Get the Flu Shot to Prevent a Heartbreaking Holiday Season!

In Malaysia, flu can occur year-round. Older persons, especially those with chronic diseases such as diabetes and high blood pressure, are advised to make flu vaccination an annual priority, especially during the holiday seasons when mingling and traveling are often inevitable. It’s important to strike a balance between staying safe and creating beautiful memories!

DO YOU KNOW THAT YOU COULD END UP WITH A HEART ATTACK OR STROKE WHEN YOU GET THE FLU?

Recent studies have cautioned that influenza increases the risk of heart attack by more than 10 times in the first 7 days after contracting the flu.

This is especially so if you are 65 and over, regardless of whether you have a history of heart disease or are living with chronic illnesses such as heart disease, diabetes, lung disease and kidney disease. In industrialized countries, most deaths associated with flu occur among older persons aged 65 years and above!

Among older persons, influenza can present as a relatively mild respiratory illness; it may also present without any symptoms (no fever and/or no cough). It can also lead to fatigue and confusion, potentially setting off a sequence of catastrophic events.

Professor Datuk Dr Zulkifli Ismail, Technical Committee Chairman of the Immunise4Life Programme, explains: “It is not just a fever, runny nose, cough and body aches, it could seriously harm your heart.”

HOW THE FLU AFFECTS YOUR HEART

When the flu virus enters your system, your immune system strings into action.

Just like fights in real life, collateral damage may result; when an infection triggers a strong response from your immune system, the immune cells can also damage your own healthy tissues and organs.

One example is COVID-19, which can trigger very high activation of the immune system, resulting in the uncontrolled release of cytokines, small molecules that aid cell-to-cell communication in immune responses and stimulate the movement of cells towards sites of infection.

This uncontrolled release (“cytokine storm”) may lead in failure and death of many organs in the body.

 

An illustration of cytokine storm, sometimes called hypercytokinemia, and how it affects both healthy and infected cells. Click on the image for a larger version.

Studies suggest that the same inflammatory response described above can trigger effects that can damage the heart (cardiovascular events) when you have an influenza infection.

Dr Alan Fong, the President of the National Heart Association Malaysia (NHAM) and a consultant cardiologist, shares that your body’s immune response, when present along the direct effects of flu on the inner lining of your blood vessels or atherosclerotic plaques, may cause rupture of such plaques or blockage in the arteries–effects that can lead to a heart attack or stroke.

OLDER PERSONS ARE ESPECIALLY AT RISK WHEN THEY CATCH THE FLU

In older persons, there are changes that occur in the immune system that leads to a decline in the ability of the body to fight off infections such as the flu; this is known as immunosenescence.

Professor Dr Tan Maw Pin, a consultant geriatrician that chairs the Flu & Older Persons Sub-Committee of the Malaysian Influenza Working Group (MIWG), tells us: “In addition to this, ageing contributes to chronic, non-infectious, low-grade inflammation—known as inflammaging—which plays a key role in the cause and progression of chronic conditions such as cardiovascular diseases.”

She further adds that ageing also promotes the development and progression of atherosclerosis, the most common cause of acute coronary syndrome. This syndrome gives rise to situations in which the blood supplied to the heart is suddenly blocked.”

“Hence, when an older person gets the flu, all these factors put them at higher risk of developing a heart attack and stroke,” Prof Tan reiterates.

FLU VACCINATION CAN PROTECT YOUR HEART

Studies have found that the flu vaccination was associated with a 34% lower risk of major adverse cardiovascular events, and those that have recent acute coronary syndrome had a 45% lower risk.

There is also an 18% reduced risk of death reported in patients with heart failure.

For people with type 2 diabetes mellitus, studies have shown that the flu vaccination reduces the risk of heart failure by 22%, stroke by 30%, heart attack by 19% and pneumonia by 15%.

Flu vaccination does not require behaviour change or a daily intervention, yet it prevents cardiovascular events as well as as other evidence-based approaches such as statin therapy, antihypertensive therapy, and smoking cessation.

This article is contributed by Immunise4Life (IFL), a collaboration of the Ministry of Health Malaysia with the Malaysian Paediatric Association (MPA) and the Malaysian Society of Infectious Diseases & Chemotherapy (MSIDC).

The article has been edited by HealthToday for publication on this website.

For more information on flu, you can visit IFL’s website Act of Love (link opens in a new tab).


References:

  1. Warren-Gash, C., Blackburn, R., Whitaker, H., McMenamin, J., & Hayward, A. C. (2018). Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland. The European respiratory journal, 51(3), 1701794. https://doi.org/10.1183/13993003.01794-2017
  2. Michos, E. D., & Udell, J. A. (2021). Am I getting the influenza shot too?: Influenza vaccination as post-myocardial infarction care for the prevention of cardiovascular events and death. Circulation, 144(18), 1485–1488. https://doi.org/10.1161/CIRCULATIONAHA.121.057534
  3. Modin, D., Jørgensen, M. E., Gislason, G., Jensen, J. S., Køber, L., Claggett, B., Hegde, S. M., Solomon, S. D., Torp-Pedersen, C., & Biering-Sørensen, T. (2019). Influenza vaccine in heart failure. Circulation, 139(5), 575–586. https://doi.org/10.1161/CIRCULATIONAHA.118.036788
  4. Vamos, E. P., Pape, U. J., Curcin, V., Harris, M. J., Valabhji, J., Majeed, A., & Millett, C. (2016). Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 188(14), E342–E351. https://doi.org/10.1503/cmaj.151059
  5. King, S. C., Fiebelkorn, A. P., & Sperling, L. S. (2020, November 2). Influenza vaccination: Proven and effective cardiovascular disease prevention. American College of Cardiology. https://www.acc.org/latest-in-cardiology/articles/2020/11/02/14/42/influenza-vaccination-proven-and-effective-cvd-prevention
  6. Vetrano, D. L., Triolo, F., Maggi, S., Malley, R., Jackson, T. A., Poscia, A., Bernabei, R., Ferrucci, L., & Fratiglioni, L. (2021). Fostering healthy aging: The interdependency of infections, immunity and frailty. Ageing research reviews, 69, 101351. https://doi.org/10.1016/j.arr.2021.101351

Could Stem Cell Therapy Be the Future of Medicine in Malaysia?

WORDS LIM TECK CHOON

Stem cells are a unique type of cell in our body. This is because they are the only type of cells that can develop, under the right triggers and condition, into a variety of more specialized cells, such as blood cells, muscle cells, bone cells, and more.

HOW STEM CELLS ARE USEFUL 
  • Researchers can generate a variety of human cells from stem cells in the laboratory. These cells are then used to test new medications for possible side effects.
  • Research is also conducted on generating healthy cells that can replace those in our body that are dying or damaged due to age or disease. Such use of stem cells is called regenerative medicine.
THE 2 TYPES OF HUMAN STEM CELLS
  • Hematopoietic stem cells (usually abbreviated as HSCs), which are found in cord blood, bone marrow, and peripheral blood
  • Mesenchymal stem cells (MSCs), which as found in the gel-like substance (Wharton’s jelly) of the umbilical cord, bone marrow, fat tissue, and tooth pulp
REGENERATIVE MEDICINE IS THE FUTURE?

Judging from the versatility of stem cells when used to produce of a variety of healthy human cells, regenerative medicine has obvious benefits for people whose tissues are damaged or dying due to diseases as well as people in need of tissue transplant.

Just some of the cells that can be generated from stem cells in the laboratory. Click the image above for a larger version.
Promising for treating heart diseases

Dr Lee Tjen Jhung, a cardiologist affiliated with the National Heart Institute (IJN), says, “While heart diseases are usually treated with medication, angioplasty and by-pass surgery, cell-based regenerative therapy is gaining popularity in the cardiovascular field due to the ability of mesenchymal stem cells to provide new blood in areas affected by restricted blood flow as well as promote the formation of new blood vessels.”

An answer to ageing-related health issues?

Dato’ Dr Rajbans Singh, the President of the Malaysian Wellness Society, points out that stem cells can play a crucial role in treating aging-related health problems.

He elaborates: “At birth, the human body has approximately 80 million active stem cells However, by age 40, less than 25 million active stem cells are functional. Ageing leads to a massive loss of stem cells in the body, affecting the ability of organs and tissues to repair and regenerate as the body gradually ages and deteriorates.”

Here’s a general, simplified overview of how the whole procedure works
  1. Stem cells are grown in a laboratory, and then manipulated to grow and specialize into a more specific type of cells (heart muscle cells, blood cells, etc)
  2. These cells are then implanted into the person that can benefit from this procedure, for example a person with heart disease could be implanted with heart muscle cells, injected into their heart
  3. These transplanted cells will then play a role in repairing and/or replacing the affected damaged tissue or organ of that person.

In reality, the procedure is not so straight forward, as there are many potential complications to take into account.

Nonetheless, the promise of regenerative medicine is too good to resist, hence researchers are continuously looking into creating and fine-tuning various procedures that can hopefully one day reduce or even replace our reliance on medications!

THE STEM CELL CONTROVERSY

There is considerable ethical debate on the use of stem cells that are sourced from fertilized egg cells or embryos that are donated for research.

These days, many centres that offer stem cell therapy claim to source their stem cells ethically—from the umbilical cords of young and healthy women after they have delivered their babies.

In Malaysia, the sourcing and processing of stem cells are governed by the Current Good Manufacturing Practices or cGMP, issued by the National Pharmaceutical Regulatory Agency (NPRA). You can view it here (link opens in a new tab).

How Much Do You Know about Male Breast Cancer? Let’s Find Out!

WORDS LIM TECK CHOON

DR NIK MUHD ASLAN ABDULLAH
Clinical Oncologist
Sunway Medical Centre
BREAST CANCER AFFECTS MEN AS WELL AS WOMEN

Breast cancer in both men and women share many similar attributes.

The most common kinds of breast cancer in men are the same kinds that are present in women, namely:

  • Invasive ductal carcinoma
  • Invasive lobular carcinoma
  • Ductal carcinoma in situ (or DCIS)

Dr Nik Muhd Aslan Abdullah says that breast cancer is, however, rare among men.

WARNING SIGNS

According to Dr Nik, many of the most pressing early warning signs of breast cancer in men are also similar to those found in women, such as:

  • Lumps in the breast tissue
  • Skin dimpling or puckering
  • Nipple retraction
  • Unusual discharge from the nipple
HORMONAL CHANGES CAN GIVE RISE TO BREAST CANCER

One reason why breast cancer is rare among men is that the hormone testosterone inhibit the growth of breast tissue, while oestrogen stimulates breast tissue growth.

While men and women have both hormones in their bodies, men have higher levels of testosterone compared to women. On the other hand, women have higher levels of oestrogen.

Some breast cancer cells have special structures at the surface, called hormone receptors. These cells are called hormone-receptor positive (HR positive for short). Oestrogen can bind to these receptors to cause the growth of these cells. Dr Nik explains that men have a higher possibility of developing breast cancer cells that are HR-positive, when compared to their female counterparts.

“Breast cancer cells in men are sensitive to hormonal imbalances,” Dr Nik explains, “so any factors or conditions that can lead to an excess of oestrogen and a lack of testosterone will increase their risk of developing breast cancer.”

What can cause the raise in oestrogen levels in men?
  • Klinefelter syndrome, a rare genetic condition in which a male has an extra X chromosome and produces lower levels of androgens
  • Injury to the testicles
  • Use of androgen inhibitors
  • Liver cirrhosis (scarring of the liver)
  • Obesity 
Family history also plays a factor

About 1 out of 5 men with breast cancer is found to have had a family history of the disease.

This is because men can also inherit a mutation in the BRCA1 or BRCA2 genes or in other genes, such as CHEK2 and PALB2. These mutations will highly increase their risk for breast cancer.

“Unfortunately, we do not have a say in the types of genes we inherit,” Dr Nik says.

He recommends that men with a family history of cancer should consider seeking counsel from their doctors about going for genetic screening tests as soon as they can, especially those over the age of 50.

Genetic screening tests involves taking a blood sample for analysis. A genetic counsellor will then advise the person, based on the results given, on what the next best steps would be for him.

How to conduct self-breast examination for men. Click the image for a larger version.
MEN WITH HR-POSITIVE BREAST CANCER ARE MORE LIKELY TO RESPOND TO HORMONE TREATMENTS

Dr Nik explains that hormone therapy can be used to help lower the risk of the cancer cells spreading or treat cancer that has come back after treatment.

Why then do men with breast cancer have lower survival rate compared to their female counterpart?

“Through many of the studies that I’ve seen, men who are diagnosed with breast cancer have a 8-9% lower survival rate than women,” Dr Nik says.

He attributes this to the fact that men with breast cancer are often diagnosed late.

“Men will sometimes wait too long to seek out a diagnosis for the symptoms they may be experiencing,” he explains, “or not recognize the warning signs of breast cancer in their bodies.”

As a result, they delay seeking help, and tend to do so only when the cancer has become advanced and spread to other parts of the body.


Dr Nik encourages men to seek a doctor’s opinion if they find themselves experiencing any of the mentioned symptoms related to breast cancer. “Breast cancer can be cured, and it is very treatable if detected early on,” he says.

A Health-Centric Wishlist for the Malaysian GE15

WORDS ANWAR ANIS

ANWAR ANIS
Executive Director
ALTY Orthopaedic Hospital
FORMATION OF A LONG-TERM PARTNERSHIP BETWEEN PUBLIC & PRIVATE HEALTHCARE

Building upon the successful collaboration between public and private healthcare during the pandemic, a long-term policy on greater partnership will benefit both the government and the private sector, with all Malaysians being the key beneficiary.

There still are waiting lists for procedures in the public hospitals, and these can certainly be reduced if there is a structure long term arrangement for the private hospitals and centres to assist in reducing and maintaining a short wait time, especially for elective procedures which can greatly enhance an individual’s productivity, although it may not be life threatening.

GREATER FOCUS ON AN AGEING SOCIETY

These include the necessary social safety nets, proper care facilities and also post hospitalization care and support.

Here, the government should consider partnering the many physio and home care organisations to ensure patients have good compliance to post hospital care, including physio, wound care and others.

An aging population also typically means reduced mobility due to various issue—for example orthopaedic-related issues, where it can be address with proper intervention, and where needed surgery.

Government subsidy for implants, such as knee and hip implants can reduce the burden for the uninsured (which is a large majority of those who need such care) – and thus ensuring they have good mobility and thus independence even as they age.

INNOVATION IN HEALTHCARE WITH ROBOTICS, 3-D PRINTING & OTHER NEW TECHNOLOGIES

The government should consider encouraging the adoption of such technologies especially in healthcare.

Grants or even personal subsidies to access such health technologies where appropriate can propel the adoption and perhaps even development of such tech.

For example, 3-D printed casts or prosthesis will improve recovery and long-term quality of life. The regulatory framework also needs to support the faster adoption of such health technologies, to ensure Malaysia is able to maintain its advantage as a healthcare travel destination.

COMPETITIVE & FACILITATIVE IMMIGRATION POLICIES

Competitive and facilitative immigration policies, for healthcare travellers especially, will allow Malaysia to be serve a greater no of patients, which in turn lowers the cost of investment in health-related technologies and equipment, thus enabling more Malaysians to access it as well.

Some of our neighbouring countries continue to attract patients from a number of different countries, despite being less competitive overall than Malaysia, primarily due to the ease of arriving into the country.

Thus, they are able to invest in technologies such as thehealthy  Proton beam, as fee paying foreign patients ensure there is a sufficient volume of patients for these advanced and latest modalities.

Important Things That You Should Know About Silent Heart Attacks

WORDS LIM TECK CHOON

DR PATRICK TIAU WEI JYUNG
Consultant Cardiologist
Sunway Medical Centre

Dr Patrick Tiau reveals that silent heart attacks, also known as silent myocardial infarction, account for 45% of heart attacks.

These heart attacks are “silent” because they occur without the usual, recognizable symptoms of a heart attack.

COMMON SYMPTOMS OF HEART ATTACK
  • Chest pain (often described as heavy or pressure sensation)
  • Radiating pain in the arm, neck, or jaw
  • Sudden shortness of breath
  • Sweating
  • Dizziness
HOWEVER, THESE SYMPTOMS ARE USUALLY NOT PRESENT WHEN ONE HAS A SILENT HEART ATTACK!
Because of this, many people may not know that they have experienced one until days or even weeks after.

However, Dr Patrick shares that there are some early warning signs to look out for.

SIGNS THAT YOU MAY HAVE HAD A SILENT HEART ATTACK

It’s good to consult a doctor when you have concerns, especially if you experience these signs and fall under the high-risk below (see below).

  • Feeling tired
  • Indigestion
  • Nausea
  • Sweating.

Dr Patrick says, “We have come across many patients who have dismissed the early warning symptoms as simply feeling tired, indigestion, nausea or sweating. By the time they seek out medical treatment for these symptoms, they are shocked to learn that what they are experiencing is actually due to a reduced blood flow to their heart, and that has caused them to have a silent heart attack.”

Silent heart attacks can lead to more serious health complications if left untreated over an extended period of time, such as an increased risk of another, potentially more deadly heart attack.

COMMON RISKS OF SILENT HEART ATTACKS
RISKS THAT CANNOT BE AVOIDED 
  • Age. The risk increases as we grow older.
  • Gender. Men are more at risk than women. However, women are more prone to a higher risk of complications after experiencing one, especially if they are diabetic.
  • Family history. The risk is higher for people with a family history of heart diseases.
RISKS THAT CAN BE MODIFIED 
  • Smoking. Chemicals in cigarettes stimulate one’s heartbeat and can dramatically increase one’s risk of heart attack.
  • High cholesterol. Individuals with elevated cholesterol levels can lead to formation of atherosclerotic plaque in the blood vessel and reduce blood flow to the heart.
  • High blood pressure: Having high blood pressure puts extra strain on the heart muscle. Over time, this causes the heart muscle to stiffen, thicken, and perform less optimally.
  • Individuals that are overweight or obese, especially when their weight tends to sit at the waist, are more at risk even if they do not have any other risk factors.
  • Physical inactivity. Doing regular exercise helps protect the heart by keeping under control other risk factors such as cholesterol, blood pressure, diabetes, and obesity.

“Undeniably our heart health is essential to allowing us to have a well-balanced and fulfilling life,” he says. “The heart itself is the first and last sign of life that is responsible for, quite literally, keeping us going. In combatting heart attacks, the most important thing to remember is that prevention is definitely better than cure.”

DR PATRICK’S TIPS TO REDUCE YOUR RISK OF SILENT HEART ATTACKS

Make the necessary small changes to daily lifestyle to reduce one’s risk factors. These changes include:

  • Regularly monitor blood pressure and cholesterol
  • Get sufficient exercise
  • Quit smoking
  • Eat a balanced diet of fruit, vegetables, lean meats and whole grains
  • Ensure that one’s blood pressure, cholesterol and blood sugar are well-controlled
  • Inform a doctor as soon as possible about any unusual symptoms that may indicate a silent heart attack

Once you go home from the hospital, it is essential that you keep taking your medications as prescribed. “This will ensure your heart health is kept in check, possibly for the rest of your life,” says Dr Patrick.

Consider joining a support group. Dr Patrick acknowledges that heart attack survivors may start to develop feelings of shock, sadness, and anxiety. This is normal, and these feelings can be managed with the right support.

“Some people find it helpful to join a support group where they can talk with others that have gone through a similar experience, or seek out companionship and encouragement through avenues such as the gym, or yoga classes,” he advises.

Here’s What You Should Know About Osteoporosis & Ageing

 

ASSOCIATE PROFESSOR (C) DR G RUSLAN NAZARUDDIN SIMANJUNTAK
Consultant Orthopaedic,
Arthritis & Sports Surgeon
ALTY Orthopaedic Hospital

Osteoporosis is a disease that weakens your bones, making them more prone to fractures.

Often, there are no symptoms. Many people only learn that they have osteoporosis after they experience a fracture and see a doctor.

Because fractures are potentially life-threatening when they occur to older persons, it is good to take steps to prevent this disease from quietly ‘sneaking up’ on you.

YOU CAN GET SCREENED TO FIND OUT HOW HEALTHY YOUR BONES ARE
If you are 65 or older, you should consult your doctor on getting screened for osteoporosis.

Tests such as bone mineral density (BMD) test will provide useful information about your bone health.

Blood profile tests help to detect presence of health conditions that can weaken the bones and increase your risk of osteoporosis.

WHEN SHOULD YOU SEE A DOCTOR AFTER A FALL?
  • When you experience severe pain that don’t improve after taking over-the-counter painkillers
  • When you are unable to move after your fall

After you are admitted, you will be given an imaging test—typically X-ray and, if necessary, magnetic resonance imaging (MRI)—to determine the location and extent of the fracture.

HIP FRACTURES CAN BE COMMON AMONG OLDER PERSONS
Hip fractures usually occur on the long bone of the thigh, called the femur (see image).

A surgery, called hip replacement, helps to address this problem.

A total hip replacement replaces the socket (acetabulum, see image) and the head of the femur.

A partial hip replacement replaces only the femoral head (see image). This is usually an option for older persons with more limited mobility.

The surgery takes place within 2 hours, and you’ll stay in the hospital for around 3 more days. During this period, a physiotherapist will guide you on the exercises that you can do to restore the range of motion of as well as to strengthen your hip.

WORK WITH YOUR HEALTHCARE TEAM TO REMAIN INDEPENDENT & MOBILE
For example, you may use a walker or wheelchair to remain mobile, and you may need to master new techniques (such as for using the toilet, bathing, dressing, etc) that take into account your condition.

 

If you have problems traveling to see your physiotherapist, consult your healthcare team on the possibility of having the physiotherapist visit your home instead.


This article is brought to you by ALTY Orthopaedic Hospital.

 

Free Age Plus App Helps Older Persons Self-Manage Their Own Health

WORDS LIM TECK CHOON

The University Malaya Medical, Business, Computing and Software Engineering teams have launched a free app, called Age Plus.

“The main objective of the project is to develop a health management application for users to self-manage their health,” shares Associate Professor Dr Mumtaz Begum Mustafa, the creator of the Age Plus app.

WHAT DOES THE APP CURRENTLY PROVIDE?
LIFESTYLE
Provides visualization patterns of your daily activities as well as personalized recommendations for a healthier lifestyle

  • Information on healthy foods
  • Calorie calculator to help you plan healthy meals
  • Seat goals for and track your water intake, caffeine consumption, sleep, and exercise

PERSONAL MEDICAL DETAILS
Useful for managing medical information such as medication and consultation detail

  • Record and keep tab on your medications
  • Record and keep track of your medical appointments
  • Find nearby hospitals

HEALTH MANAGEMENT
Improve awareness on disease-related conditions among older persons.

  • Get useful advice and tips on health-related matters
AGE PLUS IS USER-FRIENDLY

Dr Mumtaz explains that the app boasts design solutions to improve its usability especially among older persons. Features of the app that reflect this include:

  • Increased action time and reduction of multiple tasks
  • Simplified in-app navigation/navigation assistance
  • User-friendly interfaces
  • Voice-response technology, with information dissemination through speech
  • Big buttons and simple, static menus

Age Plus is now available for free for Android phone users. Visit this link (link opens in a new tab) to download the app.

Vaccines Cause Autism? Say It Isn’t So!

Vaccines Cause Autism? Say It Isn’t So!

May 7, 2022   Return

WORDS LIM TECK CHOON

Back in the 18th century, smallpox was a deadly plague that killed hundreds of thousands of lives. It was only when Edward Jenner discovered that substances taken from cowpox lesions can protect one from being infected with smallpox did the first smallpox vaccine came to be.

Even then, despite the vaccine proving to be successful in preventing smallpox and cutting down the number of deaths from the disease, there were people who railed strongly against the vaccine. Religious leaders condemned it as an arrogant attempt by humans to interfere with divine will. Rumor spread through publications and word of mouth that taking the vaccine would cause a cow’s head to burst out of one’s chest, or that the person who took the vaccine would eventually transform into a cow.

These days, it is more common for people who oppose the act of vaccination to bring up the fact that it can lead to the development of autism in children. Does it, really? A paediatrician and paediatric bioethicist weighs in on this issue.

Dr Erwin Khoo Jiayuan

Paediatrician & Paediatric Bioethicist

International Medical University (IMU)

 

The autism link to vaccine first arose in 1998, when a paper co-authored by Andrew J Wakefield appeared in the scientific journal The Lancet.

The study has since been retracted – The Lancet issued a public statement withdrawing the paper and refuting the original statement of the paper, for reasons we will get into later – but it can still be viewed online at the journal website. Just search online for the title of the paper:

Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children

“To be honest, my first instinct, when I gave a cursory read of the paper, was that there might be some truth to the study,” Dr Erwin admitted. However, he began to have reservations as he read it more critically.

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What is wrong with the paper?

Andrew Wakefield was a practicing gastroenterologist at that time, and he and a team of researchers investigated and claimed to have found a link between the measles, mumps and rubella (MMR) vaccination and autism. The paper alleged that the first symptoms of autism appeared within 1 month of receiving the MMR vaccine. Apparently, the vaccine caused the intestines to become inflamed and enabled certain protein molecules (peptides) to enter the blood stream through the intestines and affect the brain.

According to Dr Erwin, the following are the issues with that study:

Only 12 children were involved. This is a small number for a proper research, too small to properly rule out other factors that may also play a part in the development of autism. Although many medical breakthroughs began with small-scale observations, the results of this study could never be replicated.

There was no blind testing. Blind testing is a typical procedure in which the person participating in the study is not told of the expected outcome. This is done to eliminate any bias on the participant’s part that can affect the outcome of the study.

There were inconsistencies and even inaccuracies in the study. Dr Erwin points out that several of the children in the investigation did not show any symptoms in their gastrointestinal tract before they developed autism, which contradicted the conclusion of the study.

Also, there was no evidence from subsequent studies that the MMR vaccine could cause the reported intestinal inflammation in the first place!

Furthermore, remember the peptides that allegedly travel through the inflamed intestines to trigger the development of autism? To date, we have yet to identify these peptides despite numerous research on the matter.

Follow-up studies by various researchers from all over the world could not replicate the result of this study. Dr Erwin explains that the study generated much concern among researchers as well as governments, pharmaceutical companies and members of the public.

Hence, there were many subsequent studies conducted to verify the findings of Wakefield’s team. More children were involved in these studies, and more data was collected. Over time, methods for research and information collection improved, but all these studies still failed to support a link between the MMR vaccine and autism!

Wait, there were more disturbing truths to uncover…

Normally, participants in a research would be spontaneously referred by healthcare professionals and other qualified people, but in Wakefield’s investigation, he picked those that would most likely support the findings he intended for the research to yield. There were no children recruited to participate as control, hence the study did not take into account selection bias and chance association.

Why did he do this? This was the question that led UK investigative reporter Brian Deer to seek answers, and in the process, he uncovered Wakefield’s huge conflict of interest.

  • Wakefield was hired by Richard Barr, a lawyer who wanted to raise a class action lawsuit against the manufacturers of the MMR vaccine.
  • Barr needed a scientific study to back up his claims that the MMR vaccine was harmful, so he paid Wakefield to discover a “new syndrome” that the vaccine was supposed to be responsible for. This syndrome would eventually be “autistic colitis” – autism caused by the inflammation of the intestines. Wakefield had already decided on this “syndrome” before he even began his research!
  • Wakefield received an initial £55,000 payment and later, about £435,643 plus expenses for his part in the study. He should have declared these payments to The Lancet, but he chose not to.

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What happened next?

In 2010, Wakefield was summoned to a professional misconduct hearing by the UK’s General Medical Council (GMC), after which he was found to have “acted dishonestly, irresponsibly, unethically, and callously” in connection with his research. He was subsequently banned from practicing medicine in the UK.

The Lancet swiftly retracted the paper after the GMC’s verdict (if you look up the paper on their website, you can see a large “RETRACTED” across each page) with the following statement:

Following the judgment of the UK General Medical Council’s Fitness to Practise Panel on Jan 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al are incorrect, contrary to the findings of an earlier investigation. In particular, the claims in the original paper that children were “consecutively referred” and that investigations were “approved” by the local ethics committee have been proven to be false. Therefore, we fully retract this paper from the published record.

But Andrew Wakefield is still around, claiming that he was framed, and people believe him!

Some people believe him, and these people are called anti-vaxxers because they are against immunization. Wakefield is today a main proponent of the anti-vaxxer movement, and he insists still that he was framed by a movement determined to cover up the safety concerns of vaccines.

Do bear in mind that the discrediting of Wakefield’s study happened quite recently – in fact, less than 10 years ago – and hence, many people still believe that vaccines have links to autism. The evidence against Wakefield’s study is all out there in the open, however, waiting to be discovered by people who want to know the truth about vaccines.

References:

  1. Brian Deer. Andrew Wakefield – the fraud investigation. Retrieved on January 15, 2019 from https://briandeer.com/mmr/lancet-summary.htm
  2. Autism Watch. Lancet retracts Wakefield paper. Retrieved on January 15, 2019 from https://www.autism-watch.org/news/lancet.shtml

If the autism study is not true, how come there were famous court cases in the US, which saw people being awarded money after they developed autism because of vaccinations?

Ah, the Vaccine Injury Compensation Program (VICP)! The VICP had awarded families of several children who allegedly develop autism and other health issues due to having received vaccines. The most famous cases were that of Hannah Poling, who might have developed autism due to her vaccinations, and Margaret Althen who claimed that the tetanus vaccine she received had damaged her optic nerves.

Dr Erwin explains that this issue wasn’t a validation of the dangers of vaccine as it might have seemed at first. The US Office of Special Masters, sometimes called Vaccine Court because they decided on cases that fall under the VICP, isn’t a scientific or medical institution. In fact, there are medical establishments and healthcare professionals who feel that the Vaccine Court has turned its back to science.

This is because of how they determine the viability of a case: all that is required is that the petitioner (the person who wants monetary compensation) is able to propose a likely mechanism in which the vaccine caused his or her harm as well as the sequence of cause and effect. No statement from qualified healthcare professionals is needed – the ruling is made based on the abovementioned criteria alone. In the cases of Hannah Poling and other high-profile cases, it is the general opinion of the medical community that the reasonings given by the Vaccine Court for awarding these petitioners are poorly thought out and, in some cases, not scientifically accurate.

Therefore, we should keep in mind that cases such as the awards given under the VICP need not necessarily be based on science. Often, victories are decided by the degree of persuasiveness in the arguments presented by the petitioners.

Have you heard of the claim that multiple vaccines given at the same time can overwhelm or weaken the immune system? That is one of the claims that emerged from Hannah Poling’s case. Like many of the claims that originate from VICP “victories”, this claim has not been proven to be true at all.

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So … vaccine has no proven link to autism?

To date, yes, there is no proven link at all. The claimed link tends to arise and be spread around due to emotive reasons, as parents are understandably concerned about potential harm to their precious little ones. However, Dr Erwin reiterates that there had been much research done to verify whether this link exists, and despite all the work done over the years, we still do not have any evidence to substantiate its existence.

Ultimately, it is up to the parents to make the decision that they believe is best for their child, and this includes whether to vaccinate the child or not. However, Dr Erwin encourages all parents to voice openly their concerns about vaccine to a paediatrician that they are most comfortable with. With so much information out there about vaccines (with many contradicting one another!), clearing up matters with a paediatrician will be helpful to the parents’ efforts to make an educated best decision for the child. HT

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