Childhood vaccinations and autism
There has been much recent news coverage of a case in which the parents of a child with autism believed vaccinations the child received contributed to the child’s problem. The parents, one of whom is a physician, even appeared on Larry King. There is also much discussion in the medical blogosphere, for example here and here. Amid all the controversy, it is important to understand that the circumstances of this case cannot be generalized to other children. The child had a previously undiagnosed genetic problem that may well have predisposed the child to develop reactions to many stresses, one of which could have been the battery of vaccines she received.
What can we learn from this? The particular case was settled without anybody proving or disproving the truth of any link between vaccines and autism. There is an enormously contentious debate about the validity of this link — books, websites, and thousands of pending cases claim there is one. For its part, the medical scientific community has produced a long list of studies showing no association.
What do I think about it? Parents today forget how many children commonly died in the past from things like whooping cough and diphtheria. In the PICU I still care for the occasional child who becomes deathly ill from whooping cough. My own family tradition in medicine goes back over a century, and both my father and grandfather would attest to how many children once died from these diseases. Parents today who choose not to vaccinate their children are, in effect, taking advantage of the vaccine-induced rarity of these infections in the population; if vaccine rates fall, the diseases come back quickly.
What should a parent who is concerned about vaccinations do? First, of course, discuss your concerns with your child’s physician. But also read about the controversy yourself, and don’t confine your reading to one viewpoint or the other. Recognize that some claims are just silly. For example, I have heard the argument that physicians have a financial interest in promoting vaccines; of course a few dollars for a shot of whooping cough vaccine can prevent a PICU bill of many thousands of dollars. Also recognize that some physicians are going to be plain unwilling to discuss the issue at all. That is also silly — those of us who believe that, on balance, vaccines are a positive good should be able to explain why we think so.
An interesting footnote to this case is that the child’s parents are not anti-vaccine; they advise other parents to vaccinate their children.