The Daily Mail recently published a new article on MMR and autism. I was unhappy with the piece and had a conversation by email with the journalist, in which I set out my concerns.

Reasons for publishing the correspondence

1. I think that the emails provide a valuable insight into the thinking of this journalist, who writes for a very, very popular newspaper.

2. She threatened me with a libel action if I dared publish the exchange. To be honest, it was this threat that tipped the balance and convinced me to publish.

The threat

Here is the email I sent:

Dear Sue, I have found our correspondence very interesting and I think others might be similarly interested in reading it. I would like to ask your permission to publish our exchange publicly. Please let me know whether you would be amenable to this, and (if so) whether you might have any conditions regarding publication. Kind regards,

James

I thought she might have some conditions (that the correspondence be published in full, word-for-word – or perhaps that her contributions be anonymised) or that she might simply decline. For some reason, the aptly-named Sue decided a simple refusal wouldn’t be enough.

Here is the reply, in full:

Dear James, I see no reason why you would want to put this in the public domain, unless you wish to invite a libel action regarding your statements of my professional reporting skills. Sue

The original email exchange

Dear Ms Reid,

I read your article on the Italian MMR / autism court case with interest and there are a couple of points I would like to comment on.

The headline includes this: “The vast majority of doctors say there is no link between the triple jab and autism, but could an Italian court case reignite this controversial debate?”, which presents the issue as a matter for authority rather than evidence. That most doctors “say there is no link” might be interesting, but what is actually informative is that the evidence shows there is no link. As for questioning whether the ruling will reignite the debate – I am sure it will, thanks in part to articles such as the one you penned. I don’t know whether you were responsible for the headline – perhaps you might pass that comment on to the relevant person?

You write that the judgement “challenges the settled view of the majority of the medical profession”. If it does so at all, then it is a very weak challenge – the judgement reflects the opinion of one person (albeit apparently supported by three medical professionals), whereas medical consensus on MMR and autism is supported by robust evidence – the evidence is the reason for the consensus. In fact, the only mention of the evidence underpinning the view of the medical profession appears to be in the quote from the Department of Health at the very end of the article. This is something of a problem – the question of whether there is a link between the MMR vaccine and autism is best answered by robust, reliable evidence. If this evidence is not addressed, any discussion of a possible link is missing the most vital ingredient. Gerber and Offit’s paper Vaccines and Autism: A Tale of Shifting Hypotheses discusses the evidence that showed no association between MMR and autism. (See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908388/?tool=pubmed.)

Your article compares current estimates of autism prevalence to the reported rate in the 1980s and refers to the Department of Health and NHS doctors “arguing forcefully that better diagnosis of autism and environmental factors are responsible for the extraordinary rise in the number of cases”. What is characterised as “forceful argument” is a point of view that is supported by the best available evidence. The argument as presented appears to be incomplete or simplified, however – it is not just that there is “better diagnosis of autism” there is also a corresponding decline in other diagnoses. It is not simply the case that children were not previously diagnosed with autism – they were more frequently given different diagnoses than they are now. Shattuck and Baird et al have published papers describing the role of diagnostic substitution and other factors in the increase in ASD diagnoses. Yet this evidence is not mentioned. Again, it is presented as “experts argue that…” but the discussion of evidence is missing.

With Andrew Wakefield, it isn’t so much that his “research methods were later discredited” – a case series such as that presented by Wakefield could never justify the scaremongering that he began and the mainstream media fanned the flames of; the conclusions were never warranted on the basis of the results (which is why there was a partial retraction from 10 of 13 authors); his paper contained a number of errors (for example, several of the children whose cases formed the basis of the Lancet paper that was the beginning of the MMR scare had symptoms reported by Wakefield et al as occurring after administration of the MMR vaccine, but medical records which showed otherwise) and was eventually retracted in full by The Lancet when it became clear just how flawed it was. The research was later described by the BMJ as “fraudulent”.

The article includes a comment that “in the UK, this much-debated link has never been established in the courts.” The courtroom is not the place for such links to be established – and the Italian judgement has not in fact established a link. Finding no other pre-existing condition to explain the diagnosis of autism and ruling the vaccine to be the culprit on that basis is not only odd – it does not and cannot establish a link between the vaccine and autism. As far as I know, there is no reason to believe that autism is caused by “other pre-existing conditions” so simply excluding other pre-existing conditions gives no reason to even presume a link. It looks to me as if there has been a presumption of guilt in the courtroom when it comes to vaccine compensation – and I can see the merit of arguments for this to be the case, but presuming a vaccine is responsible for a condition and awarding compensation in no way demonstrates an actual link.

There are further references to “consensus of medical opinion” and “most doctors” without any reference to the evidence that the consensus is based on before we finally get to the one mention of the wealth of evidence showing no link – and that is in a quote from the Department of Health. You follow this with a comment to the effect that because of a judgement in an Italian courtroom the debate over a possible link between MMR and autism is “not over” – I think that the judgement is being treated as if it is an important contribution to the debate when it is not. I can’t see how a mere presumption that the vaccine is linked can overturn the wealth of evidence, robust evidence at that, showing there is no link.

Kind regards,

James

Dear James, If you read the Italian judgement on line you will see they did say there was a link, and it was a scientific probability, that this boy’s autism was caused by the MMR jab. Also, most importantly, the Italian High Court has since ruled that a child damaged by ANY VACCINE should get compensation – thereby making doctors (who in this country are paid bonuses to meet MMR targets of 90 per cent) think twice before they inoculate a child with a cold or stomach complaint, for instance, because they will, in Italy, now be liable if that child is later proven to have vaccine damage. I think that is a welcome safeguard and many parents have contacted me to say the same. This was a report, not a commentary. Are you suggesting that it should not have been reported? Regards, Sue

Dear Sue,

Thank you for your reply to my email.

I do accept that they said there was a link and used the term “scientific probability” but that is an opinion, not evidence. I can see no reasonable grounds for their conclusion. The basis appears to be that (a) there was a correlation between the time of vaccination and the onset of autism and (b) they could find no reason for the onset of autism. This has apparently led them to conclude that the vaccination was linked. There is an assumption that the vaccine was the cause, but no evidence to support this assumption. By contrast, the evidence that there is no link between MMR and autism is plentiful – as can be seen from the Gerber and Offit paper I referred to previously. I can understand courts presuming an association and compensating parents but this presumption of guilt is simply not evidence that there is a link.

I agree that a child damaged by any vaccine should get compensation, and I have no problem with courts presuming vaccine damage rather than it having to be established. What I have a problem with is this presumption of guilt being reported as if it is proof of a link between MMR and autism when it is no such thing.

As you bring the issue up, I should say that I have a problem with bonus payments for achieving certain levels of vaccine coverage – I note that GPs in 2002 voted to abandon the bonus payments for MMR vaccination (http://www.telegraph.co.uk/news/uknews/1399087/Doctors-abandon-bonus-scheme-for-MMR-jabs.html) but I don’t think they went far enough. I think payments for achieving certain levels of vaccine coverage introduce a financial interest where none should exist. The sole motivation for achieving levels of vaccination that ensure herd immunity should be maintaining the health of the population. With regard to the point about vaccination of children who are ill, moderate or severe illnesses are already listed as contraindications for MMR vaccination and I see no reason to include minor illness – is there any evidence to support the idea that children with minor illnesses should not receive the MMR vaccine?

You say this was a report, not a commentary, and ask if I am suggesting it should not have been reported. Personally, I don’t think it is newsworthy that a vaccine compensation court presumed a link between a vaccination and the onset of a condition – but if it is thought that people might be interested then of course if will be reported. My problem is with the way it has been reported – various opinions have been reported but as I said in my original email the evidence has not. I think anyone suggesting that public health decisions should be made on the basis of opinions rather than evidence would be unwise.

I don’t normally write to journalists with whom I disagree (there simply wouldn’t be enough hours in the day) and I have to admit that I have singled you out here, but I believe my motivation for doing so is important. The reason I take this issue so seriously is because measles is a very serious, highly infectious disease that, when outbreaks occur, causes serious harm and death – but it is a serious, infectious disease that can easily be prevented by a vaccine that is safer than the disease by orders of magnitude.

The 10 years prior to the introduction of the single measles vaccine (1958-1967) brought 863 deaths, and 4,120,936 notifications. In the 10 years following the introduction of this vaccine (1968-1977), there were 292 deaths – and 1,600,979 notifications. Even with relatively low uptake, the use of this vaccine saw a reduction in the number of deaths of 571 (66%). There was a reduction in the number of notifications of 2,519,957, (61%).

With the improved uptake of measles vaccination following the introduction of MMR in 1988, notifications and deaths fell still further. The ten years following the introduction of MMR saw 18 deaths (compared with 140 in the previous ten years). Notifications, meanwhile, fell from 837,424 to 106,210.

Around 1 in 100 cases of measles will result in hospitalisation. The complications of measles include diarrhoea, convulsion, encephalitis, and death. Italy, 2002: 3 deaths, 594 hospitalizations. Germany, 2006: 160 children hospitalized, 3 with brain inflammation. Japan, 2000: 88 deaths. Ireland, 2000: 2 children dead. California, 1989/90: 75 deaths, 3,390 hospital admissions.

The consequences of measles infection are known to be real. The idea that autism is a consequence of MMR vaccination is not. You cannot even begin to compare actual deaths with imagined links to autism. Gerber and Offit: “although no data supporting an association between MMR vaccine and autism existed and a plausible biological mechanism was lacking, several epidemiologic studies were performed to address parental fears created by the publication by Wakefield et al”. Even though there was nothing that showed an association between the vaccine and autism and there was no reason to think there might be a link, researchers still conducted studies. None of these studies showed a link. Because there simply isn’t one.

Ecological studies: in the UK, MMR vaccination rates of autistic children were similar to those of the entire study population. Also, investigators did not observe a clustering of autism diagnoses relative to the time that children received MMR vaccine. In California, the increase in the number of autism diagnoses did not correlate with MMR vaccination rates. In Canada, autism rates increased coincident with a decrease in MMR vaccination rates (i.e., as uptake of MMR vaccine went down, autism diagnoses continued to rise).

Retrospective studies: In Denmark, researchers determined vaccination status and autism diagnosis in 537,303 children. The authors observed no differences in the relative risk of autism between those who did and those who did not receive MMR vaccine.

Kind regards,

James.

Actually, James, the Office of National Statistics and the Health Protection Agency says there have been four deaths from measles in the last twenty years, and two of these were children with serious underlying conditions, and one was misreported. Read up! We were all nursed through measles and I do not know anyone of my generation who died. I must inquire, are you part of the Big Pharma industry, do work for the Priory (which charges £300.000 a year to look after an autistic child) or what is your particular interest in this Italian case? The Italians (and again this is on line) say one child should not suffer for the herd. I think you ought to visit families (one in 64 in England and Wales) who have a child with an autistic condition. Spend a weekend with them, change the nappies at 21, that kind of thing and then you wouldn’t take such a partisan view. If there is any risk it needs debate and investigation. Sue

Dear Sue,

I have read the statistics on deaths from acute measles infection over the decades. The fact there have been so few in recent years is testimony to the vaccination program that you are undermining.

That you do not know anyone of your generation who died tells us nothing about the seriousness of measles then or today. Look at the statistics I provided in my previous email – you may not recall any victims of measles but it is clear that others will. Those are not just abstract numbers – they represent actual people who sadly died and whose friends and families mourn them now. In Duisburg in 2006 measles had a mortality rate of 1 in 307 as two of the three young people with encephalitis died. The two children who developed encephalitis and died were aged 2 months, and 2 years. The infant was too young for vaccination and would have relied upon herd immunity for protection. So if we’re thinking about the children, perhaps we should start with preventable deaths?

As for the difficulties faced by families who have children with autism, I do not deny them. But I do deny that there is a link between MMR vaccination and autism.You say that “if there is any risk it needs debate and investigation” – the potential risk has been debated and investigated already and the investigations showed there was no association between MMR and autism. You seem to be ignoring the investigations that have already taken place.

As for your query about my motivations – I made them clear in my previous email. You seem to think I was being dishonest and that I am in fact paid by Big Pharma. You are wrong about this – I have never received a penny in payment from Big Pharma and have absolutely no link to them. I have zero financial interest in either vaccination or autism. I am happy to have clarified this point and I do hope that you will accept my clarification as being honest.

Kind regards,

James

Dear James, Many children (one in 64 girls and boys) and their parents, endure a living death. Also there is always this insinuation that measles is a killer. I don’t what happened in Duisberg, but what happened in Manchester, or Birmingham, or Taunton. I am not undermining the vaccination programme (spelt correctly UK style) I am merely reporting what has happened in an Italian court, after two years of medical investigation and hearings. Should we have hushed this up? Sue

Dear Sue,

You keep talking about how awful autism is. You seem to miss the point that it is not caused by vaccination. That is a rather important point to miss.

I haven’t suggested at any point that anything be “hushed up”, I’ve simply criticised the way that you have reported the case. I’m not saying ‘don’t report’ – I’m saying ‘report responsibly’.

Kind regards,

James.

Dear James, I am very concerned that you keep saying emphatically that autism is not caused by vaccination. That is what any new debate will be about. Surely parents of autistic children, of which there are many, many thousands in this country, deserve that at least? I see the Independent has reported the case too, and CBS in America is about to do so. There has been another case in Italy, and there are 150 in the pipeline….if you cannot go to a court for justice, where else? At least state medicine, the pharmaceutical giants and other vested interests are not in charge there (well, not in Italy at least). As for measles, it has been insinuated that the drop in vaccination take up because of the MMR scare has provoked a measles epidemic in England and Wales that has killed a multitude of children. This is clearly not true. And it would be disingenuous and legally dangerous to say otherwise. Sue.

Dear Sue,

I have simply pointed out that there has been rigorous investigation of the implausible notion that MMR could be linked to autism and that this rigorous investigation has shown there is no association.

You seem to think I have argued that parents should not be able to go to vaccine compensation courts – I think if you re-read my previous emails you will note that I have made no such argument.

There is at an implied assertion in your latest email that vested interests are “in control” in this country. Can you substantiate that? Are the pharmaceutical giants really in charge? What is the basis for this belief of yours?

Please point out where it has been insinuated that a multitude of children have been killed by measles in recent years.

Kind regards,

James.

Screenshot added, 27/6/12