February 9, 2009

Autism and The MMR Vaccine

Just as I was writing about the consequences of ideological bias in autism research...

Mea culpa, I will admit that I never read the primary sources either.  If I had, this blog would not exist, I would have quit psychiatry in 1998 and opened a bar called Cougars and made a fortune.

In case you do not have kids or ears, there's a controversy about whether the combination measles-mumps-rubella vaccine causes autism.  The controversy arose from the observation that previously normal kids began to regress soon after receiving the vaccine.

If you had only a rudimentary understanding of the facts (e.g. most doctors, including me) and were trying to create an explanation, you would have intuited that it is either the virus in the vaccine, or perhaps you would have recalled the word  "thimerosal," a mercury containing preservative in vaccines, which has also been linked to autism.

And you would have left it at that; on the one hand is the association, on the other hand is "the published literature" (or what you heard is the published literature) saying there is "no  evidence of a causal link."  (Well of course, they have to say that.)

And then approaches the peon with the autistic child, who, recognizing the limitations on medical science doesn't expect you to have a solution, but is hoping at least for a legitimate explanation.  Your reply to this peon, who dares to ask a Medical Professional (expecting an insider's view of the data and an educated opinion, and not expecting you to simply make stuff up based on what you heard on CNN) is: "there've been some reports, but we simply don't know enough to blame the vaccine outright."

At this point, three things should have happened:

1.  You should have wondered if  "there've" is really a word, or if you just made it up. Maybe you just threw two words together that sounded like they fit?  That's a metaphor for everything else you said.

2. You should have realized that you don't actually know if it is the MMR vaccine, or vaccines in general, that are the alleged cause of autism; and that you aren't even sure if there was/is any thimerosal in the MMR vaccine to begin with.

3. Your ignorance of contractions and medical information did not prevent you from spewing vague crap to your wide-eyed inquisitor; nor did it prevent them from believing you.


It won't be giving anything away to tell you that the evidence for the link is absolutely laughable.  But take a step back and look at the controversy itself.  "Is it vaccines?" ---No, it isn't.  ---Yes it is.  ---No it isn't.  The controversy is so powerful not because it's about vaccines, but because engaging in the controversy serves a more important function: the reinforcement of an ideological bias: "we don't have definitive evidence that the culprit is the MMR vaccine-- it looks like it is, but it may be something else.  But definitely it is something that happens after birth."


The controversy exploded with the publication of a single paper, Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.  The title is not one that would be expected to herald a 10 year ideological war, but there you go. 

First: the title of the paper that launched a million other papers, you'll observe, does not contain the following words: vaccine, thimerosal, MMR, combination.  We'll get back to this.

The actual evidence is this case series of 12 kids who developed autistic features shortly after receiving the MMR vaccine.  The entire basis for the link is this single sentence:

In eight children, the onset of behavioural problems had been linked, either by the parents or by the child's physician, with measles, mumps, and rubella vaccination.
That's it.  If you're looking for something more solid than "parents or the child's physician"  linking the two together, you're going to be disappointed.

You'd think that wouldn't be enough to merit a publication in Lancet, let alone a controversy.  Let alone a substantial decrease in vaccination rates.

However, the focus on this extra, tertiary observation masked the real point of the paper, which was observing a relationship between-- read the title-- bowel inflammation and autism.

Get it?

No?  Then it worked.  You're not supposed to focus on it-- it's supposed to become unconscious.

Still confused?

Bowel inflammation is not natural; in other words,

Both the presence of intestinal inflammation and absence of detectable neurological abnormality in our children are consistent with an exogenous influence upon cerebral function.

That something could be anything, and the bowel involvement suggests maybe it's something you eat-- indeed, the authors suggest  the possibility that it is certain foods (grains), casein from dairy, B12 deficiency.

They also list the other exogenous possibilities, including viruses.  And then there's the vaccine.

But what's important here is the understanding that the inflammation means it's exogenous.  What's important is that the belief that it is exogenous become axiomatic.


"But wait, couldn't bowel inflammation simply be another sign of autism, not the cause?  Couldn't the, say, genetic cause of autism also cause coincident bowel inflammation?"

Of course, but as long as the controversy is about the vaccine as cause, then it isn't about bowel inflammation as cause; and as long as we are not arguing about whether the bowel infammation is the cause, then we are certainly not arguing about whether something exogenous is the cause.  We are quite likely to simply internalize the something- exogenous- as- cause link.

"You're kidding, right?  You think people are that stupid to fall for that?"


So what do we do?  Well, it was one popular recommendation that if the vaccines must be given, they be given separately, not as the combined MMR.  This recommendation came right from the lead author, Dr. Wakefield, in a press conference after the study's publication.

It's sleight of hand; blink you missed it.  He took it up a step; the controversy has now become whether the combined vaccine is the cause, not whether a vaccine is the cause--  despite none of this appearing anywehere in the study.  Wakefield made this the controversy, out of thin air.  And everyone fell for it.

"What do you mean? Not everyone believed it."  That's not the point, right?  The point is to make the MMR the focus, allowing an exogenous case to become our default understanding.

It is so infective, this bias, this groupthink, that the highlighted CDC recommendations about the vaccine which are supposed to allay fears reads:

  • The MMR vaccine protects against dangerous, even deadly, diseases.

  • The most common adverse events following the MMR vaccine are pain where the vaccine is given, fever, a mild rash, and swollen glands in the cheeks or neck.

  • No published scientific evidence shows any benefit in separating the combination MMR vaccine into three individual shots.


"Surely the Lancet tried to do something about this?"

Ha! Don't be ridiculous.  They were far too busy studying social justice and peer reviewing    "America 2004: voting for a decent global society."  I'll spare you the read: vote Kerry.

Ok, that's not entirely fair on my part.  In fact, the Lancet and other medical groups/journals/individuals were highly critical of the paper.  Not critical of the results, but rather of the fact that Wakefield didn't disclose he had been previously retained as an expert in a lawsuit against the MMR manufacturer.

Before you jump onto that wagon, ask yourself: is that the single piece of missing information that would have revealed this study to be silly?  Knowing that would have made them reject the paper?   Is not knowing he was connected to lawyers the reason the entire planet missed the lack of connection between his verbal statement "separate the three vaccines" and his own study to which he was referring?

Is money the only red flag for these idiots?


If I had to come up with a punch line for all this, I couldn't do better than this:

According to the February 8, 2009 edition of a newspaper that is not written by or for doctors, Wakefield made up his findings.

However, our investigation, confirmed by evidence presented to the General Medical Council (GMC), reveals that: In most of the 12 cases, the children's ailments as described in The Lancet were different from their hospital and GP records. Although the research paper claimed that problems came on within days of the jab, in only one case did medical records suggest this was true, and in many of the cases medical concerns had been raised before the children were vaccinated. Hospital pathologists, looking for inflammatory bowel disease, reported in the majority of cases that the gut was normal. This was then reviewed and the Lancet paper showed them as abnormal.  

This would be a good place to ask the basic questions, such as

  • why the Lancet and all journals peer-review manuscripts, but never ask to see the original data itself;
  • why they allow the public to assume that the journal does scrutinize the original data;
  • why original data is not public information anyway;
  • why three idiots and an editor were not able to predict how a study would be used, and ask for the appropriate modifications;
  • why the presence of "financial conflict of interest" is the only critical test of bias, such that its mere absence earns it the imprimatur of truth.  This does not apply to NIH money, of course, which is is free of moral influence: Nihil obstat.