MMR and Autism: What Parents Need to Know, by Michael Fitzpatrick. London and New York: Routledge, 2004, 176 pp.

Don't let the title fool you: This devastating volume by London-based GP Michael Fitzpatrick is not yet another product of the scaremongering industry that has grown up around the "MMR/Autism" industry since Andrew Wakefield's infamous Lancet article in 1998.

To the contrary, Dr. Fitzpatrick has produced a meticulous, blow-by-blow account of the Wakefield story and the resulting harm done to the universal immunization program in the U.K.

For those readers of Flea unfamiliar with the Wakefield debacle, journalist Brian Deer provides the best on-line summary. For those like Flea who are familiar with the story but who do not happen to be British, Fitzpatrick provides an invaluable description of the social and cultural context in the U.K. that provided the background for the MMR scare.

One important piece of social context turns out to be the "Mad Cow" scandal of the 1990's. Few outside the U.K. realize the magnitude of the impact that Mad Cow had on the British public. Fitzpatrick credits public anger over Mad Cow and its handling by the Conservative government as a key factor in Tony Blair's Labour Party landslide victory in 1997.

In the wake of Mad Cow (which, Fitzpatrick argues contrary to popular opinion, the Tory ministers handled quite well), public distrust at government especially on matters of health was at low ebb in 1998. "Maverick" doctors such as Andrew Wakefield received a respectful hearing from a disgusted public. The lay press, with few exeptions, provided a willing and enthusiastic sounding board for Dr. Wakefield.

At the same time, the British public health apparatus found itself in the grip of what we would call in the U.S. the "patient empowerment" movement. The expert opinion of patients (or in the case of autism, of parents) became priveleged over that of the erstwhile experts, doctors and scientists. Coincident with the rise of the internet, the firestorm over MMR, and its presumed causal link to autism, could not be extinguished. MMR coverage rates fell sharply, especially in inner-city London.

Fitzpatrick then meticulously tears apart the "evidence" linking MMR to autism; but he doesn't stop there. He then throws the broken shards of the argument to the floor and jumps up and down on them a few times. Finally, Fitzpatrick offers a careful, nuanced account of the motivations that might have driven Andrew Wakefield, an ostensibly sane pediatric gastroenterologist, off the deep end.

Dr. Fitzpatrick's title delivers what it promises: everything parents need to know about the relationship between MMR and autism. In short, there is none.

There are a few shortcomings worth mentioning: Though aimed at parents, the argumentation is too dense and difficult to follow for the lay reader. The college-educated mom who recommended the book to Flea admitted to having a fair amount of difficulty understanding it. Flea fears that Fitzpatrick and his editors got carried away and forgot their audience!

There are also a few minor editorial gaffes that produced some amusing effects. For example, Fitzpatrick writes that the DTaP vaccine is given at 2, 4, and 6 weeks of age. That should read months, not weeks. No wonder the anti-vax folks are up in arms! There is also a section where Fitzpatrick becomes suddenly and inexplicably enamored of the word "scope". Happily, the affliction is brief in scope.

On the plus side, Fitzpatrick provides the best discussion Flea has yet seen of the relative risks and benefits of MMR. This is precisely the kind of argument that Flea's parents are asking for. Fitzpatrick quotes a length the work of Paul Offit, who demolishes the argument that early multiple vaccination somehow "overwhelms" the infant immune system. Offit is quoted as observing that infants could probably handle the introduction of antigens from 10,000 vaccines at a time without suffering any ill effect.

Finally, you have to love a man who closes his book with a quote from Stevie Wonder:

When you believe in things that you don't understand,
Then you suffer.
Superstition ain't the way.

Stevie knows! Flea's only worry is that the folks won't understand or believe Fitzpatrick's book. But he'll take "MMR and Autism" over superstition any day.