'Even eminent scientists have had
their careers tarnished by misinterpreting unremarkable
events in a way that is so compelling that they are
thereafter unable to free themselves of the conviction that
they have made a great discovery.
|
'Moreover, scientists, no less than
others, are inclined to see what they expect to see, and an
erroneous conclusion by a respected colleague often carries
other scientists along the road to ignominy. This is
pathological science, in which scientists manage to fool
themselves.
|
'If scientists can fool themselves, how
much easier is it to craft arguments deliberately intended
to befuddle jurists or lawmakers with little or no
scientific background? This is junk science. It typically
consists of tortured theories of what could be so, with
little supporting evidence to prove that it is so.' (Voodoo
Science: The Road From Foolishness to Fraud, Robert
Park, Oxford, 2000)
|
Having failed to come up with hard
evidence for the hypothesis of a link between the Measles,
Mumps and Rubella (MMR) vaccine and autism, campaigners
against MMR are now provoking popular anxieties by
presenting their research directly to the public before
submitting it to proper scientific evaluation and
confirmation. The result is an increasingly irrational
campaign, sustained in part by uncritical media commentary.
|
Speaking on 19 June 2002 before a US
congressional committee considering 'The status of research
into vaccine safety and autism', Dr Andrew Wakefield, the
British gastroenterologist who launched the MMR-autism scare
in 1998, outlined the progress of his research.
|
He claimed that, 'most significantly', a
currently unpublished study that is due to be presented by
virologist John O'Leary at a conference in Dublin in July,
had 'confirmed that the measles vaccine virus is present in
the diseased intestinal tissues of children with regressive
autism'. Furthermore, 'state-of-the-art molecular science'
had shown that, in the cases of 12 children with a
combination of autism and inflammatory bowel disease, the
measles virus in their intestines originated in the MMR
vaccine. For Wakefield, these studies constituted 'a key
piece of evidence in the examination of the relationship
between MMR vaccine and regressive autism'.
|
On 2 July 2002, however, Professor O'Leary
rejected Dr Wakefield's interpretation of his work,
insisting that it 'in no way establishes any link between
the MMR vaccine and autism' (1). Indeed, he strongly
recommended that parents should give their children MMR.
O'Leary's judgement echoed that of other experts who had
earlier dismissed Wakefield's claims for this research to
the congressional committee in Washington. The first piece
of evidence promising some support to the hypothesis
advanced by Dr Wakefield in 1998 was thus discredited even
before publication.
|
Though Professor O'Leary himself denied
that his work gave any support to the case against MMR, in
the weeks leading up to the July Dublin meeting it was
widely cited by anti-MMR campaigners. Throughout June 2002,
reports of the impending publication of this research
provided a major publicity boost to a campaign that had
flagged since the Christmas 2001 furore over whether Tony
Blair's son Leo had had his MMR jab (a period in which the
uptake of MMR had shown signs of recovery). The hype
surrounding the O'Leary paper reveals much about the modus
operandi of the campaign and its leading figure, Dr
Wakefield.
|
 |
|
Dr Wakefield is described
as 'a glossy-haired charismatic hero' |
|
The first hint of the significance of
Professor O'Leary's latest work came in a typically
sycophantic presentation of Dr Wakefield's case in the
Telegraph
Magazine on 8 June 2002. This article opens with an effusive
account of a visit to the Wakefield household, featuring 'a
likeable, lively family, the kind you would be happy to have
as friends'.
|
The author describes Dr Wakefield as 'a
handsome, glossy-haired charismatic hero' who is pitted
against mysterious forces who have planted bugging devices
and have stolen patients' records in 'apparently
inexplicable' burglaries. She fantasises about a Hollywood
depiction of Dr Wakefield's heroic struggle, with Russell
Crowe playing the lead 'opposite Julia Roberts as a feisty
single mother fighting for justice for her child'.
|
To appreciate the significance of Dr
Wakefield's exclusive revelations to his star-struck
interviewer, we have to go back to an earlier controversy.
In a BBC Panorama
special on MMR in February, Dr Wakefield had disclosed
claims that Professor O'Leary's team had found measles virus
fragments in the guts of autistic children with inflammatory
bowel disease. However, this study did not indicate whether
the subjects had had measles or the MMR vaccination.
|
Following widespread criticism of the
premature disclosure of these findings, the journal
Molecular Pathology
was obliged to pre-publish the paper in full on the web to
allow proper scrutiny. Commentators observed that, even if
these findings were confirmed and replicated, the presence
of measles virus fragments in the gut would not prove that
they caused either inflammatory bowel disease or autism.
Professor O'Leary issued a statement insisting that he had
'not set out to investigate the role of MMR in the
development of either bowel disease or developmental
disorder, and no conclusions about such a role could, or
should be, drawn from our findings'. Dr Wakefield, however,
continued to claim this study in support of his MMR-autism
hypothesis.
|
Then Dr Wakefield exclusively revealed
that 'more than 95 percent of those who had the virus in
their gut had MMR as their only documented exposure to
measles'. Wakefield had chosen to make this important
revelation, not in a scientific forum, not even to a science
journalist, but in a
Hello magazine style feature in a weekend supplement.
After the publication of a similar presentation of his case
in a special issue of
Private Eye in May 2002, this approach suggested a
consistent pattern, even a deliberate media strategy (2).
|
Within days, more details of Professor
O'Leary's research began to appear in the press. These were
derived from an abstract of a paper due to be presented at
the annual meeting of the Pathological Society of Great
Britain and Ireland, taking place in Dublin on 2 to 5 July
2002.
|
A five paragraph summary of a paper
entitled 'Development of an "allelic discrimination" type
assay to differentiate between the strain origins of measles
virus detected in intestinal tissue of children with
ileocolonic lymphonodular hyperplasia and concomitant
developmental disorder' was listed as 'abstract no 20' in a
series of equally snappy titles (3). The authors claimed
that they had corroborated 'previous findings of an
association between the presence of measles virus and gut
abnormalities in children with development disorder', and
that the measles virus particles were of the same strain as
that used in the MMR vaccine.
|
How had the contents of an obscure
research paper found their way from the deepest recesses of
the Pathological Society website into the mainstream media?
On 16 June 2002 the
Sunday Telegraph presented Professor O'Leary's results,
claiming that 'scientists have found new evidence to support
fears that the MMR vaccine is causing children to develop
autism and bowel disease' (an interpretation subsequently
disclaimed by Professor O'Leary).
|
|
|
|
Parents of autistic
children cling to plausible theories |
|
Similar reports published in different
newspapers over the following week quoted the same sources.
These included Jackie Fletcher, a veteran leader of the
anti-immunisation campaign JABS, Ann and Martin Hewitt,
parents of an autistic son and sponsors of the Autism
Research Campaign for Health, a new group of families linked
to Dr Wakefield's former department at the Royal Free
Hospital in London. They also included Visceral, a charity
set up to fund research into autism and bowel disease, of
which Dr Wakefield is a trustee. The common feature of these
sources, who are also prominent in the
Private Eye
special, is their close personal relationship to Dr
Wakefield.
|
A consistent pattern emerges in the
activities of the anti-MMR campaign. Before research
findings can be properly checked and evaluated in the
scientific community, they appear - often piecemeal - in the
mainstream media. Journalists with little understanding of
science are easily persuaded by extravagant claims made by a
charismatic researcher and his supporters.
|
Parents of autistic children, often
desperate for any explanation of their child's disorder,
cling to plausible theories, sometimes reinforced by the
promise of litigation. In the prevailing climate of intense
public anxiety about environmental threats to health,
parental fears about the MMR are intensified. By the time
that independent scientists refute the claims made by Dr
Wakefield and expose the inadequacies of his research and
the incoherence of his theory of the causation of autism,
the damage has been done.
|
The
Sunday Telegraph article concluded by quoting Dr
Wakefield's statement that 'Prof O'Leary and colleagues have
now provided what may prove to be the most important piece
of evidence to date in the case against the MMR vaccine.
Parents must at the very least be given a choice of single
vaccines'. Though Professor O'Leary has since explicitly
disclaimed both propositions, Dr Wakefield has not.
|
Dr Wakefield is a scientist who has turned
hypothesis into dogma, resolutely refusing to abandon his
theory despite his failure to provide convincing evidence to
support it. For the past decade he has put advanced claims
that the measles virus, either as the 'wild' or in the
attenuated form in vaccines, causes chronic diseases. In the
early 1990s, he put forward a range of hypotheses about
links between measles virus and Crohn's disease and
ulcerative colitis, which he claimed to have demonstrated.
When other researchers failed to replicate these findings,
the scientific world concluded that Dr Wakefield's theories
had turned out to be mistaken and moved on.
|
So too did Dr Wakefield, but only to claim
that another disorder was caused by the measles virus -
autism. He hypothesised that the mediating link between the
virus and the brain was an inflammatory bowel disease, which
was neither Crohn's disease nor ulcerative colitis, but a
previously unrecognised condition - 'autistic enterocolitis'.
Though one American paediatrician, Dr Arthur Krigsman, has
recently reported a high incidence of bowel inflammation in
autistic children referred to his clinic in New York, it
remains to be confirmed whether this is a distinct
condition.
|
The response of Dr Wakefield and his
supporters to the rising tide of evidence against his theory
and the crumbling of evidence in favour of it has been to
advance more complex versions of his theory. Thus when
numerous epidemiological surveys failed to demonstrate a
significant link between MMR and autism, the anti-MMR
campaigners argued that if only a small group of children
were susceptible to the vaccine they might be missed by such
techniques. Dr Wakefield has put forward a number of cases
in support of his theory that the major problems arise from
the second MMR vaccination, though there is even less
evidence for this than his earlier claims.
|
Others have produced even more convoluted
theories. One, which has been advanced in a number of
articles in the
Sunday Times (and more recently in the
New Statesman),
attempts to link the British preoccupation with MMR with a
long-running anti-vaccination campaign in the USA, which
focuses on dangers attributed to the preservative thiomersal
(containing mercury) which is used in many vaccines. The
problem here is that there is no thiomersal in MMR (because
it contains live vaccines) though it is included in the
diphtheria, pertussis and tetanus (DPT) immunisation given
to all babies in their first year (which has become entirely
uncontroversial in Britain over the past 20 years).
|
|
|
|
Perhaps the risk is
greatest when the moon is full |
|
The new hypothesis is that in some
genetically predisposed children, an accumulation of mercury
from these early jabs damages the brain and lowers immunity,
with the result that the immune system is overwhelmed by the
three live viruses in MMR, causing inflammatory bowel
disease and hence autism. It is scarcely necessary to say
that there is no scientific evidence for a single step of
this proposed pathway of causation, and much
counter-evidence. There seems no reason why campaigners
should not add the proviso that the risk is greatest when
the moon is full and Jupiter ascendant.
|
Dr Wakefield has opted out of medical
science to join the world of pseudoscientific dogma, media
celebrity and populist campaigning. He has been joined in
the anti-MMR crusade by Paul Shattock, a veteran promoter of
what he terms 'unorthodox forms of biomedical intervention'
in autism.
|
Mr Shattock, a pharmacist and parent of an
autistic son, runs the Autism Research Unit at the
University of Sunderland (4). Over the past 20 years he has
become well known in the world of autism for his advocacy of
theories that autism is a metabolic disorder, and for
recommending a wide range of dietary treatments.
|
In the last week of June 2002, reports of
his research claiming to have identified a distinct subgroup
of children whose autism is alleged to have resulted from
MMR appeared in several national newspapers and on BBC Radio
4's Today
Programme. Mr Shattock claims that these children have
abnormal levels of Indolyl Acryloyl Glycine (IAG) in their
urine. IAG is said to be a breakdown product of the amino
acid tryptophan, which is a constituent of serotonin,
melatonin, and other neurotransmitters.
|
Though Mr Shattock's researches into
urinary metabolites of neurotransmitters has the aura of
advanced science, it represents a return to the era of
'metabolic psychiatry' in the 1950s and 1960s (5). The
identification of a number of neurotransmitters and
receptors gave rise to theories that some disruption of
these substances might explain mental illnesses, such as
schizophrenia and depression.
|
For example, the celebrated discovery in
1962 of a 'pink spot' in the analysis of the urine of
schizophrenics was believed to confirm the disordered
synthesis of di-methyl-phenyl-alanine (DMPA) by
transmethylation from dopamine. This substance was thought
to be an endogenous 'psychotogen', producing psychotic
states in a similar way to exogenous hallucinogenic drugs
such as LSD.
|
When further researches failed to confirm
the 'transmethylation hypothesis', it was abandoned in
favour of the 'dopamine hypothesis', which tried to explain
the success of drugs like Chlorpromazine (Largactil) in
schizophrenia by their effects on dopamine levels. But this
theory proved inconsistent with further research findings,
and neurotransmitter theories fell out of favour (to
experience a revival with serotonin theories of depression
in the 1980s, a trend strongly promoted by the manufacturers
of Prozac and other 'selective serotonin reuptake
inhibitors').
|
In the 1970s and 80s, research in
psychiatry moved in the direction of genetics (though
theories of auto-immunity, a continuing influence on Dr
Wakefield, also became popular). Metabolic theories
continued to attract a following in the shadowy area of
alternative and fringe therapies, particularly in the USA.
The cult of 'orthomolecular psychiatry' emerged out of these
theories and popularised the treatment of a range of
psychiatric problems with a high dose of vitamins, amino
acids, minerals and other diets and dietary supplements. It
is out of this tradition, which has little concern for the
rigours of scientific research, that Mr Shattock's studies
have emerged.
|
|
|
|
It is impossible to
evaluate Shattock's findings, because they haven't been
published |
|
It is impossible to evaluate Mr Shattock's
findings because they have not been published in any form.
Indeed, virtually all his work has been published in the
'grey literature', in journals which have no formal process
of evaluation or peer review. We know from various reports
that he has studied 300 children (not 4000, as reported in
both the Daily
Telegraph and the
Guardian) and found that approximately 10 percent of
their parents believe that MMR caused their autism.
|
We do not know how these subjects were
selected or anything about the ascertainment of diagnosis or
any other aspect of the design of the study. It also appears
that in these children urinary IAG levels are abnormally low
(they are apparently usually raised in autistic children).
Again we know nothing about methods, controls or whether the
differences were significant. Mr Shattock believes that low
levels of IAG may be caused by increased gut permeability
resulting from the presence of measles virus. Even if we
accept that measles causes gut inflammation (which Professor
O'Leary does not), how increased gut permeability leads to
low urinary IAG levels and how IAG or tryptophan are linked
to autism remains obscure.
|
Mr Shattock freely concedes that his
studies do not prove a causal linkage between MMR and
autism. He does not intend to publish his full results until
he has studied 1000 cases. Yet, he believes that even these
preliminary, provisional, incomplete, unvalidated results,
if taken in conjunction with the O'Leary/Wakefield
researches, indicate the need for urgent action. It is not
clear whether this means further researches along similar
lines or some action in relation to the MMR vaccine
programme.
|
Mr Shattock also believes that the recent
disclosure of his data to the press was premature and
insists that the resulting publicity was neither expected
nor welcome. Given this reticence, there is some mystery
about how details of Mr Shattock's research entered the
public realm, via journalists sympathetic to the anti-MMR
campaign. He provided a preliminary report to last year's
Medical Research Council (MRC) investigation into the causes
of autism, but asked that its contents should not be
publicly disclosed (this is acknowledged in the report). As
it seems highly unlikely that the MRC would wish to release
Mr Shattock's data more than six months after the report was
published, suspicion about the leak falls on Mr Shattock and
his colleagues.
|
Whatever the source of the leak, what is
remarkable is that any responsible newspaper should consider
it legitimate to publish research findings which nobody is
in a position to check, but which are likely to have a
damaging effect on the national immunisation programme and
on public health. The incoherence of Mr Shattock's metabolic
theory of autism should be apparent even to a journalist
with no scientific training.
|
All commentators on the ongoing MMR-autism
controversy agree that there should be further research into
the hypotheses advanced by Dr Wakefield, Mr Shattock and
others. No doubt more research into all aspects of autism
would be desirable. It would certainly be useful to pursue
the virological and immunological studies piloted by Dr
Wakefield and Professor O'Leary and their colleagues in an
attempt to replicate their findings. It would also be useful
to clarify Mr Shattock's investigation of urinary
metabolites.
|
It is, however, important to recognise the
limitations of pursuing research in these directions. Past
experience of virological and metabolic studies, and the
conceptual weakness of the hypotheses guiding these studies,
suggests that they are unlikely to yield useful results.
Experience also suggests that negative results are unlikely
to satisfy Dr Wakefield, Mr Shattock and their supporters,
whose conviction that MMR causes autism has clearly acquired
the character of a religious faith. Furthermore, there is a
danger that scarce research funds will be diverted from
potentially more fruitful areas of inquiry, merely to
satisfy the egotism of these researchers and the zeal of
their supporters.
|
Anti-MMR campaigners have frequently
disparaged doctors and scientists who refute the MMR-autism
link for their links with the drug companies that
manufacture vaccines. This theme, forcefully articulated by
Dr Wakefield himself, has become an increasingly strident
feature of the campaign, one which has been uncritically
taken up by its journalist supporters. Yet there are
substantial commercial interests involved in the promotion
of junk science to which these same journalists remain
oblivious.
|
|
|
|
There are commercial
interests involved in the promotion of junk science |
|
Senior health correspondents from the
Daily Telegraph
and the Sunday Times
are reported to have joined a three-day junket to Norway
organised by the manufacturers of Seven Seas vitamins (6).
There is now a flourishing network of private laboratories
offering urine and blood tests of the sort carried out by Mr
Shattock - all of no recognised diagnostic value. There is a
substantial business sector selling dietary supplements,
vitamins, minerals, enzymes and all manner of special
dietary products - all of no proven therapeutic value. The
common feature of both tests and supplements is their
exorbitant cost, suggesting that high profits are being made
from peddling interventions of no proven value, often to
desperate parents, many on low incomes.
|
There are other beneficiaries of the
anti-MMR campaign. Private GPs are now making profits of
several hundred percent from selling separate vaccines.
Lawyers are eagerly collecting legal aid fees by inflating
the hopes of parents that they may gain substantial
compensation for the alleged damages from MMR through the
pursuit of litigation. It is not surprising that both are
enthusiastic supporters of Dr Wakefield's crusade. It seems
that Britain's investigative journalists are so smitten by
Dr Wakefield's charisma and so credulous towards junk
science, that they are reluctant to investigate the real
abuses generated around the anti-MMR campaign.
|
There is a remarkable reluctance among
mainstream scientists and doctors to challenge junk science
and expose its dangers, which are substantial. This has
allowed Dr Wakefield to pose as the heroic champion of
families of autistic children and to depict himself as the
victim of the medical establishment. Far from being
victimised, Dr Wakefield was treated with scrupulous
fairness by his employers at the Royal Free Hospital, which
he was encouraged to leave some time after he had abandoned
science in favour of the pursuit of dogma.
|
His work was also seriously considered by
officials at the Department of Health, who have
systematically refuted every charge he has made against MMR
- as was quite proper for those concerned with defending the
immunisation programme and the public health. As a GP, my
only criticism would be that, given the problems arising
from the anti-MMR campaign, the official response was not
stronger and made more widely available at an earlier stage.
The fact that Mr Shattock is recognised as a scientific
authority by the National Autistic Society, alongside a
small group of serious and distinguished scientists and
doctors, gives the stamp of legitimacy to a brand of junk
science that results in a substantial burden of
unrealistically raised expectations as well as financial
costs for families that are already severely stretched.
|
I do not question the motivation of Dr
Wakefield or Mr Shattock or their supporters. That is a
matter for their counsellors or their pastors. I do not
doubt their sincerity or their integrity; what I question is
the rationality of their theories and methods.
|
My concern is not with their subjective
intentions, but with the objective consequences of their
actions and statements. As a doctor and as a parent of an
autistic child, I judge these to have been damaging to the
health of the nation's children (by generating public
anxiety and discouraging the uptake of MMR) and damaging to
the interests of families of autistic children (by making
parents feel guilty about giving their children MMR and
encouraging them to pursue litigation).
|
Dr
Michael Fitzpatrick is a contributor to
Alternative Medicine:
Should We Swallow It?, Hodder & Stoughton, 2002 (buy
this book from
Amazon (UK)). He is also author of
The Tyranny of
Health: Doctors and the Regulation of Lifestyle,
Routledge, 2000 (buy this book from
Amazon UK or
Amazon USA).
Read on:
spiked-issue: MMR vaccine
(1)
MMR 'should be compulsory', BBC News, 3 July 2002
(2) See
Andrew Wakefield: misguided maverick, by Dr Michael
Fitzpatrick
(3) See the
abstracts for the Dublin meeting (.pdf)
(4) See the
Autism Research Unit
(5) See The Creation
of Psychopharmacology, David Healy, 2002
(6) Private Eye,
28 June-11 July 2002
|
