Lorene Amet, Principal Scientist at Autism Treatment Trust, and I got into a debate at Autism Gadfly blog during which I asked her to discuss her view on vaccination. She expanded these views into a blogpost which she entitled ‘Autism and the Environment’. I was puzzled at first as to why she would name a debate about vaccines such a misleading title, but then, look again at the ATT page in which Lorene Amet is listed at ATT. Her heading is described as Dr Lorene Amet, and whilst she is no doubt a doctor, it is maybe a little misleading that her biography does not make clear that she isn’t a medical doctor.
Amet’s post is awash with truthiness. Take this passage, for example:
First point I would like to make is that Autism Spectrum Disorders (ASD), regressive autism, Pervasive Developmental Disorder-Not otherwise Specified (PDD-NOS) are conditions that are on the increase starting from about 1988. I believe this is a real increase that is not just related to a greater awareness of the conditions and change of diagnostic criteria. However, there is no clear picture as far as Asperger Syndrome (AS) is concerned. There is no data on prevalence of AS alone, and almost certainly this condition was essentially unnoticed, considered as some sort of quirkiness, even in very recent past. Equally, many adults with AS have remained undiagnosed to this day. It is therefore possible that AS is not on the increase, in any case, the data is not there yet to answer this question accurately. However for the rest of the ASD kids, the increase seems real. I can argue this point using a range of additional arguments, but let’s not get too distracted, even if this is an essential point.
Feels true, doesn’t it? Except that ‘on the increase’ is a pretty ambiguous term. ‘On the increase’ suggests that there was a clear, unambiguous starting point where we knew exactly what the prevalence of autism was. The truth is, we don’t. There is no agreement from 1988 on an international level about the prevalence of autism. Even on a county by county level in the UK or State by State level in the US, data diverges wildly if it exists at all. If anyone disagrees with this, I’d love to see concrete figures from 1988. Because only from a concrete starting point can we make concrete estimates about ‘increases’.
Amet also falls into the trap of assumption. Assumption that the only two non-environmental aspects of an ‘increase’ can be a) greater awareness and b) change of criteria. Besides these two, there are issues such as greater attainment (more centres and more experts capable of diagnosing autism), diagnostic substitution and change in public policy towards ASD (amongst others).
So is there an autism epidemic? The absolute truth is that nobody knows. To claim or even infer otherwise is misleading. As Richard Roy Grinker says in Unstrange Minds:
...the old rates were either inaccurate….or based on different definitions of autism than the ones we use now.
Amet then goes on to discuss things other than autism – a lengthy part of her post which, as it doesn’t touch on autism, isn’t important to me or this post.
She then says:
The fourth point I would like to make is that Autism is associated in about 60% of the cases with health issues, digestive system, immune system and commonly presents with a regressive feature (again about 60% of cases). Some preliminary reports can be found discussed in the BMJ. This is important because we are starting to conceive that some people might be more vulnerable than others if they are placed in situations of overload. Overload can be understood quite broadly. Overload in terms of insult to the immune system, overload in terms of specific toxins (e.g. organophosphates), or overload in terms of stress, etc.
This is a very contentious argument which is again more truthiness than true. The 60% figure is unsourced and seems to be numbers gained from a very biased source – ATT caseload. I would warn Amet against the dangers of cherry picking data that seems to support your ideas. Maybe it would be better to find support from the independent science on this issue.
Although this is a post that is supposed to be about vaccines and Amet’s own views on the matter, the only ‘hard’ unequivocal statement on the matter comes here:
In short, yes, in my opinion vaccination is implicated in some cases of autism, my guess estimate is in about 20% of cases of today’s autism, possibly more, but not less. There are other issues that are very important to consider and vaccination almost certainly affects a person in combination with others environmental factors and together with a genetic susceptibility.
No data is presented to support Amet’s guess, or even to support Amet's guesstimate of 20%. This is the crux of the matter to me, and yet I see nothing of any substance in Amet’s long post to support this belief.