MMR: the making of junk science
Anti-MMR campaigners are playing a new media game.
‘Even eminent scientists have had their careers tarnished by misinterpreting unremarkable events in a way that is so compelling that they are thereafter unable to free themselves of the conviction that they have made a great discovery.
‘Moreover, scientists, no less than others, are inclined to see what they expect to see, and an erroneous conclusion by a respected colleague often carries other scientists along the road to ignominy. This is pathological science, in which scientists manage to fool themselves.
‘If scientists can fool themselves, how much easier is it to craft arguments deliberately intended to befuddle jurists or lawmakers with little or no scientific background? This is junk science. It typically consists of tortured theories of what could be so, with little supporting evidence to prove that it is so.’ (Voodoo Science: The Road From Foolishness to Fraud, Robert Park, Oxford, 2000)
Having failed to come up with hard evidence for the hypothesis of a link between the Measles, Mumps and Rubella (MMR) vaccine and autism, campaigners against MMR are now provoking popular anxieties by presenting their research directly to the public before submitting it to proper scientific evaluation and confirmation. The result is an increasingly irrational campaign, sustained in part by uncritical media commentary.
Speaking on 19 June 2002 before a US congressional committee considering ‘The status of research into vaccine safety and autism’, Dr Andrew Wakefield, the British gastroenterologist who launched the MMR-autism scare in 1998, outlined the progress of his research.
He claimed that, ‘most significantly’, a currently unpublished study that is due to be presented by virologist John O’Leary at a conference in Dublin in July, had ‘confirmed that the measles vaccine virus is present in the diseased intestinal tissues of children with regressive autism’. Furthermore, ‘state-of-the-art molecular science’ had shown that, in the cases of 12 children with a combination of autism and inflammatory bowel disease, the measles virus in their intestines originated in the MMR vaccine. For Wakefield, these studies constituted ‘a key piece of evidence in the examination of the relationship between MMR vaccine and regressive autism’.
On 2 July 2002, however, Professor O’Leary rejected Dr Wakefield’s interpretation of his work, insisting that it ‘in no way establishes any link between the MMR vaccine and autism’ (1). Indeed, he strongly recommended that parents should give their children MMR. O’Leary’s judgement echoed that of other experts who had earlier dismissed Wakefield’s claims for this research to the congressional committee in Washington. The first piece of evidence promising some support to the hypothesis advanced by Dr Wakefield in 1998 was thus discredited even before publication.
Though Professor O’Leary himself denied that his work gave any support to the case against MMR, in the weeks leading up to the July Dublin meeting it was widely cited by anti-MMR campaigners. Throughout June 2002, reports of the impending publication of this research provided a major publicity boost to a campaign that had flagged since the Christmas 2001 furore over whether Tony Blair’s son Leo had had his MMR jab (a period in which the uptake of MMR had shown signs of recovery). The hype surrounding the O’Leary paper reveals much about the modus operandi of the campaign and its leading figure, Dr Wakefield.
The first hint of the significance of Professor O’Leary’s latest work came in a typically sycophantic presentation of Dr Wakefield’s case in the Telegraph Magazine on 8 June 2002. This article opens with an effusive account of a visit to the Wakefield household, featuring ‘a likeable, lively family, the kind you would be happy to have as friends’.
The author describes Dr Wakefield as ‘a handsome, glossy-haired charismatic hero’ who is pitted against mysterious forces who have planted bugging devices and have stolen patients’ records in ‘apparently inexplicable’ burglaries. She fantasises about a Hollywood depiction of Dr Wakefield’s heroic struggle, with Russell Crowe playing the lead ‘opposite Julia Roberts as a feisty single mother fighting for justice for her child’.
To appreciate the significance of Dr Wakefield’s exclusive revelations to his star-struck interviewer, we have to go back to an earlier controversy. In a BBC Panorama special on MMR in February, Dr Wakefield had disclosed claims that Professor O’Leary’s team had found measles virus fragments in the guts of autistic children with inflammatory bowel disease. However, this study did not indicate whether the subjects had had measles or the MMR vaccination.
Following widespread criticism of the premature disclosure of these findings, the journal Molecular Pathology was obliged to pre-publish the paper in full on the web to allow proper scrutiny. Commentators observed that, even if these findings were confirmed and replicated, the presence of measles virus fragments in the gut would not prove that they caused either inflammatory bowel disease or autism. Professor O’Leary issued a statement insisting that he had ‘not set out to investigate the role of MMR in the development of either bowel disease or developmental disorder, and no conclusions about such a role could, or should be, drawn from our findings’. Dr Wakefield, however, continued to claim this study in
support of his MMR-autism hypothesis.
Then Dr Wakefield exclusively revealed that ‘more than 95 percent of those who had the virus in their gut had MMR as their only documented exposure to measles’. Wakefield had chosen to make this important revelation, not in a scientific forum, not even to a science journalist, but in a Hello magazine style feature in a weekend supplement. After the publication of a similar presentation of his case in a special issue of Private Eye in May 2002, this approach suggested a consistent pattern, even a deliberate media strategy (2).
Within days, more details of Professor O’Leary’s research began to appear in the press. These were derived from an abstract of a paper due to be presented at the annual meeting of the Pathological Society of Great Britain and Ireland, taking place in Dublin on 2 to 5 July 2002.
A five paragraph summary of a paper entitled ‘Development of an “allelic discrimination” type assay to differentiate between the strain origins of measles virus detected in intestinal tissue of children with ileocolonic lymphonodular hyperplasia and concomitant developmental disorder’ was listed as ‘abstract no 20’ in a series of equally snappy titles (3). The authors claimed that they had corroborated ‘previous findings of an association between the presence of measles virus and gut abnormalities in children with development disorder’, and that the measles virus particles were of the same strain as that used in the MMR vaccine.
How had the contents of an obscure research paper found their way from the deepest recesses of the Pathological Society website into the mainstream media? On 16 June 2002 the Sunday Telegraph presented Professor O’Leary’s results, claiming that ‘scientists have found new evidence to support fears that the MMR vaccine is causing children to develop autism and bowel disease’ (an interpretation subsequently disclaimed by Professor O’Leary).
Similar reports published in different newspapers over the following week quoted the same sources. These included Jackie Fletcher, a veteran leader of the anti-immunisation campaign JABS, Ann and Martin Hewitt, parents of an autistic son and sponsors of the Autism Research Campaign for Health, a new group of families linked to Dr Wakefield’s former department at the Royal Free Hospital in London. They also included Visceral, a charity set up to fund research into autism and bowel disease, of which Dr Wakefield is a trustee. The common feature of these sources, who are also prominent in the Private Eye special, is their close personal relationship to Dr Wakefield.
A consistent pattern emerges in the activities of the anti-MMR campaign. Before research findings can be properly checked and evaluated in the scientific community, they appear – often piecemeal – in the mainstream media. Journalists with little understanding of science are easily persuaded by extravagant claims made by a charismatic researcher and his supporters.
Parents of autistic children, often desperate for any explanation of their child’s disorder, cling to plausible theories, sometimes reinforced by the promise of litigation. In the prevailing climate of intense public anxiety about environmental threats to health, parental fears about the MMR are intensified. By the time that independent scientists refute the claims made by Dr Wakefield and expose the inadequacies of his research and the incoherence of his theory of the causation of autism, the damage has been done.
The Sunday Telegraph article concluded by quoting Dr Wakefield’s statement that ‘Prof O’Leary and colleagues have now provided what may prove to be the most important piece of evidence to date in the case against the MMR vaccine. Parents must at the very least be given a choice of single vaccines’. Though Professor O’Leary has since explicitly disclaimed both propositions, Dr Wakefield has not.
Dr Wakefield is a scientist who has turned hypothesis into dogma, resolutely refusing to abandon his theory despite his failure to provide convincing evidence to support it. For the past decade he has put advanced claims that the measles virus, either as the ‘wild’ or in the attenuated form in vaccines, causes chronic diseases. In the early 1990s, he put forward a range of hypotheses about links between measles virus and Crohn’s disease and ulcerative colitis, which he claimed to have demonstrated. When other researchers failed to replicate these findings, the scientific world concluded that Dr Wakefield’s theories had turned out to be mistaken and moved on.
So too did Dr Wakefield, but only to claim that another disorder was caused by the measles virus – autism. He hypothesised that the mediating link between the virus and the brain was an inflammatory bowel disease, which was neither Crohn’s disease nor ulcerative colitis, but a previously unrecognised condition – ‘autistic enterocolitis’. Though one American paediatrician, Dr Arthur Krigsman, has recently reported a high incidence of bowel inflammation in autistic children referred to his clinic in New York, it remains to be confirmed whether this is a distinct condition.
The response of Dr Wakefield and his supporters to the rising tide of evidence against his theory and the crumbling of evidence in favour of it has been to advance more complex versions of his theory. Thus when numerous epidemiological surveys failed to demonstrate a significant link between MMR and autism, the anti-MMR campaigners argued that if only a small group of children were susceptible to the vaccine they might be missed by such techniques. Dr Wakefield has put forward a number of cases in support of his theory that the major problems arise from the second MMR vaccination, though there is even less evidence for this than his earlier claims.
Others have produced even more convoluted theories. One, which has been advanced in a number of articles in the Sunday Times (and more recently in the New Statesman), attempts to link the British preoccupation with MMR with a long-running anti-vaccination campaign in the USA, which focuses on dangers attributed to the preservative thiomersal (containing mercury) which is used in many vaccines. The problem here is that there is no thiomersal in MMR (because it contains live vaccines) though it is included in the diphtheria, pertussis and tetanus (DPT) immunisation given to all babies in their first year (which has become entirely uncontroversial in Britain over the past 20 years).
The new hypothesis is that in some genetically predisposed children, an accumulation of mercury from these early jabs damages the brain and lowers immunity, with the result that the immune system is overwhelmed by the three live viruses in MMR, causing inflammatory bowel disease and hence autism. It is scarcely necessary to say that there is no scientific evidence for a single step of this proposed pathway of causation, and much counter-evidence. There seems no reason why campaigners should not add the proviso that the risk is greatest when the moon is full and Jupiter ascendant.
Dr Wakefield has opted out of medical science to join the world of pseudoscientific dogma, media celebrity and populist campaigning. He has been joined in the anti-MMR crusade by Paul Shattock, a veteran promoter of what he terms ‘unorthodox forms of biomedical intervention’ in autism.
Mr Shattock, a pharmacist and parent of an autistic son, runs the Autism Research Unit at the University of Sunderland (4). Over the past 20 years he has become well known in the world of autism for his advocacy of theories that autism is a metabolic disorder, and for recommending a wide range of dietary treatments.
In the last week of June 2002, reports of his research claiming to have identified a distinct subgroup of children whose autism is alleged to have resulted from MMR appeared in several national newspapers and on BBC Radio 4’s Today Programme. Mr Shattock claims that these children have abnormal levels of Indolyl Acryloyl Glycine (IAG) in their urine. IAG is said to be a breakdown product of the amino acid tryptophan, which is a constituent of serotonin, melatonin, and other neurotransmitters.
Though Mr Shattock’s researches into urinary metabolites of neurotransmitters has the aura of advanced science, it represents a return to the era of ‘metabolic psychiatry’ in the 1950s and 1960s (5). The identification of a number of neurotransmitters and receptors gave rise to theories that some disruption of these substances might explain mental illnesses, such as schizophrenia and depression.
For example, the celebrated discovery in 1962 of a ‘pink spot’ in the analysis of the urine of schizophrenics was believed to confirm the disordered synthesis of di-methyl-phenyl-alanine (DMPA) by transmethylation from dopamine. This substance was thought to be an endogenous ‘psychotogen’, producing psychotic states in a similar way to exogenous hallucinogenic drugs such as LSD.
When further researches failed to confirm the ‘transmethylation hypothesis’, it was abandoned in favour of the ‘dopamine hypothesis’, which tried to explain the success of drugs like Chlorpromazine (Largactil) in schizophrenia by their effects on dopamine levels. But this theory proved inconsistent with further research findings, and neurotransmitter theories fell out of favour (to experience a revival
with serotonin theories of depression in the 1980s, a trend strongly promoted by the manufacturers of Prozac and other ‘selective serotonin reuptake inhibitors’).
In the 1970s and 80s, research in psychiatry moved in the direction of genetics (though theories of auto-immunity, a continuing influence on Dr Wakefield, also became popular). Metabolic theories continued to attract a following in the shadowy area of alternative and fringe therapies, particularly in the USA. The cult of ‘orthomolecular psychiatry’ emerged out of these theories and popularised the treatment of a range of psychiatric problems with a high dose of vitamins, amino acids, minerals and other diets and dietary supplements. It is out of this tradition, which has little concern for the rigours of scientific research, that Mr Shattock’s studies have emerged.
It is impossible to evaluate Mr Shattock’s findings because they have not been published in any form. Indeed, virtually all his work has been published in the ‘grey literature’, in journals which have no formal process of evaluation or peer review. We know from various reports that he has studied 300 children (not 4000, as reported in both the Daily Telegraph and the Guardian) and found that approximately 10 percent of their parents believe that MMR caused their autism.
We do not know how these subjects were selected or anything about the ascertainment of diagnosis or any other aspect of the design of the study. It also appears that in these children urinary IAG levels are abnormally low (they are apparently usually raised in autistic children). Again we know nothing about methods, controls or whether the differences were significant. Mr Shattock believes that low levels of IAG may be caused by increased gut permeability resulting from the presence of measles virus. Even if we accept that measles causes gut inflammation (which Professor O’Leary does not), how increased gut permeability leads to low urinary IAG levels and how IAG or tryptophan are linked to autism remains obscure.
Mr Shattock freely concedes that his studies do not prove a causal linkage between MMR and autism. He does not intend to publish his full results until he has studied 1000 cases. Yet, he believes that even these preliminary, provisional, incomplete, unvalidated results, if taken in conjunction with the O’Leary/Wakefield researches, indicate the need for urgent action. It is not clear whether this means further researches along similar lines or some action in relation to the MMR vaccine programme.
Mr Shattock also believes that the recent disclosure of his data to the press was premature and insists that the resulting publicity was neither expected nor welcome. Given this reticence, there is some mystery about how details of Mr Shattock’s research entered the public realm, via journalists sympathetic to the anti-MMR campaign. He provided a preliminary report to last year’s Medical Research Council (MRC) investigation into the causes of autism, but asked that its contents should not be publicly disclosed (this is acknowledged in the report). As it seems highly unlikely that the MRC would wish to release Mr Shattock’s data more than six months after the report was published, suspicion about the leak falls on Mr Shattock and his colleagues.
Whatever the source of the leak, what is remarkable is that any responsible newspaper should consider it legitimate to publish research findings which nobody is in a position to check, but which are likely to have a damaging effect on the national immunisation programme and on public health. The incoherence of Mr Shattock’s metabolic theory of autism should be apparent even to a journalist with no scientific training.
All commentators on the ongoing MMR-autism controversy agree that there should be further research into the hypotheses advanced by Dr Wakefield, Mr Shattock and others. No doubt more research into all aspects of autism would be desirable. It would certainly be useful to pursue the virological and immunological studies piloted by Dr Wakefield and Professor O’Leary and their colleagues in an attempt to replicate their findings. It would also be useful to clarify Mr Shattock’s investigation of urinary metabolites.
It is, however, important to recognise the limitations of pursuing research in these directions. Past experience of virological and metabolic studies, and the conceptual weakness of the hypotheses guiding these studies, suggests that they are unlikely to yield useful results. Experience also suggests that negative results are unlikely to satisfy Dr Wakefield, Mr Shattock and their supporters, whose conviction that MMR causes autism has clearly acquired the character of a religious faith. Furthermore, there is a danger that scarce research funds will be diverted from potentially more fruitful areas of inquiry, merely to satisfy the egotism of these researchers and the zeal of their supporters.
Anti-MMR campaigners have frequently disparaged doctors and scientists who refute the MMR-autism link for their links with the drug companies that manufacture vaccines. This theme, forcefully articulated by Dr Wakefield himself, has become an increasingly strident feature of the campaign, one which has been uncritically taken up by its journalist supporters. Yet there are substantial commercial interests involved in the promotion of junk science to which these same journalists remain oblivious.
Senior health correspondents from the Daily Telegraph and the Sunday Times are reported to have joined a three-day junket to Norway organised by the manufacturers of Seven Seas vitamins (6). There is now a flourishing network of private laboratories offering urine and blood tests of the sort carried out by Mr Shattock – all of no recognised diagnostic value. There is a substantial business sector selling dietary supplements, vitamins, minerals, enzymes and all manner of special dietary products – all of no proven therapeutic value. The common feature of both tests and supplements is their exorbitant cost, suggesting that high profits are being made from peddling interventions of no proven value, often to desperate parents, many on low incomes.
There are other beneficiaries of the anti-MMR campaign. Private GPs are now making profits of several hundred percent from selling separate vaccines. Lawyers are eagerly collecting legal aid fees by inflating the hopes of parents that they may gain substantial compensation for the alleged damages from MMR through the pursuit of litigation. It is not surprising that both are enthusiastic supporters of Dr Wakefield’s crusade. It seems that Britain’s investigative journalists are so smitten by Dr Wakefield’s charisma and so credulous towards junk science, that they are reluctant to investigate the real abuses generated around the anti-MMR campaign.
There is a remarkable reluctance among mainstream scientists and doctors to challenge junk science and expose its dangers, which are substantial. This has allowed Dr Wakefield to pose as the heroic champion of families of autistic children and to depict himself as the victim of the medical establishment. Far from being victimised, Dr Wakefield was treated with scrupulous fairness by his employers at the Royal Free Hospital, which he was encouraged to leave some time after he had abandoned science in favour of the pursuit of dogma.
His work was also seriously considered by officials at the Department of Health, who have systematically refuted every charge he has made against MMR – as was quite proper for those concerned with defending the immunisation programme and the public health. As a GP, my only criticism would be that, given the problems arising from the anti-MMR campaign, the official response was not stronger and made more widely available at an earlier stage. The fact that Mr Shattock is recognised as a scientific authority by the National Autistic Society, alongside a small group of serious and distinguished scientists and doctors, gives the stamp of legitimacy to a brand of junk science that results in a substantial burden of unrealistically raised expectations as well as financial costs for families that are already severely stretched.
I do not question the motivation of Dr Wakefield or Mr Shattock or their supporters. That is a matter for their counsellors or their pastors. I do not doubt their sincerity or their integrity; what I question is the rationality of their theories and methods.
My concern is not with their subjective intentions, but with the objective consequences of their actions and statements. As a doctor and as a parent of an autistic child, I judge these to have been damaging to the health of the nation’s children (by generating public anxiety and discouraging the uptake of MMR) and damaging to the interests of families of autistic children (by making parents feel guilty about giving their children MMR and encouraging them to pursue litigation).
Dr Michael Fitzpatrick is the author of MMR and Autism, 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)).
spiked-issue: MMR vaccine
(1) MMR ‘should be compulsory’, BBC News, 3 July 2002
(2) See Andrew Wakefield: misguided maverick, by Dr Michael Fitzpatrick
(3) See the abstracts for the Dublin meeting (.pdf)
(4) See the Autism Research Unit
(5) See The Creation of Psychopharmacology, David Healy, 2002
(6) Private Eye, 28 June-11 July 2002
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