Vaccination has greatly diminished death, illness and suffering in the world. But no other medical technology has been so dogged with controversy. The book chronicles the development of the key lifesaving vaccines since the 18th century. It tells the stories of great scientists and their discoveries, of the protests and pain along the stumbling path of progress. This is the first book to tell the whole story of vaccination for a general audience. In light of controversies about flu vaccine and autism, it will be of particular interest to parents, pediatricians, public health workers and anyone fascinated by medical history. Read More>>

Also Available: Table of Contents and Index

Arthur Allen is a Washington DC-based journalist who has written on vaccine issues in The New York Times Magazine, the Washington Post Magazine, The New Republic, Atlantic Monthly, Salon and Slate.

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Autism in Court - Day 1

At 8:58 a.m. this morning,  Teresa and Michael Cedillo of Yuma, Arizona pushed their 12-year-old, wheelchair-bound daughter Michelle to the front of a gleaming federal claims courtroom. While the court officers listened in silence, Michelle, a pudgy girl with short hair, yelled and groaned and punched herself in the face for a few minutes, before her guardians wheeled her back out of the room. No one was to misunderstand what this proceeding was about.

A few minutes later, Special Master George Hastings of the National Vaccine Injury Compensation Program, known as the vaccine court, began the largest and most momentous hearing of the court’s two decades of existence. Beginning with the Cedillos, the court will examine the claims of nearly 5,000 autistic children whose parents blame their condition on vaccines and are asking the government to finance their care the rest of their lives.

Most of the 5,000 cases involve one of two theories. The majority are claiming that thimerosal, a mercury-containing preservative used until recently in three pediatric vaccines—the DTP, HiB and hepatitis B shots—damaged their children as infants. Others think their kids were hurt by the live, weakened viruses in the measles-mumps-rubella (MMR) vaccine, generally administered to toddlers.

The Cedillo case unites the two theories: her parents claim that thimerosal in her infant shots damaged her immune system, making her susceptible to damage from MMR a year later. A week or two after getting the MMR shot, Michelle Cedillo suffered intermittent high fevers for 10 days, and afterward lost her speech and her ability to socialize, according to her parents. She also had and continues to have severe bouts of diarrhea, eventually began having seizures, got arthritis and became nearly blind. Her parents blame nearly all of her medical problems on vaccines.

With their body language, the lawyers for the claimants and the defense in the case reflected what has always been true about the vaccine-cause-autism theory: one side appeals to the heart, the other to the brain. The claimants’ lawyers, Tom Powers of Portland and Sylvia Chin-Caplan of Boston, spoke with inflection and warmth and turned to face the audience on the courtroom. The government’s lawyer, the colorless-seeming Vince Matanoski, spoke to the special  masters—the judges who will decide the case.

To rule in Mrs. Cedillo’s favor, the court will have to buy the theory that thimerosal damaged her daughter’s immune system to the point that the MMR was able to permeate her gut and cause brain damage. This is a novel, untested theory—the Cedillos’ first expert witness, Dr. H. Vasken Aposhian, said on the stand that he had elaborated it “about three or four weeks ago” based on journal articles from other scientists.

Aposhian, an elderly, hard-of-hearing toxicologist with a halo of white hair surrounding his large bald pate, testified that the form of autism Michelle is suffering from is a “mercury efflux disorder.” She has a genetic susceptibility that makes her unable to get rid of toxic metals from her system. Their damage results in autism and all the other symptoms of illness she’s suffering, he said.

On cross examination, Aposhian acknowledged there was no record of any child becoming autistic as a result of mercury exposures prior to the thimerosal theory—despite the millions of tons of the stuff that we supposedly breath in from dental amalgams and factory fumes and consume in contaminated fish.

Aposhian also disputed the timeless toxicological truism that the dose is the poison. The poison, he testified, is based on the dose but also on the genetic susceptibility of the patient and the age in their development—in the case of a fetus or child. So, although all documented cases of mercury poisoning involve doses hundreds or thousands of times larger than the thimerosal given to children in vaccines, Aposhian argued, you couldn’t say that the dose in vaccines was harmless.

One peculiarity of the Cedillo case is the fact that her parents initially filed a claim with the court in 1998, alleging a post-MMR encephalopathy. Up until the late 1960s, when measles was common in the United States, the virus caused devastating brain damage in about 1,000 children each year. The measles virus contained in the vaccine, though largely stripped of its virulence, still causes a handful of such reactions annually, and the vaccine court over the years since its creation in 1986 has rewarded several dozen parents with compensation for this injury.

A year after the Cedillos first filed their claim, the thimerosal issue surfaced in the news, and they decided to alter their theory. Now, instead of claiming that their daughter’s devastating problems stemmed from a scientifically validated reaction to an MMR shot, they elaborated a much more complex theory, claiming that thimerosal set their daughter up before MMR bowled her over.

Nothing in Mrs. Cedillo’s testimony hinted at evidence that thimerosal had damaged her child. Michelle was a healthy, happy girl, her mother said, prior to receiving the MMR shot on Dec. 22, 1995, when she was 18 months old. Earlier, in her first year of life, like most American kids she had received three doses each of DTP, Hib and hepatitis B (the 135 micrograms of thimerosal in those shots is roughly equivalent to the methyl mercury contained in about two months worth of breast milk).

All in all, the Cedillos face a rough road. A critical part of the MMR thesis collapsed in the past year when papers were published refuting the evidence of measles virus in the guts of autistic children. Most of the hundreds of MMR claims in Great Britain’s version of the vaccine court were defunded after scientists cast doubt on the techniques of an Irish laboratory that had claimed to find measles RNA in children’s intestines—including in Michelle Cedillo’s.

Powers, who is leading the Omnibus proceedings for the claimants, said the parents in the case were not “anti-vaccine,” but rather “families who followed the rules and suffered injuries for the greater good.” They expected, as part of the “social compact” governing mass vaccination campaigns, to be compensated because their children were among the rare victims of the program, he said.

Powers stressed that “preponderance of evidence” rather than scientific certainty would be the deciding measure in the case, because “the science is in dispute.”

Most scientists and doctors would tend to agree with Matanoski, who spoke of the “singular lack of support” for the claimants’ experts’ contentions. But we’ll get clearer insights in the weeks to come.

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Comments

Tom

Thanks for the detailed account of today's proceedings. This case seems extremely flimsy but I guess the lawyers think it's worth the risk just in case the reduced standard of evidence in vaccine court is low enough to prevail and then seek large civil awards.

Science over minority-mob law

It's too bad that real scientists aren't cross-examining the quacks. A couple of real questions from solid scientists would have the quacks crying and running out of there. Although I'm sure their performance fees would be more than necessary to heal their wounds.

isles

This Aposhian sounds like quite a character. They might as well call that woman who told the IOM that God spoke to her through an 87-year-old priest with the message that vaccines cause autism.

María Luján

Mr Allen
Could you please list what papers are you refering to, related to the MMR past year, 2006?
A critical part of the MMR thesis collapsed in the past year when papers were published refuting the evidence of measles virus in the guts of autistic children.
Thank you in advance

Jennifer

Maria,

Here is a simple explanation of the results.

http://www.badscience.net/?p=313

(not that you will need it, but maybe useful for other readers). The main point is that Wakefield had a false positive, and the other workers also saw this false positive. As Ben Goldacre puts it: "But lastly, and most crucially, remember: this new study found just the same positives identified by the O’Leary primers, but checked, and found that they were apparently false positives. This is likely to be just as true in gut as it is in blood."

Anna

Nice post

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