To think Andrew Wakefield has blood on his hands for causing so much distrust over the MMR?

[chicaguapa]

That's it really. He's caused so much damage with his stupid little study. It was years ago, he was struck off, the study was discredited, but people still don't get the MMR because of it.

Bruffin - its not about what you believe he was trying to connect. He didn't say it at that press conference - if you have the transcript then read it.

Magdalen - the paper was a case series, which surely you must know as you seem to be well informed about it. It has an obligation to recount either patient or parental observations. Listening to patients is quite an important skill for a doctor - their history might offer clues to both their affliction and their path to treatment. It is correct to include it and to mitigate its importance as the exclusive way to form a conclusion. It would have been perverse to ignore the parental/patient observations. Remeber this was in a climate where other doctors who saw autistic children in extreme gut pain wondered if they had eaten too much paper or sand - ignoring completely the parental description of terrible pain and diarrhea. Parents saw the Royal Free, John Walker-Smith, Simon Murch and Dr. Thompson as godsends. Wakefield's investigation was gut oriented based on the clinical care the other doctors provided. He had, I think, a hundred other papers to his name and was extremely well regarded. His investigation into Crohns and its possible connection to measles was the background that led a mother to reach out to him for help for her son. This work began because the safety tests of the MMR had not been well documented at the time and it was a potential suspect. Are you misrepresenting the paper? You seem to be selectively quoting from it - the paper was about autistic entrocolitis - you are tailoring the information to suit your point of view - I am pointing out your omisions - either you didn't know or you didn't care - if its the former then it is an understandable mistake. If it's the latter then, yes, keep loving the idea because you are misrepresenting the paper and perpetuating false and now dismissed allegations aimed at not simply Andrew Wakefield but the other doctors involved. To promulgate a falsehood or lie when you've been corrected is malicious.
Cheers.

Cheers cherries I'm 11 weeks pregnant today which is way more successful than the last pregnancies (I lose them stupidly early- would have thought it was a late period if not ttc).

So feeling more optimistic. Thanks for reading I read it back and it's a bit dull but if people don't know what happens in a clinical trial it might explain it a bit.

No epidemiological studies show a significant rise in Autism since the MMR was introduced. The studies would not show causality but not correlation.

Gosh, I'm incoherent and must get off to bed!

That great news! I will keep my fingers crossed for you (note the lack of science involved :-))

Wheshewasbad - just want to add my best wishes for a continuing pregnancy for you.

cherries you are aware that there is no statistically significant evidence crossing your fingers will help in anyway it is much appreciated though have a good night.

northern cheers

Sorry crossed post Bruffin.

Good quote - he certainly damns the MMR but doesn't say it causes autism and encourages people to vaccinate with single vaccinations. Nice conspiracy theory about the single vaccine but it already existed - that's what most of my generation had! Come on, Bruffin - let this one go. The paper says they proved no association. The paper said they needed more investigation. The press conference quote says he's not sure if it is safe in the polyvalent form - he told the Royal Free he was going to say that if he was asked. What he didn't say was the MMR causes Autism and no amount of you or Brian Deer or the media claiming otherwise will change that. He has been demonized because of this lie and his commentary in the press conference was more extreme than most of his colleagues wanted to go based on the evidence they had seen.

Magdalen.....

Cheers.

Wadham,
You are misrepresenting me. I responded to Cote's claim that Wakefield et al's paper had nothing to do with autism and MMR. This claim is easily shown to be false. I note you ignore the second quote where parental association is not mentioned?
I didn't say the paper claimed the MMR 'caused' autism, I used the word "linked".
Please read what I actually write, and not what you think I wrote. I made it quite clear, for example, that the initial bit I quoted refers to a parental association. To quote me "It seems to me that they're saying that eight of the 12 children's parents associated the onset of behavioural symptoms with the MMR vaccination." The quote from the end of the paper is actually rather a different kettle of fish since they (wakefield et al) then say "In most cases, onset of symptoms was after measles mumps and rubella immunisation. Further investigations are needed to examine this syndrome and its possible relation to this vaccine." Here they state a temporal correlation between the MMR and onset of symptom (the writers of the paper, not attributing it the parents here) and call for further work on the possible relationship between the syndrome and the vaccine. We all know correlation is not equal to causation, but I think it's fair to say the researchers are linking the onset of symptoms to the vaccine in their penultimate sentence, don't you? I mean, if they're not what are they saying?
Do you actually think the way the subjects were recruited and then reported upon was ethical, by the way?
Cheers.

I wontvdo links at the moment but someone on another forum did a lovely list of AW mmr causes autism quotes that he supposed to have never said. He said it many times.
AW tried to sue BD before and came out of it badly. Justice Eady said he wasn't acting like a man trying to clear his name because of the delaying tactics he had used to keep the case in court for 2 years. He was misusing the system to silence others.
The Texas case is hilarious in that he is suing for loss of reputation as if being struck off doesn't affect your reputation.

Hey Magdalen - you misrepresented(or not)by omitting information. I read your posts carefully - even the glib ones - which believe it or not I also found mildly amusing. The parental association is one small section of the paper - but it happens to be the one that can be selectively extracted to bolster your point. Much like Bruffin's initial comment that Andrew Wakefield linked the MMR to Autism in the Press conference and then the quote that NEVER makes that link - I don't really know what to say to you - the quotes you extract are good and I can understand how you make the connections you make - but summaries tend to include information from all parts of the paper. Condensing as you've done gives one an impression of the paper but it is not the complete picture and you, obviously know that. It is this last part that makes any false allegations you make malicious.

My opinion on whether the subject selection was ethical is not particularly relevent if, as the doctors insisted and the court concluded, they were selected for treatment at the Royal Free on clinical need.

Wadham,
To quote Ben Goldacre about the issue of recruitment of subjects (who actually holds the press equally to blame for the whole MMR scare):
'The GMC have found he was ?misleading? ?dishonest? and ?irresponsible? in the way he described where the children in the 1998 paper came from, by implying that they were routine clinic referral..'
Do you actually think the GMC was being horribly unfair?
Cheers.

Bruffin - being wrong is different from being accused of fraud. I suspect the BMJ and Deer went too far with these allegations and will ultimately be punished for it. They gotten too much of a blood lust for Wakefield. But I suppose they got some pleasure out of kicking him. I don't think that pleasure is shared by parents with autistic children who have gut problems. Hold it....is this meant to be about the patient???? I can't comment on the Brian Deer lawsuit - I don't believe Mr. Deer's allegations are correct but I expect they are honestly and passionately held. Equally, I don't believe Dr. Wakefield is a fraud or someone who willfully misled anyone.

Jeez - I keep forgetting to say -

Cheers.

Is that the same Ben Goldacre who said it was "a perfectly good case study"?

If they were responding to what they thought was a new syndrome and they honestly thought that it posed a larger health risk to the population that were being given the mmr then it was their DUTY as doctors to look into it quickly. I think we can both agree that the subsequent conclusion that the mmr caused autism was not an accurate description of the situation for the wider population. Nonetheless, the consistent and widespread anecdotal parental account of their children's descent into a state that they describe as autism was extremely alarming and it would have been and still is irresponsible to ignore it -
Cheers.

Wadham,
I provided a link to the full text of the paper. I quoted briefly from the start of the findings since this is the first bit of the paper which flatly contradicts Cote's claim that the paper had nothing to do with MMR and autism, as it mentions an association made by the parents between behavioural changes and the MMR. I made it clear, indeed I have since quoted myself making it clear that this was a parental association. Then I quoted the very end of the paper, which again shows that Cote's assertion that the paper had nothing to do with autism and MMR is simply untrue as it again mentions MMR and the onset of symptoms. I mean, how does this paper not have anything to do with the MMR and autism? I'm not saying the paper claims to show the MMR causes autism, I have read the paper (which is why I linked to the thing, because I know what it does actually say, unlike Cote for example).
I think it is worth reading, for what it does and doesn't say. And to think that from that paper the whole MMR scare evolved, and now we have outbreaks of measles. Wakefield is now off in the states touting reality TV shows about curing autism (or so I read in the Guardian, it might not be true.....).
Funny old world, isn't it?
Cheers.

Magdalen - We have to stop this soon, I have to get up early in the morning but it is worth pointing out that the GMC's commentary which Ben Goldacre quoted (and you included in your post): 'The GMC have found he was ?misleading? ?dishonest? and ?irresponsible? in the way he described where the children in the 1998 paper came from, by implying that they were routine clinic referral..' was aimed at both Wakefield and John Walker-Smith (J W-S was the clinician in charge of the study and whose blanket ethical approval was used for the various procedures the patients were treated with/by). The High Court through out the GMC's judgment explaining that it could not be sustained by the evidence which had been presented to the GMC. The High Court's decision is a powerful bit of evidence to suggest that the GMC did not conduct a fair or honest examination for any of the Doctors or indeed patients involved.

Wadham,
Here's the bit of the GMC's Fitness to Practise Panel regarding Wakefield and the subjects of the research, firstly:
"The children described in the Lancet paper were admitted for research purposes under a programme of investigations for Project 172-96 and the purpose of the project was to investigate the postulated new syndrome following vaccination. In the paper, Dr Wakefield failed to state that this was the case and the Panel concluded that this was dishonest, in that his failure was intentional and that it was irresponsible. His conduct resulted in a misleading description of the patient population. This was a matter which was fundamental to the understanding of the study and the terms under which it was conducted."
Wakefield then compounded this:
"Subsequent to the paper?s publication, Dr Wakefield had two occasions on which he could have corrected the content of the Lancet paper yet both times he compounded his misconduct.
First, in a published letter in response to correspondents who had suggested that there had been biased selection of the Lancet children, Dr Wakefield stated that the children had been referred through the normal channels, a response which was dishonest and irresponsible. He provided an inaccurate statement which omitted relevant information when he knew that the description of the population in the study was being questioned by the scientific community.
Second, at a meeting of the Medical Research Council, the Chair, Professor Sir John Pattison referred to the seriousness and importance of the implications of Dr Wakefield?s research and its major public health implications. At that meeting and on the issue of bias in generating the series of cases, Dr Wakefield stated that the children had come by ?the standard route?, a response which was dishonest and irresponsible."

Do you disagree with the GMC? Do you honestly think what Wakefield did (misleading, irresponsible, dishonest, inaccurate) was acceptable?
Cheers.

I think the High Court, in its judgement in the John Walker Smith appeal shames the GMC and its judgement on all of these issues. Wakefield and Walker-Smith faced the same charges. Indeed, Walker-Smith as the clinician in charge had the greater responsibility. His character, thanks to the High Court's decision to throw out the GMC's findings, remains unblemished. These were NOT cowboy doctors although you wouldn't know it from the way they are discussed today. I beieve they were and are distinguished medical professionals with a commitment to their patients.

Cheers and...

goodnight! and

cheers.

Wadham,
Good morning. Drat, I wrote a long post and the site seems to have eaten. Oh well, I'll write it again.
You are correct that Walker-Smith succeeded in his high court appeal. Walker-Smith, not Wakefield. Let's go to that judgement by Mitting, shall we:
www.bailii.org/ew/cases/EWHC/Admin/2012/503.html
First off it notes:
"Both initially appealed, but Dr. Wakefield has subsequently abandoned his appeal."
So, let us get this clear right from the start. Wakefield abandoned his appeal.
Right, on with the judgement, because that has more to say on the subject of Mr Wakefield. I am going to quote selectively here, since the document is quite long, but people can read it for themselves if they want.
First up the whole situation with the legal aid and the firm of solicitors. The judgment quotes from a letter from Walker-Smith to Wakefield:
"My position as with measles, MMR and Crohn's disease is that the link with MMR is so far unproven. It is clear that the legal involvement by nearly all the parents will have an effect on the study as they have a vested interest. I myself simply will not appear in court on this issue.
I would have been less concerned by legal involvement if our work were complete and we had a firm view. Never before in my career have I been confronted by litigant parents of research work in progress. I think this makes our work difficult, especially publication and presentation.
I am very excited by this work and it is very worthwhile. Simon Murch and I met today and have drawn up a draft for patient selection for your comment please."
I don't really need to comment, I think Walker-Smith is quite clear in his views.
The judge talks about Wakefield's press conference:
"At a press conference, which Professor Walker-Smith did not attend, convened to accompany publication, Dr. Wakefield stated publicly the view which he had previously expressed privately to Professor Walker-Smith that he could no longer support the giving of MMR vaccine. The joint view of Professor Walker-Smith and Dr. Murch, stated in a letter to Dr. Wakefield on 21st January 1998, was that it was inappropriate to emphasize the role of MMR vaccine in publicity about the paper and that they supported government policy concerning MMR until more firm evidence was available for them to see for themselves. They published a press release to coincide with publication stating their support for "present public health policy concerning MMR". Dr. Wakefield's statement and subsequent publicity had a predictable adverse effect upon the take up of MMR vaccine of great concern to those responsible for public health. There is now no respectable body of opinion which supports his hypothesis, that MMR vaccine and autism/enterocolitis are causally linked."
May be it's just my interpretation, but don't you think the judge is here drawing a definite distinction between the behaviour of Walker-Smith and Wakefield?
Then the ethical approval issue, that gets a mention too:
"Professor Walker-Smith gave unchallenged evidence that this was the last draft of the paper which he saw. Dr. Murch said, again in unchallenged evidence, that there was then a meeting attended by all of the researchers and clinicians involved to discuss the draft, which they approved. At the end of the meeting there was a discussion between Dr. Murch, Professor Walker-Smith, Dr. Thomson and Dr. Wakefield about the reference to Ethics Committee approval of "this clinical investigation", because it was a clinically driven investigation which did not require Ethics Committee approval. Dr. Murch said that Dr. Wakefield had assured them that he would liaise with the Lancet to ensure that appropriate wording was substituted. The wording in the published paper which neither Dr. Murch nor Professor Walker-Smith saw before publication was,
"Ethical approval and consent
Investigations were approved by the Ethical Practices Committee of the Royal Free Hospital NHS Trust, and parents gave informed consent."
This statement was untrue and should not have been included in the paper."
Oh, look, is it Mr Wakefield who is off putting untrue statements into the published papers, against the express wishes of Walker-Smith and the rest?
I like Respectful Insolence's take on this:
scienceblogs.com/insolence/2012/03/08/andy-wakefield-exonerated-because-john-w/
I agree with the blogger that the judge doesn't seem to have the firmest grasp of medical research issues, but then he is a Judge not a scientist. I have linked to the blog, but will quote from its final paragraph:
"From my perspective, Judge Mitting?s decision strongly implies that, rather than being involved in Wakefield?s professional research misconduct, Walker-Smith was an unwitting dupe. Neither conclusion speaks particularly well of Walker-Smith, but I suppose it?s better to be an honest dupe than a dishonest research cheat. Personally, I?d rather be neither. No matter how hard the antivaccine movement tries to spin this as some sort of exoneration of its hero Andy Wakefield, it?s not."
Cheers.

Walker Smith defence was i was mislead by AW which is what he won his appeal on.. Murchs defence was also i was only doing what i was told by JWS and AW.
The fact that WS won his appeal does not prove that AW was innocent at all.
I think some people were under the impression that AW was a doctor treating children. His contract with the Royal Free was for research purposes only. He was forbidden to treat children so should have not been ordering lumber punctures for children. He also experimented on a child using his untested transfer for which he was also found guilty at gmc.

Nicholas Chadwick his research assistant gave evidence at the omnibus hearings in the US that they found no evidence of messes in samples but AW sent them to another lab which was known for its inaccuracies. NC refusid to put his name to the paper.
AW has had numerous occasions to clear his name. The original libel case which he dragged out. The GMC hearings where he did not bring a defence and then chose not to appeal. The current libel case deliberately set where he had no chance of winning but a half parted attempt to show supporters that he may still have a case.
The Royal Free asked him to replicate his findings but he couldn't/wouldn't which was why they parted their ways and nobody has been able replicate the findings since or find a connection.

Cheers Magdelan cross posted

I hate it when posts disappear as well - particularly when they've been carefully constructed - really annoying.

There is no doubt you would like the spin of "respectful insolence" - but it is simply spin and adds nothing to the matter but opinion - some of which is well informed and some of which appears agenda led and not very thoughtful.

The GMC linked the three cases together by hearing them together and duplicating the charges. J W-S defence was NOT that he was a dupe and once again, since you are privy to the record, you should not quote it selectively. As you point out much of the issue was over the ethical approvals - and whether it was correctly obtained as well as whether the treatments were clinically indicated.

The GMC's findings were seriously flawed and the High Court felt it could not sustain them in the case of J W-S. As he faced the same charges as AW one can reasonably assume that the same flaws were present in the GMC charges/findings that the two doctors shared.

AW abandoned his appeal because he could not fund it. How his case was conducted in the GMC by his counsel is also probably worthy of some scrutiny. Some of the decisions, including his QC's decision NOT to call parents are hard to comprehend ad leave one with the awful taste that justice had not been served.

No parent or patient complained to the GMC - many parents are left feeling, rightly or wrongly, that their interests and the interests of their children have been sacrificed to protect a programme which the Cochrane Review, in 2005 and in 2012, opined that... "design and reporting in MMR safety studies...is largely inadequate?"

Wakefield may have been iconoclastic and some of his more aggressive commentary may have been ill considered at the time but it is clear to me from talking to some - but admittedly not all - of his colleagues at the time that he was not a fraud nor did he dupe anyone. He was pursuing what many thought might have been a medical emergency. I want doctors and scientists to do that work and protect us - if they are wrong then they should admit error. The witch hunt that occurred and which you sustain is unfortunately a deterent to further research. Who would want to be on the wrong side of this issue? You lose your career!

Vaccination has been one of the great inventions/innovations and life savers. We all admit there is collateral damage. Conventional wisdom is moving toward an acceptance that the environment may be responsible for the rise in the prevalence/incidence of autisms. What the environmental insult(s) might be is yet to be proven.

The parents at the time were not ignorant. They were not misled. They were looking for answers. The Royal Free Team tried to clinically help their children and find the answers. The fallout from the quote Bruffin included in an earlier post was a catastrophy for the Royal Free doctors but - and this really is where one's sympathy and empathy (if you can summon any) should lay - it was a greater catastrophy for the mothers/fathers and children who were and remain desperate to try and understand a regressive phenomenon. A phenomenon first denied, then ridiculed but now slowly being accepted by courts in a number of countries as being plausibly linked to vaccine damage.

Demonising Wakefield is handy and it is simplistic but ultimately it is a facile response to a complex set of events - and, in my opinion - it is wrong.

Got to go to work!

Oh sugar....

Cheers.