There is no evidence that vaccines cause autism.
Moreover, the failure of parents to have their children immunized out of
fear of an association with autism has led to sporadic upsurges in acute, even
deadly, but preventable conditions.
So said the AMA in a resolution approved at the annual meeting of the
policymaking House of Delegates in June. The resolution was sponsored by the
Section Council on Psychiatry, which consists of delegates from APA, the
American Academy of Psychiatry and the Law, and the American Academy of Child
and Adolescent Psychiatry.
The resolution, which received vociferous support from physicians in all
specialties, asks the AMA to reaffirm its support for universal vaccination
and continue collaborative efforts to communicate that vaccines do not cause
It was one of several resolutions introduced by the section council
addressing broad public health concerns; other public health initiatives
included a motion asking the AMA to reassess regulations around lead levels in
children and one seeking universal neonatal screening for heritable and
The latter stemmed in part from a campaign for universal neonatal screening
launched by child psychiatrist Jenna Saul, M.D., of Milwaukee, and the family
of a young boy who died last year of a heritable disorder for which there is
now a genetic test. (Complete coverage of the issue and the house resolution
on neonatal screening will appear in the next issue.)
The resolution on vaccines was one of eight that the section council put
forward, seven of which were approved by the house during what was an
unusually eventful meeting even apart from the historic visit by President
Obama (see Obama Seeks M.D.'s Help to Reform Health Care). Other resolutions
included one on parity for mental illness and substance abuse in health system
reform, accurate estimation of American health care costs for comparison with
other countries, and physician suicide (see
Health Reform Must Include Parity, Substance Abuse Coverage, AMA Says;
AMA Opposes Single Payer, but Is Open to
Public Option; and High Physician Suicide Rate Triggers AMA Study).
The house's overwhelming support of the section council's resolution
regarding vaccines and autism reflected a growing alarm about the trend among
some parents to refuse routine childhood immunizations for their children.
Child psychiatrist Louis Kraus, M.D., tells AMA delegates that it is not
uncommon for parents of an autistic child to refuse vaccination for other
offspring because of misinformation.
Credit: Mark Moran
"The Institute of Medicine and the CDC [Centers for Disease Control
and Prevention] have done comprehensive studies and have not found any type of
relationship between vaccines and autism," said child psychiatrist Louis
Kraus, M.D., during hearings on the resolution. "Our resolution asks the
AMA to reaffirm policy and continue ongoing efforts to assist physicians and
other health care workers in communicating to parents, policymakers, and the
media that existing scientific evidence overwhelmingly shows that vaccines do
not cause autism and that decreasing rates of vaccination will lead to a
resurgence of vaccine-preventable diseases and
Kraus, who is medical director for the Easter Seals Therapeutic Schools in
Chicago for children with autism, added that it was a common occurrence for
parents of a child with autism to decide not to get vaccinations for other
offspring because of something they have seen on a television talk show or
read on the Internet.
"There are tens of thousands of children not being vaccinated
secondary to dogma," he said.
Physicians from several specialties testified that this trend has led to
spikes in the incidence of potentially deadly but preventable diseases, such
as measles, by diminishing "herd immunity"—the phenomenon by
which virtually universal protection against disease can be guaranteed when a
large enough majority of individuals are immunized, even if 100 percent of the
people are not. Herd immunity typically requires inoculation of 95 percent of
the population, and even small increases in the portion of the unvaccinated
population increase the risk to the whole.
"The inoculation rate in England has reportedly fallen below 80
percent, which has led to a rapid increase in the incidence of measles,"
including at least two confirmed deaths, said David Fassler, M.D., a child
psychiatrist and vice chair of the Section Council on Psychiatry.
He cited a May 7 New England Journal of Medicine article reporting
that 1 in 20 children not vaccinated against pertussis ultimately contracts
the illness, compared with 1 in 500 vaccinated children. "Put another
way, the unvaccinated children were 23 times more likely to get whooping
cough," said Fassler, who is also APA secretary-treasurer.
Michael Butera, M.D, an alternate delegate from the Infectious Disease
Society, testified to "the largest outbreak of measles in the last 20
years" in the affluent La Jolla section of San Diego in the early part
of the year. A February 2008 edition of the CDC's "Morbidity and
Mortality Weekly Report," reporting on that outbreak, documented 12
cases of measles among unvaccinated children there.
And Carol Berkowitz, M.D., a delegate from the American Academy of
Pediatrics, told physicians at the meeting that she had recently spoken to a
group of mothers in an affluent neighborhood of west Los Angeles where 3 of 11
mothers had refused routine vaccinations for their children.
Also widely supported was the section council's resolution seeking a
reassessment of guidelines concerning lead levels in children. As a result of
the motion, the AMA's Council on Science and Public Health will review and
update its 1994 report on children and lead and generate screening
recommendations, taking into account existing recommendations from the
American Academy of Pediatrics and the CDC.
In testimony on the resolution, Fassler told physicians that an elevated
blood lead level, as defined by the CDC, was 30 mcg/dl in the early 1980s.
That was lowered to 25 mcg/dl in 1985, and then to 10 mcg/dl in 1990.
"However, subsequent research has clearly demonstrated that even this
level of lead exposure can have significant and lasting repercussions on
physical development and cognitive functioning," Fassler said. "We
now know that blood lead levels below 10 mcg/dl are inversely associated with
children's IQ scores. Lead levels as low as 3 mcg/dl have also been shown to
be associated with decreased height and delayed puberty."
The New England Journal of Medicine article, "Vaccine
Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable
Diseases," is posted at<http://content.nejm.org/cgi/content/abstract/360/19/1981>.
The CDC report, "Outbreak of Measles—San Diego, California,
January—February 2008," is posted at<www.cdc.gov/mmwr/preview/mmwrhtml/mm57e222a1.htm>.▪