Why Does the Vaccine/Autism Controversy

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Registered: 12-14-2005
Why Does the Vaccine/Autism Controversy
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Tue, 05-12-2009 - 10:30am
Why Does the Vaccine/Autism Controversy Live On?05.06.2009
Research has soundly disproved the alleged connection, yet fears about vaccines continue to be a major risk to public health.by Chris Mooney


Image: iStockphoto


Vaccines do not cause autism. That was the ruling in each of three critical test cases handed down on February 12 by the U.S. Court of Federal Claims in Washington, D.C. After a decade of speculation, argument, and analysis—often filled with vitriol on both sides—the court specifically denied any link between the combination of the MMR vaccine and vaccines with thimerosal (a mercury-based preservative) and the spectrum of disorders associated with autism. But these rulings, though seemingly definitive, have done little to quell the angry debate, which has severe implications for American public health.


The idea that there is something wrong with our vaccines—that they have poisoned a generation of kids, driving an “epidemic” of autism—continues to be everywhere: on cable news, in celebrity magazines, on blogs, and in health news stories. It has had a particularly strong life on the Internet, including the heavily trafficked Huffington Post, and in pop culture, where it is supported by actors including Charlie Sheen and Jim Carrey, former Playboy playmate Jenny McCarthy, and numerous others. Despite repeated rejection by the scientific community, it has spawned a movement, led to thousands of legal claims, and even triggered occasional harassment and threats against scientists whose research appears to discredit it.


You can see where the emotion and sentiment come from. Autism can be a terrible condition, devastating to families. It can leave parents not only aggrieved but desperate to find any cure, any salvation. Medical services and behavioral therapy for severely autistic children can cost more than $100,000 a year, and these children often exhibit extremely difficult behavior. Moreover, the incidence of autism is apparently rising rapidly. Today one in every 150 children has been diagnosed on the autism spectrum; 20 years ago that statistic was one in 10,000. “Put yourself in the shoes of these parents,” says journalist David Kirby, whose best-selling 2005 book, Evidence of Harm, dramatized the vaccine-autism movement. “They have perfectly normal kids who are walking and happy and everything—and then they regress.” The irony is that vaccine skepticism—not the vaccines themselves—is now looking like the true public-health threat.


The decadelong vaccine-autism saga began in 1998, when British gastroenterologist Andrew Wakefield and his colleagues published evidence in The Lancet suggesting they had tracked down a shocking cause of autism. Examining the digestive tracts of 12 children with behavioral disorders, nine of them autistic, the researchers found intestinal inflammation, which they pinned on the MMR (measles, mumps, and rubella) vaccine. Wakefield had a specific theory of how the MMR shot could trigger autism: The upset intestines, he conjectured, let toxins loose in the bloodstream, which then traveled to the brain. The vaccine was, in this view, effectively a poison. In a dramatic press conference, Wakefield announced the findings and sparked an instant media frenzy. For the British public, a retreat from the use of the MMR vaccine—and a rise in the incidence of measles—began.


In the United States, meanwhile, fears would soon arise concerning another means by which vaccines might induce autism. Many vaccines at the time contained thimerosal, a preservative introduced in the 1930s to make vaccines safer by preventing bacterial contamination. But thimerosal is 50 percent mercury by weight, and mercury is known to be a potent neurotoxin, at least in large doses. In 1999 new federal safety guidelines for mercury in fish stirred concerns about vaccines as well.


The U.S. government responded by ordering that thimerosal be removed from all vaccines administered to children under age 6, or reduced to trace amounts. (Some inactivated influenza vaccines were exempted.) The step was described as a “precautionary” measure. There was no proof of harm, government researchers said, just reason to worry that there might be. Meanwhile, scientists launched numerous studies to determine whether thimerosal had actually caused an autism epidemic, while some parents and their lawyers started pointing fingers and developing legal cases.


Within weeks of this year’s federal court decisions—which examined and vindicated both the MMR vaccine and thimerosal—environmental lawyer Robert F. Kennedy Jr. wrote a column in The Huffington Post in which he continued to press his case that the government has peddled unsafe vaccines to an unsuspecting public. It is a cause he has championed since 2005, when he published “Deadly Immunity” in Rolling Stone and Salon magazines. The article was a no-holds-barred denunciation of the U.S. public-health establishment, purporting to tell the story of how “government health agencies colluded with Big Pharma to hide the risks of thimerosal from the public…a chilling case study of institutional arrogance, power, and greed.” Half a decade after the original thimerosal concerns were first raised, Kennedy claimed to have found the smoking gun: the transcript of a “secret” 2000 meeting of government, pharmaceutical, and independent researchers with expertise in vaccines. Kennedy’s conclusion: The generational catastrophe was real; our kids had been poisoned. If true, it would be perhaps the greatest biomedical catastrophe in modern history.


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“It’s not hard to scare people,” says pediatrician and leading vaccine advocate Paul Offit. “But it’s extremely difficult to unscare them.”

But for Kennedy to be right, a growing consensus in the medical establishment had to be wrong. Indeed, Kennedy blasted a leading organ of science that had just vindicated both the MMR vaccine and thimerosal, the Institute of Medicine (IOM). “The CDC paid the Institute of Medicine to conduct a new study to whitewash the risks of thimerosal,” Kennedy wrote, “ordering researchers to ‘rule out’ the chemical’s link to autism.” In reality, the IOM—a branch of the National Academy of Sciences (NAS), the government’s top independent scientific adviser—carefully creates firewalls between the funding it receives to conduct scientific assessments and the results it ultimately produces. “Funders don’t control the composition of the committee, and they don’t meet with the committee,” says Harvard public-health researcher Marie McCormick, who chaired the IOM vaccine-safety committee in question. “And on no NAS or IOM committee are the members paid; they all work pro bono. There’s no reason for them not to look at the data.”


The same year Kennedy’s article came out, journalist David Kirby published Evidence of Harm—Mercury in Vaccines and the Autism Epidemic: A Medical Controversy. He followed a group of parents from the Coalition for SafeMinds, an autism activist organization. They had grown convinced that vaccines and other environmental factors had caused their children’s conditions. Kirby’s chronicle of the parents’ efforts to publicize the dangers of vaccines became a best seller and greatly advanced SafeMinds’ cause.


Yet even as vaccine hysteria reached a fever pitch in the wake of Kennedy’s and Kirby’s writings, the scientific evidence was leaning strongly in the other direction. In discounting the dangers of both the MMR vaccine and thimerosal, the IOM had multiple large epidemiological studies to rely on. For MMR, the IOM examined 16 studies. All but two, which were dismissed because of “serious methodological flaws,” showed no evidence of a link. For thimerosal, the IOM looked at five studies, examining populations in Sweden, Denmark, the United Kingdom, and the United States (studies that vaccine critics contend were flawed). Since then, further research has strengthened and vindicated the committee’s original conclusion. It is a conclusion that has been “independently reached by scientific and professional committees around the world,” as a recent science journal commentary noted. Either the scientific community has found a clear, reassuring answer to the questions raised about thimerosal in vaccines, or there is a global scientific conspiracy to bury the truth.


Whether the public is hearing the scientific community’s answer is another matter. “It’s not hard to scare people,” says pediatrician and leading vaccine advocate Paul Offit, who himself coinvented a vaccine. “But it’s extremely difficult to unscare them.”


A backlash against vaccine skeptics is beginning to mount. Standing up to fellow celebrities, actress Amanda Peet, who recently vaccinated her baby daughter, has become a spokeswoman for the pro-vaccine group Every Child by Two. Offit’s book Autism’s False Prophets has further galvanized vaccine defenders—not only by debunking the science of those who claim vaccines are dangerous but also by contending that the parents of autistic children and the children themselves are indeed victims, not of vaccines but of medical misinformation.


The provaccine case starts with some undeniable facts: Vaccines are, as the IOM puts it, “one of the greatest achievements of public health.” The CDC estimates that thanks to vaccines, we have reduced morbidity by 99 percent or more for smallpox, diphtheria, measles, polio, and rubella. Averaged over the course of the 20th century, these five diseases killed nearly 650,000 people annually. They now kill fewer than 100. That is not to say vaccines are perfectly safe; in rare cases they can cause serious, well-known adverse side effects. But what researchers consider unequivocally unsafe is to avoid them. As scientists at the Johns Hopkins Bloomberg School of Public Health recently found while investigating whooping cough outbreaks in and around Michigan, “geographic pockets of vaccine exemptors pose a risk to the whole community.”


When it comes to autism, vaccine defenders make two central claims. First, the condition is likely to be mostly genetic rather than environmentally caused; and second, there are reasons to doubt whether there is really a rising autism epidemic at all.


It is misleading to think of autism as a single disorder. Rather, it is a spectrum of disorders showing great variability in symptoms and expression but fundamentally characterized by failed social development, inability to communicate, and obsessive repetitive behavior. Autism generally appears in children at early ages, sometimes suddenly, and its genetic component has long been recognized. Studies have shown that if one identical twin has autism, there is at least a 60 percent chance that the other also does. “From my point of view, it’s a condition associated with genetic defects and developmental biology problems,” says Peter Hotez, a George Washington University microbiologist and father of an autistic child. Hotez, who is also president of the Sabin Vaccine Institute, says, “I don’t think it’s possible to explain on the basis of any vaccine toxin that is acquired after the baby is born.” Still, scientists cannot fully rule out environmental triggers—including various types of toxicity—that might interact with a given individual’s preexisting genetic inclination. Autism is a complex disorder with multiple forms of expression and potentially multiple types of causation that are incompletely understood.


As for whether autism is rising, a number of experts say it is hard to know. Is the increase real, or is it largely the result of more attention to the condition, an expansion of the autism spectrum to embrace many different heterogeneous disorders, a new focus on children classified as autistic in federal special education programs during the 1990s, and other factors? It could be some combination of all these things.


But if environmental triggers of autism cannot be ruled out, the idea that those triggers can be found in the MMR vaccine or in thimerosal has crumbled under the weight of scientific refutation. Epidemiological studies have cast grave doubt on Andrew Wakefield’s MMR hypothesis—and so have subsequent scandals. Nearly all of Wakefield’s coauthors have since retracted the autism implications of their work; The Lancet has also backed away from the study. A series of investigative stories published in The Times of London unearthed Wakefield’s undisclosed ties to vaccine litigation in the U.K. and, more recently, suggested he fabricated his data (which Wakefield denies).


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As for thimerosal, government precautions notwithstanding, it was never clear how threatening it might be. The federal mercury standards that first heightened concern were developed for methylmercury, not ethylmercury, the form contained in thimerosal. Ethyl

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Registered: 10-18-2007
Tue, 05-12-2009 - 11:23am

I couldn't get through the bias to finish the piece. Just once, I'd like to read a piece, and not be able to tell the author's predetermined stance.

I also don't see how subjecting people to the vitriol at RI so that they may be told how they cause irony meters to explode and the stupid to burn furthers discovery. Science-Based-Medicine is less trafficked by drive-by trolls and at least has some semblance of civility.

One commenter in particular on RI, is very interesting... I found this post while reading one day:

http://passionlessdrone.wordpress.com/2009/04/22/on-the-cause-of-autism/

On the ’cause’ of autism

Posted by: passionlessdrone on: April 22, 2009


There used to be a small time hockey league that had a team in my town, the Tigersharks. This was long ago, many years before I met the mother of Kid Autism, and indeed, during a time in my life in which it would not be unusual to go out on a Tuesday night, take some alcohol, watch a hockey game, and then take some more alcohol.

As anyone who has ever attended a hockey game is aware, the intermissions are painfully repetitive; especially if you have season tickets. There is a very finite, and low, number of times you can listen to the chicken dance without wanting to randomly punch people who are participating; the more fun they’re having, the more punches they deserve.

In any case, on this one particular evening, during one of the intermissions, there was a five minute, little league ‘hockey game’. None of the participants looked to be more than six years old, and I’d bet a few were four. To describe what transpired as a game is generous; it was more like two goalies, and a mass of ten kids swarmed around the puck like a pod of baitfish. All of the kids were smacking at the puck with their sticks, skates, and simultaneously pulling and pushing each other. The blob of children moved up and down the ice randomly; you could see each child trying to get the puck, but trying to tell which child was actually having an impact at any given time was impossible, there was just too much going on and too many combined small forces being applied.

At one point, the puck squirted free and a single child embarked on a slow motion breakaway that took a full minute. The goalie fell down, and the little guy fanned over the puck in front of an open net. It was, far and away, the most exciting breakaway in the history of hockey.

In many ways, when we look at what have been identified as risk factors for an autism diagnosis, it bears no small resemblance to a pee wee hockey game. There are lots of little things happening, and figuring out which is a cause, which is a result, and which is the result of a result of a result is very difficult. And lots of these forces are probably be different for any individual child.

In very rare instances, we have well established risks that greatly increase (or dictate) autistic behaviors; the Fragile X polymorphism for example. But what is found with far greater frequency is a genetic polymorphism or environmental exposure that raises the risk of autism, just a little bit; the equivalent of one pee wee out of ten taking a whack at the puck.

For example, a recent paper regarding genetic alleles involving the MET pathway suggests that having alleles in related genes even further increases the risk of developing autism, but not by much.

From the abstract:

Replicating our initial findings, family-based association test (FBAT) analyses demonstrated that the MET promoter variant rs1858830 C allele was associated with ASD in 101 new families (P=0.033). Two other genes in the MET signaling pathway also may confer risk. A haplotype of the SERPINE1 gene exhibited significant association. In addition, the PLAUR promoter variant rs344781 T allele was associated with ASD by both FBAT (P=0.006) and case-control analyses (P=0.007). The PLAUR promoter rs344781 relative risk was 1.93 (95% confidence interval : 1.12-3.31) for genotype TT and 2.42 (95% CI: 1.38-4.25) for genotype CT compared to genotype CC. Gene-gene interaction analyses suggested a significant interaction between MET and PLAUR.

What this tells us is that having a particular polymorphism in the PLUAR gene nearly doubles your risk of having autism, and another polymorphism on the same gene increases your risk of a diagnosis by almost 2.5 times. All in all, this is not too large of an risk factor; after all, despite all of our “greater awareness”, autism is still relatively rare; a doubling of risk still leaves you very, very unlikely to have autism.

The currently understood environmental exposures, at this time, all prenatal, have also been shown also to increase your risk of developing autism by very small increments. This paper on maternal exposure to pesticide application suggests that mothers living closest to fields with particular types of pesticides increases the risk of having a child with autism by about six times compared to women bearing children the furthest from those same aggricultural fields.

Other genetic analysis have provided evidence that having a combination of mutations can confer much greater risk than having either one of the mutations alone. In other words, having polymoprhism A raises your risk of autism by two, and polymophism B raises your risk by two; but having both polymoprhism A and B raises your risk of diagnosis by seven.

What all of this means regarding finding a cause of autism is that instead, first and foremost, we need to expand our horizons, and instead, accept that there are many possible causes of autism; there could be dozens of combinations of genetics and environmental influeces that eventually result in an autism diagnosis. Once we accept this reality, it makes our task that much more difficult; but accepting a difficult assignment is still far superior to tilting away at an easier goal; one that cannot be reached with any utility.

There are a diminishing number of people who claim that autism is either solely or genetic, but this (long needed) realization needs to go further; instead, we need to acknowledge that autism is the result of many different genetic and environmental actions working in concert.

_______________

Now, can you tell if this person is a zealot of either color? No, as it should be.

-Jamie

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Registered: 12-14-2005
Tue, 05-12-2009 - 10:32am

Kirby's Response:

The following letter was sent to the editors at Discover Magazine last week, regarding a recent article on vaccines and autism. The magazine claimed that the debate is over, but ignored the fact that federal and private support of research into a possible association continues.

I have seen a number of online postings and comments from readers of Discover Magazine who are wondering why freelancer Chris Mooney did not interview doctors and scientists who believe that more vaccine-autism research is warranted in his recent article, "Why Does the Vaccine/Autism Controversy Live On?"

Chris contacted me in mid-March to ask if he could interview me for the piece. When I wrote back to say that was fine, I added that I hoped he would consider "doing an honest examination of this controversy."

I also urged Chris before, during and after our 90-minute interview to not just listen to me, but to speak with several scientists and clinicians who do not feel like the vaccine-autism question has been thoroughly answered.

Chris and Discover Magazine have every right to craft an article as they see fit, and I would not tell another journalist how to do their job. Nor am I complaining about how I was personally portrayed in the piece. I am writing this simply for the record.

Among the things I mentioned to Chris was that Department of Health and Human Services' National Vaccine Advisory Committee Vaccine Safety Working Group (NVAC VSWG) had just recommended appointing a panel of experts to explore the strengths and weaknesses of conducting studies on health outcomes in vaccinated vs. unvaccinated children, and they said it was "desirable" to include autism as one of the health outcomes.

I suggested he might want to contact some of the mainstream doctors who supported the measure, which is still moving forward, even if they didn't personally believe in a connection. I sent him the names of many of these doctors, including Bruce Gellin, M.D., MPH, Director of the HHS National Vaccine Program Office (NVPO) and Executive Secretary of NVAC, Andrew Pavia, M.D., an NVAC Member and Chair of the NVAC Vaccine Safety Working Group, and James Mason, M.D., DrPH, an NVAC member and member of the Vaccine Safety Working Group and a former CDC Director and former Assistant Secretary of Health.

I suggested Chris speak to researchers doing some interesting work coming out of Harvard (Herbert et al) and Johns Hopkins (Vargas et al) in terms of autistic brain tissue and oxidative stress, chronic neuroinflammation, autoimmunity, microglial activation, etc. I also mentioned that Martha Herbert had been looking at the role that glutathione depletion and mitochondrial dysfunction might play in autism symptoms -- and that a new study from Stanford said that glutathione depletion is probably a marker for mitochondrial disorders. Other people I mentioned were Dr. Jill James et al at the University of Arkansas and Dr. Thomas Burbacher at the University of Washington.

I brought up the court cases of Hannah Poling and Bailey Banks, and suggested that Hannah's father Dr. Jon Poling might have some interesting perspectives on mitochondria, vaccines and autism. I also said that Bailey Banks's lawyer could attest that the previously normal boy developed acute brain damage after an MMR shot, which then turned into PDD-NOS, for which he will be compensated.

(As an aside to those who still don't think that PDD-NOS is an autism spectrum disorder, or ASD, the new autism report from the State of California's Department of Developmental Services states, "ASD includes Autistic Disorder, Asperger's Disorder, Rett's Disorder, Pervasive Developmental Disorder Not Otherwise Specified (PDD NOS), and Childhood Disintegrative Disorder.")

I also mentioned that researchers at HHS and the EPA working on the National Children's Study, in which federal researchers expect to find 600 to 700 kids with an ASD by age three and will compare these outcomes to genetic and environmental factors, including vaccines.

I spoke about the CDC program called the CADDRE Network, whose five year goal is to "identify what might put children at risk for autism," including "specific mercury exposures, including any vaccine use by the mother during pregnancy and the child's vaccine exposures after birth."

I suggested that Chris contact scientists at the Cleveland Clinic, Harvard University, and Johns Hopkins University who wrote in a recent study that "There might be no difference between the inflammatory or catabolic stress of vaccinations and that of common childhood diseases" and that "Large, population-based studies will be needed to identify a possible relationship of vaccination with autistic regression in persons with mitochondrial cytopathies."

Among the authors of that paper were Dr. Richard I. Kelley of the Department of Pediatrics at Johns Hopkins University Medical Center and Division of Metabolism at the Kennedy Krieger Institute and Dr. Margaret L. Bauman of the Department of Pediatrics and Learning and Developmental Disabilities Evaluation and Rehabilitation Services (LADDERS) at Massachusetts General Hospital. I said that Dr. Bauman, in particular, might have some interesting perspectives, given that she withdrew her name as a witness for the government in the Autism Omnibus Proceedings in federal vaccine court.

Along those lines, I also suggested that Chris might want to speak with Dr. Andrew Zimmerman, a pediatric neurologist and research scientist at Kennedy Krieger Institute and Associate Professor of Neurology and Psychiatry at the Johns Hopkins University School of Medicine. Dr. Zimmerman also withdrew his name as a government witness in vaccine court, and recently published a groundbreaking book titled "Autism-Current Theories and Evidence," According to the publisher, Zimmerman's goal is to "show how the scientific method is revealing the biological bases of this spectrum of disorders, thereby leading the way to their treatment and prevention using evidence-based medicine." The book is divided into 6 sections, including one on immunology and another on environmental mechanisms and models.

I also told Chris he might enjoy speaking with Dr. Douglas Wallace, Professor of Molecular Medicine and Director of the Center for Molecular and Mitochondrial Medicine in Genetics at UC Irvine. A member of the United Mitochondrial Disease Foundation's scientific board, and father of a son with autism, he testified that children with mitochondrial disorders are not only at greater risk for autistic regression, but they are also more likely to suffer from vaccine injuries. And, he told the NVAC: "We advocate spreading vaccines out as much as possible. Each time you vaccinate, you're creating a challenge for the system, and if a child has an impaired system, that could in fact trigger further clinical problems."

There were other prominent researchers I that thought could contribute to the article, such as former NIH Director Dr. Bernadine Healy, and Dr. Geraldine Dawson, Scientific Director of Autism Speaks, which currently supports and funds vaccine-autism research.

I also mentioned Dr. Duane Alexander, Director of the National Institute of Childhood Health and Human Development, who supports autism-vaccine research and who said that, "Genetic variations exist that cause adverse reactions to specific foods, medications, or anesthetic agents -- it is legitimate to ask whether a similar situation may exist for vaccines." He added that there may be, "subpopulations unable to remove mercury from the body as fast as others, or some adverse or cross-reacting response to a vaccine component, or a mitochondrial disorder increasing the adverse response to vaccine-associated fever."

Finally, I brought up Dr, Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases who recently said that, "If we can show that individuals of a certain genetic profile have a greater propensity for developing adverse events, we may want to screen everyone prior to vaccination (for) undetectable diseases like a subclinical mitochondrial disorder." Chris said he was interested in the idea of small groups of children being genetically vulnerable to vaccine injury, and in researching ways to identify them and, as I suggested, create an alternative vaccine schedule for them.

Perhaps Chris did contact some of these experts but did not find their remarks as compelling as mine, which seems doubtful.

I am sure that he and Discover Magazine have their reasons for not including comments from any of these professionals. Also for the record, I also spent over an hour on the phone with a factchecker at Discover, discussing much of the above information. Perhaps the magazine will let us know why their reporter chose not include any comments from Doctors Gellin, Pavia, Mason, Herbert, Vargas, James, Burbacher, Poling, Kelley, Bauman, Zimmerman, Wallace, Healy, Dawson, Alexander or Fauci.

http://www.huffingtonpost.com/david-kirby/discover-magazine-ignores_b_201922.html