# 8 Reading 1: The Lancet Paper

## 8.1 Reading 1: The Lancet Paper

Fitzpatrick, M. (2004) Chapter 8 ‘The Lancet Paper’ taken from MMR and Autism: What Parents Need to Know, London, Routledge. Copyright © 2004 Michael Fitzpatrick.

> We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers.

> (Wakefield et al., 1998, p. 637)

> We did not prove a link between MMR vaccine and this syndrome [‘autistic enterocolitis’].

> (Wakefield et al., 1998, p. 641)

Dr Wakefield's landmark paper, published in The Lancet on 28 February 1998, provided the missing link in the theory that MMR was responsible for the supposed ‘autism epidemic’. That link was ‘autistic enterocolitis’ – a novel and distinctive form of inflammatory bowel disease found in children with autism and other developmental disorders. Dr Wakefield was the ‘senior scientific investigator’ in the Royal Free research team and the paper's lead author. A dozen co-authors included paediatric gastroenterologists Simon Murch and Mike Thomson, who did the colonoscopies, child psychiatrist Mark Berelowitz, and Professor John Walker-Smith, who was the ‘senior clinical investigator’. Dr Wakefield and his colleagues believed they had made a discovery of historic significance; it was rumoured that some of them wondered aloud whether they might win a Nobel Prize or some similar recognition if their bold hypothesis was vindicated.

The paper was based on the investigation of 12 children, who were said to have been consecutively referred to Dr Wakefield's clinic at the Royal Free Hospital with a history of diarrhoea, abdominal pain, bloating, and food intolerance. The dozen included only one girl; in ten cases the diagnosis was autism or ‘autistic spectrum dis-order’; in two there was a suspicion of ‘post-viral encephalitis’; and in one the diagnosis was uncertain between autism and ‘disintegrative disorder’. Examination of the lining of the large and small intestine through a fibre-optic endoscope (ileo-colonoscopy) passed up the rectum (under sedation) revealed a distinctive pattern of inflammation (non-specific colitis) associated with enlarged lymph glands at the end of the small intestine (ileal lymphoid nodular hyper-plasia). Microscopic examination of biopsy specimens confirmed chronic inflammatory changes. Furthermore, the authors reported that the parents of eight of the children believed that their behavioural symptoms, characterised as ‘regression’, began shortly after the MMR immunisation (on average after 6.3 days). They suggested that, in these children, the measles virus (present in an attenuated form in the MMR vaccine) might have produced bowel inflammation, allowing toxic peptides to ‘leak’ into the bloodstream and hence pass to the brain, causing autism.

The authors conceded that they had not proved a link between MMR and ‘autistic enterocolitis’. However, they considered that the chronic inflammatory features they had identified in both the small and large bowels of these children ‘may be’ related to neuropsychi-atric dysfunction. The interpretation offered in the summary at the head of the report, as quoted above, was that the authors had ‘identified associated gastro-intestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers’ (Wakefield et al 1998: 637). The only ‘environmental trigger’ identified in the report was MMR immunisation, which was linked by eight of the children's parents to the onset of their disturbed behaviour.

OpenLearn - The MMR vaccine: Public health, private fears
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