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.


Orac’s take on this same issue

24 responses so far