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The Doctor Who Fooled the World: Andrew Wakefield's War on Vaccines
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The Sunday Times journalist Brian Deer did not come early to the disastrous MMR party. By the time in late 2003 that he and his commissioning editor decided that those at the heart of the “controversy” over the effects of the combined vaccination needed investigation, the business had been rumbling on for half a decade.
Yet what Deer then managed to achieve through persistence, intelligence and attention to detail was the effective closure of a chapter of fraud and systemic failure that, had he not taken up the issue, might well have cost tens of thousands of lives. It’s a remarkable story and this is a remarkable book. More, whether the author knows it or not, it is a book that takes us well beyond the medical and ethical issues that it covers, helping to explain the political and social predicament that now afflicts so many of us — the crisis in truth and its exploitation by people without scruple.
First, the barest bones of the MMR affair. There has always been a rumbling antipathy towards mass vaccination among some people. The idea of putting even the tiniest amount of a bad virus into healthy citizens has flustered folk since Edward Jenner’s pioneering days. The advent of state-sponsored public health programmes created another dimension, lending a kind of rebel lustre to opponents of measures such as water fluoridation and smoking restrictions.
Then, in the late 1980s a health scare erupted when it was found that cattle were suffering from a brain disease — BSE — that might have consequences for human health. In the mid-1990s the first victims of the human variant of the disease began to die. It was widely perceived that the government and the food and farming industries had been in denial about the disaster that seemed to be unfolding.
As this was going on a young ambitious gastroenterologist called Andrew Wakefield was searching for an explanation for the onset of the bowel condition Crohn’s disease. He thought that he had discovered the measles virus in the gut of sufferers and constructed a theory about how the virus might lead to inflammation and then to the fully fledged disease. This theory coincided with a public campaign by a woman called Jackie Fletcher, who blamed her son’s brain condition on his having been given the MMR triple vaccination against measles, mumps and rubella.
As far as the public were concerned these two strands came together in sensational fashion in February 1998 when Wakefield and several others held a press conference at the Royal Free Hospital in north London. Basing his conclusions on a study of 12 children undertaken at the hospital in 1996-97, Wakefield suggested that MMR was linked to the onset of autism in young children. He recommended that parents ask for the triple vaccination to be replaced by three separate jabs. Although the hospital and some of his colleagues demurred from this conclusion, the claim of the MMR-autism link was the main media takeaway both from the conference and the subsequent paper published in the medical journal The Lancet, two days later.
From the beginning the public health authorities — not privy to the methodology and circumstances of Wakefield’s trials — denied that there was indeed good evidence of a link. And almost from the beginning it was clear to anyone who bothered to look at the epidemiological studies that there wasn’t even a correlation between MMR use and the incidence of autism, let alone proof of cause.
For too long this seemed to make no difference. At best it led to the deadly public health situation where citizens were being invited by even the most reputable media to choose between two scientists — usually Andrew Wakefield and AN Other — as to who was right about MMR. A whole generation of newspaper columnists and TV presenters — most of them entirely scientifically illiterate — declared themselves leaning towards the Wakefield thesis. When Wakefield ran into problems at the Royal Free because of his continuous breaches of protocol and failure to replicate his research and was, in effect, sacked at the end of 2001, this became merely evidence that the medical establishment was out to get him. At which point he left Britain and went to America.
By late 2003 uptake of the vaccination was trending downwards. Channel 5 screened a drama called Hear the Silence in which a noble, persecuted Wakefield was played by Hugh Bonneville, with Juliet Stevenson in the role of the anguished mother of an autistic child. It was a piece of the purest propaganda. I wrote about it for The Observer, concluding that “this is typical of what has happened in the MMR scare. One of the less-admiring broadsheet previews of Hear the Silence suggests that one’s enjoyment of the drama will depend on one’s ‘opinion’. If it is your ‘opinion’ that MMR is safe, then you won’t like it. But if your ‘opinion’ is that it may well cause autism, then you should enjoy the show. And sod the science.”
Measles was making a deadly return through sheer stupidity (I thought) and I and many others were in despair. But as it happens Brian Deer also saw the film at a screening at (I think) the Institute of Contemporary Arts in London. Speaking afterwards was one of the parents of a child who had been involved in Wakefield’s study. Deer did what the rest of us didn’t. He took a note of the name and later called her, set up a meeting and set in train a series of discoveries that would show Wakefield not just to have been mistaken, but also to have been the biggest medical fraud of our generation.
By February 2004 Deer could show that Wakefield’s MMR-autism link was no amazing scientific discovery, but a pre-planned conclusion from which Wakefield had already benefited financially. Undisclosed by him to most of his colleagues, to the hospital or to The Lancet, two years before publication of the article Wakefield had accepted a deal to work for a lawyer to establish a legal case against MMR. Furthermore Deer established that several of the children, far from having been referred by their GPs, were potential litigants (in October 2003 the class action against MMR manufacturers had collapsed in the High Court). As if that wasn’t enough, it turned out that in 1997 Wakefield had patented his own single measles vaccine alternative to MMR.
Wakefield threatened and then sued. Then withdrew, leaving behind him new troves of legally acquired documents for Deer to examine. In February 2009 Deer’s work appeared on the front page of The Sunday Times again. By dint of clever and thorough detective work Deer could now show that large parts of the study itself were fraudulent. Essentially the results had been cooked.
In May 2010, nearly three years after it had begun investigating Wakefield and some of his colleagues, and relying to a large extent on Deer’s work, the General Medical Council ordered that Wakefield be “erased from the medical register”. Seven months later the British Medical Journal (or BMJ) carried a 19-page, 24,000-word article on the Wakefield affair written by Deer. It had taken half a year to write and to check.
Towards the end of the process, Deer recalls, the journal’s editor said to him of the piece: “It’s fraud, you need to say that clearly.” To which Deer (who had already done this in The Sunday Times) replied: “Well, if you think that, it’s you who should say it.”
This moment encapsulated a feeling of anger that had been rising in me as the story unfolded. I knew that the journalistic trade had, with some big exceptions, done its readers little service during the MMR scare. And the less said about TV dramatists the better. I also realised that the judiciary, relying on solid evidence, had behaved significantly better, in this country and in the US.
What should amaze the reader of Deer’s book, however, is the weakness, venality, vanity and slowness to action of the medical establishment and its publications and institutions in the face of a rogue doctor. Most of the things that Deer did should have been done by the profession itself. Had he not so assiduously turned every one of Wakefield’s stones over, the man would probably still be licensed to practise here.
So victory, then? Since Deer closed the Wakefield case, anti-vaxxing has become a cause for populists of right and left, in Italy, Greece, France, Brazil, the Philippines and the United States. In recent demonstrations against the lockdown in various countries a component of the grievances expressed is always anti-vaccination. Towards the end of his book, reflecting on how the utterly mendacious American documentary film Vaxxed had drawn crowds for its anti-MMR message, Deer writes: “In that year of rebellion — 2016 — when the United States was stunned by Donald Trump’s defeat of Hillary Clinton, and Britain narrowly voted to leave the European Union, here were campaigners who grasped the paradox of the age; that the more incredible and outlandish their claims, the more these might spread and be believed.”
In 2001 Wakefield went to America, became a celebrity on the medical-woo campaigning circuit, made a lot of money from anti-MMR videos and appearances, wowed congressmen and film stars, shacked up with a supermodel and pitched up on inauguration night in January 2017 at Trump’s big party. Many times when there have been measles outbreaks around the world (and there have been an increasing number) it’s likely that some lucrative interventions from Wakefield will have preceded a fall in vaccination rates. He continues, in effect, to kill people with his lies and it seems no law can stop him. He is, in short, a man of our times.
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