Oct 27 2009

One Vaccine, One Ingredient and Anti-Vax Talking Points

The anti-vaccine community are a loose collection of individuals and organizations who, at their core, are dedicated to the notion that vaccines are bad. There is some variation of opinion within the anti-vaccinationists, but not much. Some claim that vaccines do not work at all, while other acknowledge some benefit. Some try to be coy by saying they are just asking questions (sure, like the 9/11 truthers are “just asking”), while others come right out and make demonstrably false claims, like vaccines cause autism. But they all cluster around the opinion that vaccines are toxic (in some way) and that they cause harm.

What is remarkable about the anti-vaccine crowd is their consistency in talking points. One might call it message discipline (enough to make Republicans jealous) but I think that implies more deliberate coordination than there is evidence for. I may be wrong in this, but I think it is enough to say that they all travel in the same virtual circles and play off each other’s rhetoric and arguments. They are a political/ideological community, and such communities are more plugged in today because of Web 2.0 than ever before.

I’m not just talking about slogans, like “Green our Vaccines”, which are designed for widespread use. Reading the various anti-vaccine websites and authors you begin to see a pattern of specific talking points coming in waves.  Squalene has been in vaccines as an adjuvant for years, yet suddenly many of the anti-vaccine sites are squawking about squalene. I have not tracked down the original source of the squalene flap – it spread so quickly through the anti-vaccine blogs.

The job of the science-blogging community has been to analyze the anti-vaccine talking points when they crop up, and to provide some actual scientific information to balance the fear-mongering of the anti-vaccinationists. With regard to squalene, for example  – this is a naturally occurring organic molecule that is made in the liver and has been used safely in vaccines for years without any adverse events. I think the fear-mongering about squalene may have been triggered by a report that Gulf War veterans had anti-squalene antibodies from the squalene in the vaccines they received, and that this might have caused Gulf War syndrome. As it turns out, there never was squalene in the vaccines the Gulf War veterans received, anti-squalene antibodies occur naturally and seem to increase with age, and have no association with vaccines. So every single element of the anti-squalene fear was factually wrong, but the anti-vaccine movement got a cycle of fear-mongering out of it, and now squalene is permanently on the list of potential toxins in vaccines (substances are added to the list, but never removed, even when they are cleared as safe).

Another talking point I have seen crop up recently, on the Age of Autism blog and elsewhere, is the minimizing of the evidence for the safety of vaccines, and specifically the lack of association with autism, as only dealing with one vaccine (the MMR) and one ingredient (thimerosal). David Kirby, writing for the (in my opinion) anti-vaccine and anti-science-based medicine Huffington Post, recently wrote:

To begin with, it is unscientific and perilously misleading for anyone to assert that “vaccines and autism” have been studied and that no link has been found. That’s because the 16 or so studies constantly cited by critics of the hypothesis have examined just one vaccine and one vaccine ingredient.

Kirby was discussing the recent study that purports to show an increased risk of autism-like features in monkeys who received the Hepatitis B vaccine. David Gorski has already dismantled this study here, so I won’t repeat it.

I was struck when reading this that I had been reading almost the exact same phrase from J.B. Handley over at the anti-vaccine site Age of Autism – a remarkable consistency of talking points. This particular point is a manifestation of moving the goalpost – no amount of evidence, of course, will clear vaccines in the eyes of the anti-vaccinationists. Let’s review a bit of history.

The oldest reference I can find to a possible link between vaccines and autism is a case report from 1976 of a child who was diagnosed with autism following a smallpox vaccine – the report concluded that a causal association was unlikely. Then there is nothing until the Andrew Wakefield study in 1998 which started the autism-MMR vaccine scare. In other words, until Wakefield raised the concern of a possible connection between vaccines and autism, there was no reason to suspect a connection. There was no basic science or epidemiology suggesting a connection, and vaccine monitoring had not triggered any red flags about autism or other neurodevelopmental disorders.

The anti-vaccine movement, which was already in existence, picked up on Wakefield’s study and (true to form) that became their latest talking point of fear about vaccines. They made the argument in retrospect that the increasing vaccine schedule of the 1990s correlated with the increasing autism diagnosis rates of this same period. Subsequent studies (summarized here) both invalidated Wakefield’s conclusions and showed that the MMR vaccine is not associated with autism.

But autism was now on the radar of the anti-vaccine movement, so they turned (without really ever giving up on MMR) to a vaccine ingredient, thimerosal, which is a mercury-based preservative in some vaccines (and, interestingly, never in the MMR vaccine). There already was in existence an anti-mercury community who had been fear-mongering about environmental mercury for years. At this point I have to say that, yes, mercury is a neurotoxin, and it is absolutely legitimate to study the effects of mercury and to limit all cause human environmental exposure to mercury. That’s all good. But it seems to be human nature that for every legitimate point there is a person or group who will take it to extremes. Mercury is a toxin, but toxicity is all about dose. The mercury-militia, as they are sometimes called, went beyond science and reason by blaming sub-toxic levels of mercury for whatever they could think of.

Needless to say, the anti-vaccine movement and the mercury militia became quite cozy over the issue of thimerosal. What is disturbing is that they have also infiltrated the autism community, and now do their best (much to the annoyance of many in the autism community) to equate autism awareness with anti-vaccine and mercury fear mongering.

In any case – fear over thimerosal exposure and autism was raised by the anti-vaccine movement, so this fear was addressed. Numerous studies have now shown no association between thimerosal exposure and autism or other neurodevelopmental disorders. The most devastating evidence was the near complete removal of thimerosal from vaccines in the US by 2002, which in the subsequent seven years had zero effect on the rate of increase of autism diagnoses. David Kirby (who did much to fan the flames of fear of thimerosal) and others predicted autism rates would plummet – they didn’t.

As an aside, the increasing rates of autism diagnoses has also been studied, and at present the consensus of scientific evidence is that the apparent increase is mostly or entirely due to a broadening of the definition of autism and increased surveillance.  True autism incidence appears to be flat over time.

Now Kirby and others are shifting to other vaccines and other vaccine ingredients. Why? There never was any reason to suspect vaccines as a cause of autism in the first place. True autism incidence is not even increasing. There is no credible data to link vaccine and autism. The consensus of evidence is that autism is dominantly a set of genetic disorders (not a single disorder or disease). There is no compelling evidence for any significant environmental factor in autism, although minor environmental factors cannot be excluded.

So you see the rhetorical trick that Kirby and Handley are playing – the published evidence only excluded MMR and thimerosal as causes of autism – not the other vaccines or vaccine ingredients. Their unstated major premise (the one they want to slip in the back door) is that there is some reason to suspect vaccines as a cause of autism in the first place.

The reason they are likely to cite is the anecdotal observation of parents that symptoms of autism appeared at or around the time of receiving a vaccine. They will make such arguments as emotional as possible – scientists are not listening to mommies, and mommies know their children. Yes, but mommies are human and subject to all the errors of observation and thinking that plague our species. It turns out that subtle signs of autism are present long before parents recognize them – even before the vaccines they blame were given. Plus, if Kirby and Handley are now willing to admit that MMR has been cleared (I don’t think they are, but that is what the “one vaccine, one ingredient” argument would imply) then they also have to admit that all those parents who observed that their child’s autism began in temporal correlation with the MMR vaccine were either wrong or victims of a coincidence of timing.

What this reflects is that the anti-vaccine movement is not intellectually rigorous or, in my opinion, even honest. They grab onto whatever argument they can, even if there is a lack of internal consistency. It is like the famous kettle defense – when an attorney puts forward several defences of their client, all of which are mutually exclusive.

Another flaw in the one vaccine, one ingredient notion is that if the MMR vaccine has been cleared by the evidence, then doesn’t that also clear all of the ingredients of the MMR? Of course, many of those ingredients are the same as many of the other vaccines. At least we can say that the evidence suggests a lack of toxicity from any of the ingredients in the MMR in the doses present in the MMR.

The strategy the anti-vaxers use for such arguments is to deny reasonable applications of the dose response that we would expect from all pharmacological effects, including toxicity. In other words, the greater the dose of the toxin the greater the toxic effect should be – in this case the risk of autism or neurological disease should increase with dose, not be flat. Anti-vaxers routinely deny this basic and generally accepted fact of biology. For example, when a study showed that doubling the dose of thimerosal had no effect on adverse outcomes, they argued that the study is useless because there wasn’t a zero thimerosal control. This blatantly denies the fact that doubling the dose of a putative toxin, in the dose range that causes toxicity, should increase the toxicity. This is one of the lines of evidence that is actually required in order to scientifically establish toxic cause and effect.

So for any ingredients that MMR shares with other vaccines, the addition of MMR should add to the toxicity (for example increase the risk of developing autism) but studies have not detected any such effect. So it is not fair or accurate to say that the evidence has looked at only one vaccine and one ingredient.

It should also be pointed out that there are vaccine monitoring systems in place. These systems are not looking for a particular correlation with vaccines – they are looking for any correlation. If there were a significant increase in the risk of developing autism from vaccines, these systems should detect it.

The moving the goalpost strategy will work forever with the anti-vaccinationists, because there is an astronomical number of permutations of vaccine ingredients, specific vaccines, and possible target diseases and disorders. We will never have definitive evidence specifically ruling out every possible vaccine combination for every possible disease. The same is true, of course, for every single medical intervention.

For example, in France anti-vaccine concerns focus on multiple sclerosis, not autism. So antivaxers in the US and UK can simply migrate over to MS once they run out of steam on autism fear-mongering.

What we do have are studies and monitoring systems looking for any signal of adverse events peaking above the noise in the data. We will also chase down any specific hypotheses that crop up. The data shows that vaccines are very safe, and despite very rare reactions to vaccines (which are acknowledged and compensated) there is no credible evidence to correlate vaccines and autism or neurodevelopmental disorders. The specific hypotheses of MMR and thimerosal have been directly studied and the evidence strongly supports a conclusion of lack of correlation.

Despite Kirby’s claim that such statements are unscientific – a fair look at all the evidence supports the conclusion that there is a lack of association between vaccines and autism. Further, there is no reason to hypothesize that there would be such a link, and further still there is compelling evidence that true autism rates are not increasing, and that autism is dominantly genetic in origin.

Responsible scientists look at the totality of evidence to make an internally consistent argument.

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35 responses so far

35 Responses to “One Vaccine, One Ingredient and Anti-Vax Talking Points”

  1. superdaveon 27 Oct 2009 at 10:06 am

    Great post. I never even heard of squalene until about two weeks ago, now it’s mentioned in just about every single place I normally see anti vaccine rhetoric. It’s amazing how fast the anti squalene propaganda spread. (the spell checker in firefox doesn’t even recognize squalene as a word)

    I have so many more thoughts o the issue but they have all been posted at some point or another. I think the best thing to do is just try to marginalize this people as much as possible.

  2. mindmeon 27 Oct 2009 at 10:11 am

    What disturbs the crap out of me is the 9/11 truthers are now getting into the anti-vax game. Found this in the public square here in toronto:

    http://i475.photobucket.com/albums/rr112/mindmetoo/Img_1755.jpg

    http://falseflagflu.com/

    It’s very interesting to see the Truthers (the bane of Bill Maher) are now on the “right” side of the issue on vaccination. Hmm. Wonder what Maher will think of this.

  3. kelskenon 27 Oct 2009 at 11:16 am

    Steve,

    As always a great presentation of the arguments…

    One anti-vax argument I recently ran across was against the polio vaccine. In short, polio was going away on its own, the polio vaccine was a failure, and doctors merely changed their diagnoses to “meningitis” instead of polio. I have looked for scientific clarification on this but all I can find are anti-vax websites promoting the idea.

    Any refutation you could supply would be appreciated.

  4. Mexicanon 27 Oct 2009 at 11:34 am

    Great post Dr. Novella. These anti-vaxers, they are cornered. I will not be surprised if they claim in the future that the cause of autism is the needle itself.

    Great post.

    Saludos amigo,

  5. Squilloon 27 Oct 2009 at 12:45 pm

    Kudos for another great post.

    I’ve also seen a number of anti-vaxers cite prenatal Rhogam/Anti-D shots as a cause of autism. (Note to anyone collecting anecdotal evidence: I got no Rhogam before my autistic son was born; got three doses during my pregnancy with my NT daughter.)

  6. provaxmomon 27 Oct 2009 at 1:51 pm

    One of the other arguments I frequently hear is the sheer volume of vax that kids get today. “731 vaccines today and when I was a kid, we only got 5!” While I’m not surprised at the perpetuation of the inaccuracy of the statement, it does surprise me how they fail to see the irrelevance.

    First, from what I’ve read from Dr. Offit, vax today are made with many few disease strains than they were years ago. Fewer disease strains need fewer adjuvants to host them, therefore less toxins. So the argument is false information, like all their other arguments.

    But, let’s suppose for a moment that it is true. Is this what they want-to put a cap on how many vax we develop?

    “Selective vaxers” tend to be ok with Dtap and Hib, so let’s say your kid gets those, if you’re a selective vaxer. Then, a new vaccine is developed. It prevents heart disease, stroke and diabetes. I’m aware these are not viral, just trying to think of what would be a very valuable vaccine. Or better yet, let’s say a vaccine is developed to prevent autism. (wouldn’t that just be the kicker?)

    What do you do? You look at your child and say “Sorry kid, you already are immunized against 4 diseases and that’s my limit.”

    It’s the non-vaxers themselves who actually prohibit us from removing any vax from the current protocol, because they won’t vax and help us eradicate the disease. So we can’t trade off one vax for another.

    Why do any research at all then? Is this what they want? Since there are “too many vaccines” I guess we should just stop science and medical research in it’s tracks.

    Their circular wisdom makes my head spin.

  7. sonicon 27 Oct 2009 at 1:51 pm

    There is no experiment that could disprove the hypothesis that vacines cause autism (or any other malady).
    “Someday we will find…” is a basically a faith based hypothesis.

  8. Veeon 27 Oct 2009 at 2:49 pm

    I listened to the last Maher episode where he defended his anti-vax comments. The two things he said (paraphrasing) were:

    “Why can’t we just have a debate, I just want to talk about it” – Which I know we had a debate, and Mahers side lost.

    then the usual:

    “They have all kinds of nasty stuff in vaccines like X, X, X…”

    Now I remember Steven talking about all the components, but I would like a breakdown of the components in vaccines that I can understand. I know things are added to help us fight the virus, but does anyone have a specific list? I looked at this list http://www.vaccinesafety.edu/components.htm but look at this shot for example:

    http://www.vaccinesafety.edu/components-DTaP-HepB-IPV.htm

    I don’t quite understand that. Excipients? When I float over that it says these things may be added for a syrup? Anyways, does Steven or anyone have a list of the stuff and specifically what it does like:

    “Formaldehyde helps the cells do this and that and so forth.”

    Thanks!

  9. agashemon 27 Oct 2009 at 3:15 pm

    I’ve posted this before but I will repeat this until all this talk stops (probably not in my lifetime) my autistic daughter did not get that way from vaccines. She is offended whenever she hears this stuff and wishes that so-called ‘normals’ would understand that she likes who she is and would not become ‘normal’ even if she could. I refer everyone to Temple Grandin who says the same thing.
    I really can’t stomach these anti-vaxxers any more than I can stomach Bill Oreilly (Really, no o’reilly,he’s Irish)

  10. mindmeon 27 Oct 2009 at 3:22 pm

    ||There is no experiment that could disprove the hypothesis that vacines cause autism (or any other malady).
    “Someday we will find…” is a basically a faith based hypothesis.||

    Right. That’s why if you make the claim, the burden is on you to offer the evidence for the claim. That’s why scientists talk about evidence for and against. If your hypothesis is “all hippos have big noses” what evidence would make this a reasonable statement to believe? Well, you figure out where hippos are likely to live in the world. You then calculate, based on your best knowledge of how hippos live, what the population size is of hippos in the world. Say, it’s 100,000.

    Then go there and start tagging and photographing hippos. If you find one with a small nose, your hypothesis is shot. If you find 90,000 hippos with big noses and none without, it’s looking pretty good your hypothesis is correct. But you could still be wrong. Oh well.

    This is pretty basic stuff, not sure why you’re pointing it out here.

    And who used the phrase “Someday we will find…”? Don’t make quotes up and then argue against them. That’s just kind of silly.

  11. JB Handleyon 27 Oct 2009 at 4:03 pm

    Novella writes: “As an aside, the increasing rates of autism diagnoses has also been studied, and at present the consensus of scientific evidence is that the apparent increase is mostly or entirely due to a broadening of the definition of autism and increased surveillance. True autism incidence appears to be flat over time.”

    From January 2009:

    “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. Published in the January 2009 issue of the journal Epidemiology, results from the study also suggest that research should shift from genetics to the host of chemicals and infectious microbes in the environment that are likely at the root of changes in the neurodevelopment of California’s children. “It’s time to start looking for the environmental culprits responsible for the remarkable increase in the rate of autism in California,” said UC Davis M.I.N.D. Institute researcher Irva Hertz-Picciotto, a professor of environmental and occupational health and epidemiology and an internationally respected autism researcher.”

    From Pediatrics, 2005:

    http://www.generationrescue.org/pdf/newschaffer.pdf

    “Cohort curves suggest that autism prev-
    alence has been increasing with time, as evidenced by
    higher prevalences among younger birth cohorts. The
    narrowing in vertical separation of the cohort curves in
    recent years may mark a slowing in the autism preva-
    lence increase.”

    Novella Writes: “It turns out that subtle signs of autism are present long before parents recognize them – even before the vaccines they blame were given.”

    Jan/Feb 2008:

    http://www.soundchoice.org/Images/Regressive_Autism_Prevalence.pdf

    Hansen RL, Ozonoff S, Krakowiak P, Angkustsiri K, Jones C, Deprey LJ, Le D-N, Croen L,
    Hertz-Picciotto I . Regression in autism: prevalence and associated factors in the CHARGE
    Study. Ambul Pediatr 8(1):25-31, 2008. 18191778 Found that prevalence of regression depends on what domains are being evaluated, and if both social and language skills are considered, the proportion of autism cases with some type of regression is higher than previously reported, over 40%.

    JB Handley

  12. provaxmomon 27 Oct 2009 at 5:09 pm

    You know what else is ironic about “Green our vaccines?” I’ve seen video clips of JM talking about how much she loves botox. Talk about injecting yourself with toxins! And she’ll really never see the hypocrisy in that, nor will the media unfortunately.

  13. daedalus2uon 27 Oct 2009 at 6:57 pm

    sonic, there are people with autism who were never vaccinated. Their autism can’t be due to vaccination, unless you allow for some really magical thinking.

    The most well replicated physical symptom of autism is a larger head and a larger brain. The larger brain results from having more neurons and a larger number of minicolumns. The number of minicolumns is fixed at ~8 weeks gestation. A vaccine 2 years later can’t change that.

    Rhogam is anti-Rh+ antibodies given to prevent anti-Rh+ antibodies from occurring in an Rh- mother carrying a Rh+ fetus by binding to the antigen first and preventing her from becoming sensitized. These antibodies pass through the placenta and so can cause hemolysis of Rh+ blood cells in the fetus.

    Rh incompatibility will cause hemolysis in utero and free hemoglobin is ~1000x more effective at destroying NO that is hemoglobin in red blood cells. Some of the anti-Rh+ antibodies in Rhogam will go through the placenta and may cause some hemolysis in utero. This will likely cause a reduction in NO levels and may shift the fetus in utero on the autism spectrum (according to the low NO hypothesis of autism). This has nothing to do with preservatives used in the Rhogam. Not using Rhogam would very likely be much worse and could even be fatal.

  14. medicatedon 27 Oct 2009 at 7:09 pm

    I just had to link to this. J.B. Handley’s answer to the claim that the anti-vax crowd is constantly ‘moving the goalposts’:

    http://www.ageofautism.com/2009/05/goalposts.html

    He keeps using that phrase. I do not think it means what he thinks it means.

  15. medicatedon 27 Oct 2009 at 7:10 pm

    Er…Handley, that is. Dr. Novella understands completely what the phrase means.

  16. superdaveon 27 Oct 2009 at 7:15 pm

    to sonic:
    I have seen research which has shown signs of autism in children as young as 1 year, before they have had many vaccines. It’s not proof as there are some vaccines they will have already received but it’s better than nothing.

  17. medicatedon 27 Oct 2009 at 8:46 pm

    Sonic:

    Hypothesis: vaccines cause Kuru.

    Let us take four groups of Fore. Group one is vaccinated against everything known to medical science. They also get delicious brains to eat. Group two is also vaccinated, but they don’t get such cerebral food. Group three is not vaccinated, and they eat brains. Group four is unvaccinated, and they have to live on veggies.

    When members of groups one and three present with symptoms of Kuru, and no member of groups two or four do, wouldn’t this tend to disprove the hypothesis?

    Of course, if your objection is merely epistemological and based on the use of the word ‘proof’, I must call ‘duh’.

  18. kill3rTcellon 27 Oct 2009 at 9:09 pm

    Steve,

    As you’ve noted, the anti-vaxers use the same arguments repeatedly, regardless of evidence/validity.

    I’m trying to put together a talkorigins style site to refute or explain each of their claims, in an ordered, evidence-based (and cited) manner. Would you or the NESS be interested in this project?

    At the moment it’s still in the planning phase, I’m trying to get people (anyone really) who might be interested, capable, whatever, to put forward ideas, skills, time (again, whatever), to get this up and running.

    Do you have any thoughts/suggestions on the matter?

    kTc.

  19. eiskrystalon 28 Oct 2009 at 7:06 am

    -was struck when reading this that I had been reading almost the exact same phrase from J.B. Handley over at the anti-vaccine site Age of Autism – a remarkable consistency of talking points.-

    Just as great minds (are said to) think alike. It appears the reverse is also true.

  20. Steven Novellaon 28 Oct 2009 at 8:17 am

    Regarding J.B. Handley’s cherry picking –

    autism incidence:

    Bishop DV, Whitehouse AJ, Watt HJ, Line EA. Autism and diagnostic substitution: evidence from a study of adults with a history of developmental language disorder. Dev Med Child Neurol. 2008 Mar 31

    Chakrabarti S, Fombonne E. Pervasive developmental disorders in preschool children: confirmation of high prevalence. Am J Psychiatry. 2005 Jun;162(6):1133-41.

    Fombonne E. Epidemiology of autistic disorder and other pervasive developmental disorders. J Clin Psychiatry. 2005;66
    Jick H, Kaye JA. Epidemiology and possible causes of autism. Pharmacotherapy. 2003 Dec;23(12):1524-30.

    Mitchell, S., J. Brian, L. Zwaigenbaum, W. Roberts, P. Szatmari, I. Smith, and S. Bryson. 2006. Early language and communication development of infants later diagnosed with autism spectrum disorder. Journal of Developmental and Behavioral Pediatrics 27(2 Suppl):S69–78.

    And the most recent evidence I discuss here: http://www.theness.com/neurologicablog/?p=1049

    Overall the evidence supports the conclusion that true autism rates are not increasing.

    Regarding the second point – regressive symptoms says nothing about timing of onset. So that point is simply a non-sequitur

  21. mindmeon 28 Oct 2009 at 8:43 am

    JB while you’re preparing your, you know, insightful reply regarding the peer reviewed science presented by Dr N., you might always want to read and comment:

    http://www.theness.com/neurologicablog/?p=523

    You’re basically made to look like the horse’s ass with tinfoil hat wearing comments like:

    ||Looking at his biography on wikipedia (which he undoubtedly wrote himself), he became a doctor 11 years ago and turns 45 years old this July. It doesn’t appear that autism, vaccines, immunology, toxicology, nutrition, or gastroenterology are part of his area of focus, expertise, or study.||

    Do you still contend he wrote his own wiki page? Or have you retracted that libel?

  22. superdaveon 28 Oct 2009 at 9:40 am

    JB, even the most credulous interpretation of the papers you presented still only lead to the conclusion that Autism has a strong environmental component. They say absolutely nothing about what those factors may be.

    also, just in case you didn’t read your own links your first page suggests that the rate of autism is still increasing while the second quote states that Autism rates are slowing. Which one is it?

  23. sonicon 29 Oct 2009 at 2:07 am

    Richard Feynman-
    “The principle of science, the definition almost, is the following: The test of all knowledge is experiment. Experiment is the sole judge of scientific ‘truth’”. (From Six Easy Pieces)
    My point is that if you have a hypothesis that can not be disproved by experiment, then it can not be disproved scientifically. While it seems clear to me that vaccines do not cause autism, this conclusion is less than experimentally tested.
    This issue may not go away- we must continue to make the case for the value of vaccines- that is my point…

  24. kill3rTcellon 29 Oct 2009 at 2:26 am

    sonic,

    To test something you do not need to set up a controlled experiment (though that is preferable). As stated many times by Steve and other SBM-ers, a vaccine-autism link can be explored by observing data that arises from the population after vaccination. This is done very rigorously, with many boards set up to observe vaccines long after they’re first okayed (which must be done given the sub-optimal level of testing of some, such as the seasonal flu vaccines).

    You may want to read the recent post on SBM on ‘Methodoltary’ for an explanation on why the worship of randomised clinical trials as the only valid form of inquiry in medicine is absurd.

  25. kill3rTcellon 29 Oct 2009 at 2:27 am

    addendum – although a retrospective analysis could be considered controlled if the variables are taken into account as best as possible.

  26. JLTon 29 Oct 2009 at 5:29 am

    “Squalene has been in vaccines as an adjuvant for years, yet suddenly many of the anti-vaccine sites are squawking about squalene. I have not tracked down the original source of the squalene flap – it spread so quickly through the anti-vaccine blogs.”

    The reason might be that some of the pandemic flu vaccines used in Europe contain squalene (Pandemrix – GSK and Focetria – Novartis). At least in Germany, the fact that squalene-containing adjuvans aren’t FDA-approved led to some nice conspiracy theories like “Big Pharma didn’t want to pay for clinical trials necessary to get FDA approval so now they’re using us as guinea pigs.”

  27. provaxmomon 29 Oct 2009 at 5:44 am

    A friend who does “selective/delayed vaxing” and I were discussing the flu vax. She brought up the mist and how it’s not for immunocompromised people.

    One of the consistent mantras of the anti-vaxers has been “One size does NOT fit all!” So what do you know, a vaccine is developed that is in fact, not for everyone. Now, they still are not happy. “See! Not safe! It puts immunocompromised people at risk” and is often used as a counter-argument when you bring up herd immunity and immunocompromised people.

    Just because extra precautions need to be taken with live vaccines does not negate the entire program. Moving goalposts, again.

    WRT to early signs of autism in young children. Dr. Offit does address this in the AFP book. If you see videos that are used in these arguments, professionals can often recognize the s/s that parents miss. I know this was the case with my own child. But he was my first, it was normal to me. Now when I compare him to my second (NT) child, I give myself a big “doh!” because the differences are remarkable.

  28. sonicon 29 Oct 2009 at 2:42 pm

    kill3rTcell-

    With experiment you get fact- scientific ‘truth’.
    What we get with long term observation is greater probability of being correct.
    These are not the same thing.

  29. kill3rTcellon 29 Oct 2009 at 4:41 pm

    sonic, I repeat:

    A randomised clinical trial is not the only form of inquiry that will yield truth. To claim that an RCT does not also yield probabilities is absurd.

  30. Steven Novellaon 29 Oct 2009 at 9:09 pm

    sonic – read this: http://www.sciencebasedmedicine.org/?p=2258

  31. JB Handleyon 30 Oct 2009 at 1:15 am

    Dr. Novella: Here’s something another neurologist wrote. Who is a parent supposed to believe? Which one of you is wearing blinders?

    JB Handley

    Blinders won’t reduce autism
    By JON POLING
    Friday, March 13, 2009
    For the million plus American families touched by autism, like mine, there is real urgency to find scientific answers to help loved ones and prevent future victims. Unfortunately, some doctors still fail to even accept the increasing autism rate as real, rather than their own better diagnosis.

    The collateral damage of “better diagnosis,” the idea that we are simply better at detecting autism, is the abandonment of families coping with autism by the medical establishment, government and private insurance companies.

    Beyond the high emotional toll autism takes on a family, many have been financially ruined. Public school systems are drowning in the red ink of educating increasing numbers of special-needs students.

    Fortunately, the ‘better diagnosis’ myth has been soundly debunked. In the 2009 issue of Epidemiology, two authors analyzed 1990 through 2006 California Department of Developmental Services and U.S. Census data documenting an astronomical 700 to 800 percent rise in the disorder.

    These scientists concluded that only a smaller percentage of this staggering rise can be explained by means other than a true increase.

    Because purely genetic diseases do not rise precipitously, the corollary to a true autism increase is clear — genes only load the gun and it is the environment that pulls the trigger. Autism is best redefined as an environmental disease with genetic susceptibilities.

    We should be investing our research dollars into discovering environmental factors that we can change, not more poorly targeted genetic studies that offer no hope of early intervention. Pesticides, mercury, aluminum, several drugs, dietary factors, infectious agents and yes — vaccines — are all in the research agenda.

    An inspiring new text, “Autism-Current Theories and Evidence,” has successfully navigated the minefield of autism science without touching the “third rail,” as Dr. Sanjay Gupta aptly describes the vaccine-autism debate.

    Dr. Andrew Zimmerman, who has studied autism for decades, prophetically writes, “The clinical heterogeneity of this disorder, together with the inherent dynamic changes during children’s growth and development, confound static, linear models and simplistic, unilateral approaches.”

    Zimmerman’s book is dense with cutting-edge science on cell biology, metabolism, oxidative stress, neuroinflammation, auto-immunity and brain pathology. That’s right — autism isn’t simply a genetic program for brain development gone awry. Dr. Martha Herbert, of Harvard Medical School, writes the final chapter defining autism in the larger framework of a multiple organ system disease with potentially reversible impairments.

    As an affected parent, I am left with a sense of hope that these professionals will produce results to stem the tide of new autism cases and ameliorate symptoms of those currently suffering.

    On the other hand, Dr. Paul Offit, the vaccine inventor whose Rotateq royalty interests recently sold for a reported $182 million, has written a novel of perceived good and evil called “Autism’s False Prophets.”

    The tome is largely a dramatic account of why Offit, who self-admittedly is not an autism expert, feels vaccines should be exonerated in the autism epidemic. In the story, Offit takes no prisoners, smearing characters in the vaccine-autism controversy as effortlessly as a rich cream cheese.

    “False Prophets” has curiously garnered support from several senior physicians in respected medical journals.

    After Offit’s drama is complete, these cheerleaders fail to realize they have traveled the road labeled “Dead End — No Through Traffic.” In his epilogue, Offit credits autism parents who have likewise gone down the dead end path to autism acceptance, without search for cause or cure.

    As both parent and doctor, I cannot fathom turning my back on a child nor science, in order to avoid inconvenient questions about vaccine safety or any other reasonable environmental factor.

    President Obama has recognized that “we’ve seen just a skyrocketing autism rate” and plans to appoint an “autism czar” to coordinate his policy efforts. Science is moving forward to connect the three dots of environment, genes and plasticity of a developing child’s brain circuitry. In the end, logic and reason will prevail over politics and profits.

    • Dr. Jon Poling, an Athens neurologist, is an assistant professor at the Medical College of Georgia. His daughter, Hannah Poling, has been a successful petitioner in the National Vaccine Injury Compensation Program.

  32. snowmiseron 30 Oct 2009 at 4:54 pm

    Well, we know, of course, that Dr. Novella can’t be trusted – being on the take from big pharma and all. I’m sure a straight up guy like yourself Mr. Handley has researched Dr. Poling, just to make sure a GENUINE case of conflict-of-interest doesn’t exist here (as I see Hannah is on the petition for compensation) Hmm…let’s see:
    http://leftbrainrightbrain.co.uk/?p=1475

    Yep, just as I suspected, you have found a fellow douchebag!

  33. sonicon 30 Oct 2009 at 5:57 pm

    Thank-you for the interesting reference.

    The problem with RCT is that the experiment is run on different people. It is not possible to give one person two treatments exclusive of each other at one time.

    The point I’m trying to make is that some science (water reduces to hydrogen and oxygen under certain circumstances) is fact- that is it has been determined experimentally and can be demonstated (reproduced). This is qualitatively different than what is often done in medicine (for practical and ethical reasons)

    I think if we acknowledge the difference between the two types of evidence, it will allow a more meaningful discussion with people who disagree about some result.

    Perhaps I get carried away…

  34. superdaveon 31 Oct 2009 at 6:30 am

    JB I hope using John Polling as a reference is your attempt at sarcasm because you are the one who routinely dismisses both clinical expertise and anyone with even an iota of a conflict of interest. Polling certainly has more riding on this debate than Dr. Novella does.

  35. daedalus2uon 31 Oct 2009 at 7:28 pm

    One of the most consistent observations of of children with autism is that they have larger heads with larger brains with more neurons. How a neurotoxin can result in a larger brain with more neurons has never been explained to me.

    These more numerous neurons are arrayed in structures called minicolumns which people with autism have in greater number than people without autism. The number of minicolums is fixed in the first trimester in utero, shortly after the teratogens that are known to cause autism (thalidomide and valproate) have their effects in causing autism by in utero exposure to the developing brain.

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