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Yet another nail in the coffin of the myth that the MMR vaccine causes autism

Arguably, the genesis of the most recent iteration of the anti-vaccine movement dates back to 1998, when a remarkably incompetent researcher named Andrew Wakefield published a trial lawyer-funded “study” in the Lancet that purported to find a link between “autistic enterocolitis” and measles vaccination with the measles-mumps-rubella (MMR) trivalent vaccine. In the wake of that publication was born a scare over the MMR that persists to this day, 11 years later. Although peer reviewers forced the actual contents of the paper to be more circumspect, in the press Wakefield promoted the idea that the MMR vaccine either predisposes, causes, or triggers autistic regressions. Even though over the next several years, investigations by investigative journalist Brian Deer revealed that not only was Wakefield’s research funded by trial lawyers looking to sue vaccine manufacturers for “vaccine injury” when he did his research (for which he is now being charged by the U.K.’s General Medical Council with scientific misconduct), but during the Autism Omnibus trial testimony by a world-renowed expert in PCR technology showed that he was incompetent. Even worse for Wakefield, in February 2009 Brian Deer published a news expose based on strong evidence that Wakefield may very well have falsified data for his Lancet paper.

None of this mattered. Andrew Wakefield still enjoys a cult of personality among the anti-vaccine crowd that no revelation seems able to dislodge, even the revelation that at the time he was both in the pay of trial lawyers and working on his study, Andrew Wakefield was also applying for a patent for a rival measles vaccine. Indeed, the anti-vaccine propaganda blog Age of Autism bestowed upon him last year its “Galileo Award” as the “persecuted” scientist supposedly fighting for truth, justice, and anti-vaccinationism against the pharma-funded or brainwashed minions of the “Church of the Immaculate Vaccination.” In the meantime, MMR uptake rates in the U.K. have plummeted over the last decade, far below the level needed for herd immunity, to the point where, last year the Health Protection Agency declared measles to be once again endemic in the U.K., 14 years after the local transmission of measles had been halted.

Since Wakefield’s study was released, a number of studies have shown that there is no epidemiologically detectable link between vaccination with MMR and autism, including one by a researcher who once appeared to be a believer in the idea that vaccines are somehow linked with autism, Mady Hornig. Hornig actually tried very hard to replicate Wakefield’s 1998 Lancet study, only this time with more children, and she found no link between MMR and autism using methodology similar to Wakefield’s. None of these studies has had any effect on the anti-vaccine movement, except to motivate them to circle the wagons even more, as J.B. Handley of Generation Rescue did when he launched a website called Fourteen Studies, whose purposes are to launch fallacious and pseudoscientific attacks on studies failing to find a link between vaccines and autism (often involving accusations of being a “pharma shill”), to promote the lousy science that gives the appearance of supporting the hypothesis that there is a link between the MMR vaccine and autism, and then slime anyone who points out how deceptive their attacks were.

Now, yet another study has been released studying whether there is a link between MMR vaccination and autism. Yet another study has failed to find a link between MMR vaccination and autism. Yet another study is all set to be attacked by Generation Rescue and the anti-vaccine movement. The sad and sordid history of reactions of the anti-vaccine movement to studies that do not support its belief in the unsinkable rubber duck of a myth that vaccines cause autism. This study was published online in The Pediatric Infectious Disease Journal by a group from Department of Epidemiology and Preventive Medicine, Jagiellonian University, Collegium Medicum, Krakow, Poland (a Polish group, my people!) and entitled Lack of Association Between Measles-Mumps-Rubella Vaccination and Autism in Children: A Case-Control Study. It’s yet another nail in the coffin of the myth that the MMR causes or contributes to autism. Indeed, this study not only shows that MMR vaccination is not associated with autism but that it may even be protective against autism. True, for reasons I will discuss shortly, I doubt that that latter interpretation is true, but there’s no doubt that this study is powerful evidence against the view that there is an association between MMR and autism. Unfortunately, I fear that all the nails in my local Home Depot would not be enough to keep the zombie of this pseudoscience from rising from its grave yet again.

Here’s the abstract of the paper:

OBJECTIVE: The first objective of the study was to determine whether there is a relationship between the measles-mumps-rubella (MMR) vaccination and autism in children. The second objective was to examine whether the risk of autism differs between use of MMR and the single measles vaccine.

DESIGN: Case-control study.

STUDY POPULATION: The 96 cases with childhood or atypical autism, aged 2 to 15, were included into the study group. Controls consisted of 192 children individually matched to cases by year of birth, sex, and general practitioners.

METHODS: Data on autism diagnosis and vaccination history were from physicians. Data on the other probable autism risk factors were collected from mothers. Logistic conditional regression was used to assess the risk of autism resulting from vaccination. Assessment was made for children vaccinated (1) Before diagnosis of autism, and (2) Before first symptoms of autism onset. Odds ratios were adjusted to mother’s age, medication during pregnancy, gestation time, perinatal injury and Apgar score.

RESULTS: For children vaccinated before diagnosis, autism risk was lower in children vaccinated with MMR than in the nonvaccinated (OR: 0.17, 95% CI: 0.06-0.52) as well as to vaccinated with single measles vaccine (OR: 0.44, 95% CI: 0.22-0.91). The risk for vaccinated versus nonvaccinated (independent of vaccine type) was 0.28 (95% CI: 0.10-0.76). The risk connected with being vaccinated before onset of first symptoms was significantly lower only for MMR versus single vaccine (OR: 0.47, 95% CI: 0.22-0.99).

CONCLUSIONS: The study provides evidence against the association of autism with either MMR or a single measles vaccine.

Indeed it does. It’s worth talking a bit about the methodology of the study. First of all, this is a case control study, which means that it’s retrospective and therefore not randomized. On the other hand, it was a case control study by Sir Richard Doll that was the first outside of Nazi Germany (whose scientists, oddly enough, had found evidence linking smoking to lung cancer more than two decades before the Surgeon General issued his report in 1964) to find an association between tobacco smoking and lung cancer, a finding that was subsequently followed up in cohort studies and found to be valid. Be that as it may, case control studies, instead of prospectively following a population over time, study a population of patients who already have a disease or condition and then try to identify factors associated with the development of that condition. Basically, this involves picking a control population that is equivalent to the study population, and this is how the investigators did it:

Subjects were identified using general practitioner records in the Lesser Poland (Małopolska) Voivodeship in Poland. The sample population of this study included children aged 2 to 15 years diagnosed with childhood or atypical autism, classified according to ICD 10-criteria as F84.0 or F84.1, respectively. Every diagnosis of autism was made by child psychiatrist. Dates of these diagnoses were recorded in general practitioners files. Cases with uncertain diagnosis of autism, secondary to disease state or trauma, were excluded. Two controls were selected for each affected child, individually matched by year of birth, gender, and physician’s practice. The first 2 children visited the physician after the time of the autistic child visit who met entry criteria served as controls.

This is a reasonable strategy to use to pick the control group, as it means that the children would be coming from the same pediatric practices as the autistic children and would be about as comparable as it is possible to make them in this sort of trial design. Another strength of this study is that it used physician reporting for vaccination history and the age at which each autistic child was first diagnosed, rather than relying on parents’ reporting, which is prone to serious confirmation bias. True, the parents were also asked when they first suspected their child’s symptoms might be related to autism, and their knowledge and beliefs regarding the cause of autism, but vaccination was not mentioned in order to avoid biasing the parents’ answers. Cases of autism were then analyzed and considered to have been vaccinated if they received the MMR prior to the onset of autistic symptoms. Controls were considered vaccinated if they had received the MMR before the age of onset of their matched case controls. Finally, the authors corrected for other potential risk factors for autism, including mother’s age, education, gestation time, medications during pregnancy perinatal injury, and the APGAR score of the child at birth. Those that appeared significant in univariate analyses were then subjected to multivariate analysis.

The money tables are Table 3 and Table 4:

Table 3

Table 4

What’s surprising about these results is that the multivariate analysis found a relative risk (RR) of autism for children vaccinated with any vaccine before the onset of autistic symptoms of 0.65 and 0.28 for children vaccinated before their “official” diagnosis of autism. When looking at the single vaccine for measles or the trivalent MMR vaccine, both appeared to be protective against autism, but the MMR appeared to be considerably more protective than the single shot measles vaccine. (This comparison could be made because the Polish national health service only covered the single dose measles vaccine and not the MMR until 2004, meaning that before 2004 parents who wanted the MMR vaccine had to pay extra.) Indeed, this study evne found that for children vaccinated with MMR before their diagnosis of autism the RR = 0.17, suggesting a six-fold decreased risk of autism in children vaccinated with MMR!

Is this really true? Is MMR vaccination really that protective against autism? Probably not. An effect of that magnitude would very likely been picked up in one or more of the large population-based studies that failed to find a correlation between vaccines and autism. There is also one shortcoming in this study is that it only looked at autistism and not other pervasive developmental disorders; however there is ample other evidence that MMR is not associated with PDDs other than autism, and the original claim of the anti-vaccine movement was that MMR causes autism. So how to explain such a result? One possibility is simply random chance, given that the sample size, although reasonable, is not that large. Another possibility is that there is a confounder that wasn’t adequately controlled for. Whatever the case, here’s one thing to remember about retrospective studies in general. They often find associations that later turn out not to hold up under study using prospective studies or randomized trials or, alternatively, turn out to be much weaker than the retrospective study showed. They do not so often find a result that is exactly the opposite of hypothesis tested for. In other words, when such a study is used to look for a positive association between a factor and a specific condition or disease, it is quite uncommon to find a negative association, particularly one this strong. One possible reason for this seeming protective effect observed was discussed by the authors:

The decreased risk of autism among vaccinated children may be due to some other confounding factors in their health status. For example, healthcare workers or parents may have noticed signs of developmental delay or disease before the actual autism diagnosis and for this reason have avoided vaccination.

I have speculated before that a study of “vaccinated” versus “unvaccinated” children could be similarly confounded by parents who have one autistic child, become convinced that vaccines caused it, and therefore don’t vaccinated subsequent children that they might have. The main point to remember is that, even though this study is not compelling evidence that MMR is protective against autism, at the very least, the Polish study is strong evidence against a positive correlation between vaccination with MMR or single vaccination against measles and the development of autism. It is yet another pebble in the mountain of evidence that vaccination with MMR is not associated with autism or “autistic enterocolitis.”

It’ll be fun to see how long it is before Handley adds this study to his “Fourteen Studies” website and renames it “Fifteen Studies.” Of course, at the rate studies failing to support Generation Rescue’s cultish clinging to the unsinkable rubber duck of a belief that vaccines cause autism, Handley will have to rename his site every few months at least, and either I or one of my partners in crime here at SBM will have to slap down yet another scientifically ignorant attempt at discrediting each new study.

On and on it goes. Meanwhile, autistic children pay the price for quackery related to anti-vaccine beliefs, and normal children face the resurgence of vaccine-preventable diseases, thanks to the efforts of anti-vaccine cranks like J.B. Handley, Jenny McCarthy, Jim Carrey, Barbara Loe Fisher, and the rest of the vaccine denialists.

Posted in: Clinical Trials, Vaccines

Leave a Comment (33) ↓

33 thoughts on “Yet another nail in the coffin of the myth that the MMR vaccine causes autism

  1. Grinch says:

    Dr. Gorski,
    Wonderful article. Thank you. Unfortunately, it will never penetrate the dense concrete blocks of the antivaxers. What’s worse is that the doctors on TV, the medical corespondents, will never hit as hard (with such passion) as the other corespondents do with “crashergate” or whatever other “gate” out there. It’s unfortunate and even pathological, when antivaxers are taken as mainstream. This, however, is not unusual, our media has gone by the way-side, while Carrey and McCarthy lob these “grenades” without being challenged.
    Anyway, thanks for the extra ammo in my arsenal.

  2. dt says:

    Potential confounders….
    Parents who have an older child with a history of autism or neurological problems may chose to not vaccinate or to give single measles vaccine to the younger child in the mistaken assumption they will be protecting it. Yet because autism has a genetic component, this chold will be more at risk.
    Was this looked for in the study?

  3. Harriet Hall says:

    Where are those sensationalist journalists when you need them? This should be trumpeted all over the media as “New Study Shows that MMR Prevents Autism!” :-)

  4. Matt says:

    Thanks for blogging this.

    It isn’t the best study in the world. But it is far from the worst! It does show that a vaxed/unvaxed study could very well show the opposite of what groups like Generation Rescue want to see.

    I do wonder how they will approach this study. My guess is that they will ignore it until they are forced to comment on it.

    They are probably looking for anyone who can read Polish right now to try to dig up any dirt they can on the authors.

  5. Scott says:

    More likely they’ll blast it for the cluelessness of thinking that looking at MMR is actually relevant. After all, we ALL know that it’s really “too many too soon”. Or no, it’s the aluminum. No wait, the squalene. Formaldehyde, maybe?

    I just can’t keep track of where the goalposts are this week.

  6. BA says:

    Though there are some weaknesses in the study, it adds to the story of the general literature which shows the MMR-autism nonlink. I see the nature of selecting controls was the next two children that visited the practice. One (unlikely) confound I’d also consider was whether the unvaccinated/single vax measles groups would be of lower socio-economic standing. That is, those opting for MMR would be families with more resources. Why I think this is unlikely is these wealthier families would presumably have more resources to bring to bear on diagnostics for developmental concerns.

    I always, in fact, have thought of the MMR as an anti-autism vaccine given research (starting back in the 70′s) that associated congenital rubella with a higher likelihood of autism.

  7. Watcher says:

    I just can’t keep track of where the goalposts are this week.

    Doesn’t matter. As long as they keep moving it’s all good.

  8. SF Mom and Scientist says:

    These studies actually make me kind of depressed. The fact that, yet again, we spend time/money/resources to prove, yet again, that MMR does not cause autism. For those of us who believe in science, this is truly another pebble on a mountain of evidence. For those religiously anti-vaccination, it will not do anything to change their minds. It just seems like a huge waste to me.

  9. Kausik Datta says:

    Echoing SF M&S, how many more nails are needed for this particular coffin, and why? I would have thought that the corpse of the MMR-autism myth is already putrescent, and it is way beyond high time that this coffin was interred.

    Yet, the myth thrives on. It lasts because of some celebrity pressure, pseudo-science and fear mongering, cleverly done PR, and ample funding coming by way of religious groups.

    The other day I was fortunate to attend a lecture by Paul Offit at the U Maryland School of Medicine. He did a great job of detailing the genesis of the anti-vaccination movement, and ended his lecture by indicating that the only way to battle this is to keep up the pressure by producing more and more data that debunks this myth.

    But at what cost to the taxpayer? Who bears the burden of the superfluous studies to re- and re-re-invent the same wheel over and over?

    Dr. Offit shared an interesting experience. Apparently, aside from the hate mail and death threats, he always receives gratitude, encouragement and good-wishes from pro-vaccination, pro-science parents and individuals. With their consent, he has repeatedly offered various news-media and websites their contact information so that pro-vaccination side of the story could come out, and could be used to counter the anti-vaccination propaganda.

    Alas! None of the media was interested in those, because apparently… wait for it… there was just information, not enough entertainment, in the pro-vaccination stories!

  10. provaxmom says:

    “”But at what cost to the taxpayer?”"

    I don’t worry about the costs to the taxpayer, but the costs to autistic people.

  11. Scott says:

    Alas! None of the media was interested in those, because apparently… wait for it… there was just information, not enough entertainment, in the pro-vaccination stories!

    It seems to me that this blows all the pious assertions that they’re just providing “balance” out of the water.

  12. reynaud 5 says:

    Dr. Korski,

    Disclosure: I am a parent of two children. I work in the medical profession at the graduate level (but I am not an MD). Yes, I did vaccinate my children. No, my children do not have any ASD.

    I am not an advocate of MANY of the methods that Andrew Wakefield utilized to execute his case report published in The Lancet in 1998 (who could be?). Much of his conduct was/is -astonishingly- inappropriate. You have rightfully called him to the mat for his conduct. Yet, I wonder if the underlying finding of his case report (colitis in ASD children) will ultimately be replicated, and demonstrated to be accurate? [Your comment please!]

    In addition, lost in the media circus that erupted around Wakefield’s “early report” of only 12 (!) children is the apparent fact that the 1998 case report by Dr. Wakefield, Professor Walker-Smith and Professor Murch (et al.) published in The Lancet did not state that the MMR vaccine causes autism.

    The Lancet case report reads, quote, “We did not prove an association between measles, mumps, and rubella vaccine and the syndrome (autistic enterocolitis) described.” The Lancet case report ends with a call for additional research. [Which I believe is appropriate.] “We have identified a chronic enterocolitis in children that may be related to neuropsychiatric dysfunction. In most cases, onset of symptoms was after measles, mumps, and rubella immunisation. Further investigations are needed to examine this syndrome and its possible relation to this vaccine.”

    I ask, if the case report by Wakefield, Walker-Smith, and Murch published in The Lancet did not say MMR vaccine causes autism, what did some of the co-authors partially retract in 2004?

    It seems nothing. Some of the original co-authors partially retracted an interpretation despite the fact that it never existed in the case report. The co-author’s partial retraction reads, “We wish to make it clear that in this paper no causal link was established between MMR vaccine and autism as the data were insufficient. However, the possibility of such a link was raised and consequent events have had major implications for public health. In view of this, we consider now is the appropriate time that we should together formally retract the interpretation placed upon these findings in the paper, according to precedent.”

    In sum, 11 of 13 authors issued a retraction of the interpretation that MMR is a possible trigger for syndrome described. This remains a possibility and a possibility cannot be retracted. [Your comment, please.]

    Dr. Korski, this is my current viewpoint. I support a robust universal vaccination policy. Anything less is recklessly irresponsible. And, of course there are no data indicating a causal relationship between the MMR vaccine and autism, or for that matter, any vaccine and autism. But, I am an advocate for a vigorous, proactive, vaccine safety policy (I think pulling Thimerisal out of pediatric vaccines was a prudent and wise action in concert with the Precautionary Pricipal and the Hippocratic Oath). Do I believe personally that there could not be any kind of relationship between any vaccine component and any kind of neurological disorder, injury, or impairment? I don’t know. I submit that no one knows. Not now. I submit that there is a lot to learn in the 21st century about the etiology of Autism.

    With considerable exposure to ASD due to my work, I have come to believe that Autism is a complex disorder affecting the neurological and immunological systems of children (and in some ASD children, profoundly, the gastrointestinal system); and that the etiology of Autism is most probably complex. Of course, “genetics” plays a profound role in the etiology of Autism, as it does in many disorders and disease. But I do not believe that it is accurate to say that genetics “causes” autism. In terms of “the cause” of Autism, I believe it is highly probable that there are multiple causes (variables), and I believe that genetics and environment are interacting in complex ways. As some epidemiologists have remarked, “Genetics loads the gun. Environment pulls the trigger.” With regard to Autism, could it be an environmental insult -or quite possibly a combination of environmental insults- that trigger the development of ASD in a subset of the pediatric population? If so, who should we consider the leading suspects? Organophosphate herbicides, heavy metals, ubiquitous industrial pollutants/toxins, novel viral pathogens, ingested mercury from food sources (tuna, etc.), mercury from coal-fired power plants, injected mercury from prenatal RhoGAM or flu shots, injected aluminum from vaccines, increased antibiotic use? A combination of several? Could there be a neurological/immunological insult as an outcome of synergistic effect and/or cumulative exposure and load?

    I find it hard to entirely dismiss the concern of several compelling individuals (all pro-vaccine of course). Bernadine Healy, MD (Harvard, former head of NIH); Jon Poling MD, PhD (Department of Neurology and Neurosurgery, Johns Hopkins); Irva Hertz-Picciotto PhD, MPH (UC Davis MIND institute); and Thomas Insel MD (Director of the National Institute of Mental Health and Chair of the federal government’s Interagency Autism Coordinating Committee (IACC), tasked with recommending funding priorities for autism research and services). All have recently stated that they suspect that the etiology of autism most probably involves an environmental
    component or trigger. All have stated we should keep an open mind and not stifle biological investigations into the etiology of Autism.

    What do you think? I sincerely await your comment and insight with appreciation.

  13. reynaud 5 says:

    Dr. Gorski,

    I apologize for the misspelling of your name!

  14. Harriet Hall says:

    The text of the Wakefield study clearly said it had not proved an association between MMR and autism. But Wakefield immediately held a press conference and told the world MMR probably causes autism and advised that everyone should stop using the triple vaccine and use individual ones. Individual vaccines were not available in the UK at that time, so children simply went without and endemic measles returned to the UK. Wakefield had applied for a patent for a separate measles vaccine – a conflict of interest which he failed to disclose.

    I can’t give the citations, but it’s my understanding that subsequent research showed no association between autism and bowel disease or MMR and bowel disease.

    If you want the whole story, read Paul Offit’s book “Autism’s False Prophets.”

  15. Joe says:

    I think this is the latest on Wakefield
    http://forums.randi.org/showthread.php?t=165917

  16. reynaud 5 says:

    Dr. Hall,

    But, that’s just it. It seems the key finding (chronic colitis found in ASD children) that Dr. Wakefield reported in his “early case report” published in The Lancet (in 1998) HAS been replicated by other medical researchers. (Interestingly, investigations are taking place in multiple other countries: Italy, Canada, USA, and Venezuela.) As I read these papers, I find them hard to entirely dismiss.

    Balzola, F., et al., Autistic enterocolitis: Confrmation of a new infammatory bowel disease in an Italian cohort of patients. Gastroenterology 2005;128(Suppl. 2);A-303.

    Balzola, F., et al., Panenteric IBD-like disease in a patient with regressive autism shown for the first time by wireless capsule enteroscopy: Another piece in the jig-saw of the gut-brain syndrome? American Journal of Gastroenterology, 2005. 100(4): p. 979-981.

    Galiatsatos, P., et al., Autistic enterocolitis: Fact or fiction. Canadian Journal of Gastroenterology. 2009;23:95-98.

    Gonzalez, L., et al., Endoscopic and Histological Characteristics of the Digestive Mucosa in Autistic
    Children with gastro-Intestinal Symptoms. Arch Venez Pueric Pediatr, 2005;69:19-25.

    Krigsman, A. et al., Clinical presentation and Histologic Findings at Ileocolonoscopy in Children with Autistic spectrum Disorder and Chronic Gastrointestinal symptoms. Autism Insights 2010:2 1-11.

    Respectfully,

    (Dr. Hall, BTW, my late father was a family practice MD for over 40 years, University of Illinois. Thank you for your service to families and in the Air Force).

  17. Chris says:

    Dr. Hall, here is one recent paper: Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study.

    For a good indepth analysis of the MMR/Autism hoax, reynaud 5, head over to Ben Goldacre’s blog, especially the one with a link to the MMR chapter in his excellent book Bad Science.

  18. reynaud 5 says:

    Dr Gorski, Dr. Hall:

    In addition:

    Horvath K., et al., High prevalence of gastrointestinal
    symptoms in children with autistic spectrum disorder (ASD). J
    Pediatr Gastroenterol Nutr 2000, 31:S174. And Melmed, R., et
    al., Metabolic markers and gastrointestinal symptoms in children
    with autism and related disorders. J Pediatr Gastroenterol Nutr
    2000, 31:S31–S32. And Horvath, K. and Perman, J., Autistic
    disorder and gastrointestinal disease. Current Opinion in
    Pediatrics 2002, 14:583–587. And Furlano, R., et al., Quantitative
    immunohistochemistry shows colonic epithelial pathology
    and γδ-T cell infiltration in autistic enterocolitis. J Pediatrics
    2001;138:366-372. And Torrente, F., et al., Enteropathy with T
    cell infiltration and epithelial IgG deposition in autism. Molecular
    Psychiatry. 2002;7:375-382. And Torrente, F. et al., Focalenhanced
    gastritis in regressive autism with features distinct from
    Crohn’s and helicobacter pylori gastritis. Am. J. Gastroenterol.
    2004;4:598-605. And Ashwood, P. et al., Intestinal lymphocyte
    populations in children with regressive autism: Evidence
    for extensive mucosal immunopathology. J. Clin. Immunol.
    2003;23:504-517. And Ashwood. P., et al., Spontaneous mucosal
    lymphocyte cytokine profiles in children with regressive autism
    and gastrointestinal symptoms: Mucosal immune activation and
    reduced counter regulatory interleukin-10. Journal of Clinical
    Immunology. 2004:24:664-673. And Wakefield, A., Enterocolonic
    encephalopathy, autism and opioid receptor ligands.
    Alimentary Pharmacology & Therapeutics. 2002;16:663-674.
    And Uhlmann, V., et al., Potential viral pathogenic mechanism
    for new variant inflammatory bowel disease. Molecular Pathology
    2002;55:84-90. And Sabra. A., et al., Ileal-lymphoid-nodular
    hyperplasia, non-specific colitis and pervasive developmental
    disorder in children. The Lancet, 1998;352:234-235. And Sabra,
    A., et al., Linkage of ileal-lymphoid-nodular hyperplasia (ILNH),
    food allergy and CNS developmental: evidence for a non-IgE
    association. Ann Allergy Asthma Immunol, 1999;82:8. And
    Valicenti-McDermott M., et al., Frequency of gastrointestinal
    symptoms in children with autistic spectrum disorders and
    association with family history of autoimmune disease.
    Developmental and Behavioral Pediatrics. 2006;27:128-136.
    And Richler, J., Luyster, R., Risi, S., Hsu, Wan-Ling, Dawson, G.,
    Bernier, R., et al., Is there a ‘regressive phenotype’ of autistic
    spectrum disorder associated with the measles-mumps-rubella
    vaccine? A CPEA study. Autism Dev. Dis. 2006, 36:299-316. And
    Sandler, R., Short-term benefit from oral vancomycin treatment
    of regressive-onset autism. J. Child Neurol. 2000;15:429-435.
    And Parracho, H., Differences between the gut flora of children
    with autistic spectrum disorders and that of healthy children.
    Journal of Medical Microbiology. 2005;54:987-991.

    —I do NOT believe that the MMR vaccine causes Autism (because there is zero compelling evidence that it does). And there certainly is no data that indicates a causal relationship. The etiology of Autism is undoubtedly complex. But, is it possible that the MMR can cause, or contribute to the cause of, the development of gastrointestinal disorder, injury, or impairment within a small subset of the pediatric population? It seems it is possible. Given the preliminary findings of the investigations cited above, it seems reasonable that more biological-based studies are called for.—

    Respectfully,

  19. Chris says:

    The papers given:
    Balzola, F., et al., Autistic enterocolitis: Confrmation of a new infammatory bowel disease in an Italian cohort of patients. Gastroenterology 2005;128(Suppl. 2);A-303
    …. was not found in PubMed…

    Balzola, F., et al., Panenteric IBD-like disease in a patient with regressive autism shown for the first time by wireless capsule enteroscopy: Another piece in the jig-saw of the gut-brain syndrome? American Journal of Gastroenterology, 2005. 100(4): p. 979-981.
    …. no abstract, looks like a case report in a letter

    Galiatsatos, P., et al., Autistic enterocolitis: Fact or fiction. Canadian Journal of Gastroenterology. 2009;23:95-98
    … two case reports…

    Gonzalez, L., et al., Endoscopic and Histological Characteristics of the Digestive Mucosa in Autistic
    Children with gastro-Intestinal Symptoms. Arch Venez Pueric Pediatr, 2005;69:19-25.
    …. not found on PubMed…

    Krigsman, A. et al., Clinical presentation and Histologic Findings at Ileocolonoscopy in Children with Autistic spectrum Disorder and Chronic Gastrointestinal symptoms. Autism Insights 2010:2 1-11.
    …… I know this will not be indexed at PubMed because it is published in a non-peer reviewed journal created just to publish papers favorable to Wakefield. This is the missing but often vaulted research from Krigsman, spoken often in the MMR Hoax chapter of Ben Goldacre’s book Bad Science (you can download that chapter on his blog, I linked to it in a comment I made an hour ago, but it seems to have not made been posted).

  20. Chris says:

    Oh, good that got posted. I am not going to attempt the wall of text listing of “studies.” Since I suspect the results will be similar, they are either small case studies, letters to the editor, speculations or published in vanity journals similiar to “Autism Insights.” For more on that journal:
    http://leftbrainrightbrain.co.uk/2010/01/autism-insights-another-journal-for-questionable-autism-research/

    Also, you need to look at all of the research, not just the ones you agree with. You might look at Mady Hornig’s paper Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study. Which is indexed on PubMed, and actually free to read at the Public Library of Science.

  21. Zoe237 says:

    Is there any association between measles itself and bowel disease?

  22. Danio says:

    Zoe237, there is no evidence to support this link. A little poking around on PubMed suggests the typical case of small studies with shoddy methods showing a possible association which is not supported by subsequent, larger/better studies.

    In case you missed it here’s a nice explanation of evidence (or manipulation thereof) for ‘autistic enterocolitis’ as described by Wakefield:

    http://scienceblogs.com/insolence/2007/06/the_autism_omnibus_the_difference_betwee.php

  23. David Gorski says:

    Is there any association between measles itself and bowel disease?

    There does not appear to be. Mady Hornig, for instance, recently tried to replicate Andrew Wakefield’s study and found no evidence. The studies that reynaud 5 listed are pretty much all crap, but I don’t have time to march through each and every one now. The dude needs to learn how to put line breaks in his list of references, too.

    BTW, stay tuned. Monday’s post is about the GMC’s ruling on Andrew Wakefield. :-)

  24. reynaud 5 says:

    Dr. Gorski, did I ever address you or refer to you as “dude”?

    Sorry for posting the citiations as I did. I posted them as I found them.

    Could every one of the individuals who conducted all of the studies cited above be “crap” medical professionals (MPH, PhD, & MDs)? I ask that sincerely. The probability that every single one of those studies is invalid and that they are all “crap” seems unlikely.

    Chris, Thank You for providing the link to Ben Goldacre’s blog and the reference to his book Bad Science, and Mady Hornig’s paper. That is very helpful. I will dive into those next.

    “And, you need to look at ALL of the research….” Of course. Of course. We all do. The tenets of medicine, and standards of care, are always evolving.

  25. Zoe237 says:

    “Is there any association between measles itself and bowel disease?

    There does not appear to be. Mady Hornig, for instance, recently tried to replicate Andrew Wakefield’s study and found no evidence. The studies that reynaud 5 listed are pretty much all crap, but I don’t have time to march through each and every one now. The dude needs to learn how to put line breaks in his list of references, too.”

    Thanks. I just wondered where they got the idea of MMR/bowel link, if kids who had measles in the ’50s had those symptoms or something.

  26. reynaud 5 says:

    Zoe237,

    “I just wondered where they got the idea of MMR/bowel link.“ No, I do not believe that there were reports of children who had contracted measles in the 1950s (or in any other time period)presenting GI disorder symptomology. Rather, reports of profound GI distress (by their parents) in children with autism began surfacing in the ‘80s and ‘90s. This does NOT mean there is a causal relationship between the MMR jab and colitis in some children (I doubt it). It may just mean that GI disorders (e.g., colitis, lymphoid nodular hyperplasia) are a symptom of ASD in some children (or not). This is being investigated right now. Time will tell.

  27. Chris says:

    Please remember that Wakefield’s notorious 1998 paper only really claimed there was measles virus in the gut of those children.

    Why would it matter if the measles in the gut was from getting measles, the single measles vaccine or the MMR vaccine? And if it is the MMR, why not start in the 1970s when it was being used in the USA and other countries?

    Especially when it was not there, the PCR results were false positives — when Wakefield was told this he still went with the false data. You can read about in the this testimony (it is in the first dozen pages):
    ftp://autism.uscfc.uscourts.gov/autism/transcripts/day10.pdf

    Here it is (from a transcription on the LeftBrainRightBrain blog):

    Q Okay. Did you personally test the gut biopsy samples for measles RNA?
    A Yes.

    Q What tests did you perform?
    A A PCR test, a polymerase chain reaction.

    Q What results did you receive from the gut biopsy materials for measles RNA?
    A They were all negative.

    Q They were always negative?
    A Yes. There were a few cases of false positive results, which I used a method to see whether they were real positive results or false positive, and in every case they turned out to be false positive results. Essentially all the samples tested were negative.

    …….

    Q So you personally tested while you were in Dr. Wakefield’s lab gut biopsy material, CSF and PBMCs?
    A Yes, that’s right.

    Q And all the results were either negative, or if they were positive it always turned out that they were false positives?
    A Yes, that’s correct.

    Q Did you inform Dr. Wakefield of the negative results?
    A Yes. Yes.

  28. Chris says:

    As I am going through the blogs between folding loads of laundry, I encountered today’s skeptico.blogs posting, where he posted a new review of the data:
    http://pediatrics.aappublications.org/cgi/content/full/125/Supplement_1/S1

    Gastrointestinal problems are not limited to autistic children. My sister was born two months premature in the early 1960s, and she started with terrible problems. Turns out she was also born lactose intolerant (there is a genetic component, my daughter developed lactose intolerance as a teenager). Fortunately it was discovered fairly early on (this was the era of cloth diapers!), and she grew up perfectly normal as the one kid in any group who was not allowed to drink milk or eat cheese. She is a mom to a normal high school aged son, who is also lactose intolerant.

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