Wednesday, September 26, 2007

Juxtaposition

I have been following the vaccine/autism debate since around January 2004. This was the month that my oldest son was diagnosed with Autism Disorder. Upon initial exposure to the concept, I had no significant reaction. I was too wrapped up in trying to figure out an effective course of action - a feeling I have in common with virtually every parent of an autistic child. A few months later, after the initial phases of adjustment to our family's new circumstance, I began to hear more about the ongoing debate.

The debate began to matter to me when I mentally framed it in terms of how it may affect treatment decisions we would make for our son. As a result, I went off in search of knowledge. To make a long story short, a story that includes stops at EOHarm Yahoo! group, at PubMed, at LeftBrain/RightBrain, and at many points in between, I eventually arrived at my conclusion. And this was a conclusion that was not to be taken lightly, as I had another baby on the way and decisions about vaccination were imminent.

As a result of my evaluation of the available evidence, I unwittingly became a member of one of the autism community's 'camps'. This camp, this school of thought, believes that autism is not resultant from vaccinations, that an autism 'epidemic' has not been convincingly shown to have occurred, that an autistic family member is not a blight upon a family, that many autistic people show significant improvement over the course of their life in the absence of 'miracle cures', that those individuals who are most profoundly affected by autism are to be valued, supported, and are no less able to understand if we are treating them with dignity and respect than their "higher on the spectrum" brethren, and much more.

Much can be said, in fact has already been said, about the (mis)behavior of many people who populate the camp on the other side of the vaccine/mercury debate. Their behaviors have been reprehensible in many cases - read just this one letter for some good examples of what I am referring to in terms of attitude towards autism and autistic people. Anyone has looked in on the EOHarm group in the recent past can vouch for the ongoing spite and malice that pervades their routine communications.

And so we come to the Juxtaposition. Juxtaposition is defined as ... "an act or instance of placing close together or side by side, esp. for comparison or contrast. " And this happened over the last week or so in the autism community.

Both camps feel vindicated in their views as a result of this juxtaposition.

The "Autism is mercury poisoning" camp (oh, wait, did they already change that message in response to a lack of data to support their position? Or did they commission their own phone survey in an attempt to support their position?) found validation last week and this week in the ongoing book tour of Jenny McCarthy. Jenny, as anyone who is reading this has got to know by now, is promoting a book in which she describes how: she believes that the MMR shot (yes, I know MMR does not contain Thimerosal) caused her son's autism and that various biomedical treatments, including the non-dangerous GFCF diet, have "rescued" her son from autism. 'Nuff said on Jenny, as plenty has been discussed elsewhere on the internet.

The other camp, my camp, the one who feels that the weight of scientific evidence exonerates mercury in childhood vaccines as a factor in Autism Disorder, also received some validation this week. Today, a study published in the New England Journal of Medicine concluded that



"...Our study does not support a causal association between early exposure
to mercury from thimerosal-containing vaccines and immune globulins and deficits
in neuropsychological functioning at the age of 7 to 10 years. "

Don't take my word for it, read the abstract yourself. The most obvious issue that the Mercury Militia will latch onto with this study is that it



"...did not assess autism-spectrum disorders."

And this criticism, as relates to the debate, is valid to a degree. However, the neuropsychological metrics that they assessed clearly fall within the scope of what are recognized to be traits involved in the Autism Disorder diagnosis.

"The outcome measures included speech and language indexes, verbal memory,
achievement, fine motor coordination, visuospatial ability, attention and
executive-functioning tasks, behavior regulation, tics, and general
intellectual functioning (Table C of the Supplementary Appendix). Measures of attention, hyperactivity, and executive functioning were based on reports from parents and teachers."



I'd like to direct you to this article by one Dr. Gilbert Ross. In the article, titled Vaccine Litigation over Mercury and Autism Puts Kids in Jeopardy, Dr. Ross promotes the view that not only have vaccines been exonerated - again! - as a cause of autism and other neurological disorders, but also that the continuing legal debate potentiates the risk of a stoppage in production of vaccines altogether due to legal liability. I think even some fringe anti-vaxxers might agree that this would not be a positive outcome in terms of public health.

The juxtaposition lies in the fact that one side of the debate has been in rapture over the occurrence that a B-list celebrity has taken to the airwaves to promote a book that discusses the author's belief that the MMR vaccine caused her son to become autistic, whilst the other side of the debate has been supported by a well-designed, large scale study that concludes that Thimerosal in childhood vaccines does not correlate with neurological dysfunction by the age range of 7-10. If the Scales of Justice were to weigh both current developments, here's one dad's opinion that the science outweighs the Indigo Mom's specious conclusions.


31 comments:

Ms. Clark said...

I read a comment from a science-minded sort of expert guy (also a father) who said he'd be willing to wear a mini-skirt and a push up bra on Oprah if she would interview him on the topic of autism.

It was said in jest, I'm sure, but it's kind of sad that that is what it would take to get Oprah to allow a well informed scientist on her show to talk about what is known about autism and what we ought to be looking at as a society in relation to autism. Same goes for Larry King and Good Morning America, no doubt. The same dad might have to appear in some kind of gorgeous suit and Hollywood sunglasses in order to get on the View... what a bunch of garbage the US population has been exposed to this week.

notmercury said...

Nice writing Steve.

It's probably worth noting that the CDC anticipated criticism from the MM crowd and invited members of vaccine/autism advocacy orgs to participate in the study design and implementation.

Sall(ie)y Bernard has plenty of experience criticizing and reviewing autism, and specifically mercury, oriented research.

If there were any "red flags", as she put it, she certainly had the opportunity to address and help to correct these before publication.

More likely she was disappointed by the outcome and asked to be listed as dissident.

Chuck said...

Your statement implies an issue that has not been proven in the scientific studies of causation.

”scientific evidence exonerates mercury in childhood vaccines as a factor in Autism Disorder”

All the scientific studies provided dispute mercury as a cause, but not a factor, in autism disorders.

notmercury said...

Chuck, can you cite any decent studies that implicate mercury as a factor in ASD?

Chuck said...

Not Mercury
Can you cite any decent studies that implicate mercury cannot be a factor in any of the diagnosis criteria currently in the DSM-IV for ASD?

That would end the discussion once and for all now wouldn’t it? Or at least until DSM-V.

notmercury said...

Chuck,
Can you cite any decent studies that implicate the Loch Ness Monster cannot be a factor in any of the diagnosis criteria currently in the DSM-IV for ASD?

Chuck said...

Not Mercury,

Can you site APA meeting minutes for the determination of diagnosis criteria in the DSM-IV that will categorically state that the Loch Ness Monster was not a determining factor to one or more of the members who published the DSM-IV criteria for ASD?

Chuck said...

I posted this over at Autism Vox

"There is no scientific study that can determine causation of a disorder that has a subjectively determined list of diagnosis criteria and can also be subjectively diagnosed."

If the scientific community wants to waste it's time and resources trying to disprove causation of an un-scientifically defined disorder, who am I to argue with them.

notmercury said...

Chuck,
I cannot. Well played sir!

Steve D said...

Chuck -
The position you are taking on this issue is far too convenient for someone who believes that Thimerosal plays a role in the onset of autism. Your statement amounts to sophism.
The burden of evidence to show that mercury causes autism falls on those who postulate that this may be the case. When efforts have been made to validate this postulation, no correlation has been found.
By your reasoning, it can never be found, therefore making your position unassailable. In other words, you are using convoluted logical 'proofs' to solidify your own world view, instead of incorporating accepted, valid science into said world view.

That is what NotMercury means when referencing the Loch Ness Monster. Your statement that "There is no scientific study that can determine causation of a disorder that has a subjectively determined list of diagnosis criteria and can also be subjectively diagnosed." prevents any variable from being removed from consideration, no matter how ludicrous. It is an intellectual cop-out, sorry.

Steve D said...

Ms. Clark - Its a classic case of drive-by science, which seems to be the way the public digests its science these days.
I have MSN as my home page. Every day I can open it and read a headline that "A New Study Shows...". Today's example is "...that all booze ups cancer risk." This is the way most people want their science: boiled down to simplicity and served by a pretty woman in as few words as possible.

notmercury said...

Steve D: "That is what NotMercury means when referencing the Loch Ness Monster."

No, I really do suspect that he (or she) has a hand (or flipper) in this.

Chuck said...

My argument plain and simple:

Environmental toxins, including Thimerosal, can adversely contribute to one or more of the currently defined diagnosis criteria. There are multiple subjectively defined diagnosis criteria and multiple subjectively determined combinations of diagnosis criteria to base a diagnosis.

Scientific causation can only be determined based on standard diagnosis criteria. There is neither a standardized diagnosis criteria nor is there an objective diagnosis of ASD.

There is also no scientifically objective neurological test to diagnose ASD. Multiple neurologists have determined there is nothing neurologically wrong with my DSM-III defined ASD child.

notmercury said...

Chuck, would you agree that in utero exposure to Thalidomide might be a "factor" in some cases of autism? How about Valproic acid or maternal Rubella infection? What percentage of ASD's do you think might be linked to "factors" like these?

Chuck said...

I learned ASL in order to communicate with a friend who was deaf due to maternal Rubella infection. I do not know the rate of maternal Rubella infection. I also do not know the usage rate for Valproic acid. Thalidomide is only used in the USA in strict scientifically controlled studies screening for pre-testing pregnancies. Given my limited expertise and knowledge base in these factors, I will take a swag at your last question and say they contribute to 20-30% of the US diagnosis of ASD disorders.

notmercury said...

Quite a bit less, actually.

What's your best guess for thimerosal?

Chuck said...

"Quite a bit less, actually."

Can you site your source showing it as a factor and not a cause?

SWAG on the Thimerosal as a factor in DSM-IV ASD 40%

Chuck said...

As long as we are on this 20 questions thread.

What is your estimate of the percentage of currently diagnosed ASD individuals according to DSM-IV that would not be diagnosed using DSM-III criteria?

notmercury said...

Chuck: "Can you site your source showing it as a factor and not a cause?"

Probably, if you feel it's important, but I'll accept either. These things increase the risk of being autistic.

If thimerosal is responsible for or contributes to more cases of autism than these other known, but quite rare, causes/factors, why is it so difficult to tease out an association?

Chuck said...

Because the scientific definition of cause is different then the scientific definition of risk.

notmercury said...

Fair enough, so why is it that science can recognize things like Rubella, Thalidomide, and Valproic acid as risks while thimerosal fails to rise to the level of significance?

Chuck said...

I do not know as I have not seen the information or the criteria they use to make that determination.

Steve D said...

Chuck -
"There is neither a standardized diagnosis criteria..."
Sorry, but there is. It is the DSM-IV-r's diagnsotic criteria. You may not like it, but it is what it is.
And you are still bouncing around in a sophist logic trap. I believe it is because you fcind yourself unable to accommodate that scientific data did not "report" that which you expected it to. You are grasping, trying to question definitions, quibbling over causation vs. risk of causation.
Why do you so badly want mercury to be involved? Why do you find it so hard to let go of that?

Chuck said...

Notmercury

I have been kind enough to answer your questions as best as I can. Will you reciprocate?

notmercury said...

I may have missed the part where you answered but I'll be happy to answer your....question, was it?

"What is your estimate of the percentage of currently diagnosed ASD individuals according to DSM-IV that would not be diagnosed using DSM-III criteria?"

I have no earthly idea. Honestly.

Chuck said...

The DSM-IV criteria are,

To quote from Pirates of the Caribbean

“more like guidelines then actual rules”

http://www.psychnet-uk.com/dsm_iv/autistic_disorder.htm

There are no “standard” diagnosis criteria, you have failed to read the DSM-IV

‘Impaired social interaction (at least 2):” This is a multiple choice or multiple elimination list, depending upon how you view it.

“Impaired communication (at least 1):” Once again, multiple choices or multiple eliminations.

“Activities, behavior and interests that are repetitive, restricted and stereotyped (at least 1 of):” Once again, multiple choices or multiple eliminations.

“Before age three, the person shows delayed or abnormal functioning in 1 or more of these areas:” Once again, multiple choices or multiple eliminations.

Some are now not doing this:
“Differential Diagnosis:”
Since it is easier for them to diagnose both

How many possible combination of the above choices will qualify an ASD diagnosis?

Of these multiple combinations, which one is the standard?

Chuck said...

Also on the “standard” issue

Anyone can enlighten me on this.

There may be differences in the diagnosis criteria in the DSM-IV and the current ICD. (I do not know if this is true or not)

There are also areas that do not use either diagnosing manual.

Therefore there is no global standard for ASD. Check with Grinker on this.

Steve D said...

Chuck -
You've got to understand the idea of context. We are not talking about a global examination of autism prevalence. Do you honestly want to try citing mercury uptake figures in, say, Pakistan? I didn't think so. So let's keep the conversation within limitations that can be realistically discussed or, alternatively, lets stop discussing it.
The DSM-IV that you just linked to represents the standard diagnostic criteria for those of us in North America.
Where are you going with this line of reasoning?
You are not making much sense, frankly.

Chuck said...

Back to basics

How can you scientifically prove/disprove causation if you cannot scientifically define what is being caused?

Neurology does not define ASD. Genetics cannot define ASD. Psychology/Psychiatry subjectively chooses from lists of multiple subjective criteria to define the symptoms.

There is no hard science on both sides of the equation. So how can science be applied?

Steve D said...

"Neurology does not define ASD."
Glial cells, Broca's area, mirror neurons, 'white matter', and microcolumns have all been tied to autism. The complete picture is not clear, but neurology has made major contributions to our understanding of the autistic mind.

"Genetics cannot define ASD."
Several very specific locations have been identified as being involved in some cases of autism. Fragile X is a straight-up genetic condition. Genetics is well established as playing a significant role, a role which is not yet fully understood but in which major leaps continue to be made.

"Psychology/Psychiatry subjectively chooses from lists of multiple subjective criteria to define the symptoms."
You are continually referring to the DSM-IV's diagnostic criteria as being in question. They are not. The format may not be to your liking, but the psych community understands and agrees that it is the benchmark for diagnosis at this time. It will be revised in the future, and that is a good thing. In the meantime, it is the standard right now. Deal with it.

"There is no hard science on both sides of the equation. So how can science be applied?"
What you really mean is that there is no science that confirms your preconceptions. Plenty of hard science exists, and you are utterly ignoring it, as is evidenced by your most previous comment.

Chuck said...

And you keep ducking and weaving on what science doesn’t know and your preconceptions of what you think it does know and only very specifically to your corner of the world. Continuation is futile and pointless for both of us and we can only agree to disagree at this point.