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An Open Letter To The Poling’s

12 Apr

Dear Poling family,

Let me first start by saying that your little girl is beautiful. I am father to two girls (as well as one boy, young man now actually) so I know how great it is to have such wonderful little people around.

I read Jon Poling’s commentary in the AJC and I have to say that I was very disappointed by the level of accuracy in the piece. For example, he says:

On Nov. 9, 2007, HHS medical experts conceded through the Department of Justice that Hannah’s autism was triggered by nine childhood vaccinations administered when she was 19 months of age…

Now I have taken a keen interest in your families case since it became clear what the situation was. I _think_ I have read most of the newspaper reports available online as well as (more importantly) the HHS document itself and (even more importantly) the case study co-authored by Andrew Zimmerman and Jon Poling.

Nowhere, I repeat, nowhere, have I seen anyone from either the HHS, CDC, US Government, or even the Zimmerman/Poling case study say that ‘Hannah’s autism was triggered by nine childhood vaccinations’.

I have seen David Kirby refer to this several times. I have heard lots of people refer to these statements as if they are true and now I hear you doing it too.

But where is this concession?

In what legal, scientific or medical document does it state unequivocally that ‘Hannah’s autism was triggered by nine childhood vaccinations’?

You are a family on the cusp of storm. You need to take more care with your statements. People all over the world are listening. The *fact* as of right now is that no one has conceded ‘Hannah’s autism was triggered by nine childhood vaccinations’. Simply stating it as if it were true does not make it true.

The HHS expert documents that led to this concession and accompanying court documents remain sealed, though our family has already permitted release of Hannah’s records to those representing the almost 5, 000 other autistic children awaiting their day in vaccine court.

Now this confuses me on two levels. Firstly, Special Masters have already said that:

….in the case that is the subject of the media reports, if the parties who supplied documents and information in the case provide their written consent, we may then be able to appropriately disclose documents in the case.

It sounds to me like Dr Poling is trying to turn something around onto the HHS without justification. Maybe your legal team haven’t told you about this news. I understand they’re very busy of late.

The second part of Dr Poling’s statement that confuses me is the allusion to the records being released ‘to those representing the almost 5, 000 other autistic children’.

I thought that you wanted your documents to be made entirely public? Are you now saying you only want the legal teams of the other omnibus lawyers to have access to them?

I would also like to draw your attention to the email I sent to Terry Poling on March 5th asking why the Poling family had not cleared Dr Andrew Zimmerman from speaking publicly about the case. Does the Poling fmaily have any intention of lifting that embargo any time soon?

Dr Poling goes on:

Emerging evidence suggests that mitochondrial dysfunction may not be rare at all among children with autism. In the only population-based study of its kind, Portuguese researchers confirmed that at least 7.2 percent, and perhaps as many as 20 percent, of autistic children exhibit mitochondrial dysfunction. While we do not yet know a precise U.S. rate, 7.2 percent to 20 percent of children does not qualify as “rare.” In fact, mitochondrial dysfunction may be the most common medical condition associated with autism.

This is very disingenuous Dr Poling. I am not sure if you are purposefully distorting the truth or simply not as knowledgeable as you think. In point of fact the figure of 7.2% is from a 2005 study ‘Mitochondrial dysfunction in autism spectrum disorders: a population-based study‘. This is _not_ (as you state) ‘the only population-based study of its kind’. It was in fact a precursor to a _second_ follow up study by the same lead researcher correcting his own data.

This second study (published October 2007) is called ‘Epidemiology of autism spectrum disorder in Portugal: prevalence, clinical characterization, and medical conditions’.

This study declares a 4.1% figure. It is disingenuous in the extreme to refer to old science when newer, more accurate science exists on the subject (and by the same author no less!).

Further, as far as I can tell, the figure of 20% has but one source – a non published summary for attendees of a 2003 LADDERS conference in Boston, USA. Therefore it has not been subject to any kind of peer review. That’s not to say the figure is wrong, merely that it hasn’t been verified or undergone any kind of the usual scientific checks and balances a published piece of work must undertake to ensure quality. This is not ’emerging science’ Dr Poling. Its a set of program notes.

Further, as I understand it from talking to people involved in all three of these different items, the percentages you talk about are expressed percentages _of regressive autism only_ . Now I might have that wrong but I’m pretty sure that’s what was communicated to me.

Taking this into account, when Dr Poling states that:

In fact, mitochondrial dysfunction may be the most common medical condition associated with autism..

and he goes on to suggest population numbers between 10,000 (1%) , 72,000 (7.2%) and 200,000 (20%) of the autistic population he estimates at one million in the US, he is incorrect.

However, if I have understood what is said to me then we need to look at regressive autism numbers only, which are estimated to account for 25%-30% of autistic people. Therefore we are looking at not 7.2% or 20% (one is incorrect, one is not scientifically justified) of one million. We are actually looking at 4.1% (the only scientifically valid number) of between 25 – 30% of one million. Lets take the upper figure of 30%. This gives us a population of 300,000 for regressive autism. Applying the 4.1% estimate we can see that – at best and only if this data is all correct – mitochondrial autism may affect about 13,000 autistic people – 1.3%. If we took the lower range of 25% for regressive autism, we barely get over 1% (10,250).

Secondly, it should be noted that approximately 40% of autism can be accounted for genetically. This already makes it the single largest established cause(s).

Dr Poling goes on to say:

Today there is no doubt that mitochondrial dysfunction represents a distinct autism subpopulation biological marker.

This is true. However, prefacing this sentence with the word ‘today’ gives the highly misleading impression that autism has been associated with mitochondrial disorders and/or dysfunctions only since Hannah Poling came into out collective conciousness. This is far from the case. I can find instances in the scientific literature going back to 1986, over 20 years ago discussing mitochondria and autism and a PubMed search for ‘mitochondrial autism’ yields 34 quality papers published over a 20 year period. This is hardly a new thing Dr Poling.

As a neurologist, I have cared for those afflicted with SSPE (a rare but dreaded neurological complication of measles), paralytic polio and tetanus. If these serious vaccine-preventable diseases again become commonplace, the fault will rest solely on the shoulders of public health leaders and policymakers who have failed to heed the writing on the wall (scribbled by my 9-year old daughter).

I fear that this is projection. You are very close to pushing an anti-vaccine agenda Dr Poling and indeed Terry Poling was active an the Yahoo Group ‘Recovered Kids’ from at least Summer 2001 where she says things like:

Really, the only way to obliterate a disease is to vaccinate everybody – or at least so “they” say

Sept 2001.

Had I told the hospital staff she was autistic they would not have believed me. The same held true for a (sic) educational consultant who came to evaluate hannah the day before the fever started. She said in her report she saw absolutely no autistic behaviors.

Nov 2001.

She has mitochondrial disease which causes her autism.

March 2004.

I do know docs that speak for drug companies but they cover all the meds for a particular disease in their talks with other docs. If they do not agree that the drug is best for certain conditions on the whole they say so.

Feb 2003.

…it [autism] is a DSM set of symptoms. When the symptoms disappear you cannot say the child still has autism…..

Oct 2001.

So Dr Poling when you try to lay the blame for vaccine preventable injuries increasing at the foot of those agencies assigned to try and stop them reappearing I think that is farcical. To me it is clear that the main responsibility lies with those who shun what are by and large safe safe vaccines on the strength of a hypothesis that is nowhere _close_ to scientific truth. I urge you to read this article and the comments left by readers. Its clear who they see as responsible. For example:

Don’t want to vaccinate your kids? Fine with me. Just don’t send them to school where they then put my kids at risk because of your decision.

You are deluding yourself if you think you can turn responsibility for shunning vaccines back on health agencies Dr Poling.

All in all Dr and nurse Poling I think that your public use of misinformation and erroneous science to make your point will serve you no good in the long run. I also continue to be puzzled by your refusal to ‘ungag’ Andrew Zimmerman. I hope you can start to realise that what has ‘happened’ to Hannah is far from remarkable. Best wishes from one autism parent to another.

Wakefield on Ethics: “I’m perfectly willing to accept my understanding was wrong.”

11 Apr

Remarkably, Wakefield has now admitted that he may have ‘misunderstood’ the ethical guidelines for research on children. Apparently, Wakefield “was not aware of ‘detailed guidance’ on the treatment of children provided by the British Paediatric Association” and is “perfectly willing to accept [his] understanding [of ethics] wrong”. Wakefield thus seems to be claiming ignorance of the fact that that certain research practices – such as when he allegedly “paid children at party £5 to give blood samples” – are unethical. Partly because of Wakefield’s apparent violation of ethical guidelines, he is accused “of acting against the clinical interests of the children who took part in his trial.”

This is bizarre. Frankly, one wonders as to how a researcher could not realise that practises such as paying kids for their blood at a birthday party might – just perhaps – be a teeny bit ethically problematic. But, even putting that aside, one should remember that Wakefield has been quick to claim [PDF] that

My actions were at times taken in the best interests of children potentially damaged by the MMR vaccine….I remain dedicated to helping these children and resolving the issue of whether vaccines are involved in this disorder or not. I will not be intimidated or coerced into stopping this work prematurely.

If Wakefield was doing this research ‘for the children’, one would have expected him to pay more attention to the ethical guidelines for research on children – and thus to the interests of the children involved in his research. Continue reading →

Dear CDC

26 Mar

I read with interest Dr Schuchat’s opinion piece in the AJC today.

Whilst it is gratifying to see someone of Dr Schuchat’s calibre responding to previous claims regarding vaccines in autism I would like to make a few points to Dr Schuchat and the CDC in general.

Firstly, this level of response is around eight years too late. What have you been doing on the media/PR front over the last eight years? I’ll tell you what your ‘opponents’ have been doing – they’ve been conducting protests outside your offices, outside the offices of the AAP etc. They’ve been setting up and organising vaccine/autism groups and heavily marketing them via the use of organic and paid for web based advertising.

The only people who have made any kind of attempt to counter these groups and the misinformation (deliberate or not) they publish is people like myself. I am not attempting to aggrandise myself at all. I am attempting to convey to you how one sided the ‘battle’ has been over the last few years.

Where were you? You were needed. You could’ve helped. Instead you sat back and hoped this would all go away. It didn’t. It won’t.

Secondly, the level of Dr Schuchat’s response is very close to condescending. Simply stating that:

Kirby’s column included many inaccuracies related to childhood vaccines. As such, it illustrates that when it comes to immunizations, child development and specific medical conditions, the best source of guidance is the child’s health care provider.

is patronising in the extreme. The level and quality of the debate has moved on in the last eight years. Bland assurances won’t cut it. You need to be specific and offer evidence. Autistic people, parents of autistic people and interested professionals are smart enough to know and understand a certain level of science these days.

Don’t be shy about providing people with science. You have some truly excellent science on ‘your side’ as I and others have attempted to blog about in the last five years to no small effect. For example, Googling mmr autism displays, amongst others, the blog of a friend of mine – also the parent of an autistic child and also convinced of the need to blog about the bad science surrounding the various vaccine/autism hypotheses. Googling thiomersal autism brings up _this_ blog. We’re doing your job for you!

You’re being left behind in this debate. Its time you caught up.

How to create a disease

25 Mar

This piece is once again guest written by ‘Nigel’, a scientist working in the field whos real name is not actually Nigel ;o)

Followers of Andy Wakefield may not have come across a little spat which took place in the correspondence section of the journal “ Histopathology” last year. It is all to do with “ autistic enterocolitis”, the alleged inflammatory bowel disease described by Wakefield and colleagues in 1998 in the infamous Lancet paper. It is worth remembering that although the MMR-autism link garnered all the publicity, a key intermediate in the link was that measles persisted in the gut, resulted in enlarged lymphoid follicles, which then somehow caused this “ autistic enterocolitis”. At Thoughtful House in Austin, Texas, Wakefield and his acolyte Artie Krigsman, are now trying to make a buck out of treating this condition.

Professors Tom MacDonald and Paola Domizio from Barts and the London School of Medicine in London were experts for the defense in the UK MMR litigation against the vaccine manufacturers out of which Wakefield trousered one million dollars. MacDonald is a pre-eminent gut immunologist with an international reputation and was recently awarded the President’s Medal of the British Society for Gastroenterology for his scientific achievements. Domizio is an extremely well known gut pathologist and is also a senior figure in the Royal College of Pathologists in the UK.

The gist of their article (Histopathology. 2007 50:371-9) was that autistic enterocolitis does not exist. In a forensic dissection of the key paper by Wakefield and colleagues in the Am J Gastroenterology in 2000 (Am J Gastroenterol. 2000 95:2285-95), MacDonald and Domizio clearly showed that the so-called enterocolitis was due to Wakefield incorrectly deeming enlarged lymphoid follicles in the gut as pathological abnormalities, and that he had also created new and unsubstantiated pathological abnormalities to give the impression of gut pathology. The image of enterocolitis in an affected child shown in this paper was an extremely highly magnified picture of a small piece of tissue, which may in fact have come from one of the original Lancet 12 (in order to bump up the numbers of patients studied, Wakefield just reported the original Lancet 12 again). This is a familiar Wakefield tactic, his “representative” images are always taken at an extremely high magnification on the microscope, presumably to hide the fact that the rest of the tissue is normal. MacDonald and Domizio also shredded other Wakefield papers of the same ilk in their article.

Key to this piece of detective work by Domizio and MacDonald was a table in the Am J Gastro paper where these invented histological abnormalities were shown. In his response ( Histopathology 2007 50:380-4) Wakefield did not address any of the substantive points raised by MacDonald and Domizio, but stated that the pathological descriptions in the table were nothing to do with him, but were the work of Prof A Dhillon at the Royal Free Hospital in London, who was not an author of the paper. Unfortunately for Wakefield, Dhillon also wrote to the journal to say that it was nothing to do with him either (Histopathology 2007 50:794). Dhillon showed his version of the table, which unsurprisingly, because Dhillon is a bona fide pathologist, contained none of the new invented abnormalities. So we have an impasse, though not enough of an impasse to stop Wakefield publishing another paper in 2005 (Eur J Gastroenterol Hepatol 17:827-36) showing the same table again, and remarkably, reporting the Lancet 12 for at least the third time! Wakefield produced no response to MacDonald and Domizio’s suggestion that since the histopathology slides from the autistic children seen at the Royal Free Hospital in London are available, it would be a straightforward exercise to have these analysed in an anonymous and independent fashion to put this question to rest.

In response to Wakefield’s defence of his work, the editor allowed MacDonald and Domizio a final say, where they demolished Wakefield again (Histopathology 2007, 51, 552–3).

Although all of this might seem highly technical, histopathological diagnosis of gut disease is a highly skilled art, with extremely high standards, and it is scientific vandalism for non-pathologists such as Wakefield to create new and non-existant abnormalities and then use them to burden children and parents with a life-long inflammatory bowel disease. The best example of this sleight of hand is his definition that a tissue section from the gut of an autistic child was abnormal if it contained a lymphoid follicle. However when the gut biopsies were taken at colonoscopy from autistic children, lymphoid follicles were specifically targeted for sampling because they wanted to look for measles in these tissues. So it is obvious that all will have pathology if one uses this invented criteria.

Throughout this saga, Wakefield has traded on the fact that autistic children do have real gut problems. However instead of attributing these problems in the majority of children to a combination of chronic and severe constipation, fecal impaction, unusual diet, diarrhea, bloating, parasites, gas etc, he had to find a new disease! However the pediatric gastroenterologists in charge of these children at the Royal Free knew what the problem was, when they wrote in the Lancet in 1998, that following cleansing of the colon needed for colonoscopy, many children underwent rapid symptomatic improvement which was maintained if constipation was avoided ( Lancet 1998;351:908). So there you have it, an inflammatory bowel disease treatable by cleansing the colon!

An interesting post-script to all this is that when challenged with the fact that the alleged “enterocolitis” in autistic children is not different from the mild changes and ileal lymphoid hyperplasia seen in chronically constipated, developmentally normal children, Wakefield and Krigsman are now saying that the constipation in autistic children is different! Give us a break !

PS. MacDonald was also an expert witness last year in the Hazelhurst versus HHS case in the USA. In his testimony MacDonald re-iterated in some depth the extent of Wakefield’s rogue and junk science, going back all the way to his identification of measles virus in Crohn’s disease using reagents which were not specific for measles virus. However he picked up yet another deception in the Am J Gastro paper. Much of the paper deals with the alleged lymphoid hyperplasia in the ileum of autistic children, graded by Wakefield on a score 0-3, with 0 being no follicles and 3 allegedly an undefined “severe” lymphoid hyperplasia. To illustrate the colonoscopic appearances of grades 0-3, a panel of photographs purportedly showing the different grades is included as Figure 1 of the paper. The date and time each photograph was taken is reproduced in figure. The image of alleged grade 0 ileal lymphoid hyperplasia (ILH) was taken on the same day and only 1 minute 54 seconds before the image of alleged grade 3 ILH. It is impossible to remove a colonoscope from 1 child and scope another child, reaching the ileum in 1 minute 54 seconds. Therefore the grade 0 and grade 3 images were taken from the same child; the grade 0 image most probably from the caecum ( the part of the colon just after the ileum) and the grade 3 image from the terminal ileum.

Urinary opioid peptides and genes

19 Mar

Two new interesting pieces of science out this week.

Firstly was the latest piece of MMR hypothesis destroying science called ‘Absence of urinary opioid peptides in children with autism’.

MMR believers say that part of the hypothetical damage the MMR does to the gut of autistic kids is cause so-called ‘leaky gut’ syndrome, an alternative medicine hypothesis roughly suspected to be on a par with homeopathy and massaging aura’s in terms of scientific credibility.

Proponents of the autism branch of this hypothesis say that the MMR causes leaky gut and that the ‘leak’ fails to parse these urinary opioid peptides which in turn would (in effect) get the patient stoned. or to put it another way:

….these peptides result in effects which are basically opioid in nature (akin to drugs such as morphine) and that they may either, themselves, have direct opioid activity or that they may form ligands for the enzymes which would normally break down such opioid peptides that occur naturally within the Central Nervous System (CNS). In either case, the consequence would be the same. The CNS neuroregulatory role, which is normally performed by the natural opioid peptides such as the enkephalins and endorphins, would be intensified to such an extent that normal processes within the CNS would be severely disrupted…

Yeah, right.

So now some actual science (as oppose to blueskying) has looked at this. And what do they conclude:

It has been claimed for a number of years that the urine of children with autism contains exogenously derived opioid peptides. This finding is said to reflect a disturbance in the integrity of the gut epithelium, act as a diagnostic marker for autism and predict treatment response to a diet excluding gluten and casein. The aim of the present study was to determine whether exogenous or endogenous peptides were present either in the urine of children with autism, or control children.

…..

There were no significant differences between the HPLC urinary profiles of the children affected by autism and the typically developing controls. In those cases where HPLC showed peaks in the locations at which opioid peptides might be expected to be found., MALDI-TOF established that these peaks did not, in fact, represent opioid peptides at all.

……

Given the lack of evidence for any opioid peptiduria in children with autism it can neither serve as a biomedical marker for autism, nor be employed to predict or monitor response to a casein and gluten exclusion diet.

So that’s yet another nail in the undead vampire of the MMR hypothesis (in fact, is there a proper word for something which is less than a hypothesis? Even using the word ‘hypothesis’ now seems aggrandising this silliness)

On the other side of research, where actual progress is being made, an as yet unpublished study (or published but the journal issue hasn’t been released or it has and I can’t find it) has found genetic connections which they think can count towards up to 2.5% of autism:

Disruptions in the gene, called contactin 4, stop the gene from working properly and appear to stop the brain from making proper networks, the researchers reported in the Journal of Medical Genetics.

These disruptions, in which the child has either three copies of the gene or just one copy when two copies is normal, could account for up to 2.5 percent of autism cases, said Dr. Eli Hatchwell of Stony Brook University Medical Center in New York, who led the study.

Now, when we put this together with Rett, Fragile-X, Tuberous Sclerosis, de-novo mutations and a few others I can’t recall I think we’re approaching between 10 – 16% of an established genetic cause for autism(s). Slightly better than the 0% that the vaccine hypotheses are running at.

Autism vs features of autism

14 Mar

In sum, DVIC has concluded that the facts of this case meet the statutory criteria for demonstrating that the vaccinations CHILD received on July 19, 2000, significantly aggravated an underlying mitochondrial disorder, which predisposed her to deficits in cellular energy metabolism, and manifested as a regressive encephalopathy with features of autism spectrum disorder.

– HHS

If one has the right set of “features” of autism, one has autism……Hannah Poling has autism — as defined in every book, in every library, in every university in the world. Dr. Parikh’s insistence otherwise is perplexing.

– David Kirby, to EoH group in response to Dr. Parikh’s article in Salon.

Its a massively ambiguous point. Do ‘features of autism’ equate to a _diagnosis_ of autism? David Kirby and some commenter’s to this site say ‘yes’. I personally think ‘no’.

But I think we need to be clear here. In this particular case, Hannah Poling can still be autistic but the HHS are arguing (in my opinion) that the features listed as those being aggravated/caused by vaccines do not add up to enough by themselves to give a diagnosis of autism.

To illustrate this idea, I went through the symptoms given by Dr Zimmerman that he put forward as being vaccine aggravated in a previous post (green = hit with DSM (IV), red = miss):

1) Loss of previously acquired language
2) Eye Contact
3) Relatedness
4) disruption in CHILD’s sleep patterns,
5) Persistent screaming
6) Arching
7) the development of pica to foreign objects,
8) loose stools
9) CHILD watched the fluorescent lights repeatedly during the examination

So, three of the symptoms given by Dr Zimmerman as being vaccine aggravated can be matched with the DSM (IV). This is way below what is needed for a diagnosis of autism.

But, we cannot discount the idea that she _could be_ autistic. To me, it seems likely that here is an autistic child who has her vaccines and who presents with nine symptoms following those vaccines, three of which tally with DSM (IV) criteria.

This presents two questions. First, is there a difference made by autism diagnosticians about autistic features vs a diagnosis of autism?

The best way to answer this is to ask autism diagnosticians. I wrote to some autism diagnosticians. They asked to remain anonymous, which I have to respect. The email I sent in essence asked them if they thought that:

a) ‘with features of autism spectrum disorder’ is directly equivalent to a diagnosis of autism?
b) ‘with features of autism spectrum disorder’ means that some elements of the DSM (IV) are present but not enough to diagnose autism?
c) ‘with features of autism spectrum disorder’ means that some elements of the DSM (IV) are present but not enough to diagnose ASD?
d) ‘with features of autism spectrum disorder’ means something else entirely?

The responses I got back stated that b) was most likely, maybe c) .

So according to these autism diagnosticians, some elements of the DSM (IV) are present but not enough to diagnose autism, or possibly ASD. This tallies with my own personal opinion.

The second question is; did Hannah Poling present with any diagnosable symptoms of autism _before_ her vaccines? Sadly, it seems we will never accurately know the answer to this question. The Poling’s will say no of course. David Kirby et al will say no of course.

I will remember the Cedillo’s however, who testified that their daughter (who they claimed was made autistic by vaccines) showed no symptoms of autism before her vaccines were administered. However, when home movies of their daughter taken before her vaccines were shown to several diagnosticians, they testified that she was indeed exhibiting symptoms of autism prior to vaccine administration. The Cedillo’s didn’t lie. Its simply not possible to remain clinically objective about one’s own child. Even for an employee of Johns Hopkins, it is not possible to remain objective about one’s own child.

That doesn’t mean Hannah Poling _did_ exhibit symptoms of autism prior to vaccines of course. It simply means that we need to be skeptical of the claim that she didn’t.

Is Hannah Poling autistic? Could be. Seems likely.

Did the vaccines cause the nine symptoms Dr Zimmerman found? HHS ‘concede’ they did.

Do the fact that three of those nine symptoms tally with the DSM (IV) mean that the vaccines are the cause of her autism? No, thats not logical.

Vaccines, Autism and the Concession

1 Mar

1) Concession Report (This document has been removed due to the possibility of it being illegally obtained). If people really wish to read the document for themselves it can be founf here, at the Huffington post
2) Zimmerman Case Study

When David Kirby wrote his piece in the Huffington Post, I’ll admit I read it with my jaw on my chest. Here was evidence I was wrong. I emailed David Kirby to get the whole report from him and he was kind enough to provide not only a PDF version but a plain text version as well.

This enabled me to contact a few people that I know are medical people and/or scientists and/or closely connected to this case. For example I contacted Dr Zimmerman and learned that it was not possible for him to offer any sort of opinion on this case due to the fact that his patients parents had not allowed him to discuss his thoughts and opinions with anyone except the court. I was told however that ‘the comments on your site with questions raised and loopholes pointed out about the way others are interpreting the facts of the situation, are right on track.’

It is clear to me then that there is some wordsmithing going on – either deliberately or unintentionally. What we need to do is look closely at the wording of two documents. The concession report and the case study performed by Dr Zimmerman.

The claim by David Kirby et al is, in essence, that the US Government have conceded that vaccines cause autism in this one case. Lets look at the so-called concession report in relation to what it says about autism.

Dr. Andrew Zimmerman, a pediatric neurologist, evaluated CHILD……on February 8, 2001. Dr. Zimmerman reported that after CHILD’s immunizations of July 19, 2000, an “encephalopathy progressed to persistent loss of previously acquired language, eye contact, and relatedness.” He noted a disruption in CHILD’s sleep patterns, persistent screaming and arching, the development of pica to foreign objects, and loose stools. Id. Dr. Zimmerman observed that CHILD watched the fluorescent lights repeatedly during the examination and would not make eye contact. He diagnosed CHILD with “regressive encephalopathy with features consistent with an autistic spectrum disorder, following normal development.”

Features consistent with. He did not diagnose her with autism. What were these features?

1) encephalopathy progressed to persistent loss of previously acquired language,
2) eye contact,
3) relatedness
4) disruption in CHILD’s sleep patterns,
5) persistent screaming
6) arching,
7) the development of pica to foreign objects,
8) loose stools
9) CHILD watched the fluorescent lights repeatedly during the examination
10) would not make eye contact

Of these ten, one is repeated (eye contact issues) so I make nine clear separate symptoms there. Which of these appear in the DSM (IV)? Green equal matches, red equal misses.

1) Loss of previously acquired language
2) Eye Contact
3) Relatedness
4) disruption in CHILD’s sleep patterns,
5) Persistent screaming
6) Arching
7) the development of pica to foreign objects,
8) loose stools
9) CHILD watched the fluorescent lights repeatedly during the examination

To meet the DSM(IV) criteria a person must meet no less than 6 of the criteria. So, as described perfectly exactly by the Dr Zimmerman in the concession report, this child has features consistent with an ASD. But its clear she does not meet the criteria for autism.

Later on,

CHILD was evaluated by Alice Kau and Kelley Duff, on May 16, 2001, at CARDS. The clinicians concluded that CHILD was developmentally delayed and demonstrated features of autistic disorder.

Almost the exact same phrasing. Consistent with. But no one has said thus far that the child has been diagnosed with an ASD.

The concession report concludes with:

the vaccinations CHILD received on July 19, 2000, significantly aggravated an underlying mitochondrial disorder, which predisposed her to deficits in cellular energy metabolism, and manifested as a regressive encephalopathy with features of autism spectrum disorder….

This is the phrasing that caused the uproar. But when looked at in light of the previous, it is clear that far from suggesting that vaccines cause autism via a mitochondrial disorder, the vaccines worsened an occluded or underlying mitochondrial disorder which took on a few of the symptoms of autism _but was never actually diagnosed as autism at all_ . Because it wasn’t autism.

Before we switch to Dr Zimmerman’s Case Study, lets clear up a few things.

No one, I repeat, no one is saying this child wasn’t autistic. She may well have been. What we are doing is looking at the science reported in the concession report and Zimmerman’s paper and seeing if what the _science_ says in these two papers means that it was the vaccines that caused any autism. The concession report clearly says that no it wasn’t. Thats why this case was uncontested. She was affected by her vaccines but autism was not the result.

Zimmerman’s case study is entitled ‘Developmental Regression and Mitochondrial Dysfunction in a Child With Autism’ – this is further evidence against the case presented that it was the vaccines that caused the autism. This child is reported as being one with autism. Not one who develops autism as a result of vaccines.

However, it is clear that this child _does_ develop autism:

We describe a female patient in whom developmental regression and autism followed normal development…..Evaluation at 23 months showed …..[t]he Childhood Autism Rating Scale (CARS) score was 33 (mild autism range), and she also met Diagnostic and Statistical Manual for
Mental Disorders-IV criteria for autism

and yet this autism was so mild that at that exact same period (23 months):

the patient began speaking again at 23 months old

which means that expressive language was lost for a sum total of one month (it is reported being lost at 22 months). It should also be noted that CARS is _not_ designed for diagnosis but is an indicator only. Overall, we get a picture of a child who had an underlying mitochondrial dysfunction exposed by the illnesses following her vaccinations which caused developmental regression. This developmental regression presented with some features of autism.

Did the vaccinations cause her developmental regression? Seems likely. It is an undisputed fact that vaccines do cause injury, that is why after all there is a compensation program to claim from in the US and the UK.

Was her developmental regression autism? No. At no point in either the concession report is it claimed that the developmental regression the child went through _was_ autism. However, in the same way that Leukemia (weakness, paleness; fever and flu-like symptoms) can have the same symptoms as flu (weakness, paleness; fever and flu-like symptoms) but be totally different, this child’s developmental regression shared certain features of autism.

So was this child autistic. She might well have been. However, her autism was not caused by a vaccine.

Update

This column was forwarded to me by a friend. Thanks to him.

The practice of calling certain things near-autism, or even autism itself is not new. Here’s a quote from a Science article regarding HIV in 1989:

The signs of AIDS dementia in children are clear and, Pizzo says, “very painful to watch. Very young children lose words.” Words like “mommy” and “daddy” and “bear” are too hard to remember as the AIDS virus multiplies in the young child’s body and penetrates the central nervous
system.

An 8-year-old boy, once normal, was rendered practically autistic by HIV, Pizzo said. He stopped speaking. Asked to trace a simple
outline of an elephant, the boy could not. Painfully, he knew what a simple task it was, and he knew he was failing it. But he could not cry even though his doctors could see tears welling up in his eyes.

Pizzo has seen children lose IQ points one boy lost as many as 28-as AIDS ravages their brains. “Kids who used to do well in school really deteriorate,” says Pizzo who has “before and after” IQ data from school-age children.

But in a series of remarkable studies, Pizzo has seen AZT (azidothymidine) reverse these symptoms. The child who lost words like “mommy” and “daddy” “got them back,” Pizzo says. The boy who lost IQ points is restored to his former capacity.

The 8 year old cries. After just a couple of weeks of continuous AZT therapy, the boy who could not trace an elephant is successful at tracing a horse.

Now, we all know that ‘tracing an elephant’ and losing IQ points are not symptoms of autism but it is intriguing to see a doctor describe a regression as ‘practically autistic’. Note also, just like in this case, in Zimmermans case study, the child quickly loses, then very quickly regains aspects of their former regression. But HIV didn’t cause autism any more than vaccines did.

Ya ken that hidden horde, aye?

24 Feb

So – the ‘Hidden Horde’ – the term that anti-vaccinationists like to smirk about as evidence of an autism epidemic. The logic goes like this: if there’s no autism epidemic then where are all the [insert age here] year old autistic adults? I’ve heard people asking for evidence of 75 year old autistics (conveniently forgetting that the average mortality age in the US and UK is around 70), 50 year olds – even 30 year olds.

Never mind that there’s been plenty of evidence for adult autistics. Thats not convenient for the anti-vaccinationist agenda so it gets ignored.

Anyway, todays Sunday Herald carries another story about adult autistics in Scotland called ‘Revealed: ‘invisible’ adults living with autism’.

According to the National Autistic Society (NAS) Scotland report, due to be launched this week, 52% of adults have not had an assessment of their needs since the age of 18…..It is estimated that more than 35,000 adults in Scotland have the condition, but campaigners said they were “invisible” to local authorities, who are failing to record the number of people with autism in their area.

The population of Scotland is 5,062,011. The latest prevalence estimates for the UK are 1 in 100. This means that 50,620 people are autistic. If 35,000 adults in Scotland are autistic then 69% of autistic people in Scotland are adults.

Hidden horde aye?

Wakefield, Baird, Archives

20 Feb

This is a Guest Blogged post, written by an author with a keen interest in Wakefield related issues. My gratitude to Nigel for writing the post which follows.

Wakefield and his colleagues were fast off the mark (http://www.thoughtfulhouse.org/pr/020608.htm) to criticise the study by Baird et al which recently appeared in Archives of Disease in Childhood. This was a well conducted study which failed to detect measles virus (MV) or elevated measles antibodies in the blood of autistic children. There is a general feeling that even if the almighty Jehovah himself, collaborating with the top researchers at the Universities of Oxford, Cambridge, Harvard and Yale, and with an advisory board of all recent Nobel laureates in medicine, produced a negative study on measles virus in autistic children, Wakefield would still find flaws in the work; remarkably rich from the single largest purveyor of junk science in the last 20 years.

As a criticism of the study Wakefield states “It is a major error to have presumed that peripheral blood mononuclear cells are a valid ‘proxy’ for gut mucosal lymphoid tissues when searching for persistent viral genetic material” and later states “ We are increasingly persuaded that measuring things in blood many years down the line tells us very little about the initiating events in what is, in effect, a static (non-progressive) encephalopathy unlike, for example, subacute sclerosing panencephalitis, which is a progressive measles encephalopathy” .

The hypocrisy of this statement is quite breathtaking, but unsurprising from someone whose relationship with scientific honesty and integrity is somewhat elastic. For those who don’t have long memories, the first “alleged “ evidence of MV in autism came from Wakefiled’s collaboration with Kawashima where using standard methodologies which were highly effective at detecting MV laboratory contaminants, Wakefield claimed that blood cells from 3/9 autistic children gave positive results ( Dig Dis Sci 2000 45:723-9). This paper formed a key part of the UK MMR litigation from 2000-2003 driven by Wakefield himself until it was mysteriously dropped from the final claimants witness reports by Wakefield himself. Perhaps the realization that blood is a poor proxy for gut came to him in 2003, or more likely, that he knew the Kawashima data were junk and would not stand up in court.

Even more staggeringly, the vast majority of samples from autistic tested for MV by O’Leary in the Unigenetics lab in Dublin were from blood; including the now infamous blood samples taken from healthy children at Wakefield’s own child’s birthday party. Steve Bustin in his testimony on the US Cedillo case comprehensively shredded all of the work that came out of that lab. All of this data on blood has never appeared in the public domain although the junk science on MV in the gut did appear in the Uhlmann paper, in a low impact factor journal which promptly rolled over and died.

As always however, you cannot believe anything Wakefield says as being scientifically valid. In the blood there are cells which are representative of the gut lymphoid tissue. This is very well established and non-controversial. When T and B cells are activated in the gut associated lymphoid tissue, they acquire the alpha4beta 7 integrin and migrate via the mesenteric lymph nodes, and the thoracic duct into the circulating blood and then home back into the rest of the gut using the mucosal addressin, MAdCAM-1.. This happens in all healthy people constantly and it is possible to identify these gut-homing cells in blood. Since Wakefield claims that MV persists in the allegedly large lymph nodes in the gut wall, cells should be infected with MV at source and carry the virus with them into the blood. So come on Andy, with O’Leary’s supersensitive PCR, you should be able to detect at least some of these cells migrating to the gut via the blood. After all, the PCR is so sensitive it can detect MV in samples of distilled water, now that is really amazing!

I suppose one should always rejoice in the repentance of a sinner, and if Wakefield has now come to the conclusion that blood is not a proxy for gut lymphoid tissue, we should be happy he is now happy to recant on all his previous claims about blood cells being positive for MV in autism. I have a sneaky feeling however that this is just another “wriggle” to keep the show on the road. If one of his acolytes claims to find MV in blood of autistic children, you can bet that blood will once again become a valid proxy for gut lymphoid tissue.

Andrew Wakefield Responds

14 Feb

Andrew Wakefield has responded to the latest MMR Study showing no link between the vaccine and autism.

Just to recap, the latest Baird et al study looked at whether autistic kids and non-autistic controls showed any variance in their measles antibody response. They don’t.

The measles aspect of the MMR vaccine is what Wakefield’s hypothesis relies on. He says because its a live virus its casing gastric issues and then autism in some kids. This study looked to see if there was any evidence of measles-virus in the blood of these kids. There wasn’t. They looked to see if any of the autistic kids had evidence of gastric issues over and above the average. They didn’t.

But Wakers thinks this isn’t good enough.

The study is severely limited by case definition in the context of the crucial ‘possible enterocolitis’ group………….We have over the last 10 years evaluated several thousand children on the autistic spectrum who have significant gastrointestinal symptoms. Upper and lower endoscopy and surgical histology have identified mucosal inflammation in excess of 80% of these children. Almost none of these children with biopsy-proven enterocolitis would fit the criteria set out above………….The requirement for the current presence of these symptoms, for 14 or more days continuously, shows a singular lack of understanding of the episodic, fluctuating, and alternating (e.g. diarrhea/constipation) symptom profile experienced by these children

Wakers thinks that the criteria for defining enterocolitis that Baird et al used was too strict. He says it will occlude the group he’s identified.

He’s probably right. But not in the way he thinks he is. Could it maybe be that _his_ definition of enterocolitis is too slack? His definition includes:

In our experience, ASD children with histologic enterocolitis typically have 1 to 2 unformed stools per day that are very malodorous and usually contain a variety of undigested foodstuffs. This pattern alternates with that of “constipation” in which the unformed stool is passed after many days of no bowel movements at all, and with excessive straining.

With which he claims is ‘identified mucosal inflammation in excess of 80%’ of his kids.

Thing is, a PubMed search for ‘mucosal autism’ returns 20 results. Of which only one support the idea of inflammation – One of Wakers own papers. In fact the only person I could see using the term ‘histologic enterocolitis’ was (you guessed it) AJ Wakefield.

The question immediately occurs: Of the ‘several thousand children on the autistic spectrum who have significant gastrointestinal symptoms’ why hasn’t there been any published, peer-reviewed, replicated, science written up by Wakefield? Why hasn’t anyone else managed to find 80% positive results and published peer reviewed science about their results?

Could it be that its only the team who have screwed up their results that find what they want to find? I think so. Lets quote Stephen Bustin once more.

Now, these are from samples that should have been discarded according to the SOP from Unigenetics because there was no GAPDH present, i.e., the RNA is degraded. If you look at the Cts for the F-gene which they reported as positive you can see they’re the same. Now, if this is degraded RNA yet I’m getting the same Cts for my F-gene target this can’t be RNA because it would have been degraded.

That’s what the GAPDH showed me. Now, if it isn’t RNA it has to be DNA. If it is DNA it can’t be measles virus it has to be a contaminant.

Plain English – Wakefield scoped kids. Sent samples to Unigenetics. They should’ve told Wakers the samples were rubbish. They didn’t. They analysed rubbish samples which were contaminated. What they found wasn’t measles virus.

A frequent complaint from the Wakefield apologists is that by analysing blood samples rather than gut tissue, science teams are not comparing like-for-like. There are a number of reasons why this is questionable.

Firstly, there has to be a _reason_ for scoping children. It is not a straightforward procedure.

Towards the end of last year, an autistic child who was scoped following a recommendation by Simon Murch, a colleague of Andrew Wakefield’s, was awarded £500,000 damages after his bowel was perforated in 12 places.

An autistic boy has won a £500,000 payout after the hospital at the centre of the MMR scandal carried out an operation that was ‘not clinically justified’.

Jack Piper, then five, was left battling for life after the procedure, which his parents claim was carried out to establish links between his condition and bowel problems.

His bowel was perforated in more than 12 places during surgery at the Royal Free Hospital in North London.

…………

The colonoscopy was suggested by Professor Simon Murch. He is being investigated by the General Medical Council over allegations that he carried out invasive tests including colonoscopies on 11 other children contrary to their best clinical interests.

It is an ethical issue – is a scoping procedure ethically justified? The answer is ‘no’ – that hasn’t stopped Wakers doing ‘thousands’ though apparently.

Secondly, is there any reason why looking blood is not good enough? Awhile ago, I asked a Doctor (who wished to remain anonymous) who told me:

measles is a lymphotropic virus, even more so for the vaccine strain which has been selected to exploit the CD46 cellular receptor. If there is a persistent MV infection the most logical place to detect it is in cells that it is most adept at infecting. Lymphocytes [a type of blood cell]

(Insert mine).

So, there’s not really any reason why blood cells wouldn’t be suitable to check for measles virus, despite Wakefield’s opinion.

And in fact, at least one team _wanted_ to use Wakefield’s samples but their request was ignored:

The groups of investigators that either had access to original autism specimens or investigated them later for measles virus detection were invited to take part in the study but failed to respond. Similarly, it was not possible to obtain clinical specimens of autism cases from these investigators for independent investigations.

Now I have to wonder why, if Wakefield et al are claiming that only scoped samples are any good, or that blood is no good they didn’t hand over the samples they had harvested with the gratitude of a team expecting to be replicated.

Maybe they didn’t really want another science team looking at these samples. Maybe they feared what another team would find.

And what about this inflammation Wakefield alleges to have found? Turns out that its possible to screen for inflammation without the need for scoping.

Fecal calprotectin is a marker for a range of gastric issues, notably IBD (irritable bowel disease) and Crohn’s which it has positive results for.

A 2002 study Effect of Pentavac and measles-mumps-rubella (MMR) vaccination on the intestine looked at:

if MMR vaccination is associated with subclinical intestinal inflammation, which is central to the autistic “enterocolitis” theory

To do this, the team:

….studied 109/58 infants, before and two and four weeks after immunisation with Pentavac and MMR vaccines, for the presence of intestinal inflammation (faecal calprotectin).

The results were:

There were no statistically significant differences in faecal calprotectin concentrations at any time points (p>0.25) or when assessed in subjects studied before and after Pentavac (p>0.2) or MMR (p>0.3) vaccination

and

There was no evidence that either Pentavac or MMR vaccination provoked subclinical intestinal inflammation in any of our apparently healthy children during the four week post-vaccination period. This lack of a detectable intestinal inflammatory response suggests that the measles vaccine virus itself is not enterotoxic in healthy infants which argues against the MMR induced autistic “enterocolitis” theory.

And so we come back to the bottom line. What direction does peer reviewed published science take us in? It takes us away from Wakefield.

There are no good reasons to believe that blood samples are not good enough to compare with gut samples and if Wakefield believes otherwise, why didn’t he provide the samples to the Afzal team when asked to?

There is no good reason to justify dangerous, invasive procedures such as the one Wakefield has used on thousands of kids and which left one child fighting for life with a massively perforated bowel. Fecal calprotectin is more than adequate as a marker of intestinal issues and using this method reveals no association between MMR and autism.

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