Andrew Wakefield’s discredited theory linking vaccination and autism stirred public fears.L. MACGREGOR/REUTERS

It is one of the most serious allegations that could be made about a doctor: manipulating patients’ histories to make money. so it is no wonder that the charges, levied by editors of the British Medical Journal (BMJ) in January against medical researcher Andrew Wakefield, are still getting close scrutiny. now an American whistleblower advocacy group has joined the fray over Wakefield, who in 1998 hypothesized a link, now scientifically disproven, between the measles, mumps and rubella vaccine (MMR) and autism.

On 9 November, David Lewis of the National Whistleblower’s Center in Washington DC published a letter in the BMJ (bmj.com) arguing that Wakefield did not commit research fraud. Lewis told Nature that he thinks the combination of public charges and a slow, secretive investigation has left the public not knowing whom to believe and is unfair to the accused researcher. “[The system] throws people like Andy into a no-man’s-land,” Lewis says.

Wakefield was the lead author of a 1998 paper in the Lancet (A. J. Wakefield et al. Lancet 351, 637–641; 1998) reporting on the case histories of 12 children who had received the MMR vaccine and developed symptoms of autism or inflammatory bowel disease.

The paper inflamed public fears about vaccines, but it was retracted in 2010 after the UK General Medical Council (GMC) concluded that Wakefield had a charge of serious professional misconduct to answer, in part because it found that his team did not have proper ethical approval for tests performed on the children. later in the year, the GMC found him guilty of the misconduct charge and revoked his licence to practice as a doctor. By then, more than 12 large-scale epidemiological studies had failed to find evidence of the hypothesized link (J. S. Gerber and P. A. Offit Clin. Infect. Dis. 48, 456–461; 2009) and the MMR vaccine is today regarded as safe.

But was the paper merely mistaken, or a deliberate fraud? Articles by medical journalist Brian Deer published in the BMJ in 2010 and 2011 accused Wakefield of reporting histories for the children that were not consistent with their records and their parents’ recollections, at a time when Wakefield was also being paid by lawyers intending to sue MMR manufacturers. Deer’s articles themselves did not allege fraud, but on their basis a BMJ editorial in January 2011 called the paper fraudulent.

Wakefield has always denied allegations of manipulating data or having a financial motive in the Lancet paper, but no institution has yet ruled on the matter. in March, University College London (UCL), which took over divisions of the Royal Free Hospital where Wakefield worked, said it had launched an investigation.

In the meantime, Lewis, a microbiologist and former whistleblower who says he was falsely accused of misconduct after alleging links between human illness and the spreading of sewage sludge, asked Wakefield for the chance to review his files. His claims are not likely to challenge the conclusion based on much other evidence that the vaccine does not trigger autism. but they could complicate the debates about Wakefield’s integrity and the UCL investigation.

The documents that Lewis reviewed include confidential forms describing biopsies from the guts of children. the forms were filled out by pathologists Andrew Anthony and Paul Dhillon, who worked with Wakefield at the Royal Free. these documents, Lewis says, are relevant to Deer’s charge that records he obtained do not support Wakefield’s claims in the Lancet paper that the children had nonspecific colitis, a supposed element of an MMR-induced syndrome. on sheets for three of the children graded by Anthony, the handwritten word “colitis” appears, and Dhillon checked a box labelled “non-specific” on 10 forms. Anthony’s sheets are dated after the Lancet publication, whereas Dhillon’s are dated before.

Lewis believes that the sheets show that Anthony and Dhillon were making good-faith diagnoses of colitis. Anthony, who has left UCL, could not be reached by Nature, and Dhillon indicated that UCL had told him not to comment. (Neither has been accused of manipulating data.)

Before publishing Lewis’s letter, the BMJ asked Ingvar Bjarnason, a gastroenterologist at King’s College Hospital, London, to review the materials. Bjarnason says he doesn’t believe they are sufficient to support claims in the Lancet paper of a new disease process. He also questions whether “non-specific” on the grading sheets refers to colitis, saying it could refer to any kind of gut changes. but he says that the forms don’t clearly support charges that Wakefield deliberately misinterpreted the records. “The data are subjective. It’s different to say it’s deliberate falsification,” he says.

Deer notes that he never accused Wakefield of fraud over his interpretation of pathology records. but he says that records read to him from the Royal Free pathology service clearly stated that the children’s gut biopsies were within normal limits, even though they were reported in the Lancet paper as having enterocolitis.

Fiona Godlee, the editor of the BMJ, says that the journal’s conclusion of fraud was not based on the pathology but on a number of discrepancies between the children’s records and the claims in the Lancet paper. she says she will be calling for a public inquiry into the matter, noting that it has been more than a year since she first informed UCL about concerns over Wakefield’s work.

Wakefield denies charges of data manipulation. He says that UCL has yet to officially request his response to any charges and he isn’t convinced that the inquiry will give him a fair hearing. A UCL spokesman says that the investigation will be “thorough, fair and wide-ranging”. but eight months after announcing its inquiry, the university is still looking for a suitable external chairman. 

The United Nations World Health Organization (WHO) has provided essential drugs to help treat an outbreak of dengue fever that has affected an estimated 1,000 people in the north-eastern Kenyan district of Mandera, which borders Ethiopia and Somalia.

There have been four unconfirmed deaths and some patients have been showing symptoms of Dengue Haemorrhagic Fever, a more severe form of the disease, the UN Office for the Coordination of Humanitarian Affairs (OCHA), reported in an update.

All neighboring districts have been alerted and people advised to seek early medical attention if they become ill.

Meanwhile, anaemia prevalence among children under the age of five in the refugee camps in Kenya’s Dadaab area is above 40 percent, according to OCHA. the camps host nearly 470,000 refugees, the majority of them from Somalia.

Three of 6 suspected cases of cholera in the Dadaab camps have been confirmed and all the patients arrived recently from Somalia. Some 82 percent of the refugee population have received measles vaccination during a recent mass inoculation campaign.

An estimated 3.75 million people in Kenya have been experiencing food shortages a result of a prolonged drought in the Horn of Africa, and relief agencies are working with the Government to scale up distributions to the affected populations through one coordinated pipeline from October.

In August, the overall number of admissions to hospital of children with severe acute malnutrition declined from 6,379 to 5,560 cases, but an increase in admissions has been reported in the districts of Marsabit, Samburu, West Pokot and Laikipia.

BM/UN

Section: East Africa, Health

Friday March 4, 2011

PITTSFIELD — Massachusetts health officials suspect they’ve identified a possible fifth case of measles in the state, and Berkshire health professionals say the county is at the ready should the highly contagious disease show up locally.

“We saw it with H1N1 [bird flu], which made it through from Mexico,” said James Wilusz of the Pittsfield Board of Health. “It doesn’t take long to get to a state of pandemic. There’s always a possibility [for the disease to reach the Berkshires], which is why we always preach prevention.”

Measles has been rarely seen in the United States in half a century. Doctors have been giving vaccinations for the disease since the late 1950s, and students are required to get two vaccinations before beginning school. Older Americans carry the antibodies from when the disease was more widely prevalent.

An employee of the French Consulate in Boston brought measles back to Massachusetts in January, the only confirmed case of the disease. since then, an additional four people in the state have been identified as having measles-like symptoms, the latest being a University of Massachusetts Boston professor.

Local officials are wary, but aren’t predicting an immediate threat here.

“Do I think it’s going to make it out here? I think the likelihood is very low,” said Dr. Philip Adamo, saying that the geographic distance mitigates much of the threat. “But if somebody in the Berkshires was in the same building as the [original patient], or rode the T when this woman did and they weren’t vaccinated, that would be the perfect storm.”

According to Adamo, measles is a condition that travels through airborne contact, including sneezing, coughing or breathing on other people. the main symptoms of the disease include fever, rashes, pinkeye, watery eyes, cough and white spots inside the mouth.

If left untreated, measles can lead to life-threatening respiratory and neurological conditions, including pneumonia, brain swelling and death. He said that with the U.S.’s history of vaccination, the most vulnerable people would be foreign-born residents, who might not have received one or both shots.

“This is a good way to educate people,” Adamo said. “It’s a very safe vaccine, so people shouldn’t worry about that.”

Wilusz said that with the county’s preparation for H1N1 and its connections with the federal government, the framework is in place to treat mass numbers if measles did somehow spread throughout the county.

When H1N1 was at its peak, Wilusz worked with the Berkshire Sheriff’s Department and the local school systems to divide the county into three coalitions.

These coalitions would then dispense vaccines or immune system-boosting treatments such as Immune Globulin, in the event someone was exposed.

“We always try to be as prepared as we possibly can — the board and I are in constant communication with emergency dispenser site plans, pandemic plans, continuation of operation plans,” Wilusz said. “We’re always doing our best to stay ahead of the curve.”

Sore throat is the inflammation of throat. it is very common among children and teenagers. Sore throat is almost non-threatening but it can cause lot of discomfort. in most cases, it occurs when a person is suffering from cold or influenza.

- Viral infection like cold and flu often accompanied by fever, achy muscles and runny nose.- Bacterial infections.- Sinusitis.- Measles.- Diphtheria.- Leukemia in rare cases.- Smoking.- Allergies.- Dry air.

- Pain- Irritation.- Inflammation.- Chills and fever.- Hoarseness.- Swelling in lymph glands.- Back of the throat may become red and even covered with greyish white membrane.- Difficulty in swallowing.- Postnatal discharge in some cases can be seen if the inflammation has spread to nasal passages.- Headaches

- Gargle with warm salt water.- The fluid of mango bark can be applied locally. it can be used as a throat gargle.- A mixture of two grams of the pulp of belleric myroblan, a quarter tsp of salt, half a tsp of long pepper, and two tsp of honey should be taken for the treatment.- A gargle made from fenugreek seeds is very effective. Add two tbsp of fenugreek seeds in a liter of cold water and allowed to simmer for half an hour over low flame. cool it and use it for gargle.- Boil one tsp of cinnamon, pinch of pepper, two tsp of honey and take it as a medicine.- Tamarind water should be used as a gargle.- A decoction made from tea leaves mixed with a pinch of salt should be used as a gargle for two or three times daily.- half a liter of water should be poured on a handful of sage leaves. when moderately cool, a little vinegar and honey should be added according to taste. Gargle.- A small piece of raw liquorice should be chewed or sucked for treating sore throat.- Gargle with an extract of kantakari plant.- Water boiled with basil leaves should be taken as a drink and also used as a gargle to relieve a sore throat.

- Fast on orange juice and water for three to five days.- when severe symptoms subside, the patient may adopt an all-fruit diet for three or four days.- After that, he or she may adopt a well balanced diet with emphasis on seeds, nuts, grains, raw vegetables, and fresh fruits.- Clean the bowels daily with warm water enema.- A wet pack should be applied to the throat at two-hourly intervals during the day, and one at night.

• Previous Entry: Underweight – Weighing less than normal – Causes, Symptoms, Remedies, Dietary Considerations
• Next Entry: Scurvy – Vitamin C Deficiency – Causes, Symptoms, Remedies and Dietary Considerations

It’s unfortunate but true that sometimes the hard facts of science don’t turn out to be so grounded in reality after all. Scientific fraud is certainly not new, but manipulation of medical data is always troubling, and potentially deadly, for the public.

That’s the case with a controversial 1998 paper published in the Lancet by Andrew Wakefield, a former intestinal specialist at Royal Free Hospital in London. This week, the editors of the British Medical Journal (BMJ) penned a commentary calling the study “an elaborate fraud,” and accompanied the charge with an in-depth study exposing apparent manipulations of the data by Wakefield to bolster his argument that the mumps, measles and rubella vaccine was linked to autism. (More on Time.com: Vaccination Rates Drop in Wealthier Kids: the Autism Rumors Take a Toll)

Summarizing nearly eight years of investigation into Wakefield’s assertions that the vaccine caused intestinal disorders that correlated with symptoms of autism, journalist Brian Deer of the Sunday Times of London was able to compare the scientist’s descriptions of the vaccinated children in the paper to the government’s National Health Service medical records of the youngsters requisitioned by England’s medical watch-dogs, the General Medical Council. what Deer and a panel of regulators found was fraud. “No case was free of misreporting or alteration,” writes Deer in the BMJ. “Taken together, NHS records cannot be reconciled with what was published, to such devastating effect, in the journal [in 1998].”

That devastating effect was the injury of hundreds of children, and even the deaths of some after they became infected with mumps, measles or rubella due to the fact that they were not vaccinated against MMR, and fueling of a worldwide suspicion of vaccines among parents. “That paper killed children,” says Dr. Paul Offit, a pediatrician at Children’s Hospital of Philadelphia and a long-time critic of the dangers of the anti-vaccine movement who has written a book on the subject, Deadly Choices: How the Anti-Vaccine Movement Threatens Us All. (More on Time.com: Study: Living Near a Highway May Contribute to Autism Risk)

Since 2003, Deer has revealed that Wakefield was paid by a personal injury attorney eager to collect damages from vaccine manufacturers for alleged health damages suffered by “vaccine-damaged” children. in his latest investigation, Deer describes how many of the 12 children in Wakefield’s small study were not recruited from the community at large, as most are in order to avoid biases, but rather came referred to the study by parent advocates convinced that their children had been damaged by vaccines, thus potentially skewing the results.

While Wakefield claimed that eight of the 12 children began showing signs of autism and gastrointestinal disorders days after being vaccinated, three, says Deer, were not diagnosed with regressive autism at all, and five already had documented developmental issues, possibly prior to their immunization. What’s more, the comparison of Wakefield’s descriptions with the children’s medical records shows that the autism symptoms for many began months, not days after the shot, thus weakening Wakefield’s argument that the two might be connected.

When Deer exposed the fact that Wakefield had received payment from the personal injury attorney to help the lawyer’s case, 10 of his 13 co-authors on the 1998 paper retracted their involvement with the work. in his book, Callous Disregard, Wakefield maintains that he informed his colleagues and the dean of the medical school of his involvement as a medical expert. As questions about his research grew, however, the Lancet retracted the paper last February and Wakefield lost his medical license in May. (More on Time.com: Study: More Hope for a Brain Scan for Autism)

Undeterred, he moved to the US where among anti-vaccine advocates, he remains a hero, appearing on television to defend his theory and penning his book with a forward by Jenny McCarthy, the actress who claims her son developed autism from vaccinations, and maintains that her own non-medical therapies have cured him of his symptoms. these supporters continue to question the role that vaccines may play in triggering autism in some children. Barbara Loe Fisher, who co-founded the National Vaccine Information Center as a advocacy group for vaccine safety, responded in a email with the following statement—“[Dr. Wakefield's] finding of an association between vaccination and developmental delays in some children has been expanded upon in subsequent studies published in medical journals. Research into the potential link between vaccination and regression of health in some children continues and should continue to answer outstanding questions about the impact of vaccination on brain and immune function.”

Officials at Autism Speaks, who commented on the BMJ’s study in a statement, note that more research is needed to fully investigate whether some children may be genetically predisposed to developing autism symptoms following vaccination, for whatever reason. But the organization also stresses that “[Many] studies provide evidence against the hypothesis that either the MMR vaccine or thimerosal [a mercury-based additive to immunizations] is linked to the increased prevalence of autism. thus, given the present state of the science, the proven benefits of vaccinating a child to protect them against serious disease outweigh the hypothesized risk that vaccinations might cause autism.” (More on Time.com: New Version of an Old Drug could Treat Autism (and Addiction Too))

That position is echoed by the strong voice of the BMJ’s editorial board, which asked “Who perpetuated this fraud? there is no doubt it was Wakefield.” the evidence revealed in the paper should be a welcome ally for pediatricians, who, thanks to Wakefield’s study, have been fielding questions from concerned parents about whether or not they should vaccinate their children. the American Academy of Pediatrics and the Centers for Disease Control recommend routine and complete vaccinations for all US youngsters, and while the new revelations of fraud are unlikely to change the mind of those who are convinced that vaccinations are a bad idea, they should help most parents rest assured that the shots are actually improving, and not harming their children’s health.

?

Ottawa Public Health is confirming that a person who contracted the measles while travelling has spread the disease to four more people in the Ottawa area.

The city’s health authority said last month one person reported contracting the disease in early December after travelling internationally. it was the first reported case of the measles in the city since 2002.

While most people have been immunized from the measles, Ottawa Public Health has urged residents to ensure their immunization is up to date.

The disease spreads through coughing, sneezing or talking, Ottawa Public Health said. Symptoms include fever, cough and tiny white spots on the mouth, followed by a severe rash.

Dr. Vera Etches, Ottawa Public Health’s associate medical officer of health, said the rarity of the disease makes it more difficult to recognize.

“It often starts with feeling like a bad cold…then moving a couple days later into a rash that starts on the head and spreads downwards,” said Etches.

“It is something that did result in hospitalization for the first case that came into the country, and it is something that makes people feel very sick. sometimes there can be infection of the brain, so it is something we want to prevent,” she said.

Etches said anyone who was born after 1970 and has not had two doses of the measles vaccine after their first birthday are susceptible to the disease.

Pregnant women, people with compromised immune systems, and children under the age of one are most at risk from the disease. Ottawa Public Health is encouraging anyone who believes they may have come in contact with the disease to notify a physician.

The cause of autism may be faulty mitochondria December 3rd, 2010

AUTISM is a puzzling phenomenon. in its pure form it is an inability to understand the emotional responses of others that is seen in people of otherwise normal—sometimes above normal—intelligence. however, it is often associated with other problems, and can also appear in mild and severe forms. This variability has led many people to think of it as a spectrum of symptoms rather than a single, clear-cut syndrome. and that variability makes it hard to work out what causes it.

There is evidence of genetic influence, but no clear pattern of inheritance. The thought that the underlying cause may be hereditary, though, is one reason for disbelieving the hypothesis, which gained traction a few years ago but is now discredited, that measles vaccinations cause autism.

One suggestion that does pop up from time to time is that the process which leads to autism involves faulty mitochondria. The mitochondria are a cell’s powerpacks. They disassemble sugar molecules and turn the energy thus liberated into a form that biochemical machinery can use. Mitochondrial faults could be caused by broken genes, by environmental effects, or by a combination of the two.

Nerve cells have a huge demand for energy, so a failure of the mitochondria would certainly affect them. The question is, could it cause autism? to try to find out Cecilia Giulivi of the University of California, Davis, and her colleagues studied the mitochondria of ten children, aged between two and five years, who had been diagnosed with autism. They have just published their results in the Journal of the American Medical Association.

Extracting nerve cells from the brains of children for a study like this is obviously out of the question. Instead, Dr Giulivi used immune-system cells called lymphocytes as surrogates. Lymphocytes, like nerve cells, use a lot of energy and thus rely heavily on their mitochondria. They are also easy to extract from blood. Dr Giulivi and her colleagues did just that, and then examined the activity of the lymphocytes’ mitochondria.

The children in question were randomly selected from a previous study on autism. They were matched with ten children of similar ages and ethnic backgrounds who were developing normally. Dr Giulivi found that mitochondria from children with autism consumed far less oxygen than those from the control group. that is a sign of lower activity. one important set of enzymes—NADH oxidases—used, on average, only a third as much oxygen in autistic children as they did in non-autists, and eight of the autistic children had significantly lower NADH-oxidase activity than is normal.

The mitochondria of the autistic children also leaked damaging oxygen-rich chemicals such as hydrogen peroxide. These are a normal by-product of mitochondrial activity, but are usually mopped up by special enzymes before they can escape and cause harm—for instance, by damaging a cell’s DNA. The level of hydrogen peroxide in the cells of autistic children was twice that found in non-autists. such high levels suggest the brains of autistic children are exposed to a lot of oxidative stress, something that would probably cause cumulative damage.

These results need to be taken with caution. First, ten is an extremely small sample. second, on the face of things, mitochondrial diseases appear far rarer than autism. They are diagnosed in fewer than six per 100,000 people in America, while autism of some sort is seen in as many as one in 110. Moreover, previous attempts to show a link have come up with a much weaker correlation between the two phenomena. a study of 69 autistic children that was published in 2005 found mitochondrial abnormalities in only five of them. that is higher than the background rate of mitochondrial disease, but nevertheless suggests that faulty mitochondria are not the only cause of autistic symptoms. This study did, however, use a broader sample of the autistic spectrum than Dr Giulivi’s, and looked at muscle cells, whose metabolic profiles are very different from nerve cells and lymphocytes.

It is also important to remember, in studies like this, that correlation is not causation. some third effect could be triggering both the symptoms of autism and the mitochondrial dysfunction. if it is really the mitochondria that are causing the problem, though, there is another hypothesis that needs to be addressed. This is that external triggers might expose such mitochondrial weaknesses earlier than would otherwise be the case.

In 2008 an American court awarded damages to a child after she developed health problems following routine childhood vaccinations. America’s Department of Health and Human Services looked into the child’s medical history and concluded that vaccines had significantly aggravated an underlying inherited mitochondrial disorder that predisposed her to metabolic problems that caused brain damage with features of autism.

The genetic condition in this particular case is rare: only four other examples are known. and no scientist—least of all Dr Giulivi—is suggesting that the new study bears on the question of environmental triggers of mitochondrial malfunction. But if faulty mitochondria do turn out to be a cause of autism, even if not in all cases, that question will have to be investigated. and you can bet your bottom dollar that somewhere out there is a lawyer wondering whether he can do just that.

Source: economist.com/node/17626864?story_id=17626864&fsrc=rss

Please share this news with friends, family and also with your contact list on Twitter, Facebook and MySpace.

Related Posts