CommentaryThe lessons of MMR
Section snippets
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
References (23)
- et al.
Retraction of an interpretation
Lancet
(2004) - et al.
Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children
Lancet
(1998) A statement by the editors of The Lancet
Lancet
(2004)- et al.
Autism
Lancet
(2003) - et al.
UK's failure to act on research misconduct
Lancet
(2000) - et al.
Unintended events following immunisation with MMR: a systematic review
Vaccine
(2003) Informed choice and balance are victims of the MMR-autism saga
Lancet Infect Dis
(2004)- et al.
Intestinal cytokines in children with pervasive developmental disorders
Am J Gastroenterol
(2003) - et al.
Factors affecting uptake of childhood immunisation: a Bayesian synthesis of qualitative and quantitative evidence
Lancet
(2002) - et al.
Sponsorship, authorship, and accountability
Lancet
(2001)
The Lancet's policy on conflicts of interest
Lancet
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2014, VaccineCitation Excerpt :During the following month The Lancet published a rectified interpretation of the study of Wakefield and colleagues [19]. The article was withdrawn and in 2010 Wakefield was barred from practising medicine in the UK [20]. A review, appeared on the British Medical Journal [21], summarizes the main theoretical structures of anti-vaccination ideology in the 19th and 20th centuries:
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2015, American Family PhysicianCitation Excerpt :Perhaps the most recent well-known retraction involved the extraordinarily small (n = 8) 1998 study published in the Lancet that suggested that the measles, mumps, and rubella vaccine is associated with autism. Since its publication (which resulted in decreased immunization rates), 10 of the 13 authors publicly retracted the interpretation they reported (again, because of fraudulent data), and the Lancet's editor has acknowledged that had they appreciated the full context of this paper, “publication would not have taken place in the way that it did.”4,5 Main Points
Investing in Health: A Contribution to the Achievement of the Lisbon Agenda
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