And those magic wristbands don’t work, either

6 01 2011

Andrew Wakefield is a fraud—and the British Medical Journal has the evidence to prove it.

I tend to stay away from anti-vaxers, not because they don’t deserve the derision, but because there are many who are much better situated than me (see, for example, this post by Orac at Respectful Insolence) to take ’em on.

It’s not that there are no risks associated with vaccines or that no one has ever been adversely affected by vaccines—every year, for a quick example, there are people who are adversely affected by the flu vaccine who likely would have been fine without it—but one has to be clear what those risks are.

Stating that the measels, mumps, and rubella (MMR) vaccine causes autism is not clarifying those risks.

In fact, Wakefield was not only wrong when he made that connection in a 1998 Lancet article (an article which was retracted in 2010), he was deliberately wrong, that is, he fucked with the data. As the editors of BMJ note:

The Office of Research Integrity in the United States defines fraud as fabrication, falsification, or plagiarism. Deer unearthed clear evidence of falsification. He found that not one of the 12 cases reported in the 1998 Lancet paper was free of misrepresentation or undisclosed alteration, and that in no single case could the medical records be fully reconciled with the descriptions, diagnoses, or histories published in the journal.

Who perpetrated this fraud? There is no doubt that it was Wakefield. Is it possible that he was wrong, but not dishonest: that he was so incompetent that he was unable to fairly describe the project, or to report even one of the 12 children’s cases accurately? No. A great deal of thought and effort must have gone into drafting the paper to achieve the results he wanted: the discrepancies all led in one direction; misreporting was gross. Moreover, although the scale of the GMC’s 217 day hearing precluded additional charges focused directly on the fraud, the panel found him guilty of dishonesty concerning the study’s admissions criteria, its funding by the Legal Aid Board, and his statements about it afterwards.

Furthermore, Wakefield has been given ample opportunity either to replicate the paper’s findings, or to say he was mistaken. He has declined to do either. He refused to join 10 of his coauthors in retracting the paper’s interpretation in 2004, and has repeatedly denied doing anything wrong at all. Instead, although now disgraced and stripped of his clinical and academic credentials, he continues to push his views. [emphasis added]

Again, I leave it to the medical and scientific folk to tear into Wakefield’s manipulations; I want to address the public health implications of his fraud.

BMJ’s editors note that it is difficult to trace declining vaccination rates in the UK and elsewhere directly to Wakefield’s work, but it is clear that rates had fallen after 1998, and are still below the World Health Organization’s recommended coverage of 95 percent of a population. In 2008, measles were “declared endemic in England and Wales”, and an outbreak of mumps in Essen, Germany revealed that of the 71 children affected, 68 hadn’t been vaccinated. Finally, according to a June 2009 Pediatrics article (as discussed in the Wired article linked to, above), pertussis rates jumped from 1000 in 1976 to 26,000 in 2004.

So what? So some kids get sick for awhile. Sucks for them, but that’s what they get for having anti-vax parents.

Except that it’s not fair for those kids, and it puts others at risk of morbidity and mortality. Measles can kill. Meningitis can kill. Pertussis can kill, and on and on. Furthermore, many of the diseases which can be prevented by vaccines depend on herd immunity—they work mainly by preventing a disease from settling into a reservoir in a population—which means that if enough people in any given group are unvaccinated, the disease can spread.

Again, what’s the problem? If folks don’t get themselves immunized, that’s on them.

But it’s not. There are some people—infants, transplant patients, people with compromised immune systems, those  who may be  allergic to (as I am to the egg in flu vaccines) or otherwise intolerant to ingredients in the vaccine, among others—who are vulnerable to outbreaks. And even those who have been vaccinated may be at risk if, say, an especially virulent form of a disease is allowed to spread.

So back to the beginning(ish): There are risks to vaccination, but so there are greater risks to not vaccinating, not only to yourself or your kid, but to everyone around you.

Some parents feel quite comfortable withholding vaccines from their kids, but the only reason they can safely do so is because every other parent is vaccinating her kids. And hey, guess what, if everyone else has to take the risk to keep the disease at bay, then so should the anti-vaxers. Unless they are willing to keep themselves and their kids away from everyone else for as long as they all remain unvaccinated, they are free-riding on the rest of us. They are, in a sense, ripping us off.

If you want the benefits, you have to bear the burdens.

Finally, it is worth noting, along with the editors of BMJ,that

[P]erhaps as important as the scare’s effect on infectious disease is the energy, emotion, and money that have been diverted away from efforts to understand the real causes of autism and how to help children and families who live with it.

Wakefield and Age of Autism and Generation Rescue are doing no favors for those who do have autism or their families. Jennifer McCarthy and JB Handley, parents of kids with autism, may sincerely believe their bullshit, but the sincerity of those beliefs does not make that bs any less malodorous.

Who knows, maybe there is a specific cause for autism, one which, if rooted out, could lead to the end of this syndrome.

But that cause ain’t the MMR vaccine.