Late last week, the anti-vaccine underground was all atwitter. The reason was the announcement of an impending press conference, scheduled for yesterday at noon in Washington, DC that proclaimed:

Investigators and Families of Vaccine-Injured Children to Unveil Report Detailing Clear Vaccine-Autism Link Based on Government’s Own Data

Report Demands Immediate Congressional Action

Directors of the Elizabeth Birt Center for Autism Law and Advocacy (EBCALA), parents and vaccine-injured children will hold a press conference on the steps of the U.S. Court of Federal Claims (717 Madison Place, NW in Washington, DC) on Tuesday, May 10 at 12:00 PM to unveil an investigation linking vaccine injury to autism. For over 20 years, the federal government has publicly denied a vaccine-autism link, while at the same time its Vaccine Injury Compensation Program (VICP) has been awarding damages for vaccine injury to children with brain damage, seizures and autism. This investigation, based on public, verifiable government data, breaks new ground in the controversial vaccine-autism debate.

The investigation found that a substantial number of children compensated for vaccine injury also have autism. The government has asserted that it “does not track” autism among the vaccine-injured. Based on this preliminary investigation, the evidence suggests that autism is at least three times more prevalent among vaccine-injured children than among children in the general population.

I could hardly wait.

After all, the anti-vaccine flacks at Age of Autism started flogging this press conference announcing this report relentlessly immediately upon its announcement. So did other anti-vaccine groups, including SafeMinds, the Autism Action Network, and others. I knew this because I’m on the mailing list for a number of anti-vaccine groups. I do it for you, to keep my finger on the pulse of the anti-vaccine movement and as an early warning system to let me know when they’re up to various forms of chicanery. Being thus plugged in to anti-vaccine blogs and various mailing lists, I can report that the entire anti-vaccine crankosphere was abuzz with excitement and anticipation over the release of this report, so much so that I was starting to wonder if there would be anything there that might be be worth paying attention to. Even FOX News took the bait:

As is usually the case when the anti-vaccine movement announces the impending announcement of some “blockbuster” study or report that will demonstrate—or so they say—beyond a shadow of a doubt that, even against the mountains of epidemiological evidence indicating no correlation between vaccines and autism, there really, truly is a good scientific reason to suspect that all that evidence is wrong and that vaccines are the cause of an “autism epidemic,” when the press conference rolled around yesterday and the report was published, I was disappointed. I thought it would be a challenge. It wasn’t. Still, I view it as my duty to explain why this report is a whole lot of nothing that in fact is entirely consistent with the current scientific consensus that vaccines don’t cause autism, not so much because I have any hope of changing any minds among those who released the report, but for the good of the fence sitters who might come across this report and find it convincing.

Not surprisingly, the report was written by anti-vaccine stalwarts, namely Mary Holland, Louis Conte, anti-vaccine lawyer Robert Krakow, and Lisa Colin and is entitled Unanswered Questions from the Vaccine Injury Compensation Program: A Review of Compensated Cases of Vaccine-Induced Brain Injury. Apparently the buildup was too great. Now that I’ve actually read this report I can’t believe it. It’s just that bad.

If there’s one thing that cranks routinely do when they can’t win their case on science is to shift to other venues to convince people that they are not, in fact, cranks. After all, if they stuck to arguing facts, science, and evidence, they wouldn’t be cranks. They also wouldn’t have a prayer of obtaining influence because the science is so much against them. So, failing at science yet again, what the anti-vaccine movement has done yet again is to move over to law. In essence, they are implying that legal decisions can mean that there is a scientific case to be made in favor of the hypothesis that vaccines cause autism. This is an utterly fallacious argument at its core, because findings of law all too often have very little to do with findings of science. Examples abound, but my favorite one is the scare over silicone breast implants during the 1980s and 1990s. The science supporting the claims that silicone from these implants was causing systemic diseases, such as cancer, autoimmune diseases, and a panoply of other conditions, was never good. In fact, it was weak to nonexistent. None of that stopped an avalanche of lawsuits from bankrupting Dow-Corning in 1995 Later, as more studies were carried out, it was found that there was no correlation between silicone implants and the conditions attributed to them. Even so, it wasn’t until 2006 that the FDA approved these implants again for cosmetic use.

Basically, law is not science, and, as much as lawyers would like you to think that the law can deal with science easily, the two cultures, law and science, are very, very different. In law, for example, the object is to win your case, not to find out how nature works and develop models (i.e., theories) that accurately describe it and predict its behavior. In law, there are no truly objective right or wrong answers about issues of science. There is only the law and how it has been interpreted by courts. Advocacy for one’s position using every tool at one’s disposal and denigrating or ignoring evidence that conflicts with that position is not just acceptable, but mandatory. And that’s what Holland et al do, with little exception. In fact, they go so far as to use the common legal tactic of making like Humpty Dumpty in this passage from Lewis Carroll’s Through the Looking Glass:

‘When I use a word,’ Humpty Dumpty said, in rather a scornful tone, ‘it means just what I choose it to mean — neither more nor less.’

‘The question is,’ said Alice, ‘whether you can make words mean so many different things.’

‘The question is,’ said Humpty Dumpty, ‘which is to be master — that’s all.’

Alice was too much puzzled to say anything; so after a minute Humpty Dumpty began again. ‘They’ve a temper, some of them — particularly verbs: they’re the proudest — adjectives you can do anything with, but not verbs — however, I can manage the whole lot of them! Impenetrability! That’s what I say!’

And that’s what Holland et al also appear to say, as well. Impenetrability based on legal jargon is their shield and their sword. They also fall back on the famous “just asking questions” ploy, so beloved of cranks, which is colloquially known among critical thinkers as JAQing off, which they do blatantly here:

This assessment of compensated cases showing an association between vaccines and autism is not, and does not purport to be, science. In no way does it explain scientific causation or even necessarily undermine the reasoning of the decisions in the Omnibus Autism Proceeding based on the scientific theories and medical evidence before the VICP. Nor does this article have anything to say about state childhood immunization mandates in general.

What this article does point to are unanswered questions about vaccines and autism, a thorny issue that affects approximately one in one hundred and ten children.10 On this point, this study strongly suggests the need for further Congressional and scientific investigation to explore the association between vaccine-­induced brain injury and autism and the integrity of this federally-­administered compensation program.

If you admit that what you are peddling is not science (and it most definitely is not), and you can’t show convincing evidence of an association between vaccines and autism (which can only be shown by science anyway), then why even bother? The answer is easy if you understand the authors’ purpose. It is not to demonstrate whether there is a true correlation between vaccination and autism or whether vaccines do cause or increase the risk of autism. Rather, it is advocacy. It is persuasion. It is a tool to use to try to get legislators to change the law, science be damned.

It is propaganda.

The core of the argument in Holland et al appears to boil down to three claims. First, they claim to have found 83 cases of autism associated with vaccine-induced brain injury, which, they claim, makes autism three times more prevalent in children compensated by the Vaccine Injury Compensation Program (VICP). Second, because they base this estimate primarily on children for whom there are reports of “autistic-like” symptoms or who ultimately developed autism, they argue that there is no difference between autism and having been noted to exhibit “autism-like” behaviors or symptoms. Finally, they claim that this means that autism is three times more prevalent in VICP-compensated children than in the general population. Let’s look at these one at a time.

Looking at the second claim first, only a non-physician could make such a risibly silly argument as this and not be expected to be subjected to ridicule:

Because autistic disorder is defined only by an aggregation of symptoms, there is no meaningful distinction between the terms “autism” and “autism-­like symptoms.” This article makes the distinction only to accurately reflect the terms that the Court of Federal Claims, caregivers, and others use. It is not a distinction to which the authors attach significance.

It is not as uncommon as we would like in medicine for conditions and diseases to be defined primarily (or even only) by aggregations of symptoms. Irritable bowel syndrome is an example. Ditto tension headache. Moreover, it is often the context within which those symptoms arise that distinguish one diagnosis from another. In any case, the DSM-IV provides fairly clear diagnostic criteria for autism. If the child doesn’t have enough of these criteria to be diagnosed as autistic, that child could have “autism symptoms” but not autism. In other words, if a child shows a number of odd behaviours but not the classic triad of impairments, then they might have ASD or Asperger’s Syndrome or HFA, but they don’t have autism because the diagnosis of autism depends upon a specific set of diagnostic criteria, and the child doesn’t meet those criteria. If he did, he’d have a diagnosis of autism. It’s just that simple, but Holland et al try to obfuscate by trying to make terms like “autism-like symptoms and similar terms mean what they want them to mean.

Humpty Dumpty indeed.

Nor are diagnostic criteria for a condition like autism spectrum disorders a difficult concept for most people; certainly they aren’t for doctors. Apparently, however, they represent a very difficult concept indeed for Holland et al, who seem to be arguing that any child with autism-like symptoms must have autism. This is akin to arguing that anyone who has a belly ache or diarrhea must have irritable bowel syndrome or that someone who experiences a headache must have migraines. In addition, such an argument assumes that all symptoms are equal when it comes to making the diagnosis of autism.

Regarding the first claim, if we take at face value the claim that there are 83 children compensated by the VICP, it is first essential to compare this number to the number of children compensated by the VICP. This the authors try to do but utterly miss the point in doing it:

This discussion must start with the caveat that we are able only to interpret the subgroup of eighty-­three compensated cases that we have located. Out of a total number of approximately two thousand five hundred compensated vaccine injury claims,137 we recognize that this is a small subset. It is our hope that this preliminary study will lead to more complete study of all cases of compensated vaccine injury. Such a study might provide a far more comprehensive understanding of vaccine injury.

83/2,500 results in an estimated prevalence rate of approximately 3.3%. On the surface, this seems to support the claim that the prevalence of autism/ASD is three-fold higher in VICP-compensated children than it is estimated to be in the general population (around 1%). Of course, there’s at least one problem. The authors are even forced to admit it. Specifically, of these 83 children, Holland et al could only find documentation of autistic symptoms for only 39. The rest of those 83 were “diagnosed” solely on the basis of a parental questionnaire. This lower number results in an estimated prevalence of autism of around 1.6% in the VICP-compensated population, an estimate that is falling into the range of what we would expect in the general population. Given that the VICP population is a skewed sample, most of whom have developmental disabilities, I’d be shocked if the prevalence of autism/ASD symptoms in this group weren’t significantly higher than they are in the general population, given how much overlap there is between symptoms exhibited by children with developmental delay and children with autism. Of course, this “study” is not good evidence that the prevalence of autism/ASD even is higher in the VICP-compensated population. Taking into account the skewed population and the noise inherent in looking at a small population over 20 years, the prevalence of autism in VICP-compensated children does not appear to be detectably different than it is in the general population. That’s even accounting for very loose criteria used by the authors to define who might be autistic. As Prometheus put it:

If the prevalance is higher among people compensated by the VICP, there is a basis for further investigation. It still wouldn’t “prove” that vaccines cause autism – it would simply be an indication for further study.

If, on the other hand, the prevalence of autism among people compensated by the VICP is the same as the general population (or less – see below), the argument that “vaccines cause autism” receives yet another (totally redundant) nail in its coffin.

The problem is that the autism prevalence numbers for the general population – even the educational numbers – use much tighter criteria than used by the authors of this study.

According to a Generation Rescue telephone survey (in other words, a “study” by the anti-vaccine movement iteself), the prevalence of autism is even higher than what Holland et al found in the VICP-compensated group of children. It’s even worse than that, though. In fact, the timing of this study’s release is very, very bad indeed. In an ironic twist of fate that leads me to think that there might justice in the universe after all, shortly before the anti-vaccine movement tried to make hay out of this poorly argued, scientifically nonsensical report, a real scientific study, was released out of South Korea that found the prevalence of autism to be considerably higher than previously believed. Steve Novella even discussed this study earlier today. Basically, in this study, researchers administered a screening test for autism spectrum disorders in a population and then did more detailed tests on children who screened positive. Their results were stunning. The study estimated that the prevalence of autism spectrum disorders was 2.64% in the population studied and that 2/3 of those cases were undiagnosed. True, this study will need to be replicated, but it adds more support for the hypothesis that autism spectrum disorders are more common than previously thought and that a significant proportion of them are subclinical and thus undiagnosed. The timing of this study, of course, couldn’t be worse for Holland et al, because it simply reemphasizes that the prevalence of autism that they think they measured in the VICP population is almost certainly not higher than the prevalence in the general population.

In other words, Holland et al did all that work and wrote all those words in order to add yet more evidence to support what we already know from copious evidence from a large and robust existing body of studies: That vaccines do not cause autism.

They just refuse to realize or admit that that’s what they’ve done.

Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.