Autism and the MMR Vaccine, Revisited

From Medscape Infectious Diseases

Paul A. Offit, MD

Hi. My name is Paul Offit. I'm talking to you today from the Division of Infectious Diseases and the Vaccine Education Center at Children's Hospital, Philadelphia. I'm sure many of you know that an editorial was published in the British Medical Journal [1,2] on January 5, 2011, looking at the issue of Andrew Wakefield and his 1998 Lancet publication claiming that the combination measles, mumps, and rubella (MMR) vaccine caused autism. The purpose of the editorial was to make the further point that this was indeed an elaborate fraud. It wasn't just that he was wrong -- it was that it was fraudulent and wrong.

I'm sure many of you know that what Dr. Wakefield claimed was that because the MMR vaccine was given as a combination vaccine, it overwhelmed the immune system, allowing the measles component of that vaccine to enter the intestines and cause intestinal damage, which allowed for the ingress of encephalopathic proteins. Not a single aspect of that hypothesis was correct, and more importantly, nothing was studied, because Dr. Wakefield's initial publication was merely a case series. The studies were to come later, and there were 14 of them that looked at hundreds of thousands of children who either did or didn't receive the MMR vaccine. These studies found that the incidence of autism, not surprisingly, was the same in the vaccinated group as it was in the unvaccinated group.

So what did we learn from this? What disappoints me about the British Medical Journal editorial was that the focus was on fraud -- that essentially this man should not be believed because he was fraudulent. But to me it doesn't matter whether you're fraudulent and wrong. In this case, the only thing that matters was that he was wrong and that his paper certainly did a lot of damage. Thousands of parents in England chose to not vaccinate their children. Hundreds were hospitalized and 4 were killed. Three in Ireland and 1 in London died because their parents feared the MMR vaccine more than they feared the measles. You could argue that the Wakefield paper killed 4 children.

I'd like to think that in the future we'd be more circumspect. When an article that could have a tremendous negative impact on the public's health is submitted for publication, both journal reviewers as well as the media should be far more circumspect. Thanks for your attention