Trouble at 'The Lancet': Wakefield and the medical profession

"It has became clear that several elements of the 1998 paper by Wakefield et al are incorrect, contrary to the findings of an earlier investigation.” So concluded one of the longest misconduct inquiries in medical history.

The editors of Britain’s medical journal The Lancet felt compelled to retract a study by gastroenterologist Dr Andrew J. Wakefield and his co-authors linking the Measles-Mumps-Rubella (MMR) vaccine with bowel disease and autism. The decision followed the findings of the UK General Medical Council’s Fitness to Practice Panel. On January 28, the Council ruled that Wakefield and his co-investigators had shown “callous disregard” for the 12 children in the study, all chronic intestinal sufferers, titled “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children” (February 28, 1998). Investigations supposedly approved by the local ethics committee had proven to be false. Nor were the children “consecutively” referred.

Another complicating factor to the study was the failure by the doctor in disclosing a conflict of interest in receiving money in legal cases where families were suing vaccine manufacturers for the harm caused to the children. Nor did the complaints stop there. Wakefield was accused of engaging in unduly invasive procedures in obtaining his material. Despite the list of complaints against the doctor’s conduct, many felt that Wakefield’s thesis itself remained untouched.

Advertising vaccine programs for the public has not always been the strong suit of many governments. In some instances, public suspicions have been justified. Fiascos such as the US National “Swine Flu” Influenza Immunization Program in 1976 yielded a series of telling side effects which eventually led to the scrapping of the program. As Dr Russell Alexander of the Public Health School at the University of Washington cautioned, “My general view is that you should be conservative about putting foreign material into the human body.”

The Wakefield study, taking root in such rich soil of suspicion, did much to hamper vaccination efforts. While numerous studies since 1998 have shown no firm link between autism and vaccines, the belief in many parents persists that it may well exist. Vaccination rates have fallen in Europe and United States, resulting in the resurgence of various infectious diseases.

The counter-argument has been made suggesting that Wakefield got a fairly raw deal: his opponents had refused to consider literature which did back his case. Convictions, Nietzsche suggests, are prisons that defy challenge.

The picture on Wakefield’s actual research remains unclear. There is little doubt that The Lancet, through its peer-review process, mishandled the matter. Warning signs were already present when 10 of the original 13 authors withdrew their names from the study. Nor did the editors seem to question the small sample size - a mere 12 children - used to formulate such groundbreaking conclusions.

Curiously enough, the journal did something similar with a 1998 paper by Scottish scientist Arpad Pusztai, whose study dealt with feeding potatoes, both genetically engineered and non-engineered, to laboratory rats. Pusztai’s own collaborators found his methods flawed. The experiment lacked “controls”; the number of animals in that case was regarded as insufficiently small. Even the diet of raw potatoes was questioned.

Instead of a constructive debate on contesting positions, political sides have been taken. Some see Wakefield as a saint martyred by the pro-vaccination movement and medical high priests trapped by dogma. David Kirby in the Huffington Post (February 2) put it fairly well: “I believe that the public lynching and shaming of Dr Wakefield is unwarranted and overwrought, and that history will ultimately judge who was right and who was wrong about proposing a possible association between vaccination and regressive autistic spectrum disorder (ASD).”

There is certainly more at stake than a crucifixion here. Autism rates are on the rise, though this may be due to the increasingly sophisticated (some might say laboured) systems of detection and ever expanding medical jargon. Nor is it entirely clear whether autism is entirely genetic. Vaccines will never be the sole causal factors - various environmental reasons may have to be considered.

The treatment dished out to Wakefield does also point to the troubles posed by smug orthodoxies that can take hold in the profession. A parallel has been made between the career of Ignaz Semmelweis, who argued for the link between birth-related deaths occasioned by puerperal fever and contagion. For that, he paid a similarly high price to that of Wakefield - academic shaming, ridicule and the loss of his job.

In the meantime, the destruction of Dr Wakefield’s medical career can only best be assessed at some later date. What we instead have here is a case of science morphing into the political and bungling at The Lancet. The march of medicine has always been littered by martyrs and quacks and it remains to be seen how much quackery there was in this entire episode.