Wakefield and the MMR for parents

by Deb on January 10, 2011

I’ve written a few vaccine pieces for this blog when I think I can explain some of the basic science such as herd immunity and the chemistry of elements and compounds.  What has unfolded over the past few days is not about basic science, it is about how science is done and how it can be derailed.

You may not have heard of Andrew Wakefield directly, but he gave momentum to the modern anti-vaccination movement.  There have been people opposed to vaccination since the beginning, using much the same arguments as today, but Wakefield gave them some scientific legitimacy with a paper he wrote in 1998 linking regressive autism and a gut syndrome he called ‘autistic enterocolitis’.  In the paper itself he admitted there was no evidence to link vaccines to these problems, but in a press conference he wasn’t so circumspect and blamed the combined MMR vaccine, recommending that parents ask for single vaccines instead.  Linking autism and vaccines created a panic and vaccination rates in the UK dropped below the levels needed for herd immunity, leading to a surge in measles cases and deaths.

Science by press conference seems to be something we now have to live with, but it misrepresents how science works.  In a press conference there is none of the nuance in a genuine paper and we only get the bits the journalists think will make a good story.  And because of the way the human brain works, we remember the original press conference and not the very long scientific discussions that follow it.  Because a scientific paper is not an end, it is a middle.  You have your hypothesis and do your experiment and think you have something interesting, and an editor and several reviewers agree and publish it.  But your results depend on how you did your experiment and how big it was and what other things you controlled for – in other words it only applies to a tiny slice of the big problem and it’s easy to make mistakes.  And that’s assuming your results are ‘real’ – all science results are probabilities and we have a built in probability, usually 1-5%, that they are due to random chance.  That may not sound like a lot when you are looking at one experiment, but when you look at the thousands that are published every year it means that a lot of them were coincidences.

So science is never, ever decided on one interesting result, even if that is what the public hears.

At the time Wakefield had his press conference it was reasonable to think that maybe there was something wrong.  There was in fact a concern about a particular type of MMR vaccine, using the Urabe mumps strain.  The Urabe strain is still used today in some countries, it is easier to produce than others but is associated with a higher level of complications.  This doesn’t mean that evil bastards use it, it means that all medical questions are complicated decisions about risks and benefits.  If you have high levels of disease causing complications and lots of children to immunise, you go with the quick one.  Once your level of disease drops and the complications from vaccines start to become more of a worry than the diseases, you can start using a strain that is more difficult but safer.  So in spite of the fact that his conclusions were controversial, researchers took them seriously and investigated links between the MMR vaccination and autism.

They don’t exist.

On the one side there was a single case series of 12 children that didn’t even look at vaccines, on the other are over 40 studies of different types, in different countries, covering thousands of children.  Instead of one tiny slice of the problem they combine to look at different aspects and all those tiny slices add up to an answer – there is no link between the MMR vaccination and autism.

The science was settled long ago in its usual messy, drawn out way, with many people adding pieces of the puzzle.  But fear of the MMR still exists like a ghost on the internet, a ghost that people worried about vaccines cling to and spread.  That is why Wakefield’s career in the last few years is so important, not because it means anything scientifically but because it shows there is no controversy and no reason to investigate.

Firstly Wakefield was investigated by journalist Brian Deer, who found that he had been paid over AU$600,000 by lawyers wanting to sue vaccine manufacturers as well as other worrying practices.  Thanks to this investigation the General Medical Council of the UK conducted an inquiry.  It proved 36 charges against him, including that he:

  • Performed unneccessary, painful and dangerous procedures such as lumbar punctures and colonoscopies on children with autism.  In fact 12 charges were proved involving abuse of developmentally challenged children.
  • Paid children at a birthday party to provide blood samples.  He later joked about the children being distressed.
  • He did not have ethics approval for his experiments on children.

He was struck off the register and may not practice medicine in the UK and the Lancet retracted the paper, meaning it no longer exists as part of the scientific record.

Now in the last week comes the denoument.  There have been hints for a long time that there were discrepancies between the data in the 1998 paper and the children’s actual records, the reason the Lancet retracted it.  Now Brian Deer has shown that they are not accidental, mistakes or sloppiness, every single child in the study had their records altered in some way.  The data in the paper are different to the data in their medical records, with all of them altered to suggest a link between the MMR vaccine and autism.  This is not a case of incorrect research, research that was out by coincidence, that didn’t account for a confounding factor or didn’t include enough people.  He made it up.

In a beautiful example of poetic justice, the man who began the modern anti-vaccination scare by using the media has now been revealed by a journalist as a fraud who was paid to lie about a vaccine for a court case.  There are no questions, no concerns, no doubts.  There is nothing that needs to be explained or that parents should investigate.

He made it up.

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{ 7 comments… read them below or add one }

Ali January 10, 2011 at 4:11 pm

Thank you for this excellent post and your others about the science behind vaccines.
There was an ABC Radio National ‘Rear Vision’ program about Andrew Wakefield and the MMR vaccine scare broadcast in 2010 which makes for good listening (or you can read a transcript). Here’s the link;
http://www.abc.net.au/rn/rearvision/stories/2010/2822340.htm

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Deb January 14, 2011 at 8:51 am

Thanks for that, I will check it out.

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Antonio January 10, 2011 at 9:27 pm

Yay for science!
I just read some stupid anti-vax piece and I find it so reassuring to read something sensible on this topic.

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Heidi January 11, 2011 at 12:27 pm

Hear, hear!
A very well written article with none of the name-calling that too often discredits those who choose to speak out in a controversial issue. What a relief these findings have been to me, who, as a parent has felt the need to DEFEND my decision to protect my kids from deadly diseases – by friends who have chosen not to protect their children from the same illnesses, thereby putting all of us at risk. Thank you for taking the time to write this post.
Heidi´s latest amazing offering ..Christmas CheerMy Profile

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Deb January 14, 2011 at 8:53 am

You’re welcome, I know the feeling. The bit I find the worst is the way he used so many people, yet they are still defending him. Parents who want to do the right thing by their kids.

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Annie January 17, 2011 at 4:54 am

A great article Deb, it is rare to read anything on EITHER side of the vaccine argument that is not written emotionally or attacking the other side. No one should really have to defend their choice to vaccinate or not – I think its really a matter of researching all the available information (and hopefully finding reliable information covering both sides and its hard to find either) and then making a choice that takes all that into account and sits well with your own values and priorities, and no one should be attacked for deciding either way.

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Deb January 17, 2011 at 9:14 am

I agree parents should not be condemned, they are trying to do their best for their kids. However the people who spread lies, misinformation and fear should be outed and stood up to at every opportunity. How are parents supposed to make decisions when they are being lied to?

As for information on both sides, science doesn’t actually work that way. ‘Balance’ and ‘both sides’ are social justice concepts, not scientific concepts. In science you look at where the majority of the good evidence lies and it is heavily biased, but biased towards facts. There is no genuine scientific controversy over vaccinations. The reason good information on one side is hard to find is because there isn’t any. And personally I’ve always found there is a lot of very good information that supports the use of vaccines. Try http://www.immunise.gov.au in Australia, and of course talking to your doctor or clinic nurse. If you are unsure let them know beforehand and they can schedule a longer appointment and find information for you.

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