On Autism: A Word Of Caution · 2010-04-15 12:57

The following Op-Ed appears in today’s Peterborough Ledger-Transcript.

With her article on autism (Ledger-Transcript, April 8), Priscilla Morrill illustrates many challenges faced by autistic children and the progress they can make with the patient, loving support of their families, teachers and service providers. Unfortunately, the article also propagates many misconceptions about autism and vaccines that facilitate the exploitation of parents and that have led to the resurgence of vaccine-preventable diseases.

Although the mother featured in the story is clearly sincere in her beliefs, epidemiological studies have failed to demonstrate a causal association between vaccines and autism. As acknowledged in the article, autism often becomes apparent during the first three years of life. Since most children in this country receive multiple immunizations during this period, recognition of autism often occurs within close proximity of a vaccination, whether or not an adverse reaction has occurred. This temporal correlation leads many parents to believe that vaccines caused their child’s autism, when this is actually unlikely. Analyses of home videos demonstrate that children often display subtle signs of autism in infancy that go unrecognized by parents. Also, research indicates that autism is highly heritable, and is associated with more than 20 different genes. Although genetically-based conditions are present at birth, they are not always immediately apparent, but emerge over the course of development, sometimes gradually, and sometimes suddenly. Although regression is one way that autism manifests, there is no distinct clinical entity called “regressive autism.”

The doctor who “explained” that “the MMR vaccine contains a preservative of ethyl mercury and Grace’s system was unable to flush out the mercury on its own” is dangerously misinformed. Live virus vaccines such as MMR and varicella have never contained the mercury-based antimicrobial thimerosal, which would render them ineffective. Although multi-dose vials of diphtheria-pertussis-tetanus vaccine and several others contain thimerosal, formulations routinely administered to infants and young children in the United States no longer contain it at preservative levels, only a miniscule residue from the production process. Levels of thimerosal to which young children may be exposed through immunizations do not result in “huge levels of mercury” in the body. True inability to “flush out” harmful amounts of mercury would eventually result in death, not autism.

Toxicologists who treat patients for acute mercury poisoning rely on tests conducted by ordinary clinical laboratories. Misinformed doctors such as the one quoted in the article often rely on “provoked” tests conducted by mail-order laboratories. In a provoked test, urine is collected after administration of a chelator, which attracts mercury, binds with it, and is then eliminated. All human bodies contain some mercury, and chelators are usually effective in drawing mercury from tissue. Provocation results in an artificial, temporary elevation of mercury in the urine that is clinically meaningless. Provoked testing does not yield a reliable measure of physiological mercury levels under normal conditions, but a snapshot of a deliberately disrupted mineral metabolism. Additionally, there are no established reference ranges for provoked tests, e.g., no gauge against which to measure whether results are high, low, or average. Comparing the results of provoked testing to unprovoked reference ranges is specious and misleading.

Reliance on provoked urinalysis as the basis for autism treatment recommendations borders on fraud. Nonetheless, misinformed doctors such as the one quoted in the article often use provoked tests to justify diagnosing autistic children with “mercury toxicity,” then recommend risky, time consuming, nauseating, frightening, stressful and expensive treatments. Tragically, many families find themselves overwhelmed by the cost of supplements, special diets, injections, chelators, intravenous treatments, hyperbaric oxygen and infrared sauna sessions, and off-label drugs recommended by the entrepreneurs in whom they place their trust. Such treatments are not covered by insurance because their efficacy in the treatment of autism is not established and because they are not medically necessary.

Families are driven into the arms of autism opportunists by heartbreaking declarations such as “Your child will never make it past the fourth grade and will never marry.” It is appalling that a clinician trained to diagnose autism made such an ignorant, irresponsible, and emotionally harmful remark. Extensive efforts have been made to educate doctors about autism, and there is growing recognition that with adequate support, autistic children are capable of considerable achievement, including communication and development of interpersonal relationships. There is no reason that clinicians cannot provide realistic hope and point families toward constructive responses to diagnosis. Failure to do so is one of the biggest factors fueling the autism-nostrum industry.

It is regrettable, yet understandable, that loving parents attribute their children’s autism to vaccines, then nearly bankrupt themselves pursuing “controversial” means of “recovering” them. Raising an autistic child can be labor-intensive, stressful and scary enough without the added burden of rage over an injury that probably never occurred and the expense of treatments of dubious efficacy.

It is less understandable that a newspaper would broadcast an assertion such as “the MMR vaccine contains a preservative of ethyl mercury.” Sympathy and good intentions do not relieve reporters of their responsibility to avoid inaccuracy, especially when covering public health issues. It is not enough to glibly remark that a scientific idea is “controversial,” then fail to confirm whether the assertions of fact one chooses to disseminate are correct. The science on autism is easy enough to find; one need go no further than the U.S. Court of Federal Claims Web site, which has published the rulings in six recently-decided test cases in the Vaccine Injury Compensation Program’s Omnibus Autism Proceeding. These rulings discuss every aspect of the evidence for and against the hypothesis that vaccines can cause autism. The court’s conclusion, and the conclusion of the great majority of scientists and medical professionals: They don’t.

Comments


  1. This is a well-written and measured editorial.

    Even though we may argue about what is “adequately supportive”, we can do our best to lessen treatments which are not only not supportive but actively harmful.

    — Adelaide Dupont    2010-04-15 21:20    #

  2. I think I’d rather check with doctors who have cured autism than corrupt courts to learn the facts.

    — Autism Healer    2010-04-17 07:33    #

  3. I was speaking to a scientist last weekend at the Mt Sinai Autism Conference who suggested that some of the chelators themselves can bind to mercury in the air. Then when the chelators are injested or applied they are actually introducing mercury to the children’s systems, explaining why the kids continue to excrete mercury.

    — Alison Singer    2010-04-18 09:03    #

  4. I tried to follow the link to the Ledger-Transcript, but I guess I was too late. I’m glad they printed it, maybe catch the same audience as this Ms Morrill got.

    And thank you for writing such an accurate description of the problems we face with media coverage and public perception.

    — Clay    2010-04-19 01:46    #

  5. Fantastic editorial. We need the continued reminder of evidence based therapy for ASD to check the charlatans that prey on the vulnerable and ill-informed in this area. For example, stem cell therapy in China for an ASD child – I don’t think so!

    — Andrew T    2010-04-20 06:01    #

  6. @ #2.
    Autism is not cured. Symptoms and behaviours are simply treated and diminished.

    — M. V.    2010-04-26 18:38    #

  7. @ Autism Healer: I think I would rather check with scientists who’ve studied vaccines for years than with corrupt anti-vaxxers who claim to have ‘cured’ neurological difference.

    — Anonymous Gamer    2010-07-23 04:22    #

  8. I’d disagree with the statement that regressive autism is not a distinct clinical entity. The study you cite does not in fact indicate that, and home video and prospective studies have demonstrated distinctions between regressed and non-regressed children. Of course, that doesn’t mean there was any trigger that set off the regression. After all, conditions such as Rett Syndrome aptly demonstrate that some kids regress purely due to their genetic makeup.

    — Ettina    2010-10-28 10:36    #

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