Autism Street

A Journal

Last year I opined that SCNM’s Arizona chelation study being published in a peer-reviewed mainstream medical journal indexed on Pubmed in the future would seem a real challenge.

“Will this research land back with the parents in a publication that is not a peer-reviewed mainstream medical journal indexed on Pubmed? Or, will it really “fly” and land with acceptance in the scientific community? At this point, the latter would seem a real challenge.”

Although I still see acceptance in the scientific community as a non-starter, I could have been very wrong about where such a study might be published. In fact there seems to be at least one journal that might welcome it (if it’s forthcoming). The journal I’m thinking of as a possibility?

Journal of Toxicology and Environmental Health, Part A
Editor-in-Chief: Sam Kacew

Why do I think of this journal? Well, Dr. Kacew appears to have made up his mind on the question of vaccines causing autism.

“According to the literature there is a relationship between vaccines and autism.”

Emphasis mine. Source - quoted from page 86.

Such an attitude would put Dr. Kacew well out of the mainstream opinion on the relationship (or lack thereof) between vaccines and autism. Is it possible that perhaps Dr. Kacew has, and will be targeted for fringe autism papers because of this apparent belief?

The following comes from the beginning of the “Aims and Scope” of this journal.

Now published twenty-four times per year, this authoritative journal features strictly refereed original research in the field of environmental toxicology in general as well as in special interest fields such as target organ toxicities, immunotoxicology, risk assessment, carcinogenesis, mutagenesis, ecotoxicology, environmental factors affecting health, and aquatic toxicology.

Strictly refereed?

In my opinion, the most recent autism article published by this journal raises questions about whether or not appropriate peer-review takes place at all.

An Article

What article am talking about?

Mercury, lead, and zinc in baby teeth of children with autism versus controls.
Adams JB, Romdalvik J, Ramanujam VM, Legator MS.
J Toxicol Environ Health A. 2007 Jun;70(12):1046-51. 

Yep, it’s the same Jim Adams who’s working on the chelation study (that I thought we’d have seen by now). Although he’s an ASU professor, the chelation study is going (or went) through the Southwest College of Naturopathic Medicine, after being rejected by ASU’s IRB.

The full-text of the “baby teeth” article contains statements that should have raised red flags for anyone with expertise in this field, in my opinion. Additionally, although it’s fine that Adams et al. cites what appears to be outdated science, the authors should have equally cited more recent works, which, in many cases, throughly refute the older publications. Was the full spectrum of the published literature cited? If not, why not? Let’s have a look at some of the statements and older science.

A thorough review by Bernard et al. (2001) reported that all of the major symptoms reported in the literature for autism were also reported for cases of infantile mercury poisoning, including especially language/communication problems and social withdrawal.

A thorough refutation of this paper was published in Pediatrics in 2003, and concluded in part, with the following:

“Nonspecific symptoms such as anxiety, depression, and irrational fears may occur both in mercury poisoning and in children with autism, but overall the clinical picture of mercurism—from any known form, dose, duration, or age of exposure—does not mimic that of autism”

Much more detail (in layman’s terms) available here.

Adams et al. states the following about oral antibiotic usage among ASD children:

Further, two studies (Konstantareas & Homatidis, 1987; Adams et al., 2003) found that children with autism had much higher usage of oral antibiotics, which (in rats) resulted in a near-total loss of the ability to excrete mercury (Rowland et al., 1980, 1984).

So one small study (42 children) from 20 years ago claims a higher rate of infection based on parental reports (I’m not sure what it says or can say about actual oral antibiotic usage). And, another is not a “study” at all, but appears to cite a DAN! Conference. That’s right if you read the references in the paper, you’ll see the the Adams et al., 2003 refers to a DAN! conference. But what really is the credibility of a small 20 year old study based on parental reports and a DAN! Conference report, compared to newer and better science that is now available?

In fact, a much larger study (more than 400 autistic children) published in Pediatrics earlier this year included the following:

“Children with subsequent diagnoses of autism do not have more overall infections in the first 2 years of life than children without autism.”

“Contrary to what we expected, these data suggest that children with ASD may have slightly lower rates of ear infections and URIs in the first 2 years of life than children without ASD. “

Adams et al. also states:

A decreased ability to excrete mercury is consistent with a recent study by Holmes et al. (2003), which found that children with autism had only one-eighth the normal amount of mercury in their baby hair (assuming that the level in hair is indicative of the level of ability to excrete mercury).

Firstly, the Adams et al. baby teeth paper appears to have seen what it wanted to with respect to the mercury found in the first baby haircuts of autistic children (Holmes et al.). The autistic children did not have one-eighth the “normal” amount of mercury in their baby hair. They had .47 (+/- .28) μg/g which is higher than the children in the NHANES study average (which included 838 children ages 1-5) who had .22 (+/- .04) μg/g. It was the “typical” children that had huge excesses of mercury in their hair samples in Holmes et al. Remeber this graph?

More on this subject here.

Secondly, the peer reviewers seemed to have missed the fact that the Adams et al. paper is making a huge assumption that doesn’t appear to be supported by any scientific research whatsoever. Mercury level in hair is not scientifically known to be indicative of the level of the ability to excrete mercury. Mercury level in hair is very simply a snapshot of circulating blood levels when the hair was formed. With a common set of major vessels (the carotid arteries) providing blood supply to the entire head, significantly lower levels in the hair means less mercury was probably reaching the brain during the time the hair was formed, that’s it.

A decreased ability to excrete mercury should result in a higher body burden, and that was demonstrated in a study by Bradstreet et al. (2003). They investigated the effect of giving meso-2,3-dimercaptosuccinic acid (DMSA) to 221 children with autism compared to 18 controls, and found that the children with autism excreted 3.1 times more mercury into their urine (which is where DMSA is excreted), but lead and cadmium levels were not significantly different.

So much for the hypothesized “poor excretion” from Adams et al.’s statements about Holmes et al. According to the data in Bradstreet et al., these 221 children were apparently “excellent excretors“. Also, this study, published in JAPandS, reported mercury as a ratio to creatinine based on a spot collection of urine, methodology that is known to be potentially problematic with ASD subjects.

As a side note: A more recent (albeit much smaller) study tested mercury levels following provocation with a chelator, but used 24-hour collection methods. The result?

“In the absence a proven novel mode of heavy metal toxicity, the proportion of autistic participants in this study whose DMSA provoked excretion results demonstrate an excess chelatable body burden of As, Cd, Pb, or Hg is zero.”

A Conclusion

There’s plenty of other silliness in this paper, including citations of Geier and Geier, and a tiny sample size that produced data that I think most people would look at and ask, “so what?”. But the bottom line is this - is the authors’ conclusion supported by the data? At the end of the day, I think any referee worth his or her salt should be able to answer that question. So let’s look at the conclusion of the Adams et al. “baby teeth” study.

In conclusion, the results of this small study suggest that children with autism have a higher body burden of mercury, probably due to a decreased ability to excrete mercury that is likely in part due to high usage of oral antibiotics.

I don’t see how this conclusion can be supported by the data. Neither mercury body burden nor excretion was demonstrated to be related to mercury levels in teeth, autistic children were not demonstrated to be “poor mercury excretors”, and high usage of oral antibiotics was not demonstrated to impair mercury excretion in humans that I can see.

If this journal will publish this “baby teeth” study, they just might be willing to publish the SCNM chelation study (if it’s forthcoming).

Selected Further Reading

Bernard S, Enayati A, Redwood L, Roger H, Binstock T. 
Autism: a novel form of mercury poisoning.
Med Hypotheses. 2001 Apr;56(4):462-71.

Nelson KB, Bauman ML.
Thimerosal and autism?
Pediatrics. 2003 Mar;111(3):674-9.

Left Brain/Right Brain Blog Autism Wiki
Bernard
http://www.kevinleitch.co.uk/wiki/Thimerosal/Bernard

Konstantareas MM, Homatidis S.
Ear infections in autistic and normal children.
J Autism Dev Disord. 1987 Dec;17(4):585-94.

Rosen NJ, Yoshida CK, Croen LA.
Infection in the first 2 years of life and autism spectrum disorders.
Pediatrics. 2007 Jan;119(1):e61-9.

Holmes AS, Blaxill MF, Haley BE.
Reduced levels of mercury in first baby haircuts of autistic children.
Int J Toxicol. 2003 Jul-Aug;22(4):277-85.

McDowell MA, Dillon CF, Osterloh J, Bolger PM, Pellizzari E, Fernando R, Montes de Oca R, Schober SE, Sinks T, Jones RL, Mahaffey KR.
Hair mercury levels in U.S. children and women of childbearing age: reference range data from NHANES 1999-2000.
Environ Health Perspect. 2004 Aug;112(11):1165-71.

Spot urinary creatinine excretion in pervasive developmental disorders.
Whiteley P, Waring R, Williams L, Klovrza L, Nolan F, Smith S, Farrow M, Dodou K, Lough WJ, Shattock P.
Pediatr Int. 2006 Jun;48(3):292-7.

Soden SE, Lowry JA, Garrison CB, Wasserman GS
24-hour provoked urine excretion test for heavy metals in children with autism and typically developing controls, a pilot study.
Clin Toxicol (Phila). 2007;45(5):476-81.

Immunization Safety Review: Vaccines and Autism
Institute Of Medicine
http://www.iom.edu/CMS/3793/4705/20155.aspx

ASU Got It Right - Out The Door!
http://www.autismstreet.org/weblog/?p=20

To Toxicity and Beyond
http://www.autismstreet.org/weblog/?p=49

Undead Bad Science
http://photoninthedarkness.blogspot.com/2006/03/undead-bad-science.html

An Old New Twist on Undead Bad Science?
http://www.autismstreet.org/weblog/?p=61

A Perfect Example of how NOT to do a Study - Part One
http://photoninthedarkness.blogspot.com/2005/07/pefect-example-of-how-not-to-do-study.html

A Perfect Example of how NOT to do a Study - Part Two
http://photoninthedarkness.blogspot.com/2005/07/perfect-example-of-how-not-to-do-study.html

Dr. Amy Holmes was just trying to help
http://autismdiva.blogspot.com/2005/12/dr-amy-holmes-was-just-trying-to-help.html

The Legend Of The “Poor Excretors”
http://www.autismstreet.org/weblog/?p=103

Significant Misrepresentations: Mark Geier, David Geier & the Evolution of the Lupron Protocol
(Contents)
http://neurodiversity.com/weblog/article/109/

Significant Misrepresentations: Mark Geier, David Geier & the Evolution of the Lupron Protocol (Part Eight)
Bibliographic Mergers & Acquisitions
http://neurodiversity.com/weblog/article/108/bibliographic-mergers-acquisitions