EDITORIAL
The MMR vaccine and autism: Sensation, refutation, retraction, and fraud
T. S. Sathyanarayana Rao, Chittaranjan Andrade1
Department of Psychiatry, JSS Medical College Hospital, Mysore, 1Department of Psychopharmacology, National Institute of
Mental Health and Neurosciences, Bangalore, Karnataka, India
In 1998, Andrew Wakefield and 12 of his colleagues[1] clearances) and scientific misrepresentation (they reported
published a case series in the Lancet, which suggested that their sampling was consecutive when, in fact, it
that the measles, mumps, and rubella (MMR) vaccine was selective). This retraction was published as a small,
may predispose to behavioral regression and pervasive anonymous paragraph in the journal, on behalf of the
developmental disorder in children. Despite the small editors.[8]
sample size (n=12), the uncontrolled design, and the
speculative nature of the conclusions, the paper received The final episode in the saga is the revelation that Wakefield
wide publicity, and MMR vaccination rates began to drop et al.[1] were guilty of deliberate fraud (they picked and
because parents were concerned about the risk of autism chose data that suited their case; they falsified facts).[9] The
after vaccination.[2] British Medical Journal has published a series of articles on
the exposure of the fraud, which appears to have taken
Almost immediately afterward, epidemiological studies were place for financial gain.[10-13] It is a matter of concern that the
conducted and published, refuting the posited link between exposé was a result of journalistic investigation, rather than
MMR vaccination and autism.[3,4] The logic that the MMR academic vigilance followed by the institution of corrective
vaccine may trigger autism was also questioned because a measures. Readers may be interested to learn that the
temporal link between the two is almost predestined: both journalist on the Wakefield case, Brian Deer, had earlier
events, by design (MMR vaccine) or definition (autism), reported on the false implication of thiomersal (in vaccines)
occur in early childhood. in the etiology of autism.[14] However, Deer had not played
an investigative role in that report.[14]
The next episode in the saga was a short retraction of
the interpretation of the original data by 10 of the 12 co- The systematic failures which permitted the Wakefield
authors of the paper. According to the retraction, “no causal fraud were discussed by Opel et al.[15]
link was established between MMR vaccine and autism as
the data were insufficient”.[5] This was accompanied by an IMPLICATIONS
admission by the Lancet that Wakefield et al.[1] had failed to
disclose financial interests (e.g., Wakefield had been funded Scientists and organizations across the world spent a great
by lawyers who had been engaged by parents in lawsuits deal of time and money refuting the results of a minor
against vaccine-producing companies). However, the Lancet paper in the Lancet and exposing the scientific fraud that
exonerated Wakefield and his colleagues from charges of formed the basis of the paper. Appallingly, parents across
ethical violations and scientific misconduct.[6] the world did not vaccinate their children out of fear of
the risk of autism, thereby exposing their children to the
The Lancet completely retracted the Wakefield et al.[1] paper risks of disease and the well-documented complications
in February 2010, admitting that several elements in the related thereto. Measles outbreaks in the UK in 2008 and
paper were incorrect, contrary to the findings of the earlier 2009 as well as pockets of measles in the USA and Canada
investigation.[7] Wakefield et al.[1] were held guilty of ethical were attributed to the nonvaccination of children.[7] The
violations (they had conducted invasive investigations Wakefield fraud is likely to go down as one of the most
on the children without obtaining the necessary ethical serious frauds in medical history.[9]
Address for correspondence: Dr. T. S. Sathyanarayana Rao,
Access this article online
Department of Psychiatry, JSS University,
JSS Medical College Hospital, M.G. Road, Quick Response Code
Website:
Mysore - 570004, Karnataka, India.
E-mail: tssrao19@yahoo.com www.indianjpsychiatry.org
How to cite this article: Sathyanarayana Rao TS, Andrade C. DOI:
The MMR vaccine and autism: Sensation, refutation, retraction,
10.4103/0019-5545.82529
and fraud. Indian J Psychiatry 2011;53:95-6.
Indian Journal of Psychiatry 53(2), Apr-Jun 2011 95
Rao and Andrade: The MMR vaccine and autism
Scientists who publish their research have an ethical evidence for a causal association. Lancet 1999;353:2026-9.
4. Dales L, Hammer SJ, Smith NJ. Time trends in autism and in MMR
responsibility to ensure the highest standards of research immunization coverage in California. JAMA 2001;285:1183-5.
design, data collection, data analysis, data reporting, and 5. Murch SH, Anthony A, Casson DH, Malik M, Berelowitz M, Dhillon AP,
et al. Retraction of an interpretation. Lancet 2004;363:750.
interpretation of findings; there can be no compromises 6. Horton R. A statement by the editors of The Lancet. Lancet 2004;363:
because any error, any deceit, can result in harm to patients 820-1.
7. Eggertson L. Lancet retracts 12-year-old article linking autism to MMR
as well harm to the cause of science, as the Wakefield saga vaccines. CMAJ 2010;182:E199-200.
so aptly reveals. We sincerely hope that researchers will 8. Anonymous. Retraction-Ileal-lymphoid-nodular hyperplasia, non-
keep this ethical responsibility in mind when they submit specific colitis, and pervasive developmental disorder in children. Lancet
2010;375:445.
their manuscripts to the Indian Journal of Psychiatry. 9. Godlee F. The fraud behind the MMR scare. BMJ 2011;342:d22.
10. Deer B. Wakefield’s “autistic enterocolitis” under the microscope. BMJ
2010;340:c1127.
REFERENCES 11. Deer B. How the case against the MMR vaccine was fixed. BMJ
2011;342:c5347.
1. Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, 12. Deer B. Secrets of the MMR scare. How the vaccine crisis was meant to
et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and make money. BMJ 2011;342:c5258.
pervasive developmental disorder in children. Lancet 1998;351:637-41. 13. Deer B. Secrets of the MMR scare. The Lancet’s two days to bury bad
2. DeStefano F, Chen RT. Negative association between MMR and autism. news. BMJ 2011;342:c7001.
Lancet 1999;353:1987-8. 14. Deer B. Autism research: What makes an expert? BMJ 2007;334:666-7.
3. Taylor B, Miller E, Farrington CP, Petropoulos MC, Favot-Mayaud I, Li J, 15. Opel DJ, Diekema DS, Marcuse EK. Assuring research integrity in the
et al. Autism and measles, mumps, and rubella vaccine: No epidemiologic wake of Wakefield. BMJ 2011;342:d2.
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