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Foreword

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Abstract

Wakefield wrote: "It is an honor to be asked to write a foreword, particularly one for such a valuable and scholarly contribution to the understanding of autism." However, in the view of the authors of the book, it was our privilege and honor, along with Jones and Bartlett Publishers, to have a scholar at Wakefield's level read, comment on, and then write this Foreword to our book.
Foreword
It
is
an honor to be asked to write a foreword, particularly one for such a valuable and scholarly
contribution to the understanding of autism.
I was involved in filming with
NBC,
grabbing some B-roll after the serious interviews and the
film
crew- a producer, a cameraman, and a sound
technician-were
talking between takes. The
cameraman noted how uncanny it was that he, the sound tech, and the producer all had nephews
with Asperger syndrome.
I,
too, have a nephew with Asperger syndrome. Four people, none of whom
had met before, were all personally impacted
by
this previously very rare autistic spectrum disorder,
originally described, coincidentally, in only four boys in Vienna
by
Hans Asperger. That same
week, U.K. newspaper headlines reported autistic spectrum disorders in 1 in 38 boys. A 2007 report
from the California Department of Developmental Services
is
just in and makes for a depressing
read. Examination of the epidemic growth of autism in the United States and the United Kingdom
indicates, with an ominous certainty, that if you are not personally affected
by
autism in your family
now, you will be in the future.
Few contemporary subjects have such immediate and long-term relevance to the "well-being"
of the human race. A 20-year period starting in the mid-
1980s-the
mere blinking of an
eye
in the
life of planet Earth-has witnessed a punctuated equilibrium in the human evolutionary continuum
reflecting what I believe
is
a huge selection pressure on humankind. The autism epidemic
is
envi-
ronmentally driven. There are many who believe that recent dramatic changes in early immune
programming lie at the heart of this and other childhood immune system disorders. This view
is
not
necessarily a sequela to the "hygiene" hypothesis that originally proposed a lack of exposure to
environmental stressors such
as
infections that might be
key
to the recent emergence of immune-
mediated diseases, but rather a proposal that an altered pattern of exposure that does not hold the
substitution of infection for vaccination to be a benign influence in this process.
This new book on autism was authored
by
professionals in communication, and it was written
for students of this subject.
As
the authors state, "The primary aim of this book
is
to apply sound
logical theory to the findings of validated empirical research concerning the autism epidemic."
They do so across the broadest landscape, taking the reader from autism's lackluster history in the
backwaters of human idiosyncrasy to its unwelcome epidemic prominence
as
the
fin
de siecle
disease-a
"mind plague"-that has stolen so many lives and disrupted so many families. What
appealed to me in particular
is
the authors' emphasis on the narrative of individual children
as
the
bedrock of a deeper understanding of the disease.
ix
'1/
Wakefield, Andrew J. (2010). Foreword in J. W. Oller, Jr., & S. D. Oller (Eds.) Autism: the
Diagnosis, Treatment, and Etiology of the Undeniable Epidemic (pp. ix-xii). Sudbury, MA: Jones
and Bartlett Publishers. ISBN-13: 978-0763752804, ISBN-10: 0763752800 [copyright reverted to
authors per Termination Agreement on file signed by respective parties July 19, 2010].
X
a:l
FOREWORD
This
is
not another book written about autism
by
someone unschooled in the subject. Rather,
it
is
a
text
written
by
those
for
whom
autism
and
the
science
of
communication
are
a
profession
and
a passion- a book grounded in analysis, reanalysis, empiricism, and logic. And it
is
a book that
should be required reading
by
health agencies.
This book
is
unashamedly invested in the belief that the vaccine-autism story has far from run
its course. Indeed, science has only just scratched the surface of this complex relationship. In parallel
with the evolution of thinking in autism
is
the story of how enthusiasm on the one hand and fear
(and its use) on the other
hand-both
devices of public relations-have distorted the history of
vaccination and inhibited rational debate. Scientists have played their part in this journey and are
by
no means blameless in the distortion of the facts. I have been blamed for causing, through the
media, a vaccine scare. In defense of
my
position and in accordance with the precautionary principle,
having reviewed all the available evidence for MMR vaccine safety, I simply recommended a return
to single measles, mumps, and rubella vaccines in preference to MMR and encouraged further
research.
In the
NBC
interview, it was put to me that I was alone with a few parents in believing that the
MMR vaccine was unsafe. I responded
by
saying that
15
years ago this was, indeed, an unusual
opinion held
by
only a handful of physicians. I was able to say, however, that
my
position on the
deficiencies in the relevant vaccine safety studies have now been reinforced
by
the systematic analysis
of
Dr
. Thomas Jefferson and colleagues from the Cochrane Collaboration, an internationally respected
body that provides independent scientific oversight. They wrote, "The design and reporting of safety
outcomes in MMR vaccine studies, both pre- and postmarketing
is
largely inadequate" (Jefferson,
Price, Demicheli, & Bianco, 2003,
p.
25). In an interview with Richard Halvorsen concerning his
2007 book The Truth about Vaccines, one of the lead authors of the Cochrane review left no doubt
as
to his true feelings when he said, "The safety studies of MMR vaccine are crap. They're the best
crap we have but they're still crap" (Child Health Safety, 2009
~
).
With respect to
my
suggested
return to the protection of children with single vaccines, Jefferson and colleagues wrote,
"We
found
limited evidence of safety of MMR compared to its single-component vaccines from low risk of bias
studies" (Jefferson et
aI.
, 2003,
p.
25). More recently,
Dr.
Lou Cooper, former head of the American
Academy of Pediatrics, made the comment in Newsweek that "There's been grossly insufficient
investment in research on the safety of immunization" (2009
~
),
and, to the Institute of Medicine,
that "[Vaccine safety] research has been done on the cheap" (Wrangham, n.d.
~
).
So what has been the response of the authorities and the vaccine manufacturers to Jefferson's
evidence-based approach? In the United Kingdom, the importation license for single viral vaccines
was withdrawn in August 1998 at the height of demand
by
a justifiably concerned public, but regu-
lators continued to deny parents the option of single-agent vaccines. Protecting policy was put before
protecting children. In the United States, Merck (the sole supplier of single and combined measles,
mumps, and rubella vaccines) has announced its intention to discontinue provision of single-agent
vaccines.
The ability of the regulators and manufacturers to take such positions has been tenuously
sustained
by
scientists bending the facts to the will of the Public Health Politburo. An example of
this
is
an extraordinary quote ascribed to the authors of a recent paper
by
Dr.
Mady Hornig and
colleagues: "The work reported here eliminates the remaining support for the hypothesis that autism
with GI complaints
is
related to MMR vaccine exposure" (Levine, 2008; Columbia University
Mailman School of Public Health, 2008 ~)
.
Clearly at odds with this extravagant and inappropriate
claim, the study actually looked at the relationship between persistent measles virus infection in
poorly characterized intestinal biopsies in only
five
children whose clinical history (regression and
onset of intestinal symptoms after MMR vaccination) identified them
as
being in the group of inter-
est. The problem with this kind of compromise
is
that for whoever made the statement and whatever
Foreword xi
their motivation, there
is
no way back. They have forsaken the scientific debate for populist blog-
speak and damaged the prospects of further research into an important area.
Part of what
is
needed in the deconstruction of the PR myth
is
an objective analysis of the "vast
number of studies that discount an association between vaccines and autism," a line frequently
employed
by
Dr.
Paul Offit (2008) among others. This book takes a closer look at the pattern
of exposure to vaccines and autism risk. A recent example of the importance of this "pattern of
exposure" phenomenon comes from Kara McDonald at the University of Manitoba involving more
than 11,500 children who received at least four doses of DTP (diphtheria, tetanus, and whole cell
pertussis vaccine), among whom the risk of asthma was reduced
by
half in children whose first dose
of DTP was delayed
by
more than 2 months (McDonald, Huq, Lix, Becker, & Kozyrskyj, 2008).
The likelihood of asthma in children with delays in all three doses was reduced still further. In con-
trast, for those children whose first dose was given ahead of schedule, there was an estimated
increased risk of asthma of
60%
compared with those children who received their first dose at the
recommended time. This gradient of risk associated with age of exposure
is
compelling and
may well explain the discordance between results of other studies that sought to examine the
DTP-asthma link.
As
part of this deconstruction, the authors of this book have taken a look at the original flawed
analysis . carried out
by
Dr.
Loring Dales, working for the California Health Services, and the CDC
(Dales, Hammer, & Smith, 2001). Using Dales et aI.'s data,
J.
W.
Oller and
S.
D. Oller show a highly
significant correlation between autism numbers and increasing uptake of vaccines over time. The
data provided here support the reanalysis of Dales et aI.'s data undertaken
by
Edwardes and Baltzan
(2001), who confirmed that the rate of early MMR immunization
is
correlated with the incidence
of autism. The correlation appears in data that were obscured in an attempted feat of graphical
wizardry
by
Dales et
al.
Although the data suggest that younger age at MMR vaccination may be
associated with a rise in autism at the population level, ecologic studies such
as
those of Dales and
colleagues are of limited value when it comes to taking the question further.
In an attempt to settle this issue, CDC researchers stepped in with a case-control study compar-
ing age at
fi
rst MMR vaccination in children from the Atlanta metro area (DeStefano, Bhasin,
Thompson, Yeargin-Allsopp, & Boyle, 2004).
By
36 months of age, significantly more cases with
autism had received MMR vaccines than controls. This association was strongest when children
received the vaccine at a younger age, particularly in the
3-
to 5-year age group (odds ratio = 2.34).
Due to diagnostic delay, a significant proportion of this group of young children had yet to be diag-
nosed with autism at the time of the study, potentially underestimating this risk. In a subgroup
analysis adjusted for birth weight, multiple gestation, maternal age, and maternal education, the
odds ratios were increased to 3.55, however, strengthening the association between younger age of
exposure to MMR and autism risk.
Why am I telling you this? Because the DeStefano et
ai.
study has been cited
as
supporting the
safety of MMR vaccination. The positive finding was deemed to be apparently an "artifact of vaccine
requirements for special needs children."
Of
course, these children are actually no different from
children in regular education. The argument
is
false, and no evidence has ever been produced to
support it. Several other "negative" studies support the association between younger MMR exposure
and increased autism risk (Richler et aI., 2006). Even so, the "no harm from vaccines" band
plays on.
It
was suggested in
my
exchanges with
NBC
that the perceived response to questioning vaccine
safety smacks of conspiracy theory. Although not directly relevant to the issue of vaccines, I was
able to provide the production team with a recent posting on the class-action suit involving Merck
and Vioxx, entitled "Drug Company Had Hit List for Doctors Who Criticized Them" (Mercola,
2009). It continued, "The international drug company Merck had a hit list of doctors who had to
xii III FOREWORD
be 'neutralized' or discredited because they had criticized the painkiller
Vio
xx,
a now-withdrawn
drug
that
the
pharmaceutical
giant
produced
"
(Mercola,
2009
~
).
Staff at Merck emailed each other about the list of doctors. The email, which became public
during a class-action suit against the drug compan
y,
included the words "neutralize
,"
"neutralized,"
and "discredit" alongside some of the doctors' names (Rout, 2009
~
)
.
The company
is
alleged to
have used intimidation tactics against researchers, including dropping hints that the company would
stop funding their institutions and possibly even interfere with academic appointments (Rout, 2009).
The article concluded with an email excerpt from a Merck employee read to the court that went
as
follows:
"We
may need to seek them out and destroy them where they live."
Who needs conspiracy? Congratulations to the authors of this text for their insights and their
courage.
Finally, I should disclose that the OIlers have offered to donate any profits from sales of this
book to Thoughtful House, a center for care of children with developmental disorders and research
into these diseases of which I am the executive director.
We
are fighting to recover children with
developmental disorders (autism, POD, Asperger syndrome, ADD, ADHD, and NLD) through the
unique combination of medical care, education, and research.
Andrew
J.
Wakefield, MB, BS, FRCS, FRCPath
Thoughtful House
Center for Children
3001
Bee
Caves Road
Austin, TX 78746
http://www
. thoughtfulhouse.org/index. php
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