Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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We cannot win
- Neville W Goodman (3 June 2005)
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Has the fat lady sung then?
- Alan Challoner (3 June 2005)
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Re: We cannot win
- John Stone (3 June 2005)
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MMR worst case scenario: worth the risk?
- Andrew N Papanikitas (7 June 2005)
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Re: MMR worst case scenario: worth the risk?
- John Stone (7 June 2005)
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Re: MMR worst case scenario: worth the risk?
- John Stone (8 June 2005)
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The MMR debate rages on
- Ruth Edwards (8 June 2005)
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Re: MMR worst case scenario: worth the risk?
- MAGDA TAYLOR (8 June 2005)
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Neville W Goodman, Consultant Anaesthetist Southmead Hospital, Bristol, BS10 5NB
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For MMR and autism, epidemiology is dismissed. For power lines and cancer (see other papers in this same issue), epidemiology is king. As Domhnall MacAuley wrote, "But many parents might have found such [anecdotal] arguments seductive." This is the problem. Personal experience speaks loudly. It is difficult to deny the evidence of one's own eyes. The MMR-dissenters start from the proven fact that MMR causes autism (because they've seen it); the EMF-cancer advocates know power lines cause cancer (because they've seen it). All later evidence is interpreted based on that experience. The rapid responses to the articles in this week's BMJ will be witness. As Geoff Watts writes in favour of perspective (p 1293), "In 2002, according to the Child Accident Prevention Trust, more than 36 000 children were hurt in road accidents and around 200 were killed... ...five cases annually of childhood leukaemia may be associated with power lines." But perspective is precisely what is rejected by personal experience: so we have illogical campaigns to uproot speed cameras, to move pylons, and to give single vaccines. Competing interests: None declared |
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Alan Challoner, Retired LL18 5UR
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Dr MacAuley, in his review of the BBC Horizon programme, Does the MMR Jab Cause Autism? [BBC 2, 29 May at 9 pm], repeats what I assume was the programme‘s determination, “…there was nothing in the MMR and autism story and many children have suffered unnecessarily from the outcome of the widespread publicity.” He also states, “But, I should confess, there was still a tiny voice in the back of my mind wondering if there might still be a grain of truth in the story about a suggested link between autism and MMR”. It is interesting that a GP will admit to a lingering doubt and that he finally disposes of that doubt on the basis of watching an Horizon programme. His final paragraph states, “We have come full circle now, and immunisation rates are creeping back up. But it is neither scientific papers nor medical journals that have made the biggest and most lasting impression. It is witnessing the suffering of others, and our emotional response to illness. Mums and dads are more likely to have their children immunised if they see what happens when others are ill.” This witnessing of suffering presumably alludes to graphic images of children who have contracted some of the diseases from which they might have been protected had they been vaccinated against them. I suspect that the only serious outcomes from non-vaccination would be through infection with measles. Mumps and Rubella in children are unlikely to produce images that would be considered graphic enough for TV. Ironically, he uses his vision of how parents might react by referring only to the vision of reality when disease strikes. He seems to forget that many parents have also witnessed the real life experience of seeing children who have had a severe reaction to vaccination, and this of course extends beyond MMR. He should consider that for many years the medical profession consistently refuted the idea that the DPT vaccination could cause brain damage and its consequent disability. In addition he should reflect that government has paid out sums as ‘awards’ to over a thousand children who have been damaged by vaccines. The world might have moved on and there are more topical medical controversies, but this story of the MMR vaccination and its problems has not been concluded. Competing interests: Father of a vaccine-damaged daughter. |
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John Stone, none London N22
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Personal experience should speak loudly. Neville Goodman cannot prove by statistics that child x has not had an ADR on the basis of statistics which contain no systematic record of ADRs in the first place. The only logical thing is to monitor and investigate ADRs. That is the origin of the remark about "looking at the children". The main epidemiological study cited by the programme, incidentally, was the Danish study [1]. The programme mentioned that it was controversial but did not say why. I refer Domhnall MacCauley and Neville Goodman to the two papers in Journal of American Physicians and Surgeons last autumn [2,3]. Madsen et al have never responded to these criticisms. [1] K. Madsen et al: 'A population-based study of measles, mumps and rubella vaccination and autism', New England Journal of Medicine: 2002: 347: 147-82. [2] Gary S Goldman and F Edward Yazbak: 'An Investigation of the Association Between MMR Vaccination and Autism in Denmark': http://www.jpands.org/vol9no3/goldman.pdf [3] Carol Stott, Mark Blaxill and Andrew Wakefield: 'MMR and Autism in Perspective: The Denmark Story': http://www.jpands.org/vol9no3/stott.pdf Competing interests: Autistic son |
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Andrew N Papanikitas, SHO in Paediatrics Eastbourne DGH, BN21 2UD
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As an SHO in Paediatrics at a DGH, asking the parents of unwell toddlers and small children about immunisations, I am frequently told things like, “We read up on it and decided not to give the MMR,” “It’s herd immunity anyway,” or “His brother got ADHD so we thought we’d better not give him MMR.” I find I have to remind myself of some simple received wisdom, before advising parents to reconsider, or discuss the matter with their GP, irrespective of whether Autistic spectrum following on from MMR is a case of ‘post hoc ergo propter hoc’ (it follows it and therefore is because of it). These are succinctly put by Prof Dick Heller of Manchester University: The prevalence of autistic spectrum disorders is 91/100 000 children. (Roberts R. MMR vaccination and autism. BMJ 1998; 316: 1824). If as many as 15% of these children had autism as a result of the MMR vaccine, 7326 children would have to be vaccinated to "produce" one child with autism. On the other hand, for measles alone, death rates are 1-2 per 1000 infected people in the U.S. and that 1 in 1000 will get encephalitis (and some of these will have permanent brain damage). (Watson JC, Hadler SC, Dykewicz CA, Reef S, Phillips L. Measles, mumps, and rubella vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 1998; 47(RR- 8): 1-57) If most children who were not vaccinated developed measles, complication rates suggest that discontinuing vaccination would do considerable harm, that would far outweigh any possible benefit from reducing the incidence of autism. (Tom Heller, Dick Heller, Stephen Pattison, and Tom Heller, Ethical debate: Dealing with uncertainty BMJ, Oct 2001; 323: 838 - 840.) Sincerely. Competing interests: None declared |
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John Stone, none London N22
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It is excellent that Andrew Papanikitas acknowledges the possibility of risk, however the source that he cites has the National Autistic Society figure wrong by a factor of 10 for the prevalence of Autistic Spectrum Disorders, and should read 91 in 10,000 not 91 in 100,000. This is a perhaps controversial statistic since it depends on the conflation of population studies which took place in Camberwell in the mid 1970s and Gothenburg in the early 1990s [1], and therefore presupposes - without independent corroboration - that incidence is static both temporarily and geographically, and presumably unaffected by environment or medical policy. [1] Lorna Wing and David Potter, 'Notes on the prevalence of autism spectrum': disorders'http://www.nas.org.uk/nas/jsp/polopoly.jsp?d=364&a=2618 Competing interests: Autistic son |
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John Stone, none London N22
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Andrew Papanikitas's quoted figure of 1-2 deaths per 1,000 measles cases seems rather high, and does not as far as I am able to ascertain reflect the conditions in 1988 when MMR was introduced in the UK. I do not have official figures for measles incidence, but I quote the health minister of that time Edwina Currie's remarks to Panorama 'Every Parent's Choice' in 1998: "We had 47,000 cases the year before [1987], we were heading for 80,000 cases in 1988. Measles is a killer. In fact in 1988 we lost 15 children who were killed by measles, all of whom were preventable, and we felt that the case was overwhelming for having a go." [1] This is quite confusing but the official death toll in 1987 for measles was 6 [2], which on the Currie figure of 47,000 cases gives a death rate of just over 1 in 8,000. Edwina only gives the projected figure for 1988, but 1988 was presumably the first year to benefit from MMR, and yet the death toll went up to 15 (16 according to official figures [2]). Of course, we had monovalent vaccination against measles in 1987. Nor is there information about how many cases and how many of the fatalities were vaccinated in each instance, and with what. None of this, however, substantiates 1-2 deaths per 1,000. Is it not remarkable how difficult real information is to get hold of? [1] http://news.bbc.co.uk/hi/english/static/audio_video/programmes/panorama/transcripts/transcript_03_02_02.txt [2] National Statistical Office CD ROM 'Twentieth Century Mortality' - England & Wales. Competing interests: Autistic son |
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Ruth Edwards, Medical writer Dubai 13700
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I found Dr MacAuley's review of the Horizon programme very interesting, though as I live in Dubai I obviously have not had an opportunity to see it and cannot comment on its content. However, Dr MacAuley expresses curiosity as to why the pregramme's producers chose to do this story now. The timing may have had something to do with the release of a book entitled “Evidence of Harm” – Mercury in Medicines and the Autism Epidemic: A Medical Controversy by David Kirby, a review of which was published here recently (Gulf News Friday Review Section, May 27, 2005). The author, who is also a journalist, interviewed several parents of autistic children who formed an organisation called Coalition for Safe Minds. The group believes that it is the use of the mercury-based preservative, thimerosal, that is the root cause of what is described as an “autism epidemic”. According to the review, Kirby does point out that in May last year, a committee from the Institute of Medicine found no causal relationship between thimerosal-containing vaccines, or the MMR vaccine, and autism. Competing interests: None declared |
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MAGDA TAYLOR, Director of The Informed Parent P O Box 4481, Worthing, West Sussex, BN11 2WH
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I would like to comment on Andrew Papanikitas's statement: 'If most children who were not vaccinated developed measles, complication rates suggest that discontinuing vaccination would do considerable harm, that would far outweigh any possible benefit from reducing the incidence of autism.' From the mid 1800s to the mid 1900s deaths from measles declined dramatically - by around 95%. This was achieved without any vaccination - it was achieved by health improvements, better living standards, better nutrition and so on. As children became healthier then the number of cases, complications, and deaths became less. Even when the measles vaccine was introduced in 1968 in the UK there was less than a 30% uptake in the first few years, and still the illness declined. (Also let's remind ourselves here that many vaccinated children still go on to developing measles anyway.) So why would there suddenly be an increase in complications from measles if children were not vaccinated. If a thousand HEALTHY unvaccinated children were to develop measles and it was allowed to run its course without suppression there is no reason why complications would occur, complications don't just happen randomly. The main question that perhaps leads on from this is then 'how do we define health' and that is where there is a large division in views. I would only urge more medical professionals to study more in the area of HEALTH which may increase their understanding of what symptoms of disease truly indicate, and what steps should be taken in response. Competing interests: None declared |
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