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Sunday, July 31, 2005

The CDC, Autism and Elastic Statistics

By Red Flags Columnist, F. Edward Yazbak, MD

A fellow of the American Academy of Pediatrics since 1963, Dr. Yazbak has devoted his time over the past seven years to the research of regressive autism, its epidemic increase and its autoimmune causes.

For years, those of us who believed that autism and autistic spectral disorders (ASDs) were increasing in the United States were told that they were not — that if indeed there were more children diagnosed with autism, it was because of more liberal criteria, better diagnosis and a variety of other causes.

Then suddenly, in January 2004, an Autism A.L.A.R.M. was issued. (1)

According to the Department of Health and Human Services, the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics, 1 in every 166 children in the United States has been diagnosed with autism. Though not clearly stated, ASDs (diagnostic code 299.80) were included with Type I Autism (diagnostic code 299.00).

For more than a year, I have been waiting for some backpedaling by the CDC. The statistic 1 in 166 cannot possibly be comfortable for the agency that is supposed to be keeping Americans healthy. An increase in autism or “diagnosed cases of autism” from 1 to 2 in 10,000 to 1 in 166 some 30 years later should have been downright frightening.

The prevalence of “autism” was estimated by the National Institutes of Health as 1 in 500 in 1996. (2) This prevalence was accepted by all in 2000.

The CDC has remained firm and convinced that:

1. The increase in the number of “diagnosed” cases of autism is mostly the result of changing criteria and better diagnosis — as if the criteria changed between 2000 and 2002, and again between 2002 and 2004, or we suddenly acquired a miraculous ability to “pick up” new cases.

2. The Measles, Mumps and Rubella (MMR) and other vaccinations and thimerosal have nothing whatsoever to do with the exploding number of newly “diagnosed” cases of autism/ASD, most of which are of the regressive variety.

When it suits their purpose, certain “experts” imply that if the number of new cases of autism and ASD did not diminish precipitously after the removal of thimerosal from vaccines, then the preservative did not cause autism. Parents counter appropriately that all mercury was not removed from pediatric vaccines in 1999 and that the flu vaccine has been added to the vaccination schedule.

The CDC finds itself in a real Catch-22 this year as the thimerosal-free generation of children begins approaching the age at which autism is usually diagnosed.

If the number of “diagnosed” cases of autism continues to increase beyond 1 in 166, people would certainly be blaming the growing number of vaccinations and the continued use of MMR. This might in turn slow down the adoption rate of new vaccines.

If the number of “newly diagnosed” cases decreases, the vocal group of “mercury parents” would certainly feel vindicated. Their worst fear — that using mercury as a vaccine preservative for 70 years was reckless — would be confirmed.

This latter, and now distinct, possibility is the main reason I was convinced that the CDC needed to backpedal from the solid and unequivocal 1-in-166 position in a hurry.

I was right.

Although the 1-in-166 prevalence was as solid as Mt. McKinley for all of 2004, it had to be quietly doctored. To the rescue came the A-team at the National Center on Birth Defects and Developmental Disabilities (NCBDDD) under the direction of Jose Cordero,MD, MPH, the group primarily responsible for autism research and information at the CDC.

I discussed Cordero’s activities relative to MMR, thimerosal and autism last month in my column, “The CDC finances, writes and helps publish Danish research: Another useless CDC-supported autism study.” Two of the epidemiologists at the “Developmental Disabilities” branch, as the center is referred to, Marshalyn Yeargin-Allsop and Diana Schendel, were directly involved with the “Danish autism studies.” (3)

The author of the principal statement on the web page of the “Autism Information Center” (NCBDDD) delineated the CDC and Cordero’s positions by stating, “Data from several studies that used the current criteria for diagnosing autism and autism spectrum disorders (ASD), such as Asperger’s disorder and pervasive developmental disabilities (PDD-NOS), found prevalence rates for ASDs between 2 and 6 per 1,000 individuals. Therefore, it can be summarized that between 1 in 500 (2/1,000) to 1 in 166 children (6/1,000) have an ASD.” (4)

To re-enforce the point, the author — just this one time — stated that the children actually had autism, and were not just “diagnosed with autism.”

The above statement is obviously quite different from what the CDC proclaimed in January 2004 in its autism alert that 1 in 166 children in the U.S. were diagnosed with autism.

I predict that this first attempt at damage control will be followed before long by another, which says actually the prevalence of autism and ASD has always been closer to 1 in 500 than 1 in 166 — stretching the present prevalence to a range that will come in handy in 2007.

If there is indeed a decrease in the number of “diagnosed” cases, as expected with the use of thimerosal-free vaccines, the new prevalence rate is likely to actually decrease to 1 in 500.

The CDC will then be able to “show convincingly” that thimerosal never caused autism, because the removal of the mercury preservative did not alter the prevalence of the disease in any way: The prevalence rate was 1 in 500 in 1996, 1 in 500 in 2004 and, still, 1 in 500 in 2007.

The author of the web page later stated casually, “Down syndrome occurs in 1 out of 800 births and is slightly less common than the ASDs.”

Interestingly, the World Health Organization states that the estimated incidence of Down syndrome is between 1 in 1,000 and 1 in 1,100 live births worldwide. (5) There is no reason to believe that the incidence of Down syndrome is highest in the United States, where we carefully check expectant mothers and spend more money on “health” than anywhere else. I personally believe that I have seen fewer and fewer children with Down syndrome in the past 20 years and certainly an increasing and much larger number of children with autism and spectral disorders.

It is clear from the web statement that the author had already excluded the 1-in-166 autism prevalence. If indeed 4 million children are born in the United States every year as stated, then possibly 5,000 of them will have Down syndrome (1:800) and 24,000 would be likely to develop autism and ASD if the statistic 1 in 166 is correct.

“Slightly less common” hardly applies to an almost 400 percent difference between those two figures.

It is gratifying to know that the CDC and the author agreed with me that U.S. Department of Education data (OSEP) are usable and reliable (6) and that not all children with ASD attending American schools are actually included in the “autism” classification: “In 2003, approximately 141,022 children were served under the “autism” classification for special education services. Not all children with an ASD receive special education services under the classification of “autism,” so the education data underestimate the actual prevalence of the ASDs.”

This suggests that the autism/ASD prevalence is even higher than 1 in 166.

The statement on the NCBDDD web page was carefully written. The author referred to “diagnosed cases” when reporting on autism, which was the tenth most commonly classified disability in the U.S. in 1994, the sixth in 2003.

The first five, and the most common, disability classifications were specific learning disabilities (2,866,908 children served), speech or language impairments (1,129,260 children), mental retardation (582,663 children), emotional disturbance (484,479 children) and other health impairments, which often includes children diagnosed with ADHD (452,442). It is interesting that the diagnoses in all these other categories were considered firm, solid and unequivocal.

The author concluded: “It is important that we treat common DDs, and especially the ASDs, as conditions of urgent public health concern, do all we can to identify children’s learning needs, and begin intervention as early as possible to enable all children to reach their full potential.”

This official statement from the Centers for Diseases Control and Prevention sadly misses the fact that prevention is the best way to control an urgent public health concern. Identifying needs is a start, beginning intervention as early as possible should be the goal, but preventing the disease altogether is by far the best possible way to enable all children to reach their full potential.

The CDC must re-examine the complete vaccine-autism issue — this time with an open mind. If indeed the parents are right and the correct measures are taken, then the autism prevalence will really decrease without elastic statistics, and early identification and intervention will not even be needed.

With all the available evidence, it is hard to believe the CDC does not know that yet.


1. link
2. http://www.bioprobe.com/ReadNews.asp?article=27
3. http://www.redflagsdaily.com/yazbak/files/2005_jun26.pdf
4. http://www.cdc.gov/ncbddd/dd/aic/about/default.htm
5. http://www.who.int/genomics/public/geneticdiseases/en/index1.html
6. http://www.redflagsdaily.com/yazbak/2005_jul22.html

Posted by Becca

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