Just the facts?

The latest news in the world of autism is the financial award to the family of a little girl with "autistic like" symptoms who developed these symptoms after receiving five shots containing nine separate vaccinations at age 18 months.

The reportage on this story has ranged from misleading to accurate, and from what I've read of the statements from the father, an MD who used to be with Johns Hopkins, there seems to be some intent on his part to cast a broader net with this story, although in one video on CNN.com, he states that he and his wife are not opposed to vaccines. This video is worth watching because Dr. Sanjay Gupta does parse some of the elements of this case in accessible language.

The nine-year-old daughter in this case has a mitochondrial disorder. I have not read an explicit statement about the form of inheritance, but based on references to her mother, I infer that it traces to mitochondrial DNA (mt-DNA). We inherit all of our mt-DNA from our mothers--it comes to us by way of that egg that meets the sperm to make Us. Distribution of mitochondria into eggs is somewhat of a crapshoot, and if there are some sick mitochondria in the originating cell, some eggs may end up with several of these, while some eggs may end up with only a few. Thus, which egg we come from determines the relative number of healthy mitochondria we have, if our mothers carry mitochondria with disease-related mutations.

The doctor/parent in this case is quoted in a story on CNN.com as saying that his daughter's symptoms must have been triggered by the shots because her mother, from whom his daughter inherited her defective mitochondria, does not exhibit signs of autism. But he ought, as a highly trained medical professional, to have a better understanding of mitochondrial inheritance than that. My undergraduate, nonmajors biology students do. They know that there can be a wide difference among individuals in a family with mitochondrial disease because of the the unpredictability of inheriting a few or many disease-related mitochondria from your mother. In other words, some people may not have symptoms at all because their cells contain so few of the disease-related organelles, while others may manifest many symptoms very early because their cells contain so many of these poorly functioning mitochondria (see picture above for a basic graphic representation).

The daughter's specific problem relates to issues with oxidative phosphorylation, a step in the process of glucose metabolism. The brain is one of the organs that relies on this biochemical pathway the most. It should come as no surprise to anyone who understands these processes that Ox-phos mitochondrial disorders have shown a relationship to autism symptoms. They are also related to myopathies and encephalopathies. Google it for yourself, attendees of Google U: autism, mitochondrial disorders, OXPHOS. Or search PubMed...use the search terms "mitochondrial disorders" and "autism."

I can understand a parent's anger and frustration over the possible connection between their child's having received a vaccine and then developing a life-changing disorder. But there are some issues and some facts that are consistently neglected in reportage of this story. These include:

1. Her disorder is quite rare, something that stories are just now really emphasizing, after the horse has left the barn.
2. Mitochondrial disorders of this nature are already associated with autism, outside the confounding influence of vaccines.
3. Why was this child receiving nine vaccines at age 18 months? My youngest son (age 18 months) just got his and received three vaccines.
4. She would not be expected to exhibit the exact same phenotype as her mother if her disease is mitochondrially inherited.
5. Some people involved in this situation are playing fast and loose with fact and emotion, including people who ought to know better.
6. The CDC has been remiss in not being more pre-emptive in its statements about this case.

Last, I know from experience that most people do not look past the hand-waving headlines or at most past the lead of a news story. I know that many many people will hear or read these sensationalistic headlines and not bother investigating further. I know that with the imprimatur of an MD who once worked with Johns Hopkins, this story will be taken as gospel by many people, obvious agendas notwithstanding. And I know that across the nation, parents who do not dig further into this story will make decisions about vaccinating their children that may not be in the children's best interest.

I wish, ineffectively, that all people could apply critical reasoning and intellectual curiosity to what they read and learn and hear. I wish that they could leave emotion at the door and look only at what the data are screaming at them. But I know that these wishes are impossibilities and always will be because our children are involved. What concerns me is that it will take the appearance of one of these diseases against which we vaccinate, in a population of unvaccinated children (either because of parental choice or child age), and serious disability or death before people remember why we have vaccines in the first place.

We vaccinated our children. We took a risk doing that, and we knew it. The known benefits accrued from the vaccines far outweighed those risks. People who choose not to vaccinate their children out of fear of those risks leave the burden of those risks on the shoulders of everyone else. If we, the "everyone else," did not take on that risk ourselves, these diseases that have killed and disabled millions before vaccines were available for them would make a comeback and devastate far more families than autism does. We who take the risk end up protecting not only our own children but also the children of those who do not vaccinate.

You're welcome.