Is This Doctor A Hero or A Health Risk?
By Tom Leonard for the Telegraph, UK http://tinyurl.com/q78yk
‘If I am wrong I will be a bad person because I will have raised this spectre. But I have to address the questions my patients put to me. My duty is to investigate their stories.” So said Dr Andrew Wakefield in March 1998, a week after he published research linking the MMR vaccination and autism.
The establishment view is – and has always been – that he was “wrong”, very dangerously wrong. And now the General Medical Council seems to think there’s a strong case for saying that Dr Wakefield may be a “bad person”, too.
So bad, indeed, that he could be charged with serious professional misconduct. This drastic move will once more polarise opinion around the person of this charming but determined doctor. Is he the victim of a government-inspired witchhunt or an irresponsible, publicity-obsessed maverick, peddling dubious science that has done enormous harm to public confidence in vaccination?
The GMC’s ultimate sanction would be to strike him off the medical register and stop him practising in Britain again, but this may be irrelevant. According to Dr Wakefield, 49, who now works in Texas where he continues to research autism, the damage has already been done and nobody in this country will ever employ him again. The once promising young gastroenterologist from the Royal Free Hospital in London says the controversy over his MMR claims has irreparably ruined his standing in the medical and scientific community.
Such a spectacular fall from grace has – both his supporters and detractors would agree – much to do with the “man with a mission” aura that has surrounded Dr Wakefield and seems so obvious in that early remark about his “duty” to investigate the stories of patients.
The parent of an autistic child and the head of a government health department are likely to have different opinions on whether it is right for a doctor to break so dramatically with the usual expectations of scientific objectivity and plunge into a fierce row with the authorities over vaccination. But he did, and if Dr Wakefield had remained simply an ordinary medical expert with a run-of-the mill health scare to impart, he certainly wouldn’t now be facing the GMC’s ultimate sanction and having his face plastered across the front page of a national newspaper under the headline “In the dock”.
Right from the start, the signs were clear that Dr Wakefield was in for the long haul. It is rare to call a national press conference to announce the results of a small-scale scientific trial, but he and four other Royal Free doctors (including the dean of the medical school) did so to reveal findings that suggested a link between vaccination of the combined measles, mumps and rubella vaccine, and bowel disorder and the onset of autism – a severe form of regressive behaviour – in children. Eight out of 12 children referred to the hospital had apparently developed autistic behaviour, as well as diarrhoea and abdominal pain, on average just “6.3 days” after receiving the jab.
Dr Wakefield had been researching such effects of MMR for some years but this was a sensational medical claim, given extra credence by being published in the Lancet.
At the press conference, Professor Arie Zuckerman, dean of the Royal Free, warned that it was “absolutely essential” that public confidence in MMR was not damaged but Dr Wakefield had a very different message to impart that day. While he admitted it was just one study and there was no conclusive proof, he called for the Government to end its policy dictating that every child should receive the first of two MMR inoculations between 13 and 15 months. “One more case of this is one too many,” he said. It was, he added, “a moral issue for me”. He couldn’t support the continued use of MMR until the issue had been resolved.
The Department of Health launched a vitriolic attack on Dr Wakefield and his views, which some believe made him even more zealous and obsessive in arguing his case.
Encouraged in the early days by parents – particularly middle-class ones – of autistic children desperate to find an explanation for how their apparently normal children had failed to continue developing normally, the press latched on to the study. Scepticism about the trustworthiness of health officials was widespread following the mad cow debacle. Some journalists had a personal involvement with autistic children; for others, the row offered an opportunity to attack the government, and particularly Tony Blair.
The Daily Mail’s enthusiasm was a crucial factor in propelling the story on to the front page. The paper was particularly incensed by the Blairs’ refusal to say whether baby Leo had received the MMR vaccine, and the Prime Minister even went on the internet to urge parents to embrace the triple jab.
Photogenic and athletically built, Dr Wakefield certainly wasn’t shy about talking to the media and usually received a sympathetic hearing. Some have speculated that he began to enjoy being in the spotlight as a medical crusader.
Meanwhile, criticism from the Government was followed by implied criticism from his collaborators, who had kept a lower profile. Dr Simon Murch, the 1998 study’s co-author, stated five years later there was “unequivocal evidence” that MMR was not a “risk factor for autism” and warned of the likelihood of a measles epidemic because of the low rate of vaccination – which sank to 61 per cent in some parts of London.
When Dr Wakefield retorted that his former colleague had caved in to pressure from his bosses at the Royal Free, Dr Murch countered that he and the other consultants involved in the research had previously written to the Lancet backing the continued use of MMR, but no one took much notice.
The Wakefield camp suffered a further setback in 2004 when it emerged that he had received £55,000 towards his research from lawyers acting for parents who claimed that the MMR jab had damaged their children. The Lancet’s editor claimed he would never have published the 1998 study if he had known of this and it was partially withdrawn.
Meanwhile, the Wakefields’ home life was in turmoil. Andrew, the son of a neurologist and a GP, had left the Royal Free in 2001 saying his position had become untenable (a month after being made a Fellow of the Royal College of Pathologists). He even claimed that the phone at his home in south-west London, which he shared with his wife Carmel, another doctor, and their four children was tapped.
He moved to America to find work – his second transatlantic career move given that he had originally worked in Canada as a transplant surgeon in the late Eighties.
But the rise of autism in children has yet to be satisfactorily explained and for the parents searching for an answer, Dr Wakefield will remain a hero whatever the GMC has to say. Jackie Fletcher, the founder of JABS, a parent support group for children allegedly harmed by vaccination, said she was “appalled” by the news of the GMC investigation.
“All he’s done is what a good clinician should do, which is to investigate his children clinically and then report his findings,” she said.
She concedes that experts have yet to confirm Dr Wakefield’s concerns but says clinicians are still saying that more research needs to be carried out.
Dr Wakefield didn’t initiate the scare, she says – that was done by parents of autistic children shortly after the MMR vaccine was introduced 10 years earlier. “Instead of being criticised, every other doctor should be following his example and listening to what parents are saying.”
Andrew’s mother, Dr Bridget Wakefield, has said that her son is “very like” her own father, another doctor.
“If he believed in something, he would have gone to the ends of the earth to go on believing,” she said. This may translate into a good bedside manner but is it really a good example for doctors to follow?