The main thrust of this paper (1) was the first description of an unexpected intestinal lesion in the children reported. Further evidence has been forthcoming in studies from the Royal Free Centre for Paediatric Gastroenterology and other groups to support and extend these findings. (2,3) While much uncertainty remains about the nature of these changes, we believe it important that such work continues, as autistic children can potentially be helped by recognition and treatment of gastrointestinal problems.
We wish to make it clear that in this paper no causal link was established between MMR vaccine and autism as the data were insufficient. However, the possibility of such a link was raised and consequent events have had major implications for public health. In view of this, we consider now is the appropriate time that we should together formally retract the interpretation placed upon these findings in the paper, according to precedent. (4)
We were unable to contact John Linnell.
*Simon H Murch, Andrew Anthony, David H Casson, Mohsin Malik, Mark Berelowitz, Amar P Dhillon, Michael A Thomson, Alan Valentine, Susan E Davies, John A Walker-Smith, Centre for Paediatric Gastronenterology (SHM, MAT, JAW-S); and Departments of Histopathology (AA, APD), Child Psychiatry (MB), and Radiology (AV), Royal Free and University College Medical School, Royal Free Campus, London NW3 2PF, UK; Institute of Child Health, Royal Liverpool Children's Hospital, Liverpool (DHC); Department of Paediatrics, Queen Elizabeth the Queen Mother Hospital, Margate, Kent (MM); and Department of Histopathology and Cytology, Addenbrooke's Hospital, Cambridge, UK (SED)
1 Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, Berelowtiz M, Dhillon AP, Thomson MA, Harvey P, Valentine A, Davies SE, Walker-Smith JA. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998; 351: 637-41.
2 Murch S. MMR and autism: the debate continues. Lancet 2004; 363: 568-69.
3 Horvath K, Perman JA. Autistic disorder and gastrointestinal disease. Curr Opin Pediatr 2002; 14: 583-87.
4 Zhang L, Lopez P, He T, Yu W, Ho DD. Retraction of an interpretation. Science 2004; 303: 467.
In an accompanying commentary (p 747), The Lancet's editor Richard Horton looks ahead to the implications of the MMR affair. He proposes that:
- Autism research now needs pump-priming by Government with at least 12.5 million of new ring-fenced Medical Research Council (MRC) funding spread over 5 years to develop sustainable programmes of clinical investigation.
- The UK Government must create an independent Council of Research Integrity to act as a referral centre for serious allegations of research misconduct.
- Mechanisms to establish vaccine safety should be strengthened by securing and constantly adding to a reliable evidence base early on in the development of any new vaccine.
- The methods of public engagement by health officials and ministers must be reviewed to take account of widespread distrust of Government information sources.
- While editors of medical journals should continue to publish original and sometimes unpopular ideas in responsible ways, they must take greater care to appreciate that their responsibility extends to all aspects of the public dissemination of the work they print.
- A collaborative consultation to learn the lessons of this episode deserves to be launched, one that includes members of the autism lay community, clinicians responsible for the care of children with autism and related disorders, the MRC, and the Health Protection Agency.
Contact: (retraction statement) Rachel Lowe, press officer, Royal Free Hampstead NHS Trust. T) 44-0-20-7830-2963; E) rachel.lowe@royalfree.nhs.uk
(Lancet Commentary) The Lancet Press Office, 32 Jamestown Rd, London NW1 7BY, UK; T) 44-0-20-7424-4949; E) pressoffice@lancet.com.
Journal
The Lancet