RAPID RESPONSE to BMJ's - Why can't the Daily Mail eat humble pie over MMR?

Humble Pie Not on Menu 15 November 2005
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Clifford G. Miller,
Lawyer, graduate physicist, former university examining lecturer in law

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Re: Humble Pie Not on Menu

Dear Sir,


For this final "Final Word" on MMR, the only relevant conclusion is
missing. It is just not there. Nowhere in this Cochrane review does it say:-

"Conclusive evidence was found that there is no causal connection between
MMR and autism"

Instead, what is claimed to the world as a 'conclusion' is not:-

"No credible evidence of an involvement of MMR with either autism or
Crohn's disease was found."

This sentence is not based on the contents of the review. That is odd. It
does not appear in the body of the text, the authors' conclusions or in the
discussion. There is more to be said later about this sentence and other
aspects. Further, as no clinical nor dechallenge rechallenge evidence was
considered then a statement in a review of statistical studies that
evidence was not found is not much of a surprise.

What is a surprise is that not only does the word 'credible' only appear
once in the body of the paper, when it does appear, it is not used in the
context of autism or Crohn's disease.

For autism outcomes, and after looking at and discounting most of 5000
papers - this review claiming safety in the current use of MMR in 90
countries around the world is based on four papers for autism and one for

DeStefano 2004
Madsen 2002
Makela 2002
Smeeth 2004
Taylor 1999

A sixth paper is completely discounted (Fombonne 2001)

Interestingly, the only paper to look at PDD (Smeeth 2004) stated "We were
not able to separately identify the subgroup of cases with regressive
symptoms to investigate the hypothesis that only some children are
vulnerable to MMR-induced disease and that this is always regressive."
These seem to be the very category of children Wakefield's original paper
was concerned with that lead to this furore. Being unable to comment of
this point, the Smeeth paper then referred to the Fombonne [1] and Taylor
[2] papers for support on this point.

However, Cochrane discounts Fombonne as noted above as being impossible to
interpret and states regarding Taylor "The absence of unvaccinated controls
limits the inductive statements that can be made from this study".
Additionally, the Taylor paper was criticised in testimony to the US
Congress by Professor Walter Spitzer an Emeritus Professor of Epidemiology
from McGill University [3]:-

"..... the use of the case series strategy of analysis is unconventional,
not accepted by mainstream scientists and leaves the paper at best as a
hypothesis-generating study ....."

Others complained about the data not being made available. This means peer
review was impossible and therefore also were key elements of scientific
method: repeatability and reproducibility.

Looks like full circle then?

As for your correspondent's comment in the main article: "If children die
from measles, the MMR scandal may indeed get worse." If children were to
die (and that is unlikely for the reasons stated below) that can be laid at
the door of our government for taking away choice of a proven alternative.
MMR is not the only vaccine. There is no need for children to die. The BMJ
is engaging in irresponsible scaremongering and should instead be calling
for choice. Choice is the official policy of the Conservative Party.

What is more, death is an unlikely outcome. In 1987, the year prior to the
introduction of MMR and when monovalent measles vaccine was in use with
incomplete and lower coverage, according to statistics from the Office for
National Statistics, out of 8,535 deaths from all causes in the age range
of children up to 14, one child died of measles, one from encephalitis and
two from pneumonia post measles. In 1989, the year following MMR's
introduction, out of a corresponding 8,061 deaths in this age range, there
was one death from encephalitis and one from otitis, post measles.

So how many cases of autism do we balance against this, Dr Fitzpatrick?

[1] Fombonne E, Chakrabarti S. No evidence for a new variant of
measles-mumps-rubella-induced autism. Pediatrics 2001;108(4):E58

[2] Smeeth L, Cook C, Fombonne E, Heavey L, Rodrigues LC, Smith PG, et al.
MMR vaccination and pervasive developmental disorders: a case-control
study. Lancet 2004;364(9438):963

[3] 106th Congress House Hearings, Autism: Present Challenges, Future
Needs--why the Increased Rates? Hearing Before the Committee on Government
Reform, House of Representatives, One Hundred Sixth Congress, Second
Session, April 6, 2000, Serial No. 106-180

Contact Clifford Miller via

Competing interests: None declared