Fall of an antivaxxer

The Doctor Who Fooled the World
Andrew Wakefield’s War on Vaccines
By Brian Deer
Scribe, A$35.00

(An edited version of these book reviews was published in The Skeptic magazine, September 2020, Vol 40 No 3)

This is an important book. Whether it’s really about “the scientific deception of our time”, as the blurb on the back cover describes it, or the result of “the most extensive investigation by a reporter into an aspect of medicine ever undertaken”, as the author describes it, history will decide. But it has to be said that the subject of the book has caused immeasurable damage to the lives of many thousands, and possibly millions, of people.

Therefore we deemed it appropriate to run two reviews – the first by your editor, and the second by noted anti-anti-vaccination campaigner Peter Bowditch, who adds a personal perspective.

Brian Deer is an experienced journalist with a list of exposes of medical fraud and mispractice in his CV. But Wakefield is probably his magnum opus. He has spent 16 years following the saga of Andrew Wakefield, “the doctor without patients”. He wrote a number of revelatory articles on Wakefield’s progress for the Sunday Times, the publication that supported him throughout, both financially and legally, as well as many TV, radio and public appearances, and a significant expose in the British Medical Journal.

Readers of this publication will be aware of Andrew Wakefield’s role in the anti-vaccination movement – the search for autistic kids who could be linked to the measles/MMR vaccine, publication in The Lancet, Wakefield’s promotion of the ‘link’ which lead to a major decline in MMR vaccinations across the world and consequent increases in cases of measles and the damage that has caused.

Deer came to this story during the anti-vaccination campaign, with Wakefield a high-profile figure riding a wave of publicity and, frankly, adulation. From 2002 until the writing of this book in 2019, Deer has followed the vicissitudes of his subject, and played a key role in exposing a range of misconduct and duplicity that eventually led to the longest-ever inquiry by the UK General Medical Council (GMC). In January 2010, the GMC judged Wakefield to be “dishonest”, “unethical” and “callous”, and on 24 May 2010, Wakefield was struck off the UK medical register. Responding to Deer’s findings, The Lancet partially retracted Wakefield’s research in February 2004 and fully retracted it in February 2010 following the GMC findings. In 2011, Deer published his findings in the BMJ with an endorsement by the editors.

Wakefield, of course, became a tragic hero of the anti-vaccination movement, a martyr to the cause, now living in the US and still promoting the supposed autism link, despite the masses of evidence against him and his claims.

Needless to say, Wakefield does not come out of it looking rosy. In fact, Deer portrays Wakefield as an opportunist, a mediocre researcher who used his personal charisma as a tool to promote himself, and who cottoned on to a ‘good thing’ and milked it – and continues to milk it – for everything it’s got.

But Deer makes clear that, despite the book’s title, there were many others contributing to the failed theory and whose involvement made them just as guilty as Wakefield; it is just that Wakefield had the charisma and drive – if not the medical knowledge and skill – to push the case to a broader public. These others include scientific and medical associates, adulatory followers, politicians, parents, learned journals, lawyers (importantly) and, of course, a complicit media. Some of these have paid the price of their association with Wakefield.

But Deer’s coverage of the media is a bit surprising. This reviewer’s background is journalism, and seeing how the media promoted and boosted Wakefield’s scare tactics was always disappointing, to say the least! There would not have been a vaccine scare without some media putting the case in hyperbolic terms. Their role in the growth of the anti-vaccination movement is considerable and intrinsic to spreading misinformation and paranoia.

Therefore, it is interesting that Deer doesn’t spend more time on the media’s involvement. Certainly, he makes reference to a number of specific and highly partisan journalists, such as Lorraine Fraser of the Mail on Sunday, Jeremy Paxman and Susan Watts on the BBC’s Newsnight, and Matt Lauer of the NBC’s Today program, but his coverage of the media is as much about their attacks on him as it is their support for Wakefield, and in some cases, once Deer’s work had been publicised, trying to gazump him with a scoop.

With that in mind, Deer’s book covers a lot of his investigation in addition to what he is investigating. This adds an element akin to a detective thriller, which takes the book along at a very readable pace. Overall, media coverage notwithstanding, this is an excellent book. The depth and detail are spot on, from well-explained scientific and medical protocols and procedures to well-told human interest elements (the parents’ responses ranging from suspect support to desperate self-blame).

It is highly likely that this is the definitive version of the Wakefield and Co saga. Now for one on the evolution of the anti-vaccination movement to complement it.

PS: The story is bookended by a couple of Australians. In the beginning was John Walker-Smith, a gastroenterologist who was instrumental in testing the children who would eventually become the basis of The Lancet paper (and who only just missed out on suffering the same professional fate as Wakefield), and at the tail end we have Elle ‘the Body’ Macpherson, super-model and consort of the superstar Wakefield. One wonders whether everyone got their just desserts.

– Reviewed by Tim Mendham

In 1996 I was commissioned to write a book about the Internet. It was to explain to people who didn’t know anything about it or the technology behind it or what it could be good and bad for. There was some hysteria about the possibility of a flood of pornography filling our lounge rooms so I actually had to research porn (it was boring!) to answer the inevitable questions in interviews. I also looked for other forms of bad information because it was obvious even then that there would be dubious information coming down the tubes. One of the bad things I found was a group of websites spreading fear about vaccinations. I commented at the time that none of the pornography I was forced to watch was as offensive as some of these sites.

In 1999 I started paying more attention to the anti-vaccination sites and it wasn’t long before I was sneeringly told that a paper by a Dr Andrew Wakefield had been published in The Lancet (the world’s second-most prestigious and influential medical journal) which proved that the MMR vaccine caused autism. As I had experience of people citing unlikely research results in the hope that nobody would check, I read the paper for myself (I had access to the medical library at Westmead Hospital) and it proved no such thing – it only suggested there might be a link. There were several red flags on the paper, one of which was that the editors of The Lancet felt the need to include an editorial statement implying the clichés “further research is needed” and “the science is not settled”.

The biggest red flag for me came from something I had been taught about research methodology at university – the sample of subjects looked too good to be true. It seemed highly unlikely that the parents of the children had independently and randomly sought out a doctor (who didn’t see patients!) at a small and relatively unknown London hospital. I mentioned my concerns in a conference presentation in 2001. The most charitable view was that there had been some cherry-picking going on mixed with some confirmation bias. The peer review process can’t always detect outright fraud, so this was a case of “the benefit of the doubt”.

But fraud it certainly was.

Journalist Brian Deer had been investigating suspicious matters around the pharmaceutical industry for some years, and in 2003 he was approached by an editor at the Sunday Times and asked to apply his investigative skills to the Wakefield story, which by then had started to have a serious effect on vaccination levels and public health. There was enough information and doubt from within the medical profession itself to suggest that the public didn’t know all the things it should have known, and it wasn’t long before the facts started coming out – that Wakefield was paid a large amount of money to find what he wanted to find, that he had applied for a patent on a measles vaccine that would have made him very wealthy if it replaced the current vaccine, that the subjects of the study had not been randomly chosen but had been supplied by a lawyer, Roger Barr, who intended taking legal action against vaccine manufacturers, that Barr had used a loophole in the regulations to stripmine the Legal Aid system for tens of millions of pounds (shared with Wakefield), that Wakefield and Barr both had close associations with prominent anti-vaccination campaigners, that the laboratory doing the tests for measles DNA had less credibility than a school science project … the list went on.

In 2010 Wakefield’s registration as a medical practitioner was cancelled and The Lancet retracted the 1998 paper. It took too many years, but we thought that at last it might all be over. We were wrong.

Brian Deer (described as “a lying dog of a journalist” by a leading anti-vaccination campaigner) has now written a complete history of the Wakefield saga. The book goes back some years before the notorious 1998 paper to reveal the involvement of lawyer Barr and vociferous anti-vaccination organisations, through the almost unbelievable litany of lies, corruption and fraud that surrounded Wakefield and the coordinated attempts to use his fraudulent “research” to damage the public’s perception of the safety and efficacy of vaccines, to his elevation to hero status in the anti-vaccination movement and his current incarnation as the director and producer of anti-vaccination films liked the execrable “Vaxxed: From Cover-Up to Catastrophe”. (The use of the word “cover-up” in the title caused irony meters across the world to shatter, given the way that Wakefield et al had covered up his deceit. Also, when the film first came out in 2016 someone commented about the propaganda: “Leni Riefenstahl would have baulked at making something this dishonest”.)

I could summarise the book into something like those old Reader’s Digest condensed novels, but I wouldn’t know what to leave out and this review would be about 300 pages long. The book is an essential read for anyone who has followed Wakefield over the years (and even I, who have followed him very closely, found many new things to wonder and grimace at). It is essential reading for anyone who thinks that scientific and medical research can’t be corrupted by greed and self-interest or to support an agenda. And it is essential reading for anyone who thinks for a nanosecond that the anti-vaccination movement is based on any philosophy that includes honesty, ethics or morality. Strangely, the book also reinforces the claim by anti-vaccinators that all medical research is corrupt and driven by money, although they will make an exception in this case.

You need this book. Buy it! Highly recommended.

– Reviewed by Peter Bowditch

Why anti-vaxxers get it so wrong

By Tim Harding

The inability to accurately appraise one’s own knowledge is a cognitive bias known as the Dunning-Kruger Effect, first identified from social psychology experiments conducted in 1999. Dunning-Kruger effects occur when individuals’ lack of knowledge about a particular subject leads them to inaccurately gauge their expertise on that subject. Ignorance of one’s own ignorance can lead people who lack knowledge on a subject to think of themselves as more expert than those who are comparatively better informed.

A recent study published in the peer-reviewed journal Social Science and Medicine (and summarised in The Conversation) demonstrated that at least some anti-vaccination views are based on the Dunning-Kruger Effect.  The study found that 71 per cent of those who strongly endorse misinformation about the link between vaccines and autism feel that they know as much or more than medical experts about the causes of autism, compared to only 28 per cent who most strongly reject that misinformation.

The researchers found that nearly a third, or 30 percent, of people who think that they know more than medical experts about the causes of autism strongly support giving parents the latitude to not vaccinate their children. By contrast, 16 percent of those who do not think that they know more than medical professionals felt the same way.

The study also found that people who think they know more than medical experts are more likely to trust information about vaccines from non-expert sources, such as celebrities. These individuals are also more likely to support a strong role for non-experts in the process of making policies about vaccines and vaccination.

Whilst these recent research findings may not come as a surprise to seasoned skeptics, we now have  empirical evidence to explain why at least some anti-vaccination views are so irrational.

Science debunks fad autism theories, but that doesn’t dissuade believers

By Scott O Lilienfeld, Emory University

According to a 2014 National Consumers League poll, 29% of American adults believe that childhood vaccinations can trigger autism. To many, these views are difficult to comprehend. After all, multiple controlled studies conducted on huge international samples have debunked any statistical association between vaccines and autism. Moreover, when the Danish government removed thimerosal – a mercury-bearing preservative that most anti-vaccine advocates regard as the suspect ingredient – from its vaccines in the late 1990s, the rates of autism went up rather than down. Why, then, does the belief persist?

Well, it’s not that surprising. The false link between autism and vaccines is merely the tip of a massive iceberg of fads and misconceptions. In a 2008 review, psychologist Tristram Smith of the University of Rochester Medical Center identified more than 50 disproven or unsupported therapies for autism that were still in use, and the number has only mushroomed since then. These therapies run the gamut from gluten-free and casein-free diets, anti-fungal treatments, Pepcid, testosterone and secretin to dolphin-assisted therapy, magnetic shoe inserts, hypnosis, hyperbaric oxygen chambers, sheep stem cell injections, trampoline therapy…and on and on.

Facilitated communication taps into misconceptions about autism. Source: Pins via Shutterstock

Debunking another fad treatment – facilitated communication

Despite the prevalence of these fad therapies, relatively few scientists who study autism have raised their voices to rebuke these methods. Perhaps that is because most do not regard public outreach as part of their job description.

In a recent article in the journal Evidence-Based Communication Assessment and Intervention, my co-authors Julia Marshall, Howard Shane, James Todd and I examined the persistence of facilitated communication, a scientifically discredited autism therapy. The premise of facilitated communication is that autism is primarily a movement disorder, not a mental disorder. As a consequence of supposed motor deficits, individuals with autism cannot articulate words properly, which presumably explains why many are incapable of speech. With the aid of a facilitator who offers gentle support to their arms, previously uncommunicative individuals with autism can supposedly type eloquent sentences and paragraphs.

If it all sounds too good to be true, that’s because it is.

Scores of controlled studies performed soon after the widespread introduction of facilitated communication to the United States in the early 1990s demonstrated that its seeming effectiveness is a mirage. Facilitators are unintentionally directing autistic individuals’ fingers to the desired letters, much as Ouija board players unknowingly direct the planchette to specific letters and numbers.

We found that facilitated communication, despite being debunked by the late 1990s, remains alive and well in much of the autism community. The method continues to be widely practiced in the US and parts of Europe. It’s still publicized in numerous trade and academic books, seminars, workshops and high-profile documentaries.

This revelation has taken many of our academic colleagues by surprise. One told me that earlier this year, he had invoked facilitated communication in a psychology course as a prime example of a fad that had long been consigned to the dustbin of pseudoscientific history. This is a critical point – for scientists these matters are settled. But that doesn’t mean the information in studies disproving claims from fad therapies has hit the mainstream.

Autism symptoms can wax and wane. Source: Gears via Shutterstock

Why is there so much misinformation about autism?

Why is autism such a magnet for fads? And why have discredited ideas endured in the face of contrary evidence? Several likely culprits conspire to create a “perfect storm” making those desperate for a cure or an effective treatment receptive to misinformation.

In the case of the autism-vaccine link, the soaring increase in autism diagnoses over the past two decades is certainly a contributor. But there is growing evidence that much of this spike reflects two factors: increasingly lax criteria for autism diagnosis across successive editions of the official psychiatric diagnostic manual (DSM), and heightened incentives for school districts to report autism and other developmental disabilities.

There is therefore ample reason to doubt that the “autism epidemic” actually reflects a genuine increase in the frequency of the condition. But the dramatic rise in diagnoses has led many people to believe in shadowy causal agents, such as childhood vaccinations.

The fact that the symptoms of autism typically become evident at about age two, soon after routine vaccinations begin, lends this belief further surface plausibility. The link in timing is coincidental, but some people connect the dots into a tidy causal narrative.

And many fad treatments for autism are surely born of desperation. There are no known cures for the condition. It’s not surprising that most parents of children with autism simultaneously seek out four to six different treatments for their children. Nor it is surprising that this field has been remarkably fertile ground for ostensible quick fixes, such as facilitated communication.

And some probably fall victim to a diabolical illusion. A number of the behavioral problems associated with autism, such as inattention and anger, often wax and wane over brief periods of time. If a natural – and unrelated – downtick in symptoms happens during or after therapy is delivered, parents and teachers may then conclude that the treatment brought the improvement, even though the decline in symptoms would probably have occurred anyway.

We see what we want to see. Source: Image of boy via Shutterstock

With autism, we sometimes see what we want to see

Appearance shapes how we view autism. Children with autism do not have the distinctive facial markers of, say, children with Down Syndrome or fetal alcohol syndrome. That fact might lead some to assume that individuals with autism are cognitively and emotionally normal individuals trapped inside a malfunctioning body. If that is so, all that is presumably required is an intervention, such as facilitated communication, to unlock their unrealized mental potential.

The popularity of autism fads imparts two sobering lessons. First, we can all be misled by the raw data of our sensory impressions. Virtually all autism misconceptions stem largely from what psychologists call naïve realism, the error of placing uncritical trust in our unfiltered observations. Second, scientists need to play a more active role in combating false information about autism and other mental disorders.

When researchers conduct studies that dispel the alleged dangers of vaccines or the alleged effectiveness of pseudoscientific treatments, they may assume that their job is done. That’s not the case. The legacy of autism fads suggests that their real work may have only just begun.

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Tristram Smith’s study “Empirically supported and unsupported treatments for autism spectrum disorders” appeared in the Scientific Review of Mental Health Practice. 2008; 6:3–21.

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

Six myths about vaccination – and why they’re wrong

By Rachael Dunlop, University of Technology, Sydney

Recently released government figures show levels of childhood vaccination have fallen to dangerously low levels in some areas of Australia, resulting in some corners of the media claiming re-ignition of “the vaccine debate”.

You can check how your postcode rates here.

Well, scientifically, there’s no debate. In combination with clean water and sanitation, vaccines are one of the most effective public health measures ever introduced, saving millions of lives every year.

Those who claim there is a “debate” will cite a series of canards designed to scare people away from vaccinating, but, if you’re not familiar with their claims, you could easily be convinced by anti-vaccine rhetoric.

So what is true and what is not?

Let’s address just a few of the common vaccine myths and explain why they’re wrong.

1. Vaccines cause autism

The myth that vaccines are somehow linked to autism is an unsinkable rubber duck. Initiated in 1998 following the publication of the now notorious Lancet paper, (not-a-Dr) Andrew Wakefield was the first to suggest that the measles mumps rubella (MMR) vaccine might be linked to autism.

What he didn’t reveal was that he had multiple conflicts of interest including that he was being paid by lawyers assembling a class action against the manufacturers of MMR, and that he himself had submitted an application for a patent for a single measles vaccine.

It eventually unravelled for Wakefield when the paper was retracted in 2010. He was struck from the medical register for behaviour classified as “dishonest, unethical and callous” and the British Medical Journal accused him of deliberate fraud.

But once the idea was floated, scientists were compelled to investigate, particularly when it stood to impact public health so dramatically. One of the most powerful pieces of evidence to show that there is no link between vaccines and autism comes from Japan where the MMR was replaced with single vaccines mid-1993. Guess what happened? Autism continued to rise.

We currently don’t know what causes autism. But we do know what doesn’t: vaccines. Image from shutterstock.com

After this door closed, anti-vaxers shifted the blame to thiomersal, a mercury-containing component (not be confused with the scary type that accumulates in the body). Small amounts of thiomersal were used as a preservative in some vaccines, but this never included MMR.

Thiomersal or ethyl-mercury was removed from all scheduled childhood vaccines in 2000, so if it were contributing to rising cases of autism, you would expect a dramatic drop following its removal. Instead, like the MMR in Japan, the opposite happened, and autism continues to rise.

Further evidence comes from a recently published exhaustive review examining 12,000 research articles covering eight different vaccines which also concluded there was no link between vaccines and autism.

Yet the myth persists and probably for several reasons, one being that the time of diagnosis for autism coincides with kids receiving several vaccinations and also, we currently don’t know what causes autism. But we do know what doesn’t, and that’s vaccines.

2. Smallpox and polio have disappeared so there’s no need to vaccinate anymore

It’s precisely because of vaccines that diseases such as smallpox have disappeared.

India recently experienced two years without a single case of polio because of a concerted vaccination campaign.

Australia was declared measles-free in 2005 by the World Health Organization (WHO) – before we stopped being so vigilant about vaccinating and outbreaks began to reappear.

The impact of vaccine complacency can be observed in the current measles epidemic in Wales where there are now over 800 cases and one death, and many people presenting are of the age who missed out on MMR vaccination following the Wakefield scare.

In many ways, vaccines are a victim of their own success, leading us to forget just how debilitating preventable diseases can be – not seeing kids in calipers or hospital wards full of iron lungs means we forget just how serious these diseases can be.

3. More vaccinated people get the disease than the unvaccinated

Although this sounds counter-intuitive, it’s actually true, but it doesn’t mean that vaccines don’t work as anti-vaxers will conflate. Remember that no vaccine is 100% effective and vaccines are not a force field. So while it’s still possible to get the disease you’ve been vaccinated against, disease severity and duration will be reduced.

Those who are vaccinated have fewer complications than people who aren’t. Image from shutterstock.com

With pertussis (whooping cough), for example, severe complications such as pneumonia and encephalitis (brain inflammation) occur almost exclusively in the unvaccinated.

So since the majority of the population is vaccinated, it follows that most people who get a particular disease will be vaccinated, but critically, they will suffer fewer complications and long-term effects than those who are completely unprotected.

4. My unvaccinated child should be of no concern to your vaccinated one

Vaccination is not just a personal issue, it’s a community responsibility, largely because of a concept known as “community immunity”. This describes a level of vaccination that prevents epidemics or outbreaks from taking hold and spreading.

Some people question the validity of this concept, sometimes referred to as herd immunity, but the impact of it breaking down can be easily observed in places where vaccination levels fall dangerously low – take the current measles outbreak in Wales, for example.

The other important factor about community immunity is it protects those who, for whatever reason, can’t be vaccinated or are not fully vaccinated. This includes very young children, immunocompromised people (such as cancer sufferers) and elderly people.

5. Vaccines contain toxins

A cursory search of Google for vaccine ingredients pulls up a mishmash of scary-sounding ingredients that to the uninitiated can sound like “franken-science”.

Some of these claims are patently untrue (there is no anti-freeze in vaccines), or are simple scaremongering (aborted foetuses – in the 1960s some cells were extracted from a foetus to establish a cell line that is still used in labs today). Some of the claimed chemicals (and remember everything is made of chemicals) are present, but are at such low levels as to never reach toxicity.

A pear has 600 times more formaldehyde than a vaccine. Image from shutterstock.com

The simple thing to remember is the poison is in the dose – in high enough doses even water can kill you. And there’s 600 times more formaldehyde in a pear than a vaccine.

Also, if you ever read the claim that “vaccines are injected directly into the blood stream” (they’re not), be sceptical of any other claims made.

6. Vaccines will overwhelm kids’ undeveloped immune systems

The concept of “too many too soon” was recently examined in a detailed analysis of the US childhood immunisation schedule by The Institute of Medicine. Experts specifically looked for evidence that vaccination was linked to “autoimmune diseases, asthma, hypersensitivity, seizures, child developmental disorders, learning or developmental disorders, or attention deficit or disruptive disorders”, including autism. The researchers confirmed that the childhood vaccination schedule was safe.

The amount of immune challenges that children fight every day (between 2,000 to 6,000) in the environment is significantly greater than the number of antigens or reactive particles in all their vaccinations combined (about 150 for the entire vaccination schedule).

So the next time you hear these myths about vaccination, hopefully you’ll have some evidence up your sleeve to debunk them.

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.