Moving Target:
The harrowing, ever-changing,
cynical, potentially paranoid, and possibly
irrelevant story of thimerosal, vaccines, and
autism.
Joshua D. Feder, MD
Faculty, Interdisciplinary Council on Developmental and Learning
Disorders
Assistant Clinical Professor, Department of Psychiatry University of
California at San Diego, School of Medicine
Why do we have
vaccines?
Are infectious diseases all that bad?
Mortality rates in the US over time -
infectious viral diseases have significant
role, overshadowed by accidents,
homicide, suicide, and cancer.
Past plagues: The plague, smallpox, flu.
Current plagues: HIV-AIDS, influenza,
risk of bioterror?
Advances Against
Infectious
Disease:Vaccination
Cowpox vaccination - late 1700’s
20th Century burgeoning of vaccines,
especially since the late 1960’s
Common side effects: headache, malaise
Less common:Guillian Barre-like syndromes,
allergic reactions.
Rare severe ones including brain damage, but
connection with vaccines not clear.
Wakefield 1998 - Lancet
Theory: Ileal-Lymphoid Nodular Hyperplasia in
children w/ autism after MMR
Countertheory: ILH is common, and it is non-
specific.
Nevertheless touched off a storm of
controversy that has not ended, and raised
other questions, e.g., re Thimerosal.
Theories and Concerns
‘Mercury poisoning looks like autism’, so
maybe mercury is a cause of autism.
‘Thimerisol breaks down to inorganic mercury
and goes to the brain’
‘Low glutathione in autism: less able to bind
and excrete the mercury’
‘Autism epidemic’ may be related to vaccines
‘We must protect our children’ and perhaps
that means avoiding vaccines
Theories and
Countertheories…….
‘Mercury poisoning looks like autism’
vs.
‘the presentation is different’
Generalized neurologic symptoms, delayed
symptoms possible; Pink’s Disease: teething
powders; The Mad Hatter
Not really consistent with the specific
symptoms of autism
Theories and
Countertheories…….
‘Thimerisol breaks down to inorganic mercury
and goes to the brain’
vs.
‘is it inert’
“Toxic” designation, data not reproduced
There are animal models and parallels to
methymercury
It is bacterostatic
Mercury
Thimerosal
Theories and
Countertheories…….
‘Low glutathione in autism: less able to bind and
excrete the mercury’
vs.
‘government studies show no neurological
problems
associated with exposure to mercury in vaccines’
James J. Neurotoxicology 2005
Thompson NEJM Sept 2007
Glutathione
Theories and
Countertheories…….
‘Autism epidemic’ vs. ‘no epidemic’
1/150 (0.67%) new and oft-cited
12/10000 (0.12%) Wazana et al, June
‘07
4/10000 (0.04%) old statistic
Expanded diagnosis
Shift of diagnosis
IDEA/IEP
Theories and
Countertheories…….
‘We must protect our children’
vs.
‘many people are out to make money, or they are
thinking emotionally and not scientifically’
‘Parents and health care providers are dedicated to
helping these kids, and to helping others’
‘Autism breeds desperation’ - doctors’ little to offer
‘Autism breeds treatments’ - easy to start a
business (not unique to Autism, see ADHD SPECT
Clinics)
‘Autism breeds lawsuits’ - families are frustrated,
attorneys are trained and paid to seek restitution
Theories and
Countertheories and
Countercountertheories….
‘IOM: no clear evidence of harm’
vs.
‘Epidemiological studies show increasing autism
rates if you look at them the right way’
Theories and
Countertheories and
Countercountertheories….
Suspicions of Foul Play
Suppression of data?
CDC influence on IOM?
Drug Company Influence with CDC and in the
government?
Suppression of negative drug studies in past
Efforts to influence health professionals have
occurred
Theories and
Countertheories and
Countercountertheories….
The California Study: Schecter Jan. ‘08
Increase in ASD reported to DDS-CA, e.g., from
0.5 to 4.5 per 1000 5 year olds, between 1989
and 2003, on a steady rise with no change in
slope when thimerosal taken out of vaccines.
Kirby: plumes of mercury vapor are coming
from China to California, AND maybe the
mercury is still there.
Theories and
Countertheories and
Countercountertheories….
‘Little or no mercury in vaccines’
vs.
‘mercury is (still) in the vaccines’
The number of vaccines has increased, with it
the dose of mercury.
But since 1999 it’s been removed…
Do HMO’s keep old doses in supply (more in
CA)?
Do vaccine mfgr’s take significant time to
retool?
February, 2008
A New Measles Outbreak
Index case - unvaccinated 7 y/o travels to
Switzerland and returns with it.
8 first generation then 3 second generation cases;
highly infectious; thankfully well contained this
time.
Typical death rate is 0.013%, encephalitis 0.29%,
hospitalization 0.8%; would take about 80 cases to
expect a death.
Unvaccinated rate in CA? Need > 90%; Switzerland
is 86% for one dose, 70% for second dose.
March 2008 -
Vaccine Court Settlement
19 month old girl has 5 shots, gets a fever,
refuses to walk, later diagnosed w/ autism
Turns out to have a mitochondrial disorder
‘The government does not concede anything
re thimerosal’
Hailed as ‘proof’ by some that vaccine theory
has merit.
‘Mitochondrial Disorder’
The Next Big Thing in Autism?
Theory: vaccine creates stress on ‘system’,
pre-existing MD makes it hard to respond,
resulting in injury
Now we check for mitochondrial disorders?
MD as the new Celiac Disease?
Chipping away at etiology: Tuberous Sclerosis,
Fragile X, LKS, now MD?
‘Mitochondrial Disorder’
It’s A Clinical diagnosis:
Muscle, and motor problems, low tone, sensory
dysfunction, migraine, seizures, Single or
multiple organs, motor, may have periods of
deterioration, show up late or, commonly,
show no symptoms at all
Supported by AST/ALT and alanine/lysine
ratios, urine markers of mitochondrial
dysfunction, muscle biopsy or check for
mutations in mitochondrial DNA
How Far We Have Come
Conflict to courthouse is not very far
Communication is poor among factions
Science is still lacking in many areas, e.g.,
finding evidence of mercury poisoning in
postmortem brain tissue
Resources spent on questionable ideas?
Genetics x Environment: Mitochondrial
Vulnerability? Toxins? Neuronal misdirection?
Relationships?
What’s Next?
Recommend seat belts, and helmets
Get your flu shot
We will likely do more screening
And we will follow the moving target
