Wednesday, May 16, 2012

Autism and MMR

When you tell people you come in contact with around the community that you are a medical student, they don't want to talk about how hard medical school is. They don't want to hear about the grossest thing you have seen or even how much money you expect to make. The conversation goes something like this:

Me: "Oh, I'm a medical student at the school here."
Them: "Do you know what you want to go into?"
Me: "Not yet, but I'm excited for years three and four when we start getting exposed to various fields."
Them: "Hey, what do you think about (insert controversial medical topic here)?"

More often than not, I have no idea what I think about the controversy they bring up and even if I did, they would not want to know what I think. Usually, people only ask to see if I agree or can validate their own beliefs. Medical ethics and controversies are not stressed very strongly in medical school. Every now and then a quick reference is made to some current movement, but largely medical students draw their own conclusions.

However, when a popular movement has been thoroughly debunked (or is patently untrue) so that there is only one position a doctor can have and maintain credentials, the teachers briefly morph into paladins of the scientific process, eager to dispense knowledge from leading authorities. This doesn't happen often, but it's kind of fun when it does.

Recently, one of those moments happened while we were discussing statistics and lab studies. The topic of autism and the role of the MMR vaccine came up and we took a few minutes to discuss it.

The issue first arose in 1998 when Andrew Wakefield, a British surgeon, published a paper along with 12 other authors claiming to have discovered a new syndrome called autistic enterocolitis which raised the possibility of a link between inflammatory bowel disease, autism, and the MMR vaccine. The paper was immediately controversial and contested in papers from Japan, but public outrage was fueled by a press conference that Wakefield held shortly thereafter.

A few years later, a new controversy emerged when it was revealed that Wakefield had applied for a patent on a single-jab measles vaccine. Certainly no conflict of interest there. Additionally, the UK General Medical Council hearing that investigated Wakefield's conduct concluded that he conducted the study without approval from the hospital ethics committee, dishonestly disclosed how patients were recruited for the study, and purchased for 5 pounds each, blood samples from 7 children attending his son's birthday party. Oh, and the sample size for his sweeping conclusions was a whopping...12.

Wakefield lost his credentials, is barred from practicing medicine in the UK, the journal that published his article fully retracted the publication, 10 of the 12 original authors released a re-interpretation of the original findings, but still Wakefield claims innocence and decries the use of MMR. Immunization rates in Britain dropped from 92% to 73% and there are estimates that as many as 125,000 US children born in the late 90s did not get the MMR vaccine. In 2011 a journal article labeled the "autism-vaccine connection as the most damaging medical hoax of the last 100 years."

Not many people listen to the CDC, USPSTF, or read medical journals. The public came to know of this controversy because a woman named Jenny McCarthy (PhD from the University of Google) championed the cause as her pet project. Jenny McCarthy started her career as a porn model for Playboy. In 2007 she claimed her son had been diagnosed with autism and she became the spokesperson against MMR vaccine and advocate for chelation therapy (the mercury in vaccines causes autism) to cure autism. She has made appearances on Oprah and Larry King.

The effects of this fiasco are manifested in the anti-vaccination movement. This website is particularly insidious because it doesn't state anything-it only implies possibilities. Is it possible, even a little bit, that vaccines could predispose to autism that might otherwise lie genetically dormant? Yes, that is a possibility. It is also just as likely that immunizations keep elephants away.

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