Elsevier

The Lancet

Volume 363, Issue 9411, 6 March 2004, Pages 747-749
The Lancet

Commentary
The lessons of MMR

https://doi.org/10.1016/S0140-6736(04)15714-0Get rights and content

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Autism research

In 1943, Leo Kanner described 11 children with a condition that differed “markedly and uniquely from anything reported so far”.4 He believed that the characteristics of these children, the fundamental feature of whom was their “inability to relate themselves in the ordinary way to people and situations from the beginning of life”, constituted a syndrome, one that he described as “an extreme autistic aloneness”. The recognition of such a distinct clinical entity was important, even urgent at

Research integrity

The latest debate surrounding Wakefield and colleagues' paper has been enormously confusing. Public inquiries have been sought into the way ethics committees operate, how the legal services commission makes its decisions, and even, once again, into the safety of vaccines. A preliminary investigation by the UK's General Medical Council is underway. A furious debate about the actions of almost all protagonists has taken place. The press has become the courtroom for this very public dispute. But

Vaccine safety

In a review of the unintended effects associated with MMR, Jefferson and colleagues10 found that the reporting of safety outcomes in MMR vaccine studies was inadequate. Here is a constantly repeated scenario in health-technology assessment (another example: the row over the safety of calcium-channel blockers). A product undergoes limited testing for efficacy and safety. It is licensed. A signal of concern is thrown up. There is no valid set of safety data to which one can turn to answer these

Public engagement

Many doctors and public-health officials have been frustrated by the debate over MMR. I have shared this frustration. One newspaper fancifully called our recent statement (see page 820) about the 1998 Lancet paper part of an “orchestrated campaign” to bolster MMR programmes.12 In fact, the events leading to today's partial retraction were sudden, sparked by an investigation by a newspaper, The Sunday Times. Our response was to determine answers to very specific allegations. We have had no

Publishing controversial new ideas

It seems obvious now that had we appreciated the full context in which the work reported in the 1998 Lancet paper by Wakefield and colleagues was done, publication would not have taken place in the way that it did. These are difficult judgments to make in hindsight. For example, our sensitivity to potential conflicts of interest is very much higher today than it was in 1998.17, 18, 19 What we will not do is to become profoundly conservative in our decision making about original ideas. A forum

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