*coughbullshitcough*

I’m kind of sick of it though, after reading and calculating and re-reading and re-calculating. They did a screening tool, and then two diagnostic instruments on the kids whose parents consented. with the number of cases they identified, out of their whole initial sample, their raw prevalence figure was 0.38%. After a couple of paragraphs comparing proportions of autism, aspergers and other ASDs, came the kicker: after “statistical adjustment for non-participants” the prevalence of ASDs was 2.64%

LOLWUT??

It’s ok, they’ll explain how they got from 0.38% to 2.64% … right?

……….

Riiiiiiiiighhhht?!??!

Nup. They just point the reader to “Table 3″ which doesn’t explain anything; it simply displays their final figures. Total crap, unless they (just like maths class in school) show their working.

Edit: ok, looking again I see that they did – before the results section – go through the way in which they calculated the adjusted prevalence. Starting (to me incomprehensibly) with:

“We hypothesized that each child’s parents have an unobservable score on a latent variable representing willingness to participate in diagnostic evaluations. Probabilities for consent and evaluation after screening positive, likely indicators of this latent construct, were modeled with logistic regression, using parent-rated ASSQ score and child’s sex and age as predictors.”

And ending up with:

“Therefore, it is reasonable to infer that the probability of ASD diagnoses among children who were not definitively evaluated is no different from that for children who had full assessments. Hence, a simple proportional weigh-back procedure was used to compute prevalence estimates for the regular schools.”

So instead of comparing their positive diagnostic results against the total population (much like an intent-to-treat-analysis) they have gone through some contortions to arrive at the position that “it is reasonable to infer” that the non-participants were the same as the participants in terms of prevalence of ASD – and therefore they can just look at their positive diagnostic results as a proportion of the participant group. This is despite saying:

“ASSQ score was significantly positively associated with parental consent and with participation in the assessment…”

So higher screening scores for ASD are correlated with participation in further assessment, but it’s reasonable to infer there’s no difference between participant and non-participant groups. Que? And it appears all their fancy statistical jiggery-pokery was based on their “hypothesis” that “each child’s parents have an unobservable score on a latent variable representing willingness to participate in diagnostic evaluations.” … ‘K …

Also, to nitpick, it’s not an hypothesis, as they didn’t test/attempt to disprove it. So it’s a guess.

The other point, is that even if the 2.64% is right, it’s wrong. If a developmental disorder is present in 1 of every 38 people, then It. Is. Not. A. Disorder. How can it be? At what point will we stop and say “ya know, maybe we’ve got this a bit wrong. Let’s have another look at the category.”?

Steve Novella has blogged very thoughtfully about this (with a less dismissive take on it than me). One of the points he makes is that:

“…many of the undiagnosed children would likely not require or even benefit from special services.”

So remind me why the frak it’s called a disorder?

And why we need to identify these kids?

Dr Novella points out that 2.64% is almost exactly 2 standard deviations on the left side of the social ability bell curve, and also correctly points out that being at the tail of a bell curve does not equate with having a disorder.

I think this study is bad science, and bad medicine. Too much getting caught up in statistical tests and figures before actually applying basic logic and common sense. Both are necessary if we are to approach the truth of anything, and thereby help people properly. Psychiatry has been described as lurching between brainlessness and mindlessness. This is generally in discussions of how much the biological or psychological are eschewed in favour of the other, but another aspect is seen in psychiatric research: whereas in years past there was insufficient scientific rigour, and our literature was somewhat brainless, now the pendulum has swung to the point that I’ve heard of psychiatrists or psychiatric research being described as “desperately in search of a p value less than 0.05″.

Mindless.

When I replied to him that I thought it was great he was going to this trouble, he wrote that he works on the principle that he hopes someone else would do the same for him. That’s not a “you scratch my back and I’ll scratch yours” notion, mind you, as there’s no immediate or even necessarily likely tangible benefit to Duane. He’s not doing this so that someone will return a media player he lost the week before or something. What this shows to me is empathy. Duane knows how he would feel if he lost so many photos, and can suppose that the original owner must feel pretty much the same – and he wants to prevent/stop that.

Thinking some more, it occurred to me that empathy like this is an excellent candidate for explaining the evolution of moral behaviour. The idea is sometimes raised that without the existence of an external authority (for example a god) there can be no absolute morals. Unsurprisingly I disagree with this, and it seems to me that empathy goes a long way to explaining how various absolute morals have evolved.

Quite simply, if you can tell how someone else is feeling – or in fact to recognise how someone probably will feel given a certain set of circumstances/events, you’re just not going to want to do unpleasant things to them. You’re not going to beat them up, because you know you would feel sad and upset if you were beaten, and you don’t want to cause that distress to another. You’ll not steal from another, because you know how you’d feel if someone stole from you, and you can suppose that others would feel the same way. To the extent there are absolute morals, I think a strong capacity for empathy pretty much covers it.

Most animals seem to get by without empathy. I would suggest that this is because the groups are small enough and the interactions simple enough. Take say a group of cats (big or small): one bites another – it’ll get quickly smacked around the head for it, which is likely to reduce the probability it’ll do it again. That’s probably fine to manage group behaviour when there’s a limited and simple repertoire. As hominids began to do more complex things, in larger groups, this direct concrete feedback (aka being beaten about the head ) might not have been enough.

Enter empathy. Perhaps some of our ancestors happened to have some capacity for empathy, to recognise the way others were feeling, and to want to prevent them feeling bad. I can definitely see that leading to increased social cohesion (as they were doing good things for each other and not having to box each others ears quite so much), and that increased group cohesion could have led to better survival, compared to groups with fewer empathic individuals. Thus there could have been a positive selection pressure for the capacity for empathy, and as our species gradually evolved to be more empathic, we developed as moral agents; instead of not stealing each other’s food because if they caught us they’d hurt us, we’d not steal because if we did it would make them hungry and unhappy.

I thought as I started typing this that I should look to see what’s already written about morals and empathy. A book called “Empathy and Moral Development. Implications for Caring and Justice” (link is a pdf of the first 20 pages: introduction and overview) by Martin L Hoffman seemed to be the main thing coming up in my google search. I was a bit disconcerted to find that the idea that empathy is an important determinant of the development of morals seems to be held mainly by one guy, who’s been working on it for 30 years Does make me wonder a bit if perhaps an incorrect tree is being barked up … but it’s an idea that still does seem to me to make a lot of sense.

When I was a psychiatric registrar (trainee) I worked for 6 months in a forensic psychiatry unit. I was interested to find when we went through doing careful diagnostic reviews, that of my 25 patients, 5 or 6 had diagnosable pervasive developmental disorders (autistic spectrum disorders). Given that autistic spectrum disorders have a prevalence of about 6 per 1,000 that was a lot. One of the primary deficits in autistic spectrum disorders is in empathy; Simon Baron-Cohen talks about “mind-blindness“. That’s not to say that people with ASD are necessarily immoral; it just measn that because they lack some or all of a normal capacity for empathy, their moral development depends to a larger extent on other factors, such as actually paying conscious attention, for example. Their moral development is likely to be more susceptible than average to harsh, abusive and antisocial upbringings, so that combination could lead more easily to a poorly-developed moral sense.

The other 20 of course didn’t have ASD, but there was an unsurprisingly high incidence of antisocial personality and even psychopathy – both of which involve a lack of empathy. So reflecting back on my time there (anecdotal though it is) serves for me to reinforce the way I’m thinking about empathy and moral evolution.

Conclusion:

In summary, what I think might lie at the base of the evolution of a moral sense – and some moral absolutes – is the capacity for empathy. The more of someone’s else’s pain, unhappiness and distress you can recognise and feel yourself into, the less likely you will be to do something to cause pain, unhappiness or distress to others. That could have led to better group cohesion, as it allows for more complex social interactions than a box around the ears provides for, and that increased cohesion could have conveyed a survival advantage, thus creating a positive selection pressure for the capacity for empathy – and hence morals.

I’d be interested in any comments – especially from any moral philosophers or evolutionary scientists who might stumble across this.

I wish simply that this Christmas Jenny Mcarthy might be visited by the Ghost of Childhood Diseases Past, and come to realise what dreadful harm she is doing by encouraging parents to not vaccinate their children.

Merry Christmas all (except for something something something Jenny McCarthy and Jim Carrey, and J.B. Handley, and Generation Rescue, and Age of Autism, and so forth; they can have about as merry a christmas as all the parents of children needlessly ill or dead of vaccine-preventable illness are having)

By the way, that’s why this is Friday ‘Filosophy,’ not ‘Philosophy’: it allows me more latitude, as long as some discussion of thinking is involved.

First off I should mention that this post is not going to focus on the vaccine/autism manufacturoversy itself, as it’s been settled firmly for anyone who will allow themselves to look rationally at the issue.

I will also credit some of the thinking in this post to Daniel Loxton who has today been making some excellent points on Twitter about the ways in which skeptics and scientists should not talk about pseudo-and un-scientific beliefs and attacks. See here here here here for a few samples – making a very important distinction between beliefs being “wrong”, and “stupid”.

The point I want to make though, is embodied by the AoA ‘Thanksgiving Nightmare’: a photoshopped picture of various prominent doctors, scientists, and rational pro-vaccine journalists sitting down to a Thanksgiving dinner of baby (yes, you read that correctly, as seen in the picture above) – complete with delightfully offensive and misogynistic comments left by AoA members. This is incredibly offensive, not to say hurtful to those so attacked, and does precisely nothing to advance debate (leaving aside the fact that in this case the debate is not necessary).

Widening the frame, the accusations often made are that we doctors know that vaccines are ‘the cause’ of autism – or that various CAM ‘treatment’ modalities really do work – but we suppress this knowledge for our own evil twisted ends. More than that, the belief is (bafflingly frequently) expressed that we go as far as intentionally causing harm to children (with vaccines) or cancer patients (with chemotherapy) or to patients with psychiatric illness (with, well, you name it: medication, compulsory treatment, ECT…) so that we can profit from their misery.

Read that again, and consider the degree of evil we’re being accused of. With apologies to the late Darcy Clay:

I trained a lot, and I worked a lot, and Jesus I was evil
I spent lots of nights, saving lots of lives, and Jesus I was evil

I listened to evidence, of the kind that is science, and Jesus I was evil
I refused to use, a ‘cure’ without proof, and Jesus I was evil

So why would we do these evil things? Apparently because we’re all ‘in league with Big Pharma’. The implication of that (and it’s not always left as implied) is that we make huge amounts of money from the misery and suffering of our fellow human beings … You know: the human beings we went to medical school – spending well over a decade in training (if you add specialty training – and general practice/family medicine is a specialty, as far as that goes), which included many years working unconscionable hours in highly stressed and under-resourced conditions – so that we could help. Those fellow human beings. Yeah, we’re just all about making them sick so we can make money with Big Pharma. That’s what drives us. Yeah.

… Damn, that actually emptied my sarcasm gland. There’s none left. Probably for the best, as I want to talk about better ways of interacting and debating.

Oh wait, I found a last spurt: if we’re all in league with Big Pharma where’s my frakkin’ yacht?

Ahhhh I’m done ….

Anyway, that is the overarching motivation ascribed to us, and the accompanying dehumanisation and demonisation  make it possible for organisations like Age of Autism to engage in vile tactics such as the now vanished post that spurred this.

AoA comment quoted by Orac

That colours every interaction. There is unpleasantness and a complete refusal to listen (for example, though I personally cannot bear to see or hear the woman, it should be easy enough to find videos floating around of Jenny McCarthy shouting down “opponents” with cries of “bullshit!”). After all, why would anyone listen to someone so evil they would give children serious disorders in order to make money?

By contrast – and despite high levels of distress and frustration, the sentiment I generally see expressed by doctors and scientists about the bulk of people caught up in ‘antivaxxing’ or CAM or whatever, is that they are caring but misguided. I’ve even seen that written about Jenny McCarthy – I’m sure even by Orac. Believe it or don’t.  When refuting CAM or bad/pseudo-science, it’s not because we don’t like the claims, it’s really truly simply because they have been demonstrated to be wrong. Honestly, if there really was a simple panacea, we would grab it with both hands, and fête the discoverer with great fête-ness. But no matter how nice something would be, if the science says no, then the science says no.

Of course there are many reasons why people (with all our built-in logical fallacies) find that hard to accept, but that’s not what I wanted to write about. The point (if I can find one ) is simply about the way to approach this. Daniel makes it very clear why those of us in the rational camp must not give in to our frustration at people not understanding what we say (after all, what we say is often complicated, uncertain, and contrary to their anecdotal experience – further validated as it is by the clustering one finds on the internet). We must not head any distance down the road AoA just thundered along (and it seems has taken the nearest exit from). If you call someone stupid – or even imply it – why would they listen to anything more you say? If we are unpleasant in our interactions, it detracts from, rather than enhances our arguments. If the science is strong it should stand up without insults – and if it’s not, then the debate needs to happen.

And just once more I’d like to mention the fact that doctors are actually a caring and dedicated group. Yes there are some that aren’t paragons of virtue, and I’m sure some who get into medicine because of a perceived comfortable lifestyle, but I’m just as sure (yes: anecdotal experience and faith, I know …) that’s a small minority. Most of us actually care about people. We do the best we can for people. This unfortunately is why some of us are susceptible to falling into pseudoscience: we want so badly to help, that when there isn’t a science-based treatment, something else that promises wonderful results can seem very appealing. But please, don’t vilify those of us who resist that siren call. We will do what we can, but we will be honest when we can’t do more. And that doesn’t mean we don’t care, it just means we’re limited. It doesn’t invalidate scientific medicine, it’s just an acknowledgement that we don’t know everything.

- And it’s no more a reason to be offensive and abusive towards us, than others’ beliefs in pseudoscience/bad science is a reason for us to be insulting back.

<group hug>

The vaccines-cause-autism crowd are up in arms over, well, many things, but a recurrent theme has been the demonisation of thimerosal – because it’s really mercury don’tchaknow, and hence (I guess) all the chelation bollocks.

They’d rather we use only “natural” things (like coffee enemas, but I digress…)

So my question is simply: when exactly did mercury stop being natural? You know? Given that it’s one of the basic elements and all ….

I know: natural doesn’t mean safe …

But according to the anti-scientific-medicine cranks, anything natural is by definition safe and good and wonderful … Like snakes and arsenic and tidal waves (oh, except they were probably created by Obama in league with the reincarnation of Hitler, to distract us while they set in motion their plan to turn us into a zombie army using the swine fly vaccine).