With vaccination rates plummeting and a measles epidemic on the horizon what's more dangerous: trusting our instincts or trusting our doctors? The controversial vaccine has aroused strong feelings at iVillage

The debate focuses on the MMR vaccine (against mumps, measles and rubella) given to children when they're 12-15 months old, with a pre-school booster before they're five.

Dr Wakefield, of the Royal London Free, seriously doubts the safety of the vaccine. An authority in the field, he has studied 170 cases of autism and bowel disease in children and believes MMR may be the trigger. The government insists there's no problem. They cite a recent Finnish study of 1.8 million children that showed absolutely no link with either autism or bowel disease. Though Wakefield is vilified as a scaremonger by almost the entire medical establishment, 50% of GPs and health professionals now admit they too have reservations. Meanwhile, 2000 UK families are taking legal action, claiming their children developed autism immediately after the MMR jab.

Here's a flavour of the debate on iVillage 'Thinking allowed':

'Trying to make a reasonable decision about whether to vaccinate with MMR or not is really difficult. My son was due to get his the day after the first media scare hit. When I arrived at the GP's surgery I was still unsure, but in the end I went ahead because:

1. After looking at all the evidence I could find, I concluded that the chances of adverse affects due to measles were higher than the chances of autism or bowel disorders. This is partly backed up by anecdotal evidence as my sister in law was left with side effects after childhood measles.
2. My health visitor said she'd never seen a single case of autism following MMR. From the reports in the media it would appear that Dr Waring would agree that MMR is in the interests of public health, although he wouldn't recommend it to any one individual. He said on the BBC 'I'm not concerned with public health but with my individual patients'. One other point: a lot of people have mentioned single vaccines as an alternative. The government's concern is that deaths from measles have occurred in Ireland when they changed to single vaccines. There's a time lag between doses, which leaves the child exposed.'

'Because measles, mumps and rubella are not seen much these days, people forget how serious they can be. Children die from measles in countries where immunisation rates are low and more and more people travel to these countries and could bring the viruses back with them. Measles can also cause meningitis, pneumonia, fits, deafness and mental retardation. Mumps can cause infertility, arthritis, meningitis and heart damage. Rubella is a danger to unborn babies, who can be born with serious abnormalities including heart and hearing problems. These are real dangers whereas the evidence for MMR causing autism or Crohns is totally unproven. The press actually mis-reported the questionnaire on health workers' opinions. Most GPs have no reservations about MMR. The media are responsible for this scare and should be made responsible for all the children who will suffer as a result.'

'People who don't have their children immunised are fools - chicken pox and measles can be deadly to children. With all this media hype there are no real statistics to show that only children who have the vaccine get autism.

That got a reaction from several people:

'You call people 'fools' who won't have their children immunised against MMR, because you think that there isn't any evidence that it can cause autism or bowel disease. Why is it then, that in the US, autism cases have increased sevenfold over the last 10 years and in 27 States it has increased by 300 per cent? (Daily Mail Jan 23rd 2001). Until more tests are carried out, I won't have my daughter immunised. I also realise that mumps and measles can lead to fatalities, but considering I have had both illnesses myself, and recovered, I am willing to take my chances with my daughter. Remember Thalidomide? That was also considered a 'safe' for all expectant mothers to stop morning sickness. Explain that to the children who were consequently born without arms or legs.'

......including this moving post

'I wish I had trusted my instincts. When my seven-year-old son was due for his MMR jab, I asked for advice from the doctor and the health visitor, as I had no idea how safe it was. Having been assured that it was perfectly safe, I allowed my son to be vaccinated. Soon afterwards, he began banging his head against the end of his cot, and rocking in his chair. He became very withdrawn, and would only relate to one person - me. He also developed his own little 'rituals' and got very upset if I changed anything at all in his daily routine. I didn't realise it at the time, but now know that these are all symptoms of autism. Needless to say I did not allow him to have the booster vaccination. Luckily his symptoms were comparatively mild, and with a lot of patience and understanding he has improved a lot. I am convinced the MMR vaccine is to blame.'

'My Daughter is 2 and I have not gone for the MMR Jab. My gut instinct is that I have been blessed with a perfectly healthy girl, why risk it? Selfishly, within a community where up-take is still at least 80% her chances of catching the viruses are slim. I talked to my health visitor extensively and she gave me some stuff to read. Unfortunately, this convinced me not to go for MMR. It was written from a health care providers viewpoint; 100,000s of children suffering from side effects or bad reactions to the vaccine had become a few %. As a mother with one precious child whose well-being is my moral and emotional responsibility every child counts.'

'It's important to remember that the immunisation is for our children's own safety against illnesses which can kill. The government are allowing more and more immigrants into the country. They could be bringing illnesses we eradicated years ago. Only tonight, I spoke to a friend of mine who had a note home from her children's school to say that there is a case of measles at the school.'

'The point about infected immigrants is a good one. I forget the exact statistic, but I recently saw a news report about the sharp resurgence of TB amongst immigrant populations. I've done some digging and found some interesting links. The best of which is: www.medinfo.co.uk/immunisations/mmr.html which gives just facts about the jab, including all 'linked' side effects and some probabilities of conditions occurring with and without the MMR vaccine.'

'Is it not a reflection on our affluent Western world that we sit and debate the pros and cons of the MMR vaccine? In the UK we have an immunisation programme that many developing countries would give their right arm for. Measles, mumps and rubella are killer diseases, and ones I would wish to protect my children against.'

Good news isn't news:

'Unfortunately the media don't report the countless ordinary success stories, only the dramatic failures. MMR has prevented countless thousands of deaths in children, yet we fear the few instances of catastrophic failure when something goes wrong and autism etc is the result. We see the few hundreds of cases of this in the news and on reports, but we don't see the hundreds of millions of healthy happy kids it has helped to bring about. But knowing this doesn't make it better. I'm weeks away from being a parent for the first time and don't look forward to making these decisions.'

Are single vaccines the answer?

'We have been very lucky in finding a private GP who prescribed the single vaccinations for our son and administered them two months apart. We have read every bit of information we can about this subject and believe that there are many questions about MMR. Japan banned it because of health risks, initial research did not extend past a four-week follow up. The Finnish study was not actually looking for autism or bowel disease. If there's no link, why are children who begin to display behavioural problems, possibly autism, recommended not to have the booster jab? My own suspicion is that these children probably have a predisposition to these problems. However, the government should stop being arrogant and begin to listen to parents' worries.'

More information please:

'Nobody here is saying that MMR definitely causes autism, but there are valid concerns to request further research and separate vaccines in the meantime. This is not scare-mongering. It's a reasoned, responsible attitude. It's the patronising attitude we see from the medical profession and our government time and again that is the real problem.'

'The Vaccination Awareness Network UK have all the information you need (www.van.org.uk) and it has certainly made me decide I am NOT going to vaccinate my child against MMR or any other vaccine. I had the MMR jab when I was 14 at school and two years later found out I had Crohns Disease. This caused me to think that something was wrong about being injected with 'mashed chick embryos and human foetal cells' 2 ingredients in the MMR jab.'

'I've just visited the VAN website and am appalled at the scare mongering and one-sided diatribe against all immunisation. For instance: the polio vaccine - this site, unbelievably a registered charity, cites a Lancet paper from 1954 to cast doubt on the vaccine's safety. 1954? They complain about us not being told all the facts, but quoting a tiny fragment from a 50-year-old report is plain irresponsible. Parents want the facts - not a patronising pat on the head from GPs, not a blinkered tirade against medicine. Can somebody out there - with authority and an empirical mind - help us?'

'When the take-up rate falls below 80% due to the selfishness of some parents and their children suffer fatalities as a result of an epidemic, will they sound so smug then? Will they blame the medical establishment or the media? The facts are available. Draw your own conclusions from the primary sources and not from a biased website. If you don't read the research behind it how can you possibly expect to take part in a scientific debate?'

'Can anyone answer the following:

1. How many children develop autism or Crohn's who have never had the MMR vaccine? ie what is the incidence per unvaccinated child.
2. What is the incidence of autism/Crohns per vaccinated child?
3. Is there a reported increase in autism because 'autistic spectrum disorder' is now included?
4. What is the evidence for using separate vaccines? Have there been any studies to show it is more/less or as beneficial?'

We asked our GP, Dr Howard Lee to answer these concerns:

Very difficult questions - I have had nearly 35 years of 'front-line action' as a GP talking this through with parents. I always allowed them the final decision after a frank and honest discussion. I tried never to add pressure or fear to affect results. So I'll just add one or two points to this debate:

Fact: No country in the world recommends that the MMR be divided and given in single doses. The vaccination schedule necessary to effect as good an immunity protection as the MMR scheme, would lead to a span of some two years between the first and the last injection. During that time children would be exposed to risk of serious infections from these diseases.

Fact: A report from the Working Party on MMR- set up in 1998 by the Committee on Safety of Medicines - reviewed the suggested link between MMR vaccination and autism/Crohn's Disease. 92 children with suspected autism and 15 with suspected Crohn's disease were examined in detail. Parents were interviewed, GP medical records considered and at least one specialist caring for each child was interviewed.

A second study - looked at Autism in the North Thames region over a 15 year period from 1979 that spanned the introduction of the MMR Vaccination (1988) This investigated the history of all 498 known autistic children born in this period. The findings in both studies were:

• No increase in autism with the introduction of MMR in 1998
• No difference in age of diagnosis between MMR immunised and un-immunised children No difference in the MMR immunisation rates between the children with autism and the general population
• No link between the timing of MMR and the onset of autism. No causal links were found.