MMR blame still casts shadow over the health establishment

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Wednesday, May 26, 2010
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This is Cornwall

The MMR scare was an appalling episode of public health mismanagement. It terrified the living daylights out of millions of parents and led to the resurgence of measles in the UK.

Several thousand children needlessly contracted the horrible illness. One died.

With luck, this week's ruling by the GMC brings this chapter of ignominy to a close. After completing the longest medical misconduct hearing investigation in its 150 year history, the GMC panel concluded that the doctor at the centre of the scare, Andrew Wakefield had been irresponsible, dishonest, callous, misleading and unethical.

He has now been struck off the medical register.

Not that it makes much difference to him. Dr Wakefield now practises in the USA, from where he continues to reject the charges against him.

The controversy erupted in 1998. The medical journal the Lancet published a paper by Wakefield, describing the results of a study of 12 children. On the back of this infinitesimally small sample, Dr Wakefield suggested there might be a link between autism and the new triple vaccine for measles, mumps and rubella, popularly known as the MMR. He conceded the link was not certain.

The size of the sample and the qualifications might have condemned the paper to obscurity, the subject of further research. What sent it hurtling onto the front pages were the comments Dr Wakefield made in a press conference.

Sweeping the caveats aside, he condemned the triple vaccine outright. He said he could no longer support its continued use and demanded urgent further research into the putative link between the jab and autism. It was, he said, a moral issue.

Parents took one look at the front pages and panicked. Other doctors scrambled in front of the microphones to swear blind there was no link. Their reassurance was not enough. It couldn't be. Parents were trapped between a rock and hard place. The overwhelming majority of parents of toddlers in 1998 did not possess – indeed still do not possess – the medical knowledge to say confidently who was right. Dr Wakefield or his critics.

Frankly most parents didn't know who to believe.

What they did know was that there was a dispute within the medical profession over the possible side effects of the MMR. The side effect in question was not the development of a mild rash or a few nights of fever but full scale autism, a condition of life changing impact.

At which point parents looked at their toddler. Their healthy toddler. Then they looked at the letter from their GP's surgery, informing them it was time they brought Baby in for his MMR jab.

And then thousands upon thousands of them balked.

Take up of the MMR collapsed virtually overnight from well over 90% to less than 70% in some areas.

It is only recently, in the face of overwhelming medical research asserting that the jab was safe, that vaccination rates have risen.

For the best part of a decade however huge numbers of children have been left uncovered and measles rates leapt.

In 1998 when Dr Wakefield first published his findings, there were 56 cases of measles in England and Wales. In 2008, there were 1,348. Hopefully that was the peak.

Dr Wakefield blames the Government for this but he cannot escape his share of the blame. He took a small sample and made sweeping assertions that study after study by his peers have failed to bear out.

He also failed to declare a glaring conflict of interest. He was being paid thousands of pounds by parents engaged in lawsuits to prove that the MMR had caused the autism of their children.

He was not however alone in creating this crisis.

The Government fuelled the flames when it made the triple vaccine compulsory. Up until then parents could choose the traditional single vaccines. Medical research suggested that these were not as effective as the MMR and it was on that basis that the Chief Medical Officer Sir Liam Donaldson, who is retiring this month, insisted that ministers stuck to their guns, withdraw the single vaccines and only offer the MMR on the NHS.

Many parents found this enraging. As long as there was a doubt about the effectiveness of the MMR, they wanted the choice of the single vaccines. Denied the choice, some went to ludicrous lengths to obtain the single vaccines – relatives of mine took their toddlers to France. Others simply opted out, a dangerous decision that left their children at risk.

Huge tributes have been paid to Sir Liam this week but the MMR scare was not his finest hour.

Because he insisted that the single vaccines be dropped at that moment of high controversy, he too must bear significant blame for the collapse in vaccination rates.

Had he played the long game, had he accepted that he must first win parents round before dropping the single vaccine option, then measles rates would not have climbed.

We too in the media cannot escape our share of responsibility. Some sections of the press embraced Dr Wakefield and championed him and his findings against the establishment.

Twelve years later, we know now that Dr Wakefield was wrong and that children have suffered. It is time lessons were learnt all round.

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