Libertarianism: For Adults Only?

Last month, Tina Carlsen was arrested last month for kidnapping her infant son, Riley Rogers. Her crime? Sneaking Riley out of a Seattle hospital in order to prevent surgery ordered by his doctors and a judge. Riley suffers from a congenital condition which is causing his kidneys to fail and the doctors want to install a catheter that would prepare him for eventual dialysis. Carlsen wanted to try alternative homeopathic treatments including ionic footbaths.

Doctors performed the surgery on June 30 and Riley was released into the custody of his father. Carlsen, who is out of jail on $500,000 bond, is being allowed state-supervised visits.

Just how bone-headed must parental decisions about a child's welfare be before the government should intervene is one of the toughest questions for philosophical libertarians. Generally I tend to bow to medical expertise (especially when the "alternative" is bogus homeopathic treatments), but medicine is not exact, so there are plenty of gray areas. It is true that Carlsen violated a court order, but is justice really being served now by prosecuting her?

Comments

[Abdul]

Recently, my wife & I have been attending childbirth classes. At the last one, the subject of childhood immunizations came up. More than half of the upper-midlle class yuppies in the class, including the midwife leading the thing, regard immunizing a child as being identical to injecting the child with 50 cc of retard juice.

I'm all for libertarianism, but then there are things that make me question the rationality of a political philosophy based in part on the majority of folks having at least a low to mediocre ability to make good decisions.

[Dan T.]

It is true that Carlsen violated a court order, but is justice really being served now by prosecuting her?

Yes. We must be willing and able to enforce court decisions or else the courts become useless.

[bombadil]

Could it depend on the evidence for alternative treatments vs. allopathic treatments for whatever case we are talking about? Suppose it's one specific form of cancer (or some other disease heretofore resistant to western modern medical techniques) where the allopathic treatment success has been 0 to 5 percent. Maybe then a parents use of an alternative treatment would not seem like child abuse.

[gaijin]

We must be willing and able to enforce court decisions or else the courts become useless.

Dan T has it right...when everything is arbitrary, then you have chaos...I don't think libertarianism = anarchy.

Having said that, one could argue that the courts are already meaningless. In which case....

[Ron Bailey]

Dan T. What about prosecutorial discretion? Not every infraction that can be prosecuted is prosecuted, right?

[matt]

From a libertarian perspective, it seems to me that allowing the state to dictate treatment (even if it happens to be the correct treatment) can only mean trouble in the long run -- i.e., further control over our lives.

[Dan T.]

Dan T. What about prosecutorial discretion? Not every infraction that can be prosecuted is prosecuted, right?

A fair point. But this appears to be a pretty severe case so I think we must be willing to show that court orders must be honored when a child's health or life is on the line.

[Wild Pegasus]

Generally I tend to bow to medical expertise

I'm shocked.

- Josh

[fishfry]

I agree ... libertarianism is not anarchy. Don't libertarian drivers appreciate traffic lights? If you have traffic lights, you need cops and courts to enforce them ... otherwise it's not safe to drive.

This case is a slam dunk. It would be different if it was a religious circumcision, but in this case it's not. Homeopathy is not accepted by modern medicine. That's not a statist plot. It's science.

[Creech]

If she had just named the kid "Elian," the government would have gone into the hospital with assault rifles and pulled the kid out for her!

[thoreau]

I suspect that we can go around in all of the same circles that we've gone around in when similar issues have been discussed. I won't try to answer any of the hard questions in this post, but simply point out that some of the questions are in fact hard and cannot be resolved by a simplified application of libertarian philosophy. Parents have rights as well as responsibilities. We can debate about where the lines should be drawn, but it's clear that as long as parents have responsibilities for their kids then it will, from time to time, be necessary for a court to intervene. Sad but true.

One thing to keep in mind is that the father didn't seem to oppose the surgery. He was very conflicted and seemed to think that both the mother and the doctors should have handled it better. The father's unease with the situation makes it murkier.

Also, Ron, you say that you usually come down on the side of medical experts. You are also very big on defending the right to engage in all sorts of medical procedures that at this point are rather speculative. Now, I realize you would not want anybody to be coerced into getting a speculative futuristic treatment, but imagine this scenario:

What if, instead of some all natural homeopathic hippy dippy age of aquarias alternative treatment, the mother had wanted to try a very new and still experimental treatment that had such buzzwords as "human enhancement" attached? (We'll assume that you own no stock in the company selling it 🙂

Would you defer to the medical experts, or would you be all in favor of trying the new frontiers of medicine?

[WSDave]

The case is far more complex (and fucked up) then you think:

From the Post:
"His mother, whose family has a history of kidney disease, questioned why the operation and the dialysis could not wait until the procedures were really needed.

Carlsen's doctor alerted Child Protective Services at least three times after Carlsen sought to treat her son with natural remedies instead of surgery. The child's parents asked to see another physician, but Dr. Nicole Becker stayed involved, according to Carlsen's attorney, Michael Shipley."

The doctor lied to the police and said that the child's life was in danger, thus prompting the Amber Alert, when in fact the child may not need the surgery EVER.

Ultimately, the doctor didn't want the mother to get a second opinion (which is why he stayed involved in the case), and wasn't about to let her do anything that he didn't okay.

I hope she sues the hospital into bankruptcy.

[thoreau]

WSDave-

Based on what you're saying, it sounds like this case is pretty simple based on the facts, and an appeal to principle is not really needed here. If the doctor lied about the danger then the situation is pretty straightforward.

That's what I get for skimming the article.

Still, Ron's willingness to go with the medical experts over alternative medicine may run into problems if the medical experts cast doubt on a speculative treatment.

Any comments, Ron?

[Captain Holly]

This is a difficult question, but at the same time, one shouldn't be so quick to assume that doctors and the social services bureaucracies are inherently better than parents when it comes to determining what's best for their kids.

And as an example, I give you the case of Parker Jensen, who was diagnosed by a pediatric oncologist as having oral cancer and was prescribed chemotherapy. When his parents requested a second opinion and less severe, "naturopathic" treatments -- a perfectly reasonable request -- the doctor turned them into the Utah child protection bureaucracy, who in turn argued in court that Parker would die within a year unless he got treatment. The judge, without hearing any contrary arguments, agreed and ordered him to be taken from his parents.

The parents took Parker and fled to Idaho. They were eventually arrested and brought back to Utah, but the resulting outcry from the public forced the state to back down. In the end, the state gave in and allowed the parents to keep him and treat him as they felt best. The Jensens just recently won a round in their lawsuit against the state employees who engineered the whole fiasco, although final payment is several years away.

And Parker? Well, almost exactly three years after he was nearly forced into chemotherapy to save him from cancer, he is still healthy and cancer-free.

[Murray Rothbard's Ghost]

We can clearly deduce the answer from the non-aggression principle. The one true correct libertarian answer is ... ah, hell, this one's hard...

[D. Saul Weiner]

Deferring to medical conventional wisdom and overriding the inclinations of parents is totalitarian and a recipe for disaster for our children. Do we need any more proof than the appalling explosion in autism coinciding with the expansion of the state-mandated vaccine schedule (notwithstanding attempts to vindicate vaccinations by government agencies)?

If the state could prove (to the satisfaction of a jury) that the parents were abusive and/or negligent, then this type of intervention might be justifiable. But to ASSUME abuse/negligence because the parent does not agree with the bureaucrats as to the appropriate treatment, basically says that you do not have the right to raise your child as you see fit, that the state is the real parent.

[Ron Bailey]

Damned server squirrels! I've been trying to post the below for a while.

Thoreau: All of my discussions concerning advanced biotech treatments (and enhancements) is premised on their being reasonably safe. See, for example, my arguments against human reproductive cloning now. Of course, what is "reasonably" safe will depend on the specific treatments when they become available. Ask me about them then.

One further note--my writing and reporting on speculative biotech treatments is basically aimed at trying to persuade people to allow the research to go forward rather than be pre-emptively banned on grounds of "repugnance" a la Kass and others. Let's wait and see what people will do when the time comes instead of assuming from the get-go that the new technologies will be widely abused.

Now I have to go get a jumpstart for my car.

[.]

It's those goddamned activist doctors.

[Ronald Bailey]

Damned server squirrels! I've been trying to post the below for a while.

Thoreau: All of my discussions concerning advanced biotech treatments (and enhancements) is premised on their being reasonably safe. See, for example, my arguments against human reproductive cloning now. Of course, what is "reasonably" safe will depend on the specific treatments when they become available. Ask me about them then.

One further note--my writing and reporting on speculative biotech treatments is basically aimed at trying to persuade people to allow the research to go forward rather than be pre-emptively banned on grounds of "repugnance" a la Kass and others. Let's wait and see what people will do when the time comes instead of assuming from the get-go that the new technologies will be widely abused.

Now I have to go get a jumpstart for my car.

[Todd Fletcher]

Homeopathy cured my excema.

[AC]

appalling explosion in autism coinciding with the expansion of the state-mandated vaccine

Now let's hear about fluoridation of water as a government-sponsored mind control method.

[thoreau]

Ron-

That is fair.

[Bretigne]

fishfry,

Re: "Homeopathy is not accepted by modern medicine. That's not a statist plot. It's science."

Actually, that's not true. In the mid-19th century there was a pretty nasty political battle within medicine between the homeopathic and the "allopathic" (what we now call conventional medicine) camps. The allopaths won with the establishment of the AMA which began to set the standards for medical schools -- with a decidedly anti-homeopathic bent. This bias was not based on any scientific studies or hard evidence, but on the political alliances of those within the AMA. In fact, one of the major beefs the allopaths had was that homeopathic doctors were making more money than they were -- in other words, they were doing a better job of satisfying their customers. The AMA, like any other union, was trying to stifle competition to the benefit of its members. They did a pretty good job.

To my knowledge, there has never been any scientific "showdown" proving that conventional medicine works better than homeopathic medicine. Medical intervention is responsible for at least 225,000 deaths annually in the US, according to JAMA (other estimates are much higher), including 106,000 deaths due to "non-error, adverse effects of medications." As far as I know, homeopathy has never killed anyone. And there are plenty of peer-reviewed professional journals documenting its successes.

My point here is not to argue that homeopathy is better than allopathy, but to point out that the science is not in on this, for the simple reason that the science has not been done. (Then of course there?s the whole question of the two systems having radically different ideas of what it means to heal or cure a patient. But that's a topic all on its own.) It amazes me that so many libertarians are so willing to put their faith in conventional medical authority simply because it is authority -- particularly when this industry is so overwhelmingly characterized by statist intervention, rent-seeking, politically motivated funding, etc.

[Bretigne]

Abdul,

Re: "More than half of the upper-midlle class yuppies in the class, including the midwife leading the thing, regard immunizing a child as being identical to injecting the child with 50 cc of retard juice."

So I guess you missed this: "Salon: Deadly Immunity"? There is plenty of evidence showing vaccines to be harmful. In fact, the medical community doesn't deny that there are risks -- the only points of contention are precisely what and how high those risks are.

"I'm all for libertarianism, but then there are things that make me question the rationality of a political philosophy based in part on the majority of folks having at least a low to mediocre ability to make good decisions."

Yeah, wouldn't it be great if everyone made "good decisions." And wouldn't it be even better if I got to be the one to decide what that meant. But I'm all for libertarianism.

[D. Saul Weiner]

AC,

Nice try to discredit me.

Rather than dismiss these concerns out of hand as irrational hysteria, why don't you do some homework and actually investigate the science behind these concerns.

This article would be a good place to start:

http://www.lewrockwell.com/miller/miller14.html

After reading this article and contemplating the matter, ask yourself if you (and by extension, the average judge or bureaucrat) really are so certain in your medical knowledge that you are qualified to take away the parent's perogative to decide what is best for their kids and put the life and well-being of another parent's kid in your hands.

[AC]

Rather than dismiss these concerns out of hand as irrational hysteria, why don't you do some homework and actually investigate the science behind these concerns.

I wouldn't be dismissing them as irrational if I hadn't already researched them. I fully understand the concerns about immunization from a libertarian point of view, but junk science is not necessary to justify those concerns.

[tzs]

Well, we have enough cases when Christian Science parents (and others) refuse medical treatment for their kids and rely on prayer. Documented cases where the kid has died.

What's the libertarian view on that?

[D. Saul Weiner]

AC,

Please enlighten us as to how junk science is being used to justify concerns regarding vaccination.

[zach]

In somewhat related news... Brain implants bypass paralysis

[Akira MacKenzie]

Oh great, a fucking pile of shit anti-vaccination woo.

Go sell your snake oil elsewhere, Weinier.

[ChicagoTom]

Go sell your snake oil elsewhere, Weinier.

It's snake oil to point out that there are legitimate risks with vaccines (like with any types of medication)? Good to know...

Let's just ignore truths because they don't fit our world view....just like the religious dogmatists you are so found of attacking....hyppocrite

[D. Saul Weiner]

Akira,

Now that you have argued the point so thoughtfully and persuasively, I don't know what I was thinking! I don't know what we would do without all of the rational commentators on the Reason blog to set the story straight!

[Akira MacKenzie]

When the "risks" are

[Akira MacKenzie]

Edit:

When the "risks" of vaccination are bullshit? You bet your ass it's snake oil!

[Akira MacKenzie]

Also, since when does being a libertarian for some now include being an anti-science knuckle-dragger? (e.g. "Global Warming is a myth!" "Evolution is just a 'theory!'" "Vaccines do more harm than good!" "AIDS is not caused by the HIV virus!" )

[Akira MacKenzie]

"...but medicine is not exact, so there are plenty of gray areas."

I hate to break it to you Ron, but "homeopathic medicine" would have eventually killed the kid surer than shit. That's an absolute.

[slightlybad]

I don't have any particular knowledge about vaccines and autism (nor, since I am currently childless, do I really give a shit). I do, however, have a friend who is a pediatrician with one of the top teaching hospitals in the country. She also has a stepson who is autistic. I asked her if there was any connection between autism and vaccination and she said there was absolutely no evidence with any basis in science. I also asked her if she was planning on vaccinating her own children and she absolutely is going to do so.

Again, no personal knowledge on my part, but when weighing her judgement against the quacks who inject themselves with silver iodine or whatever and turn themselves blue, I know who I'll take everytime.

[thoreau]

I wouldn't be at all shocked if it should turn out that vaccines carry more risks than we realize.

But....
1) I doubt that those risks come anywhere near the risks that we assume in lots of other daily activities.

2) The risks of not getting vaccinated against certain diseases are known, and the only reason those risks are so low is because everybody else is getting vaccinated.

By all means, if you don't want to do something I'm all in favor of your right to not do it. But don't kid yourself into thinking that you're the sharpest tool in the shed for not getting vaccinated.

[Ron Bailey]

Akira: That's why I called it "bogus." 🙂

[AC]

But don't kid yourself into thinking that you're the sharpest tool in the shed for not getting vaccinated.

I really don't mind if they continue to think of themselves as tools, though.

[ChicagoTom]

Akira,

Let me get this straight....

There are absolutely NO health risks associated with any vaccinations? None! Zip! Zero! Zilch! No one has ever had an adverse reaction to vaccinations ever? And anyone who even mentions a potential risk is a snake oil salesman correct?

That is your position correct?

Because no one here seems to be taking the position that the risks outweight the benefit or that they are a bad/stupid move....Just pointing out that there are risks to weigh and decisions to be made (even if they are a no-brainer to such wise people as yourself and Mr. Bailey)

[Captain Holly]

2) The risks of not getting vaccinated against certain diseases are known, and the only reason those risks are so low is because everybody else is getting vaccinated.

Or because the vaccine is more for parental convenience than for preventing significant public health hazards.

Such as the chickenpox vaccine that I recently refused for my five year-old daughter. Not because I have anything against vaccines, but because:

1) The risk of getting complications from chickenpox for healthy, normal children is almost zero;

2) There have been questions about how long the vaccine provides protection, and chickenpox is something you don't want to get as an adult;

and

3) I wanted to piss off the powers-that-be. 🙂

If she doesn't get it by the time she hits adolesence I'll probably have her vaccinated. By then there should be a clearer picture of how long the vaccine lasts.

But trust me, the folks at the Health Dept./School District were not pleased.

[D. Saul Weiner]

Akira,

Now I understand. Since an organization called "Quackwatch" (which is dedicated to attacking any practices or philosophies which compete with allopathic medicine) discounts the risks of vaccinations, I should believe them and accept their whitewash research and dismiss all evidence presented by respected doctors and scientists who I might otherwise find credible. Sure.

Don't you realize that there are statists at many think tanks who spend all their time trying to undermine libertarian philosophy and those who would like to see changes to the status quo in the political sphere? It's all about preserving the status quo. And quackwatch performs the same function for conventional medicine. Open your eyes Akira and you might discover that you're the one who's been buying the snake oil!

[MainstreamMan]

"appalling explosion in autism coinciding with the expansion of the state-mandated vaccine"

Two pieces of information:

The appallling explosion in autism is coincident with a change in the diagnostic criteria, and improved efforts to identify cases.

Prior to the change in definition, there were not good data as to the incidence of autism in the population...this makes it impossible to compare current rates with historical rates.

And just for the record, all epidemiological efforts (and there were many) to establish a link between vaccination and autism found no evidence to support the link.

It is scientifically plausible that there is an extremely small number of children who develop autism due to mercury in vaccinations, but this would be the rare (very, very rare) exception, not the rule. This means that, if it ever happens at all, it is rare that a child with autism (an already extremely rare condition) has autism due to a vaccination.

(I did an extensive review of the literature for an epidemiology class recently, this is based on pretty much all the available studies in English as of last year...I will refrain from posting the multiple pages of references).

[thoreau]

Captain Holly-

Chicken pox is one case where I agree with you. If at all possible I would refrain from vaccinating a kid until the teen years. Not so much because I'm worried about side effects, but rather because I'm worried about the protection wearing off as you point out.

[zach]

Now I understand. Since an organization called "Quackwatch" (which is dedicated to attacking any practices or philosophies which compete with allopathic medicine)...

Ah, there it is, allopathic. I almost pissed myself anticipating it.

[Bretigne]

Re: "Since an organization called "Quackwatch" (which is dedicated to attacking any practices or philosophies which compete with allopathic medicine)"

Likewise Akira's link to Skepticwiki's page on homeopathy -- it would appear that these "skeptics" are very selective in determining to whom they apply their skepticism. For a more honest appraisal, try wikipedia's page.

[Akira MacKenzie]

Soooo... We are suppose to disregard peer reviewed and tested (and retested, and retested) evidence from doctors, biologists, and other professionals from related scientific disciplines in favor of faith healers, crystal worshipers, herbalists and other con artists who have never shown any scientific evidence that they can heal shit?

Riiiiight.

[Akira MacKenzie]

For a more honest appraisal, try wikipedia's page.

Ahem:

"The neutrality and factual accuracy of this article is disputed."

Fucktard.

[ChicagoTom]

We are suppose to disregard peer reviewed and tested (and retested, and retested) evidence from doctors, biologists, and other professionals from related scientific disciplines in favor of faith healers, crystal worshipers, herbalists and other con artists who have never shown any scientific evidence that they can heal shit?

No we are supposed to look at the results, weigh the risks / rewards and make those decisions for ourselves and our families without being called rubes by people who think they are smarter than everyone else.

I know a few people who have forgone vaccinations for their children and have had no health problems other than typical colds and stuff....so from a financial perspective it might make sense to forgo them -- since everyone else is getting them maybe I dont need to.

And again -- you ignore my question -- are you asserting that there exactly ZERO risks associated with vaccinations. NONE at all???

If the answer to that is no, then is low-risk the same as no-risk -- and should you really be judging other people's risk tolerance like those statists everyone deplores?

[Bretigne]

Mainstreamman,

Re: "The appallling explosion in autism is coincident with a change in the diagnostic criteria, and improved efforts to identify cases.

Prior to the change in definition, there were not good data as to the incidence of autism in the population...this makes it impossible to compare current rates with historical rates."

Improved diagnosis doesn't explain the increase -- if it did, we would be able to see the same rate of autism in older people after 1943 (who would have been children before autism was first identified) as in children. I don't think that has been the case. It also doesn't explain why communities (such as the Amish) that don't vaccinate have near-zero rates of autism.

"And just for the record, all epidemiological efforts (and there were many) to establish a link between vaccination and autism found no evidence to support the link."

Not true. The studies cited in the Salon article I mentioned earlier ("Salon: Deadly Immunity") establish a very strong link between vaccines containing thimerosal and autism. So much so that the CDC and others tried to repress the results.

I'd be really interested to hear what the pro-vaccine folk here think of the Salon article. I've seen some attempts to rebut it but they've been pretty weak. If the article is correct, then the link seems indisputable.

[MainstreamMan]

I just posted this on the other health related thread...

http://www.compmed.umm.edu/Cochrane/index.html

Is a group who are collecting the scientific evidence for alternative medical practices...

They have links that allow you to assess the evidence yourself...

Click over to the Child of the Stars thread for more details...

Wikipedia is not a good resource in areas of controversy, much more reliable in areas where matters are pretty much settled.

[Akira MacKenzie]

It's funny, you never hear that about penicillin.

[thoreau]

I have no idea if autism rates are increasing, but (1) I know to be very skeptical because the criteria were changed and (2) comparisons with the Amish, however interesting they may be, could never be used to establish that vaccines are the cause of any discrepancy. Consider all of the other lifestyle and environmental factors that differ, and it should be obvious why such comparisons would be useless for establishing any sort of causality.

Being libertarian doesn't mean you have to buy into any and all wacky theories that come down the pipeline with no real evidence. Otherwise, libertarians would have to embrace communism.

[Akira MacKenzie]

RFK Jr's Salon junk science has been thouroghly debunked.

[Bretigne]

For a more honest appraisal, try wikipedia's page.

Ahem:

"The neutrality and factual accuracy of this article is disputed.".

I'd say that's being pretty honest. (Unlike the site you linked to that contained only a smattering of information supporting only one side of the issue.)

[zach]

It also doesn't explain why communities (such as the Amish) that don't vaccinate have near-zero rates of autism.

Actually, the improved diagnostics theory pretty handily explains that, if you consider it a moment. And it would make perfect sense if autistic adults didn't generally undergo the same tests as potentially autistic children.

[Bretigne]

Actually, the improved diagnostics theory pretty handily explains that, if you consider it a moment. And it would make perfect sense if autistic adults didn't generally undergo the same tests as potentially autistic children.

Sorry, I must be missing something. How does the improved diagnostics theory explain the lack of autism among the Amish? And why would potentially autistic adults not undergo the same testing as potentially autistic children?

[Akira MacKenzie]

Unlike the site you linked to that contained only a smattering of information supporting only one side of the issue.

As if there IS another side.

OK, What is your peer reviewed and testable evidence that alternative medicine works?

[MainstreamMan]

Bretigne,

Well, when you believe that the evidence was suppressed it is difficult to refute your position using the lack of evidence, but here is a quick summary of some of the findings from the basic science--

In a systematic review of 42 studies on the prevalence of Autism Spectrum Disorders (ASD), Williams, Higgins, & Brayne (2005) found the overall random-effects estimate of prevalence across studies of typical autism (TA) to be 7.1 per 10,000 (95% CI: 1.6, 30.6, based on 37 estimates) and of all ASD to be 20.0 per 10,000 (95% CI: 4.9, 82.1, based on 23 estimates). The extremely wide confidence intervals (e.g., over 1900% difference for TA) found in this review highlight the difficulty involved in providing convincing evidence for or against a true increase in the number of individuals with autism.
In their review, Williams et. al found several factors were significantly associated with differences in prevalence estimates. Sixty-one percent of the variation in prevalence estimates for TA was explained by three factors which included the diagnostic criteria used (OR=3.36?95% CI: 2.07, 5.46), how old children were when screened (OR=0.91 per year of age difference?95% CI: 0.83-0.99), and where the study was conducted (e.g., Japan vs. Denmark; OR=3.60?95% CI: 1.73, 7.46). For all ASD, it was found that diagnostic criteria was the most important factor associated with differences in prevalence estimates, while age of the sample explained 50% of the variance, and urban or rural location explained 53% of the variance in estimates. For both TA and ASD estimates, the authors found ?the time variation in prevalence is so closely linked to changes in diagnostic criteria, the two could not be examined separately (pg. 12).? The confounding between time and diagnostic criteria across these studies makes it difficult to support an argument that true prevalence is increasing. This problem has been recognized for a number of years (see Fombonne 2001, 2003, McCormick, 2003, Lingam et. al 2003) and has led to a call for better monitoring systems to allow for comparison across time by holding case-definitions and case-ascertainment methodologies constant (for instance, Fombonne 2001, also see Honda, Shimizu, Imai, & Nitto, 2005, Lawler, Croen, Grether,& Van de Water, 2004).

...

While it seems it should be clear that the current state of affairs does not allow for unequivocal statements about the change in the true prevalence of autism, prevalence research has been used in many studies to examine potential causes of autism. The most heated debate surrounds whether or not autism may be related to children?s exposure to certain childhood vaccinations. This debate was initially sparked by a study showing a potential association between the Measles-Mumps-Rubella vaccination and regressive autistic symptoms in 12 children referred for gastroenterology consultation (Wakefield et. al, 1998). In their report, Wakefield et. al suggest that their findings would predict a rise in the frequency of autism diagnosis in the years following the introduction of MMR in the United Kingdom in 1988. The study to test this hypothesis was conducted in the UK (Taylor et. al, 1999) and other countries with negative findings (see for instance, Fombonne, & Chakrabarti, 2001, Madsen 2002). This focus on MMR vaccinations, which are a nearly universal exposure to children in Europe and the United States, led to a broader concern with the safety of all childhood vaccinations. A hypothesis developed that autism may be the result of an interaction between genetic vulnerability and mercury exposure via the preservative thimerosal (see Bernard et al, 2001). Arguments both for and against the role of thimerosal in autism have used prevalence data to bolster their argument (see Geier &Geier, 2004, Verstraeten et. al, 2003, for instance). Because the predicted effect sizes involved are small, these studies have necessarily utilized prevalence estimates with high precision so that small effects would not be swamped by large confidence intervals. But, as was discussed, these are the very studies with the most likelihood of bias, and poorest accuracy of estimation.
In 2001 the Centers for Disease Control, the National Institute of Health, and the Institutes of medicine put together the Immunization Safety Review Committee (ISRC) to examine the hypothesis that vaccines, specifically MMR and thimerosal-containing vaccines, are causally associated with autism. In their final report (ISRC 2004), the committee concluded that the evidence favored a rejection of a causal link between these vaccines and autism. The report highlights, however, the difficulty of using epidemiological methods to answer etiologic questions in autism research.
?There are many examples in medicine of disorders defined by a constellation of symptoms that have multiple etiologies, and autism is likely to be among them. Determining a specific cause in the individual is impossible unless the etiology is known and there is a biological marker. Determining causality with population-based methods such as epidemiological analyses requires either a well-defined at-risk population or a large effect in the general population. Absent biomarkers, well-defined risk factors, or large effect sizes, the committee cannot rule out, based on the epidemiological evidence, the possibility that vaccines contribute to autism in some small subset or very unusual circumstances. However, there is currently no evidence to support this hypothesis either (p.11).?

For parents worried about whether or not their child might be part of that small subset, or in very unusual circumstances, this information may not help them feel comfortable about the vaccinations their child is getting. This is particularly true in the current information environment where parents can find endless media sources warning them of the dangers of vaccinations, many hosted by seeming ?experts? in the field (see http://www.mercola.com/, for instance). Most of these sources will cite the alarming increase in autism prevalence as a reason for parents to worry, a clear misuse of the data available.
Fortunately, however, a natural experiment is underway in the United States that may be able to answer questions regarding thimerosal. Thimerosal is being removed from most vaccines in the United States at a time when better monitoring systems have been put in place, and the diagnostic criteria for autism has stabilized. Using these improved monitoring systems to track the prevalence of autism as the exposure to thimerosal decreases provides an opportunity to use epidemiological methods to answer a question of causation. This research would need to be careful monitor other environmental sources of mercury exposure at the same time to avoid the potential confounding effects.

[M.]

Orac of Respectful Insolence at Science Blogs writes frequently about the thimerosal-autism controversy and the Geiers.

Last year, he wrote about the case of a 5-year-old autistic boy who died while receiving an 'alternative treatment' for autism (chelation therapy).

[Akira MacKenzie]

Well, when you believe that the evidence was suppressed...

Just like we faked the moon landing, or have the 500 miles-per-gallon car locked up next to the Ark Of The Covenent and Roswell Grey corpses in the Pentagon basement, right?

[MainstreamMan]

As far as the AMISH,

http://www.autismstreet.org/weblog/?p=32

[Bretigne]

RFK Jr's Salon junk science has been thouroghly debunked.

Um... not really. All this guy does is attack RFK's "conspiracy theories" and his presentation of the meeting where the CDC et al supposedly decided to keep information on a thimerosal-autism link under wraps. Nowhere does he even address the validity of the studies involved. In particular, the Verstraeten study where an epidemiologist looked at the medical records of 100,000 children and did find a link between thimerosal exposure and multiple developmental problems. His research also shows a fifteen-fold increase in autism since 1991 (when three more Thimerosal vaccines were added to the recommended infant regime.)

The Salon article also mentions other studies supporting a Thimerosal-autism link. I don't see any of these studies debunked on the site you linked to.

I'm perfectly prepared to believe that these studies are all bunk, if that's the case. So far though, I haven't seen any criticism that even addresses the question.

[Bretigne]

OK, What is your peer reviewed and testable evidence that alternative medicine works?

For one, there's the British Medical Journal study looking at 25 years of clinical studies on homeopathic medicine, that found that in 81 out of 107 trials, homeopathic medicines were effective.

There have also been clinical trials on some of the over-the counter homeopathic remedies for specific ailments that have shown them to be effective.

This is all in addition to the peer-reviewed studies appearing in homeopathic journals (at least one of which is the journal of an association made up solely of practitioners who are also MDs.)

[Akira MacKenzie]

There are a lot of things Amish avoid besides vaccinations: TV, radios, automobiles, buttons. By Bretinge's... ahem... "logic," I suppose these too must be reasons that the Amish have allegedly lower rates of autism.

Basic logic: Correlation is not causation. Nor are anecdotes "evidence."

[MainstreamMan]

If Verstraeten is your source, then maybe Verstraeten's word on his findings will help you clarify the issue...

Safety of Thimerosal-Containing Vaccines: A Two-Phased Study of Computerized Health Maintenance Organization Databases
Thomas Verstraeten, MD*,{ddagger}, Robert L. Davis, MD, MPH?, Frank DeStefano, MD, MPH{ddagger}, Tracy A. Lieu, MD, MPH||, Philip H. Rhodes, PhD{ddagger}, Steven B. Black, MD?, Henry Shinefield, MD?, Robert T. Chen, MD{ddagger} for the Vaccine Safety Datalink Team

* Epidemic Intelligence Service Program, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
{ddagger} Vaccine Safety and Development Activity, Epidemiology and Surveillance Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia
? University of Washington and Group Health Cooperative of Puget Sound, Seattle, Washington
|| Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, and Division of General Pediatrics, Children?s Hospital, Boston, Massachusetts
? Kaiser Permanente Vaccine Study Center, Oakland, California

Objective. To assess the possible toxicity of thimerosal-containing vaccines (TCVs) among infants.

Methods. A 2-phased retrospective cohort study was conducted using computerized health maintenance organization (HMO) databases. Phase I screened for associations between neurodevelopmental disorders and thimerosal exposure among 124 170 infants who were born during 1992 to 1999 at 2 HMOs (A and B). In phase II, the most common disorders associated with exposure in phase I were reevaluated among 16 717 children who were born during 1991 to 1997 in another HMO (C). Relative risks for neurodevelopmental disorders were calculated per increase of 12.5 ?g of estimated cumulative mercury exposure from TCVs in the first, third, and seventh months of life.

Results. In phase I at HMO A, cumulative exposure at 3 months resulted in a significant positive association with tics (relative risk [RR]: 1.89; 95% confidence interval [CI]: 1.05?3.38). At HMO B, increased risks of language delay were found for cumulative exposure at 3 months (RR: 1.13; 95% CI: 1.01?1.27) and 7 months (RR: 1.07; 95% CI: 1.01?1.13). In phase II at HMO C, no significant associations were found. In no analyses were significant increased risks found for autism or attention-deficit disorder.

Conclusions. No consistent significant associations were found between TCVs and neurodevelopmental outcomes. Conflicting results were found at different HMOs for certain outcomes. For resolving the conflicting findings, studies with uniform neurodevelopmental assessments of children with a range of cumulative thimerosal exposures are needed.

[Akira MacKenzie]

Really? The same British Medical Association that has just published in The Lancet "an all out attack on homeopathy?"

[Bretigne]

There are a lot of things Amish avoid besides vaccinations: TV, radios, automobiles, buttons. By Bretinge's... ahem... "logic," I suppose these too must be reasons that the Amish have allegedly lower rates of autism.

Actually, I didn't say that the lack of vaccines were responsible for the lack of autism among the Amish. What I said was that improved diagnostics didn't explain that phenomenon.

[Akira MacKenzie]

Whoops! Here's the right link:

http://www.time.com/time/columnist/jaroff/article/0,9565,1114166,00.html

[Bretigne]

Really? The same British Medical Association that has just published in The Lancet "an all out attack on homeopathy?"

Check it out yourself Akira.

[Akira MacKenzie]

But in all the anti-vax screeds I've read, the "connection" is certainly implied.

Stop dancing around the issue.

[highnumber (of questions)]

What are the theories behind how homeopathics work? Treating like with like, right?
Have there been advances in the "science" since it was thought up? If it works, how does it work?

[MainstreamMan]

And in case you don't have access to this...

Verstraeten directly addresses the issue in a letter to the editor.

Thimerosal, the Centers for Disease Control and Prevention, and GlaxoSmithKline
Thomas Verstraeten, MD, MSc
GlaxoSmithKline Biologicals
1330 Rixensart, Belgium

To the Editor.?

I am the first author of a recent article on a study undertaken by the Centers for Disease Control and Prevention (CDC) to screen for a potential link between thimerosal-containing vaccines and neurodevelopmental delays.1 The article has been subject to heavy criticism from antivaccine lobbyists. Their criticism basically comes down to the following two claims: the CDC has watered down the original findings of a link between thimerosal-containing vaccines and autism, and GlaxoSmithKline (GSK) has hired me away from the CDC so as to convince me to manipulate the data further before publication. Because I was responsible for nearly all aspects of this study, including study design, data gathering, data analysis, and writing of the article, I wish to give my opinion on these claims. These are my personal opinions and do not represent the opinion of the CDC or GSK.

Did the CDC water down the original results? It did not. This misconception comes from an erroneous perception of this screening study and other epidemiological studies. The perception is that an epidemiological study can have only 1 of 2 outcomes: either an association is found (or confirmed), or an association is refuted. Very often, however, there is a third interpretation: an association can neither be found nor refuted. Let?s call the first 2 outcomes "positive" and "negative" and the third outcome "neutral." The CDC screening study of thimerosal-containing vaccines was perceived at first as a positive study that found an association between thimerosal and some neurodevelopmental outcomes. This was the perception both independent scientists and antivaccine lobbyists had at the conclusion of the first phase of the study. It was foreseen from the very start that any positive outcome would lead to a second phase. Whereas the original plan was to conduct the second phase as a case-control study, we soon realized this would be too time consuming. The validity of the first-phase results needed urgent validation in view of the large potential public health impact. Did the CDC purposefully select a second phase that would contradict the first phase? Certainly not. The push to urgently perform the second phase at health maintenance organization C came entirely from myself, because I felt that the first-phase results were too prone to potential biases to be the basis for important public health decisions. Health maintenance organization C was the only site known to myself and my coauthors that could rapidly provide sufficient data that would enable a check of the major findings of the first phase in a timely manner.

Because the findings of the first phase were not replicated in the second phase, the perception of the study changed from a positive to a neutral study. Surprisingly, however, the study is being interpreted now as negative by many, including the antivaccine lobbyists. The article does not state that we found evidence against an association, as a negative study would. It does state, on the contrary, that additional study is recommended, which is the conclusion to which a neutral study must come. Does a neutral outcome reduce the value of a study? It may make it less attractive to publishers and certainly to the press, but it in no way diminishes its scientific and public health merit. A neutral study carries a very distinct message: the investigators could neither confirm nor exclude an association, and therefore more study is required. The CDC has taken its responsibility and is currently undertaking such additional study. The focus of all attention now should be on ensuring that these new studies are conducted under the most optimal conditions. Continuing the debate of the validity of the screening study is a waste of scientific energy and not to the benefit of the safety of US children or of all children worldwide that have the privilege of being vaccinated. All the discussion on how and why the results presented at different stages of the study may have changed slightly is futile for the same reason. The bottom line is and has always been the same: an association between thimerosal and neurological outcomes could neither be confirmed nor refuted, and therefore, more study is required.

Did GSK hire me away to manipulate the data before publication? Definitely not. This suggestion could be viewed as simply silly, were it not that it offends the ethical integrity of both the company and myself. Although I have been involved in some of the discussions concerning additional analyses that were undertaken after my departure from the CDC, I did not perform any of these additional analyses myself, nor did I instigate them. GSK was at no point involved in any discussions I had with former CDC colleagues on the study, nor were details of these discussions ever discussed between myself and GSK. The company and I had a very clear deal from the very start of my employment that I would finalize my involvement in the study on my own time and keep this involvement entirely separated from my work at GSK. I regard myself as a professional scientist who puts ethical value before any personal or material gains. I believe that I am currently employed by a company that has the same high ethical standards as myself. Therefore, any suggestion that GSK intended to have me manipulate this data is nothing short of an insult to both my and the company?s integrity. Although I deeply regret such statements, I call on any party that truly has the safety of our children and the advancement of the health of the world?s children at heart to move beyond such pitiable attitudes and focus on the future of the ongoing research.

[Bretigne]

Akira, what you don't seem to understand is that I am not pretending to have certainty about this issue. I am actually interested in finding out the truth about it.

There was actually a time when I was pretty well convinced that there was no Thimerosal-autism link, because of some studies that came out a few years ago. I have since gone back to thinking there probably is (because of further studies, such as the ones mentioned in the Salon article), but am certainly open to being wrong about that.

As for the Amish, yes, I believe it is possible that the lack of vaccines is responsible for their nearly nonexistent rates of autism. That is a far cry from asserting that it is fact. I think it is a question worth looking into -- which, by the way, seems to be a much more scientific approach than simply dismissing the possibility because it sounds unorthodox.

[Ron Bailey]

Bretigne: You might be interested in this news report of a study in Canada which casts considerable doubt on the purported link between mercury in vaccines and autism at URL:
http://www.guardian.co.uk/medicine/story/0,,1813682,00.html

New study shows no MMR link to autism

Sarah Hall
Thursday July 6, 2006
The Guardian

Further evidence has emerged to disprove a link between MMR jabs and autism.

Scientists in Canada found that more children developed the disorder after MMR take-up decreased and thimerosal - a compound that is 49% mercury and was thought to have been linked to autism - was eliminated from vaccines.

The study, by researchers at McGill University Health Centre, confirms the findings of a Japanese study last year. The new research, which assessed 28,000 children, found that after thimerosal was phased out in Quebec in 1996, the autism rate rose from 52 per 10,000 to 70 per 10,000.

[Bretigne]

Mainstreamman,

Thanks for all the info. It is very helpful. And seems to directly contradict what is presented in the Salon article.

...Unless of course Verstraeten was just covering up in the second phase what the CDC didn't want released. ("The CDC screening study of thimerosal-containing vaccines was perceived at first as a positive study that found an association between thimerosal and some neurodevelopmental outcomes.")

And no, Akira, I am not asserting that this is the case. I am putting it forth as a reasonable possibility, given the interests (and conflicts of interests) involved and the fact that corruption in medical research is not unheard of. I don't have enough information right now to know what to think about Verstraeten's statements and the second phase of the study, but I will look into it. Thanks again for the info.

I'm signing off for now, as I realize I've spent much more of my day on this than I had intended.

[Bretigne]

Ron, thanks.

[MainstreamMan]

Nice catch Ron.

It seems this would reflect evidence of an increasing identification of autism in Canada...the kind of epidemiological evidence of a prevalence change that was unavailable earlier.

In the most recent look at risk factors for autism, Larsson et. al (2005) found autism risk was associated with breech presentation at birth (risk ratio (RR) ? 1.63, 95% confidence interval (CI): 1.18, 2.26), low Apgar score at 5 minutes (RR ? 1.89, 95% CI: 1.10, 3.27), gestational age at birth

[Tobias]

I'm just jumping in here before going to sleep, so i haven't read all the comments, just want to make a few things clear.

1) It has already been shown the mother can take care of her child. The reason that the state is deciding this and not her is becuase she has been shown to be incompetent. The child wouldn't even be with her if the child weren't in the hospital. That child is going to a foster family.

2) There is no proof, no evidence, what so ever that vaccines cause mental retardation. Vaccinations have been proven to work. And the whole "MMR/Thimerosal causes autism" has by now been shown to be totally false. And i would like to add that it has never really been believed in the scientific circles.

The reason for the link between Thimerosal and autism have been made is because the vaccination is given shortly before the autism is diagnosed. That is a correlation, not a causation. That is like saying "more icecream is sold during the summer, more people have heat strokes during the summer, thus icecream causes heat strokes".

It is rarely possible to diagnose autism untill a certain age, and that age is a bit after the vaccination has been given.

Also, in both japan and denmark mercury have been removed from the vaccination, and in both countries the number of children diagnosed with autism INCREASED afterwards.

Further more. Any and all cases about the british MMR vaccination causing autism can safely be ignored. The british MMR does not now, has never, and will never contain thimerosal. Please read that again. THERE WAS NEVER MERCURY IN MMR.

There have been numerous proper peer-reviewed studies that couldn't show that mercury causes autism.

There have been no proper peer-reviewed studies that show that mercury causes autism.

There have been a few proper peer-reviewd studies saying "maybe there is something, it should be checked out". And it has been, and no link was found.

Sincerely
Tobias

Ps. I have autism myself, so trust me, i know what i'm talking about on this issue.

[Tobias]

Sorry, I must be missing something. How does the improved diagnostics theory explain the lack of autism among the Amish? And why would potentially autistic adults not undergo the same testing as potentially autistic children?

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

Easy enough.

There is autism in the Amish community, it is just harder to detect because the problems an individual with autism meet in the world today are big, but the problems an individual with autism met in the world of 200 years ago (or in amish community) are fewer and far between.

In an amish community a kid with autism will be told what to do more often than in normal society. The kid won't have to make as many decission as in normal society. The normal everyday life won't be as stressfull as in normal society. Because of all that the autism won't be as easily seen, and won't be as big a handicap, but it will still be there.

To summarize. There is autism in the amish community, it is just easier to live with it (undetected) in the amish community.

Sincerely
Tobias

[bombadil]

A couple problems with the reasoning on this thread. People attack alternative medicine without ever defining it - kind of like trying to defend the No Aggression Principle without ever really defining the boundaries on what counts for aggression.

Many types of treatments come under the rubric of alternative medicine. The failure, or lack of evidence, for one does not discount the efficacy of another. "Crystal worshiping" does not equate with acupuncture for just one example. The World Health Organization lists numerous conditions that have been proven to have been successfully treated by acunpuncture through clinical trials. Then it lists a number of other conditions where there is some evidence but not enough to qualify as demonstrable proof. But there are quite a few conditions that fall into the former category. Allergic rhinitis is one. Suppose a parent were to reject an allopath's suggested treatment in favor of acupuncture. This would hardly seem like a case of parental irresponsibility where the state should step in.

Two other conditions that have been successfully treated with acupuncture are headaches and depression. In the case of the former, a parent who gave their kid daily doses of aspirin or something stronger like parafon forte is risking kidney illnesses that could show up eventually. Acupuncture is the safer treatment - in this case, would it be fair then to say the state should step in? Afterall, the parents are taking a greater risk with daily doses of aspirin treatments. For depression, ADD, and hyperactivity, there's been a great deal of controversy over how much parents have been over-medicating their kids, and the possible damage this can do. Personally, I'm not arguing the state should automatically step in (when the state believes it's always wiser) but to base the argument on whether the treatments are 'alternative' or not, no matter the specific treatment, or the nature of the condition, or any evidence for the relative efficacy of either the specific alternative treatment or the specific allopathic treatment, does not seem like a reasonable argument to me.

Another poster mentioned that homeopathy cured his excema. I had a similar experience, though not with homeopathy. Allopathic treatments only provided temporary relief for this condition of mine. Then the creams I tried had other undesirable effects. After awhile I became fed up and wanted to try an alternative. Through a variety of different kinds of treatments, my excema was largely cured, but not by the AMA's recommended treatments.

None of this is suggesting that allopathic medicine is "not" as effective as any alternative treatments. For most cases and conditions, it's largely the demonstrably better option. But to reflexively throw anything that is not 'allopathic' under the same blanket and call it 'junk science' hardly seems reasonable either.

I'm curious why it is that Reason regularly, and reflexively rolls its eyes, when it comes to the topic of any medical practice or treatment not endorsed by the official body known as the AMA. Reason has long raised issues of possible political bias or self interest that at least possibly finds its way into the scientific practices or theories of the various groups in question. But when it comes to the AMA, there seems to be just a knee jerk acceptance of any position coming from on down high - to the point where instead of evaluating the claims of any specific practice or theory, as long as it fits the label of 'alternative' it must automatically be quackery.

[bombadil]

I realize my anecdotal evidence above does not qualify as a well-reasoned argument, but...doesn't it seem reasonable if someone's child's condition has not been successfully treated by numerous allopathic treatments, and months or years of such treatment trials have been attempted and failed, that he or she should be allowed to seek out an 'alternative treatment' for such child? Or if the prognosis for recovery, whether a terminal illness or no, under an allopathic condition is very low shouldn't the parent be allowed to go outside the establishment?

And I'm just saying, why does the AMA get a pass when the FDA or other official political-scientific bodies don't?

[D. Saul Weiner]

For those of you complaining about lack of evidence in scientific studies, read this and weep.

http://www.jpands.org/vol8no1/geier.pdf

[zach]

Sorry, I must be missing something. How does the improved diagnostics theory explain the lack of autism among the Amish?i>

I'm disappointed that this needs to be spelled out, but it would stand to reason that people less likely to receive vaccinations are also less likely to undergo formal diagnostic testing.

And why would potentially autistic adults not undergo the same testing as potentially autistic children?

The entire purpose of diagnosing children with autism at a young age is to better tailor their education, etc. to their needs. Once you or a loved one has lived with the condition for 30 years, what's the point of getting it officially diagnosed?

[MainstreamMan]

D. Saul Weiner

You obviously haven't been paying attention.
A nice link regarding the Greier's lack of scientific rigor was provided above.
Here it is again.

Search around, the very paper you cite is critiqued in detail. This article is not only correlational, but poorly done. No causal link could be made using it.

[Bretigne]

Sorry, I must be missing something. How does the improved diagnostics theory explain the lack of autism among the Amish?

I'm disappointed that this needs to be spelled out, but it would stand to reason that people less likely to receive vaccinations are also less likely to undergo formal diagnostic testing.

The study in question was one in which someone actually went into Amish communities and tested for autism. So, no, your answer does not explain this phenomenon.

The entire purpose of diagnosing children with autism at a young age is to better tailor their education, etc. to their needs. Once you or a loved one has lived with the condition for 30 years, what's the point of getting it officially diagnosed?

That's interesting speculation. And may well be how many people react to their situation. But a quick Google search reveals autism support sites like this
that indicate many adults do seek a diagnosis. Anyway, this is all a little beside the point, since the real question is: are there any reliable statistics on autism in adults/older children who would have missed out on childhood vaccinations containing Thimerosal?

[zach]

Well, you got me, I didn't even skim the study in question about the Amish people. Do you have a link to that? I thought you were talking about a general trend over the past few decades with regards to the subject. Needless to say a single study might be less than conclusive when we're talking about a large group of people over a long period of time, but again, I didn't read it.

That's interesting speculation. And may well be how many people react to their situation. But a quick Google search reveals autism support sites like this that indicate many adults do seek a diagnosis.

The relevant question is whether they did as soon as modern diagnostic techniques were introduced. Probably these tests were undergone with gradually increasing frequency like everything else.

Anyway, this is all a little beside the point, since the real question is: are there any reliable statistics on autism in adults/older children who would have missed out on childhood vaccinations containing Thimerosal?

Agreed, and I don't really know much about the subject and am going to default to the scientific consensus on this one. I was just responding to your critiques of the "improved diagnostics theory" because they didn't add up in my mind.