Wednesday, March 07, 2007

A Review of the Critiques of Fombonne et al. (2006)

Overview

The critiques of Fombonne et al. (2006) do point some relevant problems with that study. However, they also use some considerably problematic arguments themselves.

Introduction

Fombonne et al (2006) attempts to correlate data between an increase in the number of cases of the Pervasive Developmental Disorders and vaccine use in school children residing in Montreal, Canada. That research failed to reveal any such correlation. In addition the researchers found a prevalence rate of the PDD’s which match what is seen in the US (Bertrand et al., 2001), the UK (Chakrabarti & Fombonne, 2001; and Chakrabarti & Fombonne, 2005), the Faroe Islands in Northern Europe (Ellefsen et al., 2006), and matches data on Autistic Disorder in Japan (Honda et al., 2005)

Recently, two web based articles have been released and promoted based out of the National Autistic Association website. These articles were written by Dr. David Ayoub & Monica Ruscitti for one letter and Dr. Edward Yazbak for the other. These authors raise important and damaging points which call into question the validity of Fombonne et al. (2006). I note however, that not all the points raised in these critiques have equal merit; in fact some of the points raised are most notable for their lack of merit. The points raised in the critiques are discussed below.


Review of Ayoub & Ruscitti

The authors point out that Fombonne et al. (2006) only uses data from only one of Montreal’s five school districts. This district is specifically an English speaking section. The authors accurately point out that a selection bias may have occurred here. In addition the authors note that Fombonne et al. (2006) claimed they could not gain access to the other school districts’ data. The authors then claimed they gained access to this data and make specific claims about a notably higher rate of autism in the school district Fombonne et al. used. I note that these data and analysis methods are absent.

The authors note that English is only the third most common language in Quebec, the largest group being French and the second largest being assorted foreign languages. The authors note that access is restricted to the English speaking school district by a law designed to help protect the French language. However, the authors simultaneously make the claim that this English speaking school is more inclusive than the others. This claim seems contradictory. It is possible that while the English speaking district is more exclusive in general it is in fact more inclusive towards students with disabilities. However this point is not explained.

The authors correctly criticize Fombone et al. (2006) for describing thimerosal laden shots as “nil”. The authors go on to describe vaccines in Canada that continue to use thimerosal. However, the authors fail to note that none of these vaccines are actually required any longer and for that reason exposure should not be comparable.

The authors mention that fourth graders largely participated in a voluntary vaccination program for Hepatitis B, which contains thimerosal. However, the DSM-IV mandates that Autistic Disorder first appear in a child by age 3, even if it is diagnosed later. Fourth graders do not develop autism. Also, and rather remarkably the authors cite Roy et al. (1999) which is concerned with the health and safety including vaccination based on high risk behaviors of street youth in Montreal. The median age of that study was 19.5.

The authors criticize Fombonne in the following terms:

“he ignored the fact that autism rates increased following a doubling of the MMR exposure after 1996 when a second MMR shot was added to the immunization schedule and chose to emphasize that a rise in PDD rates coincided with a decline in MMR coverage rates. Obviously the increased amount of administered viral load to the population was far greater influenced by a doubling of shots administered than by a marginal drop in immunization coverage rates. He likewise ignored the potential impact of mass measles immunization campaigns in Quebec that delivered a second dose of measles to a large number of infants and children throughout 1996. (11) The subsequent rise in PDD shortly after that campaign is clearly depicted in their figures and would lead us to believe this observation supports an association between PDD and MMR exposure.”

The above assumes that the drop in thimerosal was not only made up, but actually exceeded by the increase in MMR dosage. For this explanation to work, one must simultaneously assume that both thimerosal and the MMR can cause autism. A more parsimonious explanation would be that the rate of autism would have risen regardless, which is certainly what we see in other locations including the no longer mandatory thimerosal exposure in California.


The authors also state:

“Numerous reports of higher PDD rates among immigrants have been reported in Canada and other industrialized countries.”

This claim is demonstrated no where in any research. It even seems to contradict some actual research (Kamer et al., 2004).

The authors go on to assert:

“Finally the paper’s observation about rising PDD rates seems to contradict Dr. Fombonne’s well-known contention of the lack of evidence of an autism epidemic. In an Inserm interview, Dr. Fombonne said, “to declare an epidemic, or sensible increase of the prevalence, it would take incidence studies, always the same, year after year, but this data is not available in any country.” (12) The database we obtained from the MEQ represents the type of dataset Fombonne stated was required to detect true increases in PDD. According to one Montreal-based autism organization, data from the MEQ revealed an increase in annual PDD cases in Quebec from 410 (1990-1991) to 4,483 (2005-2006), a nearly 1,000% increase over 15 years. (13) This is staggering and is strong evidence of a real rise in neurodevelopmental illnesses that cannot possibly be solely genetic in nature but supports an environmental etiology.”

The above statement is presents a false problem. An increase in this data set may not be attributable to real change in the actual number of cases. The system could be open to a lack of control for the six threats to statistical validity. This is a well known problem in other administrative data sets in the world of autism.

Review of Yazbak

The author submitted an letter to the editor detailing concerns about uptake of the MMR rate in Montreal and the increase in the PDDs. The editor forwarded this comment from Dr. Fombonne:

"This person is known to pursue the MMR-autism agenda at all
costs in order to 'demonstrate' a link he strongly believes in. The only way ahead is to encourage him to do independent research. All controlled epidemiological research thus far has concluded to the absence of such a link."


the editor of the journal had this to say:

“As a note, I believe the evidence of no link between MMR and Autism is sufficient. It's not worth publishing more on this subject. We will not be publishing this exchange of correspondence.”

I disagree with Dr. Fombonne’s approach to this situation. It is not relevant that Dr. Yazbak believes in a vaccine etiology of autism. I also disagree with his failing to address Dr. Yazabak’s criticisms which are specific and serious.

I also heartily disagree with the editor’s refusal to publish Dr. Yazbak’ criticism. While it is certainly his job to ensure that all matters within the journal merit inclusion under a serious scientific aegis, Dr. Yazbak’s criticisms are specific and fall into known categories of scientific criticism. Whether or not he believes it has no bearing on his responsibility to publish scientific criticism.

However, given the title Dr. Yazbak selected “Far-Fetched”, perhaps the editor had ground to refuse this letter or at least demand that it be re-titled. Pediatrics is a serious academic journal of high standard. In most such journals while a given level of sarcasm and dismissiveness is permitted, this seems to have crossed the line of acceptability.

Dr. Yazbak goes on to assert:

“When he was in France, Dr. Fombonne was a well known psychiatrist who published articles on psychiatric topics. He was still a psychiatrist when he moved to England …until Andrew Wakefield suggested that the link between MMR vaccination and autism should be further investigated and suddenly …Dr. Fombonne became a “psychiatrist / epidemiologist” and a consultant to the UK medical authorities on MMR vaccination and autism”

The Wakefield controversy began in 1998. So:

Fombonne, E. (1996). Is the prevalence of autism increasing? Journal
of Autism and Developmental Disorders, 6, 673–676.

Fombonne, E. (1997). The prevalence of autism and other pervasive
developmental disorders in the UK. Autism, 1, 227–229.

QED.

The author further asserts that:

“It is obviously customary to disclose sources of funding, Disclosing sources of “Non-Funding” on the other hand is unusual. In any case, it is nice to know that Dr. Fombonne’s research was never funded by the “Industry”.”

This is easily explainable in that Dr. Fombonne’s work has been informally criticized as being supported by the pharmaceutical industry, possibly with the intent that he would manipulate the data in favor of finding no association. This statement may have been given to help put such non-sense to rest.

Conclusion

It is important to remember that the weak criticisms in the critiques above do not remove the genuine and quality criticisms. The authors do point some genuine problems. The failure of both editor and Dr. Fombonne to make adequate response is also disagreeable.

By the same token some of the criticisms are remarkable for their lack of relevancy or factual basis. There are problems with these critiques that have a real potential to mislead others. It is to be hoped that the NAA and the authors will take steps to amend this, leaving their better criticisms intact.

References

American Psychiatric Association. (2000). Diagnostic and Statistical Manual ofMental Disorders, Fourth Edition, Text Revision. Washington, DC:American Psychiatric Association; 1994.

Bertrand, J., Mars, A., Boyle, C., Bove, F., Yeargin-Allsop, M., & Decoufle, P. (2001). Prevalence of autism in a United States population: the Brick Township, New Jersey, investigation. Pediatrics, 108, 1155-161.


Chakrabarti, S., & Fombonne, E. (2001). Pervasive developmental disorders in preschool children. Journal of the American Medical Association, 285,3093-3099.Chakrabarti, S., Fombonne, E., (2005). Pervasive developmental disorders in preschool children: confirmation of high prevalence. American Journal ofPsychiatry, 162(6), 1133-1141.

Ellefsen, A., Kampmann, H., Billstedt, E., Gillberg, I. C., Gillberg, C. (2006). Autism in the Faroe Islands. An Epidemiological Study. Journal of Autism and Developmental Disorders. [Electronically published ahead of print]

Fombonne, E. (1996). Is the prevalence of autism increasing? Journal
of Autism and Developmental Disorders, 6, 673–676.

Fombonne, E. (1997). The prevalence of autism and other pervasive
developmental disorders in the UK. Autism, 1, 227–229.

Fombonne, E., Zakarian, R., Bennett, A., Meng, L., McLean-Heywood, D. (2006). Pervasive developmental disorders in Montreal, Quebec, Canada: Prevalence and links with immunizations. Pediatrics. 118(1) 139-150.

Friis, R. H., Seller, T. A. (2004). Epidemiology for public health practice, 3rd ed. Sundbury, MA: Jones and Bartlett Publishers.

Honda, H., Shimizu, Y., Imai, M., & Nitto, Y. (2005). Cumulative incidence of childhood autism: a total population study of better accuracy and precision. Developmental Medicine And Child Neurology. 47(1), 10-8.

A. Kamer, A. H. Zohar, R. Youngmann, G. W. Diamond, D. Inbar, & Y. Senecky. (2004). A prevalence estimate of pervasive developmental disorder among Immigrants to Israel and Israeli natives. Social Psychiatry and Psychiatric Epidemiology. 39 (2), 141-145.

Roy, E., Haley, N., Lemire, N., Boivin, J. F., Leclerc, P., & Vincelette. J. Hepatitis B virus infection among street youths in Montreal. Can Med Assoc J. 1999;161(6):689-93.

39 Comments:

Blogger Kev said...

Good piece Jonathon. I sadly have to agree that Fombonne has questions to answer. I hope he does.

1:55 AM  
Anonymous anonimouse said...

With regards to Ayoub and Yazbak - I tend to somewhat disagree with your assessment. We are talking about individuals who have made wild government conspiracy claims, talked about vaccination as a form of genocide and insist that vaccines can cause shaken baby syndrome. The few minor scientific points they make in their responses to Fombonne are outweighed not only by the completely invalid points they make, but the obvious bias and agenda they have towards discrediting anyone who believes that vaccines are not the bane of evil.

That being said, there are legitimate criticisms of Fombonne's paper (I'm most interested in some of the methodology issues that have been brought up by others - not just Yazbak and Ayoub) that should be addressed and it is more than a bit troubling that he has failed to do so.

7:24 AM  
Blogger Fore Sam said...

"However, the DSM-IV mandates that Autistic Disorder first appear in a child by age 3, even if it is diagnosed later. Fourth graders do not develop autism."

Based on this statement, you would have to agree that Amanda Baggs is not autistic.

7:28 AM  
Blogger Bartholomew Cubbins said...

Yazbak's timeline problem with Fombonne moving to England and "switching" to epidemiology is pretty funny. QED indeed. Nice pickup.

People need to realize that mistakes happen all the time in science. That's why there's peer review, published corrections and retractions. I would find it disturbing if mistakes weren't made public. In the end, we all win.

7:46 AM  
Blogger Joseph said...

Excellent review of the criticism as well as the alleged error.

I suspect Fombonne et al. did make a mistake in the paper, and if so, they should publish errata. If not, they should explain why there's no error. That would be the right thing to do.

7:56 AM  
Anonymous mike stanton said...

Some of the criticisms are just frivolous. e.g. attacking Fombonne for transforming himself into an epidemiologist when he is in fact a psychiatrist. Some of the majotr epidemiologic studies of autism have been carried out by psychiatrists - notably Lotter and Wing.

And it should also be noted that if the biases in Fombonne's data to undermine his conclusions, that does not validate the vaccines cause autism hypothesese in any way. The proponents of these hypotheses have yet to publish any compelling evidence. A flawed rebuttal does not strengthen their arguments, which remain as weak as they were before the rebuttal was published.

Fombonne has been wrong in the past. He was wrong and Wing and Gillberg were right about the prevalence of autism in the 1990s. How do we know? Because Fombonne carried out the epidemiologic studies that settled the argument and published them.

The only reason his recent work is being challenged is because he has published it as part of the process of peer review. That is more than can be said for these critics.

7:57 AM  
Blogger Do'C said...

Thank you for the analysis Jonathan. Some of the criticisms seem valid enough, but it would be nice to see some real data. Valid criticisms should be noted and addressed.

8:09 AM  
Blogger Jennifer said...

Thanks Jonathon. I agree that there are some serious issues here. For ASD prevalence, Fombonne looked at English speaking children in Montreal. This is a large subset of the Montreal population, but a tiny fraction of the Quebec City population. So, he is looking at MMR uptake in a French speaking population, and autism rates in an English speaking population. This may well be comparing apples to oranges for the following reasons. I'd expect the diagnosis rate for ASDs to be higher in the English population, as there is still a problem in France with ASD blamed on the parents, and a very psychiatric approach taken to treatment. This is likely to apply in French speaking Quebec as well. Also, I'd expect the MMR uptake to be affected by the Wakefield effect in English speaking Montreal, but not so much in Quebec City, which is very French. So, I am very surprised that Fombonne reports that the MMR uptake rates dropped in Quebec City in that time period, when, indeed, the Canadian government was pushing for better MMR coverage.

9:29 AM  
Blogger _Arthur said...

"The authors note that English is only the third most common language in Quebec, the largest group being French and the second largest being assorted foreign languages."

This is slightly misleading. There are only 2 school systems in Quebec, Francophone and Anglophone.
Montreal is 53% Francophone, 18% Anglophone, and 29% Allophones. The allophone minorities children, (3.6% italian, 2.1% arabic, 1.8% spanish, etc..) use to chose to go to English schools, but since 1977, all new immigrants must go to French schools.

In any case, the writers of the critique provide no rationale why Quebec children in the English school system would react to vaccines differently than those in the school on the other side of the street.

It will be great if Fombonne could a study covering all Quebec schoolchildren, if he can get access to the data

10:41 AM  
Blogger Prometheus said...

A few points:

[1] "In an Inserm interview, Dr. Fombonne said, to declare an epidemic, or sensible increase of the prevalence, it would take incidence studies, always the same, year after year, but this data is not available in any country.” (12) The database we obtained from the MEQ represents the type of dataset Fombonne stated was required to detect true increases in PDD."

Unfortunately, the data available in the MEQ is prevalence data (how many cases exist at a specific time) not incidence data (how many new diagnoses are made in a period of time. While prevalence data can be "massaged" to provide pseudo-incidence data (take the prevalence from one year and subtract the previous year's prevalence), that does not eliminate the problems with immigration, emmigration and diagnostic drift.

To truly tell if an "epidemic" is occurring requires - as Dr. Fombonne specified - not only incidence data, but incidence data where the diagnostic criteria are "...always the same, year after year..."

[2] "According to one Montreal-based autism organization, data from the MEQ revealed an increase in annual PDD cases in Quebec from 410 (1990-1991) to 4,483 (2005-2006), a nearly 1,000% increase over 15 years. (13) This is staggering and is strong evidence of a real rise in neurodevelopmental illnesses that cannot possibly be solely genetic in nature but supports an environmental etiology.”


As alluded to in [1] above, the drift in diagnostic criteria of autism from year to year (both official changes and unofficial "drift" in criteria) makes it impossible to compare numbers from one year to the next. And of course, if you take a year when autism wasn't very well-known and compare it to today, then you are likely to see all sorts of inflationary results.

I am reminded of a Time magazine article about AIDS in about 1986, where the reporter made a graph showing the diagnoses of AIDS in the US, starting with zero in 1980 (prior to the coining of the term "AIDS" - so nobody would have had it) and extrapolating forward. The conclusion made in the article was that 100% of the US population would have AIDS before 2000.

The same sort of "analysis" is at work here, too.


Prometheus

10:44 AM  
Blogger Interverbal said...

The history of Amanda suggests she met criteria by age three. The persons who diagnosed evdiently agreed.

Remember the rule I states does not mean that a person "must" have been diagnosed by age three, but that the person must have been diagnosbale by age three.

11:39 AM  
Blogger Tom said...

Thanks for your efforts.

Journals and their reviewers can get sloppy when the author has a well-established track record and the outcome is consistent with previous findings. Either childhood vaccines still contained thimerosal after 1995 or they didn’t.

However, this and other concerns will not likely be addressed when they are raised by a vocal minority of fringe investigators, who tend to issue critiques in the form of press releases and letters to the editor rather than original, peer-reviewed research. They don’t have the credibility to interest an editor who has limited space to print correspondence and author replies.

But, hopefully, the journal and Fombonne will now see the value of a response.

11:54 AM  
Anonymous Anonymous said...

In response to Jonathan's comment:

Ayoub and Ruscitti (mom of a PDD child) criticisms are pertinent and valuable. In his July study, Fombonne had access to data through Lester B. Pearson School Board special support team which kept a list of children with PDD diagnosis updated every week. However, to become official, these lists have to be submitted before October 1st by every school board special support team to the Ministry of Education of Quebec whose different departments double-check it for at least 6 months before they officialize it in February and can send it to researchers. Ayoub et al. used the official data from the Quebec Ministry of Education database, contrary to Fombonne, not only for the 2003-2004 school-year but for at least 9 more school years to do a real incidence study.

French is the only official language in the Quebec province. Ayoub stated that 43% of students had French as 'mother tongue', 37% had other mother tongues and lastly, was English with 22%; therefore LBPSB was not representative of the actual demographic student population of Montreal.

When they talked about LBPSB being the only totally-inclusive school board in the province of Quebec, they didn't talk about linguistic inclusion but about integration of students with special needs like autistic children to any regular class in any of LBPSB schools http://www.lbpsb.qc.ca/strategic_plan/SP_Introduction.pdf contrary to other school boards where children with disabilities attend special classes.

I have in hand the Protocol of Immunization of the Quebec Province (Nov. 1996)(the exact year Fombonne says there were no more thimerosal-vaccines in Qc vaccines). It is considered the 'bible' for vaccinators in this province and on p. 3-9, chapter 3.5.1 Vaccines for Basic Immunization they list D25PT5-PRP-T which contained thimerosal (25 micrograms in 0.5 ml dose of adsorbed vaccine), DPT adsorbed too and many others. On Section 6.1 under Routine Immunization Schedule for Infants and Children they list DPT separated from Polio (still mention OPV) and Hib (PRP-T or Act-HibTM). DPT adsorbed and Act-Hib separately had both Tm. So those vaccines were required and did contain Thimerosal in those years.

Moreover, according to the Sociocultural Portrait of Students enrolled in Public Montreal schools, 51.1% of students are of immigrant descent. Thus, more than half of the total student population were most probably exposed to the the Hep. B vaccine which contained thimerosal when the vaccination program became free and was expanded in 1994 to children whose mother or father came from an Hep. B. endemic country. More than 100 endemic countries are targetted in this list http://www.santepub-mtl.qc.ca/mdprevention/fiches/immunisation/paysendemiciteVHB.pdf It is interesting to note that a high percentage of children in the special classes for autistic children are from immigrant descent and when I got the list of parent's nationalities I noted Haiti, Cambodgia, Algeria, exactly the same countries targetted by the Hep. B list. One principal told me all of the children in her 5-years class of autistic children were from immigrant parents... Another published study from Dr. Jean-François Saucier mentions that then number of Haitian autistic students had not doubled but tripled in special classes for autistic children in 10 years since 1987 and according to a Haitian doctor autism didn't exist in Haiti in those years. Older sibblings dont't have it only newborns in Montreal and haitian mothers don't understand why. As you know thimerosal-free Recombivax was only licensed in Canada in March 2001 and the warning from the Montreal Health Dept. not to vaccine babies younger than 1yr old with Thimerosal-containing vaccines was published only in 2004; same for he Protocole d'immunisation.
Contrary to the 1999 recommendations to ban or reduce thimerosal in the US, on December 1st 2005 the (Canadian) National Advisory Committee on Immunization recommended to update their recommendation of 2003 (Statement on Thimerosal) "...vaccines that do not contain thimerosal as a preservative
should be used preferentially in infants to reduce any
unnecessary exposure to mercury and to maintain public
confidence in vaccine programs" In 2005 it changed to: "the committee recommends that cost-benefit assessments regarding the use of thimerosal-containing versus thimerosal-free vaccines and other biological or pharmaceutical products, whether in the United States or other countries, should not include autism as a potential risk. "

When you mention DSM IV, they talk about PERVASIVE DEVELOPMENTAL DISORDERS instead of only Autistic Disorder. Dr. Fombonne and Ayoub also talk about PDD. On DSM IV there is no restriction of age for the appearance of first symptoms. On a French copy I have it says: "The first symptoms can appear during the first infancy, 2nd infancy or adolescence" and same was stated in DSM III-R.

3:42 PM  
Blogger _Arthur said...

I'm still not getting Ayoub & Rusticinni's accusation of bias.
Do they argue that Anglophones are thimerosal-proof, or something ?

Do Americans qualify as Anglophones ?

4:02 PM  
Blogger _Arthur said...

Remarks on Anonymous post:
1) English is first linguistic minority in Quebec, and in Montreal; the next minority would be Italian, with 3.6%
2) the number of Allophones is meaningless wrt the Fombonne study; Allophones in Montreal is an arbitrary gouping of linguistic minorities, that is significant for political purposes, but not for school purposes.
Allophones go to either English or French schools, depending if their parents went to Quebec English schools or not. The kids of recent immigrants have gone to French schools, for the last 30 years. So each of the 2 Schoolboards has children from all minorities, any way you slice it.
You statement that the English scoolboard population doesn't represent Quebec as a whole is meaningless, unless you have reasons to think autism or vaccines work differently for Francophones than Anglophones, or Protestants and Catholics, since the 2 schoolboards were officially called "Protestant" and "Catholic" until 10 years ago.
The number of autistic Haitian children may very well have increased with the number of Haitian immigrant families. I'll have to ask Dr. Saucier about that.
Your anecdotal evidence from an unnamed Haitian doctor is of no scientific value, but we're used to such in this and similar blogs

5:47 PM  
Blogger Interverbal said...

Mandell et al. (2005) 3.1 for autistic disorder and 3.9 for PDD-NOS,

Anonymous,

Thank you for visiting my blog and taking the time to read this post. My comments will follow below.

“Ayoub and Ruscitti (mom of a PDD child) criticisms are pertinent and valuable. In his July study, Fombonne had access to data through Lester B. Pearson School Board special support team which kept a list of children with PDD diagnosis updated every week. However, to become official, these lists have to be submitted before October 1st by every school board special support team to the Ministry of Education of Quebec whose different departments double-check it for at least 6 months before they officialize it in February and can send it to researchers. Ayoub et al. used the official data from the Quebec Ministry of Education database, contrary to Fombonne, not only for the 2003-2004 school-year but for at least 9 more school years to do a real incidence study.”

To do a real incidence study, as opposed to a study using a modified prevalence study, the authors would have had to ascertain the number of exits from their system as well as the number of new entries into it, while monitoring the system to make sure the immigration rate played no effect.

In addition, the authors would have had to offer data providing evidence of reliability of the diagnostic methods within this system over the years. If these data were not taken then the study is open to specific random and systematic statistical errors, which would call into question the validity of their analysis. This is true of both Fombonne et al. and Ayoub & Ruscitti.

”French is the only official language in the Quebec province. Ayoub stated that 43% of students had French as 'mother tongue', 37% had other mother tongues and lastly, was English with 22%; therefore LBPSB was not representative of the actual demographic student population of Montreal.”

This is significant if there is a meaningful genetic or cultural difference between the Franco and Anglophones. If this difference is not present, then this demographic difference may not be a factor.

”When they talked about LBPSB being the only totally-inclusive school board in the province of Quebec, they didn't talk about linguistic inclusion but about integration of students with special needs like autistic children to any regular class in any of LBPSB schools http://www.lbpsb.qc.ca/strategic_plan/SP_Introduction.pdf contrary to other school boards where children with disabilities attend special classes.”

Noted, however, this means that this school district is more likely than its Francophone counterparts to present a more accurate picture of the population whom it can serve.

”I have in hand the Protocol of Immunization of the Quebec Province (Nov. 1996)(the exact year Fombonne says there were no more thimerosal-vaccines in Qc vaccines). It is considered the 'bible' for vaccinators in this province and on p. 3-9, chapter 3.5.1 Vaccines for Basic Immunization they list D25PT5-PRP-T which contained thimerosal (25 micrograms in 0.5 ml dose of adsorbed vaccine), DPT adsorbed too and many others. On Section 6.1 under Routine Immunization Schedule for Infants and Children they list DPT separated from Polio (still mention OPV) and Hib (PRP-T or Act-HibTM). DPT adsorbed and Act-Hib separately had both Tm. So those vaccines were required and did contain Thimerosal in those years.”

Noted, do you have it for the following year as well?

”Moreover, according to the Sociocultural Portrait of Students enrolled in Public Montreal schools, 51.1% of students are of immigrant descent. Thus, more than half of the total student population were most probably exposed to the the Hep. B vaccine which contained thimerosal when the vaccination program became free and was expanded in 1994 to children whose mother or father came from an Hep. B. endemic country. More than 100 endemic countries are targetted in this list http://www.santepub-mtl.qc.ca/mdprevention/fiches/immunisation/paysendemiciteVHB.pdf It is interesting to note that a high percentage of children in the special classes for autistic children are from immigrant descent and when I got the list of parent's nationalities I noted Haiti, Cambodgia, Algeria, exactly the same countries targetted by the Hep. B list.”

Unfortunately, I am unfamiliar with the French language. Which table is this information located on?

“One principal told me all of the children in her 5-years class of autistic children were from immigrant parents”

Noted, what about actual data however? We do not hear of this phenomena in the US and UK so this seems very curious.

“Another published study from Dr. Jean-François Saucier mentions that then number of Haitian autistic students had not doubled but tripled in special classes for autistic children in 10 years since 1987 and according to a Haitian doctor autism didn't exist in Haiti in those years.”

I am not familiar with Dr. Saucier’s research, nor did a brief search reveal it. I would need to review his methods before I could offer comment or accept the validity of this point. Will you provide a full reference please?

As to autism not existing in Haiti, prior to 10 years ago, once again, I would need to see actual descriptive epidemiology to accept that premise.

“Older sibblings dont't have it only newborns in Montreal and haitian mothers don't understand why.”

Again, anecdote will not be acceptable in this case. I must ask for data.

“When you mention DSM IV, they talk about PERVASIVE DEVELOPMENTAL DISORDERS instead of only Autistic Disorder. Dr. Fombonne and Ayoub also talk about PDD. On DSM IV there is no restriction of age for the appearance of first symptoms. On a French copy I have it says: "The first symptoms can appear during the first infancy, 2nd infancy or adolescence" and same was stated in DSM III-R.”

Some points of clarification:

PDD-NOS is not stopped at 3 years of age, but it seldom exceeds that range. I have never heard of a case (although there might be one) where a child regressed into PDD-NOS following post pre-school. If a child did so, s/he would more likely be diagnosed with Childhood Disintegrative Disorder, which can go up to age 10 and which has a stable prevalence rate.

The current mean age of diagnosis for Autistic Disorder is 3.1 years of age, however, the current mean for PDD-NOS is 3.9 years of age (Mandell et al., 2005).

In addition the wording you describe in the French language addition is not found in English Language Edition. There is to my knowledge, no PDD, not even Childhood Disintegrative Disorder, where symptoms may be first seen in adolescents. However, the actual diagnosis may first occur in adolescents, or even in adulthood.

6:49 PM  
Anonymous Ms Clark said...

A child, at say, age 5 who regressed into Childhood Disintegrative Disorder, would never be mistaken for a PDD,nos kid. By definition CDD is sudden, and very drastic. The child may cease to be able to walk, lose bladder and bowel control,

http://www.nlm.nih.gov/medlineplus/ency/article/001535.htm
It's not, "Oh, bobby started to perseverate on thomas the tank engine sort of suddenly at age 7 and hasn't been the same since."

The only online activist type I've seen claiming that her child "regressed" after age 3 is Lujene Clark (rolls eyes) and she describes her son's descent into the hell that is Asperger's syndrome at age 9, I think. Before that, if I recall, he had been dx'd with ADHD. Whoa. So, it's just like not possible he had Asperger's all along. Never mind his apparently impressive cranium size. No, not for Lujene the conspiracy theorist and bully.

8:52 PM  
Blogger _Arthur said...

Interverbal, as I stated in my 2 other posts, I am passably familar with Quebec School system.

26% of Greater Montreal children go to the English Schoolboard. Of those, 80% are anglophones proper, 4% are Francophones (!), and 16 % are allophones.
(2004 statistic)
The statistic quoted by Ayoub is meaningless.

The statistic "51%" of Montreal children are of immigrant descent is just plain false.
Only 17% of the children have parents who were born outside Canada and few of those necessitated an Hep-B vaccine.

I'm very curious if Anonymous can provide the complete cite and reference of the alleged Dr. J-F Saucier quote. I'll try to contact him.

9:09 PM  
Blogger Interverbal said...

Arthur,

Acknowledged, thank you for the clarifications.

I also agree with your assesment that there should be no difference between the rates of chidlren attending the anglo and francophone schools.

10:32 PM  
Blogger Kev said...

For those of us getting bogged down in the details of these separate points, could someone provide a plain-english bullet pointed, point by point comparison of all these arguments?

2:15 AM  
Blogger Joseph said...

It would certainly be very curious - and documentable - if the vast majority of autistic children in the Montreal area are immigrants. I've seen abstracts of old papers that found children of immigrants to be more likely to be diagnosed autistic, but nothing that would suggest the vast majority are immigrants.

Incidentally, California keeps detailed records on ethnicity, and the differences seem minor.

7:53 AM  
Blogger _Arthur said...

If I may interject a (long) off-topic political rant:
Language is very much a hot-button issue in Québec, instead of, say, race or immigration in the US or France.
Quebeckers are 82% French-speakers, with a politically powerful 8% English-speaking minority.
Various immigrants, known as allophones, count as 10% of quebeckers. Immigrants being a misnomer, because most of these are 3rd or 4th generation quebeckers.
For reasons too complex to write here, French-speaking Quebeckers were worried about seing their culture be diluted, mosty because the overwhelming majority of new immigrants went to English schools, and associated themselves politically with the English-speaking minority.
The phenomenon was centered in Montreal, were only 53% of the population is Francophone, 18% Anglophone, and a whopping 29% "Allophone".
The political solution, with Bill 101 in 1976, as been to mandate, by law, that all new immigrants children go to French schools --even if their parents hail from UK.

All that to explain that the English schoolboard of Montreal teaches betwen 22% and 25% of Mtl kids, just about 25,000 children, and that Mr. Ayoub's critic of "bias" is just plain nonsense.
If anything, Fombonne's sample reflects more closely US cities, it contains only 4%-odd francophones. Although I expect it does contains less latinos than most US cities.

I can reassure anonymous that this sample is unbiased by a high number of Haitians -- most go to French schools, or by a high number of recent African immigrants -- by law they go to the French schools.

Fombone study, 27,000 kids in 55 schools, shows no marked change in autism cases, just the known, steady and slow increase, regardless of the change of preservative in mandatory childhood vaccines several years ago, due to a "live" vaccine being added to the combo.

8:14 AM  
Anonymous anonimouse said...

Even if the value of this study is considerably more limited than originally thought - it still begs the question of why a single credible epidemiological study showing an increase in autism related to vaccine usage has never been presented.

9:37 AM  
Anonymous Anonymous said...

Arthur:

I have lived in Montreal for the last 30 years, I came to Quebec exactly the year when Bill 101 restricted access to immigrants to English schools. I couldn't attend an English school in 1977 because one of my parents had not completed elementary in English in a Canadian school. Nor my children can now attend an English school because my husband is French-Canadian and he didn't attend all his elementary in English nor I.

When I asked the question to Ms. Thiffault, President of the Society of Statisticians of Montreal, if a school board counting only for 14% and receiving only English-speaking children (Bill 101) could be a good sublet to represent the total student demography of Montreal and its results be extrapoled to all Montreal, all the Province and all Canada. This same President of the Society of Statisticians of Montreal responded that an important bias of selection had been committed because an English school board cannot represent the French majority and multicultural student demography of Montreal and 2nd) it could have attracted more autistic clients since it is the only Centre of Excellence in autism of Montreal, the only inclusive school board of the province, and most parents wish to integrate their handicaped children to regular classes and may prefer to move to the territory covered by LBSB.

According to "Portrait socioculturel des eleves inscrits dans les ecoles publiques de Montreal" (Sociocultural portrait of students enrolled in public schools of Montreal). To find it search in Google "Comité de gestion de la taxe scolaire", if you read French click on "Publications", subject: "Education interculturelle", and click on Portrait_socio_version_complete.pdf ( 2 792 096 bytes) . Go to page 11, only 5.89% of children at Lester B. Pearson school board spoke another language than French or English at home. On p9 it says: LBPSB is the school board that has the least allophones : 12.66%.

Ayoub's statistic of 51% of Montreal children of immigrant descent IS NOT FALSE AT ALL. PROOF: If you read the same "Portrait socioculturel des eleves", Section 1.3 (Graphique 9) "Birth place of Students and their Parents" you'll find where Ayoub got his percentage of 51.1% for immigrant descent for all 5 school boards. Commite de gestion de la taxe scolaire (linked to the school boards) gives more accurate percentages for each school board, more precise than Census statistics. Graphic 1 shows the mother tongue of all public schools in Montreal which corresponds to the 43% (French mother tongue), 37% other languages and 22% English mother tongue.

In his paper, Ayoub writes he obtained data for all 5 school boards and his analysis indicated enrollment at LBPSB in 2003-2004 represented only 14% of the total enrollments in all 5 school boards.

If you check online with the Ministry of Education statistics you'll see that in 2003-2004, LBPSB had an enrollment of 27,860; English-Montreal school board of 26,679; Commission scolaire de Montreal of 76,070; Marguerite-Bourgeois of 39,342; and Pointe-de-l'Ile of 30,048. A total enrollment for all 5 school boards of 199,999. If you divide 26,679/199999= you get 13%!!! for the representation of LBPSB over all school boards enrollment. So Ayoub was more generous giving 14%.

As for the "Haitian Autistic Syndrome" in Montreal, if you can read French, I did a cut&paste from Internet:
1- LA SUR-REPRÉSENTATION D’ENFANTS AUTISTES ET DYSPHASIQUES D’ORIGINE
HAÏTIENNE SUR L’ILE DE MONTRÉAL N’EST PAS UN MYTHE.
Les panelistes cliniciens ont unanimement fait le constat du nombre anormalement élevé d’enfants d’origine haïtienne, autistes ou présentant le syndrome dysphasique sémantique-pragmatique, rencontrés dans leur pratique.
Le constat est unanime quel que soit le lieu d’évaluation et d’intervention, en hôpital, en CLSC, en scolaire.
Donnons un exemple: à la clinique pédiatrique et multidisciplinaire de Maisonneuve-Rosemont, spécialisée en troubles développementaux, alors que 6% de leur population est d’origine haïtienne, celle-ci compte pour 50% des troubles de communication graves et persistants recensés.
Voici un tableau qui illustre bien le phénomène dans une école spécialisée de la CECM:
els.
1- LA SUR-REPRÉSENTATION D’ENFANTS AUTISTES ET DYSPHASIQUES D’ORIGINE
HAÏTIENNE SUR L’ILE DE MONTRÉAL N’EST PAS UN MYTHE.
Les panelistes cliniciens ont unanimement fait le constat du nombre anormalement élevé d’enfants d’origine
haïtienne, autistes ou présentant le syndrome dysphasique sémantique-pragmatique, rencontrés dans leur pratique.
Le constat est unanime quel que soit le lieu d’évaluation et d’intervention, en hôpital, en CLSC, en scolaire.
Donnons un exemple: à la clinique pédiatrique et multidisciplinaire de Maisonneuve-Rosemont, spécialisée en
troubles développementaux, alors que 6% de leur population est d’origine haïtienne, celle-ci compte pour 50% des
troubles de communication graves et persistants recensés.
Voici un tableau qui illustre bien le phénomène dans une école spécialisée de la CECM:
Tableau 1
(Table could't be pasted)

Données recueillies par J. Bonnefil en 1996-1997 dans une école spécialisée de la CECM
qui reçoit des enfants âgés de 4 à 13 ans, diagnostiqués aussi déficients intellectuels.
Ce tableau donne une bonne idée de l’étendu du phénomène sur l’île de Montréal. En additionnant les deux
pathologies autisme et dysphasie (lesquelles sont maintenant réunies par même le code, sous l’appellation TED)
on note que 50% de la population autiste et dysphasique est constituée d’enfants de langue maternelle créole.
Ce tableau donne une bonne idée de l’étendu du phénomène sur l’île de Montréal. En additionnant les deux
pathologies autisme et dysphasie (lesquelles sont maintenant réunies par même le code, sous l’appellation TED)
on note que 50% de la population autiste et dysphasique est constituée d’enfants de langue maternelle créole.

10:11 AM  
Anonymous Anonymous said...

Response to Interverbal:

I forgot to mention that contrary to the U.S. where Hep. B is mandatory for all newborns, in Quebec and Canada vaccines are not mandatory but most parents don't know this fact and their babies just get vaccinated at birth and most parents respect very well the recommended immunization schedule (good coverage rates). In the Quebec province, school authorities ask parents for the vaccine booklet and require that have all vaccines been given to the child. Hep. B vaccine IS NOT in the regular immunization schedule for Quebec newborns; however note that newborns in the Quebec province (because each province has a different immunization schedule) who have at least 1 parent who immigrated from one of the 170 countries considered with high prevalence of Hep. B are vaccinated at birth. List easy to understand: http://www.santepub-mtl.qc.ca/mdprevention/fiches/immunisation/paysendemiciteVHB.pdf
That is probably why Ayoub insists on the proportion of students from immigrant parents, because contrary to Quebec children, if they originate from 170 countries they might have gotten the Hep B vaccines which contained thimerosal since 1994 when the free Hep. B program started until 2001 when thimerosal-free Recombivax was licensed or even 2004 when the updated Protocole of Immunization of Quebec, page 7 (1) warned for the first time not to vaccinate babies younger than 12 months with Thimerosal-containing vaccines against Hep. B http://publications.msss.gouv.qc.ca/acrobat/f/documentation/piq/chap1_18/chap10b.pdf

"This is significant if there is a meaningful genetic or cultural difference between the Franco and Anglophones. If this difference is not present, then this demographic difference may not be a factor".
- I think Ayoub meant that all school boards of Montreal (5) should have been studied like he did to have a valid mirror image of the total Montreal student population instead of only one s.b.(English) that didn't quite well represent the demographical weight of French-speakers and allophones who are the majority (43%+37%) and can't attend English schools. It didn't have anything to do with genetic or cultural grounds.

”When they talked about LBPSB being the only totally-inclusive school board in the province of Quebec, they didn't talk about linguistic inclusion but about integration of students with special needs like autistic children to any regular class in any of LBPSB schools http://www.lbpsb.qc.ca/strategic_plan/SP_Introduction.pdf contrary to other school boards where children with disabilities attend special classes.”

Noted, however, this means that this school district is more likely than its Francophone counterparts to present a more accurate picture of the population whom it can serve.
Response: Not at all because the other 4 school boards offer excellent special classes to PDD-diagnosed children and mild cases are integrated in regular classes. Moreover, as EF wrote in his paper, 86.1% of their 180 PDD-diagnosed cases came from the clinic he directs at the Montreal Children's Hospital. That clinic delivers around 350 diagnosis/year is one of the most productive/efficient in Montreal and have shorter waiting lists for diagnosis. They work in close collaboration with the ASD team of the LBPSB Centre of excellence. That explains higher concentration of PDD-diagnosed children in LBPSB than in other school boards whose children are diagnosed by hospitals with long waiting lists until recently.

Noted, do you have it for the following year as well? I do but note Fombonne emphasized that "Ethylmercury exposure was NIL from 1996 onwards when thimerosal was entirely discontinued". Protocole d'Immunization of Quebec, edition 1996, the "bible" for vaccinators in Quebec, mentions many Tm-containing vaccines in that precise year.

1:42 PM  
Blogger Interverbal said...

“I forgot to mention that contrary to the U.S. where Hep. B is mandatory for all newborns, in Quebec and Canada vaccines are not mandatory but most parents don't know this fact and their babies just get vaccinated at birth and most parents respect very well the recommended immunization schedule (good coverage rates). In the Quebec province, school authorities ask parents for the vaccine booklet and require that have all vaccines been given to the child. Hep. B vaccine IS NOT in the regular immunization schedule for Quebec newborns; however note that newborns in the Quebec province (because each province has a different immunization schedule) who have at least 1 parent who immigrated from one of the 170 countries considered with high prevalence of Hep. B are vaccinated at birth.”

Noted, however, I am curious as to why this point does not appear in the Ayoub & Ruscitti article. The authors raise the point of the voluntary 4th grade hep b vaccine and how strongly it was encouraged. Why is there this discrepancy between your claims and the authors’?

Also, what is the hep b coverage rate for children under age 5?

“I think Ayoub meant that all school boards of Montreal (5) should have been studied like he did to have a valid mirror image of the total Montreal student population instead of only one s.b.(English) that didn't quite well represent the demographical weight of French-speakers and allophones who are the majority (43%+37%) and can't attend English schools. It didn't have anything to do with genetic or cultural grounds.”

Thank you for the clarification. I will now assert that there is no logical source of bias in what Dr. Fombonne did. This would only be a problem if this study was seeking to describe what schools looked like in Montreal. Then the difference between the Anglo and Frankophones would be important.

For those who may be having trouble following this portion I will offer an analogy. It would be as if there was an accusation of selection bias involving a study of autism in Salt Lake City which has a strong Catholic population, compared to the rest of Utah, which is almost entirely Mormon. Unless there is a reason to suspect a difference in autism rates between the two due to non vaccination or genetics, then there is no valid reason to not apply the SLC rate to the rest of Utah.

“Response: Not at all because the other 4 school boards offer excellent special classes to PDD-diagnosed children and mild cases are integrated in regular classes.”

So, then these children are still in those school districts and counted? I don’t understand this at all and it seems very contradictory. What exactly does inclusion mean for these school boards in this case. Does it mean that the children are permitted in the school and counted, or does it mean that they are included in the same classes as their typically developing peers?

“Moreover, as EF wrote in his paper, 86.1% of their 180 PDD-diagnosed cases came from the clinic he directs at the Montreal Children's Hospital. That clinic delivers around 350 diagnosis/year is one of the most productive/efficient in Montreal and have shorter waiting lists for diagnosis. They work in close collaboration with the ASD team of the LBPSB Centre of excellence. That explains higher concentration of PDD-diagnosed children in LBPSB than in other school boards whose children are diagnosed by hospitals with long waiting lists until recently.”

If that is true, then this is a better control in favor of Dr. Fombonne’s study. There is an additional level of quality control not available in the other boards.

“I do but note Fombonne emphasized that "Ethylmercury exposure was NIL from 1996 onwards when thimerosal was entirely discontinued". Protocole d'Immunization of Quebec, edition 1996, the "bible" for vaccinators in Quebec, mentions many Tm-containing vaccines in that precise year.”

I noted this in my last response and I do consider it as a valid threat the data in that year in Fombonne’s study. However, I should very much like to know what if anything changed in terms of this bible in the following years, so that I can assess the extent of the damage to Dr. Fombonne’s data.

4:10 PM  
Blogger Jennifer said...

Anonymous wrote: "Ayoub's statistic of 51% of Montreal children of immigrant descent IS NOT FALSE AT ALL. PROOF: If you read the same "Portrait socioculturel des eleves", Section 1.3 (Graphique 9) "Birth place of Students and their Parents" you'll find where Ayoub got his percentage of 51.1% for immigrant descent for all 5 school boards. Commite de gestion de la taxe scolaire (linked to the school boards) gives more accurate percentages for each school board, more precise than Census statistics. Graphic 1 shows the mother tongue of all public schools in Montreal which corresponds to the 43% (French mother tongue), 37% other languages and 22% English mother tongue"

Sorry, but I am from Canada as well. Just because your "mother tongue" is not French does NOT mean you are an immigrant to Canada. Ayoub is confusing "of immigrant descent" which is meaningless, with "a child who is an immigrant". The vast majority of the Canadian population is of "immigrant descent". Only the aboriginal people would be considered not of immigrant descent, using the broadest possible definition. What we need to know for the purposes of this discussion is what fraction of children attending school in Montreal (English school board) or in Quebec as a whole - were born in a country outside of Canada. The mother language is irrelevant to this discussion because many children who were born in Canada have parents who speak languages other than English or French. This does NOT imply that they were not vaccinated under the Quebec schedule.

And I think that it is not appropriate to speculate on how many newborn children were vaccinated in hospital for HepB. This vaccine is not part of the schedule, and my children were never offered this vaccine. In fact, it is supposed to be offered ONLY to children with HepB positive mothers. If you want to suggest that a majority of parents are directly from the 170 countries on the list, then you need to supply more proof of this than a simple statement of "mother tongue".

8:42 PM  
Blogger _Arthur said...

tgeHere is a very recent document, "Education and the long-term development of the English-speaking communities of Greater Montreal" (2007)
http://www.qcgn.com/files/QCGN/a20070227_education.pdf
It shows 141,330 students enrolling in the French Schoolboards, and 52,788 in the English Schoolboards of Greater Montreal, for a share of 27.2% (2006 schoolyear).
There are 2 English schoolboards, Lester B. Pearson with 27,188 students and English Montreal with 25,600 students.
Fonbonne study was on Lester B.

In French schools 60.7% of students had French as mother tongue (MT), 5.1% had English as MT, and 34.2% had an Other MT.
That document has no specific statistics on recent immigrants, but even with supposing that ALL the 34.2% were children of recent immigrants, which I know is not the case, one cannot reach the number 51%.
Thats why I am unable to understand the 51% number in the document "portrait sociociulturel" you are using. It must be based on a different subset.

10:13 PM  
Blogger Kevin said...

This is a fascinating discussion but I will admit that I am getting bogged down in the fine details of points being made by both sides.

I hope when this discussion comes to a natural end that a summation of all points, with a simple explanation, can be presented by someone.

12:52 AM  
Blogger Interverbal said...

Hi Kev,

My next post whent he current round is over will a summery of points.

10:44 AM  
Blogger _Arthur said...

At to the Maisoneuve-Rosemont clinique, the information given is inconclusive.
Theres nothing surprising as such that a "Clinique Pediatrique et Transculturelle" (its other name), specialized in children with developmental troubles , be heavy in minorities children with verbal difficulties.
At the specialized school they "studied", which had 185 students with specialized needs in 2002, 39 speak creole (presumably from Haiti).
Of those 39 children, 18 are in the category "TED" (Trouble Envahissant du Développement), which covers autism *and related conditions*.
At the end of her paper, Dr. Bonnefil suggest that the term "Haitian Syndrome" be replaced by "syndrom of a wrong maternal language".
At that "colloque", various ideas why Haitian children are over-represented at that school are proposed. None of the participants blame vaccines.

That cluster at that specialized shool does not invalidate the Fombonne study, which show that in the LBP Schoolboard children population, the number of autism cases was not affected by the change in vaccine formulation.

12:56 PM  
Anonymous Anonymous said...

Response to Arthur:

Sorry but you are wrong. The clinic were an over-representation of children from Haitian parents was noticed is Clinique Pediatrique et Multidisciplinaire de Maisonneuve-Rosemont which has nothing to do with their other clinic Clinique Pediatrique Transculturelle (CPT). Chief-Nurse Jocelyine Fouquet (514)374-6940 with whom I just checked this said they have many external Pediatric clinics responding to different needs and Clinique Transculturelle was created only around 2000. Normally, all children go to Clinique Pediatrique Multidisciplianire. Only children with health problems arising from transcultural, psychological or adaptation causes are referred to Clinique Pediatrique Transculturelle. She said it is not the case for PDD-diagnosed children. Also, the researcher Bonnefil is a Haitian orthophonist and as so, her hypothesis is that the reason of the higher proportion of autistic diagnosis in her community is that children are mixed up when the mother talks to them in French instead of Creole which is her real maternal language (???). I don't share her opinion, many other children, have parents who speak 2 different languages at home and even a 3rd language at school and don't become autistic or PDD because of that. It is not very scientific as an explanation. However, US has banned thimerosal from vaccines as a precaution and many researchers in your country, like Verstraeden from the CDC stated in first paper and this is a transcript: "As for the exposure evaluated at 3 months of age, we found increasing risks of neurological developmental disorders with increasing cumulative exposure to thimerosal. The relative risk for this condition was significantly increased (2,04,95%) when comparing those with a cumulative exposure above 62 micrograms at 3 months compared to those with cumulative exposure equal or less than 62.5 micrograms". That is why I personally believe that children born in Montreal from immigrant parents who contrary to other Quebec children did get vaccinated at birth, 2 and 4 months against Hep. B which contained thimerosal before 2001 are at higher risk of developping ASD or other neurodevelopmental disorders later.

Response to Jennifer:

You know as I do that 'from immigrant descent' means children born somewhere, in this case Montreal, from an immigrant mother and/or father, in other words 'Immigrants of second generation' which is the word most people use. Of course Dr. Ayoub was not referring to children of 3rd, 4th, generations as you extrapolate, and you are righ, almost everybody's origins except aboriginal people come from other countries.

What Dr. Ayoub was explaining is that, contrary to Canadian children who don't normally receive Hep. B vaccine because it is not in the regular vaccine schedule YET, immigrant children AND children born here having 1 or 2 immigrant parents, BOTH CATEGORIES have in many instances received more vaccines containing Thimerosal, like Hep. B before 2001 when a Thimerosal-free hep. B vaccine was licensed. Did you read Dr. Ayoub's letter to Pediatrics in the NAA Web page? It was not published in Pediatrics only because Dr. Fombonne declined to respond. Why was he afraid of having it published? Both categories: immigrant students and 1st-generation immigrant students were and are potentially exposed to more vaccines containing Tm and they count for 51.1% of the Montreal student population. It is as plain as that. For this 51.1% check his references 2 and 3 in his letter, you will find the statistics of Comité de taxation scolaire de Montreal. Click on http://www.cgtsim.qc.ca/pls/htmldb/f?p=105:3:18162375273633681717:OK:NO:::
Find the publication 'Portrait socioculturel des élèves inscrits dans les écoles publiques
de l’île de Montréal – Inscriptions au 30 septembre 2005'. Go to Section 1.3 and watch the pie chart by yourself. It is in French, here is my English translation.
1.3 Birth Place of Students and their Parents (Montreal)
As shown on Graph 9...In 2005 students born outside of Canada from parents also born outside count for 17% of the (Montreal) school population. Then come students born in the Quebec province having both parents born outside of Canada (23.6%). Third, are the students born in the Quebec province having only 1 parent born outside of Cnada (10.5%). Together these 3 family situations give in 2005, half (51.1%) of all schools in elementary and high-school of the public sector. The proportion of children born in the Qc province from Qc-born parents is 42.2%.
------------------------

I am the mother of a PDD-diagnosed child, I wonder if Arthur, you or Jonathan are also parents of PDD or autistic children or what do you defend so much. Like most parents we suffer a lot wondering why our child got PDD, what caused this disorder, reading a lot on possible causes, noticing there were almost no cases in the 70s or 80s, looking that no one in our families had PDD or something related before, etc.

I know Dr. Fombonne was assigned as an expert-witness on June 16, 2006 (2 weeks before publishing his paper in Pediatrics) for testimony against the 5,100 petitions of parents of autist children and 4,750 cases pending. These petitioners claim PDD in their children was triggered by vaccines, at the Omnibus Autism Hearings. This places Dr. Fombonne in a situation of conflict of interest, he is also the only representative in Canada of the International Molecular Genetic Study of Autism Consortium funded by the Wellcome Trust. Nobody in your comments outlined that he lied in his conclusion that MMR was not linked to the PDD increase in Montreal. In fact, he compared vaccine coverage in Quebec city which is located 265 km away from Montreal, to the PDD increase in Montreal. Dr. Yazbak has given evidence that MMR vaccine coverage was increasing in Montreal in tandem with PDD.

10:47 AM  
Blogger Interverbal said...

Anonymous,

It is of course ridiculous that autism could be caused being exposed to two or more languages. However, if an autistic child is exposed to two or more languages this could complicate matters in terms of expressive and receptive language. It could make a child seem more severe particularly if they were an unclear case of PDD-NOS.

“Why was he afraid of having it published?”

Was he? Was he afraid, or was he exasperated, or perhaps simply not interested in engaging with an admitted true believer in the vaccine etiology of autism.

Given these possibilities, how did you decide that he was “afraid”.

I am the mother of a PDD-diagnosed child, I wonder if Arthur, you or Jonathan are also parents of PDD or autistic children or what do you defend so much.

I have noted your status before now. I am not a parent. A brief profile of me is available on the main page of this site. In terms of autism, I defend science and criticize pseudo/anti-science. It is that simple.

“Like most parents we suffer a lot wondering why our child got PDD, what caused this disorder, reading a lot on possible causes, noticing there were almost no cases in the 70s or 80s, looking that no one in our families had PDD or something related before, etc.”

Noted.

I know Dr. Fombonne was assigned as an expert-witness on June 16, 2006 (2 weeks before publishing his paper in Pediatrics) for testimony against the 5,100 petitions of parents of autist children and 4,750 cases pending. These petitioners claim PDD in their children was triggered by vaccines, at the Omnibus Autism Hearings. This places Dr. Fombonne in a situation of conflict of interest, he is also the only representative in Canada of the International Molecular Genetic Study of Autism Consortium funded by the Wellcome Trust.

I note this, but many experts who take opposing views in this situation have conflicts of interest. I do not invalidate anyone because they have an emotional, job related, or monetary conflict of interest. Nor do I agree with others who attempt to use an incidental ad hominem because of these conflicts.

“Nobody in your comments outlined that he lied in his conclusion that MMR was not linked to the PDD increase in Montreal. In fact, he compared vaccine coverage in Quebec city which is located 265 km away from Montreal, to the PDD increase in Montreal. Dr. Yazbak has given evidence that MMR vaccine coverage was increasing in Montreal in tandem with PDD.”

Did he lie, or was he mistaken? And how, were you able to differentiate?

12:31 PM  
Blogger Jennifer said...

Anonymous made a reply to Jennifer. I will now respond to this. Anonymous, I have looked carefully at the document on the multicultural aspects of the Montreal school population. Luckily, I, too, am able to read French.

I am afraid that you are mistaken in your conclusions. First, Fombonne studied the Montreal English language school board, Lester B. Pearson. On p. 30 (Table 12 and Graphic 15) of the document you refer to is the data for that particular school board. From 1998 to 2005, the students born outside of Canada to two parents born outside of Canada is only about 3%. You make an argument that that children born of non-Canadian born parents (even though the children themselves were born in Canada) are more likely exposed to thimerosal containing vaccines. I don't accept that argument - why would you say so? Do you assume that most of those mothers would test as HepB positive? Or that most of those parents originate from a country where HepB is very common? That is the only way the children would be vaccinated against HepB, since they were following the Quebec schedule. But even accepting your argument, those children only comprise about 13% of the school population. So, only about 15% of the LBP school board population MIGHT have been exposed to thimerosal.

On the other hand, I could argue that many of those immigrant children came from France, Britain, or other European countries where there is no thimerosal either.

In conclusion, anonymous, I think that Ayoub and Yazbak have a point in only one respect - the comparison of MMR uptake should have been made with at least the Montreal data, or even better, with the MMR uptake of the LBP school board itself. However, this failure can only impact the reliability of the MMR conclusions, and not the conclusions on thimerosal.

1:53 PM  
Blogger _Arthur said...

Yes, Jennifer, the Lester B Pierson went from a time where 100% of children received a compound vaccine containing Thimerosal (minus those whose parent refused vaccination), to a regime where no mandatory vaccine contained Thimerosal.

Had Thimerosal been the causative agent of Autism, one would have expected a sharp drop in the number of cases.

Kirby, or Ayoub can handwave in the general direction of other non-mandatory vaccines that at some point of the study still contained Thimerosal.

But, due to the peculiarity of Quebec Immigration (Language) Law, the number of children of recent immigrants in LBP schools is extremely low, 3% or less, so their "argument" about Hep-B fail.

If Thimerosal was the causative agent of Autism, the number of cases in LBP schools should have dropped. It didn't.

As of English Schools not being representative of other populations, I guess Ayoub and Ruscittu, or Anonymous have the right of it. Lester B. Pierson schoolchildren are not representative of the linguistic or ethic mix of Montreal Island, as Montreal Island population is not representative of Quebec population as a whole, as Quebec population is not representative of California's... etc...

However, their argument that a better study would find nice clusters of autistics in nearby French Schoolboards is extremely weak. Unless Ayoub & R can demonstrate that the LBP schoolboard is biased because the nature of its population has changed DURING THE COURSE OF THE STUDY, their argument fail.

The prevalence of autism in LBP children is high, as high as elsewhere in America, and has been unaffected by the removal of Thimerosal in children vaccines. That's evidence that thimerosal is not the causal factor, for that population ....

4:49 PM  
Anonymous Anonymous said...

Response to Jennifer and Arthur:

In July 2006 paper, Dr. Fombonne stated under Results - Prevalence: 'Of 27749 chldren enrolled in the LBPSB, a total of 180 children were identified with a PDD diagnosis'. Three paragraphs later he wrote: 'Of the 180 subjects, 158 were born in Quebec (referring to the province)'. However, in an interview given to Teri Arranga (AutismOne Radio) in July 2006(which you can download) he contradicted his paper responding: 'We excluded children born outside of Quebec...we only had children born in Quebec' and added that he wouldn't have included, for example, children born in the US who during the study years would have been more exposed to thimerosal than in Canada.

It took me a while but I finally got the official statistics I requested from the Ministry of Education for Lester B. Pearson School Board where you can see the place of birth (Canada out of Quebec, Quebec or Out of Canada)of the PDD-diagnosed child and that of each parent, for 2003-2004, the year that EF surveyed. If you both give me your emails or fax numbers it will be a real pleasure to send it to you. In turn, please confirm to your readers the official number of immigrant children and Montreal-born children having 1 or 2 immigrant parents were higher among the 180 children that EF surveyed included. Don't forget to remind your readers that those children most probably received other vaccines in their native countries, potentially exposing them to more thimerosal, and/or were revaccinated here because the rule is to revaccinate or proceed to primovaccination when doctors notice that the vaccine intervalls differ, or the products used are not the same, doubt the quality, or the child lacks a proof of vaccination. If the children were born in Montreal but had at least 1 parent born in a country with a high prevalence of hep. B (170 countries official list), being considered as a risk group, they most probably received 3 doses of Recombivax with thimerosal before 2004 when the official instruction came to use Tm-free Recombivax for babies less than 1 year old.

Data Extracted from the table received from Ministry of Education of Qc
2003-2004 Lester B. Pearson

Official Total of PDD-diagnosed: 193

9 children born in Canada, outside of Quebec
13 children born outside of Canada
63 children born in Montreal having 1 or both parents born outside of Canada

That is a total of 85 potentially exposed to other vaccines than those in the regular Qc vaccine schedule.

85 is 47% of the total number of PDD-diagnosed (N=180). It is a significant percentage you must agree with me.

If we compare that rate to the proportion of children in the general sector at LBPSB having another mother tongue (12.75%) and 2.82% who were born outside of Canada (2004)(source: Portrait socioculturel des élèves inscrits dans les écoles publiques de l'Ile de Montréal), we see a clear over-representation among the PDD-diagnosed of immigrant children (13/180 or 7.2%) and of Montreal-chidren having immigrant parents/another mother tongue (63/180 or 35%) vs. their percentage in the general sector. This proofs a correlation due to the exposure to other vaccines containing thimerosal, to revaccination, to exposure to Hep. B vaccine or all of these. Arthur, that is why probably the PDD numbers didn't drop.

Not to forget that the prevalence at LBPSB went from 21.2/10000 in 1998-1999 survey to 104.8 in 2006-2007. That is a 5-fold.
The diagnoses given at EF's ASD Clinic at the Montreal's Childrens' Hospital went from 43 in 1999, to around 70 in 2001, to 350 in 2006. (source: http://www.kidsforkids.ca/)
That is approx a 8-fold.

If he wrote that 80% of his surveyed children were diagnosed at his ASD Clinic, can we conclude that the increase in the years after thimerosal was removed (1996) (children born that year were diagnosed at age 3-4 according to another document, thus bringing us to 1999 and starting 1st grade in 2002) was MOSTLY DUE TO THE REMARQUABLE INCREASE OF DIAGNOSIS IN HIS CLINIC? WOULDN'T THIS BE A BIG BIAS?

Response to Arthur: Main origin country of parents at LBPSB at a sample school (Spring Garden) are India, Sri Lanka, Pakistan, Philippines, Jamaica.(new immigrations). Italy, Greece and Portugal are old immigrations and their 3rd generation children count as Canadian/Quebecers, therefore receive regular vaccines.

To clear your doubts, I also called the admissions office and they said that LBPSB has a special derogation notwithstanding Bill 101 (French-language protection), that makes them accept children with learning difficulties whose parents didn't attend an English school (otherwise it would be too difficult for these children to learn a 3rd language: French in other schools).

Hoping to have brought you closer to the truth,

Mother of a Montreal PDD-diagnosed child, who received more than 100 micrograms of mercury before age 1

Note: In my next email I'll send you the study that shows that adoptive children in Quebec have a singificantly higher prevalence of PDD compared to Quebec-born children.

4:16 PM  
Anonymous Anonymous said...

Response to 'Katahajime'

Each Canadian Province has a different child regular immunization schedule.

In the province of Quebec as in many Canadian provinces, the Hepatitis B vaccine is not in the infant regular immunization schedule. However, since 1994 the gratuity of this vaccination program expanded to more than only the newborns of HBsAg carriers, contacts of acute cases and children in 4th grade. It became freely available to elevated risk groups including, according to the official Montreal Health Dept. "newborns whose mother or father was born in (1) Cambodgia, China, Hong Kong, Indonesia, Laos, Malaysia, Mongolia, Myramar, Philippines, Singapour, Taiwan, Thailandia, Viet-Nam" http://www.santepub-mtl.qc.ca/Publication/synthese/let1_1.pdf

This list was expanded later to newborns who had at least 1 parent born in 1 of these 170 countries: http://www.santepub-mtl.qc.ca/mdprevention/fiches/immunisation/paysendemiciteVHB.pdf
* That is practically all children having an immigrant parent in Montreal (51.1% of enrollment in public schools).

These studies on the prevalence of Hep. B among immigrant populations in Canada must have favored that policy:
HBV is a common infection in China, Southeast Asia and parts of Africa where about one person in 10 (10%) is a chronic carrier. In Canada about one person in 200 (0.5 %) is a chronic carrier. Many of Canada's cases are in immigrant populations from high-prevalence regions of the world. It is expected the incidence of HBV in Canada will eventually fall because all Canadian children are now vaccinated in school programs, although that reduction will not be seen for many years. http://www.bmscanada.ca/bms/news/archives/?news_id=1774

Prevalence of hepatitis B virus infection in pregnant women in the Montreal area
G. Delage, S. Montplaisir, S. Remy-Prince and E. Pierri

From January 1982 to June 1984, 30,315 serum specimens from pregnant women at nine hospitals in the Montreal area were screened for hepatitis B surface antigen (HBsAg). Of the specimens 103, from 98 women, were positive, a prevalence rate of 3.4 per 1000. The ethnic origin of the 98 women and the number who were also positive for e antigen (HBeAg) were as follows: French-Canadian, 29 (3 HBeAg-positive); Asian, 28 (14); Haitian, 32 (0); other, 7 (0); and unknown, 2 (0). The prevalence rates of HBsAg positivity according to ethnic origin at one of the hospitals were 73.9 in Asians, 33.1 in Haitians, 0.9 in French Canadians and 8.0 in women of other extraction.

Two recombinant DNA hepatitis B vaccines are licensed in Canada, one prepared by
Merck Sharp and Dohme (Recombivax HB) and the other by SmithKline Beecham(Engerix-B). Recombivax HB contains 10 μg/mL and Engerix-B 20 μg/mL of purified hepatitis B surface antigen. The vaccines are adsorbed onto aluminum hydroxide with thimerosal as preservative.
Schedule and Dosages
The recommended schedule for hepatitis B vaccine is three doses given at 0, 1 and 6 months. There is evidence that the closer the last dose is given to 12 months after the first, the greater and longer lasting the antibody response will be. An alternative
four-dose schedule for Engerix-B® at 0, 1, 2 and 12 months may result in earlier
protection.
* Infants received 0.5 ml of Recombivax or Engerix which contained 12.5 micrograms of Ethylmercury. x 3 times = 37.5 mu
exposure in the first 6 months

Public Health Canada stated in 2002: "Canadian infants from the above six Canadian jurisdictions could have been exposed to between 12.5 µg and 37.5 µg of ethylmercury in the first 6 months of life (or an average of 0.069 µg/day to 0.206 µg/day), from thimerosal-containing hepatitis B vaccine.

Althoug in March 2001 the Thimerosal-free Recombivax was licensed, only in 2004 the Protocole d'Immunisation du Québec advised not to vaccine babies younger than 12 months with the Thimerosal formulation.

The enrollment of all Montreal public schools in 2006-2007 was 190,771 children. According to the following statistics 51% of Montreal students were born abroad or have 1 or 2 foreign parents. That gives a total of 95,386 students. potentially exposed to an extra 37.5 micrograms of ethylmercury, if their country is in the 170-countries list.

"Comité de gestion de la taxe scolaire": Translation: In 2005 students born in another country counted for 17% of the school population. Then come those born in Quebec prov. having foreign parents: 23.6%, then those born in Quebec prov. having only 1 parent born in a foreign country: 10.5%. Together these 3 situations concern half of all students in elementary and high-school".
"Lieu de naissance des élèves et de leurs parents
La première, celle qui reflète l’immigration la plus
récente, concerne les élèves nés à l’étranger de parents nés à l’étranger. En
2005, ces élèves représentent 17,0 % de la population scolaire. Viennent ensuite
les élèves nés au Québec, de parents nés à l’étranger (23,6 % des élèves).
En troisième lieu, il y a les élèves nés au Québec dont un seul des parents
est né à l’étranger (10,5 %). Ensemble, ces trois situations familiales
concernent la moitié (51,1 %) de tous les élèves des ordres d’enseignement
primaire et secondaire du réseau public.

Main countries of immigration in Montreal are Italy, Algeria, China, Haiti, France, Lebanon, VietNam, Morocco...

Perspicacious people have noticed that Haitian, Cambodgian, Algerian PDD-diagnosed children are over- represented or increased in the special schools and classes for autistic children in Montreal. Some classes have more than 50% of their autistic children from these "endemic" countries.

10:32 PM  
Blogger Interverbal said...

Hi Anonymous,

Thank you for the information. I have a few questions for you when you have a moment.

Is the potential exposure to thimerosal in these children less or more than what US children receive?

Are the any other nations/provinces where children of immigrant parents are more likely to receive extra vaccinations?

What does the research show in terms of immigrant populations vs. non-immigrant populations in terms of autism?

Also, I have recently read that in France autism is still sometimes seen as caused of a psychological trauma or ill-effect. Is this also true for Quebec? I have no idea and I am quite curious.

Also, is there a stigma of autism in Quebec for the parents?

10:03 PM  
Anonymous Principled said...

Interverbal

I must congratulate you on your incessant drive for the truth

Principled

3:20 PM  

Post a Comment

Links to this post:

Create a Link

<< Home