at birth certificates for African-American babies in the DeStefano study.

    August 26, 2014: Anti-Vaccine Group The Thinking Mom’s Revolution Hosts a #CDCWhistleblower Twitter Party

  13. August 27, 2014 Karoli Kuns at Crooks and Liars: Rob Schneider’s Anti-Vax Crusade Now Enters Alex Jones Territory

    There’s nothing like a good conspiracy theory to get the creative juices flowing. For actor Rob Schneider, that means getting your dander up over your incorrect belief that the CDC altered data to bury the “fact” that MMR causes autism.

  14. August 27 2014, Sullivan (Matt Carey) at LeftBrainRightBrain Autism: Discussions of the recent MMR/autism paper (and why the study isn’t what the author wants you to believe it is)

    Below are a selected list of discussions about Brian Hooker’s recent paper and the highly irresponsible way he and his team are promoting it. Let me know if you spot one I should add to the list.

  15. August 27, 2014,  Orac Knows at Respectful Insolence: The CDC “whistleblower” manufactroversy: Twitter parties and another “bombshell” e-mail

    … just how desperate the antivaccine movement is to have Brian Hooker’s incompetent “reanalysis” of a ten year old vaccine safety study and Andrew Wakefield’s despicable race-baiting video gain traction in the mainstream media. The failure of this conspiracy theory to do so is driving antivaccine activists into ever-greater fits of lunacy online.

  16. August 27, 2014, Phil Plait at Bad Astronomy, Slate: No, There Still Is No Connection Between Vaccines and Autism

    There’s a conspiracy theory going around that the CDC covered up a link between autism and vaccines. From what I can tell, this conspiracy theory is on the same level as the one that NASA faked the Moon landings. And you know how I feel about that.

  17. August 27, 2014, ToddW at Harpocrates Speaks, Anti-vaccine Activists Throw Twitter Tantrum

    … the hashtag #CDCwhistleblower to do what really amounted to the social media equivalent of a temper tantrum, whining about how the mainstream media is not reporting on the study. It was really a sad display, as they simply all copied and pasted from the same list of talking points, not even adding their own interpretation.

    August 27, 2014, in the morning: The Journal Translational Neurodegeneration removes Hooker’s paper from the public domain

  18. August 27 2014, Sullivan (Matt Carey) at LeftBrainRightBrain Autism:The Brian Hooker article “…has been removed from the public domain because of serious concerns about the validity of its conclusions”
  19. August 27, 2014, Adam Marcus at Retraction Watch: Journal takes down autism-vaccine paper pending investigation

    An article purporting to find that black children are at substantially increased risk for autism after early exposure to the measles-mumps-rubella vaccine has been shelved, amid claims that a CDC whistleblower has accused health officials of suppressing information about the link.

  20. August 27, 2014, Reuben Gaines at The Poxes Blog: Even the bottom-feeding journals seem to have some sense

    ’m still left wondering how this paper got through peer review, or who did the peer review. They seem to not have bothered with checking the biostatistics or with looking back at the DeStefano paper.

    August 27, 2014, at approximately 2:30 pm, PDT, attorneys for William W. Thompson, the CDC employee, publish Thompson’s statement

  21. August 27, 2014: Ren at Epidemiological Dr. Brian S. Hooker gets the Andrew Wakefield treatment.

    My problem with Dr. Thompson’s statement is that the data were not omitted willy-nilly. There was a protocol that was established, and it excluded from the analysis children of different ethnicities, not just African Americans. In that exclusion, a vaccine-autism signal that was confounded by different factors was lost. It wasn’t lost out of bias but out of properly adjusting for different factors.

  22. August 28, 2014, Sullivan at LeftbrainRightBrain Andrew Wakefield betrays another “whistleblower” with Brian Hooker helping

    Apparently Mr. Hooker is unaware that the secrecy of confession is absolute. Priests, real ones, not self appointed ones like Mr. Hooker, have been known to go to jail rather than divulge what they’ve been told in confession. Real priests don’t record confessions so they can betray another.

  23. August 28, 2014, Debra Goldschmidt, CNN, Journal questions validity of autism and vaccine study

    Dr. Frank DeStefano, lead author of the 2004 study, said he and his colleagues stand by their findings. DeStefano said all the study authors, including Thompson, agreed on the analysis and interpretation before the study was submitted for publication 10 years ago. However, he said he plans to review his notes and will decide whether to run another analysis on the data.

  24. August 28, 2014, Reuben Gaines at The Poxes Blog, Autism is not death, unless you want it to be

    While the black ribbon can mean different things to different people, it’s main use is for grieving or remembering the fallen, the dead. The way that these people have used it is to try to bring attention to their cause by equating autism with a death or a loss.

  25. August 28, 2014, Orac at Respectful Insolence A bad day for antivaccinationists: A possible retraction, and the “CDC whistleblower” issues a statement

    Betrayals within betrayals. This can’t all be laid on Wakefield. Thompson was played. Big time.

Posts discussing Hooker’s allegations from anti-vaccine sources and those believing Hooker’s allegations  .

Timeline

August 8, 2014: Hooker paper published online

August 18, 2014: Focus Autism Press Release published online

August 18, 2014: Andrew Wakefield’s Autism Media Channel Video Alleging a CDC Whistleblower published online

  1. August 18, 2014, Jake Crosby at Autism Investigated: CDC Whistleblower Reveals Yet More Research Fraud
  2. August 19, 2014 Age of Autism at Age of Autism: Whistleblower Says CDC Knew in 2003 of Higher Autism Rate Among African-American Boys Receiving MMR Shot Earlier Than 36 Months
  3. August 20, 2014, Mike Adams at Natural News: Vaccine bombshell: CDC whistleblower reveals cover-up linking MMR vaccines to autism in African-Americans
  4. August 20, 2014, Age of Autism at Age of Autism: Senior Government Scientist Breaks 13 Years’ Silence on CDC’s Vaccine-autism Fraud
  5. August 20, 2014 Jon Rappoport at Jon Rappoport’s Blog Breaking: Breaking: MMR vaccine, autism, CDC coverup 
  6. August 21, 2014 Jon Rappoport at Jon Rappoport’s Blog: Vaccine-autism connection: US Congressman stonewalled by the CDC
  7. August 21, 2014 Jon Rappoport at Jon Rappoport’s Blog: Advice for the secret CDC vaccine whistleblower
  8. August 21, 2014: Mike Adams at Natural News:  CDC refuses to turn over documents to Congress: Evidence linking MMR vaccines to autism intentionally withheld from investigators
  9. August 22, 2014, Ethan Huff at Natural News, CDC whistleblower confesses to publishing fraudulent data to obfuscate link between vaccines and autism
  10. August 22, 2014, metamars at My Firedog Lake: CDC refuses to turn over documents to Congress showing MMR vaccines caused autism in black children (note: metamars’ blog post, not an official Firedoglake post)

    August 22, 2014: Andrew Wakefield’s Autism Media Channel Video Naming William W. Thompson as “The CDC Whistleblower ” published online

  11. August 22, 2014 Jon Rappoport at Jon Rappoport’s Blog: CDC whistleblower revealed: William Thompson
  12. August 22, 2014 Jon Rappoport at Jon Rappoport’s Blog: What CDC whistleblower William Thompson needs to do now
  13. August 22, 2014 Jon Rappaport at Jon Rappaport’s Blog Breaking: CDC whistleblower Thompson in grave danger now
  14. August 22, 2014, at TMR at Thinking Moms’ Revolution: CDC Whistleblower William Thompson Blows the Lid on Malfeasance and Fraud at the CDC
  15. August 22, 2014, Jake Crosby at Autism Investigated, Andrew Wakefield Betrays CDC Whistleblower
  16. August 23, 2014, Inquisitr CDC Whistleblower’s Claims Cause Uproar In Autism Community
  17. August 24, 2014 Jon Rappoport at Jon Rappoport’s Blog CNN iReport on CDC whistleblower spreads like wildfire, then censored
  18. August 24, 2014, Jon Rappaport at Jon Rappaport’s Blog Rob Schneider says he has smoking gun on CDC vaccine-autism fraud  (For beginners: Rob Schneider is an actor who has in the last few years become an anti-vaccine activist. Why he would have access to sensitive information is an open question.)
  19. August 24, 2014, Sally Colletti, Examiner:  Autism and The CDC: Now What?
  20. August 25, 2014, Kent Heckenlively, Age of Autism: A Break in the Wall – William W. Thompson
  21. August 25, 2014, Ethan Huff at Natural News: CDC whistleblower exposes massive autism cover-up perpetrated by government agency
  22. August 25, 2014, Mike Adams at Natural News: CDC whistleblower’s secret letter to Gerberding released by Natural News as mainstream media desperately censors explosive story
  23. August 25, 2014, Mike Adams at Natural News CNN caught red handed covering up CDC medical genocide of African-American babies (much handwaving over open-source reports at iCNN being changed or deleted.)
  24. August 25, 2014, Zorro at Thinking Moms’ Revolution: Stop Calling Us Crazy: Autism, MMR, and Institutional Gaslighting
  25. August 25, 2014, Megan Heimer at Living Whole CDC Whistleblower Comes Out and They All Play Dead
  26. August 25, 2014, Age of Autism at Age of Autism: Rob Schneider Demands Answers on CDC MMR Fraud
  27. August 25, 2014, Jon Rappoport at Jon Rappoport’s Blog CDC vaccine-autism fraud: what victory looks like
  28. August 25, 2014, Jon Rappoport at Activist Post: CDC whistleblower, watch out; here come the mothers
  29. August 25, 2014, Kelly Brogan at Kelly Brogan MD CDC: You’re Fired. Autism Coverup Exposed.
  30. August 25, 2014, Patrick “Tim” Bolen at the Bolen Report The CDC Whistleblower… The Story Mainstream Media Doesn’t Want To Run…
  31. August 26, 2014, JB Handley at Age of Autism: Knock-out Blow Needed: Dr. Thompson Must Speak Out on MMR African American Autism Connection.
  32. August 26, 2014, John Stone at Age of Autism:CDC Frauds: Connections Between the DeStefano Paper and the Thorsen Affair.
  33. August 26, 2014, Celia Farber, Epoch Times:  Whistleblower Reveals CDC Knowingly Put Children at Risk of Autism, Media Remains Silent (Video)
  34. August 26, 2014, Jon Rappoport at Jon Rappoport’s Blog CDC whistleblower is just the tip of the iceberg
  35. August 26, 2014 Mike Adams at Natural News EXCLUSIVE: Bombshell email from CDC whistleblower reveals criminality of vaccine cover-up as far back as 2002
  36. August 26, 2014, Age of Autism at Age of Autism: CDC Whistleblower on Thimerosal in Pregnant Women (note: video interview with Brian Hooker, not William W. Thompson)

    August 26, 2014, in the evening: Anti-vaccine Activists at The Thinking Moms’ Revolution Host a #CDCWhistleblower Twitter Party

  37. August 27, 2014, “Bobby Dee” at Gianelloni Family: Erased by a Birth Certificate
  38. August 27, 2014, John Stone, Age of Autism: The CDC: the Detective Agency Which Could Never Find Anything<
  39. August 27, 2014, Anne Dachel, Age of Autism: CDC Whistleblower Story: Danke to Franchi
  40. August 27, 2014, Marcella Piper-Terry, CDC Whistleblower and Probability of Post-MMR Autism Diagnosis
  41. August 27, 2014, Marcella Piper-Terry at Thinking Mom’s Revolution How Many African-American Boys Have Autism as a Result of the CDC’s Lies?
  42. August 27, 2014, Ethan Huff at Natural News: Congressman Posey discusses autism, vaccines and lack of CDC transparency in interview with Dr. Brian Hooker
  43. August 27, 2014 Mike Adams at Natural News: Media conspiracy to bury CDC whistleblower story protects vaccine makers at the expense of human life
  44. August 27, 2014, Jon Rappoport at Jon Rappoport’s Blog Update: CDC whistleblower in touch with members of Congress

    August 27, 2014, in the morning: The Journal Translational Neurodegeneration removes Hooker’s paper from the public domain

  45. August 27, 2014 Mike Adams at Natural News: Scientific journal censors Brian Hooker’s analysis of CDC vaccine data; the Church of Science orders ‘burning of books’
  46. August 27, 2014, Age of Autism at Age of Autism: Translational Neurodegeneration Removes Vaccination Timing Article

    August 27, 2014, at approximately 2:30 pm, PDT, attorneys for William W. Thompson, the CDC employee, publish Thompson’s statement

  47. August 27, 2014, Age of Autism at Age of Autism: Statement from William Thompson, RE Pediatrics MMR African American Males Data
  48. August 27, 2014 Mike Adams at Natural News: BREAKING: CDC whistleblower confesses to MMR vaccine research fraud in historic public statement
  49. August 27, 2014, The Event Chronicle at The Event Chronicle: CDC whistleblower confesses to MMR vaccine research fraud in historic public statement
  50. August 28, 2014 Celia Farber, Epoch Times Vaccinegate: CDC Whistleblower Admits Claims of Data Fixing Were True, Complains at Being Recorded and Outed

Other links

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Autism, Atlanta, MMR: serious questions and also how Brian Hooker and Andrew Wakefield are causing damage to the autism communities

26 Aug

The groups promoting vaccines causing autism have been handed probably their biggest story in a decade. They are claiming, and it seams likely, that a senior CDC epidemiologist came to them with information that a statistically significant result of possible increased autism risk from the MMR in a specific subpopulation was not reported.

I’ll go into a lot of background below, but if you wish to read up about these events:

Here’s the press release for the recent reanalysis study

Here’s a discussion of that study by an epidemiology grad student:
Directed Acyclic Graphs and the MMR vaccine doesn’t cause autism

And another discussion of that study from The Poxes Blog:
Andrew Jeremy Wakefield plays video director while African-American Babies die, or something

And Surgeon/Scientist Orac takes on the study and more here:
Brian Hooker proves Andrew Wakefield wrong about vaccines and autism

Educator and Advocate Liz Ditz discusses the PR approach that has been taken by those promoting the study here:
L’affaire CDC-MMR: Hooker, Wakefield, and Focus Autism Accuse African-American Senior CDC Researcher of Being A Race Traitor

And the CDC have a simple statement here:
CDC Statement Regarding 2004 Pediatrics Article, “Age at First Measles-Mumps-Rubella Vaccination in Children With Autism and School-matched Control Subjects: A Population-Based Study in Metropolitan Atlanta”

Even with multiple press releases and no doubt other efforts to gain media attention, this story has yet to break out into a mainstream news story. Some alternative news sources and many parent supporters of the vaccine/autism idea have discussed this lack of media attention. And there’s a YouTube video by Andrew Wakefield that I’ll embed below. That video deserves and probably will get it’s own article here on Left Brain/Right Brain. It is remarkably bad.

It has often been said that the parents promoting the idea that autism is a vaccine-induced epidemic are their own worst enemies. As the parent of a multiply disabled autistic child I can say without reservation that these groups are no friends to the majority of the autism parent community either. Nor are they friends to the real majority of our community: autistics. The vaccines-caused-an-autism-epidemic parents have refused to support any research which goes against their idea that autism is a vaccine-induced epidemic. They don’t support research into the prevalence of autism in adults. Likely because they worry that this will show that their epidemic idea is false. In the process we lose the chance to learn from the previous generations of autistics about what has worked and what has not. Information which is critical to this autism parent. These groups have failed to accept that the lower prevalence of identified autism in racial and ethnic minorities indicates that the prevalence numbers we so often hear are not the a true count of the fraction of our population that is autistic. Because to admit that is to admit that they are misusing the numbers they rely upon to claim an epidemic. Their lack of support has hindered attempts to improve identification and get appropriate services for autistics in racial and ethnic minorities. This is a point that is incredibly ironic given the way these groups are framing their recent news as you will see (or have seen if you read Ms. Ditz’ article linked above). On top of this they have produced a way over-the-top PR campaign about their news, demonstrating their deep hatred for the CDC. If I were to tell you that Andrew Wakefield is claiming that the CDC are worse than Adolf Hitler, Josef Stalin and Pol Pot (because, you see, in Mr. Wakefield’s eyes at least those dictators were sincere), would you believe me? Would you think I was making this up? If I said that Mr. Wakefield has played the race card in a disgusting way, claiming that the U.S. vaccine program is a new Tuskegee experiment, would you believe me? You can skip down to the bottom if you want to see that discussion and video. I’ll start with the science.

About 10 years ago a team from the CDC published a study: Age at First Measles-Mumps-Rubella Vaccination in Children With Autism and School-Matched Control Subjects: A Population-Based Study in Metropolitan Atlanta (full paper here). They took data from the CDC’s Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP). In order to control for potential confounding variables–like mother’s age, birth weight and more, the authors of the MMR follow-up study pulled birth certificate records. They only pulled them for kids born in Georgia. Could be there was a logistics issue (trying to track down records across the country) or if birth records were not consistent across the US. Also, they would have had to find control kids for those born outside Georgia, and that would have been a big logistics issue. In the end there were two analyses presented–one on the raw data with all the kids, and one with a more detailed analysis done with this smaller “birth certificate” cohort.

Here’s an example of one of those analyses (click to enlarge):

DeStefano table 3

This is a good table to review this study. What did they find? The general result is that time of MMR vaccine receipt was similar between autistic kids and non autistic kids, but was statistically more common among autistic kids. In the table above we see that for the most part, the sub groups reported had generally no increased risk of autism with MMR. I.e. in most examples the 95% confidence intervals encompass 1. The unadjusted sample “all cases” and “boys” do not encompass 1. If those were all the data we had, we’d say “let’s look more closely at these”. We’d start with exactly what the authors do–check for confounding variables and see if the effect gets bigger or smaller. In the adjusted data, all the odds ratios encompass one. Some are high enough to warrant a closer look: kids aged 3-5 and boys. Combining these two I’d probably ask, “what about boys aged 3-5”, but the authors take on the age 3-5 question in general in the discussion citing that the 3-5 age group autistics were mostly in special ed preschool and were thus required to have MMR.

If you look at Table 5 (click to enlarge) you see an interesting and very strange trend. It was in the other data but it’s really clear here. The odds ratio is much larger for kids who got MMR before 36 months than for kids who got it before 24 months. The odds ratios still encompass 1, but there is something going on in the data for the kids who got vaccines between 24 and 36 months. And by “something going on” we always have to consider social factors. But take a look:

DeStefano table 5

Take, for example, maternal education. Kids with mothers who had more than 15 years of education had an odds ratio of only 0.61 if their kids got the MMR before 24 months, but that odds ratio jumps up to 2.76 if their kids got the vaccine before 36 months. In both the confidence intervals encompass 1, so we can’t say “MMR before 24 months is protective but MMR before 36 months increases risk”. But that difference is striking. Even if these results were statistically significant, it doesn’t make sense to say, “the MMR vaccine causes autism in kids when it is given between 24 and 26 months if their mothers are well educated. And, by the way, it’s protective if given before 36 months.”

While not as striking, the differences between the unadjusted and adjusted analyses in table 3 are notable. Odds ratios change when you take into account other factors. I’m no epidemiologist, but if this isn’t covered in epidemiology 101 I’ll be stunned. In physics (the field of my Ph.D.) we talk about “hidden variables”. You see one thing correlated with another but in reality a third, “hidden”, variable is actually causing the association.

That said, the CDC MMR paper is not a study without limitations (no study is). One major limitation was the need discussed above–to argue why the 3-5 age group kids had a higher prevalence.

At this point researchers (both the study authors and those reading this paper) and advocates can take a number of approaches. Here are 4:

1) They can say, “yep, that’s plausible enough. We’ve worked this dataset enough. This tells us that MMR doesn’t cause autism. Let’s move on from MMR.”

That didn’t happen and rightfully so. This isn’t a particularly strong study. It’s not the final word and I don’t think it was intended to be. It was a relatively quick study using an existing population. In the end there were more studies on autism and MMR.

2) Advocates and researchers could take the approach: “There’s an association there, but these data are too limited to really answer the question of causation. Can we do a study to nail down if there’s something about those kids born in those specific years (the 3-5 year olds) who got the MMR between 24 and 36 months? Maybe look at further subsets?” And, while it’s easy to say with hindsight, this is the approach that should have been taken in my opinion. I am unaware of work by this team of researchers or external researchers which addressed this question. I am also unaware of calls by the autism community to do such a follow up, by the way.

3) Advocates and/or researchers could say, “I think we can tease more out of these data. Hey, CDC, can I have that dataset to review myself?” Because the CDC did make these data available for serious researchers to review. CDC researchers moved on to other topics in autism and vaccines, but other researchers or qualified advocates could have taken this up.

4) Advocates (not so much researchers I suspect) could say, “I don’t trust the CDC to add 1 and 1. Give me those data and I’ll do the analysis myself. Even those areas where you show a lack of association are probably wrong.” And, yes, there are advocates like that. Well, except that no one asked for the data back then. More recently, though someone did. Which leads us to:

An autism parent and strong proponent of the failed mercury hypothesis, Brian Hooker, recently published a study re-analyzing that old CDC dataset on MMR and autism. His financial backers put out a press release claiming that not only does this study show that vaccines cause autism in a specific subgroup, but that this study was prompted by a CDC “whistleblower”. I.e. someone who was inside CDC and knew about the details of the CDC study was in contact with Mr. Hooker.

That’s a pretty dramatic press release. Let’s take some time on it.

Focus Autism Releases Findings on 2003 CDC Autism Study – Higher Autism Rate Among African-American Boys Receiving MMR Shot Earlier than 36 Months
Focus Autism releases their findings of a possible reduction in the sample size of a major 2003 study conducted by the Centers for Disease Control and Prevention. This sample size reduction negates statistically significant findings from the study.

This title is why I jumped to the press release before talking about Mr. Hooker’s paper. With this title we know (a) that Mr. Hooker is claiming an association among a specific subgroup only (African American boys) and (b) he’s claiming that there was some sort of sleight of hand by the CDC where they reduced the sample size.

Well we already know from the CDC study that autism rates were higher in kids who got the MMR before 36 months. It’s right there in the conclusion statement of the abstract. But not so much before 24 months. And we know autism rates were higher in boys. We didn’t see the analysis narrowed down to African American boys.

The press release states:

“However, CDC researchers did not include any children that did not have a valid State of Georgia birth certificate – reducing the study’s sample size by 41% . Dr. Hooker explains that by introducing this discretionary criteria into the analysis, the cohort size was sharply reduced, eliminating what would have been a higher statistical finding. ”

This is a rather odd statement. And by odd, I mean so obviously false that I wonder why it was written. See for yourself above, the study includes *both* the group with the birth certificate data and the raw data. Mr. Hooker’s explanation is, well, lacking. Sure, it is “discretionary” to try to account for confounding variables. It’s the sort of discretion I expect from epidemiologists. It’s like saying, “the engineers designing the Tacoma Narrows bridge decided against including the discretionary criteria of wind”. Also, consider that a result can be both statistically significant and wrong as is often the case when one finds something “statistically significant” without looking for or correcting for hidden variables.

In another press release Mr. Hooker calls the birth certificate data “irrelevant and unnecessary”. Again, why put out statements that anyone familiar with epidemiology would know to be false?

Elsewhere Mr. Hooker has even challenged the fact that one can obtain the stated data from birth certificates. He is in effect stating that not only is there no point in controlling for such factors, but that the CDC just lied and didn’t even have those data from the birth certificates.

Despite your assertions and the assertions of Destefano, Birth Certificates do not contain the information on the covariates you cite: birth weight, maternal age, maternal education, parity, etc. If you had read my paper, you would see that I repeated the analyses of the CDC and obtained the same results that they obtained in both what was published originally and what was withheld. Also, the birth certificate restriction was NOT applied to other race categories outside of African Americans.

Readers interested in whether Mr. Hooker is correct can take a look at the U.S. Standard Certificate of Live Birth. While this is the revised version, states standardized on birth certificates back in the 1990’s.

Epidemiologists are aware that the piece of paper a parent takes home isn’t necessarily the same birth certificate data that is in the full record.

And “Also, the birth certificate restriction was NOT applied to other race categories outside of African Americans”. Here we see the race card being played. A card that we will soon see was played with a very heavy hand. But to address the assertion made by Mr. Hooker, I wonder how he explains that there are 333 white autistic kids in the “total sample” and 199 in the “birth certificate sample”. Which is to say, his statement is false.

In one of the press releases, Mr. Hooker states

When asked if there could be any scientific basis for excluding children born outside of Georgia, Hooker responded, “I know of none, and none has been provided by the authors of the DeStefano study.”

Again, children born outside of Georgia were not excluded as Mr. Hooker asserts. Analyses were presented on both those born within Georgia (including adjustments for vital statistics found on the birth certificates) and a total sample including those born outside Georgia (the unadjusted analysis). If Mr. Hooker is “unaware” why people would do such an elementary epimiological task as adjusting data with covariates, I suggest he was a poor choice to perform Focus Autism’s study. Another thought would be that Mr. Hooker could read his own paper where he states:

It should be noted that a recent publication has shown that the prevalence of autism in African Americans is nearly 25% higher than that of whites. This value was obtained when CDC data were appropriately analyzed based on socioeconomic status

Mr. Hooker notes that when one does an analysis “appropriately” one includes socioeconomic status (such as with data found in the full birth certificates).

If Mr. Hooker would like to ask why the CDC team didn’t look for birth certificate data on kids born outside of Georgia, that’s would be a better place to start. Then we can discuss whether the CDC would then need 3 controls for each non-Georgia born kid, controls from the same place of birth as the study team did with Georgia born kids. And we could discuss how difficult that would be. And whether that would introduce more problems than it might solve. That’s a reasonable discussion. Claiming there’s no reason to gather important data is not.

Enough of the inconsistencies in Mr. Hooker’s recent statements. What was Mr. Hooker’s method and what did Mr. Hooker find in his analysis? The Poxes Blog and
epidemiologcal.net discuss this with more expertise than I can. Mr. Hooker does not recreate the CDC’s case-control study. That would require that match autistic kids and non autistic kids on the parameters he says aren’t available, and adjust for those same parameters. Instead he does a cohort study without adjustments. As discussed elsewhere, this is a much weaker approach. His main result is as the press release states “Higher Autism Rate Among African-American Boys Receiving MMR Shot Earlier than 36 Months”. He does not note in his press release “no risk for MMR and autism in everyone else”. Here is table 2 from his paper showing that.

hooker table 2

He states a relative risk that is statistically significant for African American boys who get the vaccine before 24 months (RR=1.73) and before 36 months (RR=3.36). No increased risk for African American girls. And, as Table 3 shows, no increased risk for non African Americans.

Mr. Hooker says his results are statistically significant. Others have questioned whether his analysis is really appropriate to say this, but for now let’s just benchmark this by checking how large his sample group for that large relative risk is anyway. Just so we know. The high risk group are kids vaccinated before 36 months. Here’s a figure from Table 2 of DeStefano et al.:

DeStefano table 2

There are 45 autistic kids vaccinated between 24 and 36 months. African Americans account for 40% of the total population, but let’s say about 1/2 of this 24-36 age group are African American. Or about 22 kids. 22 kids and Mr. Hooker is doing no adjustments for factors such as those found on birth certificates. The sort of socioeconomic parameters that he notes are important to get an accurate prevalence in the African American population.

Which is to say: this is not a strong finding by any stretch of the imagination.

Mr. Hooker took a subgroup–African American males–and found that there was in the unadjusted data a statistically significant relative risk. An increased relative risk is not the same thing as showing causation, especially when you are working with unadjusted data and many other limitations in this. This is enough to raise the question of whether we should do more studies to show if this increased risk holds up to further scrutiny. This is how Mr. Hooker concludes his paper:

Routine childhood vaccination is considered an important public health tool in reducing the morbidity and mortality associated with infectious diseases. However, consideration should be made in the current United States vaccination schedule for genetic subpopulations that may be associated with vaccine adverse events. Additional research is required to better understand the relationship between MMR exposure and autism in African American males.

A study relying largely on a small group of subjects (about 20) with the conclusion that more work is needed. Sounds vaguely familiar. And, as we will see, Mr. Hooker has teamed up with Andrew Wakefield to put out a video where they jump past the whole this indicates more research is needed through this is absolute evidence of MMR causing autism directly to the CDC are engaging in a racist experiment sacrificing children to autism. It’s like the events around Mr. Wakefield’s 1997 Lancet paper cranked up to 11.

Even though Mr. Hooker’s analysis is quite limited, as in it would be (and you will see is) incredibly irresponsible to jump from this to say “MMR Causes Autism in African American Males”, I’d like to see either more data or a good explanation why someone shouldn’t do it. If for nothing else, precisely to head off the sort of irresponsible and damaging PR campaign that Mr. Hooker and Mr. Wakefield have engaged in. There are a lot of data on MMR and autism since DeStefano first published (especially Hornig et al.) showing that MMR doesn’t increase autism risk. And Mr. Hooker himself has shown that autism risk is not raised in everyone other than African American boys. One can easily argue (and should) that the MMR/Autism/African American Boys result is spurious. But I’d like to see more evidence to support that. I don’t see evidence so far that this is fraud, but I don’t agree with the scientific decisions made.

All this said, can reasonable people really raise a concern about autism risk given how inflammatory that discussion can be? Yes. Here’s an example of how a study found a possible risk factor and follow up studies answered the question. The Price study was one of the largest studies on thimerosal exposure and autism risk. As part of that study they considered folic acid intake in mothers as one confounding variable for thimerosal exposure. They reported that there could be an increased autism risk from taking folic acid. The calculated risk for mothers who reported taking folic acid was about double that of those who didn’t. Keep in mind that folic acid supplementation for pregnant women is a major public health program as it reduces the risk of some developmental disabilities, so the possibility that it was increasing autism risk has major public health implications. This is a good parallel to the question of vaccines (public health program) and autism.

After the Price study, multiple studies were performed looking folic acid intake and autism risk (I can’t say that these were prompted by Price et al., but it seems reasonable to think they might):

Maternal periconceptional folic acid intake and risk of autism spectrum disorders and developmental delay in the CHARGE (CHildhood Autism Risks from Genetics and Environment) case-control study.

Association between maternal use of folic acid supplements and risk of autism spectrum disorders in children.

How can we summarize the folic acid history? A possible risk factor was found. It wasn’t plausible since folic acid seems to be protective for birth defects. But people did a second check (and even a third) and found that not only is folic acid not a risk factor, it may even reduce autism risk. Which even though this is what people would have said was biologically the most probable outcome at the start, this was a needed exercise.

Can we draw a parallel? Well, DeStefano et al. and later Hooker found a possible risk for MMR and boys (with Hooker citing African American Boys) getting the MMR vaccine late but before 36 months. It doesn’t seem plausible or even self consistent with the other results of the study dataset as has already been discussed. Reasonable people could move forward on this and see if existing data could answer this or if a new study is warranted.

Reasonable people could. As I’ve alluded to, we aren’t really dealing with a “and reasonable people” scenario. And here’s where we get into the “these people are their own worst enemies” part of the discussion. We’ve already seen how Mr. Hooker has made incorrect statements about the birth certificates of the DeStefano study. Let’s look another of Mr. Hooker’s statements and ask, “is this the statement of a reasonable person”?

He added, “The exclusion is reminiscent of tactics historically used to deprive African-Americans of the vote by requiring valid birth certificates.”

And here we see Mr. Hooker and Focus Autism playing the race card for sensational effect. One can’t even say this is a stretch. It’s just ridiculous. There was no exclusion and certainly people didn’t say, “let’s exclude African Americans and deny them their rights.” Maybe some will say this still within the realm of what a reasonable person might say. I would then ask you to watch this video produced to promote this study and the events surrounding it. The really inflammatory statements are made by Andrew Wakefield, but this looks to be a joint effort between Mr. Wakefield and Mr. Hooker. If Mr. Hooker would like to explain that he disagrees with the approach Mr. Wakefield took, I’ll be quick to rewrite this. But for now, here’s what team Wakefield/Hooker has prepared for you:

As promised above here are Andrew Wakefield and Brian Hooker claiming that the CDC are running a Tuskegee like experiment, where in Mr. Wakefield’s view African American boys are allowed become autistic by MMR for some nefarious and unexplained reason (because there are so few autistics that we need to create some for study?). I suspect Mr. Hooker will take offense at me stating that he is claiming this as it’s Mr. Wakefield who says the words. OK. Go ahead and put out a statement distancing yourself from this irresponsible attack Mr. Hooker. And, yes, I wasn’t exaggerating when I said that Mr. Wakefield thinks that the CDC are even worse than Hitler, Stalin and Pol Pot. The dictators, you see, were sincere. (8:40 into the video).

No one has yet responded in the mainstream media to the press releases and the Hooker study. And many of Mr. Wakefield’s supporters online are noticing this and asking why. Here are some possibilities:

1) The press has been burned by 17 years of bad science and unethical behavior by those promoting the vaccine/autism link.

2) perhaps the most famous person in that bad science and unethical behavior is your spokesperson on this new media campaign: Andrew Wakefield.

3) members of the press are not generally attracted to stories where people who have devoted their lives to preventing infectious diseases and to understanding developmental disability are called worse than Hitler.

4) after years of a campaign to instill fear about vaccines, we are in the midst of outbreaks of multiple vaccine preventable diseases. The founder of the blog where Mr. Hooker chose to release and discuss his new results famously once bragged that his groups was going to bring the “U.S. vaccine program to its knees

Mr. Wakefield and Mr. Hooker probably (and some of their followers certainly) have been wondering why their news of a CDC “informant” hasn’t garnered media attention. If you read the press releases and have followed the online discussions, you know that the idea for this reanalysis of the DeStefano data came from documents obtained by Congressman Issa and from phone conversations Mr. Hooker had with a CDC epidemiologist.

In their first press release, Mr. Hooker’s team noted that

According to Dr. Hooker, the CDC whistleblower informant — who wishes to remain anonymous — guided him to evidence that a statistically significant relationship between the age the MMR vaccine was first given and autism incidence in African-American boys was hidden by CDC researchers.

That was released on a Tuesday. The video came out the Monday previous, but was censored and the voice of the “informant” was obscured. On that same Monday, Mr. Wakefield noted on his Facebook page “He will be identified very soon” (referring to the “informant”). In other words, they had no intention of keeping this man’s identity secret. And a few days late, on Thursday night, the video was changed so that the censoring was gone and the voice was not obscured.

So, we have an informant who was obviously working with the Hooker/Wakefield team for months who wanted to remain anonymous. The Wakefield/Hooker team left clues about who this person was: they noted that he works for the CDC and has for some number of years and Mr. Hooker spoke of the informant as “him”. There are only two males who worked on that paper: W.W. Anderson Thompson (who has been named as the informant) and a statistician in the acknowledgments. Which of those two are on record within CDC as having voiced a strong opinion about the African American boy data? Heck, I nearly called Mr. Thompson myself to ask if he was working with Mr. Hooker. I wouldn’t be surprised if people at the CDC figured it out and that’s why his name was so quickly divulged by Mr. Wakefield. Why keep his name secret if you’ve already given out enough information to his superiors for them to break his cover?

And with that let’s get back to the “these guys are their own worst enemies” discussion. When you have someone you consider a whistleblower, it is your duty to protect that person. Not out him/her. Mr. Wakefield doesn’t seem to understand that. Years after having ignored the information given to him by a whistleblower in the UK, Mr. Wakefield not only outed that whistleblower, he first threatened the man with disclosure:

If Mr. Thompson intended to stay anonymous, and I have no reason to suspect otherwise, he chose poorly in his confidants.

Mr. Thompson had many options of to whom he could reveal his information. Many people would have taken him seriously and not taken the highly irresponsible approach that Brian Hooker has with the race-baiting video and more. I’ve read a number of people speculate that Mr. Thompson didn’t know what he was getting himself in to. If he really chose to work closely with Mr. Hooker, I can’t see how he didn’t see the extremes this information would be put to.

Mr. Hooker has had much communication with the CDC over the past decade and more. Here is some of that communication (about 3MB worth), selected by Mr. Hooker himself as an exhibit in his FOIA case with the CDC.
People at the CDC, likely Mr. Thompson included, would know of Mr. Hooker’s very strong opinions of them. A letter sent to then CDC Director Julie Gerberding is entitled “War Crimes in Your Fight Against Infectious Disease and recommends: “I would personally urge you to review the Book of Matthew 18:6 and consider your own responsibility to all children of the U.S. including my own son.” Italics in the original. Here is one version of Matthew 18:6:

But whoso shall offend one of these little ones which believe in me, it were better for him that a millstone were hanged about his neck, and that he were drowned in the depth of the sea.

Former CDC director Gerberding almost certainly did not share this with Mr. Thompson. But Mr. Thompson may have had similar exchanges with Mr. hooker in the past. As I’ve noted above, Mr. Hooker had at least some contact with Mr. Thompson previously. Also, one need only google Mr. Hooker’s name to see that he tends to exaggerate the importance of his CDC FOIA findings, his critiques of vaccine safety science are heavily biased, he is a board member of Focus Autism (Focus Autism was born out of Barry and Dolly’s desire to put an end to the needless harm of children by vaccination and other environmental factors.) and more.

Brian Hooker and Andrew Wakefield present at parent conventions such as AutismOne, where other presenters are selling their goods and services with faux autism treatments. Treatments such as bleach enemas and drinks (MMS), Lupron (a drug which shuts down sex hormone production. Essentially chemical castration), chelation, megadoses of “supplements” and more. They are sold largely on the promise of healing “vaccine injury”. By handing the Hooker/Wakefield team this PR win, Mr. Thompson will be feeding that industry.

This all said, we only have a few sentences on a video purporting to be Mr. Thompson. I have no reason yet to doubt that his his voice. I also don’t have the full conversations in context. Nor do I have evidence that Mr. Thompson agreed to be outed. Nor do I have evidence that Mr. Thompson agreed to have his phone conversations recorded. Nor do I have evidence that Mr. Thompson continues to communicate with Mr. Hooker. In fact he’s been silent since this story broke and no new quotes from him have been passed by Mr. Hooker or Mr. Wakefield.

What’s more, and rather odd, is that MMR is not really either Mr. Thompson nor Mr. Hooker’s primary interest. Mr. Thompson was author on a number of major thimerosal papers. First author on one. Mr. Hooker’s primary focus on the vaccine/autism discussion has been on thimerosal. I have been reading people online claiming that these events are what they’ve expected and hoped for: someone from CDC exposing that all the vaccine/autism work is fraudulent. But this isn’t the case at all. Nothing so far on thimerosal. One re-analysis of some MMR work that, while important to discuss, is not very strong at all. And while I have written what is possibly my longest article yet (out of something like 2000), there isn’t, as they say, much there there when it comes to anything substantial about vaccines and autism. What we do have is a public relations mess. A story that will be exploited by unethical people to frighten parents and try to revamp their own image and take some revenge.

More recently, at least one (non reliable) site is reporting that Mr. Thompson has spoken through his attorney. The message (and I paraphrase): in getting the preliminary result on African American boys out, he did what he set out to do.

In the end, it is once again public health and autism families that will pay the price. People will use this in their attempt to “bring the U.S. vaccine program to it’s knees”. More autism parents will be dragged into the self blame and guilt that comes with the vaccines-cause-autism beliefs. And disabled children will be subjected to abusive faux therapies in attempts to heal their “vaccine injury”.


By Matt Carey

Witnesses for Congressional hearing on autism announced

28 Nov

Thursday the US House Committee on Oversight & Government Reform will hold a hearing on autism: 1 in 88 Children: A Look Into the Federal Response to Rising Rates of Autism.

The witness list has been made public on the committee’s website:

Alan Guttmacher, M.D.
Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development
National Institutes of Health

Coleen Boyle, Ph.D.
Director of the National Center on Birth Defects and Developmental Disabilities
Centers for Disease Control and Prevention

Mr. Bob Wright
Co-Founder
Autism Speaks

Mr. Scott Badesch
President
Autism Society

Mr. Mark Blaxill
Board Members
SafeMinds

Mr. Bradley McGarry
Coordinator of the Asperger Initiative at Mercyhurst
Mercyhurst University

Mr. Michael John Carley
Executive Director
Global & Regional Asperger Syndrome Partnership

Mr. Ari Ne’eman
President
Autistic Self Advocacy Network

Severe Influenza Among Children and Young Adults with Neurologic and Neurodevelopmental Conditions — Ohio, 2011

17 Feb

Children with neurologic and neurodevelopmental conditions are at increased risk for severe outcomes from influenza, including death. Those aren’t my words. They are the first sentence in a new report by the CDC: Severe Influenza Among Children and Young Adults with Neurologic and Neurodevelopmental Conditions — Ohio, 2011.

Individuals with developmental disabilities are at a higher risk of harm or death from infectious diseases. They are also often more difficult to diagnose due to many factors including difficulties with communication.

The residents included a high percentage of individuals with great challenges. For example, of those with severe infections, nine had “do not resuscitate” orders (the reasons for this is not given).

All 13 residents with severe influenza had severe to profound neurologic and neurodevelopmental disabilities, including physical limitations (e.g., scoliosis, hemiplegia or quadriplegia, or cerebral palsy) (Table 1), and nine had “do not resuscitate” orders.

The story from this Ohio facility is bad on many fronts. An outbreak of influenza swept through the facility. 130 residents total. 76 residents had acute onset of respiratory illness. 13 were severely ill. 10 were hospitalized, and seven died.

All of those severely ill had the influenza vaccine. However, during the investigation it was found that the refrigerator that stored the vaccines was 27 degrees F. If the same temperature was in effect while the vaccines were stored, the low temperature could have inactivated the vaccine.

In other words, these individuals were given vaccines but they could have been rendered useless by the storage conditions.

Here is the abstract:

Children with neurologic and neurodevelopmental conditions are at increased risk for severe outcomes from influenza, including death. In April 2011, the Ohio Department of Health and CDC investigated an influenza outbreak that began in February 2011 in a residential facility for 130 children and young adults with neurologic and neurodevelopmental conditions. This report summarizes the characteristics and clinical courses of 13 severely ill residents with suspected or confirmed influenza; 10 were hospitalized, and seven died. Diagnosis is challenging in this population, and clinicians should consider influenza in patients with neurologic and neurodevelopmental conditions who have respiratory illness or a decline in baseline medical status when influenza is circulating in the community. Prompt testing, early and aggressive antiviral treatment, and antiviral chemoprophylaxis are important for these patients. When influenza is suspected, antiviral treatment should be given as soon as possible after symptom onset, ideally within 48 hours. Treatment should not wait for laboratory confirmation of influenza. During outbreaks, antiviral chemoprophylaxis should be provided to all residents of institutional facilities (e.g., nursing homes and long-term- care facilities), regardless of vaccination status. Residential facilities for patients with neurologic and neurodevelopmental conditions are encouraged to vaccinate all eligible residents and staff members against influenza.

The story notes the relatively low efficacy of the influenza vaccine (about 60%). If the vaccines were compromised by low temperature storage, 60% efficacy could have saved 4 of the seven people. So called “vaccine safety” groups should be calling for more effective vaccines, not downplaying the need for vaccines using the 60% figure.

What are the take-away messages from this? For one, influenza *is* a serious disease. Especially to many in the disability community.

Further results from the thimerosal-autism study

14 Sep

The recent study on thimerosal and autism was extensive. Much data and many results were included in two technical reports (nearly 400 pages total, volume 1 and volume 2). I haven’t had the time to read them thoroughly yet, but I did catch some interesting pieces of information.

The authors give the ASD prevalence (cases/1000) as a function of HMO and year of birth:

This is pretty flat. No huge increase seen over that 6 year time span. No evidence for an “epidemic”. The prevalence is about 1.1%. This is consistent with the current value quoted by the CDC.

There are remarkably a big variation by parents educational status (63% kids born to mothers who graduated from college). However, since the researchers are working with kids who are enrolled in an HMO, it seems likely this is due to some bias. I.e. the HMO participants could be better educated (and higher income) than the average.

There are indications that increasing parental age is related to increased autism risk. 36% of mothers were in the 30-34 age bracket, 35% were in the 35+ age bracket. So, about 70% of mothers were over 30 years of age. They list father’s age with different brackets, but 79% were 30 years old or older at the time of birth of their child. Again, could be some bias due to HMO membership, but a large fraction of the parents were older.

Some children (both ASD and controls) received no vaccines. Many received vaccines but no thimerosal–i.e. all their vaccines were thimerosal free.

The use of prenatal vitamins is given as having an increased risk of autism, but the odds ratio is not given.

Being a first-born or second-born child has a significant increased risk for autism (hazard ratios of about 1.6). They may discuss this, but I don’t know right now how much of this is due to parents of autistic kids deciding not to have larger families.

One of the stranger results–there is an increased risk of autism when mothers were using prenatal vitamins with folic acid. The hazard ratio was 2.3 with a p value of 0.0176

Pica and childhood lead exposures had very high hazard ratios: 3.7. This is a good case where it is worth asking if this is causal–does pica cause autism or, as is more likely, does autism cause pica and, with it, higher lead exposures.

Poverty was slightly protective for autism (hazard ratio of 0.92). Again, one has to question if this is real or whether poverty just results in a greater likelihood that a child’s autism will be misdiagnosed.

The authors list coexisting conditions for the autistic, ASD and control children:

Epilepsy is much higher at about 5%, compared to 1.6% for controls. Reports of the prevalence of epilepsy amongst autistics are often much higher, though.

Developmental delay (by parent report) is at about 18% for autistics, compared to about 0.66% in controls.

Gi disorder prevalence is about 2% amongst autistics. It is the same (or slightly higher) for controls. This is very interesting given the anecdotal reports of a high prevalence of GI disorders amongst autistics. I suspect this will form some of the complaints about this study–some will say they aren’t looking at the correct population and that a specific study on autism/regression/GI complaints needs to be done.

Cases (those with ASD) were more likely to get thimerosal free HepB and HIB vaccines.

Infants in this study do not get flu vaccines (near zero). Unless that habit has changed dramatically in the past few years–and that most doctors are giving infants flu vaccines with thimerosal–flu vaccines are not likely to be a reason for the continued climb in autism prevalence.

There is a lot more information there. If/when I get the chance to give the reports a more thorough read I’ll post what I find.

Thimerosal in vaccines did not cause an autism epidemic

13 Sep

There have been two main theories linking vaccines to an “epidemic” of autism. Both theories have been studied. Both have been heard in the courts. Neither theory had a sound scientific basis and epidemiological data has shown that neither theories explained the increase in autism prevalence in the last 20 years.

First it was proposed that the MMR vaccine resulted in persistent measles infections that lodged in the intestines of children leading to “leaky guts” and that harmful substances were leaked into the blood, traveled to the brain and resulted in autism symptoms. This was proposed by Dr. Andrew Wakefield and has since been shown in epidemiological and other studies to be unsound. (This theory morphed for the Omnibus Autism Proceeding, the vaccine court. The argument there was that the measles virus itself traveled to the brain. Again, it is not supported by epidemiological data and is not scientifically sound).

The second theory was that mercury in vaccines from a compound called thimerosal caused autism. In that theory, it was proposed that autism symptoms were similar to mercury poisoning (autism was a “novel” form of mercury poisoning). This theory was not scientifically sound as autism symptoms are not like mercury poisoning. Previous epidemiological studies have also shown thimerosal was not behind the rising numbers of people diagnosed with autism.

In 2007 there was a study which looked at 1,000 kids aged 7-10 to see if various neurological symptoms were more prevalent in those who received higher exposures to thimerosal. Orac at Respectful Insolence blogged it and Kev posted that piece here on LeftBrainRightBrain as well. That study showed indications that in some measures children may perform more poorly with thimerosal exposure. It also showed that in some measures children may perform better with thimerosal exposure. This mixed result is (a) not very strong in either direction and (b) not very surprising when you look at a lot of different measures at the same time. Chance will result in some measures positive, some negative.

The 2007 study was published in the New England Journal of Medicine as Early Thimerosal Exposure and Neuropsychological Outcomes at 7 to 10 Years, by Thompson, et al.. (Thompson (2007))

What was missing in that report was a direct study of autism. Given the numbers of children (1,047) selected, there would only be about 10 kids with ASD expected in the group. This is too few for a strong conclusion on autism. At the time of that study it was noted that another study would follow concentrating on autism alone.

That study has just been published in the journal Pediatrics as Prenatal and Infant Exposure to Thimerosal From Vaccines and Immunoglobulins and Risk of Autism. They studied “256 children with ASD and 752 controls matched by birth year, gender, and [managed care organizations]”. I will give some details here. I expect the treatment on the Science Based Medicine and Steven Novela’s Neurologica blogs to cover the science thoroughly should you wish more detail.

Short answer: thimerosal exposure doesn’t cause an increased risk of autism. Neither thimerosal from vaccines given to the children nor thimerosal from products like Rhogam are behind the increase in autism prevalence we have seen.

It is worth noting that the authors looked at autism with and without regression.

Here is the abstract:

OBJECTIVE: Exposure to thimerosal, a mercury-containing preservative that is used in vaccines and immunoglobulin preparations, has been hypothesized to be associated with increased risk of autism spectrum disorder (ASD). This study was designed to examine relationships between prenatal and infant ethylmercury exposure from thimerosal containing vaccines and/or immunoglobulin preparations and ASD and 2 ASD subcategories: autistic disorder (AD) and ASD with regression.

METHODS: A case-control study was conducted in 3 managed care organizations (MCOs) of 256 children with ASD and 752 controls matched by birth year, gender, and MCO. ASD diagnoses were validated through standardized in-person evaluations. Exposure to thimerosal in vaccines and immunoglobulin preparations was determined from electronic immunization registries, medical charts, and parent interviews. Information on potential confounding factors was obtained from the interviews and medical charts. We used conditional logistic regression to assess associations between ASD, AD, and ASD with regression and exposure to ethylmercury during prenatal, birth-to-1 month, birthto-7-month, and birth-to-20-month periods.

RESULTS: There were no findings of increased risk for any of the 3 ASD outcomes. The adjusted odds ratios (95% confidence intervals) for ASD associated with a 2-SD increase in ethylmercury exposure were 1.12 (0.83–1.51) for prenatal exposure, 0.88 (0.62–1.26) for exposure from birth to 1 month, 0.60 (0.36–0.99) for exposure from birth to 7 months, and 0.60 (0.32– 0.97) for exposure from birth to 20 months.

CONCLUSIONS: In our study of MCO members, prenatal and early-life exposure to ethylmercury from thimerosal-containing vaccines and immunoglobulin preparations was not related to increased risk ASDs. Pediatrics 2010;126:656–664

My guess is that there will be much discussion of the methods on many websites. For now, here are the data from Table 2 and Table 3.

Table 2 (click to enlarge)

Table 3 (click to enlarge)

As with Thompson (2007) the authors will make longer reports available on their website and will allow access to the data.

This study is not the first of its kind. Here are a few of the large studies which have shown a lack of association between thimerosal exposure and autism in the past.

Thimerosal and the Occurrence of Autism: Negative Ecological Evidence From Danish Population-Based Data

Safety of Thimerosal-Containing Vaccines: A Two-Phased Study of Computerized Health Maintenance Organization Database

Thimerosal Exposure in Infants and Developmental Disorders: A Prospective Cohort Study in the United Kingdom Does Not Support a Causal Association

Autism and Thimerosal-Containing Vaccines Lack of Consistent Evidence for an Association

There are more.

One question is whether this will finally quiet those claiming an autism epidemic caused by mercury in vaccines. Unfortunately, I sincerely doubt it. This study included Sallie Bernard of SafeMinds in the acknowledgments. Ms. Bernard was also involved in the Thompson study of 2007. At that time she was listed as a “dissenting” member of the team. She submitted a letter to the NEJM discussing the reasons for her dissention, Perhaps the lack of the word “dissenting” this time is a good sign. I’ll wait and see.

The main question is how much impact this will have on the next generation of families with autistic children. I can’t but wonder that the age of the mercury hypothesis has seen its peak. Not only in research but in general acceptance.

New study: many vaccines at once OK for kids

24 May

A new study from Pediatrics has come to the conclusion that:

Timely vaccination during infancy has no adverse effect on neuropsychological outcomes 7 to 10 years later. These data may reassure parents who are concerned that children receive too many vaccines too soon

Lead researcher Michael J. Smith said:

Our study shows that there is only a downside to delaying vaccines, and that is an increased susceptibility to potentially deadly infectious diseases,

We hope these findings will encourage more parents to vaccinate according to the American Academy of Pediatrics schedule, and reassure them that they’re making a safe choice when they do so.

Lets hope so. Today is a great day in the forward momentum of the confidence in vaccines now that Andrew Wakefield has been struck off and this latest study can only add yet more weight that no vaccine, no vaccine ingredient and no vaccine schedule has _ever_ been shown to cause autism either directly or indirectly.

This is the first time that a study such as this has been carried out:

…nobody had studied whether getting several vaccinations in a short time could have negative consequences, for instance by overloading the immune system, as many parents believe, according to Smith. He found that receiving as many as 10 different shots — including flu and whooping cough — had no impact.

And a CDC spokesman said:

Parents that are considering delaying vaccination should realize that there aren’t any specific benefits, and that they are putting their child at risk, and not only their child but also the community,

An excellent point. The benefits of vaccination are not just personal but societal. Those who refuse to vaccinate not only risk the personal well being of their children but the society they choose to live in.