Tag Archives: CDC

COVID and Caroline Leaf

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How Coronavirus is highlighting the flaws in Dr Leaf’s ministry

COVID-19.  Insidious.  Deadly.  Eroding, sculpting the bedrock of our society like the wind and waves change the shoreline, but in a fraction of the time, as if the foundations of our society – our health, our economy, our social connections – were made of soft clay.

As a doctor on the frontline, I’m witnessing first-hand the effects of just what COVID-19 is doing to our collective health.  Thankfully as a general practitioner in Australia, my experience is different to those in a hospital in London or New York.  I’m seeing the distress in my community as social distancing is slowing the spread of the viral malaise, but is creating an economic one.  In London and New York, doctors, nurses and other front-line healthcare workers are dealing with a nightmarish outbreak of COVID-19 with the virus claiming thousands of lives.  Still, whatever our experiences, novel coronavirus has changed our lives forever as we all play our part to help flatten the curve, help those who are sick, and stop the spread of this pernicious disease.

How is “Doctor” Leaf responding to COVID?  In fairness, she is doing better than some so-called ‘wellness’ experts and other heavily deluded self-proclaimed health gurus … gurus like celebrity chef Pete Evans, who is currently under investigation by the Therapeutic Goods Administration in Australia for spruiking a $14,990 device he claims to “replicate light, frequencies, harmonics, pulsed electromagnetic fields and voltage that are found in nature” to cure COVID.

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist.  More than 20 years ago, she wrote a PhD on a learning program developed for an educational setting.  She’s not a medical doctor.  She is not an epidemiologist or a public health physician.  She is no more qualified to give advice on COVID than my hairdresser is.

Which is why Dr Leaf has been more subtle in how she has been approaching her COVID coverage.  She’s largely been distancing herself from delivering advice, and instead, using other ‘experts’ to sell her message.  Having said that, Dr Leaf took it upon herself to tell her audience about how they could protect themselves from COVID in episode 138 of her podcast “Cleaning Up the Mental Mess”. Unfortunately, amongst some very reasonable advice which she’d clearly read direct from the CDC website, she also recommended people to stockpile food, that panicking about COVID would create a toxic state in your body that was worse than the virus itself, and that eating garlic, Echinacea, ginger or going in a sauna would kill the virus and boost your immune system (and there were lots of other clangers, but that’s a whole post all on its own).  In short, don’t consult Dr Leaf for medical advice.  Talk to a real doctor.

Some of Dr Leaf’s guests appear to have excellent credentials.  And some of the information they’re promoting in Dr Leaf’s podcasts hasn’t been totally wrong about COVID.  It’s the same information as what every other epidemiologist and public health official has been saying since COVID-19 spread from Wuhan and took hold in other countries.  If some of the key messaging in Dr Leaf’s podcasts is directly transcribed from the CDC, and given that it’s a message that everyone needs to hear right now, then it’s a good thing that she’s been able to get such important information to her followers.

However, Dr Leaf has also been capitalising on the COVID crisis.  First, Dr Leaf has been slipping her own pseudoscientific messages into the podcasts.  For example, in a recent episode of her podcast specifically about COVID-19 (episode 145), Dr Leaf waited until right at the very end to slip in “the importance of gut health for immunity”.  Actually, your gut has nothing to do with your immunity.  This trope is an old faithful that is constantly trotted out by every pseudoscientist and alternative practitioner for years.  Don’t get me wrong, eating well is good for you, but you’re not going to stop yourself from getting COVID-19 just by eating plants.

Dr Leaf has also been using her podcasts as a perverse promotional platform for all manner of products.  They include her own products … “Join my Peace During the Pandemic Challenge! All you have to do is download my brain detox app SWITCH and work through the 21 day program in the app! A 3 month subscription is on sale now for less 50%.”  You can also get 25% off all of her other books, DVDs, and workbooks.

She also shamelessly promotes unproven treatments from those who sponsor her.  These include the books of those who go on her show, like that of Dr Will Bulsiewicz, promoting his plant-fed mantra like other wellness gurus following in the style of the discredited Dean Ornish (https://www.scientificamerican.com/article/why-almost-everything-dean-ornish-says-about-nutrition-is-wrong/).

Then there are those who sponsor Dr Leaf’s podcasts – BLUblox who sell you glasses to “protect” you from exposure to that “harmful blue and green light” which the American Academy of Ophthalmology has confirmed isn’t actually harmful.

Then there’s Ned, Dr Leaf’s “favourite” drug dealers who want to sell you the negligible benefits of “medicinal” marijuana.  In later podcasts, Dr Leaf find a new “favourite” drug dealer, “Feals CBD (the best CBD out there!): To get 50% off your Feals CBD order see https://feals.com/drleaf. Have questions about CBD? Feals has a free hotline and text message support to help guide your personal experience!”

Many people have said that COVID is bringing out the best and the worst in people.  We’ve seen it played out in all sorts of ways – healthcare workers who heroically turn up for work to care for their patients, often without the Personal Protective Equipment that they so desperately need, and who have paid the ultimate price, while on the opposite end, some people in the community hoard food, medicines and toilet paper, or take the opportunity to price-gouge for essential items (including medical equipment making access to PPE even harder for healthcare workers).

In using this crisis to promote her own unscientific, unproven treatments, and in continuing to shamelessly promote the baseless false cures of others, Dr Leaf is much less the hero than what she is making herself out to be.  She might not be hoarding toilet paper or wasting masks, but using a global pandemic to defraud people in the middle of a global health crisis and economic depression is distinctly distasteful.

But the other thing that COVID-19 is highlighting is the folly of Dr Leaf’s teaching that “75 to 98 percent of mental and physical illness come from our thought life”.  To Dr Leaf’s pre-COVID audience, this seemed like an eminently plausible statement at face-value.  We’ve all been brought up in western countries with immunisations and strong health systems, and prior to COVID, a rampant viral plague with a huge death toll has been unimaginable.  So of course it seems like all of our illnesses, like heart disease and cancer and the like, might possibly be linked with our thinking.

Except that Dr Leaf’s fallacious factoid only seems plausible in the western context.  Take away the protection of a first-world health system – general practitioners and other forms of primary care, hospitals, sanitation, public health protection and immunisations – and the illusion that our thoughts make any difference to our health simply vaporises.

For most third-world countries, endemic plagues that carry a high mortality are almost a part of life.  Mara et al state, “At any given time close to half of the urban populations of Africa, Asia, and Latin America have a disease associated with poor sanitation, hygiene, and water.” Bartram and Cairncross write that, “While rarely discussed alongside the ‘big three’ attention-seekers of the international public health community – HIV/AIDS, tuberculosis, and malaria – one disease alone kills more young children each year than all three combined. It is diarrhoea, and the key to its control is hygiene, sanitation, and water.”  Hunter et al state that, “diarrhoeal disease is the second most common contributor to the disease burden in developing countries (as measured by disability-adjusted life years (DALYs)), and poor-quality drinking water is an important risk factor for diarrhoea.”

Diarrhoeal disease in the developing world – the second most common contributor to disease in these countries, afflicting half of their population – has nothing to do with thought.  It’s related to the provision of toilets and clean running water.  We live in a society that prevents half of our potential illness because of internal plumbing.

Now with the emergence of COVID-19, we see just how vulnerable we are in the western world to infectious disease for which there is no cure or vaccine.  The only thing that is stemming the COVID tide are whole-population public health measures like social distancing and the most basic of all good public health measures, hygiene.

Indoor plumbing, hand washing and remaining one and a half metres from other people has nothing to do with our thought lives.  Dr Leaf’s ministry is built on a lie that basic science has long proven false for anyone willing to take notice.  COVID is simply shining the spotlight on the egregious error at the foundation of Dr Leaf’s ministry of falsehoods.

I hope that when the COVID crisis is over and the church has a chance to rebuild and move forward into the post-COVID world that they will snap out of their complacency and see the ministry of Dr Leaf for what it is – a regurgitation of a few basic facts mixed in with the rancid bile of factoids and falsehoods whose sole purpose is to market false-hope and fake cures to trusting, vulnerable people.

Until that time, when we’ve stayed the course and are on the other side of this COVID crisis, stay as safe and as well as you can.  I don’t need to tell you what to do by now – we’ve all heard it … keep your distance, wash your hands.  Follow the directions from public health officials in your local area.

If you’re in Australia – your local GP is there for you, for advice in person or on the phone.  Get your influenza vaccine.  More information is available from your local state health department or the Australian government.

We can get through this crisis if remain united, armed with the truth, not fake facts and false hope.

#KeepYourDistanceStandUnited

Bibliography

Mara, D., et al., Sanitation and health. PLoS Med, 2010. 7(11): e1000363 doi: 10.1371/journal.pmed.1000363

Bartram, J. and Cairncross, S., Hygiene, sanitation, and water: forgotten foundations of health. PLoS Med, 2010. 7(11): e1000367 doi: 10.1371/journal.pmed.1000367

Hunter, P.R., et al., Water supply and health. PLoS Med, 2010. 7(11): e1000361 doi: 10.1371/journal.pmed.1000361

Post-script

Many of Dr Leaf’s acolytes will say that I’m being a hypocrite – that while I might be criticising Dr Leaf for using the COVID crisis to sell her products, I’m just using that as an excuse to gain some attention for myself.  Hey, think whatever you like.  I’m not particularly bothered.  I’m not here to sell my material or to promote myself.  Like always, I’m here to hold Dr Leaf accountable, since no one else in the church is willing to do so.  Like always, if you disagree with me, that’s fine.  I’m not here to win arguments.  I’m here to provide the truth.  Believe me or not, that’s entirely up to you.

Why all the anger?

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One of the latest vaccination memes to go viral on social media is an article by Arizona “paleo-cardiologist”, Dr Jack Wolfson.

Dr Wolfson did an interview with one of his local TV stations in January, during which he gave his opinion about the outbreak of measles centred around Disneyland.

He said, “We should be getting measles, mumps, rubella, chicken pox, these are the rights of our children to get it. We do not need to inject chemicals into ourselves and into our children in order to boost our immune system. I’m a big fan of what’s called paleo-nutrition, so our children eat foods that our ancestors have been eating for millions of years. That’s the best way to protect.” (http://www.azcentral.com/story/news/12-news/2015/01/23/12news-doctor-dont-vaccinate/22200535/)

His follow up article, the one going viral, is titled, “Why All the Anger?” Uh … how about because you’re a douche?

Let’s start by looking at his comments in January on Arizona’s Channel 12 News:

  1. “We should be getting measles, mumps, rubella, chicken pox, these are the rights of our children to get it”.
    Or in other words, by stopping our children getting sick, we’re depriving them of their rights. That’s a patently stupid statement. Our children have a right to expect care. We give them shelter, protection, education and good nutrition so that their lives can flourish. Vaccinations are part of that care. Sure, there are side effects of vaccines, but they are nothing compared to the abject cruelty of the diseases they prevent.
  1. “We do not need to inject chemicals into ourselves and into our children in order to boost our immune system.”
    Our immune systems do an amazing job at keeping us alive. Our immune systems will eventually fight off measles, chicken pox, or any other number of pathogens, but vaccines stop the “collateral damage”, the children who are overwhelmed by the full-blown infection and die, or are permanently disabled by it. Even for the children that come through ‘unscathed’ (i.e. not dead), illnesses like measles inflict weeks of suffering with high fevers, aching joints and muscles, severe fatigue, and any other number of symptoms, then there are the ongoing illnesses like shingles and the associated severe chronic nerve pain from viruses like chickenpox, all of which can be prevented by routine childhood vaccinations.
  1. “I’m a big fan of what’s called paleo-nutrition, so our children eat foods that our ancestors have been eating for millions of years. That’s the best way to protect.”
    Really? The Palaeolithic population were hunter-gatherers, and we know that the mortality of hunter-gatherer children is in the order of 40% (http://cast.uark.edu/local/icaes/conferences/wburg/posters/sara_stinson/stinson.html). That’s not what I would call ‘protective’. Besides, palaeontologists have shown that the food promoted as ‘paleo’ is nothing like the food that our ancestors ate (https://www.youtube.com/watch?v=BMOjVYgYaG8) so paleo-nutrition is just another baseless fad.

I’m guessing that the response he received after publically sharing his heterodox views wasn’t particularly favourable. In reply, he offered this article, which is the article now going viral on social media (http://healthimpactnews.com/2015/arizona-cardiologist-responds-to-critics-regarding-measles-and-vaccines/).

It seems to me like he has unsuccessfully tried to dig himself out of his own grave. Sure, those people who are also currently drinking the antivaccine-paleo Kool-Aid will take his side and point to this brave martyr standing up to the establishment, but ultimately his come-back is nothing more than diversionary blame-shifting.

Here’s what he had to say about who the real enemies are:

“1. Be angry at food companies. Sugar cereals, donuts, cookies, and cupcakes lead to millions of deaths per year. At its worst, chicken pox killed 100 people per year. If those chicken pox people didn’t eat cereal and donuts, they may still be alive. Call up Nabisco and Kellogg’s and complain. Protest their products. Send THEM hate-mail.
2. Be angry at fast food restaurants. Tortured meat burgers, pesticide fries, and hormone milkshakes are the problem. The problem is not Hepatitis B which is a virus contracted by drug users and those who sleep with prostitutes. And you want to inject that vaccine into your newborn?
3. Be angry at the companies who make your toxic laundry detergent, fabric softener, and dryer sheets. You and your children are wearing and breathing known carcinogens (they cause cancer). Call Bounce and Downy and let them know. These products kill more people than mumps, a virus which actually doesn’t cause anyone to die. Same with hepatitis A, a watery diarrhea.
4. Be angry at all the companies spewing pollution into our environment. These chemicals and heavy metals are known to cause autism, heart disease, cancer, autoimmune disease and every other health problem. Worldwide, these lead to 10’s of millions of deaths every year. Measles deaths are a tiny fraction compared to pollution.
5. Be angry at your parents for not breastfeeding you, co-sleeping with you, and stuffing your face with Domino’s so they can buy more Tide and finish the laundry. Breastfeeding protects your children from many infectious diseases.
6. Be angry with your doctor for being close-minded and not disclosing the ingredients in vaccines (not that they read the package insert anyway). They should tell you about the aluminum, mercury, formaldehyde, aborted fetal tissue, animal proteins, polysorbate 80, antibiotics, and other chemicals in the shots. According to the Environmental Working Group, newborns contain over 200 chemicals as detected by cord blood. Maybe your doctor feels a few more chemicals injected into your child won’t be a big deal.
7. Be angry with the cable companies and TV manufacturers for making you and your children fat and lazy, not wanting to exercise or play outside. Lack of exercise kills millions more than polio. Where are all those 80 year olds crippled by polio? I can’t seem to find many.
8. In fact, be angry with Steve Jobs and Bill Gates for creating computers so you can sit around all day blasted with electromagnetic radiation reading posts like this.
9.Be angry with pharmaceutical companies for allowing us to believe living the above life can be treated with drugs. Correctly prescribed drugs kill thousands of people per year. The flu kills just about no one. The vaccine never works.

Finally, be angry with yourself for not opening your eyes to the snow job and brainwashing which have taken over your mind. You NEVER asked the doctor any questions. You NEVER asked what is in the vaccines. You NEVER learned about these benign infections.

Let’s face it, you don’t really give a crap what your children eat. You don’t care about chemicals in their life. You don’t care if they sit around all day watching the TV or playing video games.

All you care about is drinking your Starbuck’s, your next plastic surgery, your next cocktail, your next affair, and your next sugar fix!”

Yes, it’s all your fault. You’re all too selfish to see how you’ve been conned by centuries of scientific evidence, and that only those who follow the doctrines of paleo-nutrition are truly enlightened.

It would be funny if it wasn’t so serious. This so-called man of science would have us believe that measles, chickenpox, diphtheria, polio and other vaccine preventable diseases are benign. Tell that to the 2.5 million children who die every year from vaccine-preventable diseases around the world (De Cock, Simone, Davison, & Slutsker, 2013).

“At its worst, chicken pox killed 100 people per year.” According to the CDC, his figure is correct – the average number of deaths from chickenpox from 1990-1996 was about 103 per year in the USA though he failed to mention the 11,000 hospitalisations per year caused by chickenpox (http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/varicella.pdf). Measles, on the other hand, kills two people for every thousand that are infected by it (http://www.cdc.gov/vaccines/pubs/pinkbook/meas.html#complications). The 2013 US road toll was 0.107/1000 (http://www.cdc.gov/nchs/fastats/accidental-injury.htm), making measles 18 times more deadly than road transportation.

“Where are all those 80 year olds crippled by polio? I can’t seem to find many.” Well, it’s hard to find anything when you’re closed minded. Polio caused paralysis in about 1 in 100 cases, and death in up to 30% of those (http://www.cdc.gov/vaccines/pubs/pinkbook/polio.html). Again, those figures are worse than the road toll.

“Be angry with your doctor for being close-minded and not disclosing the ingredients in vaccines (not that they read the package insert anyway). They should tell you about the aluminum, mercury, formaldehyde, aborted fetal tissue, animal proteins, polysorbate 80, antibiotics, and other chemicals in the shots”. Guess what, your doctor doesn’t tell you about aluminum, mercury, formaldehyde, aborted fetal tissue, animal proteins, polysorbate 80, antibiotics etc in vaccines because they’re either not there, or they’re there in amounts so tiny that you would have a greater exposure to them by simply eating. For example, Thiomersal (which contained mercury) has been removed from childhood vaccines since the year 2000 as a precautionary measure, even though there was never any evidence it caused any harm. Aluminium from vaccines is lower than everyday exposure from intake from diet or medications, such as antacids, and is well below the levels recommended by organisations such as the United States Agency for Toxic Substances and Disease Registry. And there is no aborted foetal tissue in vaccines (http://www.health.gov.au/internet/immunise/publishing.nsf/content/uci-myths-guideprov)

And the rest … more of the usual rhetoric of the paleo-minded – sugar, “tortured meat” burgers, “pesticide” fries, and “hormone” milkshakes, laundry detergent, pollutants that “cause autism, heart disease, cancer, autoimmune disease and every other health problem”, computers that bombard you with electromagnetic radiation … he even goes a little Freudian by blaming mothers for not breast feeding and co-sleeping enough. It’s all a bit of a stretch.

So why all the anger? Maybe it has something to do with the fact that people are sick and tired of so-called experts trying to debase solid science with some tarted up pseudoscientific fad. The public know more than what most snake-oil salesmen think they do, and they’re sick of being treated like idiots. People know that immunisation works, and trying to sell the idea that ‘paleo-nutrition’ is better than vaccination just makes you look like a douche.

References

De Cock, K. M., Simone, P. M., Davison, V., & Slutsker, L. (2013). The new global health. Emerg Infect Dis, 19(8), 1192-1197. doi: 10.3201/eid1908.130121

Gardasil and the Deadly Scam

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Making the rounds of Facebook is an article published on The Daily Sheeple (“Lead Developer Of HPV Vaccines Comes Clean, Warns Parents & Young Girls It’s All A Giant Deadly Scam,” 2014) about Gardasil, the Human Pappilloma Virus vaccine.

If what Sheeple are saying is correct, then Gardasil is a deadly scam!  We’ve all been conned into believing that Gardasil and other HPV vaccines were safe, and useful in protecting our children from cervical cancer, when really it doesn’t do anything but make money for Merck, that multi-billion dollar global tyrant, while our children wither and die.

True to the form of paranoid extremists everywhere, Sheeple uses hysterical accusations and mistruths in a breathless promotion of fear and ignorance.  The only deadly scam going on here is Sheeple’s.

Lets break down the article by Sheeple a little, then lets look at the facts from the peer-reviewed literature, not misquotes from misquotes.

Sheeple quotes an article on a similarly extreme blog, which took the quotes from another extremist blog.  It alleges that Dr Harper believed that Gardasil was pointless, and harmful, even more harmful than cervical cancer which it was designed to prevent.  The article alleges that there were 15,037 adverse reactions and 44 deaths.  They quote Harper to CBS stating that, “‘The risks of serious adverse events including death reported after Gardasil use in (the JAMA article by CDC’s Dr. Barbara Slade) were 3.4/100,000 doses distributed,’ Harper tells CBS NEWS.  ‘The rate of serious adverse events on par with the death rate of cervical cancer.’”

The truth is that the rates of serious adverse reactions to the HPV vaccine are incredibly small.

The CDC Morbidity and Mortality Weekly report from the 26th July 2013 states that, “From June 2006 through March 2013, approximately 56 million doses of HPV4 were distributed in the United States … During June 2006–March 2013, the Vaccine Adverse Event Reporting System (VAERS) received a total of 21,194 adverse event reports occurring in females after receipt of HPV4” (Centers for Disease Control and Prevention, 2013).  That’s an adverse events rate of 0.04%.

The vast majority of vaccination side effects are a red, sore arm and fainting, which are not exclusive side effects to HPV vaccinations, but to all vaccinations in adolescents (Centers for Disease Control and Prevention, 2013; Harper & Vierthaler, 2011).  In large trials, the rate of vaccine side effects was comparable to the rate of side effects from the placebo (Centers for Disease Control and Prevention, 2013; Gee et al., 2011; Lu, Kumar, Castellsague, & Giuliano, 2011; Rambout, Hopkins, Hutton, & Fergusson, 2007).  So the vaccine is not the problem, it’s the histrionic teenagers.

In terms of deaths from the HPV vaccine, there aren’t any.  Rambout et al. (2007) wrote, “The meta-analysis demonstrated that, overall, the incidence of serious adverse events and death was balanced between the vaccine and control groups … Most deaths were reported as accidental, and none of the deaths was considered attributable to the vaccine.”  National Centre For Immunisation Research and Surveillance (2013) states that, “HPV vaccines are approved for use in over 100 countries, with more than 100 million doses distributed worldwide … No deaths reported in safety surveillance systems data in Australia or overseas, have been determined to be causally related to either of the HPV vaccines.”

Compare that to the current Australian road toll, which currently stands at 5.2/100,000 (Road Deaths Australia, December 2013).  It’s safer to have a HPV vaccination than it is to drive a car.

The Sheeple article also fails to correctly report the benefits of the HPV vaccine, which has already shown a dramatic drop in the rate of HPV infection (Lu et al., 2011) and the incidence of genital warts (Ali et al., 2013).

Given all of this, did Dr Harper really suggest that the HPV vaccine was useless and harmful?  I doubt she said anything of the sort, since in 2011 in a formal paper in a peer-reviewed journal, she said, “Should vaccination be an option that women choose for their cervical cancer protection, Cervarix is an excellent choice for both screened and unscreened populations due to its long-lasting protection, its broad protection for at least five oncogenic HPV types, the potential to use only one-dose for the same level of protection, and its safety.” (Harper & Vierthaler, 2011)

One final word about every woman’s favourite health check, the pap smear.  Australia does have a low death rate from cervical cancer, compared to the rest of the world, even before the introduction of the HPV vaccine.  The national co-ordinated approach to cervical screening with pap smears is the reason why.  “Vaccination is not an ‘alternative’ to Pap tests; together these two approaches provide optimal protection. The National Cervical Screening Program recommends routine screening with Pap tests every 2 years for all women between the ages of 18 (or 2 years after first sexual intercourse) and 69 years.” (National Centre For Immunisation Research and Surveillance, 2013)

Is there a giant deadly scam behind the Gardasil vaccine?  Only from those who oppose it.  The same people wouldn’t think twice about letting their teenagers in a car, which is far more dangerous.  When it’s their turn, I’ll have no hesitation in having my children vaccinated for HPV.  If you disagree, that’s ultimately your choice.  But examine all the facts first.  Don’t let your children’s health rest on a baseless Internet meme.

References

Ali, H., Donovan, B., Wand, H., Read, T. R., Regan, D. G., Grulich, A. E., . . . Guy, R. J. (2013). Genital warts in young Australians five years into national human papillomavirus vaccination programme: national surveillance data. BMJ, 346, f2032. doi: 10.1136/bmj.f2032

Centers for Disease Control and Prevention. (2013). Human papillomavirus vaccination coverage among adolescent girls, 2007-2012, and postlicensure vaccine safety monitoring, 2006-2013 – United States. MMWR Morb Mortal Wkly Rep, 62(29), 591-595.

Gee, J., Naleway, A., Shui, I., Baggs, J., Yin, R., Li, R., . . . Weintraub, E. S. (2011). Monitoring the safety of quadrivalent human papillomavirus vaccine: findings from the Vaccine Safety Datalink. Vaccine, 29(46), 8279-8284. doi: 10.1016/j.vaccine.2011.08.106

Harper, D. M., & Vierthaler, S. L. (2011). Next Generation Cancer Protection: The Bivalent HPV Vaccine for Females. ISRN Obstet Gynecol, 2011, 457204. doi: 10.5402/2011/457204

Lead Developer Of HPV Vaccines Comes Clean, Warns Parents & Young Girls It’s All A Giant Deadly Scam. (2014). The Daily Sheeple.  Retrieved Jan 17, 2014, from http://www.thedailysheeple.com/lead-developer-of-hpv-vaccines-comes-clean-warns-parents-young-girls-its-all-a-giant-deadly-scam_012014 – sthash.lDJcsFRt.dpuf

Lu, B., Kumar, A., Castellsague, X., & Giuliano, A. R. (2011). Efficacy and safety of prophylactic vaccines against cervical HPV infection and diseases among women: a systematic review & meta-analysis. BMC Infect Dis, 11, 13. doi: 10.1186/1471-2334-11-13

National Centre For Immunisation Research and Surveillance. (2013). Human papillomavirus (HPV) vaccines for Australians | NCIRS Fact sheet: March 2013.   Retrieved Jan 17, 2014, from http://www.ncirs.edu.au/immunisation/fact-sheets/hpv-human-papillomavirus-fact-sheet.pdf

Rambout, L., Hopkins, L., Hutton, B., & Fergusson, D. (2007). Prophylactic vaccination against human papillomavirus infection and disease in women: a systematic review of randomized controlled trials. CMAJ, 177(5), 469-479. doi: 10.1503/cmaj.070948

Road Deaths Australia, December 2013. (2014).  Canberra, Australia: Commonwealth of Australia. Retrieved from http://www.bitre.gov.au/publications/ongoing/rda/files/RDA_Dec13.pdf.

Autism Series 2013 – Part 3: The Autism “Epidemic”

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Weintraub, K., Autism counts. Nature, 2011. 479(7371): 22-4.

Weintraub, K., Autism counts. Nature, 2011. 479(7371): 22-4.

It seems that autism is on the rise.  Once hidden away in institutions or just dismissed as odd, society is now faced with a condition that it is yet to come to grips with.  Some out in the community believe that it must be a toxin, or vaccines or mercury.  Others accuse doctors of simply giving in to the unreasonable demands of pushy parents to defraud the system of money – “Things have reached the point these days where any kid that’s not a charming little extrovert will be accused of being, ‘on the spectrum.’”[1]

So is there an epidemic of kids who are “not charming little extroverts”?  It depends on who you ask.

Take, for example, two articles written in the year 2000.  In the first, titled “The autism epidemic, vaccinations, and mercury”, Rimland said,

“While there are a few Flat-Earthers who insist that there is no real epidemic of autism, only an increased awareness, it is obvious to everyone else that the number of young children with autism spectrum disorders (ASD) has risen, and continues to rise, dramatically.”[2]

The other, written by Professor Tony Attwood, a world authority on Aspergers Syndrome, said,

“… is there an epidemic of people being diagnosed as having Asperger’s Syndrome? At present we cannot answer the question, as we are unsure of the diagnostic criteria, the upper and lower levels of expression and the borders with other conditions. Nevertheless, we are experiencing a huge increase in diagnosis but this may be the backlog of cases that have been waiting so long for an explanation.”[3]

I don’t think it’s very often Prof Attwood is lumped with ‘flat-earthers’.  But you can see the change in perspective from one side looking objectively to the other who need for there to be an “epidemic” of autism in order to strengthen their case.

So who’s right?  To see if this autism “epidemic” hypothesis has any real merit, we need to delve into some numbers.

First, some basic epidemiology – because part of the confusion in looking at the autism numbers is defining exactly what those numbers represent.  Here are some important epidemiology terms from the “Physicians Assistant Exam for Dummies”[4]:

Incidence: For any health-related condition or illness, incidence refers to the number of people who’ve newly acquired this condition.

Prevalence: Prevalence concerns the number of people who have this condition over a defined time interval.

Most autism figures are for prevalence, or often more specifically, point prevalence – “the number of people who have this condition at any given point in time.”

The other thing to remember from my last blog is that initially autism was only diagnosed on the strict rules of Kanner, and was considered to be a single disease caused mainly by bad parenting [5].  So through the 1960’s and 1970’s, only the most severe children were diagnosed as having autism because the high-functioning autism would not have met Kanners criteria, and even if they did, most parents didn’t want the label for fear of the social stigma.

So then, what are the numbers?  The early prevalence was estimated to be less than 5/10,000 or 1 in 2000[6], although in surveys done after 1987, the numbers began to rise past 7/10,000[7].  In the 1990’s, Autism prevalence climbed into the teens and the latest prevalence has been documented for autism is 20.6/10,000[7].

But that’s only about 1 in 485.  The CDC estimated a prevalence of 1 in 88 (113/10,000)[8].  Where did the other 400 people go?

This is where the importance of definitions is highlighted.  Autism is considered part of a spectrum, and at the time of the surveys reviewed by Fombonne, DSM III then DSM IV considered conditions like Pervasive Developmental Disorder and then Aspergers Disorder to be part of that spectrum.  Adding in the rate of PDD and you have a figure of 57.7/10,000 and adding in Aspergers gives you a combined rate of 63.7/10,000, or 1 in 157 people surveyed[7].

And yet even then, who you measure and how you measure makes much more of a difference, because a recent, rigorous study targeting all 7 to 12 year old children in a large South Korean populous found a prevalence of 2.64%, which is 264/10,000 or 1 child in every 38.  The authors noted that, “Two-thirds of ASD cases in the overall sample were in the mainstream school population, undiagnosed and untreated. These findings suggest that rigorous screening and comprehensive population coverage are necessary to produce more accurate ASD prevalence estimates and underscore the need for better detection, assessment, and services.”[9]

So if there has been a fifty-fold change in prevalence (from 5 to 264 cases per 10,000 people) in just thirty years, isn’t that an epidemic?

Well, no.  As much as some might ignorantly deny it, there is no real evidence for it.  Remember the definitions from the “Physicians Assistant Exam for Dummies”[4]:

Incidence: For any health-related condition or illness, incidence refers to the number of people who’ve newly acquired this condition.

Prevalence: Prevalence concerns the number of people who have this condition over a defined time interval.

It’s the rapid rise in the number of new cases diagnosed that defines an epidemic, which is the incidence and not the prevalence[10].  While the prevalence has changed a lot, the incidence has been fairly stable.  From Nature, “Christopher Gillberg, who studies child and adolescent psychiatry at the University of Gothenburg in Sweden, has been finding much the same thing since he first started counting cases of autism in the 1970s. He found a prevalence of autism of 0.7% among seven-year-old Swedish children in 1983 and 1% in 1999. ‘I’ve always felt that this hype about it being an epidemic is better explanation’, he said.”[11]

Fombonne agrees. “As it stands now, the recent upward trend in estimates of prevalence cannot be directly attributed to an increase in the incidence of the disorder.”[7]  He said later in the article that a true increase in the incidence could not be ruled out, but that the current epidemiological data which specifically studied the incidence of autism over time was not strong enough to draw conclusions.

While there’s no epidemic, there is the real issue of the genuinely increasing prevalence.  Why the rise in those numbers?  Fombonne went on to explain, “There is good evidence that changes in diagnostic criteria, diagnostic substitution, changes in the policies for special education, and the increasing availability of services are responsible for the higher prevalence figures.”[7]  Nature published a graph from the work of Professor Peter Bearman, showing that 54% of the rise in the prevalence of autism could be explained by the refining of the diagnosis, greater awareness, an increase in the parental age, and clustering of cases in certain geographic areas.

Weintraub, K., Autism counts. Nature, 2011. 479(7371): 22-4. (Adapted from King, M. and Bearman, P., Diagnostic change and the increased prevalence of autism. International Journal of Epidemiology, 2009. 38(5): 1224-34 AND King, M.D. and Bearman, P.S., Socioeconomic Status and the Increased Prevalence of Autism in California. Am Sociol Rev, 2011. 76(2): 320-46.)

Weintraub, K., Autism counts. Nature, 2011. 479(7371): 22-4. (Adapted from King, M. and Bearman, P., Diagnostic change and the increased prevalence of autism. International Journal of Epidemiology, 2009. 38(5): 1224-34 AND King, M.D. and Bearman, P.S., Socioeconomic Status and the Increased Prevalence of Autism in California. Am Sociol Rev, 2011. 76(2): 320-46.)

From Nature: “The fact that he still cannot explain 46% of the increase in autism doesn’t mean that this ‘extra’ must be caused by new environmental pollutants, Bearman says. He just hasn’t come up with a solid explanation yet. ‘There are lots of things that could be driving that in addition to the things we’ve identified,’ he says.”[11]

There is no autism epidemic, just medical science and our population realising just how common autism is as the definition becomes more refined, people become more aware, and some other biosocial factors come into play.

What can we take from the numbers?  That we’re being overtaken by Sheldon clones?  That soon there will be no more “charming little extroverts”?  If the CDC figure is accurate, then one person in every hundred is on the spectrum, so the world is hardly being overtaken by autism.  But the take home message is that Autism Spectrum Disorders are more common that we ever thought, and there are more people on the spectrum “hiding in plain sight”.  If the study from South Korea is accurate then one person in every thirty-eight is on the spectrum, but two thirds of them are undiagnosed.

Should there be more funding, more resources, or more political representation for people on the spectrum?  Perhaps, although the public and research funds are not unlimited, and other health concerns should also be treated fairly.  But since autism is life long and impacts on so many areas of mental health and education, understanding autism and managing it early could save governments billions of dollars into the future.

Rather, I think that the climbing prevalence of ASD is a clarion call for understanding and tolerance.  If we learn to tolerate differences and practice discretionary inclusion, then both the autistic and the neuro-typical can benefit from the other.  That’s a world which we’d all like to live.

REFERENCES

1. Bolt, A. If the autistic don’t get full cover, where’s the money going? 2013  2013 May 11]; Available from: http://blogs.news.com.au/heraldsun/andrewbolt/index.php/heraldsun/comments/if_the_autistic_dont_get_full_cover_wheres_the_money_going/.

2. Rimland, B., The autism epidemic, vaccinations, and mercury. Journal of Nutritional and Environmental Medicine, 2000. 10(4): 261-6.

3. Attwood, T., The Autism Epidemic: Real or Imagined, in Autism Aspergers Digest2000, Future Horizons Inc: Arlington, TX.

4. Schoenborn, B. and Snyder, R., Physician Assistant Exam For Dummies. 2012: John Wiley & Sons.

5. Pitt, C.E. Autism Series 2013 – Part 2: The History Of Autism. 2013  [cited 2013 2013 Aug 15]; Available from: https://cedwardpitt.com/2013/08/15/autism-series-2013-part-2-the-history-of-autism/.

6. Rice, C.E., et al., Evaluating Changes in the Prevalence of the Autism Spectrum Disorders (ASDs). Public Health Reviews. 34(2).

7. Fombonne, E., Epidemiology of pervasive developmental disorders. Pediatric research, 2009. 65(6): 591-8.

8. Baio, J., Prevalence of Autism Spectrum Disorders: Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008. Morbidity and Mortality Weekly Report. Surveillance Summaries. Volume 61, Number 3. Centers for Disease Control and Prevention, 2012.

9. Kim, Y.S., et al., Prevalence of autism spectrum disorders in a total population sample. American Journal of Psychiatry, 2011. 168(9): 904-12.

10. “Epidemic vs Pandemic”. 2013  [cited 2013 Sept 03]; Available from: http://www.diffen.com/difference/Epidemic_vs_Pandemic.

11. Weintraub, K., Autism counts. Nature, 2011. 479(7371): 22-4.