The martyrdom of St. Andy

i-1bf3a415e3c386fb5e8c1256da30e6e0-peterMartyrBellini.jpg

Looks like I picked the wrong week to give up sniffing glue.

Well, not really. Maybe it looks more like I picked the wrong NIH grant cycle to be submitting an R01. After all, the deadline for my getting my grant to my university’s grant’s office coincided very closely with the announcement of the General Medical Council’s ruling in the Andrew Wakefield case on Thursday. As I pointed out in a brief post yesterday, the complete 143-page ruling can be found here (if you want to avoid AoA or Generation Rescue) or here (if you want to annoy J.B. Handley by showing traffic coming from this blog). It’s long, tedious document to read but can be boiled down to one brief passage:

In reaching its decision, the Panel notes that the project reported in the Lancet paper was established with the purpose to investigate a postulated new syndrome and yet the Lancet paper did not describe this fact at all. Because you drafted and wrote the final version of the paper, and omitted correct information about the purpose of the study or the patient population, the Panel is satisfied that your conduct was irresponsible and dishonest.

Irresponsible and dishonest. Dishonest and irresponsible.

Those two words describe Andrew Wakefield in a nutshell, although I would also humbly suggest adding to them the words “unethical” and “incompetent.” After all, here is a man who did not disclose his conflicts of interest, namely that he was in the pocket of trial lawyers interested in suing vaccine manufacturers to the tune of £435,643 in fees, plus £3,910 expenses. As we say, them’s some seriously righteous bucks, the equivalent of a full R01 grant here in the U.S. But it was worse than that. As Brian Deer discovered, Wakefield was also working on a competing vaccine alternative to the MMR and had even filed a patent application for it, meaning that results casting doubt on the safety of the MMR vaccine would be very helpful to him in marketing a competing vaccine. As for Wakefield’s incompetence, that was made manifest during the Autism Omnibus proceeding when world-renowned PCR expert Stephen Bustin testified about the laboratory where the specimens from Wakefield’s clinical trial were sent to be analyzed for measles virus sequences. The long version of his testimony is discussed here. The short version is that the laboratory was contaminated with plasmid containing measles virus sequences, and that the “positive” readings for measles virus in the ileal samples sent to the laboratory were false positives because of the contamination. Add to that the findings of the GMC, namely that he experimented on children without obtaining proper ethics committee approval and that he did invasive procedures on children that were not medically indicated, and the picture of Andrew Wakefield that emerges is anything but flattering:

The verdict, read out by panel chairman Dr Surendra Kumar, criticised Dr Wakefield for the invasive tests, such as spinal taps, that were carried out on children and which were found to be against their best clinical interests.

The panel said Dr Wakefield, who was working at London’s Royal Free Hospital as a gastroenterologist at the time, did not have the ethical approval or relevant qualifications for such tests.

The GMC also took exception with the way he gathered blood samples. Dr Wakefield paid children £5 for the samples at his son’s birthday party.

Dr Kumar said he had acted with “callous disregard for the distress and pain the children might suffer”.

He also said Dr Wakefield should have disclosed the fact that he had been paid to advise solicitors acting for parents who believed their children had been harmed by the MMR.

If you want to see callous disregard for the children at that birthday party, take a look at this video. Unfortunately, the quality is poor, but it clearly shows Andrew Wakefield joking about children throwing up or passing out in fear:

Yes, that is laughter and joking, and that is but one incident that led the GMC to declare Andrew Wakefield’s “callous disregard” for children. In my opinion, that is the real Andrew Wakefield. Dishonest. Callous. Unethical. Incompetent. These words do not begin to describe the vile human being that I consider Andrew Wakefield to be. Moreover, his incompetent, COI-riddled “research” (it still sticks in my craw to use that word to discuss anything associated with Wakefield’s MMR work), aided and abetted by the sensationalistic and credulous U.K. press, led to a scare over the MMR that has not yet abated even now, more than a decade later. MMR uptake plunged throughout the U.K., dropping to as low as 50% in some areas. The result was very predictable. Over the last decade, the incidence of measles has skyrocketed in the U.K. Indeed, in 2008, 14 years after measles had been declared under control in the U.K., the Health Protection Agency stated that, as a result of almost a decade of low mumps-measles-rubella (MMR) vaccination coverage across the UK, “the number of children susceptible to measles is now sufficient to support the continuous spread of measles” and declared measles to be endemic again in the U.K.

That is the true legacy of Andrew Wakefield: The resurgence of a once-defeated vaccine-preventable disease, with all the attendant suffering its return brought with it. Truly, few people can be said to have done more harm to public health in a nation than Andrew Wakefield did in the U.K. with his incompetent, unethical, callous research.

i-13f37ea87c3f5b713773e5a144f058a6-poussin13.JPG-thumb-450x770-40240.jpeg

Not surprisingly, the anti-vaccine movement is circling the wagons to defend the martyred Saint Andrew. Proving its utter crankitude, it is reacting exactly as cranks do when their views are attacked or one of their own is brought to task for his deeds. Those who brought those misdeeds to light are being vilified, as Brian Deer has been. Indeed, in an article published in the Sunday Times yesterday, Brian Deer describes just that phenomenon. First, there’s the disbelief:

It began with a few murmurs. As Surendra Kumar, a Cheshire GP, read out the verdict of the General Medical Council (GMC) panel on the conduct of Dr Andrew Wakefield and two colleagues last Thursday there was muttering in the public seats. “Disgraceful,” grunted one woman. “Rubbish,” spat another.

As Kumar spoke the key words — “dishonest”, “irresponsible”, “contrary to the clinical interests of this child” — a crackle of anger and amazement erupted. I wondered if a fight would break out in the London committee room.

It wouldn’t have surprised me one bit if there had been a fight. Then there’s the vilification of “enemy,” or at least the perceived enemy, as described by Brian Deer:

To many of the parents I was just as much of a villain as Kumar. They blamed me for the fallout from my investigations in The Sunday Times into Wakefield’s research.

[…]

For one woman it was all too much. “It’s Brian Deer who should be on trial,” she called out. Such is the highly charged world of MMR.

For six years Wakefield and I have been locked in battle. It was my investigation that triggered the GMC’s case. He sued me for libel — and was then forced to send me a cheque to cover my legal costs when the action was withdrawn.

True to form, the anti-vaccine propaganda blog Age of Autism leapt to Andrew Wakefield’s defense using apocalyptic imagery. To the anti-vaccine cranks at AoA, this hearing was nothing less than a battle of the good Saint Andy versus Big Pharma Evil, and its verdict proof positive that the pharma conspiracy to “poison” children with vaccines was taking its vengeance on poor, poor Andy for speaking truth to power. As it became clear that, finally after all this time, the GMC was on the verge of announcing its ruling, I noticed that the AoA ramped up an increasingly bizarre and unhinged last minute propaganda campaign, complete with a hilariously inapt post by Mark Blaxill comparing Wakefield to Galileo and the GMC to the Inquisition and containing references to Stalin and Mao (I suppose I should be relieved that Blaxill refrained from playing the Hitler card); a defense of “that paper” by Wakefield himself; claims that parent witnesses had been “silenced” at the GMC hearings; and a whole series of posts by John Stone over the last few months trying to discredit the GMC.

Of course, Wakefield’s vision of himself as a brave Galileo persecuted by the forces of dogmatism is nothing new. He pulled that gambit right after the GMC Fitness to Practise Panel Hearing began in July 2007, likening himself to Václav Havel, the playwright turned political activist in Czechoslovakia who spent several terms in prison for his political activities opposing its Soviet-style Communist government in the 1970s and 1980s and ultimately played a major role in the Velvet Revolution of 1989 that led to the bloodless overthrow of Communism.

Galileo? Václav Havel? Wakefield surely does have an inflated view of himself! Next he’ll be comparing himself to Gandhi or Martin Luther King.

After the findings were announced, the smear campaign only got more heated and histrionic. That’s because in the decade since his Lancet paper began the movement that led to the resurgence of measles in the U.K. Andrew Wakefield has become a hero to the movement dedicated to the discredited idea that vaccines cause autism. He is the prototypical “brave maverick doctor” and don’t need no steeenkin’ science to know that he’s “recovering” autistic children. Evidence of this delusion is everywhere; so I’ll pick and choose. Perhaps the most obvious manifestation of the Wakefield cult of personality is this barf-inducing website We Support Dr. Andrew Wakefield. I first became aware of this website last year after Brian Deer’s revelations regarding the likely scientific fraud committed by Andrew Wakefield came to light. On the day that the GMC’s findings were announced, the website declared it a “sad day for the future of our children” and further declared:

The General Medical Council’s (GMC) verdict today concerning Dr. Andrew Wakefield brings together autism organizations across the United States who stand united in support of him, unequivocally renounce the GMC’s findings, and demand an investigation into possible conflicts of interests at the GMC. We further challenge the U.K. and U.S. governments to offer grants for gold standard research into why so many children with autism have gastrointestinal pathology, as well as any links between this pathology and the symptoms of autism, before all of the children of the world are affected.

Today’s verdict by the General Medical Council epitomized their negligence in respecting all of the sound scientific studies worldwide replicating the findings of Dr. Andrew Wakefield. In the United States we will continue to fund studies replicating Wakefield’s work. We will focus more heavily on helping to educate the British public about the dangers of the MMR. We will look with renewed vigor into possible misconduct by the GMC. And, most importantly, we will continue to recover children from autism thanks, in large measure, to Dr. Wakefield’s pioneering work. We have witnessed and applaud the sustained courage and dignity of Dr. Andrew Wakefield. He has stood by the children, and we will stand by him.

This statement is signed by AutismOne (a favorite target of mine over the last couple of years), the Autism Research Institute, Generation Rescue (big surprise there, given that GR has already declared its support for Andrew Wakefield in no uncertain terms and, in the lead up to the GMC’s findings, tried its best to demonize GMC and cast doubt on the legitimacy of the entire proceeding), SafeMinds, Schafer Autism Report, Talk About Curing Autism (TACA), Unlocking Autism. In other words, the vaccine-autism glitterati are lining up to support this statement. Notice how the statement alleges conflicts of interest and misconduct on the part of the GMC without any actual proof of such COIs. Also notice how it declares that other researchers have “replicated” the findings of Andrew Wakefield. Of course, that is true if you count charlatans and quacks, but no reputable researchers have been able to replicate his findings. More specifically, no researchers not affiliated with Wakefield and/or the anti-vaccine movement have ever been able to replicate Wakefield’s work. Indeed, the latest “study” being touted by the anti-vaccine movement as “confirming” Wakefield’s results is by…Dr. Arthur Krigsman of Thoughtful House, who happens to be on the editorial board of the journal in which the “study” was published! (Maybe I’ll take this particular study on in a separate post if I’m in the mood later this week.) Even more curious is that this paper was published in a new vanity journal that gives the appearance of being dedicated to autism pseudoscience. Most recently, as I pointed out above, a sympathetic researcher named Mady Hornig, who had previously published research seemingly supporting a link between thimerosal and autism, failed to replicate Wakefield’s results. Finally, notice how, despite numerous studies supporting the safety of the MMR and its lack of association with autism or bowel complaints in autism, these organizations continue to cling to the belief that the MMR is “dangerous” and vow to “educate” the public about the “dangers” of the MMR vaccine.

Consistent with previous reactions to criticisms of the anti-vaccine movement or one if its leaders, multiple organizations are also going on the attack, painting itself as the underdog being persecuted for speaking truth to power. For instance, here’s what the TACA wrote:

The most frightening aspect of these GMC findings is the silencing effect it could cause to scientist and researchers. These verdicts now prove that researchers who stumble upon science that is controversial have to worry about losing their licenses and careers.

Consistent with the persecution complex that the anti-vaccine movement has, yesterday AoA contributor Martin Walker tried with some truly bad writing, writing worthy of consideration for the 2010 Bulwer-Lytton Fiction Contest (given that it is pretty much fiction and its prose is the equal of previous winners) with some incredibly heated rhetoric to show just how much reason has checked out among Wakefield’s defenders:

As the recitation of the crimes of Dr Wakefield came to an end, it appeared as if Dr Wakefield, had in the mid nineties, been some kind of inhuman Nazi experimenter practicing on children in the heart of England; an overlooked human vivisector who stalked a large North London hospital committing serious crimes with the two other criminals in his firm, invisible to his colleagues and unseen by the hospital administration.

It’s actually funny that Walker would mention Nazis. It was Nazi experimentation, among other things, that led to the Helsinki Declaration, the Belmont Report and the Common Rule in the U.S., and all the other protections for human subjects involved in clinical research. These rules are quite strict, although some would argue whether they’re even strict enough. They prevent atrocities like the Tuskegee syphilis experiment. They are the same rules that Wakefield flouted.

Undeterred by reality, Walker then likens the ruling to knight knocked off his horse during a joust. I can only guess who in this contest is the White Knight and who is the Black Knight:

Today I know will be one of those times that signify a dark night of the soul, for defendants, parents and campaigners alike. This afternoon the defendants will be knocked from their horses by rib smashing lance blows, on the ground they will lie dazed and have to figure whether it is right or even possible to remount and continue the battle. Parents will contemplate the bleak landscape of their children’s illness without any treatment and with open skepticism from medical practitioners from whom they seek help. Activists and campaigners like myself will have to face the melancholic prospect of either continuing the campaign or slipping away to support apparently more equitable battles.

This particular battle is a post-modern struggle, one in which the most powerful forces, multinational companies, reshape the world hand in hand with governments. This is a struggle from which parents and citizens have been expunged. A blind struggle, in an age where all the ties between governments and citizens have been severed, where it is no longer possible for citizens to have any real effect on either the processes of industrial science or of national politics.

The “battle,” such as it is, is indeed postmodern, just not in the way that Walker seems to think it is. It is Walker’s side that is actually producing the postmodern arguments, of course, but he’s too oblivious in the depths of his conspiracy mongering, self-pity, and whining to see that.

Perhaps the most over-the-top conspiracy-packed “defense” of Andrew Wakefield comes from Mark Blaxill, published on the anti-vaccine crank blog Age of Autism and entitled Naked Intimidation: The Wakefield Inquisition is Only the Tip of the Autism Censorship Iceberg. It’s all there, nearly every common crank gambit you can think of. Check it out!

Claims that the GMC finding was designed to “intimidate” those “brave maverick scientists”? Check:

The GMC proceeding is a frightening and thoroughly modern form of tyranny. It makes you shudder to think what Stalin or McCarthy might have accomplished if their public relations had been more skillful and better organized.

The extremity of the GMC’s verdict–all three men guilty on all counts–lays bare any pretense that the British medical establishment cares one whit about the welfare of its patients. Let’s put in perspective the actions at issue here. No children were harmed and no parent or guardian has complained about the care these three men provided. In fact, the procedures involved were routine, the resulting treatments standard and the careful attention to gastrointestinal illness in autistic children has recently been endorsed by a consensus statement published in the journal Pediatrics (no friend of the autism community). Considered in this light, the GMC hearing process stands exposed for what it is. It was not about medical standards. It was not about evidence. It was not even civilized. It was, rather, a naked exercise in intimidation, a fateful moment of moral decision in which the medical industrial complex exposed its ruthless, repressive essence. They are a frightening bunch and their conduct here raises issues well beyond autism.

Actually, Wakefield was not found “guilty on all counts”; he was found guilty on several of the most egregious counts but he was also exonerated on several. Blaxill should try–oh, you know–actually reading the ruling. In any case, the only thing frightening about this case is how much Andrew Wakefield got away with and how long it took for him to be exposed as the unethical fraud he’s been shown to be by Brian Deer, the GMC, and numerous other sources.

Attacks on peer review? Of course they’re there, too:

Since the National Institutes of Health (NIH) hold a virtual monopsony (“a sole or predominant buyer” in a particular market) on scientific research in the United State, NIH grant reviews are one prominent place where researchers can be effectively intimidated. One scientist, who authored a sensitive, previous publication, when asked to join in the effort to draft a review paper, demurred with the following explanation.

I have had two rejections of NIH grants in the last two weeks. This is most remarkable, in that the grants were not deemed good enough to even be scored. In my X years on the faculty, I have never had an unscored grant. Moreover, in one grant it is clear that there is a personal vendetta ongoing. This is not totally surprising but nonetheless disturbing. I am not ready to throw my career away, and I don’t look at how Andy Wakefield has handled such problems as a good model for me. It is vital that the science of this problem get out, and this is where I want to focus my attention. Therefore, I have decided that I do not want my name on [this new review publication], for I don’t need more persecution right now, and as good as the paper is (and I think it is extraordinary), it is not going to be a definitive scientific publication. I am enclosing a section I wrote-some of this is already included-feel free to use any of it.

If an intrepid researcher goes so far as to submit a paper for publication, that’s where the more overt forms of censorship can enter in, all in the guise of “peer review.” Admittedly, rejection at the point of peer review is a common part of science, but the autism problem is especially radioactive and is a place where I have seen the unmistakable cold hand of censorship take many forms: some unwelcome research can be headed off at the pass, with journal editors making clear that papers on certain autism topics are unwelcome and won’t even be sent out for review; or unwelcome papers can be sent to anonymous reviewers the editor knows to be hostile to the topic of environmental influences;

Let’s see. I just found out on Friday that not only was a revision of a paper I wrote still not deemed acceptable for publication in the journal to which I submitted it (reviewer three strikes again!), but I also found out that I didn’t get a grant I really wanted that I had thought I had a good chance of getting. That’s academia and biomedical science. It happens all the time (although I can’t recall having had such a one-two body blow to my ego occur both in the same day, much less one at 4:30 AM after my having been up all night putting the finishing touches on a grant and then the second arriving at around 5 PM). The latter example of my failed grant is apt, too, in that the reviewers praised my proposed experimental design as being excellent but were very skeptical of the actual hypothesis being tested. Obviously, with my “dangerous hypothesis,” I must be too close to The Truth about breast cancer and how to treat it. (Yeah, yeah, that’s what I’ll tell myself, rather than that I just didn’t do a good enough job selling the project or that I didn’t have enough preliminary data to convince the reviewers of its worth.)

In any case, the complaint that “I’ve never had a grant not scored” is not indicative of “censorship.” The amount of money available for the NIH to fund grants compared to the number of grants submitted fell precipitously between 2003 and 2009. Lots of senior researchers who had never had a grant found to be “not worthy” of being given a numeric score (which indicates that the two or three primary reviewers deemed it to be in the bottom half–or even bottom 60%–of all grants being ranked in that cycle and therefore possessing no chance of being funded) have discovered the painful experience that many of us have had from time to time all along of having NIH grants coming back unscored. In these tight fiscal times, that’s just reality. In this sort of environment, though, it’s easy for scientists to tell themselves that they’re the victim of groupthink whether there’s anything to it or not.

However, Blaxill completely shattered yet another of my irony meters when he wrote his conclusion:

The GMC verdict, that honest scientists like Andy Wakefield have “failed in their duty”, makes a mockery of the value of civil debate in an open society.

The medical industrial complex is closing ranks. It’s time for responsible citizens–health consumers and principled scientists alike–to raise their voices in opposition.

No, the anti-vaccine movement has made a mockery of civil debate in an open society. Indeed, its reflexive reaction to criticism of attacking the messenger, sometimes in the most vile ways imaginable, is legendary. Journalists Amy Wallace and Trine Tsouderos, both of whom have published recent articles shedding light on the pseudoscience of the anti-vaccine movement, have been the victims of it and discovered what Brian Deer has been experiencing for several years, sometimes in the form of homophobic attacks in which his sexuality is linked to his supposed “indifference” to children. Steve Novella has been a victim of it. Paul Offit has been nearly continuously a victim of such bile and harassment, up to and including frivolous lawsuits. Sometimes, as when AoA represented Paul Offit, Steve Novella, and journalists Trine Tsouderos and Amy Wallace as sitting down to have a Thanksgiving feast, the main course of which was a dead baby, it can get unbelievably vicious. I myself have been harassed similarly on many occasions.

I suppose that’s the definition of “civil” debate from the anti-vaccine movement.

i-c29e1ac699ac9500c47bd9fe161f0b81-martyrdom-of-st-mathew-3617-mid-thumb-450x422-40243.jpg

As I have pointed out on numerous occasions before, both here and elsewhere, the anti-vaccine movement has much in common with cults. It believes, despite all scientific evidence, that vaccines cause autism and many other chronic health conditions. Its adherents see themselves as the keeper of a hidden truth that “they” don’t want you to know about, a “truth” that it desperately wants everyone to know. No facts, no science can sway them, and when one of their prophets is found to have behaved unethically, to have had massive conflicts of interest, and possibly even to have falsified research, it’s all part of a plot by The Man to keep them down. That is why, as necessary as it is for the GMC to have ruled against Andrew Wakefield, I know that it will not stop him from plying his trade on children in Texas, and I especially know that it will only feed his cult of personality by adding martyr to his list of attributes in their eyes. It will not stop him from raking in money hand over fist or Thoughtful House from racking up a huge war chest that do nothing to help autistic children.

Indeed, Wakefield himself has said as much, as Brian Deer reports:

Lawyers have told me that any one of the more than 30 charges that were proved against Wakefield would typically lead to his being struck off. His days as a medical practitioner will soon be history. A further hearing will determine whether “serious professional misconduct” was committed.

[…]

Wakefield’s economic and fan base are undented, however. He is now executive director of an autism clinic in Austin, Texas, where he earns a reported £175,000 a year. “My wife loves it here,” he said last year. “My family love it here.”

[…]

On American television in August he was asked what effect being struck off would have on him. Wakefield replied: “Well, I think my credibility among the people who I believe count — that is the children who are affected, the parents of the children who are affected — will probably remain completely unchanged.”

No doubt about that. Of course, this is a legal ruling, and as such in and of itself it doesn’t demonstrate that Wakefield was wrong. Science does. What’s gratifying is that this is an occasion where a legal ruling actually agrees with the science.

In any case, don’t cry for Andy Wakefield, antivaccinationists. He appears to be doing just fine. At today’s currency conversion rate, he’s making close to $280,000 a year selling woo to desperate parents and managing to garner creampuff “investigations” on national TV here in the U.S. Even if the GMC ultimately decides that Wakefield has committed professional misconduct (which, from its ruling, it seems to me that he has), none of that will change. In fact, as I’ve speculated before, he will likely become even more credible to the anti-vaccine movement, because it will see him as a martyred prophet, having suffered for the faith–having suffered “for autistic children.” Mark my words, the GMC is about to do Andrew Wakefield one of the biggest favors possible; he just doesn’t know it yet. He’ll be able to charge more, and he’ll be the subject of more fanatical devotion than ever. One can only hope that the Texas Medical Board takes notice, but I see no sign of that happening any time soon. Wakefield’s gravy train appears to be safe.

So does the lack of concrete effect of the GMC’s ruling on Andrew Wakefield’s activities mean that it’s a waste of time? I don’t think so. I think that Brian Deer gets it right when he quotes a physician:

Wakefield will probably never admit to his errors. But exposing his methods has been worthwhile, according to medical sources.

“People can’t understand whether a scientific study is valid or invalid,” said a senior doctor who had watched vaccination rates slump, even in the face of endless research on MMR safety. “But they can understand ‘right’ and ‘wrong’, and they can understand ‘honest’ and ‘dishonest’.”

I have found this to be true as well. People understand dishonesty. They understand unethical behavior. They understand callous disregard for children and the suffering to which they are subjected when medically unnecessary invasive procedures are performed on them. That Andrew Wakefield engaged in all of these is the finding of the GMC, and it’s very important that this be emphasized. In the long run, I’d like for the public to understand why Andrew Wakefield’s “research” is pseudoscience, but in the short run I’ll settle for the GMC concluding that he behaved dishonestly, unethically, and callously.

Until the public can understand the reasons why the “research” supported by people like Andrew Wakefield and the anti-vaccine movement he played such a large role in fueling is bad science or pseudoscience, I fear that the madness and fear fueled by the anti-vaccine movement will only end when vaccine-preventable diseases return to the point where every parent fears them again. No, it’ll have to be more than that. After all, vaccine-preventable diseases are already returning. That’s why I fear it will only end when they return to the point where the fear of disease is more intense than the fear of the vaccine-autism bogeyman. In the meantime, while Third World countries clamor for life-saving vaccines and Bill Gates pledges $10 billion to bring vaccines to the world, here in the developed world we have men like Andrew Wakefield feeding an irrational fear of vaccines that threatens to reverse all the progress of the last few decades.

Maybe 20 years from now, we’ll need the Bill and Melinda Gates Foundation to be pledging billions of dollars to bring vaccines to us.