The war on Dr Wakefield: only 12 years too late
Yes, Dr Andrew Wakefield’s MMR-autism theory was dishonest, but he’s not the only one to blame for the great vaccine scare of the past 12 years.
In the course of a number of interviews following the verdict on Andrew Wakefield at the UK General Medical Council last week, one journalist suggested that, as a long-standing critic of Dr Wakefield’s campaign claiming a link between the MMR vaccine and autism, I must be pleased that he had been found guilty of dishonesty and irresponsibility.
Well, I was relieved that the GMC had finally come to a categorical verdict on the conduct of Dr Wakefield’s research, which resulted in the 1998 Lancet paper that launched the MMR-autism scare, with damaging consequences for families affected by autism and for child health in general. But my overwhelming feeling was one of sadness for (almost) everyone involved in this protracted affair – and some anger that it has taken 12 years to reach this stage, and that it is still not concluded. The case is due to resume in April as the GMC decides what sanctions to take against Dr Wakefield and his former colleagues.
It is difficult to feel much sympathy for Dr Wakefield even as he faces such a public humiliation. His decision to attend the protest outside the GMC but not to enter the building to face in person the decision of the tribunal is typical of his evasion of accountability to his peers and of responsibility for his actions. For the past decade Dr Wakefield has avoided the medical and scientific world, producing articles for vanity-published journals and attending only conferences of parents. He even avoids scientifically informed journalists: his only interview on the GMC decision was given to a sympathetic features writer at the Daily Telegraph. Though Dr Wakefield has always enjoyed the support of sycophantic journalists and wealthy patrons (especially in the US), he cannot avoid the professional ignominy that results from the GMC proceedings.
Yet Dr Wakefield’s disgrace has caused much damage to others, including to his loyal wife and family. It has harmed the reputations of his former Royal Free colleagues, John Walker-Smith and Simon Murch, both long-serving and respected clinicians, who appear to have been dragged down by Dr Wakefield’s dishonesty. The greatest casualties are the families of children with autism, not only the Lancet 12 but the thousands – in the US as well as Britain – drawn into futile litigation as a result of their faith in Dr Wakefield. The protest in support of Dr Wakefield outside the GMC confirms that once parents chase off into the pseudo-science, conspiracy theories and quackery of the campaign against MMR, it is very difficult to find a way out of a rabbit hole such as this.
A number of myths and misconceptions have arisen around the GMC case against Dr Wakefield. One is that the GMC’s action is the result of a vendetta against Dr Wakefield by the investigative journalist Brian Deer. Another is that all three of the defendants were found guilty on all charges. A third is that nobody else is to blame for the MMR-autism fiasco. Let’s take these in turn.
It is true that, from February 2004 onwards, Brian Deer’s articles in The Sunday Times and television features for Channel 4 played an important part in exposing the truth about Dr Wakefield’s research to the general public. The GMC proceedings and the final verdict have proved a powerful vindication of Deer’s work. It should also be noted that he courageously pursued this work in the face of a vituperative campaign by supporters of Dr Wakefield. Furthermore, Deer has also successfully fought off attempts by Dr Wakefield to use the courts to suppress his revelations of conflicts of interest and unethical practices (the key charges on which he was convicted by the GMC).
Yet it was not Deer who suggested that the GMC investigate Dr Wakefield’s activities – this was the initiative of the Liberal Democrat MP Evan Harris, who first challenged Dr Wakefield in public in a television debate in December 2003. Nor was it Deer who first discredited Dr Wakefield’s research scientifically – that was the result of the work of the former Royal Free paediatrician Brent Taylor, in collaboration with immunisation specialist Elizabeth Miller and others, in a series of papers published from 1999 onwards. A mountain of scientific research, in virology and gastroenterology, as well as in epidemiology, in the US and Japan as well as in the UK and Europe, has further discredited the Wakefield thesis.
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Though it has been widely reported that the GMC verdict was ‘all three men guilty on all counts’, this is not an accurate summary of the 143-page judgment. The GMC found on numerous instances that Dr Wakefield’s conduct was ‘dishonest’ and ‘irresponsible’; his two co-defendants were found to have been ‘irresponsible’ but not ‘dishonest’.
One of the key points established by the GMC was that the children in the Lancet study had not been routinely referred to a department of paediatric gastroenterology on clinical grounds, but had been recruited to a research project to investigate a postulated new syndrome characterised by the development of autism and gastrointestinal symptoms following measles vaccination. All three doctors were found guilty of subjecting these children to invasive investigations (including lumbar punctures and colonoscopies) that were not justified by clinical need but were carried out for the purposes of research, and had not been ethically approved. As the leading author of the Lancet paper, Dr Wakefield was found to have misrepresented these cases as routine referrals. In fact, four of the 12 had not presented with gastrointestinal symptoms, but because their parents believed that there was a link between their children having MMR and developing autism. In another four cases, Dr Wakefield had been personally involved in the referral process.
The GMC found that Dr Wakefield had lied about this biased selection procedure in the original Lancet paper, in correspondence in the Lancet and in his responses to questions at the subsequent Medical Research Council inquiry. Dr Wakefield was also found guilty of failing to disclose funding from the Legal Aid Board, and of unethically and unprofessionally authorising investigations and instigating experimental treatments.
Though he was the senior consultant on the list of authors of the Lancet paper, John Walker-Smith admitted that he had not read the final draft submitted by Dr Wakefield. He was found by the GMC to have been ‘naive’ and ‘lacking in thoroughness’. Simon Murch, who carried out the colonoscopies on the children, was also considered to have ‘failed in his duties as a responsible consultant’, and in some cases of ‘not acting in the best interests of children’. However in relation to both Walker-Smith and Murch, charges of dishonesty were found ‘not proved’. Still, in all three cases, the GMC concluded that the findings were sufficiently serious to merit further consideration of whether they amounted to ‘serious professional misconduct’.
The impact of the campaign against MMR cannot be reduced to the activities of one man, or even to the three men brought before the GMC: a wider failure of medical quality control and public scrutiny allowed junk science to have an adverse effect on children’s welfare and public health. Dr Wakefield’s research was supervised by the senior (adult) gastroenterologist at the Royal Free; the press conference at which he launched the demand for separate vaccines was staged by the Royal Free medical school; the transparently flawed study was peer-reviewed and published by the Lancet. Dr Wakefield’s subsequent collaborators also have a case to answer. Studies jointly published by Dr Wakefield and the Dublin pathologist John O’Leary, claiming to have demonstrated measles virus in bowel biopsies taken from children with autism, have been authoritatively dismissed as invalid, if not fraudulent.
Despite having advance warning of the Lancet paper, the government’s Department of Health and the Medical Research Council were slow off the mark in responding to the challenge and remained several steps behind Wakefield’s skilful manipulation of the media. Before Brian Deer took up the case in 2004, the media generally and shamefully took Wakefield at his own estimation as a courageous maverick.
Indeed, before Deer did what an investigative reporter should do, The Sunday Times itself had an undistinguished record on the vaccine-autism issue. A major feature in The Sunday Times Magazine in December 1995, entitled ‘A Shot In the Dark’, played an important role in launching the MMR scare: it publicised for the first time both the notion of a link between MMR and autism mediated by inflammatory bowel disease and the research in this area being carried out by Dr Wakefield at the Royal Free. It was in February 1996, two months later, that the solicitor Richard Barr hired Dr Wakefield to support his litigation against MMR manufacturers. Seven months later, in July 1996, the first of the Lancet 12 children was admitted to the Royal Free. Between 1998 and 2004, when Dr Wakefield was at the height of his popularity, The Sunday Times followed the rest of the British media in indulging the anti-MMR campaign.
It seems that everybody now wants to see Dr Wakefield struck off the medical register. This chorus of condemnation was conspicuously absent when, in the five or six years following the Lancet paper, Dr Wakefield was the darling of the media, the subject of adoring newspaper features, a special edition of Private Eye, a hagiographical TV docudrama on Channel Five, and numerous celebrity endorsements. Once again, the crucial point is that the fault for this damaging episode lies not only with the individual who so irresponsibly started it but also with those who so irresponsibly disseminated it. Of course the media must report new and interesting scientific claims, but as with any story they have a duty to perform a basic journalistic activity. It is called ‘checking the facts’.
The clamour for retribution against Dr Wakefield also reflects a degree of bad faith in the British medical establishment. The ethical violations detailed in the GMC judgment should have been dealt with either before or shortly after the publication of the Lancet paper. Having turned a blind eye to Dr Wakefield when it mattered, the medical establishment now pursues him with a measure of vindictiveness.
The GMC’s judgment on the now notorious ‘birthday party’ incident – in which Dr Wakefield took blood samples to use as controls from guests at one of his children’s birthday parties and subsequently told the tale as a humorous anecdote in one of his conference speeches to parents – could stand as a symbol of the medical establishment’s inept handling of this affair. Instead of dismissing this trivial episode as a lapse of judgment and taste, it drew the sternest rebuke of the judgment when Dr Wakefield was castigated for his ‘callous disregard’ for the children involved. As the video clip of Dr Wakefield telling the ‘birthday party’ story has gone around the world via YouTube (and has even featured on the BBC News website) this now appears to many as his greatest crime. In fact, its inclusion in the GMC judgment merely demeans the wider case against Dr Wakefield and diminishes his real offences.
Dr Michael Fitzpatrick is the author of MMR and Autism: What Parents Need to Know (buy this book from Amazon(UK)) and Defeating Autism: A Damaging Delusion (buy this book from Amazon(UK)).