A well written article that makes a lot of sense, but…of course there is a but, why else would I write?

The difficulty in all of these things is that science (I am an engineer by profession) changes all the time. What we “know” to be true today is proved wrong tomorrow. Look at the stuff going on with RNA today, as an example. This does not imply that we should ignore science. It is jus that personal experience can not be discounted as strongly as it is done by formal scientists. That is, people are considered fringe until one day they are proved to not be fringe. The real difficulty is understanding why the personal experience is real, and not just a fiction or accident. I understand the difficulty of eye witnesses in court and know this is very shaky ground.

I know very little about the case, but I truly believe that one can see a series of events very clearly that can not be proved with known science. Yet you know these to be true even though formal proofs have not been made in any way that is reliable. I am not talking about mystical experience. I am talking about simple things that occur to everyone everyday. I went to the doctor for 30 years complaining of medical problems and was told that I had no problems. Once I found out it was Celiac Spru Disease, life got a whole lot better. There was no denying my experience.

I assume that Laura Wildman saw significant change in her son after the vaccine and thus it may well be true that a series of events around her vaccine caused the change. It could be the needle, it could be the swab that was used to clean the skin, or any number of things that nobody understands. It could be the vaccine. It could be what she fed her son that morning in combination with the vaccine. It could be any number of steps that we do not understand.

Engineering problems often take on this kind of manifestation. Someone claims that a product did something you know to be impossible. They call and complain and you say to yourself “what are they smoking this is impossible.” They complain enough, they are a big customer, and you fly out to see what they are doing. Sure enough, there is some circuitous path that you never understood or imagined that makes this particular complaint real. Can we actually say that this is not the case with autism? After all, it is a low probability event so it means that it does not happen often.

Laura Wildman has latched onto one part of the whole process, the vaccine. Our science does not know how to do this analysis. Just because it has not been proven in the past does not mean it will not be proven in the future. This is an argument by inference, not a solid proof that she is wrong. Nobody understands the variables involved and so nobody can say she is wrong, it seems. The best they can say is “we do not think so.” Real science would be able to prove that it is not true. This is not the case, as I gather from your article. There is a lot of noise and a lot of hot air but in the end, nobody has run experiments that prove this to be wrong. All the noise and emotion does not change the fact that, again according to your article, that there is no proof she is wrong.

Until there is proof that she is wrong, this is an open issue. All the circumstantial data should not make a difference.

It could have been completely unrelated to the entire vaccination process. Diagnosis of autism usually occurs during the same period in which vaccines are administered to children, therefore it is to be expected that diagnosis of autism or recognition of behavior assocatied with autism would occur quickly after vaccination in some cases given that 8 million children are vaccinated in the US each year.

Now I agree, there could be something special about this individual child, or some low probability interaction with the vaccine and other factors that brought about the autism. Perhaps it was simply the adverse reaction to the vaccine which resulted in an illness that went untreated and caused brain damage. Of course, if we seriously consider that possibility then we most consider other low probability causes. Perhaps the autism was brought on by repeated exposure to a cleaning chemical the mother used, or unreacted monomer present in the diaper linings, or exposure to the father's aftershave, or inhalation of exhaust fumes while the car idled in the driveway, or a bacterial infection acquired from placing random objects in the mouth, etc. At last I will come to my point. It makes little sense to jump to the conclusion that the vaccination played a role in the autism simply because it took place on that day, while ignoring a whole list of other circumstances and factors which were also present.

This is particularly true, given that the majority of autism cases are diagnosed at this time and a causal link between vaccination and autism is not needed to explain its diagnosis in children this age. It may be more comforting and lucrative to blame the vaccine, but the child was most likely born autistic and the parents recognized or could no longer ignore symptoms at that time. As an engineer, if I heard a loud popping noise, saw rubber fragments in my rearview mirror as my car jerked violently, and my car became difficult to control I would assume it was the consequence of a blown tire, not something that stemmed from the song playing on the radio.

A more apropos comparison would be to an engine oil additive that contained fine milled fused silicon dioxide in suspension to maintain the proper turbidity of the solution.

Now suppose that the additive is made by the Eli Daisy company, and that they claim it is safe when used properly.

Now add to that a requirement that the additive is required by the government to be used 4 times between the vehicle being 1 year and 2 years old.

Some number of automobiles will experience varying degrees of engine failure. When the owners investigate the additive, they find that they were adding sand to the oil. The types of damage that occur effect certain designs more than others; sometimes it's the piston, sometimes the valve, sometimes the bearing, sometimes it's unclear.

Why are we adding sand to the oil? Eli Daisy will claim that it is fine milled and in such a low concentration that it isn't a problem. But back when they tested it the equipment to diagnose engines was not as advanced, and in addition, there are changes in the operating conditions of the engine along with changes in oil, gasoline, coolant, and others.

This is the situation we are facing. Do you really want sand in your oil? Do you really want mercury in your children?

You both make good points and the truth is that we are guessing at what might be the right metaphor to use in this situation. For me, that is the whole point. I am not sure we have enough facts to know the right metaphor. It might well be that this is totally co-incident in time. It might, on the other hand, be that this is exactly the cause.

Inferential evidence can be and often is very persuasive in all sorts of situations. I use it every day in making decisions and guessing at what is right and wrong. "Guessing" is the key thing here, in my mind. We see every day how bad these guesses can be when we look at the people in jail that are freed because someone finally has the DNA technology to see the truth as opposed to the inferential data that was used to put them in jail. This does not mean everyone in jail is innocent. It means that we act on data that we are not sure of.

I wrote this note in the first place to suggest that an open mind where there is only indirect data is probably a good thing to have. Until we really know the cause, or scientifically eliminate possibilities, many low probability outcomes are possible. Far too often a "dismissed out of hand" alternative ends up being the cause of a problem.

Thanks

fred:

Until there is proof that she is wrong, this is an open issue.

The notion that any individual can claim causality by bringing up a coincidental association, then force the scientific community to go beyond reasonable lengths to "prove" a negative causality (something which is at best impractical, and often impossible in biological systems) before that claim is no longer "an open issue" is completely unscientific.

Here is how science is really done: Someone makes a conjecture of a relationship between two events based on an observation. Then studies are performed to bear out at least a temporal association between the two events. Then studies are performed to identify the actual causality of one event on the other.

Those claiming an association between MMR and autism need to get past the conjecture stage. Cloaking one's arguments in scientific jargon does not make your argument scientific. Insisting on proof of a negative association beyond an unreasonable doubt is not just unscientific, it is inherently anti-scientific.

Many of us in the medical community feel that all this energy spent on promoting the claims of association between vaccines and autism could instead be better directed towards working with the medical community to help find the real cause of, as well as help develop effective treatments for, autism.

Let's review some previous cases:

1) Mercury amalgam fillings. I remember a similar conversation with a dentist in the 1980's about the dangers of amalgam fillings. He claimed up and down that they were safe. In the years since there has been a clear transition away from amalgam fillings, along with an acknowledgment of their dangers.

2) Smoking. While for the last 30 years smoking the consensus about the health problems due to smoking has been clear, it is only in the last few years that tighter second-hand smoking issues have come be a major influence.

3) Alcohol. Again, the primary issue of drinking during pregnancy is one that has come into public consciousness only during the last 30 years.

4) Vioxx. How many used this drug before it was recalled? How many studies proclaimed it to be safe?

In each of the above examples, industry associations worked vigorously to protect the product. Only after clear pressure, due to scientific, medical, or legal action, did the government finally pursue the matter, and only then did the industries work to mitigate use or access of the products.

Here we have a similar situation again. An industry that vigorously defends the product. A government that supports the use through vaccine requirements. A scientific community that proclaims the product to be safe. An atmosphere that makes those who disagree with the industrial / governmental / medical / scientific complex to be labeled as hysterical, illogical, immoral, or even pathological.

Something real is happening with the incidence of autism, allergies, and other problems. There is no clear explanation for the increase. Until there is, Thimerosal and vaccines will not be able to escape the cloud of doubt that characterizes this issue.

I really hate to belabor the point but some of the other comments make the point very well. While it may not suit the scientific community to chase every case that is created by an individual that says "I do not believe" it is also a bad thing to dismiss it out of hand.

The problem of science is proof. We usually think about proof as an affirmation of a theory. Science is also the negation of a theory. Without proof, we just do not know.

Those of us in the medical consumption business have far too many examples of the medical community being totally certain of something until the day they are no longer sure of that same thing. My father took malox for his ulcer for 30 years only to find it was a bacteria problem that nobody was willing to acknowledge for a very long time.

I am not advocating total anarchy. I just think we should keep on open mind and let new ideas and new science in a little more easily.

Perhaps if we could travel into the future your reasoning would be sound, but the purpose of science is to always be on the cutting edge - to test and retest, and challenge previous findings
If we aren't finding fault with past theories, science is not behaving correctly.

That said, it is the duty of the physician to trust the latest scientific data. Yes, at times the science can be "wrong", but it is unethical to withhold treatment from sick folks because of what we might think 30 years down the line.

TakeSake:

Here we have a similar situation again. An industry that vigorously defends the product. A government that supports the use through vaccine requirements. A scientific community that proclaims the product to be safe. An atmosphere that makes those who disagree with the industrial / governmental / medical / scientific complex to be labeled as hysterical, illogical, immoral, or even pathological.

I really don't know how you can compare those other issues with the vaccines-cause-autism claims.

The medical community was quite clear in raising concerns about smoking years before the first Surgeon General's report in the 1960s. To pretend that the entire medical and scientific community was in cahoots with the government and the cigarette makers in downplaying the risks of smoking or even exposure to second-hand smoke is flat nonsense.

Quite a few reputable physicians and researchers were concerned about the risks of the COX-2 inhibitors such as Vioxx, and these issues were raised soon after the release of the product onto the market. It was clear to anyone who took a hard look at the drug company claims that they were overstating the benefits and understating the risks of COX-2s. I was always very reluctant to use these drugs, and I stopped prescribing them, especially Vioxx, in patients with significant cardiac risk factors for a full 2 years before the drug was pulled off the market. I admit I was in the minority, but I was NOT alone in my reluctance as a Family Physician to prescribe those drugs.

In both these cases, there were clear warning signs and valid data that were pointed out by reputable scientists and physicians raising responsible concerns well before you read about the issue in the local paper. You are fooling yourself if you think that one big study changed everyone's mind overnight about second-hand smoke or Vioxx. There really is no comparable scientific base to the claims that vaccines cause autism.

You seem to see the medical community, the research community, the government regulatory bodies, and industry as this big monolithic collection of individuals who share the same agenda and talking points. Sorry, but the world is a bit more complex than that.

I have noticed a tendency to lump all the critics of the vaccines-cause-autism claims in with "Big Pharma" and other bogeymen. Heck, in one thread, someone linked those critics in with Dick Cheney as well! This is little more than a cute debater's trick, and does not reflect the true lay of the land in the medical world.

Medical science is always changing. What we think we think we know today may not be what we are sure about tomorrow. But using that fact as a justification for beating a dead horse in the hope it will suddenly get up and walk again is not very sensible.

jcrash:

This is not just a coincidence in timing and diagnosis. These kids experience a CHANGE in behavior. They become different. Something causes it. You go find it, until then we can assume whatever we want.

Yes, something causes it. It is called "autism".

You are certainly free to assume whatever you want. I have no intention of prohibiting free thought or free speech. Nothing I have ever said has suggested you should not be able to think whatever way you want, no matter how incorrect you are.

But I do feel I have a similar right to speak out about what I consider to be factual errors and faulty reasoning. This is the USofA, last I checked.

I do not doubt that some families first noticed some differences in the behavior of their children around the time they had one or more vaccinations. But the schedule is set up in such a way that during the first 21 months of life, most children are at most 6 months (and most of the time only a few days or weeks) away from their most recent shots. So using the fact that a behavior change occurs after a vaccination to firmly conclude that the vaccine causes the behavior change is simply not scientific. To further conclude that the behavior change is definitely part of the autistic behaviors the child manifests later is also not scientific.

You are free to make a conjecture about a possible causality, but then you have to back it up with some scientific data, which in this case you do not have, before you can responsibly make a scientific claim. You are certainly free to either invest in or perform yourself the research needed to prove your point and make your claim a scientific one. Again, this is the USofA. Go for it. Run your grant proposal up a flagpole if you want. But I think we could better spend our time and money pursuing other possible causes of autism.