More commentary on the case of Hannah Poling by pediatrician Rahul Parikh, M.D., on Salon (March 13). As Dr. Parikh clearly states, the government’s concession does not say that vaccines caused Hannah to become autistic, but that her “underlying mitochondrial disorder” was “aggravated” by vaccines and “manifested as a regressive encephalopathy with features of autistic spectrum disorder.” Dr. Parikh continues:
Mitochondrial disorder does not equal autism [my emphasis]. Generally speaking, mitochondria are the parts of our cells that help generate energy. When they fail, the body’s cells go awry, which can lead to failures in any number of normal body functions. There are at least 40 known mitochondrial disorders, and probably many more we haven’t yet found. But it’s clear from the transcript of the court’s decision that this was not a case of vaccines causing autism. Rather, this is a case where the court deemed it plausible that vaccines aggravated an underlying disease caused by bad mitochondria, and that some of the symptoms Hannah showed were similar to autism. As you’ll see below, there are even questions about that conclusion.
Noting that “clinicians Alice Kau and Kelley Duff believed Hannah was ‘developmentally delayed and demonstrated features of autistic disorder,’” Dr. Parikh asks: What kind of “clinicians” specifically are “these two individuals.” The document about the case does not specify this. As Dr. Parikh continues:
Were they expert enough to consider a metabolic disorder like mitochondrial diseases when they evaluated Hannah? That’s a fundamental question: Clinicians (doctors or otherwise) must consider not just the obvious diagnosis, but a differential set of diagnoses as well. Because the government has not released details of the case, which remain sealed according to court rules, we do not know what evidence Kau and Duff relied upon to reach their conclusion.
Dr. Parikh then considers the other diseases that Hannah had between being diagnosed with mitochondrial disorder and receiving her vaccines.
Two of these events occurred within the expected timeline for a vaccine reaction. One — fever and irritability — seemed to be a reaction to the diphtheria, tetanus and pertussis vaccine. This is a rare but well-known side effect of that vaccine. The second was a fever and a rash that were diagnosed as a reaction to the chickenpox vaccine.
But Hannah had other many other infectious illnesses in that interval, which were well beyond the timeline of vaccine side effects. Could these subsequent illnesses have been the culprit, the aggravating factor, that tipped her into her disorder, instead of vaccines? It wouldn’t be unreasonable to conclude this.
As Dr. Jon Poling, Hannah’s father noted in a comment on the Neurologica blog, her case has raised “many intelligent discussions and questions.” As Dr. Parikh, Hannah’s case raises more than a few questions about the diagnosis of autism; about what we understand autism to be.
And I’ll once again suggest that—while I myself find these questions of diagnosis and aetiology of, indeed, intellectual interest, I’m just as much and maybe even more thinking constantly about some really basic questions, of education, of teaching Charlie and kids like him in ways that enable them to meet their full potential, and have rich and fulfilling lives.