MMR: Science and Fiction. Exploring the Vaccine Crisis; MMR and Autism: What Parents Need to KnowBMJ 2004; 329 doi: http://dx.doi.org/10.1136/bmj.329.7473.1049 (Published 28 October 2004) Cite this as: BMJ 2004;329:1049
- David Elliman, consultant in community child health (, )
- Helen Bedford, lecturer in children's health
- Islington Primary Care Trust and Great Ormond Street Hospital, London
- Institute of Child Health, London
MMR: Science and Fiction. Exploring the Vaccine Crisis
MMR and Autism: What Parents Need to Know
The publication in 1998 of an article in the Lancet proposing a new syndrome of autistic enterocolitis should have attracted little publicity (Lancet 1998;351: 637). The authors, researchers at the Royal Free Hospital, stated clearly in the article that “We did not prove an association between measles, mumps, and rubella [MMR] vaccine and the syndrome described.” However, the first author surprised his colleagues by suggesting at a subsequent press conference that children should be offered the three vaccines individually with an interval of a year between each dose. This, unlike the article, was “news.” The ensuing media frenzy resulted in a fall in uptake of the vaccine and led directly to the current real threat of large outbreaks of measles in the United Kingdom.
These two books, written by supporters of the vaccine, describe the MMR story and its context. Although both authors are doctors who have played a major part in events, the accounts are written from very different perspectives. Richard Horton, as editor of the Lancet, could be said to deserve some of the blame for the current situation. Michael Fitzpatrick, on the other hand, is a general practitioner in north London and father to a son whose autism began to manifest itself a few months after receiving the MMR vaccine.
Fitzpatrick describes how in the 1990s “popular confidence in science, medicine and government was already running low and anxieties over health issues were running high.” At the same time as people were turning away from conventional medicine, the media and complementary practitioners were blaming “immune dysfunction” for an increasing number of disorders. This was all fertile ground for the rapid growth of a scare story. The Lancet paper was the necessary seed.
As a result of the MMR story, many parents are once again being made to feel responsible for their child's condition—in this case, by accepting the MMR vaccine. Meanwhile, other parents are nervously watching their healthy MMR vaccinated children for signs of autism. This is an additional but little recognised consequence of the health scare that has caused immense grief and anxiety to some parents.
Richard Horton, as editor of the Lancet, could be said to deserve some of the blame for the current situation
Michael Fitzpatrick points out that the original “science” behind the Lancet paper was poor, and was recognised at the time to be so in an accompanying commentary by Robert Chen and Frank DeStefano. Richard Horton, on the other hand, makes a lot of the revelations earlier this year that one of the researchers had received funding from the then Legal Aid Board to ascertain whether the children's problems were a result of the vaccine. This, he claims, throws into question the validity of the original paper and casts doubt on the selection of the children included in the study.
However, the potential bias had already been clearly pointed out in the commentary at the time. More importantly, Chen and DeStefano had voiced concerns about the potential effect of this paper on public confidence in the vaccine and the consequences that might result. Although subsequent events have not been quite as bad as they predicted, their final statement has unfortunately proved to be well founded: “This painful history was shared by the UK (among others) over pertussis in the 1970s after another similar case-series was widely publicised, and it is likely to be repeated all too easily over MMR. This would be tragic because passion would then conquer reason and the facts again in the UK.”
Richard Horton proposes the setting up of an independent body—National Agency for Science and Health (NASH)—to act as a forum in which to “debate and judge conflicting evidence concerning the health effects and ethical implications” of many of the contentious issues of what is essentially public health. He is also very sympathetic to concerns about supposed conflicts of interest in this story, referring to “The Dawn of McScience,” and suggests the setting up of a Council for Research Integrity. However, to concentrate on the financial conflicts so much is probably too simplistic as for most researchers this is a minor consideration. Much more important is the esteem in which they are held by their colleagues and a genuine desire to do good for their fellow man. Sometimes the former may get out of hand and a rush for publications of low quality may result, but fraud is still uncommon. As Horton so rightly points out, without any trace of irony, the peer review system is not perfect, but he does not really come up with a better option. It is debatable whether the setting up of more bodies will help significantly.
Both books offer a useful and interesting insight into the MMR vaccine story. If you had to choose only one to read which would it be? For parents it has to be Mike Fitzpatrick's. For healthcare professionals, his account is probably still the more valuable, but if you want an insight into medical publishing it has to be Richard Horton's. While we would not agree with everything either of them says, we recommend reading both.
Competing interests DE and HB have in the past received funding from vaccine manufacturers Wyeth,Aventis Pasteur MSD,and GlaxoSmith-Kline to attend symposiums and conduct research.