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February 6, 2002        News Morgue Search  www.feat.org/search/news.asp

COMMENTARIES

·        US Media’s Reaction to Wakefield Study: News Blankout Almost Total

·        From Molecular Pathology, Journal that Published Wakefield’s New Paper

RESEARCH

·        Study Links Measles Virus To New Form Of Bowel Disease

·        MMR-Type Vaccine For Cattle Withdrawn After Test Fears 15 Years Ago

PUBLIC HEALTH

·        Most Doctors Who Set Guidelines Have Industry Ties

COMMENTARY

US Media Reaction to Wakefield Study: News Blankout Almost Total

Going into the third day since medical researcher Andrew Wakefield dropped a news concussion bomb with the publishing of his latest findings of measles virus in 83% of autistic children, there has been virtually a news black out in the US.  With a singular expectation, there has been no news in the press about the latest development of an issue in the UK that has drawn in the government, the Prime Minister, his infant son, and at least 2000 families with late onset autism, the hyperbolic British press and the national health maintenance system into a raging public Health debate.

The single report that we were able to find outside Europe and the rest of the world, is a Reuter’s piece directed to professionals and not consumers.  The article leaves autism out of the copy nearly altogether.  The article, with its curious spin is provided here below for the reader’s aghast.

Also included below is a commentary from the medical science journal where Wakefield has published his new research, which urges the public not to hysterically leap to conclusions and read too much into this latest information.  The message is that Wakefield’s work does not, they repeat, does not prove that MMR vaccines cause autism, a point Wakefield did not even attempt to make in this research, however.

“It doesn’t prove causation” agrees Barbara Loe Fisher of the National Vaccine Information Center, “but it does go a long way to show an association.”  In other word, we arguably have a smoking gun.

The defenders can continue to argue that there is no solid proof of a connection between vaccines and autism.  However, there is enough evidence for a serious hypothesis.  Given this latest addition to the puzzle of autism’s etiology, it is now time for our public health officials to finally shift their focus from spending the public’s money on research designed only to defend vaccines, to research designed to get at the at the cause of autism.

The time is over for increasingly silly dismissals of the autism epidemic.  The time is over to utterly ignore the eyewitness experiences of hundreds to thousands of parents who have seen the children slip away only after the injections.  The time is over for simply insisting that there is no proof of a connection between certain vaccines and autism.  This is not enough, for there is indeed plenty of evidence to suggest there might be.  For public health officials to remain complacent in the face of this growing evidence is simply not acceptable.

If our hypothesis about the causes of autism prove to be wrong as the defenders insist, for us it will be back to the drawing board, for we cannot join them in their complacency.  But if they prove to be wrong one cannot imagine the consequences.  For after we find the cause, treatment and cure for autism, there will be some matters of justice that wait.

* * *

Study Links Measles Virus To New Form Of Bowel Disease

[This above is the supplied headline from Reuters Health and not ours.] http://www.reutershealth.com/cgi-bin/frame2?top=/tops/med.html&left=/medl.ht ml&right=/archive/2002/02/05/professional/links/20020205clin009.html <- - article ends here.

London - Britain’s Department of Health said on Tuesday that a new study showing that the measles virus is present in children with a new variant inflammatory bowel disease does not mean that the disease is linked to the measles, mumps and rubella (MMR) vaccine.

As controversy over the safety of MMR continues to rage in the UK, a Ministry spokeswoman told Reuters Health: “We will consider this research as we always do. But it does not show a link with MMR vaccine.”

The latest research was posted in full on the Internet at http://www.molpath.com after some findings were broadcast during a BBC television investigation of MMR on Sunday. The study will be published in the April issue of Molecular Pathology.

The authors include Andrew J. Wakefield, whose work at London’s Royal Free Hospital in 1998 first raised fears that MMR vaccination may trigger bowel disorders and autism in susceptible children.

The study was set up to investigate the presence of persistent measles virus in children with ileocolonic lymphonodular hyperplasia, which has been described in a cohort of children with developmental disorder.

The results showed that 75 of 91 patients with a confirmed diagnosis of ileocolonic lymphonodular hyperplasia and enterocolitis were positive for measles virus in their intestinal tissue compared with only 5 of 70 control patients.

“The data confirm an association between the presence of measles virus and gut pathology in children with developmental disorder,” Professor John J. O’Leary of Coombe Women’s Hospital in Dublin and associates conclude. The authors suggest that the virus may act as an immunological trigger.

In a statement, Prof. O’Leary stressed that the research did not set out to investigate the role of MMR in the development of either bowel disease or developmental disorder, and “no conclusions about such a role could, or should be, drawn from our findings.”

An accompanying editorial also advises against jumping to any hasty conclusions about MMR.

“We are all aware of the public unease about a potential link between vaccination with the triple vaccine MMR...and autism or bowel inflammatory conditions, with some hundreds of parents of afflicted children undertaking legal action against the manufacturers,” Drs. A. Morris and D. Aldulaimi of the University of Warwick write.

But they add that it would be “entirely wrong” to jump to the conclusion that the measles component of MMR causes the colitis or development disorder. “Most if not all diseases are multifactorial in nature, and the data here could equally be interpreted as indicating that the colitis or developmental disorder ‘cause’ the persistence of the measles.”

The editors of Molecular Pathology, Professor John Crocker and Dr.  David Burnett, said that the research was an important piece of work that draws conclusions entirely consistent with the data, but that any link with MMR is not justified.

J Clin Pathol: Mol Pathol 2002:55;0-6.

Copyright © 2002 Reuters Limited.

[The executive editor for Reuters Consumer Health is Theresa Tamkins tamkins@reutershealth.com in the event you may want to comment to her on Reuters thoughtful attempt to keep this information shielded from us.

* * *

COMMENTARY

From Molecular Pathology, Journal which Published Wakefield’s New Paper

[By A Morris and D Aldulairni.]

http://jcp.bmjjournals.com/cgi/data/55/1/DC1/2

We are all aware of the public unease about a potential link between vaccination with the triple vaccine MMR (mumps, measles, and rubella) and autism or bowel inflammatory conditions, with some hundreds of parents of afflicted children undertaking legal action against the manufacturers.

There is no space to go into detail of the controversy over the link

here (search the web using keywords “measles, MMR, vaccination, autism”)Ð

suffice it to say that reliable epidemiologists are content that there is no

significant association between MMR and either autism or bowel inflammatory

conditions. However, epidemiology is a pretty blunt tool and the studies

done do not rule out the possibility that there may be “at risk” groups

where a real link between MMR and autism/ bowel inflammatory conditions

exists

In 1998, Wakefield and colleagues reported colitis and ileal lymphoid

nodular hyperplasia in children with developmental disorders such as autism,

and suggested a possible link between MMR vaccination and a chronic

enterocolitis associated with neuropsychiatric dysfunction in these

children. 1

In 2000, a further study by the same group supported the association of developmental disorders with a distinct form of inflammatory bowel diseaseÐ new variant inflammatory bowel disease. 2 In this present paper, 3 the authors report the association of this condition with the persistence of at least fragments of the measles virus genome within the follicular dendritic cells and lymphocytes of areas of lymphoid nodular hyperplasia.

The technique used (reverse transcriptase polymerase chain reaction) could not indicate whether whole virus was present, or whether it was replicating, but for the moment we can go along with the notion that the virus is persisting in some form in these patients. The interpretation of this finding is difficult. It would be entirely wrong to jump to the conclusion that the measles component of MMR “causes” the colitis or the developmental disorder in these particular (or any other) children.

Causation is rarely simple and never pure: most if not all diseases are multifactorial in nature, and the data here could equally well be interpreted as indicating that the colitis or the developmental disorder “cause” the persistence of the measles.

The measles virus persistence could reflect the inability of patients with a developmental disorder to clear the virus. The enterocolitis may cause failure of viral clearance. And in no way can the data presented here be used to support the generalisation that MMR causes all autism and/ or inflammatory diseases of the bowel.

There is evidence that developmental disorders are associated with a functional disturbance of the brain± gut axis. Neurogenerative disorders such as Parkinson’s disease and functional bowel diseases, such as the irritable bowel syndrome, are associated with abdominal pain, bloating, and diarrhoea.

Functional magnetic imaging has demonstrated striking differences in

cortical activation following colonic distension in patients with irritable

bowel syndrome compared with normal controls, suggesting that a disturbance

in perception in the absence of obvious pathological changes may lead to

abdominal pain, bloating, and diarrhoea. Thus, the symptoms present in the

patients with developmental disorders may result from pathological

modulation of the functional interface between the immune and sensory motor

systems of the gut. Hence, disturbance of the brain± gut axis might lead to

alterations in local neurotransmitters and mediators of inflammationÐ and so

failure to clear virus infections efficiently

“There is evidence that developmental disorders are associated with a

functional disturbance of the brain± gut axis” The data presented here are

unquestionably interesting but beg a string of further questions: Is

replicating whole virus present? Is it identical to the vaccine strain? Are

other virusesÐ mumps or rubellaÐ present? What about the nature of immunity

to measles and other pathogens in these children? These questions come

immediately to mind. Doubtless the present (and other) authors are pursuing

these (and many other) questions: we look forward to answers

J Clin Pathol: Mol Pathol 2002; 55: 0

.....................

Authors’ affiliations A Morris, Department of Biological Sciences,

University of Warwick, Coventry CV4 7AL, UK D Aldulaimi, Department of

Biological Sciences, University of Warwick, UK Correspondence to: Dr A

Morris, Department of Biological Sciences, University of Warwick, Coventry

CV4 7AL, UK; amorris@ bio. warwick. ac. uk

REFERENCES

1 Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children . Lancet 1998; 351: 637± 41.

2 Wakefield AJ, Anthony A, Murch SH, et al. Enterocolitis in children with developmental disorders. Am J Gastroenterol 2000; 95: 2285± 95.

3 Uhlmann V, Martin CM, Sheils O, et al. Potential viral pathogenic

mechanism for new variant inflammatory bowel disease. J Clin Pathol Mol

Pathol 2002; 55: XX± XX

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* * *

MMR-Type Vaccine For Cattle Withdrawn After Test Fears 15 Years Ago

[Exclusive By Sarah-Kate Templeton.]

http://www.sundayherald.com/22053

A combined vaccine similar to the controversial MMR jab was withdrawn from use on cattle because it did not work properly, a leading Scottish vaccine expert has revealed.

As a cluster of measles cases were reported in an area where parents are boycotting MMR due to suspected links with autism and bowel disorders, Dr John March of the government-funded Moredun Research Institute, warned that vaccines for cattle are tested more thoroughly than jabs for children.

March believes the measles vaccine weakens the immune system and that this can be problematic when it is given at the same time as other live vaccines, such as mumps and rubella.

He said it is not known, as yet, whether the MMR vaccine causes autism—as some experts have claimed—but he believes there is the “potential for problems”.

“Immuno-suppression can easily be detected and monitored in an individual animal. With current human vaccine trials this would never be observed,” he said.

Evidence of a problem with the cattle vaccine has been available for 15 years, but March said the comparison between the cattle and human vaccine has not been made until now as veterinary scientists and medics were working in isolation.

A paper published in the scientific journal Veterinary Record in 1987, the year before the MMR was licensed in this country, showed that when cows were given a combined cattle measles and pneumonia vaccine the measles part interfered with the pneumonia component and weakened the immune system.

In his work on animals, March and his colleagues study immune responses to vaccines over months and years, taking blood samples at regular intervals to measure whether the immune system is suppressed or modified and for how long.

March pointed out that in humans, however, blood samples are taken only on a single occasion, and the results from different children are pooled to give an average. He said the available data is therefore extremely limited and the chances of picking up individual reactions small.

“Perhaps only one in 200 children may not be able to handle three live viruses and these are the ones who become autistic. It is more likely to happen with three simultaneous live infections. We simply do not know as we have never done these studies.

“If we look at a similar situation in animals then yes, the measles vaccine did interfere with the other component. It did affect the immune response. Although there is this potential in humans, they say it is not going to happen so they are not going to investigate.”

* * *

Most Doctors Who Set Guidelines Have Industry Ties

[By Jacqueline Stenson in Reuters Health.]

http://www.reutershealth.com/cgi-bin/frame2?top=/tops/med.html&left=/medl.ht

ml&right=/archive/2002/02/05/professional/links/20020205clin009.html

The vast majority of doctors involved in establishing national guidelines on disease treatment have financial ties to the pharmaceutical industry that could potentially sway their recommendations and inappropriately influence thousands of other physicians, a new study concludes.

Eighty-seven percent of guideline authors had some type of relationship with drug companies, yet these often were not disclosed, according to survey responses from 100 authors of guidelines published from 1991 to 1999 for common diseases such as diabetes, high blood pressure and asthma.

More specifically, 38% of respondents said they had served as employees or consultants for pharmaceutical companies and 58% had received financial support for medical research. In addition, 59% had links with drug companies whose medications were considered in the particular guidelines they authored, according to the report in the February 6^th issue of The Journal of the American Medical Association.

“The findings show that people who work on committees who write practice guidelines have lots of financial relationships with companies whose products they’re assessing,” study author Dr. Allan Detsky, physician-in-chief at Mount Sinai Hospital in Toronto, told Reuters Health.

And these figures may underestimate the problem, the researchers said, because only 52% of the authors contacted for the survey responded. Some may have declined to participate because they did not want to disclose their industry relationships, the report indicates. Though the investigators did not name names, the survey did not explicitly guarantee anonymity.

While industry ties don’t necessarily mean that a doctor can’t provide an objective opinion, “it’s a potential problem,” Detsky said.

In the study, the researchers did not actually search for concrete examples in which industry ties translated into improper treatment recommendations. But when respondents were asked whether relationships with drug companies influenced guideline recommendations, 19% said they thought their co-authors’ recommendations were swayed by their relationships and 7% said they thought their own relationships influenced recommendations.

Detsky pointed out that industry relationships are often an essential part of doing business for doctors. Many of the nation’s top medical researchers at prestigious academic institutions—the same ones sought for guideline authorship—have industry relationships because it is the pharmaceutical companies who finance most of the nation’s drug research.  Detsky himself has received honoraria for speeches, consulting fees and research grant money from drug companies.

So how much industry involvement should disqualify a doctor from participation in clinical guidelines? “That’s the $64,000 question,” Detsky said. “Any cut point would be considered arbitrary with the possible exception of zero involvement.”

The researchers specifically recommended the disqualification of authors who own equity in a company whose products are being reviewed in the guidelines.

Beyond that, each medical group that sets guidelines should devise their own ways for identifying and dealing with potential conflicts of interest within their specialty—“ways we can preclude these conflicts from harming the consumer,” Detsky said.

In the survey, 55% of respondents said the guidelines they worked on had no formal process for declaring relationships with drug companies. And just 2 of the 44 guidelines evaluated in the study listed the authors’ industry relationships in print.

SOURCE: The Journal of the American Medical Association 2002;287:612-617.

Copyright © 2002 Reuters Limited.

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