How the Case Against the Vaccine Was Built

by Brian Deer
When: Thursday, June 16, 2011 8.00 – 11.00 PM
Where: The Head of Steam, 7 Lime Street, Liverpool

As the Wirral becomes the latest area of the UK to suffer a measles outbreak in an unvaccinated population, investigative journalist Brian Deer visits Liverpool to speak about how he uncovered the “elaborate fraud” behind the MMR scare.

In February 1998, the Lancet medical journal triggered a global alarm with research proposing a link between the measles, mumps and rubella vaccine and autism. The researchers’ leader, Andrew Wakefield called for the vaccine to be “suspended”. But all was not as it appeared to be. Following investigations over a period of 7 years for The Sunday Times, the British Medical Journal in January denounced Wakefield’s research as “an elaborate fraud”.

The story raced round the world. A Harris poll in the United States found that 47% of Americans had heard Deer’s story. The New York Times said his work was “extraordinary.” Now, on 16th June, he comes to Merseyside Skeptics Society to talk about how Wakefield rigged the research linking MMR with autism, how he did it, who paid him for it, how much money he expected to make out of it, and the years-long investigation which finally nailed him. This is one of the big science stories of today.

• RSVP on Facebook »
• RSVP via Email »

People go about their daily lives making decisions on the basis of beliefs about the way the world works. Their epistemological framework is a complex architecture of foundations and interconnecting supports on which rest concepts held to be “true”. While some beliefs may have little consequence for the person holding that belief, others have the potential to seriously impact the lives of both the believer and, through the actions that those beliefs precipitate, the rest of mankind. When we come to examine issues of such magnitude, we see a difference between the beliefs held by the general public and those which are held by the majority of experts in the respective fields. To understand why this is the case, it is informative to consider two claims that have been made in recent years and the variation in the reception that each has received from the public. 

Claim 1: “The measles-mumps-rubella vaccine causes autism”

The origin of this claim has been buried under the weight of subsequent newspaper stories which have clouded the issue. In 1998, an article entitled “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children” was published in The Lancet. This snappily-titled paper, without providing anything beyond circumstantial evidence, suggested that research should be carried out to investigate a causal link between the measles-mumps-rubella (MMR) vaccine and autism spectrum disorder (ASD). Parents of the 12 children involved in the study blamed the vaccine for the development of the pathology on the basis that the onset of symptoms occurred soon after vaccination. Dr Andrew Wakefield, the lead author of the paper, urged caution in the use of the MMR vaccine and recommended that single vaccines for each of the three diseases be used until further research had been carried out, a recommendation not supported by his own paper.

It came to light later that Dr Wakefield had received considerable funding from lawyers seeking evidence against vaccine manufacturers and that he had attempted to take out a patent on a vaccine that would be a rival to MMR. These conflicts of interest were not declared at the time of publication of the paper though they would have formed part of the basis for an editorial decision on its suitability for publication. After the media coverage, the percentage of children being vaccinated at the appropriate time dropped year-on-year from 92% in 1995 to 80% in 2003 before gradually climbing back to 85% in 2007. MMR uptake has never reached the 95% threshold suggested by the World Health Organisation to provide herd immunity for the population. Measles infections increased to the point at which in 2008, for the first time in 14 years, measles was declared endemic in Britain (i.e. the disease is self-sustaining). More than two-thirds of all mumps infections recorded between 1996 and 2008 (43,378 out of 64,168) occurred during 2005.

Claim 2: “Anthropogenic factors cause global warming”

That the climate is warming is now beyond doubt. The causes of this current phase of environmental change are extremely complex, though strong evidence exists for a link between atmospheric carbon dioxide concentrations and the rise in temperature. Subsequent work has implicated a range of other factors including aerosols, methane, albedo effects and fluctuations in solar radiation as contributing to the observed pattern. Climate projections from the Intergovernmental Panel on Climate Change (IPCC) suggest that temperatures could rise by between 1.1 and 6.4°C by the year 2100 depending on sociopolitical factors.

It is difficult to overstate the strength of the consensus on climate change science. A staggering list of bodies of professional scientists have issued explicit statements confirming their support for the views that (i) unequivocal warming of the climate is occurring, and (ii) the majority of this warming is anthropogenic in nature. The number of scientific papers confirming these findings provides an intimidating prospect for would-be students in the area. However, despite this there is still a substantial portion of the general public holding the belief that the current phase of warming is due solely to “natural causes”.

Public reception

Here we have two claims: the first published by a scientist possessing a strong agenda and with almost no evidence that was followed by a sound debunking from the scientific community (notably in the same issue of The Lancet as Wakefield et al.’s original paper), and the second with mountains of evidence and a minuscule number of qualified dissenters. It is possible to quantify the difference in beliefs held by the public relative to the scientific establishment in each case. The wording of the IPCC shows at least 90% certainty in their statement that environmental warming is anthropogenic in origin. This is in contrast to a 2008 Gallup poll which found that only 58% of the public believed that “human activities” caused “increases in the Earth’s temperature over the last century”. In the case of MMR, a poll carried out by the Florida Institute of Technology found that 24% of respondents believed that “because vaccines may cause autism it was safer not to have children vaccinated at all”, with a further 19% “not sure”7. This is compared to a scientific community that can be assumed to be unanimous in its non-belief in a link between vaccination and autism, given the complete absence of data supporting that link8.

The role of scepticism

Scepticism should be a tool through which we view the world but it is important to be pragmatic in our use of this tool. The most extreme form of scepticism simply plants the practitioner in an epistemological quagmire where all interpretations of observable data must be made individually by that person. Clearly this is not a practical application of the principle. Instead it is obvious that we must occasionally take the interpretations and opinions of others as a basis for our own epistemological framework. While this seems reasonable it also means that the truth of our own beliefs hinges on the choice of whom to trust. Two recent sociological changes have occurred which have made this decision more complex.

The first is that the popular media moderates what the public hears, collectively acting as a filter by which only the most sensational opinions are broadcast. The shift in purpose that has gone on in the media from informing its audience to entertaining its audience brought with it the drive to find those fringe elders who will retain the semblance of authority but generate maximum audience figures. Dr Andrew Wakefield and Dr David Bellamy (a notable climate change sceptic who once described global warming as “poppycock”) are “men-in-white-coats” wheeled out to drive up audiences regardless of the resulting decline in the level of scientific understanding of that audience.

The second sociological change is the “celebrity culture” in which we now live. This has made it possible for ignorant members of the public to hold forth on important issues and garner great followings in the process. Jenny McCarthy, a C-list actress, is the figurehead of the anti-vaccine movement; Oprah Winfrey, the world’s wealthiest woman, has advocated a range of questionable health treatments; the late author Michael Crichton was a renowned climate change sceptic. Such characters are given airtime and column inches in abundance to espouse their views, regardless of how accurate those views are.

Intellectual laziness is also an important issue. While I have already stated that listening to a certain amount of expert opinion is a necessary epistemological concession, the most pressing issues (particularly those with potentially life-threatening consequences) require that the general public delve deeper themselves. Data that can be used to investigate either of the issues outlined in this essay are readily available to any interested parties. The Mauna Loa Observatory’s carbon dioxide monitoring data can be downloaded, as can the UK Meteorological Office’s climate data. The Health Protection Agency has data on cases of measles, mumps and rubella, as well as vaccine coverage, to emphasise the importance of vaccination compliance. Anybody investigating the MMR issue could even read the following sentence in the Wakefield et al. paper from The Lancet:

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

Conclusion

The gulf between public opinion and scientific consensus is due to the general public not knowing whom to trust and when. The decision of when to resort to expert opinion and then which sources to use in gathering information is a complex matter and there is an element of trust that needs to be exercised. Greater efforts need to be made to ensure that those involved in the media reporting of these kinds of issues are held to account for the abuse of the confidence that the public places in them. In addition to being misleading, such reporting can also endanger lives. Science is a fascinating topic in the hands of a skilled journalist and does not need the kind of selective, sensationalist reporting that is so prevalent today.

The basis of this story appears to be the upcoming publication of a new edition of Richard Halvorsen’s 2007 book, “The Truth About Vaccines”. Halvorsen, a London-based GP, uses this new edition to reject unscientific claims about the purported link between vaccines and autism.  He takes the time to explain to worried parents that claims of a link are unfounded and that the scientific evidence does not support the vaccine-autism hypothesis.

Nah, I’m only fooling.  He probably just wheels out the same old canards.

Before I come to the Express story, I want to talk briefly about Dr. Halvorsen.  According to his MobileMe page, Richard Halvorsen is a family doctor who also promotes various forms of quackery, including offering the thoroughly-debunked acupuncture for back pain (and other ailments) and that trusty stalwart, the Avogadro-bustingly absurd homeopathy for goodness-knows-what.

Although I haven’t read the book, Halvorsen’s background in pseudomedicine doesn’t fill me with confidence about his critical thinking skills or his ability to wield the scientific method.  The Express, however, doesn’t seem to mind this background in quackery, cheerfully quoting Halvorsen’s thoughts on vaccination without any appeal to the actual science.

In a new edition of his book, The Truth About Vaccines, Dr Richard Halvorsen, collates the latest studies that suggest children with [mitochondrial dysfunction] have developed autism after jabs.

This seems to be part of the latest attempt by the antivax lobby to “re-brand” their vaccine denial.  First it was Andrew Wakefield and the “measles in the gut” claim; a claim Halvorsen repeats on his own website.  Then they decided it was “heavy metal poisoning” caused by the thimerosal preservatives.  Now, they’re saying it’s related to mitochondrial dysfunction.

David Gorski took a look at claims of a link between mitochondrial dysfunction, vaccines and autism in an article for Science Based Medicine last year, following the Hannah Poling case.  This is what the Express has to say about Hannah Poling.

Last year, the US government agreed compensation for 10-year-old Hannah Poling, having conceded out of court that her autism was linked to a series of jabs in July 2000 at 19 months.  Her father, a leading neurologist, later discovered that she had mitochondrial dysfunction.

My layman’s understanding of Gorski’s article is that Hannah Poling does not suffer from an Autism Spectrum Disorder, but suffered regression as a result of brain damage caused by encephalitis.  She suffers from a rare mitochondrial mutation, which can cause encephalitis in response to fever.  Any fever would have done it, but in this case it was a fever brought on by her vaccinations.

Hannah’s case is part of a 5,000-case multi-party action before the US Vaccines Court, a body funded by a 75cent levy on vaccines in the US.

Well, no, actually, it isn’t.  The Hannah Poling case was removed from the 5,000-case class action, for reasons unknown, and settled independently.  My guess would be that the case was removed because her mitochondrial dysfunction made her case atypical, but that is only a guess.

Back to the Express:

Mitochondrial dysfunction describes the failure of parts of the victim’s cells which produce energy. A recent Newcastle University study found at least one in 200 people harbours a mitochondrial mutation.

The important line here is “at least one in 200 people harbours a mitochondrial mutation”.  What this does not say is that one in 200 people harbours the same mitochondrial mutation, nor that the mutation is the one which resulted in Hannah Poling’s encephalopathy.  Of course, the Express doesn’t point that out, they just leave it for the reader to put 2 + 2 together and make 27.

This is just one of many such examples of irresponsible reporting in the article. The next one they wheel out is:

British toddler Harriet Moore suffered fits, became clingy and eventually died in the arms of her parents Sarah and Pat Moore, six weeks after receiving an MMR jab in 1998. They discovered she had mitochondrial dysfunction.

Notice that this doesn’t claim that Harriet Moore was autistic, only that she had fits and died six weeks after receiving her MMR jab.  I’m sure she did a lot of other things in those six weeks too.  Wore a new romper suit.  Ate a Farley’s Rusk.  Slept during the daytime.  No-one seems to be suggesting that these events caused her tragic death.  Why single out the MMR jab?  It’s a classic post hoc ergo propter hoc fallacy.

The same is true for the mention of mitochondrial dysfunction.  Was this related to her death?  Indeed, how did she die?  This anecdote is completely irrelevant.  It says nothing at all about the topic in hand, but leaves the casual reader with the impression of relevance because it mentions MMR and mitochondria.

Jodie Marchant from Southampton was given the MMR jab with the diphtheria, tetanus and whooping cough vaccines at 14 months. She became ill, stopped eating and lost all speech.  Jodie, now 17, has severe learning difficulties and life-threatening convulsions. This year it was found she has mitochondrial dysfunction.

Another case of ignoratio elenchi.  This seems to be a random jumble of information: Jodie had MMR; Jodie got sick; Jodie has learning difficulties; Jodie has mitochondrial dysfunction.  All true, I’m sure, but where is the science here?  Where is the data?  There is no relationship established between these events, they’re just ominously cited, one after the other.  Again, no mention is made of whether Jodie is autistic, but casual readers will likely assume she is.

Joshua Edwards, 16, from Gosport, Hants, developed autism and bowel disease after the MMR jab. Earlier this year he too was found to have the mitochondrial disorder.

Like its predecessors, this anecdote says nothing at all – although at least in this case we’re actually talking about an ASD sufferer.  However, no causation is established, just vague correlations.  There is nothing new to say here that I haven’t said already.  Has anyone told the Express that the plural of anecdote is not data?

So what does the data say?  For one thing, it says there is no link between vaccination and autism.

It says there were 56 cases of measles in England and Wales in 1998, the year Andrew Wakefield first published his paper in The Lancet linking MMR to autism.  In the press furore that followed, vaccination rates fell.  2006 saw the first death from acute measles infection since 1992 and statistics for 2008 show that there were 1,370 confirmed cases of measles in England and Wales – a rise of almost 2,500% in just ten years.

Make no mistake, this was as a direct result of uncritical science reporting in the media, like that seen in yesterday’s Express article.  People are starting to die because journalists aren’t thinking critically. It has to stop.

“I do believe sadly it’s going to take some diseases coming back to realize that we need to change and develop vaccines that are safe. If the vaccine companies are not listening to us, it’s their fucking fault that the diseases are coming back. They’re making a product that’s shit. If you give us a safe vaccine, we’ll use it. It shouldn’t be polio versus autism“. Source: Time magazine, April 2009.

She even released a video to tell us all about it, replete with demonic smile and crazy crazy eyes – originally hosted on www.generationrescue.org (I’m not hyperlinking to them – call me petty), after a wave of criticism/ridicule it was taken down.  Fortunately, this being the internet and all, nothing is ever lost – you can witness the McCarthy rant on youtube for yourself (part 1, part 2).  Go ahead, I urge you, it’s nothing short of astounding.  Oh that Miss McCarthy, she’s such a crazy yankie loon, we’d never get anything like that over here, not us smart and superior, many-sceptered-isle, green-and-pleasant-lands sorts.

So could somebody please tell that to the Daily Mail?  Because, frankly, they’re letting the side down, and showing us up.  ’I helped my son cope better with autism by changing his diet,’ the headline claims.  The headline claims.  The article itself actually tells a different story. In fact the only thing diet-related in the whole story is really only this short section:

“People don’t realise that a large proportion of autistic children have terrible gut problems, and for 18 months that was the case with Billy… Billy stopped eating most things, and eventually all that was left in his diet was cow’s milk and Weetabix. He was so skinny his hair started falling out, and he had sores all over his lips and up his arms.

Then, one day, a leaflet dropped through my door explaining how a wheat and dairy-free diet could help autistic children…  I replaced cow’s milk with rice milk and began baking gluten-free biscuits, which I gave him instead of Weetabix. Billy starved himself for a few days then began eating the biscuits  -  and, amazingly, his gut problems started to get better”

So cutting milk and wheat helped her son cope with digestive problems.  Digestive problems that were caused by autism.  Therefore diet change = helping cope with this one very specific and (amongst the myriad of symptoms and afflictions suffered by autism suffers) pretty small element of autism.  By the same logic, closing your eyes helps you cope when Jenny McCarthy is on TV.  I mean, she’s still talking, and still spreading misinformation, and still playing a role in the preventable illness and death of children, but at least you can’t see her…

Now, this Daily Mail article has been sat in my ‘to-do?’ pile for a little while now, and I wasn’t entirely sure what to make of it.  Sure, the headline is sensationalist and misleading, but the rest of the story is pretty decent (barring a few hints that autism is caused by allergies and toxins – which pretty much is to anti-vaccination what intelligent design is to creationism).  Many of the stories told in the article are positive, most likely true and of great comfort to parents in similar positions, I can imagine.  So I thought I’d give this one a pass – I mean why focus on the misleading headline when the rest of the story is pretty positive?

And then I read the comments.

“God bless you, Polly, and thanks to the Daily Mail for printing this story. Autism is treatable!  My son was diagnosed as a high functioning autistic at 4 1/2 years of age this March… With nothing to lose, I researched on the internet and found the gluten-free, casein-free (dairy free) diet. Within days of starting he was alert and looked us in the eye when speaking”

And:

“Anybody interested in the dietary and biomedical treatment of autism should also be aware of the great work of Treating Autism. Complete recovery from autism is possible – but not through the NHS. Keep up the fantastic work Polly!”

And:

“I think the only people who deny the diet does not work, is maybe the people who have not tried it. People that do not realise that it is a gut issue and not a mental disorder. Treat the gut and you treat the autism. Its as simple as that. Thank god for people like Polly putting this into the public eye. We certainly don’t have any other helpers”

And more.  I can’t reprint them all.  Now, for those that aren’t sure, there is no cure for autism, at the moment.  That’s the sad but true fact.  Science is working on it, but science isn’t quite there yet.  Speculating as to potential causes from a position of no medical basis and training, or taking stories small lifestyle and health improvements out of context and sensationalising them into a cure does nothing to help anyone.  Fortunately in this case, there also comments from mothers of autistic children which berate the evangelical nature and proposed scope of the dietary cure – and it’s these parents I feel most for.

I can’t even begin to imagine how tough, scary and genuinely heart-breaking it must be to bring up an autistic child.  To be told there is no clear understanding of the causes, and no chance of a treatment or cure must be every parents’ worst nightmare.  So when a newspaper, actor or demon-faced stripper offers a potential cure, I can’t blame any parent for being seduced into wanting to give it a go.  I CAN blame the newspaper, actor or demon-faced stripper, however.  When newspapers and celebrities dabble in medical advice, hopes get raised and dashed, valuable medicine and scientific research gets trashed, and above all people get hurt.