How lawyers paid for start of MMR scare; letters refute Andrew Wakefield's story

This page is research from an investigation by Brian Deer for the UK's Channel 4 Television and The Sunday Times of London 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

Among Brian Deer's key discoveries was that Wakefield research had been funded through lawyers suing drug firms over MMR. But in February 2004, Andrew Wakefield and his former Royal Free colleague Dr Richard Horton, editor of the Lancet, made formal public statements claiming that the legal work was "scientific" and "quite separate" from the Lancet clinical study. This was false, as these letters, obtained by Deer under the Freedom of Information Act, and audio clips from interviews by Deer below reveal

(1) 23.05.97: Wakefield asks hospital to bank money

On 6 June 1996, Andrew Wakefield and lawyer Richard Barr asked what was then the UK's Legal Aid Board (now the Legal Services Commission) for money to fund "clinical and scientific" tests on 10 children involved in a lawsuit being prepared against MMR manufacturers. They supplied the LAB with a "proposed protocol" document, and another, much longer protocol, virtually the same as one submitted soon after to the Royal Free's ethics committee.

After a contract with Wakefield was awarded by the board in August 1996, the money came through as a disbursement from Barr's law firm, Dawbarns, to the Royal Free's medical school. But the school's dean, Professor Arie Zuckerman, questioned the arrangement on ethical grounds. This posed Wakefield, who, since February 1996 had been employed by the lawyer in a joint attack on MMR, a problem. As the first letter below reveals, he then asked the hospital's management to bank it for his use in a special trust which it controlled.

ECRs, mentioned above in paragraph 2, are "extra-contractual referrals" - now disbanded "internal market" arrangements under which GP and medical centre budgets paid for patient admissions to hospitals (often very profitably for the hospital). In short, ECRs meant money.

Wakefield refers to an account already being used by the NHS hospital, and already holding hospital money "to fund Ms Rosalind Sim". In the light of its ECR income, the hospital had already agreed to pay Sim's salary from its own funds more than seven months before Wakefield's request to bank his legal money. The account was Special Trustees Account 106, established in January 1994, which received cheques from drug companies and other Wakefield sponsors.

Wakefield makes damningly explicit in his letter that the legal money was provided "for the express purpose of performing the study outlined in the enclosed protocol". This protocol describes the clinical work published in the Lancet in February 1998. Claims in 2004 by Wakefield and Richard Horton of the Lancet that the contract was for a separate "scientific" study are thus proven to be false. The MMR findings in the Lancet were simply paid for by a law firm - a position confirmed by Richard Barr in interviews with Brian Deer [listen below].

Giving evidence in 2008 before a fitness to practice panel of the UK General Medical Council, Wakefield astounded the panel by denying the plain words on the page - including the clear statement that the Legal Aid Board paid for clinical research, and also his use of the word "recruited". Wakefield's argument prompted astonished questioning from the panel when he claimed that the document was wrong because he had written it to an accountant.

In August 2009, Wakefield appeared on Dateline NBC in the United States, where he claimed that the children in the Lancet study were: "Nothing to do with research, nothing to do with class actions, nothing to do with vaccines." The material on this page, plainly, say otherwise. The very first letter explains that "the study" was funded by the Legal Aid Board, and was "to establish the validity of the parents' claims of an association with MMR".

(2) 30.06.97: Else agrees "grant", using legal income

Given the medical school's rejection of the money from lawyers to pay for Wakefield's MMR research findings, the hospital's chief executive, Martin Else, agreed to take it instead. He offered to pay it back to Wakefield's research activities as a "grant". All Mr Else, who left the hospital in 2005, required - in a letter headed "Special Trustees Fund - MMR Research" - was what amounted to a formal written waiver of impropriety.

It's clear from this letter that Else knew there was something out-of-the-ordinary about him providing "accounting functions" for money from lawyers to fund research. Moreover, as the MMR scare exploded in February 1998, it seems that the chief executive was in a position to know that the allegation in the Lancet of a possible MMR-autism connection, which terrified parents and caused a slump in immunisation rates (following a media campaign orchestrated by his staff, with foreseen consequences), had - by Wakefield's own account in these letters - been paid for through a law firm suing MMR manufacturers.

(3) 03.07.97: Wakefield promises 300 more children

Despite his later denials of the plain words of this correspondence, Wakefield unmasks his claims of 2004 when he states in the first sentence of the next letter that the research paid for through lawyers was "a clinical study of children with autism and intestinal inflammation". He adds that the research will determine "any future actions" against drug companies "if and when our studies indicate that is a valid strategy". The letter also explicitly refers to the Lancet paper.

The letter offers Else a sweetener for any inconvenience: where Wakefield speaks of "300 children who merit investigation under this protocol, most of these as ECRs (or commissioned referrals for the future)." The promise of a surge in income from autistic children may have been welcome to the hospital's management, but as of July 1997 it's clear that many of these children may have been identified through the client lists of Richard Barr, and from two organisations run by MMR litigants: Jackie Fletcher's organisation JABS, and Rosemary Kessick's Allergy-Induced Autism. Fletcher told Brian Deer in a September 2003 telephone interview that all 12 of the children in the Lancet study "were investigated through the JABS group". She was exaggerating somewhat.

(4) 24.07.97: Hospital confirms account 106 ready

In a letter to the medical school - headed "Dr A Wakefield: Legal Aid Board Sponsored Research" - the hospital identifies account 106 as the reference for the transferred money.

And so the arrangement was in place. According to these documents, money which helped finance the launch of the worldwide MMR scare was paid from the Legal Aid Board to Barr's firm Dawbarns. After the medical school's rejection, payments from Barr were transferred to the hospital's Special Trustees, who then granted it back to Wakefield's medical school research, set out in the protocol.

Finally, the Special Trustees' involvement was acknowledged in the Lancet paper ["This study was supported by the Special Trustees of Royal Free Hampstead NHS Trust"], but with the Legal Aid Board not mentioned. Thus, cash that might be regarded as contentious [evidently the dean's view] was laundered to Wakefield's benefit, with the public left none the wiser. At a US Congressional committee hearing later, Wakefield was asked squarely by an admirer: "Who funded your study?" This was his answer.

In December 2006, Brian Deer reported in The Sunday Times on more than £435,643 in fees, plus expenses, which the Legal Services Commission says it paid to Wakefield for his part in the lawsuit. Both the contractual arrangement and the payments had never been revealed before, in any forum whatsoever.

Audio clips: What they say about Lancet research cash

MP3 AUDIO [SOUNDS ON PLEASE]: Hear Professor John Walker-Smith, head of the department of paediatric gastroenterology, who admitted the children, react to the news in February 2004. He says he had no idea about Andrew Wakefield's contract.

MP3 AUDIO: Hear Richard Barr, the lawyer who ran the MMR case, explain to Brian Deer how he paid for the Lancet research and couldn't understand why this wasn't frankly acknowledged in the paper. Also how he then had only one "expert". February 2004.

MP3 AUDIO: Hear Richard Horton, editor of the Lancet, reading an email from Andrew Wakefield trying to head off Brian Deer's investigation, and telling Horton that the Legal Aid Board "contributed in no way to the funding of the report". February 2004.