Sep 01 2010

Appeals Court Rejects Autism-Vaccine Link

This is a quick update on the Autism Omnibus hearings – representative cases heard before a special court to decide if there is any credible evidence to conclude that autism may be a vaccine injury. After hearing exhaustive testimony by all sides, the special masters determined that the evidence does not support a link between autism and vaccines.

One of the cases heard was the Cedillo case, which was used as the test case for the theory that the MMR vaccine plus exposure to thimerosal can trigger brain damage that looks clinically like autism. In February of 2009 the court rejected the claim that Michelle Cedillo’s autism was caused by vaccines. No only was the theory of causation without scientific backing, evidence was presented to show that Michelle Cedillo demonstrated early symptoms of autism prior to ever receiving the MMR vaccine.

In fact the Cedillo case is representative of a fact that scientific research is increasingly demonstrating – that subtle signs of autism are present prior to parents noticing that there is a problem and long before formal diagnosis. The consensus of evidence is that signs of autism appear between 6-12 months of age, and maybe earlier in some cases. Meanwhile, the first MMR vaccine is given at 12 months. Since causes must precede effects, this fact alone is fatal to the MMR-autism hypothesis.

After being rejected by the Autism Omnibus special court, the Cedillos appealed, and their appeal was recently rejected by a federal appeals court (one notch below the Supreme Court). The Examiner reports:

The federal appeals court found that the special master’s decision was justified under a U.S. Supreme Court decision that requires trial judges to determine whether an expert witness’ theory about causation is testable, has an acceptable error rate, and has been peer reviewed and published.

The appeals panel also held that the special master could instead rely on the testimony of a U.S. government expert witness who argued that the testing done by laboratory engaged by the Cedillos was  “severely flawed, and should not be considered reliable.”

The Cedillos report that they are “considering their options” to take their case further.

In general, when complex scientific cases like this are tried in court, with an exhaustive review of the evidence and rules of evidence and argument that preclude reliance on logical fallacies, the outcome is generally favorable to science. We saw this with the intelligent design – Kitzmiller case, and here again with the Autism Omnibus hearings. There is always the risk that a case will be decided on obscure legal grounds, rather than the merits of the science. But I am glad to see that at least occasionally science rules.

Addendum:

After posting this entry, another related news item came to my attention. In the UK a court has awarded 90 thousand pounds to a family whose child (now 18) was alleged injured by the MMR vaccine. Orac has an excellent discussion of the issue. He makes many salient points, which I have also made in previous posts.

Specifically – no one denies that there are risks to vaccines and they occasionally cause serious side effects, although serious effects are rare. Also, compensation for side effects is appropriate. It also needs to be noted that the legal threshold for concluding a possible link between a vaccine and injury is much lower than the scientific threshold, and this is not unreasonable.

In this particular case the decision seems to have been based largely on the temporal association between the MMR and onset of symptoms (which occurred 10 days later). From a scientific point of view, this absolutely can be a coincidence, but from a legal point of view it was sufficient to award compensation.

It also has to be noted that the child in this case does not have autism. He suffers from seizures and mental retardation, but not autism.

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26 responses so far

26 Responses to “Appeals Court Rejects Autism-Vaccine Link”

  1. rhacodactyluson 01 Sep 2010 at 8:30 am

    Funny how when the people making the decisions make a point to be well informed, and use solid logic they always come down on the side of science . . . must just be some weird coincidence

  2. Halfdeadon 01 Sep 2010 at 9:34 am

    My second son has autism, we noticed he was a little different from birth practically. I wonder though if we would have noticed anything odd at all had we not had a neuro-typical child as our first.

    The signs were not immediately obvious it was just small things that we commented on, but did not realize meant anything until he was three and diagnosed.

  3. SpicyCupcakeon 01 Sep 2010 at 9:48 am

    @rhacodactylus and friends!
    Remember the undeniable statements of fact:

    “At best, logic is just a way to justify conclusions we have already reached unconsciously.”

    “Logic is just a way to err with confidence.”

    These are facts and cannot be subjected to your “logic”. Logic that’s only three deleted letters and one added one from Lie! These people’s facts are not to be subjected to your logic; I mean lie!

    Obviously I’m joking; always remember there are people who view solid logic as a way to be solidly wrong. Their belief precludes logic, therefore if logic doesn’t agree, logic is wrong.

    [edit: I nearly wrote an essay and decided that preaching to the choir would be a waste] =) Na-nu na-nu!

  4. daedalus2uon 01 Sep 2010 at 11:34 am

    halfdead, your experience is not atypical. It was even noted in the testimony that many first time parents don’t know what to expect and so are oblivious to the fact that their child is different. The experts who looked at video tapes of the child in this case noticed behaviors they considered diagnostic of autism even before the MMR was given.

    One of the best documented neurological differences in autistic individuals is the increased number of minicolumns. That number is fixed during the first trimester in utero.

  5. Woodyon 01 Sep 2010 at 4:02 pm

    I recognize that it is a “moving the goalpost” strategy, but the anti-vaccine movement is now claiming that thimerosal still present in influenza vaccines given to pregnant mothers are causing problems for the developing fetus. If this has already been debunked, could someone direct me to the relevant discussion?

  6. zorrobanditoon 01 Sep 2010 at 4:37 pm

    If a child suffers “seizures and mental retardation” as a result of vaccination (which I realize we do not know, the connection is only temporal) that would certainly make me, as a parent, pause before authorizing vaccination. After all, the chances that my child will be damaged by measles, mumps or rubella (all of which were unpreventable in my generation) are tiny. I contracted all three diseases and am none the worse for it.

    I completely understand the rationale by which the scientific and medical communities feel that the damage to a very few children is justified by the prevention of “damage” to very many, but I would ask the parents here to consider how they would feel if their own child fell into that “very few” category. This is OK with you? For the greater good?

  7. zorrobanditoon 01 Sep 2010 at 4:43 pm

    In my generation, knowing that rubella was devastating to the fetus but relatively harmless to children, we held “German measles parties.”

    Your female child contracted rubella. Thereupon you hosted a party for all the female children in the neighborhood, which wasn’t much fun while you had a sick child(!). They all contracted the disease in turn (it’s highly contagious), and then you had the obligation to host another such party. I did this, back in the day.

    The kicker is, vaccination only lasts for a while, but having the disease is for a lifetime. So my 35 year old, upon planning a pregnancy, consulted me on this. I said, Not to worry. They did a test on her, and of course her titre was very high.

    That would be, “thank you, mom.”

    Is vaccination better, given its limited efficacy?

  8. Chewyon 01 Sep 2010 at 9:16 pm

    zorrobandito, lets keep this simple…..

    rubella has an incubation period of 14-18 days or so. If your child contracted rubella at a “party” ?WTF then they are likely contagious for a week or two prior to their rash. I’m guessing you aren’t isolating them at home for these 2 weeks before the rash?

    So they’re walking around shedding virus to unsuspecting people, probably exposing some pregnant mums in their first trimester and passing it to adults/adolescents who can get more serious rubella complications such as encephalitis (1 in 6000)/thrombocytopenia etc. Compared with a 1 in 1 million chance of encephalitis in MMR vaccination.

    Doesn’t sound real smart does it. Your approach is a menace to the people in the community around you. Sounds like you need to give yourself a good slap around the chops and start reasoning a bit better.

    Lastly, show us the evidence that “wild” rubella confers lifelong immunity vs vaccine mediated immunity…..

  9. ChrisHon 01 Sep 2010 at 10:20 pm

    Sometimes the disease does not offer immunity, there are people (me included) who have gotten mumps more than once! We really like that herd immunity to those three viral diseases stay high.

    Also, zorrobandito, seizure disorders are not uncommon. My son had seizures before he was ever vaccinated. He spent a year on anti-convulsants and was weaned when he was about a year old. Unfortunately he contracted a now vaccine preventable disease and had more seizures. Since the cause was determined to be the disease he was not put back on medication (which has its own issues in regard to brain development).

    A relevant study:
    Encephalopathy after whole-cell pertussis or measles vaccination: lack of evidence for a causal association in a retrospective case-control study.
    Ray P, Hayward J, Michelson D, Lewis E, Schwalbe J, Black S, Shinefield H, Marcy M, Huff K, Ward J, Mullooly J, Chen R, Davis R; Vaccine Safety Datalink Group.
    Pediatr Infect Dis J. 2006 Sep;25(9):768-73.

    Also, measles tends to cause something bad at a rate of one out of a thousand cases (encephalitis, seizures, blindness, deafness, permanent neurological damage, death). Is bringing back measles to the levels seen in the UK and Japan recently worth avoiding the MMR?

  10. HHCon 01 Sep 2010 at 11:47 pm

    According to the UK case, 90,000 pounds or $139,000 was awarded to the family with the mentally retarded male youth. Since the seizures began 10 days after the vaccination, and Professor Sundara Lingam stated at the hearing, the child had a genetic predisposition for epilepsy which was triggered by the vaccine, I am curious how the genetics for epilepsy is traced in both British parents. Dr. Lingam stated the vaccine was not the cause of epilepsy. Could we assume that the child would have had sustained seizure activity with his first high fever/ childhood disease?

  11. Nitpickingon 02 Sep 2010 at 7:18 am

    Doctor Sundara Penis? Really?

  12. SteveAon 02 Sep 2010 at 7:47 am

    “The kicker is, vaccination only lasts for a while, but having the disease is for a lifetime.”

    I thought that ‘natural’ immunity only persisted if the person was regularly exposed to the disease. Is that right?

  13. zorrobanditoon 02 Sep 2010 at 11:54 am

    I could be wrong about the length of immunity conferred by actually having the disease (though my family’s experience suggests that it is quite a long time).

    I wasn’t suggesting that we re-institute the German Measles Party; I was telling a story from the times when no vaccine was available, and this was all we could do. It worked pretty well, not perfectly, but vaccination isn’t perfect either.

    I assume that someone has crunched the numbers and decided that the occasional catastrophic results of vaccination (if they could be established) are so much less than the occasional catastrophic results of non-vaccination that vaccination is a good deal FOR THE INDIVIDUAL. I understand, intellectually, the “herd immunity” argument, but I’d have a hard time with it if my child had been the collateral damage of this strategy.

  14. HHCon 02 Sep 2010 at 12:41 pm

    Nitpicking, A phallic interpretation of the word, lingam is considered a grave blunder by individuals who do not understand Sanskrit or India.

  15. ChrisHon 02 Sep 2010 at 12:57 pm

    zorrobandito:

    I assume that someone has crunched the numbers

    Yes, they have (which has been reproduced on several websites).

    About rubella, did you know there was an epidemic in the early 1960s? I am old enough to a person who was deafened, and women who lost babies. You will read about in the above link:

    In 1964-1965, before rubella immunization was used routinely in the U.S., there was an epidemic of rubella that resulted in an estimated 20,000 infants born with CRS, with 2,100 neonatal deaths and 11,250 miscarriages. Of the 20,000 infants born with CRS, 11,600 were deaf, 3,580 were blind, and 1,800 were mentally retarded.

    This is also a table of the impact of vaccines.

  16. ChrisHon 02 Sep 2010 at 1:05 pm

    zorrobandito, more information:

    DISEASE

    Measles
    Pneumonia: 6 in 100
    Encephalitis: 1 in 1,000
    Death: 2 in 1,000

    Rubella
    Congenital Rubella Syndrome: 1 in 4 (if woman becomes infected early in pregnancy)

    VACCINES

    MMR
    Encephalitis or severe allergic reaction:
    1 in 1,000,000

    So, really, with measles still only an airplane ride away, what kind of odds do you need?

  17. ChrisHon 02 Sep 2010 at 1:09 pm

    aaack! How could I forget Dr. Crislip’s article!?

  18. superdaveon 02 Sep 2010 at 1:30 pm

    Steve said
    “brain damage that looks clinically like autism.”
    The anti vaxxers don’t think that brain damage can mimic autism, they think that Autism is the actual result of brain damage. the think this is the majority cause of Autism.

    Once you accept that definition of Autism, the rest of anti vax thinking follows pretty easily.

  19. patienzon 02 Sep 2010 at 2:35 pm

    @HHC

    “According to the UK case, 90,000 pounds or $139,000 was awarded to the family with the mentally retarded male youth. Since the seizures began 10 days after the vaccination, and Professor Sundara Lingam stated at the hearing, the child had a genetic predisposition for epilepsy which was triggered by the vaccine, I am curious how the genetics for epilepsy is traced in both British parents. Dr. Lingam stated the vaccine was not the cause of epilepsy. Could we assume that the child would have had sustained seizure activity with his first high fever/ childhood disease?”

    Although febrile seizures and epilepsy clearly have a genetic component, it’s not clear from the news accounts if epilepsy was “traced in both British parent.” It may be that Lingam was relying on recent studies of children who were apparently “vaccine injured” that showed that (1) 14 of 14 children who reacted following vaccination against pertussis as the allegedly MMR-injured individual you mentioned reacted to MMR turned out to have recognized epilepsy syndromes, and 11 of 14 had de novo mutations in SCN1A; and (2) children who suffer seizures and develop encephalopathy follow the same clinical course whether or not the first seizure happens to occur in proximity to vaccination. I suspect that Lingam may have been referring to Dravet syndrome.

  20. John2on 03 Sep 2010 at 2:32 am

    Zorrobandito, your reasoning on this subject seems flawed. How exactly do you think that vaccination could be a good thing in general, but a bad thing in any given individual, unless you have a specific reason to think that that individual has a pre-existing problem?

    It’s as though I tell you that wearing your seatbelt makes you less likely to suffer injuries in an accident, and you respond “yes, in general, but what about for the individual”.

  21. HHCon 03 Sep 2010 at 1:47 pm

    patienz, Thanks for the reference to Dravet syndrome. I just read the 1993 study by Dravet. I guess the British case would have required a genetic test involving the sodium channel gene, SCN1A.
    The child in question presented myoclonic seizures.

  22. saschbon 09 Sep 2010 at 5:08 am

    I can’t add to the discussion, but I am wondering what these early, subtle signs of autism were, that the experts could detect on old home videos.
    I am asking because of our son, who’s three years old now. For the first weeks of his life, starting a few hours after his birth, he was making these strange constant, for lack of a better word, snarling sounds. Nowadays he is always pretty awkward around other kids, seldom playing with other children in his daycare group and avoiding the touch of others. In contrast, his cognitive and intellectual, e.g. speech development seem to be pretty normal and he seems to be a happy child. If you look objectively at it, it’s probably nothing, but I know that there is a wide spectrum of dysfunctions that are regarded as autism. And as a parent you always find something to be concerned of.

  23. MountainHowieon 16 Sep 2010 at 3:10 pm

    CBS news reports that the family of Hannah Poling was awarded $1.5million in the first Vaccine-Autism court award. ( http://www.cbsnews.com/8301-31727_162-20015982-10391695.html ) There are 4800 cases pending.

    It appears the federal vaccine court ruled that the vaccine did not “cause” her autism, but resulted in it, aggravating a pre-existing condition.

    Is anyone aware of the actual evidence presented in the case?

  24. ChrisHon 16 Sep 2010 at 3:47 pm

    Several links were posted here by me and others:
    http://www.theness.com/neurologicablog/?p=2294

    It was discussed quite a bit two years ago.

  25. ChrisHon 16 Sep 2010 at 3:50 pm

    Also be aware that the Polings themselves have kept the lid on anymore information.

  26. PetiteMalFleuron 08 Dec 2010 at 11:32 am

    My 4 year old has autism and was diagnosed at 2 1/2. She displayed pronounced symptoms since birth, such as extreme irritability and prolonged, inconsolable screaming throughout the night for up to 9 hours straight, and fear of the vacuum, and car. She enjoyed her Baby Einstein videos, but would lose interest when someone’s face would appear on the screen. I thought all these things were odd at the time, but it wouldn’t be until later that I realized they were signs of early Autism.

    Obviously, anecdotal evidence doesn’t mean much, but it helps when trying to impress on people that the studies are not just big pharma conspiring to make money on vaccines. In my case, not only did my daughter display signs of having autism from birth, she had all of her vaccines delayed until sometime after she was diagnosed due to the risk vaccination posed to my sister with AML (leukemia).

    I was one of the few people with a valid medical reason to delay vaccinating and this left my daughter totally dependent on herd immunity. I am swift to point out to people who avoid vaccinating their children how socially irresponsible they are because it has a direct impact on people like my daughter, who could not be vaccinated, and my sister, who’s immune system failed due to cancer.

    I must have been good with the guilt trip because one ‘antivaxer’ later told me she reconsidered her position and had her child vaccinated.

    The history of how these rumors originated and how they’ve evolved is very well documented. It baffles and angers me that they continue to perpetuate. Thanks Dr. Novella for your wonderful commentary on this subject.

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