RESPONSE from Wakefield - MMR doctor given legal aid thousands

[Guest guest]

>Latest from Deer....

>The usual lies

>Sheri

>

>http://www.timesonline.co.uk/article/0,,2087-2524335,00.html

>

>The Sunday Times December 31, 2006

>

>

>MMR doctor given legal aid thousands

> Deer

Below is Andy Wakefield's response to this ridiculous garbage...

(I copied and pasted his 2 responses instead of sending as attachments)

We must continue to pray for his family.

Barb Labrecque...............

Deer article tomorrow

Hi,

My reputation is to be further trashed by Deer tomorrow in respect of

experts' fees in the litigation.

I have attached a response and also a letter to Pediatrics in response to

the D'Souza paper. Pediatrics declined to publish it.

Kindest regards and have a great Christmas

Andy

Sunday December 24th 2006

Response by Dr Andy Wakefield to enquiries about expert fees.

Thank you for your enquiry. I hope that the points below will answer any

questions you may have about the issue of experts’ fees in the MMR

litigation.

1. I worked as an expert in the MMR class action litigation for nearly 9

years. As instructed, I charged for my services and this was at an hourly

rate recommended by the BMA after consulting with them on this matter.

2. I worked extremely hard on this very onerous litigation because I

believed and still believe in the just cause of the matter under

investigation. This work involved nights, weekends and much of my holidays

such that I saw little of my family during this time. The price for

standing by these children has been high both for my family and my

professional status.

3. The money that I received was, after tax and out of pocket expenses,

donated to an initiative to create a new center, in the first instance at

the Royal Free Hospital, for the care of autistic children and those with

bowel disease. This intention was made clear, in writing, to senior members

of the medical school. The initiative was unsuccessful at the Royal Free

but ultimately succeeded in the US.

4. My role as an expert was declared as a conflict of interest in relevant

publications (see references below) that discussed the possible role of MMR

vaccine intestinal disease and autism and to journal editors in other

instances. I have referenced the relevant publications below for your

convenience.

5. The costs judge has revised the sum payable by nearly ¤100,000 and I am

happy to abide by this ruling. He has done the same for other experts and I

am informed that this is common practice in cases such as this. A

substantial part of this money was not paid to me in the first place.

6. My actions were at times taken in the best interests of children

potentially damaged by the MMR vaccine. It was my earnest desire to

establish a centre of excellence for the care of these children in the UK.

Sadly, the political climate in there made this impossible. I remain

dedicated to helping these children and resolving the issue of whether

vaccines are involved in this disorder or not. I will not be intimidated or

coerced into stopping this work prematurely.

References

Stott C et al Journal of American Physicians and Surgeons 2004;9:89-91

Wakefield AJ et al. Medical Veritas 2006;3:796-802

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Title: MMR vaccination and autism

Letter

Authors: Dr J Wakefield MB,BS., FRCS., FRCPath and Dr Carol Stott PhD

Response to: D’Souza et al. No evidence of persisting measles virus in

peripheral blood mononuclear cells from children with autism spectrum

disorder. Pediatrics. 2006;118:1664-75.

Dear Sir,

The merit of D’Souza et al’s use of a study of peripheral blood mononuclear

cells to dismiss findings in intestinal biopsies is questionable (1). A

recent US study using nested PCR and sequencing confirmed the fidelity of

the original Uhlmann F-gene primers in the detection of measles virus in

intestinal biopsies from children with autism (2).

D’Souza et al claim that, among other things, the ‘epidemiological burden

of evidence against such an [causal] association between MMR and autism is

overwhelming”. They fail to reference the authoritative Cochrane review of

this epidemiology (3) which dismissed much of it as being of insufficient

quality to merit consideration, including Fombonne’s own work (4) of which

they said, “the number and possible impact of biases in this study was so

high that interpretation of the results was difficult.” Even the Cochrane

review failed to note that another of Fombonne’s studies using the UK

General Practice database (GPRD)(5) tested the wrong hypothesis and lacked

sufficient power to detect an association between MMR and regressive autism.

So which studies are sufficient to overwhelm? Several have looked at age of

exposure to MMR vaccine and risk of autism. Such a hypothesis is merited on

the basis that younger age of exposure to measles virus is associated with

an increased risk of adverse outcome including persistent infection and

delayed disease. Richler et al posed the question of whether there is an

autism phenotype characterized by regression associated with significant

intestinal symptoms following MMR vaccine, in a previously developmentally

normal or near-normal child (6). Children meeting these criteria were

compared with all other autistic children in their study cohort. In this,

the only epidemiologic study to at least attempt to segregate this sentinel

autism phenotype, age-of-exposure to MMR vaccine was significantly lower

(mean age 14.38 months) when compared with the remaining autistic

population (mean age 17.71 months; (p<0.05). Strangely - and at odds with

their own reported findings - the authors concluded that, ‘there was no

evidence that onset of autistic symptoms or of regression was related to

MMR vaccination’.

Three further aspects of age-of-exposure to MMR and autism have been

reported: DeStefano and colleagues performed a case-control study comparing

age at first MMR vaccination in children from the Atlanta metro area (7).

By 36 months of age, significantly more cases with autism (93%) had

received MMR than controls (91%)(Odds Ratio 1.49; 95% confidence interval

[CI] 1.04-2.14). This association was strongest in the 3 to 5-year age

group with an Odds Ratio of 2.34. Due to diagnostic delay, a significant

proportion of this group had yet to be diagnosed with autism, potentially

underestimating this risk. Moreover, in a subgroup analysis looking at

children with different disease characteristics, they found a significant

association between MMR vaccination by 36 months and autistic children with

no evidence of mental retardation (IQ>70; OR 2.54 [1.20-5.00]). The odds

ratios were increased to 3.55 in a subgroup analysis adjusted for birth

weight, multiple gestation, maternal age and maternal education, thus

strengthening the association between age-of-exposure to MMR and autism. It

is interesting that their ‘regressive group’ did not show this effect

although the interpretation of this finding is severely constrained by

their retrospective ascertainment of regression from medical records.

First, regression did not form part of the diagnostic algorithm for autism

and second, the concept of regression conflicted, until very recently, with

the beliefs of most autism diagnosticians. IQ, on the other hand, is an

objective measure and a normal IQ appears to be an increasingly common

feature among recent cohorts of affected children (8). An IQ within the

normal range may well reflect a period of normal cerebral development and

in this instance, be a better marker of the late-onset phenotype than

retrospective record review. Having tested a hypothesis and found a

significant association between autism and age of first MMR exposure, the

authors, somewhat curiously, ascribe this effect to an ‘artifact of

immunization requirements for pre-school special education attendance in

case children’. Such an interpretation would only possibly be valid if the

immunization mandate for normal pre-school children were different from

that of special education children; it is not. Moreover, the special

education group, with a likely excess of contraindications to MMR

vaccination such as seizures, should have a lesser exposure to MMR. In

addition, if there were no true association, lower exposure in the special

education group would be expected in light of higher levels of parental

concern and consequent rates of abstention in this group, a possibility

that could have been easily checked by comparing the proportions of

exemption filings held by law in all state schools. This notwithstanding,

the data of DeStefano et al are not consistent with the author’s post hoc

rationalization.

Second, es and Baltzan (9) reanalyzed the California autism data of

Dales and colleagues (10), confirming that the age of MMR immunization was

becoming younger between 1981 and 1993. The ratio of children immunized

before age 17 months to those immunized between age 17 and 24 months

increased 200% from 1981 to 1993, and the rate of early MMR immunization is

correlated with the incidence of autism. This is an important factor in

light of DeStefano et al’s observation of a greater statistically

significant association between autism and MMR vaccination by 36 months in

more recent birth cohorts (7).

Third, Suissa pointed out that according to the Danish data of Madsen et al

(11) the rates of autistic disorder by age at vaccination, are 18.9, 14.8,

24.6, and 26.9 per 105 per year respectively for ages <15, 15-19, 20-24,

25-35, falling to 12.0 per 105 with age at vaccination >35 months, compared

with the overall rate of 11.0 for the reference group of no vaccination,

over all ages (12). Suissa considered it somewhat implausible for the

age-adjusted rate ratio to fall below 1 (as presented), unless the risk

profile by age in the unvaccinated is vastly different than in the

vaccinated. Thus, rather than an apparent association between exposure and

outcome being a spurious result of confounding, this would actually

represent effect modification. The data support the hypothesis of an

association between exposure and outcome, modified, rather than confounded

by, age of exposure.

While an effect of age of exposure to MMR vaccine on autism risk is evident

from these studies, the nature of that risk is not known.

Aside from the issue of age of exposure, et al found a significant

clustering of parental concern within 6 months of MMR vaccination

(p=0·03)(13) and, as was later pointed out, a step-up in number of autism

diagnoses associated with the introduction of MMR vaccination in the UK

(14). A similar step up in the autism rate with introduction of MMR was

observed in Denmark (12).

Overwhelmed, D’Souza et al claim that the hypothesized link between MMR and

ASD is spurious. With respect, we disagree.

J Wakefield MB,BS., FRCS., FRCPath and Carol Stott Ph.D

References

1. D'Souza Y, Fombonne E, Ward BJ. No evidence of persisting measles virus

in peripheral blood mononuclear cells from children with autism spectrum

disorder. Pediatrics. 2006;118:1664-75.

2. SJ, Hepner K, Segal J, Krigsman A. Persistent ileal measles virus

in a large cohort of regressive autistic children with ileocolitis and

lymphnodular hyperplasia: re-visitation of an earlier study [abstract].

International Meeting for Autism Research (IMFAR) 2006,

http://www.cevs.ucdavis.edu/Cofred/Public/Aca/WebSec.cfm?confid=238 & webid=12

45.

3. Cochrane. Demicheli V, Jefferson T, Rivetti A, Price D. Vaccines for

measles, mumps and rubella in children (Review) The Cochrane Library.

Wiley & Sons, Ltd. 2005, Issue 4. http://www.thecochranelibrary.com

4. Fombonne E, Chakrabarti S. No evidence for a new variant of

measles-mumps-rubella-induced autism. Pediatrics 2001;108:E58

5. Smeeth L, Cook C, Fombonne E, Heavey L, Rodrigues L, P, Hall A.

MMR vaccination and pervasive developmental disorders: a case-control

study. Lancet 2004, 364:963-969

6. Richler J, Luyster R, Risi S, Hsu Wan-Ling, Dawson G, Bernier R, et al .

Is there a ‘regressive phenotype’ of autistic spectrum disorder associated

with the measles-mumps-rubella vaccine? a CPEA study. Autism Dev. Dis.

2006, 36:299-316.

7. DeStefano F, Bhasin TK, WW, Yeargin-All–sopp M, Boyle C. Age at

first measles-mumps-–rubella vaccination in children with autism and

school-mat–ched control subjects: a population-based study in metro–politan

Atlanta. Pediatrics 2004, 113:259–266.

8. Autistic Spectrum Disorders: changes in the California caseload. An

update: 1999 through 2002. California Department of Developmental Services.

A Report to the Legislature, Department of Developmental Services.

Sacramento, Calif.: www.dds.ca.gov. Accessed Oct, 2006.

9. es M, Baltzan M. MMR Immunization and Autism. JAMA 2001,

285:2852-2853

10. Dales L, Hammer SJ, NJ. Time trends in autism and MMR

immunization coverage in California. JAMA 2001, 285:1183-1185

11. Madsen MK., Hviid A., Vestergaard M., Schendel D., Wohlfarht J.,

Thorsen P., et al. A population-based study of measles mumps rubella

vaccination and autism. NEJM 2002, 347:1478-1482.

12. Stott CA; Blaxill M, Wakefield AJ. MMR and Autism in Perspective: the

Denmark Story. Journal of American Physicians and Surgeons. 2004;9:89-91

13. B, E, Farrington P, et al. Autism and measles, mumps,

rubella vaccine: no epidemiological evidence for a causal association.

1999;353:2026-2029.

14. Wakefield AJ.MMR vaccine and autism. 1999;354:950-951.

Potential conflicts.

The authors have acted as paid experts in the UK MMR vaccine litigation.

AJW is a named inventor on two viral diagnostic patents.

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Sheri Nakken, R.N., MA, Hahnemannian Homeopath

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

Vaccines - http://www.nccn.net/~wwithin/vaccine.htm