|
 U.K.
MMR RIP?
by Robert Sandall, The Sunday Times Magazine, December
14, 2003
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A conspiracy of
silence or paranoid scaremongering? Is the MMR vaccine a cause
of autism - or is it a vital health program undermined by this
medical maverick?
In March, seven mentally disturbed British children and an
escort of parents, caregivers, two doctors and three lawyers
flew to Detroit, Michigan, for a medical test that had been
denied them in the UK. The procedure, a lumbar puncture to
extract specimens of cerebral spinal fluid (CSF), is
uncomfortable and requires anesthetic - but it is routinely
carried out in advanced western countries in the treatment of
many chronic ailments, such as leukemia. In the cases of these
children, all of whom were prone to seizures as well as a range
of self-harming antics, an analysis of the liquid that bathes
the brain had been separately recommended by two neurologists.
Over the course of a year, the 246 private and NHS hospitals in
Britain equipped to carry out CSF taps had declined to touch
them, usually on the grounds that the test amounted to human
experimentation, not treatment. In November 2002 one hospital
briefly assented before putting the matter before its ethics
committee, which decided four months later not to proceed for
the same reason: the children were being used as guinea pigs.
It was an arguable point. Before an illness can be treated, it
must be fully understood, and the root of these children's
problems hadn't been ascertained. By the time a hospital outside
Detroit agreed to accept them in March, their parents and
advisers were worrying that the tests would never take place.
They were nearly proved right.
On the night before the children arrived at the hospital,
lawyers acting for GlaxoSmithKline (GSK), Merck and Aventis
Pasteur MSD, manufacturers of the MMR triple vaccines that have
been used in the UK since 1988, approached a High Court judge in
London for an injunction to prevent the CSF taps going ahead.
Two of these combination jabs had been called into question
before: Pluserix, by Smith Kline (pre-Glaxo), and Aventis
Pasteur's Immravax were withdrawn in 1992 after the "urabe"
strain of mumps virus used in them was deemed responsible for a
meningitis outbreak by the health authorities in Canada. That
strain was replaced and M-M-R II, patented by Merck but licensed
to GSK, became the triple jab most often offered in the UK. Now
the possible misbehaviour of the measles component was at issue.
The drug companies wanted a delay because their medical
representative needed to be present at the procedure, but
couldn't get to Port Huron, Michigan, in time. The injunction,
howeve
r, was denied.
The children were the claimants in a "class action" -
legal-speak for a case launched jointly by victims with the same
grievance. If successful, it would validate the claims of 1,300
other British families and trigger international damages awards
that could top $1 trillion. The proposed test, to look for
traces of measles-vaccine virus in the children's CSF, could
provide evidence that it can pass from the gut's lining into the
brain, where measles is known to affect cerebral processes.
This is one of the most contentious issues in the row about
what, if anything, brings on a disease described, but not
universally accepted, as "autistic enterocolitis". In the UK,
the condition was first identified by Dr Andrew Wakefield, but
scientists in Japan, Norway, Ireland and the US (including Buie,
Winter and Kushak, based at Harvard) have also published
research supporting a link between intestinal disease and
autism.
The theory that a malfunctioning or "leaky" gut sends partially
digested food - in the form of opioid compounds known as
peptides - up to the brain is one of the less controversial
aspects of the hypothesis under investigation. Whether measles
vaccine is what gives rise to the gut disease in the first place
is the trillion-dollar question. So far, the sum of Wakefield et
al's discoveries has not met the exacting medical standards that
establish causation. All it points to is an "association". But
the importance of the spinal-fluid link was well understood by
the defendants in the class action. Merck's QC had recently
referred to it in court as "a significant result when trying an
issue as to whether or not MMR vaccine causes autism".
Time was running out for the claimants. Their action was being
financed by the Legal Services Commission (LSC), a successor to
the Legal Aid Board, which had set a July deadline for the
submission of expert medical evidence, after which funding would
be reviewed. Having lost a year trying to get the CSF samples in
the UK, they now had to fly seven severely autistic,
occasionally violent children - most of whom had never been in a
plane before - halfway round the world.
Another bid by the defendants to secure an injunction, this time
in the US, also failed. Then the hospital called the British
party in Detroit to cancel their appointment.
Although lumbar taps on autistic children are common in the US,
this batch, Lansing hospital now felt, constituted unwarranted
human experimentation.
But the children's camp had an undisclosed back-up plan. They
had made an arrangement with another hospital in Port Huron, two
hours along the shore of Lake Michigan, and this time, despite
further delaying tactics from the lawyers in London, the CSF
taps went ahead. One of the seven children reacted badly to the
anesthetic and couldn't be tested; the other six were fine.
Now the party and the fluid samples had to be flown home for
analysis. There was bedlam on the bus as the anesthetic wore
off: one child tried to exit the moving vehicle by the back
door, while another was restrained by his mother in the toilet.
At the airport, the container of dry ice carrying the CSF was
deemed too large to be carried on as hand luggage, and another
business-class seat had to be specially purchased for it.
After the KLM flight had boarded, five US customs officers
arrived to take the lawyers and doctors off the plane - the only
passengers they apprehended - for separate, 30-minute taped
interviews. They weren't asked any questions pertaining to
passenger safety and their large container: the issue was why
the children hadn't been tested back in the UK. In transit at
Schiphol airport in Amsterdam, they were again singled out for
more questioning.
By now, several tired minds were stoking their paranoia that
these interventions might, just might, have been orchestrated to
delay delivery of the samples, allowing them to spoil. So when
the virologist in the party, Colin Fink, got them back to his
private lab, Micropathology, in Coventry, he took the unusual
precaution of placing an armed guard outside overnight.
The next day the CSF samples were couriered to their final
destination: Professor John O'Leary's laboratory at Trinity
College in Dublin, a facility whose viral-testing kit had
previously identified the DNA of measles in the guts of autistic
children. Rather disconcertingly, the package appeared to have
been opened en route, but with the war in Iraq only two days
old, customs everywhere were on high alert.
The analysis proceeded: three of the six samples tested positive
for the vaccine strain of measles virus, but only in minuscule
genetic fragments - and not enough to count as a valid research
sample. According to medical-research protocol, that result had
now to be compared to the CSFs of a "control" group of
non-autistic patients. Acquiring these took several months,
during which the claimants missed the LSC's July deadline and
had their funding temporarily suspended awaiting an appeal on
September 30.
When the doctors finally assembled their evidence, the
children's lawyers felt confident. Only 1 in 20 of the control
group - all leukemia sufferers, specifically chosen for their
high susceptibility to random viral infections - was found to be
carrying measles virus in their CSF.
The defendants' analysis of the same samples, carried out by Dr
Peter Simmonds at Edinburgh University, had found no trace of
measles in the children's CSF. But Simmonds had chosen to use a
different viral tracker, Nested, rather than the claimants'
TaqMan process. Given the accepted centrality of findings in
this area, they felt that their case against MMR looked strong
enough to take to court in April 2004. But the four adjudicators
on the LSC's funding-review committee disagreed with them.
Justifying the £15m already spent as having served the "wider
public interest", the committee stated that the £10m needed to
see the action through "would not prove a link between MMR
vaccine and Autistic Spectrum Disorder".
The claimants' lawyers suspected that the committee had made up
their minds before considering the CSF test results, as these
offered fresh evidence of just such a link. At the hearing, they
were told to await a decision at the end of the day, and written
reasons for it two days later. But if the answer was yes, they
wondered, why would the reasons not be immediately forthcoming?
They were not reassured to discover, when they looked more
closely, that the LSC's e-mailed press release dropping the case
had been originated the day before the hearing. In a footnote to
editors, the LSC admitted that its decision reflected a change
of policy rather than an assessment of evidence. "In retrospect
it was not appropriate for the LSC to fund research. The courts
are not the place to prove new medical truths." That judgment is
itself up for judicial review in the new year - though the LSC
is not bound to accept its recommendations.
Paranoia is currently the default mood on all sides of the MMR
debate. The British government is so scared of it that health
ministers will not be interviewed on it. The drug companies are
on the defensive against damages claims that, if proven, could
seriously undermine their credibility and their business. And
the anti-MMR lobby is convinced a coalition of government
agencies, the medical Establishment and big pharma are against
them, X-Files style.
In a leafy southwest-London suburb, the man whose 1998 paper in
The Lancet kicked off the fracas, Dr Andrew Wakefield, would
prefer not to talk on the phone. He believes his line was tapped
about three years ago, and now conducts regular "sweeps" to
check it for bugs.
Visiting the house whose garage has served as his office since
he resigned his post at London's Royal Free hospital in 2001, it
strikes you that Wakefield can't be doing this for the money.
From the outside, his house looks as if it might be the only
squat in an otherwise tidy, middle-class road, its overgrown
front garden dominated by a tree stump curiously carved into a
V-sign (a message to the former chief medical officer, Sir
Kenneth Calman, he later tells me). Unlike many of the activists
in the anti-MMR camp, Wakefield is a man unscarred by family
tragedy. His four children, the eldest of whom is 13, are as fit
as fleas, tearing around the house and back garden. All have had
vaccinations, he says, though not the MMR jab. As he first said
in public in 1998, he's a one-at-a-time man where vaccination is
concerned.
In appearance he's like a genial fly half, solidly built, with
hooded, watchful eyes, a boyish grin and an easy manner. What
bothers him most, he says, is the way his research has been
rubbished by colleagues who deny gut treatment to children who,
he believes, badly need it. On his laptop is a photograph of
Laurence, an autistic boy with a severely distended belly, whose
mother has been accused of starving him and was refused access
to a pediatric gastroenterologist. Next to Laurence in the
picture stands his healthy, unstarved sister. This is a classic
case of autistic enterocolitis, says Wakefield. "He's clearly
sick. That boy and his mother are being maltreated by the
medical Establishment." Such vehement declarations don't endear
him to many of his former colleagues.
Wakefield feels pretty maltreated himself. Since qualifying in
1985, he has published 128 papers in "peer-reviewed" journals,
articles that are read and assessed for their scientific
credibility by an independent panel of up to five experts before
being printed. His CV is a wodge of impressive titles and tricky
acronyms: The Lancet, JAMA (The Journal of the American Medical
Association). He has published 49 papers on aspects of autistic
enterocolitis, the most recent in November's Journal of Clinical
Immunology.
Wakefield's big beef is that his clinical findings haven't been
properly challenged on their own terms. He conducts or collates
the results of colonoscopies and biopsies of particular
children. He calls this "scoping the kids". His opponents take a
different tack: some have failed to replicate his findings using
different clinical procedures and technologies. Others say his
samples are too minute, anatomically and numerically, and
examine the statistical incidence of autism versus uptake of MMR,
and any adverse aftereffects. Study after study has found no
correlation. Research published this year in America found a
"statistically significant" risk of autism in cases reported 5
to 10 days after MMR, but in general the statistics suggest that
Wakefield is making a mountain out of a molehill.
But the way this data is compiled and analysed is troubling. In
Britain, the reporting of bad vaccine reactions is down to
parents and harassed GPs, who have to fill out and forward yet
another form to a national database, the so-called "yellow-card"
system. Big studies abroad, in Finland in 1998 and Denmark last
year, found nothing to worry about. But a similarly reassuring
analysis in the US, published in the November issue of
Pediatrics, has started a firestorm in Washington. A transcript
of a conversation at the federal Center for Disease Control and
Prevention (CDC), obtained under the Freedom of Information Act,
revealed officials admitting that data on MMR could be
manipulated to prove, or disprove, anything. The US
representative Dave Weldon, a qualified doctor himself, wrote an
open letter to the head of the CDC, noting its "selective use of
data" and pointing out that the lead author of the study left
the CDC two years ago to work for GlaxoSmithKline.
Wakefield, too, has taken a bit of stick from public officials
recently. "Junk science" - a term used earlier this year by a
High Court judge awarding in favor of a suit brought by two
estranged husbands against their wives' decision not to give the
triple jab to their children - particularly rankles. Why wasn't
he called as the expert witness for the defense, rather than
Jayne Donegan, a homeopath and GP from south London, he wonders.
(Donegan was reprimanded by the judge for not answering the
court's questions.) "It was a disgrace. We've published a lot on
this in eminent journals. The first we heard of that case was
when it was thrown out of court."
Life was different before he and six of his Royal Free team
published their Lancet bombshell, the unexplosively titled "Ileal-Lymphoid-Nodular
Hyperplasia, Non-Specific Colitis and Developmental Disorder in
Children." Up until 1998, Wakefield had been a whiz-kid. His
discovery that an inflammatory bowel disease, ulcerative
colitis, can be brought on by arterial problems rather than, as
was previously assumed, by a gut full of germs, made his name.
It also established his modus operandi. As a trained surgeon, he
based his research on observation rather than textbook
precedents.
Wakefield's next hypothesis was more controversial: the presence
of measles virus in the wrecked intestines of sufferers of
Crohn's disease - a finding that was not replicated in worldwide
studies set up by the World Health Organization in 2000 - led
him to his first brush with big pharma. His co-funders, Merck,
pulled out just before he published in 1996. Though he had
previously received half a dozen research grants, totaling
around $500,000, from Glaxo and Hoffman-LaRoche as well as
Merck, his drug-company funding now disappeared. So he recruited
a medical fundraiser, Robert Sawyer, to tap alternative
philanthropic bodies, and ploughed on looking for gut measles.
When Rosemary Kessick, the mother of an autistic child, came to
him convinced her son's problems were related to the chronic
diarrhea he developed after having the MMR jab, Wakefield
listened and looked.
Conventional diagnosis attributed the concurrence of autistic
behavior and severe bowel problems to coincidence, or held that
disturbed minds naturally led to upset tummies. Wakefield
wondered if the reverse might be true. Could "leaky guts" play a
role in developmental problems? And if so, could these problems
be alleviated by addressing the inflamed intestines? Other
specialists regarded autistic children as medically untreatable,
and none of Wakefield's business: he was a gut man. But the
interventions he proposed seemed to work. Among the 200 or so
children he oversaw, on average four times a year each at the
Royal Free, their behavioral problems appeared to subside,
though not disappear, as their guts healed. "These kids were
often in extreme pain, and that was why they were screaming or
banging their heads on the wall."
In the 12 cases that he and his team examined in detail, the
children's bowel problems coincided with evidence suggesting
that measles was lurking in the intestinal wall. Given the known
propensity of measles to linger in the gut and, in extreme
cases, to attack the brain, might this implicate MMR in their
children's autism?
It was, to put it mildly, an awkward question. Wakefield had
already raised eyebrows by treating patients traditionally cared
for by psychiatrists, virologists and community pediatricians.
One of the latter had complained in a letter to a colleague in
1987 about "a zealot surgeon who thinks that MMR is the cause of
all the problems in the western world". Now others accused him
of over-egging the Lancet article. "Anecdotal reporting of a
biased sample, "one complained. "This has no place in a
peer-reviewed journal."
And soon the fur started to fly. Wakefield had cooked the
evidence by concentrating on just 12 cases. His research
facilities were contaminated. He couldn't replicate his own
results. The last of these charges was true enough. For the
first few years, his research results were inconsistent and
contradictory. He blames this on the measuring technology. He
says that changed in 1999 with Professor John O'Leary and his
TaqMan viral detector, a machine sensitive enough to pick up
minute traces of measles vaccine DNA in 75 autistic children
with disorderly bowels. O'Leary has refused to finger MMR but he
has demanded "extensive and immediate investigation" into the
link. The presence of vaccine-strain measles, as opposed to the
"wild" variety, O'Leary referred to as "a smoking gun".
The Department of Health (DoH) was not impressed. Despite
Wakefield's submissions to the then chief medical officer,
Kenneth Calman, six months prior to publication of the 1998
Lancet article, public-health officials were understandably
resistant to a hypothesis that queried their vaccination program
on the basis of one small group of children in north London. But
not as resistant as the drug companies who, as they generally do
in teaching hospitals, sponsored a large chunk of the Royal
Free's research. Everybody, Wakefield and co included, agreed
that more studies were needed before MMR could be shown as a
cause of autism. Not everybody, though, was urging that these
should take place.
Over the next three years, Wakefield saw his research funding
dry up. He blames his bosses at the Royal Free for discouraging
potential donors. They blamed him for being "evangelical" and
needlessly scaring parents. Two key members of his team, Paul
Ashwood and Scott Montgomery, found themselves with little to
do, and took up new posts, in California and Stockholm, from
where they have continued the collaboration.
Not all of Wakefield's team were as convinced as him that MMR
was the culprit. One of the co-authors of the 1998 Lancet paper,
Simon Murch, senior lecturer in pediatric gastroenterology at
the Royal Free, recently declared his belief that MMR is safe in
a letter to The Lancet headlined "Separating Speculation from
Inflammation in Autism". Murch made his move on the eve of
publication of a study, by himself, Wakefield and others, which
compares the aggressive behavior of gut measles to HIV, adding
more fuel to the conspiracy-theorists' view that scientists
connected with Wakefield are being pressurized to recant. When
asked, Murch declined to comment.
Unlike Murch, who stayed put, Wakefield left the Royal Free,
"because it became increasingly obvious that if we were going to
get an answer to this, we had to work outside of an environment
where I was getting more involved in personal wrangles and the
attrition of grants", he says. Robert Sawyer jumped ship at the
same time to set up a charity, Visceral, that investigates
gut-mediated illnesses and supports projects that test
Wakefield's theories.
Visceral's head, and only, office is a converted broom cupboard
in the centre of Bath from which Sawyer describes himself as
running "a virtual medical school", one that has paid out £1.8m
grants to 31 lab scientists around the world. His funding
sources are mainly small charitable foundations in the UK and
US, set up to support independent research (there are around
50,000 in the UK alone). Visceral, he says forcefully, will not
take money from cranks who believe that all vaccinations are the
devil's work. They are currently funding work on genetic
mechanisms that may be perverted by a malign viral presence in
the gut, and which lead the body's immune system to turn on
itself - "aberrant signalling". The search for the virus that
sets it off is a clinical whodunnit in which he and Wakefield
still have measles vaccine down as their chief suspect.
Almost everybody who speaks out on MMR has a defined stake in
it. My reason for getting into all of this is simple: Anita and
I have a 16-month-old daughter, and we have a tricky decision to
make.
How her developing immune system will benefit from getting three
vaccines in one go, rather than having them singly and spread
out over a few months, has not been adequately explained. On the
other hand, Wakefield's belief in "viral interference" - a
tendency for invading viruses to do more damage when they're
combined - sounds plausible. He quotes three papers published in
America and Japan between 1969 and 1974, identifying the dual
presence of the mumps and measles viruses as a factor that can
make the measles more virulent and dangerous.
The DoH derides this as a "myth" but doesn't explain why on its
web page: MMR The Facts. And there is another fact to be
considered: the British government's recent acknowledgment that
"Gulf-war syndrome" exists. Most of the military personnel
afflicted believe it was brought on by multiple vaccinations
prior to the 1991 conflict. The government hasn't publicly
confirmed this but, tellingly, when British troops were sent to
Iraq this year, their jabs were not all given at once.
Multiple vaccinations are not my thing. I am of an older
generation that was expected, even encouraged, to catch measles
and mumps in early life and get over them. The first I knew that
I had survived a killer illness was when Edwina Currie, the
health minister who introduced MMR in 1988, revealed that we
were "losing a child a month in this country" to measles.
Which was not strictly true. In the year before MMR came in, the
Public Health Laboratory Service counted six deaths from a
reported 42,000 measles cases. That rate has subsequently
declined from 1 in 7,000 to 1 in 10,000. SSPE (subacute
sclerosing panencephalitis), in which measles destroys the brain
in a manner similar to variant CJD, hits about 1 in 8,000
children who catch the disease before the age of two. Measles
epidemics are undoubtedly nasty: 130 children died in the last
big outbreak in the United States in 1989.
When the single measles jab was introduced here in 1968, it was
urged not so much as a life-saver, but as a means of relieving
pressure on GPs during epidemics. Its early popularity related
to other side effects that afflict measles sufferers, such as
impaired eyesight. Mumps vaccine, on the other hand, was a
harder sell. Mumps can cause sterility in adults but only rarely
damages children, and the single mumps jabs did not catch on.
Bundling these two vaccines with the rubella jab, previously
given only to girls at age 12, and offering the package to all
children at 15 months, seemed from the outset to have more to do
with administrative convenience than with public health.
In its 1988 HMSO Handbook of Vaccination for Practitioners, the
DoH claimed a 95% protection rate for the rubella-and-measles
single jabs. In its 1996 edition, post-MMR, the measure of
effective measles immunity had dropped to 90% - beneath the
threshold guaranteeing "herd immunity". But by now the DoH's
data-collection system no longer recognized single jabs in the
compiling of individual health records.
Today we are informed that MMR is more effective than single
vaccines, as well as unimpeachably safe. But government
ministers are reluctant to address the issue in detail,
preferring to issue bland reassurances such as the one the
health secretary, John Reid, made on GMTV in November: "It is
unequivocal that there is no evidence at all that MMR is linked
to autism."
Off the record, however, DoH media briefers acknowledge that MMR
has become "too political". After receiving wobbly guidance on
poisoned eggs, mad-cow disease and the anti-arthritic drug Opren,
the public no longer believes elected politicians on health
issues, so comments on MMR are kept to a minimum. David
Salisbury has presided over all vaccination programs for the
past 15 years, and currently advises the junior minister for
public health, Melanie Johnson.
Neither of them would speak to me about a successor to MMR that
was first revealed in the press in 1998, shortly before the
Wakefield paper. This was MMRV - V as in varicella, or
chickenpox. The DoH now denies any interest in this, possibly
because research on MMRV has shown it doesn't work. A study
partly funded by GlaxoSmithKline, published last year by the
University of Melbourne, found that quadruply vaccinated
children were more prone to suffer fevers immediately afterwards
than those given MMR and varicella vaccines separately. Worse,
they did not develop a significant immunity to chickenpox after
60 days. But the drug companies haven't given up: recent press
reports tell of more tests on MMRV proceeding in Sheffield. The
DoH says it is "not aware of such a product being available for
use in the UK".
The row about MMR derives in part from a chronic uncertainty as
to what autism describes. A year after it was identified in
1943, by Leo Kanner in a study of 11 profoundly uncommunicative,
unruly children, a variant - Asperger's syndrome - proposed a
less serious version, in which poor social skills are offset by
an obsessive attention to detail that can lead to high academic
performance. For years, autism was thought to be caused by
unloving parents, and "refrigerator mothers" in particular. In
the 1960s it was redefined as an inherited brain disorder, and
then came a distinction between classic congenital autism and a
regressive variety acquired after the age of two.
Autism is now referred to as a spectrum disorder, a catch-all
syndrome whose symptoms range from semi-suicidal lunges out of
windows to a relatively harmless obsession with order and
routine. Wakefield's theories about leaky guts blur definitions
further by challenging the traditional view that autism is a
purely psychiatric problem, and arguing that it can be treated
by medical means as well as by behavioral therapies.
One thing that is apparent is that there is a lot more of it
about nowadays. We all know, or know of, somebody with an
afflicted child. Authors, notably Nick Hornby, whose ex-wife
Virginia used to be a trustee of Visceral, have written about
their experiences as parents. Official statistics from the
Medical Research Council (MRC) in 2001 revealed the rate had
shot up from 1 in 5,000 per head of population in 1970 to 1 in
165. In 1988, when MMR was introduced, it was 1 in 2,200.
That might be coincidence, and it might be that as the spectrum
of the disorder has broadened, we've got better at spotting it.
Wakefield's former colleague at the Royal Free, Professor Brent
Taylor, last year published a statistical analysis of children
in north London showing that an autism epidemic was well under
way before MMR. Then it was pointed out by Wakefield and
Montgomery that many children in the survey who appeared, from
their date of birth, not to have had the triple jab but who
still developed autism, might have been included in an extensive
"catch-up" MMR campaign targeted at older children in the early
1990s. Taylor later acknowledged this in a letter to The Lancet,
but stands by his broad findings.
In response to my request for clarification, he replied that
"the scientific argument on MMR and autism is over: MMR vaccine
is not involved". He urged The Sunday Times to "do something
positive" for MMR and for children with autism, instead of
"another half-baked panagyric [sic] for junk science". I pressed
him to explain what he meant by "junk science". He didn't mail
me back.
Such reticence from the pro-MMR party does not inspire
confidence. Nor do their efforts to identify alternative causes
for the steep increase in diagnosed autism. The Medical Research
Council was given £2.75m by the DoH last year to fund new
research. So far, none of that money has been allocated, though
12 projects are, it says, "under consideration". No details
could be supplied.
Meanwhile a three-year study that the MRC commissioned in 2000
from the London School of Hygiene & Tropical Medicine has not
yet reported. Two papers are being readied for publication, one
assessing the rise in autism since 1988 and another looking at
possible links with MMR. The scientist in charge, Professor
Andrew Hall, has inspected the GP records of 1,000 children
diagnosed as autistic and sent questionnaires to 400 parents.
Since none of Hall's team has been near an autistic child,
whatever he reports is unlikely to silence Wakefield and the "scopers".
It's stats against case studies, the old apples-versus-oranges
argument. Again.
On the day the Legal Services Commission announced it was
pulling out of the MMR class action, the DoH endorsed that,
stating that "this draws a line" under the controversy. Some
hope.
Tomorrow, Five is scheduled to screen a TV drama, Hear the
Silence, with Hugh Bonneville as Andrew Wakefield and Juliet
Stevenson as the mother of an autistic child battling to get
heard by an unsympathetic gang of haughty specialists. It is a
partisan account of the MMR story, so partisan that Five has
organized a televised discussion afterwards to let the DoH
answer back. At the time of writing, it had not agreed to take
part.
The most misleading impression given by the drama is its
portrayal of Wakefield as a gallant loner. In October, I flew to
Portland, Oregon, to attend a conference hosted by the American
pressure group Defeat Autism Now! (Dan!), where Wakefield was
one of 23 research scientists - all confirmed as anti-MMR -
making presentations to an audience of medics and parents. The
last speaker was Rick Rollens, formerly secretary to the
California state senate, and the father of an autistic son.
He presented a torrent of statistics detailing an 800% increase
in diagnosed cases of autism since California introduced MMR
jabs in 1979 and made them compulsory, in line with a nationwide
Clinton decree in 1993. The state's Developmental Services
Agency now finds that just under half its clients are autistic,
compared with the 3% it dealt with pre-MMR. The epidemic,
Rollens said, was threatening to wreck care provision in the
nearly bankrupt public administration of California.
This was a depressing and biased presentation. But at least it
dealt in what looked like hard facts. Shortly after returning
from Dan!, I attended a public seminar in London that addressed
the MMR/autism issue in ostrich-like fashion. It was hosted by
the PR company Hill & Knowlton, whose clients includes the three
drug companies that manufacture the triple vaccine, and it was
introduced by an online magazine, Spiked, one of whose
columnists, the east London GP Michael Fitzpatrick, led the
discussion. The audience was chiefly composed of health
professionals, DoH representatives and media types. Two things
stood out.
One was the meeting's concern that anxieties about MMR had been
hyped by our old enemy the media. The other was its refusal to
address the evidence that aroused public distrust in the first
place. For these people, immunization was an incontrovertible
religious doctrine. Fitzpatrick rubbished the work of Wakefield,
whose research papers currently outnumber his own by 128 to 0,
as a superstition on a par with astrology. When somebody
mentioned the divergence of scientific opinion, Professor Brent
Taylor interrupted, again announcing that "the scientific debate
is over".
Andrew Wakefield has no plans to belt up. More studies are in
the pipeline - so, no doubt, are more allegations of cover-ups
and conspiracies. If Wakefield is proved right, then we've been
poisoning our offspring, avoidably, since his 1998 study. If
he's wrong, then let's hear some intelligible evidence ASAP, so
we can get MMR vaccination rates up - from 67% in the London
area and under 80% across the country - to head off threatened
measles epidemics. And single vaccinations need to be reinstated
as an affordable alternative to the worrisome triple jab. A
typical price for a private measles jab is £150.
Having spent £3m on a TV ad campaign urging triple vaccination,
with a prowling lion protecting its young - which didn't work -
the DoH's current course is to carry on ignoring Wakefield et
al.
A low-profile series of educational road shows and advice
sessions in the 20 areas of the country with the lowest take-up
of MMR began in the summer. In London, the country's anti-MMR
capital, these have been almost invisible.
Such a feeble defense of the status quo, and a blanking of
public anxieties that might be misguided but are nonetheless
genuine, may suit embattled drug companies and embarrassed
government policy wonks. But it isn't going to silence the
enemies of multiple vaccination - nor will it do much good for
anybody's health.
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