IN TONIGHT'S premiere episode of the ABC legal drama "Eli Stone," the protagonist is a lawyer who has spent most of his professional life defending large corporations. A vision inspires him to change direction, and he starts by suing a vaccine manufacturer, representing the mother of an autistic child who claims that a vaccine caused the child's autism. The dramatic high point is reached when the chief executive of the company is forced to admit on the stand that he wouldn't allow his own daughter to receive the vaccine in question. The jury awards multimillion-dollar compensation to the child's mother.
The cause of autism is not entirely understood, but considerable evidence demonstrates that most autistic children have abnormalities present at or before birth. It has long been known that autism may in some cases be part of a larger genetic disorder, such as Down syndrome or Rett syndrome. Several recent studies have bolstered the recognition of genetic components in autism even when it is not part of a syndrome.
Vaccination is the single medical intervention that has saved the most lives over the past century. Vaccines are so successful that most Americans have never seen the diseases that they prevent, nor known anyone who has experienced them.
When new parents start to think about vaccines, they are likely to hear primarily the voices of those who fear vaccines. They are less likely to hear the voices of parents who have lost children as a result of such diseases as polio, meningitis, and hepatitis, or who have watched their children suffer with illness and lifelong complications such as paralysis, deafness or liver cancer.
Do vaccines cause autism? Two particular vaccine-autism connections have been proposed within the past 15 years. At the outset, both were biologically plausible to any of us in medicine and biology. One suggested an association with the measles, mumps, and rubella vaccine, and the other questioned whether thimerosal, a mercury-containing antibacterial compound used in some vaccines to prevent bacterial contamination, might be related to autism. Over the past decade, these hypotheses have been rigorously tested in numerous studies. Every methodologically sound study demonstrates no connection.
Two of the most intuitive arguments follow. The MMR vaccine is given after 12 months of age. In a study by Scientific Institute at the University of Pisa, home videos of children younger than 2 who were later diagnosed with autism were compared with videos of developmentally typical children at the same ages. Behaviors were scored by observers who were blinded to the subsequent development of the children. Differences were clearly present, even at 6 months of age - before the MMR vaccine could have been given.
In Denmark, thimerosal was removed from all vaccines in 1992. The incidence of autism there continues to rise faster now than it did prior to 1992.
The scientific evidence is clear: neither the MMR vaccine nor thimerosal (mercury) in vaccines has any relationship to autism. This evidence is accepted by a majority of physicians and scientists.
How, then, does ABC justify presenting a drama that depicts the position "vaccines cause autism" as a credible, even a scientifically and legally compelling argument? It is precisely the power that fictional dramas have to connect viewers to topical issues that make this broadcasting decision so harmful. Television viewers tend to blur the lines between news (fact) and drama (fiction).
ABC has announced that it will begin the program with a disclaimer: "The following story is fictional and does not portray any actual persons, companies, products or events." This doesn't in any way address the implied message about the purported connection between vaccines and autism.
Many viewers of this episode of "Eli Stone" will undoubtedly walk away from the television set convinced that vaccines do, in fact, cause autism - a position no more credible than the belief that snake oil cures rheumatism. Some viewers may be reluctant to vaccinate their children.
The fueling of this negative trend through the careless use of a storyline based on bad science is inexcusable. ABC should rethink its decision, and viewers should understand that the episode is a scriptwriter's fantasy rather than health education.
Dr. Benjamin A. Kruskal is a director of infection control at Harvard Vanguard Medical Associates. Dr. Carole Allen is director of pediatrics at Harvard Vanguard Medical Associates.
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