Dr Andrew J. Wakefield, an academic gastroenterologist, was part of a team at the Royal Free Hospital School of Medicine in London.
Wakefield once said, “I have lost my job, my career and my country”. Why, to this day, is his work perceived by some as being discredited?
In his own words, “On February 28, 1998, twelve colleagues and I published a case series paper in The Lancet, a respected medical journal, as an “Early Report”. The paper described the clinical findings in 12 children with an autistic spectrum disorder (ASD) occurring in association with a mild-to-moderate inflammation of the large intestine (colitis). This was accompanied by swelling of the lymph glands in the intestinal lining (lymphoid nodular hyperplasia), predominantly in the last part of the small intestine (terminal ileum). Contemporaneously, parents of 9 children associated onset of symptoms with measles, mumps and rubella (MMR) exposure, 8 of whom were reported on in the original paper. The significance of these findings has been overshadowed by misunderstanding, misrepresentation, and a concerted, systematic effort to discredit the work. This effort, and specifically the complaint of a freelance journalist and an intense political desire to subvert enquiry into issues of vaccine safety and legal redress for vaccine damage, culminated in the longest running and most expensive fitness to practice case ever to come before the United Kingdom’s medical regulator, the General Medical Council. At this point, the guilty verdict is in. Now, and only now, with all of the contemporaneous documentation available, is it timely to review both the original paper and its legacy.” So wrote Dr Wakefield in Callous Disregard, published in 2011.
The General Medical Council found that Wakefield had shown a “callous disregard” for the children involved in his research. Was this the case? Take two and a half minutes to see what the parents of the children say about Wakefield and his colleagues. Alternatively, read the transcript below.
An Open Letter
To Whom It May Concern
We are writing to you as parents of the children who, because of their symptoms of inflammatory bowel disease and associated autism, were seen at the Royal Free Hospital Paediatric Gastroenterology Unit by Professor Walker-Smith and Dr. Simon Murch with the involvement of Dr Andrew Wakefield on the research side of their investigations. Our children became the subjects of a paper published in The Lancet in 1998.
We know these three doctors are being investigated by the General Medical Council (GMC) on the basis of allegations made to them by a freelance reporter. Among the many allegations made are the suggestions that the doctors acted inappropriately regarding our children, that Dr. Wakefield ‘solicited them for research purposes’ and that our children had not been referred in the usual way by their own GPs. It is also claimed that our children were given unnecessary and invasive investigations for the purpose of research, and not in their interest.
We know this was not so. All of our children were referred to Professor Walker-Smith in the proper way in order that their severe, long-standing and distressing gastroenterological symptoms could be fully investigated and treated by the foremost paediatric gastroenterologists in the UK. Many of us had been to several other doctors in our quest to get help for our children but not until we saw Professor Walker-Smith and his colleagues were full investigations undertaken.
We were all treated with utmost professionalism and respect by all three of these doctors. Throughout our children’s care at the Royal Free Hospital we were kept fully informed about the investigations recommended and the treatment plans which evolved. All of the investigations were carried out without distress to our children, many of whom made great improvements on treatment so that for the first time in years they were finally pain free.
We have been following the GMC hearings with distress as we, the parents, have had no opportunity to refute these allegations. For the most part we have been excluded from giving evidence to support these doctors whom we all hold in very high regard. It is for this reason we are writing to the GMC and to all concerned to be absolutely clear that the complaint that is being brought against these three caring and compassionate physicians does not in any way reflect our perception of the treatment offered to our sick children at the Royal Free. We are appalled that these doctors have been the subject of this protracted enquiry in the absence of any complaint from any parent about any of the children who were reported in the Lancet paper.
It becomes apparent that the information we’ve been presented with by the media over the years bears little relation to the truth.
Wakefield’s “mistake” was in trying to do a thorough investigation into the health problems the children had, and in daring to (sensibly) suggest that parents should consider getting measles, mumps and rubella vaccines separately until appropriate MMR safety studies were done. His goose was cooked when he questioned government policy.
Myths surrounding the Wakefield case
Wakefield examines these myths in Callous Disregard.
The Lancet paper was funded by the Legal Aid Board (LAB)
False – Not one penny of LAB money was spent on The Lancet paper. A LAB grant was provided for a separate viral detection study. This latter study, completed in 1999, does disclose the source of funding. The Lancet paper had been submitted for publication before the LAB grant was even available to be spent.
My involvement as a medical expert was kept “secret”
False – at least 1 year before publication, I informed my senior co-authors, the head of the department, the dean of the medical school, and the CEO of the hospital. This fact was also reported in the national press 15 months prior to publication.
Children were “sourced” by lawyers to sue vaccine manufacturers
False – Children were referred, evaluated, and investigated on the basis of their clinical symptoms alone, following referral from the child’s physician.
Children were litigants
False – at the time of their referral to the Royal Free, the time material to their inclusion in The Lancet paper, none of the children were litigants.
I had an undisclosed conflict of interest
False – The Lancet‘s disclosure policy at the time was followed to the letter. Documentary evidence confirms that the editorial staff of The Lancet was fully aware that I was working as an expert on MMR litigation well in advance of the paper’s publication.
Did not have ethics committee (EC) approval
False – The research element of the paper that required such an approval, detailed systematic analysis of children’s intestinal biopsies, was covered by the necessary EC approval.
I “fixed” data and misreported clinical findings
False – There is absolutely no basis in fact for this claim and it has been exposed as false.
Findings have not been independently replicated
False – The key findings of lymphoid nodular hyperplasia (LNH) and colitis in ASD children have been independently confirmed in five different countries.
Has been retracted by most of the authors
False – 11 of the 13 authors issued a retraction of the interpretation that MMR is a possible trigger for syndrome described. This remains a possibility and a possibility cannot be retracted.
The work is discredited
False – Those attempting to discredit the work have relied upon the myths above. The findings described in the paper are novel and important.
Parents rally in support of Wakefield, above
I think it’s important for people to read what Wakefield writes under the heading Diligent Science. It really does hit home as to the degree of injustice perpetuated against him.
“The quest for precision can become a hostage to fortune, as the microscopic analysis of The Lancet children’s tissues was to prove. There are few people in the world with Professor Walker-Smith’s knowledge of the microscopic appearances of the inflammatory disease of the intestine in children. So it was that, in the absence of a paediatric pathologist expert in this field at the Royal Free, Professor Walker-Smith conducted a weekly review of his patients’ tissues and identified the fact that disease was being missed in some children. In order to reduce this risk and to standardise the reporting of the ASD children’s biopsies, all tissues were subsequently examined by a single senior pathologist with expertise in bowel disease. His findings were recorded on a specially designed chart to document specific features of tissue damage. This record formed the basis of what was subsequently reported in The Lancet. Few case series go to this level of precision.
In the hands of someone determined to discredit the work, however, discrepancies between the clinical report (which may have come, for example, from a pathologist with an interest in brain disease or gynaecological pathology) and the standardised expert analysis were falsely reported in the national media as “fixing” of the data. I was specifically accused of this, although I had no part in scoring the reviews. It is notable that despite 5 years of the investigation by the GMC, no charge of scientific fraud has been made against any of the defendants. The allegation of fraud was made by the same freelance journalist who had actually also initiated the GMC inquiry, continuing his litany of false allegations. There is no evidence that the data had been “fixed” as was alleged, and the newspaper in question has failed to produce any, despite a request to do so from the Press Complaints Commission. Paradoxically, the price paid for diligent science has been a headline proclaiming fraud. In my opinion, the intended goal – to reinforce the false belief that the work is discredited – has been achieved.”
This is Brian Deer, the journalist who initiated the GMC investigation. I personally think he’s an utter grub. Yes, I believe him to be a grub without a conscience.
And I do so enjoy seeing this image of him
Yes, Brian, who is pulling your strings. And what happened to your conscience? Can it be bought? I wonder how you look at yourself in the mirror each day.
In Science for Sale (published 2014) by David L. Lewis, PhD, we read that “Behind the scenes, Parliament was dealing with a critical loss of confidence in the MMR vaccine. From 1988 to 1992, SmithKlineBeecham marketed the MMR vaccine, Pluserix, in Great Britain. It was withdrawn because the mumps component caused outbreaks of asceptic (viral) meningitis. Because meningitis involves brain inflammation, the MMR vaccine had already been implicated in the United States as a possible factor in causing autism. At a press conference when the Lancet article was published, Wakefield was asked about the MMR vaccine controversy. He recommended that concerned parents talk with their pediatricians about having their children vaccinated with the single measles vaccine, which was available in Great Britain at the time. Reacting to parents, shifting to the single measles vaccine, the British Government withdrew it.
…Then we see the government prosecutors arranging to have their expert pediatric gastroenterologist, Professor Ian Booth, conduct a highly questionable analysis of the Lancet children’s routine pathology reports, which made it appear that Wakefield exaggerated information in the grading sheets provided by one of his senior coauthors, Dr Paul Dhillon, who was a world-reknowned expert in examining colon biopsies.
Finally, we see the British Medical Journal (BMJ), which is sponsored by manufacturers of the MMR vaccine, publishing Booth’s analysis just as the GMC hearings end. While the BMJ claims that the source of this analysis is an award-winning investigative reporter, Brian Deer, I discovered that the actual source was the GMC’s solicitors acting on behalf of the British government”.
I wonder if this might possibly be Brian Deer’s favourite song?
Andrew Wakefield tells it as it is
“The damage done to my reputation and to that of my colleagues as well as the personal price for pursuing a valid scientific question while putting the patients’ interests above all others is trivial compared with the impact of these falsehoods on the children’s access to appropriate and necessary care. My experience serves as a cynical example to discourage others. As a consequence, many physicians in the United Kingdom and United States will not risk providing the care that is due to these children. There is a pervasive and openly stated bias against funding and publication of this work, and I have been excluded from presenting at meetings on the instructions of the sponsoring pharmaceutical company. This episode in medical history has been an effective exercise in public relations and selling newspapers. But it will fail – it will fail because nature cannot be deceived.”
Dr Wakefield will have his day. Meanwhile, those of us with eyes to see can clearly see the truth. And we will never stop speaking up about it.