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Vaccines and autism: The incredible shrinking causation claim shrinks some more

Blogging on PseudoscienceI have good news and bad news for you.

First, the good news. The devastating death crud that has kept me in its grip for nearly a week now appears to be receding. For the first time, “whining” or not, I start to see the light at the end of the tunnel. Whether it’s due to PalMD’s kind offer of Pranic Healing or not, I don’t know, but things are on the mend.

And now the bad news. There will be no Friday Dose of Woo this week. The reason is simple. My mucus-laden head continues to pound, and my hacking cough continues to put me into an ill mood. This makes it very difficult to attain and maintain the appropriately light-hearted and jovial tone towards which I strive when I bring each week’s dose of amazing woo, and no one wants YFDoW to turn vicious. When that happens, it ceases to be fun.

On the other hand, my current not-quite-recovered state puts me in the perfect frame of mind to apply some richly deserved not-so-Respectful Insolence™ to David Kirby’s latest bit of antivaccination nonsense published the other day in that repository of antivaccination nonsense, The Huffington Post, entitled The Next Big Autism Bomb.

Suffice it to say that, as usual, the only “big bomb” here is the one that Kirby drops on science and logic. In fact, as per his usual M.O., Kirby carpet-bombs logic and science under a torrent of obfuscating verbiage designed to mask just how weak his arguments are. He probably thinks he’s delivered a thermonuclear blast to scientists and skeptics who tell him he’s full of crap, but in reality you’d be hard-pressed to hear a ladyfinger explosion there. In fact, I doubt it’s the equivalent of a sparkler, even. A wet, sputtering sparkler just before it fizzles out. If anything, it’s nothing more than part two of the incredibly shrinking causation claim and another desperate attempt to keep blaming autism on vaccines, despite all evidence failing to find a link.

Because Kirby, in his usual fashion, seeks to baffle with bullshit where he can’t dazzle with brilliance, before addressing other points I’m going to zero in like the proverbial laser beam on one key admission that comes near the end of the article. It’s an admission so buried in the mounds of Kirby’s usual verbal prestidigitation that it’s easy to let it slide by, even if you know that David Kirby is the author of Evidence of Harm: Mercury in Vaccines and the Autism Epidemic: A Medical Mystery, a book that three years ago contributed to massive fear-mongering about mercury in the thimerosal preservative in vaccines as a cause of autism. Since, then, as has been well documented by several studies, there has been no sign of a decrease in the incidence of autism now over six years since the last thimerosal-containing vaccines were taken off the shelf. Kirby’s been trying to dodge and weave about that originally saying that if we didn’t start to see a decline in autism rates by 2005 it would be a serious blow to the thimerosal hypothesis Of course, 2005 came and went without a decrease; so he shifted the goalpost back to 2007. Meanwhile, he started to strategically back away from blaming mercury in vaccines, going so far as to pull ridiculous excuses such as blaming mercury from the fillings of corpses cremated in California. 2007 came and went without a decrease. So most recently he shifted the goalposts back to 2011, declaring it a “tad premature” to vindicate thimerosal, while even still trying to speculate how he could revive the “thimerosal-causes-autism” gig that made him famous.

Now, here’s his admission:

And it might help explain why autism rates are not plummeting now that thimerosal levels have been significantly reduced in most childhood vaccines.

Got that? David Kirby admits that autism rates are not decreasing six years after nearly all thimerosal has been removed from childhood vaccines. Even he knows that the evidence is against the mercury militia. I suspect also that even Kirby realized how ridiculous his hand-waving blaming mercury in pollution from China or mercury in the fillings of corpses being cremated in California as the reasons why autism rates were not falling sounded. He knew he needed a new story. Thanks to the Hannah Poling case, he (and the rest of the mercury militia) found one. I will come back to that later, but the Poling case was clearly manna from heaven to rescue Kirby from what must have looked like the rest of his career (whatever his career is) wandering through the desert of crankery, and like a starving man Kirby latched onto it and fed deeply. The only problem is that in doing so, he excreted the results as pseudoscientific claptrap, and this is what we see in his Huffington Post opuses. In the meantime, remember that all of Kirby’s florid verbiage surrounding the above admission is nothing more than the desperate gasp of a man looking for a way to keep blaming vaccines for the autism “epidemic” in the face of increasingly incontrovertible science showing that they are not to blame.

Much of Kirby’s article consists mainly of anonymous quotes from people who supposedly were part of or listening in to a teleconference held earlier this month by the CDC. Apparently, it was convened to discuss the Hannah Poling case and whether mitochondrial disorders are part of the pathogenesis of autism. (My take on the question can be found here; so I won’t rehash it.) Kirby makes much hay of a number of sources who say lots of ominous things. Not surprisingly, these sources are all anonymous; not a single one is identified. Normally, I would not consider this that huge an issue, but this is David Kirby we’re talking about. For me to trust a journalist’s use of anonymous sources, I first have to trust that journalist. Kirby’s history is so replete with spreading misinformation, goalpost-shifting, and dubious statements that I just plain don’t trust him, and I think I’m quite justified in that mistrust. I have no way of knowing if this is the case, but it wouldn’t surprise me in the least if his “sources” are true believers, advocates who were included in the teleconference in the same way that antivaccinationists have been included on a major federal panel on autism. The point is that I have learned from bitter experience not to trust Kirby’s word alone on anything. If he told me it was raining outside, I’d be sure to look out my window to verify it before grabbing my umbrella.

The other part of Kirby’s article includes his rehashing two studies that he mentioned before and then going–shall we say?–a bit wild with speculations based on them. The first of these was a recently published study out of Portugal by Guiomar Oliveira et al. This study surveyed autism prevalence in mainland Portugal and the Azores, and children with a diagnosis of autism or autism spectrum disorder (ASD) were screened for associated medical conditions. They found that 20% of autistic children had associated medical problems, with what was reportedly a higher than expected incidence of mitochondrial disorders at 4.2%. This report appears to be basically a rehash of data from a study from 2005 in a group of 120 children with autism. After children with identified associated medical disorders were excluded, out of the 102 children, only 56 underwent the full planned investigative protocol, and only 69 underwent any sort of screening for mitochondrial disorders (lactate levels), of which 14 were found to be abnormal. Eleven ultimately underwent muscle biopsy (the definitive test for mitochondrial disorders) of which five were reported to have definite mitochondrial respiratory chain disorders. None of the children had any of the deletions or mutations in mitochondrial DNA tested for. If this study is reproducible (and others have not as far as I know reported anywhere near as high a level of mitochondrial disorders, at least not in any reports in peer-reviewed literature), once again, as I pointed out before it still doesn’t answer the question of whether such abnormalities are a cause of autism or an epiphenomenon. But that never stopped David Kirby from going off on wild speculations before.

Even worse is the second “study” that Kirby cites. Unlike the previous study, this study was not locatable on PubMed. In fact, the only link that I could find to it was here. It’s nowhere else that I could find. That right away gave me little confidence. Perhaps it was an abstract presented at a meeting. Whatever the case, it clearly hasn’t been published in the peer-reviewed medical literature indexed by PubMed, and its lead author doesn’t list it on his webpage. Kirby makes a great deal of this study, which claims to show that as many as 20% of autistic children have mitochondrial disorders. Of course, even if the study had been confirmed and published in the peer-revieweed literature, one caveat that would have to be made would be that this is a skewed population. The population is that referred to the Kennedy-Krieger Institute, which is known for its expertise in mitochondrial disorders. It would not be surprising that investigators at the KKI would find a much higher rate of such disorders than in the general population. Not only do they have the expertise to find them, but children with suspected metabolic disorders would be more likely to be referred there. And, once again, even if such an observation were replicated in a more general population, it would not answer the question of whether we are observing an epiphenomenon or not. Also, don’t forget that we don’t know how good the study was because we have only an abstract to look at. There is no detailed methods section to evaluate and no way to determine if the study is sound or a piece of crap. Again, none of these sorts of concerns have ever stopped David Kirby from going off on wild speculations before.

But before his speculations, Kirby couldn’t resist demonstrating his ignorance with this howler:

Another surprise came when one researcher announced an “inheritance pattern” that linked each case through the genetics of the father: In families where two cousins had autism, the genetic link was always through the father.

This unexpected discovery would clearly implicate nuclear DNA inheritance, and not mitochondrial DNA, which is inherited only through the mother.

Kirby announces this as though it meant anything. Here’s some news for Kirby: Not all mitochondrial proteins are coded for by mitochondrial DNA. Lots of them are coded by nuclear DNA, the same way every other non-mitochondrial protein in the body is. Finding a genetic mutation in the nuclear DNA involving a mitochondrial protein, defects in which can result in mitochondrial dysfunction, is entirely possible–even probable. Whether mutations implicated in individual types of mitochondrial disorders are in nuclear genes or mitochondrial genes says little about the mitochondrial dysfunction they cause, only about the mode of inheritance. Mentioning the possibility of paternal inheritance says nothing other than that whatever gene the KKI investigators claim to have implicated, it’s not a mitochondrial gene, although it apparently somehow codes for a mitochondrial protein.

But, again, that doesn’t stop Kirby from going off into the Twilight Zone of pure speculation gussied up with pretty prose to make it sound like something other than the B.S. that it is, starting thusly:

The mercury-containing vaccine preservative, thimerosal, for example, “can definitely kill cells in vitro through the mitochondria,” one teleconference participant told me. “And some people are beginning to suspect that the dose of hepatitis B vaccine given at birth might be interfering with proper mitochondrial function in certain children.”

It’s irrelevant whether thimerosal can kill cells in cell culture at high doses through the mitochondria. Once again, the dose makes the poison, and there is no evidence that thimerosal in the dose given in vaccines kills neurons in vivo, through the mitochondria or otherwise. This is nothing more than another attempt by David Kirby to keep a dead hypothesis alive. Moreover, pretty much any process that induces apoptosis will result in death through the mitochondria; the mitochondria are intimately associated with programmed cell death. In other words, so what? Kirby then proposes a “three hit” idea:

STEP ONE: Child is conceived and born healthy, but with an underlying nuclear DNA genetic susceptibility to mitochondrial dysfunction, inherited from dad.

TRIGGER ONE: An early environmental “adversity” occurs in the womb or during the neonatal period, perhaps caused by prenatal exposure to heavy metals, pollutants, pesticides and medicines. Or, it occurs in early infancy, through environmental toxins, thimerosal exposure, or even the Hepatitis B vaccine “birth dose.”

Note the convenient inclusion of an unspecified mix of “toxins” and “heavy metals,” plus the dreaded thimerosal prenatally. Anything to keep the mercury idea alive, you know! Also note his emphasis on paternal inheritance. There’s really no basis for that, given that the actual abstract he cites noted autosomal dominant inheritance, which, unless a sex-linked gene, does not imply that any susceptibility gene has to be inherited from the father. True, the abstract did mention transmission through male relatives, but I’m guessing that there was nowhere enough data in the family tree to conclude that this was a sex-linked gene. In any case, according to Kirby:

This trigger results in:

STEP TWO: Child develops mild, usually asymptomatic mitochondrial dysfunction (though I wonder if the ear infections and eczema so common in these cases might also be symptoms of mito problems).

TRIGGER TWO: Child, now with an underlying mitochondrial dysfunction, suffers over-stimulation of the immune system beyond the capacity of his or her metabolic reserves. This stress is either via a viral febrile infection, or from multiple vaccinations, as in the Poling case. This trigger results in:

STEP THREE: Acute illness, seizures, encephalopathy, developmental regression, autism.

Or, if someone with a rare genetic disorder gets a certain combination of vaccines when the moon is full, they might have a reaction that causes autism. Surely you can see the beauty of Kirby’s new hypothesis. It’s nowhere near as easy to falsify as the original mercury hypothesis. There are way more variables. Before, it was simply the mercury in vaccines, stupid. Or, as Generation Rescue used to put it, autism and ASD were all “misdiagnoses” for mercury poisoning. Very clear. Very concise. Of course, this concept had the inconvenient problem of making a clear cut and testable hypothesis: That autism rates should decline if thimerosal exposure is drastically decreased. Well, since late 2001, childhood exposure has been drastically decreased, and six-plus years later autism rates are not declining. That’s why we’re now treated to Kirby pulling calculations based on numbers from studies that have not been verified or replicated by other investigators, like this:

It remains to be seen how all this plays out. And many important questions still lie ahead.

For example, if mitochondrial dysfunction turns out to be as common as 200-per-10,000, and autism is now at 66 per 10,000, did anything bad happen to any of the other 134-per-10,000 children, apart from autism (i.e., ADD, ADHD, speech delay, etc.)?

Note that it’s hard to resist asking why Kirby assumes that children with autism are a subset of children with mitochondrial disorders. He seems to be assuming here that 100% of children with autism have mitochondrial disorders. But, wait, there’s more stupid to consider:

Moreover, if 10-20% of autism cases can actually be traced to an underlying mitochondrial dysfunction, then what about the majority of autism cases where this did not come into play?

And, if 20% of autism cases are mito related, and 6% of those cases regressed because of vaccines, that would mean that at least 1% of all autism cases were vaccine related. Some estimates of autism go as high as a million Americans – that would mean 10,000 people with vaccine-triggered autism, and billions of dollars in the cost of lifetime care.

This is just speculation on figures pulled out of Kirby’s nether regions and so loosely based on reality that Kirby should think of a career in science fiction. The figures are custom-designed to be as inflated as Kirby can possibly make them. Even taking that into consideration, think about just what this represents. This is nothing more than what Kirby’s been doing all along since the Hannah Poling case was announced. It’s nothing more than a full retreat from the claim that mercury in vaccines is a major cause of autism. The fallback has been amazingly far, all the way to “maybe somehow vaccines aggravate some rare underlying mitochondrial disorder to cause autism in some children.” Once again, Kirby’s pretty rhetorical flourishes and speculation are about nothing more than finding a way to seem relevant when he is not. They’re 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. They’re there to distract you from the existence of multiple large and well-designed epidemiological studies that have utterly failed to find a link between mercury in vaccines or vaccines in general and autism.

It’s worth repeating one more time that Kirby’s behavior is there to hide the fact that the idea that vaccines cause autism, an idea he once championed but has now clearly recognized as a loser, 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. Now Kirby’s dug up small studies, one published and one unpublished (and thus unevaluable), that claim that mitochondrial disorders may be more common in autistic children than in the general population and used them to come up with a tortured “three step” idea of autism causation that allows him to admit that thimerosal doesn’t cause autism while continuing to blame vaccines for at least some autism. It also allows him to cite wildly inflated estimates of how many children might be affected and to make up evidence-free recommendations about “numbers of antigens” that children should receive at one time.

Here’s the thing that, in all his verbiage, David Kirby hopes that you won’t notice: This strategy is in essence an admission of utter defeat of the mercury militia. Think about it. They’ve gone from claiming that mercury in vaccines was the prime cause of the “autism epidemic.” Now, even if you accept David Kirby’s hypothesis and his figures, at the very most and by Kirby’s own estimate only 1% of autism could possibly be vaccine-associated. That’s the highest estimate Kirby could come up with, even by torturing what little data there is. If that’s not defeat, I don’t know what is. I reiterate again that it is certainly worth studying whether there is a definite role for mitochondrial dysfunction in the pathogenesis of autism and ASD. However, the twisted web of causation proposed by Kirby is so far ahead of the science that it’s not just in another time zone, but I question whether it’s even on the same planet.

Of course, in the real world, there isn’t even any credible scientific evidence to support blaming even 1% of autism on vaccines. Science just doesn’t support it. So the question becomes: Why does Kirby bother? The reason, of course, is that it’s all about the vaccines. It always was all about the vaccines. It always will be all about the vaccines, no matter how often or how vociferously Kirby or any other antivaccinationist piously lectures you otherwise or tells you that they are really for “safe” vaccines. (As if scientists and physicians aren’t for safe vaccines!)

What really worries me about this new attention to mitochondrial disorders is not that they might actually implicate vaccines as a factor related to autism. As far as I’m concerned, the science will be done and the chips will fall where they may. What worries me is what the autism quackery industry will do with this. After all, the discredited idea the mercury in vaccines causes autism resulted in a huge cottage industry of quackery, the most popular form of which was chelation therapy for “detoxification” of the mercury that supposedly caused autism, a therapy that puts children at risk and has resulted in at least one death. It doesn’t take a psychic to predict that there will soon be all sorts of unvalidated “tests” for mitochondrial disorders marketed to parents with autistic children based on the idea that mitochondrial disorders plus vaccines somehow cause autism. Nor does one need to be a psychic to predict that autistic children will likely soon in large numbers be subjected to workups for mitochondrial disorders, up to and including muscle biopsies or even more invasive procedures or that all sorts of dubious “cures” for autism that claim to reverse mitochondrial dysfunction will be marketed to the parents of autistic children, just as chelation therapy and various other biomedical interventions have been in the past.

It also doesn’t require a psychic to predict that, assuming, as is likely, that science fails to find the smoking gun link that Kirby postulates here, he will happily move on to another tortured version of science that somehow, some way, manages to blame vaccines for autism.

That’s because, above all, it’s still all about the vaccines.

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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