Rapid Responses to:

PAPERS: Brent Taylor, Elizabeth Miller, Raghu Lingam, Nick Andrews, Andrea Simmons, and Julia Stowe Measles, mumps, and rubella vaccination and bowel problems or developmental regression in children with autism: population study BMJ 2002; 324: 393-396 [Abstract] [Full text]

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Rapid Responses published:

A layman's response

Anthony Weston   (10 February 2002)

No mention of this paper in the print version of BMJ

Jennifer M Fisken, Roger A Fisken   (11 February 2002)

No significant difference

Andrew M Williams   (11 February 2002)

Measles and Autism: Whom do we trust?

James J Bradstreet, MD Fellow AAFP   (12 February 2002)

Different conclusions from overlapping patient populations?

Dr Martin V Hewitt   (12 February 2002)

How are health districts selected?

John Daniel Stone   (13 February 2002)

Illiteracy

Adrian K Midgley   (13 February 2002)

Interpretation of percentage with bowel problems

Jeremy P Humphries   (14 February 2002)

Then what is the cause?

Alan Challoner   (16 February 2002)

Re: Then what is the cause?

Lisa C Blakemore-Brown   (17 February 2002)

There are so Many Parts to the Whole Picture to Consider

Carol A Teasdale   (17 February 2002)

Re: Then what is the cause?

David N Andrews   (18 February 2002)

Numbers with autism

Amelia A Hare   (18 February 2002)

Re: Then what is the cause?

Malcolm S Law   (19 February 2002)

weakness in MMR study

anne n. solomon   (21 February 2002)

Re: There are so Many Parts to the Whole Picture to Consider

Christopher Ish   (21 February 2002)

Re: Re: There are so Many Parts to the Whole Picture to Consider

Carol A Teasdale   (24 February 2002)

MMR and autism: the need for robust epidemiology

John B. March   (25 February 2002)

Repairing the damage whether vaccine-induced or not.

Michael godfrey   (27 February 2002)

Re: Re: Then what is the cause?

Alan Challoner   (5 March 2002)

What proportion of parents belive that their childs autism was caused by mmr.

Chris R Lunt   (9 March 2002)

MMR and Autism - Measuring the Risk

Robert A Greenfield   (14 March 2002)

MMR vaccination population study: no competing interest?

Eric P Segar   (15 March 2002)

Authors should provide confidence limits and provide access to raw data

Aubrey Blumsohn   (17 March 2002)

What is the problem with seperate Vaccines

Scott Cheadle   (29 March 2002)

Re: No significant difference

Donna M. Cretan   (23 October 2002)

Joined up thinking

Lisa C Blakemore-Brown   (24 October 2002)

Immediate Umbilical Cord Clamping as a Cause of Autism

George M. Morley, MB ChB FACOG, Eillen Simon, R.N. PhD   (10 March 2003)

Re: Re: No significant difference

Ankit Kant   (21 June 2003)

Another layman's criticism

Michael Yaffey   (4 August 2003)

Re: other potential causes to consider

Amy V. Haas, BCCE   (7 November 2003)

A layman's response 10 February 2002
Anthony Weston, None Retired Send response to journal: Re: A layman's response	I have taken a keen interest in the debate on this problem since it first appeared when my wife, a practice nurse at the time, let me see the advice distributed by the Department of Health. I remember reading Dr Wakefield's article, which seemed to warn there may be a problem, but he had no basis at all for drawing any more definite conclusions. The current article shows quite clearly that the MMR vaccine has not added to the development of autism or bowel problems. It also shows how anecdotal evidence can be flawed by citing the cases where the parents of thirteen children altered their accounts after the debate started. With fair reporting this should convince most sceptical or uncertain parents. However, fair reporting has not been a feature of this debate, but there may be a way forward. Because of the reporting Dr Wakefield's is the only scientist's name associated in the public's mind with this debate and his view has tended to prevail. If the current study's findings had been available four years ago he would have had no reason to worry further. Perhaps he could now be shown the evidence behind the study and issue a statement admitting that his own much more limited evidence led him to the wrong conclusions. He would show himself to be a true scientist able to be convinced by superior evidence and, more importantly, most doubters among the general public would follow.
No mention of this paper in the print version of BMJ 11 February 2002
Jennifer M Fisken, Clinical Medical Officer, Community Child Health Northallerton Health Services Trust, Northallerton, North Yorkshire, DL6 1JG, Roger A Fisken Send response to journal: Re: No mention of this paper in the print version of BMJ	We were very concerned (not to say bemused) to learn that there was an important paper on MMR in "this week's British Medical Journal", as the news on Radio 4 put it, when there was no sign of the paper in our copy of the journal. We then found the paper on your web site but could still find no reference to it in the printed version, not even in the part of the contents listings headed 'bmj.com'. There are still many people who prefer to read the BMJ in paper form or whose access to the internet is limited - why are you neglecting this large section of your readership? A new, and faintly sinister, form of discrimination seems to be emerging here, where those who are not net addicts are denied useful, or even vital, information. Let us hope that you will be more considerate in future, if only by making sure that any such papers are mentioned prominently in the contents list. Yours faithfully Jennifer M Fisken
No significant difference 11 February 2002
Andrew M Williams, Layman LL19 9SG Send response to journal: Re: No significant difference	This article raises very serious questions on how science is manipulated to varying degrees by different groups. The article is very poor in its summary, approach and detail. For example, the word significant is used more than once, however is not qualified at all. Clearly, there is a difference or the term would not have been used. You cannot use science like this, it is either absolute or it is not science at all. As a concerned parent, I would like to know 'what is the difference?', and have it qualified please against transparent data. Very poor and the case needs to be made much clearer. Andrew Williams.
Measles and Autism: Whom do we trust? 12 February 2002
James J Bradstreet, MD Fellow AAFP, Medical Director International Child Development Resource Center, 1663 Georgia Street #700 Palm Bay Florida 32907 Send response to journal: Re: Measles and Autism: Whom do we trust?	I am concerned that this present Taylor work does little to further our understanding of the role of measles virus in the development of autism. Our center has evaluated 1800 children with autism in the last 5 years. We have extensively reviewed medical records from GPs and consulting pediatricians. The correlation between parental provided evidence of regression (video tape and the like) and medical records is extremely low. Physicians have historically assumed autism was a prenatal event and hence no antenatal recording of a loss of previously acquired skills is documented. The exception to this is the generally well documented, but rare cases of childhood disintegration disorders. We have not sought to publish our medical records review experience on these 1800 children until now, however, given the high degree of confidence the authors seem to have in the reliability of the GP records, we will need to systematically collect this information and proceed with submitting it for publication. In the meantime, there is a gap apparent in the disease surveillance efforts of the UK Public Health officers. Dr. O’Leary (Molecular Pathology online) has painstakingly documented the persistence of a known pathogen – measles virus. In the UK and all developed countries, MV is a reportable disease. We are faced with a similar challenge to that we had with Helicobacter pylori and peptic ulcer disease – ie, does it just like to grow in inflammed tissue or does it cause the inflammation. Dr. O’Leary’s findings are not refuted by this retrospective chart review. So shouldn’t the call from public health be – the time has come to find a specific anti-measles antiviral. Medicine already knows all too well that viral persistence is most often at the expense of the host. If the measles virus persistent in these children is shown to be the vaccine strain – where then does our confidence rest – with molecular biology or retrospective epidemiology? Medical history has taught us to guard against presumption until all the data is gathered. The final chapter of this public health story has yet to be written.
Different conclusions from overlapping patient populations? 12 February 2002
Dr Martin V Hewitt, parent (I work at the Institute of Actuaries, but submit this letter in my onwn capacity 60 Victoria Road, London, N22 7XF Send response to journal: Re: Different conclusions from overlapping patient populations?	One possibility justifying further consideration, concerning two very different papers led by O’Leary and Brent Taylor, is that their divergent findings draw on two populations sharing a common sub-set of autistic children. Whilst one is based on clinical and the other epidemiological data, and both reach different conclusions about the agency of measles in the onset of autism, they both contain children from the North London catchment of the Royal Free Hospital – exclusively so in the Taylor paper. As parents we consented to our autistic son, a patient at the RFH paediatric gastroenterology clinic, being included in Wakefield’s research programme. On enquiring of the RFH, we were informed in writing that our son was also included in Taylor’s research. It is not uncommon for two studies drawing on children with a specific condition in a local area to share the same subjects. It is also possible that other children were subjects in both studies. This anecdote, like all anecdotes in science, deserves further consideration and a more rigorous review of the methods used in the Taylor et al paper in particular. With a common subset, one would have expected some degree of agreement. However, this is not the case. For example, in Taylor’s sample of 473 children born between 1979 and 1998 there are only two cases identified of non-specific colitis with ileal-lymphoid-nodular hyperplasia. However, again anecdotally, over the weekend we contacted parents in our local neighbourhood to confirm five children with this condition out of what must be a far larger number in the whole of North London. Indeed many of the parents of children at the RFH clinic have received letters from Dr Wakefield, with reports signed by Professor O’Leary, confirming the presence of measles in their children’s guts. Taylor finds no increase over the 20-year period in the prevalence of autism and bowel disease. Quite the contrary, he hints that bowel disease is caused by putting these children on ‘unusual diets’ and that a small group of parents may have ‘changed’ accounts of their children’s history on learning of the ’MMR’ publicity. This is an amazing, not to say offensive, suggestion which does not consider how it is possible for Taylor et al to posit such precise nuances of narrative from case records made up of many different practitioner entries. Further, parents might justifiably see different patterns in their children’s development in the light of new scientific thinking, however hypothetical. We need to know more about the procedures Taylor et al followed in constructing two key features of their study: the sample, presumed to be representative; and the case study narratives. These features are even more worrying in the light of Sir Liam Donaldson’s continuing dismissal of ‘Wakefield’s’ findings (the refuters seem to have difficulty in crediting O’Leary with lead authorship) and Dr David Salisbury’s comments on BBC Today on 9 January on Taylor’s ‘fine’ study. The two studies should both be subject to higher-level peer review, given the possibility and implications of overlapping sub-populations.
How are health districts selected? 13 February 2002
John Daniel Stone, layman 34 Outram Road, London N22 7AF Send response to journal: Re: How are health districts selected?	I am a parent of an autistic child, who has been seen at the Royal Free hospital paediatric gastro-enterology department but who has not been diagnosed as suffering suspected MMR vaccine damage. I view the MMR debate from a disinterested position although I have a deep "interested" concern in the cause(s) of the rise in autism generally. Prof. Taylor's first epidemiological study of autism and the MMR issue was based on records from eight North East London health districts, while the present study is based on only five. It would be of some interest to know the basis on which health districts came to be included and excluded in the new paper. And why cannot we be told which health districts have been used?
Illiteracy 13 February 2002
Adrian K Midgley, GP (half time sabbatical Internetworking and Health Exeter EX1 2QS Send response to journal: Re: Illiteracy	Once upon a time illiterates could complain that something important had not been read out to them by the town crier. Now we see people complaining that an article has not been printed for them. I'm not addicted to the Net, I could stop using it whenever I wanted, but I am very keen on a rapid source of information. Advice: Catch up.
Interpretation of percentage with bowel problems 14 February 2002
Jeremy P Humphries, Clerical - but I have an MSc in medical statistics Norwich Send response to journal: Re: Interpretation of percentage with bowel problems	It would be useful to have a confidence interval for the "no significant difference" in "rates of bowel problems" in the analysis of table 1. It would also help to have an explanation of how any such difference might translate into a hypothesised rate of MMR induced "new variant" autism. The translation actually depends on the prevalence of autism among children.
Then what is the cause? 16 February 2002
Alan Challoner, Retired Send response to journal: Re: Then what is the cause?	The study by Brent Taylor, Elizabeth Miller, Raghu Lingam, Nick Andrews, Andrea Simmons, and Julia Stowe*, tells us that: "The proportion of children with autism who had developmental regression or bowel problems has not changed over the 20 years from 1979. Also that, neither developmental regression nor bowel problems in children with autism was associated with MMR vaccination." Perhaps someone can enlighten me— what degree of probability of truth can be ascribed to a study of this sort, which seems to have concentrated on statistical and epidemiological data, as opposed to clinical research? If this study were supposed to encourage parents who are now withholding the MMR vaccination from their children, wouldn't it have helped if they had also been told what is responsible for the, "bowel problems and developmental regression in children with autism"? It is just as important for parents, probably even more so, to know what does cause medical problems as it is to know what doesn't. *Measles, mumps, and rubella vaccination and bowel problems or developmental regression in children with autism: population study. BMJ 2002;324:393-396
Re: Then what is the cause? 17 February 2002
Lisa C Blakemore-Brown, Independent Psychologist. Specialist in Autistic and ADHD Spectrum Disorders UK Send response to journal: Re: Re: Then what is the cause?	There have always been some children who react to vaccine. The Government has a Vaccine Damaged Fund for such children. Over time concerns have emerged from various quarters that there appeared to be an increase autism, ADHD and certain childhood illnesses, whether true or untrue, especially after the introduction of triple vaccines, reaching public consciousness in the late 1990's. Since that point, a great deal of time, effort and public money and been spent on epidemiological studies and reports of such studies trying to prove to the same public that their children are safe from these vaccines. As this message has not been easily swallowed, and the arguments and counter arguments have now reached fever pitch, I am ashamed to see health representatives become increasingly angered on television, dare I say even irrational. The public heard the inferred message, the mooting of fascist solutions. Force parents to have their children vaccinated by using threats, for instance of removal of their children from waiting lists, prevention of children from attending nurseries and schools etc. etc. Accuse parents of child abuse. For heaven's sake - what has happened to common sense and compassion? Instead of spinning out of control, if the powers that be really wanted to listen to parents who felt their children had seriously regressed into autism and were damaged medically by the vaccine, and if they were serious about wanting to protect our population from disease and brain damage, why was a prospective study not immediately commissioned at least 3 years ago when professionals expressed concerns and before the public became aware of those concerns, ensuring all pertinent variables were included? Were they afraid of the likely outcome? Is this why no-one has wanted to look clinically at individual cases of obvious damage? As there is no sign of Health officials accepting they may have been wrong, the fever rising, parents now confused and scared, why not look at the individual cases from a clinical perspective and also start a prospective study now? Ask the opinions of professionals such as myself and the parents of children who have regressed, look at the material we base our opinions on, and ensure such variables are included. In a year's time we might have some answers. Alternatively we could bring in new child abuse laws for parents who do not have their children vacinated or who seek out single vaccines, build more prisons to put them in when their guilt is `proven`. Perhaps we could bug phone lines and send Big Brother into homes all over the land to check on conversations about vaccines. Force school nurses to give the jabs. Introduce theories such as Munchausen Syndrome by Proxy to blame families when children do react and encourage health, education and social workers to lie about developmental regression. For anyone still able to think for themselves, I would recommend a visit to the Paris exhibition at the Royal Academy of Arts in Piccadilly, London. Check out Salvador Dali's `Sleep`...
There are so Many Parts to the Whole Picture to Consider 17 February 2002
Carol A Teasdale, Not employed Send response to journal: Re: There are so Many Parts to the Whole Picture to Consider	How do researchers determine any trends of significance with 81 children over 20 years, with an average of just 4.05 a year? I urge anyone who reads this study to also read Dr Wakefield's, et al, research and make comparisons of quality, regardless of your thoughts on its findings (1). The former study is largely qualitative, because of its dependence on the researchers interpretation of medical records, whilst the latter study concludes its findings on laboratory studies. I am the mother of a child who 'regressed' into hypothyroidism over 13 years. I know from experience that health care professionals do not document this kind of regression, which is similar in many ways to autism, any more than they the have time, or interest, to document the lead up to other chronic conditions. Each visit to a GP is documented as a single event, perhaps in as few words as possible. Behavioural worries are often dismissed, maybe in a well-intended attempt to reassure, and I suspect in many cases are put down to overbearing and anxious parents. Even if there is a connection that something is clearly going wrong with a child, it doesn't take a fool to realise that a researchers interpretation of events is purely subjective and the findings would very much depend on what they wanted to relate to the reader. Any GP who is reading this, and is honest enough to admit that they may be a little puzzled as to how someone might have managed to interpret their notes into any study of significance, should say so. As interesting as such studies are, people need constructive help and hope for their future, otherwise they sink into despair and begin to lose faith in those around them, especially in their health care providers. So I thought that I might mention to parents who feel that there is a definite correlation between the MMR and their child's illness that they should never give up on their search as long as there is always an answer to be found. Even if you are at the end of your tether there is someone who can empathise with your situation and will not give up on you, seek him or her out. It took me years to find just a little light at the end of my daughter’s long dark tunnel, life isn’t perfect now but it’s been turned around for us. If you have an autistic child you might consider that one of the components of the MMR is Neomycin. This is an antibacterial drug that is used to suppress gastrointestinal bacteria before surgery to avoid infection. It is also used in a variety of preparations, too numerous to mention here. This antibiotic interferes with the absorption of Vitamin B6 (2). An error in the uptake of Vitamin B6 can cause a rare form of epilepsy and children become mentally retarded (3). Vitamin B6 is the major vitamin for processing amino acids, which are the building blocks of all proteins and a few hormones. There are studies around which support the theory of treating autistic children with Vitamin B6 (4&5) I am not suggesting for one moment that G A Khakoo, and G Lack made a connection between the MMR, Neomycin and vitamin B6 in their article of April 1st 2000, nor that it was written to make a connection, but they did make a very good point "Only a few of the reports have looked for other potential allergens, such as neomycin and gelatin, which are present in larger quantities in the MMR vaccine and are known to cause serious reactions during measles vaccination." (6) I am surprised at how comfortable GP’s seem to be sitting with any vaccination that has so little research on its components, especially in light of CJD. For example, both the FDA and Medicines Control Agency are reviewing the use of gelatin in pharmaceutical products in an attempt to minimise the risk, with the FDA actually banning its use in intravenous products. (7,8&9) However, they clearly think that there is a risk worth some consideration, so why are our GP’s being so dismissive? Measles is an awful childhood illness for a few children, but it can never be totally eradicated by vaccine, because too many parents exercise their right to religious and human freedoms. Because of this, a vaccine can only create dependence within populations who choose this route to immunity, leaving them unwisely vulnerable at times of supply shortages. Research is already indicating that artificial methods of vaccinating children are disadvantageous to babies, especially those born in poverty, because vaccinated mothers cannot pass on this immunity through the placenta (10). Also that in America there has been a relentless incline in measles cases (11). I estimate that on its present course by 2006 the number of adults contracting measles could be well over 50% putting adults at a much greater risk of complications than children have ever had. It is OK to accept that children will get sick from childhood diseases, some may even die too or become disabled, and that sometimes nature has known best all along. However, it’s not OK to throw away the precautionary principle when dealing with children’s futures collectively, in terms of dealing with generations rather than individuals. We have enough knowledge, and I hope wisdom, to review policies of many years ago in light of new information and act accordingly. This isn’t ‘scare mongering’ it’s common sense. ‘Scare mongering’ is what we see in adverts designed to sell a product that is disturbing a mother’s natural instinct. I am not a professional. I do not work for anyone associated with any pharmaceutical company. I do question the motives of the DoH in refusing to allow separate vaccinations, even though essentially I believe the need for the measles vaccine has been created by its very use. I have wondered if a parent’s lack of choice over individual vaccinations might have connections to plans to introduce a chicken pox vaccine to the MMR in the near future, and if this were so would others also consider disempowering parents to these ends unethical? 1. V Uhlmann, C M Martin, O Sheils, L Pilkington, I Silva, A Killalea, S B Murch, A J Wakefield, JJ O'Leary Potential viral pathogenic mechanism for new variant inflammatory bowel disease. Molecular Pathology http://jcp.bmjjournals.com/cgi/data/55/1/DC1/1 2. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 183–4. 3. Nabbout R, Soufflet C, Plouin P, Dulac O. Pyridoxine dependent epilepsy: a suggestive electroclinical pattern. Arch Dis Child Fetal Neonatal Ed 1999;81:F125–9. 4. Autism Research Review International, Vol. 1 (4), 1987. The Autism Research Review International is a quarterly newsletter published by the Autism Research Institute (4182 Adams Avenue, San Diego, CA 92116, U.S.A.). http://www.autism.org/vitb6.html 5. Rimland B, Callaway E, Dreyfus P. The effect of high doses of vitamin B6 on autistic children: a double-blind crossover study. American Journal of Psychiatry 1978;135:472-5." For Abstract http://ajp.psychiatryonline.org/cgi/content/abstract/135/4/472?maxtoshow=&HI 6. G A Khakoo, consultant paediatrician, G Lack, consultant. Recommendations for using MMR vaccine in children allergic to eggs BMJ 2000;320:929-932 (1 April ) http://bmj.com/cgi/content/full/320/7239/B18 7. The Food and Drug Administration (FDA [Federal Register: March 8, 1999 (Volume 64, Number 44)] List of Drug Products That Have Been Withdrawn or Removed From the Market for Reasons of Safety or Effectiveness http://www.fda.gov/cder/pharmcomp/pcwd.txt 8. The Sourcing and Processing of Gelatin to Reduce the Potential Risk Posed by Bovine Spongiform Encephalopathy (BSE) in FDA-Regulated Products for Human Use September1977 http://www.fda.gov/opacom/morechoices/industry/guidance/gelguide.htm 9. Summary of the Meeting of the Committee on Safety of Medicines Sub -committee on Chemistry, Pharmacy and Standards. 3/6/1999 http://www.mca.gov.uk/ 10. Measles. Measles resurgence in 1989-1991 (page 8) http://www.cdc.gov/nip/publications/pink/meas.pdf 11. Measles . Secular Trends in the United States (page 7). http://www.cdc.gov/nip/publications/pink/meas.pdf
Re: Then what is the cause? 18 February 2002
David N Andrews, lecturer (occasional) various places including universities Send response to journal: Re: Re: Then what is the cause?	Just a word regarding autism, what causes it and whether it is in fact a medical thing. Firstly, no single cause can be identified for autism, and the "necessity and sufficiency" conditions for seeing it as a disease straight up are very much conspicuous by their absence. For example, if it is caused by MMR in some, and by brain damage in others, and then again in others we might see NO detectable anomal at all.... it is clear that other factors must therefore be at play. Secondly, if there are other factors, what are they? We tend to think of autism as being typified by "classic" autism, but in fact it is far from typical: there are, for example, about seven "cases" of Asperger Syndrome per one Kanner Syndrome "case". It would seem that even in the so-called "classic" bunch, we see a spread of different levels of functioning across the board: hardly evidence that the profound autism we sometimes see is the general rule. Why is this? (Rhetorical question) One thing is clear - the family and other social environments ARE indicators of how well an autistic child will develop. I was a classic, but high-functioning autistic child, and now have a diagnosis of Asperger Syndrome. How does that move occur? Not from changes in medical issues, that's for sure! Thirdly, when we look for causes, why is this search restricted to biological factors within the autistic person's brain? No two autistic people will have the same functioning profile (nor do so-called "normals"), and not two people have the same neurology. We cannot link autism directly then to any neurological deficit/abnormality. My opinion is that autism is best seen as a way of dealing with the world as one finds it. If it is a pleasantly and sufficiently predictable enough place, one will adapt well, because one knows what to expect. If it seems a confusing and unpredictable place, and if one is not too happy with the mental gymnastics of predicting, say, other people's intentions, then it is likely that one will reduce any discomfort and confusion by imposing routines and withdrawing from the most of it in order to keep a system which makes sense. And it doesn't matter if one is "autistic" or not: the possiblility is there for ANYONE to need to do this (in fact, social psychological research on crowding has shown that this does indeed happen in so-called "normals" to varying degrees in crowded conditions where one has a sense of little control over one's surroundings). Maybe we should refrain from seeing autism then as a disease or disorder: maybe we should see it as state of being, which can vary in accordance with factors such as sense of control, one's person constructions of external events, the expressed attitudes of those in our social environments... and so on. I have to say that I do not find anything convincing in the standard theories of autism, when I set them against the experiences of the many higher functioning people who have the diagnosis. I propose then a field theoretical approach, with the investigation of construal processes as a means to understanding autism properly. David N. Andrews sosiaalipsykologi, EPiT References: Andrews DN, 1999 "Mental Health Issues in Asperger Syndrome" Unpublished thesis for University of Leeds Andrews DN, 1996-7, Unpublished essays for studies at the University of Leeds.
Numbers with autism 18 February 2002
Amelia A Hare, Locum Consultant Obs & Gynae Warwick Hospital Send response to journal: Re: Numbers with autism	In the paper by Taylor, Miller et al I could not see in the paper any statement of the total numbers of cases of autism +/- bowel problems in relation to time time [either by date of birth, date of diagnosis or date of MMR], only the overall proportions. I realise that the numbers involved on an annual basis would be low, but it would have been nice to have an idea of the change in incidence of autism over time, since an increase in incidence has been indicated by other sources. That would give an idea of how close the population in the study was to the population at large.
Re: Then what is the cause? 19 February 2002
Malcolm S Law, Parent The New Zealand Correspondence School Send response to journal: Re: Re: Then what is the cause?	Our experience with our son who has autism and severe intellectual disability is that he received the MMR vaccine, yet subsequently contracted measles before any autistic signs were evident. I don't know what the incidence of autism is in New Zealand but the number of children under 10 in our community (small by British standards) with autism is suspiciously high. I know of three within a one kilometre radius. All are male, Caucasian, from families whose parents have tertiary education and had the MMR.
weakness in MMR study 21 February 2002
anne n. solomon, none (locum medical SHO) (previous appt (til Feb.): clin. asst. in clinical oncology at Royal Free Hosp., London NW3 Send response to journal: Re: weakness in MMR study	EDITOR- Taylor et al's study of autism and its possible relation to the MMR (BMJ 16/2/02) has two deductive weaknesses: First; the authors say that to prove MMR-related (or 'new variant')autism exists, then the subset of autistic children whose parents voiced concern regarding their development only after receiving the MMR must be larger than the subset where concern was voiced prior to vaccination. But this rests on the assumption that for non-MMR-related (or 'standard') autism, parents tend to become concerned in equal measure before and after MMR (in other words, that the incidence of autistic symptoms - and thus parental concern - is constant over time). If, however, it were true that the symptom-incidence of standard autism peaked before the age of MMR then any children presenting with new variant autism might simply raise the overall post- MMR incidence to equal the pre-MMR incidence, thus camouflaging the existence of new variant autism. Second, the authors assume that in any individual case, pre- MMR parental concern rules out the possibility of new variant autism, whereas I can think of a plausible theory whereby the two are actually positively associated with each other: What if the MMR could trigger autism only if given too early in a child's development? This theory would then predict a group of slow-developers - whose parents may already have voiced concern over their child prior to MMR - who would therefore be vulnerable at the time of their vaccination and some of these would be triggered into autism by it. This study would systematically misinterpret such cases. Yours, Dr A. Solomon Locum medical SHO (Last post - assistant in clinical oncology at Royal Free Hospital) London N16 5UQ Email asolo435@yahoo.com
Re: There are so Many Parts to the Whole Picture to Consider 21 February 2002
Christopher Ish, Physician in private practice (USA) Baltimore MD 21230 (USA) Send response to journal: Re: Re: There are so Many Parts to the Whole Picture to Consider	In response to Ms. Teasdale's musings about whether a GP's clinical notes could be incorporated into a study and whether they are likely to document a regression of function: Yes, on both accounts. The accepted standard of care during a pediatric well child visit calls for examination and documentation of both the child's development in several spheres and any parental concerns. A major regression in functioning or the parent's concern of one should be readily apparent from the clinic notes.
Re: Re: There are so Many Parts to the Whole Picture to Consider 24 February 2002
Carol A Teasdale Send response to journal: Re: Re: Re: There are so Many Parts to the Whole Picture to Consider	Dr Ish, you said; 'The accepted standard of care during a paediatric well child visit calls for examination and documentation of both the child's development in several spheres and any parental concerns' With all due respect, we live in Britain, not America. However, I am not denying that this should be an expected norm of all professionals. I am just casting doubt, from our personal experience, that it is and that findings from our GP services do not make grounds for valid research of such importance. There seems to have been a deafening silence from a British view point on your comment to my letter. Maybe recording standards are worlds apart, or perhaps your private practice affords you a luxury that British GP's do not have.
MMR and autism: the need for robust epidemiology 25 February 2002
John B. March, Head of Mycoplasmology Moredun Research Institute, Pentlands Science Park, Bush Loan, Penicuik, EH26 0PZ Send response to journal: Re: MMR and autism: the need for robust epidemiology	The timing and content of the recent paper by Taylor et al. (BMJ 2002;324:393-396) regarding MMR and autism has all the hallmarks of a hastily constructed piece of work, in which the results and conclusions had already been decided before the research was even conducted. In particular, the timing of its appearance raises the suspicion that this paper was specifically designed to counter the recent research of Uhlmann et al (J. Clin. Pathol. Apr 2002), in which a correlation between autism, inflammatory bowel disease and measles virus was suggested. The authors of this latter paper have made their raw data available for independent scrutiny. Will Taylor et al. also display a similar courtesy? This is all the more important due to the retrospective and subjective nature of the diagnoses claimed. The earliest records are apparently from 1979; it is unclear how a reliable contemporary diagnosis of regressive autism can be made from these records, particularly since such a condition was not even medically recognised at the time. What were the diagnostic criteria applied by Taylor et al.? It is claimed that a contemporary analysis of these 20 year old medical records now allow an accurate diagnosis of regressive autism. Why then, did such a diagnosis elude the treating clinician at the time? It is clear from earlier research that Taylor et al do not believe an MMR-autism link (e.g. Taylor et al. Lancet 1999; 353: 2026-2029). As such, how can the diagnoses of ‘regressive autism’ used in this paper be considered accurate and impartial, since the obvious bias will be to preferentially diagnose ‘regressive’ cases prior to the introduction of MMR. This is simple human nature, and very difficult to avoid wherever a subjective assessment of data is required. If the data were made available for independent scrutiny, this would remove any issue of bias. The issue of patient confidentiality can easily be addressed by making all data anonymous. Other aspects of the paper lack clarity. Analysis of Figure 1 reveals data to be plotted as ‘percentages’ per year, but without actual numbers of cases. This is most unusual, not to include the sample size for each year under study. For example, a ten-fold increase in the number of autistic children diagnosed in 1999 compared to 1979 would not be seen using data plotted in this way. Similarly, even if robust and reliable diagnostic criteria had been applied, and the ratio of ‘regressive’ versus ‘classical’ autistics had not changed in the twenty year period, the increase in the total number of children diagnosed per year with autism and/or bowel disease would demand explanation. As plotted, any such trends (whether upwards or downwards) are hidden. Interpretation is further hindered by the caption to Figure 1, which states ‘Percentage of children with developmental regression (top) and bowel symptoms (bottom) by year of birth.’ What this legend does not state is that the graph plots the percentage of autistic children exhibiting ‘developmental’ regression. This is an important distinction and a surprising omission. The clear implication is that this chart plots the percentage of all children with developmental regression, and this has not changed over time, whereas in fact, it is just the autistic population that is plotted. If the epidemiological data is robust and sound, and helps towards disproving a link between MMR, autism and bowel disease, then it should be properly presented in such a way as to take the debate forward. Unfortunately, the suspicion remains of a hastily-conceived piece of work specifically designed to pre-empt the research of Uhlmann et al. As it stands, this paper serves to support neither the pro- nor anti-MMR camps and most probably adds further to the confusion felt by many members of the public seeking sound scientific advice on the matter.
Repairing the damage whether vaccine-induced or not. 27 February 2002
Michael godfrey, Private practice Environmental Health 157 Fraser St, Tauranga 3001 NZ Send response to journal: Re: Repairing the damage whether vaccine-induced or not.	Sir, The debate over the MMR vaccine continues but there is little doubt amongst those at the “coal-face” that we have been seeing an epidemic of autistic spectrum disorders (ASD) and other chronic debilitating disorders. I am a primary health physician in New Zealand, and one of the very few apparently willing to become involved in trying to help these autistic and other "damaged" kids. Firstly, as there cannot be an epidemic of an inherited disease, there have to be causes for the statistically obvious epidemic of ASD that are devastating families in Britain, the USA and elsewhere. The increase is unlikely to be due to so-called better diagnosis as paediatricians were no less astute 10-20 years ago and the diagnostic criteria for ASD are well established. However, until recently, very few have really looked at the underlying causes or real effective treatments. MMR has been targeted as a major risk factor although it may just be the proverbial "final straw" and we desperately need an unbiased honest investigation into the whole vaccination issue. My main comment relates to what could be the most obvious difference in children nowadays, when compared to the previous generations. These children and their mothers are the most vaccinated generations ever, and they have the highest incidences of chronic immune disorders. We therefore have a potential compounding effect of what essentially has been an inadequately researched experiment. Even the manufacturers acknowledge this, to quote: "The complexity of vaccine delivery today ..with 15-17 (now more) injections in the first two years of life has proved to be far more difficult than previously believed due to unpredicted immune interference and incompatibilities on mixing of different components, demonstrating again the inadequacy of our understanding of how vaccines work and the empiric nature of the science." Douglas of Merck. We have to recognise that increasing amounts of multiple potentially synergistic, toxic substances are being injected into infants and young children. International statistics show unaccountable rises in chronic illnesses including asthma, eczema, glue-ear, diabetes and epilepsy as well as an up to 8-fold increase in regressive ASD over a decade. Not only has diabetes increased but the average age of onset appears to have dropped from 12 to 5 years (Classen JB., 2nd International Vaccine Conference, Sept.2000). All of these have increased commensurate with the rise in vaccinations, but have remained almost non-existent in the unvaccinated. This can thus have little to do with parenting skills or genetics. There is a possible answer and it has been in the biomedical literature for 60 years. Recent USA surveys have confirmed that 6-15% of populations are suffering from unrecognised vit.C deficiencies (serum C <0.2mg/100 ml) (1), If these cohorts are then exposed to the toxins in vaccines, the vit.C reserves could be rapidly depleted and acute scurvy result. The effect can present as (haemorrhagic) encephalitis (or SIDS or even SBS as many of the so-called "injuries" could be scorbutic), or similar disorders that could then finally result in misdiagnosed neurological and endocrinological defects. Again, who is doing serum vit.C tests as we have been misled into believing that a few milligrams of C is enough? If every child or adult was preloaded with enough vit.C before, during and after vaccination, there could be enough to inactivate any vaccine endotoxins. Recommended doses would be 500mg for an infant increasing to 5G a day for a 5 year old (as less appears to be ineffective). Safer vaccinations could then possibly continue to be given, although whether they have been actually cost-effective or not remains debatable, due to the apparent increases in vaccine-induced iatrogenic diseases. I have yet to see any properly conducted controlled studies. I am involved in an ongoing nationwide lay magazine questionnaire, comparing unvaccinated with vaccinated children at NZ Playcentres etc. With nearly 700 returns to date (2/3 vaccinated), there are already obvious differences in the incidences of asthma, eczema, tonsillitis, grommets, ADHD, diabetes, Crohn's, epilepsy and autism (p<.002). This is merely confirming what has been indicated in the medical literature regarding these illnesses and vaccinations. Extensive vitamin C research literature became available in a 3 volume textbook (Vitamin C. by Clemetson C.A.B., CRC Press, 1989) and a few articles of which a recent one is highly relevant (2). Professor Clemetson, a 1948 Oxford graduate, has recently retired as Professor of Medicine at Tulane University, New Orleans, Louisiana. I suspect that there would be very few (if any) deaths from encephalitis or meningitis if every hospital were to give intravenous C in sufficient quantities (i.e. 0.5G/kg body wt./day). It is widely known that Dr. Archie Kalokerinos reduced the previous 50% mortality in under 5 year old aboriginal infants to zero, during a 10 year period after realising that the mothers’ diet and thus their milk was scorbutic. He began injecting ascorbate into every child admitted to his hospital in the Northern Territories, Australia with fevers, infections and even in comas. It is strange that this treatment has been ignored as, according to Clemetson, it can make infectious diseases comparatively benign. Obviously, there would then be little need for exposure to some of the vaccines whose main "raison d'etre" is to prevent the very rare serious complications of common childhood infections. In contrast, I have seen reports in the British media that within 10 months of the 1999 British meningitis C vaccine campaign, there were over 16,000 adverse reactions reported including 12 deaths from the vaccine. It is possible that neither these tragedies nor those from the disease itself, would have occurred if our profession and the public knew these vitamin C facts. Could it thus be that those children who regress into ASD following exposure to endotoxins, whether by DTaP, Hib or MMR vaccines, or following repeated antibiotic therapies resulting in gut dysbiosis etc., are those in the 6-15% with undiagnosed borderline scurvy, as the great majority appear to be able to tolerate vaccinations? Would it not be worthwhile to trial this cheap and apparently highly effective treatment as, to quote Campbell Murdoch, previously Prof. of General Practice, Otago University, “ The important issue here is that our relationship with patients should result in a net benefit to the patient, or at least not cause them any harm.” (3) M.E.Godfrey, Tauranga, NZ References 1. NHANES 111 Survey. FASEB.J. 1998. 2. Vaccination, Inoculations and Ascorbic Acid. C.Alan B. Clemetson. Journal of Orthomolec. Med. 1999;14(3):137-142 3. Murdoch C. and Townsenr A. Becoming involved in controversy: an ethical appraisal 1. In the theoretical warzone between the antagonists. The NZ Family Physician 1995;22(4):136-140
Re: Re: Then what is the cause? 5 March 2002
Alan Challoner, Retired LL18 5UR Send response to journal: Re: Re: Re: Then what is the cause?	In response to the letter from David N Andrews, which in turn was, ostensibly, a response to my letter asking, "Then what is the cause?" I would like to make some further comment. Firstly, my question was not asking primarily about the cause of autism, but about the cause of the bowel problems and developmental regression in children, which have been reported by parents, and are the subject of Dr Wakefield's papers. David Andrews goes on to say that, "We cannot link autism directly then to any neurological deficit/abnormality". I am not sure that this is a correct statement. Scans and imaging of the brains of those suffering from autism, have shown specific areas of the brain which are not morphologically 'normal', and/or are not functioning normally. A third point he makes is a suggestion that, "… autism is best seen as a way of dealing with the world as one finds it. If it is a pleasantly and sufficiently predictable enough place, one will adapt well, because one knows what to expect." That may be a realistic prospect for one who suffers from Asperger Syndrome, as he has told us he does. However, for others who suffer classical autism or autistic syndrome, understanding the world and its social niceties, trying to make any sense of them, as well as knowing what 'prediction' means, is the stuff of dreams. If only they could do that, many parents such as me, would have had a less stressful life, and our children a more fulfilling one. As Geraldine Dawson of the University of Washington Autism Center says in her paper 1, "an impairment in face recognition may turn out to be one of the earliest indicators of abnormal brain development in autism". That, amongst many other things, makes the life of a person who is severely disabled by autism, a continuous journey into the unknown and unknowable. In coping with that they may well restrict themselves to a limited lifestyle which confers some degree of comfort, but this is not truly adaptation and is not a result of any discovery of predictability. 1 Dawson, Geraldine; Carver, Leslie; Meltzoff, Andrew N; Panagiotides, Heracles; McPartland, James; Webb, Sara J. Neural Correlates of Face and Object Recognition in Young Children with Autism Spectrum Disorder, Developmental Delay, and Typical Development. In Press, Child Development.
What proportion of parents belive that their childs autism was caused by mmr. 9 March 2002
Chris R Lunt, Medical Student Liverpool University Send response to journal: Re: What proportion of parents belive that their childs autism was caused by mmr.	Sir The final pargraph of Taylor et al's. paper mentions that it appears some parents beliefs have changed regarding their autistic childrens exposure to the MMR vaccine and the onset and progression of their illness, after the publicity surrounding any possible causal association. It would interest me to know whether the proportions of parents beliveing that their childs illness was precipitated by the mmr vaccine has changed since wakefield et al's. paper and the subsequent media frenzy. I would suspect that during and since the publicity the numbers of parents 'noticing' a temporal link has increased dramatically. Perhaps suggesting that many parents have found solace in a possible explanation which otherwise would not be available for them regarding a complex and highly emotionally demanding condition. Therefore I would suggest that any further research into this issue regarding reported age of onset might take into account the fact that many more parents might be associating the onset of their childs autistic behavioral patterns with the mmr vaccine, producing biased results. It might also be argued that the issue was simply highlighted to parents who had not noticed before and that there really is a temporal association. However I would suspect that because of the highly emotional nature of the subject, that the former explanation is more likely.
MMR and Autism - Measuring the Risk 14 March 2002
Robert A Greenfield, Chartered Engineer Department of Defence, Canberra, ACT 2607, Australia Send response to journal: Re: MMR and Autism - Measuring the Risk	Along with other researchers, Professor Taylor and his team conclude that no association exists between MMR vaccination and autism. I bring to readers' attention data from work by Dr Fombonne, to which Professor Taylor refers. Dr Fombonne finds that of 96 autistic children, 95 had received MMR vaccine. Compared with the general population, this is a very high vaccine coverage. From United Kingdom Public Health Laboratory Service Data, vaccine coverage for all children born between 1992 and 1995 and approaching their second birthday, the typical age when autistic symptoms are recognised, would have been close to 90%. If vaccinated with MMR, less than one per cent (90/95)of Dr Fombonne's source population yields one case of autism, compared with the 10% needed if not receiving MMR vaccine. Whatever the cause of autism, giving MMR vaccine seems to increase the risk of developing this condition by a factor of about ten. Professor Taylor also refers to Dr Kaye's work, where similar data can be found. (BMJ, February 24 2001) Of 110 autistic boys, 109 had received MMR vaccine. I find it most surprising that these data have so far escaped critical examination. Having witnessed an autistic regression in my granddaughter following a Hib vaccination at the age of two and a quarter, which was later confirmed when viewing "blindly" recorded dated home video, I believe I am especially qualified to vouch for the accuracy of many parents' descriptions of autistic regressions that have followed vaccination. Bob Greenfield C.Eng MIEE
MMR vaccination population study: no competing interest? 15 March 2002
Eric P Segar, clinical fellow Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada Send response to journal: Re: MMR vaccination population study: no competing interest?	In their paper on the MMR vaccination and its connection with bowel problems and developmental regression, Taylor et al declare that they have no competing interests. Is this strictly true given that their funding was from the Department of Health, the body that is keen to reassure the public that the vaccination is safe? Public scepticism about the safety of the vaccination has been fuelled by mistrust of government “spin” especially in light of the reluctance of some ministers to say whether their own children have had the vaccination. I wonder then how reassuring this Department of Health- funded paper is to the public and whether this qualifies as a competing interest. Philip Segar clinical fellow Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada epsegar@aol.com 1 Taylor B, Miller E, Lingam R, Andrews N, Simmons A, Stowe J. Measles, mumps, and rubella vaccination and bowel problems or developmental regression in children with autism: population study. BMJ 2002;324:393-6. (16 February.)
Authors should provide confidence limits and provide access to raw data 17 March 2002
Aubrey Blumsohn, Senior Lecturer University of Sheffield Send response to journal: Re: Authors should provide confidence limits and provide access to raw data	I have no particular interest in the MMR vaccine, but found myself reading the paper by Taylor et al. (BMJ 2002:324:393-6) with some incredulity. A primary assertion of the paper appears to be that bowel problems in children with autism is not associated with MMR vaccination. Data shown in the first line of the table is relevant to this assertion. The authors provide no confidence limits in relation to several pertinent findings. Logistic regression of a binary response variable (Y) on a binary independent variable (X = MMR prior to parental concern of bowel problems)with a sample size of 443 observations (of which 58% are in the group X=0 and 42% are in the group X=1) achieves only 15% power at the 0.05 level of significance to detect a change in the probability of bowel problems from a baseline value of 0.180 to 0.215. This change corresponds to an odds ratio of 1.25. It is stated that only single variable results are shown because "adjustment for potential confounders did not substantially affect the results". Although it is possible that adjustment for the seven listed confounders would not alter point estimates of the predictive relationships, confidence intervals would undoubtedly be altered. The authors assert that MMR is not predictive of bowel problems when N is reduced further to include only 28 cases of bowel problems thought most likely to reflect "autistic enterocolitis". Even if a predictive relationship does exist, such apparent non association is hardly surprising. Given the controversy surrounding this issue, the authors would do well to provide their raw data so that others can repeat their analysis. Aubrey Blumsohn Senior Lecturer, University of Sheffield
What is the problem with seperate Vaccines 29 March 2002
Scott Cheadle, IT Consultant - New Dad Netherlands Send response to journal: Re: What is the problem with seperate Vaccines	As a non medical person, I am just wondering about what is the problem with seperate vaccines?. Even if there is a .0001% chance that this vaccine could be linked to Autism, or any other serious disorder, then why not give seperate vaccines. I know that I certainly will be going for the seperate measles vaccine, since I have a son, so rubella is irrelevant, and mumps is not a serious problem, I rather enjoyed having mumps when I was younger since it afforded me a week off school. Even then, surely vaccines can be given for all 3 as seperate vaccines, (please correct me if I am wrong). So what is the problem with seperate vaccines?, other than the fact it means more work for the doctor.
Re: No significant difference 23 October 2002
Donna M. Cretan, RNC,BSN,IBCLC Mark Twain St. Joseph Hospital Send response to journal: Re: Re: No significant difference	Re Article Measles, mumps, & rubella vaccination...Is there a problem with giving the vaccines separately, while this controversy swirls around a possible causal relationship with childhood autism? At one time in medicine and still if there is a question, How can medicine condone continuing to give this combination vaccine to our most vulnerable population? In California there is a ' 273 per cent increase in Autism', according to a University of California Davis M.I.N.D, study by Dr. Robert Byrd. Furthermore Dr. Byrd state "this could not be attributed to a loosening of criteria for diagnosis, also he states, " more than 90% of the children were native". Figures like these cannot be ignored, somewhere there is a problem. Thank you for allowin
Joined up thinking 24 October 2002
Lisa C Blakemore-Brown, Psychologist UK Send response to journal: Re: Joined up thinking	Cynical Government systems - in all countries - can - by a sleight of hand - dismiss all children in this increased group by various means. Years ago few recognised autism. Then, as rates increased, there was recognition and support, albeit minimal.Then - as rates multiplied dramatically - there was a crisis. What to do? Could the system afford to provide support as it had in earlier years fot the children with obvious autism? Obviously not. So - what to do? One way is to cynically use the notion of inclusion and integration and say that autistic children need positive role models - like ordinary peers. So - ignore the needs and conveniently `integrate` the children in amongst the rest. Make up a fancy theory about how this helps them. It'll be years before these erors come out in the behaviour and mental health of the children. Is this whats meant by joined up thinking? Medics ignore the dangers of vaccine and don't report - educationalists help them keep up the pretence.
Immediate Umbilical Cord Clamping as a Cause of Autism 10 March 2003
George M. Morley, MB ChB FACOG, Retired 10252 E. Johnson Road, Northport, MI 49670 USA, Eillen Simon, R.N. PhD Send response to journal: Re: Immediate Umbilical Cord Clamping as a Cause of Autism	Sir: Recent rates for autism spectral disorders are estimated to be 3-4 times higher than 30 years ago (1). This increase is partly accounted for by changes in methodological factors, but the influence of new environmental exposures cannot be discounted. A causal association with measles-mumps-rubella immunization is discounted (2) and that with mercury-containing vaccines is weak (3). However, is an association with the dramatic increase in immediate clamping of the umbilical cord (ICC) at birth possible? ICC is routinely applied during premature, operative and "at risk" births, and increasingly during "normal" births following the recommendation (4) that a segment of the cord should be retrieved immediately after delivery for medico-legal purposes. The immediate effect of ICC is to deprive the neonate of placental respiration and transfusion resulting in complete asphyxia until the lungs function, and 30%-50% loss of the neonate's natural blood volume; the combined hypoxia and hypovolemia / ischemia is then conducive of hypoxic ischemic brain injury. The neonate that receives a full placental transfusion has enough iron to prevent anemia during the first year of life(5), but blood loss in a neonate subjected to ICC becomes evident in infancy as anemia.(5) In grade school children, anemia correlates with all types of autistic disorder (6) and the degree of anemia correlates with the degree of mental deficiency; (7) correcting the anemia does not correct the defect. Kinmond et al. (8) showed that delayed cord clamping combined with gravity assisted placental transfusion prevented anemia (the need for blood transfusion) in preemies. Hack et al. (9) found a high incidence of poor achievement in low birth weight babies. The correlation between autism and birth complications is supported by aother sudies. Hultman (10) reports a great increase in the risk of autism in cesarean deliveries, deliveries with fetal distress and five minute Apgar scores below seven. These obstetrical situations correlate with ICC. In extensive studies on brain damage from induced birth asphyxia (11) in primates, ICC combined with pulmonary obstruction was used routinely to produce asphyxia, brain damage and cerebral palsy. In milder cases of asphyxia, memory defects were noted without any permanent neurological defect; brain stem nuclear damage was noted at autopsy.(12) Meyers (11) found. in monkeys, that when placental circulation was left intact by delayed cord clamping, resuscitation of the depressed fetus did not result in brain damage. In humans, Gunther (13) and Peltonen (14) demostrated continued placental function (respiration and transfusion) after birth, and concluded that "there is good reason in cases of resuscitation to keep the placental circulation intact". I therefore conclude that ICC, especially when imposed on existitng birth asphyxia, can cause mental impairment without obvious neurological impairment, and therefore may well be a significant contributory cause of the current autism epidemic. Erasmus Darwin predicted the autism epidemic 200 years ago, and left instructions for its prevention and its correction (15) "Another thing very injurious to the child, is the tying and cutting of the navel string too soon; which whould always be left till the child has not only repeatedly breathed but till all pulsation in the cord ceases. As otherwise, the child is much weaker than it ought to be, a portion of the blood being left in the placenta, which ought to have been in the child." References: 1. Fombonne E The Prevalence of autism. JAMA 2003;289:87-89 2. Taylor B. et al. Measles, mumps and rubella vaccination ... in children with autism. BMJ 2002;324:393-396 3. Pichichero ME et al. Mercury concentration and metabolism in infants receiving vaccines containing thiomersal: Lancet 2002;360:1737- 1741 4. ACOG COmmittee Opinion on Obstetric Practice. Number 138. Int J. Gyn Obs 1994:45:303-304 5. Linderkamp O. Placental transfusion: determinants and effects. Clinics in Perinatology 1982;9:559-592 6. Lozoff et al. Iron deficiency anemia and Iron therap[y effects on infant development test performance. Pediatrics 1987;79:981-995 7. HurtadoEK et al. Early childhood anemia and mild to moderate mental retardation. Am J Clin Nut 1999; 69(1): 115-9 8. Kinmond et al. Umbilical Cord Clamping and Preterm Infants: a Randomized Trial. BMJ 1993; 306: 172-175 9. Hack M, et al. Outcomes in Young adulthood for very low birth weight infants. New Eng J Med Vol. 346, NO. 3 Jan, 2002:149-157 10. Department of Medical Epidemiology, Karolinska institutet, S- 17277 Stockholm, Sweden. Christina Hultman@mep.ki.se 11. Myers,RE (1972) Two patterns of perinatal brain danmage. American J Obst and Gynec. 112:246-276 12. Windle et al. Brain Damage by Asphyxia at Birth. Scientific American 1969 Oct;221(4):76-84 13. Gunther M The transfer of blood between the baby and the placenta in the minutes after birth. Lancet 1957; I:1277-1280 14. Peltonen T. Placental transfusion, Advantage - Disadvantage. Eur J Pediatr. 1981;137:141-146 15 Darwin E. Zoonomia 1801; Vol III, p301 Further references at www.cordclamping.com Competing interests:   None declared
Re: Re: No significant difference 21 June 2003
Ankit Kant, Medical Student Barts & The London Send response to journal: Re: Re: Re: No significant difference	The problem with separate vaccines is that the time interval between these vaccines being administered would leave children more exposed. This could give the almost eradicated measles and rubella a chance to thrive again. 1 The use of single vaccines is an untried policy and is generally accepted as not protecting children from infectious diseases. Begg N et al. Media dents confidence in MMR vaccine. BMJ 1998; 316: 561 Competing interests:   None declared
Another layman's criticism 4 August 2003
Michael Yaffey, retired economist Keighley, BD21 2HN Send response to journal: Re: Another layman's criticism	It seems to me that the statistician on this project has struggled with a dataset which was not thoughtfully constructed for statistical analysis. (a) The timing data is weak. Figure 1 relies on date of birth as a proxy for date of MMR vaccination. There is no discussion of how strong that link is. (b) The sizeable group with "atypical autism" is likely to disturb the analysis. I believe this includes both borderline cases of childhood autism and cases starting after age three. The latter are likely to coincide with the “vaccine before parental concern” group and should have been considered separately. (c) Moreover, the vaccine timing chosen as the explanatory variable (before, after, none) is not a proper variable, but two. Let me try to separate them. If we disregard the "none" group and look at the timing alone, we find that "before" group are more likely than the "after" group to have bowel problems, 19% against 15%, not statistically significant given the sample size but in the right direction to support Dr Wakefield’s hypothesis. If we take vaccine (regardless of timing) versus no vaccine as the key, the percentages are 18% and 16% which again gives weak support to Wakefield. Moving to regression, vaccine before gives 26% while vaccine after also gives 26%. All vaccines give 26%, whereas with no vaccine we have 30% suffering from regression. These figures for what they are worth go against the Wakefield theory, though we should remember that since the supposed causation is from MMR to regression via bowel troubles, the statistical evidence on regression would be expected to be weaker than that on bowel problems. It seems to me that what comes out of the fog of proxy variables tends to support, weakly, an association with bowel problems but not the causation of regression which Dr Wakefield proposes. I think it regrettable that the authors have not included any data for the total incidence of autism in the catchment area as a time series, as Amelia Hare and John Marsh have pointed out. Furthermore, since the child’s response to the rubella component of the MMR vaccine is at the centre of attention here, it is very regrettable that previous exposure to rubella vaccine though breast-feeding has not been considered as a variable. Michael Yaffey PhD Competing interests:   None declared
Re: other potential causes to consider 7 November 2003
Amy V. Haas, BCCE, Childbirth Educator Healthy Birth of Rochester, Fairport, NY 14450 Send response to journal: Re: Re: other potential causes to consider	Some research shows a causal connection between pitocin use/exposure and Autism. See Below: "Living in a society that believes drugs and technology solve all medical problems, birthing women need to know that no drug is considered safe during pregnancy and labor. They all have potential negative side effects, and partially unknown long-term effects. I say partially because research done in Europe promoted by Dr. Michele Odent, connects future drug addiction2, suicide3 and autism4 to drug exposure during labor. Other suspected effects are learning disabilities, dyslexia and ADD, but the connection has yet to be conclusively proven. However, when I asked the social workers and school psychologists why they were attending my classes, they would say it was because they see far too many learning disabilities and too much ADD. Not something they wanted to risk for their own children." Hattori R., et al; "Autistic and developmental disorders after general anaesthetic delivery.", Lancet, 1991; 337: pp. 1357-58. Wing L., "The Autistic spectrum", Lancet, 1997; 350: pp. 1761-661. [Excerpt from "The Emotional Aspect to Drugs in Labor: the beginning of learning to Parent" by Amy V. Haas, BCCE published in Issue # 7 of Midwifery Today's Having A Baby Today] Competing interests: None declared