Thinking Critically 10.3 >> UNPROFESSIONAL CONDUCT paper proposed a new syndrome with two conditions: chronic intestinal disease and the loss of behavioral skills that had already been acquired as part of normal child development. Out of 12 cases in the paper parents of eight of the children associated the behavioral problems with the administration of the MMR vaccine. While the paper clearly stated that no association between the MMR and the condition had been proved, the implication was there, and that was apparently enough to set off a media storm. Parents began to question the composition of the vaccination itself (specifically the thimerosal compound), and the jus- ulication for administration of all three vaccines in one dose at such a young age. Inevitably, many parents started to choose not to vaccinate their children. In Britain, 91 percent of age-eligible children were vaccinated in 1998. By 2004 that number had fallen to 80 percent which, doctors warned, was far below the 90 percent rate needed to keep the cepwater Horizon At the age of 14 months old, most children in North America and Europe receive a triple vaccination against three diseases: measles, mumps, and rubella (also known as German measles). Abbreviated as MMR, the vaccination has come under increased scrutiny over the past two decades for concerns over a potential link between MMR and autism (a neural disor- der affecting behavioral and cognitive skills). Concerned par- ents have become vocal advocates on both sides of the argu- ment. On one side, parents of autistic children believe that MMR, or specifically the preservative agent thimerosal (a mer- cury-containing chemical compound), causes significant intesti- nal problems and behavioral changes shortly after administra- tion of the vaccination. On the other side of the debate, parents are concerned that a choice not to vaccinate exposes children FatCamera/E+/Getty Images to diseases that have long been controlled in our population. This debate over a connection between MMR and autism began in earnest in 1998 after the publication in the British medical journal The Lancet of a research paper by Dr. Andrew Wakefield of the Royal Free Hospital in London. The diseases under control CHAPTER 10: MAKING IT STICK: DOING WHAT’S RIGHT IN A COMPETITIVE MARKET Despite reassurances from the Medical Research Council in Britain and the U.S. Institute of Medicine that there was no evidence of a link between MMR and autism, emotions continued to escalate. Even study data from Finland (18 millon children over a 14-year period) and Denmark (537,303 children showing no evidence of a connection failed to have a calming effect, and Wakefield’s reputation as a parent advocate continued to grow, even though his study had included only 12 cases. However, in 2004