MMR & Autism

Does MMR cause Autism?

• There is no doubt Autism exists.
• There is no doubt that Autism diagnoses have increase in the past 10-15 years.
• There is no doubt that MMr was introduced in the mid 1990's.

The connection between children receiving the MMR jab and developing Autism was a temporal one and these are notoriously complex, and often link two unlinked things.

The medical community investigated Dr Wakefield's results very carefully, to double check and see whether a horrendous mistake had been made in the introduction of MMR. However numerous studies, some covering over 30,000 children each, have shown that MMR is not linked to higher incidence of Autism.

Autism diagnoses have increased - possibly due to an increase in the number of cases, but also due to improved diagnostic criteria, more child psychiatry / psychology staff and a different approach to managing children with attention / behaviour disorders.

The Lancet and the GMC inquiry
This week sees the start of a GMC hearing into Dr Wakefield and two of his colleagues behaviour.

The Lancet who published his work have already issued a retraction and apology, as have 10 of the 12 authors of the paper.
The Lancet apology is interesting:

We do not accept Andrew Wakefield and colleagues' interpretation of the letter published in The Lancet on May 2, 1998, which was, in any event, only published 3 months after the original 1998 Lancet paper. This letter was written in response to a letter from Dr A Rouse, published in the same issue. Dr Rouse's letter raised concerns about whether children investigated in the 1998 paper had been referred to the authors by the Society for the Autistically Handicapped, and simply mentioned that his concerns arose out of a fact sheet produced by a firm of solicitors.

Although the letter made it clear that Dr Wakefield “has agreed to help evaluate” some children for the Legal Aid Board, it does not indicate that in fact such work had been commissioned and was being undertaken well before the 1998 paper was published. The natural and ordinary meaning to be drawn from Dr Wakefield's letter at the time was that following the publication of the 1998 paper he had agreed to complete evaluations of children reported in the 1998 paper for the Legal Aid Board. We understood the letter to mean that, although Dr Wakefield agreed to undertake an evaluation for the Legal Aid Board, the evaluation had not taken place before the 1998 paper's publication.

In the light of this, and Dr Wakefield's express statement that no conflict of interest existed, we had no reason to investigate the position further, until the editors were notified for the first time that Dr Wakefield's relationship with the Legal Aid Board predated the publication of the 1998 paper by some considerable time.

Some journalist have done a lot of digging around this issue - see briandeer.com if you want to see the full set of allegations. These might ordinarily be dismissed, except these allegations and investigations seem to be very similar to the charges being placed before the team from the Royal free hospital, led by Dr Wakefield, next Monday at the GMC in London.

The losers
The main losers in this case all along have been two groups of children and parents.

1. Those who developed Autism and were told that there was a causal link. These parents were told that through giving consent for an immunisation, they had harmed their child for life. the associated guilt and depression has influenced the care that their children received, with an understandable suspicion of medical intervention and treatment.
   
2. The children whose parents decided not to give them MMR, and then the child developed measles, mumps or Rubella, and subsequently was injured and developed long-term consequences.

As someone born prior to the MMR introduction, I had both measles and mumps as a small child. I survived. many children did not., the introduction of the immunisation cut the death rate from these childhood disease down to less than 1 in 1,000. With the removal of herd immunity, with less children having MMR, these levels are once again rising.

The other big loser will be public confidence in the medical profession. Dr Wakefield and colleagues have spun the issue as being them sticking up for the truth, and the Medical community covering up. Thus it rings true because it has happened before. However this does not mean it is the case this time.