Pitt expert goes public to counter fallacy on autism
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Nancy J. Minshew is finally ready to take off the gloves.
After years of sitting back and hoping the science would speak for itself, the director of the University of Pittsburgh's Center for Excellence in Autism Research has decided it's time for her to take a personal stand.
Autism is not caused by vaccinations, she says, and those who continue to push that theory are endangering the lives of children and misdirecting the nation's scarce resources for autism research.
"The weight of the evidence is so great that I don't think there is any room for dispute. I think the issue is done," said Dr. Minshew, who runs one of nine top autism research centers funded by the National Institutes of Health.
"I'm doing this for all the families out there who don't have a child with autism, who have to deal with the issue of 'Do I get a vaccination, or do I not do it and risk my child's life' because they don't understand what the science is saying."
By coincidence, her decision to speak out comes on the day that ABC is airing the pilot of a new TV drama, "Eli Stone," in which a young lawyer pursues a lawsuit on behalf of a woman who believes mercury in a vaccine caused her son's autism.
The episode, which airs at 10 this evening, upset the American Academy of Pediatrics so much that it asked the network to pull the show. The Walt Disney Co., which owns ABC, declined to do so, but agreed to run a disclaimer that will direct viewers to the federal Centers for Disease Control and Prevention's autism Web site.
That site will tell visitors what has been known for several years -- that virtually every mainstream public health and research organization, including the congressionally authorized Institute of Medicine, the CDC and the NIH, says there is no credible link between vaccines and autism.
That has not stopped a determined group of parents, iconoclastic researchers and lawyers from arguing that there is a link and that the government and drug companies have conspired to hide the truth.
"Eli Stone" picks up on that theme, and while ABC asserted that the program presents both sides of the argument, the drama clearly leans toward the vaccine-autism connection.
In real life, the main target of suspicion has been thimerosal, an ethyl mercury preservative that kept vaccines from being contaminated once they started to be used in a doctor's office or clinic.
In the TV drama, it's called "mercuritol," and the Eli Stone character says this during his closing argument to the jury:
"Is there proof that mercuritol causes autism? Yes. Is that proof direct or incontrovertible proof? No. But ask yourself if you've ever believed in anything or anyone without absolute proof. That's called faith."
Adding to the aura of conspiracy surrounding the debate, the script also has the lawyer saying to the jury, "The first lawsuit alleging a connection between tobacco and cancer was filed in 1954, but it took 30 years for a jury to award a single dollar for something we all now accept as patently true."
After watching an advance copy of the program at the Pittsburgh Post-Gazette's request this week, Dr. Minshew said she thought it was well done.
"It's great entertainment," she said. "If it didn't set off this whole other issue, I would think it was cute."
She was particularly perturbed by the tobacco reference in "Eli Stone." The evidence of heart and lung damage from smoking was overwhelming for years before tougher cigarette regulations were enacted, but there is no such parallel in the studies that have alleged that vaccines cause autism.
One of the main pieces of evidence against the vaccine theory, Dr. Minshew said, is that thimerosal has been banned from most childhood vaccines in America since 2001, and yet reported autism rates have continued to increase.
Dr. Eric Fombonne, an autism researcher at McGill University in Montreal, has an even more telling example of that.
In Quebec, children who got vaccines from 1987 to 1991 had about half as much mercury exposure as those in the United States; from 1992 to 1995, they had the same amount; and from 1996 on they had no exposure at all because mercury preservatives were removed. Yet the autism rates in Quebec increased steadily through that entire period, and actually went up faster after the mercury was eliminated.
"A key point in this debate for me," Dr. Fombonne said, "is that we have pumped a lot of money into these studies, and when do you stop pouring money into a theory which has no evidence supporting it?"
There is also the very real risk that parents who are afraid of vaccines won't protect their children against serious childhood diseases and infections, Dr. Minshew said.
In the United Kingdom, the controversy over vaccines and autism has centered more on the MMR (measles-mumps-rubella) vaccine, which does not contain mercury, following a controversial 1998 study in which a researcher claimed the measles part of the vaccine could cause autism.
A year later, more than 100 children were admitted to a Dublin hospital with measles. Seven had to be put on ventilators, and three died.
Dr. Minshew said she can remember when she was an intern 30 years ago, and a teenage girl died after being admitted with bacterial meningitis.
"And that's one of those immunizations we now have," she said. "That would not have happened today. A number of immunizations we have now prevent the deaths I saw as an intern."
One reason that the vaccine theory won't go away, she said, is the painful coincidence that most symptoms of autism show up in the second year of life, at 18 months on average, and that corresponds with the time many vaccinations are given.
When that happens, she said, "you want to blame something. Something horrible has happened to your child, and it did seem to start around that time, so for some people who aren't logical and who are affected, it's understandable that they would blame vaccinations.
"But when it gets to the point that people are seeing conspiracies at the Centers for Disease Control and they're accusing all these scientists and experts of conspiracy ... that's wrong."
In notes she made while watching "Eli Stone," Dr. Minshew wrote: "Co-occurrence does not equal cause," and "one case is not statistics."
Those are views that resonate with Lori McMaster, an attorney and the mother of a 13-year-old son who has autism.
There are two reasons Ms. McMaster knows that her son Ethan didn't get his autism from vaccines. Because he is one in a set of triplets who were born prematurely, the babies were all tracked by the Alliance for Infants project at Children's Hospital of Pittsburgh, and she knew within months of his birth that his development was delayed compared with his siblings.
The other reason, she said, is that all three children got their vaccinations on the same days from the same doctor, and neither Morgan nor Caitlin have autistic symptoms.
Ms. McMaster and her husband, David, who live in Pine, are both active in the autism parents' support group here, and she feels that those who are pushing the vaccine theory "are advocating a position that has not found support in the medical community."
On the other hand, she said it is sometimes natural for parents of autistic children to fight the medical establishment, because over the years, the medical community "has always been the last to get on board with families struggling with autism."
"I think one of the tragedies is that this ongoing debate is causing fissures in the autism community, and I would never want to contribute to that," she said. "We're all already living a tragedy. The sad thing from a parent's standpoint is that we spend so much of our time fighting -- fighting our schools for services and inclusion, fighting for treatment -- that to then have this internal debate is painful."
For Dr. Minshew, it wasn't "Eli Stone" that motivated her to speak out; it was actually a Maryland court ruling late last year in one of the many lawsuits brought by parents against vaccine makers.
In that case, the parents have sued Wyeth Pharmaceuticals, claiming their son became autistic in the 1980s after getting the company's thimerosal-laced vaccines.
In a December ruling, Baltimore Circuit Court Judge Stuart Berger ruled that none of the family's expert witnesses could testify in the case, because their research did not meet prevailing scientific standards.
The witness lineup included some of the most vocal vaccine-theory researchers, including Dr. Mark Geier, a genetic counselor who has published 15 studies on thimerosal. Judge Berger ruled specifically that "Dr. Geier's epidemiological studies purporting to show an association between thimerosal-containing vaccines and autism were not conducted in accordance with generally accepted methods."
Dr. Minshew said the judge agreed with the current scientific consensus that autism is caused by genetic abnormalities that exist before birth.
"I think if every family who has concerns got to read this decision, a lot of this crap would just stop," she said.
First Published January 31, 2008 12:00 am