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Dr. Bob vs. the MMR

As promised, here’s another installment in my critique of Dr. Bob Sears’ The Vaccine Book. This part deals with Sears’ strange attitude towards the MMR vaccine and the logic (or lack thereof) behind it.

Sorry, couldn't resist...this is my first association with the name Dr. Bob.

Another feature of Doc Sears Jr.’s alternative vaccine schedule, aside from the aluminum issue, is his recommendation to separate the MMR vaccine in infancy and give its components at different ages (mumps at 1 year, rubella at 2, measles at 3, and a combined MMR at 5). In the book, he doesn’t give a specific rationale for this other that some parents may prefer to separate the shots due to fear of their child ‘catching’ autism; however, he states elsewhere that he believes – though I know of no scientific basis for this whatsoever, and he does not provide one – that giving live-virus vaccines one at a time makes for a more effective immune response.

Another statement he makes which also does not seem to have any basis in fact is that if your child receives the MMR vaccine past the age of 4, no second dose is necessary. (page 230 in The Vaccine Book). Needless to say, the CDC’s catch-up vaccination schedule disagrees – it’s necessary to get 2 doses after the age of 12 months, at least 4 weeks apart, no matter what age the vaccination series is started. The first vaccine is ~95-98% effective, however measles is one of the most contagious diseases there are. So in the interest of eradicating measles in the population, the second dose is given to catch the 2-5% of nonresponders to the first MMR.

Another minor quibble which Sears is probably too young to remember but I am not (not because I’m so ancient – I don’t think I’m much older than he is, actually – but because the MMR was introduced in the US in 1971 and in Israel, only in 1988*) is that though mumps is a fairly benign disease in young children, back in the ‘old days’ quite a few young patients who caught the disease would present, not with the typical parotid gland swelling, but with signs and symtoms resembling meningitis, and would be hospitalized and given antibiotics until the swelling appeared a couple of days later (after which the patient would be released from hospital and everyone would sigh in relief that it was “only” mumps). Something we’re all happy to live without, I’m sure.

What I find most troubling about Sears’ attitude toward the MMR vaccine, however, is while he claims not to be a believer in the MMR/autism connection, he entirely ignores the fact that the controversy was itself born in sin – to remind you, the lead researcher who first postulated a connection, Andrew wakefield, was found to have been paid a large sum of money to establish such a connection in order to bolster a legal case brought forth by parents of autistic children. I’ve discussed this at length in my series on the MMR/autism controversy, but there is no mention of this at all in The Vaccine Book. If you were to depend solely upon Sears’ book for your information, you might think there was, or maybe still is, merit to the theory.

While Sears does mention the IOM’s conclusion that MMR doesn’t cause autism, he lends equal (if not greater) credence to Wakefield’s hypothesis and the “research” pretending to support it. Morever, another research team (led, oddly enough, by Dr. Mady Hornig, she of the thimerosal-related ‘autistic mice’ study) attempted to replicate Wakefield’s original experiment – but failed to replicate his results. Sears’ response? Good news, but we still need more studies before I believe it …and quotes Andrew Wakefield’s objections to the study verbatim (Oh noez! they checked the wrong kind of autistic children!).

Unfortunately, either Sears is not being entirely truthful about his lack of belief in the MMR/autism causation theory, or he simply is incapable of doing thorough research and differentiating a good study from a bad one. I suspect it’s a bit of both. Let’s have a look at the studies he cites as corroborating evidence to Wakefield, and the problems with them.

Uhlmann et al claimed to find the presence of vaccine-strain measles virus in the intestinal tissue of autistic children via a gene amplification technique called polymerase chain reaction (PCR), but not in those of controls.

The problem with this study, as with Wakefields’ original one (this study was also co-authored by him), is that the samples were sent for analysis to the Unigenetics lab in Ireland, run by Professor O’Leary. In the course of the British medical authorities’ inquiry into Wakefield’s misconduct in 2004, the O’Leary lab’s equipment and results were examined by one of the foremost experts in PCR, Prof. Stephen Bustin. He found that the lab had forgotten a critical step in preparing the samples for PCR, and this meant that whatever gene was being amplified, it couldn’t possibly have been measles virus RNA that they found. Bustin later testified in the Autism Omnibus proceedings regarding this; Kevin Leitch at Left Brain/Right Brain has two very good, detailed posts regarding this here and here. Presumably, the O’Leary lab cleaned up its protocol after Bustin’s 2004 visit; the new Hornig study used the Unigenetics lab as well, but corroborated the results with two other labs.

Furthermore, D’Souza et al attempted to use the PCR primers from the Uhlmann experiment to search for measles virus in the peripheral white blood cells of autistic and non-autistic children. They found plenty of corresponding genetic material in both test and control groups, but when they actually checked the genetic material amplified, none of it was measles virus RNA.

Sears also quotes another study by Thompson et al (also co-authored by Wakefield) which studied a cohort of adults who received measles vaccine in 1964 and compared them to an unvaccinated cohort, with the finding that those vaccinated had 3 times the chance of developing inflammatory bowel disease than the unvaccinated controls.

Without going into the design flaws of the original study (and there are those), I’ll point out that this is very disingenuous of Sears. Wakefield ,in his 1998 paper, was claiming that autistic children had a novel form of bowel disease (which he called ‘autistic enterocolitis’); the term “Inflammatory Bowel Disease” in the context of this study, as any doctor would know, refers to two specific diseases: Crohn’s disease and ulcerative colitis, already well-defined disease entities.

Either way, there is plenty of evidence by now that MMR does not increase the risk for those diseases, either – like here, here and here (this last also, amazingly, co-authored by Wakefield).

The other three studies Sears references are of questionable quality to begin with, and using them as a corroboration of Wakefield’s findings just goes to demonstrate just how low you need to sink just to find such corroboration.

The first two studies referenced appear in the Journal of the American Association of Physicians and Surgeons. Despite its respectable-sounding name, this is a political organization, not a medical one, and the journal’s pages have been home to articles supporting AIDS-denialism and that cases of ‘shaken baby syndrome’ are actually vaccine injuries. Kathleen Seidel’s article on the AAPS and its journal is an illuminating read.

An Investigation of the Association Between MMR Vaccination and Autism in Denmark by Gary S. Goldman, Ph.D (in computers) and Fouad Yazbak, MD. Both are long term anti-vaccine activists. Goldman also is editor-in-chief of Medical Veritas, which we’ve discussed before as the anti-vaccine (and pro-lying on other subjects) rag it is.

Anyway, Goldman and Yazbak attempt to prove that introduction of MMR into the Danish vaccine schedule in 1987 caused autism rates to skyrocket. It didn’t do very well (what it actually does sort of show is that awareness of autism rose some 5-6 years after the MMR was introduced, probably coincidentally).

The other JAAPS study is by Dr. Jeff Bradstreet, another anti-vaccine activist and a doctor associated with DAN! (Defeat Autism Now!), a group of ‘therapists’ who use questionable methods such as chelation, diabetes drugs and other uproven therapies and claim to ‘cure’ autistic children. One of the therapeutic modalities Bradstreet apparently was once fond of was…exorcism.

Bradstreet claimed to find measles vaccine virus RNA in the cerebrospinal fluid and the intestinal biopsies of 3 children with so-called “regressive” autism. Guess which lab the researchers (which included Wakefield, yet again) used? Yep, Unigenetics.

The third study is by The Geier duo. ‘Nuff said.

Anyway, if all this isn’t enough to convince one that the MMR/autism theory is deader than the proverbial parrot in the famous Monty Python sketch, I doubt very much that any more research will. While Sears claims the MMR controversy “is still an issue with parents”, his job as a doctor should be to help clarify the issue to his patients and readers, not further muddy the waters with unfounded scares.

—————————————————————————————————
*Until 1988 and the introduction of the MMR, measles had been given in Israel since the late 60s at 15 months as a single dose, and rubella was given only to the girls at age 12. Needless to say, rubella and mumps were fairly common and measles wasn’t exactly unknown, either.

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8 Responses

  1. I wrote about Sears last week and, while he still thinks it’s safer to split the vaccines up, he has come off the MMR-autism theory pretty hard:

    http://autism.freedomblogging.com/2008/09/12/sears-on-the-mmr/

  2. Excellent work, Esther. You really do a great job of pointing out the flaws in his arguments.

  3. Sam, thanks for your link. But going by what he said on his blog a mere 3 days earlier, it certainly doesn’t sound like he’s 100% convinced Wakefield is in the wrong. he certainly gave way too much credence to Wakefield’s supporters in his book, and never once mentioned the man’s ulterior motives. He does the same thing with the thimerosal issue, though he refuses to talk about that at length.

    There is also no evidence that the MMR combination is less effective or dangerous than giving the shots separately – if that were so, we’d expect to have seen a sustained surge in these diseases and side effects at the time various countries changed over from single vaccines to the MMR. Sears’ “feelings” notwithstanding, if he makes a claim, he needs some science to back it up. Especially if he’s advocating preschoolers get more needles than they should under the usual schedule – something “attached” mommies should be reluctant to do to their children for no good reason.

    I’ll believe he’s come around to not believing Wakefield when he revises his book to support giving the whole MMR at a year, or at the very least – giving the measles vaccine first, at 12 months. We had enough problems last winter protecting the under-one demographic during the measles epidemic; imagine what would things have been like if we had to worry about a significant proportion of those under age 3 as well?

  4. Esther, Your posts to his blog were spot on. He does seem to be backing away from that unfounded hypothesis, albeit slowly. His angle is to base his recommendations on what is not known (or not known to him), rather than known so of course he can exercise a fair amount of imagination launching from that platform. We’ll see if the recommendations he makes now can deviated from celebrity-based to evidenced-based.

    SM

  5. I love the picture. LOL

  6. SM – I’d like to believe he will do that. Though if you look at his responses, he still is giving the DAN! doctors way too much credit (and he thinks the majority of autistic patients agree with him, though I would think that has more to do with his patients’ demographics than anything else). As I said above, recommending the measles shot be given first would be a step in the right direction, at least.

  7. Did you see that Dr. Paul Offit takes on Dr. Bob’s alternate vaccine schedule in the January edition of Pediatrics? Its a great read, I wish I could get the folks I know who aren’t vaccinating their children because of Dr. Bob’s book to read it (although I doubt it would change their minds)
    Here’s the link:

    http://pediatrics.aappublications.org/cgi/content/full/123/1/e164

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