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To the parents
of the autistic children he treats, Dr Andrew Wakefield is a hero. To the
medical establishment, he is an irresponsible maverick. Wakefield is the
man responsible for prompting the nationwide fears about MMR, the measles,
mumps and rubella vaccine. As increasing numbers of anxious parents refuse
to let their children have the triple jab, outbreaks of measles are
spreading, and the government is blaming Wakefield.
He is the focus of the
increasingly polarised debate about the NHS’s refusal to provide an
alternative to MMR, which Wakefield has linked to autism and a form of
bowel disease in some children. The row has reached such proportions —
embroiling the prime minister’s son Leo — that Wakefield feels “enormous
anxiety” about whether his fears about MMR will ultimately be proved
correct or not.
“Sometimes I feel like
the person who put an axe into the Rokeby Venus in the National Gallery,”
he confessed.
At the age of 45, he
has had to walk away from his post at the Royal Free hospital, in north London,
although he insists he will continue to work on research on the hundreds of
children being treated there. Officially, his work was “no longer in line
with the department of medicine’s research strategy”.
This summer he will
uproot his family — his wife Carmel, who trained as a physician and now
works as an adviser to NHS trusts on medical negligence and risk, and their
four children aged five, seven, 11 and 13 — to live in Florida. He plans to
continue his research work there, based at a private clinic partly funded
by Visceral, a UK charity.
Wakefield, a former
surgeon and consultant gastroenterologist, says the past few years have
taken their toll. “I’ve lost my job, and my standing in the medical and
scientific community is at an all-time low. There’s no way I’m going to
work again in this country. Nobody will want to employ me.”
He added: “What keeps
me going is that I have to be able to face parents and say we did our best
and we did not walk away from this because it was uncomfortable. And these
parents at every stage so far have been shown to be right and therefore one
is enormously reassured that this is the right course to pursue.”
So, what is Wakefield’s
case against MMR? In Britain and the United States the number of children
diagnosed with autism has risen dramatically in recent years. Some of the
increase is likely to be accounted for by better awareness and increased
diagnosis rather than solely a rise in incidence. But many parents, and a
small but vocal number of researchers, believe the increase is genuine and
that vaccines including MMR are to blame.
The MMR controversy has
surfaced periodically since Wakefield and colleagues at the Royal Free
published research in 1998, the first to suggest the MMR jab could be a
possible cause of autism and a new type of bowel disease in children.
Wakefield told a press
conference launching the study — which then included only 12 children —
that as a parent he could only advocate giving separate vaccines for measles,
mumps and rubella and that the government should allow parents this choice.
What led him to such an
unequivocal position on the basis of apparently scant evidence? By the time
the paper was published, Wakefield says, they had examined about 60 children
in Britain and America all sharing the same conditions of autism and bowel
disease.
Wakefield cites three
further factors. First, he had analysed all the safety data since MMR’s
introduction and had concluded that tests were inadequate. Second, he had already
published research that he says showed that measles and mumps vaccines may
cause inflammatory bowel disease. This work had led some parents of
autistic children with bowel problems to consult him. Finally, the research
on these children “observed a novel form of inflammatory bowel disease was
occurring in children who had developed symptoms shortly after the MMR
vaccine”.
The most recent review
of evidence by the Medical Research Council concluded that epidemiological
studies failed to prove or disprove any link between MMR and autism. But
last Monday Wakefield and colleagues published their latest research.
It revealed the
presence of the measles virus in the gut of 75 of 91 autistic children with
the variant form of bowel disease. Measles was found in the gut of only 5
out of 70 healthy children tested.
The researchers
conceded that these results were not proof of a causal link between MMR,
autism and bowel disease. But they concluded: “These data confirm an
association between the presence of measles virus and gut pathology in
children with developmental disorder.”
Wakefield believes the
findings are “consistent with the hypothesis that MMR is a contributory
cause of autism and bowel disease in some children”.
When MMR was introduced
in 1988, doctors were told officially that parents who rejected it should
be allowed single vaccines for their children. Labour reversed this advice
after coming to power in 1997, decreeing that the single vaccines should
not be used by the NHS. It insisted that MMR was the best protection
against measles, a potential killer.
Wakefield describes the
government’s handling of the whole issue, and the Blairs’ refusal to say
whether or not their baby has had MMR, as a “complete shambles”.
At prime minister’s
questions in the Commons last week Tony Blair, while still refusing to
state whether or not Leo had had the jab, insisted the vaccine was safe.
Next day a rattled Sir
Liam Donaldson, the chief medical officer, suggested that he and other
vaccine advisers at the Department of Health would have to resign if
ministers caved in and made the single vaccines available on the NHS for
those parents who wanted them. This would be like playing Russian roulette
with children’s lives, he said.
Wakefield claims the
vaccine advisers are blinkered. “I think the problem comes because the
politicians are driven by the mandarins at the Department of Health who
have an almost evangelical belief in the rightness of their course of
action. And the danger with that is that, because it’s a complex issue, the
politicians rely very much on the information they get and decisions are
taken according to that information. The problem is that it is not
objective.”
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