Why all the anger?

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

Advertisements

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

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.