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.

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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.

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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.

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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.

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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.

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The Centers for Disease Control (CDC) has published the results of their latest study on the prevalence of autism. There is no question that in the last 20 years the number of autism spectrum disorder (ASD) diagnoses has increased. What is also clear is that during this time there has been increased surveillance and a broadening of the diagnosis of ASD. Whether or not this accounts for the entire increase in ASD numbers, or if there is a true increase in there as well, is unknown.

Into that context, the CDC adds their most recent numbers, concluding:

In 2006, on average, approximately 1% or one child in every 110 in the 11 ADDM sites was classified as having an ASD (approximate range: 1:80–1:240 children [males: 1:70; females: 1:315]). The average prevalence of ASDs identified among children aged 8 years increased 57% in 10 sites from the 2002 to the 2006 ADDM surveillance year. Although improved ascertainment accounts for some of the prevalence increases documented in the ADDM sites, a true increase in the risk for children to develop ASD symptoms cannot be ruled out. On average, although delays in identification persisted, ASDs were being diagnosed by community professionals at earlier ages in 2006 than in 2002.

That 1 in every 110 children on average now carry an ASD diagnosis is not new news. This CDC data was actually released ahead of publication in October. At the same time a phone survey published in Pediatrics found 110 in 10,000 children carried an ASD diagnosis – or a little more than 1%. This 1% figure seems to be highly replicated – a National Health Services survey released in September also found a prevalence of 1% for ASD in the UK.

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Like my science-blogging colleagues, I get e-mail. I always appreciate it when readers (or listeners, in the case of the SGU) take the time to write. Sometimes the e-mails are questions from someone who disagrees with my position on a hot issue. I especially like these e-mails – they are good blog fodder, and I think the format of answering questions is more compelling and interesting than making a didactic argument.

Below is an example of the kind of question I most like to get – from someone who disagrees with me, but still manages to ask polite and cogent questions. This stands in stark contract to most hostile e-mail I get, which are just strings of ad hominems, straw men, and other logical fallacies. I get the impression (and some of my e-mailers have later even admitted this) that the e-mails were not meant as an opening to serious discussion, but as a venting rant into the ether of the internet.

Harold asks some very important questions about the alleged autism-vaccine link and research priorities, and I am happy for the opportunity to clarify my position. His e-mail begins below the fold:
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I and other science bloggers spend a lot of time and virtual ink doing damage control on bad science reporting in the media. It’s hard not to get a little jaded after wading through one terrible science article after another.  I discuss this problem and one stunning example of promoting pseudoscience passing for journalism today on SkepticBlog.

But occasionally I do make a point of celebrating good science journalism when I see it – and not just a solid piece discussing a new science news item, but a reporter tackling a controversial topic and getting it right. Most of the time mainstream journalism of fake scientific controversies or fringe ideas falls for the “false balance” fallacy – presenting fake science and real science side by side, as if they were equivalent, or just a matter of opinion. Or, even worse, we get token skepticism, or no skepticism at all.

Last week the Chicago Tribune printed a long piece on biological treatments for autism by Trine Tsouderos and Patricia Callahan, and an excellent piece it was. They clearly understand what the real story is – a subculture of fringe doctors and others who are essentially doing unethical experiments and children with autism. They are exploiting desperate parents (who then sometimes contribute to the exploitation of the next desperate parents) who are seeking any possible help for their children.

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Politics is partly about setting priorities and agendas, and therefore it is impossible to keep politics out of science. Politicians are also in control of the public’s purse strings, and so funding science also cannot be free from politics.

But ideally we should have an atmosphere in which politicians and funding agencies set broad agendas, and then let scientists decide the details of which research should be funded based upon the science. It is, in fact, an important trust that public money that is spent on scientific research be utilized optimally, and not to promote someone’s narrow ideological agenda. Examples of abuses are legion; my favorite example is the National Center for Complementary and Alternative Medicine (NCCAM), Senator Tom Harkin’s pet project in which the usual standards of medical research have been subverted to promote sectarian medicine.

We want scientists to follow their noses – to research those questions they think are most fruitful. But scientists are often forced to follow the funding, and this distorts the direction of research. Industry funding distorts research in ways that are advantageous to industry – a real problem that is being examined and there are at least attempts to deal with it. Government funding should be neutral, and provide a counterbalance to industry funding, but is often subverted to ideology. Even well-meaning patient-groups can distort funding if they try to dictate what scientists should be researching in exchange for their fund-raising, with detrimental effects.

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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.

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