In January, The British Medical Journal began its attack on Dr. Andrew Wakefield by claiming he altered every single one of 12 children's case histories to create a phony link between the MMR vaccine and autism. In five cases, it said, signs of autism actually began before the shot was even given.
As the strongest case in point, author Brian Deer described how Child 11's symptoms appeared “too soon” -- a full two months before the measles-mumps-rubella shot. Deer said the father himself spotted the "anomaly" and was deeply upset about Wakefield's deception.
But none of that is true.
Child 11’s measles-mumps-rubella shot came first, and the symptoms of physical illness and regression followed, just as Wakefield reported. No one but Deer claims otherwise. Multiple records by independent medical experts establish the facts, the child’s father confirms them, and BMJ Editor Fiona Godlee and Deer have known it for months – because I told them about it and showed them the evidence, and so did the father.
Yet Godlee has refused to correct that error and numerous others of similar significance, continuing to publicly insist there were none.
This is the strange counter-factual universe into which the British medical establishment has plunged the controversy over autism and vaccines. The BMJ’s Wakefield investigation – despite peer-review and supposedly rigorous fact-checking – is replete with the kind of misrepresentations, elisions and outright falsehoods it charges Wakefield with committing.
To date, installments in our series have examined the BMJ’s failure to adhere to its own standards of confidentiality and fairness, as well as tactics employed by Deer, whom it commissioned to investigate Wakefield – tactics that included “blagging,” or using a false identity, to interview parents of vaccine-damaged children for The Sunday Times of London, where most of the material later reported in the BMJ first appeared. (In the wake of the News International scandal, the Murdoch-owned Sunday Times has now banned blagging, although Deer said he remains “immensely proud” of his reporting techniques.)
We now turn to the elements of fraud alleged by Deer and the BMJ. We begin, as the journal did, with Child 11. None of the children were named in the original 1998 Lancet article written by Wakefield and 12 co-authors. Like Deer, I was able to determine the families’ identities but – unlike Deer, whose reporting was limited and selective – I reached out to every one I could find, and in every case heard a very different account from the one Deer reported.
I met Father 11 at a Peet’s Coffee shop in an affluent, picture-perfect Southern California enclave, and we sat outside in the mid-60s sunshine he jokingly called “a little frosty.” A wealthy businessman who lives in a gated community nearby, he wore a light jacket emblazoned with “Cal,” for the University of California at Berkeley where he got an engineering degree. He carried a thin file folder and a spiral notebook.
In this laid-back setting, it was hard to grasp the role he and his family have played in one of the major medical controversies of our time, one that unfolded in a foggy city 6,000 miles to the east.
This father is Deer’s best witness among the parents of the 12 children described in the Lancet paper – in fact, his only one, the lone parent who is hostile to Wakefield, not just a little frosty, but coldly angry. His anonymous comments to Deer in the BMJ seemed to fully support the January 5, 2011, cover story: “Secrets of the MMR Scare: How the Case Against the MMR Was Fixed.”
“The father need not have worried,” Deer continued. “My investigation of the MMR issue exposed the frauds behind Wakefield’s research.”
Child 11, in fact, was Deer’s opening.
He was among those “whose parents apparently blamed MMR,” but Deer commented acidly that “Child 11’s case must have been a disappointment. Records show his behavioural symptoms began too soon.” [Italics in original] Deer quoted from a Royal Free Hospital discharge summary: “His developmental milestones were normal until 13 months of age. In the period 13-18 months he developed slow speech patterns and repetitive hand movements. Over this period his parents remarked on his slow gradual deterioration.”
Deer summarized: “That put the symptom two months earlier than reported in the Lancet, and a month before the boy had MMR. And this was not the only anomaly to catch the father’s eye. …” (Note that it is Deer, not the discharge paper, saying the symptoms came “a month before the boy had MMR.”)
The BMJ report was the coup de grace for serious consideration of a link between vaccines and autism. Wakefield was “convicted of fraud,” wrote Time magazine in an article titled “The Dangers of the Antivaccine Movement.” An editorial in The New York Times, titled Autism Fraud, noted Britain’s General Medical Council had already stripped Wakefield of his medical license, and the Lancet retracted the paper: “Now the British Medical Journal has taken the extraordinary step of publishing a lengthy report by Brian Deer, the British investigative journalist who first brought the paper’s flaws to light — and has put its own reputation on the line by endorsing his findings.”
Indeed it did.
“Clear evidence of falsification of data should now close the door on this damaging vaccine scare,” Editor in Chief Fiona Godlee wrote. She said “there is no doubt it was Wakefield” who was responsible for the “elaborate fraud,” despite having 12 co-authors.
Hold the door, please. I was about to learn that Deer’s explosive claim about Child 11 – Exhibit A in this alleged hoax -- was false. And that was just the first step of my journey into a world where things were not at all as they seemed.
The father opened the file folder – guarding the papers against a fickle coastal breeze -- and showed me a letter he had written on January 1, 1997, to “Dr. Andrew Wakefield, Royal Free Hospital, London, England.”
"My son [name deleted] at age 15 months, was immunized with the Merck MMR vaccine and became ill for the next several months,” the letter began.
“As his pediatric records indicate he came down with a viral infection, and shortly thereafter viral pneumonia. His condition slowly deteriorated over time, and was diagnosed as being autistic on his birthday at age 3. The onset of his autistic behavior began around 18 months. … He was diagnosed as moderate to severe, with no speech, no eye contact, and cognitive function at 6 months overall.”
Multiple specialists in the United States confirmed the autism diagnosis, the letter added, as well as their suspicions of the MMR vaccine as the cause. Further workups in California also revealed “indeterminant inflammatory bowel disease” -- the dual syndrome Wakefield was then investigating at the Royal Free. That was why the father wanted the hospital’s pediatric gastroenterologists to evaluate his child.
So – first came the shot, then the symptoms. The father’s account, and medical records created before he got anywhere near Wakefield, could not be clearer. But didn’t he tell Brian Deer exactly the opposite, as recounted in the opening of the BMJ cover story? And didn’t a hospital record confirm that?
No. And no.
Though you’d never know it, the father was actually disputing how long after the shot specific symptoms occurred. In fact, the father did directly blame the MMR for causing his son’s illnesses and autistic regression – a fact that appears to have escaped Deer’s notice, or at least acknowledgement.
Yes, the father was angry at Wakefield. Yes, he disagreed with other points, some of them unrelated to the content of the Lancet article. But no – he did not say that the symptoms came before the shot. That was not an “anomaly” in the Lancet paper that caught his eye, as Deer wrote.
And the discharge document itself? It was simply wrong, one of thousands of pieces of paper generated by many medical personnel in a complicated medical case stretching over many years; perhaps the “13-18 months” was a typo for “15-18,” since that is what the father had reported all along. Regardless, the father says he never told Deer that the symptoms came first, and there is no evidence to the contrary. Deer apparently did not bother to check that one piece of paper against the large volume of other evidence, or to confirm it with the father, or to make sure that his own claim that symptoms began “a month before the boy had MMR” coincided with any actual chronology.
As far as I can tell, no one on the planet -- no doctor, no parent, no document – has ever said Child 11 was anything but healthy and developing normally before the MMR. No one, that is, but Brian Deer in the BMJ. And here we see Deer at work: Because Wakefield was by definition a fraud – because Deer said so – any discrepancies between data in the Lancet paper and any other source was proof against Wakefield. One document says 13-18 months for the period of regression? That was evidence enough that Wakefield “used bogus data … to manufacture a link” between the MMR and autism.
To my surprise as we sat outside in Southern California, the father told me he hadn’t read the BMJ article, and he declined my offer to quote from it or have him read it during our visit. He would rather lay out the sequence in his own words, he told me.
That turned out to be a useful approach.
His son had been completely healthy and developing normally, he said, until the MMR shot at 15 months triggered a downhill progression.
“I very much believe it,” he said about the relationship of the shot to the symptoms: The measles component of the vaccine triggered an immune deficiency that produced the cascade of devastating physical and mental problems. This, in fact, was Wakefield’s provisional hypothesis.
When I showed Father 11 what Deer had written about the shot-and-symptoms sequence, he said, emphatically, “That’s not correct.”
A few days later, after he read the BMJ piece, the father sent Deer and myself an email.
“Mr. Deer’s article makes me appear irrational for continuing to believe that the MMR caused difficulties which predated its administration, but until the incorrect dates in the discharge summary were pointed out to me this week, I failed to realize that the discharge summary was inaccurate.”
The father wrote that this was an honest mistake on Deer’s part.
“Based on the incorrect discharge summary I shared with him, Mr. Deer reasonably inferred that my son’s autistic symptoms predated his receipt of the MMR vaccination, which they did not.”
I’m no engineer, but neither is Father 11 a journalist. As someone familiar with the norms of my profession, I had rather a different reaction. I found it hard to see how Deer -- who interviewed the father in person twice, once in California and once in London, corresponded by email, and must have heard the same story I did — could get something so important so wrong. The number of times he used the father’s quotes to misleading effect – appearing to angrily assert that the symptoms preceded the shot – was too high; the way he did it seemed too artful.
He made the father appear irrational. Yet when I met him, Father 11 was as straightforward and precise as you might expect from a successful engineer. By the time I finished my Peet’s, I had no doubt about the chronology or the documentation.
Besides, the imperative to get the facts correct – and to correct them promptly and prominently if called for – is implacable. Even more than a hurried newspaper account, there were not supposed to be any mistakes in Deer’s work in the august British Medical Journal. They said so themselves.
“The BMJ stands by the article by Brian Deer and the linked editorial published on 5 January,” Godlee wrote in February in response to e-mails critical of its reporting by readers at Age of Autism. “The article, which was subjected to peer review and editorial checking, was based on enquiries carried out over some seven years, involving, among other things, interviews with parents of children enrolled in Andrew Wakefield's research. Four such parents are quoted in the article. As made clear in the article, the core data on which the findings were based were evidenced, except in the case of one child, by the transcript of a General Medical Council fitness to practise hearing which sat between July 2007 and May 2010.”
That “one child” – the exception for which no independent evidence existed -- was Child 11.
Dan Olmsted is Editor of Age of Autism. He is the co-author, with Mark Blaxill, of The Age of Autism – Mercury, Medicine, and a Man-made Epidemic, published in paperback in September by Thomas Dunne Books.
An Elaborate Fraud Series: Brian Deer, BMJ, Murdoch, Dr. Andrew Wakefield