Wakefield, vaccines and ME

Earlier today, Dr Andrew Wakefield, who published a study in the Lancet, a major British medical journal suggesting that the triple vaccine against measles, mumps and rubella (MMR) might be a cause of autism, was struck off the British medical register by the General Medical Council, which found him guilty of serious professional misconduct. The same happened to another of his colleagues, Prof John Walker-Smith, who is 73 and retired; another colleague, Prof Simon Murch, was found not guilty of serious professional misconduct “despite there not being ethical approval for the research” according to the BBC report.

Wakefield, who now lives in the USA, was interviewed on the BBC Radio 4 news programme Today this morning, and an hour later Dr Mike Fitzpatrick, a London GP who published a book called “MMR and Austism: what parents need to know”, which encouraged parents to give their children the vaccine, was interviewed. If you’re in the UK, you can listen to the interview here (Wakefield is just after 1hr 30min, Fitzpatrick just after 2hr 30m). Ben Goldacre (the Guardian’s Bad Science columnist) called the interview with Wakefield “staggeringly weak”, and said that Wakefield “is a bad man and shares half the blame” for the scare and for the fall in measles vaccinations; he blames the media for the other half (he explains this in detail in his book, Bad Science, in which he wrote that the media have a tendency not to report studies with negative findings as they don’t have the news value that scare-inducing positive studies do).

It’s worth pointing out how nasty what Wakefield did was. There is an article in today’s Times by Brian Deer, the investigative journalist who broke the story. The mother of one of the children in Wakefield’s study, identified as Child 2, said that her son’s symptoms were different to those described in the study, and when Deer put this to Walker-Smith, the latter refused to comment. Deer also quoted the father of “Child 11” as emailing him: “Please let me know if Andrew W has his doctor’s licence revoked … His misrepresentation of my son in his research paper is inexcusable. His motives for this, I may never know.” Among Wakefield’s methods:

His research on the children was found to be “dishonest” and “unethical”. In pursuit of his patented theory that the vaccine caused bowel disease, for instance, he had had tubes inserted into their guts and needles into their spines — both risky medical procedures that they did not need.

There is an awful lot of quackery surrounding autism, and a lot of cruelty in fringe treatment of the condition. There is one treatment which involves giving an autistic child an anti-androgen drug called lupron, normally given as a slow-release “depot” into a muscle every three months (one of those involved in this is not even a doctor, but merely the son of a doctor with a bachelor’s degree in biology). More recently, those behind this treatment have started advocating giving the child one small injection of that drug per day (imagine what that’s like for any child, let alone an autistic one with unusual sensitivities who might not know what’s really going on around him). While there are parents who say that the treatment has had positive effects, scientists say that their treatment has no scientific basis and they have claimed supporters such as Simon Baron-Cohen who are in fact opposed to their protocol.

However, Wakefield made a valid point in his interview, namely that the government took part of the blame for the upsurge in measles by withdrawing authorisation for the single measles vaccine. My generation got the single measles vaccine (although I think I got measles) and the girls got the rubella jab just before puberty, so as to stop them getting it while pregnant. Nobody got vaccinated against mumps. The scare may have been Wakefield’s and his colleagues’ fault, but the parents who didn’t take up the MMR did so because they cared for their children, because many of them had had measles and didn’t remember it as being a particularly serious illness (although it actually can disable and kill) and it didn’t leave them autistic. Not only did they not want their children harmed, they certainly did not want to have them harmed, which is what it would have been if they had been harmed as a result of a vaccine they had let them have.

The parents who refused the vaccine were portrayed in some sections of the media as over-educated white middle-class fools, and it was seen as a great irony that measles was on the way up in the more affluent parts of the UK and USA, while the less wealthy believed what the establishment told them and so their children were safe. The problem is that the medical establishment has got things wrong before, sometimes catastrophically so, as with ME in which patients were run into the ground because of inappropriate advice to exercise (or being forced to do so), sometimes ending up bedridden, quadriplegic or both, and with severe pain and cognitive dysfunction among numerous other symptoms. This was partly due to ignorance about an illness which had in fact been known about for decades and partly because some elements actively denied it existed as a physical illness (one of those involved has a history of “psychologising” physical illnesses, including the effects of the Camelford water poisoning incident).

But vaccine worries are not just confined to these big media incidents. A couple of weeks ago, one of my Facebook friends (who has ME) asked why, if the BCG, flu and Hep B vaccines were triggers for ME, the government were still advertising them? The answer is that BCG is one of the safest vaccines around and although Lynn Gilderdale fell ill after getting her BCG and vaccinations (and other injections) have been known to provoke relapses in people with ME (as pointed out by two ME sufferers during the Facebook discussion), that does not mean a vaccination can in fact cause it — even Kay Gilderdale pointed out, in her interview on Radio 2 two weeks ago, that it was in fact her daughter’s immune system that let her down. If dozens of people had developed ME, or any other serious illness, as a result of the BCG or any other vaccine, there would surely have been some sort of investigation; as it happens, as far as is known only one did, even among those who received the same “batch”, while without it, thousands of people might have died or suffered prolonged illness from TB.

It is not a case of some people getting ill from the vaccine being “a price worth paying” for avoiding epidemics — you could not say that about a known risk of any number of people ending up like Lynn Gilderdale — but if the risk involved happens to be ME, then a viral illness such as mumps can actually trigger that condition, so foregoing vaccines where there is no known risk is not worth the gamble. It should be remembered that, before vaccines were developed, people died in large numbers from illnesses like measles, diphtheria and TB and were left dead or paralysed for life by polio (some, for example, requiring iron lungs or ventilators).

I am more sympathetic when it comes to vaccines such as the new Gardasil and Cervarix, which offer partial protection against some of the viruses that cause cervical cancers; they do not eliminate the risk anything like totally and have been linked to a number of seriously debilitating and painful side effects in some of the girls who have received them. I would be hesitant to allow any daughter of mine to receive them, because the risks quite possibly outweigh the benefits either to them or to society generally. This is not the case with vaccines against measles, polio, TB or similar illnesses which are contagious and which could kill large numbers of people. It is, however, not only ordinary people’s but the government’s responsibility to protect the public from such epidemics, and if people will not take up a newly introduced vaccine because of perceived risk, they must offer the next best thing until the issue is resolved.

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