- NEWS
REVIEW: TRUTH OF THE
- MMR
VACCINE SCANDAL
The
Sunday Times (London) January 24 2010
After an
epic misconduct hearing, the doctors who caused panic
over the vaccine are about to learn their fate. Brian
Deer reports on the greatest health scare of recent
times
They travelled
to London in the mid-1990s, each carrying or pushing
a child. A dozen anonymous families with 11 boys and
one girl, who were to trigger the health scare of our
time. The children had brain disorders. Some had
autism; others, Asperger’s or epilepsy. And
nearly all of the parents had come to believe that
the cause was the measles, mumps and rubella (MMR)
vaccine.
I think it was
I who later dubbed them “the Lancet 12”,
after the medical journal from which they leapt into
the headlines. Written up in February 1998 by Dr
Andrew Wakefield and other doctors at the Royal Free
hospital, in north London, their cases at first
appeared to provide credible grounds for the panic
that took off over the vaccine.
Whether or not
I named them, the moniker has stuck. And over the
past 2½ years, in a central London committee room,
their numbers have been called like pedalos in the
park during the longest medical misconduct inquiry
ever held.
“Now,
sir, Child 5 ... If the panel would turn to Child 9
... We’ll resume with Child 4 after lunch . .
.”
With each call
of a number, at the West End offices of the General
Medical Council (GMC), lever-arch files have been
yanked from cardboard crates. Front covers have been
lifted. Tabs pulled. And then five QCs, five
disciplinary panel members, the three doctors under
investigation and a witness have together located a
page — say, a GP’s note from 1996 — to
be read aloud.
“Mum
taking her to Dr Wakefield, Royal Free hospital, for
CT scan, gut biopsies, query Crohn’s. Will need
ref letter. Dr Wakefield to phone me.”
Throughout 29
widely spaced weeks of evidence and submissions, such
notes have been pored over like the Dead Sea scrolls.
What was wrong with these children? Why were they
brought to the Royal Free? How did their medical
problems end up in The Lancet?
I can answer
all of that. I can name the 12 from memory.
They’ve been part of my mental landscape for
half a decade. As the reporter whose investigations
exposed the flaws in Wakefield’s research and
sparked this unprecedented inquiry, I’ve
sometimes felt that these kids and I were
mysteriously in it together, like the passengers on
the Orient Express.
Most of their
parents would be outraged by the idea: some of the
mothers have grown to hate me like satan. I’m
the man who pulled the rug from under the idea that,
however painful, helped them to make sense of their
world, and I feel for their grief.
This week,
more of the saga of MMR will unfold, with
“findings of fact” on who did what at the
hospital. After nearly 200 days (the trial of OJ
Simpson lasted 134), a panel of three doctors and two
lay members will open the latest, but not the last,
chapter in the story, with rulings on a raft of
extraordinary charges of professional misconduct.
Strenuously
denying them are three of the men whose Lancet report
set off a tsunami of anxiety in 1998. That report
claimed that within days of receiving MMR, eight of
the 12 children showed the first signs of what was
called “regressive autism”, and 11 later
developed bowel disease.
At the time,
the three doctors were consultants at the Royal Free,
where the kids were brought for a battery of
investigations. John Walker-Smith, now 73, was the
most senior. He was professor of paediatric
gastroenterology. Short and white-haired, with his
voice betraying Australian origins, he has seemed to
age as each lever-arch file has flopped open.
To his right
at the hearing was Simon Murch, 53, a paediatrician
whose speciality was colonoscopies. Tall and languid,
he’s now a professor at Warwick University and,
as the mammoth hearing has progressed, he has written
and selfpublished a novel about old chums going
boating on the Thames.
The sharpest
spotlight was on Andrew Wakefield, 53, who sat to
their left, amid a phalanx of barristers and
solicitors. In the 1990s he was a researcher in the
Royal Free’s medical school. And for two years
before the Lancet report, at £150 an hour, he had
been helping a Norfolk lawyer to gather evidence
about MMR for a planned lawsuit against its
manufacturer.
A former
trainee gut surgeon and champion amateur rugby
player, Wakefield had double Walker-Smith’s
presence. He was quizzed for 22 days but called no
witnesses. Then he flew to Austin, Texas, where he
now runs an autism clinic, and arrived back in London
last Wednesday morning.
I suppose I
might call them “the MMR Three”. But, after
breaking innumerable stories on how the vaccine scare
was contrived, I found the doctors — like the
hearing room’s dry air and ochre carpet —
less memorable than the stories of the 12.
The first,
Child 1, was a little boy from Lincolnshire. His
mother brought him to the hospital in July 1996, when
he was just 3½ years old. He was autistic, like his
brother. After being admitted to a sixth-floor ward,
he endured five gruelling days of tests, in what
appears to have been a hunt for vaccine damage.
The other 11
kids were brought in over the following seven months:
a sporadic, sad procession of broken dreams. Some
were severely retarded and irrevocably autistic. None
was from London. Two were brothers. One was American.
Two were registered at the same GP surgery on
Tyneside. Three were patients at another hospital
clinic.
I’ve met
many of their parents, and even some of the children.
The most memorable was the American: Child 11. Now a
dark-haired teenager, he recently came over for
Wimbledon fortnight.
All 12
underwent similar procedures. They had an
ileocolonoscopy under anaesthetic — a method of
inspecting the bowel. It is a rare investigation in
children, listed in ethical guidelines as “high
risk”. Nearly all had lumbar punctures, MRIs and
EEGs.
What was going
on here? The Royal Free had no department of, and
little expertise in, children’s development
disorders. The GMC’s case is that the 12 were
enrolled in unapproved medical research. It says
Wakefield’s mission was to find evidence, in gut
tissue and brain fluid, to prove a theory about how
MMR could cause autism.
That theory,
now discredited, proposed that autism and bowel
disease were caused by the measles virus, found in
the vaccine. And to show this, the council says,
Wakefield wanted to examine children’s bowels
and other organs.
“No one
doubts or has questioned the tragedy of these
children’s disorders, nor the love of their
parents,” Sally Smith QC told the panel last
March, closing the council’s submissions.
“But this case is about the nature of the
doctors’ duties towards their patients. And, of
course, it is the child who is the patient in every
case.”
In addition,
she said, the hearing was about the reporting of
research: the “accuracy and honesty and
transparency” of the Lancet report. And third,
she told the panel, chaired by a GP, Dr Surendra
Kumar, it was about “conflicts of interest”
on Wakefield’s part. “It’s a case
about breaches of some of the most fundamental rules
in medicine,” she said.
These are
among the gravest professional charges any doctor can
face, striking at the heart of medical ethics. After
Germany’s experience in the second world war,
volumes of regulations have evolved to protect
patients, especially children, from any possibility
of being treated as guinea pigs.
Against the
council’s case, Wakefield and his colleagues say
the tests on the 12 were solely in the
children’s interests. Although no Royal Free
witness or document verified this narrative, the
doctors each assured the panel that every
investigation, every blood test, was part of the
children’s normal clinical care.
“Dr
Wakefield had a profound interest in, and concern
for, these children, many of whom were known to him
as a result of initial contact by the parents,”
said Kieran Coonan QC, Wakefield’s lawyer,
closing his remarks.
Only one
parent sat in the witness chair: the mother of Child
12, who had spoken of her grief on being persuaded,
in the summer of 1996, that the child’s
condition could be due to the vaccine. She gave
evidence to the hearing back in August 2007, although
she stressed that her six-year-old son was kindly
treated. She had originally gone to Wakefield after
contact with an MMR campaigner and the Norfolk lawyer
Wakefield was working with, four years after the boy
received his shot.
On Thursday
this week the panel is expected to give its
judgments. Vaccine safety will be back in the news.
Not the old chestnut about whether MMR causes autism:
this time the debate will be about the extent to
which those who proposed the link can or cannot be
trusted.
As for the
Lancet 12 themselves, they are now young adults. Only
one came, briefly, to listen. Others are in
institutions, either full-time or during the week.
Just a handful might comprehend their place in
history.
What was
reported on these children in 1998 triggered an
epidemic of fear. But there have been other —
forgotten — victims of the scare: the parents,
who for years believed it was their own fault that a
son or daughter had a brain disorder. The debate over
MMR stalks their souls.
Before
vaccination, their children appeared healthy and
happy. Some time afterwards, there were signs of a
problem and parents were led to believe it was caused
by the vaccine. “I had this perfectly normal
child,” said Mrs 12, giving evidence. “It
was like a jigsaw puzzle that seemed to fit into
place.”
More of the
picture will be visible on Thursday.
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.
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appreciated - via the briandeer.com
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