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How the Case Against the Mmr Vaccine Was Fixed

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How the Case Against the Mmr Vaccine Was Fixed MMR SCARE HOW THE CASE AGAINST THE MMR VACCINE WAS FIXED In the first part of a specialBMJ series, Brian Deer exposes the bogus data behind claims that launched a worldwide scare over the measles, mumps, and rubella vaccine, and reveals how the appearance of a link with autism was manufactured at a London medical school hen I broke the news to the brain and bowel diseases. Child 11 was the closed £150 (€180; $230) an hour through a father of child 11, at first he did penultimate case. Norfolk solicitor named Richard Barr, he had not believe me. “Wa kefield told Running his finger across the paper’s tables, been confidentially put on the payroll for two us my son was the 13th child over coffee in London, Mr 11 seemed reassured years before the paper was published, eventu- they saw,” he said, gazing for by his anonymised son’s age and other details. ally grossing him £435 643, plus expenses.4 Wthe first time at the now infamous research But then he pointed Curiously, however, paper which linked a purported new syndrome at table 2—headed “The regulator’s main focus Wakefield had already with the measles, mumps, and rubella (MMR) “neuropsychiatric was whether the research identified such a syn- vaccine.1 “There’s only 12 in this.” diag nosis”—and for a drome before the That paper was published in the Lancet second time objected. was ethical. Mine was project that would on 28 February 1998. It was retracted on “That’s not true.” whether it was true” reputedly discover it. 2 February 2010.2 Authored by Andrew Wake- Child 11 was among “Children with enteri- field, John Walker-Smith and 11 others from the eight whose parents apparently blamed tis/disintegrative disorder [an expression he the Royal Free Hospital and School of Medi- MMR. The interval between his vaccination used for bowel inflammation and regressive cine, London, it reported on 12 developmen- and the first “behavioural symptom” was autism5 form part of a new syndrome,” he tally challenged children, and triggered a reported as 1 week. This symptom was said and Barr explained in a confidential grant decade long public health scare. to have appeared at age 15 months. But his application to the UK government’s Legal Aid “Onset of behavioural symptoms was associ- father, whom I had tracked down, said this Board,6 before any of the children were inves- ated by the parents with measles, mumps, and was wrong. tigated. “Nonetheless the evidence is undeni- rubella vaccination in eight of the 12 children,” “From the information you provided me on ably in favour of a specific vaccine induced began the paper’s “findings.” Adopting these our son, who I was shocked to hear had been pathology.” claims as fact, its results section included in their published study,” The two men also aimed to show a sudden added: “In these eight chil- he wrote to me, after we met again onset “temporal association”—strong evidence dren the average interval from in California, “the data clearly in product liability. “Dr Wakefield feels that if exposure to first behavioural appeared to be distorted.” we can show a clear time link between the symptoms was 6.3 days (range He backed his concerns with vaccination and onset of symptoms,” Barr told 1-14).” medical records, including a Royal the legal board, “we should be able to dispose Mr 11, an American engi- Free discharge summary. Although of the suggestion that it’s simply a chance neer, looked again at the the family lived 5000 miles from encounter.”7 paper: a five page case series the hospital, in February 1997 the boy But child 11’s case must have proved a dis- of 11 boys and one girl, aged (then aged 5) had been flown to London appointment. Records show his behavioural between 3 and 9 years. Nine and admitted for Wakefield’s project, the symptoms started too soon. “His developmen- children, it said, had diag- undisclosed goal of which was to help tal milestones were normal until 13 months noses of “regressive” autism, sue the vaccine’s manufacturers. of age,” notes the discharge summary. “In while all but one were the period 13-18 months he developed slow reported with “non-specific Wakefield’s “syndrome” speech patterns and repetitive hand move- colitis.” The “new syndrome” Unknown to Mr 11, Wakefield was ments. Over this period his parents remarked brought these working on a lawsuit,3 for which he on his slow gradual deterioration.” together, sought a bowel-brain “syndrome” as That put the first symptom two months l i n k i ng its centrepiece. Claiming an undis- earlier than reported in the Lancet, and a BMJ | 8 JANUARY 2011 | VOLUME 342 77 MMR SCARE HOW THE LINK WAS FIXED The Lancet paper was a case series of 12 child patients; it reported a proposed “new syndrome” of enterocolitis and regressive autism and associated this with MMR as an “apparent precipitating event.” But in fact: month before the boy • Three of nine children reported with regressive I travelled to the ad mission, at age 8, after she had discussed her had MMR. And this was autism did not have autism diagnoses at all. family home, 80 miles son’s story with Wakefield.10 not the only anomaly Only one child clearly had regressive autism northeast of London, As I later discovered, each family in the project to catch the father’s • Despite the paper claiming that all 12 children to hear about child was involved in such discussions before they were “previously normal,” five had documented eye. What the paper 2 from his mother. saw the hospital’s clinicians. Wakefield phoned pre-existing developmental concerns reported as a “behav- That was in Septem- them at home, and must have at least sugges- • Some children were reported to have ioural symptom” was experienced first behavioural symptoms within ber 2003, when the tively questioned them, potentially impacting noted in records as a days of MMR, but the records documented lawsuit fell apart after on later history taking. But I knew little of such chest infection. these as starting some months after vaccination counsel representing things then, and shared my confusion with “Please let me • In nine cases, unremarkable colonic 1500 families said Walker-Smith, who I met shortly after Mrs 2. know if Andrew W has histopathology results—noting no or minimal that, on the evidence, “There is no case in the paper that is consist- his doctor’s license fluctuations in inflammatory cell populations— Barr’s autism claims ent with the case history [Mrs 2] has given me,” revoked,” wrote Mr 11, were changed after a medical school “research would fail.15 By that I told him. “There just isn’t one.” who is convinced that review” to “non-specific colitis” time, Mrs 2 had seen “Well that could be true,” the former professor many vaccines and • The parents of eight children were reported her son’s medical of paediatric gastroenterology replied, disarm- as blaming MMR, but 11 families made this environmental pollut- records and expert ingly. He knew the case well, having admitted allegation at the hospital. The exclusion of ants may be responsi- three allegations—all giving times to onset reports, written for her the boy for the project and written reports for 16 ble for childhood brain of problems in months—helped to create the case at trial. Barr, who paid him £23 000. disorders. “His misrep- appearance of a 14 day temporal link Her concerns about “Well, so either what she is telling me is not resentation of my son • Patients were recruited through anti-MMR MMR had been noted accurate, or the paper’s not accurate.” in his research paper campaigners, and the study was commissioned by her general prac- “Well I can’t really comment,” he said. “You is inexcusable. His and funded for planned litigation titioner when her son really touch on an area which I don’t think motives for this I may was 6 years old. But should be debated like this. And I think these never know.” she told me the boy’s troubles began after his parents are wrong to discuss such details, where The father need not have worried. My inves- vaccination, which he received at 15 months. you could be put in a position of having a lot of tigation of the MMR issue exposed the frauds “He’d scream all night, and he started head medical details and then try to match it with this, behind Wakefield’s research. Triggering the banging, which he’d never done before,” she because it is a confidential matter.” longest ever UK General Medical Council fit- explained. It was not merely medically confidential, it was ness to practise hearing, and forcing the Lancet “When did that begin, do you think?” I asked. also legally protected: a double screen against to retract the paper, last May it led to Wakefield “That began after a couple of months, a few public scrutiny. But responding to my first MMR and Walker-Smith being struck off the medical months afterward, but it was still, it was con- reports in the Sunday Times, in Fe bruary 2004,17 register.8-10 cerning me enough, I remember going back.” the GMC decided to investigate the cases and Wakefield, now 54, who called no witnesses, “Sorry. I don’t want to be, like, massively per- re quisitioned the children’s records. was branded “dishonest,” “unethical,” and “cal- nickety, but was it a few months, or a couple of The regulator’s main focus was whether the lous.”8-10 Walker-Smith, now 74, the senior clini- months?” research was ethical.
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