I learned this morning that the state of Maryland has suspended the license to practice medicine of Mark Geier – elder of the father-son Geier team who have notoriously been treating children with autism with chemical castration.

This is very good news. It is heartening to occasionally see a state medical review board actually do their job and discipline physicians who are practicing abject quackery. I am only partly blaming state boards for their general lack-luster performance in this area. In many cases their hands are tied by state laws designed specifically to hamper their ability to discipline unscientific or substandard medical practices.

For further background on the Geier lupron protocol, here is a good article by David Gorski at Science-Based Medicine. He has been following the story closely.

Continue Reading »

I have been following the literature on autism diagnosis both because of my general interest as a neurologist, but also because it is at the center of the vaccine-autism myth. There is no question that autism diagnoses have been on the increase over the last 20 years. There are some who assume that this increase in the number of diagnoses being made represents a true increase in the incidence of the disorder – hence an autism “epidemic”.

However, careful analysis reveals that the increase in diagnosis is largely explained (perhaps completely explained – but a small real increase cannot be ruled out) by increased awareness of autism and an expanded diagnosis. (See my earlier posts for a full explanation.)

A recent study sheds further light on this issue. The study was not addressing the broader question of the causes of the increase in autism diagnosis, but rather was focusing on socioeconomic disparities in diagnosis. The results, however, do lend support to the conclusion that the rising autism diagnoses was largely due to increased awareness, rather than a true increase.

Continue Reading »

The intellectual dishonesty, or such blinkered stupidity that it is indistinguishable from this, of the anti-vaccine crowd is always a spectacle. J.B. Handley is a prime example. He has made himself into an intellectual bully, and internet thug for the Age of Autism.

In a recent piece for this wretched hive of anti-vaccine propaganda, Handley write:

“It’s been asked and answered, vaccines don’t cause autism.”

This lie, it really drives me nuts. More, and I can say this and mean it, anyone who repeats this lie is immediately my enemy. I mean that, I really do, because there are just too many kids in the mix and this is just too important and if you are either intellectually too lazy or too dishonest to understand the science around vaccines and autism, then, well, you are my enemy. Sorry, it’s a hard knock life.

That captures his “Goodfellas” approach quite nicely. If you disagree with him – you are his enemy, the gloves are off, and anything is justified. To add irony to his thuggery, Handley himself is just too intellectually lazy, or (in my opinion) scientifically illiterate to “understand the science around vaccines and autism.” Yet he presumes to lecture those who have dedicated their lives to studying science, and in fact is willing to make them his enemy because they have the audacity to point out that his understanding of science is hopelessly flawed.

Continue Reading »

Brian Deer is the investigative journalist who has spent years building a case that Andrew Wakefield’s original Lancet paper alleging a connection between the MMR vaccine and an autism-GI disorder syndrome was not only bad science, it was fraud motivated by greed. In part two of his BMJ series detailing the results of his investigation, Deer follows the money, showing that Wakefield stood to make millions from a monovalent replacement vaccine as well as testing for his proposed new GI disorder. For those interested in the details – read the BMJ article. In short Deer builds a convincing case that Wakefield created a fraudulent study designed to generate fear regarding the MMR vaccine that he would then exploit to make millions. Meanwhile he was also paid over a million dollars by trial lawyers to build a case against the MMR vaccine.

What I want to write about today is a recent blog post by Brian Deer in which he accuses the medical establishment of circling the wagons (at least initially) around Wakefield. Deer specifically cites Ben Goldacre and Paul Offit as examples of physicians who were unwilling to accuse Wakefield of fraud. Deer writes:

But a Philadelphia-based commentator was not impressed by the BMJ’s intervention. “It doesn’t matter that [Wakefield] was fraudulent,” Dr Paul Offit, a vaccine inventor and author in Pennsylvania, was quoted in the Philadelphia Inquirer the next day as saying. “It only matters that he was wrong.”

I wasn’t surprised. From his establishment vantage-point, this was the third time Dr Offit had popped up to opine on the issue. Twice previously he’d been quoted as saying that my findings were “irrelevant” (although he’d been happy enough to use them in his books). Science had spoken, his argument went. There was no link between the vaccine and autism. It was experts like him who should rule on this matter, he seemed to imply, not some oik reporter nailing the guilty men.

Continue Reading »

In 1998 Andrew Wakefield and 12 coauthors published a now infamous paper in the Lancet alleging a connection between regressive autism and nonspecific colitis (bowel inflammation). They also reported a “strong temporal association” between this alleged new syndrome and injection with the MMR vaccine. The study was based upon 12 case reports of children with this apparent syndrome. It sparked fears regarding the MMR vaccine specifically, and vaccines in general, that spread initially through the UK but then around the world, including the US. The result was a surge in the anti-vaccine movement, declining vaccine compliance – and in some communities low enough to reduce herd immunity resulting in outbreaks of vaccine-preventable diseases, like measles and whooping cough.

In early 2010 the Lancet finally retracted the paper, citing ethical concerns, and later that year the General Medical Council found that Wakefield had acted unethically. He was eventually struck off and now is self-employed in the US – professionally disgraced but he remains unrepentant and a martyr and hero of the anti-vaccine movement. Like many cranks, Wakefield hides behind a veil of accusations of conspiracies and persecution.

Despite his downfall, the damage had already been done. During this time journalist Brian Deer relentlessly investigated Wakefield and the Lancet paper. The chilling result of this investigation is now detailed in a BMJ paper (the first in a series).

Continue Reading »

This is a quick update on the Autism Omnibus hearings – representative cases heard before a special court to decide if there is any credible evidence to conclude that autism may be a vaccine injury. After hearing exhaustive testimony by all sides, the special masters determined that the evidence does not support a link between autism and vaccines.

One of the cases heard was the Cedillo case, which was used as the test case for the theory that the MMR vaccine plus exposure to thimerosal can trigger brain damage that looks clinically like autism. In February of 2009 the court rejected the claim that Michelle Cedillo’s autism was caused by vaccines. No only was the theory of causation without scientific backing, evidence was presented to show that Michelle Cedillo demonstrated early symptoms of autism prior to ever receiving the MMR vaccine.

In fact the Cedillo case is representative of a fact that scientific research is increasingly demonstrating – that subtle signs of autism are present prior to parents noticing that there is a problem and long before formal diagnosis. The consensus of evidence is that signs of autism appear between 6-12 months of age, and maybe earlier in some cases. Meanwhile, the first MMR vaccine is given at 12 months. Since causes must precede effects, this fact alone is fatal to the MMR-autism hypothesis.

Continue Reading »

In order to teach science to the public it is better to tell a story about how questions are resolved in science, rather than simply to teach authoritatively the current findings of science. The process is interesting – often more so than the facts.

One such story is the true cause of the increasing autism prevalence over the last 20 years. There is no question that the number of people being diagnosed with autism is increasing. There are various theories as to why, the best, in my opinion, is that the increasing numbers are an artifact of broadening the diagnosis and increased surveillance. Meanwhile, a true increase may also be hiding in the numbers, and that would present an interesting (and important) mystery to solve.

I have written about this before (here and here on SBM, and again here on NeuroLogica). Now there is a new study which may shed some light on the question, but to quickly summarize where the evidence is: There are several ways to address the question of whether or not there is a true increase in autism numbers. One is to assess autism prevalence at various age groups. If true autism incidence is increasing, that younger age groups should have more diagnoses of autism than older age groups – when the same diagnostic criteria are applied. When this kind of analysis is done it appears that autism incidence is stable over time, which is powerful evidence against a true increase.

Continue Reading »

Andrew Wakefield, the UK researcher who sparked unwarranted fears about the risks of the MMR vaccine, has been the subject of a two-and-a-half years ethics investigation by the General Medical Council (GMC). This afternoon the GMC announced their conclusion, ruling that Wakefield acted “dishonestly and irresponsibly” in his research and with “callous disregard” for the children that were the subject of his research.

Wakefield’s Story

In 1998 Wakefield and others published a story in the Lancet where they claimed to find an association between finding the measles virus in the GI tract of children with autism following the MMR vaccine. The study itself was small – only involving 12 children, and the conclusions were modest, not specifically suggesting a link between MMR and autism. But in subsequent press conferences Wakefield raised the alarm, saying, “Urgent further research is needed to determine whether MMR may give rise to this complication in a small number of people.”

The result was a significant drop in MMR compliance and a resurgence of measles cases, as this BBC chart demonstrates.

Continue Reading »

As part of her series on autism quackery, Chicago Tribune writer Trine Tsouderos has written another eye-opening article – this one about the drug OSR#1 that is being given as a “supplement” to children with autism.

The story highlights what I have been writing for years – that the current supplement regulation in the US under the Dietary Supplement Health and Education Act (DSHEA) is an anti-consumer farse.

OSR#1 is a drug. It is a compound that was manufactured by a company for its pharmacological activity. They claim it was developed as an anti-oxidant, but the Tribune reports that the compound may have originally been developed as an industrial chelator – a compound that binds heavy metals to clean them from soil or industrial spills.

Continue Reading »

In a recent supplement of the journal Pediatrics is published the report of a consensus panel on the issue of gastrointestinal (GI) disorder in children with autism. This is not a new study and no new evidence is presented – it is a systematic review of the literature by 28 experts from various disciplines. These formal expert reviews are often a helpful way to make sense of a large and complex medical literature on a specific question.

The most significant finding of the panel is that:

The existence of a gastrointestinal disturbance specific to persons with ASDs (eg, “autistic enterocolitis”) has not been established.

In addition they found that there is no evidence for benefit from special diets. About 1 in 5 children with autism are on a special diet designed to improve the symptoms and outcome of autism, usually by removing gluten or casein from the diet, but there is simply no scientific evidence that such diets are helpful.

The alleged link between GI disorder and ASD was started by the now-discredited study by Andrew Wakefield in 1998. He proposed a “leaky gut syndrome” that allowed the measles vaccine to cause an infection which eventually led to the brain damage that causes autism. His research was later refuted and he is now even suspected of fraud. But the idea that GI disorders contribute to ASD was out in the public and took on a life of its own, separate from scientific evidence.

Continue Reading »