A prestigious British medical journal has retracted a controversial 12-year-old article that first linked autism to childhood vaccines and set off global fears about immunization and the causes of the developmental disorder that persist today.
Medical experts and some advocates for people with autism said the move was long overdue, but few expected the retraction to change the minds of vaccine skeptics.
In the years since the Lancet published Dr. Andrew Wakefield's study, numerous review articles have rebutted his claims that the combination measles, mumps and rubella vaccine causes autism. Nevertheless, a vocal minority of parents and their supporters have clung to the notion that the vaccine is unsafe. Recent studies have shown an increase in parents who are opting out of some routine childhood vaccinations, alarming public health experts who fear that diseases once nearly eradicated could return.
"This is welcome. It's overdue; this paper should never have been published," said Dr. Neal Halsey, director of the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health, who added that it is highly unusual for a prominent medical journal to retract an article. "Dr. Wakefield has stated in the reviews that he was not honest. There is nothing to this hypothesis, that's the bottom line. But unfortunately, it took hold and has been given credibility when it should never have been credible."
A British medical panel said last week that Wakefield's study of a dozen children provided false information, and an investigation is under way that could cause him to lose his medical practice. Several years ago, Wakefield's co-authors conceded that they didn't have enough information to conclude there was a link between the vaccine and autism. And later, reports surfaced that Wakefield was paid by attorneys representing families suing the makers of the vaccine.
"He created incredible pain and suffering among people and gave this false belief that physicians did harm to their children by giving them this vaccine," said Dr. Dan Levy, an Owings Mills pediatrician and past president of the Maryland chapter of the American Academy of Pediatrics.
Parents with autistic children face many hardships and are often desperate for clues to the disorder. Wakefield took advantage of their feelings of helplessness, Levy said.
Levy said he's often confronted by parents who are reluctant to vaccinate their children - not just against measles, mumps and rubella, but with other lifesaving childhood vaccines. After he explains the evidence, many parents agree to vaccinate against what Levy calls the most dangerous of childhood illnesses. Among them: polio, whooping cough and diphtheria. But he won't take on patients who refuse all major vaccines. The risk is too great for his other patients, he said.
Just three weeks ago, he said, he had a child come in with a case of mumps. Recently, other patients came down with whooping cough and chickenpox. "I fear we're going to see much more serious diseases," he said.
The federal Centers for Disease Control and Prevention reported in 2008 that the rate of measles had reached a 12-year high, with as many as 131 cases in 15 states and the District of Columbia.
"In the U.S., it's about 1 to 3 in 1,000 children will die from measles, depending on the age of the child," said Halsey. "It is a very dangerous disease. I hope the retraction of this article will help gain more confidence among parents that MMR is a very safe vaccine."
But Paul A. Offit, chief of infectious diseases at Children's Hospital of Philadelphia and the author of "Autism's False Profits," which defends the safety of vaccines, said the Lancet's retraction won't be the last word on the debate. For those on the fence about the vaccine's link to autism, the retraction might increase confidence that the vaccine is safe, he said.
But for others who support Wakefield, the retraction won't change any minds.
"There are people who see him as being rejected by the mainstream, who will only see this as another reason to see him as a maverick, someone who stands up against the medical establishment and stands up for what he thinks is right," Offit said.
Indeed, vaccine skeptics have come to Wakefield's defense, including Generation Rescue, a group founded by celebrity Jenny McCarthy.
"Dr. Andrew Wakefield is perhaps this debate's greatest hero," the organization said in a statement last week. "He's a doctor who has held onto the truth, unbowed, through pressure that would break most mortals."
Last week, Wakefield defended his work, telling The Times of London: "The allegations against me and my colleagues are unfounded and unjust."
But Offit, who has been vilified by vaccine opponents, said Wakefield's work has caused nothing but harm.
Dr. Gary Goldstein, president and chief executive of Baltimore's Kennedy Krieger Institute, which specializes in children's developmental disabilities, said after Wakefield's article appeared, the field of autism research was flooded with studies testing his hypothesis, including a 2004 analysis by the Institute of Medicine that refuted it. After all, if vaccines were the preventable cause of autism, the public health impact would be huge, he said.
But those efforts took attention away from research trying to unlock autism's true causes, he said.
"If we are researching if there are environmental triggers for autism, I think it's fine to have vaccines on that list. But why are we picking on that one out of the 40,000 other things that might be at play?"
Some who have autism say they were pleased with the Lancet's actions. Paula C. Durbin-Westby said it may put an end to the constant questions she gets about what vaccines she had as a child growing up in Maryland.
She did not receive the MMR vaccine, and doesn't much care what caused her autism anyway.
She's more interested in making sure those with autism are treated properly. As a member of the board of the Autistic Self Advocacy Network, she works on services, education and other policies that could improve the lives of those with autism.
She said there will always be "believers" in the autism-vaccine link, but Tuesday's news may help sway a few more parents of autistic kids.
"I was born before the MMR vaccine came out, so I sort of laugh about it," she said. "People will say it was some other vaccine. ...We need to move beyond causation theories and work on pressing issues that face people on the autism spectrum."
Katie Miller, a graduate student at Maryland Institute College of Art in Baltimore, agrees. She assumes she had the MMR vaccine along with her other childhood vaccines, but doesn't believe there is a connection to her autism.
She believes the Lancet action will convince those with doubt about vaccines that they are safe.
Miller recently tried to persuade some of her students to get H1N1 vaccines. Many had seen a popular YouTube video in which a woman claimed to have contracted a rare disorder from the shot, and they didn't want to take the risk - even though swine flu was infecting millions and killing thousands.
"It really scared me that there was this 'let's not listen to science' movement," she said. "Fear of vaccines had moved beyond fear of autism into the more generic culture. I got my vaccine as soon as I could. But I think news like this will help convince people vaccines are safe. I definitely hope so."
So does Dr. Peter L. Beilenson, Howard County's health officer. He said he heard from a lot of people who were nervous about getting the swine flu vaccine, especially pregnant women and those with young children who are in the high-risk categories for flu complications.
Beilenson said most young parents don't remember the 1930s, '40s and '50s, when whooping cough, measles and other diseases were common and infected and killed millions. If enough refuse vaccines, they could return as the region's herd immunity wears off.
"They haven't seen the disastrous consequences," he said.
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