Were I given free rein to repopulate Dante’s Inferno, there’s nobody I’d more gleefully plunk right into Malebolge than Andrew Wakefield, charlatan par excellence. He could while away eternity swapping stories with Ulysses and Diomedes as they all flickered together, the latter listening intently to Wakefield’s tale of starting the whole vaccine and autism controversy with his debunked and retracted MMR study.
The New York Times has a lengthy story about poor Dr. Wakefield, and it offers some glimpses into the worldview of people who still believe what he has to say. But let’s get something cleared up right away.
For Wakefield, the attacks have become a kind of affirmation. The more he must defend his research, the more important he seems to consider it — so important that powerful forces have conspired and aligned against him. He said he believes that “they” — public-health officials, pharmaceutical companies — pay bloggers to plant vicious comments about him on the Web. “Because it’s always the same,” he says. “Discredited doctor Andrew Wakefield, discredited doctor Andrew Wakefield.” He also “wouldn’t be surprised” if public-health officials were inflating the number of measles mortalities, just as he thinks they inflate the risks of the flu to increase uptake of that vaccine. Having been rejected by mainstream medicine, Wakefield, the son of well-regarded doctors in Britain, has apparently rejected the integrity of mainstream medicine in return. [emphasis added]
Not me, folks. This is coming to you gratis. I’m doing it for the love.
Neither Wakefield nor his acolytes come off particularly well in the article. Here’s how he responds to the reporter’s various questions:
… Wakefield spoke with the calmness of the self-certain, ready with a counterargument for every concern. How does he respond to the decline in vaccination rates that some attribute to his theory? If only officials had offered a single measles vaccine, he said, there would have been no uptick in unvaccinated children. (Immunologists argue that spacing out vaccines increases the likelihood that children will not receive all of the vaccines and that they could contract a serious illness during the interim.) Why was there no mention in his Lancet paper that initial pathology reports found little indication of bowel disease in the cases Wakefield wrote about? “You have incredibly limited space,” he told me in a subsequent conversation. As for the accusation that he received financing for the paper from lawyers intending to sue vaccine manufacturers, he insisted that the money was for a separate study. And why did the lawyer behind the litigation essentially say otherwise on tape? “He was confused,” Wakefield explained. His faith in his theory also remains intact, which he made clear when I asked him, in a separate interview, if he still believed M.M.R. caused the autism in the children in the Lancet paper. “Is that a serious question?” he said. “Yes, I do still think M.M.R. was causing it.”
It’s no surprise that he doesn’t care about waning vaccine rates, since keeping people healthy isn’t really his concern. I found the answer to the sticky question about the missing information in his paper particularly risible, as though he would gladly have included data that undermined his thesis if only there had been more space. (I’ve authored or co-authored a few articles, and never has space been a consideration when making edits.) It’s similarly amusing that Wakefield can’t dispute taking money from lawyers planning to sue vaccine manufacturers, and just expects people to believe that there was no conflict of interest because he says so.
But more fascinating to me than Wakefield’s attempts to keep his chicanery alive were the attitudes of his followers. Confronted with the presence of a reporter at a rally in Wakefield’s support, here’s one:
“Be nice to him,” she said, “or we will hurt you.”
If the response to scrutiny is a threat of violence, then the ideas in question clearly cannot stand on their own merits. Menace is not an argument.
Then there’s this, from one of Wakefield’s biggest boosters:
“To our community, Andrew Wakefield is Nelson Mandela and Jesus Christ rolled up into one,” says J. B. Handley, co-founder of Generation Rescue, a group that disputes vaccine safety. “He’s a symbol of how all of us feel.”
And that’s why I’m fighting a losing battle when I try to change anyone’s mind about vaccines and autism. It makes no more sense to listen to Andrew Wakefield’s opinions on vaccines than it does to ask Bernie Madoff to manage your investments, and yet people still cling to his theories. Why? Because they’re not interested in science, they’re interested in a savior. You can’t fight Jesus Christ with Jonas Salk.
But before I shake my head in bemusement, there is this to consider:
“I mean, I remember, Dr. Wakefield was there,” Guppy said, her voice starting to quaver. “And you know, it was just the validation. I don’t care if my son was overtreated or cured — just the validation that we as parents who knew something was wrong got an answer. Just the fact that someone listened and someone tried to do something — someone said, ‘Yeah, this is not just autism; your son has a real medical issue that we can treat.’ I think that validation is all that parents want — just that someone is taking the symptoms we report and looking at them to see what can we do about it.”
It’s not surprising that Wakefield paid attention to these parents. Con men always pay attention to their marks. But this woman doesn’t even seem all that concerned about whether Wakefield did any good for her son. She just wanted someone to listen to her, and I infer that the mainstream doctors she visited before she met Wakefield made her feel dismissed.
It can be frustrating taking care of patients with vague symptoms, particularly when they are chronic and hard to explain. Add in a devastating diagnosis like severe autism, which lacks a known cause and which makes it hard for patients to express how they feel, and it creates the perfect opportunity for misunderstanding and a break-down in the physician-patient relationship. Nevertheless, it is always our responsibility to do the very best we can, even when we don’t have answers time after time. It is genuinely very sad that this mother left her interactions with the legitimate medical community feeling unheard, and that she sought redress wherever it was offered. I am sorry that Wakefield has made his name by exploiting the anxieties and fears of a deeply vulnerable population, but I am more sad that those people didn’t get the help they needed from their doctors in the first place.
The whole antivaccination crowd is a pet peeve of mine. Ben Goldacre at Bad Science, Orac at Respectful Insolence, Phil Plait at Bad Astronomy, Liz Ditz at I Speak of Dreams, and the League’s own Dr. Dan at Bleakonomy have all written extensively about the antivax movement, if anyone’s looking for other writings.
A few considerations:
Since vaccination levels are well above those necessary to sustain herd immunity for all of the diseases for which we commonly vaccinate (Only making Wakefield a martyr would change that.), why such histrionics from the science and medicine hard core? There will always be a few radical theories and scattershot guesses orbiting at the far edge of the auxiliary belt. What makes Andrew Wakefield’s radicalism more deserving of professional mockery than, say, Linus Pauling’s outward-facing triple-helix or vitamin C fetish or Freeman Dyson’s views (on global warming)? Or does this all basically amount to burning a heretic?
There are and have been cures worse than the disease before: Guillain-Barre after the Fort Dix flu outbreak, psychosis in children receiving anti-virals after the most recent H1N1/09 epidemic, and personality changes from anti-ADHD meds come to mind, not to mention the uncertainty commanded by an inherent lack of longitudinal studies for new medications.
As the formalization of systems biology and ecological medicine is legitimizing, the human body and the environment on which it depended was once a complex and unpredictable system at peaceful equilibrium (when viewed on the scale of an average human lifespan).
As we continue to unplug from the natural world in favor of a system increasingly more and more of our own sophomoric creation, variables which we never even knew existed (such as chemical exposure levels and lifestyle changes) fly around uncontrollably. Vaccines and other medications make huge waves which may result in something desirable (immunity from smallpox) or undesirable (cancer) according to criteria which we may never understand or be able to fully articulate. But, chaos theory seems to fit the data on what we commonly refer to as “lifestyle diseases”.
On the other hand, I don’t know anyone with “rubella”. What’s that?
I’m playing devil’s advocate quite a bit here, but I tried to lay out a sophisticated conceptual framework under which not getting my children vaccinated is the rational choice.
Also, this may be a strange question, but I’m hoping you’ll humor me: does the mechanism of autism in the individual patient somehow recapitulate the historical epidemiology of autism at the population level?
I’m not quite sure I understand your last question, Christopher. Answering as best I can, I can only say that we don’t really know the mechanism of autism in individuals, which makes it such a frightening and confounding diagnosis.
I realize that you’re playing devil’s advocate. In fact, I’m not arguing that parental choice to avoid vaccinating their children isn’t to some degree rational. It is, of course, profoundly selfish, but it’s not entirely irrational.
Linus Pauling’s ideas about DNA and vitamin C were, as far as I can tell, harmless. I will admit ignorance of Freeman Dyson. Perhaps if I encountered some harmful legacy of these men in my professional life, over and over and over, I would be more exercised about them. We rail against the harms we see.
Threshold levels of vaccination are not a box that can be ticked off and forgotten. They require the constant renewal that comes from immunizing children and boosting immunity when it wanes. If the threshold isn’t met, then previously eradicated illness return. This has been demonstrated over and over and over and over.
Parents who opt not to vaccinate rely on other parents to expose their children to a risk they are unwilling to take for their own. They expect to enjoy the benefits of someone else’s risk. They are bad citizens.
I must admit I also don’t follow your comments about smallpox and cancer. The former is a disfiguring and deadly disease that has been wiped from the face of the earth, one of vaccination’s great success stories. As for the latter, vaccinations have made at least two forms of cancer (hepatic and cervical) less likely for thousands of children. The argument against them escapes me.
I don’t care to prosecute heretics. Wakefield isn’t a heretic. He’s a fraud, and a dangerous fraud whose ethical violations have contributed to a diminished state of health for innumerable children.