Way, way back in the deepest darkest depths of history, before I entered the Knowledge Room and sold my soul to big pharma to become a pharma blogger (in other words, way back in 2005), my inauguration as a skeptical blogger taking on anti-vaccine misinformation, pseudoscience, and lies occurred in a big way when I referred to Robert F. Kennedy, Jr.’s infamous article Deadly Immunity as flushing Salon.com’s credibility down the toilet. That was when I discovered the mercury militia, that subset of the anti-vaccine movement that believes that mercury in the thimerosal preservative that used to be in vaccines until the CDC and AAP recommended its removal in 1999, a process that was completed in 2002. Since 2002, there has been no mercury in infant vaccines other than in the flu vaccine (for which there are thimerosal-free alternatives) and trace amounts in some childhood vaccines. Even though one would expect that, if thimerosal in vaccines cause or contribute to the development of autism or autism spectrum disorders, autism incidence should start to drop significantly three to five years after the last thimerosal-containing vaccines were taken off the shelf given that most autism is diagnosed around age 3, there has been no such decrease, as multiple studies have documented. By 2007, even Generation Rescue was backing away from its claim that autism is a “misdiagnosis for mercury poisoning.” Even the cranks seemed to see the writing on the wall. Even the cranks seemed to be read to bow under the weight of the evidence and move on to other, vaguer, more difficult-to-falsify hypotheses, which they did with gusto with “too many, too soon” and blaming vague combinations of “toxins” in vaccines for autism.
Even so, there remained a contingent of the anti-vaccine movement that clung to the thimerosal hypothesis, refusing to let go of it until science pried it from their cold, dead hands. Which science tried to do repeatedly. In any event, even though the biggest anti-vaccine groups moved on to more fertile (and more profitable) pastures of biomedical woo based on exaggerating mitochondrial disorders, more generalized “detoxification,” and “antioxidants.” Even so, the thimerosal hypothesis was the zombie that wouldn’t die. (Are there any other kinds?) Seemingly killed again and again, like Jason or Freddie or Michael Myers or any other fictional slasher, who ends one movie seemingly deader than the proverbial doornail, only to return to slash again a year or two later in another movie, the thimerosal hypothesis returned again and again.
It’s back again in 2010, and the mercury militia looks like it’s ready to party like it’s 2005. They’ve even brought back the same old crew from 2005, up to and including even Deirdre Imus. That’s right. Deirdre Imus, who appeared again in that repository of all things quackery and anti-vaccine, The Huffington Post. This time around, she posted an article entitled The Age of Autism. For once, I’m not referring to the anti-vaccine crank blog Age of Autism, but rather a book by AoA stalwarts Dan Olmsted and Mark Blaxill, the not-so-dynamic duo who have teamed up to pen The Age of Autism: Mercury, Medicine, and a Man-made Epidemic. Before I get to Imus, let’s look at what this book is supposedly about:
Leo Kanner’s original cases, linked only by this overlooked association with mercury, suggest that from the very beginning autism was an environmentally induced illness– a toxic injury rather than something inherited or inculcated. Certainly, some children were more susceptible to mercury exposure– and that may implicate genetic vulnerabilities. This is very different, however, from saying that autism is an inherited genetic disorder.
Tragically, the best and the brightest in science and medicine have missed these clues from the start, blinded first by the belief the parents were responsible and then by their ongoing pursuit of the “autism gene.” The Great Autism Gene Hunt has come up empty– but continues to drain off millions of dollars and thousands of hours that should go to more promising environmental research.
Having thoroughly failed to solve the autism puzzle, the medical industry is putting forth a new wave of epidemic deniers to claim autism isn’t really increasing after all. Simply put, this idea is nonsense; and sadly, it prolongs the epidemic and prevents the urgent response this public health crisis demands.
Ah, yes. it’s the same outline that scientifically dubious books since time immemorial have followed. There’s some sort of horrific health threat that, somehow, either no one in mainstream medicine or science has noticed or mainstream medicine is outright denying. Then, of course, there’s the coverup (big pharma, of course, and the government) that prevents anyone from finding out The Truth. These books are so predictable that I’ve thought of trying to write one myself, as a sort of attempt at a quack Poe, and then seeing if anyone can tell if it’s serious or not. Of course, if I ever were able to find the time to write a book, I don’t think I’d waste my time doing that, but it’s a fun idea. Instead, apparently, we’ll have to do with Age of Autism, which, not surprisingly, Deirdre Imus appears to love, as evidenced by her fawning interview ith the authors of said pseudoscience, Olmsted and Blaxill, which she introduces thusly:
The new book “The Age of Autism: Mercury, Medicine, and a Man-made Epidemic” is shaking up the autism world. Orthodox scientists and medical groups have dismissed and even ridiculed the idea that incredibly toxic ethyl mercury — still in flu shots given to infants and pregnant women — could be linked to the explosion in autism rates beginning in the 1990s, when the vaccine schedule was rapidly expanded. Just the day before the book came out this week, the CDC issued yet another flawed study that found not only was mercury safe — it actually had a protective effect against the risk of autism. This is obviously absurd, as is the fact that almost all the children in the study had received mercury-containing shots, rather than including a control group without any mercury exposure. Authors Dan Olmsted and Mark Blaxill — two names well-known in the autism community and editors of the blog Age of Autism (ageofautism.com), have for the first time traced the roots of autism beginning in the 1930s. What they found is electrifying and suggests the debate is about to heat up again, whether the government and medical industry like it or not.
Well, probably not, this book notwithstanding. As has been pointed out, it’s not exactly setting the book world on fire, sales-wise, and we’ve seen similar claims before for a recent anti-vaccine book by someone who is far more famous among the general public than Dan Olmsted or Mark Blaxill will ever be. That’s right; I’m talking about Andrew Wakefield and his book Callous Disregard: Autism and Vaccines–The Truth Behind a Tragedy, a truly execrable book that made a very brief flash around its release just before Memorial Day and had faded into oblivion long before the 4th of July. Of course, it never made the best seller lists, as far as I can tell; so its flash was minimal indeed. Similarly, I predict that The Age of Autism is likely to suffer a similar fate. By Halloween, it’s likely to be gone. Maybe by Columbus Day.
Imus’ interview with Olmsted and Blaxill is long and covers a lot of well-trod ground as far as mercury militia claims go, many of which will be familiar to long time readers of this blog. However, it starts off with a statement that is quite revealing, but not in the way that B & O think it is:
The other thing that we want people to embrace is contained in the title — this really is The Age of Autism. Autism is the single most devastating childhood disorder any of us have faced in our lifetime — and it has become a national health emergency. The rates of autism have gone from effectively zero before the 1930s to 1 in 100 children today, and that’s happened in the lifetime of a single individual — in just seven decades.
This is, of course, the well-known claim favored not just by the mercury militia but the anti-vaccine movement in general, that there is some sort of “autism epidemic,” that something must be causing autism prevalence to be approximately 1% (which is the commonly accepted estimate these days). It never occurs to them that that “something” is very likely a huge broadening of the diagnostic criteria resulting in diagnostic substitution combined with much more intensive screening efforts. What’s often hard for people to accept is that, as a general principle, the more intensely you look for a condition, the more of it you find. There also tends to be a shift to milder cases that would have been missed or diagnosed as something else before. That’s largely what we have seen with autism and ASDs. It’s an open question whether there has been a true increase in prevalence, but what is pretty clear is that there has not been a massive increase in ASDs. Studies of adults suggest that the currently estimated prevalence of around 1% appears to have been stable for at least decades, as evidenced by the prevalence of ASDs being similar in adults as it is in children. Basically, the “autism tsunami” myth confuses diagnosis for condition.
The revealing part, however, is how Blaxill characterizes autism. It’s not just a problem, but the “most devastating childhood disorder than any of us have faced in our lifetime” and a “national health emergency.” I’m sure that parents of children with cerebral palsy, profound mental retardation, or other permanent conditions in which there is little or no hope of improvement and whose victims require every bit as much around the clock care as a child with severe autism does would beg to differ. In contrast to these children, a significant proportion of autistic children can and do make significant progress–even recover to “leave the spectrum.” But by what definition does Blaxill declare autism to be such a horrific health problem? There’s no doubt that autism is a significant burden on the health system, but the most significant burden?
Basically, the entire interview consists of one long commercial for B & O’s book. That in and of itself is not unexpected. After all, authors do interviews to promote their books. The problem is, the B & O’s self-promotion consists of a continuous string of anti-vaccine nonsense. What’s different is that B & O have taken the hoary old ghost of the thimerosal-autism claim and thrown a fresh coat of makeup and lipstick on it, much like the proverbial pig. Basically, the not-so-dynamic duo claim to have located seven of the eleven original children identified by Leo Kanner in 1943 as having autism:
So we decided to look more closely at this group of children, who were identified only by a first name and last initial. In this Internet age, we were able to identify 7 of those 11 children — and what we found was a startling link in those families: both to mercury exposure in general and specifically to the new ethyl mercury compounds that were first commercialized around 1930. There were three initial commercial uses for ethyl mercury — in agriculture as seed disinfectants and lumber treatment, and in medicine as a preservative in the new diphtheria vaccine.
They dismiss any question over whether this might be a coincidence thusly:
We think the pattern of evidence is much too strong to be dismissed as pure chance. Kanner’s initial case series was a small cluster of 11 children and the mercury link really jumps out. The problem is that Kanner noticed the parents’ professional accomplishments and focus and all the working mothers — many working in the medical industry — and suggested there were “very few really warm-hearted fathers and mothers” in the entire group. Although he later backed off of that accusation, people like Bruno Bettelheim turned parent-blaming into the prevailing theory of autism causation.
No, in eleven children, it’s virtually impossible to say anything about exposures. True, such a sample might raise suspicions of an environmental etiology for a disease or condition, but that’s all it can do. Like acupuncturists who point to small preliminary studies that suggest efficacy for acupuncture, B & O point to their small sample that may or may not be representative and whose original reports are separated from the present by 67 years. There’s been a lot of research since then, and it has failed to show a link between vaccines and autism, mercury in vaccines and autism, or mercury exposure and autism. Look at it this way. For an environmental exposure to cause what is described as an “epidemic” of autism, the causal linkage would have to be very strong, if, as is claimed by the mercury militia, it’s the driving cause of an “epidemic” that pushed the prevalence of autism from close to zero to over 1% of the population. There’s just no evidence of such a strong link; indeed, just last week there was yet another study that failed to find a link. Meanwhile, Olmsted completely misunderstands the concept of genetic predispositions with low or incomplete penetrance:
Then, when it became clear that there was a higher rate of autism in twins, parent-blaming was discredited. But scientists misunderstood the gene studies to conclude that autism was therefore a genetically-determined disorder that could not be prevented or treated. But there are plenty of identical twins who are discordant for autism — one has it, the other is typical — and there are also fraternal twins, who are no more identical than they are with other siblings, who both have autism. That suggests some sort of environmental injury in genetically vulnerable children.
Well, yes and no. It might suggest that. Or it might suggest low penetrance, which can be difficult to distinguish from environmental factors, or, as studies have suggested, it might suggest a complex, multi-gene condition. In any case, notice how Olmsted doesn’t actually say what the concordance is for identical twins and autism compared to fraternal twins. It’s actually quite high. Funny how Olmsted neglects to mention that, assuming he knows it.
When I saw that Deirdre Imus is once again leaping into the fray, playing the role of the sycophant and publicist for the anti-vaccine movement, I debated whether or not even to bother with it. After all, I did predict that by Halloween this book will be as forgotten as Wakefield’s tome. On the other hand, it is educational to point out just how little has changed in five years. Yes, B & O have put a slightly new twist on an old canard, put new wine in an old bottle, so to speak. Besides, looking at these tired old arguments makes me feel as though it were 2005 again.
If only I could shave five years off my actual age. My hair was a bit less gray, my waistline a bit less wide, my blood pressure a bit lower, and my skin a bit less wrinkled then.