Continuing Vaccine Controversy

July 21, 2008

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HEALTH & SCIENCE

Vaccine-autism

link unsupported by science, but theory lives on

A central figure in advancing the concept may have his United Kingdom medical license revoked.

By Stagg Elliott, AMNews staff. July 28, 2008.

At

the Autism One conference in Chicago on

Memorial Day weekend, hundreds of parents and clinicians gathered to hear a

keynote by McCarthy, an actress and the mother of an autistic child, who

has publicly associated her child's illness with vaccines. Many conference

sessions were dedicated to doubts about immunizations. And, even when it wasn't

the focus, the notion that some aspect of vaccines may play a role in autism

was evident.

As the

number of children diagnosed with autism has increased, so has the number of

national support groups like this one. Parents often turn to these

organizations for help in finding an explanation for their child's condition.

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Discuss

on Sermo

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Fearing the vaccine more

than the disease

§

Mitochondrial disorders'

role

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" Is

the vaccine association real? Yes, I think it is. The future is going to see

some major advances in our understanding of vaccine strategies that are safer

for many, many more children, " said Dr. Wakefield, who was among

the conference's most well-known speakers. He also is the executive director of

Thoughtful House Center for

Children in Austin, Texas. He is not licensed to practice medicine in that

state.

Dr.

Wakefield was lead researcher for the controversial 1998 paper published in The Lancet, which linked the measles,

mumps and rubella vaccine with gastrointestinal disease and developmental

regression in 12 children.

His

Autism One speech outlined his side of the story regarding some of the fallout

from that paper -- specifically, the United Kingdom's General Medical Council hearings, which will

continue through August. At these proceedings, the council is considering

allegations of misconduct surrounding his research. The charges could result in

the removal of his right to practice medicine in his home country. It also is

reviewing the contributions of two co-authors on the 1998 paper. Dr. Wakefield

denies the charges of any wrongdoing. His speech received a standing ovation.

Two

different perspectives

Day in

and day out, physicians spend time refuting the theory that vaccines play a

role in the development of autism. The idea has been extremely tough to put to

rest, even though significant scientific efforts, numerous studies and multiple

evidence reviews have found no link.

" Scientific

data overwhelmingly shows that there is no connection between vaccines and

autism, " said AMA Trustee L. Langston, MD. " Autism is a

heart-wrenching condition, and the upheaval felt by parents whose children have

been diagnosed with autism is understandable -- as is their search for answers.

We need more research to investigate the actual causes of autism. "

More U.S. measles cases were detected in the first 4 months of 2008

than in the same period for any year since 2001.

But

those on the other side of the issue say the studies dismissing the

relationship are not conclusive. They wonder about the impartiality of the

Centers for Disease Control and Prevention, which has carried out many of the

investigations but promotes vaccine uptake as a part of its mission to improve

public health.

In

addition, people in this camp want biological rather than epidemiological

studies and resent being labeled " anti-vaccine. " They say they are

seeking safe vaccines for all children, including the ones they suspect may

have been harmed because of a genetic predisposition.

" I

don't feel that vaccines cause or have caused autism, but I do believe that

many of our children have problems with toxins, the metals that they may be

exposed to, and the things we add to vaccines, " said O'Hara, MD, a

pediatrician from Wilton, Conn., who presented data on this subject at the

Defeat Autism Now clinicians' seminar, which preceded the Autism One convention.

" These children cannot detoxify as well as neurotypical children. ... We

need a more individualized approach to giving vaccines, and to look at these

genetically predisposed children in a different way. "

Some also

argue that, even though thimerosal has been removed from most vaccines, there's

still enough to cause problems. And if thimerosal is not to blame -- because

that's never been proven -- then something about vaccines is causing autism.

Every so

often, a small study such as the one conducted by Dr. Wakefield comes along to

buttress that belief. In this case, the momentum has held, even though 10 of

the 13 authors on the 1998 paper published a statement in The Lancet in 2004 retracting the original

interpretation that their data indicated a causal link between MMR and autism, and Dr. Wakefield faces significant

professional scrutiny.

To many,

such retractions and medical board inquests are part of a conspiracy.

" It's a witch hunt, " said Mayer Eisenstein, MD, JD, MPH, a lawyer and medical director of Homefirst Health

Services in Chicago, who presented a session on vaccination at the Autism One

meeting. " These combination vaccines cannot be right. "

Rebuilding

trust

This

degree of staying power is why those who work on vaccine issues speak of the

need not only to investigate possible adverse events but also to rebuild public

trust surrounding the entire enterprise. A special article published in the

July Pediatrics called for more

public engagement in immunization issues and education on the complexity of the

vaccine safety system. The article also urged that more time be allowed to

build understanding about the rationale behind new vaccines before promoting

them, and that reliance on mandates to force parental compliance be reduced.

" It's

quite clear that the issues are really complex and don't lend themselves to

sound bites, " said Louis Z. , MD, lead author and professor emeritus

in the Dept. of Pediatrics at Columbia University's College of Physicians and

Surgeons in New York. He also is a former president of the American Academy of

Pediatrics, although he was speaking personally.

The steps

outlined in that article are needed because, experts say, despite all the

science supporting vaccine safety, this confidence has not necessarily been

conveyed to the public. A Web search on the word " vaccines " will turn

up many sites that question such assertions. Moreover, the general public has a

tendency to internalize the horrors of individual cases -- whether about a

child down the block, the experience of a friend-of-a-friend-of-a-friend or a

personal story found on the Internet -- rather than respond to population

studies.

" It's

very difficult to communicate good science to the public, and it's very easy to

scare people. It's very hard to unscare them, " said A. Offit, MD,

chief of infectious diseases at Children's Hospital of Philadelphia. He is also the co-inventor of one of the rotavirus

vaccines.

There's

no question that the seeming impossibility of putting this theory to rest has

done damage. In June, the United Kingdom's

Health Protection Agency declared measles endemic for the first time since 1994

and announced the first death from the disease since 2006. In May, the CDC

announced that more measles cases have been detected in the U.S. this year than in any year since 2001.

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ADDITIONAL INFORMATION:

Fearing the vaccine more than the disease

After

publication in The Lancet of the

1998 paper that associated the combination measles, mumps and rubella vaccine

-- MMR -- with the development of autism, and thesubsequent

media coverage, immunization rates in England dropped and the number of measles and mumps cases

went up. While the percentage of children beingvaccinated is rising again,

measles is now considered endemic there.

Percent

of 2-year-olds in England who received at least one dose of MMR, and the number of cases of measles and mumps reported:

Shots

Measles

cases

Mumps

cases

1995-96

92%

112

93

1996-97

92%

177

170

1997-98

91%

55

116

1998-99

88%

92

370

1999-00

88%

99

699

2000-01

87%

67

770

2001-02

84%

305

421

2002-03

82%

394

1,101

2003-04

80%

181

7,480

2004-05

81%

77

39,621

2005-06

84%

736

4,152

2006-07

85%

958

1,427

Note: The

time period for vaccination rates runs for the fiscal year from April 1 to

March 31. Cases are for the calendar year. The case numbers for 2007 are

provisional.

Source: Health Protection Agency, United Kingdom

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Mitochondrial disorders' role

In

response to concerns about the association between autism and mitochondrial

disorders, several federal health agencies in June convened a workshop in Indianapolis to discuss the science on this subject.

" Is

there a segment of kids with autism who have underlying mitochondrial

disorders? " asked Walter J. Koroshetz, MD, deputy director of the National

Institute of Neurological Disorders and Stroke, one of the agencies sponsoring

this event. " It's worth investigating to find out. "

The

workshop followed the United Mitochondrial Disease Foundation's annual

symposium and was in part a response to the case of 9-year-old Hannah Poling. A

special vaccine court awarded damages last fall to the Polings when it

concluded that a series of shots may have aggravated an underlying

mitochondrial disorder, leading to autistic-like symptoms.

That case

reignited public concern about a possible link between autism and vaccines.

Most physicians attending the workshop said, though, that the preventives were

crucial for children with mitochondrial disorders because infections can cause

them to deteriorate rapidly.

" The

feeling is that the risk-benefit ratio is in favor of vaccinating kids with

mitochondrial disorders, " said Dr. Koroshetz.

In

addition, significant interest emerged regarding further investigation of the

links between autism and problems with this genetic material responsible for

producing cellular energy. Researchers would like to set up studies that could

lead to ways to screen for this issue in autistic children, because detecting

such links is currently difficult.

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Weblink

Vaccine

safety, Centers for Disease Control and Prevention (www.cdc.gov/vaccinesafety)

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