Redwine: I clearly say in my post that dd1 was showing signs of autism pre-mmr. Dd2 is unvaccinated, and will remain so until I fully understand the implications of giving her jabs (she has possible mitochondrial dysfunction, something that has been conveniently ignored by paeds because the outcome is that she may be susceptible to vaccines, and she has an older sister with autism already. I suspect her notes read soething along the lines of ?loopy mother insists that mmr causes ASD, or similar )
Seeker: for the last time, Wakefield NEVER stated there was alink between mmr and autism. He suggested a possibility that there was a link between mmr and autistic enterocolitis, I believe. That is very different.
This whole thing has become sucha game of smoke and mirrors, with misquotes (both deliberate and accidental) all over the place. (not aimed at you, I mena in general over the last 12 years).
Wakefield hypothesised that there might be a link between mmr and a new form of bowel disease. He recommended that more safety studies take place on the mmr, and that singles should be made available, and used, for children who might be affected.
Along the way, this has been mixed up with a whole host of other things ? media spin, claims of ?anti-vaxxers? scaremongering, claims of ?pro-vaxxers? scaremongering, etc etc. It has all got into such a state that it is now impossible to report side effects form vaccines (most are dismissed, a few filed wrongly, lots just ignored).
The case, as I see it, is as follows:
MMR is safe for the vast majority of children. If you look at what Wakefield actually said - it was very little. He has repeatedly reminded people he is talking about a small subgroup of the autism population. He has repeatedly said MMR is safe for the majority. He has told people t vaccinate and said his own children have been vaccinated with the MMR
He didn't even say don't vaccinate he said use singles (and no not his singles before someone repeats Brian Deer without actually reading the patent application for themselves).
There is a theory that a small subgroup of predisposed children react badly to vaccines and develop bowel problems and neuropsychiatric problems as a consequence. Whether the vaccine schedule, as a whole, is a factor by presenting an cumulative, synergistic immunological insult or whether one or two specific vaccines or elements of them could act as a trigger is not known, and is suspected to vary from individual to individual. In terms of predisposition issues such as; an impaired ability to process mercury and aluminium, low gluthathione production levels and mitochondrial malfunction have been identified (among others). Family medical histories of autoimmune disease, in particular diabetes, have been identified as risk factors. Children usually have similarities in their own medical histories such as recurrent ear/upper repository infections, heavy antibiotic use, heavy paracetamol use, food allergies, intolerance to casein and gluten, constipation/diarrhoea, upset sleep patterns and often eczema. Many of the children reacted at the time of vaccination by very high fever, screaming for long periods, sleep disturbances, swelling at injection site.
So that is the theory. The reason this theory has been developed is because thousands of children have been observed following this pattern.
Although many children have been observed, in reality, compared to the high numbers vaccinated, there are statistically very few (although devastating if you are one of them). Because we are talking low numbers presenting a rare reaction most epidemiological studies will not detect an association (and cannot prove causation anyway).
When the MMR was first introduced to the UK three vaccines were licensed. Two of those vaccines contained the Urabe mumps strain.
Despite the fact that use of Urabe strain MMRs had led to unacceptably high rates of meningitis in Canada which led to the vaccines being withdrawn, the vaccines were introduced to the UK. I guess UK officials thought that they would give the vaccines a second chance and see if UK kids were more resistant to developing meningitis than Canadian kids. They weren't. The same thing happened in Japan. The vaccines were (eventually) withdrawn
It was at this point, before anyone had heard of Dr Wakefield, that public confidence in the MMR faltered and vaccination rates dropped. It was at this point that the UK government put all their eggs in one basket and went all out for the third remaining vaccine the MMRII. Single vaccines were discouraged and later made unavailable
Seems to me that about 95% of this controversy is about measles. No child actually needs the MMR. Children's health could be better, more safely and more judiciously safeguarded by the use of single vaccines
Re: the many studies that apparently disprove Wakefield?s hypothesis. A lot of the press releases accompanying papers 'proving' the safety of the MMR have been disingenuous to say the least as they have suggested that these papers disproved Wakefield's hypothesis when they haven't even tested it. Instead they've tested the 'MMR has caused the rise in autism' hypothesis, which seems to have been made up to disprove.
the bulk of evidence suggests that there is no association between MMR and ASD at population level. (I would debate the methodology and impartiality of much of that evidence but that is probably a whole new thread.) the large scale studies neither address Wakefield's findings nor provide data which sheds any light on the soundness of his hypothesis. They also, unfortunately, do nothing to help the suffering of his patients.
why is data that is irrelevant to the clinical findings in a small subgroup being held up as evidence that that small subgroup doesn't exist, (something the authors of the studies admit themselves is beyond the scope of the data)?
Why is the man who identified the subgroup being lied about and misrepresented?
Why is his science (that has never been put to test let alone found to be flawed) being censored?
Why are the numerous other relevant papers by Dr Wakefield and others never mentioned?
Why are we constantly told that his findings have never been replicated when they have?
How can it be that whilst it has gradually become accepted that many autistic children have intestinal disorders, the man who made this discovery is being subjected to an extreme media smear campaign and is being accused by the GMC of misconduct because his team examined autistic children with bowel disorders the GMC is, by implication, denying exist in autistic children
regardless of the politics of all this, the science of the 1998 Lancet paper, and the subsequent research it has led to, remains unchallenged. Still, 12 years later.
You have to start with identification of different autism groups, and crucially (if you want ot test the Wakefield hypothesis) the right sub group of ASD children/patients
the research has just not been done. It all treats autism as one thing, and it all examines MMR versus the rise in autism. Which isn't and never has been the question. So the MMR research out there isn't much use in making a decision anyone who has children at risk of vaccine damage, or autism.
The only way to figure out what has happened to the children in question is to examine the children in question and perform clinical studies.
Clinical studies that have been done implicate MMR and they remain unchallenged. The people who have performed these clinical studies have made themselves very unpopular and are being picked apart by the medical community, the press and the GMC. The science remains untouched though
On the ethical side, the GMC findings were interesting to say the least.
If you read the judgement it seems to centre around the way children were recruited into the research study. So in some cases parents contacted him directly after hearing about him. That doesn't seem particularly unethical to me. Supposedly he used the wrong diagnosis. In Jauary the new criteria for diagnosis was revealed (as a first draft). They are using the same scheme as Wakefield.
He supposedly ordered clinically unnecessary tests. Yet if you read the consensus for treatment of gastrointestinal disorders in autism published in pediatrics in January you find that he followed that (judging by symptoms described in the hearings).
So the doctors who failed to investigate gut problems in autistic children didn't fail in their duties at all, then? Only Wakefield... he is definitely a scapegoat
The procedures were ethical providing they were carried out with clinical need. Wakefield says they were, the GMC says they weren't.
If you read the judgment you can decide for yourself. Parents clearly wanted their child investigated and believed there was a clinical need. There seems to be an acceptance that the children were presenting with histories of abdominal symptoms although these weren't always mentioned in referrals. Of course it's hard to demonstrate a clinical need in advance when you are looking at a new disorder.
The GMC seems to be saying that any child with regressive autism rather than disintegrative disorder should not have been included. Never mind that they're different names for the pretty much the same thing. The only difference between them is the age of onset. Up to 2 for autism, 3+ for CDD
In January this year the journal Pediatrics published a consensus report on how gastrointetinal disorders in autism should be evaluated, treated and managed.
Read that, then the judgment, and you will find that the methods used fall well within this consensus. Ten years ago they were meeting standards laid down this year. And yet they were supposedly acting unethically. Maybe someone could explain it to me.
This quote is particularly relevant I think, especially when you remember the children did have clinical indications or gastrointestinal disease:
"Empiric treatment, initiated by a gastroenterologist or specialist skilled in understanding neurenteric dysregulation, may be warranted for some patients without other indicators of disease, such as weight loss, fever, and bloody stools, before proceeding to invasive evaluations. However, for children with ASDs, behavioral indicators may be the only manifestation of pain, and determining who should be evaluated medically and who should be treated empirically can be problematic. Evaluating all children may result in some with IBS and FAP having potentially unnecessary invasive evaluations; treating children empirically may delay identification of morbidities that could be remedied by medical or surgical intervention." Ethics approval was given for children with 'disintigrative disorder' who had received a "measles/rubella" vaccination.
A lot of the included participants had regressive autism and MMR.
The GMC is saying that 'disintigrative disorder and regressive autism are not the same thing (they are) and that only children who received a single measles or MR vaccination should have been included. See how clever it is? Suddenly he's acted unethically
Eg A child is referred to Wakefield with diarrhoea/abdominal pains/frequent soiling but this isn't mentioned on the referal letter. However it is noted at the initial examination including descriptions of the child's cries of pain (read pediatrics for the relevance of that). A request is then put in for a colonoscopy but crucially the doctor writes on the colonoscopy request something like ?needed for investigation into autistic 'disintigrative disorder.? Now of course you shouldn't do a colonoscopy for autism alone. But it's fine yes because the examination and case history revealed the gastrointestinal issues and the GMC knows that because they have recorded it in the judgement. Oh but hang on it didn't say it on the colonoscopy request form so ........they ruled no clinical need.
Wakefield says btw that colonscopies were covered under a 1986 project ethics approval
Oh, and btw, GMC didn't actually have a problem with the payment at the kids birthday birthday (one charge they didn't hold against him). they had a problem with him joking bauot it at a conference, but no problem with the £5 in the party bags...