Black Triangle

The hypothesis that vaccines are causally linked to autism was dealt another blow today in the US today. After the channeling of millions of dollars through lawyers, three judges have handed down their verdicts in three separate cases. The verdicts are here.

Arthur Allen writes about the cases and notes the judges devastating verdict on the “experts” who led the parents of the children down this Primrose path.

In one of the cases, Special Master George L. Hastings declared the evidence against vaccines contributing to the injuries of Michelle Cedillo, a severely retarded and autistic wheelchair-bound 14-year-old, was “overwhelming.” I have no doubt, he wrote, “that the Cedillo parents and relatives are sincere in their belief that the MMR vaccine played a role in causing Michelle’s devastating disorders. Unfortunately, the Cedillos have been misled by physicians who are guilty, in my view, of gross medical misjudgment.”

This comment got to the nub of the case. The vaccine court is intended to bolster our mandatory immunization program by offering compensation to children truly damaged by vaccines while avoiding excessive litigation. But in the autism case, plaintiffs, and especially their lawyers, forced taxpayers and the pharmaceutical industry to spend millions to defeat a clearly flawed theory.

At one point in testimony, a University of Virginia pediatric neurologist named Robert Rust tried to explain the dogged persistence of the vaccines-cause-autism theory. The believers have many data points at their fingertips, thanks to the Internet. Rust compared them to Tycho Brahe, the 16th-century astronomer who convinced his contemporaries that the sun revolved around the Earth. Frustrated parents and scientists who have long rejected the vaccine-autism connection frequently return to that analogy. Alison Singer quit her leadership position in the charity Autism Speaks because she tired of its demand for more vaccine studies. “The question has been asked and answered and it’s time to move on,” she told Newsweek last month. “We need to be able to say, ‘Yes, we are now satisfied that the earth is round.’ “

The UK legal cases were stopped in 2004 when it was judged that wasting 10 million pounds was a waste of public money. Individuals were upset at the time. In some ways this was a blessing for those involved, since it has prevented another four years of building up expectations that were sure to be dashed. The legal judgments do have a bearing on the UK, in that they directly address the hypothesis put forward by Wakefield about MMR, and Wakefield’s scientific conduct.

As well as the general criticism of the medical expects who grossly misled the parents, there is specific criticism of individuals like Andrew Wakefield.

[R]espondent’s experts in this case provided much testimony relevant to the credibility of Dr. Wakefield’s procedures in developing his theory.

For example, Nicholas Chadwick in 1996 was a Ph.D. student working in a London laboratory for Dr. Wakefield, performing PCR testing for measles virus. Chadwick’s interactions with Dr. Kawashima’s laboratory, which was collaborating with Wakefield in the area of measles detection, convinced Chadwick that Kawashima’s positive results in measles virus testing were “false positives,” the result of contamination. Chadwick related that conclusion to Dr. Wakefield. Nevertheless, Wakefield submitted for publication a manuscript relying on the purportedly positive results from Kawashima’s PCR testing. Chadwick asked that his
own name be taken off the manuscript, because he was not comfortable with the data.

Dr. MacDonald described the Wakefield 2000 article as “deception”, in two respects. He opined that the article deliberately described normal findings in the intestines of the autistic children as “pathology”–i.e., abnormality indicative of disease–in order to create the false impression that the autistic children had much more intestinal pathology than the non-autistic children in the study. Dr. MacDonald also testified that the article misrepresented a photograph of a child’s cecum (a part of the large intestine) as being a photograph of the child’s ileum (a part of the small intestine). He opined that it was “highly unlikely” that this misrepresentation was a mistake, as opposed to deliberate deception.
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Dr. MacDonald, indeed, went so far as to opine that Dr. Wakefield’s “autistic enterocolitis” theory was merely an “invention” created for litigation purposes. Similarly, Dr. Rust summarized Wakefield’s process of developing and disseminating his general theory, and described it as “scientific fraud.”

If this view of Wakefield’s work is accurate, then it seems unbelievable that an individual would think it possible to get away with this. However, he did, and it has taken over ten years to get to this stage. Despite peer review processes, skeptical scientists who were wary of his work, research to refute the claim (which admittedly takes time), and because of a media that has all too easily fallen for a smooth media-friendly maverick scientist, it has taken far too long to dismantle the ediface that was built on such shakey foundations.

As it falls away, it leaves in its wake thousands of unvaccinated children, and the risk of serious outbreaks of measles in the UK. In the same way we had to learn things in the wake of the Shipman case, ought we not re-examine how we allowed this farce to continue for so long. Should some people have spoken out about their concerns sooner? Were they not under an ethical obligation to do so? Is the scientific community too respectful sometimes?

A friend and I published a paper concerned with graphical misrepresentation of data by Wakefield in a Lancet letter. We initially sent it to a vaccine journal and were told by one referee:

On the other hand I also (very strongly) hold the views that the original authors (Andrew Wakefield etc, if approachable) should also be given a chance to answer the questions raised of the misrepresentation of data. After all, the data were published in a peer reviewed scientific journal which is abided by its scientific vigour in the form of expert refereeing and editorial approval.

The paper was rejected despite no substantial criticisms of the examination of Wakefield’s graph. It was seen as sensationalist to make such claims. We sought publication elsewhere. Reading that comment in the light of the criticism of today’s ruling, I can’t help thinking that the scientific community, as well as the media, failed.