Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Unscientific Bias
- John Stone (13 May 2005)
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So Mumps cases DID have MMR?
- Lisa C Blakemore-Brown (13 May 2005)
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Tepid mumps
- Lenny Schafer (15 May 2005)
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When?
- John Stone (16 May 2005)
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No level playing field
- John Stone (21 May 2005)
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M, M and R in Japan
- Catherina G. Becker (12 June 2005)
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Re: M, M and R in Japan
- John Stone (13 June 2005)
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Do we really know anything?
- John P Heptonstall (17 June 2005)
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Re: Do we really know anything?
- John Stone (19 June 2005)
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Think mumps, but vaccination in a child?
- Dr JK Anand (23 June 2005)
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think mumps vaccination in every child!
- Catherina G. Becker (30 June 2005)
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Mumps and deafness--no association
- Clifford G. Miller (12 August 2005)
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John Stone, none London N22
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The proposition that vaccines unlike other pharmaceutical products are inherently safe is risible. The medical profession predetermine their own results. Parents are told to disregard even severe adverse reactions [1]. They are subjected to withering scorn by governments, the medical profession and much of the media if they do report them. Professionals who try to investigate or draw attention to them are persecuted (Andrew Wakefield [2,3], Lisa Blakemore-Brown). Evidence is misrepresented or suppressed. There are many examples. I have recently highlighted how the Burbacher study - which actually reported disturbing levels of inorganic mercury in the brain from thimerosal - was either misleadingly reported to suggest that the mercury was expelled from the body efficiently, or it was not reported at all (notably in the BMJ) [4]. In the recent Japanese study of MMR the study did not disclose that while the autism rate did indeed go up in parallel with MMR being abandoned (due to falling take up) it was replaced by three monovalent jabs administered in close proximity. Since Andrew Wakefield had originally advised separating the three jabs by spacing them at year intervals the study actually supported rather than confuted his view, but this was not what people were told [5]. There are many such instances as anyone who follows Rapid Responses will realise. You wonder if vaccine is safe why so much careful news management is necessary. As it is, I invite Fiona Godlee to take an interest in the fact that when my son had DPT HiB he went red down one side, his temperature shot up to 39.5 and we were advised that this was routine and we should give him some Calpol. A month later the same thing happened again. Naturally, no medical record of these events survive. Is this really what we should expect? [1]http://www.mmrthefacts.nhs.uk/questions/question.php?id=79 [2]John Stone, 'To spell out the problem', 31 october 2004,http://bmj.bmjjournals.com/cgi/eletters/329/7473/1049#83037 [3]John Stone. '"The confusion": Richard Horton - a remarkably frank passag', 2 November 2004,http://bmj.bmjjournals.com/cgi/eletters/329/7473/1049#83447 [4] John Stone, Re: Pharmaceutical Medicine as a Specialty (but if the truth will out will it make any difference),http://bmj.bmjjournals.com/cgi/eletters/330/7496/0-g#106376 [5]Andrew Wakefield and Carol Stott, 'Japanese study is the strongest evidence yet for a link between MMR and autism', http://www.redflagsweekly.com/articles/2005_mar06_2.html Competing interests: Parent of an autistic child who had to severe reactions to DPT HiB vaccines ignored by the medical profession |
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Lisa C Blakemore-Brown, Psychologist UK
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In the study on a new wave of Mumps outlined by Fiona Godlee we are told "Most cases in 2004 were in 19-23 year olds—young adults who were not exposed to mumps as children (because of the dramatic fall in rates of natural infection after the MMR vaccine was introduced in 1988) and who for various reasons didn't receive the recommended two doses of MMR vaccine." We read that this group of 19 - 23 year olds : 'For various reasons didn't receive the recommended two doses of MMR vaccine' This implies that they DID receive ONE dose of the vaccine. So it is NOT the case that these individuals who have now caught Mumps were not vaccinated. We are then invited to believe that its not that they were not vaccinated, its that they were not vaccinated ENOUGH. Mmm. Why is it that this hasn't been happening to everyone too old to have been given the MMR school booster? Competing interests: Expert in ASD and ADHD spectrum disorders |
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Lenny Schafer, Schafer Autism Report -Editor 9629 Old Placerville Rd. Sacramento, CA 95827 USA
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Such mumps alerts as this have appeared in dozens of lay UK publications as well this week. Curiously missing are the usual parade of frightening case examples of morbid and mortal sufferers. Surely there must be one agonized mumps victim near the edge of death, somewhere for demonstration? And where are the reports of resulting deaths? Could there be none of the above? This will not go very far in stampeding a frightened citizenry into inoculation compliance and will not much mollify vaccine pharma investors. Competing interests: Parent of a child with autism |
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John Stone, none London N22
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I pose this as a question to Fiona Godlee. When is the lecturing going to stop and the listening going to begin? Virtually everyone I know on the vaccine concern side of the debate started off from the point of trust, but we have not been repaid. And even what goes on in Rapid Responses does not begin to redress the balance. As things are every point raised - however well-informed and argued - will be met with stony silence, and all of it will be excluded from the hard edition. There is no dialogue: one side has closed the discussion when the other side has many very good questions. I think BMJ need to consider whether this is the long term way to engender public trust. Competing interests: Parent of an autistic child |
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John Stone, none London N22
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Given the severity of the professional consequences to Andrew Wakefield over an alleged non-disclosure of interest which led to him being pilloried in the media for four days in February of last year and GMC proceedings, it is interesting to reflect that four vaccine related articles in the last issue of BMJ - referred to in Fiona Godlee's editorial - failed to include significant details in the competing interest box: http://bmj.bmjjournals.com/cgi/eletters/330/7500/1154#106667 http://bmj.bmjjournals.com/cgi/eletters/330/7500/1132#106674 http://bmj.bmjjournals.com/cgi/eletters/330/7500/1120#107331 http://bmj.bmjjournals.com/cgi/eletters/330/7500/1119#107407 Competing interests: Parent of an autistic child |
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Catherina G. Becker, Senior Lecturer Edinburgh
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John Stone writes that in Japan, the MMR vaccine was "replaced by three monovalent jabs administered in close proximity". This is not correct. Mumps was not included in the Japanese routine vaccination schedule after the MMR was abandoned. Dr. Honda, one author of the study in question (which Mr. Stone neglects to cite; [1]), wrote the following in an email to me: "Compared to measles (90-100%) and rubella (50-60%), the uptake of mumps vaccine has been low in Japan after the withdrawal of the MMR, because among M, M, and R, only mumps vaccination has not been strongly recommended by the government, i.e., parents must pay all the cost for mumps vaccine. And, because of the same reason, the government does not have the data on the proportion of the children who was vaccinated with mumps vaccine. When estimated from the amount of consumed vaccine per year, the proportion is perhaps less than 30%." It is evident from the above percentages (measles 90-100%, rubella 50 -60% - I am guessing mostly female vaccinees, and mumps <30%) that very few Japanese children would have received M, M and R "in close proximity". Still, as Dr. Honda and collegues report, the incidence of autism continued to increase. [1] Honda H, Shimizu Y, Rutter M. No effect of MMR withdrawal on the incidence of autism: a total population study.J Child Psychol Psychiatry. 2005 Jun;46(6):572-9 Competing interests: None declared |
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John Stone, none London N22
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I am grateful to Catherina Becker. I note the rational approach of the Japanese public towards mumps vaccine and readily agree that the situation in Japan was a bit more complex than indicated in my Rapid Response (above). It would obviously greatly enhance understanding of the problem if the authors of the study (Honda et al) would engage more directly with the published criticisms of it. I list some: Andrew Wakefield and Carol Stott, 'Japanese study is the strongest evidence yet for a link between MMR and autism', http://www.redflagsweekly.com/articles/2005_mar06_2.html F Edward Yazbak, 'MMR – Autism Epidemiological Studies: Just a distraction', http://www.redflagsdaily.com/yazbak/2005_mar10.php Hilary Butler, 'John Rumbold and Japan', 5 March 2005,http://bmj.bmjjournals.com/cgi/eletters/330/7483/112-d#99188 Viera Scheibner, 'Re: MMR and Japan: a commentary by Wakefield and Stott', 15 March 2005, http://bmj.bmjjournals.com/cgi/eletters/330/7483/112-d#99926 John Heptonstall,'Evidence suggests MMR and Monovalent Vaccines cause ASDs' 16 March 2005, http://bmj.bmjjournals.com/cgi/eletters/330/7491/558- a#100450 Clifford Miller, 'POWERFUL EVIDENCE MMR CAUSES AUTISM - RECHALLENGE AT A POPULATION LEVEL', http://bmj.bmjjournals.com/cgi/eletters/330/7491/558-a#102393 Competing interests: Autistic son |
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John P Heptonstall, Director of the Morley Acupuncture Clinic Leeds LS27 8EG
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Fiona Godlee seems assured of certain facts... "localised antivaccine activism... Two years ago, Nigerian Muslims boycotted polio vaccination after local imams claimed that the vaccine was part of a US plot to spread AIDS or infertility in the Islamic world." Yet is she sure the Imams were incorrect in their assumptions? "the children and adults suffering the consequences of what are entirely preventable diseases". Is she sure the diseases are entirely preventable and if so by what means and how is this proved? "Most cases in 2004 were in 19-23 year olds—young adults who were not exposed to mumps as children (because of the dramatic fall in rates of natural infection after the MMR vaccine was introduced in 1988) and who for various reasons didn't receive the recommended two doses of MMR vaccine...As a result of the vaccine's success, few UK doctors who qualified in the past 15 years will ever have seen a case of mumps". Is she sure that those 19-23 year olds were not exposed to mumps as children and didn't receive two doses of MMR? I would ask Fiona to explain how she can be sure that the above facts, as she discloses them, are true? I also think scientists should be less ready to accept as fact the information of others unless the weight of evidence, which should accompany that information, supports beyond reasonable doubt the facts. For example, were all those 19-23 year olds investigated for previous mumps vaccinations or wild mumps? Perhaps Fiona, who seems sure of her facts, could advise? Regards John H. Competing interests: None declared |
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John Stone, none London N22
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With respect to John Heptonstall I would not like to suggest that the views of the Nigerian Imams are any better founded than Fiona Godlee's, though certainly important questions have arisen about the evidence base for received opinion in correspondences following BMJ's 'Think Mumps' issue [14 May), notably under Gupta et al 'Mumps and the 2005 UK epidemic': http://bmj.bmjjournals.com/cgi/content/full/330/7500/1132 An interesting commentary by Sherri Tenpenny on the African polio vaccine crisis, its hazards and the WHO's heavy-handedness in its implementation can be read at: http://www.mercola.com/2005/jun/2/vaccine_refusal.htm The real message is that we need to have much greater care for everybody. Competing interests: Autistic son |
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Dr JK Anand, Retired public health physician Not applicable
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I agree that mumps should be considered in the differential diagnosis in appropriate circumstances. Vaccination is, however, a different matter (in children). Mumps is, in children, a relatively mild infection - often unrecognised, but conferring life-long immunity. Christie (1) stated, "...in reading much about mumps I have found few accounts of deafness and complications are probably very rare.A BMJ editorial (2) which may have escaped Dr Godlee's notice, put it thus, "Anyone who subscribes to the view that any disease which is preventable should be prevented would believe that mumps vaccine should have wide application.......The vaccine might find useful aplication in selected groups - say, youths shown by antibody studies to be susceptible......" I am persuaded by the views of Christie and the BMJ leader-writer of 1977, cited above. JK Anand References: 1. Christie AB, Infectious Diseases Churchill Livingstone, 1987,vol 1, p 643 2. Editorial (anon) Mumps, BMJ, 1977, number 6075, p1489 Competing interests: None declared |
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Catherina G. Becker, Senior Lecturer Edinburgh
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Contrary to Dr. Anand, I am not at all convinced by Christie and collegues. Deafness as a consequence of mumps infection is a very well documented fact. Chuden et al. (1) find impaired hearing in almost 5% of children investigated after mumps infection. In Japan, where mumps vaccination uptake is particularly low, cases of mumps and mumps deafness have increased to an estimated 254,711/650 in 2001 (2). Most cases of mumps induced hearing loss occur between ages 5 and 9 and are permanent. Vaccination against mumps provides a significant risk reduction of acquiring the disease and suffering from its neurological consequences. It makes little sense to wait with such a risk reduction until puberty. (1) Chuden HG, Michtl W, Stehr K. Hearing loss due to mumps. Laryngol Rhinol Otol (Stuttg). 1978 Aug;57(8):745-50 (2) Kawashima Y, Ihara K, Nakamura M, Nakashima T, Fukuda S, Kitamura K. Epidemiological study of mumps deafness in Japan. Auris Nasus Larynx. 2005 Jun;32(2):125-8. Competing interests: None declared |
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Clifford G. Miller, Lawyer, graduate physicist, former university examining lecturer in law BR3 3LA
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MUMPS AND DEAFNESS - NO ASSOCIATION "The role of viruses in the production of sensorineural loss is controversial...... Although measles, mumps, and other common viruses are often cited as causative agents, their role in postnatal hearing loss remains unproved." [1] Accordingly, this carefully researched 1993 NEJM paper deals with the incorrect proposition of a prior contributor [2] that "Deafness as a consequence of mumps infection is a very well documented fact." basing the statement on a paper twenty years older from 1973 [3]. The other paper from Japan cited as evidence of an association [3] is not. The paper was based on figures where the association was assumed, not proven and the paper did not deal with establishing specific causation in any particular case. The figures of mumps deafness cases were estimated on the basis of cases of deafness assumed to be mumps from studies of patients recorded as treated for 'mumps deafness'. There appears to have been no follow up, nor does it seem possible for any of the Bradford Hill guidelines to have been applied. Further, the numbers of cases were so small (300 in 1987, 400 in 1993 and 650 in 2001) compared to background levels that as a 'signal' they cannot realistically be taken to establish anything. Not really what can be described as either scientific, conclusive or convincing - just epidemiology (statistics). As a guide to background levels of the prevalence of deafness:- In the US population "..4 percent of people under 45 years of age
and
29 percent of those 65 years or over have a handicapping loss of
hearing. A similar survey in Great Britain found that approximately 25
percent of the population questioned had some hearing difficulty, and
audiometric evaluation of a portion of that population found that 20
percent had a hearing impairment exceeding 25 dB HL (hearing level) in
the better-hearing ear. .......... Clinically, loudness is expressed in
decibels
HL; the threshold for the perception of a sound at a given frequency by
normal persons is 0 dB HL. Normal conversational levels are 45 to 60
dB, and the loudness of a jet engine at 31 m [lo0 ft] is 140 to 150 dB.
The threshold for a handicapping hearing loss - that is, one severe
enough to interfere with speech acquisition in a child or effective
conversation in an adult - is approximately 25 to 30 dB.) It has
been
estimated that more than 28 million Americans have hearing impairment
and that as many as 2 million of this group are profoundly deaf.
........ Approximately 1 per 1000 infants has a hearing loss
sufficiently severe
to prevent the unaided development of spoken language. More than
360 per 1000 persons over the age of 75 have a handicapping hearing
loss." [1]
[1] Medical Progress - Nadol 329 pps1092-1102 NEJM 7 Oct '93 [2] think mumps vaccination in every child! BMJ Rapid Response 30 June 2005 Catherina G. Becker, Senior Lecturer, Edinburgh [3] Epidemiological study of mumps deafness in Japan. Kawashima Y, Ihara K, Nakamura M, Nakashima T, Fukuda S, Kitamura K. Auris Nasus Larynx. 2005 Jun;32(2):125-8. Competing interests: None declared |
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