Vaccinations Part 1 -MMR

I've been having a bit of a discussion with Henry over at his place about vaccinations. Basically he is of the somewhat fringe, Vaccines-are-filled-with-poison-and-cause-autism frame of mind, and I'm a bit more of a shill for big Pharma and the State. I'm still waiting for that cheque, Glaxo, if you're reading.
So, rather than run 20-odd comments in his posts, I thought I'd fire out my 2.5 cents on why vaccines are both safe and necessary, and why this scaremongering is dangerous and unwarranted.

First off, lets talk about MMR.
I've mentioned Andrew Wakefield before (bits of which I've stuck into this post), but you can't talk about MMR without mentioning him, as he is pretty much the only cause of the scare.

He published an article in The Lancet in 1998 detailing how he had performed biopsies via colonoscopy on 12 kids who had intestinal problems and developmental issues. 10 of the children were autistic and he had found a pattern amongst them of intestinal inflammation. Now the Parents of 8 of these kids thought they had developed symptoms of autism right after they had the MMR jab.
The paper he then published stated clearly:

We did not prove an association between measles, mumps and rubella vaccine and the syndrome described . Virological studies are underway an may help resolve the issue.

He then went ahead and told a press conference to say the MMR vaccine probably caused autism anyway. He also recommended switching to the single vaccinations, even though these were not available at the time. The response from the likes of the Mail was predictable and devastating i.e. "Ban Three-In-One Jabs say Doctors".
Compliance with the MMR schedule dropped from 92% in the UK down to 85%, and measles cases soared from only 58 cases in 1998 to 1,348 cases in 2008. Which is just over a 2000% increase. Of those 1348, two kids died.
In one hospital in Ireland, 100 children were admitted for pneumonia and brain swelling caused by measles and of those, three died.

In 1994, measles had been declared under control; in 2008 it was endemic again.

Wakefield’s data was later utterly debunked as incorrect and fabricated, but even if it had been right, it wouldn’t have been good science.
To show that intestinal inflammation is linked to autism, you would have to compare the rate in autistic children to the rate in non-autistic children. Wakefield used no controls to demonstrate this.
To implicate the MMR vaccine, you would have to show that the rate of autism was greater in children who got the vaccine and verify that autism developed afterwards. Wakefield made no attempt to do that.
His thinking was fanciful and full of assumptions, but short on logic and a plausible mechanism. He hypothesized that the measles virus damaged the intestinal wall, that the bowel then leaked some unidentified protein, and that protein went to the brain and somehow caused autism. Well, assuming this wasn't so much made-up bollocks, if the measles component caused this condition, it would do it in the single jab form as well, wouldn't it? As one of his critics pointed out:

“Single vaccines, spaced a year apart, clearly expose children to greater risk of infection, as well as additional distress and expense, and no evidence had been produced upon which to adopt such a policy.”

Anyway, it turns out that whilst some have given Wakefield the benefit of the doubt regarding whether he was incompetent or knowingly fraudulent about his 'study', Brian Deer at the Times has found out that his biased and incorrect results might of been fiddled to suit his scaremongering.

However, our investigation, confirmed by evidence presented to the General Medical Council (GMC), reveals that: In most of the 12 cases, the children’s ailments as described in The Lancet were different from their hospital and GP records. Although the research paper claimed that problems came on within days of the jab, in only one case did medical records suggest this was true, and in many of the cases medical concerns had been raised before the children were vaccinated. Hospital pathologists, looking for inflammatory bowel disease, reported in the majority of cases that the gut was normal. This was then reviewed and the Lancet paper showed them as abnormal.

The GMC also accused him of ordering invasive and potentially harmful studies (colonoscopies and lumbar punctures) without proper approval and contrary to the children’s clinical interests. One child suffered multiple bowel perforations during the colonoscopy. Several had problems with the anaesthetic. Children were subjected to sedation for other non-indicated tests like MRIs.

When human research is conducted, it must be approved by your facilities' ethics board. This study was not approved. It also turns out he bought blood samples for his research from children as young as four - who were attending his son's birthday party. To be fair, he did give them a fiver each. What a guy.

The further into his past you looked, the worse it got; 2 years before the study, Wakefield had been approached by a lawyer representing autistic children, who then specifically hired Wakefield to do research to find evidence to support a class-action lawsuit against MMR vaccine manufacturers. The children to be studied were the children of the lawyer's clients, and 11 of the 12 studied were eventually litigants. Obviously, Wakefield failed to disclose any of this.
He also failed to disclose the half-million pounds he received from the lawyer, via his Wife's company.
Also, Brian Deer discovered that Wakefield had patented his own 'alternative' MMR vaccine prior to conducting his research, and would stand to make a massive profit if he could reduce confidence enough in the existing vaccine.

After all this was revealed, his co-authors disowned the paper and the Lancet printed a retraction. Wakefield now works at an autism facility in the States and still has a large number of followers.

No subsequent research has ever been able to replicate Wakefield's supposed findings - shockingly enough. Other studies showed that the detection of measles virus was no greater in autistics; that the rate of intestinal disease was no greater in autistics; that there was no correlation between MMR and autism onset, and that there was no correlation between MMR and autism, whatsoever. Furthermore, the only developed country to give in to public concern and abandon the MMR jab -Japan- has not seen the drop in autism one would expect if MMR were to blame(although there was a subsequent epidemic of mumps).

And so the 'MMR controversy' (and it's subsequent consequences) has proven to be a product of media scaremongering, and their entirely credulous reporting of a fraudulent and badly performed scam.

Also, here's some graphs courtesy of Ben Goldacre (oh and that article is worth reading to hear an idiot radio presenter making a fool of herself talking about MMR):



Key Research and summaries courtesy of ScienceBasedMedicine.org


MMR and Autism

Honda H, Shimizu Y, Rutter M. 2005. No effect of MMR withdrawal on the incidence of autism: a total population study. Journal of Child Psychology and Psychiatry 46(6):572–79.
Summary: Population-based study of 300,000 in Yokohama, Japan looking at ASD diagnoses from 1988-1996. From 1988 to 1993 MMR vaccination rates declined, and there were no MMR vaccinations after 1993. Meanwhile, during the same period of time ASD diagnoses steadily increased. Therefore there was a significant lack of correlation between exposure to the MMR vaccine and the subsequent diagnosis of ASD.
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Hornig M, Briese T, Buie T, Bauman ML, Lauwers G, et al. (2008) Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study. PLoS ONE 3(9): e3140. doi:10.1371/journal.pone.0003140
Summary: This study replicated the original Lancet article by Andrew Wakefield that started the scare that the MMR vaccine might be associated with autism. The researchers found that there was no correlation between measles virus being found in the gut and autism, and also found no correlation between the timing of the MMR vaccine and the onset of autism or GI symptoms. (Further discussion here and here.)
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Wakefield AJ et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet, Volume 351, Issue 9103, Pages 637 – 641, 28 February 1998 doi:10.1016/S0140-6736(97)11096-0
Summary: This is the original Lancet article by Andrew Wakefield that spawned the MMR-autism scare. The study is a small analysis of 12 subjects that Wakefield claims had evidence of the measles virus in their GI tract and that this correlated with the MMR vaccine and the onset of autism. This study has subsequently been discredited on a number of levels. It turns out that Wakefield had undisclosed conflicts of interest – namely a patent application for a replacement MMR vaccine. He was also a consultant for an attorney looking to sue the manufacturers of the MMR vaccine, and in fact many of the subjects of this study were childen of clients of this attorney. The techniques used to identify measles virus in the GI tracts were later disputed and failed to replicate. Review of records also disputes the timing of the onset of symptoms and the MMR vaccine. The scandals surrounding this study eventually led to 10 of the original 12 co-authors to retract their support for the paper. (For a more detailed history and analysis see Brian Deer’s investigation.)
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