Dr. Jon Poling to Dr. Steven Novella: Don't Attack the Moms

Managing Editor's Note: The following is a letter sent to Dr. Steven Novella, a neurologist at Yale University, from Dr. Jon Poling. (We've printed the letter with permission.) Dr. Novella is the founder of The New England Skeptical Society (meetings, 1st Tuesday of the month, on the lawn of the House of the Seven Gables, Salem, MA. BYOB (bring your own blinders.) and is a contributing editor to Quackwatch. Dr. Poling is a neurologist/PhD and the father of Miss Hannah Poling.

Dear Dr. Novella,

Your assertion that the scientific question of Autism etiology belongs to the medical community rather than Hollywood Stars is correct.  I also agree that Hollywood opinions are more likely to be broadcast to millions because of their position in the media.  This heightened awareness is nothing but a positive thing for the million families struggling with this difficult, and all too common, disorder.  Jenny McCarthy is an Autism Mom looking for answers and rattling some cages—good for her.  Amanda Peet is a new mom who believes in the importance of vaccines to protect her baby—good for her too.  Don’t attack the moms, listen to them.   

These issues are very complex as we exchanged before and not amenable to soundbites.  Regarding your entry on Hannah’s case, your blog entry unfortunately propagates several of the mistakes from the media.

In criticizing the journalism of Mr. David Kirby, you wrote:

“He refers again to the Hannah Poling case, a girl with a mitochondrial disorder who developed a neurodegenerative disorder with “features of autism” after getting a fever from vaccines.”

Actually—Hannah has diagnoses of DSM-IV Autism (by JHU/KKI psychology) and mitochondrial disorder (by two metabolic experts).  The only ‘degeneration’ that occurred (along with 6mos of total growth failure) after 18mos of NORMAL development followed vaccination and nothing else! Of course, any ‘scientist’ can obviously point out that temporal correlation in a single case never proves causation. Rule number one of pediatrics though is “LISTEN TO THE MOM.”  Are 10s of thousands of autism moms over the last decade suffering from mass hysteria induced by Hollywood?  Not likely.

You also noted:

“This special case - which is not a case of autism being caused by toxins in vaccines - says nothing about the broader vaccine-autism debate.”

The only thing unique about my little girl’s case is the level of medical documentation—5 to 20% of patients with ASDs have mitochondrial dysfunction.  Many other cases where mitochondrial testing is WNL is because "we never looked" not because the testing would be "within normal limits."  Most mitochondrial experts will tell you that the dots of autism and mitochondrial disorders are strongly connected.

Finally, you say:

“The case was settled (not judged in Poling’s favor, but settled) because both sides realized it was a special case that could not be extrapolated to other vaccine-autism cases.”

The case was not settled, it was conceded by medical representatives of Sec HHS.  We are obviously pleased with the HHS decision to concede our case, but we had NOTHING to do with the concession.  This was a unilateral decision from HHS (recall that HHS is the respondent, rather than the vaccine maker, as manufacturers have blanket liability protection afforded by the Vaccine Injury Program established in 1986)  I will not speculate on the obvious question—why concede?   Hannah’s case was positioned to set precedent as a test case in the Omnibus Autism Proceedings for potentially thousands of other cases.

With regard to the science of Autism, I have no argument with the assertion that a single case does not prove causation of a generalized autism-vaccine link.  What the case does illustrate though is a more subtle point that many physicians cannot or do not want to comprehend (ostensibly because vaccines are too important to even question).  Autism is a heterogeneous disorder defined by behavioral criteria and having multiple causes.  Epidemiological studies which have not found a link between autism and aspects of vaccination do not consider the concept of autism subgroups.  Indeed, in a heterogeneous disorder like Autism, subgroups may indeed be ‘vaccine-injured’ but the effect is diluted out in the larger population (improperly powered study due to inability to calculate effect size with unknown susceptible subpopulation).   I think former NIH Director, Dr. Bernadine Healey explained it best in that population epidemiology studies are not “granular” enough to rule-out a susceptible subgroup. 

Furthermore, ‘science’ has not systematically studied the children who fell ill following vaccination to determine what the cause(s) for their adverse reaction was.  It would follow that if you never tried to understand why a single child developed encephalopathy following vaccination—you wouldn’t have the first clue as to what aspects of vaccination you could alter which could increase the relative risk of that adverse event (whether it be thimerosal, live virus, or ‘too many’). Could the susceptibility be a mitochondrial genetic haplogroup similar to Chloramphenicol toxicity—sure it could!  Why did a few Alzheimer’s patients die of fatal encephalitis following administration of the failed AN-1792 vaccine, but the majority had no ill effects (vaccine didn’t work though)? 

Definition:  Autism is a heterogeneous systemic disorder with primary neuropsychiatric manifestations due to complex genetic and gene-environmental interactions likely affecting synaptic plasticity early in childhood development.  This new theory of Autism is rapidly replacing the ‘old guard’ dictum that Autism is a genetically predetermined developmental brain disorder of synaptic formation/pruning that is set in motion prenatally.  By the ‘10 year rule of science,’ your time is about up! 

Until the biological basis of ASD subgroups are better understood, further epidemiological and genetic studies regarding “Autism” causation will be relatively meaningless.  We need good science to be able to address these complex issues which parallel nicely the emerging story of genetic and environmental influences in Parkinson’s disease.  Perhaps some Parkinson’s researchers want to take a crack at Autism?

Recommended SCIENCE reading for the evening:
 
Altered calcium homeostasis in autism-spectrum disorders: evidence from biochemical and genetic studies of the mitochondrial aspartate/glutamate carrier AGC1. Mol Psychiatry 2008 Jul 8.  (The discussion includes thimerosal as a potential toxin that could trigger further perturbations of calcium homeostasis leading to neuronal injury—and in a mainstream Nature publication no less)

Thank-you Dr. Novella and his band of skeptics for continuing the debate.

Dr. Jon Poling

Jon S. Poling MD PhD
Managing Partner, Athens Neurological Associates
Clinical Assistant Professor, Department of Neurology, Medical College of Georgia
Diplomate, American Association of Neuromuscular and Electrodiagnostic Medicine
ASN Certified in MRI and CT Neuroimaging

Comments

[Twyla]

Dr. Nobody, in the context of this article and these comments, your comment makes no sense. Dr. Poling certainly does no name-calling and makes no ad hominem attacks, and his article is extremely knowledgeable and logical. There are many well reasoned comments here, with good scientific references.

I have seen ad hominem attacks and name calling on both sides, but overall more of this from the vaccine defenders than from the vaccine critics.

If anything, you are the one casting aspersions, when you say "those who are in so much pain they can't think straight." That is a stupid and untrue stereotype. And Dr. Novella offers illogical repressive nonsense, not science.

[Cherry Sperlin Misra]

To A Little confused here,
You have lots of company. Many if not all AOA writers were confused too- at least at one time. Now we have got used to the house of mirrors build by modern medicine for their vaccines. But we are still angry and we are very sorry to see people like yourself tricked and lied to. Yes, mercury moves very easily from the mother to the fetus and doctors ought to know that. Yes, many flu vaccines still have plenty of mercury in them . If they contain mercury, your childs brain might just lose some neurons or develop an inflammation and for sure his immune system will be damaged for some time, so he is most likely to get sick with anything within some months after his flu shots, because mercury does not leave the body easily. On top of that it seems that during the time when we naively imagined that mercury in vaccines had stopped- it was not. Many vaccines still contained it- some in high levels even. Is the mercury really gone now? Well, in the field of mercury and vaccines, the truth is always a moving target, so its doubtful that you can get a very accurate answer to that. Now get this- There are "routine childhood vaccines" and then there are vaccines that somehow are not "routine"- but kids get them anyway because your doctor is going to give you a really dirty look if you dont. If you wish to avoid mercury in vaccines for those "non routine" vaccines- Here is one method: Go to your pediatrician without your child and ask for the insert of the vaccines (Its in the doctors waste basket) Purchase a magnifying glass and look for the word Thimerosal. If its there, you dont want that vaccine. And when you have some spare time do a Google search for sources of mercury. There are plenty of ways of coming into contact with mercury besides vaccines and neither you nor your child need it. You will be glad you did that.And with all sincerity- any parent who protects his child from mercury is a truly blessed person. One day you will be telling your grownup child how you did that

[Nepotism.Inc]

Dr Nobody

You are a liar and a fantasist. In the post below you are world-weary professional:

http://www.ageofautism.com/2008/07/watch-cbs-news.html

while here a dewey-eyed medical student. Still your talents are evidently well suited to (1) a career in the vaccine industry (2) an internet troll - and I am sure Dr Novella will appreciate your sentiments.

[Dr. Nobody]

Kudos to Dr. Novella.

As a medical student who has been reading both sides of this argument, I must salute the good Doctor. Not only does he make methodical analyses, but he avoids ad hominem.

Most of those against him resort to name calling and poorly supported arguments. For someone who is not a true believer in either side, those traits make your arguments very hard to review. Dr. Novella, thank you for coming here and posting, offering science to those who are in so much pain they can't think straight. Keep up The Great Work.

[Kelli Ann Davis]

Well, there you go! Girls rule (and don't even know it half the time) and Darla had it all figured out *without* even looking at "The Man Song" a.k.a; the-top-secret-spill-the-bean-5-bucks-a-pop-video-clip-that-I'm-trying-to-hawk.

BTW: Did'ya notice how the *man pact* lasted a whooping 1 minute once Darla walked onto the scene?

Moral of the story: Gals - 1, Guys - Zip.

(PS. I wonder who invented the cooties? ;-)

[Randy]

That'll learn me

Hopefully Craig and I helped to wash off some of the Savage comments this week. Little did I know that in doing so I ran the risk of being "outed" - guess there goes my membership in the "He Man Woman Haters Club"...

http://freemasonry.bcy.ca/fiction/other/our_gang.html

[Craig Willoughby]

Randy!! Traitor!! You're man-club license has been revoked.

:P

[Kelli Ann Davis]

Okay Randy, that by far is one of the funniest video clips I have *ever* watched in my life. I was rolling. *THIS* is a definite keeper.

So, you're telling me, in a nutshell, that we women could *make you* carry the purse if we really, really, I mean really wanted you to and that scares the you-know-what out of you?

Ahhhh....the feel of POWER! I wish I could bottle it and sell it. But since I can't do that, I'll just sell women this video clip instead.

So let the record show that RANDY spilled the beans.

5 bucks. Do I hear 5 bucks?

[Randy]

unfortunately i think the ultra-super-secret-man-code thing has been leaked...

http://www.toilette-humor.com/the-man-song.html

[Ilena Rosenthal]

It is not just coincidental that Novella, a part of the Quackwatch / Healthfraud team, made this very telling misstatement about cell phone dangers.

Cell phones, breast implants, vaccinations, genetically modified foods, second hand smoke, and amalgams are just a sampling of the issues that the respective industries merge their PR monies to pay junkscience.com and the so called "American Council of Science & Health" and various quacky frontgroups related to them.

They profit by keeping the facts covered up.

As a Breast Implant Awareness Activist, for 13 years, I have watched the identical tactics of these industries deny the dangers of their products, and Quackwatch and ACSH.org and junkscience.com used as their mouths for hire.

Their well funded game is to claim to have 'debunked' the dangers ... when in fact, the opposite is true. They are anti-science and fake "skeptics" ... having closed minds and opinions about ongoing medical concerns.

In my opinion, they are the current day equivalent of George Orwell's "Ministry of Truth" ... with up meaning down, black meaning white, and war meaning peace.

Perhaps Novella would be so kind as to admit how much he is being compensated and by whom to spend vast amounts of time and energy to give industry viewpoints on cell phones and vaccinations.

As silly as the name they gave themselves sounds, Stephen Barrett, David "Orac does not KNow" Gorski, and their "snake-oil vigilantes" are centers of disinformation and industry propaganda on Wikipedia, blogs, Usenet and their Healthfraud List.
www.BreastImplantAwareness.org/snake-oil.htm
(reproduction of list)

I am very grateful to see so many intelligent, organized, educated people standing up for the truth here.

With love & respect from Ilena
Victor, Barrett Vs Rosenthal
http://www.BreastImplantAwareness.org/BarrettVsRosenthal.htm