Professor Alan Emond author of a new study claiming to overturn the link between autism and bowel disease has failed to disclose his conflict of interest as member of the UK’s Joint Committee on Vaccination and Immunisation [JCVI Members]. Emond’s paper omits mention of and fails to comment on a series of medical papers establishing the condition.
The UK National Autistic Society reports that because of the controversy over MMR vaccine and autism parents of autistic children suffering severe bowel disease continue to have extreme difficulty getting medical treatment with many going untreated [National Autistic Society - General Medical Council Hearing Against Andrew Wakefield].
A 1998 Lancet medical journal study first published the link between autism and bowel disease and controversially suggested a possible cause might be the vaccine: [Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children Lancet 1998:351;9103]. The study has proven robust in a series of papers [cited below] despite being widely attacked in the media for suggesting a link with MMR vaccine and claimed to be “discredited”.
Archives of Disease in Childhood have since publication of Emond’s paper posted an eletter pointing out Professor Emond’s competing interest [Observations and concerns].
In 2006 after infant Georgie Fisher died following MMR vaccination it appears Professor Emond did not disclose JCVI membership to the infant’s father and his wife when Emond was brought into the investigation by the coroner: [Georgie Boy MMR]. The Coroner subsequently discounted MMR as implicated in the death: ["MMR baby 'chatting away' hours before his death, inquest hears" - Lee Glendinning - The Guardian 2 December 2008]
Allegations of a failure to include a formal disclosure of interests of an appointment as a Court expert witness resulted in one of the authors of the 1998 Lancet study Dr Andrew Wakefield facing unprecedented investigation by the UK General Medical Council with a potential sanction of being struck from the UK’s medical register. Evidence before the GMC shows The Lancet knew specifically of Dr Wakefield’s appointment up to a year before the 1998 publication. A decision is not expected until the end of this year or early in 2010.
Emond’s non-disclosure comes at a time when confidence in medical journals is falling. Recent news includes blatant ‘fixing’ of the published scientific evidence base by drug industry interests: [Merck published fake journal - Bob Grant - The Scientist - 30th April 2009]. Drug maker Wyeth has also flooded medical journals with some 40 ghostwritten articles penned by prominent physicians who sold their name for cash, in an all-out effort to offset the scientific evidence linking its female hormone replacement drug, Prempro, to breast cancer: Judge orders Wyeth papers unsealed – Associated Press – July 25, 2009].
The JCVI decides UK MMR and other vaccination policy and was recently given sole legal power by the New Labour Government: [UK Government Hands Drug Industry Control of Childhood Vaccination]. In 1988 the JCVI approved defective MMR vaccines and failed to call for withdrawal when large numbers of British children were seriously injured [British Government’s Reckless Disregard for Child Health Safety].
The Emond paper reviews medical data many years old for which no laboratory tests are available. Emond’s study uncovered a rate of 1 in 167 children with ASD born between April 1991 and December 1992, whereas the recently published study by Baron-Cohen detected a rate of 1 in 64 based on school data collected in the first half of the present decade: [Prevalence of autism-spectrum conditions: UK school-based population study Br J Psychiatry. 2009 Jun;194(6):500-9.].
Reuters news agency reported on Emond’s paper:
Autistic spectrum disorders are a group of developmental conditions that hinder people’s ability to communicate and build relationships. Previous studies, though inconclusive, “have described gastrointestinal symptoms in children with autism,” Dr. Alan Emonds, of the Center for Child and Adolescent Health, Bristol, and colleagues note in their study in the journal Archives of Disease in Childhood.
However, based on their results, “The bowel habits of young children with autistic spectrum disorder, in general, are no different from the rest of population,” Emond told Reuters Health. [Autism not tied to bowel movement patterns David Douglas - Reuters Thu Jul 23, 2009]
Editor Howard Bauchner of the Journal publishing Emond’s paper drives home the political message in an editorial:
The 1998 Wakefield paper in the Lancet ignited a worldwide concern that there was a link between MMR vaccine and autism. Despite no credible evidence that such an association exists, many groups remain concerned that immunisations are somehow fuelling the increasing prevalence of autism.
The UK is just now recovering from the impact of the Lancet paper on MMR immunization rates. Unfortunately, it appears that many of the concerns raised by parents in the UK have crossed the pond and are affecting immunisation rates (and schedule) in the US. Drs Sandhu, Steer, Golding and Emond, from the University of Bristol report that during the first 42 months of life, children with autistic spectrum disorder have a similar stool pattern to other children. Although there was a slight increase in stool frequency between 30 and 42 months of age they conclude: “There were no symptoms to support the hypothesis that ASD children had enterocolitis.” [Atoms: Autism and primary gastrointestinal pathology Howard Bauchner, Editor-in-Chief Archives of Disease in Childhood 2009;94:i]
The summary conclusion of Emond’s new study states:
During the first 42 months of life, ASD children had a stool pattern that was very similar to that of other children, apart from a slight increase in stool frequency at 30 and 42 months. There were no symptoms to support the hypothesis that ASD children had enterocolitis.
There has been considerable debate following publication of a Lancet paper in 1998 describing 12 children with lymphoid hyperplasia, non-specific colitis and pervasive developmental disorder of sudden onset. Wakefield and colleagues suggested that a primary gastrointestinal pathology, an enterocolitis which they described as a new variant of inflammatory bowel disease, plays an important role in the onset and clinical expression of autism. [The early stool patterns of children with autistic spectrum disorder Archives of Disease in Childhood 2009;94:497-500].
Papers Supporting the 1998 Lancet Study Linking Autism to Bowel Disease
The claim to have found a new inflammatory bowel disease published in the 1998 Lancet paper as ‘consistent gastrointestinal findings’ involving ‘nonspecific colitis’ were supported first by a series of peer reviewed papers including in The Lancet itself:-
Distinct genetic risk based on association of MET in families with co-occurring autism and gastrointestinal conditions. Pediatrics. 2009 Apr;123(4):1255.]. Furlano R, Anthony A, Day R, Brown A, Mc Garvey L, Thomson M, et al. “Colonic CD8 and T cell filtration with epithelial damage in children with autism.“ J Pediatr 2001;138:366-72.
Sabra S, Bellanti JA, Colon AR. “Ileal lymphoid hyperplasia, non-specific colitis and pervasive developmental disorder in children”. The Lancet 1998;352:234-5.
Torrente F., Machado N., Perez-Machado M., Furlano R., Thomson M., Davies S., Wakefield AJ, Walker-Smith JA, Murch SH. “Enteropathy with T cell infiltration and epithelial IgG deposition in autism.” Molecular Psychiatry. 2002;7:375-382
Wakefield AJ, Anthony A, Murch SH, Thomson M, Montgomery SM, Davies S, Walker-Smith JA. “Enterocolitis in children with developmental disorder.” American Journal of Gastroenterology 2000;95:2285-2295
Ashwood P, Anthony A, Pellicer AA, Torrente F, Wakefield AJ. “Intestinal lymphocyte populations in children with regressive autism: evidence for extensive mucosal immunopathology.” Journal of Clinical Immunology, 2003;23:504-517.
Papers Replicating The 1998 Lancet Study Original Finding
Another series of papers replicated the findings of The Royal Free Hospital London’s 1998 Lancet paper:-
Gonzalez, L. et al., “Endoscopic and Histological Characteristics of the Digestive Mucosa in Autistic Children with gastro-Intestinal Symptoms“. Arch Venez Pueric Pediatr, 2005;69:19-25.
Balzola, F., et al., “Panenteric IBD-like disease in a patient with regressive autism shown for the first time by wireless capsule enteroscopy: Another piece in the jig-saw of the gut-brain syndrome?” American Journal of Gastroenterology, 2005. 100(4): p. 979- 981.
S. Walker, K. Hepner, J. Segal, A. Krigsman “Persistent Ileal Measles Virus in a Large Cohort of Regressive Autistic Children with Ileocolitis and Lymphonodular Hyperplasia: Revisitation of an Earlier Study” [IMFAR May 2007]
Balzola F et al . “Autistic enterocolitis: confirmation of a new inflammatory bowel disease in an Italian cohort of patients.” Gastroenterology 2005;128(Suppl. 2);A-303.
WHAT YOU CAN DO
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- British Government’s Reckless Disregard for Child Health Safety
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- AUTISM – US Court Decisions and Other Recent Developments – It’s Not Just MMR
- Vaccine Risks Outweigh Risk of Disease
- Mercury in British Vaccines, Autism and Your Child’s Allergies
- In Whom Can You Trust?
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