Moving Target:

The harrowing, ever-changing,

cynical, potentially paranoid, and possibly
irrelevant story of thimerosal, vaccines, and
autism.
 Joshua D. Feder, MD

Faculty, Interdisciplinary Council on Developmental and Learning

Disorders
Assistant Clinical Professor, Department of Psychiatry University of
California at San Diego, School of Medicine
 Why do we have
vaccines?
 Are infectious diseases all that bad?
 Mortality rates in the US over time -
infectious viral diseases have significant
role, overshadowed by accidents,
homicide, suicide, and cancer.
 Past plagues: The plague, smallpox, flu.
 Current plagues: HIV-AIDS, influenza,
risk of bioterror?
 Advances Against
Infectious

Disease:Vaccination
Cowpox vaccination - late 1700’s
 20th Century burgeoning of vaccines,
especially since the late 1960’s
 Common side effects: headache, malaise
 Less common:Guillian Barre-like syndromes,
allergic reactions.
 Rare severe ones including brain damage, but
connection with vaccines not clear.
 Wakefield 1998 - Lancet
 Theory: Ileal-Lymphoid Nodular Hyperplasia in
children w/ autism after MMR
 Countertheory: ILH is common, and it is non-
specific.
 Nevertheless touched off a storm of
controversy that has not ended, and raised
other questions, e.g., re Thimerosal.
 Theories and Concerns

 ‘Mercury poisoning looks like autism’, so

maybe mercury is a cause of autism.
 ‘Thimerisol breaks down to inorganic mercury
and goes to the brain’
 ‘Low glutathione in autism: less able to bind
and excrete the mercury’
 ‘Autism epidemic’ may be related to vaccines
 ‘We must protect our children’ and perhaps
that means avoiding vaccines
 Theories and
Countertheories…….
‘Mercury poisoning looks like autism’
vs.
‘the presentation is different’

 Generalized neurologic symptoms, delayed

symptoms possible; Pink’s Disease: teething
powders; The Mad Hatter
 Not really consistent with the specific
symptoms of autism
 Theories and
Countertheories…….

‘Thimerisol breaks down to inorganic mercury

and goes to the brain’
vs.
‘is it inert’

 “Toxic” designation, data not reproduced

 There are animal models and parallels to
methymercury
 It is bacterostatic
Mercury
Thimerosal
 Theories and
Countertheories…….

‘Low glutathione in autism: less able to bind and

excrete the mercury’
vs.
‘government studies show no neurological
problems
associated with exposure to mercury in vaccines’

 James J. Neurotoxicology 2005

 Thompson NEJM Sept 2007
Glutathione
 Theories and
Countertheories…….
‘Autism epidemic’ vs. ‘no epidemic’

 1/150 (0.67%) new and oft-cited

 12/10000 (0.12%) Wazana et al, June
‘07
 4/10000 (0.04%) old statistic
 Expanded diagnosis
 Shift of diagnosis
 IDEA/IEP
 Theories and
Countertheories…….
‘We must protect our children’
vs.
‘many people are out to make money, or they are
thinking emotionally and not scientifically’

 ‘Parents and health care providers are dedicated to

helping these kids, and to helping others’
 ‘Autism breeds desperation’ - doctors’ little to offer
 ‘Autism breeds treatments’ - easy to start a
business (not unique to Autism, see ADHD SPECT
Clinics)
 ‘Autism breeds lawsuits’ - families are frustrated,
attorneys are trained and paid to seek restitution
 Theories and
Countertheories and
Countercountertheories….
‘IOM: no clear evidence of harm’

vs.

‘Epidemiological studies show increasing autism

rates if you look at them the right way’
 Theories and
Countertheories and
Countercountertheories….
Suspicions of Foul Play

 Suppression of data?
 CDC influence on IOM?
 Drug Company Influence with CDC and in the
government?
 Suppression of negative drug studies in past
 Efforts to influence health professionals have
occurred
 Theories and
Countertheories and
Countercountertheories….
The California Study: Schecter Jan. ‘08

 Increase in ASD reported to DDS-CA, e.g., from

0.5 to 4.5 per 1000 5 year olds, between 1989
and 2003, on a steady rise with no change in
slope when thimerosal taken out of vaccines.
 Kirby: plumes of mercury vapor are coming
from China to California, AND maybe the
mercury is still there.
 Theories and
Countertheories and
Countercountertheories….
‘Little or no mercury in vaccines’
vs.
‘mercury is (still) in the vaccines’

 The number of vaccines has increased, with it

the dose of mercury.
 But since 1999 it’s been removed…
 Do HMO’s keep old doses in supply (more in
CA)?
 Do vaccine mfgr’s take significant time to
retool?
 February, 2008
A New Measles Outbreak
 Index case - unvaccinated 7 y/o travels to
Switzerland and returns with it.
 8 first generation then 3 second generation cases;
highly infectious; thankfully well contained this
time.
 Typical death rate is 0.013%, encephalitis 0.29%,
hospitalization 0.8%; would take about 80 cases to
expect a death.
 Unvaccinated rate in CA? Need > 90%; Switzerland
is 86% for one dose, 70% for second dose.
 March 2008 -
Vaccine Court Settlement
 19 month old girl has 5 shots, gets a fever,
refuses to walk, later diagnosed w/ autism
 Turns out to have a mitochondrial disorder
 ‘The government does not concede anything
re thimerosal’
 Hailed as ‘proof’ by some that vaccine theory
has merit.
 ‘Mitochondrial Disorder’

The Next Big Thing in Autism?

 Theory: vaccine creates stress on ‘system’,
pre-existing MD makes it hard to respond,
resulting in injury
 Now we check for mitochondrial disorders?
 MD as the new Celiac Disease?
 Chipping away at etiology: Tuberous Sclerosis,
Fragile X, LKS, now MD?
 ‘Mitochondrial Disorder’

It’s A Clinical diagnosis:

 Muscle, and motor problems, low tone, sensory
dysfunction, migraine, seizures, Single or
multiple organs, motor, may have periods of
deterioration, show up late or, commonly,
show no symptoms at all
 Supported by AST/ALT and alanine/lysine
ratios, urine markers of mitochondrial
dysfunction, muscle biopsy or check for
mutations in mitochondrial DNA
 How Far We Have Come
 Conflict to courthouse is not very far
 Communication is poor among factions
 Science is still lacking in many areas, e.g.,
finding evidence of mercury poisoning in
postmortem brain tissue
 Resources spent on questionable ideas?
 Genetics x Environment: Mitochondrial
Vulnerability? Toxins? Neuronal misdirection?
Relationships?
 What’s Next?

 Recommend seat belts, and helmets

 Get your flu shot
 We will likely do more screening
 And we will follow the moving target