By Perri L. Zinberg, Ph.D., Licensed Clinical Psychologist
A victory was won yesterday in the fight to protect the health of children in California. The California Senate voted in favor of SB 277, a bill that would eliminate the “personal belief exemption” for childhood vaccinations, and only provide exemptions based on medical reasons. This isn’t the final step. The bill must pass through the Senate education, judiciary, and appropriations committee; it must then pass in the committees in the state Assembly, and ultimately be signed by Governor Jerry Brown. This is part of the renewed effort by physicians, educators, and legislators to ensure that parents vaccinate their children in the wake of the measles outbreak started in Disneyland. Not surprisingly, this has been met with loud opposition by “anti-vaxxers”, who discourage current vaccination protocols or who are against vaccinating altogether.
That there is an argument against childhood vaccinations strikes me as bizarre. In all of medical science, there are few things that have done so much good and so little harm as vaccines. Articles are continuously appearing on social media warning of the dangers of vaccines, most citing yet again the fraudulent claim that autism is caused by Thimerisol (a mercury based preservative) in the MMR vaccine), or equally specious arguments about the causes behind the rising rates of autism.
Yes, the rates of diagnosed cases of autism have been rising, and will continue to do so. The reasons are NOT environmental, biochemical, or diet-related. There is a confluence of events that have resulted in the increase. Let me be clear: there is NO increase in the actual incidence of autism. There is only an increase in the number of cases that are recognized and diagnosed. There are clear and simple reasons for apparent rise in autism.
The increase in the number of diagnosed cases of autism is due to:
- The expanding definition of autism over the years to include increasingly milder, subtler symptoms, which apply to far more people.
- Psychologists, educators, and physicians are now better-educated regarding autism. They recognize the symptoms more readily, and refer more children for evaluation and treatment.
- The public – including parents- is more aware of the disorder due to media coverage, leading many more to bring their children in for evaluation.
- This confluence is enough to account for the increase.
There is no relationship between autism and vaccines. The 1998 report by Dr. Andrew Wakefield in “The Lancet” (British medical journal) started the fallacy that vaccines cause autism. The report has been proven false time-and-time again. In 2010 Dr. Wakefield was found guilty in a court of law of falsifying data and committing fraud, and it was found that he had financial incentives to publish fraudulent data. He had his medical license revoked, and the Lancet was forced to print a retraction.
There have been numerous metadata studies (a statistical examination of the data compiled from hundreds of studies globally); the determination was made that there is zero correlation between autism and vaccines or between autism and Thimerisol. The amount and type of mercury in Thimerisol is harmless. It is still used as a safe preservative in some multi-dose vaccines to prevent the growth of a deadly (not harmless!) fungus. Despite its safety and efficacy, Thimerisol was removed from all single-dose vaccines in 2001 as a result of public pressure in the aftermath of the Wakefield report. If Thimerisol caused autism, we would have seen a decrease in autism rates when it was removed from nearly all vaccines in 2001. We have seen the opposite.
To understand the change in rates of autism diagnoses, it’s important to know how diagnoses are made. Psychological and neuropsychological disorders are diagnosed according to a manual called the Diagnostic Statistical Manual of Mental Disorders (DSM), which was first published in the early 1950’s. This book is revised periodically; we are now on the 5th edition, DSM 5. In each revision, the criteria for various disorders may be changed, expanded, or eliminated. For example, homosexuality was originally considered a mental disorder in the 1950’s DSM. In subsequent versions it was changed to “ego-dystonic homosexuality”, until it was finally removed from DSM altogether.
Autism was originally a colloquial, non-clinical term for what the DSM called a “Pervasive Developmental Disorder” (PDD). This was an extremely severe, narrowly defined disorder that impacted a tiny portion of the population. In subsequent versions of the DSM, the definition was repeatedly expanded, to include milder and subtler symptoms – utilizing the term “autism”. In DSM IV-TR, Asperger’s (a disorder involving primarily social behavior) was not officially considered “autism”. In DSM 5, the diagnosis of Asperger’s was eliminated. Children diagnosed with Asperger’s are now included under the “autism” umbrella, and are given the new diagnosis of “Autism Spectrum Disorder” (ASD), which includes yet even more, subtler symptoms than before. To compound the issue, school districts have funded specific programs aimed at children with Autistic Spectrum Disorder (ASD) – which now includes children previously diagnosed with Asperger’s. There is sometimes encouragement to “label” a child with ASD so that they can receive services from school district. For example, if a child has severe ADHD or Bipolar Disorder, it will be more challenging for them to receive needed services at school; if they are re-diagnosed with ASD – they qualify for a host of free services. I have had college counselors suggest that I re-diagnose patients who have ADHD with ASD, because it will make it easier for the college to provide accommodations for the student (I declined of course, and pushed for appropriate accommodations related to the actual problem the student had).
For a thorough review of the changes in diagnosis of autism or ASD, go to: http://www.unstrange.com/dsm1.html
The unintended consequences of Wakefield’s report -and the celebrity endorsement of his views by Jenny McCarthy and Jim Carrey on the Oprah show- has been a decline in childhood vaccinations, ultimately leading to a resurgence of measles here in California, polio, and whooping cough. These diseases were eradicated prior to 1998. Because these diseases have been gone for so long, perhaps people have forgotten how deadly and terrifying they can be. I know that there are those people who will continue to believe that there is a link between autism and vaccines, or that there is a “Big Pharma” conspiracy to unnecessarily vaccinate children. Unfortunately, you cannot argue with belief. Science, however, doesn’t need you to believe. Vaccines work whether you believe in them or not.