The latest medical nonsense


Well. Now we have another cause of autism. Thanks, RFK jr!

There’s two studies that show children who are circumcised early have double the rate of autism. It’s highly likely because they are given Tylenol, Kennedy stated during a Cabinet meeting on Thursday.

That man is just incredibly stupid. He doesn’t understand cause and effect, he doesn’t understand correlation, and he doesn’t understand that you shouldn’t make off-the-cuff remarks drawing unfounded conclusions.

One of the papers he claims support his conclusion is direct that it is a correlational study, and it doesn’t even look at tylenol use.

The 2013 study looked at circumcision rates in boys versus autism rates. The authors admitted that national and state averages may show correlation, not causation, and said their study may have mistakes, bias and confounding. “Circumcision practices are also tied to culture and religion, which also affect autism diagnoses and health care use,” said Dr. Céline Gounder, CBS News medical contributor and editor-at-large for public health at KFF Health News.

Another expert brings up a rather salient point.

“There is absolutely no studies establishing any causality,” Dr. Steven Abelowitz, founder and medical director of Ocean Pediatrics, told CBS News. “While some observational studies suggest possibly an association, there’s no studies (showing causality) — and the conclusion by any credible medical resource is agreeing that there’s no causal relationship between Tylenol, circumcisions or vaccines to autism.”

“We almost never, ever use Tylenol after circumcision,” Abelowitz said, adding he’s performed about 10,000 circumcisions across his 30 years of practice.

Fire that guy.

By the way, circumcision is a pointless cosmetic procedure that you shouldn’t do anyway, but not because it causes autism.

Comments

  1. birgerjohansson says

    The practice may have started because men exposed to sand storms get sand grains under their foreskin when urinating, leading to painful inflammation (as reported by allied troops in North Africa).
    .
    If the idiot was right, we should have a solid statistical signal from millions of muslims and jews.

  2. numerobis says

    Circumcision is a really odd one, where the science pretty clearly says it’s stupid, but the vocal opposition comes from a flock of utter nutters inventing crazy reasons to oppose it.

  3. raven says

    The available evidence is that the genetic contribution to autism is high at 80%.
    The environmental factors that contribute are not well understood right now.

    Medical research also shows that autism is set in fetal development.

    Trends Neurosci. 2020 Apr 15;43(5):326–342.
    PRENATAL ORIGINS OF ASD: THE WHEN, WHAT AND HOW OF ASD DEVELOPMENT
    Eric Courchesne 1,2,*, Vahid H Gazestani 1,2,3,*, Nathan E Lewis 3,4,*

    Abstract
    ASD is a largely heritable, multistage, prenatal disorder that impacts a child’s ability to perceive and react to social information. Most ASD risk genes express prenatally and fall into two categories: broadly-expressed regulatory genes that express in the brain and other organs and brain-specific genes. In trimesters 1 to 3 (Epoch-1), one set of broadly-expressed (the majority) and brain-specific risk genes disrupt cell proliferation, neurogenesis, migration and cell fate, while in trimester 3 and early postnatal (Epoch-2) another set (the majority being brain-specific) disrupt neurite outgrowth, synaptogenesis and “wiring” of cortex.

    A proposed model is that upstream highly interconnected regulatory ASD gene mutations disrupt transcriptional programs or signaling pathways resulting in dysregulation of downstream processes such as proliferation, neurogenesis, synaptogenesis and neural activity. Dysregulation of signaling pathways is correlated with ASD social symptom severity. Since the majority of ASD risk genes are broadly-expressed, many ASD individuals may benefit by being treated as a broader medical disorder. An important future direction is the non-invasive study of ASD cell biology.

    The tl;dr version.

    A proposed model is that upstream highly interconnected regulatory ASD gene mutations disrupt transcriptional programs or signaling pathways resulting in dysregulation of downstream processes such as proliferation, neurogenesis, synaptogenesis and neural activity.

    We have identified hundreds of autism associated genes, with small effects that act together, i.e. poygenic. These genes are expressed in the fetal brain. The details after that aren’t at all clear.

    Needless to say, nobody is circumcising fetuses.

  4. John Watts says

    If this is true, then isn’t the best course of action not to circumcise infants?

    I’ve always viewed circumcision as a barbaric custom without any practical benefits. I would never inflict such pain on an infant. It’s a terrible introduction to the world.

  5. imback says

    @John Watts #4, even almost forty years ago, when our two sons were born, there was zero medical reason to perform circumcision, and we decided not to do that procedure with our boys. Unfortunately, people are still making stuff up to support one side or another.

  6. stuffin says

    If your momma took Tylenol while she was pregnant and you were circumcised, you have autism. And yet we are treating (preventable) communicable diseases as if they were our bosom buddy. As a medical professional for >40 years, this shit makes my brain hurt.

    The disconnect between preventable disease management and the spread of unsubstantiated medical claims is troubling.

    I guess I’m only half autistic, Tylenol didn’t come out until after I was born.

  7. Tethys says

    I guess it was his turn to make an absolutely bullshit claim to flood the public square with outrageous distractions.

    By modern standards, Einstein would be diagnosed as autistic. No idea on his circumcision status, but he clearly wasn’t exposed to Tylenol or childhood vaccines.

    I do hope that non-neurotypical people will someday be considered just that, atypical but completely normal. It’s not really a problem to be above average in intellect
    but find most human social behaviors exhausting and pointless.

  8. robro says

    “That man is just incredibly stupid.” Yeah, but stupid sells. Stupid i’s really big in America, Must do reasonably well in other parts of the world.

    A little surprising to me that so many of my boomer generation have this anti-science, anti-science-based-medicine sentiment. The first anti-vaxers I knew were boomer hippies living in the hills on “borrowed” land. Anti-vax was anti-government. Yet, all of us grew up on vaccines. I distinctly remember the Salk vaccine in 1954…first grade, my classroom window overlooking the annexes where they gave the shots. Much weeping and wailing, some screaming. Deeply unsettling, but I was imbued with how necessary it was. And it was.

    I wonder—has anyone investigated whether the rampant stupidity among boomers might be related to getting polio vaccines?

  9. seachange says

    Or, I could just suppose he is a cranky boomer being gratuitously antisemitic, he doesn’t really care what the study says, he never cared what the study said.

  10. imback says

    Saying that some random feature is uniquely found in common with boomers as a class is almost as much of an old wives tale as saying Wednesday’s child is full of woe. Come to think of it, that sort of kneejerk is also like prejudging the narratives from old wives.

  11. numerobis says

    Raging Bee:

    numerobis: WTF are you talking about? Who are these “utter nutters,” and what “crazy reasons” are they “inventing?”

    I was commenting on a post about how RFK Jr is claiming that circumcision causes autism. What do you think I’m talking about?

  12. numerobis says

    seachange:

    Or, I could just suppose he is a cranky boomer being gratuitously antisemitic, he doesn’t really care what the study says, he never cared what the study said.

    Possibly, but circumcision was widespread among boomers.

  13. Hemidactylus says

    robro @9
    The Salk vaccine was what I suppose is now known as IPV. I’m skimming Wikipedia. Every generation since the Boomers has gotten polio vaccinations but there was a shift to the oral Sabin vaccine. Before that was an infamous Cutter incident involving a bad batch of IPV. After several decades there was another shift in the US away from oral polio vaccination due to backmutation making vaccine derived polio remain in the population, but that switch happened after Gen X, and Millennials, and maybe some Zoomers got their doses of OPV. So some Boomers and then Zoomers got IPV.

    I recently got a series of IPVs though I probably had OPV as a child. I should be really stupid now. Long story short I can’t think of anything connecting the Salk vaccine or IPV to an alleged Boomer trait.

    I’ve seen some insinuation that later Boomers and Xers like me got too much lead exposure. This is usually coming from the younger generations. Grrrr!!! Was RFK Jr huffing leaded gasoline or eating paint chips?

    On the upside it is possible that shingles vaccinations might reduce risk of dementia. I wonder if RFK Jr would tout that. Thankfully chickenpox vaccination is now available, though I recall reading that may have contributed to an upswing in shingles in older generations dependent on occasional chickenpox exposure as a booster.

  14. numerobis says

    Hemidactylus:

    I recall reading [the chickenpox vaccine] may have contributed to an upswing in shingles in older generations

    That was a fear, and based on that fear, the UK decided not to vaccinate children, but it hasn’t really panned out. The incidence of chicken pox and shingles in children is dramatically reduced (not 100% of course, and indeed a friend just had their vaccinated kid break out in chicken pox). The risk of shingles later in life is also dramatically reduced. The risk of shingles in parents of young children is slightly increased if the kids are vaccinated, while that in anyone older or who doesn’t have kids is unaffected.

  15. chrislawson says

    Hemidactylus@14–

    IPV (inactivated polio vaccine) is a class of vaccine. Salk is an IPV. The current recommended polio vaccines are also IPVs but they are not Salk.

    Salk’s vaccine is IPV because it involves culturing polio, treating it chemically with formaldehyde so there are no active virions left, cleaning it up a bit, then giving it out as injections. In theory it is safer because there is no active virus.

    Sabin’s OPV (oral polio vaccine) is an attenuated live virus. That is, the virus is cultured for generations, repeatedly selecting strains that cause less severe infection, until we arrive at a strain that causes only minor symptoms but still gives a strong immune response to the wild virus. As you say, there is a chance with an OPV that it will back-mutate to become more like the wild variant, and there are even a few examples of polio outbreaks in under-immunised communities from regained virulence.

    The main reasons for the switch from Salk to Sabin were (1) the Cutter incident and (2) logistics.

    The Cutter incident was triggered by a number of children getting paralysis of the injected arm, and even some cases of full-on polio, which should not have been possible. The cause was failure of complete inactivation in the Cutter lab’s manufacturing process. Vaccinees were getting dosed with active polio, and not the nice attenuated version.

    In the light of this disaster, public health doctors re-evaluated polio immunisation and realised that the Sabin vaccine had a number of advantages. It gave an active viral infection, so the immune response was better. It only took a few drops by mouth (it didn’t taste bad and could even be dripped onto a sugar cube) rather than injection. It was much, much cheaper to manufacture, distribute, and administer. And it had the knock-on effect of often immunising entire families because the vaccinated child sheds attenuated virus, passing it on to others in the household (polio is highly infectious).

    The swing back to IPV was driven by the low but serious rate of back-mutation in the OPV. When you have a well-immunised community (as we used to have in the West before anti-vax nonsense went mainstream), it means that despite the low risk of back-mutation, it becomes the most common cause of clinical polio infection.

    But modern polio IPVs are very different to Salk. They are not cultured and killed. They are made of selected polio antigens that are inserted into GMO organisms and then harvested and purified. As a result, they do not contains thousands of unnecessary antigens (old IPVs like pertussis could have 16,000+ antigens iirc, mostly cellular debris from the killed culture cells, which meant lots of unpleasant immune responses to antigens that were not relevant to pertussis protection), and more importantly, live viral particles are not used in any part of production so there is no chance of another Cutter incident. IPVs are still a lot more expensive, less immunogenic, and more ouchy than OPVs.

    OPVs may make a comeback given new research where attenuated strains have been genetically modified to be less susceptible to back-mutation. It would some pretty impressive epidemiological numbers to make it happen, though, so I suspect it’s a fair way off. Having said that, OPV is still used in countries where the logistical benefits make it superior–usually less wealthy countries with limited infrastructure and remote or difficult to access population groups.

    There you have it…more than you ever wanted to know about IPVs vs OPVs!

  16. Hemidactylus says

    numerobis @15
    Yeah, this one here kinda puts the dampers on the putative benefits of being exposed periodically to chickenpox as a boost against developing shingles:
    https://academic.oup.com/jid/article/226/Supplement_4/S470/6764830

    When the US varicella vaccination program was introduced in 1995, its impacts on the epidemiology of herpes zoster (HZ) were not precisely known. We used a large claims database to examine HZ incidence in the US during 1998–2019 among persons aged ≥30 years (the prevaccine cohort, born before 1990), and aged 1–29 years (includes the postvaccine cohort, born since 1990). We defined incident HZ as the first instance of an outpatient or emergency department (ED) claim with an HZ diagnostic code. Additionally, we examined the proportion of HZ visits among all ED visits as a complementary method to assess for healthcare-seeking artifacts in the findings. In persons aged ≥30 years (prevaccine cohort), we observed age-specific increases in HZ incidence during the earlier study years, with decelerations in later years, starting in 2007 with oldest age groups. Similar patterns were seen when we examined HZ visits as a proportion of all ED visits. For persons aged 1–29 years, age-specific HZ incidence increased early in the study period for the oldest age groups who were born prevaccine, but later declined in a stepwise pattern once each age group was comprised of persons born in the postvaccine period. Our results, corroborated with previously published studies, do not support prior modeling predictions that the varicella vaccination program would increase HZ incidence among adult cohorts who previously experienced varicella. Our findings also suggest that continued declines in age-specific HZ incidence as varicella-vaccinated cohorts age are likely.

    This one is very complicated, mostly over my head, and focused on Alberta. I guess it’s better to focus on long term benefits more than the short term hiccups if they do exist:
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6015493/

    Our study suggests that over the longer time period, there will be a reduction in shingles incidence driven mostly by the depletion of source of shingles reactivation, suggesting that in the long-term a universal chickenpox vaccine would be a good policy to reduce both chickenpox and shingles cases. However, in the short to medium term some age cohorts may experience an increase in shingles incidence.

    Even with the chickenpox vaccine there might be some sort of much milder and perhaps rarer form of vaccine derived shingles decades down the road if I am interpreting this correctly:
    https://www.chop.edu/vaccine-education-center/vaccine-details/varicella-vaccine

    Like the natural virus, the vaccine virus can also live silently in the nervous system. However, it has been shown that the varicella vaccine virus is much less likely to reawaken. If it does reawaken, it is much less likely to cause severe shingles compared with natural varicella virus. This makes sense because the varicella vaccine virus is much weaker than the natural virus.

  17. beholder says

    Genital mutilation is bad. It doesn’t need to do the things RFK claims it does for me to oppose it.

  18. Hemidactylus says

    chrislawson @16
    Thanks for the distinction between Salk’s vax vs the more general IPV category and improved technology since. I was mainly (poorly) setting a vague timeline to assess robro’s tongue in cheek attribution of Boomer issues to that earlier polio vaccine (or polio vaccines in general?).

    Looking at things a little deeper Gen X may have really got the brunt of lead exposure in our formative years versus even later Boomers. That seems more an issue than vaccines and their ingredients.

  19. John Morales says

    beholder @18, that’s not the point. The point is that bullshit bases for policy pollute epistemic processes.

    I know PZ was singling out the very bullshittiness of it, so the ostensible point is RFK Jr spouts medical nonsense, but you know, he is in fact in charge.

    This is real and current:
    EPA: Scott Pruitt
    Education: Betsy DeVos
    Interior: Ryan Zinke
    Council on Environmental Quality: Kathleen Hartnett White
    USDA: Stephen Vaden
    IRS: David Kautter
    HHS: Robert F. Kennedy Jr.

    Each and every one of them has stated views that are antithetical to the agency’s brief, and has acted to weaken its function.

    And don’t get me started on people such as Tulsi Gabbard being appointed Director of National Intelligence by Trump. You reckon Harris could have put in a more Russia-friendly operative in charge?

    (You reckon Harris as Prez would have done as badly or even worse with that?)

    As I noted elsethread, a good way to see this admin is as a stress test for the USA constitution.

    (Not looking great, but too soon to despair, that’s my assessment as an outsider)

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