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February 12th, 2009
01:03 PM ET

Court rules vaccines not to blame for autism

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

There is a special court, known colloquially as a vaccine court. It is a place where judges called “special masters,” who are legal experts, not medical doctors, hear claims about vaccine injuries. It’s been around since the late 80s, in part prompted by the scare over the DPT (diphtheria, pertussis and tetanus) vaccine possibly causing injuries. If the court finds that an injury was likely caused by a vaccine, it can make a monetary award. For example, a few years ago, there was a case of optic neuritis after the tetanus vaccine. Other awards were given for fibromyalgia after the MMR (mumps, measles, rubella) vaccine; transverse myelitis after the HiB (Haemophilus influenzae type B) vaccine; and Guillain-Barre and MS after the hepatitis B vaccine.

Many people started paying attention to the court after the federal government last year awarded damages to the family of Hannah Poling, conceding that Hannah was injured by a vaccine, causing her autism-like symptoms. (Read about Hannah’s case here) According to the Department of Justice, more than 1,500 people have been paid in excess of $1.18 billion since the inception of the program in 1988.

There is no question there is lots of money at play here. For more than 20 years now, the program has been funded by an excise tax of 75 cents on every purchased dose of covered vaccine. And, with today’s decision, some of the big questions about vaccines and autism are being addressed. It is worth noting the standard the court was using allowed for the petitioners (the parents of the children with autism) to demonstrate “biologic plausibility” as opposed to direct cause and effect. Scientifically, biological plausibility is an easier standard to meet. (Read about vaccine court now).

While this can by no means be a complete overview of the hundreds of pages that composed the ruling (read the decisions here), it is safe to say that the court found no biological plausibility of a connection between autism and either the MMR vaccine, or the combination of MMR vaccine and thimerosal-containing vaccines: no awards will be granted in any of these test cases. We spent some time with Michelle Cedillo, one of the children represented in the test cases last year (meet her here). You will no doubt hear a lot more about this in the days to come. Within the world of autism and vaccines, this is a huge deal and a major ruling.

Couple of points: Remember that thimerosal is a mercury-derived preservative that was present in many childhood vaccines that did not contain a live virus (for example, the MMR vaccine never contained thimerosal). Nowadays thimerosal has been removed from or reduced to trace amounts in all vaccines that are routinely recommended for children six years of age and younger, with the exception of inactivated influenza vaccine. In case you are curious, a preservative-free version of the inactivated influenza vaccine (contains trace amounts of thimerosal) is available in limited supply at this time for use in infants, children and pregnant women. And, in the interest of clarity, vaccines with trace amounts of thimerosal contain 1 microgram or less of mercury per dose. (Learn more about vaccines here)

On page 278 of the decision in of the cases, Snyder v. Secretary of Health and Human Services, the statements even get a little snide. The special master, Denice K. Vowell, wrote “to conclude that Colten’s condition was the result of his MMR vaccine, an objective observer would have to emulate Lewis Carroll’s White Queen and be able to believe the six impossible (or, at least highly improbable) things before breakfast.” She goes on to say “the families of ASD and the court have waited in vain for adequate evidence to support the autism–MMR hypothesis.”

So, do you feel like you are gazing through the “looking-glass?”

I hope you get a chance to click on the links above and read the rulings. You will find that not all the experts agreed with one another and the evidence is worth reading. After that, I’m eager to hear what you think.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


February 12th, 2009
11:40 AM ET

How long will an aneurysm repair last?

As a new feature of CNNhealth.com, our team of expert doctors will answer readers’ questions. Here’s a question for Dr. Gupta.

Asked by Isabel, Lancaster, California

I had cerebral aneurysm in 2001 and now have two titanium aneurysm clips in my head. How long do these clips last? Do they at some point in time get loose and I will have a hemorrhage again? I've always wondered about this. "

Answer:

 Hi Isabel, I am so glad that it sounds like you are doing well. The type of operation you are describing is one that I have done many times, as recently as this week. As you may know, cerebral or brain vessel aneurysms are sort of like blisters on the wall of the blood vessel. They are little bulges where the blood vessel becomes weak.

The concern is they can start to leak blood slowly into the brain or they can rupture, causing a large amount of bleeding, called a subarachnoid hemorrhage. If that happens, the patient is likely to experience what is known as a thunderclap headache. This is not an ordinary headache. These come on suddenly and are often described as the worst headache of the individual's life. I had one patient describe it as if someone came up and struck him in the head with a baseball bat. A CT scan will reveal the blood in the brain and a lumbar puncture test will show blood in the cerebrospinal fluid, which is the fluid that bathes and nourishes the brain and spinal cord. Unfortunately many patients will suffer permanent neurological deficits or die after a cerebral aneurysm rupture.

 The goal for the operation is to fix that blister, and to reconstruct the weakened vessel so there is no more bleeding. This operation has to be done quickly, because the highest likelihood of the aneurysm bleeding again is in the first few days. And that gets us to your question, Isabel.

The titanium clips you had placed have been studied for many decades. There is a very low likelihood they will come loose or that the aneurysm will come back, if the clips were placed satisfactorily at the time of your operation. Your doctors probably recommended an angiogram to check that around the time of your operation and in follow-up. One large study says the chance of re-bleeding is less than 1 percent. So, you should be in good shape. Do make sure your clips are MRI compatible should you ever need an MRI, but don't worry about setting off airport detectors or other metal detectors.


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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.

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