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Sunday, August 07, 2005

Meet the Press transcript - David Kirby & Dr. Fineberg

MR. RUSSERT: Coming next, autism: what we know and what we don't know. Dr. Harvey Fineberg of the Institute of Medicine and David Kirby, author of "Evidence of Harm: Mercury in Vaccines and the Autism Epidemic: A Medical Controversy," next, right here on MEET THE PRESS.


MR. RUSSERT: The controversy over childhood vaccines and autism, after this brief station break.


MR. RUSSERT: And we are back.

Dr. Fineberg, Mr. Kirby, welcome both.

In your book, Mr. Kirby, you raise early on two questions. "Why did the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) allow mercury exposures from childhood vaccines to more than double between 1988 and 1992 without bothering to calculate cumulative totals and their potential risks?" And "Why ... was there a corresponding spike in reported cases of autism spectrum disorders? Why did autism grow from a relatively rare incidence of 1 in every 10,000 births in the 1980s to 1 in 500 in the late 1990s? Why did it continue to increase 1 in 250 in 2000 and then 1 in 166 today?" Have you answered those questions?

MR. DAVID KIRBY: No, nobody's answered those questions. And we have to answer those questions as soon as possible. We need to solve this mystery. We need to get this controversy behind us so we can go on to find ways to help these kids. Mercury is toxic. It's a known neurotoxin. If it gets into the brain, it could stay there virtually forever. Children born in the '90s received mercury far in excess of federal safety limits. That's indisputable. And yet we're looking at a neurotoxin. And yet most of the evidence developed by the public health sector has been looking at the epidemiology. And we really need to look at what this mercury is doing inside the bodies and brains of these children if we're going to solve this mystery one way or the other.

MR. RUSSERT: Dr. Fineberg, in your 2004 report from the Institute of Medicine, you said this: "While some information suggests that autism rates may be rising, it is not clear whether the observed increase is real or due to factors such as heightened awareness of the disorder or the use of a broader diagnostic definition. ..."

Do you think there's an epidemic of autism or do you think it's simply a change in defining it?

DR. HARVEY FINEBERG: There's definitely a huge number of cases diagnosed with autism, Tim. What is clear is that number recognized has increased dramatically. It's also clear that the definition was broadened markedly in the 1980s and 1990s, and there were increased incentives to recognize children from increased awareness and availability of services. No one knows with certainty what part of the increase is genuine, a genuine increase in numbers, and what part is from increased recognition of people who were already there but not previously recognized. Remember we're talking about a spectrum of diagnoses here, autism spectrum diseases, which range in severity from relatively mild to relatively severe.

MR. RUSSERT: For a layman, in a few words, how would you explain autism?

DR. FINEBERG: Autism is a severe neurodevelopmental disorder that is characterized by social withdrawal, by repetitive behaviors and by some kind of focal attention in its classic form. Basically, it's an inability to relate to others.

MR. RUSSERT: Let me go back and review two of the studies that the Institute of Medicine did because this has helped feed much of this controversy and discussion. Back in 2001, the headline on your press release was "Link Between Neurodevelopmental Disorders And Thimerosal Remains Unclear. Current scientific evidence neither proves nor disproves a link between the mercury-containing preservative thimerosal and neurodevelopmental disorders in children, says a new report from the Institute of Medicine... While very few vaccines given to children in the United States today still contain thimerosal, prudence dictates that precautionary measures be taken to decrease thimerosal exposure even further. ... It is medically plausible that some children's risk of a neurodevelopmental disorder could rise in part through increased mercury exposure from thimerosal-containing vaccines."

Thimerosal being a preservative that is put into the vaccine. Then about three years later in May of 2004, the Institute of Medicine issued this headline: "MMR Vaccine And Thimerosal-Containing Vaccines Are Not Associated With Autism, IOM Report Says. Based on a thorough review of clinical and epidemiological studies"--I'll always destroy that word--"neither the mercury-based vaccine preservative thimerosal nor the measles-mumps-rubella (MMR) vaccine are associated with autism, says a new report from the Institute of Medicine..."

What changed in those three years?

DR. FINEBERG: When you're dealing with a problem as complex as autism, Tim, you have to look at it from many different points of view and assemble evidence from many different vantage points. Biological evidence in humans and in animals, toxicologic evidence, how does the body deal with toxins, and evidence looking at the actual experience in populations. When the 2001 report was written, there was a lot of suggestive information about the toxic properties of mercury and the problem of autism incompletely understood. By 2004, the main change was that there were completed additional studies that were actually looking in the population at the relationship of receipt of vaccines containing thimerosal and the development of autism.

These studies were carried out in the United States, in Great Britain, in Denmark and Sweden. These studies covered hundreds of thousands of individuals, children, in these populations. They compared systematically in different ways whether you received vaccine with no thimerosal, with some thimerosal, with more thimerosal, and they looked at the relationship of those experiences with the development of autism. Uniformly, the best of those studies all show no association between receiving vaccine of different amounts with thimerosal or without and the development of autism. It was the absence of that association which was the main reason for reaching the conclusion that the evidence points to no association between vaccines and autism.

MR. RUSSERT: Mr. Kirby?

MR. KIRBY: Well, I think those five epidemiological studies range from severely flawed to seriously questionable. And I also think that you cannot rely solely on epidemiology to prove or disprove causation. In fact, I have right here--this is from the federal court system, but they ruled that epidemiology is not acceptable to prove there is no causal link between an adverse event and a pharmaceutical.

MR. RUSSERT: Explain that in layman's language.

MR. KIRBY: Well, it means that you really, like the doctor said, need to look at the kids as well as look at the large population studies. You need to look at the biology, the toxicology; you need to look at the cellular level. You need to look at immunology, and I would say that what the IOM did last year--I was at that meeting on February 9. Virtually half of the evidence against the theory, that was presented against the theory was epidemiological--I have the same problem as you. The other half supporting the theory was largely biological. And yet the committee gave a preponderance of evidence or emphasis to the epidemiological evidence and rather, I would say, gave short shrift to the biological evidence.

Dr. Fineberg has mentioned that there are 215 references in the report. I counted them up. By my count, it's roughly a 2:1 ratio, about 115 references for epidemiology, 60 references for biology, and of those, only seven were toxicological reports. Now, we're talking about a known neurotoxin, and there were no toxicologists on the committee, either. So I think even Dr. McCormick, the chairwoman of the committee, told me that there was definitely an emphasis on the epidemiology over the biological evidence.

MR. RUSSERT: When we announced this program, as you might expect, we heard from both sides who are very emotional and passionate about this. The National Autism Association, Dr. Fineberg, wrote a letter to us including this: "The five studies the Institute of Medicine based its conclusion upon are fatally flawed, have never been replicated and have ties to the CDC"--Center for Disease Control-- "(or foreign equivalent mandating vaccines in other countries) and/or the pharmaceutical industry. However, the Institute of Medicine chose to completely ignore the biological and clinical data supporting the link between thimerosal exposure and injuries to children conducted by independent appropriately- credentialed researchers."

DR. FINEBERG: Tim, the Institute of Medicine panel that came together represented a spectrum of experts who were asked to look at all of the evidence, and they did. They assessed the evidence that bears on the question. Some of it is biological, as I mentioned; some of it has to depend on what you actually find when you go out and look in the population. Is there or is there not an association? Keep in mind that there are many neurotoxins in the world. Dozens of natural and industrial substances have neurotoxic properties. When you're trying to assess a specific association, there are biological studies that are relevant, and there are epidemiological studies that are relevant. All of these studies are not equally valid. Some have more deficiencies and limitations than others.

The committee went through very carefully and assessed each of those studies representing its strengths and weaknesses. All of this is laid out in its report, which is available for download to anyone who wants it from the IOM Web site, www.iom.edu. And anyone can read for themselves how the committee evaluated critically and carefully all of this evidence.

When the letter you read states that these five studies were not replicated, I can't help but think that each one of them has been replicated four times. We have now a growing body of evidence, while imperfect, altogether convincing and all reaching the same conclusion, even though they vary in their methods and in their approaches. And that conclusion was no association between the receipt of vaccines containing thimerosal and the development of autism.

MR. RUSSERT: Why was thimerosal then taken out of the vaccination?

DR. FINEBERG: There's no question that mercury is a neurotoxin. And if there were ways, which there are, to protect vaccines without using mercury-containing substances, it was prudent to remove it, not because there was evidence that it caused autism or even definitive evidence that the amounts in those vaccines caused any neuro problems, but because it was an added measure of precaution that was sensible and correct. And I might add that the latest vaccines that contained any thimerosal as a preservative, with the exception of some flu vaccines, were completed in 2001 and outdated in 2003. So anyone watching this program, any parent can be confident that when they take their child to the pediatrician to be immunized this year, they will receive vaccines without thimerosal as a preservative.

MR. RUSSERT: But prior to this year, there may be some concern?

DR. FINEBERG: Prior to 2003, there were some that still had thimerosal, but the concern is not reaching the level of evidence related to the development of autism. The concern is a more general concern about mercury as a potential neurotoxin.

MR. RUSSERT: Mr. Kirby?

MR. KIRBY: Well, if I could get back to the IOM report, that meeting was held 14--or the report was actually issued 14 months ago. This story is moving very, very fast. In those last 14 months, there has been an equally growing body of evidence, again on the biological side, that would suggest that, in a small subset of children with a certain genetic predisposition, they are unable to properly process the mercury that they were exposed to. And, by the way, the rates of exposure were quite high in the 1990s. At two months of age, children got three shots for a total of 62.5 micrograms of mercury. For their body weight, that's 125 times over the EPA level. For me to reach that level, that would be about 1,125 micrograms.

We know that certain children with autism, again, seem to have higher levels of mercury accumulating in their body. We know that when we give mercury to infant primates, the--there's two types of organic mercury: ethylmercury in vaccines, methylmercury in fish. What they found was that the ethylmercury, once it got into the brain, it converted to inorganic mercury very, very quickly. Inorganic mercury basically gets trapped in the brain, and there's evidence to suggest that, in an infant brain, in the first six months to a year when the brain is still growing, when inorganic mercury gets trapped in that brain, you're going to have this hyper neuroinflammation, or the rapid brain growth that we see in autistic children.

These are the types of things that I think need to be researched further. Yes, we need to look at the epidemiology. There's a whole lot of new biology. This has all been published. None of the biology was published at the time of the IOM hearing. It has since been published, and I actually wonder if the IOM would consider reconvening a new committee or a new hearing to consider the evidence that's come out in the year and a half since the last report.

MR. RUSSERT: Would you?

DR. FINEBERG: Tim, Mr. Kirby's description about the certitude of this evidence, I think, exceeds the actual balance of evidence that is produced when you look at the totality. It's true that mercury is handled differently in the body when it's in the form of so-called ethylmercury, which is in vaccines, and methylmercury, which was actually the form which was--on which the standards of exposure were based. That's the type found in fish, as has been mentioned. But when you look back at the studies of actual poisonings of children with large amounts of methylmercury and ethylmercury, most toxicologists believe that the ethyl form of the mercury is less toxic than the methyl form--less toxic to the nervous system. And that's based on many experiences with poisoning by these different forms of mercury.

MR. RUSSERT: Many parents have written us over the last couple of days saying that they have put their child in the process of chelation, which removes the mercury poisoning from the system, and they say they've seen vast improvement. Wouldn't that suggest that there may be some relationship between the mercury from thimerosal and the removal from the child?

DR. FINEBERG: Tim, autism is a complicated illness, and children with a variety of treatments and non-treatments show improvement over time, which is all to the good. But when you have a single story and a repeated story of an experience that a parent has with a treatment like chelation, you have to keep in mind that the history of medicine is strewn with discarded treatments that people at one time believed in very, very strongly. When you have one case after another, it's one anecdote after another, and the plural of anecdote in scientific terms is not evidence. The only way to know whether a treatment works or does not work compared to other things is to do the clinical trial, comparing those who are given the treatment in a systematic and balanced way with those who are not.

MR. RUSSERT: Mr. Kirby, in your book, you talk about a conference on June 7 to 8 in 2000 in Simpsonwood, Georgia. We've gotten many e-mails and letters about a government conspiracy, that the CDC and the FDA and the Institute of Medicine and everyone has gotten together and really tried to deny information to the parents of children with autism. Do you believe that?

MR. KIRBY: Well, I think the word "conspiracy" and "cover-up," those are very loaded words and I never use them. I do think there has been a lack of transparency and I would think Dr. Fineberg would probably agree with that statement. In this entire process...

MR. RUSSERT: Do you agree with that?

DR. FINEBERG: I don't agree that the lack of transparency has, had had any bearing on conclusions, and I'm not sure what we mean by a lack of transparency.

MR. RUSSERT: Right now many parents are seeking information from studies from the CDC through the Freedom of Information Act, and they're being told that the HMOs now have that information and they cannot share it because of privacy. And the parents are saying that's outrageous. It could easily be obtained by the CDC and disburse that science, that data so people can look at it and make their own judgments. Should the CDC at least do that?

DR. FINEBERG: In fact, Tim, the Institute of Medicine looked separately in a different study at this system that was in place and did urge the CDC to make these records more available to qualified researchers. But that is not the same as a lack of transparency in the studies or in the reports. All anyone has to do in the case of the Institute of Medicine report is to read the report. All of the logic is laid out, all of the weighing of considerations. Not everyone may agree with each assessment, but they have all the relevant evidence right before them.

MR. RUSSERT: Mr. Kirby, you have said, "I am totally willing to accept there are other factors at play. It may turn out not to be thimerosal at all." What do you think should be done?

MR. KIRBY: Well, I think, first of all, we need clinical trials for treatments. We need to try to help these children as best we can. There is a clinical trial of chelation therapy under way right now at the University of Arizona [editor's note: should be Arizona State University]. Dr. Fineberg said we need these trials. I wish the government was funding them. We need to listen to these parents as well. And I think that they've gotten a lot of dismissal from the scientific community. Parents were telling scientists that their children were born normally and then regressed. A lot of people dismissed that and said that couldn't be the case. We now know from a brand- new study from the University of Washington using videotapes of one-year birthday and two-year birthday that is indeed the case. If the parents were right about regression, maybe they're right about chelation.

Just getting back to transparency for one second if I could and this whole safety data base that we're trying to get access to from the report that Dr. Fineberg cited, it says right here, "The lack of transparency of some of the processes also affects the trust relationship between the NIP, the National Immunization Program, and the general public." The lack of trust and the lack of transparency is what's threatening the vaccine program, not talk about mercury. So the doctor's own committee said that there was a lack of transparency again inside this process of analyzing this data that was presented at that conference in Georgia.

MR. RUSSERT: Many of the National Autism Association and other groups, Doctor, point to Task Order 74. This is the arrangement between the CDC and the Institute of Medicine, a one-page memo which helps define the study and why it won't be released. Is there a reason?

DR. FINEBERG: I don't know what exactly that's referring to, Tim, but when the Centers for Disease Control contracts with the Institute of Medicine to undertake a study, they do pay the actual costs of the study. But keep in mind that the panel of experts that are assembled by the Institute of Medicine receive no compensation whatsoever for their volunteer service. And when a government agency conveys money to the Institute of Medicine, it's not the agency's money. It's the American people's money. And our obligation is to do the best we can to assess the evidence on behalf of the American public.

MR. RUSSERT: Since thimerosal is now out of the vaccine, latest as of '03, we will know in a few years whether or not there is a connection...

MR. KIRBY: Yes. That's correct.

MR. RUSSERT: ...definitively by the number of cases?

MR. KIRBY: I think so, but again we need to look at the biology, but the epidemiology is very important. If the case rates start to drop in the next couple years, I think that will be hugely significant. If I could also just get back to this commission by the CDC of the report, I'd like to do that as well.

MR. RUSSERT: Real fast.

MR. KIRBY: Well, there's evidence that there was pressure put on the committee by the CDC, and we have internal transcripts. I think that's what you were referring to. There are transcripts of private meetings. Some of them were leaked. They're not obtainable through the Freedom of Information Act. Many people are trying to get copies of the other transcripts, and I do hope that the IOM will make those available in the name of transparency in this.

MR. RUSSERT: Was there pressure?

DR. FINEBERG: Absolutely not, Tim. In fact, the whole reason why the Institute of Medicine, the National Academy of Sciences, the National Research Council exists is to be an independent voice outside of government to work on behalf of the needs of the American people. That's what we do. Agencies do not always hear from us what they want to hear. Sometimes the evidence does not point in a direction that is welcome. Stem cell guidelines or information about climate change or, for example, the ways to fix the Hubble Telescope which came out of the national academies--all of these are studies undertaken on behalf of the American public and the same was true for our assessment of vaccine safety.

MR. RUSSERT: You're absolutely convinced there's no connection between thimerosal and autism?

DR. FINEBERG: I'm convinced that the best evidence all points to the lack of an association. These studies can never prove to the point of absolute certainty an absence of an association. But I would say this, other avenues of research looking at other possible causes today are much more promising ways to spend our precious resources.

MR. RUSSERT: And our viewers should know that there is no thimerosal now in vaccinations, other than flu vaccinations, and so it's safe for your children to do --(Unintelligble).

DR. FINEBERG: And even some flu vaccines for children are now available without thimerosal, as well.

MR. RUSSERT: You believe there is a possibility of a connection?

MR. KIRBY: Absolutely. And I think one day we'll find out that there might have been--this has contributed to some of the cases in autism in this country.

MR. RUSSERT: Thank you for a very civil discussion. To be continued.

Posted by Becca

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