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A turning point in the vaccine safety debate?

On Tuesday, the British medical journal The Lancet took a remarkable action.
It finally retracted a discredited 1998 study that had linked the measles, mumps and rubella (MMR) vaccine with autism and bowel disorders.
The retraction came a week after

On Tuesday, the British medical journal The Lancet took a remarkable action.

It finally retracted a discredited 1998 study that had linked the measles, mumps and rubella (MMR) vaccine with autism and bowel disorders.

The retraction came a week after the U.K.’s General Medical Council issued a scathing ruling that charged the study’s lead author, British surgeon and medical research Andrew Wakefield, with unethical behavior, including “callous disregard” for the children used in the study.

Here are just a few of the details of Wakefield’s “dishonest,” “misleading,” and “irresponsible” actions, as described in the council’s 143-page report:

  • Wakefield took blood from his son’s friends at a birthday party (paying them each the equivalent of $8) and then joked about it at a medical meeting several months later.
  • He ordered some children who did not meet the inclusion criteria (gastrointestinal symptoms) for his research to undergo unnecessary colonoscopies, spinal taps, brains scans and other tests.
  • He failed to declare serious financial conflicts of interests. Before he even began his research, Wakefield was hired by a lawyer to “produce unassailable evidence in court so as to convince a court that these vaccines are dangerous” (according to a confidential letter written by that lawyer). In addition, just months before the study appeared in The Lancet, Wakefield had filed a patent for a different, “safer” vaccine that would have been in direct competition with the MMR vaccine.

(For the truly devastating details of this case, see the summary of reporter Brian Deer’s series of investigative articles that ran in Britain’s Sunday Times.)

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Wakefield will most likely be banned soon from practicing medicine.

But it isn’t just his methods that have been discredited. So have his findings: the link with autism. In fact, 10 of his co-authors submitted a retraction of the study in 2004, and numerous studies published since then have found no link between autism and the MMR vaccine.

The 1998 study, by the way, involved only a dozen children — many of whom were part of the lawsuit filed by the lawyer that hired Wakefield.

Yet, the damage has already been done. Doubt about the safety of vaccines has been implanted in the minds of some parents — doubt that has festered into a full-blown anti-vaccine movement. None of the damning evidence presented during the 148 days of hearings seems to have persuaded Wakefield’s fervent followers that his science was deeply flawed.

Indeed, spectators heckled the council’s chairperson as she read aloud the report’s key findings last week.

Trust will take years to regain
I spoke on Wednesday with Patsy Stinchfield, a nurse practitioner and director of infectious disease and immunology at Children’s Hospitals and Clinics of Minnesota.

A passionate advocate for childhood immunizations, she was relieved by the council’s ruling.

“I think it’s a wonderful decision,” she said. “I hope that we can mark that day as a turning point in the vaccine safety conversation.”

But despite the “enormous amount of science” showing no connection between vaccines and autism, some people will continue to deny the evidence, Stinchfield said. That denial is why health officials must keep up their efforts to educate the public about vaccine safety, she added.

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“It’s going to take us years, if not decades, to turn around the thinking that was based on this paper and on what was pretty poor science,” she said.

The impact of Wakefield’s flawed study has been felt around the world — and often with tragic results.

“Before that paper was published in the U.K.,” said Stinchfield, “they had maybe 50 or 60 cases of measles each year.” After the paper came out — and parents stopped immunizing their children — the annual cases of measles rose as high as 1,500. “They’ve had some deaths there as well,” she said.

Most parents don’t realize that measles can be a very serious illness, Stinchfield pointed out. “It’s not just a rash,” she said. “It can cause pneumonia and encephalitis, as well as brain damage in children who survive.”

According to the latest statistics from the Minnesota Department of Health, Minnesota had only 18 isolated cases of measles during the 11 years from 1997 to 2007. But the threat of an outbreak remains.

Stinchfield vividly remembers Minnesota’s last major measles outbreak, which occurred in 1990. “We had 440 cases in the state,” she said. “A lot of them were young children. Our hospital was just overflowing with measles cases.”

Three children died from measles-related complications that year — the first deaths from the disease in Minnesota in more than 10 years.

After that, the state laid down the law regarding childhood vaccinations — literally — with a “no jab, no school” piece of legislation. Parents can, however, opt out for religious or philosophical reasons. It’s that loophole — coupled with the misinformation that’s feeding the growing anti-vaccine movement — that has many health providers concerned.

It used to be that less than 1 percent of all Minnesota parents submitted a notarized consciousness objection to exclude their child from immunizations. “But that number has slowly increased,” said Stinchfield. “The last I heard, it was about 3 percent.”

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Even parents who’ve had their child immunized need to worry about that number. The measles vaccine is only about 95 percent effective, so some children who’ve been vaccinated may catch the highly contagious disease from an unvaccinated classmate or other child with the illness. And, of course, a child who has not yet reached the age to receive the vaccination is also at risk.

Stinchfield remains puzzled and frustrated by parents who continue to deny the scientific evidence that vaccines save lives.

“Before we had a measles vaccine, we had 4 million cases of the disease each year in the U.S. — and 3,000 deaths,” she said. “Now for us to have any cases of the measles is extremely rare, and a death would be headline news. We don’t want to go back to that.”