Very easy less than 5 page Reading and 5 simple questions.

Page 1“Tragic Choices” by Matthew P. Rowe

Part I – The Choice Kristen typically loved the monthly Sunday brunches with her mother Anne and older sister Carly. Kristen adored them both. Her mother was, in Kristen’s eyes, a saint, having worked two jobs as a single mom to not only raise both girls, but also put them through college. And Carly was that great older sister, always supportive, helping Kristen with her math homework when mom was working the night shift at a local restaurant. Carly graduated from East Texas State University four years ago, was married, had a four-year-old son Ian, and was a successful graphic artist in Dallas. Kristen herself completed a BA degree in marketing last year, worked as a sales manager for Time-Warner Cable in Austin, was also happily married, and had a 14-month-old daughter named Alissa. Th e monthly “girls’ day out” was an excuse for the three women to celebrate the love and commitment that helped them through the diffi cult times when Anne was working 80 hours a week and Carly was helping care for Kristen. Th e monthly brunches were also an opportunity for Carly’s and Kristen’s husbands to bond with their own young children, who (although Anne loved them dearly) were not invited to the brunches.

Th e last gathering, however, had been strained. Following Kristen’s graduation, Anne courageously tackled her lifelong dream and enrolled in a nursing program at East Texas State. After the fi rst year of course work, Anne was near the top of her class. “Not bad,” thought Kristen, “for a 50-year-old ex-waitress from Fort Worth.” Anne’s increasing expertise in health issues made her, once again, a resource for the entire clan, as Ian had been diagnosed with Autism Spectrum Disorder (ASD) just four months after his fi rst birthday. Autism can take a heavy toll on a family, especially those with children exhibiting the most extreme form of the disease. Ian unfortunately was in this group—regressing from a happy and interactive one-year-old to a toddler who was completely unresponsive to his parents, and whose long bouts of repetitive rocking were interspersed with brief but intense periods of uncontrollable aggression and self-abuse. Anne’s genuine love for her daughters and grandchildren, coupled with her access to the medical school’s library, made her a knowledgeable and compassionate counsel for Carly.

Two seemingly random events led to an uncharacteristic and heated exchange at their last gathering. Anne was taking a course in microbiology, and Carly had stumbled onto an episode of “Larry King Live” while channel surfi ng.

Kristen was running late. When she was directed to a patio table to join her mother and sister, she found them engaged in the same battle left unresolved a month ago.

“Mom, Jenny McCarthy is just one of many celebrities speaking out against the measles vaccine—and she has the right to—her own son is autistic, and Jenny is convinced that the combined measles, mumps, and rubella (MMR) vaccine is the cause. She and actor Jim Carrey made a very convincing case on the Larry King show, while the scientists looked to be in bed with big pharmaceutical companies, Big Pharma as they call it, to make money from selling vaccines.

by Matthew P. Rowe Department of Biological Sciences Sam Houston State, Huntsville, TX

NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE

Tragic Choices: Autism, Measles, and the MMR Vaccine

NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE

Page 2“Tragic Choices” by Matthew P. Rowe

It’s a huge business. And there has to be something behind this epidemic of autism. Did you know that the MMR vaccine replaced the old, simple measles vaccine in 1988? And did you know that during the 20 years following its introduction, autism rates increased by almost 600%? And the rates are still increasing—one in every 110 kids today develops some form of ASD.”

Anne tried not to sound smug or motherly in her response, but a recent topic in her microbiology course dealt with the amazing benefi ts of vaccines, including the shot (or “jab” as it was known in Great Britain, Anne remembered from lecture) against measles.

“Carly, both the original and the more eff ective MMR vaccines have nearly eliminated a serious and deadly disease. Th e measles virus kills. A paper we had to read for class showed that during the 20 years following its release in 1963 the measles shot prevented fi fty million cases of measles and saved at least 5,200 lives in the United States alone. And that’s not all. A common complication from measles is encephalitis, a massive swelling of the brain, which can lead to brain damage and mental retardation. During that same 20-year period, at least 17,000 American kids were spared that tragedy. And I don’t believe the link between MMR and autism has been fi rmly made.”

Carly interrupted before Anne could fi nish. “I know the link has been made,” she said with more than a hint of anger in her voice. “Just look at Ian. He was a happy and interactive one-year-old. I take him in for his MMR shot at 15 months, just like my pediatrician said to, and a week later he stops smiling, he stops talking, and he stopped looking me in my eyes—he just slipped away. Jenny McCarthy has spoken with hundreds of parents of autistic children, all caused by the vaccine, and a highly respected scientist in Great Britain proved the connection.”

“But Carly, epidemiological studies show that if less than 90% of a population receives the measles vaccine, the disease will return, killing….”

“Mom, stop, just stop right there! I refuse to sacrifi ce my children for the greater good. I won’t do it, I can’t do it anymore. I’ve lost Ian. And I’m responsible. I thought the vaccine would help, I was told it would help, and I held his tiny little hand while he took it. He didn’t even cry. Now he is gone. And I’m scared. We’re running out of time. Kristen has to choose. I don’t want her to carry around the guilt that I will carry forever. I don’t want us to lose Alissa, too.”

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Page 3“Tragic Choices” by Matthew P. Rowe

Part II – The Connection Carefully examine the evidence presented below; then answer the questions at the end of this section.

Th e data table below has been taken from the scientifi c investigation referenced by Carly when she snapped at her mother that “a highly respected scientist in Great Britain proved the connection” between autism and the MMR vaccine.

Table 1: Neuropsychiatric diagnosis and interval post MMR vaccination.*

Child Behavioral Diagnosis Causal agent (identifi ed by parents or pediatrician)

Interval from exposure to symptoms

1 Autism MMR 1 week 2 Autism MMR 2 weeks 3 Autism MMR 48 hours 4 Autism? Disintegrative

disorder? MMR Dramatic deterioration immediately after

MMR booster at 4.5 years 5 Autism None–but MMR at 16 months Self-injurious behavior started at 18 months 6 Autism MMR 1 week 7 Autism MMR 24 hours 8 Post-vaccinial encephalitis? MMR 2 weeks 9 Autistic spectrum disorder Recurrent inner-ear infections 1 week (MMR 2 months previously)

10 Post-viral encephalitis? Measles (previously vaccinated with MMR)

24 hours

11 Autism MMR 1 week 12 Autism None-but MMR at 15 months Developmental deterioration noted at 16 months

*Adapted from Table 2 in Wakefi eld et al. (1998) Ileal-lymphoid-nodular hyperplasia, non-specifi c colitis, and pervasive developmental disorder in children. Lancet 351:637–641.

Questions 1. What should Kristen do? 2. How long does she have to decide?

Figure 1. Prevalence of autism in the United States 1996–2007 (cases per 1,000 children age 6–17). (Figure from Autism 2011; graphic constructed by Eubulides and posted at http://en.wikipedia.org/wiki/Autism).

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Page 4“Tragic Choices” by Matthew P. Rowe

Part III – Conference On February 28, 1998, the same day that his article was to be published in the Lancet, Dr. Andrew Wakefi eld called a press conference. He announced that he and his team believed they had found a link between a routine childhood vaccine and autism. Eight of the 12 children in their study developed this neurological disorder within a few days of receiving the MMR “jab.” Somehow, the vaccine was causing intestinal infl ammation, allowing harmful proteins to enter the child’s bloodstream, eventually traveling to the brain, causing the disorder. To prevent this, parents simply needed to request that their pediatrician separate the MMR vaccine into three separate shots, one each for measles, mumps, and rubella, the same way these immunizations had been delivered prior to the development of the combined vaccine.

Question 1. How do you think the public reacted to Wakefi eld et al.’s fi ndings?

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Page 5“Tragic Choices” by Matthew P. Rowe

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Credit: Photo of baby © Dmitry Naumov | iStockphoto. Case copyright held by the National Center for Case Study Teaching in Science, University at Buff alo, State University of New York. Originally published March 22, 2011. Please see our usage guidelines, which outline our policy concerning permissible reproduction of this work.

Part IV – Consequences Figure 2 shows what happened in Great Britain. Th e picture in the U.S. is similar. After examining these patterns, answer the questions below.

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Figure 2. Vaccination rates (blue line) and the number of laboratory confi rmed measles cases (red bars) in Great Britain during the years 1992–93 through 2009–10. The arrow shows the approximate publication date of the Wakefi eld et al. (1998) article in the Lancet. See also Jansen et al. (2003) and Salzberg (2010). Data graciously provided by the Health Protection Agency, United Kingdom (Health Protection Agency 2010a; NHS Information Center 2010). Data on lab-confi rmed measles cases prior to 1996 are unavailable due to a change in screening methods (Alexandra Baker, Health Protection Agency, personal communication).

Questions 1. Did Wakefi eld et al.’s data and interpretations merit the resulting public fear of the MMR vaccine? Why or

why not? 2. Design a better study to examine the purported cause and eff ect relationship between the MMR vaccine and

autism. Be prepared to discuss the details of your study design.