Two recent studies concerning the prevalence of autism in the US have been getting a lot of attention, because they indicate that autism prevalence may be higher than previously estimated. This, of course, fuels the debate over whether or not there are environmental triggers of autism.

One study was conducted by the CDC but has yet to be published. The results were announced ahead of publication by the US Health and Human Services Secretary Kathleen Sebelius to the autism community. She reports that the new prevalence of autism spectrum disorder (ASD) is now estimated at 1% or 100 in 10,000 children. This is an increase over the last few years. In 2002 the prevalence was estimated to be 66 per 10,000.

The second study was published in the journal Pediatrics and is a phone survey of 78,037 parents. They asked if they had any children who had ever been diagnosed with an ASD. Here are the results:

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The BBC reports today of a National Health Service study that shows that autism rates are consistent at about 1% among all age groups. If true, this has profound implications for the now-discredited notion that autism rates are rising and that this rise is linked to vaccines.

Starting in the late 1990’s fear swept the UK over the MMR vaccine and a possible link to autism – sparked by research by Andrew Wakefield. In the decade since, a succession of studies have shown that Wakefield’s original research was not valid and that there is no detectable link between vaccines and autism. Attention shifted, especially in the US, from the MMR vaccine to a preservative, thimerosal, in some childhood vaccines. This prompted the Centers for Disease control and the FDA, to mitigate public concerns, whether justified or not, to remove thimerosal from the vaccine schedule, which they did by 2002 (except for insignificant trace amounts). This dramatic decrease in thimerosal exposure had no effect on the rate of increase of autism diagnoses – pretty much the nail in the coffin of the thimerosal-autism hypothesis.

Unfortunately – this is a fake controversy, not a genuine scientific one, and dedicated anti-vaccinationists are not swayed by compelling evidence, so their vaccine-autism fear mongering continues, and has even been increasing. They have migrated their claims away from MMR and thimerosal to other “toxins” (mostly imagined), and made-up claims such as vaccines overwhelm children’s immune systems (when in fact they represent an modest addition to the antigens kids are exposed to).

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I applaud the recent attempts by the American Academy of Pediatrics to fight back against the anti-vaccine misinformation scare-mongering machine. As part of that goal August is Vaccine Awareness Month. However, this just brought home for me how much better the PR machine is on the anti-vax side than on the side of science. Here we are half way through August and I am just learning it is Vaccine Awareness Month. This is a topic I track quite closely, and blog about frequently. Where was the media blitz? Where was the rallying of troops?

The Good

OK – it’s not all bad. They did put out an open letter with a fair number of authoritative signature. Here is a brief excerpt:

We, the undersigned, support immunizations as the safest, most effective way to control and eradicate infectious diseases. This August, as another National Immunization Awareness Month comes to a close, we are reminded that diseases such as smallpox and polio were once commonplace in the United States. Thanks to vaccinations, we have not seen or experienced many of the infectious diseases that gripped past generations, but other countries have not been so fortunate and outbreaks continue in the United States.

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Maybe David Kirby, author of Evidence of Harm and one of the major proponents of the notion that thimerosal in vaccines was largely responsible for the recent increase in autism diagnoses, is sincere when he claims he is not anti-vaccine. I say that because he has backed so far off from his stance that vaccines are the culprit – not completely, and without overtly acknowledging his past errors, but has put some significant distance between him current position and his prior certainty.

In his 2005 book Kirby asks the question:

Did the injection of organic mercury directly into the developing systems of small children cause irreparable harm? It’s a plausible proposition, and a hugely important question. If the answer is affirmative, someone will have to pay to pick up the pieces.

He coyly insists he was just asking questions, but the book makes a strong and, in my opinion, one sided case that there is “evidence of harm” – specifically evidence that thimerosal was a major contributor to autism. It also builds a case for a grand conspiracy to hide this fact from the public. Kirby then made a career out of promoting the notion of a link between vaccines and autism with government and professional malfeasance. He became a hero of the anti-vaccine movement.

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It seems I have gotten under the skin of notorious anti-vaccine crank J.B. Handley, the founder of Age of Autism. He recently wrote an entire article dedicated to the character assassination of yours truly. It seems I had the temerity to critique the latest anti-vaccination propaganda initiative called fourteen studies, an attempt to discredit the scientific evidence against a link between vaccines and autism.

Handley’s attack is an astounding example of hypocrisy, logical fallacies, and tortured reasoning. He really exposes the intellectual bankruptsy of the anti-vaccine movement, which is only reinforced by the supporting comments left by his avid readers.

He begins:

In general, I think the site (fourteen studies) so resolutely exposes the dirty underwear of the mainstream’s weak science on the vaccine-autism debate that most critiques of the site seem to center around the idea that “you have no need to go look at the site, and please pay no attention to the dirty underwear behind the curtain…”

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The much awaited decision on the first test case of the Autism Omnibus was just announced – and it’s good news. They have found that the petitioners failed to make their case that vaccines caused their children’s autism, and that therefore compensation was not appropriate.

The Autism Omnibus hearings were set up to evaluate for thousands of petitions for compensation under the vaccine injury compensation program. This is a program set up in the US to compensate those who suffer adverse effects from vaccines, and it is paid for by a tax on all vaccines. This is a sensible system because it allows manufacturers to produce much needed vaccines without risking bankruptcy over fad pseudoscientific accusations – like those that took down Dow Chemical. It also more quickly and fairly compensated families, which is fair given that vaccines are somewhat compulsory in the US (although in most states it is all too easy to get an exemption).

These cases arise out of the now scientifically discredited notion that certain vaccines or something in vaccines (like thimerosal) is linked to autism. I have written extensively about this controversy, and what we can say at this time is that the scientific evidence is solidly against any link.

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In 1998 Andrew Wakefield and others published a small study of only 12 subjects in the Lancet. This small study sparked a huge controversy – Wakefield used it to claim that the MMR (mumps measles and rubella) vaccine caused autism. As a result compliance with the MMR dropped from 92% in the UK down to 85%, and measles cases soared from only 58 cases in 1998 to 1,348 cases in 2008.

Despite the fact that Wakefields paper has been thoroughly discredited, and subsequent studies showed convincingly that there is a lack of association between MMR or vaccines in general and autism, the controversy sparked by Wakefield continues. It has spread to the US as well, where measles cases are also starting to jump. The existing anti-vaccine movement latched onto Wakefield’s study and have been running with the vaccines-cause-autism fear-mongering ever since. While not letting go of MMR, they did shift over to thimerosal (which was never in the MMR vaccine), which has also been cleared from any association with autism (but was removed from vaccines in the US and most countries anyway).

The real story of MMR, thimerosal, vaccines, and autism is a scientific one, and the science has spoken. While further research is always welcome (as long as it is ethical) the question is essentially settled – vaccines do not cause autism. The scientific evidence does not care for the personal saga of Andrew Wakefield, but he has never-the-less become a central figure in this story. He has now been elevated to the status of folk-hero by the antivaccinationists. So while I consider Wakefield a footnote, his story is interesting and instructive.

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This morning I received the following e-mail from Jennifer:

The above article was quite comprehensive and thoughtful but a few things haunt me. One is the fact that just because thimerosal was removed in around 2003 does not mean there will be a neat distinction in the numbers of autism (presuming thimerosal is the cause-some even see it as a symptom now of autism rather than the cause). This could be for many reasons,  including:

using up of thimerosal stocks already in existance up until the expiry date.
flu shots or multi-dose vials (containing mercury) could still be in use.
pregnant ladies are actually given flu shots and these may contain mercury
immigrant children ( from countries where thimerosal is not removed) may move to areas and be inluded in epid. studies
Also, you do not mention many shots at once and the lack of safety studies in regard to this.
Also,also, recently the mumps portion of the MMR was reduced. It was quadrupled in 1990 from what it was. This may also play a role in autism development.
What about all the kids with seizures and asthma these days. Why is MSG in the shots. EWWWW

I frequently receive similar e-mails, and similar questions appear in the comments of this blog whenever I write on the issue of vaccine and autism.  Jennifer touches on many of the current points in the moving target of anti-vaccine propaganda.

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It is without controversy that the number of autism diagnoses being made is on the rise. In 1991 there were about 6 cases per 10,000 births, and in 2001 there were about 42. This number continues to rise at about the same rate.

The cause of this rise, however, is very controversial. There are basically two schools of thought: 1 – that true autism rates are on the rise, and 2 – that the measured rise is an artifact of increased surveillance and a broadening of the definition. A new study published today in the journal Epidemiology lends support to the school claiming that autism rates are truly rising – or at least that is how proponents are interpreting it. After a closer look, I am not so sure.

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There is a dedicated fringe anti-vaccine movement. They are dedicated to some permutation of the collection of beliefs that vaccines are: 1) not effective; 2) have not reduced or eliminated any infectious disease; 3) are not safe; and 4) are a conspiracy of Big Pharma, the government, and paid-off doctors. Specific claims have wandered over the years, but they have as a central theme that vaccines are bad. When one specific claim collapses, they will move on to the next anti-vaccine claim.

While anti-vaccine cranks have been around as long as vaccines, it is only recently that they have captured the attention of the mainstream media and the skeptical movement and the battle has really been engaged.

Anti-vaccinationists have focused much of their recent efforts on the claim that vaccines cause autism. At first the MMR vaccine was blamed, sparked by a now-discredited study performed by Andrew Wakefield. This led to declining vaccination rates in the UK and a resurgence of measles.

As the MMR claim was in decline (although by no means abandoned), attention shifted to thimerosal – a mercury-based preservative in some vaccines. There are many flaws with the thimerosal hypothesis, and numerous studies have shown no link between thimerosal and autism or any neurological disorder. But the fatal blow to the thimerosal hypothesis was struck when thimerosal was removed from the routine childhood vaccine schedule (thimerosal, incidentally, was never in the MMR vaccine) in the US by 2002. In the subsequent 6 years the rate of autism diagnoses kept increasing at their previous rate, without even a blip. Only the most rabid (or scientifically illiterate)  anti-vaccine fanatics still cling to the thimerosal claim.

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