Wakefield (Hero to zero) and MMR

[Deetee]

This week's BMJ has a couple of MMR related items.
The first to catch my eye was "Hero to Zero" - a piece by Michael Fitzpatrick on Wakefield's fall from grace as the media pin-up boy.
http://www.bmj.com/cgi/content/full/336/7642/479
He tells us about a new book on the saga by Tammy Boyce:
Boyce T. Health, risk and news: the MMR vaccine and the media. New York: Peter Lang, 2008.

In her authoritative survey of media coverage of the MMR controversy at its height in 2002, Tammy Boyce, a researcher in media studies at Cardiff University, details the media’s influential bias against the MMR vaccine.1 As she puts it, "The media coverage told parents not only what to think, but also how to think about the MMR vaccine, that the vaccine might be unsafe and science and the government could not be trusted." She shows how much of the press took Dr Wakefield at face value, as a maverick and martyr, and failed to give the public an accurate account of the weakness of his case when weighed against the scientific evidence. The result was that newspaper, radio, and television coverage exacerbated popular fears, leading to a significant fall in uptake of the vaccine and leaving a substantial number of children vulnerable to measles outbreaks.

and:

By the summer of 2007 Dr Wakefield found himself linked in the press to reports of a settlement made by his former employer, the Royal Free Hospital, in respect of complications claimed to have been sustained by a patient after a colonoscopy carried out by another doctor. He was also stigmatised for outbreaks of measles in 2006 and 2007, which were concentrated among Irish travellers and orthodox Jews, despite these being communities in which neither the mass media nor Dr Wakefield has much influence and in which a low uptake of MMR vaccine long predates his notorious Lancet paper. After briefly basking in the limelight Dr Wakefield has now been cast into the gutter. Once readily absolved by journalists of all responsibility for falling vaccine uptake, he now gets the blame for things over which he has no direct responsibility.

Meanwhile, in another section of the BMJ is an article about the uptake of MMR in the UK. They followed a cohort of kids born in 2001-2.
Use of single measles vaccines increased for the expected groups - educated, better-off, older Mums.

Snippets:

There are no routine data on use of single antigen vaccines in the UK, and estimates derived from local level studies9 10 11 and a national survey of providers12 range from around 2% to 21%.

Reasons why parents choose not to immunise their children with MMR include concerns about the safety of the vaccine, the potential risks of the vaccine outweighing the risks of contracting the disease, negative publicity, and not trusting the advice given by health professionals and the government.10 19

Previous research has shown that single parenthood, area deprivation, and high birth order and family size are associated with lower uptake of MMR,13 14 15 16 although since concerns over the safety of MMR were raised in 1998, uptake has declined more among parents living in more affluent areas and those with more highly educated residents.15 18

We estimate that 88.6% of children born in 2000-2 had received MMR by the age of 3 and a further 2.7% had received all three of the single antigen vaccines. Although coverage is relatively high, it remains lower than the estimated level required to ensure herd immunity (over 95%), leaving a substantial proportion of children susceptible to avoidable infection.

It would have been interesting to see if children opting for single doses of vaccines went on to complete all of them, but this data does not seem to be presented.

 

[Rolfe]

There was a doctor in Hertfordshire who was struck off for inadequately vaccinating children who were brought to him privately for single vaccines. I can't remember what he did - didn't use vaccine or something? Somebody checked antibody titres and they weren't there, and a whole bunch of kids had to be revaccinated with MMR.

And I do blame Wakefield for the tinkers and the orthodox Jews. He caused the herd immunity to fail, leaving them vulnerable.

Sigh. Our neighbours where we used to live drove to Birmingham (from central Scotland) to get each of their two children single jags. I don't know if they completed the courses or not. I threatened to tell the mother she was endangering her children far more by driving all that distance than she ever would by giving them MMR, but my mother threatened to disinherit me if I said anything.

Rolfe.

 

[Capsid]

There was a doctor in Hertfordshire who was struck off for inadequately vaccinating children who were brought to him privately for single vaccines. I can't remember what he did - didn't use vaccine or something? Somebody checked antibody titres and they weren't there, and a whole bunch of kids had to be revaccinated with MMR.

Dr Pugh is his name. Times coverage. Some parenting websites hailed him has a hero. He went to Australia but got struck off and sentenced to 9 months jail in his absence. Don't know if he ever served his time.

 

[Rocko]

What's happening with the BMA hearing on Wakefield? It kicked off in a blaze of publicity the middle of last year, and then seemed to vanish from the news. I'm sure it hasn't been completed, but I'm surprised it's taken going on a year.

 

[Deetee]

What's happening with the BMA hearing on Wakefield? It kicked off in a blaze of publicity the middle of last year, and then seemed to vanish from the news. I'm sure it hasn't been completed, but I'm surprised it's taken going on a year.

It was adjourned and is due to resume on 25th March at the GMC in London.
I think he stands a chance of being cleared actually, which would have the antivaxers in raptures (although the charges are to do with Wakefield's financial irregularities, honesty and trial ethics, and have nothing to do with the veracity of his work per se, which has been shown to be nothing but speculative and incorrect froth).

Dr Wakefield is charged that:
In reporting a link between MMR and a regressive autistic state, as he did in the Lancet, he was dishonest, irresponsible and misleading.

In reporting cases of children who for various reasons fell beyond the inclusive criteria of the ethics committee, he acted, dishonestly, irresponsibly and contrary to ensuring the provision of accurate information.

In relation to the Lancet paper, Dr Wakefield is charged that he failed to declare disclosable interests with respect to funding which he received from legal aid.

In relation to Transfer Factor, Dr Wakefield is charged that in relation to one child who was prescribed Transfer Factor, he acted against the clinical interests of this child and abused his position of trust as a medical practitioner.

At the time of his son’s birthday party, he took blood from children, paid them £5 for so doing and later recounted the incident at a presentation in March 1999. In doing these things, he did not have ethics committee approval, carried out the procedure in an inappropriate social setting, offered children inducements, showed a callous disregard for the suffering and pain of the children involved, abused his position of trust and brought the medical profession into disrepute.

 

[Rocko]

It was adjourned and is due to resume on 25th March at the GMC in London.
I think he stands a chance of being cleared actually, which would have the antivaxers in raptures (although the charges are to do with Wakefield's financial irregularities, honesty and trial ethics, and have nothing to do with the veracity of his work per se, which has been shown to be nothing but speculative and incorrect froth).

Thanks for that - why was it adjourned then? Are they gathering more info?

Out of interest, why do you think he's got a good chance of being cleared? Not disagreeing with you; you clearly know a bit about this.

 

[Deetee]

Thanks for that - why was it adjourned then? Are they gathering more info?

Out of interest, why do you think he's got a good chance of being cleared? Not disagreeing with you; you clearly know a bit about this.

Not too sure why the GMC had a long break on this one - could have been some procedural thing I guess.

I think that they will be pushed to make sufficient charges stick - as to reporting of the research, he can claim he submitted it for publication and it was peer reviewed so it's not his fault. He went one further than this, he had a press conference during which he went beyond the findings in his paper, and suggested single vaccines. That was the thing that sent the media and public into a frenzy. He could argue that the reaction to his comments was not something he could forsee, so he is not culpable.
The other charges, though serious, would probably not be sufficient to get himself struck off.

However, it is always difficult to predict with the GMC as they come to many strange conclusions. In the case of Southall (and probably Meadows) they seemed to over-react and exceed their remit. Yet in the case of Donegan, they went all weak at the knees and let her off.

 

[Ivor the Engineer]

How do you think the GMC over-reacted in the Southall case? Did he not base his entire report on a TV interview he saw of the children's father?

The GMC hearing centred around conclusions Professor Southall drew after seeing an interview with Mr Clark on Channel 4's Dispatches programme broadcast in April 2000.

In his interview, Mr Clark described how the couple's first baby Christopher had suffered a nosebleed just 10 days before he died in December 1996.

Professor Southall told police he believed Mr Clark had killed the children after watching the interview.

He later outlined his concerns in a report. It was submitted to the family court, which was considering who should take care of the Clark's third child.

Professor Southall drew up his report even though he had no access to case papers, medical records or post mortem results.

He did not interview Steve or Sally Clark before submitting the report.

The GMC panel's criticisms centred around Professor Southall's decision to write a report on the family.

The paediatrician had defended his actions during the seven-day hearing and denied serious professional misconduct. He also said that he still believed Mr Clark may have killed his two sons.

What was a jury supposed to think when Meadows came out with the now-infamous "73 million to 1 odds of two cot deaths in the family" claim?

During Mrs Clark's trial, Sir Roy said the probability of two natural unexplained cot deaths in the family was 73 million to one.

The figure was later disputed by the Royal Statistical Society and other experts said that once genetic and environmental factors were taken into consideration, the odds of a second cot death in the same family were closer to 200 to one.

 

[Deetee]

There are different Southall cases.

The one you refer to is when he was found guilty of serious professional misconduct but not struck off. He was suspended from child protection for 3 years.

There were other complaints against him which were heard more recently, and he was subsequently struck off by the GMC. The allegation was that he had accused a mother of killing her child. This is the case I was referring to and which I think the GMC got completely wrong. Quite how they reached their decision is mystifying.

Southall had been asked to investigate a case where a child was found hanged and there was much uncertainty about the circumstances and concerns about the safety of the child's sibling. As part of Southall's discussion with the mother concerning this, he had to explore all possible explanations for the death, and rightly asked questions exploring/dismissing the possibility that the mother may have been involved in some way. Later she stated he had accused her of murdering her child, something that he denied. Nevertheless the GMC accepted the mother's account which was contrary to the account of the social worker and Dr Southall, and not backed up by the documentary evidence produced.

Mrs M’s complaint relates to events in a closed room in a hospital in Stoke-on-Trent in 1998. There were three people in this room: Mrs M, Professor Southall, and Francine Salem, a senior social worker. Ms Salem made handwritten notes at the time which were clearly quite comprehensive, and which Mrs M accepted at the hearing as an accurate account of the meeting. These notes, and her sworn evidence given over three days at your hearing, clearly show Professor Southall acting entirely appropriately and professionally. Mrs M, however, claimed an almost diametrically opposing scenario, despite accepting that Ms Salem’s notes were accurate.

 

[Rolfe]

Hmm, why do I think the GMC's verdict might be political whichever way it goes?

I think there were three main problems. First, Wakefield misrepresented his research to the Lancet - he said that the 13 children in the study were consecutive GP referrals, implying that they were representative of the population as a whole and were not selected for in any way. However, it transpired that the referrals were as a response to Wakefield's tame solicitor publishing adverts calling for people who believed their child had been harmed by a vaccine to come forward. Thus the cases were indeed highly selected. The editor of the Lancet said he would never have allowed the paper to be published with the conclusions stated if he'd known that. It's no defence to say that your work passed perr review if in fact you misrepresented your work to gain such approval.

Second, Wakefield had some pretty dodgy finance going on. He was being paid to do stuff that was/should have been covered by the NHS, and he didn't declare some funding. Plus the fact that he hoped to make a mint acting as an expert witness for the parents in court cases against vaccine manufacturers. Plus the fact that he had a patent out on some sort of alternative to the MMR at the time he criticised MMR to the press. Not to mention paying children a fiver a go for blood samples. This is not something the GMC really approves of.

Third, he did some pretty unpleasant and invasive procedures on some very disturbed children, apparently for the purposes of his research, rather than for the good of the children.

I'd be interested to know how the GMC plans to let him off on all that lot.

Rolfe.

 

[Ivor the Engineer]

Deetee,

I agree with you it appears bizarre the GMC struck off Southall for the case you were referring to.

 

[Deetee]

Third, he did some pretty unpleasant and invasive procedures on some very disturbed children, apparently for the purposes of his research, rather than for the good of the children.

For me this is one thing I am unable to understand, but the relevance of this seems to have been played down quite a lot.

If one sees a child with autism, doing a spinal tap when not clinically indicated but just to further one's research hypotheses is certainly excessive, and I wonder how this ever got through ethics approval, never mind consent from parents unless he sold it to them as a way of helping diagnose their autism condition.

He is still promoting the investigations into his fictitious condition "autistic enterocolitis", by advocating doing invasive endoscopic examinations and bowel biopsies in children who have autism. According to W, the signs of enterocolitis can be so subtle that no-one can see them (except him of course). They include things like griping abdominal pain - something that most autistic children get at some stage because constipation is so common.

 

[Deetee]

Deetee,

I agree with you it appears bizarre the GMC struck off Southall for the case you were referring to.

I think he has submitted an appeal. Not too sure tho.