Wakefield Second Essay

No name in contemporary English medicine is greeted with such polarized reactions as that of Dr. Andrew Wakefield, formerly of the Royal Free Hospital in London and now Director of Thoughtful House, an autism treatment and research facility in Austin, TX. To many he is a scientist who has abandoned the basic principles of his science by engaging in unacknowledged conflicts of interest, publishing shoddy research, inappropriately criticizing the MMR vaccine, and authorizing invasive procedures, not ethically legitimate or approved, on children. On the other hand, Dr. Wakefield is revered by a wide number of people, including physicians and parents, for standing up for their interests and listening to their stories about the debilitating effect of the MMR vaccine on children.

Much of the reasoning of those who attack him is based on their understanding of the course of events leading to the publication of his now-famous, jointly-written Feb. 1998 article in the Lancet medical journal. This critical or negative reading of Wakefield, most recently reinforced by Dr. Paul Offit in his book Autism's False Prophets , consists of fleshing out five statements: (1) Dr. Wakefield's early work on Crohn's disease was flawed because he concluded that the measles vaccine might either exacerbate or precipitate symptoms of Crohn's; (2) His being paid 55,000 pounds by litigators suing makers of the MMR vaccine to help the litigators make their case--a case that Offit and others say was published in the Lancet in 1998--posed a fatal conflict of interest for him; (3) His selection of the children for the study published in Lancet was done in awareness that these children were litigants in the aforementioned class action, and his procedures on the children were unnecessarily invasive; (4) His statements at the press conference announcing the publication of the Lancet article on Feb. 28, 1998, where he recommended using "monovalent" (measles) rather than "polyvalent" (i.e., the MMR) vaccine, precipitated the immediate decline in use of the MMR in England, leading to virulent outbreaks of measles a few years after 1998 and even resulting in the death of one young person from measles a few years later; and (5) His motivation, all along, for denouncing the MMR was so that he could substitute his own vaccine, for which he was seeking a patent, thus perhaps leading to tremendous financial windfalls for himself. Thus, this case against Dr. Wakefield is one that begins with his bargain with the devil (in the form of his being an expert witness in a class action lawsuit), continues with a flawed study and ends with blood and money, figuratively, dripping from his hands.

This negative story concerning Dr. Wakefield forms the basis of charges pending against him before the General Medical Council ("GMC") in England. That body has the power to strike him from the list of physicians authorized to practice medicine in England. Prosecutors made their case against him in 2007; he responded in 2008; and a decision is expected in 2009. It is not the purpose of this paper to re-tell or summarize the case before the GMC. Nor is it my purpose to analyze the scientific validity of any one of his theories. Rather, my purpose is to put a different interpretation on the events in the crucial two years between early 1996 (when he signed on as an expert witness) and February 1998 (when the Lancet article was published) than appears readily available elsewhere. I tell a different story because, as I delved into the case more and more, I began to see that the aforementioned five points are, in large measure, untrue, unprovable or refutable by virtue of documents not available to those who made the case attacking him. I also tell a different story because of extensive interviews with Dr. Wakefield, interviews that not only revealed a consistently different but also a much more convincing story than his attackers' account. The novel idea of actually talking to him seems not to have been successfully pulled off by most, if not all, of his critics. In the final analysis, I write this account in order not simply to "set the record straight," but to provide what anthropologist Clifford Geertz calls a "thick description" of important events in that crucial two-year window. As in many things in life, the most important point as this paper develops will be the demonstration of one simple fact--which I will enigmatically state here--that there were really two studies that the documents point to, and not just one. Well, this point, and its importance, will become crystalline, I trust, as the paper continues.

After an initial section (1), this paper is organized into seven sections, not all of which correspond precisely with the five criticisms listed above, but which substantially get at all those issues. They are: (2) Dr. Wakefield's signing on with the class action lawsuit as expert and the First Study; (3) The emergence, and eventual dominance, of the Second Study (the Lancet study); (4-5) The confusion, and resolving the confusion, between the two studies; (6) A discussion of issues surrounding the publication of the Lancet article; (7) A description of issues surrounding Dr. Wakefield's June 1997 patent application; and (8) A description of the events relating to the release of first major journalistic story critical of Dr. Wakefield, which appeared in the London Times on Feb. 22, 2004. First, however, a story.

Reprinted here: http://briandeer.com/mmr/lancet-paper.htm . The title is "Ileal-Lymphoid-Nodular Hyperplasia, Non-Specific Colitis, and Pervasive Developmental Disorder in Children, Lancet 351, (Feb. 28, 1998), 637-41.

Columbia Univ. Press, 2008.

I conducted approximately 12 hours of interviews over three days (Jan. 15-17, 2009) with Dr. Wakefield in Austin and Dallas TX.

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