Autism, MMR and the consequences of misguided science.

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The news this week that The Lancet has retracted Andrew Wakefield’s 1998 paper claiming to have found a link between autism and the MMR vaccine is satisfying in the sense that the mills of science may grind exceeding slow but they grind exceeding small. Science – the process of peer review, of establishing the truth by attempting to replicate results independently – works.

The Lancet‘s withdrawal has come after Britain’s General Medical Council ruled (PDF) at the end of January that Wakefield had dishonestly misled The Lancet and its readers about the nature of the research and the criteria for the selection of subjects. It called Wakefield “callous”. In the meantime, Times journalist Brian Deer, besides mounting a campaign to discredit the paper, discovered a patent application with Wakefield’s name on it (PDF) for an alternative vaccine claimed to treat autism.

Discovering that your child has an autism spectrum disorder is a frightful experience; it happened to one of my oldest friends. First you’re happily and optimistically watching your child develop like any other excited parent – and then you’re watching your child regress and the gap between him and normal kids his age inexorably widen. You wonder what’s going on inside his mind; you worry about his care should something happen to you; and as he gets older you worry about how people will react to him when he passes puberty and non-standard behaviour becomes more scary than cute. With the number of diagnoses growing – the US Centers for Disease Control puts the rate at about 1 in 150 children; the advocacy organisation Autism Speaks says 1 in 110 – small wonder that terrified parents grasp at anything that looks like it might be a cure or a preventive measure. The coincidence of timing – MMR is administered at roughly the same age at which children begin displaying the symptoms of autism disorder – means that vaccines seem an entirely plausible cause.

Wakefield’s paper, which studied a sample of only 12 children, provided a plausible and simple answer: vaccines. That was helpful for Wakefield, who had a second career as a plaintiff’s expert in autism litigation. You can see the temptation: vaccines, unlike genetics, have manufacturers who can be sued. as Forbes has a nice piece on this type of conflict of interest, and proposes that academic journals should include opposition-side expert witnesses in the peer review panel for any author who has acted as an expert witness in litigation.

In the more than ten years since its publication, Wakefield’s paper has spawned an entire movement of anti-vaccinists. Utterly predictably, once-vanishing “childhood” diseases are on the rise, bringing back all the dangerous complications doctors invented vaccines to eradicate in the first place. There are the inevitable celebrities, most notably Jenny McCarthy. And, since everyone loves a good conspiracy theory, the sad thing is that retracting the paper merely fuels the martyred conviction of anti-vaccine groups that Big Pharma has won again.

In this situation, no one has won. The Lancet‘s reputation is damaged. Wakefield is likely to lose his licence to practise medicine. Children have died of diseases like whooping cough that were so long gone doctors don’t even recognise the symptoms. Despite lowered vaccination rates the number of autism cases continues to rise. And parents of autistic children are still desperate and frightened.

Tony Blair’s government must take some of the blame. The UK has sometimes backed invasive and expensive legislation on the basis that “If it saves the life of just one child…” But in this particular case, despite public loss of confidence after BSE, Blair basically told parents with concerns to shove it, take the vaccine, and shut up. He was, we now know, scientifically right, but he was culturally wrong. A more painstaking approach might have meant less rejection of the government’s backing of the MMR vaccine.

When I started The Skeptic the big topics we were concerned about tended to be psychic fraud. That stuff is small fry. It may be annoying that people believe in astrology or believe in the physical effects created by the occasional washed-up stage magician, but you don’t die of that kind of gullibility. The big stuff is science fraud, especially because while the scientific process can undo the damage and rebuild the truth, the consequences for innocent bystanders often can’t be undone.

Wendy M. Grossman, http://www.pelicancrossing.net

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