Perspective by Dr. Dennis Niewoehner February 2, 2010 — The venerable British medical journal The Lancet has retracted a 1998 study suggesting a link between autism and childhood vaccination with the measles-mumps-rubella MMR vaccine.
The Lancet tells WebMD that it has retracted “10 or 15″ studies in its 186-year history. The retraction follows the finding of the U.K. General Medical Council (GMC) that says study leader Andrew Wakefield, MD, and two colleagues acted “dishonestly” and “irresponsibly” in conducing their research.
The Lancet specifically refers to claims made in the paper that the 12 children in the study were consecutive patients that appeared for treatment, when the GMC found that several had been selected especially for the study. The paper also claimed that the study was approved by the appropriate ethics committee, when the GMC found it had not been.
“We fully retract this paper from the published record,” The Lancet editors say in a news release.
The retraction means the study will no longer be considered an official part of the scientific literature.
BMJ, formerly known as the British Medical Journal, has competed with The Lancet since 1840. BMJ editor Fiona Godlee says she welcomes the Lancet retraction.
“This will help to restore faith in this globally important vaccine and in the integrity of the scientific literature,” Godlee says in a news release.
In 2004, 10 of Wakefield’s 13 co-authors disavowed the findings of the 1998 study. Although the study never claimed to have definitively proven a link between the MMR vaccine and autism, sensational media reports ignited a public panic. MMR vaccinations fell dramatically.
More rigorous studies have found no link between autism and the MMR vaccine. Last year, the U.S. “vaccine court” rejected U.S. lawsuits claiming that there was a plausible link between the vaccine and autism.
Wakefield continues to proclaim his innocence and defends his earlier work. He now resides in Texas, where he is executive director of an alternative medicine center for autism treatment and research.
WASHINGTON (Reuters) Mar 07 – Federal health officials said on Thursday the government has not conceded that vaccines cause autism even after a Georgia girl won federal compensation in a case arguing a vaccine led to her autistic condition.
Hannah Poling, 9, had a rare mitochondrial disorder and a federal court ruling said regular childhood vaccinations may have contributed to some of her autism-like symptoms. She was awarded compensation under the National Vaccine Injury Compensation Program in a case that became public this week.
Some activists who argue vaccines can trigger autism jumped on the case as vindication of their cause, but Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention (CDC), denied this.
“Let me be very clear that (the) government has made absolutely no statement about indicating that vaccines are a cause of autism,” Dr. Gerberding told reporters in a telephone briefing.
“That is a complete mischaracterization of the findings of the case, and a complete mischaracterization of any of the science that we have at our disposal today. So I think we need to set the record straight on that.”
The vaccine injury program is a no-fault system that has a $2.5 billion fund built up from a 75-cent-per-dose tax on vaccines. It was set up to ensure companies would not be afraid to make vaccines, and to provide injured children an easier way to seek compensation.
Thousands of lawsuits have been filed by parents who argue their children have autism caused by vaccines.
The Institute of Medicine, an independent organization set up to inform U.S. policy, has found there is no evidence that vaccines can cause autism. Many recent studies have come to the same conclusion.
Some autism advocacy groups argue that the mercury-containing thimerosal preservative in vaccines can cause autism. Republican presidential candidate Sen. John McCain entered the debate last week, saying there is “strong evidence” linking autism to a thimerosal.
Dr. Edwin Trevathan, director of the CDC’s National Center on Birth Defects and Developmental Disabilities, said the Poling case did not demonstrate any link between vaccines and autism.
“I think it’s also worth noting that most children with autism do not seem to have a mitochondrial problem,” he told the briefing.
“So this association between mitochondrial disorders and autism is actually probably relatively rare. But the association between mitochondrial disorders and severe brain damage and dysfunction is one that is not as rare and is actually quite important.”
Dr. Trevathan said it is not clear whether a fever caused by a vaccine might further stress a child with such a condition, causing autism-like symptoms.
The CDC estimates that about one in every 150 children has autism or a related disorder such as Asperger’s syndrome — 560,000 people up to age 21 in the United States.
“Our message to parents is that immunization is life-saving. There’s absolutely nothing changed in the adamant recommendations that we are making to get children vaccinated,” Dr. Gerberding said.
Excerpt from “Psychological Considerations in Food Allergy” Chapter in Food Allergy (4th ed), Blackwell Science, in press:
Childhood autism is characterized by significant abnormal or impaired development in social interaction and communication, and restricted repertoire of activity and interests [1]. Immunologic abnormalities, gluten sensitivity, and food allergy have been proposed to play a role in the pathogenesis and management of autism [2-4]. However, evidence supporting the beneficial effects of dietary manipulation on behavior and cognition in children with autism spectrum disorder have consisted mainly of anecdotal reports and small trials.
Bidet and colleagues [5] reported increased basophil degranulation to food allergens in 10 autistic children and Lucarelli [6] reported improvement in behavioral disturbance in 36 autistic children placed on a cow’s milk elimination diet More recently, two small trials examined the benefit of gluten and casein free diets in autistic children. One trial [7] reported reduction in autistic traits but equivocal results on cognitive skills, and on linguistic and motor ability. The trial by Knivsberg [8] studied 10 autistic children over one year and reported improvement in the children on the gluten and casein free diets.
Other studies by Sponheim [9], Renzoni, [10] and Pavone [11] were unable to demonstrate improvement in behavior with a gluten free diet, or any association between autism and food allergy or celiac disease. Studies by Walker-Smith [12] and McCarthy [13] failed to demonstrate an increased prevalence of celiac disease in autistic patients using antigliadin assays and jejunal biopsies.
Lymphocytic infiltration in the upper and lower GI tract [14], immune activation [15], and abnormal lymphocytic responses to dietary antigens [16] have also been recently reported in children with autism, but the relevance of these findings to cognitive function or to development of autism is still unclear.
These studies demonstrate the need for large scale quality controlled trials in this area. Given the lack of hard evidence supporting the benefits of dietary manipulation in preventing or treating autistic patients, implementation of rigorous elimination diets should be undertaken with great caution. Such unproven measures may divert the autistic patient’s family from more useful treatments and contribute to poor nutrition and further social isolation in families already facing great difficulties.
References:
1. DSM-IV Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington DC: American Psychiatric Association; 1994.
2. Coleman M. Autism: Non-drug biologic treatments. In: Gilbert C, ed. Diagnosis and Treatment of Autism. New York:Plenum Press; 1989:219-35.
3. Goodwin MS, Cowen MA, Goodwin TC. Malabsorption and cerebral dysfunction: A multicariate and comparative study of autistic children. J Autism Child Schiz 1971;1:48-62.
4. Tsaltas MO, Jefferson T. A pilot study on allergic responses. J Autism Dev Disorders 1986;16:91-2.
5. Bidet B, Leboyer M, Descours B, Bouvard MP, Benveniste J. Allergic sensitization in infantile autism. J Autism Dev Disorders 1993;23:419-20.
6. Lucarelli S, Frediani t, Zingoni AM, et al. Food allergy and infantile autism. Panminerva Med 1995;37:137-41.
7. Millward C, Ferriter M, Calver S, Connel-Jones G. Gluten-and casein-free diets for autistic spectrum disorder. Cochrane Database Syst Rev. 2004; (2): CD003498.
8. Knivsberg AM, Reichelt KL, Hoien T, Nodland M. A randomised, controlled study of dietary intervention in autistic syndromes. Nutr Neurosci. 2002 Sep;5(4):251-61.
9. Sponheim E. (Gluten-free diet in infantile autism. A therapeutic trial). Tidsskr Nor Laegeforen 1991;111(6):704-7.
10. Renzoni E, Beltrami V, Sestani P, Pompella A, Menchetti G, Zappella M. Brief report: Allergological evaluation of children with autism. J Autism Dev Disorders 1995;25(3):327-33.
11. Pavone L, Fiumara A, Bottaro G, Mazzone D, Coleman M. Autism and coeliac disease: failure to validate the hypothesis that a link might exist. Biol Psyhciatry 1997;42:72
12. Walker-Smith J. Gastrointestinal disease and autism-the result of a survey. Symposium on Autism. Sidney, Australia: Abbott Laboratories; 1973.
13. McCarthy DM, Coleman M. Response of intestinal mucosa to gluten challenge in autistic subjects. Lancet. 1979;2:877-8.
14. Ashwood P, Anthony A, Pellicer AA, Torrente F, Walker-Smith JA, Wakefield AJ. Intestinal lymphocyte populations in children with regressive autism: evidence for extensive mucosal immunopathology. J Clin Immunol 2003 Nov, 23(6): 504-17.
15. Ashwood P, Anthony A, Torrente F, Wakefield AJ. Spontaneous mucosal lymphocyte cytokine profiles in children with autism and gastrointestinal symptoms: mucosal immune activation and reduced counter regulatory interleukin-10. J Clin Immunol, 2004 Nov;24(6):664-73.
16. Jyonouchi H, Geng L, Ruby A, Zimmerman-Bier B. Dysregulated innate immune responses in young children with autism spectrum disorders: their relationship to gastrointestinal symptoms and dietary intervention. Neuropsychobiology. 2005;51(2):77-85.
