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Autism and vaccination: Study debunked

Susan Hyman
Thursday, January 6, 2011; 1:30 PM

Susan Hyman, M.D. and division chief of neurodevelopmental and behavioral pediatricsat Golisano Children's Hospital at theUniversity of Rochester Medical Center, discusses today's story about a link between autism and vaccinations.

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Rocci Fisch: Autism/vaccine link: Another nail in the coffin

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Susan Hyman: Hi, Susan Hyman,MD here to discuss questions and comments you may have about autism. I am a Developmental and Behavioral Pediatrician at the University of Rochester School of Medicine and an expert in Autism

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Lawsuits: Have any drug companies been forced to pay damages because of their vaccines due to these erroneous studies? I generally have no sympathy for the giant drug corporations, but this debate has been raging long enough that I would not be surprised if this has happened.

Susan Hyman: The Special Masters (judges) who have ruled on vaccine cases to date have not based their rulings on this study.

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Autism and vaccination: Study debunked: Who was it that did this study?

Susan Hyman: Brian Deer is a British Journalist who has pulled together data from multiple sources to compile the published report. The editors of the British Medical Journal also wrote an editorial based on their opinions.

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What protocols for treatment?: Since the autism-vaccine-mercury link has been debunked (yet again), what sorts of treatments should a parent look into for an autistic child? Seems the whole DAN! heavy metals protocols would also be suspect. My child is 6 years old and ASD--he is improving, but still compromised socially and in speech. Anything other than speech therapy/social skills groups we should consider? He doesn't have a seizure disorder (that we know of). There's so much out there that people try that it's hard to know what to do sometimes. Thanks.

Susan Hyman: It is very important for families of children with autism to examine therapies based on scientific evidence - that is why the current controversy is so important. The Peer Reviewed scientific literature (medical and scientific journals) depend on both editors and volunteer scientists to review the studies submitted for accurate interpretation and ethical conduct.Children with autism benefit from intervention that reinforces communication: for some who do not have speach that means sign or picture exchange, for those who speak that may mean conversation. They benefit from intervention that directly teaches social interaction, developmental skills and helps the family generalize these skills.Medical work up includes a complete history and physical to guide further evaluations. About 10% of children with autism have underlying genetic predisposition that can be identified using current testing. It is important for families to have a developmental specialist to help them and their primary care provider navigate available therapies

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Why the Increases: I'm not a believer in the vaccine claims, but why the drastic increases in the number of cases diagnosed? My concern is the almost wholesale categorization - primarily of young boys - and the long-term impact on today's kids. 20 years ago we probably overdiagnosed ADHD (again, on boys primarily). I believe more in gender bias by elementary school teachers than medical conditions...

Susan Hyman: The increased identification of children - and previously unidentified adults - adults with autism spectrum disorders (ASDs) may relate to a broader definition (1994), improved screening and awareness, the availability of services, OR the possibility that prevalence is actually increasing. the Diagnostic and Statistical Manual published discrete criteria for ADHD, ASD and other behaviorally define disorders so there is not widespread misdiagnosis. It is important to have discrete criteria so treatment can be studied and causes understood.

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Autism Study: Isn't there some way for the general public to know and for other researchers to know more about the actual data used in a study when it gets published?

Susan Hyman: Studies that are funded through the National Institutes of Health often are required to make the data available for outside analysis after the authors have completed their work. The reason for Peer Review by anonymous scientists prior to publication is to have someone else make certain that the claims are supported by the data presented.

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Any word from Jenny McCarthy?: While it would be ridiculous for many people to use this pin-up as a role model, she lent some semblance of credibility to these reports by putting an (attractive) human face, and was pretty zealous in spouting off anti-vaccine talking points; while many people ignored her, how many listened, esp. when she made the daytime talk circuit? Has there been a mea culpa from her?

Susan Hyman: In addition to celebrities, the media has a responsibility to present the evidence that contributes to opinions offered - especially if there is an impact on public health.

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Rockville, MD: Have you seen Penn and Teller's episode of Bull**** that discusses this (and totally skewers the anti-vaccine crowd)? Aside from the language (and the visuals at the very end), I thought it was very well done. Do you think there would be a place for more things like what they put together, if it was a little more PG?

Susan Hyman: I have not seen this episode.

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Rocci Fisch: Retracted: the Wakefield et al Lancet paper which launched claims into medical research

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Have rates gone down?: One thing I've never seen is the statistics about autism rates since they took the mercury out of most childhood vaccines. Have rates gone down in the last 8 years? Do we have stats on that? Thanks!

Susan Hyman: The rates of autism continue to rise. We do not know if this represents the true rate of the disorder in the population or if pediatricians and parents are more aware of the symptoms resulting in improved diagnosis across the age span and across intellectual abilities.Mercury was never in the MMR vaccine.

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Vaccination and autism: I was watching CNN last night and a fellow names JB Handley claims that there are new studies out from Stonybrook and Pittsburgh that do find a link between some vaccines and autism. He also claimed that the "correct" study, one done comparing children who received absolutely no vaccines versus those who did, has not been done and that is the only type of study that could put this issue to rest. In your opinion, how much water does the latter argument hold? Does he have a point? Do scientists need to design and execute better studies on this?Also, are the new studies he cites any good? It's one thing to claim that a study proves your point, but it doesn't necessarily mean it's a good study. There are published studies that claim HIV doesn't cause AIDS, but I wouldn't want to hang my hat on any of those. Where is the reasoned voice that out there that can discuss these issues and bring some reasoned debate?

Susan Hyman: Infants die from pertussis, there was an epidemic in LA reported last year that sent one infant to the hospital after an unimmunized child exposed over 800 people to measles with 11 documented cases in unimmunized children.Children who do not get immunized because of personal or religious beliefs may not be a representative control group. The size and expense of a randomized prospective study would be prohibitive and with holding vaccines unacceptable by medical standards. Studies in Denmark, where vaccine is elective, did not find an increased rate of autism in children who were vaccinated.

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Study population number: Hi, thank you for doing this chat. I am surprised that the original study was considered worthy of the Lancet when, according to news articles, the original study population included only 12 people. I realize it can be hard to get a large number of subjects for specific conditions, but isn't 12 a pretty small study number?

Susan Hyman: Yes, this is considered a case series. It is not the level of scientific design that would typically cause a change in medical practice or public policy

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Peer-review: Supporters of the anti-vaccine movement claim that because the original paper was peer-reviewed that it should be believed. But isn't the debunking of it the REAL proof that the peer-review system works? After all, when someone goes to such lengths to commit fraud as the original author, it's difficult for reviewers to spot it.

Susan Hyman: This is an excellent point: for us to practice evidence based medicine we need to be able to believe the evidence.Peer review assumes a certain trust that the data was collected under the auspices of an Institutional Review Board that protects human subjects and ensures ethical study design. It assumes that the investigator submits accurate data.

Susan Hyman:

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public image of "science": Considering the unfortunate fact that many critics of "science" use its failure to approach infallibility to discredit well-supported findings that undermine their own political, religious, or economic interests, what steps might we take in the discipline in order to minimize the damage done by highly publicized scientific miscalculations? In short, how do we keep the yahoos from using snafus to discredit important scientific data?

Susan Hyman: Discussion is desirable in science - few "facts"emerge as facts but require an iterative process of research and confirmation by other studies.Confirmation and further study is critical

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Autism and parental recreational drug use: Isn't it more likely that autism, etc., is a result of parental use of recreational drugs, leading to harmful mutations later passed down to the embryo in its genetic inheritance?

Susan Hyman: While case series have identified an association of autism with certain prescription drugs (thalidomide, valproic acid, misopristol), studies to date have not identified an association with prenatal use of opiates, tobacco, marijuana or alcohol. This is not to say that prenatal exposures are NOT associated with developmental disabilities: tobacco decreases IQ and increases the risk for ADHD, alcohol is associated with decreased IQ and ADHD. Prenatal exposures to environmental agents may indeed impact gene function and result in autism and other developmental disabilties. A combination of epidemiologic studies and basic science is necessary to figure this out

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Lost respect for the Lancet: Given what we know now - ethyl mercury vs. methyl mercury, and that doctor's patent for a non-thimerosol (spelling?) MMR vaccine, shouldn't the Lancet have done more due diligence before publishing that paper? I have lost any high regard for that journal because of the harm that publishing that paper did to Public Health. Even though they retracted it now, some still say, "it was published in a leading journal!

Susan Hyman: Medical journals require contributors to disclose financial interests that they may have in a product or conclusion. This results in public disclosure so the reader can identify potential bias. Disclosure should alert the reviewers and the editors for potential conflict of interest.

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Money: There are so many groups soliciting for money for autism based on the theory that vaccines cause autism. Any word if they will continue to insist that vaccinations are the cause? It is often true that one-cause charities are very hesitant to give up on their sometimes absurb claims.

Susan Hyman: These might be productive avenues for research to be directed

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Autism Data: I hear that NIH has a database called the National Database for Autism Research that provides access to data used in autism studies. Can this be used when volunteer scientists and others peer review publications?

Susan Hyman: NDAR (National Data Base for Autism Research) contains data from NIH funded studies. It does not contain all data collected, but NIH can be approached for analysis of this data for peer reviewed publication.

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Debunking bad science: Ben Goldacre has been debunking this for years, as have many other people. Why is there a big discussion now?Plus, I think you need to emphasize that peer-review is only ONE way to check the quality of scientific research. The results must also be repeatable by other scientists, the sample size needs to be large, and negative bias needs to be considered across the range of study before there can be any confidence in results.

Susan Hyman: Agreedintervention used in standard dosing and provided in a double blind placebo controlled fashion

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Autsim, Vaccines & Diets: Our son is 5 and has ASD. He was developing normally until his 18 month vaccinations. Shortly after, he lost any speech he had developed and slowly began stimming. Now, he has a significant speech delay and other related disorders (social, mainly). He's a very fun, loving and active child and does not have many of the ailments or issues that many kids on the spectrum suffer from. Through treatments and testing, we have found he has a high level of measles titers in his system. He also has high levels of yeast and very low levels of "good" bacteria in his system. We are working on the yeast and bacteria and can mainly attribute that to multiple antibiotics at an early age. We have altered his diet based on his food allergies and sensitivities. If vaccines are not attributed to ASD in any way, then why does my son still have high levels of the measles virus disrupting his system, and what are some methods that have been successfully done to correct it?

Susan Hyman: The measles titre measures his ability to form immunity and response to the vaccine. Studies have not demonstrated that measles titers are elevated or causative in autism. With that said, there is evidence that probiotic use may have benefit in some children related to GI symptoms and other pediatric disorders other than autism.Research regarding behavioral effects of diet is ongoing

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Dr. McCarthy?: Unfortunately, I don't think Jenny McCarthy and her band of pseudo- and fraudulent-science believers will care one bit about the newest evidence that the study is a fraud. Just like the "birthers" will never believe President Obama was born in Hawaii, even with documented proof and eyewitness testimony, McCarthy's followers will never believe that vaccines aren't the reason their child developed autism. There must be someone to blame, because bad things aren't allowed to happen to innocent children. Why are so many, otherwise intelligent and rational people willing to believe a word that comes out of the mouth of a former Playboy bunny who has absolutely no medical or science training? Also, is there any estimate to the number of children who have become sick and/or died as a result of not getting vaccines due to the scare?

Susan Hyman: The CDC reported 131 cases of measles in 2008, of those there were no deaths but several hospitalizations. Of the 11 cases reported in the LA epidemic last year, one hospitalization and no deaths were reported. Measles continues to be a major cause of childhood death and neurologic disease in the developing world. In this age of travel and immigration it is important to be vigilant in our protection of children.

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Wakefield's intentional fraud: Where is Dr. Wakefield practicing now? With this proof of his intentional fraud, done for financial gain, he should not be allowed to continue his "research" in the United States either. Do we know where he is and what institution he's affiliated with? Is it possible that the United States can withdraw his work visa based on this new evidence?

Susan Hyman: Dr. Wakefield was originally associated with Thoughtful House in Texas. To my knowledge he terminated his association with that organization prior to the current increase in controversy.

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Pediatrician/health care professional responsibility: Obviously, parents want the best for their children and frequently discuss medical decisions with their pediatricians. What responsibility do healt- care professionals have in helping parents understand the science behind vaccinations so parents understand they're safe? Seems like many peds are willing to let patients go unvaccinated to retain business.

Susan Hyman: Excellent question. The concept of the "medical home" for children with special health care needs advocates for ongoing collaboration in the care of children with disabilities between their parents and pediatricians. The AAP supports protecting children from vaccine preventable illness and educating families regarding both vaccines and autism.My observation is the opposite, that many clinicians will adjust the immunizaiton schedule to retain patients and get children immunized.

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Prenatal testing: Is there any prenatal testing on the horizon to identify fetuses predisposed to autism? I'd think many expectant parents would appreciate having such information in order to evaluate it and make the best decisions for their families.

Susan Hyman: Research is ongoing that examines combinations of genes that might increase prediction in families in whom there is already one child with autism.The causes of autism include prenatal events - either genetic, environmental or the combination of the two so research in this area is important

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Case series: Do you think Lancet's experience here will make other bioscience journals less likely to accept and publish case studies and case series in the future?

Susan Hyman: I think that editors and reviewers will look more closely at all data that is submitted

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Criminal prosecution?: Can Dr. Wakefield be prosecuted criminally for fraud? If so, in which jurisdiction(s)?

Susan Hyman: I believe the courts in the UK have examined the evidence and ruled accordingly

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And then?: What are the odds that the further spread of facts will make any difference at all to believe who believe vaccines cause autism?

Susan Hyman: The answerto this would not be evidence based!

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Susan Hyman:

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