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Friday, November 26, 2010

Study: Some Autistic Brains Really Are Wired Differently

And not a single mention of Vaccines!  For someone who is in the least bit intellectually honest, that is not surprising.

Study: Some Autistic Brains Really Are Wired Differently
Too many tight connections in frontal-lobe circuits and too few long-distance links between the frontal lobe and the rest of the brain may cause some of the language,  social problems and repetitive behavior seen in autism spectrum disorders, according to a new study published in Science Translational Medicine. The research links a variant of the CNTNAP2 gene to this particular type of rewiring in the brain.

The new findings, which used functional magnetic resonance imaging (fMRI) to measure the types and strength of connections between brain regions, could provide autism experts with some important clues for early intervention and treatment. (More on Time.com: Special Report: Kids and Mental Health)

"I think it is quite a beautiful study," says Kamila Markram, director of the Autism Project at the Brain Mind Institute of the École Polytechnique Fédérale de Lausanne in Switzerland, who was not associated with the current research. "What's new is that it brings the genetic data together with the functional brain activity and that is usually not done. Either people look at gene expression or they look at functional brain activity. To bring them together and relate them to say, 'That particular gene is responsible for the different connection pattern that one observes,' that's a unique research area and that's the beauty of the study."

The gene produces a protein called CASPR1 and is active during brain development — mostly during frontal-lobe development. "During early development, it is localized to parts of brain that are 'more evolved' — areas where learning and language happen, the frontal lobes where really complex thinking takes place," says Ashlee Scott-van Zeeland, a postdoctoral fellow at the Scripps Translational Science Institute in La Jolla, Calif., and lead author of the study. "[It is] thought to help structure the brain." The gene also influences the development of reward regions of the brain, which are involved in motivation, pleasure and learning. (More on TIME.com: Is Picky Eating an Early Sign of Autism?)

For the new study, researchers compared 32 autistic and typically developing children, aged 11 to 13. Some had an autism-risk variant of CNTNAP2, while others had a non-risk variant. In the sample, the non-autistic children were just as likely to have the risk variant as the autistic children. Indeed the CNTNAP2 gene, which 1 in 3 people in the general population carry, doesn't guarantee autism — the gene is only one of many risk factors involved in the disorder. "In autism, there are many roads to Rome," explains Scott-van Zeeland. "You can have some of the common risk variants and they all stack up. [Only] if you have enough of them [will you] fall over edge."

All the kids underwent an fMRI scan. While in the scanner, the kids played a learning-related game that gave them monetary rewards for correct answers. The task was chosen because it activated many of the brain regions affected by CNTNAP2, including those involved in reward. (More on Time.com: 1 in 5 Kids With an Autistic Sibling Show Subtle Symptoms Too).

Regardless of autism diagnosis, the children with autism-risk variants showed different patterns of activity within the frontal lobe and between the frontal lobe and the rest of the brain. During the task, they showed more activity throughout the frontal cortex. For example, they had increased activity in the medial prefrontal cortex, which normally tends to be active when the brain is not engaged in a task; carriers of the risk variant showed less decrease in activity during the game than those without the risk variant. (More on TIME.com: Genetic Testing for Autism)

In children with the non-risk variant of CNTNAP2, brain pathways more strongly linked the frontal regions to parts of the left side of the brain, areas that typically specialize in language. In risk-variant carriers, the frontal lobe was connected more diffusely to both sides of the brain, which may help explain why the variant can be associated with delays in speech.

In addition, children without the risk variant had better long-range connections between brain regions — from the front to the back of the brain, for example. There were no differences in IQ associated with the risk variant alone.

CNTNAP2 — pronounced catnap two — is "a really interesting gene," says Scott-van Zeeland. It was first discovered in a family whose members suffered from obsessive-compulsive disorder and Tourette's syndrome (symptoms of both disorders are also frequently seen in autism). The same gene has also been linked to ADHD, schizophrenia and a language disorder known as Specific Language Impairment. (More on Time.com: A Five-Minute Brain Scan Tracks Kids' Development and May Spot Disorders).

"Genes do not code for diagnoses. They code for proteins, which then go about creating an effect," says Nancy Minshew, professor of psychiatry and neurology at the University of Pittsburgh, who has done prior research on brain connectivity in autism but was not associated with the current research. "Hence the same genes may be seen in clinically related disorders." All of the related disorders involve problems with directing attention and controlling behavior.

The new findings lend support to the "intense world" theory of autism, which has posited that patterns of brain circuitry that result in excessive functioning in some regions may lead to extremes in attention and perception, which can produce both the deficits — and the sometimes extraordinary intellectual talents — that characterize some people with autism. (More on TIME.com: Is Anorexia a 'Female' Form of Autism?)

In a brain wired with hyper-local connections, those regions would be prone to hyperactivity; in turn, the excess activity leads to hyper-responsiveness to incoming information and quick learning. "They react more to stimulation than normal circuits. And not only do they react too much, they also learn too much," says Markram, an author of the intense world theory.

Although that sounds like it could be a good thing — it may well explain the abilities of autistic savants, who are extremely gifted in mathematics, computer science or music — in the context of decreased long-term connections between brain regions, the end result can be overwhelming. Indeed, many people with autism describe being incapacitated by sensory experiences — whether they are bright lights, loud noises or social interactions.

"At a psychological level, basically, it would mean that the autistic person could feel, perceive and learn too much. That could lead to sensory overload, as well as consequences like social avoidance or withdrawal and repetitive behavior," says Markram. Autistic people tend to use these behaviors to keep their world the same, and to keep an overly intense world at bay.

"If you have too much noise — all that talking that's going on in the frontal lobes — it might be hard to figure out what sources of information to pay attention to," says Scott-van Zeeland. "To figure out what's going on requires these long-term connections."

Still, in the absence of other genes or environmental risk factors that lead to full blown autism, the pattern of brain connections associated with the risk variant of CNTNAP2 may carry certain advantages. "It would be really exciting to see what would be the strengths of this kind of connectivity pattern," says Scott-van Zeeland. "A lot of people carry this variation — if it weren't beneficial in some way, you would expect it to disappear."

Going forward, researchers may focus on using the new information to improve early autism interventions. Early brain development is complex and shaped by environmental signals, but a brain that is paralyzed by sensory overload misses early social cues, which may change the entire course of its development. So autistic children may have social problems not because their social brains are defective, but because sensory overload and the methods children use to cope with it prevent them from absorbing and understanding the information they need to develop socially.

Early social intervention could help prevent — or at least significantly mitigate — the disability associated with autism. "If you can identify these early brain signals and know what the problem is, you can do more intensive therapy," Scott van-Zeeland says. "A child's brain is so flexible. So instead of letting a child obsess over trains, you could spend a lot more time teaching them to pay attention to mom's face and trying to get that be rewarding. Once we find out what circuits are not automatically doing what they should, if you can explicitly tell them what they should do, that would go a really long way.”

As autism researcher David Mandell told the New York Times this week in a story on early autism intervention:
What you ultimately might be doing is preventing a certain proportion of autism from ever emerging ... I'm not saying you're curing these kids, but you may be changing their developmental trajectory enough by intervening early enough that they never go on to meet criteria for the disorder. And you can't do that if you keep waiting for the full disorder to emerge.

Wednesday, November 24, 2010

The Skeptical Teacher: Anti-Vaccination PSA Coming to a Theater Near You… Literally!

I saw this, and had to spread this around.  For some reason, there are people out there that will tell any lie than can in order to promote their dangerous and skewed agenda, and endanger the public while they are at it.  The level of deceit that goes into something like this is boggling.  There is no way that these people can honestly not know that they are lying, right?  Sadly, the nature of these sort of denialists and nutters is that their brains have something wrong with the wiring, and they end up like this.  I present you someone else's reaction to this unedited.  If he sounds furious, that's good, because I'm sure he is, as well as I am.

Anti-Vaccination PSA Coming to a Theater Near You… Literally!

Posted by mattusmaximus on November 20, 2010

**Update (11/23/10): I may have spoken too soon with my earlier update, folks.  It seems that over the last day or so we’ve received some conflicting reports about exactly what is & isn’t going on at AMC with these ads.  Elyse Anders provides more details over at Skepchick on this – until we have more info, stay tuned & continue contacting the theaters in question.


**Update (11/21/10): It appears the executives at AMC (which owns some of the theaters in question) have listened to the public outcry – they say they have pulled the ad and do not plan to show it. However, some of the other theaters may not be owned by AMC, so please contact them.

===============

It’s time to kick some ass… I just found out that the anti-vaccinationist groups called Age of Autism and SafeMinds are planning on running a public service announcement (PSA) in movie theaters nationwide the weekend following Thanksgiving. I’ve seen the 30 second ad, and it contains the usual thoroughly debunked nonsense regarding “mercury toxins in vaccines” and how this is supposedly dangerous for children.  The facts are that there is ZERO evidence that the mercury preservative in vaccines, called thimerosal, is any sort of danger – there are no links between thimerosal & autism, either (a common claim by various anti-vaxxers).  In fact, even after the U.S. government removed thimerosal from the vaccine schedule for children the rate of autism continued to rise!

But don’t tell that to the anti-vax crowd, because they don’t give a whit about the science.  They believe in their heart of hearts that they know the “truth about vaccines”, and they don’t care one way or the other what the actual evidence is… and they want to proselytize this lunacy to you:




Folks, the purpose of this ad is simple: it is to sow fear & distrust of vaccines in the hopes that you & your kids don’t get them at all – that’s it.  These anti-vax groups are, for whatever reason, ideologically opposed to the very idea of vaccinations, and they’ll use every slimy tactic in the book to push it on you.  If you can stomach it, here is their ad…



And here is the list of theaters that are currently being targeted by Age of Autism for this dangerous propaganda (with the potential to reach over 500,000 people):

*Empire 25 in New York City
*Long Beach 26 in Long Beach, California
*River East 21 in Chicago, IL
*Boston Common 19 in Boston, MA
*Phipps Plaza 14 in Atlanta, GA
*Tyson’s Corner 16 in McLean, VA
*Northpark Center 15 in Dallas, TX
*Rosedale 14 in Saint Paul, MN
*Pavillions 15 in Denver, CO

We cannot let this stand… I suggest that if you live in any of these areas (or know people who do) that you contact the theater in question to find out whether or not they plan to run this PSA, and if they do plan to do so then make it well known to them that you will boycott that business in perpetuity (and you will encourage everyone you know to do the same) – when it comes to stuff like this, money talks & bullshit walks.  I would also notify your local health department and medical doctors’ organization about this, on the chance that they might wish to make some kind of public statement against this idiocy.

And spread the word – the skeptical & pro-science community needs to send a strong, clear message to those who would spread such life-endangering pseudoscience that we will not stand for it.  We didn’t ask for this fight, be we will fight it & we will finish it.

 

Friday, November 12, 2010

Vaccine Central: 2009 H1N1 toll in the US

Remember, those numbers aren't just numbers.  They are people.  Someone's wife, husband, brother, sister, child, etc.  Every single one of those numbers have a name.  And something as simple as a vaccine could have prevented them from going to a hospital or grave.  Even if the pandemic was not as horrible as the insane media made it out to be, there were still 12,000 people who DIED as a result.

2009 H1N1 toll in the United States

The Centers for Disease Control and Prevention has tabulated estimates of the toll the 2009 H1N1 pandemic took  in the United States. The numbers are sobering and require no additional comments. The CDC tabulated the numbers through direct observation in 62 counties covering 13 metropolitan areas of 10 states, which were then extrapolated to the entire US Population. So without further ado, here is what the 2009 H1N1 pandemic did in the US.
  • Total Cases60,837,748 (yep, millions) which break down as such:
    • 0-17 years   – 19,501,004
    • 18-64 years – 35,392,931
    • 65+ years – 5,943,813
  • Hospitalizations274, 304 which break down as such:
    • 0-17 years    - 86,813
    • 18-64 years  - 160,229
    • 65+ years     –  27,263
  • Deaths – 12, 469 which break down as such:
    • 0-17 years    - 1,282
    • 18-64 years  - 9,565
    • 65+ years     –  1,621
So, to put this in perspective. If you’re a 30-year-old such as myself, over 9,500 of our peers have died; 1,282 of our children are dead, and 1,621 of our parents are gone, all due solely to H1N1 flu. Chances are then, there is someone out there who lost his spouse, child and one parent to this disease. Makes you think twice about not vaccinating no?

Friday, November 05, 2010

Vaccine Central: Vaccine Misconception of the day – Aluminum in vaccines

Since most parents are NOT chemists, nor do they understand biology on an intimate level, this particular canard seems to be really prevalent in their decisions to expose their children to life threatening diseases that can easily be prevented.  Take that Big Boob (oh, wait, was that supposed to be big pharma?).

Vaccine Misconception of the day – Aluminum in vaccines

One of the common arguments the anti-vaccine advocates use is the “toxins in vaccines” argument. They say that because some substance in vaccines is known to be toxic, such as aluminum, then its mere presence makes vaccines dangerous. What they fail to mention in almost every case however is how much of said substance is in vaccines, and at what levels is this substance toxic.

Water can be toxic to a human in high enough quantities; it’s called drowning. Oxygen can be poisonous; it’s called oxygen poisoning. The list of examples goes on and on but the take home point is this: any substance can be toxic in the right dose; and most substances will not be toxic at low enough levels. As they say the dose makes the poison. The same applies to aluminum.

So, how much aluminum is there in vaccines anyway, and is that level dangerous for babies? To answer that, the Vaccine Education Center at the Children’s Hospital of Philadelphia has set up a short, concise, informative PDF that is available to all, for free, titled “Aluminum in Vaccines: What you should know“. And unlike those in the anti-vaccine camp, the Vaccine Education Center provides all their sources in the PDF itself, for anyone who wants to verify the accuracy of their report.

What they report should satisfy everyone’s curiosity.
During the first 6 months of life, infants could receive about 4 milligrams of aluminum from vaccines. That’s not very much: a milligram is one-thousandth of a gram and a gram is the weight of one-fifth of a teaspoon of water. During the same period, babies will also receive about 10 milligrams of aluminum in breast milk, about 40 milligrams in infant formula, or about 120 milligrams in soy-based formula.
So to put this in perspective: a baby will get 2.5 times the amount of aluminum from breast milk, 10 times the aluminum from infant formula, and 30 times the aluminum from soy-based formula. I know of no babies that are raised without either breast milk or formula, including the babies of each person in the anti-vaccine camp, and any baby who wasn’t vaccinated due to parent’s fear of aluminum toxicity in vaccines. 

It appears to me that the anti-vaccine crowd should switch its focus from “greening” vaccines to “greening” baby formula. I hear Big Formula makes a lot of money too out of its product….!

 

Vaccine Central: Analysis of Anti-Vax Graphs

As I mentioned in the previous post from A Photon in the Darkness, item 2 is a particularly dishonest bit of work.  Vaccine Central has delved into this one a bit more, and I think it's well worthwhile to deconstruct this a bit more.

Analysis of Anti-Vax Graphs


READ THE FULL ENTRY AT SOFTWARE 3D.COM

by Robert Webb

The anti-vaccine movement sometimes presents graphs to support their cause, supposedly to show that diseases were on the decline before vaccines came along, and that vaccines had no effect. Graphs seem hard to argue with. They look scientific, represent actual data, and are compelling to many people. And indeed a good graph should be compelling. But their graphs are not good. Let’s have a look at how the true data, which supports the fact that vaccines have had a huge positive effect, can be manipulated to manufacture the conclusion the anti-vax movement wants.

Death rates

Firstly, most of the graphs they show are of death rates, not infection rates. Yes, death rates dropped significantly before vaccines were introduced because other improvements in medicine and sanitation meant that we were better at treating the disease, but it does not indicate that less people had the disease to begin with.

They also tend to show graphs going back a long time to when death rates for common diseases like measles were very high. To fit these high figures on the graph it’s necessary to scale down all the figures, meaning that by the time the vaccine is introduced you can no longer see any drop it may have caused in deaths.
They never show graphs of death rates from third world countries where due to poor sanitation etc. death rates for diseases like measles can still be quite high.

Here’s a nice graph though showing both infection and death rates in the US and it’s clear from both that the 1963 vaccine had a huge effect.

Source: http://www.iayork.com/MysteryRays/2009/09/02/measles-deaths-pre-vaccine/

The anti-vaxxers claim (e.g. here) that death rates are more reliable than infection rates because they don’t trust the diagnoses made by doctors. The idea is that doctors are biased against diagnosing a disease if the patient has been vaccinated against it. But if the symptoms match, why wouldn’t they test for it? We all know that vaccines are not 100% effective. The above graph shows that infection and death rates are very closely matched, year by year, so it seems that the doctors’ diagnoses match the coronors’ reports, so where’s the evidence for this supposed misdiagnosis?

Infection rates

So the best way to see if a vaccine worked is to look at infection rates. I’ve only seen one infection graph presented by the anti-vax side (in several places, but I found it on the AVN website), so let’s look at that in some detail. Here it is:

This graph has already been demolished on Science-Based Medicine, so I’ll try not to repeat too much of that, though I need to recap a little. Mostly what I want to show is some new graphs (the big ones further down) that help explain what Dr. Obomsawin did to create the graph he wanted.

Dr. Obomsawin gives his source for the graph as here:


But a better graph of the same data, where actual data points are shown, can be seen in here:

So what’s wrong with the graph?

Here’s some (but not all) of the ways that this graph deceives us.
  • First, note the slight difference between these last two graphs. The latter graph shows a different point in 1959, before there was a ten year break in national reporting of measles. It appears to be a glitch in the former graph, showing a data point in 1959 when no data is available for that year. My guess is that the graph was made as if all data points were equally spaced, then the ten year gap was inserted, giving the impression that the graph dips down before the introduction of the vaccine, when in fact the dip should be spread across the gap in reporting where the vaccine was introduced. Dr. Obomsawin’s graph makes good use of this non-existence point. I have recreated his graph over the top of the best version of the original graph:
  • You’ll also notice immediately that his graph looks nothing like the source graph. This is because he has only used a data point every 12 years. So he has taken a graph with 68 data points, and used only 5 of them! When accused of cherry picking the data, he responds:
    • “the data was not selectively “cherry picked”, but rather consistently spaced giving accurate data for every 12th year running from 1935 to 1983, a period which is roughly equivalent to a half century.”
    But cherry picking can still involve evenly-spaced data. Why every 12 years? Why starting at 1935? I’ll show you exactly why this is so important. Simply start at 1933 instead. We’ll even keep Dr. Obomsawin’s arbitrary choice of 12-year spacing. Here’s what you get:
     
  • Yep, it looks completely different, though I’m using exactly the same technique as Dr. Obomsawin to generate this graph from the same original data.
READ THE FULL ENTRY AT SOFTWARE 3D.COM

 

A Photon in the Darkness: Three Popular Anti-vaccine Myths Deconstructed

I love when people take to task the lies and distortions of the anti-vax pro-disease nutters.  While I don't think these are the most prevalent or the ones that cause parents to willingly subject their children to the dangers of infectious diseases that can kill them, they are the sort of things that anti-vax pro-disease nutters will go on about at length.  So, A Photon in the Darkness deconstructs them (pay attention to point 2, will be posting about that in a second):

Three Popular Anti-vaccine Myths Deconstructed

Anyone who spends any amount of time dealing with autism will eventually (usually within the first 24 hours) run into the mythical “vaccine-autism connection”. I say “mythical” because, much like its cousin the Loch Ness Monster, the “vaccine-autism connection” is much talked about and even widely believed without any solid data supporting its existence.

Since this is “Vaccine Awareness Week“, I thought I’d try an address at least a few of the other myths about vaccines (after several sharp jabs from readers prodding me in that direction).


[1] “You claim that vaccines are 100% safe and effective!”:
It seems that whenever I get into a discussion - face-to-face or virtual - about vaccines, someone will point out that vaccines have risks associated with them. This, strange as it may seem to some people, is not unknown, even among those who generally support the widespread use of vaccines.

Every real medical intervention has risks. I say “real” because there are a number of “non-real” medical interventions that are essentially risk-free (apart from the risk of using them instead of real medical treatment to treat a real illness) - homeopathy being the best example. Apart from the risk of choking, true homeopathic remedies (as opposed to “alternative” medicine remedies that are marketed as homeopathic but have measurable amounts of active ingredients) are about as risk-free an activity as you can engage in on this planet. They aren’t going to help you, but they are exceedingly unlikely to hurt you.

Back to the point, real medical treatments carry real (if usually very small) risks of death or injury. Vaccines are not an exception to this rule. What real medical practitioners look at is the risk-benefit ratio. The risk of death or injury from a vaccine is less - often millions of times less - than the risk from the disease it is produced to prevent. This is actually better than the risk-benefit ratios from most antibiotics, where the risk of serious allergic reaction is often cited as one in ten thousand or so [1].

So, what’s the myth?

The myth - as it is usually stated - is that people who support the widespread use of vaccines, including the use of vaccines in children, are claiming that vaccines are 100% safe. An variation on this them is that supporters claim vaccines are 100% effective.  Neither myth is true, either about the vaccines or the supporters of vaccines.

This myth is a straw man fallacy. The people using it are trying to find an easier position to argue against (one that their “opponent” doesn’t actually support) because trying to refute the actual argument - that vaccines are safer than going unvaccinated - would be hard. “Hard” as in impossible.

 No medical treatment is 100% safe or 100% effective - not one. Anyone who makes that claim is sadly misinformed (or is lying). And anyone who claims that someone else is making that claim had better be prepared to show proof.

[2] ”Vaccine-preventable diseases were in decline before the vaccines were introduced”:
Another popular vaccine myth is that vaccine-preventable diseases were disappearing even before the vaccines were introduced because of improvements in hygiene, nutrition or just about anything except vaccines. I’ve seen this ancient canard trotted out for both polio and measles in recent years. The usual “data” used to support this claim are the mortality figures for the disease in the years preceding introduction of the vaccine.

The key to this myth is the use of mortality data rather than incidence data. Although the myth is that the incidence of the disease was waning prior to the vaccine, the data show something very different: that the number of deaths attributed to the disease were declining.

So, how is this different, you might ask?

Let’s take a look at measles, as an illustration. When you look at a graph of reported measles cases (incidence), you will see a dramatic drop immediately after the vaccine was introduced [2]. Further, if you “scroll back” through the years preceding the vaccine, you’ll see that the number of cases was consistently high. This is only sensible, since measles is highly contagious and, prior to the vaccine, 95+% of the population had it by adulthood.

So, what about the graphs that show the measles mortality gradually drifting downward long before the measles vaccine? Well, most of them seem to be derived from the information presented in a 1975 paper by Engelhardt et al [3]. In this paper, the authors have a graph of measles mortality and measles incidence from 1912 to 1975. It’s figure 1, on page 1167. I’ll wait while you go look at it.

 Back already?

As you look at this graph, there are two things you should note: first, the vertical axis (the “Y” axis) is logarithmic. Second, you should note that while the incidence of measles (the number of cases per 100,000 population) didn’t show any overall decline until after 1963 (hint: the measles vaccine was introduced in 1963), the mortality rate (number of deaths per 100,000 population) was declining by the 1920’s (and possibly earlier).

So, does this mean that the claim that measles was already on the way out long before the vaccine was introduced is correct?

No.

The incidence of measles was unchanged until after the introduction of the vaccine, which shows that whatever advances there had been in hygiene, nutrition, etc. had no impact on the incidence of the disease. However, it does show that something - better hygiene, better nutrition (although that fails to explain the continued decline in mortality during the Great Depression), better medical care, better reporting of measles cases, etc. - gradually decreased the case-fatality rate (number of deaths per case of measles) from over 20 per 1,000 cases in 1912 to less than 1 per 1,000 cases in 1963 (from the graph in figure 1).

Anyone who wants a more in-depth discussion of the impact of the measles vaccine on measles incidence and mortality should check out two now-classic papers by RM Barkin [4][5].

As it turns out, the myth that “better hygiene (etc.) was eliminating measles (et al) before vaccines” is largely based on a classic “bait and switch” - they are claiming that there was a decline in disease incidence but only show data about disease mortality. In fact, while better hygiene, nutrition and whatever were clearly reducing the mortality rate of measles before the vaccine - at a rate of approximately one order of magnitude (factor of ten) in 20 years - the introduction of the measles vaccine reduced the mortality rate by another order of magnitude within five years after it was introduced.

No matter how you slice the numbers, introduction of the measles vaccine had a tremendous effect on measles, even if you only look at mortality. When you look at the actual incidence of measles, there is simply no room for doubt: the vaccine effectively ended measles outbreaks in the US (until a certain British doctor muddied the waters - but that’s a topic for another day).

[3] “The chickenpox vaccine causes shingles!”
[Note: the terminology of human herpes virus 3 infections is a bit confusing, primarily because the primary infection (varicella or "chickenpox") and the secondary infection or reactivation (herpes zoster or "shingles") were thought to be different diseases until 1964. The virus is alternately called varicellovirus, varicella virus, varicella-zoster virus, herpes zoster virus or human herpes virus 3 (HHV-3); I will call it human herpes virus 3 (HHV-3), in keeping with the current semi-standard in virology.]

I most recently saw this myth on Dr. Joseph Mercola’s medical parody website, where he wrote one of the most humourous statements about virology I have seen in a long time:
Chickenpox and shingles are related. They are caused by similar viruses, both in the herpesvirus family. After you recover from chickenpox, the virus can remain dormant (”asleep”) in your nerve roots for many years, unless it is awakened by some triggering factor such as physical or emotional stress. When awakened, it presents itself as shingles rather than chickenpox.[emphasis added]“
“Chickenpox” (varicella) and “shingles” (herpes zoster) are, in fact, caused by exactly the same virus (human herpes virus 3 or HHV-3). I suppose it could be argued that they would then be, of course, very similar - as similar as my right hand is to my right hand. Although Dr. Mercola is rather ambiguous in his wording, he is correct that after a primary HHV-3 infection (i.e. “chickenpox”), the virus does remain in the cell bodies of the dorsal root ganglia of your spinal cord. What “awakens” (reactivates) this dormant virus - according to available data - is a decline in immunity against the virus, which can be the result of a number of things:
[a] time - without recurrent stimulation, the immunity naturally declines over time.

[b] immune suppression - whether from infection (e.g. HIV, wild-type measles), disease (e.g. lymphoma, leukemia, etc.), medication (e.g. steroids, chemotherapy, etc.) and - yes - even that vague and ill-defined “stress”, immune suppression reduces immunity.

[c] age - the immune system ages along with the rest of the body, even if you are taking “supplements” and eating the right foods and getting proper exercise.

Let’s take a closer look at [a]: time. One of the features of the human immune system (when it is working properly) is that it doesn’t maintain an immune response indefinitely in the absence of continued challenge. This is part of the “check and balance” (or “yin and yang”) nature of the immune system, balancing stimulation and suppression to keep from under- or over-responding to foreign substances.

What we are finding with so-called “life-long immunity” to chickenpox (and measles, mumps etc.) is that at least part of the extended duration of this immunity is the result of periodic re-exposure to the virus. In pre-vaccine days, almost everyone got these diseases as children and those that survived were immune - for life, we originally thought. It turns out that this “life-long” immunity relies on periodic exposure to the virus - a “natural booster”, in effect.

In the days when 90+% of children had chickenpox at some point, there was no shortage of runny noses, uncovered sneezes and aerosolised crusts (from the lesions) to provide a timely inocculum for surrounding adults. However, even in those blissful days before the chickenpox vaccine, a certain percentage of otherwise healthy adults experienced a sufficient decline in their immunity to HHV-3 that they experienced a secondary (or reactivated) infection - known popularly as “shingles”.

The rash in shingles looks just like the chickenpox rash except that it is generally restricted to the distribution of one (sometimes more) sensory nerve root. Unlike the primary infection (”chickenpox”), however, the sensory nerve root is damaged - sometimes permanently. Patients experience this as the burning, stinging pain of shingles or - if they are unlucky - permanent post-herpetic neuralgia. If the nerve involved is the ophthamic branch of the trigeminal nerve, blindness is a very real possibility.

It is the prevention of shingles and post-herpetic neuralgia that make the chickenpox vaccine doubly important. While the mortality and diability rates from HHV-3 primary infection (”chickenpox”) are low (but not as low as the mortality and disability rates from the vaccine), the incidence of post-herpetic neuralgia from the secondary infection (”shingles”) is nearly 6 per 10,000 population per year [6].

Enter the chickenpox vaccine. One of the major differences between the HHV-3 vaccine strain and the wild-type is that the vaccine strain isn’t readily passed from person to person (the wild-type virus is highly contagious, as most parents of older children probably remember). Although some people may be inclined to doubt this, the fact that we are seeing an increase in adult shingles cases [7][8] - as Dr. Mercola correctly notes - is proof that the vaccine strain isn’t passed between people [see note below]. Let me explain why we can say that.

[Note: transmission of the chickenpox vaccine strain from recently vaccinated children to severely immunocompromised patients or from immunocompromised patients to healthy non-immune caregivers has been reported a number of times. However, transmission between immunocompetent people has been detected only rarely and usually in the presence of chronic illness [*] or between young siblings [**][***]. Thanks to Science Mom for pointing out this omission.]

We know that the HHV-3 vaccine strain, when given to older adults (the risk of shingles rises dramatically after age 50 as immunity declines - this was true even before the chickenpox vaccine) reduces the incidence of shingles [9]. We also know - as I mentioned above - that the incidence of shingles is increasing despite near-universal childhood vaccination with the chickenpox vaccine. If the vaccine strain was readily communicable, we wouldn’t see the rise in shingles because adults would be getting their “natural booster” from vaccinated children.

And before Dr. Mercola or some else claims that the rise in shingles cases are due to primary infections of adults with the vaccine strain, remember that the primary infection - with the wild-type HHV-3 or the vaccine strain - causes a generalised (over the whole body) rash, not the limited, dermatomal rash of shingles [Note: the rash is very mild to undetectable with the vaccine strain, although in immunosuppressed patients, the vaccine strain can cause an illness identical to wild-type HHV-3]. We also have evidence that the HHV-3 vaccine strain, when it is reactivated, will not cause the nerve damage that makes shingles (wild-type) so debilitating [10].

So, yes, the chickenpox vaccine is leading to a rise in shingles, but not in the way some people might want you to think. The good news is that the same vaccine that is “causing” the problem (by reducing exposure to wild-type virus - a good thing if you’re immune suppressed) can be used to “cure” it. In addition, if we are diligent about vaccination, it might be possible to eradicate HHV-3 (wild-type) and prevent future generations from having to suffer from shingles and post-herpetic neuralgia.

Summary:
This is just a taste of some of the many myths about vaccines that you can find on the Internet and in your community. If I had the time (and you had the patience), this could have easily been extended to the top three thousand anti-vaccine myths. As always, I encourage people to be skeptical of any sources of information that don’t “show their work”, especially if you agree with them. My references are below, if you want to check my work. I especially recommend [6] for those who are concerned about the chickenpox vaccine.

Prometheus

References:
[1] International Collaborative Study of Severe Anaphylaxis. Risk of anaphylaxis in a hospital population in relation to the use of various drugs: an international study. Pharmacoepidemiol Drug Saf. 2003 Apr-May;12(3):195-202.
[2] Meissner HC, Strebel PM, Orenstein WA. Measles Vaccines and the Potential for Worldwide Eradication of Measles. Pediatrics. 2004 Oct;114(4):1065-1069.
[3] Engelhardt J, et al. Measles Mortality in the United States 1971-1975. Am. J. Public Health. 1980;70(11):1166-1169.
[4] Barkin RM. Measles mortality. Analysis of the primary cause of death. Am. J. Dis. Child. 1975 Mar;129(3):307-9.
[5] Barkin RM. Measles mortality: a retrospective look at the vaccine era. Am. J. Epidemiol. 1975 Oct;102(4):341-9.
[6] Bennett GJ, Watson CP. Herpes zoster and postherpetic neuralgia: past, present and future. Pain Res. Manag. 2009 Jul-Aug;14(4):275-82.
[7] Jardine A, Conaty SJ, Vally H. Herpes zoster in Australia: evidence of increase in incidence in adults attributable to varicella immunization? Epidemiol. Infect. 2010 Aug 23:1-8.
[8] Patel MS, Gebremariam A, Davis MM. Herpes zoster-related hospitalizations and expenditures before and after introduction of the varicella vaccine in the United States. Infect. Control Hosp. Epidemiol. 2008 Dec;29(12):1157-63.
[9] Schmader KE, et al. Effect of a zoster vaccine on herpes zoster-related interference with functional status and health-related quality-of-life measures in older adults. J. Am. Geriatr. Soc. 2010 Sep;58(9):1634-41.
[10] Gutzeit C, et al. Identification of an important immunological difference between virulent varicella-zoster virus and its avirulent vaccine: viral disruption of dendritic cell instruction. J. Immunol. 2010 Jul 1;185(1):488-97.
[*] Grossberg R, et al.  Secondary transmission of varicella vaccine virus in a chronic care facility for children. J. Pediatr. 2006 Jun;148(6):842-4.
[**] Brunell PA, Argaw T. Chickenpox attributable to a vaccine virus contracted from a vaccinee with zoster. Pediatr. 2000;106:e28.
 [***] Otsuka T, et al. Transmission of Varicella Vaccine Virus, Japan. Emerg. Infect. Dis. 2009 Oct;15(10):1702-3.

 

A Photon in the Darkness: They DID a Study

I wanted to pass a long a few stories that I have seen that I think need to be publicized a bit more.  There is a blog called A Photon in the Darkness that I also follow (along with Vaccine Central and many others) that publishes some good stuff.  He manages to get many more comments in his blog, even though he publishes rather infrequently.  But it bears repeating the information he publishes on other blogs that may not get as much traffic, just on the off chance that someone else may read it and learn from it.

They DID a study!

After years of whinging that nobody was studying the effects of thimerosal on the prevalence of autism, the die-hard members of the “thimerosal-causes-autism” club have finally gotten their wish. A study looking relationship between thimerosal and autism was released today (13 Sept 2010) in the journal Pediatrics:
Price et al. Prenatal and Infant Exposure to Thimerosal From Vaccines and Immunoglobulins and Risk of Autism.
This study, which was conducted at three managed care organisations (MCO’s), compared 256 children with autistic spectrum disorder (ASD) to 752 non-autistic controls who were matched by age, gender and MCO. They also examined a sub-group of autistic children who had a history of regression (”regressive autism”).
All children had to have been in one of the three MCO’s from birth to two years of age and currently be in the MCO. This made it possible to collect all thimerosal exposures from conception to age two years. The children with ASD were all evaluated to ensure that they met the criteria; the control subjects were not examined, but their parents were interviewed to identify (and exclude) any children with developmental abnormalities. The ASD group was further partitioned into two sub-groups: autistic disorder (AD) and autistic spectrum disorder with regression.
ASD was defined as: “ADOS scores that indicated abnormalities in all 3 areas and had ADI-R scores that indicated abnormalities in reciprocal social interactions and either communication or patterns of behavior”. The AD sub-group was defined as: “a subset of ASD children who had higher scores on all 3 areas of the ADOS, had ADI-R scores that indicated abnormalities in all 3 areas, and had onset at younger than 36 months”. ASD with regression was defined as: “the subset of case-children with ASD who reported loss of previously acquired language skills after acquisition”.
Thimerosal exposures were broken into time periods: prenatal, birth to one month, birth to seven months and birth to twenty months.
The authors examined the data using both an unadjusted model and a covariant model. The covariants examined were:
-Child and family characteristics (maternal and paternal age at birth of child, maternal education level, family income, single-parent status, birth order, twin/triplet, breastfeeding duration)
-Maternal exposures during pregnancy (exposure to mercury from fish, from cosmetics or medicines, or from dental fillings.
-Use of tobacco, alcohol, or illegal drugs
-Use of folic acid or valproic acid
-Viral infections
-Child birth conditions (birth weight, Apgar score, birth asphyxia, respiratory distress syndrome, hyperbilirubinemia)
-Early-childhood health conditions (anemia, lead exposure, pica, encephalitis)
-Maternal health care–seeking behavior (Kotelchuck prenatal care index, cholesterol and Papanicolaou test screenings)
For both the unadjusted and covarient models, the odds ratio (OR) for ASD was calculated both for a two standard deviation (2SD) increase in thimerosal exposure and for a 1 microgram per kilogram (μg/kg) increase in thimerosal exposure (1 microgram (μg) in prenatal exposure). The 2SD values were as follows:
“For the measure of prenatal exposure, 2 SDs = 16.34μg. Two SDs of the birth-to-1-month measure is 4.08 = μg/kg. Similarly, 2 SDs of birth-to-7-month and birth-to-20-month exposures are 15.56 μg/kg and 17.82 μg/kg.”
Finally, we come to the results:
“We found no evidence that increasing ethylmercury exposure from TCIs was associated with increased risk of ASD, AD, or ASD with regression. The unadjusted model results showed no significant associations between exposure and risk of ASD or AD.”
“In the covariate adjusted models, we found that an increase in ethylmercury exposure in 2 of the 4 exposure time periods evaluated was associated with decreased risk of each of the 3 ASD outcomes. We are not aware of a biological mechanism that would lead to this result.” [emphasis added]
Let me repeat that - there was no increase in ASD, AD or ASD with regression associated with thimerosal in any of the time periods. In fact, there was a decrease in ASD, AD, and ASD with regression seen with increasing thimerosal exposure in the birth to seven months and birth to twenty months time periods.
For those without a vested interest in keeping the “thimerosal-causes-autism” dead-parrot hypothesis alive, this study is the final nail in the coffin.
For those whose devotion to this long-dead hypothesis cannot be extinguished, not even this study will convince them. Mind you, I doubt that they would be convinced if God wrote in letters of fire six miles high “Thimerosal Does NOT Cause Autism”. Faith, I am told, transcends all doubt - all data, as well, it would appear.
Of course, the “debate” has moved on to more fruitful pastures already; only the truly committed (or truly in need of committment) will still admit they believe thimerosal (or mercury) causes autism. The rest have all moved on to more amorphous, ambiguous and - more importantly - less testable claims of “toxins” or other evil beasties in the vaccines. The most sophisticated of the bunch have even made a virtue of vagueness by claiming “Too many, too soon”. For more on that, see my previous post.
For now, the data are very clear that thimerosal is not associated with autism. The fact that the goalposts have been moved does not alter that fact.

Why ID is NOT Science

As of late, I have put up a lot of information about vaccines (it's that time of year when folks should be getting their flu vaccines, hence my focus on that).  However, this page also talks a lot about evolution.  Now, if you read the evolution page, and the sub menu tabs, you'll see that pretty much every argument they have made up has been addressed.  In the past 150 years, there hasn't really been much new at the root of their arguments.

As an aside, one must wonder, how is it that when the initial idea of descent from common ancestors (i.e. evolution) was proposed, and there were many fields that we had no idea about like genetics, cellular biology, microbiology, taxonomy, etc.  If a 19th century scientist was going to make up something, or try to intentionally deceive the scientific community, how could he possibly have pulled it off?  EVERY SINGLE DISCOVERY in biology and genetics supports evolution.  Read that again.  Every single one!  Even Newton's theory on gravity didn't stand up that well to time and subsequent discoveries.

Anyway, a fellow by the name of Wowbagger, over at the JREF forums, made this post that I really enjoyed, and wanted to share with you all:

There are a few ways to tell who is really doing the science, and who is not.

Progression vs. Reaction
Intelligent Design seems to be almost entirely reactionary. They never seem to be the ones making new, innovative discoveries; nor are they capable of predicting what might be found in a particular study: At least not in any detail.

What often happens is that evolutionary biologists will make a new discovery, of some sort: Perhaps a new fossil or a new way in which genes can vary, or a new way in which genes are expressed. And, all I.D. can do is react: "Yeah, but this can also be explained in this way..." And, that "way" would be very creative and convincing to a great many people. Except: They were not the ones who could ever come up with that discovery. It would be an entirely post-hoc analysis.

For example: As evolutionary development scientists (evo/devo) discover more facts about epigenetics, ID can react by calling them all examples of "front loading". ID is not capable of making the discoveries, nor are they capable of predicting what would be "frontloaded" or not, using their own hypothesis.

Another example is in the Recurrent Laryngeal Nerve (RLN). One would not expect a nerve to take a path like that, if it were designed. But, since we discovered it, all ID can say is "yeah, there is a reason for it". Of course, this is not even an argument against evolution: The nerve could still be the result of evolutionary heritage, and not contradict claims of how it is used. But, at least evolutionary biologists can still map how the nerve got to be that way, over time. ID cannot present evidence of a Creator's desires.

A third example, in the finding of fossils: The careful study of evolution can help us predict where new fossils can be found, such as the Tiktaalik. ID could make all the claims it wants about it "not being a transitional fossil". But, they did not predict its discovery. All they can do is react.

Utility as a Framework
The end result of all this is that Evolution continues to make headway as a framework for solving problems in the field of biology. Its findings, though not perfect nor complete, yet, are still far more reliable than anything Creationists have come up with.

Examples aplenty can be found here:   http://evolution.berkeley.edu/evolibrary/search/topicbrowse2.php?topic_id=47

ID seems to be entirely superfluous: It does not add anything that a scientist, charged with the responsibility of solving a problem in biology, would ever want to incorporate.

Quality of Evidence at the Core
Every claim made by evolutionary biologists (but, not necessarily the strawman claims that creationists claim evolutionists make) is backed by empirical evidence: We can isolate and measure each property at the core of our claims, and then some.
The same cannot be said for ID: There is no testable hypothesis that can isolate and measure the properties of the Designer. Not even in principle, it seems.

ID proponents are content with having the core of their claims be unknowable. But, the nature of the empirical beast that is science demands that claims should strive to be otherwise.

If evolution were all a hoax, then why does it continue to be productive in the fields of biological sciences? If ID was a superior science, then how come it is almost entirely reactionary?

Ask yourself: Who is really conducting science in biology?