Washington Post reviews Wakefield story so far, with plans for Texas business

This page is research from an investigation by Brian Deer for The Sunday Times of London and the UK's Channel 4 Television into a campaign linking the MMR children's vaccine with autism. | Go to part I: The Lancet scandal | Go to part II: The Wakefield factor

On Sunday July 11 2004, Glenn Frankel, reported from London for the Washington Post, after interviewing some of the key players in the MMR scandal. His story ran from page A1, under the heading "Charismatic Doctor at Vortex of Vaccine Dispute"

After opening with Wakefield's familiar claim to "listen to his patients" [although, as an academic gut surgeon, Wakefield had no patients], Frankel recounts a version of the story told by Rosemary Kessick, who runs a Wakefield fan club called Allergy-Induced Autism. The report then explains Wakefield's theory that children with autism might also have a gut problem, with both caused by MMR. Although public health officials insist that he is wrong, the Post explains, vaccination rates have fallen and measles outbreaks risen.

Now his credibility has taken another blow, from a Sunday Times newspaper report that Wakefield failed to disclose that his work had been supported by funds from a group of parents filing a lawsuit against the vaccine companies. Wakefield has vehemently denied any conflict of interest, but the editor of the Lancet, a distinguished medical journal, now says he would not have published Wakefield's groundbreaking 1998 report had he known about the funding.

Ten of the 13 physicians involved in the original report have withdrawn their support, and the cabinet secretary in charge of Britain's national health service has called for an investigation.

The Wakefield story is about public health and risk and the abiding mistrust that many people hold toward government officials, especially when it comes to issues of health and safety. It is also about how the media can transform complex matters of public policy into simple narratives with heroes and villains. And it is about one charismatic doctor who contends he holds the key to unlocking a medical mystery and that many of his colleagues are either too craven or too frightened to seek the truth.

Frankel describes Wakefield in traditional manner ["tall, square-jawed and soft-spoken"], and describes him as once having been "a golden boy in the medical world". After some biographical detail, the report returns to Mrs Kessick:

By the time Kessick came to see Wakefield with her son William, he had already begun to theorize about a link between the rising numbers of children with Crohn's disease, an inflammatory intestinal disorder, and the introduction of the MMR vaccine a few years earlier. William's case, Wakefield says, helped convince him that there could be a connection between the vaccine and autism as well.

Frustrated to the point of rage by what she saw as a general lack of understanding in the medical profession, Kessick had schooled herself in the disorder. She discovered that autism comes in many shapes and sizes, but its most general characteristic is profound isolation -- an autism sufferer cannot communicate with or understand others. Some children seem to suffer from autism at birth, while in others it develops in the first few years of life.

Kessick also learned that autism rates were rapidly rising -- although there is no agreement on exactly how fast or why. Many experts argue that improved diagnosis and deeper awareness among professionals have led to more accurate and earlier identification of the problem. Others contend that the absolute number of cases is rising, not just medicine's ability to find them. In their view, something in the environment must be to blame.

Based upon William's nightmarish decline, Kessick was certain that the MMR vaccine was at least one of the environmental factors. Most of the doctors she saw dismissed her as an obsessed and guilt-stricken mother looking for an answer to an unsolvable mystery.

The Washington Post report describes, among other things, the study set up at the Royal Free hospital to test William Kessick and other children, followed by a reference to the 1998 press conference called to launch the now-infamous Lancet paper.

But other researchers were failing to reproduce his results and various epidemiological studies of large, controlled populations failed to uncover a link between MMR and autism. The Institute of Medicine in Washington, part of the National Academy of Sciences, has compiled 14 large-scale studies in the United States, Canada and Europe that all exonerate the vaccine. Wakefield suggests each study has been flawed either because of its methodology or because its authors massaged the findings to get the answers they sought.

David Salisbury, head of Britain's national immunization program, said he understands why Wakefield's views gained traction with the public. "Unfortunately we have a long tradition of vaccine scares in this country," he said in an interview, "and people no longer accept the rather patronizing 'Do as I say because I'm the doctor.'"

Still, says Salisbury, the MMR has passed every test. "It's now been looked at by studies from numerous industrialized countries conducted in many different ways and they all come to the same conclusion -- we can find no evidence of an MMR-autism link," he said.

The report then discusses the "single jabs" issue, sparked by an unsubstantiated claim by Wakefield at the press conference that these might be safer than the triple MMR, before moving on to the failure of the intended MMR lawsuit after the Legal Services Commission "pulled the plug on funding". Other points follow, before Frankel turns to London GP Mike Fitzpatrick.

He says he got involved in the controversy after the mother of an autistic child told him she blamed herself for allowing her child to receive the triple jab. "What really annoyed me was Andy Wakefield setting himself up as spokesman for the parents when in fact what he was doing was visiting guilt upon many parents," said Fitzpatrick, who has just published a book, "MMR and Autism: What Parents Need to Know."

"People are anxious, they're frightened and so it's easy for many to adopt the default position and do nothing," Fitzpatrick said.

Frankel later turns to Brian Deer, then the Texas plan:

Last November a Sunday Times journalist who identified himself as Brian Lawrence paid a visit to Kessick's home north of London. He spent nearly six hours questioning her about William's autism, Wakefield and the entire MMR controversy. Afterward, she said, she felt like she had been grilled like a witness under cross-examination. She said that Lawrence didn't seem to believe anything she told him.

Her suspicion was not far off. "Brian Lawrence" was actually Brian Deer, a prize-winning investigative journalist with a reputation for breaking stories about the pharmaceutical industry. Deer said he used a false name -- Lawrence is actually his middle name -- because he didn't want Kessick to check his web site and find out that one of his specialties was tracking down false claims of damage from vaccines.

Deer said he had planned to attend the trial of a major MMR lawsuit due to begin in April. When it was suspended indefinitely, he decided to launch his own probe. He found Kessick, like many of the plaintiffs, to be sympathetic people but less than reliable witnesses. He concluded that they wanted to believe MMR had caused their children's autism and that they may have bent the truth to prove it.

"I took her through her evidence as she would be asked in court," he recalls. After about several hours, he says, he told her she and the other plaintiffs could never win their case.

Wading into the huge volume of records in the case, Deer discovered something Wakefield had neglected to tell the Lancet: that the Royal Free Hospital had received some $90,000 in funding from the plaintiffs for Wakefield's help in doing a study of 10 of the victims. Four of the plaintiffs, including William Kessick, were among the dozen patients included in the Lancet article.

Rather than showing up at the Royal Free as consecutive referrals from disinterested general practitioners, Deer alleged, the Lancet 12 had been carefully chosen to prove Wakefield's theory and help lend credence to the lawsuit.

Wakefield insisted he had done nothing wrong -- that the Lancet study and the legal case had been kept entirely separate. But Lancet editor Horton said his former colleague should have disclosed the potential conflict before the original study was published. "If we had known the conflict of interest Dr. Wakefield had in this work, in my judgment it would have been rejected," Horton told the BBC.

A few weeks later, 10 of the 13 doctors on the original study issued a "Retraction of an interpretation" in which they declared that "no causal link was established between MMR vaccine and autism." Wakefield refused to sign.

The retraction was "absolute nonsense, just spin," he says. "There's absolutely no doubt they've been under huge pressure and it's very sad. We did discuss this in detail and I said, 'Guys, I can't sign up to this'."

Wakefield lost other allies as well. John O'Leary, an Irish microbiologist who has been one of his key collaborators, pronounced himself "shocked and disappointed" that Wakefield had not declared the potential conflict.

But Wakefield's core supporters, such as Rosemary Kessick, continue to believe in him. Robert Sawyer, chief executive of Visceral, Wakefield's research group, says donations are still coming in. But he expects to move Wakefield's research unit to Texas over the next few years. The United States, with its privatized health care system and entrepreneurial spirit is much more fertile ground than Britain for a medical pioneer like Wakefield, Sawyer said.