Wakefield’s wake – the curse of ego driven research

Dr Andrew Wakefield, a Canadian trained gastroenterologist has been charged with serious professional misconduct by the General Medical Council in the United Kingdom.

Wakefield’s story is one of intrigue in a field that elicits passion, often irrational. Wakefield published a controversial research article (1) in 1998 in The Lancet linking the MMR (measles, mumps, rubella) vaccine with a form of colitis in children; with a supposition that it was the cause of autism. Wakefield painted himself and has been touted by certain community groups as an anti-MMR (and anti-immunisation) guru, fighting for children against an insidious iatrogenic disease.

Unfortunately, it is almost certainly bogus. There is no convincing evidence that the MMR vaccine causes inflammatory bowel disease or that it causes autism. There is abundant evidence that the MMR vaccine prevents measles, mumps and rubella, three nasty and potentially fatal disease. The Cochrane Database of Systematic Reviews (an organisation that helps collate evidence based medicine and is independent of industry and government) published a review (2) in 2005 to this effect. The Cochrane Library's “plain language summary”:

“Measles, mumps and rubella are three very dangerous infectious diseases which cause a heavy disease, disability and death burden in the developing world. Researchers from the Cochrane Vaccines Field reviewed 139 studies conducted to assess the effects of the live attenuated combined vaccine to prevent measles, mumps and rubella (MMR) in children. MMR protects children against infections of the upper airways but very rarely may cause a benign form of bleeding under the skin and milder forms of measles, mumps and rubella. No credible evidence of an involvement of MMR with either autism or Crohn's disease was found. No field studies of the vaccine's effectiveness were found but the impact of mass immunisation on the elimination of the diseases has been demonstrated worldwide.”

Thankfully in the Antipodes Wakefield’s influence on consumer opinion on childhood immunisation has been slight. In the United Kingdom, however, the effect has been significant. In early 2003, immunisation rates dropped to 78.9% (from 92% in 1996) and had gone to as low as 60% in parts of London. The result was a massive resurgence in the three diseases (for mumps around 4000 cases in 2003 to over 56,000 cases in 2005). In April 2006, a 13 year old boy became the first person in Britain to die from measles in 14 years. He was not immunised with MMR.

Wakefield’s “professional misconduct” is not for his damaging effect on public health, but rather for a gross conflict of interest in his original paper. Wakefield had received £55,000 ($AU 136,000) from the Legal Aid Board paid into his research fund by lawyers representing parents and children allegedly damaged by the MMR vaccine (to look for evidence that would help them in their case). Wakefield had not disclosed this to either The Lancet or to even his co-researchers. In 2004, 10 of his 12 co-authors retracted from the article published in 1998.

Wakefield continues to battle on with his hypothesis that autism is caused by the MMR vaccine.

In the field of biomedicine, perhaps more so than other fields of scientific endeavour, research is often driven by ego; singular dedicated “über-researchers”. For those who are eventually proven right, the rewards are great – retrospectively hailed as visionary and courageous before their sceptical and conservative peers. However, for those who are proven eventually wrong, everything unravels. I believe that Wakefield truly believes in his own cause, much to the harm to his own career, to the medical profession and to the public at large.

Wakefield's dedication and drive blinkered him from keeping an open mind; that his hypothesis could be wrong. His perspective was so skewed that he committed what is an inexcusable lapse of judgement with regards to the non-declaration of the serious conflict of interest.

It is interesting to consider what makes a highly intelligent and dedicated man like Wakefield to lose the founding principles of ethical research.

Money? Fame?

I think not. I wonder whether some of these researchers become so identified with their research and theories that they feel an obligation to themselves, colleagues and patients to “prove it right”. One small lie, accidental perhaps slips through. Then another compounds to another. Another small fabrication slips through, deliberate this time to “tidy up the numbers”. Before they know what has happened, their work is declared visionary and so much momentum has built up that living in the delusion is the only path.

The example is perhaps stark with Dr Hwang Woo-suk, disgraced former top human cloning scientist of South Korea. With much of his most notable research now known to be fabricated it has brought a crushing blow to the field. What is real and what is fake?

It is difficult to know what can be done about this flaw in medical research. Certainly, peer based review is sound – insofar that there is nothing better than can replace it. Perhaps, what needs to be addressed is the culture of medicine and biomedical research. Hierarchical deference to seniors and professors is certainly a factor as to why occurrences of scientific misconduct or outright fraud are discovered so late. This is illustrated particularly in the South Korean scandal.

I believe that the only way to shake the “curse of ego-driven research” is for a culture of egalitarianism to be developed within the profession.

Research articles
(1) Wakefield AJ. Murch SH. Anthony A. Linnell J. Casson DM. Malik M. Berelowitz M. Dhillon AP. Thomson MA. Harvey P. Valentine A. Davies SE. Walker-Smith JA. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. [Journal Article. Retracted Publication] Lancet. 351(9103):637-41, 1998 Feb 28. [download PDF : 335 Kb]

(2) Demicheli V, Jefferson T, Rivetti A, Price D. Vaccines for measles, mumps and rubella in children. The Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD004407 [download PDF : 277 Kb]


Source articles:
The Independent: In the dock: the man who caused the great MMR scare

Wikipedia: Andrew Wakefield

The Sunday Times: Schoolboy, 13, dies as measles makes a comeback

Wikipedia: Hwang Woo-Suk

BBC News: S Korea cloning research was fake