By Jake Crosby
March 13, 2010 http://www.ageofautism.com
Cold-Blooded Lies
3 Year Olds, A
Reliable Age For The Final Cohort?
Mercury in Retrograde?
Continuing Increases?
The role of changing
methods in California
Erasing the trail
on the California autism data
The Media and the
CDC’s Disinformation Campaign
In Canada, Eric
Fombonne, a
psychiatrist with ties to Sanofi-Pasteur, who is not even an epidemiologist,
conducted his own combined thimerosal-MMR study on a school district in
Montreal, and it was a total failure. His claim that autism rates went up after
thimerosal was removed rested entirely on the Kindergarten cohort, for which
enrolment was optional, so only about half the kids out of the total enrolled.
However, all the children with autism enrolled because the school provides many
services to autistic children. In fact, the school district Fombonne studied has
an autism center for excellence, and even draws children with autism from other
districts. Had enrollment been mandatory, the estimated prevalence would have
dropped by one-half, indicating a decrease rather than an increase. According to
biochemist Dr. Paul G. King, this is what is called “negative enrollment bias.”
Furthermore, there was also thimerosal exposure during the years where exposure
was labeled “nil.”
His MMR data were no more reliable. Instead of using local MMR immunization
rates to compare to autism rates, he used immunization data from Quebec City,
145 miles away. Even though the Cochrane Collaboration had this to say about his
previous MMR study from 2001, "The number and possible impact of biases was so
high that interpretation of the results was difficult," and even though the
collaboration included a person who also acted as a legal consultant to MMR
manufacturers, such discrediting apparently has not stopped Fombonne from doing
more completely flawed, post-marketing research.
But back to thimerosal, because just two years ago, Robert Schechter and Judith
Grether of the California Department of Public Health accessed the records of
the California Database for Evaluation and Research (CDER) of the California
Department of Developmental Services in children ages 3-5. The purpose was to
see if autism rates had declined after the supposed removal of thimerosal from
vaccines. According to Schecter and Grether's analysis, they hadn’t. Using their
interpretation, the two researchers determined that thimerosal must not be a
primary cause of autism, in a study published in the Archives of General
Psychiatry entitled “Continuing Increases in Autism Reported to California’s
Developmental Services System: Mercury in Retrograde.” However, their own
errors, it now appears, contradicted their conclusions.
3 Year Olds, A
Reliable Age For The Final Cohort?
The very last cohort the study looks at are 3 years olds, which already is not a
sufficient age group to base any conclusions from, as they would be hopelessly
premature. This is especially relevant to point out because Schechter and
Grether suggest that the first full thimerosal-free year was 2003, yet this was
the final birth year fully studied, and children born during this year would
have been diagnosed the earliest for reasons that will be explained later.
Moreover, the claim that children received no more exposure to thimerosal after
2002 is not true either. Expiration dates on many of the vaccines that contained
thimerosal were well after 2003. Furthermore, unpublished statistics show that
there were sharp increases in thimerosal exposure from flu shots given to
infants and pregnant women, while other sources of mercury exposure further
confound the study’s conclusions.
Even if the premise for this study had been correct, that thimerosal was removed
in 2002, it is still inherently flawed by the fact that its conclusions that
thimerosal and autism are unrelated are based on one birth year of very young
children (three year olds born in 2003), which is only the beginning of when
autism cases start getting filed into the DDS CDER archives. Drawing any
conclusions from this age group alone would be a false hope.
Perhaps recognizing this problem, the authors then proceed to combine cases
designated as three years of age with those ages four and five, but this only
adds to the problem, creating a simple ascertainment bias that would make the
designated 3 year old age group, by virtue of having less time to enter the
system, smaller than the group labeled as four years old, which would in turn be
smaller than the age group labeled as 5 years of age. This is especially
important because older kids would have been more likely to receive greater
quantities of thimerosal than younger kids. Yet they are all combined into one
whole age group from which to draw conclusions based on prevalence.
Mercury in Retrograde?
This relates primarily to the less quantifiable problems in relation to autism
rates, which were issues with elemental mercury exposure from amalgam fillings,
methylmercury exposure from coal-burning facilities, the remaining childhood
vaccines preserved with thimerosal that were not taken off the shelves, and for
that matter thimerosal exposure from the flu shot while exposure from other
vaccines was being reduced.
Complicating this further is the fact that there seems to be no consensus on
when the first year routinely recommended vaccines truly contained no thimerosal
preservative. Schechter and Grether said the preservative was all gone from
vaccines in the middle of 2002, citing the IOM Report. However, all the IOM said
was that the ACIP gave an “expressed preference” that all thimerosal be removed
by 2002, hardly reflective of actual thimerosal content in vaccines. The FDA
said the last lots preserved in thimerosal expired at the beginning of 2003, but
the Council of State Governments said it was early 2004, while parents have
found vaccines on the shelves of doctor’s offices with expiration dates that
surpass all these years. So no one really knows.
On top of all this, the parallel increase in uptake of flu shots, like those
during pregnancy, may contribute to earlier onset autism, due to earlier
exposure, and therefore contribute to the disorder being diagnosed earlier.
Unfortunately, there is no available immunization data for prenatal flu shots.
What is available, however, is the immunization data for the rate of postnatal
flu shots among children ages 6-23 months of age, as reflected among clients
enrolled in the Northern California Kaiser HMO, which jumped from 5% during the
2001-2002 influenza season, to 45%, in the following season. By winter of
2004-2005, 57% of 6-23 month olds were getting flu shots, practically all of
which were preserved with thimerosal. Data for pregnant women are not available,
but they were also a target group for flu vaccines in the same period.
Continuing Increases?
That is the final and main problem I found with this paper, which has been used
to support the untrue claim that autism rates have continued to go up. First,
the claim that prevalence of autism was counted in 3-5 year old children is
misleading. Schecter and Grether’s estimates of age rely on subtracting the year
of birth of the child from the year the child is currently enrolled as an active
client, but that does not mean the child really is that age For example, I was
born in 1988, so by Schechter and Grether’s counts I would be 22, but I’m
actually 21. So many children are getting counted as older than they really
were. Many children labeled as four years old are actually three and many
children labeled as five years old are actually four, and roughly half the five
year olds are not included but actually classified in with children six or
older. Children in the studied age group could be as old as five, but that’s not
the same as including the entire five year old age group.
So the Schecter and Grether study only fully accounts for 3 and 4 year olds; the
only other study I can recall which looks at children that young is the infamous
Verstraeten study. This is key, especially since during the years it looked at
the rates after thimerosal "removal" (which is also dubious), the California
Department of Developmental Services’ regional centers made changes that may
artificially skew autism clients, especially those in the youngest age groups,
towards an upward trend.
According to a CDDS report “Controlling Regional Center Costs:”
“Responding to this concern (increasing autism rates), the Legislature enacted a
requirement for the Department to develop evaluation and diagnostic procedures
for the diagnosis of ASD and to develop a training program for regional center
clinical staff in the utilization of the diagnostic procedures. These procedures
were published in 2002.”
See
HERE.
So, now the youngest possible autism age groups in the CDER archives of the CDDS,
3 and 4 year olds, the only ones Schechter and Grether fully account for, are
heavily biased. Not only would developing procedures for diagnosis skew autism
figures towards the youngest children, but also since they are done at reporting
centers, children may now enter the DDS system as soon as they are diagnosed.
This will mean the proportion of younger children to older children with autism
will shoot way up, and that is exactly what we see in the Jaunuary 2009 Hertz-Picciotto
study published in Epidemiology, where starting in 2002, new cases of autism in
the CDDS of children ages 0-4 go up linearly but the rate for children ages 5-9
starts to flatline. It also means that, amidst all this, the increasing
proportion of total numbers of new cases, assuming the autism rate were to
continue to remain the same, must also balance out with the total number of
cases leaving the system as well as the decreasing proportion of older children
entering the system. So changes in the youngest clients would still be reflected
indirectly in total new autism cases, as they are all part of the same system.
As a result, looking solely at autism rates in the youngest children does not
give the full picture.
What does, however, are the results obtained by Dr. Mark Geier, a fellow of the
American College of Epidemiology, and his son David Geier, when they analyzed
both the Vaccine Adverse Event Reporting System of autism-related adverse events
and the California Department of Developmental Services data of total new autism
cases and found a decrease in both, according to a study entitled “Early
Downward Trends in Neurodevelopmental Disorders Following Removal of
Thimerosal-Containing Vaccines,” published in the Journal of American Physicians
and Surgeons.
Not only that, the CDDS graph of autism (page 12) from this study provides
further evidence for early diagnosis bias in the Schechter and Grether paper. An
increase in the proportion of younger children who enter the system, namely
three, four and some five year olds who are the youngest clients enrolled in the
CDDS CDER database, while it may positively affect the reporting system overall,
would still mean that there would have to be a corresponding decrease of older
children with autism being enrolled to the system; that would be offset by an
acceleration of younger cases if rates were to remain stagnant, and as a result
cause a stagnation in the number of new cases. New autism cases would also have
to offset the increasing numbers of older cases reported from previous quarters
leaving the system, if they do, then the autism rate has not gone down.
However, this is not the case based on the fact that the increase in prevalence
among 3-5 year olds from 1995 to 2007 in Schechter and Grether is a straight
line maintained at a constant rate, not an accelerating curve as would be
expected with younger children entering the system, likely due to thimerosal
removal. Further evidence for this can be seen from Figure 3 of Geier et al.,
showing the scatter plot of total new autism cases entered to the CDDS, which
shows a downwards trend beginning in early 2002.
See HERE.
To be fair, however, the Geiers' study drew some criticism. Critics claimed the
decrease was the result of state law that went into effect in mid 2003. However,
the change in trend noted by the Geiers began in early 2002.
The role of changing
methods in California
Those who use the California DDS data to exonerate thimerosal's role in autism
will point to changes in the state law in 2003 that raised demands of those
being served by CDDS, saying that clients must show “substantial disability” in
three or more areas of life because the state was facing a budget crisis, and
that therefore, the California database was if anything, taking fewer cases than
it would have.
This, however, is unlikely to have made an impact on cases of full-blown autism
admitted to the system, the only autism spectrum disorder for which this new law
applied. Rick Rollins, autism parent and cofounder of the UC Davis MIND
Institute, says “children with full syndrome autism generally fail in at least 3
and as many as 6 of the areas of 'major life activities' as defined above,
therefore one would expect that autism would be the least impacted of all the
categories by the new, additional requirements for eligibility.”
Furthermore, if one were to believe these changes have a significant impact on
the reporting of full-blown autism at all, one would expect a disproportionately
lower growth in full-blown autism as compared with Aspergers and PDD-NOS, since
the “substantial disability” criteria only applies to classic autism between the
years of 2002 and 2007. However, growth for autism compared with other ASDs for
which “substantial disability” criteria does not apply increased at
approximately the same rate during this period. (page 27):
See HERE.
Then there are the changes that took place in the CDDS in 2002 that culminated
in the emergence of early diagnosis and evaluation policies for ASDs that had
not previously existed, that would positively skew the numbers of autism
spectrum disorders enrolled in the database, especially in the youngest
children. This is far more likely to bias the database in a positive direction
than requiring extra proof of “substantial disability” in cases with classic
autism, which is already a substantial disability.
While I have previously speculated that increased exposure to thimerosal from
flu shots plays a role, the results are likely to be primarily due to drastic
administrative changes as stated before in reference to the 2007 Report
“Controlling Regional Center Costs.” The budget crisis that had been going on
during this time period, if anything, caused the Department to divert more funds
to early diagnosis and intervention programs for autism, given that autism has
increased at a much higher rate than the other disabilities the system keeps
track of. This change to the CDDS database came as a result of a state law
passed the year before in 2001, the most widely cited year for alleged
thimerosal removal.
Even slight fluctuations in the average age of diagnosis alone can have a major
impact on autism rates in young ages. In Denmark, for example, in a study
published in the Archives of Pediatrics and Adolescent Medicine entitled “Autism
Prevalence Trends Over Time in Denmark: Changes in Prevalence and Age at
Diagnosis,” a drop in the average age of autism diagnosis from 5.1 to 4.7 was
attributable to a 37% autism increase in 3 year olds while the drop in the
average age of ASD diagnosis from 5.9 to 5.3 as attributable to a growth of 66%
in 3 year olds. Even modest shifts in the average age of diagnosis can have a
huge impact on autism in the youngest age groups. So the change in age of
diagnosis definitely would have impacted the studied age groups of 3, 4 and some
5 year olds. (19047542[PMID])
See HERE.
However, it should be noted that one of the study’s authors, Poul Thorsen, had a
hand in one of the previous studies from Denmark “exempting” thimerosal, and
another equally flawed study attempting to do the same with the MMR vaccine. He
is currently under criminal investigation, facing possible charges of fraud and
forgery.
Erasing the trail
on the California autism data
Just as egregious was when the CDDS changed its reporting mechanisms in 2008 in
a big way, which would include many more cases, one week before the Schecter and
Grether study was published. This meant that the database from there on out
would be unusable to track the autism rates to determine if there would be a
decline any time soon. This had a profound impact on the monitoring of autism
cohort systems in California, ultimately leading up to their closure for autism
surveillance, This occurred one week before the publication of this premature
and totally biased study looking at the autism rates in the CDDS. Such a
sequence of events raises considerable doubt about the integrity of the
research.
This was not unlike when the CDC blocked off all access to the Vaccine Safety
Datalink Project after December 2000, after which, presumably, the thimerosal-phase
out began. A fact worth noting is that these results are also consistent with
the words of an anonymous CDC monitor who was quoted in “Evidence of Harm” by
David Kirby as saying that the autism rate in the Vaccine Safety Datalink was
going down during thimerosal reduction.
Even before this study, however, the California Department of Health has proven
it is not credible, especially its immunization branch. The CDC funds it, and
when this study in California was being done, Robert Davis was head of the
Immunization Safety Office; he also helped Epidemic Intelligence Surveillance
officer Thomas Verstraeten eliminate the relative risks with each draft of his
study.
Robert Schechter, the lead author, is merely the successor of Loring Dales who
did the glaringly flawed study from 2001 that tried to clear the MMR vaccine in
a similar fashion. This study was later criticized for not having sufficient
power to detect an association if one were to exist, according to a later study
in 2002 by Madsen et al. which also attempted to exonerate the MMR, but omitted
many children who received the MMR vaccine and developed autism because they
were too young to be diagnosed. The 2001 California study also included Natalie
Smith, then head of immunization in California, in its list of coauthors, as
well as an attendee to the illegal Simpsonwood Meeting in June 2000 where
officials discussed bringing down statistical connections between thimerosal and
neurodevelopmental disorders while hiding data from the public.
The second author of the California thimerosal study, Judith Grether, prior to
joining the California Department of Public Health was an epidemiologist for the
March of Dimes, a charity founded on the premise of developing an effective
polio vaccine. She coauthored a paper in 2002 with Lisa Croen of the Health
Management Organization, Kaiser Permanente, to argue against a real rise in
autism. Croen and Grether later retracted their findings after having their
errors were pointed out to them by a research team led by Mark Blaxill, along
with fellow autism father and professor of neurosurgery Dr. David Baskin of the
Baylor College of Medicine and McGill epidemiologist Professor Walter Spitzer.
Ultimately, affiliations and prior discrediting on autism research makes it not
surprising that the coauthors, Schechter and Grether, ignored a major artificial
bias that would turn a decrease, especially in the youngest cases,
post-reduction of thimerosal into an increase, not unlike the Denmark studies,
the Swedish data, or Eric Fombonne’s “study.” The public’s knowledge of the
thimerosal-autism link has been greatly skewed ever since.
The Media and the
CDC’s Disinformation Campaign
Purveyors of spreading this misinformation include Eric Fombonne, who wrote a
complementary article to this study entitled “Thimerosal Disappears But Autism
Remains.”
Another familiar misinformant is Arthur Allen, author of “Vaccine: The
Controversial Story of Medicine’s Greatest Lifesaver,” having written on his
blog, "The most convincing evidence comes from California, where the number of
3-to-5 year old children diagnosed with autism has doubled over the last five
years, although children now being diagnosed with autism received little or no
thimerosal-containing vaccines."
In The Los Angeles Times, Michael Fumento, a freelance writer noted for his
strong industry connections, just wrote in a February 5, 2010 piece,
“Anti-vaccinationists initially claimed California autism cases dropped. False.
The ‘data do not show any recent decrease in autism in California’ despite the
discontinuation of thimerosal use, the state's Department of Developmental
Services found in 2008.”
Meanwhile, Gardiner Harris writes in The New York Times, “Because of concerns
over the preservative, vaccine makers in 2001 largely eliminated thimerosal from
routinely administered childhood vaccines. But
this change has had no apparent impact on childhood autism rates.”
USA Today also repeats this inaccuracy, claiming “autism rates continued to rise
after Thimerosal was removed from virtually all child vaccines in 2001,” even
linking to Schechter and Grether’s completely flawed study.
This myth has even trickled down to academia and is currently being taught in
universities. According to my own textbook, “Human Genetics” by Ricki Lewis,
“Scientific evidence does not support a link to the mercury compound once used
in vaccines-autism has increased since that ingredient has been removed.”
Even worse, the California Department of Public Health study is widely cited to
claim that thimerosal is safe, and therefore fine to leave at preservative
levels in seasonal flu shots routinely recommended for pregnant woman and
children, despite the fact that the thimerosal exceeds EPA safety limits.
In fact, last January the CDC launched a press release to encourage pregnant
women and children to get the multi-dose H1N1 vaccine that also contains the
preservative. The last section is titled, “Research Shows No Link Between
Thimerosal and Autism.” The last sentence of this reads, “In fact, sadly, autism
rates have actually gone up since thimerosal was taken out of childhood vaccines
in 2001, providing further evidence that thimerosal-containing vaccines are not
related to autism.”
What is truly sad is that this big hungry lie continues to be repeated in order
to justify the population-wide poisoning of countless infants and fetuses.
--
Jake Crosby is a college student at Brandeis University who is
double-majoring in History and Health: Science, Society and Social Policy, and a
contributing editor to Age of Autism.