Left Brain Right Brain

On the 5th May a Letter from Kenneth P Stoller appeared in Pediatrics.

UW-Madison researcher Paul Shattuck concludes that special education figures being used are “faulty and do not substantiate such a claim” (that there is an autism epidemic). Paul Shattuck seems to be saying that all the reported autistic children have always been here, they were just called something else.

Shattuck makes no such conclusion. In a clarifying comment on Scienceblogs, Paul Shattuck stated:

Unfortunately, the media and some advocacy groups have distorted what my article was all about. I was quite explicit in the article that A) my work does not prove or disprove the existence of an epidemic and I think that is still an open issue….My number one goal was to raise awareness about the limitations of the special ed. data.

As a pediatrician, who has been in practice for over two decades, I find it more than a little insulting as well as disturbing to have someone say that these children were always there.

Several pediatricians do not find it insulting. Suniti Chakrabarti for example – who diagnosed my own daughter – co-authored a paper with Eric Fombonne which confirned a high but stable prevalence for autism. There are also several interesting studies that indicate that ASD has historically been very underdiagnosed.

In 2004, an ‘autism audit‘ was performed in Scotland. One of the questions the audit asked was how accurate they thought the prevalence rate estimates were for their area. 45% of authorities who responded made a point of noting that they felt diagnosis for adults was very underrepresented. For example, Perth and Kinross council stated

Figures for adults reflect the national findings that the numbers known to services/diagnosed represent a significant underestimate of those individuals likely to be affected. For example day centre managers locally consider a number of people to be on the spectrum who have had no formal diagnosis.

Also, in a New Scientist piece last year, the findings of the University of Nottingham were reported. The team reexamined data from the 1970’s which resulted in five diagnosis. Using modern diagnostic criteria, the team found 56 cases, a ten-fold increase.

Lastly, earlier this year, Health Minister Liam Byrne reported figures that demonstrated autism diagnoses for children have nearly doubled in 8 years from 3100 to 6170. Meanwhile adult diagnoses have nearly tripled in the same period from 1120 to 3000.

The idea of ‘insult’ is irrelevant to the substantiation of a case. And yet again, Shattuck made no claim that ‘these children were always there’. Such purposefully misleading statements entirely invalidate Stoller’s case.

As a scientist, I find the current approach to the autism epidemic – “The Emperor’s New Clothes” approach – to be deeply disturbing.

Appeals to authority do not make one automatically correct. I’m sure there are several people who could say that ‘as scientists’ they question the idea of there being an epidemic of autism at all. That wouldn’t automatically make them right either. What does lend their viewpoint some weight as the fact that the science supports their opinions.

For years the vaccine division at the CDC and others have said the reason for the dramatic increase in autism is due to “better diagnosing” and “greater awareness.””They have encouraged those like Paul Shattuck to manufacture uncertainty.

This is quite simply yet more purposefully misleading rubbish. This study was funded largely by the Autistic Society of America. Paul Shattuck has also stated his affiliations with the CDC quite clearly:

As for the $540,000 from the CDC…it’s not entirely clear what they are talking about. I certainly don’t have a grant that big from anyone. They are probably talking about the autism surveillance grant that our center received from the CDC…a proposal which I helped prepare but am not listed as a co-investigator and am not funded from….I do have a small grant for about $12,000 from the CDC to investigate racial and socioeconomic disparities in the timing of autism diagnosis and service utilization.

Why Stoller indulges in such flagrant misrepresentation is not apparent. I am forced to conclude in the absence of a good reason, that Stoller has nothing to fall back on other than annoyance that Shattuck’s conclusions did not meet his beliefs and thus he felt it necessary to resort to distortion and spin.

There are no studies that have found the previously undiagnosed or misdiagnosed autistic individuals among older Americans. They simply aren’t there.

Mr Stoller is once again making assumptions. I have found no studies in PubMed that even attempt to pose this question, let alone answer it. How Stoller concludes there are none when no studies have sought an answer to this question is bewildering. I would like to suggest Mr Stoller examines the evidence from the three UK sources I quote from above. The US and the UK have a near identical autism prevalence. It seems reasonable that older patterns of prevalence might follow suit.

Now, the increase of autism has been linked to the increase in mercury exposure through fish and industrial sources, amalgam and additionally, through increased parenteral exposure to ethylmercurithiosalicate.

Its also been linked to alien invasion and plastic cups. Surely a scientist understand the concept of correlation not equaling causation?

A recent study, using infant Macaca fascicularis primates exposed to injected ethylmercury or those exposed to equal amounts of ingested methylmercury, showed that ethylmercuy was retained twice as much inorganic mercury in their brains in comparison to the methylmercury exposed primates.(Burbacher T, et al. Comparison of blood and brain mercury levels in infant monkeys exposed to methylmercury or vaccines containing thimerosal. Environmental Health Perspectives, 2005 Aug:113(8):1015-21.)These primates were exposed to mercury levels at a rate equal to what children in the United States received via standard childhood vaccines from 1991- 2003.

What’s not often discussed about the Burbacher study is the interesting point that the group did not use thiomersal containing vaccines. They used non-thiomersal containing vaccines and then added thiomersal to them. It is difficult to know how this fresh preparation compares with vaccine formulas when thimerosal is part of the manufacturing process and may have suffered some degradation to inorganic Hg in the vials before administration.

Cysteine and glutathione synthesis are crucial for mercury detoxification, and are reduced in autistic children, possibly due to epigenetic polymorphisms.

The Deth paper made no such claim. The basic gist of the Deth paper is that various toxins, including thimerosal, affect methionine synthase activity (a process that helps in building proteins) and that this can adversely affect children. In short, the Deth paper alleges that thimerosal causes methionine synthase dysfunction (MSD). However, autism and MSD are entirely dissimilar.

Therefore, autistic children have 20% lower levels of cysteine and 54% lower levels of glutathione, which adversely affect their ability to detoxify and excrete metals like mercury. (James, S.J. et al.: Metabolic biomarkers of increased oxidative stress and impaired methylation capacity in children with autism. Am. J. Clin. Nutr. 80, 1611-1617 2004).This leads to a higher concentration of free mercury in blood, which then transfers into tissues and increases the half-life of mercury in the body, as compared to children with normal levels of cysteine and glutathione. As was shown by Bradstreet et al (Bradstreet, J et al.: A case control study of mercury burden in children with autistic spectrum disorders. J. Am. Phys. Surg. 8, 76-79 2003) in a study involving 221 autistic children, vaccinated autistic children showed about 6 fold elevation of urinary mercury than normal controls after appropriate mobilization with the chelating agent DMSA.

And so we get down to it – Bradstreet and JAPANDS. A man who recommends exorcism and a journal who don’t publish errata or retractions. Great. Next!

Stoller then goes on to describe a whole host of things thiomersal apparently does without ever stating the fact that none of these things appear in the diagnostic criteria for autism.

This is an unconscionable oversight failure at best, at worse it is an example that we have left consensus reality to be created by the liars, thieves, cheats, killers, and the PR junk scientists they employ.

Quite a statement from someone who has actively misled people regarding Paul Shattucks connections with the CDC. I would put forward the idea that a PR junk scientist is one who isn’t even able to research the simplest of facts and instead concentrates solely on misrepresentation and spin. As for killers, its my opinion that Dr Roy Kerry is a great example of a DAN! protocol follower.

We are living in a time where an incredible overplay and lies and self-aggrandizing behavior and non-science is the norm.

Stoller has no argument from me there. He would seem to me to be living embodiment of that statement. He cites studies from people like Burbacher who’s ‘science’is funded by SafeMinds – a group whos mission statement is to establish a causal relationship between vaccines and autism. He cites people like Deth who are listed as expert witnesses for the prosecution in the omnibus proceedings against vaccine manufacturers.

Is it stretch to realize that by putting our heads in the sand about the autism epidemic we have made it possible for the groundwork to be put in place for Marshal Law?

Er, yes. Yes it is.

No something easy to contemplate? Then ask why haven’t pediatricians come forward to demand the end of the use of ethylmercurithiosalicate once and for all, and to advocate for the treatment of these children before it is too late?

Simple: they realise that the science doesn’t support your beliefs Mr Stoller. They understand the massive societal benefits of vaccination – a benefit being well demonstrated now that vaccine uptake is falling thanks to your scare mongering as Mumps epidemics sweep your country and measles epidemics resulting in 12% hospitalisation and at least one death so far sweep mine.

Stoller declares no conflicts of interest and yet in his signature he describes himself as a member of the International Hyperbaric Medical Association. This treament is a favourite of DAN! practitioners – people who profit by ‘treating’ autism – and yet there have been no published randomized controlled trials for low-pressure hyperbaric oxygen therapy as an autism treatment yet. Only one paper exists in Pub Med relating to HBOT and autism which blogger Dad of Cameron found at least one significant error in.

Mr Stoller establishes once more his propensity to bend or totally shatter facts by claiming no conflict of interest when it is clear he supports a therapy being widely utilised for profit on autistic children. Throughout this whole letter he willfully and (one must assume) knowingly misrepresents people like Paul Shattuck, relationships between people and institutions. He quite clearly has little knowledge of the limitations of the science he quotes as backing up his beliefs and then goes on to rage about ‘PR junk scientists’ whilst he promotes the use of a very expensive treatment with no established – or even reliably investigated- appreciable effect on autistic children.

Whenever anyone else hears the word ‘DAN!’ with that little exclamation mark do they go ‘DAN! – DAN! – DAN – DAN!’ to the opening four bars of the theme to ‘Dragnet’? No? Ah well, just me then.

Ken Aitken is a psychologist. He’s also a DAN! Doctor. One doesn’t need to be an actual Doctor to be a DAN! Doctor apparently:

As for choosing a DAN!, it just depends on what type of treatment you are looking for. DAN!’s that are MDs or DOs are typically going to be much more into testing and genetics and lots of expensive and invasive stuff. This, of course, is a gross generalization and isn’t necessarily true of all DAN! MDs, but rather something to be cautious of. A DAN! who is a homeopath or naturopath is typically going to do things more naturally and less invasive. Again, it’s a generalization. There are chiropractors, allergists and other types of doctors that are DAN!s as well, so it is really the type of doctor and treatment that best suits your needs. Many people go with a MD or DO because they can get insurance coverage for some of the services.

Homeopaths and Naturopaths doing things ‘naturally’. Heh. Does this lack of training in medical matters prevent them from performing things like chelation (source as above)?

…which is why we went with a homeopath/naturopath…….We decided to get the mercury out because I knew that Seth had had way too much put into him and it wasn’t coming out at all (he’s a non-excretor).

Homeopaths and Naturopaths doing chelation. Cool.

I talked to one yesterday (a DAN doctor mind you) and how he got qualifications to be one is beyond me. He told me has a couple of autistic patients and knows of the chelation process. If this is all that is required to be a DAN doctor then I don’t see a distinct advantage to them either.

Source.

Is your mind boggling yet? Here’s the reply to this commenter (source as above):

I think that being on the DAN list (in the past) meant something like that the person had attended some DAN training– or something rather general like this. Someone (in some post, somewhere) who went to the recent DAN conference wrote about that there is/was some discussion afoot to try to improve on this and make the
info on doctors more useful (or more detailed….or something??)

This doesn’t sound like a recipie for disaster at all. Was Roy Kerry a DAN! Doctor? I don’t know.

I came across some priceless websites pushing the DAN! protocol. They had numerous things in common, chiefly the disclaimer – all variations on the theme of:

this is not medical advice

Which is odd because from that point on, they mostly plough into what can only be thought of as _advice_ about what _medication_ an autistic child should take. There’s a fairly representative sample of what a dutiful DAN! Doc should do on the website of Miriam Jang MD. First, the usual copout from responsibility:

At this point, I would like to point out that this is not medical advice, even though I am a Medical Doctor. Rather, this is a wish for your child or your loved one(s) to have the advantage of what took us eight years to discover. Please take this as a medical disclaimer. All suggestions here should be done at your own risk.

‘Own risk’. Right. Or actually – wrong. She means the risk of the child receiving the treatment. Thats whos health will suffer when if it all goes wrong.

Dr Jang decides to lead off with some impressive science:

In both Chinese medicine and Ayurvedic medicine, the sages believed that there were only two ways to health: one was to correct deficiencies; the other was to get rid of toxicities.

Ayurvedic? What the hell?

This ancient art of healing has been practiced continuously for over 5,000 years. The principles of many natural healing systems now familiar in the West, such as Homeopathy and Polarity Therapy, have their roots in Ayurveda. Ayurvedic practices restore the balance and harmony of the individual, resulting in self-healing, good health and longevity.

So, DAN! Doctors are homeopaths and naturopaths who practice er, Polarity Therapy. Polarity Therapy? What the hell?

Polarity Therapy is a comprehensive health system involving energy-based bodywork, diet, exercise and self-awareness. It works with the Human Energy Field, electromagnetic patterns expressed in mental, emotional and physical experience.

Riiiight. OK. Back to er, Doctor (?) Jang. Basically, there’s a load of stuff with no cites – such as:

An important finding is that about 85 percent of Autistic kids are high in Copper and low in Zinc. Furthermore, these kids are very low in an important protein call Metallothionein, or MT Protein.

Hmm. Searching PubMed for ‘Metallothionein autism’ reveals two results. One is an inaccessible review and one is a free PDF published in the confidence inspiringly named ‘Alternative Medecine Review’. A Google search for the same reveals the predicted circus of quackery.

Except….another one of the mercury/autism darlings, Vijendra K. Singh has a paper that states:

serum level of MT did not significantly differ between normal and autistic children. Furthermore, autistic children harboured normal levels of anti-MT, including antibodies to isoform MT-I (anti-MT-I) and MT-II (anti-MT-II), without any significant difference between normal and autistic children.

A dilema, no? (You can read more on this paper here.)

Dr Jang continues with:

I will include a list of supplements that Marky is taking. There are many protocols, with many rationales. When we write down the dosages, please take into consideration that Marky is 11 years old and weighs 75 pounds. Please adjust your dosages according to your child’s weight.

Marky is her son. But isn’t it amazing how a DAN! Doctor is assuming parents know *how* to adjust medications for weight – and is happy to trust them to do so without medical supervision or even consultation!

Towards the end of her piece she says:

Please remember that, if you introduce your child to a new supplement, it is not unusual for the child to experience some adverse effects for a short while…When this happens, it does not necessarily mean that you should discontinue the supplement, unless the adverse effects are dangerous, or persistent….If there are adverse effects, stay at this dose until the adverse effects are gone, then proceed to a slightly higher dose, etc.

So there may be adverse effects but don’t stop unless the adverse effects are dangerous, instead stay on the same dose until the adverse effects are gone. I can’t imagine any Doctor thinking this is good advice. Interestingly, the following appeared from Dr Jang as part of an email newsletter:

I would like to start with some very serious news: we do have to be careful of Vitamin A toxicity with our sweet kids. There is a child with reported Vitamin A toxicity that was so severe that the child had to be hospitalized for 12 days.

Her patient? I wonder. Maybe the practitioner (whomever s/he was) read her advice to ‘stay on the same dose until the adverse effects are gone’.

Dr Jang tells us in relation to supplements that:

We noticed a difference in Marky in less than a week.

And yet later on she says:

In addition, you may not see the beneficial effects of these supplements for a period of time.

Something of a glaring contradiction. Which is true?

Anyway, having expounded all this good advice, Dr Jang closes with:

So, be curious and be persistent. Take good care of yourselves so that you can endure this arduous journey called “Autism”!

Yes, be curious – try everything that takes your fancy. Be persistent – whats a little Vitamin A poisoning between friends? And above all take good care of _yourselves_ so that _you_ can endure this journey…..except, its not _you_ who’s undergoing all these treatments is it? Its your child.

Dr Jang is also a big clay bath fancier (clay baths cure autism? Who knew?)

“…I have put a huge number of patients on these clay baths and the levels of heavy metals – mercury, lead, arsenic, aluminum, and cadmium have come down dramatically…I have been monitoring the levels of metals using all three methods (TD DMPS, oral DMSA and clay baths)and the clay baths are way faster in the removal of metals”.

Hoooo boy! Rashid’s going to be plenty pissed with her. Better than TD DMPS? Surely not! Why not use both? Smother your child with TD DMPS and then wash that stuff off in a nice clay bath? At least your child will have a nice happy splash in a bath.

So, Ken Aitken – welcome to your new role as a Dan! Doctor. I feel sure you can uphold the strong scientific standards your colleagues demonstrate.

Yesterday, my fellow countryman Mike Stanton left the following comment in response to a previous commenter about his belief regarding how his child had become autistic:

There may not be a single answer. But that does not mean we can pick any answer we like. There has to be some scientific validity to any hypothesis.

This is such a good comment. It reflects something I’ve felt increasingly over the last year or so – the increase in pseudo-scientific theories posed as a ‘menu’ for parents to choose from. It reminds me of sauntering up to the counter at McDonalds and saying – “I’ll have one of those, one of those and one of those.”

I recently came across a post made on the Onibasu list which illustrates my point. This is the signature of the poster in question. Its a list of treatments she’s trying on her child:

My son is using M-B12 (Hopewell) since Dec 2003, Wellness Essential GSH (had been using TD-Glut but levels were always low), TD-DMSA (3 on and 4 off – 8 hr schedule) (Lee Silsby) since Oct 2005, (Used TD-DMPS Jan 2005 ?Oct 2005) TD-ALA (Lee Silsby) since Oct 2005, TD-LDN (Wellness) Since Oct 2005, (High Tech Health) FIR sauna, Magnetico bed, High Tech Health’s water machine, and a lot of supplements.) GFGFSF diet.

The post in question is also asking about Lupron. Thats a total of 12 separate treatments, ‘a lot of’ supplements and she probably is in the process of adding Lupron to that list as we speak.

And can you Supersize me please?

What worries me is even a bog-standard bottle of Asprin has a warning on it about responsible use. Is it really sensible to risk giving one’s child such a massive cocktail of drugs on the word of someone who quite obviously is more interested in money than science?

Medicine shouldn’t be such a pick and mix affair. Its quite worrying about what this reveals about how the West’s perception of doctors has changed. Doctors who have undergone 7 years plus of training are viewed with suspicion and sued at the drop of an opinion whilst ‘doctors’ who have shops rather than practices are lauded as heroes.

How did it come to this? When did McScience start to replace science? How did it come to pass that the process of peer review (designed to give a good _starting point_ to a paper) meant nothing and the process of buying an entry in a pseudoscience rag or buying a misleading advertmeant everything?

I’m nobodies scientist. It takes me longer to understand the science because I need to go through it time after time so I understand all the words and understand the implications. I ask questions of actual scientists and get them to translate for me so it stands to reason to me that for an article to be peer reviewed in a decent journal assures that the standard of science in that article will be fairly high. It might not make the paper _right_ , but at least we can be sure its been thought through properly.

Surely that needs to be the absolute baseline of quality we should come to expect for papers that discuss such important questions. Otherwise we really do end up at the counter of McScience – like kids in a sweet shop, taking what we think we’ll like rather than what we need.