March 12, 2008

CJR: The Wrong Debate Over Autism

IMHO: Mr. Juskalin misses the point a bit here.

Instead of "Why focusing on thimerosal misses a larger story", I think it would be more accurate to say, "Why focusing on thimerosal is the tip of a larger story"

Most autism looks to be derived from a toxic insult, of which vaccines are likely the worst offender, and of the ingredients of which mercury is most likely the worst offender.

The questions at the conclusion are important, but they have pretty much been answered. And those answers are leading to recovered children. It is hard to argue with results.

The Wrong Debate Over Autism
Why focusing on thimerosal misses a larger story

By Russ Juskalian Tue 11 Mar 2008 10:51 AM

Columbia Journalism Review

Back in 2005, CJR published a story by Daniel Schulman about media coverage of "whether a mercury-containing vaccine" preservative called thimerosal was to blame for an alarming spike in autism cases among a generation of children. Last summer, yet another study was released that showed no link between autism and vaccinations, and last week came news of a lawsuit settlement that required a girl's medical costs to be covered by the government after she was diagnosed with a rare mitchochondria disorder and autistic symptoms related to receiving nine vaccinations in one day. Clearly, the debate rages on, so we decided to take another look at the press-coverage landscape.

Schulman concluded in his piece that the media had been too quick to close the door on the potential link between thimerosal and autism. "[W]ith science left to be done and scientists eager to do it, it seems too soon for the press to shut the door on the debate," he wrote. He cited stories like a New York Times piece by Gardiner Harris and Anahad O'Connor in June of the same year, with the headline: "On Autism's Cause, It's Parents vs. Research".

Schulman, now an editor at Mother Jones, noted that while the vast majority of studies appeared to disprove a vaccine link to autism, there were serious researchers (notably Dr. Mady Hornig and Dr. Ezra Susser, both epidemiologists at Columbia's Mailman School of Public Health; Richard Deth, a Northeastern University pharmacologist; and Jill James, a professor of pediatrics at the University of Arkansas) who supported the possibility that environmental factors—and perhaps thimerosal in vaccinations—could at least be triggers for autism in predisposed populations that might otherwise not have developed the disorder.

(It's a lot like the global warming debate in reverse: almost every major study said there was no credence to the autism-vaccine link, but there were, and still are, a few credible voices out there saying the case isn't closed.)

So, where are we now?

Last summer, a report on vaccinations and neurological problems in children was published in the New England Journal of Medicine and the vaccine-autism debate got a little more fuel. Depending on which side of the fence you stand, the argument can be made that coverage of this report was good or bad. Autism is a touchstone issue, so it was often mentioned in headlines and stories, even if only to note that the study itself was not focused on autism.

A sample of stories and headlines from September 27, 2007, paints a picture:

Newsday: "CDC: Vaccines are safe; Though autism was not a focus, study says mercury preservative in shots did not cause neurological problems"

Federal health officials yesterday reassured parents that childhood vaccines are safe and that kids who got routine immunizations a decade ago when shots contained a controversial mercury preservative are not at risk of neurological problems….An investigation examining autism and thimerosal, the preservative that once was added to common vaccines, is expected to be published within 12 months, scientists at the Centers for Disease Control and Prevention said yesterday.

The New York Times: "Vaccine Compound Is Harmless, Study Says, as Autism Debate Rages"

Yet another study has found that a controversial vaccine preservative appears to be harmless. But the study is unlikely to end the increasingly charged debate about vaccine safety.

The Globe and Mail (Canada): "Vaccine preservative can cause tics; But according to U.S. research, thimerosal does not appear harmful to kids' learning skills or physical abilities"

"The scientific literature to date does not support a causal link between autism and thimerosal, but it's important to say this study isn't of autism," she said. "There's a separate CDC study ongoing that's going to get at that question to provide more information."

Even more recently, the issue of an autism-vaccine link came up in response to a settlement involving the government and nine-year-old Hannah Poling. Poling started showing symptoms typical of autism shortly after receiving a bundle of vaccinations when she was a toddler. The government decided that Poling's vaccinations, given on top of a rare metabolic disorder, caused her problems.

The headlines this time covered broader ground: KHBS Fort Smith, "Vaccine-Autism Link Unproven By Controversial Georgia Case"; Atlanta Journal-Constitution, "Ga. girl helps link autism to childhood vaccines"; The New York Times, "Deal in an Autism Case Fuels Debate on Vaccine".

Not even John McCain could let this one go by as was noted by Benedict Carey in the Times, in a piece titled, "Into the Fray Over the Cause of Autism":

"It's indisputable that autism is on the rise among children," Senator John McCain said while campaigning recently in Texas. "The question is, What's causing it? And we go back and forth, and there's strong evidence that indicates that it's got to do with a preservative in vaccines."

With that comment, Mr. McCain marked his entry into one of the most politicized scientific issues in a generation.

It appears that Schulman was on to something when he claimed the media had taken too narrow a tack on the autism-vaccine link issue. But he, too, may have had his keyboard aimed in the wrong place.

The problem with the coverage was not that the few credible opposition voices didn't receive balanced coverage, but rather that the whole issue of whether vaccines containing thimerosal or mercury cause autism served as a distraction from the ongoing efforts to tease apart the causes of this enigmatic disorder. That's not to say the vaccine issue shouldn't be covered at all, but that there are many more important—if less emotionally driven—questions related to autism that deserve further investigation.

Is autism caused by environmental factors? Can it be triggered by these factors? How does epidemiology try to solve these riddles? Are some people genetically predisposed to respond to environmental factors (like mercury)? Can we find a way to screen for these predispositions (like Poling's metabolic condition)? What else is in our environment that poses a risk?

Lest we forget about the long list of environmental contaminants that have been pointed out going back to Rachel Carson's Silent Spring, the AP just released its own investigation that found a wide array of pharmaceuticals in tap water across America. A potent reminder that while important, the vaccination story is only one part of a bigger issue.

Schulman is right about one thing: when we simplify science to "yes" or "no" questions the repercussions can be dangerous. And simply because a few scientist are in the minority does not mean their careers and their work should be dismissed with the wave of a hand.

We may never find an answer to the autism-vaccine debate that satisfies everyone—and that's okay. Science pushes on, and the myriad questions about autism will continue to be researched long after the last mercury-containing inoculation is administered.

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