1. In trying to understand the extent of the CDC whistleblower reports I did some reading. One of the top hits on Google is actually an old CDC Whistleblower report related to none other than autism and vaccines (2014). We need to discuss this in context of a much larger picture.

2. The TIME post isn't bad per se, it does an okay job introducing the complaint and why it may not be totally valid, including the issue of causal inference. Posted in 2014, it seems this complaint is arguably linked to a VERY recent cropping up of multiple studies.

3. The complaint alleges that the CDC covered up data that indicated that Black boys who were vaccinated have a higher incidence of autism. Immediately, my thoughts were that someone overlooked the inequities faced by Blacks in the medical system

4. Blacks face inequities in healthcare, receiving suboptimal care compared to whites. As a result, there is distrust in the system and many are less likely to seek medical care. We need to do better.

This issue is incredibly deep in autism. And it is grossly overlooked.

5. We have known for a long time that minorities are overlooked in autism diagnoses (and diagnoses in general). Some of this may be the result of less care-seeking, due to stigma from the healthcare system, the distrust. I wouldn't want to visit a doctor who won't believe me.

6. Some of this may be the result of resource considerations, poorer access, our lack of universal healthcare. BUT autism has another layer: for those who do make it to a doctor, the means by which symptoms are reported varies across minorities. Thus, diagnosis is influenced.

7. Compared to white parents, Black parents tend to report less severe behaviors, and report less restricted, repetitive behaviors, behaviors that are required for an autism diagnosis. Why? Stigma may drive some of this. Black parents may be afraid of being further judged by Drs

8. Less severity = less likely you receive a diagnosis. But that's not all- doctors rate severity too, and doctors tend to rate Black children's behaviors as more severe than white children. Yet, whites are still more likely to receive a diagnosis. Same for other minorities.

9. Blacks and minorities, instead are more likely to have their autism ascribed to misbehaving, or are misdiagnosed as conduct disorder. On average, children who are Black receive an autism diagnosis 2 years later than children who are white.

10. So how does this fit into the TIME article above? Well, the complaint doesn't account for any of this. It instead acts as if all things in healthcare are equal. It may be possible that the reason that the reason the incidence of autism in Black children appears higher is..

11. Because the children who are vaccinated may represent a group that engages in more care-seeking behavior, thus they are more likely to have an autism diagnosis. A later article talks about how the prevalence of co-occurring intellectual disability is also higher in minorities

12. So what is likely occurring is that the more severe cases, cases in which there isn't much question about diagnosis are receiving care. More severe cases can generally get better access to needed services and as such, may also be more likely to be vaccinated.

13. By comparison, whites have more resources to receive a diagnosis even if their child does not present nearly as severe. This means the number of Blacks with autism who are vaccinated will be artificially inflated compared to the number of children without autism who are not.

14. Because some of the no autism/not vaccinated children who are black may actually have autism and have been overlooked by the various inequities in healthcare. They are missing their diagnosis or have been misdiagnosed altogether.

15. As an additional point for thought, many studies show that intellectual disability is associated with higher income, do you really believe this? Or is this just an artifact of someone who has the resources to seek a diagnosis? Beware of hidden inequities.

16. I am not done with this thread, as this post lead to be a host of studies related to the recent rise in prevalence in autism among minorities, which state that minorities have now surpassed whites beyond "catching up".

We need to discuss this, but I will make a new thread.