It may metaphorically be said that natural selection is daily and hourly scrutinising, throughout the world, the slightest variations; rejecting those that are bad, preserving and adding up all that are good; silently and insensibly working, whenever and wherever opportunity offers, at the improvement of each organic being in relation to its organic and inorganic conditions of life. We see nothing of these slow changes in progress, until the hand of time has marked the lapse of ages… — Charles Darwin, The Origin of Species (1859)

One hundred and fifty years ago Charles Darwin published On The Origin of Species by Means of Natural Selection, or The Preservation of Favoured Races in the Struggle for Life. It was an instant success – being a highly anticipated work, and definitely has lived up to the hype.

The Origin of Species (as it is often shortened) is an absolute classic of science. Few books have had such an impact on our view of nature, and still produce so much controversy even after a century and a half.

The controversy over Darwin’s humble proposal began on day one. In a letter to Darwin, Thomas Henry Huxley (Darwin’s Bulldog) wrote:

As for your doctrines I am prepared to go to the Stake if requisite … I trust you will not allow yourself to be in any way disgusted or annoyed by the considerable abuse & misrepresentation which unless I greatly mistake is in store for you… And as to the curs which will bark and yelp – you must recollect that some of your friends at any rate are endowed with an amount of combativeness which (though you have often & justly rebuked it) may stand you in good stead – I am sharpening up my claws and beak in readiness.
— Thomas Henry Huxley

In other words – get ready for a fight, and I’ve got your back, buddy.

It is hard to imagine a book having the impact today that The Origin of Species did. The work was the culmination of decades of thought and research by Darwin – all tied together in one grand theory. Today this work would be spread out over dozens of papers, dribbling out over years. This is partly due to the pace of scientific progress today – a researcher sitting on an idea as important as evolution would risk being scooped – as Darwin himself almost was by Alfred Russell Wallace. (Some argue he was scooped, but his friends made sure that Darwin received first credit.)

Also, Darwin was a gentleman of independent means, while scientists today need to show steady progress in order to keep their job and their grants.

In any case, Darwin’s work changed the way we see the natural world, and our place in it, almost overnight. And his ideas have stood the test of time – 150 years later evolution is a vigorous and successful scientific theory.

The Origin of Species is a work now in the public domain. This means that you can read it for free – the book is available online at talkorigins.org.

Of course, if you still like to hold a bound wad of paper in your hands, there are many printings of the book available. One of interest is a version being handed out by creationist Ray Comfort. To “celebrate” the 150th of Darwin’s work, he is handing out thousands of free copies of The Origin of Species. But here’s the catch, he inserted an introduction in the beginning – 50 pages of long-debunked creationist nonsense.

I suppose this is only fitting – in a way it does celebrate the revolutionary nature of evolutionary theory, and the way in which it challenges our view of ourselves and the way nature works. The creationists are still desperately taking pot shots at Darwin, and failing miserably.

Comfort is a particularly intellectually lazy and sloppy proselytizer. His arguments are brain-dead and unoriginal. The National Center for Science Education has put together a nice point-by-point take down of Comfort’s intro (something anyone familiar with creationist canards could have done in their sleep).

I’m not worried about Comfort’s sad attack on Darwin. He is so incompetent that he is an enemy to his own side. In fact, it’s nice easy pickings for youg science enthusiasts who want to cut their teeth on some easy pseudoscience. It would be a good assignment in science class – pick a dozen points and refute them with logic and evidence. Be Darwin’s Bulldog for a day, and make T.H. Huxley proud.

If a more upscale copy of The Origin of Species is to your liking, you may be interested to learn that a rare first edition has recently been discovered – in the guest bathroom of a home is southern England. Imagine finding that laying around. It is going up for auction and is expected to fetch about $100k.

It’s been a while since I read The Origin of Species. I have a copy on my bookshelf – I will make it a point to read it again sometime this year.

Also – mark your calendars. On July 5 2037 we celebrate the 350th anniversary of the Philosophiæ Naturalis Principia Mathematica by Isaac Newton.

During high-risk procedures like surgery or childbirth, oral anticoagulants must be discontinued to minimize the chance of bleeding complications. While patients are off oral anticoagulants, they are given preventive treatment with antithrombin derived from pooled human blood. With any human blood product there is a small risk of infection with diseases like hepatitis C. And human antithrombin supplies are not plentiful.

Clever researchers found an ingenious solution. Put a human antithrombin gene in goats, milk them, isolate the human antithrombin protein from the milk, and voila! An udderly safe and plentiful source. A Brit might call it bleatin’ brilliant.

Yes, transgenic goats. No, they are not human/goat hybrids, despite a recent report that a goat had given birth to a human faun in Zimbabwe.

Sex between humans and animals does happen, but it can’t result in pregnancy because of the chromosome differences and other factors. 28% of men with bestial desires are attracted to goats. Goats come fourth after canines, equines and bovines.

You probably don’t know anyone who practices bestiality, but that doesn’t mean it doesn’t happen. I was e-mailed a video clip filmed by a Marine unit in Iraq, a light magnified night image (Improved Thermal Sight System). The marines were monitoring a known Taliban safe house. When they saw a suspect acting strangely, they thought he might be emplacing an IED. As they filmed him, they realized he was copulating with a donkey. They caught the whole thing on video. The best part is their comments as they watch the blurry images and gradually realize what they are seeing. It was apparently on YouTube briefly before it got banned. There is a similar clip with two Iraqis, one holding the donkey, that hasn’t been banned yet. Of course, I can’t guarantee this isn’t video trickery. But in 2005 there was a well-documented case of a man who died after having sex with a horse just a few miles from where I live. Washington State is one of 17 states where sex with animals is not against the law. Instead of choosing a receptive female equine, this unfortunate man chose a stallion. The man died of a perforated colon; the horse suffered no physical damage, although I suppose we could speculate about possible psychological damage… The whole thing was caught on videotape. Now there is even a movie. I report the facts without judgment: humani nihil a me alienum puto.

Pardon the prurient diversion. Back to the subject. Transgenic goats can’t be created by such “natural” methods: they require complicated tricky maneuvers in the lab. They are just like normal goats in every respect except that they produce one human protein, antithrombin. Still, it’s a wonder the religious fundamentalists haven’t been denouncing the evil scientists and bombing goat labs. Do they even know about this?

The recombinant human antithrombin is marketed under the brand name ATryn. It has been approved by the FDA for patients with antithrombin deficiency who are undergoing surgery or childbirth. Two clinical studies were done with 5 and 14 patients, respectively. Small studies, but it didn’t seem to call for a lot of investigation since it only amounted to replacing one of the patients’ own deficient proteins. No serious adverse events were reported.

The Medical Letter has evaluated ATryn (Volume 51, issue 1323, October 19, 2009. pages 83-63) and concluded it is a safe and effective source of replacement that may well turn out to have additional therapeutic applications.

Only one problem. It costs $2.34 per international unit, and patients in one study received anywhere from 39,200 IU to 294,000 IU. That adds up to $91,728 to $687,960 for one course of treatment for one patient. The manufacturer has a patient assistance program, but WOW! That’s a lot of money to protect one patient during childbirth! We don’t yet know how many patients will need to be treated to prevent one blood clot or save one life.

I can’t stop thinking about this. I am constantly amazed at the cost of some of the new drugs with limited applications, especially chemotherapy. And it’s not just the new, limited-use drugs. I recently got a prescription for what I thought was a cheap old antibiotic long available as a generic, and I was appalled at the price. It was more than ten times what I would have guessed.

It’s wonderful that science can accomplish such feats, and I have no ethical qualms about using goats as factories to help humans, but I wonder about the ethics of saddling society with unaffordable bills for treatments that provide only a small advantage. As we develop more of these expensive drugs, we could go bankrupt trying to provide them for every patient. It’s a dilemma that bears thinking about before it happens. One of the 4 basic principles of medical ethics is justice, or fair distribution of medical services to society.

However you look at it, our technical ability will eventually outrun our ability to pay.

And there is no doubt about the abuse potential and withdrawal potential of marijuana except among hard core denialists. The data is clear: marijuana discontinuation is associated with a withdrawal syndrome in many users, with some experts likening it in symptoms and severity to nicotine withdrawal.

As with any pharmacologically active substance, there are no “side effects”, only effects which we desire and those we do not. Given that cannabis is clearly a powerful pharmacologic agent, that there is a great deal of anecdotal evidence supporting its use, and that there is scientific plausibility to these claims, its potential use as a therapeutic drug should be investigated seriously.

As marijuana becomes increasingly available for medical use, practitioners of science-based medicine need to evaluate the evidence for the use of this drug. In evaluating a new drug, we must ask a number of questions, including those of safety, efficacy, and perhaps redundancy. Claims for the efficacy of marijuana tend to be hyperbolic, with no condition being exempt from its benefits. The state of Michigan passed a law last year allowing the use of medical marijuana. The statue requires a doctor to attest to the following:

It is my professional opinion that the applicant has been diagnosed with a debilitating medical condition as indicated above. The medical use of marihuana is likely to be palliative or provide therapeutic benefits for the symptoms or effects of applicant’s condition.

Once a patient has this certification, they are allowed to grow a small amount of pot for their own use.

What conditions does this apply to?

• Cancer �
• Glaucoma �
• HIV or AIDS Positive (sic)
• Hepatitis C
• Amyotrophic Lateral Sclerosis
• Crohn’s Disease
• Agitation of Alzheimer’s Disease
• Nail Patella

OR a medical condition or treatment that produces, for this patient, one or more of the following and which, in the physician’s professional opinion, may be alleviated by the medical use of medical marihuana.

• Cachexia or Wasting Syndrome
• Severe Chronic Pain
• Severe Nausea
• Seizures (Including but not limited to those characteristic of Epilepsy)
• Severe and Persistent Muscle Spasms (Including but not limited to those characteristic of Multiple Sclerosis.)

“Cancer” means so many different things as to be nearly meaningless. What if in my professional opinion the patient’s basal cell cancer might be improved with a toke? Leaving this aside, what evidence do we have that marijuana is safe and effective in the listed conditions, and that it has a better risk/benefit profile than extant treatments?

For example, a recent review of marijuana for for the use of muscle spasticity in multiple sclerosis found little objective evidence for its benefit. Glaucoma, one of the original “indications” for medical marijuana, is a condition for which many sophisticated and effective interventions exist, but the literature for the use of cannabis for this disorder is anemic to say the least.

The use for marijuana for many of these indications barely passes the plausibility test. Of what possible use could pot be in the treatment of hepatitis C or Crohn’s disease? The agitation of Alzheimer’s could just as plausibly be exacerbated by pot as palliated, and a recent review found no benefit.

Some areas with better plausibility include cachexia (weight loss due to chronic disease) and nausea, although the development of drugs such as ondansetron, with its minimal side-effects and excellent anti-emetic activity makes pot look redundant at best.

Dronabinol, a synthetic and legal marijuana-based drug has been used for a number of years for nausea and appetite loss, but the data have not been all that encouraging.

Marijuana offers many promising avenues of investigation, although there will be little advancement without a change in US government policy. But for a physician, the reason for the lack of data is not nearly as important as the lack of data itself. As physicians, we cannot ethically prescribe or recommend a powerful pharmaceutical whose effects are not at least reasonably well-known. In fact, it’s hard to envision any situation in which prescribing marijuana would be ethical. If there were a condition with a lot of anecdotal data and no other effective treatment, and the risks of the condition were such that they outweighed the health risks and dependence potential of marijuana, we would maybe—maybe—have something to work with. But for now, people who want to take cannabis should not count on a doctor to approve it for them.

But occasionally I do make a point of celebrating good science journalism when I see it – and not just a solid piece discussing a new science news item, but a reporter tackling a controversial topic and getting it right. Most of the time mainstream journalism of fake scientific controversies or fringe ideas falls for the “false balance” fallacy – presenting fake science and real science side by side, as if they were equivalent, or just a matter of opinion. Or, even worse, we get token skepticism, or no skepticism at all.

Last week the Chicago Tribune printed a long piece on biological treatments for autism by Trine Tsouderos and Patricia Callahan, and an excellent piece it was. They clearly understand what the real story is – a subculture of fringe doctors and others who are essentially doing unethical experiments and children with autism. They are exploiting desperate parents (who then sometimes contribute to the exploitation of the next desperate parents) who are seeking any possible help for their children.

Of course the desire of parents of autistic children to do everything they can to help them is perfectly understandable. But there is a quagmire out there – an insidious trap waiting to ensnare the vulnerable, in the guise of professionals offering help. So-called DAN (for Defeat Autism Now) doctors and others are offering a slew of experimental and often highly implausible treatments for autism.

These include chelation therapy, which is based upon the notion that autism is caused by heavy metal toxicity, including mercury. This idea has essentially been disproved, and there is no evidence to support the efficacy of chelation therapy – which is a risky treatment that can potentially be fatal. Tsouderos and Callahan point out that using an unproven therapy is akin to experimentation, but that these experiments on vulnerable children are not being conducted with proper protocols – so they are experiments that can never provide useful evidence. They will never prove that the treatments work or don’t work.

Further, parents are not being provided with the kind of informed consent that proper human research demands. These treatments are therefore unethical on multiple levels: the providers are not giving formal informed consent, they are not conducting proper trials that are gathering useful information, they are overselling their therapies, and they are charging for experimental treatments.

Further, they are wrapping their entire philosophy is a grand conspiracy theory – turning parents against the medical establishment, the government, regulatory agencies, and professional organizations. The result is a culture of hostility toward science and the institutions of science, while relying on fanciful and implausible experimental treatments.

They discuss the result of the Autism Omnibus hearing:

The scientists who testified sharply criticized the research behind alternative treatments, using words like “careless” and “misleading.”

“So much of what’s said doesn’t make scientific sense,” testified Dr. Robert Rust, a chaired professor of neurology at University of Virginia. “There is what I regard as cherry-picking, picking little pieces from the paper and ignoring the rest of it, and in some instances I think misrepresenting what the paper says.”

This hits upon the fact that alternative autism treatments are pseudoscience – they wrap themselves in the trappings of science, but this is simply a cover – they use evidence to support what they want to believe, not to discover where the truth lies. Then, of course, they turn around and accuse mainstream scientists of doing just that – a preemptive strike against their critics.

Another example of this pseudoscience is the use of provoked heavy metal urine testing. One test for heavy metal poisoning is to collect a 24 hour urine sample and see how much is being excreted in the urine. There are validated normal and abnormal levels, like all useful medical tests. But dubious testing companies, supporting the dubious treating doctors, perform a provoked urine test. They first give a drug that binds to heavy metals and excretes them in the urine. This dramatically increases, temporarily, the amount of heavy metals in the urine (we all have trace amounts of heavy metals in our system that we absorb from the environment). So of course these levels are much higher than the background level in the urine – but they use the normal values for unprovoked urine testing to claim that the high provoked levels means there is heavy metal toxicity. This is simply fraudulent behavior. It is malpractice.

This malpractice, however, exists in an “alternative” world, where practitioners have done everything they can to shield themselves from the mechanisms that enforce a standard of care.

It surprises me that more reporters have not caught onto the story behind this scandal. There is an obvious consumer-protection angle that usually works. But perhaps the tide is turning a bit – and thanks to Tsouderos and Callahan for a job well done.

Even worse, the myth that vaccines cause autism has led to ideas. Dangerous ideas, and not because they “challenge” medical orthodoxy. These ideas are dangerous because they have direct consequences for children with autism. These consequences take the form of subjecting children to unscientific treatments that are ineffective at best and harmful at worst, sometimes even life-threatening. Indeed, I have written about case histories in which children were subjected to injections of “stem cells” into their cerebrospinal fluid by lumbar puncture and various other “treatments,” as well as chemical castration in combination with chelation therapy. That latter bit of quackery is something I wrote about years ago, but that the mainstream press only just noticed earlier this year. Better late than never, I guess. Even better than that, though, the same reporting team at the Chicago Tribune that reported on Mark and David Geier’s advocacy of Lupron to treat autistic children back in May. Sadly, the result of that story does not appear to have been actions by the State of Maryland to take away Dr. Mark Geier’s medical license or to go after his son David for practicing without a license. Neither does it appear to have resulted in insurance companies going after them for prescribing an expensive drug for an indication for which it is not appropriate. What it does appear to have done, however, is to inspire the same journalist, Trine Tsouderos, along with another journalist from the Chicago Tribune, Patricia Callahan, to pursue an even bigger target that Mark and David Geier, namely the entire “autism biomed movement,” which is for the most part rank quackery, in the following articles:

• Autism treatments: Risky alternative therapies have little basis in science
• Autism treatment: Success stories more persuasive to some than hard data
• Questionable treatments for children with autism

This is another rare case of excellent reporting on this issue, and I hope that this report (another installment of which was published early this morning after I had written this post) will grab the attention of more reporters and news outlets, leading to shining a light on the dark underbelly of the autism biomed movement.

The aspect of this report that I most like is that Ms. Tsouderos gets it. She understands what I and other critics have been saying all along, namely that the autism biomed movement is almost all pseudoscience and quackery and that much of it “amounts to uncontrolled experimentation on children.” This is a message that has been a hard sell, because most lay people (and, sadly, a lot of doctors) do not understand clinical trials, clinical trial ethics, and why the physicians and “healers” promoting these unsupported therapies are in essence doing uncontrolled, poorly done, and poorly monitored clinical research, whether they recognize that’s what they’re doing or not. The rules and laws built up over decades exist for a reason, to protect patients and human research subjects from harm and risk as much as is possible. Because of their emotional and ideological investment in such therapies, they throw out rules in such a way that they’d find utterly unacceptable if a mainstream scientist or even worse–gasp!–big pharma were to do. The story sets up this concept right from the beginning:

James Coman’s son has an unusual skill. The 7-year-old, his father says, can swallow six pills at once.

Diagnosed with autism as a toddler, the Chicago boy had been placed on an intense regimen of supplements and medications aimed at treating the disorder.

Besides taking many pills, the boy was injected with vitamin B12 and received intravenous infusions of a drug used to leach mercury and other metals from the body. He took megadoses of vitamin C, a hormone and a drug that suppresses testosterone.

This complex treatment regimen — documented in court records as part of a bitter custody battle between Coman, who opposes the therapies, and his wife — may sound unusual, but it isn’t.

Thousands of U.S. children undergo these therapies and many more at the urging of physicians who say they can successfully treat, or “recover,” children with autism, a disorder most physicians and scientists say they cannot yet explain or cure.

But after reviewing thousands of pages of court documents and scientific studies and interviewing top researchers in the field, the Tribune found that many of these treatments amount to uncontrolled experiments on vulnerable children.

Remember how many times Jenny McCarthy has said of her son, “Evan is my science”? Indeed, take a look at this transcript from an interview she did a couple of years ago (sadly, the original video no longer seems to be on the web):

You know, I could in two months turn Evan completely autistic again. I could do it completely through diet. And maybe getting some vaccine boosters. Through diet, I could load him up again with all the things that will aggravate the damage that was done. Right now, what happened now was that I healed him to the point where he got everything back to this baseline level and it stays there like this. But I mess with it at all–boom!

Combine McCarthy’s frequent invocation of the mantra that “Evan is my science” plus the attitude that if she were to stop doing everything combine to demonstrate that this is indeed “experimentation” with therapies, as documented by the Trib (and that have been documented here many other times), that are at best unproven and implausible and at worst ineffective and potentially dangerous:

The Tribune found children undergoing daylong infusions of a blood product that carries the risk of kidney failure and anaphylactic shock. Researchers in the field emphatically warn that the therapy should not be used to treat autism.

Children are repeatedly encased in pressurized oxygen chambers normally used after scuba diving accidents, at a cost of thousands of dollars. This unproven therapy is meant to reduce inflammation that experts say is little understood and may even be beneficial.

Children undergo rounds of chelation therapy to leach heavy metals from the body, though most toxicologists say the test commonly used to measure the metals is meaningless and the treatment potentially harmful.

Indeed. The justification for using chelation therapy to treat autism is two-fold. First, claim its adherents, children are either “mercury-toxic” or “heavy metal-toxic.” Originally, back in the days when Generation Rescue used to proclaim boldly, “”There is no such thing as autism. Autism is a misdiagnosis for mercury poisoning.” These days, even J.B. Handley has moved the goalposts and now attributes autism to a more vague “overload of heavy metals, live viruses, and bacteria,” due to “the tripling of vaccines given to children in the last 15 years (mercury, aluminum and live viruses); maternal toxic load and prenatal vaccines; heavy metals like mercury in our air, water, and food; and the overuse of antibiotics.” The second rationale is a dubious, unreliable, and unproven diagnostic test in which children are given chelating agents and then the levels of mercury and other metals are measured in urine samples. Surprise, surprise! These levels are virtually always elevated (mainly because that’s what chelation therapy does, binds metals and leads to their excretion in the urine, even in normal children. These “provoked urinary toxic metals tests” are virtually guaranteed to show “elevated” levels of various metals, particularly because often the “normal” ranges used for these tests are based children who have not recently had a chelating agent administered:

Nobody knows what normal results of this test would look like, toxicologists say. There is no accepted reference range. Nonetheless, the lab sends back color-coded charts that show alarming peaks of metals graphed against a meaningless reference range that was calculated for people who had never been given a chelator.

“That is exactly the wrong way to do it,” said Dr. Carl R. Baum, director of the Center for Children’s Environmental Toxicology at Yale- New Haven Children’s Hospital. “There is a whole industry that preys on people’s fears of heavy metal poisoning.”

Though most labs note that the reference range used is for unprovoked results, the apples-to-oranges comparison still can set off panic in parents.

Indeed. It’s inherently deceptive to do medical tests this way. Whether that deception is due to the incompetence of the “biomed” doctors doing them or outright dishonesty probably depends upon the specific practitioner. In any case, study after study has failed to find evidence that elevated mercury or heavy metal levels has any relationship to autism. Moreover, representatives of the labs doing such tests even admit that they’re not clinically validated. Their excuse for not working on clinical trials to validate them? About as lame as it gets:

Toxicologist William Shaw, lab director of The Great Plains Laboratory in Lenexa, Kan., said determining appropriate reference ranges for provoked tests will take more research but noted that it is difficult to get such studies approved by ethics boards and to get parents to enroll their children.

Both Shaw and Johnson of Defeat Autism Now! said the labs are identifying real problems, saying they have seen children benefit from chelation. Johnson also pointed to improved test results.

“Our only bedrock here is the observation by clinicians and parents that their children get better when they are given agents which are known to remove heavy metals from the body,” Johnson wrote in an e-mail.

Except that, as Prometheus has pointed out time and time again, autism is a disorder of developmental delay, not developmental stasis. Autistic children can and do “get better,” a significant fraction of them even so far as to lose their diagnosis and an even large fraction of them improving enough to be able to be productive members of society when they grow up. That’s why anecdotes about autistic children “recovering” after chelation therapy are inherently unreliable, not to mention that there’s no control group against which to compare. Indeed, in an accompanying sidebar, Ms. Tsouderos points out several things that need to be driven home again and again. Anecdotes are inherently unreliable, particularly in a condition that waxes and wanes as much as autism. She emphasizes, as did Prometheus, that 10-20% of children with autism may make so much progress that they become indistinguishable from their peers and “lose” their diagnosis.

Three other points stand out. First is the reaction of a luminary of the autism biomed movement to this story, specifically Dr. Martha Herbert. (We’ve met her before.) I’m rather amused at how she responded to e-mail exchanges about chelation therapy, after pointing out that she supports “biomed” treatments for autism:

In an earlier e-mail she wrote that she would sue the Tribune if she was portrayed as “an uncritical booster and fan of potentially dangerous unorthodox treatments.”

“I’m not defending chelation,” Herbert said in an interview. “I will sue you if you say that.”

That quote’s not going to endear poor Dr. Herbert to the biomed movement at all, I suspect. On the other hand, because she so desperately wants to be the “respectable” face of the autism biomed movement, Dr. Herbert does need to try to protect what’s left of her academic reputation, and supporting obvious quackery like chelation therapy for autism would not help her in that endeavor.

The second point was that it’s really, really easy to become a Defeat Autism Now! (DAN!)-certified biomed practitioner and to be listed as such. First off, you don’t even have to be a physician! You can be a nutritionist, naturopath or a homeopath, chiropractor, or nurse. Then all you have to do is to attend a 13-hour seminar held by the Autism Research Institute, sign a statement agreeing with the group’s philosophy regarding autism, and then pay $250 a year. After that, you, too, can push supplements, give chelation therapy, and promote whatever biomed woo you want to desperate parents!

Finally, it was interesting to see what happened to Dr. Roy Kelly, an ENT doctor turned DAN! doctor whose incompetence and quackery killed an autistic child back in 2005. Unfortunately, his license was only suspended for six months, with two and a half years probation. In my opinion, it should have been permanently revoked because he has proven himself to be practicing outside the standard of care in a way that killed a child. Amusingly, however, he registered as a DAN! doctor a year after having killed an autistic child and continued to be listed until, well, I’ll let the story tell:

Less than a year later, Kerry was added to the registry. In 2008 he voluntarily surrendered his medical license pending criminal charges of involuntary manslaughter in connection with the boy’s death, according to the Pennsylvania Board of Medicine.

Those charges were dropped, but in July of this year the state board suspended his license for six months, with 2 1/2 years of probation, state records show.

Kerry’s lawyer, Al Augustine of Chicago, said there was no proof chelation killed the child and that Kerry agreed to the suspension to avoid the cost and emotional hardship of contesting it.

Defeat Autism Now! continued to list the doctor until Nov. 5, a day after the Tribune inquired about his inclusion.

Johnson said the group had already planned to drop him this month because he had not filled out paperwork on his medical license.

Such are the standards for DAN! doctors. Even worse, that Dr. Kerry only had his license suspended for six months as a result of what looks to me like gross negligence demonstrates the utter ineffectiveness of our system for licensing and monitoring doctors. Another luminary of the autism biomed movement, Dr. Rashid Buttar, in addition to selling autism “biomed” in the form of “transdermal chelation therapy” (sometimes jokingly referred to as “Buttar’s butter”) and even apparently urine injection therapy, provided unproven cancer “cures” for years for many patients, charging huge sums for them. The North Carolina State Medical Board has tried unsuccessfully to strip Dr. Buttar of his medical license. In any case, it does look amusingly not coincidental that DAN! didn’t drop Dr. Kerry from its roles until reporters from the Trib started sniffing around. If only the Pennsylvania State Medical Board were less reluctant to discipline wayward physicians like Dr. Kerry.

Not surprisingly, the autism biomed movement (or, as it is in my opinion, the autism quackery movement) wasted no time striking back. Indeed, within a couple of hours of the Trib story going live on its website, the anti-vaccine crank blog Age of Autism posted a notice to “Tell the Chicago Tribune They Are Wrong.” Instantly, the comments section of the Trib story was flooded with outraged boosters of “biomed” autism therapy. The dogmatism and pseudoscience on display are truly depressing to contemplate. But AoA wasn’t done. Yesterday, Kent Heckenlively, the AoA blogger who hit his daughter’s grandfather up for $15,000 to take his daughter to Costa Rica for dubious “stem cell” injections into her cerebrospinal fluid, next likened the Trib story to “playing the ‘telephone’ game,” complaining that the Trib didn’t take seriously the “studies” that he had referred Ms. Tsouderos to. Of course, real experts had told her the value of those studies, which is basically nil. I will give Mr. Heckenlively credit for melting my irony meter into a dripping, quivering pool of molten metal and rubber by saying that Ms. Tsouderos, “gives the appearance of thinking without actually engaging in the activity.” That statement, better than anything else, sums up the savvier members of the anti-vaccine movement. The less savvy members can’t even give the appearance of thinking, at least not of thinking critically and scientifically.

Autistic children have paid the price. They will continue to pay the price until somehow, some way, science-based medicine, rather than anecdote- and pseudoscience-based medicine can prevail. Autistic children deserve no less than the best scientific medicine that can be brought to bear on helping them to develop and alleviating their symptoms. They most certainly don’t deserve the unethical and uncontrolled experimentation to which far too many of them are being subjected.

There are other specimens of H. floresiensis, but none with cranial parts. The type specimen described above, designated LB1, is the only good specimen.

There has been a controversy surrounding how to interpret this fossil. In one camp are those who claim it is a modern human with dwarfism and microcephaly – a developmental disorder that results in a small head and brain. They cite as evidence morphological anomalies in the face and teeth.

The other camp maintains that LB1 is a new hominin species, separate from modern humans, deserving of its own taxonomical designation – H. floresiensis. In 2007 Dean Falk published an analysis of a virtual endocast of LB1’s skull – essentially a virtual picture of her brain. He argues that her brain does not have features in common with a microcephalic brain. It looks more like a modern human brain, but also has unique features all its own. In other words – it looks like the brain of a new and separate hominin species.

In May of this year another team published an analysis of LB1’s foot. They concluded that the foot definitely is that of a biped, but is more primitive than modern humans. It is longer in proportion to the femur, for example.

Now another team from Stony Brook University Medical Center has published a statistical analysis of all of the LB1 fossils. Rather than focusing on one feature, they looked at all the specimens and compared them to modern humans and to extant apes and humans with dwarfism. They found that LB1 does not cluster with modern humans or humans with dwarfism, but rather clusters with apes.

This finding is consistent with the interpretation that LB1 is a hominin species that branched off from the human line some time in the past. It now seems that the bulk of the evidence, and multiple independent lines of evidence, are all pointing toward this conclusion and away from the microcephaly hypothesis.

There are still two anticipated lines of evidence, however, that we do not yet have. We need to find more H. floresiensis specimens with skull parts, to confirm that LB1 is a representative specimen and not an anomaly.

Also, because LB1 is only 18,000 years old, and not fossilized (the bones were found in a wet area and are a bit mushy) this creates the potential that we may be able to extract mitochondrial DNA from the bones. If we can (perhaps not likely because of the moisture) then we can compare this to humans, Neanderthals (whose mitochondria we do have) and apes and see where LB1 falls.

Beyond confirmation that LB1 is a new species of bipedal hominins (although not ancestral to modern humans – just a side branch) there are also questions about how H. floresiensis is related to the human line.

In addition to the fossils which are 18,000 years old, there are stone tools that range from 13,000 to 90,000 years old that are associated with the fossils in such a way that they were almost definitely made by and used by H. floresiensis. These stone tools are more sophisticated than those used by H. erectus and are different than those used by modern humans. This also supports the side-branch hypothesis.

Stone tools were found elsewhere on Flores that date to about 840,000 years ago. These could be from an earlier population of H. floresiensis, or they could be from a population of H. erectus. H. erectus lived from about 1.6 million to 400,000 years ago – although specimens in Java could be as young as 50,000 years ago. In any case, this is within the 840,000 year timeline.

The reason to suspect that these tools may be from H. erectus, and that H floresiensis branched off from H. erectus, is that this was the first hominin species to spread out of Africa and across Asia. If H. floresiensis branched off earlier that H. erectus, then that would imply that some earlier hominin species spread out of Africa – something for which there is currently no evidence.

So H. floresiensis may force us to rewrite the story of hominin evolution and radiation – although not really the story of human evolution, because H. floresiensis is not on the line to humans.

The hesitation about simply concluding that H. floresiensis evolved from H. erectus is that LB1 has a really small brain, smaller than H. erectus – even when accounting for the reduction in overall stature. In other words, if you shrink down H. erectus to the height of a H. floresiensis, you don’t end up with the body proportions of H. floresiensis. H. floresiensis has a smaller brain still (about the size of a chimpanzee, but larger in proportion as chimps are bigger overall).

This suggests that H. floresiensis specifically evolved a small brain, while retaining a rather advanced tool-making ability. This has led some to speculate that H. floresiensis had a more efficient brain design – packing more cerebral power into a smaller space.

Overall, a fascinating story, that has much to teach us still. What I await most eagerly is the next high quality fossil specimens of H. floresiensis – that is almost certain to pack some surprises.