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TV might cause autism?

24 Oct

The blogosphere and certain Yahoo groups are _outraged_ by the idea that a study from Cornell University alleges that TV might have a role to play in autism.

The idea is pretty stupid. Basically, the Cornell guys are saying that because there’s autism in places where there’s lots of rainfall and because when its raining kids watch TV that autism has a link to TV. In fact, that piece of thinking goes beyond ‘pretty stupid’ and inhabits the landscape of ‘hilariously inept’. To give them their due they stop short of claiming a causative connection but they claim its a major piece of the puzzle.

We are not saying we have found the cause of autism, we’re saying we have found a critical piece of evidence

Guys – you _so_ haven’t.

Anyway, the merits of this study aren’t the focus of this post (hilarious as the study is, I couldn’t do better than Joseph’s takedown ). What’s interested me over the last few days are the outraged splutterings coming from a certain section of the autism community.

As they have dumbed down this society over the past generation and people took the history of science courses as opposed to pharmacology/pharmacology, all sorts of insane theories and mischief can emanate from a population of social/mental dingbats whose primary source of production is television shows as opposed to hard goods.

H Coleman, Evidence of Harm Yahoo Group.

First and foremost this is a perfect example of what happens when economists that know nothing of a medical condition try to find some statistical relationship between their beloved data and a condition.

The authors of this study made no effort to explain how TV watching could trigger chronic intestinal inflammation, toxic levels of heavy metals, inability to sleep, hard and bloated abdomens, food allergies or intolerances, and much more.

Kendra Pettengill, EoH Yahoo regular

I could go on but I think you get the idea. In a nutshell, the mercury militia are _not happy_ that TV has been linked to autism. Most of them are not happy because the study is totally ridiculous. On that I agree with them. Some of them are unhappy because they think its a study trying to put the blame back on parents in a bettlehiem-esqe manner. I think thats an overreaction but I can see what they’re saying.

However, a lot are unhappy because it refuses to recognise mercury as being ‘in the mix’. Thats as hilarious, predictable and sad as the study in question.

But I’m _still_ not making my point. My point is this. OK, this TV study is junk but here’s a question for you my mercury obsessed cherubs – what scientific merit does your vaccine/thiomersal/MMR theory have that elevates it above this TV study? I’m going to go right ahead and assert that the vaccine theory has no more causative evidence behind it than this joke of a study.

Both hypothesis have, at their core, an implausible correlation with a couple of self-congratulatory scientists dabbling with numbers that they want to twist to fit their theories. And that’s it. _No_ clinical evidence, no decent epidemiological evidence and a mainstream science community sniggering openly. What this TV theory needs is a bunch of credulous people to form pretentious sounding groups – SAFE TVINDS maybe or Notelly.org, then they can part-fund some crappy science to support the original crappy science, write books, organise marches on Hollywood instead of the CDC, get harvested by a whole new crop of quacks etc etc.

In all seriousness: mercury boys and girls – how you see the TV theory (a mixture of borderline tolerable amusement and offence to science) is exactly how the rest of the world see’s you.

What has autism ever done for us?

23 Oct

I was reading this article the other day where a therapist was detailing her attempts to reconcile a couple on the verge of splitting up due to the horror/abyss/hell/tsunami of autism. Its pretty depressing reading.

It’s a common refrain – how autism has affected someone’s life. Usually there’s a long list of how finances, relationships and life generally have all suffered since the diagnosis entered their lives.

To me, its all about how you approach the issues. Are you someone who sees the glass as half empty or half full? These were definitely half empty people.

I’d like to describe how autism has affected my life.

My wife and I will have been married 10 years next year. Something I consider quite an accomplishment in this day and age. We’ve had a lot of difficult times and rowed often. When Meg was diagnosed we were stunned, angry, hurting. However as we came to accept, we started talking to each other more. We started to back each other up more. We started supporting each other better. Autism didn’t only bring us a beautiful little girl, it brought us each other in a new way.

Naomi and I used to be members of a parent-oriented autism forum. There were a few good people there and a few drama queens. One couple used to complain that they now only managed to get away three or four times a year with each other for ‘little weekend breaks to Prague’. Well, boo-hoo. Poor them. I heard later that the husband of this couple had a nervous breakdown due to the stress.

Right. I hear less than five weekend breaks to Prague per year can do that to a man.

Please note: I’m not belittling anyone who genuinely has had a nervous breakdown. This guy whoever, was (is?) a primadonna without equal.

The last holiday Naomi and I had was our honeymoon. And I couldn’t possibly care less. Naomi has had a couple of breaks with the kids and her parents whilst I stayed here and worked as we couldn’t afford not to be earning. Whenever I hear biomed parents crying over the cost of all that TD-DMPS I roll my eyes and think of that old adage about a fool and their money.

Naomi and I watch DVD’s together, we talk together. We spend hours chatting after the kids are asleep. When we feel like celebrating, Megan and I walk into town, I buy some nice grub, a bottle of wine or three and after the kids are asleep (assuming they go to sleep) we put on nice clothes and have our nice meal with the TV off and the lights down. If Meg’s having a bad night, we take it in turns, a few hours each, to sit with her.

If Anthony’s over for the weekend then we sometimes play Monopoly or cards or we play along with Who Wants to be a Millionaire. I watch the American wrestling with Anthony on TV (possibly the funniest, campest thing on TV).

Because of autism, we found our family.

We have less money than we used to. I can’t pursue the heady heights of my career. Most web developers of my age and experience are head of design studios or successful freelancers. I couldn’t possibly care less. We have enough money to keep a roof over our heads, food on the table, clothes on our backs, the odd DVD collection (Prison Break Season One currently) in the player and lots of time. Because I’m not scaling the corporate ladder, I don’t have to stay late at work. I can get home before the kids go to bed. I can help my wife tidy up. Money can’t buy me the time I get to sit besides the bath as my two girls splash around in it before bedtime. Whilst my friends organise their working lives via their mobile phones, my wife’s sending me stills and video’s of the funny/cute things my kids are up to on mine.

Autism has made me more patient, calmer, confident, determined and considerate. I think I’m a better person and a better husband and father since Megan was diagnosed. So, to echo John Cleese’s classic ‘All right, but apart from the sanitation, the medicine, education, wine, public order, irrigation, roads, a fresh water system, and public health, what have the Romans ever done for us?’ I’d ask ‘Alright, but apart from a great family life, strong bonds with my wife, being a better husband, having the time to be a good dad and generally enjoying life, what has autism ever done for us?’

MMR and statistics and science

16 Oct

Measles Mumps Rubella Timeline

Now that we have a couple of clinical papers refuting the findings of Wakefield, Krigsman, O’Leary et al – and not only refuting them but even showing exactly how they screwed up – I thought a retrospective look at the data concerning the fall in uptake of the MMR vaccine corresponds to the latest data on prevalence for autism in the UK and what it might mean for the MMR theory.

This table shows vaccination uptake rates across England. I’m going to highlight the years 97/98 – 04/05. An eight year period that starts when the original Wakefield paper was released and ends with the latest set of known data from last year. I’ll also be ignoring everything except MMR data.

Year Uptake percentage
2nd birthday in 1997/98 91%
2nd birthday in 1998/99 88%
2nd birthday in 1999/00 88%
2nd birthday in 2000/01 87%
2nd birthday in 2001/02 84%
2nd birthday in 2002/03 82%
2nd birthday in 2003/04 80%
2nd birthday in 2004/05 81%

So we can see that MMR uptake _dropped by a factor of 10%_ in eight years. Thats a pretty sobering stat.

When we look at how many live births there have been between 1998 – 2005 (inc) we see that there have been a total of 4,959,995. Ten percent of _that_ figure means that 496,000 have not (for whatever reason) received the MMR. And if prevalence (as established by Baird et al) really is 1 in 100 then we should expect to get 49,599 diagnosis of autism since 1998 (1% of live birth rate).

But, if MMR proponents are right, then we _should not_ have 49,599.autism diagnosis. We should have 45,036 (49,995 (dx) – 4,959 (10% of dx)).

To put it another way – if MMR uptake has fallen by 10% over the last 8 years, then there should’ve been a corresponding 10% fall in autism diagnosis. Has there been?

Obviously not. Bill Welsh of the Autism Treatment Trust certainly doesn’t think so:

It will come as no surprise to parents throughout Scotland that there has been a “sharp increase in autism” (July 14). The diagnosis of this devastating childhood developmental condition has increased to such an extent since 1990 that many, many families are now affected. It is very worrying that it has taken well over 10 years for the authorities at last to recognise that an autism epidemic has been sweeping the UK.

And lets not forget Chakrabarti and Fombonne who also found a high but stable prevalence of autism in the UK. Both things cannot be true. If MMR causes autism then as MMR uptake has dropped off the rate of autism cannot possibly have remained the same, unless we want to try and find a substitute that not only acts in the exact same way as MMR but also slots exactly into the numerical data, rising as MMR falls. Possible but pretty unlikely.

Mark Geier, David Geier and the VSD

10 Oct

Introduction

One of the many anecdotal lynch pins of the Mercury Militia is the fabled story of what happened when the Geier’s attempted to study the VSD database.

Please bear in mind that to the Militia this story carries a *lot* of weight. It is one of the few supporting crutches left under the hypothesis that since thiomersal was removed from vaccines autism cases have gone down. Educational data has failed them. CDDS data has failed them. The Geier’s paper using VAERS (a non starter if they’d only thought about it) was so bad it couldn’t be published in a proper science journal and so this VSD story is all that’s left.

This story is enshrined in the hallowed pages of Evidence of Harm although the source of the story is unclear. Here’s the Militia version.

What The Geier’s Said

The VSD is the Vaccine Safety Database. This database carries raw data related to vaccine safety. The Geier’s were allowed access to this data, together with their computer expert Vale Kernik who would run the statistical programming tool in the SAS language that the CDC’s VSD uses. SAS is a widely used solution for statistical analysis.

The VSD’s Wikipedia page says that:

Only two outside researchers, Mark Geier and David Geier, have thus far gained access to the raw data. They faced formidable obstacles before being allowed into the CDC computer center, and then resistance from staff and software malfunctions once inside. Nevertheless, they reportedly found highly elevated risks for autism among children in the highest mercury exposure group. The Geiers study on the VSD, “A two-phased population epidemiological study of the safety of thimerosal-containing vaccines: a follow-up analysis” was published in the Medical Science Monitor in 2004 volume 11(4):CR160-CR170.

NB: This page has been edited by a member of the Geier household – against Wikipedia recommendations.

Evidence of Harm (the Kirby book) deals with the same event:

In late July the CDC informed the Geiers that the requested data set had been assembled. After paying a processing fee of $3,200, the Geiers were given two dates in August to come and run their studies. But there was another entirely unexpected wrinkle. Just two days before their appointment, a CDC technician called to make sure they were fluent in the programming language SAS, which is used in the VSD database. The Geiers had never heard of it before. “You must not be epidemiologists,” the technician said, “They all speak SAS.” If that were true it was news to the Geiers……Reluctantly they cancelled the appointment. It took two weeks to find someone who could run SAS…..They got new dates in October 2003… the dad, Vale Krenik, flew in from Texas. The were met by a woman who introduced herself and said she would be their “monitor

Evidence of Harm, p280 – 282.

And then things got very surreal. Their ‘expert’ programmer (who apparently taught himself SAS in two weeks) was stymied by the most dreaded sights for programmers – a command line interface.

How on earth can this be happening?” Mark muttered shaking his head, “Once again they got us.” Silence filled the room. There would be no number crunching today. The men stared at the screen.

Sorry. I’m being facetious. Any ‘expert’ who can’t work in a command line at even a very basic level is _not_ an expert.

The weirdness continued when the CDC monitor who was due to accompany the fearless trio for the duration of their stay popped her head out the door, looked both ways, came back into the room and:

She sat down and took a deep breath. “Don’t tell anyone this,” she said in a low voice, “But I can help you.”….I’m telling you, they know,” she said conspiratorially. “There’s a big problem”…..”The autism numbers are going down,” she said, “We are watching them drop.”

This mystery CDC monitor became known as ‘Mrs Toast’. Over on the EoH Yahoo Group, it was discussed why:

There is a woman who I refer to as Mrs. Toast. She is a CDC staffer who was responsible for monitoring the Geiers when they were instructed to visit the Vaccine Safety Datalink by Congress. When she saw the Geiers datasets, she walked out into the hallway, looked both ways, and came back into the room shutting the door behind her.

The Geiers thought they had epi-evidence. Mrs. Toast told them to look at hers. She told them she was responsible for running weekly autism datasets. She was instructed to run datasets on HMO vaccination adverse outcomes to see what effect removing thimerosal from vaccines was having on the epidemic. She had an affected child and made sure that the Geiers understood that the rates were dropping each and every week.

Author David Kirby had an interview set up, flew down to Atlanta, was in a car on the way to CDC to talk to her, but CDC had found out and they were threatening for end her career if she spoke to him.

When Congressman Dave Weldon found out about her not willing to blow the whistle on CDC’s cover-up he said, “THIS WOMAN IS TOAST!” Which is were I gave her the formal name of Mrs. Toast.

Robert Bloch, EoH Yahoo Group

Hilarious right? Mrs Toast.

And so, off trudge the Geier’s with their expert (the one unable to operate DOS). _Imagine_ their surprise when they get a letter from the CDC that said:

1) The Geier’s had violated the terms of their IRB
2) They asked how to merge datasets in a contradiction of the agreed terms of use of the data
3) They were told they couldn’t and yet they tried to anyway
4) If they had managed to merge the datasets they would have increased the risk of a breach of confidentiality.
5) The research team had attempted to rename data files to make them look like part of the SAS program (by changing the file extension to ‘.sas’)

As a result of this, the Geier’s IRB (Kasier) suspended them from undertaking any more data collection at the VSD.

The Geier’s responded by hotly denying these allegations. They first state that they didn’t violate the protocol but as Kathleen says in her exhaustive look at their reply:

The Geiers here claim to have followed the design of their research protocol, yet simultaneously acknowledge that they were attempting to conduct analyses of information not encompassed by it.

More amusingly, on page two of their reply the Geier’s state:

It is impossible for the datasets given to us by CDC to be merged

And then on page three of the same letter state:

What we were attempting to accomplish was to merge the datasets given to us by CDC to build a record…

And so the situation is now that the Geier’s pet ‘expert’ couldn’t figure out SAS, they had no meaningful results and what they did have was gained under extreme deception to the point their IRB approval was suspended.

And so, they decided to go ahead and publish anyway (well, you would, wouldn’t you?) and thus A two-phased population epidemiological study of the safety of thimerosal-containing vaccines: a follow-up analysis was born in 2005 (hereafter referred to as G05).

Geier, Geier, pants on fire?

G05 made reference to the VSD data that the Geier’s couldn’t collect/collected part of/pick your belief. In this respect it was similar to a paper written by ex-CDC staff member Dr. Thomas Verstraeten which _also_ used VSD data to look at thiomersal and autism in 2000. This paper (hereafter referred to as V00) found a statistically significant correlation between thiomersal and developmental disorders.

Oh no!!!! Doesn’t this back up the Geier’s et al?

Well, it _might_ except that as Verstraeten himself states in a letter to Paediatrics:

The CDC screening study of thimerosal-containing vaccines was perceived at first as a positive study that found an association between thimerosal and some neurodevelopmental outcomes. This was the perception both independent scientists and antivaccine lobbyists had at the conclusion of the first phase of the study. It was foreseen from the very start that any positive outcome would lead to a second phase. The validity of the first-phase results needed urgent validation in view of the large potential public health impact. Did the CDC purposefully select a second phase that would contradict the first phase? Certainly not. The push to urgently perform the second phase at health maintenance organization C came entirely from myself, because I felt that *the first-phase results were too prone to potential biases* to be the basis for important public health decisions.

Because *the findings of the first phase were not replicated in the second phase*, the perception of the study changed from a positive to a neutral study. Surprisingly, however, the study is being interpreted now as negative by many, including the antivaccine lobbyists.

So, in short, the first phase of the study using a small sample size indicated there might be an issue. When the second phase was undertaken with a larger sample size, the issue disappeared. Not uncommon in the slightest. Its standard practice to conduct a small, pilot study to see if there’s any issue to study further before committing large amounts of public money to a full scale study.

But I digress – back to the Geier’s.

They knew about the V00 paper – of course they did, it would be hard not to – and as they wrote G05 then they looked at it again. Remember that the Geier’s had struggled at the CDC VSD headquarters.

As Kathleen once again unearthed, the Geier’s – with a lack of VSD data at their disposal wrote their paper. It had some odd elements to it. Here’s a table of stats from the V00 pilot study:

And here’s a table of stats from G05:

Take a look at the numbers. Aside from one category they’re identical. Further the V00 paper states:

The final number of children thus included in our cohort was 109,993.

And G05 states:

The final number of children thus included in the cohort examined was 109,993

Woah! Spooky! By some miraculous, completely bizarre accidental coincidence, the Geier’s – who had little to no data from their visit to the VSD – have the _exact same cohort numbers and divisional figures_ as a paper written 5 years earlier resulting from a pilot study that showed a now debunked association!! What are the odds of _that_ ? I wish I knew a betting man who could tell me!

And maybe my betting amigo could tell me the odds of those same two papers having over ten more virtually identical passages and/or tables of figures? Maybe the Geier’s should drop the litigation gigs and move to Vegas and live on the strip.

A Different Interpretation

So here’s what _I_ think happened. Just conjecture but persuasive I think.

First of all, this odd SAS programming language. The CDC think its common amongst stat-fans. The Geier’s say its really really rare. Google says there are over four and a half million web related resources for SAS programming. That doesn’t sound pretty rare to me.

A leading SAS expert says:

Millions of people around the world in business, science, government, and education use SAS software to work with data. SAS software runs on many operating systems, including Microsoft Windows, UNIX, OS/2, Mac, MVS, and VMS. Most features of SAS software operate the same way in these different operating systems.

Still not sounding rare. In fact its one of the few apps that runs on Win, Mac and Unix. Not a good indicator of rarity.

And as for how quickly their ‘expert’ was defeated by SAS, SAS author Rick Astor states:

Fortunately, SAS programming is not that hard to learn.

Unless of course you’re a computer expert terrified of command lines. Vale Krenik is quoted and described on this page. His job (and former jobs) is described as:

Business Manager, Strategic Supplier Manager, Global Telecom Manager

It’s true that one of these roles has a techy requirement but absolutely _none_ can be swapped with the title ‘programmer’ or ‘expert’.

I think that the Geier’s needed someone who knew computers and settled on Krenik. When it came to it, Krenik didn’t know what the hell to do with SAS. If you’re reading this Mr Krenik, the three lines of code you need to merge datasets in SAS are available. I think they panicked and tried to grab as much data as they could in a brute force attack and then change the data files appearance to try and make them look like SAS files by renaming them with a ‘.sas’ extension.

I further think that the whole Mrs Toast episode is entirely fictitious. It even reads like a bad John Grisham novel. Bloch states that Kirby had an interview set up with the nameless Mrs Toast and that she cancelled at the last minute. Frankly, I don’t believe a word of it. I wonder who set up and then cancelled this meeting? One of the Geier’s by any chance? Does anybody know?

And then there’s the magically duplicated data. The Geier’s realised their VSD data landgrab had failed utterly and so they copied the data (and hence conclusions) from the V00 paper.

I don’t believe the Geier’s have ever seen VSD data. I don’t believe ‘Mrs Toast’ exists.

Our thanks and appreciation should go to Kathleen for the painstaking research she has assembled on the Geier’s. I know mine do.

Originally posted at Left Brain/Right Brain.

Crumbling science

3 Oct

Krigsman, Wakefield Error Highlighted

A study this month in Paediatrics tackles head-on the ‘science’ that is still yet to be published (a number of years later) by Arthur Krigsman in which he claims that he has found evidence of persistent measles virus in autistic kids and thus backing up the work of his business partner Andrew Wakefield.

In layman’s terms what this study did was replicate the result of Krigsman et al and then eliminate the poor science that led Krigsman to his erroneous conclusions. Of the samples that still showed as positive, no trace of MV was found.

The real-time assays based on previously published primers gave rise to a large number of positive reactions in both autism spectrum disorder and control samples. Almost all of the positive reactions in these assays were eliminated by evaluation of melting curves and amplicon band size. The amplicons for the remaining positive reactions were cloned and sequenced. No sample from either autism spectrum disorder or control groups was found to contain nucleic acids from any measles virus gene. In the nested polymerase chain reaction and inhouse assays, none of the samples yielded positive results. Furthermore, there was no difference in anti-measles antibody titers between the autism and control groups

Now thats pretty hardcore science language. I’ve emailed the authors to see if they are willing to explain (and be quoted) on an English translation of the above but in essence, the facts are as I state them above. Krigsman et al (and Wakefield before him?) failed to eliminate false positives and counted them as part of his result set. When these false positives are eliminated then the samples left contain no MV.

I’m hoping that Bart Cubbins, No Mercury, Maria, Ms Clarke et al (who are wise in the ways of this terminology) might offer more input into the meaning of the exact phraseology used and as I say, I’ve mailed the authors for clarification too. In the meantime – Krigsman’s (unpublished) work is now pretty much refuted (by published work).

Daubert’s Revenge – Martha Herbert

As reported by Autism Diva, Dr Martha Herbert has now reached the dizzy heights Boyd Haley and Mark Geier have scaled in having her ‘expert testimony’ found severely wanting following a Daubert hearing.

Herbert basically claimed that a childs autism (diagnosed by her following a differential diagnosis) was caused by mold. Yes, mold. However, upon being cross-examined:

When asked whether there is ‘any evidence that mold is a trigger [for autism],’ Dr. Herbert responded by referring to research regarding brain inflammation and immunological abnormalities in autism. Asked about research showing that ‘any of the mold or any of the mildew or any of those other things also cause brain inflammation,’ she responded ‘that’s a hole in my knowledge. In terms of autism, I don’t believe that’s been done.’

Right. Well, thank goodness she’s so rigorous. Wouldn’t want to just make assumptions right? That would just be a waste of everyone’s time right?

In another classic piece of thinking Herbert goes on to say:

Dr. Herbert commented, ‘she doesn’t have any of the known genetic syndromes, or known in-utero infections. I personally consider it symptomatic, but not in the established set of categories, in that I hope that when more research is done she’ll move in the symptomatic category.’

In other words she doesn’t know what caused the childs autism (gasp!) but that it doesn’t fit any known profile but that maybe some research at some unspecified point in the future might help categorise it (whatever ‘it’ is).

Oh, it gets better.

Dr. Herbert was asked, ‘[c]an you say to a reasonable degree of medical certainty that if Emilia Ward had been in a sterile environment, she would not suffer from autism” She responded, ‘My guess would be, yes, that she probably would not.’ The basis for that ‘guess,’ she testified, was ‘her having regressed after the mold exposure and that she gets worse with exposures.’

Wait… _guess_ – her _guess_ ? Well surely she meant ‘informed opinion’, or ‘scientific judgement based on the evidence to hand’…..except there _is_no evidence to hand:

In response to questions she acknowledged that she has never done any research on mold or mildew as an environmental toxin, and is not aware of any published peer review articles that link mold and mildew exposure to autism.

And so it is no great shock to find the court saying:

Dr. Herbert’s publications indicate that she is an outspoken advocate of increased attention to the possibility of environmental influences. Even she, however, despite that acknowledged perspective, speaks in her published work of possibilities and potentialities, rather than of the ‘reasonable degree of medical certainty’ to which she offers to testify under oath in this case.10 Neither Dr. Herbert’s publications, nor any others cited, identify mold exposure as even a suspected, still less a known or proven, trigger of autism……Dr. Herbert’s method, to the extent the Court can discern it from the materials offered, is a series of deductions based on possibilities…..*Clearly, Dr. Herbert’s method is not generally accepted in the scientific community*. Dr. Herbert’s theory of environmental triggers of autism may some day prove true. It has not yet. *Her proffered testimony does not meet the standard of reliability required by the case law*, and cannot be admitted in evidence at trial.

FDA Spanks Mercury Milita

Back in 2004, Dr Paul King of dr-king.com, uh, fame, submitted a ‘citizen petition’ to the FDA requesting:

[The FDA]…take numerous actions pertaining to vaccines and other FDA-regulated products containing thimerosal or other mercury-based preservatives….After review and consideration, we deny the petition for the reasons stated below in this response.

The response is very detailed (the whole thing is available at Kathleen’s site) but can be summed up in one quote:

The evidence on which your petition relies either does not support your requests, or is too flawed to be considered valid scientific evidence.

Which seems to be something of a growing refrain for the mercury (and apparently mold!) militia.

Damn science with its rigorous pursuit of accuracy eh? If only we could rely on opinions and guesses.

Just Sayin: Part III

26 Sep

A film/documentary will be released in Spring 2007 about the link (ahem) between mercury and autism. After viewing the trailer I thought that possibly an examination of same of the claims made and scare-tactics used might be in order. I kept a tally of the more obvious logical fallacies as the trailer progressed.

A little perspective

18 Sep

Parental beliefs about autism.

A study published this year looked at parental beliefs regarding the;

etiology, diagnosis, and treatment of autism spectrum disorders.

It found some interesting stuff that not only turned a spotlight on the beliefs of parents but also gave a little perspective to the ‘thiomersal/vaccine’ believers and the prominence (or otherwise) of their role in the wider community. It was also interesting to me as just over a year ago, I reported on a study that looked at the type of treatments parents used in connection with their autistic kids.

In that survey, detoxification (including chelation) was the least used treatment coming in bottom across groups of treatment and groups of autism ‘severity’ (as judged by the researchers). I was interested to see how things had changed after a year or so.

In this survey, 26% of parents believed there was a specific cause or contribution to their child’s autism. 45% answered ‘maybe’. That’s a frustrating example of a poor question. ‘Cause’ and ‘contribution’ are two very different things. It would’ve been better if the research team had separated those options. But that’s what we have.

In terms of those causes, vaccines and genetic predisposition stand almost neck and neck at 29% and 26% respectively. Other options included mother and/or child environmental insult, pregnancy complication, antibiotic taken by child, other medication and prem birth. Me? I’m with the 29% who obviously answered ‘I don’t know’. I’m not aware of anyone who thinks autism is strictly and only genetic and as we know the people who believe autism is strictly and solely vaccines are kooks like the John Best’s of this world. As far as I can see, the twin studies quite clearly demonstrate that genes _and_ environment play a part. Anyone who believes its definitely one or the other needs to clear their head and think again.

87% of parents reported having used a CAM (complimentary/alternative medicine) based therapy with the average number of treatments tried being 6.

This is the most interesting (to me) part of the survey. It’s like a look at the Spectrum of Biomed and based upon it I’m going to start classifying biomed based beliefs where Bio(Dtx) – which refers to the detox parents – is the most severe form of biomed and Bio(Diet) -which refers to parents who stop with GFCF etc – is the least severe. I really suggest you download this whole file and read the table on page 6.

First up we have the Bio(Diet). This is simply stuff like GFCF or other restricted diets. I can’t see what the issue with this is at all. I also can’t see how its an autism treatment particularly. Most kids would probably benefit from a reduction in carbs or sugars. My daughter has Aspartame banned from her diet. Not because we believe there’s a Illuminati plot to control the world via sweeteners but because it gives her headaches and makes her go hyper. I’m not keen on it myself.

However, we need to be clear – the efficacy of these diets is not in question (to me). What _is_ questionable is calling it an _autism_ treatment.

After that we have what I’m going to categorise Bio(supps). This is edging very slightly into woo territory now. Some of the stuff is probably useless but also non-dangerous (extra Zinc, Folic Acid etc). It may improve health, but does it ‘improve’ autism? I don’t see how. Also, the option ‘megadose vitamins’ is in this category and that treatment has been known to hospitalise autistic kids on at least one occasion.

After _that_ we get into genuine woo in a big way. This is Bio(Dtx) and encompasses the detox options like chelation as well as things like AIT and Homoeopathy as well as things I’d consider ‘nice’ but not ‘treatment’ such as music and dance therapy and swimming with dolphins.

Lastly, there are the Bio(meds) people. These are the people who use Neuroleptics and anti-depressants. Not sure we can call this woo as such but its definitely questionable as to merit.

Across those four groupings, the Bio(Dtx) crowd were in shortest supply. This was very reassuring to me. It gave me some perspective about how well represented this particular group were in the wider autism (not autistic) community.

They’re small. Things haven’t noticeably changed in a year. They still make up the smallest percentage of Biomed parents (chelation users stand at 13%, less than AIT users). Its a much smaller group than last years survey (77 vs 500) but last year chelation users stood at just under 8%. They’ve progressed by 5% in a year if we discount the influence of a such smaller population.

Because I tackle these people head on, there’s sometimes a tendency to think of them as having more influence than they actually do and them being in greater numbers than they actually are. Studies like this offer some perspective as to the real size of these organisations populations.

That is _not_ to say we in the more sceptical community should ignore them – not at all, they are dangerous zealots with a penchant for absolutism which must be constantly countered – but maybe we should remember that their influence is not as great as they like to think it is.

This paper also has some interesting things to say about the role of physicians in diagnosing autism. This is beyond my remit but I would like to see Orac or NHS Blog Doc taking them on. Especially the parts suggesting doctors should accommodate altie therapies.

Just Sayin’ Part II

28 Aug

Professor Richard Lathe. Brain, Autism and Environment Part II: Strong Convictions

26 Aug

In my previous post on this subject I tackled the shortcomings in the Porph study and Professor Lathe’s reliance on extremely haphazard science. I also touched on his strange reluctance to publish _all_ associated data relating to that study and his peculiar relationship with co-author and DAN! doctor Lorene Amet. I also reported on how Lathe conceded that several key aspects of his theory relied on unverified science – notably the Holmes et al paper.

In this post I’ll be discussing key aspects of Lathe’s book ‘Autism, Brain and Environment’ and how they do not hold up to scrutiny.

The central theory of the book is that we are experiencing something Lathe calls ‘New Phase Autism’ which is a new type of genetically based, environmentally triggered autism – notably via metals such as tin, lead and mercury. His hypothesis states that some people have a genetic predisposition which, when exposed to environmental insults, reveals occult phenotypes.

There are two main supporting arguments that Lathe attempts to marshal to support this hypothesis.

1) Prevalence.

2) Limbic system ‘damage’. Lathe makes strong use of the Limbic system because a) it governs socialisation and b) its (to some degree)
repairable.

Lets be clear, without these arguments, Lathe’s entire hypothesis falls. Without an ‘epidemic’ there is no reason to suspect a new type of metal influenced autism and without strong science to support the autism/limbic system hypothesis there is no reason to _assume_ a connection here either.

We know from Mike’s sterling work that the prevalence issue was very selectively presented and only utilised data that supported Lathe’s hypothesis. The much more valid and pertinent data that did _not_ support Lathe’s hypothesis was ignored.

What I intend to do in this post is address the issue of limbic system involvement. Why Lathe argues for it and why his hypothesis rests on very shaky foundations.

On page 64, Lathe states:

….it is the limbic system which is believed to be centrally involved in the problems associated with ASD.

No paper is cited to support this opinion. No evidence is offered to show support for this belief.

Lathe discusses a number of papers that clearly establish a connection of some kind between the limbic regions of the brain and autism but none of these studies refer to the limbic _system_ being _central_ to ASD. Lathe himself points out the many issues with the techniques used to gain data in this area, noting that histological study of the post-mortem brain is restricted to those very few samples available. Imaging studies are also skewed towards the older and Asperger end of the spectrum and thus cannot be representative of the whole spectrum.

Nevertheless this does not stop Lathe from pronouncing that limbic damage is central to ASD. He attempts to prove this by seeing if:

ASD features are consistent with limbic dysfunction.

Lathe states that anxiety is closely associated with limbic dysfunction (p76) and then goes on to say that anxiety is often an accompaniment to ASD. But lets not forget that Lathe is centring the role of limbic damage around his hypothesis of ‘new phase autism’ – a new type of chemically and metal caused autism that results in ‘severe/kanners/classic’ autism. It’s interesting to note that as far as anxiety is concerned that:

ASD children are significantly more anxious than controls, but the severity of anxiety varied according to ASD subtype with *Asperger disorder exceeding PDD-NOS, and both exceeding autism proper* […] on the anxiety rating scale.

This does not shed any light on Lathe’s ‘new phase’ autism. Rather it shows that if we look at anxiety as a correlator of limbic damage and ASD, then AS and PDD-NOS are more closely related than ‘autism proper’.

Lathe next examines ‘desire for sameness’ (p76) saying that it is:

[characteristic of autism]…as noted in the clinical behavioral rating _”obsessive desire for sameness”_ employed by several researchers.

And yet once again, Lathe fails to cite these researchers or the work that showed them employing this rating, or in what context it was used. It should be noted that ‘desire for sameness’ forms no part of the DSM(IV) and there are no cites showing how common a desire for sameness actually is amongst autistic children, particularly children Lathe might judge to be part of his ‘new phase’ subgroup.

In fact the only clinical studies Lathe cites in this section are two studies on rats from 1964 and 1965 respectively. And yet when discussing a later study Lathe states (p100):

…it is perhaps unsafe to extrapolate too freely from rodents to humans.

Quite.

In an odd contradiction, Lathe later goes on to describe sameness as the inverse of novelty which Lathe claims can be attributed to the hippocampus and amygdala – both components of the limbic system – and that lack of appreciation of novelty can be attributed to amygdala damage. He then cites an example he knows of where an autistic child (p77):

…seemingly failed to react to the presence of a film crew in the bath.

This seems a rather bizarre contradiction. On one hand Lathe claims that ASD can be characterised by an ‘obsessive desire for sameness’ and on the other hand that ASD kids are unfazed by large scale changes in routine. Both, surely, cannot be true.

Lathe next states that ‘deficit in recognition of facial emotions’ (p77) is a key component of ASD and limbic system damage. The evidence he cites is:

This is shared by *some* patients with frontotemporal dementia, *associated* with limbic atrophy and by *some* patients with schizophrenia where involvement of the…[components of the limbic system]…has long been *suspected*

In other words, its an educated guess. Might be right but might equally be wrong.

Social interaction is next on Lathe’s list which is one of the very few items on Lathe’s list which genuinely _is_ a defining feature of ASD. Lathe makes his case valiantly but freely admits that (p77):

Few satisfactory studies have been performed on humans

and once more falls back on rodent studies which (as we know) Lathe has strong reservations about. He also makes of use a study using monkeys and yet, as with rodents, Lathe later states (p82):

….it may not be easy to extrapolate from monkey to man.

Which begs the question of why this chapter relies so heavily on rodent and monkey studies?

Lathe next makes a central and common error regarding autism, stating that (p78):

Language delay is a central diagnostic feature of ASD.

This is not correct. Language delay is merely one of four possibilities encompassed under a criteria heading of ‘Impaired *communication*’. This is _not_ a trivial distinction. Especially when we recall that this must all fit within the umbrella on Lathe’s ‘new phase autism’.

Lathe next tackles seizures, stating that seizures are recorded in up to 30% of autistic people (p79). However, we must again remember that Lathe is attempting to tie this in to his ‘new phase autism’ and his subsequent discussion of how autistic adults have a continued level of seizure (around 25%) this would indicate that seizures are not new to autism and hence cannot be part of Lathe’s ‘new phase autism’.

Sensory deficits is next on Lathe’s list. He starts off by stating what may well be uncontested fact – that hearing deficits (using Lathe’s words) are present in less than 9% of the autistic population, visual impairments in less than 24% and a lack of response to painful stimuli ‘has been noted’ in a 1999 study and given at rates of 7 in 18 in a study from the 1970’s.

However, Lathe freely admits that there is little to no research to tie in sensory processing and the limbic system, limply noting one study on monkeys. A subject group we will remember Lathe has reservations about.

Lathe next looks at stereotypy and repetitive/compulsive behaviours, correctly noting that this is a diagnostic feature of ASD. However, Lathe then goes on to state:

To this one must add alteration between a restricted range of activities…..This behavior is consistent with limbic damage.

As before when Lathe makes this bold assertion he does so without any evidence. No cites are made in support of this apparently imperative addition and it does not appear anywhere in the DSM(IV). It seems that this imperative addition is only imperative to establishing a link between a hypothetical ‘new phase’ type of ASD and limbic damage.

Lathe devotes a whole chapter to GI disturbances which is outside the scope of this particular post suffice it to say that that chapter contains frankly embarrassing references to unpublished work from Krigsman and cites altcorp.com as a valid reference of science.

In this chapters concluding pages, Lathe cites a study that he says (p83):

Causally link limbic damage to autistic behaviour.

In fact, he says there are seven but he only references one so its hard to place much faith in the others. The one referenced paper is over thirty years old.

Lathe then attempts to wrap up his case (p85 – 86):

behaviors associated with limbic damage resemble autism in a long list of different categories.

Thats a possibility but as we’ve seen, Lathe’s supporting evidence is flawed on numerous levels.

1) Over reliance on animal studies. A flaw Lathe makes note of himself.
2) Reliance on very old science.
3) Misrepresentation of the ASD diagnostic criteria. Theories should fit the known facts. The known facts should not need to be twisted to make a theory work.
4) Lathe is attempting to make a case for a new metal/chemically caused type of autism. A lot of his cited science relies on adult subjects born well before the time period Lathe needs to concentrate on.

Second, the limbic brain is consistently abnormal (in ASD).

Definitely interesting but yet again argues _against_ new phase autism, not in support of it. If limbic damage is _consistently_ abnormal in ASD then why the insistence on limbic damage being supportive of ‘new phase autism’? Remember that a lot of Lathe’s cites references adult autistic people born and diagnosed long before the time frame Lathe targets as the birth epoch of his ‘new phase autism’.

Professor Richard Lathe. Brain, Autism and Environment Part I: Strange Bedfellows

22 Aug

Richard Lathe, ex Edinburgh University and currently of Pieta Research has recently published a new book on Autism Brain and Environment.

The book build on his recent study – discussed here – that attempted to show a link between Porphyrin excretion in urine and ASD.

It transpired that there were notable question marks over the means of expression and design of that study and Professor Lathe was generous enough with his time to participate in a respectful exchange of views via email to discuss these question marks and also to widen the discussion out to his new book.

As regards the paper, I had two main issues with it. Firstly, I was curious as to the role of established DAN! zealot Ms. Lorene Amet. Secondly – and this is peripheral to Ms Amet’s participation – how did the study account for the question mark over low creatinine being noted by several people, including DAN! doctors such as Ms Amet.

I’ll quote now from our email correspondance. I asked Lathe how Amet had come to be involved in the study and why she had not mentioned the DAN! accepted potential of low creatinine given that the study would be utilising it as a constant to express ratios against.

Ms Amet was not a primary contributor to the paper and none of us, as far as I am aware, discussed creatinine with her. I personally have no connection with DAN et al. Her independent association with biomedical remediation was after the porphyrin results were out (first draft of the Nataf paper in the last quarter of 2004). To my mind, it is unreasonable and distracting to critique the data on what authors do after the analysis. Perhaps you should leave this aside.

Which is fair enough. However, to suggest she didn’t know is not likely and to suggest that the study was unalterable is interesting. At the very least this should have been mentioned and addressed – if only to discount it. It is a very large question mark over the results.

When I pressed Lathe further on Amet’s involvement, he had this to say:

Re Dr. Amet, her participation was difficult and her role in the study marginal. I have no further comment to make.

It seemed a nerve had been touched. Earlier in our conversation I had alluded to Ms Amet’s role as Editor along with Boyd Haley and Andrew Wakefield of the non peer reviewed journal Medical Veritas to which Lathe had opined:

May I add my informal view that Medical Veritas is a load of quasi-scientific mumbo jumbo, and detracts from attempts to address the real issues.

An opinion I’m in complete agreement with. I had also referred to Amet as Lathe’s partner, by which I meant writing partner. However, I got the following reply:

Sorry, the lady is not my partner, my wife has that chore.

To which I apologised, clarified I had meant writing partner and moved on.

Now I’m as curious as the next person and something here wasn’t ringing true at all. A poke around revealed that they had (at least at one time) been an item:

Lloyd Allanson was diagnosed with autism last year His drawings have been selected for exhibition by his mother Lorene Amet and her partner Richard Lathe.

Source.

So what? I hear you ask. All this is evidence of is a bad break up that Lathe doesn’t want to talk about. Not my business or yours, right? True enough but at the same time its more than a little misleading to describe her slide into biomed as ‘independant’ when it clearly was not. It made me question everything that Lathe told me from that point on.

Back to the creatinine. In reference to the lowered creatinine potential of autistic kids, Lathe said:

1.There was no significant decline in urinary CRT levels in any of the autism groups, though there was a non-significant trend to a reduced level.
2. Reduced CRT, and increased porphyrin, both appear to be markers of environmental toxicity.

Neither of which is discussed in the paper at all and which Lathe went on to say was ‘pointless’ to publish. I disagreed. I think it was a) dishonest to distance the paper from Amet when its clear there was both a professional and personal connection. Lorene Amet discusses the paper at length in the minutes of the May 2005 Action Against Autism (now Autism Treatment Trust) and knew quite a lot about it. I would not describe her knowledge as ‘marginal’. Hence I have strong reservations about what Professor Lathe judges to be significant and what is not. It seems to me that this matter could easily be settled by publication of *all* data. However, to his credit, Lathe admitted that:

The long and short of it is that the response of CRT to different levels of heavy metal toxicity has not been studied adequately.

Also not studied adequately is a key concept the paper (and subsequently the book – to be addressed in a later post) rely heavily on. Lathe made a point regarding excretion of metals:

We have not looked at the metals themselves because (a) the body burden of heavy metals does not parallel excretion (b) there is a possible deficit in heavy metal mobilization.

(a) is interesting but (b) is fascinating. This ‘possible deficit’ becomes a key concept of the book and the seasoned warriors amongst us (of both sides) will recognise that Lathe is talking about the Holmes et al paper. Lathe started off by lauding it greatly. However, when I pointed out the shortcomings of the paper:

This study has been criticized, among other reasons, because its findings have not been duplicated and are not consistent with two other studies that used better methods. (See Def. Reply Brief, Document #102, Expert Report of Susan E. Folstein, Ex. 2 at 4 (“Thus, the study by Holmes is highly suspect – it used a peculiar sample, a suspect laboratory (IOM 2004) and uncertain methods of statistical analysis, and it offered a highly idiosyncratic interpretation of data.”).)

Justice Beaty

In a case-control study, the mean hair-mercury level was significantly lower in a group of 94 children with autism (0.47 ppm) than in a group of 45 matched controls (3.6 ppm), leading the authors to speculate that enhanced mercury retention plays a role in the etiology of autism (Holmes, Blaxill, & Haley, 2003). The mean hair-mercury level in the control children was much higher than would be expected, however, as the geometric mean in 1- to 5-year-old U.S. children is 0.12 ppm (McDowell et al., 2004). This suggests that the control samples in this study might have been contaminated.

Psychological Science in the Public Interest, Vol. 6 No.3 p. 83

…which confirm the blog posts of Prometheus and DoC

and to which Lathe responded:

The same hair samples analysed by Holmes were reanalysed by a different technique and the result confirmed (Hu et al.)

which was a paper I hadn’t read so I went ahead and did read it and was surprised that Lathe was relying on this paper. The study listed three participants and the way the hair samples were collected were in contradiction with a statement from Mark Blaxill (which i cannot find) that specified baby’s _first_ haircuts _must_ be used. I summed it up thusly:

a) it is important that they are first baby haircuts – in which case Hu is irrelevant, or b) it isn’t important – in which case the bulk of the evidence shows that there is something wrong with the Holmes data.

Lathe’s answer was:

I agree with your caveats. One must hope that someone will independently confirm or refute the Holmes study.

This is not a minor point. A large part of both the paper and (even more so) the book need the Holmes papers findings to be right. It was at this point that I started to suspect that the book might contain equally glaring reliances and errors. This suspicion was confirmed when I read Mike’s thorough examination of chapter four of Lathe’s book. Chapter Four is the base from which the book expounds its theory. Mike kicked that base away comprehensively.

But there are other areas of Lathe’s theory that need addressing. In Part II, I’ll be doing that.

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