MMR: the controversy continues
Despite Dr Andrew Wakefield's increasing isolation, broader suspicion of medical authority is keeping his campaign going.
Even though Dr Andrew Wakefield, the leading protagonist of the MMR-autism link, has been discredited, and the Lancet paper that launched the scare in 1998 has been repudiated by 10 of its 13 co-authors, the controversy continues. This suggests that the key factor in the scare is not Dr Wakefield’s flawed science, but the wider climate of fear of environmental dangers and suspicion of scientific, medical and political authority.
The emergence of Carole Caplin, Cherie Blair’s former lifestyle guru, as Dr Wakefield’s latest media champion, may have caused some apprehension in the anti-MMR camp, but Caplin’s presentation of the case provides some insights into the outlook that sustains public concerns about the vaccine. For Caplin, the controversy is a Manichean conflict between the forces of good and evil.
On the side of darkness are ‘very senior government health bureaucrats, who advise our politicians, and leading figures in the British medical establishment, who advise the bureaucrats’, forces of ‘vast power and ruthlessness’. The drug companies ‘coexist very cosily indeed’ with the public health authorities, with the result that ‘at the heart of the conventional medicine system, there exists a toxic mix of money, great power and arrogance’. For Caplin, ‘it’s been crystal clear that extremely powerful forces would like nothing better than to suppress public debate about the issue and discredit anyone questioning MMR’. To these ‘powerful vested interests’ who ‘always play dirty when under threat’ and ‘behave like bullies’, Dr Wakefield is ‘a traitor who must be crushed’.
On the side of light stands Dr Wakefield, ‘a courageous lone voice’, a ‘compassionate man’ and a doctor ‘who actually believes that it is his duty as a doctor to listen to his patients’. Caplin believes that Dr Wakefield has been ‘smeared in the press as having a possible conflict of interest’ - ‘what a joke’. (Curiously, Caplin also concedes that ‘Dr Wakefield obviously made a serious mistake’ in not disclosing the conflict of interest arising from his receipt of £55,000 in legal aid funds from the solicitor leading the anti-MMR litigation. Her advice that ‘he needs to own up to that mistake’ may not be as well received by Dr Wakefield as the rest of her article.)
Caplin argues that the revelations about Dr Wakefield’s funding were part of ‘a series of orchestrated attacks on him in the media’ timed to coincide with the judicial review of the decision by the Legal Services Commission to withdraw legal aid funding for the anti-MMR campaign (which was upheld).
I present this account in some detail because it is one that undoubtedly strikes a chord with many people. It has a particular resonance among the disaffected middle classes, who have become increasingly anxious and insecure as a result of wider social and political shifts over the past decade. A combination of a sense of vulnerability to environmental threats and a distrust of scientific and medical expertise and of all forms of authority has made many receptive to a wide range of scares about health-related issues.
This outlook cuts across traditional sociological and political alignments - it can be found as readily among readers of the Guardian as among those of the Daily Mail. However, a jaundiced view of the world may result in seriously distorted perceptions of reality - which are evident in the highly irrational view of the MMR controversy advanced by Caplin.
Though Caplin’s depiction of the medical establishment is widely believed, it bears little relation to reality. Far from being arrogant, authoritarian and ruthless, the medical establishment is diffident, lacking in confidence and ineffectual in pursuing its interests: witness its defensive response to the inquiries into the Bristol children’s heart surgery unit, the Alder Hey ‘retained organs’ scandal and the murders of Harold Shipman (1).
The conciliatory response to Prince Charles’ recent proposal to incorporate alternative ‘complementary’ medical treatments into the NHS reflects a loss of confidence in scientific medicine. Yet the very impact of the MMR scare confirms the dangers of indulging fashionable alternative modes such as homeopathy. Though this is widely regarded as a harmless fad, it has nurtured irrational anti-vaccine notions such as the idea that immunisation compromises natural immunity and may cause autoimmune disorders, which have spread from a bohemian fringe to acquire mainstream influence in society.
No doubt the pharmaceutical corporations, like all capitalist enterprises, are more concerned about their profitability than the welfare of their consumers. There are many areas in which they can be legitimately accused of profiteering, disease-mongering and sharp practice. Yet vaccine development, a relatively low-volume, low-profit sector, is not one of them. Indeed, it is an area characterised by low investment and declining innovation, partly as a result of the climate of risk aversion and litigiousness, particularly in the USA. For Caplin, the corrupt links between the public health authorities and the drug companies, is a subject ‘we all know’ about (and she can be confident that many of her readers share this presumption). Hence she does not have to provide any evidence for a proposition that is highly implausible (while confirming her readers’ prejudices).
The fact that it has taken the Lancet - and Dr Wakefield’s co-authors - six years to repudiate a paper that should never have been published in the first place is testimony to the equivocal response of the medical establishment to bad science backed up by a popular campaign, generously subsidised by legal aid and with friends in high places, notably in the media. In the world of autism, few authorities have been prepared to challenge the absurd claims made by the anti-MMR campaign, despite its damaging effect on numerous parents.
It is true that immunisation authorities at the Department of Health rejected Dr Wakefield’s claims about MMR and took a firm stand against the demand for separate vaccines that his campaign encouraged. The major difficulty in presenting this approach to the public was that it stood in stark contrast to the strongly populist and consumerist ethos promoted by the government in every other area of health policy. When every instinct of New Labour and many in the medical establishment was to equivocate, the chief medical officer had to threaten to resign to hold the line on MMR, recognising that any concession to the Wakefield campaign would undermine public confidence in the whole immunisation programme.
Is Dr Wakefield a secular saint for the twenty-first century, martyred at the hands of ruthless medical conspirators? In relation to extravagant claims made for Dr Wakefield’s role at the Royal Free, it is important to recall that he never had clinical responsibility for the children referred there (he was employed as a researcher, not as a clinician, and is not qualified to treat children). Dr Wakefield has repeatedly expounded this commitment to listening to the patient, but does not seem to recognise that the reason he found this so congenial was that they were often expressing his previously publicised views (if they had not been directly sent by the anti-MMR solicitor Richard Barr, via their own GPs). Dr Wakefield’s listening skills do not seem to extend to either parents or colleagues who do not share his views.
No doubt Dr Wakefield’s sympathetic manner endeared him to many parents, but as one of his former colleagues recalls, he mainly provided a ‘front of the house’ show, meeting and greeting families (as reflected in the Channel 5 film Hear the Silence), while less flamboyant doctors got on with the work of the clinic (not shown in the film). While he expressed concern that his departure might adversely affect the clinical care provided to autistic children at the hospital, others wonder whether all the adverse publicity resulting from his campaign may have had a more damaging effect. While Dr Wakefield has devoted his energies to the anti-MMR campaign, his former colleagues have quietly continued both seeing children with autism and bowel problems and conducting further research into the still contentious diagnosis of ‘autistic enterocolitis’.
It is true that Dr Wakefield’s career in mainstream medical research has been effectively destroyed by his anti-MMR campaign. But this is more the result of his refusal to follow the rules of scientific research by persistently promoting a hypothesis that neither he nor anybody else has been able to substantiate (at least to the satisfaction of any reputable scientific authority), than the consequence of some arbitrary persecution. It is not the medical establishment that has suppressed debate about MMR, but Dr Wakefield who has avoided it.
In 2001, Dr Wakefield rejected an invitation to attend the Medical Research Council’s review of autism research, an inquiry that included leading authorities in all the relevant disciplines. Ironically in view of recent revelations, he justified this evasion on the grounds that some of the specialists invited had been retained as expert witnesses by solicitors defending the drug companies in the anti-MMR litigation. Dr Wakefield’s former colleague, Dublin virologist Professor John O’Leary is recorded as not responding to an invitation to attend. This refusal by the leading figures in the campaign against MMR of an opportunity to put their case before a forum of experts suggests a lack of confidence in their evidence for the MMR-autism link (further confirmed by the collapse of the litigation).
In response to The Sunday Times revelations regarding Dr Wakefield’s legal aid funding, he has again dodged public debate. Hiding behind an elite PR firm, he has briefed selected journalists, selected apparently on the basis of their scientific illiteracy and past sympathies towards Dr Wakefield’s position (it is striking that broadsheet science and medicine reporters are excluded). An increasingly isolated figure, he has come to rely on authorities whose expertise in the relevant disciplines is dubious.
One is Dr Peter Harvey, the only co-signatory of the 1998 Lancet paper who refused to sign the retraction published in the Lancet this week. As an adult neurologist at the Royal Free, it is not clear why he - rather than a paediatric neurologist - was invited to examine the children included in the paper. It is however clear that he had taken early retirement from the Royal Free before the paper was published so that he could devote himself exclusively to private practice. He is co-owner of a substantial property in Harley Street from which he conducts his largely medico-legal practice, specialising as an expert witness in cases such as whiplash and repetitive strain injury. He has recently become a trustee of Dr Wakefield’s charity Visceral, whose website provides him with the title of professor, though it is unclear where this was acquired. Though Dr Harvey has also been a beneficiary of Mr Barr’s legally aided largesse, the nature of his expertise in this matter remains a mystery.
Another loyal supporter of Dr Wakefield is Dr Jeff Bradstreet, who was cited by Melanie Phillips in her - well-briefed - defence of Dr Wakefield in the intransigently anti-MMR Daily Mail. Dr Bradstreet is director of the International Child Development Resource Center in Florida (where Dr Wakefield was said to have taken up employment after his departure from the Royal Free). In the Channel 5 debate, Dr Bradstreet, presented himself as a paediatrician, a family practitioner and a professor of neuroscience. Melanie Phillips introduces him as ‘a US autism researcher’.
It should be pointed out that he has also helped to develop ‘Sea Buddies Concentrate’, a nice little earner advertised as a ‘high potency formula with five ingredients that help support healthy focus and concentration in children’. According to the website of his Good News Doctor Foundation, based in Melbourne, Florida, the multi-talented Dr Bradstreet has also conducted ‘vast research’ into the Bible, which has given him a ‘clear grasp’ of Scripture.
Well praise the Lord - and God help the families of children with autism who have been dragged into this circus.
Dr Michael Fitzpatrick is the author of MMR and Autism: What Parents Need to Know, Routledge, 2004 (buy this book from Amazon (UK) or Amazon (USA)); and The Tyranny of Health: Doctors and the Regulation of Lifestyle, Routledge, 2000 (buy this book from Amazon UK or Amazon USA). He is also a contributor to Alternative Medicine: Should We Swallow It? Hodder Murray, 2002 (buy this book from Amazon (UK) or Amazon (USA)).
MMR: Investigating the interests, by Dr Michael Fitzpatrick
spiked-issue: MMR vaccine
(1) See After Bristol: the humbling of the medical profession; The high price of Alder Hey; After Shipman, by Dr Michael Fitzpatrick