Hero of the antivaccine movement Andrew Wakefield strikes back

The antivaccine counterattack against Brian Deer continues.

As you recall, about a month ago British reporter Brian Deer published an exposé, a tour de force of investigative journalism that led him to discover that Andre Wakefield had not only had incredibly blatant undisclosed conflicts of interest (his having been in the pocket of trial lawyers suing vaccine manufacturers and his forgetting to mention the little fact that he had been developing a competing version of a measles vaccine that he had been hoping to market) when he published his infamous 1998 Lancet paper linking MMR to regressive autism and enterocolitis, but that he had in fact committed scientific fraud and falsified data. Although it took longer than I thought, the counterattack was forthcoming, first with David Kirby playing Keith Olbermann for a fool by using Olbermann’s hatred for Rupert Murdoch to convince him that somehow Brian Deer had an undisclosed and irreconcilable conflict of interest. He did not. Next up was the “We Support Dr. Andrew Wakefield” petition, which was as blatant of example of cultish behavior as I’ve ever seen. Most recently, the counterattack involved some seriously burning stupid laid down by that tag-team of antivaccine propaganda, David Kirby and Robert F. Kennedy, Jr., twisting and distorting an old Vaccine Court case to make it sound as though the U.S. Government had conceded that MMR can cause autism. So what’s left?

Why, a different tag-team attacking Brian Deer, of course! Behold, David Kirby serving once again in his role as Andrew Wakefield’s mouthpiece in both the antivaccine crank blog Age of Autism and that repository of antivaccine pseudoscience The Huffington Post by trumpeting Wakefield’s “complaint” to the UK’s Press Complaints Commission (PCC) about Brian Deer!

Rarely have I seen two pieces of writing so utterly toxic and destructive to my irony meter. It’s like the acid that runs in the veins of the title beings in the Alien movies.

I’m not going to deal (much) with David Kirby’s HuffPo piece because, quite frankly, it’s nothing more than the credulous parroting of Wakefield’s complaint. I will, however, point out that in any dictionary of sayings, under the saying “pot calling the kettle black,” they should put a picture of David Kirby alongside that of Andrew Wakefield. The man made his name publishing a fear mongering book sympathetic to the mercury militia (i.e., the movement that, confusing correlation with causation, believed against all science and reason that the mercury in the thimerosal preservative that used to be in vaccines was the cause of the “autism epidemic”). Since then (four years ago now), he has been one of the primary mouthpieces of the antivaccine movement, and, as far as I (or anyone else) have been able to tell, has no other source of income. Yet he somehow manages to blog prolifically for Age of Autism and The Huffington Post and has, as far as I can tell, published nothing else, not even freelance. As far as anyone knows, Kirby is not independently wealthy; so the question becomes: Where does David Kirby get his income? He’s never answered this question, and it’s hard not to conclude that he derives his money from his antivaccine activities. Of course, Kirby could always set me (and everyone else who wonders about this) straight and make us eat crow about this very easily, but for some reason he never has. In any case, Kirby’s prominence, name, fame, and possibly his income all depend on continuing to stoke the fires of the myth that vaccines cause autism. If that manufactroversy went away, so would all the attention and adoring minions of the mercury militia who currently lionize Kirby. He is, as much as Andrew Wakfield, a walking, talking, writing, distorting, and dissembling embodiment of a conflict of interest.

Unfortunately for him and David Kirby, Wakefield’s “defense” of himself and “complaint” against Brian Deer is thin gruel indeed, consisting of a whole lot of nitpicking pedantry mixed in with bad science and logical fallacies. Let’s take a look. First, Wakefield whines:

The articles presented, as fact, allegations that I committed scientific fraud inasmuch as I “changed and misreported results in [my] research”2 in a paper in the medical journal The Lancet in 1998, with the clear implication that this was intended to create the appearance of a possible link between MMR vaccination and autism and that I did it for money.

These allegations are false and/or misleading and will have a hugely adverse effect on my credibility as a scientist and my ability to ever practice again in my chosen field.

I have news for Wakefield. His credibility has been shot for at least five or six years, although the good ship Wakefield took one torpedo under the waterline when Deer showed his massive conflicts of interest that were undisclosed at the time of his publication of his Lancet paper, as well as the documented fact that he had held back data that contradicted his hypothesis. Then Wakefield took yet another torpedo when PCR expert Stephen Bustin testified at the Autism Omnibus and demonstrated the utter ineptitude of the laboratory that he later used to report PCR. Brian Deer’s revelations that Wakefield had falsified data was only the last torpedo below the waterline. In reality, Deer’s final report last month was more akin to torpedoing an already sunken wreck and, in essence, rearranging the barely recognizable scraps of rusted metal on the seabed, but Wakefield just refuses to admit defeat. If you’ll forgive me for shamelessly mixing metaphors, these days Wakefield reminds me more than anything else of the Black Knight in Monty Python and the Holy Grail, who, having had all of his arms and legs hacked off by King Arthur, continues to refuse to admit defeat. We last see him yelling at Arthur, who continues on his path, “Oh. Oh, I see. Running away, eh? You yellow bastards! Come back here and take what’s coming to you. I’ll bite your legs off!”

So here comes his bite, and all I can say is that Brian Deer doesn’t have anything to fear for his legs. All Wakefield can do is nibble around the edges, throw everything he can think of against Deer and hope it sticks, and in the end failing to produce anything that would call into doubt the firm conclusions of Deer’s reporting. He begins by repeating his charge that Deer initiated the British General Medical Council investigation that has been going on since 2007:

Mr. Deer’s latest article was based upon ‘evidence’ that he claims was presented at the GMC hearing – which started in 2007, is due to conclude sometime in 2009 – without disclosing the fact that it was he who brought the original complaint. He therefore has an undeclared interest in its conclusions. Failure to have disclosed this conflict to readers of the Sunday Times is misleading.

Brian Deer has answered that charge and it has figured prominently in the antivaccine counterattack against Brian Deer, but even if it were true that Deer had brought the complaint, his alleged conflict of interest would not even be in the same solar system as Wakefield’s extensive and documented undisclosed conflicts of interest at the time he published the Lancet paper. It would be like comparing an ant to the planet Jupiter; indeed, even if it were true that Deer had brought the complaint, that would not invalidate what he wrote. Wakefield and his antivaccine supporters want you to believe it would, but it wouldn’t. Besides, this is the same Andrew Wakefield who boldly declared in 2004:

In February 2004, after a Sunday Times investigation, Wakefield declared that he would welcome an inquiry as an opportunity to clear his name.

“It has been proposed that my role in this matter be investigated by the General Medical Council,” he said in a statement. “I not only welcome this, I insist on it.”

Wakefield got what he wanted. What’s he complaining about?

Wakefield also makes the proverbial mountain out of a molehill:

“Although the research paper claimed that problems came on within days of the jab, in only one case did medical records suggest this was true, and in many of the cases medical concerns had been raised before the children were vaccinated.”

There are two parts to this allegation.

• “the research paper”

This was not a “research paper”. It was a clinical ‘case series’ that contained additional research elements. Labeling it as a research paper is intended to convey the impression that the children were investigated purely for the purposes of experimentation; an allegation that formed a central part of Mr. Deer’s original complaint to the GMC. In contrast, the paper reported on clinical referrals who were investigated on the basis of the presenting symptoms.

I’m really not sure what Wakefield is trying to accomplish here. For purposes of medical ethics and the requirement of approval by an institutional review board (or the British equivalent), there is no difference between a case series and a research protocol. It’s still human subjects research, even if a case series involves looking at retrospective patient data. The same ethical guidelines apply, namely those laid down in the Helsinki Declaration and the Belmont Report. The bottom line is that it’s the logical fallacy known as the red herring, a seemingly important but in fact a irrelevant fact thrown out to distract from the main issue. Much of Wakefield’s “complaint” consists of the legalistic parsing of words similar to that in the above passage in order to distract.

I once said that there were only two likely explanations for Wakefield’s misreporting of the timeframe of vaccination relative to the onset of autistic regression symptoms: scientific fraud or sloppiness passing the line into incompetence. Wakefield in essence pleads sloppiness:

“However, our investigation, confirmed by evidence presented to the General Medical Council (GMC), reveals that: In most of the 12 cases, the children’s ailments as described in The Lancet were different from their hospital and GP records.”

The documents relevant to the evidence presented in the Lancet paper are clearly identified in that paper. These included the Royal Free Hospital records and, where available, the prospective developmental records from parents, Health Visitors and General Practitioners (GPs). The team therefore relied on the totality of the information available to them, as stated in the paper. This is entirely normal practice. Since then further records have been collated for the GMC enquiry, which were not available to the hospital team at the time of writing the paper.

The records that were before the GMC included a complete set of the children’s local hospital records, a full set of the GP records to include all GPs who had been 4 involved the child’s care, as well a the Royal Free Hospital records and any other records relating to the child e.g. school medical records.

Reliance on differences between these data sources, i.e. those relied on by the Lancet authors and those relied upon by Mr. Deer in his allegations, is disingenuous and misleading since the majority of the latter records were not available to the Royal Free doctors at the material time.

Of course, this excuse is highly disingenuous in that Wakefield should have been susipicious that nearly all of these children were referred from outside of the Royal Free Hospital’s normal catchment area, and given his close contacts with lawyers suing vaccine manufacturers for autism it strains credulity for him to claim that he didn’t have an inkling that there might be more to the stories of these 12 children. The charitable explanation is that didn’t want to know. The not-so-charitable explanation is that he falsified data. Be that as it may, if Wakefield were a good scientist, an honest scientist, he would feel betrayed by these parents for not not having given him and the Royal Free Hospital accurate medical histories. If Wakefield were an honest scientist, he would apologize for not having been thorough enough and then retract the paper, rather than going to the incredible extremes that he is going to in order to defend his own sloppiness.

Now here’s the meat of the matter:

“Hospital pathologists, looking for inflammatory bowel disease, reported in the majority of cases that the gut was normal. This was then reviewed and the Lancet paper showed them as abnormal.”

The substance of this latest allegation illustrates how rigorous clinical and scientific investigation is vulnerable to misrepresentation. I am accused of a grave scientific misdemeanor – falsifying data. As an example of the fallacy of this allegation, a detailed explanation is provided of the process by which the pathology in tissue biopsies from these children was diagnosed and reported. Crucially, I played no part in the diagnostic process at all. Further, the fact that a review of the samples took place is clearly spelled out for all to read in the Lancet paper itself. (See below). There was no sinister attempt to hide any initial assessments as implied by the Sunday Times.

Biopsies were initially reviewed by duty pathologists who often had no specialist expertise in gastrointestinal disease, particularly in children. Professor John Walker-Smith, the senior clinician, who has an unparalleled experience of the appearances of bowel disease in children, as was his normal clinical practice, reviewed all biopsies at a weekly clinico-pathological meeting of his team. This was undertaken with the assistance of histopathologist Dr. Sue Davies. At these meetings Professor Walker-Smith pointed out the fact that inflammation had been overlooked in some cases.

This would all be fair enough if it had been mentioned in the paper exactly for which patients there had significant disagreements between the initial reading and he readings used for the paper. It wasn’t. It might also be fair if the final pathological diagnoses reported by the hospital for these children agreed with what was reported in the paper. After all, if there were a significant disagreement between the diagnosis as originally reported and the diagnosis as determined in a review of the samples by another set of pathologists, the normal course of events would be for the pathologists who did the review to amend the diagnostic reports. Why wasn’t that done? It might even be fair if it weren’t for the fact that every single change in diagnosis made always went in the direction of supporting Wakefield’s hypothesis. That alone fails to pass the “sniff test.”

There’s a whole long section of Wakefield’s whine about individual patients that would probably drive you all screaming away if I were to go through it bit by bit in one post, and I don’t think I have the stomach to make a blog series out of it. Perhaps someone more intrepid than I could manage it. To make a long whine short, through most of them Wakefield in essence accuses Deer of either lying about what was in the medical records of these children or selectively citing it. (Again, the irony boggles the mind.) If he really thinks Deer was lying about him, he should sue Deer for libel. Given Britain’s notoriously plaintiff-friendly libel laws, he would be virtually guaranteed to succeed if his action had any merit. He might even succeed if his action had only dubious merit. He won’t, of course, because he knows he can’t win. Instead he makes excuses and concocts massive conspiracy theories.

Wakefield then goes on to claim that his “findings” have been reproduced or confirmed by other scientists. He cites the following papers:

  1. Gonzalez, L. et al., Endoscopic and Histological Characteristics of the Digestive Mucosa in Autistic Children with gastro-Intestinal Symptoms. Arch Venez Pueric Pediatr, 2005;69:19-25.
  2. Balzola, F., et al., Panenteric IBD-like disease in a patient with regressive autism shown for the first time by wireless capsule enteroscopy: Another piece in the jig-saw of the gut-brain syndrome? American Journal of Gastroenterology, 2005. 100(4): p. 979-981.
  3. Krigsman A et al. http://www.cevs.ucdavis.edu/Cofred/Public/Aca/WebSec.cfm?confid=238&webid=1245 (last accessed June 2007) (paper submitted for publication).
  4. Balzola F et al . Autistic enterocolitis: confirmation of a new inflammatory bowel disease in an Italian cohort of patients. Gastroenterology 2005;128(Suppl. 2);A-303.

Of course, whether these results have “replicated” or “confirmed” Wakefield’s results depends, as a former President would say, on what the meaning of the word “confirm” is. Reference #1 appears not to be in a journal indexed by PubMed; I couldn’t find it. All I could find was a reference in Whale.to that described its results thusly:

Additionally in 2005, a study (27) was published by Gonzalez, Lopez et al, seeking evidence of immunological alterations in 68 autistic children ages 22 months to 11 years and presenting with digestive systems, and examining biopsies from their digestive tracts. Endoscopies and colosopies were undertaken, with biopsies of the esophagus, stomach, duodenum and colon, with verification of presence of inflammation, eosiophil infiltration, lymphoid nodular hyperplasia and CD-4 and CD-8 cells. The results were that lymphoid nodular hyperplasia was discovered in 2/68 esophagus, 6/68 stomachs, 8/68 duodenums and 36/68 (53%) of colons. Eosiophil infiltration with more than 20 eosiphils per field were found in 3/68 eosphagus, 1/68 stomach, 8/68 duodenum and 24/68 (35%) colons. Inflammatory reactions were found in 56/68 (82%) esophogitis, 64/68 (94%) gastritis, and all (100%) presented with duodenitis and colitis. CD-4/CD-8 relationship existed of >3 in 42/68 (62%) and <1 in 16/68. The authors concluded that the children presented immunological and immunohistochemical alterations of the biopsies of their digestive tracts, and that there was a significant finding of lymphoid nodular hyperplasia, eosiophilinfiltration, and that prevalence of greater CD-4 than CD-8 cells in the inflammation of the intestinal wall demonstrated in favour of a Th2 type allergic reaction.

This is thin gruel indeed. All the children presented because of their bowel symptoms; so it’s not surprising at all that–ta-daaa!–many of them had evidence of inflammation in their GI tracts. What it does not show is that enterocolitis is more common in autistic children than it is in children without autism. That is actually a fairly controversial area, and it is not clear that autistic children are any more prone to bowel complaints. Even if they were, the way to verify that autistic children do in fact have more bowel complaints is not to study only autistic children with bowel complaints. The way to do it is to study children with and without autism and then determine if the incidence of bowel complaints is any higher in the group of autistic children. Moreover, remember that the claim made by Wakefield was that the MMR vaccine was associated with both regressive autism and GI symptoms, a claim that, as far as I can tell, this obscure paper published in an even obscurer journal fails to support.

The next paper is a single case report; you can’t make any conclusions from a single case report, only (possibly) formulate hypotheses to test. The third paper, I couldn’t access. The URL doesn’t work, anyway. In any case, it’s by Arthur Krigsman and, even if it shows what it purports to show, can hardly be considered independent verification, given that Krigsman now works at Wakefield’s Thoughtful House.

The final reference by Bazola et al, I couldn’t find on a PubMed search, even though I know that the journal is indexed by PubMed. So I went to the journal itself and found the specific issue mentioned. It appears to be just an abstract included in the Gastroenterology abstract supplement for the year 2005 and it only involved nine patients. All of them had autism and enterocolitis; so it is not surprising that selection bias led to a correlation. No, this is hardly replication of Wakefield’s findings, either, and, worse, it hasn’t been published since as a full journal article, as far as I can tell. Worse, still, the most recent and rigorous attempt to replicate Wakefield’s research utterly failed to confirm his results. Dr. Wakefield must be pretty hard up if these are the best papers he could come up with as “verification” of his work.

Perhaps the most hilariously badly timed part of Wakefield’s whine is this:

Indeed, the notion that any researcher can cook such data in any fashion that can be slipped past the medical community for his personal benefit is patent nonsense.

Dr. Wakefield, meet Dr. Reuben. Dr. Reuben, meet Dr. Wakefield.

What was that Wakefield was saying again about it being “patent nonsense” that any researcher can “cook data” and remain undetected by the medical community being “patent nonsense”? In fact, unfortunately, it wasn’t really the medical community in either case, that of Dr. Reuben or of Dr. Wakefield, who caught on to the fraud. In the former case, it was a hospital’s clinical trial office charged with human subjects protection who noted that Dr. Reuben had published two abstracts for which there was no record of an approved human subjects research protocol. In the case of Dr. Wakefield, although a lot of the medical community viewed his results with great suspicion and suspected that something was not quite kosher, it was an investigative journalist, not the medical community, who uncovered Andrew Wakefield’s irreconcilable undisclosed conflicts of interest and “data cooking.” In any case, now I suspect I know why Age of Autism hasn’t made a huge stink about the Reuben fraud case. Its silence struck me as profoundly anomalous, given what a huge, juicy target Reuben was as “proof” that scientists are in the pocket of big pharma and “cook” results to its liking, but now I think I understand. I could be wrong, but I suspect I’m not. It wouldn’t do to make a stink about that case of fraud when the antivaccine movement has its own fraud to worry about, especially if part of Wakefield’s defense was going to be that it’s not possible to “cook the data” for so long without the scientific community catching on. The Reuben case is an “inconvenient” counterexample that occurred in very close temporal proximity to Wakefield’s planned counterattack.

Personally, I’m rather glad that Wakefield made this complaint. The reason is that it will inevitably bring more attention to his scientific dishonesty. Moreover, if, as is likely, the Press Complaints Commission dismisses the complaint, it will be one more hit to Wakefield’s credibility, albeit a small one in comparison to the previous hits he’s taken. Personally, I’m more disturbed that it took so long for these allegations to come out. We in the biomedical science community have some soul-searching to do if frauds like Drs. Wakefield and Reuben can get away with their frauds for more than a decade.