Autism News Beat

Add Readers Digest to the growing number of media outlets that have criticized the anti-vaccine fringe. “Childhood vaccines save lives by preventing killer diseases,” writes Anne Underwood. “They’re not risk-free, but an immense amount of evidence says the risks do not include autism.”

The Trouble with Celebrity Science singles out three icons of our news and entertainment culture, and their causes célèbres: Oprah Winfrey (hormone replacement therapy); Jenny McCarthy (vaccine rejectionism); and Elizabeth Hasselback (gluten free diets). In classic RD fashion, the article sketches the background for each claim, efficiently outlines the scientific evidence against, and neatly summarized with a no-nonsense “Reader’s Digest version” of the best available evidence.

Missing is the false balance and credulous appeal to authority that is the staple of most mainstream media stories about autism. Clearly, the magazine that publishes “I Am Joe’s Duodenum” and “Humor in Uniform” can teach most journalists something about accurate science reporting.

In what is surely a sign of the coming apocalypse, anti-vaccine celebrity activist Jenny McCarthy has agreed to mind meld with Oprah Winfrey’s stable of talk show hosts. According to the Hollywood Reporter, McCarthy has signed a contract to join Winfrey proteges Rachel Ray and “Dr. Phil” McGraw. For now, she’s blogging about PMS and sugar at Oprah.com. Be afraid - be very afraid.

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Mary Ann Roser reports in the American-Statesman about the alleged insurance fraud and autism quackery at Austin’s CARE Clinic. Our friend Dr. Stephen Barrett at Quackwatch first warned us about CARE in February, in a post appropriately titled Be Wary of CARE Clinics and the Center for Autistic Spectrum Disorders. Roser’s piece stops short of warning parents, but she largely avoids false balance, making it clear there is no real science behind the “alternative treatments” employed by CARE:

The owner of an Austin-area clinic that treats children with autism — using techniques that are controversial in mainstream medicine — says investigations by three major insurers have left it with a pile of unpaid claims and a crisis: She’s had to lay off most of her staff and drastically reduce the clinic’s hours.

In addition, Kazuko Grace Curtin said the Texas Medical Board is investigating her medical director. She and the doctor — Jesus Caquias — say the investigation is a way of harassing them because they offer nontraditional care for autism patients.

This is a great piece of investigative journalism that will work in just about any major media market, where shady clinics lure parents with unproven and potentially harmful autism treatments. Insurance companies, says Rosen, are finally catching on.

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Dr. Ryan Coller takes no prisoners in his Sunday LA Times Op-Ed on the fabricated vaccine-autism link. The pediatrician and incoming chief resident at UCLA’s School of Medicine covers familiar ground, but it’s a message worth repeating:

It’s no wonder the public is confused, with competing celebrities saying vaccines do or don’t cause autism and a lot of media attention on the subject. Vaccines, like every medicine, can have real side effects. Autism, however, is not one of them. Though I believe those who decline vaccines are doing what they believe is best for their children, their fears about vaccines and autism are not only unsubstantiated, they have been fully refuted. There is no rational reason to put children in harm’s way by declining vaccinations.

We are retreating into illnesses that had nearly vanished, and we are stalling research progress by deferring enormous sums of money to dismantle autism/vaccine theories and establish campaigns to educate families. Wouldn’t that money be better spent understanding the true causes of autism and pursuing effective therapies?

We must vaccinate against this misinformation, and stop its spread.

Unfortunately, there is no herd immunity against ignorance.

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Kristy Davies, general assignment reporter for south New Jersey’s Courier-Post Online got an earful while covering an anti-vaccine conference held in Cherry Hill. Rev. Lisa Sykes, whose vaccine-related lawsuit was dismissed last year, told the U.S. Autism & Asperger Association’s regional conference over the weekend  that the “The American government is labeling (autism) as genetic to protect industry from catastrophic liability. The madman named mercury has returned.”

Davies says she’s since been deluged with emails and calls, both pro- and anti-vaccine. “I was just there to cover a conference. I’m not writing any more about autism,” says says.

Davies’ report is largely a recitation of anti-vaccine talking points with little effort at clarification or setting the record straight. But she still considers her story balanced. “I included what the CDC says about vaccines. The story is balanced,” she says.

Here’s the paragraph:

According to the Centers for Disease Control and Prevention, there is no convincing scientific evidence of harm caused by the low doses of thimerosal in vaccines, except for minor reactions like redness and swelling at the injection site. But after a public outcry of concern in 1999 the Public Health Service agencies, the American Academy of Pediatrics and vaccine manufacturers agreed that thimerosal should be reduced or eliminated in vaccines as a precautionary measure.

So if thimerosal has been removed from scheduled pediatric vaccines all these years, what is Rev. Sykes talking about? Informed readers need to know.

Kudos to Jay Gordon, MD, FAAP, for retracting all but one of the baseless charges he made in Monday’s Huffington Post column. We understand his need to save face with the base. But there’s still work to do if Gordon is serious about reforming extremist anti-vaccine rhetoric, and this is a nice start.

Gordon, who has advised Jenny McCarthy on matters medical and scientific, is well positioned to become a change agent in the autism wars.  As a physician he swore to “never do harm to anyone”,  and what better place to start than debunking some of the destructive myths at the heart of the anti-vaccine movement. A few that come to mind are:

There is no anti-freeze, ether, or aborted fetal tissue in vaccines, and formaldehyde is a natural by-product of single carbon metabolism. “Green vaccines” is a deceptive marketing pitch with no practical application in the physical world.

The evidence for an autism epidemic is paper thin, and most of today’s children with ASDs would have received a different diagnosis, or no label at all, prior to 1989.

The benefits of vaccination far outweigh the risks of serious adverse reactions, which are rare.

The scientific method is the best way that we have to separate nonsense from fact. And though imperfectly applied, it is far more reliable than talk show wisdom or diagnosis by celebrity.

It was bad enough when the Michigan Law Review published Dr. Jay Gordon’s “expert opinion” that parents could not be sued for damages if their unvaccinated child infected someone else. And although his star turn as legal scholar was marred by his own factual errors, and up-staged by case law, our Pediatrician to the Stars has returned for a sequel.

Yes, Attorney Gordon is back, this time on Huffington Post, where he accuses a pro-vaccine doctor of committing “ethics and HIPAA violations so egregious that the Medical Board must take him to task.”

Gordon is outraged by an April 20 Los Angeles Times column by Dr. Rahul Parikh, a Walnut Creek pediatrician, who wrote:

It wasn’t my first lesson about the importance of vaccines. That had happened a year earlier, when I was an intern at Cedars-Sinai Medical Center, half a world away. One night, we admitted a 9-month-old girl who was having trouble breathing. She arrived with her parents — Mom in tears and Dad tense with worry. Her parents were movie stars from a Hollywood borough who, unlike that mother from a Bollywood slum, needed nothing. In a way, they had chosen “nothing” for their daughter from the time she was born — refusing all vaccines for her.

“Too much information!” cries Gordon, who claims that Parikh exposed the patient’s identity in violation of HIPPA regulations which guard patient privacy:

Dr. Parikh is a well-published medical author and blogger and he speaks of a patient he saw as an intern in the year 2000 at Cedars-Sinai Medical Center. (His bio on many sites lets you know that year.) He identifies the parents, their unique profession and their child’s age and illness. This family can be identified by anyone who can use Google.

They have given me permission to respond to the LA Times article.

What he has done is illegal and unethical and violates the family’s and child’s privacy.

He had no noble goals and very little educational intent. He just wants to scare parents and is willing to break the rules and violate medical confidentiality to do it.

He even identifies me in his story: “We stuck more needles into her tiny veins, and her doctor performed a spinal tap to make sure she didn’t have bacterial meningitis.” He knows that I’m the only private attending pediatrician who comes to Cedars to do spinal taps.

It doesn’t take a Philadelphia lawyer to know that Gordon gave more clues to the identity of the movie star couple than did Parikh. He even outed himself as the mysterious midnight spinal tapper, providing yet another clue. “Movie star” may be a unique job title in fly over country, but certainly not in LA, where you can’t swing a dead cat without whacking one upside the head.

For HIPPA privacy to be breached, patient health information must either identify the individual or disclose information which provides a reasonable basis to identify the individual. Identifying the parents of the patient as movie stars from Hollywood is not even close to meeting this test.

Parikh did not identify Gordon as an attending physician, either by specialty or name.  Even if he did, no patient privacy laws would have been broken because in this case it is no more possible to identify the patient through a physician than by identifying the treating hospital.

So while no HIPPA violations occurred, our Legal Assistant to the Stars does have legitimate concerns over California’s defamation laws, which define libel per se as:

“a libel which is defamatory of the plaintiff without the necessity of explanatory matter, such as an inducement, innuendo or other extrinsic fact, is said to be libel on its face.   As the court stated in Bates v. Campbell, if the statements have “the natural tendency to injure a person’s reputation” it is libel per se. Bates v. Campbell, (1931) 213 Cal. 438, 441;  Adams v. Cameron, (1915) 27 Cal. App. 625 (1915) (libel per se was found where a train passenger wrote letters stating that the conductor was intoxicated and was loud and vulgar because of his intoxicated state); Slaughter v. Friedman, (1982) 32 Cal. 3d 149.

A plaintiff suing for libel per se does not need to prove damages. Parikh’s lawyers need only argue that Gordon’s statements clearly attack their client’s professional reputation and imply that Parikh violated the ethics and laws which govern the way physicians work. Let’s look at Gordon’s accusations again:

“(Parikh) commits ethics and HIPAA violations so egregious that the Medical Board must take him to task” and “What he has done is illegal and unethical and violates the family’s and child’s privacy.” Tough words coming from Gordon. Tougher still to prove them true.

In his story about a resurgence of polio in Africa, Don McNeil at the New York Times writes:

Despite more than 20 years of eradication efforts, two strains of polio have spread out from northern Nigeria and northern India — both places where many Muslims have resisted vaccines because of rumors that vaccine efforts are a Western plot to sterilize them.

Sadly, this nonsense is not confined to wild-eyed, third-world imams. A Springfield, Illinois radiologist, Dr. David Ayoub, has been telling audiences for years that the World Health Organization uses vaccines to sterilize poor women in third world countries. In this video Ayoub attacks the Global Alliance for Vaccination Initiatives (GAVI), and asks “Are powerful forces really trying to help the poor people or could it be for another agenda; the sterilization of the poor?”

Among GAVI’s founding partners is the Bill and Melinda Gates Foundation, which has funneled hundreds of millions of dollars into the vaccines, and saved millions of young lives.

Astonishingly, Ayoub has a following in America’s homegrown anti-vaccine movement, and is a regular at anti-vaccine conferences, such as the AutismOne conference in Chicago last May. A Columbia, Missouri television news program has featured him as a vaccine expert without mentioning his penchant for improbable conspiracy theories.

Dr. Nancy Snyderman is mad as hell and she’s not taking it anymore:

I received the most vicious e-mails and letters I have ever received in 20 years of reporting. I was ambushed at 30 Rockefeller Plaza (where NBC News is located) by a reporter who came armed with a camera and screamed that I was lying to the American public. I was rattled. Never before had I been singled out like this. I received letters from congressmen, celebrities and lawyers. As the months ground on, I opted out. I wouldn’t do any more reports on autism. It just wasn’t worth the hassle. The fact that I cowered didn’t make me proud, but it did make my life simpler.

Snyderman has played canary in the media coal mine since last October, when she told Matt Lauer ” NO! Matt, there’s no controversy over vaccines and autism.” In one respect, she is right. In autism news coverage, “controversy” is short hand for “this is a very complicated story and we don’t want to offend anybody with the truth, so we’ll pretend that nobody really has the answer.” Snyderman is having none of it. More, please.

Universal assent is like oxygen to the anti-vaccine movement. While scientists debate, question, and squabble amongst themselves, vaccine rejectionists nurture one another with sympathy and shared delusions. OK, fine. To each his own. I just wish they could be more honest about the nature of their movement.

I bring this up because I was just refused press credentials to the 2009 Autism One conference in Chicago. I attended last year’s conference, until I was expelled on day four for not being registered. Except I was registered, as even AutismOne spokeman Ed Arranga now admits. So Arranga fabricated a new reason for my ejection - an alleged agreement last year not to videotape presentations. Arranga knows that isn’t true. None of his emails mentioned videotaping. There were no signs posted to that effect at the conference, and nothing mentioned in the literature. Besides, your typical AutismOne conference has more video cameras than gluten free cookies, and you can see some of the results here, here, and here. I made no effort to hide my camera, and the four hours of video that I shot includes subjects looking directly into the lens, obviously aware they were being filmed.

It hasn’t been a good year for vaccine opponents, and Arranga has no doubt invested a good deal of hope in the upcoming conference. Organizers have dedicated the May 20-24 gathering to disgraced UK physician Dr. Andrew Wakefield, who cannot legally practice medicine during his self-imposed exile in Texas. Saturday’s keynote speaker is soft porn comedienne Jenny McCarthy, who says the medical community will finally take her seriously when polio returns. At least the conference’s theme, “Change Has Come”, rings true in one respect - conference organizer have posted a video camera policy on their 2009 website.

World Autism Awareness Day, April 2, is ideally a time for news and entertainment media to educate and enlighten the public on autism spectrum disorders. That’s a tall order, given the tsunami of bad information, urban myth, fear mongering, and dishonesty bearing down on newsrooms. Judging from last year’s crop of WAAD stories, too many reporters fall prey to baseless assumptions, such as the myth of the autism epidemic. Additionally, reflexive he-said-she-said reporting gives far too much credence to the discredited vaccine-autism connection.

Sometimes a reporter’s good intentions can lead to the spread of misleading and even dangerous information. A staple of autism reporting is the Struggling Parents interview, which invariably focuses on unproven alternative treatments for autism, and a parent’s desperation to make her child “normal”. These stories usually note that a child has improved since starting the treatment. That’s no surprise. Given enough time, and lack of a control group, tap water will look like a miracle cure. That’s because autism is best understood as developmental delay, not stasis. All else being equal, these kids continue to grow and learn and adapt, albeit at their own pace.

So what’s an overworked general assignment reporter to do? First, beware of unwarranted and unproven assumptions, as you would with any story. A few that come to mind include:

The Myth of the Autism Epidemic. Virtually every wrong-headed idea about autism flows from the claims, far from confirmed, that we are experiencing an “epidemic” of autism.

What we call “autism” is really a spectrum of disorders ranging from mild to severe. Fringe anti-vaccine interest groups deliberately mislead when they tells us that the prevalence of autism has increased from 6 cases per 10,000 children in 1983 to 150 cases per 10,000 in 2008. Don’t be fooled. More than two-thirds of the children that are diagnosed with autism spectrum disorders today would have received a difference diagnosis, or no label at all, 25 years ago.  There are a number of reasons for this. Diagnostic criteria for autism have broadened since the 1980s, and today children with milder forms of the disorder are included. A large part of the increase can also be explained by diagnostic substitution, especially for children who have the more severe forms of the disorder who were once labeled mentally retarded. In fact, data show that as autism diagnoses rose during the 199os, cases of mental retardation decreased - strong evidence for diagnostic substitution. Furthermore, the percentage of children receiving special education services has remained flat during a time when autism was supposedly skyrocketing. Check out this graph from D’oC at Autism Street:

I know the temptation to use skyrocket as a verb is great, but the fact is that claims for an autism epidemic are unfounded. What has skyrocketed is public awareness of the disorders. Be skeptical of anyone who tells you otherwise.

A must read article that explains how autism is diagnosed, and the reasons to be skeptical of claims for an epidemic, can be found here.

The controversial vaccine-autism connection. Among bona-fide researchers there is no controversy. More than 25 studies over ten years and across three continents show no association between the MMR vaccine and autism. At least ten more similarly show no link between thimerosal containing vaccines (TCVs) and autism.

Sharon Begley at Newsweek very nicely lays out the case against the TCV connection here.

The government has admitted that vaccines caused Hannah Poling’s autism. The US Federal Court of Claims, which hears vaccine injury cases, never ruled on the case because HHS conceded before it came to court. The standard of proof for vax cases is “more likely than not” - what lawyers call “50% and a feather”. The court was in fact set up during the Reagan administration to expedite vaccine injury claims, and claimants are paid by a fund drawn from a tax of 75 cents on every vaccine shot given. If Poling’s case was heard in civil court the family probably would have lost, since it is essentially unknowable what caused the girl’s symptoms of autism. Science blogger Steve Novella, MD, explains it here.

Even the Poling family’s physician, Dr. Andrew Zimmerman, says “there is no scientific basis for a connection between measles, mumps and rubella (MMR) vaccine or mercury (Hg) intoxication and autism.” Zimmerman’s comment can be found in the report he submitted to the US Federal Court of Claims, as part of the recently concluded Omnibus Autism Proceeding. Scintillating analysis here.

No writer should go wanting for autism-related stories. An estimated 500,000 children in the US have an autism spectrum disorder, and the ways in which families, educators, and caregivers accommodate these kids is worth telling. Then there’s the shady and opportunistic autism cure industry, and the vacuous celebrities who mislead and exploit parents.  It’s a target rich environment for any enterprising reporter willing to spend some extra time learning the facts. Don’t waste your time, or your readers’, chasing shadows.

It happens to the best of them. Keith Olbermann, my hero, the heir apparent to Edward R. Murrow,  and the only reason left to watch cable TV, has been played by the anti-vaccine lobby.

A few nights ago, Olbermann called much-needed attention to the UK physician who kicked off the decade-long wave of mass hysteria known as the anti-vaccine movement. During the Countdown segment, Andrew Wakefield, or “Wakers” to his diminishing fan base,  was named The Worst Person in the World.

Anti-vaccine activists went on quicksilver alert, and besieged MSNBC with emails, faxes, phone calls and much  gnashing of teeth. Olbermann caved, or rather bent over and grabbed his ankles. It could have been a phone call from Robert F. Kennedy, Jr., Arriana Huffington, or any number of dwarf stars in the anti-vaccine firmament. Whatever. Olbermann was pwned by the same barking loons who think the Amish don’t vaccinate, and that measles leads to all-you-can-eat ice cream binges. Without evidence or cause, Olbermann repeated vaccine rejectionist talking points, and unfairly attacked the journalist who exposed Wakefield’s malfeasance.

Watch it here:

Brian Deer, the freelance investigative journalist whose reporting helped bring Wakefield to justice, is guilty of - investigative journalism. Or, as Olbermann puts it:

The Times of London did not bother to mention that the British investigation into whether or not Wakefield did that was the result of a complaint by… Brian Deer.

The guy who wrote the article about the investigation never mentioned he was the complainant who precipitated the investigation.

The word “complaint” needs to be unpacked. In an administration-speak, a “complaint” is a formal action, documented, and assigned to a party. But Olbermann conflates the dry, boring definition of complaint with the vernacular, which is “an expression of displeasure”. Deer’s reporting is a complaint, but only if you stand way back and squint your eyes, imagine how documenting the activity of an out-of-control doctor might trigger an expression of displeasure, which in turn sets off waves of hand-wringing in the British medical establishment, thus resulting in the filing of a formal complaint. In this case, the complaint was brought by the General Medical Council with the encouragement of … Andrew Wakefield!

IN February 2004, after a Sunday Times investigation, Wakefield declared that he would welcome an inquiry as an opportunity to clear his name.

In fact, he insisted on an investigation!

Dr Wakefield said that he would insist on a full GMC inquiry after it was suggested by John Reid, the Health Secretary, on Friday.

And if MSNBC can tolerate facts, Deer has proof that he is not “a complainant”:

I have a letter from the GMC’s lawyers, which was also supplied to Wakefield, stating that I am not the complainant, but that I am an “informant”, like, say, a health authority.

Yet according to Olbermann, Deer is guilty of “a vast conflict of interest”.

The truth about the doctor’s research may be in doubt here, but not Deer’s vast conflict of interest nor the Times of London’s journalistic malfeasance. The paper is owned by Rupert Murdoch, and it’s my bad for forgetting his new motto: “We have never been a company that tolerates facts.”

To recap:

Brian Deer, an investigative reporter, wrote about Wakefield’s shady research and obvious conflicts of interest.

Wakefield invited, nay,  insisted upon a full investigation of the allegations outlined in Deer’s articles.

The UK medical board obliged Wakefield by filing a formal complaint and commencing the investigation for which Wakefield longed.

Deer continued to investigate and report the story.

That Keith Olbermann was lured and skewered by a mendacious vaccine rejectionist press release speaks to Rovian levels of media manipulation. “Olbermann’s team fell for it hook, line, and sinker,” notes Orac, to continue the fishing metaphor. “Nor did they consider that the U.K. has some of the most plaintiff-friendly libel laws in the world, so much so that some plaintiffs indulge in libel tourism there. If Deer’s reporting was not true, he would have been at serious risk of being sued and losing.”

Keith, I love ya man, but you really screwed the pooch this time.

This is far from over. Keith’s enemies in the right wing news and entertainment media are legion, and now he’s open  to serious and valid criticism. If this latest skirmish in the autism wars results in a ratcheting up of coverage, Olbermann may be forced to retract once again, or bury his head and wait for the dust to settle.

Good night and good luck with that one.

Update

Brain Deer’s response to Olbermann can be seen at Orac’s blog. The money quote:

You were apparently supplied with your baseless allegations by a New York-based freelance journalist, David Kirby, who has made substantial sums of money through attacking childhood vaccines, and who is an advisor to Wakefield. Extraordinarily, you even supplied Kirby with a copy of the script of your attack on me, prior to broadcast, and thus appear to have acted in cahoots with him.  Kirby was sufficiently motivated, and stupid, to publish your script on a website before the item was aired.

Your defamation of me has been taken up by others, and you are plainly responsible for this.  You have no possible defence, since your claims are simply false.  They were fabricated and placed with you by antivaccine campaigners and cranks. You can argue no privilege or free speech right to make such false allegations, not least since you published them with complete disregard for their truth or falsity. NBC’s lawyers will no doubt explain to you the particular difficulties of such conduct in the UK jurisdiction.

Grab some popcorn. This is going to be good.

Thank you Keith Olbermann for moving this story one more notch up the news and entertainment media agenda. Can SNL be far behind?