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Flashback - The real scandal of the MMR debate

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Flashback - 7/12/02 "The more things change, the more they stay the same."

The real scandal of the MMR debate - by Walter Spitzer, Ph.D.

The real scandal of the MMR debate

About 18 months ago I was asked by a barrister involved in a case in the UK to look at the evidence concerning the MMR vaccine and a possible link with autism.

It was not something I had focused on before, so I had no preconceived notions. It has since become my view that there is growing credible clinical evidence to support the contention that MMR - and possibly other vaccines - may partly, or completely, explain the cause of autism.

At present, there is no epidemiological evidence from a large population study to allow one to rule this theory in or rule it out.

Personally, I would be delighted if we could rule it out because MMR certainly protects millions of children from the misery of measles, mumps and rubella.

But I fear that precisely because MMR is a highly effective immunisation, most specialists in public health have talked themselves into believing it is safe.

We should be very worried because it hasn't been demonstrated to be safe. I call myself a worried agnostic. I am worried about losing MMR as a useful and effective vaccine, but I am also worried that we seem to be doing nothing to determine its safety.

While there are many studies proving how well MMR prevents illness, I have not yet been able to find a single study dealing with the safety (as opposed to efficacy) of the vaccine in terms of causing other illnesses or side-effects.

I cannot understand why the regulators have not demanded scientifically valid safety studies or, if they do exist, why no one has produced even one.

I am also concerned that there has not been a single study of the use of MMR vaccine in large populations of children where those who were vaccinated were compared with those who were not.

Last week, the UK Medical Research Council reported on this subject, and I am distressed that it declared there was no evidence to support a link between MMR and autism.

There is evidence to suggest at least the possibility of a link and, at the very least, I believe the MRC should have called for an epidemiological study.

The evidence comes from the laboratory and demonstrates it is plausible that a tie might exist between MMR and autism. For instance, Irish findings presented to a committee of the U.S. House of Representatives about 18 months ago showed there was an appreciably higher probability that individuals with measles virus material - either from contracting the illness or from the vaccine - in their bowel, gut or glandular tissue would be autistic.

This is not conclusive evidence, and the sample size was small, but it clearly suggests the possibility of a connection. Let me repeat, as a public health doctor, that I hope to see a connection between MMR and autism ruled out because immunisation is the keystone of prevention of major diseases that have been killers in the past.

But there is another major disease that concerns me, too, and it is on the rise.

The most important thing I have learned in the past 18 months is that autism is a terminal illness. Autistic children are never cured or, at least, so rarely as for it to be a medical curiosity.

If the side-effect of MMR was death, the concern would be much, much larger, but a deferred death - and in the most severe cases that is what autism is, a dead soul in a live body - just does not generate the concern that it should.

Indeed, Dr Andrew Wakefield, the consultant gastroenterologist who first identified a possible link between MMR, autism and bowel disease, was forced to quit his job at the Royal Free Hospital Medical School in London earlier this month for the precise reason that he was raising concern.

To me, this demonstrates a worrying lack of academic independence for scientific investigators. We in Canada inherited our traditions of academic freedom from Britain, but it would seem Britain needs to reclaim them if it is now allowing this kind of thing to happen.

(Perhaps I should mention at this point that I hold shares in GlaxoSmithKline - one of three vaccine manufacturers - as part of a pension plan. They were bought as Glaxo shares before its merger with SmithKline and at a time when Glaxo had no involvement with vaccines.

When I began my pro bono work at the request of the British barrister in 1999, I raised the matter of the shares and was advised that there was no conflict of interest because I was working for free, and because I was volunteering my services to the plaintiffs against the manufacturers and not the other way round.)

So what should be done next to try to solve the MMR dilemma for parents? Some scientists, including myself, think it is possible that some children might be genetically susceptible to becoming autistic as the result of vaccination.

It is vital, therefore, that we continue the excellent genetic research that has been done in several universities on both sides of the Atlantic. It is also vital that we conduct a definitive epidemiological study with the proper control groups for comparisons.

One probably cannot do this alone in England or the U.S. or even in Canada because the penetration of MMR in these populations has been so high that one cannot get the necessary control groups of children who have never been vaccinated, or who have perhaps received individual vaccinations against measles, mumps and rubella.

A group of 20 investigators from three continents have already pooled resources, and we have designed an eight-country study. Pilot work is under way even though funding is not. Scientists are volunteering their time to make progress possible now.

The primary focus is on countries in which the proportion of children vaccinated does not exceed 50 per cent and where the health care system is otherwise adequate - for example, Germany, Poland, Brazil and Argentina.

We are working for free because, despite having one of the finest international epidemiological teams ever assembled to do this type of research, it is extremely difficult to get governments or large foundations to fund this work. One has to wonder why.

Our goal is to complete this study over the next five years and to confirm or eliminate autism as a side-effect of MMR once and for all.


Sandy Gottstein

Date: 7-12-2002