Landmark ruling finds no link between vaccine and autism
■ Physicians applauded the special court's finding and hope parents who had refused vaccines will now have their children immunized.
By Susan J. Landers — Posted March 2, 2009
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Washington -- Vaccine supporters rejoiced Feb. 12 when judges in a special federal court rejected the theory that the measles, mumps and rubella vaccine combined with the preservative thimerosal caused the disabling autism that affected three children and their families.
The three had served as the petitioners in test cases representing about 5,000 families who sought damages from the National Vaccine Injury Compensation Program. The families believed vaccines, particularly the MMR vaccine administered to their children as infants, caused the disorder.
But the judges, known as special masters, ruled that the vaccine was not to blame. In doing so they lined up on the side of a massive amount of scientific evidence gathered by the Centers for Disease Control and Prevention and the Institute of Medicine that also failed to find a link between the vaccine and the disease. The special masters made clear the petitioners could not receive compensation through the VICP.
The court sifted through 5,000 transcript pages and more than 700 pages of posthearing briefs. They reviewed 939 medical articles for one case alone -- well beyond the 10 typically reviewed in a vaccine action. Physicians provided testimony on both sides of the issue.
Special master George L. Hastings chastised the physicians who testified in support of the autism-vaccine link. He wrote that the family whose case he heard had been "misled by physicians who are guilty, in my view, of gross medical misjudgment."
After studying the evidence, Hastings wrote in his decission that the reports and advice given to the family by physicians who proposed a causal connection between their child's autism and the MMR vaccination "have been very wrong."
The decision was welcomed by physicians who view vaccines as one of the greatest public health tools.
It was "enormously, enormously helpful," said Paul Offit, MD, director of the Vaccine Education Center at Children's Hospital of Philadelphia and an outspoken critic of the anti-vaccine movement.
Although science already had cleared the vaccine of blame, the ruling adds important weight, he said. "I think the public views courts as independent reviewing agencies."
Most physicians are optimistic that the blame directed toward vaccines will now begin to dissipate and attention will focus on autism's other possible causes. Genetic research, for example, is beginning to yield clues.
"Autism is a heart-wrenching condition," said Joseph M. Heyman, MD, chair of the American Medical Association's Board of Trustees, "and the upheaval felt by parents whose children suffer with autism is understandable -- as is their search for answers."
Continuing the search for a cause
"We need ongoing research into the causes of autism, but cannot let unfounded myths keep us from giving our children the proven protection they need against infectious diseases," Dr. Heyman said.
Peter Hotez, MD, PhD, is president of the Sabin Vaccine Institute at George Washington University in Washington, D.C., and the father of a 16-year-old daughter with autism. He was surprised it took the court so long to reach a decision, because "there is no plausible mechanism by which these vaccines could cause autism." The proceedings had begun in 2007.
"It is quite clear this is a genetic condition associated with abnormalities in neural migration and brain structure," he said.
The decision could mark the "beginning of the end" of the movement to blame vaccines for autism, Dr. Offit said. Although, he noted, "there is a core group of parents for whom nothing will ever change that, no IOM reports or court decisions."
Some advocacy organizations for people with autism were disappointed and angered by the decision. Autism Speaks, which has offices throughout the U.S. and abroad, said in a statement that it would continue to support research that addresses questions about the vulnerability of some individuals to the adverse effects of vaccines. The National Autism Assn., based in Missouri, expressed outrage at the court's decision, calling it "a broken promise of medical care following a vaccine injury."
But many physicians hope parents who had rejected vaccines for their children will now opt for them.
Despite evidence to the contrary, the belief that the vaccine could trigger autism has caused immunization rates to drop in some parts of the United States and in other countries. This downturn has triggered outbreaks of measles and mumps.
"In some respects, vaccines have been their own worst enemies," said Robert W. Frenck Jr., MD, professor of pediatrics in the infectious diseases division at Cincinnati Children's Hospital Medical Center. "Many families ... have never seen the diseases these vaccines prevent."
Dr. Frenck related a childhood experience in which he visited a young friend with polio. The friend was in a room full of people in iron lungs. The image was disturbing. "When there was a vaccine available for polio, no one thought twice about getting it."
And even in the midst of current fears of an autism-vaccine link, many parents remain committed to vaccination. Jocelyn Kuhn of Cincinnati, whose 7-year-old son Michael is autistic, made sure all three of her children were fully immunized. "The thought of not vaccinating my kids scares me to death."
Most health professionals share this perspective.
"Vaccines are one of the best public health accomplishments of all time and have proven time and time again their ability to keep horrific diseases at bay," Dr. Heyman said.
As a vaccine researcher, Dr. Hotez travels to developing nations and sees the toll taken by vaccine-preventable diseases. "To think we could see a resurgence of these diseases in the U.S. because parents aren't vaccinating their kids is devastating."
With one ruling handed down and one more still to come from the special masters -- on whether thimerosal alone might have caused autism -- all parties agree that families, such as the Cedillos, whose teenage daughter, Michelle, was at the center of one of the test cases, deserve attention and support.
In his decision, Hastings praised the Cedillo family's "loving, caring and courageous nature."