In her 2003 Daily Mail article,
entitled ‘MMR: The truth’, Melanie Phillips claims to offer the public the
facts regarding the MMR vaccination scare, which started with the publication
of a 1998 research paper by Andrew Wakefield and colleagues at the Royal Free
Hospital and School of Medicine in Hampstead, London. However, within the first
few lines of the article, she has already set the tone of the story, describing
Mr Wakefield as an “outcast and an enemy” who has been “driven from his job” by
the scientific establishment. The use of such language immediately evokes an
emotional response aimed at creating a feeling of sympathy for Wakefield,
before presenting any facts, whether against or in defence of his claims.
Shortly afterwards, Miss Phillips claims Wakefield’s detractors were “allegedly
bribed or threatened not to have anything to do with him” – a claim she does
not substantiate anywhere in her article, but which further creates the
impression that Wakefield is the victim of a global conspiracy.
Her attempt to evoke an emotional
response continue in parts two and three of the investigation, where she
interviews the parents of a number of autistic children who allegedly began to
display symptoms of the disease shortly after vaccination. Use of descriptions
such as “a bubbly and jolly baby” and “bright as a button”, followed by
accounts of the children’s parents’ observations of how their development
regressed, resulting in terrible symptoms, constitute anecdotal evidence at
best, but they further create bias against the ‘callous’ establishment that
continues to deny that MMR can have devastating consequences.
Another method used by Phillips
to create bias in favour of Mr Wakefield’s claims is the misrepresenting of a
report on the safety and continued use of the vaccine. She quotes a report by
the Institute of Medicine of the National Academies (wrongly called the
‘American Institute of Medicine’ in the article), claiming that the report
found that “evidence
from a booster would constitute a strong case that the vaccine and the symptoms
ascribed to it were linked”. Although the report’s authors may have made that
point, the conclusion of the report actually stated that, while more research
was needed, “The evidence favours rejection of a causal relationship at
the population level between MMR vaccine and autistic spectrum disorders.” (IOM
2001) Then, in part three of her article, Phillips explains the UK Department
of Health’s defence of the MMR vaccine by revealing that the government of
Japan decided to abolish the polyvalent vaccine in 1993 after the Urabe strain
of mumps in the vaccine caused an outbreak of aseptic meningitis, adding that
the DoH had by then already removed vaccines containing this strain, but
immediately pointing out that the department had knowledge of the risks when it
introduced the vaccine. She does not mention that Japan’s government is
planning to reintroduce a polyvalent vaccine to replace the single jabs it has
used since 1993. In addition, a study published two years after Melanie
Phillips’ article found that autism rates in Japan have continued to rise since
the abolition of MMR, offering evidence against a link between the two. (Honda
et al 2005)
Despite the fact that the
overwhelming majority of scientists and doctors have dismissed the claims made
by Andrew Wakefield, Phillips cites only two such figures; child psychiatrist
Dr Patrick Bolton and fellow autism expert Dr Eric Fombonne. However, she is
quick to point out that the latter is “advising the drug companies that make
MMR” in an attempt to discredit him. Meanwhile, claims to provide evidence that
“utterly inconclusive studies” have been used as proof that MMR is safe, but
fails to cite any studies – whether supporting or contradicting her claims.
Finally, the article repeatedly
claims that those critical of Andrew Wakefield’s research are paid by the
pharmaceutical industry to claim MMR is safe, but it fails to provide any proof
of these allegations. Furthermore, Phillips does not appear to have
investigated the conduct of Wakefield himself, who later faced claims of
misconduct and fraud together with two of his colleagues, nor does she mention the
decision of the majority of co-authors of his paper to retract their support
for its findings. An investigation published in The Sunday Times a year after the Daily Mail article revealed that Wakefield himself had a conflict
of interest regarding the publication of the paper, having submitted a patent
application for a new measles vaccine in 1997. (Deer 2004) This investigation
also claimed that Wakefield had falsified data, and ultimately led to legal
proceedings which saw him banned from practising medicine in the UK.
THE RESEARCH
In 1998, The Lancet published a report, created by Andrew Wakefield and his
team at the Royal Free Hospital and School of Medicine in north London, describing
a one-week research project involving 12 children between the ages of three and
ten, all of whom had been referred to the unit after suffering a regression in
development, combined with symptoms such as diarrhoea and abdominal pain.
(Wakefield et al 1998) In eight of the cases, the parents or the child’s GP had
identified the MMR vaccine as a possible cause; in one case measles was
identified, in another otitis media, and in two cases no link was established
prior to admission. Neuropsychiatric diagnosis was autism in ten cases,
post-viral encephalitis in one case and post-vaccinial encephalitis in another.
After carrying out a range of tests over a period of one week, the team
concluded that:
Intestinal
and behavioural pathologies may have occurred together by chance, reflecting a
selection bias in a self-referred group; however, the uniformity of the
intestinal pathological changes and the fact that previous studies have found
intestinal dysfunction in children with autistic-spectrum disorders, suggests
that the connection is real and reflects a unique disease process. (Wakefield
et al 1998)
Prior to publication of the
report, senior scientific investigator Andrew Wakefield arranged a press
conference, during which he called for the suspension of the MMR vaccine
pending further research, warning that it appeared the vaccine could cause
autism and bowel disease in a small percentage of recipients. His comments made
headlines in the UK and abroad, and led to widespread concerns and a fall in
uptake of the vaccine. However, no study in the 14 years since the report’s
publication has been able to replicate Mr Wakefield’s results, and
epidemiological studies have consistently reported no evidence for a link
between MMR and autism.
In 2000, the Pediatric Infectious Disease Journal published an epidemiological
study conducted in Finland. (Patja et al 2000) The study analysed data from
hospitals and health centres throughout Finland concerning adverse effects
reported in children who had received the MMR vaccine between 1982 and 1996.
Over this period, 1.8m individuals were given a total of three million MMR
vaccinations, resulting in reports of 173 alleged potentially serious
reactions. These included 77 neurologic reactions – however, 45pc of the total
number of reactions were later “proved to be probably caused or contributed by
another factor.” (Patja et al 2000) Ultimately, the researchers concluded that
a link between the vaccine and adverse events cannot be established “solely on
the basis of a temporal relation,” and that the risks of natural MMR diseases
are far greater than the minimal risks posed by the vaccine.
Five years later, a Japanese team
published an epidemiological study which had analysed autism rates in Japan in
children up to age seven in the city of Yokohama between 1988 and 1996. (Honda,
Shimizu, Rutter 2005) It was reported that between 1988 and 1992, autism rates
in the city declined significantly. The last polyvalent MMR vaccine in Japan
was given in 1993, and between 1993 and 1996 the rate of ASD was found to have
increased significantly. The study’s authors concluded that withdrawal of the
MMR vaccine in countries where it was still being used would be unlikely to
lead to a reduction in ASD rates.
In 2008, an international team
published a report on a study that analysed the presence of measles vaccine
(MV) RNA in bowel tissue of children with autism. (Hornig 2008) The study
looked at 25 US children with autism and GI disturbances, and another 13 with
GI disturbances alone, who served as a control group. The researchers did not
discover a difference between the presence of MV RNA in the ileum and cecum,
and concluded that this offered evidence against a causal link between exposure
to MMR or persistent MV RNA in the GI tract and autism.
In the face of ongoing concerns,
the Cochrane Collaboration carried out a meta-analysis of 31 studies into the
alleged link between autism and MMR published before 2004. (Demicheli et al
2008) The authors concluded that reporting and design of safety outcomes in MMR
vaccine studies are largely inadequate, noting that “The evidence of adverse
events following immunisation with MMR cannot be separated from its role in
preventing the target diseases.” (Demicheli et al 2008) Analysis of the
studies further found that although the MMR vaccine was associated with an
increased risk of symptoms including irritability, there did not appear to be a
link between the vaccine and Crohn's disease, ulcerative
colitis, autism or aseptic meningitis. The authors were not able to identify
studies that met their inclusion criteria, which assessed the effectiveness of
MMR.
REFERENCES
BOSELEY
S. (2004) “MMR vaccinations fall to new low.” The Guardian, 24 September 2004 [online]
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DEER
B. (2004) “Revealed: MMR research scandal.” The
Sunday Times, 22 February 2004 [online]
Available
from: http://briandeer.com/mmr/lancet-deer-1.htm[Accessed 11 February 2012]
DEMICHELI
V. et al (2008) “Vaccines for measles, mumps and
rubella in children.” Cochrane Library
[online] October
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HONDA
H., SHIMIZU Y., RUTTER M. (2005) “No effect of MMR withdrawal on the incidence
of autism: a total population study.” The
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572-579
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HORNIG
M. et al (2008) “Lack of Association
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OF MEDICINE OF THE NATIONAL ACADEMIES (2001) Immunisation safety review: Measles-mumps-rubella vaccine and autism (report
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LAURANCE
J. (2008) “Official warning: Measles ‘endemic’ in Britain.” The Independent, 21 June 2008 [online]
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PATJA
A. et al (2000) “Serious adverse events after measles-mumps-rubella vaccination
during a fourteen-year prospective follow-up.” Pediatric Infectious Diseases Journal [online] v. 19 (12),
December, pp. 1027-1034
Available
at: http://www.nccn.net/~wwithin/MMR.pdf[Accessed 10 February 2012]
PHILLIPS,
M. (2003) “MMR – The truth.” Daily Mail March/April
2003 [online]
Available
from: http://www.dailymail.co.uk/health/article-171316/MMR--The-Truth.html, http://www.dailymail.co.uk/health/article-171527/MMR--warnings-ignored.html, http://www.dailymail.co.uk/health/article-171779/MMR-true-facts.html[Accessed 10 February 2012]
WAKEFIELD, A.J. et al (1998) “Ileal-lymphoid-nodular hyperplasia,
non-specific colitis, and pervasive developmental disorder in children
(retracted).” The Lancet [online] v.
351 (9103), February, pp. 637-641
Available at: www.sciencedirect.com[Accessed 10 February 2012]
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