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 Jacob