February 9, 2009

Autism and The MMR Vaccine

Just as I was writing about the consequences of ideological bias in autism research...

Mea culpa, I will admit that I never read the primary sources either.  If I had, this blog would not exist, I would have quit psychiatry in 1998 and opened a bar called Cougars and made a fortune.


In case you do not have kids or ears, there's a controversy about whether the combination measles-mumps-rubella vaccine causes autism.  The controversy arose from the observation that previously normal kids began to regress soon after receiving the vaccine.

If you had only a rudimentary understanding of the facts (e.g. most doctors, including me) and were trying to create an explanation, you would have intuited that it is either the virus in the vaccine, or perhaps you would have recalled the word  "thimerosal," a mercury containing preservative in vaccines, which has also been linked to autism.

And you would have left it at that; on the one hand is the association, on the other hand is "the published literature" (or what you heard is the published literature) saying there is "no  evidence of a causal link."  (Well of course, they have to say that.)

And then approaches the peon with the autistic child, who, recognizing the limitations on medical science doesn't expect you to have a solution, but is hoping at least for a legitimate explanation.  Your reply to this peon, who dares to ask a Medical Professional (expecting an insider's view of the data and an educated opinion, and not expecting you to simply make stuff up based on what you heard on CNN) is: "there've been some reports, but we simply don't know enough to blame the vaccine outright."

At this point, three things should have happened:

1.  You should have wondered if  "there've" is really a word, or if you just made it up. Maybe you just threw two words together that sounded like they fit?  That's a metaphor for everything else you said.

2. You should have realized that you don't actually know if it is the MMR vaccine, or vaccines in general, that are the alleged cause of autism; and that you aren't even sure if there was/is any thimerosal in the MMR vaccine to begin with.

3. Your ignorance of contractions and medical information did not prevent you from spewing vague crap to your wide-eyed inquisitor; nor did it prevent them from believing you.

II.

It won't be giving anything away to tell you that the evidence for the link is absolutely laughable.  But take a step back and look at the controversy itself.  "Is it vaccines?" ---No, it isn't.  ---Yes it is.  ---No it isn't.  The controversy is so powerful not because it's about vaccines, but because engaging in the controversy serves a more important function: the reinforcement of an ideological bias: "we don't have definitive evidence that the culprit is the MMR vaccine-- it looks like it is, but it may be something else.  But definitely it is something that happens after birth."

III.

The controversy exploded with the publication of a single paper, Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.  The title is not one that would be expected to herald a 10 year ideological war, but there you go. 

First: the title of the paper that launched a million other papers, you'll observe, does not contain the following words: vaccine, thimerosal, MMR, combination.  We'll get back to this.

The actual evidence is this case series of 12 kids who developed autistic features shortly after receiving the MMR vaccine.  The entire basis for the link is this single sentence:

In eight children, the onset of behavioural problems had been linked, either by the parents or by the child's physician, with measles, mumps, and rubella vaccination.
That's it.  If you're looking for something more solid than "parents or the child's physician"  linking the two together, you're going to be disappointed.

You'd think that wouldn't be enough to merit a publication in Lancet, let alone a controversy.  Let alone a substantial decrease in vaccination rates.

However, the focus on this extra, tertiary observation masked the real point of the paper, which was observing a relationship between-- read the title-- bowel inflammation and autism.

Get it?

No?  Then it worked.  You're not supposed to focus on it-- it's supposed to become unconscious.

Still confused?

Bowel inflammation is not natural; in other words,

Both the presence of intestinal inflammation and absence of detectable neurological abnormality in our children are consistent with an exogenous influence upon cerebral function.

That something could be anything, and the bowel involvement suggests maybe it's something you eat-- indeed, the authors suggest  the possibility that it is certain foods (grains), casein from dairy, B12 deficiency.

They also list the other exogenous possibilities, including viruses.  And then there's the vaccine.

But what's important here is the understanding that the inflammation means it's exogenous.  What's important is that the belief that it is exogenous become axiomatic.

III.

"But wait, couldn't bowel inflammation simply be another sign of autism, not the cause?  Couldn't the, say, genetic cause of autism also cause coincident bowel inflammation?"

Of course, but as long as the controversy is about the vaccine as cause, then it isn't about bowel inflammation as cause; and as long as we are not arguing about whether the bowel infammation is the cause, then we are certainly not arguing about whether something exogenous is the cause.  We are quite likely to simply internalize the something- exogenous- as- cause link.

"You're kidding, right?  You think people are that stupid to fall for that?"

IV.

So what do we do?  Well, it was one popular recommendation that if the vaccines must be given, they be given separately, not as the combined MMR.  This recommendation came right from the lead author, Dr. Wakefield, in a press conference after the study's publication.

It's sleight of hand; blink you missed it.  He took it up a step; the controversy has now become whether the combined vaccine is the cause, not whether a vaccine is the cause--  despite none of this appearing anywehere in the study.  Wakefield made this the controversy, out of thin air.  And everyone fell for it.

"What do you mean? Not everyone believed it."  That's not the point, right?  The point is to make the MMR the focus, allowing an exogenous case to become our default understanding.

It is so infective, this bias, this groupthink, that the highlighted CDC recommendations about the vaccine which are supposed to allay fears reads:

  • The MMR vaccine protects against dangerous, even deadly, diseases.

  • The most common adverse events following the MMR vaccine are pain where the vaccine is given, fever, a mild rash, and swollen glands in the cheeks or neck.

  • No published scientific evidence shows any benefit in separating the combination MMR vaccine into three individual shots.


V.

"Surely the Lancet tried to do something about this?"

Ha! Don't be ridiculous.  They were far too busy studying social justice and peer reviewing    "America 2004: voting for a decent global society."  I'll spare you the read: vote Kerry.

Ok, that's not entirely fair on my part.  In fact, the Lancet and other medical groups/journals/individuals were highly critical of the paper.  Not critical of the results, but rather of the fact that Wakefield didn't disclose he had been previously retained as an expert in a lawsuit against the MMR manufacturer.

Before you jump onto that wagon, ask yourself: is that the single piece of missing information that would have revealed this study to be silly?  Knowing that would have made them reject the paper?   Is not knowing he was connected to lawyers the reason the entire planet missed the lack of connection between his verbal statement "separate the three vaccines" and his own study to which he was referring?

Is money the only red flag for these idiots?

VI.

If I had to come up with a punch line for all this, I couldn't do better than this:

According to the February 8, 2009 edition of a newspaper that is not written by or for doctors, Wakefield made up his findings.

However, our investigation, confirmed by evidence presented to the General Medical Council (GMC), reveals that: In most of the 12 cases, the children's ailments as described in The Lancet were different from their hospital and GP records. Although the research paper claimed that problems came on within days of the jab, in only one case did medical records suggest this was true, and in many of the cases medical concerns had been raised before the children were vaccinated. Hospital pathologists, looking for inflammatory bowel disease, reported in the majority of cases that the gut was normal. This was then reviewed and the Lancet paper showed them as abnormal.  

This would be a good place to ask the basic questions, such as

  • why the Lancet and all journals peer-review manuscripts, but never ask to see the original data itself;
  • why they allow the public to assume that the journal does scrutinize the original data;
  • why original data is not public information anyway;
  • why three idiots and an editor were not able to predict how a study would be used, and ask for the appropriate modifications;
  • why the presence of "financial conflict of interest" is the only critical test of bias, such that its mere absence earns it the imprimatur of truth.  This does not apply to NIH money, of course, which is is free of moral influence: Nihil obstat.





Comments

לכל איש ישראל אחד צדיק ואחד... (Below threshold)

February 9, 2009 5:15 PM | Posted by Diana: | Reply

לכל איש ישראל אחד צדיק ואחד רשע יש שתי נשמות

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I'm genuinely confused abou... (Below threshold)

February 9, 2009 8:20 PM | Posted by Aaron Dvaies: | Reply

I'm genuinely confused about one thing in this series: are you ascribing any particular motivation to the assumption that autism is caused by environmental, not genetic, factors? The terms you use to discuss the bias are those generally associated with an ideological bias, but I haven't seen any reference to one in this case.

If not, how did it happen that the bias arose in this direction? We see spurious claims of genetic bases for all sorts of things. Had a random paper on correlation of some genetic marker with autistic traits been published fifteen years ago and caught on, would the entire scientific establishment now assume it's all genetic?

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In my experience the abilit... (Below threshold)

February 9, 2009 8:49 PM | Posted, in reply to Aaron Dvaies's comment, by Fargo: | Reply

In my experience the ability of the human animal to latch onto some meme like it's a life preserver, then cling to it despite having long since made it to shore, doesn't require much motivation. I make an effort to avoid it and still I sometimes find myself falling into it.

That said, if your child is autistic and someone happens to blurt out some half-baked idea about a potential cause, that's bound to aggravate the response. You start to think in absolutes, have dreams of preventing it from ever happening again, and it's really all downhill from there. I think the key here, of it being glommed onto so fiercely, is that it's something you can do something about. Genetics? That would require tests, not rutting, lord knows what else, and would more prevent the child with the condition than the condition. Don't get vaccinated? Hot damn, more time to watch QFC.

Kind of like saying "TV makes your kids stupid". There doesn't have to be evidence, there just has to be a kid that's doing so hot in school watching television. Bam, a bunch of parents are convinced. Of course, that whole argument backslid because parents tend to be just as lazy after reproducing as they were before, so it becomes not TV as a whole, just certain kinds of TV. Certainly playing that Blues Clues tape 108 times a day is helping, yes?

I'm putting it out there right now; Blues Clues causes autism. It's the interaction between the particular shade of blue pulsing at 60Hz changing certain neural pathways.

That's all just my take on this sort of thing, and I'm bitter, cynical, lonely human being. Just figured I should put that out there in the interest of disclosure. Also, it's all lies that the people behind Barney The Dinosaur paid me to revamp their branding.

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nice post - but some gramma... (Below threshold)

February 9, 2009 9:40 PM | Posted by Anonymous: | Reply

nice post - but some grammar typos makes it less than it could be.

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Ya know LP I have a love/ha... (Below threshold)

February 10, 2009 4:29 AM | Posted by ItsTheWooo: | Reply

Ya know LP I have a love/hate relationship with yer blog. On one hand I appreciate and enjoy your cynical thoughtful commentary about humanity and society. On the other hand I grow tired of these teaser posts where your headline makes the reader think they might be privy to some new interesting information (or an analysis of the information) about autism and MMR (or anything for that matter) and then whoops the content of the post has absolutely nothing to do with it. I am perpetually frustrated and yet I can't stop reading.

I for one believe autism is a genetic predisposition which is triggered prenatally by exposure to certain endogenous toxins, particularly opioid peptides (e.g. casein and gluten). I cannot help but notice that the incidence of personalities with numerous autistic features, and even clinical disorders/illnesses in the autistic spectrum seems much higher in people with noted gluten intolerance/allergy. I'm not talking bullshit 70's style faddy food intolerance either, I'm talking about people who have severe immune system freakouts when they eat it... people who have already ruined their thyroid glands, guts, skeleton, or who have horrid asthma attacks or something of that nature as a result of the immune system screwery.

Even if gluten and casein allergy is not ubiquitous, I do think that the immune system is involved in all cases of autism.

It's definitely programmed prenatal. It's simply triggered during development when the brain connects and organizes itself and whoops look at that, the dough is off and fails to rise properly. Ironically today I was reading about how clinodactyly is found in children with autism as well as more obviously genetic/prenatal disorders like downs and fetal alcohol syndrome (in clinodactyly the second finger bone of the pinky finger being wedged shaped making the pinky short and curved inward toward the fourth). I think if you examined a child with autism you would discover numerous anatomical boo boos indicating something was amiss before he was born.

I find it interesting this is a finding in autism as I consider myself to have an abnormal excessive amount of autistic traits. I've always thought my brain is simply incapable of the normal social tasks and is drawn toward pointless rote hobbies and obsessions just like an autistic. It is definitely not entirely learned, even as a very small child I would play with my building blocks and ignore my parents cues to smile and interact with them. Additionally I've always fussed about my short pinky finger that curves toward my fourth finger... I knew it looked weird, but I never knew it was an indication of some kind of prenatal screwery.

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And here's another camp: ou... (Below threshold)

February 10, 2009 8:20 AM | Posted by Joeymom: | Reply

And here's another camp: our son was born with autism. No "external environmental trigger" needed. Casein and gluten free diets did nothing for our child. That's right: NOTHING. He was autistic before he was vaccinated. None of his vaccines had thimerasol, anyway. He was not sick a single day until he was two and a half: when we sent him to school because he was a non-verbal, "moderately" autistic child who needed intervention in order to learn. In fact, every theory of "cause" that has been tossed at us, our child has been the exception, a case to disprove the rule. It's become something of a joke around here.

The whole MMR "controversy" has been a fascinating train wreck- you just can't pry your eyes away from it, even though you know it's a bunch of make-up idiocy. Famous names and faces get pulled in, transform it to their own money-making machine, and plow on. Local families, desperate for answers, get drawn into spending thousands of dollars on therapies and treatments they claim to work- even though the only difference I see in their children is a natural growing up process (and often still slower than the usual rate), if there is any progress at all. What have we seen work? Speech therapy. Occupational therapy with sensory integration therapies. Physical therapies in children with gross motor issues. All the rest of it seems to be very expensive woo. Speech, OT, and PT are expensive enough, and often not covered by insurance because they are "educational" instead of "medical" interventions.

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Let me say right off the ba... (Below threshold)

February 10, 2009 9:25 AM | Posted, in reply to Joeymom's comment, by Anonymous: | Reply

Let me say right off the bat that I don't think vaccines cause autism.

But Joeymom, you say: "He was autistic before he was vaccinated." And then say "He was not sick a single day until he was two and a half"

So you didn't have your son vaccinated until he was 2.5 years old?

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I don't know why anyone wou... (Below threshold)

February 10, 2009 6:51 PM | Posted by Anonymous: | Reply

I don't know why anyone would choose "Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children." when they had the chance to open a fine establishment called Cougars, but I do know that I'll never be able to fully enjoy ladies night at Blind Willy's now that I know there's a Cougar sized void in the world.

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Autism or schizophrenia, th... (Below threshold)

February 12, 2009 10:18 PM | Posted by Sally: | Reply

Autism or schizophrenia, the problem is that these "conditions" are vague and undiagnosable, and as your mention of the placenta study hints, possibly, descriptions of symptoms caused by viruses and we humans don't even understand yet what viruses are or the duration of a viral problem. The common cold keeps some people home sneezing for a day or two and kills others and it's a virus.

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I think this post isn't rea... (Below threshold)

February 16, 2009 2:12 PM | Posted by SusanC: | Reply

I think this post isn't really about autism.

At the end of the whole MMR-and-autism fiasco, we weren't much wiser about what causes autism than we were at the start. (Well, except that out of a zillion random things in the universe you could pick on, MMR doesn't look very likely).

But it was a very instructive case study in the dynamics of a media scare story, which might well have lessons for for other media scare stories, about other things.

Now I think autism research is pretty important, but there's a whole other thread of psychological research on media panics, which is pretty cool. You can do things like build epidemiological models (of the spread of the scare story itself, not the condition the story is about, which doesn't even need to exist). You can propose evo-psych theories that we're evolved to fall for some kinds of scare stories and not others. (e.g. shark attacks are good for a news story, regardless of the actual liklihood of you being killed by a shark. The evo-psych version goes that we're predisposed to worry about large animals with big teeth. Compare the use of chainsaws in horror films).

For the anthropological version, see Mary Douglas's "Purity and Danger" and "Risk and Culture". Douglas starts with the example of the Hima people, who believe that cattle diseases are caused by contact with women. Once you've bought into the idea that this is not because this is what really causes cattle disease, you can move on to examples closer to home.

For more recent work, see, for example, Frank Furedi.

I take Alone's point that this is not just about researchers with a financial conflict of interest. There are some scare stories that just wouldn't take off, no matter how much you bribed some researcher to publish them.

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