ABC drama with mercury-autism plot creates controversy

ABC, the same network that brought us 'Fatal Impact' -- the 2006 TV movie presenting a much-criticized dramatization of an avian flu pandemic -- is drawing fire from medical groups regarding the plot of the premiere episode of 'Eli Stone', a legal drama scheduled to debut on January 31.

As this New York Times story first reported last week, the plot of the first episode involves a 'ripped-from-the-headlines' case about a mercury-based vaccine preservative (called 'mercuritol' in the show) alleged to have caused autism in Eli Stone's client. At the end of the show, the jury apparently agrees that a link exists, deciding against the pharmaceutical industry and awarding the plaintiff $5.2 million.

News of the episode's plot has generated a remarkable amount of criticism from the medical community, including campaigns demanding ABC not air the episode. Here's a follow-up by the Times, "ABC Show Will Go On, Over Protests By Doctors." Leading the opposition has been the American Academy of Pediatrics -- here's a press release demanding the episode's cancellation and a letter to ABC from AAP President Renee Jenkins. Here is more coverage from the Associated Press, Reuters, and USA Today.

While all accounts suggest that 'Eli Stone' is a light-hearted series rather than a serious courtroom drama (commercials for the show prominently feature a singing-and-dancing George Michael, the 1980s pop singer who appears in 'visions' of the lead character), the medical community is still concerned that the show's plot will impact parents' decisions regarding vaccination. Today, the Immunization Action Coalition -- among the nation's most prominent advocates of vaccination -- encouraged readers of its e-mail newsletter to contact ABC and request that they cancel the episode.

Recent papers on vaccine-autism history, mandates, vaccine law, and YouTube

There have been an exceptional number of papers published in medical journals over the past several weeks that are worth mentioning...

• "Mercury, Vaccines, And Autism: One Controversy, Three Histories" -- American Journal of Public Health (subscription required for full text; published online ahead-of-print). From Jeffrey Baker, a physician and historian of medicine at Duke, an examination of the multiple histories that have contributed to the nature of current arguments linking vaccines to autism. Baker traces the parallel histories of thimerosal as a vaccine preservative, mercury as a health risk, autism as a diagnosis, and the relatively recent intersection of these stories.

• "Mandating Vaccination: What Counts as a "Mandate" in Public Health and When Should They Be Used?" -- American Journal of Bioethics (subscription required for full text). By Matthew Wynia of the American Medical Association, a commentary on the imprecise usage of the term 'mandate' (with respect to both vaccination and other public health activities) and the implications thereof. A nice introduction to a topic that deserves more attention from scholars.

• "Vaccine Law 101" -- Journal of Law, Medicine, and Ethics (subscription required for full text). Exactly what the title suggests, a high-altitude overview of the many laws, regulations, and types of litigation related to vaccines. A summary of a conference panel session of the same name. Short on insights and argument, but a very useful starting point for those interested in legal aspects of vaccination.

• "YouTube as a Source of Information on Immunization: A Content Analysis" -- JAMA (subscription required for full text). From a research team at the University of Toronto, a review of vaccine-related content posted on YouTube, examining claims made about vaccines and vaccination as well as the general attitude expressed toward vaccines. Slightly more than half of all videos were not expressly positive about vaccination, and those critical of vaccination tended to receive higher ratings from YouTube visitors. Here's a press release about the paper.
  

More evidence against thimerosal-autism link; critics disagree

This paper in the Archives of General Psychiatry, part of the JAMA family of journals, reports that data "do(es) not show any recent decrease in autism in California despite the exclusion of more than trace levels of thimerosal from nearly all childhood vaccines. The DDS data do not support the hypothesis that exposure to thimerosal during childhood is a primary cause of autism."

Seemingly yet another piece of evidence refuting the thimerosal-vaccines-autism hypothesis, the paper led to coverage from ABC News, the Associated Press, the San Francisco Chronicle, and elsewhere.

Advocates of the link between thimerosal and autism were not swayed, as this Baltimore Sun story explains. SafeMinds, perhaps the most prominent organization focusing on mercury-related vaccine risks, published its own analysis of the paper arguing that the imprecision of the data in the study prevented any variable (including thimerosal) from being ruled out as a cause of increasing autism rates.

Research updates: meningococcus, dengue, and cocaine(!?!)

While we were away, there's been news on several fronts related to research on new vaccine candidates, some much farther along than others:

• Meningococcus -- The Jan. 9-16 issue of JAMA reported positive Phase II clinical trial data for a new meningococcal vaccine for infants manufactured by Novartis. The vaccine, called Menveo, would be the first available for infants, a population not covered by two meningococcal vaccines currently licensed in the U.S. Phase III trials are underway. An editorial on the results accompanied the paper in JAMA. Here's the Novartis Press Release and coverage from USA Today and HealthDay News.

• Cocaine -- There's been a great deal of attention to stories like this one on preliminary research at Baylor University that aims to develop what its (media-savvy) researchers generously describe as a "cocaine vaccine." Similar to reports of a "nicotine vaccine" that made the rounds a few years back, more interesting than speculation about a therapy that is many, many years away (if ever) is the continued broadening of the meaning of 'vaccine' by researchers working on just about any strategy that involves the immune system. Nevertheless, the media strategy worked, as one newspaper headline (originally in the Houston Chronicle) proclaims, "Researchers develop cocaine vaccine." Time magazine was on top of the story as well, publishing a news story as well as a bioethicist Q&A with the rather sweeping headline, "The Ethics of Vaccination."
  

• Dengue -- This commentary in the Jan. 9-16 issue of JAMA co-authored by NIAID Director Anthony Fauci reviews public health risks related to dengue and hemorrhagic fever in the United States. The essay reviews the progress and unanswered questions related to dengue vaccine development.
  

2008 recommended vaccination schedule; Paper on historical changes in disease rates

Last week's issue of MMWR included the recommended vaccine schedule for children and teenagers (i.e., birth to age 18). The familiar color-coded tables incorporate changes made in the joint recommendations of CDC, AAP, and AAFP over the past year. (The updated schedule was also published nearly simultaneously in the journal Pediatrics earlier this month.)

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Speaking of CDC, a paper by a group of researchers at its National Center for Immunization and Respiratory Diseases was published in JAMA in December titled, "Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States."(free abstract; subscription required for full text). From the abstract, here is what the researchers report:

"A greater than 92% decline in cases and a 99% or greater decline in deaths due to diseases prevented by vaccines recommended before 1980 were shown for diphtheria, mumps, pertussis, and tetanus. Endemic transmission of poliovirus and measles and rubella viruses has been eliminated in the United States; smallpox has been eradicated worldwide. Declines were 80% or greater for cases and deaths of most vaccine-preventable diseases targeted since 1980 including hepatitis A, acute hepatitis B, Hib, and varicella. Declines in cases and deaths of invasive S pneumoniae were 34% and 25%, respectively."

A table showing this 'before-and-after vaccines' disease incidence data is a mainstay of Powerpoint presentations by vaccine policy-makers and researchers. While the numbers are impressive, such analyses of historical disease rates are fraught with challenges, particularly when attempting to isolate the impact of a certain variable (such as a vaccine) over many decades. To their credit, the authors of the paper note some of the many other factors that also contributed to the changes in disease rates during the 20th century, such as improvements in health care, standards of living, and many others.

The major decline in disease rates is impressive, and there's no doubt that vaccines play a major part in these successes. However, without being given comparisons to rates of other infectious diseases for which vaccines are not available, the reader of this paper could not be faulted for forgetting that vaccines are part of a much larger story of changes in medicine, health, and disease during the 20th century.