LAST WEEK, researchers at the
University of California opened a Pandora’s box that British officials
have been trying to keep the lid on for years. The team claims that the
dramatic increase in the number of children with autism in the state —
the numbers have tripled in the past 15 years — is a genuine increase
that is caused by some unknown factor, not by greater awareness of the
disease.
If this is true, it is dynamite. Doctors and officials in America and
Britain have long tried to explain away the increases in autism by
claiming that we just had not diagnosed the disease properly before.
It remains to be seen how people react to the new research, but there
is no question that it has finally opened up the debate. Dr Robert Byrd,
who led the California team, said that it was now important to
investigate possible causes of autism, including vaccinations such as
the triple mumps, measles and rubella (MMR): “A large number of our
families believed vaccines were to blame. Until we can definitively
answer that question it seems the research in autism is stuck.”
Will this finally make British officials take autism seriously?
Although the Medical Research Council says that the disease now affects
one in 166 British children under the age of eight — a tenfold increase
since 1988 — the Government has been strangely reluctant to investigate
this crippling brain disorder that often leaves children unable to
speak, rocking compulsively and unable to form normal social
relationships. This is because the Department of Health is terrified of
undermining confidence in its vaccination programme. But its dogmatic
approach has already lowered confidence in the very vaccines it wants to
protect.
Scientists who have dared to suggest that autism and MMR are linked
have been treated as heretics — the Prime Minister has accused them of
“scare-mongering”.
So far, so medieval. But the Inquisition isn’t working. The more the
Government insists that MMR and other vaccines are safe, the more alarm
there seems to be.
More than a thousand families are going to court next year claiming
that their children have been damaged by the MMR vaccine. Cases are
pending from a further 100 who claim that their children have been
damaged by the vaccine for diphtheria, pertussis, tetanus (DTP).
Vaccination rates for MMR have fallen so low that the Department of
Health is predicting a measles epidemic. An ICM poll in July said that
only 55 per cent of adults have confidence in the MMR vaccine and that
76 per cent would support an inquiry into whether it is linked to
autism.
Scares are created when people sense that they are not being told the
whole truth. “Pretty much the first lesson you learn in medical school,”
says Dr Richard Nicholson, editor of the Bulletin of Medical Ethics,
“is never to use the words ‘never’ or ‘always’. There is no absolute
certainty in medicine. The Government is being dishonest by saying MMR
is totally safe.”
David Thrower, whose son Oliver deteriorated into autism after
receiving first a measles/rubella jab and then the MMR, says: “The
Department of Health suspends common sense. The main objective of the
department seems to be to preserve public confidence, rather than
investigate suspected adverse consequences. People are scared to strike
a match in case the whole thing explodes.”
No one has proved a link conclusively between autism and vaccines,
but there is a small but growing body of research that raises serious
questions. What is strange is the Government’s refusal to take this
research seriously.
The first scientist to raise the alarm was Dr Andrew Wakefield, a
consultant gastroenterologist at the Royal Free Hospital in London, who
published his findings in The Lancet in 1998. He had
noticed a huge increase in cases of inflammatory bowel disease since the
1970s and closer examination showed that many of his patients were
infected with the measles virus. Astounded by the findings, he
investigated and concluded that the measles virus alone was not causing
the illness — it was the presence of the mumps virus that made the
disease possible. His later research suggested that many children
developed autism shortly after receiving the MMR vaccine and that 24 in
25 autistic children he examined had traces of the measles virus in
their gut.
The Department of Health went to great lengths to rubbish Dr
Wakefield’s research, and officials have insisted that no other study
has replicated his work. But in June, Dr Arthur Krigsman, from the New
York University School of Medicine, told a US congressional committee
that in 90 per cent of his autistic patients he had found a pattern of
inflammatory bowel disease identical to that found by Dr Wakefield.
Earlier this year Professor John O’Leary and colleagues in Dublin
found the vaccine strain of measles virus in the gut of 12 vaccinated
children who had both bowel disease and autism. In August, Professor
Vijendra Singh at Utah State University found that autism might be
linked to an antibody response to MMR.
Some researchers have suggested that autism may be a new form of
mercury poisoning. Studies have found high rates of autism in places
where exposure to mercury is high, such as Brick Township in the US and
some Japanese cities. Mercury is a neurotoxin that is used as a
preservative in some vaccines.
In the US, large payments are being made to children damaged by
thiomersal, the mercury preservative used in the US (though not the UK)
version of the MMR vaccine. More than $1 billion has been paid out under
the National Vaccine Injury Compensation Programme, established in 1986
by US drug companies and the Government.
Around 12 of the 18 vaccine doses that the average American child
receives before the age of two contain mercury. Petitioners claim that
this adds up to almost 30 times the level considered safe for an adult.
In 2000, a study by the American Centres for Disease Control and
Prevention suggested that three-month-old babies exposed to 63
micrograms of mercury were two-and-a- half times more likely to develop
autism.
Mercury is not used in MMR in Britain, but it is present in some
other vaccines. Dr Richard Halvorsen, a London GP, believes that “there
is potential for interaction between medical interventions — mercury and
MMR may somehow be co-factors in triggering autism. At the moment there
is no other sensible explanation for the massive increase in autism.”
Last year the Department of Health asked UK vaccine manufacturers to
stop using mercury “where feasible”, but a spokesman said it had set no
timetable and will not be monitoring the manufacturers’ response.
Health officials generally seem more interested in discrediting
scientists than in investigating whether health is really at risk. Some
of the studies cited by the Government in its contention that MMR is
safe simply look at the old case notes from the children with autism.
They do not examine patients. Most of the research does not compare
children who have had MMR with those who have not, nor does it compare
children before and after MMR vaccination.
Responding to criticism from the Government’s Public Health Service
Laboratory last month, Professor Singh said: “If they enter their same
old data in the statistical equation they will continue to find the same
old answer, ie, there is no possibility of a connection between MMR and
autistic regression. I do not wish to show disrespect towards them, but
please do me a favour and ask them what new research they have done to
discredit my research. The answer will be none.”
Some of the other studies cited by government have been linked to
vaccine manufacturers. A Finnish study which claimed to prove that there
was no link between MMR and autism was paid for by Merck, the US vaccine
manufacturer. Last month, the Department of Health announced that it had
given £300,000 to fund a study that would attempt to copy Dr Wakefield’s
research. Campaigners have since discovered that one of the lead members
of the team, Dr Phil Minor, is retained by Glaxo-SmithKline, Britain’s
biggest MMR manufacturer. Dr Minor was also a member of the Medical
Research Council’s review body into autism which concluded last year
that there was “no evidence” to support a link. A third of the members
of the UK Committee on Safety of Medicines, which has advised that the
triple MMR is safe, have declared personal or non-personal links with
drug companies that make the vaccine.
Dr Richard Nicholson, of the Bulletin of Medical Ethics, says that
the Government prefers scientists who have already made up their minds.
“If you’ve got people funded by government who for years have been
shouting from the rooftops to anybody who will listen that there is no
link between MMR and autism, how much credence do you give the results?
Why does the Government think it is worth spending money on this kind of
research unless it wants it for propaganda purposes?” Lord
Clement-Jones, Liberal Democrat spokesman in the House of Lords and
vice-chair of the All-Party Parliamentary Group on Autism, feels
similarly frustrated. “The argument has got extremely theological,” he
says, “and has gone well beyond the point where people are discussing
the facts.”
The Government has had a long time to get to grips with these issues
and to prevent the slide into emotion. In the mid-1990s, two men raised
their own concerns privately with the Department of Health about MMR in
the hope that the Department would investigate and prevent a health
scare. One was Dr Andrew Wakefield, who was subsequently rubbished by
government and accused of being a selfpublicist.
The other was Richard Barr, a partner in one of the law firms that is
co-ordinating the claims of more than a thousand families who believe
their children have developed autism as a result of receiving MMR.
“In 1996,” says Barr in a recent letter to The Lancet, “I
became so concerned about what seemed to be happening that I wrote to
the chairman of the Committee on Safety of Medicines offering to make
available the medical records and other information about children who
had apparently been affected by the vaccine. My offer was put to the
Government on three occasions but was turned down.” It is not clear why
the Department of Health was so reluctant to investigate. But under
pressure, officials eventually made a small concession. They agreed to
send questionnaires to Barr’s list of parents about their children’s
symptoms, although it is not clear how they expected this to shed any
new light on the matter.
Richard Barr again: “The Department of Health, without referring to
us or our clients, set up a working party to look at the families’
questionnaires, and questionnaires they later sent to the treating
family physicians. They now use the resulting report as part of the
evidence to support the assertion that the MMR vaccine and autism are
not linked. They describe it as involving a detailed assessment of more
than 100 children’s records referred to them by solicitors, yet the
report itself states that it took into account only evidence derived
from the parental and medical questionnaires. The report’s conclusion is
that it is impossible to prove or refute the suggested associations
between MMR vaccine and autism, pervasive development disorder, or
inflammatory bowel disease because of the nature of the information
used.”
The Department of Health’s intransigence on MMR, and its apparent
nonchalance about links with drug companies, is not only undermining
confidence in the MMR vaccine but leading some parents and doctors to
question the whole childhood vaccination programme.
“We need to take stock,” says London GP Dr Richard Halvorsen. “We’re
introducing more and more vaccines earlier, and that concerns me. When
do we get to the stage where we could be giving too many? I believe that
any medical intervention has the potential for side- effects in some
people. We have to be pretty damn sure that we are doing more good than
harm.”
Grandparents who had only one jab in childhood — against smallpox —
are amazed that their grandchildren are routinely receiving 22 vaccine
doses before they are old enough to start school. British babies now
receive six vaccine doses in one go at the age of eight weeks, including
DTP. Britain has had the most aggressive DTP programme in Europe since
1990, when the programme was accelerated to reduce “drop-out” rates. At
the same time GPs were given extra money if they managed to achieve 70
per cent or 90 per cent vaccination coverage. With this incentive, the
proportion of GPs reaching the highest coverage level went from 60 per
cent to 90 per cent in two years.
Britain’s childhood vaccination programme is clearly convenient and
profitable for both drug companies and GPs. But is it sensible? Allison
Edwards does not think so. Her son Jonathan was born a week and a half
early but still had his first set of injections at eight weeks because
“they don’t count for early births, they just start at week one. I asked
questions and was made to feel like a troublemaker. The health visitor
was push, push, push. Nothing checked — no questions about possible
contraindications — they just went straight in there with the needle. I
think his little body couldn’t take it.”
Jonathan Edwards, now 5, is diagnosed as autistic, with a mental age
of 12 months.
The astonishing thing about many of the parents who believe their
children have been affected by vaccines is how moderate they are. Most
seem bewildered by the Government’s lack of interest, rather than
bitter. Most support the overall vaccination programme. David Thrower
again: “We must protect children from communicable diseases. But we need
to screen out a small percentage of children from the immunisation
programme to protect its credibility for the future.”
This measured approach is in stark contrast to the Government’s
tactics. Fear of MMR has led many parents to travel around the country
to pay for single doses. The Government has responded by restricting
imports of the single doses, which is further reducing the number of
vaccinated children. Parents are taking matters into their own hands and
are trying to assess the relative risks of vaccination for themselves.
If vaccination rates fall too much farther, a new generation of children
could be in danger from serious diseases, such as measles.
Something must be done before next October, when the MMR cases will
come before the High Court.
“If the legal judgment goes against the vaccine manufacturers,” says
Dr Richard Halvorsen, “I fear the public confidence in the whole
immunisation policy may come crashing down.”