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NEWS: Scott Gottlieb Study finds no connection between MMR vaccine and autism BMJ 2004; 328: 421-a [Full text]

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Was the presence of an "autistic factor" equally distributed between autistic children vaccinated earlier, rather than later?

Jeffrey Mann   (20 February 2004)

Gottlieb's article did not find an "autistic factor"

Frank Moos   (20 February 2004)

Reply to Frank Moos

Jeffrey Mann   (21 February 2004)

Research is needed, not propaganda.

F. Edward Yazbak, Falmouth, Massachusetts, USA   (22 February 2004)

Re: Research is needed, not propaganda.

Raymond W. Gallup   (26 February 2004)

Thimerosal + Antibiotics +MMR = Autism Explosion

Saadedine Tebbal   (28 February 2004)

Complete and total confusion in the population

Brent J Gaddis   (27 May 2004)

Re: Complete and total confusion in the population

Liam Farrell   (27 May 2004)

Re: Re: Complete and total confusion in the population

Lisa C Blakemore-Brown   (28 May 2004)

Re: Complete and total confusion in the population

Adam Jacobs   (30 May 2004)

Re: Re: Re: Complete and total confusion in the population

John D Stone   (1 June 2004)

Was the presence of an "autistic factor" equally distributed between autistic children vaccinated earlier, rather than later? 20 February 2004
Jeffrey Mann, Retired physician Salt Lake City, UT 84103 Send response to journal: Re: Was the presence of an "autistic factor" equally distributed between autistic children vaccinated earlier, rather than later?	The headline of Mr. Gottlieb's news report states-: "The study finds no connection between MMR and autism". When I reviewed the study in Pediatrics, I noted that the purpose of the study was "to compare ages at first measles-mumps-rubella (MMR) vaccination between children with autism and children who did not have autism in the total population and in selected subgroups, including children with regression in development." The study was based on a hypothesis - an assumption. The authors stated their assumption-: "The assumption implicit in this exposure comparison is that if the MMR vaccine increases the risk of autism, which usually develops before 24 months of age, then children who are vaccinated at younger ages would have a higher risk of developing autism." Therefore, I presume that the study only tested an arbitrary assumption that if MMR causes autism, earlier vaccination should result in a higher risk of developing autism in children who are vaccinated earlier - if all other factors are held constant (no imbalance in confounding baseline variables). I find the study's results uninformative. I presume that if there is a possible causal connection between MMR vaccination and the development of autism, and yet only a very small fraction of MMR vaccinated children develop autism, that there must be some other "autistic factor" (? genetic ? enviromental) in play, that explains why only a very small percentage of MMR vaccinated children develop autism. A study of a few hundred autistic childrens' time of first MMR vaccination, in comparison to a control group of children, can surely not uncover whether there is another "autistic factor" in play, because one cannot be certain that chance-events would result in an equal proportional distribution of that other "autistic factor" in children vaccinated earlier rather than later. Therefore, I conclude that the news report that states that "the study finds no connection between MMR and autism" should have been worded "a study cannot determine whether there is a connection between MMR and autism, because it was too small in size to ensure that the autistic children vaccinated earlier would have the same proportional likelihood of having a presently undiscovered "autistic factor" as the autistic children vaccinated later." Competing interests: None declared
Gottlieb's article did not find an "autistic factor" 20 February 2004
Frank Moos, no academic app't; father of autistic 12 y/o boy Trinity Communications, Inc. Send response to journal: Re: Gottlieb's article did not find an "autistic factor"	I found Mr. Mann's argument to be specious. He agreed that the Gottlieb work found no causal connection between MMR vaccination and autism, but goes on to say that he "believes" that such a connection exists, probably because of some "autistic factor" that Gottlieb did not control for. This in spite of the fact that dozens of other trials, here and in Denmark, have found no connection between vaccines and autism, and despite the fact that no one has ever seen evidence suggestive to an objective mind of an "autistic factor." As the father of a son profoundly handicapped by autism, I share the evident frustration of Mr. Mann over the inability of the medical community to find a cause for autism. However, it's in no ones best interest to substitute "beliefs" for real scientific evidence. Gottlieb's conclusion that there was no link between MMR vaccination and autism is an objective fact; Mr. Mann's belief that it showed the opposite, and his "belief" that there is an "autistic factor" are just that: beliefs, similar to religious beliefs. There is a place in our hearts for "beliefs" about our autistic loved ones, but let's not confuse those beliefs with scientific evidence. Competing interests: None declared
Reply to Frank Moos 21 February 2004
Jeffrey Mann, Retired physician Salt Lake City, UT 84103 Send response to journal: Re: Reply to Frank Moos	Perhaps I didn’t explain my position sufficiently clearly so that I could avoid being misunderstood. Frank Noos states that I believe that there is a connection between MMR vaccination and autism. I never made any such claim. I merely stated that if MMR vaccination does have some causal connection with autism, and if it only causes autism in a very small fraction of MMR vaccinated children, then there must be some other undiscovered factor in play that causes only a very rare MMR vaccinated child to develop autism. Whether that undiscovered factor is inherent in the MMR vaccine, or a factor associated with the vaccine, or rather a singular, but rare, predisposition in a susceptible child – I have no idea. I simply labelled that unknown factor (if it exists) an “autistic factor”. Because that theoretical “autistic factor” must be extremely rare (considering that autism is so uncommon relative to the number of children who get MMR vaccination), then one cannot search for its presence by looking at a small sample of children vaccinated early rather than late, because if it actually exists, there is no guarantee that it would be distributed proportionally (equally) in a small population sample of children vaccinated early versus a small population of children vaccinated late. The same analogy of an undiscovered “causal factor” exists in the relationship between cigarette smoking and the development of coronary heart disease (CHD). Statistically, there is a definite association between cigarette smoking and an increased likelihood of developing CHD. However, only a small percentage of cigarette smokers develop premature CHD. Therefore, there must be some undiscovered “causal factor” in play (? genetic) that causes smoking to cause CHD in a particular (susceptible) individual. If one studied a small sample of 100 smokers, versus a small sample of 100 non-smokers, and then compared the ten year incidence of CHD in smokers versus non-smokers, one may not necessarily find a strong causal association between smoking and CHD -- if by chance that undiscovered “causal factor” just didn’t occur as frequently in that small sample of 100 smokers as it does in the general population of smokers. The same analogy applies to searching for an unknown (if it exists) “autistic factor” in a small sample of MMR vaccinated children. If that “autistic factor” actually exists, then there is no guarantee that it is distributed as frequently in a “particular” small sample of vaccinated children as it does in the general population of vaccinated children. Therefore, a small study involving a few hundred, or a few thousand patients, may not be large enough when one is dealing with a clinical situation where a postulated accessory (but necessary) “causal factor” occurs very infrequently. Competing interests: None declared
Research is needed, not propaganda. 22 February 2004
F. Edward Yazbak, Director TL Autism Research, Falmouth, Massachusetts, USA Send response to journal: Re: Research is needed, not propaganda.	The author starts by stating that the results of a recent study published in Pediatrics (1) “show no relation” between the MMR vaccine and the development of autism when in fact the DeStefano study only showed that children diagnosed with autistic disorders in Atlanta Georgia received their MMR vaccination at about the same age as a control group of non-affected children. Next, the author refers to the 2001 meeting of a special committee of the US Institute of Medicine (IOM) but fails to mention that the committee also stated that “the conclusion does not exclude the possibility that MMR vaccine could contribute to ASD in a small number of children.” Interestingly, the Vaccine Safety Committee of the IOM met again on February 9, 2004. The following are quotes from 3 presentations: “Mind you, half of Dr. Wakefield’s theory has been proven correct and accepted in the medical community. Hundreds of children with regressive autism and GI dysfunction have been scoped and clinicians are seeing the inflammatory bowel disease he first described. The NIH is finally funding an attempt to repeat Dr. O’Leary’s findings of measles RNA in Wakefield’s biopsy specimens, though I am disappointed it has taken this long”. US Representative Dave Weldon, Florida, 15th District, a physician "Based upon our experimental research, it is plausible to postulate that an atypical measles infection that does not produce a typical measles rash but manifests neurological symptoms might be etiologically linked to autoimmunity in autism. The source of measles virus could potentially be MMR vaccine or a mutant measles strain, but more research is necessary to establish either of these two possibilities…Fundamentally, I tend to think that autistic children have a problem of their immune system, which is the “faulty immune regulation.” Hence they have abnormal immune reactions to measles virus and/or MMR vaccine” Vijendra K. Singh, Ph.D., Research Associate Professor of Neuroimmunology, Utah State University, an expert in the autoimmune causes of autism. “In light of encephalopathy, presenting in children as autistic regression closely following MMR vaccination … The findings confirm a highly significant statistical association between the presence of MV RNA in CSF and autistic regression following MMR vaccination.” Jeff Bradstreet MD, Director, International Child Development Resource Center, Melbourne, Florida. Dr. Bernard Rimland, Founder of the Autism Society of America, President of the Autism Research Institute and a full-time professional research scientist in the field of autism for 45 years has stated “Late onset autism, (starting in the 2nd year), was almost unheard of in the ‘50s, ‘60s, and ‘70s; today such cases outnumber early onset cases 5 to 1, the increase paralleling the increase in required vaccines.” (2) This directly contradicts the following statement by the author “Because autism is usually diagnosed during the toddler years…” Lastly, MMR does not contain Thimerosal and the majority of pediatric vaccinations are given in the first year of life. A relatively simple study would be to compare the age of onset of autistic symptoms in affected children in Atlanta who received the MMR vaccine at 15 months with those vaccinated at 30 months of age. I believe, from my own research, that such a study will show that autistic behavior follows MMR vaccination and that fewer and milder cases will be noticed in the cohort vaccinated at 30 months, since vaccination at a younger age is more damaging. Another reasonable study would be to compare Measles, MMR and Myelin Basic Protein antibody titers of children who developed autism shortly after MMR vaccination in Atlanta to an equal sample of normal children similarly vaccinated. Obviously there is an inherent risk with these studies; they could prove that regressive autism after MMR vaccination is not a coincidence. References 1. DeStefano F. et. al. Age at First Measles-Mumps-Rubella Vaccination in Children With Autism and School-Matched Control Subjects: A Population-Based Study in Metropolitan Atlanta PEDIATRICS Vol. 113 No. 2 February 2004, pp. 259-266 2. The Autism Epidemic is Real and Excessive Vaccinations Are the Cause A Statement: Bernard Rimland, PH.D.July 14, 2003 Available at: http://autismautoimmunityproject.org/Rimland.htm (accessed February 17, 2004) Competing interests: Grandfather of a child with autism who happens to have evidence of Measles Genomic RNA in his intestinal biopsy.
Re: Research is needed, not propaganda. 26 February 2004
Raymond W. Gallup, Founder of The Autism Autoimmunity Project Lake Hiawatha, NJ 07034 Send response to journal: Re: Re: Research is needed, not propaganda.	Dear Sir: I agree with F. Edward Yazbak, MD with the studies that he calls for. There is no reason why they shouldn't be done especially if we want to stop the autism epidemic and prevent more children from developing regressive autism. It is not a coincidence that more and more children are getting regressive autism after receiving the MMR vaccine at 15 months. Recently the CDC and the American Academy of Pediatrics are now reporting that 1 out of 6 children are diagnosed with a developmental disorder and 1 in 166 children are diagnosed with an autism spectrum disorder (1). Several years ago it was reported that 1 in 500 children had an autism spectrum disorder, then 1 in 250 children had an autism spectrum disorder and now it is 1 in 166 children that have an autism spectrum disorder. The Autism Autoimmunity Project has kept track of the US Department of Education figures regarding autism for school aged children from 6 to 21. The US Department of Education started tracking autism in 1991/1992 and have consistently used the same diagnostic criterion for autism. In 2000/2001 there was a total of 78,717 children with autism (2)nationwide. In 2001/2002 the nationwide total of autism increased 19,130 to 97,847 (3) and in 2002/2003 the nationwide total of autism increased 20,755 from 97,847 to 118,602 (4). I anticipate that the 2003/2004 figures that will be out in October 2004 will show an even larger increase. The critics of the link between the MMR vaccine and autism should pay attention to the figures of autism that are continuing to skyrocket. At The Autism Autoimmunity Project we will continue to document the numbers. More clinical science needs to be done and denials of a link to the MMR vaccine and autism will not help the children/adults already affected nor will it stop the autism epidemic. The critics should be explaining to us with clinical science why children with autism have measles in the gut, why they test positive for myelin basic protein antibodies and why they have elevated measles antibody titers. The critics should also work to see what we can do to reverse the damage of those children/adults with autism with treatments. Hopefully, the attitude of the critics will change so that we can stop the epidemic of autism. If not, then we maybe reporting in the next five to ten years that autism affects 1 in 50 children, 1 in 25 children and yes, 1 in 2 children. That, in deed, would be a tragedy. References 1. An Autism ALERT http://autismautoimmunityproject.org/A.L.E.R.T..htm 2. The US Autism Epidemic http://autismautoimmunityproject.org/shame.html 3. 2001-2002 Autism figures (97,847 701% nationwide increase) http://www.ideadata.org/tables25th/ar_aa3.htm 4. 2002-2003 Autism figures (118,602 870% nationwide increase) http://www.ideadata.org/tables26th/ar_aa3.htm Competing interests: Founder of The Autism Autoimmunity Project and father to Eric Gallup who has regressive autism with myelin basic protein antibodies, elevated measles antibody titers, T-cell abnormalities, and colitis
Thimerosal + Antibiotics +MMR = Autism Explosion 28 February 2004
Saadedine Tebbal, None Texas, 77477 Send response to journal: Re: Thimerosal + Antibiotics +MMR = Autism Explosion	Trying to relate just MMR or just thimerosal to autism is a losing war because there is more than one parameter that needs to be present for autism to start. Furtheremore, epidemiologic studies are not going to prove anything since they can be manipulated at will. Prof. Boyd Halley at the chemical department of the university of Kentucky suggested that thimerosal suppresses the immune system allowing the attenuated measles virus to get a foothold inside of intestinal cells that leads to the inflammatory bowel disease (IBD). He showed in his experimental (and not epidemiologic) studies about thimerosal effect that the presence of aluminium (MMR while free of thimerosal is high in aluminum) dramatically increased the rate of neuronal death (brain cells) caused by thimerosal. He also showed that antibiotics especially tetracycline and ampicillin increased the toxicity reaction to thimerosal. In other experimental studies, he found that neurons pre-incubated with estrogen demonstrated substantial protection against thimerosal-induced neuronal death. In contrast, a low nano-molar level of thimerosal that gave less than 5 percent neuron death in three hours resulted in 100 percent cell death by the addition of one micromolar level of testosterone. This may explain why boys are four times more affected with autism than girls. All these studies can be duplicated at very low cost in any biochemistry lab by chemists who dont have any competing interest. Why not start with that? The current vaccines are still not thimerosal free. A hundredth of a percent is still highly toxic to infants. A millionth of a percent is 10 microgram per liter which is high by any standard used. Vaccines should be free (zero concentration) of any toxic metal, ethanol, or formaldehyde before they are considered safe. Competing interests: Kid with autism
Complete and total confusion in the population 27 May 2004
Brent J Gaddis, Soon to be parent San Diego, CA Send response to journal: Re: Complete and total confusion in the population	As a soon to be parent, I must say that it is frustrating and obvious that there is not a clear answer one way or the other here. There seem to be so many opinions, positions, studies, etc... and the problem that parents today face is that there is no clear answer from the people/organizations who are supposed to be protecting the population. Every single couple in my "soon to be parent classes" expressed concern about immunizations and autism. I have been around long enough to see that the opinions of medical doctors change, the FDA removes drugs that they previously approved, etc... These things happen and to follow blindly is scary if not dangerous. Especially when dealing with our children. Can somebody tell me who thought that putting one of the most toxic substances on the planet (i.e. mercury or mercury derivative) into the bloodstream was a good idea. Break a thermometer, call HAZMAT. Other than that, shoot that heavy metal right into the bloodstream. It is scary that that went on for so long before it was halted (we hope the drug companies are telling us the truth now) There are too many vaccines. Its a big money business. Don't think otherwise. Chickpox vaccines? For what? Hell, everyone I know had the chickpox. Flu vaccines? Please. Each year they tout them on the news. Most of the time, they later state that the vaccines didn't address the particular flu strain for that year. Oh and by the way, some of them still contain thimerosal. Why is that? Until such time that parents see an actual unbiased study that is conclusive and definite, there is going to be confusion. How about this for an idea: Create a cross discipline team of researchers (i.e. medical doctors, chiropractors, government officials, drug company manufacturers, etc... - make it a sort of a "cross functional jury") to conduct a study together. That way, the members of the "jury" would be forced to keep each other in check as far as scientific approach, force each other to ignore biases or other "interests", etc... It is way too easy to bend statistics to prove a position. Way too easy. It seems that for every study or statement that denies a link between MMR and Autism, there is a conflicting study or statement from a doctor or chiropractor suggesting a link. All of this is very confusing to the average parent. You experts need to figure it out. You are the experts and as a society, if we can fly a person to the moon or make a bomb hit a house 1000 miles away, we can surely conduct an unbiased study and come up with a damn answer. As parents, we are counting on you. Until that happens, I'm not letting anyone stick a needle in my child for any vaccination. The lack of conclusive evidence one way or the other coupled with the lack of unbiased, unrefutable research is not comforting as a parent. I want to believe that the CDC and our govt and medical community is looking out for our best interests. However, the length of time it is taking to figure this out and either establish the link or disprove it is ridiculous considering all the smart people who are involved. I'm to the point of reverting to what I perceive as common sense. That is, sticking a needle in the arm of a baby and injecting soemthing foreign into the bloodstream just doesn't sound like a good idea to me. Especially before their little immune systems are able to handle it. Competing interests: None declared
Re: Complete and total confusion in the population 27 May 2004
Liam Farrell, GP Crossmaglen Health Centre Co Armagh N. Ireland BT359HD Send response to journal: Re: Re: Complete and total confusion in the population	Dear Brent, here is some common sense; get your child vaccinated Competing interests: None declared
Re: Re: Complete and total confusion in the population 28 May 2004
Lisa C Blakemore-Brown, Psychologist UK Send response to journal: Re: Re: Re: Complete and total confusion in the population	Here's some more: Will every Medical professional who vaccinates a child sign a form to say a) the child is perfectly healthy and has no medical weaknesses or sign of autism or vulnerability to haemorrhage b) that if such events happen after vaccination they will be financially responsible for caring for this child throughout the rest of their lives - or - if they die - they will compensate for the loss of their lives. Competing interests: I assess children on the autistic spectrum
Re: Complete and total confusion in the population 30 May 2004
Adam Jacobs, Director Dianthus Medical Limited, London SW19 3TZ Send response to journal: Re: Re: Complete and total confusion in the population	I think the reason Brent Gaddis is confused is because of the way the MMR and autism story has been reported in the popular media. One of the first things journalists are taught at journalism school is that it is important to be balanced, and always to give both sides of an argument. This works well for political journalists, as there are opposing views to most political stories. It would be quite wrong for a journalist to report the government's views on the latest political issue without also reporting the opposition's views. Unfortunately, it works considerably less well for science journalists. It is true that some medical stories reflect genuine controversies, such as whether we should screen for prostate cancer. Here, giving equal weight to both views is no bad thing. The trouble arises when one point of view is supported by overwhelmingly greater evidence than the other: journalists still feel they have to give both sides of the story equal prominence, which grossly distorts the story. A great deal of research has been done on the possible link between MMR and autism. Although it is never possible to prove a negative, the research has shown convincingly that if any link exists, it must be extremely small. Nonetheless, a vocal minority of anti-vaccinationists have managed to keep the story going, which has been made possible by journalists' well intentioned, but misguided, sense of duty to report their views. It is important to realise that the anti-vaccinationsists' point of view is supported by almost no evidence. In a previous BMJ rapid response on this topic [1], I asked the simple question 'Are there any published studies with a sample size of more than 12 that have shown a causal link between MMR vaccination and autism?' That question has yet to be answered, which I suggest may provide the clear answer that Gaddis is looking for. References: 1. http://bmj.bmjjournals.com/cgi/eletters/327/7428/1411#44490 Competing interests: My company provides consultancy services to various clients, who have occasionally included vaccine manufacturers. We would be happy to work for anti-vaccinationists as well if they were to agree to our normal evidence-based approach.
Re: Re: Re: Complete and total confusion in the population 1 June 2004
John D Stone, none London N22 Send response to journal: Re: Re: Re: Re: Complete and total confusion in the population	I wish there were grounds for Liam Farrell's confidence. Unfortunately, I have read the press release of Rep. Dave Weldon in response to the Institute of Medicine (IOM) report Tuesday before last (18 May) endorsing the safety of MMR and Thimerosal (so far unreported here). In case there is any doubt about Rep. Waldon's professional credentials or political bias it ought to be pointed out that he is both a medical doctor and a Republican. Here are some extracts [1]: "Today's report is premature, perhaps perilously reliant on epidemiology, based on preliminalry incomplete information, and may ultimately be repudiated...Unfortunately, this report will lead many clinicians to believe that thimerosal is safe and there is no problem with MMR; however, it will do nothing to allay the concerns of thousands of parents of autistic children. It will only drag the IOM under the cloud of the controversy that has currently engulfed the CDC. This concern is what lead me earlier this year to request that Dr. Julie Gerberding delay the meeting and the report." He goes on: "In 2001 the IOM stated that it is "unclear whether ethylmercury [from vaccines] passes readily through the blood brain barrier...". The IOM recommended several biological and clinical studies to answer this question and whether this mercury could cause developmental problems. These studies were in large part never done...The IOM's scope of investigation was severely narrowed for this review...This raises suspicions that this IOM exercise might be more about drawing pre-designed conclusions..." Rep. Waldon goes on to say: "unfortunately, the epidemiology studies that the IOM bases its findings on are not immune from conflict or controversy. Many of the authors have conflicts of interest including funding from vaccine manfacturers, employment by manufacturers, or conflicts in that they implemented vaccine policies that are now being investigated. Futhermore, the studies were designed to examine entire populations and would miss subgroups of genetically susceptible populations...The IOM report is based on studies examining populations in the United Kingdom, Denmark, Sweden and the United States - all of whom have different vaccines, vaccine policies, and mercury exposures. Study results are only as reliable as the design of such studies. Relying on these studies to draw conclusions is shaky ground." Turning specifically to MMR he writes: "...the IOM review of this matter is totally premature; the NIH is only now attempting to duplicate the work of Dr. Andrew Wakefield. Half of Dr Wakefield's work has been demonstrated to be correct. Attempting to draw "conclusions" at this time is counterproductive. Statistical studies of this matter are of little benefit, only clinical pathological study will lay this issue to rest." Dave Weldon concludes: "Lastly, I am also troubled by the lack of liability or accountability by these decision-makers should they be proved wrong. I want more than just a "sorry" from them should their conclusions be found erroneous a few years down the road. Two many lives are at stake." Well, Dr Farrell? [1] News from Dave Weldon, May 18, 2004, contact: Jaillene.Erickson@mail.house.gov Competing interests: Parent of a child with autism. Pro safe vaccination.