Autism and Vaccination: A Trench Warfare Scenario

A particular kind of argument that I have noted emerges when both sides in a dispute believe they are right, and the evidence "proves" their case. What seems to happen is a retrenchment, when both sides get dug unto fixed positions, very much like the opposing sides in the Great War, and lobby shells across the no-mans land to try and strike at the enemy. Rationality seems to take a back seat. There is no denying the sincerity of the people involved, but what they do is to seek confirmatory instances which prove their case, while ignoring any data that does not fit.

Imre Lakatos noted this in his seminal paper "Proofs and Refutations", which was a study in the history and logic of mathematical discovery. Given a "monster" which represents a challenge to an existing model or position, the options are:

Surrender - Throw the model away and start again

Monster barring - Reject the exception as invalid, a "monster". This usually involves refining the definition of one or more constructs, to explicitly exclude the exception as a monster. (1)

A case in point last year was a resurgence of the dispute over whether there is any link between vaccines and autism. In September 2010, CBS News reported on the case of Hannah Poling:

Terry and Jon Poling spoke publicly for the first time Thursday about a case being watched by thousands of families with autistic children. "My daughter, who had been completely normal until getting nine vaccinations in one day, was suddenly no longer there," said Terry Poling, mother of 9-year-old Hannah. Hannah Poling appeared to be like many children. At 19 months, her pediatrician noted she was "alert and active" and "spoke well." At that same visit, she got five shots - nine doses of vaccines. She almost immediately developed fever, seizures and severe health problems. Eight years later, the government has quietly conceded that vaccines aggravated a cell disorder nobody knew Hannah had, leaving her with permanent brain damage and autistic-like symptoms. (2)

The first court award in a vaccine-autism claim is a big one. CBS News has learned the family of Hannah Poling will receive more than $1.5 million dollars for her life care; lost earnings; and pain and suffering for the first year alone. Hannah was described as normal, happy and precocious in her first 18 months. Then, in July 2000, she was vaccinated against nine diseases in one doctor's visit: measles, mumps, rubella, polio, varicella, diphtheria, pertussis, tetanus, and Haemophilus influenzae. Afterward, her health declined rapidly. She developed high fevers, stopped eating, didn't respond when spoken to, began showing signs of autism, and began having screaming fits. In 2002, Hannah's parents filed an autism claim in federal vaccine court. Five years later, the government settled the case before trial and had it sealed. It's taken more than two years for both sides to agree on how much Hannah will be compensated for her injuries

In acknowledging Hannah's injuries, the government said vaccines aggravated an unknown mitochondrial disorder Hannah had which didn't "cause" her autism, but "resulted" in it. It's unknown how many other children have similar undiagnosed mitochondrial disorder. All other autism "test cases "have been defeated at trial. Approximately 4,800 are awaiting disposition in federal vaccine court.(3)

The language can be seen to be deliberately slippery. What is the difference between "caused" and "resulted"? It seems the legalese is being used to differentiate between a kind of direct cause - A and only A caused B, and indirect causality, A with C caused B.

There is a difference, but it is one of ignorance. If I give someone penicillin, not knowing that they are allergic to that antibiotic, I may kill them unintentionally, but I have not deliberately set out to do so, and I have given them an antibiotic that is very effective for a good many people. Drug allergy is a good case in point, because it occurs in smaller numbers:

Around 15 per cent of patients hospitalised in the UK report adverse reactions to medication, but less than five per cent of those reports are true allergic reactions (mostly to antibiotics). Of this five per cent, less than one per cent are fatal. (4)

But testing for something which is definitely known to happen - there are no "drug allergy deniers" out there - is in fact incredibly difficult:

Most medications are chemicals that bind with various proteins in our body, called haptens. It's this drug/hapten complex that may trigger an allergic reaction. As a consequence, these reactions are difficult to recreate on the skin or in a blood test, so blood testing for drug allergies is unreliable and inaccurate, with false positive and negative results.

Only penicillin, amoxicillin, sulphonamide and cephalosporin allergy can be checked by skin and RAST testing, and in such cases still has only 50 per cent reliability. (4)

Given this problematic scenario with regard to known allergies, it is probably that any autism / vaccine / genetic indirect causality would be even more problematic. That does not stop Congress Rep, Doctor Dave Weldon, for pushing for more research into screening:

Weldon has long been pushing the government to aggressively work to develop ways to screen for children who might be the most susceptible to ill effects from vaccines. The government has been telling the public for more than a decade that there's absolutely no reason to be concerned about any link. "I wouldn't recommend they say something like that in light of the Poling case and the admission on the part of the government," Weldon said.

While the Poling case is the first of its kind to become public, a CBS News investigation uncovered at least nine other cases as far back as 1990, where records show the court ordered the government compensated families whose children developed autism or autistic-like symptoms in children including toddlers who had been called "very smart" and "impressed" doctors with their "intelligence and curiosity" . until their vaccinations. They were children just like Hannah Poling. (3)

The Poling's had a special advantage, Jon Polling is a neurologist and had co-authored a peer-reviewed study on the his daughter, which was not contested by the government -

Autistic spectrum disorders can be associated with mitochondrial dysfunction. We present a singleton case of developmental regression and oxidative phosphorylation disorder in a 19-month-old girl...

To determine the frequency of routine laboratory abnormalities in similar patients, we performed a retrospective study including 159 patients with autism (Diagnostic and Statistical Manual of Mental Disorders-IV and Childhood Autism Rating Scale) not previously diagnosed with metabolic disorders and 94 age-matched controls with other neurologic disorders. Aspartate aminotransferase was elevated in 38% of patients with autism compared with 15% of controls (P < .0001). ... These data suggest that further metabolic evaluation is indicated in autistic patients and that defects of oxidative phosphorylation might be prevalent. (J Child Neurol 2006;21:170-172; DOI 10.2310/7010.2006.00032). (5)
There was some criticism of Jon Polling for using his daughter (if anonymously) as the subject of a paper, and of a potential conflict of interest. This seems to have stemmed from the "no problem at all with vaccines" lobby, which is a good example of how ad hominem arguments enter the fray, as if somehow because it was his daughter who was one of the test subjects, that his research would thereby be definitely biased.

However, this line of research seems to have been followed up later in the "Journal of the American Medical Association" in an article entitled "Mitochondrial dysfunction in autism." published in December 2010

Objective To evaluate mitochondrial defects in children with autism.

Design, Setting, and Patients Observational study using data collected from patients aged 2 to 5 years who were a subset of children participating in the Childhood Autism Risk From Genes and Environment study in California, which is a population-based, case-control investigation with confirmed autism cases and age-matched, genetically unrelated, typically developing controls, that was launched in 2003 and is still ongoing. Mitochondrial dysfunction and mtDNA abnormalities were evaluated in lymphocytes from 10 children with autism and 10 controls.

Results The reduced nicotinamide adenine dinucleotide (NADH) oxidase activity (normalized to citrate synthase activity) in lymphocytic mitochondria from children with autism was significantly lower compared with controls (mean, 4.4 [95% confidence interval {CI}, 2.8-6.0] vs 12 [95% CI, 8-16], respectively; P = .001).

Conclusion In this exploratory study, children with autism were more likely to have mitochondrial dysfunction, mtDNA overreplication, and mtDNA deletions than typically developing children.

Now this is a small study, and has been seized upon as "proof" that vaccines cause autism. In fact, the author of the study, Professor Giulivi, clearly regards this as a pilot study, as revealed in an interview:

KL: Do you think, based on available science (including your paper) that vaccines cause autism?

CG: We do not have any evidence for this in our study. Our study was cross-sectional not longitudinal so it cannot point to any cause (not just vaccines), meaning we do not have any data supporting one way or another.

KL: "Do you believe your own paper adds weight to any opinion regarding autism causation by any means?"

CG: "No. At this point we do not know if it is mainly genetic, environmen­tal or a combinatio­n of both. Again, with a cross-sect­ional study you get a snapshot of the situation but not how you got to that situation

The author of the interview (Kevin Leitch) is clearly determined to debunk the idea that there could be any autism vaccine link, and notes that this means that the "study in question does not add weight to any hypothesis of autism causation, let alone vaccines." He rightly has also observed that a biological malfunction could cause side effects from causes other than vaccines, such as illnesses, but if it is a weakness to the immune system, why is he so concerned to absolve vaccines from the possibility of being involved?

It is obvious that a study of 20 individuals could hardly lend much "weight" to anything, but equally Professor Giulivi is open to the idea that autism could be "genetic, environmen­tal or a combinatio­n of both"; any kind of complex causality has not been ruled out as rapidly as the author of the interview suggests.

What strikes me is the way in which those people arguing the case for an autism vaccine link jump rapidly to any kind of causal link, and magnify results, while those who deny any link at all seem quite content to defend the status quo.

From my own examination of the situation:

a) there are a number of subsets of biological markers with associations with autism. Fragile X is well known, Mitochondrial dysfunction could well be another. This field is very much in its infancy.

b) At the moment, autism is defined largely on the basis of behavioral markers. This is a major weakness. To take an analogy from evolution, "convergent evolution" is when environmental pressures cause widely differing species to develop the same kind of characteristics - water born mammals, such as dolphins, and fish being one example. The present state of play with autism is rather like classifying creatures by the look of the thing, in which dolphins are a singular kind of fish - by the original Greek etymology, most likely the name means "a 'fish' with a womb".

c) Even when we have biological markers, the small numbers involved, and the complexity of reactions (just considering allergic reactions, and problems of determination) suggest either proving or disproving any causality would be a long way off. However, determining conditions such as mitochondrial dysfunction could help isolate "at risk groups" for whom single vaccines, carefully monitored, would be a better option. However that would not take away all risk, but only reduce it, because any other environmental insult could also cause problems.

d) Better reporting of adverse vaccine reactions is required. In Jersey, for example, in the early 1990s, not only were vaccine batch numbers not recorded properly, there was also no procedural mechanism to enable any reporting of adverse reactions; it was purely the discretion of the health visitor, who would usually suggest taking Calpol, and make no file notes. I don't know if matters have improved, or are any better in the UK. In the USA, Adverse Vaccine report documents can be downloaded and completed by anyone, from health professionals to parents. This is not the case in the UK or locally.

Statistics are only as good as their collection, and while there were no extreme cases of reaction locally requiring hospitalisation, no reliable data is available on any less severe reactions which might have shown a pattern. Part of the problem here is that the medical establishment (less so in the USA) "know" that vaccines are definitely safe, hence don't see the need for proper procedures to monitor that this is true, and then cite the statistics to "prove" their case, without checking the reliability of those statistics.

e) In most cases, I am sure vaccines are safe. But not all vaccines have the same safety record, even if they have the same desired outcome. In 1992, for example, the Urabe strain MMR was withdrawn because of significantly severe side effects - asceptic meningitis (8), which is why more detailed studies are now done on new vaccines to check safety. There is also the problem associated with risk. A minute risk to a population may loom larger to an individual; statistics are good for generalisations over the large population, but general fatality statistics don't tell me what my personal risk would be if I decided to climb Everest, for example, where factors such as my personal fitness might well play a more significant role.


Links
(1) http://www.users.globalnet.co.uk/~rxv/kmoi/monster.htm
See also Proofs and Refutations: The Logic of Mathematical Discovery. Edited
by John Worrall & Elie Zahar. Cambridge University Press, 1976.
(2) http://www.cbsnews.com/stories/2008/03/06/eveningnews/main3915703.shtml?
(3) http://www.cbsnews.com/8301-31727_162-20015982-10391695.html
(4)
http://www.bbc.co.uk/health/physical_health/conditions/in_depth/allergies/allergicconditions_drug.shtml
(5) http://jcn.sagepub.com/content/21/2/170.abstract
(6)
http://jama.ama-assn.org/content/304/21/2389.abstract%22%20target=
(7)
http://leftbrainrightbrain.co.uk/2010/12/mitochondrial-dysfunction-and-autism-brief-q-and-a-with-lead-author/
(8) http://www.springerlink.com/content/0khbch9v3r10mgnq/

"Faith" in the MMR Vaccine

A recent report in the JEP shows that parents in Jersey now have more faith in the MMR vaccine. I'd have more faith if I knew that:

a) adverse reactions were properly notified, the general health visitor response to raised temperature is to give calpol. No record is kept of such adverse reactions; it is just a verbal communication, lost to the system.

b) parents were given details of the batch numbers of the MMR vaccines. The record keeping back in the 1990s was certainly extremely sloppy, and if a parent wanted the details, they might actually be inaccurate, i.e., not tally with the vaccine manufacturers own details. I've never seen a health visitor note down the number, so this is hardly surprising.

Given this lack of data, it beggars belief that reports - based on statistical analysis of adverse reactions, and vaccines - can be trusted. If there is a rogue batch, how could it be tracked, given that there is no tracking, no policy on adverse side effects recording at all. "Faith" in this respect, seems more akin to the kind of religious belief lambasted by Richard Dawkins - such "faith" is powerful enough to immunize people against rationality.

Look at how different the situation is with the CHAT - the childhood autism "early warning" tests devised by Simon Baron-Cohen; if this flags up a warning, the child's development is monitored, and periodically reviewed. Nothing like that happens with vaccines, and adverse reactions, and the logic is that it is safe, and not required.

Incidentally, a recent report on the USA 2006 outbreak of mumps reveals that the vaccine does not necessarily confer much immunity - 63% coming down with mumps having had two MMR jabs. And because it has been bound up - for largely political and economic reasons in the USA, Canada, the UK, and Jersey (but not France, for example) - there is no single mumps only vaccine available to give a third "booster". Which leaves the health authorities in a quandary. Faith the MMR, it seems, may not give immunity after all.

Some of the scientists adopt the question begging approach, saying the situation would have been larger if the vaccine had not been given, or the outbreak more severe, but as there is no control group, that is pure speculation - especially as no reports have been made of more severe outbreaks among those who had not had the two MMR jabs, which surely would provide some degree of control group evidence. But surprisingly, no such detailed reports have surfaced, which is strange, if the hypothesis was more than rhetoric of people who simply didn't know why the vaccine had failed so spectacularly, and wanted to bolster the public's continual "faith" in the MMR vaccine.

"Faith", says Dawkins, "means. blind trust, in the absence of evidence, even. in the teeth of evidence"

Do you have "faith" in the MMR?

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Jersey shows faith in MMR vaccine

Diane Simon

MORE parents in the Island have greater confidence in the MMR vaccine for their children, according to recently released statistics.

The uptake in Jersey of the vaccine against measles, mumps and rubella now stands at 86 per cent of those who are eligible to take it compared to 73 per cent in 2005.

Immunisation nurse specialist Linda Diggle said that the increase was mostly due to the effort that Health, GPs, school nurses and health visitors had made in answering parents' questions about the vaccine.

'Predominantly, parents in Jersey have shaken off the adverse publicity about the MMR vaccine in the last few years,' she said. 'The evidence is very strong that this vaccine is safe and the best way to protect children from these diseases.'

JEP Published 1/5/2008

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http://canadianpress.google.com/article/ALeqM5jho73tvnoJ4y5V2ZCfimTXdmyvxg

A new U.S. study suggests the timing of the delivery of mumps vaccine or the number of shots given might need to be tweaked to avert or control future outbreaks of the disease.

The study, a report on a large mumps outbreak in the U.S. Midwest in 2006, revealed that 63 per cent of the people who came down with mumps had received the recommended two doses of mumps vaccine in childhood. That suggests waning immunity played a role in the outbreak.

But trying to shore up immunity to mumps into adulthood by delaying delivery of the second dose of mumps vaccine is not something immunization advisory bodies would opt for without more research and more evidence of need, the senior author of the study said in an interview.

That's because mumps vaccine comes mixed in a vaccine cocktail that also protects against measles and rubella, two diseases public health authorities view with more concern.

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http://abcnews.go.com/Health/Germs/story?id=4620377&page=1

But she did not contract and spread the disease due to her failure to receive proper immunizations. Indeed, like many of the other students on her campus who contracted the disease, she received the two-dose measles, mumps and rubella (MMR) vaccine when she was a child.

Now, new research suggests that the mumps outbreak that began early in 2006 — the largest outbreak of mumps in the United States in two decades — was probably due more to vaccine failure than the failure of people to get their recommended immunizations.

Researchers at the Centers for Disease Control and Prevention looked at mumps cases in the United States in 2006. They studied the 6,584 reported cases of mumps and found that in most cases, the vaccine from childhood no longer provided enough protection in adulthood.

MMR overdose given to 93 pupils

Let's hope there are no adverse side effects!

MMR overdose given to 93 pupils

Pupils at three Birmingham schools have been given an overdose of the MMR vaccine, health chiefs have confirmed.

Ninety-three children at the Holyhead School in Handsworth, Aston Manor School and King Edward III School, both in Aston, were affected.

They were given the vaccination against measles, mumps and rubella after receiving the recommended two doses.

The Heart of Birmingham Primary Care Trust said it had written to parents and the dosage would not be harmful.

Third dosage

During April and May the PCT offered doses to pupils who had missed the second dose of the vaccine.

It has since emerged that some 14 and 15-year-olds signed up for a third dosage by accident.

A spokesman for the PCT said: "On checking our records, it appeared that 93 of those whose parents took up the invitation had already received their second vaccine.

"We have written to the parents of those children as it is right that they should be made aware of this - and we can assure them that the additional immunisation does not pose any risk to their child."

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/1/hi/england/west_midlands/6980398.stm