A RESPONSE TO JP
Again, I believe you're off-base on a few comments.
As I've stated numerous times on my blog - if you're trying to ask the question of whether vaccines (or mercury in vaccines) played a role in moving the needle towards the 1 in 166 number we see today, epidemiology is the ONLY way to answer that question. So I think Offit's right in that regard.
I haven't heard Offit's interview, but I don't think that's necessarily inconsistent with saying that autism might have an environmental component, but that component isn't necessarily vaccination. I personally think that's a real possibility - there are MANY factors at work with the increase in autism throughout the years. Some of them are expansion of the ASD criteria and availability of services. Some of them may be external.
I disagree with your assessment of the Burbacher study. The Burbacher study illustrated that ethylmercury clears the body faster than methylmercury, but leaves more inorganic mercury behind. In the study itself, Burbacher doesn't necessarily say that the inorganic mercury left behind is dangerous or even meaningful, because nobody knows if it is or not. (other than one study that postulates that fact) So Offit's again, right on that point.
As to whether methylmercury exposure is more dangerous than ethylmercury exposure, well, there is the pesky fact that methylmercury is everywhere. We can't get away from it. It's in the food we eat, the water we drink and the air we breathe. If mercury is a cause of autism, it would be logical to assume that methylmercury is the prime culprit. You are correct in saying we have no studies to know that for sure, but it's a reasonable hypothesis.
And as I said above, Offit giving more weight to epidemiology IS appropriate. It's how you're going to make decisions about population-based issues. Reductionist studies aren't going to help shape public health policy. They can't, they're not powerful enough, they're not right often enough.
As to the Verstraeten study - while Verstraeten did classify the study as "neutral", I've now talked to three different folks involved with the study who disagree with that assessment. They all agree, however, that a more probative study (and there's one being conducted based on a similar Faroe Islands study several years ago) is necessary.
And as I said on my blog (and confirmed by two different individuals involved with the CDC) the data used in the Verstraeten study IS available for anyone who wants to use it. I've heard that fallacy of the "data is missing" so long now that it's become almost a given, which is a shame.
And as to your claim in a previous comment that Offit has deeply entrenched "vaccine industry ties" - I guess I'd like to see some actual proof of that. Offit himself has said, on numerous occassions, that he does NOT take money from drug companies. I've yet to see someone counter with hard evidence that he does, other than the claims of Merck hush money or misuse of "unrestricted educational grants" that is to date unfounded.
Wade, all in all, I think that Offit's position - while anathema to you - has a fair amount of validity. And as I told Ginger Taylor a while back - you have every ability in the world to prove me wrong. Epidemiological studies. Clinical trials of chelation therapy. Rather than rush headlong into curing kids with treatments that are of questionable validity and effiacy, why not do the due dilligence to know you're right first?
I started to compose a reply to JP in the comments section, but I soon realized there was enough to say for a whole new post.
First of all, JP’s comment that the astounding increase we saw in ASD over the course of 10 years results from changes in diagnostic criteria and availability of services is an argument that even the most tireless vaccine apologists are beginning to abandon. Note that in Dr. Offit’s interview, he acknowledged that autism “has apparently become more common.” I hate to parse oral statements, but Dr. Offit did not say that “reported cases of autism have increased.” Granted, the use of the word “apparently” leaves a little wiggle room, but Dr. Offit’s phrasing is consistent with what we hear from public health officials who, even though they do not wish to give credence to a vaccine connection, admit that there seems to be a rise in the incidence of ASD. Genetics cannot account for that rise. For a less scientific confirmation, simply ask any elementary school teachers who have been on the job for more than 15 years if they see more kids on the spectrum. (I should note that statements attributed to Dr. Offit have been all over the board on the issue of whether there is an epidemic.)
Epidemiology can get us to the one in 166 number, but it can not show the impact of the increased exposure to thimerosal (or the combined impact of thimerosal-containing and live-virus vaccines) after a large number of vaccines were added to the schedule. Only clinical and biological studies can show that, and Dr. Offit’s insistence that epidemiology can definitively provide and answer leads me to question either his intellectual honesty or his scientific competence.
With regard to the Verstraeten report, let me quote the author: “The bottom line is and has always been the same, an association between thimerosal and neurological outcomes could neither be confirmed nor refuted and therefore more study is required.” Dr. Verstraeten did not say that his study indicates a lack of an association, but it needs to be replicated. Rather, he said his study was inconclusive.
I believe that in making that statement, Dr. Verstraeten showed more intellectual honesty as a full-time employee of a vaccine manufacturer than Dr. Offit has ever displayed as a part-time consultant. Dr. Verstraeten knew that limiting the scope of his study to a strictly defined definition of autism as opposed to the full scope of ASD, together with including a cohort too young to be diagnosed with autism, dramatically altered the outcome of his report. It went from showing a probable association to being “neutral.”
While I have not spoken to anyone at the CDC as JP claims to have done, my understanding is that the raw datasets are gone. At least that’s what the CDC indicated when a member of Congress looked into the matter. What may be available are the final “archived” sets that do not include all data that was examined. Moreover, anyone who wishes to examine the data is given very limited access, reportedly on privacy grounds, even though all personal identifying information has already been removed. The only means of either replicating or refuting Dr. Verstraeten’s published “findings” is to have access to the original raw data with the same unhampered access as Dr. Verstraeten had.
The Danish and Swedish studies Dr. Offit finds so convincing as replication have no relevance at all to the Verstraeten report. First, the level of thimerosal exposure in those countries was far lower than the exposure to our children here in the United States. Moreover, the use of different populations in the “before” and “after” numbers provides a textbook example of data manipulation.
I can only assume that the “Faroe Island” studies to which JP refers are the same studies Dr. Verstraeten described as being “as comparable to our issue as apples and pears at the best.” He fought against using those studies as part of his report despite the fact that “many experts, looking at this thimerosal issue, do not seem bothered to compare apples to pears and insist if nothing is happening in these studies then nothing should be feared of thimerosal.” Of course, Dr. Verstraeten wrote that before he left the CDC for the greener pastures of Glaxo-SmithKline. One cannot help but wonder how Dr. Verstraeten’s report would have ended up had he not opened it up to the “suggestions” of others with vested interests.
JP correctly argues that a single reductionist study cannot control public policy. But that is the nature of reductionist studies; they each comprise a single part of a larger puzzle. When enough pieces of the puzzle come together, one can see the whole picture. Enough of those pieces are coming together now that we can see the plausibility of a link, but Dr. Offit -- and apparently JP as well -- will not put the pieces together.
For example, I cannot argue with JP’s statement that the Burbacher study, in itself, does not show the harmful impact of inorganic mercury in the brain. But it does show that inorganic mercury can accumulate in the brain, if ethylmercury is not excreted. And the Jill James study shows the plausibility of some children being genetically hampered in their ability to excrete ethylmercury. Moreover, I can’t help but be reminded that Dr. Offit’s primary criticism of Richard Deth’s in vitro studies of ethylmercury was that there was no evidence that ethylmercury crossed the blood-brain barrier. That answer was supplied by the Burbacher study. Dr. Deth’s study shows a probability that ethylmercury is every bit as dangerous as methylmercury. But again, one has to put the pieces of the puzzle together by looking at a number of reductionist studies, something Dr. Offit apparently does not have the patience to do.
JP’s argument about the pervasive risk from methylmercury is almost word-for-word the same argument we often hear from Dr. Offit. Certainly potential exposure from methylmercury is a risk factor, and can present a possible envoironmental trigger for all sorts of things, including ASD. But the bolus dose of ethylmercury my child received in any of his thimerosal-containing vaccines exceeded the exposure of methylmercury from other sources, especially considering the ethylmercury was injected directly into his body. Mercury poisoning just doesn’t get any more efficient than that.
JP may be willing to take Dr. Offit’s claim that he does not take money from vaccine manufacturers at face value, but I think he is hopelessly naïve to do so. Dr. Offit acknowledged that he has been a consultant for Merck, although he has refused to say what remuneration he receives for his services. Dr. Offit and his partner received a $350,000 grant from Merck for the development of their rotavirus vaccine, and then got to keep the patent. In essence, Merck paid to have the option to use the patent. Merck purchased 20,000 copies of Dr. Offit’s book, Vaccines: What You Should Know, to distribute to physicians. There is nothing dishonest about entering into these arrangements, but to pretend that the relationship doesn’t exist is wrong.
Of course, Dr. Offit’s grasp on the concept of a “conflict of interest” is a little shaky. He served on the Advisory Committee for Immunization Practices for the CDC. While on the committee, Dr. Offit voted three times in favor of adding a Wyeth vaccine for Rotavirus to the national vaccine schedule. Because his association was with another manufacturer, he saw no reason to cast a vote on the issue even though the first vaccine’s approval would make it easier to gain later approval for alternatives like Merck’s vaccine. It was not until the committee met again -- after the Wyeth vaccine killed 10 children in a two-week period -- that Dr. Offit thought that the appearance of impropriety might be enough to prevent him from voting on the vaccine’s removal from the schedule.
I practice in a profession that takes conflicts of interest pretty seriously. I should be thankful for people like Dr. Offit, because his actions make shady lawyers look relatively honest.
Let us suppose for the sake of argument that Dr. Offit did not have close ties to the industry, and that he speaks out simply because he believes so very much in a vaccine program that has saved countless lives. (Indeed, that is the reason JP gives for his own involvement in the debate.) The arrogant statements Dr. Offit has made, such as “full disclosure can be harmful,” from a New York Times Magazine article, show his attitude toward patients and parents. Look at the following quote from the interview he gave David Kirby for Evidence of Harm:
… you did more harm than good in sort of, quote/unquote, allowing the parent to be fully informed. There’s no politically correct way to say this, but being fully informed is not always the best thing.
I can picture Dr. Offit on the witness stand, shouting out: “You can’t handle the truth!!!”
Dr. Offit’s stated concern in making those statements was that parents were being deterred from having their children vaccinated. That concern may be laudable, but I would submit that Dr. Offit has done far greater damage to the vaccine program by making it easier to conceal the truth than would have been done if the problem would have been openly acknowledged. In his view, it may be better to hide some of the truth and sacrifice a minority of the children for the greater good. I have a hard time seeing that greater good, because I live with one of Dr. Offit’s sacrificial lambs.
JP says that we “have every ability in the world” to prove he is wrong. I am not sure what planet JP lives on, but here on Earth, research takes a lot of money. As long as men like Paul Offit provide cover for politicians and bureaucrats, some of whom benefit from the contributions of vaccine manufacturers, it will be difficult to convince government to allocate the necessary resources to definitively determine the causal connection between vaccines and autism. So the inquiry will take much longer than it should. Still, JP, tell Dr. Offit not to get too comfortable. It may take some time, but we’re going to find the answer.