Medical Examiner

Wakefield’s First Try

Before the disgraced doctor Andrew Wakefield said that the MMR vaccine caused autism, he thought that it led to Crohn’s disease.

Andrew Wakefield

Last week, Andrew Wakefield, the man who is associated with proposing the highly controversial link between the MMR vaccine and autism, was struck off the U.K. medical register —essentially, he lost his license. The author of the infamous 1998 Lancet paper retracted earlier this year by the publication, Wakefield is also known for his inappropriate attempts to prove his hypothesis: At one time, he even bragged about subjecting children at his son’s birthday party to blood tests and paying them 5 pounds a pop. He is also said to have conducted other invasive procedures on children that he wasn’t qualified to perform, without proper ethical approval. The General Medical Council said that he had “callous disregard for the distress and pain the children might suffer.”

Over the last decade, Wakefield has been named a hero by several autism groups and endorsed by former Playboy Playmate Jenny McCarthy. But rather than making him a pariah, last week’s decision seems only to serve as further fuel for him to plug his conspiracy stories as he travels around the United States promoting his new book Callous Disregard. The man is said to be responsible for a sharp reduction in the number of children being inoculated for MMR, allowing the number of measles cases in the United Kingdom to soar to more than 1,300 in 2008, compared with 56 in 1998. It is deeply troubling that Wakefield’s new book rocketed into Amazon’s list of best-selling parenting titles.

But although it made him famous, the MMR-autism link was not Wakefield’s first attempt to connect the vaccine with chronic health problems. Since 1989, he has tried desperately to convince the world of several theories involving the measles virus, measles vaccine, and the MMR vaccine—all of which have now been scientifically disproven.

So where did it all begin? After qualifying from St. Mary’s Hospital at the University of London in 1981, Wakefield specialized in surgery and worked in intestine transplant surgery for a few years. However, he decided to move into research and focused on Crohn’s disease, a chronic and severe inflammatory disorder of the bowel. Its cause remains a mystery, but in the late 1980s, Wakefield announced he had discovered that the root of Crohn’s disease was the measles virus.

In 1993, in a paper published in the Journal of Medical Virology, Wakefield said that his analysis showed that 13 out of 15 histological intestinal tissue samples from patients with Crohn’s were positive for the RNA of the measles virus. From this he proposed that the measles virus may have caused Crohn’s in those patients. Wakefield continued to publish papers to this effect in the Lancet and elsewhere. By 1995, his claims had evolved. He now argued that the measles virus and measles vaccinations were associated with not only Crohn’s but also ulcerative colitis, another serious and chronic inflammatory disease of the large intestine and rectum.

Karel Geboes, a professor in pathology from Belgium, was never convinced by the strength of Wakefield’s studies in this field and said that he “over-interpreted” his findings: “He is not a pathologist but a surgeon. … His claim was too rigorous, and there was no real proof for the hypothesis. It is not enough to find viral material—there are plenty of studies showing the presence of microorganisms.” Finding microorganisms doesn’t mean that they caused the disease in question.

Meanwhile, Wakefield seemed to have become a regular at the patent office. In 1996, he filed for a patent for a method of diagnosing Crohn’s or ulcerative colitis by detection of the measles virus—and he applied for the patent under his home address rather than his institute’s address. That is just “bizarre behavior,” says Tom MacDonald, dean of research and professor of immunology at Barts and the London School of Medicine and Dentistry.

A year later he would patent a “safer” measles vaccine; though this was just a year before his MMR-autism paper was published in the Lancet, he did not declare this patent in his conflicts of interest to the editors of the publication. By this point, Wakefield had begun to propose that the MMR vaccine and its three virus strains put pressure on the body’s immune system, which resulted in the development of Crohn’s or ulcerative colitis. If the Department of Health listened to him and took MMR off the shelves, his new patent and vaccine could have been very profitable.

Wakefield kept quite busy in addition to his studies on Crohn’s. In two decades, his work has been published in gastroenterology, rheumatology virology, dermatology, and urology journals. His studies included ferret, pig, and rat models. He conducted biotechnology studies, liver studies, and even looked at the effects of smoking and the contraceptive pill on Crohn’s disease; an unusual array of work for one researcher. Wakefield was desperately trying to make his name in research, and it didn’t seem to matter what field it was in.

But more and more research groups, with more sophisticated techniques, failed to confirm Wakefield’s findings. In 1998, the chief medical officer from the U.K. Department of Health and a group of experts reviewed Wakefield’s studies and concluded that the there was no support for a causal role for the measles virus infection in Crohn’s disease. Furthermore, they found that there was no link between the MMR vaccine and bowel disease. In 2000, the U.K. Medical Research Council also conducted a review and came to the same conclusion, as did a Japanese research group: “We failed to detect any measles virus genome or measles virus antigen in gut tissue from patients with [inflammatory bowel disease],” the authors stated. So Wakefield abandoned his initial theory on Crohn’s disease and measles.

In 1996, just as Wakefield began to get hit with fierce criticism about his Crohn’s claims—culminating in a British TV program called The Big Story—along came a solicitor, Richard Barr, who was representing parents who believed that their children had been harmed by the MMR vaccine. Investigations by journalist Brian Deer in the Sunday Times questioned Wakefield’s conflicts of interest in the Lancet study, and he reported that Barr was desperately looking for some scientific basis for claims that the MMR vaccine caused a wide range of adverse effects, including bowel and developmental disorders. It later transpired in the General Medical Council hearing, as Deer had previously reported, that Barr had paid Wakefield nearly 450,000 pounds with money from the U.K. legal aid fund to conduct his 1998 Lancet study, all financial conflicts that he never declared to the Lancet.

His failure to establish a link between the vaccine and Crohn’s link did not teach Wakefield to think smaller: Soon after meeting Barr, his ideas became bigger and more complicated, and he had now “discovered” a new link between the MMR shot and autism.

Michael Fitzpatrick, a general practioner who is the father of a boy with autism as well as the author of MMR and Autism: What Parents Need To Know, explains Wakefield’s new four-stage theory: 1) The measles virus or vaccine caused persistent infection, which became localised in the bowel; 2) the patient went on to develop inflammatory bowel disease, which resulted in a leaky bowel; 3) the leaky bowel allowed toxic peptides to get into the bloodstream, 4) which reached the brain and resulted in autism. Wakefield even went on to announce a “new” disorder associated with the MMR vaccine. He labeled it “autistic enterocolitis”—but it is still not recognized in the gastroenterology field.

Sadly, despite scientific evidence, some parents of autistic children still hang onto Wakefield’s every word and will continue to support him. “Led by the pharmaceutical companies and their well-compensated spokespeople, Dr. Wakefield is being vilified through a well-orchestrated smear campaign,” Jenny McCarthy claimed when the Lancet withdrew the MMR-autism study. Wakefield seemed to think that people who did not accept his theories had a personal vendetta against him. “This was a recurrent feature of Wakefield’s approach to research,” said Fitzpatrick. “He could not accept evidence that contradicted his hypothesis, which became a conviction sustained by faith in face of the evidence.”

But why did the autism idea stick when the Crohn’s theory never did? Tom MacDonald notes that autism is very difficult to study, while Crohn’s researchers can actively take samples, and patients are available for assessment. “However,” he says, “no one can get into the gut of autistic kids because it is unethical.”

It looks like Wakefield has found his key audience and supporters in the United States, where he is now based. As he continues to tour the United States, telling parents that “the scientific system has failed you,” real scientists will continue to endeavour to use appropriate research methods to try and find the cause or causes of autism.

“Once a crook,” Ingvar Bjarnason, professor of digestive diseases and consultant physician at King’s College Hospital, says of Wakefield, “always a crook.”

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