Draw line under MMR scare, plead top doctors

· 'More children will die' unless jabs get all-clear
· Warning as England faces big measles epidemic

Ian Sample,
science correspondent
Tuesday June 27, 2006
The Guardian

A group of Britain's leading paediatricians and childhood vaccination experts has warned that more children will die unless a line is drawn under the autism and MMR (measles, mumps and rubella) vaccine controversy.

In an open letter, 30 scientists, including some of the country's most eminent child health experts, say that an overwhelming body of evidence shows the vaccine is safe. They add that urgent immunisations are necessary to prevent potentially devastating outbreaks among schoolchildren.

The warning comes as England faces its biggest measles outbreak in 20 years, fuelled by the refusal of some parents to have their children immunised because of now discredited claims linking the MMR jab and autism.

The letter, whose signatories include Patricia Hamilton, president of the Royal College of Paediatrics and Child Health, and Professor Sir David Hall, a paediatrician at Sheffield University, says: "The time has come to draw a line under the question of any association between the MMR vaccine and autism. The UK's children are in danger of serious illness or death if they are left unimmunised."

This month, the Health Protection Agency reported 449 cases of measles so far this year - more in just six months than the 438 reported cases in 2003. In 2005, there were only 77 reported cases.

Confidence in the MMR vaccine slumped in 1998 when a team led by Andrew Wakefield at the Royal Free hospital, north London, published research in the Lancet on bowel disease and autism. Dr Wakefield later suggested that there might be a link between autism and the MMR jab. He now faces professional misconduct charges brought by the General Medical Council.

In the letter, the scientists raise concerns that many children born during the height of the MMR scare are now set to enter schooling without the immunisation. "We are now faced with a potentially serious situation. Years of low uptake mean large numbers of unprotected children are now entering school. Unless this is rectified urgently, and children are immunised, there will be further outbreaks and more unnecessary deaths," it says.

Although immunisation rates are rising, they are still below the 95% level the World Health Organisation says is needed for "herd immunity". A year ago MMR uptake stood at 70.8% in London and 83% for the whole of the UK. The letter adds: "It is not too late to avert this predictable tragedy. It is time that due weight is given to the overwhelming body of scientific evidence in favour of the vaccine. Misguided concepts of "balance" have confused and dangerously misled patients. We all, media, politicians and health professionals, have a responsibility to protect the health of our children."

David Elliman, a consultant in community child health at Great Ormond Street Hospital, and a signatory of the letter, said that a vast body of research now vindicated the MMR vaccine, but he added that some media reports remained "partisan" in their coverage of research into the vaccine.

"Parents should be wary of simplistic headlines and information they read on the internet," he added.

Publish or be damned

Ben Goldacre

The Guardian

MMR is back. "US scientists back autism link to MMR," squealed the Telegraph. "Scientists fear MMR link to autism," roared the Mail. "US study supports claims of MMR link to autism," croaked the Times, a day later.

Strap me to the rocket and print my home address in the paper, I'm going after them again. So what was this frightening new data? Well it's hard to tell, since it hasn't been properly published anywhere yet. This is now standard operating procedure for all scare stories, because journalists have learnt that informed and informative public debate on unpublished research is basically impossible. So it turns out that these three stories were all about a poster presentation at a conference that had yet to occur on research not yet completed by a man with a track record of announcing research that then does not appear in academic journals.

The story is that Arthur Krigsman may have found genetic material (RNA) from vaccine-strain measles virus in some gut samples from children with autism and bowel problems. Some believe that this could implicate the vaccine in causing health problems.

But let's not forget, the Mail was promoting Dr Krigsman's research back in 2002: at that time, he was putting endoscopes into the bowels of young children with autism, and said he had found evidence of inflammation. Four years later, looking on PubMed, the standard database for all medical papers, it seems this research still has not been published in a peer-reviewed academic journal. Forgive my bluntness, but it seems a shame to go poking around up there if you're not going to write up your findings properly.

Meanwhile the Telegraph says his latest unpublished claim replicates similar work from 1998 by Andrew Wakefield, and from 2002 by Professor John O'Leary. But there is no such work from 1998 by Dr Wakefield, at least not on PubMed. Meanwhile it is well documented that other labs have tried to reproduce the 2002 study and come back with different results, and that the protocol was likely to have problems with false positives because of the tests used: two perfect examples of the importance of research being fully written up and published, so it can be replicated and assessed.

I could go on, but instead, here is the news you didn't read: in the May issue of the Journal of Medical Virology there was a similar study, only this one has actually been published. It looked for measles RNA in children with regressive autism after MMR vaccination but found no evidence of the magic vaccine-strain measles RNA to implicate MMR, and perhaps because of that unfrightening result, the study was loudly ignored by the press. Like all science in the real world it has its flaws, but because it has been published in full, I can read it, and pick holes in it.

In the spirit of science, the least opponents of MMR could do is share their data, and most importantly publish their scientific work, in full, openly, before their peers, rather than the press.