TV gets it right!

Wow I can't believe it's been a month since my last post. Things got a little behind during the holidays. I hope all one or two of you reading this had a happy holiday! This post is only marginally TV related though :)

Normally I revel (and cringe) at pointing out medical mistakes on TV and in the movies. Although Nip/Tuck is one of my favorite shows (so twisted!!!) I don't think they have ever once managed to maintain a sterile operating field. I could see a small contamination that most of the TV-watching public would never know about, but this week they went so far as to have Christian Troy remove his mask and vomit into a kidney basin over the patient's open pectoral implants. Of course, he has breast cancer now so I suppose it is to be expected, but still :) And with all the vomiting on that show this week, you would think someone would have taken pity on him with some anti-nausea meds, I'm just saying.

But every once in a while, they get something right on TV. Usually Private Practice is among the worst in terms of realism (Addison is somehoe a world-class general surgeon, OB/GYN, neonatologist, and pediatric surgeon at the age of 30, right?) but last week they touched on an issue that I think is a sore point for most pediatricians, the supposed relationship between vaccines and autism.

I would like to give them props for correctly pointing out that there is no relationship between vaccines and autism. No matter what Jenny McCarthy tells you. Time and time again the evidence is overwhelming that there is no causal relationship between vaccination and development of disorders along the autistic spectrum.

This issue first came up in the late 1990's, in 1998 a paper was published that claimed a causal relationship between thimerosal containing vaccines (specifically the MMR or measles, mumps, rubella vaccine) and an increase in the rate of autism. Since then there have been multiple well designed large scale clinical trials looking into this and the evidence has been conclusive that there is no relationship. For examples of some of these articles look here, here, and here. Those are only the first three of literally hundreds of scholarly articles returned by a search of pubmed and google scholar that all support the same conclusion. The evidence from the medical side of things is very clear.

Despite this overwhelming evidence, companies that make vaccines have stopped using thimerosal as a preservative in their vaccines. In 1999, the CDC recommended that thimerosal use be discontinued, most vaccine suppliers had complied with this recommendation by 2001. The last few batches of thimerosol containing vaccines expired in 2003, with the exception of some influenza vaccines which were still available for use in the 04/05 flu season. To find out more about this, look here. So even if you don't believe all the studies, the fact is that today all children are being vaccinated with thimerosal free vaccines.

So why the increase? The apparent increase in the rate of austism and other disorders along the autistic spectrum has more to do with a change in the way primary care providers think about the diagnosis and treatment of these disorders than an actual increase in prevalence. Treatment-wise, it has been shown that early intervention with a wide range of services helps these children to significantly improve their social, interpersonal, and cognitive skills. Unfortunately, these services are often expensive and insurance companies are hesitant to pay for them without an underlying diagnosis. More and more practitioners are placing children with social and behavioral impairment on the austic spectrum to allow them to gain access to these treatment modalities. Previously these children might have been diagnosed as mentally retarded or with one of many behavioral problems. We have also improved diagnostically, as autism screening should now be a part of routine well child care. The American Academy of Pediatrics has recommended adding an extra well child visit specifically to screen for red flag behaviors for austim. Well validated screening tools like the M-CHAT are now available for use by clinicians as well. For more information about the AAP's recommendations for early screening for childhood autism look here.

The last thing I need to say here is that even if there was a proven link, nobody ever died from being autistic. Unvaccinated children do die, every year, without fail. Nobody ever thinks it will happen to them, until it does. Most of these cases occur in children who are too young to have completed their primary series of vaccinations (ie, those under six months of age) but there are always a few older children who have not been vaccinated for one reason or another. They die of things like pertussis mostly, but also measles and other preventable illnesses. They are not dying in record numbers, but statistics like that don't mean anything to a family who has just lost their child.

I just felt a need to get this information out there, please pass this on to anyone who you think might be interested.