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.”