Autism Awareness
    Vaccine/autism Link Gets Double Shot In The Arm
    By Becky Jungbauer | February 12th 2009 01:40 PM | 21 comments | Print | E-mail | Track Comments
    About Becky

    A scientist and journalist by training, I enjoy all things science, especially science-related humor. My column title is a throwback to Jane

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    Parents and advocates who believe vaccines cause autism were dealt a double blow this week. On the scientific front, a discredited 1998 study that launched the vaccine-autism debate onto the forefront made headlines, and on the legal front, a special U.S. court ruled that vaccines are not to blame for the disease.

    The Office of Special Masters in the U.S. Court of Federal Claims
    oversees cases brought by "persons allegedly suffering injury or death as a result of the administration of certain compulsory childhood vaccines."

    The court ruled on three cases, saying it "was abundantly clear that petitioners’ theories of causation were speculative and unpersuasive" – in this instance, that the MMR vaccine and thimerosal don’t cause autism.

    Over 5,500 claims regarding vaccines and autism have been filed, so the court isn’t done yet. But the outlook isn’t good for the remaining claims that point to the organomercury compound thimerosal as the causal agent of autism, rather than the entirety of the vaccine – one of the masters stated that the petitioners "have failed to demonstrate that thimerosal-containing vaccines can contribute to causing immune dysfunction."

    Unfortunately, as indicated by a statement by the consumer group National Vaccine Information Center's president, the rulings will likely not change the fervent believers of the vaccine/autism link.

    Barbara Loe Fisher said the court’s ruling will do little to change the minds of most parents who suspect a link between vaccines and autism and more studies are needed. "I think it's a mistake to conclude that, because these few test cases were denied compensation, it's been decided that vaccines don't play any role in regressive autism."

    Actually, Barbara, that is what has been decided. And as the head of a vaccine consumer group, you should be aware of the scientific precedent and plethora of evidence against the link. Sadly, if legal rulings and scientific evidence don’t convince you, nothing will, and there’s no point in debating with you any further.

    Paul Offit, author of a number of scientific articles on vaccines, said in a Medscape article t
    hat "many people are reassured by these studies, although there are still a group of parents who hold that vaccines cause autism, much as some people hold a religious belief. To those people, it really doesn't matter how many studies you do, it’s not going to change their minds."

    Wakefieldgate and the creation of a house of cards

    Offit recently published an article in Clinical Infectious Diseases sy
    stematically disproving three main theories behind the vaccine/autism link. [Note: Offit is a co-inventor and co-patent holder of Merck’s rotavirus vaccine Rotateq. This doesn’t disqualify his research, but transparency is important.]

    MMR: One of the theories – that the measles/mumps/rubella vaccine causes autism – was promulgated by Andrew Wakefield in a 1998 Lancet article.

    The Wakefield article is making headlines this week, with a charge from a reporter who says that the medical records of the children shows all but one of the eight studied had autism symptoms before they were administered the MMR vaccine.

    You read that right – eight. Only eight children, and "a mini-industry of lawyers and activists" was launched, "and caused millions of children to risk their lives on the result."

    What happened? Wakefield’s article described eight children who received the MMR vaccines and within one month developed symptoms of autism. (Wakefield also parlayed these results into an argument for a gastrointestinal link to autism as well.) He hypothesized that the vaccine caused intestinal inflammation, which produced peptides that migrated through the bloodstream to the brain and affected development.

    Somehow a number of factors escaped early detection, according to Offit’s CID article (although the research was later discredited). One, there wasn’t a control group. Two, the study was unblinded. Three, gastrointestinal symptoms did not predate autism in several children. Fourth, measles, mumps, or rubella vaccine viruses have not been found to cause chronic intestinal inflammation or loss of intestinal barrier function. And finally, putative encephalopathic peptides traveling from the intestine to the brain have never been identified (although to be fair, this doesn’t mean they don’t exist). Thirteen descriptive and observational studies have demonstrated that there is no link between MMR vaccine and autism, Offit says.

    Thimerosal: The second theory Offit addresses in his paper is the thimerosal link.


    In 1997, the FDA Modernization Act mandated identification and quantification of mercury in all food and drugs; two years later, FDA found that children might be receiving as much as 187.5 micrograms of mercury within the first 6 months of life. Despite the absence of data suggesting harm from quantities of ethylmercury contained in vaccines, in 1999, the American Academy of Pediatrics and the Public Health Service recommended the immediate removal of mercury from all vaccines given to young infants.

    However, Offit says, because the signs and symptoms of autism are clearly distinct from those of mercury poisoning, concerns about mercury as a cause of autism were – similar to those with MMR vaccine – biologically implausible. A CDC study years later confirmed that conclusion. Seven descriptive or observational studies have also confirmed this finding.

    Multiple vaccines: Finally, Offit addresses the theory that "simultaneous administration of multiple vaccines overwhelms or weakens the immune system and creates an interaction with the nervous system that triggers autism in a susceptible host."

    This theory is flawed for several reasons, he says: one, vaccines do not overwhelm the immune system. Two, multiple vaccinations do not weaken the immune system. Three, although the exact cause of autism is unknown, autism is not an immune-mediated disease. Four, No studies have compared the incidence of autism in vaccinated, unvaccinated, or alternatively vaccinated children (although he acknowledges that these studies would be difficult to do practically and ethically).

    What do autism societies say? Interestingly, a number of them, such as the Autism Society of America and Autism Speaks, make no mention vaccines as a causal agent. The CDC and NIH also refute the link.

    The Autism Research Institute is one that clearly lists vaccines (along with environmental toxins) as one of the key triggers of autism and sadly advocates a number of opinions in editorials that are reminiscent of Barbara Loe Fisher.

    So what’s next? I’m not sure. As Offit says, people like Fisher will find support from folks like those behind Age of Autism, who refuse to accept anything other than what they believe is truth. Meanwhile, CDC and NIH and others will continue to research possible risk factors for autism. [For a dramatic look at the issue, check out this episode of Private Practice online.]

    Autism is a complex disease, and there's no denying that it can be a blessing and a curse. More research is needed, but we should expend our efforts on other triggers, and stop using vaccines as a crutch.

    Comments

    There *is* a relationship between vaccines and autism. The relationship is in the form of parents of autistic children being strongly convinced that vaccines caused their children's onset of autism. Not to overstate the obvious, but the question shouldn't be "is there are relationship between vaccines and autism?" but "what is the nature of the relationship?". Children undergo many tests and procedures, and there are many childhood ailments. Out of all of the different possible causal connections that parents could make about their children's health, why are they continually linking these 2? Is it just psychological? Maybe. But in that case, why vaccines and why autism? Why not eating dirt and learning disorders? Or having blood drawn and ADHD? I have to admit that I'm not particularly knowledgable about this area, but I've seen lots of studies denying the connection, but few satisfying explanations for why parents keep bringing it up. The few psychological explanations, I think, are demeaning to the parents; yes they've gone through a borderline traumatic parenting experience, but so have other parents of children with other developing problems that occur around the same age. People with MS were suffering from the condition long before it was recognized medically; part of the difficulty in recognizig is that science, esp. medicine, can be slow to change. But the failure is also one of close-mindedness and ignoring the concerns of those members of the public that the profession was supposed to be taking care of. I worry the same is the case in the autism-vaccine debate.

    Becky Jungbauer
    Well said. It's difficult as a parent to want to "fix" your kids and no one can give you a definitive answer; I can see how they'd grasp at anything that offers a smidgen of hope. Your point that scientists failed by ignoring the concerns of those members of the public that the profession was supposed to be taking care of is an interesting one; I think that it wasn't so much a failure as perhaps an underestimation of those members of the public and their refusal to accept the evidence. If you assume that everyone will base his/her opinion on the output of the scientific method, you will be wrong. Scientists did communicate with the public, but perhaps not in the way that the public needed in order to understand what was going on. ("What we have is a failure to communicate!") I could be wrong, but that's my reading of it.
    Gerhard Adam
    I wouldn't overlook the increased public skepticism about the pharmaceuticals.  People have become much more cynical when the results of a study support a corporate bottom-line (even if it is justified).

    Another problem is that the nature of scientific query is never absolute, so when parents hear that varous drugs, etc have side-effects (regardless of how small), this represents a finite probability and therefore becomes a possible connection.  Unfortunately, they have a point in that small effects are rarely adequately researched to determine what the full ramifications might be.

    Even relatively recent history has shown drugs that were approved for public use, and then a few years later there's a reluctant admission that death was a possible consequence resulting in the drug suddenly being pulled.  It's little wonder there is no trust in the information being provided to parents.
    Mundus vult decipi
    Even relatively recent history has shown drugs that were approved for public use, and then a few years later there's a reluctant admission that death was a possible consequence resulting in the drug suddenly being pulled. It's little wonder there is no trust in the information being provided to parents.

    It's doubly tough with vaccines because there's a public health component supporting them as well. I've heard some researchers claim that, among doctors in public health, there's a strong confirmation bias to discredit the link between vaccines and autism.

    Skepticism about overlooked side-effects in modern drugs could certainly play some role, be it in the actual side-effects of vaccines or in parents' perceptions. But I don't think that the latter can fully explain the link, b/c there's still the problem of specificity. I've repeatedly heard sympathetic doctors say things like vaccines and autism occur around the same age, so it's natural that parents might link the 2 together. But again many things occur at the same age, including starting various other drugs.

    Autism is clearly complex, but for this reason we can't afford to pass over any clues. If vaccines don't cause autism in the general public, then what about those cases in which they do seem to cause, or at least spur, autism? How do children with seemingly vaccine-induced autism compare to those without it, be it in terms of genetics, patient history, or etiology? What bodily processes are similar to those that occur in response to vaccines? Which theories can incorporate a role of vaccines?

    It's a shame that science is often so cooped up in laboratories to incorporate knowledge from unconventional sources. And this is an awfully strong hint, b/c no one knows a child as well as his or her mother. No one. And the issue has grown so large that if the relationship was absolutely null then it would warrant psychological research to explain precisely why these mothers are so convinced - perhaps that would teach us all something new about human cognition, and if it was well-conducted, it might even convince these parents why they're wrong. But in the absence of such a study, I think it's best to assume that there is a valid relationship of some sort between vaccines and autism, and that science has either failed or isn't strong enough to grasp it.

    Becky Jungbauer
    If vaccines don't cause autism in the general public, then what about those cases in which they do seem to cause, or at least spur, autism? How do children with seemingly vaccine-induced autism compare to those without it, be it in terms of genetics, patient history, or etiology? What bodily processes are similar to those that occur in response to vaccines? Which theories can incorporate a role of vaccines?
    Good questions; if you click on the NIH and CDC links in the article you'll see some of the research that is targeted at addressing at least a few of those issues. The problem is that there isn't an answer yet, so people mistakenly think, "Well, if science doesn't have an answer, then my theory is as good as any." I'd like to see people move forward on what IS happening in these kids, instead of fighting about what it might have been. Another thing to consider, regarding the timing - autism is diagnosed around the time of the vaccinations, so my first instinct would be to blame them as well, but so far the evidence doesn't seem to support it.
    Hank
    I have a hard time being as condescending as some in the science community (not here, but you know what I mean) about vaccines because parents are struggling for answers.   It doesn't help if a pharmaceutical company that gets hits with a $5 billion settlement starts doing major PR about a new vaccine you must have if you care about your children.
    Becky Jungbauer
    I think that's why the ruling today caught the attention of so many - I saw it on every newscast I watched tonight, and it's been on the search engine news sites all day. Parents are struggling for answers, and how can you not want to help these kids? I was glad that the special masters involved in the case review expressed sympathy for the family - perhaps it was a paltry sum, given what the families have gone through, but the masters at least demonstrated they were human and understood that this isn't an easy decision.
    Becky Jungbauer
    You are correct, Gerhard - there is skepticism, and I think it is definitely deserved. Sometimes I'm surprised anything is considered safe! I jest - there are some truly dedicated and wonderful people at the agency that honestly want to do the best they can for public health. But the scope is so large, and the nature of the agency as a governmental entity is so bureaucratic, that inevitably mistakes happen. There has been a concerted effort over the past several months to address the gaps - at a number of advisory committee meetings, during which outside experts advise FDA on whether to approve drugs or not, the panel members have explicitly stated their concerns that they need to be thorough and careful, because they've made mistakes in the past and it's come back to haunt them, and they can't lower the bar for standards of evidence (a direct quote). But it takes two to tango, or three, in this case - FDA, the pharma companies and the public.
    ms_w
    This is a nice summary of what's been going on in this area. I was surprised to hear that the "study" that seems to have started all this controversy was so poorly executed.  Autism is still such a mysterious condition in many ways- I understand that there are a lot of frustrated parents out there who want a reason, but it doesn't seem like we are going to find one anytime soon.
    Becky Jungbauer
    I was surprised as well. The study itself sounds laughable, so why it gained such traction is a mystery to me. There is a lot of research into the mechanistic underpinnings of autism, thanks to the publicity efforts of dedicated parents and advocates, but you're right, I'm not sure we're going to find one anytime soon. It's such a complex disease - think cancer, or something rare like hereditary angioedema - that it will take a while to untangle all the threads (if we even can).
    Considering all the commentary by Ms. Barbara Loe Fisher I went to the NVIC site to look up her qualifications.
    On this link: http://www.nvic.org/about/barbarafisherbio.aspx
    I see what is supposed to be a complete biography but there is no mention of her ever having been to college (let alone holding a degree), or even high school!

    Hank
    It's difficult to have a fair basis for 'qualifications' - James Hansen is the foremost authority in the world on global warming yet does not have a climate science degree and works at Goddard as an astrophysicist.    Al Gore has a bachelor's degree in English.   

    She's wrong on autism but not wrong in thinking vaccines for everything could be risky - biologists know this, ecologists know this.    There are big pharmaceutical marketing companies that see a gold mine in vaccines - Merck began a PR blitz for Gardasil, for example, after losing a $5 billion Vioxx settlement.   And why wouldn't they?   $5 billion was peanuts compared to what they made and if Gardasil does more harm than good, a settlement there could be peanuts too.    Now parents are told if they don't give a 9 year old girl a vaccine that only works 70% of the time they are killing their children.   I don't think that's right but their PR campaign is clever and will get the more militant internet writers to claim I am "anti science" if I don't agree that we need 200 vaccines for anything a pharmaceutical company claims is good for us.
     
    The world needs consumer watchdogs too.    She is wrong on autism, and should take her lumps, but that doesn't mean she will always be wrong on everything.  Ralph Nader has been wrong on plenty but was right about cars blowing up - and did not have a degree in mechanical engineering.   :)
    HedgehogFive
    Could we have your thoughts on James Hansen, please?  The Hedgehog frequents the Telegraph Blogs, but finds that it is a nest of anti-global warmers.  This is not untypical of their output: Leading climate change cheerleader James Hansen has 'lost the plot'.

    The mere mention of Al Gore will ensure that Hansen, by the African Tortoise Effect, will not get a fair hearing.
    Hank
    I don't have an opinion on him other than at some point media attention makes people more inclined to say what they are supposed to say rather than looking at all evidence. Anyone who disputes any aspect of CO2 is going to be dismissed by him (and others) because they've 'heard it all before' - which is fine, since most people don't know jack and just want to poke holes in things rather than be constructive (much the same as in opponents of evolution) but just like in biology, we learn new things every day, so books written even 20 years ago may not be as accurate.

    Climate science is tricky stuff. It relies not just on numerical models, which can have issues with the data sets and methodology but also knowledge of ice cores and expert statistical awareness. Who has all those things? Certainly not me.
    The Vaccine Court's release of its opinion on Darwin's 200th birthday was fortuitous, seeing as the vaccine-autism faithful have a good deal in common with religious fundamentalists. They are so invested in their ideas that they ignore or attack any evidence to the contrary, and treat gaps in the opposing evidence as further proof in their favor.

    The obscenity of the "anti-vax" movement is stupefying-- a campaign to reinstitute open sewers or ban refrigeration could scarcely threaten greater violence to the public health.

    I have much more to say on this topic here.

    Below I pasted an interesting rebuttal to the ruling (from http://www.lvrj.com/blogs/vin/No_vaccine_autism_link_can_be_found_if_you...). The author claims researchers have been blocked from receiving the necessary funds to thoroughly test the autism-vaccine link. The issue really interests me on two levels: First regarding the relation btwn autism & vaccines, and more broadly regarding the role of the gov't in funding research. My concern about the latter is that when organizations like the CDC or NIH develop national priorities, or refuse to fund researchers who disagree with them, they're might be doing more harm to science than good. I'd be interested about people's thoughts about either level.

    No vaccine autism link can be found if you don't look
    Posted by Vin Suprynowicz
    Wednesday, Jan. 28, 2009 at 04:15 PM

    We are told there have been no studies showing a link between autism and vaccinations. Could that be because they refuse to let Congress fund them?

    "Even as the evidence connecting America's autism epidemic to vaccines mounts, dead-enders at the Centers for Disease Control (CDC) -- many of whom promoted the current vaccine schedule and others with strong ties to the vaccine industry -- are trying to delay the day of reckoning by creating questionable studies designed to discredit any potential vaccine-autism link and by derailing authentic studies," Robert F. Kennedy, Jr. and David Kirby write this week at Huffington Post.

    They report that earlier this month a bunch of mid-level health bureaucrats voted to quietly strip vaccine research studies from funding allocated by Congress in the Combating Autism Act (CAA) of 2006. The authors said, "Members of Congress had said that this money should be used to study the vaccine-autism connection. ...

    "The bureaucrats responsible for this scandal are on the wrong side of history and it's hard to not attribute an obstructionist motive to their act since vaccine-autism research has already entered the realm of mainstream science," Kennedy and Kirby conclude. "Serious scientists (except those tied to the vaccine industry) no longer debate whether vaccine-autism research should be done, but rather how it should be done, and by whom."

    Becky Jungbauer
    Hi - thanks for posting the interesting rebuttal. There is plenty to say on government funding setting research priorities, but I'll let those more knowledgeable on the subject do that (one big example in the news right now - embryonic stem cell research).

    I am rather confused by this article, however. I found it online here, and can't really make heads or tails of it. They seem to be making several points, but what those are exactly isn't clear. They note, and I think correctly, that "Serious scientists (except those tied to the vaccine industry) no longer debate whether vaccine-autism research should be done, but rather how it should be done, and by whom." I completely agree. This doesn't imply, though, that by doing the studies scientists believe a link exists, but rather that valid, well-designed, rigorous studies need to be done to answer this question once and for all. (A subtle but necessary difference.)

    They also write that vaccine-autism research has gone mainstream, but castigate a committee for not funding studies. Perhaps the government isn't funding the studies they want, or isn't funding them enough, but if research has gone mainstream, someone is funding somebody, and research is getting done.

    The reasons they give for research going mainstream largely center around mitochondrial disorders - that comes up out of the blue, after railing against vaccines - and then a majority of the national studies are sponsored by none other than the CDC. So are they, or are they not, funding studies?

    The authors end with these two paragraphs, addressing Obama's call for more research:
    We could not agree more. The government must study the genetic and environmental factors that cause autistic symptoms such as neuro-inflammation and rapid brain growth, immune dysregulation, oxidative stress, glutathione depletion and microglial activation.

    Hard science is increasingly pointing to vaccines and heavy metals -- among other environmental triggers -- as suspects in the epidemic.
    These two paragraphs don't follow or connect. There are all of these genetic and environmental factors that trigger autism (which I agree definitely needs more research) - but then they state that vaccines are among the cause. Science does not in fact point to vaccines and heavy metals.

    While I applaud the effort, I think it lacks in coherence and execution.
    I agree; after posting the comment, I couldn't really find any more evidence for their point. I guess it's difficult b/c you can't really see who is receiving funding and who isn't, and even if you could, I'm not sure that would clarify the issue. I guess you really have to know the area and the different approaches.

    Although my mind keeps returning to a parallel situation, just b/c I know about it, which is research into chronic fatigue syndrome (CFS). The CDC has a modest but sizable budget to study CFS, but ever since CFS emerged, they've alienated a group of highly dedicated physicians and researchers. The latter group, despite their almost entire lack of funding, have been responsible for most of the progress in the field, including pushing what might soon be the first drug approved for it, along with running all sorts of ingenious shoe-string budget studies, all in spite of their lack of public funding.

    A part of me is suspicious that the same is occurring with the CDC, where they're just directing their funds to people who agree with them. But I guess it can be hard to prove this accusation when looking from the outside-in.

    The problem about the autism/vaccines issue is that the 'no link school' is comprised of liars. It just cannot be put any more delicately than that. Offitt says mercury poisoning and autism are different. Well in significant ways they are not. In the hat making industry in Northampton, UK and in Danville, USA there are tons of data about 'hand flapping' and other signs of Mad Hatters Disease that I have seen in hundreds of autistic people. Didn't a North American study into zebrafish show similar eye damage to that suffered by autistic people who employ peripheral gazes to see things around them? Is it not true that mercury and testosterone potentiate into a blood brain barrier crossing toxin that damages neurons? In any event isn't it also true that the USA federal gocernment has introduced hundreds of laws legislating against the use of mercury in appliances and prearations? Hasn't the World Health Organisation decreed that all future use of mercury will be met from re-cycled material? Is it true that the last mercury mine in the world closed in the last year or two? If it is OK to inject mercury into small infants why all these measures. If it is not safe to inject mercury into small infants doesn't Dr Offitt think that it's just possible that its past use has had some consequences?

    Tony Bateson, Cheltenham, Glos, UK GL52 3DS

    Gerhard Adam
    The problem about the autism/vaccines issue is that the 'no link school' is comprised of liars.
    That will definitely help convince people.  Simply accuse everyone else in the world of being dishonest and lying.  You're simply a fool and it's clear from your post that you understand nothing about mercury or autism.  It's people like you that simply think you can form an opinion, without any research or even any data.  You're the only ones that can see the "truth", so therefore everyone else must be lying because it's so obvious to you.

    You're an idiot.
    Mundus vult decipi
    It is not intended to convince anyone but simply to correct claims made by people who are entrenched in their views that mercury is safe whilst everything that is happening in many areas of mercury use suggests that it is not safe. The facts about Mad Hatters and the research about zebrafish can be easily found, the Boyd Haley conclusions about mercury and testosterone the same, and the closure of the worlds last working mercury mine was widely reported in mainstream media. I suspect you are one of the paid hacks I referred to. Latest reports suggest that 250 companies are paid by the Pharma industry to write to the media to massage its messages to the general public. If so its shameful to what extent the media has sold itself to big business.

    Tony Bateson, Cheltenham, UK