Dr. Andrew Wakefield was almost single-handedly responsible for frightening the public about a possible association between autism and the MMR vaccine. His alarmist recommendations directly led to lower vaccination rates and a resurgence of measles to endemic levels in the UK. The MMR/autism interpretation of his 1998 article in The Lancet was retracted by 10 of his 12 co-authors. The article itself was “fully retracted from the public record” by The Lancet. And now Wakefield has lost his license to practice medicine after the General Medical Council’s exhaustive 2½-year review of his ethical conduct.

His career was in shreds and there was only one way left for him to fight back: to write a book. Callous Disregard: Autism and Vaccines — The Truth Behind a Tragedy has just been published. I tried hard to read it with an open mind and to understand his point of view. He did make some points that I will accept as valid unless they can be refuted by the others involved. Some of what he said and did was apparently misinterpreted and distorted by his critics. But the book did not convince me that he was an ethical, rigorous scientist or that MMR is linked to autism or to bowel disease. In my opinion the book does nothing to scientifically validate his beliefs or to excuse his behavior, but rather boils down to self-serving apologetics and misleading rhetoric. It also undermines his claim that he is a good scientist by showing that he values anecdotal evidence (“listening to the parents”) over experimental evidence.

The preface is by Dr. Peter Fletcher of the UK’s Committee on Safety of Medicines. Some of what he says is demonstrably wrong. He alleges that vaccines have only been “minimally investigated,” that concerns about anaphylaxis have been neglected (Wakefield also stresses the danger of anaphylaxis), and that the mortality rate from MMR vaccines approaches the pre-vaccination mortality rates for measles. These allegations are ridiculous and easy to disprove with a couple of minutes’ Googling. (In an Australian study of 1.7 million school children vaccinated with MMR, there was only one anaphylactic reaction and no deaths. Before the introduction of vaccines, measles used to kill 100 people in the UK every year and MMR vaccine has never been known to kill anyone.) Fletcher also offers his unsupported opinion that the subjects in Wakefield’s study had “a complex new syndrome” whose root cause is “almost certainly vaccines.”

The foreword is by Jenny McCarthy, who offers the tired old “listen to the parents” argument and calls Wakefield “the symbol of someone who stood up for truth.”

Wakefield starts the book with an anecdote about a mother who killed herself and her autistic child: moving, but irrelevant to the questions of whether Wakefield was unethical or whether vaccines cause autism.

Wakefield does not recognize that he has done anything wrong. Instead, he accuses the regulatory authorities of callous disregard of children’s safety; he accuses his accusers of having personal motivations to destroy him and to maintain the vaccine party line at all costs; he accuses Brian Deer, the investigative reporter who exposed him, of getting the facts wrong; he accuses others of not reporting their own conflicts of interest, etc.

He accuses the regulators and the vaccine industry of “ruthless, pragmatic exorcism of dissent” and tries to show that they are effectively anti-vaccine because they have caused the decrease in public confidence that is the greatest threat to the vaccine program. He says if consumers don’t get the answers they want (presumably a guarantee of 100% safety), they should trust their intuition, because

Maternal instinct… has been a steady hand upon the tiller of evolution; we would not be here without it.

These are not the words of a critical-thinking scientist; they sound more like something Jenny McCarthy might say.

Then he claims that the US vaccine court has been compensating for cases of vaccine-caused autism and secretly settling cases out of court. This is not true. The only source he gives for this misinformation is this report from CBS News that distorts the facts, confusing vaccine injury with encephalopathy and mitochondrial disorders with injury from autism. In reality, the vaccine court has evaluated the best test cases lawyers could come up with and has determined that there is no evidence for vaccines causing autism.

He stresses that the paper itself did not claim that MMR caused autism. That’s true. The problem was not the paper itself, but Wakefield’s interpretation of it in his press conference, where he advised against the MMR and recommended single vaccines instead. His comments at that press conference were what led to the public rejection of MMR vaccines and the resurgence of measles in the UK. He devotes a whole chapter to the press conference. He gets bogged down in minutiae about what the dean thought he was going to say and who knew or said what and when. He cannot justify his recommendation of single vaccines instead of the combined MMR, and he doesn’t address the fact that he had filed a patent application for his own single measles vaccine, a clear conflict of interest that he failed to disclose.

He has a whole chapter on the UK government’s delay in rejecting a particular brand of MMR vaccine that had been withdrawn in Canada. That episode says nothing about vaccines and autism and is not justification for Wakefield’s actions.

He denies that the lawyer funded the 1998 Lancet study, but admits that the lawyer was already funding a related measles virus study of Wakefield’s at the time. He offers convoluted explanations of how the subjects came to him. He denies that they were sent by the lawyer or that they were litigants at the time of the study. While that may be technically true, Wakefield was already known for his criticism of the MMR vaccine and for his hypotheses about measles virus and bowel disorders, and he readily admits that his reputation led a network of concerned activists to direct patients to him. These were not simply patients who presented to the clinic in the normal course of things. He says he was not required to report this sort of thing as a conflict of interest under the rules in effect at that time, but that the rules subsequently changed. Whether it was a requirement or not, it is something I would have wanted to know when I originally read the study.

He still doesn’t understand what was wrong about paying children to let him draw blood samples at his son’s birthday party. He doesn’t understand why scientists don’t usually use “samples of convenience” like this for a control group, and he doesn’t understand the element of coercion. He doesn’t even have the decency to apologize for making fun of the children in public, joking about them crying, fainting, and vomiting. He just doesn’t get it.

He tries to claim that doing invasive procedures like colonoscopies and lumbar punctures (LPs) on the subjects in his study was not for research but something that should have been done on every autistic child for the child’s clinical benefit. He doesn’t make a convincing case. Certainly the majority of clinicians who evaluate autistic children do not do these studies routinely.

He says that autism must not have existed in 19th century Paris because Charcot did not describe it! He implies that the rise in autism was temporally associated with the introduction of MMR vaccine; but a recent study showed that the prevalence of autism in adults was equal to that in children and did not decrease with age, even in those over 70 who were far too old to have been exposed to any of the modern children’s vaccines.

He says his findings of a new gastrointestinal syndrome related to measles virus and autism have been replicated around the world. They have not. He cites a few papers that seem to support his hypothesis but fails to cite the bulk of data that refutes it. For instance this study showed no association between autism and overall incidence of gastrointestinal symptoms. This one showed no autism/GI connection either. And this study showed strong evidence against association of autism with persistent measles virus RNA in the GI tract or with MMR exposure.

He tries to demolish the GMC’s case against him. If he could do so in a book, one can only wonder why he didn’t present his evidence at the hearing. He goes into excruciating, mind-numbing detail about points that are really peripheral to the central issues.

He dissects a newspaper article by Brian Deer, but most of what he calls “false allegations” amount to trivial nitpicking about wording or interpretation. Some of it is reminiscent of a certain former president’s quibbling about what the meaning of the word “is” is. Deer made many other allegations in his exposés that Wakefield does not mention or attempt to refute, such as the apparent attempt to hide his source of funding (for a different study?) by funneling the lawyer’s payments through a company of Wakefield’s wife. There are many unanswered questions.

Perhaps the most unfortunate chapter in the book is “Poisoning Young Minds,” a prime example of Godwin’s law. He describes how a math question in schools in Nazi Germany used Jews as an example, thereby sowing the seeds of anti-Semitic propaganda into young, fertile Aryan minds. He compares this to a question on a UK biology exam that used Wakefield’s study as an example, asking students whether it was reliable scientific evidence or might have been biased. This takes up a whole chapter!

In his concluding epilogue, he says

In the battle for the hearts and minds of the public, you have already lost… Why? Because the parents are right; their stories are true; their children’s brains are damaged; there is a major, major problem. In the US, increasingly coercive vaccine mandates and fear-mongering campaigns are a measure of your failure — vaccine uptake is not a reflection of public confidence, but of these coercive measures, and without public confidence, you have nothing.

How ludicrous: he is clearly the one who undermined public confidence, not the scientists and agencies that are doing their best to reduce the incidence of preventable diseases and to protect the public from alarmists like him.

In my opinion, the whole book is an embarrassing, tedious, puerile, and ultimately unsuccessful attempt at damage control. Wakefield has been thoroughly discredited in the scientific arena and he is reduced to seeking a second opinion from the public. Perhaps he thinks that the truth can be determined by a popularity contest. Perhaps he thinks the future will look back at him as a persecuted genius like Galileo or Semmelweis. Jenny McCarthy thinks so; I don’t.

Posted by Harriet Hall

Harriet Hall, MD also known as The SkepDoc, is a retired family physician who writes about pseudoscience and questionable medical practices. She received her BA and MD from the University of Washington, did her internship in the Air Force (the second female ever to do so),  and was the first female graduate of the Air Force family practice residency at Eglin Air Force Base. During a long career as an Air Force physician, she held various positions from flight surgeon to DBMS (Director of Base Medical Services) and did everything from delivering babies to taking the controls of a B-52. She retired with the rank of Colonel.  In 2008 she published her memoirs, Women Aren't Supposed to Fly.