Richard I. Kelley, M.D., Ph.D., is the Director of the Division of Metabolism, Kennedy Krieger Institute, and a member of the Department of Pediatrics, in Johns Hopkins University. The National Library of Medicine’s Pubmed database shows that Dr. Kelley has written dozens of articles on mitochondrial disease, but none that concludes that thimerosal or the measles, mumps and rubella vaccine plays a causal role in causing autism by inducing or aggravating mitochondrial disease. In one article, Kelley opines:
“Large, population-based studies will be needed to identify a possible relationship of vaccination with autistic regression in persons with mitochondrial cytopathies.”
Jacqueline R. Weissman, Richard I. Kelley, Margaret L. Bauman, Bruce H. Cohen, Katherine F. Murray, Rebecca L. Mitchell, Rebecca L. Kern, and Marvin R. Natowicz, “Mitochondrial Disease in Autism Spectrum Disorder Patients: A Cohort Analysis,” 3 PLoS One e3815 (Nov. 26, 2008). Those large scale population-based studies to support the speculation of Kelley and his colleagues have not materialized since 2008, and meta-analyses and systematic reviews have dampened the enthusiasm for Kelley’s hypothesis.[1]
Special Master Denise K. Vowell, in the Federal Court of Claims, has now further dampened the enthusiasm for Dr. Kelley’s mitochondrial theories, in a 115 page opinion, written in support of rejecting Kelley’s testimony and theories that the MMR vaccine caused a child’s autism. Madariaga v. Sec’y Dep’t H.H.S., No. 02-1237V (Ct. Fed. Claims Sept. 26, 2015) Slip op. [cited as Madariaga].
Special Master Vowell fulsomely recounts the history of vaccine litigation, in which the plaintiffs have presented theories that the combination of thimerosal-containing vaccines and the MMR vaccine cause autism, or just the thimerosal-containing vaccines cause autism. Madariaga at 3. Both theories were tested in the crucible of litigation and cross-examination in a series of test cases. The first theory resulted in verdicts against the claimants, which were affirmed on appeal.[2] Similarly, the trials on the thimerosal-only claims uniformly resulted in decisions from the Special Masters against the claims.[3] The three Special Masters, hearing the cases, found that the vaccine-causation claims were not close cases, and were based upon unreliable evidence.[4] Madariaga at 4.[5]
In Madariaga, Special Master Vowell noted that Doctor Kelley had conceded the “absence of an association between the MMR vaccine and autism in large epidemiological studies.” Madariaga at 61. Kelley attempted to evade the force of his lack of evidence by retreating into a claim that “autistic regressions caused by the live attenuated MMR vaccine are rare events,” and an assertion that there are many inflammatory factors that can induce autistic regression. Madariaga at 61.
Special Master described the whole of Kelley’s testimony as “meandering, confusing, and completely unpersuasive elaboration of his unique insights and methods.” Madariaga at 66. Although it is clear from the Special Master’s opinion that Kelley was unbridled in his over-interpretation of studies, and perhaps undisciplined in his interpretation of test results, the lengthy opinion provides only a high-altitude view of Kelley’s errors. There are tantalizing comments and notes in the Special Master’s decision, such as one that reports that one study may have been over-interpreted by Kelley because he ignored the authors’ comment that their findings could be consistent with chance because of their multiple comparisons, and another that paper that failed to show statistical significance. Madariaga at 90 & n.160.
The unreliability of Kelley’s testimony appeared to be more than hand waving in the absence of evidence. He compared the child’s results on a four-hour fasting test, when the child had not fasted for four hours. When pressed about this maneuver, Kelley claimed that he had made calculations to bring the child’s results “back to some standard.” Madariaga at 66 & n.115.
Although the Special Master’s opinion itself was ultimately persuasive, the tome left me eager to know more about Dr. Kelley’s epistemic screw ups, and less about vaccine court procedure.
[1] See Vittorio Demicheli, Alessandro Rivetti, Maria Grazia Debalini, and Carlo Di Pietrantonj, “Vaccines for measles, mumps and rubella in children,” Cochrane Database Syst. Rev., Issue 2. Art. No. CD004407, DOI:10.1002/14651858.CD004407.pub3 (2012) (“Exposure to the MMR vaccine was unlikely to be associated with autism … .”); Luke E. Taylor, Amy L. Swerdfeger, and Guy D. Eslick, “Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies,” 32 Vaccine 3623 (2014) (“Findings of this meta-analysis suggest that vaccinations are not associated with the development of autism or autism spectrum disorder. Furthermore, the components of the vaccines (thimerosal or mercury) or multiple vaccines (MMR) are not associated with the development of autism or autism spectrum disorder.”).
[2] Cedillo v. Sec’y, HHS, No. 98-916V, 2009 WL 331968 (Fed. Cl. Spec. Mstr. Feb. 12, 2009), aff’d, 89 Fed. Cl. 158 (2009), aff’d, 617 F.3d 1328 (Fed. Cir. 2010); Hazlehurst v. Sec’y, HHS, No. 03-654V, 2009 WL 332306 (Fed. Cl. Spec. Mstr. Feb. 12, 2009), aff’d, 88 Fed. Cl. 473 (2009), aff’d, 604 F.3d 1343 (Fed. Cir. 2010); Snyder v. Sec’y, HHS, No. 01-162V, 2009 WL 332044 (Fed. Cl. Spec. Mstr. Feb. 12, 2009), aff’d, 88 Fed. Cl. 706 (2009).
[3] Dwyer v. Sec’y, HHS, 2010 WL 892250; King v. Sec’y, HHS, No. 03-584V, 2010 WL 892296 (Fed. Cl. Spec. Mstr. Mar. 12, 2010); Mead v. Sec’y, HHS, 2010 WL 892248.
[4] See, e.g., King, 2010 WL 892296, at *90 (emphasis in original); Snyder, 2009 WL 332044, at *198.
[5] The Federal Rule of Evidence technically do not control the vaccine court proceedings, but the Special Masters are bound by the requirement of Daubert v. Merrell Dow Pharm., 509 U.S. 579, 590 (1993), to find that expert witness opinion testimony is reliable before they consider it. Knudsen v. Sec’y, HHS, 35 F.3d 543, 548-49 (Fed. Cir. 1994). Madariaga at 7.
