A Study of Disinformation

Abstract

Dateline February, 2010. The premier, usually reliable British medical journal Lancet has announced the retraction of the journal’s publication of the influential 1998 Andrew Wakefield article which purported to show a definite link in 12 children who had received MMR vaccine and their subsequent diagnosis of autism.Lancet, which has retracted relatively few published studies in its 186-year history, acted following a report by a panel of the UK General Medical Council, which after a 2½-year review accused Wakefield and two colleagues of “dishonesty and irresponsibility” in the conduct of their research. Fiona Godlee, editor of BMJ (The British Medical Journal) applauded the Lancet retraction, stating that “this will help to restore faith in this globally important vaccine and in the integrity of the scientific literature.”A well-designed study by Mrożek-Budzyn and associates, to be published in Pediatric Infectious Disease, examined the possible increase in the risk of development of autism in children vaccinated with MMR vaccine.1 Their results support many earlier studies which argue against the Wakefield hypothesis that developmental changes in children with autism may have resulted from the presence of measles virus in the intestine of children vaccinated with MMR. In fact, this study came to an opposite conclusion — ie, children who had been vaccinated with measles vaccine alone had a lower risk of autism and an even lower risk if the source of the measles agent was MMR.Pediatricians are well aware of the public furor in the media following the Wakefield report. In England and the US, parents refused to allow their children to be immunized with measles vaccine, and their fear spread to a suspicion of all vaccines. This unfortunate development left thousands of children unprotected against an entire spectrum of preventable childhood diseases with the predictable increase in mortality and morbidity.The unconscionable result of this disinformation remains with us today, as parents bombarded with reports of the increased incidence of autism continue to reject the established safety of vaccines and remain under the influence of pseudoscience.The persistent questions raised by the “Wakefield-Lancet” mistake have added to the cynicism expressed by the public toward science in general and specifically childhood vaccination programs. The collaborative campaign by pediatricians and public health agencies to provide parents of US children authentic, accurate information about recommended vaccine practices will hopefully turn the tide and form a foundation for protecting our children.The extent of the havoc caused by the Wakefield2 paper is staggering and included: worldwide parental worry, delayed or refused vaccines, recrudescent disease with its attendant morbidity and mortality, and the waste of scarce resources by the autism community. Only now, as this tragic episode comes to an end, can we gain some perspective and try to discern what can be learned to reduce the risk of a repetition.Among the important lessons was the failure of multiple mechanisms to safeguard research subjects and ensure the integrity of clinical research.3 Wakefield was not simply a “bad apple” whose work was sensationalized by the media. The systems in place at the Royal Free Hospital where Wakefield worked were so seriously flawed and apparently compromised by conflict of interest as to justify regarding them as akin to unindicted coconspirators, and raise serious concerns about contemporary professional medical/scientific culture. Indeed, it appears it was the press, not the professional community, who first raised questions about the propriety of Wakefield’s studies. Those who might regard the press as a scientifically naive nuisance and the protections of human subjects by institutional review boards as impediments to progress would be well advised to delve into the detail of this debacle.