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Secrets of the MMR scare

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The Lancet's two days

to bury bad news

BMJ, the British Medical Journal, 19 January 2011

Brian Deer

In the third part of a special BMJ series, Brian Deer reveals what happened when he reported misconduct in Andrew Wakefield’s MMR research to the medical journal that published it

Preparing to give evidence in London to a UK General Medical Council fitness to practise panel, Richard Horton, editor of the Lancet, nodded in turn to three accused doctors, seated among their lawyers to his left. First, Simon Murch, almost close enough to touch. Next, John Walker-Smith, more distant. Finally, Andrew Wakefield, at the far end of the hearing room. Each smiled thinly and nodded back.

The four had last met together three and a half years before, at the Lancet’s offices, nearly two miles north. There they had begun the journey that now brought their reunion in this, the longest medical disciplinary inquiry ever. Running for 217 days, between July 2007 and May 2010, it would probe the research and a paper that launched the MMR vaccine scare, and would lead to Wakefield and Walker-Smith being struck off.

Their previous encounter was in 2004, on the afternoon of Wednesday 18 February. They had gathered in Horton’s office to deal with an approach from me concerning a four month Sunday Times investigation. For five hours that morning, I had briefed the Lancet’s senior staff about a now notorious 1998 paper in their journal. It reported on 12 children seen at the Royal Free hospital, north London, and claimed to have discovered a possible “new syndrome” involving regressive autism, inflammatory bowel disease, and MMR.

Mostly I had stood, occasionally pulling documents, as Horton, with five editors, took notes. I told them that the paper’s first author, Wakefield, was retained by a lawyer and was funded to help sue vaccine manufacturers. Admissions criteria for the study had been manipulated and ethical safeguards flouted. A group of developmentally challenged children of parents who blamed MMR had been brought to the hospital to create a case against the vaccine. I said I thought that the study was “rigged.”

At one point, I drew a diagram of a cluster of complaints, which had been used to link autism with the vaccine. “In the paper, the parents of eight of 12 children apparently said words to the effect of ‘It was the MMR, doctor,’” I told the meeting, convened around the journal’s boardroom table. “But when the series was extended to 30 children, only the parents of three more made that claim. So, why would the allegations bunch together at the start?”

I had assumed that when I finished Horton would say that an investigation was needed to untangle these complex matters. There were at least three strands: possible research fraud, unethical treatment of vulnerable children, and Wakefield’s conflict of interest through the lawyer. But within 48 hours, and working with the paper’s three senior authors, the journal was to publish a 5000 word avalanche of denials, in statements, unretracted to this day.

Years later, in the witness chair at the GMC hearing, Horton recalled that morning. “These were three sets of allegations which went to the heart of the credibility of the paper, and were clear allegations of research misconduct,” he told Sally Smith, Queen’s Counsel for the doctors’ regulator, on 7 August 2007. “We contacted Dr Wakefield, Professor Walker-Smith and Dr Murch, and asked the three of them to come to the Lancet’s offices so that we could discuss these allegations.”

Observing the GMC proceedings, I too remembered that day. Wakefield had arrived at the Lancet before I left the building. All three authors were former Royal Free staff, as was Horton—a fellow in the late 1980s. A decade before Wakefield’s publication, he had researched in hepatology, on the same corridor as Wakefield in gastroenterology.

During the 2004 meetings—first with me, and then with the authors—Horton was caught in a bind. Facing public alarm over MMR and professional scepticism towards the research, for years he had championed his former colleague. “I do not regret publishing the original Wakefield paper,” he said in a 2003 book, at the height of the UK scare. “Progress in medicine depends on the free expression of new ideas. In science, it was only this commitment to free expression that shook free the tight grip of religion on the way human beings understood their world.”

Raising Galileo’s ghost, he could not have then known how much of Wakefield’s research was free expression. As I revealed in the BMJ two weeks ago, in not one case in the series of 12 children could the now retracted paper be reconciled with National Health Service records. And last week, I reported on Wakefield’s secret business scheme, intended to harvest millions from the scare.

Horton, moreover, was a crusader for integrity and had pressed for tough action against research fraud. As a force behind both the International Committee of Medical Journal Editors and the Committee on Publication Ethics, he had campaigned with Richard Smith, then the BMJ’s editor, for a statutory watchdog on research misconduct. Despite their efforts, however, nothing had come of this, and Horton would now adopt a different approach.

Impropriety denied

“In this particular case,” he told the GMC tribunal of three doctors and two lay members, seated to his right at the hearing, “we went to the vice-dean of the Royal Free, laid out the nature of the problem, and asked him to investigate and come back to us, as best he could, with his own judgment of the veracity or not of the allegations. In addition to that, we would look at the documentation as best we could and try and form our view as to whether those allegations were true.”

It was a position he would develop in March 2010, after the panel’s findings fully endorsed what I had told him. “We asked the institution where the work was conducted—the Royal Free hospital—to complete an investigation,” he submitted in a written statement to the journalists’ magazine Press Gazette. “They did, and they cleared Wakefield of wrongdoing.”

But documents, emails, and replies obtained under the Freedom of Information Act reveal no formal investigation. What emerges is merely a scramble to discredit my claims during the 48 hours after I disclosed the information. They show the journal’s editor, the paper’s senior authors, and the Royal Free medical school, frantically mobilising against me. Were it not for the GMC case, which cost a rumoured £6m (€7m; $9m), the fraud by which Wakefield concocted fear of MMR would forever have been denied and covered up.

The denial began as soon as I left the Lancet on that Wednesday in February 2004. Seated around a circular table in Horton’s private office, the four doctors shared their thoughts and devised a strategy. Wakefield admitted only being retained for a lawsuit and denied receiving money himself. His legal role, he said, was to perform “quite separate” viral research, not the clinical study that appeared in the journal.

Copyright, Brian Deer. All rights reserved. No portion of this article on MMR and Andrew Wakefield may be copied, retransmitted, reposted, duplicated or otherwise used without the express written approval of the author. Responses, information and other feedback are appreciated - via the contact page