Doctor who warned of autism fear over controversial baby jab criticises Tony Blair and threatens to take his research battle to America

LAST YEAR, after 13 years, I left my job as a gastroenterologist at the Royal Free Hospital and University College in London, largely as a result of the measles, mumps rubella vaccine controversy.

Now that I have left, there is one overriding priority: to ensure that children with autism and bowel disease get the investigation and treatment they need and deserve.

Prior to my departure, the situation had become very difficult. During the course of our investigations, my colleagues and I had at all times followed the rules of scientific hypothesis testing, peer review and publication.

Despite this, not only was our research programme under threat, but also the provision of clinical care for these children was under increasing pressure, in large part because of the political baggage that the MMR issue brought with it.

However, I have made it clear that I have no intention of stopping the work. Parents should be reassured that the current research programme will be completed. Thereafter, I will go wherever I have to go to continue it.

There are other people in the United States doing this work and one possibility is to continue there. One problem for such work, however, is that within the conventional university structure it is vulnerable. Universities are susceptible to external pressures because they are increasingly financially dependent upon the pharmaceutical industry.

The clinical issue - autism, bowel disease, and possible links with MMR - is a relatively simply story that has become obscured by layers of personal, political, financial and other imperatives that threaten to subvert the issue of how to help these children. This must be resisted if we are to separate fact from wishful thinking.

From the outset, parents have, in good faith, reported their children's symptoms linking bowel symptoms to developmental and behavioural regression. Their concerns have been almost universally dismissed by health care professionals. Some had to wait many years before getting their child investigated.

As doctors we must first listen and then act upon what we have heard. This is one of the tenets of conventional clinical medicine. I was fortunate enough to work with paediatricians who share this belief and are also world leaders in the field of childhood intestinal diseases.

Early in our investigations it became clear that the parents were right. They have helped us to identify what appears to be a new bowel disease in a group of children with autism.

Since our first report came out in 1998, we have investigated more than 200 children with autism, the majority of whom have a strikingly consistent pattern of intestinal inflammation. There is also growing support from other doctors. People are coming off the fence and acknowledging that genuine questions need to be answered. Unfortunately, the Government's determination to exonerate the MMR vaccine has led to research data being used inappropriately. Conflicts of interest abound, scientific arguments have been misconstrued, and what remains amounts to little more than propaganda.

Latterly the spotlight has fallen on Leo Blair. I entirely respect the Blairs' right to privacy. Nonetheless, Tony Blair's response to media questions, while full of sound and fury, was neither convincing nor very helpful. To the more cynical it was reminiscent of the ambiguity of other Presidential denials, such as when Bill Clinton made the infamous remark: 'I did not have sexual relations with that woman'.

I believe that the Government's response has been inadequate, at times inappropriate, and will ultimately be deemed irresponsible.

This is, in my opinion, made inevitable by a structure where politicians, in the face of a controversial medical issue, are dependent on their mandarins at the Department of Health. The latter represent a polarised and rarefied view point, making politicians extremely vulnerable. The Government and its representatives in the Department of Health rely upon epidemiological studies that, among many flaws, have tested hypotheses that have little or no bearing upon the children we have investigated.

Meanwhile, the tragedy for these children continues.

Denied appropriate health care already, they continue to be ignored because acknowledgement of their plight could raise the spectre of an association between their disease and the vaccine.

Until we have sufficient evidence, parents should be in a position to choose how they protect their children from these diseases.

The parents' dilemma is shared by my wife Carmel and me. Two of my four children, now four and seven, have not received the MMR vaccine and have yet to receive the single vaccines.

When we were trying to work out what to do for the best, the data were only just coming to light. Now, they are beyond the age where measles is really an issue. It is children under two years of age who are at greatest risk if they get measles, and for this reason I would strongly recommend protection with the single vaccine at the recommended age of 15 months.

At times, the criticism over my work has been fierce.

My wife has been very supportive. It would have been impossible to continue if she hadn't. We are of a like mind. She reminds me that we have four healthy children and that one can't walk away from the issue saying: 'This is uncomfortable for me so I'm off to a career in liposuction and removing ingrowing toenails.'

The debate should not be polarised into pro or anti-vaccine. The issue is one of how best to protect children. Clearly, if children were to die because there was a measles epidemic and there was no available effective alternative to the MMR jab, that would be enormously regrettable.

For this to happen when an effective alternative has been denied would be completely unacceptable.

There should be no reason to raise fears about complications of measles epidemics and measles deaths because the alternative - the single measles vaccine - is there. I regret the message has been distorted and that we have been unable to establish the kind of dialogue that we sought with the Department of Health.

I have no personal regrets; rather it has been a privilege to be involved. Any gratification is however tempered by a knowledge that precious time has been lost for these children to territorial and political imperative.

In the end, for doctors, it may stand as a lesson in humility, reinforcing the roots of clinical medicine. And also humility in deference to the powerful evolutionary forces of parental instinct and recidivist micro-organisms like measles that will return to haunt you if you fail to accord them the greatest respect.

It is also a lesson that there is no substitute for listening.

© Dr Andrew Wakefield