Moving 20target 20vaccines 20thimerosol 20and 20autism 1

Moving Target: The harrowing, ever-changing, cynical, potentially paranoid, and possibly irrelevant story of thimerosal, vaccines, and autism.

Joshua D. Feder, MD Faculty, Interdisciplinary Council on Developmental and Learning Disorders Assistant Clinical Professor, Department of Psychiatry University of California at San Diego, School of Medicine

Why do we have vaccines?  

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Are infectious diseases all that bad?

Mortality rates in the US over time - infectious viral diseases have significant role, overshadowed by accidents, homicide, suicide, and cancer.

Past plagues: The plague, smallpox, flu.

Current plagues: HIV-AIDS, influenza, risk of bioterror?

Advances Against Infectious Disease:Vaccination  

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Cowpox vaccination - late 1700’s 20th Century burgeoning of vaccines, especially since the late 1960’s Common side effects: headache, malaise Less common:Guillian Barre-like syndromes, allergic reactions.

Rare severe ones including brain damage, but connection with vaccines not clear.

Wakefield 1998 - Lancet 

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Theory: Ileal-Lymphoid Nodular Hyperplasia in children w/ autism after MMR Countertheory: ILH is common, and it is non-specific.

Nevertheless touched off a storm of controversy that has not ended, and raised other questions, e.g., re Thimerosal.

Theories and Concerns   

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‘Mercury poisoning looks like autism’, so maybe mercury is a cause of autism.

‘Thimerisol breaks down to inorganic mercury and goes to the brain’ ‘Low glutathione in autism: less able to bind and excrete the mercury’ ‘Autism epidemic’ may be related to vaccines ‘We must protect our children’ and perhaps that means avoiding vaccines

Theories and Countertheories…….

‘Mercury poisoning looks like autism’ vs. ‘the presentation is different’ 

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Generalized neurologic symptoms, delayed symptoms possible; Pink’s Disease: teething powders; The Mad Hatter Not really consistent with the specific symptoms of autism

Theories and Countertheories…….

‘Thimerisol breaks down to inorganic mercury and goes to the brain’ vs. ‘is it inert’  

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“Toxic” designation, data not reproduced There are animal models and parallels to methymercury It is bacterostatic

Mercury

Thimerosal

Theories and Countertheories…….

‘Low glutathione in autism: less able to bind and excrete the mercury’ vs. ‘government studies show no neurological problems associated with exposure to mercury in vaccines’  

James J. Neurotoxicology 2005 Thompson NEJM Sept 2007

Glutathione

Theories and Countertheories…….

‘Autism epidemic’ vs. ‘no epidemic’      

1/150 (0.67%) new and oft-cited 12/10000 (0.12%) Wazana et al, June ‘07 4/10000 (0.04%) old statistic Expanded diagnosis Shift of diagnosis IDEA/IEP

Theories and Countertheories…….

‘We must protect our children’ vs. ‘many people are out to make money, or they are thinking emotionally and not scientifically’    

‘Parents and health care providers are dedicated to helping these kids, and to helping others’ ‘Autism breeds desperation’ - doctors’ little to offer ‘Autism breeds treatments’ - easy to start a business (not unique to Autism, see ADHD SPECT Clinics) ‘Autism breeds lawsuits’ - families are frustrated, attorneys are trained and paid to seek restitution

Theories and Countertheories and Countercountertheories….

‘IOM: no clear evidence of harm’ vs.

‘Epidemiological studies show increasing autism rates if you look at them the right way’

Theories and Countertheories and Countercountertheories….

Suspicions of Foul Play   

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Suppression of data?

CDC influence on IOM? Drug Company Influence with CDC and in the government?

Suppression of negative drug studies in past Efforts to influence health professionals have occurred

Theories and Countertheories and Countercountertheories….

The California Study: Schecter Jan. ‘08 

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Increase in ASD reported to DDS-CA, e.g., from 0.5 to 4.5 per 1000 5 year olds, between 1989 and 2003, on a steady rise with no change in slope when thimerosal taken out of vaccines.

Kirby: plumes of mercury vapor are coming from China to California, AND maybe the mercury is still there.

Theories and Countertheories and Countercountertheories….

‘Little or no mercury in vaccines’ vs. ‘mercury is (still) in the vaccines’     

The number of vaccines has increased, with it the dose of mercury.

But since 1999 it’s been removed…

Do HMO’s keep old doses in supply (more in CA)?

Do vaccine mfgr’s take significant time to retool?

And it’s still in the flu shots..

February, 2008 A New Measles Outbreak 

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Index case - unvaccinated 7 y/o travels to Switzerland and returns with it.

8 first generation then 3 second generation cases; highly infectious; thankfully well contained this time.

Typical death rate is 0.013%, encephalitis 0.29%, hospitalization 0.8%; would take about 80 cases to expect a death.

Unvaccinated rate in CA? Need > 90%; Switzerland is 86% for one dose, 70% for second dose.

March 2008 Vaccine Court Settlement 

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19 month old girl has 5 shots, gets a fever, refuses to walk, later diagnosed w/ autism Turns out to have a mitochondrial disorder ‘The government does not concede anything re thimerosal’ Hailed as ‘proof’ by some that vaccine theory has merit.

‘Mitochondrial Disorder’ 

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The Next Big Thing in Autism?

Theory: vaccine creates stress on ‘system’, preexisting MD makes it hard to respond, resulting in injury Now we check for mitochondrial disorders?

MD as the new Celiac Disease?

Chipping away at etiology: Tuberous Sclerosis, Fragile X, LKS, now MD?

‘Mitochondrial Disorder’ 

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It’s A Clinical diagnosis: Muscle, and motor problems, low tone, sensory dysfunction, migraine, seizures, Single or multiple organs, motor, may have periods of deterioration, show up late or, commonly, show no symptoms at all Supported by AST/ALT and alanine/lysine ratios, urine markers of mitochondrial dysfunction, muscle biopsy or check for mutations in mitochondrial DNA

How Far We Have Come   

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Conflict to courthouse is not very far Communication is poor among factions Science is still lacking in many areas, e.g., finding evidence of mercury poisoning in postmortem brain tissue Resources spent on questionable ideas?

Genetics x Environment: Mitochondrial Vulnerability?

Toxins? Neuronal misdirection? Relationships?

What’s Next?    

Recommend seat belts, and helmets Get your flu shot We will likely do more screening And we will follow the moving target