AGE OF AUTISM/DR. ANDREW WAKEFIELD'S RESPONSE TO BAIRD G. ET AL

[Guest guest]

http://www.ageofautism.com/2008/02/dr-andrew-wakef.html

Please visit this site and read the article there also......

02/12/2008

DR. ANDREW WAKEFIELD'S RESPONSE TO BAIRD G. ET AL

Thank you to Dr. Wakefield, of Thoughtful House Center for Children

for sending us this important piece:

Response to Baird G. et al. Measles vaccination and antibody response in

autism spectrum disorders. Archives of Disease in Childhood. Published 5th

February 2008.

In a case-control study of 10 to 12-year-old children with either autism,

special-educational needs, or normal development, the authors examined

measles-antibody responses (plaque reduction neutralization assay) and the

presence of measles virus in peripheral blood mononuclear cells (reverse

transcriptase polymerase chain reaction). The study apparently sought to

identify autistic children relevant to the original MMR/autism hypothesis,

i.e., those who regressed and those with bowel symptoms.

The study is severely limited by case definition in the context of the

crucial ‘possible enterocolitis’ group. For inclusion in this group they

required the presence of two or more of the following five current

gastrointestinal symptoms:

• current persistent diarrhea (defined as watery/loose stools three or more

times per day >14 days),

• current persistent vomiting (occurring at least once per day, or more

than five times per week),

• current weight loss,

• current persistent abdominal pain (3 or more episodes [frequency not

specified by authors] severe enough to interfere with activity);

• current blood in stool;

plus:

• past persistent diarrhea >14 days’ duration, and excluding current

constipation.

We have over the last 10 years evaluated several thousand children on the

autistic spectrum who have significant gastrointestinal symptoms. Upper and

lower endoscopy and surgical histology have identified mucosal inflammation

in excess of 80% of these children. Almost none of these children with

biopsy-proven enterocolitis would fit the criteria set out above. Firstly,

these children rarely have vomiting, current weight loss (as opposed to

failure to gain weight in an age-appropriate manner), or passage of blood

per rectum. The requirement is thus narrowed to a child having two of two

relevant symptoms – current persistent diarrhea and current abdominal pain

according to their criteria, plus a past history of persistent diarrhea

excluding current constipation.

The requirement for the current presence of these symptoms, for 14 or more

days continuously, shows a singular lack of understanding of the episodic,

fluctuating, and alternating (e.g. diarrhea/constipation) symptom profile

experienced by these children. In our experience, ASD children with

histologic enterocolitis typically have 1 to 2 unformed stools per day that

are very malodorous and usually contain a variety of undigested foodstuffs.

This pattern alternates with that of “constipation” in which the unformed

stool is passed after many days of no bowel movements at all, and with

excessive straining. This group is entirely overlooked by the arbitrary

criteria set forth in their paper. With respect to diarrhea and

constipation, a detailed discussion of stool pattern in these children is

available1 which further highlights the shortcomings of the above criteria.

Moreover, the interpretation of pain as a symptom in non-verbal children,

as it often manifests as self injury, aggressive outbursts, sleep

disturbances, and abnormal posturing, is notoriously difficult. This

interpretation requires an insight based upon the correlation of symptoms,

histological findings, and response of symptoms to anti-inflammatory

treatment. There is no evidence in the Baird et al. paper that these

crucial factors were taken into account. This study’s inappropriate symptom

criteria would explain the discordance with other reports that have

revealed a high prevalence of significant gastrointestinal symptoms in

general autism populations2,3.

It is surprising that Dr Sullivan, a co-author on the paper, who

presumably provided the above gastroenterological criteria, was not aware

of the aforementioned limitations. In his role as a Defendant’s expert in

the UK MMR litigation, he will have had access to the clinical records of

autistic children with the relevant intestinal symptoms and biopsy-proven

intestinal inflammation.

We suggest that the authors might wish to reflect on the ethical

implications of setting the bar too high for the investigation of such

children by ileo-colonoscopy, with the attendant risk of missing

symptomatic, treatable inflammation.

Since the relevant MMR/autism children are considered to be those with

regression and significant gastrointestinal symptoms, the appropriate

stratification for between-group analyses of measles virus antibody levels

has not been conducted; therefore the paper is difficult to interpret,

adding little if anything to the issue of causation. Moreover, it is a

major error to have presumed that peripheral blood mononuclear cells are a

valid ‘proxy’ for gut mucosal lymphoid tissues when searching for

persistent viral genetic material.

A further major problem in this study is the number of children who dropped

out or who were unable to provide adequate blood samples. We know nothing

about either the 735 children who were lost at stage two, or the 100

children for whom blood samples were not available. At the very least, we

should be told whether the children who dropped out were likely to be

representative of those who stayed in, with regard to the key issues of

interest.

For reasons that will emerge in the near future, it would be of interest to

know whether siblings of autistic children were included in either of the

two control groups. This information is not provided.

As a general observation, this paper contributes nothing to the issue of

causation, one way or another. Case definition alone is likely to have

obscured the relevant group of autistic children. The study tells us

nothing about what actually happened to the children at the time of

exposure. We are increasingly persuaded that measuring things in blood many

years down the line tells us very little about the initiating events in

what is, in effect, a static (non-progressive) encephalopathy unlike, for

example, subacute sclerosing panencephalitis, which is a progressive

measles encephalopathy. The gut is a different matter, and analysis of

mucosal tissues has been very informative, since here, in the relevant

children, active ongoing, possibly progressive4, inflammation has been

identified.

References.

1. Wakefield AJ. Autistic enterocolitis: is it a histopathological entity?

Histopathology 2006;50:380-384.

2. Valicenti-McDermott M, et al. Frequency of Gastrointestinal Symptoms in

Children with Autistic Spectrum Disorders and Association with Family

History of Autoimmune Disease. Developmental and Behavioral Pediatrics.

2006;27:128-136.

3. Horvath K, and Perman JA. Autistic disorder and gastrointestinal

disease. Current Opinion in Pediatrics. 2002;14:583–587.

4. Balzola F et al. Autistic Enterocolitis in childhood: the early evidence

of the later Crohn’s disease in autistic adulthood? Gastroenterology

2007;132:suppl 2, A 660.

Competing interests

Dr Wakefield, Dr Krigsman, and Dr. Stott acted as Claimant experts in the

UK MMR litigation

in Current Affairs, Epidemic, Science, Treatment | Permalink

Digg This | Save to del.icio.us

TrackBack

TrackBack URL for this entry:

http://www.typepad.com/t/trackback/2465202/26000330

Listed below are links to weblogs that reference DR. ANDREW WAKEFIELD'S

RESPONSE TO BAIRD G. ET AL:

Comments

Thank you very much Dr. Wakefield and Age of Autism.

These people like Baird G et al are paid by the PharmaNazis to put out

their pro-vaccine propaganda.

Hired Hessians!!!!!!

Gallup

Posted by: Gallup | 02/12/2008 at 05:48 PM

Yes, thank you Dr. Wakefield!

Your years of real research, pertinent data, and targeted treatments have

been a blessing for the autism community. Much gratitude for your continual

scrutiny of these " bullshit " studies and your passion in helping our sick

children.

Conrick

Posted by: Conrick | 02/11/2008 at 07:56 PM

Yes, thank you Dr. Wakefield and Age of Autism! I am so thankful that my

child is on the road to recovery as well. Also, for the record, I don't

think Age of Autism is " sensational " or " negative " whatsoever despite what

some commenters say. People who write things such as this contribute

nothing. Thanks you again Age of Autism and all the wonderful people who do

contribute so much to help the children.

Posted by: | 02/11/2008 at 06:24 PM

Dear Dr. Wakefield,

Thank you for your courage. Thank you for looking for answers to a serious

problem that hurts many. Thank you for not walking away from our families -

no matter HOW MANY AND BIG the pressure became. Thank you for listening to

parents. Thank you for finding answers.

Andy - you are a hero. You are courageous. Thank you.

- Jeffs mom and hundreds of thousands of kids like him

Posted by: | 02/11/2008 at 06:23 PM

As always, Andy, thanks for your thoughtful commentary and all the work you

do on behalf of our children.

As Andy's commentary shows yet again, this paper from Baird et al is

another part of a disinformation campaign designed to confuse and obscure

the issues in autism and to undermine (with hostile rather than scientific

intent) some serious and troubling evidence regarding the biology and caus

of autism. If someone really wanted to test the evidence on what Andy has

called " autistic enterocolits " , does it really make sense to design an

experiment like this? And when a sloppy study design yields a negative

results, does it really deserve any kind of press attention? Does this new

press flurry contribute anything more than another bit propaganda to add to

the " information cascade " designed to defend potentially unsafe products?

And does this pattern of misinformation and propaganda does anything to

promote confidence among parents in the integrity of the broader scientific

entreprise?

The answer to all these questions, of course, is a resounding no.

Which leads one to ask, why is it Andy who is on trial defending his

license to practice medicine?

Posted by: Mark | 02/11/2008 at 11:44 AM

If it hadn't been for Dr. Wakefield's work, our kids wouldn't be

recovering. I always think of him, the price he's paying for truth and for

the sakes of all our children when I hear the Indigo Girl's song " Galileo " .

Posted by: Gatogorra | 02/11/2008 at 10:27 AM

Thank you Dr. Wakefield and Age of Autism!

--------------------------------------------------------

Sheri Nakken, former R.N., MA, Hahnemannian Homeopath

Vaccination Information & Choice Network, Nevada City CA & Wales UK

Vaccines - http://www.wellwithin1.com/vaccine.htm Vaccine Dangers &

Childhood Disease & Homeopathy Email classes start in February