Autism and Vaccines: Can there be a final unequivocal answer?

The suggestion that early MMR vaccination of babies can result in autism — first made by Andrew Wakefield et al. in 1998 — has been given new life by the revelation that Dr. William Thompson of (or formerly of? or soon to be formerly of?) the Centers for Disease Control & Prevention has admitted to collaborating in a scheme to disprove any correlation between MMR vaccination and autism. CNN is also charged with complicity by deleting its article about this, see for example Celia Farber’s “CNN complicity in media blackout of CDC MMR Vaccine whistleblower deepens” and earlier blog-posts. The Liberty Beacon cites a number of published studies that support a vaccine-autism connection: “New published study verifies Andrew Wakefield’s research on Autism – Again (MMR Vaccine causes Autism)”.

The literature about this, pro and con, is enormous. Typically for such matters, the published material is highly polarized, which means highly biased. On one side, defenders of mainstream medicine over-react against any suggestion that any vaccination could be harmful; on the other side a fairly well-grounded suspicion that the mainstream can be wrong while never admitting it combines with anecdotal accounts from personally affected families as well as those who recognize that Wakefield has been treated unfairly, to say the least.

At some future time, relatively unbiased observers will sift through this enormous literature in an attempt to clarify the “scientific facts” as well as the social aspects of the controversy. In the meantime, there are very sound reasons for remaining on the fence, rejecting the claims made on both extremes. Perhaps the strongest reason is that the general question is unanswerable in the universal absolute form in which it is commonly framed: “Does MMR vaccine cause autism?” That asks whether the vaccine causes autism, presumably quite often if not always. But the Wakefield et al. publication only suggested that it had happened in a few cases.

A better question would be, “Can MMR vaccine cause autism?”

After all, there is no disagreement that many vaccines can harm a few individuals, though the reason may not always be evident — perhaps an allergic reaction, perhaps something unique about an individual’s precise condition at the time of vaccination, perhaps something unusual about an individual’s immune system in general or at times. No matter the reason, the fact is acknowledged, to the extent that public funds are available to compensate the small proportion of such unfortunate outliers from the more common experience of lack of harm [1].

The mainstream defense, that MMR vaccine does not cause autism, is based on statistical analysis. That can legitimately be stated as, “There is no statistically significant evidence”, which does not rule out that some small proportion of babies do react to MMR vaccine in a manner that predisposes to autism.

This point is not specific to the MMR-vaccine controversy, it is very generally applicable to clinical trials, drug approval, and proper medical practice: Medical “science” as incorporated in clinical trials delivers only statistical answers, whereas patient-doctor interactions should be on an individual basis, recognizing that any given individual may react differently than do most people [2]. In a sense, this is the sort of situation described by Alvin Weinberg as “trans-scientific” [3]: A question can be framed as though it could be answered “scientifically” when in reality it cannot, because there is no absolute universal answer, only a probabilistic one.

As Healy [2] points out, anecdotal evidence in medicine should not be dismissed automatically as “unscientific” and therefore to be completely disregarded. When administration of a drug produces an immediate or almost immediate effect, that should not be discounted just because not every person or patient reacts in the same way.

There exists no system that could potentially convert anecdotal evidence into widely useful information, but such a system can be envisaged in this age of information technology. If all data from all patients were archived and made mutually accessible, the rates of rare “side” effects and atypical reactions would become evident over time. For example, one might find that a small proportion of babies given MMR vaccine at early age do in fact seem to become more likely to develop autism.

At the moment, though, such data are not available. Decisions need to be made in absence of conclusive evidence. The issue then becomes, to what degree should informed parental consent be decisive as to the administration of MMR vaccine?

This question brings in not only the scientific uncertainty but also larger sociopolitical and even religious factors. Should Christian-Science parents be allowed to eschew antibiotics or blood transfusions for their children?

Such extreme cases make bad laws and may never have fully satisfying answers or outcomes. But for most intermediate situations, mainstream institutions ought to practice a degree of humility in the face of uncertainty and not overplay the evidence at their disposal. Since it is far from impossible that some babies might suffer autism after early vaccination with MMR, why not allow parents to choose between MMR and separate vaccines? And how strong are the data showing an advantage of earlier as opposed to later vaccination?

Sizable amounts of data have indicated that the mercury-containing vaccine preservative thimerosal has no statistically significant damaging effect. But since organic mercury compounds are known to be harmful, might not a few babies be harmed by even the small amount of thimerosal in these vaccines? It is not irrational, surely, for parents to wish to avoid even a small risk if the potential benefit is also not large.

The issue of informed consent in medical practice is in itself complicated. In most situations, patients are not given the opportunity to be truly informed, in part because physicians themselves may be uninformed or misinformed: cholesterol-lowering statins and blood-pressure-lowering drugs and bone-density-increasing drugs are prescribed promiscuously in absence of genuine evidence that their benefits outweigh the damage from their “side” effects [4].

The claim of whistleblowers and cover-ups should not be dismissed as conspiracy theorizing. As George Bernard Shaw pointed out, all professions are a conspiracy against the lay public. All bureaucracies, which means most institutions, have self-preservation and self-preferment as their highest goal. A massive organization like the Centers for Disease Control & Prevention makes public statements through an administrative hierarchy at whose public end are press and public-relations staff whose mission is to parrot the institution’s official positions, which do not normally include an admission of being wrong about anything.
Does MMR vaccine cause autism?
Perhaps God knows. We humans cannot be sure that it never does, only that most commonly it seems not to — which does not entail, however, that it never does, nor that it has no harmful effect at all on brain function even if autism does not ensue.

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[1] National Vaccine Injury Compensation Program
[2] David Healy, Pharmageddon, University of California Press, 2012
[3] Alvin M. Weinberg, “Science and trans﷓science”, Minerva, X (1972): 209-22
[4] Järvinen et al., The true cost of pharmacological disease prevention, British Medical Journal 2011: 342d2175;
doi: 10.1136/bmj.d2175

 

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