http://www.spectator.co.uk/melaniephillips/568226/the-wakefield-witchhunt.thtml
no linkbetween the MMR vaccination and autism. This new research was said to have shown that, contrary to the claims made by Dr Andrew Wakefield, the surgeon at the centre of the MMR scare, there was no relationship between gut problems and autism, the core of his concerns. It also claimed that the discovery furthermore damaged the related theory that a gluten-free diet could help children with autism.
Dr Hilary Cass, from Great Ormond Street, said: ‘It is very distressing to have a diagnosis of autism, a lifelong condition.Many families are driven to try out interventions which currently have no scientific basis. For example, advocates of the leaky gut hypothesis offer children a casein and gluten-free diet which as yet lacks an evidence base.’This particular observation is a telling indication that this study bears little relation to reality. For there are countless families whose autistic children’s suffering from gut problems has only been eased, and their autistic symptoms improved, by the introduction of precisely such a diet. ‘No evidence base’? Tell that to those families. It is their lived experience.
…The study is severely limited by case definition in the context of the crucial ‘possible enterocolitis’ group. For inclusion in this group they required the presence of two or more of the following five current gastrointestinal symptoms:
- current persistent diarrhea (defined as watery/loose stools three or more times per day >14 days),
- current persistent vomiting (occurring at least once per day, or more than five times per week),
- current weight loss,
- current persistent abdominal pain (3 or more episodes [frequency not specified by authors] severe enough to interfere with activity);
- current blood in stool;
plus:
- past persistent diarrhea >14 days’ duration, and excluding current constipation.
We have over the last 10 years evaluated several thousand children on the autistic spectrum who have significant gastrointestinal symptoms. Upper and lower endoscopy and surgical histology have identified mucosal inflammation in excess of 80% of these children. Almost none of these children with biopsy-proven enterocolitis would fit the criteria set out above. Firstly, these children rarely have vomiting, current weight loss (as opposed to failure to gain weight in an age-appropriate manner), or passage of blood per rectum. The requirement is thus narrowed to a child having two of two relevant symptoms – current persistent diarrhea and current abdominal pain according to their criteria, plus a past history of persistent diarrhea excluding current constipation.
The requirement for the current presence of these symptoms, for 14 or more days continuously, shows a singular lack of understanding of the episodic, fluctuating, and alternating (e.g. diarrhea/constipation) symptom profile experienced by these children. In our experience, ASD children with histologic enterocolitis typically have 1 to 2 unformed stools per day that are very malodorous and usually contain a variety of undigested foodstuffs. This pattern alternates with that of “constipation” in which the unformed stool is passed after many days of no bowel movements at all, and with excessive straining. This group is entirely overlooked by the arbitrary criteria set forth in their paper. With respect to diarrhea and constipation, a detailed discussion of stool pattern in these children is available1 which further highlights the shortcomings of the above criteria. Moreover, the interpretation of pain as a symptom in non-verbal children, as it often manifests as self injury, aggressive outbursts, sleep disturbances, and abnormal posturing, is notoriously difficult. This interpretation requires an insight based upon the correlation of symptoms, histological findings, and response of symptoms to anti-inflammatory treatment. There is no evidence in the Baird et al. paper that these crucial factors were taken into account. This study’s inappropriate symptom criteria would explain the discordance with other reports that have revealed a high prevalence of significant gastrointestinal symptoms in general autism populations2,3.
It is surprising that Dr Peter Sullivan, a co-author on the paper, who presumably provided the above gastroenterological criteria, was not aware of the aforementioned limitations. In his role as a Defendant’s expert in the UK MMR litigation, he will have had access to the clinical records of autistic children with the relevant intestinal symptoms and biopsy-proven intestinal inflammation.
We suggest that the authors might wish to reflect on the ethical implications of setting the bar too high for the investigation of such children by ileo-colonoscopy, with the attendant risk of missing symptomatic, treatable inflammation.
Since the relevant MMR/autism children are considered to be those with regression and significant gastrointestinal symptoms, the appropriate stratification for between-group analyses of measles virus antibody levels has not been conducted; therefore the paper is difficult to interpret, adding little if anything to the issue of causation. Moreover, it is a major error to have presumed that peripheral blood mononuclear cells are a valid ‘proxy’ for gut mucosal lymphoid tissues when searching for persistent viral genetic material.
A further major problem in this study is the number of children who dropped out or who were unable to provide adequate blood samples. We know nothing about either the 735 children who were lost at stage two, or the 100 children for whom blood samples were not available. At the very least, we should be told whether the children who dropped out were likely to be representative of those who stayed in, with regard to the key issues of interest.
For reasons that will emerge in the near future, it would be of interest to know whether siblings of autistic children were included in either of the two control groups. This information is not provided.
As a general observation, this paper contributes nothing to the issue of causation, one way or another. Case definition alone is likely to have obscured the relevant group of autistic children. The study tells us nothing about what actually happened to the children at the time of exposure. We are increasingly persuaded that measuring things in blood many years down the line tells us very little about the initiating events in what is, in effect, a static (non-progressive) encephalopathy unlike, for example, subacute sclerosing panencephalitis, which is a progressive measles encephalopathy. The gut is a different matter, and analysis of mucosal tissues has been very informative, since here, in the relevant children, active ongoing, possibly progressive [AV1]4, inflammation has been identified.
As I have repeatedly said, I have no idea whether Wakefield is correct or not in his concerns about the possible adverse effects of the MMR vaccine on a small sub-set of vaccinated children. Nor do I know whether any of the charges being levelled against him at the GMC has any legs. But I do believe — as I wrote in my series of articles on the subject for the Daily Mail in 2003 here, here and here — that many of the statements made by the Department of Health and medical establishment about the ‘proof’ of the vaccine’s unchallengeable safety are deeply misleading. And I also believe, having spoken to many parents of such children, that their experiences simply cannot be dismissed as they have been by the medical establishment. No-one has ever suggested that the MMR vaccine causes all or most of the incidence of autism. If Wakefield is correct, it is only a small proportion of children whose immune systems may be unable to cope, for whatever reason, which makes them particularly vulnerable to such ill-effects. And contrary to the message being pumped out by the medical establishment that the vaccine has been proved to be safe — by studies which are all either flawed, inadequate or irrelevant — the fairest and most accurate thing to say is that the jury is still out.
One of the most reprehensible weapons being wielded in the witch-hunt against Wakefield is the claim that anyone who gives any credence whatever to his concerns is responsible for the incidence of measles amongst children whose parents are as a result too frightened to give them the MMR vaccination. There are two obvious points to make in response to this piece of moral blackmail: 1) the whole panic could have been avoided by offering single measles, mumps and rubella jabs rather than the triple MMR, and 2) it is surely just as important as avoiding cases of measles mumps and rubella to avoid causing the kind of catastrophic damage to the brain and gut displayed by the children at the heart of this controversy.
Another letter to the Archive of Diseases in Childhood from John Stone, the parent of an autistic child, makes terrifying and distressing reading:
In this regard it is worth noting the recent warning of the National Autistic Society (NAS):‘The National Autistic Society is keenly aware of the concerns of parents surrounding suggested links between autism and the MMR vaccine. The charity is concerned that the GMC hearing, and surrounding media coverage, will create further confusion and make it even more difficult for parents to access appropriate medical advice for their children. It is particularly important that this case is not allowed to increase the lack of sympathy that some parents of children with autism have encountered from health professionals, particularly on suspected gut and bowel problems. Parents have reported to the NAS that in some cases their concerns have been dismissed as hysteria following previous publicity around the MMR vaccine. It is crucial that health professionals listen to parents' concerns and respect their views as the experts on their individual children…’
The NAS warning relates to the GMC hearing involving doctors Wakefield, Walker-Smith and Murch which is set to resume on 25 March approaching. I do not think it is being unduly cynical to query the publication of this study at the present time as a media event, bearing in mind that it seems to have been carried out five or six years ago. Moreover, the study has once again been promoted as refuting the Wakefield hypothesis when it in fact tests for a possibility that had not been proposed. Meanwhile, the plight of autistic children with gastro- intestinal symptoms is excluded both from the study and public attention, as if they did not exist. The NAS statement warned of ‘creating further confusion’ and this is precisely what this study and its media exposure has done.
NB: This is a corrected version of my earlier post in
which I said that the Great Ormond Street study was a rehash of
the Baird study. I had been told that these studies were
connected, but my source -- who could not be contacted over the
holiday weekend --now accepts that he was mistaken. My apologies
for the error, and thanks to the readers below who drew my
attention to it.
field
March 21st, 2008 3:37amChris Brehm
March 21st, 2008 8:26amNatasa Blagojevic
March 21st, 2008 9:12amedward
March 21st, 2008 9:48amThe motivations of the BMA may be negative, but I think I would rather believe the BMA that the media, which tend to love a good story. This is a field of expertise in which even the most distinguished journalists may lack the necessary evaluative skills.
edward
March 21st, 2008 9:50amThe motivations of the BMA may be negative, but I think I would rather believe the BMA that the media, which tend to love a good story. This is a field of expertise in which even the most distinguished journalists may lack the necessary evaluative skills.
ross
March 21st, 2008 1:26pmAdrian Camp
March 21st, 2008 1:34pmJean Muscroft
March 21st, 2008 1:50pmStephanie Grabiec
March 21st, 2008 2:33pmplh
March 21st, 2008 3:28pmGeorge Wade
March 21st, 2008 3:59pmWith all our faults -- it is refreshing to think that I can get at least something of the kind of health care I wish for just by reading, listening and doing it. More by paying for it. People around me don't criticise me, too much, for being different: they watch and judge by results.
The present results of that attitude are that thousands of children are being recovered from autisms by behavioural therapies; thousands more by whatever diet, with supplements, works for the individual child. More solid recoveries are based on combining the therapies; then adding in clinical nutrition and even prescription drugs as necessary.
Google DAN! or Autism Research Institute to see how solid Melanie Phillips' article is. Autisms recovery research is now 40 years old in San Diego; starting with Bernie Rimland, one psychiatrist who would not give up on his own autistic son.
Ann
March 21st, 2008 4:02pmDBCJohn
March 21st, 2008 4:04pmRichard
March 21st, 2008 4:04pmJohn Stone
March 21st, 2008 4:05pmRich Scopie
March 21st, 2008 4:06pmJohn Stone
March 21st, 2008 4:28pmSusan Hamlyn
March 21st, 2008 5:31pmMark H
March 21st, 2008 5:35pmLarissa
March 21st, 2008 6:18pmRich Scopie
March 21st, 2008 7:10pmJohn Stone
March 21st, 2008 8:03pmAnn
March 21st, 2008 8:30pmSandy Gottstein
March 21st, 2008 9:44pmElizabeth
March 21st, 2008 11:43pmRaymond Gallup
March 21st, 2008 11:50pmfield
March 22nd, 2008 2:06amNatasa Blagojevic
March 22nd, 2008 9:38amDavid
March 22nd, 2008 11:29amNatasa Blagojevic
March 22nd, 2008 1:36pmdrained
March 22nd, 2008 1:51pmJohn Stone
March 22nd, 2008 10:34pmslippinaway
March 23rd, 2008 12:05amClifford G. Miller
March 23rd, 2008 4:01amGrasshopper
March 23rd, 2008 12:22pmfield
March 23rd, 2008 2:06pmmike stanton
March 23rd, 2008 2:14pmNura Aabe
March 23rd, 2008 8:27pmdrained
March 24th, 2008 9:32amCybertiger
March 24th, 2008 9:49amfield
March 24th, 2008 12:34pmSergey
March 25th, 2008 7:48pmMeasles lethality drastically plummeted in last few decades, from several procents to one case in thousand infected. Most of it was due to concurrent bacterial infection pneumonia, which now effectively treated by antibiotics; these 1/1000 deaths are also caused not by virus itself, but autoimmune reaction on this virus targeting brain tissue. But there are sound reasons to fear that attenuated vaccine virus can induce analogic reactions. Many parents reported onset of autism symptoms immediately (several hours after) vaccination. Too early for viremia, but timing is exact for autoimmune reaction.
Michele
March 25th, 2008 8:46pmJohn Thurston
March 25th, 2008 10:26pmDavid
March 26th, 2008 9:33amNatasa
March 26th, 2008 11:47amMargaret Collins
March 26th, 2008 9:27pmMy son also reacted badly to the DTP vaccine, of which he received the first dose when his corrected age was only two weeks (and the NHS wanted to vaccinate him even sooner). He had a severe local reaction (massive swelling of the leg with induration) and the GP was called out and witnessed this. Because I was worried, the second dose was delayed and I went back to the GP, saying that I was concerned about the reaction. I was told not to worry, it meant nothing and probably wouldn’t happen again. So my child had a second dose. (He shouldn’t have had this: the Department of Health’s Green Book, issued to every GP’s surgery in the country, stated that if a severe local reaction to the DTP occurred no more doses of the whole cell vaccine should be given.) This time he had a severe general reaction: very high fever and screaming. Neither of these adverse reactions was reported under the Yellow Card scheme, and I am sure that you know that the vast majority of adverse reactions are never reported.
He stopped smiling, his development stalled, went into reverse and at nine months of age he was diagnosed with Infantile Spasms. In retrospect I realise he had a neurological illness for some time months before the fits became obvious. When I raised the possibility that the Infantile Spasms were connected with the adverse reaction to the pertussis element of the DTP the Neurologist said that a large scale study had been carried out some years ago and it was certain that the vaccine did not cause Infantile Spasms.
In fact, the study didn’t say the DTP was safe and it was flawed in its design. However, over the years the Department of Health managed to persuade everyone through its propaganda machine that the vaccine was safe. Only comparatively recently was a possible mechanism by which the whole cell pertussis toxin could cause encephalopathy identified by researchers in Ireland. Another (British) study monitored reactions to the DTP when given to infants born prematurely and discovered severe apnoeic episodes in these infants following the administration of the DTP. They recommended that babies in this group be given the vaccine in hospital and be monitored closely for adverse events.
Dr Bill Inman, who set up the Yellow Card scheme in this country, was very closely involved in all or most of the committees set up to look into the safety of the pertussis vaccine. He wrote about the whooping cough vaccine in his book Don't Tell the Patient: Behind the Drug Safety Net ( ISBN-10: 0967581206). The career of the previously respected doctor who had first raised the question of the safety of the whole cell pertussis vaccine, Gordon Stewart, was badly damaged. Dr Inman independently calculated that 1:30,000 children given the vaccine suffered permanent neurological damage. He says that a colleague of his, following a separate route, later came up with the same figure. Yet officially the whole cell vaccine was “safe” – it is many years since any payout has been made for damage caused by the pertussis vaccine. The route of court action was also closed off.
Since the mechanism by which the vaccine worked was (still is) so poorly understood and since many forms of learning disability and other problems cannot be detected in a young baby it is impossible to prove that the vaccine is the cause of these in a particular case.
My son has autism and severe learning difficulties. I don’t know why. I suspect the involvement of the DTP in his Infantile Spasms; many other parents whose children have had Infantile Spasms have suspected the same. I do know that the Department of Health interpreted and spun the results of a study concerning the whooping cough vaccine until there was widespread acceptance in the medical profession that the vaccine was completely safe. The study didn’t prove this. There are parallels with the way the Department of Health MMR has selectively used the results of studies to claim that the MMR is proven to be safe.