Legacy of lies
The fraudulent doctor who claimed the MMR vaccine caused autism lost his medical licence. But the effects of his deceit still linger in this post-truth era. David Aaronovitch reports.
The Sunday Times journalist Brian Deer did not come early to the disastrousMMRparty. By the time in late 2003 that he and his commissioning editor decided that those at the heart of the ‘‘controversy’’ over the effects of the combined vaccination needed investigation, the business had been rumbling on for half a decade.
Yet what Deer then managed to achieve through persistence, intelligence and attention to detailwas the effective closure of a chapter of fraud and systemic failure that, had he not taken up the issue, might well have cost tens of thousands of lives.
It’s a remarkable story and his is a remarkable book. More, whether the author knows it or not, it takes us beyondmedical and ethical issues, helping to explain the political and social predicament that now afflicts somany of us – the crisis in truth and its exploitation by people without scruple.
First, the barest bones of theMMRaffair. There has always been a rumbling antipathy towardsmass vaccination among some people. The idea of putting even the tiniest amount of a bad virus into healthy citizens has flustered folk since Edward Jenner’s pioneering days. The advent of statesponsored public health programmes created another dimension, lending a kind of rebel lustre to opponents of measures such as water fluoridation. In the late 1980s a health scare erupted when itwas found that cattlewere suffering from a brain disease, BSE, that might have consequences for human health. In the 1990s the first victims of the human variant began to die. It was widely perceived that the UK government and the food and farming industries had been in denial about the disaster that seemed to be unfolding.
As this was going on a young ambitious gastroenterologist called Andrew Wakefield was searching for an explanation for the onset of Crohn’s disease. He thought that he had discovered the measles virus in the gut of sufferers and constructed a theory about how the virus might lead to inflammation and then to the fully fledged disease. This theory coincided with a public campaign by awoman called Jackie Fletcher, who blamed her son’s brain condition on his having been given the jab for measles, mumps and rubella.
As far as the public were concerned these two strands came together in sensational fashion in February 1998 when Wakefield and several others held a press conference at the Royal Free Hospital in north London. Basing his conclusions on a study of 12 children undertaken at the hospital in 1996-97, Wakefield suggested that theMMR vaccinewas linked to the onset of autism in young children. He recommended that parents ask for the triple vaccination to be replaced by three separate jabs. Although the hospital and some of his colleagues demurred from this conclusion, the claim of theMMR-autism link was the mainmedia takeaway from the conference and the paper published in themedical journal The Lancet two days later.
From the beginning the public health authorities denied that there was indeed good evidence of a link. And almost from the beginning it was clear to
anyone who bothered to look at the epidemiological studies that there wasn’t even a correlation betweenMMRuse and the incidence of autism, let alone proof of cause.
For too long this seemed to make no difference. At best it led to the deadly public health situationwhere citizens were being invited by even the most reputable media to choose between two scientists – usually Andrew Wakefield and AN Other – as towho was right about MMR. Awhole generation of newspaper columnists and TV presenters, most scientifically illiterate, declared themselves leaning towards theWakefield thesis. WhenWakefield ran into problems at the Royal Free [Hospital] because of his continuous breaches of protocol and failure to replicate his research and was, in effect, sacked at the end of 2001, this became merely evidence that the medical establishment was out to get him. At which point he left Britain and went to America.
By late 2003 uptake of the vaccination was trending downwards. Channel 5 screened a drama called Hear the Silence in which a noble, persecutedWakefieldwas played by Hugh Bonneville. Itwas a piece of the purest propaganda.
Measles was making a deadly return through sheer stupidity. But as it happens Deer saw the film at a screening at (I think) the ICA in London. Speaking afterwards was one of the parents of a child who had been involved in Wakefield’s study. Deer took a note of the name, set up ameeting and set in train a series of discoveries that would show Wakefield not just to have been mistaken, but also to have been the biggest medical fraud of our generation.
By February 2004, Deer could show that Wakefield’s MMR-autism link was a preplanned conclusion from which Wakefield had already benefited financially. Undisclosed by him to most of his colleagues, to the hospital or to The Lancet, two years before publication of the article, Wakefield had accepted a deal to work for a lawyer to establish a legal case against MMR. Deer also established that several of the children, far from having been referred by their GPs, were potential litigants. As if that wasn’t enough, it turned out that in 1997Wakefield had patented his own single measles vaccine alternative to MMR.
Wakefield threatened and then sued. Then withdrew, leaving behind him new troves of legally acquired documents for Deer to examine. In February 2009, Deer’s work appeared on The Sunday Times’ front page again. By dint of clever and thorough detective work, Deer could show that large parts of the study were fraudulent. Essentially the results had been cooked.
In May 2010, nearly three years after it had begun investigating Wakefield and some of his colleagues, and relying to a large extent on Deer’s work, the General Medical Council ordered that Wakefield be ‘‘erased from the medical register’’. Seven months later the carried a 19-page, 24,000-word article on the Wakefield affair written by Deer. It had taken half a year to write and to check.
Towards the end of the process, Deer recalls, the journal’s editor said to him of the piece: ‘‘It’s fraud, you need to say that clearly.’’ To which Deer (who had already done this in The Sunday Times) replied: ‘‘Well, if you think that, it’s you who should say it.’’
This moment encapsulated a feeling of anger that had been rising in me as the story unfolded. I knew that the journalistic trade had, with some big exceptions, done its readers little service during theMMRscare. I also realised that the judiciary, relying on solid evidence, had behaved significantly better, in the UK and in the US.
Yetwhat should amaze the reader of Deer’s book is the weakness, venality, vanity and slowness to action of the medical establishment and its publications and institutions in the face of a rogue doctor. Most of the things that Deer did should have been done by the profession. Had he not so assiduously turned over every one of Wakefield’s stones, the man would probably still be licensed to practise.
So victory, then? Since Deer closed the Wakefield case, anti-vaxxing has become a cause for populists of right and left. In recent demonstrations against the lockdown in various countries, a component of the grievances expressed is always antivaccination. Towards the end of his book, reflecting on how the utterly mendacious American documentary film Vaxxed had drawn crowds for its anti-MMRmessage, Deer writes: ‘‘In that year of rebellion – 2016 – when the United States was stunned by Donald Trump’s defeat of Hillary Clinton, and Britain narrowly voted to leave the European Union, here were campaigners who grasped the paradox of the age; that the more incredible and outlandish their claims, the more these might spread and be believed.’’
In 2001, Wakefieldwent to America, became a celebrity on themedical-woo campaigning circuit, made a lot of money from anti-MMR videos and appearances, wowed congressmen and film stars, shacked up with a supermodel and pitched up on inauguration night in January 2017 at Trump’s big party. Many times when there have been measles outbreaks around the world (and there have been an increasing number) it’s likely that some lucrative interventions from Wakefield will have preceded a fall in vaccination rates. He continues, in effect, to kill people with his lies and it seems no law can stop him. He is, in short, aman of our times.