lawyers acting for GlaxoKline try to stopCSF(cerebral spinal fluid) taps

[Guest guest]

lawyers acting for GlaxoKline try to stopCSF(cerebral spinal

fluid) taps

" .......lawyers acting for GlaxoKline (GSK), Merck and Aventis

Pasteur MSD, manufacturers of the MMR triple vaccines that have been

used in the UK since 1988, approached a High Court judge in London

for an injunction to prevent the CSF(cerebral spinal fluid) taps

going ahead. ........ "

MMR RIP?

http://www.timesonline.co.uk/newspaper/0,,176-931673_1,00.html

REPORT BY ROBERT SANDALL

A conspiracy of silence or paranoid scaremongering? Is the MMR

vaccine a cause of autism — or is it a vital health programme

undermined by this medical maverick?

In March, seven mentally disturbed British children and an escort of

parents, carers, two doctors and three lawyers flew to Detroit,

Michigan, for a medical test that had been denied them in the UK.

The procedure, a lumbar puncture to extract specimens of cerebral

spinal fluid (CSF), is uncomfortable and requires anaesthetic — but

it is routinely carried out in advanced western countries in the

treatment of many chronic ailments, such as leukaemia. In the cases

of these children, all of whom were prone to seizures as well as a

range of self-harming antics, an analysis of the liquid that bathes

the brain had been separately recommended by two neurologists.

Over the course of a year, the 246 private and NHS hospitals in

Britain equipped to carry out CSF taps had declined to touch them,

usually on the grounds that the test amounted to human

experimentation, not treatment. In November 2002 one hospital

briefly assented before putting the matter before its ethics

committee, which decided four months later not to proceed for the

same reason: the children were being used as guinea pigs.

It was an arguable point. Before an illness can be treated, it must

be fully understood, and the root of these children's problems

hadn't been ascertained. By the time a hospital outside Detroit

agreed to accept them in March, their parents and advisers were

worrying that the tests would never take place. They were nearly

proved right.

On the night before the children arrived at the hospital, lawyers

acting for GlaxoKline (GSK), Merck and Aventis Pasteur MSD,

manufacturers of the MMR triple vaccines that have been used in the

UK since 1988, approached a High Court judge in London for an

injunction to prevent the CSF taps going ahead. Two of these

combination jabs had been called into question before: Pluserix, by

Kline (pre-Glaxo), and Aventis Pasteur's Immravax were

withdrawn in 1992 after the " urabe " strain of mumps virus used in

them was deemed responsible for a meningitis outbreak by the health

authorities in Canada. That strain was replaced and M-M-R II,

patented by Merck but licensed to GSK, became the triple jab most

often offered in the UK. Now the possible misbehaviour of the

measles component was at issue. The drug companies wanted a delay

because their medical representative needed to be present at the

procedure, but couldn't get to Port Huron, Michigan, in time. The

injunction, however, was denied.

The children were the claimants in a " class action " — legal-speak

for a case launched jointly by victims with the same grievance. If

successful, it would validate the claims of 1,300 other British

families and trigger international damages awards that could top $1

trillion. The proposed test, to look for traces of measles-vaccine

virus in the children's CSF, could provide evidence that it can pass

from the gut's lining into the brain, where measles is known to

affect cerebral processes.

This is one of the most contentious issues in the row about what, if

anything, brings on a disease described, but not universally

accepted, as " autistic enterocolitis " . In the UK, the condition was

first identified by Dr Wakefield, but scientists in Japan,

Norway, Ireland and the US (including Buie, Winter and Kushak, based

at Harvard) have also published research supporting a link between

intestinal disease and autism.

The theory that a malfunctioning or " leaky " gut sends partially

digested food — in the form of opioid compounds known as peptides —

up to the brain is one of the less controversial aspects of the

hypothesis under investigation. Whether measles vaccine is what

gives rise to the gut disease in the first place is the trillion-

dollar question. So far, the sum of Wakefield et al's discoveries

has not met the exacting medical standards that establish causation.

All it points to is an " association " . But the importance of the

spinal-fluid link was well understood by the defendants in the class

action. Merck's QC had recently referred to it in court as " a

significant result when trying an issue as to whether or not MMR

vaccine causes autism " .

Time was running out for the claimants. Their action was being

financed by the Legal Services Commission (LSC), a successor to the

Legal Aid Board, which had set a July deadline for the submission of

expert medical evidence, after which funding would be reviewed.

Having lost a year trying to get the CSF samples in the UK, they now

had to fly seven severely autistic, occasionally violent children —

most of whom had never been in a plane before — halfway round the

world.

Another bid by the defendants to secure an injunction, this time in

the US, also failed. Then the hospital called the British party in

Detroit to cancel their appointment.

Although lumbar taps on autistic children are common in the US, this

batch, Lansing hospital now felt, constituted unwarranted human

experimentation.

But the children's camp had an undisclosed back-up plan. They had

made an arrangement with another hospital in Port Huron, two hours

along the shore of Lake Michigan, and this time, despite further

delaying tactics from the lawyers in London, the CSF taps went

ahead. One of the seven children reacted badly to the anaesthetic

and couldn't be tested; the other six were fine.

Now the party and the fluid samples had to be flown home for

analysis. There was bedlam on the bus as the anaesthetic wore off:

one child tried to exit the moving vehicle by the back door, while

another was restrained by his mother in the toilet. At the airport,

the container of dry ice carrying the CSF was deemed too large to be

carried on as hand luggage, and another business-class seat had to

be specially purchased for it.

After the KLM flight had boarded, five US customs officers arrived

to take the lawyers and doctors off the plane — the only passengers

they apprehended — for separate, 30-minute taped interviews. They

weren't asked any questions pertaining to passenger safety and their

large container: the issue was why the children hadn't been tested

back in the UK. In transit at Schiphol airport in Amsterdam, they

were again singled out for more questioning.

By now, several tired minds were stoking their paranoia that these

interventions might, just might, have been orchestrated to delay

delivery of the samples, allowing them to spoil. So when the

virologist in the party, Colin Fink, got them back to his private

lab, Micropathology, in Coventry, he took the unusual precaution of

placing an armed guard outside overnight.

The next day the CSF samples were couriered to their final

destination: Professor O'Leary's laboratory at Trinity College

in Dublin, a facility whose viral-testing kit had previously

identified the DNA of measles in the guts of autistic children.

Rather disconcertingly, the package appeared to have been opened en

route, but with the war in Iraq only two days old, customs

everywhere were on high alert.

The analysis proceeded: three of the six samples tested positive for

the vaccine strain of measles virus, but only in minuscule genetic

fragments — and not enough to count as a valid research sample.

According to medical-research protocol, that result had now to be

compared to the CSFs of a " control " group of non-autistic patients.

Acquiring these took several months, during which the claimants

missed the LSC's July deadline and had their funding temporarily

suspended awaiting an appeal on September 30.

When the doctors finally assembled their evidence, the children's

lawyers felt confident. Only 1 in 20 of the control group — all

leukaemia sufferers, specifically chosen for their high

susceptibility to random viral infections — was found to be carrying

measles virus in their CSF.

The defendants' analysis of the same samples, carried out by Dr

Simmonds at Edinburgh University, had found no trace of

measles in the children's CSF. But Simmonds had chosen to use a

different viral tracker, Nested, rather than the claimants' TaqMan

process. Given the accepted centrality of findings in this area,

they felt that their case against MMR looked strong enough to take

to court in April 2004. But the four adjudicators on the LSC's

funding-review committee disagreed with them. Justifying the £15m

already spent as having served the " wider public interest " , the

committee stated that the £10m needed to see the action

through " would not prove a link between MMR vaccine and Autistic

Spectrum Disorder " .

The claimants' lawyers suspected that the committee had made up

their minds before considering the CSF test results, as these

offered fresh evidence of just such a link. At the hearing, they

were told to await a decision at the end of the day, and written

reasons for it two days later. But if the answer was yes, they

wondered, why would the reasons not be immediately forthcoming?

They were not reassured to discover, when they looked more closely,

that the LSC's e-mailed press release dropping the case had been

originated the day before the hearing.In a footnote to editors, the

LSC admitted that its decision reflected a change of policy rather

than an assessment of evidence. " In retrospect it was not

appropriate for the LSC to fund research. The courts are not the

place to prove new medical truths. " That judgment is itself up for

judicial review in the new year — though the LSC is not bound to

accept its recommendations.

Paranoia is currently the default mood on all sides of the MMR

debate. The British government is so scared of it that health

ministers will not be interviewed on it. The drug companies are on

the defensive against damages claims that, if proven, could

seriously undermine their credibility and their business. And the

anti-MMR lobby is convinced a coalition of government agencies, the

medical Establishment and big pharma are against them, X-Files style.

In a leafy southwest-London suburb, the man whose 1998 paper in The

Lancet kicked off the fracas, Dr Wakefield, would prefer not

to talk on the phone. He believes his line was tapped about three

years ago, and now conducts regular " sweeps " to check it for bugs.

Visiting the house whose garage has served as his office since he

resigned his post at London's Royal Free hospital in 2001, it

strikes you that Wakefield can't be doing this for the money. From

the outside, his house looks as if it might be the only squat in an

otherwise tidy, middle-class road, its overgrown front garden

dominated by a tree stump curiously carved into a V-sign (a message

to the former chief medical officer, Sir Calman, he later

tells me). Unlike many of the activists in the anti-MMR camp,

Wakefield is a man unscarred by family tragedy. His four children,

the eldest of whom is 13, are as fit as fleas, tearing around the

house and back garden. All have had vaccinations, he says, though

not the MMR jab. As he first said in public in 1998, he's a one-at-a-

time man where vaccination is concerned.

In appearance he's like a genial fly half, solidly built, with

hooded, watchful eyes, a boyish grin and an easy manner. What

bothers him most, he says, is the way his research has been

rubbished by colleagues who deny gut treatment to children who, he

believes, badly need it. On his laptop is a photograph of ce,

an autistic boy with a severely distended belly, whose mother has

been accused of starving him and was refused access to a paediatric

gastroenterologist. Next to ce in the picture stands his

healthy, unstarved sister. This is a classic case of autistic

enterocolitis, says Wakefield. " He's clearly sick. That boy and his

mother are being maltreated by the medical Establishment. " Such

vehement declarations don't endear him to many of his former

colleagues.

Wakefield feels pretty maltreated himself. Since qualifying in 1985,

he has published 128 papers in " peer-reviewed " journals, articles

that are read and assessed for their scientific credibility by an

independent panel of up to five experts before being printed. His CV

is a wodge of impressive titles and tricky acronyms: The Lancet,

JAMA (The Journal of the American Medical Association). He has

published 49 papers on aspects of autistic enterocolitis, the most

recent in November's Journal of Clinical Immunology.

Wakefield's big beef is that his clinical findings haven't been

properly challenged on their own terms. He conducts or collates the

results of colonoscopies and biopsies of particular children. He

calls this " scoping the kids " . His opponents take a different tack:

some have failed to replicate his findings using different clinical

procedures and technologies. Others say his samples are too minute,

anatomically and numerically, and examine the statistical incidence

of autism versus uptake of MMR, and any adverse aftereffects. Study

after study has found no correlation. Research published this year

in America found a " statistically significant " risk of autism in

cases reported 5 to 10 days after MMR, but in general the statistics

suggest that Wakefield is making a mountain out of a molehill.

But the way this data is compiled and analysed is troubling. In

Britain, the reporting of bad vaccine reactions is down to parents

and harassed GPs, who have to fill out and forward yet another form

to a national database, the so-called " yellow-card " system. Big

studies abroad, in Finland in 1998 and Denmark last year, found

nothing to worry about. But a similarly reassuring analysis in the

US, published in the November issue of Pediatrics, has started a

firestorm in Washington. A transcript of a conversation at the

federal Center for Disease Control and Prevention (CDC), obtained

under the Freedom of Information Act, revealed officials admitting

that data on MMR could be manipulated to prove, or disprove,

anything. The US representative Dave Weldon, a qualified doctor

himself, wrote an open letter to the head of the CDC, noting

its " selective use of data " and pointing out that the lead author of

the study left the CDC two years ago to work for GlaxoKline.

Wakefield, too, has taken a bit of stick from public officials

recently. " Junk science " — a term used earlier this year by a High

Court judge awarding in favour of a suit brought by two estranged

husbands against their wives' decision not to give the triple jab to

their children — particularly rankles. Why wasn't he called as the

expert witness for the defence, rather than Jayne Donegan, a

homeopath and GP from south London, he wonders. (Donegan was

reprimanded by the judge for not answering the court's

questions.) " It was a disgrace. We've published a lot on this in

eminent journals. The first we heard of that case was when it was

thrown out of court. "

Life was different before he and six of his Royal Free team

published their Lancet bombshell, the unexplosively titled " Ileal-

Lymphoid-Nodular Hyperplasia, Non-Specific Colitis and Developmental

Disorder in Children. " Up until 1998, Wakefield had been a whiz-kid.

His discovery that an inflammatory bowel disease, ulcerative

colitis, can be brought on by arterial problems rather than, as was

previously assumed, by a gut full of germs, made his name. It also

established his modus operandi. As a trained surgeon, he based his

research on observation rather than textbook precedents.

Wakefield's next hypothesis was more controversial: the presence of

measles virus in the wrecked intestines of sufferers of Crohn's

disease — a finding that was not replicated in worldwide studies set

up by the World Health Organization in 2000 — led him to his first

brush with big pharma. His co-funders, Merck, pulled out just before

he published in 1996. Though he had previously received half a dozen

research grants, totalling around $500,000, from Glaxo and Hoffman-

LaRoche as well as Merck, his drug-company funding now disappeared.

So he recruited a medical fundraiser, Sawyer, to tap

alternative philanthropic bodies, and ploughed on looking for gut

measles. When Rosemary Kessick, the mother of an autistic child,

came to him convinced her son's problems were related to the chronic

diarrhoea he developed after having the MMR jab, Wakefield listened

and looked

Conventional diagnosis attributed the concurrence of autistic

behaviour and severe bowel problems to coincidence, or held that

disturbed minds naturally led to upset tummies. Wakefield wondered

if the reverse might be true. Could " leaky guts " play a role in

developmental problems? And if so, could these problems be

alleviated by addressing the inflamed intestines? Other specialists

regarded autistic children as medically untreatable, and none of

Wakefield's business: he was a gut man. But the interventions he

proposed seemed to work. Among the 200 or so children he oversaw, on

average four times a year each at the Royal Free, their behavioural

problems appeared to subside, though not disappear, as their guts

healed. " These kids were often in extreme pain, and that was why

they were screaming or banging their heads on the wall. "

In the 12 cases that he and his team examined in detail, the

children's bowel problems coincided with evidence suggesting that

measles was lurking in the intestinal wall. Given the known

propensity of measles to linger in the gut and, in extreme cases, to

attack the brain, might this implicate MMR in their children's

autism?

It was, to put it mildly, an awkward question. Wakefield had already

raised eyebrows by treating patients traditionally cared for by

psychiatrists, virologists and community paediatricians. One of the

latter had complained in a letter to a colleague in 1987 about " a

zealot surgeon who thinks that MMR is the cause of all the problems

in the western world " . Now others accused him of over-egging the

Lancet article. " Anecdotal reporting of a biased sample, " one

complained. " This has no place in a peer-reviewed journal. "

And soon the fur started to fly. Wakefield had cooked the evidence

by concentrating on just 12 cases. His research facilities were

contaminated. He couldn't replicate his own results. The last of

these charges was true enough. For the first few years, his research

results were inconsistent and contradictory. He blames this on the

measuring technology. He says that changed in 1999 with Professor

O'Leary and his TaqMan viral detector, a machine sensitive

enough to pick up minute traces of measles vaccine DNA in 75

autistic children with disorderly bowels. O'Leary has refused to

finger MMR but he has demanded " extensive and immediate

investigation " into the link. The presence of vaccine-strain

measles, as opposed to the " wild " variety, O'Leary referred to as " a

smoking gun " .

The Department of Health (DoH) was not impressed. Despite

Wakefield's submissions to the then chief medical officer,

Calman, six months prior to publication of the 1998 Lancet article,

public-health officials were understandably resistant to a

hypothesis that queried their vaccination programme on the basis of

one small group of children in north London. But not as resistant as

the drug companies who, as they generally do in teaching hospitals,

sponsored a large chunk of the Royal Free's research. Everybody,

Wakefield and co included, agreed that more studies were needed

before MMR could be shown as a cause of autism. Not everybody,

though, was urging that these should take place.

Over the next three years, Wakefield saw his research funding dry

up. He blames his bosses at the Royal Free for discouraging

potential donors. They blamed him for being " evangelical " and

needlessly scaring parents. Two key members of his team,

Ashwood and Montgomery, found themselves with little to do,

and took up new posts, in California and Stockholm, from where they

have continued the collaboration.

Not all of Wakefield's team were as convinced as him that MMR was

the culprit. One of the co-authors of the 1998 Lancet paper, Simon

Murch, senior lecturer in paediatric gastroenterology at the Royal

Free, recently declared his belief that MMR is safe in a letter to

The Lancet headlined " Separating Speculation from Inflammation in

Autism " . Murch made his move on the eve of publication of a study,

by himself, Wakefield and others, which compares the aggressive

behaviour of gut measles to HIV, adding more fuel to the conspiracy-

theorists' view that scientists connected with Wakefield are being

pressurised to recant. When asked, Murch declined to comment.

Unlike Murch, who stayed put, Wakefield left the Royal

Free, " because it became increasingly obvious that if we were going

to get an answer to this, we had to work outside of an environment

where I was getting more involved in personal wrangles and the

attrition of grants " , he says. Sawyer jumped ship at the same

time to set up a charity, Visceral, that investigates gut-mediated

illnesses and supports projects that test Wakefield's theories.

Visceral's head, and only, office is a converted broom cupboard in

the centre of Bath from which Sawyer describes himself as running " a

virtual medical school " , one that has paid out £1.8m grants to 31

lab scientists around the world. His funding sources are mainly

small charitable foundations in the UK and US, set up to support

independent research (there are around 50,000 in the UK alone).

Visceral, he says forcefully, will not take money from cranks who

believe that all vaccinations are the devil's work. They are

currently funding work on genetic mechanisms that may be perverted

by a malign viral presence in the gut, and which lead the body's

immune system to turn on itself — " aberrant signalling " . The search

for the virus that sets it off is a clinical whodunnit in which he

and Wakefield still have measles vaccine down as their chief

suspect.

Almost everybody who speaks out on MMR has a defined stake in it. My

reason for getting into all of this is simple: Anita and I have a 16-

month-old daughter, and we have a tricky decision to make.

How her developing immune system will benefit from getting three

vaccines in one go, rather than having them singly and spread out

over a few months, has not been adequately explained. On the other

hand, Wakefield's belief in " viral interference " — a tendency for

invading viruses to do more damage when they're combined — sounds

plausible. He quotes three papers published in America and Japan

between 1969 and 1974, identifying the dual presence of the mumps

and measles viruses as a factor that can make the measles more

virulent and dangerous.

The DoH derides this as a " myth " but doesn't explain why on its web

page: MMR The Facts. And there is another fact to be considered: the

British government's recent acknowledgment that " Gulf-war

syndrome " exists. Most of the military personnel afflicted believe it

was brought on by multiple vaccinations prior to the 1991 conflict.

The government hasn't publicly confirmed this but, tellingly, when

British troops were sent to Iraq this year, their jabs were not all

given at once.

Multiple vaccinations are not my thing. I am of an older generation

that was expected, even encouraged, to catch measles and mumps in

early life and get over them. The first I knew that I had survived a

killer illness was when Currie, the health minister who

introduced MMR in 1988, revealed that we were " losing a child a

month in this country " to measles.

Which was not strictly true. In the year before MMR came in, the

Public Health Laboratory Service counted six deaths from a reported

42,000 measles cases. That rate has subsequently declined from 1 in

7,000 to 1 in 10,000. SSPE (subacute sclerosing panencephalitis), in

which measles destroys the brain in a manner similar to variant CJD,

hits about 1 in 8,000 children who catch the disease before the age

of two. Measles epidemics are undoubtedly nasty: 130 children died

in the last big outbreak in the United States in 1989.

When the single measles jab was introduced here in 1968, it was

urged not so much as a life-saver, but as a means of relieving

pressure on GPs during epidemics. Its early popularity related to

other side effects that afflict measles sufferers, such as impaired

eyesight. Mumps vaccine, on the other hand, was a harder sell. Mumps

can cause sterility in adults but only rarely damages children, and

the single mumps jabs did not catch on. Bundling these two vaccines

with the rubella jab, previously given only to girls at age 12, and

offering the package to all children at 15 months, seemed from the

outset to have more to do with administrative convenience than with

public health.

In its 1988 HMSO Handbook of Vaccination for Practitioners, the DoH

claimed a 95% protection rate for the rubella-and-measles single

jabs. In its 1996 edition, post-MMR, the measure of effective

measles immunity had dropped to 90% — beneath the threshold

guaranteeing " herd immunity " . But by now the DoH's data-collection

system no longer recognised single jabs in the compiling of

individual health records.

Today we are informed that MMR is more effective than single

vaccines, as well as unimpeachably safe. But government ministers

are reluctant to address the issue in detail, preferring to issue

bland reassurances such as the one the health secretary, Reid,

made on GMTV in November: " It is unequivocal that there is no

evidence at all that MMR is linked to autism. "

Off the record, however, DoH media briefers acknowledge that MMR has

become " too political " . After receiving wobbly guidance on poisoned

eggs, mad-cow disease and the anti-arthritic drug Opren, the public

no longer believes elected politicians on health issues, so comments

on MMR are kept to a minimum. Salisbury has presided over all

vaccination programmes for the past 15 years, and currently advises

the junior minister for public health, .

Neither of them would speak to me about a successor to MMR that was

first revealed in the press in 1998, shortly before the Wakefield

paper. This was MMRV — V as in varicella, or chickenpox. The DoH now

denies any interest in this, possibly because research on MMRV has

shown it doesn't work. A study partly funded by GlaxoKline,

published last year by the University of Melbourne, found that

quadruply vaccinated children were more prone to suffer fevers

immediately afterwards than those given MMR and varicella vaccines

separately. Worse, they did not develop a significant immunity to

chickenpox after 60 days. But the drug companies haven't given up:

recent press reports tell of more tests on MMRV proceeding in

Sheffield. The DoH says it is " not aware of such a product being

available for use in the UK " .

The row about MMR derives in part from a chronic uncertainty as to

what autism describes. A year after it was identified in 1943, by

Leo Kanner in a study of 11 profoundly uncommunicative, unruly

children, a variant — Asperger's syndrome — proposed a less serious

version, in which poor social skills are offset by an obsessive

attention to detail that can lead to high academic performance. For

years, autism was thought to be caused by unloving parents,

and " refrigerator mothers " in particular. In the 1960s it was

redefined as an inherited brain disorder, and then came a

distinction between classic congenital autism and a regressive

variety acquired after the age of two.

Autism is now referred to as a spectrum disorder, a catch-all

syndrome whose symptoms range from semi-suicidal lunges out of

windows to a relatively harmless obsession with order and routine.

Wakefield's theories about leaky guts blur definitions further by

challenging the traditional view that autism is a purely psychiatric

problem, and arguing that it can be treated by medical means as well

as by behavioural therapies.

One thing that is apparent is that there is a lot more of it about

nowadays. We all know, or know of, somebody with an afflicted child.

Authors, notably Nick Hornby, whose ex-wife Virginia used to be a

trustee of Visceral, have written about their experiences as

parents. Official statistics from the Medical Research Council (MRC)

in 2001 revealed the rate had shot up from 1 in 5,000 per head of

population in 1970 to 1 in 165. In 1988, when MMR was introduced, it

was 1 in 2,200.

That might be coincidence, and it might be that as the spectrum of

the disorder has broadened, we've got better at spotting it.

Wakefield's former colleague at the Royal Free, Professor Brent

, last year published a statistical analysis of children in

north London showing that an autism epidemic was well under way

before MMR. Then it was pointed out by Wakefield and Montgomery that

many children in the survey who appeared, from their date of birth,

not to have had the triple jab but who still developed autism, might

have been included in an extensive " catch-up " MMR campaign targeted

at older children in the early 1990s. later acknowledged this

in a letter to The Lancet, but stands by his broad findings.

In response to my request for clarification, he replied that " the

scientific argument on MMR and autism is over: MMR vaccine is not

involved " . He urged The Sunday Times to " do something positive " for

MMR and for children with autism, instead of " another half-baked

panagyric [sic] for junk science " . I pressed him to explain what he

meant by " junk science " . He didn't mail me back.

Such reticence from the pro-MMR party does not inspire confidence.

Nor do their efforts to identify alternative causes for the steep

increase in diagnosed autism. The Medical Research Council was given

£2.75m by the DoH last year to fund new research. So far, none of

that money has been allocated, though 12 projects are, it

says, " under consideration " . No details could be supplied.

Meanwhile a three-year study that the MRC commissioned in 2000 from

the London School of Hygiene & Tropical Medicine has not yet

reported. Two papers are being readied for publication, one

assessing the rise in autism since 1988 and another looking at

possible links with MMR. The scientist in charge, Professor

Hall, has inspected the GP records of 1,000 children diagnosed as

autistic and sent questionnaires to 400 parents. Since none of

Hall's team has been near an autistic child, whatever he reports is

unlikely to silence Wakefield and the " scopers " . It's stats against

case studies, the old apples-versus-oranges argument. Again.

On the day the Legal Services Commission announced it was pulling

out of the MMR class action, the DoH endorsed that, stating

that " this draws a line " under the controversy. Some hope.

Tomorrow, Five is scheduled to screen a TV drama, Hear the Silence,

with Hugh Bonneville as Wakefield and t son as the

mother of an autistic child battling to get heard by an

unsympathetic gang of haughty specialists. It is a partisan account

of the MMR story, so partisan that Five has organised a televised

discussion afterwards to let the DoH answer back. At the time of

writing, it had not agreed to take part.

The most misleading impression given by the drama is its portrayal

of Wakefield as a gallant loner. In October, I flew to Portland,

Oregon, to attend a conference hosted by the American pressure group

Defeat Autism Now! (Dan!), where Wakefield was one of 23 research

scientists — all confirmed as anti-MMR — making presentations to an

audience of medics and parents. The last speaker was Rick Rollens,

formerly secretary to the California state senate, and the father of

an autistic son.

He presented a torrent of statistics detailing an 800% increase in

diagnosed cases of autism since California introduced MMR jabs in

1979 and made them compulsory, in line with a nationwide Clinton

decree in 1993. The state's Developmental Services Agency now finds

that just under half its clients are autistic, compared with the 3%

it dealt with pre-MMR. The epidemic, Rollens said, was threatening

to wreck care provision in the nearly bankrupt public administration

of California.

This was a depressing and biased presentation. But at least it dealt

in what looked like hard facts. Shortly after returning from Dan!, I

attended a public seminar in London that addressed the MMR/autism

issue in ostrich-like fashion. It was hosted by the PR company Hill

& Knowlton, whose clients includes the three drug companies that

manufacture the triple vaccine, and it was introduced by an online

magazine, Spiked, one of whose columnists, the east London GP

Fitzpatrick, led the discussion. The audience was chiefly

composed of health professionals, DoH representatives and media

types. Two things stood out.

One was the meeting's concern that anxieties about MMR had been

hyped by our old enemy the media. The other was its refusal to

address the evidence that aroused public distrust in the first

place. For these people, immunisation was an incontrovertible

religious doctrine. Fitzpatrick rubbished the work of Wakefield,

whose research papers currently outnumber his own by 128 to 0, as a

superstition on a par with astrology. When somebody mentioned the

divergence of scientific opinion, Professor Brent

interrupted, again announcing that " the scientific debate is over " .

Wakefield has no plans to belt up. More studies are in the

pipeline — so, no doubt, are more allegations of cover-ups and

conspiracies. If Wakefield is proved right, then we've been

poisoning our offspring, avoidably, since his 1998 study. If he's

wrong, then let's hear some intelligible evidence ASAP, so we can

get MMR vaccination rates up — from 67% in the London area and under

80% across the country — to head off threatened measles epidemics.

And single vaccinations need to be reinstated as an affordable

alternative to the worrisome triple jab. A typical price for a

private measles jab is £150.

Having spent £3m on a TV ad campaign urging triple vaccination, with

a prowling lion protecting its young — which didn't work — the DoH's

current course is to carry on ignoring Wakefield et al.

A low-profile series of educational road shows and advice sessions

in the 20 areas of the country with the lowest take-up of MMR began

in the summer. In London, the country's anti-MMR capital, these have

been almost invisible.

Such a feeble defence of the status quo, and a blanking of public

anxieties that might be misguided but are nonetheless genuine, may

suit embattled drug companies and embarrassed government policy

wonks. But it isn't going to silence the enemies of multiple

vaccination — nor will it do much good for anybody's health.