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Vaccines and Autism Revisited

http://content.nejm.org/cgi/content/full/359/6/655?query=TOC

To the Editor: In his Perspective article on a possible connection between

vaccines and autism, Offit (May 15 issue)1

<http://content.nejm.org/cgi/content/full/359/6/655?query=TOC#R1> speculates

about my daughter, Hannah, and repeats inaccuracies from a March New York Times

opinion piece that was officially corrected by the Times and our April 5 letter.

By omitting critical information from my March 6, 2008, statement, Offit

misrepresents my position. I said, " Many in the autism community and their

champions believe that the result in this case may well signify a landmark

decision as it pertains to children developing autism following vaccinations.

This still remains to be seen, but currently there are almost 5,000 other cases

pending. "

Offit's remarks about Hannah's case are not evidence-based. He has no access to

my daughter's personal medical records, legal documents, or affidavits. In

contrast, physicians from the Department of Health and Human Services (DHHS) who

studied this information recommended that the government concede Hannah's case.

The clinical history Offit presents contains significant inaccuracies, and the

resulting conclusions are consequently flawed.

Offit confuses issues by comparing Hannah's case with unrelated decisions in

" vaccine court. " The Office of the Secretary of DHHS, through the Department of

Justice, conceded Hannah's case. There was no courtroom hearing and no decision

from the " unusual vaccine court. "

Offit is frequently cited regarding the " biologically plausible " theory that

simultaneous administration of multiple vaccines is safe. His opinion is

unsupported by clinical trials, much less investigations in potentially

susceptible subpopulations.

Despite the high frequency of mitochondrial dysfunction in autistic children,2

<http://content.nejm.org/cgi/content/full/359/6/655?query=TOC#R2> studies have

not established primary or secondary roles. To explore this question, we need an

immunization database for children with metabolic disorders to establish safety

guidelines3 <http://content.nejm.org/cgi/content/full/359/6/655?query=TOC#R3>

and improve vaccine safety for minority subgroups of children.

I agree with the statement of Bernadine Healy, former director of the National

Institutes of Health, who said, " I don't think you should ever turn your back on

any scientific hypothesis because you're afraid of what it might show. . . . If

you know that susceptible group, you can save those children. If you turn your

back on the notion there is a susceptible group . . . what can I say? " 4

<http://content.nejm.org/cgi/content/full/359/6/655?query=TOC#R4> Also

commendable is the new 5-year research plan of the National Vaccine Advisory

Committee, which will entail the study of minority subpopulations, including

patients with mitochondrial disorders.5

<http://content.nejm.org/cgi/content/full/359/6/655?query=TOC#R5>

A strong, safe vaccination program is a cornerstone of public health.

Misrepresenting Hannah Poling v. HHS to the medical profession does not improve

confidence in the immunization program or advance science toward an

understanding of how and why regressive encephalopathy with autistic features

follows vaccination in susceptible children.

Jon S. Poling, M.D., Ph.D.

Athens Neurological Associates

Athens, GA 30606

jpoling@...

Dr. Poling is the father of Hannah Poling and reports receiving consulting or

lecture fees from Pfizer, Eisai, Ortho-McNeil, Biogen, Teva, Immunex, and

Allergan. No other potential conflict of interest relevant to this letter was

reported.

References

1. Offit PA. Vaccines and autism revisited -- the Hannah Poling case. N Engl J

Med 2008;358:2089-2091. [Free Full Text]

<http://content.nejm.org/cgi/ijlink?linkType=FULL & journalCode=nejm & resid=358/20/\

2089>

2. Oliveira G, Ataíde A, Marques C, et al. Epidemiology of autism spectrum

disorder in Portugal: prevalence, clinical characterization, and medical

conditions. Dev Med Child Neurol 2007;49:726-733. [iSI]

<http://content.nejm.org/cgi/external_ref?access_num=000249660400004 & link_type=I\

SI> [Medline]

<http://content.nejm.org/cgi/external_ref?access_num=17880640 & link_type=MED>

3. Brady MT. Immunization recommendations for children with metabolic disorders:

more data would help. Pediatrics 2006;118:810-813. [Free Full Text]

<http://content.nejm.org/cgi/ijlink?linkType=FULL & journalCode=pediatrics & resid=1\

18/2/810>

4. CBS News. The " open question " on vaccines and autism. May 2008. (Accessed

July 18, 2008, at

http://www.cbsnews.com/blogs/2008/05/12/couricandco/entry4090144.shtml.)

5. Draft ISO Scientific Agenda for NVAC Vaccine Safety Working Group. Centers

for Disease Control and Prevention's Immunization Safety Office scientific

agenda: draft recommendations. April 4, 2008. In: Scientific review. Washington,

DC: National Vaccine Advisory Committee Vaccine Safety Working Group, April 11,

2008:30. (Accessed July 18, 2008, at

http://www.cdc.gov/vaccinesafety/00_pdf/draft_agenda_recommendations_080404.pdf.\

)

Meryl Dorey

Editor

Informed Voice Magazine

PO Box 177 BANGALOW NSW 2479

Phone (61 +2) 02 6687 1699

FAX (61 +2) 02 6687 2032

meryl@... <mailto:meryl@...>

www.informedvoice.com.au <http://www.informedvoice.com.au/>