November 30, 2000
Autism, MMR and 60 Minutes Another Pediatrician's Perspective
[This is from F. Edward Yazbak, MD, FAAP TL Autism Research
in
Falmouth, Massachusetts.]
The recent 60 Minutes program on MMR vaccine was an
excellent
awareness-raising report on the debate surrounding regressive autism and its
explosion. What struck me most are the following:
* The tragic pictures of the little boy who opened
the show and his
parents' heart-breaking pain and suffering;
* The beautiful mother, standing with her arm raised,
like most of
the audience, because she believed her child was injured by the MMR
vaccine -- caught crying by the scanning camera; and
* Andrew Wakefield, sincere, truthful, principled,
unassuming and
ready to sacrifice everything in the pursuit of the truth.
First, my background: I am trained in infectious
diseases and
pediatrics. During my training I personally cared for children and adults
with serious and complicated contagious illnesses. I subsequently "really"
practiced pediatrics and was a school physician for 34 years. I personally
administered my own vaccines and enforced every Health Department mandate.
I also informed myself thoroughly about regressive or late onset autism.
Because of research I am now conducting, I strongly suspect that there is an
autism-vaccine connection (*below).
The following crucial facts were unfortunately not
discussed in the 60
Minutes piece:
* The measles virus was isolated from the gut wall of
children with
autism. It was further identified by very precise PCR techniques by O'Leary,
and was confirmed to be of vaccine origin by Kawashima and his group.
* Sixty new cases with autistic enterocolitis were
reported by
Wakefield in the September 2000 issue of the American Journal of
Gastroenterology.
* Children with autism have statistically significant
co-existing
high titers of MMR and Myelin Basic Protein antibodies (Singh).
The authorities like to repeat that Wakefield's findings
have not been
duplicated by other researchers. This may be true for the case of children
with autism but only because no one has tried to. Indeed after seeing the
onslaught of attacks on Dr. Wakefield because of his research, it is
unlikely that anyone would want to. Sabra et al at Georgetown University,
however, have described identical ileal lymphoid nodular hyperplasia in the
guts of children with ADHD.
Thousands of parents believe that the MMR vaccine has
contributed to
their children's autism. They have pictures and videos to prove the 'before
' and 'after.' They speak of the MMR being the only new event in their
child's life in that period between normal development and autistic
regression. They point out their children's marked immune system
dysfunction, something with which they were not born.
These parents certainly did not acquire their conviction
from reading
about the twelve cases reported in Dr. Wakefield's first paper. Nor would
they simply be looking for a scapegoat. Please remember, and always
remember, their children were normal and their disease is acquired.
Regardless of how often the authorities attest that the MMR vaccine is safe,
an increasing number of parents here and in Europe are refusing to believe
them. Safety trials not looking beyond 3 weeks post-vaccination convince no
one. Equally alarming to the parents is the fact that the infectious
disease specialists and epidemiologists who make decisions and mandate
vaccines have little knowledge of autism and its immune etiology.
It is inevitable that the present intransigent and
unbending attitude
of the vaccine authorities will lead to measles, mumps and rubella
outbreaks. When these diseases return, and they will, the authorities-- and
the authorities alone-- will have to be held responsible. There is no
reasonable justification to tell a parent who is adamant about not using MMR
but who is willing to return three times for the monovalent vaccines, that
they are simply not available and/or illegal. Dr. Wakefield only asked that
more research be done into the triple live-virus vaccine. To intimate that
his research will cause epidemics is a flagrant distortion of the truth.
It took us a long time to perfect the single (monovalent)
mumps,
measles and rubella vaccines. Most pediatricians and parents trusted them.
Epidemics stopped and few adverse vaccine reactions were reported.
When the MMR vaccine was licensed in 1971 and became
available shortly
thereafter, many pediatricians refused to use it and continued vaccinating
with the monovalent products at 3-6 months intervals. These pediatricians
were concerned with the potential decreased efficacy and increased side
effects of the combination. Many of us were also aware that no long-term
safety studies of the MMR vaccine were available, on going or contemplated.
Two things happened simultaneously in the late seventies to
change
things dramatically:
1.) HMOs arrived on the scene and cut down the number
of "regular
check-ups" 2.) The State Health Departments started providing the vaccines
free of charge to the practicing pediatricians and GPs. The Health
Departments made it clear that it was cheaper to buy and easier to store and
distribute the 3 in 1 vaccine and, on that basis, simply mandated its use.
Pediatricians had no choice but to comply.
To say that we are not sure the parents will bring the
child back for
subsequent shots is false. Certainly this argument could be made in a third
world country but certainly not in the West. Any "practicing" pediatrician
knows that a parent is much more likely to keep a doctor's appointment if a
vaccine is due. One must be cautious not to insult parents' intelligence.
Secondly, to say that added injections will cause pain and
discomfort
to the child is ridiculous. I believe that the pain caused by an aqueous
injection administered sub-cutaneously by an experienced health professional
does not even come close to the living hell of Autism.
Interestingly, the only people who raise these two
arguments are
members of vaccine boards and committees and rarely treat patients. Wouldn'
t it be more appropriate to have the parents make that important choice if
they have such marked reservations? After all it is their child. As well,
it seems hypocritical to mention pain when the vaccine authorities are
introducing new vaccines of questionable efficacy and safety all the time
It was intimated on 60 Minutes that a multitude of studies involving large
populations has proved that the MMR vaccine was perfectly safe and did not
cause autism. THIS IS NOT TRUE. There is NO long-term safety research
proving that MMR does not cause autism. There is a sole epidemiological
study by Taylor et al, often publicized as proving decisively that autism
did not increase in the UK after 1988, when MMR was introduced with great
fanfare. This study was financed and ordered by The Medicines Control
Agency and The Public Health Laboratory Service.
A noted British statistician whose specialty is medical
research,
looked carefully at the Taylor study. He wrote: "A myth is being created
that the Taylor et al study shows that MMR is not triggering autism. The
evidence presented in their Lancet paper is [in fact] consistent with the
MMR triggering a substantial proportion of autism cases in this North London
population. The study does not find evidence to support an association
between MMR and autism onset because of a flaw in the study design. This
does not mean that such an association does not exist."
The reason for this expert's comments is that the
"case series design"
used in the Taylor study is well known to be statistically unsatisfactory
for chronic conditions and inadequate for a small sample (293 confirmed
cases). Even the authors of the study themselves alluded to its
methodological problems.
At times, while figures clearly demonstrate an increase in
autism,
this fact is denied in the written text. At others, contradictions are
evident:
* "There is uncertainty about whether the
prevalence of autism is
increasing," immediately followed by: "Our study is consistent with an
increase in the incidence of autism in recent birth cohorts."
* "For age at first parental concern, no
significant temporal
clustering was seen for cases of core autism and atypical autism, with the
exception of a single interval within 6 months of MMR vaccine associated
with a peak in reported age of parental concern at 18 months," and "Our
results do not support the hypothesis that MMR vaccination is causally
related to autism."
By far, however, the Taylor study's most serious problem
was to look
only at children born after 1987. This effectively excluded all children
born in 1986-87 and initially vaccinated in 1988 or later. It also excluded
all 2-5 year old children previously non- or partially immunized and who
received MMR boosters in 1988 or later. More importantly, this design flaw
added all excluded children to the opposite group. Last but not least, Dr.
Taylor has repeatedly refused to let anyone see his raw data, in the hopes
of replicating his findings, thus becoming probably the first author in the
history of the Lancet to do so.
The 'authorities' need to get away from rhetoric.
They must look at
and commission real science to support their claims. Until the safety of
the MMR vaccine is proved conclusively, it will be wise to allow parents a
choice between the single vaccines and the trivalent MMR. All of us who
have been touched by the autism epidemic appreciate the efforts put forth by
CBS and 60 Minutes. We hope that numerous and more balanced, informative
programs will follow.November 30, 2000
Autism, MMR and 60 Minutes
Another Pediatrician's Perspective
[This is from F. Edward Yazbak, MD, FAAP TL Autism Research
in
Falmouth, Massachusetts.]
The recent 60 Minutes program on MMR vaccine was an
excellent
awareness-raising report on the debate surrounding regressive autism and its
explosion. What struck me most are the following:
* The tragic pictures of the little boy who opened
the show and his
parents' heart-breaking pain and suffering;
* The beautiful mother, standing with her arm raised,
like most of
the audience, because she believed her child was injured by the MMR
vaccine -- caught crying by the scanning camera; and
* Andrew Wakefield, sincere, truthful, principled,
unassuming and
ready to sacrifice everything in the pursuit of the truth.
First, my background: I am trained in infectious
diseases and
pediatrics. During my training I personally cared for children and adults
with serious and complicated contagious illnesses. I subsequently "really"
practiced pediatrics and was a school physician for 34 years. I personally
administered my own vaccines and enforced every Health Department mandate.
I also informed myself thoroughly about regressive or late onset autism.
Because of research I am now conducting, I strongly suspect that there is an
autism-vaccine connection (*below).
The following crucial facts were unfortunately not
discussed in the 60
Minutes piece:
* The measles virus was isolated from the gut wall of
children with
autism. It was further identified by very precise PCR techniques by O'Leary,
and was confirmed to be of vaccine origin by Kawashima and his group.
* Sixty new cases with autistic enterocolitis were
reported by
Wakefield in the September 2000 issue of the American Journal of
Gastroenterology.
* Children with autism have statistically significant
co-existing
high titers of MMR and Myelin Basic Protein antibodies (Singh).
The authorities like to repeat that Wakefield's findings
have not been
duplicated by other researchers. This may be true for the case of children
with autism but only because no one has tried to. Indeed after seeing the
onslaught of attacks on Dr. Wakefield because of his research, it is
unlikely that anyone would want to. Sabra et al at Georgetown University,
however, have described identical ileal lymphoid nodular hyperplasia in the
guts of children with ADHD.
Thousands of parents believe that the MMR vaccine has
contributed to
their children's autism. They have pictures and videos to prove the 'before
' and 'after.' They speak of the MMR being the only new event in their
child's life in that period between normal development and autistic
regression. They point out their children's marked immune system
dysfunction, something with which they were not born.
These parents certainly did not acquire their conviction
from reading
about the twelve cases reported in Dr. Wakefield's first paper. Nor would
they simply be looking for a scapegoat. Please remember, and always
remember, their children were normal and their disease is acquired.
Regardless of how often the authorities attest that the MMR vaccine is safe,
an increasing number of parents here and in Europe are refusing to believe
them. Safety trials not looking beyond 3 weeks post-vaccination convince no
one. Equally alarming to the parents is the fact that the infectious
disease specialists and epidemiologists who make decisions and mandate
vaccines have little knowledge of autism and its immune etiology.
It is inevitable that the present intransigent and
unbending attitude
of the vaccine authorities will lead to measles, mumps and rubella
outbreaks. When these diseases return, and they will, the authorities-- and
the authorities alone-- will have to be held responsible. There is no
reasonable justification to tell a parent who is adamant about not using MMR
but who is willing to return three times for the monovalent vaccines, that
they are simply not available and/or illegal. Dr. Wakefield only asked that
more research be done into the triple live-virus vaccine. To intimate that
his research will cause epidemics is a flagrant distortion of the truth.
It took us a long time to perfect the single (monovalent)
mumps,
measles and rubella vaccines. Most pediatricians and parents trusted them.
Epidemics stopped and few adverse vaccine reactions were reported.
When the MMR vaccine was licensed in 1971 and became
available shortly
thereafter, many pediatricians refused to use it and continued vaccinating
with the monovalent products at 3-6 months intervals. These pediatricians
were concerned with the potential decreased efficacy and increased side
effects of the combination. Many of us were also aware that no long-term
safety studies of the MMR vaccine were available, on going or contemplated.
Two things happened simultaneously in the late seventies to
change
things dramatically:
1.) HMOs arrived on the scene and cut down the number
of "regular
check-ups" 2.) The State Health Departments started providing the vaccines
free of charge to the practicing pediatricians and GPs. The Health
Departments made it clear that it was cheaper to buy and easier to store and
distribute the 3 in 1 vaccine and, on that basis, simply mandated its use.
Pediatricians had no choice but to comply.
To say that we are not sure the parents will bring the
child back for
subsequent shots is false. Certainly this argument could be made in a third
world country but certainly not in the West. Any "practicing" pediatrician
knows that a parent is much more likely to keep a doctor's appointment if a
vaccine is due. One must be cautious not to insult parents' intelligence.
Secondly, to say that added injections will cause pain and
discomfort
to the child is ridiculous. I believe that the pain caused by an aqueous
injection administered sub-cutaneously by an experienced health professional
does not even come close to the living hell of Autism.
Interestingly, the only people who raise these two
arguments are
members of vaccine boards and committees and rarely treat patients. Wouldn'
t it be more appropriate to have the parents make that important choice if
they have such marked reservations? After all it is their child. As well,
it seems hypocritical to mention pain when the vaccine authorities are
introducing new vaccines of questionable efficacy and safety all the time
It was intimated on 60 Minutes that a multitude of studies involving large
populations has proved that the MMR vaccine was perfectly safe and did not
cause autism. THIS IS NOT TRUE. There is NO long-term safety research
proving that MMR does not cause autism. There is a sole epidemiological
study by Taylor et al, often publicized as proving decisively that autism
did not increase in the UK after 1988, when MMR was introduced with great
fanfare. This study was financed and ordered by The Medicines Control
Agency and The Public Health Laboratory Service.
A noted British statistician whose specialty is medical
research,
looked carefully at the Taylor study. He wrote: "A myth is being created
that the Taylor et al study shows that MMR is not triggering autism. The
evidence presented in their Lancet paper is [in fact] consistent with the
MMR triggering a substantial proportion of autism cases in this North London
population. The study does not find evidence to support an association
between MMR and autism onset because of a flaw in the study design. This
does not mean that such an association does not exist."
The reason for this expert's comments is that the
"case series design"
used in the Taylor study is well known to be statistically unsatisfactory
for chronic conditions and inadequate for a small sample (293 confirmed
cases). Even the authors of the study themselves alluded to its
methodological problems.
At times, while figures clearly demonstrate an increase in
autism,
this fact is denied in the written text. At others, contradictions are
evident:
* "There is uncertainty about whether the
prevalence of autism is
increasing," immediately followed by: "Our study is consistent with an
increase in the incidence of autism in recent birth cohorts."
* "For age at first parental concern, no
significant temporal
clustering was seen for cases of core autism and atypical autism, with the
exception of a single interval within 6 months of MMR vaccine associated
with a peak in reported age of parental concern at 18 months," and "Our
results do not support the hypothesis that MMR vaccination is causally
related to autism."
By far, however, the Taylor study's most serious problem
was to look
only at children born after 1987. This effectively excluded all children
born in 1986-87 and initially vaccinated in 1988 or later. It also excluded
all 2-5 year old children previously non- or partially immunized and who
received MMR boosters in 1988 or later. More importantly, this design flaw
added all excluded children to the opposite group. Last but not least, Dr.
Taylor has repeatedly refused to let anyone see his raw data, in the hopes
of replicating his findings, thus becoming probably the first author in the
history of the Lancet to do so.
The 'authorities' need to get away from rhetoric.
They must look at
and commission real science to support their claims. Until the safety of
the MMR vaccine is proved conclusively, it will be wise to allow parents a
choice between the single vaccines and the trivalent MMR. All of us who
have been touched by the autism epidemic appreciate the efforts put forth by
CBS and 60 Minutes. We hope that numerous and more balanced, informative
programs will follow.