Mark Geier: vaccine lover

7 Sep

Sometimes reality is just stranger than fiction. Consider Mark Geier. He’s the doctor whose license has been suspended in Maryland for his treatment of autistic children with Lupron. He’s been a regular expert witness in the vaccine court for something like 20 years. He’s got multiple papers out on the dangers of mercury in vaccines.

Think that’s enough to please the vaccines-cause-autism crowd? Think again.

Stroll over to Facebook where a heated discussion is ongoing.

…you’re wrong on that one…. from personal experience having dinner with Dr. Geier….he has no problem with the vaccines other than mercury. He told me to my face at dinner that he gave his patients the H1N1 vaccine last year (Hg free of course). Sorry, but that is from personal experience….he’s a hack in my book.

Yep. Giving vaccines makes one a hack. Treating faux precocious puberty, not so much.

the response?

…thanks for saying that…I detected he was a vaccine lover.

Yep, he’s a “vaccine lover”. Mark Geier. That’s his failing.

… I know I’ll probably make some enemies over this but I call em’ as I see em’ and this was NOT hearsay. He told me that to my face at dinner…I got up, called him a moron and didn’t come back to finish my dinner. I fumed all night!

Well, there you have it. Tell the wrong people you gave vaccinations and you are a hack, a “moron” and you make people lose their appetite.

The world never ceases to amaze.

MMR Vaccine and Autism: Vaccine Nihilism and Postmodern Science

6 Sep

In a commentary for the Mayo Clinic Proceedings, Gregory A. Poland, MD writes about MMR and autism. In case you don’t get the idea of his stance from the title of the article, MMR Vaccine and Autism: Vaccine Nihilism and Postmodern Science, it starts out with a quote:

Nothing is more terrible than to see ignorance in action.

Johann Wolfgang von Goethe

I’m sure people will counter that they are very “smart” and “well educated” and, therefore, not ignorant when they promote the MMR/autism notion. Is it ignorance, willful ignorance, bias, dishonesty, some mix or something else entirely that is behind the perpetuation of the idea? I don’t know. On a very real level, it doesn’t matter. What matters is the fact that the MMR hypothesis was wrong and that those who continue to promote it are causing a very real danger to society.

That said, here are Dr. Poland’s views in the introduction to his paper:

It is a truism that acting in one’s perceived self-interest is not always in one’s self-interest. Perhaps nowhere is this truer in contemporary public health than for the issue of the measles-mumps-rubella (MMR) immunization and persistent fears about a possible connection with autism. Although each of these 3 diseases had been controlled in the United States with the widespread use of the MMR vaccine, in the past decade those gains have been slipping. Even though the United States has had fewer than 50 measles cases per year during the past decade (mostly imported from other countries), 156 cases have already been identified in the first 6 months of 2011. 1 European countries such as England, Wales, Italy, France, Spain, and Germany are also experiencing substantial increases in measles outbreaks.

Why should we be concerned? Measles is the most transmissible human disease known. Even with modern medical care, approximately 1 of every 3000 infected persons die, and many more are hospitalized or otherwise harmed as a result. Population coverage (herd immunity) needs to be in excess of 96% to prevent outbreaks. In addition, measles is a disease for which eradication is both possible and planned, a goal that obviously cannot be met given current vaccine coverage levels.

This predictable sequence of falling coverage levels, followed by outbreaks of disease, has occurred because of decreased public confidence in the safety of the MMR vaccine. In large part, this has resulted from incorrect assertions that the vaccine plays a role in the development of autism, an idea promoted by Andrew Wakefield. No credible scientific evidence, however, supports the claim that the MMR vaccine causes autism, and indeed, national medical authorities and scientific professional societies have unanimously …

This article is commentary (i.e. not a research article), but there are some good points and questions made:

Why in the face of nearly 2 dozen studies and every scientific committee rejecting such an MMR-autism connection does this myth persist?

As expected, he notes the celebrity aspect of the vaccine-causation notion. He also discusses the recent paper in the PACE Law Review.

Under “Moving Forward”, Dr. Poland writes:

At some point, a point I believe we have well passed, the small group of people who claim such connections, who have no new or credible data, and for which their assumptions and hypotheses have been discredited must simply be ignored by scientists and the public and, most importantly, by the media, no matter how passionate their beliefs to the contrary. Such individuals are denialists at best, and dangerous at worst. Unfortunately, the media has given celebrities who comment on an autism-MMR link far more attention than they deserve, and the public, unfamiliar with the background science, has confused celebrity status with authority. Such a phenomenon has not been lost on those wishing to continue the discussion. As an example, J. Hanlon, cofounder of Generation Rescue (an organization that advocates for an autism-MMR vaccine link) commented, in regard to the finding that both Andrew Wakefield and his assertion of a connection between autism and MMR vaccine had been discredited, that to those who believe vaccines cause autism “Andrew Wakefield was Nelson Mandela and Jesus Christ all wrapped in one.”

Prediction: we will hear all about how this commentary is obviously worthless because the author didn’t correctly cite J.B. Handley. If you are wondering what I mean, read again, Mr. Handley is referred to as J. Hanlon. I wish the author hadn’t made that mistake as such small errors are exploited in exactly this way. But, at the same time, this puts some perspective on the situation regarding Mr. Handley. He is a well known name in a very small community. He has become one of the go-to people for comments critical of vaccination (as in the Jesus Christ/Nelson Mandella article).

Prediction 2: Dr. Poland’s article will be called an attempt at censorship (see the conclusion below). Probably with no sense of irony by the same people who recently stated that Autism Speaks should “Shut up, shut down and go away.”

Prediction 3: People will still refuse to see how strange the “Nelson Mandela and Jesus Christ” comment read to the majority of readers. OK, I am predicting the past here, but I expect this to go forward too. Dr. Poland didn’t pick this quote to place Andrew Wakefield in good light.

That all said, I agree with Dr. Poland. It is well past time for the MMR story to be set aside. Just because there are adherents to the idea doesn’t mean that news organizations need to give it false balance.

Dr. Poland concludes his article with a simple summary: the MMR/autism question has been investigated closely and no link is found. The decision to forgo immunization based on this fear is not without danger. Those who promote the MMR/autism link in the face of all the evidence are not working for the public good:

For anyone adhering to the scientific model of discovery, experimentation, and evidence, the trial is over and the jury back—there is no known scientific association between receipt of MMR vaccine and the subsequent development of autism. Making the decision to not immunize children with the MMR vaccine because of fear of such an association —rather than credible scientific evidence—places children and others at great risk as current measles outbreaks in the United States and Europe illustrate. Vaccine nihilists who continue to claim such associations are simply wrong, and they pedal an agenda other than for the public good. At this point, the antivaccine groups and conspiracy proponents promoting such an association should be ignored, much as thinking people simply ignore those who continue to insist that the earth is flat or that the US moon landing in 1969 did not really occur

He concludes simply but strongly:

There is no law against being foolish, nor any vaccine against ignorance; however, in the meantime the health of millions of children in the United States and worldwide is being placed at unnecessary and real risk through continued deliberate misinformation and discredited unscientific beliefs, and that should be a crime.

Sacramento County Schools “See” The Invisible Epidemic

5 Sep

At the end of this past week, California’s Sacramento Bee reports that “Autism rates quadruple in local schools over last decade“. The article, written by Phillip Reese, seems largely unremarkable. Even though headline is suggestive, there are no claims of “autism epidemic” that follow. In fact, Reese points out that:

Whether autism is actually more prevalent — as opposed to just more frequently diagnosed — is a matter of controversy.

From a scientific perspective, Reese definitely could have dug a lot deeper, but to a casual reader, the relevant facts seem pretty accurate, and a clear chart is provided.

The problem with an article like this, is that to a casual reader it may appear that there doesn’t seem to be any explanation in sight. “Autism is on the increase in Sacramento County Schools for the past decade”, and that’s that – “Why” is some sort of “controversy”, “some districts have more autistic students than others”, “here’s a chart”, and the article ends.

Did the Sacramento Bee miss an opportunity to carry their headline further, and expose an acutal “autism epidemic” in northern California schools?

Not surprisingly, Age Of Autism (always on the lookout for support of the notion that there’s been an autism “epidemic”) thought so. As it turns out, AoA resisted the urge to dig much deeper too. They were apparently satisfied to present a simple retort to the indication that whether or autism is actually more prevalent or more frequently diagnosed is “controversial”.

Seems the SacBee hasn’t read the study from their own state U that said, A study by researchers at the UC Davis M.I.N.D. Institute has found that the seven- to eight-fold increase in the number children born in California with autism since 1990 cannot be explained by either changes in how the condition is diagnosed or counted – and the trend shows no sign of abating.

Emphasis AoA’s.

If you think the emapahsized quote above sounds more like a press release than an acutal study, you’d be correct. Does the quoted press release overstate the actual conclusions of the study?

I’ll let readers be the judge of that, here’s the actual study’s conclusion:

Autism incidence in California shows no sign yet of plateauing. Younger ages at diagnosis, differential migration, changesin diagnostic criteria, and inclusion of milder cases do not fully explain the observed increases. Other artifacts have yet to be quantified, and as a result, the extent to which the continued rise represents a true increase in the occurrence of autism remains unclear.

Emphasis mine.

As foreshadowed for us in the conclusion of the actual study, what other artifacts might there be, that have “yet to be quantified”? Big ones like changes in awareness or diagnostic substitution?

Let’s quantify one of those potential artifacts (diagnostic substitution) for the Sacramento County Schools data, shall we?

Here’s the data (available online to the public):

To sum things up, I think Reese’s article/blurb would have been more interesting, only requiring a few extra minutes (the data is already there, presented on the same page when looking up the autism numbers), if it had included information about other changes like the “more than offsetting decrease” of Specific Learning Disabilities over the same time period.

Tell us what you think? Could newspapers do better when reporting on autism data, or do they simply present what their readers are really looking for?

Additional reading on this subject:

California’s Invisible Autism Epidemic (Jan 2009)

California’s Invisible Autism Epidemic Continues (Feb 2010)

California’s Specific Learning Disabilities Counter Epidemic (Feb 2011)

Lessons from the MMR scare by Fiona Godlee

2 Sep

Fiona Godlee, editor of the British Medical Journal, will address the National Institutes of Health (NIH) on Tuesday, Sept. 6th. Her talk, Lessons from the MMR scare, will take place at 11am eastern time, and is scheduled for 90 minutes.

It will also be videocast.

Please join BMJ Editor Fiona Godlee for a discussion of the stunning investigation she published earlier this year that revealed the MMR scare was based not on bad science but on deliberate fraud. The three-part series was produced by journalist Brian Deer, who spent seven years investigating Andrew Wakefield’s infamous study linking the MMR vaccine with autism, discovering Wakefield had been paid by a lawyer to influence his results and had blatantly manipulated the study data.

In an editorial accompanying Deer’s report, Godlee and colleagues noted, “Science is based on trust. Without trust, research cannot function and evidence based medicine becomes a folly. Journal editors, peer reviewers, readers, and critics have all based their responses to Wakefield’s small case series on the assumption that the facts had at least been honestly documented. Such a breach of trust is deeply shocking. And even though almost certainly rare on this scale, it raises important questions about how this could happen, what could have been done to uncover it earlier, what further inquiry is now needed, and what can be done to prevent something like this happening again.”

For more information, read the BMJ articles:

The fraud behind the MMR scare, Fiona Godlee, et al
Wakefield’s article linking MMR vaccine and autism was fraudulent
Institutional and editorial misconduct in the MMR scare

Secrets of the MMR scare: Brian Deer

Part 1: How the case against the MMR vaccine was fixed
Part 2: How the vaccine crisis was meant to make money
Part 3: The Lancet’s two days to bury bad news

The NIH website gives a brief biographical blurb on Ms. Godlee:

About Fiona Godlee

Fiona Godlee has been Editor in Chief of the BMJ since 2005. She qualified as a doctor in 1985, trained as a general physician in Cambridge and London, and is a Fellow of the Royal College of Physicians. Since joining the BMJ in 1990 she has written on a broad range of issues, including the impact of environmental degradation on health, the future of the World Health Organisation, the ethics of academic publication, and the problems of editorial peer review. In 1994 she spent a year at Harvard University as a Harkness Fellow evaluating efforts to bridge the gap between medical research and practice. On returning to the UK, she led the development of BMJ Clinical Evidence, which evaluates the best available evidence on the benefits and harms of treatments and is now provided worldwide to over a million clinicians in 9 languages. In 2000 she moved to Current Science Group to establish the open access online publisher BioMed Central as Editorial Director for Medicine. In 2003 she returned to the BMJ Group to head up its new Knowledge division. She has served as President of the World Association of Medical Editors (WAME) and Chair of the Committee on Publication Ethics (COPE) and is co-editor of Peer Review in Health Sciences. She lives in Cambridge with her husband and two children.

hat tip to a commenter at Respectful Insolence for this information.

Prof. Paul Shattuck: ASD outcomes in adulthood

2 Sep

Below is a presentation given at the last IACC (Interagency Autism Coordinating Committee) meeting. Prof. Shattuck has done some excellent work in recent years. He’s one of the people looking into the areas I find critical and underserved. If you want to hear about research which can have a real impact on the life of this generation of autistic youth, you should set aside the time to listen to this talk.

Prof. Shattuck is looking at the critical transition from school to adulthood. How well are autistic students making that transition (largely, not so well as it turns out). What are the factors that help make that transition successful? If we don’t look into these questions today the problems will only continue unresolved.


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Autism Talk TV – Ep. 16 – What’s the Deal With Women, Fatherhood, and Executive Functioning?

2 Sep

Alex Plank, Kristen and Jack Robison went to the ASA conference in Florida and have a lot of video in the can. This is their first finalized video from that trip.

Kristen speaks to Dena Gassner (subject: Women), Alex and Jack speak with Claire Dumke (subject: executive functioning), and Alex speaks with Robert Naseef (subject: Fatherhood).

Five years ago…

1 Sep

Left Brain/Right Brain has been around since 2003. Yesterday I thought to myself: I wonder what a look back would tell us. Say, 5 years? To summarize: it tells us that things move slowly.

Some of the faces have changed over the years. For example: I wasn’t writing then but Autism Diva was. Some regular commenters have moved on. Some new ones have joined. David Kirby (author of Evidence of Harm), Rick Rollens (California Lobbyist) and others were frequently in the news and now they are rarely heard from.

But, in the end, many things stay the same:

In Autism Diva: Kelloggs Just Trying To Help , Kev pointed to a post by Autism Diva who was discussing an awareness program by Autism Speaks where AS was getting their name on cereal boxes.

I seem to recall being critical of Autism Speaks just recently…

In Dr David Ayoub – Hidden Agenda and Stone Cold Certainty we see Dr. Ayoub, a vocal proponent of the idea that vaccines cause autism. This was about the time when people were discovering that Dr. Ayoub had some interesting beliefs. He was posing “difficult questions” like “2) Is there evidence that vaccines can deliver antifertility products? Have they been used?” and “3) Does thimerosal fulfill criteria as an antipopulation agent?”. This as well as some other odd ideas, as discussed in David Ayoub, Black Helicopters and Social Movement.

Years later, even after this, Dr. Ayoub still pops up from time to time (for example, on mercola.com last year).

In, “Its The Mercury, Stupid! No Wait!“, Kev was discussing people were predicting a drop in the autism counts which were then published quarterly by the California Department of Developmental Services (CDDS).

He quoted David Kirby:

[Kirby] “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.”

So, now that we know that they never dropped is the opposite ‘practically undeniable’?

Let’s not forget what David Kirby told Citizen Cain:

“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 drop didn’t happen. The goalposts moved. The mercury idea lost some momentum but, unfortunately, still lives on despite evidence.

In “A Blogging Catch Up” Kev discusses the “Rain Mouse” study (a study claiming autistic behaviors in mice injected with thimerosal. The MIND Institute tried to replicate the study later and found they could not, even with much higher doses of thimerosal). Also in the “catch-up” was the revelation by Kathleen Seidel of some of the misdeeds of the Geier’s. This included the fact that they had failed to obtain appropriate IRB approval for one of their studies. 5 years later and they are just now facing some disciplinary action for the way they’ve conducted their business.

Like I said. Some things move slowly. Sure, the “autism is nothing but a misdiagnosis for mercury poisoning” idea has mostly (mostly) gone by the wayside. I often read people writing, “Is this the end of autism/vaccine idea?”. The idea has certainly lost momentum. I doubt it will die in my lifetime.

Thankfully, it wasn’t all vaccines (then or now). In Calling all autistic college students, Kev set out to help an organization trying to gather information about autistics in college.

Interagency Autism Coordinating Committee (IACC) Conference Call

31 Aug

The Interagency Autism Coordinating Committee will hold a conference call on a draft letter to the Secretary of Health and Human Services on issues relating to seclusion and restraint.

The call is September 7, 2011 from 3:00 p.m. to 5:00 p.m. ET.

Please join us for a conference call of the IACC on Wednesday, September 7, 2011 from 3:00 p.m. to 5:00 p.m. ET for a discussion and vote on the draft letter to the Secretary of Health and Human Services on issues related to seclusion and restraint and autism spectrum disorder (ASD).

The conference call will be accessible by the phone number and access code provided below. Members of the public who participate using the conference call phone number will be able to listen to the meeting, but will not be heard.

Conference Call Access
USA/Canada Phone Number: 800-369-1673
Access code: 2298100

Individuals who participate using this service and who need special assistance, such as captioning of the conference call or other reasonable accommodations, should submit a request to the contact person listed above at least seven days prior to the meeting. If you experience any technical problems with the webcast or conference call, please e-mail IACCTechSupport@acclaroresearch.com or call the IACC Technical Support Help Line at 443-680-0098.

Please visit the IACC Events page for the latest information about the meeting, remote access information, the agenda and information about other upcoming IACC events.

Contact Person for this meeting is:

Ms. Lina Perez
Office of Autism Research Coordination
National Institute of Mental Health, NIH
6001 Executive Boulevard, NSC
Room 8185a
Rockville, MD 20852
Phone: 301-443-6040
IACCpublicinquiries@mail.nih.gov

Dementia in intellectual disability: a review of diagnostic challenges

31 Aug

A study out of South Africa looks at Dementia in individuals with Intellectual Disability (ID). The basic idea to me is an excellent question: how to evaluate and support intellectually disabled individuals as they go through dementia.

When parent’s say, “what will happen to my kid after I die”, they may not even be considering old age, dementia and other factors. How do we insure that all people are treated with dignity and respect through what can be an incredibly challenging time for many? And who will be there to advocate for them?

This is one reason why researching the needs of autistic adults is so critical to me. I’d say we are already behind on learning about subjects like aging and dementia. The time to start filling in those gaps is now.

Dementia in intellectual disability: a review of diagnostic challenges.

The evaluation of dementia in individuals with intellectual disability (ID), which will guide subsequent intervention, care and management depends on the systematic review of a number of factors: (1) the individual historical context, obtained from multiple sources, (2) evaluation of the pre-existing cognitive, behavioural, psychiatric, medical and adaptive skill profile, (3) the constellation, and pattern of evolution, of presenting signs and symptoms, (4) results of focused investigations, and (5) refinement of the differential diagnosis. In patients with ID, standard clinical methods need to be supplemented by careful, longitudinal behavioural observations, and individually tailored assessment techniques. Co-morbidity, multiple biological, psychological and socioenvironmental factors, and complex interactions among events, are the reality for many ageing people with ID. Determining the various influences is often a formidable clinical task, but should be systematically carried out using medical, cognitive, behavioural, neuropsychiatric and psycho-social frameworks.

Internet survey shows high autism rate in unvaccinated children

31 Aug

Informal surveys are fraught with problems. There can be all sorts of biases. Many ways for the data to be skewed one way or another. A great example of this was the Generation Rescue phone survey. The results were all over the map, and clearly flawed. Many of the results pointed to higher autism rates in partially vaccinated over fully vaccinated children.

That was four years ago. Recently an internet survey was undertaken to explore vaccine questions. The survey results can be found on the site vaccineinjury.info. People with agendas certainly can do surveys, but they shouldn’t be surprised when their agendas are pointed out. I won’t go into the survey or results in detail. I have a suspicion the results will be analyzed elsewhere. Rather, let’s just look at the autism results.

Here is the age distribution of the (mostly) children reported on in the study. Very skewed towards the very young.

Here is the distribution of an age distribution of the fraction of kids in each group reported to be autistic (click to make bigger)

If you are wondering, “did they just publish a graph showing high autism ‘prevalences’ in unvaccinated kids?”, you are correct. They are showing that in some age groups the fraction of unvaccinated autistic kids is about 2%. The current prevalence estimate for the U.S. and the U.K. is about 1%.

Do we really want to put any weight on this result? No, not really. It is a nicely packaged internet survey, but it is an internet survey after all. Can we speculate a little as to what this means? Sure. It could mean that the groups that were recruited for this survey included more families with autistic children. Given the high recurrence risk of autism (i.e. the high chances that a younger sibling of an autistic kid would be autistic) it is not only reasonable, but predicted, that such a survey might show a high fraction of autistic kids.

Keep something in mind–the number of autistic kids is small. If I did the math correctly, there are only 37 autistic kids total. [edit to add–this is incorrect. There are 44. I left out two age groups in my total] That means big uncertainties (error bars) in the “results”. Results which, as we’ve already discussed, are pretty skewed just by the design and limitations of the survey.

Must be unexpected for the people doing the survey. Rather than show a low autism prevalence, they show a high one. For those who claim (sometimes over and over) that there are no unvaccinated autistic kids, here is another piece of evidence that they are wrong.

It’s clear enough that even commenters at the Age of Autism blog have noticed it. From “Sarah”:

Help! What am I doing wrong trying to read these graphs? The one titled autism in UNVACCINATED children shows autism percentages above the commonly accepted level in vaccinated children, but in the full study, which also shows a similar graphic, they say only 4 children in the study had severe autism. Are the graphs supposed to be the levels in vaccinated children? What am I missing here? Does this study show higher rates of autism among the unvaccinated?

Yes, Sarah, you are seeing correctly. The study shows higher rates of autism amongst the unvaccinated. That’s what the >1% values for ages 3-12 means when compared to the 1% value currently reported for the United States.

And, you can see people trying to “interpret” these results in interesting ways:

Sarah, I see 0.57% for autism roughly half of the rate seen in vaccinated children.
Note also that many who are not vaccinating are doing it because they have a child with autism already and these families have an increased likelihood of another child having autism as well. These numbers could be much lower in a larger survey and the cases are less severe as noted already. I hope this helps.

Yes, if you want to water down the results by averaging, including infants too young to be reliably diagnosed, you can get a lower prevalence. Of course, to do that one has to ask: what is the prevalence of diagnosed autism amongst infants? We don’t know.

The website notes:

Due to the fact that the majority of children in the survey are between 0 and 2 years of age and some diseases generally do not appear in this age group, the results are subdivided into different age groups (click on the graphic). Information about country, gender, age, age distribution, breastfeeding, preferred tretment[sic] can be found here.

And they are correct. There are no autistic kids in the age 0-2 group reported. Looking at just the ages 3-18 kids, there are 4326 kids, making a “prevalence” of 0.85, if you want to average. That would be within the error bars of the current autism prevalence estimate in the U.S..

As I’ve noted, the Age of Autism blog has already discussed this (thanks to those who sent me the link). I doubt this will get much play from these groups as the results are really not good from their point of view.

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