By Julie Obradovic
You know, I was wondering. Is the rate of pizza consumption in Chicago related to the rate of obesity in Boston?
Or, just what is the likelihood of being diagnosed with obesity in a hospital within 3 month intervals over several years after eating pizza in Finland back in the early 1980's?
Or, how likely is it that I will have evidence in my gut of having eaten pizza that made me sick 12 years ago, but not by actually looking at my gut?
Or, in Japan, when nobody ate pizza with sausage, pepperoni, and mushrooms for a little while, but still ate pizza with either sausage or mushrooms, any chance the obesity rate dropped?
Or, what about the chance that if we looked at a whole bunch of people in the US who ate pizza that all gained weight afterwards, the pizza had something to do with it if only a significant amount of them developed obesity?
Or how about the likelihood that if you eat this pizza in the UK before you gain weight the higher the rate of obesity?
And finally, among those same people in the UK who eat this pizza, any evidence they are thin, then gain weight and then develop obesity in that order? And if a significant number of them don't, like say they were already gaining weight when they ate the pizza, nobody became obese from the pizza?
Oh, I'll stop. I'm just being silly. A little humor to introduce a really not so funny topic. And now I'm hungry.
What has been studied about the MMR?
Although I will go into detail about the actual MMR studies shortly, I think the above analogies make it pretty easy if you just do the following. Everywhere you see these words, make these substitutions: eat= get; pizza = MMR vaccine; gain weight=develop bowel problems; obesity = Autism. If you do that, you now have a summary of the studies that have been done on the role of the MMR in Autism that supposedly prove it is not causal for anyone.
Again, I do not attempt to take this issue lightly by comparing it to pizza consumption and I'm not suggesting it's the perfect analogy. I simply want to point out the insufficiency of the studies that have been done thus far. They are a blatant example of how the MMR hypothesis is being fundamentally misinterpreted; the underlying assumption that if the MMR is causing Autism, it is causing Autism in everyone who has Autism, or paradoxically, that it would cause Autism in everyone who got the MMR. Based on these assumptions, researchers assume it should be picked up epidemiologically and more important, that if it's not, the MMR is exonerated of causing harm.
This is a wrong assumption and the reason the studies are inadequate for our children.
In science, you can do a study that is methodically perfect, every "t" crossed and "i" dotted. The researchers can be of the utmost integrity with impeccable credentials. But unless the question you are trying to answer is appropriate for what you studying, it doesn't matter. None of these studies ask the right question, even though many of their results show us the right answers.
So What Is the Right Question?
It is no secret that among those of us with children with Autism, we have different stories relating to the impact of the MMR on our children's disease. For some of us, its impact was obvious. Within weeks, days and sometimes hours there was a dramatic shift in our children's health. Seizures, diarrhea, high pitched screaming, fever, loss of skills and other signs of distress manifested quickly.
But for some of us, the impact was hardly noticeable if at all; it was quite some time before we recognized the damage retrospectively. For others, it doesn't appear to have had anything to do with their Autism what-so-ever.
Does that mean the role of the MMR can be dismissed entirely because we experienced different things? Of course not. As has been postulated for years, there may be many paths towards the same end result.
Among the many hypotheses of how the MMR and other vaccines may play a role are:
Susceptible children are first being assaulted with toxins that are known to damage the immune system and mitochondria leaving them vulnerable to a reaction from the MMR and/or the many other vaccines usually given simultaneously at that visit.
Or because the MMR is towards the end of a very aggressive vaccination schedule, it is the proverbial "nail in the coffin" for a child with a vulnerable immune system.
Or perhaps there is a specific genetic vulnerability to the measles virus or its vaccine components that causes an autoimmune reaction.
Maybe a history of antibiotic use coupled with other gastrointestinal distress that damages the gut flora has something to do with it.
Maybe because it's a triple live virus given simultaneously with the DTaP vaccine that contains aluminum and thimerosal there is a synergistic reaction between the metals and viruses.
Maybe it's all of this. Maybe it's none of this.
These are all questions that we don't have all of the answers to, and certainly there are more. We have no idea why only some children are reacting to the MMR vaccination visit, but that does not mean they aren't. So the question should be, why are certain children reacting to the MMR vaccination visit (or any vaccination visit for that matter) resulting in or exacerbating developmental regression and/or gastrointestinal distress, and are the two related?
This is a substantially different question than the only studied question, "Are children reacting to only the MMR in this way based on a comparison to children who did not?"; the equivalent of studying hundreds of thousands of children who eat peanuts and then publishing that because an insignificant amount of them went in to anaphylatic shock, peanuts aren't causal. You have to dig deeper than epidemiology when correlation and causation aren't obvious through it, not stop looking. It's the first step, not the only step.
In fact, several of the studies I will discuss do provide evidence of small groups of children who are affected by the MMR in precisely the way they are trying to rule out, and strangely, the authors repeatedly acknowledge this.
Which leads me to study #1. (Remember, the studies are being presented in the order in which they appear on the Fourteen Studies website and that M1 represents MMR study #1, etc.)
The Studies, General Concerns
There have been 8 major studies completed on the role of the MMR in Autism. Of the 8 studies, 4 of them were completed by a vaccine patent holder and/or expert witness for the government in MMR litigation (M 2,3,4, 6). One study did show that the MMR may be associated with Autism when the data was reanalyzed (M5), and only one study (M1) used children from the United States (significant because US children are more vaccinated than any other). This study found that indeed 20% of the study participants did regress into Autism in this order: MMR-GI disturbance-Autism diagnosis.
No study compared children who received the MMR to those who have never been vaccinated at all, and even in one that compared children who got the MMR to those who didn't (M5), those who didn't, did in fact receive the Measles and Rubella vaccines. And finally, no study looked at the children who were affected by the MMR immediately following their reaction to it to look for evidence of a problem.
The Studies, Specific Concerns
1. Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study (Hornig, et.al 2008)
Question Asked: Do 25 children in the US with Autism have a persistent measles virus RNA in their GI tract that they got from their MMR vaccine that 13 other children with GI disturbances but not Autism don't have? And in those 25 children with Autism is there a temporal relationship between MMR vaccination, GI episodes, and Autism onset?
Published Conclusion: No. There is not a significant amount of children with Autism that either had Measles RNA in their guts compared to the children without Autism, or that regressed in the order of MMR, GI stress, and Autism.
Conflicts: CDC and AAP participation; 2 authors were compensated for expert witness statements regarding MMR in UK litigation.
• This study looks exclusively at kids who have GI problems, 25 with Autism and 13 without Autism, hardly a large sample size of kids to look for such a specific pathology. Still, 52% of the chlidren with Autism did indeed regress after the MMR, and 52% of all of the children did indeed experience their GI problems after the MMR. 20% of the children with Autism did regress into Autism in this order: MMR, GI problems, and then Autism. 1 child with Autism did have Measles virus RNA in his small and large intestinal biopsies, replicating Wakefield's findings. Additionally, 64% of the children with Autism had evidence of GI disturbances prior to the MMR. This fits the hypothesis that they are already susceptible to reacting to the MMR, which we know can cause further damage to the gut and is home to much of the immune system. It is entirely plausible that the MMR can exacerbate existing problems. Finally, this study took place years after the MMR vaccination was given, making it plausible the virus cleared before the biopsy but left behind damage.
Actual Conclusion: This study shows that even among 25 kids with Autism, 5 of them regressed into Autism in the order of MMR-GI problems-Autism and 1 of them still had Measles RNA in their guts years later. So YES, for some children the MMR is an issue.
2. MMR Vaccination and Pervasive Developmental Disorders: A Case-Control Study (Smeeth, 2004)
Question Asked: Do children in the UK who got MMR vaccine before Autism diagnosis have higher rates of Autism?
Published Conclusion: No.
Conflicts: An author is an expert witness for vaccine manufacturer and member of the Joint Committee on Vaccination and Immunization.
• The authors were not able to separately identify the subgroup of cases with regressive symptoms to investigate the hypotheses that only some children are vulnerable to MMR induced disease, which is truly the point. Also, the odds ratio associated with MMR vaccination varied according to the age they entered the database used. Odds were higher for children who joined the database at birth or before their first birthday to be diagnosed with Autism after MMR.
Actual Conclusion: This study does nothing to identify subsets of chlidren of children susceptible to MMR-induced disease.
3. Pervasive Developmental Disorders in Montreal, Quebec, Canada: Prevalence and Links with Immunizations (Fombonne 2006)
Question Asked: Are Thimerosal use and MMR uptake in Quebec City related to rates of Autism in Montreal?
Published Conclusion: No.
Conflicts: Lead author is expert in MMR litigation.
• Study looked at MMR uptake in Quebec City and compared it to rates of Autism in Montreal. I'm serious. Moreover, thimerosal was not discontinued in Canada until 1996, and estimates are that it wasn't off the shelves until 1998, yet this study does not evaluate the health outcomes of children born after 1998. It does not include exposure to Thimerosal via Hep B shot, Flu Shots or Rhogam shots, and the actual exposure to Thimerosal the children studied received was estimated, not actual. No never-vaccinated children were studied.
Actual Conclusion: Maybe the stupidest study done in the group. Worthless. Pointless. Sorry, just being honest.
4. No Evidence for a New Variant of Measles-Mumps-Rubella Induced Autism (Fombonne, 2001)
Question Asked: Is there evidence in children in the UK between MMR vaccine and a form of Autism that is a combination of developmental regression and gastrointestinal symptoms that occur shortly after immunization?
Published Conclusion: No.
Conflicts of Interest: Fombonne again.
• There are no biological investigations on the children in the study and instead survey responses are used. Compared 96 children diagnosed with PDD post MMR to 98 children diagnosed with Autism pre-MMR to 68 patients diagnosed with Autism post-MMR. No children without MMR and Autism or PDD were studied, and no children with a PDD diagnosis pre-MMR were used, imbalancing the study. Shockingly, no inflammatory bowel disorders were reported among any of the children surveyed. Finally, the author arbitrarily defines how the MMR must be involved in Autism if it is involved at all with no basis for his definition. He assumes that it must 1) be identified closer to immunzation than other Autisms 2) now be more common 3) have distinct symptoms and severity problems 4) is associated with gastrointestinal symptoms and/or imflammatory bowel disorder. No never-vaccinated children were studied.
Actual Conclusion: Did nothing to answer the question about a specific subset of children affected by MMR induced disease based on clinical and/or biological data.
5. No Effect of MMR Withdrawal on the Incidence of Autism: A Total Population Study (Honda, 2005)
Question Asked: Did MMR withdrawal in Japan in 1993 have an effect on incidence of Autism?
Published Conclusion: No, but admits, "Epidemiological data, however, cannot test the very different hypothesis that MMR might involve an increased risk of ASD in a very small number of children who, for some reason, are unusaually susceptible to damage from the vaccine." Well, no kidding.
Conflicts: None listed.
• Study did not address the affected children. A recalculation of the data does show that the MMR does appear to have had an affect on Autism Spectrum Disorder rates. And finally, while children in the study were not vaccinated with MMR in 1994 and beyond for some time, children were still vaccinated against Measles and Rubella between 12 and 36 months; Mumps was optional for children on year or older. No never-vaccinated children were studied.
Actual Conclusion: Study tells us nothing about a subset of children who could be affected by MMR.
6. Measles Vaccination and Antibody Response in Autism Spectrum Disorders (Baird, 2008)
Question Asked: Do children in the UK with Autism, special needs or normal development aged 10-12 years old have presence of measles virus in the bowel, but not by actually looking at the bowel? And is there a dose-response relationship between autism symptoms and antibody concentrations?
Published Conclusion: No.
Conflicts: Lead author is defendant's expert in UK MMR litigation; 2 others have given unpaid advice to lawyers in MMR litigation.
• Claims using mucosal samples of children's guts is "unethical" (slam of Dr. Wakefield, no doubt) and therefore used "an appropriate proxy for gut mucosal cells" called peripheral blood mononuclear cells. In other words, they looked for measles virus in the gut without looking at the gut. Additionally, they admit the limitations of using a survey to elicit accurate reporting of gut symptoms, "...the children were too old for accurate reporting of retrospective gut symptoms confidently contemporaneous with MMR vaccination," which is kind of the point of the study, no? Finally, only vaccinated children were studied 9 years post MMR vaccination, and only 29% of the ASD kids had a second MMR compared to 50% of those who had no ASD diagnosis. This is significant for trying to find out if there is a dose related response by measuring titers.
Actual Conclusion: Study fails to tell us anything about what happened to the affected children at time of exposure.
7. Neurolgoic Disorders After Measles-Mumps-Rubella Vaccination (Makela 2002)
Question Asked: Are neurological disorders associated with MMR uptake in Finland from 1982-1986 based on the likelihood of being hospitalized for Autism within 3 month intervals of receiving the MMR up until 1996?
Published Conclusion: No.
Conflicts: Sponsored in part by a grant from Merck, makers of the MMR.
• Oh, where to begin. Let's see...used kids in Finland...in 1982...that got hospitalized for Autism...within 3 month intervals following their MMR. Authors did not identify one child with Autism with an inflammatory bowel disorder and had no access to outpatient data. Study admits, "Reliable assessment of causality between immunization and rare disorders is extremely difficult...evidence of several of the suspected adverse effects of MMR vaccination has remained inconclusive....diagnosis of Autism does not always involve hospitalization...as the coverage of the MMR vaccination register was not complete, some children regarded as unvaccinated may have actually been immunized during the study period."
Actual Conclusion: Study tells us nothing about the affected children in a real world setting. The likelihood of being hospitalized for "Autism" is virtually non-existent. And none of the children "hospitalized" for Autism made visits because of inflammatory bowel diseases.
8. Association of Autistic Spectrum Disorder and the Measles, Mumps and Rubella Vaccine: A systematic Reveiew of Current Epidemiological Evidence (Wilson, 2003)
Question Asked: Do the previous studies as of 2003 support an association between MMR and Autism?
Published Conclusion: No.
Conflicts: Funded by a grant from Canadian Institutes for Health Research
• This is simply a study of the other studies. It excluded the studies done examining only a link between the MMR and the GI tract, or between maternal MMR and then development of ASD (Wakefield and Yazbak). It concludes that, "...limited epidemiological evidence exists to rule out a link between a rare variant form of ASD and the MMR vaccine", but still recommends maintaining our current MMR vaccination policy because the danger is theoretical only. Finally, it sites a study as evidence of MMR safety that finds no cases of ASD in 1.8 million individuals who received MMR. Exactly where are these people with no Autism among 1.8 million of them? FINLAND....which begs the question, how can that be? That study was done by the same author using the same data as study #7 which found 309 children hospitalized for Autism (out of 535,544 1-7 year olds vaccinated with MMR between 1982-1986) between 1982-1996, yet NONE in almost 2 million in another study using the same people in the same time period? And both studies are used as evidence for MMR safety?Hmmm....
The only conclusion we are left with after all of these studies is this:
The results are inconclusive at best, and as evidenced by the last study, being drawn from questionable data.
Even assuming it weren't, the only conclusion we can truly draw is that the MMR does not appear to be causally linked to Autism for the general population, but we still have no idea if it is causing Autism in a susceptible sub-group of children that could not be identified epidemiologically. Those are the words of the authors themselves.
So why they don't feel inclined to dig deeper and answer that question then is beyond me. No wait, it disgusts me. These are our children, and they deserve better. They deserve more research into this, not less. And damn it, they deserve it now.
How many more of them will be "theoretically" harmed before they get it?
Julie Obradovic is the mom of a recovered child. She is a member of NAA, a Rescue Angel, and a leader of the TACA Chicago Chapter and a Contributing Editor for Age of Autism.