Archive for May 24th, 2010

Denouement for the MMR scare – updated

May 24, 2010

In which Dr Aust looks back over four years of commenting about MMR, and many more years of a modern tragedy

In just a few hours Dr Andrew Wakefield, of MMR infamy, will be facing the General Medical Council (GMC) for what is almost certainly the final time. The GMC Hearings calendar says:

“Update: It is now expected that on Monday 24th May 2010 at 9.30am the Fitness to Practise Panel will announce the final determinations on serious professional misconduct and, if necessary, sanction in the hearing of Dr Andrew Wakefield, Professor John Walker-Smith and Professor Simon Murch.”

It is widely believed, after the damning GMC findings released back in January, that Wakefield will be “struck off” – removed from the register of licensed medical practitioners. Even the man himself seems to think so, as publicity for his book – yes, he has written a book* – on Amazon says:

“In the pursuit of possible links between childhood vaccines, intestinal inflammation, and neurologic injury in children, Dr. Wakefield lost his job in the Department of Medicine at London’s Royal Free Hospital, his country, his career, and his medical license

Does he know, er, something we don’t? Anyway: today.  And if you want a preview and a bit of a retrospective, Brian Deer, the man above all responsible for exposing Wakefield, offers both in the Sunday Times.

Words, words…

Now, over the years I have been writing on the blogs and forums – it is roughly four years, since the early Summer of 2006 – I suspect I have typed in more actual words about the MMR farrago, and Andrew Wakefield, than about anything else. Indeed, he, and the press coverage of his work and its aftermath, probably did more to make me into a blogger than any other single instance of media misreporting of science.

You won’t find many of these words here, though.

I have, in fact, not done all that many actual blogposts on MMR. I have done most of this writing in comments threads. Sometimes I try and stick to correcting obvious misconceptions about things that are sort of scientific, or that I know a bit about – aluminium in vaccines, or formaldehyde in vaccines, or antibiotics in vaccines, or thimerosal in vaccines (which it usually isn’t). But I have also, against my better judgement, got involved in some long arguments with the anti-vaccine mafia, e.g. on autism blogs, or at the Guardian’s depressingly troll-infested Comment is Free, and at the now sadly disappeared NHS Blog Doctor blog.

These arguments have actually involved some of my most seminal internet commenting experiences. For instance:

– I have been denounced for being pseudonymous by several of the anti-vaccine zealots  (if you want to see one reason why I have a ‘nym, keep reading).

– I have had comments “deleted by a moderator” at Comment is Free –  the only place I have ever been deleted, apart from on some of the madder homeopathy blogs.  Apparently at CiF it is non-PC to call a conspiracy theorist a “conspiracy theorist”, something  I would argue is a simple statement of fact when it is demonstrably true.

– I have, in a rare bit of writing under my real name a few years back, been “trailed” back to my medical school website by an anti-vaccine campaigner. He then picked the names of a couple of pharmaceutical companies off the list of “organisations the Faculty have ties with” – note this usually means something like “funds a student prize in” – so that he could smear me on the thread where we were arguing with:

“I notice there is no response from Dr Aust of the Faculty of Science at the University of Snarkfield, corporate partners EvilPharma and BigPharma”

– yes, the  famous Pharma Shill Gambit, favourite opening salvo of conspiracy theorists and health crazies.

But nonetheless, despite all the commentary, there have been fairly few actual posts.

This is partly since all one could think of to say about MMR would typically already have been said much better. For the MMR saga has generated a vast amount of skeptical coverage, reflecting its status as the mother and father of all “bad science” stories.

Above all, the peerless Brian Deer has dug into Wakefield’s lies and evasions, doggedly and relentlessly, until ultimately the whole edifice of Wakefield’s carefully cultivated image as “the caring doctor” came tumbling down.

Ben Goldacre has documented, over many years and many articles, the laziness, conspiracy-theorising and scare-mongering of the media that helped give birth to, and sustain, the scare.

And other Badscience bloggers, like jdc325, Holfordwatch, and infectious disease doctor DeeTee have done their bit too.

Not to mention the many excellent autism sites that have covered each twist of the story in exhaustive detail, like Left Brain/Right Brain and Action for Autism

And there are many, many others, who I haven’t time to mention here.

So I have only rarely felt I had anything much to BLOG about on the MMR scare. But I like to feel I have done my bit in the comments department.

Indeed, the MMR scare was one of the first things I found myself commenting on over at Ben Goldacre’s Bad Science blog – see e.g. this thread about MMR from June 2006, where you will find me, er, holding forth.

And it was also one of the frst things I commented on over at the Bad Science forums. You can see a typical four-year old comment here.

I will quote one bit:

“People in science and medicine that I know find the determination of Melanie Phillips et al to see Wakefield as a “wronged crusader for the children” utterly barmy. That is as restrained as I can put it.”

Indeed, probably the thing I have written about most in commenting on the MMR scare was this idea that, given the trust parents had placed in Wakefield, and their belief that he was a caring and sympathetic doctor, he could not possibly be a “wrong ‘un”.

Another aspect of this is the belief, fervently-held among many of Wakefield’s followers, that he was a scientist of the highest class, and that his record of publications meant, again, that his scientific standing and integrity were beyond question.

Of course, this is nonsense, not even in any way specific to Wakefield, but simply because scientists – and doctors-turned-scientists – are human beings. They are not wholly dispassionate and logical. Anyone who works in science, like me, can tell you this, if it wasn’t already blindingly obvious. There is a thread talking about it over on the scientiists forum Nature Network right now.

Scientists are human.

They have pet theories. They have hobby horses.

Some even have idées fixes.

Andrew Wakefield, as was obvious long before his work on the children in the Lancet paper, had an idée fixe about the MMR vaccine. In particular, he had earlier tried to finger the vaccine as a cause of Crohn’s Disease in adults, an idea which got a little bit of attention in the literature and then sank without trace, as ideas which do not pan out tend to.

Plus: here is something else that anyone in the business can tell you. As human beings, researchers – whether, scientists or doctors, or doctors-turned scientists – face ethical challenges.

For instance:

– How much data editing is “making the true pattern emerge from nature’s noise?”

– How much is “making the data fit the hypothesis?”

– And how much is “research fraud”?

Now, these are real questions, and they are not a secret, and we debate them in PhD student training programmes. Indeed, I once even got to debate these things with Ben Goldacre at just that sort of forum. But they are everyday questions that scientists face. We wrestle with them, and we see our colleagues wrestle with them.

Most people are after the truth, and understand that they are fallible. So they try and watch themselves for “wishful thinking”.

Some are not so good at it.

And still others are so blinded by their pet theories, or their ambition, that they cross the line.

And some can’t even see that they crossed it.

Now, if you work in scientific research, you see all sorts.

You see some people who would no sooner “tweak ” the data than they would murder a bunch of people.

And you see others who are more “flexible”.

And just occasionally you may come across someone who is so convinced of their pet theory, and perhaps of their own brilliance, that people in the field will mention their papers with a special raised eyebrow that says “Don”t be too sure of anything coming out of this lab”

Which is, of course, one of the reasons why it is so important that science is a collective-but-also-competititve endeavour. Results get picked over. More spectacular or ground breaking results more so. Experiments get repeated. People compare their data with other peoples’ data. People look and say:

“Well if this is true, then we should be able to see this too, with our method”.

And so on, and so on.

And if, after all that, a result doesn’t stand up, people wonder how the result came out the way it did. Maybe it was an error. Maybe it was an artifact. Those are the common reasons.

Or maybe – just maybe – it was something a bit more sinister.

Considered, checked – and rejected

And that is what has happened with Wakefield’s work. It was published. People critiqued it. They looked carefully at the findings in the paper to see if they stood up. Other researchers tried to look for the relationship he suggested between autism and MMR vaccination in other kinds of studies. Or for the postulated relationship between autism and inflammatory disease in the bowel.

People also did the same with Wakefield’s subsequent work. His methods, particularly the “virus detection molecular biology”, were repeated in other labs.

Now, all of this was an entirely normal part of the scientific process, if rather more urgent because of the connection to the MMR vaccine.

And the answer? None of Wakefield’s work stood up. None of it.

But the more the evidence mounted up that the connection between MMR and autism was a mirage, the more Wakefield stuck to it. Right up until now.

At which point you essentially have two choices.

Either Wakefield is the saint his followers still insist he is, and all the evidence that contradicts his work is wrong, or fabricated, and this is a witch-trial.

Or…  the vast array of science that speak against Wakefield’s work is sound, and Wakefield is as we now see him – exposed as “callous, unethical … dishonest”, in the GMC’s words.

It comes down to the evidence, and how you see it. Two kinds of evidence, actually. First, the scientific evidence, in totality. And second, the evidence we now have of how Wakefield did his research, and reached his conclusions.

And it also comes down, of course, to how you see Wakefield.

As I frequently repeat when I am talking about this, and have repeated for the last several years,  I have never talked to a doctor or scientist about MMR – and I must have talked to hundreds – who doesn’t have a clear view on Wakefield. Universally, it is a view that does not cast him in a favourable light.

You can work the rest out for yourself.

Can this really be… the end?

So is this likely to be the end? If Wakefield is removed from the register? Will that be it for vaccine scares?

Somehow I doubt it. As others have observed, the furore over MMR was eerily reminscent of earlier vaccine scares, like that over Dip-Tet.

And there are sectors of the media that still find vaccine scares irrestible. The Daily Mail and Sunday Express coverage of the recent introduction of the HPV vaccine was, again, scarily reminscent of their “work” on MMR.

In fact, I fear that as long as anti-vaccine stories make headlines, and sell papers, the stories are not going to die. And they will always make headlines , and sell papers, because they play on fear. And that gives them power.

Looking at the old Bad Science Forum thread I linked to, I noticed another of my old comments,  this one rather melodramatically headed “Fear is the Key:

“Fear – even irrational fear with absolutely no basis in fact, like of Autism-from-vaccines – is incredibly powerful. You kind of have to take the decision to vaccinate despite some Id-type part of you wanting NOT to vaccinate because your fears have been aroused [i.e. by all the media scare stories]. What you know fights with your primal fear of the unknown, if that doesn’t sound too portentous…

People don’t just operate on higher reasoning. They operate on beliefs (rational or not) and Hollywood’s old favourite “gut instinct”. That is why it is often so hard to change peoples’ minds through reasoned argument, no matter how compelling.”

And that is also, of course, why the media coverage of MMR, keying on tragic families, and mothers’ fears, was so incredibly damaging.

Which brings me to a final point. The familiies’ tragedies are real. The anti-vaccine mob, like John Stone, make a habit of accusing those sceptical of their hero of  “callous disregard” for the suffering of the autistic children Wakefield was investigating, and of their families.

Which is a crock. Brian Deer has always been crystal clear about this, regardless of the mob baying for his blood outside the GMC:

Among the worst victims of the MMR scare were the parents who believed Wakefield’s findings — a few of whom will no doubt once again be shouting slogans tomorrow. I feel only compassion for them. Imagine how terrible it must be to believe that your son or daughter’s autism is your own fault, just because you had your child vaccinated.

“In a way, making the connection was worse for us,” said the mother of the youngster referred to as Child 12 in The Lancet. “We had convinced ourselves it was nothing we had done. Now we knew it was our fault.” ….”

As I said on another blog, the parents had to be “sold” the guilt in order to then be sold the conspiracy: “But you did it because they [i.e. the doctors and the Govt] lied to you!”

And I would call that selling them the guilt…  plain wicked. There is no other word.

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Update 1:  10:55 Monday

As predicted by everybody, including himself, Wakefield has been struck off.

So the old sceptical joke has come true:

“Disgraced ex-researcher Andrew Wakefield – or, to give him his full medical title…

…Andrew Wakefield.”

Update 2: 3.45 pm

Professor John Walker-Smith, the senior paediatric gastroenterologist at the Royal Free involved in the autism work, is also to be removed from the Medical Register – like Wakefield, he has been found guilty of “serious professional misconduct”. Walker-Smith is 73 and retired a decade ago.

The third of the doctors involved, Professor Simon Murch, has been found not guilty of serious professional misconduct and is free to continue in practise. Murch is currently Professor of Paediatrics at the University of Warwick.  The GMC’s press release discussing Murch’s role can be found here. It indicates that Murch had concerns at the time of the work about the ethical approval for the project, and had sought reassurance from senior colleagues. One of these was Professor Walker-Smith, under whom Murch had trained at the Royal Free. Murch also discontinued doing lumbar punctures on the children when he felt that they were revealing no clinically useful information. More on the story in the Guardian here.

The text of the GMC’s press release detailing the reasons for erasing Wakefield from the Medical Register can also now be found over at Left Brain Right Brain.

Update 3: 9.30 pm

Tom Chivers of the Daily Telegraph has a good post on Wakefield and the MMR saga here. The comments thread seems to be gradually filling up with anti-vaccine people. Of course, as anyone familiar with MMR-related threads will know, they tend to “out-last” other commenters. Anyway, Tom seems to be doing a good job of rebutting their dafter assertions, though he could perhaps do with some help.

An interesting aspect of the whole sorry saga is precisely how the 1998 Wakefield paper came to get published in The Lancet in the first place.

Well, they submitted it, it was peer-reviewed and then published… but of course, with journals at the “high-impact” end of science and medicine there often tends to be more to it than that. Anyway, over at the Guardian, clinical  epidemiologist Professor Christopher Butler has written a piece which talks about some of the likely behind-the-scenes stuff – and also points out some of the technical shortcomings in the paper that a referee with the right background might have picked up on.

Another of the murky stories from the start of the MMR scare is how his colleagues at the Royal Free Hospital Medical School regarded Andrew Wakefield and his work, something which probably had a significant influence on how events played out. I discussed this some time back in a comment here. Like many people, I am hoping that Brian Deer will one day write the definitive book on the whole saga.

Wakefield? Who he?

Finally, back in the Bad Science blogosphere, jdc325 has been noting the Daily Fail’s remarkable selective amnesia on their ex-hero Andrew Wakefield. They seem not to remember that he was once their poster boy of the “Brave Maverick Doctor”. You would think they would remember, given the vast amount of anti-vaccine guff they have printed over the last few years – see jdc’s post for the details.

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* The book is due to go on sale… today. May 24th. What an amazing co-incidence. Not.

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