Earlier this year, reports that the US Federal Court of Claims had conceded that vaccines had contributed to the onset of autistic symptoms in the case of Hannah Poling led to much speculation and debate about (1) if mitochondrial disorders could be linked to autism and (2) how common mitochondrial disorders might be among autistic children. A number of experts on mitonchondrial disorders met in June to discuss the “controversial case” of Hannah Poling. An article in the November 26th PLoS One entitled Mitochondrial Disease in Autism Spectrum Disorder Patients: A Cohort Analysis investigates the medical records of 25 patients with a primary diagnosis of ASD by DSM-IV-TR criteria. These children were later determined to have “enzyme- or mutation-defined mitochondrial electron transport chain (ETC) dysfunction”; of these, 24 had “one or more major clinical abnormalities uncommon in idiopathic autism” and 21 had “histories of significant non-neurological medical problems.”

“Idiopathic autism” has “become somewhat of a catch-all phrase where a cause, most often genetic, is unknown,” according to the Not Mercury blog. The “non-neurological medical problems” noted in 21 of the 25 participants in the PLoS One  study were primarily gastroinesstinal dysfunction; some also had “pancreatic dysfunction or liver disease–gastrointestinal disorders that are rare in persons with ASD.” Indeed, the authors later state that “non-neurological disorders were nearly universal in our patients.” Also noted was an “increased frequency of prenatal and perinatal complications ….. in children with ASD” and a “high frequency of multiple gestation births.” And, while autism spectrum disorders are diagnosed at a much higher rate in males than in females, in the cohort studied in the PLoS One article, there was an equal number of males and females. In regard to a link between vaccines and mitochondrial disorders, only one of the 25 participants was reported as having “autism/neurodevelopmental deterioration appeared [following] vaccination,” but “such timing does not prove causation.”

Among the conclusions of the researchers was that “careful clinical and biochemical assessment identified clinical findings” in the 25 participants that differentiated them from children with idiopathic autism; accordingly, it is possible that a “disturbance of mitochondrial energy production as an underlying pathophysiological mechanism” might be found in a “subset” of autistic individuals. How common, indeed, are mitochondrial disorders among autistic individuals—are they widely prevalent or a subpopulation? Journalist David Kirby writes about the study in the Huffington Post and seeks to argue that they are not so rare.

Much of the energy fueling the past several months’ discussion about mitochondrial disorders and autism has stemmed from an ongoing interest in identifying a biological cause for autism. The researchers of the PLoS One article note that they found “diverse and complex developmental, neurological, and medical phenotypes of persons with mitochondrial autism”:

Although many children with ASD exhibit some degree of hypotonia, most attain their early gross motor milestones on time. In contrast, 64% of our patients were delayed in attaining early developmental milestones and 32% were five or more standard deviations later than the mean in walking independently. In addition, although regression has been reported to occur in approximately one third of autistic children, typically before age three years, 40% of our patients demonstrated unusual patterns of regression–either repeated regressions, regressions involving losses of gross motor function, and/or regressions after age three years.

I note this mention of hypotonia—decreased muscle tone—and regression. In accounts of the onset of autistic symptoms in Hannah Poling, it was noted that she “refused to walk” and that she “lost her ability to speak” and showed other signs of regression in her development. On a more personal note, my son Charlie was very delayed in meeting all of his gross motor milestones as an infant and toddler. He rolled over, sat up, and walked late—he was 15 months when he was able to walk. He never “regressed” as he often seemed to take a very long time to acquire skills that other children his age had long had. Charlie was often said to be hypotonic when he was younger.

I have to say “was” because it’s been a long time since I heard the word used in reference to Charlie. Charlie learned to swim at 6, around the same time that Jim got him going on his bike (with and soon without training wheels, Jim soon had Charlie pedaling all over the sidewalks and then into the street). Charlie walks for miles with us now, and bikes for even more, and probably would swim for miles in the ocean, if we let him (no we are not). Friday afternoon he pedaled so fast that Jim could barely keep up with him at some moments. Hypotonic no more, Charlie’s in shape.

The authors of the PLoS One study conclude:

Overall, our results demonstrate substantial clinical heterogeneity of individuals with co-occurring autism and defects of mitochondrial oxidative phosphorylation, nearly all of whom we found to be clinically distinct from children with idiopathic autism. The data do not exclude the possibility of persons with isolated autism having a disorder of oxidative phosphorylation–in fact, one of our patients did not have any major clinical features that distinguished her from typical autism. In addition, it is possible, if not likely, that a still broader clinical, biochemical and genetic spectrum of mitochondrial autism exists.

………………The data reported here, and other cases of mitochondrial autism, argue that defective mitochondrial oxidative phosphorylation is an additional pathogenetic basis for a subset of individuals with autism.

The reasons that children may have “co-occurring autism and defects of mitochondrial oxidative phosphorylation” arise from a number of varying causes and much more–”a still broader clinical, biochemical and genetic spectrum of mitochondrial autism”—remains to be explored. It’s suggested that such cases of mitochondrial autism are a “subset,” whose size remains to be determined.

Among the books about autism at the public library in our town are this, this, and this—I’ve put in requests for a few other things.

To be very honest, we rarely visit our library. While there’s no lack for books of every sort at our house, Charlie’s not a reader. I was interested to read about a program called Project Inclusion, which is described in the November 26th Wausau Daily Herald (Wisconsin):

Project Inclusion’s overall goal is for the participating libraries to “take a proactive stance to address the literacy needs of children with disabilities and to make libraries meaningful and welcoming places for these children and their families.” Special emphasis was placed on adding materials especially for and about children on the autism spectrum.

These materials include a book called My Best Friend Will by fifth-grader Jamie Lowell and teacher Tara Tuchel; it’s about Jamie’s friendship with Will, who’s autistic and who she’s known since kindergarten. Other materials include DVDs like Know the Code and Skill Building Buddies; Emotes! a new book series designed to help children process and understand their emotions with Manga-style graphics; books from the publisher Orca and also a series called Steady Readers; and visual timers (perhaps like some of these?).

Which leads me to the question—what autism books are on the shelves of your library? Or what books would you like to see?

Back in July, it was reported that the rate of autism in Somali children in Minnapolis was notably high. According to the Minnesota Department of Education:

in the Minneapolis’ early childhood and kindergarten programs, more than 12 percent of the students with autism reported speaking Somali at home. According to Minneapolis school officials, more than 17 percent of the children in the district’s early childhood special education autism program are Somali speaking.

Almost 6 percent of the district’s total enrollment is made up of Somali-speaking students, and about 6 percent of the children in the district’s overall early childhood and kindergarten special education programs are Somali.

Speculation about what could be causing this “cluster” of autism cases in so specific a population immediately started up, especially among proponents of environmental causes of autism such as journalist David Kirby. Mike Stanton at Action for Autism gives an overview of all this, and notes how Kirby and others sought to connect the Somali autism rate—or, more precisely, the rate of autism among children born in the Minneapolis area to immigrant parents from Somalia—to vaccinations, and also to a theory that a Vitamin D deficiency can be linked to autism. Dr. Steve Novella at the Neurologica blog writes specifically about the notion of a “cluster” of autism cases being found:

apparent clusters of diseases are reported all the time. Most of the time the clusters are not real, meaning they are just statistical flukes. So the first question to answer with any apparent cluster is - does this represent a real epidemiological phenomenon.

……….

One problem with the cluster hypothesis is that other immigrant Somali communities have not experienced increased autism rates. If there is an environmental trigger causing the two identified clusters, why are there not clusters in these other communities?

If it turns out to be true that autism rates have significantly increased in some Somali immigrant communities, above what is seen in Somalia or in non-Somali in the same communities, then we can conclude that something is going on and a potential trigger should be sought.

It also has to be noted that autism is really a collection of diseases, not a specific disease. So we may be seeing a new entity that has clinical overlap in features and symptoms with recognized forms of autism.

Dr. Novella writes that more investigation is indeed needed about the Somali “cluster” and if it is real, and what factors might be playing a role, whether genetic or environmental. He references an article from the Simons Foundation Autism Research Initiative that cites Judy Punyko, an epidemiologist at the Minnesota Department of Health. I August, Punyko formed a study group of 12 experts (including epidemiologists, physicians, school administrators and special education teachers) to study the rate of autism in Somali children in Minneapolis with “age-matched controls.”

Even then, she adds, educational data may be incomplete or inaccurate. The 13 special education categories reported to the state and federal government are intended to help provide a child with the best available educational services. If a child has two conditions, such as autism and developmental delay, they can only be assigned to one primary category; Minnesota does not require a medical diagnosis of autism to be included in the category. Finally, some schools, especially those in poorer districts, often overlook mild forms of autism.

Population data used for the analysis also comes from the 2000 census, which may be vastly different than current numbers. “The population of Somalis is a fluid number in Minnesota,” says Punyko.

Mike Stanton also notes that “in Minnesota there is no reliable epidemiological data for autism”—because, as he points out, the “administrative data for children in receipt of autism services” is based on “teacher assessment,” with a diagnosis from a “trained clinician” not required.

I know this from experience: My son was first evaluated for “delays” in Minnesota, by a Child Study Team from the St. Paul Public Schools. That was in the spring of 1999 (he wasn’t 2 years old yet) and he immediately started to receive services (speech, OT, and special ed, only a few hours each week). He wasn’t actually diagnosed with autism until July of 1999 (and the only change in the services was that he qualified for more hours of special education, which we were urged to have him receive in a school setting, rather than at home—that classroom was not appropriate for Charlie—but this is another story, and a whole ‘nother post). Also (and this is completely anecdotal), a number of Somali families lived in a high-rise apartment that was right next to the building where Charlie’s pediatrician had his office, and there were many Somali mothers with strollers and young children waiting beside us among the little tables and fish tanks in the waiting room). (And, also really anecdotally, no Somali children in Charlie’s special ed program in St. Paul, back in the summer of 1999.)

One question that (following on today’s earlier DSM-V post) needs to be addressed is how cultural factors might be at work here. And Dr. Novella writes that

Somali parents certainly believe they are experiencing something new, and some pediatric neurologists in these areas have had their suspicions also. But this is not enough to form a scientific conclusion - only to justify further research.

The true autism rate in Somalia needs to be investigated also. We should not assume that because the culture does not recognize autism it does not exist.

Besides keeping in mind the particular conditions that a child is said to be “autistic” in Minnesota—again, a child can receive autism services through assessment by a teacher (as my son did) and without receiving an official diagnosis from a “trained clinician”—we need to get a better sense of how autism is understood in Somalia, and what the numbers there are, and how these are determined.

So thimerosal’s not the “‘smoking gun‘” linking vaccines to autism, according to David Kirby, whose 2005 book, Evidence of Harm: Mercury in Vaccines and the Autism Epidemic: A Medical Controversy argued that thimerosal—-a mercury-based preservative—-was the culprit behind what he calls the “autism epidemic.”

From an article in today’s Star-Ledger (New Jersey) about an October 23rd forum on infant and child vaccines at the Deirdre Imus Environmental Center for Pediatric Oncology at Hackensack University Medical Center:

[Kirby]…..said he believed that thimerosal, which still exists in trace amounts in some childhood vaccines, was no longer the “smoking gun.” Several national studies have found no connection, and a California study found that, even after thimerosal was removed from vaccines, diagnoses of autism continued to rise.

But, he said, the links between vaccines and conditions like autism are still strong and more research is needed. One area to look at is to determine which children might have a genetic propensity for a condition such as autism, for which vaccines may act as a trigger.

……

“New Jersey is lousy with mercury,” he said, much of it from air pollution that is spread in rain.

But he also pointed to the “universality of vaccines” as an explanation for so many children’s contracting chronic illnesses.

“Not everybody lives near cell phone towers, uses the same baby food or household products, but everyone gets vaccines,” he said. He cited the example of the immigrant Somali population in Milwaukee. Pregnant women, mothers and babies were given up to 10 vaccines “and the autism rates among Somali refugees are through the roof,” he said.

So Minneapolis (not Milwaukee) is “lousy” with Somali children who have autism (which is not, of course, a “chronic illness”)?

As everyone knows, it’s generally said that New Jersey is simply “lousy”; based on the autism education Charlie’s gotten here, with speech therapy and OT and daily PE integrated into his school day, and good lines of communication between the teacher and me thanks to email and the phone, I would beg to differ. (But I do tend to weigh education and schools heavily in my thinking.)

And as for it raining mercury here in Jersey? It has been raining all day here—-snowing even in some places—-Charlie and I got a bit wet on our way to the dentist office. He’s never been inclined to use an umbrella—-good thing we both have hooded rain jackets—-neither of us has yet to become more autistic.

So now that thimerosal’s off the suspect list for causing autism, what’ll be next?

There’s plenty to debate about regarding autism and the speech about special needs children that Vice Presidential candidate Sarah Palin is to give today in Pittsburgh —-her first about public policy—-should set off more. According to the Pittsburgh Post-Gazette, she’s to deliver the speech this morning at the morning at the Airport Marriott in Pittsburgh before an invited crowd of 350.

Update 13:00 EST: Here’s the text of Palin’s speech.Palin talks about “these beautiful children” and these are her three policy proposals: more choices for parents, fully funding IDEA, and efforts to reform and refocus. I just heard about some budget issues in my own school district that have reminded me of the need to fully fund IDEA and Palin’s noting of this is good to hear. IDEA, she notes, will be funded by “prioritizing” how money is spent, and especially funds that are “earmarks for political pet projects” such as “fruit fly research in Paris, France, or a public policy center named for the guy who got the earmark.” “School choice” has been a central part of Senator John McCain’s educational policy throughout the campaign and Palin adapts the notion “school choice” to special needs students.

In a McCain-Palin administration, we will put the educational choices for special needs children in the right hands their parents’. Under reforms that I will lead as vice president, the parents and caretakers of children with physical or mental disabilities will be able to send that boy or girl to the school of their choice — public or private.

Under our reforms, federal funding for every special needs child will follow that child. Some states have begun to apply this principle already, as in Florida’s McKay Scholarship program. That program allows for choices and a quality of education that should be available to parents in every state, for every child with special needs. This process should be uncomplicated, quick, and effective — because early education can make all the difference. No barriers of bureaucracy should stand in the way of serving children with special needs.

……..

Even the best public school teacher or administrator cannot rightfully take the place of a parent in making these choices. The schools feel responsible for the education of many children, but a parent alone is responsible for the life of each child. And in the case of parents of children with disabilities, there are enough challenges as it is, and our children will face more than enough closed doors along the way. When our sons and daughters need better education, more specialized training, and more individual attention, the doors of opportunity should be open.

Like John McCain, I am a believer in providing more school choice for families. The responsibility for the welfare of children rests ultimately with mothers and fathers, and the power to choose should be theirs as well. But this larger debate of public policy should not be permitted to hinder the progress of special-needs students. Where their lives, futures, and happiness are at stake, we should have no agenda except to ease the path they are on. And the best way to do that is to give their parents options.

The “options” Palin discusses here are only vaguely connected to the educational issues that face autistic children and their families. Being able to have one’s child attend the “school of one’s choice” is just one issue among many others that families have to consider in providing an appropriate education for their child: Training of teachers and staff, adequate teachers and staff, supervision, inclusion for special needs students with their non-classified peers are just a few that must be considered first and foremost.

Palin’s been quoted as saying that families with special needs children would “‘have a friend and an advocate in the White House’” were she and Senator John McCain to win the election; what, though, about adults with disabilities, who make up 90% of the those with disabilities in the US?

Another autism topic that is regularly the subject of heated debate is whether or not vaccines or something in vaccines can be linked to autism. But while more and more scientific studies refute a link, this particular topic is still regularly portrayed as a “debate” with two equally valid sides, and as a debate and even a disagreement that puts cold-hearted science-bound scientists against distraught parents of autistic children who are staunch and fearless advocates.

There’s a tendency, that is, to invoke a sort of symmetry principle in talking about the notion that vaccines or something in vaccines might be linked to autism. The adamantine pronouncements of scientists defending science itself are contrasted to the pained, highly emotional charges of parents trying to “get to the bottom” of whatever “made” a child to “become” autistic. An October 23rd Bergen Record article about a conference at Hackensack University Medical Center and hosted by the Deirdre Imus Environmental Center for Pediatric Oncology. Journalist David Kirby and the grandmother of an autistic child are contrasted with scientists and doctors.

Dr. Lawrence Rosen, a pediatrician and one of the speakers, told the audience that every family he treats is consumed by the issue.

“Ten years ago, I was having these discussions maybe once a week,” Rosen said “Now it’s every single family that comes in.”

While none of the speakers advocated an anti-vaccine perspective, Kirby said there are many questions that need to be resolved, adding that studying differences in the vaccinated and unvaccinated population should be a national priority.

The author of “Evidence of Harm: Mercury in Vaccines,” Kirby said he suspects that that there are children with a genetic predisposition that makes them vulnerable to an adverse reaction.

“It may be a very small percentage, but if they exist, we need to identify them, and I believe separate them out and possibly vaccinate them separately,” he said.

He also said his research showed that many of the autistic children were ill when they were vaccinated.

“You don’t vaccinate a sick child,” Kirby said. “It says so right on the label.”

Margaret Fisher, medical director of the Children’s Hospital at Monmouth Medical Center, said there are sound medical reasons for the early required immunizations.

Thos who regularly follow this topic have, too, regularly noted David Kirby’s reliance on rebranding and rhetoric to keep the notion of a vaccine-autism link alive. “‘You don’t vaccinate a sick child…..It says so right on the label’”: These short and snappy sound byte-ish phrases regularly lace the arguments of antivaccinationists, who call out “change the schedule!” and “green our vaccines.” And they are effective. As the Bergen Record notes, seemingly every family with young children is raising the question of whether or not to vaccinate.

Sound bytes stick in the mind. But surely we ought to make decisions about our children’s health based on something more substantial?

“For families struggling with autism finding the latest treatments is a top priority,” begins an October 14th WCBStv story about “a controversial approach” that “is making headlines” (which, of course, has nothing to do with the actual efficacy of said approach). The approach is hyperbaric oxygen therapy and the doctor is Dr. James Neubrander, whose website refers to autism as the “treatable untreatable disorder!.” A hyperbaric chamber will set you back $21,000, WCBStv notes. Dr. Neubrander says that HBOT treats “decreases inflammation” and somehow altars the brain chemistry of autistic children and, while there’s no studies to back it up, he says:

“No, the studies are not there, but it doesn’t invalidate what we see. The studies are coming.”

It’s a familiar refrain about how “studies” and especially studies “in the future” will provide proof that some alternative treatment or other does what it it claimed that it does. Dr. Mark Geier and David Geier are also members of what some call the “autism treatment subculture” and continue to publish studies seeking to offer evidence for claims of a vaccine-autism link. At yesterday’s Pathophilia, the metabolite values used by the Geiers are under question—and this is important, as the Geiers seek to show that “levels of these metabolites—as markers of oxidative stress and “decreased detoxification capacity”—in children with ASD are significantly different from those in children without ASD.”

Pathophilia examines the figures by the Geiers and supplied by their cited references or other relevant sources. Details are here; here’s the conclusions:

Geier et al present metabolite values in children with or without ASD that are questionable. In particular, some values measured by Geier et al—for example, cysteine (whether total or free), oxidized glutathione, and total sulfate—are considerably different from those published elsewhere, including those values obtained or calculated from references cited by the authors. Other values from ASD or neurotypical subjects—for example, reduced glutathione and taurine—are within the reference ranges published in the literature.*** Only in the case of plasma free sulfate was the mean level in ASD subjects outside of the normal range provided by the substantiating literature.

Before any diagnostic or treatment recommendations can be made on the basis of this study (or any study, for that matter), results must be shown to be reliably reproducible by a different set of authors using more than one experienced, reputable laboratory, and any discrepancies between control values and those in the literature must be noted and explained. It should also be determined whether tighter controls, particularly in the form of age matching between autistic and neurotypical subjects, should be performed when comparing these metabolite levels. Last, the significance of any mean values in autistic children that lie within the published reference ranges, although they may be statistically different from a given study’s control values, must be considered cautiously.

In other words, of the metabolite values that the Geiers say are in autistic children, most do not match up with those found in other studies, including the studies cited by the Geiers. Does this study, then, have any application beyond itself—-or, what can do you with a $21,000 HBOT chamber, if you’re not able to cure autism with it?

My main priority as the mother of an autistic son is not to find those “latest” treatments, but to ensure he has the appropriate, and the best possible, school, services and supports that he needs to help him move forward into the future.

As the October 1st issue of Scientific American Mind reminds us, words have power. I know this even more whenever I hear my son Charlie speak. He was very, very late to talk and he first didn’t talk at all, but used sign language. Today he speaks in short phrases and sentences, and almost-sentences.

A lot of words get thrown around about autism on the Internet, on blogs and newspaper and media websites and who knows where else. Too often, even most often, it seems that the vast percentage of those words are in the realm of misinformation, as the numerous mentions of notions about what causes autism, from power plants in Texas to the quite infamous hypotheses about vaccines and/or mercury. As Dr. Paul Offit noted on his Science Blogs Book Club post today:

A couple of bloggers praised the book for its tone, that I never appeared to get angry at the false prophets described in the book. The reason for that is that I’m not the father of a child with autism. If I were, I would have been quite angry. Angry because I think that the anti-vaccine forces have taken the autism story hostage. And angry that because of their influence, the media almost never carries stories about the real cause or causes of autism.

“Taken hostage”—-yes, that’s pretty much what has happened to autism discussions. Whether about education, safety concerns, how to get your child to eat more: Too often discussion devolves into “but look at this study” and “but you still can’t say 110% plus that there some vaccine won’t lead to some adverse effect in some child.” It’s an oh-so-endless game of bait and switch and if you, as I do, do not think that vaccines or something in vaccines can be linked to autism, it seems you’re d**ed if you do join in the fray, and doubly d**ed if you don’t.

The saddest thing, or thing that makes one maddest, is that–as Kev blogged today—autism has become a secondary concern in these debates. One has only to read the latest Age of Autism post by David Kirby about the “‘weaknesses and limitations’” of the CDC’s Vaccine Safety Datalink (VSD) to feel that much, if not most, of the discussion about vaccines and autism has strayed far away from talking about actual autistic people, like the boy who’s sitting across from me savoring fresh chunks of watermelon as I write this on a Thursday night: That boy lugged a whole quarter melon around a grocery store as we shopped, and slung the bag with the melon and a lot of other food items  over his left shoulder with a grin because he was doing it on his own, and didn’t need my help.

As Dr. Offit has also pointed out in chapter 5 of his recently published book, the information in the VSD needs to be read and interpreted with care; for instance, the VSD lists the diagnoses of children by codes, rather than from “direction information from medical charts” (p. 93). In the VSD (of necessity) it’s a database of information—a child is a code, a diagnosis, with certain features and symptoms; the portrait of a child presented in the VSD (or any database) is an abstraction, a distillation of certain features.

And shouldn’t the discussion about autism be about autistic people, and centered round what autistic people themselves have to say, rather than endless musings about bits of data and numbers and figures?

Over at Salon on his blog sWell blog, physician Rahul K. Parikh deconstructs David Kirby’s September 24th presentation to Congressional staffers. The presentation’s title was “The Vaccine-Autism Debate: New Developments from Science and Policy” and the PowerPoint slides and a write-up are posted on the Age of Autism weblog. Sullivan has been posting about the hearing as Vaccines on the Hill III, Vaccines on the Hill II, and Vaccines on the Hill. Liz at I Speak of Dream noted that this latest attempt to “indoctrinate congressional staffers” by the usual suspects in the anti-vaccine/pro-vaccine safety annals—-Davis Kirby, Mark Blaxill (VP of Safe Minds)—-gets a fail.

Dr. Parikh explains why after assessing the claims of each of Kirby’s slides with an eye to Kirby’s use of certain rhetorical strategies. Two examples:

Slide 3: “A New Autism Vocabulary” [compare this phrase to Kirby's constant rebranding of autism]

Here goes onto use many scientific terms here. Among them, “autoimmunity,” “neuro-inflammation,” “gliosis”

Assessment: Mr. Kirby tries to establish his credibility as “an expert” by using words we learn in medical school and college neurobiology class. All of these terms could describe mechanisms by which autism, or any other neurodevelopmetal disorder in children or the elderly, start and progress. But none are specific to autism. “neuro-inflammation,” for example, could just as easily describe what happens when an elderly person develops Alzheimer’s Disease. But the “principle of authority” technique he uses helps to establish himself as a guru who deserves our attention.

Slide 4: This slide appears to cite a commentary (NOT a STUDY) from the medical journal, Pediatrics (he uses the logo at the top).

The commentary was about a conference convened in 2007 at the Insitute of Medicine to discuss the opportunities for research into and treatments of autism. Below the big header, Mr. Kirby writes, “The environment may play a significant role in triggering autism” and that “genes alone cannot account for its cause.”

Assessment: There is nothing said here that experts on both sides of the vaccine “debate” would disagree over. Genes + Environment = disease. It’s true for every chronic disease from Asthma to Diabetes to Heart Disease. A more accurate thing for Mr. Kirby to do would have beeen to actually cite his sources. It helps keep him accountable and credible.

I should note, however, the commentary he cites doesn’t mention vaccines at all.

And so on for several more slides; Dr. Parikh sums his analysis up with this:

There you have it. Mr. Kirby effectively uses fancy medical lingo to build his credibility and tell us things we already know, relies on science that he can’t cite the source of or that can’t be applied beyond Monkeys, gives us book reports on mitochondrial diseases and neuro-inflammation, calls court decisions and quotes from famous people proof of his point.

Just what was that point, anyway?

Further testimony to the fact that never was (and never should have been) any controversy over vaccines and autism, and that the belief that there is has been kept alive with a fair amount of propaganda?

‘Tis September and, it seems, the season for autism books: Started off the month with Dr. Paul Offit’s Autism’s False Prophets: Bad Science, Risky Medicine and the Search for a Cure and now here comes Jenny McCarthy’s autism book #2, Mother Warriors: A Nation of Parents Healing Autism Against All Odds , and accompanying appearances on Oprah, video clips, and the like.

So there you have it. The Vaccine Doctor and the Autism Mom Heroine. In this script, Jenny and her following of David(a)s are poised, too-good non-toxicness products in their hands, to take on the evil Goliath of the Medical Establishment, Big Pharma, the dreaded CDC. I guess we should look out for flying stilettos (or maybe Crocs; warrior moms have to take their kids to the pool for sensory relief) while hearing refrains of “Just Say No to Jabs,” “Vaccines Can Take a Vacation,” and “For Shame, Bad Doctors!”. Moms in distress fighting to their last, giving it their all, to save their child: You need look no further than Bambi for this plot, and the doctors with their shots get equated with the guys with the munitions. (Get it, they shoot.)

It’s an emotional topic, this vaccine-autism business. But the problem is, developing vaccines and treatments, conducting studies to figure out what causes autism, whether thimerosal has anything to do with it (it doesn’t)—these are the stuff of scientific study, and emotions cloud things up. But how parents feel—about what “made” their child autistic, about who listens when they’re hurting—-plays at least some part in the choices parents make. So in responding to Dr. Rahul Parikh’s review of Autism’s False Prophets does journalist David Kirby appeal to emotions, entitling a post Dr. Rahul K. Parikh, I Am Becoming Embarrassed For You. Kev at Left Brain/Right Brain responds with David, I am not embarrassed but puzzled. Dr. Parikh responds by listing the rhetorical, but not science-based, tactics used by Kirby:

attacking the messenger, citing irrelevant science, moving the target, demanding that alternative views to theirs be squelched, or relying on slick slogans and celebrity endorsements

Thrust and parry.

Dr. Parikh notes that he has been smacked down by Kirby: Fighting words, via a metaphor from the wrestling ring, if there ever was one.

And now that we’re gonna have all these warrior mothers jumping into the fray, looks like this latest round of the vaccine-autism “war/controversy/not a controversy/debate/not a debate because they science says that vaccines don’t cause autism”—-looks like it could get at least a little ugly-toxic-heated.

Me, being the mother of an autistic son, and a mother who knows vaccine didn’t cause him to be autistic, I’ll be trying to side-step way through the midst of the fray, and see who floats, and whether or not there’ll be a surprise plot twist.

Seems a band called Elbow has won the Nationwide Mercury Prize—-a “staple of UK music accolade-giving since 1992“—-for its album The Seldom Seen Kid. Considering the attention devoted by some “autism activists” (Safe Minds etc.) to the belief that vaccines or something in vaccines, like the mercury-based preservative thimerosal, can be linked to autism, there would indeed be some competition for, I don’t know, “most mad about mercury” and “best talking about detoxing autism.” Jenny McCarthy—now starting up a lifestyle line of non-toxic products—would be a fair contender, as would Evidence of Harm author David Kirby who has again and again “rebranded autism”—-renaming it vaccine-transmitted mercury poisoning or “Environmentally-acquired Neuroimmune Disorder,” to name but two examples—-all while stating that it’s something in the environment behind the epidemic rise in cases of autism, be it vaccines, dental amalgams, or a “Shanghai Plume” of mercury from coal plants built in China that’s wafting across the Pacific Ocean.

Dr. Paul Offit’s recently published book, Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure charts the rise and fall of the vaccine/something in vaccine causes autism hypothesis. A growing body of scientific research refutes such a hypothesis, but not before it has stoked so many parental fears that vaccination rates for the MMR have decreased in the UK and that the US has had its largest outbreak of measles. Just last week, a new study disputed a link between the MMR and autism; as more such studies have been published, anti-vaccine/pro-vaccine safety advocates have cried foul and claimed that scientists have “deep ties to Big Pharma”: Rather than weighing the scientific evidence, there’s a tendency among such advocates to cry out “conspiracy!” and talk around what the evidence says.

And, too, they keep digging for connections and links and bits of data that would suggest that, for instance, some of the autistic children described in Leo Kanner’s 1943 article on infantile autism had been exposed to something suspicious, and even toxic, in the environment; a number of articles by journalist Dan Olmsted have claimed such coincidences. The latest such coincidence was described in a September th  of Autism post, in which Olmsted hypothesized that Neurodiversity blogger Kathleen Seidel is literally “toxic,” due to an alleged brush with ethylmercury—an “occupational exposure to chemicals”—that, who knows, “triggered autism” in her……….

This is Dan Olmsted’s hypothesis, though one can’t but help noting that the post’s title, “Is Kathleen Seidel Toxic?”, has at least two meanings. The first meaning is that noted above—-that Seidel is “toxic” (like autistic children who “become” autistic due to mercury poisoning or some such)—-and the second is that she’s “toxic” in a more metaphorical sense, insofar as her extremely-well-researched and thought-out posts on Neurodiversity have exposed the anti-vaccine/pro-vaccine-safety advocates to some trenchant scrutiny. Seidel is also featured in Dr. Offit’s new book, and was featured as well in a New York magazine article on neurodiversity. She’s indeed been rather “toxic” (in a figurative sense) to the vaccine-autism hypothesis, and to the purveyors of a number of biomedcal and alternative, and often experimental, treatments for autism; Seidel has strongly objected to the detrimental effects of calling autistic persons “trainwrecks” or “poisoned” or “tragedies.” (And here’s more about toxicity.)

Seidel’s scrutiny of vaccine litigation and alternative treatments for autism is much-needed. Of course, families will choose the treatments that they discern are best for their child, but it’s not so easy to evaluate claims of what works and what does not, and when a quack is quacking. Take something as apparently innocuous as organic food: Talk About Curing Autism (TACA) indeed suggests that “considering and going organic is another important step in this process for better eating, health, and digestion.” Then one reads history professor James E. McWilliams in the September 8th Slate about how organic agriculture might be polluting food with heavy metals:

Scientists have known since the 1920s that organic fertilizers used by farmers to supplement conventional systems—composted animal manure, rock phosphates, fish emulsions, guano, wood ashes, etc.—further contaminate topsoil with varying concentrations of heavy metals. Organic advocates, who rely exclusively on these fertilizers, remain well aware of the problem today, although they rarely publicize the point.

No one is saying that organic soil has higher heavy-metal counts than conventional soil as a rule—scientists have not conducted enough research to make such a determination. Still, some evidence indicates that organic soil can, in some cases, be more contaminated. George Kuepper, an agriculture specialist with the National Center for Appropriate Technology, observed in a 2003 report that composting manure actually concentrates the fertilizer’s metal content, which could lead to greater levels of the contaminants in organic soil.

So even while, as TACA says, “these [organic] foods do not contain nasty chemicals added during the growing process,” something—even “heavy metals” of the type some talk about “detoxifying” a child of—may still be present in organic food (which maybe is not exactly “better” for us). There’s more than meets the eye, and the label.

When the talk is about autism, there’s been enough time devoted to arguing for and refuting hypotheses of vaccines as linked to autism. Dr. Offit’s Autism’s False Prophets traces the history of this hypothesis, now in decline. What is not, of course, in decline is the number of children and adults diagnosed with autism. Understanding and awareness of autism—what it is, how to teach autistic persons—have also been growing in the past decade. These are growth trends that are not about to stop, and we need to keep calling for more and better educational supports and services, for schools and schools programs, for job-training, actual jobs, actual housing, and many other services and suports for autistic person, throughout their lifespan.

You’ve got a chance to say what you think about autism services to the Interagency Autism Coordinating Committee (IACC): Send in comments about autism services by September 19, and send in comments about the draft of the Strategic Plan for ASD Research by September 30. Sullivan on Left Brain/Right Brain has also taken a closer look at the Strategic Plan (which you can see here).

We don’t want our kids to be the losers in the vaccine-autism debate, but they and we can lose out on a lot if so much attention remains fixated on this one hypothetical cause of autism. I could care less about taking home any awards, but I’m not interested in my son being a loser when so much is at stake—-and yes, I’ll keep on talking.