Vaccines, autism, and bad science

The controversy over vaccines and autism just took a turn for the worse, due to an unfortunate decision by the U.S. vaccine court. For the first time, the court has awarded compensation to a family who claim their daughter's autism was caused by vaccines. What the court actually decided was that an underlying disorder - in this case a genetic defect in the girl's mitochondria - was made worse by the vaccine shots she received in July 2000, when she was 18 months old. Her parents say that her autism appeared soon after those shots.

This is bad news in several ways. First off, there is still no evidence that vaccines cause autism, despite this case. This is a legal ruling, not a scientific study. But the public won't understand the difference, and it's being reported all over the media (yesterday and today) as "evidence" that vaccines cause autism. I doubt that the public can make the distinction between legal evidence and scientific evidence.

The Institute of Medicine published EIGHT REPORTS examining the supposed link between vaccines and autism. They concluded that "the body of epidemiological evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism." This conclusion hasn't changed, but court rulings such as the one this week are likely to muddy the waters. Why? Because there are thousands of people out there, many of them parents of autistic children (perhaps some who will reply to this blog) who insist that there is a link.

This all started with some spectacularly bad science by a British doctor named Andrew Wakefield, who published a study in The Lancet in 1998 claiming to have discovered a link between vaccines and autism. This study was later revealed to be fraudulent in several ways, including the fact that the lead author, Wakefield, had recruited children to join the study through a small-time UK lawyer named Richard Barr, whose goal was to file a lawsuit against drug companies that manufactured the MMR vaccine. Wakefield was paid a large sum of money, 435,000 pounds (about $780,000), for consulting work supporting this lawsuit. There are many other blatently fraudelent aspects to this study, summarized in a lengthy article by Brian Deer here. 10 of his 12 co-authors retracted the article when they learned of his fraud.
Wakefield is under investigation for fraud in the UK, but he left long ago and set up shop in the U.S. (How nice that we are so friendly to medical frauds!) He travels the country promoting the vaccine-autism link, and unfortunately he continues to attract attention, much of it positive. He has convinced many parents that he is a hero, fighting the medical "establishment" who just won't see the truth of his claims.

Autism is a tragic illness, and the parents' tales are heartbreaking. Autism usually becomes evident in children at about the same time they get their vaccines, which means that many parents make the understandable - albeit erroneous - inference that vaccines caused the autism. However, study after study has shown that this just isn't true.

Now along comes this vaccine court case that has awarded compensation to the parents of an autistic child based on a supposed vaccine link. There are nearly 5000 other autism cases pending, and if the court starts awarding funds in many of them, the vaccine fund will quickly go bankrupt. This fund has been a tremendous success - it was created by Congress (along with the vaccine court) as a mechanism to compensate people who are, in very rare cases, hurt in some way by vaccines. Vaccines provide a tremendous public good, and in order to be successful, we need to have as many people vaccinated as possible. The vaccine fund sets aside federal money to achieve this public benefit, and to avoid scaring off vaccine manufacturers from producing vaccines (a very real possibility in our overly-litigious society).

The press and many parents are reporting this as a "landmark" case. It may be, but it isn't a good one. The impact on the public, sadly, is likely to be a decreased rate of vaccination among children whose parents hear about this. Most parents aren't going to investigate carefully, and even if they do, most of the media outlets are reporting this as if there is a genuine link that has now been discovered.

If fewer children are vaccinated, the result will be that hundreds, possibly thousands, of children will die from childhood diseases that are currently under control in the U.S. and Europe. Public memory is short, and no one with young children today is old enough to remember the (recent) era when children got ill - and some died - of a host of diseases such as measles, mumps, rubella, polio, and meningitis. I hope we don't have to experience a new epidemic of childhood deaths to re-educate people on the importance of getting their children vaccinated.