Wakefield’s article linking MMR vaccine and autism was fraudulent
BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.c7452 (Published 06 January 2011) Cite this as: BMJ 2011;342:c7452All rapid responses
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As
humans, we are endowed with the ability to reason, not by believing, but
by falsifying, but collectively we fail as a society to do just that. The
fact that this is all because of a report based on 12 patients and that
there have since been a series of well-designed control studies reporting
the contrary makes it even more difficult to comprehend. We can't blame
specific actors or actresses either as intelligence and rationality are
not necessarily considered virtues in their particular profession. But as
human beings, perhaps especially those who are in positions of influence,
we owe each other to sharpen our intellect as serious inadvertent and very
tangible damages can result and society can even be destroyed; in this
case, one's child could die, say from meningitis, as a result of his
neighbor's stupidity.
Competing interests: No competing interests
I agree with Mr. Sardi's comments. I have documented the epidemic of
autism from 1992/1993 using the US Department of Education figures. Also I
have found through a Freedom of Information Act (FOIA) request from the
Social Security Administration that nationwide in the US, the numbers of
adults/children with Autism Spectrum Disorder (ASD) collecting Social
Security (SSI) benefits has skyrocketed from around 42,000+ in 2002 to
111,000+ in 2008.
In New Jersey, the state Division of Developmental Disabilities
estimates nearly a quarter of 40,000 people it serves have autism as at
least one of their diagnoses. Nationally, more than 250,000 students with
autism were in schools in 2006-07, more than a 600 percent increase over a
decade, according to the National Center for Education Statistics. And a
2007 National Survey of Child Health estimated that more than 680,000
children aged 2 to 17 have some form of autism -- a rate of 1 out of every
91 children.
In deed, I would think it would be more important to find out how the
medical community could stop this epidemic by prevention and treat the
children and adults that have regressive autism like our son. If it isn't
done, all the denials about vaccines and autism will not stop this
epidemic and it will be costly not only in economic terms but human terms.
Competing interests: Son who was born normal but regressed into autism after receiving the MMR vaccine based on home videotapes; and blood tests indicating elevated measles titer antibodies ten times above normal and testing positive for myelin basic protein antibodies
Mr. Wakefield continues his research in the United States. For
example, he is studying a form of low pressure hyperbaric therapy
for autism (http://clinicaltrials.gov/ct2/show/NCT00406159 ). This study
was done in 2006 and finally apparently completed in 2009.
He recently appeared in my state, Minnesota, to organize research on
Somali immigrants
(http://minnesota.publicradio.org/display/web/2010/12/17/somali-autism/ ).
His advocates cite his UK General Medical Council Status as "Registered
without a licence to practise. Doctor erased. Not yet in force." They
emphasize Mr. Wakefield's legitimacy by that last sentence.
I appreciate the BMJ material but would hope the GMC would finalize the
revokation of his fitness to practice.
Competing interests: No competing interests
It is most unfortunate to read the Andrew Wakefield episode, the
physician being demonised for linking MMR vaccines with autism. In my
opinion, he has erred on the side of caution, despite lack of appropriate
scientific rigor, or accusations of fraud. A quick PubMed search shows
that at least 500 articles relate vaccines with autism, with some
suggesting that "U.S. male neonates vaccinated with the hepatitis B
vaccine prior to 1999 (from vaccination record) had a threefold higher
risk for parental report of autism diagnosis compared to boys not
vaccinated as neonates during that same time period (Gallagher CM, Goodman
MS.J Toxicol Environ Health A. 2010 Jan;73(24):1665-77). Other hypotheses
suggest that the "combination measles-mumps-rubella vaccine causes autism
by damaging the intestinal lining, which allows the entrance of
encephalopathic proteins; (2) thimerosal, an ethylmercury-containing
preservative in some vaccines, is toxic to the central nervous system; and
(3) the simultaneous administration of multiple vaccines overwhelms or
weakens the immune system" (Gerber JS, Offit PA..Clin Infect Dis. 2009 Feb
15;48(4):456-61.Vaccines and autism: a tale of shifting hypotheses)In
Canada, researchers estimated the prevalence of pervasive developmental
disorder with respect to MMR vaccination in 27,749 children from 55
schools in Quebec (Fombonne E, Zakarian R, Bennett A, Meng L, McLean-
Heywood D. Pervasive developmental disorders in Montreal, Quebec, Canada:
prevalence and links with immunizations. Pediatrics. 2006;118:e139-50).
Although 20 epidemiologic studies have shown that neither thimerosal nor
MMR vaccine causes autism, it is not clear if the vaccine is entirely safe
if used in the wrong way (any controlled studies?). And Dr.Wakefield's
publications might have only highlighted the pitfalls associated with
abuse of MMR vaccines in particular and vaccines in general. He has erred
but only on the side of caution given the myriad biotech and
pharmaceutical products out there, not one of which is entirely safe and
efficacious. After all, it is a question of risk-benefit analysis, and if
in some cases the risk is overhyped or exaggerated, it should not be a
cause for concern. It is something to be appreciated, instead, despite all
the missed childhood vaccinations!
Competing interests: No competing interests
The BMJ is to be congratulated on publishing Brian Deer's articles on
Wakefield. Although the original study has long been discredited, it is
essential to publish all the facts so as to regain the confidence of the
public in biomedical research. Sadly, the new revelations are unlikely to
shake the misplaced confidence in Wakefield of those families struggling
with autism, nor diminish the industry of bogus therapies claiming to cure
autism.
Competing interests: No competing interests
Will modern medicine please exert as much effort in determining the
cause(s) of autism as it is in disparaging a research paper that should
have never been published. Or was this paper published to become a "pin
cushion" for vaccine advocates? And is there no criticism of vaccines at
all? I have hard evidence that a flu vaccine in 1992 caused so many
deaths it resulted in a decline in life expectancy in the U.S. The data
is clear, but the link to the flu vaccine simply went unreported. When
vaccines killed, modern medicine looked the other way.
Competing interests: No competing interests
Can anyone say why you would expect in the real world the medical
history, as taken down by a leading consultant - in John Walker-Smith's
case perhaps predominant figure in the field of study - to tally exactly with
preceding GP compiled notes?
Incidentally, the GMC case hinged on the claim that the Lancet was a
misconducted version of the Legal Aid Board protocol 172-96 and not an
"early report" as stated. The panel, for which Harvey Marcovitch has
executive responsibility, found this to be the case beyond reasonable
doubt but I was unable to find any specific evidence cited in the findings
on the fact that it was so. I wonder if anyone can explain this apparent
lacuna?
The paper of course reported the history of adverse reaction to MMR
vaccine in 8 cases but is it not rather egging the pudding - given the
severity of the accusations - to say that it linked MMR and autism?
Competing interests: Autistic son
How many pots are calling the kettle black?
Fiona Godlee asks: "Who perpetrated this fraud? ... We hope that declaring the paper a fraud will close that door for good."
For a very long time, the BMJ has occasionally focussed on how much of medicine does NOT stand on a solid base. BMJ also has said much about preventable medical error, which will kill far more children than parents deciding not to vaccinate their children. I have many articles from the BMJ archives about the 1940's treatment of diphtheria, measles and other diseases, which were it attempted today, would result in the administering doctors being had up for attempted murder.
The debasing manner of this "debate" is focussed sharply for me because of two books on my bookshelf. The first is Dr William H Holmes 1940 textbook called: "Bacillary and Rickettsial infections" which I bought last week for the princely sum of $7.58 (USA) and have just finished reading. This book was a discard from Harvard Medical School library. And I can see why it's a discard. The book is absolutely brilliant - interesting, erudite and far more informative than most modern textbooks I have.
This is the work of a man who worked up close and personal with all the diseases he wrote about, and who really understood his subject. But more than that, he was very widely read, and it shows. Why was this book discarded? Perhaps above all, because this man was honest, and delved deeply into why the standard treatments of most of the diseases covered, were more likely to kill the patient rather than cure. (Not something that the BMJ has ever discussed widely, to my knowledge...) He also expands a lot on historical standard practice of medicine in all those diseases, and what an eye opener. Treatment was barbaric at best, and torturous at worst. Which brought back to mind another book which I bought about three years ago, for $10.00 NZ.
This book was a discard from a public library, called "A History of Poliomyelitis" by Dr John R Paul, funded by Merck.
Dr Paul wrote truthfully about the absolute barbaric and cruel ridiculous treatment of poliomyelitis through the ages, which continued to the 1960's. Dr Paul also detailed how badly medical students were taught, right up to the 50's. And noted in passing, that many of those who went on to become "greats" simply bought their degrees. Hmmmm...
My point is this. The medical literature throughout the ages, has been full to the gunnels of accepted, unquestioned unsound science, which continues to this day. Most of that is never talked about. Why? If the public knew the history of medicine which medical journals never talk about, would that too destroy their faith in what their doctors have to say? And how do we know that accepted and unquestioned treatments of today, are really any better?
Unless medical students take the time to study books like the two mentioned above, they will not appreciate just how much of what they learn today, might still sit on a foundation of sand. Perhaps that's why so few medical libraries contain important books like these two.
William H Holmes had this to say in his introduction, which holds true for today's doctors:
"The text most popular with the student is the one which follows a conventional outline, which furnishes him the essential facts required for the passing of his examinations, and which serves as a ready reference in the solution of a specific medical problem. Such texts, no doubt, fill a need.
Nevertheless, the mere accumulation of facts, however valuable they may be in actual practice, cannot be regarded as an ideal form of education. The student who is interested in acquiring only immediately useful facts becomes a sort of tradesman or artisan actuated by the viewpoint that his sole obligation is to treat disease - the particular disease which a patient may happen to present. He is not likely to see his patient as a complex integrated organism whose many functions are intimately coordinated, interrelated, and interdependent. Neither does he see the patient in relation to the environment, and therefore cannot realise that illness is often the result of a long series of social and economic maladjustments, hereditary tendencies, insanitary conditions, vicious habits or education neglect.
Another defect in the form of education based on the accumulation of unasserted, poorly understood factual data is that it inevitable leads to atrophy of the critical faculties. How much more satisfying it would be to the young physician if, in his all-too-short period of training, he could find the time to study medicine as it has slowly evolved, and thus learn really to understand the relation of medicine to the growth of civilization..... he would gain a better insight into the obligations he assumed on becoming a member of the profession... he would sharpen his critical faculties while acquiring habits of thinking and study, and this would result in his becoming a man of wide interests and broad vision and, eventually, perhaps, in his becoming an educated physician."
What has this to do with the editorial above?
A lot. The removal of this book from a medical library is easily excused by the off-hand comment of "lack of space". But what this book would have afforded a student, was a real road map to critical thinking, unlike the textbooks of today, which are so often an exam-passing aid.
Which brings us back to my beginning paragraphs. How many of those so ready to leap into print, are utilising to the full,.... their critical thinking abilities?
Might those now passing judgement on Andrew Wakefield, be better served asking themselves the question, "Does the work I publish and do, conform to all the standards of scientific accuracy, rigour etc, which the BMJ and all others are now saying that Dr Wakefield's work lacked?"
How many pots are calling the kettle black? Or will that only be revealed in a medical text in 50 years time?
Why not review the many other undiscussed "elephants" still in the room, which today kill far more patients every day, than the lack of an MMR vaccine ever will?
Hilary Butler.
Competing interests: I very much enjoy studying bad science throughout the ages...