I’m a couple of months late with this article because of life and reasons, but a bit over 20 years ago, in February 1998, Andrew Wakefield published his infamous article in Lancet, which was eventually retracted in 2010. He stated that “onset of behavioural symptoms was associated, by the parents, with measles, mumps, and rubella (MMR) vaccination in eight of the 12 children.” Because Wakefield claimed that most of the behavioral problems were autism, that became the rallying cry of the anti-vaccine religion for the past 20 years – the MMR vaccine, if not all vaccines, cause autism.
I actually remember getting that particular issue of Lancet 20 years ago, and I ran across that article. My first thought was, “why in hell would Lancet publish such a troublesome article with just 12 freaking (not the word I used) data points.” Then I wondered who that Wakefield character was – was he an expert on vaccines and childhood behavioral issues? Well, the internet in 1998 didn’t have search engines like we do today, so finding out anything about Andrew Wakefield was difficult at best. I just assumed that if the Lancet, one of the top medical journals in the world, published it, Wakefield must have some level of respect.
Even though the internet was as much a bastion of pseudoscience and conspiracists as it is now, you would never “do your research” on the internet. But our local newspaper had a blurb about the Wakefield study in a Sunday health section, and my wife read the article. She got panicked that our two young daughters, who were having upcoming MMR vaccines, would become autistic. That was my first experience in having to defend vaccines against nonsense (don’t tell my wife I called her worries were nonsense).
My daughters eventually got that vaccine (and received all subsequent vaccines up to and including the HPV vaccine), although even I monitored my children for a few weeks for any behavioral changes. Knowing what I know now, I should have just a fun dad, but I admit to worrying.
Let’s remind everyone about the frauds and lies of Andrew Wakefield because it has led to the return of vaccine-preventable diseases.
That paper by Andrew Wakefield was terrible
In today’s environment, I would have been really tough on the Lancet article, much like I am with the anti-vaccine nonsense from “researchers” like Shaw and Tomljenovic. So, let’s take a critical look at the article as if it were published last month.
- The “study” only included 12 children. I have come to the point that I don’t generally trust a clinical study unless it includes at least 1,000 patients or an epidemiological study unless it has over 100,000 patients. This study falls far short of showing anything.
- This type of research is called a case study, which is nearly at the bottom of the hierarchy of biomedical research that can be used as evidence in medicine. Case studies do have value – for example, a surgeon could report a new technique that increases positive outcomes. But generally, they have no statistical significance and no controls. It is one of the weakest types of medical research, and it is obviously insufficient to make a decision to stop giving vaccines to children.
- The study had a significant amount of bias, as the children seemed to have a tremendous amount of bias, pre-selecting children specifically for this study. Now, it’s hard to see that in the paper, and of course, I am reading this article with the knowledge that there were a lot of questionable methods employed by Wakefield that we will discuss in a bit.
- We have no professional psychological assessments prior to the study that would indicate whether these children were diagnosed with autism in the first place. As I wrote previously, diagnosis of autism in the late 1990s is much different than it is now – many cases of autism were either misdiagnosed or missed completely. It’s entirely possible that this study found missed diagnoses until they children they were in the study.
- Because the anti-vaccine flock loves to use strawman arguments, they always claim that the Wakefield study really wasn’t trying to show that the MMR vaccine causes autism (yes, he did). But to show some level of biological plausibility, Wakefield proposed a link between the MMR vaccine and an inflammatory bowel syndrome, which was later called “autistic enterocolitis.” In case you were wondering, that proposed link has been thoroughly discredited. In fact, a report in BMJ examined the histology scoring sheets from 62 intestinal specimens taken from 11 of 12 children – several pathologists examine them and found them to be overwhelmingly normal.
In the world of science, this type of study would need to be replicated with 100s, if not 1000s of patients. Then we could determine whether it represents an actual link between vaccines and autism. But guess what? Wakefield has never had the courage to repeat it (mostly because of what you’re going to read below). And no one else has either.
A BMJ editorial in 2011 called out Wakefield for not repeating the study:
Wakefield has been given ample opportunity either to replicate the paper’s findings or to say he was mistaken. He has declined to do either.
I have stated on more than one occasion that repeatability is the cornerstone of good science. If a study, whether a clinical or a basic science one, lacks repeated research in a variety of locations using a variety of researchers, it’s hard to take it seriously. I have a personal policy – unless the research is incredibly well done, I dismiss it until I see newer publications that repeat the results. And we’ve never seen it from Wakefield.
What we know now about Andrew Wakefield
Since then, we have, of course, received a lot more information about this study and Andrew Wakefield. And none of it is good.
First of all, BMJ, once known as the British Medical Journal, published a series of articles, written by Brian Deer (see Note 1), about Wakefield’s despicable deceit, you can read about it here, here, and here. Deer, an investigative British reporter, actually met with the families of each of the 12 kids in the study (I think that would be almost impossible today). He found that there was “no case (that) was free of misreporting or alteration.” Let me remove that legendary British reserve in writing, and make it as plain as day – Andrew Wakefield manipulated the data for this study.
Brian Deer followed up with the families of each of the 12 kids in the study, he found, “No case was free of misreporting or alteration.” In other words, Wakefield, the lead author of the original report, manipulated his data. (See the pop-up chart in this report for details.)
But there’s more, much more.
Deer also reported that Wakefield had a major financial conflict of interest that completely clouds the Lancet study – while he was discrediting the MMR vaccine (specifically, the measles component), he was filing patents for his own measles vaccine. That is reprehensible on so many levels of ethics – despite the claims of the anti-vaccine religion, the vast majority of ethical researchers would never do this.
But, it gets worse. Deer also reported on another unethical conflict of interest (see Note 2):
…he had been hired to attack MMR by a lawyer, Richard Barr: a jobbing solicitor in the small eastern English town of King’s Lynn, who hoped to raise a speculative class action lawsuit against drug companies which manufactured the triple shot.
The previous two conflicts of interest are the very definition of a shill – Andrew Wakefield was just an anti-vaccine shill. And he still is.
Then, in 2004, 10 of the 13 co-authors of Wakefield’s paper suddenly retracted their authorship and withdrew their names from the paper (although, that doesn’t have any practical effect since their names remain on the paper when searched on PubMed).
And it goes downhill from there. On 28 January 2010, General Medical Council of the UK, which determines which physicians are licensed to practice in the UK, struck Wakefield off the register of licensed physicians after 197 days of evidence, submissions, and deliberations. The verdicts branded Wakefield as “dishonest”, “unethical”, and “callous.” He was found guilty (using a criminal standard of evidence) of more than 30 charges including 4 counts of dishonesty and 12 counts of abusing developmentally-challenged children.
The GMC also said that Wakefield acted with “callous disregard for the distress and pain the children might suffer.” Read that carefully – he consciously mistreated the 12 children who were in that study. If that does not show you what a loathsome individual Wakefield is, I don’t know what else to say. Not only was his research was found to be dishonest and unethical, it was effectively harmful to those children.
What does this all mean?
The fraudulent research of Andrew Wakefield spawned a billion dollars of research trying to find out if the MMR and other vaccines were causally linked to autism. That’s how science works, a new hypothesis arises, one that could have a dramatic effect on an important tool to prevent harm to children, and real scientists across the world jumped into action to examine the issue.
And you know what they found? Hundreds of studies, including some huge epidemiological ones (like this one, this one, and this one) have affirmatively established that there is no evidence of a link between vaccines and autism. The overwhelming scientific consensus considers this settled science – there are no links between vaccines and autism.
If you want to change the consensus, bring evidence in the same quantity published in the same peer-reviewed journals.
As we all know, there have been disastrous consequences to Wakefield’s paper. Before 2000, we thought that measles had been eradicated in many countries. Sadly, measles outbreaks have hit the USA, Europe, and Australia, especially in areas where vaccine denial is highest. And if you believe that measles (and many other vaccine-preventable diseases) is some minor disease, think again – it can have serious consequences such as pneumonia, brain damage, and death.
As a result, many governments have instituted mandatory vaccinations or even fines for parents. California passed SB277 which required parents to vaccinate their children before entering public or private schools. France and Italy have implemented the same with harsher penalties to parents.
So we really have no reason to celebrate Wakefield’s 20th anniversary of the publication of that horrible retracted article. We spent massive amounts of money to study a nonexistent issue – money, by the way, that could have been used to actually research real issues in causes and treatment of autism spectrum disorder. And of course, all of the children left unprotected because of a fraudulent study that has started a cottage industry of people making money off of this false premise.
Vaccines don’t cause autism, no thanks to Andrew Wakefield. They save lives.
Notes
- Brian Deer and BMJ have been sued several times by Wakefield for libel and other things. He’s tried it in the UK and in Texas, where he lives in a huge mansion, supported by his “charity” and such. He’s never won, but I’m sure he’s wasted money and time for both Deer and BMJ.
- Brian Deer has published his investigative reports in numerous high-quality publications like BMJ and The Times of London. However, he has republished them on his own website just to keep all the articles together in one place. I’m not exactly sure how many articles he’s published about Andrew Wakefield, but it’s got to be close to 40 or 50. At any rate, I have linked to his website in many cases, just because it’s easier than digging up the actual source, especially in newspapers with paywalls.
Citations
- Retraction–Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 2010 Feb 6;375(9713):445. doi: 10.1016/S0140-6736(10)60175-4. PubMed PMID: 20137807.
- Deer B. Pathology reports solve “new bowel disease” riddle. BMJ. 2011 Nov 9;343:d6823. doi: 10.1136/bmj.d6823. PubMed PMID: 22077090.
- Deer B. How the case against the MMR vaccine was fixed. BMJ. 2011 Jan 5;342:c5347. doi: 10.1136/bmj.c5347. PubMed PMID: 21209059.
- Deer B. Secrets of the MMR scare . How the vaccine crisis was meant to make money. BMJ. 2011 Jan 11;342:c5258. doi: 10.1136/bmj.c5258. PubMed PMID: 21224310.
- Deer B. Secrets of the MMR scare. The Lancet’s two days to bury bad news. BMJ. 2011 Jan 18;342:c7001. doi: 10.1136/bmj.c7001. PubMed PMID: 21245118.
- Gerber JS, Offit PA. Vaccines and autism: a tale of shifting hypotheses. Clin Infect Dis. 2009 Feb 15;48(4):456-61. doi: 10.1086/596476. Review. PubMed PMID: 19128068; PubMed Central PMCID: PMC2908388.
- Godlee F, Smith J, Marcovitch H. Wakefield’s article linking MMR vaccine and autism was fraudulent. BMJ. 2011 Jan 5;342:c7452. doi: 10.1136/bmj.c7452. PubMed PMID: 21209060.
- Jain A, Marshall J, Buikema A, Bancroft T, Kelly JP, Newschaffer CJ. Autism Occurrence by MMR Vaccine Status Among US Children With Older Siblings With and Without Autism. JAMA. 2015 Apr 21;313(15):1534-1540. doi: 10.1001/jama.2015.3077. PubMed PMID: 25898051.
- Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, Thorsen P, Olsen J, Melbye M. A population-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med. 2002 Nov 7;347(19):1477-82. PubMed PMID: 12421889.
- Peltola H, Patja A, Leinikki P, Valle M, Davidkin I, Paunio M. No evidence for measles, mumps, and rubella vaccine-associated inflammatory bowel disease or autism in a 14-year prospective study. Lancet. 1998 May 2;351(9112):1327-8. PubMed PMID: 9643797.
- Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Harvey P, Valentine A, Davies SE, Walker-Smith JA. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998 Feb 28;351(9103):637-41. Erratum in: Lancet. 2004 Mar 6;363(9411):750. Retraction in: Lancet. 2010 Feb 6;375(9713):445. PubMed PMID: 9500320.
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