MMR

The MMR jab is a combined vaccine for measles, mumps and rubella. One version of the vaccine available in 2010 in the UK is made by Merck.M-M-R® II (MEASLES, MUMPS, and RUBELLA VIRUS VACCINE LIVE), Merck, 2009, acc 12 May 2010 Another version is made by GlaxoSmithKline (GSK)Stephen Foley, GSK insists MMR jab is safe as profits rise, The Independent, 15 Feb 02, acc 26 May 2010 and is marketed under the name Priorix.Priorix Product Information, GSK website, acc 26 May 2010
==The Wakefield Controversy==
The MMR vaccine became controversial in February 1998, when a research team headed by Dr Andrew Wakefield suggested that it might be linked to inflammatory bowel disorders and play a role in an increased risk of autism. James Meikle and Sarah Boseley, MMR row doctor Andrew Wakefield struck off register, The Guardian, 24 May 2010, accessed 26 January 2011 
It was GSK's version of the MMR vaccine that was at the heart of the Wakefield case.Stephen Foley, GSK insists MMR jab is safe as profits rise, The Independent, 15 Feb 02, acc 26 May 2010 Dr Wakefield claimed: BBC News. MMR Research Timeline Accessed on 3 February 2009.
* ‘[Autistic enterocolitis] is a genuinely new syndrome and urgent further research is needed to determine whether MMR may give rise to this complication in a small number of people. The combination of the three virus strains in the vaccine may overwork the body's immune system and cause the bowel disorder to develop.'
As the lead author of a peer-reviewed paper published in the respected medical journal The Lancet, his claims sparked high-profile media coverage over the next decade, including campaigns by the Daily Mail, Telegraph and Private Eye questioning the safety of the UK government’s chosen vaccine. Public confidence in the MMR jab plummeted, resulting in a sharp fall in uptake Nick Allen, MMR-autism link doctor Andrew Wakefield defends conduct at GMC hearing, The Telegraph, 27 Mar 08, acc 26 May 2010. and a reported rise in measles cases among children. Fiona Godlee, Jane Smith, Harvey Marcovitch, Wakefield’s article linking MMR vaccine and autism was fraudulent, BMJ 342:doi:10.1136/bmj.c7452, 5 January 2011
Allegations of ethical misconduct against Wakefield and two former colleagues involved in the Lancet study prompted the British General Medical Council (GMC) to begin in 2007 what became its longest ever ‘fitness to practise’ investigation. In January 2010 a GMC tribunal ruled that Wakefield and Professor John Walker-Smith were guilty of serious professional misconduct. As a result, The Lancet retracted the original paper, 12 years after it was first published. Both doctors were struck off the medical register in May 2010, James Meikle and Sarah Boseley, MMR row doctor Andrew Wakefield struck off register, The Guardian, 24 May 2010, accessed 26 January 2011 and have since filed High Court appeals. Brian Deer, Secrets of the MMR scare: How the vaccine crisis was meant to make money, BMJ 2011; 342:c5258, 11 January 2011, accessed 25 January 2011
===The BMJ calls Wakefield's Study an ‘Elaborate Fraud’===
 
In January 2011 the British Medical Journal took the rare step of declaring Wakefield’s study “an elaborate fraud” and published a series of lengthy articles by investigative journalist Brian Deer, who had covered the case for over seven years. These detailed alleged falsification of data and conflicts of interest. The BMJ also called for the veracity of Wakefield’s previous research papers to be examined. 
A BMJ editorial by editors Fiona Godlee, Jane Smith and Harvey Marcovitch stated they had “no doubt” that Wakefield “had perpetrated… fraud” in his flawed 1998 paper. Investigations by journalist Brian Deer, they said, had uncovered “clear evidence of falsification” of patients’ medical histories by Wakefield “in order to support his claim to have identified a new syndrome”. They stated that:
:not one of the 12 cases reported in the 1998 Lancet paper was free of misrepresentation or undisclosed alteration, and … in no single case could the medical records be fully reconciled with the descriptions, diagnoses or histories published in the journal.
Furthermore:
:a great deal of thought and effect must have gone into drafting the paper to achieve the results he wanted: the discrepancies all led in one direction: misreporting was gross.” 
Wakefield responded to the BMJ in a raft of TV interviews in the USA. He claimed Brian Deer had got it wrong.
:when you analyse the records, as I have done meticulously .. what he has done is manipulated and falsified the way in which he compared the original GP's records … with what we wrote. What we wrote in the Lancet is a precise replication of what the parents told us. And … when you go back and check it with the original [GP] records … which I have to say ... were not available to us at the time. Interview with Andrew Wakefield, British Researcher Wakefield Defends Link Between Vaccine and Autism , Good Morning America, ABC News, 17 January 2011
<youtube size="tiny" caption="‪Wakefield defends his autism vaccine research‬ on CNN, January 2011" align="right">8QHGKPNMtUQ</youtube>The BMJ editors said hard lessons had emerged from this “highly damaging saga”, particularly for the co-authors who the GMC had found were seemingly unaware of which child was which in the study’s anonymised text and tables; it was Wakefield alone who wrote the final version of the paper. In a subsequent editorial, editor-in-chief Fiona Godlee declared that a review of documents on the Lancet’s supposed ‘full investigation’, obtained under the Freedom of Information Act, made it “hard to escape the conclusion that this represents institutional and editorial misconduct”. 
Wakefield, who now lives in the USA, continues to stand by his research and deny all allegations against him, including the GMC’s 2010 findings. His supporters, mostly parents of autistic children, maintain he is the victim of a conspiracy and witch-hunt. We support Dr. Andrew Wakefield, accessed 31 January 2011 In recent TV interviews responding to the BMJ’s articles, Wakefield said he would publish documents that would disprove the allegations and called upon people “to read the truth in my book”. CNN News, Medical journal: Study linking autism, vaccines is 'elaborate fraud' January 2011 He said: “There was no fraud, there was no falsification, there was no hoax." Interview with Andrew Wakefield, British Researcher Wakefield Defends Link Between Vaccine and Autism, Good Morning America, ABC News Video, Jan.17, 2011, accessed 27 January 2011.
==Adverse reactions to the vaccine, according to manufacturers==
Adverse reactions following administration of the combined vaccine or one or more of its component vaccines, according to Merck's MMR vaccine package information leaflet, include, but are not restricted to: 
:atypical measles; pancreatitis; diarrhea; vomiting; parotitis; nausea; diabetes mellitus; anaphylaxis; arthritis; arthralgia; myalgia; encephalitis; encephalopathy; Guillain-Barré Syndrome (GBS); febrile convulsions; afebrile convulsions or seizures; ataxia; polyneuritis; polyneuropathy; ocular palsies; paresthesia; aseptic meningitis; and death.M-M-R® II (MEASLES, MUMPS, and RUBELLA VIRUS VACCINE LIVE), Merck, 2009, acc 12 May 2010
GSK's Priorix information leaflet lists adverse reactions including bronchitis, diarrhoea, vomiting, colitis, gastroenteritis, herpes zoster (varicella), herpes simplex, viral infection, lymphadenopathy, arthritis, thrombocytopenia, thrombocytopenic purpura, and meningitis.Priorix Product Information, GSK website, acc 26 May 2010
==MMR studies==
According to the BMJ, since Wakefield’s research was published in 1998 various epidemiological studies ‘have consistently found no evidence of a link between autism and the vaccine'. 
*In March 1998, the Medical Research Council set up a panel of experts, headed by the GP, Dr Michael Fitzpatrick, to examine the claims. They concluded there was ‘no evidence to indicate any link’ between MMR jab and bowel disease or autism in children. Fitzpatrick, M MMR and the Medical Research Council Accessed on 2 February 2009 
*A 14-year study by Finnish scientists concluded in April 1998, claiming to find no danger associated with the MMR vaccine. BBC News. MMR Research Timeline Accessed on 3 February 2009.
*In 1999 Brent Taylor and Elizabeth Miller provided ‘a powerful defence of MMR’, described by the US Institute of Medicine’s immunisation safety review in 2001 as ‘the most extensive epidemiological study and the strongest published evidence against the hypothesis that MMR causes ASD [autistic spectrum disorder] Fitzpatrick, Michael. (2004) Chapter 8 ‘The Lancet Paper’, in MMR and Autism: What Parents Need to Know, London, Routledge. Accessed 1 February 2011.
*In April 2000, ‘Dr Wakefield and Professor John O'Leary, director of pathology at Coombe Women's Hospital in Dublin, presented research to the US Congress showing what they said was ‘compelling evidence’ of a link between autism and MMR. However, it did not ‘confirm that the virus causes autism, or even that the source of the virus found is the MMR vaccination, which contains "dead" versions of the measles and mumps viruses.’ The Department of Health said the claims were ‘unverifiable by usual scientific means.’ BBC News. MMR Research Timeline Accessed on 3 February 2009.
*In January 2001, Dr Wakefield announced that the vaccine had never undergone proper safety tests. In a study published in the journal Adverse Drug Reactions and Toxicology Review, Dr Wakefield said original safety checks on the vaccine were poorly conducted and only lasted for four weeks. The Department of Health rejected the claim again. Wakefield, A.J., Montgomery, S.M. (2000) MMR vaccine: through a glass darkly, Adverse Drug Reactions and Toxicology Reviews; 19: pp.265–83.
*In February 2001, the British Medical Journal published a major statistical analysis concluding the soaring rate of autism in recent years was almost certainly not due to the MMR injection. Kaye, J., del Mar Melero-Montes, M., Hershel J. (2001) Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis British Medical Journal. Accessed on 3 February 2009. The study was conducted by James A Kaye, Maria del Mar Melero-Montes, and Hershel Jick, associate professor of medicine, at Boston Collaborative Drug Surveillance Program, Boston University School of Medicine. Kaye, J., del Mar Melero-Montes, M., Hershel J. (2001) Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis British Medical Journal. Accessed on 3 February 2009. In 2003, a footnote of another paper published in the BMJ by Kaye and Jick stated, "The Boston Collaborative Drug Surveillance Program is supported by grants from Abbott Laboratories, Berlex Laboratories, GlaxoSmithKline [a MMR manufacturer], Hoffmann-La Roche, Ingenix Pharmaceutical Services, Johnson & Johnson Pharmaceutical Research and Development, Pharmacia Corporation, and Novartis Farmacéutica."James A Kaye and Hershel Jick, Incidence of erectile dysfunction and characteristics of patients before and after the introduction of sildenafil in the United Kingdom: cross sectional study with comparison patients, BMJ 2003;326:424-425 (22 February)
*In September 2001, researchers from St George's Hospital in London and the Institute for Child Health gave the vaccine ‘the all-clear after examining all the studies into MMR that have been carried out.’ The research is published in the journal Archives of Disease in Childhood. The researchers say: "Using separate vaccines is an untried and untested policy and, as far as protecting children from infectious disease is concerned, a backward step." BBC News. MMR Research Timeline Accessed on 3 February 2009.
*In December 2001, the Medical Research Council announced the results of research commissioned by the Department of Health. They found no link between the vaccine and autism. BBC News. MMR Research Timeline Accessed on 3 February 2009.
*In February 2002, Dr Wakefield and Professor O'Leary publish a paper in the journal Molecular Pathology. It suggested a possible link between the measles virus and bowel disease in children with developmental disorders. However they emphasised it would be wrong to jump to any hasty conclusions about MMR causing either bowel disease or developmental disorders such as autism. The journal's editors also stressed that the paper did not set out to investigate the role of MMR in developmental disorders or bowel disease - and no role was suggested for it.BBC News. MMR Research Timeline Accessed on 3 February 2009. O'Leary, J.J. (2002) Link found between measles virus and gut abnormalities in children with developmental disorder (Press Statement) (see mp.bmjjournals.com/cgi/content/full/54/DC1). V Uhlmann, CM Martin, O Sheils, L Pilkington, I Silva, A Killalea, SB Murch, AJ Wakefield, JJ O’Leary. [http//www.jcp.bmjjournals.com/cgi/data/55/1/dc1/1. Potential viral pathogenic mechanism for new variant inflammatory bowel diseases] 
*In February 2002, a team from the Royal Free Hospital published a study on the British Medical Journal website saying there is no link between MMR and autism. BBC News. MMR Research Timeline Accessed on 3 February 2009.
*In March 2005, researchers at the Yokohama Rehabilitation Center and the Institute of Psychiatry in Japan said they had strong evidence that the MMR vaccination is not linked to a rise in autism after they found a rise in the incidence of autism after the withdrawal of the measles, mumps and rubella jab in their country in 1993. Coghlan, A. Autism rises despite MMR ban in Japan New Scientist. Accessed on 2 February 2009.
*In May 2006, Dr Stephen Walker in America reported that his research team had found measles virus in the guts of autistic children with bowel disease. Although he stated that the finding did not show that the MMR vaccine caused the condition, he said: "Of the handful of results we have in so far, all are vaccine strain and none are wild measles. This research proves that in the gastrointestinal tract of a number of children who have been diagnosed with regressive autism, there is evidence of measles virus. What it means is that the study done earlier by Dr Wakefield and published in 1998 is correct. That study didn’t draw any conclusions about specifically what it means to find measles virus in the gut, but the implication is it may be coming from the MMR vaccine. If that’s the case, and this live virus is residing in the gastrointestinal tract of some children, and then they have GI inflammation and other problems, it may be related to the MMR."Sally Beck, Scientists fear MMR link to autism, Daily Mail, 6 Dec 2006, acc 12 May 2010 BBC News. MMR Research Timeline Accessed on 3 February 2009.
*In February 2008, ‘a team led by London's Guy's and St Thomas's Hospital looked at any differences in the immune response from the MMR jab to see if that could have triggered autism. They found no difference between children with autism and those without, and concluded the study showed there was no link.’ BBC News. MMR Research Timeline Accessed on 3 February 2009.
==Comments on the studies==
===2005 Japanese study===
In Japan, the MMR was replaced by single vaccines. Children given these single vaccines formed the control group in the 2005 Japanese studyCoghlan, A. Autism rises despite MMR ban in Japan New Scientist. Accessed on 2 February 2009.. These single vaccines contain similar ingredients to the MMR, albeit that they are given separately. For example, the single measles vaccine contains the live measles virusFor example, see "Attenuvax", RxList, the Internet Drug List, accessed March 2009, which has been identified in some studies as a possible causative factor in Crohn's disease.There is a discussion of this issue in Ghosh, S. et al, Detection of persistent measles virus infection in Crohn's disease: current status of experimental work, British Medical Association, 2001, full article accessible by subscription only. Therefore the Japanese study does not show that MMR is safe but does show that the triple MMR is no more likely to cause autism than single vaccines. It does not exclude the possibility that both the MMR and the single vaccines may cause autism. 
The rationale behind giving single vaccines is they are less likely than combined vaccines to overwhelm the child's immune system. But this is an assumption that is not proven. As of 2009, according to Dr David Haslam (chairman of the college of the council of the Royal College of GPs and a supporter of MMR), there is no proof that single vaccines are safer than combined vaccines, and there are fewer studies of single vaccines.Dr David Haslam, quoted in Jeremy Laurance, "MMR fears lead to six-month wait for parents seeking single vaccines", The Independent, 19 February 2002, accessed March 2009.
Dr Viera Scheibner, a long-term researcher and critic of vaccinations, also expressed caution about Andrew Wakefield's backing for single vaccines in an article co-authored with Bronwyn Hancock, although critics of Scheibner point to her lack of medical training: 
:researchers ... and parents, particularly in the United Kingdom, are calling for the three vaccines (measles, mumps and rubella) to be administered individually as if this were the solution to the problem. However it is not just the combined vaccines, such as MMR or DPT that cause autism, and therefore the separate administration of the vaccines will NOT resolve the problem. In fact we know of cases of autism occurring after the individual vaccines. Indeed, the risk may, to the contrary, be even increased. Dr Wakefield has not referred to ANY research that has looked into the relative risk of developing autism after the separate vaccines as opposed to the combined MMR (and we are not aware of any), so there is no basis for such a recommendation.Dr Viera Scheibner and Bronwyn Hancock, "Autism", February 2001, accessed March 2009
==Doubts about MMR safety==
Among those who went on record as doubting the safety of MMR is Dr Peter Fletcher, former chief scientific officer at the UK's Department of Health. A 2006 article in the Daily Mail reports:
:after agreeing to be an expert witness on drug-safety trials for parents' lawyers, he [Fletcher] had received and studied thousands of documents relating to the case which he believed the public had a right to see.
:He said he has seen a "steady accumulation of evidence" from scientists worldwide that the measles, mumps and rubella jab is causing brain damage in certain children.
:But he added: "There are very powerful people in positions of great authority in Britain and elsewhere who have staked their reputations and careers on the safety of MMR and they are willing to do almost anything to protect themselves."Sue Corrigan, "Former science chief: 'MMR fears coming true'", Daily Mail, 22 March 2006, accessed March 2009.
==MMR and freedom of information==
In January 2009 the Daily Mail reported on a Freedom of Information ruling on MMR data:
:Confidential documents on the introduction of the MMR vaccine should be released by the Department of Health, says the Information Commissioner. Richard Thomas ruled that their release was in the public interest, despite months of foot-dragging by officials.
:He said minutes from three committee meetings before the introduction of the Measles Mumps and Rubella jab in 1988 should be published under the Freedom of Information Act.Jenny Hope, "Confidential MMR vaccine files should be opened in the public interest, watchdog rules", Daily Mail, 13 January 2009, accessed March 2009
The article says the information is expected to include data from the pre-licensing studies of MMR before the nationwide immunisation began in 1988. Jackie Fletcher, who runs the vaccine awareness group Jabs, said parents who believed their children were damaged by MMR, want to know the basis on which the vaccine was originally approved.Jenny Hope, "Confidential MMR vaccine files should be opened in the public interest, watchdog rules", Daily Mail, 13 January 2009, accessed March 2009
==MMR litigation==
===Group claim (UK)=== 
In June 2007, a group claim by parents against vaccine manufacturers for damages on behalf of children allegedly damaged by the MMR vaccination collapsed when legal aid was withdrawn. The litigation, which at one time peaked with 2,500 children in the group, had been in progress for several years.MMR group legal claim collapses in high court, FOIA Centre, 08/06/07, acc 26 May 2010
A high court judge, Justice Keith, ruled that all but two claims against various pharmaceutical companies must be discontinued, under threat of being struck out, because the withdrawal of legal aid by the Legal Services Commission had made their pursuit impossible. But the judge said his ruling did not amount to a rejection of any of the claims that MMR had seriously damaged the children concerned.MMR group legal claim collapses in high court, FOIA Centre, 08/06/07, acc 26 May 2010
The collapse of all the other cases because they had no public funding came a month after the FOIA Centre revealed that another high court judge who had blocked legal aid in 2004 had a brother who sits on the board of a drugs company embroiled in the litigation. The ruling by Sir Nigel Davis – whose brother, Sir Crispin Davis, is a non-executive director of GlaxoSmithKlineBoard of Directors, GSK website, acc 26 May 2010 – to dismiss the attempt to restore legal aid left many families without lawyers to represent them.MMR group legal claim collapses in high court, FOIA Centre, 08/06/07, acc 26 May 2010
Some of the parents involved in the litigation complained to the Office for Judicial Complaints (OJC) about the conflict of interest. Private Eye reported on the verdict of the OJC on the complaint:
:MMR LEGAL AID: Mr Justice Davis has been cleared of any wrongdoing for not disclosing that his brother was a director of Glaxo SmithKline when he sanctioned the withdrawal of legal aid from families who claim their children were damaged by the drug company's MMR vaccine.
:The Office for Judicial Complaints (OJC) has advised more than 100 parents who complained of the conflict of interest that the high court judge states categorically that he was not aware at the time that his brother, Sir Crispin davis, was a non-executive director of GSK, one of three defendant drug companies in the MMR controversy.
:But when the Eye and others asked his office about a potential conflict five months ago, a statement was issued on his behalf which said: "In 2003, Mr Justice Davis's brother was appointed as a non-executive director of GSK. At the date of the hearing before Mr Justice (February 2004), the possibility of any conflict of interest arising from his brother's position was not raised with him and did not occur to him. If he was wrong, any possible remedy must be sought in the court of appeal."
:This is not quite the same as saying he knew nothing about it. The parents are now asking Sir John Brigstocke, the judicial ombudsman, to investigate this apparent inconsistency. They are also asking whether the OJC were right to dismiss a second complaint of a possible conflict. Sir Crispin is also Chief Executive of Reed Elsevier, publishers of The Lancet. Although the magazine published the original controversial research by Dr Andrew Wakefield and others at the Royal Free Hospital, its editor Richard Horton had been widely quoted just before the legal aid hearing saying the study was flawed because of an alleged conflict of interest.MMR Legal Aid, Private Eye No 1196 26 October-8 November 2007, acc 26 May 2010
In the High Court case before Mr Justice Keith, Mrs Wickens, a mother of an alleged MMR-damaged child who was suing for damages in the litigation, testified that she had called the Legal Services Commission and asked why the legal aid for the case had been dropped. Mrs Wickens said:
:Somebody very senior from the Legal Services Commission phoned me back and in the course of the conversation, he said that the decision to stop the Legal Aid came from above. Now I said to him, what do you mean by above. He said (inaudible) that the decision to stop Legal Aid came from the Government.Court transcript, High Court of Justice case no. S/01/0173 and others, Queens Bench Division, Court 76, 26 July 2004, acc 27 May 2010
===US litigation===
In early 2008 the US government awarded compensation under its vaccine damage programme to a child diagnosed with symptoms of autism after she had a series of vaccinations, including MMR. The decision was hailed as "unprecedented" by vaccine damage campaigners. The claim was one of nearly 5000 cases pending in the American vaccine "court", which allege that mercury-containing vaccines resulted in autism.
Washington-based attorney Jim Moody, one of the lawyers involved in the cases, said the case was scheduled to go to trial in May, but "to everyone's surprise" the government conceded liability.
"It is also significant they conceded it was causing autism, they could have just said vaccines caused injury or been vague," he said. "Never before has our government linked vaccines to autism."Judith Duffy, US to award vaccine damage payment, The Herald, Scotland, 1 Mar 2008, acc 3 Jun 2010
==GMC investigation of Wakefield and colleagues==
In January 2010, the GMC announced the results of a two-and-a-half year investigation by a five-member panel into the fitness to practise of Wakefield and two other doctors from the MMR research team, Professor Simon Murch and Professor John Walker-Smith. Wakefield and Walker-Smith were found guilty of professional misconduct and were struck off the medical register.Brian Deer, ‘Callous, unethical and dishonest’: Dr Andrew Wakefield, Sunday Times, 31 Jan 2010, acc 26 May 2010Danny Buckland, Rebel medic who sparked a national panic over MMR jab is struck off, The Mirror, 25/5/10, acc 26 May 2010 Murch was found not guilty.Coventry doctor not guilty of professional misconduct over MMR research, Birmingham Post, 24 May 2010, acc 27 May 2010
The disciplinary panel also found Wakefield guilty of dishonesty concerning the study’s admissions criteria, its funding by the Legal Aid Board and his statements about it afterwards. 
The GMC report on the hearing (GMC, Fitness to Practise Panel Hearing, 28 January 2010) can be read here. 
The Panel made it clear this case was "not concerned with whether there is or might be any link between the MMR vaccination and autism"but rather “concerned itself exclusively with the conduct, duties and responsibilities of each doctor at the material times”.GMC, Fitness to Practise Panel Hearing, 28 January 2010, e.g. p. 2
The report outlines 30 charges against Wakefield, including four counts of dishonesty and 12 of causing children to be subjected to invasive procedures that were clinically unjustified. Brian Deer, Secrets of the MMR scare How the vaccine crisis was meant to make money, BMJ 2011; 342:c5258, 11 January 2011, accessed 25 January 2011 The panel found Wakefield had not obtained proper ethics committee approval for the tests he allowed to be performed on children, and rejected the proposition that no specific approval was required. 
Some other detailed points that emerged:
 
*Serious symptoms of bowel dysfunction and autism were suffered by children that featured in Wakefield et al's case review, and these were linked by parents and in some cases by GPs and consultants (ie not just Wakefield and the other two doctors on trial) to the MMR vaccineGMC, Fitness to Practise Panel Hearing, 28 January 2010, pp. 5, 8, 15, 18, 36, 37
*A whole team of doctors and consultants - not just Wakefield and the other two doctors on trial - were caring for and deciding on the investigations to be performed on the children and on their treatment. These experts are all named in the report.GMC, Fitness to Practise Panel Hearing, 28 January 2010, e.g. p. 34
*The invasive procedures (colonosocopy and lumbar punctures) that Wakefield was accused of causing to be done on the children were standard investigations performed at the hospital on children suffering serious bowel symptoms and/or suspected meningitis. It also becomes clear that Wakefield was not in charge of deciding on or carrying out these procedures, which were done by consultants whose speciality they were. However, the GMC panel decided that in the case of a lumbar puncture on a child, "by signing the forms you [Wakefield] ordered the investigations".GMC, Fitness to Practise Panel Hearing, 28 January 2010, p. 36
While all the allegations against the doctors are published fully in the report, with the GMC panel's verdict on each allegation (e.g. "proven" or "not proven"), the doctors' defences do not appear, other than in the brief phrase ‘admitted’. As of June 2010, the main coverage of the doctor's defences is by health writer Martin Walker, who regularly attended the hearingMartin Walker, Eye Witness Report from the UK GMC Wakefield, Walker-Smith, Murch Hearing, Age of Autism website, 31 Jan 2010, acc 3 Jun 2010 and in the account of Jim Moody, attorney for the National Autism Association (NAA) in the US, who alleged "false and misleading testimony" was given against the doctors at the hearing.Jim Moody, Attorney Jim Moody Describes False Testimony at GMC Hearing: Video Here, Age of Autism website, Jan 30 2010, acc 3 Jun 2010 Moody submitted an official complaint to the GMC against some of those who testified against Wakefield and colleagues (Dr Richard Horton, Dr David Salisbury, Dr Arie Zuckerman, Dr Michael Pegg, and Dr Michael Rutter), for what Moody alleged was "Breach of duty of honesty and candor; False Testimony; Misuse of Professional Position, Failure to Disclose Conflicting Interest, False Expert Testimony". Jim Moody, First Amended Complaint Before the General Medical Council London, United Kingdom In the Matter of: Dr. Richard Charles Horton (#2927877) Dr. David Maxwell Salisbury (#1413890), Dr. Arie Jeremy Zuckerman (#0870254), Dr. Michael Stuart Pegg (#1560424), Dr. Michael Llewellyn Rutter (#0639943), undated, acc 3 June 2010
===Lancet retracts Wakefield study===
On 2 February 2010, The Lancet retracted Wakefield and his co-authors' paper. Editor Richard Horton told the press: "It was utterly clear, without any ambiguity at all, that the statements in the paper were utterly false." The Lancet’s press statement did not comment on the paper’s findings but focused on how the children were referred to researchers and whether ethics committee approval had been obtained at the time of publication: Sarah Boseley, Lancet retracts 'utterly false' MMR paper, Guardian, 2 Feb 2010, acc 27 May 2010 It stated:
:Following the judgment of the UK General Medical Council’s Fitness to Practise Panel on Jan 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al are incorrect, contrary to the findings of an earlier investigation.
:In particular, the claims in the original paper that children were ‘consecutively referred’ and that investigations were ‘approved’ by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record."Clare Dyer, Lancet retracts Wakefield’s MMR paper, BMJ 2010;340:c696, acc 3 Jun 2010
This was a volte-face on the journal's 2004 internal investigation, which had concluded the evidence did not support the allegation that proper ethical approval was not received:
: The evidence we have seen indicates that ethics committee approval was given for data collection from clinically indicated investigations in the children with an initially undiagnosed illness and who were described in the 1998 Lancet paper.Mark Henderson, MMR medics challenged over child spinal taps, The Times, 26 Feb 2004, acc 3 Jun 2010
Similarly when the ethics committee approval question was raised in 2004 by Evan Harris in Parliament, Humphrey Hodgson, Vice-Dean of Royal Free and University College Medical School, had replied: 
:We are entirely satisfied that the investigations performed on the children reported in the Lancet paper had been subjected to appropriate and rigorous ethical scrutiny.Sarah Boseley, Lancet retracts 'utterly false' MMR paper, 2 Feb 2010, acc 3 Jun 2010
According to journalist Brian Deer, Wakefield had also claimed in 2005: "In contrast to a clinical research study requiring ethical approval, the Early Report [the initial paper published in The Lancet] was a report of clinical findings of tests which had been performed solely on the basis of clinical need".MMR scare study published in the Lancet wasn't approved by an ethics committee, briandeer.com, acc 3 June 2010 The GMC rejected this argument in 2010.
===Conflicts of interest: GMC===
*Professor Denis McDevitt, who was originally proposed by the GMC as chair of its fitness to practice investigation into Wakefield and colleagues, was himself a member of a 1988 government safety panel which approved Pluserix MMR vaccine as safe for vaccine manufacturer Smith Kline & French Laboratories (later GlaxoSmithKline). This was revealed in previously secret government minutes that were disclosed by the MMR litigation brought by parents of alleged MMR-damaged children.Joint Subcommittee on Adverse Reactions to Vaccination and Immunization, Minutes of the meeting held on Tuesday 8 March 1988 at 10.30 am in Room 1612, Market Towers, acc 27 May 2010 Also, at the time that the panel approved the vaccine, McDevitt was being paid as a research fellow by MMR vaccine manufacturer, Smith Kline & French Laboratories.Joint Subcommittee on Adverse Reactions to Vaccination and Immunization, Minutes of the meeting held on Tuesday 8 March 1988 at 10.30 am in Room 1612, Market Towers, acc 27 May 2010MMR Conflict of Interest Zone, Private Eye, 8 June - 21 June 2007, acc 27 May 2010 
The government minutes that reveal these facts are also interesting from the point of view of the adverse reactions reported to the early version of the MMR vaccine, using the subsequently discontinued Urabe strain of mumps virus. The reactions included convulsions, neurological complications, meningitis, and encephalitis. One member of the panel raised concerns about "the potential infectivity of the mumps component of MMR to susceptible contacts", though he was "assured" that it was "not transmissible".Joint Subcommittee on Adverse Reactions to Vaccination and Immunization, Minutes of the meeting held on Tuesday 8 March 1988 at 10.30 am in Room 1612, Market Towers, acc 27 May 2010
According to an article by Martin Walker on the Age of Autism vaccine damage information site, McDevitt was dropped as proposed chair of the GMC fitness to practice hearing into the three doctors when campaigners revealed these conflicts of interest. The chair subsequently chosen by the GMC was Dr Surendra Kumar.Martin Walker, Counterfeit Law: And They Think They Have Got Away With It, Age of Autism website, acc 3 Jun 2010
*Dr Surendra Kumar chaired the GMC fitness to practice hearing into the three Royal Free doctors. He read out the verdict of the General Medical Council (GMC) panel, which condemned the doctors as “dishonest”, “irresponsible”, and as acting “contrary to the clinical interests of this child”.Brian Deer, ‘Callous, unethical and dishonest’: Dr Andrew Wakefield, Sunday Times, 31 Jan 2010, acc 26 May 2010 In 2003 Kumar disclosed a shareholding in GlaxoSmithKline.INDEPENDENT REVIEW PANEL FOR ADVERTISING Declaration of Interests, Medicines Act 1968 Annual Reports 2003, MHRA website, acc 26 May 2010 He still had shares in GSK in 2004.THE INDEPENDENT REVIEW PANEL FOR ADVERTISING ANNUAL REPORT FOR 2004 Declaration of Interests, Medicines Act 1968 Annual Report 2004, MHRA website, acc 27 May 2010 GSK was a defendant in litigation brought by parents of alleged MMR-damaged children under the legal aid scheme, litigation in which the parents employed Wakefield as an expert witness.Danny Buckland, Rebel medic who sparked a national panic over MMR jab is struck off, The Mirror, 25/5/10, acc 26 May 2010
===Conflicts of interest: Andrew Wakefield===
====Legal aid work for parents suing vaccine manufacturers====
Dr Andrew Wakefield was first publicly accused in 2004 of a conflict of interest regarding his employment by the lawyers for the group of parents who sued vaccine manufacturers for alleged vaccine damage of their children. He had received £55,000 for this work, which was deposited in a special trust controlled by the Royal Free. Brian Deer, [How lawyers paid for start of MMR scare; letters refute Andrew Wakefield's story, accessed 26 January 2011. Dr Richard Horton, then editor of The Lancet, told the GMC that he was unaware of this at the time he published the MMR paper, though Wakefield told the GMC he had declared it. A discussion of this incident by John Stone, a supporter of the vaccine-damage advocacy group JABS and parent of an autistic child, based on contributions to the BMJ Rapid Responses forum, can be read here.
One argument that Andrew Wakefield was legally correct in stating this was not a conflict of interest was made, ironically, by those making the case for MMR. In defending herself against a parallel allegation of conflict of interest made in Private Eye (19 March 2004), Professor Elizabeth Miller, head of the Health Protection Agency's Immunisation Department and expert witness for the vaccine producers - presumably with the best legal advice - wrote:
:there can be no conflict of interest when acting as an expert for the courts, because the duty to the courts overrides any other obligation, including to the person from whom the expert receives the instruction or by whom they are paid.Dr Elizabeth Miller, letter to Private Eye (19 March 2004). Cited in Martin V. Hewitt, Parliamentary Protection and Open Science, BMJ Rapid Responses to Annabel Ferriman, MP raises new allegations against Andrew Wakefield, BMJ 2004; 328: 726-a, acc 27 May 2010
Barrister Robert Hantusch also gave this legal view in a letter to the Times dated 24 February 2004:
:But the courts do not consider that the engagement of someone to act as an expert witness in litigation has the effect that that person is then biased. Indeed, if this were the legal position, no paid professional could ever at any time give evidence to a court.Robert Hantusch, Controversy over accusation of research bias on MMR, Letter to The Times, 24 Feb 04, acc 27 May 2010 
Documents obtained under the Freedom of Information Act and published by The Sunday Times in December 2006 revealed Wakefield had been paid over £435,643 in fees and £3910 in expenses from legal aid funds over an 8-10 year period. Five of his former colleagues at the Royal Free, received a total of £183,000 in fees, according to the Legal Services Commission. One of those who received the payments, Dr John Murch, acknowledged there “was a huge conflict of interest".MMR doctor given legal aid thousands, accessed 27 January 2011.
====Patenting a rival vaccine====
Wakefield was accused of another conflict of interest by Brian Deer in the Sunday TimesBrian Deer, MMR SCARE DOCTOR PLANNED RIVAL VACCINE, Sunday Times, 14 Nov 2004, acc 3 Jun 2010Revealed: the first Wakefield MMR patent claim describes "safer measles vaccine", briandeer.com, acc 3 June 2010 and Channel 4 Television's 'Dispatches' for filing a UK patent in 1997 as a co-inventor of an alternative vaccine against MMR, and a pharmaceutical composition for treating inflammatory bowel disease.Andrew Jack, MMR row doctor denies abuse of trust, Financial Times, 16 Jul 07, acc 27 May 2010 Revealed: the first Wakefield MMR patent claim describes "safer measles vaccine", briandeer.com, acc 3 Jun 2010.
Wakefield had instructed agents to file the patent, naming the applicants as the Royal Free Hospital and Neuroimmuno Therapeutics Research Foundation, a US-based organisation headed by immunologist Hugh Fudenberg, his proposed co-inventor.Royal Free's autism pill partner, Herman Hugh Fudenberg, wasn't fit to prescribeRevealed: the first Wakefield MMR patent claim describes "safer measles vaccine" Brian Deer, Secrets of the MMR scare How the vaccine crisis was meant to make money, BMJ 2011; 342:c5258, 11 January 2011, accessed 25 January 2011 
Wakefield refuted Deer's and the Dispatches allegations on this issue in a written statement (below), which Deer published on his own website. This issue also formed one of the planks of libel proceedings against Deer and Channel 4, which Wakefield later dropped and was ordered to pay costs on.
:The claim appears to be that, whilst at the Royal Free Hospital, I was developing a new vaccine to compete with MMR and that I conspired to undermine confidence in MMR vaccine in order to promote this new vaccine, and that this represented a conflict of interest. This is untrue. The facts are that:
:*no vaccine or anything resembling a vaccine was ever designed, developed or tested by me or by any of my colleagues at the Royal Free Hospital;
:*it has never been my aim or intention to design, produce or promote a vaccine to compete with MMR;
:*my genuine concerns about the safety of MMR are wholly unrelated to any desire or opportunity to develop a competing vaccine;
:*there was no conspiracy as insinuated by the Sunday Times article;
:*there was no conflict or interest, actual or perceived.
:In contrast, it was our intention, at one stage, to conduct a formal therapeutic clinical trial of a compound that might have the ability to promote the body’s immune response to measles in order to assess the effects of this therapy upon the disease in children with regressive autism and bowel disease. This compound is known as Transfer Factor and whilst there is a large scientific literature on this subject, the nature and mechanism of action of Transfer Factors are largely unknown.
:The Transfer Factor that was intended for use in the trial was to be against measles virus. I have urged and continue to urge parents to have their children vaccinated against measles using the current vaccines. This would be in direct conflict with the intentions that are part of the claim that I was developing a new vaccine to bring onto the market. Whether a Transfer Factor could ever protect children against measles is entirely speculative and is something that was never studied or pursued by me or any of my colleagues.
:The Channel 4 programme implies commercial aspirations for personal gain. In fact, the aim of the patent was to generate funding for the research programme and a new Centre for Gastroenterology at the Royal Free Hospital. This can be substantiated by contemporaneous documentation.
:The patent application was motivated by two main factors. First, it was felt that there may be difficulty in raising traditional grant funding for cutting edge, controversial work that was vulnerable by virtue of the fact that it might conflict with perceived wisdom and the commercial interests of others. Secondly, there was, and is, a government-led emphasis on commercial exploitation of discoveries within the medical school.Issues Raised by the Sunday Times and the Channel 4 Dispatches Programme. A statement by Dr Andrew Wakefield, BrianDeer.com, acc 3 Jun 2010
In 2010, the GMC report stated as ‘admitted and proved’ that Wakefield had approached the Royal Free ethics committee around the same time he was involved in a proposal to set up a company called Immunospecifics Biotechnologies Ltd to specialise in the production, formulation and sale of Transfer Factor. The proposed MD of the company was the father of ‘Child 10’, with Wakefield as research director. The GMC panel found Wakefield had ‘inappropriately caused Child 10 to be administered Transfer Factor. p.52 
In 2011 articles by Brian Deer in the BMJ further outlined Wakefield’s complex business arrangements on this matter. See: Secrets of the MMR scare: How the vaccine crisis was meant to make money.
==BBC drama featuring criticism of MMR banned==
In 2006, two episodes ("One Angry Man" and "Heart of Darkness", series 5) of the BBC legal drama series, Judge John Deed, contained a storyline critical of MMR.Series 5 and 6 Judge John Deed, website of the writer of the episodes, GF Newman, accessed 10 May 2010 Just one viewer complained, whereupon the BBC banned the re-broadcast or distribution on DVD of the two episodes in their original form.Editorial Complaints Unit - Quarterly Report, July - September 2006, BBC, accessed 10 May 2010
The following information regarding these episodes of Judge John Deed has been placed in the public domain by the BBC:Editorial Complaints Unit - Quarterly Report, July - September 2006, BBC, accessed 10 May 2010
:Judge John Deed, BBC1, 10 February 2006
:Complaint
:A viewer complained that various aspects of the storyline combined to convey the message that the MMR vaccine was harmful to children’s health.
:Ruling
:We agreed that the episode conveyed the message complained of, and was therefore in conflict with the obligation of due impartiality on matters of public controversy. Steps were already being taken by Drama and Editorial Policy to ensure that future episodes would observe the requirements of impartiality insofar as they apply to drama of this kind, and it was agreed that the episode in question would not be re-broadcast, except in a context in which the requirements of impartiality were met. On that basis, we considered the complaint to be resolved.
A Freedom of Information request to the BBC requesting disclosure of the correspondence on this subject between the complainant and the BBC was refused by the BBC on the grounds that "The BBC’s independence and impartiality would be at risk through disclosure of further information on editorial complaints".BBC Information Policy and Compliance, Freedom of Information request – RFI20100641, 7 May 2010
==Resources==
*Michael Fitzpatrick, MMR and Autism: What Parents Need to Know, Routledge; 1st edition (24 Jun 2004). Defends the safety of MMR.
*Richard Horton, MMR: Science and Fiction - Exploring a Vaccine Crisis, Granta Books (30 Sep 2004). Horton is an advocate of MMR but analyses the malign influence of financial conflicts of interest in medical research today.
*Silenced Witnesses, Volumes 1 (2008) and 2 (2009). Written by the parents of the MMR class action lawsuit. Ed. Martin Walker. Slingshot Publications.
See also: 
*Crispin Davis
*Nigel Davis
*Andrew Wakefield
==Notes==
Category:Big Pharma