Wednesday, 3 February 2010

It's literature integrity week...

The integrity of the scientific literature is at issue in not one but two news stories this week. Firstly, the 1998 Lancet paper by Andrew Wakefield and several co-authors, which purported to show a link between autism and the MMR vaccination, was retracted [PDF] by the journal. Meanwhile, there is an ongoing brouhaha about a 1990 Nature paper that has some implications for climate change research.

I'm only going to deal with Wakefield here because, you know, I have other things to do. The retraction by the Lancet is really the final nail in the coffin of Wakefield's paper, which has been heavily criticised for numerous reasons. Of the thirteen authors, ten had previously retracted the interpretation that there was any link between autism associated with gastro-intestinal problems and the MMR vaccine. Only Wakefield himself and one P Harvey refused to sign up to this: the remaining author could not be contacted. It has also been known for some time that the methodology of the paper was flawed. So what suddenly changed this week?

For some time the General Medical Council (GMC) has been investigating Wakefield and two colleagues, Simon Murch and John Walker-Smith, over allegations relating to their research on autism. The GMC findings were released on January 28th, and can only be described as devastating. You can find the whole thing here [PDF], or there's a good summary at Respectful Insolence.

The GMC did not look at whether the research findings were right or wrong: rather they looked at the research methodology. Essentially, the major problems were these:

1. Wakefield had an undisclosed conflict of interest, because he was being paid by lawyers whose clients believed their children had been harmed by the MMR vaccine.

2. Wakefield ordered invasive diagnostic tests, including colonoscopies and lumbar punctures, that were unnecessary and not in the children's interests, and he had neither the required ethical approval nor the requisite expertise to order those tests.

3. Wakefield obtained blood samples at his son's birthday party by paying children £5 each. The GMC panel described Wakefield's actions as comprising "callous disregard for the distress and pain the children might suffer".

4. The 12 children were described as having been "consecutively referred", but this was not true.

Heres what the Lancet had to say:
Following the judgment of the UK General Medical Council’s Fitness to Practise Panel on Jan 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al1 are incorrect, contrary to the findings of an earlier investigation.2 In particular, the claims in the original paper that children were “consecutively referred” and that investigations were “approved” by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record.
So that's that. The problem with the paper is not that it was wrong; that has been known for some time. In fact, simply being wrong would not be a reason to retract the paper. Science often progresses by building on papers that were not quite right. No, the problem with the Wakefield Lancet paper was that it was fraudulent, unethical and incompetent, as well as being wrong. As a result, the takeup of MMR has fallen below the ~95% level at which herd immunity is maintained, and measels has once again been declared endemic in the UK. That's why you should try to avoid publishing fraudulent and unethical research. We'll let you off if your research is merely wrong, as long as it was honestly and competently wrong.

Wakefield eh, what a hero? Unfortunately, as we'll see in my next post, some people in the most unexpected places still believe in the Cult of Andy...

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