Friday, 6 April 2012

What I Have Learned About The MMR

I am delighted to say that Adam is absolutely fine after his vaccinations yesterday.   It was hard for me to take him and I spent a lot of time praying for him yesterday, still hoping I was making the right decision and still knowing that it was the only decision I felt I could make as I try to protect him the best way I know from more illness.  Exactly as she promised, Wendy sat with me in the waiting room to give me time to talk and also came with me when Adam was called in to see the vaccination nurse.  We talked a little bit about how I was doing but in all honesty, all I could really say to her on that topic was, "I'm here, just don't expect me to be fine as well!"  Fortunately Wendy knows me very well and could see through my smile that even though I was smiling, I was still scared.

The vaccinations themselves were of course horrible - but I'd expected that.  Adam had been cheerfully chattering and smiling, only for me to take his trousers off and hold him gently but firmly while the nurse gave him two injections in one leg and a third in the other.  Of course, from the first injection he was absolutely screaming and crying such tears.  I was more than a bit choked up myself and I just wanted to run away with him to keep him safe from what was hurting him...but I knew that what was hurting him at that moment was precisely designed to keep him safe in the future and so I held him and tried not to cry myself.  Both Wendy and the nurse were reassuring me saying I was doing very well and even though it sounds a bit silly to write that, it's exactly what I needed to hear.  Once the injections were over and the plasters put over the little marks on Adam's legs, I was able to give him a big cuddle and he slowly started to calm down.  Then Wendy had a bit of a cuddle and just about succeeded in raising a watery smile before Adam made it quite clear that in fact, he wanted Mummy now, please and thank you.  :-)  

The nurse warned me that in a few weeks time, he might have a small rash around the site of the injection that looks like measles but that it won't be the actual illness, though of course I need to keep an eye on it and give him Calpol if he has any fever or ring the doctors if I have any concerns.  Then, Wendy and I returned to the waiting room to wait the allotted ten minutes to make sure Adam didn't develop any form of reaction to the injections.  While we sat waiting, we talked about vaccinations, about the fears of links between autism and MMR, and the realities of what Measles can do - and is currently doing to those people in England who are caught in the current outbreak.

Wendy has told me these things before, when we first talked about my fears over accepting vaccinations for Adam, but she reminded me of them as we talked yesterday.  It helped to calm my fears a great deal and for that reason, I think it's important to share them here, particularly as I've received so many comments of both opinions on my first post about vaccinations.  First of all though, please remember that I'm not a doctor, I have no medical training and this post is only intended to (hopefully) help other parents thinking their way through this decision; it is not in any way intended to be medical advice.  If anyone reading this does have questions or concerns, please do find a well informed doctor, nurse or Health Visitor who won't dismiss your fears but who will talk through this decision with you.  One thing I've realized on this journey, is that there are so many websites filled with people's opinions and their version of facts (which I'm certain they genuinely believe to be true) but I've learned it's so important to question those opinions and "facts" on either side of the argument rather than just accepting them.  So with those caveats, here are some of the things I've learned about the MMR, from talking with Wendy and also researching it myself.

Andrew Wakefield is the former British surgeon and researcher who first released the 1998 study in which he believed there were links between the MMR vaccine and autism; it was originally published in the medical journal, The Lancet.  He caused a huge storm of controversy, sparked many fears and has left a long-term, if not permanent, mark on the issue of vaccinations as a result.  The massive decline in acceptance of vaccinations both in England and also America has been linked to this study, as has the consequent rise of Measles outbreaks in both countries.  After four years, other researchers were still unable to reproduce his results and questions about his research were starting to grow.  By 2004, a reporter from the Sunday Times had discovered that Wakefield had "financial conflicts of interest" in his study - in other words, he was sponsored in his research by the people who make the single vaccines and are in direct competition with the manufacturers of triple vaccine, the MMR.  

As soon as I learned this first fact, that he was actually sponsored by people who very much wanted to increase the use of their product and therefore decrease the use of the MMR, that sounded warning bells to me and I think it should to others who fear the MMR as well.  As an aside, this reminds me of the news round about a year ago, that a study was being released saying it wasn't actually necessary to breastfeed an infant to six months but that four months was adequate before weaning.  This was in direct contradiction to World Health Organization recommendations and despite being widely publicized in the media, it was very rapidly learned that the study had been sponsored by manufacturers of formula milk.  As a result, the study died a very quick death indeed!  The Wakefield study didn't die quite so quickly, even though most of the co-authors of the study withdrew their support for it when this conflict of interest was discovered.  The Lancet also retracted their support for its publication.

The General Medical Council (GMC) which is the English regulatory body for doctors and health professionals, conducted an investigation into Wakefield's study and by 2010 they returned three dozen charges against Wakefield which included four counts of dishonesty and twelve counts of abuse of developmentally challenged children.  The panel ruled that Wakefield had "failed in his duties as a responsible consultant", had acted against the interests of his patients, was also dishonest and irresponsible in his published research and that parts of it had been falsified.  He was struck off the register which means he is no longer allowed to practice medicine in the UK.  Despite this, he still maintains that his research is true and accurate and stands by it saying there was no fraud, hoax or motive for profit.  

Apparently, there were quite a number of flaws in Wakefield's study, and these are just a few:

One of the things he said was that toxins from vaccines linger in the bowels of autistic children and so cause bowel problems.  But he *only* studied autistic children - he didn't have what's known as a "control group" of healthy children to compare his results.  Apparently, most if not all autistic children have bowel problems, it's a side effect of the condition, so without this control group, there's no way of knowing if the bowel problems were affected by the vaccines or not...but considering that autism comes with bowel problems, it's unlikely.  In the course of his study, Wakefield apparently also subjected developmentally challenged children to unnecessary medical procedures, including colonoscopy's and lumbar punctures and didn't seek the appropriate permission from the ethical boards to do so - this has therefore been ruled as abuse.

The MMR vaccine is given at around the age of one and unfortunately, if a child is going to develop autism, then the developmental time for symptoms to start showing themselves is also the age of one.  So while it's very easy to make a link between a post-vaccination reaction and symptoms of autism, there's no guarantee that the autism wasn't already present and wouldn't have shown itself anyway even without the vaccine.  It's just as much a case of unfortunate timing for the vaccination as it is of any link between the two.

I've also learned that Wakefield's own children were autistic and, as he struggled to come to terms with this diagnosis, he was determined to find the answer to the question of "Why?"  Presumably, why them?  Why us?  This prompted his research and influenced the results.  As a parent facing the disability of a child, he wasn't able to simply accept that sometimes bad things happen for which we have no explanation, he needed to *find* a reason - by any means necessary.  I think any parent who has faced illness, disability or even the death of a child can understand the desire and need for answers, but of course this does not condone finding those answers by fraudulent and abusive means and then publishing them.  

I can't now remember if it's linked to Wakefield or not, but I know one of the other controversies is over Thimersol, a preservative in vaccines, that many believe is dangerous.  I have been told that first of all, this ingredient isn't used in UK vaccines anyway but even where it is used in America, that a small misspelling has caused confusion over what ingredient is actually used - the one that is used is apparently safe but the dangerous one, alleged to be used, in fact isn't.  I won't say more on that now because I can't remember the details so it wouldn't be right to do so, but suffice to say that this controversy has also been brought into question as to whether or not it is legitimate.  

I'm fairly sure there were other flaws in Wakefield's study but those are all the ones I can remember for now, and I think it's enough to make my point.  The fear over vaccines, particularly the MMR, was sparked by false, inaccurate research that could not be reproduced - and this isn't just something I'm saying with no medical training whatsoever, it's been confirmed by the GMC.  The author of the study has been discredited by those who are charged with verifying studies like these, those who protect us from rogue or criminal practitioners and make sure that doctors, "first do no harm".  Wakefield is only one person, I know he is only one of many who have and who continue to study vaccinations.  I also know that those who disagree with vaccinations would back up their beliefs with extensive information from other sources which they believe supports their anti-vaccination stance.  

Equally, I know there are many medical professionals - particularly in America where the anti-vaccination lobby is strong - who stand by their belief that vaccinations are dangerous.  It would not be true to suggest that these people are fraudulent as Wakefield was proven to be, they believe research supports their anti-vaccination stance and are willing to stake their medical reputations and careers on this belief.  But if, as some believe, the controversy was originally sparked by Wakefield in England who then exported his beliefs to America, then the foundation of the anti-vaccination stance has little to no merit.  But of course, the response to this would be that if those who are pro-vaccine spent half as much time studying the safety of vaccines as they do trying to discredit the studies calling them into question, then maybe they would see that vaccines are in fact dangerous!  So the two camps remain entirely polarized and cannot find agreement anywhere and parents remain caught in the middle trying to decide what is safe and what will protect their children.

There is however one other thing I've learned.  Vaccinations work best when around 95% of the population are immunized because it creates something referred to as "herd immunity".  Currently, the rate of vaccinations in England is around 83% partially because of those who refuse vaccinations and also because of immigration from countries where vaccination programs are not as strong.  The people who refuse vaccinations truly believe they are protecting their children in the best way they know how; but the problem is that their decision doesn't just affect their own children, it affects other children including mine.  Because if enough of "the herd" (to use the attractive phrase!) is not immune to the disease then an outbreak can happen and those who are vaccinated become more vulnerable despite their vaccinations.  As a parent who, after much soul-searching and agonizing, decided to accept that vaccines are safe, this fact is chilling.  What if my attempt to protect my child is made less effective by the decisions of another parent?

Ultimately as you will know, I have decided to vaccinate Adam and thankfully he has not shown any form of reaction to them, despite my fears.  This is a personal decision and in all honesty, despite what I said above, the concept of "herd immunity" didn't actually factor in my decision one way or the other.  I decided to vaccinate him because I ultimately decided the information in favour of vaccination was stronger than that against it.  I truly hope the fact that he is now vaccinated - and will be again at the age of three - will protect him from Measles and all of the other conditions the jabs are designed to prevent.  Whatever decision you come to, for or against, I truly hope it's not one you come to regret because enduring the illness or disability of a child is a very hard road to walk.

So what do you think?  Did you know about the reasons why Wakefield and the original MMR study was discredited?  Do you believe that's enough or do the other professionals who are against vaccinations sway your opinion?  When it comes to making your decision, would you consider how it may affect other children or not?  

*Note, this is my second post on vaccinations, if you wish to see the first please click here:  Why I Am Choosing to Vaccinate Adam

4 comments:

  1. The anti-vaccination movement most likely has its origins in the completely natural fear of "horrifying invasions" of the body. The very thought of putting something related to sickness INTO to body, even as a preventative, is enough to give anyone the collywobblies .

    Even though the original claim of a connection between MMR vaccine and autism has been scientifically refuted

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136032/?tool=pubmed

    the seed has been planted and continues to validate the deep primal fear we have of being jabbed with something unclean. And for the parents of autistic children, a scapegoat serves as a viable substitute for personal guilt, despite the fact that autism can neither be predicted nor prevented ( at least, not yet).
    Talk to a parent of a child who has suffered brain damage from measles-related encephalitis, and see how difficult the choice can become. Measles killed a lot of people in the 19th and early 20th century, which is why vaccination for it used to be mandatory for school-aged children of my generation.

    The MMR vaccine and autism: Sensation, refutation, retraction, and fraud
    www.ncbi.nlm.nih.gov
    Taylor B, Miller E, Farrington CP, Petropoulos MC, Favot-Mayaud I, Li J, Waight PA. Lancet. 1999 Jun 12; 353(9169):2026-9.

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  2. I think Hugh, as I said in my last post, that one thing there is far too much of is misinformation about measles. I've heard many times that a) it's rare and b) it's not that serious. But as you say, complications of measles can include brain damage. Wendy tells me that Meningitis is also a common complication. In the case of German Measles, I know permanent deafness can occur (and I've met a woman who's mother had German Measles in pregnancy and so has spent her entire life profoundly deaf). But despite this, that "deep primal fear" has been planted and once fear exists, it's very hard if not impossible to logic it away. Sadly, many people hear of vaccination fear second or third hand, don't do research themselves and so refuse them not as a reasoned decision but as a reaction to what other's believe. Even if I disagree with a reasoned choice, I can still accept that far more than one unfortunately made based on rumour.

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  3. We didn't find it an easy decision when our children were younger - the deciding factors were a) reading what research we could find, b) asking our GP what he'd done for his children and c) knowing someone in the village whose son had died from measles.

    It didn't make taking them for the jabs and then watching them closely afterwards easy, but we did and do feel we made the right decision.

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  4. That's a really interesting point JaneEliz - asking the GP what they do for their children. It's one thing to consider them as medical experts based on training and profession but quite another to remember that often, they're parents too who also want the best for the children they love.

    I remember, not long after Adam came home from hospital, I was carrying him in his carseat for our first outing. To my horror and terror, I tripped and fell and his carseat landed upside down on the ground. He was ultimately fine although it took me far longer to recover from the trauma, but the greatest comfort to me was my GP telling me that he had once dropped his own daughter so he understood how terrified I had been.

    Those moments of humanity really help I think, whether it's comfort after an accident or asking what decisions they have made for their children. Thank you for your comment, you've really made me think.

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