Wednesday 3 February 2010

Private Eye still believes in Wakefield...

As discussed in my previous post, and many other places all over the internet, the GMC ruling against Andrew Wakefield was damning. But not so much if you write for Private Eye, who have been defending Wakefield for years. So, in the light of the GMC findings that Wakefield behaved unethically, with "callous disregard" for the wellbeing of the children involved, and that parts of his research were fraudulent, is it time for the Eye to admit it was wrong?

Apparently not. In an "In the Back" piece, the Eye had the following to say:
Although the GMC said the hearing was not about vaccination and autism, it is fairly clear that the two and a half years of disciplinary proceedings were to bring the MMR debate to a conclusion. The three doctors were to some degree being accused (and found guilty) of causing a public health scare which led to a fall in vaccination rates, so damaging "herd immunity", particularly with regard to measles.
Nope. They were found guilty of conducting invasive diagnostic procedures, against the children's interests and without ethical approval; of not disclosing serious conflicts of interest; and of presenting false information in the publication of their research (which finally led to the Lancet retracting the paper).
Several parents of the children who featured in the team's original research paper, which was at the centre of the GMC case, stormed out of the hearing in angry protest at the findings - particularly the suggestion that their children's tests were not clinically necessary...They say they would have told the GMC that the treatment they received at the hospital helped their children's symptoms - but they were never called to testify.
Eh? We're not talking about treatment here, we're talking about invasive diagnostic tests. These were done without ethical approval, without the required expertise, and against the interests of the children. Perhaps we should just get rid of ethical approval, as it gets in the way of heroic doctors doing whatever they need to vunerable patients.

And finally:
None of this debate about conduct, however, changes the fact that no subsequent research has supported Wakefield's thesis of a possible link between the MMR vaccine and autism. Nor does it change the fact that despite previous attempts to justify the Eye's coverage at the time, some readers are still deeply critical of the magazine's reporting of the MMR debate between 2001 and 2007, when we wrote about the concerns of Wakefield, the families and their lawyers, and endorsed calls for more research (see Letters).
Well, indeed. So why is the Eye still apparently defending the indefensible? I still buy the Eye, for all the other good that they do, but they've made a mistake over MMR and they ought to be big enough to admit it. They would surely ask the same of any of the politicians and industry figures they regularly lampoon.

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...