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Rapid Responses: Rapid Responses published:
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Another view
- richard horton (12 December 2003)
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Where the problem really lies
- CA Johnson (12 December 2003)
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Richard Horton's view
- Neville W Goodman (12 December 2003)
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Hear the Silence Reviews
- Gary S. Goldman (13 December 2003)
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Re: Hear the Silence Reviews
- Mark Wilks (13 December 2003)
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"Hear the Silence" Reviews
- Gary S. Goldman (14 December 2003)
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societal responsibility
- Jan M Perkins (14 December 2003)
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Dr Elliman is WRONG
- Kathleen F. Yazbak, David Elliman, Helen Bedford (14 December 2003)
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Hear the Silence
- William Pimm (14 December 2003)
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Beliefs are just Beliefs ?
- L S Lewis (14 December 2003)
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Re: Another view
- David Elliman, Helen Bedford (14 December 2003)
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Two separate questions
- Ed Cooper (14 December 2003)
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Why don't you ask 'Why'?
- Heather C Adams (14 December 2003)
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A conspiracy of silence
- GH Hall (14 December 2003)
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Re: Two separate questions - but to one we KNOW the answer
- L S Lewis (15 December 2003)
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Re: Re: Another view
- M C Feliciello (15 December 2003)
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Re: Re: Two separate questions - retract or clarify?
- Ed Cooper (16 December 2003)
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Re: Re: Two separate questions - and the lessons of historyfy?
- L S Lewis (17 December 2003)
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We heard the silence
- John Phillip Heptonstall (18 December 2003)
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Hear the Silence
- Fred V Griffiths (18 December 2003)
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Re: We heard the silence
- MC Felicello (18 December 2003)
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MMR
- Carol C Williams (19 December 2003)
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Re: MMR
- Penny Mellor (19 December 2003)
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Autism protocol
- Ellen C G Grant (19 December 2003)
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More than just being wrong
- Lenny Schafer (22 December 2003)
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Reviews of "Hear the Silence"
- Donna M. Samuels (23 December 2003)
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There are non so blind...
- Paul Lynch (25 December 2003)
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Re: There are non so blind...
- Thomas Valentine (26 December 2003)
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Re: Re: There are non so blind...
- Paul Lynch (27 December 2003)
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Re: Re: Re: There are non so blind...
- Thomas Valentine (27 December 2003)
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Blair answer the question or resign
- Brian George Smith, SS8 8LL (1 January 2004)
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For those who do not believe that there are serious side effects from live or attenuated vaccines
- Alan Challoner (4 January 2004)
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Re: For those who do not believe that there are serious side effects from live or attenuated vaccines
- Ed Cooper (4 January 2004)
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Re: For those who do not believe that there are serious side effects from live or attenuated vaccines
- Peter J Flegg (5 January 2004)
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Re: Re: For those who do not believe... A response to Dr Flegg
- Alan Challoner (6 January 2004)
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Epidemiology - Relevance and Usefullness
- David R Sherman (6 January 2004)
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Re: Epidemiology - Relevance and Usefullness
- Adam Jacobs (7 January 2004)
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Re: Epidemiology - Relevance and Usefullness
- sharon m latta (7 January 2004)
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SSPE and measles vaccine
- Peter J Flegg (8 January 2004)
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Hear the Protocol
- MC Feliciello (10 January 2004)
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Re: Re: Epidemiology - Relevance and Usefullness
- David R Sherman (11 January 2004)
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Re: Re: Epidemiology - Relevance and Usefullness [Correction]
- David R Sherman (12 January 2004)
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Re: Hear the Silence Reviews And the Danish Study
- David R Sherman (15 January 2004)
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Unequal standards
- John Daniel Stone (18 January 2004)
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Re: Unequal standards
- David R Sherman (18 January 2004)
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Unequal standards
- John Daniel Stone (19 January 2004)
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Unequal standards: a challenge to David Elliman, Helen Bedford and Mike Fitzpatrick
- John Daniel Stone (23 January 2004)
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The basic question
- David R Sherman (24 January 2004)
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The silence continues
- John Daniel Stone (25 January 2004)
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Re: Re: Unequal standards
- David R Sherman (5 February 2004)
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richard horton, editor, the lancet the lancet
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The outrage expressed over Channel 5's Hear the Silence by those on the front-lines of care, especially those who deliver vaccination services to vulnerable individuals and communities, is understandable and justified. However, the refusal of those with senior public-health responsibilities to engage in a debate provoked by this programme is, in my view, a serious error of judgement - one that only feeds existing public scepticism about the profession's and the Department of Health's attitude to Andrew Wakefield's extreme and unsubstantiated claims about the safety of MMR. There is an alternative reading of Hear the Silence. I write as the editor of the journal that published Andrew Wakefield and colleagues' first paper on this subject. But, more importantly, I write as the parent of a 3-year-old girl who has had the MMR vaccine and who is healthy and happy - and protected from several life-threatening illnesses. 1. The film presents us with the acute feelings of two caring and loving parents who see their child develop in ways that are entirely alien to them, and to which they react in contrasting and sometimes conflicted ways. This developmental pathway creates challenges at school, within the family, and during encounters with often stretched medical and welfare services. A perfectly natural reaction, surely, is to say, "Something happened to my child. What could that something have been?" How should we as doctors respond to this question? With a mix of compassion and evidence, of course. The full weight of the latter has been brought to bear on this debate. But the tone of outrage in the reaction to this film diminishes the former, and so belittles the experiences of some families living with a child who has autism (although not all, as Mike Fitzpatrick's piece so tellingly shows). 2. It is easy to condemn Hear the Silence for taking a one-sided view. The programme shows a clear uncertainty within the family about the cause of their son's illness. At one point, the mother and father debate the events that preceded their child's first symptoms. "It didn't happen", says the father. Was he ever normal? he asks. And how would we know? In a subsequent scene, the father points out that temporal association is not the same as cause (having a heart attack in a car, he argues, does not mean that the car caused the heart attack). While the film proceeds to lend considerable emotional force to the mother's early view that MMR and autism are linked in some way, the programme presents a more complex and contrasting picture than reviewers have so far suggested. 3. Hear the Silence seems to me to be, first and foremost, an investigation into the evolution and nature of the mystery we call autism - and the mystery that it still remains. The conclusions of the film, as I read them, are that the MMR/autism hypothesis is unproven, that the vast majority of medical opinion aggressively supports the safety of the vaccine, but that research should continue nevertheless. Most of us who have read the published (and in some cases unpublished) research know that an overwhelming quantity of data now exists to rule out MMR as a cause of autism. But the problem we face is that there is imperfect laboratory evidence that is claimed to support Andrew Wakefield's point of view. That work needs to be repeated, improved upon, and published to reveal, finally, the true validity of his all-but refuted hypothesis. While these laboratory studies remain unchallenged, Andrew Wakefield's claims are likely to retain some measure of credibility. 4. The programme also raises the issue of individual responsibility in sharing a very low level of risk from vaccination in return for large gains that will benefit a community. This matter is put very emotively in Hear the Silence - that children's vaccine-related adverse effects are the cost of society's commitment to herd immunity. (Although the film does responsibly indicate that there is not one shred of evidence to support a divided vaccine policy.) One does not have to be anti-vaccination to recognise that this is an issue worth debating, especially at a time when in some areas of health, such as HIV-AIDS, human-rights perspectives controversially dominate over traditional public-health approaches. 5. How do we as a profession value our patients' testimony? In this film, Andrew Wakefield says, "I can't censor the patients' story". His "evidence" is dismissed as "anecdotal" by colleagues. Yet doctors know that there is truth in both arguments. Patient histories can indeed be notoriously unreliable, and they certainly need to be supported by other evidence from physical examination, investigations, and so on. But histories can also sometimes contain essential truths that we as doctors must look for with care and attention. There are sadly countless examples where histories have been ignored, to everybody's cost. So why can we not discuss the value, validity, and imprecision of the patient testimony honestly and openly and calmly? 6. The Department of Health is portrayed as being cold and heartless in its reaction to Wakefield's arguments. But perhaps a more interesting question arises here, one that is only fleetingly touched on in Hear the Silence - namely, how should government respond to a challenge to one of its cornerstone public-health measures? It is surely reasonable to ask whether the Department has handled this matter effectively? Do we not want a health service that takes evaluation of policies, as well an technologies, seriously? And why can that debate not be conducted publicly? In sum, while the characterisations in this film are sometimes ludicrously unfair (the depiction of Ken Calman, for example), and while Andrew Wakefield is romanticised to the point of embarrassing caricature, Hear the Silence is a thoughtful drama that raises important questions that both profession and public alike should be prepared to sit down and discuss. That one side of this much-needed engagement resists dialogue, with what comes across as a mixture of anger and scorn, seems to me to be unforgivable. Richard Horton Note: I have seen a preview copy of Hear the Silence. I did not take part in its production. Competing interests: None declared |
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CA Johnson, Parent LA9
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"All this film can do is raise anxieties," say David Elliman and Helen Bedford. They may be right. Most haven't seen it yet and until we do can't review or comment. But helpful or dangerous, many parents will view it as at least as trustworthy as the advice of the medical establishment, the vaccine manufacturers and the Department of Health. Just this week I listened to a doctor on BBC Radio 4 tell listeners that we should blanket vaccinate the UK for hepatitis B. When specifically asked about side- effects, he carefully ommitted the serious ones (including arthritis and heart problems) aired on the very same station a few days earlier! Why, I ask, if not to disseminate pro blanket-vaccination propaganda? The one-size-fits-all approach to vaccination causes more needless deaths than a mere film, both by serious reactions to the vaccines and by breeding distrust of vaccines in general. It will not achieve its goal (herd immunity and the prevention of deaths from disease) as the public grows ever more skeptical and self-informed. The message from previous public health debates, e.g. BSE, is clear: acknowledge problems, research them, develop strategies to combat them, and the public will trust you. Ignore the personal testimonies, vaccinate all regardless and villify those who rock the boat, and you will breed yet more distrust. Money must be put into researching why adverse reactions to various vaccines occur in a few cases. That is the way to combat public fear and falling uptake. Competing interests: Mother of healthy (touch wood) children who have received MMR on schedule) |
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Neville W Goodman, Consultant Anaesthetist Southmead Hospital, Bristol, BS10 5NB
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Richard Horton's observations about 'Hear the Silence' (which I have not yet seen) are valid, but any such observations must be made in the context of their being, first, overwhelming evidence in favour of the risk -benefit of the vaccine and, second, decreasing take-up of the vaccine, which threatens the public health. It seems to me that his observations bear the same relation to real life as much moral philosophy does: it is interesting to argue the points, but it's not what happens. This play has received enough advance publicity for it to get higher audiences than Channel 5 usually gets. As Horton says of the play, "the characterisations in this film are sometimes ludicrously unfair (the depiction of Ken Calman, for example), and ... Andrew Wakefield is romanticised to the point of embarrassing caricature...". One has to ask: why these characterisations? The effect of the play will be to reduce the uptake of vaccine even further. I would be surprised if there were not epidemiologists out there waiting to correlate vaccination rates with the weeks before and days after the programme is broadcast. Where I do agree with Richard Horton is in his questioning the government's attitude. By making single vaccines available for those who wanted them, while continuing to support the triple vaccine, they would have defused the issue, and Channel 5 would not have commissioned such a play. As I have quoted before (1), of the Italian government's response to Di Bella's claims to cure cancer, 'To ignore the emotional element in the public response is to omit a critical factor from the problem and thereby render it insoluble' (2). 1 Goodman NW. MMR: a public health disaster? Hospital Medicine 1998;59:584. 2 Anonymous. Support for a pragmatic health minister. Nature 1998;392:421. Competing interests: None declared |
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Gary S. Goldman, Computer Scientist Gary S. Goldman, Computer Consultant
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I have read numerous commentaries on the upcoming docudrama concerning MMR and Autism and was hoping someone could provide me with the "numerous epidemiological studies showing no link." I have engaged in research recently that demonstrated the number of cases of autism among individuals aged 6 to 21 in U.S. schools increased from 12,222 in 1992-1993 to 97,847 in 2001-2002, for an overall increase of 700% [United States Department of Education, Individuals with Disabilities Act (IDEA). U.S. Annual Report to the Congress; http://www.ideadata.org/tables25th\ar_aa3.htm. Last accessed November 7, 2003]. The Denmark study by Madsen et al published in 2002 was believed to be the most exhaustive and therefore most convincing study concluding no association exists between MMR vaccination and autism in Denmark. This retrospective cohort study investigated 537,304 children during 2,129,864 person-years, born between 1991 and 1998, or a mean age of 4 years old. However, since autism is usually diagnosed at age 5 or older in Denmark, many children born in 1994 and thereafter had not as yet been diagnosed during this study period. Furthermore, of the 2.1 million person-years of observation time, 0.81 million person-years (537,304*1.5) or 39% were among children aged less than 1.5 years who had not received the MMR vaccination. Thus, the systematic error associated with missing the majority of autism diagnoses in the Madsen study was a major shortcoming and the conclusions would have benefited by the additional consideration of both longitudinal autism incidence data and the examination of older cohorts. Children with Asperger's Syndrome and high functioning autism, who have minimal speech and behavior impairments, are not suspected and diagnosed as early as those children who have been deeply affected since birth. Additional confounders inherent to the Madsen study contributed to further bias resulting always in the underestimation of autism among children immunized with MMR vaccine, thus leading to a defective conclusion. The other historical studies that opposed a link between MMR vaccine and autism had insufficient follow-up time, too small sample size or insufficient statistical power, utilized passive surveillance, demonstrated conflicts of interests, or had other limitations that made the nature of the study inconclusive. These comments apply to the following studies that I have personally reviewed in great detail: [1] Peltola H, Heinonen OP. Frequency of true adverse reactions to measles-mumps-rubella vaccine: a double-blind placebo-controlled trial in twins, National Public Health Institute and Children's Hospital, University of Helsinki, Finland, Lancet April 26, 1986; 1(8487):939-42. [2] Miller C, Miller E, Rowe K. Surveillance of symptoms following MMR vaccine in children, Practioner Jan. 1989, 233(1461):69-73. [3] Taylor B, Miller E, Farrington CP, et al. Autism and measles mumps and rubella vaccine: no epidemiological evidence for a causal association, Lancet, Jun. 12, 1999; 353(9169):2026-9. [4] Patja A, Davidkin I, Kurki T, Kallio MJ, Valle M, Peltola H. Serious adverse events after measles-mumps-rubella vaccination during a fourteen year prospective follow-up. Pediatri Infect Dis J, Dec, 2000; 19(12):1127-34. [5] Kaye JA, del Mar Melero-Montes M, Jick H. Measles, mumps, and rubella vaccine and the incidence of autism recorded by general practioners: a time trend analysis, BMJ Feb. 2001; 322(7284):460-3. [6] Dales L, Hammer SJ, Smith NJ. Time trends in autism and in MMR immunisation coverage in California, JAMA March 7, 2001; 285(9):1183-5. [7] DeStefano F, Chen RT. Autism and measles-mumps-rubella vaccination: controversy laid to rest? CNS Drugs 2001; 15(11):831-7. [8] Taylor B, Miller E, Lingam R, Andrews N, Simmons A, Stowe J. Measles, mumps, and rubella vaccination and bowel problems or developmental regression in children with autism: population study. BMJ 2002 Feb 16; 234(7334):393-6. [9] Wing L, Potter D. The epidemiology of autistic spectrum disorders: is the prevalence rising? Ment Retard Dev Disabil Res Rev 2002; 8(3):151-61. [10] Elliman DA, Bedford HE. Measles, mumps and rubella vaccine, autism and inflammatory bowel disease: advising concerned parents. Paediatr Drugs 2002; 4(10):631-5. [11] Makela A, Nuorti JP, Pella H. Neurologic disorders after measles -mumps-rubella vaccination. Pediatrics 2002 Nov; 110(5):957-63. In my continuing research I found recent studies that include clinical and laboratory data suggesting that a link between MMR and autistic disorders is biologically plausible: [1] Weibel RE, Caserta V, Benor DE, Evans G. Acute encephalopathy followed by permanent brain injury of death associated with further attenuated measles vaccines: a review of claims submitted to the National Vaccine Injury Compsensation Program. Pediatrics, March 3, 1998; 101(3 Pt 1):383-7. [2] Singh VK, Lin SX, Yang VC. Serological association of measles virus and human herpesvirus-with brain autoantibodies in autism. Clin Immunol Immunopathol. 1998 Oct; 89(1):105-8. [3] Kawashima H, Mori T, Kashiwagi Y, Takekuma K, Hoshika A, Wakefield A. Detection and sequencing of measles virus from peripheral mononuclear cells from patients with inflammatory bowel disease and autism. Dig Dis Sci, Apr. 2000, 45(4):723-9. [4] Spitzer WO, Aitket KJ, Dell'Aniello S, Davis MW. The natural history of autistic syndrome in British children exposed to MMR. Adverse Drug React Toxicol Rev, Aug. 2001; 20(3):160-3. [5] Singh VK, Lin SX, Newell E, Nelson C. Abnormal measles-mumps- rubella antibodies and CNS autoimmunity in children with autism. J Biomed Sci., Jul-Aug 2002; 9(4):359-64. [6] Uhlmann V, Martin CM, Shiels O, et al. Potential viral pathogenic mechanism for new variant inflammatory bowel disease. Molecular Pathology, 2002; 55:1-6. [7] Mehta BK, Munir KM, Does the MMR vaccine and secretin or its receptor share an antigenic epitope. Med Hypotheses 2003 May; 60(5):650-3. I am hoping someone could actually provide me one or more references to support their side of the issue. Certainly when only a few cases of autism occur in close proximity to the MMR and cause late onset autism where there were verbal skills and other skills present and then a regression, it might be easy to dismiss these cases as due to coincidence. When there are hundreds of cases, one starts to think, "Can all of these be in error?" Presently, we seem to be beyond this stage. Would appreciate your thoughts. Sincerely, Gary S. Goldman, Ph.D. Competing interests: None declared |
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Mark Wilks, Clin Scientist St Barts Hospital EC1A 7BE
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I read Richard Horton’s letter on the Hear the silence’ debate with interest. Horton points out that there is ‘imperfect laboratory evidence that is claimed to support Andrew Wakefield's point of view’ and some of us might put it a bit stronger than that. But his claim that ‘(w)hile these laboratory studies remain unchallenged, Andrew Wakefield's claims are likely to retain some measure of credibility’ shows a complete failure to grasp the nature of the problem. The believe that MMR vaccine and autism or colitis or a sub set of either disease or both diseases are linked to MMR cannot be refuted by laboratory experiments. It might be possible to demonstrate such a link, but it cannot be refuted by a negative result or a 100 negative results, it is simply a belief: just as someone who is convinced that a mobile telephone mast has given them (or a neighbour) cancer cannot be convinced by a sophisticated epidemiological study that there is no correlation. The more interesting question is why such health scares find such a widespread and receptive audience in society, a point that Michael Fitzpatrick addresses in his book ‘The tyranny of health’. No one would expect anything much of a Channel 5 programme anyway, but it was Horton‘s decision to publish the original study of 12 cases in the Lancet in 1998, albeit with a critical commentary, did more than any other single event to boost the anti MMR campaign, and I’m sure much more than this programme will. Gary Goldman, in his response, finds fault with a number of epidemiological studies on MMR and autism, although I’m not sure how many of these he dismisses for ‘demonstrating conflicts of interest’. If he really can’t find ‘numerous epidemiological studies showing no link’, he could do worse than start with the most recent work from Taylor and Miller and co-workers of which he must be aware (1-4). Or has he dismissed those as these demonstrating a conflict of interest too? 1: Lingam R, Simmons A, Andrews N, Miller E, Stowe J, Taylor B. Prevalence of autism and parentally reported triggers in a north east London population. Arch Dis Child. 2003 Aug;88(8):666-70. 2: Miller E, Andrews N, Waight P, Taylor B. Bacterial infections, immune overload, and MMR vaccine. Measles, mumps, and rubella. Arch Dis Child. 2003 Mar;88(3):222-3. 3: Andrews N, Miller E, Taylor B, Lingam R, Simmons A, Stowe J, Waight P. Recall bias, MMR, and autism. Arch Dis Child. 2002 Dec;87(6):493-4. 4: Taylor B, Lingam R, Simmons A, Stowe J, Miller E, Andrews N. Autism and MMR vaccination in North London; no causal relationship. Mol Psychiatry. 2002;7 Suppl 2:S7-8. Yours Dr Mark Wilks Department of Microbiology Competing interests: None declared |
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Gary S. Goldman, Computer Scientist Gary S. Goldman, Computer Scientist
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The four manuscripts cited by Dr. Mark Wilks have a common author/coauthor, Andrews N, and a common confounder. This is best illustrated perhaps using the manuscript titled, “Recall bias, MMR, and autism” in which the abstract indicates parents of autistic children with regressive symptoms who were diagnosed after the publicity alleging a link tended to recall the onset as shortly after MMR more often than parents of similar children who were diagnosed prior to the publicity.” When physicians and parents are told that vaccines are virtually completely safe and not made aware concerning the possibility that a severe adverse event can follow vaccination, often times such event is not correlated with the vaccination and as a consequence it goes unreported. In this instance, any such vaccine-induced adverse events that are reported are grossly underestimated. So, indeed, prior to publicity hinting that there might be a link, there were very few if any physicians and/or parents even willing to consider the possibility that late-onset autism may be linked with MMR vaccination. This reporting bias has skewed the data that has been analyzed and presents a significant confounder in the referenced studies. Sincerely, Gary S. Goldman, Ph.D. Competing interests: None declared |
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Jan M Perkins, Assistant Professor CMU 49340
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I appreciate the thoughtful response of Richard Horton and his raising the issue of societal responsibility in the choice of families to give vaccines. I am not interested in debating the interpretation of research studies with closed minds and shall not do so. Instead I would like to address this issue of responsibility. As others have noted there should not be a one size fits all vaccine policy. There are recognized reasons why some individuals should not have some vaccines. There are also certain to be unrecognized vulnerabilities. Where some individuals are predisposed to suffer damage such as autism and gut pathology from particular vaccination schedules is not know and cannot be known without better research. Surely it makes sense to identify such vulnerabilities and allow altered schedules. Or if individuals are forced to follow a schedule that causes them harm in the name of benefiting society, then does not society have a responsibility to those individuals? Shouldn't society ensure that the individuals and their families who are destroyed by this be given enough support to allow their life to be endurable even if it can never be normal again? Epidemiological studies, retrospective chart reviews, and the like cannot capture the gut pathology of autism or chart its timeline. When a child is spending his days smashing his head into a concrete floor and screaming it is easy to miss gut problems and hard for them to rate mention in medical notes. When treating the gut eliminates the behaviours it all seems so obvious. But for ideological, not scientific, reasons it is all but impossible to get a physician to acknowledge or treat the gut pathology. In typical children who later acquire the diagnoses of ulcerative colitis or Chron's disease, the only predictive early finding is failure to thrive. If a parent can get a physician's attention long enough to get a height and weight on an autistic child, any variations are dismissed as artifacts of the autism or the self-limiting diets that often develop along with the autism and gut pathology. Even a plain x-ray to reveal the increase incidence of constipation on up to acquired megacolon or rectum in these children is very difficult to get. I do believe that individuals should at times act for the greater good. But this means that society owes a debt to those who are harmed as a result. The all too frequent tragedies that occur when families are left to cope alone with severe autism make it clear that this debt is not being acknowledged and needed support is not provided. There is also the broader issue of whether classic utilitarian ethics is the best model for the complex modern health care system. It works beautifully for managing a large computer network where defective systems can be scavenged for spare parts and thrown on the trash heap when they cease to have enough useful parts to make them valuable. With the increased number of sacrifices for the greater good required by using this model in health care, we risk creating a world in which unacceptably large numbers of individuals are left with the greatest misery. jan perkins Competing interests: Sibling of an individual who developed "atypical encephalitis" shortly afer MMR, mother of a severely autistic child who was developmentally normal till MMR, health professional committed to reviewing evidence with an open mind |
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Kathleen F. Yazbak, Director of a Nonprofit Organisation Boston, MA 02114, David Elliman, Helen Bedford
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“Hear the Silence” is a Channel 5 drama due to be aired on Monday, 15 December. The content of this programme has been widely discussed in newspapers and airwaves across Britain. I am utterly dismayed at the personal attacks being launched against Dr Andrew Wakefield, and am writing to publicly support his crucial research. The obvious defensiveness of the public health authorities and government officials who have aimed their vitriol at Dr Wakefield speaks for itself. If there were no credence to a potential MMR-Autism link, why would they even give Dr. Wakefield the time of day? I’d like to mention that many of the public health authorities who are bemoaning this programme are the very same ones to whom I have personally written incessantly over the last 6 years, and from whom I have never received a single response, not even to say, “I’m sorry you believe this happened to your child.” There have been 2 articles published this week in The Guardian that mention “inaccuracies” in the script written by Timothy Prager. The source of these accusations hasn’t been publicly revealed. But the result is that we have a national British daily that has published unattributed quotes, and hasn’t even checked out the supposed inaccuracies. This is simply unethical, immoral and irresponsible. Timothy Prager wrote “Hear the Silence” after meeting many families like mine. Juliet Stevenson’s character, Christine Shields, is an amalgam of the hundreds and thousands of us who have witnessed, with horror, our previously normally-developing child regress into autism. “Hear the Silence” has a strong message: Why is the medical research simply not being allowed? So I ask, why aren’t the authorities concerned that the incidence of autism is sky-rocketing? The Scotsman published the following quote just this week, on 6 December, 20003: “One primary age child in 49 has been diagnosed with, or is awaiting diagnosis of, autistic spectrum disorder in the Inverness area, according to the survey carried out by the authority’s education department.” This statistic is staggering. I also wish that the authorities would stop saying that regressive autism is not a new phenomenon. Dr. Bernard Rimland, who runs the Autism Research Institute in San Diego, CA, and who has been compiling statistics on autism for over 40 years, said on July 14, 2002, “Late onset autism, (starting in the 2nd year), was almost unheard of in the ‘50s, ‘60s, and ‘70s; today such cases outnumber early onset cases 5 to 1, the increase paralleling the increase in required vaccines.” And if it isn’t MMR, then what is causing this epidemic? I can tell you that the answer is not to be found in the epidemiological, or “statistically” based studies that those in authority purport as the final word. Parents need to be interviewed and children need to be examined. In my son’s case, when the team at the Royal Free Hospital conducted biopsies during a colonoscopy, they found something sinister: measles genomic RNA in the walls of his intestine. Why aren’t the authorities concerned about the presence of vaccination strain measles in some children with autism? Shouldn’t the health of our children, and not political imperatives, come first? Isn’t there enough smoke around this topic to allow parents the choice of single vaccinations rather than forcing them to choose between MMR or nothing? Only when the scientific research is allowed will we know definitively whether MMR causes autism in certain children. Please know that I am one of thousands of mothers who will not stop being a thorn in the authorities’ sides until this research occurs. Kathleen Yazbak Boston, Massachusetts Competing interests: I am the mother of a 10 year old boy who suffers from regressive autism and bowel disease, and has measles genomic RNA in his gut tissue |
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William Pimm, Student tr112af
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Dear Ed Up till now supporters of MMR vaccination have tried to use science to support their cause, pointing out flaws in Wakefield's research methodology and publishing studies that show there is no link between autism and MMR vaccination. Central to this argument is an examination of the strengths and flaws in methodology, but this makes boring television and is not understood by newspaper hacks or TV journalists and is a complete turn off for the viewing public. Can you imagine Jeremy Paxman and David Dimbleby quizzing scientists on confidence intervals, correlation coefficients and the difference between association and causation. No - my advice to the advocates of MMR vaccination is to hit back with another TV film in which paediatricians and scientists who support MMR are portrayed in the same romantic light given to Andrew Wakefield in 'Hear the Silence' , with Sean Connery (or better still Russell Crowe?) playing the part of Brent Taylor, who can be portrayed comforting parents whose children have died or been brain damaged from measles, while he pursues honest scientific endeavour in the face of media headlines spreading scare stories about the risk of vaccination. Meanwhile Andrew Wakefield can be portrayed as an adult surgical gastro-enterologist, with minimal training in paediatrics, little contact with the on-going care of children with autism, no expertise in the management of autism, but handsome, telegenic, self promotional, and giving desperate parents a much needed explanation for their child's problems. I hasten to add that this suggestion has no bearing to the facts as they stand, and any resemblance to characters living or dead is entirely coincidental if not completely false. Will Pimm Competing interests: None declared |
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L S Lewis, General Practitioner Surgery, Newport, Pembrokeshire UK SA42 0TJ
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<The believe that MMR vaccine and autism or colitis or a sub set of either disease or both diseases are linked to MMR cannot be refuted by laboratory experiments. It might be possible to demonstrate such a link, but it cannot be refuted by a negative result or a 100 negative results, it is simply a belief: > Such a crass and disingenuous statement presupposes that these 'beliefs' are mistaken, surely ? Or is Mark saying that ALL beliefs are incapable of disproof ? I currently believe that MMR does not cause Autism. But evidence would change my mind.. Karl Popper showed better than I that Science proceeds by serially discarding hypotheses ( ie: by showing certain beliefs to be untenable - so make a new hypothesis). Gary Goldman has summarized his rational researches to date into the question 'Can one refute the statement that MMR did cause autism ?'. The hypothesis should be stated thus:- 'MMR Vaccination increases the incidence of Autism' Failure to find statistical significance should lead to rejection of this 'belief'. I put it to you, Mark, that thoroughgoing pilot studies comparing Treated vs 'untreated' groups, can straightforwardly confirm or refute the hypothesis, and should have been performed before any Mass Medicine be recommended. To date such studies as there are can be sullied by critics, and the general public shuns MMR. History shows that single vaccinations (ie: the schedule prior to MMR introduction was NOT associated with anything like the current rates of autism ). That schedule did protect against Measles - but sadly today doubting parents are NOT allowed by State and licensing laws to return to that option... Isn't this unreasonable ? Meanwhile Autism goes on rising, whilst MMR is falling !! Armed with this knowledge ( or is that a mistaken belief, Mark ? ) can we now get on with acceptable single or multiple vaccination schedules, and look vigorously elsewhere for the real causes of Autism? I agree with Richard Horton. Public Health professionals are foolish not to seize the opportunity to get into the Channel 5 debate... Hear the Silence ? Competing interests: Maximising Vaccination VS. Free Society |
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David Elliman, Consultant in community Child Health Great Ormond street Hospital, London, WC1, Helen Bedford
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Richard Horton does us a disjustice when he implies that our criticism of the film shows a lack of compassion. We frequently speak to parents who, because of the grossly distorted media portrayal of Dr Wakefield's research, are anxious about allowing their children to have the MMR vaccine. The parents' distress is entirely understandable, but should have been unnecessary because of the lack of evidence for the MMR- autism link. We have repeatedly stated this and our sympathy for parents with autism. To say that the film throws up doubts about the supposed MMR- autism link and is mainly a depiction of autism suggests that Richard has not seen the same film that we did and all the other people whose accounts we have heard or read about. Even those sympathetic to the film have not come away with this impression. It is very clearly an account of the search of a mother and a doctor for the cause of autism. Once they came up with a hypothesis linking the development of autism and the administration of the MMR vaccine, nothing else is considered and the dramatic licence allows the producers to make no significant mention of any opposing views. It is indeed easy to condemn the film as being one-sided, because it is. Enormous sums of money have been spent on research into autism and this research continues. It is a great pity that money has had to be spent in refuting an hypothesis which should never have been given the attention it has received. Richard suggests that professionals don't listen to parents enough. This may be true, but listening to parents means just that. It means listening carefully to what they say, (after all they do know their children best) and then interpreting what they say, turning it into a credible hypothesis and testing it. If a parent tells us that A follows B, we should not doubt that. If a parent tells us that A caused B, we should use our training to test out whether that is likely. To do anything different is abrogating our responsibility of care. Neither of us has resisted dialogue in the past and nor will we in future. However we have no intention of adding respectability to what is essentially a piece of irresponsible entertainment. If Channel 5 really did want to open up the debate in a useful manner, then they would have made a very different film. One that really was a thoughtful drama, something this was not. Competing interests: We have received funding for research from vaccine manufacturers. |
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Ed Cooper, Locum Cons. Community Pediatrician Gt Ormond St, London WC1
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Much of the confusion is caused by the conflation of two questions into one. I have found this when I talk with families in immunisation advisory clinics; it is there in some affected parents’ BMJ rapid response contributions; and it appears now that even the editor of the Lancet is not quite free of it. Here is one question: is there any connection between measles virus, natural or attenuated for vaccine use, as one strain or another, and autism? Here is another question: if - if - there is any connection between measles virus and autism, is it influenced by giving, simultaneously, two other attenuated strains of live virus, mumps and rubella, together with the attenuated measles virus, as a vaccine? The first question is a good research question. Andrew Wakefield and some colleagues asked it. Wakefield had previously asked another good research question: Crohn’s Disease is gut inflammation of quite unknown cause – could measles virus, wild or attenuated, be implicated in its etiology? He chose reasonable strategies to try to answer the question and, without the certainty that is so elusive in science, he and others, friends and enemies, effectively came up with the answer: no. In the course of that research the autism question came up. Autism is like Crohn’s Disease in that its cause is a complete mystery. Wakefield and colleagues published the 1998 Lancet paper. It was a question-raising paper, proposing a hypothesis but not testing it. Testing a hypothesis involves testing it against potentially refuting data, either simultaneously through some sort of control, or later through predictions following from the hypothesis that are either borne out or fail. In that 1998 paper there was a complete absence of any controls, but the predictions have subsequently been tested and – without the certainty that is so elusive in science, etc., etc. – they have not been borne out. It was still a valid question. Tired and frustrated public health doctors are disgruntled that the Lancet published a paper so much weaker than many that have been rejected, but the Lancet has always seen its function as grabbing new ideas, it was not such a big sin, Dr. Horton is fairly clean in responsibility for the subsequent debacle. But, in the public relations business that went along with the launch of that 1998 paper, at a press conference, Dr. Wakefield emitted an idea of his own, based on no research, just a thought: maybe it was better not to combine measles vaccine with mumps vaccine and rubella vaccine. And the trouble began. Time and again since then there have been headlines in the press along the lines of: “New research throws further doubt on controversial MMR vaccine”, but there is never anything to read below the headline on mumps or rubella. To the best of my knowledge, Wakefield himself has attempted no research on MMR vaccine, just on measles vaccine and measles virus. As things stand, anyone who has doubts on giving their child MMR vaccine should have the same doubts on giving their child measles vaccine alone, as a single vaccine. Parents who fear MMR are generally willing to give single measles vaccine because they know that any risk of that vaccine is outweighed by the risk of measles, a condition that makes children much sicker than modern parents find tolerable even when it is uncomplicated, and that kills or maims them when it is complicated. Presumably the risk they tolerate on behalf of their child includes the tenuous, speculative risk of autism following the single vaccine. If they are willing to give single measles vaccine then they can only be unwilling to give MMR if they believe that there is some evidence suggesting a difference in late side-effects between measles vaccine in MMR and measles vaccine alone, and there is absolutely no such evidence. There is no reason to seek it because there is no basis for a research question. There is no more reason to test MMR vaccine for late side-effects against a single measles vaccine of the same strain than there is to test a blue vaccine against a white vaccine. That has not been done either. It is not absolutely, formally impossible that blue vaccine is safer than white vaccine, but naturally the list of possible questions of the blue-white type is infinite. This is why almost no public health and child health doctors view the single-vaccines alternative as the middle ground, the compromise area. A programme attempting six separate single virus injections per child (on top of all the other immunisations) could only harm attempts at population herd immunity, as well as causing pain and increasing fear in individual children. To embark on such a programme in the absence of any reasoning – well, no. The debate, however, is bringing up real issues on individual choice versus the public good and some of the most telling points have been made in BMJ responses from parents, professionals, journalists and others, from all over the world. But the debate has not been served by conflation of possible risks of attenuated live measles vaccine with the risk of a combined vaccine. Competing interests: None declared |
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Heather C Adams, none 02030
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Sir, So yet again the debate on MMR rages as it has done so for many years. Numerous studies have been published supposedly supporting its safety. As a parent of an affected child,I remain perplexed as to why none of these studies has looked at the affected children . At what point will the professional members of your subscribers turn their considerable energies to asking why these children developed bowel disease along with developmental regression? I fear this curiosity will remain dormant for many a year to come and in its abscence I have grown weary of relying on your profession for answers. Reluctantly, I moved my family to the USA two years ago where difficult questions are more readily aired and political will to address the catastrophe of autism is not buried in invective rhetoric at those seeking answers. Competing interests: Parent of autistic child. |
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GH Hall, Retired physician EX1 2HW
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What has been wrong with the whole MMR fiasco and indeed other vaccination problems is the refusal of the authorities to reveal what they knew about the efficacy and safety of these products before they were released. How stringent were the tests? Where were they done, and by whom? Was there any independent assessment? What numbers were involved and what was the power of the studies to reveal a 1%, 2%, 3% risk of damage at 1, 2, 3 years- and so on? Why aren't the drug firms obliged to open their work books about results on currently used vaccines? Why is it permissible to excuse workers in this field of the conventional mandatory need to run proper randomised controlled trials to obtain convincing answers? The usual answer to these questions- if one can elicit a response at all -is that the whole matter of population protection is too important to be subjected to this sort of delay and questioning. This amounts to a classic example of begging the question- ie, assuming you know the answer already. The hypocrisy of the DoH mandarins, BMA and academics is sickening: openness, honesty, and transparency are promised but not delivered when the chips are down. The public is right to suspect that things are being hidden from it. The issue is not whether or not MMR causes autism or Crohn's disease, but to expose the real facts about the competence or otherwise of vaccine and drug testing, and why discussion of these matters is suppressed. Our watchdogs have been debarked, and I for one am pleased to see that the media are keeping up the pressure. Competing interests: None declared |
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L S Lewis, GP Surgery, Newport, Dyfed, SA42 0TJ
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Ed Cooper states.. < As things stand, anyone who has doubts on giving their child MMR vaccine should have the same doubts on giving their child measles vaccine alone, as a single vaccine. > But he forgets that we gave single measles vaccine to infants long before MMR was invented. I certainly did - for 15 years before MMR the childhood vaccination schedule included single measles vaccine at 9 months. The rate of Autism was much less than it is today - even allowing generously for 'unrecognised cases'. We therefore KNOW it was safe in this regard ! Yet the DOH is taking issue with ANYONE who offers single Measles vaccine - because it mistakenly believes it 'undermines' its own case for MMR. The single products are no longer licensed 'because the manufacturers did not apply', but off-licence use with informed consent by a doctor remains (for the moment) legal and difficult to obtain. I am not against MMR - I believe it is safe - but I am in favour of facts being acknowledged, and false arguments being refuted. So Ed - would you care to retract your statement ? Competing interests: None declared |
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M C Feliciello, N/A Leeds
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Dr Elliman, in your rapid response of 14.12.03 I noted the comment: "If a parent tells us that A caused B, we should use our training to test out whether that is likely. To do anything different is abrogating our responsibility of care." Which is laudable, but I was curious as to how often this rigorous testing has been carried out in laboratory conditions rather than relying on apparently questionable statistical analysis. After all, the parent is citing the individual case of their childs health history not that of a population, would it not be good manners to investigate the individual claim in each instance? MCF Competing interests: Parent of Autistic child |
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Ed Cooper, Locum Cons. Pediatrician Gt. Ormond St, London, WC1
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I can retract willingly enough, because I agree with Dr. Lewis that measles vaccine does not cause autism. But the sentence he objects to is only intended as an "if...then..." argument: if and only if you fear MMR as a generator of autism, then you should fear single measles vaccine by the same token. Dr. Lewis points out one more good, historical reason not to fear single measles vaccine. My point is that fear of the addition of mumps and rubella to that vaccine is a separate question from the fear of measles vaccine itself. Whereas there is contentious, convoluted and suspect "evidence" for the measles fear - DNA signal from gut cells, for example - there is no evidence of any kind whatsoever, good, bad or indifferent, for the other fear. Giving single vaccine to a young child in 2003: to perform a second- best medical procedure in the absence of any argument for it other than the irrational choice of the patient's proxy, against what I believe to be the best interest of the patient, troubles me. Competing interests: None declared |
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L S Lewis, General Practitioner Newport, Pembrokeshire, SA42 0TJ
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Thanks Ed for being so kind. We both agree that Single measles Vaccine does not cause Autism. But some parents fear that combination MMR might, and I cannot persuade them otherwise. So I want to be allowed to give them what we both agree is a safe alternative - single Measles vaccine. This worries you, not me. Compulsion and brow-beating is not an option. If I am not allowed to give single Measles vaccine then the child will go unvaccinated. Soon the threshold of 'herd immunity' will be crossed and severe Measles mayhem will follow (Mumps and Rubella are not an immediate danger - consequnces will come smaller or later ). I would prefer to get on with consent and raise the rate of Measles immunisation. Back to your 'worries' about accepting parents concerns and offering second-best.. Isn't that exactly how we weathered the public's collapse in confidence in Pertussis ? - We continued with DT&Polio, as 'second -best'... and continued to discuss, explain and negotiate with parental concern. DT&Polio, and separate D, T, or P remain available at Doctors' discretion. It is also interesting to note how an authoritarian line that Pertussis was 'completely safe' soon gave way to admissions that Some vaccines were worse than others - and eventually we switched to Acellular Pertussis. The DOH has chosen to ignore this experience, and instead persists with an authoritarian line that 'nothing else but MMR will be allowed'. Such a line, in the face of unpersuaded parents who withhold consent, beggars belief. It is fiddling while Rome burns - and looks to some parents like offering BSE burgers to our children. Best Wishes, Competing interests: None declared |
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John Phillip Heptonstall, Director of The Morley Acupuncture Clinic and Complementary Therapy Centre Leeds LS27 8EG
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Sir The authors 'rose tinted spectacles' view of the medical approach to dealing with autistic children and their parents is unsurprising...it would take little research for them to have an accurate perspective, as that shown in the film, something they have obviously not done despite their stated roles - I notice the lack of declaration of their status as having been oft' funded by vaccine supliers, perhaps the BMJ could correct this omission. The silence my wife and I heard from the medical system when our son was pre-diagnosis was deafening. GPs were oblivious and uncomfortable; he was managed by a Professor of paediatric neurology for a couple of years; then a Child Development Centre Consultant for a couple of years; and a Professor of Psychiatry for poor sleep for months who we later found had written of his suspicion of autism in our sons medical notes but had not told us, but he had told the Child DC Consultant. A Speech Therapist later admitted to us that 'it was more than her jobs worth to have informed us of her suspicions of autism during the 2 years she worked with him'....the list goes on. Granted this was in the late '80s/early '90s but what sort of medical fraternity denies patients - children - and the people entrusted with their care (parents) their suspicions of autism. WE had to confront the Psychiatrist about his suspicions of autism, he then had to show us his file, we then had to confront the Consultant. Gps had been singulalry useless in the face of autism, and the education system and educational psychologist referred to our son as 'severely mentally retarded' without mention of autism. It was schools for autism Headteachers who so easily 'diagnosed' him - through his demeanor, movements, actions in certain surroundings, the sounds that he made we were told were typical of a classically autistic child. We sought a further Psychiatric opinion and the Professor rapidly confirmed the autism. The whole system - government, medical, educational and social is still in denial about autism and the consequences to society, though less so thanks to the enduring publicity autism has received this past decade. A diagnosis leads to special needs funding - finance - and therein lay the problem according to people we dealt with over the years - lifelong funding; funding by the public for the public, the same public who unwittingly pay for vaccines that probably cause a good percentage of autism while the system remains in denial. The portrayal on TV of an autistic child and his family was not untypical from our experiences, and of families with autism we know; some families have had a much harder ride and continue to do so - the programme probably portrayed a middle way. The debate that followed was a travesty - the 'system' could not find a scientist to debate with eminent scientists 'worried about MMR'. No one of scientific import would appear to debate for the public and MMR on such an important and emotive topic - yet they seem very eager to front epidemiological studies on behalf of government that are so obviously scientifically flawed - a pretty damning endightment on government scientists and strong confirmation that most scientific evidence in favour of the MMR probably lacks conviction. One hopes the public learnt a good lesson. Regards John H. Competing interests: An autistic son |
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Fred V Griffiths, General Practitioner Polzeath Cornwall PL27 6UG
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Concerning this very biased documentary, I felt that there was one big flaw in the storyline. By any standards, this child's reaction to the first injection was severe. --When he had the second injection was enquiry made about this? If not why not. I believe many would not have given it. I certainly would not. --F.V.Griffiths General Practitioner.
Competing interests: None declared |
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MC Felicello, n/a Leeds
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John Heptonstalls response of 18.12.03 brings into sharp relief an issue often overlooked, but was touched on in the film "Hear the Silence" Regardless of parental suspicions of aetiology of Autism, one of the many facets that appears to unite Parents and Carers is a deep and well founded bitterness due to the fragmented & disparate nature of the diagnostic procedures and subsequent inadequate care pathway. Johns' account is not too dissimilar to that of other parents and reflects the lack of co-ordination of awareness or resources still prevalent. Dietary Intervention as touched on in the film, is as yet little understood or implemented by health authorities. Usually funded and managed by the parent as the most appropriate and effective non- pharmacological means of reducing their childrens pain and "fog". In many cases it provides the platform of increasing clarity necessary for successful implementation of educational strategies of which ABA is but one. ABA is as yet an intervention to be fought for on an individual basis with each LEA. Expensive, intensive and all too often funded by the parent as the most appropriate tool to reach their child, it can provide the means to allow the child access to mainstream education as depicted. I know of at least one couple resorting to a re-mortgage of their home to continue educational intervention in this way, though that option is not available to every family affected. In one scene, the character Christine Shields chooses to read the fairy tale of "The Little Red Hen" to her children; a tale that may yet offer some insight to those who have professional contact with parents of affected children and have failed to employ listening skills. MCF Competing interests: parent of an autistic child |
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Carol C Williams, Clerical Assistant Mount St Nottingham NG1 2BR
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When my daughter had the DPT, oral polio, hib at 6 months she reacted badly and had a respiratory arrest. It took 2 years for her development to get back to normal, during which time I had to look after her and only when I flipped in hospital did I get any respite care. I would like to ask Dr Elliman why even with daughters previous reaction is it still recommended that she has the MMR. It seems to me that health professionals are just thinking about getting a higher uptake of the MMR and forgetting about the child itself. Competing interests: None declared |
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Penny Mellor, Advocate Home WV9 5HX
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Andrew Wakefield, that's what I call a doctor, committed, brave, caring and somebody who listened to parent's concerns and didn't dismiss them as being "over potective" or "hysterical" and not a "munched" mother in sight! I am a mother to 8 children ages ranging from 24 years down to two, all my children were breastfed until they were at least one with the exception of my last baby who was stopped when Judge Guy Whitburn put me in prison. None of my children have ever been vaccinated with anything apart from BCG not just because of the controversy, because not one solitary scientist has ever been able to show me any evidence that I had not adequately immunised my children via the breastfeeding, neither could they tell me that if I had have vaccinated on top of antibodies already recieved via me, would I be overdosing them. Here are the facts for the fence sitters. Not one of my children (and it can't all be genetics because there are three different fathers) has any allergies, asthma, learning problems, had apnoea, gut problems, nothing and apart from a couple of bangs on the head which had to checked at A & E, none of them have ever been hospitalised, none go to the GP's, none of them are ever ill apart from the usual childhood illnesses. Within my family on my mothers side, they all suffer from hayfever, that has not manifested itself in my children. All my children contracted the usual childhood diseases all were kept off school and drove me mad because they were fit as fiddles, all play outside in the dirt, climb trees, fish in streams etc, I have two cats and two dogs so my children have been exposed in every sense possible to diseases that according to the government could kill or maim them. Simple question, if GP's are paid to encourage uptake of the MMR vaccine and "breast is best" why aren't they paid to encourage to get more women breastfeeding? SIDS is at a much lower rate with breastfed babies and all the recent research proves that it helps babies develop positively in every area, not to mention the automatic immunity against diseases the first few days of breast feeding gives a child. So I see this as my own "research". Breast is best and I believe that my children are living proof that there are alternatives to vaccines, much less lucrative for the drug companies of course, because of course collustrum can be obtained for free! Competing interests: Cynical about the medical profession and their links to the drug companies |
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Ellen C G Grant, physician and medical gynaecologist 20 Coombe Ridings, Kingston-upon-Thames, Surrey, KT2 7JU, UK
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Maddalena Feliciello has asked me if I use the DAN (Defeat Autism Now) protocol, which is described at www.autism.com. This has been developed by Bernard Rimland, whom I first met at a Clinical Ecology Conference in Miami in 1979. We had already found that allergic reactions to foods were more common in migraine patients with higher serum copper/zinc ratios. Wheat and milk were the commonest food precipitants to be unmasked by exclusion diets. Clinical Ecologists in the UK are usually members of the British Society for Allergy, Environmental and Nutritional Medicine and have the advantage of being able to use Biolab Medical Unit for relevant investigations. Similar protocols are used for most patients. We published evidence from two studies that children with specific learning problems had lower zinc in thier sweat and higher toxic meatls in their sweat and hair than children without problems. Preconception care involves attempting to reduce the risks of unexplained infertility and recurrent miscarriages and unhealthy children by assessing nutritional and toxic metal status in prospective parents, who may be otherwise symptomless. Ideally, repletion of common deficiencies, usually of zinc, magnesium, manganese, chromium, selenium, molybdenum, B vitamins and essential fatty acids, should be confirmed several months before conception. A functional superoxide dismutase test is needed to determine copper status. As about one in three pregnancies are unplanned, annual testing seems to be the way forward. Zinc deficiency and toxic metal overload increase the risk of recurrent infections. Repeated courses of antibiotics increase the risk of a positive gut fermentation test and also increased gut permeability to larger than normal protein particles, including those from wheat and milk. Zinc and magnesium deficiencies increase the numbers of foods causing demonstrable reactions, such as changes in pulse rate. Long-term zinc deficiency can reduce pancreatic exocrine secretions, which in turn, also prevents absorption of nutrients or supplements. High protein low allergy diets, monitored nutritional repletion, antifungal medication and immunoglobulin-containing probiotics are used to treat or prevent many conditions. Excessive consumption of wheat and milk can increase urinary losses of zinc and magnesium, which in turn cause B vitamin and EFA pathway deficiencies. Lead levels have reduced because of lead free petrol but mercury levels can increase from tuna consumption, dental amalgam and some vaccines. Most cadmium contamination is from tobacco smoke and aluminium from food containers. Competing interests: Mother of two dyslexic children |
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Lenny Schafer, advocate Schafer Autism Report, 9629 Old Placerville Rd. Sacramento, CA 95827 USA
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The outrage expressed over Channel 5's Hear the Silence by those on the front-lines of care [. . .] is understandable and justified. That one side of this much-needed engagement resists dialogue, with what comes across as a mixture of anger and scorn, seems to me to be unforgivable. Well, which is it Mr. Horn? Should caregivers’ outrage be “justified’ or ‘unforgiven’? I, however, anticipate the day when the truth finally emerges and perhaps many of those obfuscators in pubic health and their apologists would face the justice of medical tribunals for their criminal negligence for ignoring the autism epidemic. Know sir, that you and fellow collaborators face a far greater consequence than the embarrassment of being wrong. You are accessories after the fact for the iatrogenic epidemic of autism. However, if I’m wrong, no big deal, I’m supposedly only an ignorant, hysterical parent of a child with autism. Perhaps, but many such parents are getting very tired of eating your medical cake. If not vaccines, then what? Why aren’t our children being properly examined? Since when do public health officials ignore the victims of a potential epidemic? Since they have developed conflicted interests like saving their hides over dirty vaccines. Competing interests: Writer has a child with autism. |
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Donna M. Samuels, mother and homemaker Mt. Washington, KY 40047
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In regards to the negative reviews of the “Hear the Silence” TV drama, a quotation comes to mind spoken during the Congressional hearings on Thimersol-Containing vaccines. During these hearings, Bernard Rimland, the founding director of the Autism Research Institute of San Diego, stated he once heard, “The chronology of man’s progress is the history of authority refuted.” The link between thimerosal-containing vaccines to neurodevelopmental disorders has biological plausibility. It is a moral and scientific imperative that this issue be fully investigated with the highest level of professional integrity. Competing interests: I am the mother of a son with autism. |
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Paul Lynch, Patient advocate Swansea
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Having already responded to Michael Fitzpatricks' damming review of "Hear the Silence" (1) I find myself somewhat disappointed that yet again competing interests have not been declared. David Elliman and Helen Bedford have both received money from the vaccine manufacturers SmithKline Beecham and Pasteur Merieux Merck Sharp & Dohme. And, that Elliman and Bedfords' subsequent report was used by the government to reiterate its obstinate and increasingly polarized view that the MMR vaccine is (allegedly) safe. (2) Perhaps these staunch supporters of the MMR vaccine have been blinded by glare of the mercury career ladder within the medical establishment (the hotter the topic the higher they rise) and are therefore unaware that the autism process has been objectively and cogently explained far beyond their own explanations (3), consequently rendering their opinions extremely naive, if not entirely suspect.. Regards, Paul Lynch (1) http://bmj.bmjjournals.com/cgi/eletters/327/7428/1411?ck=nck#43975 (2) http://www.whale.to/m/all/elliman.html (3) http://www.countrydoctor.co.uk/education/education%20- %20Pollution%20update,%206.03.htm Competing interests: None declared |
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Thomas Valentine, teacher n/a
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Dear Paul Lynch I suggest that you have tried to counter the views of Helen Bedford and David Elliman by pointing out a real or perceived conflict of interest but you have not addressed the issues that they raised in their review. It is legitimate to point out a conflict of interest, but a conflict of interest, real or perceived, does not in itself, mean that a statement or argument is false. Thomas Valentine Competing interests: None declared |
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Paul Lynch, Patient advocate Swansea
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Dear Thomas Valentine, I thought I had expressed my opinion of the so-called issues raised in the review by Bedford, Elliman and indeed Fitzpatrick more than sufficiently. However, for the sake of clarity, I shall sum up in one word: "Humbug". All in all it's just more bricks in the wall of silence. Regards, Paul Lynch Competing interests: None declared |
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Thomas Valentine, teacher n/a
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Dear Paul Lynch You succinctly sum up your opinion of the review by Drs Elliman and Bedford as 'Humbug'. Does this apply to their comments that the film is "an accurate portrayal of the extreme difficulties of looking after a child with autism and the obstacles in the way of getting appropriate educational provision" or a factual statement when they point out that "at one time Dr Wakefield believed he had proven a link between the single measles vaccine and adult Crohn's disease" ? Would it not be more accurate to say that the parts of the review that you found to be humbug are where the opinions of Dr Elliman and Bedford differ from your own? Best wishes Thomas Valentine Competing interests: None dec | |||