The number of children with autism seemingly has increased dramatically in recent years. Many people have speculated that vaccinations - specifically the MMR vaccine - are causing the increase, but that allegation has not held up to scrutiny.
Recently, there has been much publicity given to allegations of a more specific link between vaccines and autism - specifically, the preservative thimerosal, which contained mercury in excess of the EPA standards for exposure and was included in vaccines given to children until 1999.
In the recently-passed Homeland Security bill, someone (Bill Frist, speculates Hesiod) inserted a provision at the last minute insulating makers of thimerosal from most of the lawsuits.
This last-minute insertion into the law has drawn much ire. Aside from general good-government concerns, the caricature of evil Republicans protecting big corporations such as Eli Lilly from the consequences of causing autism in children is far too tempting to pass up.
TAPPED has a short post on the subject which perfectly encapsulates that view, noting as an aside that the subject involves "medicines that apparently gave children autism."
There's only one problem: the caricature is probably wrong.
1) I would never want to be in the position of Dwight Meredith, father of an autistic child who wonders if sheer idiocy on the part of vaccine manufacturers and the medical establishment is responsible for his son's autism. I could certainly never deal with the topic with the level head that Mr. Meredith displays. But even Mr. Meredith is careful to note:
It is important, however, to stay focused on what is actually known about the relationship, if any, between mercury in vaccines and autism. There have been no studies of which we are aware that demonstrate that thimerosal in vaccines causes autism. Thus, it would be wrong, or at least premature, to conclude that vaccines have caused autism in any child.
Some, however, have suggested that there is no evidence of a link between thimerasol and autism. That is also not true. The increase in the incidence of autism in California coincides with the increased exposure of children to mercury in the form of thimerasol in vaccines. Mercury is known to cause brain damage to some kids at some level of exposure. That is evidence of a link but it is in no way conclusive evidence of causation.
I'm no expert, but it seems that Mr. Meredith may be too generous to the evidence of a link between thimerosal and autism. The CDC hasn't heard about it yet, and an unnamed friend of Mark Kleiman cites other evidence. Chemist Derek Lowe argues against the plausibility of a link between thimerosal and autism (click here and scroll up for more). Here's a study from The Lancet (free registration required) which reaches the following conclusions:
Overall, the results of this study show that amounts of mercury in the blood of infants receiving vaccines formulated with thiomersal are well below concentrations potentially associated with toxic effects. Coupled with 60 years of experience with administration of thiomersal-containing vaccines, we conclude that the thiomersal in routine vaccines poses very little risk to full-term infants, but that thiomersal-containing vaccines should not be administered at birth to very low birthweight premature infants.
At the very least, TAPPED's offhand statement that the thimerosal-preserved vaccines in question "apparently gave children autism" is a massive overstatement, which doesn't stand up to even a cursory reading of the evidence. A stronger link may be proven (especially since, as Meredith notes, a test will occur naturally based on the fact that thimerosal was eliminated from vaccines after 1999), but the current evidence doesn't seem to provide anything close to a reliable link.
2) As Mark Kleiman's friend notes:
When Congress established the Vaccine Injury Compensation Program in 1986, it was a rare legislative acknowledgment that the tort system is incapable of serving the public interest. At the time, you may recall, vaccine manufacturers were leaving the industry, vaccine prices were skyrocketing, and vaccination rates were falling sharply. VICP created a no-fault system for vaccine-related injuries. The system is inevitably imperfect, but it's clearly served the public interest. Vaccine prices and availability improved; the number of lawsuits plummeted; program costs have been modest ($110 million a year for pre-1988 injuries; an excise tax of 75 cents per dose for post-1988 injuries); and compensation to genuine victims has been non-trivial (VICP has paid over 1500 claims averaging just under $1 million per).
But of course the trial lawyers despise no-fault systems, and in thimerosal they see an opportunity to bypass and undermine VICP. They claim that thimerosal-related injuries (if there are such things) should not be covered under VICP because the injuries don't stem from the vaccine proper but from a "contaminant." They're suing the thimerosal manufacturers, who are not covered under VICP. They're aggregating millions of claims of $1000 or less because VICP precludes suits for > $1000. And so on.
Undermining VICP can't possibly serve the public interest. Thimerosal has already been phased out of childhood vaccines. There's an effective system in place for dealing with vaccine injuries; if there is credible evidence of thimerosal-related damage, then victims should fight to have the relevant adverse events added to the VICP vaccine injury table.
There's no reason to be believe that courts can deal with this. Juries routinely accept junk science when faced with heart-rending individual cases. (E.g., epidemiological evidence does not support a link between silicone breast implants and autoimmune disease. Some solace to the bankrupt manufacturers.) The threat of huge awards and litigation costs leads to settlement of meritless cases. (Last year, the vast majority of asbestos settlements were paid to unimpaired claimants.) Plaintiffs shop for judges that have been elected by the trial lawyers and for jurisdictions (in, e.g., WV, MS, and TX) that have absurdly pro-plaintiff rules. The record shows that in mass tort situations, legal costs typically absorb 50% - 80% of judgment and settlement dollars. And the 20% - 50% that trickles down to victims and "victims" is distributed in arbitrary and unequal fashion.
I have little to add to this. Even Kleiman admits: " That the tort system does a miserable job of handling medical injuries is too clear to be worth arguing about."
Even if you believe that pharmaceutical companies are profiteering, heartless entities which deserve to be humbled - and worse, heavily regulated (I think that's a fair summation of the editorial line at The American Prospect ), wouldn't it be proper to have evidence of truly harmful malfeasance before subjecting the companies to "bet-the-company" litigation? (No one remotely familiar with the history of mass torts can deny that lawsuits such as the thimerosal-vaccine claims have the potential to destroy any company, regardless of size. Ask Dow Corning, W.R. Grace, etc.) "Due process" and all that stuff.
I agree that it was sleazy to amend the law in the last-minute, anonymous fashion at issue. But the ideas behind the amendment were perfectly defensible - and its sponsors should not have been afraid to defend those ideas. That fear was the true scandal.
UPDATE: Thanks to TAPPED for the kind words. And they do paraphrase the issue correctly, though they should say that thimerosal "was" often added to vaccines, as it has been mostly removed due to the concerns raised about potential mercury poisoning (which formed the basis for the lawsuits at issue).
A couple of notes, as long as I'm revisiting the topic. First, I was struck by the following observation in the New York Times piece about the controversy:
On July 7, 1999, at Halsey's urging, the American Academy of Pediatrics and the Public Health Service released a statement urging vaccine manufacturers to remove thimerosal as quickly as possible and advising pediatricians to postpone giving most newborns the birth dose of the hepatitis B vaccine. The decision, which helped to create vaccine shortages and led some babies to become infected with hepatitis B... (Emphasis added)
That consequence helps show that the removal of thimerosal was not a costless decision. I do not know if there have been any good studies done to estimate the number of babies who contracted hepatitis B but would not have done so if thimerosal-preserved vaccine had been administered. But in theory, if further studies show no link between thimerosal and mental incapacitation, the costs of removing thiremosal from vaccines may be shown to have outweighed the benefits.
Second, TAPPED reiterates:
The real scandal here, such as it is, is that that someone friendly to Eli Lilly stuck a provision in the homeland security bill to exempt Lilly from tort lawsuits just in case there turns out to be such a link.
If that was indeed the expected progression of events - i.e., if lawsuits would follow evidence of a link - I'd agree. But in reality, the lawsuits have been filed by the dozen long before any such link had been established (check out this search result for an indication). This is not atypical for the mass-tort context, either. With that in mind, it's harder to see the amendment as illegitimately depriving legitimate claimants of recourse; I'd even argue it's closer to an attempt to maintain neutrality while studies are performed to establish whether or not the link exists. (I'd argue that if studies show such a link, Congress may well repeal the amendment. But that's a different argument.)
