MMR

MMR is an issue that continues to polarise debate in the world of autism. There are parents who believe that the triple measles, mumps and rubella vaccine played a part in the development of autism in their child. Opposing them are governments and health authorities who want to reassure parents that the vaccine is safe.

The controversy centres around the research of Dr Andrew Wakefield, formerly of the Royal Free Hospital, London. Wakefield was the first to identify a link between the jab and the subsequent development of autism.

The MMR vaccine is typically given at around 18 months. It is around this time that speech usually develops into fuller sentences, and that the first signs of autism may emerge. Critics of Wakefield's theories argue that this coincidence of timing leads parents to assume that MMR causes cases of autism. However the marked regression in speech and behaviour that certain children showed after having the injection has convinced some parents that there was no coincidence.

Wakefield's first study in 1998 involved just 12 children. This research, published in The Lancet, linked measles found in the gut with inflammatory bowel disease and autism. It was largely a self-selected group, with the parents approaching Wakefield and asking him to investigate. The sample was too small to draw any definite conclusions from, so he did not. At that point Wakefield merely suggested that further research was needed. Since then he has continued to investigate MMR and autism, in spite of political pressure. He left his post at the Royal Free Hospital to continue his work.

Politics and budgets

Measles can be fatal or severely disabling, so if parents are too worried to get their children vaccinated, some may die. Mumps and rubella are usually less severe, although the latter can be particularly dangerous to unborn children. Some theorise that the triple vaccination overloads the immune system, and that it is better to have three single jabs spaced out by a month or so. Unfortunately this is expensive. Parents who choose to pay privately pay around £250 for the three injections. They are not available on the NHS.

The British Government is at pains to assure the public that MMR is safe, and that it has not led to a rise in autism. They point to studies in England (500 people), France (6000 people), and Finland (1.8 million people), that found no evidence of a link. These were statistical studies rather than physical examinations, and they made no distinction between the different types of autism. Not all cases of autism go hand in hand with bowel disease, only a subset of autistics are affected in this way.

According to Paul Shattock, around 10% of parents of autistics will swear blind that their child's autism was caused by MMR. On the BBC breakfast news of 6th September 2002 he said:

"We believe that this is a new variant of autism".

There is no doubt that the incidence of diagnosed cases of autism is rising. How much of this is due to more accurate diagnosis is open to debate. Awareness of this condition, which was almost entirely unheard of sixty years ago, has certainly increased. This rise is worldwide, and it continues. If MMR was the only culprit the increase in autism would be expected to have levelled off, but it has not.

Thimerosal, a mercury-based preservative, has been implicated in autism and bowel disease. This was used in vaccinations until quite recently.

To date the MMR controversy has raised a lot of questions, and answered few. Has there been any change in the ratio of autism with bowel disease compared to autism without? Do the people who are being diagnosed now generally have less severe autism and aspergers than those diagnosed in the past? And perhaps the biggest question of all is, what are the causes of autism? It will take time and a great deal of money before we are any closer to settling this issue.