restricted access 4. MMR and Autism

From: Vaccine

The Johns Hopkins University Press colophon
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MMR and Autism The British vaccine controversy focused on the combined vaccine against measles, mumps, and rubella and the allegation that it causes, triggers, or exacerbates symptoms associated with autism. As with thimerosal and autism in the United States, health officials in Britain quickly produced evidence that there was no causal link between the vaccine and autism, and they rigorously disputed any claim of a connection. For vaccine-anxious parents who found vindication in the claim that the vaccine against measles, mumps and rubella might cause autism, however, no amount of scientific refutation of the work was persuasive. In Britain, parents’ anxieties about vaccines were piqued after Andrew Wakefield, a British academic gastroenterologist, suggested that the measles, mumps and rubella vaccine (MMR) be split into three separate vaccines because the combined vaccine might cause gastrointestinal difficulties that could lead to neurological problems like autism. In 1987, Wakefield arrived at the Royal Free Hospital in London to head the Inflammatory Bowel Disease (IBD) Study Group. From the late 1980s through the mid-1990s, he received significant funding from pharmaceutical companies and charities in support of his work, which focused on identifying the causes of inflammatory bowel diseases. Wakefield and his colleagues in the Inflammatory Bowel Disease Study Group published research that suggested that ailments like ulcerative colitis and Crohn’s disease might be caused by a virus or multiple viruses, possibly in concert with a genetic predisposition or with other environmental factors. By the early 1990s, the IBD researchers had narrowed their search to one specific virus and one particular form of IBD; their research had led them to believe that the measles virus was responsible for triggering, causing, or helping to cause Crohn’s disease. Between 1993 and 1997 they adapted their hypothesis to include the claim that not just the measles virus, but perhaps also the measles vaccine, could play a role in the onset of Crohn’s disease. In February 1998 Wakefield, in collaboration with a dozen other colleagues, published a paper in the Lancet, Britain’s premier medical journal, which 4 MMR and Autism 95 linked chronic intestinal disorders with autism and asserted that symptoms for both began shortly after patients received the combined measles-mumpsrubella vaccine. With this publication, the public controversy in Britain over an alleged link between the MMR vaccine and autism began. Wakefield would later coin the term autistic enterocolitis to describe the form of IBD he believed was in some way caused by the MMR vaccine, which he believed in turn caused neurological problems that are consistent with autism . The controversy developed slowly, and we are able to follow it step-bystep , article-by-article, throughout the early and mid-1990s. By the end of the decade, the relatively small group of researchers engaged in the discussion grew into small armies of polemicists from various clinical and academic specialties, all of them publishing voluminously on the topic. By 2002, the scientific and medical communities in Britain and the United States concluded that Wakefield’s hypothesis was incorrect—in fact, there was no causal association between the MMR vaccine and autism. Soon after, Wakefield left Britain surrounded by considerable public controversy—made worse by charges of professional misconduct—and immigrated to the United States. In America, he found significantly more public support for his claims about a link between vaccines and autism, and he has continued both his private practice and his public advocacy for autistic children and their parents . In the United States as in Britain, the weight of opinion within the medical and scientific communities has remained steadfastly opposed to Wakefield ’s claims about the potential of vaccines, in particular the MMR vaccine, to cause autism. Despite the central role that he has taken in the modern vaccine debates— and unlike the some of the chiropractors we met in an earlier chapter— Wakefield is not an opponent of vaccines. To the contrary, he has repeatedly stated his belief that vaccines are an important tool in preserving an individual ’s health and in protecting the nation’s public health. As with Robert F. Kennedy Jr.’s criticisms of officials’ attitude toward thimerosal, Wakefield argues that if we want to maintain high levels of vaccine compliance, we need to be especially careful about maintaining the public’s confidence in their safety. From our perspective, Wakefield is significant not because his claims about autistic enterocolitis are correct, but because of the passion that his work has aroused, both for and against his claims. The...


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