MMR: the unanswered questions

By Melanie Phillips
Daily Mail, 31 October 2005

Since Dr Andrew Wakefield first triggered the furore over a possible link between autism, bowel disease and the measles, mumps and rubella triple jab in 1998, the controversy has never died away. Now a study by the respected Cochrane Library has said, on the basis of 31 pieces of research into the possible side effects of MMR, that it found no association between MMR and autism.

Cue a frenzy of gloating by Wakefield’s enemies, ripe denunciations of those like this newspaper who took his concerns seriously and demands that we apologise for creating a scare that left children unvaccinated and at risk of measles, mumps and rubella. The Cochrane Library study, they shrieked, had found MMR to be ‘safe’, given it the ‘all clear’ and declared all such fears to be ‘unfounded’.

This is a load of old baloney. These people should start by reading the actual study rather than lazily recycling the press release.

For the study didn’t say anything like this at all. Certainly the lead Cochrane reviewer Vittorio Demicheli said in that press release: ‘We conclude that all the major unintended events, such as triggering Crohn’s disease or autism, were suspected on the basis of unreliable evidence.’

But Wakefield never suggested a link between MMR and Crohn’s disease, a disorder of the bowel. Wakefield reported instead the discovery of an entirely new syndrome, autistic enterocolitis, which produced distressing bowel symptoms along with a number of developmental problems resembling autism — but which the Cochrane report did not even mention.

Moreover, it did not conclude that Wakefield’s evidence was unreliable. On the contrary, it said that no fewer than nine of the most celebrated studies that have been used against him were unreliable in the way they were constructed. As a result, it said, their conclusions that MMR was ‘safe’ or ‘well-tolerated’ need to be ‘interpreted with caution’.

Next, the press release said: ‘There was no credible evidence behind claims of harm from the MMR vaccination.’ But the study did not say that. It did not even examine those claims of harm, which arose not from the epidemiological studies of patterns of disease which Cochrane investigated, but from clinical investigations of actual children.

What the report did say but was not mentioned in that extremely odd press notice was this: ‘The design and reporting of safety outcomes in MMR vaccine studies, both pre-and post-marketing, are largely inadequate’. And just as significant, this: ‘We found only limited evidence of the safety of MMR compared to its single component vaccines…’

In other words, far from saying MMR was safe the study said explicitly that the evidence for its safety was not good enough. Yes, it also said the evidence it looked at did not support any association between MMR and autism. But that does not mean it said the vaccine was safe. It was rather that it didn’t find anything to suggest that it was not.

And that was because the epidemiological studies that it examined are intrinsically unlikely to reveal the truth about the effects of MMR. For a start, they rely on medical records. But the parents complained that their children’s doctors dismissed all their concerns about autistic symptoms or bowel disease. So they never entered anything out of the ordinary on their medical records.

Furthermore, for the vast majority of children, the vaccine poses no problem at all. Only a very small proportion are said to have been badly affected, possibly through a combination of environmental or genetic factors. But population-wide studies are considered too large and insensitive to pick up small numbers like this.

It is the evidence that Cochrane did not examine that is the only material worth studying. This is the clinical evidence obtained not just by Wakefield and his associates but by others, which has posed alarming questions that have never been answered.

Wakefield’s discovery of autistic enterocolitis as a completely new syndrome has now been replicated in studies around the world as a new and so far unexplained disease in patients with autism.

It has also been discovered that autistic symptoms have got far worse in a number of children after they received booster jabs — and such booster jab evidence has been accepted by the American Institute of Medicine, at least, as an indication of cause and effect.

Most explosively of all, vaccine-strain measles virus has been found in the cerebro-spinal fluid of some autistic children — which suggests that in those cases the vaccine may have had a catastrophic effect on the brain.

None of this proves that MMR has caused autism in some children. But it does raise questions which need to be resolved as a matter of urgency. The only way to do so is to conduct large-scale clinical trials, which the government has consistently refused to do.

Hopes of examining the existing clinical evidence were pinned on the legal case being brought by parents claiming compensation on behalf of children said to have been damaged by the vaccine. But this case foundered when the parents’ legal aid was abruptly withdrawn.

Now Wakefield himself is being arraigned before the General Medical Council on eleven counts of serious professional misconduct, including an alleged conflict of interest over receiving funding from the parents’ lawyers, which he has strenuously denied.

Compare this with the Cochrane paper, where under the rubric ‘potential conflict of interest’ Dr Tom Jefferson, who is listed as the study’s second author, acknowledges that in 1999 he acted as a consultant for a legal team advising the MMR vaccine manufacturers.

Another researcher who helped with the Cochrane paper was one of the authors of a prominent study which rubbished Wakefield’s research -- a study which the Cochrane report itself then investigated.

And a number of epidemiological studies which the government has used to state that MMR is safe have been written by researchers with links to drug companies or to governmental bodies with an interest in disproving Wakefield’s concerns.

Are these not real conflicts of interest which should be investigated, rather than hounding the doctor whose discoveries have raised concerns over public health which have never been addressed?

Read full article at: http://www.melaniephillips.com/articles/archives/001468.html

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