March 6, 2008 -- Neurologist Jon Poling, MD, PhD, is not surprised that the federal government decided to grant compensation from a federal vaccine injury fund because his daughter Hannah, now 9, had developed autism-like symptoms after receiving childhood vaccines.
He knew the case was a good one.
An experience like that might understandably turn any parent -- even a doctor -- against childhood vaccines at all costs. Surprisingly, it has not, Poling tells WebMD.
"I don't think the case should scare people," says Poling, 37, who emphasizes that vaccines, like all of medicine, carry risks and benefits.
In deciding the case, which has sparked anew the vaccine-autism debate, the federal government has not said that childhood vaccines cause autism. Rather, federal officials conclude the vaccines, given to Hannah in 2000, aggravated a pre-existing condition that then manifested as autism-like symptoms.
The pre-existing condition was a disorder of the mitochondria, the "power sources" of the cell, according to Poling.
Court vs. Science
Proving the link legally is quite different than proving it scientifically, Poling says. "When you are talking about the courtroom vs. science, the burden of proof is different," Poling tells WebMD.
"We showed there was a plausible mechanism, we showed that an injury occurred shortly after her vaccination. Her growth curve went flat for months."
To prove something scientifically, rather than legally, he points out, only a 5% possibility (or one in 20 chance) that something happens by chance is allowable.
Decision Made, Questions Remain
In the wake of the decision, Poling, like other experts, says many questions remain about autism, vaccines, and mitochondrial disorders. "This mitochondrial issue, is it rare? Is it inherited?" he asks.
Poling says that Hannah's doctor in Atlanta, John Shoffner, MD, who was also a co-author on a scientific paper Poling wrote about the disorder and its link with autism, "has a number of cases of children who have mitochondrial disorder and autism. But he is not sure that the one causes the other or vice versa."
Even so, Poling says, "I don't think Hannah's case is as unique as many experts believe."
Poling Not Anti-Vaccine
The experience with Hannah, Poling says, has not turned him against vaccines. "I want to make it clear I am not anti-vaccine," he says. "Vaccines are one of the most important, if not the most important advance, in medicine in at least the past 100 years. But I don't think that vaccines should enjoy a sacred cow status, where if you attack them you are out of mainline medicine."
"Every treatment has a risk and a benefit. To say there are no risks to any treatment is not true.''
"Sometimes people are injured by a vaccine, but they are safe for the majority of people. I could say that with a clean conscience. But I couldn't say that vaccines are absolutely safe, that they are not linked to brain injury and they are not linked to autism."
Poling is hopeful that the decision will trigger government action. "I hope it will force government agencies to look further into what susceptibility factors are out there for children to develop brain injury after vaccination, to look into the susceptibility factors of people at risk."
Vaccine Safety: What Can Parents Do?
His advice for parents?
Poling says they should demand to know a vaccine's safety record before agreeing to give it to their child, including any known links with metabolic disorders and susceptibility to injury from the vaccine.
Coming to Terms With Autism
Although Poling has an MD and a PhD and is trained as a neurologist, he admits it was very difficult to come to terms with his daughter's diagnosis. In his neurology practice in Georgia, some of his patients are children with autism, so he is very familiar with the condition. His wife, Terry, is both a nurse and an attorney.
Even so, he says, they had some trouble initially getting doctors to take their concerns seriously. When Hannah exhibited symptoms after a series of five immunizations including nine vaccines, doctors initially passed them off as nothing serious. But as the symptoms didn't abate and in fact got worse, as parents, the Polings knew something was wrong.
"After six months of essentially our daughter being a zombie and gone, we knew this wasn't going away," he says. "This was chronic. And we had to come to grips with that."
In the beginning, it wasn't easy, he says. "We had denial," he admits. She had previously been treated for middle ear infections. "When Hannah got sick, we thought, 'Her ears are clogged. That is why she is not responding.'"
As he heard from other parents dealing with the same diagnosis, the initial denial, followed by difficulty in accepting the reality, was a common thread, Poling found.