Pathological Optimist poster

Quacks have discovered that a couple of the most effective tools out there to influence opinion are videos and documentaries. Videos, of course, can be made on the cheap and posted to YouTube, then later sold, either online or in DVD form. An excellent example of one such quack video series is Ty Bollinger’s The Truth About Cancer. Of course, videos like this do not have the cachet of actual documentaries, and there has been a cornucopia of these promoting quackery too. I’ve written about several of them, such as The Beautiful Truth (promoting Gerson cancer quackery), Burzynski The Movie: Cancer Is Serious Business and its sequel Burzynski: Cancer Is A Serious Business, Part 2 (both promoting Stanislaw Burzynski’s antineoplaston cancer quackery), The Greater Good (promoting antivaccine quackery), Simply Raw: Reversing Diabetes in 30 Days (overblown claims for vegan diets), and, of course, VAXXED: From Cover-up to Catastrophe (more antivaccine quackery, this time from Andrew Wakefield himself). Of course VAXXED made a lot of news last year because Robert De Niro bypassed the normal judging process to show it in the Tribeca Film Festival, of which he is a co-founder. When the film list for the festival was released, the uproar, both from the press and filmmakers, was so intense that De Niro was forced to pull the movie from his festival. At least we learned that De Niro is antivaccine.

Speaking of VAXXED and Andrew Wakefield, what happens when a legitimate, generally respected filmmaker takes on a topic related to the antivaccine-movement? It’s something I’ve never dealt with before, but now I have the opportunity to do so. Such a film is a different kettle of fish entirely from the sort of propaganda films listed above. In the case of those films we know the filmmaker is not only biased but making the film to promote the quack or quackery featured. In contrast, when a legitimate filmmaker with a decent track record decides to take on a topic like Andrew Wakefield, we don’t know that and hope for a compelling, accurate documentary. In this case, I’m referring to the recently released movie The Pathological Optimist, which is portrayed as a “balanced” portrait of Andrew Wakefield, who basically inspired modern iteration of the antivaccine movement through his fraudulent science linking vaccines to autism in the late 1990s.

Here’s the trailer:

Here’s how the film’s website describes the film:

Who is the man behind the most highly controversial, intensely debated topics in modern medicine? In THE PATHOLOGICAL OPTIMIST, director Miranda Bailey brings us a character study of Dr. Andrew Wakefield, one of 13 co-authors of a notorious 1998 paper in the UK medical Journal The Lancet, but who became the very public face of what has come to be known as “The Anti-Vax Movement.” An expat from Britain who currently resides in Austin, Texas, Wakefield allowed Bailey and her team to follow him and his family for five years beginning in 2011 as he fought a defamation battle in the courts against the British Medical Journal and journalist Brian Deer. The results of that case – and the self-reflection, pronouncements, and observations of Wakefield, his legal team, wife, and his children – create a complex and incisive look at one of our era’s most fear-provoking and continuously provocative figures. THE PATHOLOGICAL OPTIMIST takes no sides, instead letting Wakefield and the battles he fought speak for themselves.

The “take no sides” claim sends up huge red flags for me. My retort to this is that, when it comes to pseudoscience, “not taking a side” is taking a side, the side of giving that pseudoscience far more believability and stature than it deserves. It’s also utter nonsense to claim that “letting Wakefield and the battles he fought speak for themselves.” If there’s one misconception about documentaries, it’s that they are (or should be) objective. They’re not. A documentary filmmaker has a story to tell, and that story is very much colored by how she chooses to frame it, what she decides to show (and, equally importantly, not to show), what order scenes are shown in, who is interviewed and who isn’t, and even the music and narration used. Bailey’s film no more “lets Wakefield and the battles he fought” speak for themselves than Wakefield’s VAXXED is an objective portrait of a CDC “conspiracy.” It is how Miranda Bailey chose to tell Wakefield’s story. Indeed, it’s hard not to note that the only people directly interviewed for the film are Andrew Wakefield, his family, and his supporters. All criticism of Wakefield comes in the form of grainy archival footage from TV news interviews, which Wakefield or one of his supporters gets to answer.

How do I know this? I’ve seen the movie. If there’s one thing that strikes me most about it is that it taught me that bias in a film is at least as evident, if not more so, in what the director chooses not to show and tell than in what she does show and tell. Overall, The Pathological Optimist is basically Wakefield’s side of the story, with occasional archival footage of Brian Deer, Paul Offit, Bill Gates, The Lancet editor Richard Horton, and a few others from TV appearances attacking Wakefield, but not enough to demonstrate that Wakefield is, as is his wont, laying down heaping helpings of misinformation designed to present him as the Brave Maverick Doctor persecuted by The Man for telling an “inconvenient truth.” The end result is that Bailey leaves out a lot of context and Wakefield ends up coming off far more favorably than unfavorably, his key claims mostly unrefuted. That’s because, if you don’t know the context behind many of Wakefield’s claims, you’ll tend to take what he says and how Bailey presents the events portrayed in the film at face value. If you don’t know who several of the Wakefield supporters interviewed are and what they do, you’ll take their claims at face value as well.

Wakefield the man, as portrayed in the film

The Pathological Optimist begins with rather fawning shots of Wakefield heading out to do yoga, with a voiceover in which Wakefield points out that a charge of scientific fraud is a death sentence to a scientist’s career (usually true) and claiming that the media in the UK didn’t pay much attention to Brian Deer’s BMJ report that Wakefield had committed scientific fraud was largely ignored in the UK but hyped in the US. I can’t personally speak to the veracity of this claim, given that I live in the US, but I can say that I do remember quite a few news articles coming out of the UK about the article at the time and that readers who do live in the UK tell me that this claim is a load of fetid dingo’s kidneys. As Wakefield does yoga, archival news footage of Dr. Paul Offit and Bill Gates criticizing Wakefield’s fraud is shown. Cue the credits while Andy does yoga, followed by an interview with him as he drives home. Next comes the introduction of Wakefield’s frivolous libel lawsuit through Wakefield looking over one of his filings. Thus is the tone of the movie set, as the movie is framed around Wakefield’s libel suit against Brian Deer and The British Medical Journal (BMJ) in Texas, which—spoiler!— ignominiously never got off the ground when a Texas appeals court ruled it didn’t have jurisdiction. It’s a rather weak frame, given that relatively little screen time is devoted to it compared to multiple other aspects of Wakefield’s history. Of course, it was a weak case, too, far more a vehicle for Wakefield to raise money than having any real chance to succeed.

Those who have been following Wakefield’s career will, if they see this movie, likely feel a rising tide of bile welling up in the back of their throats as they watch. There are lots of shots of Wakefield and his family clearly designed to portray him as a devoted family man. One near the beginning of the film shows him making breakfast for his teenaged children before school and standing in the door with a cup of coffee wistfully watching them leave. There’s another scene of him sitting in the stands watching his son at rugby practice after having driven him there. Elsewhere, Wakefield speculates that the worst disadvantage that his children have is having him as a father. (I probably have to grant him that.) Late in the film, we learn from a scene of his wife Carmel O’Donovan walking through the grounds of the Wakefield estate with her daughter that Wakefield likes to take out his frustrations by chopping wood. Indeed, the last scenes of the film feature Wakefield in a tank top chopping underbrush and wood, interspersed with news reports about the backlash over VAXXED being accepted into the Tribeca Film Festival. The film closes with a shot of Wakefield surveying the enormous pile of chopped branches that he had created over the years. I suppose there’s a metaphor in there somewhere.

Money is a theme that surfaces repeatedly in the film. Wakefield and his wife frequently lament about not having any money because the “persecution” has made him unemployable. Yet they’re repeatedly shown living in a rather impressively large and beautiful house with extensive land surrounding it. True, there is one scene where Carmel tells her youngest daughter about Andrew’s and her plans to sell the house and move into smaller digs after she leaves for college. She notes that only two of the Wakefield children still live there and explains that her parents did the same thing when she left for university. Not surprisingly, we’re never informed whether the Wakefields ever actually did sell their house. As far as I know, they’re still living there. So where does Wakefield’s money come from? Who knows? I’ve often wondered that. In the film, we see him in several scenes fundraising for his legal fund, but where the income that keeps him and his family in that large house comes from, we never learn. We are, however, treated to multiple shots throughout the film of Wakefield’s adoring fans fawning over him. One can almost understand why near the end of the film Wakefield compares himself to Nelson Mandela in his belief that he will be vindicated.

Speaking of Wakefield’s wife, Carmel is featured in several scenes. In one, she talks about how difficult it was for her to raise four children alone in the UK for four years after Wakefield had moved to Austin to run the “wholistic autism clinic” Thoughtful House. She relates an anecdote about how jet lag totally wipes Wakefield out. Basically, after being a single mother for so long, she looked forward to her husband coming home to England so that he could watch the kids a while, only on his arrival to find him nearly nonfunctional due to jet lag. In another segment, she is shown childishly mocking the judge overseeing Wakefield’s libel suit, Amy Clark Meacham, as flipping her hair like a teenaged girl. Later Carmel attacks Meacham as biased because her husband is a lobbyist for the pharmaceutical company. In still another scene, she refuses to say anything about Wakefield’s leaving Thoughtful House after he was struck off by the GMC and his Lancet paper retracted, citing a nondisclosure agreement. (Wakefield was almost certainly fired after his being struck off and having his paper retracted made him someone that not even a quack clinic like Thoughtful House wanted to be associated with.)

At least a two of the scenes are so obviously staged to make Wakefield appear sympathetic that the only reaction from someone who is familiar with Wakefield’s history is an intense desire to barf. For instance, early in the film, Wakefield is shown driving his son to rugby practice and asking him if he thinks his dad’s a “bad guy.” What on earth is a teenaged boy supposed to say in response to a question like that from his father, particularly while on camera? Of course, he says he doesn’t think his dad is a bad guy. He also responds that he doesn’t believe the bad things he hears about his father but does believe the good things. Later in the film, we see a conversation between Wakefield and his mother in which she tells him that all his father, who was apparently too ill when the interview was filmed to travel to Texas, has ever wanted was for his son to be vindicated and exonerated before he dies and how his father had had a very difficult time with all the negative press coverage of Wakefield. We also learn that Wakefield never really explained to his parents why he left the Royal Free Hospital, and we’re treated to an emotional scene of Wakefield apologizing to his mother for that lapse.

In fairness, there is at least one segment where Wakefield doesn’t come off well at all. It is the part of the film describing the infamous birthday party incident. Those familiar with Wakefield’s history will recall that at his son James’ 10th birthday party, Wakefield decided it would be a good time to get some blood samples for normal controls for a study, offering the children £5 each to let a nurse draw their blood. Of course, such a practice is highly unethical; yet Wakefield, his wife, and his son James are all shown defending it. James claims it was fun and that the children were fighting to be first in line to get their blood drawn. Wakefield claims multiple times that what he did was ethical, even while admitting that he didn’t have the approval of an ethics board to do what he did. A video of him joking about it is then shown. This is a video that can be found on Brian Deer’s website, but it was also widely broadcast in the UK at the time it surfaced. (The film implies that Deer was the only source publicizing the video.) In it Wakefield jokes that two children passed out and one threw up all over his mother. Worse, the audience laughed. He also then contended that this is a market economy and that the kids would be asking for £10 next year. James and Carmel both claim that Wakefield was wrong, that nothing like that happened at the party, and basically excused it all as a misguided attempt at humor. I also can’t help but note that Wakefield said more than that at his talk and that it was actually far worse than what Bailey portrays.

Even so, despite that segment, The Pathological Optimist paints a portrait of Wakefield that is far more positive than not. Sure, you do get the feeling that he’s obsessed with conspiracy theories, mainly because he frequently claims that big pharma, the British medical establishment, and the US press are out to get him. Yes, we do see the birthday party incident, albeit with excuses from his son and wife. But the rest shows a devoted father, a persistent scientist adored by mothers of children with autism and other health issues, and someone willing to suffer rather than admit he was wrong. All the while Bailey basically lets him tell his side of the story (mostly) unanswered.

Which brings us to the next section.

A misleading portrait by omission

I started out this post by mentioning how the bias in a documentary can often be detected by what is omitted more than by what is shown. However, to know what is omitted requires a knowledge of the subject of the film, which is why omission is such a powerful technique. After all, it’s safe to say that relatively few people know a lot about Wakefield’s history, which means that they won’t know the context that was omitted in so many places in the film. There are so many examples, that it’s hard to decide what to include, lest this post balloon to a length even longer than my usual logorrhea. A few examples do stick out, however.

Early in the film, Wakefield claims that his now-retracted 1998 Lancet case series has been “scrutinized unlike any article in the history of science,” which may or may not be true. (I vote for not true, but hyperbole can be allowed.) Then we see his legal team pulling a play straight from the Wakefield playbook and pointing to a single sentence in the paper:

We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described.

Yes, it’s true. The paper itself did say that. However, after you’ve been in the science biz a while, you come to recognize statements that are almost certainly there not because the author wants them to be there but because the reviewers of the manuscript forced the author to include them in the revised manuscript if they wanted their paper published. The above passage strikes this surgical scientist as being just one of those statements demanded by reviewers. One reason is that it sticks out like a sore thumb from the rest of the discussion; it caught my attention when I read it because it didn’t jibe with the rest. Moreover, Table 2 in the paper explicitly tries to link MMR vaccination to subsequent autistic regression and bowel symptoms. What the paper is trying to show is very clear, that one disclaimer notwithstanding, and those who know how to read scientific and medical journal articles can recognize that. Reinforcing that impression is what Wakefield writes later in the manuscript:

If there is a causal link between measles, mumps, and rubella vaccine and this syndrome, a rising incidence might be anticipated after the introduction of this vaccine in the UK in 1988.

And

We have identified a chronic enterocolitis in children that may be related to neuropsychiatric dysfunction. In most cases, onset of symptoms was after measles, mumps, and rubella immunisation. Further investigations are needed to examine this syndrome and its possible relation to this vaccine.

Now, it is true that later Wakefield is briefly shown in an interview from what looks like the 20 minute video the Royal Free Hospital released around the time the Lancet paper was published, but it is not until much later in the film. What is shown right after Wakefield’s lawyer honing in on that one sentence is Wakefield giving talks to antivaccine groups about how the MMR vaccine causes autism. In any case, the context was not provided immediately, and it should have been. Anyone who’s followed Wakefield knows that that video was a doozy, with Wakefield making a number of claims about how he thought a link between MMR and autism needed to be urgently investigated. Parents got the message Wakefield was laying down then. He implied it in the paper, but he said it explicitly in many appearances after the paper was published. Wakefield was telling British parents that the MMR could cause autism. Oh, sure, he qualified it with enough weasel words to appear cautious, but basically recommended that parents get single vaccines, rather than the trivalent vaccine (MMR), because the MMR was somehow not as safe, because he thought that it could autistic regression. It’s all there, and it’s all clear. It worked, too, aided and abetted by the sensation-mongering credulous British press.

Elsewhere in the film, Wakefield takes issue with Brian Deer’s claim that he had a patent for a competing measles vaccine, as reported by Brian Deer. And indeed he did file such a patent. Deer has a copy on his website. The patent is for a “combined vaccine/therapeutic agent” that is safer and can treat inflammatory bowel disease as well. In that patent, he also states that he has “found that regressive behavioural disorder (RBD) is associated with measles, mumps, and rubella (MMR) vaccination.” In any case, in the film, Wakefield makes a massive straw man of what Deer reported, claiming that his MMR-autism claims were all a scam intended to discredit the MMR so that he could bring his own single measles vaccine to market and thereby bring down the pharmaceutical companies. Of course Deer’s claims were more modest and nuanced. For instance, we know Wakefield was paid by a lawyer to undertake research to link MMR to autism. So there’s one motivation. We also know that he did indeed have a patent for his own MMR vaccine, which by no coincidence claimed that this new vaccine could also to treat inflammatory bowel disease.

Wakefield then goes on to cite how he was going to use something called transfer factor in his new vaccine to “boost immunity.” Sounds benign, right? Yet somehow Bailey neglected to point out another very important aspect of Deer’s reporting on this patent. Basically, transfer factor is pure quackery thought up by Hugh Fudenberg. For those of you who haven’t heard of him before, the late Hugh Fudenberg was a collaborator and co-inventor with Andrew Wakefield. Dr. Fudenberg also happens to have been involved in some very dubious “treatments” for autism that led to some problems with his medical license. In November 1995, the South Carolina Medical Board concluded that Fudenberg was “guilty of engaging in dishonorable, unethical, or unprofessional conduct,” and he was fined $10,000 and ordered to surrender his license to prescribe controlled substances (narcotic drugs). His medical license was also placed on suspension. In March 1996, he was permitted to resume practice under terms of probation that did not permit him to prescribe any drugs. His medical license expired in January 2004; and in March 2004, he applied to have it reinstated. However, after a hearing in which the Board considered a neuropsychatric report issued in 2003, Fudenberg agreed to remain in a “retired” status and withdrew his application for reactivation of his license.

Later, Dr. Fudenberg ran a nonprofit “research” organization called Neuro Immunotherapeutics Research Foundation that sold dubious remedies for autism. He also charged $750 per hour for “review of past medical records,” $750 per hour for “determining what new tests need to be ordered; ordering of new tests; evaluation of new tests,” and $750 per hour for “determining which therapy will work and which will not; discussing this with patient along with an in-depth study of past medical history to determine what makes a patient better or worse.” If you look at Fudenberg’s PubMed publication list, you’ll find that there is nothing after around 1989 other than review articles, speculative articles in Medical Hypotheses, plus a fair number of publications on his “transfer factor” in low impact journals such as Biotherapy. Looking at the list, a knowledgeable person can tell right about when Dr. Fudenberg started to descend into fringe medicine, sometime between 1985 and 1989.

In any case, the specific dubious autism treatment with which Dr. Fudenberg was involved is the use of something called “transfer factor” to make a combined measles vaccine and autism “cure.” The method of making these so-called “transfer factors” is bizarre in the extreme and involves injecting mice with measles, extracting and processing white blood cells, injecting the result into pregnant goats, milking the goats after kid-birth and turning the product into capsules for autistic children. In a patent application (based in part on the infamous Lancet paper) obtained by Brian Deer, Wakefield represented a vaccine/therapy for “MMR-based” autism using transfer factor as potentially a “complete cure” for autism or for “alleviation of symptoms.”

Oh, and Fudenberg liked to claim that the flu vaccine causes Alzheimer’s disease.

Another closely-related example of misinformation by omission involves how the film treats the case of John Walker-Smith, who was a co-investigator with Wakefield in his 1998 Lancet paper. Prof. Walker-Smith was also struck off the British medical register (lost his medical license) along with Wakefield for, like Wakefield, research fraud. Unlike Wakefield, Walker-Smith appealed. More than that, he actually won his appeal and was reinstated. Bailey lets Wakefield portray the fact that Walker-Smith was exonerated by the British General Medical Council as a slam dunk reason that he should be exonerated too. It wasn’t. Basically, Walker-Smith prevailed because he convinced the Council that he didn’t believe he was doing research, but rather routine clinical care of the children in the Lancet case series. In actuality, the ruling was rather contradictory in that the ruling acknowledged that what Walker-Smith did could be reasonably viewed as research, but exonerated him because it could also be viewed as therapeutic:

The panel made no express finding on this issue and cannot have appreciated the need to do so. It was not helped by the premise upon which the GMC’s case was founded. There was a good deal of evidence, to which I refer in greater detail below, that Professor Walker-Smith and his team were undertaking what any reasonable body of medical practitioners would categorize as research – but also that he intended and genuinely believed that what he was doing was solely or primarily for the clinical benefit of the children. When such an issue arises, a panel will almost always have to determine the honesty or otherwise of the practitioner.

In other words, the ruling, as muddled and demonstrating a poor grasp of medical ethics, says nothing about Wakefield, nor does it exonerate him. After all, Wakefield clearly knew he was doing research. Yet Bailey makes a big deal of how Walker-Smith’s exoneration was “underreported.”

It’s also mentioned in the film that the Vaccine Court “admitted” in a case that vaccines cause autism. I wasn’t sure what case was being referred to in the film, but fortunately she tells us in an interview:

It seemed like every 6 months or so something big was going to come out and turn Andy’s life around. Some story would finally show the world that they were wrong to take away Andy’s license. For example while we were filming him a child named Hannah Poling and her family were awarded over a million dollars for vaccine induced autisim [sic] in a US court. This was a big deal in the Wakefield supporter communities because the media was shouting at them that vaccines don’t cause autism and that anyone who thinks or says they do is a quack. Yet our own US government admitted it in this case. Andy and the people around him thought this would be big news and change the media’s opinion about them. . . but nothing happened. It was crickets.

That’s because the Vaccine Court did not “admit” that vaccines cause autism in the Hannah Poling case. I note that in the same interview Bailey says that she’s “not saying that because Walker Smith was exonerated that Wakefield should have been, but surely it is big news completely blacked out in the same US media that so fervently reported on Andrew’s fraud in the BMJ in 2011 and continues to do so to this day.” Note the disingenuous comparison. Somehow, I don’t believe her disclaimer that she doesn’t think that Walker-Smith’s exoneration means that Wakefield should have been exonerated too, and only someone sympathetic to Wakefield would think that Walker-Smith’s exoneration should be big news on par with Brian Deer’s reports of Wakefield’s fraud.

Of course, I can’t help but note that in her film’s portrayal of how VAXXED was accepted and then eliminated from the Tribeca Film Festival last year, Bailey neglects to mention that Robert De Niro bypassed the usual selection committees and abused his position as founder of the festival to include VAXXED in his festival. Instead, she portrays the uproar and De Niro’s subsequent decision to cut VAXXED from the Tribeca Film Festival as yet more of the seemingly irrational persecution of Wakefield.

Bias is as bias does

Clearly, The Pathological Optimist has a point of view, and that point of view is obviously sympathetic to Andrew Wakefield. A particularly telling example was reported in Jezebel in an article by Ellie Shechet entitled “How Not to Make a Documentary About Vaccines.” If there is a subtle framing in the film that lets you know whose side the filmmaker is on, it’s Bailey’s treatment of Brian Deer, who is frequently portrayed as the antagonist and at one point shown being jeered down by Wakefield supporters as he tries to comment on Wakefield’s losing his medical license.

Shechet first notes that the only people who speak directly to the camera in Bailey’s movie are Wakefield and his family: Wakefield, his wife, his children, his brother, two of his lawyers, a few fans at his book signings, and a supporter of Wakefield’s who believes her son became autistic immediately after receiving the MMR vaccine. I also can’t help but notice that that mother is Jennifer Larson. What we are not told about her is that she is a wealthy woman who’s become an influential antivaccine activist and political donor who has used her money to try to influence Congress to hold hearings on vaccines and autism. In the film, she’s portrayed as nothing more than a mother who believes that vaccines caused her son’s autism, and Wakefield is portrayed as the kindly champion who admires the boy’s art. All of this was in the context of a segment showing how antivaccine protestors rallied near the University of Wisconsin when Brian Deer was invited to speak to the journalism school there in 2012. Antivaxers demanded that Wakefield be allowed to appear to rebut Deer’s charges and lamented that there was “no debate.” Wakefield, ever the publicity hound, obligingly showed up for the spectacle. In The Pathological Optimist, this incident is framed entirely as a fear on Deer’s and UW’s part of a “debate.”

In any case, at the end of the film shortly before the credits, we see this:

This is the third to last text screen before the credits roll. What follows it are a text screen bragging how VAXXED has grossed $1 million and how Wakefield remains optimistic that he will be vindicated.

This is the third to last text screen before the credits roll. What follows it are a text screen bragging how VAXXED has grossed $1 million and how Wakefield remains optimistic that he will be vindicated.

It turns out that that Wisconsin incident was very important, because that’s the pretext that Bailey’s team used to reach out to Deer, who notes that in September 2012 he got an email from Gabriel Geer asking if he’d be willing to be interviewed while he was in Wisconsin. Deer responded:

So, forearmed against the unethical, in September 2012, I responded to the email from Geer. “Forgive me for being somewhat cautious,” I wrote, “but I have seen what has happened in the field of Aids denialism, where people have cooperated in good faith with documentary makers only to find themselves presented in unexpected and unfair contexts.”

I alluded to the Golding scam, and added: “In the UK, where I’ve made films, we normally tell participants things like the names of the producers, the drift of the project and the context within which the participant might feature. So I would really need a better idea of what you had in mind.”

I can think of other examples, too, such as Richard Dawkins being misled about the nature of the anti-evolution film Expelled! when interviewed and Paul Offit (as well as other pro-vaccine doctors and scientists) being misled on the nature of the antivaccine film The Greater Good (which Miranda Bailey loved, by the way, citing a glowing review by über-quack Joe Mercola).

Deer exchanged e-mails, during which Bailey’s team described the genesis of the project and how it was to be about the “MMR controversies.” Deer then discovered:

What I didn’t know then, but I do know now, is that whoever wrote that email was lying. They weren’t making a film “about the MMR controversies”. For the previous 19 months, they had been working with Wakefield, filming with him in staged and choreographed sequences, as he pursued a vexatious and hopeless gagging lawsuit against me and the British Medical Journal.

And:

I’m not just featured in “The Pathological Optimist”. The structure of the film is essentially a series of replies to video snips featuring me. A few-second clip from CNN, for example, will be screened to begin a false account from Wakefield, melding lengthy public relations sequences (including dogs, children, and breakfast tables) with sly interviews in which Bailey and her people feed him opportunities to fool the audience.

It’s a glorification of the former doctor, and a highly motivated, personal attack on one individual: me.

I’m not quite sure the attack was that personal, but Deer’s quite correct that the structure of the film was basically a series of answers by Andrew Wakefield to charges made by Deer in his well-documented reporting, all with no evidence other than that Wakefield said it. It’s not just Deer, though. A certain friend of the blog features in the film as well. At around a third of the way through the film, Wakefield is seen perusing posts about him, and this 2012 post is shown. As Wakefield peruses it, he says:

I’m looking at bullshit from a guy who calls himself Orac who doesn’t have the cojones [note: mispronounced] to put his name to his website. Every other word is garbage. It’s just wrong. It’s offensive to me to actually be on this website; so if you don’t mind I’m going to get off it.

Trust me. Orac’s life is now complete. It is unlikely that he will have a more satisfying experience in blogging than knowing that he pissed off Andrew Wakefield. I know. Also, given that Orac’s real identity is about the worst kept secret on the Internet (and was in 2012) Wakefield and/or Bailey almost certainly intentionally declined to mention it so that they could disingenuously use the “anonymous cowardly attacker” gambit against Orac. In any event, right after this, Wakefield makes fun of Seth Mnookin’s appearance as he clicks on a link to an article by the Good Thinking Society announcing that Wakefield had beat out Prince Charles for the Golden Duck Lifetime Achievement Award for his contribution to quackery. Ultimately, he dismisses his critics by saying:

It’s fascinating what people waste their time doing when they’ve really got nothing to contribute to society whatsoever.

Obviously, I don’t in any way mean to say that this little swipe against Orac and the Good Thinking Society is in any way as relentless or bad as the pointed attempts to refute and cast aspersions on Brian Deer throughout the movie. I mention it mainly because the movie does at times get just this petty. (Also, because Orac loves it that something he wrote irritated Wakefield this much.)

Finally, to bring it all back around to my original point in closing, remember how I said that a film’s bias can be identified at least as much by what it decides not to show as by what it does show? Shechet zeroes right in on this. Noting that when she asked Bailey “if they’d reached out to anyone else who could provide a counter-argument to various things Wakefield and others say throughout the film,” Bailey responded that the style of documentary she was aiming for was cinéma vérité, which would make such counterarguments difficult to weave in:

“Once the style of the film found itself, which was not the style of, you know, a news show—once it was clear that it was a character study about this figure in history, then it felt like, when you’d have those things, they weren’t attached to the character study and it seemed like a messy concept,” Bailey told me.

“I’m not a newsperson, I’m not there to show a balanced—I’m not Fox News, I don’t need to do interviews. Interviews are boring, also.”

If interviews are so “boring, why did Bailey include so many of them with Wakefield, his family, and his ardent supporters? Inquiring minds want to know.

It gets worse, though. Here’s more of Bailey justifying her style:

I gather that your question to me is really wanting me to answer why I didn’t show interviews of other people who can tell me that Wakefield is a fraud, and a charlatan etc. Well, that information is already out there. It’s in every piece of news we read about him. If you are familiar with the story you already know all of that. I wanted to show you what you haven’t seen which is inside his life living with these charges.

This is, of course, complete and utter nonsense. Shechet drolly counters that the “expectation that a viewer would come to the documentary with extensive foreknowledge isn’t really a fair one, or one likely to result in clarity.” No kidding.

She also nails it again:

You can refute some of his statements, and question him about his discrepancies, and show news footage of Anderson Cooper reaming him on CNN, but the decision to physically focus this documentary entirely within Andrew Wakefield’s perspective, giving him and his family an opportunity to repaint himself as wronged and his research as ethical when there is quite a lot of evidence to the contrary, is an odd one, given the stakes of the subject matter.

Remember what I said about omission, folks. Miranda Bailey is either lying or deluding herself when she asserts that The Pathological Optimist “takes no sides.” Of course it does, and the side it takes is unequivocally Wakefield’s. It couldn’t be otherwise. Does anyone really think that Wakefield would have given Bailey—or any filmmaker—such close access to him and his family for five years if he had any doubts whatsoever that the result would be anything other than a film that allows him unfettered opportunity to argue his position more or less unrefuted and paints him as the brave doctor only in it “for the children”? Of course he wouldn’t. If you look at the film’s website, you’ll see that he’s even appearing with Bailey for Q&A sessions after some screenings:

Indeed, in the closing credits, Bailey makes it clear just how much she identifies with Wakefield. Partway through the credits, there is text stating that the “director of this documentary received an e-mail from her lawyer asking her to call him.” After this, as the rest of the credits continue to roll, we hear a recorded phone call between Bailey and her lawyer in which her lawyer says that he was chatting with Bailey’s agent and that they both have “concerns” about the film she was making, specifically how this might affect her and whether she should “continue to go forward with it in light of what’s been going on with his [Wakefield’s] documentary and the backlash and all.” He goes on to warn that that controversy could transfer to Bailey and affect her career and reputation. He ends by saying “Can you handle that?” No answer is given. We reach the end of the credits, which is obviously her answer to her lawyer’s question.

I fear that this film will be far more damaging than VAXXED. After all, VAXXED never pretends to be anything but a vehicle for Wakefield to try to rehabilitate his reputation. In contrast, The Pathological Optimist is made by a real filmmaker who’s been successful in topics unrelated to vaccines, which means that the mainstream media and filmgoers will take it a lot more seriously than VAXXED could ever be taken.

Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.