Vaccination

A diagnosis of autism in the family can lead to much confusion and loneliness. The world wide web can provide great supports to help get through the early stages of accepting the diagnosis, but it can also add to the confusion: the web abounds with snake oil salesmen who will gladly take your money to cure your child's newly discovered autism. Further adding to the confusion, a lot of people sincerely believe that their own children's autism was caused by the Measles, Mumps and Rubella (MMR) vaccine.

Doubts and fears of vaccinations have been around since vaccinations have been around. Wikipedia has a succinct summary of the history of vaccine controversies: http://en.wikipedia.org/wiki/Vaccine_controversy. In summary, history frequently repeats itself as follows: (1) some controversy begins to surround a particular vaccine, (2) vaccinations decrease across the population despite ample proof against the controversy and (3) children get sick and die because of the disease they should have been inoculated against.

The belief that the MMR vaccine causes autism is upheld because the first signs of autism are often only clear when a child is one year old, which is the time when most children are given the triple vaccine.

The chronology of the MMR vaccine's believed link to autism is as follows:

• 1994: a solicitor named Richard Barr successfully wins legal aid funding for the pursuit of a class action against the manufacturers of MMR under the Consumer Protection Act 1987 in the United Kingdom. The class action case was aimed at Aventis Pasteur, SmithKlineBeecham, and Merck, all manufacturers of MMR vaccines. The suit was based on a claim that MMR is a defective product and should not have been used. Owing to a 10 year limit on the period in which an action can be brought under the Consumer Protection Act, court proceedings were started before the medical research had concluded.

• 1995: medical researcher Dr Andrew Wakefield,

following up his 1993 paper discussing a possible link between measles and Crohn's disease, publishes a paper suggesting a link between the measles vaccine and inflammatory bowel disease.

• 1996: Barr, noticing Wakefield's two publications, contacts Wakefield for his expertise.

• 1998: Wakefield and twelve collaborators publish a paper in The Lancet, a respected British medical journal, strongly suggesting a link between the MMR vaccine and autism. Wakefield is the lead author. In conjunction with the release of the paper, Wakefield leads a press conference advising parents to vaccinate their children against measles, mumps and rubella in three shots, separated one year apart, rather than in the one single shot which is the MMR vaccine.

• 2004: A Sunday Times article by Brian Deer reveals that Wakefield received £55,000 funding from Barr and other solicitors for his research alleging a link between the MMR vaccine and autism, a clear conflict of interest. Furthermore, Deer accuses Wakefield of subjecting the 12 children used in the study to a battery of invasive procedures, including colonoscopies and lumbar punctures. The article reveals that several of the parents of the twelve children were Barr's clients, and there was no actual scientific evidence of an autism-vaccine link in the paper, only testimonials from the parents. Many of the 1998 paper's collaborators are shocked to learn of the conflict of interest. Soon after, ten of the twelve collaborators retract the interpretation from the paper linking the MMR vaccine with autism. In 2006, Deer would reveal that Wakefield had received a further £400,000 from the lawyers responsible for the MMR lawsuit.

• 2005: Shortly after Wakefield's 1998 article, Japan had begun administering the MMR vaccine in three separate doses. Years later, in 2005, an article in The Journal of Child Psychology and Psychiatry demonstrates there is no link between the combination of the three vaccines and autism. The rate of autism has continued to increase in Japan, same as the rest of the world, despite the separation of the vaccinations.

• 2007: the General Medical Council (GMC), which is responsible for licensing doctors and supervising medical ethics in the UK, begins investigation of the affair.

• Also in 2007, former Playboy Playmate of the Year Jenny McCarthy

publishes Louder than Words: A mother's journey in healing autism. It is a memoir of the diagnosis of Ms McCarthy's son, Evan, with autism. The book suggests (but never explicitly states) that Evan's autism was caused by the MMR vaccine. A foreword, written by paediatrician Jerry J Kartzinel, also suggests (but never explicitly states) that his own son's autism was caused by the vaccine. The memoir also suggests that autism can be cured using the correct diet and behavioural therapies.

• 2008: The rate of measles inoculation in the UK has now fallen to below 80% compared with 93% in 1998 (pre controversy).  The number of confirmed cases of measles in England and Wales have risen from 56 in 1998 to 1348 in 2008, with two child fatalities this year.

• January 2010: the GMC gives a preliminary verdict of its investigation: Wakefield was found to have acted "dishonestly and irresponsibly" and to have acted with "callous disregard" for the children involved in his study, conducting unnecessary and invasive tests. The trial used for the 1998 paper involved procedures with medical risks but was not approved by an Independent Ethics Committee. Wakefield was shown to have multiple conflicts of interest in the conduct of the study. Days later, The Lancet retracts Wakefield's paper from the public record.

• May 2010: the GMC publishes its verdict: Dr Wakefield is found guilty of serious professional misconduct over unethical research, and is struck off the medical register.

• In mid-2010, Wakefield publishes the autobiographical Callous Disregard, with foreword by Ms McCarthy, arguing that he has been unfairly treated by the medical and scientific establishment.  He is not licensed to practise medicine in the US nor in the UK.

(The above chronology is mostly paraphrased from http://en.wikipedia.org/wiki/MMR_vaccine_controversy and other Wikipedia sites. I know Wikipedia is not always 100% reliable, and it certainly isn't my only source. However, having done my own research, I have chosen to paraphrase Wikipedia since it seems to neatly summarise what I have already found to be true.)

Since 1998, many scientific and medical papers (in addition to the one mentioned above) have proven that there is no link between any vaccinations and autism. So why do many people continue to believe there is? Why would so many people rather believe the testimonies of a Playboy bunny and a disgraced doctor, rather than believe a decade of hard evidence? The answer is, quite simply, the majority do not. Today, in 2010, the MMR vaccine "controversy" is just a lot of noise being made by an ignorant few. Thanks to the web, a noisy minority can easily make an unpopular belief seem popular: it is up to every parent to be on their guard and seek out the truth for themselves. 

For those of you who would go with gut instinct rather than published scientific papers, I want give a gut-instinct story which shows the controversy is just a big load of hooey by recounting two conversations I had with my wife, Anne. 

The first conversation took place years ago, when our children were newly diagnosed with autism. The controversy surrounding MMR only came to our attention through conversations with other parents, and through a documentary which Anne and I watched together. The documentary starts with some testimonials of parents who swear their kids became autistic after receiving the vaccination. Then, the documentary gives several pieces of evidence demonstrating there is absolutely no link between autism and the vaccination. The most convincing argument was an exhaustive study of all Danish children over the course of several years: the Danes, apparently, keep a central database of every single medical visit, including inoculations and autism diagnoses. A study of this data proved there is no link between the two. The documentary ends by revisiting the parents from the start, who still swear MMR causes autism. When the show was over, Anne tearfully said to me, "I don't know why you insist on giving the kids those stupid vaccinations. You probably caused their autism."

The second conversation took place last week, when I told Anne I wanted to write a blog entry about the vaccination controversy. She warned me that I'd get a lot of hate mail. She told me that one of the mothers in our neighbourhood still strongly believes that MMR vaccination causes autism. I asked Anne if she thought there was a link. She said "No because, looking back, I felt in my gut that something wasn't right with Rémi long before he turned one and got vaccinated."