- FOCUS:
"CALLOUS, UNETHICAL
AND DISHONEST"
The
Sunday Times (London) January 31 2010
Brian Deer,
who first exposed the scandal, reports on how Dr
Andrew Wakefield's reputation has been left in
tatters
It
began with a few murmurs. As Surendra Kumar, a
Cheshire GP, read out the verdict of the General
Medical Council (GMC) panel on the conduct of Dr
Andrew Wakefield and two colleagues last Thursday
there was muttering in the public seats.
“Disgraceful,” grunted one woman.
“Rubbish,” spat another.
As
Kumar spoke the key words —
“dishonest”, “irresponsible”,
“contrary to the clinical interests of this
child” — a crackle of anger and amazement
erupted. I wondered if a fight would break out in the
London committee room.
Since
July 2007 Kumar and four colleagues — two
doctors and two lay members, supported by a QC acting
as a legal assessor — have been hearing a
fitness to practice case brought against Wakefield
and his fellow doctors John Walker-Smith and Simon
Murch.
It
was the longest medical misconduct inquiry ever
held.The three men had been charged with offences
relating to research they had conducted during the
1990s at the Royal Free hospital in Hampstead, north
London, concerning the measles, mumps and rubella
(MMR) vaccine and supposed links to autism in
children.
Among
the charges was that Wakefield had not disclosed
commercial conflicts of interests. “Your
non-disclosure was contrary to your duties,”
Kumar read.
However,
the object of his remarks was not present. Wakefield,
53, was boycotting the proceedings, just as he once
urged parents to boycott MMR.
“You
caused this child to undergo a programme of
investigations for research purposes without having
ethics committee approval,” Kumar continued,
glancing to where Wakefield should have been sitting.
The
panel’s findings were astounding, both in their
number and substance. More than 30 charges were found
proven against Wakefield. For him alone they ran
across 52 pages. Embracing four counts of dishonesty
— including money, research and public
statements — they painted a picture of a man not
to be trusted.
Other
proven charges included nine of mistreating
developmentally challenged children: causing invasive
“high-risk” research to be carried out
without ethical approval and against their best
clinical interests.
The
panel ruled that Wakefield caused three children to
undergo lumbar punctures without clinical reason.
Three more rulings said he had breached his
employment contract at the hospital’s medical
school which forbade him from involvement in patient
care.
He
was also found to have shown “a callous
disregard” for the “distress and pain”
of children to whom he paid £5 in return for blood
samples at his son’s fifth birthday party.
The
reaction among some in the public seats at the
tribunal was disbelief. Wakefield retains the support
of a hard core of the families of children with
autism. A woman in a sheepskin coat suddenly
shrieked: “This is a setup. This is rubbish.
This isn’t true.” She was escorted from the
room.
Tensions
rose. Another outburst followed: “Those doctors
are not guilty of anything other than saving our
children. You are outrageous. This is a kangaroo
court.”
To be
honest, I shared the surprise of the parents, if not
their outrage. As one by one the charges were read
out and declared to have been “proven”, I
gasped.
To
many of the parents I was just as much of a villain
as Kumar. They blamed me for the fallout from my
investigations in The Sunday Times into
Wakefield’s research.
Kumar
turned to the paper in The Lancet medical journal,
where Wakefield first published his research and
which unleashed a tsunami of fear about MMR. Released
in February 1998, it reported on just 12 children,
aged between three and nine. They all had brain
disorders and the parents of eight of them allegedly
said that the first signs came on within days of
their receiving the MMR vaccination.
For
one woman it was all too much. “It’s Brian
Deer who should be on trial,” she called out.
Such is the highly charged world of MMR.
For
six years Wakefield and I have been locked in battle.
It was my investigation that triggered the GMC’s
case. He sued me for libel — and was then forced
to send me a cheque to cover my legal costs when the
action was withdrawn.
My
first big story in The Sunday Times about his work
was in February 2004. I exposed his deal with a
lawyer, Richard Barr, who was preparing a case
against the manufacturers of the MMR vaccine and
revealed that the parents of the Royal Free children
were mostly litigants, recruited through anti-vaccine
campaign groups.
Later
that year I revealed he had patented a single measles
vaccine which could succeed only in the wreckage of
MMR.
Thus
the “maverick” doctor stood exposed as a
two-timer. An apparent quester after truth — but
for a lawyer and, potentially, for his own benefit.
More
than that, he had fuelled a public health scare. MMR
has been proved to be safe in countless tests, yet in
the wake of Wakefield’s Lancet paper
immunisation rates in Britain dropped dramatically
and led to a surge in measles cases. In April 2006 a
child died of the disease in Britain for the first
time in 14 years.
Even
today the rate of MMR uptake stands at 85% for
two-year-olds; well below the 95% which the World
Health Organisation says will give the population
“herd immunity” from measles. Outbreaks
remain a danger.
That
is not Wakefield’s fault, he insists. Instead it
is the government that is to blame for not dancing to
his tune. Parents should have been offered the choice
of single measles shots, he says, notwithstanding the
grievous risks of rubella. Nor did he do what the GMC
says he did.
“It’s
a story that the government and the pharmaceutical
industry don’t want me to tell,” he told a
conference of young mothers in Chicago in 2008.
As
for the proven charges — the product of 197 days
of investigation — well, Kumar and his panel are
wrong. “The allegations against me and my
colleagues are both unfounded and unjust,” he
declared to his supporters outside the GMC’s
offices on Thursday. “I repeat, unfounded and
unjust.”
Wakefield
will probably never admit to his errors. But exposing
his methods has been worthwhile, according to medical
sources.
“People
can’t understand whether a scientific study is
valid or invalid,” said a senior doctor who had
watched vaccination rates slump, even in the face of
endless research on MMR safety. “But they can
understand ‘right’ and ‘wrong’,
and they can understand ‘honest’ and
‘dishonest’.”
Lawyers
have told me that any one of the more than 30 charges
that were proved against Wakefield would typically
lead to his being struck off. His days as a medical
practitioner will soon be history. A further hearing
will determine whether “serious professional
misconduct” was committed.
Yet
more troubling for Wakefield’s future are his
prospects for research, or at least of getting it
published.
“Any
journal to which a researcher shown to be dishonest
submitted a paper would reject it,” said Richard
Smith, former editor of the British Medical Journal,
this weekend. “They would say, ‘This man
can’t be trusted’. His career as a
researcher is effectively over.”
Wakefield’s
economic and fan base are undented, however. He is
now executive director of an autism clinic in Austin,
Texas, where he earns a reported £175,000 a year.
“My wife loves it here,” he said last year.
“My family love it here.”
Even
before Kumar spoke, a ferocious campaign took off
online denouncing the GMC as corrupt. “False
testimony denies Lancet doctors a fair hearing,”
trumpeted a lawyer advising Wakefield on an autism
website.
On
American television in August he was asked what
effect being struck off would have on him. Wakefield
replied: “Well, I think my credibility among the
people who I believe count — that is the
children who are affected, the parents of the
children who are affected — will probably remain
completely unchanged.”
He
may be right. “We are a very welcoming, somewhat
renegade, community,” said a paediatrician who
works in Austin but is no fan of Wakefield.
“Even the lynching he’s had in our local
paper is probably not enough to turn parents away.
But hopefully it will turn away the financial
backers. Only time will tell.”
The
town’s motto, she said, is “Keep Austin
Weird”. Its citizens should have come to the GMC
last week.
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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