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Autism, Denmark and again no link with vaccines.

25 Aug

For a while now, I’ve been hoping that someone would publish data on the current state autism prevalence by birth year in Denmark. Denmark has been used for epidemiological studies for autism since their is a national database for health care. Thus, one can obtain a count of all people in Denmark who have been diagnosed with autism. Which is not the same thing as saying they have a count of all people in the country who are autistic. One can be autistic and not be diagnosed, as we will see.

A recent study using the Danish database is Recurrence of Autism Spectrum Disorders in Full- and Half-Siblings and Trends Over Time: A Population-Based Cohort Study. It’s an interesting study and I feel somewhat guilty for pulling the time-trend data out for my own discussion. In short, the study found that if a family has one child who is autistic, the chance for a subsequent child to be autistic is about 7 times higher than for families without an autistic child. This is fairly consistent with many other sibling studies over the years, but much lower than found in the recent baby siblings study out of the MIND Institute. That might be due to the active surveillance used by the team at MIND. I.e. they were actively monitoring and testing baby siblings.

Much more, they conclude:

Although the results from our comparison of recurrence in full- and half-siblings support the role of genetics in ASDs, the significant recurrence in maternal half-siblings may support the idea of a contributing role of factors associated with pregnancy and the maternal intrauterine environment. Finally, the lack of a time trend in the relative recurrence risk in our data suggests that the likely combination of genetic and environmental factors contributes to the risk for ASD recurrence in siblings or that the risk for recurrence because of such factors has not been affected by the rise in the ASD prevalence.

Very interesting–whatever is behind the higher prevalence among younger siblings, it seems to be the same today as 30 years ago.

What’s the overall prevalence of autism in Denmark according to this study? For childhood autism, they report 0.3%. For all ASD’s, 1.2%.

Autism, we are told by those promoting the autism/vaccine link, is unmistakable. Each autism prevalence report is not an estimate, but an accurate count of every autsitic because there is no way to miss an autistic. Back in the day, Rick Rollens was a constant fixture in the news on autism. He was a strong proponent of the idea that one could not miss autism:

WATSON:
Like many parents, Rick is convinced that Russell was damaged by a series of vaccinations. He strongly rejects the idea that the epidemic of autism can be entirely explained by poor diagnosis in the past because numbers have rose over the last few years.

ROLLENS:
Missing child with autism is like missing a train wreck. For us now to now think that somehow we have better identified a child who can’t talk, who has repetitive behaviour. Who makes no eye contact. Who is self- involved and in many cases self-abusive just defies logic.

Mr. Rollens was wrong on two counts (leaving aside his inflammatory and derogatory language). First, autism is not just the child who can not talk, self-involved and self-abusive. Second, yes, a lot of autistics have been missed. We’ve seen that time and time again. Look at the same population at different times and the later study will have found more autistics. An this goes for autistics with intellectual disability, as shown in the recent UCLA/Utah autism followup: “Today’s diagnostic criteria applied to participants ascertained in the 1980s identified more cases of autism with intellectual disability. ”

But, what about Denmark? A study from 10 years ago looked at autism incidence following the removal of thimerosal in Denmark in 1992. Thimerosal and the occurrence of autism: negative ecological evidence from Danish population-based data

In that study they found 956 children born in their study period who were diagnosed with autism by 2000:

A total of 956 children with a male to female ratio of 3.5:1 had been diagnosed with autism during the period 1971–2000.

The current Denmark study included individuals diagnosed until the end of 2010. I.e. there were 10 more years of followup. In those 10 years a lot more people were diagnosed. Where there were 956 diagnosed with autism by 2000 (for birth years 1971 to 2000), 2321 were diagnosed by 2010. That’s an increase of 240%. And the new study focused on birth years 1980 to 1999. I.e. the entire 1970’s birth cohort is not included in this count, and they still found over twice as many autistics. Where were they in 2000, when the previous study was performed? Living in Denmark, not identified as autistic.

There are a few factors which are likely behind this increase, but here we have a great example of “increased awareness” affecting autism prevalence.

And, those numbers were for childhood autism. For ASD, the increase is even larger. 10,377 Danes had an autism spectrum disorder diagnosis (for birth years 1980-1999) in the new study (the previous study included none). That’s a whopping 1080% increase. Again, there are a few reasons for this (including the increased awareness above), but here’s what “expanding the definition” does to autism.

Those increases would be an “epidemic” to some if it weren’t for the fact that those autistic Danes were there all along. They just weren’t diagnosed in 2000.

For many years, groups touting the idea that vaccines cause autism have pointed to Denmark as part of their argument. Denmark uses fewer vaccines than the U.S.. Generation Rescue used to have this on their website discussion of vaccines:

Comment: Denmark is a first world country based in Western Europe. Their schedule appears far more reasonable than ours. They have also been reported to have a much lower rate of autism than the U.S. Do they know something we don’t?

What was that Danish vaccine schedule that Generation Rescue recommended?

DTaP at 3, 5 and 12 months
Hib at 3, 5 and 12 months
IPV at 3, 5 and 12 months, plus 5 years
MMR at 15 months and 12 years

No mercury (Denmark phased that out in 1992). No birth dose of Hepatitis B. Fewer vaccines overall than in the U.S.. And the same autism prevalence of about 1%.

If you dive into more details, it gets even worse for the vaccines and/or thimerosal cause autism argument. Let’s look at the prevalence as a function of birth year for childhood autism and ASD from the recent study:

AutismPrevalenceDenmark

Consider this statement from a previous study:

This means that children who followed the full vaccination program during the period 1961–1970 had received a total of 400 g of thimerosal or 200 g of ethyl mercury by the age of 15 months and during the period 1970–1992 they had received a total of 250 g of thimerosal or 125 g of ethyl mercury at 10 months of age. In March 1992 the last batch of thimerosalcontaining vaccine was released and distributed from Statens Serum Institut in Denmark.

The thimerosal exposure was higher prior to 1992 than after. But the prevalence of both childhood autism and ASD is higher after the removal of thimerosal. This is the same result as shown in the 2003 study. The number of vaccines seems to be constant over this time period, so number of vaccines/aluminum/too-many-too-soon or other arguments don’t work either.

How about taking just a single year. The prevalence for ASD in 1996-97 was 1.4%. What is the autism prevalence in the U.S. for that year? To answer accurately, I’d contend we need a count today, not an old one. But people promoting the idea that vaccines cause autism take the CDC reports as absolute measures of autism, comparing each report and telling us all about the epidemic. So, let’s take the CDC number for kids born in 1994: 0.8%. That study was reported in 2009.

So, we have 1.4% in Denmark and 0.8%, nearly half the Danish prevalence, in the U.S.. Denmark had no thimerosal, no Hepatitis B shot (birth or otherwise), fewer vaccines and less aluminum exposure. And much higher reported autism prevalence.

Oddly enough, even though there have been many prevalence studies out of Denmark, Tomljenovic and Shaw didn’t include Denmark in their study “Do aluminum vaccine adjuvants contribute to the rising prevalence of autism?” My guess is that Denmark didn’t fit their conclusion then, and, like Iceland, would make their analysis fall apart now. It is even more odd that Tomljenovic and Shaw didn’t use Denmark as Denmark was used in a faux-study put out by Generation Rescue. In AUTISM AND VACCINES AROUND THE WORLD: Vaccine Schedules, Autism Rates, and Under 5 Mortality Someone at Generation Rescue made the first attempt at the sleight of hand of comparing the autism prevalence in various countries vs their vaccine schedules. At that time, 2009, Generation Rescue claimed that the autism prevalence in Denmark was 1 in 2,200, misrepresenting the 2003 study discussed here. The raw prevalence in this 2008 study was 0.65% or about 1 in 153. That value didn’t fit the thesis that the Generation Rescue author wanted to convey.

One argument found on the internet is that the 2003 Denmark paper fudged the results by clipping the last years off the data presented. An email involving people involved in the study is quoted as saying, “But the incidence and prevalence are still decreasing in 2001“. Oh, my, we are told, the autism prevalence and incidence actually went down after the removal of thimerosal!

But, it didn’t. The prevalence of childhood autism (basically what was studied in the 2003 paper) in Denmark is flat from birth cohorts 1996-2004. Flat. The prevalence of ASD’s do see a decline. That must be it! Evidence that thimerosal was causing autism in Denmark! But it isn’t. The prevalence of ASD in 2003-04 is the same as that in 1990-91, before thimerosal was removed. Why does the ASD prevalence go down? We can’t say for sure, but my strong suspicion is that it’s the same reason why the authors in 2003 were seeing a decrease: too few years of follow up. Autistic kids are typically diagnosed earlier than those with other ASD’s, but the average age was about 5 in Denmark in 2003 (as I recall). ASD kids can have an average age of diagnosis of 8. Recall that the recently released study followed kids up to the end of 2010. It’s no surprise to me that the estimated prevalence for ASD kids born in 2002 is lower than that for kids born in 2000 in this study. And this is consistent with the flat prevalence for kids with childhood autism diagnoses, as they are typically diagnosed earlier and 8-9 years would be enough to find the majority of the autistics in that population.

What about the idea that there’s a “changepoint” in the autism prevalence in Denmark and California pointing to some event in the late 1980s that’s contributing to autism prevalence? For one thing, the present study notes that the recurrence risk doesn’t change with time, so that’s good evidence against such an idea. There is no changepoint in the California data in the 1980’s, as it is exponential and fitting it to two straight lines is just a mistake. What about the prevalence data just released? The data are not finely spaced in birth years, in my opinion, to give a good idea of any “changepoints” in the 1980’s. But there is a changepoint of sorts in the childhood autism data in the 1990’s. The data plateaus at about 1996. But, as already noted, this doesn’t coincide with anything related to vaccines. The ASD prevalence appears to peak at about 1994, but, again, this doesn’t coincide with vaccine events and, I suspect, results largely from lack of follow up for the kids in the later birth years.

How about the MMR vaccine? MMR uptake for young children (MMR1) was basically flat from 1987-1997. Uptake rose somewhat after that. So, during the period that the estimated prevalence was increasing, MMR uptake was basically flat. During the time that the estimated prevalence was either flat (childhood autism) or decreasing (ASD’s), the MMR uptake was increasing. So if we were to play the “correlation equals causation” game, MMR prevents autism. (two notes, preventing rubella infections most likely does prevent some autism and the link above shows a nice example of rubella infections going down after MMR was introduced in 1987. The two points are not linked because most women in Denmark who were infected with rubella before 18 weeks gestation chose abortion, resulting in a low congenital rubella syndrome prevalence).

How about the “fetal cells in vaccines cause autism” argument? It’s one without biological plausibility, but then so was the thimerosal idea. I’d be interested in seeing how the vaccines were produced in Denmark in the 1990’s, but at present, the MMR vaccine there is developed using chicken eggs, not fetal cell lines. And they don’t routinely vaccinate against chickenpox, another vaccine in the U.S. using fetal cell lines. It looks like at least as far back as 1999 they were using egg-based vaccine production for MMR.

So, it appears we have a country with no vaccines grown in fetal cell lines with an autism prevalence as high or higher than that in the U.S.. In other words, the “vaccines from fetal cell lines caused the ‘autism epidemic’ theory” also appears to be debunked by the Denmark data.

In case you are looking for correlations with the vaccine program, here’s the history in Denmark.

So, how about the rise in estimated prevalence in the 1980’s. Is it “real”, as in does it represent an actual increase in the fraction of autistics in the population? It’s a good question and one which could be answered by performing a real study of autism prevalence in adults. The sort of study I and others have called for in the U.S., but that most autism-parent advocacy groups have refused to support. Such a study would not only answer the question of the prevalence, but it would give us valuable data on what has led to success and failure among the autistic adult population.

For those promoting the idea that environmental mercury emissions are a factor in the increase of autism rates, if you have data for Denmark, I’d love to see it. In the U.S., environmental mercury emissions dropped by over 50% in the 1990’s.

Lastly, let’s discuss a comment statement one will read or hear. It goes something like “the autism prevalence was 1 in 10,000 in 1980 and it’s 1 in 1,000 today”. This involves a number of sleights of hand. First, the autism prevalence wasn’t 1 in 10,000 in 1980. It was a few in 10,000 (Wing and Gould reported about 5/10,000). Doesn’t sound like a big deal, but when people start taking ratios (it went up a gazillion percent) a factor of 2 or 3 in the denominator makes a difference. Second, this was the estimated prevalence based on the number of autistics diagnosed at the time. As shown above, the childhood autism prevalence estimate for Denmark in the 1980’s increased by 240% in the past decade. This was not a real increase, but better identification. Third, the comparison is between autism (childhood autism, DSM-III autism or some other restrictive definition) vs. autism spectrum disorders. Also shown above was that the prevalence of ASD’s in the 1980’s increased by a factor of 10, increasing only in the past 10 years.

A factor of 10 in the numerator, a factor of 3 or 4 in the denominator and pretty soon you are talking about a big part of the increases observed.

In the end, none of the above arguments are that new. Or, to put it better, none of the vaccines-cause-autism arguments had much real support. The mercury idea has lost much of the support it had 10 years ago in the parent community, but it persists. The aluminum in vaccines idea has risen to try to take the place of the mercury hypothesis, but it is based on the exact same smoke and mirrors. The idea that the increase in autism is due to the MMR has been scientifically dead for years. And, yet, these ideas persist. And they cause harm, both to the community at large and to the autism community.

—
Matt Carey

Jenny McCarthy angling for a spot on The View?

15 Jul

I don’t spend much time following celebrities. Jenny McCarthy was, for a time, an exception. She became the number one spokesperson for the idea that vaccines cause autism as well as for unproven and sometimes dangerous “therapies” for autism. She made a lot of money from autism, autism kept her name in the press and, as the money dried up, Ms. McCarthy quieted down on the topics that only a short time before she was so passionate about. Jenny McCarthy now makes news for topic like, “Jenny McCarthy ‘dating’ Donnie Wahlberg“.

New reports recently came out that Jenny McCarthy is being considered for a spot on the TV show “The View”. I saw a number of these sorts of news stories before I cancelled my news alerts. “Jenny McCarthy in talks with….for a job” They struck me as publicity and trial balloons. Attempts to get buzz going to help get the job.

If Jenny McCarthy’s publicity team are floating this as a trial balloon, they should have known the response they would get:

U.S. News and World Report: Jenny McCarthy’s Pseudoscience Has No Place on ‘The View

Slate: The View of Jenny McCarthy

Salon: Don’t put Jenny McCarthy on “The View” The “warrior mother” is dangerous for television

Atlantic: Destabilizing the Jenny McCarthy Public-Health Industrial Complex

Most discussions focus on Jenny McCarthy’s views on vaccines. She adheres to the idea that vaccines cause autism. It’s good to point out this stance but, as I’ll discuss below, I personally question why The View would be considering Jenny McCarthy given her unprofessional attitude and lack of integrity in regards to her visits on The View.

The vaccine stance has been a bit of a liability for Ms. McCarthy and her organization (Generation Rescue). They have toned down their message a great deal over recent years. Back at the time when Generation Rescue was founded, they were very upfront:

Generation Rescue believes that childhood neurological disorders such as autism, Asperger’s, ADHD/ADD, speech delay, and many other developmental delays are all misdiagnoses for mercury poisoning.

With the number 1 reason for “How was my child poisoned” being thimerosal in vaccines.

The founder of Jenny McCarthy’s autism charity famously wrote once:

With less than a half-dozen full-time activists, annual budgets of six figures or less, and umpteen thousand courageous, undaunted, and selfless volunteer parents, our community, held together with duct tape and bailing wire, is in the early to middle stages of bringing the U.S. vaccine program to its knees.

Generation Rescue both before and since Jenny McCarthy has had a focus on various “cures” for autism. They range from relatively harmless (homeopathy) to dangerous and clearly ill founded (Lupron), promoted at their parent conventions like AutismOne.

Jenny McCarthy not only promotes subjecting disabled children to dangerous therapies, she attacks those parents who don’t accept her advice in this regard.

What’s very interesting with the possible gig on The View is the fact that Jenny McCarthy has a very checkered past with that show. In her first autism book tour, the one person who had the guts to challenge Jenny McCarthy was Barbara Walters on The View. Jenny McCarthy was so angered by this that she reportedly told a rally of her supporters exactly where Barbara Walters could “stick her microphone”. (On a local autism news group, when some people proposed putting video of this event on YouTube they were discouraged from doing so. Even then people realized this was not a good move by Ms. McCarthy.)

In a later book, Jenny McCarthy told the story of her confrontation with Barbara Walters on The View, making herself into a brave “warrior” mom. Only, the story that she gave in the book was very different from the version she gave in a televised interview. In other words, at least one of the stories appears fabricated.

She also posited that Barbara Walters was jealous of Jenny McCarthy and that was the reason why Ms. Walters challenged her. Ms. McCarthy even “forgave” Ms. Walters for the incident. Barbara Walters acted like a journalist and asked Jenny McCarthy to back up her statements. Jenny McCarthy slammed Ms. Walters publicly and quite rudely. And Jenny McCarthy forgave Ms. Walters.

Seemed at the time, and still does, that Ms. McCarthy should have been apologizing, not forgiving.

In the time between the incident on The View and Ms. McCarthy offering “forgiveness”, Ms. Walters had published her biography. In it Ms. Walters disclosed that her sister was intellectually disabled. Jenny McCarthy then “understood” that Ms. Walters was jealous of the fact that she had recovered her son, while Ms. Walters’s sister did not have that opportunity. Forgiveness with a side order of condescension.

An interesting point in the “forgiveness” story. Jenny McCarthy didn’t offer forgiveness when Ms. Walters made the disclosure in her biography. No, Ms. McCarthy waited four months until her own book tour to make the statement. It doesn’t strike this observer as anything beyond a cheap publicity stunt by Ms. McCarthy.

Another interesting point is that it has since been reported that Jenny McCarthy’s “recovered” son needs a $100,000 per year school. So, tales of “forgiveness” because she had recovered her kid while Ms. Walters’s sister remained disabled her whole life fall rather flat.

I did find it interesting that when Jenny McCarthy returned years later to The View for another book tour, it was on a day when Barbara Walters was not present.

Barbara Walters is still active onscreen and behind the scenes at The View. Ms. Walters is a true pioneer of journalism. She didn’t last this long without a very thick skin, so I doubt any of the childish antics from Jenny McCarthy bother her personally. On the other hand, Ms. Walters has been able to see first hand how Jenny McCarthy puts integrity aside in favor of self promotion.

The View is not the sort of hard journalism that is the backbone of Ms. Walters’ legacy. But, one does wonder why Ms. Walters (co-producer and co-owner of The View) would take on Ms. McCarthy. Jenny McCarthy is not and never will be on par with Barbara Walters. Few of us are. But bringing Jenny McCarthy into The View would cheapen, just a bit, a lifetime of hard work and excellence by Ms. Walters.

—
By Matt Carey

In the News: John L. Young, a partner of Mark Geier, had his medical license suspended

6 Mar

The Baltimore Sun has an article up: USM regent said to have used controversial therapy for autism, subtitled: John L. Young, a partner of Mark Geier, had his medical license suspended.

USM in the Univiersity System of Maryland. John L. Young was a Regent of USM. And a former business partner for Mark Geier. From the article:

In the order suspending Young’s license, the Board of Physicians concluded he wrote Lupron prescriptions for nine of Geier’s patients, who ranged in age from six to 17 and who all lived outside of Maryland. The board also said in the order that Young, who sometimes used Skype to speak with patients, broke restrictions against prescribing medicine for people who live outside of the state.

Young’s actions “constitute a substantial likelihood of risk of serious harm to the public health, welfare and safety,” the board wrote in the suspension order. The board did not say Young used chelation therapy.

If I interpret this correctly, after his license was supsended, Mark Geier was using his partner to continue the Lupron perscriptions.

Geier’s theory was that autism was the result of high levels of mercury from vaccinations and that too much testosterone exacerbates the symptoms, hence the use of both Lupron and chelation therapy. Geier diagnosed the children with early-onset puberty, usually a rare diagnosis, and used Lupron to control their hormone development.

I note that the patients range in age from 6 to 17. 17’s a bit old for “precocious puberty”.

Mr. Young was to serve as a regent until 2014. He is not presently on the website for the board of regents.

It appears that the Maryland medical board is recognizing that prescribing Lupron itself as an autism treatment is worthy of censure.

—
By Matt Carey

California Special Education autism counts, ages 3-5 over the past decade

27 Feb

The California Department of Developmental Services data, once called “the gold standard” for autism epidemiology by those promoting the vaccine-autism link, shows that autism rates are higher today for kids who did not receive thimerosal containing vaccines compared to those who did. This was discussed recently in No, the autism prevalence in California did not go down after removing thimerosal from vaccines.

Here are those data:
California SpEd age 3-5

As noted previously, thimerosal was removed from vaccines nationwide, phasing out production by 2001. California passed a law prohiting the administration of vaccines with thimerosal in pregnant women and children under 3 from 2006 onwards. So, kids 3-5 in 2012 did not receive thimerosal from vaccines. And there are more kids in the Autism special ed category in 2012 than in any year previously. The trend is a relatlively smooth increase over time.

It is very clear that these data do not in any way indicate a drop in the increase in autism special ed rates with the removal of thimerosal.

Add to that, vaccine uptake in general and MMR in specific are not changing much over time.

Special Ed data and CDDS data are not the best for tracking autism, especially in such a raw form as this. But these are exactly the tools that were used for years to promote the idea that vaccines cause autism. I don’t think it is a coincidence that there aren’t webistes and discussions devoted to special education any more. I’ll await the claim that it must be the rotavirus vaccine…which contains neither thimerosal, measles virus or aluminum.

—
By Matt Carey

No, the autism “rate” in California did not go down after removing thimerosal from vaccines

26 Feb

I recently attended a talk where the speaker showed autism prevalence by age group for a large HMO in California. The administrative prevalence (fraction of people in the HMO identified autistic) was still going up as of 2010, and the speaker indicated this trend continued to 2012. California is an interesting case study because not only was thimerosal removed from vaccines along with the rest of the U.S. starting in the late 1990’s, but the state enacted a law which required that pregnant women and children under three be given thimerosal free vaccines from 2006 onward. So, with the exception of an an exemption in 2009 and another one right now, even the influenza vaccine in thimerosal free. I bring this up because it is a common argument that somehow the exposure from the flu vaccine is keeping the rate climbing, even though at most this is a lower exposure than that from the 1990’s pediatric vaccine schedule.

This all said, the talk made me dive back into looking at autism prevalence. I decided to finally write about the fact that the autism prevalence in Denmark is higher post thimerosal than while thimerosal containing vaccines were in use. This is completely unsurprising, but a myth has been propogating that it came down and that fact was being hidden.

As it turns out I also checked back with what once was the most common source of autism data for the armchair epidemiologist: the California Department of Developmental Services (CDDS). (I admit one could argue that Special Education data are the most common source for the armchair epidemiologist). The CDDS provides services to disabled Californians and keeps and makes public statistics on their client base. For a long time, every quarter they would come out with a report. For a long time, every quarter these reports would be followed by announcements about how the data showed that vaccines cause autism. One of the people you could always count on was David Kirby (author of the book, Evidence of Harm: Mercury in Vaccines and the Autism Epidemic: A Medical Controversy, and basically a PR man for some of the vaccine-causation groups). Mr. Kirby went so far as to claim that these data were the “gold standard of autism epidemiology”. Well, the data had their uses (such as identifying and quantifying some of the social influences behind the increase) but it is not an easy task to get results from them. The idea that they represent an accurate count of all those with ASD’s (or even accurately account for all individuals with autistic disorder) is a stretch.

But this didn’t stop David Kirby. Back in 2005, David Kirby was claiming that there was an indication that the administrative prevalence in California was starting to drop, and if the trend continued this was a sign that the removal of thimerosal was having an effect:

Stay tuned. If the numbers in California and elsewhere continue to drop – and that still is a big if — the implication of thimerosal in the autism epidemic will be practically undeniable.

Well, by 2007 it was clear that the California data were not really showing a drop. In addition, the lack of a drop was published in 2008 as Continuing increases in autism reported to California’s developmental services system: mercury in retrograde.\

The rise in the number of autism clients in the CDDS database was key to the idea of the mercury-induced epidemic. David Kirby (and others) relied on these data and Mr. Kirby even acknowledged that the data should start showing a drop (statement from 2005):

If the total number of 3-5 year olds in the California DDS system has not declined by 2007, that would deal a severe blow to the autism-thimerosal hypothesis.

The reason is that 5 year olds in 2007 were born after the removal of thimerosal from vaccines. Their exposure to thimerosal was much less than kids in the 1990’s. If the “thimerosal caused an autism epidemic” idea were true, the rates would have to drop. They should drop back to pre-1990 (actually pre 1980) levels if thimerosal were the main, or even a main, cause of the rise.

My recollection is that Mr. Kirby did later backpedal and claim that we would have to wait until some much later date, but it was a weak argument (even by David Kirby standards).

Sorry to keep diving into past history, but one of the strangest moments in the mecury debate (and I can use the term this time, because there was a debate) came in San Diego in 2007. David Kirby debated Arthur Allen in the UCSD Price Center (about 100 yards from my old office, as it turns out). Presented with the fact that even though thimerosal exposure from vaccines had gone down, the California numbers kept going up, David Kirby presented (in something like 100 power point slides!) a four pronged response. First was a claim that California HMO’s had stockpiled thimerosal containing vaccines, so the exposure from vaccines didn’t really go down as much as reports were claiming. Then:

1) A gigantic plume of coal smoke from Chinese power plants has settled on California, depositing lots of mercury and therefore causing the autism numbers in the state to continue to grow.

2) Bad forest fires have put tons of mercury into the air, depositing lots of mercury etc…

3) Cremations (!). The burning of dead bodies with mercury amalgam in their mouths has added even more mercury to the air.

It was a hail Mary pass, to be blunt. Lot’s of handwaving and ignoring the facts.

In 2007, the CDDS changed the way they assessed and counted their clients and they stopped publishing the quarterly reports. As you can imagine, many claimed this was part of a conspiracy to hide the fact that the autism rates were declining in California. And with that the quarterly ritual of misinterpreting and deconstrucing the data came to an end.

All amusing history, sure, but one might ask, why bring all this up again? Well, because it turns out that the CDDS started putting out quarterly reports again in 2011. Yes, there’s a gap of a few years in the data. Yes, some things changed (for example, the CDDS now shows the PDD fraction of autism client base). Given these limitations–and the other limitations in the CDDS data (i.e. they are *not* the “gold standard” of autism epidemiology), what do these data show? The upward trends continue. More individuals served by the CDDS with autism, even though thimerosal was removed from vaccines. Here’s the total–all ages–count for CDDS clients in the autism category (click to enlarge):

CDDS total

Looking at the younger age groups, those whose exposure to thimerosal is much lower than for kids born in the 1990s, there is also an increase. Here is the age 3-5 age group (click to enlarge)

CDDS 3-5

and the 6-9 age group (click to enlarge):

CDDS 6-9

9 year olds in 2012 were born in 2003. Post the removal of thimerosal nationwide. 5 year olds were born in 2007, post thimerosal nationwide and post the California law prohibiting mercury in vaccines for pregnant women and small children. In both groups, the CDDS autism counts are higher than they were in 2002 (the earliest date in the currently available data). Which, in turn, was much higher than the counts from the 1990’s. Here is a figure from the Schechter-Grether paper refenced above:

S-G CDDS paper figure

Which is all a very long way of saying: years ago the evidence was against the thimerosal/epidemic idea; it is even more clear now. For years we heard Mr. Kirby and others talk about how those responsible should step up and admit what happened. Well, the fact is they did. Now it is time for those who promoted the mercury notion to step forward and show they have the guts to admit they were wrong. Because they were. Clearly wrong. It would take a lot of guts to step forward and admit the mistakes. Even though their influence has waned, it would help the autism communities. While I have focused on David Kirby in this discussion, the list is much longer of people who should step forward. I’m not going to hold my breath.

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By Matt Carey

No, the autism prevalence did not go down in Denmark after the removal of thimerosal

25 Feb

Once there was an open question of whether the thimerosal containing vaccines, previously used for infants in the U.S. could be contributing to the increase in autism diagnoses being reported. Even with multiple studies showing no increased risk due to thimerosal exposure, there is still a group who not only believes in the mercury-induced epidemic, but they believe that there has been a concerted effort on behalf of the U.S. government and other groups to hide this “fact”.

An email obtained through a freedom of information act (FOIA) request is often cited in online discussions of not only the “fact” that the mercury-induced-epidemic is real, but that the government conspiracy is real. The email reportedly was made by one of the authors of a study from Denmark. The authors had used a sort of natural experiment: Denmark had phased out thimerosal from vaccines in the early 1990’s. They reported that the prevalence of autism continued to increase even with the phase out, thus indicating that thimerosal was not the driving force behind the increase.

The study, by Madsen, et al., was published in 2003. An email obtained by FOIA reportedly shows the authors removing data for the final years of the study period:

I need to tell you that the figures in the manuscript do not include the latest data from 2001….But the incidence and prevalence are still decreasing in 2001.

Sounds alarming, doesn’t it? Data which supposedly shows that autism rates actually dropped following the removal of thimerosal was removed from a paper. Well, I think they should have included the data, a possible explanation and done a follow-up study. That said, the statement really doesn’t bother me. Why? A few reasons but mainly because the data are clear that autism prevalence did continue to go up in Denmark. And much of that data are below.

First, what was the prevalence in the 1990s? Here’s a study from 2007. They were using data where from 2004 (followup through 2004):

Time trends in reported diagnoses of childhood neuropsychiatric disorders: a Danish cohort study. 2007
ASD:
Birth cohort 1994-1995. Prevalence: 0.58%
Birth cohort 1995-1996. Prevalence: 0.47%
Birth cohort 1998-1999. Prevalence: 0.32%

Childhood autism:
Birth cohort 1994-1995. Prevalence: 0.18%
Birth cohort 1995-1996. Prevalence: 0.17%
Birth cohort 1998-1999. Prevalence: 0.18%

Yes, they are showing ASD prevalence dropping in the 1990’s, which should be an admission that the prevalence went down after the removal of thimerosal! I guess they forgot to censor that paper. While ASD prevalence seems to be going down, Childhood Autism is relatively flat. Why would that happen, do you think? Here’s one reason: average age of diagnosis for autistic disorder (childhood autism) is lower than that for the other ASD’s. While autism is not as obvious as many would have us believe, childhood autism *is* more obvious than the other ASD’s (and even with that it gets missed). Consider 1998-1999. That’s only 5 years or so until the followup date from the study: 2004. Average age of diagnosis for ASD in Denmark was about 5 years. So, about 1/2 of the ASD kids born 1998-1999 were not diagnosed at the time of the study. More of the ASD kids born in 1995-1996 and even more of those from 1994-1995. So, what looks like a declining prevalence is most likely just an artifact of how many years of follow-up there were from birth to study date.

I’d say it is even more than “looks like”. Consider the studies below. These are the papers I could easily find that give autism prevalence values for Denmark. I give the title, with a link to pubmed, the year of the study, the birth cohorts reported and the prevalence.

Autism prevalence in the 1990’s?

a href=”http://www.ncbi.nlm.nih.gov/pubmed/14519711″>Association between thimerosal-containing vaccine and autism. 2003
Birth cohort 1990-1996. Prevalence 0.26%

Autism prevalence for cohorts including kids born after 2000? More like 1%. Consider this first paper:

Autism after infection, febrile episodes, and antibiotic use during pregnancy: an exploratory study. 2012
Birth cohorts 1997-2003. Prevalence: 1%

But there are more. The cohorts don’t always match between studies, and we don’t have individual years for kids born 2000 and later. But the prevalence is repeatedly reported as above the 0.26% found for the 1990’s.

In other words, the prevalence continued to go up.

Using maternally reported data to investigate the association between early childhood infection and autism spectrum disorder: the importance of data source. 2012
Birth cohorts 1997-2003. Prevalence: 1%

Parental age and autism spectrum disorders. 2012
Birth cohorts 1980-2003. Prevalence: 0.73%

The rising prevalence of autism: a prospective longitudinal study in the Faroe Islands. 2012
Birth cohort 2002. Prevalence: 0.56%
Birth cohort 2009. Prevalence:0.94%

A comparison of autism prevalence trends in Denmark and Western Australia. 2011
Birth cohort not in abstract. Prevalence (ASD) 0.685%

Risk of autism spectrum disorders in children born after assisted conception: a population-based follow-up study. 2011
Birth cohort 1995-2003. Prevalence: 0.61%

Association of hospitalization for infection in childhood with diagnosis of autism spectrum disorders: a Danish cohort study. 2010
Birth cohort 1980-2002. Prevalence 0.52%

Association of family history of autoimmune diseases and autism spectrum disorders. 2009
Birth Cohort 1993-2004. Prevalence: 0.48%

The incidence and prevalence of pervasive developmental disorders: a Danish population-based studyBirth cohort 1971-2000. Prevalence 34.4 (“corrected”)

Association between thimerosal-containing vaccine and autism. 2003
Birth cohort 1990-1996. Prevalence 0.26%

A population-based study of measles, mumps, and rubella vaccination and autism 2002
Birth cohort 1991-1998. Prevalence: 0.14%

The more early birth cohorts a given study uses, the lower the average prevalence. The more years included post 2000, the closer the prevalence is to 1%.

Sure, it would be great if we had data for prevalence by individual birth year going to 2000 and beyond. But there’s enough data above to make it clear that the autism prevalence in Denmark did not go down after 2000. Quite the contrary. Similarly, measures of autism prevalence in my home state, California, have continued to go up even after thimerosal was removed.

The idea that thimerosal caused an autism-epidemic is just not consistent with the facts. The same data people used over and over to make the argument that thimerosal causes autism–the various autism prevalence estimates–don’t support the idea any more. Thimerosal went away, autism prevalence continued to climb.

So I’m just not swayed when I read people write about how the autism prevalence went down in Denmark with the removal of thimerosal. It didn’t go down. It is sad that people are being misled to think there is still some substance to the mercury-epidemic idea. Cherry pick one email out of how many FOIA’d documents, present it out of context and play it up as something real–while ignoring the evidence that is right in front of you. This is not treating the autism community with respect. This is misleading people.

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By Matt Carey

Tax forms for CoMeD (a Geier nonprofit)

17 Feb

A recent article here at Left Brain/Right Brain showed how Mark and David Geier spend their money: on a large house in this case. Another place where the Geiers spend their money is on their nonprofit: CoMeD, the Coalition for Mercury Free Drugs. Their 990 forms are avaiable on GuideStar.com:

2009 Form 990
2010 Form 990
2011 Form 990

In 2009, CoMeD was Mark Geier (President) and David Geier (VP). Mark Geier was paid $1000.

In 2010 and 2011, the officers are:

Mark Geier (Treasurer)
David Geier (VP)
Lisa Sykes (President)
Paul King (Secretary)

In 2010, officers were all paid $500 each. In 2011, officers were all paid $6,000 each.

CoMeD brought in the following sums:
2009: $12,693
2010: $61,062
2011: $121,217

That’s a big jump. A factor of 10 increase in 2 years. Where does CoMeD spend their money? In 2009 they list one contributer (JB and Lisa Handley, of Generation Rescue) with a $5,000 donation. They don’t list contributers in 2010, but in 2011 the contributers are:

ASD Centers, LLC: $103,915
James and Wendy Abrams: $20,000
Institute of Chronic Illness: $1,975
MEDCON: $5,083.

ASD Centers, Institute for Chronic Illness and MEDCON are all run by the Geiers. So, CoMeD is run by and mostly funded by the Geiers.

Where do they spend their money? Let’s focus on 2011 as it is the largest budget:

$44.6k on travel
$34.8k was spent on legal fees.
$24k on compensation of the officers.
$17k on printing and publications.
$15.3k on other professional services

So, CoMeD apparently spends its money on flying the Geiers around and paying attorneys. Plus paying the Geiers small salary. But they are the primary donors so CoMeD is paying the Geiers their own money. Plus printing and publications.

I would be very interested in seeing the details of these expenses. Especially considering how close inspection of expenses by the special masters in the vaccine court have routinely found strange accounting practices. The Geiers have been travelling to try to convince the U.N. to include a ban on thimerosal in vaccines in the global mercury treaty. They have brought lawsuits against two HHS secretaries (Leavitt and Sebelius. But did those require large legal fees? And that much travel? And publications? Their website certainly doesn’t cost much money. Perhaps there are flyers out there somewhere. Or, maybe, they are paying the publication charges for their papers?

Bottom line: if you want to pay the Geiers to travel the world, pay attorneys and pay themselves, this could be the charitable contribution for you.

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By Matt Carey

A look at the financials for Generation Rescue and the Strategic Autism Initiative

15 Feb

Generation Rescue is a well known charity with a focus on alternative therapies for autism and promoting the idea that vaccines cause autism. The Strategic Autism Initiative was formed by Andrew Wakefield after he left Thoughtful House (now the Johnson Center). Many of these organizations have close ties and, in fact, GR helped SAI get started with a $100k grant its first year.

The most recent tax forms are from 2011 and are below:

Generation Rescue IRS form 990Strategic Autism Initiative IRS form 990

Generation Rescue pulls in a great deal of money, nearly $1.2M. Of which about $240k goes to the “rescue grant” program. About $125k goes to running their website. Another $125k to pay their executive director.

Under grants, Generation Rescue (GR) has two:

$25,000 to the Strategic Autism Initiative
$20,000 to Jackson State University

Both “for researching causes of autism”. We see again the link between GR and SAI. Jackson State is the institution engaged by Generation Rescue and the SAI to perform a vaccinated/unvaccinated study using homeschooled kids. I’ll point out that when I reviewed the GR and SAI tax forms last year, I speculated that they were starting to fund the vax/unvaxed study.

Now consider the SAI’s form 990. SAI pulled in $284k. They paid out $250k in salaries and other compensations. Yep, 88% of intake went to salaries. Luckily they had a bit of a war chest from the year before to draw on. But let’s look at those salaries. Andrew Wakefield is compensated $200k/year for a reported 30hours/week. That’s $270k/year (his salary at Thoughtful House). Terri Arranga ( of AutismOne) was paid $28.8k for reported 15hours/week.

But, as I said, they had a war chest from 2010 (due in big part to a $100k donation from GR). How did they spend that? Well, they appear to have a grant of $25k to Generation Rescue for “research related to the vax/unvax study”. Which strikes me odd as GR gave SAI $25k, so it looks like the money went in a circle.

That said, what expenses did SAI report?

$158k to Dr. “Lenys G. Gonzalez” to work with Arthur Krigsman and Stephen Walker on “molecular and clinical signatures of inflammatory bowel disease and adverse vaccine reactions in autistic children.”

Lenny Gonzalez is a researcher in Venezuela who was funded by Wakefield at Thoughtful House in one of the supposed “independent” replications of Wakefield’s findings. Arthur Krigsman is a former colleague at Thoughful House, with a colorful history. Stephen Walker’s name comes up periodically in regards to a study he presented at IMFAR but never published which supposedly confirmed Andrew Wakefield’s finding of measles virus in intestinal tissues of autistics.

$43k for a study on “vaccination status and health outcomes among homeschool children in the United States”, with Anthony Mawson of Jackson State. Mr. Mawson was named as the lead researcher for this project back when GR was seeking funding from money left over from a class action lawsuit to fund it.

$86k for an “IRB approved” (are the others not?) investigation using the Florida Medicaid database. And, no surprise, this is to look at vaccines. (1) acute adverse reactions to vaccines as predictors of neurodevelopmental disorders and (2) age of vaccination and risk of adverse outcome.

I am curious if the Florida project is the same one the Geiers were attempting to get pushed through approval a few years ago. A t that time a vaccine-causation focused chiropractor and heavy political donor was pushing both access to the Florida medical records and for things like changing a bill to improve access to services for families with autistic children into a vaccine bill.

Many people might be wondering how Andrew Wakefield managed to gather half a million dollars in under two years. I can’t say for sure but I can put out some information for speculation.

One of his board members is Elizabeth Avellan. She also serves on the board for Mr. Wakefield’s “Autism Trust”, which lists her accomplishments as including ” highly successful film producer and co owner of Trouble Maker studios “. Troublemaker Studios has the “Spy Kids” franchise.

Another board member is Phil Rawlins. There was a Phil Rawlins in Austin who owned a soccer team. He has since moved to Florida.

So whatever skills he had, Mr. Wakefield is basically now a fundraiser. He’s good at it, you gotta hand it to him. I can think of a lot of ways that money could be better spent, though.

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By Matt Carey

The Geiers’ Second Home

2 Feb

Mark Geier is well known within the autism alternative medicine community (think chelation, lupron) and as a consultant and expert for the attorneys in the vaccine court. David Geier is his son and has also been associated with the alt-med treatments (much criticised research, being accused of practicing medicine without a license) and tried to break in to the vaccine-court expert/consultant business. The Geiers are currently suing the attorneys who represented the families in the Ominibus Autism Proceeding (the vaccine court hearings on vaccine causation of autism). According to court papers, the Geiers are seeking $600,000 in fees and expenses they feel are owed to them. The vaccine court denied the application for paying for their fees.

In looking over the documents I was struck by an odd fact: the address given for the Geiers is not the same one I am used to seeing. It isn’t their usual home base in Maryland. So I decided to take a look at what sort of home they are currently claiming as their residence.

Here’s a picture (click to enlarge pictures):

House 1

The home is described online as 7,800 square feet, on a 20 acre lot. The backyard comes complete with a swimming pool.

House 2

Apparently, the estate was listed for $2.6M in 2011, but pulled from the market. Eidt to add: I’ve been informed that Mark and David Geier (not Mark and his wife) purchased the property in Nov. 2011 for $2M.

the Interior is not understated:

B-Room Geier

and

B-Room Geier

If you work out where they live, please don’t post it here. It is publicly available information, but it is not relevant to this discussion. What is releavant is this: there’s a lot of money in alternative medicine and promoting the idea that vaccines cause autism. Mark Geier has 20 years experience working with, and being critcized by, the vaccine court, including for double charging and for charging for costs well outside their roles (such as trips to Europe)

A single study they assisted in preparing for the Omnibus was billed at $440k, even though it was of low quality and was not useful in the case. The special master was very clear:

Clearly, no rational “hypothetical paying client” of the PSC would have agreed to pay for the production of such a flawed study. Thus, the fact that the Young-Geier article did not add any value to the petitioners’ causation presentation in this case is a very strong reason why I should decline to compensate the PSC for the cost of producing the article.

The Special Masters of the Court of Federal Claims (the vaccine court) appear to have closed the door on payments to the Geiers. But not until nearly two decades of low quality work was compensated. Mark Geier has lost his license to practice medicine in multiple states, but, again, not until after he was able to spend decades “treating” people with and charging people for therapies which make no sense.

The Geiers may not get the $600k they believe they are owed for work on the Omnibus. Their multistate franchise of lupron treatment centers may be closed. They may not be able to charge the American taxpayer for future low quality “expert” reports for the Court. Perhaps Mark Geier will have to retire a little early (reportedly, he’s 64), to his new home. Shared with his wife and son. Except for the living out one’s retirement with David Geier, I’m not seeing this as a difficult time for him. As to David Geier, one does wonder if he will ever amount to anything. Extrapolating from existing data, I’m not betting on it. But, as with his father, I don’t see cause to worry for his future. The U.S. taxpayers, and medical consumers, have taken care of this father/son team far better than we have our disabled citizens. And with less return to show for it.

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By Matt Carey

Minamata Convention Agreed by Nations: thimerosal containing vaccines exempt from mercury ban

23 Jan

Shot of Prevention are reporting Decision Made: No Global Ban on Thimerosal. A worldwide treaty has been finalized involving reducing mercury in the environment. Much discussion of late focused on whether thimerosal containing vaccines (thimerosal being a mercury compound) would be included in the mercury ban.

According to the United Nations Enviromntal Programme (UNEP) press release on the Minamata Convention:

Governments approved exceptions for some large measuring devices where currently there are no mercury-free alternatives.

–Vaccines where mercury is used as a preservative have been excluded from the treaty as have products used in religious or traditional activities

–Delegates agreed to a phase-down of the use of dental fillings using mercury amalgam.

From my perspective I would be happy to see thimerosal replaced with another safe preservative. There is no tested alternative method–either through preservatives or improved cold-chain control of vaccine distribution. And this U.N. body, people highly focused on the need to reduce the worldwide emissions of mercury, has determined that the use of mercury containing vaccines can continue. In other words–the arguments made that thimerosal containing vaccines were potentially unsafe were not convincing to a body whose sole purpose is limiting exposure to mercury. This includes the argument that thimerosal containing vaccines increase the risk of autism. And for this site, that is the important take-away: the notion of a mercury induced autism epidemic really isn’t well supported. Yet another example of how unconvincing the argument is.

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By Matt Carey

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