Autism, Vaccines, and the Wakefield Fraud

Allegations of out-and-out fraud against one of the authors of the scientific paper that linked vaccines to the onset of autism have fired up the Web in the past weeks. In fact, there has been so much coverage of investigative journalist Brian Deer’s takedown of Andrew Wakefield, and his 1998 Lancet paper, that it’s easy to forget that it was already retracted by the journal last year, and Wakefield stripped of his medical license. Most of the original co-authors had already jumped ship, back in 2004.

One of Wakefield’s conclusions—that measles, mumps, and rubella vaccine (MMR) could possibly precipitate regressive autism—was actually roundly condemned in the wider scientific and medical world the minute the paper was published.  So why so much interest in this final indictment—that Wakefield falsified children’s medical records?

First, it’s important to understand that the fears about vaccines that the original paper incited were never more just that—fears, which remain almost completely immune to protestations by credible researchers in the field that there is no scientific data at all to support them.

This is in part because the rap on vaccines was never based on specific, firm claims in the first place. It was based on vague, suggestive statements in the now-discredited study:  “In eight children, the onset of behavioural problems had been linked, either by the parents or by the child’s physician, with measles, mumps, and rubella vaccination,” the paper reads.

Hmmm. Sounds like something that might be studied, not something that had been studied. Similarly, the paper’s conclusion reads:

“We have identified a chronic enterocolitis in children that may be related to neuropsychiatric dysfunction. In most cases, onset of symptoms was after measles, mumps, and rubella immunisation. Further investigations are needed to examine this syndrome and its possible relation to this vaccine.”

For a scientist, a doctor, a researcher, that sort of statement means little—essentially that the researchers thought developmental disorders “may be” related to intestinal problems, a fairly classic if similarly unproven correlation, and that they noticed something odd during their investigation and thought it deserved further study.

But for parents of children with autism—and parents concerned about their children developing autism (and who isn’t?)—the study had a different effect: a “vaccine panic,” as it is often called, that has led to a drastic falloff in vaccinations in the UK, and a less severe one in the US that has nonetheless been tied to disease outbreaks and deaths that should have been unthinkable in the modern era.

Discrediting the article didn’t seem to change parents’ minds or mitigate the anti-vaccine movement, so Deer and the British Medical Journal appear to have felt that discrediting Wakefield personally, by proving that he falsified data for material gain, might be more effective.

But the attempt falls short on two counts.

First, the allegations are so numerous and detailed—falsifying data, rearranging the timeline, and selectively presenting evidence are just the tip of the iceberg—and they’re presented with such outrage that it comes off more as character assassination than investigative journalism. Deer has apparently been dogging Wakefield for seven years, even after the work was already debunked. “It has taken the diligent skepticism of one man,” the accompanying BMJ editorial crows, “standing outside medicine and science, to show that the paper was in fact an elaborate fraud.” This risks sounding a lot more like a vendetta than a cure for a worrying trend.

Which brings us to the second count: Wakefield’s opponents have disregarded him from the beginning, and his adherents think he is a martyr—a man who dared to go public with an unpopular idea, who has been punished for it. He is a target of mainstream science and Big Pharma, they say; his declining status, loss of his medical license, etc., are evidence of his martyrdom for the cause.

And Wakefield, we might add, has continued to feed the fears about vaccines. “Do vaccines lead to autism? I don’t know,” Wakefield told ABC News earlier this week, in responding to the Deer expose. “I am for safety first. I am not for anti-vaccine. The vaccine strategy in this country is not safe.”

This is vague and careful talk that still manages to be dangerous. If we are to believe Deer’s allegations, Wakefield is not just a misguided man or a weak scientist but a calculating opportunist—a doctor who held a patent for an alternative vaccine to MMR and then manipulated a study to suggest that MMR was potentially dangerous; who at the same time was being paid by a law firm bringing suit on behalf of parents who believed that MMR caused developmental delay; and who continued and continues to insinuate the connection despite all evidence to the contrary.

But there is a deeper, more disturbing reason that people who believe in the vaccine connection won’t let go. The legitimate scientific community has no alternative answer to the question “What causes autism?”  In the face of that vacuum—occupied only by confusing information about the interplay between genetic, familial, and environmental factors that it is hoped will in the future lead to effective prevention—avoiding vaccines might well appear to be the only thing parents can do to protect their children.

But that investment of faith in the debunked link between autism and vaccines doesn’t give real hope; it gives false hope. Real hope only comes with real science, which certainly does not come from a retracted if not fraudulent paper by a defrocked physician. And theBMJ blames Wakefield for hobbling the very research that could eventually produce real hope. “Perhaps as important as the scare’s effect on infectious disease is the energy, emotion, and money that have been diverted away from efforts to understand the real causes of autism and how to help children and families who live with it.”

In fact it’s not Wakefield’s fault that research into all the possible causes of autism has been underfunded; it is everyone’s fault, as it is our collective fault that scientists and clinicians have not been encouraged to massively collaborate on this important issue.

The editors of the BMJ write that the Lancet ‘s retraction of the piece last year, while it debunked the methodology and ethical standards of the study, left the door open “for those who want to continue to believe that the science, flawed though it always was, still stands. We hope that declaring the paper a fraud will close that door for good.”  They should know better: Understanding the real cause, or causes, of autism is what would close that door for good.