January 7, 2011

Wakefield And The Autism Fraud-- The Other Part Of The Story

get it?

Does the MMR vaccine cause autism?  Merely writing those words guarantees the google crawler is going to summon the trolls.  But it's a legitimate question, not legitimate in that it is true but legitimate in that since someone says it does, we should all be interested in finding out one way or another.

Short version: a paper in 1998 with more authors than test subjects observes that previously normal kids developed autism after the MMR vaccine.  Back and forth, the science is questioned, 10 of the authors renounce the study and Lancet ultimately retracts the study.

However, a new analysis finds that Wakefield wasn't just wrong, but he probably faked the study.

From AP:

The analysis [by Deer] found that despite the claim in Wakefield's paper that the 12 children studied were normal until they had the MMR shot, five had previously documented developmental problems. Deer also found that all the cases were somehow misrepresented when he compared data from medical records and the children's parents.
The obvious outrage is how this guy frauded all of us, and may have inadvertently/on purpose caused thousands of kids to not get the MMR vaccine.

But there are two other problems that should also generate outrage, or at least bafflement.

First, it's 2011.  The paper was written in 1998.  How long does it take to look over the primary source data? 

Which brings us to the next, larger problem: the people who finally reviewed Wakefield's paper, scrutinized the primary sources, and went and talked to the parents was not a team of neurologists or 3 new peer reviewers, but a journalist

That's who we have fact checking our science.

This journalist did what all of medicine did not do for a decade: email 12 people.


Hold on: as we now already knew for years, Wakefield wrote this paper in order to support a lawsuit against the vaccine manufacturers.  In 1998.  There were several other Illness v. Vaccine civil cases as well.


Let me spell it out for you: in these gigantic cases with millions of dollars at stake and every possible resource imaginable-- Wakefield himself got $500k-- no one in the legal community thought to verify the science either.  They just trusted the expert witnesses, who, of course, never read a primary source on anything-- always review articles and books.  All that money hinging on, essentially, the word of Wakefield, and no one bothered to check his work.

Think about this when you meet with your public defender.


I get it: Wakefield's evil.  A Big Legal shill who faked the data to enhance his testimony and own profits.  He probably thought-- and this is in fact what happened-- that it would be a small enough study that no doctor would care about it, but he could use it in court to say "there is evidence to support the notion that..."  And, indeed, no one read that paper until 2 years later, when Wakefield pressed his luck by writing more articles citing that study.

We should "extradite him to Britain to face fraud charges," said some article somewhere.

Whatever.  If you want to be cattle and moo with the herd, fine: blame Wakefield.  But Wakefield didn't do this, Wakefield is a product of this.  It's like blaming Bernie Madoff for the banking crisis.  He's guilty, but he isn't the cause of the problem, he's the result of the problem.

You scientists have created a system that trusts, implicitly, the word of every scientist-- except if he is getting paid by Pharma, of course (as everyone knows, NIH and university funds do not influence results.)  If he says the patient had a -7 on a scale, then it was -7, end of story. "Well, we have to trust the researcher a little bit, otherwise the whole architecture falls apart."  Exactly.   Why then do you not trust bankers that way?  If a banker lies he goes to jail. Are there any penalties for making up a study?  Do you seriously believe that scientists have less reason to nudge the numbers than bankers do? 

Then, you'll engage in serious academic disputes about whether MMRM is better than LOCF for analyzing a double blind study-- you'll assert that double blind trials are the gold standard!-   when you all know that 75% of the time we can tell if it's placebo or drug.  When you title the paper, "A Double Blind, Placebo Controlled Trial of---" you are lying.

And why wouldn't you?  The system is set up for you to lie.

Why, in the internet age, is the primary data not part of the paper? 

Peer Review is a joke-- why do you call it that?  They're not my peers, they're my close friends or my mortal enemies depending on my/my department's relationship with the editor; and they're not reviewing it, they're writing asinine, self-important comments that will never be noted after publication.

Why doesn't it change?  The answer is precisely in what Wakefield did: he wrote a tiny paper that he hoped would not be scrutinized (or even read.)  He just wanted to be able to say he wrote it, he wrote it not for science but for himself.  Now pick up any journal.  How many articles within are not for clinicians to act on, they're to put on a CV, get a promotion, get a grant, establish a name.  That's why we have ten million journals, none of which anyone reads, ever.

Fortunately enough good science gets done, loudly, powerfully, that medicine moves forward.  But the amazement shouldn't be that Wakefield's study was a fraud, the amazement should be why we haven't discovered hundreds of studies that are frauds.

I'll save you the meta-analysis: it's because we don't have enough journalists.


From 2009:

MMR Vaccine Finally Cleared Of Assault

Autism And The MMR Vaccine: Bait And Switch, For Profit