How much risk is too much?

In a comment to Lisa Jo Rudy’s brief examination of some of the issues in the autism-vaccine debate, Dadvocate had this to say:

Rather, it is that some, in their zeal to promote public health may be erroneously accepting a level of adverse reaction risk that is too high (and possibly avoidable by reverting to a more conservative schedule)….

The obvious (to me) question from this is, “Given that the current vaccine schedule results in an unacceptably high risk of autism in vaccinated children, what level of risk is acceptable? If the current risk is 1-in-150 (which, I should note is actually the prevalence and not the odds of being autistic), what risk is acceptable? 1-in-500? 1-in-1000? 1-in 10,000? None?”

This question is really for those who believe that vaccines are to blame for autism, and is but one strand in a much more complex thread. Among other things, the risk of individuals becoming autistic would need to be weighed against the risk to the public at large of reducing vaccinations.

At the risk of retreading old ground, exactly where do you think the balancing point would be between protection of individuals from autism and protection of society from communicable diseases? (If you don’t think this is a valid question, by all means let me know. I’m interested in that possibility as well.)

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19 thoughts on “How much risk is too much?

  1. Well… the question is valid if we know that there is a 1:150 chance that vaccines will cause autism.

    So far as I’m aware, we know no such thing. We have scads of anecdotal evidence of individual families’ claims – but outside of the Polings, I’m not aware of any replicated studies that support that idea. In fact, there are far more replicated studies out there that seem to point to a combination of genetics, brain structure, etc….

    So IF that were a real scenario, I’d say of COURSE vaccines pose an overwhelming risk, and 1:150 is completely unacceptable. But I don’t think even the most absolute vaccine-autism believers would say that every child with autism is a child with a vaccine injury!

    My own guess (and this is purely a guess) is that a very small percentage of autism cases are caused by some combination of immune disorder and/or allergy that’s set off by vaccines. Certainly not those cases in which a child is born with autism (as seems to be the case with my son).

    Best,

    Lisa (autism.about.com)

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  2. Lisa,

    My intent was to say, “For the sake of argument, assume that the current vaccine schedule….” The engineer/mathematician in me let the “Given that” slip. I didn’t mean to imply that there is a 1-in-150 risk of autism from vaccinations because, like you, I don’t believe that. Thanks for keeping me honest.

    Like you, I’m just trying to figure out what the “autism debate” is really all about, and where common ground can be found. It’s all well and good to say “this is what autism is” and “this is what we should do about it”, but the truth (if there is such a thing) will inevitably fall between the two extremes.

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  3. “…but the truth (if there is such a thing) will inevitably fall between the two extremes.”

    I’m not sure I understand. Is this like saying that the Earth falls somewhere between round and flat? Perhaps, I’ve misunderstood.

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  4. As I’ve written before, even if it was fact that vaccines cause autism, I’d rather be autistic than have a disease such as measles, mumps, rubella, or any of a number of other vaccine-preventable diseases. Some say, but the disease would be temporary, whereas autism lasts a lifetime. And yes, I am aware that being autistic can mean being non-verbal, needing full-time care, etc. depending on the individual. But you can die of these diseases, and being autistic doesn’t kill you.

    So there’s my opinion on that. But, let’s examine a more realistic situation, one that more closely approximates what we know of reality. There isn’t evidence that vaccines increase the risk of a person being autistic. So on the one hand there is the known, proven risk that if we stopped vaccinated against these diseases that kids would definitely get sick, and some would definitely die. Whereas, there is the mere speculation and theorizing that some kids might get autistic and the certainty that no kid is going to die of being autistic.

    The balance seems pretty clear to me.

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  5. Agree with dyslexic_angeleno.
    I remember also your previous post where you said that there must be at least one person with autism caused by mercury – I wondered, why do you think so? (I am not saying that mercury is harmless. It is a known neurotoxin causing well described damage clearly different from autism).
    To your question: As far as I know, among the vaccine-preventable diseases, measles alone has a mortality rate of about 1 per 1000, the exact value varying among populations with different socioeconomic status. So, to me, IF WE PRESUME THAT VACCINES MAY CAUSE AUTISM, we must set the acceptable risk at 1 per 1000 or higher. If we say that the acceptable risk is 1 per 10000, lower or none, we actually say “I prefer my child dead than autistic”.

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  6. How valid are any studies based on a line in the sand determined by subjective and ever changing criteria in the DSM?

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  7. See, it’s this kind of thing that’s so completely reckless and I’m flummoxed as to why it’s so blithely accepted:

    “My own guess (and this is purely a guess) is that a very small percentage of autism cases are caused by some combination of immune disorder and/or allergy that’s set off by vaccines.”

    Marriages, I understand, have broken up over the vaccine issue (due to blame); children, I’ve heard, have asked their parents if they are ‘poisoned’; some ASD kids are exposed to very dubious medical procedures and, here, we have a well-known web site author who just “guesses” and a hub blogger who actually gives it credence? I’m still confused!!

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  8. dyslexic_angeleno:

    My first reaction to your comment about the flat earth / round earth debate was, “That’s not at all the same.” But thinking about it a bit more, I think it might be an OK – if not good – example to use.

    It is “true” that the earth is not completely flat. But neither, however, is it completely round. Due to effects of earths rotation, etc., it has a little bit of both. And of course, a lot of it depends on where you are viewing the earth from, how much of the earth you can actually see, and for what purpose you plan to use the information about flatness or roundness.

    If you are looking at your own little patch of ground, it can appear quite flat. If you are in orbit aboard the ISS, it looks round. From the viewpoint you have, and the purpose for which you use the information, both viewpoints are equally valid. (If I’m playing catch with my son, I don’t care about the curvature of the earth; if I’m in orbit, angular mechanics are very important.)

    Like I said, an OK example. Maybe a bit of a stretch, but I think highlights how “truth” appears different to those looking at a local impact versus a global impact.

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  9. Melody,

    Based on your thoughts, maybe a better way to phrase the question to those who believe in the vaccine / autism connection would be:

    “If you had to decide between 1 in 150 children becoming autistic because they got a measles vaccination, or a number of children contracting and dying from measles because vaccinations were halted, what would an acceptable number of measles deaths be?”

    Or, more concisely,

    “How many children would you be willing to kill with measles in order to insure no more children would become autistic?”

    Overly simplistic, I know, but it kind of gets to the heart of the matter (imho).

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  10. Maya,

    I think that the question Chuck asks kind of gives an answer to your first question. Lacking any change in the (incredibly broad and liberally applied) diagnostic criteria, I think that there are those that suffer from mercury poisoning (and probably several other environmental insults) that are diagnosed as autistic – rightly or wrongly.

    Again, goes back to the question of “what is autism”?

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  11. dyslexic_angeleno,

    It is not my intent to give credence (or not) to the argument that all autism is caused by vaccines. But this is the starting point from which a significant number of people base their discussion of autism, and in order to engage in a meaningful discussion it seems a good place to start.

    I’ve heard the arguments, the pleas to CDC to change the vaccination schedule, etc. What I’m curious about is what would be an acceptable outcome. In other words, at what point would they stop and say, “Thank you, CDC, for addressing our concerns and fixing the problem.”

    Sadly, very few of those folks have responded (yet) to my questions here. I guess they don’t subscribe to the hub, I wonder if I can get them to publish me on Age of Autism ;-)

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  12. So, then _your truth_ is that Planet Earth falls somewhere between a plane and a sphere? Is that correct?

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  13. I’ve heard the arguments, the pleas to CDC to change the vaccination schedule, etc. What I’m curious about is what would be an acceptable outcome. In other words, at what point would they stop and say, “Thank you, CDC, for addressing our concerns and fixing the problem.”

    In all honesty, there is no point where “they” would stop because all this is from emotion and not logic. It’s really not about change in schedule, or “greener vaccines, or anything of the like, it’s about NO vaccines at all … ever.

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  14. I don’t know if I would say the earth is “somewhere between a plane and a sphere”, but I can say with great confidence that the earth is neither a plane nor a sphere.

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  15. “How many children would you be willing to kill with measles in order to insure no more children would become autistic?”
    I like this formulation of the question :-). Anyway, I gave my answer of what autism risk I find acceptable, now it is the turn of antivaxer folks to say what level of mortality they find acceptable. Unfortunately, as you mentioned, they don’t seem to read your blog. Except Chuck, but he didn’t answer.
    He says that studies disproving vaccine-autism link are based on sand, but studies suggesting it were based on the same sand, weren’t they? Or the Geiers have other, constant, rock-solid epidemiological data?
    I also wonder, what prevalence of autism (and other disabilities) due to congenital rubella are antivaxers ready to accept?

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