U.S. Court of Claims Denies Claim of Vaccine/Autism Link

A specially convened vaccine court, part of the process required to seek compensation under the Vaccine Injury Compensation Program, has ruled against parents saying that the MMR vaccine caused autism in their children. The court specifically said that there was absolutely no compelling scientific proof of the claim, and that the "petitioners' theories of causation were speculative and unpersuasive."

This was one of three test cases going before the court, and the court has yet to rule on the claim that thimerosal alone is the culprit. However, the language the court used in this case is very telling: "The petitioners have failed to demonstrate that thimerosal-containing vaccines can contribute to causing immune dysfunction."
-Kelly Hills

Reproduction of 1998 Wakefield Study Finds NO MMR/Autism Link

It's pretty commonly known that Andrew Wakefield's 1998 Lancet paper on the link between autism and the MMR vaccine has been the source of considered controversy over vaccinations and autism, even after the majority of the paper authors removed their names and the journal retracted the paper. Wakefield's unethical conduct, the leaps of logic, and the small sample size itself, all contributed to reasons the paper was ultimately discredited.

Unfortunately, that sort of discrediting might hold weight in academic spheres, but doesn't necessarily take hold in the public sphere. It's much more entertaining to write scare-tactic headlines touting fears of vaccines and the rise of autism than it is to say "woops", let alone "woops, we maybe made something worse... sorry about that, please go vaccinate your kids before measles skyrockets to new epidemic proportions."

Hopefully the news that a reproduction of the Wakefield study shows absolutely no link between autism and the MMR vaccine will gain foothold in the media at large, and go a long way towards convincing parents that vaccinating their children is not only a socially responsible action that contributes to the common good (via herd immunity), but is the responsible action as a parent taking care of their child's health.

Like Wakefield's study, the new study looked for evidence of potential links between MMR vaccinations, autism and the digestive (gastrointestinal, or GI) problems sometimes seen in autistic children.

"If in fact you want to implicate a factor in the causation of an illness, it must be present before the illness," said W. Ian Lipkin, a professor of epidemiology, neurology and pathology at Columbia University, explaining the idea behind the study. "In the event MMR was responsible for autism, the MMR must precede the onset of autism. There was no evidence . . . MMR preceded either autism or GI problems" in the children studied, he said.

In the first eight months of this year, there have been almost 140 cases of measles alone. The vast majority of these cases have occurred in unvaccinated children - cases of measles that could have easily been prevented.

Let's hope that this is the final nail in the coffin of the link between the MMR vaccine and autism, and that while research into causes, origins and cures for autism continue, our vaccination rate also goes back up to healthy levels for the entire population.

-Kelly Hills

Parents Want Alternatives

by Leane Scoz

Autism is a developmental disorder defined by impairment in social interaction and communication, and the presence of repetitive or unusual behavior and interests. The Center for Disease Control and Prevention (CDC) reports that 1 in 150 children under the age of 8 have an autism spectrum disorder (ASD). With a cure yet to be found, parents of autistic children are seeking alternative treatments over the limited conventional treatments currently available.

Chelation is one alternative therapy gaining rapid popularity among the autistic population. The unproven treatment, which removes heavy metals from the body, is believed to help children with autism by removing levels of mercury from the body. According to a recent CBS News article, the theory behind the treatment stems from the believe that mercury in vaccines triggers autism.

Since this theory has never been scientifically proven and mercury (thimerosal) has been discontinued in childhood vaccines since 2001, scientists believe the proposed government study to test chelation treatment on autistic children is unethical and dangerous. Many parents of autistic children disagree and are even resorting to using chelation without results from a study to prove whether it is beneficial or not. In fact, CBS News reports the proposed study is on hold due to safety concerns after an animal study linked the treatment to lasting brain problems in rats.

The concerns are certainly not without merit since a 5-year-old autistic boy died after undergoing chelation therapy in 2005 and hundreds of lawsuits are currently underway because of the effects of chelation therapy. However, parents of autistic children are not deterred. An estimated 3,000 autistic children in the United States participate in chelation treatment at any given time. Some children are under the care of a physician during treatment and others under the care of their parents since chelation therapy can be done with a variety of over-the-counter dietary supplements.

Parents of autistic children simply want answers. They want their children to live a normal life, free of a developmental disorder. If regulated medicine can not provide them with the answers they are seeking, they have not choice but to resort to alternative treatments, such as chelation. But, at what cost? Is it really worth putting your child's health and well-being in danger in the hopes of possibly finding an answer? It is an ethical question autistic parents will struggle with until a cure for autism is discovered.

Neurodiversity blogger subpoenaed in "vaccine-autism link" lawsuit

Kathleen Seidel, of Neurodiversity Blog, has been subpoenaed by the plaintiffs' lawyer in a lawsuit claiming that vaccines caused autism. It appears that this subpoena may be retributive action from the lawyer for the plaintiffs, whom Seidel criticized a few weeks ago.

She has since filed a motion to quash the subpoena because she is uninvolved in the Sykes v. Bayer case other than as an independent blogger who has discussed issues related to neurobiology and autism.

This action has many potential impacts for the medical and legal arenas, and opens up the possibility of harassment and undue barriers for bloggers if they can be required to produce the amount of paperwork required in a subpoena at the drop of a hat by a bitter lawyer who perpetuates fraud.

More from:

* Pure Pedantry

* Pharyngula

Autism Vaccine Settlement

The parents of nine-year old Hannah Poling, daughter of a Georgia couple, speak out about the government's admission of responsibility for their daughter's vaccine-linked autism, and have agreed to pay an as yet undisclosed settlement amount to compensate the Poling's for their family's pain and suffering as a result. The CDC is calling the case an anomaly, not an outcome to be experienced by the majority of children receiving vaccines. What should be a reasonable settlement for these types of cases? What are the ethical issues facing parents fearing an autism-link to vaccines in the decision to vaccinate or not?

See the entire CNN article here.

Politics, science, and autism: part 547

Despite substantial evidence to the contrary, some people believe that vaccines (specifically, trace amounts of mercury in vaccines) cause autism. Apparently John McCain is one of those people. He was quoted this week as saying that the incidence of autism is rising (true, according to the CDC's most recent report), and that "there’s strong evidence that indicates that it’s got to do with a preservative in vaccines."

It just ain't so. That's according to--at least--the Institute of Medicine (report here); researchers at the California Department of Public Health (abstract); and the Centers for Disease Control (ongoing research). And a study reported last month in Pediatrics concluded that babies excrete thimerosal (the mercury-containing preservative in vaccines) more quickly than previously thought.

The NYT suggests that the Senator's claim is designed to garner support from the numerous parents' groups that believe in the thimerosal-autism connection. To further confuse the issue, the Department of Health and Human Services recently agreed to settle a case that alleges that administration of standard childhood immunizations caused illness in a child with a pre-existing mitochondrial abnormality. You can learn more in this New Scientist article.

This isn't to pick on Senator McCain--we're nonpartisan on the blog--but it did make me think about how and why politicians choose sides on controversial issues in science. In that sense, the autism controversy isn't much different from climate change or evolution. If the meta-issue here (politics and science) is of interest to you, check out Sciencedebate 2008--a call for the presidential candidates to share their views on the environment, health and medicine, and science and technology policy.

Primum Non Nocere

First, do no harm. I don't know anyone who practices any aspect of medicine who disagrees with this foundational concept of what medicine should be and do - do no harm. And on an intuitive level, harm seems so self-evident, and easy to avoid.

Except, of course, anyone who's spent more than an hour reading about the history of medical ethics knows that this isn't the case. Harm, unfortunately, is one of those words that is flexible, has a definition that changes depending on context, case, even attitude. Ultimately, what does it mean to cause harm?

I had a class last year where a student would argue that anything which caused someone to be "not normal" was harmful, and therefore doing no harm meant doing your best to make sure everyone was normal. Ignoring the more Harrison Bergeron aspects of that thought for a minute, what does it even mean to be normal? Again, it's one of those things that seems self-evident, until you stop and think for a minute. We're accustomed to this argument now (at least, I hope the folks who'll be reading this are) when it comes to think like Deafness or dwarfism - parents who are dwarfs or Deaf who want children sharing these same genetic and physical traits. It is, for them, what is normal - point being that normal itself is not a concrete concept, but flexible. You could argue that normal is normative.

There's been a lot of debate about whether or not, for example, Deaf parents should be "allowed" to have Deaf children - that is, should fertility doctors be trying to create embryos that are deaf, should couples be able to request eggs or sperm from Deaf donors to increase their chances of having a Deaf child. I've argued strongly for this in the past, and won't go into the reasons here, except to say that part of the reason for my arguing for this is based on the notion of preserving culture, and not making a judgment call on what is normal. There are, after all, many people for whom the experience of being Deaf is perfectly normal, and I'm simply not comfortable pointing a finger and saying "you are abnormal".

That's why this particular YouTube video has been so thought-provoking for me. I suppose, when it comes down to it, I do have a concept of normal that includes "being able to communicate with the world" - I don't assume that means everyone; after all, I don't speak the majority of the languages on this earth. But the idea that someone who has what we would consider severe autism is communicating with the world, and it's simply the world that has not yet figured out how to communicate in return, is a novel and I'll admit, somewhat difficult, concept for me to wrap my head around.


Amanda Baggs, the woman in the video, is featured this month in Wired, and has a blog here.

I won't suggest that Ms. Baggs doesn't bring up interesting - and disturbing - questions in her video (obviously there's something here to think about, or I wouldn't have anything to write). But I wonder - given what she describes as being her language, is it even possible that someone who is not autistic, or cognitively different, could learn to communicate in it? Or maybe even more to the point - in my general notion of a language, it is a device that allows me to communicate with you - we both have the ability to learn it and use it to exchange ideas. Is Ms. Baggs' language one that more than a single person knows, uses, inhabits? I'm not necessarily convinced that, if it is an individualistic thing, if she is the only person speaking this language, than it can rightfully be called a language. But I also don't want to swing so far to the other side as to say it's not possible - I simply don't know.

I have some other concerns that are still marinating, so I'll just leave it at this for now.
-Kelly

Animal and Human Cognition: Are the differences that great?

Two articles in the Science Daily news examine the differences in human and animal cognition -- the first, an article linked to the Public Library of Science (PLoS) Biology Journal that asks the question, "Do Animals Act Like Autistic Savants?: When Temple Grandin argued that animals and autistic savants share cognitive similarities in her best-selling book Animals in Translation (2005), the idea gained steam outside the community of cognitive neuroscientists. Grandin, a professor of animal science whose best-selling books have provided an unprecedented look at the autistic mind, says her autism gives her special insight into the inner workings of the animal mind. She based her proposal on the observation that animals, like autistic humans, sense and respond to stimuli that nonautistic humans usually overlook."

Grandin explains in a separate commentary "the basic disagreement between the authors and me arises from the concept of details--specifically how details are perceived by humans, who think in language, compared with animals, who think in sensory-based data. Since animals do not have verbal language, they have to store memories as pictures, sounds, or other sensory impressions... As a person with autism, all my thoughts are in photo-realistic pictures," she explains. "The main similarity between animal thought and my thought is the lack of verbal language."

But you don't have to be autistic or an animal to think in pictures -- according to Wikipedia, "Research by Child Development Theorist Linda Kreger Silverman suggests that less than 30% of the population strongly uses visual/spatial thinking, another 45% uses both visual/spatial thinking and thinking in the form of words, and 25% thinks exclusively in words. According to Kreger Silverman, of the 30% of the general population who use visual/spatial thinking, only a small percentage would use this style over and above all other forms of thinking, and can be said to be ‘true’ “picture thinkers”. All of which suggests that perhaps the differences in cognition are not as great as we might think.

However, in the second article "What Is The Cognitive Rift Between Humans And Other Animals?" Harvard scientist Marc Hauser presents a new hypothesis on what he thinks defines the cognitive rift between humans and animals: "He identifies four key differences in human thought that make it unique. Animals, for example, have 'laser beam' intelligence, in which a specific solution is used to solve a specific problem. But these solutions cannot be applied to new situations or to solve different kinds of problem. In contrast, humans have 'floodlight' cognition, allowing us to use thought processes in new ways and to apply the solution of one problem to another situation."

Of course, neither of these settle the debate, however, both studies provide substantial food for thought.

(Photo Credit: iStockphoto/Jurie Maree)

Fiction or...?

As I'm sure most of the regular blog readers have realized, I'm a fan of pop culture. I'm endlessly fascinated with the media and how it spreads knowledge - or misinformation.

The new ABC show Eli Stone, which I have quite been looking forward to - the premiere has George Michael as prophet singing Faith - is by the same producer who's given us Brothers & Sisters and Dirty Sexy Money. So I was thinking "how in the world could this go wrong, it'll be fabulous!"

Well, apparently the world likes to make a point sometimes. The American Academy of Pediatrics wants the first show either pulled or substantially re-edited, because the opening scene involves a woman suing a pharmaceutical company over the supposed autism/vaccine link, saying that it's the reason her child is autistic. The link we know doesn't exist. Where the lead researcher involved was charged with misconduct in an effort to put the link/controversy to rest. The lawyers settle, after the woman makes your typical heartwarming by a wronged mother speech.

Given the description, you would think that the pharma companies would be going after ABC, but instead it's the pediatricians. They're worried that the heavy promotion ABC has been giving Eli Stone (a new show in a sea of repeats due to the writer's strike), and the likelihood of high viewership, will result in frightening more parents away from vaccinating.

The sad thing is, it's clear from the entire set-up that the scenario is supposed to make us dislike Eli, the main character, so that at his redemption we feel something for him. But it would have been completely possible to make him an utter bastard of a lawyer - and not propagate medical misinformation in the process.

ABC's response, to run a website for the CDC at the end of the show, isn't going to alleviate fears - it's not even going to address them. It's the difference between using scare tactics to get a message across versus a mass mailed flyer. And ultimately, they're counting on popular misconception and fear to tell their story for them, which is plain lazy writing.

But don't take my word for it, make your own decision. You can see for yourself. The first seven minutes of the show are available at ABC. Just select Eli Stone from the left side menu, and then select the sneak peak episode.
-Kelly

Bobby Fisher, Bioethics, and Asperger's

[Hat tip to colleague Terry Tomsick for bringing this to our attention] In a recent MSNBC article, bioethicist Art Caplan ponders the question "Would you have allowed Bill Gates to be born? Advances in prenatal genetic testing pose tough questions". Upon hearing the very sad
news this past week about the death of chess champion Bobby Fisher – I had to ask the same question: Would you have allowed Bobby Fisher to be born?

While we don't know for sure, Fisher's outrageous and at times hateful and bigoted behavior may have been caused by Asperger's syndrome which is part of the autistic spectrum . Or perhaps Fisher suffered from having an "extreme male brain" as characterized by Simon Baron Cohen, PhD, MPhil, a professor of developmental psychopathology in the departments of psychiatry and experimental psychology, a Fellow of Trinity College, Cambridge, and director of the Autism Research Centre at the University of Cambridge, in the United Kingdom, and author of the book "The Essential Difference: The Truth about the Male and Female Brain".

We may never know the truth but it would be tragic if he were simply remembered as a hateful, reclusive genius and not for the many accomplishments he brought to the world.

Dr. Caplan captures the key bioethical challenge these new genetic technologies and our understanding of the brain pose:

As genetic testing moves into the world of mental health, we are going to face some very tough questions. Will medicine suggest that any and every variation from absolute normalcy is pathological? How can we draw lines between disabling diseases such as severe autism and
more mild differences such as Asperger's, which may give society some of its greatest achievers? Will parents have complete say over the kind of children they want to bear? And what sorts of messages will doctors and genetic counselors convey when talking about risks, probabilities and choices that involve not life and death but personality and sociability, genius and geekiness?

Neither medicine nor the general public are at all ready to deal with the emerging genetic knowledge about autism, Asperger's or other aspects of mental health. But the future of our society may well hinge on how we answer these questions.

Bobby Fisher: May you rest in peace.