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The Autism-Vaccine Connection: Reopened Can of Worms

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At a news conference in Atlanta on Thursday (which I haven’t seen, but read accounts of), the Atlanta parents of 9-year-old Hannah Poling revealed that in November, the vaccine court conceded their claim that vaccines caused her autism-like symptoms. At first glance, this case seems to contradict the scientific consensus that vaccines don’t cause autism. Anti-vaccine groups are howling with glee about it. The decision requires some explanation, and it will take a bit of space.

The vaccine court, to back up, is part of the U.S. Court of Federal Claims. Congress set it up in 1988 amid a wave of costly lawsuits over the whole-cell pertussis vaccine, which has since been replaced. The idea of the court is to provide timely compensation to kids demonstrably injured by vaccines. If you want to sue a drug company for a vaccine reaction, you have to come here first. The court protects the drug companies from runaway juries, which helps keep litigation from driving pharma out of the not-terribly-profitable vaccine business.

Science.jpg
Science.jpg

Illustration by: Matt Mahurin

People don’t sue in vaccine court–they file claims, which the government can contest, or concede. In this peculiar little institution, Department of Justice lawyers represent the defendant, which is the Department of Health and Human Services. Special masters–administrative judges schooled in vaccine matters–rule on the cases.

Over the past decade, nearly 5,000 claims from parents with kids on the autism spectrum have flooded the court. To deal with these numbers, the court set up an Omnibus proceeding, similar to those established to deal with asbestosis claims. The court has been planning to run nine test cases out of the bunch. These test cases, which deal with various theories of how the vaccines might have caused autism, would then be used to resolve the thousands of other cases.

The first three test cases have been heard but not yet adjudicated. Poling was to have been one of the next test cases, but her lawyers withdrew the claim and settled on the side. It is extremely important to understand why they did this, because it gives an indication of how typical Poling’s case is among the population of autistic kids with claims before the government.

It seems that Poling’s case was withdrawn because it’s very unusual, and therefore wouldn’t be a good test case. Poling developed normally at first, her parents say, then suffered seizures and “autism-like symptoms” after getting five vaccinations when she was 19 months old. Some time later, doctors discovered that she had a mitochondrial disorder, a condition that occurs in about 1 in 4,000 kids and can bring about a range of problems.

Poling’s symptoms started with a 102-degree fever a couple days after the shots. This may point to the live, attenuated viruses in the measles-mumps-rubella (MMR) or chickenpox vaccines she received as possible triggers of the reaction. Although this may be the first time that compensation for autism-like symptoms has been awarded by the court, encephalopathy–brain disease–is a rare, but recognized adverse event linked to the MMR shot. The court recognizes such cases, and compensates the children, a few times a year.

If this is the correct scenario, then we could assume Poling is an outlier whose case has nothing to do with the bulk of autism. Epidemiological studies have demonstrated (see Laura’s post earlier today) without a doubt that the increased diagnosis of autism is not linked to thimerosal in vaccines or to the MMR shot, the two factors at play in the autism Omnibus.

That said, children with autism or autistic syndromes may have somewhat higher rates of mitochondrial disorders. These underlying conditions are more likely to be triggered by garden-variety infections than by vaccines. Yet there may be additional kids in the autism Omnibus who fit into this category. Whether the course of their problems fit as neatly as Poling’s did remains to be seen.

In the past, the court has ruled in dozens of cases of a rare genetic disorder called tuberous sclerosis complex (TSC). Like mitochondrial disorders, this is a condition that often doesn’t manifest itself until a child is several months to a few years old. Many parents of TSC children who suffered reactions and subsequent brain disorders following administration of the whole-cell pertussis vaccine–known as DTP–took them to the vaccine court in the 1980s and 1990s. Generally, they lost. The court determined that the underlying condition would have crippled the child regardless of the reaction to the DTP. But in some cases, they won. Incidentally, a small but significant portion of TSS children have “autistic-like symptoms.”

To wrap up, this is probably an isolated case, but we won’t know for a while. Clearly, though, the anti-vaccine forces, bolstered by the glitter of people like Jenny McCarthy and the wealth of donors like investment banker JB Handley, are going to play it for all they can.

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