Jan 28 2010

Andrew Wakefield “Acted Unethically”

Andrew Wakefield, the UK researcher who sparked unwarranted fears about the risks of the MMR vaccine, has been the subject of a two-and-a-half years ethics investigation by the General Medical Council (GMC). This afternoon the GMC announced their conclusion, ruling that Wakefield acted “dishonestly and irresponsibly” in his research and with “callous disregard” for the children that were the subject of his research.

Wakefield’s Story

In 1998 Wakefield and others published a story in the Lancet where they claimed to find an association between finding the measles virus in the GI tract of children with autism following the MMR vaccine. The study itself was small – only involving 12 children, and the conclusions were modest, not specifically suggesting a link between MMR and autism. But in subsequent press conferences Wakefield raised the alarm, saying, “Urgent further research is needed to determine whether MMR may give rise to this complication in a small number of people.”

The result was a significant drop in MMR compliance and a resurgence of measles cases, as this BBC chart demonstrates.

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The original Lancet article spawned follow up research which failed to replicate Wakefield’s results. (Also see here and here.) The final disconfirmation came from a recent study finding no link between MMR, measles virus, and autism. Most significantly, the PCR technique used to detect measles virus in the original Wakefeld paper (which was itself later discredited) was performed by Professor O’Leary, who also did the PCR in the recent study contradicting Wakefield.

Doing sloppy research that is later discredited happens frequently enough in science and itself does not warrant investigation for ethics violations. That came from other accusations – specifically that Wakefield paid children 5 pounds at his child’s birthday party to participate in the study.

Further, investigative journalist Brian Deer has uncovered a host of dubious behavior on the part of Wakefield, beginning with serious conflicts of interest. These include applying for a patent on an alternate MMR vaccine – so Wakefield could potentially benefit from the results of his research. Also, Wakefield was being paid by an attorney specifically to support the claim that the MMR is linked to autism, and some of the same children whose parents were involved in such law suits were part of Wakefield’s Lancet study. These conflicts caused the Lancet to later withdraw their support from the paper.

Most recently Deer has published what he believes is evidence that Wakefield may have even faked some of the data in his original paper.

After a multi-year investigation, the GMC finds that there is some truth to the accusations against Wakefield and has ruled against him. They will now deliberate on what sanctions should result from their findings (which should take a couple of months).

MMR and Autism

But of course, conflicts of interest and unethical behavior, while it calls into question Wakefield’s research, is not the final word on the science. The question of MMR and autism has been thoroughly investigated and no link has been found. The data is very robust because we have the opportunity to observe autism diagnosis rates in various countries with differing MMR policies over time.

We now have data from Poland, the UKDenmark, Finland, and Japan (the Japan study is most interesting because there the MMR vaccine was actualy withdrawn and was not followed by any decrease in autism). These studies show a remarkable concordance of evidence – there is no association between MMR and autism. (See here for a more complete list of studies.)

Conclusion

The Wakefield story is a disturbing one. By all accounts he conducted scientifically and ethically dubious research, with undisclosed conflicts of interest, and used that to trigger fears about the safety of MMR, resulting in a demonstrable increase in disease. He also helped propel the overall anti-vaccine movement.

It is good to see that the GMC had done a thorough investigation and are now bringing Wakefield’s malfeasance to light, and I await to see what sanctions they decide are appropriate.

Meanwhile, Wakefield in unrepentant. He has moved his practice to the US where he continues to be a darling of the anti-vaccine movement. In fact, official judgments against Wakefield only serve to increase his status as a cult-hero among anti-vaccinationists.

Unfortunately, the Wakefield story is not over.

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49 responses so far

49 Responses to “Andrew Wakefield “Acted Unethically””

  1. gingerwigon 28 Jan 2010 at 4:21 pm

    I wonder if there is a child death count related to Dr Wakefield’s claims? Unfortunately even if there is he will never face criminal charges.

    Wayne Povey, UK

  2. ChrisHon 28 Jan 2010 at 5:46 pm

    Yes, two in the UK, and possibly several on the continent. There is also other injuries due to measle: Focus: The real victims of Britain’s MMR scare.

    Also several people, including very small children, have been hospitalized in the USA and elsewhere due to reduction of herd immunity of measles, mumps and rubella.

  3. Jerryon 28 Jan 2010 at 5:49 pm

    well, there’s always the http://www.jennymccarthybodycount.com/Jenny_McCarthy_Body_Count/Home.html

    This should’ve happened within a few years of wakefield’s fraud. It’s too late now :(

    Of course, the media won’t come out now with SCIENTIST FORGED DATA!!! – why would they, they didn’t when it seemed a small part of the IPCC report was not entirely correct.

  4. lizditzon 28 Jan 2010 at 7:16 pm

    One of my blogging habits is to collate pro and con posts on a particular issue.

    One reason to do is that each blog has its own set of commenters and often the comments reveal aspects of the issue previously not considered elsewhere.

    The comments at pro-Wakefield sites are fascinating, in a “I can’t look away from the car wreck” sort of way.

    Today’s issue is the UK’s General Medical Council’s ruling on Andrew Wakefield.

    I’ve included this post in the list.

    The list can be found at

    http://lizditz.typepad.com/i_speak_of_dreams/2010/01/andrew-wakefield-dishonesty-misleading-conduct-and-serious-professional-misconduct.html

  5. _Arthuron 28 Jan 2010 at 8:53 pm

    Wakefield was being paid TWICE to perform the same research/”study”/”project” ?

    And all the money came (indirectly) by the UK government ?

    Life is good.

  6. superdaveon 28 Jan 2010 at 11:03 pm

    the AoA is reporting that Wakefield study has finally been reproduced. Nevermind that the people reproducing it work for his organization. Can you look over that paper they are waiving around?

  7. sheldon101on 29 Jan 2010 at 3:10 am

    The other approved study was Walker-Smith could take 2 extra biopsies during colonoscopies.
    ———————-
    Much has been made of the fact that Dr. Wakefield and the others had blanket ethics approval for the research component of the studies they did that ended up in the 1998 Lancet Paper. This is the two studies theory.

    Unlike bullet 399, which really did all that damage, the two studies theory is a bad joke.

    Specific details on this other, approved study, have not been easy to find even though it was used as a defense by many of Wakefield’s fans.

    I never could understand what it was. Thanks to the nice people at Age of Autism, we now have the details.

    The approved study that is supposed to exonerate them was merely permission for Professor Walker-Smith to take 2 additional biopsies for research purposes during colonoscopies he performed at the hospital. That’s it.

    The GMC specifically rejected this argument.

    For details see http://vaccineswork.blogspot.com/2010/01/16295-or-162-95-two-studies-defense-of.html

  8. provaxmomon 29 Jan 2010 at 8:35 am

    While I’m pleased at the decision and eagerly await the sanctions, I’m afraid the anti-vax people will just see this as an opportunity to introduce martyrdom into their scenarios. Poor Dr. Wakefield…..persecuted because he chose to question the system .

  9. Eternally Learningon 29 Jan 2010 at 10:10 am

    Steve,

    Maybe I’m just missing something here, but that graph confuses me a bit. Sure I can see the relationship between the dip in compliance and the rise in measles clearly in the trend that peaked during 2003, but the sudden sharp increase in measles from 2005 to 2009 seems to completely ignore the compliance statistics. Is there some other factor at work here that isn’t represented or does this imply that the two are not really related as closely as it seems?

  10. Gareth Binkson 29 Jan 2010 at 11:21 am

    Great piece…..its the blogging of this kind that will hopefully get picked up as the proper facts.
    As with homeopathy its the reporting of this in the mainstream that will changing the general publics perception.
    There will be loads of fluff pieces coming out and denial from JMarthy about everything!

  11. Gareth Binkson 29 Jan 2010 at 11:21 am

    Great piece…..its the blogging of this kind that will hopefully get picked up as the proper facts.
    As with homeopathy its the reporting of this in the mainstream that will changing the general publics perception.
    There will be loads of fluff pieces coming out and denial from JMcarthy about everything!

  12. sensecharityon 29 Jan 2010 at 12:13 pm

    You’re right, the story is not over, and we must start to focus on rebuilding the public perception of the vaccine.

    I work at Sense, the charity for deafblind people and we work with families still living with the effects of previous rubella outbreaks. You can read our full response to this story on our website: http://bit.ly/dARXbU

    So, how can we start giving parents the confidence again to have their children vaccinated.

  13. Steven Novellaon 29 Jan 2010 at 12:16 pm

    EL – there is a delay from the drop of compliance to the later rise in measles cases. Even though MMR rates increased after 2003, they still leveled off at below herd immunity levels. The persistent sub-herd immunity levels eventually kicked off an epidemic, and that is the sharp increase.

    We are still dealing with an infectious disease with its own unpredictable patterns and ups and downs. You can really only look at the big picture – sustained vaccine levels below 90% leading to an eventual return of measles as endemic in the UK.

  14. provaxmomon 29 Jan 2010 at 12:40 pm

    Autism News Beat just posted the story, including a link to this morning’s Today show coverage. “Wakefield vowing to press on…” blech

  15. Matt Pon 29 Jan 2010 at 1:21 pm

    A few minutes after seeing the Wakefield news, I saw this on an autism “report” (a blog that just copies the beginnings of other published stories and links you to the rest):

    Critical Work of Dr. Andrew Wakefield Replicated

    Clinical Presentation and Histologic Findings at Ileocolonoscopy in Children with Autistic Spectrum Disorder and Chronic Gastrointestinal Symptoms http://www.la-press.com/article.php?article_id=1816

    I read the study, and although I didn’t understand a lot of the words in it, it seems to me to be saying, “Kids with autism and stomach problems have autism and stomach problems.” I couldn’t find anything that seemed to have “replicated” Wakefield’s “critical work.”

    Am I missing something? What did this study accomplish, exactly?

  16. daedalus2uon 29 Jan 2010 at 1:58 pm

    A correction, the original Wakefield paper used antibodies to “detect” (actually a false postive, but then antibodies are not very specific) the protein said to be from measles virus. Wakefield knew those were false positives at the time because his collaborator and graduate student Nicholas Chadwick did PCR on the exact same samples that Wakefield found to be “positive” and found only false positives. Every positive Chadwick got via PCR he sequenced and found it was a false positive. Chadwick testified under oath that he told Wakefield that they were all false positives before the Lancet paper was published.

    Later very sloppy PCR (not done by Chadwick) showed “positives”, but none of those “positives” were done properly, they didn’t have the right controls and none of them were sequenced to verify that they were true positives.

    PCR is many orders of magnitude more sensitive and orders of magnitude more specific. If a PCR result is negative, then a positive immunological result is useless because it is virtually certain to be a false positive. If Wakefield had released the PCR data, the immunological data would have been rejected as artifact.

  17. Juanon 29 Jan 2010 at 2:45 pm

    I have to admit I am not familiar with the legal matters in medicine but shouldn’t these revelations result in Wakefield loosing his license abroad and here? How is he able to practice anywhere?

  18. etorigoeon 29 Jan 2010 at 3:21 pm

    The bars in the chart are a little misleading. The bars represent the % of children who are being vaccinated. A better comparison would be with the total population without immunity to MMR (mostly due to a lack of vaccination I would guess). When the % vaccinated drops, the rate of growth (the slope) of this population increases.

    If the normal % vaccinated is 90% and a scare causes a drop in the rate to 80%, and there are N children eligible to be vaccinated, then that means that there are an additional (0.1)*N unvaccinated children in the population due to the scare.

    The population of the UK is 62 million. According to Wikipedia 18% of the population is between 0-14. So let’s guess that the population eligible to be vaccinated (0-5) is N = (0.06)*62 million = 3.7 million. So if the scare causes 10% fewer children to be vaccinated then the unvaccinated population increases by an addional 370,000 children.

    Guesstimating from the graph and again assuming a normal rate of vaccination to be 90%, over 10 years the scare has increased the unvaccinated population by 2.4 million children in the UK alone.

    While there may be a phase lag, the number of cases of measles certainly seems to correlate with the growth in the unvaccinated population.

  19. Steven Novellaon 29 Jan 2010 at 4:30 pm

    Regarding the percent unvaccinated – you also have to understand the the unvaccinated are not randomly distributed. They typical occur in pockets – or rather, there are communities with particularly low vaccination rates – and that is where the measles outbreaks are occurring.

  20. sheldon101on 29 Jan 2010 at 5:48 pm

    Re: Critical Work of Wakefield Replicated

    Krigsman did 143 colonoscopies on ASD kids. What he definitely replicated was the concern of the GMC with Wakefield, Walker-Smith and Murch— namely doing invasive research on kids without ethics review board approval and in fact doing it after it was denied.

    So how did Krigsman manage to get his research into a peer reviewed journal on which he and Wakefield are on the editorial board?

    They used a commercial ethics review board company and even then limited the use of the review board company to “IRB approval was limited to retrospective review and compilation of findings using these procedures.”

    I guess that means they weren’t concerned that the hospital was concerned enough that Krigsman was doing research colonoscopies on kids that they put in place a requirement that each colonoscopy he did had to be approved by another doctor.

    So I’ve sent an email to Copernicus, the IRB company, asking them to retract their approval for the study.

    More details here:http://vaccineswork.blogspot.com/2010/01/letter-to-copernicus-group-re-ethics.html

  21. ChrisHon 29 Jan 2010 at 6:39 pm

    sheldon101:

    So how did Krigsman manage to get his research into a peer reviewed journal on which he and Wakefield are on the editorial board?

    Possibly because it is not a peer reviewed journal. It is their own journal, as you can see by the list of editors (Wakefield, Carol Stott, Brian Jepson, etc). It is very similar to Gary Goldman’s Medical Veritas (where Wakefield is also an editor/author) and Medical Hypothesis (which is indexed at PubMed, though that may change after publishing a bunch HIV/AIDS denialist articles).

  22. ChrisHon 29 Jan 2010 at 11:11 pm

    Sheldon, more on the journal the Krigsman article was published in:
    http://leftbrainrightbrain.co.uk/2010/01/autism-insights-another-journal-for-questionable-autism-research/#comment-74998

  23. etorigoeon 29 Jan 2010 at 11:41 pm

    I think I made a calculation error earlier. On a yearly basis there are probably 1/5 of the 3.7 million I originally quoted who are scheduled to get the vaccine in the UK. That would mean that the UK gives around 700k child vaccinations per year. Does that number sound correct?

    Anyway, adding up the additional unvaccinated children due to the scare between 1998 and 2008 from the graph I get a number closer to 500k.

    This is a very back of the envelope calculation that I thought was interesting. It is a measure of the cumulative effect of this misinformed anti-vaccination campaign. I made a lot of assumptions and guesstimations that limit the accuracy of this number.

    Based on the spatial density fluctuations of the unvaccinated (as noted by SN) and other non-linear factors it will probably hard to determine an expected relationship between the unvaccinated population and the rate of infection. So, I’m not making a strong claim about the meaning of this 500k number I calculated.

  24. johnmatthewsonon 30 Jan 2010 at 1:26 pm

    The real problem here is that the British Government refused to allow single vaccinations. They absolutely insisted that babies have the triple vaccine rather than three, separate single vaccinations. Wakefield cannot be blamed entirely for the measles outbreak.

    Remember that the British Government once insisted that beef was safe and the CJD fears were unfounded. One of the scientists involved in the CJD scare was also hunted down by the government but he was vindicated by events.

    Obviously to launch a “scare” on the basis of one research paper is wrong and governments should quieten the media. But the way the British Government behaved was a mistake, they should have allowed single vaccines for a period, discussed the research with Wakefield, asking him to call for calm and ensured a rapid replication/follow up study.

  25. ChrisHon 30 Jan 2010 at 1:56 pm

    The UK NHS failing in one area in no way exonerates Wakefield. If you look, you will see the 1998 Lancet paper did not in any way show that the MMR was the cause of autism, and the call for single vaccines was only presented by him in a press conference.

    The MMR vaccine being used in the UK since 1992 is the same one that has been used in the USA since 1971.

    The call for single vaccines is incredibly stupid and unfounded. It means three times as many vaccines, with more time between them. This leaves more chance of a child getting one of the three diseases, and more chance of an injury from the needle (which is small, but why triple it?).

    Plus, single vaccines just does not work. It did not work in the UK in the 1980s, and it did not work in Japan in the 1990s/2000s (a country which exported measles to the USA, and is now having problems with mumps).

    Do not even try to argue that girls should not be protected from mumps, or boys do not need to be vaccinated for rubella as a way to reduce injections. It is extremely ignorant to think that herd immunity can be maintained by vaccinating only half the population. Even if all the girls get vaccinated for rubella, there is a chance the vaccine will not take, leaving a pregnant woman vulnerable to some little boy who could pass rubella to her. Go up and read the link from “sensecharity.”

    Also, I think it is incomprehensibly sexist to deny girls a mumps vaccine because they do not become infertile. There are other side effects from mumps, including deafness and oophoritis (look it up!).

    No, Mr. Matthewson, the blame is on the media. They created a tempest in a teapot and a mountain in a molehill. Except there was no teapot, nor was there a molehill.

    Wakefield lied. The media ran away with that lie, and children have suffered for it.

    I suggest you read Ben Goldacre’s book Bad Science. Or at a minimum read the pertinent chapter here:
    http://www.badscience.net/2008/08/the-medias-mmr-hoax/

  26. johnmatthewsonon 30 Jan 2010 at 2:48 pm

    “The call for single vaccines is incredibly stupid and unfounded”.

    No, it would have been a sensible transitional arrangement before returning to MMR when the evidence was in. Your comments are typical of the approach of the government

  27. ChrisHon 30 Jan 2010 at 3:24 pm

    Obviously you have issues with reading. Actually, it is the approach of science. If you have any evidence that it would have worked, please present it. Did you look up oophoritis? Did you read the link posted by “sensecharity”? do you think that the Sense Charity is a government group? Do you understand the concept “herd immunity”?

    If you have any evidence that MMR (which, I repeat has been used in the USA since 1971) has issues that would require the use of some other vaccine method please present it. By what I mean by evidence, actual scientific studies, and not government conspiracy rants.

    In the mean time, I am reading a very long PDF I downloaded from Ben Goldacre’s BadScience blog:
    http://www.esrc.ac.uk/ESRCInfoCentre/Images/Mapdocfinal_tcm6-5505.pdf

    Another prominent theme of the coverage was the proposal to give parents the choice of three separate jabs. While this proposal is strongly supported by Dr Wakefield, there is no empirical research that suggests this is a safer option. Some newspapers actively campaigned for this option, although most media simply reported the fact that there was support for it. Either way, some 31 per cent of respondents in our October survey now appear to favour this option, with only 47 per cent now preferring the MMR jab. This loss of confidence was initially overestimated in both the early coverage and by our respondents, but there is no doubt that the long term public health consequences of a fall in vaccination levels are profound.

  28. tmac57on 30 Jan 2010 at 8:23 pm

    johnmatthewsom-”No, it would have been a sensible transitional arrangement before returning to MMR when the evidence was in.”
    So, by that logic, anytime some “researcher” make a statement questioning some therapy in a press release, then governments around the country, or the world should immediately cease the standard of care regarding that therapy, until new studies show that it is safe?

  29. johnmatthewsonon 31 Jan 2010 at 4:21 pm

    Reply to tmac57:

    Many of the correspondents seem to be forgetting that when Wakefield made his results public no one knew whether or not MMR was responsible for the results.

    If a piece of “research” is creating a health scare then firstly it should be assessed by scientists in the department of health. Next, if, as in the case of Wakefield’s research, it appears as if something unexpected might be occurring they should get the researcher to announce that as yet no definite conclusions can be drawn and should sponsor research to check the findings.

    If the scare is undermining public health they should introduce stop-gap measures until the situation is clear to ensure that the risk to the population is minimised.

    Wakefield is an example of one of these incidents where the researcher was wrong. The history of health research is littered with examples from the “Stepney pump” to CJD where the government got it wrong and they persecuted the researcher who brought the bad news. The civil servants in government should stop being so incompetent and devise a civilised plan for dealing with these events – after all, they occur every decade or so.

    I stick by my initial comments, a competent government would have saved Wakefield from himself and the country from an increased prevalence of measles.

  30. ChrisHon 31 Jan 2010 at 7:57 pm

    Actually, what he reported in the press release had nothing to do with what was written in his paper. There was a complete disconnect.

    In short: he lied.

    He lied in the paper, and he lied in the press release. He also suggested that the single vaccines be spaced a year apart, which would make children more vulnerable to disease and further erode herd immunity (again, do you understand the concept of herd immunity?).

    There is absolutely no reason for a public health policy to be changed on a two bit researcher’s press release that misrepresented his own results (which were fudged).

    Now, what you seem to be missing is even if he had not lied, it was just a small reporting of twelve case reports. In no way did it show actual problems with the MMR. Which (in case you forgot, or seem to be ignoring) had been used in the USA and else for over two decades.

    You are also missing that the government did not have control over the media mania that perpetuated his lies. Really, read the links I gave, especially the one on the analysis of media reports on the MMR, climate change and cloning.

    Stop trying to blame a government for the media treatment. Are you suggesting that a “competent” government is one that has control of the media? Kind of like what is happening in Venezuela?

    You say “Wakefield is an example of one of these incidents where the researcher was wrong.” He had one paper that showed nothing remarkable (and he actually lied about it). That does not in any way change the decades of research conducted on the MMR before he was contacted by a lawyer. Plus, in the decade of research after his press release his “results” were never replicated, and the MMR has again proven to be safe (in studies covering the medical records of hundreds of thousands of children in several countries).

    Also, you have failed to show any data that would show that the single vaccine option would be safer. Why is that? Do you have something against real science?

    Is your empiricism just based on what you think the results should be? If it is, then you are doing it wrong.

    Show that Wakefield contributed anything useful, or that the single vaccine offer would have been safer with real evidence. And evidence directly relating to the MMR vaccine, measles, mumps, and rubella — not distractions into other research or governments. In short: put up or shut up.

  31. ChrisHon 31 Jan 2010 at 9:39 pm

    I know you will not read Ben Goldacre’s book Bad Science, nor will you read Paul Offit’s Autism’s False Prophets, that both detail the story behind Wakefield’s paper, and why it was not to be taken seriously in 1998. It is quite clear you have not even read what Dr. Novella wrote, and are completely ignoring all the other input.

    But I do have a copy of both books, and noticed that the excerpt in the link provided above did not include certain passages from Dr. Goldacre’s book. I have hand typed them and present them here for you (though really, you should try to catch up the the whole history and science behind this whole fiasco, perhaps even read about the devastation iin Germany caused by Wakefield’s action here: http://justthevax.blogspot.com/2010/01/gmc-ruling-on-andrew-wakefield-in-and.html ).

    Excerpts from the 2nd edition of Bad Science by Ben Goldacre:

    Page 294:

    In February 1998 a group of researchers and doctors led by a surgeon called Andrew Wakefield from the Royal Free Hospital in London published a research paper in the Lancet which by now stands as one of the most misunderstood and misreported papers in the history of academia. In some respects it did itself no favours: it is badly written, and has no clear statement of its hypothesis, or indeed of its conclusions (you can read it free online if you like). It has since been partially retracted.

    Continuing later on page 295:

    What can this kind of paper tell you about something as common as MMR, and something as common as autism? Basically nothing, either way. It was a collection of twelve clinical anecdotes, a type of paper called a ‘case series’ — and a case series, by design, wouldn’t demonstrate such a relation between an exposure and an outcome with any force.

    Which is followed by a definition of a ‘cohort study’ and a ‘case-control study. Neither of which of describe Wakefield’s paper, that you so much think that should change the UK NHS’s vaccine policy. Indeed, the UK taxpayers already had wasted enough of their funds from the public legal fund on this folly. There is absolutely no reason to squander even more of the UK taxpayers money on single vaccines.

    Continuing on about the use of single vaccines on page 296-297:

    We are all entitled to our clinical hunches, as individuals, but there was nothing in this study of twelve children, or any other published research, to suggest giving single vaccines would be safer. As it happens, there are good grounds for believing that giving vaccines separately might be more harmful: they need six visits to the GP, and six unpleasant jabs, which makes four more appointments to miss. Maybe you’re ill, maybe you’re on holiday, maybe you move house, maybe you lose track of which ones you’ve had, maybe can’t see the point of rubella for boys, or mumps for girls, or maybe you’re a working single mum with two kids and no time.

    Also, of course, the children spend much more time vulnerable to infection, especially if you wait a year between jabs, as Wakefield has recommended, out of the blue. Ironically, although most of the causes remain unclear, one of the few well-characterised single causes is rubella infection itself, while the child is in the womb.

  32. tmac57on 31 Jan 2010 at 10:26 pm

    Well done ChrisH !

  33. johnmatthewsonon 01 Feb 2010 at 7:09 am

    ChrisH: “Also, you have failed to show any data that would show that the single vaccine option would be safer. Why is that? Do you have something against real science?”

    Do you have something against competent government or do you believe those in government should react like ill educated “bovver boys” and blimps? You have not tackled my basic point which is that Wakefield’s announcements could have been dealt with by competent government and need not have lead to an increase in measles.

    The ignorant, “bovver boy” approach to government would be to shout loudly that the results are doubtful and to attack Wakefield’s credibility and smear his reputation “off record”. It might well be the case that the results were indeed doubtful and Wakefield was indeed dubious but this panicky, school playground bullying approach is incompetent.

    I have spent many years doing research in British Hospitals and in the private sector. The hospital researcher is isolated and no-one cares about them. Had I done Wakefield’s research in a hospital environment it would have had to be published. All that would have mattered would have been “paper count”. I have also worked for pharmaceutical companies. Had I come up with something like Wakefield at one of these companies there would have been a meeting with senior researchers who would have come up with a plan for dealing with it. I would not have been exposed personally and would have been protected by the experience of senior scientists and managers who were wise to the ways of science and the world. Of course, these comments apply to a general piece of research, had the research involved any pharmaceutical company’s own vaccines there would have been board level involvement and a total “lock down”!

    Whatever you think of Wakefield’s research, the fact that it led to a health scare was a supervisory failure at the institution where it was performed and gross incompetence in government. After all, who paid Wakefield? The government and the hospital/medical college. All the government needed to do was get Wakefield to say that the results were provisional (after all, they were provisional) and, given that the scare was serious, to produce a leaflet that said “So you want single vaccines” in which the parent’s fears would be allayed but they would be allowed single vaccines if they filled in a detailed 5 page form and gave solemn undertakings to complete the course, perhaps with the penalty of refunding the cost of the treatment if they failed to do so.

    What can we learn from Wakefield?

    The first point is that Hospital/Medical College Research should have a management structure with shared responsibility for quality control amongst those managing the project. This would have stopped the Wakefield saga in its tracks. The appropriate people exist in Medical Colleges and Hospitals and should really be fulfilling this function already.

    The second point is that the government should talk to those scientists who are creating a serious health scare at the earliest opportunity and, if there is doubt about the work, persuade them to announce that the results are provisional and further work is needed so there is no need for alarm.

    The third point is that if alarm has spread so that it has become a danger then, to ensure public health, the government should allow some way round the problem and should not just try to bully it away.

  34. johnmatthewsonon 01 Feb 2010 at 7:22 am

    ChrisH: “In short: put up or shut up.”

    I’ve got to respond to this. I have “put up”. What I am talking about is management, not science. A collegiate atmosphere where staff such as Wakefield can find guidance, consultation between department of health and researchers and an intelligent response to the concerns of parents are management issues. It is nothing like your scary: “Are you suggesting that a “competent” government is one that has control of the media? Kind of like what is happening in Venezuela?”.

    I detect hospital consultant or other health service staff behind some of the comments here. The British NHS has bred a rather nasty competitiveness and bullying mentality in its staff. The working atmosphere is like Eastern Europe at the height of Stalinism. Thank goodness I only had to witness this behaviour, it must be a nightmare to work within such a system.

  35. SteveAon 01 Feb 2010 at 9:00 am

    “# johnmatthewson”

    You seem incapable of accepting the fact that Wakefield has been shown to be a deliberate liar. This is not a management issue. It’s one of ethics and honesty. You seem desperate to absolve this man of any responsibility for his actions and blame some ‘all powerful’ bureaucracy that somehow failed to protect him from himself.

    You seem divorced from reality in other ways. The UK government’s response to the vaccine scare should have been to…Da-da-dum!…Write a leaflet.

    A leaflet?

    A leaflet…!

    As far as naive statements go, you just turned the dial up to 11. No make that 12.

  36. johnmatthewsonon 01 Feb 2010 at 12:02 pm

    SteveA: “You seem incapable of accepting the fact that Wakefield has been shown to be a deliberate liar. ”

    I am not defending Wakefield but I am pointing out that an institutional failure also occurred. A problem became a scare and the scare risked lives. This could have been tackled and nipped in the bud if the hospital/college and department of health were not poorly managed. Do you really believe that one out of the hundreds of thousands of health workers and researchers in UK government employment will not give rise to another situation like this within a decade or two? Some simple and low cost management