Action For Autism

MMR and Autism - No connection

10 years go a remarkable press conference took place to mark the publication of a new study in the Lancet. It was remarkable because this was a preliminary report, based on a series of only twelve case studies - not the normal stuff of press conferences. It suggested a new disorder, autistic enterocolitis. There had been suspicions about a link between gut disorders and autism for years. While this study was far too small to settle the issue it did suggest that a large scale study was called for. But why a press conference?

Richard Horton, editor of the Lancet, explains

“In the week of the paper’s publication, some of the Royal Free research team decided to hold a press conference to announce their findings. This gave them an opportunity to express the benefits of the MMR vaccine and the inconclusive nature of their results in respect to the link between the syndrome and the vaccine.” (MMR Science and Fiction by Richard Horton. Granta Books 2004)

So why did they issue this scaremongering press release, which Horton quotes in his book?

“The majority opinion among the researchers involved in this study supports the continuation of MMR vaccination. Dr Wakefield feels that vaccination against the measles, mumps and rubella infections should undoubtedly continue but until this issue is resolved by further research there is a case for separating the three vaccines into measles, mumps and rubella components and giving them individually spaced by at least 1 year.”

The answer, implicit in Horton’s account, is that Wakefield was a dynamic researcher who was shaking up a moribund department of medicine that had been resting on its laurels. He was their star player and was granted more leeway than normal in the hope that he would deliver glittering prizes. Wakefield was pursuing his own glittering prize. He was convinced that there was a connection between measles virus and inflammatory bowel diseases like Crohn’s syndrome. He suspected that measles vaccine might also be involved. He was developing his own single vaccine for measles that would bypass these difficulties and had issued a patent application in the name of the Royal Free Hospital in 1997. He was also employed by solicitors to demonstrate a link between MMR and autism, particularly where it involved symptoms of inflammatory bowel disease.

How much of this was known to his colleagues at the Royal Free? Did it influence their better judgement and allow Wakefield to hijack the press conference? Would there even have been a press conference without Wakefield? Did Wakefield’s ambition and personal conviction lead him to breach the ethics of his profession? All this is still the subject of conjecture and debate and, with regard to ethics, ongoing disciplinary hearings at the GMC. What is beyond conjecture is that, despite no credible evidence to support it, the idea that MMR causes autism became firmly implanted in the public consciousness. Vaccination rates declined and measles is once more endemic in the UK. It is widespread in Europe and spreading in America where concerns about the safety of a mercury preservative in vaccines coalesced with concerns about MMR to create vaccine resistant hotspots, primarily in affluent areas where people can afford the privilege of being the “worried well.”

All this comes at a time when deaths from measles are declining rapidly in the developing world thanks to a vigorous campaign of vaccination. To place this in context, deaths from measles are still statistically insignificant in Europe and North America. Success for the vaccination campaign in Africa, Asia and South America means that “only” around 250,000 children died from measles related causes last year compared to the 750,000 that was commonplace a decade ago.

Given the propensity of wealthy Americans and Europeans for foreign travel to exotic places it would be a tragic irony if the fragile success of the vaccination programme in the developing countries was compromised by western tourists carrying the virus into unvaccinated parts of the third world. It would be even more tragic if the anti-vaccine movements in the USA and Europe gained a foothold in those countries that desperately need vaccines and undermined the efforts led by the World Health Organization, with equally devastating consequences.

So one would hope that a definitive study that effectively disproves any link between MMR and autism would be trumpeted from the rooftops and receive coverage that was commensurate with the thouands of scare stories about MMR that have been in circulation for at least a decade since Wakefield’s inglorious announcement.

We shall soon have an opportunity to judge. Less than an hour ago Forbes Magazine reported on a new study which found no relation between MMR and autism. Of course there have been numerous studies before. These have singularly failed to persuade the Wakefield acolytes and their media friends. As Ben Goldacre noted last week:

“In the Journal of Medical Virology March 2006 there was a paper by Afzal et al, looking for measles RNA in children with regressive autism after MMR vaccination, using tools so powerful they could detect measles RNA down to single-figure copy numbers. It found no evidence of the vaccine-strain measles RNA to implicate MMR. Nobody wrote about this study, anywhere, in the British media (except for me in my column).

This was not an isolated case. Another major paper was published in the leading academic journal Pediatrics a few months later, replicating the earlier experiments very closely, and in some respects more carefully, also tracing out the possible routes by which a false positive could have occurred. For this paper by D’Souza et al, like the Afzal paper before it, the media were united in their silence. It was covered, by my count, in only two places: my column, and a Reuters news agency report

[...]

Journalists like to call for “more research”: here it was, and it was ignored. Did the media neglect to cover these stories because they were bored of the story? Clearly not. Because in 2006, at exactly the same time as they were unanimously refusing even to mention these studies, they were covering an identical claim, using identical experimental methodology: “US scientists back autism link to MMR” said the Telegraph. “Scientists fear MMR link to autism” squealed the Mail.

What was this frightening new data? These scare stories were based on a poster presentation, at a conference yet to occur, on research not yet completed, by a man with a well-documented track record of announcing research that never subsequently appears in an academic journal. This time Dr Arthur Krigsman was claiming he had found genetic material from vaccine-strain measles virus in some gut samples from children with autism and bowel problems. If true, this would have bolstered Wakefield’s theory, which by 2006 was lying in tatters. We might also mention that Wakefield and Krigsman are doctors together at Thoughtful House, a private autism clinic in the US.

Two years after making these claims, the study remains unpublished.”

It will not be so easy to ignore this report.

1. The study is a deliberate attempt to replicate Wakefield’s original study. It looks for measles in the gut of autistic children with bowel disorders. Furthermore it includes a control group of non-autistic children with bowel disorder.
2. It uses three different laboratories to test its results, including the original laboratory that Wakefield used. This lab, run by Professor O’Leary, had its results in the Wakefield study dismissed by world expert Stephen Bustin, because of cross-contamination that made them meaningless. Now that it has literally cleaned up its act its results concur with the other two labs: no evidence of measles in the intestines of autistic children with bowel disorder.
   • “We found no difference in children who had GI complaints and no autism and children who had autism but no GI complaints,” Dr. Ian Lipkin of Columbia University told reporters in a telephone briefing.
3. There was no temporal association between MMR vaccination and onset of GI symptoms.
   • “We found no relationship between the timing of MMR vaccine and the onset of either GI complaints or autism,” Dr. Mady Hornig, also of Columbia, said in a statement.

Look at those names. Mady Hornig was the author of a controversial study that suggested a link between the mercury in some vaccines and autism. Ian Lipkin is her long time collaborator. Rick Rollens, a Californian politician who has been a powerful advocate for a vaccine induced autism epidemic and used to believe that the MMR vaccine was the final straw in his own child’s autism is quoted by Forbes commenting favourably on this study.

Not even the most diehard anti-vaccine activist could claim that this is just another big pharma/big government sponsored cover up. Or could they? What they are claiming, judging by some of the anti-vaccine contributors to the Environment of Harm email list is even more bizarre. Because O’Leary’s lab has produced bone fide results that contradict Wakefield they are arguing that the results he produced supporting Wakefield must be equally valid. I kid you not. It is as if someone watching Gordon Ramsay’s Hells Kitchen were to argue that, because the eventual winner delivered a perfect service in the final, their undercooked disaster in the opening round that very nearly got them eliminated also had to be cookery of the highest order.

I suspect that the true believers will never be persuaded. [Update: I was right. Kev has just blogged the NAA response. They call this a CDC study throughout to avoid admitting that "one of their own" Mady Hornig authored this study. NB for new readers: CDC in the NAA demonology equates to big pharma/government cover-up.] But I am encouraged when open minded scientists can pursue a hypothesis, believing it to be correct, and publish results that prove themselves wrong. So full marks to Lipkin and Hornig for upholding scientific values.

More blogging here

http://www.blacktriangle.org/blog/?p=1833

http://leftbrainrightbrain.co.uk/?p=1252

http://www.autismvox.com/mmr-vaccine-does-not-cause-autism-not-that-you-didnt-know-that-already/

http://blogs.discovermagazine.com/badastronomy/2008/09/03/antivax-new-evidence-shows-again-no-link-to-autism/

http://onedadsopinion.blogspot.com/2008/09/now-is-it-over.html

UPDATE

Now Orac joins the fray.

September 4th, 2008 Posted by Mike | Andrew Wakefield, MMR, Uncategorized, science, vaccines | 6 comments