Response to "Theoretical aspects of autism: Causes A review" by Ratajczak, HV (Journal of Immunotoxicology 8:68 79, 2011)
In a recent review paper by Ratajczak (2011) on theoretical aspects of autism, the lines between speculation and well supported science were blurred with respect to how possible risk factors for autism were described. Considering the potential public health implications if speculation leads to action, we felt that we needed to respond to the way in which Dr. Ratajczak presented information in the review. Autism is a childhood disease that has an estimated prevalence of 1 in 110 children in the United States (CDC, 2009) The accompanying social costs of treating autistic children have sky rocketed, and the emotional costs endured by families with autistic children are impossible to estimate. Hindrances to the treatment and prevention of autism are directly related to the heterogeneity of risk factors that likely contribute to an autism diagnosis and the phenotypic heterogeneity of the disease itself. Genetic susceptibilities combined with a myriad of exogenous factors including maternal infections, stress, environmental pollutants, pharmaceutical agents, and dietary insufficiencies are thought to contribute to the etiology of autism. However, specific pathways are hypothetical at best and causality among putative risk factors has not been established. The review by Dr. Ratajczak goes beyond a discussion of scientific studies of putative risk factors of autism to assign both causes and specific preventative measures linked with those causes. In our opinion and based on the present state of the scientific literature, this is inappropriate. In her review on autism, we feel that Dr. Ratajczak misrepresented the following points: (1) Perhaps the most publicly and scientifically debated issue surrounding risk factors associated with autism is vaccine safety. Dr. Ratajczak writes that "The incidence and prevalence data indicate that the timing of introduction of vaccines and changes in the type and increasing number of vaccines given at one time implicate vaccines as a cause of autism." Several recent studies indicate that vaccination, specifically the vaccination against measles mumps rubella (MMR) does not increase the risk of autism. Notably, a longitudinal study done in Japan over a 4 year period (1989 1993) demonstrated that the incidence of autism was not different across the interval before, during, and after this MMR vaccination window (Uchiyama et al. 2007) The vaccine controversy arose from a single paper published in 1998 (Wakefield et al. 1998) suggesting that the MMR vaccine was linked to autism. For parents with autistic children looking for a reason to explain their child's diagnosis, this paper seemed a blessing and led to anti vaccination cries from celebrities and advocacy groups. The original Wakefield et al. 1998 paper was fully retracted by the Lancet on 2 Feb 2010 following a report of the United Kingdom's General Medical Council. The British Medical Journal concluded that the study had been fraudulently concocted (Godlee et al. 2011) However, the damage to public health persists. The outcome of this flawed work included the resurgence of previously controlled diseases in the United States and United Kingdom that led to injuries and deaths in children who were not immunized against MMR. Numerous studies were unable to replicate the fraudulent Wakefield findings LETTER TO THE EDITOR
Journal of immunotoxicology