BMJ: Wakefield is a fraud

In a stunning article in the British Medical Journal we are told that Andrew Wakefield, possibly the principal cause of the recent vaccines-are-evil-hype, is even less trustworthy than we discovered before.

Of course, who but Orac is on the prowl:

The discrepancies between the case reports as described in Wakefield's Lancet paper and the actual medical records are anything but random; all are in the direction of suggesting a link between the MMR and Wakefield's as yet unverified syndrome of regressive autism and enterocolitis. The cases that were selected appear not to have been random, sequential patients but were rather recruited specifically through anti-vaccine activists and trial lawyers.

And:

There is no innocent explanation possible for the systematic and numerous discrepancies between the medical record and Wakefield's paper, as the editors of the BMJ point out in their accompanying editorial:

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.

Nevertheless:

Wakefield continues to deny that he has done anything at all wrong and blames the criticisms leveled against him on conspiracies. In reality, given the way the anti-vaccine movement has begun to circle the wagons to defend Wakefield yet again, it's tempting to claim that this is a conspiracy.

In his analysis Brian Deer likens this fraud in scope to Piltdown Man. The next commentator is Phil Plait who writes:

Brian Deer, an investigative journalist, has written a multi-part series on the BMJ site which slams Wakefield. Fiona Godlee, BMJ’s editor-in-chief, also writes about this… and just to be clear, she uses the word "fraud" nine times in her editorial. Not surprisingly, it’s been picked up by several news outlets like CNN, MSNBC, and ABC.

His conclusion:

Andrew Wakefield may not have started the antivax movement, but he certainly egged it on very strongly, along with such mouthpieces as Jenny McCarthy, and Meryl Dorey and the AVN in Australia. If the charges of fraud can be made to stick, then we might be able to make some progress toward reality once again, and lower the rate of outbreaks of measles, pertussis, and polio… and save a lot of lives in the process.

This is exactly why I am not opposed to accountability for willfully endangering other people by invoking free speech. More on the BMJ story by both Pharyngula, Deltoid, and Jeffrey H. Toney.

In the past I have wondered why people adhere to a worldview that has been thoroughly discredited. My unscientific opinion was that it must be some form of delusional disorder. Later, I noted the cognitive dissonance which has been shown to explain such behaviour. In light of what the BMJ has just made public one would hope the infectious-disease-promotion-movement will lose members. Unfortunately, being a cynic, I doubt that will happen.

Update: Be sure to read this too.

Update II: A roundup of responses to the BMJ article is provided by Liz Ditz. The Autism Blog discusses the alleged replication of Wakefield's results: it does not exist. In Scientific American David Ropeik explains that there is a discrepancy between the perceived and factual risk:

Sometimes we’re more afraid than the facts say we need to be (vaccines). With many of the bigger threats, we’re not afraid enough (infectious disease). The gap between our fears and the facts can be dangerous all by itself. Just ask the parents of the thousands of kids worldwide now getting, or dying of diseases that vaccines had pretty much controlled.

And:

The harm he [Wakefield] and others have done will persist for a long time…and will continue to serve as a reminder of the risk we face if we don’t recognize that the way we perceive risk can be a huge risk in and of itself.

The danger of the infectious-disease-promotion-movement is shown by Maryn McKenna who contracted whooping cough in India and wrote an article in Wired about the rise in cases. Take home message:

The worst news in this upsetting trend is this: We’re doing it to ourselves. As far as anyone can tell, the rise in pertussis is not due to any change in the organism, or to any mysterious error among the manufacturers who make pertussis vaccines. It’s due to vaccine refusal, to parents turning away from vaccines because they think the vaccines are more harmful than the diseases they prevent — or, more selfishly, because they think the wall of immunity created by other vaccinated children will protect their unimmunized ones.

Grant Jacobs, for Code for Life, made an overview, and Skepacabra did the same. Nice review of communication pitfalls by The Thoughtful Animal:

Giving us incidence and death rates and other such statistics doesn't really get the job done. It doesn't communicate what they want it to. Nor will glossy pamphlets (like the one they gave me) featuring Mia Hamm telling us to get vaccinated. What will get the job done is story-telling, appealing to emotion, and utilizing accessible analogies. Instead of telling us how many gazillions died last year, tell us how many airplanes full of people, or how many football stadiums full of people died last year.

Update III: Luckily Jenny McCarthy comes to our recsue and rehashes long ago refuted non-arguments. Apparently, true or false is determined by the number of times you make a claim.

Vaccine Unawareness Week

November has arrived and the infectious-disease-promotion-movement has its "Vaccine Awareness Week." Therefore they are being offered a less Halloween inspired week of science-based information regarding vaccines. Probably they are not interested in a rational debate because the willfully blind ignore information contradicting their ideology. This inoculates them against the current correcting "misinformation week"-week. So, this week supporters of critical thinking attempt to reach the worried and misguided adherents of the anti-science crowd. Articles promoting critical thinking can be suggested at Science-Based Medicine:

Many of our fellow science bloggers are on board as well. We will use this site at aggregate as many science-based posts about vaccines and public health as we find. If you have or know of any that are not listed, please let us know in the comments and we will add it.

The first posts are already on-line. Steven Novella deconstructs the propaganda surrounding flu vaccines while Orac revisits a previous post:

About seven months ago, I encountered a profoundly intellectually dishonest set of graphs done by Obomsawin that were designed to demonstrate that "vaccines didn't save us."

and:

I note that, not only have the graphs not been changed as far as I can tell, but Dr. Obomsawin is scheduled to give a webinar tomorrow evening (exactly 24 hours from now, actually) entitled Graphic Reality: The Charting of Truth in which he is apparently going to argue the same old nonsense that "vaccines didn't save us."

Orac notes that he:

intended for a while to go back and revisit Obomsawin's remaining nonsense. Somehow I just never got around to it. As you may recall, in my original post I didn't deconstruct all of his graphs and how deceptively he used them. Vaccine Awareness Week might be the perfect opportunity to rectify that oversight.

Please visit the above mentioned aggregate site frequently this week for more. You may also be interested in what immune response is, since this is what vaccines attempt to augment. Some background can be found here.

Update: Red flag? Mercola will help us fight those scientists. All you need to do is buy something from him.

Update II: Collecting articles trying to protect us against the infectious-disease-promotion-movement Liz Ditz makes it easy for us to follow these posts.

Update III: At Science-Based Medicine Harriet Hall adds:

Physicians, has a feature called AFP Journal Club, where physicians analyze a journal article that either involves a hot topic affecting family physicians or busts a commonly held medical myth. In the September 15, 2010 issue they discussed “Vaccines and autism: a tale of shifting hypotheses,” by Gerber and Offit, published in Clinical Infectious Diseases in 2009.  
The article presented convincing evidence to debunk 3 myths:

1. MMR causes autism.
2. Thimerosal (mercury) causes autism.
3. Simultaneous administration of multiple vaccines overwhelms and weakens the immune system, triggering autism in a susceptible host.

Next is Steven Novella who analyses the history of chicken pox and the fairy-tales from the anti-vaccine brigade, and Orac shows another example of crank magnetism.

Update IV: The current endeavour is noticed in New Zealand by Skeptics in the Pub. Information on Vaccination Safety and Quality is available at the WHO website and EBM-first offers us some valuable links. More on influenza, effectiveness of vaccination and its risks, are discussed by Science-Based Pharmacy. Also, I found an old, but sadly still relevant, article there which was a response to the misinformation spread by those who prefer the return of preventable infectious diseases. As an aside, in Canada there already was a National Immunization Awareness Week earlier this year. Striking is an article written by Dr. Jay L. Wile. In his own words:

He is best known for the "Exploring Creation with..." series of textbooks written for junior high and high school students who are being educated at home.

With this background I was pleasantly surprised to read:

Because people in California are refusing the whooping cough vaccine in large numbers, whooping cough is rearing its ugly head there. Children are needlessly becoming sick and dying, and we have the misinformation spread by anti-vaccine people to thank for it.

Pretty amazing. Then there is the nice overview "Not Dangerous, and Irresponsible to Opt-out of" by Todd W. Finally, for those wandering the intertubes, here is a guide to evaluate trustworthiness of websites.

The infectious-disease-promotion-movement

Numerous blogs, this one included, have written about the pernicious effect Andrew Wakefield has had on vaccination levels in children. He singlehandedly was able to get nearly irradicated diseases reintroduced by claiming this highly effective method of preventing disease causes autism. This summer the infectious disease promotion movement suffered a setback when British General Medical Council (GMC) ruled against him. Since his adherents suffer from both a delusional disorder and the Dunning-Kruger effect, they may want to read about statistics in medicine, his downfall has not been the boost for vaccination rates less intellectually challenged people had hoped for. The legacy of his misbehaviour is a decreased herd immunity which still kills. Joseph Albietz remembers the death of a child:

He was unvaccinated, but that was because of his age.  He was part of the population that is fully dependent on herd immunity for protection, and that is exquisitely prone to a life-threatening course once infected.  

The failure of maintaining herd immunity makes him observe that:

the medical community in general is delusional if we think we can resolve the public health threat posed by the undercurrent of distrust in the vaccination program on our own.  No number of studies, consensus statements, or ad campaigns by the CDC, WHO, AAP, AAFP, etc (not to mention countless blog posts) will be sufficient to maintain the public trust in the vaccination program.  We need public support as well.

The Force remains strong in the anti-science camp. Luckily Penn & Teller offered us another solution by spending an episode of Bullshit on the subject. Orac reviewed it for us, and has the video. Yet another approach is suggested by Joseph Albietz:

In Atlanta, Georgia this September is a rather sizable (~40,000 people) convention called Dragon Con.  Our skeptic friends at Skepchick.org and the newly formed “Women Thinking Free Foundation” are launching their their “Hug Me! I’m Vaccinated” education campaign at Dragon*Con, and have organized a local pertussis vaccination clinic during the event.  In coordination with the local health officials, they are providing free TDaP vaccinations for any Dragon*Con participant, as well as information and educational materials.

But as long as airhead celebreties keep falling for the denialism-virus ....... Sigh.

Update: Another explanation for the importance of herd immunity is given by ERV.

Update II: The importance of herd immunity is surprisingly lost on the anti-vaccination crowd. The Watchdog Institute reports:

that waivers signed by parents who choose to exempt their children from immunizations for kindergarten enrollment have nearly quadrupled since 1990. California allows parents to opt out of some or all shots on the basis of personal beliefs, be it religious objections or distrust of the medical establishment.

This causes Orac to observe:

Failure to vaccinate also endangers the unvaccinated children as well. Last year, in fact, this risk was quantified in a study that found that unvaccinated children have a 23-fold elevated risk of catching pertussis compared with vaccinated children.

That is, if you accept what physicians say about herd immunity. We all know they don't know as much about diseases as the average celebrity.

Update III: What happens if others get infected because you object, for whatever reason, to vaccinations, i.e. you support the spread of infectious disease. The possible legal liability is discussed by attorney Jann Bellamy. The short version:

Those who breach their duty to avoid the spread of communicable disease may be liable to those injured for damages.

Update IV: If you still think the infection-promotion-movement is a harmless bunch of "sceptics" try reading about the harassment Amy Wallace was subjected to after writing an article called "An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All." Her experience with this witchhunt she explains here:

Autism’s False Prophets, Dr. Offit’s 2008 book, opened my eyes to the risks of reporting on vaccines. Before I began working on my Wired story I read it, focusing at first on his straightforward description of what being a vaccine advocate had cost him. He’d been vilified on the Internet as a profiteer, a prostitute who serviced Big Pharma, and worse. He’d been physically accosted. His life had been threatened. Once, an anonymous caller had even implied they might go after Offit’s two children.

What I experienced in the wake of my Wired story was similar in tone (although my child was spared). Like Offit, the vast majority of the feedback I received was positive, but the negative stuff would make your hair stand on end.

Despite all this she does not regret a thing:

My Wired piece was a chance to contribute in a meaningful way to a discussion that must be had.

She ends the article with some suggestions for those interested in promoting rational debate. Another article, by Shot of Prevention, also mention the Watchdog Instute's investigation and the effect of not vaccinating on herd immunity:

Perhaps more concerned parents should demand to know how many of their children’s classmates are coming to school unvaccinated.  As Dr. Mark Sawyer, pediatric infectious disease specialist at Rady Children’s Hospital in San Diego noted, “Un-immunized people in general contribute to any disease rates. As the rates of un-immunized kids go up, we are inevitably going to see more and more outbreaks of diseases.”  It is clear that a failure to vaccinate children attending school endangers us all.

Then there is the CDC which estimated the number of deaths due to influenza. I wish there was a way to prevent those infections.

Surprise: Dr. Wakefield 'abused position of trust'

The Independent reports on the General Medical Council (GMC) hearing, regarding Andrew Wakefield, which observed his:

conduct brought the medical profession "into disrepute" after he took blood samples from youngsters at his son's birthday party in return for payments of £5.

And it found that he:

"failed in his duties as a responsible consultant" and went against the interests of children in his care in conducting research. He further acted dishonestly and was misleading and irresponsible in the way he described a study which was later published in The Lancet medical journal.

This article claimed a relationship between MMR vaccination, bowel disease and autism, and became the cornerstone of the "infectious disease promotion movement." The Times notes that this study

sparked the biggest vaccine scare in a generation and has been blamed for the resurgence of measles in Britain.

Subsequent investigations repeatedly established its unscientific nature, confirmed by the GMC today, and medical science has refuted those proposed links as non-existent. The Times describes the ensuing debate following the article:

The research has since been discredited by subsequent studies involving millions of children, which found no evidence for the link between the triple jab and autism. It has since been retracted by the Lancet, and ten of the original 13 authors disowned the research. But the claims sparked a massive drop in the number of children given the triple jab for measles, mumps and rubella. Vaccination rates have still not fully recovered to levels before the scare.

The Guardian discusses the same ruling, and Steven Novella has an elaborate overview of who Wakefield is and what he has accomplished.

Update: A somewhat superfluous, to those following the "infectious disease promotion movement," rersponse is given by Orac who describes Wakefield's legacy as:

The resurgence of a once-defeated vaccine-preventable disease, with all the attendant suffering its return brought with it. Truly, few people can be said to have done more harm to public health in a nation than Andrew Wakefield did in the U.K. with his incompetent, unethical, callous research.

The post is a detailed review of the ruling and includes the delusional, and inherently cult-like anti-science, platitudes his defenders use to prove the GMC's conclusions were nothing less than blasphemy. Of course, this difference of opinion is best explained by Tim Minchin:

Science adjusts it’s beliefs based on what’s observed
Faith is the denial of observation so that Belief can be preserved.

The Lay Scientist, Science-Based Medicine, and Skeptico also comment on the outcome of this science vs. Paranoid R Us spectacle.

Update II: A very unusual decision has led The Lancet to retract the original article. Steven Novella details the high threshhold journals have for retracting articles such as this. Even when it is obvious fraud is involved.

Update III: Oddly enough the Paranoid R Us Crowd -while claiming "The Censorship of Autism Treatment"-is objecting to the scientific principle, rational thought, and plain decency by asking us to support poor persecuted Mr. Wakefield.

Update IV: More from Orac and The Globe and Mail.

Update V: ABC has a big article too.

Update VI: More here.