How seeds of doubt were sown by doctor

Long battle to quell fear over controversial theory left department

Sarah Boseley, health editor
Society

Monday December 24, 2001

Seeds of doubt over the safety of the combined measles, mumps and rubella vaccine were planted in 1998 by the researcher Andrew Wakefield at the Royal Free hospital, who was backed in some aspects of what he said, but not all, by colleagues.

The Department of Health, the public health laboratory service and the medical research council have expended much time and effort over three years to establish that there is nothing for parents to fear, but the genie firmly refuses to go back in the bottle.

Dr Wakefield's field of research was the gut. He became concerned when he saw a small number of children suffering from Crohn's disease - which inflames the bowel - who had also developed autism some time after they were given their MMR innoculation. The vaccination is usually administered before the second birthday, which is also when autism first becomes apparent. Dr Wakefield, however, believes there is a connection.

His 1998 paper, which was published in the Lancet - the journal has taken a lot of flak from some scientific quarters because of its decision to run it - focused on 12 children with gut disorders, nine of whom were also autistic. Eight out of the nine started to show a loss of developmental skills after the MMR jab and one after catching measles.

The paper acknowledged that the link was no more than a theory. "We did not prove an association between MMR vaccine and the syndrome described," it said. The Lancet also ran two critical commentaries from US experts in the same edition. But despite the caution, the idea was out and it has proved im possible for health officials to assuage public fears. Dr Wakefield has continued to pursue this line of research and recently left the Royal Free where tensions had developed over his work.

Timing alone - the fact that parents noticed developmental problems in their children shortly after the MMR jab when they may have been looking for an explanation - is not proof of any link. Much of Dr Wakefield's work before the Lancet publication had focused on whether measles virus was responsible for an increase in Crohn's disease. Scientists from the PHLS say that he has not established that measles virus can cause bowel disease, let alone that it can cause autism.

The Royal Free group claimed that they found measles virus in inflammatory bowel tissue affected by Crohn's disease, but other scientists could not replicate the results.

Dr Wakefield's theory was that MMR vaccine might damage the bowel, causing lesions through which opioid chemicals occurring in the bowel could escape. Opioids, it is suggested, might reach the brain and affect development.

But his opponents say there is no evidence that this can or does happen. They claim that the epidemiological evidence is also against the theory. There has been a steep rise in cases of autism, but the PHLS which collects the data on the prevalence of disease in the UK, says the rise began 10 years before the MMR was widely introduced in 1988, and that when every child began to be vaccinated, there was no significant change in the incidence of autism.

But however much evidence the Department of Health puts out against the Royal Free theories, the row over the MMR refuses to die down. The crisis in confidence has been made worse because of the issues over individual rights raised by the government's refusal to allow parents to have the three vaccines given separately. Dr Wakefield, launching his 1998 Lancet paper, suggested it might be better to have them separately, although his colleagues disagreed.

Parents have latched on to this idea as a means of safeguarding their child, in spite of all the evidence assembled by the Department of Health to prove the three vaccines do not interact. The government refuses to budge, on the grounds that a child who is given one vaccine is left exposed for longer to the other diseases.

Guardian Unlimited © Guardian Newspapers Limited 2001