The only thing worse than bad science is ... worse science

New Scientist has a worthwhile article by Jim Giles on a controversy developing in the States regarding a new treatment for autism.

This is not the first time that the words autism, vaccine and controversy have found themselves tied together, at least not on this side of the Atlantic. In 1998, Andrew Wakefield published an article in the Lancet which suggested a causal link between the MMR vaccine and autistic spectrum disorder. The paper itself showed no basis for making such a conclusion but that didn't stop Wakefield making a name for himself on the pundit circuit as an expert in legal cases against vaccine manufacturers. It turned out that Wakefield had been bankrolled by some of the litigants involved and his credibility was rightly destroyed. It took six years for the other authors of the paper to retract their conclusions and another six years before the journal itself retracted the paper. Unfortunately this wasn't enough to stop Wakefield from scaring the everloving shit out of an untold number of parents around the world. Here in Ireland, the fallout from the controversy resulted in a drop in immunisation rates to below 80% and in some areas to as low as 60%. This resulted in a vastly increased number of hospital admissions leading to the deaths of three children, while more were left seriously ill.

Now a father and son team, Mark and David Geier have taken a leaf out of Wakefield's book and ignited a new vaccine controversy. In this case, however, the danger lies in the Geiers' promotion of a new treatment for autism, which is so dangerous it's hard to believe that anyone has taken them seriously. The Geiers published an article in Medical Hypotheses in 2005 which suggested Lupron as a possible treatment for autism. Lupron is a GnRH analog which is commonly used in the treatment of cancers such as breast cancer and prostate cancer because it has the effect of lowering the testosterone levels in the body. As a result it is also used to treat cases of steroid abuse. It can cause serious side-effects, however, such as respiratory distress and can even lead to a higher mortality rate in prostate cancer patients who also have a risk of heart disease. The Geier theory is that mercury is a leading cause of autism and that in the body mercury binds to testosterone. Therefore if the testosterone level can be lowered, a similar reduction in mercury level can be achieved. Unfortunately for the Geiers, such a mechanism is wholly unsupported by the evidence and led to the American Academy of Pediatrics publishing this consensus statement.

Since the Geiers' paper many more institutes have weighed in on the controversy and all have concluded that there is no basis for linking mercury with autism. This should have put the final nail in the coffin of this whole sorry business. Does it ever really work that way though? Now the Geiers have convinced a group of doctors in Florida to start treating children using Lupron. Such a development is likely to grow before the relevant authorities or good science steps in. We can only hope that this happens sooner rather than later. The difficulty is that the trust placed in doctors by parents can sometimes be extremely fragile and a controversy like this is likely to do irreparable damage to that trust as well as put the lives of thousands of children in danger.

The lesson here is that doctors should follow the science and not their own opinions or their wallets. In the words of Rodney McKay from Stargate Atlantis:

Medicine is about as much of a science as ... voodoo.