Judging autism

Science has failed to convince many people that vaccines do not cause autism. Will last week's court ruling finally change their minds?

Published February 19, 2009 11:31AM (EST)

Health and medicine got a big headline last week: "Vaccines Didn't Cause Autism, Court Rules." The details have been extensively discussed, but here's the gist of the story: Three special federal judges working for the government's Vaccine Injury Compensation Program issued three separate decisions in what's become known as the Autism Omnibus Trial. The trial is a class-action lawsuit in which almost 5,500 families have sued the government, claiming routine childhood vaccines caused their children to develop autism. Last Thursday, each judge, known as a special master, reviewed the claim of one family, and in each case, ruled against it. Physicians praised the decisions, calling it great day for children and science. Anti-vaccination activists declared it unjust, wrong and unfair.

Among those expressing shock and disappointment was Rebecca Estepp, the mother of an autistic child, who is one of the claimants and the national manager of the advocacy group Talk About Curing Autism. "It's tough when you're taking parent support calls and you hear the same story day after day," she told the Wall Street Journal. "When does anecdotal evidence become enough?"

Her question isn't a new one, especially in a society where belief, emotion and science so often conflict. For scientists, the answer to Estepp's question is never. Developing a hypothesis from anecdotes or observations (whether one or a hundred of them) is merely the first step in a longer process. Next comes the hard part: testing that hypothesis to see if you can back it up with hard data, and then sharing the data with others to see if they can reproduce the findings, often multiple times.

Observe. Test. Repeat ad nauseam. That, in a nutshell, is the scientific method. It's a rigorous and disciplined way of thinking. The outcome holds promise because hard data remains the most objective measure we have, providing us the closest thing to that ideal called truth.

That said, we've never been a society with a worldview that holds science in high esteem. Consider the results of a recent Gallup Poll about evolution: On Charles Darwin's 200th birthday, only four in 10 Americans say they believe in the theory of evolution. As a result, from the Scopes Monkey Trial to Kitzmiller et al. v. Dover Area School District, we’ve sent conflicts between faith and science to the courts to arbitrate.

In the case of autism and vaccines, we've made the same decision. The debate has aroused intense feelings: On one side are physicians and medical groups, convinced that vaccines are safe and effective, perhaps the most lifesaving breakthrough in medical history. On the other side are parents, like Estepp, who struggle every day to raise a child with autism. Painfully watching their children become autistic after receiving vaccines is their lasting proof. It's the answer when doctors and medicine can't answer why. For them, the emotion of the issue can't be quieted by science's hypotheses.

Where is the burden of proof greater? Scientific investigation achieves objectivity by demanding that gut feelings be verified with experimentation and data. Compare this with jurisprudence, where people weigh the evidence and make it subject to all the biases and flaws of human nature. If you don't buy that, try serving on a jury of your peers. At the other end of the spectrum, consider how DNA testing has revolutionized criminal and family law.

Now, read that headline again: "Vaccines Didn't Cause Autism, Court Rules." It doesn't say, "Vaccines Didn't Cause Autism, a Decade's Worth of Rigorously Conducted and Verified Medical Research Rules." That may not be as sexy as the recent headline, but it is the truth. The scientific community disproved the vaccine-autism connection long ago, multiple times. Anti-vaccination crusaders have countered with science of their own, but it has been weak at best and probably fraudulent at worst -- a fact the vaccine court recognized in its decisions.

In the vaccine court case of Michelle Cedillo, heard in 2007, the special master George L. Hastings commented on the anti-vaccination side's medical experts: "I have no doubt that the Cedillo parents and relatives are sincere in their belief that the MMR [measles, mumps and rubella] vaccine played a role in causing Michelle's devastating disorders. Unfortunately, the Cedillos have been misled by physicians who are guilty, in my view, of gross medical misjudgment."

While it's easy to blame the bad science of the anti-vaccination community, it's not enough. Legitimate scientists must own up to the controversy and learn to communicate better. Too often they use guarded, often complicated language, reflective of their skeptical and cautious perspective. Take this comment from the CDC in 2007: "The vast majority of science to date does not support an association between … vaccines and autism. But we are currently conducting additional studies to further determine what role, if any … in vaccines may play in the development of autism."

Meek statements like that lose out to fiery emotion every time. In this instance, the statement was read by Oprah Winfrey on her show in 2007. That day, Jenny McCarthy was her guest, sharing emotional and frightening anecdotes about her son developing autism after his immunizations. After the show, the score was Jenny 1, Science 0. As doctors and scientists, we all have a lot to do to make our messages stick. By communicating with conviction and compassion, we can only benefit our patients.

In the case of autism, science and reason have too often failed to reach people. And consequently they have turned to the courts. For those of us who believe in the scientific method, the autism trials have not been necessary. But judges, unlike doctors in their cold white coats, still command a great deal of respect, and so perhaps the court's recent ruling will sink in and finally persuade parents to regain their confidence in vaccines. If so, the end will have justified the means.

By Rahul K. Parikh

Rahul K. Parikh is a physician and writer in the San Francisco Bay Area. He wrote the Vital Signs column on Salon in 2008-2009. His pop culture-medical column, PopRx, runs on alternate Mondays.

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