People sometimes ask why this blog is all about vaccines when it is supposed to be about autism. Of course it is not all about vaccines. But it must seem like that because a lot of the time I am responding to the argument that vaccines are a cause of autism. Why do I bother when there is no scientific basis for any of the supposed pathways?
MMR was only ever supported by the work of one team of researchers grouped around Wakefield and working for the lawyers pursuing claims for compensation against the vaccine manufacturers. The testimony of Bustin and Chadwick at the Omnibus Autism Proceedings demonstrated the flawed nature of much of that research. Other scientists have failed to replicate Wakefield’s findings and epidemiological studies have shown no connection between autism and MMR.
Thiomersal, a mercury based preservative that used to be found in minute quantities in some childhood vaccines, has also been blamed. A speculative paper suggested similarities between the symptoms of mercury poisoning and autism. This idea was thoroughly debunked but the idea persisted because the growth in reported prevalence of autism in the USA coincided with an increase in the number of vaccines containing thiomersal. Advocates for this theory never adequately explained why autism numbers in the UK were growing at least as fast as those in the USA while the number of thiomersal containing vaccines [TCVs] in the UK never increased. And when TCVS were eliminated from the recommended childhood vaccine schedule in the USA in 2002 the numbers continued to rise.
The latest “theory” that we give our children “too many too soon” and overwhelm their natural defenses ignores the simple fact that advances in vaccine development mean that the entire vaccine schedule contains less active ingredients than ever before. A single dose of smallpox vaccine with 200 antigens contained more antigens on its own than all today’s vaccines put together. And in 1960 smallpox plus polio plus diptheria, tetanus and pertussis vaccines delivered 3,200 antigens!
“Too much too soon” is part of the “Green Our Vaccines” campaign. It is coupled with a spurious argument about toxins in vaccines. The Green Our Vaccines list of alleged toxic ingredients has been thoroughly dismissed. There are some potentially toxic chemicals used in vaccine production. These have all been tested for safety and are necessary to prevent contamination during production, storage and delivery of vaccines. I wonder how many of us use equally potent ”toxins” to cleanse work surfaces on which we prepare food for our children.
Their “science” is non-existent. But the anti-vaccine element have proved impossible to ignore because the media continue to give them publicity. And this publicity has contributed to the decline in vaccine uptake, paticularly the MMR. For example last month the Daily Telegraph published a ridiculous story entitled “MMR; the debate that will not go away.” Yesterday the Telegraph, with no apparent sense of shame, carried another story, “Teenager dies of Measles as cases continue to rise, Government officials say.”
This young man did have problems with his immune ystem which made it difficult for him to have vaccinations. Instead he relied on the “herd immunity” conferred on society when sufficient people are vaccinated to prevent a disease taking hold. 95% is usually held out as the threshold figure. But thanks to previous scare stories in papers like the Telegraph coverage is much lower. 84% of two year old have had the MMR. But only 75% of 5 year olds have had their second shot. In London the situation is worse with figures of 71% and 50% respectively according to the Independent. Measles is once again becoming endemic in the UK with 461 cases so far this year.
Most cases are thankfully not fatal. But they can still cause terrible illness. A woman in Blackpool nearly lost her daughter to the complications of measles.
Leah, who picked up the disease from her brother, was rushed into Blackpool Victoria Hospital on June 4 and kept on a drip for four harrowing days.
Mrs Hartley explained: “She had an horrendous sounding cough, a sky-high temperature, an upset stomach, conjunctivitis and she couldn’t stay awake.
“At one point she woke up and was hallucinating so she started screaming and crying, it really was terrifying.
“My mind was racing and I didn’t think she was going to pull through it – I never would have believed measles could make anyone so ill.”
Out of curiosity I visited the JABS forum. JABS claims to be neither pro nor anti vaccine. But it comes across as anti-vaccine and a supporter of the mmr-autism connection. Both the Telegraph report on the death from measles and the Independent report on the rise of measles were posted there on Saturday afternoon. Thus far at 1.00am on Sunday morning the young man’s death has been read 29 times with no comments. But the Independent report on the endemic has attracted 88 readers and comments like these.
Natural measles exposure is the best immunity you can get so I would imagine many parents will welcome this news with open arms.
One case of measles [in which a young man dies] makes the front page thousands of cases of autism unmentioned…agenda or what???
MMR RIP
if they can now justify mentioning individual measles cases, [He means a measles death]when normally they dismiss them in favour of epidemiology, then this must give the green light to discussing adverse reaction individual cases??
I will continue to post stories about vaccines in order to remind myself of what happens when quackery combines with conspiracy theory to drive out reason and compassion. Let us hope that the need to post such stories will diminish as the link between vaccines and autism is finally severed.
June 22nd, 2008
Posted by
Mike |
Andrew Wakefield, MMR, journalism, mercury, vaccines |
15 comments
Over on Left Brain Right Brain Kev has just blogged this article in the Mail. The article starts in typical tabloid style:
There is little hope given to parents of children with autism. Mainstream medicine offers no explanation for the cause of this life-long learning disability, thought to affect one in 100, and there are no effective treatments.Perhaps the most cruel characteristic of the condition, which impairs communication development and ability to relate to others, is that children often develop normally until about two years of age, when they suddenly ‘regress’, becoming mute, withdrawn, refusing to make eye contact and prone to tantrums.
Many never take part in mainstream education and some require full-time care, even as adults.
In the absence of solutions, desperate parents are increasingly turning to the world of alternative medicine in their search for a cure.
Or does it? There are the usual buzzwords - hope, desperate, cruel. But autism is described as a life-long learning disability, not strictly true but better than the usual this devastating disease. And the headline
The great autism rip-off …
How a huge industry feeds on parents desperate to cure their children
suggests more substance than I have come to expect from a paper that has done more than most to promote Andy Wakefield and the MMR scare over autism. Now they are investigating the claims of alternative therapists who sell dubious treatments to parents on the back of the media hype about vaccines and autism. The world is turning.
Journalist, Barney Calman posed as a parent and contacted 5 different Defeat Autism Now (DAN) practitioners. All charged serious money just to talk to the parent on their own and suggested an expensive battery of tests without ever seeing the child. All were happy to discuss a variety of treatment options and claimed great success while pointing out that their therapies might not work for a minority of children.
This is the beauty of quackery. You pay money for tests that indicate treatment. But they do not indicate if the treatment will work. So the parent moves on to the next practitioner in the hope of finding the one therapy that will work for their child.
First up was a former GP, David O’Connell who took £440 in consultation fees without ever seeing the child and recommended a barrage of tests on blood, stool and urine costing a further £1546. His recommended treatment is Secretin! He claims that previous studies were flawed. What, even this one? As I wrote elsewhere
The CEO of Repligen had a double interest in Secretin. He was not just another businessman looking for a profit. He was also the parent of two autistic children. He wanted it to work and he was ready to pay handsomely to make it work. Unfortunately his company’s research, rigourously conducted to satisfy the US regulatory bodies, “failed to meet the study’s dual primary endpoints.” That has not stopped other, less scrupulous individals from continuing to promote secretin and even homeopathic secretin as a cure for autism.
O’Connell goes on to state that
I’ve not published my findings in peer reviewed journals because I am unwilling to submit children to double blind trials.
But he will submit them to unproven treatments like Secretin at £450 monthly injection and immune globulin at £550. These quotes are revealing.
‘The only limiting factor is money.’
[...]‘The more injections a child has, the better the result,’ he says.
‘Autism can be a life sentence if you do nothing about it. And the sooner you start treatment, the more chance it will work.’
Parents used to be blamed for causing their child’s autism in the bad old days of Bettleheim’s refrigerator mothers. Now they are encouraged to blame themselves and then pay large sums for unproven and potentially harmful treatments in order to ease their guilt.
Next up was
Dr Asha Rekha Chagarlamudi, a locum GP who runs ‘The Autism Clinic’ one day a week from her home, a semi-detached house on a private estate in Bromley, South-East London.
She recommended IV chelation (Remember Abubakar Tariq Nadama?) and Hyperbaric Oxygen Therapy. (HBOT) She does not seem quite as mercenary as O’Donnell but I was a little perturbed because she is the medical advisor to the Autism Treatment Trust in Edinburgh. That is an eight hour drive away, which is not very convenient if the non-medical Dr Amet in Edinburgh needs treatment advice. Like Dr Chagarlamudi Dr Amet has an autistic child herself and was featured in this blog.
Dr Amet makes the striking claim that her series of blood and urine tests (£480) will give a complete picture of your child’s health and what has caused his autism. Her follow up consultation (£400) will discuss the test results and devise a treatment plan consisting of a special diet and supplements contains no mention of the IV chelation and HBOT recommended by her medical advisor 440 miles away, down in Kent, which is probably for the best.
Surprisingly, the cheapest therapist is based in that bastion of privilege and private medicine, Harley Street. Dr Damien Downing will do an initial consultation, urine and blood tests, follow up and seven rounds of transdermal chelation for just under £700. The only drawback is that transdermal chelators do not work
[S]ome enterprising doctors have formulated skin creams containing chelators like Transdermal DMSA. There are glowing testimonials for TD DMSA on the web. But DMSA is water soluble and so it is extremely unlikely that it could ever pass through the skin. Think about it. Our skin is a barrier that acts to keeps the water in. Without it we would dehydrate and die. It also keeps the water out. We do not absorb water like a sponge when we bathe or shower. So how does the DMSA pass through our skin? It does not. And so there is no way for it to have any effect on our bodies at all.
Calman also went to Dublin to meet
Dr Gabriel Stewart, a specialist in chelation therapy for adults, who tells me he tries to dissuade parents from giving their autistic children intravenous infusions ‘not because it’s dangerous, but because it isn’t effective in clearing mercury from the blood’. Consequently, Archie was not suitable for treatment.
He also warns that some ‘DAN! doctors’ are less than reputable.
‘All you need to do is attend one conference in the US and you can say you’re a DAN! doctor - and many of them aren’t medically trained.’
All this is true. It is also true that Dr Stewart is also a DAN doctor. While his refusal to use IV chelation on children is commendable his website reveals that he is a member of ACAM, whose ambiguities over the use of EDTA were exposed at the time of Tariq Nadama’s death. And he has bought into the entire DAN protocols for treating autism. The scientific bases for these protocols are being seriously challenged by expert witnesses in the Omnibus Autism Proceeedings that are taking place in the USA. See this example where the expert testimony of Dr Dean Jones is discussed.
All in all, an excellent piece of journalism from Mr Calman, marred only by a factual error in a sidebar on What is Autism. The prevalence figure of one in a hundred refers to the entire autistic spectrum. So called classic autism with associated learning difficulties is closer to 1 in 500.
June 1st, 2008
Posted by
Mike |
Autism, DAN!, Quackery, biomedical interventions, chelation, mercury, vaccines |
7 comments
If I could be in London next week for David Kirby’s PR visit these are some of the questions I would like to ask him. You may care to add your own.
Your book, Evidence of Harm, explores the premise that a 150 per cent increase in the mercury burden in US vaccines (from 75 to 187 microgams of ethyl mercury) that began in 1987 caused the dramatic rise in recorded cases of autistic spectrum disorder in the USA. Given that exposure to ethyl mercury in vaccines in the UK remained at 75 micrograms until it was finally removed in 2004, and we experienced a similar growth in autism, what possible relevance could your book or your theories have for the UK?
Thiomersal was completely removed from US vaccines and stocks exhausted by 2002. Yet autism rates have continued to rise. Do you agree that whatever plausibility there was to the thiomersal hypothesis when you were writing your book, it is contradicted by the data and should now be rejected? Are you now prepared to state publicly that there is no evidence of harm? That vaccines do not cause autism?
In your public debate with the journalist Arthur Allen you conceded that autism rates had not declined in line with your predictions after the removal of thiomersal from vaccines but went on to invoke other environmental sources of mercury such as toxic plumes crossing the Pacific from Chinse coal powered power stations, forest fires in California and even the smoke from crematoria. The UK is not being overwhelmed by pollution either from China or the USA and our autism rates are at least as high as yours. How do you explain this?
The organizations that are sponsoring your visit have been scathing in the past about the conflict of interest of scientific researchers who have repudiated any connection between mercury and autism. Does the fact that you are sponsored by anti-vaccine groups like Safe Minds and Generation Rescue and your current journalistic output is published on the Generation Rescue blog, The Age of Autism, create any conflicts of interest for you that might affect you impartiality as a journalist or are you happy with your role as a publicist for these organizations?
In recent months you have returned to the vaccine bandwagon, this time claiming that a significant number of autism cases are down to a reaction to vaccines that triggers a pre-existing mitochondrial disorder. You base your arguments on confidential documents leaked to you by people connected to Hannah Poling whose case is in the process of being settled at the US Court of Federal Claims. It is very difficult for us to judge the situation based solely on your speculations and the public statements of the Polings. When journalist Ken Reibel asked the Polings at the Autism One conference last month if they were prepared to release Hannah’s medical records and allow her treating physicians to comment publicly his press credentials were revoked and hotel securiy were summoned to expel him from the building. Surely this one sided speculation should cease until the case is settled and the science can be freely discussed by those qualified to do so?
May 31st, 2008
Posted by
Mike |
Autism, journalism, mercury, vaccines |
14 comments
Lord Hodgson, who is sponsoring David Kirby’s speaking engagement at the Palace of Westminster, has made good use of his position in the House of Lords to question government ministers on vaccine safety. He is particularly interested in thiomersal/thimerosal and has even enquired after its use in cosmetics.
On December 16, 2002
Lord Hodgson of Astley Abbotts asked Her Majesty’s Government:
How many of the standard vaccinations that children receive in the United Kingdom contain thiomersal; for how many years these standard vaccinations have contained thiomersal; and what research has been carried out into the cumulative effects of the mercury content of thiomersal on infant children.[HL429]
Lord Hunt of Kings Heath replied:
Vaccines containing thiomersal (a mercury-containing compound known as thimerosal in the United States) have been in use for over 60 years. The only vaccines used in the routine United Kingdom childhood immunisation programme which contain thiomersal as an excipient in the final product are diphtheria, tetanus and whole cell pertussis (DTwP) and diphtheria and tetanus vaccines.
In 2001, the Committee on Safety of Medicines (CSM) reviewed the available data relating to possible neurotoxicity of thiomersal in vaccines and advised that there is no evidence of harm caused by doses of thiomersal in vaccines. The CSM concluded that the risk: benefit balance of thiomersal-containing vaccines remains overwhelmingly positive. The Institute of Medicine (IOM) in the United States also published a detailed review of the evidence relating to possible neurotoxicity of thiomersal in vaccines in October 2001. The IOM findings were consistent with the CSM conclusions.
We are aware of two new studies in the UK looking at the relationship between mercury in vaccines and neurodevelopmental disorders in children. One of these studies is funded by the Department of Health and uses the Avon Longitudinal Study of Pregnancy and Childhood. The other study is using the General Practice Research Database and is funded jointly by the World Health Organisation and the Public Health Laboratory Service (which receives its funding from the department). Neither of these studies supports an association between thiomersal exposure through the UK programme and neurodevelopmental disorders in children. The results of these studies have been made available to the department and a summary of the findings is available in a report to the US Congress which has been placed in the Library.
In addition to the above studies, evidence from a recent study by M Pichichero et al (published in the November 30 2002 Lancet) showed that giving vaccines containing thiomersal does not raise blood levels of mercury. The findings of this paper suggested that ethylmercury is rapidly eliminated from the blood after administration intra-muscularly. The levels of ethylmercury in the blood were no higher than in samples taken at birth—before any vaccines had been received.
On January 27, 2003
Lord Hodgson of Astley Abbots asked Her Majesty’s Government:
Whether each child will by its 16th week of life have received, as part of the standard diphtheria, tetanus and pertussis (DTwP) immunisation programme, 150 micrograms of thimerosal which, in turn, contain 75 micrograms of mercury; and, if not, how much each child will receive.[HL1023]
The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath) replied:
The recommended vaccine for routine immunisation of children against diphtheria, tetanus and pertussis remains diphtheria, tetanus and wholecell pertussis (DTwP) vaccine. A course of primary immunisation with DTwP vaccine consists of three doses starting at two months, with an interval of one month between each dose. Each dose of the standard DTwP vaccine contains 50 micrograms of thimerosal (containing 25 micrograms of ethylmercury). Therefore, by 16 weeks the total thimerosal exposure would be no more than 150 micrograms (75 micrograms ethylmercury).
This is significant. In 2003 the exposure to thiomersal in the UK was the same as that in the USA in 1987. Then the USA added the thimerosal containing vaccines HIB and Hep-B to the infant vaccination schedule. These raised the exposure levels for ethyl mercury in 6 month old infants who were fully vaccinated from 75 micrograms to 187 micrograms. Throughout the 1990s recorded rates for autistic spectrum disorders rose both in the UK and in the USA. In fact the UK has consistently recorded higher rates compared to the USA. The headline figure in the US is currently 1 in 150. In the UK it is around 1 in 100.
Whatever the cause for the increase, one would expect it to be the same for two countries who share so many other features. Thiomersal is obviously not the reason for the increase in the UK. So why invoke it to explain the increase in the USA? And why is our noble lord so concerned to invoke thimerosal in the UK? This is even more pertinent when we consider Lord Hodgson’s next foray into the world of vaccines, which confirmed that the infant vaccine schedule in the UK is now thimerosal free.
On October 11, 2004
Lord Hodgson of Astley Abbotts asked Her Majesty’s Government:
What is the difference in cost between Pediacel and the vaccine currently in use.
The Parliamentary Under-Secretary of State, Department of Health (Lord Warner) replied:
Pediacel costs over £5 more per dose than the vaccines previously used.
Lord Hodgson of Astley Abbotts asked Her Majesty’s Government:
Whether Pediacel will be the only form of vaccine available for the immunisation of children against diphtheria, tetanus, pertussis, HIB and polio, or will others be available on request.
Lord Warner replied:
For infants, Pediacel will be the only vaccine supplied by the National Health Service because it provides the best protection against these serious infections.
Lord Hodgson of Astley Abbotts asked Her Majesty’s Government:
Whether the inactivated polio vaccine, part of the new five-in-one vaccine, is incompatible with the preservative Thiomersal.
Lord Warner replied:
Thiomersal is not a component of the new vaccines as it would render the inactivated polio vaccine component ineffective.
So there you have it. There was never very much thiomersal in the UK vaccine schedule and now there is none. Case closed. But two months later Lord Hodgson was back on the case.
December 8, 2004
Lord Hodgson of Astley Abbotts asked Her Majesty’s Government what they propose to do to increase the level of public trust in their vaccination and immunisation programme. The noble Lord said:
My Lords, the trigger for my decision to ask this Question was the Government’s sudden decision in August this year to introduce a new five-in-one child vaccine called Pediacel. Pediacel replaces the four-in-one vaccine previously used and adds polio to the diptheria, tetanus, pertussis and haemophilus influenzae type B—HIB—vaccine. The other critical by-product of the introduction of Pediacel has been the withdrawal of the preservative thimerosal which consists of 50 per cent ethyl mercury.
The withdrawal of a toxin as potentially harmful as that contained in thimerosal from infants’ vaccine, however small the amount contained therein, is a positive development on which the Government are to be warmly congratulated. However, I am not clear as to why this step was taken, if one is of a cynical turn of mind, in early August during the holiday season when minimum press comment could be expected.
He is still pursuing the argument that thiomersal was dangerous to health and had no place in childhood vaccines. He is implying that the government knew this all along and sneaked the thimerosal out of the vaccines in the same underhand way that they had originally sneaked it in. There follows a good bit of politicking on the same theme before he comes to the scientific evidence for thiomersal’s harmful nature
Most recently, a study by Doctors Hornig, Chian and Lipkin of Columbia University, published online on 8 June 2004 in the Nature publication, Molecular Psychiatry, indicated that postnatal exposure to thimerosal can lead to the development of autism-like damage in autoimmune disease susceptible mice. This reinforces previous studies, such as the works of Dr Mark and Dr David Geier, showing that a genetic predisposition in combination with certain environmental triggers can cause an increased risk of an adverse reaction.
I do not know who led Lord Hodgson to Mady Hornig’s infamous mouse study. It was probably the same person who introduced him to the Geiers’ less than monumental contribution to the literature of autism. I do not know if he actually read this tosh or was merely informed about it as part of a briefing. If he read it he was obviously not qualified to judge its merits. You might describe it as a failure of Peer review.
The noble lord then continues with his twin themes of government incompetence in undermining confidence in their own vaccine schedule and simultaneously implying that the schedule is not safe anyway. But this combination of politicking and scientificking is fundamentally dishonest. Lord Hodgson advocates for the sort of bad science that has had a demonstrable effect in undermining public confidence in vaccines on both sides of the Atlantic. He contributes to the scare stories and then admonishes the government for is ham-fisted response to those scare stories. He continues:
To a Written Question I put down on 22 January 2003, the noble Lord, Lord Hunt of Kings Heath, the Minister’s predecessor, answered that,
“there is no evidence of harm from thiomersal contained in vaccines. Therefore, the CSM advised that the benefits of immunisation with thiomersal-containing vaccines outweigh any potential risks of vaccination”.—[Official Report, 22/1/03; col. WA 101.]
Such responses exemplify the Government’s reaction to the thimerosal debate over the past two years. Until August this year the Government gave the impression that it was much ado about nothing and there was no reason for thimerosal to be withdrawn. In August, at the height of the holiday season, thimerosal was suddenly withdrawn.
Whether thimerosal does have an effect on certain autoimmune disease sensitive infants may be proved or disproved in times to come or there may never be a conclusive result. But what does matter is that the Government should maintain the highest degree of transparency and openness in their communications with the public in this important and sensitive area.
There we have it. The only thimerosal debate in the UK that I am aware of is the one initiated by Lord Hodgson. He knows full well why thiomersal (I will stick with the UK spelling, even though the noble lord has recently taken to using the American version) was removed. Pediacel does not require it. In fact thiomersal reduces the potency of the IPV component. There has never been any firm evidence to suggest that thiomersal causes harm to people.
Lord Hodgson is arguing from some very poor studies that it could cause harm and what if it did and what is the government going to do about this hypothetical danger that is completely lacking in empirical evidence and no wonder people are losing confidence in the vaccine programme and just look at MMR and its ALL YOUR FAULT. And so it goes on. Etc. etc. for another 1300 words.
Lord Hodgson is an intelligent and able politician. Unfortunately he has been sold on some very dubious science and agreed to lend his name to a PR exercise fronted by David Kirby. Perhaps he should be told.
May 28th, 2008
Posted by
Mike |
Autism, Quackery, mercury, politics, vaccines |
6 comments
Science Based Medicine is a new blog that promises to explore “issues and controversies in the relationship between science and medicine.” It has got off to a good start with posts about the false dichotomy between the beneficial effects of natural plant remedies and those nasty chemical based drugs, homeopathy, an excellent book review that discusses a recent book by R. Barker Bausell: Snake Oil Science: The Truth About Complementary and Alternative Medicine and, finally a discussion of yet another paper that debunks the mercury/autism hypothesis. Mercury in vaccines as a cause of autism and autism spectrum disorders (ASDs): A failed hypothesis
I heartily recommend it to you all. Family matters preclude me from writing substantial posts at the moment. But I will continue to recommend other blogs and autism resources to keep you going in the interim.
January 8th, 2008
Posted by
Mike |
Autism, Uncategorized, mercury, science |
no comments
Ken Aitken is a clinical psychologist who co-authored a text book on autism. (Trevarthen et al. 1996). The book acknowledges that rubella in pregnant women is a cause of autism but notes that, “greater awareness of the disorder and widespread inoculation have virtually eradicated rubella as a significant cause of autism.” (page 91)
Five years later Aitken appeared as an expert witness before an enquiry into the safety of MMR vaccine called by the Scottish parliament. But instead of supporting a vaccine that had helped to eliminate “a significant cause of autism” he supported the connection between the MMR vaccine and autism. He specifically rejected the suggestion that mercury might be to blame in the UK because, compared to the USA, there are negligible amounts of mercury in our vaccines. (Aitken 2001)
So, when Aitken addressed the Treating Autism Conference in Edinburgh, held on 14 - 15 October 2005 I was surprised to see a slide attacking mercury in his presentation. (Aitken 2005) Has the amount of mercury in our vaccines suddenly increased? Is Aitken a mercury convert because the case against MMR has collapsed? Or was he playing to the gallery because he knew that his audience was sympathetic to the mercury hypothesis?
Whatever the reason, his present position is in marked contrast to the views expressed in his book. Then he argued that, “It now seems certain that the brains of person’s who became autistic in their early childhood already had microscopic faults in their development in early intra-uterine life, probably expressed among cells of the early embryo, in the first month.” (page 80)
Now he argues that
There is a dramatic increase in autism that is caused by new forms of autism that occur in normally developing children who regress after an environmental insult in early childhood.
Regressive autism now dwarfs other forms of autism.
Is there an increase in numbers?
More and more people are being diagnosed. But as early as 1979 the Camberwell Study suggested that autism was far more prevalent than people had previously thought. It found rates around 20 in 10000 in children with learning difficulties. (Wing and Gould 1979). This is identical to the prevalence rate in California that is cited as evidence for an “autism epidemic” In the 1990s.
“The cumulative prevalence of autism in California increased from 7.5 per 10,000 for the sample 1983-85 birth cohort to 20.2 per 10,000 for the 1993-95 birth cohort, an increase of 269 percent.” (CDDC 2003)
Scotland is the one part of the United Kingdom where there is a system in place for recording all known cases of autism. Aitken acknowledges that if we accept official estimates of a prevalence rate of 60 in 10000 only 44% of cases are diagnosed. (PHIS 2001) So what is going on? A diagnostic rate of 26 in 10000 in Scotland is evidence of under diagnosis. A diagnostic rate of 20 in 10000 in California is evidence of an epidemic.
Is there an increase in regressive autism?
Aitken believes that cases of regressive autism have “grown to dwarf those with more ‘typical’ presentations.” Published research shows that the proportion of cases of regressive autism have not changed. (Taylor, Miller, Lingam, Andrews, Simmons & Stowe 2002. (page 394))
Aitken knows this because he cites the same paper as evidence of a link between bowel problems and regressive autism.
“…bowel problems were reported more frequently in children with regression than in those without, 31 of 118 (26%) and 49 of 351 (14%) respectively (P = 0.002).”
Though it would have been more honest to quote the whole paragraph:
“Although neither bowel problems nor regression was related to MMR vaccination, bowel problems were reported more frequently in children with regression than in those without, 31 of 118 (26%) and 49 of 351(14%), respectively (P = 0.002). This relationship between bowel problems and regression did not significantly vary by type of bowel problem (P = 0.35). For the 31 children with both bowel symptoms and regression, there was also no association with MMR vaccination (P = 0.20) and no association with year of birth (1.01, 0.92 to 1.11; P = 0.79).”
Taylor, Miller, Lingam, Andrews, Simmons & Stowe 2002. (page 395)
Much of the evidence for regression comes from parental reports. And it is not always clear whether they are reporting regression or failure to meet expected milestones. It is also necessary to exercise caution when dealing with parental evidence. Aitken knows this. It is in the same study by Taylor et al.
“ A review of each record showed that in 13 children the history given by the parents had changed after the extensive publicity about MMR vaccine and autism. Before the publicity the parents often reported concerns early in their child’s life, usually before their first birthday; the current history for the same children recorded symptoms as developing only after MMR vaccination, in some cases shortly after.”
(Taylor, Miller, Lingam, Andrews, Simmons & Stowe 2002. page 395)
So, Aitken has taken research that contradicts his previous position on the connection between MMR, bowel problems and regressive autism and selectively quoted from it to support his view that there is a connection between bowel problems and regressive autism, while ignoring the authors’ qualifying remarks about the reliability of parental memories concerning regression. There’s more. Aitken misrepresents a pilot study for a screening checklist as if it were an authoritative measure of autism incidence among 18 month old children. (Baird G, Charman T, Baron-Cohen S, Swettenham J, Wheelwright S, Drew A 2000)
This study successfully predicted autism in 10 subjects out of 16,235 children but failed to identify a further 40 autistic children. Finding 6 in 10000 out of an actual incidence of 30 in 10000 in a particular birth cohort does not prove that the other children are victims of regression. This was a just pilot study for a screening test, not a full scale case finding exercise using the latest diagnostic techniques. Aitken uses it to support his thesis that regressive autism dwarfs traditional autism. What utter nonsense!
These are just a few of the problems I have with Aitken’s presentation. Another feature of his theory is that if there is a new form of autism there has to be a really low rate of autism in populations born prior to the alleged autism epidemic. Aitken uses these sources as proof.
Burd and colleagues in North Dakota estimated 3.26 per 10,000 in those born between1967 and 1983 (Burd, Fisher & Kerbeshian 1987; Burd, Kerbeshian, Klug &McCulloch 2000). In Sweden, Nylander and Gillberg (2001) found a prevalence rate of 2.7 per 10,000, screening previously undiagnosed adult psychiatric outpatients.
The problem is that Burd (1987) was using DSM III criteria that were highly restrictive compared to the present DSM IV(R) criteria. There is an interesting discussion about diagnostic criteria, autism epidemics and the perils of comparing prevalence rates over time that Aitken ought to read (Medscape 2005)
The second study by Burd et al. was actually a follow up to assess the methodology used in the original study and using the same methodology the authors found another autistic individual whom they had missed in 1987. This was not a study to assess the prevalence of autism in North Dakota in 2000.
The study by Nylander and Gillberg (2001) actually found
“at least 19 patients in this population (1.4%) had a definite ASD. Seventeen of the ASD patients had been previously diagnosed with other psychiatric disorders, most frequently schizophrenia (n=5). Of patients attending a treatment centre for severe psychiatric disabilities (n=499), 3.2% had an ASD.”
So where did Aitken find his figure of 2.7 per 10,000? Perhaps he reads the British Medical Journal. Mark Blaxhill, a board member of Safe Minds, the acronym for the snappily named Sensible Action For Ending Mercury-Induced Neurological Disorders. Blaxhill wrote to the BMJ citing these same three references as proof that there was no “hidden horde” of previously undiagnosed adults.(Blaxhill 2002) Has Aitken read any of the studies he cites or does he just accept the citations given to him by the “mercury moms” and their supporters?
REFERENCES
Aitken 2001 http://www.show.scot.nhs.uk/mmrexpertgroup/Aitken-rep.htm
Aitken 2005 http://www.actagainstautism.org.uk/presentations/14th/aitken.pdf
Baird G, Charman T, Baron-Cohen S, Swettenham J, Wheelwright S, Drew A (2000) A screening instrument for autism at 18 months of age: a 6-year follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 2000 Jun, 39(6):694-702
Blaxhill 2002) Letter to the editor. British Medical Journal Volume 324 2 February 2002 page 296
Burd L. Fisher W. Kerbeshian J. (1987) A prevalence study of pervasive developmental disorders in North Dakota. Journal of American Academy of Child and Adolescent Psychiatry, 1987, Vol. 26(5), pp. 700-703
Burd L, Kerbeshian J, Klug MG, McCulloch K. (2000) A prevalence methodology for mental illness and developmental disorders in rural and frontier settings. Int J Circumpolar Health. 2000 Jan;59(1):74-86.
CDDC (2003) AUTISTIC SPECTRUM DISORDERS Changes In The California Caseload An Update: 1999 Through 2002
http://www.dds.ca.gov/autism/pdf/AutismReport2003.pdf
Medscape 2005 http://www.medscape.com/viewarticle/508429
MRC (2001) http://www.mrc.ac.uk/pdf-autism-report.pdf
Nylander L. Gillberg C. (2001) Screening for autism spectrum disorders in adult psychiatric out-patients: a preliminary report. Acta Psychiatrica Scandinavica, 2001, June, Vol. 103 (6), pp. 428-434
PHIS (2001) Autistic Spectrum Disorders Needs Assessment Report
http://www.phis.org.uk/pdf.pl?file=publications/Autistic%20Spectrum%20Disorders.pdf
Taylor, Miller, Lingam, Andrews, Simmons & Stowe (2002) Measles, mumps, and rubella vaccination and bowel problems or developmental regression in children with autism: population study British Medical Journal, 2002, Vol. 324, pp. 393-396
Trevarthen, C., Jacqueline Robarts, J., Despina Papoudi, D. and Aitken, K. (1998) Children with Autism Diagnosis and Intervention to Meet Their Needs. Jessica Kingsley Publishers London.
Wing, L. & Gould, J. (1979). Severe impairments of social interaction and associated abnormalities in children: epidemiology and classification. Journal of Autism & Developmental Disorders, 9, pp. 11-29.
December 22nd, 2005
Posted by
Mike |
MMR, autism epidemic, mercury, vaccines |
3 comments
Well done to Mike Fitzpatrick for setting out the issues so clearly in yesterday’s Guardian. This paragraph in particular summed up the essence of the argument for me.
“Over the past decade popular discontents have raged around a range of political issues - fuel prices, student loans, blood sports and the invasion of Iraq. Yet MMR provided a focus for protest that was both intensely personal and political. It brought together issues of health and child welfare that were already central preoccupations of a highly individuated society. The controversy over immunisation allowed scope for individual initiative - at least in the form of a gesture of defiance - that was generally lacking in the public sphere. If you could do nothing about the demise of politics, the apparent decline in social cohesion and civility, and the threat of bioterrorism and war, at least you could take a stand on the issue of MMR.”
Now the anti vaccine impetus has moved away from MMR. It is focused on a form of mercury known as thimerosol in the USA or thiomersal to the rest of the world that is used as a preservative in some vaccines. This has given some campaigners a renewed opportunity to vilify George Bush and vaccines at the same time.
To adapt Mike Fitzpatrick,
“They also can do nothing about the demise of politics, the apparent decline in social cohesion and civility, and the threat of bioterrorism and war. But at least they can take a stand on the issue of Thiomersal. This poster is accompanied by two Bushisms
‘ Rarely is the question asked: “Is our children learning ?” ’
George W. Bush, January 11th, 2000
“They misunderestimated me.”
G.W.Bush, no date
They came at the start of a recent presentation by erstwhile MMR advocate Dr Ken Aitken. Our Ken used to back MMR as a cause of autism and is a recent convert to mercury. I will return to Dr Aitken in a later post. But this neatly illustrates the tactic of linking popular mistrust of politicians to the anti vaccine bandwagon. Has Leo Blair had his mercury shots?
December 1st, 2005
Posted by
Mike |
MMR, mercury, politics, vaccines |
no comments
