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David Kirby and the government “concession that vaccines cause autism”: The incredible shrinking causation claim

I didn’t want to blog about this. I really didn’t.

No, the reason why I didn’t want to blog about this latest screed by mercury militia enabler David Kirby is not because it is about any sort of slam-dunk proof that vaccines do after all cause autism, a mistaken impression that you might get if you just looked at the crowing throughout the antivaccination blogosphere. Rather, it’s because I’ve been forced once again to wade through Kirby’s smug, self-congratulatory, and intentionally obfuscatory prose to try to figure out just what the hell he was talking about and then try to make sense of the actual story that he is crowing about and the nine questions in boldface he oh-so-triumphantly asks.

It’s enough to drive a skeptical blogger to throw up his hands. Fortunately, this skeptical blogger is made of sterner stuff (although I did refrain from the temptation to blog about this immediately), and it’s worth delving into the muck that is David Kirby’s purple prose because it realizes just how much the antivaccinationists have allowed their claims about vaccines and autism to shrink from what they were saying just a few years ago.

What has Kirby all hot with excitement is a report that on November 9, 2007, the government conceded one of the vaccine injury cases in the Autism Omnibus. Before I deal with Kirby’s premature gloating, I thought a little background would be in order. As you may recall, the Autism Omnibus is the name given to a huge case in which nearly 5,000 parents who believe their children’s autism was somehow caused by vaccines are applying to the Vaccine Injury Compensation Program (VICP). In the proceedings, overseen by Special Masters, several “test cases” were chosen, the first of which was Michelle Cedillo. The rulings on the plausibility of whether vaccines caused the autism of the plaintiffs in these test cases will determine whether the remaining thousands of cases can go forward. One thing that you should definitely remember when reading David Kirby’s blather is that we are talking about legal plausibility, not scientific plausibility here. The way the Autism Omnibus proceedings are set up is to make the bar that the plaintiffs must jump with the evidence quite low, specifically on the legal standard of plausibility, which in essence means “51% probability,” or, as one lawyer for the families called the standard “50% and a feather.” Also remember that the entire VICP is set up to compensate any injury clearly caused by a vaccine. This is the case even if the evidence is not clear cut enough to meet a strictly medical or scientific standard. Indeed, let’s take a trip back in time to June to see what I said about the Omnibus when it first started:

The problem is that scientific and epidemiological evidence ultimately may not matter in this case. As Steve Novella points out, there is history to support a pessimistic viewpoint regarding the ultimate outcome of the Autism Omnibus, specifically the case of silicone breast implants and their alleged link to autoimmune disorders and cancer. Based on poor quality studies purporting to show a correlation between these implants and a wide variety of autoimmune diseases, hordes of activists waged legal war against Dow Corning, in essence suing it into bankruptcy. More recent studies fail to find a link between silicone implants and autoimmune disease. Certainly, there are risks of local complications, such as implant rupture and capsular contracture, but the risk of connective tissue disorders and autoimmune disease is not elevated in women with silicone implants.

If you think the same thing that happened with silicone breast implants can’t happen with vaccines, think again.

I hope I wasn’t prophetic.

Be that as it may, it is not in the least bit surprising that the government has agreed to settle one case so far. Even so, just because the standard of evidence is so low doesn’t mean there might not be a link in this particular case. Consequently, it’s reasonable to ask if there indeed was anything in this case that is strong evidence that vaccines cause autism. In other words, we want to know if this case is, as the ever-histrionic and ever-idiotic Kent Heckenlively gloats, evidence that: “The sky has fallen. The fat lady has sung. Pigs are flying.” or that “The government just dropped its pants.” Let’s just say that the best thing that can be said about Kent is that his commentary on this case is less over-the-top than it was when he wrote about toxins in vaccines. But only barely.

But let’s get back to David Kirby, who begins:

After years of insisting there is no evidence to link vaccines with the onset of autism spectrum disorder (ASD), the US government has quietly conceded a vaccine-autism case in the Court of Federal Claims.

The unprecedented concession was filed on November 9, and sealed to protect the plaintiff’s identify. It was obtained through individuals unrelated to the case.

The claim, one of 4,900 autism cases currently pending in Federal “Vaccine Court,” was conceded by US Assistant Attorney General Peter Keisler and other Justice Department officials, on behalf of the Department of Health and Human Services, the “defendant” in all Vaccine Court cases.

The child’s claim against the government — that mercury-containing vaccines were the cause of her autism — was supposed to be one of three “test cases” for the thimerosal-autism theory currently under consideration by a three-member panel of Special Masters, the presiding justices in Federal Claims Court.

Keisler wrote that medical personnel at the HHS Division of Vaccine Injury Compensation (DVIC) had reviewed the case and “concluded that compensation is appropriate.”

The doctors conceded that the child was healthy and developing normally until her 18-month well-baby visit, when she received vaccinations against nine different diseases all at once (two contained thimerosal).

Days later, the girl began spiraling downward into a cascade of illnesses and setbacks that, within months, presented as symptoms of autism, including: No response to verbal direction; loss of language skills; no eye contact; loss of “relatedness;” insomnia; incessant screaming; arching; and “watching the florescent lights repeatedly during examination.”

Seven months after vaccination, the patient was diagnosed by Dr. Andrew Zimmerman, a leading neurologist at the Kennedy Krieger Children’s Hospital Neurology Clinic, with “regressive encephalopathy (brain disease) with features consistent with autistic spectrum disorder, following normal development.” The girl also met the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) official criteria for autism.

I first have to wonder where Kirby got a copy of a “sealed ruling” that was sealed to “protect the plaintiff’s identity.” Courts generally don’t look kindly on a journalist publishing excerpts from a sealed ruling, especially when the ruling concerns a minor. Even worse, that propaganda organ for the mercury militia, Age of Autism, has posted the entire ruling. Reading it, given the unusually close correlation between the last round of vaccines and the permanent deterioration involved, I think the case may well represent a rare true vaccine injury. Be that as it may, it allows us to examine the ruling and determine that Kirby is playing semantic games with it to make it sound as though the government is making some sort of bombshell of a concession, as a brief summary of the case will demonstrate.

Basically, the plaintiff (noted as “CHILD” in the ruling) was born in December 1998 to a mother who suffered from gestational diabetes. The child received her normal vaccines (listed in the ruling) without incident. At seven months of age, the child developed the first of bouts of recurrent otitis media that ultimately required the placement of tubes. Because of the child’s recurrent otitis media, the mother didn’t allow her child to be vaccinated with standard 12 and 15 month vaccines. Through it all, the child met the normal developmental milestones through the first 18 months of her life and showed no signs of autism or ASD. At the July 19, 2000 examination, the child received the DTaP, Hib, MMR, Varivax, and IPV vaccinations. Two days later, the child developed a fever to 102.3° F, exhibiting a high-pitched scream and a decreased reaction to stimuli. During the next few months, the child had several visits to her pediatrician due to fevers, rashes, and bouts of otitis media requiring tubes again. By November, the child had been noted to have lost some language skills. To make a long story short, the child was diagnosed with an “encephalopathy progressed to persistent loss of previously acquired language, eye contact, and relatedness.” Ultimately, a metabolic disorder, specifically a mitochondrial disorder was suspected, and ultimately confirmed through genetic testing, which showed “a mitochondrial DNA (“mtDNA”) point mutation analysis revealed a single nucleotide change in the 16S ribosomal RNA gene (T2387C).” As part of her course, the child also developed a seizure disorder.

Ultimately, the government concession read:

In sum, DVIC has concluded that the facts of this case meet the statutory criteria for demonstrating that the vaccinations CHILD received on July 19, 2000, significantly aggravated an underlying mitochondrial disorder, which predisposed her to deficits in cellular energy metabolism, and manifested as a regressive encephalopathy with features of autism spectrum disorder. Therefore, respondent recommends that compensation be awarded to petitioners in accordance with 42 U.S.C. § 300aa-11(c)(1)(C)(ii).

In other words, Kirby’s wrong when he implies that the government conceded that vaccines cause autism, and the ever-excitable Kent Heckenlively is totally wrong when he out and out says it. All the government conceded was that it is more likely than not (remember the “50% and a feather” rule) that vaccines aggravated an underlying mitochondrial disorder (almost certainly genetic) that manifested itself as a regressive encephalopathy that had features of ASD. Also remember the purpose of the VICP. It is not to determine whether or not vaccines cause autism; it is to compensate families whose children were injured by vaccines, regardless of what the specific injury is.

I had contemplated marching dutifully through all nine of Kirby’s questions but decided that it would be an exercise in futility. The reason is that Kirby’s article is nothing more than one huge moving of the goalposts buried under his characteristic clever verbiage. Indeed, it’s evidence of just how far the mercury militia has fallen and the claims of the antivaccinationists regarding vaccines and autism have shrunk from its days less than three years ago when it was being confidently stated by David Kirby and friends that mercury in vaccines is the One True Cause of autism. Let’s remember what the full title of Kirby’s book was: Evidence of Harm: Mercury in Vaccines and the Autism Epidemic, a Medical Controversy, not Evidence of Harm: Vaccines Aggravating a Rare Preexisting Genetic Mitochondrial Disorder and Causing a Condition That Mimicks Autism. As for the rest of the mercury militia, J.B. Handley’s Generation Rescue used to say with utter confidence that “childhood neurological disorders such as autism, Asperger’s, ADHD/ADD, speech delay, sensory integration disorder, and many other developmental delays are all misdiagnoses for mercury poisoning.” It then shifted the goalposts to say, “We believe these neurological disorders (“NDs”) are environmental illnesses caused by an overload of heavy metals, live viruses, and bacteria.” Now he’s crowing in the comments of Age of Autism that this ruling is the “single largest bombshell in the history of the vaccine-autism fight.”

Let’s see. The court ruled that a child with a rare mitochondrial disorder may have been injured by vaccines with, among other consequences, and encephalopathy that resembles ASD, a case that’s likely to apply to a very small number of children, and J.B. Handley is gloating about how it is such a huge bombshell? Here’s a hint: The court did not rule that vaccines cause autism. As for the ever-loquacious David Kirby, if you want to get an idea of how much he has moved the goal posts and isobfuscating what is likely the true import of this ruling, you only have to check out some of his own article:

Another article, published in the Journal of Child Neurology and co-authored by Dr. Zimmerman, showed that 38% of Kennedy Krieger Institute autism patients studied had one marker for impaired oxidative phosphorylation, and 47% had a second marker.

The authors — who reported on a case-study of the same autism claim conceded in Vaccine Court — noted that “children who have (mitochondrial-related) dysfunctional cellular energy metabolism might be more prone to undergo autistic regression between 18 and 30 months of age if they also have infections or immunizations at the same time.”

It’s difficult not to note that the child in the concession had not just immunizations, but a history of multiple infections. Another example of Kirby’s obfuscatory prestidigitation:

For most affected families, such linguistic gymnastics is not so important. And even if a vaccine injury “manifested” as autism in only one case, isn’t that still a significant development worthy of informing the public?

Except that this vaccine “injury” didn’t manifest itself as autism, at least not the classic common variety that has been increasingly diagnosed since the early 1990s.

More amusing and also annoying is how, after Kirby admits that mitochondrial disorders are “rare in the general population, affecting some 2 in 10,000 people), he goes on to do what he would probably call a thought experiment but what I would tend to call “making shit up” in which he speculates about how many children with autism or ASDs have mitochondrial disorders. Of course, the articles that he cites do not support the implication behind his other speculations that these mitochondrial diseases plus vaccines lead to autism, nor does his pointing out that dubious biomedical interventions for autism resemble interventions for mitochondrial disease support his obvious implication that there must be something to these “treatments.” Finally, as Kristina Chew so astutely points out, this article is also nothing more than another example of David Kirby’s trying to redefine autism so that he doesn’t have to admit that his “great” accomplishment, the book that made him a god among the antivaccinationists, is looking increasingly ridiculous in light of several studies failing to find the strong link between vaccines and autism claimed by the mercury militia, antivaccinationists, and their apologist, David Kirby:

From here, Kirby posts his nine questions, suggestively speculating that there might be a connection among “vaccines, mitochondrial disorders and a diagnosis of autism, at least in some cases” and going so far as to suggest that some type of “vaccine aggravated mitochondrial disorder” is “mimicking” autism–just as, a year ago, Kirby speculated that what we call “autism” in children with various gastrointestinal symtoms is not “autism,” but (Kirby’s neologism) “Environmentally-acquired Neuroimmune Disorder” or “E.N.D..”

It is no surprise that Kirby keeps on making up elaborate names for some disease “mimicking” autism: I’ve read his book and numerous essays and blog posts and interviews, and each time am left with the sense that he indeed is not talking about autism. Kirby’s writings are packed with scientific references and just enough jargon, with a kindly phrase interwoven to acknowledge the suffering of those with autism and of those who take care of him. But I remain hard-pressed to find an actual reference, a basic description, of an autistic person in his writing, beyond (on and off last year) rather purplish descriptions of rivers of diarrhea spewn forth on carpets.

One thing that you should remember about Kirby’s pretty rhetorical flourishes and speculation. It’s all there to distract you from the utter failure of science to support the original claims of the mercury militia, namely that mercury in vaccines was the cause for most cases of autism, or, as Generation Rescue puts it, that autism is a “misdiagnosis for mercury poisoning.” Multiple large and well-designed epidemiological studies have utterly failed to find a link between mercury in vaccines or vaccines in general and autism. Indeed, the idea that vaccines cause autism is the incredible shrinking hypothesis. It’s gone from confident claims that mercury or vaccines cause nearly all cases of autism to a lot of handwaving based on one case conceded by the government in which the plaintiff had a rare mitochondrial disease which may have been aggravated by vaccines plus multiple bouts of inflammation due to otitis media, a far cry from previous cries blaming vaccines for an “autism tsunami.” Is it possible that in rare cases vaccines can aggravate a preexisting condition and lead to injury that resembles autism or ASD? Despite all the studies cited by Kirby in is speculations, what we really have is one documented case of a child in which childhood vaccines probably exacerbated a preexisting mitochondrial disease who later went on to meet the diagnostic criteria for mild autism; so it’s possible. It’s also a far cry from the original claims of the mercury militia. Don’t forget that. Also don’t forget that, no matter what new physiologic alterations or abnormalities are found in autistic children, antivaccinationists always–and I mean always–manage to find a rationale to link it to vaccines, no matter how tortured that rationale is.

Once again, it really is all about the vaccines, not finding the cause of autism and ways to ameliorate the cognitive problems associated with it.

Finally, if you’re still not convinced and think that this concession means that the government is really admitting that vaccines cause autism, ask yourself this simple question: If this case conceded by the government is such a slam-dunk piece of evidence that mercury in vaccines or vaccines themselves cause autism, why on earth did the plaintiff’s allow it to be dropped from the Autism Omnibus and settled? If, as Kirby implies and Handley and Heckenlively outright state, this case is slam-dunk, irrefutable evidence that vaccines cause autism so strong that the government couldn’t fight it, then keeping it in the Autism Omnibus as a test case would have allowed it to serve as a precedent that would provide a significant proportion, if not all, of the plaintiffs of the nearly 5,000 cases to follow a much better chance of obtaining compensatio? If this case is so damning, as Kirby et al imply that it is, would dropping it from the Autism Omnibus make any sense?

Maybe David Kirby or one of the other antivaccinationists crowing over this concession by the government can explain that one to me.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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