Wakefield Witch Hunt: What's Up?

The BMJ, a medical journal that is more open to controversial subjects than most, just published an investigative piece and editorial claiming that Andrew Wakefield et al's research on children with developmental and gastrointestinal disorders and the MMR vaccine was "fraud." Wakefield's original research paper was retracted last year by the Lancet, following a decision by the General Medical Council (GMC) to pull Wakefield's license to practice medicine in the UK on the basis of his work on autism, 12 years after initial publication.  I commented here.  The paper had been, in its day, the exemplar of research on vaccine safety problems.

As such, it drew heavy fire from its initial publication until retraction in February 2010.  Lancet pulled the paper on the basis that the child subjects were not "consecutively referred," and that the research had not been approved by a local ethics committee. A large proportion of academic papers in top tier journals are tainted by gross forms of research misconduct, such as not having been written by their purported authors (an estimated 10% plus according to JAMA editors).  Yet very few papers get retracted.

The author of the BMJ piece is Brian Deer, a journalist who has been writing attack articles about Wakefield's work since 2004.  Deer's interest appears to be uncovering scandals.  He has pursued a variety of targets, but has especially focused on "uncovering" the truth about DPT/ pertussis and MMR vaccine injuries.  Deer has challenged some parents and doctors of alleged vaccine-injured kids as liars.

His piece in the BMJ claims that several of Wakefield's case series patients did not really have autism, or developed symptoms prior to receiving the MMR vaccine.  Yet some of the parents he interviewed have challenged his statements.  Brian Deer apparently interviewed parents using a false name and grossly false pretenses (promising to try and get them funds to help care for their children).  See video by Alan Golding here.  How did he even learn the patient names, which were confidential?  For Deer to call Wakefield a fraud is an example of the pot calling the kettle black. 

Fraud is very serious, and should absolutely be uncovered and punished when it occurs.  But I am not convinced that Brian Deer is a trustworthy source of such charges.  And there is no other independent source to utilize at this point to sort out the truth of the matter.

Another issue regarding Deer is massive conflict of interest.  Deer was the  complainant with the UK General Medical Council that led to the GMC spending millions of pounds to conduct its case against Wakefield.  So Deer was essential to creating the story and keeping the pot boiling... then covering the story as if he was an uninvolved journalist:  another example of acting under false pretenses.  Martin Walker has written extensively on this subject.

The BMJ article was immediately re-reported by media worldwide, presumably to discredit the vaccine-autism link.  I found 720 articles on Google News this week that include the terms "Andrew Wakefield" and "fraud".  It would be surprising if this outpouring of "news" occurred by chance.

After  BMJ editor Fiona Godlee slammed Wakefield for fraud, she said the following in an interview:

I’m in no doubt at all that there’s a lot of bad science. There are people who feel it’s got so bad that one can’t really trust anything that’s in medical journals. I’m not really at that level. I think there’s some good science around, too. Telling the difference is what’s hard. There’s also the difference between bad science and fraud. I think there’s a great deal more bad science out there than there is fraud...

I think fraud is always going to be extremely hard to detect. In other cases, frauds have been detected sooner, so I think this is unusual in having survived in the glare of full publicity for so long without being detected.

For me, Wakefield and Deer aside, the bottom line is whether receiving the MMR (or measles vaccine alone) may lead to neurological disease in susceptible children.  

I have spoken with many parents of autistic children (sometimes my own patients) over many years.  I have heard the parents report chronic diarrhea and other bowel problems more often than not in affected children.  A number of parents have told me how their child regressed into autism, after being neurologically normal, around 12-18 months of age: after receiving the MMR vaccine.  Some of the parents had never considered a vaccine link when they told me their story.

One month after Wakefield's original Lancet paper, a study of vaccine injury claims by US government scientists in the journal Pediatrics found that 48 claimants developed encephalopathy within 15 days after receiving an attenuated measles vaccine, resulting in severe neurological sequelae or death.  This happened in "a nonrandom, statistically significant distribution of cases on days 8 and 9."  The authors concluded:

This clustering suggests that a causal relationship between measles vaccine and encephalopathy may exist as a rare complication of measles immunization.

Here is the abstract and here is the full text. 

You cannot deny that the lives of some children and their parents have been destroyed after a measles vaccination.  Their number keeps growing.  It behooves us to find out why, and to find preventive measures for infectious diseases that will be safer for all children.