Letter to Lenny
‘MMR; the unanswered questions’, Melanie Phillips’ article in support of Dr Andrew Wakefield’s suggested link between autism and the MMR vaccine seems to be a reprise of Robert Kennedy Jr’s efforts in establishing the link between mercury and autism. Never let the facts get in the way of a good story
Phillips is very unhappy with the Cochrane Collaboration Study: “Vaccines for measles, mumps and rubella in children (Review)”, that concluded:
“Exposure to MMR was unlikely to be associated with Crohn’s Disease, ulcerative colitis, autism or aseptic meningitis.”
Phillips is especially concerned that this will start a feeding frenzy among the piranhas - those who never believed Wakefield in the first place and states acerbically that
“ These people should start by reading the actual study’.
Phillips should take her own advice. One of the pillars of her argument is that
“Wakefield never suggested a link between MMR and Crohn’s disease, a disorder of the bowel. Wakefield reported instead the discovery of an entirely new syndrome, autistic enterocolitis, which produced distressing bowel symptoms along with a number of developmental problems resembling autism – but which the Cochrane report did not even mention”.
Contrast this with the following from Wakefield’s publication in the Lancet.
Wakefield’s findings showed that “All 12 children had intestinal abnormalities, ranging from lymphoid nodular hyperplasia to aphthoid ulceration.” Further, from his endoscopy results “Four cases showed the "red halo" sign around swollen caecal lymphoid follicles, an early endoscopic feature of Crohn's disease.”
It becomes apparent that the term enterocolitis covers a range of enteric pathologies, including Crohn’s disease. Phillips goes sadly astray in attempting to use a generic term as a specific and calling it a brand new one at that.
Phillips then goes on to state unblushingly that the Cochrane study did not find Wakefield’s research unreliable. True. They left out all four articles, one because it was a case series, one on the grounds that it had no data and two because they had no comparative data. There was no way to tell if they were unreliable or not. They certainly were not reliable enough to be included. However, the bottom fell out of Wakefield’s claims to reliability when it was found by his own laboratory that no measles RNA could be detected in any of the biopsy samples from Wakefield’s 12 ‘autistic enteropathy’ patients.
One could conjecture that Phillips has a taste for linguistic acrobatics. Her next salvo concludes that while the Cochrane report said that the design and reporting of safety outcomes was ‘largely inadequate’ this means that the MMR could not be considered safe despite the finding by the Cochrane report of no association between MMR and autism. Phillips’ line here says it all:
“ But that does not mean that it said the vaccine was safe. It was rather that it didn’t find anything to suggest that it was not”.
Those of us who like to preserve our sanity usually presume that something is safe if we have tried hard but can’t find sound evidence to the contrary rather than take the sure route to paranoia through adopting Phillips’ position.
Apparently studies like the Cochrane review are too crude to pick up the small minority of children who for whatever reason are going to be susceptible to regressive autism through exposure to the MMR, a valid point if you ignore the Finnish study. Phillips appeals to the clinical evidence “obtained not just by Wakefield and his associates but by others”. Phillip’s is saying very clearly that Wakefield’s clinical findings have been replicated. This is highly significant, the very crux of the matter. So, where are the references? What clinical findings are we talking about here? If there is reliable evidence, apparently replicated, that enterocolitis, autism and the MMR are linked then why is Wakefield the subject of a medical board enquiry? Shouldn’t they be giving him a medal instead? Strangely the Institute of Medicine, cited by Phillips, does not seem to be aware of these highly significant, indeed, crucial findings. The National Health Service UK, also in ignorance of this critical data, has compiled a veritable encyclopaedia of every paper ever written on the subject of the MMR vaccine including Wakefield and the disreputable Geier’s VAERS study.
Reminiscent of the autism=mercury poisoning cabal, Phillips castigates the Government for refusing to carry out large scale clinical trials to prove once and for all that there is no link between the MMR and autism with enterocolitis. One wonders how large the scale must be to qualify as ‘once and for all’ since Phillips is essentially implying that there is no clinical data available, which is untrue and incidentally, inconsistent with her later assertion of the appropriate venue for examining this clinical evidence.
Phillip’s penultimate thrust is to compare apples and oranges in the ‘conflict of interest’ market. Apparently, the upfront disclosure of having once advised a pharmaceutical company's legal team is on a par with Wakefield concealing that some of his original study patients were about to embark on a class action against the manufacturers of the MMR, not to mention his patent application for a ‘safer’ single dose vaccine regime. This is, quite frankly, dishonest.
Finally some mention should be made about Phillips’ rather peculiar notions of examining the clinical evidence. According to Phillips, “Hopes of examining the existing clinical evidence were pinned on the legal case being brought by the parents claiming compensation on behalf of children damaged by the vaccine”. One would hope that the validity or otherwise of the clinical evidence would have been settled long before the lawyers enter the fray. Questions of this type are tried in the court of scientific peer review, not in courts of justice where, obviously, expertise is absent. In addition, Phillips treats parental evidence as sacrosanct, whereas in the real world, it is freely admitted that recall bias is endemic in these situations.
The ultimate appeals to emotion do nothing to bolster Phillips’ arguments. It is possible for parents to be both honest in what they believe to be the case, that is, Joey declined within two weeks of the MMR jab, and to be dead wrong. Public anxiety would not be relieved overnight by a change to single dose vaccinations. On the contrary, as has happened with the removal of thimerosal, some sections of the public would take this as proof that there was something wrong after all.
Having contributed to the ‘no smoke without fire’ scenario, I find the sincerity of Phillips’ assertion that ‘every responsible person wants to see children vaccinated against dangerous diseases’ unconvincing.