The Age of Autism: Sick children

WASHINGTON, Apr 26, 2005 (United Press International) -- Dr. Elizabeth Mumper is an unlikely contrarian. Mumper is a pediatrician in the southern Virginia city of Lynchburg, best known as the home of the Rev. Jerry Falwell's Liberty Baptist University.

She graduated from the University of Virginia Medical School, where she was chief resident and today is associate professor of clinical pediatrics.

About a decade ago, Mumper said, she began noticing a change for the worse in the overall health of the children she was seeing, including a startling rise in cases of autism. Ultimately, Mumper came to suspect the increasing number of childhood vaccinations in the 1990s -- and particularly the mercury-based preservative called thimerosal in many of those vaccines -- was a big reason.

The federal government recommended phasing out thimerosal in childhood vaccines in 1999 as a precautionary measure, but health officials said the epidemiological evidence favored rejection of thimerosal, or any vaccine link, as a culprit.

Last week, Mumper was appointed medical director of the Autism Research Institute in San Diego, a group that suspects mercury -- and possibly some vaccines themselves -- are implicated in an alarming increase in childhood disorders. This weekend, she and several like-minded colleagues will outline their approach at a conference in Charlottesville, Va.

This first of two articles is the transcript of a United Press International interview with Mumper.

Q. What got you going on this line of thinking? As you know, mainstream medical groups, including the American Association of Pediatrics, have firmly rejected the idea that vaccines played any role in autism or other disorders. They also say that continuing to push this idea is dangerous -- not to mention a waste of money -- because parents might stop vaccinating their children. Many also believe there is no real increase in these disorders, just more diagnoses.

A. In the mid-1990s, I had a general intuitive sense, as a clinician who's walked into rooms with thousands of patients at this point, that children were sicker.

When I asked myself what I was seeing, I realized I was seeing more development problems; I was seeing more stuttering; I was seeing more speech and language issues; I was seeing more autism; I was seeing lots more ADHD (Attention Deficit Hyperactivity Disorder); I was seeing more asthma, more eczema -- all those sort of auto-immune allergic conditions.

I started having more diabetic patients. In this very small practice -- I've only got 1,700 patients -- I've got four insulin-dependent diabetics, and they're younger, diagnosed as young as 16 months old. The incidence of diabetes used to be something like one in 2,000 kids 15 years ago.

So, for me as a clinician, we shouldn't get hung up on questions like, "Is this really autism?" or "Is it Asperger's (a milder variation)?" or have we broadened the definition and included more neurologically damaged kids? The question should be: What has happened to 1 in 6 children in America that both the CDC and the American Academy of Pediatrics acknowledge have a neurodevelopmental disability?

That, to me, is the question.

Q. And that's more than it used to be?

A. Oh, yes. In Virginia, it's a 66-fold increase in ADHD since 1985. So, even if you say, "OK, maybe we're overdiagnosing half the cases, because the drug reps are visiting us all and pushing more meds, and we're writing out prescriptions for kids when they don't really have a problem" -- I could throw out half my ADHD cases and I've still got a huge increase that begs for an explanation.

Autism has increased 11-fold in Virginia since 1985. If you independently look at things like peanut allergies and asthma, those numbers are going up, too.

Now, how much of that is vaccine related, how much of that is environmental toxins or other factors? It quickly gets very, very, very muddy, but when you've got bench (laboratory) science that's looking at the mechanism of thimerosal toxicity and that for many, many years has documented all the horrible things mercury does to your immune system and your nervous system; and when you've got all these things that theoretically could be caused by a culprit like thimerosal; and the levels of thimerosal (in vaccines), the levels of Ritalin, the levels of autism, the levels of ADHD all follow the same curve in time, how can you not look at that in a compelling way?

Q. The Institute of Medicine, the Centers for Disease Control and Prevention, the Food and Drug Aministration and others say they have looked at it, and that the epidemiology basically refutes it. The IOM said autism research funding should now go to "promising" areas.

A. But when you look at the Danish study, which they use a lot to refute the thimerosal-autism connection, it's not analagous to the United States.

Danish children only received six doses of thimerosal-containing vaccines in the first year of life vs. 12 doses in the United States. The Danish study purported to show an increase in autism after thimerosal was removed in 1992, but the diagnostic criteria changed and they added in outpatient cases of autism, whereas previously they only counted inpatients with autism.

Secondly, epidemiology uses too blunt a tool to look for the connection in the first place. Clearly, thimerosal didn't make every kid (who was vaccinated) autistic, so when epidemiology does not look at genetic predispositions, you are not going to be able to tease out those subsets and make meaningful conclusions about them.

Epidemiology missed the folate connection to neural tube defects, but clinical science established the link.

Q. This is the deficit in pregnant women that can cause spina bifida (an opening in the back around the spinal cord)?

A. Right. So, why does epidemiology trump clinical science and bench science? That's the thing that I don't understand. Also, the epidemiology studies have to be designed to answer the question they're asked to answer. If the studies are designed one way, and then you go back 10 years later and try to use those studies to answer a question about thimerosal or mercury toxicity or MMR (the measles-mumps-rubella vaccine), or whatever, you can't expect to find answers to questions it wasn't designed for in the first place.

Epidemiology is a tool for public health, and clearly it has a place in making these decisions, but I don't think it should have trump power over all the rest. It's very frustrating to believe that clinical observations and individual case histories have something valuable to teach, and to be told "that's all anecdotal" and we don't see these kids when we look at large populations.

Well, come to my office, they're here every day. It's the most puzzling thing I've ever tried to wrap my mind around.