bmj.com Rapid Responses for Tanne, 325 (7373) 1134

Rapid Responses to:

NEWS:
Janice Hopkins Tanne
MMR vaccine is not linked with autism, says Danish study
BMJ 2002; 325: 1134a [Full text]

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Rapid Responses published:

MMR Vaccine Proven to Not Cause Autism, Again...: Tony Floyd (16 November 2002)

Yes: we do need confirmation: Neville W Goodman (20 November 2002)

Confirmation of what?: Tony Floyd (27 November 2002)

Which MMR?: John P Heptonstall (10 December 2002)

Autism. Time to Look for Real Solutions.: Tony Floyd (23 February 2003)

Criticisms of Madsen et al in the Journal of American Physicians and Surgeons: John Stone (7 September 2004)

Re: Criticisms of Madsen et al in the Journal of American Physicians and Surgeons: John Stone (8 September 2004)

Re: Criticisms of Madsen et al in the Journal of American Physicians and Surgeons: Dr John MM Rumbold (8 September 2004)

Criticism Pulled From the Air Are Not Helpful!: Paul Shapiro (9 September 2004)

An Apology Is In Order!: Paul Shapiro (9 September 2004)

THE INTERESTING QUESTION - AND OUR CHILDREN ARE NOT SAFE: John Stone (10 September 2004)

Re: THE INTERESTING QUESTION - AND OUR CHILDREN ARE NOT SAFE: John P Heptonstall (27 September 2004)

Re: Autism. Time to Look for Real Solutions.: John P Heptonstall (27 September 2004)

Re: Re: Autism. Time to Look for Real Solutions.: Peter Flegg (27 September 2004)

Re: Re: Re: Autism. Time to Look for Real Solutions.: John P Heptonstall (28 September 2004)

Re: Re: Re: Re: Autism. Time to Look for Real Solutions.: Peter Flegg (28 September 2004)

Refutation of Madsen in the Journal of American Physicians and Surgeons: Dr M L Grove (30 September 2004)

Re: Refutation of Madsen in the Journal of American Physicians and Surgeons: John Stone (30 September 2004)

Re: Refutation of Madsen in the Journal of American Physicians and Surgeons: Andrew L. Schlafly (30 September 2004)

Re: Refutation of Madsen in the Journal of American Physicians and Surgeons: Adam Jacobs (1 October 2004)

Re: Refutation of Madsen in the Journal of American Physicians and Surgeons: Mark Struthers (1 October 2004)

Re: Refutation of Madsen in the Journal of American Physicians and Surgeons: Jane M. Orient, Tucson, AZ 85716 (1 October 2004)

So what else happened in Denmark?: F. Edward Yazbak (1 October 2004)

Re: Journal of American Physicians and Surgeons: Matthew L Grove (1 October 2004)

HAVE VICARS-GENERAL OF VACCINATION GOT THE NEEDLE?: Clifford G. Miller (2 October 2004)

Re: HAVE VICARS-GENERAL OF VACCINATION GOT THE NEEDLE?: Adam Jacobs (3 October 2004)

Re: Re: Journal of American Physicians and Surgeons: Jane M. Orient, Tucson, AZ 85716 (3 October 2004)

Endorsement for mmrthefacts advice: John Stone (3 October 2004)

Re: Re: Re: Re: Re: Autism. Time to Look for Real Solutions.: John P Heptonstall (3 October 2004)

Superficial and Misleading Critique: Harold E Buttram, MD (4 October 2004)

Re: Re: Re: Re: Re: Re: Autism. Time to Look for Real Solutions.: Peter Flegg (4 October 2004)

Re: : Autism. Time to Look for Real Solutions.: Carol Johnston (4 October 2004)

Re: Re: : Autism. Time to Look for Real Solutions.: Tony Floyd, Jennifer Hawkins (5 October 2004)

Re: Superficial and Misleading Critique: Adam Jacobs (5 October 2004)

Re: HAVE VICARS-GENERAL OF VACCINATION GOT THE NEEDLE?: Clifford G. Miller (5 October 2004)

Advancing ?: Lisa C Blakemore-Brown (5 October 2004)

Re: Re: Re: Re: Re: Re: Re: Autism. Time to Look for Real Solutions.: John P Heptonstall (5 October 2004)

Response to Carol Johnston.: Peter Flegg (5 October 2004)

Re: Endorsement for mmrthefacts advice: John Stone (5 October 2004)

Re: Re: Re: : Autism. Time to Look for Real Solutions.: MC Feliciello (5 October 2004)

NOW WE ARE TALKING REAL NUMBERS: Clifford G. Miller (5 October 2004)

Re: Re: Endorsement for mmrthefacts advice: Adam Jacobs (5 October 2004)

Re: Re: HAVE VICARS-GENERAL OF VACCINATION GOT THE NEEDLE?: Adam Jacobs (5 October 2004)

Re: Re: Re: Endorsement for mmrthefacts advice: John Stone (6 October 2004)

Re: NOW WE ARE TALKING REAL NUMBERS: Peter Flegg (6 October 2004)

MMMRTHEFACTS: THE POLICY FLIES WITHOUT SAFETY CHECKS AND NO ONE SAYS ANYTHING: John Stone (8 October 2004)

RE: MMR the facts ?: Matthew Grove (8 October 2004)

RE: MMR the facts - addendum: Matthew L Grove (8 October 2004)

Re: MMMRTHEFACTS: THE POLICY FLIES: Graeme Johnston (8 October 2004)

Re: RE: MMR the facts ?: L. Travis Haws (8 October 2004)

MMR CAUSES AUTISM - CASE PROVEN - NOW ON RISK/BENEFIT: Clifford G. Miller (10 October 2004)

Re: RE: MMR the facts - addendum: Carol Johnston (10 October 2004)

Re: Graeme Johnston's reply: John Stone (10 October 2004)

Re:Superficial and Misleading Critique: Raymond Gallup (10 October 2004)

The demise of common sense, and logical immunity: Hilary Butler (10 October 2004)

Re: MMR information in PDR: Graeme Johnston (10 October 2004)

Advice from MMR the Facts: Carol Johnston (10 October 2004)

Re: Advice from MMR the Facts: Ed Cooper (10 October 2004)

Re: Re: Advice from MMR the Facts (Ed Cooper's response to Carol Jonston): John Stone (11 October 2004)

Re: Re: Advice from MMR the Facts: Carol Johnston (11 October 2004)

Re: MMR CAUSES AUTISM - CASE PROVEN - NOW ON RISK/BENEFIT: Adam Jacobs (11 October 2004)

Re: MMR CAUSES AUTISM - CASE PROVEN - NOW ON RISK/BENEFIT: Raymond Gallup (11 October 2004)

Re: Re: MMR information in PDR: L. Travis Haws (11 October 2004)

Limits of epidemiological studies: Deborah Kahn (11 October 2004)

Re: Limits of epidemiological studies: Adam Jacobs (12 October 2004)

Re: Re:Superficial and Misleading Critique: Lisa C Blakemore-Brown (12 October 2004)

Re: Adam Jacobs: "Limits of epidemiological studies", or here we go round the mulberry bush: John Stone (13 October 2004)

Re: Re: Limits of epidemiological studies: John Stone (13 October 2004)

Re: Adam Jacobs :Limits of epidemiological studies - here we go round the mulberry bush II: John Stone (13 October 2004)

MMRTHEFACTS: THE POLICY CONTINUES TO FLY WITHOUT SAFETY CHECKS: John Stone (14 October 2004)

Re: Re: Adam Jacobs: "Limits of epidemiological studies", or here we go round the mulberry bush: eamonn clarke (14 October 2004)

Re: Re: Re: Adam Jacobs: "Limits of epidemiological studies", or here we go round the mulberry bush: John Stone (14 October 2004)

Limits of epidemiological studies in autism without clinical tests: Ellen C G Grant (14 October 2004)

Re: Limits of epidemiological studies: Raymond Gallup (15 October 2004)

Re: Re: Limits of epidemiological studies: Adam Jacobs (17 October 2004)

Constructive debate: Dr John MM Rumbold (17 October 2004)

Re: Limits of epidemiological studies: Raymond Gallup (18 October 2004)

Re: Re: Re: Limits of epidemiological studies: John P. Heptonstall (18 October 2004)

Re: Re: Re: Re: Limits of epidemiological studies: Adam Jacobs (18 October 2004)

Hypothetical MMR Survey: Michael D Innis (19 October 2004)

Re: Re: Re: Re: Re: Limits of epidemiological studies: L. Travis Haws (19 October 2004)

Adam Jacobs: "association and causation": John Stone (19 October 2004)

Re: Re: Re: Re: Re: Limits of epidemiological studies: John P. Heptonstall (19 October 2004)

Just a thought.: Hilary Butler (19 October 2004)

Re: Hypothetical MMR Survey: Adam Jacobs (19 October 2004)

Re: Re: Hypothetical MMR Survey: John Stone (20 October 2004)

Re: Just a thought.: Adam Jacobs (20 October 2004)

Re: Re: Hypothetical MMR Survey: John P Heptonstall (20 October 2004)

Re: Re: Just a thought.: John Stone (21 October 2004)

Re: The Smeeth Report: Michael D Innis (21 October 2004)

Just a bigger thought.: Hilary Butler (21 October 2004)

Re: Re: Re: Hypothetical MMR Survey: Adam Jacobs (21 October 2004)

Re: Re: Re: Hypothetical MMR Survey: Adam Jacobs (21 October 2004)

"I have a dream .....": E J Northey (21 October 2004)

I AM NOT AN ANTI-VACCINATIONIST - PLEASE RETRACT: John Stone (21 October 2004)

Re: "I have a dream .....": MC Feliciello (21 October 2004)

Re: Re: Just a thought.: John P Heptonstall (21 October 2004)

Re: Re: The Smeeth Report: L. Travis Haws (21 October 2004)

Re: Re: Re: The Smeeth Report: Nicholas Bennett (22 October 2004)

Re: Re: Re: Re: Hypothetical MMR Survey: John P Heptonstall (22 October 2004)

Objective Correlative?: Dr. Herbert H. Nehrlich (22 October 2004)

The most troubling thing about the Smeeth study: John Stone (25 October 2004)

Re: Re: Refutation of Madsen in the Journal of American Physicians and Surgeons: Adam Jacobs, Matthew L Grove (29 October 2004)

Re: MMR the facts: the policy continues to fly without safety checks: John Stone (12 December 2004)

Re: Re: Re: Refutation of Madsen in the Journal of American Physicians and Surgeons: John Stone (31 December 2004)

Re: Response to Carol Johnston.: C Johnson (3 January 2005)

Refutation of Madsen in the Journal of American Physicians and Surgeons and Adam Jacobs's interests: John Stone (5 January 2005)

Where are the named authors of the beleaguered Madsen and Smeeth papers?: John Stone (7 January 2005)

Re: Where are the named authors of the beleaguered Madsen and Smeeth papers?: John F McCleary, Monmouthshire NP7 8LR (10 January 2005)

Madsen, Come Out, Come Out from Where Ever You Are!: Paul Shapiro (10 January 2005)

Re: Where are the named authors of the beleaguered Madsen and Smeeth papers?: Michael D Innis (10 January 2005)

So Unusual: F. Edward Yazbak (11 January 2005)

Re: So Unusual: John Stone (17 January 2005)

Re: Re: Where are the named authors of the beleaguered Madsen and Smeeth papers?: Alan D Rees (18 January 2005)

Re: So Unusual - but where is the explanation?: John Stone (27 January 2005)

MMR Vaccine Proven to Not Cause Autism, Again... 16 November 2002

Tony Floyd,
Medical Student
Newcastle University, Newcastle Australia 2308
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Re: MMR Vaccine Proven to Not Cause Autism, Again...

Janice Tanne's BMJ News Article(1) highlights the findings by Madsen et al(2), showing that, if anything, MMR vaccinated children have LESS chance of being diagnosed with autism compared to unvaccinated children.
Did we really need ANOTHER study to confirm that there is no link between autism and MMR? Were the studies in England(3), Finland(4), Sweden(5) and California(6) not enough? Victims of autism might benefit more from research into a real cause rather than yet more evidence proving the same thing ad infinitum.
Sincerely,
Tony Floyd
References:
1. Tanne JH. MMR vaccine is not linked with autism, says Danish study. News. BMJ 2002;325:1134 (16 November)
2. Madsen K. M., Hviid A., Vestergaard M., Schendel D., Wohlfahrt J., Thorsen P., Olsen J., Melbye M. A Population-Based Study of Measles, Mumps, and Rubella Vaccination and Autism N Engl J Med 2002; 347:1477- 1482, Nov 7, 2002.
3. Taylor, Brent. Miller, Elizabeth. Farrington, C Paddy. Petropoulos, Maria-Christina. Favot-Mayaud, Isabelle. Li, Jun. Waight, Pauline A. Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet. 353(9169):2026- 2029, June 12, 1999.
4. Patja A. Davidkin I. Kurki T. Kallio MJ. Valle M. Peltola H. Serious adverse events after measles-mumps-rubella vaccination during a fourteen-year prospective follow-up. Pediatric Infectious Disease Journal. 19(12):1127-34, 2000 Dec.
5. Gillberg C, Heijbel H. MMR and autism. Autism. 1998;2:423-424.
6. Dales, L. Hammer, S J. Smith, N J. Time Trends in Autism and in MMR Immunisation Coverage in California. Year Book of Psychiatry & Applied Mental Health|Year Book of Psychiatry & Applied Mental Health. 2002:47-48, 2002.
Competing interests: None declared

Yes: we do need confirmation 20 November 2002

Neville W Goodman,
Consultant Anaesthetist
Southmead Hospital, BS10 5NB
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Re: Yes: we do need confirmation

The reason that we needed the NEJM study, and probably need even more, is, sadly, obvious when you put 'MMR' and 'autism' into an internet search engine. Readers might like to go to:
http://www.redflagsweekly.com/extra/2002_nov08.html
which dismisses the NEJM study. I'm sure there are plenty of similar sites.
Competing interests: None declared

Confirmation of what? 27 November 2002

Tony Floyd,
Medical Student
Newcastle University, Newcastle Australia 2308
Send response to journal:
Re: Confirmation of what?

In response to Dr Goodman's response:
The fact that putting MMR and Autism into an internet search engine results in a whole gaggle of quack-sites is hardly a surprise. Whilst the volume of misinformation available (some of it even purporting to be supported by fact) is certainly of concern, I can't imagine why that itself is a valid justification for even more studies proving that there is no link between MMR and Autism.
As for the web page address you provided; if the author (a journalist who also believes that AIDS is not caused by HIV) believes he has a point aside from referring to the NEJM article as 'dog poop' as he does, then please invite him to post his comments here for the edification of all.
Sincerely,
Tony Floyd
Competing interests: None declared

Which MMR? 10 December 2002

John P Heptonstall,
Director of The Morley Acupuncture Clinic and Complementary Therapy Centre
LS27 8EG
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Re: Which MMR?

Sir
The debate about MMR-autism rages on and the Danish study is but another weak link in the chain promoted by those who, it appears, would vaccinate and be damned. Neville Goodman quotes a site that I suspect he opines will bring disrepute on anti-vaccine authors � perhaps he and Tony Floyd could look at the �critical analysis � of the Danish Study by Ulf Branell (1) and comment. They might throw light on the validity of Branell�s statistical appraisal of the Danish study.
The Danish study does nothing to alter my view that MMR is probably a cause of autism, but the authors have perhaps unwittingly identified an important avenue of investigation (assuming their values are sound) that may lead us to the proof that MMR causes autism. If Denmark has largely avoided MMR-induced autism, then maybe the measles vaccine (MV) strain used was responsible; MMR vaccines in general cannot be exonerated but the Moraten vaccine strain used by Denmark may be safer than others in that regard. Studies have shown that various types and titres of attenuated vaccine strains produce varying levels of efficacy, long and short-term side effects, and even death; these vaccines are used commonly in the West where a strong public lobby believes that MMR vaccines cause autism (2)- (11).
The UK�s MMR vaccines used throughout the late 80s and early 90s contained Urabe Am9 mumps strain proven to cause meningitis. They were withdrawn from use around 1993 but not before being injected into millions of children, and this probably muddied waters later used to evaluate MMR generally. The two vaccines withdrawn were Immravax and Pluserix used in 85% of UK vaccinations, this left MMR2. All three are cited by JABS (12), after statistical analysis of anecdotal data, as being linked to convulsions, loss of speech, losing ability to walk, behaviour change, in addition to autism and numerous other serious adverse reactions including non-autism communication, speech and language disorders. Ironically, although Immravax and Pluserix were withdrawn for their increased probability of causing meningitis, JABS statistics show the vaccine now in use and a major source for UK children, MMR2, may provide even greater risks of �losing ability to walk�, convulsions, �stopping babbling/talking�, than either Immravax or Pluserix. Parent reports to JABS of lasting problems suggest that all three vaccines may cause developmental delays, regression, speech/language/ communications problems, epilepsy and autism. JABS figures also highlight the significance of batches; some vaccine batches appear to be responsible for a higher prevalence of certain post-vaccine disorders � a fact that appears to have been overlooked by �MMR research� teams.
In June 1989 Yamada et al reported a virological method using polymerase chain reactions (PCR) technique to differentiate between vaccine strain mumps virus related aseptic meningitis and meningitis caused by wild mumps virus; a number of cases following MMR vaccination were reported and in October 1989 the Japanese Ministry of Health and Welfare conducted nationwide monitoring for aseptic meningitis after MMR vaccination. In October 1991 Japanese researchers tested a number of MMR vaccines looking especially at the mumps components for cause of meningitis in children within 35 days after vaccination (13). Ironically it was the Biken (producers of Urabe Am9 strain) MMR vaccine that showed the lowest incidence of aseptic meningitis (0/10,000 doses), yet the Standard MMR vaccine (also containing Biken Urabe Am9 strain) showed the highest incidence (16.6/10,000 doses). It turned out that Biken had changed the manufacturing process both for MMR vaccine and monovalent mumps vaccine when they started to make Biken MMR vaccine, coincident with the onset of the large nationwide surveillance. Their Urabe Am9 in the Biken vaccine M-3 A turned out to be different from that in the Standard MMR; the latter had been made by combining two different bulks, M-3 A and M-3 B, of mumps vaccine at ratio 2:1. It was still not clear how the nucleotide sequence changes were connected to the incidence rates of aseptic meningitis following the two MMR vaccines, but clear that the original Biken Urabe Am9 was much safer, in terms of meningitis, than the other Biken Urabe Am9.
The tests further showed that other MMR vaccines, Takeda MMR containing Torii mumps strain and Kitasato MMR containing Hoshino mumps strain caused aseptic meningitis at rates above Biken Urabe Am9 M-3 A, 11.6 / 10,000 doses and 3.2 / 10,000 doses respectively. In March 1993 a case of transfer of mumps vaccine virus (Standard MMR vaccine) was found to have occurred between siblings (14). In April 1993 the Japanese Ministry of Health and Welfare recommended the suspension of all MMR vaccines, for both routine and optimal immunisation.
This illustrates how MMR vaccines can vary from different suppliers and that a difference in two strains can result in one vaccine that is responsible for a large number of serious outcomes in children whilst the other is relatively safe. Is this the case with MMR strains, batches and suppliers in the West and, if so, why is this ignored by researchers?
I think the pro-vaccine lobby has become so deluded by pro-vaccine propaganda generated by those who gain from the commercialisation of vaccines that children suffer unnecessarily. We need to damn self-serving rhetoric and praise scientific integrity, not easy (witness recent revelations about the institutionalisation of corruption in medical science) but essential to our health and welfare.
The authors of the Danish Study admit they cannot quantify the probability of cases of �regressive autism� in their study, and do not know if parents who had experienced vaccine damage, eg autism, later refused vaccines for others siblings, yet Dr. Edward Campion, senior deputy editor of The New England Journal of Medicine, writes �This careful and convincing study shows that there is no association between autism and MMR vaccination�. I find the almost blind acceptance of research findings puzzlingly common and as eccentric as the concept that one�s credentials qualify one�s opinions.
Clearly the �anti-vaccine lobby� has genuine concerns about vaccines in general and MMR in particular. Any reasonable person with an interest in the inordinate amount of disease affecting our children, from recurrent �unidentified� infections, cancers and diabetes to disorders inducing severe learning difficulties, ought to be seeking explanations for this explosion of illness and should be very concerned when told by a medical advisor �we don�t know why� when that same advisor is so sure that �vaccines are safe�. New virus strains are regularly identified around the world, one wonders how many of these are a result of the attenuation of strains for vaccines therefore yet another potential source of �recurrent unidentified illnesses� for everyone to develop. (15)-(18)
The final irony would be if so many �unquantifiable psychiatric problems� ravaging modern youth is a genetic throwback to the source through which many vaccine virus strains have evolved; these are the attenuated strains used so liberally in the West that were created by repeated passage through cell lines derived from the aborted babies of two psychiatric patients. Two cell lines commonly used are MRC-5 (Medical Research Council 5) and WI-38 (Wistar Institute 38). MRC-5 originates from the lung tissue taken from a 14 week male foetus aborted �for psychiatric reasons� from a 27 years old woman in the 1970s. WI-38 originates from a female foetus aborted for �psychiatric reasons� in the 1960s. Vaccines using these �human diploid� strains, which are licensed and commonly used in the West, include MMRII of Pasteur Merieux MSD, Priorix MMR of SmithKline Beecham (SKB), Polio (Wellcome, Medeva), Rubella (Erevax) of SKB, Hepatitis A (Havarix) of SKB, Hepatitis A of Pasteur Merieux (19).
Traditional Chinese Medicine implies that one�s etheric self/selves (soul, spirit, animal spirit etc.) are present throughout the body, for example the �animal spirit�, our base nature of survival, is said to be housed in the Lung System, our �soul� or human aspect of consciousness is said to be housed in the Liver system. Part of these aspects of consciousness is passed on through successive generations so one might expect foetal cell lines to have passed on aspects of consciousness of their donors. Homeopaths may appreciate this as an increasingly powerful quantum memory derived from ever increasing dilutions for attenuation. Autism was originally referred to as juvenile schizophrenia.
References
1. http://www.motgift.nu/Div/SIEM/MMRE2E.html
2. Parks CL et al �Analysis of the Noncoding Regions of Measles Virus Strains in the Edmonston Vaccine Lineage�, J Virol 2001 Jan; 75(2): 921-33
3. Atabani S et al �Sex-associated differences in the antibody-dependent cellular cytotoxicity antibody response to measles vaccines�, Clinical and Diagnostic Lab. Immunology, Jan. 2000; 7(1): 111-113
4. Vesikari T et al �Comparison of the Urabe Am9-Schwarz and Jeryl Lynn- Moraten combinations of mumps-measles vaccines in young children�, Acta Paediatr Scand 1983 Jan; 72(1): 41-6
5. Bitnun A et al �Measles inclusion-body encephalitis caused by the vaccine strain of measles�, Clin Infect Dis 1999 Oct; 29(4): 855-61
6. Wyde PR et al �Infection of leucocytes by measles vaccine viruses Edmonston-Zagreb and Enders-Moraten has different consequences: potential mechanism for increased vaccine efficacy or aberrant activity in field trials�, Vaccine 1994 Jun; 12(8): 715-22
7. Valsamakis A et al �Strains of measles vaccine differ in their ability to replicate in and damage human thymus�, Journal of Infect Dis 2001; 183:498-502
8. Dos Santos BA et al �An evaluation of the adverse reaction potential of three measles-mumps-rubella combination vaccines�, Rev Panam Salud Publica 2002 Oct; 12(4): 240-46
9. Calain P, Roux L, �Generation of measles virus defective interfering particles and their presence in a preparation of attenuated live virus vaccine�, J Virol 1988 Aug; 62(8): 2859-66
10. Bellocq C et al �Wide occurrence of measles virus subgenomic RNAs in attenuated live virus vaccines�, Biologicals 1990 Oct; 18(4): 337-43
11. Morfin F et al �Detection of measles vaccine in the throat of a vaccinated child�, Vaccine 2002 Feb 22; 20(11-12): 1541-3
12. �A report on MMR and DTP questionnaires and personal communications� JABS 1995
13. Kimura et al �Adverse events associated with MMR vaccines in Japan�, Acta Paediatrica Japonica 1996; 38:205-11
14. Sawada et al, �Transmission of Urabe mumps vaccine between Siblings�, Lancet 1993; 342:371)
15. Christensen LS et al �Sequence analysis of measles virus strains collected during the pre- and early-vaccination era in Denmark reveals a considerable diversity of ancient strains�, APMIS 2002 Feb; 110(2): 113-22
16. Jin L et al �Characterisation of a new genotype of measles virus detected in China and England�, Epidemiol Infect 1998 Dec; 121(3): 691-7
17. Xu W et al �New genetic group of measles virus isolated in the People�s Republic of China� Apr; 54(2): 147-56
18. Outlaw MC, Pringle CR �Sequence variation within an outbreak of measles virus in the Coventry are during spring/summer 1993�, Virus Res 1995 Nov; 39(1): 3-11
19. http://www.catholicdoctors.org.uk/CMQ/Indiv_Articles/altyernatives_to_mmr
Competing interests: � None declared

Autism. Time to Look for Real Solutions. 23 February 2003

Tony Floyd,
Medical Student
Newcastle University, Newcastle Australia 2308
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Re: Autism. Time to Look for Real Solutions.

Closely tied as I am to an Autism sufferer I'd be as keen as anyone to find a cure. Continuing to try and pin all that is evil on vaccines is really starting to wear thin.
For starters let's take a closer look at two of the references given in the response above, Christensen LS(1) and Jin L et al(2). Both available on-line, and neither seem to support any concerns about vaccinations.
A little further searching reveals both authors are well-published in their respective fields, such as Christensen's study of Cases of measles in Denmark...(3) which clearly states:

"Measles vaccination was implemented in the child vaccination programme in Denmark in 1987 and produced a rapid decline in the incidence."
Dr Lin Jin was also one of the authors of an article studying vaccination coverage in Ireland(4), the results of which:

"suggested that suboptimal vaccine uptake facilitated the spread of imported measles infection."
Jin and colleagues also found that:

"Initial cases were reported from an area of Dublin with low vaccine uptake and a large immigrant population.."
Both researchers have hence published evidence that vaccines reduce disease and that outbreaks of disease occur when vaccine uptake is low.

References
(1) Christensen LS et al �Sequence analysis of measles virus strains collected during the pre- and early-vaccination era in Denmark reveals a considerable diversity of ancient strains�, APMIS 2002 Feb; 110(2): 113-22
(2) Jin L et al �Characterisation of a new genotype of measles virus detected in China and England�, Epidemiol Infect 1998 Dec; 121(3): 691-7
(3) Christensen LS et al. Cases of measles in Denmark are caused by reintroduction of virus from abroad Ugeskr Laeger 2001 Apr 16;163(16):2244-7
(4) Coughlan S, Connell J, Cohen B, Jin L, Hall WW. Suboptimal measles-mumps-rubella vaccination coverage facilitates an imported measles outbreak in Ireland. Clin Infect Dis 2002 Jul 1;35(1):84-6

Competing interests: � None declared

Criticisms of Madsen et al in the Journal of American Physicians and Surgeons 7 September 2004

John Stone,
none
London N22
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Re: Criticisms of Madsen et al in the Journal of American Physicians and Surgeons

The fall edition of the Journal of American Physicians and Surgeons carries two peer reviewed papers which contradict the data and conclusions of the Madsen et al study.
Gary Goldman and F. Edward Yazbak [1] obtained access to the original data and found that among other factors the Madsen study had been skewed by the inclusion of children under 15 months of age who had not yet been vaccinated, and children under 5 years of age who would not yet have been diagnosed due to a practice of late diagnosis in Denmark.
Stott et al [2] publish a letter by Professor Samy Suissa of McGill University refused by the New England Journal of Medicine in which she calculated on the basis of Madsen et al's published figures that children were 45% more likely to have autism after MMR as against Madsen et al's calculation of 8% less. Professor Suissa's credibility should be recognised on all sides of this fraught argument since she contributed to the Institute of Medicine's Immunisation Safety Review [3]. Stott et al also had access to new data from the Danish Psychiatric Central Register which also documents an increase in autism incidence after the introduction of MMR.
The Madsen study has been a linch-pin in the defence MMR safety both the British and US governments (and, of course, around the world), and if its data is flawed then a public review of the safety of the policy is urgent. It is much to be hoped that a news report of these studies will follow in the next edition of BMJ.
[1] 'An investigation of the association of MMR vaccination and autism in Denmark', JAPandS, Vol 9 No 3 p.70-75 2004.
[2] Carol Stott, Mark Blaxill and Andrew Wakefield, Commentary: 'MMR and autism in perspective: the Denmark Story', JAPandS, Vol 9 No3, p 89- 91.
[3] http://www.iom.edu/file.asp?id=6952 Presentation Samy Suiisa, Immunisation Safety Review Hepatitis B, Vaccismus vaacines and the risk of relapse in multiple sclerosis.
Competing interests: Parent of an autistic child

Re: Criticisms of Madsen et al in the Journal of American Physicians and Surgeons 8 September 2004

John Stone,
none
London N22
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Re: Re: Criticisms of Madsen et al in the Journal of American Physicians and Surgeons

Some of these issues are addressed by Gary Goldman in his Rapid Response to Bedford and Elliman's review of 'Hear the Silence' 13 December 2003: http://bmj.bmjjournals.com/cgi/eletters/327/7428/1141-a#43391
Competing interests: As above

Re: Criticisms of Madsen et al in the Journal of American Physicians and Surgeons 8 September 2004

Dr John MM Rumbold,
n/a
West Midlands
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Re: Re: Criticisms of Madsen et al in the Journal of American Physicians and Surgeons

Having perused the Goldman & Yazbak paper (Yazbak at least being a strident opponent of vaccination) the paper proves nothing - the investigators did not even go into vaccination status. There is no explanation for the dip in autism cases recorded in the middle of the study period. Why did autism cases not suddenly jump up if MMR is such a strong factor in autism?
Competing interests: None declared

Criticism Pulled From the Air Are Not Helpful! 9 September 2004

Paul Shapiro,
Retired
Great Neck, NY, USA, 11021
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Re: Criticism Pulled From the Air Are Not Helpful!

Response To Dr John Rumbold Re:His Criticism of the Goldman & Yazbak Paper: An Investigation of the Association Between MMR Vaccination and Autism in Denmark; Journal of American Physicians and Surgeons, Fall 2004 Vol 9 No 3 Pages 70 through 91
I am curious as to whether, Mr Rumbold, after perusing the reference paper found flaws in the mathematical analysis. Broad statements of outright dismissal of the work, such as, "the paper proves nothing" is not constructive and fails to contribute to the discussion or understanding of the problem at hand. Are the assumptions used for the Danish Study reasonable? And is the analysis correct? If either are not and are in error, the conclusions are meaningless. The Goldman/Yazbak study demonstrates where the Danish Study failed the conditions above.
Mr Rumbold, please demonstrate the flaws in the Goldman/Yazbak study.
Competing interests: Vaccine Damaged Grandson

An Apology Is In Order! 9 September 2004

Paul Shapiro,
Retired
Great Neck, NY, USA, 11021
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Re: An Apology Is In Order!

Response To Dr John MMR Rumbold Re:His Criticism of the Goldman & Yazbak Paper: An Investigation of the Association Between MMR Vaccination and Autism in Denmark; Journal of American Physicians and Surgeons, Fall 2004 Vol 9 No 3 Pages 70 through 91
I have reperused and reread Mr MMR Runbold's statement, "(Yazbak at least being a strident opponent of vaccination)" and find it in bad taste and not true. I have read many of Dr Yazbak's paper's addressing vaccines and vaccination and found that he is Pro vaccination, with the caveat, that the vaccine(s) be tested to a standard of "DO NO HARM". Nowhere in the reference paper or in the many other papers Dr Yazbak authored, could one find a statement that he is an opponent of vaccination.
Mr MMR Runbold, you owe Dr Yazbak and apology.
Competing interests: Grandpa to Vaccine Damaged Mathew

THE INTERESTING QUESTION - AND OUR CHILDREN ARE NOT SAFE 10 September 2004

John Stone,
none
London N22
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Re: THE INTERESTING QUESTION - AND OUR CHILDREN ARE NOT SAFE

While the BMJ should rightly take pride in the open forum it provides Rapid Responses it really is an extraodinary reflection of our medical establishment that the editor could not allow a full report of these papers, now at least (and at last) reported on the BBC after an interview with Jackie Fletcher of JABS this morning. If our medical establishment cannot talk about these matters openly it really ought to start doing some dramatic soul-searching behind closed doors. The message is that fundamental ethical issues, and basic Scientific principles, are being side-stepped. Epidemiology is produced which is not transparent, and data is not made available for independent scrutiny. In this case, in which researchers were able to obtain the data, the original study apparently unravelled and that statistics now make the opposite case: that MMR and autism are strongly linked.
If Professor Madsen et al dispute this, let them dispute it, and let theM re-validate their case in the face of criticism. But if they, and our health officials and our leading medical journals duck these questions, then the conclusion we can all draw as bystanders is obvious.
Competing interests: Parent of an autistic child

Re: THE INTERESTING QUESTION - AND OUR CHILDREN ARE NOT SAFE 27 September 2004

John P Heptonstall,
Director of The Morley Acupuncture Clinic and Complementary Therapy Centre
LS27 8EG
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Re: Re: THE INTERESTING QUESTION - AND OUR CHILDREN ARE NOT SAFE

Sir
I would add to John Stone's quest for answers from Prof Madsen about (1):-
Can the good Professor explain how a study performed by Anders Hvlid et al (2), who is a co-author of Madsen's paper (1), apparently managed to obtain an estimate for the rate of childhood autism + ASDs in Denmark that was about half that found by Prof Madsen et al in (1) yet both studies utilised their own rates to arrive at results they each published?
Both research teams are said to have taken great care to ascertain the most accurate possible results for Danish children (1) for Denmark, born between 1/1/91 and 31/12/98 and (2) for Denmark, born between 1/1/90 and 31/12/96 - not that far apart yet the rates appear to differ by almost 100% (from about 1 in 381 for Hvlid et al 2003 to 1 in 728 for Madsen et al 2002) amongst the whole population of Danish children? I note that (2) has been claimed to be "a huge study, comprehensive, covering almost 99% of children born in Denmark..." (3).
Can both studies be accurate and, if not, what of their use of such figures to conclude on 'MMR and autism', and 'thimerosal and autism'?
Regards
John H.
References
1. "A population-based study of MMR and autism", Madsen KM, Hvlid A et al NEJM 2002;347:1477-1482
2. "Association between thimerosal-containing vaccine and autism", Hvlid A. et al JAMA 2003; 290:1793-1766
3. "Thiomersal not linked to autism", http://jr2.ox.ac.uk/bandolier/band118/b118-5.html
Competing interests: None declared

Re: Autism. Time to Look for Real Solutions. 27 September 2004

John P Heptonstall,
Director of The Morley Acupuncture Clinic and Complementary Therapy Centre
LS27 8EG
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Re: Re: Autism. Time to Look for Real Solutions.

Sir
I agree with Tony Floyd that we should "look for real solutions" but note that he chose to ignore my reference Outlaw MC, Prigle CR 1995(1) (when focussing on measles virus types) which speaks of an MMR vaccine virus-related illness identified in Coventry UK in 1993 suggesting that strains of vaccine viruses may also be prominent causing illnesses in vaccinated societies in addition to the wild variants found as described in my other references he uses.
Why ignore this aspect when one is "looking for real solutions"?
Regards
John H.
1. "Sequence variation within an outbreak of measles virus in the Coventry area during Spring/Summer 1993", Outlaw MC, Pringle CR, Virus Res. 1995 Nov;39(1):3-11
Competing interests: None declared

Re: Re: Autism. Time to Look for Real Solutions. 27 September 2004

Peter Flegg,
Consultant Physician
Blackpool, UK
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Re: Re: Re: Autism. Time to Look for Real Solutions.

John Heptonstall may like to presume that the article in question (1) suggests "strains of vaccine viruses may also be prominent causing illnesses in vaccinated societies", but this is not my interpretation of the data.
The sequence analysis actually showed that most measles viral isolates were what we would term "escape mutants" of measles virus, with deleted 35 carboxyl-terminal H amino acids:- i.e. measles that would not have been prevented by immunisation with the vaccine then in use. (I believe there has since been "retargetting" to overcome this).
In fact there was only one single case where the clinical measles was linked to the vaccine strain of virus.
Subsequent analysis of measles virus genotypes in the UK has yielded no further instances of this variant, suggesting it has not continued to circulate. All cases of clinical measles in the UK are due to wild-type strains, usually imported (2).
(1) Outlaw MC, Pringle CR. Sequence variation within an outbreak of measles virus in the Coventry area during spring/summer 1993. Virus Res. 1995 Nov;39(1):3-11.
(2) L. Jin, D. W. G. Brown, M. E. B. Ramsay, P. A. Rota and W. J. Bellini. The diversity of measles virus in the United Kingdom,1992�1995. Journal of General Virology (1997), 78, 1287�1294.
Competing interests: None declared

Re: Re: Re: Autism. Time to Look for Real Solutions. 28 September 2004

John P Heptonstall,
Director of The Morley Acupuncture Clinic and Complementary Therapy Centre
LS27 8EG
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Re: Re: Re: Re: Autism. Time to Look for Real Solutions.

Sir
Peter Fleggs's interpretation of the said data and the lack of concern he shows for "one single case" as he puts it, differs from mine. Also I used it to show that a vaccine virus caused an illness in Coventry, UK, in support of my argument that vaccine viruses cause illness, they are agents of disease, and have been found in the UK.
Flegg obvioulsy cannot dispute that so he tries to limit the effect that knowledge ought to have on vaccination debate by supporting his argument with reference (1) which I looked up and, lo and behold, after a 10 second search on related articles found (2) which further supports my own argument but which Flegg must have overlooked. It is even present in the same journal Flegg cites.
In addition to the potential for creating new vaccine-virus strains circulating globally, with who knows what potential as disease-causing agents, one must also consider that mass vaccination may be causing unknown shifts to even more harmful strains of virus due to the vaccines' inhibiting effects on known wild viruses paving the way for 'new variants/strains' of wild virus attacking humanity - many of which may have have remained aloof of the latter if not given advantage through vaccination (3).
Perhaps Peter could use his experience as a research scientist with around 30 papers to his name to look more critically at the disease- inducing potential of vaccines rather than remain starry-eyed about their claimed value?
Regards
John H.
1. L. Jin et al The diversity of measles virus in the UK, 1992-95, J Gen Virol 1997;78:1287-94
2. Kreis S et al, Sequence analysis of the nucleocapsid gene of measles virus isolates from South Africa identifies a new genotype, J Gen Virol 1997 Jul;78:1581-7
3. Lee CW et al, Effect of vaccine use in the evolution of Mexican lineage H5N influenza virus, J Gen Virol Aug;78(15):8372-81
Competing interests: None declared

Re: Re: Re: Re: Autism. Time to Look for Real Solutions. 28 September 2004

Peter Flegg,
Consultant physician
Blackpool, UK, FY3 8NR
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Re: Re: Re: Re: Re: Autism. Time to Look for Real Solutions.

There are many different measles virus genotypes, and our characterisation of them is probably incomplete. Nevertheless, numerous molecular epidemiology studies have confirmed that only wild-type, usually imported, strains have been responsible for measles outbreaks in Western countries (1-3).
It is one thing to dig out a reference describing isolated cases of illness linked to vaccine strain measles virus, but quite another to imply, as Heptonstall has done, that they are a prominent cause of illness. Vaccine strains are not a cause of epidemics and it is incorrect to suggest these strains are �prominent�.
Much of the anti-vaccination �evidence� conforms to this ritualised pattern. If there is anything that points to possible harm or inefficacy relating to a vaccine, then exaggerate its importance. If it heightens levels of hysteria and increases resistance to vaccination, so much the better. Ignore the fact that the problem may be one of little clinical relevance (and keep your fingers crossed that no-one actually reads the original papers you cite in case they may discover this for themselves).
(1) Rota JS, Rota PA, Redd SB, Redd SC, Pattamadilok S, Bellini WJ. Genetic analysis of measles viruses isolated in the United States, 1995- 1996. J Infect Dis. 1998;177(1):204-8.
(2) L. Jin, D. W. G. Brown, M. E. B. Ramsay, P. A. Rota and W. J. Bellini. The diversity of measles virus in the United Kingdom,1992�1995. Journal of General Virology 1997; 78:1287�1294.
(2) Chibo D, Birch CJ, Rota PA, Catton MG. Molecular characterization of measles viruses isolated in Victoria, Australia, between 1973 and 1998. J Gen Virol. 2000 :81:2511-8.
Competing interests: None declared

Refutation of Madsen in the Journal of American Physicians and Surgeons 30 September 2004

Dr M L Grove,
Consultant Rheumatologist
NTGH NE29 8NH
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Re: Refutation of Madsen in the Journal of American Physicians and Surgeons

I'm sorry, but has anyone had a quick glance over the other articles in this journal? "Peer Reviewed" they may be, NEJM quality they certainly aren't.
There is a thin veneer, but it's clear that this is an anti-central government mouthpiece that specialises in championing borderline areas of medical controversy and opposes vaccination on principle. Have a look at the piece on shaken baby syndrome, or the article alleging DDT is actually safe and shouldn't have been banned, or the article on interaction between free iron in the brain and vaccines to cause haemorrhagic encephalopathy ...
Much better quality than most misinformation, but clearly not mainstream science, and definitely suspect. Treat references from this journal with great caution.
Competing interests: None declared

Re: Refutation of Madsen in the Journal of American Physicians and Surgeons 30 September 2004

John Stone,
none
London N22
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Re: Re: Refutation of Madsen in the Journal of American Physicians and Surgeons

This is an ad hominem attack. Dr Grove offers no evidence, but he does not like what he hears. If Madsen et al did do their sums right they can defend themselves, and moreover ought to urgently. Simply being haughty, or falling back on institutional power, does not impress and it is not winning the argument.
Competing interests: Parent of an autistic child

Re: Refutation of Madsen in the Journal of American Physicians and Surgeons 30 September 2004

Andrew L. Schlafly,
Attorney
Far Hills, New Jersey
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Re: Re: Refutation of Madsen in the Journal of American Physicians and Surgeons

"M.L. Grove" takes a swipe at the Journal of American Physicians and Surgeons because it published a few articles questioning vaccine policy and shaken baby syndrome. After harshly attacking the Journal, "M.L. Grove" concludes with "Competing interests: None declared."
Apparently this is the "Matthew L. Grove" who wrote on June 9, 2003 that BMJ should be "presenting both sides of the argument." He is selective about when he wants debate. Then "Matthew L. Grove" concluded with "Competing interests: I have been sponsored to attend meetings by Wyeth ...," which he conveniently left out this time. http://bmj.bmjjournals.com/cgi/eletters/326/7400/1161-a
It was Wyeth that sold the rotavirus vaccine. At the time the Association of American Physicians and Surgeons was criticized for declaring the rotavirus vaccine unsafe based on a simple review of the limited approval data. After infants subsequently died and many more were badly injured by intussusception, the CDC ultimately reversed its recommendation of the vaccine and Wyeth pulled it from the market.
Open debate saves lives. Dr. Grove should recognize that and disclose his conflicting interests.
Andy Schlafly
Competing interests: General Counsel for the Association of American Physicians and Surgeons

Re: Refutation of Madsen in the Journal of American Physicians and Surgeons 1 October 2004

Adam Jacobs,
Director
Dianthus Medical Limited, London SW19 3TZ
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Re: Re: Refutation of Madsen in the Journal of American Physicians and Surgeons

I am grateful to Dr Grove for pointing out the 'quality' of the articles in the Journal of American Physicians and Surgeons. I must confess that I had previously only looked at the article by Goldman and Yazbak. This in itself, given the gross mismatch between the title of the article and its content, makes you wonder about the quality of peer review at JAPS, but nonetheless, I followed Dr Grove's suggestion to look more closely at the journal.
I read the article on the interaction between free iron in the brain and vaccines to cause haemorrhagic encephalopathy [1]. The article actually offers no evidence whatever that interactions between free iron in the brain and vaccines cause haemorrhatic encephalopathy. But it does tell us that 'some human studies now indicate that adverse vaccine reactions may be taking place on a larger scale than currently recognized', and offers 3 references to back this up. The first is a 20- year old letter, and the second is a 49-year old journal article. Without going to a library with good archival facilities, I can't check what they say, but somehow I doubt they give the last word on the subject.
The third reference was easier to check, although it took me longer than it should have done to track it down because the title of the article had been changed from its original 'Cytokine profile after rubella vaccine inoculation: evidence of the immunosuppressive effect of vaccination' to the more punchy, but less accurate 'Vaccines suppress the immune system' in the citation list of the JAPS paper. The paper doesn't actually investigate adverse vaccine reactions, but simply measures short term changes in T-lymphocyte populations following rubella vaccination.
If the JAPS article was really 'peer-reviewed', you do have to wonder whether the peer-reviewers actually read it. It seems to me that Dr Groves is quite right to point out that anything from JAPS needs to be read with caution.
References:
1. Buttram HE. Does Free Iron in the Brain Interact with Vaccines to Trigger Lipid Peroxidation and Hemorrhagic Encephalopathy? Journal of American Physicians and Surgeons 2004:9(3):81- 82
Competing interests: My company provides consultancy services to pharmaceutical companies.

Re: Refutation of Madsen in the Journal of American Physicians and Surgeons 1 October 2004

Mark Struthers,
GP
Bedfordshire, UK
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Re: Re: Refutation of Madsen in the Journal of American Physicians and Surgeons

If it looks like a duck, flies like a duck, then it probably is the NEJM. If it doesn't quack like the NEJM, then it probably isn't.
I'm sorry if that opening statement was as meaningless as that thin veneer of spite vented by M.L. Grove at the anti-central government, vaccine skeptical, Journal of American Physicians and Surgeons.
Come on Dr Grove, throw caution to the wind, join the debate and argue out those interests and conflicts surrounding shaken baby syndrome and other �borderline areas of medical controversy�.
Competing interests: I remain suspicious of the motives of the vaccine lobby and a resolute 'mainstream' sceptic following the SBS/SIDS trial scandals.

Re: Refutation of Madsen in the Journal of American Physicians and Surgeons 1 October 2004

Jane M. Orient,
physician
1601 N Tucson Blvd Suite 9,
Tucson, AZ 85716
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Re: Re: Refutation of Madsen in the Journal of American Physicians and Surgeons

Like the BMJ, the Journal of American Physicians and Surgeons has a policy of open access, at www.jpands.org.
Letters to the editor are welcomed.
We notice that Dr. Grove disagrees with a number of our articles but cites no specific errors of fact or logic.
His assertion that we are opposed to vaccination on principle is absolutely false. We invite readers to visit the website and come to their own conclusions.
Jane M. Orient, M.D.
Competing interests: Managing Editor, Journal of American Physicians and Surgeons

So what else happened in Denmark? 1 October 2004

F. Edward Yazbak,
Pediatrician, Director
TL Autism Research, Falmouth, Massachusetts 02540, USA
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Re: So what else happened in Denmark?

Autism has increased in Denmark (1, 2) since the introduction of the MMR vaccine in 1987.
So what else happened in Denmark?
� Among 2520 randomly selected children in Denmark, nearly all (98%) nine year-old children had IgG antibodies to measles virus BEFORE the MMR campaign started (3)
� In response to a 1991 questionnaire, 29% of the general practitioners in Denmark were less positive about vaccination for measles, mumps and rubella (MMR) than about the remainder of the recommended childhood vaccinations (4)
� Also in 1991, only 56% of 171 practitioners interviewed expressed a whole-hearted positive attitude towards MMR Vaccination. The average vaccination rate in practices with unreservedly positive attitudes was 85%, compared with 69% in practices with more guarded attitudes (5)
� In 1992, a predictive study extending to 2002 revealed that compliance with vaccination among 12-year-olds had to quickly improve in order to maintain the level of immunity that was present prior to institution of the MMR vaccination program (6)
It is clear from the above, that the MMR vaccination rates in Denmark in the early nineties were not very high. As shown by Goldman (1), when the majority of children in Denmark had received the MMR vaccine and when those children were old enough to be diagnosed with autism (around age 5), the increase in the prevalence of autism was evident.
Children included in the Madsen (7) MMR study were born between January 1, 1991 and December 31, 1998. Many of those born in the first four years had not received the MMR vaccine and many of the affected children born in the last four years were too young to have been diagnosed. By studying the period between 1980 and 2002, Goldman was able to report more accurate figures.
Noteworthy is the fact that Madsen himself published another study (8) about autism in Denmark, just ten months after his NEJM report, in which he stated: �From 1991 until 2000, the incidence increased and continued to rise after the removal of thimerosal from vaccines, including increases among children born after discontinuation of thimerosal.�
Those same figures should have been available to Madsen in 2002 when he published his research, that was co-sponsored by the CDC, in the New England Journal of Medicine.
Dr. Madsen seems confident that the increase in autism in Denmark after the removal of Thimerosal from pediatric vaccines is real.
References:
1. Goldman GS, Yazbak FE: An Investigation of the Association between MMR Vaccination and Autism in Denmark. JAmPhysSurg 2004; 9(3):70-75 http://www.jpands.org/vol9no3/goldman.pdf
2. Stott C, Blaxill M, Wakefield AJ: MMR and Autism in Perspective: The Denmark Story. JAmPhysSurg 2004; 9(3):89-91 http://www.jpands.org/vol9no3/stott.pdf
3. Glikmann G, Petersen I, Mordhorst CH. Prevalence of IgG-antibodies to mumps and measles virus in non-vaccinated children: Dan Med Bull 1988 Apr;35(2):185-7 [PMID: 3359817]
4. Johansen M, Haurum J. Attitudes to and knowledge of contraindications against measles, mumps and rubella vaccination (MFR- vaccination) among general practitioners [Danish] Ugeskr Laeger 1991 Mar 4;153(10):709-12 [PMID: 2008714]
5. Trier H. Doctors� attitudes and MMR-vaccination. Scand J Prim Health Care 1991 Mar;9(1):29-33 [PMID: 2041925]
6. Ronne T, Trier H. Changes in measles, mumps and rubella (MMR) immunity until the year of 2002 after the introduction of MMR vaccination [Danish] Ugeskr Laeger 1992 Jul 13;154(29):2014-8 [PMID: 1509567]
7. Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, Thorsen P, Olsen J, Melbye M. A population-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med. 2002 Nov 7;347(19):1477- 82.
8. Madsen KM, Lauritsen MB, Pedersen CB, Thorsen P, Plesner AM, Andersen PH, Mortensen PB. Thimerosal and the occurrence of autism: negative ecological evidence from Danish population-based data. Pediatrics. 2003 Sep;112(3 Pt 1):604-6.
Competing interests: Grandfather of a boy with autism who has evidence of measles virus genomic RNA in the intestinal wall

Re: Journal of American Physicians and Surgeons 1 October 2004

Matthew L Grove,
Consultant Rheumatologist
NTGH, NE29 8NH
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Re: Re: Journal of American Physicians and Surgeons

Whew! I certainly didn't expect to trigger that flood of invective. I'll try to address the points my learned colleagues raise above.
Firstly, John Stone. This is indeed an ad hominem attack. I don't particularly like JAPS politics. Are you against gun control? Do you favour unrestricted private medicine, and feel that medicare or any other form of nationalised medicine is anathema? If so, JAPS is for you. Don't beleive me? Have a look around their website (1), or check them out under their original name of the Medical Sentinel (2).
Medicine is political. I didn't attack Goldman and Sachs on their science - I intend to read their paper thoroughly, as I consider the Madsen paper one of the best I have read on the MMR issue and am genuinely interested in their reanalysis - but was just surprised by the company it kept. JAPS clearly has a political line I don't agree with; that doesn't mean the science in the paper is wrong, but decisions to publish can be political as well as science based on occasion.
To Andrew L. Schafly - I apologise unreservedly. My ommission of the one-off sponsorship from Wyeth two years back was because it was on the subject of osteoporosis, and my only involvement with this particular company has been in relation to HRT. I mentioned it in the other rapid response because I was arguing that the BMJ was grossly understating the case against HRT after the WHI trial ... and that therefore this conflict was relevant there. I was however arguing that they were effectively letting Wyeth off the hook, by failing to adequately present the case against HRT! I have had no involvement with rotavirus vaccine.
To Mark Struthers - come on, you're an NHS GP! I can't beleive you're a vehement fan of less gun control, abolishing the NHS and unrestricted private medicine! Well JAPS is ... does this not worry you even slightly? I'm not about to get into SBS and the other controversial areas (we can at least agree they are controversial surely?) because I simply don't have the time (and I wish I did - the titles of these papers - there's a nice one on how gulf war syndrome and autism are both linked in an earlier copy of JAPS- are certainly striking). I just note in passing that Goldman's paper keeps interesting company. Do you feel the peer review process itself is not open to question when a journal is the mouthpiece of a political organisation?
To Jane M. Orient - I applaud your policy of open access; if only more journals (notably the NEJM!) were so open with their papers. I agree that I did not cite particular errors of fact or logic. There may not be any such errors, but I thought your output consistent with your politics. You are open in having a political agenda that wants less government involvement in medicine (and this is fair enough: it is a valid political point and deserves debate).
Vaccination is a prime example of the state imposing a medical intervention on an unwilling public - are you sure you don't oppose it on principle? Many free-thinking people have argued against compulsory vaccination on precisely these grounds.
(1)http://www.jpands.org/ (2)http://www.jpands.org/hacienda/issues.html
Competing interests: Have accepted sponsorship from Wyeth to attend meetings and an honorarium from Lilly to speak on the subject of osteoporosis.

HAVE VICARS-GENERAL OF VACCINATION GOT THE NEEDLE? 2 October 2004

Clifford G. Miller,
Lawyer, graduate physicist and former university examining lecturer in law
Beckenham, Kent, England, BR3 3LA
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Re: HAVE VICARS-GENERAL OF VACCINATION GOT THE NEEDLE?

Dear Sirs,

Re: Refutation of Madsen in the Journal of American Physicians and Surgeons

"Devotees of 'Yes, Minister' know Sir Humphrey's advice. If you cannot attack the opponent's case, attack him personally ..." which I wrote earlier this year regarding the attacks on Dr Andrew Wakefield (1). For this opportunity to say the same, I thank Adam Jacobs, Director of Dianthus Medical and Dr M L Grove and their recent contributions (2).

Neither of these feisty defenders of the Madsen paper (3) have so far raised any material issues either contradicting the Goldman/Yazbak paper in the Journal of American Physicians and Surgeons (4), nor the Wakefield, Blaxill, Stott paper published in the same journal on the same point (5). This is only natural, is nothing to be concerned about and is treatable. It arises from the difficulty in defending a now irreparably damaged offering.

Madsen is itself one in a long line of such damaged offerings from the devout followers of the Taliban of Toxicology to their Gods of Immunisation. As Dr Yazbak has highlighted (6), each fallen idol has toppled one by one. Yet our government's officials and others fervently seek out a new replacement offering, with pious press releases hailing it as the new God of Vaccinology. But even the latest (7) is already being shown to be based on questionable data (8) and it will inevitably fall to the omnipotent God of Pharmacology. The power of the standard pharmacology, challenge-dechallenge-rechallenge (CDR) and challenge-dechallenge (CD), applied to the case histories of the MMR children is proof of causation (not mere evidence, but proof), as I have noted here on a number of occasions (9).

So bad has the position become for credibility of papers relied on by the government that instead of citing other science in support, the NHS now cites in aid how many newspapers (including the tabloid Sun) report on the announcement of the latest paper, even though the establishment's own press machines or those of it supporters were responsible for making sure the media got the story in the first place:

"There is no evidence for a link between the MMR vaccine and autism, reported five newspapers on 10 September 2004. The newspapers accurately reported the findings of a large case-control study and systematic review, both of which seem to be reliable. On 10 September 2004, the Daily Telegraph, The Times , The Sun , The Independent and the Financial Times all reported the news that new research had found no evidence for a link between MMR vaccination and autism in children" (10)

In contrast, the lack of specifics, corroboration and references in Mr Jacobs' recent contributions in other parts of this journal provoked the remark

"... that a considerable proportion of his responses to various responders have minimal fact and maximal requests for figures ...." (11).

Having been defeated in argument, it seems Mr Jacobs moves on, leaving unfinished business, as has also been noted elsewhere:

"I even remember challenging Adam Jacobs back in June to explain and defend it, and met with silence." (12).

Furthermore, Mr Jacobs' attack on the Buttram paper (13) is not straight, which is apparent when one considers the clear purpose of the paper. Mr Jacobs says:

The article actually offers no evidence whatever that interactions between free iron in the brain and vaccines cause haemorrhatic encephalopathy.

The very point of the paper is that Dr Buttram is asking a question, which he makes abundantly clear by ensuring it is the title of the paper. To show the question has validity, he cites at length, and concludes by saying:

"The situation demands sober, objective, scientific investigation to find the underlying truth"

In this context, it is worthy of note that Mr Jacobs made a claim of his own (14) without any citations whatsoever in support nor any supporting evidence and concluded:

I should stress that I have no evidence to support the idea that autism genes lead to an increased desire to reproduce or that they are more common now in the population than they were a generation ago. But I do maintain that it is a plausible hypothesis, and I am unaware of any evidence against it. It ought to be possible to design studies .....

So this is not even a case of "Sauce for the goose ..." as Dr Buttram made out his case with corroboration that his question was valid.

Similarly, Dr Grove has strongly held and expressed views, and no doubt is sincere, as Mr Jacobs is. And others have answered Dr Grove's recent contribution, which has also shown to be short on substance, long on rhetoric.

However, there is a further point worth noting. Dr Grove admits '..... neonatal Rubella is a recognised cause of autism ....' (15). It must then follow that in order to infect the foetus, the rubella virus must be able to cross the blood/placenta barrier and reach the brain and all other parts. However, Dr Grove fails to make the connection that whilst rubella virus in the wild might find more difficulty in getting directly into an infant's blood, injecting live rubella virus into the blood stream of infants at the same time as weakening the immune system with measles and mumps viruses, might have the same effect in some vaccinated infants and cause autism. Is it so impossible? Where is the research that says so Dr Grove? Could it be fair to maintain, as Mr Jacobs has maintained with his propositions, that:-

" .....it is a plausible hypothesis, and I am unaware of any evidence against it. It ought to be possible to design studies ....."

_____________________________________________________________________________________
1) TIME FOR POLITICIANS TO ACT RESPONSIBLY AND ADDRESS THE ISSUES 26 March 2004

2) Re: Refutation of Madsen in the Journal of American Physicians and Surgeons
Click here for Jacobs:-
Click here for Grove:-

3) A Population-Based Study of Measles, Mumps, and Rubella Vaccination and Autism NewEngland Journal of Medicine (2002;347:1477-82)

4) 'An investigation of the association of MMR vaccination and autism in Denmark', JAPandS, Vol 9 No 3 p.70-75 2004.

5) Commentary: 'MMR and autism in perspective: the Denmark Story', JAPandS, Vol 9 No3, p 89- 91. Carol Stott, Mark Blaxill and Andrew Wakefield.

6) The Bigger They Are� 20 September 2004

7) Smeeth L, Cook C, Fombonne E, Heavey L, Rodrigues LC, Smith PG, Hall AJ. MMR vaccination and pervasive developmental disorders: a case-control study. Lancet 2004;364:963-9.

8) See Rapid Responses to Study shows no link between MMR vaccination and autism Susan Mayor BMJ 2004;329:642 (18 September), doi:10.1136/bmj.329.7467.642

9) a few of a number of examples being:-
LOSING SIGHT OF WHAT WE ARE LOSING SIGHT OF 28 September 2004

Confused - Aren't we all - Including those who can still do their sums 9 September 2004

MMR KIDS - LIVING SCIENTIFIC PROOF MMR CAUSES AUTISM 23 Jul 2004

UNRELIABILITY OF SCIENTIFIC PAPERS AS EVIDENCE F. Edward Yazbak, 17 Mar 2004

10) NHS National electronic Library for Health 'MMR study finds no link with autism' 13th September 2004

11) Re: GPRD case control with or without control control? Heptonstall, J. 29 September 2004

12) GPRD case control with or without control control? Stone, J 30 September 2004

13) Buttram HE. "Does Free Iron in the Brain Interact with Vaccines to Trigger Lipid Peroxidation and Hemorrhagic Encephalopathy?" Journal of American Physicians and Surgeons 2004:9(3):81- 82

14) Swimming at the shallow end of the gene pool 29 September 2004

15) MMR reduces risk of autism shock! 10 Jun 2003

Competing interests: Close relative with life threatening food allergy

Re: HAVE VICARS-GENERAL OF VACCINATION GOT THE NEEDLE? 3 October 2004

Adam Jacobs,
Director
Dianthus Medical Limited, London SW19 3TZ
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Re: Re: HAVE VICARS-GENERAL OF VACCINATION GOT THE NEEDLE?

Clifford Miller states that I have not 'so far raised any material issues contradicting the Goldman/Yazbak paper in the Journal of American Physicians and Surgeons'. I assume he didn't read my post of 22 September on another of the BMJ's many vaccine debate pages where I did just that [1].
References:
1. http://bmj.bmjjournals.com/cgi/eletters/329/7467/642#75225
Competing interests: As stated previously

Re: Re: Journal of American Physicians and Surgeons 3 October 2004

Jane M. Orient,
physician
1601 N. Tucson Blvd. Suite 9,
Tucson, AZ 85716
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Re: Re: Re: Journal of American Physicians and Surgeons

The Association of American Physicians and Surgeons does take a stand against forced vaccination, on the principle that patients have the right to refuse medical treatment if they choose. That is not the same as being "opposed to vaccination on principle." Physicians should base their recommendations for vaccines on the basis of the risks and benefits to their individual patients under the prevailing circumstances, and patients (or the parents of minor patients) should be free to accept or reject their physicians' advice.
Some vaccines (such as rabies for a patient bitten by a rabid dog) are much more important than others (such as chickenpox). Some have a long -established safety record, and some (such as rotavirus) are new or have risks outweighing the benefit for most children.
At J P&S, we do not base our assessment of a scientific paper in the BMJ or the NEJM on the journal's record of publishing papers that advocate gun control, socialized medicine, or other political positions. In general, we oppose the concept of guilt by association.
The self-correcting mechanism of science cannot operate if dissent and controversy are suppressed.
All medical interventions have side effects. These will not be exposed and minimized in the absence of free discussion -- and of the right to choose. Indeed, universal (or nearly universal) immunization creates a major methodologic problem in evaluating alleged complications: the lack of an adequate unimmunized control group.
Jane M. Orient, M.D.
Competing interests: Managing editor, Journal of American Physicians and Surgeons

Endorsement for mmrthefacts advice 3 October 2004

John Stone,
none
London N22
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Re: Endorsement for mmrthefacts advice

Would Dr Grove or any other medical person/contributer to this site (including Adam Jacobs, Eamonn Clarke, Liam Farrell, Samantha Line, Stephen Black) care to endorse this advice from mmrthefacts website?:
"Q My son had a severe reaction to the first MMR jab. Does this mean that he is well protected from these diseases, or ia second dose still necessary?
"A If a child has responded well to the components of the vaccine the first time, he will not have a problem being exposed to viruses a second time.
"If he hasn't made protection to all three diseases after the first time, he will still be susceptible to those natural infections, and still needs the 2nd dose.
"Reactions after the 2nd dose are essentially the same as the first dose but if they do occur are even rarer. The advice is therefore that it is safe for your child to the 2nd dose in order that he is properly protected."
Given this blanket advice - which is no doubt widely followed - to disregard a "severe reaction", how are we to take the claim of safety seriously. This is surely double talk...And did any real person ever ask that sample question?
Competing interests: As above

Re: Re: Re: Re: Re: Autism. Time to Look for Real Solutions. 3 October 2004

John P Heptonstall,
Director of The Morley Acupuncture Clinic and Complementary Therapy Centre
LS27 8EG
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Re: Re: Re: Re: Re: Re: Autism. Time to Look for Real Solutions.

Sir
Peter Flegg seems to have lost his way yet again - having been unable to contradict the facts I gave he alters the focus of my statement. I did not say that epidemics of measles, or major outbreaks in Western countries, are caused by vaccine viruses but that there is evidence that vaccine viruses do cause disease (Outlaw et al, Jin et al -references already given). This fact supports two considerations I originally made, from which Flegg has diverted attention
1. That vaccines are disease-causing agents and must therefore be acknowledged as such legally; if unlawful to intentionally infect another with a known disease-causing agent, any vaccinator who causes a disease through vaccinating must face legal consequences if a prosecution is sought - eg. if intentional, if neglectful, if through inadequate information such that recipient is incapable of making an informed decision, or through any other act that is deemed to have contributed to a recipient's suffering. At the moment there is rarely any attempt to isolate an offending 'virus', and even less public understanding that a 'viral illness' could be a 'vaccine virus illness' and not an 'act of God'.
2. That vaccine viruses do rebound on humanity, they are not 'disease free' agents. Even if such agents might cause little disease compared with wild agents, their negative as well as positive action must be recognised so victims of vaccine-induced diseases can obtian legal redress - not some half-baked 'vaccine damage payments scheme' that excludes proper in-depth investigation and prosecution in a properly attended court of law with all that entails.
Flegg treats the Cambridge case I cited of a vaccine-virus disease as of little concern. He says I imply that vaccine strain measles viruses are a prominent cause of illness and that is incorrect. Although I used Cambridge as an example of vaccine viruses ability to cause disease, I would also again refer him to (1) as well as Outlaw et al, and Jin et al already cited. Kresi et al found 3 vaccine viruses amongst 20 isolated in outbreaks in South Africa, Jin et al found 2 vaccine viruses in 50 isolates during outbreaks in the UK. I make the prominence of those vaccine viruses about 4% in the UK study and 15% in the S. African study. Not exactly undistinguished!
Apart from Flegg's first 2 of 3 "Western country" references only apply to 92-95 and two countries with overlap, I note his reference 3. (Chibo et al), supposedly more eviednce that there is no prominent measles vaccine virus activity in 'western Countries' is actually for Australia - ironic when his final point was "(keep your fingers crossed that no-one actually reads the original papers you cite...)".
Regards
John H.
1. "Sequence analysis of the nucleocapsid gene of measles virus isolates from South Africa identifies new genotype" Kreis et al, J Gen Virol 1997 Jul ;78(pt7):1581-7
Competing interests: None declared

Superficial and Misleading Critique 4 October 2004

Harold E Buttram, MD,
private practice, family medicine
5724 Clymer Road, Quakertown, PA 18951, USA
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Re: Superficial and Misleading Critique

In reference to the comments by Mr. Adam Jacobs of October 1, 2004 concerning my article in the Journal American Physicians & Surgeons (JPS),(1)he was correct in pointing out that I offered no definitive proof for my contentions, but he missed the entire point of the article in that there have never been any safety studies done for any vaccine in use today that would meet the criteria of scientific proof. All we have are epidemiologic studies, which are indicators but not proof in and of themselves, or some preliminary before-and-after studies most of which have never been repeated.
In order to meet the criteria of scientific proof, a vaccine safety study would need to perform before-and-after human studies designed to screen for possible adverse effects on the neurological, immunologic, and hematological systems, comparing vaccinated with unvaccinated subjects, both in sufficient numbers and followed for sufficient periods of time to be meaningful. There have never been any studies of this nature, and apparently none have been attempted. Based on personal observation, it appears that before-and-after testing has been studiously avoided by government health agencies for fear that the results would discourage public confidence in vaccine programs.
Until this level of safety testing is done, it is a virtual certainty that many adverse vaccine reactions are taking place unrecognized and will continue to take place. By the same token,until meaningful, objective vaccine safety testings are done, in my opinion the NIH, CDC, FDA can justifiably be accused of negligence in protecting the health and welfare of the American public, especially the children.
Regarding comments of Adam Jacobs concerning the editorial policy of JPS, this journal is unique in working to reverse the present trend towards depersonalization in the care of patients in today's medicine and a return to the traditions of medicine as an art as well as a science. I must wonder if Adam Jacobs is opposed to this, considering the nature of his remarks.
(1) Buttram H, Does free iron in the brain interact with vaccines to trigger lipid peroxidation and hamorrhagic encephalopathy?, Journa American Physicians and Surgeons, Fall 2004; 9(3):81-82.
Competing interests: I have testified in defense of SBS cases and have sometimes been paid for my services

Re: Re: Re: Re: Re: Re: Autism. Time to Look for Real Solutions. 4 October 2004

Peter Flegg,
Physician
Blackpool, UK
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Re: Re: Re: Re: Re: Re: Re: Autism. Time to Look for Real Solutions.

Having spent the last few months trying to persuade everyone that measles is a trivial infection unworthy of prevention, John Heptonstall now seems to be getting extremely concerned about the "suffering" that might occur in the extremely rare instances of vaccine-induced measles, to the point of encouraging prosecution of those giving vaccinations. And he accuses me of losing my way?
I must also take issue with Heptonstall�s interpretation of our recent correspondence.
On the 27th September he stated: "I agree with Tony Floyd that we should "look for real solutions" but note that he chose to ignore my reference Outlaw MC, Prigle CR 1995(1) (when focussing on measles virus types) which speaks of an MMR vaccine virus-related illness identified in Coventry UK in 1993 suggesting that strains of vaccine viruses may also be prominent causing illnesses in vaccinated societies"
Implication: Vaccine strain measles virus may be prominent causing illnesses. (ignore for the moment that this is only Heptonstall�s interpretation, and not the authors� as he would have us believe).
Now Heptonstall asserts (3rd October): "[Flegg] says I imply that vaccine strain measles viruses are a prominent cause of illness and that is incorrect".
We seem to be going round in ever-diminishing circles here, and we all know the eventual outcome of that. Is he implying it is a prominent cause of illness, or isn't he? You choose. Perhaps he is having second thoughts, or has finally read the reference he cited and realised it contradicts his earlier statment?. We can but speculate. Or perhaps Heptonstall is right - I have "lost my way", along with all my critical faculties of comprehension, and I should give up trying to understand what he actually is implying.
For the record, I do agree with him that measles vaccine can cause measles. However it is not "prominent"; and as my previous references have shown, it comprises a negligible component of measles in vaccinated societies.
Finally I must apologise for referring to Australia as a "Western" country. We were discussing vaccine-induced measles in vaccinated societies in the context of a westernised, first world setting, and Australia qualifies admirably for this epithet in my opinion. I am sorry for confusing him with my "western" short hand description. I only wish he would be as critical of his own errors and misinterpretations of other words (e.g "prominent").
Competing interests: None declared

Re: : Autism. Time to Look for Real Solutions. 4 October 2004

Carol Johnston,
Carer
Carshalton, Surrey UK
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Re: Re: : Autism. Time to Look for Real Solutions.

I have a couple of points regarding diseases in vaccinated individuals.
Okay, for the record measles. When an oubreak of measles is identified, is it a matter of course that the particular virus is isolated and identified so it can be established where the virus originated from, ie is it a vaccine strain or imported or a completely new strain?
Secondly, my son had an illness which caused his face to swell like a chip munk. He had mumps. On presentation to A&E (because they never seem to get really sick during surgery hours, evening is a great time for an illness to worsen), sorry I digress. Upon arrival at A&E I voiced concerns that I thought my son had mumps, it has a singular appearance, he also had high temperature. Doctor asked had my son had MMR. I said yes 1 shot but not booster. Doctor said cant be mumps then! Doctor said is probably just a virus and was given oral antibiotics as my son's temperature had broken. In fairness they attempted to take blood samples for further analysis but my son being severely autistic just does not cooperate with things like that.
I was sent home with antibiotics and instructions to bring him back if he got worse. I did not give him antibiotics and he seemed to improve of his own accord. The crisis was over.
The point is my son's illness was dismissed as mumps because of him being vaccinated.
Since presumably there are many strains of a virus and vacccines do not protect against all strains, it is possible to catch the illness even though you have had vaccine (it seems mumps is very common now in teens!).
So, joining in the circle of virus etc. Since many illnesses are dismissed as "unknown virus", just how many cases of measles, mumps and rubella are slipping through without proper diagnosis.
Presumably a mild case of measles could in fact be overlooked. What is atypical measles?
I thought atypical measles was measles in a vaccinated individual (my son had this following his MMR). My neighbours grandsons both fully vaccinated had measles a couple of months ago. She was told by doctor, it would have been worse had they not have had MMR!
As far as I know tests for measles were not carried out. the illness was dismissed as mild. Could these boys both have had a vaccinated strain of the measles?
It seems Dr Flegg that these diseases are under reported. How on earth will we know how effective these vaccines are when suspected cases are dismissed summarily because of an indvidual's vaccination history.
Also because I have a vivid imagination, do virus have the ability to mutate and evolve, by giving three live virus together sometimes along with Meng C (which my daughter had), could the virus mutate and become some sort of superbug? Bit like MRSA. Okay, I have read more than enough sci-fi books to worry do we really know what these modified virus do when re-introduced into the human body.
Aside from this it seems by vaccinating we are changing the patterns of these traditional childhood diseases and shifting the illnesses to older age groups where the consequences are more serious.
Any views on this?
Regards
Competing interests: 2 ASD kids following MMR

Re: Re: : Autism. Time to Look for Real Solutions. 5 October 2004

Tony Floyd,
Medical Student
Newcastle University,
Jennifer Hawkins
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Re: Re: Re: : Autism. Time to Look for Real Solutions.

A study assessing 35 years of MMR in France (1) came to this conclusion:

"In France over the period of time considered, almost 2 million meningitis, 60 000 encephalitis, 170 subacute sclerosis panencephalitis and more than 5600 neurological sequaela including more than 600 deafness cases have been avoided as a result of the MMR vaccination programme. Moreover, 590 000 pneumonia, more than one million of acute otitis media and 300 000 orchitis, 3000 rubella infection cases occurring during pregnancy have also been avoided. Overall, more than 12 000 deaths that have been avoided as a result of the MMR vaccination."
The French, however, lack the benefit of the Daily Mirror.
Real solutions are what the victims of autism need, not just an obsession with a vaccine.

***
References:
(1) Reinert P, Soubeyrand B, Gauchoux R. [35-year measles, mumps, rubella vaccination assessment in France] Arch Pediatr. 2003 Nov;10(11):948-54. French.

Competing interests: None declared

Re: Superficial and Misleading Critique 5 October 2004

Adam Jacobs,
Director
Dianthus Medical Limited, London SW19 3TZ
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Re: Re: Superficial and Misleading Critique

The studies that Mr Buttram would like to see done sound rather like clinical trials, which of course are done for all licensed vaccines before they can be licensed.
Buttram is quite right, however, to point out that such trials are not done on sufficient numbers and with sufficiently long follow-up to reliably identify rare adverse events. Clinical trials can identify common adverse reactions, but other methods must be used to identify the rare ones.
The best evidence would, of course, come from large clinical trials, enrolling millions of participants, in which participants were randomised to receive or not receive vaccination. Unfortunately, such studies cannot be done: not only would the cost be prohibitive, but it would also be unethical to leave the control group exposed to the risk of infectious diseases. I don't think there is any evidence to support Buttram's assertion that such studies have been avoided 'for fear that the results would discourage public confidence in vaccine programs'.
Vaccines do, of course, have side effects, and no doubt Buttram is correct in stating that some of the rare ones have yet to be identified. The question is whether the low risk of serious adverse reactions to vaccination is an improvement on the risk of serious consequences of the infectious diseases against which they offer protection.
Competing interests: As stated previously

Re: HAVE VICARS-GENERAL OF VACCINATION GOT THE NEEDLE? 5 October 2004

Clifford G. Miller,
Lawyer, graduate physicist, former examining university lecturer in law
Beckenham, Kent, BR3 3LA
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Re: Re: HAVE VICARS-GENERAL OF VACCINATION GOT THE NEEDLE?

Dear Sir,

HAVE VICARS-GENERAL OF VACCINATION GOT THE NEEDLE?

I thank Adam Jacobs, Director of Dianthus Medical for his recent contribution (1).

Mr Jacobs again tacitly acknowledges the assertion I have made several times (2). This is that standard pharmacology proves the MMR children's autism and pervasive development disorders were caused by MMR. Challenge-dechallenge-rechallenge (CDR) and challenge-dechallenge (CD), applied to the case histories of the MMR children are proof (and not mere evidence, but proof) that MMR is the cause.

If I may assist with the new point he makes, of his 22 contributions over the past month since the publication of the Goldman/Yazbak paper in the Journal of American Physicians and Surgeons (3), he tells us that one (4) raises a material issue contradicting it. Forgive my lack of familiarity with what medical science considers to be material. The issue Mr Jacobs raised was so material it was dispatched in three sentences by another contributor (5). It was also so material that it is easily missed by blinking whilst scrolling down the screen. That may have something to do with it citing not a single passage or reference from the Goldman/Yazbak paper or anywhere else in support of Mr Jacobs' assertions.

Further, the Goldman/Yazbak paper fatally damaged the key Madsen paper. Yet Mr Jacobs's material issue was that, in Mr Jacobs' opinion, the Goldman/Yazbak paper just said autism increased in Denmark (4). Mr Jacobs made a further claim not even the authors of the Goldman/Yazbak paper made. Mr Jacobs incorrectly claimed Goldman/Yazbak assert:

"MMR must be the cause of this increase in autism".

That is not correct. Goldman/Yazbak shows, which Mr Jacobs admits, autism increased in Denmark. That is a significant admission. All the time Madsen's paper was interpreted as saying that it did not. Madsen was used as the entire basis for denying there was any evidence that MMR causes autism, all prior papers to that effect relied on by government officials having been shown to be defective in that regard. Now Madsen suffers the same fate, devastated by Goldman/Yazbak, it is not the "all-singing-all-dancing" answer government officials have been claiming it to be.

The end result is that the mountain of medical 'scientific' papers, oft referred to in press releases and media reports, is not just not a mole-hill, but such that to describe it as a pile of anything, even ashes, might be considered too high. What is more, Dr Yazbak has been kind enough to grace this journal with more of his knowledge and sets out some very interesting facts about Denmark and measles (6) which helps neither Madsen nor the religious fervour with which the government's advisors adhere to their dogma.

It is also significant that Mr Jacobs cites in his defence one of his contributions (4) that lacks references or substantiation. This is relevant to the value of his contributions to this dialogue and is further support for the observations made previously of:-

"Mr Jacobs' ability to generate at least ten times more words in responses than he uses in his contributions is admirable." (7)

"....the lack of specifics, corroboration and references in Mr Jacobs' recent contributions in other parts of this journal...." (2)

"I fear it is the red herring which is swimming here. Being genetically predisposed to avoid the main issues it flourishes in those conditions. Its prevalence here seems to be increasing as the arguments on the main issues become all the sharper and those against weaker." (8)

___________________________________________________________________________________
1) HAVE VICARS-GENERAL OF VACCINATION GOT THE NEEDLE? Adam Jacobs 3 October 2004

2) HAVE VICARS-GENERAL OF VACCINATION GOT THE NEEDLE? Clifford Miller 2 October 2004

3) 'An investigation of the association of MMR vaccination and autism in Denmark', JAPandS, Vol 9 No 3 p.70-75 2004.

4) Re: Danish MMR study 22 September 2004

5) Re: Danish MMR study 22 September 2004 John Stone

6) So what else happened in Denmark? F. Edward Yazbak 1 Oct 2004

7) Re: LOSING SIGHT OF WHAT WE ARE LOSING SIGHT OF 27 Sep 2004

8) FIRST THINGS FIRST - STUDY THE MMR KIDS AS LIVING EVIDENCE 29 Sep 2004

Competing interests: Close relative with life threatening food allergy.

Advancing ? 5 October 2004

Lisa C Blakemore-Brown,
Psychologist
UK based
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Re: Advancing ?

As the system has consistently and cruelly ignored the actual terrible pain and suffering of children who undoubtedly changed after vaccine, why are they so concerned about the predicted terrible pain and suffering of children who may develop, say, measles, if we lose the `herd` immunity?
When I was a child we used to be taken to measles' parties so we would catch it and strengthen our immune systems. The most ill I was as a child was after my first vaccine.
When my daughter was a child the medics advised that she should not be given the whooping cough vaccine as I had asthma - which developed after the first vaccine I had as a child. The GP considered that this would make her more likely to suffer a reaction to the vaccine. My daughter had whooping cough, measles and chicken pox - just as I also had the `childhood illnesses`.
What has changed to convince the system that NO contraindications or reactions should be taken into consideration when vaccinating the population?
From where I stand, this is not advancement.
Competing interests: Expert in Autism

Re: Re: Re: Re: Re: Re: Re: Autism. Time to Look for Real Solutions. 5 October 2004

John P Heptonstall,
Director of The Morley Acupuncture Clinic and Complementary Therapy Centre
LS27 8EG
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Re: Re: Re: Re: Re: Re: Re: Re: Autism. Time to Look for Real Solutions.

Sir
I have explained why I believe that vaccine strain measles viruses are a prominent cause of illness, not least with a prominence of 15% amongst other vaccine viruses found in the South African study I cited (Kreis et al.) I have also explained that that prominence requires to be taken on board by our citizens as we are currently unlikely to be proferred any information on 'prominence' before or after vaccine virus-induced damage, not least it would appear by Peter Flegg.
I don't remember spending any of "the last few months trying to persuade everyone that measles is a trivial infection unworthy of prevention", perhaps Flegg can support that statement? I thought the essence of this debate was the relevance of autism to MMR vaccine - it's people like Flegg who seem hell bent on altering the focus of the debate when losing ground.
Measles, and atypical measles - triviality or not and how best to prevent, and if to prevent - is a very different subject...
Regards
John H.
Competing interests: None declared

Response to Carol Johnston. 5 October 2004

Peter Flegg,
Physician
Blackpool, UK
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Re: Response to Carol Johnston.

I will have a go at answering your questions (4th October).
Regarding measles: Diagnoses of this are clinical � if in doubt or complicated, there may be proof in a simple blood test. Detailed typing of the virus is hardly ever done routinely, but may be as part of a research or epidemiological study. So, yes, there is a chance for misdiagnosis of measles. This was unlikely in the past � doctors who had seen a few cases could be very good at diagnosing it, but this is less true now since many doctors have not seen a case. It is also possible that vaccine strains of measles circulating in the community contribute to some of the clinical measles cases diagnosed, but as I have pointed out elsewhere, this is rare.
Doctors themselves may be fooled by the protective efficacy of vaccination � they often assume (quite wrongly) it will magically eliminate all possible risk of subsequent infection. Therefore it is not surprising to see them categorically declare �This can�t be measles/mumps/whatever because you have been vaccinated� and call the illness something else. What people should realise is that vaccination is NOT fully protective, and some people remain susceptible. For measles, it is only about 90% protective after a single dose, rising to 97% or so after booster. There is even a genetic basis for some of these �failures�- some individuals can actually have a specific genetic defect in measles antibody production.
You are correct about atypical measles � it is measles in a vaccinated individual but there is a bit more to it than that. Some people/doctors will (again wrongly) diagnose �atypical measles� when it is nothing more than a standard case of measles in a vaccinated individual (who has remained susceptible because of vaccination failure). Atypical measles is actually a well-defined clinical condition of unusual measles with an abnormal presentation and complications. The rash starts in the extremities, and can be severe. There is often inflamation internal surfaces lining the lung/heart (polyserositis). This �syndrome� is due to a hypersensitivity in individuals who have been sensitised to measles antigen. It is typical of some cases who were immunised with inactivated measles vaccine, and does not occur in those who have had attenuated vaccine. So it is unlikely to be seen nowadays, and I have only ever seen one case. Unfortunately the term �atypical measles� has entered common parlance, and is incorrectly used.
Young adults can get more severe symptoms. In all measles outbreaks, there will be cases in infants/children, but another peak in adults. This may occur for 2 reasons. Firstly, these individuals may never have been vaccinated, and only herd immunity has helped them avoid exposure until the time they start to travel around and meet others at college/ university etc. Then they get measles. Secondly, they may have been vaccinated, but immunity has waned. Many adults may only have had one dose of vaccine as an infant, or maybe more relevant, they may have been immunised at 12 months of age rather than 15. Significant maternal measles antibody may still exist at 12 months, limiting vaccine efficacy.
Your friend�s grandsons got measles despite vaccination. This might have been vaccine strain causing "measles" if it developed shortly after vaccination, but if it occurred much later it is far more likely to be wild strain in someone who for some reason has not fully responded to the vaccine. It happens.
No, there is no chance of a super-bug measles arising from vaccination along with other antigens. I take your point about changing the patterns of childhood diseases � it is happening, but that is exactly what we hope to do with vaccination. The fact that as a consequence there will be some unusual presentations, or infections in those already vaccinated, or more cases in adults should not sway us from trying to prevent what are potentially devastating childhood diseases.
Competing interests: None declared

Re: Endorsement for mmrthefacts advice 5 October 2004

John Stone,
none
London N22
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Re: Re: Endorsement for mmrthefacts advice

Just to note that no one has taken up the challenge to endorse this advice. This is the advice of the Department of Health. How can it be safe if no one will endorse it? Any takers?
Competing interests: As above

Re: Re: Re: : Autism. Time to Look for Real Solutions. 5 October 2004

MC Feliciello,
parent looking for a solution
Leeds
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Re: Re: Re: Re: : Autism. Time to Look for Real Solutions.

I would like to thank Mr Tony Floyd et al for their contribution to this discussion and would love to read their particular citation (1)hence would be most grateful for free access to it. What, not possible? Shame.
I don't read the Daily Mirror which they seem to think offers a contrasting viewpoint, do you think I ought to for the sake of a balanced argument?
Gosh, one never knows the best source of a suitably clever, if not accurate and informed, opinion nowadays?
By the way, do stop shouting Dear
MCF
(1) Reinert P, Soubeyrand B, Gauchoux R. [35-year measles, mumps, rubella vaccination assessment in France] Arch Pediatr. 2003 Nov;10(11):948-54. French.
Competing interests: Parent of child diagnosed ASD

NOW WE ARE TALKING REAL NUMBERS 5 October 2004

Clifford G. Miller,
Lawyer, graduate physicist, former university examining lecturer in law
Beckenham, Kent, England, BR3 3LA
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Re: NOW WE ARE TALKING REAL NUMBERS

I am grateful to Tony Floyd for the figures he has cited in Re: Autism. Time to Look for Real Solutions 5th October 2004. This is a signal from him of his genuine concern, which is a most welcome development. The risk/benefit equation is one that is important to all parents who need to get some answers, so it is only right that we turn to it.

I refer back to DO VACCINES KILL BEFORE MEASLES CAN?, 11 Sep 2004. 600 UK SIDS deaths over 35 years gives 21,000. This is nearly double Tony Floyd's figure of 12,000 French cases (similar population to UK of approx 66 million).

The real numbers tell us the scales have swung in the direction of natural incidence and against vaccination for healthy well nourished western economy children. What is more, there are effective simple treatments for measles, so the risks of vaccination are not necessary.

This is an important dialogue and initiating it signals acceptance that MMR causes autism. The real reason so much effort has been put into denial that MMR causes autism is that it is the thin end of a very large wedge. Having established MMR causes autism, it then means the health authorities, regulators, government and vaccine manufacturers have some explaining to do about the other adverse reactions to vaccines they have also been studiously ignoring such as SIDS, SBS and all the rest. Further, MMR is not the only cause, nor the only vaccine to contain agents which can cause autism.

I do not remember voting in the last UK election for the heavily pharmaceutical company influenced World Health Organisation or for its targets for eradication of measles in the very near future. Accordingly, I trust that WHO will not mind too much if I do not endorse its interventionist invasive vaccine policy, but prefer policies more appropriate to western economy children. And for those of you who say that is selfish of a western economy citizen, I ask, how many millions of third world children have we in the wealthy West killed as a consequence of administering vaccines to malnourished and/or unwell children? And that is ignoring those we have maimed. In our wealthy guilt, we say 'Oh those poor children, we must save them with vaccines'. And when none die of measles we say, 'Haven't we done well?', forgetting that we have probably killed all of the children who would have died of measles before the disease could do it.

I intend to return to this issue as soon as I am able, but in the meantime, look forward to others contributing to this important debate. This is not a game of who is right or wrong, and when Tony Floyd eventually concedes validity to the arguments that will be put, it will be a sign of strength of character, not weakness and I will commend him for it.
Competing interests: Close relative with life threatening food allergy.

Re: Re: Endorsement for mmrthefacts advice 5 October 2004

Adam Jacobs,
Director
Dianthus Medical Limited, London SW19 3TZ
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Re: Re: Re: Endorsement for mmrthefacts advice

Seems like a fair question to me. I don't know what evidence the advice is based on, but presumably whoever wrote the advice must have some evidence. If John Stone would like to make enquiries of the 'MMR the facts' website to find the references for the evidence behind the advice, and post those references on this forum, then I would be happy to offer my opinion, for what it is worth, on how robust the evidence is.
Competing interests: As stated previously

Re: Re: HAVE VICARS-GENERAL OF VACCINATION GOT THE NEEDLE? 5 October 2004

Adam Jacobs,
Director
Dianthus Medical Limited, London SW19 3TZ
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Re: Re: Re: HAVE VICARS-GENERAL OF VACCINATION GOT THE NEEDLE?

Clifford Miller is quite right. My previous criticism [1] of the Goldman and Yazbak study [2] did indeed address only the new data they presented and the conclusions they drew from it. I did not make any criticism of Goldman and Yazbak's critique of the study by Madsen et al [3].
So, here goes.
Goldman and Yazbak's first criticism is that Madsen et al's follow-up was not long enough to detect all cases of autism, particularly those of late onset. Madsen et al's follow-up was an average of about 4 years, although some children were followed up longer than this and some for less time. It is of course true that longer follow-up would have detected more cases of autism, which would have given the study greater statistical power. However, the relatively narrow confidence intervals of the risk ratios in Madsen et al�s study show that lack of statistical power was not a major shortcoming. The failure to detect late onset autism would only introduce important bias that could mask a genuine association between MMR vaccination and autism if vaccination had a delayed effect, causing autism only several years after vaccination. Does anyone want to argue that that is true? Given that the reason why MMR vaccination was hypothesised to cause autism in the first place was a case series in which the onset of autism came within just a few days after vaccination [4], it is hard to see how it can be plausibly argued that MMR vaccination only causes autism after a period of several years.
Their next criticism is of 'unusual distribution of ages in the cohorts'. Madsen et al used a population cohort, so the age distribution simply reflects the birth rate in Denmark during the study period. Goldman and Yazbak don't say what is strange about the age distribution, but given that Madsen et al adjusted for age in their analysis, I don't see what difference it would make. In any case, it seems a little harsh to blame the Danes for the rate at which they breed.
We are next told that Goldman and Yazbak don't like the censoring rules applied to cases, but are not told why.
The next criticism is of Madsen et al's failure to separate autism into regressive and classical cohorts. This is perhaps the most valid criticism. If you believe that MMR vaccination only causes regressive, and not classical autism, and if regressive autism is rare compared with classical autism, then Madsen et al's study would not be able to detect an increase in regressive autism. However, if all that is true, then any effect of MMR on autism at the population level will be small, and it certainly can't explain large increases in the prevalence of autism in recent years.
Finally, Goldman and Yazbak tell us that unimmunised children were clustered in the earlier years of the study, and that this could introduce bias as a result of longer follow up time for unimmunised children. This is a strange thing to say, since Madsen et al tell us that 'much of the follow-up for the unvaccinated group involved young children'. Presumably young children would be those who entered towards the end, rather than the beginning, of the study period. In any case, it is irrelevant, because Madsen et al's results were adjusted for age, calendar period, and follow- up time.
Given the weakness of Goldman and Yazbak's criticisms, it seems something of an overstatement to claim that they have 'fatally damaged the key Madsen paper', as Miller would have us believe.
References:
1. http://bmj.bmjjournals.com/cgi/eletters/329/7467/642#75225
2. Goldman GS, Yazbak FE. An investigation of the association between MMR vaccination and autism in Denmark. J Am Phys Surg 2004;9(3):70�75
3. Madsen KE, Hviid A, Vestergaard M et al. A population-based study of measles, mumps, and rubella vaccination and autism. NEJM 2002;347(19):1477�1482
4. Wakefield AJ, Murch SH, Anthony A. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998;351:637�41
Competing interests: As stated previously

Re: Re: Re: Endorsement for mmrthefacts advice 6 October 2004

John Stone,
none
London N22
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Re: Re: Re: Re: Endorsement for mmrthefacts advice

I am grateful to Adam Jacobs. However:
1)MMRthefacts in my experience take in excess of two weeks to reply and they blanked my last question anyway (others I know have experience of this as well).
2)The question does not address the issue of whether the procedure is safe and no such claim is made: it addresses itself to whether a "severe reaction" is indicative that the child has "made protection". The message is to disregard adverse reactions.
3) This goes against all sense and proper medical practice, and the documented fact that serious adverse reactions occur (and are admitted by the manufacturers).
Competing interests: As above

Re: NOW WE ARE TALKING REAL NUMBERS 6 October 2004

Peter Flegg,
Physician
Blackpool, UK
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Re: Re: NOW WE ARE TALKING REAL NUMBERS

Like Clifford Miller, I too am grateful to Tony Floyd (Re: Autism. Time to Look for Real Solutions 5th October 2004) for his timely reminder of the true benefits of MMR. However I am somewhat bemused by Miller's attempts to draw out some comparison with SIDS deaths (which he wrongly estimates as being double the actual rate). Why does he try and raise the red herring of SIDS deaths when we are discussing MMR? The only logical reason I can think of is to try and distract attention from MMR's clearly apparent and undisputed benefits.
Alternatively, Miller may genuinely (and obviously mistakenly) feel that all SIDS cases actually are caused by MMR. This is an entirely new one on me, as I suspect it will be for most others, but I have reached the point where I would not really be surprised to see MMR accused of absolutely anything.
Competing interests: None declared

MMMRTHEFACTS: THE POLICY FLIES WITHOUT SAFETY CHECKS AND NO ONE SAYS ANYTHING 8 October 2004

John Stone,
none
London N22
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Re: MMMRTHEFACTS: THE POLICY FLIES WITHOUT SAFETY CHECKS AND NO ONE SAYS ANYTHING

Despite my three posts this week on this topic no one has come out of hiding to explain how or why this policy is safe. People who have contributed to this thread in the last week who tell us that MMR is safe offer no explanation. Matthew Grove, Peter Flegg, Tony Floyd and Jennifer Hawkins keep their own counsel: Adam Jacobs feels there must be an explanation but he does not know what it is.
So, in fact, when presented in this light there is no defence for the policy. And the people who have previously claimed that the policy and the product are safe are apparently at a complete loss. Where are they all now? Where are Sir Liam Donaldson and Dr David Salisbury? Will nobody explain?
Competing interests: As above

RE: MMR the facts ? 8 October 2004

Matthew Grove,
Consultant Rheumatologist
NE29 8NH
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Re: RE: MMR the facts ?

This is a response to John Stone, specifically the question whether I would endorse the advice given on the "MMR the facts" website to disregard a "serious reaction" to the MMR vaccine and proceed to a second dose.
To digress a little, I first got into the MMR issue a couple of years back when my 18/12 old son approached the date of his vaccination. A friend's child had developed autism and they blamed MMR. Like many of the posters on this website, I found the British Government's line that the whole thing was entirely safe and all doubters were misguided hard to swallow, particularly as I had followed the BSE issue in some detail as a medical student and seen the (frankly) bad science that the Government based some of it's advice on at that time. Subsequent events have shown the error of that advice, but were entirely predictable from the available data at the time, properly critically appraised (except that the transmission rate to humans has, fortunately, turned out to be lower than might have been possible).
I therefore got out all the basic science and epidemiological studies on MMR and read them myself. After which I concluded that the doubters were misguided, and that by and large the risks of vaccination are easily outweighed by the benefits. Autism is, however, not a risk of vaccination as far as I could tell from a critical reading of the research; other risks did exist, but were very small. My son was duly vaccinated, and was fine other than for a mild pyrexia for a few days afterwards.
To go back to "MMR the facts": if my son had had a severe reaction (by which I mean an anaphylactic-type reaction) to MMR, I would not have proceeded to a second dose. "MMR the facts" seem to be implying that either (a) a "severe reaction" is a definite infection post vaccination (in which case the second time he'll be safe as he already has antibodies) or that (b) he is still vulnerable and therefore needs the second dose, and that (c) reactions are less common after the second dose.
Now, (c) would seem self-evident if some "severe reactions" are actually more marked infective episodes, because in those cases (a) would be true and the event would not recur as the child is already immune.
However, (b) is irrelevant in the context of a genuine severe anaphylactic reaction. Under these circumstances, whether the child is allergic to either the viral or (far more likely) the excipient components of the vaccine, I would feel the risk of a further (possibly life threatening) anaphylactic reaction would outweigh the benefits (it isn't absolutely necessary for every individual in society to be immune, providing there is adequate herd immunity), and, if it were my child, I certainly would not proceed to a booster.
I feel strongly that one of the biggest problems with the way the UK Government handles all "health scares" is that the people they pick to do the communicating are often pretty poor at it. It'd be far preferable if this kind of advice were given with an evidence base, rather than a patronising "we know about these things, and trust us, it'll be fine" because the modern sceptical concerned parent justifiably will not trust this approach.
Competing interests: as previously stated

RE: MMR the facts - addendum 8 October 2004

Matthew L Grove,
Consultant Rheumatologist
NE29 8NH
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Re: RE: MMR the facts - addendum

Oh, one other point. In all fairness to "MMR the facts", the question as stated reads:
"My son had a sever [sic] reaction to the first MMR jab. Does this mean that [a] he is well protected from these diseases, or [b] is a second dose still necessary?"
([a] and [b] added by me)
The answers to these questions are correctly given by "MMR the facts:"
[a] not necessarily [b] yes, for protection a second dose is needed.
The third question - which is not asked - is "[c] should he therefore have a booster?". To evade [c] is to set angels dancing on the head of a pin, so my answer still stands as above - "no, because he might have a further severe reaction".
Competing interests: as previously stated

Re: MMMRTHEFACTS: THE POLICY FLIES 8 October 2004

Graeme Johnston,
Student
MK7 6AA
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Re: Re: MMMRTHEFACTS: THE POLICY FLIES

John Stone questions the advice on the "mmrthefacts" website, but it is in line with the advice given under MMR in the British National Formulary, and the advice in the DoH's "Immunisation against infectious disease".

The current MMR vaccine may cause mild versions of mumps, measles, and rubella -- and a subsequent dose of MMR vaccine may cause a milder version still.

What severe effects is John Stone referring to? Different ones, I expect -- but is there any actual evidence for an association? For thrombocytopenia (for example) there is, and the BNF gives clear advice about this.

The mmrthefacts website gets no points for clarity, but the information seems robust.

Competing interests: None declared

Re: RE: MMR the facts ? 8 October 2004

L. Travis Haws,
Dentist
Lakewood CO 80228
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Re: Re: RE: MMR the facts ?

Editor: First of all, Grove talks of ONLY two potential severe reactions. Anaphylaxis (allergic reaction) and getting the illness itself. This is absurd. First, passive surveillance, and the lack of willingness to look at the children themsleves, for severe vaccine reactions gives us no clue of what countless severe reactions may actually be out there. As found in the PDR (55th edition 2001) on page 1884, severe reactions include encephalitis, subacute slerosing (hardening) panencephalitis, Guillain-Barre' syndrome, febrile and afebrile convulsions, seizures, ataxia, ocular palsies, anaphylaxis, angioneurotic edema, bronchial spasms, panniculitis, vasculitis, atypical measles, thrombocytopenia (decrease of number of plateletts), lymphadenopathy, leukocytosis, pneumonitis, Stevens-Johnson syndrome, erythema multiforme, urticaria, deafness, otitis media, retinitis, optic neuritis, rash, fever, dizziness, headache, and death!!! That is JUST FOR MEASLES vaccine. All of that rings a bell (not otitis) as it has been seen in these pages of the BMJ before.
If my child has any of the above reactions, no way would they get a second dose as, if you ask me or most sound thinking people, they are now SENSITIZED to respond in a severe way. Many of the above reactions are neurological, auto-immune, and/or allergic. If I'm sensitized to an allergen, my allergies don't go away, they usually get increasingly worse. If one of my patients has a severe reaction to penicillin (or even a rash), for example, no way am I prescribing penicillin again. And would even be cautious prescribing cephalosporins. You know, cross-reactivity to similar drug classes. How do they come off saying a reaction is less rare the second time? Using the above analogy, it is highly probable to have another severe reaction and I don't see how a vaccine is now somehow different than another drug. Except for the biologic pathogens, simian viruses, other species proteins, and an array of known neurotoxins.
I am glad to note that Grove would not give his child a second jab if he/she had anaphylaxis to the first. Maybe Dr. Grove feels seizures are insignificant, or thrombocytopenia? How about dizziness? Sorry, bad question. Dizziness is a little hard to assess in an infant, now isn't it?
And, how are many of the above reactions checked for? Before we go about nonchalantly giving booster after booster after vaccine after vaccine. How many CT scans are performed following a child with post- vaccinal seizures to look for encephalitis, sclerosed nerves? Death gets checked off as SIDS and so therefore sibling is ok. How many bleeding profiles are done when a child presents ill following vaccination. Heaven forbid they have a bruise or nosebleed from thrombocytopenia as the child will surely be relocated to foster care under the SBS and MSbP proponents.
So, what appears as an everyday illness to a doc, may very well be one of the severe reactions. And you tell me to give them the next shot. I'd rather take my chance with wild measles and Vitamin A.
And, if antibodies are developed to one strain, that doesn't necessarily protect from other strains, and we've all seen citations throughout these BMJ pages that antibodies don't necessarily mean immunity or "protection". There are many diseases I have even natural antibodies to, but seem to get them again, and again. Often times the last common cold was worse than the prior one. Not more mild. But we're told if we do get a vaccine type of "preventable" disease, it will surely be mild as we've been "protected". Again, a double standard. How should it be much different than natural diseases we get more than once. They are not guaranteed to be more mild as we have been previously exposed via the "protective" vaccine.
I wonder what the MMR advice website would have to say about the above? Nevermind, I think I already know.
Competing interests: None declared

MMR CAUSES AUTISM - CASE PROVEN - NOW ON RISK/BENEFIT 10 October 2004

Clifford G. Miller,
Lawyer, graduate physicist, former university examining lecturer in law
Beckenham, Kent, England, BR3 3LA
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Re: MMR CAUSES AUTISM - CASE PROVEN - NOW ON RISK/BENEFIT

Dear Sir,

Re: HAVE VICARS-GENERAL OF VACCINATION GOT THE NEEDLE? 5 October 2004 - Adam Jacobs

Whilst I am obliged to Mr Jacobs, Director, Dianthus Medical, for taking the time to prepare such a detailed critique (1) there is absolutely no reason for responding to it. The main premise for the Madsen paper (2) has been shown to be invalid. Mr Jacobs has already confirmed that (3). It is over, the main point is conceded, Madsen is irrelevant and that is on top of all the other evidence (summarised below) proving MMR is one of the causes of the autism epidemic. Just to ensure there is no misunderstanding, I summarised the point on Madsen previously (4) as follows:-

"Goldman/Yazbak shows, which Mr Jacobs admits, autism increased in Denmark. That is a significant admission. All the time Madsen's paper was interpreted as saying that it did not. Madsen was used as the entire basis for denying there was any evidence that MMR causes autism, all prior papers to that effect relied on by government officials having been shown to be defective in that regard. Now Madsen suffers the same fate, devastated by Goldman/Yazbak, it is not the "all-singing-all-dancing" answer government officials have been claiming it to be.

The end result is that the mountain of medical 'scientific' papers, oft referred to in press releases and media reports, is not just not a mole-hill, but such that to describe it as a pile of anything, even ashes, might be considered too high."

The person who should be explaining in this journal is Madsen. We also need explanation from Dr David Salisbury, Professor Sir Liam Donaldson and the Secretary of State for Health why they have pursued this charade. There are more.

Let us summarise the other evidence. Standard pharmacology, CDR and CD prove MMR causes autism. Further strong proof of causation, not hitherto brought into play, is the extremely close temporal association between administration of vaccine and recorded adverse reactions. The case histories of the children are also proof. The testimonies of the parents backed by video, photographs and medical records. There is also evidence of vaccine persisting in children who have suffered adverse reactions, when that is only previously known to occur in pathological circumstances.

It is overwhelming.

So, there is no need to look further at yet more weak and debunked epidemiology. And there never was need in the first place.

There is also no need to go into 'extra time' on any of this after the game is over. Mr Jacobs' constant changes of direction in these responses are indicative of a lack of the same.

I am moving on to the risk/benefit issue, as it is critical to the debate and the one thing the parents need to know about in making their decision. And it is their decision. It is not the World Health Organisation's decision. It is not Professor Sir Liam Donaldson's decision. It is not Dr David Salisbury's decision. And it is certainly not Tony Blair's decision.

If Mr Jacobs or any of this clients or the government or its officials would like this l'il ole lawyer from a village in Kent, England to comment on the supposed criticisms of Yazbak, they must first deal with the criticisms of Madsen and then deal with Yazbak. If they want me explain to them on these pages, it would assist if they get their cheque books out, as they are being paid for their efforts, whilst I am not.

I also use the 'extra time' game analogy advisedly. It seems to me someone is playing a game here, it is not me and it is a very dirty game.

When Dr Wakefield was interviewed (5) in 2001 after giving evidence to the US IoM on the MMR children's case series, he tells us the IoM were agitated by his evidence and went into a closed session, in which he was asked to present the evidence, including the CDR and CD evidence. Subsequently we are told that Congressman Dan Burton of the US House Oversight Committee requisitioned the tapes as part of an investigation. The first set the IoM presented to the Oversight Committee were blank. Congressman Burton requisitioned the originals. They were blank.

In the UK this goes into the office of the UK Prime Minister. What possible reason did he have to get involved? Why was such pressure brought to bear to deny the MMR children justice and cast the burden of their care on their impoverished families and the taxpayer? So is this what 'New Labour' is all about: Machievellian political manoeuvering against the small children of this country to achieve some unstated end, coincidentally of benefit to vaccine manufacturers whilst killing and maiming some of our children with adverse reactions to vaccines our authorities are not prepared to document or investigate?

Unlike Tony Blair's government who will no doubt whoop with joy at the first case of congential rubella syndrome ('CNS') or the first death from measles, at least Conservatives are taking a responsible line and seem to care about whether children get measles and CNS. They alone are prepared to offer single vaccines. At least this will assist in providing some immunity to our young girls approaching puberty and to the unborn children of our country-women from rubella. Tony Blair's government cynically and recently withdrew that protection; no doubt with an eye to planning another Blair spin campaign on the back of the first deaths and injuries.

1) HAVE VICARS-GENERAL OF VACCINATION GOT THE NEEDLE? 5 October 2004 - Adam Jacobs

2) Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, Thorsen P, Olsen J, Melbye M. A population-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med. 2002 Nov 7;347(19):1477- 82.

3) Re: Danish MMR study 22 September 2004 - Adam Jacobs

4) HAVE VICARS-GENERAL OF VACCINATION GOT THE NEEDLE? 5 October 2004 - Clifford Miller

5) Autism and the MMR Vaccine - An interview with Andrew Wakefield, MD - Fall 2001

Competing interests: Close relative with life threatening food allergy.

Re: RE: MMR the facts - addendum 10 October 2004

Carol Johnston,
Carer
Carshalton, Surrey UK
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Re: Re: RE: MMR the facts - addendum

Mathew Grove says what severe reactions are we talking about?
How about seizure, rash, high temperature, loss of speech, balance and coordination unable to walk, screaming, rocking their bodies, onset of dirroeah, incontinenance, loss of eye contact, a "blank" look in their eyes. Some of the MMR kids are in wheelchairs now Mr Grove.
Does Mr Grove believe that parents who blame MMR for the regression and subsequent autism in their children are totally mistaken? Perhaps Mr Grove would care to explain why I saw regression 3 times in my children and why by some amazing coincidence it followed vaccination with MMR?
How is drug safety monitored, if it is not for patients reporting adverse reaction. Yet with vacination many reactions are dismissed in the bid to dismiss any causal link with autism or PDDs.
The Vaccine Damage Payment Unit has paid out for death in relation to MMR.
Unless Mr Grove knows the reason why regressive or late onset autism occurs then how is it he dismisses what parents are saying. In the absence of research directly looking at these children he chooses to go by epidemological studies alone.
Does Mr Grove stand by the official figures of stated vaccine reactions when citing the phrase "benefits outweigh the risks". How many vaccine reactions go unreported. how many reactions are officially recorded - not very many it seems.
Does it not concern Mr Grove in the least that the measles virus has been found in these children's gut and brains?
I am glad that Mr Grove's son was fine with the MMR. My children were not so lucky.
Why doesnt the MRC look at our kids and tell us what happened rather than just ignoring what we are saying and trotting out advice as to "benefits outweighing risks" and politically motivated epidemilogical studies.
For my kids the risks outweighed the benefits.
Why should I risk vaccinating my son with the MMR booster? If I go ahead and have booster and my son worsens or dies then what? He would be one less autistic child to drain the economy. Therefore I will NOT risk boosters or any more vaccines for either of my children - despite what MMRtheFacts say.
If Mr Grove and others are saying that no child has become ill eg encaphalitis, meningitis, seizure, or died following MMR then I would accept that autism/PDD could never caused by MMR. However, serious reactions to medicines happen every day. MMR is no different. If you accept MMR can have adverse effects on infants then you have to accept the possibility that there could be such a thing as vaccine induced autism or degeneration and regression in some children.
I will trust what I saw happen with my own eyes.
Vaccination is not infalliable Mr Grove I will take my chance with natural virus from now on as official policy has left me no choice. My kids may be an acceptable risk to you but they are my children and have been damaged enough.
I am not misguided or mistaken, my son regressed after his first MMR, there is no doubt about that. Video tape, photographs, child development records all show the regression.
My daughter lost the ability to walk at 12 months, at 4.5 years she stopped talking, had balance and coordination problems (kept falling over), incontinence and was very withdrawn.
I wonder if Mr Grove has read the manufacturers list of side effects which comes with the MMRII vaccine. Perhaps he can tell me whether or not the extensive list of neurological side-effects could in all probability lead to damage and ultimately regression and diagnosis of autism.
Yet the official line is vaccinate no matter what. The herd must be protected at all costs!
MMR/autism gut disease risk is not proven, neither has the MMR been proven innocent that it does not cause or contribute to autism/gut disease.
I will go by what I witnessed and trust my instincts as a parent to protect my children from further harm. I cannot risk any further vaccines.
Competing interests: 2 ASD kids followign MMR vaccine

Re: Graeme Johnston's reply 10 October 2004

John Stone,
none
London N22
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Re: Re: Graeme Johnston's reply

1) The word "severe" (mispelt "sever") derives from the mmrthefacts website, and is not somered-herring invented by myself - this presumably cannot be identical with the "mild" effects mentioned by Johnston. Not admittedly very scientific language.
2) Johnston does not seem very bothered by the possibility that if you systematically disregard severe adverse side-effects you will (a) not know what they are (b) not be able to help the patient. In my experience, when I have been ill in the past doctors have ordered dozens of tests. In this case, oddly, no one wants to know.
Competing interests: As above

Re:Superficial and Misleading Critique 10 October 2004

Raymond Gallup,
Founder of The Autism Autoimmunity Project
45 Iroquois Avenue, Lake Hiawatha, NJ 07034
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Re: Re:Superficial and Misleading Critique

Harold Buttram, MD is right on all counts in what he says about the lack of independent, long-term safety studies done on any vaccines and the lack of studies comparing unvaccinated subjects with vaccinated subjects.
Vijendra Singh, PhD. has done numerous studies that show children with autism have elevated measles antibody titers. (1) Andrew Wakefield, MD has done numerous studies that show children with autism have measles in the gut. (2) Another recent study by Dr. Wakefield and associates (3) shows that there are children with autism that have measles in the spinal fluid. Where is the CDC, NIH and FDA when it comes to this science? Nowhere to be found since they have to protect the pharmaceutical companies over the public interest.
The recent controversy about the deaths caused by Vioxx manufactured by Merck is just one more example of the FDA looking the other way when it comes to public safety. The anti-depressant drug scandal where they were causing suicides in the USA is another example of the FDA looking the other way.
Meanwhile the epidemic of autism continues to skyrocket as in the case of this year's figures (2003/2004) from the US Department of Education that shows a 1,055% increase from the 1992/1993 figures. (4)
So when will this autism epidemic be stopped and help provided to the victims? I don't have a crystal ball but when the numbers become too staggering and the costs too prohibitive to the communities involved, then something will be done. The disgrace is that nothing has been done so far.
References
1. http://www.whale.to/vaccines/singh.html
2. http://www.whale.to/vaccines/wakefield.html
3. http://www.jpands.org/vol9no2/bradstreet.pdf
4. http://www.taap.info/stats.htm
Competing interests: Founder of The Autism Autoimmunity Project and father to Eric Gallup, who was born normal and regressed into autism after receiving the MMR vaccine

The demise of common sense, and logical immunity 10 October 2004

Hilary Butler,
freelance journalist
home 1892, New Zealand.
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Re: The demise of common sense, and logical immunity

Peter Flegg says:
[quote]For the record, I do agree with him that measles vaccine can cause measles. However it is not "prominent"; and as my previous references have shown, it comprises a negligible component of measles in vaccinated societies.[/quote]
If you go by published references, this is indeed true. But here, we have a problem.
In this country, there are regular outbreaks of "measles", which, coincidentally, usually follow the MMR being administered in schools.
We are only one family, whose chidren have had "measles" twice. Yes, "twice". Both times, following an MMR vaccination campaign. The second time, I pleaded with the hospital to do both viral assays, and blood work, but they declined on the basis that he wasn't going to die, and it was a waste of health resources.
"Why" (I can hear you ask) "was your son in hospital then"? He was in hospital, because our then doctor did not believe that it could be measles a second time. The child concerned had a severe ear infection, which led to him behaving as if he was more ill than he was, so the doctor decided that he might have meningitis, hence an 'enforced' trip to hospital. Only to find that the staff agreed it was measles. Until, that was, they saw in his files, that he had had "measles" once before. So, they changed the file to "morbilli-like infection". Hence the discussion. Was the first one perhaps a "morbilli-like-infection" and the second measles? Shall we do some tests to find out please?
The reaction was to run away and put their heads into the sand. What you don't investigate, can't be used in evidence against you, Mr Flegg.
And that is the problem. YOU say vaccine-virus measles isn't common. I say that it is common, but it isn't in the literature, because you and yours do not investigate it, when you have the opportunity.
And you don't see it, because you don't expect to see it, and deny it when it is in front of you.
And should you "see it" and find that vaccine virus-measles might be so much more common than you previous thought, would you dare to publish it?
And on a related note, we recently had a mumps outbreak locally. Funnily enough, following a local MMR initiative. Not even a copy of Takao Nagai's "Mumps vaccine virus genome is present in throat swabs obtained from uncomplicated healthy recipients" (Vaccine 19 (2001)1353 - 1355 would convince the local doctor that it was even an issue worth consideration. Such is the immunity to "novel" concepts, that vaccines inflict upon doctors.
You (Peter Flegg) state in response to Carol Johnson:
[quote]The fact that as a consequence there will be some unusual presentations, or infections in those already vaccinated, or more cases in adults should not sway us from trying to prevent what are potentially devastating childhood diseases.[/quote]
Tell me, Mr Flegg. What are some of the factors that can make these diseases potentially devastating?
I've recently seen chickenpox in an adult who was vaccinated about six years ago. She was severely ill, in bed for two weeks, and found it very hard to get over. Afterwards, she was tested to see if she had an immunodeficiency, and she didn't.
But there was one thing they never bothered to look at. The doctor, at the beginning of the illness, when they didn't know it was chickenpox advised the parents to use paracetamol to reduce the fever, which they did, for several days..
The damaging role of chemical antipyresis to the immune system, is something which doctors should be addressing as a matter or urgency.
While you may say this is another issue altogether from the MMR/Vaccine issue, it is not.
I am deeply troubled by the current medical profession's blase advice on the use of drugs to bring down temperatures ((which are the "infections" way of using a "sprinkler" system to dampen down the effects of the pathogen ("fire") ))~ advice which I believe can lead to infections becoming more serious.
Fever is there for a good reason. To stop diseases becoming more serious. To slow down, and get on top of pathogens. To eliminate the resulting "complications"...
Fever has a vital function.
Reviews of Infectious Diseases, Vol 10, No 1 January-February, 1988. New concepts on the pathogenesis of Fever, Charles A. Dinarello et al:
Page 184:
�Elevated body temperature enhances the inflammatory response and function of the immune system at the same time that it reduces the replication of microbes and tumor cells.�
Reviews of Infectious Diseases 1991; 13: 462 � 472 Impact of Temperature Elevation on Immunologic Defenses. Norbert J. Roberts.
Page 469: �Overall, it appears that temperature elevation within the physiologic range most effectively enhances the processes involved in initial antigen recognition and support for immunologically specific response to challenge.�
Pg 470: �Accumulated direct and indirect evidence suggests an overall beneficial effect of physiologic temperature elevation or fever on host defense mechanisms.�
Antipyresis and Fever, Barbara Styrt, MD, Barrett Sugarman MD. Arch Intern Med � Vol 150, August 1990,
Pg 1594: �The decision to administer antipyretics is frequently made without a documented rational. Current understanding of the mechanisms and pathogenesis of fever suggests that the febrile process has a role in host defense and that routine antipyretic therapy for fever is generally unnecessary and conceivably harmful. �
Alas, I can only find one sane doctor prepared to come right out and agree with me in this:
http://www.australianprescriber.com/index.php?content=/magazines/vol18no2/paracetamol.htm
Aust Prescr 1995; 18: 233- 234. Paracetamol: use in children. Frank Shann, Intensive care Unit, Royal Children�s Hospital, Melbourne.
�Paracetamol may prolong infection and reduce the antibody response in mild disease, and increase morbidity and mortality in severe infection.�
�there is no evidence that antipyretics prevent febrile convulsions.�
�Immunity. Too many parents and health workers think that infection is bad, infection causes fever and that therefore fever is bad. In fact, fever is often a beneficial host response to infection, and moderate fever improves immunity. Therefore it may not be a good idea to give drugs that reduce temperature to patients with several infection. I have recently reviewed the results of 9 controlled trials in mammals of the effect of paracetamol or aspirin on mortality of virus excretions.. Four trials found that aspirin increased mortality in bacterial or viral infection. Viral shedding was increased by paracetamol or aspirin in 3 studies, possibly increased in one, and not affected in two (one used only pharyngeal washings, and one had only 9 subjects in the aspirin and placebo groups). One study found that antibody production was impaired by both paracetamol and aspirin, but no effect on antibody production was detected in the study with only 9 subjects in the aspirin and placebo groups. This evidence suggests that aspirin and paracetamol increase mortality in severe infection, and that they may prolong the infection and reduce the antibody response in mild disease.�
Conclusion: There is little evident to support the use of paracetamol to treat fever in patients without heart or lung disease, or to prevent febrile convulsions. Indeed paracetamol may decrease the antibody response to infection, and increase morbidity and mortality in severe infection.
It should be explained to parents that fever is usually a helpful response to infection, and that paracetamol should be used to reduce discomfort, but ***NOT TO TREAT FEVER ***"
end of quote
Chickenpox treated antipyretically with Tylenol/Ibuprofen provokes bacterial skin infections into fulminant necrotising fasciitis (Pediatr I(Pediatrics Vol 103, No 4, April 1999, 783-784 and 785-790) (Infect Med1999 16 (5):307) Just two of many references for antipyretic induced complications of chickenpox.
"There is overwhelming evidence in favor of fever being an adaptive host response to infection... as such, it is probable that the use of antipyretic/anti-inflammatory/analgesic drugs, when they lead to suppression of the fever, result in increased morbidity and mortality during most infections; this morbidity and mortality may not be apparent to most health care workers..." Infect Dis Clin North Am 1996 Mar;10(1) : 1-20.)
J. Paediatr. Child health (1993) 29; 84 �85: Paracetamol: When, why and how much. Editorial
�in patients without heart and lung disease fever is harmful only at temperatures over 41 o C; such high termperatures are usually caused by heat stroke or brain injury, and they do not respond to paracetamol or aspirin.�
�There is no evidence that antipyretics prevent febrile convulsions�
As to my friend's daughter, while she didn't get necrotising fasciitis, I have to wonder if the reduction of the fever increased the severity of the chickenpox. After all, it does with the flu, so why not with chickenpox?
Pharmacotherapy December 2000; 20: 417 � 422;
(http://id.medscape.com/reuters/prof/2000/12/12/04/20001201clin003.html)
As reported on internet, by �Health Scout� and Reuters medical News for the professional:
Findings. Those with influenza A who took antipyretics were sick much longer than their flu-infected counterparts who took nothing.
Health Scout : Quoting Dr Leland Rickman, Associate clinical professor of medicine, University of California:
�an elevated temperature may actually help the body fight the infection quicker or better than if you don�t have a fever.�
Quoting Dr Karen Plaisance, Associate Professor at the University of Maryland School of Pharmacy and one of the study�s authors �Influenza A sufferers who were treated with aspirin or acetaminophen extended their illness from five days to about 8 � days.�
Acta Paediatr Jpn 1994 Aug; 36(4) 375 � 378. Risks of antipyretics in young children with fever due to infectious disease. Sugimura T, et al.
�The objective of this study was to determine whether paracetamol (acetaminophen) affects the outcome of children with fever due to bacterial infectious disease�.. the data suggest that frequent administration of antipyretics to children with infectious disease may lead to a worsening of their illness.�
Given that doctors have been advising parents to use antipyretics for as long as they have been on the market, and given that you, Mr Flegg, are concerned at the potential severity of these diseases, would it not be an appropriate idea to actually look at first line advice that the medical profession gives?
These illnesses can be devastating, but are far less likely to be devastating, provided they are in younger children, and are not accompanied by the routine, across the board use of antipyretics like liquid paracetamol or tylenol, which seems to be the standard advice of doctors these days. Not to mention the deaths, and potential liver and kidney toxicity of such compounds.
BMJ 2002;325:678 ( 28 September ) http://bmj.bmjjournals.com/cgi/content/full/325/7366/678,
FDA. http://www.fda.gov/ohrms/dockets/ac/02/slides/3882S1_05_Nourjah- Ahmad-Karwoski.ppt
You may say that if you give the MMR vaccine, then such antipyretic "advice" is redundant, but that is not true. Vaccines do not always protect. In fact, very often, they do not. And besides which, fever is not just related to Measles, Mumps and rubella.
Many parents don't just see the foundations of the "vaccine" sacred cow as being suspect, they are coming to realise that the WHOLE MANNER in which the medical profession approaches ALL infectious disease is based upon quicksand.
Doctors treat all infections as if they are something to be fought, put out, smothered, killed, anti-bioticized, a battle against biological terrorists, when what medicine should be looking at is working with and supporting the immune system, finding appropriate mechanisms to assist the body to do what it is designed to do.
I cannot help but look at the increase in serious meningitis and other serious complications of infectious disease, without wondering whether some of the alleged dangers of these diseases lies fairly and squarely at the iatrogenic door of people who advise inappropriate treatment methods in the first place.
To treat fever the way you now advise, is inappropriate, non- scientific, has no benefits, and actually huge potential risks. Even the WHO admits current advice is wrong. http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042- 96862003000500012&lng=en&nrm=iso
It's time doctors stopped treating parents who don't want to vaccinate their children, as paraiahs of society.
And its also time doctors got their act together in re-educating themselves, so that they can give parents proper, sensible, appropriate advice on how to assist the body in getting on top of infectious pathogens in the most effective way, which will not contribute to increased disease morbidity and mortality.
Hilary Butler.
Competing interests: None declared

Re: MMR information in PDR 10 October 2004

Graeme Johnston,
Student
MK7 6AA
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Re: Re: MMR information in PDR

The (American) "Physicians Desk Reference" information about MMR can be found here. Reading the whole document gives a different and much clearer picture than just reading Travis Haws's selections did.

Competing interests: None declared

Advice from MMR the Facts 10 October 2004

Carol Johnston,
Carer
Carshalton, Surrey UK
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Re: Advice from MMR the Facts

From MMR the Facts:
In this weeks top 5 questions
Q: "If I have epilepsy , and my child is due to have the MMR is there a risk they could develop it? "
A: Epilepsy in a first degree relative (father, mother or a brother or sister) or even in the child is not a contraindication to having MMR. There is no scientific evidence to support the suggestion that MMR causes it, and the advice is that your child should have the MMR when it is due.
http://www.mmrthefacts.nhs.uk/questions/question.php?id=80
However in direct contrast the manufacturers leaflet states under "Adverse Reactions: Nervous/Psychiatric" - Febrile convulsions in children, afebrile convulsions or seizures.
And again under:
Precautions: Other - Due caution should be employed in administration of M-M-R� II to persons with individual or family histories of convulsions, a history of cerebral injury or any other condition in which stress due to fever should be avoided. The physician should be alert to the temperature elevation which may occur 5 to 12 days following vaccination.
Now reading the reply from MMRtheFacts there is absolutely no mention of risk in fact the statement "no scientific evidence" contradicts the advice of the manufacturer.
It seems the advice from MMRtheFacts is to immunise, cross your fingers and hope for the best because if your child does develop seizures or epilepsy worsens - it has nothing to do with the MMR and any involvement of MMR will be denied.
One wonders whether advice to go ahead and immunise no matter what, is really in the best interests of the child? I think not!
Would anyone here knowing that there is a known risk of epilepsy go ahead and immunise?
In my opinion this advice is bordering on negligent, it does not inform parents of known risks so how can an informed choice be made?
Competing interests: 2 ASD following MMR

Re: Advice from MMR the Facts 10 October 2004

Ed Cooper,
Locum Cons. Pediatrician
London
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Re: Re: Advice from MMR the Facts

Carol Johnston�s rapid response on �MMR The Facts� needs reading slowly and carefully. Such a reading will show that the contradiction she believes she has found between the reply on the Website and the manufacturer�s leaflet does not exist. This is worth a reply because it might alarm a user of the vaccine who skims through Carol Johnston�s response and does not think it through.
�MMR The Facts� says: There is no scientific evidence to support the suggestion that MMR causes [epilepsy].
Epilepsy is a predisposition to have fits, also known as convulsions or seizures. In order to be able to say that a person has a predisposition to fits, like any predisposition to any event, the fits must occur on several, separate occasions.
There is one predisposition to fits that is, by convention, not called epilepsy, and that is the predisposition to have a fit in response to an infection, usually as the temperature rises. This is then called a febrile convulsion. It is common among young children. The reason it is not called epilepsy is that it is a predisposition that disappears after early childhood. Unlike epilepsy, it is not associated with any other brain abnormality and has no bearing on e.g. later life insurance risk or suitability for any occupation.
�MMR The Facts� is correct to say that there is no scientific evidence to support the suggestion that MMR causes epilepsy.
The manufacturer of MMR-II is also correct to say that possible adverse reactions to the vaccine include a single or repeated fit. This is because the attenuated infections produced by the live viruses in the vaccine may lead to this as part of the response of the child to them, often accompanied by fever. The manufacturer is not saying that there is any risk that the vaccine may lead to a predisposition to have fits of any kind. The manufacturer is saying that given the pre-existing predisposition to have fits with fevers, this may occur after the vaccination and the advised caution is to be alert to this possibility.
As �MMR The Facts� says, any pre-existing predisposition to fits � and the industrial manufacturer in the interest of self-protection is trying to cover every conceivable predisposing factor � any pre-existing predisposition is not a contra-indication to vaccination, i.e. it is not a reason not to give it. However, as the manufacturer says, it is a reason to take precautions, e.g. to make paracetamol (acetaminophen) and plenty of fluid available if the child shows any signs of the mild infections produced by this attenuated live-virus triple vaccine.
It is worth pointing out that any child predisposed to fits, whether it is epilepsy or febrile convulsions that have been diagnosed, will tend to have them in association with any infection, including wild-virus measles, mumps, rubella and the common cold.
Competing interests: None declared

Re: Re: Advice from MMR the Facts (Ed Cooper's response to Carol Jonston) 11 October 2004

John Stone,
none
London N22
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Re: Re: Re: Advice from MMR the Facts (Ed Cooper's response to Carol Jonston)

However, according to the PDR (my thanks to Graeme Johnston) "Due caution should be employed in administration of M-M-R-II to persons with a history of cerebral injury, individual or family histories of convulsions, or any other condition in which stress due to fever should be avoided". But not, apparently, in the UK.
Competing interests: As above

Re: Re: Advice from MMR the Facts 11 October 2004

Carol Johnston,
Carer
Carshalton, Surrey UK
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Re: Re: Re: Advice from MMR the Facts

As Ed Cooper rightly points out that any child predisposed to fits, whether it is epilepsy or febrile convulsions that have been diagnosed, will tend to have them in association with any infection, including wild- virus measles, mumps, rubella and the common cold.
My son recently had tonsilitus with subsequently high temperature and a 24 hour vigil of keeping him cool and sponged down I was painfully aware of the risk of the seizure, because statistically the type of autism my son has he an increased risk of developing seizures.
Many of the children involved in the UK MMR litigation developed seizures after having MMR. I refer to the story of little Hannah Buxton.
http://66.70.140.217/a/mmr_killed.html
Carol Buxton, Hannah's mother was quoted as saying:
"She was suffering up to 40 fits a day but we were told that it would take months or years before a decision could be made. But 2 years after she died our case was heard and the link between her illness and MMR was agreed"
However I reiterate again that MMRtheFacts fail to mention any possibility of a risk factor associated with seizures and skim over that possibility with the statement "no scientific evidence".
The majority of children who have reportedly developed seizure after having MMR have no known history or pre-disposition to seizure. So it seems that all parents in order to make an informed choice should be made aware of the possibility of seizures.
As a parent who took my children for immunisation I was never told of the possibility of seizure, my son developed atypical measles 5 days after MMR elevated temperature and rash, high pitched screaming. I would not have termed this reaction as a "mild" illness.
My son subsequently became severely autistic.
Of course there is no proof that MMR causes autism either.
Being aware of this possibility of seizures, I find myself constantly watching him, everytime he has a fluttering or rolling of the eyes, watching him as he sleeps.
Perhaps this worry would prompt Ed Cooper and others to advise to have MMR Booster to avoid the possibility of natural diseases with risk of associated elevated temperature.
Again looking at the advice from MMRtheFacts. The parent who asked the question has real concerns regarding the effects of the MMR. The reply from MMRtheFacts makes no mention of due caution or even the manufacturers advice. Would it have not been more appopriate to mention the advice from the manufacturer rather than dimissing any risk with the statement "no scientific evidence". As a parent reading this reply, I would assume that there is no risk at all with the MMR.
Perhaps Ed Cooper feels this advice is wholly adequate for a parent who has concerns to make an informed choice. Every parent contemplating vaccination should be given a copy of the manufacturers leaflet in order to make an informed choice.
If Ed Cooper feels that the industrial manufacturer in the interest of self-protection is trying to cover every conceivable predisposing factor, there are plenty of other conditions they could put there to cover all possibilities . The list of side effects although formidable does not cover all illnesses and conditions. Why not add autism or learning difficulties or behaviour problems like ADHD, PDD and bowel problems like IBD - because there is no "scientific evidence" that MMR causes this either?
So, Ed Cooper assures parents that although it is mentioned by the manufacturers, ignore it, the manufacturers put it there to cover themselves, just in case!
I would ask Ed Cooper if a patient of his developed multiple seizures following MMR would he deny involvement of MMR?
I wonder just how he would approach this situation?
Competing interests: 2 ASD kids following MMR

Re: MMR CAUSES AUTISM - CASE PROVEN - NOW ON RISK/BENEFIT 11 October 2004

Adam Jacobs,
Director
Dianthus Medical Limited, London SW19 3TZ
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Re: Re: MMR CAUSES AUTISM - CASE PROVEN - NOW ON RISK/BENEFIT

At first I thought that Clifford Miller hadn't actually read my responses when he said:
'The main premise for the Madsen paper has been shown to be invalid. Mr [sic] Jacobs has already confirmed that.'
Then I realised that it is more likely that he hasn't read the Madsen paper. He seems to be under the impression that the main premise of that paper was a claim that the prevalence of autism is not increasing. Madsen et al do not claim this: in fact, they agree that it is increasing (page 1481, paragraph 2, lines 10-15). The main finding of the Madsen paper was that autism was no more common in children who had received MMR vaccination than in those who hadn't.
As I argued in my previous response, Goldman & Yazbak's attempts to cast doubt on that finding do not stand up to scrutiny. I therefore still believe that the findings of Madsen et al are valid.
Competing interests: As stated previously

Re: MMR CAUSES AUTISM - CASE PROVEN - NOW ON RISK/BENEFIT 11 October 2004

Raymond Gallup,
Founder of The Autism Autoimmunity Project
45 Iroquois Avenue, Lake Hiawatha, NJ 07034
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Re: Re: MMR CAUSES AUTISM - CASE PROVEN - NOW ON RISK/BENEFIT

Adam Jacob says the following:
"As I argued in my previous response, Goldman & Yazbak's attempts to cast doubt on that finding do not stand up to scrutiny. I therefore still believe that the findings of Madsen et al are valid."
The Madsen et al study never did any clinical science regarding the children with autism. There were no immune blood panel tests, no spinal tabs, and no colon biopsies. I'm an Accountant by trade and know that math is a pure science but to use math to come to a scientific conclusion without using clinical science is faultly science.
It would be like me saying one plus one equals two (which is good, valid math) and then coming to a scientific conclusion that the earth is flat (invalid scientific conclusion, where's my science to prove that the earth is flat?).
The Madsen study was funded by the Centers for Disease Control (CDC) and the National Association for Autism Research (NAAR). The CDC promotes vaccines and NAAR has consistently said there is no connection between the MMR vaccine and autism while taking funding from pharmaceutical companies such as Merck (who manufactures the MMR vaccine). (1). The CDC would not fund a study that would go against their position of promoting vaccines. NAAR would not fund such a study either since over the years to the present they have not funded one study linking autism to vaccines.
Again, where's the science by the Madsen et al? There has been no clinical science done by Madsen et al. A computerized number study, yes, but no clinical science.
References:
1. http://www.naar.org/news/render_pr.asp?intNewsItemID=99
Competing interests: Founder of The Autism Autoimmunity Project and father to Eric Gallup, who was born normal and regressed into autism after receiving the MMR vaccine

Re: Re: MMR information in PDR 11 October 2004

L. Travis Haws,
Dentist
Lakewood CO 80228
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Re: Re: Re: MMR information in PDR

Editor: I would like to take this opportunity to thank Graeme Johnston for providing the PDR link he did. It has made it much easier for others to see the correct information I displayed.
Graeme Johnston says "Reading the whole document gives a different and much clearer picture than just reading Travis Haws's selections did." Hmmm...interesting, I wasn't talking about the whole document. I listed severe reactions and then asked if one saw such a reaction, would they recommend a second dose as the MMRthefacts site nonchalantly does. If one but only looks under the severe reaction section in the link provided by Graeme Johnston, they will see every single reaction I listed, and then some. I did, however, leave out Diabetes Mellitus, pancreatitis, diarrhea, vomiting, arthritis, paresthesia, aseptic meningitis, measles inclusion body encephalitis (MIBE) etc. Oh, it also then mentions VAERS. What a joke that has turned out to be as it is well known only 1 - 10 percent of adverse events are even considered or reported, and some of the reported ones, like death, are stated as SIDS by the person reporting the event? Or subdural hemorrhage is checked off indiscriminantly as SBS? You telling me encephalitis coupled with vasculitis (just two of the countless reactions) can't manifest as a SDH, brain edema etc.?
Interestingly, the site states "The following adverse reactions are listed in decreasing order of severity, without regard to causality, within each body system category and have been reported during clinical trials, with use of the marketed vaccine, or with use of monovalent or bivalent vaccine containing measles, mumps, or rubella". Of course causality will never be admitted by our health officials. As shown by the CDC dealing with data, that demonstrated a statistically significant association between neurodevelopmental disorders and thiomersal exposure, that one can see under the links in one of my prior responses (http://bmj.bmjjournals.com/cgi/eletters/329/7466/588-b#76162).
The site goes to greath lengths to disclaim any causal association (of which I'm sure Graeme Johnston is referring us to), says reports of "Post-marketing surveillance of the more than 200 million doses of M-M-R and M-M-R II that have been distributed worldwide over 25 years (1971- 1996) indicates that serious adverse events such as encephalitis and encephalopathy continue to be rarely reported." One question, who is doing the reporting? How does this relate to VAERS complete failure of passive reporting? How is this being assessed clinically? Back to some questions in my prior response.
Then the site goes on, and this is found: "Although a causal relationship between the Urabe strain of mumps vaccine and aseptic meningitis has been shown, there are no data to link Jeryl Lynn mumps vaccine to aseptic meningitis." What? You telling me that if one Mumps strain (Urabe) can cause aseptic meningitis, we are to take comfort that the experts think Jeryl Lynn can't despite the fact Urabe can and does? Then Singh and/or Wakefield find Measles vaccine strain in the gut and brain...all following massive increases of PDD's of which many also have GI problems. Parents like Carol Johnston have video evidence of regression and re-regression (you know Clifford Miller's CD and CDR proof) following MMR vaccine. I wonder what dormant type of situation Rubella vaccine strain is awaiting to unveil. Let's not forget the associated risks of the three-in-one punch of DTaP, or HiB, Flu, Varicella, Polio, Pneumococcal vaccines to an immature developing immune and neurologic system/s. How many parents do you think are consently informed of the multitude of potential reactions and that these reactions are likely 90% plus under-reported?
Chalk it up to another of the all too common idiosyncrasies. An idiosyncrasy that a prescriber of medicine would not prescribe most any drug a second time, if the first resulted in a moderate to severe reaction. But, in the name of vaccination, take a complete 180 degree stance.
Competing interests: None declared

Limits of epidemiological studies 11 October 2004

Deborah Kahn,
Librarian
05602
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Re: Limits of epidemiological studies

I've been following the argument about MMR for several years now. The aspect I find most puzzling is the total reliance on epidemiological studies to dismiss the MMR autism question. Please, has anyone besides Wakefield actually examined these children directly? If not, why not? How can a connection be dismissed based only on large population epidemiological studies? How can an accurate assessment be made by looking at children's medical records but not at the children?
Wakefield has said that he has now seen hundreds of children who have autism and bowel problems. If MMR is not the cause of this syndrome, what is? Who is researching the problem? Are the ill children being treated? How?
I'd appreciate some answers.
Deborah Kahn
I do not have any autism in my family, which has been anti-vaccine since the 1920's. Due to a vaccine reaction, of course.
Competing interests: None declared

Re: Limits of epidemiological studies 12 October 2004

Adam Jacobs,
Director
Dianthus Medical Limited, London SW19 3TZ
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Re: Re: Limits of epidemiological studies

Deborah Kahn and Raymond Gallup both question the relevance of epidemiological studies designed to answer the question 'does MMR vaccination cause autism?'
If MMR vaccination did cause autism, then you would expect to find that autism was more common in children who had received MMR vaccination than in those who did not. Surely no-one can argue with that? Epidemiological studies have consistently found that autism is not more common in children who have received MMR than those who have not. This provides very strong evidence against the hypothesis that MMR causes autism.
Clinical examination of individual children is no doubt very valuable in the management of those individual children. But I have a question for Kahn and Gallup: how would you design a study based on clinical examination of individual children that could answer the question of whether MMR causes autism?
Kahn and Gallup may not be aware that by trying to claim that epidemiology is irrelevant, they are keeping some rather dubious company. The same tactic has been used by the tobacco industry, who have tried to claim that there is no proof that smoking causes lung cancer, on the grounds that the evidence that it does is all epidemiological [1].
References:
1. Iida K, Proctor RN. Learning from Philip Morris: Japan Tobacco's strategies regarding evidence of tobacco health harms as revealed in internal documents from the American tobacco industry. Lancet 2004;363:1820-24
Competing interests: As stated previously

Re: Re:Superficial and Misleading Critique 12 October 2004

Lisa C Blakemore-Brown,
Psychologist
UK based
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Re: Re: Re:Superficial and Misleading Critique

Raymond Gallup writes: "So when will this autism epidemic be stopped and help provided to the victims? I don't have a crystal ball but when the numbers become too staggering and the costs too prohibitive to the communities involved, then something will be done. The disgrace is that nothing has been done so far."
Today, 12th October 2004, here in the UK, we are being told about the very grave issue of how the population will survive as they reach retirement given the �57 billion shortfall in the amount people are saving for retirement. It is predicted that millions will face poverty in old age.
Without a doubt, the current population of children will be expected to help provide - as its always been done - for its elderly. This problem of `saving` hides many other issues - not least that of the depleted number of children who will be able to support the elderly when they get older.
It does not take a rocket scientist to work out that if a normal child grows up without serious accident or injury, it will be able to meet its own potential and contribute to society in numerous ways, not least financially.
If, however, that same child is robbed of its potential through a serious accident or injury, the child, family, community and society loses all they may have had to offer.
The system cannot really legislate for unforeseen accidents and injuries, but it can and surely must now face up to its responsibilities in relation to the millions of children who have been damaged by vaccine whose contributions to society have been lost, and who will become burdens on the state for the rest of their lives.
The system might have got away with ignoring and denying the problem whilst responsible parents take the weight, the cost and the profound stress onto their own shoulders, but they too will grow old - and probably sooner given the pressures - and the system will be forced to take over.
Perhaps a statistician out there can work out the costs of lifetime care multiplied by the numbers of children with documented autism (irrespective of cause) The latter figures are available as the epidemic of autism (irrespective of cause) is undeniable. Perhaps they could add to this figure the loss to society of that person's predicted contribution, had they been able to do so. There must also be a built in amount for the loss to society of brilliance, especially in the field of science and technology, given the higher chance of autism developing in families with such skills. Additional costs, despite trying to deny the problems and fighting parents in Tribunals to wear them down and not provide what they need to improve their child's life chances, are the added (more than the ordinary pupil would cost) costs of education for the children currently, over the last few years and until they reach the end of their education.
Then there are the costs of keeping children in care who were taken from parents accused of causing the autism and related medical problems.
Then we can set this against the �57 billion shortfall in pensions in the UK, as just one example in the world, and we can also compare it with the profits and costs of litigation which are at the root of denying vaccine damage autism in the first place.
Competing interests: Expert in Autism

Re: Adam Jacobs: "Limits of epidemiological studies", or here we go round the mulberry bush 13 October 2004

John Stone,
none
London N22
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Re: Re: Adam Jacobs: "Limits of epidemiological studies", or here we go round the mulberry bush

"It is often hard to infer causality from epidemiological studies. Epidemiological studies are good at discovering associations but less good at determining whether those associations are causal. A good illustration of this is the finding from epidemiological studies that HRT is associated with lower rates of heart disease. Now, I am no expert on HRT, but it is my understanding that few would now argue that the association is causal." [1]
Why in the first place are we talking about designing studies rather than investigating the condition of sick children?
[1]Adam Jacobs, "Re: Whose side is Adam Jacobs really on?" http://bmj.bmjjournals.com/cgi/eletters/328/7442/773#74472
Competing interests: As above

Re: Re: Limits of epidemiological studies 13 October 2004

John Stone,
none
London N22
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Re: Re: Re: Limits of epidemiological studies

Deborah Kahn asks about clinical research on the MMR-autism link.
Dr Tim Buie at Massachussets General Hospital (Harvard) found the same histopathology as Andrew Wakefield [1].
Dr Arthur Krigsman of New York City School of Medicine found similar results but his hospital would not support the study and the pathology is now being carried out at National Insistute of Health [2].
Dr Vijendra K Singh of Utah State University has produced serological evidence supporting MMR damage [3].
See also Visceral publications http://www.visceral.org.uk/publications.php
Finally, David Thrower's extensive and modestly named reference work: 'MMR and acquired autism - a briefing note' (July 2004) can be downloaded from http://www.autism-arch.org at no charge.
[1] http://www.autismnwaf.com/harvardproject1.htm
http://autism.about.com/cs/autisminprint/a/wakefieldfired.htm
[2] http://whale.to/a/a3.html
http://mercola.com/2002/Jul/10/mmr_autism.htm
http://autism.about.com/library/weekly/070902d.htm
[3] http://64.41.99.118/vran/vaccines/autism/aut_singh.htm
http://whale.to/vaccines/singh.html
Competing interests: As above

Re: Adam Jacobs :Limits of epidemiological studies - here we go round the mulberry bush II 13 October 2004

John Stone,
none
London N22
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Re: Re: Adam Jacobs :Limits of epidemiological studies - here we go round the mulberry bush II

In addition to the Goldman and Yazbak paper in the Fall issue of Journal of American Physicians and Surgeons (JPS)there was the Stott et al paper which included the letter by Prof Samy Suissa originally refused publication by the New England Journal of Medicine which recalculating Madsen et al's own figures showed that even on that basis children were 45% more likely to have autism having had MMR as against 8% less likely in Madsen et al's calculations [1]. Furthermore, Goldman and Yazbak patently detect further biases in Madsen's sample [2]. Madsen et al could clear the air by addressing these questions forthwith, if they can. At the moment the issue is going by default. No good anyone pretending.
[1] JPS vol 9 no 3 (Fall 2004)p.89-90.
[2] JPS vol 9 no 3 (Fall 2004)p.70-75.
Competing interests: As above

MMRTHEFACTS: THE POLICY CONTINUES TO FLY WITHOUT SAFETY CHECKS 14 October 2004

John Stone,
none
London N22
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Re: MMRTHEFACTS: THE POLICY CONTINUES TO FLY WITHOUT SAFETY CHECKS

It is ten days (3 October 2004) since I put out a challenge on this topic. After a slow start I managed to elicit a few replies.
1) Adam Jacobs (5 October) seemed to agree that it was mystifying, but thought there must be an explanation. He offered to mediate an mmrthefacts explanation if I obtained one, despite a previous protestation only 4 days previously, that he did not have competence in the terrtory of infant diagnosis [1].
2) Matthew Grove (8 October) conceded that he would not follow the advice himself, but did not answer the conundrum that if this is the advice being given how can we be satisfied by the safety of either the policy or the vaccine. He did not respond to further points made about safety by Travis Haws (8 October), or the parental evidence of Carol Johnston (10 October).
3) Graeme Johnston (8 October) failed to note that the designation "severe" derived not from myself but from the mmrthefacts website and that therefore his discussion of mild side effects was irrelevant (see my reply 10 October). His citation of the Physicians Desk Reference (PDR) in response to Travis Haws was too vague to illustrate any specific point and as Travis Haws further pointed out (11 October) there was plenty in the PDR to give rise to additional concerns. Graeme Johnston has not returned to the discussion.
4) Ed Cooper responded to a supplementary point about seizures and epilepsy made by Carol Johnston (both 10 October) by making a distinction between infant seizures and epilepsy. However, as I pointed out (11 October) the PDR cautioned about both. He did not respond to this or the further rational fears expressed by Carol Johnston (11 October).
AS FAR AS I CAN SEE NO EFFECTIVE DEFENCE OF THE POLICY HAS BEEN OFFERED. WHERE DO WE GO FROM HERE?
[1] http://bmj.bmjjournals.com/cgi/eletters/329/7467/642#76637
Competing interests: As above

Re: Re: Adam Jacobs: "Limits of epidemiological studies", or here we go round the mulberry bush 14 October 2004

eamonn clarke,
gp
cambs
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Re: Re: Re: Adam Jacobs: "Limits of epidemiological studies", or here we go round the mulberry bush

John Stone: "Why in the first place are we talking about designing studies rather than investigating the condition of sick children?"
I am genuinely interested in this suggestion which is frequently made in this forum. Could I ask what sort of study of children Mr Stone and others have in mind? Would it be based on physiology, microbiology or pathology? Or would the study be qualitative in nature?
Competing interests: Previously on the BMJ wing

Re: Re: Re: Adam Jacobs: "Limits of epidemiological studies", or here we go round the mulberry bush 14 October 2004

John Stone,
none
London N22
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Re: Re: Re: Re: Adam Jacobs: "Limits of epidemiological studies", or here we go round the mulberry bush

I think Eamonn Clarke misunderstood what I was saying. It was Adam Jacobs who raised the question of designing studies, not I. I was suggesting that it is normal to test and monitor sick people, and there seems to be some double standard operating here. In the case of Andrew Wakefield and others in relation to the MMR problem they have taken biopsies from the gut and the cerebrospinal fluid of affected children.
In the case of heavy metal toxicity it would probably be very easy, cheap and uninvasive to run studies which looked for abnormalities among autistic children and others with neuro-developmental disorders in comparison with a control group. I recall Ellen Grant's response "Re: the effects of toxic metals in autistic children": http://bmj.bmjjournals.com/cgi/eletters/588-b#74117.
Competing interests: As above

Limits of epidemiological studies in autism without clinical tests 14 October 2004

Ellen C G Grant,
physician and medical gynaecologist
20 Coombe Ridings, Kingston-upon-Thames, KT2 7JU
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Re: Limits of epidemiological studies in autism without clinical tests

Simple blood tests are a good way to start investigating the health problems of autistic children.1
Dr John McLaren-Howard presented the results of testing 61 autistic children at a Biolab Workshop for Doctors in June 2004, as he was attempting to find out which nutritional tests should be recommended. Among the 42 boys and 19 girls most were deficient in zinc and magnesium. Many were also deficient in copper, chromium, manganese, molybdenum and B vitamins. Therefore, essential fatty acids were also likely to be deficient. 16 children had DNA-adducts in leucocytes to malondialdehyde, 12 to cadmium, 9 to nickel,3 to mercury and one had DNA-adducts to lead.2 37 children had antigliadin IgG antibodies, while 30 children had malabsorption detected by a D-xylose test. Malabsorption was most common in those with Asperger's type syndrome, 16 out of 18 children.
We have been finding for decades that children with behaviour and learning problems and allergies are likely to be deficient in essential minerals in sweat and often in hair analyses, neither of which tests are invasive.
We have also learned that the essential nutrient status of parents before conception is of prime importance for children's health.2
1. Grant ECG. McLaren-Howard.Re: The effects of toxic metals in autistic children. http://bmj.com/cgi/eletters/329/7466/588-b#74117, 13 Sep 2004
2 McLaren Howard J. The Detection of DNA Adducts (Risk Factors for DNA Damage). A Method for Genomic DNA, the Results and Some Effects of Nutritional Intervention. J. Nutr. & Env. Medicine. 2002; 12: 19-31.
2.Grant ECG. Nutritional supplements to prevent pregnancy complications. http://bmj.com/cgi/eletters/329/7458/152#67502, 16 Jul 2004
Competing interests: None declared

Re: Limits of epidemiological studies 15 October 2004

Raymond Gallup,
Founder of The Autism Autoimmunity Project
45 Iroquois Avenue, Lake Hiawatha, NJ 07034, USA
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Re: Re: Limits of epidemiological studies

Adam Jacobs says the following:
"Clinical examination of individual children is no doubt very valuable in the management of those individual children. But I have a question for Kahn and Gallup: how would you design a study based on clinical examination of individual children that could answer the question of whether MMR causes autism?"
My answer is that there should be further research to find out why children with autism have elevated measles antibody titers, measles in the gut and measles in the spinal fluid. Shouldn't there be a scientific interest by the medical community to see the cause (especially if they say it isn't the MMR vaccine, then show me as they say in Missouri, what is causing it and prove beyond a doubt what the cause is)? After all, if clinical science isn't science then what is? Isn't the medical community knowledgeable about science? If they are then they should put something together to examine this.
They could start, as Dr. Harold Buttram said with comparing vaccinated populations with non-vaccinated populations. We have non- vaccinated populations in New Jersey and Pennsylvania.
What is so hard about doing such a study/studies unless the medical community is afraid of what they will find?
Competing interests: Founder of The Autism Autoimmunity Project and father to Eric Gallup, who was born normal and regressed into autism after receiving the MMR vaccine

Re: Re: Limits of epidemiological studies 17 October 2004

Adam Jacobs,
Director
Dianthus Medical Limited
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Re: Re: Re: Limits of epidemiological studies

I am intrigued by Raymond Gallup's suggestion that 'there should be further research to find out why children with autism have elevated measles antibody titers, measles in the gut and measles in the spinal fluid'.
How exactly would such studies be designed? How would this shed light on whether autism and vaccination are causally related? Or would that not be the objective of the studies?
Competing interests: As stated previously

Constructive debate 17 October 2004

Dr John MM Rumbold,
n/a
West Midlands
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Re: Constructive debate

In my opinion rapid responses should be for debate that informs medical professional. In the case of this thread the message I get is that lay campaigners misunderstand (deliberately or otherwise) the points made by medics. Please could the lay campaigners do some reading if they do not understand the points made?
Competing interests: None declared

Re: Limits of epidemiological studies 18 October 2004

Raymond Gallup,
Founder of The Autism Autoimmunity Project
45 Iroquois Avenue, Lake Hiawatha, NJ 07034, USA
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Re: Re: Limits of epidemiological studies

Per Adam Jacobs:
"I am intrigued by Raymond Gallup's suggestion that 'there should be further research to find out why children with autism have elevated measles antibody titers, measles in the gut and measles in the spinal fluid'."
"How exactly would such studies be designed? How would this shed light on whether autism and vaccination are causally related? Or would that not be the objective of the studies?"
As I mentioned in my previous response there could be studies comparing unvaccinated children with vaccinated children. Research can be done on those affected adversely by the MMR vaccine by doing tests that check for the vaccine strain of measles/rubella.
Quite frankly, when we had immune blood panel tests done on my son, Eric and found that he had elevated measles antibody titers I knew it was from the MMR vaccine. I had the wild measles virus in the early 1950's as a kid and developed a fever and rash. I had to stay home from school in a darkened room for two weeks so I know what measles is all about. Eric didn't have the measles but he did get the MMR vaccine. We have video tapes of Eric developing speech up till April 28, 1986 when he got the MMR shot.
After that shot, he regressed into autism, no more speech, no eye contact, lots of hyperactivity and no social interaction. So that was proof enough for me. I realize for the medical community they like to think that vaccines are safe, just as drugs like Vioxx are (that was recently been pulled from the market, not the first drug to be pulled from the market, nor will it be the last one). Remember the thalidomide drug scandal a few decades ago? Remember the American Home Products Rotavirus vaccine pulled from the market? (1)
Clinical research can be done. It isn't impossible. I realize the pharmaceutical companies won't do it since profits come before safety. Right now the medical community promotes sickness rather than wellness care, and it should be the other way around. Eventually it will be done because the pressures will be there to force the issue. You can not keep the lid on a pot full of boiling water forever!
References:
1. http://www.nccn.net/~wwithin/prevnar3.htm
Competing interests: Founder of The Autism Autoimmunity Project and father to Eric Gallup, who was born normal and regressed into autism after receiving the MMR

Re: Re: Re: Limits of epidemiological studies 18 October 2004

John P. Heptonstall,
Director of the Morley Acupuncture Clinic
Leeds LS27 8EG
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Re: Re: Re: Re: Limits of epidemiological studies

Sir
I really think Adam Jacobs should do his homework before responding with uninformed comments.
Raymond Gallup appears to be referring to research that found children with autism have elevated measles antibody titers (Singh et al), measles in the gut and measles in the spinal fluid (Wakefield et al, and others). I would add that Singh et al designed and carried out further studies which showed MMR antibodies in the brains of autistic persons and not in non-autistic controls.
I leave Jacobs to locate these studies, they have been mentioned at length by myself and others many times on the eBMJ, and in autism research circles they are well documented. Perhaps Jacobs could start by reading that relevant research and he will see what design was used by the eminent Drs Singh, Wakefield, et al.
I refer of course to Jacob's "How exactly would such studies be designed? How would this shed light on whether autism and vaccination are causally related? Or would that not be the objective of the studies".
Regards
John H.
Competing interests: None declared

Re: Re: Re: Re: Limits of epidemiological studies 18 October 2004

Adam Jacobs,
Director
Dianthus Medical Limited, London SW19 3TZ
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Re: Re: Re: Re: Re: Limits of epidemiological studies

I am aware of the studies that Heptonstall refers to, but I don't remember reading any that gave evidence to support a causal relationship between vaccination and autism. Finding elevated measles antibody titres in autistic children doesn't prove very much: I am sure Heptonstall is aware of the important difference between association and causation. If he knows of any studies that show a causal relationship, perhaps he could be kind enough to supply the reference.
The same failure to differentiate between association and causation seems to apply to Gallup's suggestion to compare vaccinated and unvaccinated children. What exactly would the study be designed to find out? How would it achieve that objective? Vague suggestions about comparing unvaccinated with vaccinated children are not very convincing without further details.
Competing interests: As stated previously

Hypothetical MMR Survey 19 October 2004

Michael D Innis,
Director Medisets International
Home 4575
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Re: Hypothetical MMR Survey

Editor,
Adam Jacobs, referring to the MMR controversy and its putative association with vaccines asks, �how exactly would these clinical and pathological studies be designed? What result would show that vaccines cause autism? What result would convince you that vaccines have nothing to do with autism?�
Here is a design and method that would convince even the most sceptical that an association does exist between MMR and Autism but not between DTaP and Autism.
Immunization status of 706 pairs of children, Autistic and Non- autistic, matched for age, sex and ethnicity Autistic children immunized against MMR 618 Non-autistic children immunized against MMR 569 Autistic children immunized against DTaP 646 Non-autistic children immunized against DTaP 640

I repeat this is an ILLUSTRATION OF A DESIGN that Adam Jacobs calls for. The numerical values relate to a different survey [1]. As far as I am aware no such survey has been done with MMR , DTaP and Autism.
Michael Innis (micinnis@ozemail.com.au)
Reference: 1. Innis MD. Oncogenesis and Poliomyelitis vaccine. Nature (1968) 219; 972-73
Competing interests: None declared

Re: Re: Re: Re: Re: Limits of epidemiological studies 19 October 2004

L. Travis Haws,
Dentist
Lakewood CO 80228
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Re: Re: Re: Re: Re: Re: Limits of epidemiological studies

Editor: Perhaps Adam Jacobs with his extensive knowledge surrounding vaccine efficacy and benefits could tell us the "appropriate" study. Never mind, I'm sure it would fall under the thoroughly debunked series of Madsen, Smeeth etc. etc. or the manipulated CDC study that did originally find a statistically significant association between thiomersal exposure and a variety of neurodevelopmental disorders.
It seems to me that many of these children serve as their own controls. Gallup's son was clearly developing fine (control) then subsequent to MMR (the trigger man/women) regressed to essentially a non- functional level. Carol Johnston's children were developing fine, and then regressed and re-regressed s/p MMR pulling the trigger. But they are dismissed as if some chime of the clock or black magic voodoo doll and chicken foot had coincidentally thrust their children into a state where all milestones were skipped across the lake and they were left floundering. Then compare these to autistic children who were not vaccinated and also compare the level of autism.
You know, for example, like Scheibner's pre-vaccine recording of breathing patterns and then s/p vaccine a sudden change of breathing patterns to the point of cessation of breathing which would require intervention. You know Jacobs, an endotracheal intubation and vent. But we're to believe the child was coincidentally about to start having breathing problems anyways?
Jacobs talks about environment and genetics. Could Jacobs please outline the environmental impacts of an infant/child, or what would have the most impact on mutating the genetic code (I would generally think of the environment and genes modifying to adapt to the environment--or being damaged by the environment). And in doing so, could Adam Jacobs please let us know what environmental factor would have more of an impact (or better yet, even come close) on our infants and children than the constant onslaught of vaccine after vaccine and their noxious constituents. Most infants I know are pretty isolated. Not too many are out their club hopping, tearing down asbestos, manufacturing pesticides, purifying uranium and last but not least...are not on the assembly line as the person putting mercury into the thermometer or sphygmomanometer.
Perhaps they are on the assembly line after all. Problem is, they some how ended up being the thermometer. Could anyone explain how that happened? How our kids became the sacrificial lamb of quackery. How we let the play on our fear let that happen.
Competing interests: None declared

Adam Jacobs: "association and causation" 19 October 2004

John Stone,
none
London N22
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Re: Adam Jacobs: "association and causation"

The issue of designing studies is plainly a red-herring, though both Jacobs and Eamonn Clarke seem to be trying to make a point about it - no doubt some obscure game of medical one-upmanship. There are obviously many separate questions involved in such a complex clinical issue and you have no doubt to design different studies to resolve different aspects as for instance the many papers published by Andrew Wakefield and colleagues since 1998). This does not mean that the broad picture is not clear.
Adam Jacobs has argued vigorously that epidemiological association was a minimal requirement for showing clinical interest in whether MMR might be a cause of autism: now he freely acknowledges research that shows an association between measles and autism but for no logical reason pours scorn on the idea that there might be a causal connection. This becomes ever more perverse in a world in which most children have had MMR and few have caught measles as an illness. Even more perverse that he then chooses to ignore the many documented cases in which children have fallen ill and regressed after receiving MMR vaccine.
The odd thing is that he claims no direct knowledge of the matter but has the temerity (or possibly the downright rudeness) to dismiss the experiences of Raymond Gallup (above) and Carol Johnston [1] who have contributed to this site. On what basis does he feel he has the right to discount the observations of the parents? Or what about the harrowing testimony of Lisa Blakemore-Brown [2]? In this light it is interesting that he recently found himself perplexed by the advice I quoted from the 'MMR the Facts' website in which parents were encouraged to disregard adverse reactions [3]. Why, you might ask - in the light of the evidence of Raymond Gallup, Carol Johnston and Lisa Blakemore-Brown - should he be in the least bit surprised? And what does he suppose happens to those who report or try to investigate such occurrences? Frankly - for someone with so many opinions - what does he know about it?
Under normal legal and clinical guidelines the extraordinary burden of proof that has been put on parents of these children to prove drug damage would not apply: it is not normal to have produce forensic evidence of every link in the chain of damage to register an adverse reaction to a drug. On that basis any kind of drug monitoring would become impractical. Jacobs shrugs aside the precise and well researched legal and scientific arguments of Clifford Miller in post after post [4]. No one to date has actually disputed anything Clifford Miller has said on this topic. And all ordinary clinical and legal safeguards remain mysteriously inactivated.
But also - finally - I am not clear on what basis Adam Jacobs asserts his superiority.
[1] Under the name Carol J "What of the children?" 31 May 2004 http://bmj.bmjjournals.com/cgi/eletters/328/7442/773#61118 .Carol was not a litigant in the MMR case.
[2] "Weaving the actual truth" 17 June 2004 (13 September) http://bmj.bmjjournals.com/cgi/eletters/328/7442/773#63081 . "Our world is totally irrational now" 25 July 2004 http://bmj.bmjjournals.com/cgi/eletters/329/7459/239#68602
[3] See above: Adam Jacobs "Re: Re: Endorsement for mmmrthefacts advice", 5 October 2004; John Stone "Re: Re: Re: Endorsement for mmrthefact advice" 6 October and "MMRTHEFACTS: THE POLICY CONTINUES TO FLY WITHOUT SAFETY CHECKS" 14 OCTOBER.
[4] "UNRELIABILITY OF SCIENTIFIC PAPERS AS EVIDENCE" 11 March 2004 http://bmj.bmjjournals.com/cgi/eletters/328/7440/602-c#52948
MMR KIDS - LIVING SCIENTIFIC PROOF MMR CAUSES AUTISM 23 & 25 July 2004; YOUR OWN DO IT YOURSELF KIT - RELIABLE PROOF MMR CAUSES AUTISM 26 July 2004 http://bmj.bmjjournals.com/cgi/eletters/329/7459/239
Competing interests: Parent of an autistic child

Re: Re: Re: Re: Re: Limits of epidemiological studies 19 October 2004

John P. Heptonstall,
Director of the Morley Acupuncture Clinic
Leeds LS27 8EG
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Re: Re: Re: Re: Re: Re: Limits of epidemiological studies

Sir
Adam Jacobs did not ask Raymond Gallup to suggest study designs to show causal relationship, but study designs that would "shed light on" whether vaccination and autism are causally related; both the Singh and Wakefield team study designs did "shed light on" this, albeit as we probably all agree, more work is necessary to "prove" a causal relationship.
To use Jacob's recent response, those studies also "gave evidence to support a causal relationship" between vaccination and autism.
If I use the analogy of a crime. A person found carrying a gun at the scene of a shooting is automatically suspected of being involved in the crime - a causal relationship that might "shed light" on the crime is implied but not proven. The Wakefield and Singh study results are similar, perhaps moreso in that the 'gun carrier' has also been implicated beyond others - it being 'the gun carrier' who has been found in association with the 'crime' (ie. in the gut, spine and brain' of autistic 'victims') and no other suspects exist in association with the victim - including checks on other 'control suspects'. Hence more indepth investigation is necessary and, in terms of any authoriity that really wishes to 'solve the crime', is essential.
Once must ask why our governments are not immediately funding such further clinical investigations into this 'crime'? It is as though science is degrading the true value of evidence to its own ends, therefore investigations into 'suspect' and 'crime' are undervalued - particularly the concept of circumstantial evidence - such that, witness the recent refusal of legal aid for victims of potential vaccination 'crimes', the judiciary (government) is allowing degradation by science to influence legal opinion.
Regards
John H.
Competing interests: None declared

Just a thought. 19 October 2004

Hilary Butler,
freelance journalist
Home, NZ, 1892
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Re: Just a thought.

Since the supposed experts haven't come up with any "ideas" as to how to prove causation, can I, as an "ignorant" journalist, with few small brains, make a tiny suggestion?
I believe it has been said, that Measles VIRUS has been found in the spinal fluid and other places, in children with autism.
Correct?
VIRUS, that is, ... not antibodies, ...since the argument is, that antibodies tell us nothing.
Correct?
I gather that Merck Sharpe and Dohme, or whichever manufacturer you wish to insert in MSD's "place"... has a Polymerase Chain Reaction (PCR) record of the "signature" of all the vaccine viruses used in the MMR vaccine. therefore, each vaccine lot should be trackable.
Correct?
I gather also, when someone comes down with, say, diphtheria, the bacteria sample is sent off, and similarly "fingerprinted." It is then checked genetically, using a PCR library, which has lots of different pictures of of all the diffent "fingerprints" of all the different PCR signatures for diphtheria, which then tells the doctor which "region" the diphtheria came from, based on the how close to the DNA "finger-prints" match which one from the "book" in the library.
Correct?
Well, if the measles virus in "whatever" part of the autistic child's body it is found in, is from the vaccine, should it not be a reasonable match to the fingerprint of whichever vaccine it came from?
Perhaps there might be some differences, because of the very same "attentuation" processes that developed the vaccine virus, which also meant that attentuated live polio vaccine virus, when it travelled through the child's gut, shed off some attenuation characteristics, and was able to "acquire" a more "wild" fingerprint.
But, if the laboratories have seen fit to "fingerprint" the wild measles viruses in the location in which these autistic children life, there should also be regional "wild controls" with which to compare the 'alleged' vaccine strain.
So in this elusive hypothetical trial, you could also have unvaccinated children, who might allegedly have autism as well.
You'd need to type their "measles" if measles virus is found, because we know from articles in VACCINE magazine, that actually, live measles and mumps virus can be obtained by swabbing perfectly healthy vaccine recipient's throats. So you never know. These unvaccinated children might have 'caught' vaccine virus, and you wouldn't know without attempting to type theirs as well. And also "assuming" that the measles virus wouldn't "revert" as the polio virus used to... and then checking that against the PCR fingerprints for the wild measles virus in their area.
So you might see that the unvaccinated children were carrying wild virus, or you might see that they had actually caught vaccine virus.
I seem to remember that the vaccine polio virus that caused some of the polio cases in the unvaccinated Dominican children maintained key vaccine mutation points, and was definable as vaccine virus.
so I would have though the DNA fingerprinting of measles virus was quite possible. It seems to be done for just about everything else.
Back now, to the experts, who in turn, might give us all their reasons as to why they wouldn't, couldn't, didn't, or shouldn't do PCR fingerprinting of the measles vaccine viruses in question, or the wild ones, for that matter.
Unless the answer to that question might be that it hasn't been done, because no-one "wants" to know....
Hilary Butler.
Competing interests: None declared

Re: Hypothetical MMR Survey 19 October 2004

Adam Jacobs,
Director
Dianthus Medical Limited, London SW19 3TZ
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Re: Re: Hypothetical MMR Survey

Michael Innis might be delighted to know that a study very similar to the one he suggests has recently been published [1], although the study investigated only MMR and not DTP vaccination.
I agree that, had the study found that MMR vaccination was more common in autistic children than in controls, it would have convinced me and no doubt many others that MMR vaccination and autism are related. However, what the study actually found was that MMR vaccination was not more common in autistic children than in controls. This should 'convince even the most sceptical' that MMR vaccination and autism are not related, but clearly there are some who will always believe that MMR vaccination causes autism, no matter how much evidence is produced to the contrary.
References:
1. Smeeth L, Cook C, Fombonne E. MMR vaccination and pervasive developmental disorders: a case-control study. Lancet 2004;364:963�969
Competing interests: As stated previously

Re: Re: Hypothetical MMR Survey 20 October 2004

John Stone,
none
London N22
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Re: Re: Re: Hypothetical MMR Survey

It is noteworthy that Adam Jacobs only had the courtesy to respond to one of four replies posted this morning.
Jacobs' endorsement of the Smeeth paper must of course be seen in the perspective of the eletter responses [1] attached to the BMJ report of the paper to which Prof Smeeth himself contributed [2], and notably John Heptonstall's response of 7 October 2004 [3]. It would obviously be a lot more interesting if Prof Smeeth replied to these criticisms than Adam Jacobs, but he has not yet done so.
[1] Rapid Responses to Mayor 'Study shows no link between MMR and autism' http://bmj.bmjjournals.com/cgi/eletters/329/7467/642
[2] Susan Mayor, 'Study shows no link between MMR vaccination and autism' BMJ 18 September 2004, http://bmj.bmjjournals.com/cgi/content/full/329/7467/642
[3] 'Criticisms of Smeeth et al' http;//bmj.bmjjournals.com/cgi/eletters/329/7467/642#77164
Competing interests: Parent of an autistic child

Re: Just a thought. 20 October 2004

Adam Jacobs,
Director
Dianthus Medical Limited, London SW19 3TZ
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Re: Re: Just a thought.

Once again, remember the distinction between association and causation. If you did the study that Hilary Butler suggests, and if you found that autistic children had persistent measles virus of a vaccine strain and non-autistic children didn't, then how would you know whether measles vaccination causes autism? Those results could just as easily (more easily, in fact, given the weight of epidemiological evidence) be explained by suggesting that autism causes an unusual response to vaccination.
Competing interests: As stated previously

Re: Re: Hypothetical MMR Survey 20 October 2004

John P Heptonstall,
Director of The Morley Acupuncture Clinic and Complementary Therapy Centre
LS27 8EG
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Re: Re: Re: Hypothetical MMR Survey

Sir
An interesting response from Jacobs supporting Smeeth et al; he completely ignores the criticisms of Smeeth et al I gave in my response "Criticisms confounding Smeeth et al" on 7th October at Responses to bmj.bmjjournals.com/cgi/content/full/329/7467/642 which, if valid, should completely demolish that paper and of which he is very familiar as it was he who asked me to provide certain facts which I incorporated into that response - and from which he, in what has become expected of Adam Jacobs, 'did a runner'.
I await his return from 'self-imposed exile' to "Criticisms confounding Smeeth et al" but hardly expect it; after all, one does not expect statisticians to be too interested in the quality or accuracy of data presented for processing, they work with what they're given so inevitably risk what is known in IT as GIGO.
Regards
John H.
Competing interests: None declared

Re: Re: Just a thought. 21 October 2004

John Stone,
none
London N22
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Re: Re: Re: Just a thought.

Once Adam Jacobs professed to be interested in what causes autism including by implication MMR [1] but his latest contortion is to argue that autism - which is a non-specific condition - gives rise to persistent measles virus. Apart from the insult to many parents who have watched their children become ill and regress after MMR, it is hard to see how he can now argue that there should not be a rigorous clinical investigation into what causes what. Once he professed to be interested in evidence based medicine [2], now he makes it all up on the hoof, preferring an explanation which is so far held by no one else to one which is widely held by many on the evidence of their senses.
[1]'Re: Re: Re: Re: Failure of the medical profession to engage in debate' http://bmj.bmjjournal.com/cgi/eleters/328/7442/733#62155
[2] 'Re: Complete and total confusion in the population' http://bmj.bmjjournals.com/cgi/eletters/328/7437/421-a#61031
Competing interests: Parent of an autistic child

Re: The Smeeth Report 21 October 2004

Michael D Innis,
Director Medisets International
Home 4575
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Re: Re: The Smeeth Report

Editor,
The report of Smeeth et al[1] documents the Immunization status of Autistic and Non-autistic children, matched for age, sex and general practice as follows
Total number of Autistic children 1294 Autistic children immunized against MMR 1010 Total number of Non-autistic children 4469 Non-autistic children immunized against MMR 3671

With these figures their Interpretation should not have been �Our findings suggest that MMR vaccination is not associated with an increased risk of pervasive developmental disorders.�
They should have been more positive and said, �Our findings definitely suggest that MMR vaccination is protective against pervasive developmental disorders.�
Is that not what their results show?
Michael Innis
Reference. 1. Smeeth L, Cook C, Fombonne E et al; MMR vaccination and pervasive developmental disorders: a case control study Lancet (2004);364:963-69
Competing interests: None declared

Just a bigger thought. 21 October 2004

Hilary Butler,
freelance journalist
home 1892, New Zealand.
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Re: Just a bigger thought.

Dear Sir,
The causation of autism after MMR is known, Mr Jacobs. And its been proven.
But not in ways the medical profession wants to hear. That is why whenever someone suggests a tiny idea like "lets link the vaccine virus with the condition" we get red herring back like "lets not confuse causation..."
How is it then, Mr Jacobs, when a few hours after an antibiotic is given to me, I start to choke, I can't breathe and my face swells up, after I come around from the fairly brutal treatment that keeps me alive, that I am told it is the antibiotic? I am told not to have it again. (I am now at the point where I can't have any antibiotics at all, and haven't had any for 26 years.).
Actually, the problem isn't the antibiotics. After all, lots of other people can have them no problem. The problem is me, my body.
But I wear a medic alert which screams out to paramedics and doctors "Don't do this to this woman."
If I avoid antibiotics I am fine. No problem.
Yet, when it comes to the vaccines, its never the vaccine that has to be avoided is it? Why is it so hard for medical people to assign causation to a vaccine?
Does the medical profession even understand the new born's immune system? NO.
Does the medical profession even understand how vaccines work? NO.
http://www.eurekalert.org/pub_releases/2000-05/NS-Whal-2305100.php
Quotes <<<<< Vaccines work simply by producing antibodies, right? Well, probably not. And this misconception coupled with basic ignorance of how they do work is stalling the urgent quest for an AIDS vaccine, claim leading HIV researchers. They say no one has bothered to find out how highly successful vaccines like polio, measles and hepatitis B actually protect people from disease.
"I'm amazed by the amount of basic science we don't know," Philippe Kourilsky, director of the Paris-based Pasteur Institute, told the meeting: "We've had many successful vaccines over the past decades but we've missed a chance to see how these vaccines work."
The assumption that successful vaccines work by simply producing antibodies is almost certainly wrong, (talking about the Hep B vaccine...) The vaccine probably stimulates some protective effect relying on killer T cells. But no one knows how it does it or what exactly the process is-even though the vaccine has been widely used for nearly ten years>>>> /end quote
I have never met one Autistic child that doesn't have totally battered immune perameters. But most immunologists just scratch their heads, and have NO IDEA what some of the immunological abnormalities mean.
Which comes first? The vaccine (antibiotic) reaction, or the immune dysregulation that might have triggered it?
I know all about this personally, because after a rubella vaccine, within three weeks, I had arthralgia, which turned to permanent arthritis. It was only after 13 years, when the arthritis got so bad, that immunological tests showed I had an immunodeficiency. Of course, the "reaction" to the vaccine was blamed on the immunodeficiency. It was supposedly autosomal recessive, but tests showed that no-one else in the family had it. And I was not the milkman's daughter.
When I found out about the immunodeficiency, I started studying nutrition and quackery, since the Vioxx predecessors did not appeal to my idea of "curing" the problem. What doctors have to offer, simply 'puts a lid' on the problem, and when you take the lid off, it comes right back up, snarling and screaming.
Quackery got rid of my arthritis in three months. With a caveat. I have to continue on a specific mineral and vitamin regime based around a mineral rich diet, organic foods only. If I stop it, within about four to six months, I start to feel "sand" in the joints...
But I also know this. I will never have another vaccine, for the same reason as I will never have another antibiotic. Because I know that without antibiotics I will at least have a chance of living. And without any more vaccines, I will have a better chance of avoiding things like arthralgia and arthritis.
So why is it so hard to look at children, who get autism after vaccines in the same way? and if they are shown to have high levels of viremia with vaccine virus, and evidence that the body isn't dealing with it, why is it so hard for you to accept that the MMR might actually "cause" autism, just as antibiotics could well kill me?
Hilary Butler.
Competing interests: I got arthritis following the rubella vaccine.

Re: Re: Re: Hypothetical MMR Survey 21 October 2004

Adam Jacobs,
Director
Dianthus Medical Limited, London SW19 3TZ
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Re: Re: Re: Re: Hypothetical MMR Survey

I had already responded to most of the points Heptonstall made in the criticism of Smeeth et al that he refers to. However, on re-reading his criticism just now, I see there are one or two new points that I hadn't responded to. I'll number them as per Heptonstall's original list.
3. Get hold of any good statistics textbook and look up the concepts 'significance' and 'multiple testing'.
4. The study never claimed to investigate DTP vaccination.
5. If regressive autism exists and if it is caused by MMR vaccination, then it must be very rare, otherwise it would show up in the overall statistics. It's true that Smeeth et al's study can't rule out the possibility that a tiny subset of children have MMR-induced autism, but if such a group exists, it is way too small to explain recent increases in the population prevalence of autism.
Competing interests: As stated previously

Re: Re: Re: Hypothetical MMR Survey 21 October 2004

Adam Jacobs,
Director
Dianthus Medical Limited, London SW19 3TZ
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Re: Re: Re: Re: Hypothetical MMR Survey

John Stone is quite correct to point out that I replied to only one of four responses. If only all anti-vaccinationists were able to interpret the evidence before them in such an objective, unbiased, and quantitative manner.
John Heptonstall's response of 19 October actually made some very interesting points, which deserve a more considered response than I have time to write at the moment. But I hope to get on to it soon.
As for the other responses to which I did not reply, I will always have better things to do with my time than respond either to points I have responded to many times before or to random ad hominem rantings.
Competing interests: As stated previously

"I have a dream ....." 21 October 2004

E J Northey,
Parent of an autistic child
Guernsey
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Re: "I have a dream ....."

I write on behalf of all the parents whose children have developed late-onset autism since the late 1980s.
"I have a dream" (1) ..... please share my dream with me .....
That a medical research team in the United Kingdom would investigate exactly what has happened to the ever-increasing number of children being diagnosed with autism in this country.
Ideally, this team would carry out blood tests, chromosome tests, urinary analysis for the presence of opioid peptides (2), MRI scans, bowel function tests, coeliac disease tests (3), tests for heavy metal toxicity and nutritional deficiencies, etc. - you're the doctors, which tests should also be included? Taken into account in the research would be statements from other involved professionals and also the parents who often have photographs and camera-dated camcorder footage showing their children's descent into late-onset autism. Where possible, family medical histories would also be taken. If, as we are told, autism is genetic then there should be clear indications in preceding generations.
If it was thought too difficult to find these children, then website and postal appeals to the membership lists of the National Autistic Society (4), JABS (5) and Allergy Induced Autism (6) should provide enough children to carry out at least a pilot study. Many parents of autistic children would dearly love to participate in clinical research into the causes of autism - why aren't we being asked to do this? At the risk of asking the blindingly obvious, why is this research not being carried out already?
Why do we need any more epidemiological studies of medical records? Why aren't we directly examining the autistic children themselves and reporting on what is found? When will the Medical Research Council allocate funds for the clinical examination of autistic children as outlined above?
There's my dream. Can anybody out there tell me it might come true someday?
Competing interests: Parent of a child with late-onset autism.
(1) Speech of Dr. Martin Luther King Jnr., 28th August 1963, Washington D.C. (www.mecca.org/#crights/dream)
(2) The Autism Research Unit at the University of Sunderland (www.osiris.sunderland.ac.uk/autism)
(3) Undiagnosed coeliac disease at age seven: population based prospective birth cohort study. Bingley et al. (www.bmjjournals.com/cgi/content/full/328/7435/322#SEC2)
(4) National Autistic Society (www.nas.org.uk)
(5) JABS (Justice, Awareness and Basic Support)(www.jabs.org.uk)
(6) Allergy Induced Autism (www.autismdiet.co.uk)
Competing interests: Parent of a child with late-onset autism

I AM NOT AN ANTI-VACCINATIONIST - PLEASE RETRACT 21 October 2004

John Stone,
none
London N22
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Re: I AM NOT AN ANTI-VACCINATIONIST - PLEASE RETRACT

I am not an anti-vaccinationist: I think it is worth making the point. There are people who might loosely be called "naturopaths" who contribute to the Rapid Responses who object in an ideological way. Others may simply feel that something which may be of benefit is being employed in too widespread and indiscriminate a manner, and without proper safeguards. Pharmaceutical products are supposed to undergo proper trials and be properly monitored. This is blatantly not happening, and an opaque survey like the one by Smeeth et al is worthless: its conclusions ultimately unverifiable. When Adam Jacobs endorses it - quite apart from the evident flaws - he takes everything on trust.
When Sir Liam Donaldson and Dr David Salisbury start to call publicly for the full use of the yellow card scheme in relation to vaccine, when the Chair of the Joint Comittee on Vaccination and Immunisation Prof Michael Langman ceases to receive payment from Merck [1] and the committee becomes free of interest, when the General Medical Council abandons hearings against Andrew Wakefield and Jayne Donegan, and Dr Wakefield is invited back to pursue his research at the Royal Free Hospital in Hampstead, I might begin to regain my faith in the integrity of the system.
Let's stop pretending everything in the garden is rosy.
[1] Sunday Times and Sunday Telegraph 15 August 2004.
Competing interests: Parent of an autistic child

Re: "I have a dream ....." 21 October 2004

MC Feliciello,
n/a
Leeds
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Re: Re: "I have a dream ....."

Many overlapping conditions are now sheltered under the umbrella term "Autism", a rapidly growing population in fact.
This "shelter", this umbrella term, what does it really tell us about the real and significant differences between those categorised as such, their presentation of the triad of impairments and how if at all it relates to underlying health or potential aetiology.
As E J Northey comments in her personal plea for sanity(1), how on earth one can hope to make any headway without examining this specific population in clinical terms is beyond me.From a parental viewpoint, many tests and assessments are available to me, should I have the resources to pursue them privately, but like many, I don't and can�t. Unless there is a co-ordinated attempt to look at the children in question, even those that can follow this route are marginalised, along with their results.
Epidemiology can be a useful tool, but when you are working with an Autistic population so diverse, with so many sub-groups, it's little more use than looking through a telescope at the wrong end to view the moon.
mcfeliciello@yahoo.co.uk
(1) E J Northey Rapid response to BMJ 21/10/04 �I have a dream��
Competing interests: parent of child diagnosed ASD

Re: Re: Just a thought. 21 October 2004

John P Heptonstall,
Director of The Morley Acupuncture Clinic and Complementary Therapy Centre
Leeds LS27 8EG
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Re: Re: Re: Just a thought.

Sir
Hilary Butler's suggestion is so eminently sensible (and Adam Jacob's so nonsensical) that one realises that failure to follow such protocols must be accompanied by a desire not to seek the truth.
The problem governments and vaccinators face, knowing that there is now overwhelming evidence from the public as winesses and victims supported by clinical work from people like Wakefield, O'Leary and Singh, et all, is that owning up to responsibility for the mass degradation of public health one sees from vaccination that they are responsible to the public for must never be brought to light; the best way to obfuscate therefore is to show a willingness to 'do science' whilst avoiding ever having to face the argument about 'causation', so epidemiology is their answer - governments can be seen to be 'doing science' which, by definition, has nothing to say about causation.
As for vaccine virus studies in sick people, it's obviously not rocket science and is done regularly for common viruses - the same process has been done to locate vaccine viruses; the problems for government and vaccinators is that it would reveal
1. Just how prevalent vaccine viruses really are in our communities
2. Just how prevalent vaccine virus diseases are, of what type and how they manifest, that beset our communities
3. Who is responsible
and that won't do will it?
Regards
John H.
Competing interests: None declared

Re: Re: The Smeeth Report 21 October 2004

L. Travis Haws,
Dentist
Lakewood CO 80228
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Re: Re: Re: The Smeeth Report

Editor: As follow up to Michael Innis' response, it seems to me the results can also be interpreted as: 1) of 1,294 autistic children, 78% were immunized against MMR and, 2) that of 4,581 children immunized against MMR, 22% have autism! Now could someone please show us the autistic rates among a non-immunized population? Or is that too difficult?
Seems like, while all along MMR has been proven to be causally linked to autism via Challenge-Dechallenge and Challenge-Dechallenge-Rechallenge (CD and CDR), once again the epidemiology junk the "experts" hang their hat on doesn't hold their hat...or their coat.
Competing interests: None declared

Re: Re: Re: The Smeeth Report 22 October 2004

Nicholas Bennett,
Infectious Disease Postdoc/Clinician
Department of Pediatrics, University Hospital, Syracuse NY
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Re: Re: Re: Re: The Smeeth Report

L Travis Haws' calculations leave a lot to be desired: the study population is not representative of the general population, or else 22.4% of all kids would have autism!
1294 of a total of 5763 kids in the study.
It is clearly only designed to compare relative risks of autism within the treated:untreated groups, and not between them. A weighted study sample would have had 761,176 non-autistic kids for 1294 autistic children (assuming a 17 per 10,000 rate of autism). There would be 625,258 non-autisic kids given the MMR. The total number of kids getting the MMR would be 625258+1010 = 626268
Therefore, the rate of autistic kids getting the MMR is 1010/626268 which is around 16 per 10,000. This does suggest that MMR is actually protective for Autism, since the overal population rate is 17 per 10,000. The rate of autism in the non-MMR group would be 284/134908 = 21 per 10,000.
For what it's worth. This doesn't detract from the anecdotal evidence that SOME kids show a temporal association between vaccination and some kid of regression syndrome, which to my non-psychiatrist mind doesn't really sound like autism anyway - isn't that a developmental delay rather than a regression...like Retts? Having read a lot recently on the MMR/autism story I am of the opinion that (a) overall, the MMR doesn't increase the risk of autism (b) something IS going on, in a select subset of patients, (c) this subset MIGHT have something triggered by a measles exposure, either wild-type or vaccine.
I do not think that large-scale studies will answer the question, since the data (such as that above) argues against any effect. Coming from an originally skeptical position, I am now of the opinion that something might well be going on, but I still consider that on the whole the MMR is safe. If there is a subset of the population who are susceptible in some way to a trigger, be it the MMR or not, then it would be well worth finding that out. Somehow...and giving the shots individually rather than as a triple vaccine won't necessarily make a blind bit of difference.
Nick Bennett njb35@cantab.net
Competing interests: None declared

Re: Re: Re: Re: Hypothetical MMR Survey 22 October 2004

John P Heptonstall,
Director of The Morley Acupuncture Clinic and Complementary Therapy Centre
LS27 8EG
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Re: Re: Re: Re: Re: Hypothetical MMR Survey

Sir
Might I suggest that Adam Jacobs gets a good dictionary and looks up the concepts "had" and "responded".
Jacobs has not even begun to respond to my critique of Smeeth et al, he got stuck on his unprovable "1% hypothesis" that I easily refuted in that critique - hence he continues to avoid all issues except his responses which again are so easily refuted:-
3. The "significance" of my point being that Smeeth et al's "insignificant" risk is still a risk that may become "significant" if the confounders I have introduced in my critique are accurate.
4. I never said Smeeth et al claimed to investigate DTP vaccination - I said it should have. Without that investigation/analysis alone Smeeth et al is probably doomed for reasons I gave in my critique.
5. No one expects or suggests that regressive autism will answer for the rapid increase in incidences of ASDs - it is probably a small part of the whole, a part that Smeeth et al not only could not find, but that in not being able to find is probably, by fault of design, incapable of finding all other small parts that make up the whole ASD continuum.
For example, evidence exists to suspect M, MMR, MR, MMR2, DTP, DT vaccines in the development of ASDs.
1. Singh et al, Wakefield et al and O'Leary et al favour measles virus and measles vaccine virus as cause.
2. Common sense favours Rubella vaccine virus as a possible cause due to the already established link between autism and congenital rubella; vaccine viruses cause illness in vaccine recipients and can infect contacts of that recipient so autism might result from rubella vaccine virus in a post natal recipient of MMR, or in the new born of a pregnant female who was infected by that MMR recipient during 'infective' state (eg mother or other close pregnant contact).
3. DTP/DT is suspected of causing ASDs through mercury content.
None of these have been ruled out as causes because epidemiology can say nothing of cause.
A major problem with statistical analysis (and Jacobs will probably bear me out on this) is that probability cannot answer the question "who did what to whom?". It might suggest who might have, but also has to suggest who might not have. So if one of 12 people at a scene shot a victim and stats knew that one carried a gun, depending on the question it was asked stats could say there's a 1 in 12 chance one of them shot the victim; it could say there's a strong probability the gun carrier shot the victim; or it could say "there's an 11 to 1 chance no one shot the victim" - presentation may be reasonably expected to be dependent on the competing interests of the statistician.
Regards
John H.
Competing interests: None declared

Objective Correlative? 22 October 2004

Dr. Herbert H. Nehrlich,
Private Practice
Bribie Island, Australia 4507
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Re: Objective Correlative?

Excellent point by MC Feliciello. It seems to me that she is still angry, which is a very good sign and shows that excess cynicism has not yet taken hold of her.
Epidemiology, of course is a tool of very limited usefulness, although this does not stop white- coated experts in ivory towers from using it shamelessly to prove a point and as a means to a lucrative in- or outcome. Put bluntly, epidemiology is simply correlation, which simply is apparent association. It never is, on its own, a cause and effect signal.Allow me to briefly tell you about the situation on my island to prove a point about epidemiology: We have a population of 19,000, with a significant percentage of older people who, like elsewhere, tend to suffer from illnesses for various reasons and aetiologies.
There is a large number of patients who have skin cancers, mostly SCC's and BCC's, and a special skin cancer clinic has recently been opened. There is also a seemingly disproportionate 'glut' of cataracts and this is being addressed by modern medicine.
Since the percentage of these conditions appears to be significantly higher here than in the neighbouring 'big city' of Brisbane it stands to reason that causative factors involved would have a stronger presence on my turf.
Epidemiology has allowed me to solve the puzzle. There are several thousand traffic lights in the big city, NONE on our little island. It has got to be the spectrum of light that is responsible.
What is important in this discussion is how autism and other socially important issues are 'handled'. Yes, clinical evaluation is crucial, I would have thought this obvious, yes, the financial resources ought to be available to everyone. But this isn't so, and that dates back to the time when someone decided that this unfairness was going to be our social conscience.
Experts will tell you that there is only so much money to go around and not everything can be done the way it ought to be done.
But rest assured that when those experts sit in the pub having a few of the more expensive ones they won't be muttering "suffer the little children" .
Competing interests: None declared

The most troubling thing about the Smeeth study 25 October 2004

John Stone,
none
London N22
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Re: The most troubling thing about the Smeeth study

Before we start to argue too earnestly over the data in the Smeeth study I think it is worth returning to two points I made when it first appeared. The first is that the study was presented both in its introductory material - and as the main story on the BBC news - as being based on a database of high quality, yet all we can deduce from the information available is that the General Practitioners Research Database only had data on autism and pervasive development disorders of the lowest grade. Yet seven scientists laboured over this project for three years.
The other point is that its claims are not independently verifiable. I recall that Jackie Fletcher of JABS requested that the raw data be made available when interviewed with Prof Smeeth on the BBC news on 10 September, and nothing has been done.
Certainly, unless we know more it cannot be held to be of any scientific value.
"Yet more smokescreen" 17 September 2004 http://bmj.bmjjournals.com/cgi/eletters/329/7463/411#74532
"Adam Jacobs response" 20 September 2004 http://bmj.bmjjournals.com/cgi/eletters/329/7467/642#75031
""We can now move on..": Oh no you don't Prof Smeeth!" 17 September 2004 http://bmj.bmjjournals.com/cgi/eletters/329/7467/642#74567
Competing interests: Parent of an autistic child

Re: Re: Refutation of Madsen in the Journal of American Physicians and Surgeons 29 October 2004

Adam Jacobs,
Director
Dianthus Medical Limited, London SW19 3TZ,
Matthew L Grove
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Re: Re: Re: Refutation of Madsen in the Journal of American Physicians and Surgeons

We are grateful to Jane Orient not only for her journal's laudable policy of open access, but also for pointing out that letters to the editor are welcomed.
We have recently submitted a letter to the Journal of American Physicians and Surgeons in response to the article by Goldman and Yazbak, in which we point out the specific errors of logic in that article. We are pleased to hear that JAPS is not opposed to vaccination on principle, and look forward to seeing our letter in print.
Competing interests: As stated previously

Re: MMR the facts: the policy continues to fly without safety checks 12 December 2004

John Stone,
none
London N22
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Re: Re: MMR the facts: the policy continues to fly without safety checks

Just to note that at some point in the past two months someone at the Department of Health had the good sense and discretion to remove from the site this compromising piece of advice to disregard serious adverse reactions. But it is more than a little late.
Competing interests: Parent of an autistic child

Re: Re: Re: Refutation of Madsen in the Journal of American Physicians and Surgeons 31 December 2004

John Stone,
none
London N22
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Re: Re: Re: Re: Refutation of Madsen in the Journal of American Physicians and Surgeons

Adam Jacobs and Matthew Grove's letter to the Journal of American Physicians and Surgeons can now be viewed at:
http://www.jpands.org/jpands0904.htm
together with a response from Gary Goldman and Edward Yazbak, and a further very interesting commentary on the Madsen paper by Jeffrey Trelka and Brian Hooker. According to Jacobs's declaration:
"AJ's company regularly provides consultancy services to a variety of pharmaceutical companies, some of which make vaccines, including SmithKline Beecham and Aventis Pasteur".
Jacobs does not note that these two companies are manufacturers of MMR, although many will instantly recognise this (Merck, however, is the best known in the US). Jacobs is also unspecific about the nature of the consultancy services his company provides. For a more detailed account of this see his Rapid Response 'In defence of medical writers' (28 October 2004):
http://bmj.bmjjournals.com/cgi/eletters/329/7472/0-g#82383
and subsequent posts by Jacobs and myself. It is noteworthy that while Madsen et al have been silent in the defence of their paper in the two years since its publication, Jacobs and Grove have been increasingly exercised over the matter.
See also my Rapid Response 'A letter the Lancet failed to publish' (22 December 2004):
http://bmj.bmjjournals.com/cgi/eletters/329/7467#90113
Competing interests: Parent of an autistic child

Re: Response to Carol Johnston. 3 January 2005

C Johnson,
parent
LA9
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Re: Re: Response to Carol Johnston.

Peter Flegg states:
"There is even a genetic basis for some of these "failures"- some individuals can actually have a specific genetic defect in measles antibody production."
Does this not lend weight to the argument against the indiscriminate mass vaccination programme? What other genetic "failures" might be found if politics would only let the research be done? One that makes a few of us more sensitive to mercury toxicity than others? One that causes a few of us to mimic neonatal Rubella induced neurological damage post MMR? One that makes a few of us susceptable to Measles induced neurological damage post Measles/MMR vaccination? Think what we might discover and prevent one day...
Meanwhile the "collateral damage" (i.e. ruined lives) of the one-size -fits-all programme continues to taint what good it has achieved.
C Johnson (not Carol Johnston)
Competing interests: None declared

Refutation of Madsen in the Journal of American Physicians and Surgeons and Adam Jacobs's interests 5 January 2005

John Stone,
none
London N22
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Re: Refutation of Madsen in the Journal of American Physicians and Surgeons and Adam Jacobs's interests

I think the point is worth stressing that in his 40 or so posts on Rapid Responses regarding vaccination and autism Adam Jacobs has never (a) declared specific links with Smith Kline Beecham and Aventis Pasteur or (b) been clear about the nature of the services he provides for his clients i.e. writing medical papers. But he was sufficiently motivated in writing to Journal of American Physicians and Surgeons to declare his specific links to MMR manufacturers for the first time, which he should certainly have done earlier in Rapid Responses.
Furthermore, following his letter "In defence of medical writers" [1] in which his principal point was that medical ghost writers were often named on papers, he failed twice to respond to my published challenges to list any papers on which he was named, or of which he was author. I submit also that he should have been clear about the nature of the services he provided to drug companies and other clients when writing on the topic of autism and vaccination both in BMJ and Journal of American Physicians and Surgeons. Lastly, I note that he terms authoring medical papers as "providing consultancy services to a variety of pharmaceutical manufacturers" [2], an odd turn of phrase unless of course he is referring to still other services which we do not know about.
This is all very interesting but I am still not sure we have got to the bottom of it.
[1] 28 October 2004, http://bmj.bmjjournals.com/cgi/eletters/329/7472/0-g#82383 and following.
[2] Declaration in Journal of American Physicians and Surgeons vol 9 no 4 p.100 http://jpands.org/jpands0904.htm
CORRECTION. The full URL for my response 'A letter the Lancet failed to publish' (22 December 2004) mentioned in my previous post should have been http://bmj.bmjjournals.com/cgi/eletters/329/7467/642#90113
Competing interests: Parent of an autistic child

Where are the named authors of the beleaguered Madsen and Smeeth papers? 7 January 2005

John Stone,
none
London N22
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Re: Where are the named authors of the beleaguered Madsen and Smeeth papers?

Once again we had to put up with Dr Evan Harris MP on the radio yesterday morning (5 January) denouncing concern about the safety of the MMR as discredited and "bad science" [1]. Yet the remarkable fact is that to the best of my knowledge these two papers which form the bulwark of the British Government's scientic defence - government sponsored studies supporting government policies - have never been defended in print by the named authors against the most scientifically disciplined, and principled criticisms. Nor have the journals which originally published the papers allowed any of these criticisms to be aired. By any objective academic criteria it is the Government epidemiology which is the "bad science", and which today stands completely condemned.
[1]http://news.bbc.co.uk/1/hi/health/4147969.stm
Competing interests: Parent of an autistic child

Re: Where are the named authors of the beleaguered Madsen and Smeeth papers? 10 January 2005

John F McCleary,
Former Government lawyer
Grosmont,
Monmouthshire NP7 8LR
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Re: Re: Where are the named authors of the beleaguered Madsen and Smeeth papers?

I support the letter posted by John Stone. If the authors of these studies consider that the criticisms of those studies are wrong, they should say so and explain why.
Competing interests: Parent of ASD child

Madsen, Come Out, Come Out from Where Ever You Are! 10 January 2005

Paul Shapiro,
Grand-Dad
Retired Engineer
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Re: Madsen, Come Out, Come Out from Where Ever You Are!

I have been following the thread of discussion since the publication of the Madsen et al paper on the MMR vaccine not having a causal relationship to the onset of autism. There has been heated discussion on both sides of the position the paper presented; but only Goldman and Yazbak have published a paper that challenges the assumptions and statistical analysis of the data.
Months have past and Madsen et al have not responded to the challenge. Are they hiding under Rock? Or is this an admission that they got it wrong. I know for sure, if it were me, after all that hard work, if I believed I got it right, I would defend my work with all my strength. If I learned that I got it wrong I know I have the courage to admit my errors.
Madsen and coauthors please reappear and let the world know where you stand!!!
Competing interests: Grand-Dad of a Vaccine Damaged Beautiful Child

Re: Where are the named authors of the beleaguered Madsen and Smeeth papers? 10 January 2005

Michael D Innis,
Director Medisets International
Home 4575
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Re: Re: Where are the named authors of the beleaguered Madsen and Smeeth papers?

Editor,
Referring to the work of Dr Wakefield and the MMR vaccine Dr Harris said "We now know that was a nonsense story. Not only is MMR an effective and safe vaccine, but the controversy around it was fabricated on the basis of not just wrong science, but bad science." [1]
Dr Harris may believe the MMR vaccine is safe but to prove the �controversy around it was fabricated� perhaps he can address the �Yazbak challenge�[2]:
�To prove me wrong �.. show me:
ONE normal child who has evidence of both MMR antibody and Myelin Basic Protein auto-antibodies in his serum or his CSF
Or
ONE child who regressed after MMR vaccination and who does not have one of the following: The gut findings described by Wakefield, a suggestive pattern of urinary polypeptides, elevated serum measles virus antibody, MMR antibody or Myelin Basic Protein auto-antibodies.�
JUST ONE NORMAL CHILD with the above mentioned features is all that is required Dr Harris.
��.
Now hear the Silence.
No more talk of �fabricated� wrong science or bad science from Dr Harris or anyone else.
Michael Innis
References:
1.BBC News Wednesday 5th January 2005 10.10 GMT
2.Yazbak F.E A black spot�on a Great Journal Rapid Responses 1st January 2005.
Competing interests: As previously declared

So Unusual 11 January 2005

F. Edward Yazbak,
Pediatrican, Director
TL Autism Research, Falmouth, Massachusetts 02540 USA
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Re: So Unusual

On November 16, 2002, Janice Hopkins Tanne reported �MMR vaccine is not linked with autism, says Danish study� [BMJ 2002;325:1134 ] (1) thus endorsing the findings of the CDC-funded Madsen study that had just been published in the NEJM. (2)
The Tanne article precipitated FIVE rapid responses in the BMJ until September 2004 when Goldman and Yazbak published �An Investigation of the Association between MMR Vaccination and Autism in Denmark� (3) in the Fall Issue of the Journal of American Physicians and Surgeons (JPandS) and compared the prevalence of autism and autistic disorders in Denmark before and after the introduction of MMR vaccination.
In a commentary in that same issue, Stott, Blaxill and Wakefield (4) supported our finding, namely that autism had indeed increased in Denmark after 1987, when the MMR vaccination program was inaugurated. The authors also quoted S. Suissa, Professor of Epidemiology at Mc Gill University who directly contradicted Madsen�s findings relative to MMR vaccination and autism.
There have been, in the last four months, over ONE HUNDRED rapid responses to Tanne�s article in reaction to our investigation but none from Dr. Madsen. Drs. Rumbold, Jacobs and Grove were particularly angry with us and the Journal of American Physicians and Surgeons.
Dr. Madsen also chose not to write to JPandS but Drs. Grove and Jacobs did and their letter was published in the following issue of the Journal. (5) In their letter, Dr. Jacobs disclosed for the first time some liaisons with SmithKlineBeecham and Aventis-Pasteur. We were happy to respond (5) and pointed out, among other things, that Madsen himself reported an increase in autistic disorders in Denmark in the nineties. (6)
A detailed and most informative letter by Trelka and Hooker criticizing the Madsen conclusions was also published in that same issue of JPandS. (5)
The findings of the Madsen study were a major argument for discontinuation of legal aid and the abrupt ending of MMR litigation in the UK. They also influenced the decision of members of a special committee of the IOM who decreed in February 2004, that an MMR-autism connection did not exist.
Since his conclusions and findings were questioned in the Journal of American Physicians and Surgeons, there has been no reaction from Dr. Madsen, his declared co-authors or his sponsors. This is rather unusual. Authors have always personally responded to challenges in peer-reviewed journals.
As the Madsen study is starting to fade away, like other epidemiological studies before it, it is even more unusual that its defense has been delegated to Dr. Jacobs.
The epidemic of regressive autism on the other hand has not relented (7, 8) and while clinical studies looking at auto-immune causes remain limited and under-funded, a whole generation of children is being lost.
Because it is so unusual for the CDC to fund a study in Denmark, some aspects of the relationship between the parties involved deserve attention.
On December 10, 2002, Walter O. Spitzer, MD, MPH, FRCPC, Emeritus Professor of Epidemiology at Mc Gill University testified about the just- published Madsen MMR study at a Special Session of the House Committee on Government Reform. Professor Spitzer had several issues with the study and its funding by the CDC: �The concerns are about the process of funding, the interaction of sponsors with protocol formulation and approval, compliance with protocol, the role of investigators vis-a vis sponsors in the actual conduct of research and the input of CDC epidemiologists in the preparation of the report with its conclusions.�
Professor Spitzer also asked several questions: �Was there a protocol? Who approved it? Were there changes as the study progressed? Who approved the changes? Who monitored work-in-progress? Who approved the final report? Was there a Scientific Advisory Board? What exactly was the role of the CDC and its professionals?
To date, no one has attempted to respond or answer Dr. Spitzer's questions.
May be Dr. Jacobs can.
May be he will also be able to tell us what happened to Dr. Madsen.
References
1.http://bmj.bmjjournals.com/cgi/content/full/325/7373/1134/a
2."A population-based study of MMR and autism", Madsen KM, Hvlid A et al NEJM 2002;347:1477-1482
3.Goldman GS, Yazbak FE: An Investigation of the Association between MMR Vaccination and Autism in Denmark. JAmPhysSurg 2004; 9(3):70-75 http://www.jpands.org/vol9no3/goldman.pdf
4.Stott C, Blaxill M, Wakefield AJ: MMR and Autism in Perspective: The Denmark Story. JAmPhysSurg 2004; 9(3):89-91 http://www.jpands.org/vol9no3/stott.pdf
5.http://www.jpands.org/vol9no4/correspondence.pdf
6.Madsen KM, LauritsenMB, Pedersen CB, et al. Thimerosal and the occurrence of autism: Negative ecological evidence from Danish population- based data. Pediatrics 2003;112 (3Pt1):604-6
7.http://www.ewg.org/reports_content/autism/pdf/AutismAlarm.pdf
8.Yazbak FE. Autism in the United States: A Perspective JamPhysSurg 2003;8:103-107
Competing interests: Grandfather of a child with regressive autism

Re: So Unusual 17 January 2005

John Stone,
none
London N22
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Re: Re: So Unusual

You wonder why Janice Hopkins Tanne did not report this in the latest edtion of BMJ, rather than the Mayo Clinic study.
Competing interests: Parent of an autistic child

Re: Re: Where are the named authors of the beleaguered Madsen and Smeeth papers? 18 January 2005

Alan D Rees,
interpreter
Words AB
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Re: Re: Re: Where are the named authors of the beleaguered Madsen and Smeeth papers?

I went looking for the highly-paid Danes who fearlessly inject toxins into infants to discuss the demolition by Ulf Br�nell and myself of the first Danish MMR study. (NEJM refused to publish it so here it is, on the net: http://www.whale.to/a/branell.html or http://66.70.140.217/a/branell.html )
When I turned up at Statens Serum Institut with my vaccine-injured child so that we could discuss their work, they told the receptionist to tell me they would call the police. I said they were welcome to do so and that I would call the media so they could watch a vaccine-injured child being chucked out into the snow by vaccinators. And that was that.
I also issued a challenge to the Danes: if they really believe in their studies and really think that vaccines are harmless and that I and all the other victims are victims only of our own imaginations, they should let me vaccinate them with all the childhood vaccines, the dose being adjusted to their body weights, assuming an average weight at vaccination of 5 kilos. They would then be exposed to the same risks as the infants they vaccinate. They refused. I have repeated this offer to various people on a number of occasions and had no takers. Nobody in the world seems willing to do it. I shall now repeat the offer in the most illustrious forum possible: the BMJ. Let us sort out the vaccine controversy. Are any doctors willing to let me vaccinate them? Let us all gather at the offices of the BMJ, you can then roll up your sleeves and let�s see what happens to you.
The Danes may be shy, but this is where you will find me: alandavidrees@hotmail.com
Competing interests: Father of a vaccine-injured child.

Re: So Unusual - but where is the explanation? 27 January 2005

John Stone,
none
London N22
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Re: Re: So Unusual - but where is the explanation?

Should not Adam Jacobs and Matthew Grove finally explain - when there are such great interests at stake over this issue - why they stuck their professional necks out to such a degree, when the authors had abandoned the field and there was no apparent benefit to them in acting as proxy? Jacobs has still not disclosed his competing interest with Smith Kline Beecham and Aventis Pasteur in BMJ Rapid Responses, and we are still surely owed an explanation.
Competing interests: Parent of an autistic child