Following an article that appeared in this newspaper last Sunday about a new film linking the MMR vaccine to autism, consultant paediatrician Victor Grech explains why the claims are utterly false.

Massive research (at the taxpayers’ [our!] expense) showed, and continues to show, that MMR and autism are unrelated. But the two continue to be incorrectly linked by the media, on the internet, and in a new film by British medical researcher Andrew Wakefield.

What are my qualifications for delving into this? I am a paediatrician with some experience with children. I understand public health (and am reading for a dissertation in this field) but am not employed as a public health doctor – so I do not have to toe any lines. I am known to generally speak my mind – with caution and scientific evidence behind me.

The MMR vaccine is a free vaccine given by the local health centres – I naturally make no earnings whatsoever from this and I have no shares in any vaccine company. So I have no disclosures or conflicts of interest.

What is the backdrop to this particular conspiracy theory?

In 1996-1998, Wakefield, a former doctor in the UK, worked on a lawsuit on behalf of parents of children with autism. He claimed an undisclosed £150 (€180, $230) an hour (earning £435,643, plus expenses) studying a very, very small group of children (12 actually) before publishing a paper in 1998 in which he proposed a new bowel-brain “syndrome” (including autism) following vaccination with the MMR (measles, mumps, rubella one-year vaccine).

Autism is a chronic and genetic developmental disorder characterised by difficulties in communication and social interaction, typically accompanied by restrictive and repetitive behaviour. This condition is often diagnosed after one year of age, around the time when MMR is given. But temporal association (events occurring close together) does not automatically imply causality unless scientifically and rigorously proven.

Wakefield’s claims were investigated and the exposé by the investigative journalist Brian Deer of the Sunday Times of London triggered the lengthiest ever UK General Medical Council fitness to practise hearing. The original paper reporting the purported link was withdrawn and Wakefield was struck off the Medical Register, deemed unfit to practise medicine.

He displayed an incredible degree of various conflicts of interest, while utilising methodologically and ethically flawed research techniques (see further below).

Furthermore, in the interim, Wakefield had filed a patent claiming to have discovered an alternative to the measles vaccine, a fact that he later repeatedly denied, displaying not only a shocking conflict of interest with the intention of making future financial gain but also the ability to lie and to continue to be believed despite this clear evidence of medical and scientific malfeasance.

Moreover, this purported measles alternative is only a theoretical possibility that has still not been developed, more than a decade later.

‘Do not leave your children at risk. Vaccinate’

Wakefield was found guilty of ethical violations for personal financial gain since he had performed invasive investigations (endoscopy) on children without obtaining the customary, necessary, crucial and mandatory ethical clearances. He was also found guilty of scientific misrepresentation.

Wakefield’s claims have been repeatedly invalidated by other researchers including governments. This is because obviously, it is not in governments’ interest to administer a vaccine that would result in an individual who would require lifelong care by the state. However, despite millions of vaccine dose administrations studied (think of the money wasted in these studies! From our collective taxes!), no link between MMR and autism has been found.

Consequences of non-vaccination

Measles, mumps and rubella are all potentially serious infections. Measles in particular may lead to death or brain infection, resulting in serious and permanent mental and neurological disabilities. Mumps may cause meningitis and permanent hearing loss. In pregnant women, rubella may cause severe brain damage, deafness and blindness in the developing baby. The MMR vaccine protects us against all of these illnesses.

Unfortunately, parents the world over unwisely and irrationally chose not to vaccinate their children, exposing them to the risks of these diseases and the well-documented and incontrovertible complications. Measles outbreaks have occurred since in the UK in 2008 and 2009 as well in the US and Canada. People have died or suffered complications of these conditions. The body count is unknown.

The Wakefield affair is thus far arguably the most serious fraud to date, a myth that continues to be promulgated without a shred of credible medical or scientific evidence. Scientists have an ethical and moral responsibility to ensure the highest possible standards of research. There can be no comprise as error or deliberate deceit (as in Wakefield’s case) can harm individuals and indeed, entire populations.

It remains a matter of grave concern to the scientific community that the Wakefield fraud exposure was the result of journalistic investigation, rather than academic vigilance, implying systematic failure in the way in which research is published and disseminated.

The internet does not help and neither do celebrities who posture and promote anti-vaccination rhetoric. One disadvantage of the web is that due to excessive credulity by readers, anyone who hatches a conspiracy theory can convey it to the world through the web, exponentially. If the world does not accommodate your views, no matter how irrationally crackpot, then you can go ahead and create your own realities and inevitably, these will be disseminated on the web and you will predictably find people who share your distorted version of reality. This naturally encourages the proliferation and promulgation of conspiracy theories of all sorts.

Conspiracy theories in turn appeal to individuals who feel that society and the world are failing to provide them with the realities that they desire. Deliberately media-hyped controversy does not help – except to sell newspapers and advertising therein. This is factual cynicism, not a conspiracy theory.

Do not believe all that you read on the internet. I personally looked at the entire MMR autism charade back in 2005 (in a paper published in the Malta Medical Journal) and have revisited the issue and reread my own paper – and can find nothing further to add. A PDF copy of this paper is attached to this article. 

This paper also lists the known and incontrovertible complications of the diseases prevented by the vaccine. A table listing common parent MMR misgivings and misconceptions is also particularly apt.

The Maltese Paediatric Association continues to emphasise the overwhelming evidence showing that there is absolutely no link between the MMR vaccine and autism. Do not leave your children at risk. Vaccinate.

MMR vaccine and autism: why the research was a fraud

Andrew Wakefield’s paper, when dissected, was shown to have numerous inconsistencies and discrepancies, with data and information massaged and manipulated in order to fit in with Wakefield’s proposed bowel-brain “syndrome”. These inconsistencies included:

There was no clearly stated research hypothesis.

The study group was highly selected, extremely small, had no blinded investigators, included no controls, had a very short follow-up period and was therefore inherently incapable of proving or excluding a causal link between MMR and autism or inflammatory bowel disease.

The alleged link with MMR vaccination was made solely on the basis of retrospective parental recall, that is, parents who had signed a consent form to take part in a study to determine a causal link between MMR and autism were asked to remember how closely in time the vaccine was with the onset of autism-like behaviour pattern in their child. This is known as recall bias and is to be avoided at all costs in serious research.

Three of nine children reported to have regressive (progressive) autism did not have autism diagnosed at all and only one child clearly had regressive autism.

Despite the claim that all 12 children were normal prior to vaccination, five had documented pre-existing developmental concerns.

No test was consistently abnormal in all of the children.

Some children reported as experiencing their first behavioural symptoms within days of vaccination only had documented records to this effect months after vaccination.

In nine cases, bowel biopsy results were actively changed from “normal” to “non-specific colitis”.

Inconvenient dates from vaccination to perceived onset of symptoms were excluded, thereby fostering and reinforcing the illusion of a 14-day link between vaccination and symptoms.

The children chosen to be investigated were not consecutive cases as reported in the paper but selected to suit the agendas of the study.

Two independent laboratories, which tested bowel samples from the same children, failed to confirm Wakefield’s findings.

Children were recruited via anti-MMR campaigners, and the study was funded with the intention of instituting a lawsuit to discredit MMR vaccination, another clear conflict of interest.

It is certain that had Wakefield declared his various conflicts of interest, the paper would not have been accepted for publication.

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