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I saw an interesting medical news story this morning that said a small study was done that seemed to show that autistic children benefited from hyperbaric oxygen therapy (HBOT) compared to children who were exposed to slightly pressurised room air (hyperbaric oxygen chambers have higher levels of oxygen and are more pressurised).

I haven’t yet had a chance to read the study, so I am not sure how well done it is, but go and have a look to see for yourself.  The study is being published in the peer reviewed journal BMC Pediatrics, here is a link to the abstract and preliminary article.

The thing I found interesting about the particular report of this study in Medpage Today, is that there is some commentary by Paul Offit expressing scepticism about this study because the parties who conducted the studies (Daniel Rossignol, Lanier Rossignol, Scott Smith, Cindy Schneider, Sally Logerquist, Anju Usman, Jim Neubrander, Eric Madren, Gregg Hintz, Barry Grushkin and Elizabeth Mumper) are in some cases DAN! doctors who make their living treating autistic children, and who use HBOT to treat them, at least in some instances.

“I’d like to see [the study] reproduced in an academic medical center that doesn’t have the financial incentives,” said Dr. Offit.

That sounds a bit funny coming from Paul Offit, who spends his time studying, developing, handsomely profiting from and publicly promoting vaccines.  If the physicians in question have prima facie questionable intention and/or honesty because of their capacity to profit from their work, then one can’t help but wonder how Offit can avoid the very same criticism that he levies at them.

I happen to think it’s impossible to be utterly unbiased; every researcher comes to a study with an idea or a viewpoint that they expect to validate.  The methodologies of science aim to minimise these various biases, and of course where conflicts of interests exist, they should be completely disclosed.  But I think it’s quite something to disapprove of a study because the physicians profit from procedures they study and recommend, when one has profited from the development of a vaccine one has studied and recommends.  Offit routinely rebuffs criticism that he has a conflict of interest.  I wonder how he thinks these physicians who studied HBOT are differently situated.

In fact, in 2000 the Committee on Government Reform in the U.S. House of Representatives criticised practices of the Advisory Committee on Immunization Practices (which makes recommendations on childhood vaccines) with regards to their poor management of conflicts of interest, specifically citing Paul Offit (as well as others) who voted for the recommendation of the Wyeth RotaShield (rotavirus) vaccine on three occasions, when he was also developing a rotavirus (RotaTeq) vaccine with Merck, because of their worry about this as a conflict of interest.  They said “A recommendation for Wyeth-Lederle’s vaccine would help pave the way for future recommendations for the products of Merck and SmithKline-Beecham.”

That sounds like at least as worrisome a conflict as he is now concerned about with these DAN! doctors.

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I was rather foolishly unable to keep myself from reading yet another New York Times Op-Ed about mercury and vaccines, this one authored by Paul Offit, well-known vaccine advocate who works for the Children’s Hospital of Philadelphia, and has previously served on the CDC’s Advisory Committee on Immunization Practices (ACIP). He has perhaps more famously consulted for Merck, who gave him a $350,000 grant to develop the RotaTeq rotavirus vaccine which is now recommended by the CDC for infants in the US at 2, 4 and 6 months of age (he shares the patent for this vaccine and therefore financially profits whenever the vaccine is given). Rotavirus was killing about 60 infants a year in the US, but hopefully millions of vaccinations will now lower that figure since Rotateq is allegedly quite effective (98% according to New Scientist).

This latest offering by Offit is entitled “Inoculated Against Facts”, and appeared in the NYT on the of 31st of March in response to the media frenzy surrounding the Hannah Poling vaccine court settlement. Offit is obviously worried that the Poling case is going to have fewer people vaccinating, because he spends a lot of time trying to make it seem as though the decision to settle this case was nonsensical, and that the underlying health problem for Hannah Poling (even though no one knows if it existed before the vaccines or not) is extremely rare. He even goes so far as to as to say the “…vaccine court judges have turned their back on science by dropping preponderance of evidence as a standard.” He complains that now petitioners need only “propose a biologically plausible mechanism” in order to prevail in vaccine court. Thankfully, the Polings (who are a physician, lawyer and nurse between them) seem quite committed to setting the record straight on both medical and legal fronts, and have done so here, as a rebuttal to this op-ed in the New York Times, and in the Atlanta Journal-Constitution, (text at the end of this post).

As usual, there is some (junk) food for thought in the comments, courtesy of the New York Times faithful, intelligent, well-educated readers. I’m getting a little hardened to all the tedious rhetoric in those comments, by people who clearly just repeat the propaganda, with very little understanding of what it means. But the best one is this one, from JJ, from Boulder, Colorado. Here’s a partial quote:

It’s called “public health” for a reason: the health of the public is put first, and for good reason. I say this as a parent of a 3 yr old who has received all shots on time; I asked appropriate questions about those shots as they came up (re. thimerosal, etc.) but never questioned whether I would vaccinate, because I believe in something called civic responsibility.

I was absolutely gobsmacked. Do you think that if JJ had gotten his/her child vaccinated, and s/he stopped speaking and lost all eye contact within a week, that they’d be together at pro-vaccine demonstrations these days, with their kid in an over-sized, disabled child’s stroller, with a big sign proclaiming the pride in the sacrifice of their child for the benefit of everyone else? The only persons confident enough to moralize about people not risking their children’s well-being for the greater good are those who have already made the “sacrifice” and emerged unscathed. Those who are not so lucky have a very different perspective.

_____________________h

By Jon S. Poling

For the Atlanta Journal-Constitution

Published on: 04/11/08

Autism in the U.S. has reached epidemic levels, at 1 in 150 children. Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, has recently upgraded autism to “an urgent health threat.” The most contentious issue of the autism debate is the link to routine childhood vaccines. My daughter’s case, Hannah Poling v. U.S. Department of Health and Human Services, has changed this debate forever. Hannah has pointed us in a new and promising direction —- the mitochondria. On Nov. 9, 2007, HHS medical experts conceded through the Department of Justice that Hannah’s autism was triggered by nine childhood vaccinations administered when she was 19 months of age. This concession was granted without any courtroom proceedings or expert testimony, effectively preventing any public hearing discussing what happened to Hannah and why. Contrary to some reports, the Special Masters, “judges” who preside over the “vaccine court,” did not issue a decision. Four months later, on March 6, with trepidation my wife, Terry, and I stepped forward to announce this news —- providing hope and awareness to other families. The HHS expert documents that led to this concession and accompanying court documents remain sealed, though our family has already permitted release of Hannah’s records to those representing the almost 5, 000 other autistic children awaiting their day in vaccine court. Mitochondria key To understand Hannah’s case, it is important to understand mitochondria, which act like batteries in our cells to produce energy critical for normal function. Because the government’s concession hinged on the presence of Hannah’s underlying medical condition, mitochondrial dysfunction, some claim the decision is relevant to very few other children with autism. As a neurologist, scientist and father, I disagree. Emerging evidence suggests that mitochondrial dysfunction may not be rare at all among children with autism. In the only population-based study of its kind, Portuguese researchers confirmed that at least 7.2 percent, and perhaps as many as 20 percent, of autistic children exhibit mitochondrial dysfunction. While we do not yet know a precise U.S. rate, 7.2 percent to 20 percent of children does not qualify as “rare.” In fact, mitochondrial dysfunction may be the most common medical condition associated with autism. Biological markers Although unlikely, if the Portuguese studies are incorrect and mitochondrial dysfunction were found to be a rarity occurring in less than 1 percent of all autism, it would still impact up to 10,000 children (250,000 worldwide), based on current estimates that 1 million people in the U.S. (25 million worldwide) have autism. If, on the other hand, the research showing that 7.2 percent to 20 percent of children with autism have mitochondrial dysfunction is correct, then the implications are both staggering and urgent. Autism researchers do not currently understand whether mitochondrial dysfunction causes autism or is simply a secondary biological marker. Autism clearly has many different causes, and should really be separated into multiple autism(s). I propose that we clearly identify and research the subpopulation term of “mitochondrial autism,” which is distinguished by its unique biological, but not genetic, markers. Based on what we know now, it is time to follow the prestigious Institute of Medicine 2004 report regarding autism and vaccines: “Determining a specific cause (for autism) in the individual is impossible unless the etiology is known and there is a biological marker. Determining causality with population-based methods requires either a well-defined at-risk population or a large effect in the general population.” A paradigm shift When the IOM report was published, mitochondrial dysfunction defining an autistic subpopulation was not firmly established. Today there is no doubt that mitochondrial dysfunction represents a distinct autism subpopulation biological marker. I urge health officials and the IOM to embrace their own report and pursue this breakthrough in the science of autism. National public health leaders, including those at CDC, must now recognize the paradigm shift caused by this biological marker with regard to their current position of dispelling a vaccine-autism link. In light of the Hannah Poling concession, science must determine more precisely how large the mitochondrial autism subpopulation is: 1 percent, 7.2 percent, 20 percent? Based on the 2004 IOM analysis, if the mitochondrial autism subpopulation is found to be relatively uncommon, then all conclusions from prior epidemiological studies refuting an autism-vaccination link must be discarded. New studies then need to be performed exclusively with the mitochondrial subpopulation. If mitochondrial autism turns out to be common, then we could re-analyze the data from prior studies to determine if these studies were powered sufficiently based on a predicted effect size. If not powered appropriately, the conclusion refuting an autism-vaccine link would again have to be rejected. These statistical concepts are basic. The current vaccine schedule, co-sponsored by the CDC and the American Academy of Pediatrics, injures a small but significant minority of children, my daughter unfortunately being one of those victims. Every day, more parents and some pediatricians reject the current vaccine schedule. In an abundance of caution, meaningful reform must be performed urgently to prevent the re-emergence of serious diseases like polio or measles. Need for research As a neurologist, I have cared for those afflicted with SSPE (a rare but dreaded neurological complication of measles), paralytic polio and tetanus. If these serious vaccine-preventable diseases again become commonplace, the fault will rest solely on the shoulders of public health leaders and policymakers who have failed to heed the writing on the wall (scribbled by my 9-year old daughter). The mitochondrial autism scenario that my daughter has so eloquently painted has the CDC and public health experts logically cornered. Denial and fear tactics won’t close Pandora’s Box. Whether we find that mitochondrial autism is rare or common, there is urgent research left to be done to fully understand the interrelationship of vaccines, autism and mitochondria. Reform of the vaccine schedule will be an important part of the solution, whether vaccines play a major or minor role in autism. Our public health agencies and programs need a reconstruction plan. Day one of the reconstruction hopefully starts at the Vaccine Safety Advisory Committee’s Working Group, to be held at HHS headquarters today in Washington. > Dr. Jon S. Poling is a practicing neurologist in Athens and clinical assistant professor at the Medical College of Georgia.

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