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.

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The study has since been retracted – The Lancet issued a public statement withdrawing the paper and refuting the original statement of the paper, for reasons we will get into later – but it can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.

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.

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.

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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