Andrew Wakefield predicts a “mass extinction” due to vaccines in the pages of—where else?—JPANDS

It’s been a while since I’ve written about the Association of American Physicians and Surgeons (AAPS) and its journal, the Journal of American Physicians and Surgeons (JPANDS). The last time the AAPS was much of a thing on this blog was shortly after the election of Donald Trump, when President-Elect Trump announced that his nominee for Secretary of Health and Human Services would be Tom Price, who, it turned out, was a member of AAPS. Naturally, I took it upon myself to educate the world about just how much of a crank organization AAPS is and just how antivaccine it is. My words have been justified a thousandfold by the actions of the AAPS, this time around, it’s giving Andrew Wakefield the Featured Article position in its latest issue of JPANDS. The article? It’s called The Sixth Extinction: Vaccine Immunity and Measles Mutants in a Virgin Soil, and in it Wakefield argues that we’re heading for a sixth extinction because of—you guessed it!—vaccines.

AAPS and JPANDS: Crankery galore!

Before I get to Wakefield’s magnum opus of antivaccine fear mongering, let’s review a bit of background for those not familiar with AAPS and its official journal JPANDS. The first time I wrote about AAPS and JPANDS was over 13 years ago. In that post, I described AAPS as the John Birch Society for physicians, given its far right-wing tilt. More recently, I like to refer to AAPS as a right wing crank organization disguised as a medical professional society, given how assiduously AAPS likes to don the trappings of a society like the American Medical Association, the better to use the medical profession to give the appearance of scientific legitimacy to its views. In essence, though, the AAPS world view rejects all restrictions on physicians autonomy in the practice of medicine, purportedly for the good of the patient; supports private practice as the One True Practice Model, rejecting being employed or accepting government or third party insurance; violently hates government involvement in medicine, either financially or regulatory; and embraces an Ayn Rand-style view of doctors as supermen and women whose unfettered judgment results in what’s best for patients and medicine. Basically, the AAPS view of a great doctor appears to be epitomized by the character Dr. Thomas Hendricks in the Ayn Rand novel Atlas Shrugged. In that ideological screed disguised as a novel, Dr. Hendricks was a surgeon who left society to join John Galt’s capitalist utopia of “makers” because there was too much government red tape and he “would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward.” He had also supposedly discovered a cure for all strokes but wouldn’t share his discovery with humanity because ordinary peons weren’t worthy of benefiting from his work and he wasn’t getting paid enough. He was a really swell guy.

If you read JPANDS for a few issues, you’ll rapidly find that AAPS views doctors as special and “outside of the herd” to the point that it not only tolerates quackery and antivaccine pseudoscience within its ranks, but embraces them. Indeed, I have found many forms of quackery and medical pseudoscience published in JPANDS over the years, including antivaccine pseudoscience blaming vaccines for autism, including a view that is extreme even among antivaccine activists, namely that the “shaken baby syndrome” is a “misdiagnosis” for vaccine injury; its HIV/AIDS denialism; blaming immigrants for crime and disease; promotion of the pseudoscience claiming that abortion causes breast cancer using some of the most execrable “science” ever; rejection of evidence-based guidelines as an unacceptable affront on the godlike autonomy of physicians; or the way the AAPS rejects even the concept of a scientific consensus about anything. Let’s just put it this way. The AAPS has featured publications by antivaccine mercury militia “scientists” Mark and David Geier and many others. No form of quackery and pseudoscience is too ridiculous for JPANDS

This brings us back to Andrew Wakefield. In many ways, Wakefield is a perfect fit for AAPS and for the lead article in JPANDS. He “doesn’t follow the herd” (unless it’s a herd of antivaxers) but does bucks the system (albeit in a horrible way). He rejects evidence- and science-based medicine if they don’t conclude what he believes and thereby reinforce his beliefs. He possesses an ego as inflated as that of the fictional Dr. Hendricks, feels completely unappreciated because the medical profession rejects his pseudoscience and scientific fraud. He doesn’t believe that he as a physician—a no longer licensed physician, I hasten to add, his having had his license stripped from him by the UK—should have to bow to any medical authority or science- and evidence-based guidelines, and his narcissism is knows no bounds. You get the idea. So naturally, AAPS would see Wakefield as a perfect contributor to its house organ JPANDS. I’m only surprised that it hasn’t happened before, as far as I can remember. (I’m not going through JPANDS back issues to see if he’s contributed before.)

I also can’t help but be surprised at what Wakefield has written in JPANDS for AAPS. Wakefield has always assiduously tried to deny and avoid the label of “antivax.” Yet, here, he goes further off the deep end of antivaccine pseudoscience, general medical pseudoscience, and conspiracy mongering than I’ve ever seen him go before. In this article, Wakefield manages to be a denialist not only of vaccines, but he also flirts with evolution denial (or at least an incredibly poor understanding of evolution), and even sidles up to germ theory denialism. To set the stage, he starts with Louis Pasteur (of course!), proceeds to evolution, where he misrepresents a lot of science. Naturally, AAPS and JPANDS, being AAPS and JPANDS, the editors and ludicrous “peer reviewers” let it all pass without questioning.

Andrew Wakefield in JPANDS: Pasteur and Sir Alexander Fleming got it wrong!

Wakefield begins by decrying how Pasteur framed his germ theory, which is not entirely unreasonable, given how much of our microbiological flora are either beneficial or neutral, something that wasn’t understood in the late 19th century. It doesn’t take long for Wakefield’s complaint to go from semi-reasonable to ludicrous as he abuses science more and more in the article. Predictably Wakefield can’t resist invoking the microbiome, which is a recent understanding of how our very own bacterial and other microbial flora affect our biology and health. Quacks and cranks love the microbiome, because its existence allows them to make all sorts of dubious claims extrapolating from our current limited understanding of the relationship between the microbiome and our health. As you might imagine, antivaxers like the microbiome because they like to claim that if your microbiome is “healthy,” you don’t need vaccines and that you can manipulate your health by manipulating the microbiome. That latter contention might have some truth to it, but inevitably antivaxers wildly extrapolate far beyond what science shows. From here Wakefield proceeds to the Sir Alexander Fleming, penicillin, and the antibiotic era, making the observation that bacterial resistance has evolved as a result of overuse of antibiotics. At this point, it becomes quite obvious where Wakefield is going with this:

Antibiotic use has selected out multiply resistant, more dangerous, and more pathogenic strains of bacteria. This growing threat has led what many senior public health officials in the UK and the U.S. to describe as the “post-antibiotic apocalypse” and the “end of modern medicine.” It is estimated that 50,000 annual deaths occur in Europe and the U.S. from infections that “antibiotics have lost the power to treat.” So in fewer than 80 years, we have reached the point at which, for example, with prosthetic surgery, wards are being closed down, patients are being sent home, and operations are no longer possible, because once the prosthesis becomes infected with such bacteria, it is virtually impossible to get rid of them.

Are vaccines destined for a similar fate? It’s a very interesting question. One answer is, why not? For vaccines, resistance equates to strains of the microbe, the virus, or the bacteria that can elude the imperfect immunity created by the vaccine.

Yes, it’s an interesting question, but it’s not anywhere near the slam dunk analogy that Wakefield clearly thinks it is. First, let’s let Wakefield blather on a bit. Not surprisingly, the first example to support his thesis for which Wakefield reaches is pertussis. It’s a common argument among antivaxers that the reason we’re seeing more cases of pertussis in people who have been vaccinated against it is because pertussis is either “evolving resistance,” or because it is shifting to a different strain not covered by the vaccine. I’ve written about this (at least twice), as has Skeptical Raptor. You can read the links if you want to know more, but the short version is that the acellular pertussis vaccine works, but that its immunity wanes; this can be corrected with additional booster shots. Also, as I said at the time, while it is possible that the B. pertussis bacteria is developing “resistance” to the vaccine through natural selection, the evidence that it is doing so struck me as weak and preliminary. Even if it were evolving resistance, the answer would be to change the vaccine in order to include the altered antigens. Others agree, and I’ll discuss this more after considering Wakefield’s other “examples.”

Next up is Marek’s disease, a highly contagious viral disease of chickens that is a major problem in the poultry industry and for which a vaccine exists. Citing an article by Melinda Wenner Moyer claiming claiming that the vaccine was causing the virus to evolve more virulence and a single study that inspired it, Wakefield claims:

The idea that vaccines are pushing pathogens to evolve follows from the notion that natural selection removes pathogenic strains that are so “hot” that they kill their hosts and, therefore, themselves. Vaccines that “leak,” which let the hosts survive but do not prevent the spread of the pathogen, relax this selection and allow the onward transmission of strains otherwise too lethal to persist. Andrew Read et al. demonstrated this effect in experiments with chickens immunized against Marek’s disease.18 Authors concluded that “the future challenge is to identify whether there are other types of vaccines used in animals and humans that might also generate these evolutionary risks.”

As is frequently the case in a denialist screed published in JPANDS, Wakefield conveniently leaves out a very important bit of information about this vaccine. Unlike the vast majority of vaccines, particularly vaccines used to prevent disease in humans, the Marek disease vaccine does not prevent transmission of the virus. It only prevents symptoms of the disease, namely the tumors caused by the virus. That’s why it’s called a “leaky vaccine.” Vaccinated chickens can still spread disease. Under normal conditions, a highly virulent strain would kill the host before the virus could spread too far, thus selecting for strains that are not too virulent. However, a leaky vaccine changes the selective pressure and permits the evolution of highly virulent strains because the virus retains the ability to continue to spread among vaccinated populations, leading to the vaccine selecting for the most virulent mutations. Basically, Wakefield is citing the single example of this phenomenon that has been suggested by experimental evidence, and Read himself has written that, even if this phenomenon occurs with a human vaccine—it doesn’t, as far as we know—that’s an even more compelling reason to be vaccinated. After all, if a human vaccine lets deadlier versions of a disease flourish, that is all the more reason to be protected from those deadly strains.

Wakefield then moves on to HPV (of course):

Markowitz et al. examined this issue in the setting of widespread use of human papilloma virus (HPV) vaccine. As shown in Figure 1, after the introduction of the HPV vaccine, the prevalence of vaccine-targeted HPV strains went down, and concomitantly the prevalence of other strains went up.2 The overall prevalence of HPV in sexually active women aged 14 to 25 years was 54.4% in the pre-vaccine era (2003-2008) and 58.1% in the post-vaccine era (2009-2012). In the pre-vaccine era, the prevalence of strains in the quadrivalent vaccine (4vHPV) was 18.6% overall or about 34% of all HPV, decreasing to 10.8% overall or about 20% of all HPV in the post-vaccine era.

This is brain dead, even by Wakefield (or even JPANDS) standards. The HPV vaccines target only the cancer-causing strains of HPV. Their purpose is not to eliminate all HPV infection, just infection by the HPV strains that cause cancer, mainly cervical but also head and neck cancers. So it’s a good thing that vaccinating with HPV vaccine causes the cancer-causing strains to decline in prevalence, and it doesn’t so much matter that the other strains increased in prevalence to make up the difference. The answer, of course, was (and is) to cover more strains, in order to cover all the cancer-causing strains if possible. That’s why there is now a nonavalent (covering nine strains) version of Gardasil.

Measles and “natural herd immunity”

Wakefield eventually moves on to measles. Apparently he had been on Del Bigtree’s video podcast claiming that measles is mutating in response to the MMR vaccine. He starts out with the intellectually dishonest “vaccines didn’t save us” gambit, which tries to suggest that vaccines aren’t that useful because mortality from a given vaccine-preventable disease was declining before the vaccine was introduced. I call it intellectually dishonest, because the reason more people survived, for instance polio, before the vaccine was introduced was because of the introduction of better supportive care, such as mechanical ventilation with the iron lung, which allowed patients whose respiratory muscles had been paralyzed by the virus to survive until their paralysis resolved or even if their paralysis was permanent. The implication that antivaccinationists want people to draw is that hygiene, sanitation, and the like were the “real” causes of the decrease, but disease incidence does not equal mortality and disease incidence has always plummeted after the introduction and widespread use of a vaccine against it.

Another antivaccine trope invoked by Wakefield is the “natural immunity” trope:

For measles, let us separate herd immunity into natural herd Immunity that operated before the vaccine era and vaccine-associated “herd immunity” in the vaccine era. What is natural herd immunity and what has it achieved? Natural herd immunity was the presence within a population of a level of immunity against measles adequate to protect those at high risk of serious infection, and by minimizing serious infection, consequently reduce serious morbidity and mortality. Natural herd immunity did not operate to prevent the infection. It did not prevent measles, but rather operated passively to permit measles in childhood at a time and in a way that it is least harmful, thus leading to improved survival, good health, and most importantly the benefit of lifelong immunity.

I see what you did here, Wakefield. Basically, Wakefield’s combining a common antivaccine argument that measles isn’t a harmful disease with the claim that “natural herd immunity” led to a predominance of a less harmful measles strain. This is utter and complete bullshit, given that measles has always been a serious disease, the invocation by antivaxers of a 50-year-old episode of The Brady Bunch that played the measles for laughs as evidence that people didn’t think measles to be a big deal before the vaccine notwithstanding. Wakefield bases this “permissive infection constraint” on the observation that one infection with measles provides lifelong immunity and that infants were protected by passive transplacental and breast milk immunity from mothers who had themselves experienced natural measles. One problem with Wakefield’s handwaving should be obvious. Even if maternal antibodies in breast milk were as protective against measles as Wakefield thinks they are, even back then women didn’t breastfeed their children until they reached school age, that time when, Wakefield claims, measles is “least harmful.” (“Least harmful”? What drugs is Wakefield on?)

Also, unfortunately for Wakefield’s line of “reasoning,” the past and present rebuke antivaxers like Wakefield who claim that measles was a “benign” disease. It is not. Indeed, measles produces immunosuppression that lasts years after infection. Also, the whole point of vaccination is so that there can be immunity, both individual and herd, without the necessity of thousands upon thousands of children suffering from measles and its potential complications, such as pneumonia, encephalitis, and deadly SSPE.

Wakefield mangles evolution for AAPS in service of antivax pseudoscience

Next up in his JPANDS article, Wakefield decides that he’s the second coming of Richard Dawkins and invokes evolution…badly…while repeating the intellectually dishonest “vaccines didn’t save us” gambit:

Measles was a major killer of children in the UK until 1920, with a mortality of 1,200 per million children during biannual epidemics. Then there was a precipitous fall in case fatality rate, with at least a 95% reduction rate before the introduction of the vaccine. This decrease in case fatality rate occurred well before the introduction of antibiotics to treat secondary bacterial pneumonias, to which patients often succumbed. This trend had nothing to do with medicine or public health but was largely the result of natural herd immunity operating over 100 years as measles had rapidly become a progressively milder disease. Why measles is milder in children than at other ages, while not the subject of this paper, is due in part to the interrelatedness of factors such as age, dose of exposure, immune system maturation, and nutritional status. The fact is, that natural herd immunity achieved a dramatic improvement in the outcome from measles infection in a short space of time, and left to its own devices, may well have reduced mortality and morbidity to rarities by now. This is the benchmark against which the benefits of measles vaccines must be measured.

Notice how Wakefield presents no evidence to support his claim that “natural herd immunity” had somehow resulted in a massive decrease in the virulence of the measles virus. There’s an obvious question here, too, that Wakefield doesn’t address: Why did the case fatality rate fall after 1920? You can’t just magically wave your hands and say that “natural herd immunity” did it without showing evidence, but that’s just what Wakefield did. How did “natural herd immunity” achieve this miracle? Why did “natural herd immunity” only apparently arise after 1920? Didn’t nearly all children catch the measles sometime during their childhood before 1920, as they did after 1920 until the 1960s, when the vaccine was deployed? What changed around 1920 that led to this “natural herd immunity” arising? Wakefield sure doesn’t tell us. He just expects you to believe his narrative, even though it’s full of obvious massive holes. It’s classic bullshit from a master bullshitter: Trot out something that sounds superficially plausible, safe in the expectation that the vast majority of people reading it won’t see the massive holes in the story. More AAPS and JPANDS “peer review” at its finest. Sadly, Wakefield’s fans (like Del Bigtree) are eating this nonsense up and asking for seconds.

Here’s where Wakefield starts flirting with germ theory denial:

When measles vaccination started, President John F. Kennedy wrote a letter to a November 1961 meeting of the National Institutes of Health (NIH), describing measles as a “formidable and widespread threat.”This was not a view shared by other invited experts including Sir Graham Wilson, at that time one of the world’s authorities on microbial pathology. At a time when mortality from measles was one in 100,000, he described measles as one of the inevitable but rarely important maladies of childhood. This was in 1960. He suggested that the more important question was, “What is different about the child who dies?” Before rushing into universal vaccinations for every child, should we not be asking what is unique, what is different about that one child in the million, about what Claude Bernard described as the “terrain,” which makes a child susceptible to this infection?

First, where did Wakefield get this ludicrously low estimate for the case fatality rate of measles in 1960? Tellingly, he didn’t cite his source. Similarly, whenever I searched for Sir Graham Wilson’s having supposedly warned about not having a vaccine that conferred lifelong immunity, the only sites that come up are antivaccine websites. It is true that Wilson wrote a book called The Hazards of Immunization. It’s not what antivaxers think. For one thing, there are relatively few mentions of issues with the measles vaccine. Most of the book, as reading the table of contents and skimming som chapters revealed to me, deals with problems with contamination, faulty manufacture, faulty administration, and adverse reactions. Interestingly, he even mentions the antivaccine movement early in the book. He does say this about measles, though:

Measles presents an interesting example of a disease in which the mortality in relation to morbidity in Great Britain is extremely low but in which respiratory and neurological complications leaving behind them permanent damage are not infrequent. We know, as yet, little of the possible dangers of measles vaccines, but when we do learn about these we shall be in a better position to judge how far vaccination should be applied in practice.

So much for the idea that scientists in the 1960s believed measles to be a “benign” disease. Wakefield, of course, harps on the relatively low mortality of measles, but ignores, as Sir Wilson did not, the serious pulmonary and neurological complications that result from measles, which Sir Wilson described as “not infrequent.” It should be noted that Sir Wilson’s book was published in 1966 and was based on lectures from a couple of years before, when the measles vaccine was truly a new vaccine and the MMR was a decade off. We now know, as Sir Wilson did not know yet then, that the MMR vaccine is extremely safe. As usual, Wakefield conveniently leaves out a lot of information.

Measles “mutants”

From here on out, Wakefield goes pretty much whole crank, totally off the deep end, listing the “greatest hits” of antivaccine conspiracy theories, including the Simpsonwood conference, thimerosal, and the like, and then, in a feat of projection that only an antivaxer could pull off, accuses scientists of being “too certain”:

The book Crusade to Immunize the World’s Children by William Muraskin concerns the Gates Foundation. Muraskin used to attend all of the meetings of the Gates Foundation, which put tens of billions of dollars into vaccination campaigns worldwide. I interviewed him and asked: “At those meetings where all of the people from the industry, and the people from the World Health Organization (WHO), and UNICEF, and you are all around a table discussing vaccination policy for the developing world, did you ever discuss safety?” He said, “Not once.” That is certainty in the real world.

There is no place for certainty in biological sciences. Stephen J. Gould, American evolutionary biologist wrote: “Organisms… must remain imperfect in their form and function, and to that extent unpredictable since they are not optimal machines. We cannot know their future with certainty.”

I call BS here again, BS and confirmation bias. Just because Muraskin doesn’t remember ever hearing discussions of safety doesn’t mean they didn’t occur. Then Wakefield invokes physics…badly again:

In physics, if you have two related phenomena such as the momentum and the position in space of a particle, Heisenberg’s Uncertainty Principle states that the closer you come to knowing one variable, the further you get from knowing the other. With vaccination, we have multiple variables, each of which, when changed, could change another in ways we can’t even predict, with inherent uncertainty. With a large number of variables, each of which can influence others, there is virtually infinite uncertainty. Uncertainty is the only certainty. Perhaps one certainty is that, as with antibiotics, nature will find a way; she will defy us and haunt the high ceilings of our ambition

I can just hear my physicist readers facepalming out there. The Heisenberg Uncertainty Principle doesn’t apply here and isn’t even a good analogy to a situation like this. Yes, it’s true that as you add variables it’s harder to control for them all. However, we have large epidemiological studies that demonstrate the safety and efficacy of the current vaccination schedule. This is nothing more than an appeal to uncertainty tarted up with quantum mechanics, the way that Deepak Chopra likes to do.

This brings us to the central claim Wakefield is making in his JPANDS article, that “natural herd immunity” is being subverted, both because of vaccination itself and because measles is “mutating” in response to vaccination into forms that are less effectively prevented by vaccination. He cherry picks an example:

Muñoz-Alía et al. have recently identified a variant of measles virus that escapes neutralization by monoclonal antibodies targeting the neutralizing epitope antigenic site, the main target of protective neutralizing antibodies.13 Two measles virus genotypes emerged in their study: those with (D4.2) and those without (D4.1), the genetic variant that allowed escape from neutralization. The former had emerged in countries that have vaccinated intensively and for prolonged periods against measles (UK and France). The latter was present in isolates from East Africa. The D4.2 subgenotype viruses showed a trend toward diminished susceptibility to neutralization by human sera pooled from North American donors. In other words, a mutant has emerged against which vaccine immunity is reduced in the face of intensive, imperfect vaccination, a situation that deserves our urgent attention.

Naturally, I went straight to the source study. (It’s Wakefield. I’d be a fool to accept his description about any study.) Yes, this is what the authors observed, more or less. They identified two strains of measles virus less susceptible to neutralization by pooled human sera. Wakefield, however, took the significance of this observation beyond what the data support, because of course he did, and he left out something very important, but that’s more because the study authors pulled a trick that I hate. Here’s what I mean. What this study did not show is that these strains of measles identified by the authors are any more virulent or any more likely to cause disease in vaccinated children. Tellingly, Wakefield failed to mention that the difference between the strains in their susceptibility to neutralization by immune sera was not statistically significant—not even close. The p-value was 0.21. (The term “trend towards” is always a red flag that could indicate that an experiment’s results were not statistically significant. I’m shocked that peer reviewers allowed it. The correct interpretation is that the researchers did not observe a difference in neutralization between the strains, not that there was a “trend” towards resistance to neutralization. You might get away with that for p-values between 0.05 and 0.10, but certainly not for 0.21.) In other words, the experiment Wakefield cited is a negative experiment, at least as far as sera from vaccinated individuals being less able to neutralize these measles variants. I hate when researchers try to make a non-significant result sound real by saying there was a “trend,” and this was a particularly egregious example.

Another issue that Wakefield doesn’t mention is that, compared to the influenza virus, for instance, the measles virus is known to be slower to evolve than the average RNA virus. An interesting study from 2015 showed that the surface proteins that the measles virus uses to enter the cell are rendered ineffective if they undergo any mutation, meaning that changes to the virus come at a high cost. The authors suggested that the “inelasticity of these proteins prevents the sequence variation required to escape antibody neutralization in the host, allowing for long-lived immunity after infection with the virus.”

And Andrew Read himself, whom Wakefield cited as having shown that Marek disease evolved more virulence in response to vaccination, has written:

Drugs and vaccines both impose substantial pressure on pathogen populations to evolve resistance and indeed, drug resistance typically emerges soon after the introduction of a drug. But vaccine resistance has only rarely emerged. Using well-established principles of population genetics and evolutionary ecology, we argue that two key differences between vaccines and drugs explain why vaccines have so far proved more robust against evolution than drugs. First, vaccines tend to work prophylactically while drugs tend to work therapeutically. Second, vaccines tend to induce immune responses against multiple targets on a pathogen while drugs tend to target very few. Consequently, pathogen populations generate less variation for vaccine resistance than they do for drug resistance, and selection has fewer opportunities to act on that variation. When vaccine resistance has evolved, these generalities have been violated. With careful forethought, it may be possible to identify vaccines at risk of failure even before they are introduced.

He even discussed why measles virus appears not to evolve much in response to vaccination, summarizing some of the evidence about measles evolution. Bottom line: invoking evolution of the measles virus in response to mass vaccination doesn’t explain our current measles outbreaks any more than Wakefield’s totally made-up idea about “permissive infection constraint” and “natural herd immunity” do.

Basically, evolution of resistance to vaccination is very uncommon, far less common than evolution of resistance to drugs, so much so that it’s even been proposed that vaccination is the answer to the development of antimicrobial resistance.

Andrew Wakefield and AAPS: The final “extinction”

As he wraps up his ridiculous tangle of bogus arguments, Wakefield invokes a famous germ theory denialist conspiracy theory:

There is an apocryphal story that Pasteur recanted his germ theory on his deathbed, stating that “[Claude] Bernard was correct. I was wrong. The microbe (germ) is nothing. The terrain (milieu) is everything.”24 Whether the story is true or not, we would do well to ask, as did Sir Graham Wilson, “What is it about that child, that terrain, that makes him vulnerable?”, rather than pushing universal vaccinations.

The story about Pasteur recanting and renouncing germ theory in favor of the competing idea at the time, is a lie. It’s one that I first wrote about a very long time ago. Basically, it’s nonsense. There is no evidence that Pasteur ever said anything like what he is claimed to have said on his deathbed. Before me, Peter Bowditch actually read the earliest existing biography of Pasteur and showed that there was no evidence that Pasteur ever renounced germ theory on his deathbed or at any other time. Just for reference, the competing idea about the “terrain” being all was promoted by Antoine Béchamp, a rival scientist, as well as Claude Bernard. Béchamp’s hypothesis was known as the pleomorphic theory of disease and stated that bacteria change form (i.e., demonstrate pleomorphism) in response to disease. In other words, they arise from tissues during disease states. Béchamp further postulated that bacteria arose from structures that he called microzymas, which to him referred to a class of enzymes. Béchamp postulated that microzymas are normally present in tissues and that their effects depended upon the cellular terrain. Ultimately, Pasteur’s theory won out over that of Béchamp, based on evidence, but Béchamp was influential at the time, and, given the science and technology in those days, his hypothesis was not entirely unreasonable. It was, however, superseded by Pasteur’s germ theory of disease and Koch’s later work that resulted in Koch’s postulates. Besides not fitting with the scientific evidence, Béchamp’s idea had nowhere near the explanatory and predictive power that Pasteur’s theory did.

On the other hand, there is a grain of truth in Béchamp’s ideas. Specifically, it is true that the condition of the “terrain” (the body) does matter when it comes to infectious disease. Debilitated people do not resist the invasion of microorganisms as well as strong, healthy people. Of course, another thing to remember is that the “terrain” can facilitate the harmful effect of microorganisms in unexpected ways. For example, certain strains of the flu (as in 1918 and H1N1) are more virulent in the young because the young mount a more vigorous immune response.

Yes, by implication, Wakefield is invoking germ theory denialist ideas.

Of course, Wakefield buys into the “autism epidemic” distortion, including ridiculous claims that autism prevalence will be 100% before too long, even saying that we are “approaching a situation in which everyone either has autism or is caring for someone with autism.” To him, this is a potential extinction-level event:

And perhaps there is another player waiting in the wings while center stage these battles between Germ and Terrain, Caution and Certainty, Profit and Loss, Truth and Propaganda play out. In the wings we have an old adversary in the guise of an ambitious understudy—measles.

I am not the first to contemplate the idea of the final outcome, if current trends continue, not just with severe neurodevelopmental disorders, but with declining fertility worldwide. There have been five major extinction events in the history of planet Earth, and I believe that if something does not change, we face a sixth extinction event as surely as eggs are eggs.

No, vaccines are not causing so much severe autism that people will stop reproducing, nor are they, as Wakefield implies but doesn’t explicitly state, causing decreasing fertility. If they are, they’re doing a poor job of it, because the earth’s population is, as Wakefield fails to mention, continuing to increase, and even the source he cites states that this will continue until the end of the century, at which point there will be nearly 10.9 billion. Let’s just put it this way. We’re in far more danger of a major extinction event from human-caused climate change than from vaccines, declining fertility, the evolution of superbugs due to vaccines, or any of the other things Wakefield handwaves about in his article.

Wakefield’s gone even further off the deep end than he usually does. Unfortunately, antivaxers will eat it up, and I’m sure even some who aren’t antivax will find his wild speculations plausible, even though they are neither plausible nor supported by evidence. He, AAPS, and JPANDS are made for each other. I wonder if Wakefield’s a member. Whether he is or not, I predict more abominations against science by Wakefield in JPANDS in the future.