Volume 1  Number 3  July 23, 2004
Second Opinions

Scientific Misconduct Masquerading as Medical Evidence: Autism and the MMR Vaccine Controversy

Autism is a mysterious disorder whose symptoms range from a lack of social skills to a profound inability to relate or communicate with others via eye contact, body movement, language or speech. Other features include lack of response or over responsiveness to sensory stimulation. Classically, autistics have been described as being in their "own world". vs. the "outside world,." The condition appears either at birth or within the first three years of life and affects 1-2 children per 1000 births.

In 1998 a study published in The Lancet implied that the MMR (measles, mumps, rubella) vaccine might be a cause of autism. Suggestions were made that Thiomerosol, a mercury-containing preservative used in some vaccines and other products since the 1930's was the culprit. Previously, no harmful effects had been reported from Thiomerosol at doses used in vaccines, except for minor local reactions. Nevertheless, in July 1999, the Public Health Service (PHS) agencies, the American Academy of Pediatrics (AAP), and vaccine manufacturers agreed that Thiomerosal should be reduced or eliminated in vaccines as a precautionary measure.

Today, none of the vaccines used in the U.S. to protect preschool children against 11 infectious diseases contain this compound.

The Lancet study ultimately prompted research involving huge numbers of children, including a study of over 500,000 Danish children published in 2002 in the New England Journal of Medicine, which failed to confirm the original findings. Once the question was raised whether the MMR vaccine might trigger autism in some children, even mounting evidence to the contrary failed to allay public fears. The widespread media coverage stemming from the original British report continues to the present day. While the vaccination rate has dropped since the study, the incidence of autism continues to rise.

In February 2004, allegations of research misconduct were raised against the original paper, asserting that the dozen children selected in the study were not randomly chosen, but included children involved in a legal action claiming vaccine injury. This possible conflict of interest was not disclosed to the Editors of the Lancet nor was the receipt of over $100,000 by the lead investigator for helping to prepare the legal action. The Lancet investigated these claims and issued a partial retraction of the original paper in the March 6, 2004 issue. Ten of the 13 authors of the research paper issued a partial "retraction."

Commenting on the issue, the Editor of the Lancet, Dr Richard Horton, declared that important lessons were to be learned. Medical journals should continue to publish original and sometimes-unpopular ideas in responsible ways, he said, but he argued they must take greater care to consider the impact on the public of the work they print. He concluded: "Information that once could be confined to a small community of professionals is now open to wider distribution and comment (by the press)—accurately or otherwise… there is now a duty to ensure that the public (is) fully aware of this retraction. Professionals may know about it, but do parents?"

The autism MMR affair continues to be the subject of extensive media coverage, although a majority of independent research experts recently concluded there was no evidence of a causal link between vaccines and autism. In May, 2004 The National Academy of Sciences, Institute of medicine concluded that the available evidence does not support a causal link between MMR vaccine and autism.

Another important lesson is to be drawn here: When it comes to science reporting in the media there is often sensationalism and bias in the guise of "breaking news." Readers and watchers must remain initially skeptical of scientific "evidence" presented in the press. Don't believe everything you read, at least not at first. As of this writing, a Google search yielded 60,000 URL’s under the search terms "autism mmr." Most of these references were simply wrong or "stale" in light of the above findings (as the report in 2000 on "60 Minutes."). This means, those unfamiliar with the latest official repudiation of the research, will be misinformed by some searches when they encounter URL’s which should have been updated or removed.

One of the unintended consequences of the autism-vaccine controversy has been a decline in rate of immunizations for measles, mumps, and rubella (mmr) in some regions.

Martin F. Sturman, MD, FACP

Copyright 2004, Mathemedics, Inc.

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