Especially since there exists significant controversy surrounding this book, as a reviewer my focus is to help the potential reader of this book understand the content rather than argue about matters that have little to nothing to do with the actual scope of this book. In reading some of the reviews here, as well as the great amount of comments that have been submitted in response to these reviews (especially shortly after book release), it is apparent that some have not actually read this book, and the reader of this review can rest assured that this reviewer has read the entire content (an action which is aligned with his consistent policy to do so prior to submitting any review).
In pursuing possible links between childhood vaccines, intestinal inflammation, and neurologic injury in children, these events concluded with Wakefield losing his position in the Department of Medicine at London's Royal Free Hospital as well as his license to practice medicine in the UK. Because of the complexity of the events leading up to these ends, it is difficult for any review of this size to give this book justice. The first chapter discusses the original paper written by physicians (among them Wakefield) at the Royal Free Hospital and subsequently published in "The Lancet" (the self-described "world's leading general medical journal and specialty journals in Oncology, Neurology and Infectious Diseases") in 1998 entitled "Ileal lymphoid nodular hyperplasia, non-specific colitis and pervasive developmental disorder in children".
This paper discussed "clinical findings in 12 children with an autistic spectrum disorder (ASD) occurring in association with a mild-to-moderate inflammation of the large intestine...accompanied by swelling of the lymph glands in the intestinal lining...predominantly in the last part of the small intestine". At the same time, parents of 9 (8 in the original paper) of the 12 ended up indicating that onset of ASD symptoms occurred following exposure to the measles, mumps, and rubella (MMR) vaccine. As explained by the author, the seemingly small number of 12 reflects the nature of a "case series", of which this original paper was the first. Wakefield sites Hennekens and Buring's "Epidemiology in Medicine" explanation of case series - "the experience of a single patient or group of patients with a similar diagnosis" that "may lead to formulation of a new hypothesis". May. The discussion continues by indicating that an analytic study can then be performed to investigate possible causal factors. The case study itself is not designed to investigate possible causality.
No hypothesis was stated in the paper, and because of this there is no hypothesis to test. The paper simply indicated that the authors "did not prove an association between measles, mumps and rubella vaccine and the syndrome described" and that "further investigations are needed to examine this syndrome and its possible relation to the vaccine". If it were not for the seriousness of this topic, the dialogue between medical school dean Zuckermann and the press, the proceedings at the General Medical Council, and the nature of many of the myths surrounding this controversy and the resultant misinformation that has resulted would be rather amusing. Wakefield is very exhaustive in his presentation, so be prepared for one of the most dense texts written for a general audience that you have ever read. While some portions of the text can be difficult to follow at times, the common themes that run throughout enable readability.
In addition to a thorough discussion of the original case series paper, the children involved in the case series paper, the effort to terminate vaccine safety research, the press briefing following case series paper publication, the events surrounding the distancing of the editor and the other authors from the case series paper, and the General Medical Council (GMC) proceedings, Wakefield provides pertinent historical information in the concluding chapters of this book that might be of interest to some readers, especially since context can help provide additional perspective to a topic that has increasingly become more controversial in recent years due to the apparent increase in autism, the desire to discover causes in order that autism might be treated, and the conflicts of interest that reside within and between some of the parties involved in this debate.
While the author provides a historical backdrop throughout this book, it is not until chapter nine that he discusses to any significant degree events prior to the last 15 years. This reviewer paused when he read the first sentence of the tenth chapter, where the author stated that he has "often wondered where autism might be today had it not fallen into the hands of child psychiatrists". While a new syndrome, "dementia infantilis", later called Childhood Disintegrative Disorder (CDD), was described in 1908 within the "Journal for Research and Treatment of Juvenile Feeblemindedness", it was not until 1943 that child psychiatrists first laid claim to autism (and readers may recall recent reports in the media that indicate ASD will continue to be listed in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5) set to be published in a couple years).
Wakefield also provides an examination of the diagnosis process, urging alongside other researchers to standardize studies on comprehensive neurological and medical investigation, because autism rates cannot be compared across studies without regard to statistical sample or comprehensiveness. In the words of Wakefield, "it took a group of gastroenterologists to recognize the significance of these symptoms, not through some preternatural wisdom, but through the diligent application of their training. A new syndrome was described and the findings replicated around the world. Erasure from the Medical Register is a small price to pay for the privilege of working with affected families".
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