Antivaccination rhetoric running rampant on the Huffington Post
So far, I'm not impressed.
Indeed, during its 16 days of existence, Huffington's group blog appears to have already become a repository for anti-vaccination propaganda based on the usual pseudoscientific and fallacious arguments that most antivaccination zealots use. (Tip o' the hat to "chaperonin60," who pointed this out to me.) I've already counted at least five posts "questioning" the efficacy of vaccination or postulating a (probably nonexistent) link between thimerosal in vaccines and autism. They come from three writers. First, there is an article by Janet Grilo, an autism advocate on the Cure Autism Now advocacy group. It's hard to criticize this article that much, because Ms. Grilo is the mother of a child with autism. However, her article blames her son's condition on thimerosal-containing vaccines and mentions "studies" that supposedly prove a link (without actually directly citing any of the studies). As much as I sympathize with parents of autistic children, I also realize that their desperation to do anything to help their child can make them prone to believe all sorts of questionable science and quackery that offer them a cause for their child's plight and a hope that the child might get better. Indeed, autism is one of the most common diseases that quacks prey on, mainly because it has no effective treatment and is so devastating to the child and family. Quacks will offer all sorts of ineffective treatments, particularly chelation therapy (and here), bilking the parents for sometimes as much as hundreds of thousands of dollars. The Institute of Medicine has examined the evidence and affirmed the safety of vaccinations twice, in 2001 and 2004, but that doesn't deter the quacks pushing chelation therapy for autism. Indeed, it feeds their conspiracy mongering, allowing them to claim that the government is prematurely trying to "dismiss" or "suppress" the "real story," and that is to the harm of children with autism and their parents.
Next up in the queue are two articles (and here) by David Kirby, the author of Evidence of Harm. The first one is brief and more or less a plug for a movie, plus a bunch of "questions." The second one is a rant against the CDC, which Kirby accuses of withholding data. He also makes dark unsubstantiated accusations that the CDC covered up data showing a link, approvingly referring to a study by Dr. Mark Geier and David Geier that purports to have found a link between thimerosal and autism using the CDC's own data set. I'm not sure which study he is referring to, but I'm guessing that it is a 2003 study that was rife with methodological errors and inadequate description of statistical methods. Kirby also neglects to mention that Dr. Geier has been a consultant and expert witness in many cases presented to the National Vaccine Injury Compensation Program and that he has also been deemed unqualified to be an expert witness in several cases. David A. Geier, his son, is president of MedCon, a medical–legal consulting firm that helps vaccine injury claimants to obtain money from both the National Vaccine Injury Compensation Program and through civil litigation. Kirby also neglects to mention that, in their zeal to find a link between thimerosal and autism, the Geiers have engaged in data collection irregularities, drawing a rebuke from the CDC and suspension of Dr. Geier's IRB approval from Kaiser-Permanente. Odd that Kirby didn't mention this. Perhaps he thinks this is all part of a nefarious plot by the CDC to discredit the Geiers. Or perhaps he doesn't see anything the least bit questionable about the Geiers' data collection irregularities or their clear conflict of interest in making their livings consulting for and representing parents bringing litigation against the NVICP and thus sees no reason to mention it. Who knows? Of course, anti-vaxers frequently dismiss studies that fail to find a link between mercury in vaccines and autism by pointing out when the investigators have ties to industry. In contrast, they seem blithely unconcerned when two of the leading advocates of a link happen to make their living off of parents trying to get compensation from the NVICP, which is the only reason I mention the Geiers' activities in the legal realm. What's good for the goose is good for the gander.
Personally, though, I'd prefer to get back to the data. Consequently, I'd ask Kirby a few questions of my own, based on known evidence: First, if thimerosal is indeed the cause of the increase in the incidence of autism observed over the last 25 years, as he clearly seems to believe, then why is it that autism rates are still rising, even though thimerosal has been removed from virtually all early childhood vaccines, as shown by a Danish study (also here)? Remember, this is years after thimerosal was ordered removed from childhood vaccines in Denmark in 1992 (vaccines were completely free of thimerosal in that country by 1995)? Similar observations have been reported in California (and here), although there are those who point out that earlier diagnosis of and expanded diagnosis criteria for autism accounts for the majority of the increase. In this country, thimerosal was removed from most vaccines in 2000 and none of the required early childhood vaccines have had thimerosal in them since 2002-2003. Few children under four have received a thimerosal-containing vaccine, and even those that did have received far less thimerosal than older children. However, even correcting for better diagnosis and the broadening of diagnostic criteria (which have definitely contributed the lion's share to increase in the apparent number of new cases of autism), autism rates are probably still rising, just not nearly at the rate that the anti-vaxers claim. In any case, if mercury in vaccines really does act as some sort of environmental "trigger" for autism, wouldn't we expect rates to have started to fall precipitously by now (particularly in Denmark, where it's been 10 years since there was thimerosal in any of its vaccines) or at least leveled off, given the usual age range children show the first symptoms? Second, I'd ask him if, as he seems to believe, a major part of the pathogenesis of autism is mercury from vaccines, then why is it that autistic children do not demonstrate the known symptoms of mercury toxicity, which include visual disturbances, unsteady gait, slurred speech, and numbness in the digits? Third, why is it that no increase in the blood level of mercury to above safe levels is observed in infants who have received thimerosal-containing vaccines and that much of the mercury is rapidly eliminated in the feces? Finally, why is it that there is no correlation between the dose of mercury received and the incidence and/or severity of autism observed? All of these are pretty significant pieces of data casting doubt on a mercury-autism link.
Unfortunately, the most disappointing two articles of the bunch come from a physician, Dr. Jay Gordon, who posted the first anti-vaccination article a week ago under the title Parents' Right to Choose and then followed it up with another piece entitled Vaccines and Autism: Answers. Although he is clearly not a full-fledged anti-vaxer, Dr. Gordon's website suggests that he is bordering on being altie and maybe even an HIV/AIDS denialist, given that he seems to buy at least partially into the idea that anti-HIV drugs contribute to AIDS and lists a number of "alternative" methods to "strengthen the immune system" (a favorite altie all-purpose "treatment strategy") of AIDS patients. I'll give him some credit that at least he does give his patients most of the recommended vaccines, but in many places in his website he expresses "skepticism" over the safety of vaccines and emphasizes again and again how few cases of the diseases being vaccinated against there are (forgetting, perhaps, the concept of herd immunity and how mobile people throughout the world have become). Unfortunately, though, even though he claims to "rebut" antivaccination activists, he seems to buy at least partially into a standard anti-vaccination line that the mercury in the thimerosal preservative of some vaccines causes autism:
Very few experts agree with the only partially proven hypothesis that vaccines have contributed to the huge increase in autism and related disorders. Vaccines remain a public health triumph but still worry many parents. They worry me, too.
The “triggers” to this huge increase (from 1 case/5000 in 1980 to 1/166 in 2005) undoubtedly include mercury. Mercury from vaccines is a very likely culprit and the most recent studies support this. Conflicting analyses do exist. Most of the doctors and researchers involved in denying that vaccines cause autism are recipients of large sums -— millions of dollars in some cases -— from the vaccine industry.
Dr. Gordon, I had hoped you wouldn't invoke the usual conspiracy theory mongering that anti-vaxers love. I really had, as your website, flaky as some of its contents are, is fairly unremarkable in its medical advice about other areas and downright reasonable in comparison to many of the loony anti-vaxer websites I have had the misfortune of encountering. However, when I see someone so quick to intimate that those who disagree with their beliefs are, in essence, shills for some corporation or other, I know I'm reading someone who is probably well along the path to the Dark Side, even if he has not yet arrived there. To such people, anyone who questions their assertions regarding vaccines must be in the pocket of the pharmaceutical industry. There can be no other explanation. Surely they couldn't have come to their conclusions through science and their own research, at least not according to alties. Other than well-documented examples like the Geiers, I don't automatically assume that researchers who believe there is a link between thimerosal and autism have a financial interest in finding out that there is such a link, and I try hard to evaluate each study on its own merits. (I may or may not succeed, but I try.)
Worse, through the link in his article, Dr. Gordon invokes Professor Boyd Haley, Chairman of the Department of Chemistry at the University of Kentucky, who has become the darling of the anti-vaccination movement and has even gone so far as to refer to autism and ADHD as "mad child disease." This insensitive remark provoked a petition demanding an apology, which Dr. Haley has refused to do, claiming he had said "M.A.D. child" disease (for Mercury-Acquired Disease of children--an extremely insensitive and tasteless acronym even if you take Dr. Boyd at his word that the acronym was the meaning that he had originally intended when he made the statement). He is also an advocate for dental amalgam removal, a favorite altie stalking horse for practically every chronic disease humans suffer from, particularly fibromyalgia and autoimmune diseases. Indeed, he is Chair of the Advisory Committee for Toxic Teeth, an anti-amalgam group. Even worse, an educated layperson has been able to show many of the fallacies of Dr. Haley's claims, particularly the oft-repeated anti-vax claim that vaccines contain 50-100 times the FDA safe dose of mercury. Well, that's not exactly true; older vaccines contained 50-100 times the FDA safe dose for one day (originally developed as a guideline for eating fish, which may contain mercury). As the study I mentioned above shows, even that dose of mercury in vaccines does not raise blood levels above levels considered safe.
The bottom line is that the evidence purporting to show a link between thimerosal and is weak at best to nonexistent at worst. Does that mean a link definitely doesn't exist? No. However, the observation that autism rates are still rising despite the reduction and elimination of thimerosal as a preservative in childhood vaccination is pretty strong epidemiological evidence that there is probably no link or, if such a link exists, it is probably very, very weak. In fact, the only thing I agree with Dr. Gordon on is that in the next few years, as more and more of the present generation of preschoolers who have never received thimerosal-containing vaccinations reach and pass the age range where autism is most frequently diagnosed, doctors and scientists will "break" this case. However, based on the experience in Denmark, I consider it highly unlikely that they will come to the conclusions that Dr. Gordon apparently thinks they will. (In a way, though, I sometimes actually think it would be great if such a neat link were discovered, because then we could anticipate that the rate of diagnosis of new cases of autism will fall precipitously over the next few years. Given the devastation that autism causes to children and their parents and the cost of taking care of these children, who wouldn't want that?)
In reality, though, even if autism rates do continue to rise and further research does continue to fail to demonstrate an epidemiological or biological link between the thimerosal in vaccines and autism, that still probably won't stop anti-vaxers from continuing to blame vaccines for autism. Like Ahab, they've identified their whale and will pursue it to the end, no matter what. Most likely, their explanation for a supposed link between vaccines and autism will simply shift to another area. For example, they still blame MMR vaccines for autism, even though MMR does not and never has contained thimerosal and there is no link other than a discredited study which the majority of authors have now renounced. I'm guessing they'll find other creative ways to blame vaccines for autism. No doubt we'll see articles on the Huffington Post about that, too, when it happens.
ADDENDUM: Earlier today, the Huffington Post printed a rebuttal to David Kirby's and Dr. Jay Gordon's earlier posts by Dr. Marc Strasburg, an adjunct Professor of Epidemiology at UCLA. It's about time. Let's see, five anti-vax posts, and one short rebuttal. Oh well, at least they let someone post something. Now just wait for a flurry of posts attacking Dr. Strasburg's article. Just wait. I hope I'm wrong, but I predict it's coming.
ADDENDUM #2: Apparently more recent posts on the Huffington Post now allow comments.