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Notes:  First, it is important to know the vaccination status of those with and without autism.  Perhaps a better comparison would have been between those who were vaccinated and those who were not, comparing their autism incidence.  Second, it is interesting how easily the studies which show a relationship between vaccination and autism are dismissed (with a virtual wave of a wand), while those studies which allege to disprove any connection are always accepted. - SM

http://bmj.com/cgi/content/full/325/7361/0/i

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BMJ 2002;325 ( 24 August )

Editor's choice

How to avoid criticism

Rarely a month goes by in the developed world without a claim or counterclaim about autism and the role of MMR vaccine. Last week, from America, came reports of an MMR antibody in children with autism but not in controls (17 August, p 354. This week we weigh in with another study using the UK General Practice Research Database.

Corri Black and colleagues have used the database to see if there is a relation between childhood autism and gastrointestinal disorders (a variant of autism characterised by bowel problems has been linked to MMR vaccine). They find no such relation: 9% of 96 children with autism and 9% of matched controls had a history of gastrointestinal disorders before the diagnosis of autism (p 419).

Yet, as Robert Wolfe and Lisa Sharp warn on p 430, we shouldn't expect such evidence to have much impact on the beliefs of those opposed to vaccination. Their historical survey shows that there has been an anti-vaccination movement since the 19th century, when Britain passed a series of vaccination acts making vaccination compulsory. The laws were followed by rioting in Ipswich and Henley, the publication of tracts and journals, a demonstration of 100 000 people in Leicester, and the setting up of a royal commission. Similar reactions occurred in many other countries. Wolfe and Sharp maintain that the arguments of the anti-vaccinationists in the 19th and 21st centuries are very similar, "suggesting an unbroken transmission of core beliefs and attitudes over time." Their advice to medical authorities is to tread a fine line between passivity, which could endanger public health, and heavy handedness, which can threaten values of individual liberty. "This creative tension will not leave us and cannot be cured by force alone."

Another Education and Debate article reminds us that public policy can often be built on mythswhat Steven Cummins and Sally Macintyre call "factoids." Most readers of journal articles are familiar with the much cited reference that actually doesn't say what it is always quoted as saying. Cummins and Macintyre track down the references behind the belief that poor areas have become "food deserts" where people cannot get healthy food at reasonable prices. A bill is going through the British parliament to tackle such food poverty. Yet this new public policy is based on the false premise that research shows that healthy food costs more in deprived areas than it does in affluent ones: the research shows no such thing.

The recollection of the research in this case is clearly just wrongdistorted because people read the message they want to read. In other cases interpretation is governed by how results are presented. For example, several correspondents take us and the authors of a trial on ramipril in stroke to task for presenting results in "a way that exaggerates the findings" (p 439). They urge us to follow our own advice and report numbers needed to treat. That way, says P Badrinath, we'll help readers and "avoid criticisms of the authors, reviewers, and editors."

Footnotes

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© BMJ 2002
 

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Rapid Responses:

Read all Rapid Responses

'improving", not "opposing", vaccinations

Larrie D Ferreiro

bmj.com, 23 Aug 2002 [Full text]

Related letters in BMJ:

Preventing stroke with ramipril

P Badrinath, Andrew P Wakeman, Jacqueline G Wakeman, John S Yudkin, Malvinder S Parmar, and Birte Twisselmann
BMJ 2002 325: 439. [Letter]

 

Other related articles in BMJ:

PRIMARY CARE
Relation of childhood gastrointestinal disorders to autism: nested case-control study using data from the UK General Practice Research Database.

Corri Black, James A Kaye, and Hershel Jick
BMJ 2002 325: 419-421. [Abstract] [Full text]  

 

EDUCATION AND DEBATE
Anti-vaccinationists past and present.

Robert M Wolfe and Lisa K Sharp
BMJ 2002 325: 430-432. [Full text] [extra: Boxes]  

 

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