Jan 13 2011

Deer Criticizes Doctors for Defending Wakefield

Brian Deer is the investigative journalist who has spent years building a case that Andrew Wakefield’s original Lancet paper alleging a connection between the MMR vaccine and an autism-GI disorder syndrome was not only bad science, it was fraud motivated by greed. In part two of his BMJ series detailing the results of his investigation, Deer follows the money, showing that Wakefield stood to make millions from a monovalent replacement vaccine as well as testing for his proposed new GI disorder. For those interested in the details – read the BMJ article. In short Deer builds a convincing case that Wakefield created a fraudulent study designed to generate fear regarding the MMR vaccine that he would then exploit to make millions. Meanwhile he was also paid over a million dollars by trial lawyers to build a case against the MMR vaccine.

What I want to write about today is a recent blog post by Brian Deer in which he accuses the medical establishment of circling the wagons (at least initially) around Wakefield. Deer specifically cites Ben Goldacre and Paul Offit as examples of physicians who were unwilling to accuse Wakefield of fraud. Deer writes:

But a Philadelphia-based commentator was not impressed by the BMJ’s intervention. “It doesn’t matter that [Wakefield] was fraudulent,” Dr Paul Offit, a vaccine inventor and author in Pennsylvania, was quoted in the Philadelphia Inquirer the next day as saying. “It only matters that he was wrong.”

I wasn’t surprised. From his establishment vantage-point, this was the third time Dr Offit had popped up to opine on the issue. Twice previously he’d been quoted as saying that my findings were “irrelevant” (although he’d been happy enough to use them in his books). Science had spoken, his argument went. There was no link between the vaccine and autism. It was experts like him who should rule on this matter, he seemed to imply, not some oik reporter nailing the guilty men.

And then later he write:

So, what’s my point? I think these comments reveal a striking pattern: doctors default to defending other doctors.

While I greatly respect the time and dedication of Brian Deer in doing actual investigative journalism and building an impressive (and very useful) case against Wakefield, I have to disagree with him here.

At the core of this disagreement is the relative role of journalists vs scientists in bringing down Wakefield and taking on the MMR-autism public scare. I see this as a pointless disagreement and a false dichotomy – in my mind these have always been complementary approaches to Wakefield that both contribute significantly to counteracting his fraud and bad science. Of course the journalist will emphasize the role of the investigative journalism and the scientists will emphasize the role of the science – this is not, in my opinion, doctors defending doctors, and that conclusion is a bit lazy on Deer’s part.

On the whole Wakefield has been soundly criticized by the medical community. For those physicians who blog about the anti-vaccine phenomenon we have spared no criticism for Wakefield. Deer, for example, could have quoted either me or David Gorski, which would have shown that there was no consistent “circling the wagons.”

I also think that Deer is misinterpreting the intent of Ben Goldacre’s and Paul Offit’s comments. I have spoken to Ben on this exact issue, and his point was this: The UK media were largely responsible for stoking the fires of vaccine fear after Wakefield’s paper was published. They pinned a lot of the scare on the plucky determination of this one charismatic maverick researcher. When the evidence started to turn against an MMR-autism link, however, they attacked Wakefield and acted as if his personal fall is what killed the case against an alleged link.

Ben’s point was that what matters most is the science – what does the scientific evidence say. Follow up studies failed to replicate Wakefield’s results. And many studies have failed to show any epidemiological link between the MMR vaccine, or vaccines in general, and autism. Wakefield’s claimed autism-GI syndrome does not appear to exist. In the final analysis, the science is what matters – not the fortunes of one man.

Ben’s and Paul’s comments were also in the context of accusations of a financial conflict of interest – not scientific fraud. Of course scientific fraud is important, and that alone discredits Wakefield’s research (although by itself does not answer the deeper question of whether or not there is a link). This is something that is also far easier for the public to understand, rather than parsing complex epidemiological studies.

To put the conflict of interest thing into perspective (and I can relate to this a bit) physicians who are skeptics and/or have popularized science and medicine to the public, sometimes by taking on the cranks and charlatans, have all been routinely accused of having financial conflicts of interest. This is mostly without the slightest bit of evidence, and I can personally know in my case and those with whom I have a close professional relationship, that such accusations are cheap and bogus. But the “pharma shill” is common, none-the-less. People who do not like our opinions, or who wish to brush aside our criticisms, often do so by accusing us of being in the pocket of industry. This has become a running joke among us.

Meanwhile, the medical community has become more aware of the impact of genuine conflicts of interest – a move that we all support. At the very least journals should demand full disclosure of potential conflicts of interest for any authors. This, in fact, was the first scandal regarding Wakefield’s Lancet paper – he had undisclosed conflicts of interest.

But dealing with potential conflicts requires some nuance and judgment. Not all potential conflicts mean that the results of a study are fraudulent, biased, or wrong. Some conflicts are more meaningful than others. And searching for potential conflicts can easily degenerate into a witch hunt and used as a propaganda tool against unwanted evidence or opinions.

In light of all this, many medical science bloggers (myself included) have had to point out that accusations of conflicts of interest are not sufficient to dismiss evidence. They should be admitted and explored, but by themselves are not the final arbiter of reliability. In the end, the quality of the scientific evidence is what matters.

Also, it should be obvious why science bloggers do not want to speculate wildly or easily accuse others of fraud, simply because we think their science is crap. For these above reasons it is prudent to advocate keeping focused on the science, and not getting distracted by speculation about motives.

Deer misses all of this context, and goes for the easy answer of doctors defending doctors. His choice of examples is odd, given that Ben Goldacre and Paul Offit have been on the front lines of the public battle against the anti-vaccinationists.

Investigative journalists and media scientists are on the same side in this issue, and we need to work together if we are going to be effective. Inside squabbling about which contribution is greater is ultimately silly and counterproductive. But we do come from different backgrounds and perspectives, and it seems we are seeing these differences in Deer’s blog post. Science bloggers and authors also need to be careful not to overreact and not to minimize the value of investigative journalism – when actual fraud is demonstrated, it’s OK to take off the gloves. Hopefully my explanation will help both sides see our vast common ground.

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Orac’s take on this same issue

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24 responses so far

24 Responses to “Deer Criticizes Doctors for Defending Wakefield”

  1. CrookedTimberon 13 Jan 2011 at 10:13 am

    Very well said as usual Dr N.
    In my opinion this case demonstrates the value of having scientists participate in blogs and other media. Unfortunately some in the public are not convinced by the science alone and respond better to the whole story as written very nicely by Brian Deer. The relationship in this case is and should be symbiotic and hopefully a model for better science journalism.

  2. ccbowerson 13 Jan 2011 at 10:29 am

    I would frame this a bit differently. The fact that “doctors” focused on the science and investigative journalist invesitgate other aspects, such as fraud, is generally the correct approach. Although “doctors defending doctors” is a bit simplistic, there is a general attitude of sticking to the science primarily because doctors are not investigative journalists. There is nothing wrong with this. One could criticize any profession the same way. The media is actually much worse with things like this, generally following the momentum of the story. Investigative journalism is the exception it seems.

    I do find the quote: “It doesn’t matter that [Wakefield] was fraudulent…” a bit disturbing. Even from a science perspective fraud matters a great deal beyond being wrong. Most scientists are “wrong” quite often, but fraud is a whole other thing. Perhaps in context this phrase was a bit clearer, but it is at best poorly worded.

  3. Steven Novellaon 13 Jan 2011 at 10:35 am

    I agree that Offit’s wording is troubling, but we are given no context – even in the original article. And I know from Offit’s other writing that he was harshly critical of Wakefield.

    It cuts both ways. Scientists are appropriately cautious, but should not be naive about fraud and should not minimize the value of investigative journalism. As you say – these are complementary enterprises. We should cultivate a working relationship – and largely, we are. This departure is odd and disappointing.

  4. tmac57on 13 Jan 2011 at 10:57 am

    Another good reason for Drs to focus on the science is the example of what happened to Simon Singh in his recent battle with the BCA.The potential for getting dragged in to the swamp of litigation in the UK,has a chilling effect on what sort of claims a public figure is willing to risk making. If a Dr can make the point that a researcher’s study is unsound scientifically,without the added peril of being brought up on libel charges,then it is easy to see which is the easier choice.

  5. Steven Novellaon 13 Jan 2011 at 11:51 am

    No one doubts that there are psychological, and even tangible, benefits to seeing a practitioners. It makes one feel better, we respond well to attention, to the hope that derives from it, and we may also take care of ourselves in other ways now that we see the hope of getting better.

    These are all generally recognized non-specific effects of the therapeutic interaction. They are also limited in what they can realistically do, but they are of value.

    What we are seeing today is a proliferation of pseudosciences that are either deceptively, or explicitly, exploiting these non-specific effects in order to promote specific and absurd treatments. This makes no sense.

    You can get the benefits of a good bed-side manner without the pseudoscience, even if there is nothing much that science-based medicine can do. There are always palliative treatments, life-style adjustments, and quality of life interventions to use. There is no legitimate role for magical nonsense, and nonspecific effects do not support their use.

  6. Watcheron 13 Jan 2011 at 1:07 pm

    I agree that this is a false dichotomy, probably from both sides. Each is important and tells the whole story. Wakefield isn’t just a bad researcher, he’s a poor excuse for a human-being also.

  7. marc82281on 13 Jan 2011 at 1:18 pm

    It’s comment’s like this:

    “In light of all this, many medical science bloggers (myself included) have had to point out that accusations of conflicts of interest are not sufficient to dismiss evidence.”

    which reaffirm my admiration for Steve as a leader of the skeptical community (not that my admiration needed any reaffirming…I mean, from a Bayseian perspective, Steve has shown himself to be so full of skeptical/intellectual integrity so many times that he’d have to do something really biased and douchey for me to feel otherwise)

    Wakefield is one of the lowest of the low. He’s down on the ground. The media is kicking him. Yet the his most vocifierous critics stand tall, rise above, forgo the opportunity to kick him while he’s down, and demand that he his science be rejected b/c it’s bad science; not b/c it came from a bad scientist and a fraudulent douche. That’s awesome in my book.

  8. Draalon 13 Jan 2011 at 4:31 pm

    FYI, Deer made a correction to his blog, possibly in response to either Dr. Gorski or Dr. Novella.
    “This article was amended on Wednesday 12 January 2011. The original suggested the quote from Dr Ben Goldacre was from an article by him in the BMJ. It also didn’t make clear the quote pre-dated the GMC’s ruling. This has been corrected.”

  9. Draalon 13 Jan 2011 at 4:39 pm

    I have a question, has Wakefield paid the proper price for committing fraud? When those that commit fraud in other fields say financial markets or politics, they can be sent to jail. Why should a “scientist” like Wakefield not be convicted as a criminal? I assume he’s caused financial harm to the vaccine industry. He’s responsible for what the SGU has called a “body count”.
    I can see that Wakefield used the guise of science to commit his fraud. That’s what I think Deer is focusing on. The fraud preceded the science. Why shouldn’t what Wakefield did not be viewed as a white collar crime?

  10. Draalon 13 Jan 2011 at 4:46 pm

    Opps. Disregard my first post as irrelivant as I read over Orac’s post a little to quickly.

  11. tmac57on 13 Jan 2011 at 6:10 pm

    Dr. N, you last comment made me think of the Wizard Of Oz handing out his tokens of ‘brains’,'heart’,and ‘courage’. Homeopathy is indeed Wizard of Oz medicine.

  12. daedalus2uon 16 Jan 2011 at 10:16 am

    I agree with Offit. What matters is that the idea was wrong. How it was wrong, what wrong steps happened to make it wrong don’t really matter. There are plenty of wrong ideas that were not derived via fraud. That a wrong idea was not derived via fraud doesn’t make it a little bit more right, it is still wrong.

    We can’t have the standard for accepting an idea be that the idea was not derived via fraud. We also can’t vilify scientists who come up with wrong ideas. We should vilify scientists who commit fraud. There are unscrupulous individuals who are all too willing to vilify their opponents as a tactic to defeat them in the marketplace of ideas, even if they are correct. The anti-vaccine disinformation campaign has tried to vilify pro-vaccine individuals even when they are correct.

    The standard for proving fraud is much more difficult than simply showing that an idea is wrong. If we hold onto ideas until they are shown to be fraudulent, then we will hold onto many wrong ideas.

    Why are there no legal sanctions against the lawyer who hired Wakefield using public funds from the government? Why could he take public funds, hire Wakefield to generate fraudulent data and no one seems to mind?

  13. ccbowerson 16 Jan 2011 at 12:02 pm

    “How it was wrong, what wrong steps happened to make it wrong don’t really matter.”

    …and the rest of your post directly contradict this statement. If your/his point that “it doesn’t really matter” is in reference the obvious lack of relationship between “wrongness” and “fraudness” then you are making a very small point in a very narrow sense. Science has room for and expects a great deal of wrongness that occur through the normal process of scientific inquiry, but fraud is viewed as completely unacceptable at any level.

    Fraud does matter a great deal more than just being wrong for some of the reasons you mentioned later in the same post. In addition, it points to some possible systemic flaws (and maybe some positives) that allow such a paper to be published and take >10 years to be retracted. The value of science is directly related not only to the accuracy of findings, but to the trust that people have in those findings. It does no good to be correct if no one is listening.

    You can make an analogy with politics. I can accept that many politicians are uninformed and make decisions that are due to their ignorance and incompetence, but I view corruption as a far greater problem even if the magntitude of its damage is less. The former is viewed as part of the process and the later is detrimental to the process.

  14. Draalon 16 Jan 2011 at 1:20 pm

    “…and the rest of your post directly contradict this statement.”
    I agree with ccbowers too.

    Deer bent over backwards to prove that fraud was committed using science. Wakefield is still walking free in the US, able to continue making money and still promoting the vaccine/autism link. I think its appalling that he has not been fined or charged with a crime and extradited to the UK.

  15. Draalon 16 Jan 2011 at 1:35 pm

    “How it was wrong, what wrong steps happened to make it wrong don’t really matter.”

    And what about, “the ends justify the means?” An idea can be right, but if a scientist knowingly uses illegal means (lying to patients, use of illegal practices, ect), he should be held accountable. It shouldn’t matter that he’s a scientist, or was performing science, or his ideas were right. If he commits a crime like fraud, then he should be subject to the judicial system.

  16. daedalus2uon 16 Jan 2011 at 3:35 pm

    To accuse someone of fraud is to beat them with a gigantic stick. Michael Mann has been accused of fraud and has been investigated multiple times. Some of those investigations are purely politically motivated (yes by republican AGW deniers in positions of authority).

    In my opinion, science would be better off trying to replicate studies and gather new data which is cleaner and better rather than trying to investigate allegations of fraud. Investigating fraud takes a long time and is extremely expensive to all involved and can result in equivocal results. Allegations of fraud can be used as a weapon to destroy opponents. There is no funding to cover the reasonable expenses of those falsely accused of fraud.

    Michael Mann is being investigated for fraud solely for intimidation, to shut him up and to waste his time. It is essentially a SLAPP lawsuit but brought by the Attorney General of VA.

    http://en.wikipedia.org/wiki/SLAPP

  17. Draalon 16 Jan 2011 at 5:03 pm

    Daedalus,
    First off, science didn’t investigate fraud allegations of Wakefield, or anyone for that matter. Deer, the investigative journalist was. Deer is frustrated that Offit and other doctors dismissed his work as irrelevant and did not recognize the usefulness of his findings.

    Must a scientist throw away all other critical thinking arguments and use the scientific method as their only tool? Dr. Novella and other skeptics teach us to be skeptical of claims, even from authority figures. The authority figure’s background becomes a relevant factor if it pertains to their claims. Fraud sure as hell does.

  18. Draalon 16 Jan 2011 at 5:28 pm

    Here’s a useful comment that appears to be written by Ben Goldacre on Brian Deer’s blog entry.

    bgoldacre

    12 January 2011 4:28PM

    I can’t find the quote attributed as written by me in the BMJ on Google, in a BMJ search, or in my own email, so I don’t know if I did write that. I may well have, it would be interesting to see the context, and the date when I wrote it.

    My view on the Wakefield Lancet paper has changed with time and new evidence, the GMC ruling, Deer’s BMJ pieces, etc.

    Initially, it seemed like Wakefield’s paper was a perfectly good 12 subject case series report, a description of 12 childrens’ clinical anecdotes. My view then was that a 12 subject case series report is weak evidence for something causing something else, and therefore this paper should not have triggered a gigantic and lengthy scare story throughout the entire British news media. It’s significance was overstated by journalists.

    Now, my view has changed, in the light of Brian Deer’s excellent work: we now know that this was a flawed and misleading 12 subject case series report. So that’s two big problems with it triggering a gigantic and lengthy scare story: it was a weak form of evidence to start with, by design, but on top of that, it was itself dodgy.

    I think it’s worth reiterating that even if Wakefield’s paper had been a perfect and immaculately well-conducted 12 subject case series report, Wakefield’s Lancet paper should still never have triggered a gigantic and lengthy scare story throughout the entire British news media, because a 12 subject case series report is still very weak evidence for something causing something else.

    One possible context for the possible BMJ quote attributed to me (I’m speculating) is this: people often suggest that the Lancet were wrong to publish a case series report, as if such a piece of weak speculative research is always and automatically useless. As I’ve said on various occasions, I think it’s dangerous to say that academic journals should refuse to publish things on the grounds that they might be misunderstood by the public, or overstated by journalists, so I do think that a case series report is a perfectly sensible thing for an academic journal to publish, because academic journals are edited to be read by academics, with a critical eye.

    Another possible context (again I’m speculating) is this: anyone who’s read my stuff will know that I blame the media *and* Andrew Wakefield for the MMR scare, but also, as I’ve written more recently, I think it’s problematic that the media have now let themselves off the hook by pinning all the responsibility for the scare onto Wakefield, when they need to look at their own mistakes too.

    I’ve been unswervingly supportive of Brian Deer’s work, linked to it, written about it, and promoted it at every opportunity, including now (there has been almost total media silence in the UK on his current revelations), and I’ll continue do so.

  19. Draalon 16 Jan 2011 at 5:41 pm

    I do agree that Deer’s examples of Offit and Goldacre are really really bad examples.

  20. ccbowerson 16 Jan 2011 at 11:39 pm

    “Investigating fraud takes a long time and is extremely expensive to all involved and can result in equivocal results.”

    That sounds alot like most worthwhile endeavours. Someone could make the same criticism of science. Besides, no one is saying that individual scientists should spend more of their time investigating fraud. And just because investigations can be used as intimidation does not mean that appropriate investigations are not valuable. Investigation of fraud should be a rare occurence but lets not close our eyes and pretend it will go away, because fraud (or the perception of it) is a serious threat to science. It can add to the already excessive mistrust of science by the public. Appearing to not value the integrity of science is among the worst attitudes that scientists can portray to the public.

  21. daedalus2uon 17 Jan 2011 at 9:40 pm

    Cc, scientists are not good at uncovering fraud. Randi showed that as a magician used to doing things to trick people into perceiving something wasn’t there, he was a much better fraud detector than were many scientists.

    The problems that Wakefield caused would have been just as severe if he hadn’t committed fraud. The problem wasn’t the fraud, it was the media blowing his “results” all out of proportion and people believing the “lone maverick scientist” had uncovered something that everyone else was too biased to find.

    The problem wasn’t with the science, it was how the media took extremely preliminary results and blew them all out of proportion. A lot of the problem (I think) is that Wakefield is a charismatic person, and can be charming and compelling (the way that many sociopaths can be). Media personalities are very poor BS detectors.

    News media isn’t put out to be “informative”, it is put out to be entertainment. News media has to be compelling entertainment, or people will switch the channel to something more compelling, a game show, a sports contest, a sit-com, or porn.

    Fraud cannot be uncovered on the 24 hour news cycle.

    Wakefield’s fraud could have been uncovered much sooner. Chadwick knew that Wakefield’s results were bogus. Chadwick had done PCR on all the samples that Wakefield claimed were positive via antibodies. Chadwick had sequenced every positive result he got and he found that all of the positives were false positives. He told this to Wakefield before Wakefield published the Lancet paper with positive antibody results. Chadwick was scheduled to be listed on the paper but he had Wakefield take his name off it. I don’t fault Chadwick, he was in an impossible situation. He was doing good work but being supervised by a fraud. If he blew the whistle on that fraud in the wrong way, Chadwick would have been destroyed, his career would have been destroyed and he would never have been a scientist.

    The “apprenticeship” aspect of science and PhD programs is something that needs to be fixed. Senior scientists cannot be allowed to have life-and-death control over their students, there is too much potential for abuse. Science had some articles a while back about grad students in the lab of a faculty member that was committing fraud. They blew the whistle on her, and I think 3 out of 5 had their careers destroyed before they even started. One had to restart her PhD thesis for a different advisor, the others had to drop out.

    The problem with Wakefield was a problem of main stream media. Wakefield played the media for fools and the media allowed themselves to be played for fools and amplified Wakefield’s ability to do harm by many fold. Wakefield was able to tell a made-up story that resonated with the media and parents, played on their fears. Scientists and health care providers only had facts and logic to work with, they couldn’t just make stuff up the way that Wakefield did.

    We were very lucky that Brian Deer just happened to start digging into Wakefield’s stuff when he did.

    I would like to see Wakefield go to prison, I would like to see the lawyer that funded him go to prison too. 20 years for each of them would not be too long. They caused the deaths and suffering of many children.

    If Brian Deer things that scientists “circled the wagons” around Wakefield, wait until he tries to get sanctions against the lawyers that funded Wakefield. I suspect he wouldn’t even be able to get suggestions that the lawyers should be investigated into print (which is why I think there haven’t been any).

  22. Draalon 18 Jan 2011 at 9:35 am

    “Cc, scientists are not good at uncovering fraud.”

    CC and myself are not saying scientists are or expected to be investigating fraud. Stop with that straw man, please!

    “If Brian Deer things that scientists “circled the wagons” around Wakefield, wait until he tries to get sanctions against the lawyers that funded Wakefield.”

    Deer said doctors. A doctor is usually not scientist.

    “I would like to see Wakefield go to prison, I would like to see the lawyer that funded him go to prison too. 20 years for each of them would not be too long. They caused the deaths and suffering of many children.”
    I agree.

  23. daedalus2uon 18 Jan 2011 at 10:03 am

    To elaborate on my earlier comment. I am not defending fraud or minimizing how bad fraud is, but the problem with the anti-vaccine hysteria wasn’t about fraud even though Wakefield is a fraud.

    It was about bad and inadequate science being used to formulate policy and to formulate treatments for people which harm them. This is not limited to cases of fraud. Eliminating all fraud would be a good thing, but it won’t eliminate the use of bad and inadequate science to formulate policy and to formulate treatments for people that harm them.

    I don’t think there is any fraud in the XMRV controversy, but there is certainly a lot of hype and overblown conclusions. There are people being treated with anti-retrovirals on the basis of the work that has been done so far. I think that is very unfortunate. People receiving anti-retrovirals for CFS are being subjected to malpractice and are very likely being harmed.

    I think it is the same in the chronic Lyme. I don’t think there is any fraud among those treating people with long term antibiotics, just poor understanding of infectious diseases, poor understanding of how antibiotics work, a lot of groupthink and poor judgment. People being subjected to long term antibiotic treatment is harmful.

  24. ccbowerson 18 Jan 2011 at 11:30 am

    It appears that there is not much disagreement here.

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