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NEWS: Clare Dyer Pressure mounts for inquiry into MMR furore BMJ 2004; 328: 483-a [Full text]

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Inquiry into Wakefield: Best and worse case scenarios

Pru Hobson-West   (28 February 2004)

How can vaccines cause damage?

Alan Challoner MA (Phil) MChS   (29 February 2004)

Responding to parental concerns on MMR safety: will the genie go back in the bottle?

Chris D McVittie, Niko Tiliopoulos, Judith Gellatly   (3 March 2004)

Why we don't know, what we should know...

Hilary A Butler   (4 March 2004)

Richard Smith said it best!

Gurli Bagnall   (5 March 2004)

Vaccine Side Effects, Adverse Reactions, Contraindications, and Precautions

Alan Challoner MA (Phil) MChS   (5 March 2004)

MMR and conflicts of interest

Gurli Bagnall   (6 March 2004)

Re: Richard Smith said it best!

helen williams   (6 March 2004)

Andrew Wakefield's Research is Sound

Lawrence J. O'Brien, Arlington, Virginia 22209 USA   (10 March 2004)

Re: How can vaccines cause damage?

Raymond Gallup   (11 March 2004)

As Simple as this

Kathy Blanco   (11 March 2004)

Pressure Mount on the Medical Establishment

Saadedine Tebbal   (13 March 2004)

IMMUNIZATION SCIENCE LEGALLY UNRELIABLE

Clifford G. Miller   (15 March 2004)

Not Really

F. Edward Yazbak   (20 March 2004)

Inquiry into Wakefield: Best and worse case scenarios 28 February 2004
Pru Hobson-West, Leverhulme Research Training Fellow Institute for the Study of Genetics, Biorisks and Society (IGBiS), University of Nottingham, NG7 2RD Send response to journal: Re: Inquiry into Wakefield: Best and worse case scenarios	Yes, pressure is clearly mounting for a ‘full inquiry’ after the latest revelations about Wakefield and his potential conflict of interest. But what should this inquiry look like? And what are the best and worst case scenarios? Scenario 1: From the point of view of those who support MMR, the best that could happen is that an inquiry by the General Medical Council (GMC) would discover what Dr Andrew Wakefield did and did not disclose when publishing his 1998 article, and what precisely his role was in relation to the Legal Aid Board and the MMR legal action. Evidence of a definite conflict of interest may be revealed, casting doubt on the reliability of his research. Concerns about the link between MMR and autism would reduce, vaccine uptake would increase, measles outbreaks would be averted, and general public confidence in the recommended vaccine system would be maintained. Indirectly, we would also know more about the tricky realities of research funding and increase the likelihood of some sort of journal code of conduct 1. Scenario 2: The worst case scenario, however, must also be considered. Wider academic and media debate about conflict of interest would inevitably mean that more attention is given to the financial interests of those who promote vaccination. This risky strategy would assist those parent groups who wish to advertise this particular issue. Wakefield’s image as maverick scientist could evolve into brave whistle- blower. Much concern has been voiced about the impact of press coverage of MMR. This week, some of the press is already making comparisons between Wakefield and David Kelly 2. The Hutton report has not silenced criticism of the Iraq War, and has not even silenced calls for a broader inquiry. Ditto a GMC inquiry and MMR. So which scenario is more likely? If press articles are correct and this entire subject is down to one researcher, one paper and one press conference then Scenario 1 may prevail. If, however, you believe that the Wakefield study only was able to fuel a controversy in a particular social and political context, then we should brace ourselves for this issue to run and run. This is not the 1970s, the culture of deference has arguably been eroded, and most social scientists agree that the relationship between attitude and behaviour is not straightforward and not predictable. In short, social factors are important in how we assess risk 3 and how we make decisions about vaccination 4. Wakefield is only part of this context. He may not the sole cause and therefore an inquiry into him may not be the sole solution. References 1. BBC online. Journals plan regulation scheme. Http://news.bbc.co.uk/1/hi/health/3489664.stm 2004 2 Glover, S. Assassins! How Blair seeks to destroy any critic. Daily Mail, Tuesday, February 24, 2004. 3 Alaszewski, A., Horlick-Jones, T. How can doctors communicate information about risk more effectively? British Medical Journal 2003;327:728-731. 4 Hobson-West, P. Understanding vaccination resistance: moving beyond risk. Health, Risk and Society, 2003;5:273-283. Competing interests: Pru Hobson-West is carrying out PhD research which looks at childhood vaccination and is funded by the Leverhulme Trust.
How can vaccines cause damage? 29 February 2004
Alan Challoner MA (Phil) MChS, Retired LL18 5UR Send response to journal: Re: How can vaccines cause damage?	It seems to be unduly restrictive to keep any enquiry about Wakefield and the MMR/Autism factor to his paper. What the public is demanding by its concerns about the MMR vaccine and its possible ill effect on children, is not only for research to be stepped up but also for previous research to be compiled and analysed in an attempt to come to genuine conclusions. By genuine I mean those that are not just subservient to epidemiological policy of mass vaccination to create herd immunity. Below are just a few examples of work that has been done. Much of is probably not in public knowledge. Even more striking is the argument put forward by the pro-vaccine adherents that there is no evidence that vaccines cause harm. How can vaccines cause damage? No vaccine is perfectly safe. An adverse event can be said to be caused by a vaccine (i.e., a true reaction) if it is associated with a specific laboratory finding and a specific clinical syndrome or both. Alternatively, a clinical or epidemiological study is needed to find out whether the rate of a given syndrome in vaccinated individuals exceeds that expected among unvaccinated controls. Immune panels and other laboratory tests, medical histories, and the supporting medical literature support a causal association, with increased risks among those children who are sick or have recently been sick. Vaccination may damage children in several ways. Live or attenuated virus vaccination can actually produce the infection that the vaccine is supposed to prevent. A second mechanism of damage comes from neurotoxic materials found sometimes in vaccines. Thimerosol is the most widely discussed, since it contains mercury. The third, and probably the most important theory of vaccine damage, relates to allergic reactions and the development of an autoimmune response, stimulated by the vaccine and its adjuvant. Vaccines always contain adjuvants, which are substances known to amplify the body's response to the vaccine. These adjuvants are known to sometimes cause allergic and autoimmune responses on their own. The US Center for Disease Control (as its name implies) represents one answer to these questions, while the National Vaccine Information Center (NVIC) champions the rights of individual families to refuse vaccines. The NVIC makes a very important, sometimes neglected point: "Vaccination is a medical procedure which carries a risk of injury or death. As a parent, it is your responsibility to become educated about the benefits and risks of vaccines in order to make the most informed, responsible vaccination decisions." A similar statement can be made about any medical procedure. There area also possible, but unproven links between MMR vaccine and juvenile diabetes multiple vaccines and autism, and OPV and Gulf War syndrome. Time and further research will tell if these proposed relationships are real [1] The DPT Vaccine There is a large amount of evidence showing that the DPT vaccines in use up to the end of the 20th C., and still in use in some places, was the cause of brain damage in some children. As early as 1948, Randolph Byers and Frederick Moll, of Harvard Medical School and the Federal Drug Administration, carried out tests on DPT vaccines at Children's Hospital in Boston and concluded that severe neurological problems could follow the administration of DPT vaccines. The results of the tests were published in Pediatrics. In 1976, Dr. Charles Manclark, a FDA scientist, remarked that "the DPT vaccine had one of the worst failure rates of any product submitted to the Division of Biologics for testing." According to the testimony of the Assistant Secretary of Health, Edward Grant, Jr., before a U.S. Senate Committee on May 3rd, 1985, every year, 35,000 children suffer neurological damage related to the DTP vaccine. In 1990, a Workshop on Neurologic Complications of Pertussis and Pertussis Vaccination [2] was convened. It concluded that pertussis vaccines are not standardised between manufacturers, that vaccines are not standardised by each manufacturer from one batch to another, that there is no inherent difficulty in assigning cause and effect to the vaccine and subsequent permanent neurological damage, that there was sufficient experimental data to implicate both endotoxin and pertussis toxin in adverse neurological reactions to pertussis vaccine, and that there was a consensus between neurologists that the seizures following pertussis vaccination could not accurately be described as "febrile convulsions" because they are not necessarily benign. Incredibly, in the face of their own conclusions, they released a report that concluded, "there is no demonstrated association between DPT vaccination and SIDS, because sudden death after pertussis vaccination is too rare to be detectable in the context of presently available series." There are 10,000 cases of SIDS in the United States each year. The conspiracy runs deep. In the 1990 Journal of the American Medical Association an editorial clearly labelled vaccine- induced encephalopathy "a myth", ironically accusing the American Association of Pediatrics (AAP) "and other well-meaning physicians" of "joining forces with parents groups and lawyers." Ironic, because the AAP was the one who recommended in 1992 that babies in the United States should be given five doses of pertussis vaccine. It is interesting how the AAP changed their tune within two years. The end result of this insanity led to the formation of the National Vaccine Injury Program. Another bit of irony is that finally in 1992, the Institute of Medicine admitted that, "the evidence is consistent with a causal relation between DPT vaccine and acute encephalopathy, defined in the studies reviewed as encephalopathy, encephalitis or encephalomyelitis, and the evidence indicates a causal relation between DPT vaccine and anaphylaxis, between the pertussis component of DPT vaccine and protracted, inconsolable crying." In other words, brain damage in progress. These are but a minuscule of the evidence available on the DPT vaccine, but show just how evidence can be hidden from the general public in the guise public protection issues. DPT & Autism Megson [3] proposed that autism is linked to the disruption of the G- alpha protein, affecting retinoid receptors in the brain. A study of sixty autistic children suggested that autism could be caused by inserting a G- alpha protein defect, particularly the pertussis toxin found in the D.P.T. vaccine, into genetically at-risk children. This toxin separates the G- alpha protein from retinoid receptors. Those most at risk report a family history of at least one parent with a pre-existing G-alpha protein defect, including night blindness, pseudohypoparathyroidism, or adenoma of the thyroid and/or pituitary gland. Megson proposed that natural vitamin A could reconnect the retinoid receptors critical for vision, sensory perception, language processing and attention. Megson proposed that treating autistic children with natural cis - forms of Vitamin A could have the effect of reconnecting the hippocampal retinoid receptor pathways, critical for vision, sensory perception, language processing and attention. Megson noted that many autistic children needed natural, unsaturated cis forms of Vitamin A found in sources such as cold water fish (salmon, or cod liver), kidney, and milk fat, foods not commonly available in the modern diet. Instead, children depend on Vitamin A Palmitate, found in commercial infant formula and low fat milk. Unfortunately, absorption of Vitamin A Palmitate requires an intact gut mucosal microvilli surface at the right pH, in the presence of bile for metabolism. Since many autistic children already had damaged mucosal surfaces due to unrecognized wheat allergy or intolerances, their capacity to absorb vitamin A is questionable. Megson also argued that live viral measles vaccine depleted children of their existing supply of Vitamin A, negatively impacting retinoid receptors. Natural Vitamin A, in the cis form, is important for activation of T and B cells for long-term immune memory. Measles, mumps and rubella titers are either significantly elevated or negative, in spite of one or two doses of the vaccine given to many of these children. Fish oils contain one retinoid metabolite, alpha 14 hydroxyretroretinol that has a role in T-cell activation, vision and growth of lymphoblasts. The MMR and other vaccines T. Zecca , et al. at the New Jersey Medical School's Children's Hospital of New Jersey in Newark compared rubeola virus in autistic and normal children. Among 16 children diagnosed with autism followed in their clinical practice, they found a 3-fold increase in rubeola titers over expected normal range. A Wilcoxon Kruskal Wallas test comparing 13 rubeola titers from normal children revealed a statistically significant p-value of 0.005. The following facts are significant: a) The incidence of Autism has increased significantly in the last decade. b) There is every reason to believe that this trend will continue. c) No one has proved that MMR vaccine plays a role in autism. d) No one has proved conclusively that it does not. e) Serious studies by independent researchers are desperately needed, to look into all aspects of this dreadful disease. [4] Until recently, most vaccines presented antigens according to the same principals as they were 200 years ago- when vaccines consisted of the whole micro-organism, alive or killed. The new generation of vaccines contains other defined antigens, called "subunit vaccines". Newly developed genetic technology gives us the means to produce the defined antigen in large enough amounts to generate a low price. However, accessory technologies are required to make these defined antigens immunogenic, including new approaches for the optimum physical presentation of the antigen and the addition of adjuvants. An effective adjuvant formulation provides the antigen with both an optimal physical presentation and a boost to create immune recognition and reaction. A construction aimed at fulfilling these requirements is called an ISCOM, or "immuno-stimulatory complex". [5] The concept of immuno-modulation is also important to modern vaccination principles. It includes the induction of specific antibodies of desired isotypes and IgG subclasses, the induction of selected T-helper cell responses as classified by the resulting cytokine production, the induction of cytotoxic T-cell responses, and the distribution of the immune response to various lymphatic sites - for example, mucosal surfaces. Any of these factors may be important to obtain protective immunity - the ultimate goal for a vaccine. In addition to the efficacy of eliciting a protective immune response, there is concern about the toxicity of adjuvants. A number of adjuvants evoke strong immune responses, and are widely used in research, but are unsuitable for human and animal vaccines because of these toxic side effects. Several substances have been tried for adjuvant activity and safety. Still, even today, adjuvants and adjuvant formulations, which combine both immuno-enhancing capacity and low toxicity, are lacking. [1] http://www.healing-arts.org/children/vaccines/index.htm#return [2] http://www.vaclib.org/basic/trufax/v6.html [3] Megson, M. N. Is autism a G-protein defect reversible with natural vitamin A? Unpublished research available from Dr. Mary Megson, 7229 Forest Ave, Suite 211, Richmond, VA 23226. [4] F. Edward Yazbak, MD, FAAP. Pro & Con Research on MMR, Autism Connection Compared. http://www.healing-arts.org/children/autism- overview.htm#MMR%20Vaccine%20and%20Autism [5]Uppsala University, Sweden. Uppsala Biomedical Centre. Vaccine Research at the Virology Department. Competing interests: Father of vaccine damaged daughter
Responding to parental concerns on MMR safety: will the genie go back in the bottle? 3 March 2004
Chris D McVittie, lecturer Queen Margaret University College, Clerwood Terrace, Edinburgh EH12 8TS, Niko Tiliopoulos, Judith Gellatly Send response to journal: Re: Responding to parental concerns on MMR safety: will the genie go back in the bottle?	EDITOR - Since an MMR-autism link was first proposed (1), numerous studies have produced evidence to contradict this suggestion. Such studies have largely reported outcomes of epidemiological or population-based research rather than investigation of causal factors. This evidence, while widely accepted by the medical community, has done little to convince many parents of the safety of the vaccine. MMR vaccination rates remain well down on pre-1998 levels and differences between medical practitioners and many parents are commonly aired in debates such as that as recently screened on UK television (Channel 5, 15 December 2003) and elsewhere. Addressing parental concerns requires an understanding of their decisions for and against MMR vaccination. A UK study of parental views (2), to be extended to the United States and to Australia, identifies three main factors as predictors of parental decisions. The predominant factor identified, perceived importance of research findings, strongly predicts decisions of non-immunising parents. Ratings of government advice and health professionals’ advice emerge also as predictors, but only of decisions for vaccination: to non-immunising parents these factors are of little importance. It is therefore interesting to note the reported statement by the Editor of the journal that published the original study (3). The claim that, in effect, he was misled into publication by a failure to declare a potential conflict of interest is to be investigated by the General Medical Council at the instigation of the UK Government. This marks a change of focus from earlier rejections of the claimed link: the emphasis shifts from the message to the messenger as the source of misleading information. To what extent though an inquiry can restore parental faith in the MMR vaccination is questionable. Given that non-immunising parents do not regard government or health professionals’ advice as important, they are unlikely to be reassured either by the repudiation of the original publication or by the outcome of a government initiated inquiry. Parental concerns are, of course, by no means peculiar to MMR vaccination (4). As Hepworth (5) observes, there comes a point where reassurance fails to be reassuring and parents require clear unambiguous evidence as to the safety of vaccination of their children. This however is one area that will remain unexamined by the forthcoming inquiry. Until this central question is addressed, production of contrary evidence and criticism of the original author will remain little more than attempts to wish the MMR-autism genie back into the bottle. Dr Chris McVittie, PhD, CPsychol. [1] Wakefield AJ, Murch SH, Anthony A et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998; 351: 637-41. [2] Electronic responses. McVittie C, Tiliopoulos, N, Gellatly, J. Predicting parents’ decisions on vaccination. BMJ 2004; 328: 51. (accessed 28 February 2004). [3] BBC News. Journal regrets running MMR study. http://news.bbc.co.uk/1/hi/health/3508167.stm. (accessed 23 February 2004). [4] Leask J-A, Chapman S, Hawe P. Concerns about immunisation. Facts are not enough. BMJ 2000;321:109. [5] Electronic responses. Hepworth J. When reassurance is longer reassuring: addressing parental concerns on vaccination. BMJ 2004; 328: 51. (accessed 28 February 2004). Competing interests: None declared
Why we don't know, what we should know... 4 March 2004
Hilary A Butler, freelance journalist home Send response to journal: Re: Why we don't know, what we should know...	Dear Sir, What should the purpose of any enquiry into the MMR vaccine issues really be? Clare Dyer reports the media facts, but the article skirts the fundamental concerns. Which ironically are touched on in another BMJ article in this issue, http://bmj.bmjjournals.com/cgi/content/full/bmj;328/7438/473 Perhaps the MMR vaccine should be seen through glasses labelled not "What we don't know, we don't know" but "Why we don't know what we should know"? Richard Horton's comments that Dr Wakefield's funding negated the validity of the research were extraordinary, incorrect, and transparently foolish to anyone with a finger on "real science". To shoot the messenger on the unconfirmed basis of information from one reporter is potentially hasty, to be polite. And looking further down the line, I wonder how many bullets he will subsequently fire off into both his own feet. The correspondents to Clare Dyer's article, however, start to touch on a few actual issues... Pru Hobson-West is concerned about the media exposing the financial conflict of interests held by most medical people who promote vaccination, something well known by those who follow such things as congressional hearing admissions from the horses mouths, and discovery files in court cases.... Doesn't she think though, that people out there, (beyond those who put their brain into gear and research these things for themselves) should know that this situation is really a massive pot-calling-kettle-black scenario where some of the messenger-shooting finger-pointers can often be up to their necks in "financial-conflict tills" themselves? Or does she prefer the old patriarchic mode of "Trust us, you don't need to know more than that we wouldn't advise this if it weren't the best thing to do."? And does she think that the whole axis of the MMR vaccine argument revolves around one paper? Since the original Lancet study, many others have confirmed and expanded on Dr Wakefield's findings, but these appear to have been ignored by "the medical system", in the seeming desire to pillory and discredit Dr Wakefield personally, and thereby by implication, all other "articles" and "persons" that come after. Such an action seems to be that of desperate drowning persons' last irrational gasp. Or medico-political necessity...as it was in the days of William Harvey, Semmelweis, Theobald Smith and Louis Pillemer to mention just a few "run over" by the medical majority, or "flat earthers" of their day. Regarding Christ McVittie, et al's comments... the reason that epidemiological studies thus far, cut no ice, has everything to do with the fact that such studies are easily subject to manipulation of definitions and data to suit the outcome desired. For instance, in the Finnish study, the definition of Autism appears to have been changed part way through the study, and there were other methodological biases and errors which were blatently obvious to anyone with a basic understanding of statistical manipulation. Most of the other epidemiological studies on MMR have also suffered from these rather obvious outworkings of conflicts of interest, in my opinion, precisely BECAUSE they were done by people who have every reason to NOT find the truth, who therefore couched the questions and methods to get a specific result. And whose primary aim appears to have been to create a fallacy of authority, not by science, but by "weight of numbers". But this is not unique. And if we look at why we don't know, what we don't know, in the context of history a couple of examples serve us well. As John Emery once said about SIDS (1) "We have not found the right answers because we have not asked the right questions" and when discussing as to why this might be in the BMJ (2) he said: "Among research workers there is much vested interest against change. Lip service is paid to possible multiple causes, but each acts as if his or her own theory is universal" Another relevant quote from To Rognum (3) is: "Where you "stand" depends upon where you "sit", and different groups of pathologists are likely to adopt their own pragmatic criteria for the SIS diagnosis" Or as David Peat puts it in “Science, Order and Creativity” when discussing the difficulty of challenging scientific research; “One particularly significant mechanism which the mind employs to defend itself against the inadequacy of its basic ideas is to deny that it is relevant to explore these ideas. Indeed the whole process generally goes further because it is implicitly denied that anything important is being denied! Scientists, for example, may avoid confronting deeper ideas by assuming that each particular difficulty or contradiction can be dealt with through some suitable modification of a commonly accepted theory. Each problem therefore produces a burst of activity in which the scientists seeks a “new idea.” But rather than looking for something truly fundamental, scientists often attempt an addition or modification that will simply meet the current problem without seriously disturbing the underlying infrastructure… the whole problem of ending the mind’s defense of its tacitly held ideas and assumption against evidence of their inadequacy cannot be solved within the present climate of scientific research. For within this context, every step that is taken will, from the very outset, be deeply conditioned by the automatic defense of the whole infrastructure”. Nothing changes under the sun. Just the topic heading, and different vested interests... The only form of study which will cut any ice with parents of autistic children, are studies of THEIR children, in which the doctors conclusively eliminate the existence of vaccine related compounds causing trouble, in the bodies of their children. Nothing else will suffice. And to argue speciously, that the tests administered were unethical is rather rich from a profession that specialises in agressive neonatal management sometimes to the point of exsanguination. In epidemiological terms, it's no good studying the causes of car crashes, by bean counting, number crunching, or other circuitous means. AS with car crashes, autism will only be unravelled when epidemiologists stop pushing pens and desks, put their shoes on, get out their microscopes, and for once put aside their preconceived ideas, and financial conflicts of interests, and actually LOOK AT THE CHILDREN. As Wakefield and others have tried to do. Counteracting the REASONS why some parents won't vaccinate their children will not "fix" the problem as doctors perceive it, though no doubt the medical profession would wish that. Parents aren't stupid. Dr McVittie is right in that the ONLY thing that will START parents listening, is clear unambiguous evidence as to the safety of all vaccines. (IF... that is, that parents haven't woken up to all the other litany of "disasters" scattered far and wide through medical practice in general) Furthermore, IF vaccine manufacturers are so sure of their products, they should have the confidence not only to fund the studies required, but to allow the appointment of a panel of doctors equally split down the middle. One lot with "vested interests" and the others, the likes of Andrew Wakefield whose "vested" interests lies with the children, rather than with a vaccine. Parents should also be allowed input into study protocols... You would think that if everyone's primary goal was "first do no harm" then these three groups would have no trouble working together. Do I think it might happen? Only when pigs grow wings. There is far too much at stake here for the pro vaccine medical profession, medical bodies like WHO, Governments and the pharmaceutical companies to risk such a child-centred scientifically accurate, altruistically helpful approach. To make matters worse, this situation is further compounded by the fact that we STILL have a "poverty of medical evidence" in so much of medicine, (Why we don't know, what we don't know) as elaborated years back by David Eddy in the BMJ (4): "only about 15% of medical interventions are supported by solid scientific evidence, David Eddy, Professor of Health Policy and Management at Duke University, North Carolina, told a conference in Manchester last week. This is partly because only 1% of the articles in medical journals are scientifically sound and partly because many treatments have never been assessed at all. “If,” said Professor Eddy “it is true, as the total quality management gurus tell us, that ‘every defect is a treasure’ then we are sitting on King Solomon’s mine.” I am sure that Robert Good would have also understood this, when he wrote (5) many years ago: “I sat in the front row of every class. I took down everything the professor said, complemented this body of knowledge with the information I learned from my instructors in the laboratory, from relevant information I would glean from reading and digesting the best textbooks on each subject, and even from extracting the substance of the most relevant articles in contemporary scientific journals. All this I included in my notes for study in beautiful Morocco-bound notebooks. The scheme seemed to work because it gave me very high grades in school, top scores in state and national board examinations, and my choice of training spots and fellowships. I closed my notebooks, however, for 10 years. When I opened them again and studied them 10 years after so carefully completing them, I was astonished to find that they were almost entirely filled with lies. Except for a few descriptions, such as well-established anatomy, everything that seemed so orderly and beautiful with the rather comprehensive treatment I had given it for one moment in history had changed, grown and been reordered by the scholarship of the intervening 10 years.” The medical profession should return to its altruistic roots of honest enquiry, unencumbered by status, money, reputation, prestige, and a love for the largesse of pharmaceuticals, and start looking at the King Solomon's mine they sit on. I fear it might just be too late. The public can only stand so many bad apples in the barrel labelled "The Medical System" before they decide the whole breed might also be likewise corrupt, through and through. But I wish that I would be proved wrong. Hilary Butler. 1) Emery J. L. Sudden Infant Death: Modern Medicine October 1984 pgs 9 - 11 "Are we asking the right questions?" 2) Emery J. L. BMJ 18 November 1989 volume 299 pg 1240 "Is sudden infant death syndrome a diagnosis? Or is it just a diagnostic dustbin?" 3) Rognum, T., Acta Paediatr 85: 401 - 3, 1996. "SIDS or not SIDS? Classification problems of sudden infant death syndrome" 4) BMJ Vol. 303, 5 October 1991 The poverty of medical evidence” 5) Dr Robert Good in :The Immunoglobin A System" 1973, pages 514 - 515 Competing interests: None declared
Richard Smith said it best! 5 March 2004
Gurli Bagnall, Inedpendent Patients' Rights Campaigner Marlborough Sounds, 7372, New Zealand Send response to journal: Re: Richard Smith said it best!	Richard Smith argues for parents' right to choose over single vaccinations or MMR. (Editor's Choice) Abusing patients by denying them choice "It first hit me that denying patients choice is a form of abuse when about six years ago I read a paper on patient choice in screening for colorectal cancer. One hundred Californian patients were given full information on five options…. Patients were told about the nature of the test, the preparation required, the need for sedation, the time required, how often the test would be repeated, the likely results with both positive and negative outcomes in detail, and the cost. The result was that patients chose very different options. "Steve Woolf, a family physician and North American editor of the BMJ, wrote: "Suppose these same 100 patients had not received this information and were instead cared for by a physician who routinely performs flexible sigmoidoscopy because he considers it the best test. According to these data, fully 87% of the patients would undergo a procedure other than the one they would prefer if properly informed" ( J Fam Pract 1997;45: 205-8[ISI][Medline]). Nine out of 10 patients have been abused…." "Some 15-20 years ago an editorial in the BMJ suggested that every menopausal woman should have hormone replacement therapy. That now looks like bad advice…. The main arguments against fully informing patients are that 'It's too difficult, costly, and time consuming.' But they are neither evidence based nor politically sustainable." (BMJ 2004;328 (14 February), doi:10.1136/bmj.328.7436.0-f ) Medical history is littered with treatments that caused more harm than good yet supposedly intelligent people seem incapable of learning the lessons. Competing interests: None declared
Vaccine Side Effects, Adverse Reactions, Contraindications, and Precautions 5 March 2004
Alan Challoner MA (Phil) MChS, Retired LL18 5UR Send response to journal: Re: Vaccine Side Effects, Adverse Reactions, Contraindications, and Precautions	Recently published guidelines on vaccinations contain evidence that many vaccines can harm and that "although immunisation has successfully reduced the incidence of vaccine-preventable diseases, vaccination can cause both minor and, rarely, serious side effects." The following papers should be scrutinised by all who are involved in the vaccination conflict. Update: Vaccine Side Effects, Adverse Reactions, Contraindications, and Precautions Recommendations of the Advisory Committee on Immunization Practices (ACIP) http://www.cdc.gov/mmwr/preview/mmwrhtml/00046738.htm#top Vaccinating With MMR http://www.medscape.com/viewarticle/469133?mpid=25309 [FULL REPORT] Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP) http://www.cdc.gov/mmwr/preview/mmwrhtml/00046738.htm#top Competing interests: Father of Vaccine damaged daughter with autistic syndrome
MMR and conflicts of interest 6 March 2004
Gurli Bagnall, Independent Patients' Rights Campaigner Marlborough Sounds, 7372, New Zealand Send response to journal: Re: MMR and conflicts of interest	A few months ago, the BMJ used conflicts of interest as a theme. The rapid responses showed that while some members of the profession disapprove strongly of pharmaceutical industry bribery, others believed there is no harm in it. Indeed, Simon Wessely, professor of psychiatry, proudly proclaimed he currently holds 53 conflicts of interest and he urged all to accept the situation for it is now a fact of life. How can we argue with that when doctors who reach a target of MMR vaccinations, are financially rewarded? It seems to me that the current attack against Andrew Wakefield for a conflict of interest, is not only hypocritical but typical of the manner in which medical whistle-blowers have traditionally been treated. The following rebuttal by Wakefield was published in "What Doctors Don't Tell You". Permission to repost was given. I do hope the BMJ has a sufficient sense of fair play to accept it for publication as a rapid response. DR WAKEFIELD: His side of the story Many of you will know that Dr Andrew Wakefield, who pioneered research into a link between autism and the MMR vaccine, was strongly attacked in the London Sunday Times the other week, as reported in the previous E-News. In particular he was criticised for receiving funds from a legal aid charity that was representing parents of children who were possibly injured by the vaccine. His statement follows in full... "Serious allegations have been made against me and my colleagues in relation to the provision of clinical care for children with autism and bowel disease, and the subsequent reporting of their disease. These allegations have been made by journalist Brian Deer who has expressed, in front of witnesses, his aim of destroying me. All but one of the allegations, which are grossly defamatory, have been shown to be baseless. One allegation remains against me personally. That is, that I did not disclose to the Lancet that a minority of the 12 children in the 1998 Lancet report were also part of a quite separate study that was funded in part by the Legal Aid Board. It is the Lancet's opinion but not mine that such a disclosure should have been made since it may have been perceived as a conflict of interest. This is despite that fact that the funding was provided for a separate scientific study. It needs to be made clear that the funds from the Legal Aid Board were not used for the 1998 Lancet study, and therefore I perceived that no financial conflict of interest existed. The Lancet defines a conflict of interest as anything that might embarrass the author if it were to be revealed later. I am not embarrassed since it is a matter of fact that there was no conflict of interest. I am, however, dismayed at the way these facts have been misrepresented. Whether or not the children's parents were pursuing, or intended to pursue litigation against the vaccine manufacturers, had no bearing on any clinical decision in relation to these children, or their inclusion in the Lancet 1998 report. It is a matter of fact that there was no conflict of interest at any time in relation to the medical referral of these children, their clinical investigation and care, and the subsequent reporting of their disease in the Lancet. As far as the 1998 Lancet report is concerned, it is a matter of fact that we found and reported inflammation in the intestines of these children. The grant of £55,000 was paid not me but to the Royal Free Hospital Special Trustees for my research group to conduct studies on behalf of the Legal Aid Board. These research funds were properly administered through the Royal Free Hospital Special Trustees. The Legal Aid research grant to my group was used exclusively for the purpose of conducting an examination of any possible connection between the component viruses of the MMR - particularly measles virus - and the bowel disease in these children. This is entirely in line with other studies that have been funded by the Legal Aid Board (latterly the Legal Services Commission) and reported in the BMJ. If and when this work is finally published, due acknowledgement will be made of all sources of funding. It is unfortunate that, following full disclosure of these facts to the editor of the Lancet, he stated that in retrospect he would not have published facts pertinent to the parent's perceived association with MMR vaccine in the 1998 Lancet report. Such a position has major implications or the scientific investigation of injuries that might be caused by drugs or vaccines, such as Gulf War Syndrome and autism, where possible victims may be seeking medical help and also legal redress. Health Secretary John Reid has called for a public enquiry. I welcome this since I have already called for a public enquiry that addresses the whole issue in relation vaccines and autism. It has been proposed that my role in this matter should be investigated by the General Medical Council (GMC). I not only welcome this, I insist on it and I will be making contact with the GMC personally, in the forthcoming week. This whole unpleasant episode has been conflated to provide those opposed to addressing genuine concerns about vaccine safety with an opportunity of attacking me - an attack that is out of all proportion to the facts of the matter. I stand by everything that I have done in relation to the care, investigation and reporting of the disease that I and my colleagues have discovered in these desperately ill children. My family and I have suffered many setbacks as a direct consequence of this work. As a family, we consider that our problems are nothing compared with the suffering of these children and their families. For the sake of these children, this work will continue." * To search the WDDTY database - where every word from the last 14 years of research can be found – click on http://www.wddty.co.uk/search/infodatabase.asp Competing interests: None declared
Re: Richard Smith said it best! 6 March 2004
helen williams, mum london nw3 Send response to journal: Re: Re: Richard Smith said it best!	Families want choice. Why dont all these researchers make their kids have the tripple jab? Competing interests: None declared
Andrew Wakefield's Research is Sound 10 March 2004
Lawrence J. O'Brien, author/consultant 1200 N. Nash Street -- Ste.535, Arlington, Virginia 22209 USA Send response to journal: Re: Andrew Wakefield's Research is Sound	Russell Blaylock, MD has published a review article in the Fall 2003 issue of an obscure journal, The Journal of the American Neutraceutical Association. The title of this article is: "Interaction of Cytokines, Excitotoxins, and Reactive Nitrogen and Oxygen Species in Autism Spectrum Disorders." The Abstract of Blaylock's article reads as follows: ABSTRACT There is growing and compelling evidence that excessive peripheral as well as central immune activation of brain microglia can result in alterations in brain growth and connectivity during rapid brain growth, the so-called “brain growth spurt.” A considerable amount of evidence, presented in this paper, demonstrates the deleterious effects of immune factors, such as cytokines, chemokines, and excitotoxins, when present in excess. The interaction between excitotoxicity, ROS and RNS injury and immune dysfunction is discussed. It is concluded that excessive activation of the brain’s immune system during critical growth periods can occur when vaccines are given as combination vaccines, using schedules that are too close together or by the use of certain live viruses in the vaccines. Blaylock concludes his article with three recommendations, as follows: 1) Since the greatest period of synaptogenesis occurs during the first two years of life, all vaccines should be delayed until after this period unless absolutely critical to individual health; 2) A halt in the use of live virus vaccines; 3) A reduction in the innoculation schedules. ...This would mean that no more than one vaccine should be given during a physician visit and that each of the vaccines be spaced at least six months apart. Blaylocks paper is chock full of evidence linking "overstimulation of systemic immunity" to a variety of "deleterious effects [such as] autism and autism spectrum disorders." The science is complex, the evidence of linkage with MMR -- especially from autopsies performed on children who had suffered from autism or a related disorder -- is overwhelming and conclusive. In contrast, arguments from ignorance, i.e., that the pharmaceutical industry has no knowledge of harm being caused by MMR and other vaccines, are clearly seen as being empty and fallacious. The pharma industry may indeed be ignorant of the harm caused by some of its products, but do they need to keep reminding us of this deplorable fact? British medicine ought to see through the fog of criticism that now surrounds Andrew Wakefield's 1998 Lancet paper, and rapidly adopt the three recommendations offered by Dr. Blaylock. The welfare of thousands of children is at stake, and there is no doubt at all that Andrew Wakefield's research on this subject is sound. Lawrence J. O'Brien Competing interests: None declared
Re: How can vaccines cause damage? 11 March 2004
Raymond Gallup, Founder of The Autism Autoimmunity Project 45 Iroquois Avenue, Lake Hiawatha, NJ USA Send response to journal: Re: Re: How can vaccines cause damage?	I would like to add to Alan Challoner's response on a human level regarding, "How can vaccines cause damage?". Our son was born normal on January 17, 1985 and regressed gradually into autism after receiving the measles- mumps-rubella (MMR) vaccine on April 28, 1986. Since 2002 to the present, our son, Eric, has had aggressive tantrums including biting, kicking, pulling hair, scratching, choking and head-butting. Eric is over 6 feet tall and over 200 pounds and when he would have a tantrum at home, my wife, my 15 year old daughter and I would have to lock ourselves in our room. Since 2002 we had to call the Parsippany police many times and have Eric taken to St. Clare's Hospital emergency room. Eric has been suspended several times from the special school for autism because of his behaviors. On December 10, 2002, Congressman Dan Burton read my letter to the people at the Government Reform hearing mentioning the fact that Eric was kicking down doors and that we were living in hell and under seige because of Eric's behaviors. Congressman Dan Burton mentioned his grandson who has autism and said that when he gets to be Eric's age, he is expected to be 6'10". He said to the participants at the hearing that imagine what it would be like when there are other young adults like Eric and his grandson having these behaviors and being so strong. Eric was suspended from school on Monday, February 23, 2004 because of his behaviors on the prior Friday. I took Eric with me to the supermarket in the morning and Eric pulled my hair and kicked me. I had to call the police and Eric was taken to St. Clare's Hospital emergency room where he was transferred to the Psychiatric Intensive Care Unit. On Friday, March 5, 2004, we were told that if Eric wasn't taken home or transferred to Greystone Park Psychiatric Hospital by Sunday, March 7, 2004 we would be sued by the lawyers for St. Clare's Hospital. This was despite the fact that we had private health insurance and Medicaid. He was transferred to Greystone on March 7, 2004 and we are awaiting word on when Eric can be treated at the Kennedy Krieger Institute in Baltimore, Maryland for a long-term inpatient stay. We have been waiting since July 2003 to get Eric into Kennedy Krieger Institute but they only have 16 beds and treat only 40 children/young adults with autism a year. They rehabilitate these children/young adults who have autism and behavior problems. On the front page of the Sunday edition, February 22, 2004 of the Orlando Sentinel was an article titled, "Living with Disabilities. Nearly 14,000 disabled Floridians need help with daily living, but a strained state program can't keep up. Many are ...........DESPERATE". Also, there was an additional related article titled, "Family struggles alone to deal with autistic son." by Debbie Salamone. It told the following about the family of David and Beth Schaefer that included their 16 year old daughter, Emily and their 11 year old son with autism, Dillon: "The loud squeak of a chair echoes through the house as Dillon rocks wildly back and forth. He leaps up and runs from his bedroom to the kitchen, where his screams echo through the house. He turns the lights on, off, on, off. He runs to the bathroom and flushes the toilet once, again and again. He races into the living room, slams himself into the windows and throws himself on the couch. He rushes toward his older sister and pinches her. Then he targets his mother. She tries to restrain him, but Dillon is almost her size. In an instant, he slams his head into her mouth. Tiny drops of blood slowly ooze from her swelling lip. This is actually a good morning." I talked to a New Jersey Department of Developmental Disabilities (NJ DDD) representative and they said over 50% of their placement cases are for young children with autism. Like Florida and other states in the United States, New Jersey has problems getting funding for group homes and residential centers for children and adults with autism. NJ DDD in fact told us in July 2003 that Eric could only be placed in a residential center in Pennsylvania which was 2 1/2 hours from our home and that many placements were being done outside New Jersey in states as far away as Texas. In the prior February 22, 2004 response by Dr. F. Edward Yazbak response and my response titled, "Research is needed, not propaganda", a strong point is made regarding research and the numbers. (1) The United States, United Kingdom as well as other countries will be facing a big problem with financial costs involving the autism epidemic that will involve millions if not billions of dollars/pounds. The human cost can not be calculated and will be an international tragedy that is a ticking time bomb waiting to go off. The longer our governments wait, the bigger the disaster. References: 1. BMJ Rapid Responses "Research is needed, not propaganda" http://bmj.bmjjournals.com/cgi/eletters/328/7437/421-a#51141 Competing interests: Founder of The Autism Autoimmunity Project and father to Eric, who has regressive autism and tested positive for myelin basic protein antibodies, has elevated measles antibody titers, T-cell abnormalities and colitis.
As Simple as this 11 March 2004
Kathy Blanco, Mother Founder of Childscreen 97006 Send response to journal: Re: As Simple as this	As mom researcher, and founder of Childscreen, the first think tank of it's kind on the PREVENTIONS of autism, I ask this very very simple question...that is...had my child(ren) been identified as a "sitting duck child", would I in fact not have two autistic children? The answer, YES. I will tell you why. Both of them have complement C4B deficiency, both inherited anulle genes from both my husband and I. Both come from autoimmune histories. Both had infections in utero dealt with by antipyretics (www.rollingdigital.com/autism), both came from parents that have the STEALTH VIRUS, both come from a mom with amalgam fillings, both were exposed to malathione (an immune lowering mercury salts pesticide), both were visablly injured and medically injured by DPT 11 days after, and MMR 2 weeks after, including biomarkers of those diseases in their gut, in their brain, in the CSF. As far as I am concerned, I am a well researched non hysterical parent, calling for a hysterical and wicked conclusion to this argument, TEST THEM. Biological codes of ethics calls for any child, any person, to be measured against the strength of a biologic, AKA VACCINES. We ignore this ethic code routinely. We also set up damage by cord clamping these kids into hypoxia in speech centers, opened blood brain barriers and iron overload at birth, setting them up if you will for the last trigger HEP B or MMR or DPT shot with opened and damaged BBB's, which pushes them over the edge in a critical time of maturation and pruning of the brain. YOU DOCTORS MAKE ME SICK, in that you have not put this puzzle together, and I, a mom, have... So if it sounds as if I cloud the issue with all of these ioatragenic causes, your right, but if you don't ask the questions OF WHAT WE CHANGED IN THE LAST 50 YEARS since Autism's first recognition, HOW POISINED WE HAVE BECOME, your genes genes genes theory is bogus bogus bogus. Cure autism never, is your calling cards, and your genomic project will simply go into oblivion until one out of every two children have AUTism or ADD or MBD and every gene causes autism...last count 30 genes cause autism. WHERE ARE YOU REAONSABLE PEOPLE???? A NEWBORN SCREEN MUST BE DEVELOPED!!!! Kathy Blanco www.childscreen.com www.voicesofsafety.com Competing interests: Mother of two children with autism, vaccine induced-founder CHILDSCREEN, a NPO calling for a newborn screen to identify a child with immune and metabolic difficulties before vaccinating them like pin cushions.
Pressure Mount on the Medical Establishment 13 March 2004
Saadedine Tebbal, None Texas, 77477 Send response to journal: Re: Pressure Mount on the Medical Establishment	Let's clear the fogs created by the medical establishment and drug companies and see really what the issue is all about: BIG MONEY 1)Parents complaining about vaccines and especially parents of autistic kids like me have the ultimate proof that we, unfortunately, believed in the medical system since we vaccinated our kids. We will regret for our whole life that we did not ask questions and that we trusted a still in the Stone Age medical establishment. Thus, we are not nuts or over-reacting, we have been hurt immensely. 2)I have three friends who are M.D.’s. Upon heated discussion, I found out that none of them followed the vaccination schedule mandated by the Center of Disease Control or by the American Pediatric Society. They dismissed Hep B at birth for their kids and they never allowed their kids pediatrician to put more than one vaccine at a time. Unlike me, they did not allow the pediatrician to vaccinate when the baby was sick (fever, diarrhea, or under antibiotics). Unlike me, they delayed most of the vaccines until the kid immune system was mature enough. Thus, whoever wants to discuss vaccine safety will have to show first his own kid’s vaccination record. 3)The tobacco liability was in the $250 billions. This was for a leisure product that was not mandated by the government and mostly hurting people old enough to know what they were doing. Vaccines are totally different. The government mandates them. They are put in kids who are not aware of the danger and side effects. We all know that the liability for vaccines is in the trillion dollars and that all what it is about. 4)Drug companies spent more than any other industry on lobbying - $256 million in the US in 1999-2000. They had 625 Washington lobbyists at a cost $92.3 millions. They are making sure that no research shows that mercury and MMR and over-vaccination had an effect on Autism until there is a law protecting them from any liability. They almost passed the first one with a Homeland Security Bill. They are working on another right now. 5)Two years ago, when I started noticing something wrong with my kid, my wife and I went through 4 specialists and a battery of tests in what is called the world-class medical center in Houston. Except for the genetician who did not find anything abnormal after examination of our kid and analysis of the test results, all the other ones (gastroenterologist, developmental pediatrician and neurologist) knew without any doubt the cause of our son disease: GENETICS "What a wonderful word". They did not know why my son’s mercury was very high (43 mcg/l) but according to them it did not have anything to do with autism. They never read all the scientific articles that I showed them because they read only trade journals published by their respective association. According to them, they keep up to date with science because twice or 3 times a week they attend a free lunch seminar sponsored by a drug company about different SCIENTIFIC subjects. 6)I have read a lot of articles on Autism for the past 2 years. The epidemiological studies are all flawed toward the author belief and goals. Take any good statistician and he can prove that readers of BMJ are all women or men depending on what you want him to prove. Choosing the right representative sample is all what it takes. 7)Let's read real science before talking science. Saadedine Tebbal, Ph.D. Competing interests: Kid with Autism
IMMUNIZATION SCIENCE LEGALLY UNRELIABLE 15 March 2004
Clifford G. Miller, Solicitor Beckenham, Kent, BR3 6QX Send response to journal: Re: IMMUNIZATION SCIENCE LEGALLY UNRELIABLE	Please cross refer to the following rapid response also published on the BMJ website. It explains why, in law, the science behind some of the claims immunization is wholly safe is flawed and legally unreliable and why governments, courts and officials may be making a fundamental error in applying the wrong standard of proof when relying on that science to make public interest decisions. The article is unique in its field and in the way it explains the issues in a manner accessible to the non lawyer. See BMJ rapid response:- http://bmj.bmjjournals.com/cgi/eletters/328/7440/602-c#52948 The BMJ article to which it responds can be found at:- http://bmj.bmjjournals.com/cgi/content/full/328/7440/602- c Competing interests: Practising English lawyer, graduate in physics, sometime examining lecturer on law, standards and ethics (particularly, law of evidence) to Masters technology students at the Imperial College of Science Technology and Medicine. Personal interest - close relative with life threatening food allergy.
Not Really 20 March 2004
F. Edward Yazbak, Pediatrician, Director TL Autism Research, Falmouth, Massachusetts 02540 Send response to journal: Re: Not Really	Please allow me to comment on certain statements in Ms. Clare Dyer’s piece: Statement I: “Andrew Wakefield's study of 12 children, published in the Lancet (1998;351: 637) …provoked a huge media controversy that was followed by a substantial fall-off in the percentage of children given the triple vaccine.” Comment: Not Really. The fact is that Andrew Wakefield never suggested that vaccination against measles, mumps and rubella be stopped. On the contrary, his recommendation to have the monovalent vaccines available, alongside the MMR, would have improved vaccination rates in the United Kingdom, because all parents, including those concerned about the safety of the triple vaccine, would have rushed to have their children vaccinated. Furthermore, MMR uptake in the United Kingdom had already decreased substantially before the February 1998 article by Dr. Wakefield. The source of the following information is a document entitled “NHS Immunisation Statistics, England: 1997-1998” [www.doh.gov.uk/pub/docs/doh/imstat98pdf]. If it cannot be accessed online, the document is available from the UK Department of Health. Between 1994 and 1998, MMR (first dose) vaccination rates decreased at a faster rate (16.1%) than all other vaccines. In 1993-94, 588,000 children received three doses of pertussis vaccine and 640,000 received the first dose of MMR. In 1997-98, 589,000 children received the pertussis vaccine series of three injections and only 563,000 received one dose of MMR. Put in perspective, British parents were more likely in 1997 to bring their children back THREE times to receive the pertussis vaccine, a vaccine that has historically been a concern in the United Kingdom, than once for the MMR vaccine. The authors’ comment was: “In the case of pertussis, coverage rates have regained the ground lost in the mid-1970’s due to public anxiety about the safety and efficacy of the vaccine. The recent fall in MMR coverage may be the result of similar concern over the vaccine”. Examining the vaccination rates in the year of second birthday, 93.7% of eligible UK children received 3 doses of pertussis and 91.9% received their first MMR in 1995-96 compared to 94.2% for 3 doses of pertussis vaccine and 90.8% for MMR in 1997-98. When one looks at coverage rates, at age 24 months, by health district in England, only 4 of the 100 health authorities reported a coverage rate of less than 90% for diphtheria, tetanus and polio in 1997- 98 and 72 reported rates of 95% or over. For MMR, 28 health authorities reported coverage rates of less than 90% including 9 with rates below 85% and only 6 reported rates of 95% or over. The United Kingdom district range vaccination coverage at age 2 years in 1997-98 was a low of 82.6% and a high of 97.6% for three doses of pertussis vaccine compared to a low of 75.2% and a high of 95.9% for one MMR. Statement II: “The chief medical officer for England, Professor Liam Donaldson, told BBC radio's Today programme that Dr Wakefield's research had led to a loss of confidence in a vaccine that had saved millions of children's lives”. Comment: Not Really. I respectfully submit that measles deaths had decreased precipitously before the introduction of the measles vaccine because of better nutrition and hygiene. The following can be checked with the DOH. In 1901, there were 9,019 deaths attributed to measles in a population of 32,612,1000 in England and Wales, giving a mortality rate of 276.5 per million. In 1960, there were 80 deaths and the population was 45,775,000. The measles mortality rate in England and Wales was therefore 1.75 per million in 1960. In other words, the mortality rate from measles had decreased by 99.12% before the introduction of the measles vaccine. If Professor Donaldson were talking about measles control (and not deaths) then indeed vaccination would be most helpful. He offers two options: MMR or “nothing”. Dr. Wakefield offers two other options: MMR or single vaccines. I submit that single vaccines are immensely better than “nothing”. Unfortunately, for many English parents, it has been “nothing” for years before Dr. Wakefield’s article. Statement III: Professor Donaldson added: "We have always thought that Dr Wakefield's original study was poor science, but it is not just us that thought that. Individual experts and individual medical bodies around the world criticised it," Comment: Not Really. Six years after the study in question, there is ample evidence by several independent investigators, from respectable scientific centers, in support of Wakefield’s research. Identical endoscopic findings have been described, measles virus persistence in diseased tissues has been documented and abnormal measles immunity, in a specific subset of children with regressive autism, has been repeatedly detected. Many of the individual experts and medical bodies who criticized Wakefield had ties with the health authorities, the immunization programs or the vaccine manufacturer. In adition, most of the epidemiological studies they quoted had serious flaws and were funded by the CDC or the vaccine manufacturer. (1) Two of those anti-Wakefield studies actually reported increases in autism after the introduction of the MMR vaccine in the UK and in one, a regression after MMR vaccination was also documented. In the first by Taylor and Associates, (2) the authors stated: “We looked for evidence of a change in trend in incidence or age at diagnosis associated with the introduction of MMR vaccination to the UK in 1988… There was a steady increase in cases by year of birth… No significant temporal clustering for age at onset of parental concern was seen for cases of core autism or atypical autism with the exception of a single interval within 6 months of MMR vaccination.” Two co-authors of this study are employees of the Immunisation Division, Public Health Laboratory Service Communicable Disease Surveillance Centre, London. In addition, Dr. Taylor’s inter-personal conflict with Dr. Wakefield should have been declared. The second study by Kaye and Associates (3) is based on information from the UK general practice research database (GPRD). The authors reported that: “The incidence of newly diagnosed autism increased sevenfold, from 0.3 per 10 000 person years in 1988 to 2.1 per 10 000 person years in 1999.” Dr. Kaye is employed at the Boston Collaborative Drug Surveillance Program. He disclosed the following: Funding: No specific funding. Competing interests: The Boston Collaborative Drug Surveillance Program is supported in part by grants from AstraZeneca, Berlex Laboratories, BoehringerIngelheim Pharmaceuticals, Boots Healthcare International,Bristol-Myers Squibb Pharmaceutical Research Institute, GlaxoWellcome,Hoffmann-La Roche, Janssen Pharmaceutica Products, R W JohnsonPharmaceutical Research Institute; McNeil Consumer Products, andNovartis Farmaceutica. Dr. Kaye did not perceive that he had a conflict because GlaxoSmithKline was a defendant in the MMR litigation in the UK. Statement IV: “The furore was sparked by a Sunday Times investigation (22 February, pp 1, 12, 13) which also cast doubt on whether research ethics approval had been properly granted for the study” Comment: Not Really. Statements by the Editor of the Lancet also sparked much of the furor. Now that the dust has settled, here are the facts. A class action suit brought by hundred of parents, who believed that the MMR vaccination was responsible for their children’s regressive autism, was getting to Court at last, when suddenly legal aid funds were cut. Simultaneously, the researcher, who dared to suggest that there was a link between the triple vaccine and autism, was attacked and vilified. His pioneer research was also deemed flawed because he did not disclose to the Lancet that a minority of the 12 children in his original study was included in a separate study that was partly funded by the Legal Aid Board. According to the editor of The Lancet, such a disclosure should have been made, because of the potential perception of a conflict of interest. From Andrew Wakefield’s point of view, there was neither a real nor a perceived financial conflict. Funds from the Legal Aid Board were never used for any part of the study that was published in The Lancet, in February 1998. In addition, Dr. Wakefield did not personally receive any portion of the much-publicized Legal Aid Board grant of £55,000 to the Royal Free Hospital Special Trustees. In a letter published in the Lancet in May 1998, Dr. Wakefield reported that he was undertaking a pilot study on behalf of the Legal Aid Board to examine the merits of parental claims of an association between their child’s exposure to the MMR vaccine and subsequent autistic regression and intestinal symptoms. It is evident that the editor of The Lancet did not perceive, for six long years, that any conflict of interest existed because neither did he question the principal investigator nor did he disavow the research. He only made his recent accusations just before the Sunday Times report of February 22, 2004 for reasons that we can only conjecture. The fact is that the first 12 children reported in the Lancet study were properly referred to the Royal Free specialized unit solely because of their intestinal symptoms. The physicians, who examined and investigated them and later reported their findings, had no interest in, and probably no knowledge of, any future litigation. The February 1998 Lancet article (4) consisted of a summary of each child’s history as reported by the parents and the relevant clinical and laboratory findings. The authors, including Andrew Wakefield, did not claim that a causal association with MMR vaccination existed and only suggested further research and investigation of the findings. When most of Wakefield’s co-authors simply repeated that fact recently, the Press and the vaccine lobby and its puppets hailed their statement as an earth- shattering event. The clearly orchestrated efforts by numerous parties to halt the MMR- Autism litigation in the UK had to target the man who appeared to have some answers. Being unable to refute his findings by clinical studies, Wakefield’s enemies targeted him personally and attacked his integrity and his character. Such attack will not change the beliefs of many parents who are seeing their legal cases stalled and the UK Government investing over £3 million to promote the MMR vaccine and not a penny to-date towards autism research. So is the Government going to convince parents that the MMR vaccine has never caused autism in a small percentage of predisposed children? Not Really. Is Andrew Wakefield going to just go away? Not Really. Will the truth ever come out? Absolutely. References 1. Regressive Autism and MMR Vaccination F. Edward Yazbak, MD, FAAP, TL Autism Research. http://www.redflagsweekly.com/yazbak/2003_nov01_1.html 2. Taylor B, Miller E, Farrington, Cetropoulos M, P, Favout-Mayaud, JL, Waight P, Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet 1999; 353: 2026- 29. 3. Kaye JA, del Mar Melero-Montes M. Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis. BMJ 2001; 322: 460-463 (24 February.) 4. Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998; 351: 637-41. Competing interests: Grandfather of a boy with two documented regressions, autistic enterocolitis and evidence of measles genomic RNA in the gut wall.