Autism and vaccine safety: Courtroom controversy, exam room reassurance

Physicians should be poised to help parents maintain confidence in this public health accomplishment in preventive medicine.

Posted Aug. 27, 2007.

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Action in the U.S. Court of Federal Claims in Washington, D.C., has grabbed headlines this summer as claims of an alleged link between childhood vaccines and autism pass beyond the boundaries of science into the legal realm.

The court is being asked to determine if such an association exists.

Science already says it does not. But if the court finds differently, families of autistic children would be eligible for compensation under the Vaccine Injury Compensation Trust Fund, a program created by Congress and funded by a tax on administered vaccines.

As these court proceedings continue, media attention likely will cause doctors to hear more questions from parents about whether immunizations are really the culprits. Physicians can play a critically important role in separating fact from fiction and in reassuring patients that vaccination is a wise choice.

Public health organizations, including the American Medical Association, have expressed strong concerns that the plaintiffs' position could undermine the public's confidence in vaccine safety.

Vaccines are ranked among history's top public health achievements. But medical and health experts worry that a finding for the plaintiffs would lead more parents to decide not to vaccinate their children, thereby contributing to an environment in which childhood illness and death rates rise.

That's why so many eyes are focused on the first test case, Cedillo v. Secretary of Health and Human Services, which began in mid-June and is being heard by Special Master George Hastings Jr.

It involves 12-year-old Michelle Cedillo. She has autism, arthritis, generalized seizures and severe gastrointestinal problems. The court will decide if her problems result from a measles, mumps and rubella vaccine -- or the mercury-containing vaccine preservative thimerosal -- she received as an infant. Her family is one of 4,800 seeking government compensation for what they say are vaccine-related injuries. Two additional special masters will hear other test cases before any decisions are rendered. Deliberations could last at least a year.

For years, the issue has been gaining attention as its advocates battle the medical establishment to advance the belief that vaccines have driven autism rates up. The fight is passionate and pitched, steeped in accusations of scientific conspiracies and cover-ups.

Over time, though, the evidence countering their charges has been unequivocal. Reports from the Centers for Disease Control and Prevention and the Institute of Medicine, as well as dozens of peer-reviewed studies and scientific panels, impugn the vaccine-autism connection. Moreover, in 2001, thimerosal was removed from routine childhood vaccines. Scientists say that if it were the cause, removing the preservative would have led to sharp drops in autism. Early data indicate this is not the case.

Meanwhile, for doctors, the possibility of more exam-room discussions about the issue will translate into more teachable moments.

The most basic messages, of course, are that immunizations have an excellent track record of safety, which is maintained by a series of approval and surveillance systems that are among the world's finest. Parents also need to be reminded about the removal of thimerosal -- with the exception of some formulations of the influenza vaccine. Even in regard to that preventive, the choice between the hazards associated with contracting the illnesses are far greater than other real or purported risks. These points are central because, if vaccine-safety concerns are left to fester and immunization rates drop, the result could be outbreaks of illnesses thought vanquished.

There is no question that autism is a mysterious, heart-wrenching disease. It is impossible not to feel sympathy for the families of children with autism -- their sorrow and their burdens can be staggering. Their search for an explanation is understandable. But vaccines do not deserve the blame.

Not so long ago, such compassion was extended to families who lost children to a whole range of childhood illnesses. But fears of these diseases have been addressed by public health progress. It is imperative that physicians continue to stand firm in safeguarding these successes.

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