I want to thank all of those who have commented on this blog for their thoughtfulness and reason. In answer to some of your questions:
Regarding the scope of the book: One commenter asked if I had considered including material in the book that was not directly related to the vaccine-autism debate. Yes. The one area that I didn't address was the history, scope, and impact of the anti-vaccine movement in the United States. There is probably no more powerful influence on how many parents make decisions about vaccines than that of the cynically named National Vaccine Information Center. This group, using a variety of scare tactics, consistently puts out misinformation about vaccines on their website. I would have liked to have spent some time in the book describing the origins of this group, their ties to personal-injury lawyers, and their influence on Congress.
Regarding the child on the cover of the book: One commenter asked why I had chosen to put an unclothed child on the cover, viewed from the back. This wasn't my choice, but rather the choice of the art director at Columbia University Press. The drama of the picture owes to the fact that the child is viewed from the back (remember the picture of Babe Ruth viewed from behind, kneeling in the on-deck circle in his later years) and is exposed from the waist up. My concern with the picture is that one could argue that this child is too young to be reasonably given the diagnosis of autism spectrum disorder.
Regarding the recent ruling by the Georgia Supreme Court: On October 6th, 2008, the Georgia Supreme Court ruled in favor of a couple who wanted to directly sue vaccine makers on behalf of their autistic child, claiming that thimerosal in vaccines had been the cause. This ruling appears to be in direct contradiction to the National Childhood Vaccine Injury Act (NCVIA) of 1986, which protected vaccine makers from initial lawsuits against vaccines by creating a Vaccine Injury Compensation Program managed through a federal claims court. Previous appeals to state supreme courts in New York and Pennsylvania have failed to circumvent this Act. What some may not realize is that despite the NCVIA, a parent can still sue vaccine makers directly; they just have to wait until their case has failed both in this federal vaccine court and the court of appeals. The goal of the lawyers appealing to the state Supreme Court in Georgia was simply to skip a step. Historically, claims that have failed in the federal vaccine court and the federal court of appeals have fared poorly in state courts, so lawyers have been reluctant to take these cases. However, if lawyers can make their initial claims directly to juries in state courts, instead of first having to make them in front of federally appointed judges in federal vaccine court, they are more likely to win. All of this is very bad news for children. Vaccines are not big moneymakers for pharmaceutical companies. If this Georgia ruling stands--and parents directly sue vaccine makers without first going through the Vaccine Injury Compensation Program--we might end up right back where we were before the Program was created and manufacturers were on the verge of completely abandoning vaccines for American children. Again, the perceived rights of the individual will trump the rights of society.
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Dr. Offit, what books containing a history of vaccines might you suggest?
Re the Georgia Supreme Court decision, doesn't that mean that the standards of proof become more stringent and that Daubert will be applied? If so, then the lawyers may not realise that their evidence and experts may not be admitted to the court, since the judge will direct that these are just not good enough. What then? How persuadable are juries when the 'evidence' isn't there to be manipulated?
Sure to be an interesting case. As for the precedent, can this be appealed to the Federal Supreme Court?
Dr. Offit wrote "The one area that I didn't address was the history, scope, and impact of the anti-vaccine movement in the United States. There is probably no more powerful influence on how many parents make decisions about vaccines than that of the cynically named National Vaccine Information Center."
Much of this history is covered in Arthur Allen's book:
With regard to alyric's post. What type of "daubert" are you referring? Hearing, motion, standard?
The standard jdt, thanks
Hi, Alyric, the Ferraris could petition the US Supreme Court for review of their case. The Court wouldn't have to accept the case, but it will sometimes take a case where state court decisions conflict on an issue the Supreme Court deems important. This could possibly be a case that the US Supreme Court would want to decide.
Some states, like Georgia, use the Daubert standard, and the rest of them use the pre-Daubert Frye standard for admissibility of expert testimony and scientific evidence. Both Daubert and Frye are tests of reliability. If only some of the proferred evidence is excluded, the jury decides the case based on what's admitted. But if enough of the evidence is excluded, the judge might take the whole case away from the jury. That's what happened in Blackwell -- the court excluded testimony from all of the Blackwells' experts (including the usual suspects, Haley, Deth, Mumper and Geier) using the Frye test, and then granted summary judgment for Wyeth.
Dr. Offit, you make a good point that state law vaccine injury claims aren't completely preempted by the vaccine act - it's more a requirement to exhaust an administrative remedy first. But if you're assuming that the Ferrari case establishes that vaccine injury claimants can always by-pass the vaccine program, that's not correct.
Thank you Anne. I assume that you're my Anne:)
Oops, did I say that the Ferraris could appeal? Obviously, they couldn't and wouldn't. The defendants would appeal, and they probably will.
with respect to the scope of the book, everyone comes at autism from their own angle. As the mom of an autistic adult child, I thought Dr. Offit did a great job describing some of the predation and abuse that's directed at families of autistic kids. But I would like to see people from other fields cast a critical eye on more mainstream ways of treating autism, since even some of the non-alternative treatments that are used - such as the off-label use of psychiatric drugs and certain behavioral therapies - can be ineffective at best, and possibly harmful. Autistic kids, and adults under guardianship, sometimes come under control of the state if their parents or family guardians won't agree to these treatments, so the stakes can be high.
Hey, Alyric, yeah, it's me.
Urgent request for pubmed reference. I have been doing my bit in other fora and quoted AFP, the citing of gershon (page 44)concerning the leaky gut phenomenon - the leaks have to go both ways - hypothesised opioid compounds to the blood and blood proteins to the gut, but no blood proteins were found. I have been asked for the research reference backing this up and would appreciate a reference. Thanks
As Dr. Offit reported the statement in AFP, undoubtedly he would be the best reporter of the specific source, but this is what I found related to the attributed statement.
I think Dr. Michael Gershon's statement is from p. 175
AUTISMï¿½WHY THE INCREASED RATES? A ONEYEAR UPDATE
HEARINGS BEFORE THE COMMITTEE ON
GOVERNMENT REFORM HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTH CONGRESS
APRIL 25 AND 26, 2001
Serial No. 107ï¿½29
(Dr. Gershon's full testimony with citations is pp. 174-189).
"...The thought that inflammation damages the epithelial lining of the bowel, causing its permeability to increase, is plausible. On the other hand, there is no reason that a leak in the gut should be a one-way leak. Nor is there any explanation as to how a leak could be specific so as to let only some molecules through and not others of the same size and shape pass through.
No movement of peptides or proteins from the tissue fluid to the intestine has been detected in autism or as a result of MMR vaccination. Protein-losing enteropathy has not been reported to be associated with autism, nor has it been reported to be a sequela of MMR vaccination in any significant number of people.
On the other hand, if the bowel were to be permeable in a size manner so that the large molecules of the body do not get out, then small molecules from the gut would go both ways through the proposed hole. That would cause massive malnutrition and malabsorption in the patients, which has not been reported.
The idea that opioid peptides or other toxins enter the body from the bowel and cause autism overlooks another filter that is in place to remove them, and that filter is the liver...
I am writing to note that it is one week since Dr. Jay Gordon's last post in the SB Book Club thread and two days since he posted in any SB thread. Funny how he always run off when Orac asks him to stick around. So brave!
to alyric: Absence of urinary opioid peptides in children with autism. Arch Dis Child 2008 Sep;93(9):745-50.
To M and Regan, many thanks!
Considering the complexity, and to some extent, still not well understood mechanisms of the immune system, the notion that two disorders may posses a similar set of clinical symptoms with different causes is not controversial. Unless you disagree, an analogy between Downï¿½s Syndrome and autism with respect to increased cytokine levels is successful in a ï¿½Drill, Baby Drill!ï¿½ fashion, but ultimately an example of gross over simplification, intentional or otherwise.
I have yet to argue or provide the assumption that vaccines are ï¿½the causeï¿½ of autism; but rather; that the studies thus far are incomplete to answer the question if they increase risk of developmental disorders. You have made up a phantom argument, placed it in my mouth, and ask that I defend it. If this is incorrect, it should be simple to provide a quote.
Historically, claims that have failed in the federal vaccine court and the federal court of appeals have fared poorly in state courts, so lawyers have been reluctant to take these cases.