Abstract
This White Paper will address to the masses that vaccinations, specifically the MMR vaccine, do not play into the role(s) of correlation or causation with the development of Autism Spectrum Disorders, and instead, convey the necessary role that vaccinations play in the prevention of infectious disease and safety of society. There have been studies on both sides of this argument; however, all of the published studies that have tried to support this conception have been retracted. Before continuing with the full explanation of this issue, there are some specific key terms that need to be addressed so as to improve overall understanding of the concepts that are to be presented.
Vaccine – A vaccine, according to vaccines.gov, a federal government website that is monitored by the U.S. Department of Health and Human Services, is the combination of very small amounts of weak or dead germs that can cause diseases, preparing your body to fight the disease faster and more effectively.
Vaccination – the act of receiving a vaccine
MMR vaccine – This stands for Measles, Mumps, and Rubella, and is a vaccine given to prevent these serious illnesses/diseases. As they are all very dangerous and highly contagious. This is vaccine that is most widely considered to cause ASD development.
Autism Spectrum Disorder – Generally shortened to ASD, this encompasses the various types of autism that can develop. These include Autistic Disorder, Childhood Disintegrative Disorder, Pervasive Developmental Disorder, and Asperger Syndrome. These are generally diagnosed/develop before the age of three.
Prevention – I will use Merriam-Webster’s definition of this word, “the act of preventing or hindering.” (8)
Infectious Disease – Highly contagious and/or highly lethal disease(s), pertaining specifically to measles, mumps, and rubella.
Retraction – The withdrawal of a statement, accusation, or undertaking. Taken from Dictionary.com (7)
Introduction
This paper will be directed towards the misconceptions that have arised about the correlation and/or causations of ASD and the receiving of the MMR vaccination in children. This belief arised in 1998 when Dr. Alex Wakefield published a journal stating that 12 of his patients who received the vaccine then developed various levels of ASD, because of a serious bowel condition that had arised. He hypothesized that the vaccine caused this bowel infection, which then led to the absorption of toxic neuropeptides through the gastrointestinal tract. Although this study was later retracted due to critical flaws in the evidence and study, this still led to the downfall of parental confidence in consenting to give their children this vaccination.
My objective with this paper, is to explain to the general public, through understandable and simplified language, that there is in fact no evidence that vaccinations can lead to the development of ASD in their children, as well as provide a compelling line of reasoning to convince parents that vaccinating their children is a vital action that must be taken to prevent infectious diseases and in some cases, death.
There are some specific questions that I will focus on answering with this paper, including but not limited to, “How did Dr. Alex Wakefield come to this hypothesis and why is it wrong?” “What studies have been done to disprove this hypothesis?” and finally, “What can be done to solve this issue?”
Because of the broadness of these questions and the answers that would follow, there are some limitations that I am enacting onto this paper so as to stay on topic and remain direct towards the central issue. For this paper, I am choosing to only focus on the MMR vaccine, as that is the central vaccine from where this controversy arose, and is the one most focused on by scientists. Along with that, I will not be researching or discussing the other potential dangers of getting vaccines. There are dangers to any sort of medical procedure, and for the sake of proper discussion and debate, this paper will strictly focus on the believed inherent danger of ASD development after the vaccination with the MMR vaccine. Lastly, as this is a scientifically based research paper, I will not be including any personal opinions of neither myself, nor any of the scientists, doctors, etc. that are stated within the sources cited or the sources referenced used to construct this white paper.
The arrangement of this paper henceforth will be as follows. The next section will consist of the refutations of my primary argument and objective, including the original study published that brought forth the believed danger of getting the MMR vaccine, as well as the other main studies done which provided evidence that was considered to conclude with supporting evidence to the original hypothesis. That section will end with the explanation of why those studies resulted with either skewed numbers/evidence, as well as why they were retracted and now labeled as incorrect findings.
The section following the latter mentioned will include what studies have been done in disproving the original hypothesis, including how the studies were conducted, what evidence was obtained, and what the studies concluded from the evidence. I will include in these studies the five major studies that have been conducted since this original hypothesis, as they are recognized as the most credible studies done to this date in regards to this issue.
Succeeding the section of evidence that I am providing towards my overall claim, I will discuss what a proposed solution to this argument is, as well as provide answering to common questions that might arise after the review of this paper. These answers will hopefully provide a better understanding to the paper as a whole, and most importantly, to the proposed solution of this issue.
This paper will end with a short bibliography of my credentials as well as any specifics that I will personally take away from information of this paper, and a quick summarization of why the issue presented is of the utmost importance right now.
This paper will finalize with the list of sources cited and sources references.
Body
The Origin of Cynicism in Vaccines
On February 28, 1998, Dr. Alex Wakefield, along with colleagues, published a scientific journal titled, Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children, studying the whereabouts of the diagnosis of 12 children who were all suffering from chronic enterocolitis and regressive developmental disorder. With an average age of six, these children were all referred to a pediatric gastroenterology unit, as they all shared, “a history of normal development followed by loss of acquired skills, including language, together with diarrhea and abdominal pain(1),” with the hopes of discovering an association between these diagnoses and an unknown entity. After an ensemble of tests, including, “gastroenterological, neurological, and developmental assessment and review of developmental records. Ileocolonoscopy and biopsy sampling, magnetic-resonance imaging (MRI), electroencephalography (EEG), and lumbar puncture,” no promising results could be concluded, leading to the look into the histories of the children.
The abnormality, which needs to be noted, among these children is the fact that they were understood to be developing as any other child would, but in their later years began to suffer from a regressive developmental disorder. This is contrasting when put in comparison of other children, as the reigning majority develop this regressive developmental disorder from infancy.
After reviewing the medical histories of these children, they found a common denominator that in essence linked their problem with a solution. All of these children had received the MMR vaccine, and it appeared that all of these children on average began to lose communication skills very soon, “6·3 days (range 1–14),(1)” after the vaccine had been given.
With this vaccine being introduced only a decade prior to this incident in 1988 in the UK, giving the connotation of still being new in terms of medical discoveries, this MMR vaccine raised a lot of red flags among Dr. Wakefield and his colleagues.
After the unearthing of this possible link, the team pulled more medical records and assessments done of these children by both medical professionals and by the parents of the children. Based on the evidence found, Dr. Wakefield and his team concluded the study with the basis that the injection of the MMR vaccine shares a strong interrelationship with the end diagnosis of regressional developmental disorders. Out of the 12 children being used as test subjects, “onset of behavioural symptoms was associated, by the parents, with measles, mumps, and rubella vaccination in eight of the 12 children.(1)” Along with this, nine of the 12 children who had received this vaccine would be diagnosed with the behavioral disorder categorized as Autism.
This understood outcome is what led to the decline in confidence of the MMR vaccine around the world, leading to MMR vaccine rates falling in Britain and 25 times the amount of measles cases, totalling 1370, within 10 years of the publication of this journal (3).
Retraction of Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children
This article, published in 1998, was still considered entirely true until March 6, 2004, at which time it was issued an erratum (in layman's terms, there were errors in the journal) and the conclusion of the article was retracted by 10 of the 12 original authors of this study(2). The collective decision to retract the original results published was based on the culmination of many feelings and reasonings, but it should be emphasized that the main two factors involved in this decision were based around the evidence used to reach this conclusion, and the resulting outcome from which this inaccurate representation held. Although the conclusion published was formatted in such a way so as to avoid legal dispute, stating that, “We did not prove an association between the measles, mumps, and rubella vaccine and the syndrome [colitis and autism] described,(1)” the conclusion was still very impactful, as it stated further down, “In most cases, [the] onset of symptoms was after the measles, mumps, and rubella immunization.(1)” This statement lead to the implication that the MMR vaccine was linked to autism. The understanding of the full ramification caused by this journal, in that the vaccine at hand was factually believed to result in cognitive depreciation, is what lead this group of original authors to issue this retraction.
It should quickly be noted that Dr. Alex Wakefield, the leading scientist and author behind this publication, was not part of the group of 10, and stood by his research and interpretation of the research.
Even with the retraction of the original interpretation, the article itself was still considered “valid,” as it had not been officially retracted by the UK General Medical Council. This full retraction of the journal by the council was finally done on February 2, 2010, stating that, “It has become clear that several elements of the 1998 paper by Wakefield et al. are incorrect (3).” This decision was primarily influenced by the research of London’s Sunday Times, who investigated specific ethical and procedural flaws that took place during the different stages of the original scientific study by Dr. Wakefield and his team. The council then looked into these allegations and found them to be true.
Flaws of the original experiment
Some of the most critical flaws within this experiment are explained in detail by Dr. Paul A. Offit, Chief of Infectious Diseases, the Director of the Vaccine Education Center, and the Henle Professor of Immunologic and Infectious Diseases at the Children’s Hospital of Philadelphia, in his 2006 publication, Vaccines and Autism. The explanations of these flaws are written for a specific audience who has much higher understanding of science, medical terms, and disease in comparison to the common man, because of this, the following breakdowns have been reduced to simpler terms for better understanding. (Note – the breakdown of these concepts might result in a less accurate understanding because of the lack of language available)
The first of these flaws has to do with the omittance of viable information about the measles virus and how it relates to the children with autism being examined in the experiment. Virus’s get picked up by Antigen-Presenting Cells (APC), a mobile cell that can travel around the entire body. In the journal, they noted that children with autism were found to have the measles virus in their intestines. Instead of cross-checking this hypothesis with both children with and without autism, the team chose to ignore the research of this additional information even though it directly related to the hypothesis of the experiment. (Flaws one through four found in 4)
Second, measles was still prominent in England at the time of the experiment. The team never tested the patients to see whether the measles they were detecting was the actual disease, or the measles from the vaccine, even though there are tests to do so. (Flaws one through four found in 4)
Third, working with measles leaves a high risk of obtaining experiment results that appear to be true, when in actuality they are not. The journal did not discuss within the method section the procedure they would use to avoid this risk. (Flaws one through four found in 4)
Fourth, during the conducting of scientific experiments, there are certain guidelines that the experimenters must abide by so as to produce only factual results. One of these is to maintain what is called a blinding, where the experimenter does not know whether they are testing is from the test or control group. By having this blinding in place, it prevents the opportunity of having a bias during the experiment. This control is not expressed within the method section of the paper, raising a similar flag as seen in the third flaw above. (Flaws one through four found in 4)
These flaws, were not the only factors in the final decision to officially retract the article. Evidence was uncovered that the patients who were stated as being “consecutively referred” within the paper, were in fact not; instead, patients for the study were selected by Wakefield and his team, labeled as a recruitment bias. Finally, and perhaps one of the biggest indications of bias and fault within the experiment, Sunday Times’ investigation revealed that Dr. Alex Wakefield “knew that some of the patients selected were a part of a lawsuit against MMR vaccine manufacturers, as well as was working as an paid advisor in the creation and patent of a competing vaccine.(3)” The potential ethical bias this creates removes Wakefield’s credentials as a completely objective based scientist over this topic, experiment, and publishing.
This journal is now indisputably false, and has been discredited of all scientific advocacy.
Journals Refuting the Original Study
Since the publication of this controversial article, there have been numerous studies done with the the intention of testing the original interpretation, none of which have resulted in finding the same positive result from their study. From the list of studies conducted, the most credited and notable of them have been from Dr. Kreesten Meldgaard Madsen, who was the lead scientist in the 2002 study, “A Population-Based Study of Measles, Mumps, and Rubella Vaccination and Autism,” as well as the studies done by Brent Taylor in 1999.
The study done by Madsen is regarded as one of the most thoroughly done, as it examined 537,303 children, from various age groups. From this population, around 82% of the children being studied had received the MMR vaccine.With all these children being examined in a hope to find any sort of connection, the researchers concluded their study with the interpretation that, “There was no association between the age at the time of vaccination, the time since vaccination, or the date of vaccination and the development of autistic disorder.(5)” This conclusion is very powerful, as it would be assumed that if the original study done, which had not yet been discredited by the publication of this study, was to be deemed true, then this study should find the same, if not even stronger, correlation between the MMR vaccine and the diagnosis of a regressive developmental disorder. Instead, this study found that there was no link between these two aspects, and even further than that, “ The risk of autism in the group of vaccinated children was the same as that in unvaccinated children… as well as that time of vaccination played no part in this resulting side-effect either.(4)”
The other study that was incredibly impactful in terms of debunking this controversial interpretation that Alex Wakefield published was by Professor Brent Taylor. This study was published June 12, 1999, very recently after the original study was published in 1998. This study examined 498 children who with autism, all of which had been registered with this developmental disorder. During this study, Taylor and his team examined three key things: percentage of children with autism and received the vaccine versus those who had autism and did not receive the MMR vaccine, the age of diagnosis and autism, and finally, how long after the vaccine was given did developmental disorders begin to develop. In the first finding, their results showed that the percentage of those who received the vaccine and had autism was no different than the percentage of children who did not receive the vaccine and still had autism. The second finding was that the age at which the vaccine was administered had no resulting effect on whether or not a child would begin to develop autism. Lastly, “ the onset of regressive symptoms of autism did not occur within 2, 4, or 6 months of receiving the MMR vaccine.(6)” All three of these results countered the original findings would strong refute the interpretation found from Alex Wakefield and his colleagues on their own, but with all three, this study found almost completely opposite results than what the Wakefield journal implied in their conclusion. This study found no relationship between the MMR vaccine and a regressive developmental disorder, as per their conclusion from their journal, stating that, “Our analyses do not support a causal association between MMR vaccine and autism.(6)” Later in the conclusion, Taylor and his colleagues wrote that, “if such an association occurs, it is so rare that it could not be identified in this large regional sample.(6)” Unfortunately, even though this study was released shortly after the Wakefield publication, the damage and mindset had already been established among society.
Conclusion
Alex Wakefield and his team published a study on February 22, 1998 that largely impacted the trust people had in vaccines, doctors, and medical professionals worldwide, as it led the global population to believe that a vaccine that was meant to protect their children was instead harming them. The problem with this stems from what is known as the Backfire effect, in that a person’s beliefs will only become stronger in a subject the more refutation towards that belief they receive. This eventually reverses once enough factual argumentation has been brought against the belief; unfortunately; scientific journals are not often read or received among the general population. Since the original study, there have been numerous studies researching the same topic, all of which have found no link to MMR vaccines and autism, or any regressive developmental disorder in general, as well as the original study was entirely discredited, both in the actual research done, and the interpretation found.
The goal of this paper is to break down and bring to life the foundations, methods, and results of where this public issue has arisen, and hopefully, change the minds of those who are not specialized in this field enough to read and rationalize an opinion from the published studies in relation to this matter. From the studies and research thus far, we can undoubtedly conclude that the measles, mumps, and rubella vaccine shares absolutely zero relationship with the development of regressive developmental disorders, and the fear of this result is indefensible and should not be of concern to any person(s).