Schafer Autism Report, July 14, 2003

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A New Look At Birth Defects: Wheat Herbicides Suspected Scientist says study does not make a direct link between birth defects and use of the chemicals, but findings do strongly suggest more research is needed

AP - Babies born in major wheat-producing counties were twice as likely to have birth defects as those born in rural counties with low wheat production, a new federal study shows.

The research, published in the July issue of Environmental Health Perspectives, a peer-reviewed journal of the National Institutes of Health, suggests exposure to common herbicides applied to wheat could be responsible for the increased rate of birth defects.

The study was conducted by Dr. Dina Schreinemachers, a researcher with the Environmental Protection Agency in North Carolina. She examined more than 43,000 births from 1995 to 1997 in 147 rural counties in Montana, North Dakota, South Dakota and Minnesota.

She divided the counties by their rates of wheat production according to U.S. Department of Agriculture data, then compared the rates of birth defects among children born in the counties as provided by the National Center for Health Statistics.

Schreinemachers said results of her study indicate that in rural, agricultural counties with high wheat production - where the use of chlorophenoxy herbicides is higher - rates of certain birth defects “significantly increased.”

Specifically, instances of circulatory-respiratory and musculoskeletal defects were twice as frequent in high-wheat counties, she said.

Even more significant, baby boys born in high-wheat counties and conceived during April or June - when herbicide application normally is in full swing - were nearly five times as likely to have birth defects than boys conceived during other times of the year and born in counties with low wheat production, the study concluded.

Death rates from birth defects among male infants in high-wheat counties also were more than twice the rates of low-wheat counties, the study found.

Schreinemachers said Thursday the disparity between male and female infants was not clear.

She said her study does not make a direct link between birth defects and use of the chemicals. It also did not determine whether the children with birth defects were born to parents who had direct contact with the herbicides. But the study strongly suggests that more research is needed, she said.

“We do not know how much of these herbicides was used in those particular counties, for instance” she said. “But we know that according to the USDA, these herbicides are used most often on spring and durum wheat.”

A spokeswoman for CropLife America, the trade group for agriculture chemical makers, did not immediately return a telephone call seeking comment on the study.

The findings are similar to conclusions contained in a 1996 study by Dr. Vincent Garry of the University of Minnesota.

His study of births in Minnesota between 1989 and 1992 found a higher rate of birth defects in western Minnesota, where chlorophenoxy herbicides are applied to wheat. That study, however, also implicated certain fungicides as a possible cause.

Chlorophenoxy herbicides are widely used to control weeds in grain farming. In the four wheat-producing states included in Schreinemachers’ study, more than 85 percent of the wheat acreage was treated with herbicides such as 2,4-D and 4-chloro-2-methylphenoxyacetic acid, or MCPA, the study said.

Dr. Michael Spence, Montana’s state medical officer, said he was aware of Schreinemachers’ study, but had not reviewed it yet. However, he said the findings were not a surprise, since the herbicides have been linked to other health problems in previous studies.

An ongoing study funded jointly by the National Cancer Institute, National Institute of Environmental Health and the EPA is tracking 90,000 herbicide applicators and their spouses to look for possible health effects of pesticides.

Philanthropists do not typically lavish their money on swine. Or mosquitoes, for that matter.

But Bill Gates is no ordinary philanthropist. If immunizing pigs can end the spread of tapeworms, which cause virulent neurological disorders, he will pay to vaccinate them. If mosquitoes can be neutralized as malaria carriers by altering their genetic code, his money — and lots of it — will support the research.

“The basic science that can be applied to these problems has been advanced greatly,” Mr. Gates, the chairman of Microsoft, said in a recent interview at the company’s headquarters in Redmond, Wash. “So all you have to do is take a modest amount of the rich world’s resources to have a huge impact on the poor world.”

“Modest” is a relative term, particularly when the person using it is the world’s richest man and is speaking of his plans to solve intractable health problems on a global scale.

The Bill & Melinda Gates Foundation, which has distributed $6.2 billion since its founding less than four years ago, has pledged more than half of that total, or $3.2 billion, to improving health in the developing world. The foundation’s influence now rivals that of the World Health Organization and Unicef.

Here is one point of comparison: The Global Fund to Fight AIDS, Tuberculosis and Malaria, a partnership of 14 countries with private charities, foundations and industry, plans to spend roughly $1.5 billion to fight those diseases over the next two to three years, some $50 million or $60 million of which comes from the Gates Foundation. The Gates Foundation on its own has already spent more than $610 million on those diseases, and will spend at least another $478 million by the end of 2005.

The foundation’s influence can already be seen in rising vaccination rates in some of the world’s poorest countries, in clinical trials of drugs that are promising but have limited commercial potential and in new devices that make the delivery of health care easier and cheaper.

Dr. Tore Godal, executive secretary of Global Alliance for Vaccines and Immunization, a major Gates beneficiary, said it had delivered more than 180 million doses of vaccines since 2000, thus saving more than 100,000 lives. Mr. Gates figures that his philanthropy will have touched more than a million lives by the end of the decade, and his goal is to reach tens of millions more.

“Bill Gates is going to be remembered more for what he did for international public health than what he did for the world of computers,” predicted Richard T. Mahoney, a professor at Arizona State University who has wide experience dealing with health issues in poor countries.

Those who think of Mr. Gates as a ruthless billionaire monopolist, the man who was so testy and sarcastic with government prosecutors during the Microsoft antitrust trial, may find it hard to reconcile that image with one of a humorously self-deprecating philanthropist.

Many suspected that Mr. Gates’s plunge into works of charity, which took off at the time of the trial, was aimed at polishing his image.

But if his foundation is a public relations exercise, it is one that experts in the field agree is innovative, ambitious and bold.

“It seems to me — and I’ve been following his work — that this is a guy with a vision,” said Michael Bailin, president of the Edna Clark McConnell Foundation. “He’s willing to put his money out there and make some big but good gambles on some of the most important issues there are.”

Where the fledgling Gates Foundation once sought guidance from philanthropic bluebloods like Rockefeller and Carnegie, budding philanthropists are now turning to Gates for advice. In April, Michael S. Dell, the computer billionaire who is quietly increasing his philanthropy, sent Janet Mountain, the new executive director of his foundation, to Seattle to see how the Gates Foundation does things. What she saw was a foundation that spreads its wealth generously but cautiously, hedging its bets by financing collaborative efforts that involve governments, private industry, scientists, nonprofit groups and agencies like Unicef.

Fully 80 percent of the foundation’s contributions to global health are funneled through public-private partnerships that bring together all the parties needed to sustain successful programs.

In part, that approach is a necessity: the foundation needs a big conduit to accommodate its big grants.

Teachers won’t be the only ones issuing grades from now on. The Food and Drug Administration plans to start grading health claims on product labels.

The ranking system will assign letter grades -- ranging from “A” to “D” -- on each claim a company makes, indicating the quality and strength of the scientific evidence that supports the claim.

“We want to see more of a focus on getting that information out to consumers and we want to see more of a focus on food producers competing based on the health consequences of their products,” says FDA Commissioner Dr. Mark McClellan.

The measure is intended to encourage the manufacturers of foods, beverages and dietary supplements to present only health claims that are firmly backed by sound science. An FDA spokesperson said the new grades are intended to inform consumers about the products they buy.

But consumers won’t see the changes right away. “The new regulations take effect in September, but it’ll likely be months after that before consumers see any change in their food labels,” reports ABCNEWS correspondent Lisa Stark.

Health Claim Report Card Under the new plan, an “A” grade will be assigned to claims supported by many well-designed studies. For instance, if a food high in fiber boasts the ability to one’s reduce risk of colon cancer, the claim will be given an “A” since the link between fiber and gastrointestinal cancers has been well established by scientific research.

Health claims with “good” but not entirely “conclusive” supporting evidence will be assigned a “B” designation. Label statements made with little or no conclusive evidence to back them up will fall into “C” and “D” categories.

This new proposal does not censor the health claims; rather, it retains claims while noting their strength. The measure might have been prompted by the 1999 court decision, Pearson v. Shalala , which requires the FDA to permit all truthful and non-misleading health information on herbal supplement labels, says Dr. Alice Lichtenstein, director and senior scientist at the Cardiovascular Nutrition Laboratory at Tufts University in Medford, Mass.

“The system is an excellent approach,” says Dr. David Katz, director of Yale University’s Prevention Research Center in New Haven, Conn.

Katz says the program will be particularly helpful because consumers are becoming increasingly responsible for reaching their own health-care decisions, which may often be based on direct-to-consumer advertising. This initiative would provide consumers with information in a recognizable way so that they are informed about what it is they are buying.

A changing and flexible grading system can also mirror the advances made in science as new health claims are studied and explored, adds Lichtenstein. Consumers could therefore be kept up to speed on the latest scientific evidence and what they are buying.

Noralyn Wilson, a registered dietitian and spokeswoman for the American Dietetic Association, believes consumers will be well-protected by this particular measure, particularly people who consume dietary supplements. “The FDA is just trying to get its arms around it [the dietary supplement industry],” she says.

Consumer Concern Currently, only health claims proven conclusively through science are printed on product labels. Some experts say that this new measure is a step in the wrong direction.

“Today’s FDA action lowers the standard for making health claims and it means that health claims on food packages will be less reliable. The agency is presenting a marketing advantage to the food companies at the expense of consumer welfare,” says Bruce Silverglade of the Washington-based Center for Science in the Public Interest.

“I think the grading system is going to make American shoppers even more confused about nutrition,” says Jeffrey Hampl, a registered dietitian at Arizona State University in Mesa. “Shoppers won’t be paying close attention to the A, B, C or D. They’ll see the health claim and base their decision to buy on that.”

Other experts assert that a passing out letter grades may not be so easily applied to health promises as it is to students, and believe that only claims for which there is sound scientific proof should be allowed on labels.

“No more fables on labels, please,” says Dr. Keith-Thomas Ayoob, associate professor of nutrition at Albert Einstein College of Medicine in New York. He contends that because claims receiving “C” and “D” statements are not sufficiently backed by scientific research, they simply have no place on a product label.

Although expert opinions are mixed, all agree that consumers deserve to be informed. “[We] need to focus resources in answering these uncertainties,” says Lichtenstein, “and potentially modify the system on the basis of what is learned.”

Background: Narrative assessment is sensitive to the communication impairments of children with specific language impairment and those with autistic spectrum disorders.

Although both groups of children tend to show deficits in narrative, it is unclear whether these deficits are qualitatively different and how language and pragmatic ability may impact on narrative competence.

Comparing these two groups of children with children who exhibit pragmatic language impairment without autism may help to clarify these issues.

Aims: This study explored the relationship between structural language ability and pragmatic competence in narrative in children with communication impairments and typically developing children.

Methods and Procedures: Diagnostic status was determined using the Children’s Communication Checklist.

All children were asked to generate a narrative to the wordless picture book Frog, Where are You? (Mayer 1969).

Narratives were analysed according to their global structure, local linguistic structure and the child’s ability to provide evaluative comments, especially about mental or emotional states.

Outcomes and Results: No group differences were seen in global structure or evaluation.

Children with specific language impairment and autistic disorder made more syntactic errors, and children with autism were significantly more likely to provide ambiguous references in the story.

No significant relationships were evident between the Children’s Communication Checklist and narrative measures.

The complexity of language used was related to evaluation in the clinical groups.

Conclusions: Narrative is a good way of assessing linguistic ability in older children with communication impairments.

Core language abilities rather than pragmatic skill or diagnostic status are likely to influence narrative development.

Chang HL, Juang YY, Wang WT, Huang CI, Chen CY, Hwang YS. Department of Child Psychiatry, Chang Gung Children Hospital, Republic of China, Kewi-Shan, Taiwan

Patients with adult autism spectrum disorder (ASD) continue to suffer from impairment in socialization and communication skills, and a proportion of them may develop psychiatric symptoms.

It is thus likely that physicians in adult psychiatric departments may see a number of patients with ASD.

Identification of patients with ASD is helpful and important for rehabilitation.

This study estimated the prevalence of ASD among adult psychiatric outpatients in a Taiwanese medical center.

A total of 660 patients were screened with Nylander and Gillberg’s “Autism Spectrum Disorder in Adult Screening Questionnaire.” Patients with high scores then underwent a diagnostic clinical interview conducted by child psychiatrists.

Department of Biology and Biotechnology Center, Utah State University, Logan, Utah, USA

To examine the etiologic link of viruses in this brain disorder, we conducted a serologic study of measles virus, mumps virus, and rubella virus.

Viral antibodies were measured by enzyme-linked immunosorbent assay in the serum of autistic children, normal children, and siblings of autistic children.

The level of measles antibody, but not mumps or rubella antibodies, was significantly higher in autistic children as compared with normal children (P = 0.003) or siblings of autistic children (P </= 0.0001).

Furthermore, immunoblotting of measles vaccine virus revealed that the antibody was directed against a protein of approximately 74 kd molecular weight.

The antibody to this antigen was found in 83% of autistic children but not in normal children or siblings of autistic children.

Thus autistic children have a hyperimmune response to measles virus, which in the absence of a wild type of measles infection might be a sign of an abnormal immune reaction to the vaccine strain or virus reactivation.

Developmental Neuropsychology Unit, Department of Psychology, University of Essex, Wivenhoe Park, CO4 3SQ, Colchester, UK

Executive skills are those involved in concept formation, problem solving, switching tasks, inhibiting inappropriate responses, initiating rapid and fluent responses, planning and sustained attention.

Different patterns of disorder amongst these skills have been found in several developmental abnormalities including autism, attention deficit hyperactivity disorder (ADHD) and Turner’s syndrome (TS).

This study explored, for the first time, executive skills in children with Klinefelter’s syndrome (KS), a sex chromosome abnormality in which there is one or more additional X-chromosomes.

A battery of executive tasks was administered, in a series of case studies, to three 10-year-old boys with KS and to controls matched for age, sex and intelligence.The results demonstrate that children with KS have impairments in executive skills.

There is evidence from multiple tasks of impairment in inhibitory skills, for each case of KS.

In contrast, concept formation, problem solving, task switching and speeded responding are normal.

These results support theories that argue for distinct sub-components of executive skills within development that may develop relatively independently.

The results have relevance for modelling both child and adult executive systems.

They also confirm that an additional X-chromosome has highly selective effects upon the consequent cognitive phenotype seen in development.

C.M. was known to throw chairs and punches, screaming and clawing in violent outbursts that left his classmates frightened and teachers exasperated.

The 16-year-old’s tantrums were well-documented and lasted anywhere from several minutes to two hours. Students in his classroom at Desert Ridge High School in Mesa had to be evacuated during some of the episodes in which he hit, kicked and poked others.

His disability precluded Gilbert Unified School District administrators from normal disciplinary procedures; the boy’s autism was to blame. School officials suggested placing him in a more structured environment because of his “dangerous and disruptive behavior.”

Where C.M. goes to school this fall is uncertain, and his case demonstrates a controversy centering on the Individuals with Disabilities Education Act, or IDEA. District officials are hoping to get a federal judge to uphold their decision to put him in a private school at district expense while his parents, citing the IDEA, want him to remain at Desert Ridge.

C.M.’s parents filed a petition with the U.S. Department of Education in May to keep their child at Desert Ridge. (Both the boy and his parents are referred to by their initials in court documents.) The hearing is scheduled for Aug. 15, a day after class begins, and school officials fear the child is a danger. The law says the boy will stay at the school until all appeals have been exhausted.

It’s not the first time a school has had difficulty with removing a violent, disabled student from the classroom. Current tenets of IDEA mandate educators carry out a number of steps before removal is an option, and parental consent is required at all junctures.

Under IDEA, exceptional students are guaranteed a free, public education in as normal an environment as possible as long as the student is learning and progressing as outlined in the individualized education plan. If not, the child may be transferred to an environment where there would be individual instruction and close supervision.

The IDEA does not have a provision for special-education students who are harmed by their classmates nor does it provide protection for staff.

Part of the problem, says the chairwoman of the Council of School Attorneys, is that parents believe school districts exaggerate the harm their children are creating in a “normal” setting.

“I think they feel very strongly about inclusion - that their child ought to be included no matter what,” said Nancy Fredman Krent, an Illinois attorney specializing in special education. “But I think it does a great disservice both to that child and to the other children in the classroom.”

Cases such as a 2002 U.S. District Court decision demonstrate the tendency of federal judges to favor the safety of classmates over IDEA regulations, Krent said. In that New Jersey case, the district court upheld a school’s decision to place a disruptive special education student in a different school despite the parent’s desire. The case focused on an autistic child whose parents wanted him to remain in an inclusion program at his home school despite transfer recommendations.

Revisions to the IDEA that are before Congress could mean fewer such cases, observers say.

The House recently passed a bill under which schools could not use IDEA funds to pay for disabled students to attend private schools. Instead, those funds would be used for supplemental educational services. The House bill also makes it easier to remove violent students by slashing several steps in the process.

Gilbert Unified lawyer Denise Lowell-Britt said she hopes Congress will approve more district-friendly amendments.

“There’s so much about special education law that is unfair to the school systems, unfair to the other students,” Lowell-Britt said.

An independent auditor recommended last week that the Fairfax County School Board close more than a dozen special education centers over the next decade and drastically reduce the number of students referred into special education.

To do so could mean a savings of more than a half-billion dollars in the next 12 years, consultant Greg Gibson told the board. He said the district spends between $12,700 and $38,700 per special education pupil -- 82 percent more than the cost of teaching a general education student.

“We’re not saying don’t serve these kids,” Gibson said. “We’re trying to say find another way.”

The School Board hired the Texas-based Gibson Consulting Group Inc. to evaluate the efficiency and effectiveness of the region’s largest school district. Yesterday, Gibson, the company president, presented the first of several cost-cutting recommendations.

The report on special education asks the board to close two special education centers every other year, ultimately leaving five or six open. Fairfax County now operates 21 centers, 15 of which serve emotionally disturbed children.

After hearing Gibson’s hour-long presentation, Superintendent Daniel A. Domenech said the school system has been modifying programs, and he cited the closure of a special education center in Franconia. But, he said, “we are aware of the demanding public that we serve. We have a litigious community.”

Some parents of special education students long have complained that the district seeks too readily to classify their children as emotionally disturbed or having special needs. They often accuse the district of doing so to isolate their children from others in the high-performing school district and to avoid lowering mainstream scores on important standardized tests. Lawsuits, too, remain common among families who say schools could be doing more to help their children individually.

Just over 14 percent of Fairfax students are in special education, but 22.6 percent of school employees work in special education, Gibson said. He called for more training of regular teachers and a more inclusive approach toward students who need additional help. “Inclusion,” which is already practiced in some classrooms in the county, brings resources into a mainstream classroom for special-needs children instead of sending the children out.

A high rate of referrals “happens because regular teachers run into an issue they cannot resolve with their own resources,” he said.

His presentation was met with much scrutiny and skepticism from both board members and school administrators.

“You get what you pay for,” Sanford Robeck, principal of the Chantilly Center, said in an interview. “It’s always been that the parents wanted more. They want the best for their child.”

The report questioned the centers’ effectiveness, saying that they are not necessarily the “least restrictive environment” for learning and are not strictly accountable for students’ performance.

That may have been so years ago, Robeck said, but he said the federal No Child Left Behind Act now requires special education students to show progress, too. “They are not exempt from testing,” he said, adding that the centers are a cost-effective alternative to obliging the district to pay private school tuition for special-needs children.

The Fairfax County Federation of Teachers for years has accused the School Board of spending too much on remediation and special education. “I’m ecstatic and feel vindicated,” President Judy Johnson said. “Every time I go to the powers that be to ask for more money, they say they have none. This report found half a billion of waste.”

Domenech said his staff needs to study the report before determining whether action will be taken.

It struck me as ironic when I read the ‘concerned’ response from the BioPort anthrax vaccine manufacturer about how anthrax was ‘called out’ as the cause of 22 year old Rachel Lacy’s death.

“There were five immunizations given at the same time,” BioPort spokeswoman Kim Root said.”To call one or two of them out would be the thing that concerns us.”

New moms are being beseiged with news touting the new 5 in 1 Pediarix for babies as the next greatest thing. The industry openly notes it was created to make room for more vaccines in the ‘schedule’ and to increase vaccine compliance. What they forgot to mention---that Kim Root of BioPort appears to inadvertently share with us---is that they expect full immunity for themselves too-- from liability.

The July 10, 2003 issue of the Schafer Autism Report had both an abstract and parent letter on the gastrointestinal problems seen in children with autism [Ask: “What Caused That?”, from Terri Small]. If the abstract is correct, at least 24% of our kids are suffering. And the author of the letter is right: As a parent, you suspect that the GI issues are either causing or exacerbating behavior problems, lack of attention, anxiety and a host of other symptoms we chalk up to part of our day-to-day battle with autism. For what it’s worth and in case it helps someone else, here are the nauseating details of our story:

In our case it was chronic constipation. When he was 4-and-a-half, our HFA son, Brian, just stopped moving his bowels. If you think this is impossible, let me assure you that, for what ever reason, in some children with autism it’s not. Despite many trips to pediatricians and specialists through the years, there seemed to be nothing we could do about it. Laxatives, Enulose, mineral oil, liters of mixtures that my son could not tolerate taking. We either couldn’t get it down him or if we could, it didn’t do any good. By around six, he began to “leak”, meaning he had lost muscle control and had become bowel incontinent. He smelled and had to wear a pull-up at all times.

The very intelligent letter from Teri Small prompts me to share the following notes that I took down recently during a lecture given by William Walsh, PhD of the Pfeiffer Treatment Center ( http://www.hriptc.org/ ).

I’ll add no comments (the notes are long enough in their own right), other than to say my son, now 18, started Pfeiffer’s protocol two years ago.

Lab tests do show a biochemical improvement. Even in the absence of results, I believe these people are onto something, and that this is precisely the sort of work that professionals need to be doing on behalf of our kids. (See http://www.latitudes.org/autism_articles.htm )

In 1968 Dr. Walsh was working in nuclear physics. He became interested in crime prevention as a community service (various do-gooder activities such as setting up educational programs and other services for convicts in prison, and helping them get a fresh start in life after release). He was surprised to discover that many convicted felons had ideal families, and began to think their crimes could not be the result of poor upbringing.

Some mothers of convicts told him they’d seen something wrong with their children as early as six weeks of age (children who resisted being helped and who when they got older would torture pets, could not be disciplined, etc.). These kids continued to have problems when they went to school, and of course the school blamed the parents. Sometimes powerful medications such as thorazine were tried, without any benefit. Ditto behavior modification. “A parent of a criminal is often a parent with a broken heart.”

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