Andrew Wakefield

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Andrew Jeremy Wakefield (born 1957) is a british surgeon, who created a lot of attention with an 1998 publication in The Lancet in both among experts and in the public. The article titled Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children[1] correlates MMR-vaccination with autism. As a consequence, vaccination rates dropped, especially in Great Britain.

2004 it emerged, that Wakefield hat recieved prior to publication 55,000 £ from lawyers representing parents of autistic children.[2]. They were searching cor connections between autism and vaccination in order to sue manufacturers of vaccines. This was known neither to Wakefields co-authors nor to The Lancet. As a consequence, ten of thirteen authors stepped back.[3] February 2010 the article was retracted by The Lancet.[4]

Wakefield left his position in the Royal Free Hospital in London 2001, and now works for a private hospital in the US. 2007 he had to face charges by the british medical association.[5]In May 2010 he received an occupational ban[6].

Non the less, his long refuted theories are still taken up by esoteric or CAM inspired circles, e.g. Christopher Maloney.

The Lancet article in 1998

In February 1998 a group around Andrew Wakefield published a report titled "Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children" in the renowned medical publication The Lancet.[1] The report analysed the cases of twelve autistic children, who were treated 1996-1997 in the Royal Free Hospital north of London. It describes bowel related symptoms, which according to Wakefield are proof of a completely new syndrome, which he later called autistic Enterocolitis. Wakefield recommended a closer investigation of possible causes in the environment of the children, amongst others the MMR vaccine. In the publication, a connection between stomach-bowel symptoms and developmental disorders of these children is suspected, which are ostensibly related to the MMR vaccination. A causal connection, that MMR vaccines lead to autism, was not reached however. In a press conference prior to publication Wakefield said he recommends to use single vaccines instead of the triple MMR until clarification. He further stated that eight of the twelve parents consider the vaccination a possible cause, as vaccination and first symptoms followed within days. He stated that he cannot support the further use of MMR vaccine without detailed investigation. In a videorecording prepared for TV in advance he demanded, that MMR be no longer used and single vaccines be used instead.[7]

the resulting dispute

Report, press conference and video unsettled the bitisch people. A heated debate followed, where both sides used Wakefields research as arguments. He was publicly attacked, his critics doubted correctness as well as ethics of his research. Government and National Health Service (NHS) emphasized that extensive epidemiological data would show no correlation between MMR-vaccination and developmental disorders. Many parents refused to believe this, as official information was discredited earlier, as in the case of BSE. Government was blamed that the higher cost of single vaccinations is the cause for their rejection. As a result, MMR vaccination rates dropped from 92% (1996) to 84% (2002). For parts of London it was suspected, that only 60% of neccessary MMR vaccinations are performed, which is substantially below what is needed for herd immunity of measels. Although no measeles epidemic was observed so far, physicians warned of its possibility as the number of infections is on the rise.

One factor in the dispute is, that only the combined vaccine is available via the NHS. Parents rejecting this vaccine can pay themselves or not vaccinate at all. Then prime minister Tony Blar defended the MMR-vaccine in public, but refused to comment on the vaccination of his son Leo.

The majority of paediatricians prefers the combined vaccine, as it is less wearing for the child, and parents have rather one vaccination done instead of three.

Epidemiological research on hundret thousands of children in numerous studies failed to indicate a link between MMR-vaccination and autism. Critics of these studies, as the retired intern John Walker-Smith, despite being in support of the triple vaccine, labelled epidemiology a 'blunt tool', which does not neccesarily expose such connections.[8] As an example, it is difficult to find to populations differing only in vaccination.

Dr. Wakefield ceased to work at the Royal Free Hospital 2001 and works now for a controversil private hospital in the USA. His continued studies include work on possible immunological, metabolical and pathological changes caused by "autistic Enterocolitis", as well as connections between bowel diseases and neurological disorders in children and their possible connection to vaccines[9]

conflict of interests

In february 2004 the Journalist Brian Deer exposed, that Wakefield hat recieved £ 55.000 in third-party funds prior to publishing the Lancet-report from lawyers in search of a connection between autism and MMR-vaccination.[10] According to the Sunday Times several of the quoted parents where involved in law suits against MMR-vaccine manufacturers. Despite Wakefield stated, that these third-party funds were public from the beginning, it was critizized that this fact was known neither to the Lancet, nor to his Co-authors. Feb. 20th 2004 the Lancet called Wakefields study due to a fatal conflict of interest as flawed and stated it should have never been published. Several of Wakefields Co-authors also critizized the lacking information about the third-party funds in clear words.[11] The General Medical Council, in Great Britain responsible for licensing physicians and surveillance of medical ethics, began investigations.[12]

Further, Wakefield and the Royal Free Hospital Medical School in London submitted 9 Months before the incriminated report caused world-wide fear and uncertainity with respect to the MMR-vaccine, a series of patents protecting a number of potentially very profitable products. These would only have a chance on the market, if the renown ot the MMR-vaccine is damaged. The patents regarded an allegedly safe measles-vaccine and medication for the treatment of bowel diseases and autism, which were based on the assumption that they are caused by the MMR-vaccination.[13]

Withdrawal of the Lancet-report

As a consequence of Brian Deers article ten of the thirteen authors of the report formally renounced the claim to have found a connection between autism and MMR.[14] Deer continued his investigation in a documentation on british TV MMR: What They Didn't Tell You, which was broadcats Nov. 18. 2004. In it, Wakefield was accused to own patents for competing products to MMR and to know of tests from his own lab clearly contradicting his claims.[15] Feb. 2nd 2010 The Lancet announced to completely remove the article from 1998 from his list of publications.[4][16]

Anti-Vaccination lawyers paid 3,5 Million Pound

Further investigation by the english newspaper Sunday Times yield, that prior to the publication Wakefield and others recieved up to 3,5 Million british Pound from a law firm, which represents the parents of allegedly marred children. Andrew Wakefield supposedly has recieved half a million pound, the first payments being made two years before the publication. Five of his co-authors and one reviewer, who checked the publication for The Lancet had recieved personal payments, too. [17]

Inzwischen bereitet die britische Ärztekammer einen Ausschluss von Andrew Wakefield vor.[18]

Neuere Studien zum Thema Autismus

Epidemiologische Forschungen zeigen für die vergangenen Jahrzehnte einen Anstieg bei Autismus. Die Ursache ist unklar, vielfach wird allerdings weniger ein realer Anstieg als die Veränderung der Diagnose- und Erhebungsmethodik als Grund vermutet.[19][20][21] So ist die Diagnose für Autismus in den vergangenen Jahren ausgeweitet worden und Kinder werden heute intensiver und eher als früher diagnostisch untersucht. Ein kausaler Zusammenhang zwischen MMR und Autismus kann dagegen inzwischen als so gut wie ausgeschlossen gelten, wie die im Folgenden zitierten, im Unterschied zu Wakefields Arbeit sehr umfangreichen, Studien gezeigt haben. Die Forschung geht heute davon aus, dass die verschiedenen Erscheinungsformen des Autismus ganz entscheidend von genetischen Faktoren mitbestimmt werden. Welch großen Stellenwert die Genetik bei der Entstehung von Autismus hat, zeigen unter anderem Zwillingsstudien: Während eineiige Zwillinge eine Konkordanz von 80% bis 90% aufweisen, ist die Wahrscheinlichkeit, dass beide Kinder erkranken, bei zweieiigen Zwillingen wesentlich geringer.

  • In der Folge von Wakefields Veröffentlichung folgten viele Studien, die den Zusammenhang zwischen MMR und Autismus untersuchten.[22] Im Oktober 2003 wurde eine von der Europäischen Union finanzierte Übersichtsarbeit veröffentlicht, welche die Ergebnisse aus 120 anderen Studien und Nebenwirkungen des MMR-Impfstoffs zusammenfasste und näher analysierte.[23] Die Autoren schlossen:
    • Der Impfstoff ist mit einigen positiven und einigen negativen Wirkungen assoziiert.
    • Es ist 'unwahrscheinlich', dass es eine Verbindung zwischen MMR und Autismus gab.
    • 'Das Design und der Bericht von sicherheitsrelevanten Ergebnissen in MMR-Impfstoff-Studien [...] sind überwiegend inadäquat.'
  • Im Januar 2005 wurde nach intensiver Forschung in einer einzelnen Grafschaft in Minnesota von einer Verachtfachung des Auftretens von Autismus berichtet. Der untersuchte Zeitraum umfasst die frühen 1980er Jahre und endet in den späten 1990ern. Bei der Forschung wurde kein Zusammenhang mit MMR entdeckt. Die Autoren vermuten, dass der Anstieg mit verbesserter Diagnostik der Störung und sich wandelnden Definitionen zu erklären ist.[21]
  • Im März 2005 schloss eine an 30.000 in einem Distrikt von Yokohama geborenen Kindern durchgeführte Studie, dass das Auftreten von Autismus weiterhin anstieg (von 46-86 Fällen auf 10.000 Kinder zu 97-161 auf 10.000), obwohl die Nutzung des MMR-Impfstoffs in Japan im April 1993 eingestellt wurde. Die Schlussfolgerung der Autoren lautet. "Die Bedeutung dieser Ergebnisse ist, dass MMR-Impfung höchst wahrscheinlich keine Hauptursache von ASD ist, da sich hiermit der Anstieg des Auftretens von ASD über die Zeit nicht erklären lässt und dass von einem Rückzug des MMR-Impfstoffs in denjenigen Ländern, die ihn noch verwenden, kein Rückgang im Auftreten von ASD zu erwarten ist".[24] Wakefield behauptet indes, der Anstieg von Autismus, welchen die Daten belegen, würde seine Hypothese stützen.[25] Seine Ansichten fanden jedoch wenig Unterstützung.[26]
  • Im Oktober 2005 veröffentlichte die Cochrane Library eine Überprüfung von 31 wissenschaftlichen Studien und schloss: "Es gibt keinen glaubwürdigen Beweis hinter den Behauptungen der Schadhaftigkeit des MMR-Impfstoffs". Allerdings bemängelten auch diese Autoren, das Design und der Bericht von sicherheitsrelevanten Ergebnissen in MMR-Impfstoffstudien sei überwiegend inadäquat.[27] Cochrane, in Oxford, England, wird von Wissenschaftlern weithin als die höchste unabhängige Prüfinstanz medizinischer Literatur angesehen und als Küster der "beweisgeführten Medizin".
  • Ein Fall-Kontrollstudie von 2008 lässt es als sehr unwahrscheinlich erscheinen, dass eine Masernimpfung ursächlich mit Autismus in Zusammenhang gebracht werden kann.[28]

Berufsverbot

Wakefield wurde im Mai 2010 von der britischen Ärztekammer seine Zulassung für Großbritannien wegen standeswidrigen Verhaltens entzogen. Das General Medical Council beschäftigte sich allerdings nicht mit den wissenschaftlichen Grundlagen der Untersuchung, sondern mit ihrer Durchführung. So soll Wakefield beim Kindergeburtstag seines Sohnes Blutproben von dessen Freunden entnommen und ihnen dafür Geld gegeben haben. Damit hat er den Arztberuf in Verruf gebracht, begründetet die Kammer ihre Entscheidung.

Wakefield wanderte vor einigen Jahren in die USA aus, wo er 2005 ein gemeinnütziges Autismus-Zentrum gründete. Ungeachtet des Berufsverbots in Großbritannien darf er dort weiter praktizieren[6].

Literatur

  • Parker, S.J., Schwartz, B., Todd, J., and L.K. Pickering. 2004. Thimerosal-Containing Vaccines and Autistic Spectrum Disorder: A Critical Review of Published Original Data. Pediatrics, 114(3): Seiten 793-804

Weblinks

Quellennachweise

  1. ↑ 1.0 1.1 Wakefield AJ et al.: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 351(9103), 1998, S. 637-41 PMID 9500320 (PDF, 592 kB) Cite error: Invalid <ref> tag; name "Wakefield98" defined multiple times with different content
  2. ↑ Brian Deer: Revealed: MMR Research Scandal The Sunday Times (London) February 22 2004
  3. ↑ Murch SH et al.: Retraction of an interpretation. Lancet. 2004;363(9411):750 PMID 15016483
  4. ↑ 4.0 4.1 The Editors of The Lancet: Retraction – Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet, Early Online Publication, 2 February 2010. doi:10.1016/S0140-6736(10)60175-7
  5. ↑ Reiner Luyken: Panik vor dem Piks. DIE ZEIT, 19.04.2007, 17/2007
  6. ↑ 6.0 6.1 http://www.spiegel.de/wissenschaft/medizin/0,1518,696472,00.html
  7. ↑ Video des Wakefield-Interviews
  8. ↑ http://www.vaccinationnews.com/DailyNews/February2002/AutBowMeas.htm
  9. ↑ A. Wakefield at his new employer
  10. ↑ B Deer: Revealed: MMR Research Scandal. The Sunday Times, London, 22. Februar 2004
  11. ↑ [1]
  12. ↑ [2]
  13. ↑ http://briandeer.com/wakefield-deer.htm
  14. ↑ Murch SH et al.: Retraction of an interpretation. Lancet. 2004;363(9411):750 PMID 15016483
  15. ↑ B Deer: Further accusations
  16. ↑ http://news.bbc.co.uk/2/hi/health/8493753.stm Lancet accepts MMR study 'false'
  17. ↑ H. Kaulen: Artikel in der FAZ, 8. Januar 2007
  18. ↑ Reiner Luyken: Panik vor dem Piks. Die Zeit, 19. April 2007, Nr. 17
  19. ↑ B Taylor et al.: Measles, mumps, and rubella vaccination and bowel problems or developmental regression in children with autism: population study. British Medical Journal, Vol 324, 16. Feb. 2002, S. 393-396 PDF
  20. ↑ BMJJournals.com - 'Rapid Responses to: Increase in autism due to change in definition, not MMR vaccine' British Medical Journal (Meinungsaustausch der BMJ-Website)
  21. ↑ 21.0 21.1 WJ Barbaresi et al.: The incidence of autism in Olmsted County, Minnesota, 1976-1997: results from a population-based study. Arch Pediatr Adolesc Med. Jan. 2005, 159(1), S. 37-44 PMID 15630056
  22. ↑ Auflistung von 17 Studien zum möglichen Zusammenhang MMR-Autismus, Immunization Action Coalition [3]
  23. ↑ T Jefferson: Unintended events following immunization with MMR: a systematic review. Vaccine. 2003 Sep 8;21(25-26), S. 3954-60 PMID 12922131
  24. ↑ H Honda, Y Shimizu, M Rutter: No effect of MMR withdrawal on the incidence of autism: a total population study. J Child Psychol Psychiatry. 2005 Jun;46(6):572-9. PMID 15877763
  25. ↑ Japanese Study Is The Strongest Evidence Yet For A Link Between MMR And Autism. The Red Flag, 6. März 2005 [4]
  26. ↑ I Sample: Lingering fears of MMR-autism link dispelled. The Guardian, 3. März 2005 [5]
  27. ↑ V Demicheli,T Jefferson, A Rivetti, D Price: Vaccines for measles, mumps and rubella in children. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD004407. PDF
  28. ↑ Hornig M, Briese T, Buie T, Bauman ML, Lauwers G, et al. 2008 Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study. PLoS ONE 3(9): e3140 doi:10.1371/journal.pone.0003140 


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