Why did the Lancet take so long?
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c644 (Published 02 February 2010) Cite this as: BMJ 2010;340:c644
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Dr A Wakefield did not state that MMR was the cause of regressive
autism but that he was struck by the frequent suspicion of
parents. Furthermore the small primary series has been extended(1) and
confirmed by others(2)and others.. As most viruses are immunosuppressive ,
it is a bit strange to inject three all at once .(I have sought answer to
this ,but the vaccination champions have so far remained silent) I have
repeatedly listened to Wakefield and if anything his data are impressive
and very carefully presented and evaluated.All new hypotheses needs lots
of follow up work, but should not be banned because of a preliminary
nature.
To me the tradition of English fair play has clearly been set aside for no
good reason at all. A profession that has condoned major surgery including
lobotomies etc is hardly capable of judging minor infringements, blown up
out of proportion. How our profession has been able do condone massive
psychodynamic interventions in disorders that have a strong heridtary
component (In Autism shown by Sir M Rutter) , remains a much more serious
ethical dilemma if not a serious problem.
1. Wakefield AJ et al ( 2000) Am J gastroenterol 95: 2285-2295
2.Krigsman A (2007) Medical veritas 4: 1522-1530
Competing interests:
I work on peptide s, dietary intervention and autism
Competing interests: No competing interests
Wakefield's name has been dragged through the mud, and a lot of
rumors have surrounded his retracted article. I have the retracted article
at hand.
Anyone who thinks that Wakefield did not state a hypothesis, should
read the last paragraph on page 639. It states, "...inflamed or
dysfunctional intestine may play a part in behaviorial changes in some
children." In other words, inflammatory bowel disease could exacerbate
autism. That is a sound hypothesis that is backed by scientific findings
to support that possibility.
The article did make an association between the MMR and inflammatory
bowel disease, but the article states, "We did not prove an association
between measles, mumps, and rubella vaccine and the syndrome described."
In other words, they did not prove that the MMR caused the inflammatory
bowel disease associated with behaviorial symptoms.
The article also suggested that these autistic children could have a
genetic susceptibility--the inability to handle viruses appropriately,
including inattenuated viruses.
Competing interests:
None declared
Competing interests: No competing interests
Following a legal complaint several responses have been removed.
Competing interests:
None declared
Competing interests: No competing interests
Mr. Deer is absolutely correct: My grandson was not one of the 12
children enrolled in the original Wakefield study that was published in
the Lancet in February 1998. If he had been, I would have certainly
mentioned that among my competing interests for the last 10 years. Had Mr.
Deer written earlier, I would have made that clear.
It almost seems that Mr. Deer is less upset about what I wrote than
about the fact that some web site somewhere had picked it up. I certainly
have no idea where my remarks were circulated and by whom and I have no
control of that.
In any case: If anyone else misunderstood my statement (s), I
sincerely apologize for the confusion. No deceit was ever intended!
From everything I have read, it seems clear that the accusatory
claims related to pain, suffering and unwarranted risky investigations
that were discussed in the last few years were not limited to those
original twelve children. They certainly seemed to be about the many
others who were later seen and “studied” for autistic entero-colitis at
the Royal Free GI unit and whose cases were reported in subsequent
publications and presentations. When I mentioned “all available parents
and grandparents of the children…” I certainly had in mind those hundreds
of parents and grandparents that were never interviewed by the GMC
committee. Whether they were inside the hall or on the sidewalk, outside
of London or outside of the United Kingdom, many of them would have been
elated to testify. It is regrettable that they were not allowed to.
When we took our boy to the Royal Free, we wanted to find out what
was wrong with him. We just could not see him suffer and cry all day
anymore. It was our understanding that while many children with autism and
GI problems were being treated at the unit, only few could be fully
investigated because of a multitude of reasons. We were therefore most
elated when my grandson was selected. That is what I meant when I
mentioned the “study”. We still count our blessings that my daughter and
her family were living in London at the time.
It is no secret that I have been and will always be a supporter of
Dr. Wakefield. Yet, I would point out that I did not submit a single rapid
response to the BMJ in nearly two years and that I did not criticize the
GMC ethics hearings while they were going on. Dr. Wakefield’s attackers on
the other hand never hesitated to publish defamatory remarks about him
throughout that same period of time.
Mr. Deer is fortunate not to have a child, a relative or a friend
with regressive autism. We were not so lucky and when we were down and
out, we received comfort and extra good care from three wonderful
physicians who unfortunately are still being subjected to a living hell.
Competing interests:
Grandfather of a boy with regressive autism
Competing interests: No competing interests
Editor
I, for one, am disgusted at the Lancet, GMC and Medical Profession
who are apparently blind to the fact that Wakefield and his colleagues
discovered raised methylmalonic acid in the MMR vaccine treated group.
The obvious conclusion is some ingredient of the vaccine, when given
to a genetically susceptible child, causes Cobalamin deficiency with all
the signs and symptoms of pervasive developmental disorder.
Stop vaccinating cildren until the offending ingredient is identified
and removed. The lives of these children must be consideed before the
profits of Big Pharma
Michael Innis
Competing interests:
As previously declared.
Competing interests: No competing interests
"Neurotoxicology. 2009 Oct 2. [Epub ahead of print]
WITHDRAWN: Delayed acquisition of neonatal reflexes in newborn primates
receiving a thimerosal-containing Hepatitis B vaccine: Influence of
gestational age and birth weight." [1]
The paper had cleared all those successive hurdles necessary for a
paper to be published. The paper had passed eligibility screening, peer
review and gained statistical, technical and editor's approval for
publication in a prestigious international journal. It had been
disseminated in electronic format and with the designation "in press", it
stood in line for publication in
the print version of 'Neurotoxicology'. On 12 February the paper was
quietly withdrawn.
Was the topic area important and relevant to the 'Neurotoxicology'
readership?
Yes. Questions have long been asked about the possible link between
mercury in vaccines and neurodevelopment outcomes. Since vaccines
containing the preservative thimerosal, (Th) including neonatal hepatitis
B (HB) vaccine, continue to be used routinely in developing countries,
continued safety testing is important, particularly for premature and low
birth weight neonates. Exploration of the neurotoxicity of mercury
containing vaccines would certainly have been appropriate for the
readership of 'Neurotoxicology' and highly relevant to a general medical
readership, so long as it was scientifically robust.
In summary, the researchers concluded that their primate study
provided "preliminary evidence of abnormal neurodevelopmental responses in
male infant macaques receiving a single dose of Th-containing HB vaccine
at birth and indicates that further investigation is merited." Birth
weight and GA (gestational age) appeared to be important variables that
predicated susceptibility. [2]
Having jumped all the hurdles to publication, one can only assume
that the science was robust. Why then was the paper withdrawn? Can erasing
this paper from the official record be a good thing for science? Could
Professor Greenhalgh please explain?
[1] PubMed.gov. US National Library of Medicine, National Institutes
of Health.
http://www.ncbi.nlm.nih.gov/pubmed/19800915.
[2] Accepted Maunuscript. Title: Delayed Acquisition of Neonatal
Reflexes in newborn Primates receiving a Thimerosal-containing Hepatitis B
Vaccine: influence of gestational age and Birth weight. Authors: Laura
Hewitson, Lisa A. Houser, Carol Stott, Gene Sackett, Jaime L. Tomko, David
Atwood, Lisa Blue, E. Railey White, Andrew J. Wakefield.
http://www.rescuepost.com/files/hewitson-et-al-09-primate-hbv-study.pdf
Competing interests:
None declared
Competing interests: No competing interests
I am very concerned by the e-letter from Dr Edward Yazbak, a retired
paediatrician of Falmouth, Massachusetts, claiming to be a grandparent of
a child enrolled in the Wakefield Lancet study of February 1998. With
this apparent credential, he lauded praise upon Wakefield, as he has done
at public meetings which they have addressed together.
I know the names and family backgrounds of all 12 of the children
enrolled in the study, including the child enrolled from the United
States. I don't believe that Dr Yazbak has a family relationship with any
of them.
If what Dr Yazbak ought to have said was that a grandchild of his
receieved clinical care at the Royal Free at some time subsequent to
February 1997, then it's an additional concern that he should indicate, as
he did, a belief that the boy was taking part in a study. He might
clarify the position, and also indicate what service the north London
hospital offered to his grandson that was not available in New England.
The Royal Free had no department or reputation for evaluating
developmental disorders, and ileocolonoscopy, if indicated, would have
been available on his doorstep. As the GMC has made clear, Dr Wakefield
had a non-clinical research contract, and so it's not clear what service
he could have offered any child.
Dr Yazbak's claims have been widely disseminated on anti-vaccine
websites, as something accorded the additional credibility of being
apparently published at a BMJ site.
Competing interests:
My investigation of Wakefield led to the GMC hearing and the Lancet's retraction
Competing interests: No competing interests
Editor,
I agree with Raymond Gallup - the Lancet withdrawal of the Wakefield
paper is of no importance. As he says "Hitler burned books in Nazi Germany
but he didn't really destroy forever the books he burned. The same can be
said for the Lancet, they can't destroy the science."
The science they seek to destroy is the crucial observation "urinary
methylmalonic acid was significantly raised in all eight children who were
tested, compared with age-matched controls".
This means the MMR vaccine, while raising the levels of methylmalonic
acid, also causes a reduction in Cobalamine the typical signs and symptoms
of which in infancy are "failure to thrive, movement disorders,
developmental delay, regression, and megaloblastosis, but neurological
symptoms and signs can develop even without hematological abormalities.[1]
One can understand Editors being reluctant to acknowledge MMR vaccine
may cause pervasive developmental disorder in children. Big Pharma is
watching.
Michael D Innis MBBS;DTM&H;FRCPA;FRCPath
Reference
1. Bjorke Monsen AL;UelandPM. Homocysteine and methylmalonic acid in
diagnosis and risk assessmetnt from infancy to asolescence. American
Journal of Clinical Nutrition 2003;vol 78:7-21.
Competing interests:
i have warned my family of the hazards of MMR and other vaccines.
Competing interests: No competing interests
My friend, Dr. Yazbak makes a very good point. The Lancet and any
other medical journal can never get rid of science even if they retract an
article. Hitler burned books in Nazi Germany but he didn't really destroy
forever the books he burned. The same can be said for the Lancet, they
can't destroy the science.
My challenge to the MD's and people like Brian Deer that have a
vendetta against Dr. Wakefield and his colleagues is this. If you think
vaccines are safe, then take the vaccine challenge. Get all the vaccines
babies are required and make sure they are adjusted upward in dosage for
your body weight.
If vaccines are so safe then why are a large majority of physicians
avoiding vaccination? The following makes my point:
"It's not only the public that needs educating. Wexler can't believe
how few health professionals get vaccines themselves, particularly flu
shots. "I was so shocked that only 34 percent of M.D.s and R.N.s get
vaccinated annually,"
she says. "They think they don't get sick, but you can have a mild case of
the flu and spread the disease to somebody and make them really sick."--
"Giving Vaccines a Boost" Family physician-turned-publisher,
Deborah Wexler, M.D.
http://www.mmaonline.net/publications/MNMed2002/February/Whisnant.html
And this............
http://www.dailymail.co.uk/health/article-179088/Doctors-children-
avoid-MMR.html
Some MDs Decline Certain Vaccinations for Their Own Children
NEW YORK (Reuters Health) Nov 09 - Nonpediatric physicians in
Switzerland often decline having their own children immunized against
measles, mumps,hepatitis B, and Haemophilus influenzae type b, according
to a report in
the November issue of Pediatrics. In addition, they may postpone DTP or
MMR vaccination.
The report indicates that 10% of nonpediatricians would not follow
official immunization recommendations for their children, compared with 5%
of pediatricians. According to the study authors, these findings suggest
that
many physicians are misinformed about the benefits and risks of
vaccination and are "unlikely to answer parental concerns adequately."
In the new study, Dr. Claire-Anne Siegrist, from the University of
Geneva in and colleagues sent a Web-based survey to 2070 Swiss physicians
in October 2004 to gauge their feelings about vaccinations for their own
children.
The overall response rate was 49.1% and just over half of the
respondents were pediatricians. Ninety percent of respondents had at least
one child.
The nonpediatricians included 317 general practitioners, 144
internists,and 95 physicians from other specialties. Compared with
pediatricians,nonpediatricians were more likely to be male, but less
likely to work in
private practice.
As noted, nonpediatricians were less likely than pediatricians to
have their child immunized against measles, mumps, hepatitis B, or
Haemophilus
influenzae type b and more likely to postpone DTP and MMR vaccination.
Both groups of physicians advocated the use of vaccines not included
in current recommendations, such as vaccines against hepatitis A,
influenza,and varicella.
Pediatricians were more than twice as likely as nonpediatricians to
give pneumococcal and meningococcal C vaccine to their own children.
Conversely,
nonpediatricians were more likely to give tick-borne encephalitis virus
vaccine.
"Despite their scientific training and education,
(nonpediatricians)express the same concerns as those that prevail in the
public," the authors conclude. "Unless additional vaccine education and
information efforts
targeted toward these physicians eventually prove successful, the control
of communicable diseases such as measles may prove impossible in
Switzerland and other countries."
Pediatrics 2005;116:e623-e633.
Raymond Gallup
Lake Hiawatha, NJ USA
RayGallup@optimum.net
Competing interests:
I have a son with autism who was born normal and
regressed into autism after getting the MMR vaccine
Competing interests: No competing interests
Original Sources Best
John Stone, Age of Autism, quotes (24th February 2010) from an
article by
Melanie Phillips, 'A deer in the headlights', The Spectator 16 February
2009,
when naming Brian Deer as complainant about Dr Wakefield to the GMC.
I suggest the more appropriate citation would have been the original
Queen’s
Bench Division judgement of 21st December 2006, by THE HON. MR JUSTICE
EADY, from which the Phillips quote was taken, because this sheds light on
the
subsequently much pondered process by which the identities of patients and
parents were disclosed. There really was no mystery. Disclosure to Channel
Four
Television Corporation, Twenty Twenty Productions Ltd and Brian Deer was
ordered by the court under strict conditions.
Furthermore, a search on the law resource site: http://www.bailii.org
using
search terms “Wakefield Deer Eady” gives two results. The second earlier
one,
from 4 November 2005, sheds further light on events surrounding abandoned
libel proceedings commenced by Dr Wakefield.
Competing interests:
None declared
Competing interests: No competing interests