Teresa
Binstock
Researcher in Developmental & Behavioral Neuroanatomy
February 04, 2010
Dr. Ignaz Semmelweis (1)
was among the first to perceive that birth-related deaths caused by
puerperal fever were due to a contagion. He dared collect data which
indicated the life-saving merit of having physicians wash hands when
proceeding from one obstetrical patient to another. He also dared
publish his findings, along with admonitions that physicians not in the
habit of washing their hands acquire the hand-washing habit.
Ultimately, his findings were in "Conflict with established medical
opinions" (1) and stand as precedent for how Andrew J. Wakefield, M.D.,
has been the primary focus of an inquisition by the General Medical
Council in the United Kingdom.
In exploring parallels between Semmelweis' career and Wakefield's,
several paragraphs from an excellent Wikipedia presentation (1) are
illustrative:
"Semmelweis's observations
conflicted with the established scientific and medical opinions of the
time. The theory of diseases was highly influenced by ideas of an
imbalance of the basic "four humours" in the body, a theory known as
dyscrasia, for which the main treatment was bloodlettings. Medical
texts at the time emphasized that each case of disease was unique, the
result of a personal imbalance, and the main difficulty of the medical
profession was to establish precisely each patient's unique situation,
case by case.
"The findings from autopsies of deceased women
also showed a confusing multitude of various physical signs, which
emphasised the belief that puerperal fever was not one, but many
different, yet unidentified, diseases... Semmelweis's groundbreaking
idea was contrary to all established medical
understanding.
"As a result, his ideas were rejected by the
medical community..." (1)
These aspects of the Semmelweis history can be rewritten in regard to
Wakefield:
Wakefield's
observations conflicted with the established scientific and medical
opinions of the time. Theories of autism causation were strongly
influenced by faith in genetics and by a priori certainty that
vaccinations played no role in causing some cases of autism [but, eg,
see 16-19].
Findings from autopsies and medical profiles of children with autism
showed a confusing multitude of various physical signs, which
reinforced the belief that autism was neurological even in the presence
of associated pathologies. Wakefield's groundbreaking findings of ileal
lymphoid hyperplasia and the suggestion that, in some cases, this
pathology was related to the MMR vaccine was contrary to all
established medical understanding.
Although Semmelweis was dismissed from his position at a teaching
hospital, his ideas gradually became accepted (1). Similarly, as
establishmentarian furor arose from the initial Wakefield paper which
described gastrointestinal pathologies and which suggested the
possibility of an etiologically significant relationship among the MMR,
a unique gastrointestinal pathology, and autism in a subgroup of
children (2). Indeed, Dr. Wakefield was dismissed from his position at
the Royal Free Hospital, even as subsequent studies by him and by
others have further documented gastrointestinal pathologies in autistic
children (eg, 3-12; see also 13).
Importantly and also parallel to gradual acceptance of Semmelweis's
findings, the American Academy of Pediatrics recently gave its approval
of gastrointestinal evaluations for autistic children (14-15). The
scientific significance of Wakefield et al's original and subsequent
findings is conveyed in a brief review following two case
presentations, wherein Galiatsatos et al wrote, "One of the earliest
studies investigating GI anomalies in autistic children was reported by
Wakefield et al...in 1998..." (11; see also 2).
Several issues swirl about Dr. Wakefield: (i) his willingness to
explore, document, and report gastrointestinal pathologies in subgroups
of autistic children, and (ii) his daring to suggest that vaccinations
may have been etiologically significant in regard to some autistic
children's gastrointestinal pathology and their regression into autism
(2).
Now that The Lancet has now officially retracted (20; see also 22) the
1998 study by Wakefield et al (2), a conclusion seems likely: The
Lancet editors retracted Wakefield et al 1998 not because of the
findings described therein and subsequently replicated but instead
because of the co-authors suggestion that, in a subgroup of children
who received the MMR, their regression into autism and their
gastrointestinal pathology mayhave occurred as
a result of the way those individual children's bodies responded to the
MMR, its live-viruses, and its endogenously induced pulse of interferon
gamma (eg, 21).
Thus we return to Wakefield and Semmelweis. Each committed an act of
heresy against prevailing medical opinion. In the case of Dr.
Semmelweis, data had been collected and eventually published (1), but
his tragic flaw became significant when he suggested that doctors ought
change their ways. In the case of Drs. Wakefield, Murch, and
Walker-Smith, the heresy meriting inquisition lay in daring to suggest
that, in somechildren with
autism, the MMR may be been etiologically significant to the child's
gastrointestinal pathology and to his or her regression into autism.
For daring publish the findings (2) and to state the MMR-gut-autism
relationship as a possibility, and for refusing to recant, Dr.
Wakefield has become a hero to many parents who witnessed their child
develop gut pathologies and regress into autism soon after receiving
the MMR vaccination.
A petition - actually a letter - in support of Dr. Wakefield and to the
United Kingdom's General Medical Council can be viewed and signed
online. Comments from signers can be viewed by clicking on a "comments"
link below the thermometer-like icon. Although the petition is now
closed, Dr. McCandless letter to GMC, in support of Andy Wakefield,
M.D, can be viewed via this link: :http://tinyurl.com/yacv2xp
References:
1. Ignaz
Semmelweis
http://en.wikipedia.org/wiki/Ignaz_Semmelweis
2. Ileal-lymphoid-nodular hyperplasia, non-specific
colitis, and pervasive developmental disorder in
children
Wakefield AJ et al.
Lancet. 1998 Feb 28;351(9103):637-41.
3. Enterocolitis in
children with developmental disorders
Wakefield AJ et al.
Am J Gastroenterol. 2000 Sep;95(9):2285-95.
7. Colonic CD8 and
gamma delta T-cell infiltration with epithelial damage in children with
autism
Furlano RI et al.
J Pediatr. 2001 Mar;138(3):366-72.
8. The significance
of ileo-colonic lymphoid nodular hyperplasia in children with autistic
spectrum disorder
Wakefield AJ et al.
Eur J Gastroenterol Hepatol. 2005 Aug;17(8):827-36.
9. Immune activation
of peripheral blood and mucosal CD3 lymphocyte cytokine profiles in
children with autism and gastrointestinal
symptoms.
Ashwood P, Wakefield AJ.
J Neuroimmunol. 2006 Apr;173(1-2):126-34.
10. Are there more
bowel symptoms in children with autism compared to normal children and
children with other developmental and neurological disorders?: A case
control study
Smith RA et al.
Autism. 2009 Jul;13(4):343-55.
"There was a significant difference in the reporting of certain bowel
symptoms (constipation, diarrhoea, flatulence) and food faddiness
between the autism group and the mainstream school control group... It
would appear, however, that this is not specifically associated with
autism as bowel symptoms were reported in similar frequency to a
comparison group of children with other developmental and neurological
disorders."
11. Autistic
enterocolitis: Fact or fiction?
{excellent, brief overview}
P Galiatsatos, A Gologan, E Lamoureux
Can J Gastroenterol. 2009 Feb;23(2):95-8.
http://www.pulsus.com/journals/abstract.jsp?sCurrPg=journal&jnlKy=2&atlKy=8619&isuKy=837&isArt=t
12. Clinical
Presentation and Histologic Findings at Ileocolonoscopy in Children
with Autistic Spectrum Disorder and Chronic Gastrointestinal
Symptoms
Arthur Krigsman, Marvin Boris, Allan Goldblatt and Carol Stott
Autism Insights 2010:2 1-11; 27 Jan 2010
http://www.la-press.com/clinical-presentation-and-histologic-findings-at-ileocolonoscopy-in-ch-a1816
13. Gastrointestinal
pathologies in autism: Did Mayo's Ibrahim and colleagues
err?
Teresa Binstock, Jan 31, 2010.
14.
Evaluation, Diagnosis, and
Treatment of Gastrointestinal Disorders in Individuals With ASDs: A
Consensus Report
Buie T et al.
Pediatrics 2010;125:S1–S18.
http://pediatrics.aappublications.org/cgi/content/full/125/Supplement_1/S1
15. Recommendations
for Evaluation and Treatment of Common Gastrointestinal Problems in
Children With ASDs
Buie T et al.
Pediatrics 2010;125:S19–S29
http://pediatrics.aappublications.org/cgi/content/full/125/Supplement_1/S19
16. Thimerosal
exposure in infants and neurodevelopmental disorders: an assessment of
computerized medical records in the Vaccine Safety
Datalink
Young HA, Geier DA, Geier MR.
The George Washington University School of Public Health and Health
Services
J Neurol Sci. 2008 Aug 15;271(1-2):110-8.
$ http://linkinghub.elsevier.com/retrieve/pii/S0022-510X%2808%2900157-3
The study evaluated possible associations between neurodevelopmental
disorders (NDs) and exposure to mercury (Hg) from Thimerosal-containing
vaccines (TCVs) by examining the automated Vaccine Safety Datalink
(VSD). A total of 278,624 subjects were identified in birth cohorts
from 1990-1996 that had received their first oral polio vaccination by
3 months of age in the VSD. The birth cohort prevalence rate of
medically diagnosed International Classification of Disease, 9th
revision (ICD-9) specific NDs and control outcomes were calculated.
Exposures to Hg from TCVs were calculated by birth cohort for specific
exposure windows from birth-7 months and birth-13 months of age.
Poisson regression analysis was used to model the association between
the prevalence of outcomes and Hg doses from TCVs. Consistent
significantly increased rate ratios were observed for autism, autism
spectrum disorders, tics, attention deficit disorder, and emotional
disturbances with Hg exposure from TCVs. By contrast, none of the
control outcomes had significantly increased rate ratios with Hg
exposure from TCVs. Routine childhood vaccination should be continued
to help reduce the morbidity and mortality associated with infectious
diseases, but efforts should be undertaken to remove Hg from vaccines.
Additional studies should be conducted to further evaluate the
relationship between Hg exposure and NDs.
17. Hepatitis B
triple series vaccine and developmental disability in US children aged
1-9 years
Gallagher C, Goodman M. Toxicol Environ Chem 2008 90(5):997-1008.
{free online}
http://fourteenstudies.org/pdf/hep_b.pdf
This study investigated the association between vaccination with the
Hepatitis B triple series vaccine prior to 2000 and developmental
disability in children aged 1-9 years (n = 1824), proxied by parental
report that their child receives early intervention or special
education services (EIS). National Health and Nutrition Examination
Survey 1999-2000 data were analyzed and adjusted for survey design by
Taylor Linearization using SAS version 9.1 software, with SAS callable
SUDAAN version 9.0.1. The odds of receiving EIS were approximately nine
times as great for vaccinated boys (n = 46) as for unvaccinated boys (n
= 7), after adjustment for confounders. This study found statistically
significant evidence to suggest that boys in United States who were
vaccinated with the triple series Hepatitis B vaccine, during the time
period in which vaccines were manufactured with thimerosal, were more
susceptible to developmental disability than were unvaccinated boys.
18. Hepatitis B
vaccination of male neonates and autism
[conference abstract as published]
CM Gallagher, MS Goodman, Graduate Program in Public
Health, Stony Brook University Medical Center, Stony Brook, NY
Annals of Epidemiology, p659
Vol. 19, No. 9 Abstracts (ACE) September 2009: 651–680.
PURPOSE: Universal newborn immunization with hepatitis B vaccine was
recommended in 1991; however, safety findings are mixed. The Vaccine
Safety Datalink Workgroup reported no association between hepatitis B
vaccination at birth and febrile episodes or neurological adverse
events. Other studies found positive associations between hepatitis B
vaccination and ear infection, pharyngitis, and chronic arthritis; as
well as receipt of early intervention/special education services (EIS);
in probability samples of
U.S. children. Children with autistic spectrum disorder (ASD) comprise
a growing caseload for EIS. We evaluated the association between
hepatitis B vaccination of male neonates and parental report of ASD.
METHODS: This cross-sectional study used U.S. probability samples
obtained from National Health Interview Survey 1997–2002 datasets.
Logistic regression modeling was used to estimate the effect of
neonatal hepatitis B vaccination on ASDrisk amongboys age 3–17 years
with shot records, adjusted for race, maternal education, and
two-parent household.
RESULTS:Boyswho received the hepatitis B vaccine during the first month
of life had 2.94 greater odds for ASD (nZ31 of 7,486; OR Z 2.94; p Z
0.03; 95% CI Z 1.10, 7.90) compared to later- or unvaccinated boys.
Non-Hispanicwhite boys were 61% less likely to have ASD(ORZ0.39;
pZ0.04; 95% CIZ0.16, 0.94) relative to non-white boys.
CONCLUSION: Findings suggest that U.S. male neonates vaccinated with
hepatitis B vaccine had a 3-fold greater risk of ASD; risk was greatest
for non-white boys.
19. Generation Zero
{FOIA-based analysis of CDC's 1999 thimerosal findings}
Blaxill M, Safeminds 2004
http://www.safeminds.org/research/library/GenerationZeroPowerPoint.pdf
20. Retraction—Ileal-lymphoid-nodular hyperplasia,
non-specific colitis, and pervasive developmental disorder in
children
The Editors of The Lancet
http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673610601757.pdf
21. Kinetics of
immunologic responses after primary MMR
vaccination.
Pabst HF et al.
Vaccine. 1997 Jan;15(1):10-4.
22. An Interest in
Conflict? The ‘conflict of interest’ policy of the General Medical
Council and the fitness to practice hearing of Dr. Andrew Wakefield,
Professor Walker-Smith, and Professor Simon
Murch
by Martin J. Walker, MA
© Copyright 2009, Medical Veritas International Inc. All rights
reserved.
http://www.medicalveritas.com/images/00211.pdf
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