Olmsted on Autism: The Caplan Cadre

By Dan Olmsted

Art Caplan, the University of Pennsylvania ethicist, certainly knows how to get a rise out of many parents of children with autism. Here's something he wrote in February: "If there has been a more harmful urban legend circulating in our society than the vaccine-autism link, it is hard to know what it might be. At a time when vaccines may be our last best hope in facing some of the greatest challenges we and our children face, this legend needs to be put to rest. Vaccination, not vaccine-bashing, is what this nation needs."

Last week Caplan took the next logical step, co-writing a piece in the Journal of Law, Medicine and Ethics titled "Off the Grid: Vaccinations Among Homeschooled Children."

According to the abstract, "With the spectacular growth in the number of homeschooled students, it is becoming more difficult to reach these youth to ensure that they are immunized at all. These children are frequently unvaccinated, leaving them open to infection with diseases that are all but stamped out in the United States with immunization requirements. States should encourage parents to get their homeschooled students vaccinated through enacting the same laws as those used for public school students. This could be done by enforcing current laws through neglect petitions or by requiring that children be immunized before participating in school sponsored programs. As most states require some filing to allow parents to homeschool their children, it would be easy to enact laws requiring that homeschooled children be immunized or exempted before completing registration."

Let's put aside for the moment the issue of whether homeschooled kids ought to be subject to the same immunization requirements as publicly-schooled children. For me the issue that hits close to home, so to speak, is Caplan's welcome stipulation that such children are "frequently unvaccinated." Given that the estimates of homeschooled children is anywhere from 1 million to 2 million, that's a sizable pool of never-vaccinated kids -- in the tens of thousands at a minimum, I would estimate.

A big-enough pool, that is, to study total health outcomes between vaccinated and never-vaccinated American children. In June 2005, I wrote an Age of Autism column for UPI titled "Homeschooled," in which I quoted Dr. Jeff Bradstreet on an apparent lack of autism among the never-vaccinated children in that group. Here's how the story started:
--
Where are the unvaccinated homeschooled children with autism? Nowhere to be found, says a doctor who treats autistic children and is knowledgeable about the homeschooled world. "It's largely nonexistent," Dr. Jeff Bradstreet told UPI's Age of Autism. "It's an extremely rare event."
Bradstreet treats autistic children at his medical practice in Florida. He has a son whose autism he attributes to a vaccine reaction at 15 months. His daughter has been homeschooled, he describes himself as a "Christian family physician," and he knows many of the leaders in the homeschool movement.

"There was this whole subculture of folks who went into homeschooling so they would never have to vaccinate their kids," he said. "There's this whole cadre who were never vaccinated for religious reasons."
In that subset, he said, "unless they were massively exposed to mercury through lots of amalgams (mercury dental fillings in the mother) and/or big-time fish eating, I've not had a single case."

Bradstreet said his views do not constitute a persuasive argument that low vaccination rates are associated with low rates of autism, but it is worth studying. "That's not yet science," he said. "It doesn't rise to the level of a powerful observation. It's a place to say, OK, well that's interesting, what does that tell us?"
--
Well, what it tells me is that there's a perfect "control group" out there waiting to be matched up with fully vaccinated children to see how the rates of the Four A's -- autism, ADD, asthma and allergies -- compare. While we're at it, let's toss in another A -- juvenile rheumatoid arthritis -- along with juvenile diabetes, gastro and skin disorders, anaphylactic peanut allergies, obesity, SIDS -- you name it, let's rule it out. It's just awfully interesting that such a study has never been done, given the view of mainstream medicine that confidence in vaccines represents "the last best hope," in Caplan's words, against the oncoming horde of microbes.

Without a decisive full-on study, reasonable people have reason for concern that the rates of at least some of those disorders, especially autism and asthma, might well be lower in never-vaccinated kids. That evidence comes from sources as diverse as a medical practice in Chicago whose thousands of never-vaccinated kids have almost no autism and asthma, to the Generation Rescue survey that found significantly higher rates of both in vaccinated children. I also found anecdotal evidence of the same phenomenon among the Amish.

It's easy to criticize all of that --- the Amish in particular because of their genetic homogeneity and cultural insularity. Even Bradstreet said he thinks the Amish are not a suitable group to study: "The purists would say that's too odd of a group," Bradstreet told me, and added that he agrees. "You can't draw conclusions from that kind of population."

Maybe the homeschooled kid across the street is different from you and me, as well. In that case, the government should spring for the tens of millions of dollars needed to do a conclusive study and get know-nothings like me off the backs of experts like Art Caplan. A trillion-plus federal budget and we can't use any of it to "put to rest" (Caplan's phrase) one of the most controversial health issues in America today?

In fact, such a study -- whether of homeschoolers or an even broader sample of American kids -- would only strengthen Caplan's argument, assuming it's correct. If there are simply no material adverse events following vaccination of the kind that so many parents cite -- autism being the poster-child for alleged developmental and chronic health disorders resulting from the current vaccination schedule -- it would certainly affect my attitude. Maybe in that case there should in fact be more strenuous and stringent vaccine mandates, applied across the board and not just to homeschoolers. Maybe exemptions should be ended, period, by federal decree and not allowed to vary widely state-by-state as is the case today. That could be argued as a matter not merely of medical necessity but of equal treatment under the law.

But if we take Caplan's idea on its own -- force all homeschooled kids to get fully vaccinated as soon as possible -- we'd lose one more population that could end concerns that vaccines are a hidden factor in the oh-so-mysterious rise in developmental and chronic health disorders among America's kids over the past two decades. And surely everyone believes that a definitive conclusion to this debate is in the best interests of not just worried parents but public health officials, the pharmaceutical companies and pediatricians.

Don't they?
--

Comments

[P.F. Jennings]

-

I wonder if Caplan has heard about the problem from the use of Prevnar? Here's the beginning of the story . . .

-

Vaccine Tied to 'Superbug' Ear Infection
Kansas City Star
By MARILYNN MARCHIONE

CHICAGO (AP)- A vaccine that has dramatically curbed pneumonia and other serious illnesses in children is also having an unfortunate effect: promoting new superbugs that cause ear infections.

On Monday, doctors reported discovering the first such germ that is resistant to all drugs approved to treat childhood ear infections. Nine toddlers in Rochester, N.Y., have had the bug and researchers say it may be turning up elsewhere, too.

It is a strain of strep bacteria [which is] not included in the pneumococcal vaccine, Wyeth's Prevnar, which came on the market in 2000 . . .

-

[P.F. Jennings]

-

What reply would Caplan have to this?
-

If there is a whole cadre, thousands and thousands, of unvaccinated kids?
-

Then where are the dire illnesses and infectious diseases sweeping through those groups?
-

Last time I heard about such things, the illnesses were sweeping through the vaccinated as well as the unvaccinated.
-