Intended for healthcare professionals

Views & Reviews Review of the Week

Trust me, I’m a scientist

BMJ 2009; 339 doi: (Published 09 September 2009) Cite this as: BMJ 2009;339:b3658

Close to agreement ?

John makes many good points, and obviously does not have a closed
mind on causality, nor the urgent need for good research into autism and
vaccine safety. And I thank David for his helpful and conciliatory points
of agreement.

As the Rapid responders state, a conviction that MMR is safe has not
actually been tested by the appropriate science - a blinded prospective
RCT. Instead we are forced to cast about retrospectively looking for
second-best survey evidence, which for what it is worth shows no good
reason for alarm. It hasn't persuaded doubting parents, and in part we
are all to blame ( whether by accidentally poor communication,
authoritatrian or ridculing approaches, or flat-earthist mentalities ). So
it is highly relevant to public trust in science and doctors, that Flu-
vaccine continues to be robustly tested by blinded RCT, otherwise next
month there will be all-hell to pay !! We used to think HRT was safe,
until the RCT was done. We used to advocate Aspirin widely for primary
prevention, until the rigorous analysis of the RCTs this year !! And
I've lost count of how many drugs have been withdrawn in my lifetime as
evidence of harm emerged !!

I do agree the need for some very robust data on the incidence of
Autism. A closely-defined National Autism Register being a major
objective. In yesterday’s Daily Telegraph ( it was lying in my hotel
lobby ) reported a NHS Information Centre released study on 4000
households, reported to show no difference between autism rates between
adults and children, suggesting therefore that there has been no
discernible increase over a generation. Yet so much anecdote and
experience tells us that autism is on the increase… Is this a real
increase ( implicating a new environmental cause), or merely an increased
awareness ( detection bias) ? A robust historical incidence register,
with cross-referencing capability to vaccination status ) would go a long
way toward exonerating or implicating particular vaccines, such as MMR.
An NHS-constructed postal survey of parents , and specialist registers
would be a good start. The NHS already holds a robust vaccination
register. And a close 10-year tracking follow-up of the non-randomised
UK national study of MMR-accepters versus MMR-refusers would be well worth
publication. Perhaps I missed it ?

Time, gentleman, please .. to pursue the research ?

Competing interests:
I am paid by the NHS to vaccinate people.

Competing interests: No competing interests

24 September 2009
L Sam Lewis
GP Trainer
Surgery, Newport, Pembrokeshire, SA42 0TJ