Clifford G. Miller,
Lawyer, graduate physicist, former sometime University examining lecturer in law

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Dear Dr Godlee,

I wonder if you would be so kind, in your capacity as the new BMJ editor, as to answer the following queries, especially in the light of the title of the BMJ Editorial this week "Has the UK government lost the battle over MMR?" (1)

I appreciate that the BMJ, as the official journal of the BMA, will never be as authoritative as a truly independent journal. However, it is as important for the medical profession as it is for the public that one of the professions' own journals takes pains to publish accurate balanced reports.

There appears to be a policy in the BMJ of reporting stories stating there is no MMR/autism link, but never the converse, even when those prior reported stories are shown to be incorrect. I was wondering why that is and whether you have any proposals for dealing with the matter?

Another example is that when the BMJ reports on each new MMR epidemiology paper it never seems to mention that the epidemiology is not relevant to the MMR/autism debate. I was wondering whether the BMJ has any proposals to correct this in future? Further, whilst all government epidemiology so far has been shown to be flawed, the BMJ never reports that. I was wondering why this is and whether we are likely to see any change in the future?

Further, the public and the profession are constantly being told there is a large body of scientific evidence that shows MMR does not cause autism. A recent example is the statement in the current Nursing Times MMR confidence poll and there are similar examples in the BMJ:-
"Despite new and overwhelming evidence that the measles, mumps and rubella (MMR) vaccine is not linked to autism, public confidence in childhood immunisation is low with take-up rates below recommended levels.

Do you think nurses should be doing more to boost confidence in immunisation?"

However, that general proposition is simply not true, as I set out below. This is not just because epidemiology is only a form of statistics and not a science. Nor is it just because epidemiology is always approximate and error prone.

As the new BMJ editor, do you have any proposals for ensuring the BMJ balances statements of such a nature?

This is particularly important in the light of comments made to me this week by a well known media medical commentator. It was explained to me that in conversations following a recent lecture to an audience comprising many epidemiologists, the topic of Wakefield was broached and 'there were many heads nodding in agreement' that Wakefield is right.

The evidence continues to build to support that proposition and the epidemiology continues to fall but the BMJ reports neither fact. I was wondering why that is? For example, and whilst it is unlikely on current form the BMJ will report the matter, there are fatal flaws in the recent Honda, Rutter et al paper published last week which not only make it wholly invalid, but which are powerful indicators the facts reported support the exact converse proposition, viz that MMR and other vaccinations are a cause of autism. This is apart from the fact this well trumpeted Japanese paper is curiously co-authored by a UK based author and psychiatrist Sir Michael Rutter.

Additionally, yet another peer reviewed paper is to be published reporting the replication of the Wakefield findings. Will that be reported in the BMJ?

Regarding epidemiology, it is well known:-
  • when the epidemiology is inaccurate it cannot prove a large number of cases are not caused by MMR
    • this is precisely the situation that exists with MMR,
    • do you not agree it is inexplicable that the pro MMR lobby can only produce epidemiology?
  • there is no accurate epidemiology
    • eg. see the bizarrely inappropriate confidence interval of the now discredited Jewel in the Crown, Madsen
  • even the most highly accurate epidemiology cannot prove a small number of cases are not caused by MMR
    • to be so accurate
      • the data used must be standardised and accurate
      • none of the databases so far used are
      • the methods employed in analysis must be scrupulously accurate
      • it would seem that also does not apply
All this is so whilst standard government practice, science, and pharmacology is being deliberately ignored:-
  • textbook adverse drug reaction assessment is clinical
  • epidemiology is not mentioned in the textbooks as part of such assessment
    • this is logical because population studies tell us nothing about the individual case
    • no standard ADR assessments have been carried out on any of the MMR children even though they are plainly Adverse Drug Reaction victims
How it the BMJ going to handle this matter as the evidence mounts up?

I also find it difficult to reconcile with medical ethics the general approach of the medical profession to espouse wholesale vaccination when, as the example of mumps as a generally benign childhood illness shows, this is an unnecessary invasive medical procedure with adverse effects which are not properly understood qualitatively and particularly not quantitatively. The principal beneficiary of mumps vaccination becomes clearer when the phrase 'significant public health burden' is used. Viz, this is a health service cost issue - it being less burdensome to vaccinate than visits to GPs when there are outbreaks. At the same time, we have no long term vaccination safety studies and adverse vaccine reactions seem to largely go unreported by the profession.

Concerning postings to Rapid Responses, it has been brought to my attention that the BMJ appears to allow sometimes somewhat Bohemian, sometimes bizarre and often ad hominem postings to personally attack those who attempt, against the odds, to put the facts to the profession. How does the BMJ account for that? Such postings seem to me to be likely to disrupt and devalue the contributions of others to the discussions in point and are likely to deter serious readers from taking any of the postings concerned seriously.

I was wondering what action might be taken to address that issue also.

I would appreciate your kind attention to these matters, albeit I appreciate you must be busy with your new rôle.

Yours sincerely,

Clifford G Miller
email: bmj050311"insert @ sign"
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1) BMJ 2005;330:552-553 (12 March), doi:10.1136/bmj.330.7491.552

Competing interests: Close relative with life threatening food allergy.