Stop stifling debate, critics warn government
£3m advertising campaign could backfire as support grows for rebel doctor's views on links with autism
Sarah Boseley, health editor
Wednesday January 24, 2001
The Guardian
The government's £3m campaign to persuade parents to take their children for MMR vaccination looked as though it could backfire yesterday, as critics argued that the government was out to stifle debate over controversial claims that it could be linked to autism.
"Government money should be spent on the vital research needed to answer the questions raised about MMR and autism, not advertising," said the National Autistic Society (NAS). "These hollow advertising campaigns only serve to patronise parents and raise their suspicions.
"The NAS is aware that there have been a number of high quality research proposals which have been submitted to the various research funding bodies, including the Medical Research Council, and have been turned down. There is no doubt that public confidence in MMR is falling. Advertising campaigns do not provide answers. Proper research does. The government should think again about its priorities."
The Department of Health is to blitz parents, GPs, practice nurses and health visitors with leaflets and videos, as well as funding four weeks of national television adverts, but it was clear yesterday that the groups of scientists from the Royal Free hospital medical school in London who believe there may be a link between the MMR, bowel disease and autism will not give up and go away. Andrew Wakefield, the consultant gastroenterologist who has been at the centre of the row, is believed to have further research projects in the pipeline.
Dr Wakefield's supporters say he is under heavy pressure from the medical establishment and unable to speak out freely in defence of his views, but that he will not give up his hypothesis, in spite of the weight of evidence against him advanced by the Department of Health. He has become the champion of the parents who have arrived at the Royal Free in increasing numbers, worried that their children's autism may be caused by the MMR vaccination. His original study group was 12. He now says he has 170 in which the majority of parents have documentary evidence that the symptoms first showed after the jab.
The hostility of the Department of Health, which has tended to write off his concerns as "bad science", has only served to make him more determined to look after the interests of those parents and their children, say his supporters.
Positions are hardening. In an interview at the weekend, Dr Wakefield said the government's insistence that study after study had proved the MMR was safe was "not an honest appraisal of the Science and it relegates the scientific issues to the bottom of the barrel in favour of winning a propaganda war."
Yesterday Scott Montgomery, an epidemiologist who co-authored the latest piece of work which looks at the safety data from the trials of the combined MMR vaccine before it was licensed in the UK in 1988, said the government would not reassure the public by dismissing their concerns. "People are always suspicious when they think they can hear the cogs of the propaganda machine in motion," he said.
He and others who work with Dr Wakefield believe there may be adverse events or side effects of the vaccination that take time to show themselves. "What we are concerned about is delayed events, events that occur some time after vaccination, and insidious events like autism which doesn't have a day when it obviously starts - it creeps up and it is hard to pinpoint the time when that starts exactly."
They argued in their paper in the medical journal Adverse Drug Reactions that the children given MMR in clinical trials were only followed up for a maximum of 28 days, not long enough for any possible problems in the gut or autism to be detected. The Department of Health said this was factually incorrect, as some trials were followed up for six to nine weeks. Dr Wakefield's supporters counter that any such trials are not in the public domain because the drug companies have claimed they are commercially confidential.
There have been further bitter exchanges over a 10-year study of the side effects of MMR in Finland, which the De partment of Health claimed proved that there was no possible link to autism. Dr Montgomery and others have dismissed the study as a passive surveillance exercise, saying autism would not be picked up because none of the doctors reporting side-effects was aware of the possibility.
Yesterday Elizabeth Miller, epidemiologist and head of the immunisation service of the Public Health Laboratory Service, defended the Finnish study. "It is not fair for Wakefield to dismiss it as a passive surveillance system," she said. Clinicians were specifically asked to report any chronic disease that set in after the jab. In Dr Wakefield's original study of 12 children published in the Lancet in 1998, the average onset of autism was given as 6.3 days after the injection. "Cases of autism in association with bowel disease would certainly have been detected," she said.
But Dr Wakefield and his inflammatory bowel diseases study group at the Royal Free believe they are piecing together a jigsaw. His original study found inflammation of the bowel in autistic children. Yet to be published is a study in Dublin, which is said to have found measles RNA, which could only have been produced by the measles virus, in the gut of autistic children and not in the gut of others without autism.
The next piece of the jigsaw is work suggesting that toxic chemicals which get into the gut in our food can pass through it if the gut is damaged by inflammatory disease. The Norwegian scientist Kalle Reichelt in the 1980s found an excess of opioid peptides, which occur naturally in bread, milk and other foods, in the central nervous system of autistic children.
Paul Shattock, director of the Autism Research Unit at Sunderland University, says that changing the diets of autistic children by removing glutens, for instance, can bring about improvements. "We're slowly producing evidence that what parents have said for years about diet is true," he said. But his unit finds it hard to get funding to carry out research on the scale and to a standard that the medical establishment would accept.
"Our work is considered flaky," he said. "It is not popular with the medical establishment. The medical establishment is trained to treat diseases by giving drugs and patients are trained to ask for drugs."
He backs Dr Wakefield's theory on toxins passing through the gut to the brain, although he says more research is needed before we can identify the MMR as the cause of the disease in the gut that makes it possible.
Dr Miller, of the PHLS, says the diet theory is one of many in the treatment of autism. "There is a plethora of other hypotheses that children may be improved by certain regimes. It is right and proper that work should be done to find the cause of this condition, but the work must be amenable to others to test it."
She rests on the epidemiological case against Dr Wakefield. In the PHLS study in North Thames, every child with autism - around 500 - was reviewed. The rate of those with autism who had been given the MMR and among those who had not been vaccinated was the same. http://society.guardian.co.uk/news/story/0,7838,427239,00.html
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