I thought I’d have just one more follow up post to my book review of Autism's False Prophets earlier this week, which was followed by David Kirby's Smackdown of it.
Mr. Kirby gave a presentation to a room full of Congressional staffers in our nation’s capital on 9/24.
As far as I can tell, only anti-vaccine folks presented their views. No counterpoint was given, no skeptical questions were asked.
I thought I would try to help be a skeptic by deconstructing Mr. Kirby’s slide presentation, “The Vaccine-Autism Debate: New Developments from Science and Policy” available here:
You can look at the slides, but here’s a basic summary of what they say, followed by my analysis:
- Slide 2 (1 is his bold title): “Talking Points”
Mr. Kirby notes that the “Debate not over—many unresolved questions”; he goes onto talk about “genetic susceptibilities” to autism and possible environmental triggers; he mentions thimerasol among those possible triggers
Assessment: Like a good PR person (which is Mr. Kirby’s background), he puts his TV talking points up first. The debate is not over—if he is referring to the cause of autism, he is correct, we don’t know and there are many unresolved questions we need to answer.
- Slide 3: “A New Autism Vocabulary”
Here goes onto use many scientific terms here. Among them, “autoimmunity,” “neuro-inflammation,” “gliosis”
Assessment: Mr. Kirby tries to establish his credibility as “an expert” by using words we learn in medical school and college neurobiology class. All of these terms could describe mechanisms by which autism, or any other neurodevelopmetal disorder in children or the elderly, start and progress. But none are specific to autism. “neuro-inflammation,” for example, could just as easily describe what happens when an elderly person develops Alzheimer’s Disease. But the “principle of authority” technique he uses helps to establish himself as a guru who deserves our attention.
- Slide 4: This slide appears to cite a commentary (NOT a STUDY) from the medical journal, Pediatrics (he uses the logo at the top).
The commentary was about a conference convened in 2007 at the Insitute of Medicine to discuss the opportunities for research into and treatments of autism. Below the big header, Mr. Kirby writes, “The environment may play a significant role in triggering autism” and that “genes alone cannot account for its cause.”
Assessment: There is nothing said here that experts on both sides of the vaccine “debate” would disagree over. Genes + Environment = disease. It’s true for every chronic disease from Asthma to Diabetes to Heart Disease. A more accurate thing for Mr. Kirby to do would have beeen to actually cite his sources. It helps keep him accountable and credible.
I should note, however, the commentary he cites doesn’t mention vaccines at all.
- Slide 5: “Link between mercury and autism?”
Here Mr. Kirby gets into the meat of his stance, throwing up bullet points. He writes about drop in “severe autism” amng youngest children, “most top university show an association between background mercury/thimerasol and autism” etc.
Analysis: First, Mr. Kirby offers no sources or citations for where his bullet points come from. This is a sure red flag for people watching science—ish speakers. One point Mr. Kirby has been using regularly has been the notion that immigrants have rising rates of autism because in the “3rd world,” thimerasol is still in use.
That’s a very shaky argument, and here's why: If immigrants are being diagnosed with autism, they are being done so by experts in their new home country. Autism is a “clinical diagnosis.” We see symptoms of it and we call it this. There is no lab test we can do to confirm it. In other words, developmentally delayed kids may have had problems since birth, they were probably just labeled with another diagnosis (or never had access to comprehensive health care to begin with). So they come here, meet us, and we label them autistic.
- Slide 6 “Report to Congress on Vaccine Safety Datalink (VSD)”
He uses a quote from the NIH: “We identified several area of weakness that were judged to reduce the usefulness of the VSD for addressing the potential association between exposure to thimerasol and risk of ASD (autism)”
Analysis: Is this the Smoking Gun? The VSD is a tracking system used to track adverse effects from vaccines. Bascially, if a child has a serious, adverse reaction to a vaccine, we doctors are supposed to record it. The NIH is right in that there is probably underreporting of these events. But what does that mean? That we are underreporting autism due to thimerasol? No. The studies that have been done to examine any link between autism and vaccines have not relied on this database. It just means doctors and other health professionals could stand to fill out the forms more often.
- Slides 7-8: Animal studies that show that thimerasol damages the brains of monkeys.
Analysis: To his credit, Mr. Kirby actually cites where these studies came from. I addressed the feasibility of these animals studies in my last post:
Lately, anti-vaccine folks have been funding and citing a series of animal studies demonstrating thimerasol is toxic. But none really furthers the case that thimerasol causes autism (I’ll get to aluminum below). For one thing, the relative concentration of thimerasol animals are exposed to in these experiments is very different than in kids. Here’s why: In pediatrics, we dose drugs and therapies by weight, so kids who are heavier get more. This ensures medicine is effective and safe. If you give, as has happened in many of thee animal experiments, the same amount of thimerasol to a rat or monkey as to a child, you’re giving much greater relative amount because these animals weigh much less than a child. Just about anything given in high enough amounts can be toxic. An example of this is the Ames cancer test, in which you can place any suspect chemical onto a testing medium that reacts if that suspect chemical is carcinogenic. The thing is, the Ames test reacts to just about everything you put on it if you add enough of it. Think of these animal thimerasol experiments like placing infinite amounts of mercury onto the Ames test—it will cause a reaction and then every anti-vaccine advocate will declare that they’re right.
- Slide 9-10, 22: Cites two studies showing that brains of children with autism demonstrate inflammation.
Analysis: Again, he cites the studies here as well. So perhaps this is just a good lead into what’s going on in the brains of children with autism.
- Slides 11-14: Detailing the Hannah Poling decision and Mitochondiral Disorders
Kirby goes on the show us the timeline for Hannah Poling’s manifestation and diagnosis of a mitochondrial disorder that caused autistic-like symptoms, and then launches into a sidebar about mitochondrial disorders.
Analysis: Mr. Kirby assumes that Hannah’s disorder was triggered by her vaccines. But if you look closely at the what spare information we have, you’ll see that it could have been triggered by any other intercurrent infections as well. Mitochondrial disorders are a class of diseases we don’t know a whole lot about, so it’s easy for someone to suggest that vaccines=autism because kids with autism have mitochondrial disease. But if that’s the case, we will be changing their diagnosis from autism to mitochondrial disease. The argument just goes around in circles (to the benefit of anti-vaccine folks).
Remember, the Poling decision is a court decision, and the actual records behind that decision have not been released. More on the Poling case here:
- Slide 19-20: “Meeting to Discuss Top Vaccine Safety Issues In DC”
He describes some questions that the CDC is looking into regarding vaccines side effects.
Analysis: Vaccines have side effects and risks, and the points he shows in this slide are ones worth looking into. But autism just isn’t one of them (nor is it mentioned in the slide).
- Slide 23 (my favorite) Quote from Obama and McCain:
Barack Obama: April, 2008 “We've seen just a skyrocketing autism rate. Some people are suspicious that it's connected to the vaccines. The science right now is inconclusive, but we have to research it.”
John McCain: March, 2008 “It's indisputable that autism is on the rise amongst children, the question is what's causing it. And we go back and forth, and there's strong evidence that indicates that it's got to do with a preservative in vaccines.”
Analysis: Mr. Kirby loves to use “social proof” (as opposed to scientific proof) to make his case. Here he does it to perfection, taking quotes from the Presidential Candidates to tell us that yes, vaccines are the cause of autism.
- Slide 24: Quote from Dr. Healy and Slide 25: Laundry list of endorsements
“Officials have been too quick to dismiss the hypothesis as 'irrational,' without sufficient studies of causation, without studying the population that got sick. Never turn your back on any scientific hypothesis because you are afraid of what it might show."
Analysis: Lately, Mr. Kirby and others like him have been using the slogan “Go Tell It to Dr. Healy!” when someone questions their point of view. Dr. Bernadette Healy used to sit on the Institute of Medicine (although she never had anything to do with its report on vaccines and autism). I’m not sure I get this quote, because there have been many studies over the past decade looking into this link. Slide 25 looks like a something someone running for office would throw up on the screen—“look who’s voting for me!”
There you have it. Mr. Kirby effectively uses fancy medical lingo to build his credibility and tell us things we already know, relies on science that he can’t cite the source of or that can’t be applied beyond Monkeys, gives us book reports on mitochondrial diseases and neuro-inflammation, calls court decisions and quotes from famous people proof of his point.
Just what was that point, anyway?
10/10/08: Correction: Regarding my evaluation of slide #20, the slide does mention autism and the report the slide refers to does as well. Here is a link to that report.