How the case against the MMR vaccine was fixed

BMJ

Volumn 342, Issue 7788, 2011, Pages 77-82

  Deer, Brian ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

MEASLES MUMPS RUBELLA VACCINE;

AUTISM; BEHAVIOR DISORDER; COLITIS; DISEASE ASSOCIATION; ENTEROCOLITIS; FEVER; HUMAN; LAW SUIT; MEASLES; MEDICAL SCHOOL; MOUTH ULCER; MUMPS; PAIN; PRIORITY JOURNAL; PUBLIC HEALTH; REVIEW; RUBELLA; UNITED KINGDOM; WEIGHT REDUCTION;

AUTISTIC DISORDER; CHILD; CONFLICT OF INTEREST; DATA COLLECTION; HUMANS; JURISPRUDENCE; MEASLES-MUMPS-RUBELLA VACCINE; SCIENTIFIC MISCONDUCT;

EID: 78651383689     PISSN: None     EISSN: 17561833     Source Type: Journal    
DOI: 10.1136/bmj.c5347     Document Type: Review

References (132)

1. Wakefield AJ, Murch SH, Anthony A, Linnell, Casson DM, Malik M, et al. Ileal lymphoid nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998;351:637-41 [retracted].
2. Editors of the Lancet. Retraction: ileal lymphoid nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 2010;375:445.
3. One child, child 5, was admitted without any developmental diagnosis, but was in treatment for epilepsy.
4. Although the paper makes clear that the research did not prove an association between MMR and the purported syndrome, it describes its table 2 as summarising "the apparent precipitating events; onset of behavioural features; and age of onset of both behaviour and bowel symptoms."
5. David Casson. Discharge summary. 21 May 1997.
6. Although Wakefield and the Lancet would later claim that the Legal Aid Board commissioned a quite separate "viral" study, the work specified in the documents submitted to the Legal Aid Board, seeking funding, on 6 June 1996, included clinical examination, ilecolonoscopy, histology, immunohistochemistry and molecular analysis for measles virus, neuropsychiatric studies, MRI brain scan, lumbar puncture, EEG and evoked potentials, B12 studies, modified Schilling test, and various blood and urine tests. The document includes costings, such as £1750 for colonoscopy with four night's stay, £1000 for MRI scans, and £1400 for medical reports. Molecular, immunohistochemical, and electron microscopic analysis of tissues was priced at £500 per child. Named investigators for the legal project who would also be authors of the Lancet paper were Andrew Wakefield, John Walker-Smith, Simon Murch, David Casson, Amar Dhillon, John Linnell, Mark Berelowitz, and Peter Harvey. The document states: "The objective is to seek evidence which will be acceptable in a court of law of the causative connection between either the mumps, measles and rubella vaccine or the measles/rubella vaccine and certain conditions which have been reported with considerable frequency by families of children who are seeking compensation. It is hoped that using the testing protocol attached it will be possible to establish the causal link between the administration of the vaccines and the conditions outlined in this proposed protocol and costing proposal." The board commissioned the project under an "authority to do contract work," naming Wakefield, issued on 22 August 1996. The technical specification is materially identical to a protocol submitted for approval by the Royal Free's ethics committee, and the work to be performed is materially identical to the study submitted by Wakefield to the Lancet, with data sliced into two paired papers, which were peer reviewed together. One was published on 28 February 1998, and the other was rejected by the journal.
7. MMR and MR Vaccine Litigation Sayers and others v Smithkline Beecham plc and others - [2007] All ER (D) 30 (Jun).
8. Although some of his professional colleagues have admitted awareness of a relationship between Wakefield and the lawyer, his co-authors have denied any knowledge that he was contractually employed and funded by Barr. For example, in an email dated 27 February 2004, Walker-Smith wrote: "No financial details of Andy's work was ever discussed with me by anyone and I was totally unaware of the grant of £55,000 that had been paid to him in an NHS Trust Fund, until Deer told me to my astonishment in December 2003." Also in February 2004, John O'Leary, a Wakefield research collaborator and business partner, issued a statement to Deer, through lawyers: "We were not made aware, nor were we aware, of any liaison between Dr Wakefield and Mr Richard Barr of Alexander Harris Solicitors that apparently existed since 1996. In addition, we had never been informed that the LSC [the Legal Services Commission, successor to the Legal Aid Board] had funded Dr Wakefield."
9. Deer B. MMR doctor given legal aid thousands. Sunday Times2006 December 31. www.timesonline.co.uk/tol/news/uk/article1265373.ece/.
10. Wakefield A. Introduction to the rationale, aims and potential therapeutic implications of the investigation of children with Disintegrative disorder (regressive autism; Heller's disease and intestinal symptomatology." (Document issued by Wakefield and mailed to doctors and parents who approached the Royal Free , dated 3 February 1997.)
11. Barr R, Wakefield A. Proposed protocol and costing proposals for testing a selected number of MR and MMR vaccinated children (and attached specification). Submitted to the Legal Aid Board 6 June 1996. [GMC fitness to practise panel hearing in the case of Wakefield, Walker-Smith and Murch. Day 11.]
12. Child 1 attended an outpatient appointment on 19 June 1996, and was admitted on 21 July 1996.
13. Barr R. Letter to the Legal Aid Board. 22 November 1996. Day 11.
14. General Medical Council. Dr Andrew Wakefield: determinations on serious professional misconduct and sanctions. 24 May 2010. Wakefield: www.gmc-uk.org/Wakefield-SPM-and-SANCTION.pdf-32595267.pdf.
15. General Medical Council. Professor John Walker-Smith: determinations on serious professional misconduct and sanctions, 24 May 2010.www.gmc-uk.org/ Professor-Walker-Smith-SPM.pdf-32595970.pdf.
16. General Medical Council. Fitness to practise panel. Findings of fact. 28 January 2010. www.gmc-uk.org/static/documents/content/Wakefield--Smith-Murch. pdf.
17. British Paediatric Association. Guidelines for the ethical conduct of medical research involving children. Bull Med Ethics 1992;80:13-20.
18. Panel findings of fact. Ten children (1, 2, 3, 5, 6, 7, 8, 9, 10, 12) were found to have been subjected to invasive investigations for research purposes without ethical approval. In seven cases (1,2,3,5,8,9,12) this was found to be contrary to the child's clinical interests..Eight children (1, 2, 3, 4, 5, 8, 9, 12) were caused to undergo colonoscopies which were not clinically indicated. Seven children (1, 2, 3, 5, 8, 9, 12) were caused to undergo barium meals and follow throughs which were not clinically indicated. Three children (3, 9, 12) were caused to undergo lumbar punctures which were not clinically indicated.
19. Interviewed by Brian Deer, both Mrs 2 and the organiser of JABS confirmed this.
20. (a) Neil Thomas. Evidence to the panel. Day 107.
21. (b) Michael Rutter. Evidence to the panel. Day 35.
22. (a) Richard Cartmel. Evidence to the panel. Day 14.
23. (b) Royal Free history taken: 2 September 1996. Day 40.
24. Buie T, Campbell DB, Fuchs GJ, Furata GT, Levy J, VandeWater J, et al. Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: a consensus report. Pediatrics 2010;125(suppl 1): s1-18.
25. Lord Justice May. Judgment in the court of appeal, London. R on the application of "H" v the Legal Services Commission. 28 February 2006.
26. Richard Cartmel. GP record. 2 November 1994. Day 14. "Nil obvious re MMR story."
27. Child 2 was born on 29 July 1988 (mother's interview with Deer; register of births), and vaccinated with MMR on 8 November 1989 (GP records. Day 14)
28. (a) David Casson. Discharge summary. 16 September 1996. Day 24. "Mum notes a normal developmental progress. Mum does recount that at 13 months of age he had his MMR immunisation and two weeks following this had started with head banging behaviour and screaming throughout the night. Subsequently seemed generally sickly but nevertheless the main changes appeared to have stemmed from the age of 20 months when he started losing words and became hyperactive and stopped recognising people and responding normally." The summary, like the Lancet paper, gives a wrong age (13 months) for child 2's vaccination, taken from the mother by Mark Berelowitz.
29. (b) Peter Harvey. Neurology report. 9 September 1996. Day 107. "Head banging after MMR inoculation followed by progressive intellectual damage."
30. Berelowitz told the panel that the "core part" of the job to which he was appointed in 1993 was to head the paediatric liaison service, which helped children and families deal with psychological complications of severe physical illness. Day 12.
31. Panel findings of fact. Page 13.
32. Andrew Wakefield. Evidence to the panel. Day 59. "Firstly, as with all other potential referrals, the parents had made contact with me and had described their child's problems as they perceived them..." In some cases, he sent them documents setting out his theories and plans. Day 59. Although an academic researcher with no clinical duties, Wakefield was anxious to talk with parents before referral. For example, he wrote to family of child 4. Day 51. "Thank you very much for your letter regarding your son. I would be very grateful if you could phone me or my secretary with your telephone number so that we can discuss this directly." He wrote to the parents of child 12. Day 42. "It will be necessary for me to discuss the nature of the referral with your GP and I would be grateful if you could let me have his/her name, telephone number. Also could you please let me have your telephone number so that I can speak to you directly on the subject."
33. Deer B. Revealed: Undisclosed payments to Andrew Wakefield at the heart of vaccine alarm. http://briandeer.com/wakefield/legal-aid.htm
34. Deer B. Revealed: MMR research scandal. Sunday Times 2004; Feb 22. www.timesonline.co.uk/tol/life-and-style/health/article1027636.ece.
35. The GMC panel examined records for all of the Lancet children except child 11. It also examined the records of an additional patient, child JS, a Barr client who was denied by his paediatrician enrolment into the study, despite repeated requests from Wakefield and Walker-Smith. This boy was later admitted as a private patient and became a lead claimant, alongside child 2, in the lawsuit.
36. Sylvia Dean, lay member; Wendy Golding, lay member; Surendra Kumar, GP (chair); Parimala Moodley, psychiatrist; Stephen Webster, geriatrician.
37. Kieran Coonan QC for Wakefield. Stephen Miller QC for Walker-Smith. Adrian Hopkins QC for Simon Murch. Sally Smith QC appeared for the GMC. The independent legal assessor, advising the panel, was Nigel Seed QC.
38. The third defendant was Simon Murch, at the time of these events consultant paediatric gastroenterologist at the Royal Free, and now professor of medicine at Warwick University. On 28 January 2010, Day 197, he was found to have misled the Royal Free's ethics committee, acted contrary to the clinical interests of children, and failed in his duties as a responsible consultant. On 24 May 2010, Day 217, the panel noted that Murch's involvement with the project was "subsidiary to and more limited" than Wakefield's and Walker-Smith's, that he had shown insight into his conduct, and had "demonstrated errors of judgment but had acted in good faith". He was acquitted of serious professional misconduct.
39. Deer B. MMR doctor fixed data on autism. Sunday Times2009 Feb 8. www.timesonline.co.uk/tol/life-and-style/health/article5683671.ece.
40. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. 1994.
41. Andrew Wakefield. Evidence to the panel. (a) Day 49. "Q: What did you understand that phrase to mean, 'pilot study'? A: This refers specifically and exclusively to the Legal Aid Board pilot study. That is, the investigation of five children with Crohn's disease and five children with regressive autism and gastrointestinal symptoms." (b) Day 52. "Q: The second aspect concerns the second box down, which is noted 'Diagnosis' and you see what you have written there: 'Regressive autism + ? inflammatory bowel disease'. Again, what did you intend to convey by using that expression on this document? A: Based upon my understanding at the time, that was the likely diagnosis in this child."
42. Mr Justice Bell. Judgment in the high court, London. Paul Sayers & Ors v SmithKline Beecham & Ors. 19 December 2001. "The mechanisms all take their point of departure from the demonstrated persistence of measles virus in the body of children with regressive autism."
43. Andrew Wakefield. Evidence to the House of Representatives committee on government reform. 25-6 April 2001.
44. Michael Rutter. Evidence to the panel. Day 37. Day 39.
45. Dr N. GP records. Day 6.
46. Dr N. GP note. 18 March 1993. Day 6. The record says child 6 received MMR on 15 June 1993.
47. John Trounce. Report. June 1995. Day 6. Child 7 received MMR on 24 November 1995.
48. John Walker-Smith. Letter to Andrew Wakefield. 4 October 1996. Day 41.
49. Filipek PA. Autistic Spectrum Disorders. In Swaiman KF, Ashwal S. Pediatric neurology: principles and practice. 3rd ed. Mosby, 1999.
50. Panel findings of fact. Page 25.
51. Panel findings of fact. Page 93.
52. Repeated, multiple comparisons between Casson's documentation shows an exceptional degree of concordance with clinical records generated by consultants.
53. David Casson. Letter to Sian Bennett. May 1997. Day 102.
54. John Walker-Smith. Outpatient history, taken from the mother. 2 October 1996. Day 41. "He had behaviour changes within a week, although the mother has only relatively recently associated the change of behaviour with MMR."
55. Andrew Wakefield. Letter to Mrs 12. 19 July 1996. Day 28. "Thank you for your letter regarding your son. We have recently taken a profound interest in this subject, particularly in view of the link between bowel problems and Asperger's Syndrome. I would greatly appreciate if you would mind calling me at the Royal Free before 3rd August and in addition I would like you to seek a referral from your GP to Professor John Walker-Smith, Professor of Paediatric Gastroenterology at the Royal Free Hospital, for investigation."
56. Gillian Baird, at the Newcomen Centre, Guy's hospital. September 1996. Day 36.
57. Panel findings of fact. Page 34.
58. Michael Rutter, an expert witness for the GMC, said that there was "no evidence that I could identify" in the child's records indicating any significant regressive element in his disorder. Day 36.
59. Mrs 12. Evidence to the panel. Day 28.
60. Richard Barr. Letter to Mrs 12. 14 August 1996. Day 28.
61. Mrs 2 ran Allergy-induced Autism, a since-disbanded national group.
62. Panel findings of fact. Page 22 (child 4); page 37 (child 8).
63. An academic pharmacist in Sunderland, England, and JABS.
64. "We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers." This claim was retracted by 10 of the 13 authors in March 2004. (Murch SH, Anthony A, Casson DH, Malik M, Berelowitz M, Dhillon AP, et al. Retraction of an interpretation. Lancet 2004;363:750.)
65. Dr Steel. Letter to Dr Sendall. 19 May 1988. Day 6 and Day 36.
66. William Tapsell. GP records. Day 6.
67. Dr Jackson. Letter to health visitor. 1988. Day 6.
68. ENT surgeon. Day 36. "At the age of two years and one month he apparently has a few single words only. He does not seem able to communicate his needs to his mother... Obviously I am more concerned about his increasingly apparent general delay. Mum was asking about this and although initially denying any problem, is obviously concealing quite deep seated worries about him being 'backward'."
69. Government vaccine damage payments unit. Request for information. 18 September 1995. Day 36.
70. Consultant geneticist letter. Day 6. "We are not sure whether this deletion is significant at all and certainly there is a very high possibility that it has nothing to do with [child 4's] autism."
71. Consultant to consultant letter. Day 6.
72. William Tapsfield. Referral letter to Wakefield. 1 July 1996. Day 41.
73. Panel findings of fact. Page 4.
74. Wheldon Houlsby. Letter to Neela Shabde. 17 February 1995. Day 29. "I was asked to see [Child 8] last year when there was concern about her development generally. When I saw her in clinic at the age of 10 1/2 months I discovered that she had a coarctation, and referred her to the paediatric cardiologists. This was repaired surgically, and she is now well from this point of view. However concern about her development persists."
75. For reference, according to Medline Plus, from the US National Library of Medicine and the National Institutes of Health, the typical 18 month old "Can say 10 or more words when asked". According to the Early Identification of Developmental Delay and Disability project, funded by the state of California, at age 15 months, a child typically "uses 4-6 words", and at 16-18 months "uses 7-20 words".
76. Michael Rutter. Evidence to the panel. Day 37. "It is the kind of account that one often gets with an autism spectrum disorder. The fact that the child had only two to three words would make one uncertain as to whether this is a true bill or not, in that that is a very small amount of language to lose, but this is the kind of thing that one often sees so that the picture that comes out of all of these records is of a developmental problem that began early, involves language, involves some autistic-like features, quite a lot of hyperactivity, so that there does not seem much doubt that there was some sort of pervasive developmental disorder that could be regarded as falling on the autism spectrum at an earlier point."
77. Diana Jelley. Referral letter to Wakefield. 3 October 1996. Day 29.
78. Diana Jelley. Note of a telephone call from Mrs 8. 30 September 1996. Day 29.
79. Andrea Barrow. Referral letter to Walker-Smith. 17 May 1996. Day 5.
80. Andrea Barrow. GP record. 4 November 1993. Day 5.
81. Hospital record. 23 October 1996. Day 36.
82. Child 1 was born on 14 January 1993 and received MMR on 19 January 1994.
83. Anthea Barrow. Referral letter. 17 May 1996. "Mr & Mrs 1's most recent concern is that the MMR vaccination given to their son may be responsible for the autism." Day 5.
84. John Walker-Smith. Letter to Wakefield. 21 June 1996. Day 36.
85. John Walker-Smith. Letter Andrea Barrow. 21 June 1996. Day 77. Day 102.
86. David Casson. Child 1 admission clerking note. 21 July 1996. Day 24.
87. David Casson. Child 1 discharge summary. 9 August 1996. Day 24.
88. Patent Office. Pharmaceutical composition for regressive behavioural disease. UK patent GB 2 325 856 A. Priority date 6 June 1997. Publication date 9 December 1998.
89. Child 5 was born on 10 December 1988 and received MMR on 10 April 1990.
90. Geoffrey Shillam. GP records. 24 November 1989. Day 11.
91. Dr Williams. Letter to Dr Wilkinson. January 1992. Day 11. Day 36. "At one year he had convulsions which led to a further hospital admission but these appear to have been due to a high fever. From then on his parents noticed a difference in his development and feel that these febrile epileptic seizures continue to the present day... At 10 months of age he was saying mummy and daddy but then became very miserable and appeared to lose ground in his development after he had been in hospital."
92. Child 9 was born on 11 June 1990 and received MMR in October 1991.
93. Mohsin Malik. Discharge summary. 14 January 1997. Reported in the first statement of Clifford Spratt. Day 23.
94. Trevor Hopkins. GP records. Day 5.
95. (a) Peter Harvey. Neurology record. 5 December 1996. Day 64. "No doubt about relationship with MMR at onset. No doubt of normal earlier development... Parents have no doubt about the relationship with MMR."
96. (b) David Casson. Discharge summary. 6 December 1996. Day 24. "His parents feel that the onset of his neurodevelopmental symptoms stems from the period two months after having had the MMR vaccination which he received on the 10 April 1990. A few months subsequent to this he started losing his skills."
97. Mohsin Malik. Discharge letter. 14 January 1997. Reported in the first statement of Clifford Spratt. Day 23. Spratt said: "The letter also informed me that [child 9]'s mother linked his mental regression at age 18-20 months to MMR which he was given at 16 months of age."
98. Andrew Wakefield. Royal Free form, ordering tests. Day 61. Day 36. "Autistic spectrum disorder and bowel disorder after MMR".
99. Note also: (a) Legal aid certificate to sue the vaccine's manufacturer issued 9 October 1996, prior to a first outpatient clinic dated 18 October.
100. (b) Mary Stuart. GP record. 25 July 1996. "Call from Dr Wakefield. Needs colonoscopy B12 absorption tests. History of measles vaccination reaction." Day 7. Day 64.
101. Mrs 12. Evidence to the panel. Day 28.
102. Dawbarns. Newsletter. February 1996. Day 37. Day 58.
103. The first referral letter for any child in the Lancet series - child 3 - was dated 19 February 1996.
104. Andrew Wakefield. Evidence to the panel. Day 66. "Q: What I am suggesting to you and what I now want to ask you is where you make it clear that the children had come to the Royal Free in the first place, at least in the majority of cases, in the letters that we have looked at, because their parents, or in some cases their doctor through their parents, thought that MMR might have caused the damage? A: That is implicit to anyone reading this paper. When we talk in the discussion about a possibility of a referral, selection bias, in a self-referred group, the group is self-referred because of the symptoms manifest by the children, including the history of a possible exposure to a vaccine or an infection that has led to the problem, and then seeking help from a specific unit. That is explicitly what self-referral means. Inherent in that is, to the reader, those elements of the history of the patient that have caused them to come to that unit. To anyone reading this, we would have considered that to be self-evident. Self-referral on the basis of one or more of the symptoms of gastrointestinal problems, developmental regression and an association with environmental exposure... Q: I asked you why you did not make it clear, as we have seen from the letters that we looked at yesterday, that, at least in the vast majority of cases, these children came in the first place because their parents thought that MMR had caused that condition. You immediately to go a line where you talk about self-referral, but that particular reference does not include the very point that I am asking about, and you say is implicit, namely the association with MMR. How does any reader, whether a scientist, doctor or otherwise, read that into what you say there? A: The patients, children, are self-referred based on their symptoms and their history. That contains the three key elements of an environmental exposure, gastrointestinal problems and developmental regression. That self-referral encapsulates those three elements. That is, I would have thought, evident to any reader."
105. Deer B. It's all change as MMR paper reveals key differences from published Lancet study. http://briandeer.com/mmr/lancet-versions.htm
106. Patent Office. Filing receipt. 6 June 1997, published at Deer B. Revealed: the first Wakefield MMR patent describes "safer measles vaccine". http://briandeer.com/wakefield/vaccine-patent.htm
107. Child 3 was born on 1 January 1990 and received MMR on 1 March 1991.
108. Ajjegowda Shantha. Evidence to the panel. Day 5. "Q: I think the first record of any parental concern in relation to development was when child 3 was 2 1/2 in June 1992... A: Yes."
109. John Walker-Smith. Letter to Ajjegowda Shantha. 4 April 1996. Day 5.
110. Lewis Rosenbloom. Letter to Dr Oppenheim. "The mother's main concerns are [child 3's] lack of speech." GP records. Day 5.
111. Mr and Mrs 3. Letter to Lewis Rosenbloom. August 1994. Day 36.
112. The family reapplied through Barr, and were granted legal aid.
113. Child 3's development was plainly delayed from at least a very early point. A consultant letter, written in December 1992, when the boy was almost 3 years old, summarised the history. "He walked at 13 months of age and used 2-3 words of speech until he was 18 months when this left him. He now has lots of unintelligible babble and appears to understand at one word level." Day 36.
114. Although, in addition to making a legal claim, they also made a claim to the government's vaccine damage payments unit, prior to referral. Day 36.
115. (a) Ajjegowda Shantha. GP records and evidence to the panel. Day 5.
116. (b) John Walker-Smith. Evidence to the panel. Day 91.
117. Murch S, Thomson M, Walker-Smith J. Author's reply [letter]. Lancet 1998;351:908.
118. Squires RH and Colletti RB, Indications for pediatric gastrointestinal endoscopy: A medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition. Journal of Pediatric Gastroenterology and Nutrition1996; 23: 107-110.
119. Ian Booth. Evidence to the panel. Day 41. "Looking for inflammatory bowel disease would be a most unusual way of approaching a patient with severe, long-standing constipation."
120. Afzal N, Murch S, Thirrupathy K, Berger L, Fagbemi A, Heuschkel R. Constipation with acquired megarectum in children with autism. Pediatrics 2003;112:939-42
121. Deer B. Wakefield MMR-autism sign was recognized for years: as benign finding in children. http://briandeer.com/wakefield/ileal-hyperplasia.htm
122. Turunen S, Karttonen TJ, Kokkonen J. Lymphoid nodular hyperplasia and cow's milk hypersensitivity in children with chronic constipation. Journal of Pediatrics 2004;145:606-11.
123. Deer B. Wakefield's "autistic enterocolitis" under the microscope. BMJ 2010;340:838-41.
124. Panel findings of fact. Page 70.
125. Histology report for child 3. Printed 13 September 1996.
126. Walker-Smith J. Letter to Ajjegowda Shantha, with revised discharge summary. 31 December 1996. Day 5.
127. Wakefield A. Complaint to the Press Complaints Commission. March 2009 (suspended by the PCC on 10 February 2010 on grounds of non-pursuit by the complainant). http://briandeer.com/solved/wakefield-complaint.pdf
128. Deer B. Vaccine victim: Andrew Wakefield invents a bizarre conspiracy [video]. http://briandeer.com/solved/tall-story.htm
129. Profile: Andrew Wakefield , the man at the centre of the MMR scare. Times2010 May 24. http://www.timesonline.co.uk/tol/news/uk/article7135099.ece
130. Walker-Smith J. Evidence to the panel. Day 97. "We all rely on trust. I trusted Dr Wakefield."
131. California Department of Public Health. Pertussis report. 15 December 2010. www.cdph.ca.gov/programs/immunize/Documents/PertussisReport2010-12-15.pdf.
132. NBC News. A dose of controversy. Dateline NBC, with Matt Lauer. 30 August 2009, repeated and updated 30 May 2010.