Little over a year ago, when Wampum was just a wee blog, a still unknown member of Congress in the dead of night secretly attached an amendment to the Homeland Security Bill due to be brought to the House and Senate floors in the closing hour of the 104th Congress. The addition, with included language identical to that which Senator Bill Frist twice failed to even get out of the HHS committee, slipped by nearly undetected in the House, where only a few legislators realized the gravity of the situation before the bill passed by a healthy margin. By the time the Senate took up the bill, the alarms were raised, and while phone calls, faxes and letters poured into Senators offices and the blogosphere, including right here, rallied to the call, the debate spread to the floors of the chamber, with Democratic Senator after Senator calling for the body to protect the rights of the most vulnerable in our society, children potentially injured by the addition of neurotoxic mercury to vaccines. [nota bene: For those who assert that Washington Democrats don't have the backbone to stand up to Bush and the neocons, I offer the CSPAN archives for last December.]
The midnight rider sought to indemnify the manufacturers of a vaccine preservative, thimerosal, just as dozens of liability cases against the manufacturers, the largest of all pharmaceutical giant, Eli Lilly, were successfully proceeding through the courts. While Congress had passed liability protection for childhood vaccine manufacturers in 1986, the courts in various cases had ruled that mercury was a "contaminant", not a vaccine ingredient, and thus allowed the lawsuits to proceed. The amendment to the Homeland Security Bill would supercede the courts, making the mercury in the vaccine preservative an "ingredient", and thus not subject to liability.
The argument should be openly investigated and debated by Congress. But the sleazy manner in which it was tacked on to completely unrelated legislation certain to pass unexamined in both chambers prompted a handful of honorable Republican Senators, Olympia Snowe and Susan Collins of Maine, and Lincoln Chafee of Rhode Island, to withhold their yea votes on the entire bill until extracting a promise that the Eli Lilly rider, and other questionable last minute provisions, would be stripped away when Congress reconvened in January.
And thus it went...
But alas, like the orc hordes of Mordor, the big-Pharma lobbyists and their Conservative media mouthpieces have returned, this time armed with questionable science and the vilification of even those few Republicans who now question their motives. Monday, that bastion of scholarly scientific inquiry, the editorial desk of the Wall Street Journal, took up now-Senate Majority Leader Frist's payback to his pharmaceutical campaign contributors, and called for the passage of Frist's bill to overhaul the National Vaccine Compensation Fund.
The WSJ editorial is just rife with inaccuracies and misrepresentations, both of recent research on thimerosal as well as the impact of the pending lawsuits on future childhood vaccine production. While ignoring the NIH's admission that a thimerosal-autism link is biologically plausible and the CDC's original study, which found children injected with thimerosal had a 2.5 time greater chance of the condition, the editors instead offered up as evidence controversial studies tainted with claims of methodological inconsistencies, small sample size, and conflict of interest, i.e., funding by and other ties to vaccine manufactures. But as I read through my old posts (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, and that was just November, 2002) on the thimerosal controversy, I became clear that the Senate Majority Leader hands (or those of his staff) were all over yesterday's editorial. In fact, some of the language so closely mirrors Frist's own press releases that either the WSJ is guilty of plagiarism, or the wording was used with the original author's permission. [My spouse is curious to know whether Frist is moonlighting for any other publications and if he's being fairly compensated as a journalist.]
While picking up the often-used brush to paint the parents of autistic children as psychologically unstable, grasping, greedy and irrational, the WSJ also knowingly misrepresents the possible consequences of the current thimerosal litigation:
their [parents] understandable passion shouldn't be allowed to trump undeniable evidence and damage childhood immunizations that are essential to public health. Vaccine makers stopped using thimerosal a few years ago, but the autism lawsuits threaten those companies with enough damage that their ability to supply vaccines is in jeopardy.
Eli Lilly stopped producing childhood immunizations years ago, because they weren't profitable, and although it is involved in development of new smallpox and anthrax, both of those are protected under Executive Order and do not fall under the National Vaccine Compensation Fund legislation. And there is no evidence that immunization rates in the US have dropped due to the lawsuits. Senator Frist's bill, however, would extend unlimited protection to Lilly and other thimerosal manufacturers, while stripping children potentially covered by the NVICP of their rights, even the limited compensation for themselves and their families. His goal? Well, besides the obvious sop to unlimited funds for Republican candidates by the pharmaceutical industry, Frist gets his grubby hands on the multi-billion dollar vaccine fund, a ploy to shift funds to his own pet projects.
Amazing that the Wall Street Journal editorial desk, with it's fixation on money, would leave out that part.
Posted by MB Williams at December 30, 2003 10:07 AM | TrackBackI also commented on the editorial on my weblog:
I have never claimed thimerosal causes autism. At most it's one possible hypothesis. But I do know there's not a single blessed reason for putting mercury in vaccines. It's a preservative, used to keep the vaccine from going bad. It doesn't make the vaccine one bit more effective. Imagine mercury was being added to the milk that children
drank in school to keep it from going sour. There would be an uproar regardless of whatever studies showed it was safe because there's not a single good reason to have it in there. The same is true of thimerosal and vaccines.
What really chaps me about the WSJ editorial is the title: "The Politics of Autism --
Lawsuits and emotion vs. science and childhood vaccines."
The editorial then quotes only three very questionable and flawed studies (the Demark study, the Rochester study and the Pediatrics study) while ignoring the Geier studies, the hair sample study and various others that point towards involvement of mercury in autism.
The real irony is that the conflict between science and politics really is central to the thimerosal/vaccines/autism story but in exactly the opposite direction from where the WSJ is pointing.
Posted by: dwight meredith at December 31, 2003 02:33 AMdwight, as far as I understod teh Danish study, it only focused on studying if the vacinations might cause autism. There is not the same level of mercury, and there have never been, in the Danish vacinations, so it has no relevance to the case at hand.
Posted by: Kristjan Wager at December 31, 2003 08:19 AMKristjan, you are exactly right abiout the Danish study. The Rochester study was of only 40 kids (which means that it the chance of including a kid with a predisposition to autism was less likely than not) and did not look at peak loads of mercury but rather at the average loads.
The science remains ambiguous but the weight of the science is tilting towards establishing a link between mercury and autism.
Posted by: dwight meredith at December 31, 2003 08:57 AMA few pertinent details about this controversy:
1) an identical twin with autism has a 70 to 90% chance of sharing autism with the other twin; a fraternal twin has between a 5 and 10% chance. It's very difficult to make a case that this could be due to anything other than multiple-gene causation or new mutation.
2) mercury is certainly toxic to neurons, but the problem with autism is NOT cell death: autistic children do not face early deaths due to degeneration, unlike Down Syndrome sufferers. In fact, their brains tend to be greatly overgrown by the age of 3. So, whether the mercury in thimerosal has a negative effect or not, it is highly doubtful that any amount of mercury could ever cause autism.
3) you can't really explain the spike in autism rates by saying that its due to doing the same thing we have done since the 1930s.
4) autistic children frequently display some of their characteristic behaviors within the first few days of life, i.e. before inoculation.
By all means, have your fun and hammer Frist and his pharmaceutical buddies for doing an end-run around the legal process. But as to getting at the actual causes of autism, this is a dead-end.
Posted by: Social Scientist at January 1, 2004 01:08 PMSocial Scientist, it's not a subject I know much about, but are the causes for autism well know? It's not my impression.
You write:
it is highly doubtful that any amount of mercury could ever cause autism.
Could it be that autism isn't caused by mercury, but that a high amount of mercury affects the body in such a way, that autism is more likely? Similar to the principle that HIV doesn't cause a number of other diseases, but the likelihood of catching many otehr diseases are greatly increased if you are HIV-positive.
Posted by: Kristjan Wager at January 1, 2004 02:13 PMKristjan:
With most disorders, the mercury would be a possibility--pretty much any noxious substance is going to make disease onset more likely. But the genetic element in autism is just too large. The disparity between identical and fraternal concordance is the highest I've seen for ANY disorder, and that tells me that what happens after conception is of very little import. (Presumably fraternal twins share as much of their environment as identicals.) This tends to be true of the most disabling disorders. Chromosomallly-caused are the worst, then genetic, then womb-environment, then the caused-by-the-whole-rest-of-your-life seems to be the hierarchy of impact on the possible development of mental disorders.
We don't actually know the etiology very well--my argument (and that of the general scientific community) is that we know it's genetic by deduction. Still completely valid.
There is certainly a real question about why there is such a rise in diagnosis. Most believe that it is a true rise in incidence-- which may indicate some very worrisome stuff about the quality of our gene pool.
Posted by: Social Scientist at January 1, 2004 03:23 PMSocial Scientist:
You bring a great deal of assurance to a very difficult and doubtful area. I have looked hard at the data both supporting and refuting the idea that mercury is causally linked to autism. It is difficult to find assurity in that data.
If autism is simply genetic, should not the incidence among identical twins be 100%?
Similarly, if the cause of autism is simply genetic and if, as the UC Davis and CDC studies suggests, there has been a ten fold increase in the incidence of autism over little more than a decade, to what do you attribute the high rate of increase in genetic defects?
Is it possible that genetics results in a predisposition towards autism and that an environmental or developmental trigger is also necessary? If so, what trigger to you suggest?
An unstated premise in your comments is that autism is one single thing with one single cause. Austism is simply a description of certain behaviors. There may be many causes of autism with any number of possible genetic defects and any number of possible triggers. The data suggests that mercury exposure may be one such trigger for some people.
I have no doubt that genetic defects are part of the autism puzzle. I have great doubt that genetic defect is the only piece.
After reading about, thinking about and investigating the causes of autism every day since my son's diagnosis more than six years ago, I am unable to summon the degree of certainty you exhibit. I am envious of your certainty.
Posted by: dwight meredith at January 1, 2004 03:58 PMSocial Scientist:
No one in the autism community has argued that it's due to something we've been doing since the 1930s, because injecting a child with 12.5 mm/ul of mercury every 6 months is very different than injecting a newborn with 37.5 mm/ul every 3 months. The problem is the incredible increase in mercury load foisted upon children as the immunization schedule expanded to include 20 injections.
Also, the number I've seen (and even googled before writing this) is 60-70%, which means that 30-40% of identical twins do not develop autism. As Dwight mentioned, what accounts for that. Even some genetists question the relevance of the former number, as it's possible that merely being an identical twin in utero might have play a role, see http//news.bbc.co.uk/2/hi/health/1949329.stm for details.
As far as characteristics from birth, how does that negate the thimerosal theory, as most children receive both a HepB and HIB vaccine as a newborn or soon there after. And the M.I.N.D. Institute study found 40% of autistic children now exhibit "regressive" autism, where they develop normally until 12-18 months, and then lose their language and other developmental skills.
And autistic individuals, especially those with classic Kanner autism, do appear to have a shortened lifespan, with few living past age 50.
Autism is most likely a set of symptoms hobbled together until an umbrella diagnosis. I have two children with "autism", yet how the condition manifests itself in both children is completely different (one child stims, the other doesn't; one child has bowel disease, the other doesn't; one plays appropriately, the other doesn't, etc.)
Posted by: MB at January 1, 2004 04:30 PMDwight:
Autism is one of the most genetically mediated mental disorders; the only once I know that are more so are secondary to a physical problem medical condition, such as PKU. When scrambling to explain the rest of the causation, the first place one would normally look is in the environment of the womb. For instance, if the mother suffered a severe infection during the first or second trimester, it should have a much greater impact than any vaccine. Especially if I'm looking at a disorder of very early onset, I would consider genetic or chromosomal aspects more important.
I don't necessarily consider autism a unified disorder or a composite of symptoms. The symptom cluster of language impairment, social impairment, and repetitive behavior has some decent clinical backing. Actually, it's a bit harder to get high genetic concordance with a diffuse syndrome.
The thing is, I'm not at all certain about which genes. It seems likely that the social impairment/repetitive behavior/savantism is X-linked, while language problems may be related to chromosome 15. But two genes would not explain the disparity between identical in fraternal twins. All I really sure of is that this process has to begin before inoculation.
I wish you good luck with your son. You may wish to look into the research of Eric Hollander, who has done some excellent work on the treatment (pharmacologically) of separate symptoms. Remember, just because it's mostly genetic does not mean there's nothing you can do about it.
Posted by: Social Scientist at January 1, 2004 07:49 PMI'm unaware of literature supporting this statement:
1) ... identical twin with ... fraternal twin has ...
This one too:
2) ... autistic children ... In fact, their brains tend to be greatly overgrown by the age of 3.
This one is at odds with documentation of changes in vaccination over the period referenced:
3) ... same thing we have done since the 1930s.
This one is hard to reconcile with the diagnostic standard for autism:
4) autistic children frequently display some of their characteristic behaviors within the first few days of life ...
But I like this:
By all means, have your fun and hammer Frist and his pharmaceutical buddies for doing an end-run around the legal process. But as to getting at the actual causes of autism, this is a dead-end.
It sounds so friendly and chatty.
MB:
The major problem with the thimerosal theory is that they're really isn't any good reason to believe it. Why would these inoculations cause a massive rise in autism yet not in other disorders, especially when the problem with the autism is, if anything, that the brain matures too early? I am by no means an expert on mercury poisoning, but there is no way that this is going to lead to overgrowth of the brain over the next two years.
I think the basic paradox that none of us can get our minds around is that genetic disorders are supposed to be stable in a population, and this one has ceased to be such. Truly disturbing.
Anyway, I have no problem with banning thimerosal, but I think the advocates of this theory are giving false hope about a return to the old autism prevalence. And so many other avenues of research are vastly more promising about understanding and possibly preventing autism, it just seems a shame.
P.S. Could you send me or post the lifespan reference? I can't find that information anywhere. Thanks.
Posted by: Social Scientist at January 1, 2004 08:24 PMEric:
I'm unaware of literature supporting this statement:
1) ... identical twin with ... fraternal twin has ...
Autism as a strongly genetic disorder: evidence from a British twin study.
Bailey A, Le Couteur A, Gottesman I, Bolton P, Simonoff E, Yuzda E, Rutter M.
Psychol Med. 1995 Jan;25(1):63-77.
Genetics of autism: complex aetiology for a heterogeneous disorder.
Folstein SE, Rosen-Sheidley B.
Nat Rev Genet. 2001 Dec;2(12):943-55
Genetic studies of autism: from the 1970s into the millennium.
Rutter M.
J Abnorm Child Psychol. 2000 Feb;28(1):3-14.
This one too:
2) ... autistic children ... In fact, their brains tend to be greatly overgrown by the age of 3.
Amply documented, especially in the work of Eric Courchesne. Try:
Courchesne E. Abnormal early brain development in autism. Mol Psychiatry. 2002;7 Suppl 2:S21-3.
Courchesne E, Carper R, Akshoomoff N. Evidence of brain overgrowth in the first year of life in autism. JAMA. 2003 Jul 16;290(3):337-44.
This one is hard to reconcile with the diagnostic standard for autism:
4) autistic children frequently display some of their characteristic behaviors within the first few days of life ...
Here I was referring to their lack of eye contact, their focus on mechanical objects over humans, and their lack of physical affection. These are not, of course, in the DSM-IV criteria, but are widely accepted as signs.
Posted by: Social Scientist at January 1, 2004 08:47 PM#3 seems to have gotten lost somewhere.
Turning to your #4 (phrenology and a twins study just don't rise to my level of interest), at what point during my 4 year old autistic's first week post-partum, at term, spent in a NICU, in my primary care, ... I'm sorry. I really think you are a helium balloon left by an errant visitor.
Posted by: Eric at January 1, 2004 11:12 PMActually, Social Scientist, if you visit the University of Kentucky's site on mercury and thimerosal, you'll see that ethylmercury has been implicated in a number of other health "epidemics", including the rise in asthma and immune disorders. There's also some question about an association with type 1 diabetes. It's not just about autism. Mercury is a poison, and as such, will manifest itself within a population in various ways. The brain just happens to be particularly vulnerable in this case, due to mercury's ability to pass the blood/brain barrier.
Posted by: MB at January 2, 2004 07:12 AMMB--I never said that mercury couldn't be involved in a variety of disorders. Heck, it's known to be toxic, how could it not be? I'm saying one thing, only: not autism. For me, the real guts of the argument are that you don't get these effects right away and that autistic brains aren't per se unhealthy (e.g. show cellular damage like retardation, schizophrenia, etc.).
Eric: You asked me for references on gentics and brain size--I gave them. Then you poo-poo them as "phrenology" and twin studies that don't "interest" you. I now realize your request was in bad faith, that you don't speak respectfully or show any legitimate interest in gaining a fuller understanding through exchange.
Posted by: Social Scientist at January 2, 2004 08:50 AMOh well. You've made your mark as the man who knows that autistic children frequently display some of their characteristic behaviors within the first few days of life ... their lack of eye contact, their focus on mechanical objects over humans, and their lack of physical affection. That's quite an accomplishement.
Well, way back in 1944 Hans Asperger proposed that autism is an extreme version of the "male brain" due to an exaggeration in the autistic of these classically male behaviors. Since then the clinical literature has recorded them many times as being observable in the first days of life. I'm not the one who "knows", I'm just someone who respects the literature.
And speaking of respect: thanks for the harrassing phone call. I have debated all sorts of subjects on all sorts of blogs, but this was a first for me. Shows you really care.
Posted by: Social Scientist at January 2, 2004 02:21 PMHarrassing phone call? We get dozens of hits from Eli Lilly and it's patsies whenever we post on thimerosal, and from what I understand, Eric was just verifying that you were fact a daycare provider, not a pawn of BigPharma. Nothing to get bent out of shape about, right?
It's interesting that you're so sure autism and ethylmercury aren't linked, when the National Institutes of Health asserts the link is biologically plausible (which under their criteria means that initial reports indicate a link, but more follow-up research is needed.) How about the CDC report showing a 2.5xs increase. So how is it you're so sold on thimerosal NOT being the cause, when there are no medical (not epidemiological) studies disproving the link.
And please stop with the "extreme male brain" hypothesis. Talk about junk science. Geez. Asperger also believed, like Kanner, that autism was caused as well by "refrigerator mothers" - if you buy one part of his hypothesis, do you buy that part as well?
Posted by: MB at January 2, 2004 07:38 PMI respect the reason for the call, but I should have been told that's what he was doing. All I was left with was the impression that I was being watched.
As for the "extreme male brain hypothesis": Newton believed in alchemy--does that mean his optics doesn't work? Freud believed in penis envy--does that mean there's no unconscious? Further, clinicians are in a far better position to accurately discern the character of a disorder than its causation--so we should treat the causative remarks as speculation.
Among the behaviors and cognitive features in which autistic children and adults act more extremely "male" (i.e. normal male behavior is in-between autistic and female behaviors) are: empathy, sensitivity to facial expressions, eye contact, language development, attention to detail, preference for structured information, toy preference, specialized abilities, collecting, and systematizing.
This doesn't "prove" that they are "more male" (especially if they are female), or whatever, but it seems a useful way to characterize the syndrome. It's not junk science.
(Reference: Simon Baron-Cohen,Trends in Cognitive Neuroscience, June 2002)
There is also at least one study showing some success treating the obsessive-compulsive type symptoms with the maternal hormone oxytocin.
I've looked only a little at the CDC, NIH, and IOM papers, but I haven't seen anything beyond "there's no data supporting it, but we can't disprove it." And I do put stock in the Danish study. I know it's flawed, but I still find it truly powerful.
Since I know you're following the Counterspin thread, I won't repeat myself here on the thimerosal/vaccination distinction I'm trying to draw--except maybe to add that the symptoms of organic mercury poisoning in adults bear very little resemblence to autism: tremor of the extremities, tongue, and lips, fatigue and lethargy, confusion, and gait problems. I think there are a lot of gait problems in autism, but the others really don't relate.
One different problem: How is it possible that: "... a still unknown member of Congress secretly attached an amendment to the Bill ..."? If it is possible to secretly attach amendements to the bills, maybe even the janitors have the power to change the law. Shouldn't there be a procedure where every attempt to modify a bill is recorded with names and motives?
Posted by: GB at January 2, 2004 11:56 PMAnd I do put stock in the Danish study. I know it's flawed, but I still find it truly powerful.
Then you really don't understand the theoretical mechanisms behind the proposed thimerosal-autism association. Children in the US, like in Denmark, have been exposed to low doses of thimerosal for decades. It wasn't until the actual load of ethylmercury surpassed EPA guidelines, and at a much earlier age, i.e., immediately following birth, that the US saw autism rates begin to explode. Denmark's immunization schedule never expanded to include the extra thimerosal-laden vaccines (HepB and HIB) that the US did, so children were only being injected with 12.5 mm/ul at a time in the DTP shots, same as in the US in the pre-HepB/Hib years. If the pharmaceuticals were truly interested in learning if thimerosal was in part responsible for this trend, those would be the kind of epidemiological studies carried out, in the US, not in areas with limited thimerosal use.
(note: neither of my sons received thimerosal in their immunizations, so I personally don't believe it to be the culprit in this household. One of my children appears to have been vaccine-injured by MMR (a completely different issue, since MMR has never contained mercury, despite misreporting by the media) and my other son was poisoned by a different neurotoxin. Both are diagnosed with regressive autism, had average head measurements and growth and hit their developmental targets until 12-15 months. But I've read enough evidence to support the IOM/NIH's assertion that a link is biologically plausible.)
Then you really don't understand the theoretical mechanisms behind the proposed thimerosal-autism association.
Possibly not. But at least I'm in good company with the editors of Science and JAMA. At any rate, what we're really trying to do here is explain the upsurge. The US raises thimerosal and has an upsurge. Denmark eliminates it and has an upsurge. Sweden never had it and has an upsurge. So if we say it's thimerosal, then we're talking about two (or more) different accelerating mechanisms, one for here and one for Scandinavia. I suppose it's possible, but is it plausible?
Posted by: Social Scientist at January 3, 2004 08:46 AMOops--Sweden had thimerosal and eliminated it.
Posted by: Social Scientist at January 3, 2004 10:39 AMNo one has ever claimed thimerosal is the only reason for the upsurge, just as critics of MMR (a completely different kettle of fish) have never asserted that it is the only contributing factor. But in both Sweden and Denmark, the upsurge in cases was very significantly lower than in the US, which only provides fodder to the theory that thimerosal may in fact be to blame in part.
Neither of my sons were injected with thimerosal, but both developed "regressive" autism, i.e., hit all their developmental targets until 12-15 months and then developed autistic symptoms. With my eldest son, the symptoms appeared at the same time he developed a severe viral infection and entercolitis, or severe bowel disease/celiac sprue, and immediately after his MMR injection. He is the poster child for Wakefield's theory on autistic entercolitis. My younger son developed autism after being exposed to another neurotoxin, lead. New research points to a possible mutation of a gene regulating the protein production which allows for the metabolization of heavy metals, such as lead, mercury and arsenic. The fact that all of my children exist in the same environment and yet only one not only had lead poisoning but none of the others had even elevated levels indicates this new theory may play a factor in some children, including my son. Children with the mutation who were exposed to excessive mercury loads via thimerosal may play into the increase as well. But then increases in methylmercury through polluted water, air and food supply (fish in particular) might also contribute.
The problem with so many of these studies is that they are in fact looking for one single bullet, versus synchronicity in varying different mechanisms. Autism may in fact merely be the umbrella of symptoms, not an actual condition - my two sons' symptoms, other than those which indicate an autism diagnosis, are so disparate to otherwise indicate completely different diseases. World renowned epidemiologists testified in Congress last year to this weakness in the current crop of research methodologies, yet time and again, vaccine manufacturers and their apologists point soley to those single-causation studies to bolster their positions. And until we have research which is truly unfettered by BigPharma money, we won't come close to seeing unbiased results.
Posted by: MB at January 3, 2004 11:01 AMCan anyone provide me with a link to the Danish study? In Danish is okay. I've only read what the Danish newspapers wrote about it, and they focused on other issues than thimerosal.
If it's not online, a reference of where to find it would be fine. Then I can always get hold of the article through the Royal Danish Library.
I think I need to get better informed about the content of that study, as I come across references to it quite often.
Posted by: Kristjan Wager at January 4, 2004 02:46 PM