Friday, March 13, 2009

Trolling against Poling

There is an excellent opinion article in Friday's Atlanta's Journal-Constituion by Dr Jon Poling. Dr Poling, for those of you who were under a rock about a year ago, is the father of Hannah Poling whose vaccine injury case before the Vaccine court was conceded by the government.

In his opinion piece Dr Poling touches on a range of topics from the myth of better diagnosis, to thoughts on investing research dollars, and even takes the time to smack down Dr Paul Offit (always a good time).

Go read the opinion, it is definitely worth it.

This article is being written about in some of the normal places. Harold Doherty at Facing Autism in New Brunswick has an entry here. Age of Autism has the full opinion here.

And then you have the other side of the commentaries, one written by Do'C on Autism Street here and Sullivan on LBRB wrote one here.

The right wing of the autism world doesn't seem to be mounting an effective response this time around. So lets look at what Do'C had to say. His first point is that :
Yep, Hannah Poling’s case was conceded, but contrary to popular internet re-interpretations which claim a court “decision” about autism causation, the case was apparently never actually heard by the court - and no court ruling about whether or not Hannah’s autistic features were caused by vaccination was ever made.
So the point that the it wasn't a decision by a special master of the court but rather by Department of Health and Human Services means that it wasn't the judicial branch of the government but rather the executive that made the "decision" is supposed to be important. Why it matters I couldn't tell you.

Next up, straw land:
Anyone who claims “better diagnosis” is solely responsible for the increase in autism diagnoses over the past couple of decades is pretty likely to be fairly scientifically illiterate. Writing to suggest that this may embody any representative scientific consensus, is nothing more than construction of a giant straw man argument.
So, no one claims that better diagnosis is involved in the increase of autism. Or as Do'C would have you believe, Dr Poling claimed that better diagnosis is "solely" responsible. The only problem is that he never said that. Regardless, lets see if we can find any references to better diagnosis by these "scientific illiterate".

Here is one on msnbc from Feb 12th of this year :
Recent data suggest a 10-fold increase in autism rates over the past decade, although it’s unclear how much of the surge reflects better diagnosis
Here's another from the Washington Post from 2007 :
The cases are rising, experts say, primarily because of better diagnosis and services: Parents and teachers are more attuned to the signs of autism, and doctors are better equipped to spot it than they were two decades ago.
Here is one from Autism Vox, a blog that was written by Kristina Chew before she went on to write at :
But could it be that we are simply diagnosing autism better? That we ourselves have gained greater knowledge and understanding of autism, and are therefore counting cases of autism more and more accurately?
Finally here on page 10 of the decision reached by the vaccine court written by Special Master Hastings (as everyone knows, a real scientific "illiterate"):
Other experts argue that the increase in diagnosis does not represent a real increase in the incidence of the condition, resulting instead from a broadening of the diagnostic criteria for autism, improved recognition of autism, and other factors.
I think it is safe to say that it better diagnosis is commonly used. So survey says - one stack of straw for Do'C.

Next up Do'C take issues with Dr Poling's claim of "drowning in the red ink of educating increasing numbers of special-needs students" by showing a graph of the percentage of children served in California under IDEA vs the residential population over the past 10 years. This graph is a straight line implying that there has been a) no rise in the number of special needs students, and b) no rise in cost.

The problem is that the if a percentage is flat but the underlying population is growing then the actual number of students would be increasing. The other problem is that his chart has no information whatsoever about the costs incurred by the school districts while educating these children.

Lets not even talk about the fact that just because California has one pattern that not all other school districts in the country are the same. And lets certainly not discuss the differences in cost between providing relatively simple services such as speech therapy and the very costly proposition of providing a one-on-one aid for a child on the spectrum or a special purpose classroom.

None of that is apparently relevant. Just keep your eye on the nice flat line.

That's the end of my attention span for Do'C. So lets turn to what Sullivan has to say.

His main beef seems to be that:
why is it that people who claim to support “gene-environment” interactions seem to have disdain for the “gene” part? How are we supposed to separate the various autism subgroups without identifying the genes? And, if we identify genes, won’t their function give us some idea of what environmental causes might be worth studying?
For which he gets the "YOU'VE MISSED THE POINT" award of the year. The point that Dr Poling was making is that continuing to pour more research dollars into a fruitless search for a gene or genes that could be contributing autism is doing nothing to help create early interventions that could help prevent autism. His point was that if we can identify the environmental trigger you could change the course of the disorder.

There have been countless genetic searches done for the "smoking gun" gene that "causes" autism. It has yet to be found, most likely because it as a singular entity does not exist.

So instead of continuing to dig in the same haystack for that one piece of hay that might not even exist it might be time to consider switching to more other neglected areas that have more potential to show results.

I will skip Sullivan rehashing Do'Cs arguments - regurgitated straw doesn't taste good.

Sullivan's final point is that the entire reason for Dr Poling's piece is that this "is rather poorly disguised attempt to air his ongoing battle with Dr. Paul Offit." I think Sullivan has a point here, after a fashion.

There is clearly a disagreement between Dr Poling and Dr Offit. These two have been having a back and forth over these issues for a while in a variety of places, from journals to newspapers.

On one side you have have Dr Offit who represents everything that is wrong about the modern medical industry. He is an insider who has had large vested financial interests in one side of the argument winning. Autism is not his field, he just comments on it as a hobby.

On the other side you have Dr Poling who is the father of a child whose autism was caused by vaccinations. Dr Poling has done research with other scientists to try to determine how his daughter developed autism - and he found the answer. He helped to document how his daughter's autism was caused.

Dr Offit has repeatedly attacked him and the acknowledged fact that his daughters autism was caused by vaccinations. This is despite the fact that Dr Offit had no special knowledge of Hannah Poling's case or medical history. From all appearances he did it solely to protect his vested interest in the vaccine industry.

So whose side are you going to take? An industry-made millionaire or the father fighting for his child with autism?

It isn't a tough choice.


  1. Hi MJ -
    I didn't realize you also wrote a blog until I clicked through from my own.
    I am commenting here simply to point out a tremendous flaw in your reasoning towards the end of this post.
    You see, painting Dr. Offit as the sole possessor of bias in his tete a tete with Dr.Poling (which, by proxy, represents the vaccine/autism debate) is highly disingenuous. You seem to ignore the fact that Dr. Poling was a litigant with a vested interest in proving vaccine/mito causation at the time he performed his research. Further, he failed to disclose this COI. Maybe there is a reason you gave him a pass while condemning Dr. Offit for the same category of offense?

  2. You have a good point Steve. There are a few factors to make the difference to me.

    First, from what I can recall of the time line of events, the research that Dr Poling was done before he filed a claim in vaccine court but was not accepted for publication or published until afterwards.

    But it has been a while since I read about it so I could be wrong here and remembering incorrectly.

    Regardless you are correct in that the conflict should have been disclosed if it occurred prior to the research being published.

    But then again that would have required that he disclose the subject of the study was his daughter which would have likely blocked the publication of the study.

    Second, there is a difference in the amount of money we are talking about in the conflict. I believe that Dr Offit has made far more money from his patent than Dr Poling has from the award in the vaccine court. There are no hard numbers on either side but I don't think this is a stretch.

    Third, there is a difference in what I see to be the motives of the two individuals. I think Dr Offit is trying to protect an industry and the vaccine program while Dr Poling is trying to help his daughter and prove that there is a potential path, however small between vaccinations and autism.

    Forth, Dr Offit from his initial comments has misstated the facts of the case and gotten basic facts wrong. And even when he was corrected by Dr Poling he still maintains his incorrect position.

    That to me says that he is more concerned with promoting his view and protecting his interest and less concerned with having a real dialog about the issues.

    Lastly, and probably most relevant, I don't like Dr Offit very much. I don't trust his motives and I don't think he is being completely honest when he talks about issues. He is holding himself out as a scientific authority but then starts selling like a used car salesmen. You can't be both at the same time.

  3. MJ -
    As we seem to inhabit entirely different universes on this topic, I'm going to attempt to respond but not really expect you to grasp my perspective.
    First off: I have nothing against Dr. Poling's attempts to do the right thing by his daughter. Securing funds from the VICP for her vaccine injury was the right thing for him to do, and I don't feel any injured person should be denied such compensation.
    Having said that, his COI's are fairly egregious in my view. Whether or not his work was done prior to filing, he certainly had to know at some point during the research process that he'd be building a case for VICP. After all, the study was published in 2006, just 2 years prior to the HHS settlement. If you are correct in that the study should not have been published at all had it been publicized that his own daughter was the subject, then this makes it doubly egregious by any measure.
    As an aside, Shoffner is already on the record stating his belief that vaccines do not cause autism, and Zimmerman apparently included his opinion to that effect as well in the OAP expert reports. It is telling that of the 4 authors, only Poling is publicly asserting that any link b/t vaccines and autism is biologically plausible.

    To your second point:
    I disagree that the amount of money plays any role whatsoever. However, I'll play your game, but change the currency to human suffering.
    Dr. Offit is the inventor of one of the two rotavirus vaccines currently marketed throughout the world. The "millions" of dollars he earned were from selling the licensing rights to his invention to one of the pharmaceutical giants (Merck?). Why did they want to buy it?
    An excerpt: "Rotavirus infection is the leading cause of severe acute diarrhea among young children worldwide (1,2). An estimated 527,000 children aged <5 years die from rotavirus diarrhea each year, with >85% of these deaths occurring in low-income countries of Africa and Asia (3). Two licensed rotavirus vaccines have shown efficacy of 85%--98% against severe rotavirus diarrhea in trials conducted in the Americas and Europe (4,5), and they have been introduced into routine immunization programs in 11 countries in these regions and in Australia."
    By my calculation, Dr. Offit's invention stands to save over 400,000 human lives, per year, ad infinitum. Over the course of 10 years or so, his "millions" may amount to $1 per life saved. Do you consider that a value? Coming from the "vaccine skeptic" position you hold, the retort just quivering at the end of your tongue probably reads something like: "yeah, but his vaccine causes intussusception, and rotavirus doesn't kill babies in the U.S.". In truth, here is what Rotavirus does in the U.S.:
    An excerpt: "Rotavirus is the most common cause of severe gastroenteritis in infants and young children worldwide. Before initiation of the rotavirus vaccination program in the United States in 2006, approximately 80% of U.S. children had rotavirus gastroenteritis by age 5 years. Each year during the 1990s and early 2000s, rotavirus resulted in approximately 410,000 physician visits, 205,000-272,000 emergency department visits, and 55,000-70,000 hospitalizations among U.S. infants and children, with total annual direct and indirect costs of approximately $1 billion."
    Now, please explain to me again how you can favor Dr. Poling by placing value on the outcome of his efforts.

    Your third point speaks to intent of the efforts, as opposed to outcome. Again, I would refer you to the above figures. If you had Dr. Offit's skillset, would you strive to achieve the same end that he did? I sure would, and I would trumpet the vital importance of vaccines from the highest mountaintop. Dr. Offit, you see, is not the dissenter here - Dr. Poling is. Dr. Poling does not even have the support of his co-authors on the mito study, while Dr. Offit is regularyl exposed to and has a deep understanding of exactly how powerful and sensitive our own vaccine safety reporting features are. Did you know that intussusception was detected as a side effect of Rotashield (not Dr. Offit's vaccine - an earlier one) becuase the VAERS was triggered at 15 such occurrences per million doses, when only 14.7 per million were expected? That is how sensitive our "alarms" are. And during phase III trials, btw, the same vaccine triggered below-placebo levels of IS.
    I'm afraid, MJ, you have bought the "Offit-as-Baalzebub" line of the anti-vax contingent hook, line, and sinker. But, as I said at the beginning of this comment, I don;t really expect to convince you. After all, you just don;t like the guy, do you?

  4. "I'm going to attempt to respond but not really expect you to grasp my perspective."

    Actually I do appreciate you taking the time to respond. It is always worth listening to other points of view and it is only by listening to opposing points of view that you can hope to learn anything.

    "Having said that, his COI's are fairly egregious in my view."

    I think we can agree that he had conflicts but I think we have to disagree on how severe the conflicts are.

    To my mind getting the research published and starting the ball rolling on other people looking at this area is a good thing. Assuming (big assumption) that there is something to the mito/vaccine/autism link then if it is possible to prevent any cases of autism by looking at this link then that is a good thing. But only time will tell if something will develop from this or if this will be another dead end.

    "As an aside, Shoffner is already on the record stating his belief that vaccines do not cause autism"

    I am not sure that is the case. I think he was cautioning that there needs to be more evidence and research, and that there is no proven link - not that there is no link. He also also complaining about Dr Poling confusing the issue with some of his public statement.

    For example look at the end of the first page of this:

    "Zimmerman apparently included his opinion to that effect as well in the OAP expert reports"

    His statement was in a separate case that was quite different from the Poling case. It will be interesting if see what his opinion is if the Poling records are ever released.

    "It is telling that of the 4 authors, only Poling is publicly asserting that any link b/t vaccines and autism is biologically plausible."

    I don't think that is surprising. If you were a researcher would you touch the third rail of the autism debate if you could avoid it?

    "I disagree that the amount of money plays any role whatsoever"

    So if we are talking about 100,000 dollars vs 100,000,000 dollars you don't think that effects people differently?

    "Do you consider that a value? Coming from the "vaccine skeptic" position you hold, the retort just quivering at the end of your tongue probably reads something like: "yeah, but his vaccine causes intussusception, and rotavirus doesn't kill babies in the U.S."."

    Yes, I do consider saving lives a value. And I am not really a "vaccine skeptic" nor anti-vaccine. Vaccines are a life saving invention that have a useful function.

    My concerns in the area come down to timing, extra ingredients, and possible sub groups that have extra vulnerability. That and I really don't agree with the whitewashing that goes on by the medical establishment. It shouldn't be that hard to admit that there can be, in some small number of cases, problems with vaccines. Every other medicine out there comes with disclaimers about possible side effect yet how often are we treated to the "perfectly safe" line?

    But, for the record, my children are (mostly) vaccinated. There are a few that we haven't done yet because they are too new (HPV) or won't do because of a bad experience (flu shots)

    As to the rotavirus vaccine - it is needed in some parts of the world. In first world countries it isn't as needed (but still a good idea) because with proper hydration rotavirus becomes much less life threatening.

    But lets assume for the minute that it is everything that you say it is - my question is does that really change that fact that Dr. Offit has made a tremendous amount of money from his patent?

    We are talking a very serious amount of money - I do not think it is possible that his objectivity has not been affected by it.

    "Your third point speaks to intent of the efforts, as opposed to outcome."

    Yes it does. The ends do not justify the means. Lets accept that your figures above about the number of lives saved every year but assume that do get there all you had to do was distort the facts about a possible link between other vaccinations and autism. I won't even go as far as saying lying about a link or covering up a link, just twisting the truth a little. Would you do it?

    " That is how sensitive our "alarms" are."

    Then why isn't there a single straight forward study done on US populations that looks at the risks using the VAERS data that disproves a link? If the data is as sensitive as you say then this should be an easy thing to do.

    The point here is that this argument should have been put to bed a long time ago yet it hasn't been. I can't believe with all of the information available that this question is not answerable. And the longer the question goes without a good answer then the more entrenched the debate is going to become.

    But all of this is really beside the point. This isn't really about vaccines. This is about the characters of the two people involved, and I find a lot in the character of Dr Offit that I do not like.

    Do you see his attack piece on Dr Sears in Pediatrics? Did you notice his flagrant disregard of the facts? If you haven't read it I suggest you read the original article and the rebutal by Dr Sears.

    "I'm afraid, MJ, you have bought the "Offit-as-Baalzebub" line of the anti-vax contingent hook, line, and sinker."

    Actually my opinions are my own based on my own experiences and what I have read from many "sides" of the debate. If you look around at some of the other things I have written I try to write more about the nonsense that appears on blogs and to some extent recent research (although I may not do the best job with that).

    I may have been picking on ND sites as of late but that is only because they have been more absurd and I really have issues with some of the discouraging of treatment that goes on. That is not the same as saying that I agree with the mercury militia or anti-vax group or whatever they are being called this week. I really try to look at the facts and make up my own mind.