Vaccines and Autism: The Hannah Poling Case

Last week, one of the most important medical stories of our time hit the media widely. I think we will look back on the Hannah Poling case as a key turning point in understanding autism.

For those of you who aren't aware of Hannah's case, David Kirby has done a typically remarkable job documenting the details at the Huffington Post. His posts are must-reads; this one broke the story and this one reveals the actual court concession document.

For the first time that we know, the U.S. government conceded a vaccine-autism case in "vaccine court." Yes, there is a vaccine court. According to the HRSA, "On October 1, 1988, the National Childhood Vaccine Injury Act of 1986 (Public Law 99-660) created the National Vaccine Injury Compensation Program (VICP). The VICP was established to ensure an adequate supply of vaccines, stabilize vaccine costs, and establish and maintain an accessible and efficient forum for individuals found to be injured by certain vaccines. The VICP is a no-fault alternative to the traditional tort system for resolving vaccine injury claims that provides compensation to people found to be injured by certain vaccines. The U. S. Court of Federal Claims decides who will be paid." This Court is known colloquially as the "vaccine court." There are 5000 cases pending that contend that vaccines contributed to the development of autism in children. Hannah's case was one of these - and the government did not elect to try the case, conceding before it got to that point. Some speculate this was to limit public relations damage given the strength of the medical evidence in her case, and due the fact that her father is a pediatric neurologist, and her mother is a nurse (and attorney).

In fact, Dr. Poling has published a scientific paper discussing Hannah's case, and he has written about the details at Age of Autism.

There are some key points which are nuanced and not being portrayed accurately in most media stories.

1. Hannah has been diagnosed with autism. Officially. The notion of a distinction between "autism-like symptoms" and "autism" is ridiculous - autism IS autism-like symptoms. The DSM-IVR criteria are what's used by professionals to diagnose autism, and it's a list of symptoms. Period.

2. Hannah is not unique. I made this point on Larry King Live last week. If we really believe she's the only one, well, that's about as likely as all children having her condition.

Here's the transcript of this part of the show:

KING: Dr. Rosen, if, as they said today -- if the vaccination caused Hannah to have autism, what does a parent to do?
DR. LAWRENCE D. ROSEN, PEDIATRICIAN: That's an excellent question. This is a discussion that I and I'm sure Dr. Karp has in his office many times a day. And I think it is important, and I agree with what Dr. Poling said, that vaccination is a very important development in this country over the last 100-plus years. However, I think what this case tells us is that in Hannah's case, clearly, there was a connection between vaccines and the development of autism. And we can mince words and say it was a mitochondrial disorder manifesting the symptoms, but she has autism. And I think it would be naive to believe that Hannah is the only child in the world for whom that is true.

What is this "underlying mitochondrial disorder" Hannah has? Well, it turns out that she has what's more aptly termed mitochondrial dysfunction. Dr. Jeff Bradstreet has recently written about this concept of mito dysfunction - which I am partial too given its functional medicine paradigm. In essence, children can have metabolic differences that are triggered by environmental stressors (infections, vaccines). This is different from the rarer mito disorders that often present earlier in life and are associated with more severe biochemical findings. These children, too, can suffer medical crises upon environmental stressors. We don't know for sure whether Hannah's mitochondrial dysfunction left her more vulnerable to multiple vaccines/thimerosal or was caused by the vaccines/thimerosal. While Hannah's situation is unclear, as her mito testing was all done post-vaccination and autism diagnosis, other children I believe will come to public attention who have documented normal mito function prior to vaccination and then show symptoms of both mito dysfunction and autism. And this is scientifically plausible. Stay tuned.

3. Why is it surprising that vaccines (especially this many, in a child with a history of atopic disease/eczema and multiple ear infecctions/antibiotics) can cause neurologic symptoms? We already know that. Even recently, the Merck combination vaccine ProQuad (MMR and varicella combined) was shown to increase rates of seizures compared to the single vaccines, MMR and Varivax. It is time to rethink the vaccine development policy, in which more and more vaccines combined in one are considered "better" than single vaccines. The thought is that this will lead to fewer shots per visit and that we are more likely to achieve 100% vaccination of children in the U.S. this way. Unfortunately, we have sacrificed safety for efficiency, I believe.

I think you all can appreciate how hard it is to walk that line between supporting vaccines in general as a public health preventive policy and criticizing the current U.S. immunization policy/system. The media does not like nuances – they want sound bites. But this is a nuanced and complex issue. But instead of looking at Hannah's case as an opportunity to find the truth in an open and transparent way, the CDC and other government groups continue to bury their heads in the sand and issue the same, tired defensive statements. Isn’t it time we separated the CDC’s dual functions as vaccine promoter and vaccine safety monitor? The Weldon-Maloney bill in Congress to address this conflict of interest has been held up for political reasons.

In the end, to me, it’s about being open and honest and caring about one thing – the health of our children.

Comments

[jmalak]

Pediatricians also have a dual function / conflict of interest dilemma. We don't want to see HIB meningitis; nor do we enjoy seeing an 18 month-old regressing after vaccination.

We enjoy having our staff receive lavish lunches everytime a new vaccine is roled out (which is about every 2 months these days). That makes it a little tough to be objective. The conflicts are much worse at the FDA, which since 1992 is funded by the pharmaceutical industry. That makes objectivity impossible!