mmr and austism -- retraction of lancet article

[Lorien]

Did you see that most of the authors of a 1998 Lancet (British Medical Journal) article on the links between MMR and autism have withdrawn support for the article, saying it was flawed? Seemed quite an interesting turn of events. Or am I way out of date?

Article attached below from www.idinchildren.com

Wakefield?s co-authors retract support for MMR-autism link
Some anti-vaccine lobbyists claim the 1998 paper ?proved? a link between MMR vaccine and autism.
by Bryan Bechtel
Staff Writer

April 2004

In a stunning departure, 10 of 13 researchers of a Lancet article have retracted an interpretation of data that purports a link between the measles-mumps-rubella (MMR) vaccine and autism.

The 1998 Lancet study by Andrew Wakefield, MD, and colleagues at the Royal Free and University College Medical School in London, ?Ileal-lymphoid-nodular hyperplasia, non-specific colitis and pervasive developmental disorder,? did not report direct evidence of a link between MMR vaccination and autism.

However, in reviewing unusual intestinal lesions in 12 children with developmental delays, including eight children with autism, the researchers cited MMR vaccination as a cause of the children?s conditions.

The vaccine community took notice almost immediately after the publication of the article. Concerned parents refused immunization with measles-containing vaccines, and in some parts of the United Kingdom, immunization rates fell from more than 90% to as low as 84.6%.

Many studies, including several large epidemiological investigations, have since refuted the link between MMR and autism, but the fallout from the original Lancet study has been undeniable. According to a report last year, three children in Northern Ireland died as a result of a measles outbreak that has been attributed to the decline in immunization rates.

In their retraction, the authors asserted that the data were inconclusive to determine a link between autism and MMR vaccination, and that the purported link was merely a possibility.


But after allegations surfaced of a potential financial conflict of interest concerning Wakefield, and after years of criticism from the vaccine and public health communities, it appears that some of Wakefield?s early supporters and fellow colleagues are distancing themselves from the 1998 article.

According to a partial retraction published in the March 6, 2004, issue of The Lancet, co-authors Simon Murch, PhD, Andrew Anthony, MB, David Casson, MRCP, Mohsin Malik, MRCP, Mark Berelowitz, FRCP, Amar Dhillon, MRCP, Michael Thompson, FRCP, Alan Valentine, FRCR, Susan Davies, MRCP and John Walker-Smith, FRCP, have withdrawn their support for the suggestion that MMR vaccination could cause autism.

The Lancet could not reach co-author John Linell, PhD. Wakefield and Peter Harvey, FRCP, another researcher, refused to sign the partial retraction.


Retraction
The retraction refers to the implication of MMR vaccine as a cause for the 12 children?s developmental regression.

In the retraction, the 10 researchers asserted that the data were inconclusive to determine a link to MMR vaccination, that the purported link was merely a possibility and that given the public health fallout, ?now is the appropriate time that we should together formally retract the interpretation placed upon these findings in the paper.?

The retraction raises serious doubts among vaccine experts, who are left wondering why the 1998 paper was published in the first place if the results were so spurious that they now require a retraction.

?My feeling about the Lancet paper is that it should never have been published.?
? Paul Offit, MD


According to Paul Offit, MD, chief of infectious diseases at Children?s Hospital of Pennsylvania in Philadelphia, and a member of the Infectious Diseases in Children editorial board, every aspect of the article has been refuted in published studies.

Even the suggestion of intestinal inflammation in children with neurodevelopmental delays seems dubious, as larger-sized lymph nodes are typical in children. The finding of ileal-nodular hyperplasia on endoscopy, as reported in the 1998 article, could have been simply a normal variant, Offit said.

?My feeling about the Lancet paper is that it should never have been published. When a medical journal determines whether or not data are worthy of publication, those data should be solid and consistent,? said Offit.

?The data that were presented in that paper were at best raising a hypothesis, and in no way testing a hypothesis.?


Financial conflict of interest
In a Feb. 23 online statement, the Lancet editors leveled charges against Wakefield, the most serious of which is that he did not tell his collaborators about funding he received from the Legal Aid Board, a British legal fund representing parents of children suing the vaccine?s maker over alleged injuries.

Based on an investigation by the British newspaper The Sunday Times into the events surrounding the publication of the 1998 article, Lancet editors claim Wakefield received £55,000 to perform ?virological investigations as part of a study funded by the Legal Aid Board.?

The funded research was not directly related to the case review, but ?since there was a substantial overlap of children in both the Legal Aid Board funded pilot project and the Lancet paper, this was a financial conflict of interest that should have been declared to the editors and his [Wakefield?s] co-authors and was not,? Lancet editors said.

Wakefield did not return requests for an interview, but in a published response to the Lancet editors, he called the funded research ?a hypothesis-testing laboratory study to examine for the presence or absence of measles virus in autistic children when compared with appropriate controls,? to elucidate the causative factors in the children?s intestinal findings.

Wakefield admitted receiving the Legal Aid funding but said it did not influence his review. Furthermore, Wakefield said the list of 10 patients reviewed for the unpublished virological investigation was given to him by Richard Barr, a lawyer with ties to the Legal Aid Board.

Barr reportedly listed patients who had been referred to the Royal Free College for treatment, but who also had contacted the legal board regarding pending MMR litigation. According to Wakefield, any overlap between the 12 children in the case series and the 10 cases reviewed for causality occurred without his knowledge, as he was unaware of the legal status of the children reviewed in the 1998 Lancet study.

For more information:
Murch SH, Anthony A, Casson DH, et al. Retraction of an interpretation. Lancet. 2004;363(9411):750.
Wakefield A, Murch S, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis and pervasive developmental disorder. Lancet. 1998;351(9103):637-641.
?A statement by the editors of The Lancet,? including responses by Drs. Murch, Walker-Smith and Wakefield, as well as comments from the Royal Free and University College Medical School. www.thelancet.com. Accessed on March

[Davros]

You are way out of date! Look at the In The NEws section

[Jimjams]

You are way out of date. And how on earth can anyone "retract an interpretation"? Especially when the interpretation in the paper was that there was no proof of a link (so if they're retracting that dos that mean they now interpret that there is a link). That's quite enough interpretations I think

[Clarinet60]

jimjams!

[Clarinet60]

If you go to the Lancet website (www.thelancet.com) you can access the original Wakefield paper, plus the numerous letters, etc since, some of them from Wakefield himself. It's free to register, and many of the articles require no subscription, including the MMR stuff. It's interesting reading. This is an extract from someone talking about the epidemiological research done on MMR. It's interesting reading, but long, sorry.

Sir--Simon Murch has previously made an important contribution towards treating children with regressive autism and bowel problems, and so it is vital to respond to his letter (Nov 1, p 1498)1 with hard fact rather than emotion.

The evidence to support his claim that there is no link between the measles, mumps, and rubella (MMR) vaccine and regressive autism comes from a large number of studies, too numerous to comprehensively reference here. But all of these studies have only been epidemiological. Perhaps the most interesting was the study by Kaye and colleagues,2 which showed that autism in the UK had increased seven-fold between 1988 (the year MMR was introduced in the UK) and 1999. That study explained the increase away as possibly being "due to increased awareness of the condition among parents and general practitioners, changing diagnostic criteria or environmental factors", although the authors offered no evidence to support this speculation. There is thus prima facie evidence of an underlying real increase in autism in the UK since 1988.

Careful review of the numerous epidemiological studies (how many of MMR's defenders have personally taken the time to read them all carefully and test the methods and conclusions of each to destruction?) exposes each one as flawed, with unsupported assertions, questionable hypotheses, and overstated outcomes. For example, studies based on the UK General Practice Research Database are utterly reliant on the relevance of that database to an affected child's detailed bowel condition and developmental history. This is clearly a heroic assumption on an industrial scale. Few such children have undergone ileocolonoscopy or had tissue samples analysed. And none of the epidemiological studies distinguished between regressive autism and other autism--a crucial failure.

Another epidemiological study3the only one to look at records of actual damaged childrenpublished in support of MMR's safety, was that by the UK Committee on Safety of Medicines. This study, based on records of several hundred UK children obtained from lawyers, was so weak that it was forced to admit that "it was impossible to prove or refute the suggested associations between MMR vaccine and autism or inflammatory bowel disease because of the nature of the information [made available to the study]". No children were clinically examined, and no parents interviewed.

There also have been no clinical studies of damaged children with regressive autism that firmly refute Andrew Wakefield's hypothesis of an association between MMR and regressive autism. Are these epidemiological studies Murch's sole evidence of MMR's safety?

We now turn to studies that offer some background support to the ground-floor level of Wakefield's hypothesis (again, note that he has never claimed that MMR causes all autism, only a subset of cases). Several studies have been published, or papers presented, that indeed strongly suggest that Wakefield's hypothesis of a link between gut pathology and regressive autism is correct. Among these is a paper by Timothy Buie.4 Buie found evidence of chronic inflammation of the intestinal tract among autistic children he examined, with ileal lymphoid nodular hyperplasia (ILNH) in 15 of 89 children. Buie concluded that the children "are ill, in distress and pain, and not just mentally, neurologically dysfunctional". His findings thus support at least some link between a disorder of the gastrointestinal tract and some cases of autism. No contrary published evidence to refute Buie's work has been offered or presented to date.

A paper by Arthur Krigsman5 noted his finding that a large proportion of his autistic patients had chronic unexplained gastrointestinal symptoms. In his assessment of 40 children, 90% had lymphoid nodular hyperplasia of the terminal ileum. Most of the cohort had a clear history of developmental regression, with a precipitous or gradual decline at age 12-18 months after earlier normal development. Again, no evidence to refute Krigsman has since been offered.

These findings, together with those of Wakefield and his co-authorsincluding Murchstrongly suggest a link between ILNH and regressive autism. The numerous defenders of MMR's safety might at least wish to acknowledgeor provide clinical evidence to contradictthis vital first stage in the unfolding story of regressive autism's cause.

The most up-to-date figures available from the US Individuals with Disabilities Education Act (State-sourced) database confirm that children and young people aged 6-21 years with autism, in full-time education, have increased from 12222 in 1992-93 to 118602 in 2002-03, a deeply-troubling increase. It emphasises the huge and rapidly-rising cost to the community of autism, in all its forms, and the importance of making real progress in tracing its causes.

Child health is not just about measles, or vaccine take-up rates. In the UK, a dozen suspected measles cases is a media headline. A thousand cases of autism go unnoticed, unrecorded, and unreported, yet their lifelong physical and economic effect is vastly greater. It is vital that the medical community now recognises the importance of the pioneering work of Wakefield, Buie, Krigsman, and other co-workers, accepts that there is a prima facie connection between ILNH and regressive autism, and conducts the most urgent research as to its potential causal pathways. It is an extreme understatement to emphasise that there is much at stake. I am the parent of an autistic child.

[Clarinet60]

That last paragraph is so pertinent that I'm going to copy it again.
Here:


'Child health is not just about measles, or vaccine take-up rates. In the UK, a dozen suspected measles cases is a media headline. A thousand cases of autism go unnoticed, unrecorded, and unreported, yet their lifelong physical and economic effect is vastly greater. It is vital that the medical community now recognises the importance of the pioneering work of Wakefield, Buie, Krigsman, and other co-workers, accepts that there is a prima facie connection between ILNH and regressive autism, and conducts the most urgent research as to its potential causal pathways. It is an extreme understatement to emphasise that there is much at stake. I am the parent of an autistic child.'

I'll copy his name in later, if anyone's interested.

[Jimjams]

I read that before. It's excellent isn't it.

Why oh why does no-one notice the other little link. When MMR was introduced, the timing of the thimerosil containing DTP's was altered from being spread over a year to being given at 2,3 and 4 months. I'm sure that needs to be looked at.

There are many routes to autism, and MMR may well be one of them. Just not in large enough numbers for the dept of health to care. Sucks to be te one affected though.