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FEATURE: Rebecca Coombes Vaccine disputes BMJ 2009; 338: b2435 [Full text]

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A plague on both your houses: come clean!

Harry Hall   (24 June 2009)

Adverse reactions to vaccines are well known

Lisa C Blakemore-Brown   (26 June 2009)

Trust and fiscal partiality

Mark Struthers   (26 June 2009)

Before criticising other people do your own research

John Stone   (26 June 2009)

Vaccines: Pro & Con

Hugh Mann   (27 June 2009)

Half-Truths and Baloney.

Bill Welsh   (28 June 2009)

The origins of antivaccine activism

Peter J Flegg   (28 June 2009)

Re: Vaccines: Pro & Con

Michael D Innis   (28 June 2009)

Re: The origins of antivaccine activism

Lisa C Blakemore-Brown   (29 June 2009)

Re: The origins of antivaccine activism

John Stone   (29 June 2009)

Bogus medical history

T Vemmer   (29 June 2009)

A plague on both your houses: come clean! 24 June 2009
Harry Hall, Retired physician EX1 2HW Send response to journal: Re: A plague on both your houses: come clean!	It's a shame that the polarisation has become so absolute that neither side dare admit that the other's case has any merit. I have some reservations about the so called side of the angels- ie, science, overall benefit to children, etc mainly because of an experience I had some years ago when I tried to extract from the Dept.of Health information about the efficacy and side effects of the current influenza vaccine. Working up through my GP, local public health consultant, dept of health, medicines control agency, and Prof. Salisbury himself I was unable to obtain the relevant figures. Various reasons were given but it was clear that commercial confidentiality was the excuse. I think if such figures, that is showing actual experience, with sources, numbers and statistical applicability were freely available about the current vaccine it would go a long way to relieving anxiety about its suitability or not. Indeed, anything less than this is really not on, especially if compulsion is entering the equation Competing interests: None declared
Adverse reactions to vaccines are well known 26 June 2009
Lisa C Blakemore-Brown, Psychologist UK Send response to journal: Re: Adverse reactions to vaccines are well known	Everyone working in public health knows that there are adverse reactions to every drug and vaccine that's ever been manufactured. These reactions are multiple and have been studied by medics for decades. What is shocking is that instead of admitting this, extraordinary efforts have been put in place to damn those who dare to mention them, including the innocent parents who took their child for vaccine and watched them react. Ms Coombes, sad to say, joins the ranks of the establishment who will do anything rather than admit that sometimes vaccines cause adverse reactions to some people. That includes blaming the parents and hounding them to their own graves. It is helpful and timely that Ms Coombes has picked up the Trinidad and Tobago case from The One Click website. The baby in question had a nose bleed following vaccine before he died. This is not an isolated incident following vaccine. A glance at VAERS reveals that there have been over 350 reports relating to people of all ages (so not just children before Ms Coombes blames Barbara Loe Fisher for directing parents there} who have suffered from Epistaxis following vaccine (amongst other things). What is tragic is that, of the infants who reacted in this way, many died, compared to just one reported death amongst older people. Clearly those infants could not cope with the assault on their vulnerable systems. Surely, instead of turning their backs on these children, "science" should be establishing why they reacted, not turning blind commercial eyes to them, thus increasing their suffering. Competing interests: None declared
Trust and fiscal partiality 26 June 2009
Mark Struthers, General Practitioner Bedfordshire Send response to journal: Re: Trust and fiscal partiality	In 1991 the Tory government introduced a target system of payment for GPs to carry out childhood immunisations. And I distinctly remember the very large drop in income that was incurred when a small number of children missed their jabs. The targets and the potential losses certainly focussed the mind and encouraged the GP’s powers of persuasion over wavering or dilatory parents. But congratulations to the Department of Health: the fat financial carrots dangled in front of GPs did absolute wonders for vaccine uptake around the country. But since 1991, where has the concerned parent been able to go for impartial medical advice about vaccines for their children? The well informed parent will have come to understand that the GP’s advice would be very much tainted by financial self interest. And the perceptive GP would have realised that hard won trust between doctor and patient would steadily - and inevitably - leak away. Competing interests: None declared
Before criticising other people do your own research 26 June 2009
John Stone, Contributing editor: Age of Autism London N22 Send response to journal: Re: Before criticising other people do your own research	Rebecca Coombes' article 'Vaccines disputes' [1] side steps the science and resorts to personal attacks. Yet, Ms Coombes' own mastery of the subject patently lags far behind any of the people she assumes such superiority over. Perhaps I can help her a little. 'A large body of evidence has built up to discredit the decade old Lancet paper that linked the measles virus with irritable bowel syndrome and autism.' Coombes obviously has not read the paper, and does not know the difference between 'irritable bowel syndrome' and 'inflammatory bowel disease'. The paper made no pretence to establish a link. [2] She goes on: 'This includes a 2005 Cochrane systematic review of 139 studies to assess the effects of the MMR vaccine in children, and a 14 year long Finnish study that concluded that the vaccine was not dangerous...The study, which followed 1.8 million people, found that serious adverse events were rare and greatly outweighed by the risks of disease.' Cochrane [3] which selected only 31 of 5000 related studies is riddled with contradictions but in fact condemns the science behind MMR: "The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate." "We were disappointed by our inability to identify effectiveness studies with population or clinical outcomes." So, no scientific basis for either safety or effectiveness. This statement from Cochrane is troubling: "Low risk of bias evidence did not support a causal association with Crohn's disease, ulcerative colitis or autism." bearing in mind that none of the six autism studies included were rated of low risk of bias. They did admittedly favour a study looking at bowel disease (Davis 2001) which, however, was funded and financed by the US Centers for Disease Control, and therefore not remotely independent. Cochrane did not apparently consider the "Finnish study" worth including, it did not collect data for autism or bowel disease, and was supported by MMR manufacturer Merck [3,4]. Coombes writes: "The One Click Group was hostile when I approached them with some straightforward questions. I was directed to another charity and, bizarrely, Peter Fletcher, former chief scientific officer at the Department of Health." However, this is not bizarre at all bearing in mind Fletcher's statements to the Mail on Sunday in 2006 [5]: "A former Government medical officer responsible for deciding whether medicines are safe has accused the Government of "utterly inexplicable complacency" over the MMR triple vaccine for children. "Dr Peter Fletcher, who was Chief Scientific Officer at the Department of Health, said if it is proven that the jab causes autism, "the refusal by governments to evaluate the risks properly will make this one of the greatest scandals in medical history". "He added that after agreeing to be an expert witness on drug-safety trials for parents' lawyers, he had received and studied thousands of documents relating to the case which he believed the public had a right to see." "He said he has seen a "steady accumulation of evidence" from scientists worldwide that the measles, mumps and rubella jab is causing brain damage in certain children." "But he added: "There are very powerful people in positions of great authority in Britain and elsewhere who have staked their reputations and careers on the safety of MMR and they are willing to do almost anything to protect themselves."" Prof Offit's rotavirus vaccine has notched up 136 deaths on the US Vaccine Adverse Events Reporting System in less than 3 years [6], so no clear benefit. There can be no comparison between confirmed cases of measles in 2008 and 1996 when there was little laboratory testing. Notified cases were 5,614 in 1996, as compared with 3,700 in 2007, the last year for which data is available. A quick glance at the HPA table shows that the statement that the death in 2006 was the first for 14 years is simply untrue [7]. So, Coombes has not done her research. What Coombes' article documents is not acccountable science but overwhelming and arrogant hostility towards anyone who reports, or investigates vaccine damage, as manifested by her own attitude to these people. Why is not Prof Salisbury politely listening to us rather than dismissing everything we tell him out of hand? Uncorroborated accusations of intimidation and uncivility are made by Coombes in her article, but what does she think she's doing? We are all being told to go away and not talk like good little children. These are just a few points. [1] Rebecca Coombes, 'Vaccine disputes', British Medical Journal 22 June 2009, http://www.bmj.com/cgi/content/full/338/jun22_2/b2435 [2] Wakefield A J et al, 'Ileal-lymphoid-nodular hyperplasia, non- specific colitis,and pervasive developmental disorder in children', http://www.autismresourceconnection.com/documents/Ileal-colonic- lymphoid.pdf [3] Demicheli V et al, 'Vaccines for Measles, Mumps and Rubella in Children' Cochrane Library 2005, http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004407/frame.html [4] Peltola H et al, 'No evidence for measles, mumps and rubella vaccine-associated inflammatory bowel disease or autism in 14 year prospective study' Lancet 2 May 1998, http://www.freenetpages.co.uk/hp/gingernut/lancet/Finland%20May%201998.pdf [5] Sue Corrigan, 'Former science chief: 'MMR fears coming true'', Mail on Sunday, 22 March 2006, http://www.dailymail.co.uk/health/article- 376203/Former-science-chief-MMR-fears-coming-true.html [6] http://tinyurl.com/3xstxj [7] http://www.hpa.org.uk/web/HPAweb&HPAwebStandard;/HPAweb_C/1195733835814 Competing interests: Autistic son
Vaccines: Pro & Con 27 June 2009
Hugh Mann, Physician Eagle Rock, MO 65641 USA Send response to journal: Re: Vaccines: Pro & Con	Vaccines are a mixed blessing. They can stimulate our immune system and generate an immunity to acute disease, but they can also overwhelm our immune system and generate a susceptibility to chronic disease. The question about vaccines is not whether they work; the question is whether the cure is worse than the disease. Are we better off with the artificial immunity that results from vaccines? Or are we better off with the natural immunity that results from the usual childhood diseases of measles, mumps, and chickenpox? Let’s re-visit this question in a calm, objective manner, without polarizing, ad hominem arguments. Competing interests: None declared
Half-Truths and Baloney. 28 June 2009
Bill Welsh, President Autism Treatment Trust, ATT Clinic, 29A Stafford Street, Edinburgh. EH3 7BJ. Send response to journal: Re: Half-Truths and Baloney.	I regularly tell parents of vaccine damaged children that when the infamous Finnish study (1) is quoted in any article as ‘proof’ that the MMR vaccine is unconnected to autism it reveals two things, 1) that the journalist has not carried out the necessary research and 2) that the article itself will likely be festooned in government half-truths and baloney. “Vaccine Disputes” by Rebecca Combes offers splendid confirmation of this theory. Firstly we can forget Sir Sandy Macara’s BMA debate on introducing mandatory vaccination, it is an exercise in kite flying, a ploy to re- affirm the establishment position re MMR (as safe) while demonstrating that the medical profession is, in the main, of a liberal persuasion (no compulsion). What we cannot ignore however are some of the other statements in the article attributed to Dr David Salisbury, director of immunisation at the Department of Health. He says “Why should I accept it? This degree of personalisation." when referring to the threats he claims he has received. Is this the same Dr Salisbury who has placed himself at the very forefront of government vaccination policy, and made himself the face and voice of MMR by appearing frequently in the media? Surely it is not so surprising that parents, rightly or wrongly, have identified him as the person most likely responsible for their child’s unforgivable MMR vaccine damage? Perhaps if he had remained out of the limelight, as civil servants normally do, he would not be receiving the flack he claims. As the French essayist said: “Fame and tranquillity can never be bedfellows”(2). Another quote: "For some campaigners no study is acceptable if it continues to show no link—you get answers by rote: the study was weak, didn’t look at the right children, didn’t use the right method.” Fact is parents today will not be fobbed off with studies that are designed to dismiss the hypothesis of vaccine involvement. The director of immunisation has been told that the epidemiological studies he uses are actually designed to promote the MMR as safe and unconnected to the upsurge of bowel disease and autism worldwide----not to investigate its role. These epidemiological studies are also inappropriate as ‘safety’ studies. In referring to studies such as these, what is generally meant is that the authors have carried out large-scale population based studies, either by comparing cases (with autism) and controls (no autism) in terms of MMR exposure, or by comparing those exposed and unexposed to MMR in terms of autism or Autism Spectrum Disorder as an outcome. Whilst it is tempting to assume that studies of large populations are somehow ‘better’ by virtue simply of their size, this is by no means necessarily the case. The failure of the population based studies that are frequently cited as supporting the safety of MMR is in their total lack of reference to the original hypothesis formulated by Wakefield. In a presentation at the International Meeting for Autism Research (IMFAR) last year Dr Carol Stott (3) produced evidence to indicate that of over 50 studies claiming to test what can be referred to as the Wakefield hypothesis, only 5 actually addressed it fully, and four of these supported it, at least in part. Of these four, two were clinical studies and two were ‘population’ based. Another significant failing is that whilst population based evidence from case-control or cohort studies might indicate a possible association between two or more factors – and to some extent be used to indicate causality - it can obviously not be applied to prove that in any particular case X did not cause Y. We are also told in Rebecca Coombes article that: "Here (in the UK) vaccine was an individual, narrow, problem; when the science unpicked it, and Andrew Wakefield was in turn unpicked by press, it became very difficult to advance the argument that MMR causes autism.” It is of great concern that the public is being mis-informed that “science has unpicked it” (the original study). It has done no such thing. Let me quote Dr Richard Horton, editor of the Lancet, and one of the architects of the ongoing GMC trial of Dr Andrew Wakefield, Professor John Walker-Smith and Professor Simon Murch: 'The essential clinical findings remain unchallenged as far as their accuracy is concerned' (4). The peer reviewers and other witnesses at the GMC trial have been most praiseworthy of the science, science that could benefit hundreds of thousands of autistic children worldwide. Lest we forget, Dr Andrew Wakefield and his team identified a new form of bowel disease affecting autistic children, an incredible discovery and one that has been lost in the ensuing brouhaha. Another informative quote: "The government did not appease—we didn’t change policies. We did not offer a choice, despite the existence of single vaccines. We had no close links with dissenters." Is this is the language we associate with public health policies? It sounds more like the language of an embattled government fighting Taliban terrorists. The UK is in fact the only country on the planet ever to ban single vaccines. Think about that! The tenor of Rebecca Coombes article suggests that the MMR/bowel disease/autism controversy has dissipated. Nothing could be further from the truth. In the context of issues of public concern this debate has now extended beyond eleven years and understandably the media has wearied. Importantly the parents of MMR vaccine damaged children while living with the reality of a damaged child are faced with a level of opposition previously unmatched---three of the world’s largest pharmaceutical companies, Central government, the medical hierarchy and all combined with a deluge of publicly funded misinformation and propaganda for which the Third Reich would have been proud. And still the issue has not gone away. Over three years ago I opened a clinic in Scotland to assist autistic children and their parents. Never did I expect to see in my lifetime so many British children who had been harmed in such an appalling way. Children who are now non-verbal, unable to concentrate, often in considerable distress and pain, with gastro-enterological problems (bowel disease, reflux etc) and all with autistic symptoms plus much more. Many of these defenceless children have been abandoned by the state, disenfranchised from gastro-enterological services and treatments, and all because they had the misfortune to take ill following MMR vaccination. They are a living contradiction of the government mantra that MMR is safe and unconnected to bowel disease and autism. They are living proof that MMR is a crude experiment using the world’s most precious asset, our children. They are the reason that this issue will never be allowed to go away. References. (1) Patja A, Davidkin I, Kurki T, Kallio MJ, Valle M, Peltola H. Serious adverse events after measles-mumps-rubella vaccination during a fourteen-year prospective follow-up. Pediatr Infect Dis J 2000;19:1127- 34.[ISI][Medline] (2) Michel De Montaigne. Essays. (1580-88).Bk 1, ch. 39. (3) A novel form of Inflammatory Bowel Disease (IBD) with Pervasive Developmental Disorder: A Systematic Review of the state of the evidence" Poster Presentation, IMFAR, London 2008”. Stott CM. (4) Personal communication with Dr Carol M Stott. Competing interests: Grandfather of an MMR vaccine damaged boy.
The origins of antivaccine activism 28 June 2009
Peter J Flegg, Consultant Physician Blackpool, FY3 8NR Send response to journal: Re: The origins of antivaccine activism	Rebecca Coombes has written a succinct and superb summary of the efforts of the antivaccination lobby to decry the scientific evidence about MMR’s benefits and risks. But it fails to explore the question as to why the various groups have resorted to the tactics they have. Since the days of BSE (and probably before) there has been an unfortunate but understandable distrust of the Public Health diktats handed down to us by those in authority such as the Department of Health. Regarding MMR, parents preferred to believe the worst, thinking they were acting in the best interests of their children (when in fact the opposite was true) and little was done at the time to prevent this. It is hardly believable to realise that in 2002, based purely on unevidenced, media- generated froth about MMR causing autism, one in four parents believed that “The weight of scientific evidence supports a link between MMR and autism” (1). One could hardly find a more sobering indictment of the failure of those in authority to effectively counter baseless scare- mongering about the vaccine. It is no wonder that some parents (particularly those unfortunate enough to have an autistic child) and activists who bought into the propaganda about autism/MMR felt strongly enough to set up campaign groups and to promote their own brand of vaccine “science” of the sort that comes courtesy of the University of Google (with no medical expertise necessary). Eleven years after Andrew Wakefield’s now discredited paper was published, there has been no replication and not a jot of properly validated scientific evidence to support their claims, and they see their arguments progressively slipping away from them. Mired in the cognitive dissonance of unreason, it appears that many of them find it difficult to respond in a measured manner, and the result has been the vilification of the scientists and doctors who have done nothing but put children’s best interests first. Rebecca Coombes’ piece paints a very graphic picture of what it means today to be someone who is prepared to stand up and be counted as a proponent for vaccination. Respondents such as John Stone have misinterpreted her article completely. It is not intended to be a scientific investigation into the risks of autism from MMR; science has already spoken on this point, and the vaccine is completely exonerated. Instead Coombes’ article does exactly what it says on the box, namely “investigates the role played by the antivaccine lobby”, and it does so brilliantly. Stone does some nit- picking over wording, trots out his usual canards and cherry-picks quotes of his own, but comes nowhere near to responding to the thrust of Coombes’ expose. Instead he says she makes “uncorroborated accusations of intimidation and uncivility” by antivaccinationists towards doctors. I am surprised Stone calls these accusations “uncorroborated”, since I know he has seen these for himself in the past on the JABS forum where he has been a regular poster. If his memory is still lacking, I would be glad to provide links to the relevant archived webpages. For those wishing to read a further exploration of the vaccine/autism story as it unfolded in the United States, might I recommend this article on the “Vaccine Autism Wars” (2). (1) http://www.comminit.com/en/node/177710 (2) http://www.plosbiology.org/article/info%3Adoi%2F10.1371%2Fjournal.pbio.1000114 Competing interests: None declared
Re: Vaccines: Pro & Con 28 June 2009
Michael D Innis, NA Home Send response to journal: Re: Re: Vaccines: Pro & Con	Gone are the days when all the kids in the neighborhood were invited to a party if one of them had measles or mumps or chicken pox. In those days the HLA system was trusted to take care of the virus and it usually did - I know because my children were party goers. But now, as John Stone , Mark Struthers and Lisa Blakemore-Brown have pointed out the children must take their chances with MMR - and hope for no adverse reactions. A bit of advice from Alan Clemetson and Archie Kalokerinos - always give the child vitamin C before immunization and never immunize an unwell infant. Competing interests: None declared
Re: The origins of antivaccine activism 29 June 2009
Lisa C Blakemore-Brown, Psychologist UK Send response to journal: Re: Re: The origins of antivaccine activism	Dr Flegg. Here's a simple question - have there ever been adverse reactions to vaccinations? Competing interests: None declared
Re: The origins of antivaccine activism 29 June 2009
John Stone, Contributing editor: Age of Autism London N22 Send response to journal: Re: Re: The origins of antivaccine activism	Perhaps Peter Flegg can advise on the correct medical course if a parent reports an adverse reaction to vaccine followed by ill-health, mental regression or death. Or, perhaps he would simply advise re- education? Perhaps he could also tell us whether adverse reactions to vaccines should be carefully monitored (because I can assure him they are not). Meanwhile, I think he should be troubled by the factual inadequacies in this article, and the prejudicial tone. Hard, of course, to argue with someone who uses such maniloquent phrases as "science has already spoken on this point". Evidently, Peter Fletcher was not so convinced: http://www.bmj.com/cgi/eletters/329/7472/939#80961 http://www.bmj.com/cgi/eletters/329/7472/939#81928 But, then, Rebecca Coombes did not interview him, did she? Competing interests: Autistic sone
Bogus medical history 29 June 2009
T Vemmer, Consultant Pain Physician Montagu Hospital, S64 0AZ Send response to journal: Re: Bogus medical history	Rebecca Coombes puts the wrong disease in the explanatory parentheses: << They look at these black and white photographs of children [with tuberculosis] in an iron lung, ...>> That should have been polio, surely. Hope the rest of the article is better researched. Competing interests: None declared