The big point on this is that the decision was made to pay out in this particular case, rather than spend a lot of time and effort splitting hairs in court. The court did NOT decide that vaccines were responsible for the girl's problem. It was sort of the equivalent of a...mental blank, starts with an "H", plea -- in which you say, "I'm not admitting guilt, but I think a jury might find me guilty," or of a plea-bargain.
The anti-vaccine crowd are anxious to spin the case as being "proof" that They (the conspiracy of CDC/big Pharma/the AMA) know they can't afford to let the evidence come up in court--which is bogus. The big anti-vax line has been disproved by innumerable studies. Mercury preservative and the vaccines themselves have not been the "cause" of autism. They have not been the trigger of autism.
I think people will spin the story either way depending on many factors, which is indeed consistent with how polarized the debate over a vaccine-autism link has played out, and continues to... If one takes the middle road and concentrates on objectivity, then, in my opinion, investigating physiological mechanisms(always being cognizant of interindividual variation) would be of utmost importance in determining the validity of the proposed link to vaccine administration. (note: I would not assert that vaccines are a singular cause). Epidimiological studies play an important role in generating new hypotheses and identifying patterns, which can be further studied from a physiological standpoint, but it seems they are inadequate for categorically confirming or refuting causation, in ASD regression. This inadequacey stems from the high degree of heterogeneity among individuals afflicted with Autism, often having a number of potential factors playing part in the etiology, and therefore making it more difficult to adequately design epidemiological studies. For example, an imaginary epidemiological study of 100 ASD diagnosed individuals reveals that regression has no link to vaccines. This could be an entirely valid study with sound methodology, BUT that doesn't equate to categorical certainty that all instances of ASD have no connection to vaccine administration. Whereas, en epidemiological study of 100 people who became plagued by a pathogenic bacterial outbreak, can with reasonable certainty pinpoint its etiology.
A relevant Journal article to the Hannah Poling case is here
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0003815
http://content.nejm.org/cgi/content/full/358/20/2089 -- an article by Paul Offit regarding Hannah .
http://content.nejm.org/cgi/content/full/359/6/655 --A response from Jon Poling(Hannah's Dad) who is a neurologist.
Here are some salient points from the results/discussion section:
In one case, the timing of regression coincided with a recent vaccination.
Recently, there has been increased concern regarding a possible causative role of vaccinations in autistic children with an underlying mitochondrial cytopathy [35], [36]. For one of our 25 patients, the child's autism/neurodevelopmental deterioration appeared to follow vaccination [12], [36]. Although there may have been a temporal relationship of the events in this case, such timing does not prove causation. That said, there might be no difference between the inflammatory or catabolic stress of vaccinations and that of common childhood diseases, which are known precipitants of mitochondrial regression [37]. Large, population-based studies will be needed to identify a possible relationship of vaccination with autistic regression in persons with mitochondrial cytopathies.
This indicates to me that we are still in the unknown phase of linking vaccination to triggering autism, let me know what you think.
From a biochemical perspective, patients' blood and urine laboratory data revealed marked interindividual variation that did not appear to correspond with specific ETC defects or clinical phenotypes. Significant intraindividual variation was also noted for determinations of blood lactate and pyruvate levels, plasma alanine levels, serum transaminases and CPK, and urinary organic acids, with intermittent normal levels in most cases.
Because of the variability of phenotypes associated with these putative mutations, it is possible that there are important environmental or genetic factors in addition to the mtDNA mutation that contribute to the development of autism in a child with one of these mtDNA mutations. The mutations noted here are different from those described in prior case reports of children with autism and mitochondrial disease
For most individuals with defects of oxidative phosphorylation, the diagnosis is made through ETC determination but an underlying nuclear or mitochondrial mutation usually cannot be identified [43], [48], [49]. The biochemical assessment of mitochondrial disorders, especially ETC enzyme assay, is complex and subject to limitations [49], [50]. Even a clear-cut deficiency of one or more ETC activities in vitro does not prove a genetic defect of oxidative phosphorylation because ETC deficiencies can be secondary to other conditions
So the questions arise: are all mitochondrial disorders that may predispose an individual to autism rare inherited genetic defects? Why couldn't a dysbiosis in the gut lead to impaired nutrient digestion and assimilation, which could impact oxidative phosphorylation? Do some individuals that have minor instances of energy impairment(i.e. not show up as genetic defect) also have other predispositions which make them at risk for a regression into ASD upon substantial triggering?
A couple other hypothesis regarding the proposed MMR vaccine autism link, and I can't seem to find any peer reviewed studies looking at these aspects but here they are:
One: It has been documented that the MMR vaccine elicits a prolonged endogenous pulse of interferon gamma, which is a cytokine that modulates various immune responses. This cytokine is also implicated in increasing the permeability of both the gut epithelial lining and the blood brain barrier, two membrames which normally tightly control the flow of molecules across their path. Obvious implications here are the translocation of viral pathogens into sterile sites as well as the translocation of activated immune complexes into unwanted areas. Both of which could play an etiologic role in the gut problems and regression into Autism, which has been amply documented in the anecdotes of parents.
Two: In addition the the endogenous production of Interferon gamma and resulting increased permeability, the measles virus as well as the attenuated virus used in the MMR vaccine suppress the host immune system, this is just part of the normal virulence of Measles. This immunosuppression could allow translocated viral pathogens to replicate with less inhibition from the immune system.
Lastly, Interferon gamma increases the host cell presentation of MHC I molecules. These are the molecules which when presented alert the circulating immune system to step in and initiate apoptosis. Now, if the individual had a latent CNS infection by one of many viral pathogens, which have an affinity for hiding out in neural cells(various herpes simplex viruses, CMV, epstein barr virus) and also can be congenitally passed on and the individual can be asymptomatic,then this increase in MHC I presentation could be a possible etiologic clue. By, increasing presentation of viral peptides by MHC I molecules on neuronal cells, the immune system would target these cells and initiate cell death.
To me these are interesting hypotheses and if any one would like to read more here is the link: (note the hypotheses are supported by a plethora of peer reviewed journals, which support every step of the rationale)
http://members.jorsm.com/~binstock/index.htm
Exactly because this child's medical condition is so rare, and has so few knowns, and produces autism-like symptoms, it would be difficult to disprove the idea that vaccines contributed to, or exacerbate, her symptoms. Given the the court was willing to hear it, it's prudent to go for a pay-out without a decision of cause, and argue the point on a clearer case.
This above statement is inconsistence with the evidence.
When she was 19 months old, Hannah, the daughter of Jon and Terry Poling, received five vaccines — diphtheria–tetanus–acellular pertussis, Haemophilus influenzae type b (Hib), measles–mumps–rubella (MMR), varicella, and inactivated polio. At the time, Hannah was interactive, playful, and communicative. Two days later, she was lethargic, irritable, and febrile. Ten days after vaccination, she developed a rash consistent with vaccine-induced varicella.
Months later, with delays in neurologic and psychological development, Hannah was diagnosed with encephalopathy caused by a mitochondrial enzyme deficit. Hannah's signs included problems with language, communication, and behavior — all features of autism spectrum disorder. Although it is not unusual for children with mitochondrial enzyme deficiencies to develop neurologic signs between their first and second years of life, Hannah's parents believed that vaccines had triggered her encephalopathy. They sued the Department of Health and Human Services (DHHS) for compensation under the Vaccine Injury Compensation Program (VICP) and won.
To win a VICP award, the claimant does not need to prove everything that is required to hold a vaccine maker liable in a product liability lawsuit. But a causal connection must be shown. If medical records show that a child had one of several listed adverse effects within a short period after vaccination, the VICP presumes that it was caused by the vaccine (although the government can seek to prove otherwise). An advisory committee helps to amend the list of adverse effects as the consensus view changes with the availability of new studies. If families claim that a vaccine caused an adverse effect that is not on the list, the burden of proof rests with them. Autism is not on the list for any vaccine, and the VICP has rejected about 300 such claims outright.
So, as you can see in this case the burden of proof rested on the Poling's and they had to show a causal connection.
Are you not intrigued of the possibility of a vaccine-autism link by the sequence of events in Hannah's case?
My heart goes out to families going through this; and it's a horrible thing to face. But the American worldview seems to now include something akin to, "A bad thing has happened! Someone else now needs to pay for it!" That's simply invalid.
What is invalid? As far as the "American worldview" goes, yes, there is a gravitation towards "sue happiness" but that is more a consequence of the social justice system we have all been raised and accustomed to. I personally, don't hold the belief system that accidents always have to be compesated for monetarily, but in the case of Hannah, a series of vaccines administered in close temporal succession was too much stress for her particular biochemistry and triggered a regression into autism. The choice was available to either not pursue legal recourse against the state for damages incurred or to sue for compensation, which would include continued care for her autistic disorder. However, this doesn't have any particular significance as to whether there exists a vaccine autism link in this case.
Speaking to another comment on whether or not research is going on, lots of research is going on. It's just going on in areas where there's some strong evidence suggesting that research will be fruitful.
Agreed, in fact the research for the next five years is being determined by a conglomerate of individuals and groups,in an effort to appeal to the concerns of the public. This, IMO, is a comendable approach, and pretty much nullifies any idea that there is a huge conspiracy trying to cover evidence.
On April 11, 2008, the National Vaccine Advisory Committee took an unusual step: in the name of transparency, trust, and collaboration, it asked members of the public to help set its vaccine-safety research agenda for the next 5 years.
Right now, we have such a bewildering array of things included in "autism spectrum disorders" that what really needs to happen is to have Autism defined, and delineated, to a particular set of neural processing issues. That condition seems to have a very strong genetic component. When you get into "pervasive developmental disability" and such, though, you're overlapping with a lot of prior work on other forms of learning disability, and we don't have a clear path to work on. Unfortunately, the publicity and indignation--as well as the sensational fear-mongering--of the Enraged Parents has pushed the clamor for research well ahead of the clear path for research.
I don't agree with the above statements. First of all trying to obtain a nice neat classification of Autism is what I see as applying the outmoded paradigm of disease<->diagnosis to a disorder that has roots in the differences of individuals. Although there are overlapping and common symptoms of this disorder, I don't think that defining autism to a particular set of neural processing issues is going to facilitate the understanding of etiology, rather, I would contend that this type of "boxing in" will only prove detrimental to further research. I would also contend that this won't happen because of the increasing understanding of the importance of individual heterogeneity in the etiology of ASD.
It's not easy to screen for environmental factors when you don't even know, reliably, who is and is not affected by a "disease". Untangling the increase in diagnosis from any possible increase in occurance is the logical first step; as is, in parallel, looking at concurrent medical problems, as has been posited for gut issues.
Gut issues are my particular interest, as the potential of the microbiome of the gut to influence the host, both negatively and positively is not completely understood. The avenues of reasearch into the ecology of the GI tract and its impact on the immune system, nutritional digestion and assimilation, causitive role in inflammatory disorders, and the important connections between the state of the gut and the state of the brain are beyond intriguing to me. And warrant an exhaustive approach to researching these intricacies.
Again, the challenge is separating anecdote from evidence, and the very organizations that one would expect would want to lead the charge are encouraging obfuscation. It makes me very sad. It made me stop giving money to my preferred Autism charity, which merged with Autism Speaks (which is on record saying it will "not accept" any study that the CDC is involved with)
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I personally think it is the exact opposite, I think the challenge is going to be integrating anecdote with evidence, in fact the avant garde of ASD treatment is trying to establish a new approach to understanding called narrativomics. I think that we have to realize that the basic relationship of patient/doctor is predicated upon the anecdote and the cummulative history of the patient. Therefore, anecdote should and will be considered an important piece of the puzzle, in unravelling the mysteries surrounding ASD.
