30/11/01 Private Eye - UK - MMR: The Doctor's Reply

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From Jackie at JABS in the UK! jabs@...

This is the follow up to the article recently in Private Eye in October

(there is no URL)

Like this comment

" We stated in the article that we have received funding from vaccine

manufacturers (none of which has been personal profit). It would be

professional suicide to take a particular stance on an issue for reasons other

than the scientific evidence. "

Professional suicide - right!

Sheri

30/11/01 Private Eye

MMR: The Doctors Reply

Sir,

" More needle over MMR " (1038) criticised our report in Archives of Diseases in

Childhood in which we reviewed the evidence on the purported link between MMR

vaccine and autism for our colleagues in child health.

The intention was not to " rubbish " Wakefield but to examine the

scientific evidence. Unfortunately, since the research suggesting a link

between MMR, autism and bowel disease has been almost exclusively conducted by

Wakefield and colleagues, any criticism of the evidence may be

construed

as criticism of the author rather than the science.

You state that we made " great claims " for the " Finnish study " . It is

unfortunate that you failed to notice that we were not referring to the recent

much quoted study by Patja, but to two more rigorous studies published in 1986

and 1998. We also cited not only the original 1999 paper, but a more

recent paper in which the data were re-analysed to allow for the diagnosis of

autism up to three years following MMR vaccine. This re-analysis confirmed no

association between MMR vaccine and autism.

In referring to a regimen of the three single vaccines never having being used

in this age group, we meant exactly that. This fact is fundamentally

important.

Single measles vaccines were indeed used in the UK from 1967 to 1988, and are

still recommended by WHO in some circumstances. Rubella vaccine was commonly

used in secondary school girls. This is entirely different from the regimen

that some professionals are advocating. It is not possible to predict, from

this experience, the safety and efficacy of the proposed regimen ie single

measles, mumps and rubella vaccines at yearly intervals. Following the

introduction of the combined MMR vaccine there was a significant reduction in

these diseases.

We assume that the reference to the outbreak of measles in a highly immunised

population concerns a paper published in the South African Medical journal in

1994 ( " The 1992 measles epidemic in Cape Town - a changing epidemiological

pattern " Coetzee et al). The authors concluded not that there was a difference

in efficacy between the combined MMR and the single measles vaccine, but that

the MMR had not been stored properly. This emphasises the importance of

reading

the original scientific research, in full, rather that relying on someone

else's interpretation. This also applies to the 1988 paper by Wakefield et al,

often quoted as the basis for the fears about the safety of MMR vaccine.

However, in the paper the authors themselves said " We did not prove an

association between measles, mumps and rubella vaccine and the syndrome

described " .

Our " selective " questioning of the use of two specific strains of mumps

vaccine

was to highlight the problems inherent in the use of unlicensed products. Some

children have been given these vaccines and are now either inadequately

protected or ran the risk of developing meningitis.

The Archives paper reviewed the evidence to date concerning a proported

association between MMR vaccine, autism and bowel disease, it was not intended

to provide a complete review of the safety profile of MMR vaccine. In your

piece you gave the impression that the infrequent associations of idiopathic

thrombocytopenic purpura (ITP) and convulsions and MMR vaccine have only just

been revealed. They have been recognised for many years, albeit at a much

lower

incidence than occurs with natural infection.

We stated in the article that we have received funding from vaccine

manufacturers (none of which has been personal profit). It would be

professional suicide to take a particular stance on an issue for reasons other

than the scientific evidence. We are not alone in concluding that the evidence

does not support an association between MMR vaccine and autism or bowel

disease.

In presenting an unbiased picture, you will of course be reporting the latest

paper by Fombonne in which he reported no association between MMR vaccine and

regressive autism as originally suggested by Dr Wakefield?

We stand by our conclusion that: " While the final decision rests with the

parents, the evidence of the safety and efficacy of MMR vaccine is so

overwhelmingly conclusive that health professionals should have no hesitation

in recommending its use. "

Yours sincerely

DAVID ELLIMAN, Consultant in Community Child Health, St 's Hospital,

London

HELEN BEDFORD, Lecturer in the Epidemiology of Child Health, Institute of

Child

Health, London

Sir,

Re: " More Needle over MMR " , (3 October 2001.) I am writing to you to correct

several significant factual inaccuracies which appeared in the above

article in

Private Eye earlier this month.

Your report implies that the media coverage of the " Archives of Disease in

Childhood " paper suggested that this was new research, rather than a review of

previous reasearch. No attempt was made by the PHLS to present this as

anything

other than an overview. Indeed, as your own article points out, I described it

as such in my commentary; and the PHLS press office was at pains to point out

to journalists who called us that this was not " new research " .

You state that the policy of using separate vaccines is fully sanctioned by

the

WHO - it is not. The WHO fully endorses the use of the triple MMR vaccine as

the best way of protecting children against the disease; it has never endorsed

the use of single measles, mumps and rubella vaccines.

I stand by the view that there is no evidence about the safety and

effectiveness of single vaccines used in place of MMR. You are correct to say

that there are studies of single vaccines used in isolation, such as the 1994

measles vaccine study. However, there is no evidence looking at the safety or

effectiveness of giving single measles, mumps and rubella vaccines, separated

by a time interval, to the same child as part of a routine immunisation

schedule. Parents who have expressed concern about MMR have often cited the

interaction of the three elements as a key concern; the lack of evidence about

how three single doses will interact is therefore likely to be of particular

concern to those parents.

The separate measles and mumps vaccines being imported are not licensed in

this

country; where doctors give such vaccines, they do so on an unlicensed, named

patient basis.

You might like to note that I have done work investigating adverse

reactions to

vaccines; as you mention in your article, I have published (and publicised)

work which looked at the association between MMR and idiopathic

thrombocytopenic purpura (ITP), a rare rash disorder. The study concluded

that

the measles and rubella vaccine components of MMR were associated with an

increased rate of ITP, but that the reaction was rare, and relatively mild

compared with the effect of the diseases measles, mumps and rubella

themselves.

I also led the research work which showed a link between a strain of mumps

vaccine (the Urabe strain) and increased rates of viral meningitis. In this

case the work led to the vaccine being withdrawn altogether. To suggest as you

do that I am not prepared to be critical of vaccines when they are unsafe is

simply not supported by the facts.

Finally, you state that my work on MMR paved the way for its licensing. In

fact, the work I coordinated on MMR was not part of the licence application at

all. The vaccine licence was granted on the basis of work done elsewhere.

I hope this clarifies the situation.

Your sincerely

DR. ELIZABETH MILLER,

Head, PHLS Immunisation Division.

--------------------------------------------------------

Sheri Nakken, R.N., MA

Vaccination Information & Choice Network, Nevada City CA & Wales UK

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