Andrew Wakefield and Vaccine Safety

30 Apr

All about Andy

Even if everything Andrew Wakefield says about the safety of MMR were true it would still not advance the claim that it causes autism.

Having failed, over the past 15 years, to come up with evidence for his theory of a link between the MMR vaccine and autism (or even for his original claim of a link between measles virus and inflammatory bowel disease), Andrew Wakefield has resorted to making wider (and wilder) claims about the safety of MMR. Moving away from his former field of academic gastroenterology, Wakefield has embarked upon studies in paediatrics, vaccinology and public health. These are spheres in which he has neither expertise nor experience – and it shows. He has alleged that surveys associated with the introduction of MMR in Britain 25 years ago were methodologically inadequate, too small in scale, too short in duration or otherwise unsatisfactory. He claims that evidence of adverse reactions was suppressed, conflicts of interests among public health authorities were undisclosed and whistleblowers were silenced. Critics of the programme are alleged to have had their phones tapped, their homes burgled and to have been persecuted by the medical/political/pharmaceutical establishment. Most recently Wakefield has claimed that procedures for dealing with potential anaphylactic reactions within the MMR programme were inadequate.

I do not intend to revisit here the case against Wakefield’s claims about the safety of MMR which is presented in my book MMR and Autism: What Parents Need To Know. (1)On the red-herring of anaphylaxis, including a report of a curiously high incidence in association with separate measles vaccine in a private clinic, see these studies. (2,3,4) Here I would like to pose three questions that arise for anybody who accepts his allegations about the introduction of MMR in Britain after 1988.

1. What about the other countries in which MMR has been introduced?

Surely, if there are significant dangers associated with MMR – which were supposedly ignored in Britain – these would have been noticed in the 60 countries in which the vaccine has been introduced (both before and after 1988)? In fact, the excellent safety record of MMR – 500 million doses and counting – is a major reason for its successful worldwide use. Several countries in Europe and the Americas have been able to declare measles eradicated, apparently without experiencing the sort of adverse effects Wakefield and anti-vaccine campaigners have attributed to MMR in Britain. Indeed, even if public health authorities had succeeded in suppressing reports of adverse reactions to MMR 20 or 25 years ago, these must surely have become apparent by now?

2. Did MMR not dramatically reduce the incidence of mumps meningitis (even if one strain of the vaccine caused a small number of cases)?\

One of the recurring complaints of Wakefield and his supporters is that in the early years of the programme, British vaccine authorities used a brand of MMR including a strain of the mumps virus (Urabe), which was associated with a small number of cases of meningitis, a recognised complication of mumps. In 1992 this was replaced by another strain (Jeryl Lynn) which does not cause this problem. However, if the Jeryl Lynn strain had not been available, it would still have been preferable to carry on with the MMR including Urabe because the benefit of dramatically reducing the incidence of mumps (in the 1980s the commonest cause of viral meningitis) far exceeded the risk of vaccine-related meningitis. A judgement of this sort was made for many years in relation to the use of the oral polio vaccine which caused a handful of cases of polio every year (until it was finally replaced by the currently used injected polio vaccine, which does not carry this risk).

3. Even if MMR is shown to be unsafe in general, how does this support the specific claim that it causes autism?

Wakefield’s strategy appears to be that, if the safety of MMR in general can be put in doubt, the credibility of any particular risk attributed to the vaccine is raised. In reality, this strategy merely draws attention to his failure – over 15 years – to produce any evidence in support of the MMR-autism theory.

Given his failure to substantiate the MMR-autism hypothesis, Wakefield’s persistence in his campaign against MMR has acquired an increasingly irrational character, confirmed by his bizarre video diatribes against leading figures associated with the MMR programme. He is still bitterly aggrieved that British authorities did not accede to his preposterous demand (issued at the notorious 1998 press conference to launch his now retracted Lancet paper) for the replacement of MMR with separate vaccines given 12 months apart. Not a single member of his own team supported this proposal, which was not included in the paper and was in no way supported by it. Such a scheme has never been implemented in any country. Wakefield is further incensed that vaccine authorities insisted on upholding the integrity of the MMR programme in face of his proposal.

If Wakefield had any experience of child health he might have a better understanding of the importance of the organisation of a vaccine programme. Before the introduction of MMR, a measles vaccine had been available in Britain for 20 years, but its administration was unsystematic, uptake remained unsatisfactory and outbreaks continued to occur. In a similar way, rubella vaccine had been given to schoolgirls with considerable success, but occasional cases of congenital rubella were still reported. Mumps vaccine had never been made widely available and cases were seen commonly in surgeries and hospitals. The introduction of the new combined MMR vaccine – within a comprehensive administrative framework, inviting parents into clinics when their children’s jabs were due, properly recording them – brought within a few years a dramatic improvement in children’s health.

If Wakefield had seen, as I have, children suffering from measles, or if he had admitted children to hospital, as I have, with mumps meningitis, or if he had cared for adults with the multiple handicaps of the congenital rubella syndrome, as I have, he might not be so casually disparaging of the MMR programme. But, unfortunately, for Wakefield it is all about Andy and his petty personal grudges against the vaccine authorities who have quite properly put children’s health before his combination of bad science and egotism.

Now, what about that debate?

REFERENCES
1. Michael Fitzpatrick, MMR and Autism: What Parents Need To Know, Routledge 2004; p 128-133.
2. Lakshman R, Finn A (2000). MMR vaccine and allergy, Arch Dis Child 2000;82:93-95 doi:10.1136/adc.82.2.93.
3. Erlewyn-Lajeunesse M, Manek R, Lingam R, Finn A, Emond A (2008). Anaphylaxis following single component measles and rubella immunization, Arch Dis Child 2008; 93:974-975. doi:10.1136/adc.2008.138289;
4. Erlewyn-Lajeunesse M, Hunt LP, Heath PT, FinnA (2011). Anaphylaxis as an adverse event following immunisation in the UK and Ireland, Arch Dis Child 2011; doi:10.1136/archdischild-2011-301163.


By Michael Fitzpatrick

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13 Responses to “Andrew Wakefield and Vaccine Safety”

  1. Dave May 1, 2013 at 11:21 #

    I am not sure this article has the desired effect. For the who agree with you, this article is simply beating a dead horse. For those who disagree with you, the article repeats Wakefield’s claims, some of which may still turn out to be true.

    I find it fairly easy to believe that the vaccine industry works to silence critics and punish dissent. That is not even the question. The question is: Did any of the critics make any claims that were correct? If any claims turn out to be correct, then you are putting yourself in the odd situation of having to defend every action made by every company in an entire industry. I wish you luck, but the effort seems destined to fail.

    I think it is fairly easy to substantiate the claim that vaccines have done more good than harm. I think it is fairly hard to substantiate the claim that vaccines have never harmed anyone. If those are the ground rules of the argument, I suspect you will have a very hard debate in front of you.

    • dingo199 May 1, 2013 at 13:14 #

      @Dave, I am not sure you have understood Fitzpatrick’s article. He is not making a claim that “vaccines have never harmed anyone”, in fact the reverse is true since he clearly sets out the problems of meningitis and paralysis with Urabe MMR and polio vaccines. You are trying to conjure up some false dichotomy with your artificial “ground rules” argument.

    • Sullivan (Matt Carey) May 1, 2013 at 14:04 #

      You may finding easy to believe that the vaccine industry works to silence critics and punish dissent, but (a) is it true and (b) would it mean Wakefield was correct about the MMR?

      First consider the man who linked the H1N1 vaccine to narcolepsy. He had a difficult time publishing because his peers are wary of a new scare. Who is funding him now? A vaccine manufacturer. That’s an odd way to silence a critic.

      Mr. Wakefield’s primary hypothesis, that autism in children with GI disease is caused by a persistent measles infection in the intestine is incorrect. His assertion that the introduction of the MMR set off an autism epidemic is incorrect. Invoke any manner of silencing conspiracy but those facts remain unchanged.

      • futuredave5 May 2, 2013 at 00:35 #

        I think it is fairly clear at this point that Wakefield changed data to support his predefined conclusions. It is also clear that the medical establishment went after him with a vigor normally reserved for terrorists.

        I suspect that if the response had been more muted, the backlash would have also been less, but that is just a suspision, not a fact.

        I can say for a fact, though, that many of the people I know give more credence to Wakefield because of the quality of his enemies. Didn’t Merck get in trouble for withholding evidence that its cholesterol drugs didn’t work? Isn’t this the same company that set up secret “independent” research on Vioxx that later turned out to be fake?

        The general rule is that “when big multinational companies tell you that the billions of dollars they are making are also good for you, be skeptical.”

        I never believed the link between MMR and autism, because it seemed to be an off-hand conclusion tossed out at a press conference, rather than within the body of the research. Even the original paper dismissed the link as “self-referred”, or “self-described”, or some such.

        I am much more interested in the link to IBD, which seemed to get lost in the whirlwind.

        My son had adverse reactions to vaccines, but we already knew he was autistic. The question is not whether the vaccines caused autism but whether the autism caused a more severe vaccine reaction.

        I fully expected to see dozens of studies to explore why autistic children seemed to react more poorly to vaccines. Instead, every few weeks, I see yet another scientist revisit the original complaints against Wakefield to flog him yet again for his scientific failings.

        I understand why: Measles is a serious disease, and vaccines help more than they hurt. But that is just a general rule. Most people who are reading this blog are like me: We are the “exceptions” to a lot of general medical rules. We are actually a lot more interested in the exceptions, rather than the general rule.

      • Sullivan (Matt Carey) May 2, 2013 at 00:47 #

        “It is also clear that the medical establishment went after him with a vigor normally reserved for terrorists.”

        Not many terrorists are offered a year or two of financial support and no other duties but to replicate their own results.

        “I fully expected to see dozens of studies to explore why autistic children seemed to react more poorly to vaccines.”

        Why? What in Mr. Wakefield’s statements or those of the organizations promoting vaccine causation would lead you to that conclusion? The scientists are revisiting the “original complaints” against Mr. Wakefield. They are revisiting his claims. Which were empty. They also revisit the claims of those who believed (and some still) that thimerosal caused an autism epidemic. There is little discussion and there was even less in the day that the primary question was that autistics react more often to vaccines.

        Also, people don’t fund science nor do they take their time to write papers to “flog” Andrew Wakefield. Mr. Wakefield is pretty much a non entitity outside of a minority of the parent community. No one wants to waste their time on that. They do want to answer questions that keep being raised even though there is a ton of evidence.

  2. lilady May 1, 2013 at 20:11 #

    @ Dave:

    “I am not sure this article has the desired effect. For the who agree with you, this article is simply beating a dead horse.”

    People in the U.K., rightfully so, have accused him of dissuading parents from having their children immunized against measles which has resulted in a huge outbreak of measles in Wales (more than 1,000 cases)…and still climbing:

    http://www.bbc.co.uk/news/uk-wales-22350001

    “For those who disagree with you, the article repeats Wakefield’s claims, some of which may still turn out to be true.”

    Really Dave? How many more studies about Wakefield’s thoroughly debunked “theory” of measles-vaccine-causing-autism would you need, beyond the 342 published studies listed here on PubMed?

    http://www.ncbi.nlm.nih.gov/pubmed?linkname=pubmed_pubmed&from_uid=19952979

    Have you seen that video produced by Wakefield’s company (Autism Media Channel), where he purportedly wants to defend himself…by framing his arguments into “a debate”? I have.

    More at issue here, is whether we should allow this discredited former doctor any more publicity and permit him to run a Gish Gallop in a public debate. Do we debate neo-nazis, AIDS denialists or other quacks to give them publicity, legitimacy or the ability to claim that there is still “a debate”?

    There…is…no…debate…period

    • Katie Mia May 2, 2013 at 07:35 #

      Thank you Matt Carey for your valuable analysis of the public health benefits that led to the decision to move to a MMR vs. single antigen measles vaccination, in the UK.

      Wakefield is not having an impact on the population in the US per herd immunity but he does have a loyal following of over 30K people globally that have viewed his slant on his story in the video you reference above.

      As you say it is not so much an issue in the larger world, but it is most important that people have the full facts in the parent community to assess their personal decisions on vaccinating their children, as these diseases are making a come back, on a global basis, in the western developed world and those who are not vaccinated will be at higher risk in the future.

      There was another thread where I attempted to explain the health care benefit in a question a person asked about why the public official told Mr. Wakefield that a move away from offering only MMR would hurt the public health program of vaccinations.

      I provided references from the CDC, but did not have the references here from the UK you provide, that was of specific interest to the person asking the question.

      In further response to the “manipulation” of facts in Mr. Wakefield’s recent video, I found it interesting that he referred to data from a South Korea study with findings from a Yale study of a “1 in 36″ prevalence of ASD that he came across recently.

      There is no record of a study releasing data that I can find of recent from Yale, and in fact there is one done two years ago by Yale, easily accessible and reported globally now for two years, per a 1 in 38 statistic of prevalence of ASD in South Korea.

      I find it hard to believe that Mr. Wakefield with his high level of intelligence and involvement in these issues for over a decade was not aware of the real public health benefit of moving to MMR, in the UK.

      I find it just as hard to believe he did not come across that Yale study until a few days before he made the video you referenced that has been viewed by over 30K people.

      If there is no other ongoing study from Yale specific to a 1 in 36 statistic, I would like to see him explain how he managed to overlook the 1 in 38 statistic for 2 years, until “cleverly” finding it a few days before his video presentation, to “convince” others of his message.

      His 30K plus followers on youtube are not likely going to question his facts unless they are equally presented without “personal attacks” against Wakefield that will only raise anger, instead of logic and attention to detail.

      It is becoming clearer to me now of the degree of potential self serving motive of Wakefield, with these additional facts, but attempting to view his video without the details I am aware of, he is very effective as a “charismatic” emotional communicator, in what appears to be subtle manipulation of the facts, to warrant fear that is not reasonable.

      For the most, people that visit this website are not the individuals “in the wild” on the internet, looking for details like this to answer valid questions like “why did the UK” or “why did the US” discontinue single antigen measles shots.

      The CDC provides adequate information of justification on that website, but again, this is a valuable resource of information from the UK, where the concern and support for Wakefield is at the highest of levels in that country, overall.

      And finally, once again, one cannot dismiss this man’s effective techniques of influencing numbers in the tens of thousands, globally, per their actual decision on vaccinating their children.

      Every person convinced of “the facts presented in whole with unbiased intent”, is a potential life struggle in disease avoided.

      In terms of facts and real life potential consequences your efforts here are appreciated, Matt Carey.

      • Katie Mia May 2, 2013 at 08:19 #

        “My son had adverse reactions to vaccines, but we already knew he was autistic. The question is not whether the vaccines caused autism but whether the autism caused a more severe vaccine reaction”

        Dave, that is a valid question and there is research that is not directed at a causal link of Autism and Vaccinations but is directed at potential variables of “co-moribidity” among a potential relatively rare subgroup of children on the spectrum that may be more vulnerable to side effects of vaccines.

        Per the link below from a 2011 report from the online publication “Nature”, the Autism Speaks organization funded close to 2 percent of research funding, per quote by Geraldine Dawson..

        http://www.nature.com/news/2011/111102/full/479028a.html

        That was more than what the Autism Science Foundation raises in an entire year in revenue, as noted in that report by Allison Singer.

        Dawson from Autism Speaks, was quoted as making it clear in that report that it was not research directed at a direct causal link of Autism and Vaccinations, but into areas of co-morbid consideration of vulnerability.

        It is important in these type of discussions that your real concerns are addressed and acknowledged as worthy of the research that is being done to address the issue of potential co-morbid vulnerabilities associated with Autism.

      • DT35 May 3, 2013 at 20:23 #

        @ Katie MIa — I would question your assertion that Wakefield has “a loyal following of over 30 K people.” Perhaps that many have watched his self-serving video, but they include lilady, according to her comment, Dr. Fitzpatrick, who accepted the challenge to debate, and very likely many, many others who do not consider themselves part of his “loyal following.”

    • futuredave5 May 2, 2013 at 10:47 #

      Lilady: Unfortunately, the nature of science is that generally-agreed facts are still subject to debate. Evolution, climate change, and vaccines are just a few common examples. In some circles there is still an ongoing debate about the nature of gravity. Regardless, I am not the one who used the word “debate”.

      The original article repeated several Wakefield claims other than the vaccine-autism link. In particular, the original article repeated: “He claims that evidence of adverse reactions was suppressed, conflicts of interests among public health authorities were undisclosed and whistleblowers were silenced.” These are the claims that may turn out to be true. Even if true, it is a red herring, but it could serve to make Wakefield more sympathetic. Because logical fallacies are frequently as effective as logic, many more people will believe his other claims.

      As to your question about how many more times I need for this website to repeat itself, besides 342, the answer is: “None for me, thanks, I am full.”

      • Katie Mia May 3, 2013 at 01:40 #

        Facebook Like, on the first two paragraphs.

        This is a key point in why one might not reasonably consider the whole picture as not important.

  3. lilady May 3, 2013 at 06:46 #

    @ FutureDave5: I posted a comment at Dave. Are you “Dave”?

    There is no need to re-argue any of Andrew Wakefield’s fraudulent research at the Royal Free Hospital. The GMC decision is available on the internet, as are the multiple articles written by Brian Deer, science bloggers, doctors, and researchers.

    The point I made was that Wakefield is trying to capitalize on the tragedy of low vaccination rates in areas of the U.K., which now have experienced large outbreaks of measles, by “moving the goal post”…once again…by demanding “a public debate”.

    Wakefield is a disgraced and discredited former medical doctor who is a public health menace, who, once again, is using a tragedy to promote himself. No way, no how is he credible.

    There…is…no…”debate”…period.

Trackbacks/Pingbacks

  1. Andrew Wakefield: Now, what about that debate? | Left Brain Right Brain - April 30, 2013

    [...] have another article by autism parent and general practitioner Michael Fitzpatrick. In his article, Andrew Wakefield and Vaccine Safety, Dr. Fitzpatrick discusses how Mr. Wakefield’s claims about the MMR are without [...]

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