Tuesday, December 29, 2009

Autism and ScienceBlogs: Dr. Gorski Replies, Sort Of

Alleged science blogger Dr. David H. Gorski is at it again lashing out at anyone who disagrees with his views, and hurling ad hominem attacks. Once again Dr. Gorski  demonstrates no knowledge of autism disorders while commenting, albeit indirectly, on autism causation.

Dr. Gorski displays poor research skills  by describing me as an Age of Autism hanger on which is quite funny because I have over the years often disagreed with views posted on that site. A year ago I questioned Kent Heckenlively of Age of Autism about his apparent endorsement of the ACE Pathway investigation one of several critical posts  I made about ACE Pathway which I viewed with concern.

If Gorski actually read anything on this site he would know that I advocate for evidence based interventions and services for autistic children and adults and have done so for a decade along with other parents, and with some real results, in my home province of New Brunswick, Canada. In our autism advocacy efforts studies and reports by  American health and science experts on autism were the foundation of our efforts. They were invaluable. Dr. Gorski's name was not amongst those that I have encountered over the years as having any expertise on the subject of autism.

I never used to accept that vaccines played any role in causing autism.  I have  moved from agreeing with the view  that there was no merit at all to the vaccine causes autism theories to accepting that the issues arising from the injection of vaccines into children and pregnant women have not been "determined for all time" and may trigger autism in some vulnerable predisposed children.   My move toward an open mind on these issues was prompted not by the Age of Autism but by Dr. Healey, Dr Poling and even Dr. Julie Gerberding, the soon to be Merck vaccine division head and former CDC director. Dr. Gorski would know this if he actually read this site before slinging mud.

Dr. Gorski, apart from failing to demonstrate any knowledge of autism in his new commentary, also tried to reduce my views, and the views of many others, about potential environmental causes of autism to the vaccine issues.  He does so  no doubt because it is easier to attack people who question vaccine safety than those who question the impact of environmental chemicals generally on the neurological development of children. Dr. Paul Offit has led a very successful campaign to whip the mainstream media into condemning people who question vaccines as fringe, hysterical extremists.  It is more difficult for Gorski, or Offit for that matter, to argue that it has been "scientifically proven for all time" that there are no environmental causes or triggers of autism.

I don't know if Dr. Gorski is aware of the recent CDC study which measured and reported on 212 toxic chemicals found in our bodies today,  a list which included mercury, lead, aluminum, arsenic and many other goodies.  Like the autism prevalence study and the Gerberding move to Merck announcements, this study too was "publicized" in the pre-Christmas period when most people, and especially the mainstream media, are busy with family and Christmas.  With so many toxic chemicals in our bodies, with rising incidence of autism disorders in our children it is not just unscientific to assume that these chemicals are not involved with causing autism disorders ....  it is foolish.

My lay person's understanding of science is based on the notion, perhaps naive, that issues are not "decided for all time".  I am now in the undecided camp about vaccines and autism and suspect that in some instances vaccines may trigger autism disorders, and other neurological damage, in some children.   I believe that more study should be done on this issue.  

And I believe very firmly that the imbalance in funding of autism research must be shifted from the near 100% funding of genetic based autism research to a  model which provides equal funding for environmentally focused autism research. 

I hope that the ScienceBlogs bloggers abandon cheap personal attacks on those who question vaccine safety and offer ... some real science.   I hope they live up to their claim of being science bloggers ... at least when they are discussing autism disorders.

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farmwifetwo said...

Bon chance.... doubtful.

I fall into the "there is more in heaven and earth" catagory when it comes to autism. If genetics was the one and only cause. If Dev Ped's were magically dx'ing everyone that had the slightest quirk with autism... then genes would have been discovered and IMO the Dev Ped's should be charged with malpractice for lying.

Although..... according to my FSW... there is a psychiatrist in the area that for $75 will give you that dx.... the question is... to everyone??? She had concerns.

David Gorski said...

My goodness, Harold. I'm confused. Could you please tell me when and where I have ever argued that 'it has been "scientifically proven for all time" that there are no environmental causes or triggers of autism' or that the issue is "decided for all time"?

Seriously. I want to know.

In fact, I challenge you to show me where I've ever argued that.

You just don't like the fact that I don't buy into the anti-vaccine nonsense claiming that vaccines cause autism and say so vigorously or that I've written the occasional post showing that alleged connections with environmental causes or triggers of autism have been crappy science. For instance, the claim last year that power plant emissions were a cause of autism clusters:


Let's look at the final paragraph of that post, shall we? Here it is:

"It’s entirely possible that some environmental factor, or factors, may contribute to the development of autism, either on their own or by acting with some genetic susceptibility, but if that is the case with mercury this study is thin gruel to use to support such a hypothesis. In fact, it’s not even that good as a hypothesis-generating study. There’s just too much potential interference from confounding variables that hasn’t been accounted for. I have to wonder about the quality of the peer review of this particular journal. After all, if Joseph and I, neither of whom are epidemiologists and one of whom is not a physician or scientist, can spot the glaring flaws in this study, why couldn’t the peer reviewers?"

D'oh! That doesn't sound very much like I've declared the matter "scientifically settled for all time," now does it?

My goodness. If you're going to criticize me, at least do me the solid of criticizing me for something I actually said or wrote. What you've accused me of isn't even a straw man. It's just plain false. I have said time and time again that vaccines don't cause autism because the scientific evidence is overwhelming that there is no link between them. I have never, however, said that there is no enviromental trigger or cause and that the science is completely settled for all time. Of course when anti-vaccinationists say "environmental trigger," it's almost always code for "teh vaccines done it!" but I'll take your word for it that you don't mean it that way.

Unknown said...

Dr. Gorski

If you are confused well, then you are confused. I will try to clarify.

My references to your views on the environmental components of autism were not direct quotes and were not presented as direct quotes. They reflected how I interpret, after sorting through statements you have actually made on the subject, in your usual rambling, angry fashion.

1) You reduce the environmental component of autism disorders to the vaccine issue about which you obsess frequently.

In your comment on the Greg Laden article "Autism Study Examines Cause of Apparent Rise in Rate" you criticized the UC Davis MIND study on autism prevalence by referencing what you see as anti-vaccine associations:

"H-P's criticism of the Schechter study (Ref. 13) as using an "error-prone" method is also off-base. Worse, it rather uncritically cites not one, not two, but three by thimerosal/autism conspiracy mongers, specifically two studies by Mark Blaxill (Refs. 11 and 25; by the way Mark also blogs for the crank antivaccine blog Age of Autism, in case you doubt his antivax cred) and one study Mark and David Geier (Ref. 12; search for "Geier" on my blog, and you'll find a panoply of their nonsense examined). In fact, Ref. 12 as published in the Journal of American Physicians and Surgeons, a crank journal that publishes lots of antivaccine articles. (Search for "JPANDS" on my blog, and you'll see; I'd also be happy to show you the link on my blog to my analysis of that very study.) If you knew the background and the players in this game, you would have noticed these problems right away before even looking at the methods and the data analysis. You don't, and you didn't; so you thought this study was a lot better than it really is.
Another thing: It's a straw man to claim that we who are skeptical of this study deny the possibility of an environmental influence. We don't. It is also a straw man to imply that we deny the possibility of a real increase in autism prevalence, as you seem to be doing. We do not deny that possibility, either. In this case, what we do say is that the Hertz-Picciotto study is not particularly good evidence for an environmental component to autism, and, as Steve Novella points out, David Kirby and other antivaccinationists have coopted this study as evidence that it must be the vaccines when it is nothing of the sort."

2. With respect to the permanency issue you note that previous studies on autism prevalence did not reach the same conclusion as the H-P study as though somehow that automatically diminishes the data and conclusions of the H-P study.

"In any case, this topic is not something new. This is not something that hasn't been studied before. That history isn't really properly reflected in H-P. Indeed, the discussion in the introduction is entirely inadequate; it doesn't even mention Shattuck's study, which was a very important one."

continued ...

Unknown said...

...... continued from previous comment

3. You stated that, and I am quoting you here, note the quotation marks"

"Quite frankly, Greg, you now come across as someone who has only just discovered the concept of the "autism epidemic" and remains unaware that there have actually been quite a few studies that have looked at the issue other before this one and that the emerging consensus is generally that, if there is a true increase in the rate of ASDs, it is small compared to the apparent increase due to diagnostic substitution, broadening of the diagnostic criteria, and increased surveillance, and, if there is an environmental component, it, too, is quite small compared to genetics. This study does nothing to cast significant doubt on that tentative consensus."

You provided no source or substantiation for your assertion that there is a consensus that IF there is an environmental component to autism and autism rates it too is quite small compared to genetics.

To my knowledge you have no specific expertise in autism disorders. Professor Simon Baron Cohen who does have such expertise has spoken publicly on at least three occasions that I am aware of that there has to be an environmental component to autism. The links to those public comments can be found on this site if you do a search.

Baron Cohen does not, to my knowledge, attempt to determine the extent to which environment AS OPPOSED to GENETICS influences the development of autism.

The emerging consensus and I believe it was such in January of 2009, is that autism disorders result from the interaction of genetic and environmental factors. The IACC strategic plan January 2009 stated:

"Although most scientists believe that risk factors for ASD are both genetic and environmental, there is considerable debate about whether potential environmental causes, genetic precursors, or interactions between genes and environmental factors should be the highest priority for research aimed at identifying the causes of ASD. To date, few studies have ruled in or ruled out specific environmental factors. While there are reports of associations of ASD with exposure to medications or toxicants prenatally, and to infections after birth, it is still not known whether any specific factor is necessary or sufficient to cause ASD. Similar to other disease areas, advancing research on the potential role of environmental factors requires resources and the attraction of scientific expertise. Bringing this to bear on autism will help focus the environmental factors to study, as well as the best approach for staging studies to examine environmental factors, interaction between factors, and between individual susceptibility and various environmental factors. For example, some researchers believe that it is important to study a large number of exposures, or classes of exposure, that are known to affect brain development. Others support more tightly focused studies of one exposure or a limited number of exposures, with greatest biologic plausibility for interacting with known or suspected biologic or genetic ASD risk factors. In addition, it is also important to design studies that assess environmental exposure during the most relevant exposure windows: pregnancy and early development. In doing this research, it will be important for the field to develop sound standards for identifying and claiming that environmental factors contribute to ASD, as it would be for genetics."


Unknown said...

conclusion from previous 2 posts

I suspect you are aware that IACC head Dr. Insel has recently stated categorically that there is no question that environment is a component of autism. Dr. Insel made those comments in an interview with David Kirby so I hope that doesn't cause you too much stress. He also made them in response to CDC study results released in the pre-Christmas news period which now show autism rates at 1 in 110. Please don't offer the 1994 diagnostic definition changes to explain the latest drop fully.

Dr. Insel interviewed Dr. Peter Bearman on the autism increases, Dec 17 2009


From about minute 6:30 gets into discussing the 50% of the autism epidemic that can not be explained by diagnostic changes or increased awareness.

Very few people who follow autism issues closely dispute that genetics play a substantial role in autism causation. The problem has been that possible environmental causes have not received anywhere near the same level of attention of research funding dollars ad pointed out back in 1999 by Teresa Binstock and again by Dr.Irva Hertz-Picciotto.

With more research focusing on environmental factors the extent to which environmental factors are involved with autism might be better known.

Anonymous said...

As Gorski continues to perseverate defensively online -- splitting hairs, misrepresenting and obfuscating -- he inadvertently provides more discomfiting details about his personal agendas, social ineptitude and disturbing psychopathologies.

In his awkward way he typifies that old adage, the end of which is "...open your mouth and remove all doubt." Because actions speak louder than words, there's precious little science at the Island of Misfit Toys mislabeled as Science Blogs.

Anonymous said...

Gorski appears to be a very insecure doctor who seems to have more time on his hands than most doctors. Business must be slow with his kind of attitude and bedside manner.