The Lancet Retracts the MMR Paper
In a historic act, on 2 February 2010, The Lancet
retracted the 1998 paper by Andrew Whitfield, et al. which had
proposed the controversial link between the MMR vaccine and autism. The
paper "Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and
pervasive developmental disorder in children" was based on data from 12
children with developmental disabilities in whom bowel symptoms,
colonoscopy and biopsy findings were described and suggested further
studies to prove a link between MMR vaccine and autism. In a press
conference before the paper was published, Whitfield said it would be
prudent to use single vaccines rather than the combined vaccine of MMR
till further proof was available.
The indiscriminate media orgy which followed resulted
in sharp drop in vaccination in the UK and Ireland, and subsequent rise in
measles and mumps cases - some culminating in significant morbidity and
mortality. In 2004, the investigative reporter Brian Deer introduced a
fresh angle and disclosed that Whitfield had been paid £55,000 by a group
of solicitors who were seeking evidence against vaccine manufacturers.
Many of the parents of the children in his study were also found to have
been litigants. Whitfield himself had applied for a patent on a vaccine
which was a rival of the MMR vaccine. Lack of disclosure of these facts to
the journal at the time of publication was taken extremely seriously.
The case was then taken up by the General Medical
Council (GMC) of Britain, which is responsible for licensing doctors and
supervising medical ethics. The GMC has found Dr Whitfield guilty on many
charges including having acted "dishonestly and irresponsibly", showing
"callous disregard" for the children involved in his study, conducting
unnecessary and invasive tests including colonoscopies and lumbar
punctures, lack of ethics committee clearance and having conflicts of
interest.
Of the 13 original authors, 10 have later retracted the
interpretation of the study and subsequent research round the world has
failed to prove the link between MMR and autism. The risks of giving
academic credence to aleatory associations of diseases with something like
vaccinations can be catastrophic (The Lancet, 2 February, 2010, BMJ
2010; 340: c696).
Preserving Fertility in Children with Cancer
Survival rates in childhood cancers have improved
dramatically from 58% to 81% between 1975 and 2005, according to
statistics from the National Cancer Institute, USA. But on the flip side,
a significant proportion of patients are subfertile. Options so far had
included freezing ova or embryos till therapy was complete and subsequent
IVF and implantation. However drugs used to induce ovulation may sometimes
accelerate hormone responsive tumors and may be ineffective in
prepubescent girls. Hence, a new technique of removing one ovary is now
being proposed. The ovary is removed endoscopically, cut into pieces and
frozen at –300° C by a process called vitrification. When desired, the
ovary can be thawed and then surgically implanted into the other ovary or
ligament. This allows the woman to conceive naturally.
Two scientists from Scotland, Wallace and Kelsey have
also developed a mathematical model of ovarian reserve from conception to
menopause. They are trying to use it to predict which dose of cancer
therapy may lead to loss of fertility. These may help to identify
potential candidates for ovary freezing. According to them, the ovarian
reserve of a 30 year old is 12 % of original capacity and falls to 3% by
age 40. Hence women who are delaying childbirth due to career demands or
lack of a partner may also consider this procedure (Scientific
American, 3 February, 2010).
The Indian Barefoot Doctor
The Medical Council of India (MCI) and the Union Health
Ministry have proposed a 4 year new course – Bachelor in Rural Medicine
and Surgery. This initiative comes in the wake of failure of multiple
attempts to lure medical graduates to rural areas. The MCI has also
approved the curriculum with the course to be held in two phases, the
first in a Community health facility and second in a Secondary level
hospital. The aim is to encourage students from rural areas who are
willing to live and work in rural areas rather than coercing city slickers
to do their bit for the country (The Times of India 6 February 2010).