http://bmj.com/cgi/content/full/324/7334/386

 

BMJ 2002;324:386 ( 16 February )

News

Parents' champion or loose cannon?

As the government launches a campaign to revive confidence in the measles, mumps, and rubella vaccine, Roger Dobson speaks to Andrew Wakefield, the doctor at the centre of the storm

"He's a doctor of gastroenterology, the head of cutting edge research groups, writer of more than a hundred papers on the subject, honoured and recognised by his peers. Not only that, he's got a good sense of humour, cultured British accent, good looks, and the body of a rugby player."

Spectrum, an online news and radio service, was clearly impressed with the man it had interviewed at the Autism 2000 conference in Kamloops, British Columbia.

Also impressed were delegates to a second autism conference in Orlando, Florida, one of whom said: "His argument is so powerful here that it moved many of us to tears. What an incredible tragedy this would be if it is proven to be true."

For some, Andrew Wakefield is the MMR warrior, a cutting edge researcher campaigning on behalf of parents and patients for the truth about the MMR vaccine and its links with autism. For others, he is public health enemy number one, a loose cannon who is undermining the vaccination programmes against measles, mumps, and rubella not just in the United Kingdom, but worldwide.

Few researchers have attracted as much personal attention, or as many internet website references, or have generated such a volume of column inches in publications as diverse as the BMJ and the satirical magazine Private Eye.

The controversy over the MMR vaccine and links with autism began back in February 1998 when Wakefield and colleagues at the Royal Free Hospital Inflammatory Bowel Disease Study Group published the results of their research (Lancet 1998;351:637-41[Medline]).

Speculation over a link between the MMR vaccine and autism gained prominence after that paper, which described the cases of 12 children who were reported to have developed both behavioural problems and intestinal symptoms. In January 2001, a second paper was published suggesting that early trials of MMR vaccines had pointed to gastrointestinal problems but that the researchers and authorities at the time had failed to pick this up (Adverse Drug Reactions and Toxicological Reviews 2001;19:265-83).

A subsequent review by the Medicines Control Agency and the Department of Health found what were described as serious errors in the second paper, and the Public Health Laboratory Service was critical too. Elizabeth Miller of the latter's immunisation division and Nick Andrews of its statistics unit said in January 2001: "Overall, we find this paper lacking in a coherent scientific rationale, selective in the reporting and interpretation of other work and statistically invalid. We would recommend that those charged with peer review do not accept uncritically the opinions of authors whose work has previously been shown to be flawed when appropriate expertise is brought to bear."

Since then papers in several journals, including JAMA, Archives of Disease in Childhood, Pediatrics, and Vaccine, have not found a causal link between the MMR vaccine and autism.

The criticism of Wakefield and his work has again peaked this week in the wake of a measles outbreak in London that has been linked to a low uptake of the MMR vaccine. But with the whirlwind ranging around him, Wakefield continues his work and told the BMJ that more papers are in the pipeline.

He is now based at home in London after leaving the Royal Free Hospital by mutual agreement in October last year. The hospital said his research was no longer in line with the department of medicine's research strategy.

Wakefield told the BMJ this week: "I am working on the same lines and will continue to do so, to try and find the answer to questions. I am now based at home and I have a collaborative agreement with colleagues at the Royal Free for the next two years, and we will continue to publish the data that we have accumulated. We have many more publications planned. The next is likely in March or April---I can't say where. It will be the same aspect, looking at relationships with virus and vaccines and trying to answer the parents' questions."

Wakefield's interest in autism started around five years ago: "Parents were phoning up saying their child had been developing normally and had then had MMR and regressed to autism, and bowel symptoms were being ignored by the medical profession. The parents were right---there is undoubtedly bowel disease in these children," he said.

He regards listening to parents and patients as pivotal to his work: "Everything I know about autism, I know from listening to parents. I was told by my mentor to listen to the patient, or the patient's parents . . . the answers you are looking for, they have," he told Spectrum.

And in a report in FEAT, a newsletter produced by Families for Early Autism Treatment in the United States, he said, "Parents have driven the science behind this disease. Sadly, the contributions to the understanding of autism from the medical profession and the allied professions have been trivial compared to the contributions that have come from the parents."

He went on, "Maybe this is the way medicine should be. The parents are the ones who make the observations and tell you about the symptoms. It's up to the medical profession to take those findings at face value and investigate them---to allow themselves to be educated by the parents.

"It's a lesson in humility that the medical profession does well to bear in mind. I'm not a public health doctor, and if public health doctors have done their jobs properly, then we could all sleep easier in our beds.

"It has been very difficult for my colleagues to come to terms [with the fact] that there may be a genuine problem with inoculations, something that is supposed to be one of the great medical achievements of the 20th century. Unfortunately we have major problems that need to be addressed, and they're not addressed by burying our heads in the sand and pretending the problem of questionable vaccines will go away."

Asked if he had any regrets, he said, "You go into it with your eyes as open as they can be, and clearly you will encounter difficulties along the way. I have no complaints at all."

And in a similar theme he told the Sunday Herald, "I don't want to moan about what has happened to me. We have got to fight this on the science . . . Yes, you are taking on your colleagues, the health department and the biggest drug companies in the world, but the question you have to ask is, `Who do you represent?'"

He is also obviously aware of the criticism: "I couldn't say into your microphone what they called me," he told Spectrum at the Autism 2000 conference in Kamloops. "It's not been very nice." (See p 393.)

 

(Credit: IAN MCILGORM)



© BMJ 2002

ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.