Abstract
The furor over possible adverse effects of childhood vaccinations provides an informative case study that can help uncover approaches for assessing assumed causal relationships in empirical studies. Briefly put, a causal relationship between vaccinations and autism-spectrum disorders (i.e., autism, atypical autism, and Asperger’s syndrome) is not supported by the evidence from well-designed and executed clinical studies. But, due to unwarranted publicity-touting flawed studies that claim that vaccinations cause autism and other adverse events, large numbers of parents in the USA and the UK now believe that the risks presumably associated with vaccinations outweigh their disease-prevention benefits, and are choosing not to vaccinate their children, even to prevent the consequences of polio and other diseases. As the percentage of unvaccinated children in an area increases, the risk of outbreaks of diseases increases, creating potentially severe public health problems. Moreover, as the vaccination coverage decreases in developed countries, it becomes more difficult to justify vaccinations in countries with lower levels of human development, thus worsening the health of children globally (United Nations Development Program 2003 254–257).
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Notes
- 1.
At first glance this controversy is similar to the much earlier controversy stemming from Ignaz Semmelweis’s (1861) finding that agents (i.e., germs) transmitted by physicians were causing the deaths of mothers soon after their giving birth. The medical establishment in Vienna neither appreciated his findings nor his recommendation that the physicians wash their hands in a chlorine solution, which they followed only sporadically. He resigned his position in Vienna, moved to a less central position, and later on his wife committed him to an insane asylum, where he died. Wakefield challenged the medical establishment, was forced to resign his position, and became marginal. However, Semmelweis was correct and his recommendation saved lives; Wakefield is incorrect and his recommendation has led to the outbreak of preventable diseases and the deaths of children.
- 2.
Randomized controlled trials have established that trivalent MMR vaccinations are not more likely to have adverse consequences than the singular vaccinations. Demicheli et al. (2005, 6–8) reviewed six such trials; five preceded the publication of the article by Wakefield et al. (1998). They also reviewed 14 cohort studies that reached the same conclusion; that is, no difference between the trivalent and the single-disease vaccination; nine of these cohort studies where published prior to Wakefield et al. (1998). That article should have taken into account the findings of these earlier studies. No credible empirical research then supported, or now supports, Wakefield’s alarming statement. Consequently, ten of the original 13 authors have stated that their data were insufficient to establish a causal link between MMR vaccine and autism (Murch et al. 2004) and The Lancet has retracted the article (Editors, 2 February 2010).
- 3.
Brian Deer states (8 February 2009, e6–e7):
What parents did not know was that, 2 years before [the study began], Wakefield had been hired by Jabs’s lawyer, Richard Barr, a high-street solicitor in King’s Lynn, Norfolk. Barr had obtained legal aid to probe MMR for any evidence that could be used against the manufacturers. He is adamant that at all times he acted professionally, and diligently represented his clients. A string of Sunday Times reports have exposed how Wakefield earned £435,643 through his work with Barr, plus funding to support his research. …
The objective,” they wrote, “is to seek evidence which will be acceptable in a court of law of the causative connection between either the mumps, measles and rubella vaccine or the measles/rubella vaccine and certain conditions which have been reported with considerable frequency by families who are seeking compensation.
- 4.
Plotting data from the World Health Organization (WHO) and UNICEF, McCartney (2009, 10) documents the decline and recovery of measles immunization rates in the UK and globally. For the UK the approximate percentages (read from her graphs) are 1998 = 87%, 2001 = 84%, 2004 = 81%, and 2008 = 86%. She attributes this decline to Wakefield's “infamous” 1998 article and his press conference where he claimed the MMR vaccine could cause bowel disorders and, possibly, autism. She notes that all but three of the 13 authors retracted their article’s interpretation of the hypothesized linkage between MMR vaccinations and autism (Murch et al., 2004). Global immunization also declined and recovered during this period reaching a higher percentage than in the UK (also read from her graph): 1998 = 80%, 2001 = 72%, 2004 = 85%, and 2008 = 87%. She notes that an outbreak of measles occurred in Dublin in 2000 when the coverage rate was only 79%, much less than the 95% coverage needed to prevent such an outbreak. Consequently, 13 children needed intensive care and another three died because of the measles. A former chairman of the British Medical Association opined that parents in the UK should be compelled to vaccinate their children rather than leaving vaccinations to their discretion.
- 5.
Brian Deer (8 February 2009, e6) reports that: “Wakefield has left Britain to live in Austin, Texas, where he runs a clinic offering colonoscopies to American children. He tours the country, giving lectures and speeches against the vaccine, and attracting a loyal following of young mothers.”
- 6.
Evidence of how AutismCoach propagates misinformation is provided by its advocacy of the flawed research of David A. Geier, B.A. and Mark R. Geier, M.D (viewed on the AutismCoach web site, 17 September 2009). These researchers purportedly show that the switch to vaccines without thimerosal (a mercury-based preservative) has reduced the occurrence of autism; that is, the mercury previously in the vaccines had caused autism. The AutismCoach web site does not mention that the Institute of Medicine characterizes the Geier studies as uninformative regarding causality, and that the body of evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism (Institute of Medicine 2004, 6–7, and discussion of findings in this chapter).
- 7.
The review committee specified three categories of evidence about biological mechanisms: plausible theoretical evidence, experimental evidence on humans or animals, and evidence that the mechanism results in known human diseases (Institute of Medicine 2004, 29).
- 8.
The IOM defines two other aspects of causality. Did it? causality asks if the “evidence strongly suggests that the vaccine did cause the adverse event in one or more cases, then it is logical to conclude that it can cause the event” (Institute of Medicine 2004, 23). Will it? causality “refers to how frequently a vaccine causes a specific adverse event and can relate to either individuals or populations. … For either individuals or populations, the answer to Will it? is best estimated by the magnitude of the risk difference (attributable risk): the incidence of the adverse event among vaccine recipients minus the incidence of the adverse event among otherwise similar nonrecipients” (Institute of Medicine 2004, 27).
- 9.
Susser (1973, 87) defines relative risk as follows: Relative risk is the ratio of the incidence of cases among those exposed to the risk or causal factor to the incidence among those not exposed. The relative risk of lung cancer for smokers is the ratio of the rate of lung cancer in smokers to the rate in nonsmokers. Stated another way, this risk is ratio of the incidence observed in smokers to the [counterfactual] incidence to be expected among them had they experienced the rates of nonsmokers.
- 10.
The Wikipedia entry for the Geiers suggests that they have a financial interest in propagating the spurious linkage between vaccinations and autism:
The Geiers have developed a protocol for treating autism that uses the castration drug Lupron. Mark Geier has called Lupron “the miracle drug” and the Geiers have marketed the protocol across the U.S. … According to expert pediatric endocrinologists, the Lupron protocol for autism is supported only by junk science. … When treating an autistic child, the Geiers order several dozen lab tests, costing $12,000: if at least one testosterone-related result is abnormal, the Geiers consider Lupron treatments, using 10 times the daily dose ordinarily used to treat precocious puberty. The therapy costs approximately $5,000 per month. The Geiers recommend starting treatment on children as young as possible, and say that some need treatment through adulthood (Downloaded 3 October 2009 from http://en.wikipedia.org/wiki/Mark_Geier). Also see on the internet “Confessions of a Quackbuster Mark Geier Untrustworthy: Autism, Thimerosal, Vaccinations” (Downloaded 3 October 2009).
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Smith, R.B. (2011). Childhood Vaccinations and Autism. In: Multilevel Modeling of Social Problems. Springer, Dordrecht. https://doi.org/10.1007/978-90-481-9855-9_15
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