Jan 06 2011

BMJ Slams Wakefield

In 1998 Andrew Wakefield and 12 coauthors published a now infamous paper in the Lancet alleging a connection between regressive autism and nonspecific colitis (bowel inflammation). They also reported a “strong temporal association” between this alleged new syndrome and injection with the MMR vaccine. The study was based upon 12 case reports of children with this apparent syndrome. It sparked fears regarding the MMR vaccine specifically, and vaccines in general, that spread initially through the UK but then around the world, including the US. The result was a surge in the anti-vaccine movement, declining vaccine compliance – and in some communities low enough to reduce herd immunity resulting in outbreaks of vaccine-preventable diseases, like measles and whooping cough.

In early 2010 the Lancet finally retracted the paper, citing ethical concerns, and later that year the General Medical Council found that Wakefield had acted unethically. He was eventually struck off and now is self-employed in the US – professionally disgraced but he remains unrepentant and a martyr and hero of the anti-vaccine movement. Like many cranks, Wakefield hides behind a veil of accusations of conspiracies and persecution.

Despite his downfall, the damage had already been done. During this time journalist Brian Deer relentlessly investigated Wakefield and the Lancet paper. The chilling result of this investigation is now detailed in a BMJ paper (the first in a series).

Brian Deer deserves a great deal of recognition for his investigative journalism – something we don’t have enough of these days. He tracked down the 12 children in the Wakefield study, reviewed hospital records (all made available through the GMC investigation) and compared them to the Lancet paper. What he found was systematic distortion and misrepresentation of the basic facts.

In order to make his case Wakefield had to show that children with regressive autism also had symptoms of colitis and further that their symptoms began shortly after receiving the MMR vaccine. Deer found that the actual facts in the 12 cases do not support this narrative. In fact, after reviewing the records Deer could not recognize any of the study subjects by the details reported in the paper – there was simply no correlation. The paper goes into great detail, but here is the summary of the problems with Wakefield’s paper.

*Three of nine children reported with regressive autism did not have autism diagnosed at all. Only one child clearly had regressive autism

*Despite the paper claiming that all 12 children were “previously normal,” five had documented pre-existing developmental concerns

*Some children were reported to have experienced first behavioural symptoms within days of MMR, but the records documented these as starting some months after vaccination

*In nine cases, unremarkable colonic histopathology results—noting no or minimal fluctuations in inflammatory cell populations—were changed after a medical school “research review” to “non-specific colitis”

*The parents of eight children were reported as blaming MMR, but 11 families made this allegation at the hospital. The exclusion of three allegations—all giving times to onset of problems in months—helped to create the appearance of a 14 day temporal link

*Patients were recruited through anti-MMR campaigners, and the study was commissioned and funded for planned litigation

Every aspect of the alleged new syndrome appears to have been fabricated by Wakefield. It is hard to explain this as just sloppy research. The fingerprints of deliberate fraud seem clear, in my opinion.

The last point is often a subtle problem that may be missed by how studies are reported. Wakefield alleged an association between autism and GI symptoms. In order to validate this a proper study would look at either random cases of autism or sequential cases, and then compare the rates of GI symptoms or disorders with an appropriate control population. Wakefield, however, solicited his cases through anti-vaccine networks, and specifically asked for children with autism and GI symptoms. So his methods could not help but confirm his hypothesis – and even then he had to fix the results. This is called selection bias, and is often a subtle and missed bias in case series like this.

We also see in these cases how the timing was altered. It is interesting that most of these families believed there was a connection between MMR and their child’s symptoms, even though there were clear problems prior to the vaccine in many cases. Some of these problems were significant, including dysmorphic features and clear developmental delay. What this case series unwittingly documents (after Deer’s careful investigation) is how a belief in a temporal connection and cause and effect can persist despite being out of sync with documented evidence. One father admitted: “We were just vulnerable, we were looking for answers.”

This, of course, is understandable. And the psychological effects involved are also ubiquitous – we are all prey to  false memories and faulty thinking. But the point of scientific rigor is to control for such things. Clearly that did not happen here.

Wakefield has responded to these allegations by doing what charlatans typically do – they go on the offensive against their accusers. In a CNN interview Wakefield responds:

Wakefield dismissed Brian Deer, the writer of the British Medical Journal articles, as “a hit man who has been brought in to take me down” by pharmaceutical interests.

The “Big Pharma” gambit is especially lame coming from Wakefield, who had applied for a patent for an vaccine alternative to the MMR he tried to trash in his Lancet paper. It’s always a cheap and easy dig, and plays well to the anti-vaccine crowd. Deer, meanwhile, discloses that he has no financial conflicts of interest. Unable to dig up any actual dirt on Deer defenders of Wakefield resort to claiming that he was paid to write his articles. Yeah – he is a full time journalist who makes his living by getting paid for writing.

Of course, Age of Autism is backing Wakefield and doing their typical smear campaign against Brian Deer. One comment that managed to get through (rare on AoA to let a critical comment through) sums it up nicely.

In the above comments I see lots of ad hominem attacks, blanket statements about conspiracies in the big pharma and big media, and (perhaps more substantial) concern about access to medial records, but I would like to see SPECIFIC counter-arguments against the journalist’s research and conclusions. You have to admit that all the lather of socialist-this and sinister-bastards-that don’t carry well in argument against a pretty extensively detailed piece of investigative journalism.

AoA puts up a lot of smoke and mirrors, but nothing to actually counter Deer’s investigation, or the conclusion of the GMC after an extensive ethics investigation. It’s all just plausible deniability, the last refuge of the red-handed.

Conclusion

Brian Deer and the BMJ have done good work in exposing Wakefield and the Lancet article for what it is. Hopefully this will counteract some of the damage to public health that resulted from his dubious research.

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12 responses so far

12 Responses to “BMJ Slams Wakefield”

  1. Jim Shaveron 06 Jan 2011 at 10:02 am

    I watched Anderson Cooper’s interview with Andrew Wakefield last night, and I thought Cooper did a good job of keeping the pressure on Wakefield to answer the key questions and to not let him get away cleanly with his accusations of conspiracy and ad hominem attacks against Brian Deer.

    One thing was clear to me from that sequence: Wakefield may be a bad doctor and a worse researcher, but he is very skilled at public relations and at standing up to harsh criticism. He is charismatic. It’s no wonder that he is able to maintain a following among the anti-vaccination crowd, even after his profound professional failure.

  2. CrookedTimberon 06 Jan 2011 at 10:03 am

    Damn fine sleuthing by Brian Deer, I hope he wins an award. This is exactly the type of comprehensive investigative journalism that is lacking these days.

    Cases like this should serve as a “teachable moment” to educate people about science and faulty thinking (along with breast implants and cancer, power lines and leukemia, etc) but unfortunately I don’t see too many minds being changed.

  3. daedalus2uon 06 Jan 2011 at 10:47 am

    I think in “teachable” moments like this, people usually learn the wrong message. Instead of not trusting anyone but verifying their facts and logic, people instead look to a charismatic heroic figure to trust instead. Instead of checking facts, they look to a hero to rescue them. They apply the same bad logic that lead them to trust Wakefield and use it to trust someone else.

  4. lizditzon 06 Jan 2011 at 11:42 am

    Agree: Brian Deer deserves an award.

    I have a question for the scientists: will this last chapter in the sordid Wakefield saga have any impact on scrutiny of research and/or science publishing.

    I have one other thought after watching Elliot Spitzer allow JB Handley to promote the idea that autism is too caused by vaccines (the “too many too soon gambit”) — when will American interviewers get tough with promoters of anti-science?

  5. locutusbrgon 06 Jan 2011 at 3:05 pm

    what I am stymied by is how losers like rush Limbaugh use this as an example of how science is not trust worthy. There are many unsinkable rubber ducks to quote JRandi, but this is ludicrous.
    He makes it sound like the science community has not been screaming about this for years. Even worse he discusses how this is somehow a parallel with climate science. AAAAGH!
    Listen to a douchebag and get crap. When anti science losers get to use nonsense as a reason why science is not trustworthy I want to scream. Today I felt like maybe media reporting is finally getting it, then talking head moron advocates begin moving the goalposts.
    There I have vented enough…

  6. Jim Shaveron 07 Jan 2011 at 9:39 am

    Locutus: “There I have vented enough…”

    No. No, you really haven’t.

  7. Kawarthajonon 07 Jan 2011 at 10:51 am

    The bottom line here is that Andrew Wakefield has done something very unethical – lying, cheating and trying to profit directly from his lies. Not only that, but there are many many innocent victims of his unethical behaviours – the children who have suffered or died from a lack of vaccination.

    What can we do to curb this kind of behaviour in influencial researchers? I am putting it out there that this guy should be charged with Fraud for fudging his research and trying to directly profit from it. The evidence that he has done significant harm to society is clear and that he did it for self-profit. If I were an crown attorney in the UK, I would be seriously looking at trying to prosecute this guy for the things he has done. (of course, his die hard supporters would just claim that this was another conspiracy against them, but who cares about their opinion?)

    Steve, what do you think about criminally charging people who do this, given your role as a researcher?

    What does it say about the people from AoA when their HERO is a lying, cheating, scammer?

  8. HHCon 07 Jan 2011 at 2:17 pm

    There was a short news segment at 12:45pm on WGN, Chicago television on Wakefield, Deer, and the retracted Lancet article. The Chicago reporters stated clearly that the autism rate is not effected by vaccination. Got to see the talking head shots of Wakefield and Deer!

  9. rmcon 07 Jan 2011 at 11:23 pm

    Outstanding journalism, and bravo to the BMJ for making access to the report free. Surely there is a special place in hell reserved for people like Wakefield. How many people could so brazenly and greedily create lies that effectively roll back the public health progress of several first-world nations?

    The one thing that puzzles me:

    If someone was being paid to fabricate the scientific underpinnings for a massive lawsuit against vaccine manufacturers, why bother gathering a dozen patients in the first place? Why not simply pull the case studies out of your nether regions? Was it simply that adding collaborators to the project gave an air of legitimacy to the lies? Or did Wakefield enter the study really believing that this syndrome existed?

  10. BillyJoe7on 08 Jan 2011 at 12:47 am

    rmc,

    “Surely there is a special place in hell reserved for people like Wakefield. ”

    I don’t know about Hell, but there is a grave waiting for him and I’ll be stomping on it when they toss him in:

    You fasten all the triggers
    For the others to fire
    Then you set back and watch
    When the death count gets higher
    You hide in your mansion’
    As young people’s blood
    Flows out of their bodies
    And is buried in the mud.

    Let me ask you one question
    Is your money that good
    Will it buy you forgiveness
    Do you think that it could
    I think you will find
    When your death takes its toll
    All the money you made
    Will never buy back your soul.

    And I hope that you die
    And your death’ll come soon
    I will follow your casket
    In the pale afternoon
    And I’ll watch while you’re lowered
    Down to your deathbed
    And I’ll stand over your grave
    ‘Til I’m sure that you’re dead.

    (Bob Dylan “Masters of War”)

  11. lizditzon 11 Jan 2011 at 11:37 am

    By the way, I’m keeping a little list….

    of positive responses to the BMJ (Yes Wakefield is a fraud, and here are the implications…) and negative responses (Wakefield’s research IS TOO valid and vaccines cause autism anyway) at A roundup of responses to the BJM & Wakefield’s research was motivated by fraud. The list also indexes the excellent coverage at LeftBrain/RightBrain.

    Some observations
    1. The positive responses come from a broad range of sites — politically left and right; people who are skeptics/ people who have heretofore (to my knowledge) never commented on vaccines or autism before, and so on. The negative responses are from a predictable set of sites and people.
    2. The news coverage in the US has (perhaps inadvertently) perpetrated the idea that all parents of children with autism believe in the vaccine causation myth. It is a complete falsehood. Many parents of children with autism and adults with autism robustly reject the myth.
    3. Kev Leitch, whose daughter has intense autism, has a moving post on how Wakefield’s actions have damaged everyone affected by autism.

  12. tmac57on 12 Jan 2011 at 9:46 am

    To hear some of the damage that Wakefield has caused,listen to this segment of Science Friday
    where Ira interviews Dr. Paul Offit about his book ‘Deadly Choices’. A Caller named Leslie is a prime example of the culture of very confident but misinformed parents out there that have been bamboozled by this dangerous fraud.

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