The three federal judges who convincingly rejected the theory that vaccines cause autism delivered a devastating blow to crank science today. The battle will go on in the blogs and in the courts. But the most important arena has always been the space between the ears of parents who are deciding whether it's safe to vaccinate their kids. This decision could do a heap of good by stemming the tide of vaccine-shunning that has led to outbreaks of preventable disease.
The rulings cap 10 years of divisive legal, scientific, and rhetorical battles. In reality, the science looked pretty settled by the end of 2002, as the first of 5,000 parents of autistic children began lodging claims in the Federal Court of Appeals' special vaccine injury compensation program. Hundreds of millions of dollars later, the court concluded as most other observers have for years. This was a slam dunk. "Petitioners' theories of causation were speculative and unpersuasive," wrote Special Master Denise Vowell in the case of Colten Snyder v. HHS. "To conclude that Colten's condition was the result of his MMR vaccine, an objective observer would have to emulate Lewis Carroll's White Queen and be able to believe six impossible (or at least highly improbable) things before breakfast."
The vaccine court, which began operating in 1990, assigns special masters to weigh claims of vaccine injury brought by parents or guardians. In their ruling in the Autism Omnibus, the special masters considered three test cases in which the parents of autistic children alleged damage by two "toxic" vaccine mechanisms acting in concert. Traces of ethyl mercury in several vaccines had weakened their children's immune systems as infants, went the plaintiffs' theory, which allowed the measles-mumps-rubella vaccine to damage their brains when it was administered after their first birthdays.
In one of the cases, Special Master George L. Hastings declared the evidence against vaccines contributing to the injuries of Michelle Cedillo, a severely retarded and autistic wheelchair-bound 14-year-old, was "overwhelming." I have no doubt, he wrote, "that the Cedillo parents and relatives are sincere in their belief that the MMR vaccine played a role in causing Michelle's devastating disorders. Unfortunately, the Cedillos have been misled by physicians who are guilty, in my view, of gross medical misjudgment."
This comment got to the nub of the case. The vaccine court is intended to bolster our mandatory immunization program by offering compensation to children truly damaged by vaccines while avoiding excessive litigation. But in the autism case, plaintiffs, and especially their lawyers, forced taxpayers and the pharmaceutical industry to spend millions to defeat a clearly flawed theory.
At one point in testimony, a University of Virginia pediatric neurologist named Robert Rust tried to explain the dogged persistence of the vaccines-cause-autism theory. The believers have many data points at their fingertips, thanks to the Internet. Rust compared them to Tycho Brahe, the 16th-century astronomer who convinced his contemporaries that the sun revolved around the Earth. Frustrated parents and scientists who have long rejected the vaccine-autism connection frequently return to that analogy. Alison Singer quit her leadership position in the charity Autism Speaks because she tired of its demand for more vaccine studies. "The question has been asked and answered and it's time to move on," she told Newsweek last month. "We need to be able to say, 'Yes, we are now satisfied that the earth is round.' "
Today's ruling isn't the only bad news for the vaccine-autism theory. It suffered another blow in the court of public opinion earlier this week when the Times of London reported that British gastroenterologist Andrew Wakefield may have altered data in his 1998 Lancet study that first raised the possibility of a link between MMR and autism. It had previously been reported that a law firm paid Wakefield in the neighborhood of $1 million to conduct examinations of autistic children whose parents blamed the MMR shot, a fact he did not disclose to the editors of the Lancet.
It's hard to overestimate the impact of Wakefield's paper in terms of disease, unfounded worry, and the expenditure of hundreds of millions of legal dollars. In Britain, which has no compulsory vaccination, rates of MMR vaccination fell from 92 percent to as low as 80 percent. Herd immunity slipped away; as a result, last year there were 1,348 British measles cases, including two deaths and hundreds of hospitalizations, compared with 56 cases in 1998.
Surveys of U.S. parental opinion conducted for the American Medical Association in 2006 and 2008 show growing concern about the safety of vaccines. A study done by APCO Insight found that about 18 percent of parents had changed their vaccination practices out of safety concerns—compared with 12 percent in 2006. An outbreak of 135 cases of measles around the United States last year—the biggest in a decade—began in unvaccinated children. Haemophilus influenzae type B, a disease nearly eliminated by a vaccine, killed an unvaccinated child in Minnesota last year.
There's hope that today's ruling will reverse that trend. It won't affect the true believers. The notion that a government-backed, pharmaceutical-company-enriching program damaged their children has become a crusade and hobby and hangout for thousands of people, including movie stars like Jenny McCarthy and Jim Carrey, as well as doctors, lawyers, businessmen, and even a few scientists. An industry of hucksters, personal-injury lawyers, and clueless alternative-medicine practitioners has fed off of the desperation of parents of autistic children. Many parents, frantic to alter their children's diagnosis, turn to untested drugs, foods, vitamins, and extracts that promise to halt, or even reverse, autism—promising claims that some parents cling to.
In a brief filed in January, Cedillo's lawyers threatened to flood the courts with their claims should they lose the case. They wrote, "[I]t would behoove the parties, and the manufacturers, to join forces and achieve a global settlement in the Vaccine Program. The alternative is civil litigation by thousands of profoundly damaged autistic children and their families in all 50 states."
An appeals court will likely review the findings, and the claimants have the right to sue in regular courts once the vaccine court denies them compensation. But in the past two decades, the vaccine court's rulings have been effective in keeping vaccine litigation out of the civil court system.
That what's heartening about today's decision. A profoundly democratic institution, in which judges do their best to offer justice to the casualties of public health, gave 10,000 parents their day in court. But as they sing in The Unsinkable Molly Brown, "The lord answered your prayers. The answer was no." It's time to move on.
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