Autism and vaccines: The story morphs

I have to hand it to Dan Olmsted. As Dr. Michael Egnor is for "intelligent design" creationism, ol' Danny Boy is the Energizer Bunny of antivaccinationism. Tag-teaming with fellow "journalist" David Kirby, who seems able to live rather well without actually, you know, having a regular job, ex-UPI correspondent Olmsted form the not-so-dynamic duo of vaccine and autism pseudoscience, the unrelenting propagandists who, despite all evidence to the contrary, keep insisting that it really, truly is the mercury in the vaccines and then, when science shows that it really isn't the mercury in vaccines, insist that it really, truly is the vaccines themselves. Diligently seeking across the country any shred of evidence that he can twist into blaming vaccines for autism, Olmsted is, if nothing else, persistent. There's no claim that's too woo-ful, antivaccination statement so unsourced and unverifiable that he won't report it as though it's the Gospel Truth about autism.

In the wake of the Hannah Poling case, this not-so-dynamic duo is partying like it's 1999 (which is the last time anyone could say that the "thimerosal causes autism" hypothesis was the least bit plausible from a scientific viewpoint). What's funny is how the story now changes. In fact, the partying started before the Hannah Poling case was announced. First, let's take a look at Tweedle-Dee, namely Dan Olmsted, who penned a paean to a failed hypothesis entitled 7 reasons not to give up on the mercury/autism link.

I don't want to march through each of the seven reasons. Suffice it to say that it's the same old crap, idiocy parroted credulously by luminaries of the mercury militia like Don and Deirdre Imus and Robert F. Kennedy, Jr. The first thing I notice is that Olmsted, like Kirby and other mercury militia luminaries such as J. B. Handley, is furiously backing away from the original claim of the mercury militia, which was that it was the mercury in the thimerosal preservative in vaccines that is responsible for the "autism epidemic":

Thimerosal could be sufficient to cause autism, but not necessary - the MMR shot plus background mercury levels in the pregnant mother could be an issue; the soaring coal pollution from China could be taking up the slack. (One in six American women now has enough mercury to risk neurodevelopmental problems in her offspring; and, golly, one in six American children now has a developmental disorder). Tons of other toxins whose dangers are untested and unknown could be having the same effect, and they are only increasing as time goes on. Vaccines themselves, in their ever-growing and ever-earlier combinations, could account for much of what we're seeing.

Yes, indeed, it's the same idiocy spouted by Kirby about mercury from Chinese factories. (I suppose that we should be grateful that he refrained from Kirby's crematoria gambit. Pile on top of that the usual toxic myth about vaccines, and it becomes apparent that to Olmsted, just like to antivaccinationists everywhere, it's always all about the vaccines.

The rest is a panoply of the usual tired old canards thrown out by antivaccinationists, including vacuous attacks on the Verstraeten study, confusing correlation with causation, Mady Hornig's "rain mouse" experiment, and various other antivaccinationist greatest hits. What really caught my eye was how one of Olmsted's stories morphed. In particular, I'm talking about the claim by Dr. Mayer Eisenstein, the medical director of the woo-friendly Homefirst medical group in Chicago that virtually none of his non-vaccinated patients had autism. Here's how Olmsted reported Dr. Eisenstein's claim two years ago:

But thousands of children cared for by Homefirst Health Services in metropolitan Chicago have at least two things in common with thousands of Amish children in rural Lancaster: They have never been vaccinated. And they don't have autism.

"We have a fairly large practice. We have about 30,000 or 35,000 children that we've taken care of over the years, and I don't think we have a single case of autism in children delivered by us who never received vaccines," said Dr. Mayer Eisenstein, Homefirst's medical director who founded the practice in 1973. Homefirst doctors have delivered more than 15,000 babies at home, and thousands of them have never been vaccinated.

The few autistic children Homefirst sees were vaccinated before their families became patients, Eisenstein said. "I can think of two or three autistic children who we've delivered their mother's next baby, and we aren't really totally taking care of that child -- they have special care needs. But they bring the younger children to us. I don't have a single case that I can think of that wasn't vaccinated."

And:

Eisenstein stresses his observations are not scientific. "The trouble is this is just anecdotal in a sense, because what if every autistic child goes somewhere else and (their family) never calls us or they moved out of state?"

Dr. Paul Schattauer, another Homefirst doctor, said at the time:

Schattauer seconded Eisenstein's observations. "All I know is in my practice I don't see autism. There is no striking 1-in-166," he said.

[...]

Schattauer, interviewed at the Rolling Meadows office, said his caseload is too limited to draw conclusions about a possible link between vaccines and autism. "With these numbers you'd have a hard time proving or disproving anything," he said. "You can only get a feeling about it.

"In no way would I be an advocate to stand up and say we need to look at vaccines, because I don't have the science to say that," Schattauer said. "But I don't think the science is there to say that it's not."

At the time, longtime readers may remember that I ripped this claim as anecdotal and utterly unscientific, nothing more than confirmation bias based on the memory of an antivaccinationist physician. Now, behold! In the little more than two years since then, Olmsted's characterization of Eisenstein's claim has grown. Now, it goes like this:

It drives the public health establishment absolutely bananas when the question of the autism rate in never-vaccinated American children is flung at them. By now they have their answers down pat: not enough never-vaccinated kids, too many anomalies in groups like the Amish with lower vaccination rates. The press mostly repeats this nonsense. But there are plenty of typical, never-vaccinated kids in America. Forget the Amish. Check out Homefirst Medical Services in Chicago where careful, computerized records show thousands of never-vaccinated kids, and almost no autism or asthma. I wrote about that more than two years ago, yet Homefirst's medical director says no one from the CDC, the NIH or the mainstream media has ever called to follow up.

Sometime in the two years since Olmsted's original report, his story about Homefirst has morphed from "I don't think we've ever had a case of autism in children not vaccinated" and "these are unscientific observations" to "careful, computerized records" showing no autism in the unvaccinated Homefirst patients (as he reported two years ago). Olmsted then goes on to cite Generation Rescue's incompetent and worthless telephone survey that it tries to represent as a legitimate "study."

It would be hilarious if so many people didn't take this nonsense seriously. Come to think of it, that's a perfect description of David Kirby's latest opus, an op-ed article entitled Give us some answers on vaccines that somehow managed to slime its way into the Atlanta Journal-Constitution. I'm not going to spend a lot of time on it, mainly because it largely rehashes the unctuous prose and pseudoscientific prestidigitations found in his recent Huffington Post articles that I dealt with recently, and I don't want to repeat all that again. However, that doesn't mean there isn't something new to take on.

First off, once again Kirby seems to revel in exposing court documents that are supposed to be sealed, as he did in the Hannah Poling case originally. One can't help but wonder who is feeding him these documents. The other thing that I can't help but shake my head at is the way Kirby seems to pull "facts" out of his nether regions without a shred of understanding or science, but first he can't help but bring home the stupid with this comment:

And there was more. The November document claimed that Hannah had a mitochondrial "disorder." But by February, this was modulated to a mere mitochondrial "dysfunction."

That's because Hannah's underlying condition was asymptomatic and most likely environmentally acquired. It was not some rare, grave, inherited disease that would have progressed to autism anyway, as many officials contend.

Dysfunction/disorder? Kirby's doing nothing more than semantics. Referring to a "dysfunction" does not necessarily imply a condition that is more or less serious than a "disorder." Indeed, "dysfunction" is part and parcel of a "disorder." Kirby's semantic ploy may impress people who don't know much about medicine, but I know enough call it for what it is: Bullshit. As for his claim that the mitochondrial dysfunction/disorder was environmentally caused, that too is almost certainly bullshit. Remember, Hannah Poling had a specific mutation in a specific mitochondrial gene. That isn't the sort of thing that is environmentally caused, at least not in all the mitochondria of all the cells in the body. As for her condition being asymptomatic, that too is nothing remarkable. Remember, mitochondrial diseases do not necessarily manifest themselves in infancy. In fact, one could argue that Hannah's recurrent bouts of otitis media and susceptibility to infection were early manifestations of her mitochondrial disorder.

But that level of malignant stupidity is not enough for Kirby. Oh, no. He has to top it:

But the real bombshell was this: Hannah's autism was caused by vaccine-induced fever and overstimulation of her immune system, according to court documents. Her low cellular energy and reduced metabolic reserves, due to mitochondrial dysfunction, were overstressed by the contents of nine vaccines (including mercury) at once.

Talk about spin! Of course, fever was probably the precipitating event! It may well have been fever due to a vaccine reaction. But fever from any cause could have done it. Recurrent bouts of otitis media, for example, stressed this girl's metabolic reserves. The government conceded the case probably because vaccines can cause fevers and fevers can precipitate a crisis in children with mitochondrial diseases. Given the temporal course of Hannah's deterioration, the possibility that this was a vaccine had to be considered. Morever, nothing in the government concession says anything about mercury in vaccines having anything to do with Hannah Poling's deterioration, and Kirby's rebranding autism again. Hannah had some symptoms of autism but not most, and she had multiple other problems as well. Finally, it's interesting to note that the original "hypothesis" for the Autism Omnibus, of which Hannah Poling's case was a part, was that mercury in vaccines administered before the MMR "weakened" the immune system, allowing measles to run wild in the gut. Now Kirby is saying that her immune system was "overstimulated"? But, then, antivaccinationists were never good at keeping their stories straight or presenting a consistent hypothesis. Vaccines suppress or "overstimulate" the immune system, apparently depending on whatever rationale is most convenient at the time for antivaccinationists to use to attack them.

Nauseatingly pious in pretending to concerned that the Hannah Poling case will "only drive people away from vaccines in anxiety-ridden droves" while neglecting to mention that his book and his regurgitation of antivaccination misinformation are contributing to that very anxiety, Kirby, all outraged, asks why we don't test for mitochondrial disorders before vaccinating. (Won't you think of the children?) He seems to think that there's a magical test out there for such disorders. There isn't. To be useful, a screening test has to meet certain criteria. I'm not going into the issue of false positives and negatives, although those are certainly important criteria for any mass screening program. What's more relevant to Kirby's blather is this: First, the condition must be common enough to be worth screening for. This is where there must be a balancing of cost versus benefit. Screening for rare diseases can be worth it if the cost of the test is small, as it is for phenlyketonuria, while even expensive screening can ultimately be prove to be cost-effective and worthwhile for conditions that are common (example: colonoscopy for colon cancer in people over age 50). Mitochondrial disorders are neither common (indeed, they are quite rare), nor are the tests for them easy and cheap. Hannah Poling's diagnosis, for example, took MRIs, karyotyping, metabolic tests, a muscle biopsy, and a full neurogenetics evaluation. Another important aspect to a screening test is that there must be an intervention that will cure or at least alleviate the condition detected. In the case of mitochondrial disorders, it's arguable whether this is true or not. Fever and infection can certainly precipitate a crisis. What's the most common cause of fever in children? Not vaccines. It's infection. Consequently it is considered important to vaccinate children with mitochondrial disorders, albeit with much more care to watch for reactions.

Finally, Kirby confuses correlation and causation once again, citing an incidence of mitochondrial disorders as high as 20% in autistic children, a claim I deconstructed before. (This time Kirby doesn't even bother to cite studies; it's almost as though he's given up trying to seem legitimate.) The brief version: We do not know if mitochondrial disorders are in any way a cause of autism or merely an epiphenomenon that appears more frequently with autism. Steve Novella explained this quite well. It's certainly worth studying oxidative abnormalities in autistic children further, but Kirby is putting the cart so far before the horse that it's in a different time zone.

Sadly, it's clear that antivaccinationists plan on milking the Hannah Poling case for all it's worth. I wish it were otherwise, but it isn't. I do, however, want to conclude with an quote by David Kirby that sums him and Olmsted up better than anything I can say:

Gerberding was either grossly misinformed, or lying.

Pot, kettle, black, Mr. Kirby. Pot, kettle, black.