The dark art of the MMR-autism scare

‘New fears over big surge in autism’; ‘I told the truth all along, says doctor at the heart of autism row’. Headlines in last week’s Observer (8 July) provide a media boost for Dr Andrew Wakefield as he faces charges of professional misconduct at the UK General Medical Council (GMC) over the conduct of the research that first suggested a link between the MMR vaccine and autism in 1998.

Under the first headline, Denis Campbell reports that two members of a Cambridge research team believe that an apparent increase in the prevalence of autism among local primary school children ‘may’ be linked to MMR. Under the second headline, the same journalist presents an exclusive interview with Dr Wakefield in which he appears as a doctor committed to the welfare of children with autism and as a dogged seeker after truth ‘regardless of the personal cost’, who is being persecuted by the medical establishment (1).

Ten years after he launched the MMR-autism scare, Dr Wakefield and his supporters display the formidable PR skills that have provoked and maintained a high level of public disquiet about childhood immunisations. Unfortunately, Dr Wakefield’s scientific achievements lag far behind his successes in media manipulation: after 10 years (and the expenditure of £15million in legal aid funding), he has yet to produce credible evidence that MMR has caused autism in a single child (2).

The Observer story contains three features common to the episodic upsurges in media interest in the MMR-autism link provoked by anti-vaccine campaigners over the past decade. These are the leak of an unpublished scientific paper ostensibly supporting the link; the endorsement of the link by some maverick scientist or doctor; the prominent report by a journalist lacking any relevant expertise or experience. By the time that the paper is revealed to be rubbish (or irrelevant), and the maverick is exposed as something less than a reliable authority or to be on the litigation pay roll (or both), the damage to confidence in MMR has been done. While the shabby scaremongering caravanserai moves on in search of its next media opportunity, parents are left with the burdens of anxiety and guilt (and children who miss out on immunisations as a result may be left with even heavier burdens of disease and disability).

The appendix to this article provides some earlier examples of the media exploits of the vaccine-autism campaigners. Here we look more closely at this week’s classic example of the anti-MMR scare story genre.

• The dodgy leak

  According to the Observer, a study produced by the Autism Research Unit at Cambridge University suggests that the prevalence of autism among primary school children in Cambridgeshire may be higher than earlier estimates of prevalence in comparable populations. Furthermore, two members of the team – academic psychologists Dr Fiona Scott and Dr Carol Stott, puffed up as ‘leaders in their field’ – ‘privately believe that the surprisingly high figure may be linked to the use of the MMR vaccine’.

  Given that this paper has not been published, it is impossible for anybody to judge the validity of its findings. However, it is immediately clear that the object of the study was to discover the prevalence of autism in a particular population: it made no attempt to investigate possible causes of autism. Hence the views of Scott and Stott (who are not, as it happens, recognised ‘leaders’ in the field of autism, and have no expertise in relation to immunisation) on MMR are of no more import than those of Denis Campbell. Professor Simon Baron Cohen, head of the Cambridge ARC and supervisor of this research project, has emphatically rejected the notion that it provides any support for the MMR-autism thesis. So too has Dr Scott, but not Dr Stott….

Dr Stott is recorded as receiving £100,000 in her capacity as expert witness in the UK anti-MMR litigation. (Dr Scott received £28,000.)

For 10 years Dr Wakefield has been claiming that a new study is about to be published which confirms his MMR-autism hypothesis – and after 10 years this cheque is still lost in the post. Though he has failed to persuade any reputable medical or scientific authority that his hypothesis is anything more than speculation, he has received the support of a number of disaffected individuals, usually lacking in relevant expertise and often beneficiaries of either the litigation or the sale of single vaccines (or both). While serious science and health reporters have long recognised the emptiness of Dr Wakefield’s thesis, naive journalists have been captivated by his charisma and his postures of crusader and victim.

For this combination of egotism, cynicism and irrationality, families affected by autism have already paid a high price – and those of children who end up with vaccine-preventable illnesses may yet have to pay an even higher one.

Dr Michael Fitzpatrick is a GP in London and the author of MMR and Autism: What Parents Need to Know (buy this book from Amazon UK and The Tyranny of Health: Doctors and the Regulation of Lifestyle (buy this book (buy this book from Amazon UK).

References

(1) In true Fleet Street style, another exclusive interview (with strikingly similar content) appeared in the following week’s Sunday Express.

(2) See ‘The MMR-autism theory? There’s nothing in it’ by Dr Michael Fitzpatrick

(3) Perpetual motion goes into reverse, Ben Goldacre, The Guardian, 7 July 2007

(4) See Brian Deer’s website

Appendices

1) The benefits of being an MMR maverick

Income received from the anti-MMR litigation by prominent supporters of the Wakefield campaign:

Dr Kenneth Aitken		private clinical psychologist, Edinburgh		£232,000
Dr Carol Stott		academic psychologist		£100,000
Dr Peter Fletcher		long-retired government scientist		£40,000
Dr Jeffrey Bradstreet		Florida preacher, vitamin salesman		£22,000
Dr Arthur Krigsman		private gastroenterologist, New York		£17,000
Dr Peter Harvey		Harley Street neurologist		£10,000
Mr Paul Shattock		pharmacist, urine analyst, diet enthusiast		£8,000
Dr Mark Geier		US genetic counsellor, chelator/castrator		£7,000
Dr Richard Halvorsen		private GP selling single vaccines		£6,000

For a full list of litigation-related incomes, see Brian Deer’s website here.

2) Gullible hacks: journalists duped by the anti-MMR campaign (not an exhaustive list)

Heather Mills, Private Eye
Lorraine Fraser, Daily Telegraph
Melanie Phillips, Daily Mail
Justine Picardie, Daily Telegraph
Beezy Marsh, Daily Mail
Robert Sandall, The Sunday Times
Camilla Cavendish, The Times
Nigella Lawson, The Times
Allison Pearson, Evening Standard
Libby Purves, The Times
Suzanne Moore, Mail on Sunday
Lynda Lee-Potter, Daily Mail
Quentin Letts, Daily Mail
Peter Hitchens, Mail on Sunday
Lucy Johnston, The Sunday Express

3) Earlier media scams by anti-MMR campaign

A section from Dr Michael Fitzpatrick’s book, MMR and Autism: What Every Parent Needs to Know:

THREE CASE HISTORIES

O’Leary’s apostasy

Sunday Telegraph, 16 June 2002
REVEALED: MORE EVIDENCE TO CHALLENGE THE SAFETY OF MMR

‘Government claims that vaccine presents no danger to children are undermined by tests, reports Lorraine Fraser
Specialists from Trinity College, Dublin, have detected the strain of measles virus used in the MMR jab in tissue samples from the inflamed intestines of 12 children, who each developed autism after receiving the injection… Dr Wakefield said last night: “Professor O’Leary and colleagues have now provided what may prove to be the most important piece of evidence to date in the case against the MMR vaccine. Parents must at the very least be given a choice of single vaccines…”‘

Similar stories appeared on the same day in the Sunday Times and the Mail on Sunday; another featured in the Daily Mail the following Monday. The articles included quotes from Dr Wakefield or a spokesman for Visceral, the charity that now supports his work. The journalists had been briefed on the contents of an unpublished paper by virologist John O’Leary, which was due to be presented at a conference in Dublin the following month. Most of the articles also referred to the fact that Dr Wakefield was due to reveal details of this work to a US congressional committee the following week.

In his statement to the Washington committee on 19 June, Dr Wakefield claimed that, ‘most significantly’, Professor O’Leary’s work had ‘confirmed that the measles vaccine virus is present in the diseased intestinal tissues of children with regressive autism’. Furthermore, ‘state of the art molecular science’ had shown that, in the cases of 12 children with a combination of autism and inflammatory bowel disease, the measles virus in their intestines originated in the MMR vaccine. For Wakefield these studies constituted ‘a key piece of evidence in the examination of the relationship between MMR vaccine and regressive autism’ (Wakefield June 2002).

However, on 16 June, in response to the articles in the British Sunday newspapers, Professor O’Leary issued a press statement that directly contradicted Dr Wakefield’s interpretation of his research. Its headline stated that ‘neither this publication nor any public presentation made by me or my research team has stated that MMR causes autism’ (O’Leary June 2002). Referring to the work, ‘which is due to be presented next month at a scientific meeting in Dublin’, he insisted that ‘the research in no way establishes any link between the MMR vaccine and autism’. Professor O’Leary recommended that parents give their children MMR, adding that he considered it wrong for them not to do so.

The only report of O’Leary’s apostasy to appear in the British media was by Niall Dickson on the BBC television news. O’Leary’s statement was subsequently quoted in a report on the British Medical Association conference on the BBC News website on 3 July. None of the newspapers that reported Dr Wakefield’s interpretation of Professor O’Leary’s work covered O’Leary’s repudiation of it.

Following Dr Wakefield’s presentation in the USA, a WHO expert commented that his technique could not reliably discriminate between ‘wild’ and vaccine strains of measles virus. When presented with this commentary in Washington, Dr Wakefield conceded that, if this was so, ‘the conclusion [of O’Leary’s paper] was not justified’. Wakefield’s sensational volte face was not reported in any British newspaper and he has yet to withdraw either his earlier claims on behalf of O’Leary or his recommendation of separate vaccines.

Shattock’s ‘one in ten’

Guardian, 28 June 2002
MMR ‘MAY CAUSE 1 IN 10 CASES OF AUTISM’
James Meikle, Health correspondent

‘The controversy over the MMR vaccine was fuelled yesterday by a researcher who suggested it might be responsible for one in ten cases of autism. Paul Shattock, director of Sunderland University’s autism research unit, believes the absence of biological markers of ‘traditional’ autism in the urine of some children could indicate that their condition was caused by measles. He stressed more work was needed to establish a firm link with the triple jab, saying evidence from his unpublished study of 4,000 cases of autism was strong, but not conclusive.’

After the news broke in an interview of Radio 4’s Today Programme on Thursday 27 June, the story about the urine tests conducted by Mr Shattock ran through the weekend in the newspapers. Similar stories appeared on Friday in the Daily Telegraph, The Times, and the Independent, in the Daily Mail, the Daily Express, The Sun and the Glasgow Herald. On 30 June the Mail on Sunday carried references in two articles to Mr Shattock’s research. On the following Monday, the Daily Mail featured Mr Shattock in two more articles and an editorial. These dramatic revelations were cited in support of the Daily Mail’s ongoing campaign for a public inquiry into the MMR–autism affair.

The ‘one in ten’ statistic featured prominently in all the articles. In some accounts, notably in the Daily Mail, the story was presented in the terrifying terms that ‘one in every 1,500 MMR injections could trigger autism’ (this was based on Mr Shattock’s estimate that autism occurred in one in 150 children).

Although Mr Shattock, a pharmacist and parent of an adult autistic son, has published many articles in the ‘grey literature’ (in journals which have no process of evaluation or peer review), he has no record of serious scientific research. Yet he now claimed to have identified a distinct subgroup of children whose autism results from MMR: these children are said to have abnormal levels of Indolyl Acrolyl Glycine (IAG) in their urine. IAG is a breakdown product of the amino acid trytophan, which is a constituent of serotonin, melatonin and other neurotransmitters.

Although most of the above reports quoted a figure of 4,000 cases, it subsequently emerged (in a document submitted by Mr Shattock to a meeting of the Parliamentary and Science Committee on 1 July) that he had so far studied only 300 children, 10 per cent of whose parents believed that MMR caused their autism. He indicated that he did not intend to publish his results in full until he had studied 1,000 cases.

Indeed it was impossible for anybody to evaluate Mr Shattock’s findings because they had not been published in any form. We do not know how his research subjects were selected, or anything about the ascertainment of diagnosis or any other aspect of the design of the study. It appears that, in these children, urinary IAG levels are abnormally low (they are apparently usually raised in autistic children). Again we know nothing about methods, controls or whether the differences were significant. Mr Shattock believes that low levels of IAG may be caused by increased gut permeability resulting from the presence of measles virus. Even if we accept that measles causes gut inflammation (which Professor O’Leary does not), it is not clear how increased gut permeability leads to low urinary IAG levels and how IAG or tryptophan are linked to autism.

Mr Shattock concedes that his studies do not prove a causal linkage between MMR and autism. However, he does believe that even these preliminary, provisional, incomplete, unvalidated and unpublished results, if taken in conjunction with the O’Leary/Wakefield researches, indicate the need for urgent action. It is not clear whether he is calling for further research along similar lines or some action in relation to the MMR vaccine programme.

It is remarkable that any responsible newspaper should consider it legitimate to publish research findings that nobody is in a position to verify, but which are likely to have a damaging effect on the national immunisation programme and on public health. The incoherence of Mr Shattock’s metabolic theory of autism should be apparent even to a journalist with no scientific training.

The Geiers

Daily Mail, 20 May 2003
MMR RAISES RISK OF BRAIN DISORDERS SAY RESEARCHERS
Jenny Hope, Medical correspondent

A study carried out by Mark and David Geier in the USA claimed that MMR may be a factor in up to 15 per cent of cases of autism and other neuro-developmental disorders. It was reported, first in the GP magazine Pulse (19 May 2003), then on the BBC News website (19 May), and in the Daily Mail (‘“MMR raises risk of brain disorders” say researchers’, 20 May). It was thereafter widely reported on radio and television. These reports followed an earlier account of the Geiers’ researches, by the veteran anti-immunisation reporter Rosie Waterhouse, in the Daily Telegraph on 7 April.

Mark Geier is a genetic counsellor in Maryland, USA; his son, David, is a graduate student who runs MedCon – a firm providing advice to families pursuing litigation claims over alleged vaccine injury. Although neither has any academic or professional expertise in any discipline relevant to immunisation, the Geiers feature prominently in the conferences and websites of autism parents and other anti-immunisation groups in the USA. The paper reported in the Daily Telegraph in April was published in the Journal of American Physicians and Surgeons. This sounds impressive, but turns out to be the recently relabelled Medical Sentinel – organ of the Association of American Physicians and Surgeons, a Right-wing medical faction based in Tucson, Arizona, distinguished by its commitment to the practice of private medicine and its hostility to immunisation. The Geier’s latest paper is published in International Pediatrics – another apparently impressive title, this is the house journal of the Miami Children’s Hospital.

In response to the paper in the Journal of American Physicians and Surgeons, which focused on the alleged dangers of vaccines containing the mercury-based preservative thiomersal (known as thimerosal in the USA), the American Academy of Pediatrics (AAP) published a detailed critique (AAP 2003). The most important defect of this article (shared by the International Pediatrics article) is its reliance on data gathered by the Vaccine Adverse Event Reporting System (VAERS). This is a passive surveillance system (analogous to the ‘yellow card’ reporting system in Britain) that relies on professionals and parents reporting what they suspect may be adverse reactions to vaccines. Such reports may represent true adverse events, coincidences or mistakes: ‘inherent limits of VAERS include incomplete reporting, lack of verification of diagnoses, and lack of data on people who were immunised and did not report problems’ (AAP 2003:1). Such data are useful for flagging up possible problems and raising questions for further investigation. They can be legitimately used for ‘hypothesis generation’ but not for ‘hypothesis proving’.

The AAP condemned the Geiers for using data inappropriately and the paper for containing ‘numerous conceptual and scientific flaws, omissions of fact, inaccuracies and misstatements’. They had ‘failed to acknowledge the inherent limitations of the VAERS database when drawing conclusions of adverse event associations contained in this report and in their other publications’ (AAP 2003:1). The AAP commentary includes a 15-point catalogue of further statistical flaws, errors and omissions in the Journal of American Physicians and Surgeons paper.

Although their main focus is thiomersal, the Geiers are sympathetic to Dr Wakefield and his anti-MMR campaign, which has attracted considerable support in the anti-immunisation fringe in the USA. It is thus fortuitous that their researches have led to the conclusion that ‘thimerosal contributed to about 75 per cent of cases of neurodevelopmental disorders, while MMR contributed to 15 per cent’. Quite apart from the methodological errors in this research and the failure of intensive previous studies to confirm these adverse effects, the notion that 90 per cent of neuro-developmental disorders can be attributed to immunisation is impossible to reconcile with the well-established genetic contribution to autism, not to mention Down’s syndrome, Fragile X, tuberous sclerosis and numerous other conditions. It is extraordinary that such self-evidently preposterous claims can be taken seriously by anybody.

The Geiers’ latest study plumbs new depths of absurdity (MHRA 2003). The authors compare the rates of adverse reactions following MMR (given at 15–18 months in the USA) with the rates of the same conditions reported after DTP (given at 2, 4 and 6 weeks). It is scarcely surprising to find higher rates of ‘gait disturbance’ in toddlers compared with infants in the first three months of life when infants are unable to walk and hence have no gait that might be disturbed. Nor is it surprising that there were more reports of autism and mental retardation among the older children: such conditions are generally not recognised until the second year of life and are certainly not likely to be identified in babies.