I had written previously about the plight of Kathleen Seidel, from the neurodiversity blog, who was the target of an inappropriate subpoena that was little more than blatant harassment. Kathleen filed her own motion to quash the subpoena, and now she reports that her motion was granted – the subpoena is quashed. Congratulations.

Last month I wrote about John McCain’s ignorant parroting of the false claims for an autism epidemic and a possible link to vaccines. I had mentioned at the time that Hillary Clinton had also made some pandering remarks, such as that she is, “Committed to make investments to find the causes of autism, including possible environmental causes like vaccines.”

Orac now gives us an update on the situation. About Hillary he writes:

And when asked if she would support a study of vaccinated vs. unvaccinated children, she said: “Yes. We don’t know what, if any, kind of link there is between vaccines and autism – but we should find out.”

A month ago I praised Obama for having a scientific statement about vaccines on his website. But now he has descended into pseudoscientific pandering, stating:

“We’ve seen just a skyrocketing autism rate. Some people are suspicious that it’s connected to the vaccines. This person included. The science right now is inconclusive, but we have to research it.”

There appears to be no science-friendly candidate left, at least on this issue. The current disconnect between science and politics is very disturbing.

Addendum: This video of Obama making the above comments clearly shows that when he said, “This person included.” he was not referring to himself but someone in the audience. However, his later comment about the science being “inconclusive” is inaccurate.

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Note: On Wednesdays I also post over at Science-Based Medicine.

No. But David Kirby and other anti-vaccinationist ideologues and members of the so-called mercury militia would like you to think so. For background, the Autism Omnibus refers to a set of hearings before the Vaccine Injury Compensation Program regarding claims by about 5000 parents that their childrens’ autism was caused by vaccines. These claims are primarily based upon the various hypotheses that the MMR vaccine, or thimerosal in some vaccines (but not MMR), or the combination of both, is a cause of autism.

So far there have been hearings, but only one final decision. In November the US government settled one case in favor of the petitioner. This is the case those who have supported the failed hypothesis that vaccines cause autism now point to as admission that they were right all along (or at least as a means of stoking the flames of fear about vaccines.) But the US government did not admit vaccines cause autism – they conceded one case that is highly complex and not necessarily representative of any other case and cannot be reasonably used to support the vaccine/autism connection.

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We predicted it, and it has come to pass. Now that the evidence has laid to rest the dubious claims that thimerosal in vaccines causes autism, the antivaccine crowd is already planning the next phase of their pseudoscientific attack on vaccines. In a recent Huffington Post article, David Kirby writes:

But if thimerosal is vindicated, or shown to be a very minor player, then what about other vaccine ingredients? And what about the rather crowded vaccine schedule we now impose upon families of young children? And what about reports of unvaccinated children in Illinois, California and Oregon who appear to have significantly lower rates of autism? Shouldn’t we throw some research dollars into studying them?

At least now Kirby is admitting defeat on the thimerosal issue. He writes:

Finally, to all those who are going to post comments about the autism rates in California not coming down, following the removal of thimerosal from most vaccines: You are right. The most likely explanation is that thimerosal was not responsible for the autism epidemic. But that does not mean that it never harmed a single child.

Considering how shrill Kirby was in insisting that thimerosal was the cause of autism, including all the cries of conspiracy and malfeasance, this is quite an admission. It also should make a reasonable person wonder why Kirby should be taken seriously at all. But Kirby is not quite ready to give up on thimerosal completely. He is still holding out that future data will show thimerosal played some role, and he claims that we won’t really know the effects of removing thimerosal until 2011 (even though previously he was citing 2007 as the date).

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I and some other medical science bloggers have spent much time addressing the claims of antivaccinationists and those who attempt to link vaccines and autism. This is because they are engaged in nothing less than an all out campaign to eliminate vaccines. They seem to be driven by ideology and fear, their tools are misinformation, lies, and logical fallacies, and they have been tireless in waging war against vaccines. On their side are dubious and discredited scientists, misguided celebrities, naive or scaremongering politicians, and families who range from sincere but misinformed to ideological true believers. This antivaccination movement overlaps considerably with those who are anti-science or anti-scientific medicine (promoting instead some form of “alternative” medicine). They also enjoy much support from anti-government conspiracy theorists.

Standing against these forces are those few scientists who take the time to confront their claims and set the record straight – mainly through blogs and the occasional article. Government agencies, like the CDC, try but have been fairly ineffective (and sometimes counterproductive) in the PR department. Mainstream scientists and scientific organizations have been doing good research and promoting good science and medicine, but have shied away from confronting the antivaccine cranks directly (sometimes because of direct intimidation).

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The latest issue of the Skeptical Inquirer features a cover article on vaccines and autism by yours truly. I have written quite a bit about this issue over the last year on this blog, and the article is a good compilation of everything I have written, and brings the reader up to date on this issue.

But of course the world of print media grinds much more slowly that the blogosphere. I wrote the article about three months ago and already there have been developments in the vaccines and autism story. As I wrote about in September, a large study conducted by the CDC was published and showed that use of thimerosal does not correlate with any adverse neurological outcome. The study did not look at autism specifically, but at a long list of neurological symptoms. A similar study looking at thimerosal and autism is under way and should be published next year. The mercury militia, true to form, completely misrepresented this negative study, claiming against the evidence that it showed a correlation.

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A new study just published in the New England Journal of Medicine, Early Thimerosal Exposure and Neuropsychological Outcomes at 7 to 10 Years, does not support a correlation between mercury in vaccines and neurological damage. It adds to the growing evidence that vaccines are safe and they do not cause neurological disorders. This study did not look at autism (a study that will be published next year looks, again, at vaccines and autism), but the mercury-causes-autism crowd are still unhappy with the results.

I have been following this issue closely for several years. Although my awareness of the issue goes back much farther, I started to seriously research the claim that the MMR vaccine, or that thimerosal in other vaccines, causes autism while researching an article on the topic for the New Haven Advocate. As a physician (a neurologist) and a skeptical activist I knew I had to get this issue right. I certainly did not want to falsely stoke the flames of public fear, nor did I want to cast myself in the role of denier.

Early on in my research I really did not know which way I was going to go with the issue. Should my bottom line be that there is real reason for concern here, that there is nothing to the claims, or that we really don’t know and will have to just wait for further research? But after reading through all the claims on both sides, and all the research, it was an easy call – vaccines, and specifically the MMR vaccine and thimerosal, do not cause autism, and the alleged autism “epidemic” is likely just an artifact. Those claiming there is a connection were drowning in conspiracy thinking, logical fallacies, and blatant pseudoscience. Meanwhile every piece of reliable clinical data was pointing in the same direction – no connection.

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Despite a critical lack of supporting epidemiological evidence, there are those who cling to the belief that mercury found in the vaccine preservative thimerosal is an important cause of autism and is responsible for the recent epidemic increase in this diagnosis. Never mind that this epidemic is probably mostly or even entirely an artifact of increased efforts at diagnosis while simultaneously broadening the definition (reflected in the new terminology of “autism spectrum disorder” or ASD).

The argument was based on the assumption of causation from correlation: primarily in the 1990’s the number of routine childhood vaccines was significantly increased. During this same time the number of ASD diagnoses increased dramatically as well (from 1-3 to about 15 cases per 10,000, although the true incidence is probably between 30-60 per 10,000). It would be reasonable to draw from this the hypothesis that maybe there is a causal link between the two – but there are those who drew the conclusion that there must be a link – and that was their folly.
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RFK Jr.’s recent speech about autism has sparked a lot of deserved anger. But like many things in life, it’s even more complicated than you think it is, and this is a good opportunity to explore some of the issues surrounding this diagnosis.

While the definition has shifted over the years (like most medical diagnoses) autism is currently considered a fairly broad spectrum sharing some underlying neurological features. At the most “severe” end of the spectrum (and to show you how fraught this issue is, even the use of the term “severe” is controversial) people with autism (or autism spectrum disorder, ASD) can be non-verbal or minimally verbal, have an IQ <50, and require full support to meet their basic daily needs. At the other end of the spectrum are extremely high-functioning individuals who are simply considered to be not “neurotypical” because they have a different set of strengths and challenges than more neurotypical people. One of the primary challenges is to talk about the full spectrum of ASD under one label. The one thing it is safe to say is that RFK Jr. completely failed this challenge.

What our Health and Human Services Secretary said was that normal children:

“regressed … into autism when they were 2 years old. And these are kids who will never pay taxes, they’ll never hold a job, they’ll never play baseball, they’ll never write a poem, they’ll never go out on a date. Many of them will never use a toilet unassisted.”

This is classic RFK Jr. – he uses scientific data like the proverbial drunk uses a lamppost, for support rather than illumination. Others have correctly pointed out that he begins with his narrative and works backward (like a lawyer, because that is what he is).  That narrative is solidly in the sweet-spot of the anti-vaccine narrative on autism, which David Gorski spells out in great detail here. RFK said:

“So I would urge everyone to consider the likelihood that autism, whether you call it an epidemic, a tsunami, or a surge of autism, is a real thing that we don’t understand, and it must be triggered or caused by environmental or risk factors. “

In RFK’s world, autism is a horrible disease that destroys children and families and is surging in such a way that there must be an “environmental” cause (wink, wink – we know he means vaccines). But of course RFK gets the facts predictable wrong, or at least exaggerated and distorted precisely to suit his narrative. It’s a great example of how to support a desired narrative by cherry picking and then misrepresenting facts. To use another metaphor, it’s like making one of those mosaic pictures out of other pictures. He may be choosing published facts but he arranges them into a false and illusory picture. RFK cited a recent study that showed that about 25% of children with autism were in the “profound” category. (That is another term recently suggested to refer to autistic children who are minimally verbal or have an IQ < 50. This is similar to “level 3” autism or “severe” autism, but with slightly different operational cutoffs.)

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A recent BBC article highlights some of the risk of the new age of social media we have crafted for ourselves. The BBC investigated the number one ranked UK podcast, Diary of a CEO with host Steven Bartlett, for the accuracy of the medical claims recently made on the show. While the podcast started out as focusing on tips from successful businesspeople, it has recently turned toward unconventional medical opinions as this has boosted downloads.

“In an analysis of 15 health-related podcast episodes, BBC World Service found each contained an average of 14 harmful health claims that went against extensive scientific evidence.”

These includes showcasing an anti-vaccine crank, Dr. Malhotra, who claimed that the “Covid vaccine was a net negative for society”. Meanwhile the WHO estimates that the COVID vaccine saved 14 million lives worldwide. A Lancet study estimates that in the European region alone the vaccine saved 1.4 million lives. This number could have been greater were in not for the very type of antivaccine misinformation spread by Dr. Malhotra.

Another guest promoted the Keto diet as a treatment for cancer. Not only is there no evidence to support this claim, dietary restrictions while undergoing treatment for cancer can be very dangerous, and imperil the health of cancer patients.

This reminds me of the 2014 study that found that, “For recommendations in The Dr Oz Show, evidence supported 46%, contradicted 15%, and was not found for 39%.” Of course, evidence published in the BMJ does little to counter misinformation spread on extremely popular shows. The BBC article highlights the fact that in the UK podcasts are not covered by the media regulator Ofcom, which has standards of accuracy and fairness for legacy media.

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In an optimally rational person, what should govern their perception of risk? Of course, people are generally not “optimally rational”. It’s therefore an interesting thought experiment – what would be optimal, and how does that differ from how people actually assess risk? Risk is partly a matter of probability, and therefore largely comes down to simple math – what percentage of people who engage in X suffer negative consequence Y? To accurately assess risk, you therefore need information. But that is not how people generally operate.

In a recent study assessment of the risk of autonomous vehicles was evaluated in 323 US adults. This is a small study, and all the usual caveats apply in terms of how questions were asked. But if we take the results at face value, they are interesting but not surprising. First, information itself did not have a significant impact on risk perception. What did have a significant impact was trust, or more specifically, trust had a significant impact on the knowledge and risk perception relationship.

What I think this means is that knowledge alone does not influence risk perception, unless it was also coupled with trust. This actually makes sense, and is rational. You have to trust the information you are getting in order to confidently use it to modify your perception of risk. However – trust is a squirrely thing. People tend not to trust things that are new and unfamiliar. I would consider this semi-rational. It is reasonable to be cautious about something that is unfamiliar, but this can quickly turn into a negative bias that is not rational. This, of course, goes beyond autonomous vehicles to many new technologies, like GMOs and AI.

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