Today's New York Times is running an article called "Autism Fraud," about the recent fracas over Andrew Wakefield's fully, utterly and repeatedly debunked 1998 study which linked the mump-measles-rubella (MMR) vaccine and autism. This is just one of many articles, radio shows and TV "bites" which wonder why, now that Wakefield's study has been absolutely trashed, parents still worry about vaccines as a possible cause of autism.
I'll take the question one step further: while it's true that Andrew Wakefield's 1998 study was a catalyst for vaccine fears, the study's conclusion never actually pointed to the MMR as a direct cause of autism. And many, many studies make it clear that vaccines really couldn't possibly be the cause of an autism epidemic.
So why are there still fears about vaccines and autism?
Here are a few of the reasons:
- Like every medical intervention in the world, from aspirin to antibiotics, vaccines carry risks for some people. In point of fact, vaccines - very rarely - can cause serious neurological injury. The Vaccine Court was specifically set up to ensure the public health while also compensating injured families. Recent articles regarding Wakefield's study suggest that vaccines are risk free - but anyone who looks into the issue can see that there are both serious and relatively benign exceptions to this rule. When parents, reassured by physicians, learn that vaccines really do carry risks of real and significant injury - no matter how slight the risks - trust begins to erode.
- Last year, the Poling family received a settlement of over $5 million from the Vaccine Court. The case involved Hannah Poling, a little girl who received multiple vaccinations in a single day, and had a reaction which led to neurological damage. While Hannah's injury related to an underlying, asymptomatic mitochondrial disorder, the family and their lawyers state that Hannah received an autism spectrum diagnosis after damage from vaccines. There is plenty of controversy over the precise details of the Poling case, but it raised many families' awareness of the possibility of vaccine injury.
- Logic and common sense can trump science when the issue is a child's safety. While science can, and does, tell us that the risk of vaccine injury is far less than the risk of contracting potentially deadly disease, parents find the science hard to swallow. Parents must make an active decision to have their children vaccinated, and when media figures tell them (despite no evidence to support the idea) that their children are receiving "too much, too soon," it makes emotional sense. Injecting a tiny child with multiple antigens is a scary thing to do, even when science tells us it's far safer than the alternative.
- We first world parents have forgotten what it means to contract some of the diseases from which we are presently protected (measles, mumps, rubella, whooping cough, Hib, etc.). And even as the vaccine rate drops and these diseases become slightly more prevalent, they are still rare. While pediatricians in hospitals may speak and write about deadly infections, very few parents have ever seen such diseases in person. Parents do, however, see autism all the time - and of course they see far, far more diagnosed autism today than they did when they were children.
- Researchers are actively searching for the causes of autism, and new studies come out all the time linking autism with one or another environmental factor - ranging from television to mercury emissions from factories to pesticides. Even the CDC's information sheets cite possible environmental factors, saying "We do not know all of the causes of ASDs. However, we have learned that there are likely many causes for multiple types of ASDs. There may be many different factors that make a child more likely to have an ASD, including environmental, biologic and genetic factors." When even top federal agencies can't tell us what does cause autism - but do say that environmental factors may play a role - parents are reasonably concerned not only about vaccines, but also about a whole range of possible issues. The same parents who eschew vaccines are also likely to select only organic foods, avoid use of pesticides, and so forth.
- There was, is, and will continue to be a very vocal community ensuring that the idea of a vaccine-autism link will not die. Organizations like Generation Rescue, led by Jenny McCarthy and JB Handley, are specifically dedicated to this issue. Their voices are amplified by the media; Jenny McCarthy wrote an article in the Huffington Post, and Handley was recently a guest on CNN.
- Anyone who visits the Generation Rescue site (or the websites of many other like-minded organizations) will find long lists of research studies which appear to support the idea of an autism-vaccine link. Some of these studies really have little or no relationship to vaccines, diet, etc., and seem to be included only to bulk up the list. And many of the studies were authored by individuals such as Mark and David Geier, whose work is refuted by many top researchers. But the fact remains that the studies were conducted, and many of them are listed in the NIH's PubMed, a site that includes studies published in peer-reviewed journals.
If the medical establishment and media really want to understand parents' concerns - or want to help parents make smart decisions for their children's health - it's important that they understand where those concerns come from. While it's true that one study did have a significant impact on public worries over vaccines, it's no longer the sole foundation for parents' fears.