- FOCUS:
HOW A SPURIOUS HEALTH SCARE
BROUGHT AN OLD KILLER BACK
The
Sunday Times (London) June 18 2006
Brian
Deer
As health chiefs last week reported the worst
outbreaks of measles across Britain in 20 years, slow
progress was being made in bringing to justice the
doctor who sparked the MMR scare. At the high court
in London, lawyers for the General Medical Council
(GMC) gave the first public hearing to disciplinary
charges against Andrew Wakefield, whose scientific
paper published eight years ago caused millions to
shun the vaccination for fear that their children
might contract autism.
The
charges against Wakefield, 50, are some of the most
extensive seen. Timothy Dutton QC told Mr Justice
Silberman that the GMC, the body that regulates
doctors, was considering 10 counts of serious
professional misconduct. They include publishing
“inadequately founded” research, obtaining
funding “improperly” and subjecting
children to “unnecessary and invasive
investigations” without proper ethical approval.
Early
next year these and other charges will be heard by
the GMC’s fitness to practise panel. Empowered
to strike Wakefield off the medical register, the
hearing is expected to last two months and will be
one of the most high-profile adjudications seen.
Wakefield
was not in court last week. Having been shunned by
colleagues in Britain, he runs a business in Austin,
Texas, selling surgical tests for autistic children.
Among
the cramped pews and gothic ornamentation of court
10, however, his presence hung over the proceedings.
The hearing had been called at the GMC’s request
in an effort to obtain the court’s help in
gathering documents. Wakefield has said he has lost
vital documents and destroyed a key paper. After more
than two years of trying, the GMC’s frustrated
lawyers were getting tough.
IN
February 2004, after a Sunday Times investigation,
Wakefield declared that he would welcome an inquiry
as an opportunity to clear his name.
“It
has been proposed that my role in this matter be
investigated by the General Medical Council,” he
said in a statement. “I not only welcome this, I
insist on it.” He may have insisted, but he did
not cooperate. His lawyers, financed by the Medical
Protection Society, have fought trench warfare
against the GMC.
The
GMC’s work has been made harder by the
legislation that governs disciplinary proceedings
against doctors. According to the Medical Act of
1983, the council can demand that any person disclose
any document “except the practitioner in respect
of whom the information or document is sought”.
In other words, Wakefield cannot be made to hand over
his papers.
Field
Fisher Waterhouse, the GMC’s lawyers, have been
driven close to despair. Unable to secure the facts
from Wakefield, they last week took the course of
acting against the solicitors who — as The
Sunday Times discovered — hired him to make the
case against the vaccine before he triggered the MMR
scare.
In
the event the solicitors agreed to the request after
the judge ordered the hearing into secret session.
Dates and documents would be handed over within a
month, they agreed, bringing the hearing of
Wakefield’s case a step closer.
It’s
a case in which, Wakefield’s critics say,
closure is desperately needed. “We need to get
this over with,” said a close observer last
week. “We’ve got to stop the endless
re-running of a story that isn’t a story. Every
time there is something like the GMC mentioned,
journalists keep talking about the link between MMR
and autism, and there isn’t one.”
As
health chiefs revealed last week, Britain is now in
the grip of what has every sign of becoming a measles
epidemic. In March the first child in 14 years was
killed by the virus. Clusters of infections, such as
in Surrey and Yorkshire, have propelled the number of
confirmed cases this year to 449, the largest number
since the MMR jab was introduced in 1988.
“People
think measles is a trivial disease, but it is
not,” said a spokesman for the Health Protection
Agency. “Our message to parents is to get their
children vaccinated to reduce the risk.”
The
return of what was once a common disease is almost
entirely the result of the MMR scare, say
Wakefield’s critics. As Dutton told the court
last week, a paper published by the former gut
surgeon in The Lancet medical journal in February
1998 was the trigger for all that followed.
In
its outward appearance the paper was scientific. It
claimed that Wakefield and his team had happened upon
a link between the MMR jab — the combined
inoculation against measles, mumps and rubella —
and the onset of autism in 12 children who had passed
through the hospital.
But
unknown to the Lancet, the medical profession or the
public at the time, the parents of these children
were rather special: in 11 of the 12 cases they were
suing the manufacturers of MMR — and Wakefield
was being paid by a firm of solicitors to help them.
As
Dutton told the court, this hidden conflict of
interest places a major question mark over the
“scientific validity” of the paper and
Wakefield’s professionalism in having failed to
disclose it.
Yet
from 1998, when Wakefield launched his scare at a
press conference at the Royal Free hospital, in north
London, his version of the facts ran almost
unchallenged for the next six years.
The
story, as told by Wakefield, was of nagging clinical
and scientific evidence pointing to a link between
the jab and autism. The Daily Mail, Daily Telegraph
and the magazine Private Eye gave him full backing.
Wakefield
himself played the role of a scientific maverick.
Some admirers compared him with Galileo.
Then
in February 2004 his reputation was shattered after
an exposure by this newspaper. It revealed that
Wakefield had been paid by solicitors attempting to
sue the vaccine’s manufacturers — and that
some of the children’s parents were also
litigants, with an understandable axe to grind.
Following
these revelations, the prime minister made a
statement of support for MMR. “I hope, now that
people see that the situation is somewhat different
to what they were led to believe, they will have the
triple jab because it is important to do it,”
Tony Blair said.
The
Lancet, which published the original claims, did an
abrupt about-turn and described the Wakefield
research as “fatally flawed”. Most of his
co-authors retracted their claims. Far from
discovering an MMR-autism link, it seemed that
Wakefield had created one.
“There
was never one shred of verified evidence in his
work,” said Brent Taylor, head of child health
at the Royal Free’s medical school, and a noted
researcher on vaccine safety. “There was
absolutely no basis whatsoever for his claims.”
Later
that year Wakefield took another tumble as his
business ambitions became known. A Channel 4
Dispatches inquiry revealed patent applications,
lodged months in advance of The Lancet paper, on an
array of products, including Wakefield’s own
vaccine. There were also testing kits and treatments
— possibly what he called “a complete
cure” — for autism.
New
scientific findings also took their toll of
Wakefield’s position. None but his collaborators
confirmed his claims. Study after study — both
epidemiological and virological — reported that
they could find no evidence to link the MMR vaccine
with autism.
Researchers,
meanwhile, gave up even bothering to debate
Wakefield’s claims. The influential Oxford-based
Cochrane Collaboration reviewed all relevant
scientific papers last October and found “no
credible evidence of an involvement of MMR”.
Parents,
too, began turning their backs. “Public
confidence in the MMR is returning,” said Mary
Ramsay of the Health Protection Agency last week.
“Coverage among two-year-olds in June 2005 was
83% — up from 78.9% in January 2003.”
TO
KEEP measles under control, by so-called herd
protection, the vaccination rate needs to be 92%.
“What makes measles so difficult to stamp out is
the extraordinary infectivity of the virus,”
said Neil Ferguson of Imperial College London.
“Each
person who catches the disease will spread it, on
average, to another 15-20 people in an unvaccinated
population.”
One
couple for whom these are no dry statistics are Clare
and Paul Hooper from Nottingham. Their youngest
daughter Olivia caught measles when she was 10 months
old.
“Olivia
caught measles at nursery before she could have the
vaccination. It was a very stressful experience. My
husband and I are both doctors and are very aware of
the risks that come with measles. It can have all
kinds of complications including deafness and brain
infection.
“You
could say it’s selfish of some parents not to
immunise their children because they are putting
younger children like Olivia at risk... undoubtedly
Wakefield’s research led to many parents
deciding not to vaccinate.”
Experts
believe the only way forward is for the Wakefield
case to be heard — and heard fast.
Despite
his personal difficulties, however, sections of the
media appear determined to continue campaigns to
support him, no matter what the evidence. Last month
the Daily Mail launched a fresh attack on the
vaccine, claiming that “new American
research” had found a possible MMR-autism link
and “appears to confirm” Wakefield’s
findings.
This
much-hyped but unpublished research was no more than
a poster on a wall, however. It was presented at a
Canadian autism conference by Steve Walker, an
American university lecturer who specialises in
researching the effects of alcohol.
The
poster highlighted what was said to be evidence of
measles fragments, which experts say might be found
harmlessly in almost anybody along with genetic
remnants of countless other viruses.
Some
observers now believe the MMR debate has moved from
the realm of science to pseudo-religion and that,
whatever the GMC finds, the anti-MMR campaign will
continue.
“The
interesting thing to me is that you can line up the
chief medical officer and the chief nursing officer,
the presidents of the royal colleges, and it makes no
difference,” said Richard Smith, a former editor
of the British Medical Journal.
“If
you think vaccination policy is a conspiracy, then it
only makes you more sure that it’s a
conspiracy.”
The
man himself is unrepentant, according to his
solicitors, RadcliffesLeBrasseur. “Andrew
Wakefield has always and continues to strongly
contest any allegation of wrongdoing,” they said
in a statement. “He is satisfied that he has
acted properly and in good faith at all times. Dr
Wakefield has always stated that he is keen to
co-operate with a properly convened inquiry into
these matters, but cannot comment upon them whilst an
investigation is ongoing.”
Copyright,
Brian Deer. All rights reserved. No portion of this
article on MMR, Andrew Wakefield and the return of
measles may be copied, retransmitted, reposted,
duplicated or otherwise used without the express
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