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Denmark: Autism-MMR link back?

shanek

Penultimate Amazing
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Quick history of this debate:

Older: MMR vaccine might cause autism.

Newer: No, it doesn't.

Most recent: According to this month's Journal of American Physicians and Surgeons, a study of Denmark children shows a sharp rise in autism after the introduction of the MMR vaccine:

The measles, mumps, rubella (MMR) vaccine was added to the childhood immunization schedule in Denmark in 1987. From 1998 to the present, there has been concern over whether there is an association between MMR vaccination and autism. Prevalence of autism by age category during 1980 to 2002 was investigated, using data from a nationwide computerized registration system, the Danish Psychiatric Central Register, in order to compare the periods preceding and following introduction of MMR vaccine.

Prior to a classification change in 1993/1994 and a change in enrollment in 1995, an increase in autism prevalence was noted. Linear regression analysis was performed separately on the trend during 1990 to 1992, the period that preceded the introduction of both effects. The prevalence in 2000 could then be derived excluding the sources of ascertainment bias.

Prevalence of autism among children aged 5-9 years increased from a mean of 8.38/100,000 in the pre-licensure era (1980-1986) to 71.43/100,000 in 2000 and leveled off during 2001-2002. The relative risk (RR) is therefore 8.5 (95% CI, 5.7 to 12.7). After adjusting for greater diagnostic awareness, the RR is 4.7 (95% CI, 3.1 to 7.2). Among individuals less than 15 years old, the adjusted RR is 4.1 (95% CI, 3.5 to 4.9).
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Trends in prevalence data in Denmark suggest a temporal association between the introduction of MMR vaccine and the rise in autism. Because thimerosal was not used in any pediatric vaccine in Denmark since 1992 and the greatest increase in autism prevalence followed that year, it is likely that one or more of the viral components or their combination in the MMR vaccine contributed to the reported increase.

Autism rates in the U.S. have surpassed those of Denmark. Notably, in the U.S. the MMR vaccine was administered at the age of 12 months, often with two thimerosal containing products, the B and hepatitis B vaccines, while it was usually administered alone in Denmark at the age of 15 months. Additionally, by the age of 6 months, infants in the U.S. had been exposed to 12 vaccines and up to 187.5 micrograms of thimerosal, compared to 6 vaccines with no thimerosal in Denmark...Developing safer vaccination strategies and supporting further investigation of the hypothesized link between the MMR vaccine and autism should have a high priority.
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http://www.jpands.org/vol9no3/goldman.pdf

There's also a commentary in the issue, "MMR and Autism in Perspective: the Denmark Story":

http://www.jpands.org/vol9no3/stott.pdf

Reactions? Rebuttals?
 
Even if the Denmark data is accurate, there is that whole correlation versus causation thing.
 
I noticed this bit
Because we did not request population data stratified by vaccination status, we were unable to compare vaccinated and unvaccinated cohorts as had been done in historical studies. Instead, since the vast majority of children aged 5 to 9 years received MMR vaccine, we compared autism principally in this age group in periods before and after introduction of the vaccination program.
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I'm no statistician, but it seems that there is an incidence of < .08% for autism in the 5-9 year age group and a maximum take up of 80% for MMR. Now, if you add in the confounding factor of the change in the classification system for autism in 1994 (which the authors claim to have adjusted for) how confident can you be of the conclusions in this paper when you are "unable to compare vaccinated and unvaccinated cohorts"? I know we have some people proficient in these statistical matters on the board, perhaps they can help us out here.

Also, the whole tone of the paper seems anti-MMR with speculation like this
When physicians and parents are told that vaccines are virtually completely safe, they are less likely to connect a severe adverse event with vaccination. Thus, vaccine-induced adverse events are underreported and grossly underestimated.
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Hmm. So, no controversy then? No headlines in national newspapers about a supposed MMR-autism link? Or was that just in the UK?
I smell a rat. What do you think shanek?
 
I see that one of the authors of the Commentary (shanek's second link) is none other than Dr. Andrew Wakefield. No bias there then.
(Yes I know what Argumentum ad Hominem means, but I don't trust him - anyone who has been following this story knows why - see this thread.)
 
Stott

Figure 1 contradicts Goldman's claim that children are diagnosed with autism at age 5+. Here, we see that the time of diagnosis is after 2 years, and then it drops dramatically. That's odd indeed.

Goldman

Take a look at the graph on page 2.

Something odd happened in 2000: The number of 0-4 year olds and 5-9 year olds rise, but the number of 10-14 year olds drop. Why? Everyone in that last age group got the thimerosalMMR vaccine.

Why does the number of 5-9 year olds drop in 1993 - 6 years after thimerosal-MMR was introduced? Shouldn't there be an increase, especially if the majority of children are diagnosed with autism when they are 5?

The real "jump" comes in 1995, a full 9 years after introduction. Why don't we see this in 1992, after the 5 years it takes for infants to get to the age (of 5) where they are usually diagnosed? We don't even see a continuous rise after 1992, as expected: There's a drop in 1993.

Why does the number of 10-14 year olds rise at the same time as the 0-4 year olds and 5-9 year olds? The 10-14 year olds did not get a thimerosal-MMR.

None of the 0-4 year olds in 2002 have gotten thimerosal vaccinations, so why doesn't the number drop to pre-thimerosal levels? If there is a causal link to autism, we should see this dramatic drop. We don't.

It doesn't look as if there is a direct link between thimerosal and autism from this report. Something else is happening. It is more likely that we simply got better at diagnosing autism around 1994-5 (the authors acknowledge that the definitions changed at this time). We know that Denmark reports side-effects more often, and is better at describing them as foreign reports Source, in Danish Or, perhaps some other factor caused it.

But it isn't thimerosal, that's for sure.

Good link on QuackWatch
 
There isn't any thiomersal in MMR, and I think the study as reported tends to confuse two different vaccines - MMR, and a different one with thiomersal in it.

Sounds like very dodgy statistics to me. I don't have the actual reference, but I heard about a study in London where they actively traced every child born in a certain borough over (I think) a 20-year period and ascertained their mental health status. They found a steady gradual increase in the rate of diagnosed autism over that time, with not the slightest suggestion of a blip which could be attributed to the introduction of the MMR.

Anybody got a link to the actual study?

Rolfe.
 
Denmark quacks are scrambling to debunk a different Denmark study showing there is no difference in autism rates between children vaccinated and unvaccinated. First, they claim THAT OTHER study showing MMR does not cause autism was "biased". Now they are trying to show autism rates are dropping since the mercury based preservative was removed. Why not recruit Wakefield's help? They know he is anti-vaccine.

G.S. Goldman, Ph.D.
F.E. Yazbak, M.D., F.A.A.P.

These guys sound familiar too. Ah yes, very prevalent in other anti-vaccine web sites:

http://www.whale.to/a/ata.html

Always spouting the conspiracy theories.

So, their conclusion states that viral components cause autism. So, measles virus causes autism? No, measles can cause encephalitus, which then can cause autism.

The mercury based preservative was not used in MMR either, but the quacks' conclusion spouts on about it. Did you read the conclusion?

Oh, and AAPS is notoriously anti-vaccine as well and full of other conspiracy theories as well. You will not find one study or article of theirs in support of vaccines. Don't let the oh so official name impress you.

AAPS Journal traces suppression of abortion-breast cancer link - 8/14/2003
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Rigghhht.

The source of this study posted on vaccines is insane.
 
To sum up:

The journal is notoriously anti-vaccine, the researchers involved are anti-MMR for sure, and the research itself is kinda bogus.

There was a rise in autism in Denmark between 1990-1992. There was also a greater rise in autism after 1994, when some diagnostic and reporting criteria were changed.

From this assumption, the authors conclude that there is a temporal relationship between the introduction of the MMR vaccine and the rise in autism. Of course, without comparing the rate of autism in unvaccinated children to the rate of autism in vaccinated children, it is impossible to make any judgements of that nature. What the study showed me is that post 1994, the number of autism cases in Denmark rose, probably due to diagnostic and reporting criteria changes.

This is anti-vax bull wrapped in legitimate-sounding pseudoscience.
 
Oh, and there's this in Wakefield's rebuttal:

"AJW is a named inventor of a viral diagnostics patent."

So not only is he beholden to his lawyer friends, he's also got a direct financial interest in his "viral diagnostic" tools being used to determine the presence of measles virus in autistic children. If he can ever get enough people to buy that MMR really does cause autism, well, he'll certainly make some bucks won't he?

But the drug companies are the evil ones.
 
shanek said:
...Journal of American Physicians and Surgeons, ...
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About that organization:
http://www.ratbags.com/rsoles/comment/aaps.htm

Also see "More persistent people (28/8/2004)" comment in http://www.ratbags.com/rsoles/

Another thought: The use of MMR started in the USA in 1971 --- how does this jive with the perceived increase in autism?

What are the numbers of children being diagnosed as "mentally retarded" and/or "emotionally disturbed" versus the various flavors of autism (Kanners, Aspergers, PDD, etc) from 1971, 1975 (when the law dictating that kids with disabilities must be allowed a public school education, before that they were told to go elsewhere or were institutionalized), and the dates of the last two "Diagnostic Standards for Autism" (DSM-III and DSM-IV)?
 
Rolfe said:
Sounds like very dodgy statistics to me. I don't have the actual reference, but I heard about a study in London where they actively traced every child born in a certain borough over (I think) a 20-year period and ascertained their mental health status. They found a steady gradual increase in the rate of diagnosed autism over that time, with not the slightest suggestion of a blip which could be attributed to the introduction of the MMR.

Anybody got a link to the actual study?

Rolfe.
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http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12876158

CONCLUSIONS: The prevalence of autism, which was apparently rising from 1979 to 1992, reached a plateau from 1992 to 1996 at a rate of some 2.6 per 1000 live births. This levelling off, together with the reducing age at diagnosis, suggests that the earlier recorded rise in prevalence was not a real increase but was likely due to factors such as increased recognition, a greater willingness on the part of educationalists and families to accept the diagnostic label, and better recording systems. The proportion of parents attributing their child's autism to MMR appears to have increased since August 1997.
 
Thank you sodakboy93 and HCN, your information covered all the questions I had left.

Any comments from Shanek? Does this makes sense? This whole issue can be really flrustrating when trying to make sense of what is actual information and what is not.
 
Now I'm wondering how he happened across that crazy site he found the MMR article on that he posted here. Looking for stuff on 2nd hand smoke? I wonder what the crazy site has on 2nd hand smoke...
 
Dragon said:
I noticed this bit I'm no statistician, but it seems that there is an incidence of < .08% for autism in the 5-9 year age group and a maximum take up of 80% for MMR. Now, if you add in the confounding factor of the change in the classification system for autism in 1994 (which the authors claim to have adjusted for) how confident can you be of the conclusions in this paper when you are "unable to compare vaccinated and unvaccinated cohorts"?
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That is a problem I noticed...On the other hand, parents aren't very likely to admit that they broke the law and didn't have their children vaccinated, don't you think?

The change in classification does pose a huge problem, I agree. They seem to have done a good job in compensating, but I would think it's impossible to compensate 100%.

I know we have some people proficient in these statistical matters on the board, perhaps they can help us out here.
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That's mostly what I'm looking for here. Can this change be seen to be statistically significant, given the factors you mentioned?

I smell a rat. What do you think shanek?
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I don't know. That's why I started this thread.
 
Dragon said:
I see that one of the authors of the Commentary (shanek's second link) is none other than Dr. Andrew Wakefield. No bias there then.
(Yes I know what Argumentum ad Hominem means, but I don't trust him - anyone who has been following this story knows why - see this thread.)
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Interesting. Are there any studies comparing the safety of MMR vs. "single-jab" vaccinations?

However, I'm less interested in the commentary than in the study itself. Although I'm puzzled as to why anyone would have any kind of bias against MMR vaccines particularly.
 
CFLarsen said:
Figure 1 contradicts Goldman's claim that children are diagnosed with autism at age 5+.
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Just FYI, my son was diagnosed with autism at age 3. What the significance of that data point is I don't know, but there you go.

Something odd happened in 2000: The number of 0-4 year olds and 5-9 year olds rise, but the number of 10-14 year olds drop. Why? Everyone in that last age group got the thimerosalMMR vaccine.
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I'm told that with some forms of autism (and they think my son is of this kind) the child grows out of it upon reaching adolesence. If the kind of autism that is suspected in this study to be the result of MMR vaccines tend to be of this variety, at least in a greater proportion than it is among the general population of autistic children, then this could explain the drop.

One problem I have is that I've discovered that autism covers such a wide continuum of things that it seems difficult to peg down any cause of it. My son is in a structured class of children with autism and other delays, and I can tell you that no two of the autistic children are alike. It's not like there's an autism gene or germ or hormone or anything objective that you can measure. It's basically a long list of things, and if you have a certain number of characteristics in this list to a degree that results in a developmental delay, then you're said to have autism. Diagnosing my son was a long and sometimes confusing process.

Another disturbing trend I've seen is for the state to classify a disproportionate number of children as being delayed. By definition, a child is said to be developmentally delayed if he is in the lowest 25% in terms of how he's progressing. Around here, it's actually more like 35%, and since the state gets more money based on how many developmentally delayed children are in the system, this makes me very suspicious. If a similar thing is in place in Denmark, and occured at around the same time (which may be possible because, as you pointed out, the metric for determining autism changed), that may explain the increase.
 
sodakboy93 said:
"AJW is a named inventor of a viral diagnostics patent."
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Hmmm...this may answer my above question. But that still only deals with the commentary, not the report itself.
 
Re: Re: Denmark: Autism-MMR link back?

Hydrogen Cyanide said:
About that organization:
http://www.ratbags.com/rsoles/comment/aaps.htm
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Well, I'm more interested in the data, not attacks on the source, although if you can both show a bias and how the bias affected the study that certainly is relevant. But as a rebuttal, I don't think "get it published in Science or Nature" is very relevant since my understanding is that those journals receive far more entries than they can ever hope to publish.

This journal is apparently peer-reviewed. If you want to investigate the quality of that peer-review, go right ahead, but the above argument just falls flat with me.
 
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