Autism and the MMR: an historical Review

The history of autism and the MMR seems to be a classic case of a consensus of eminent opinion
showing a blinkered and unscientific approach to the data; medical history is littered with such
examples, such as the investigation by John Snow of the cholera epidemics in the 19th century, and
that of Oliver Wendel Holmes and Ignaz Semmelweis of hygiene in labour wards. This brief essay is
an attempt to put together what facts exist, and make a case for future investigation.

The epidemic which began to be noted in the 1940s of retrolental fibroplasia demonstrates how a
medical intervention can actually do harm to children because of unforeseen side-effects. In the case
of RLF, the sudden blindness in premature babies was directly attributable to an excess of oxygen,
introduced ironically because of better medical care for the premature child. By 1950, RLF had
changed from being amongst the rarest to one of the most common causes of blindness in children.
Only after extensive experimentation was the epidemic brought under control with the proven
discovery that RLF was caused by excessive concentrations of oxygen; reducing the administration of
oxygen to a bare minimum reduced the epidemic status of RLF. However, it is still apparent that
while RLF is caused by excessive oxygen, this is not the only causative factor - while the risk of
developing RLF is correlated strongly to oxygen, not all children exposed to excessive oxygen will
develop RLF. The factors involved in determining why some develop RLF but some escape even
when receiving high dosages of oxygen have still not been discovered.

The current epidemic of autism seems similar to the epidemic of RLF in two clear respects: the
epidemic quality of autism, and the nature of the causative agent.

Firstly, it is only over about the last twenty years (since the 1980s) that the incidence of autism has
reached epidemic levels. The logical conclusion is that a new factor, an environmental insult, has
been introduced into the population of young children which was not present before, much in the
same way that the new medical advances in aiding premature babies was responsible for introducing
excessive quantities of oxygen to a larger population. The nature of the factor is unknown, but it
would seem likely that it is related to a medical intervention of some kind, and the epidemic in
autism is iatrogenic in nature.

Secondly, it seems probable that the environmental factor is strongly correlated to autism in the same
way that blindness is correlated to oxygen in premature babies. This would mean that where the
factor is present, there would be an increase in the number of cases of autism, but not all children
would be effected, although the factors conferring immunity would (as with RLF) be extremely
difficult to isolate.

What needs to be found then is an environmental factor which correlates strongly to autism, has only
been introduced in the last two decades, and damages only a subset of susceptible children. This can
be extremely difficult to determine; even with RLF , it was not until 1954, over a decade after the
epidemic had begun, that the aetiology was determined.

Popular thinking implicates the MMR as the causal factor involved. The health authorities and the
government, with a few exceptions, is vigorous in its denial of this as a possible cause. There are a
few disquieting facts about this stance.

Firstly, it is not possible to rule out the MMR unless the primary causative factor in the epidemic of
autism is determined. The MMR could only be directly ruled out by conducting a trial over an area
with a large enough population and a current high incidence of autism. If this area was trialed with
separate vaccines, vigorously followed up and monitored, and the incidence remained the same, then
and only then would it be prudent to suggest that the MMR is most unlikely to be implicated. No
such experimental procedure has been forthcoming; instead studies have concentrated only on areas
where the entire population is given the MMR.

Secondly, the promotion and presentation of studies on the MMR are clearly suspect, even to the
naivety of the general public. The actual measles virus is known to have a risk of severe
complications, including encephalitis; it is not unreasonable to assume that even an attenuated form
of the live virus used in vaccines might have a similar effect, if the susceptibility is increased by the
use of the immune system adjusting to a multiple vaccine programme. Moreover, studies "proving"
that the MMR may simply demonstrate that the studies involved were not thorough enough rather
than ruling out the MMR. The determination of the epidemology of yellow fever is an instructive
example of how timing in incubation period of viruses can be critical in any study; also the
investigation of Kuru in new Guinea demonstrated how a viral agent can remain dormant for a long
period of time after the original infection.

It seems that the conclusions of current studies are still rooted in the verification principal of logical
positivism in their belief that an accumulation of evidence that the MMR did not cause autism in a
large number of children proves that it cannot be implicated in a smaller subset of that population.

Finally, if the epidemic in autism is iatrogenic, and the MMR is implicated, then there is a similar
problem to that faced by the studies of RLF, where it is known that while oxygen increases the risk of
RLF, lack of oxygen increases the mortality rate. The dilemma for the MMR would be that to avoid
an epidemic of autism, it might be necessary to risk an epidemic of measles, and vice versa.
Fortunately, the use of single vaccines would provide an alternative which is not so simple in the case
of RLF.

As the onset of autism is in the early years, and any factor would seem to damage the higher
executive functions, and in particular the development of language, another experimental procedure
would be to delay the MMR in a trialed area until speech had developed and then carefully monitor
these children for any degeneration in linguistic ability. This would not rule out the possibility that
the MMR could be a causative agent at an earlier stage, but it would put a marker where it could be
safely used pending further investigation.

The risk of a measles epidemic grows each year, as parents become unwilling to risk their children
with the MMR. It is therefore urgent that due weight is given to addressing these concerns by taking
as a working hypothesis the theory that the MMR is implicated in the rise of autism, and developing
experimental procedures either to rule this out, or to determine the risks involved. Equally due
weight should be given to detailed studies to determine what other iatrogenic or environmental factor
might be strongly implicated, as if this is determined, it would also rule out the MMR. It does not
seem likely that the most eminent professional reassurances on the MMR would be sufficient to
concerned parents any more than those given to mothers by Klein before Semmelweis was vindicated
by Pasteur.
Glossary
Retrolental fibroplasia (RLF): blindness resulting from the administration of excessive
concentrations of oxygen to premature infants, causing the formation of fibrous tissue behind the lens
of the eye.
Iatrogenic: an iatrogenic complication is an unfavourable response to medical treatment that is
induced by the therapeutic effort itself.