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(All you have to do is get the package inserts from the vaccines the doctors will be giving your child. it's page after page of "We don't know how this works or what the effect will be.")
Before the autism-related controversy started in 1998, some concern had already arisen about the safety of the MMR vaccine due to side effects associated with the Urabe mumps strain including rare adverse events of aseptic meningitis, a transient mild form of viral meningitis.[24][25] A late-1980s trial in Britain of a form of the MMR vaccine containing the Urabe mumps strain produced three cases of probably associated febrile convulsions per 1,000 vaccinations. Concerns about adverse reactions to the vaccine were raised by American and Canadian authorities based on reports from Japan linking Urabe MMR with meningoencephalitis. In early 1988, Canadian authorities suspended distribution of the Urabe-based MMR and eventually recalled the product.
The UK National Health Service introduced an MMR vaccine using the Urabe mumps strain in 1988, replacing it entirely with the Jeryl Lynn strain in September 1992 following the identification of an unacceptable risk of aseptic meningitis 15–35 days after vaccination.[26] Decisions taken by British authorities at this time were to be criticized later following documents delivered by FOIA.[27] With no such risk seen in vaccines using the Jeryl Lynn mumps strain,[26][28] the UK NHS withdrew two of the three MMR vaccine then available (Immravax, made by Merieux UK, and Pluserix, made by SmithKline Beecham) in favor ofMerck Sharp and Dohme's MMR II brand, based on the Jeryl Lynn strain.[28] Although MMR administration did continue with MMR II, the MMR vaccination rate first began to fall after 1996, following claims by Wakefield that it was linked to the inflammatory bowel disease, Crohn's disease.[29]
The Urabe strain remains in use in a number of countries; MMR with the Urabe strain is much cheaper to manufacture than with the Jeryl Lynnstrain,[30] and a strain with higher efficacy along with a somewhat higher rate of mild side effects may still have the advantage of reduced incidence of overall adverse events.[28]
litigation (which is barely possible now)
In April 1994, Richard Barr,[34] a solicitor, succeeded in winning legal aid for the pursuit of a class action against the manufacturers of MMR under the Consumer Protection Act 1987. The class action case was aimed atAventis Pasteur, SmithKlineBeecham, and Merck, manufacturers respectively of Immravax, Pluserix-MMR and MMR II.[35] This suit, based on a claim that MMR is a defective product and should not have been used, was the first big class action lawsuit funded by the Legal Aid Board (now the Legal Services Commission) after its formation in 1988. Noticing two publications from Andrew Wakefield that explored the role of measles virus in Crohn's disease and inflammatory bowel disease,[36][37] Barr contacted Wakefield for his expertise. According to Wakefield supporters, the two men first met on 6 January 1996.[38]The Legal Services Commission halted proceedings in September 2003, citing a high probability of failure based on the medical evidence, bringing an end to the first case of research funding by the LSC.[39]
In February 1998, a group led by Andrew Wakefield published a controversial paper in the respected British medical journal The Lancet, supported by a press conference[40] at the Royal Free Hospital in London.[41] This paper reported on twelve children with developmental disorders referred to the Royal Free Hospital. The parents or physicians of eight of these children were said to have linked the start of behavioral symptoms to MMR vaccination. The paper described a collection of bowel symptoms, endoscopy findings and biopsy findings that were said to be evidence of a possible novel syndrome that Wakefield would later call autistic enterocolitis, and recommended further study into the possible link between the condition and the MMR vaccine. The paper suggested that the connection between autism and thegastrointestinal pathologies was real, but said it did not prove an association between the MMR vaccine and autism.[1]
At the press conference before the paper's publication, later criticized as 'science by press conference',[40] Wakefield said that he thought it prudent to use single vaccines instead of the MMR triple vaccine until this could be ruled out as an environmental trigger; parents of eight of the twelve children studied were said to have blamed the MMR vaccine, saying that symptoms of autism had set in within days of vaccination at approximately 14 months. Wakefield said, "I can't support the continued use of these three vaccines given in combination until this issue has been resolved."[42] In a video news release issued by the hospital to broadcasters in advance of the press conference, he called for MMR to be "suspended in favour of the single vaccines."[43] In a BBC interview Wakefield's mentor Roy Pounder, who was not a coauthor, "admitted the study was controversial". He added: "In hindsight it may be a better solution to give the vaccinations separately,... When the vaccinations were given individually there was no problem."[44] These suggestions were not supported by Wakefield's coauthors nor by any scientific evidence.[45]
The limited initial press coverage of the story was reasonable for a small and not very significant study. The Guardian and the Independentreported it on their front pages, while the Daily Mail only gave the story a minor mention in the middle of the paper, and the Sun didn't cover it.[13]
[edit]Wakefield Lancet paper controversy
The controversy began to gain momentum in 2001 and 2002, after Wakefield published papers which suggested that the immunisation programme was not safe. These were a review paper with no new evidence, published in a minor journal, and two papers on laboratory work which he claimed showed that measles virus had been found in tissue samples taken from children who had autism and bowel problems. There was wide media coverage including distressing anecdotal evidence from parents, and political coverage attacking the health service and government peaked with unmet demands that Prime minister Tony Blairreveal whether his infant son Leo had been given the vaccine. It was the biggest science story of 2002, with 1257 articles mostly written by non-expert commentators. In the period January to September 2002, 32% of the stories written about MMR mentioned Leo Blair, as opposed to only 25% which mentioned Wakefield. Less than a third of the stories mentioned the overwhelming evidence that MMR is safe.[13] The paper, press conference and video sparked a major health scare in the United Kingdom. As a result of the scare, full confidence in MMR fell from 59% to 41% after publication of the Wakefield research. In 2001, 26% of family doctors felt the government had failed to prove there was no link between MMR and autism and bowel disease.[46] In his book Bad Science,[47] Ben Goldacre describes the MMR vaccine scare as one of the "three all-time classic bogus science stories" by the British newspapers (the other two are the Arpad Pusztai affair about genetically modified crops, and Chris Malyszewicz and the MRSA hoax).
Confidence in the MMR vaccine increased as it became clearer that Wakefield's claims were unsupported by scientific evidence. A 2003 survey of 366 family doctors in the UK reported that 77% of them would advise giving the MMR vaccine to a child with a close family history of autism, and that 3% of them thought that autism could sometimes be caused by the MMR vaccine.[48] A similar survey in 2004 found that these percentages changed to 82% and at most 2%, respectively, and that confidence in MMR had been increasing over the previous two years.[49]
A factor in the controversy is that only the combined vaccine is available through the UK National Health Service. The importation license for the single measles vaccine was withdrawn in 1988, and as of 2010 there are no single vaccines for measles, mumps and rubella licensed for use in the UK.[50] Prime minister Tony Blair gave support to the programme, and said that "the vaccine was safe enough for his young son, Leo",[51] but refused on privacy grounds to state whether Leo had received the vaccine; in contrast, the subsequent Prime Minister, Gordon Brown, explicitly confirmed that his son has been immunised.[52] Cherie Blairconfirmed that Leo had been given the MMR vaccination when promoting her autobiography.[13][53]
Administration of the combined vaccine instead of separate vaccines decreases the risk of children catching the disease while waiting for full immunisation coverage.[54] The combined vaccine's two injections results in less pain and distress to the child than the six injections required by separate vaccines, and the extra clinic visits required by separate vaccinations increases the likelihood of some being delayed or missed altogether;[54][55] vaccination uptake significantly increased in the UK when MMR was introduced in 1988.[54] Health professionals have heavily criticized media coverage of the controversy for triggering a decline in vaccination rates.[56] There is no scientific basis for preferring separate vaccines, or for using any particular interval between separate vaccines.[57]
John Walker-Smith, a coauthor of Wakefield's report and a supporter of the MMR vaccine, wrote in 2002 that epidemiology has shown that MMR is safe in most children, but observed that epidemiology is a blunt tool and studies can miss at-risk groups that have a real link between MMR and autism.[58] However, if a rare subtype of autism were reliably identified by clinical or pathological characteristics, epidemiological research could address the question whether MMR causes that autism subtype.[59] There is no scientific evidence that MMR causes damage to the infant immune system, and there is much evidence to the contrary.[57]
In 2001, Berelowitz, one of the co-authors of the paper, said "I am certainly not aware of any convincing evidence for the hypothesis of a link between MMR and autism".[60] The Canadian Paediatric Society,[61]the Centers for Disease Control and Prevention,[7] the Institute of Medicine of the National Academy of Sciences,[8] and the UK National Health Service[9] have all concluded that there is no evidence of a link between the MMR vaccine and autism, and a 2011 journal article described the vaccine-autism connection as "the most damaging medical hoax of the last 100 years".[23]
[edit]Conflict of interest allegations
In February 2004, after a four-month investigation, investigative reporter Brian Deer wrote in The Sunday Times of London that Wakefield had received £55,000 funding from Legal Aid Board solicitors seeking evidence to use against vaccine manufacturers, that several of the parents quoted as saying that MMR had damaged their children were also litigants, and that Wakefield did not inform colleagues or medical authorities of the conflict of interest. When the editors of The Lancetlearned about this, they said that based on Deer's evidence, Wakefield's paper should have never been published because its findings were "entirely flawed."[2] Although Wakefield maintained that the legal aid funding was for a separate, unpublished study[62] (a position later rejected by a panel of the UK General Medical Council), the editors ofThe Lancet judged that the funding source should have been disclosed to them.[63] Richard Horton, the editor-in-chief, wrote, "It seems obvious now that had we appreciated the full context in which the work reported in the 1998 Lancet paper by Wakefield and colleagues was done, publication would not have taken place in the way that it did."[64]Several of Dr. Wakefield's co-researchers also strongly criticized the lack of disclosure.[2
(I thought Andrew Wakefield found out about the connection by accident. He wasn't even looking for it, and then he got interested. They are making a mountain out of a molehill in this biased article.)
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