FEAT DAILY NEWSLETTER      Sacramento, California      http://www.feat.org

November 30, 2000

 

Autism, MMR and 60 Minutes

Another Pediatrician’s Perspective

 

[This is from F. Edward Yazbak, MD, FAAP TL Autism Research in Falmouth, Massachusetts.]

The recent 60 Minutes program on MMR vaccine was an excellent awareness-raising report on the debate surrounding regressive autism and its explosion.  What struck me most are the following:

·        The tragic pictures of the little boy who opened the show and his parents’ heart-breaking pain and suffering;

·        The beautiful mother, standing with her arm raised, like most of the audience, because she believed her child was injured by the MMR vaccine—caught crying by the scanning camera; and

·        Andrew Wakefield, sincere, truthful, principled, unassuming and ready to sacrifice everything in the pursuit of the truth.

First, my background:  I am trained in infectious diseases and pediatrics.  During my training I personally cared for children and adults with serious and complicated contagious illnesses. I subsequently “really” practiced pediatrics and was a school physician for 34 years.  I personally administered my own vaccines and enforced every Health Department mandate.  I also informed myself thoroughly about regressive or late onset autism.  Because of research I am now conducting, I strongly suspect that there is an autism-vaccine connection (*below).

The following crucial facts were unfortunately not discussed in the 60 Minutes piece:

·        The measles virus was isolated from the gut wall of children with autism. It was further identified by very precise PCR techniques by O’Leary, and was confirmed to be of vaccine origin by Kawashima and his group.

·        Sixty new cases with autistic enterocolitis were reported by

Wakefield in the September 2000 issue of the American Journal of Gastroenterology.

·        Children with autism have statistically significant co-existing high titers of MMR and Myelin Basic Protein antibodies (Singh).

 

The authorities like to repeat that Wakefield’s findings have not been duplicated by other researchers.  This may be true for the case of children with autism but only because no one has tried to.  Indeed after seeing the onslaught of attacks on Dr. Wakefield because of his research, it is unlikely that anyone would want to.  Sabra et al at Georgetown University, however, have described identical ileal lymphoid nodular hyperplasia in the guts of children with ADHD.

Thousands of parents believe that the MMR vaccine has contributed to their children’s autism.  They have pictures and videos to prove the ‘before ’ and ‘after.’  They speak of the MMR being the only new event in their child’s life in that period between normal development and autistic regression.  They point out their children’s marked immune system dysfunction, something with which they were not born.

These parents certainly did not acquire their conviction from reading about the twelve cases reported in Dr. Wakefield’s first paper.  Nor would they simply be looking for a scapegoat.  Please remember, and always remember, their children were normal and their disease is acquired.  Regardless of how often the authorities attest that the MMR vaccine is safe, an increasing number of parents here and in Europe are refusing to believe them.  Safety trials not looking beyond 3 weeks post-vaccination convince no one.  Equally alarming to the parents is the fact that the infectious disease specialists and epidemiologists who make decisions and mandate vaccines have little knowledge of autism and its immune etiology.

It is inevitable that the present intransigent and unbending attitude of the vaccine authorities will lead to measles, mumps and rubella outbreaks.  When these diseases return, and they will, the authorities—and the authorities alone—will have to be held responsible.  There is no reasonable justification to tell a parent who is adamant about not using MMR but who is willing to return three times for the monovalent vaccines, that they are simply not available and/or illegal.  Dr. Wakefield only asked that more research be done into the triple live-virus vaccine.  To intimate that his research will cause epidemics is a flagrant distortion of the truth.

It took us a long time to perfect the single (monovalent) mumps, measles and rubella vaccines.  Most pediatricians and parents trusted them.  Epidemics stopped and few adverse vaccine reactions were reported.

When the MMR vaccine was licensed in 1971 and became available shortly thereafter, many pediatricians refused to use it and continued vaccinating with the monovalent products at 3-6 months intervals.  These pediatricians were concerned with the potential decreased efficacy and increased side effects of the combination.  Many of us were also aware that no long-term safety studies of the MMR vaccine were available, on going or contemplated.

Two things happened simultaneously in the late seventies to change things dramatically:

1.)  HMOs arrived on the scene and cut down the number of “regular check-ups” 2.)  The State Health Departments started providing the vaccines free of charge to the practicing pediatricians and GPs. The Health Departments made it clear that it was cheaper to buy and easier to store and distribute the 3 in 1 vaccine and, on that basis, simply mandated its use.  Pediatricians had no choice but to comply.

To say that we are not sure the parents will bring the child back for subsequent shots is false.  Certainly this argument could be made in a third world country but certainly not in the West. Any “practicing” pediatrician knows that a parent is much more likely to keep a doctor’s appointment if a vaccine is due.  One must be cautious not to insult parents’ intelligence.

Secondly, to say that added injections will cause pain and discomfort to the child is ridiculous.  I believe that the pain caused by an aqueous injection administered sub-cutaneously by an experienced health professional does not even come close to the living hell of Autism.

Interestingly, the only people who raise these two arguments are members of vaccine boards and committees and rarely treat patients.  Wouldn’ t it be more appropriate to have the parents make that important choice if they have such marked reservations?  After all it is their child.  As well, it seems hypocritical to mention pain when the vaccine authorities are introducing new vaccines of questionable efficacy and safety all the time It was intimated on 60 Minutes that a multitude of studies involving large populations has proved that the MMR vaccine was perfectly safe and did not cause autism.  THIS IS NOT TRUE.  There is NO long-term safety research proving that MMR does not cause autism.  There is a sole epidemiological study by Taylor et al, often publicized as proving decisively that autism did not increase in the UK after 1988, when MMR was introduced with great fanfare.  This study was financed and ordered by The Medicines Control Agency and The Public Health Laboratory Service.

A noted British statistician whose specialty is medical research, looked carefully at the Taylor study.  He wrote:  “A myth is being created that the Taylor et al study shows that MMR is not triggering autism. The evidence presented in their Lancet paper is [in fact] consistent with the MMR triggering a substantial proportion of autism cases in this North London population.  The study does not find evidence to support an association between MMR and autism onset because of a flaw in the study design.  This does not mean that such an association does not exist.”

The reason for this expert’s comments is that the “case series design” used in the Taylor study is well known to be statistically unsatisfactory for chronic conditions and inadequate for a small sample (293 confirmed cases).  Even the authors of the study themselves alluded to its methodological problems.

At times, while figures clearly demonstrate an increase in autism, this fact is denied in the written text. At others, contradictions are evident:

·        “There is uncertainty about whether the prevalence of autism is increasing,” immediately followed by: “Our study is consistent with an increase in the incidence of autism in recent birth cohorts.”

·        “For age at first parental concern, no significant temporal clustering was seen for cases of core autism and atypical autism, with the exception of a single interval within 6 months of MMR vaccine associated with a peak in reported age of parental concern at 18 months,” and “Our results do not support the hypothesis that MMR vaccination is causally related to autism.”

By far, however, the Taylor study’s most serious problem was to look only at children born after 1987.  This effectively excluded all children born in 1986-87 and initially vaccinated in 1988 or later.  It also excluded all 2–5 year old children previously non- or partially immunized and who received MMR boosters in 1988 or later.  More importantly, this design flaw added all excluded children to the opposite group. Last but not least, Dr.  Taylor has repeatedly refused to let anyone see his raw data, in the hopes of replicating his findings, thus becoming probably the first author in the history of the Lancet to do so.

The ‘authorities’ need to get away from rhetoric.  They must look at and commission real science to support their claims.  Until the safety of the MMR vaccine is proved conclusively, it will be wise to allow parents a choice between the single vaccines and the trivalent MMR.  All of us who have been touched by the autism epidemic appreciate the efforts put forth by CBS and 60 Minutes.  We hope that numerous and more balanced, informative programs will follow.

Take Some Mystery out of Autism

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