For an excellent analysis of the medical considerations regarding the
recent decision by the US Government see:

http://www.theness.com/neurologicablog/index.php?p=203

Kirby is wrong. Period.

Has the Government Conceded Vaccines Cause Autism?

No. But David Kirby and other anti-vaccinationist ideologues and
members of the so-called mercury militia would like you to think so.
For background, the Autism Omnibus refers to a set of hearings before
the Vaccine Injury Compensation Program regarding claims by about
5000
parents that their childrens' autism was caused by vaccines. These
claims are primarily based upon the various hypotheses that the MMR
vaccine, or thimerosal in some vaccines (but not MMR), or the
combination of both, is a cause of autism.

So far there have been hearings, but only one final decision. In
November the US government settled one case in favor of the
petitioner. This is the case those who have supported the failed
hypothesis that vaccines cause autism now point to as admission that
they were right all along (or at least as a means of stoking the
flames of fear about vaccines.) But the US government did not admit
vaccines cause autism - they conceded one case that is highly complex
and not necessarily representative of any other case and cannot be
reasonably used to support the vaccine/autism connection.

David Kirby, author of Evidence of Harm, wrote a highly misleading
article the other day in the Huffington Post on this issue. Orac has
already done an excellent job of tearing down Kirby's claims. He
points out that legal cases are often decided for legal - not
necessarily scientific - reasons. That the government only conceded
that "compensation is appropriate." That is all - they conceded
nothing about the larger question of vaccines and autism. Orac also
points out that if this case were a concession of a connection why
would the petitioner's lawyers settle and give away a case that could
win them all their other cases?

David Kirby has also written a follow up article, where he publishes
verbatim the US government's decision. Kirby asks his readers:

If you feel this document suggests that some kind of link may be
possible, you might consider forwarding it to your elected
representatives for further investigation.

But, of course, if you feel that this document in no way implicates
vaccines, then let's just keep going about our business as usual and
not pay any attention to all those sick kids behind the curtain.

I think Kirby is hoping that most people will not have the patience
or
medical background to read and understand the entire document, and
that they will come away with a vague notion that there must be
something to all this vaccine fear-mongering. What does the document
really tell us?

To summarize the case history, the child in the case appeared normal
and healthy, except for chronic otitis media, until about 20 months
of
age at which time he had a series of vaccines according to the
routine
vaccination schedule. Two days later the child had a fever to 102.3,
was lethargic, irritable, and would arch his back when he cried. The
child then developed a rash. It was later determined that the child
had: "encephalopathy progressed to persistent loss of previously
acquired language, eye contact, and relatedness." The child regressed
and developed symptoms similar to those of autism spectrum disorder.
However, the child does not have autism - he has a regressive
neurological disorder that includes blood and muscle abnormalities
not
seen in autism, and any clinical resemblance to autism is not a
reflection of a common cause.

Six years after symptoms began the child also developed partial
temporal lobe epilepsy that required treatment.

During this time the child also had an extensive workup, which
discovered:

A CSF organic acids test, on January 8, 2002, displayed an increased
lactate to pyruvate ratio of 28,1 which can be seen in disorders of
mitochondrial oxidative phosphorylation.

A muscle biopsy test for oxidative phosphorylation disease revealed
abnormal results for Type One and Three.

In February 2004, a mitochondrial DNA ("mtDNA") point mutation
analysis revealed a single nucleotide change in the 16S ribosomal RNA
gene (T2387C)

It if often difficult or impossible to draw firm conclusions from a
single case, so I will lay out what I see as all the possible
alternative hypotheses to explain this information.

1) One possibility is that the child was perfectly normal prior to
the
vaccines, which caused an encephalitis (inflammation of the brain)
which caused brain damage, including the later seizures. The
metabolic
disorder and mutation may be a red herring and have no bearing on the
child's clinical condition.

2) The mitochondrial disorder predisposed the child to have a
reaction
from the vaccines, resulting in encephalitis. The subsequent
neurological regression was due to some combination of the vaccine-
induced encephalitis and the underlying mitochondrial disorder.

3) The child's mitochondrial mutation is the primary cause of their
neurological regression, but that this regression was exacerbated by
the vaccine-induced encephalitis (this seems to be the US
government's
conclusion).

4) The child has a mitochondrial encephalopathy which is the sole
cause of all of the child's neurological signs and symptoms. The
reaction to the vaccines may have played no role at all in the
subsequent regression, and the child's current neurological condition
is exactly what it would have been had they never been vaccinated. It
is even possible that the encephalitis was merely the first
manifestation of the mitochondrial disorder and the timing after the
vaccines was merely coincidental.

That lays out the spectrum of possibilities in this case. At this
point in time we do not have (or at least I am not privy to)
sufficient scientific information to say definitively where along
this
spectrum the truth lies. The US government's decision was based
partly
on this uncertainty - erring on the side of compensating the child
and
family.

But we can discuss the plausibility of each scenario. Kirby dismisses
anything resembling option 4, but his dismissal is naive and
unjustified. In fact the patient's clinical syndrome resembles what
is
called a mitochondrial encephalopathy - with increased lactic acid,
abnormal muscle biopsy, neurological regression, appropriate age of
onset, even seizures. It is probably not a coincidence that the child
has a point mutation in a gene that has been previously linked to
these very mitochondrial disorders. Kirby incorrectly argues:

While it's true that some inherited forms of Mt disease can manifest
as developmental delays, (and even ASD in the form of Rhett Syndrome)
these forms are linked to identified genetic mutations, of which
T2387C is not involved. In fact little, if anything, is known about
the function of this particular gene.

This is misleading. Kirby refers to "this particular gene" which
makes
me think that he believes T2387C is a gene. It's not - it describes a
point mutation (at location 2387 a thymidine has replaced a
cytosine).
The gene is the 16S ribosomal RNA gene. Mutations in this gene have
been identified to cause mitochondrial encephalopathy. So Kirby is
just wrong. It is true that I could not find that this specific
mutation has been identified before, but that is common in genetics -
a disease is linked to point mutations in a specific gene (or perhaps
specific regions of a gene) but most or all families identified have
their own specific mutation.

This makes option 4 very plausible - it would be an incredible
coincidence if this child just happened to have a mutation in a gene
that was known to cause their exact constellation of neurological
signs and symptoms and yet the mutation was not the sole or primary
cause of those symptoms.

But it does not rule out option 3 - that the mitochondrial disorder
was the primary cause of the child's neurological disorder but that a
reaction to the vaccines worsened the ultimate symptoms. Therefore
the
government's decision was reasonable - but is absolutely not a
concession about any claim made by the petitioners concerning a link
between vaccines an autism.

It does, however, make any hypothesis resembling option 1 or 2
extremely unlikely. Further testing regarding the physiological
effects of this child's specific mutation would be helpful, and such
testing may be under way but I could find nothing published to date.
It is theoretically possible that the identified mutation does not
cause a change in the gene product or mitochondrial function, and is
therefore just a coincidence. But this is unlikely given the clinical
features in this case are a good match to known mutations of that
gene.

Kirby, however, apparently wants to wring as much fear and confusion
out of these events as he possibly can. So now he speculates wildly
that maybe children diagnosed with autism really have this
mitochondrial disorder combined with vaccines (he has to keep
vaccines
in the loop). Given the rarity of such mutations, and the fact that
there were specific features in this case that would likely be
uncovered in the routine evaluation of a child with autism (like an
elevated lactic acid), it is highly unlikely that there are many
children with vaccine-triggered mitochondrial encephalopathy
mimicking
autism out there.

It has been found that some children with autism have mitochondrial
dysfunction - one study found that 7.2% of subjects with autism had
"definite mitochondrial respiratory chain disorder." Poling et al, in
response to this child's case, did a retrospective study of children
with autism and with other neurological disorders and found that
"Aspartate aminotransferase was elevated in 38% of patients with
autism compared with 15% of controls." Such findings are preliminary
-
the only conclusions that can be drawn is that the association
between
autism and metabolic disorders requires further investigation.
However, these studies did not look at the incidence of suspicious
mitochondial mutations in autism, and these findings may not be
relevant to this case.

Kirby also wildly speculates that perhaps the evil toxins in vaccines
caused the mutation in the first place. He writes:

Use of the AIDS drug AZT, for example, can cause Mt disorders by
deleting large segments of mitochondrial DNA. If that is the case,
might other exposures to drugs or toxins (i.e., thimerosal, mercury
in
fish, air pollution, pesticides, live viruses) also cause sporadic Mt
disease in certain subsets of children, through similar genotoxic
mechanisms?

Among stiff competition, this is perhaps the most absurd and
scientifically ignorant thing Kirby has every written. AZT does NOT
cause a genetic disorder. AZT blocks DNA replication (it blocks the
copying of DNA) - that is its mechanism as an anti-retroviral drug.
In
patients it can also block mitochondrial DNA replication, thereby
causing mitochondrial depletion. This results in there being too few
mitochondria (the energy factories of cells) in some cell populations
and causes dysfunction in tissue that is especially susceptible to
the
effects of this dearth of mitochondria. This is a side effect of AZT
and also other retrovirals because of sustained use at doses designed
to inhibit DNA replication. This does result in some effects that are
similar to mitochondrial genetic disorders - because both result in
insufficient mitochondrial activity. But that is the only similarity.
AZT does not cause a disseminated somatic mutation, which is the
incredible analogy that Kirby is making.

What Kirby is suggesting is that in infants and toddlers toxins can
cause the same point mutation in millions of different cells
throughout the body. Toxin-induced mutations do not cause genetic
diseases, unless they occur in a germ cell in which case a mother or
father can pass the mutation onto their children. If it occurs in the
womb then large cell populations may be affected (whatever cells
derive from the cell that had the mutation). But in a child a point
mutation would affect only one cell and any cells that derive from
it.
A toxic mutagen would cause different random point mutations in
different cells. This could not cause the mitrochondrial
encephalopathy in this child. It can increase the risk of cancer,
because cancer can develop from a single mutation in a single cell
that causes it to become neoplastic.

Conclusion

This is a unique and idiosyncratic case that raises more questions
than it answers. In my opinion as a neurologist, with the information
provided, the child has a mitochondrial encephalopathy. The role of
the vaccines is unclear, but at worst a rare vaccine reaction
exacerbated the underlying mitochondrial disorder. This case has no
clear implication for the larger question concerning vaccines and
autism, which is likely why both sides agreed to settle.

Yet those who insist, despite the evidence, on claiming that vaccines
or mercury are linked to autism are likely to add this permanently to
their litany of misinformation and fear-mongering.

Note: I am searching for any follow up information pertinent to this
case and will post any addendum here.