What was once a medical or scientific question—do childhood vaccinations cause autism?—has now become a legal question. Increasingly, parents are turning to the courts to try to prove that their autistic children were damaged by the injections they were given as infants, with arguments often centering around one component of earlier vaccines, the mercury-containing preservative thimerosal. In two major articles in its September 27 issue, the New England Journal of Medicine takes on the troubled history of vaccines and autism and offers a cautionary tale about thimersosal. As of now, the journal reports, 5000 families of autistic children have filed claims with the Vaccine Injury Compensation Program (VICP), a program that was created by Congress 20 years ago in response to a scare about the pertussis portion of the diphtheria-pertussis-tetanus (DPT) vaccine. The VICP provides compensation to children who have serious adverse effects from any childhood vaccination, with compensation intended to cover medical and related expenses, lost future income, and up to $250,000 for pain and suffering. There have been some 7000 claims so far for adverse effects other than autism, with payments in 2000 of those claims averaging about $850,000. The VICP frequently takes more than two years to process a petition, and approximately 700 claims remain unresolved. Autism is not on the VICP’s list of possible adverse reactions to vaccination, and families who make autism claims must prove in some way that there was injury. That’s a significant barrier, since most medical and scientific experts have concluded that there is no proof of a causal tie between autism and thimerosal or the MMR vaccine, says Dr. Stephen Sugarman. So far, the VICP has rejected at least 300 autism claims outright. With thousands of autism claims pending, however, the VICP announced in 2002 that it would examine the general causation question, using a few test cases. The first of nine test cases was heard this past summer, but judges on the so-called Vaccine Court are not expected to rule before next year. Meanwhile, families are bypassing the VICP process and going directly to other courts, where lawsuits "seem a long way from resolution," according to Sugarman. On the specific question of whether thimerosal in vaccines caused autism, Dr. Paul Offit suggests in a second journal artricle that the campaign against thimerosal "has caused legal, political, and social harms." Although the preservative is now banned from most childhood vaccines, with the exception of some influenza vaccines, there has been no apparent decline in the incidence of autism and "the controversy continues to be emotionally charged." A lesson learned from the thimerosal scare came after the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) asked pharmaceutical companies in 1999 to remove the preservative from their vaccines. The AAP said parents should not be worried, since "The current levels of thimerosal will not hurt children, but reducing those levels will make safe vaccines even safer." "Critics wondered," Offit says, "how removing something that hadn’t been found to be unsafe could make vaccines safer. But many parents, frightened by the sudden change in policy, reasoned that thimerosal was targeted because if was harmful, and their faith in the vaccine infrastructure was shaken. Doctors were also confused by the recommendation." All of that has led to drops in vaccination compliance, and, in the case of autistic children, a "cottage industry of charlatans" offering chelating agents that are supposed to remove traces of mercury from a child's body. Physicians, government scientists and others who have said publicly that vaccines don't cause neurological problems or autism have received hate mail and occasionally death threats. "The CDC, in response to planned protests at its gates, recently beefed up security and instructed personnel about how to respond if physically attacked." "During the next few years," Offit writes, "thimerosal will probably removed from influenza vaccines, and the court cases will probably settle down. But the thimerosal controversy should stand as a cautionary tale of how not to communicate theoretical risks to the public; otherwise, the lessons inherent in the collateral damage caused by its precipitate removal will remain unlearned." The articles, "Cases in Vaccine Court—Legal Battles over Vaccines and Autism," and "Thimerosal and Vaccines—A Cautionary Tale," were published in the September 27, 2007, issue of the New England Journal of Medicine.
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