There was a time when the names Wakefield and Krigsman were synonymous with Thoughtful House. Wakefield was director of research. Krigsman was director of the gastroenterology clinic.
Dr. Wakefield is one of the founders of Thoughtful House. He has been an integral part of the organization since its inception, particularly in the research program.
That is what it used to say on the Thoughtful House website. Now it says nothing at all. The press release containing that statement has been removed, though it is still in Google’s cache. In fact all the press releases at Thoughtful House have been removed. That page is now “under construction.” So are the publications page and the page for research associates.
The links to conference presentations by Wakefield and Krigsman are broken. Krigsman you may recall left Thoughtful House around the same time as Wakefield. Krigsman’s biography and the gastroenterology FAQ at Thoughtful House are gone. If you Google them the link takes you to this one page website The announcement of Krigsman’s “new” research that is supposed to vindicate Wakefield is also gone from the website.
It is as if they are becoming non-persons, edited out of the record in a manner reminiscent of the old Soviet Union. So has there been a coup? I believe that Wakefield was forced out. After the GMC ruling his position was untenable. Krigsman’s departure was probably driven by business considerations to do with health insurance and billing procedures. But it does seem to have happened at an opportune moment for Thoughtful House
Their rising star is Bryan Jepson. His book is featured on the front page. He is the medical director at Thoughtful House. He has strong links to Defeat Autism Now. He seems to represent a return to traditional biomedical interventions for autism. These may be unproven but at least they are not disproven like the MMR hypothesis. Healing the gut and repairing the immune system via diet and supplements and normalizing behaviour via ABA may lack a sound evidence base but they are not yet discredited. Mainstream researchers continue to investigate them. Parents of autistic children who might be wary of anti-vaccine rhetoric and worried about invasive procedures and the dangers of chelation will consider other biomedical treatments.
That is not to say that Thoughtful House have rejected the anti-vaccine position completely. Laura Hewitson, their lead researcher now Wakefield has gone, is a plaintiff in the Omnibus Autism Proceedings. Her research appears tailored to prove her case before the vaccine court. But Thoughtful House is not going to be at the forefront of any anti-vaccine movement.
They will happily concede to parents beliefs in regard to vaccines while selling them diets, supplements and ABA programes. But the goalposts have been shifted away from vaccines to broader, vaguer environmental toxins within which vaccines are a special case affecting a minority of genetically susceptible children and not the driving force behind the so-called epidemic.
March 12th, 2010
Posted by
Mike |
Andrew Wakefield, MMR, Uncategorized, biomedical interventions |
5 comments
What are we to make of recent events at Thoughtful House, the integrated autism clinic and research centre that, until recently operated under the auspices of Dr Andrew Wakefield as director of research? First Wakefield resigned. Then the Times carried a story (now confirmed) suggesting that Arthur Krigsman was standing down as well.
Following the recent GMC hearings whose findings of fact confirmed a series of damning breaches of research ethics, dishonest reporting and callous disregard for the suffering of children it was no surprise that the Lancet finally retracted the paper that marked the start of the MMR scare in 1998. Then his latest paper, Delayed acquisition of neonatal reflexes in newborn primates receiving a thimerosal-containing Hepatitis B vaccine: Influence of gestational age and birth weight, was withdrawn and removed from the Neurotoxicology website. Although they are refusing to comment, the editor at Neurotoxicology may have been influenced by the revelations at the GMC and the Lancet’s decision and taken another look at Wakefield’s study and decided that the faults identified by Prometheus Orac and others were too serious to be ignored.
All this was to be expected. Wakefield is isolated both as a doctor and a researcher. His links to the mainstream are damaged beyond repair. But he has managed to retain a loyal following of parents and until now Thoughtful House has provided him with a firm base in America and a source of income.
So Wakefield’s departure from Thoughtful House came as something of a shock as much for the manner of his leaving as anything else. Although the press release defending Wakefield that was issued after the GMC announced its findings is still on the website it is no longer featured on the home page. Stranger still, there is no press release concerning Wakefield’s resignation on the website even though his name has been removed from the staff list.
We do have this statement from Jane Johnson first posted on the Thoughtful House email list on Wednesday 17 February and widely repeated in all the press reports and blogs that this news has generated
The needs of the children we serve must always come first. All of us at
Thoughtful House are grateful to Dr. Wakefield for the valuable work he has done here. We fully support his decision to leave Thoughtful House in order to make sure that the controversy surrounding the recent findings of the General Medical Council does not interfere with the important work that our dedicated team of clinicians and researchers is doing on behalf of children with autism and their families. All of us at Thoughtful House continue to fight every day for the
recovery of children with developmental disorders. We will continue to do our
very best to accomplish our mission by combining the most up-to-date treatments and important clinical research that will help to shape the understanding of these conditions that are affecting an ever-increasing number of children worldwide.
Jane
The most favourable interpretation, and the one that Jane Johnson is promoting on the email list in response to the loyal parents who are upset by Wakefield’s departure is that
Dr. Wakefield feels he needs to pursue the GMC issue, and he’s concerned that the continued press coverage will hurt Thoughtful House. Those who know Dr. Wakefield will not find it implausible that he would step aside in order to protect an institution he helped found.
It is not implausible. Neither is it very convincing. Why has Wakefield remained totally silent? He has issued statements every step of the way during this long and sorry saga designed to make his supporters feel informed and happy. Why is there no official statement on the Thoughtful House Website? And if he really needed time off to concentrate on the GMC wouldn’t it have made more sense to do that during the hearing instead of waiting until they they found against him?
And what of Jane Johnson’s role in all this? She has been a wealthy backer of Thoughtful House in the past. Her wealth derives from Johnson and Johnson, the pharmaceutical company. Now that is ironic. A constant jibe thrown at all Wakefield’s critics is that we are bought and paid for pharma shills. Now it turns out that Wakefield has his own links to Big Pharma. Ms Johnson is described as the co-managing director of the board of Thoughtful House. I gleaned this from the dust jacket of a book she co-authored with Bryan Jepson MD, who is described as Director of Medical Services at Thoughtful House. I tried to verify this but the current list of directors at Thoughtful House has been removed from their website. I can confirm that Ms Johnson is executive director of Defeat Autism Now.
It has been suggested that Thoughtful House has some major financial backers: wealthy parents of autistic children and corporate sponsors, who are unhappy with the publicity that Wakefield is attracting. Brian Deer has suggested that some may be genuinely shocked by the revelations about his character and his research credentials.
Perhaps the most surprising feature of Wakefield’s departure is the total lack of comment by any of the bloggers who traditionally support him. Take Age of Autism. They have posted 36 articles supporting Andrew Wakefield since the GMC verdict on January 28th. The last one was on February 16th. In the five days following his resignation they have posted nothing about him at all.
It is plain that this has taken his supporters by surprise and not everyone is happy with it. One of the first objections came from an Italian organization, again taken from the Thoughtful House email list but repeated elsewhere.
Emergenzautismo (Italy) feels TH’s acceptance of Wakefield’s resignation
to be extremely detrimental to current science, our children and, not least,
Andrew Wakefield. Never has there been a more important time for a united front.
We are very confused and disappointed.
Ornella
administrator www.emergenzautismo.org
The feeling was compounded when it merged that Arthur Krigsman was also leaving Thoughtful House. This story broke in the Times but it was not until a concerned parent posted the LBRB version on the Thoughtful House email list and parents started to question what was happening that Jane Johnson again responded.
Dr. Krigsman’s decision to relocate his clinical practice to a facility outside
Thought House reflects his belief that the complexities inherent in a referral-based practice can be best addressed by his working independently. We will continue to refer patients for GI evaluations when appropriate, and we look forward to continuing to work with Dr. Krigsman on research projects. We are grateful to Dr. Krigsman for his dedication to Thoughtful House and for the work he does on behalf of the children we serve.
Just to be clear, this is official.
Jane
In my opinion the two events are not linked. If they were we would have seen a much more polished PR operation from Thoughtful House. Krigsman was probably already planning his move and will continue to see children at Thoughtful house until his new office in Austin is ready. His main clinic is in New York and he visits Thoughtful House for a few days once a fortnight. it looks like he is regularizing his business arrangements - a private practise that enjoys an association with Thoughtful House but is not part of it.
But the timing of the two events has caused a lot of parents to wonder just what is going on. Just as with the Autism Omnibus Proceedings they have been fed a line that everything is going well and the GMC is going to vindicate Wakefield. Now some of them must be wondering if they are being fed another line.
It would be tempting to think that Wakefield and Krigsman have been ousted in a power struggle that sees DAN doctor Jepson and DAN director Johnson firmly in control. But unless I see hard evidence to the contrary I will settle for the cock-up theory of history over the conspiracy theory.
As Oscar Wilde wrote in The Importance of Being Earnest
To lose one parent, Mr Worthing, may be regarded as a misfortune; to lose both looks like carelessness.
But if Bryan Jepson MD is the next to go I may have to revise my opinion and quote the words Ian Fleming gave to Goldfinger:
Once is happenstance. Twice is coincidence. The third time it’s enemy action!
While writing this post I have learned of a new article by Brian Deer exposing a failed attempt by Mark Blaxill of Safe Minds to employ Max Clifford to manage Wakefield’s PR disaster. Instead he is adding to it. Perhaps Jane Johnson’s do nothing approach was for the best. You can join the discussion on this latest development over at LBRB
UPDATE
Age of Autism has finally broken its silence with “an exclusive interview” with Andrew Wakefield. Four days after he was sacked by resigned from Thoughtful House the announcement comes, not via a press release or a public announcement on the Thoughtful House website, not even an exclusive interview with Sally Beck or Melanie Phillips or another of his remaining friends in the mainstream media. No. He is reduced to talking to ex journalist and Generation Rescue PR hack Dan Olmsted on a fringe anti-vaccine website.
Wakefield claims to be looking forward to an
entirely new sort of opportunity that will allow me to continue my work on behalf of autism families.
Perhaps his friend Mark Blaxill will create a job for him at Safe Minds. Or maybe Jenny McCarthy’s Generation Rescue beckons. Either way it is a sad end to what could have been a distinguished career.
February 21st, 2010
Posted by
Mike |
Andrew Wakefield, MMR |
5 comments
Autism Insights has published a new editorial addressing the question,
They neglect to mention Tim Buie’s recent consensus report on gastrointestinal disorders and autism and autism published in Pediatrics. Nor, for that matter, do they refer to Arthur Krigsman’s study which they published last month. However, despite it being retracted by the Lancet, they manage to reference Wakefield’s discredited paper along with another of his studies twice.
10. Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998;351:637–41.
11. Wakefield AJ, Anthony A, Murch SH, et al. Enterocolitis in children with developmental disorders. Am J Gastroenterol. 2000;95:2285–95.
12. Wakefield AJ, et al. Enterocolitis in children with developmental disorders. Am J Gastroenterol. 2000;95(9):2285–95.
13. Wakefield AJ, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998;351:637.
The authors present an analysis of the complete medical history records of the Autistic Genetic Resource Exchange (AGRE). They compare parental reports of Gastrointestinal disease in autistic subjects and their non-autistic siblings. The data is interesting, if inconclusive. The only significant differences were the greater frequency of constipation and diarrhoea in autistic subjects. But no reasons were offered as to why this might be the case.
The most striking feature was the complete absence of inflammatory bowel disease (IBD). I was surprised that the authors did not pick up on this during the discussion as they highlighted the controversy surrounding IBD and autism in their introduction.
To return to the question, “Is there a relationship between autism and gastrointestinal disease?” the answer is we do not know. We are still waiting for some definitive data. On the evidence so far I do not expect to find it any time soon in Autism Insights.
February 15th, 2010
Posted by
Mike |
Andrew Wakefield, Autism Insights, GI disorders |
10 comments
If you watch a lot of cop shows you soon come to recognize the basic plot lines. Perhaps the villain is obvious from the start but is able to elude justice until a dogged investigator uncovers the evidence that will put him away. Or else all the evidence points in one direction but a lone detective refuses to buy it and unearths the secret that saves an innocent man from a miscarriage of justice. Sometimes the guilty are protected by their friends in high places. Then along comes the brave maverick policeman who overcomes all obstacles to expose the corruption and justice prevails at the end.
I was reminded of this by responses to the recent judgement against Wakefield by the GMC and the subsequent retraction of his 1998 Lancet paper. Wakefield’s defenders still see him as the brave maverick. Vaccines are the villain and so far they have evaded justice thanks to the corruption at the heart of the medical/research establishment. We have reached that stage in the plot where everything seems hopeless. Our hero has been all but destroyed. The conspirators are congratulating themselves. Evil has triumphed. Or has it?
Now, when they least expect it, our hero strikes. They have no answer to his new and devastating evidence. They realize their mistake and try to silence him. Too late! The truth will out and Justice shall prevail. Of course real life is not like the movies. But that fact is lost on many of Wakefield’s supporters. They clutch at the flimsiest of straws to convince themselves that we are about to enter the final reel when all will be revealed.
One such straw is Arthur Krigsman’s long awaited paper which supports Wakefield’s premise that gastro-intestinal disease and autism are connected. In fact it is so faithful to the master’s original that Krigsman even replicates Wakefield’s breaches of medical ethics. We are promised more studies and devastating proof that Wakefield was right along. This proof is so devastating that it could not be used in his defence at the GMC and had to be held in reserve until after his public humiliation and the destruction of his professional reputation (aka “the witch hunt,” “kangaroo court,” “censorship,” “conspiracy,” etc., etc.,)
At this point in the script I should be saying that the plot thickens. But sadly for Wakefield et al it seems that the plot is unravelling instead. His most recent paper, an attempt to diversify into mercury and vaccines has been withdrawn by the editor. no reason was given. It may the undisclosed conflict of interest from lead author Laura Hewitson or simply the fact that it is an atrocious piece of work. Meanwhile his fan base are doing their best with a number of gambits.
No parent ever complained to the GMC.
The GMC brought the complaint after it was made aware of Brian Deer’s allegations. As Deer points out in this comment on LBRB Wakefield’s parent supporters may have packed the public gallery and joined protests outside the hearing but the only parent to give evidence appeared for the prosecution not the defence.
Not only could Wakefield have called anybody he wanted (and he called nobody whatsoever, and didn’t even ask questions of the government’s vaccine supremo), but a parent of one of the 12 kids – Rochelle Poulter – DID give evidence. She appeared in August 2007 for the prosecution, and gave them a mass of documents which were devastating to Wakefield’s case. One of the letters was to Walker-Smith where she says that he’d told her that the research might not help her child, but might help other children. Devastating stuff.
There was an estabishment conspiracy to silence Wakefield.
All I can say is they did not do a very good job. Two of the most pro establishment newspapers in Britain, the Mail and the Telegraph, regularly carry pro Wakefield stories. The BBC still gives the pro Wakefield website, JABS, web address alongside every MMR story it runs. The Spectator, unofficial house magazine of the Conservative Party, continues to carry pro Wakefield stories from Melanie Phillips. Fiona Phillips (no relation) is still writing paeans to Wakefield in the pro-Labour Daily Mirror. Even the Guardian Group succumbed with a terrible front page article in the Observer that had to be withdrawn and a fawning two page spread by sports writer turned health editor. Meanwhile science that refutes Wakefield has been virtually ignored by the mainstream media outlets.
Government witnesses lied to the GMC
This potentially libellous accusation from Ron Moody made a brief flurry but seems to have faltered along with an open letter to the GMC from a retired sex therapist and the We Support Dr Andrew Wakefield petition against Times Newspapers. Claiming to represent “multitudes of citizens worldwide” they have collected around 2000 signatures so far. But with names like Seymour Butz, Fivepounds Forkidsblood and Al Coholic, not every signatory is taking it seriously.
Good Cop or Bad Cop?
To return to my original theme, I think that they are all watching the wrong movie. What about the story where the cop goes after the bad guy and finds out that he is innocent? But he is so convinced of his guilt that he goes after him for something else. And when the evidence fails again he decides to fake it. The bad guy has to be guilty. No way is he going to escape on a technicality like lack of evidence.
Wakefield is a surgeon with a research interest in gastroenterology. He was supposed to be investigating the causes of Crohns Disease. He thought a potential cause was measles virus, possibly measles vaccine virus. But his research was flawed and when others failed to replicate his results the theory was forgotten.
At this point if his prime purpose was to research Crohns he would have dropped the failed measles hypothesis and explored other venues. But Wakefield had a prime suspect - MMR. If he could not tie it to Crohns he would get it for something else. Why not autism?
But what if the bad guy was innocent all along? What if the cop let his obsession cloud his judgement, leading him to ignore the real evidence and fabricate his own so-called proof. We all know how that movie ends.
Sadly for us as well, real life is not like the movies. While Wakefield’s career as a serious medical researcher may be over he appears to have made good his escape and seems set to enjoy his ill-gotten gains in his Texan hideaway for some time yet.
February 15th, 2010
Posted by
Mike |
Andrew Wakefield, MMR, Uncategorized |
2 comments
Arthur Krigsman has finally published a paper which is supposed to provide independent verification of Wakefield’s premise that gastro-intestinal disease and autism are connected. It is published in Autism Insights, an open access journal. There is nothing wrong with this except that Andrew Wakefield is on the editorial board of Autism Insights alongside one of Krigsman’s co-authors, Carol Stott. Like Krigsman, Stott works for Andrew Wakefield’s Thoughtful House. In fact the Editorial Board is dominated by Wakefield’s allies and associates. The editor in chief, Anthony J Russo has only two autism related papers listed on PubMed and one of those was co-authored with Krigsman, Wakefield and Bryan Jepson, medical director at Thoughtful House and also a member of the Autism Insights editorial board. Autism Insights has only published two articles since its inception in September 2009. I suspect that it has been set up with the sole purpose of publishing papers by biomed supporters that cannot find a reputable journal that will publish them. This would make it no better than the bogus journals that Elsevier set up to publish infomercials for drug companies posing as bona fide research.
I can understand why other journals might be wary of Krigsman. He lists his main academic affiliation as Assistant Professor of Pediatrics, New York University School of Medicine. However, under cross examination as an expert witness in the Autism Omnibus proceedings it emerged that although he was on the staff at NYU he had never taught a class there and had never been paid a salary.
RICCIARDELLA: Doctor, your C.V. states that you’re a clinical assistant professor at New York University. Is that correct?
KRIGSMAN: Correct.
RICCIARDELLA: Are you currently on staff there?
KRIGSMAN: Correct.
RICCIARDELLA: When was the last time you taught a class at NYU?
KRIGSMAN: I haven’t taught there.
RICCIARDELLA: You’ve never taught a class at NYU.
KRIGSMAN: I’m on staff there.
RICCIARDELLA: Are you salaried?
KRIGSMAN: From NYU?
RICCIARDELLA: Yes.
KRIGSMAN: No.
RICCIARDELLA: Have you ever been salaried at NYU?
KRIGSMAN: No.
One of the co-authors, Marvin Boris, also boasts an NYU affiliation, Associate Clinical Professor of Pediatrics, New York University School of Medicine. But NYU had nothing to do with this research. Krigsman used to work at Lenox Hill Hospital in New York but left under a cloud in 2004. Their IRB had turned down his research proposals on three occasions in 2001/2002 because they were concerned for patient safety and concerned that he might be performing invasive procedures for research purposes on patients for whom there was no clinical indication. Krigsman went ahead anyway and even announced his research when he testified before the United States House of Representatives Committee on Government Reform on ‘The Status of Research into Vaccine Safety and Autism.’ (June 19th 2002)
To check whether he was in fact carrying out research without IRB approval the Lenox Hill Medical Board asked to see the records of ten patients selected at random. Krigsman refused. [source] He even tried to sue the hospital and when his suit was dismissed, his resignation brought all inquiries into his conduct to an end. [source] Krigsman presented his research as a slide show at IMFAR 2004 Two years later there was a poster presentation at IMFAR 2006 which listed Krigsman as co-author. This time he claimed to have discovered measles virus in his samples. He also claimed to have IRB support for his research. There is no mention of measles virus in the current paper. But there is IRB approval from the Copernicus Group who provide independent oversight and scrutiny to researchers at institutions that do not have an IRB.
I do not know how rigorous Copernicus are. Perhaps it is just bad luck that as well as Krigsman they also gave IRB approval to the Geiers for a paper which had already been published using a fake IRB packed with business associates and family members of the researchers. Now they have approved research that was refused IRB approval at the hospital where Krigsman worked when he took the specimens from autistic children who underwent colonoscopies at Lenox Hill Hospital. Remember that Krigsman was turned down three times for IRB approval by Lenox Hill IRB. He first applied in January 2001 and
This proposal was rejected by the Hospital’s IRB on February 21, 2001, due to concerns that the procedure’s risks would outweigh its anticipated benefits.
This is a clear indication that he was refused permission to carry out colonoscopies or take biopsies for research purposes. A revised proposal was submitted in June to retrospectively analyse the results from 50 children who had already had colonoscopies that, according to Krigsman, were clinically indicated. A decision was deferred pending revision of the proposal. This revision of the revision was finally refused permission in December 2002 on the grounds that
Dr. Krigsman had not obtained informed consent from the subjects or their legal representatives.
Perhaps that explains the delay in publication because now, eight years after the event, he does claim that
Informed consent was obtained for each child included in the study.
Meanwhile, way back then, there were concerns about the 200 autistic children that Krigsman had already subjected to colonoscopies. Where these all clinically necessary procedures or was Krigsman using these children for research purposes without IRB approval?
On January 23, 2003, Dr. Jerome Waye, the Chief of Endoscopy; Dr. Armando Grassi, the Chairman of the Deparment of Pediatrics; Dr. Hary Ioachim, the Chairman of the IRB; and, Ms. Debora Marsden, Lenox Hill’ s Compliance Officer, met to discuss Dr. Krigsman predicament. In light of the IRB’ s concerns, Dr. Krigsman was advised that Dr. Waye s approval was required before he could perform any endoscopic procedures at the Hospital.
Dr. Grassi instituted a corrective action procedure, which is employed to review the situation whenever a hospital’s staff member’s activities are called into question. Here, there were concerns that Dr. Krigsman may have been conducting research without approval and that he may have performed invasive endoscopic procedures as well as tissue biopsies on autistic children without medical necessity.
Pursuant to the Hospital’s by-laws, a Deparmental Ad Hoc Review Committee was appointed to investigate. Two hundred of Dr. Krigsman s cases were reviewed and discussions were held with pediatric gastroenterologists. Concerns about the medical necessity of the endoscopic procedures persisted. The Ad Hoc Review Commttee recommended that Dr. Krigsman’s patients’ hospital charts be reviewed and that he be advised not to use information gathered from past patients without the IRB’ s permission. Following review of Dr. Krigsman’ s patients ‘ hospital records, the Hospital’s Medical Board still questioned the necessity for medical procedures performed by him. Since Dr. Krgsman had informed the Ad Hoc Review Commttee that his patients had undergone a complete work-up in his office prior to their hospitalizations, the Hospital’s Medical Board recommended that the Ad Hoc Review Committee randomly review ten of Dr. Krigsman s patients’ office records in an attempt to further evaluate the need for the procedures in question. Dr. Krigsman refused this request on June 2 2003. [source]
Krigsman then decided to sue the hospital. His suit was dismissed in April 2004 and Krigsman elected not to seek renewal of his contract of employment when it expired at the end of that year. As he was no longer employed by Lenox Hill this ended the Office for Human Research Protections‘ investigation into his conduct there.
To summarize
- Krigsman carried out research without IRB approval and without informed consent.
- Krigsman carried out invasive procedures whose clinical necessity has been questioned.
- Krigsman obstructed investigations into his questionable conduct and sued his employers in an attempt to circumvent due process by artful pleading.
- When this ploy failed he left the hospital rather than face a proper investigation.
- Now he has published his research, in breach of advice not to use information gathered from past patients without the IRB’ s permission.
According to Wakefield’s supporters Krigsman’s research vindicates Wakefield and shows how flawed the GMC ruling is. In my opinion the only flaw in the GMC ruling is that it does not include Krigsman, whose conduct is every bit as egregious as that of his master.
February 14th, 2010
Posted by
Mike |
Andrew Wakefield, MMR |
14 comments
There is a mighty blog storm surrounding the announcement last week of the General Medical Council’s “finding of fact” in relation to the Fitness To Practice hearing regarding Andrew Wakefield, John Walker Smith and Simon Murch.
Liz Ditz is collating blog responses to the decision here:
Andrew Wakefield: Dishonesty, Misleading Conduct, and Serious Professional Misconduct: Blog Posts Approving of Verdict; Blog Posts Critical of Verdict
Kathleen Seidel has posted the entire ruling and for those who may not have the time or the inclination to read all 143 pages she has posted the edited highlights on her blog:
U.K. General Medical Council Rules Wakefield & Co. “Dishonest,” “Irresponsible”.
And of course Brian Deer has reported on the findings for the Sunday Times in a story headlined ‘Callous, unethical and dishonest:’ Dr Andrew Wakefield.
Among Wakefield’s supporters the reaction to the GMC’s verdict is one of disbelief.
The One Click group has been supporting for Wakefield during the GMC hearings. In April 2008 they were confident of victory.
The Defence presentation has demonstrated that the position always maintained by Dr Wakefield of there being no conflict of interest, no issues relating to funding, that the investigations of these children were clinically justified and that the research was ethically approved has been very clearly established.
Now that “clearly established” case has been dismissed we are told this is a kangaroo court and a show trial. Government witnesses are supposed to have lied. The GMC “moved the goal posts.” According to Cry Shame
The Panel has chosen the facts it wants, and rejected those it doesn’t want, to find the doctors guilty on fact – facts that go back 16 years.
An Honorary Consultant
Wakefield has never treated a child for autism. I do not know if he has ever treated a child for anything. In the UK senior hospital doctors or consultants have responsibility for patient care. Wakefield never made the rank of consultant. He was a lecturer and a researcher whose contract specifically excluded him from treating patients.
Dr Andrew Wakefield was a Senior Lecturer in the Departments of Medicine and Histopathology at the Royal Free Hospital and from 1st May 1997 a Reader in Experimental Gastroenterology. He was an Honorary Consultant in Experimental Gastroenterology with a stipulation in his contract that he had no involvement in the clinical management of patients.
Yet it was Wakefield who signed the orders for medical investigations into children, despite the clause in his contract and despite having no paediatric qualifications. The medical investigations he sanctioned were not clinically indicated but carried out purely for reasons of research. This breached medical ethics and was not in the interest of the child.
Follow the Money
Wakefield was initially paid £50000 to cover the cost of investigations into children for solicitor, Richard Barr. The money came from the Legal Aid Board (ie taxpayers’ money). However, because the children were admitted to the Royal Free as National Health Service patients, the NHS (taxpayers’ money again) picked up half the bill. Wakefield should have returned the extra £25000. Instead he used it in part to fund salaries for researchers.
Conflict of Interest
The research proposal submitted to the LAB in June 1996 for funding was judged by the Panel to be essentially the same as the project submitted to the Royal Free for ethical approval in September of that year. But the ethics committee were not informed of any involvement with MMR litigation. Nor did Wakefield inform them of the LAB funding.
Ethical Conditions
Part of the ethics committee conditions were that approval only covered children enrolled after 18 December 1996. Yet seven of the twelve children in the study had been enrolled, admitted to hospital and subjected to invasive tests before that date.
All patients had to show signs of intestinal disease or dysfunction and all procedures had to be clinically indicated - ie intended to investigate or treat the intestinal disease or dysfunction. But these procedures were not always clinically indicated even where the child did show evidence of intestinal disease or dysfunction.
Child 1 for example
Professor Walker-Smith, after his assessment of Child 1 on 19 June 1996, concluded in his letter to Dr Barrow that Child 1 had the features of “toddler’s diarrhoea” and planned to see Child 1 again in three months’ time. However, Child 1 was admitted to hospital one month later. There were no apparent clinical reasons for this change in plan. Child 1 underwent a colonoscopy, MRI scan of his brain, an EEG and a variety of blood and urine tests. These were some of the investigations listed in the programme of the project. He was further admitted on 23 October 1996 for further investigations regarding the “etiology of the autism”, again for no obvious clinical gastro-intestinal reasons.
During this admission, Child 1 underwent a barium meal and follow-through and a lumbar puncture. These were also the investigations listed in the programme of the project. The Panel has concluded that Child 1 underwent a programme of investigations for research purposes and for which there was no Ethics Committee approval.
Children enrolled in the study had to have “manifested disintegrative disorder.” I find this a bizarre construction. Childhood Disintegrative Disorder is a very rare manifestation of PDD, first identified as Heller’s Syndrome a century ago. Its diagnostic validity and its place on the autistic spectrum have both been questioned. Why not refer to regressive autism instead?
Most bizarre of all, given the consequences, MMR was not even mentioned! A condition of admission to the programme was that all children were to have been vaccinated with the measles or measles/rubella vaccine. Thus every child in the study breached its own guidelines!
So we have an investigation into a new form of autism that manifests itself after MMR vaccination in which neither autism nor MMR are mentioned in the protocol. Were Wakefield and his team guilty of sloppy thinking and using ill defined terms or was this a deliberate attempt to mislead?
Patents and Single Vaccines
One thing I never understood about Wakefield advising parents to use single vaccines was this. If it was the measles component of MMR that did the damage why would giving it in isolation be less damaging? Of course it wouldn’t. But if the doctor who discovered the danger was able to develop a safer single vaccine it would make sense. And quel surprise! Even before he began his research, Wakefield had taken out a patent for a single vaccine that protected against measles and treated the Inflammatory Bowel Disease and Regressive Bowel Disease allegedly caused by the old vaccine. RBD refers to the autistic enterocolitis that he had not discovered yet. IBD was a reference to his previous theory that Crohns disease was caused by measles virus. This too was without foundation and may explain why he switched is attention to autism.
Wakefield began treating one of the study children, Child 10, with this transfer factor in 1997 and set up a company with the child’s father to exploit the invention. After the Lancet paper was published he applied for permission to run a clinical trial on autistic children. So he had a vested interest in damaging the reputation of the MMR vaccine and was prepared to try out his experimental treatment on Child 10 for research purposes.
Brian Deer summarized this Transfer Factor in his investigation
Recipe for madness?: Wakefield’s claims for a measles vaccine, and treatments for bowel disease and autism, were bizarre. The technology involved is of so-called “transfer factors”, a now largely abandoned fringe conjecture based on a theory that special substances can be harvested from white blood cells. The Royal Free’s recipe advised injecting mice with measles, extracting and processing white cells, injecting the result into pregnant goats, milking them after kid-birth and turning the product into capsules.
The Birthday Party
Buying blood samples from children at his son’s birthday party; this is probably the one element of the whole affair that did most to turn public opinion against Wakefield. The amazing thing is not that he did it but that he felt able to joke about it to an audience of parents who did not find it repellent. This goes some way to explain the hubris of a man who surrounds himself with admirers who believe he can do no wrong. The GMC was more level headed in its verdict
You showed a callous disregard for the distress and pain that you knew or ought to have known the children involved might suffer,
Found proved
in the circumstances you abused your position of trust as a medical practitioner,
Found proved on the basis of the above findings.
Your conduct set out in paragraph 42.b. was such as to bring the medical profession into disrepute;’
Found proved on the basis of the above findings.
The Honorary Consultant dishonoured
The science behind Wakefield’s theory was always tentative and has been thoroughly repudiated by subsequent research. This has not always been reflected in media coverage. Journalists and the public they serve often stumble over the science. But everyone can understand dishonesty, callous disregard for the suffering of children, unethical conduct. I just find it terribly sad that Wakefield had to be discredited as a person in order for people to reject his bad science. The quacks who play by the rules and do not attract the attention of investigative journalists and professional oversight committees continue to prosper at the expense of a public who have a poor understanding of what science based medicine means. The GMC hearings have done nothing to alter that fact.
February 3rd, 2010
Posted by
Mike |
Andrew Wakefield, MMR |
9 comments
Polly Tommey is feeling the pressure. According to an article she wrote for The Age of Autism leading autism organizations in the UK, academics and celebrities are telling her that her continuing support for Andrew Wakefield is a liability. Even her advertisers are threatening to pull out.
Specifically, I have been “warned” not to print any more articles written by Dr. Andrew Wakefield (he wrote for the first time in the last issue); I was also warned not to invite him to speak at our conference. Separately, some organizations have warned me that they will not have anything to do with me if I continue to support and publish papers by him. Some advertisers tell me they have to stop working with us as they are “under pressure” to pull out, and a number of celebrities, high earning individuals, journalists, scientists, practitioners, and people who want to contribute to the magazine or to our campaigns say that it’s more than their job’s worth to be associated with the work of this man more than their job’s worth to even listen to what he has to say. All of them say that they can’t support The Autism File if The Autism File appears to support Dr. Wakefield.
Tommey presents this as a threat to her editorial integrity. “They” are trying to silence her. The pressure is all “political.” Even people who might want to work with her or write for the Autism File are afraid to because Andrew Wakefield has been discredited and if they identify themselves with his most stalwart supporter in the UK they too could be discredited and marginalized. Academics are afraid of losing their government funding.
Tommey offers no real evidence to support these claims. She describes a meeting with a senior representative of a leading autism organization,
The message I was very clearly given at this meeting was that if The Autism File magazine continued to publish Dr. Wakefield’s work, if I continued to support him publicly, and if I allowed him to speak at our conferences, then they could not work with either me or The Autism File. He also reminded me, very pointedly, that they worked closely with the Department of Health and were the decision makers regarding many important issues relating to autism . . . .
At some unspecified time in the past, some time ago, an unnamed eminent academic was invited to join the scientific advisory board of the Autism File
He was keen but stated he could only do so if certain existing members – specifically including Andrew Wakefield – were removed from it. He then bluntly warned me that if The Autism File continued to support Dr. Wakefield it would be “shut down.” Despite his standing and expertise, his concern was such that ultimately he chose not to even write for our magazine because, he said, “it is too controversial,” and, given that he is funded by the government, he felt that if he did, then his funding would be at risk.
Finally, she tells of the time when she was appearing on a popular daytime TV show, The Wright Stuff.
Before going on air, the host Matthew Wright joined us in the “green room” and said that he had been told by the show’s lawyers that if Dr. Wakefield’s name was mentioned, he had to say that Wakefield was “discredited.” We questioned why, but Matthew said that he had no choice these were his lawyers’ instructions . . . .
When I was on GMTV they said pretty much the same thing, and we have all read the same in many newspapers.
That is the sum total of her evidence, or at least the evidence that she chooses to present to support her claim that
a number of people and organizations have evidently decided that they should be determining the editorial policy of our magazine
But Polly Tommey is unbowed. She sets out to refute all claims that Wakefield has been discredited and restates her commitment to publish reports and stories that are sympathetic to Wakefield and his theories.
Part of Tommey’s problem is that she is a victim of her own success. The Autism File is a professionally produced, attractive read. It’s basic premise is that autism is a medical disorder that responds to biomedical interventions associated with alternative therapists - diet, supplements, chelation etc. Tommey’s husband, Jonathon runs an Autism Clinic which is promoted by The Autism File and offers
Dietary Modifications
Nutritional Supplementation
Immunological Regulation/ Modulation
Homoeopathy
Gastrointestinal Treatments
Liver Support & Enhanced Detoxification (methylation and transulfation)
Glandular Support (adrenals, thyroid and pancreas)
Heavy Metal Clathration(sic) Therapy
Physical Therapies - exercise, massage, reflexology, kinesiology, lymphatic drainage, yoga, breathing and relaxation techniques, etc.
This is the secret of its success. It has a core readership amongst those parents who believe autism has environmental causes that are treatable. These beliefs are never challenged. According to Tommey
The Autism File exists to provide help and support to parents, professionals, and caregivers in understanding autism better by bringing informed articles and opinions on the condition from all over the world and enabling them to then make up their minds about whether this advice will help their families and their children. We have done this for over 10 years and our readers’ feedback supports our continuing to do this.
But the Autism File does this by offering positive endorsements to a number of approaches including non-biomedical aspects of autism like behavioural therapies, educational therapies and services for adults. It does not publish critical views of any of these therapies. Though it may publish opinion pieces about why conventional research that does critique these therapies is flawed. Unlike its American counterparts that sneer at neurodiversity it acknowledges some of the concerns of autistic adults. It is supporting Gary McKinnon’s campaign against extradition to the USA. It boasts Temple Grandin on its editorial board and publishes articles on education by Stephen Shore. These are two autistic individuals, prominent speakers and authors who distinguish themselves by either endorsing biomedical cures (Grandin) or displaying a benign agnosticism (Shore).
The Autism File has been a commercial success. The international edition is on sale in over 2000 bookshops in the USA and Canada, there is a Spanish language edition and the UK magazine is available from W.H. Smiths, Sainsbury’s, Borders, and selected Tesco stores. Tommey has used this success to promote herself as an autism advocate. I have referred in the past to her successful PR campaigns that have resulted in meetings with the Prime Minister and his wife and invitations to speak at seminars.
But all this limelight has brought her support for Andrew Wakefield into focus. This did not matter when the Autism File was a subscription only house magazine for the Andy Wakefield Fan Club. But now the magazine and its proprietor are bidding to go mainstream they are meeting with widespread suspicion and hostility for their support of Wakefield.
In her defence of Wakefield Tommey seems to think that this is all the fault of a couple of journalists; Horton at the Lancet and Deer at the Sunday Times. She fondly imagines that their campaign to discredit Wakefield will all come unstuck when the GMC delivers its verdict on Wakefield this year after a lengthy investigation into accusations of professional misconduct and breaches of research ethics. I do not know what the outcome will be. If the GMC runs true to form it will probably deliver a fudge that satisfies nobody.
Never mind. In one sense the hearings are irrelevant. Wakefield is already discredited because his ideas have been proved wrong. The NAS fudged the vaccine question for years. Now they have come out against a link between MMR and autism because the science overwhelmingly says so. The MMR hypothesis has been tried in the US courts and found wanting.
Tommey poses some of the bigger questions.
• Why is it so important that Dr. Wakefield is seen to be discredited?
• Whom is it important to?
• Who stands to gain from this?
• Who will lose out if the truth is revealed?
• What is it that people are so frightened of?
• What is it they don’t want us to know?
Given the overwhelming nature of the evidence against Wakefield’s theories one could equally ask similar questions of the Autism File itself and its continuing support for Wakefield and anti-vaccine quackery.
January 8th, 2010
Posted by
Mike |
Andrew Wakefield, MMR, Quackery, journalism |
31 comments
Even though the controversy about MMR and autism originated in the UK our National Autistic Society has always tried to steer clear of the controversy on the grounds that we are not a medical charity. This used to be our position. You can still find it in a forgotten corner of the NAS website.
National Autistic Society position statement
The National Autistic Society (NAS) is keenly aware of the understandable concerns of parents surrounding suggested links between autism and the MMR vaccine. The NAS urges continued efforts on the part of the Chief Medical Officer, supported by further authoritative research, to put these matters beyond doubt and allay any remaining public concern.
While there is still no conclusive evidence, it is crucial that health professionals listen to parents’ concerns and respect their views as the experts on their individual children. Some parents experience a lack of sympathy and understanding in the healthcare system on medical issues related to their child’s autism. This urgently needs to be addressed to ensure equal access to services.
But now the NAS has come off the fence. Our new statement begins:
The National Autistic Society (NAS) is keenly aware of the understandable concerns of parents surrounding suggested links between autism and the MMR vaccine. We recognise that the weight of epidemiological evidence indicates that there is no statistically significant link between the MMR vaccine and autism.
The statement could be stronger. To my knowledge there are no epidemiological studies showing a link between MMR and autism. As well as the epidemiology the clinical studies also stack up against the hypothesis. Hornig et al (2008) found
strong evidence against association of autism with persistent MV RNA in the GI tract or MMR exposure.
Baird et al (2008) found
no evidence of a differential response to measles virus or the measles component of the MMR in children with ASD, with or without regression, and controls who had either one or two doses of MMR.
D’Souza et al (2006) found
no evidence of measles virus persistence in the peripheral blood mononuclear cells of children with autism spectrum disorder.
Afzal et al (2006)
failed to substantiate reports of the persistence of measles virus in autistic children with development regression.
I can understand why the NAS has taken so long to adopt its new stance. Within the NAS some of our members have been vocal in their support of Andrew Wakefeld and the MMR connection. Others have been equally vocal in opposing the idea. In the beginning I was undecided. The ham-fisted way in which the government went about reassuring us that MMR was safe was unconvincing and many of us, myself included, were inclined to give Wakefield the benefit of the doubt. See Mike Fitzpatrick’s article MMR: why government reassurances won’t work for one explanation of this widespread mistrust.
Support for Wakefield was more prevalent among parents of autistic children than it was among the general public. Our experience of government agencies in relation to diagnosis and provision for our autistic children was often fractious and confrontational. We bitterly referred to our own triad of impairments, meaning Health, Education and Social Services. The second issue of the NAS sponsored journal, Autism, in November 1997 examined the experience of 1200 families seeking diagnosis and the frustrations and dissatisfaction expressed by many parents.
Little wonder then, that if it was Wakefield versus the Government many of us were willing to give him the benefit of the doubt. The NAS was alert to our anger and was keen to bring us together to campaign for improvements in services. It had no desire to enter a divisive argument over MMR. So what has changed?
First and foremost the campaign strategy has been successful. Things are changing. We are putting autism on the statute books. The government is consulting with the NAS on a strategy for adults. The emphasis is on providing those adjustments and accommodations that will enable autistic people to lead a full and active life as contributing members of society. If some people decide to jump ship over MMR they are jumping from a successful ship.
By way of contrast, one of Wakefield’s staunchest allies is Polly Tommey. Her magazine, The Autism File promotes the MMR connection and a host of biomedical “remedies” that are supposed to reverse vaccine damage and cure autism. Yet her actions belie her words. Her latest project is to set up rural enclaves providing sheltered living and employment for autistic adults away from society.
Second, autistic adults are taking a leadership role in our campaign strategy. When it was just about the parents, as it largely was a decade ago, a diplomatic fudge made some sort of sense. But you cannot fudge the issues with an autistic person. If the science says there is no connection then why don’t we say there is no connection?
Science can cut both ways. Autistic adults insist that they are not damaged or defective. They are different. They do not want research into the causes of autism if the agenda is prevention and cure. But most research into the causes of autism is carried out in order to facilitate prevention and cure.
We managed to fudge the vaccine question for years. That era is coming to an end. Now we face important debates about the nature of autism that cannot be fudged. Autistic adults are challenging the assumptions of scientists and posing their own questions. It is not altogether clear which is the most appropriate domain for these debates: science, ethics, moral philosophy? The three most important books on my shelves at the moment are:
Representing Autism - cultural criticism
Unstrange Minds; remapping the world of autism - anthropology
The Ethics of Autism - philosophy
I am sure that there are other, equally essential works and that they will likely transgress the boundaries of traditional autism disciplines like psychology and neurology. But there again, autistic people of my acquaintance are used to transgressing boundaries (and having their own boundaries transgressed). It is we neurotypicals who become defensive when we are taken out of our comfort zone.
We may be headed for uncomfortable times but I expect them to be far more productive and ultimately satisfying than the necessary but stultifying “autism wars” we have fought around the question of vaccines which should now be over.
September 19th, 2009
Posted by
Mike |
Andrew Wakefield, MMR, National Autistic Society, adults, science |
6 comments
The press release issued by the Columbia University Mailman School of Public Health that announced the results of their recent study into MMR and autism ended with this remarkable statement from W. Ian Lipkin, John Snow Professor of Epidemiology and director of the Mailman School’s Center for Infection and Immunity.
“The study design process was a critical piece for us, as there is still so much public concern over the safety of the MMR vaccine. For this reason, we involved the autism parent/advocacy community as we designed the study to ensure that all issues were being addressed. We are hopeful that this process of community engagement will build important partnerships among members of the autism community, physicians, public health agencies, and clinical researchers; serve as a paradigm for the conduct of future studies to understand the causes of this disorder; and facilitate the rapid communication of clinically relevant scientific findings to the broader community.”
I understand this to mean that the research team consulted with those sections of the parent/advocacy community who have voiced concerns about a possible connection between MMR and autism. The obvious candidates are SafeMinds, the National Autism Association (NAA), Generation Rescue and Talk About Curing Autism (TACA)
I visited TACA first. They make a big deal out of having Jenny McCarthy as their spokesperson and she blamed MMR for her son’s autism when she appeared on Oprah. But there was no mention of this latest research on their website.
Then I went to Generation Rescue. They have Jenny McCarthy as a board member and just like TACA they feature her prominently on their website. And just like TACA they do not mention this new research either.
Next stop SafeMinds. Nothing there either, which is strange. Because there is a press release that purports to come from SafeMinds circulating on the internet. Kev has commented on it over at Left Brain Right Brain and I have no reason to doubt its authenticity. It first appeared on EOHARM, one of those anti vaccination, autism parent/advocacy email lists. It begins:
A scientific study released today examined the hypothesis that measles virus persisting in the intestinal tract from the MMR vaccine causes or exacerbates autism. The study refuted this hypothesis for the majority of autism cases…
That is stretching the truth slightly. According to Columbia University the lead researcher actually said,
“Our results are inconsistent with a causal role for MMR vaccine as a trigger or exacerbator of either GI difficulties or autism [...] The work reported here eliminates the remaining support for the hypothesis that autism with GI complaints is related to MMR vaccine exposure. We found no relationship between the timing of MMR vaccine and the onset of either GI complaints or autism.”
That sounds to me as if they are saying the study refutes the MMR hypothesis in ALL cases, not just the majority.
…while validating the link between gastrointestinal (GI) disease, inflammation and autistic regression. The study design precluded assessment of a role for acute measles infection from MMR in a subset of children with autism…
More spin. The study was designed to test Wakefield’s hypothesis that persistent measles virus infection in the gut was associated with GI disorders and autism. Is there anything anywhere in the literature to suggest that anybody has developed autism as a result of an “acute measles infection from MMR? Never mind autism. What is the prevalence of acute measles infection from the vaccine?
…and did not examine the role of other vaccines, vaccine components such as thimerosal, or other environmental exposures which can trigger gastrointestinal and immunological problems…
And what about everything else that it did not examine? Science does not work by examining everything at once. You isolate the variable that interests you and try to control for other factors that might confound your results. Did Wakefield examine the role of other vaccines etc. in his original study?
…The topic is of public health interest due to the increasing autism epidemic and parent and scientific reports connecting mercury and vaccines, including MMR, with autism onset.
Not exactly. This topic is of public health interest because anti-vaccine scares have led to an increase in cases of measles in Europe and America. The autism epidemic is a canard. And despite what SafeMinds thinks, most of the science reports a disconnect between mercury and vaccines and autism. The press release continues in similar vein. It is obvious that even if SafeMinds were one of the parent/advocacy groups consulted on the design of the study they are not happy with it.
NAA at least did publish their press release on their website. Orac has done an excellent job of analysing it over at ScienceBlogs, so I don’t have to. Suffice to say that NAA are not enamoured of Mady Hornig’s latest offering and there is no evidence that they were involved in the design of the study.
It must be remembered that until a short while ago Mady Hornig was a hero in these circles. Her mouse study was lauded as proof of the thiomersal/autism connection and printed on their websites. She was a keynote speaker at their conferences and a key figure in the whole vaccine/autism movement. One “bad” study and they have turned on her.
So who else is there to consult in the autism parents/advocacy community? It occurs to me that probably the aforementioned groups were consulted about their concerns and the scientists went away and incorporated those concerns in their study. But the data came back negative. This happens all the time in science. You think you know something. You test it and you learn that you were wrong. So you think again.
The problem with TACA, NAA, Generation Rescue and SafeMinds is that they have convinced themselves that they already have the answer. If the science does not validate their beliefs they do not think again. Instead they reject the science and often malign the motives of the scientists.
On a recent US talk show a caller came out and said there was nothing that science could say or do to persuade her to alter her beliefs about vaccines and autism. She is another of Jenny McCarthy’s acolytes. McCarthy is not to blame for all this. She came late to a party that was already well established. They lionize her because of her celebrity and celebrity endorsements are all they have left.
Unfortunately celebrity seems to count for a lot more than science in a lot of the media. McCarthy is due to launch another book with another apearance on Oprah. Her endorsement prolongs the life of a movement that no longer commands any scientific support. Doubtless her presence will recruit a few more parents to the cause and further threaten vaccination rates. When vaccine preventable diseases then make an inevitable comeback she will attract an equally inevitable opprobrium.
But she is just a mum like most of the foot soldiers in this charade. Jenny McCarthy may be foolish and misguided, but misguided by whom? The doctors and scientists who have abandoned all professional standards in order to perpetuate the vaccine-autism hoax are the culpable ones. Who will call them to account?
September 6th, 2008
Posted by
Mike |
Andrew Wakefield, MMR, science, vaccines |
22 comments
10 years go a remarkable press conference took place to mark the publication of a new study in the Lancet. It was remarkable because this was a preliminary report, based on a series of only twelve case studies - not the normal stuff of press conferences. It suggested a new disorder, autistic enterocolitis. There had been suspicions about a link between gut disorders and autism for years. While this study was far too small to settle the issue it did suggest that a large scale study was called for. But why a press conference?
Richard Horton, editor of the Lancet, explains
“In the week of the paper’s publication, some of the Royal Free research team decided to hold a press conference to announce their findings. This gave them an opportunity to express the benefits of the MMR vaccine and the inconclusive nature of their results in respect to the link between the syndrome and the vaccine.” (MMR Science and Fiction by Richard Horton. Granta Books 2004)
So why did they issue this scaremongering press release, which Horton quotes in his book?
“The majority opinion among the researchers involved in this study supports the continuation of MMR vaccination. Dr Wakefield feels that vaccination against the measles, mumps and rubella infections should undoubtedly continue but until this issue is resolved by further research there is a case for separating the three vaccines into measles, mumps and rubella components and giving them individually spaced by at least 1 year.”
The answer, implicit in Horton’s account, is that Wakefield was a dynamic researcher who was shaking up a moribund department of medicine that had been resting on its laurels. He was their star player and was granted more leeway than normal in the hope that he would deliver glittering prizes. Wakefield was pursuing his own glittering prize. He was convinced that there was a connection between measles virus and inflammatory bowel diseases like Crohn’s syndrome. He suspected that measles vaccine might also be involved. He was developing his own single vaccine for measles that would bypass these difficulties and had issued a patent application in the name of the Royal Free Hospital in 1997. He was also employed by solicitors to demonstrate a link between MMR and autism, particularly where it involved symptoms of inflammatory bowel disease.
How much of this was known to his colleagues at the Royal Free? Did it influence their better judgement and allow Wakefield to hijack the press conference? Would there even have been a press conference without Wakefield? Did Wakefield’s ambition and personal conviction lead him to breach the ethics of his profession? All this is still the subject of conjecture and debate and, with regard to ethics, ongoing disciplinary hearings at the GMC. What is beyond conjecture is that, despite no credible evidence to support it, the idea that MMR causes autism became firmly implanted in the public consciousness. Vaccination rates declined and measles is once more endemic in the UK. It is widespread in Europe and spreading in America where concerns about the safety of a mercury preservative in vaccines coalesced with concerns about MMR to create vaccine resistant hotspots, primarily in affluent areas where people can afford the privilege of being the “worried well.”
All this comes at a time when deaths from measles are declining rapidly in the developing world thanks to a vigorous campaign of vaccination. To place this in context, deaths from measles are still statistically insignificant in Europe and North America. Success for the vaccination campaign in Africa, Asia and South America means that “only” around 250,000 children died from measles related causes last year compared to the 750,000 that was commonplace a decade ago.
Given the propensity of wealthy Americans and Europeans for foreign travel to exotic places it would be a tragic irony if the fragile success of the vaccination programme in the developing countries was compromised by western tourists carrying the virus into unvaccinated parts of the third world. It would be even more tragic if the anti-vaccine movements in the USA and Europe gained a foothold in those countries that desperately need vaccines and undermined the efforts led by the World Health Organization, with equally devastating consequences.
So one would hope that a definitive study that effectively disproves any link between MMR and autism would be trumpeted from the rooftops and receive coverage that was commensurate with the thouands of scare stories about MMR that have been in circulation for at least a decade since Wakefield’s inglorious announcement.
We shall soon have an opportunity to judge. Less than an hour ago Forbes Magazine reported on a new study which found no relation between MMR and autism. Of course there have been numerous studies before. These have singularly failed to persuade the Wakefield acolytes and their media friends. As Ben Goldacre noted last week:
“In the Journal of Medical Virology March 2006 there was a paper by Afzal et al, looking for measles RNA in children with regressive autism after MMR vaccination, using tools so powerful they could detect measles RNA down to single-figure copy numbers. It found no evidence of the vaccine-strain measles RNA to implicate MMR. Nobody wrote about this study, anywhere, in the British media (except for me in my column).
This was not an isolated case. Another major paper was published in the leading academic journal Pediatrics a few months later, replicating the earlier experiments very closely, and in some respects more carefully, also tracing out the possible routes by which a false positive could have occurred. For this paper by D’Souza et al, like the Afzal paper before it, the media were united in their silence. It was covered, by my count, in only two places: my column, and a Reuters news agency report
[...]
Journalists like to call for “more research”: here it was, and it was ignored. Did the media neglect to cover these stories because they were bored of the story? Clearly not. Because in 2006, at exactly the same time as they were unanimously refusing even to mention these studies, they were covering an identical claim, using identical experimental methodology: “US scientists back autism link to MMR” said the Telegraph. “Scientists fear MMR link to autism” squealed the Mail.
What was this frightening new data? These scare stories were based on a poster presentation, at a conference yet to occur, on research not yet completed, by a man with a well-documented track record of announcing research that never subsequently appears in an academic journal. This time Dr Arthur Krigsman was claiming he had found genetic material from vaccine-strain measles virus in some gut samples from children with autism and bowel problems. If true, this would have bolstered Wakefield’s theory, which by 2006 was lying in tatters. We might also mention that Wakefield and Krigsman are doctors together at Thoughtful House, a private autism clinic in the US.
Two years after making these claims, the study remains unpublished.”
It will not be so easy to ignore this report.
- The study is a deliberate attempt to replicate Wakefield’s original study. It looks for measles in the gut of autistic children with bowel disorders. Furthermore it includes a control group of non-autistic children with bowel disorder.
- It uses three different laboratories to test its results, including the original laboratory that Wakefield used. This lab, run by Professor O’Leary, had its results in the Wakefield study dismissed by world expert Stephen Bustin, because of cross-contamination that made them meaningless. Now that it has literally cleaned up its act its results concur with the other two labs: no evidence of measles in the intestines of autistic children with bowel disorder.
- “We found no difference in children who had GI complaints and no autism and children who had autism but no GI complaints,” Dr. Ian Lipkin of Columbia University told reporters in a telephone briefing.
- There was no temporal association between MMR vaccination and onset of GI symptoms.
- “We found no relationship between the timing of MMR vaccine and the onset of either GI complaints or autism,” Dr. Mady Hornig, also of Columbia, said in a statement.
Look at those names. Mady Hornig was the author of a controversial study that suggested a link between the mercury in some vaccines and autism. Ian Lipkin is her long time collaborator. Rick Rollens, a Californian politician who has been a powerful advocate for a vaccine induced autism epidemic and used to believe that the MMR vaccine was the final straw in his own child’s autism is quoted by Forbes commenting favourably on this study.
Not even the most diehard anti-vaccine activist could claim that this is just another big pharma/big government sponsored cover up. Or could they? What they are claiming, judging by some of the anti-vaccine contributors to the Environment of Harm email list is even more bizarre. Because O’Leary’s lab has produced bone fide results that contradict Wakefield they are arguing that the results he produced supporting Wakefield must be equally valid. I kid you not. It is as if someone watching Gordon Ramsay’s Hells Kitchen were to argue that, because the eventual winner delivered a perfect service in the final, their undercooked disaster in the opening round that very nearly got them eliminated also had to be cookery of the highest order.
I suspect that the true believers will never be persuaded. [Update: I was right. Kev has just blogged the NAA response. They call this a CDC study throughout to avoid admitting that "one of their own" Mady Hornig authored this study. NB for new readers: CDC in the NAA demonology equates to big pharma/government cover-up.] But I am encouraged when open minded scientists can pursue a hypothesis, believing it to be correct, and publish results that prove themselves wrong. So full marks to Lipkin and Hornig for upholding scientific values.
More blogging here
http://www.blacktriangle.org/blog/?p=1833
http://leftbrainrightbrain.co.uk/?p=1252
http://www.autismvox.com/mmr-vaccine-does-not-cause-autism-not-that-you-didnt-know-that-already/
http://blogs.discovermagazine.com/badastronomy/2008/09/03/antivax-new-evidence-shows-again-no-link-to-autism/
http://onedadsopinion.blogspot.com/2008/09/now-is-it-over.html
UPDATE
Now Orac joins the fray.
September 4th, 2008
Posted by
Mike |
Andrew Wakefield, MMR, Uncategorized, science, vaccines |
6 comments
