Science and Rising Autism Rates

Title: Science and Rising Autism Rates

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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning, everyone. One of the things we're doing on this show during Trump's first 100 days is a health and climate Tuesday section of the show. As some of you know, this builds on and expands the climate story of the week that we had been doing on Tuesdays the last two years are thinking right now is that there are so many headlines coming from the new administration that are pretty monumental on a daily basis that health and climate ones risk getting lost in the shuffle. Today, for example, the big headlines are about Trump's tariff chaos apparently tanking the stock market and Ukraine launching an actual military attack on Moscow. We're talking about those things too, of course, on the show and throughout the day on the station, but we lead today with our health and climate section to make sure these things don't get lost. We'll keep doing this on Tuesdays at least through the first 100 days.

On climate, the new energy secretary Chris Wright yesterday shrugged off climate change as a side effect of building the modern world and said the cure is worse than the disease as the Trump administration cuts back on permits and investment in renewable energy. We'll talk to climate journalist Emily Atkin coming up.

On health, we're staying on the RFK beat this week. We'll do this one first and get to climate second. There's a headline in The New York Times today, Kennedy links measles outbreak to poor diet and health, citing fringe theories. It was about an interview he gave to Fox News. And it actually gets fringier than that headline as you read through the article.

Also, in the Trump address to Congress last week, with all the lies he told about millions of 140 year olds getting Social Security payments and other things getting so much attention afterwards, we may not have noticed as much or people around the country may not have, that he promised that RFK would get to the bottom of what's causing the rise in autism diagnoses in children, which implied that it could be vaccines because we know what RFK says.

Sure enough, despite Kennedy's promise in his confirmation hearing that he would do nothing to discourage people from getting the measles vaccine, he has now announced an official investigation into whether vaccines cause autism. They're going to rereview the literature and announce that they will reevaluate the childhood vaccination schedule.All of this as they slash research funding into all kinds of research that hasn't come up with solutions for anything yet.

We thought for our Tuesday health segment, we would ask someone knowledgeable to actually walk us through the science of how the vaccines and autism theory got started, how it got debunked through multiple studies, and what scientists actually do and don't know about why there's been a rise in autism diagnoses.

With us now is Dr. Paul Offit, Director of the Vaccine Education Center and an attending physician in the Division of Infectious Diseases at Children's Hospital of Philadelphia. He is also the Maurice R. Hillman professor of vaccinology at the Perelman School of Medicine at the University of Pennsylvania. His books include Tell Me When It's Over: An Insider's Guide to Deciphering COVID Myths and Navigating Our Post-Pandemic World, published last year. He's a member of the Food and Drug Administration Vaccines and Related Biological Products Advisory Committee and importantly, a founding advisory board member of the Autism Science Foundation.

Dr. Offit, we appreciate you coming on the show again. Welcome back to WNYC.

Dr. Paul Offit: Thank you. It's my pleasure.

Brian Lehrer: I want to tell everybody you have a fabulous page on the Children's Hospital of Philadelphia website that, folks, I recommend you go to after the show called Vaccines and Autism, Q and A that clearly for the lay reader, walks us through the timeline of this story. Thank you for that. I'm going to ask you to do a short radio version for our listeners.

Part one is about the two studies by a scientist named Andrew Wakefield in 1998 and 2002. Maybe it's the second study we should focus on as the bigger thing.

At the time, it found evidence of the measles virus, which he said could have been from the vaccine. In 75 out of 91 kids with autism studied, they didn't find it much in a sample of kids without autism of about the same size. You write, on its surface, this was a concerning result, but the Wakefield paper was critically flawed. Can you give us some Wakefield studies 101 and what the critical flaws were?

Dr. Paul Offit: His original paper, which was published in 1998, was basically eight children who had recently received the measles, mumps, rubella, or MMR vaccine, and then, within a month or so developed signs or symptoms of autism. The nicest thing you could say about that paper is it raised the question, could vaccines cause autism? Which is perfectly reasonable. My child was fine. They got a vaccine. Now, they have signs and symptoms of autism. Could the vaccine have done it?

The way to answer that question is with epidemiological studies, meaning look at children who got the vaccine or didn't get the vaccine and then make sure that you control for these potentially confounding variables like healthcare seeking behavior, medical background, socioeconomic background. That study has been done more than 12 times in 7 countries on 3 continents, involving thousands and thousands of children, and the result has always been the same.

The MMR vaccine does not increase your risk of autism. A choice not to get an MMR vaccine doesn't decrease your risk of autism, it only increases your risk of vaccine-preventable disease. But that paper, and then the subsequent paper, dramatically caused a decrease in vaccination rates. Now, people were scared of the MMR vaccine and you're seeing the result today.

Brian Lehrer: Why would they have found that in 75 out of 91 kids with autism studied in that 2002 paper, they found evidence of measles virus, and in a similar sample size of kids without autism, they didn't find it much. How do you explain it?

Dr. Paul Offit: It would be nice if anybody could have reproduced that study. I mean, I think Andrew Wakefield has shown that he has a bias and I think that he has shown that he's generally not trustworthy. When his paper was retracted, his 1998 paper was retracted, it was retracted because he had a patent on a "safer measles vaccine."

It was retracted because he'd received hundreds of thousands of dollars from a legal services commission, basically to launder legal claims through a medical journal because a handful of those children were in the midst of suing pharmaceutical companies. It was retracted because he had misrepresented both biological and clinical data. I think he has shown himself to be an untrustworthy investigator.

Brian Lehrer: You're actually charging bad faith there, not just the vagaries of scientific uncertainty and things can happen in small sample sizes.

Dr. Paul Offit: That's right. It would have been nice. Again, the strength of science is in its reproducibility, and no one has been able to reproduce that finding.

Brian Lehrer: Then, in your Children's Hospital of Philadelphia webpage, you lay out some of the studies that refute with better evidence the Wakefield studies. The first is by a scientist named Brent Taylor and his coworker. Then you describe a study by Madsen and colleagues published in The New England Journal of Medicine in the '90s that included 500,000 kids. You call that one of the best studies. Tell our listeners briefly about that.

Dr. Paul Offit: Again, there are some countries that can do a better job than we can in terms of having electronic medical records, health records. And so Denmark, for example, can look at its entire population to determine whether or not the MMR vaccine was associated with autism. But again, it's really an epidemiological question in the end and I think that question has been asked and answered.

Brian Lehrer: And we don't have time to give more examples. But you're saying there were many others in addition to Madsen and Taylor. That's the main message here in terms of small studies at the beginning versus many large and reproducible studies.

Dr. Paul Offit: Right. I think the strength of science is in its reproducibility. When somebody has a finding, as you could argue Andrew Wakefield did in 1998 when he published his Lancet paper, whether it is true or not will be determined by whether or not other investigators working with other populations of children find the same thing and they didn't.

Brian Lehrer: Just to give our listeners a little example of how these things were studied in the Brent Taylor study, findings were, according to your paper, the percentage of children vaccinated was the same in children with autism as in other children. That's key. No difference in the age of diagnosis of autism was found in vaccinated and unvaccinated children. The onset of symptoms of autism did not occur within two, four, or six months of receiving the MMR vaccine. Those are examples of how you control for a variable and isolate in a big study. What correlation, not to mention cause and effect, might actually be or not be, right?

Dr. Paul Offit: Right, and that's what's compelling to parents, "My child was fine," then they got a vaccine and now there's a problem. Could the vaccine have done it? It's a powerful thing. Anecdote is a powerful thing. I think for people who see that, and then they see these basically statistical studies, it's often hard to talk them out of it. For example, my wife is in private practice, pediatrics. She was helping the nurse give vaccines on a busy weekend, and there was a mother sitting along the side holding her four-month-old.

While my wife was drawing the vaccine up into the syringe, the four-month-old had a seizure and then went on to have a permanent seizure disorder, epilepsy, and died at age five of a chronic neurological condition. If my wife had given that vaccine five minutes earlier, I think there are no amount of statistical data in the world that would have convinced that mother of anything other than the vaccine caused the problem.

Brian Lehrer: Your children's hospital webpage then goes on to other information on the causes of autism. Let me play that clip of Trump in his address to Congress last week and ask you to bounce off of that to describe what we actually do or don't know. Here's the clip.

Trump: Our goal is to get toxins out of our environment, poisons out of our food supply and keep our children healthy and strong. As an example, not long ago, and you can't even believe these numbers, 1 in 10,000 children had autism, 1 in 10,000, and now it's 1 in 36. There's something wrong, 1 in 36, think of that. We're going to find out what it is and there's nobody better than Bobby and all of the people that are working with you--

Brian Lehrer: Trump last Tuesday. Dr. Paul Offit of the Children's Hospital of Philadelphia and a founding advisory board member of the Autism Science Foundation, among other things, is our guest. Now, Dr. Offit, first of all, are the basic numbers Trump gave there in the ballpark of reality on the growth of autism diagnoses.

Dr. Paul Offit: When autism was first introduced by Leo Kanner in the 1930s, it was considered a very rare disorder, something on the line of schizophrenia. Then, what's happened over time are a few things. One is the definition of autism has been broadened to include a broader spectrum, so-called autism spectrum disorder. There are better diagnostic tools to make that diagnosis and there's certainly increased recognition. I mean, I can think of at least one, if not two children in my elementary school class who definitely would have been considered on the spectrum, but we just didn't use that term then, even though it had already been introduced in the 1930s.

I think that's the biggest reason for the increase. But the notion that it's toxins or poisons is not supported by the things that we do know. That's what's interesting is there are a lot of promising leads in the area of autism. It's at least genetic. About 80% of autism is genetic. It's not a single gene like cystic fibrosis or sickle cell disease. It's many genes, but they're developmental genes that often are expressed early in pregnancy.

The infant microbiome, which is to say the bacteria that initially colonize our intestinal tracts when passed through the birth canal, then entered the world, also has been associated with autism. Drugs taken during pregnancy, like valproic acid especially, have been associated with an increased risk of autism. Maternal age and paternal age have been associated.

There are a lot of promising leads, none of which are vaccines. But I think that the anti-vaccine activists, like Robert F. Kennedy Jr., have taken this story hostage, I think, much to the harm of children who have autism who are really suffering from this. It is true from a recent paper in the Journal of the American Medical Association that children with autism are less likely to be vaccinated, as are their healthy younger siblings.

Brian Lehrer: Less likely to be vaccinated. That's maybe worth lingering on for a second.

Dr. Paul Offit: Yes, that's right, because we've scared parents, and so they think, "This is something I have control of. If I want to decrease the instance of autism, I'll just not vaccinate or not vaccinated with the MMR vaccine, which does nothing to lessen the risk of autism and only increases the risk of vaccine-preventable diseases.

Brian Lehrer: If RFK really does reinvestigate the autism and vaccines theory, how would they restudy it or how should they?

Dr. Paul Offit: I don't see how we can add to what's been done. I mean, we have almost 18 studies that have been done. Do we think the 19th one is going to be the one that finally clinches it? I think that we have done the studies the way they need to be done. I think you probably learn everything you needed to learn by watching the way RFK Jr. handled his second confirmation hearing in front of the health committee. He was asked by both Senator Sanders and Senator Cassidy, "Can you please at least reassure the American public that vaccines don't cause autism, that you believe those studies," and he wouldn't do it.

Then towards the end of that, he held up a paper and he said, "This is a high-quality paper that showed that vaccines cause autism." That was a paper that wasn't published in a scientific journal. It wasn't published in a medical journal. It was supported by an anti-vaccine group. It wasn't peer reviewed, it was horribly flawed, and that was a proof of nothing because it was such a terribly performed paper. To him, that was a proof. He's just looking to shoehorn data into his hypothesis so that he can be proven right. I think it's just much to the detriment of children with autism.

Brian Lehrer: How transparent do you expect the research methods to be of whatever they do? Will you and others be able to peer review the studies officially or like this for public commentary?

Dr. Paul Offit: What's happening now is you're starting to see these journals that are popping up that are not real journals. That's what this particular paper he was holding up was published. It was more like a med blog than it was a journal. I think the general public doesn't distinguish those things. I do think what he does is very clever. He says we need radical transparency for these advisory committees, like the FDA Vaccine Advisory Committee or the Advisory Committee for Immunization Practices to the CDC. We need to look at their conflicts of interest.

What happened is we had a meeting canceled in March that we were supposed to have at the FDA. The CDC canceled its ACI Advisory Committee for Immunization Practices meeting. Those are meetings open to the public. Those are groups of experts who are transparent because they have open meetings. By canceling those meetings, you're pulling everything behind closed doors so he can presumably produce the kind of studies that show he's right for something that he's not right about.

Brian Lehrer: We know there was already a decline the last few years in getting kids the MMR vaccine, measles, mumps, rubella, before RFK, who was health and human services secretary. Obviously, I think because of the political attacks on the COVID vaccine, then generalizing, you tell me. But in light of that, is it possible that it could become a good thing that RFK and company are going to restudy vaccines in autism? Because if everything you say is right, reality will be confirmed by the review, and then maybe the anti-vax movement will be seriously discredited in average moms and dads' minds, or is that too optimistic?

Dr. Paul Offit: That's pretty optimistic. You sure you're not a Philadelphia Eagles fan? Yes, that's really optimistic. I think he has this fixed, immutable belief that he holds with the strength of a religious conviction. He's never going to back off that. He's never going to say vaccines don't cause autism. He can't even say it now in the midst of a massive epidemic in West Texas that's now spilled over to New Mexico.

When you have 228 people, mostly children, who suffered measles, you have two deaths from measles. The first child death in this country since 2003. What is he talking about now? He's still talking about vaccines causing autism in West Texas and that people should go there and look at the parents in the eye and tell them that you're sorry that vaccines have caused autism. He still says that in the face of this massive epidemic. He is the single worst person to have this position in the midst of this epidemic.

Brian Lehrer: That headline today, Kennedy links measles outbreak to poor diet and health, citing fringe theories. Any brief response to that?

Dr. Paul Offit: He doesn't believe in the germ theory. He believes in the miasma theory, which you can find if you read his book The Real Anthony Fauci. This is the miasma theory, that there are these general toxins, poisons in the environment and that germs really are meaningless as long as you have good nutrition, and in his case, take vitamin A, and you're not going to have to worry about these diseases. That's where he's from.

Brian Lehrer: Last question, what's the opportunity cost here? If they're cutting scientific research generally, which seems to be the case, but spending money on this, do you see that as an opportunity missed to study other causes of various childhood diseases about which we actually know much less?

Dr. Paul Offit: Certainly, and this is an administration that talks about wanting to cut costs and just spend money in an efficient way. To do yet another study on whether vaccines cause autism is a terrible waste of money. It's just a misdirection. Why don't we focus on the things that are far more likely to be causes, the things that we already know about?

Brian Lehrer: Dr. Paul Offit, Director of the Vaccine Education Center and attending physician in pediatrics in the Division of Infectious Diseases at Children's Hospital of Philadelphia. He's the author of books, including Tell Me When It's Over, which came out last year. Thank you so much for giving us some time today, very clarifying.

Dr. Paul Offit: Thank you.

Brian Lehrer: Brian Lehrer on WNYC. Much more to come.

 

 

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