The always fun topic of autism and vaccines has been in the news again.  Truth is, it never leaves, but this time the whole movement has found new life and hope in the brave, new world of mitochondrial disorders.  It all started when the first ever vaccines caused my child to develop autism case was won in court a few months ago by one of my fellow child neurologists.  Now, with one case in the law books, a second has arrived. I thought I might attempt a look at the issues this brings up.

I am now breaking a vow of silence and entering dangerous territory, the swirling vortex of controversy that is Autism and vaccination.  This is a difficult path for my conflict avoidant self to tread.  The amount of blog space devoted to this subject is long, the tone is invariably impassioned and the feelings involved are raw.  In a way, this is more interesting to me than the question of whether vaccines cause Autism itself.  Why is this such a lightning rod of an issue?

Because they are babies!!!

 

    The answers are actually rather complex, but the biggest factor is dealing with children, whom we subject to multiple needles full of mysteriously weakened viruses and various unknown and frightening substances at regular intervals in our weakest and most vulnerable population.  This undoubtedly requires a great deal of faith and trust in the medical field. I know that we doctors do not always behave in a manner completely worthy of this trust.  The parent child relationship is intense.  Our desires to want the best for them are very real.  There is a very real impulse to take the frustration that comes along when all is not well with the child and direct it at the physician.  I know, because I walk the tightrope associated with this in dealing with the parents of sick children every day.  My hope is that I might allay a fear or two without appearing to be insulting the impassioned opposition.  I have a hard time faulting parents for caring too much.

     Mitochondria are a little bacteria sized piece of molecular machinery found in every cell in the body that take oxygen and change it into chemical fuel, called ATP, that our cells can use for energy. They act almost like an independent cell within a cell as they have their own DNA.  We get this DNA, in fact we get the mitochondria themselves, directly from the egg cell we all came from, straight from our mothers.  They also require some genes found in the nucleus to function.  These can come from either or both parents.

The Mitochondria

 

      When the genes involved in this fueling process are bad, our cells run the risk of running out of gas.  The brain is the single most energy demanding organ in the body and tends to take hits in mitochondrial disorders when the body is stressed.  Parts of the brain can just die and stroke right out, development can stop or move backwards, or patients even die.

       Fever is a sressed state requiring lots of energy.  Vaccines very commonly cause fever.  So the reasoning goes that in a child that develops autims with a noticeable move backwards in development right after shots, bada-bing, bada-boom, the shots did it.  It is all perfectly plausible, and I think it is an important question to be studied.  In fact, an initial study seems to have found a problem with mitochondria in about 20% of autistic patients.  This was published in the Cambridge journal rather than a seriously peer reviewed neurology journal and may have its flaws, but there it is.

  Here is the problem as I see it.  Bad mitochondria are a ticking time bomb.  Any cold, flu, stomach bug, or rash could end up your trigger.  If you are afraid of vaccines, by all means, give your child tylenol 30 minutes prior to the shots, but if the mitochondria are a problem, they will continue to be a problem whether you give the vaccines or not.  For some reason I am unclear on, this fact was not apparent to a jury in the first ever successful vaccine/autism lawsuit, but it is very apparent to me. 

      Who else do we blame?  The daycare worker with the cold, the neighbor kids that gave your child chicken pox, the parent with a sore throat that didn’t wash their glass?  The fever is clearly the issue here and not the vaccine.   Fear and blame are powerful forces in human behavior.  We find blame very emotionally satisfying.  Fear can cause us to do some of the most uncharacteristic things.  In the case of Autism, fear and blame might just one day take down vaccination entirely.  What I fear is that the much more fearsome and prevalent spector will then rear it’s ugly head as some of modern medicine’s greatest achievements are rolled back and fearsome plagues return.  I am trying very hard not to blame and let this fear pull me out of character.

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