From the
Mail on Sunday, January 6, 2002 - by Dr Andrew Wakefield
Doctor who warned of
autism fear over controversial baby jab criticises Tony Blair and threatens to
take his research battle to America
LAST YEAR, after 13 years,
I left my job as a gastroenterologist at the Royal Free Hospital and University
College in London, largely as a result of the measles, mumps rubella vaccine
controversy.
Now that I have left, there
is one overriding priority: to ensure that children with autism and bowel
disease get the investigation and treatment they need and deserve.
Prior to my departure, the
situation had become very difficult. During the course of our investigations,
my colleagues and I had at all times followed the rules of scientific
hypothesis testing, peer review and publication.
Despite this, not only was
our research programme under threat, but also the provision of clinical care
for these children was under increasing pressure, in large part because of the
political baggage that the MMR issue brought with it.
However, I have made it
clear that I have no intention of stopping the work. Parents should be
reassured that the current research programme will be completed. Thereafter, I
will go wherever I have to go to continue it.
There are other people in
the United States doing this work and one possibility is to continue there. One
problem for such work, however, is that within the conventional university
structure it is vulnerable. Universities are susceptible to external pressures
because they are increasingly financially dependent upon the pharmaceutical
industry.
The clinical issue -
autism, bowel disease, and possible links with MMR - is a relatively simply
story that has become obscured by layers of personal, political, financial and
other imperatives that threaten to subvert the issue of how to help these
children. This must be resisted if we are to separate fact from wishful
thinking.
From the outset, parents
have, in good faith, reported their children's symptoms linking bowel symptoms
to developmental and behavioural regression. Their concerns have been almost
universally dismissed by health care professionals. Some had to wait many years
before getting their child investigated.
As doctors we must first
listen and then act upon what we have heard. This is one of the tenets of
conventional clinical medicine. I was fortunate enough to work with
paediatricians who share this belief and are also world leaders in the field of
childhood intestinal diseases.
Early in our investigations
it became clear that the parents were right. They have helped us to identify
what appears to be a new bowel disease in a group of children with autism.
Since our first report came
out in 1998, we have investigated more than 200 children with autism, the
majority of whom have a strikingly consistent pattern of intestinal
inflammation. There is also growing support from other doctors. People are
coming off the fence and acknowledging that genuine questions need to be
answered. Unfortunately, the Government's determination to exonerate the MMR
vaccine has led to research data being used inappropriately. Conflicts of
interest abound, scientific arguments have been misconstrued, and what remains
amounts to little more than propaganda.
Latterly the spotlight has
fallen on Leo Blair. I entirely respect the Blairs' right to privacy.
Nonetheless, Tony Blair's response to media questions, while full of sound and
fury, was neither convincing nor very helpful. To the more cynical it was
reminiscent of the ambiguity of other Presidential denials, such as when Bill
Clinton made the infamous remark: 'I did not have sexual relations with that
woman'.
I believe that the
Government's response has been inadequate, at times inappropriate, and will
ultimately be deemed irresponsible.
This is, in my opinion,
made inevitable by a structure where politicians, in the face of a
controversial medical issue, are dependent on their mandarins at the Department
of Health. The latter represent a polarised and rarefied view point, making
politicians extremely vulnerable. The Government and its representatives in the
Department of Health rely upon epidemiological studies that, among many flaws,
have tested hypotheses that have little or no bearing upon the children we have
investigated.
Meanwhile, the tragedy for
these children continues.
Denied appropriate health
care already, they continue to be ignored because acknowledgement of their
plight could raise the spectre of an association between their disease and the
vaccine.
Until we have sufficient
evidence, parents should be in a position to choose how they protect their
children from these diseases.
The parents' dilemma is
shared by my wife Carmel and me. Two of my four children, now four and seven,
have not received the MMR vaccine and have yet to receive the single vaccines.
When we were trying to work
out what to do for the best, the data were only just coming to light. Now, they
are beyond the age where measles is really an issue. It is children under two
years of age who are at greatest risk if they get measles, and for this reason
I would strongly recommend protection with the single vaccine at the
recommended age of 15 months.
At times, the criticism
over my work has been fierce.
My wife has been very
supportive. It would have been impossible to continue if she hadn't. We are of
a like mind. She reminds me that we have four healthy children and that one
can't walk away from the issue saying: 'This is uncomfortable for me so I'm off
to a career in liposuction and removing ingrowing toenails.'
The debate should not be
polarised into pro or anti-vaccine. The issue is one of how best to protect
children. Clearly, if children were to die because there was a measles epidemic
and there was no available effective alternative to the MMR jab, that would be
enormously regrettable.
For this to happen when an
effective alternative has been denied would be completely unacceptable.
There should be no reason
to raise fears about complications of measles epidemics and measles deaths
because the alternative - the single measles vaccine - is there. I regret the
message has been distorted and that we have been unable to establish the kind
of dialogue that we sought with the Department of Health.
I have no personal regrets;
rather it has been a privilege to be involved. Any gratification is however
tempered by a knowledge that precious time has been lost for these children to
territorial and political imperative.
In the end, for doctors, it
may stand as a lesson in humility, reinforcing the roots of clinical medicine.
And also humility in deference to the powerful evolutionary forces of parental
instinct and recidivist micro-organisms like measles that will return to haunt
you if you fail to accord them the greatest respect.
It is also a lesson that
there is no substitute for listening.
© Dr Andrew Wakefield
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