Atomic City Talk

So, as luck would have it, my daughter is a week away from her first MMR shot (the vaccine currently under fire as a potential cause of some forms of autism). I hesitate to get caught up in the hype, but I'd be foolish, if not irresponsible, to not at least do a little homework. As with most things, I'm finding plenty of claims and counter-claims by what appear to be credible sources. I'll have a conversation or two with her doctor before the big day arrives, but it's pretty hard to ignore the big-picture stats:

• 1 in 150 births(1)
• 1 to 1.5 million Americans(2)
• Fastest-growing developmental disability
• 10 - 17 % annual growth
• Growth comparison during the 1990s(3):
o U.S. population increase: 13%
o Disabilities increase: 16%
o Autism increase: 172%

http://www.autism-society.org/site/PageS...FactsStats

Sure, our methodology and abilities to diagnose advance and change over time, but 172% increase still seems pretty darn high in such a short timeframe, don't ya think? Some sources have stated the rate as formerly being 1 in 3,000 and 1 in 10,000 (in the last 30 or so years I think?)

Doc - I'm all ears.

There's no doubt that diagnoses of autism spectrum disorders are on the rise. What this has to do with thimerosal or vaccination is beyond me.

Anyway, according to this, the MMR vaccine is innocent:

http://www8.nationalacademies.org/onpine...rdID=10997

My daughter had the MMR vaccine and she's not autistic. She is a National Merit Scholar, however, and as far as I can tell, there's at least as much evidence to support the conclusion that her National Merit Scholarships were caused by the MMR vaccine as there is that autism is caused by the vaccine. So you can take your chances. We did.

It is a lie that there is a link between autism and the MMR vaccine. There is as much evidence that autism is caused by a mother's milk, or by weaning to solid food. Frankly, I am surprised at this thread.

I could take the time to cut and paste all of the information out there to carry on the debate, but if you guys aren't up for the challenge I guess there's no point. But, if anyone else is interested, here's just one link that refutes the IOM report Doc referenced:

http://www.autismwebsite.com/ari/newsletter/iom.htm

Oh, and Cracker, thanks for your always insightful, but unsubstantiated opinion.

Trina, that link doesn't "refute" the IOM report, it refutes certain claims made about the report by pointing out that the report language admitted that they couldn't prove that the MMR vaccine could not possibly "contribute" to ASD in a few cases. It is ultimately impossible to prove a negative. Beyond that, it doesn't "refute" anything in the IOM report because it offers no data of its own. It is merely an angry screed attacking the MMR vaccine and the IOM panel. It is not science, it is polemics. The Autism Research Institute made the list of "Questionable Research Entities" on Quackwatch:

http://www.quackwatch.com/04ConsumerEduc...ecorg.html

There are other reasons to approach information from the ARI with a healthy skepticism. The ARI was founded by Bernard Rimland, whose stock in an ultimately failed autism treatment helped support the Institute:

"Conflict of interest is something that the supporters of various "alternative" autism hypotheses throw around a lot. They use it to explain why studies fail to show a connection between thimerosal and autism. They use it to explain why we should pay no attention to the dozens of excellent scientists and doctors who say that there is no connection. They use it to explain why nobody is doing research that finds a connection between mercury and autism.

But they don't use it to explain why many of the people on their "side" are doing what they do.

While looking through the material for my last post, I stumbled across the fact that Dr. Bernard Rimland was one of the people who patented the use of secretin in any form to treat autism. That patent was then sold to the Repligen Corporation, which then began testing (recombinant) secretin as a treatment for autism. Dr. Rimland (and the other owner of the patent) donated the Repligen stock to the Autism Research Institute (ARI) - which is run by Dr. Rimland.

When Repligen decided - in January of 2004 - to stop the secretin study because of unfavorable preliminary results, Dr. Rimland published a letter to the CEO of Repligen in the ARI newsletter, Autism Research Review International. This letter included the following statement:

"We have gotten, and continue to get, communications from upset parents and physicians, many of whom are Repligen stockholders."

The following graph of Repligen's stock price may help illuminate at least some of the cause of the upset: (stock chart). The stock price had gone over $8 in October of 2003 but was down to around $4 in late December. The precipitous drop (to about $2.50) in January 2004 was probably linked to the news that their promised blockbuster was a non-starter.

Now, I'm sure that Dr. Rimland had many other reasons besides stock values to be upset about the end of the study, but don't you think that it would have been ethical to at least mention that ARI was a major stockholder in the company? That might have informed readers that there was a potential conflict of interest involved in Dr. Rimland's letter and editorial.

Instead, Dr. Rimland mentioned that many of the parents and physicians who had communicated with him were stockholders and completely ommitted any mention of ARI's role as a major stockholder.

Other conflicts of interest abound in the "alternative" autism world.

Geier and Geier - famous for their ability to glean definitive information from a corrupted database - make their money doing "expert witness" work for parents suing (or trying to sue) over alleged vaccine injury. Besides other ethical issues that they might have (see here), it is clear that they have a financial stake (i.e. a conflict of interest) in finding that vaccines - or a component of vaccines - cause autism (or other disorders that one can sue over).

The "alternative" autism conferences are filled with people who are providing "infomercials" about the "therapy" they are selling without explicitly disclosing this fact to the parents at these conferences.

For example - Boyd Haley lectures on how mercury causes autism and - coincidentally - is founder of a company that sells some "advanced" dental diagnostics and also promotes the idea that mercury (from dental amalgams and/or vaccines) causes a number of chronic conditions, including autism.

Given the incredible conflicts of interest seen among the "scientists" supporting both the autism-mercury and autism-vaccine hypotheses (granted, there is a significant overlap), I find it almost laughable that they accuse other people of conflict of interest. Almost, but not quite.

Clearly, the conflict of interest issue is just a red herring, since the very people making the accusation are untroubled by gross conflist of interest among people on "their" side. In fact, it seems more like a case of projection, where they accuse others of the very transgression that they, themselves, are repeatedly committing.

So, it seems that the leaders and "researchers" of the autism-mercury group have lost their moral compass (if, indeed, some of them ever had one)."

http://photoninthedarkness.blogspot.com/...chive.html

(You'll have to scroll down to find the link--there's no permalink to the post)

In the interest of full disclosure, I'm a scientist and a geneticist by training. I have a joint appointment in the Department of Pediatrics at my medical school.

I read up on autism research a couple years ago for a friend with an autistic son. I won't burden you here with the technical reports on twin studies. Here is a link that explains that scientists favor a genetic basis for autism and believe that vaccines and vaccine preservatives are unlikely to be the cause:

http://www.pittsburghlive.com/x/pittsbur...29931.html

"I could take the time to cut and paste all of the information out there to carry on the debate, but if you guys aren't up for the challenge I guess there's no point."

Bring it on, Trina.

Doc, if the cause is found to be genetic+environmental (like PKU, I think), is there any way to test babies for that genetic trait, so as to avoid the environmental component (whatever it may be)? The PKU test is a simple blood-spot test taken from a baby's heel, but I have no idea what they're looking for in that blood spot.

Can many genetic anomalies be checked via a blood test?

The traditional early diagnosis are listed here. Scroll down to the Diagnosis section.

The full genetic basis of the disease or its susceptibility is not understood but when the vaccine scare tactics were implemented and vaccination against childhood diseases dropped, diseases increased. That increase included the diseases that the vaccines protected against as expected and autism, which continued to increase despite the drop in vaccinations.

That was a clear, though immoral, scientific test.

"Doc, if the cause is found to be genetic+environmental (like PKU, I think) . . ."

Well, not exactly. PKU is entirely genetic, a single locus trait (phenylalanine hydroxylase). The "environmental" component is the mental retardation, which can be prevented by modifying the infant's diet. That's why it is important to diagnose PKU in infants. But there is no doubt that the disorder has an underlying genetic basis.

" . . . is there any way to test babies for that genetic trait, so as to avoid the environmental component (whatever it may be)?"

According to the director of the genetics division of our Pediatrics department, there are some strongly linked DNA markers emerging for autism.

"The PKU test is a simple blood-spot test taken from a baby's heel, but I have no idea what they're looking for in that blood spot."

Phenylalanine (an amino acid) levels. Normal is ess than 4 milligrams per deciliter or less than 240 micromoles per liter.

"Can many genetic anomalies be checked via a blood test?"

More and more all the time. All states screen for PKU, galactosemia and congenital hypothyroidism. All but NH screen for hemoglobinopathies. Some states screen for maple syrup unine disease, homocystinuria, congenital adrenal hyperplasia, biotinidase deficiency, tyrosinemia, cystic fibrosis, organic acidopathies and fatty acid oxidation disorders. The problem with this sort of testing is who pays for it.

If, like PKU, everyone (parents, insurance companies, government, etc.) knew that the devastating effects of autism could be prevented by avoiding specific environmental interactions, it doesn't seem like "who pays for it" would be much of an obstacle.

I don't know what it costs (or what is involved) to detect a specific DNA marker, but I do know that autism yields staggering costs (economic and human capital), both for the directly affected families and for the public. If the cost of testing could be offset by the savings, it seems doubtful that anyone would question it.

If DNA testing were more commonplace, would it not become less expensive?

What does 18 years of (publicly funded, age 3 to 21) special education cost? What does a lifetime of group home residency and support cost?

These questions are based upon IFs, but IF the genetics+environmental theories turn out to be the answers, it would sure set us in the right direction to preventing something that any parent would go to the ends of the earth to avoid.

"If, like PKU, everyone (parents, insurance companies, government, etc.) knew that the devastating effects of autism could be prevented by avoiding specific environmental interactions, it doesn't seem like "who pays for it" would be much of an obstacle."

I don't think there's any scientific evidence for environmental interventions that can prevent autism. WRT PKU, I doubt most parents know the devastating effects of undiagnosed PKU because testing is routinely done in the hospital. And, of course, most folks are well aware of the devastating personal and societal effects of smoking and obesity, yet few people seem willing to do anything about it.

Who pays for it is an obstacle when (1) you're too poor to pay for it yourself, (2) your insurance company does the math and doesn't see a profit or (3) voters don't see themselves at risk.

"I don't know what it costs (or what is involved) to detect a specific DNA marker, but I do know that autism yields staggering costs (economic and human capital), both for the directly affected families and for the public. If the cost of testing could be offset by the savings, it seems doubtful that anyone would question it."

Hmm. Well, there are lots of genetic diseases we can test for but, like autism, can't cure. Huntingtons, Fragile X, myotonic dystrophy, Duchennes muscular dystrophy, Downs, etc. Collectively, they represent a significant economic and human cost. We don't test everyone for any of these diseases at birth.

"If DNA testing were more commonplace, would it not become less expensive?"

Yep. It will certainly continue to become more commonplace and less expensive. It is believed that one day, probably in our lifetimes, each person could have their entire genome sequenced and the sequence could be analysed for genetic risk factors for heart disease, cancer, alcoholism, etc.

"These questions are based upon IFs, but IF the genetics+environmental theories turn out to be the answers, it would sure set us in the right direction to preventing something that any parent would go to the ends of the earth to avoid."

I agree it is the right direction. Experience teaches me that not all parents go to the ends of the earth to avoid what you and I recognize as obvious risks.