Emotive and controversial issue that splits medical profession

THE possibility that the childhood vaccination programme may be causing damage or disease in some children is one of the most emotive in medicine. It highlights the tension between public health doctors seeking the best for whole populations and clinical physicians trying to do their best for each patient.

Dr Andrew Wakefield, a gastro-enterologist who has conducted research in the field for a decade, is driven by the belief that casualties of the vaccination programme must be recognised and supported.

He said yesterday: "It is a moral issue with me. If there are children who are damaged by these preventive measures they have to be listened to, investigated and treated. I know it makes it difficult for the public health doctors [promoting vaccination] but there is nothing to be done about it."

Professor Arie Zuckerman, dean of the Royal Free and a virologist, who chaired yesterday's press conference but was not a member of the research team, takes the opposite view and upbraided his colleagues for failing to emphasise the dangers of measles and the protective benefits of vaccination. "Hundreds of millions of doses of these vaccines have been given world- wide, both separately and in combination, and they have been shown to be safe," he said.

The work of the Royal Free team remains controversial within the scientific community. Their 1994 study linking measles infection with Crohn's disease, also published in the Lancet, was criticised in a review of research in the British Medical Journal in January which declared the hypothesis dead.

When the latest paper was received by the Lancet last August it was sent to four experts for peer review, and was discussed by the editorial committee on three occasions. Critics said it should not be published because it was based on a small sample of patients attracted to a hospital department known to have an interest in their condition.

The Department of Health said last night that there would be no alteration to the vaccination programme. The Committee on Safety of Medicines and the Joint Committee on Vaccination and Immunisation had kept in close touch with the work at the Royal Free and neither had advised any change.