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Think harm always

BMJ 2004; 329 doi: (Published 01 July 2004) Cite this as: BMJ 2004;329:0-g

Rapid Response:

Irresponsible claims about vaccine safety? Questions for Sir Liam Donaldson and Prof Lewis Wolpert.

In an NHS leaflet [1] Sir Liam Donaldson, the Chief Medical Officer
is asked: "Does MMR overload young bodies?" to which he replies: "Again,
all the evidence refutes this. In fact, a child's immune system is
designed to cope with many different viruses at the same time, so a
combined vaccine is a natural choice."

I asked mmrthefacts: "Is the CMO entitled to present this as a
medically established fact rather than a theoretical proposition? What is
the experimental evidence that all children are equally able to sustain
multiple exposure? What does the CMO mean by "designed?"

To which I had the reply (received 27 May 2004, 13.10):

"The CMO is entitled to present his statement about the immune system
as a medically established fact rather than theoretical proposition. From
the moment of birth a child's immune system is able to cope with the
constant barrage of pathogens. As the CMO stated, this is what
the..."immune system is designed cope tih (sic)..."As for example, the
digestive system is "designed" to digest food and liver is "designed" to
detoxify the blood. Part of the licensing process of any combination
vaccine, such as MMR, has to show that the combination is safe and
effective when administered to the age group for which it is intended.
There is recent research from the US which supports this statement as it
has specifically looked at the ability of children's immune systems,
estimating that a child's immune system could cope with 10,000 vaccines
any one time. Please see Offit PA et al (2002) Addressing parents'
concerns: Do multiple vaccines overwhelm or weaken infant's immune system?
Pediatics, 109 (1): 124-9

Support Team"

There are patently contradictions here. On the one hand we are being
assured that children's immunes systems are of incredible robustness, and
this is apparently stated as a fact. But if this was the case you might
wonder why they needed to be vaccinated at all. Secondly, we are assured
that the multiple vaccine products are tested to ensure their safety,
because (presumably) the science that declares that their immune system is
so robust cannot be relied upon. Thirdly, the extreme theoretical claim of
Offit et al, is offered as evidence (but presumably no one is queuing up
to test their child with the 10,000 vaccines claim).

As to the point about the immune system being "designed", even if we
accept the gloss of the mmrthefacts support team we have to answer: fine,
but what happens when the digestive system goes wrong, and what happens
when the liver goes wrong, and what happens when the immune system goes

So, to return to the point that Prof Wolpert made in the Evening
Standard (24 February 2004):

"One should be suspicious of maverick scientists. With rare
exceptions, they are simply wrong. The core of science
is remarkably reliable, and when there are disputes it takes exceptional
scientific skills to make the right judgements."

But I submit that it would be misleading to claim that Andrew
Wakefield has challenged "the core of science". His challenge exists in a
field of exceptional uncertainty (unless Offit's paper is a cornerstone of
modern science): the effectiveness and safety of pharmaceutical products,
and whether these particular products are adquately tested, or properly

[1] An NHS leaflet "The facts about MMR and your child - A letter
from the Chief Medical Officer". I have not been able to locate the text

[2] See recent entries under Watts 'The new MMR?' BMJ 2004: 328: 773

Competing interests:
Parent of an autistic child

Competing interests: No competing interests

03 July 2004
John Stone
London N22