I recently saw another news report about anti-Thimerisal protesters, and one again I am struck by the way people confuse increases in reported incidents with increases in absolute numbers. Now, I am not going to argue here whether or not Thimerosal has anything to do with autism, the medical community has done a pretty good case in presenting their arguments. What I want to discus is the possibility that autism numbers are increasing for reasons other than an increase in the absolute number of people suffering from autism*.

In the past decade we have seen an explosion of diagnostic tests being applied to children. In the past only a small fraction of the children who are diagnosed today would have even seen a therapist. In addition, as diagnostic criteria are expanded, more and more people fall under the rubric of autism. Where previously only today's most severe cases of autism would have been called autism, today people are diagnosed autistic who would have been considered healthy, if a bit strange, in the past.

Now many will say "if you ever knew anyone with autism you wouldn't say that"**. But they ignore the fact that the "spectrum of autism" now covers people with Asperger's, which can be so mild that an Asperger's sufferer competed on America's Next Top Model. That is hardly the definition of a crippling disease. Yes, there are horribly debilitating cases of autism, but autism is also applied to much less severe cases. So please do not tell me that people diagnosed today with autism could not have been missed completely in the past.

All of which is a long winded way of saying that perhaps the increase in cases has nothing to do with Thimerosal, or any other cause, but is instead an artifact caused by increased reporting. If it is nothing but an indication of either improved diagnostics or a shift in diagnostic criteria, then there really is no need to look for a cause, as it is not so much an increase in cases as an indication that we are finding cases we would previously have missed, or classified differently.

Such a statistical artifact is not unique. When our testing ability went from registering parts per million to parts per billion to parts per trillion, reports began that our drinking water was becoming ever less safe. Unfortunately, the truth was somewhat different. The parts per trillion of various chemicals had always been present, we simply could not see them. But, since we can now detect them where we could not before, scientifically illiterate newscasters suddenly began running reports on the dramatic increase in pollution.

It is an unfortunate side effect of our sound bite society, the incorrect 30 second blurb get reported because the accurate report takes too long to present. It is easy to shout "we're all going to die" and much harder to explain improvements in testing techniques.

I hoped that with the birth of the 24 hour news cycle the increased time available would allow for more in depth reports and act as something of a counterbalance to this trend, but it appears the 24 hours of the cycle are still filled with 30 second sound bites, meaning news has increased greatly in quantity but not one iota in quality.

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* I wrote before that I am sympathetic to some of the claims of Thomas Szasz. Despite his association with a Scientologist front group (which shows he has bad judgment, not that his arguments are invalid). I am not entirely convinced that our conception of mental illness is the proper approach. On the other hand, I am also open to alternate positions. In this case my mind is not completely made up. I tend to discount biological explanations, but I am still open to any argument.

** During college, before working in the refinancing field, I worked teaching mentally retarded adults to perform janitorial jobs, so I have quite a bit of experience with severe cognitive impairments as well as mental disorders, as the retarded seem to suffer from more mental illness than normal. So I have quite a bit of first hand experience with mental problems, I am hardly speaking from ignorance. (My wife also worked as a social worker in a mental hospital prior to receiving her RN, so I have some second-hand experience as well, for what that may be worth.) Granted someone suffering form both mental retardation and a mental illness is a different case than someone with only a mental illness, but I am hardly unfamiliar with mental disorders.

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POSTSCRIPT

By the way, to those who argue that we should just eliminate Thimerosal, we are doing so. And so are many other nations, in most cases several years before the increase in autism began. However, one consequence has been that immunizations have become more expensive, as, without preservatives, larger containers of vaccines will spoil, so they need to be packaged in smaller containers. It likely does not matter to relatively affluent westerners, but it will have quite an impact on attempts to inoculate less wealthy nations. If ther eis no health consequence to using Thimerosal,. then we will be depriving these less affluent people of needed vaccinations in order to avoid an imaginary threat. (Then again, in the case of DDT we allowed millions of deaths to avoid imaginary dangers, so perhaps that is not enough to dissuade policy makers.)