The new thimerosal study published in Pediatrics leaves a lot of open questions. So does the response to the study by the Editor-in-Chief of the journal, Dr. Lewis First.
In his blog introducing the study, Dr. First wrote that, "You'll be reassured that the results show essentially no differences between groups who did or did not get thimerosal in their vaccines-and you'll want to know this information when talking with parents of your patients about the safety and benefits of vaccines."
But that made no sense. The study clearly stated that all children received thimerosal in the first year of life - some got 62.5 micrograms and the rest got 137.5 mcg. But there were no children who "did not get thimerosal," as Dr. First urged America's pediatricians to tell parents.
I thought I would write to AAP and clear things up, and see if a correction would be run. Officials there were (and have been) courteous, respectful and professional. So I sent the following email to the press office of the Academy:
As you can see by the study, there were only two groups - lower thimerosal exposure and higher exposure. The lower exposure group had no Hg in their DTaP, but did have it in their HepB and DT. The higher exposure group had Hg in DTaP, HebB and DT. Therefore, the statement by Dr First in Pediatrics is wrong, and somewhat misleading for Pediatricians to now relay to their patients across the country. I would like to ask for official comment from the AAP on a few questions,
1) Why did Dr. First urge pediatricians to tell parents that this study examined children "who did or did not get thimerosal in their vaccines?"
2) Will a statement of correction be sent out to members?
3) Does the AAP feel that this study had an under-ascertainment of ASD cases (1 in 1,700 vs. 1 in 150 in the US) or does the Academy believe that the rate in Italy is actually 1 in 1,700?
4) If there was an under-ascertainment of ASD, could it be due to the fact that study only looked at healthy children, and excluded premies and others? Also, if this study somehow excluded children with ASD (the US rate is 11 times that found in this Italian study) - isn't it possible that some children who developed other NDDs might have been equally excluded?
5) If the actual rate of ASD in Italy is only 1 in 1700 (about
6-per-10,000) - how can you explain the much higher rates in the US and UK? Is it just better reporting?
Many thanks, David Kirby
Shortly after that, to his credit, Dr. First himself wrote back to me:
Dear Mr. Kirby,
Susan Martin referred your email below to me regarding your concern about how I have discussed the findings in the current article in the February issue on thimerosal in my blog. Please understand that the purpose of my blog is to encourage our readers to read the articles in the issue. The blog expresses an opinion and is not meant to be a formal review of the data that has already been peer-reviewed. Thus I have used the information that the authors have shared in their abstract and "what this study adds" section of their article to preview what I hope readers will read for themselves and then interpret as they see fit. I have used the word "essentially" in my blog to express my own opinion/interpretation and to note, by using that phrase "essentially" that the data may still note associations but not ones that I personally feel are meaningful as per the data they have presented. Others such as yourself can and will feel differently, and I would encourage you to share your concerns on the e-letters page of our website where (once it has been received and reviewed by our e-letters editor) your review of the data can be displayed and commented upon by others, including the authors of the study who are best positioned to answer your questions as asked below. Thanks for your ongoing interest and comments on this article. I hope you will consider sharing them on the e-pages for others to comment upon as well.
Lewis R. First, MD
As I said, courteous and professional. But not what I asked. So I wrote back again:
Dear Dr. First,
Many thanks for your reply, it is much appreciated. However, it leaves me a little confused as it did not address the central question I had, which is why did you interpret the study to mean that there was a zero-exposure arm in the data? More importantly, are you going to run a correction, or will you allow your members to relay this inaccurate information in your blog to millions of parents around the country?
Perhaps you could clear that up before I write my own blog?
Also, I was wondering if you or anyone at AAP could provide comment to the following limitations in the study:
1) The cumulative intake of thimerosal was relatively low.
2) The analysis included only healthy children. Some families might have declined to participate because their children had cognitive developmental problems. This might have reduced the prevalence of adverse neuropsychological conditions.
3) Only 1% of children in this study received hepatitis B virus vaccine at birth.
4) Participation by low birth weight children was limited.
5) The study was not powered to detect an association of thimerosal exposure and neuropsychological development in low birth weight infants.
6) There was no comparison group with no exposure to thimerosal, and an absence of any evidence suggesting a threshold dose for observation of an effect.
These statements were taken directly from the authors themselves.
I thought sure that this time the doctor would at least acknowledge his error, but he didn't seem to think he had made one - it was simply his personal opinion and interpretation of the study. Dr. First wrote back:
Dear Mr. Kirby,
Again, I can understand your having a different interpretation of the data and respect that. My blog is not meant to be a critique of the article's limitations but an encouragement for our readers to read the article and form their own opinions of the data that is being presented.
(My use of the word "essentially" was purposeful for just the reasons I have stated before--it allows me to express my own interpretation but also notes that the data is not necessarily perfect to absolutely prove that my opinion is the correct one). I would continue to encourage you to share your points about the limitations of this study that you have identified as an e-letter so that the authors of the article (with whom you should be corresponding with your questions) can be notified and respond to you and the rest of our readers via that area of our website.
I will be sending my questions shortly to the authors. One thing I would really like to ask about is the exclusion of children of low birth weight, who are thought to be more prone to autism and other neurodevelopmental disorders - (among preemies, the risk of autism may
be as high as one in four). If you eliminate all the unhealthy kids from your study, you may be inadvertently eliminating those who are most at risk for injury from vaccine mercury.
Finally, it is astounding how the media has portrayed this as a story about how "vaccines" do not cause "autism," when it showed no such thing. As the lead author said in reply to an email from Lisa Rudley, a New York State activist and mother, "We did not have the objective to specifically study children with autism and the number of subjects included in our study would have been insufficient to make any epidemiological assessment on this subject."
So some people in the media went ahead and made that assessment for him.
PS: The response to my Huffpo piece with RFK, Jr. has been predictable. But this comment really stuck out as emblematic of the hysterical and low-rent quality of the people who oppose vaccine-autism research:
"Mr. Kennedy," the commenter wrote, "I hope that your new friends on the loony-tunes quackery fringe make you feel big and important, lending your name to their campaign of lies and death. And I hope you die from something there's a vaccine
Wishing death on a member of the Kennedy family Such is the caliber of the debate from those on the "other side."
David Kirby is author of www.evidenceofharm.com and a contributor to Age of Autism.