ABC Drama Takes on Science and Parents
Jonny Lee Miller, left, as Eli Stone, with Laura Benanti as the mother of an autistic child, and William Topputo in “Eli Stone.”
Eli Stone, the evil corporate lawyer turned superhero defender of the downtrodden, recently made his debut performance on ABC by battling the dark vaccine menace. With this program, the public is once again bombarded by the sensational but utterly false premise that vaccines are a cause of autism. Here he helps defend a mother and her little boy, hapless victim of the pharmaceutical companies and their vaccine preservative, mercuritol (in real life, thimerosal), which has rendered him autistic. Those of us on the side of science and reason just can’t get a break. As a pediatrician, I struggle daily to reassure, explain, and convince parents that there is no rational basis for believing that vaccines are a cause of autism. That there is, in fact, just as much evidence that your astrological star chart can predict your future. Or that homeopathy is more than an expensive placebo. Reams of data from a very large number of well conducted studies have clearly and overwhelmingly (at least in the halls of science which, after all, are the only halls we should be traversing here, right?) refuted any notion of a purported link . There is not enough room to discuss the origins of that myth here (stay tuned for a future entry on that voluminous subject), but suffice it to say that there really is no controversy among respected scientists and physicians. If you follow an evidence-based approach to medical decision making, there is no conclusion to draw other than that absolutely no such link exists. As for the issue of the vaccine preservative thimerosal being a cause of autism, again the data do not demonstrate any evidence of a link. On a multitude of levels there is ample reason to reject any link between thimerosal and autism:
- All of the legitimate studies to date have failed to demonstrate any link. That’s a pretty good reason right there:
- Thimerosal-Containing Vaccines and Autistic Spectrum Disorder: A Critical Review of Published Original Data
- Early Thimerosal Exposure and Neuropsychological Outcomes at 7 to 10 Years
- Thimerosal Exposure in Infants and Developmental Disorders: A Prospective Cohort Study in the United Kingdom Does Not Support a Causal Association
- Safety of Thimerosal Containing Vaccines: A Two-Phased Study of Computerized Health Maintenance Organization Databases
- The apparent increase in autism cases has continued even after the removal of thimerosal from vaccines.
- Thimerosal and the Occurrence of Autism: Negative Ecological Evidence from Danish Population-Based Data
- Continuing Increases in Autism Reported to California’s Developmental Services System: Mercury in Retrograde
- Pervasive Developmental Disorders is Montreal, Quebec, Canada: Prevalence and Links with Immunizations
- Finally, and a usually neglected part of the story, the kind of mercury contained in thimerosal (ethylmercury) is very different from the kind produced by industrial pollution, and that ends up in the fish you eat (methylmercury). While methylmercury becomes concentrated in the body’s tissues (most importantly the brain) and thus remains for prolonged periods, ethylmercury is much more rapidly eliminated, and is therefore much less readily stored by the body. Recent studies have demonstrated just how different the pharmacokinetic properties of these two types of mercury are in the bodies of infants. This is important when we consider the US EPA “reference dose” (RfD) for mercury. This is the upper level daily amount, over a lifetime, of a substance that is considered safe to the most sensitive individuals in a population. The RfD for mercury set by the EPA is 0.1 micrograms per kilogram of body weight per day. Many people who believe the thimerosal-autism link point to the fact that, before thimerosal was removed from vaccines, some infants received a total daily dose of mercury from vaccines that came close to or exceeded the EPA’s RfD for mercury. Keep in mind, however, that the RfD was based on long-term, life-time daily exposures, not one time or even multiple time exposures. Also, as a safety factor the RfD was set 10 times higher than the actual estimated safe level. But most importantly, the RfD for mercury is based on data for methylmercury, not ethylmercury. That is, all the assumptions about the hypothetical dangers of exceeding the RfD for mercury, on potentially a few occasions, are based on an RfD for the wrong kind of mercury. As discussed above, the data on the pharmacokinetics of ethylmercury suggests a very different, and far less concerning picture for thimerosal in vaccines.
Which brings us back to Eli Stone and his heroic quest to slay the evil, two-headed, medical-pharma beast. It’s nothing new to see television making mince meat of science. It is fiction after all. In fact, after the American Academy of Pediatrics wrote ABC to protest the airing of the show, the producers placed a disclaimer of sorts at the end of the show (while people were channel surfing or getting another beer from the fridge), stating that vaccines are important, and directing viewers to the CDC’s website. Needless to say, the damage was done. The danger of this kind of TV is that people actually do often believe what they see and hear on the boob tube. Even if they know that what they’re watching is fictional, the messages absolutely effect behaviors. Particularly when they are so often bombarded by misleading and factually incorrect information. In this case, those behaviors involve potentially very dangerous errors in judgement regarding an extremely important medical decision about childrens’ health. Of course, the real-life court room drama that unfolded last month, involving the Federal Vaccine Court, will do even more damage. While the court’s ruling in favor of the family of an autistic child said nothing about vaccines causing autism, the perception many have come away with is just that - that the government has conceeded that vaccines are a cause of autism. I will discuss this case in more detail in an upcoming post. But the two courtroom dramas, one fictionalized, the other frightfully real, will both serve to further tarnish the image of the greatest advance medical science has ever seen, and take us another step backward toward the prevaccine era, and the re-emergence of more childhood death and disease.
When did vaccines stop using thimerosal? And more importantly, do you think the removal of thimerosal was a misguided move by vaccine manufacturers, stoking fears surrounding vaccine safety rather than quelling them?
As part of the FDA Modernization Act of 1997, a list was complied of all regulated products that contained mercury of any kind. This list inlcuded vaccines containing thimerosal. Subsequently, as part of an effort to eliminate as many mercury exposures to children as possible, the AAP and the Public Health Service recommended the removal of all mercury from vaccines. The pharmaceutical industry then began the process of voluntarily removing thimerosal as a preservative from vaccines. This was partly in response to the above recommendations, assuming there would likely be forthcoming mandatory requirements, and partly out of liability concerns in the face of these official recommendations. Nonetheless, by the end of 2001, all routine pediatric vaccines were thimerosal free. Keep in mind, however, that most vaccines were either already thimerosal free, or contained only trace amounts to begin with. The only remaining thimerosal containing vaccine is the injectable form of the influenza vaccine, and one brand has a thimerosal free version.
I do think it was wise to remove mercury from the vaccines, as there are other non-mercury containing preservatives available that are effective. But that is not the same as an admission of risk from thimerosal. There has been no credible evidence to suggest any danger from the thimerosal in vaccines. And there certainly is no evidence (and much evidence to the contrary) that thimerosal has anything to do with autism.
It was a prudent idea to remove thimerosal from vaccines, but to the conspiracy-minded crowd it did give the impression of a cover up, and is still incorrectly used as evidence that the powers that be knew all along that mercury was dangerous.
It has been difficult to convince many of the ardent believers that there is no thimerosal-autism link. And I think the withdrawal has at least given them another weapon (albeit an unfair one) in their continued attack on reason. I suspect that, as the mountain of evidence grows even higher, a new culprit will emerge (aluminum is already rearing it’s head). We must continue to keep our guard, but rational thought has never been much of a match for dogmatism and blind irrational belief.
Good stuff! There were a couple of points in your third bullet point that grabbed me (safety factors, the fact that the RfD is based on life-time exposure, the differences between ethyl- and methyl- mercury). I had wondered about the calculation of safe levels of mercury and what sort of uncertainty factor had been used in this calculation - the EPA pages on methylmercury make for interesting reading.