Monday, February 8, 2010

Lancet vs. Wakefield

I love the Lancet. I have my own subscription, and it isn't cheap. However, the Lancet took a cheap shot last week, when it retracted a paper on autism by Wakefield et al. immediately following a ruling by the UK's General Medical Counsel. The Lancet has been embroiled in controversy (and repeatedly tried to extract itself, but that's another story) since publishing the 1998 Wakefield et al. paper that put the issue of autism and measles vaccine on the map.

But the retraction didn't have to happen. The abstract discussed in the post just below this one shows that DHHS doctors came to a similar conclusion (that measles vaccine and neurologic damage in children should be investigated) the same year as Wakefield. Those authors were never put on trial, have retracted nothing, and Caserta is currently running the vaccine injury compensation program for swine flu vaccine.

Why is the Lancet retracting the paper now? The editors list two reasons: the children were not "consecutively referred" and the studies weren't approved by the local ethics committee. Well, after the many prior investigations of this paper, I am astonished that it took 12 years for Lancet to discover the lack of IRB approval. Sounds fishy.

Lancet is upset the children were not "consecutively referred"? Isn't that reaching a bit, editors?
Have you forgotten that JAMA recently published a paper claiming that 10% of your published papers are written by ghost authors? Maybe those papers should be retracted? Isn't faked authorship more important to root out than lack of consecutive referral, whatever that is supposed to mean?

Here is the Lancet statement:
The Lancet, Volume 375, Issue 9713, Page 445, 6 February 2010
Retraction—Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.
Following the judgment of the UK General Medical Council's Fitness to Practise Panel on Jan 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al. are incorrect, contrary to the findings of an earlier investigation. In particular, the claims in the original paper that children were “consecutively referred” and that investigations were “approved” by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record.
And here are the major conclusions of the Wakefield paper that are being retracted, although their accuracy has not been disputed:
Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998; 351: 637-641.

We did not prove an association between measles,
mumps, and rubella vaccine and the syndrome described.
Virological studies are underway that may help to resolve
this issue.

If there is a causal link between measles, mumps, and
rubella vaccine and this syndrome, a rising incidence
might be anticipated after the introduction of this vaccine
in the UK in 1988. Published evidence is inadequate to
show whether there is a change in incidence or a link
with measles, mumps, and rubella vaccine. A genetic
predisposition to autistic-spectrum disorders is suggested
by over-representation in boys and a greater concordance
rate in monozygotic than in dizygotic twins...

We have identified a chronic enterocolitis in children
that may be related to neuropsychiatric dysfunction. In
most cases, onset of symptoms was after measles,
mumps, and rubella immunisation. Further investigations
are needed to examine this syndrome and its possible
relation to this vaccine.

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