August 11, 2005

THERE HAS TO BE SOMEONE TO BLAME:

Epidemic or illusion?: The autism epidemic that never was (Graham Lawton, 13 August 2005, New Scientist)

What could be causing so many children to lose their footing on a normal developmental trajectory and crash-land into the nightmare world of autism? The change has occurred too suddenly to be genetic in origin, which points to some environmental factor. But what? There is no shortage of suspects. In the UK, blame is often laid at the door of the combined measles, mumps and rubella (MMR) vaccine. In the US, mercury added to a range of childhood shots has been accused. Food allergies, viral infections, antibiotics and other prescription drugs have all been fingered, often by campaign groups run by mystified and angry parents. The problem is that none of these suggested causes has any solid scientific evidence to support it (see "The usual suspects").

Perhaps there's a simple explanation for this: there is no autism epidemic. On the face of it that sounds ridiculous - just look at the figures. But talk to almost any autism researcher and they will point to other explanations for the rise in numbers. Some say it's still an open question, but others are adamant that the autism epidemic is a complete myth. And if the most recent research is anything to go by, they could be right. Studies designed to track the supposedly increasing prevalence of autism are coming to the conclusion that, in actual fact, there is no increase at all. "There is no epidemic," says Brent Taylor, professor of community child health at University College London.

Autism is a developmental disorder sometimes noticeable from a few months of age but not usually diagnosed until a child is 3 or 4 years old. It is characterised by communication problems, difficulty in socialising and a lack of imagination (see "What is autism"). It is not a single disorder, but comes in many forms, which merge into other disorders and eventually into "normality". There is no biochemical or genetic test, so diagnosis has to be made by observing behaviour. Autistic children also often have other medical conditions, such as hyperactivity, Tourette's syndrome, anxiety and depression. The upshot is that "one person's autism is not another person's autism," says epidemiologist Jim Gurney of the University of Minnesota in Minneapolis.

In recognition of this ambiguity, autism is considered part of a continuum within a broader class of so-called "pervasive developmental disorders" (PDDs) - basically any serious abnormality in a child's development. Autism itself is divided into three categories: autistic disorder, Asperger's syndrome (sometimes called "high-functioning autism"), and pervasive developmental disorder-not otherwise specified (PDD-NOS), sometimes called mild or atypical autism. Together these three make up the autistic spectrum disorders.

Confused? You're not the only one. The difficulty of placing children with developmental problems on this spectrum has led to several major shifts in the way autism is diagnosed in the past 30 years. In the late 1970s, the autism label was kept for those with severe problems such as "gross language deficits" and "pervasive lack of responsiveness". But since 1980 the diagnostic criteria have been revised five times, including the addition of PDD-NOS in 1987 and Asperger's in 1994.

This massive broadening of the definition of autism, particularly at the milder end of the spectrum, is one of the main factors responsible for the rise in cases, says Eric Fombonne of McGill University in Montreal, Canada, a long-standing sceptic of the epidemic hypothesis. Tellingly, around three-quarters of all diagnoses of autism today are for Asperger's and PDD-NOS, both of which are much less severe than the autism of old. "There is no litmus test for who is autistic and who is not," says Tony Charman of the Institute of Child Health at University College London.

Changes in diagnostic criteria apart, there are other reasons to believe that autism is simply being diagnosed more often now than in the past. One is the "Rain Man effect" - the huge increase in the public awareness of autism following the 1988 film starring Dustin Hoffman. Awareness has also increased massively among healthcare workers. "Twenty years ago there were maybe 10 autism specialists in the country. Now there are over 2000," says Taylor.

Another factor is that one of the stigmas of autism has largely disappeared. Until about 10 years ago a prominent idea was that autism was caused by an unloving "refrigerator mother". Now it is a no-blame disease. "Parents are more willing to accept the label," says Taylor. One expert New Scientist spoke to went as far as to describe autism as "trendy".

Finally, while some parents still have to fight for help for their autistic children, far more services are now available.


Just because a disease is terrible and a families suffer tragically doesn't mean they shouldn't be challenged for making up facts.

Posted by Orrin Judd at August 11, 2005 6:03 PM
Comments

It's the floride, I tell you, the floride.

Posted by: David Cohen at August 11, 2005 6:55 PM

Not Fluoride, manganese. Or something else that junk science can get to a jury in a raid on a deep pocket.

Posted by: Lou Gots at August 12, 2005 12:57 AM

Hey, Lou, it must be Windows. The correlation is almost perfect and what else do we need. I go round up some experts and you start the paperwork for a lien on Gates' house.

Posted by: David Cohen at August 12, 2005 7:31 AM

It's the iPod halo effect, it's so strong that it streches out into the past.

Posted by: Dave at August 12, 2005 3:02 PM

I'm not buying the "there is no epidemic" story, at least not completely. And I know two close friends who both have "PDD" kids; I don't see much humor to mine here.

I know that when I was a kid (say, 1970) I hardly ever ran into any kids who were "PDD" or mildly handicapped or whatever other term one might use. At least, not nearly as often as one does today. Why is that? And that has nothing to do with expanding diagnoses, since I wasn't a doctor then, and I'm not one now. Where were all these kids, if the true rate of autism hasn't changed?

I still find the evidence of a possible connection to mercury poisoning (via various channels, not just vaccine) to be pretty compelling. And if that is indeed the case, and if recent changes designed to eliminate mercury exposure to the baby, such as the newer restrictions on pregnant moms eating tuna and the lack of thimerasol in all vaccines, lead to a much-decreased rate of PDD-related syndromes over the next 10 years, then I'm not sure what other conclusions one could draw.
An amazing coincidence, perhaps?

Posted by: Jeff Brokaw at August 12, 2005 6:13 PM

Jeff:

When I was a kid I was. You grow out of it.

Posted by: oj at August 12, 2005 7:56 PM

Jeff: Seriously, the alien abduction people present reasoned, well-supported arguments compared to the immunization-causes-autism people. Worse, the latter loonies might do real harm if enough people were to take them seriously and not have their kids immunized. Even if the theory were true, immuization would be a good deal, and the theory ain't true.

Actually, I doubt that reasoned argument is worth anything here, but the experiment you posit has been run. The Danes got rid of their themerisol in 1992 and have seen no change in their incidence of autism. None. Zip. Zero. Nada. It's not the themerisol. There has been no explosion of new cases, there have simply been new and newly relaxed diagnoses included in the DSM.

Posted by: David Cohen at August 13, 2005 12:57 AM

Same with ADD and "dyslexia"--it's all about making sure parents, teachers, etc., can assign blame.

Posted by: at August 13, 2005 8:16 AM

David -

Thanks for the info. I've heard of the Dane thing before, and it is interesting, but not having reviewed it in detail, I can't really comment on it. And it doesn't disprove that mercury in general, not just thimerasol, might be a major factor. I'm not looking for an argument via this blog -- few things are more tedious -- but I am stunned by your rather cavalier dismissal of some pretty compelling evidence on neurotoxins.

Let's ground ourselves in some facts:
Mercury is a neurotoxin. Babies under 1 year old have weak immune systems. Introducing any type of toxin into a person is a health risk. Introducing the same level of toxins into a person with a weakened immune system is an even bigger health risk. The symptoms of PDD-related syndromes are exactly the same as mercury poisoning. There is not now, nor has there ever been, a known safe level of ethyl mercury consumption (in thimerasol). Different people can tolerate different levels of "bad stuff" like toxins.

So let's stipulate there are an awful lot of well-known contradicting facts surrounding the idea that any vaccine containing any form of mercury could possibly be 100% harmless.

Yet you throw all this aside based on a few studies sanctioned by, and vindicating, those who would be most liable -- in the U.S., the FDA, AMA, vaccine producers, and even individual doctors? Liable for BILLIONS of dollars? How convenient for them.

Sounds like "fox guarding henhouse" to me. YMMV.

From the FDA's own thimerasol site:
"However, depending on the vaccine formulations used and the weight of the infant, some infants could have been exposed to cumulative levels of mercury during the first six months of life that exceeded EPA recommended guidelines for safe intake of methylmercury."

And "Lacking definitive data on the comparative toxicities of ethyl- versus methylmercury, FDA considered ethyl- and methyl-mercury as equivalent in its risk evaluation." This is science?

Also from that same FDA page, the 2004 commission investigated the "... hypothesis that vaccines, specifically the MMR vaccines and thimerosal containing vaccines, are causally associated with autism". I haven't read that whole study, but as stated, this doesn't test for the possibility that overall mercury exposure, of which thimerasol would just be a fraction, causes autism and PDD-related disorders.

Also, from the section entitled "Guidelines on Exposure to Organomercurials" on that same page, you'll find info like:
"fetuses were found to be more sensitive to the effects of methylmercury than adults"
and
"Sensory and motor neurologic dysfunction and developmental delays were observed among some children who were exposed in utero to lower levels of methylmercury." Those symptoms match pretty well with PDD-related disorders.

And let's not forget about all the recent troubles with FDA-approved drugs being yanked from the market lately, and the controversy when that senior scientist (forget the name) quit over safety concerns a few months ago. It's a bureaucracy; why would I trust it to watch over my family's health?

Does all of this prove that mercury is at fault? No. It does, however, establish a certain level of suspicion that must be overcome by something more than a few studies, studies designed only to exonerate thimerasol itself, not to address the general problem of mercury.

Posted by: Jeff Brokaw at August 13, 2005 3:10 PM

David and Jeff,

The Danish study turns out to be a terrible study when you look at it.

I posted a piece in response to supportvaccination.org on my site today that describes the fatal flaws in the Denmark studies and another study that the IOM and CDC use to exonerate thimerosal from contributing to neurodevelopmental disorders.

http://tinyurl.com/c723q

I would love it if you would take a look at it.

My evaluation of the studies does not prove that vaccines cause autism. It does show that the studies that most people rely upon to prove that thimerosal does not have any relationship autism, don’t do anything of the kind.

Ginger Taylor, M.S.


Posted by: Ginger Taylor at August 13, 2005 4:23 PM

Ms. Taylor:

There is no link between autism and themerisol and the claim that there is threatens harm to many more children and adults than any possible link. On your site, you note that: Therefore, parents like me have assumed that there probably is some sort of epidemiological link, and moved on with out them. As a therapist, you might want to consider how you would respond to a client who, with no evidence, became obsessed with that some third-party was responsible for all the bad things in her life.

David Cohen, AB, JD.

Posted by: David Cohen at August 14, 2005 2:37 PM

Here we go ... this is the problem. People who will now due to this foolish article will down play the true problem that exist. This article in my mind is worthless. Just another, how we can sweep away the issue under a rug.

I have a son with autism. Prior to my son reaching to the age of 3 years old, I had not a single clue of what autism was. We took him to 2 pediatricians, both of whom said he was fine and that my son was a late bloomer. The same crap I got from family members stating ... "don't worry, boys take longer to talk than girls".

Not until I saw, a news program concerning the rise in Autism and they listed the symptoms (most of which he matched).

- Him being non-verbal, the spinning, banging his head on the wall, the appearance of almost being deaf (due to unresponsiveness), the arm flapping, the lining up of toys in a straight line over and over again, the no making eye contact, and the list goes on.

As clear as day, it hit me what my son had. I was like a double edge sword. It was great that I now know what he has (I can now give it a name and others would understand) but it truly sucks that he has it. My wife was in denial. I don't blame her, who would want to know that their child has a mental defect (and that what it truly is).

I have read almost every article I can find on the subject. I am part of many different groups on the subject. All in hope that I can find a cure for my son.

But when, I see articles like this, it makes me angry. Trying to brush off or lightly coat this problem. After, I learned what the Autism spectrum was, I would spot an autistic child and even adults a mile away.

I know of at least 3 families, who due to contact via my children's school or my work, have autistic children. But they are in denial and don't want to take action. And now because of articles like this, they probably won't.

Sadly, no one has the cure or answer to what causes autism. This BS about, well in the UK from this time period compared to another time period there was no rise. That's just hogwash. Can someone explain to me why is it that based on some articles there are very few people with autism in the Amish community (here's the link http://washingtontimes.com/upi-breaking/20050508-112601-3643r.htm )?

Ok, maybe you want to say ... well the Autism of today is not the same as of yesterday. Fine. But don't tell me that there isn't still a problem. And it's no just called Autism; it's called the autism spectrum disorder. Which means that a person can fall within a spectrum of this disorder. Some have it more severe than others. Thank God, my child is on the high functional end, meaning that he has it mildly. But nonetheless, he is autistic and has mental problems.

I would give my right arm (seriously) to have my son not have this. He's a great kid. But it hurts that as much love and affection that I have for him, he just gives me blank stares. I am accepting of him and all that he does, but I know society would rather ridicule and brush him aside.

For all those naysayers who claim that this is not an epidemic and a true problem. I would hope that you bear a child with autism (since it's not a problem) so that you can walk in my shoes. I'm willing to bet that the author of this article doesn't even have an autistic child.

Posted by: ignorance is bliss at August 17, 2005 10:08 AM

ignorance:

That's a lovely sentiment, but what's it have to do with vaccinations, an imaginary epidemic or over-diagnosis?

Posted by: oj at August 17, 2005 10:37 AM

I can only say how much I wish it was true that Autism isn't on the rise. I know a few people (myself included) that have children on the spectrum. I also don't remember anyone like my son when I was growing up. No one in my school. None of my friends siblings.

I do not know what the cause is. Searching for an answer "why" isn't my focus. I want help for him. I had hoped to find it here.

Right now he is in special preschool through our local school district. He receives speech and occupational theropy. According to everyone who works with him they tell me he is doing absoluty wonderful. It is hard for me to tell.

I don't know what to expect or what the next years hold. I do want him to live the best life that he possibly can. And I want everyone to truly understand that children on the autism spectum are amazing.

I am fortunate that my son is very loving. He loves to laugh and smile. He does seek out companionship. At this point he has a diagonsis of mild pdd-nos. Even still as a parent it is completely heartbreaking.

Posted by: concerned mom at August 30, 2005 5:48 PM
« EVERYBODY LOVES THE CIRCUS...: | Main | TOO BAD THE HAPPY MEAL DOESN'T COME WITH WILL POWER: »