Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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We have a duty of care to stop this programme
- richard m lindley (12 December 2003)
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Hear the Silence
- Raymond W. Gallup (12 December 2003)
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Re: We have a duty of care to stop this programme
- M C Feliciello (13 December 2003)
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We DO NOT have a duty of care to stop this programme
- L S Lewis (13 December 2003)
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Hear the silence
- JK Anand (14 December 2003)
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Stop this programme? No
- JK Anand (14 December 2003)
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Powerful anecdote
- Neville W Goodman (14 December 2003)
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The Emperor's New Clothes?
- Jenny L Robertson (14 December 2003)
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Wakefield's Lancet Paper
- Michael J Fitzpatrick (16 December 2003)
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Hear the Silence
- Lisa C Blakemore-Brown (16 December 2003)
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Re: Powerful anecdote
- Hannah Hutton (16 December 2003)
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Autism and Toxic metals
- Ellen C, G Grant (16 December 2003)
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Re: Autism and Toxic metals
- s m latta (16 December 2003)
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The hypocrisy of Michael Fitzpatrick
- Nigel J Thomas (16 December 2003)
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Answer to Hannah Hutton
- Neville W Goodman (16 December 2003)
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Clarification on one of the sources of evidence used in the televised debate
- Tom Jefferson (17 December 2003)
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Autism, epidemiology and toxic metals
- Ellen C G Grant (17 December 2003)
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Re: Hear the Silence
- C S Anton (17 December 2003)
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Reply to Jenny Robertson
- Neville W Goodman (17 December 2003)
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Re: Powerful anecdote
- John Phillip Heptonstall (17 December 2003)
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Re: We have a duty of care to stop this programme
- John P Heptonstall (17 December 2003)
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degrees
- Nottingham John (18 December 2003)
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Re: Dr Fitzpatrick and the Lancet Paper
- JK Anand (19 December 2003)
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I Am Glad "Hear the Silence" Was Aired
- Paul Shapiro (19 December 2003)
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No naive belief
- Neville W Goodman (19 December 2003)
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Re: No naive belief
- Deborah Kahn (21 December 2003)
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MMR, Christening and Cake
- William Pimm (22 December 2003)
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Has Dr Fitzpatrick omitted some conflicts of interest?
- Mark Davies (23 December 2003)
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Time to End the Pharma-Cartel
- Paul Lynch (23 December 2003)
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A question
- Adam Jacobs (23 December 2003)
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Re: MMR, Christening and Cake
- L S Lewis (23 December 2003)
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Let's Beat Up on Dr Wakefield!
- Paul Shapiro (23 December 2003)
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Re: Wakefield's Lancet Paper
- ELizabeth C Lucy-Jones (23 December 2003)
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Christmas Quiz
- Thomas Valentine (24 December 2003)
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Re: Answer to Hannah Hutton
- Alan Challoner MA (Phil) MChS (2 January 2004)
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Re: Re: Answer to Hannah Hutton, Dr Challenor's letter
- William Pimm (4 January 2004)
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Safety of MMR vaccine
- mrudula a phadke, Prasad Kulkarni, Pralhad Patki, Suresh Jadhav, Subhash Kapre (6 February 2004)
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Re: Re: Re: Answer to Hannah Hutton, Dr Challenor's letter
- Alan Challoner MA (Phil) MChS (8 February 2004)
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To the Point - Tapestries of destruction
- Lisa C Blakemore-Brown (9 February 2004)
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Re: To the Point - Tapestries of destruction
- Alan Challoner MA (Phil) MChS (10 February 2004)
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MMR/Autism link IS REAL
- Amelia Tyler (17 March 2004)
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Re: MMR/Autism link IS REAL
- Louise K Sutcliffe (18 June 2004)
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richard m lindley, SpR paediatric surgery sheffield children's hospital, s11 7ax
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The consensus of opinion from the reviewers in the week's BMJ is that "Hear the Silence" is a biased account of the MMR contoversy and the debate that follows is equally flawed by not taking a proportionate look at the evidence. As doctors, we have a duty of care to protect the health of children in the community. If parents watching this programme will be less likely to have their children immunised, and therefore run the risk of their children suffering serious and/or lethal complications of measles, then we should make every effort to protest against it. The contact details for Channel five are: email: dutyoffice@five.tv post: Duty Office Five 22 Long Acre London WC2E 9LY tel: 08457 050505 Incidentally, an article in the Guardian this week by Ben Goldacre effectively and systematically demolishes the "case" against MMR: http://www.guardian.co.uk/life/feature/story/0,13026,1103958,00.html I would urge BMJ readers to inform Channel Five of their mistake. Competing interests: None declared |
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Raymond W. Gallup, Founder, The Autism Autoimmunity Project and parent 45 Iroquois Avenue, Lake Hiawatha, NJ 07034 USA
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As a parent of an adult that was born normal and regressed into autism after receiving the measles-mumps-rubella (MMR) vaccine on April 28, 1986 (when he was a year and 3 months old), I'm glad that Hear the Silence will be aired on Channel 5 TV. I know Andrew Wakefield, MD personally and he is a terrific doctor as well as a terrific human being. He has risked his career to do the right thing for our children. He is a hero and those who oppose him show their lack of knowledge about real science and also a lack of integrity by putting the interest of the vaccine companies before that of our children. Our son, Eric, has colitis, elevated measles antibody titers, tested positive for myelin basic protein antibodies and T-cell abnormalities indicating an autoimmune disorder. James Oleske, MD of UMDNJ, Newark, NJ (world famous AIDS pediatric immunologist) and Vijendra Singh, PhD. of Utah State University both found the elevated measles antibody titers in Eric. Arthur Krigsman, MD of New York, who is replicating Dr. Wakefield's work found colitis in Eric. It says quite a bit when the Andrew Wakefield was sacked at the Royal Free Hospital in London, England and that Arthur Krigsman was prevented from doing his pathology work at hospitals in New York. It says that the people that are against the science that Dr. Wakefield and Dr. Krigsman are producing, do not want the truth to come out. It seems apparent that vaccine companies with their deep pockets control the medical community to the point that real science and children are sacrificed for the good of corporate profits. Also, those that oppose the science do not have an explanation for why children with autism have measles in the gut and/or elevated measles antibody titers in the blood. Competing interests: I have an adult with autism that tested for elevated measles antibody titers and colitis. Also, I'm Founder of The Autism Autoimmunity Project that funded Dr. Andrew Wakefield's independent research. |
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M C Feliciello, n/a Leeds
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Mr Lindley, I refer to your rapid response of 12.12.03 "If parents watching this programme will be less likely to have their children immunised, and therefore run the risk of their children suffering serious and/or lethal complications of measles, then we should make every effort to protest against it." Perhaps you might consider an alternate proposition. Would you consider the censorship of the film "Hear the Silence" from national screening an effective means to restore herd parental trust in public health policy? MCF Competing interests: Parent of an Autistic Child. |
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L S Lewis, General Practitioner Surgery, Newport, Pembrokeshire UK SA42 0TJ
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I think any medico-legal chappie should quickly declare that 'we as doctors' do NOT owe a 'duty of care' to such a nebulous and expansile group as "the nation's children".. But certainly I would agree that 'as a citizen' I owe both duties of conscience, and legal duties to the nation's children ( and all the world's children for that matter ! ).. 'As a doctor' I feel no doubt about my legal duty to seek VALID CONSENT, VOLUNTARILY GIVEN, AND FULLY-INFORMED. How does censorship of legal material in a free society achieve that ? Competing interests: Fully-informed consent VS. maximum vaccinations |
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JK Anand, retired Retired
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Dear Dr Fitzpatrick I did not see the TV programme. Nor did I listen to the debate in which you participated. However, there is nothing to stop you or anyone else, from preparing and presenting - even if only as an advert - a programme to counter the contents of the Channel 5 "drama". "Leading authorities" refusing to take part in a debate! Really. No one should assume that in this day and age, declamation from Whitehall will win converts. And, please, do not forget that Wakefield was just one of the authors of the 1998 paper - a paper which I have re-read a few days ago. I found it to be a very soberly written paper. I presume you did read it in full. Perhaps you could tell the readers where, in that paper, you found anything exceptionable? Dr JK Anand retired Competing interests: I sit on the fence, now. I was pro-MMR once. |
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JK Anand, Retired Retired
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We do not have a duty to stop this programme. We have a duty to see or hear the opposite point of view - if anyone cares to present one. If the programme were to be censored, I for one would feel that the government has lost the argument. And if no one presents the opposite point of view, I would assume that the opponents simply do not have a case. Could the vaccine manufacturers present their side of the case? Why are they silent? Dr JK Anand retired Competing interests: I was pro-MMR once. Now I sit on the fence |
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Neville W Goodman, Consultant Anaesthetist Southmead Hospital, Bristol, BS10 5NB
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Mr Gallup, I am sorry that you have an autistic child: it is a devastating experience and there is no doubt that we need much more research into why children develop autism and how best we can treat it and how best to ease the burden of affected families. But I want to ask you a question: why should it be in the interests of the medical profession and of the drug companies to suppress evidence that MMR causes autism? The only point of suppressing evidence of an ill- connection of this sort is to avoid the connection becoming public. Once the connection is public, then, if true, it is bound to become more and more obvious with the passage of time. Why should every single official body within medicine in the UK hold that MMR is not linked to autism? If the manufacturers of MMR thought – even only a little bit – that their product caused autism, they would cease making it. Dow Corning went into bankruptcy for a product – the silicone of breast implants – that did not even cause the auto-immune diseases that it was alleged to cause; the manufacturers of MMR know what would happen if MMR was shown to cause autism. Competing interests: None declared |
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Jenny L Robertson, Journalist SW15 5DP
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I do think anaesthetist Mr Goodman is being rather niave in his response. "If the manufacturers of MMR thought their product caused autism, they would cease making it...they know what would happen if MMR was proved to cause autism." Yes....quite, perhaps that is the point. The Department of Health also knows what would happen. Nobody likes getting egg on their face. Without wanting to get carried away with conspiracy theories, could this be a reason why "every single official body within medicine in the UK holds that MMR is not linked to autism." Commonsense would suggest that ANY medical intervention is going to carry with it an element of risk. The risk may be tiny, but nevertheless it exisits. It would be unlikely that a strong cocktail of drugs like the MMR, injected into babies, would not carry some risk of adverse reactions. Why not acknowledge that? It may well be that the pros of the MMR hugely outnumber the cons - one would certainly hope so. But denying that there MIGHT be a very small minority who could be adversely affected by the MMR seems rather silly. It is generally not sensible to ignore the voices of your consumers - in this case deeply concerned parents. In so doing the medical profession and the DoH are rapidly losing credibility. The US Government, by contrast, has acknowledged that vaccines can indeed cause serious adverse reactions and has set up a vaccine compensation body. Drug manufacturers pay into it, and the amount they pay varies according to the type of vaccine. These sums are presumably not plucked out of the sky and are a reflection of the fact that some vaccines are known to cause more adverse effects than others. Competing interests: None declared |
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Michael J Fitzpatrick, GP Barton House Health Centre, London N16 9JT
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Can I reassure Dr Anand that I have indeed read Dr Wakefield's February 1998 Lancet paper? (1) Perhaps I could draw his attention to some points of continuing importance. Dr Wakefield and his colleagues conceded that 'we did not prove an association between MMR vaccine and the syndrome described ['autistic enterocolitis']'. It would be more accurate to say that they did not even present any evidence for such an association. They merely noted that in 8 of the 12 cases they described, 'the onset of behavioural symptoms had been linked, either by the parents or by the child's physician with MMR vaccination'. It is clear that parents' inclination to blame MMR for their children's bowel and behavioural problems was likely to have been influenced by publicity for Dr Wakefield's work from 1995 onwards. Dr Wakefield became an enthusiastic listener to parents who attended his clinic because he was hearing an echo of his own views.(2) The authors invited epidemiological investigation of their hypothesis, suggesting that 'if there is a causal link between MMR vaccine and this syndrome ['autistic enterocolitis'], a rising incidence might be anticipated after the introduction of this vaccine in the UK in 1988'. In a number of studies, Professor Brent Taylor and colleagues investigated this question in North London and found no evidence for such a link. Further investigations of this potential association in other countries have also failed to confirm it. In response to the failure of the sort of epidemiological studies they invited in the Lancet paper to confirm their theory, Dr Wakefield and his supporters have moved the goalposts. Having once claimed that MMR was responsible for an epidemic of autism, they now claim that it is to blame only for a subset of cases too small to measure by epidemiological methods. Dr Wakefield and colleagues also indicated that 'virological studies are underway that may help to resolve this issue [the hypothesised link between MMR and 'autistic enterocolitis']'. In the course of 2002, Dr Wakefield on two separate occasions claimed that work about to be published by the Dublin virologist Professor John O'Leary would vindicate his hypothesis. Twice Professor O'Leary publicly repudiated Dr Wakefield's claims and indeed, when published, his work failed to convince anybody (apart from anti-MMR zealots and their solicitors) that the case for the link with MMR had been in any way substantiated. (3) Despite spending £15m in the attempt to produce some evidence of the MMR-autism link for the purposes of litigation, in not one single child has the link been shown to exist even to the satisfaction of the preliminary stages of the legal process (hence the recent decision by the Legal Services Commission to withdraw legal aid funding). Though Dr Anand considers the Lancet paper 'sober', this is not an adjective commonly used to describe the press conference at which it was launched. Dr Wakefield seized this occasion to propose that MMR be made available in its separate components (a measure for which there is no evidence whatever). This proposal was not publicly supported by any of his 12 co-authors and it was explicitly rejected by the three paediatricians on the team (Dr Simon Murch, Professor John Walker-Smith, Dr Mike Thomson). It would appear that the only co-author who continues to back Dr Wakefield is the adult neurologist Dr Peter Harvey. If Dr Anand can receive Channel5 then he still has a chance to see both the drama and the debate on Monday 15 December, from 9pm. I hope that, on reflection, he will get down from the fence, a most uncomfortable position for a GP, especially after retirement. Dr Michael Fitzpatrick 1. Wakefield A.J., Murch, S.M., Anthony, A., Linnell, D.M., Casson, D.M., Malik, M., Berelowitz, M., Dhillon, A.P., Thomson, M.A., Harvey, P., Valentine, A., Davies, S.E., Walker-Smith, J.A. (1998) 'Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children', Lancet; 351: 637-41. 2. Michael Fitzpatrick, 'MMR: fact and fiction', 11 December 2003, http://www.spiked-online.com/Printable/00000006E00D .htm. 3. Michael Fitzpatrick, 'MMR: the making of junk science', 5 July 2003, htttp://www.spiked-online.com/Printable/00000006D97 0.htm. Competing interests: I have an autistic son |
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Lisa C Blakemore-Brown, Psychologist UK
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I have seen this film before it is screened. I was advised that Dr Fitzpatrick was sitting behind me at the NFT and Dr Elliman was at the back of the theatre. Both spoke. So did I. I applauded the team for having the courage to make and show this film. A film which it has been necessary to make because parents who consider that their child has been affected by vaccine - whether the DPT or the MMR or both, possibly in an accumulative manner, have never been given a voice. Now they have. I also agreed with the portrayal of Dr Wakefield as a person who had been vilified and who had even had his phone tapped, because this has happened to me. I told the assembled company, including Dr Fitzpatrick, that I had also been vilified, had the phones tapped, the computer hacked into many times, false complaints, house ransacked, many other things, and even had my book (1) suppressed. Surely this is what was done to the Russian intelligentsia - I hope that sort of influence is not lurking behind all this! This damp squib of a book which registers hardly any sales - a row of noughts yet again on my recent Royalty statement - is not even about vaccines, but does include a reference to reactions to vaccine as a causative possibility, as part of a tapestry including medical vulnerability which could be linked to prematurity, for instance, and possible genetic susceptibility. In some cases a child may just not be well and at risk of reactions because of that. I make reference to Thimerosal, the Mercury derivative which is in DPT and linked in many studies which show a compromise of the immune system and I have been informed recently is also in the processing of MMR, though not listed a a product within it. In the book I also included a case study of `Lorelei` in which there had been a proven reaction to pertussis vaccine and the BMJ published this case after confirming details and gaining consent from the parents. (2) To make matters worse for myself I also discussed the false use of Munchausen Syndrome by Proxy and without a doubt there would be those who were very concerned that readers might make a link between vaccine reactions - etc - and the use of Munchausen Syndrome by Proxy as a cover up. Of course I did not directly refer to such a link, but you have to wonder. I am interested to know why Dr Fitzpartrick should not be enormously concerned as to why the voices of not just parents but also professionals should be silenced in a democracy. 1. Blakemore-Brown LC Reweaving the Autistic Tapestry Jessica Kingsley Publications. 2002. 2nd impression 2003. 2. Blakemore-Brown LC To the Point bmj 2001 Competing interests: I have consistently maintained that there are children who react to vaccines, develop allergies and get damaged by triple vaccines. |
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Hannah Hutton, Mother GU51
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Perhaps the best way to answer Mr Goodman’s question is to turn the question round – what would happen to the medical profession and the drug companies if evidence that MMR causes autism is NOT suppressed? The fact that they would lose all credibility plus it would leave the way open for massive lawsuits is enough to make sure that even the most blindingly obvious evidence must be suppressed. Why else would the class action against the three companies be effectively stopped; why would they make it as difficult as possible for samples to be obtained, etc.? These companies would suffer terribly if the evidence were made public, but they already know that which is why they make such big efforts to suppress it. If they were so sure of their product, then they could have offered to pay the legal costs in the court case. But of course they should have known there would be problems, especially in the case of a vaccine where long term studies have not been done and recent studies do their best to exclude affected children. There is no way they can afford to let any evidence on the link be made public – therefore a film like “Hear the Silence” is the only way that suspicion can be directed at people who want to suppress the truth. I would have thought that an anaesthetist in Bristol of all places would have had some understanding of the uncovering of evidence. Surely Andy Wakefield ought to be able to conduct his research without hindrance, or perhaps research that negatively impacts profits is unacceptable? Hannah Hutton Competing interests: Now a non-vaccinating mother after finding out about the risks of vaccinating the hard way. |
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Ellen C, G Grant, physician and medical gynarcologist 20 Coombe Ridings, kingston-upon-Thames, Surrey, KT2 7JU
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Richard Horton correctly described “Here the Silence” as a thoughtful drama. I agree. It was an excellent portrayal of a mother’s fight for her son’s health against institutional ignorance, research blocking, and complacency. For many years my dyslexic children had to be taken from school several times each week to attend “special remedial classes”. One of their teachers said, “If you don’t fight for your children, no one else will”. As part of that fight, I also wanted to know why. My colleagues and I were able to publish in 1981 and 1988 that dyslexic children had significantly higher concentrations of toxic metals in their hair and sweat than control children.1,2 These studies found higher levels of mercury, copper, cadmium and lead in the hair and sweat of the dyslexic children. Sweat zinc was severely deficient in the dyslexic children, being 66% lower than that for control children. This work suggests that zinc deficiency and high toxic metals together may form Andrew Wakefield’s missing co-factor. In the USA in particular, autistic children are treated repletion of essential nutrients, plus a low allergy diet milk and wheat-free diet, as highlighted in the film, and by chelating toxic metals. I found Kenneth Calman to be a very helpful Chief Medical Officer in my other battle is against the effects of the contraceptive hormones. He had personal experience in zinc and cancer research and organised for us a day long presentation at the Department of Health. Taking progestogens and oestrogens can cause zinc deficiency and children of mothers who have recently used hormones may also be zinc deficient. 1. Capel ID, Grant ECG, et al. Comparison of concentrations of some trace, bulk and toxic metals in the hair of normal and dyslexic children. Clinical chemistry 1981; 27: 879-81. 2. Grant ECG, Howard JM, Davies S, et al. Zinc deficiency in children with dyslexia: concentrations of zinc and other minerals in sweat and hair. BMJ 1988; 296: 607-9. Competing interests: Mother of two dyslexic children |
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s m latta, Director po16
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It is of note that with any other medication a list of reactions are known. This is true of any over the counter medication and a warning is always printed to that effect. A small minority of people will have an adverse reation and the large majority will benifit. What i do not understand is that when a child has a reaction to vaccination that the medical proffesion will not accept that this can occur. Vaccination for the greater population has health benifits but for the small minority the effects are catastrophic. With vaccination it is known that reactions can occur, if not then why after immunisation would we be told to stay in the waiting room for 15mins, is this not due to the fact that it is known that a baby can fit? Parents should be listened to when they feel that vaccination caused the ill health of a child, as parents they are that childs medical expert. Rather than the medical proffesion trying to say that this is not the case would it not benifit all to look into this situation and try and find the factor that makes some children at more risk of reaction than others? As a mother who has seen a vaccination reaction no-one will every tell me that the immunisation was not the catalyst at the minimum of my childs ill heath. I am not a medical expert but i am the expert of my children as every parent is. Could this just not be accepted as another grey area of medicine and looked into with the aim of trying to identify those most at risk? Competing interests: None declared |
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Nigel J Thomas, Graduate Securitas Cash Management
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It is amazing to read a review of a film which the reviewer calls a, 'crudely propagandist drama' when his own review is so blatantly a 'crudely propagandist review' that it is itself more a dramatisation than the film of which it was attempting a critique. We’ll skim over the patronising way Michael Fitzpatrick refers to Andrew Wakefield (who is, incidentally, a scientist more qualified than the general practitioner himself) as ‘St. Andrew’ and go straight on to the first mistake in the review in which Fitzpatrick states that the, ‘heroic Christine loses her high-flying banking job’ when in actual fact, she resigns. This is, I admit, a small point which I only mention as it makes me wonder how closely Fitzpatrick has paid attention to other ‘minor’ details in the rest of the film. He is obviously paying attention to something, as he notices that Juliet Stevenson does not lose her ‘sultry good looks,’ and seems to think that perhaps losing your looks is something necessary in a film portraying a ‘fight for justice.’ Would Fitzpatrick have given the film more credit if the heroine were played by a less aesthetically pleasing person, or does he feel that Juliet Stevens is too glamorous to be a ‘real’ parent? However Fitzpatrick does seems to think it a dramatisation that ‘the medical professionals she encounters (apart from Andy) are unsympathetic, pompous, and patronising.’ Perhaps if he had actually spoken to more parents himself, (or watched his own exchanges with a parent in the later debate) he would be less amazed. As the brother of two autistic children, I have experienced it first hand. Fitzpatrick goes on to say that, ‘It appears that the creators of this drama have listened exclusively to Dr Wakefield and his anti-MMR campaign supporters.’ Why does he write about what simply ‘appears’ to be the case, when he could have contacted the makers of the show to ask them? How can he say that the film can ‘compound the burdens of autism parents with the unwarranted fear’ and then not demand for the research in to the MMR to be properly, independently funded, so that the fears of parents may conclusively be found to be unwarranted or otherwise? He says he wishes that the makers of the film would, ‘consider the consequences in death and disease that is likely to result from the return of measles, mumps, and rubella if this drama contributes to a further decline in the uptake of MMR.’ and yet does not support single vaccines which would not only give parents the choice they deserve, but prevent the ‘death and disease’ which he fears. Fitzpatrick then continues his hyperbolic review, claiming that the film is so ‘grossly one sided’ that ‘a number of leading authorities’ (note that he does not mention which) are not prepared to redress the imbalance! If these ‘leading authorities’ of which he speaks were so absolutely confident in the safety of the MMR, surely they would feel certain enough in their convictions to be able to talk about it on a pre- recorded late night Channel Five debate. Even if they were, as Fitzpatrick claims ‘outraged that the Wakefield campaign was going to get even more publicity’ it is laughable to suggest that anyone could seriously believe that their refusal to take part in a debate reduced the publicity of so important an issue. Thus on one hand he laments the lack of, ‘not a single paediatrician, epidemiologist, microbiologist, or autism specialist’ and yet salutes their not being present for fear of increasing the publicity of Andrew Wakefield’s research. Even here Fitzpatrick gets it wrong, as there was an autism specialist present, whose life’s work had been studying autism. Following the film, parents in the debate spoke of how much of the evidence in support of the MMR was based on statistics rather than scientific evidence. It was therefore rather amusing to see how Fitzpatrick claims that, ‘ the division of medical and scientific opinion approximates to 99% for and 1% against’ the MMR, and I would be delighted to see his source for this particular ‘statistic (or should I say ‘evidence’ as Fitzpatrick and his colleagues seems to find the two so interchangeable). I do agree with Fitzpatrick on one point however, when he states that the debate was, ‘not even-tempered’ as he himself seemed unable to listen to what anyone else had to say without interrupting. Perhaps jealous of the ‘heroic’ status he has placed on Andrew Wakefield, Fitzpatrick ends his review with an almost apologetic statement that his team, ‘did our best’ in such a ‘difficult framework imposed by the organisers‘ against the ‘absurdities of the anti-MMR campaign.’ If a campaign to seek the truth and justice is called ‘absurd’ by Fitzpatrick, I wish him well in seeking a suitable term for his own review. Competing interests: Brother of two autistic children |
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Neville W Goodman, Consultant Anaesthetist Southmead Hospital, Bristol, BS10 5NB
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The point I was making is exactly what you say in your first sentence: "what would happen to the medical profession and the drug companies if evidence that MMR causes autism is NOT suppressed?" Once evidence of a medical cause and effect surfaces, nothing can stop investigation of that cause and effect. Eventually, if there really is a cause and effect, it will be shown by proper scientific evidence. There has been an enormous amount of effort put into looking at the cause and effect with MMR and autism. To say the medical profession has ignored it is simply not true. There is no evidence. But it is impossible to prove a negative. All one can do is look hard for a positive. Eventually one has to say that it is more and more unlikely that there is a positive, and realise that there is a negative. In medicine, there are too many people with different agendas looking to make a name for themselves that, to quote you again, "even the most blindingly obvious evidence must be suppressed". It is not possible to suppress blindingly obvious evidence: real evidence is strong stuff. But now we come to the real point of difference: you believe that the connection in time of MMR and autism is real evidence, as do all the other parents. It sounds convincing, but it has to be examined by proper epidemiological methods. They are not exciting; they are tedious and painstaking. They do not make good television. A mother on the discussion programme said (and I paraphrase): I don't go for all this epidemiology; I'm a mother and I know the MMR caused my child's autism. But that won't do: we cannot do without proper science, which in this case is epidemiology. Many have said, including in these e-letters: find what does cause autism; find a cure - that will absolve MMR. Yes indeed - but answering those questions cannot be guaranteed. President Nixon poured billions of dollars into conquering cancer, from which little emerged. The answers to questions in medicine do not come more easily just because we are desperate to know them. Others have said: surely the best thing to do look at the suffering children; they will provide the answers. Again, this is not necessarily so - and, in any case, that is what epidemiology does. It compares the suffering with the non-suffering, and looks for common factors. You say, "I would have thought that an anaesthetist in Bristol of all places would have had some understanding of the uncovering of evidence." Yes I do (and, incidentally, it is only surgeons who are Mr; I am Dr Goodman): but you and I have different views of what evidence is. As to your final point, "Surely Andy Wakefield ought to be able to conduct his research without hindrance": I cannot comment on this. I can only echo the comments that were made in the discussion after the programme by the pro-MMR group: if Dr Wakefield's work is so good, why is it not accepted by most of the other people who work in the field? As I said above: real evidence cannot be kept down for ever. Competing interests: None declared |
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Tom Jefferson, Coordinator, Cochrane Vaccines Field 00061 Anguillara Sabazia (Rome)
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I would like to clarify that the "Cochrane review" mentioned during the televised debate is in fact a systematic review of the evidence of safety of the MMR vaccines published earlier this year (1). The current Cochrane protocol for a review assessing evidence of safety and effectiveness of the MMR vaccines should be published as a full review by the end of 2004 (2). 1. Jefferson TO, Price D, Demicheli V, Bianco E. Unintended Events following immunisation with MMR: a systematic review. Vaccine 2003; 21(25- 26):3954-60. 2. Bianco E, Price D, Jefferson T, Demicheli V. Vaccines for measles mumps and rubella in children (Protocol for a Cochrane Review). In: The Cochrane Library, Issue 4, 2003. Chichester, UK: John Wiley & Sons, Ltd. Competing interests: None declared |
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Ellen C G Grant, physician and medical gynaecologist 20 Coombe Ridings, Kingston-upon-Thames, KT2 7JU
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Wherever happened to basic Medicine? How did medical practice come to be ruled by epidemiologists? True,epidemiologists been given power and money but unless basic mechanisms are also investigated, epidemiologists can sorely mislead. Why else have we had huge increases in breast, cervical and ovarian cancer and/or hysterectomies and oophorectomies, matching increases hormone use for 40 years? Epidemiology is not only a blunt tool but also a lethally dangerous one, if epidemiology receives most of the research money while basic research is strangled at birth because of its ability to clarify unwanted facts. Always listen to the patient or parent. If epidemiological results doesn't match individual experiences, look for the inadequacies in the studies. For example, if the susceptibility to autism is increased by toxic metal overload,and if lower class parents are less likely to have an MMR jab for their children, but they are more likely to smoke, their children would have higher cadmium levels but possibly lower mercury levels. An epidemiological study would not find a difference but an analysis of minerals would. Competing interests: Mother of two dyslexic children |
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C S Anton, Personal Birmingham, UK
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As Mr Gallup seems so pre-occupied with degrees I think it's fair to point out that Dr Andrew Wakefield does not have an MD degree, but the usual BS and MB. (1) Reference 1. http://www.gmc-uk.org/ (accessed on 17th December 2003) Competing interests: None declared |
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Neville W Goodman, Consultant Anaesthetist Southmead Hospital, Bristol, BS10 5NB
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Jenny Robertson writes,, "I do think anaesthetist Dr Goodman is being rather naive in his response. "If the manufacturers of MMR thought their product caused autism, they would cease making it...they know what would happen if MMR was proved to cause autism." Yes....quite, perhaps that is the point. The Department of Health also knows what would happen. Nobody likes getting egg on their face." Of course no one likes to be shown that they are wrong. But Andrew Wakefield must have the same emotion: he would not wish it to be shown that he was wrong, or that his experiments could not be replicated. I'm sure that in one way he would be happy - in that it would mean children were not at risk of autism from MMR - but it would not do his reputation as a scientist any good. So one could interpret his attempts to get support as being just as "desperate" as the Department of Health to protect the vaccine. Competing interests: None declared |
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John Phillip Heptonstall, Director of The Morley Acupuncture Clinic and Complementary Therapy Centre Leeds LS27 8EG
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Dr Goodman holds the naive belief that drugs companies would not suppress evidence that could work against them. Not only does this fly in the face of numerous examples, but the situation of suppression of evidence will have been played over and over in courts of law for years. One expects that evidence of serious problems with drugs is best (for the industry) kept from the public, and government is so often suspected of supporting such an antisocial agenda eg. with BSE policy - drugs companies 'offloaded' the production of vaccines known to contain bovine products to other companies despite government 'advising them' to remove bovine products from their supplies in the late '80s - products that remained 'contaminated' with bovine products till the mid '90s and and beyond; polio vaccines contained bovine products until 2000 and many adolescents were given polio shots - without prior warning - with their BCG shots right up to the 2000 deadline despite government knowing that a potential link between polio vaccines and BSE had surfaced in Southampton area; why did government not step in to protect those children from potential BSE harm through known 'contaminated' polio vaccine products?). We have seen immoral practices identified - not by government or medical practitioners but by media researchers of integrity - when banned or unlicensed drugs are conveniently dumped on unsuspecting third world populations, or when drugs not fit for 'under 5s' have their labels conveniently altered by the drugs company to 'under 1s' before the product is sold in the third world; these acts add to the mounting evidence of wrongdoing. Both government and the drugs industry needs a good shakedown and who better to lead the way than the medical fraternity? Regards John H. Competing interests: None declared |
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John P Heptonstall, Director of The Morley Acupuncture Clinic and Complementary Therapy Centre Leeds LS27 8EG
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Sir I would expect that 'duty of care' to encompass a responsibility for the minds of children, hence regular complaints to the media, affected by the proliferation of material both written and enacted that should be seen an offensive and potentially damaging to children. The MMR programme and following debate paled to insignificance when compared to some of the offensive material which proliferates nowadays yet one hears no cries for censorshiop from this or other physicians - little to gain I suppose. Regards John H. Competing interests: None declared |
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Nottingham John, consultant pathologist Northampton
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In response to Mr. Anton, my post graduate qualification does not appear on the GMC web-site either but I am pretty sure I have one (FRCPath for the record). I do not know whether Dr. Wakefield has an MD or not but its absence from the GMC list is meaningless since they do not publish them here. Competing interests: None declared |
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JK Anand, retired retired
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I would have thanked Dr Fitzpatrick if he had stuck to the points I raised. Instead, Dr Fitzpatrick wandered off.... In summary, as the dozen co-authors have not withdrawn their co- authorship, it remains a paper by Wakefield, Murch, Linnell and the credit or condemnation must be shared by all the authors. I wonder if the co- authors will write to THE LANCET, withdrawing their authorship. I doubt it. I said it was a sober paper. I asked Dr Fitzpatrik to point out the sections which he took exception to. His best effort was to say , about one section, "It would have been more accurate to say...." Not a hanging offence, Dr Fitzpatrick. And if someone is to be hanged, all the authors should hang together. Dr JK Anand (retired) Competing interests: Once pro-MMR. Now on the fence. |
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Paul Shapiro, retired Self Employed, 11021
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I am happy that channel 5 stuck to the scheduled airing of "Hear the Silence" It is government vaccine oversight agencies and medical establishments on both sides of the Atlantic that have been stifling any and all challenges and debate to their positions regarding the combined MMR jab.. The number of children struck with late onset autism has been increasing for the passed 15 years. The responsible government agencies and the medical establishment stand pat and refuse to study to determine the cause of this scourge. It brings to mind the positions taken with respect to Thalidomide. Refusal to act! And we know the results of inaction and delay tactic. To discount the suspicions of parents when it comes to the health of their children is an indefensible position. These agencies together with the medical establishment and the vaccine manufacturers must have a lot to hide, because they fought so hard to censor the showing of this movie. I'm just an old grandpa whose beautiful grandson was struck autistic after receiving the MMR jab. My life's experience tells me: put all information out there and the parents will respond with spectacular intelligence. Competing interests: Grandfather to a beautiful little boy who made all development benchmarks and was struck autistic after recieving thr MMR vaccine |
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Neville W Goodman, Consultant Anaesthetist Southmead Hospital, Bristol, BS10 5NB
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John Heptonstall and Jenny Robertson suggest that I have a naive belief about the behaviour of drug companies, but they have misunderstood me. There is no doubt that drug companies attempt to suppress bad news about their products. However, what I wrote was that, once there is evidence out in the public arena, it becomes impossible to do this effectively. Good evidence will always win in the end. The suggestion that MMR causes autism has been in the public arena for a long time. We have gone beyond the point at which suppression of real evidence of causation could be anything beyond a delaying tactic, which would be pointless. Competing interests: None declared |
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Deborah Kahn, student student at McGill University H3A 2T5
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"We have gone beyond the point at which suppression of real evidence of causation could be anything beyond a delaying tactic, which would be pointless." How in the world do you know at exactly what point the suppression of real evidence would cease to be effective? Are there any peer review studies of this topic? Case histories? The assumption you are laying out only works if the drug companies and the government do not have something to cover up. If they are trying to hide the truth, then all of the studies that have been sponsored by either the government or a drug company have been fudged in one way or another. In that case, none of the epidemiological evidence which everyone keeps citing is worth squat. Dr. Wakefield found that children with autism sometimes have bowel disease. This finding has been confirmed by other doctors. Please, if the bowel disease is connected with the autism, what is causing it? Has there been a real increase in autism? If so, it cannot be due only to genetic factors. What are the possible environmental factors? Chemicals, drugs, vaccines. Who is researching these environmental factors? Anyone? Deborah Kahn
Competing interests: None declared |
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William Pimm, Student tr22r 68g
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Dear Ed There is overwhelming evidence from TV programs that Christening should be curtailed, or at the very least separated from the eating of cake. We can not ignore unequivocal evidence from home videos and interviews by TV journalists, that seizures and developmental regression occur immediately after, or within a day or two of the ceremony. Yet if Christening and the eating of cake were separated, none of this would be a problem. Developmental regression and uncontrollable seizures often start at an age when children are Christened. Parents must be given the choice of opting out of Christening, or be given the choice of Christening and the eating of cake on different days. No one can prove that Christening and cake eating are a greater risk factor than Christening alone, but surely the two together are an unacceptable hazard, and I reserve the right to alarm the public. Will Pimm PS. Can anyone prove to me that Diphtheria vaccine is not the cause of dyslexia or that the MMR vaccine is not the cause of the increase in diabetes in childhood? If not please send me some grant money or at least let me know how I trouser £2000 in an afternoon giving single vaccines? Competing interests: Wanting to appear on TV |
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Mark Davies, parent Teddington, Middlesex
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I am surprised by the amount of whinging from many quarters, including in your review of Hear the Silence, that representatives of an alleged 99% majority view felt too intimidated by the other 1%, led by Dr Wakefield, to participate in Channel 5's studio debate after the drama. You for one did not seem at all intimidated. Are these eminent medical establishment figures and experts in their field really such shrinking violets? Do they not feel called by a sense of public responsibility to debate the issues with Dr Wakefield in a public forum? Please, they're grown adults, and if they can't put their case robustly in a studio with their opponents, that's their problem. How many of them have lost jobs or research funding for their views on MMR? (Not as many as in the Wakefield camp, I'll wager.) However, I was also surprised that you did not declare any interests at the bottom of your review, as is customary BMJ practice. Surely, as a trustee of Sense about Science, which receives funding from the pharmaceutical industry, you have a competing interest? The BMJ also encourages the declaration of political affiliations which readers might believe had clouded a contributor's judgement were they to be subsquently revealed. Perhaps your long association with Living Marxism (little lamented since its demise after libellously accusing ITN of fabricating Serbian war atrocities in the 1990s) and its online successor should, in this light, have been declared? Competing interests: None declared |
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Paul Lynch, n/a Swansea
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I suggest both Andrew Wakefield and his wife deserve a medal, and Juliet Stevenson and Oscar. As a person affected by autism in the family, and some other toxins / vaccine related issues, I have today sent a letter to my MP Donald Anderson relating to, "Hear the Silence". (1) Readers of the BMJ may be aware Michael Fitzpatrick is a father of an autistic son, but are they aware that he is also a trustee of both Global Futures and Sense About Science ? (2) I'd like to echo the quote the Guardian article that said: "Hear the Silence's power lay in its believability, one which no amount of out-of- hand dismissal will dispel. It spoke of a breakdown in trust between citizen and state that is almost utter." (3) Regards, Paul Lynch (1) http://health.groups.yahoo.com/group/MEND-UK/message/1422 (2) http://www.guardian.co.uk/comment/story/0,3604,1102753,00.html (3) http://www.guardian.co.uk/tv_and_radio/story/0,3604,1107932,00.htm Competing interests: None declared |
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Adam Jacobs, Director Dianthus Medical Limited, London SW19 3TZ
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Are there any published studies with a sample size of more than 12 that have shown a causal link between MMR vaccination and autism? Competing interests: None declared |
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L S Lewis, GP Surgery, Newport, Pembs, SA42 0TJ
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William, I suppose Christmas is a time for flippant jokes, but I fear that you do mistakenly believe your statement that ' No one can prove that Christening and cake eating are a greater risk factor than Christening alone ' You are a student, but maybe not of Science ? It is often said that a negative cannot be proved. By the same token, of course - NOTHING can be 'proved'.. In science, we can merely show that the our best hypotheses stand up to scrutiny until such time as they are rendered untenable by new evidence. It would be very easy to show in a randomised controlled trial that Christening and Cake-eating, vs. one or other alone, is or is not associated with any subsequent significant difference in risk of seizures.. The 'epidemic' of autism is a serious business, and we need to coolly continue to do good sound science. Thus far, the combination of M M and R has not been shown in controlled trials to carry higher risks of autism, compared to the single products. But have you studied these trials ? Are they large enough ? Controlled properly ? Adequately blinded ? Meanwhile, people ARE free to choose Christening and/or Cake-eating, and they should in my opinion remain free to choose M, M, and/or R too. wishing you a peaceful Christmas Competing interests: None declared |
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Paul Shapiro, Retired Self Employed
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Let's Beat Up on Dr Wakefield! Here is the way I see it. A number of mothers brought their autistic children to Dr. Wakefield because they had abdominal pain and other gastro-intestinal symptoms. Dr Wakefield began testing these children and observed some unusual conditions. His curiosity was peaked and he performed additional tests and discovered consistent findings in the children with autism that were not present in normal children. He thought that he may be on to something and decided to publish his preliminary research to inform the medical establishment of his findings and with the hope someone would duplicate and verify them. But no! The medical establishment including the companies having a vested interest in maintaining the status quo, rose up to strike the maverick who dared to question their "Sacred Cow" and their positions and beliefs. Obviously, one would have expected the medical establishment to cordially welcome this fresh speculation of a cause for the epidemic increase in autism. Instead Wakefield was vilified and his work was summarily rejected. When things became unbearable, Andrew Wakefield resigned. Years have passed yet the establishment and Dr. Michael Fitzpatrick continue to bash him, never trying to scientifically disprove his theory. Not once! Now if I may I would like to ask a few simple questions. * Where are the data from long term studies performed to a standard of "Do No Harm" on the MMR vaccine before the product was allowed on the market? * Where are the post-licensure studies? * Why hasn't the establishment funded independent researchers to verify or disprove Dr Wakefield's findings? * Why haven't Wakefield critics examined and investigated normal and autistic children instead of looking at statistics and meaningless or "manipulated" data? * Why is everyone Hell-bent on destroying Dr Wakefield? Is there something behind the rock that he disturbed? And one last reflection: Seems to me the establishment got tangled in ego, control, power and money interests and lost sight of the fact that children and families are being damaged and are suffering; maybe all efforts should be concentrated on ending this slaughter of the innocent! Competing interests: Grandfather to a beautiful little boy who made all development benchmarks and was struck autistic after receiving the MMR vaccine |
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ELizabeth C Lucy-Jones, none (home) SW5 9BA
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I never cease to be amazed at the apparent 'deafness and blindness'(no offence to anyone) of anyone disagreeing with Dr.Wakefield et al. A brief overview: Q. Does Dr.Wakefield believe MMR causes autism? A. No. Q. Has a measles virus -the vaccine (MMR) strain-been detected in children in his and other studies? A. Yes Q. Are babies tested for allergies/sensitivities to ingredients of *prior* to being given any vaccines? A.No Q. A trace of nuts in a food product could kill an allergic child, why is it so impossible that children having chemical sensitivies and or food allergies could develop encephalitis/ Autism /gut problems etc., ? A. I would like an answer to that one. Dr.Murch prescribed Vancomycin for my son (and various other antibiotics for other children) for my sons' 'LNH Grade 3' - I was not told what 'bacteria' was found, or virus, and/ or what 'LNH Grade 3' actually is? He also prescribed the Gluten and Casein free diet for my childs' gut disorder. My local Authority have disregarded Dr.Murch's diagnosis and now only treat my son for constipation, that my son has had for many years (at age 11 he is still in nappies with every nappy soiled due to overflow') but this is 'normal' according to our local Paediatric Gastroenterologist at the Chelsea and Westminster hospital. He was the reason we went to the Royal Free in the first place as he saw my son and said 'children like him get these things' and dismissed us. My son is still impacted 3 years on and on strong medication every day despite being told ''it is mild constipation''contrary to Dr.Murch who now, according to the C&W Hospital, will not see my son again. I had found an article on the internet saying that Vancomycin had been used successfully to treat Autism but that children became immune and regressed back into Autism after prolonged use, I refused to give the Vancomycin to my son as social workers had already had meetings about my parenting and I found out later I had been accused of having 'msbp' along with hundreds of other parent's of ASD children. (See Paul Shattock's statement to the sunderland echo 'Parent's Risk Losing Children Over MMR' at www.msbp.com) I would be grateful for answers and congratulations to Dr.Wakefield et al remaining composed as they did during the debate after the 'Hear The Silence' programme. I have to do the same now. Competing interests: Parent of an Autistic child diagnosed by Dr.Murch at the Royal Free Hospital as having Lymphonodularhyperplasia Grade 3, ex-campaigner for Autism Information Matters (A.I.M) |
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Thomas Valentine, Teacher n/a
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Here is a Christmas quiz. You are asked to go through the rapid response columns of the BMJ for the last 14 days (or indeed any 14 days) and try to spot the following false and misleading arguments. This is not in any way a complete list. Using the Mandy Rice-Davis argument as the sole defence of your case - 'he would say that, wouldn't he'. It is legitimate to point out a conflict of interest but a conflict of interest, in itself, does not make a statement or argument false. Arguing against a proposition that has not been put forward by your opponent or exaggerating your opponents position to an unreasonable one that is easier to defeat. Not answering the question that your opponent asked but answering a completely different question that you pretend was asked and would like your opponent to have asked (variant of the above). Using emotive language to add 'spin' to an argument. Giving references to your own work to add a false respectability to your case when the work quoted is not directly relevant to the argument. Turning all arguments round to the same one in which you attack a person or group of people who have no apparent connection with or stance in relation to the argument at hand. Promoting your views as a reasonable compromise between two extremes when the 'compromise' view you put forward is in reality strongly supportive of one 'extreme'. Using 'all' or implying 'all' when there is no evidence for all and 'some' would be more accurate, though less emotive. eg 'All teachers are bullies' or 'teachers are bullies' rather than 'some teachers are bullies'. Selective quoting of the literature and quoting out of context. Equating your opponents use of humour to shallowness in all his or her arguments. Positioning yourself as more caring and humanitarian than your opponent and using this as a way of avoiding a discussion of methodology and science and conversely trying to diminish your opponents standing by parading a knowledge of science and statistics when it is not relevant to the issue under discussion. Best of all doing both these things at once. There is also a condition not proven to be associated with false arguments, but suspected to be so (research is underway). It is known as rapid responsitis chronica continualis whereby those afflicted imagine that the world hangs on their every word and readers of the BMJ can't wait to read lengthy offerings on a wide variety of subjects, when in reality all that is required to enter these august columns is to be ability to press the send button after scribbling down something that is not overtly libellous. Happy Christmas Competing interests: None declared |
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Alan Challoner MA (Phil) MChS, Retired LL18 5UR
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Neville W Goodman writes that there is no evidence of cause and effect with MMR and autism. He is wrong. There is evidence that combined live viruses can mutate, and that this can cause brain damage. Classical autism has been shown to result when there is unusual development of certain parts of the brain. If these parts are damaged in an otherwise normal brain, then autistic syndrome can result. Competing interests: Father of a daughter who was brain damaged by the DPT vaccine, and who also has autistic syndrome. |
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William Pimm, Student n/a
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Dear Dr Challenor May I humbly suggest that your letter does not provide evidence that the MMR vaccine causes autism but puts forward a hypothesis that combined live viruses (you are presumably referring to MMR), might mutate and cause brain damage. You have not provided evidence that this occurs. Best wishes William Pimm Competing interests: None declared |
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mrudula a phadke, consultant, government of maharashtra Mumbai, 400021, India, Prasad Kulkarni, Pralhad Patki, Suresh Jadhav, Subhash Kapre
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We read with interest the review of ‘Hear the Silence’ by Michael Fitzpatrick [1] The misinformation spread by the play is indeed dangerous. The resurgence of measles and mumps is already noticed due to fall in coverage of MMR vaccine. [2, 3] The safety of MMR vaccine needs to be stressed to the common public in order to regain the confidence and contain the incidence of these diseases. Hard evidence based on field studies is very essential for this purpose. In this regards, we would like to report our experience with pharmacovigilance of MMR vaccine over 5 years in India. We used postal survey methodology, previously described by Gogtay NJ et al [4], for conducting post-marketing surveillance of MMR Vaccine. The vaccine under study was manufactured by Serum Institute of India Ltd, Pune, India. Each lyophilized dose of the vaccine contains L-Zagreb strain of Mumps virus, Edmonston-Zagreb strain of Measles virus and RA 27/3 Rubella virus. The vaccine is used in children older than 12 months, 0.5 ml reconstituted solution injected subcutaneously. Data was gathered from qualified pediatricians by sending two sets of Questionnaires. Data sought was for last 5 years. The follow-up was done with direct telephonic communication with the pediatrician. The first set of questionnaire was responded by 68% (204/300) pediatricians. The second questionnaire was sent to 25 doctors, who reported events like excessive crying, boggy fontanel and convulsions. 23 (92%) doctors responded this questionnaire. 1,90,723 children were given MMR Vaccine over a period of 5 years. There was no case fatality. The reported adverse events were as follows: Fever 2.5698% (95% C.I. 2.1936% to 2.3275%), Rash 0.69% (95% C.I. 0.6549% to 0.7288%), Excessive crying 0.21% (95% C.I. 0.1944% to 0.2365%), Lymphadenopathy 0.13% (95% C.I. 0.1134% to 0.1462%), Parotitis 0.079% (95% C.I. 0.0666% to 0.0923%), Arthralgia 0.053% (95% C.I. 0.0432% to 0.0644%), Local reactions 0.045% (95% C.I. 0.0400% to 0.0490%), Febrile Convulsions 0.003% (95% C.I. 0.00195% to 0.00384%) The only neurological adverse events reported were two cases of Aseptic Meningitis. One case of Anaphylaxis was also reported. There was no report of autism or inflammatory bowel disease by any of the pediatricians. Since the data is for 5 years, this information is very important, ruling out any association of MMR vaccine and autism/inflammatory bowel disease. We could not ascertain whether AM was causally related to the vaccine, because in a developing country like India, facilities for CSF viral culture are not always available. However, based on the clinical evidence, causality association seemed probable. Similarly, anaphylaxis occurred within 15 minutes after vaccination. Therefore, MMR vaccine seems to the incriminating factor for anaphylaxis. It is thus seen that the incidence of Aseptic Meningitis (AM) appears to be one in 95,361.5 doses administered, and that of Anaphylaxis one in 1,90,723 doses. We feel that this study clearly proves the non-association of MMR vaccine with autism/inflammatory bowel disease in an uncontrolled real life situation. The risk of other events like AM and anaphylaxis is very small. It is the responsibility of the medical fraternity to educate the public using electronic and print media for highlighting the safety of MMR vaccines. We hope that our study will contribute to the safety information on MMR vaccines, especially when used in a community setting. References: [1] Michael Fitzpatrick. Hear the Silence BMJ 2003; 327: 1411 [2] Pugh RN, Akinosi B, Pooransingh S, Kumar J, Grant S, Livesley E, Linnane J, Ramaiah S. An outbreak of mumps in the metropolitan area of Walsall, UK. Int J Infect Dis. 2002 Dec;6(4):283-7. [3] Jansen VA, Stollenwerk N, Jensen HJ, Ramsay ME, Edmunds WJ, Rhodes CJ. Measles outbreaks in a population with declining vaccine uptake. Science. 2003 Aug 8;301(5634):804. [4] Gogtay NJ, Mangalvedhekar SS, Kshirsagar NA. Adverse drug reaction monitoring in India and the postal survey as a useful tool for ADR detection. Pharmacoepidemiology and Drug Safety 2000, 9, 235-236. Competing interests: Prasad Kulkarni, Pralhad Patki, Suresh Jadhav, Subhash Kapre are employed by Serum Institute of India Ltd |
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Alan Challoner MA (Phil) MChS, Retired LL18 5UR
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The reply that you seek has been posted here before. However, as it would seem that you have missed it, I will post it again. In response to those who do not believe that there are serious side effects from live or attenuated vaccines, I would like to suggest further areas for research based on the following evidence. The fact that there even exist different strains of the vaccine has to do with the way they are produced. Most vaccines in use today contain live, attenuated viruses (as do measles, polio, rubella, influenza, yellow -fever, varicella). The "transmutation" (attenuation) of a virulent wild strain into a vaccine is today still an empirical process. The virus is subject to several passages in various cell cultures under non-optimal growth conditions. Through this process the virus changes its specific properties, remains however a "live" virus. The mechanism involved in thisattenuation is not known in any detail. Following that, a few safety investigations are made and the reactivity and efficacy is tested on laboratory animals and volunteers. Live vaccines posses a higher risk of contamination with micro- organisms than other vaccines. Oncogenetic viruses are, for example, present in mammalian cell strains used in vaccine production. [1] Live vaccines attenuated by conventional procedures are commonly carriers of unknown genetic modifications. Particularly when these modifications are only minor, like localised mutations, the danger of backmutation into a pathogenetic virus is possible. Because vaccines are applied million-fold on entire populations, overlooked viral contaminations, back mutations, new mutations of the attenuated vaccine, or insufficient attenuation of the pathogene may have dramatic consequences for a large number of people. [2] This would be consistent with an existing theory that autistic individuals suffer a chronic state of over-arousal, and portray abnormal behaviours to diminish the arousal. The lack of lateral inhibitors, contained in the cortex, would affect an individual's ability to discriminate between competing sensory information, (Casanova, idem). Researchers do not yet know whether the difference in the number and size of the mini-columns is attributable to a gene mutation or some other factor. [3] The U.S. Department of Health & Human Services, Centers for Disease Control and Prevention, National Immunization Program, promulgatesthat the risks from MMR vaccine can be permanent brain damage, [4] and influenza. (The US Institute of Medicine’s immunisation safety review committee has been investigating whether the influenza vaccine might carrya risk of the demyelinating disorder Guillain-Barré syndrome.) [5] Coulter’s hypothesis presents molecular mechanisms that may account for the similarities in sequelae to various central nervous system infections and, in some children, to vaccinations. [6] Based upon the facts, (i) that fever is a vaccination reaction experienced by many individuals [7], and (ii) that fever and oedema are stimulated by similar cytokines [8,9,10] A subset of vaccinated children— as a direct result of vaccination- induced cytokines release— may be likely to experience both encephalitis and subsequent encephalopathy. [11] For instance, recent research findings are instructive regarding autistic children for whom— as neonates, infants or toddlers— medical records show a history of infections, antibiotic treatments, vaccinations,and temporally associated onset of autistic traits (e.g., Baker et al (idem), & Coulter (idem). As suggested by Coulter (idem), a range of mild but significant post- vaccination neuropathies may occur. i. Fever is strongly associated with interleukin-1, interleukin-6, and tumour necrosis factor alpha (IL-1, IL-2, TNF-alpha; (Luheshi et al, idem)). ii. Brain inflammation is strongly associated with those same cytokines,. [12,13]iii. IL-1 and IL-6 are among primary components in inflammatory expansionsof B-cells and T-cells, which can migrate to tissues from which, for instance, the anti-neural epitopes are derived. Furthermore, because the very mechanism of vaccination-induced immunity derives from clonal expansions of B-cells [14], cytokines needed for B- cell clonal expansionsare induced and present as a causally related response to vaccination. If, prior to or immediately subsequent to vaccination, any neuronal damage, however slight, has occurred in response to the child's infectionsand/or antibiotic treatments, then the child probably has some activated microglia [15] and some anti-neuronal antibodies, as well as activated T-cells and B-cells whose epitopic focus is derived from neurons that were injured either, (i) during the prior infections and treatment, or (ii) as a result of vaccination-induced oedema [16]. Not only do inflammatory cytokines modulate blood-brain barrier permeability [17], but perivascular microglial cells of the blood brain barrier can become antigen-presenting cells encoded with epitopes from theinjured tissue within the brain, and these perivascular cells allow activated T-cells to pass from peripheral circulation, across the blood brain barrier, into cerebro spinal fluid wherein additional autoimmune- like damage can ensue. A similar crossing of the blood brain barrier occurs with activated B-cells. If, from the child's prior infection(s) and/or from vaccination- induced oedema, activated T-cells and B-cells exist with neuronally derived epitopes, at least in some individuals during their response to vaccination, the following sequence may ensue: (i) clonal expansions of existing T-cells and B-cells having neuronally derived epitopes, (ii) further activation of microglia in brain regions already damaged, (iii) increases in blood brain barrier permeability, thereby allowing activated T-cells, etc, to enter the brain. (iv) Furthermore, as the clonally expanding T-cells, etc, travel toward brain cells having sequences similar to the neuronally derived epitopes, encephalitis would be one result of these events and, more importantly, additional sequelae would include increased autoimmune-like damage to neurons that, prior to the vaccination, had been only mildly, perhaps evenunnoticeably damaged by the prior infections. In extreme cases of individuals having vaccination-induced clonal expansions of immunological cells with neuron-based epitopes, autism mightbe a result. Nearly any vaccine may have the potential for inducing neuronal damage in persons with neuronally derived epitopes. In other words, any vaccination that induces strong antibody responses, (i) would appear to be capable of inducing fever-generating cytokinesand, therefore at least hypothetically, (ii) could simultaneously induce clonal expansions of pre-existing T- and B-cells encoded with neuronally derived epitopes, thereby leading to increased neuronal damage in varying degrees across individuals. That vaccinations are helpful to society is without question; however, that some individuals suffer permanent and damaging sequelae to vaccinations is also well documented. The purpose of further research would be to understand better the mechanism by which vaccination-induced neuronal damage can occur in some individuals. Three additional concepts are helpful for understanding inflammation- related pathologies of the central nervous system: (i) molecular mimicry— whereby epitope sequences are virtually identical between an immunogenic pathogen and a naturally occurring molecular sequence [18], (ii) cross-reactivity— e.g., when a lipo- polysaccharide amidst a cellular bilipid layer induces a wider range of immunological responses involving self-membrane sequences [19], and (iii) epitope-spreading or "determinant spreading", i.e., a process that also describes spontaneously occurring widening ranges of immunogenicity. Each of these three processes illustrates ways that autoimmune neuronal damage may be induced and the range of neuronal targets expanded in response to fever-related levels of cytokines release that occur in response to vaccinations. These processes would be more likely in some children if, due to infections and/or antibiotics, the child has T- and/orB-cell subsets encoded with neuronally derived epitopes. In extreme cases, sufficient interleukin-2 levels in damaged areas ofthe central nervous system could mobilise lymphokine-activated killer cells (LAKs), which then might induce a more general damage, thereby yielding increasingly severe neurological deficits. Additional factors may augment the mechanisms of neuronal damage outlined here in above: i. Targeting the cerebellum and temporal lobe: Swartz [20] mentions that the temporal lobe and cerebellum are likely targets for oedema- induced neuronal damage. Furthermore, certain hippocampal regions as well as Purkinje cells of the cerebellum have a relative deficit of apoptosis- related protein Bcl-2, thereby inclining cells in those regions toward apoptosis [21] if and as oedema-induced injury occurs [22]. ii. Cerebellum: Discrete lesions of the cerebellum are associated with mania, depression, bipolar disorders, and OCD; and more than thirty bacterial, fungal, and viral infectious agents are known to be able to affect the cerebellum [23]. iii. Other inflammatories: In addition to IL-1, IL-6, and TNF-alpha, the following are additional factors influencing brain inflammation: Platelet-activating factor, prostaglandins E2 and I2, leukotriene B4, and polymorpho-nuclear neutophil leukocytes [24]. As stated in a recent guideline for physicians, vaccination-induced inflammation ought be treated aggressively (Fukuyama et al, idem), and better understanding of pathogenic processes, of risk factors, and of preventive or corrective measures are worthwhile goals. From Hansard 11 Jan 1999 : Column 63 The information given to the public has always been that the MMR vaccine has been safely used in other countries, particularly the United States, and that it provides lifelong protection against all three infections with a single administration. What the public are not told is that in a study that was completed before the launch of the 1994 MMR campaign, children given the injection were three times more likely to suffer convulsions than those who did not receive it, and that the vaccine caused five times more cases of the rare blood disorder thrombocytopenia purpura than expected. Besides sometimes causing dangerous mutations like atypical measles, the vaccine has been associated with numerous side effects, including deafness, encephalitis, febrile convulsions, Guillan-Barre Syndrome and sub acute sclerosing panencephalitis— a fatal wasting disease that is only very rarely associated with measles. The noble Lord, Lord Clement-Jones, mentioned thepossible connection with autism. For contraindications and side effects of live measles vaccination see; http://www.rxlist.com/cgi/generic2/measlesvax_ad.htm [1] KIMMAN TG, Risks connected with the use of conventional and genetically engineered vaccines, Veterinary Quarterly , Aug 1992, Vol 14(3), 110-118 [2] BROWN F, Review of accidents caused by incomplete inactivation ofviruses, Dev Biol Stand, 1993, 81 (1), 103-7 [3] CASANOVA MF, BUXHOEVEDEN DP, SWITALA AE, ROY E. Minicolumnar pathology in autism. Neurology 2002 Feb 12; 58(3): 428-32. [4] http://www.cdc.gov/nip/publications/VIS/vis-mmr.pdf [5] BMJ 2003;326:620 ( 22 March 2003 ) [6] ALLEN, A.J., LEONARD, H.L., & SWEDO, S.E. (1995), Case study:a new infection-triggered, autoimmune subtype of pediatric OCD and Tourette's syndrome. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 307-311. [7] BELLANTI, J.A., FISHMAN, H.D., & WIENTZEN, R.L. (1987), Adverse reactions to vaccines. Immunology and Allergy Clinics of North America, 7, 3, 423-445. [8] LUHESHI, G., & ROTHWELL, N. (1996), Cytokines and fever. International Archives of Allergy and Immunology, 109, 301-307 [listing IL -1, IL-6, and TNF-alpha as the primary cytokine pyrogens]. [9] QUAGLIARELLO, V.J., WISPELWEY, B., LONG, Jr., W.J., & SCHELD W.M. (1991), Recombinant human interleukin-1 induces meningitis and blood- brain barrier injury in the rat: characterization and comparison with tumor necrosis factor. Journal of Clinical Investigation, 87, 1360-1366. [10] YAMASAKI, Y., MATSUURA, N., SHOZUHARA, H., ONODERA, H., ITOYAMA,Y., & KOGURE, K. (1995), Interleukin-1 as a pathogenetic mediator of ischemic brain damage in rats. Stroke, 26, 676-81. [11] BAKER, S.M., & PANGBORN, J. (1996), Clinical assessment options for children with autism and related disorders: a concensus reportof the Defeat Autism Now! (DAN!) conference, Dallas, Texas, January 1995. San Diego, Autism Research Institute. [12] BANKS, W.A., KASTIN, A.J., & GUTIERREZ, E.G. (1993), Interleukin-1-alpha in blood has direct access to cortical brain cells. Neuroscience Letters, 163, 41-44. [13] CERIANI, G., MACALUSO, A., CATANIA, A., & LIPTON, J.M. (1994), Central neurogenic antiinfammatory action of alpha-MSH: modulationof peripheral inflammation induced by cytokines and other mediators of inflammation. Neuroendocrinology, 59, 138-143. [14] ADA, G.L. (1993), Vaccines. In: Fundamental Immunology, 3rd edition, Paul, E.P., editor, New York: Raven Press, Ltd. [15] MICROGLIA are the smallest of the glial cells. Some act as phagocytes cleaning up CNS debris. Most serve as representatives of the immune system in the brain. Microglia protect the brain from invading micro-organisms and are thought to be similar in nature to microphages in the blood system. [16] FUKUYAMA, Y., SEKI, T., OHTSUKA, C., MIURA, H., & HARA, M. (1996), Practical guidelines for physicians in the management of febrile seizures. Brain & Development, 18, 479-84. [17] BANKS, W.A., & KASTIN, A,J. (1991), Blood to brain transportof interleukin links the immune and central nervous systems. Life Sciences, 48, PL117-PL121. [18] BAUM H, DAVIES H, & PEAKMAN M. (1996), Molecular mimicry in the MHC: hidden clues to autoimmunity? Immunology Today, 17, 64-70. [19] VAN ROOIJEN, N. (1989), Are bacterial endotoxins involved in autoimmunity by CD5+ (Ly-1+) B cells? Immunology Today, 10, 334-336. [20] SWARTZ, M.N. (1984), Bacterial meningitis: more than just the meninges. New England Journal of Medicine, 311, 912-913. [21] There are 3 different mechanisms by which a cell ‘commits suicide’ by apoptosis. (1) one generated by signals arising within the cell, (2) another triggered by death activators binding to receptors at the cell surface. [TNF-a; Lymphotoxin; and Fas ligand (FasL)]; (3) a thirdthat may be triggered by dangerous reactive oxygen species. [22] HARA, A., HIROSE, Y., WANG, A., YOSHIMI, N., TANAKA, T., & MORI, H. (1996), Localization of Bax and Bcl-2 proteins, regulators of programmed cell death, in the human central nervous system. Virchows Archives. 429, 249-53. [23] COHEN, B.A., & LIPTON, H.L. (1990), The cerebellum and CNS infections. In: Infections of the central nervous system. D Schlossberg, editor; New York: Springer-Verlag. [24] SAEZ-LLORENS, X., RAMILO, O., MUSTAFA, M.M., MERTSOLA, J., &Mccracken, G.H. (1990), Molecular pathophysiology of bacterial meningitis:Current concepts and therapeutic implications. The Journal of Pediatrics, 116, 671-684. Competing interests: Father of a daughter who was brain damaged by the DPT vaccine and has autisic syndrome. |
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Lisa C Blakemore-Brown, Psychologist UK
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Another year over, and still no political will to look at vaccines, indeed, removal of legal aid during the last few months from a class action appears designed to put a lid on it for good, rather like the Hutton Inquiry and Iraq. The invariable trashing of all alternative opinion, including the documentary Hear the Silence, is getting tedious, predictable and giving Britain a bad name. Dr Challoner sets out many examples of hitherto indisputed side effects of vaccinations, since they were first developed, mysteriously now not acknowledged. Any attack on the brain by a virus can lead to the onset of autism. Viral infection is a known causal factor for autism. Certain types of genetic vulnerability will make a child more susceptible, but the final trigger is necessary in this destructive tapestry. I was in the Royal Courts recently when Lord Justice Judge read out the Decision in the Cannings case, the mother who was wrongfully convicted of murdering her children and locked away for life. Knowing that one of Sally Clark's babies died within hours of a triple vaccine, that Alan Yurko's baby died following vaccination, yet he is locked up in the US, that other cases are awaiting trial with the same story, it was staggering to listen and read of the temporal associations between triple vaccinations - DPT and MMR - and the sudden illness or sudden death of Angela Cannings' babies. The first child died within 24 hours and was a bouncing baby before the vaccination. Another child became immediately very ill within 24 hours of the MMR and was dead within 10 days. Immunisations were implicated with the other two children but less clearly defined, one of whom survived, and more details are needed. I would be interested in Dr Challoner's views on this 10 day period, which I have heard about in a number of cases, and what may be happening to the system of a baby following the triple vaccine during the subsequent 10 days. The fact that innocent parents have been jailed for life for murder when such startlingly obvious temporal associations have been brushed aside and not even mentioned beggars belief but must surely be examined. In fact their very omission in the original court cases surely speaks volumes? At a conference in Australia last week, many people spoke about immune system problems following vaccines, about reactions which look like a child has been beaten, about the rapid rise in bowel problems, autistic and attentional problems, asthma and ezcema, apnea, ME etc. in the last 15 years. I in 100 children are now found to have Coeliac Disease and many others will have bowel problems which just fall short of the full criteria for this disorder. This is incredible. It is now expected that at least one autistic child will be found in every street, yet in the mid eighties most people thought you were saying `artistic` not `autistic` when asked about professional interests - it was so rare. What is happening to our society that we are all blind to the obvious? or are we all too scared to speak out about this outrage? Well we should be scared - we will all have to rely on this generation to look after all of us in the not so distant future. Perhaps we will get what we deserve. Competing interests: None declared |
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Alan Challoner MA (Phil) MChS, Retired LL18 5UR
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In response to Lisa C Blakemore-Brown’s request for an opinion about children who die within 10 days of a vaccination, my first thought is that all children differ in their responses to any foreign protein that enters the brain. Indeed the vaccine itself will vary from batch to batch and even within a batch. When the particular elements of the vaccine and their products enter the brain, the site at which they cause damage is again variable and from child to child. Just as it is hardly possible to predict if a certain child will respond unfavourably to vaccination, so it is also impossible to predict, if they do, what damage will occur, what the sequence will be, and whether the outcome will be a return to normality, neurological injury or death. For brain cells to be damaged in this way there usually needs to be pyrexia following the event of vaccination. A fairly recent study of the clinical characteristics and risk factors for a complex first febrile convulsion showed that any acute febrile convulsion should be abbreviated soonest possible as neurological abnormalities, which may be signs of cerebral insult become more likely with increasing duration of seizures. The increased incidence of acute neurological deficits detected in children with complex febrile convulsion appeared to be more related to focality and duration of seizure rather than to multiplicity of seizures. Children with focal seizures were often associated with Todd’s hemiparesis, (it is thought that in patients with hemi-convulsions and Todd’s paralysis, the prolonged cerebral hyperfusion may be the result of impaired vascular auto-regulation and its effects on cerebral function [1] ) explaining their higher propensity to neurological deficits. From this study, the risk of developing neurological deficits increased with increasing duration of seizure. Although all children in this study, with neurological deficits, made uneventful recoveries, this finding indicated that prolonged duration of the seizure might be a more important factor in causing insult or injury to the brain compared to multiple but short seizures. [2] Just as all vaccinations are not safe, all seizures are not fatal. The problem with the 10-day issue is that in many cases the progress of the child’s condition is not monitored to a degree that can allow aetiological certitude. Often the parent’s judgement and instinct may be a reliable factor however, this does not gain enough of the Court’s respect compared to the statements of expert witnesses. [1] M Kimura, H Sejima, H Ozasa et al [ Shimane Med Univ Japan] Technetium - 99m - HMPAO SPECT iin Patients with Hemiconvulsions followed by Todd’s Paralysis. Pediatr Radiol 28; 92-9, 1998. [2] Ling, S G. Clinical Characteristics and Risk Factors for a Complex First Febrile Convulsion. Singapore Med J 2001 Vol 42(6) : 264-267 Competing interests: Father of a daughter who was brain damaged by the DPT vaccine and has autisic syndrome. |
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Amelia Tyler, medical student w12
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The people that are dismissing the MMR Autism link without researching it are both iresponsible and incompetant. The link is real. I have an autistic son, Jake, and I KNOW his autism was caused by the MMR. Channel 5's Hear The Silence was intended to bring out the Wakefield and co research, not the propaganda the government try to ram down our throats 24/7 about how the MMR is safe. It is not. It ruins lives. It's ruined Jake's life. I refuse to be called a liar by the government. I know my son, they don't. Competing interests: None declared |
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Louise K Sutcliffe, Pharmacologist Roche Pharmaceuticals, AL7
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I stumbled across this thread of comments while researching this topic for a (non-scientific) friend of mine who has a child who will be having vaccinations soon, and is worried about the issue. I said I would do some research for her so she could make an informed decision. Reading these comments (especially William's!) has quite brightened up my day. I read the paper Dr Wakefield wrote without having any prior knowledge of this particular subject (bar, of course, via the media, and some very basic researches on autism for my friends), and it seemed to me to say 'Certain children may have a genetic deficiency which may possibly cause them to respond to the MMR vaccine by developing autism, possibly linked with colitis and ileal lymphoid hyperplasia'? I am unsure of where this idea that all children may be at risk of developing autism has come from. Perhaps from the Channel 5 documentary? Please forgive me, those parents and grandparents of children who developed these problems, if you know for certain that your child was not positive for this allele. Perhaps (obviously after more research) a simple screening for this gene would suffice to put worried parents' minds at rest, and even warn of a risk of autism for their child later on? Those whose children test positive may then opt for the single vaccine. Informed consent is, of course, a given. Once again, I beg forgiveness, this time for my habit of assuming pharmacogenetics solves all ;) I completely agree with Alan's comments regarding the risks of live vaccines... this is a matter that should be addressed during informed consent (see above), and there is undoubtedly a neurological risk from injecting what are after all, live viruses adapted to live in the nervous system, into children's bodies. I am not certain here: Are the single vaccinations any more or less live viruses with a chance of causing these problems? Are they using different strains? At the risk of sounding discompassionate (I have no children.. you may consider me biased now if you wish) we have a cost-benefit situation here. The risk of possible neurological damage versus the risks associated with these three diseases, when a frightened parent decides not to vaccinate? Which is greater? I am inclined to go with the latter. I do not know Dr Wakefield personally (I would like to, then I could get a primary source), nor did I see the documentary, but based on his paper, I would say the villains Dr Fitzpatrick should be railing at are Channel 5 and the media who terrify parents with this so they can sell papers/gain ratings (although not Juliet Stevenson who I quite liked in "Truly, Madly, Deeply"). If this review were directed at them, I should be quite behind Dr Fitzpatrick the whole way. Dr Wakefield seems to have been the unfortunate man with his hand on the opener when the worms all came wiggling out of the can. As for the scruples of big companies when their profits are endangered.. I ain't sayin' nuffink ;) References Please see everyone else's posts. Competing interests: Employee of pharmaceutical company. Close friend of Asperger's sufferer |
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