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    Tuesday, June 03, 2003

    Sleight of Hand: I haven’t paid much attention to the thimerosal controversy. Mostly because I think the issue of thimerosal causing autism is about as valid as the issue of cell phones causing brain tumors. Thimerosal was used as a preservative in immunizations for over thirty years without any observable adverse effects. It was removed from vaccines a couple of years ago at the suggestion of the FDA because newly adopted standards for mercury exposure (lower than before, largely due to the precautionary principle) and an increased number of recommended childhood vaccines meant that adding up environmental mercury exposure with vaccine exposure would give children more mercury exposure than the new standards recommended. It’s impossible to completely eliminate mercury from the environment (it’s a natural element), but it was possible to eliminate it from vaccines. So, thimerosal preservatives were discontinued.

    But, when trial lawyers heard of this, they automatically assumed some malfeasance on the part of vaccine manufacturers in collusion with the FDA. Rather than seeing the move to discard thimerosal for what it was - the attempt to avoid any hint of doing harm, no matter how remote - they saw it as an admission of guilt. It was, in some ways, the perfect case for trial lawyers anxious to make big bucks - products that were used in millions of children for years combined with a supposed injury (neurological damage) that because of its many causes, most of which are difficult to pin down in each individual case, can be also be found in millions of children. It’s a situation ripe for exploitation.

    It’s also one that lends itself easily to sleight of hand when manipulating data to try to prove a link. Recently, that’s just what two people who make their living testifying in vaccine cases did. The father and son team of Geier and Geier published a study (warning: pdf file) recently that purported to show a definite link between childhood vaccinations, thimerosal and autism. It got some media exposure, enough to catch the attention of the American Academy of Pediatrics which took the unusual step of publishing a detailed analysis and rebuttal of the study on its website. Among its most damning observations:

    The authors claim falsely that children in the United States in 2003 may be exposed to higher levels of mercury from thimerosal contained in childhood immunizations than any time in the past, when in fact, all routinely recommended infant vaccines currently sold in the United States are free of thimerosal as a preservative and have been for more than 2 years.

    That’s precisely right. No childhood vaccines sold in the United States contain thimerosal. There’s a lot of other stuff in the AAP’s analysis that shows the Geier’s paper for what it is - a sham. The elder Mr. Geier is a geneticist who has supplemented his income by testifying at trials against vaccine manufacturers and giving lectures about the dangers of vaccines. He’s also testified before Congress on the subject. His son and co-author runs a consulting firm that specializes in providing advice to trial lawyers on the vaccine issue. They may sincerely believe that vaccines are dangerous, but given their dependence on trial lawyers professionally, their impartiality has to be questioned.

    Then, there’s the matter of the reputation of the journal in which the study appeared. It’s the latest incarnation of the Medical Sentinel the mouth organ of the Association of American Physicians and Surgeons, a collection of professional loose cannon. As an example of its standards for publication, consider this article that blames Castro for West Nile Virus. The autism and vaccine study is no better. It just uses statistical sleight of hand to make it seem better.

    (Thanks to The Bloviator for pointing this out.)

    UPDATE: Reader observations on thimerosal and childhood immunizations:

    At one point I had high hopes that the thimerosal link would explain the uptick in the incidence of autism. That hypothesis seems to be suffering at the hands of the facts, LOL.

    However, as a moderately intelligent non-scientist, I more than anything else have come to have a lot of skepticism about the claims of the vaccine manufacturers. I looked at this chart (admittedly from an advocacy group), after I read your statement
    that there is no mercury in childhood vaccines now sold in the US. Maybe you are right, but the flu vaccine looks to me like it does. I wish somebody who has no axe to grind would really and seriously dig into where the science is OR at least assess the impact on public health compliance that the not unreasonable mistrust is generating.

    When I think about

    *the pressure to immunize the under 2 crowd for flu

    *the requirement that newborns get HepB vaccines, in part to make their parents more compliant with future vaccine requirements

    *the rapid development of the Chickenpox vaccine from a lifestyle choice for working moms who couldn't take off 10 days for itchy kids to a legal requirement before entering school

    *the rotavirus debacle

    I don't see a conspiracy, but I do see a lack of deference to
    parental choice, which is filling the arsenal of those who would
    attack vaccine makers.

    Excellent points all. The flu vaccine does contain thimerosal, but it isn’t considered a routine childhood immunization. (Although there are some who would like to see it become one.) In fact, I don’t know too many physicians who followed the recommendations this fall to immunize all children against influenza. The knowledge that there are thimerosal class-action lawsuits out there, weighted against the very marginal benefit a child gets from an influenza vaccine, just didn’t make it worth the while. (A list of routine childhood vaccines and their thimerosal content, compiled by the FDA, can be found here.)

    And the expansion of childhood immunizations to include diseases that are neither as widespread, as dangerous, nor as communicable as the traditional immunization-targeted childhood diseases is, at least in my patient population, a major reason that there is a growing number of parents who refuse to vaccinate their children. I ranted about this issue last fall, so I won’t go on at length here. But I do wish the public health experts who make the recommendations that become mandates would reconsider their approach to childhood immunizations. Just because we have a vaccine for something doesn’t mean we're required to use it.

    posted by Sydney on 6/03/2003 08:58:00 AM 0 comments


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