Focus: “Callous, unethical and dishonest”

The Sunday Times, 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.

READ HOW DEER’S WAKEFIELD
INVESTIGATION WAS CHECKED

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.