Published: 22/07/2004, Volume II4, No. 5915 Page 20

Now that the scare over the MMR vaccine has been widely discredited, it is possible to identify the sorry saga's real losers, the author of a new book tells Helene Guldberg MMR and Autism

What parents need to know By Michael Fitzpatrick Published by Routledge ISBN: 0415321794£14.99

East London GP and health commentator Dr Michael Fitzpatrick's new book, MMR and Autism: what parents need to know, argues that highly dubious scientific claims about the potential damage caused by a triple vaccine have managed to throw the political and medical establishment into turmoil and knock a major UK immunisation programme off course.

Dr Fitzpatrick persuasively demolishes the key plank of the measles, mumps and rubella panic: claims of a link between the MMR vaccine and autism.

Indeed, any risks associated with the MMR vaccine are virtually non-existent. 'When 500 million doses of a vaccine have been given in 80 countries over more than 30 years, and serious adverse reactions are found to be extremely rare, then it is fair to describe it as 'safe', ' he says.

Meanwhile the case for immunisation is indisputable.

Not so long ago, Dr Fitzpatrick was better known for his involvement with left-wing politics than his interest in child immunisation. But as he explains, politics has changed a great deal since then - as has the social significance of such basic medical issues as vaccines.

'The MMR controversy is a good indicator of the changing character of politics over the past decade or so, ' he argues. 'For a generation of young parents, the question of whether to give their child MMR - or single vaccines, or no vaccines at all - has become a bigger issue than which party to vote for in the election, or indeed, whether to vote at all.'

Dr Fitzpatrick places the MMR controversy in the context of the collapse of traditional left and right politics, and the rise of a more individuated, risk-averse society. As Politics with a big P has ceased to matter so much to people, issues relating to health, lifestyle and education have assumed an increasing importance in people's lives. And as people have become more preoccupied with their own health and that of their children, the government has adopted a higher profile on health issues.

'Health policy is no longer concerned primarily with providing services, but is more directed towards provoking individual anxieties and fears about smoking, obesity and other 'unhealthy' lifestyles, and relating to people's daily health concerns through initiatives like NHS Direct, ' he says.

The key 'evidence' of a link between MMR and autism remains the work of Dr Andrew Wakefield, the high-profile gastroenterologist widely credited (and now widely discredited) as the protagonist in the MMR debate.His claims, that there was a link between the MMR vaccine and autism that was mediated by inflammatory bowel disease, were first publicised in 1998. Dr Fitzpatrick's initial response when reading the paper was sheer amazement.

'I could not believe that such an insubstantial and speculative report could have such an impact, ' he says. 'It did not provide any evidence of a link between MMR and autism.'

But he stresses that the problem cannot be reduced to Dr Wakefield's actions. 'The striking thing is that Dr Wakefield is almost universally regarded by serious scientists as someone whose work cannot be taken seriously.Yet he seems to have been very persuasive to some journalists.

'There is a great irony here, ' continues Dr Fitzpatrick. 'The anti-MMR campaign has been very successful in the media and one of its great successes has been to depict itself as being victimised and intimidated.

Whereas the opposite is true: the people who have been really victimised and intimidated are the supporters of the vaccine...' Dr Fitzpatrick has for a long time warned against the danger of using the tactic of scaremongering to promote public health. In his previous book, Tyranny of Health, he emphatically laid out his objection to public health campaigns 'that have an emphasis on moralising about people's lifestyles when the evidence for their efficacy is very dubious'.

Those public health campaigns to which he objects are distinct, he stresses, from 'public health measures which have been shown to be dramatically effective - like sanitation reform and immunisation campaigns'.

'These have been demonstrated over a very long period of time to have very palpable benefits'.

The MMR controversy has become the focus for a wider set of anxieties. 'That is what makes the issue of choice so central:

people feel they can make a choice by opting for single vaccines in a way they feel unable to with very many other things in their lives, ' explains Dr Fitzpatrick. 'At least they can say:

'Right, I am not going to do this.'

'But unfortunately the victim of that false sense of choice is their own child and other people's children. This is the sad thing - that people feel they can only exercise choice in such limited areas, where the consequences of exercising the choice has an entirely negative effect both on their children, who are left vulnerable, and other people's children, who are also left vulnerable.

'The government has made choice a central theme of health policy and this is a good example of the sort of problem it creates, ' he says. 'The object of immunisation policy is not to provide a 'pick-and-mix' selection to the public, but to provide a coherent programme for the prevention of infectious diseases.'

Book offer for HSJ subscribers HSJ has teamed up with Routledge to offer HSJ subscribers a 15 per cent discount on MMR and Autism: what parents need to know .To take advantage of this offer, e-mail your details (ideally quoting the subscriber number printed on the plastic wrapping) to nick. edwards@emap. com Helene Guldberg is managing editor of political website Spiked, where a longer version of this article first appeared. www. spiked-online. co. uk