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Tuesday, May 11, 2010

In Another Federal Decision, Court Rules No Autism-Vaccine Connection
By Gina Shaw
On March 11, a special vaccine court definitively declared that there is no scientific basis for the claims that mercury in vaccines causes autism. The rulings are part of the Omnibus Autism Proceeding, a “class-action” suit begun in 2002 on behalf of more than 5,000 families of children with autism, which had sought to give them the right to receive compensation from the federal vaccine injury fund. Children who develop complications known to be associated with a vaccine are automatically eligible for compensation from the fund, but autism has never been accepted by the fund as a complication of vaccines.
The omnibus proceeding was based on six “test cases,” involving three different theories positing that vaccines can cause autism. In the three cases most recently before the vaccine court, parents had sued claiming that the preservative thimerosal, used in some vaccines (but almost eliminated from current vaccines), had caused their children’s autism.
In 2009, the same three judges rejected parents’ claims in the first three cases — rulings that have since been upheld on appeal — that the measles-mumps-rubella (MMR) vaccine, either by itself or in combination with thimerosal from other vaccines — the MMR vaccine has never contained thimerosal —was the autism culprit. A third set of test cases has yet to go before the court, but may have been abandoned by the petitioners.
Special Master Denise Vowell, ruling in a case brought by the family of a boy named Colin Dwyer, was particularly withering in her criticism of the petitioners’ claims: “Petitioners propose effects from mercury… that do not resemble mercury’s known effects on the brain, either behaviorally or at the cellular level.
To prevail, they must show that the exquisitely small amounts of mercury in TCVs [thimerosal-containing vaccines] that reach the brain can produce devastating effects that far larger amounts experienced prenatally or postnatally from other sources do not,” she wrote.  “…The witnesses setting forth this improbable sequence of cause and effect were outclassed in every respect by the impressive assembly of true experts in their respective fields who testified on behalf of respondent.”
The ruling was hailed by many pediatric neurologists and autism experts, who noted that the science regarding an autism-vaccine connection has long been settled.
“There is no credible research to support the claim that mercury exposure causes autism,” said Max Wiznitzer, MD, associate professor of pediatric neurology at Rainbow Babies and Children’s Hospital in Cleveland, OH, who testified before the vaccine court during the 2009 cases.
“Special Master Vowell said it very nicely — basically, if low-grade chronic exposure to mercury, such as through breastfeeding, doesn’t cause this clinical picture, why would a few shots do it? These decisions confirm what science has been telling us for a long time, that mercury has the potential for being a neurotoxin but ethylmercury (the preservative found in vaccines) does not cause autism.”
Although they praised the decision, neurologists were skeptical as to whether it would change much in terms of public opinion. “People that rely on paranoid ideations will only dig themselves deeper into the trenches, with ‘big pharma collusion with the government’ theories,” said Manuel Casanova, MD, the Gottfried and Gisela Kolb Endowed Chair in Outpatient Psychiatry and a professor of anatomical sciences and neurobiology at the University of Louisville, who also testified before the vaccine court.
“In the 2009 ruling, one of the special masters used the words ‘gross medical misjudgment’ about the petitioners’ experts. Those should be eye-opening words. But whether it will make a difference in the way that people think, I am not all that sure.  You can see the reaction on the blogs — it’s been explosive. We haven’t seen the end of this.”
Isabelle Rapin, MD, professor of neurology and pediatrics at Albert Einstein College of Medicine and a pioneering researcher in autism, thinks the discussion needs to be refocused on the complications and dangers of vaccine-preventable diseases like measles.
“There has been a resurgence of measles as a result of declining vaccine rates, and this is a serious disease that can produce brain damage,” she said. “There are also other complications such as pneumonia, but measles encephalitis, which affects one in 1,000 children who get this disease, is devastating. Current doctors have never seen measles encephalitis because measles had been virtually eliminated, but now measles is coming back and it’s going to be a problem. Doctors who haven’t seen it may not be as vehement as those of us who have, but most neurologists have seen various forms of encephalitis and know it’s nothing to sneeze at.”
It’s also worth noting that the vaccines-cause-autism theory is not yet done with its days in court, Dr. Casanova said. In March, the US Supreme Court agreed to hear arguments in Bruesewitz v. Wyeth, a case addressing whether or not the family of a child that they consider to be “vaccine-injured” can pursue traditional “design defect” claims under state law when the Vaccine Injury Compensation Program has already determined that the child’s condition is not related to a vaccine injury. The Bruesewitz case involves a seizure disorder, not autism, but if the family prevails, it could theoretically open the floodgates to dozens of autism-vaccine suits in state courts. The Supreme Court will hear the case this fall.
Strategies to Counter Public Misperceptions
Autism experts suggested strategies to help counter some of the misinformation promoted about a vaccine-autism link:
  • “One way to communicate with your patients, and with their parents if you’re a pediatric neurologist, is to set up a Twitter feed,” said Max Wiznitzer, MD. Let parents know they can sign up and when new information comes out Tweet a very brief synopsis of what this means. Younger parents, especially, use social networking and new technologies a lot and so should we.”
  • All neurologists, and especially pediatric neurologists, should have the fact sheets for parents about vaccine safety, published by the CDC and the American Academy of Pediatrics, available to their patients:
  • Promote the strides that have been made in autism research, said Nancy Minshew, MD, who directs the Center for Excellence in Autism Research at the University of Pittsburgh. “Higher-functioning children will respond to new neurocognitive interventions, and lower-functioning kids will respond to a biologic intervention, like rapamycin that’s now being used for tuberous sclerosis.” (Half of all TSC patients also suffer from autism.) “Families need to shoulder the burden of helping us move the stones forward to help us find the solutions out there like rapamycin because they’re out there and they will work.”