The Autism Epidemic, Vaccinations, and Mercury
While there are a few Flat-Earthers who insist that there is no real epidemic of autism, only an increased awareness, it is obvious to everyone else that the number of young children with autism spectrum disorders (ASD) has risen, and continues to rise, dramatically.
I first called attention to the increase in an editorial in the September 1995 issue of Autism Research Review International, which I edit, titled "Is there an autism epidemic?" [ 1]. My answer was "Yes! There clearly has been a sharp increase in the number of autistic children." Some readers agreed, others did not.
Five years later, the number of autistic children, as well as the amount of evidence documenting the increase, has continued to escalate. My most recent editorial on the subject (June 1999) was accordingly titled "The Autism Explosion" [ 2].
The evidence was compelling in 1995, and is overwhelming in 2000. Nevertheless, I read and hear daily about professionals, including many regarded as authorities on autism, who assert that there is no real increase in the autism population. They insist that the increase is illusory, and merely the result of greater awareness and improved diagnosis.
Bennett Leventhal, Professor of Child Psychiatry and Pediatrics at the University of Chicago, has been quoted by a newspaper reporter as replying "Rubbish!" when asked about my position on the increase. "There is increasingly powerful evidence that this is a genetic disorder," he stated. Since, of course, there is no such thing as an epidemic of a genetic disorder, there can be no increase of autism, he assumes.
Eric Fombonne, of the Institute of Psychiatry in London, says that the perceived increase reflects only "improved recognition" and "a broadening of the concept."
I don't think so.
I saw the word autism for the first time in the spring of 1958, five years after I had earned my PhD in psychology. My wife and I had taken our implacable, screaming newborn son to our pediatrician two years earlier. Dr Black had been in practice for 35 years and had never seen a child like Mark. Nor had any other physician we consulted. When Mark was two years old his strange, aloof, ritualistic behavior reminded my wife of a child she had read about in an old college textbook. There, in that textbook, I first saw the word "autism."
William Crook of Tennessee, a pediatrician who had received his medical training in the 1940s at Johns Hopkins, where Leo Kanner taught, became intrigued by autism and actively sought such cases by letting his pediatric colleagues throughout the South know of his special interest. It was not until 1973, 24 years after starting his practice, that he had his first autistic patient. Then came more. "I am absolutely certain that there is a huge increase in autism," Dr Crook told me. I have heard similar tales from many physicians as well as special education teachers and school administrators whose experience dates back to the early 1970s and before. Autism was truly rare in those days.
The argument that there is simply greater awareness and better recognition of autism nowadays makes no sense. Shelly Reynolds, a mother, states her position very clearly: "Imagine our family at the dinner table some evening, and me remarking to my husband `By the way, Aiden, have you noticed that our three-year-old son is not talking yet and doesn't do anything except sit there flapping his hands?' Those doctors who say there is no increase, just greater awareness, must think that we parents are a bunch of fools!" And she is right!
Responding to the autism establishment's denial of the obvious increase in autism, parent activists began insisting that governmental authorities investigate the problem. The Federal Centers for Disease Control (CDC), prodded by a group of parents, conducted a study of the prevalence of autism in the town of Brick, New Jersey. In California, parent Rick Rollens persuaded the state legislature to fund a statewide study of the prevalence of autism (California represents over 10% of the total US population).
Before looking at the results of these and other recent prevalence studies, note that my 1989 review reported 4.5 cases of autism per 10,000 live births as the average of more than a dozen studies. That figure has been used as a prevalence base for autism by many researchers.
THE BRICK, NEW JERSEY (US) STUDY 
In early 2000 the CDC researchers reported a rate of 67 cases of autism spectrum disorder per 10,000, and, using stricter criteria, 40 per 10,000 of so-called classic autism. This is approximately 1000% higher prevalence than expected.
THE CAMBRIDGESHIRE (UK) STUDY 
The prevalence reported in the New Jersey study is very close to the 57 per 10,000 prevalence rate reported in a recently completed study in Cambridgeshire, England. The study obtained data on 34,262 out of 42,000 children in the local schools, and counted as "autistic" only children officially diagnosed as such.
THE LONDON (UK) STUDY 
Another UK study found almost exactly the same prevalence; 58 per 10,000 in 16,235 7-year-old children in London, using the CHAT diagnostic instrument.
THE CALIFORNIA STUDY 
The massive California study showed increases between 1987 and 1998 ranging between 273% and 346%, depending on which definition of autism was used. An especially interesting aspect of the California study was the inclusion of statistics for four developmentally disabled populations; autism, cerebral palsy, epilepsy and mental retardation. The increase in cerebral palsy, epilepsy and mental retardation was about 3% per year for the 1987-98 period--running parallel to the increase in the general population of California. Autism was the only developmental disability to show the precipitous increase. If those who claim that the rise of autism is due to better diagnosis and awareness were correct, one would expect to see a corresponding decrease in the prevalence of other developmental disabilities, especially mental retardation. No such decrease was seen.
Most of those in the medical establishment who dispute the reality of the autism increase have resorted to rather cavalier, off-hand remarks in their attempts to dismiss the problem. To my knowledge, the only person who has done serious work in an attempt to dispute the reality of the prevalence increase is Eric Fombonne. His 1999 review of the epidemiology of autism [ 7] covered 23 epidemiological studies published between 1966 and 1998. In brief: The 12 studies published between 1966 and 1988 showed an average prevalence rate of 4.3 per 10,000, while the 11 studies published between 1989 and 1998 showed a rate of 7.2 per 10,000. Fombonne chooses to attribute this increase of 67% as "probably reflecting an improved recognition and detection of autism, together with a broadening of the diagnostic concept and definition." I have two comments on Fombonne's paper: First, the increase he reports of 67%, while falling far short of the 300% to 1000% increase reported in other studies, is not at all trivial. I don't know why he chooses to consider it as reflecting only awareness, not real change in prevalence. Second, I would venture to estimate that there is, on average, a 5-year delay between the end of the data-gathering phase of the typical prevalence study and the actual publication of the study. If I am correct, the 11 more recent studies published between 1989 and 1998 were based on autistic children who were mostly born between the mid-1970s and the mid-1980s--before the autism epidemic really took off. I have asked Fombonne to provide year-of-birth data, where available, for studies he cites.
By late 1996 the autism epidemic had attracted the attention of alarmed parents in the UK. The Dawbarns law firm announced that it was working with 150 families who felt that their child's autism was linked to the introduction of the MMR vaccine, given as a single shot rather than as 3 separate vaccines, starting in the UK in 1988. An area in Norfolk which had expected to see 3 or 4 new cases of autism had reported 46 new cases. Since many of the UK children were experiencing diarrhoea and other gastrointestinal problems, Dr Andrew Wakefield, a gastroenterologist at the Royal Free Hospital, was consulted.
The ensuing battle, conducted in the pages of The Lancet in articles, editorials and letters [ 8, 9, 10] would, if reported in detail, take more space than can possibly be devoted to it here, and is probably well known to the reader. Suffice it to say that the acrimonious charges and countercharges are still being heard, and the fight is far from over.
Let me dispel several myths promoted by those who deny the autism/vaccine connection:
1. They claim the vaccines are safe, but physicians are
indoctrinated to discredit claims of harm and are not
trained to recognize or required to report adverse
reactions. From 90% to 99% of the adverse reactions
reported to US doctors are never reported by those
doctors to the government's extremely lax Vaccine
Adverse Event Reporting System, known as the VAERS.
2. They say that the suspected linkage between the MMR
vaccination and autism has been disproven by a study
conducted by Brent Taylor and his colleagues in London,
and published last year in The Lancet . The Taylor
study is seriously flawed in many ways, as has been
noted in a number of letters to the editor of The Lancet
and in a number of additional letters on the subject
which have been posted on the Internet. It was subject
to strong attack at a recent meeting of the British
Statistical Society. I have been a full-time researcher
my entire professional life, for almost 50 years, and I
respectfully asked Dr. Taylor for a copy of the data so
that I could reanalyze them. He refused this ordinary
professional courtesy, and I have subsequently written
to the editor of The Lancet requesting that an impartial
committee be asked to reexamine Dr Taylor's statistical
3. They say that autism has a large genetic component, and
therefore vaccines must play a minimal role, if any, in
the causation of autism. My book Infantile Autism ,
in 1964, was the first systematic attempt to marshal the
evidence for genetics as a contributing cause of autism,
so I am certainly not hostile to that idea. However,
genes do not begin to account for the huge increase in
the incidence of autism, ranging from 250% to 1000% in
various places. I might add that I recently reviewed all
of the recent genetic studies for the Autism Research
Review International . The results are spectacularly
inconsistent. The best guess is that there are at least
20 different genes involved in the causation of autism,
with none playing a major role. Gene therapy is decades
away, and may be unfeasible.
4. They claim that autism naturally occurs at about 18
months, when the MMR is routinely given, so the
association is merely coincidental and not causal. Data
on many thousands of cases collected by the Autism
Research Institute since 1965 show that the onset of
autism at 18 months is a recent development. Autism
starting at 18 months was very uncommon for several
decades, then rose sharply in the mid-1980s, when the
MMR vaccine came into wide use (see Figure 1). A
Autism is not the only severe chronic illness which has reached epidemic proportions as the number of (highly profitable) vaccines has rapidly increased. In the US children now typically receive 33 vaccines before they enter school--a huge increase. Could this be the reason for the upsurge in autism, ADHD, asthma, arthritis, Crohn's disease, lupus and other chronic disorders?
Soon after my book Infantile Autism was published, I began to hear from other parents. Many parents told me that their children were normal until getting an earlier triple vaccine--the DPT shot. In 1965 I began systematically collecting data on the symptoms and possible causes of autism. Thirty-three years ago, in 1967, I began querying the parents specifically about the child's response to the DPT shot. Many had reported marked deterioration.
During the past few years, the Autism Research Institute has been flooded with an upsurge in pleas for help from parents throughout the world--from wherever the World Health Organization vaccine guidelines are followed. The majority of these parents say their children were normal until getting the MMR triple vaccine.
The Mercury Connection
During the late 1960s, my then graduate-student assistant, Dale Meyer, became interested in the fact that mercury poisoning mimicked many of the symptoms of autism. She wrote a research paper on the subject which is no doubt still somewhere in my stored files (I rarely throw anything away!). She wrote that acrodynia and pink disease were puzzling ailments which caused numerous symptoms, including those of autism, that had baffled medical investigators until the cause (mercury in teething lotions and diaper powders) was discovered. "Interesting," I remember thinking. "Another mystery solved. But only of historical interest." How wrong I was!
I had assumed, very naively, as it turned out, that the medical establishment would thenceforth avoid mercury like the plague. I was aware that minute amounts of mercury, along with other toxins, aluminum and formaldehyde, were used as preservatives in vaccines, but, after all, I thought, everyone now knows that these substances are extremely toxic and those highly sophisticated vaccine-makers would not possibly use amounts which even approach dangerous levels. Bad guess!
In early 2000, a group of concerned and inquisitive parents began looking into the mercury issue. They learned that thimerosal, a preservative containing high levels of mercury, was used in most vaccines at levels that greatly exceeded the upper limits decreed safe by the US Environmental Protection Agency (EPA). (The scientific paper by Bernard et al. may be found on the website of the Autism Research Institute [ 14].)
In her testimony before the US House of Representatives in July, Sallie Bernard, the primary author of the report, testified: "the symptoms which are diagnostic of or strongly associated with autism itself are found to arise from mercury exposure, as described in available literature on past cases of mercury poisoning" [ 15].
"These similarities," she testified, "include the defining characteristics of autism--and they include traits strongly associated with autism and found in nearly all cases of the disorder--sensory disturbances such as numbness in the extremities and mouth, aversion to touch, and unusual response to noise; movement disorders like toe-walking, hand flapping, clumsiness, and choreiform movements; and cognitive impairments in specific domains like short-term, verbal and auditory memory and in understanding abstract ideas." In addition, she noted, mercury poisoning can cause many of the same biological abnormalities as are seen in autism, including immune system dysfunction and anomalies in the cerebellum, amygdala, and hippocampus.
Bernard noted that the growing prevalence rate of autism closely matches the introduction and spread of thimerosal-containing vaccines and that autistic symptoms generally emerge at the time the child is given the thimerosal-containing vaccines. She added, "Our group has also documented a number of cases of autistic children with toxic levels of mercury in hair, urine and blood." In addition, she noted, mercury is more toxic to males than to females, and the male-to-female ratio in autism is 4 to 1.
Noting that low doses of mercury tend to harm genetically susceptible individuals, Bernard pointed out that "autism has been recognized as one of the most heritable of all neurological disorders and is strongly associated with familial autoimmune disorders."
Bernard and her colleagues called for an immediate ban on thimerosal-containing childhood vaccines, noting that the cumulative amount of mercury which a six-month-old received from a full course of vaccinations exceeds the acceptable dose levels set by federal agencies.
At a Congressional hearing on vaccine safety in August 1999, Congressman Dan Burton stated that his grandson (who became autistic following routine vaccinations) received in one day 41 times the level of mercury considered permissible by adult standards. Lyn Redwood, an RN whose child also became autistic following multiple vaccinations, has calculated that her child received 125 times the maximum permissible daily exposure in one day of vaccinations.
The US Government has agreed to take the thimerosal-containing vaccines off the market next year. A parent group has gone to court demanding that mercury-containing vaccines be banned immediately.
Needless to say, the (re)discovery of the mercury/autism connection has had many ramifications. Since mercury is highly toxic to multiple organs (including not only the brain but the immune system) it increases the child's vulnerability to all vaccines, including MMR, which (at least in the US) does not contain mercury. And of course the fact that a baby's liver and other detoxifying organs are underdeveloped greatly amplifies the problem.
Parents are flooding their pediatricians for help in removing the mercury, only to be met with puzzlement. DMSA? DMPS? Dosage? Timing? Mineral replacement? Melatonin? Alpha Lipoic acid? IV Vitamin C and glutathione? The questions abound. What do we do?
In the midst of all the controversy there stands one incontrovertible fact: these are interesting times!
ISSN 1359-0847 print/ISSN 1364-6907 online/00/040261-06 (C) Taylor & Francis Ltd
GRAPH: FIG. 1. Autism onset at 18 months became common only after MMR use became common.
 Rimland B. Is there an autism epidemic? (Editorial) Autism Res Rev Int 1995; 9 (3): 3.
 Rimland B. The autism explosion. (Editorial) Autism Res Rev Int 1999; 13 (2): 3.
 Prevalence of autism in Brick Township, New Jersey, April 2000. Center for Disease Control, 2000. http://atsdr1.atsdr.cdc.gov/HAC/PHA/bri/bri%5ftoc.html
 Scott F, Baron-Cohen S, Bolton P, Brayne C. Brief Report: Prevalence of autistic spectrum conditions in children aged 5-11 years in Cambridgeshire, UK. Presented at the All-party Parliamentary Group on Autism, London, 15 May 2000.
 Baird G, Charman T, Baron-Cohen S, Cox A, Swettenham J, Wheelwright S, Drew A, Kemal L. A screening instrument for autism at 18 months of age: a 6 year follow-up study. J Am Acad Child Adoles Psychiatry 2000; 39: 694-702.
 Changes in the Population of Persons with Autism and Pervasive Developmental Disorders in California's Developmental Services System: 1987 through 1998. A Report to the Legislature. Department of Developmental Services, 1600 Ninth Street, Room 240, Sacramento, CA 95814. 1999
 Fombonne E. The epidemiology of autism: a review. Psychol Med 1999; 29(4): 769-86.
 Wakefield AJ. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998; 351(9103): 637-41.
 Letters. Lancet 1999; 353(9169): 2026-9.
 Wakefield AJ. MMR vaccination and autism [letter; comment]. Lancet 1999; 354(9182): 949-50.
 Taylor, B et al. Autism and measles, mu mps and rubella vaccine: no epidemiological evidence for a causal association. Lancet 1999; 353: 2026-9.
 Rimland B. Infantile Autism: the syndrome and its implications for a neural theory of behavior. New York: Appleton-Century-Crofts 1964.
 Rimland B. The genetics of autism: four large-scale studies find no answer. (Editorial). Autism Res Rev Int 2000; 14 (1): 1.
 Bernard S, Enayati A, Roger H, Binstock T, Redwood L, McGinnis W. Autism: a unique type of mercury poisoning. 2000. www.autism.com/ari
 Remarks to the US House of Representatives Committee on Government Reform Hearing, "Mercury in Medicine: Are We Taking Unnecessary Risks?". http://www.house.gov/reform/hearings/healthcare /00.07.18/bernard.htm
By Bernard Rimland, PHD, Autism Research Institute, 4182 Adams Avenue, San Diego, California 92116, USA