Monday, October 27, 2008

Heroes, Prophets and Presidential Candidates

Add candidates Obama and McCain to the national autism discussion. And, with that, add an unsettling note for vaccines during the next four years.

Earlier this month, we wrote about praise from an unusual quarter for Congressman Henry Waxman (D-CA). An American Enterprise Institute scholar called the Democrat a “hero” in the effort to reassure the country about the safety of childhood vaccines. Waxman was praised at a book review event for a new work tracing the history and misdirected arguments from the evangelists of a perceived new epidemic of autism (“Autism’s False Prophets,” Paul Offit).

Then, as a perfect example of how politically potent the subject of autism has become, the subject was raised by both candidates in the final presidential debate on Oct. 15.

Republican candidate McCain, who has previously suggested support for those arguing that a link exists between vaccines and autism, raised the issue first in the Oct. 15 debate. McCain discussed autism in relation to his choice of Sarah Palin as a running mate.

Palin “understands special-needs families,” McCain declared. “She understands that autism is on the rise, that we’ve got to find out what’s causing it, and we have to reach out to these families, and help them, and give them the help that they need as they raise these very special needs children.” [Note: Perceptive fact-checkers quickly clarified Palin’s familial relationship to the issue: she has a nephew who has autism.]

Not to cede the issue of caring about autism to his opponent, Obama jumped in when asked for a response on Palin’s qualifications: “I think it’s very commendable the work she’s done on behalf of special needs. I agree with that.”

But Obama said that McCain’s stated plan to freeze federal spending would make it impossible to conduct further work on autism research. “I do want to just point out that autism, for example, or other special needs will require some additional funding, if we’re going to get serious in terms of research.”

McCain returned to the subject of autism forty minutes later in the debate in a section on funding for education. He said again that vice-presidential candidate Palin “knows about” special educational needs and autism “better than most.” The Republican candidate promised that “we’ll find and we’ll spend the money, research, to find the cause of autism.”

As sensitive barometers of the hot political/social issues, the candidates confirm the potency of attention to autism. Both candidates are primed to pay attention to the disease from the White House. But because of the lingering public misperception of a link between vaccines, the political statements represent a discordant note for the public health effort and for the vaccine community from the upcoming election.

The “further research” approach to autism in the third debate, however, is an improvement, from the vaccine community’s point of view, over earlier references to concern about a relationship between the condition and vaccinations.

One current legislative push, under the sponsorship, of Manhattan Democrat Carolyn Maloney would require the National Institutes of Health to conduct comparative trials of vaccinated versus unvaccinated populations “to study and resolve the question of the possible link between thimerosal in vaccines and autism.”

A definite answer from a controlled clinical trial: that sounds like the best way to put lingering questions about the safety of vaccines to rest. But it is not as easy as it sounds.

George Washington University anthropologist and international affairs professor Roy Richard Grinker has devoted close attention to the issues of prevalence and incidence rates of autism. A father of an autistic daughter, in 2007, he wrote “Unstrange Minds: Remapping the World of Autism.

Grinker questions the fundamental assumption that there is an epidemic of autism. He maintains that the perceived change in prevalence rates in autism that is driving the public attention is not really a change in rates but stems from changes in diagnostic criteria and methods and an increase in the numbers of childhood psychologists doctors. He told an American Enterprise Institute event on autism on October 11 that comparing historic prevalence rates of autism to current rates is not comparing “apples to oranges,” it is more like comparing “apples to automobiles.”

Grinker also says that it will be very difficult, if not ethically impossible, to compare vaccinated versus unvaccinated populations. Some of the groups suggested as the unvaccinated arms are not unvaccinated.

“There is a myth out there that the Amish are unvaccinated,” Grinker says. “That is not the case: the Amish are vaccinated, probably at a rate similar to African-American communities in urban areas.” He noted that the population of unvaccinated children tends to be children with other issues (such as compromised immune systems) which will make them difficult to study.

The promise of more studies sounds good in a political campaign. Autism studies may even develop into a health priority during the next budget-strapped years. If Grinker is correct, however, the practical issues surrounding those studies will make them much harder to perform than to promise.

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