The question of whether autism can be caused by vaccination with the MMR (measles-mumps-rubella) vaccine can be put to bed once again, and the answer is still 'no.'
In 1998, the British medical journal The Lancet published a paper by Dr. Andrew Wakefield and his colleagues titled “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children”. It looked at a population of twelve children who had simultaneously developed a bowel disorder, nine of whom also had symptoms of autism, and suggested that both sets of symptoms occurred after the children were vaccinated with MMR.
While at the time Dr. Wakefield did not suggest completely forgoing MMR but vaccinating for each disease separately, the reaction was a public health disaster. Parents all across the United Kingdom declined to have their children vaccinated out of fear. In the end, four children ended up dying from measles, with hundreds more getting sick. In 2008, measles, once almost non-existent because of the vaccine, was delcared endemic in the UK again after a 14 year absence.
In 2009, The Lancet issued a formal retraction of Dr. Wakefield's study. Last week, the British Medical Journal (BMJ) ran an editorial that called the study “an elaborate fraud,” with accusations of falsification of data and also of Dr. Wakefield receiving an unethical payment of over 400,000 British pounds from a law firm planning on bringing a lawsuit against MMR manufacturers. Since then there have been 18 other studies that tried to reproduce Dr. Wakefield's results, and none have succeeded.
While the medical establishment in the United States and United Kingdom have now declared that MMR is not a causal agent for autism, it can not undo the damage that has been done to the thousands of children who were put at risk for preventable disease because of bad science.
Nor does it undo the beliefs of the millions of people who continue to believe in Dr. Wakefield and the original study, such as the Coalition for Vaccine Safety, which just put out a press release calling BMJ's editorial “libelous” and a “character assassination” of Dr. Wakefield, as well as still stating that MMR as a causal agent for autism is an “open question.”
At the core of this controversy is the question of ethics in research and what to believe. One would like to believe that doctors and those involved with medical research are bound by the Hippocratic oath and the strictest of ethical and legal research guidelines, but money and publication deadlines can trip up the best of intentions. What can the average person believe?
Dr. Paul A. Offit, Chief of Infectious Disease at Children's Hospital of Philadelphia, writes in a Wall Street Journal editorial that the blame for the MMR vaccine scare lies not just with Dr. Wakefield and his colleagues, but with The Lancet editors and the media. He writes that despite Dr. Wakefield's paper being rejected by four out of six peer reviewers, Lancet editor Richard Horton published it despite the negative reviews. In addition, Dr. Offit writes that the media should have realized that the importance of Dr. Wakefield's study was grossly overestimated; that a case report of only 12 selected children was not enough evidence for a sweeping generalization of causality. Dr. Offit challenges peer-reviewed journal editors to be more exacting in their acceptance of data, and that a return to strict scientific method will prevent future cases such as the MMR scare.
Brian Deer, the investigative journalist who is responsible for uncovering and exposing almost all of the case against Dr. Wakefield, suggests a different approach. The scientific method he writes, as championed by Dr. Offit, was exactly what led to the MMR scare, and suggests that doctors tend to protect doctors through an “old boys network of the medical establishment,” even in light of serious accusations of fraud. Deer suggests that the onus is now on investigative journalists and the media to expose such fraud, as bringing Dr. Wakefield's personal ethical lapses to light was one of the only reasons that the truth about the MMR scare came out.
In the end, the question of medical research and what to believe in terms of new research and new information is a question of public trust, much like politics or the justice system. The patient can choose to put their faith in the idea that medical doctors and researchers have pledged to work ethically and soundly, and that truth and only truth is the ultimate goal.
At the same time, patients should practice optimistic skepticism. Realize that incredible breakthroughs need to be tested and re-tested, and knee-jerk reactions to new research in either the positive or negative direction may not be the best course. If you read about a scientific or medical finding that seems too good to be true, or a bit too ominous, take the time to read as much as you can about the study and speak to your doctor about it if it concerns your or your child's health.
