It is not a shining moment for science or for law.
Indeed, the story reads more like a gripping thriller — one that the reader finally sets down by the side of the bed at 3 AM thinking that it was an exciting enough tale to forgo sleep even if it was totally unbelievable. Imagine the plot summary. A physician, receiving handsome payments from an attorney who wants to bring a class-action suit against a vaccine manufacturer, invents a fictional disorder and fabricates data to establish a fraudulent link with the vaccine. The stuff of Ian Fleming or John Le Carre.
In 1998, Andrew Wakefield and twelve other others published a paper in Lancet, a prestigious medical journal, implying a link between the measles, mumps, and rubella (“MMR”) vaccine and a new syndrome of autism and bowel disease. Many scientists were skeptical, pointing to any number of scientific weaknesses in what was reported. But large segments of the public relied on the paper when its findings were reported in the general press. Vaccination rates plummeted as parents determined that the risk of autism in their children was too great. The inoculation rate dropped most dramatically in Britain, from about 92% to below 80%, but many children in other parts of the world also failed to receive the MMR vaccine as a direct consequence of the Wakefield paper. From having been declared “under control” in the mid 1990’s in Britain, measles was declared “endemic” in Britain only ten years after publication. The U.S. Centers for Disease Control notes that more cases of measles were reported in the United States in 2008 than in any year since before publication, with more that 90% of those having not been vaccinated (or having a vaccination status that was unknown).
A series of articles being published in the British Medical Journal began last week, exposing a fraud surrounding the paper that author Brian Deer likens to the Piltdown Man scandal, an elaborate hoax that disrupted the natural course of paleontology research and that took decades to uncover. I briefly discussed Piltdown man some months ago here. Deer describes how Wakefield was retained by attorney Richard Barr two years before the paper was published, and paid more than £435,000, six times his annual salary as a physician. The children in the “study” that he conducted on MMR were targeted and preselected to have desired symptoms, he reinterpreted clinical records to suit his contrived syndrome, and “chiseled” histories to reach unsupported clinical diagnoses. While admonishing many who failed to exercise sufficient diligence — coauthors, fellow scientists, hospital managers, journal editors — Deer reports that the evidence shows it was Wakefield alone who perpetrated the scandal and that not even the attorney who paid him knew what he was doing.
When Deer first reported on irregularities surrounding the study in 2004, ten of Wakefield’s coauthors retracted the interpretation. In January 2010, a five-member tribunal of the British General Medical Council found dozens of allegations of misconduct proved, including four counts of dishonesty and twelve involving the abuse of developmentally challenged children. A copy of the results of the Fitness to Practise Hearing, which was the longest ever conducted by the Council, can be found here.
The consequences of the misconduct are truly staggering. Epidemiological studies were conducted at great public expense, unable to confirm any link between autism and the MMR vaccine. Research funds and personnel were diverted from more legitimate avenues to understand the actual causes of autism and to help those affected by it. Many children who might otherwise have been vaccinated suffered an illness that we have the technology to prevent and may be among the small number who died as a result of having contracted measles. At the moment, the effect on mumps contraction remains unclear because its peak prevalence is in older adolescents.
In its editorial, the British Medical Journal pulls no punches. It asks whether it is possible that Wakefield was wrong but not dishonest. After all, scientists are allowed to be wrong. Indeed, it is a strength of the scientific method that all honest ideas should be considered so that they can be scrutinized and dismissed if they are incorrect.
The answer it gives is a simple one: “No.”
Not a single one of the case studies was reported accurately. The pattern of the misreporting shows an intent to mislead. Already actions are being taken to examine Wakefield’s other publications, mindful of the experience that misconduct is rarely an isolated event.
When I write about various issues on this blog, one of the things that I am reminded of repeatedly are the similar ethical requirements that attorneys and scientists are expected to adhere to. Those ethical requirements exist because of the importance of the work that they do, and the trust that is necessarily placed in them by the public.
Attorneys suffer a great deal from distrust by the public, and I have always thought that that is one of the prices to be paid for the system. Attorneys deal with controversies between parties that have opposing interests and operate in a system that requires that the best arguments be put forward on behalf of their clients, most especially for those clients who seem unlikeable and potentially subject to victimization if the state or other opposing party is not held to the strictest standards of proof.
Scientists have generally enjoyed a more favorable reputation by the public, but misconduct of this scale has repercussions that extend far beyond even vaccines and autism. Such acts of misconduct erode public confidence in the legitimate conclusions of science, putting members of the public in a circumstance where they do not know who or what to believe. They are inconsistent with the openness that is the very bedrock of science, which seeks to communicate not only what we do know but also what we don’t. Because if people are to make decisions in their lives based on the results that science achieves, they deserve to know both.