“Paranoia Strikes Deep”*: MMR Vaccine and Autism

On February 12, 2009, the US Court of Federal Claims issued a trio of long-awaited decisions in its Omnibus Autism Proceeding.¹ The 3 were representative cases chosen from more than 5500 pending MMR/autism cases by the Plaintiffs’ Steering Committee. Each presented the theory that the measles-mumps-rubella (MMR) vaccine in combination with thimerosal, a mercury-based ingredient contained in some diphtheria-tetanus-pertussis (DTP), diphtheria-tetanus–acellular pertussis (DTaP), hepatitis B, and Haemophilus influenzae type B (Hib) vaccines, causes autism. In nearly 700 combined pages that reviewed the scientific and epidemiological evidence, all 3 opinions determined that the plaintiffs had not demonstrated a link between these vaccines and autism.

One opinion ended most dramatically: “To conclude that [the child’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 6 impossible (or at least highly improbable) things before breakfast.”

In July and August 2009, the US Court of Federal Claims affirmed the findings in all 3 cases.

During this same period, Andrew Wakefield-the UK physician credited with originating the vaccine/autism theory-came under substantial criticism. London’s Sunday Times reported that Wakefield had falsified his findings in his 1998 article in The Lancet.² On January 28, 2010, the UK’s General Medical Council (GMC) concluded what has been called the “longest and most complex disciplinary hearing ever held,”³ with findings that detailed Wakefield’s “callous, unethical, and irresponsible” conduct.⁴ In response, on February 2, 2010, The Lancet retracted Wakefield’s paper.

Neither the judicial decisions, the ethics findings, nor The Lancet’s retraction appears to have shaken the Wakefield faithful. The National Autism Association posted this in the hours following the GMC’s announcement: “Parents of children with autism around the world are calling the findings against Dr Andrew Wakefield in the UK’s General Medical Council unjust and a threat to researchers investigating autism as a medical condition. . . . Bravo to Dr Andrew Wakefield.”⁵

Age of Autism posted this in response to The Lancet’s retraction: “those who will stand behind Wakefield . . . will remain standing proudly with integrity, truth, and honor . . . the lancet will slide into a pool of ignorant denial . . . along with all their lies and cover ups [sic].”

This article seeks to illuminate the debate by reviewing autism prevalence over time, summarizing the findings of the Wakefield ethics hearing, analyzing the legal proceedings, and providing a modest glimpse into the future.

Autism prevalence through the years

The word “autism” derives from the Greek autos, meaning “self.” Swiss psychiatrist Paul Bleuler coined the word in 1912 to describe a condition in which a person removes himself or herself from social interaction.⁶ Leo Kanner, who founded the world’s first child psychiatry program at Johns Hopkins and authored Child Psychiatry-the first text on the subject-published the first description of autism in his 1943 article, “Autistic Disturbances of Affective Contact.”⁷

It would be nearly 4 decades after Kanner’s seminal article before “autism” entered the lexicon of most mental health clinicians. The closest diagnosis listed in the first rendition of DSM in 1952 was “Schizophrenic reaction, childhood type.” In 1968, DSM-II would add that the “Schizophrenia, childhood type” disorder might include symptoms of “autistic, atypical and withdrawn behavior.” DSM-III contained the first listing of “Diagnostic Criteria for Infantile Autism,” and DSM-III-R presented “Diagnostic Crite-ria for Autistic Disorder.” DSM-IV-TR reiterates the presentation of DSM-III-R.

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