Interview:
Dr Andrew Wakefield,
research
team leader,
Royal Free
Hospital School of Medicine
INTERVIEWER:
Dr Wakefield, what exactly have you
found?
DR ANDREW WAKEFIELD:
Well this work started just
over a year ago when we were
contacted by a group of mothers who
complained that their children had been
developing perfectly normally until they
had encountered an environmental insult,
in many cases they claimed it was the
measles, mumps and rubella vaccine, and
then had lost their … all their
acquired skills, such as speech,
language, developmental milestones. And
at the time we were not sure of the
implications of that. But what was
interesting is that those children had
also suffered gastrointestinal symptoms,
diarrhoea, alternating constipation and
diarrhoea, sometimes blood loss. And it
became evident to us that after five
calls in two days we had to look at this
very seriously to (investigate) these
gastrointestinal side effects in
particular. Now one of the questions that
had been raised before … the claims
had been rather put to one side of
gastrointestinal disturbances, these were
just a function of the behavioural
problems, but we felt they merited taking
a little more seriously and so that we
investigated them. Interestingly, we
set out a study, ten children, we thought
we might find inflammation perhaps in one
or two based upon the history --
we’ve now looked at 40 children and
39 of those have exactly the same
findings. And that’s been
intriguing. The children have a patchy
inflammation of the colon, rather like
colitis as we recognise it historically.
And they also have great big swollen
lymph glands in the terminal ileum, that
is the end of the small intestine. And
that combination, as we call it
‘ileo hyperplasia’, follicular
hyperplasia of the terminal ileum and
colitis, is the, is the core of the
gastrointestinal syndrome. Interestingly,
they also have all undergone
developmental regression after a period
of normal development.
INTERVIEWER:
There has been concern recently over any
long term effects as a result of the MMR
vaccine, are you saying now then that
there does appear to be a proven link
between the vaccine and the side effects?
DR ANDREW WAKEFIELD:
No, the work certainly raises a question
mark over MMR vaccine, but it is, there
is no proven link as such and we are
seeking to establish whether there is a
genuine causal association between the
MMR and this syndrome or not. It is our
suspicion that there may well be but that
is far from being a causal association
that is proven beyond doubt.
INTERVIEWER:
But if you say there’s at least a
question mark over it now, should the
vaccine continue to be administered while
you’re investigating?
DR ANDREW WAKEFIELD:
I think if you asked members of the team
that have investigated this they would
give you different answers. And I have to
say that there is sufficient anxiety in
my own mind of the safety, the long term
safety of the polyvalent, that is the MMR
vaccination in combination, that I think
that it should be suspended in favour of
the single vaccines, that is continued
use of the individual measles, mumps and
rubella components.
INTERVIEWER:
Because that begs the question that you
know, are the … do the advantages of
continuing with the vaccines outweigh the
disadvantages of a problem developing if
you, if you continue to have them?
DR ANDREW WAKEFIELD:
Well I think it’s a very complex
question. Certainly if you continue, as I
would recommend to use the single
vaccine, you do not incur a greater risk
of those diseases in the children, so
that you do not lose the benefits of
vaccination if you space them over time.
INTERVIEWER:
(CUTS) So even measles?
DR ANDREW WAKEFIELD:
Well as yet we don’t know, but there
is no doubt that if you give three
viruses together, three live viruses,
then you potentially increase the risk of
an adverse event occurring, particularly
when one of those viruses influences the
immune system in the way that measles
does. And it may be, and studies will
show this or not, that giving the measles
on its own reduces the risk of this
particular syndrome developing.
INTERVIEWER:
So you’re saying that a parent
should still ensure that their child is
inoculated but perhaps not with the MMR
combined vaccine?
DR ANDREW WAKEFIELD:
Again, this was very contentious and you
would not get consensus from all members
of the group on this, but that is my
feeling, that the, the risk of this
particular syndrome developing is related
to the combined vaccine, the MMR, rather
than the single vaccines.
INTERVIEWER:
Now what you seem to be indicating is
that there’s … the effects are
on this intestinal disease of the gut and
also autism which is a personality
disorder. What’s the link there? How
can there be a link?
DR ANDREW WAKEFIELD:
Well this is intriguing of course.
We’ve been looking for the cause of
autism in the brain for many many years
and yet have failed to define it. People
have been saying for some time, people on
the periphery of autism, have been saying
for some time that this may well be
related to bowel damage. The Italians for
example have found that children who are
autistic have in many cases a leaky
intestine. Others, biochemists, have been
saying that it may be a toxic state that
absorption of chemicals such as opioid,
peptides, morphine like substances from
the gut that you and I produce in our
diet from milk and wheat, are actually
getting access through that leaky gut
into the developing brain. And perhaps if
that occurs at a particular time of life,
when the brain is rapidly developing,
then it is susceptible to long term
damage. And that is intriguing again,
because many parents report that certain
foodstuffs make their children’s
behaviour much worse, and that
withholding that food, those foods,
improves their behaviour. What we’ve
been able to do here, by directly
visualising and biopsying the bowel, is
to confirm, at least in this group of
children, that there is a link, it may
well be a link between gut inflammation
and behavioural abnormalities.
INTERVIEWER:
Is this likely to be permanent damage or
can, can it be treated?
DR ANDREW WAKEFIELD:
We simply don’t know at this stage.
We have … We entered this as a
pilot study to look at ten children,
we’ve now looked at 40 children,we’ve
been going for a year; we sincerely hope
that we can (CUTS) something to
ameliorate the damage that has been done,
but we do not yet know whether
that’s the case.
INTERVIEWER:
Of course there’ll be many parents
whose children have had this MMR vaccine
who will now be concerned about what may
happen to their children. What advice
would you give to them?
DR ANDREW WAKEFIELD:
Well, the interesting thing is that the
damage, the behavioural or developmental
change tends to occur quite soon after
administration, and this is where, why
parents or GPs or paediatricians have
been able to make the link, the
association with MMR. So if that
hasn’t happened then it is extremely
unlikely to happen.
INTERVIEWER:
But there are going to be parents now
whose children are about to have the
vaccination, and they’re gonna say:
I’m not gonna risk it. What would
you say to them?
DR ANDREW WAKEFIELD:
Well, my message is for the Department of
Health and the regulatory authorities,
and that is that this needs urgent
investigation; it needs funding and it
needs the appropriate level of commitment
in terms of basic scientific research and
clinical research to answer the question.
And until that time we cannot offer any
definitive evident, any definitive
message to parents about this.
INTERVIEWER:
Sounds to be saying, you seem to be
saying perhaps don’t?
DR ANDREW WAKEFIELD:
My opinion, again, is that the
monovalent, the single vaccines, measles,
mumps and rubella, are likely in this
context to be safer than the polyvalent
vaccine.
INTERVIEWER:
That’s the MMR vaccine?
(INTERVIEW ENDS)