May 2, 2016

Autism: Controversy Continues to Swirl

By
EDITOR’S NOTE: April was National Autism Awareness Month, and the subject continues to stir controversy nationwide. ICD10monitor e-News recently conducted an interview with H. Steven Moffic, MD, a nationally renowned psychiatrist, to sift fact from fiction, science from opinion. Below are some excerpts from that interview.

Autism came roaring back into the news recently when film star Robert De Niro, whose 18-year-old son has autism, told NBC's TODAY show that he believes there is a link between autism and vaccines – a reference to the since-discredited film "Vaxxed," a movie he later pulled from his own film festival. However, De Niro still seems to be open to the suggestion there might be a link. 

HSM: Chuck, it is interesting that you use the word "believe" in your question. Surely, Mr. De Niro and his followers believe that there is a link between autism and the MMR vaccine. The party who just told us that we were sitting in their seats in the theatre (was) sure they were right, but the data on our tickets proved they were wrong. That is what science does; it tries to prove whether beliefs are true whenever it is possible to do so. 

It indeed was possible to do so, in this situation. 

Does his persona add to the controversy? 

HSM: The scientific and medical jury is clear about vaccines and autism, although as with most juries, there can be dissenters. You are astute to ask if Mr. De Niro's persona adds to the controversy. I'm afraid it does. When people idolize celebrities, they tend to generalize from what the celebrity is known for. In other words, if Mr. De Niro is a great actor, which he is, he likely is a great analyzer of information – which is a bad assumption. Celebrities like him and other public figures therefore have the potential to do more harm (than) good with what they say or do. 

Clinically, what is the difference between autism and Asperger syndrome? 

HSM: Autism and Asperger, at least from the newest psychiatric diagnostic standpoint, DSM 5, are on a continuum called the autism spectrum. They are connected in the sense that they both (involve) communication challenges, though autism is more severe. In the older ICD-10, they are separate disorders. Asperger is more common and those who have it tend to be socially awkward, whereas those with autism can act in a stranger manner, but also have special strengths, which is why high-tech companies are staring to hire them for their ability to intensely focus. 

The movie "Vaxxed: From Cover-Up to Catastrophe" has been called an anti-vaccination film – the producer, Andrew Wakefield, a former doctor, claims there's a link between the MMR vaccine and autism and focuses on an alleged "CDC whistleblower" cover-up. 

Is there a link?  

HSM: The original study that claimed there was a link turned out to be deliberately fraudulent and was retracted. The doctor who published the study lost his license. 

Just to be sure, as good science does, our independent Institute of Medicine and our Centers for Disease Control and Prevention did their own reviews and study. They concluded there is no link. 

Now, people can believe the science or not, but it is clear that vaccines have been one of the great advances of the last half-century, saving innumerable lives and suffering. 

Autism is a challenge for all concerned, and we don't yet know its cause. It is better right now to focus on all we can do – and should do – to help those who have it and their loved ones. Hopefully, science will give us more answers in the future.

Scientists on both sides of the global warming issue continue to debate the subject, even in the light of empirical evidence showing that warming is happening. Is this vaccine/autism debate the same kind of issue, suggesting no clear evidence to the contrary? 

HSM: No, the vaccine question is much different than the global warming controversy. The vaccines can be tested out in real time in relationship to autism. Although there is a suggestion that some recent warm weather years relates to future global warming, the future concerns are computer projections, which can't be scientifically verified. Predicting the future is science fiction, not science. So, actually, we need some belief that these projections will turn out to be true because the risk is so high. There have been warming periods in the past, but what does have current scientific verification is that the current warming relates to human behavior, which is something we can change. 

California Senate Bill No. 277, which goes into effect July 1, removes the "personal belief vaccine exemption" from children attending private and public schools. Is this a good measure?

HSM: That California bill is a very good public health measure, for if not enough children are vaccinated, not only will their health be at risk, but that of other children (will be as well) – because the vaccines are not foolproof, (and) the non-vaccinated can infect each other.

There's been increased governmental focus on opioid abuse of late, with a particular emphasis on avoiding over-medication of legal, synthetic opioids. What role does medication play in autism, and could kids with autism be over-dosed?

HSM: Medication does have a role in treating some with autism, but in general, a whole variety of behavioral therapies are necessary. As with all psychiatric disorders, medication should be used judiciously and at the lowest effective dose for the shortest period of time, which would be the same recommendation for opiates. 

Is the jury still out on the efficacy of vaccines? 

HSM: The scientific and medical jury is clear about vaccines and autism, although as with most juries, there can be dissenters. 

About H. Steven Moffic, MD 

H. Steven Moffic, MD has received numerous awards for his practice, writings, and administration. Deemed a "Hero of Public Psychiatry by the American Psychiatric Association," he is an editorial board member of and regular contributor to Psychiatric Times. Dr. Moffic’s book, “The Ethical Way: Challenges and Solutions for Managed Behavioral Healthcare” (Jossey-Bass, 1997), was the first on the subject. 
Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Chuck Buck

Chuck Buck is the publisher of ICD10monitor and is the executive producer and program host of Talk Ten Tuesdays.

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