GROUNDHOG DAY IN APRIL

There has been much action on the scientific, political and media fronts in the ongoing debate over the connection between vaccines and the autism epidemic (and, yes, I will continue to use that word). First, was all the news out of the M.I.N.D. Institute, including the announcement of the Autism Phenome Project, and the release of a study showing damage to the immune system from thimerosal exposure. Then, we had the letter by eight members of Congress, led by Senator Joe Lieberman, calling upon the National Institute of Environmental Health Sciences to take a new look at the hypothetical link. Last week, at a press briefing that included Dan Olmstead and David Kirby, Representative Carolyn Maloney announced her legislative efforts to mandate further studies. And this week will see the Generation Mercury March and a DAN! Conference in Washington.

That much activity just naturally has to make for a collective case of the jitters among those who have a vested interest in denying any link between vaccines and autism. Their reaction was predictable.

A letter was addressed to the individual members of Congress by 22 organizations, pleading that there be no legislative restrictions on the use of thimerosal in vaccines. The groups’ rationale was open fear. Some people might interpret a ban on mercury in vaccines as being an admission that there is a problem, or that “vaccine safety oversight is inadequate.” Well, duh!

The 22 organizations declared that they “stand behind the enormous amount of scientific evidence that shows no link exists between thimerosal in vaccines and the development of autism.” Perhaps if they said they believe the research does not support a link, I could call their position a legitimate disagreement with the growing body of evidence of a link. But to say there is an “enormous amount” of evidence against a link is laughable. The 2004 IOM report cited the Verstraeten study, which even in its post-Simpsonwood version was labeled “neutral” by its author. The other evidence relied upon by the IOM committee consisted of foreign studies in which the level of exposure was less than the United States, and at least one Danish study changed the criteria for its pre-thimerosal-removal and post-thimerosal-removal cadres. Have I missed some startling revelation of the last year or so?

The other sign that the powers that be are worried is the resort to their favorite tactic. They trot out Dr. Paul Offit to let everyone know that no attention should be paid to the man behind the curtain. Just like Punxsutawney Phil, Dr. O emerges from his safe area, sees the shadow of bad news on the horizon, and then speaks reassuringly to those who don’t live with the issue every day. Just like Phil’s weather forecast, however, any similarity between Dr. Offit’s pronouncements and reality is purely coincidental. And just like the movie, Groundhog Day, in which Bill Murray lives the same day again and again, what we’re hearing from Dr. Offit is pretty much the same thing we’ve heard him say before.

“Every Child by Two,” an organization dedicated to promoting childhood immunization (this was one of the 22 organizations sending the letter to Congress), hosted a teleconference with Dr. Offit for the media. In her introduction, Amy Pisani, the Executive Director of Every Child By Two, noted that the purpose of the conference was “to discuss vaccine safety and legislation that’s being introduced in many states to ban the use of thimerosal in vaccines.” Of Dr. Offit, Ms. Pisani remarked that “he has the uncanny ability to make sense of the abundant research that’s been conducted around the world to disprove allegations that the preservative thimerosal that is in some vaccines ever caused autism in children.” That was an interesting introduction inasmuch as the bulk of actual autism research was barely mentioned.

The closest thing to a surprise in the teleconference was Dr. Offit’s admission that environmental insults may trigger autism in genetically predisposed children. In particular, he mentioned studies based on mothers taking thalidomide or being exposed to rubella, both insults having to occur early in pregnancy. To refute the connection between mercury and autism, however, Dr. Offit cited a study reportedly indicating that Rhogam use in pregnancy does not increase the odds of developing autism. According to Dr. Offit, that study was presented in March 2005 in Chicago at the American College of Genetics annual meeting. I must admit that I am unfamiliar with such a study, and if it was ever published, it is not readily accessible through a pubmed search. There is certainly evidence to suggest the contrary conclusion.

But the main rationale cited by Dr. Offit was, as usual, the same epidemiological studies on which the IOM report was based. He calls the results “clear and consistent and reproducible.” Apparently, Dr. Offit still labors under the misconception that the European studies, based on different levels of exposure than the United States experience, somehow reproduce and validate the “neutral” results of the Verstraeten study.

In the teleconference, Dr. Offit points to levels of mercury in the environment apart from vaccinations, and implies that an infant is more in danger of mercury poisoning from breastfeeding than from receiving a flu shot. He bases that argument not only on the volume of mercury involved (ignoring the fact that injection is a far more efficient means of introducing mercury than digestion), but also on thimerosal containing ethylmercury “a form of mercury which will be excreted much more quickly.” When a reporter later asked about the Burbacher studies, which demonstrate that ethylmercury is as dangerous ⎯ if not more so ⎯ than methylmercury, Dr. Offit moved the subject back to script with the aplomb of a presidential candidate at a debate: “again, I think ⎯ I mean, I think that ⎯ you know, there’s nothing as strong, frankly, as the epidemiologic studies.” As usual, Dr. Offit did not wander far from his comfort zone. There was no real discussion of any studies that might point to conclusions he won’t like.

Paul Offit is now taking the show on the road. On April 11th, he will be the featured speaker at a seminar in Jacksonville, Florida, entitled Vaccines and Autism: The Provider’s Role in Communicating Vaccine Safety. Soon we will have lots of Offit clones all telling us that there is nothing to worry about, and we should trust people who must be lots smarter than the rest of us. Interestingly, there is no fee for attending the seminar, but that can be explained by the acknowledged “commercial support” for the program from GlaxoSmithKline, Merck & Co., Inc., Sanofi Pasteur, and Wyeth Vaccines. At least those sponsors were up front about their interest in presenting the program; Dr. Offit reports that he has “no relevant commercial relationships to disclose.”

Punxsutawney Phil seems to be a genial fellow who can entertain a crowd. But I wouldn’t want to place my faith in his forecasting skills. Is it any wonder that Punxsutawney Phil and Paul Offit both come to us from the great state of Pennsylvania? Hey, wait a second . . . isn’t Dr. Offit from somewhere around Gladwyne, Pennsylvania? Could it be???

Before I close this one out, I just wanted to extend best wishes to all who will be at the rally and the DAN! conference in Washington. While at the conference, keep an eye out for my spouse, Sym, and go say “hi.” And if you see her on Saturday, remind her to call home and wish her husband a happy anniversary.