Jeff Bradstreet, MD

      I spent about 30 minutes talking to Christine Gorman from TIME magazine about this difficult subject. Obviously, what was printed represents a very small piece of that interview, and is highly edited by TIME to reinforce their perspective. Everyone who knows me, also knows the very public life led by my son Matthew. His laboratory findings are part of the Congressional Records of the Reform Committee Hearings from both 2001 and 2002. No one has more reason for concern about the MMR than I do, havingfound vaccine strain MV in my son’s bowel, blood and spinal fluid. Simultaneously, I know he developed seizures shortly after his second MMR vaccine, and that he lost precious developmental ground after each vaccine containing MMR. But MMR was never given to Matthew in isolation. He always had other vaccines – mercury containing vaccines given at the same or nearly the same time. How is it then that I am quoted as stating the MMR vaccine does not cause autism?

Before getting into details about my position regarding the NEJM “Danish MMR” study, I would first like to discuss the misrepresentations inherent in the TIME piece.  The caption and title imply all vaccines were study and that all vaccines have always been safe as in their caption, “Childhood shots get a clean bill of health.” This is decidedly not my position. I told the reporter it is clear that MMR is not the main cause of autism in Denmark. The in Denmark portion didn’t find its way into the article. But I am not that uncomfortable saying MMR cannot be supported as a major cause of autism with the epidemiological data available to us today. Simultaneously, as I will discuss, MMR is unquestionably associated with autism. The difference occurs in the meaning of first causes (primary causality) and co-occurrence, which by definition would represent an association.

      Here’s an analogy.  If I let the air out my tire it goes flat – in this example letting the air out is casual to the flat tire – and everybody accepts it as truth.  But in another example, if I go the beach I always get sand in my shoes, and if I go without sunscreen I get sunburned if it is a sunny day. Sand in my shoes does not cause sunburn and not using sunscreen doesn’t cause sunburn – exposure to the sun causes sunburn. Sand in my shoes is associated with my sunburn, but not causally. Not using sunscreen seems logically associated with my sunburn, but if I was well tanned, or the day was cloudy, or I was of African decent, I wouldn’t need sunscreen, and likely still wouldn’t get burned, but I would still have sand in my shoes. This second example became a little more complicated and parts of it were less obvious. Some of you would be arguing that lack of sunscreen, caused, my sunburn. Scientifically, you would be wrong, even though there is a clear association. And lack of sunscreen is not always associated with sunburn or with sand in my shoes. These are what we call conditional variables. Amount of shade, time of year, weather and lots of other things are also variables in my sunburning or not. But ultimately, we cannot get away form the simple first cause which is exposure to sun in a vulnerable person (pale-skinned). Those of you who are thinking I need to get out more – are right, and I will take my sunscreen if it is a sunny day.
      So, logic and science tell us that when we find vaccine strain measles virus years after exposure almost exclusively in children with autism, that there is an association. There must be an association, but it need not be causal to autism and it may not be causal to bowel or brain symptoms, although it likely plays an important role in symptoms. So, if the epidemiologists tell us MMR is not the cause of autism (and remember we are not talking about autistic entercolitis), we can accept that until new, better or different data refute these observations. But equally it is a tremendous injustice to the children suffering with persistent measles virus  and autism to claim there is no association. How is this true? The best way to understand this is through the hypothesis that an underlying immune disorder which would permit MV to persist if exposed through the injected pathway, also directly or through other pathogens allows the development of autism. And this immune disorder likely has many manifestations.

Remember for a moment that a wide array of pathogens have been proposed, published and associated with autism. These include yeast, anerobic bacteria, borna viruses, influenza in pregnancy, as well as other viruses and toxins, including mercury. How do we explain all of these and MV at the same time? Given the large body of immunological and immunogenetic literature in autism, it is appealing to assume a foundational immune disorder is the actual first cause, or that toxins like mercury are directly involved. But even in the case of mercury we still have to account for gender differences and variable expression of toxic effects despite equal exposures. All of these exposures could start at any point in the child’s development.

Unlike the comments in the TIME article and many others like it, primary genetic disorders are not the cause of autism. This fact was driven home by the recent MIND Institute California study which clearly and rightly concluded environmental factors had to account for the rapid rise in autism rates in that state.

Mercury, aluminum and the inherent immune skewing of vaccines are still under intense scrutiny and research. All of these directly influence the immune system as does the MMR vaccine itself. So MMR in its current form is certainly not my choice way to protect children from these diseases.  Neal Halsey MD from Johns Hopkins, who is decidedly in favor of the MMR vaccine and believes it has no association with autism whatsoever, admitted before the Institute of Medicine in July of 2001 and in a New York Times story, Sunday November 10th, 2002, he had never calculated the dose of thimerosal (mercury) in micrograms and that the dose in the vaccines greatly exceeded all Federal guidelines. He has repeatedly apologized publicly for this obvious toxicological error.

In 1991, the NIH (Vaccine 1991 Oct;9(10):699-702) reported that the aluminum in vaccines was of toxic concern and could be replaced with safer adjuvants (things that make the vaccine more potent). They also recommended the removal of aluminum from vaccines. To date no action by the FDA or CDC has been taken to heed the NIH recommendations.  Recently, Imani and Kehoe (Infection of Human B Lymphocytes with MMR Vaccine Induces IgE Class Switching. Clinical Immunology, Vol. 100, No. 3, September, pp. 355–361, 2001) also from Johns Hopkins, reported that MMR vaccine induced a change in human immune cells consistent with the induction of allergy and asthma. They stated this: “Vaccination provides great protection against the mortality and morbidity associated with many childhood diseases and should not be discouraged, but it is possible that a side effect of viral vaccination constitutes an increase in the incidence of IgE-mediated disorders. A better understanding of the mechanism underlying this event may yield improved vaccines in the future.” And the Danish study in question in no way investigated the occurrence of bowel disease in children with autism (vaccinated or otherwise). Recently, Professor O’Leary and his team of molecular pathologists did in fact identify vaccine strain measles virus in the gut of children with developmental disorders, but not in healthy controls (V Uhlmann, C M Martin, I Silva, A Killalea, O Sheils, S B Murch, A J Wakefield, J J O’Leary. Potential viral pathogenic mechanism for new variant inflammatory bowel disease. J Clin Pathol: Mol Pathol 2002;55:0–6).

In the well reviewed article they state this: “Conclusions: The data confirm an association between the presence of measles virus and gut pathology in children with developmental disorder.”  In July of 2002 they presented their additional data which clearly identifies vaccine specificity for the type of measles virus, and so they have continued to enhance our understanding of MMR in this disorder. Let me be very clear, I in no way believe a live attenuated MMR vaccine is safe for a subset of children. How large that subset is remains a mystery to me at this time. But equally, these concerns are different from placing a causal relationship for autism at the vaccine’s doorstep. I know I can find persistent measles in the blood, bowel, cerebral spinal fluid and brain (through recent biopsy findings), and that gives me no reassurances of safety. My belief is hinted at in the TIME article when they share my comment about worsening pre-existing conditions (I never limited my concerns to autistic conditions as inflammatory bowel disease is not an autistic condition) and I assume this is a simple misunderstanding by the reporter.       

 So, with regard to the TIME article I find it cleverly deceptive and far from conveying a balanced view of the debate. My view of the Danish study is much the same.  I believe the authors greatly overstep the bounds of their data and make general comments about MMR vaccine safety while sweeping the molecular biology aside with barely a thought. As an example, the authors sometimes claim a lack of association of MMR with autism, when in fact they mean to state a lack causality of MMR for autism. While they usually do limit their discussion to causality this slip is no subtle difference. It is by no means trivial to the science at hand or to the children afflicted. Here is an example of how the line gets blured: “Studies designed to evaluate the suggested link between MMR vaccination and autism do not support an association, but the evidence is weak and based on case-series, cross-sectional, and ecologic studies.” For the reasons already stated, I do not believe this is a true reflection of the state of the science. “Studies” in this sentence actually should say “epidemiological studies” and “association” should say “casual association”.

 Why am I being so particular in this situation?  We are not dealing with something as simple as the letting air out of tire example. And it is far more complex than the sunburn example too. Ignoring the immunological weakness or peculiarity of the children who cannot rid themselves of the measles virus is a huge error in scientific reasoning. There is an un-refuted association of MV with autism, because children with autism are much more likely than controls to still possess the virus for years after exposure. The epidemiology may be giving us accurate data about causation at the same time. In the early 1990s the Institute of Medicine rightly concluded vaccines could do three things: 1) nothing harmful, 2) exacerbate (worsen) an existing condition, or 3) cause a disease de novo. The Danish study provides an additional piece of evidence that MMR does not participate in number three - ONLY for autism, not for all the other issues (like bowel disease or allergies) which we have discussed regarding the vaccine. Why? Because they didn’t have those data, nor did they seek to find the data for a cohort of children with autism.

The reality is that we are still a long way from the truth despite the joyful proclamations of the public heath officials and the epidemiologists. The Danish study is still important in several ways. The number of children on a percent basis is much less than the US and England. What is protecting them from our rates of autism? We do not know why, but it would be a great place to start looking. Further, it is a small country with unique genetics which may preclude easy comparison to other populations, a point which is lacking from the article as the authors attempt to use their findings to generalize to all autism in the entire World. Finally the authors admit measles virus causes an autoimmune reaction to myelin proteins, and yet they neglect the large body of research by Warren and Singh on this subject with regards to autism.
      From the study:
            "However, wild-type measles can infect the central nervous system and even cause postinfectious  encephalomyclitis, probably as a result of an immune-m ediated response to myclin proteins."


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