It took years, and an enterprising reporter to check on the facts, but now it’s official: The  “MMR vaccine causes Autism”paper was not only flawed, but was made up. It was part of a money making scam concocted by a lawyer who hoped to make money off of a class action lawsuit, with the help of a doctor who was paid by that lawyer to “find” something to sue, and who also had monetary interests in pushing a different vaccine.

The original study, which was based on only 12 patients, was itself flawed. Often studies show a “cluster” of disease in an area, by coincidence, or rarely from a local illness. If the vaccine was the cause, other physicians would have noted a similar cluster of problems, yet no one did.

But in this case, the doctor recruited many of the patients from all over the place, so the extent of the “problem” would be exaggerated, since 12 cases who walk off the street and get seen in a hospital may signal an epidemic, but searching and finding only 12 cases out of millions of children in the UK who got the vaccine over several years may or may not prove anything but a simple coincidence.

But the tabloids and other groups soon took hold of the flawed scientific finding, and exploded the “problem” out of proportion: yet doctors were less convinced, for the dirty little secret is that when you compared population statistics, no one else seems to have found more autism in children who got MMR than who didn’t..

From an editorial in The British Medical Journal:

…the paper was a small case series with no controls, linked three common conditions, and relied on parental recall and beliefs.4 Over the following decade, epidemiological studies consistently found no evidence of a link between the MMR vaccine and autism.5 6 7 8 By the time the paper was finally retracted 12 years later,9 after forensic dissection at the General Medical Council’s (GMC) longest ever fitness to practise hearing,10 few people could deny that it was fatally flawed both scientifically and ethically.

So we have a flawed study that exploded into an urban legend. And no matter how many doctors and scientists protest, the parents who argue against it have passion and their beloved handicapped child to argue we are wrong.

Science has problems when it confronts blind belief in quacks and faith healing scams, but  in this case, the parent’s story makes for better headlines (and more profits for the tabloid press) so alas science was not getting it’s truth out there to the public.

But in this case, the consequences of the hysteria were concrete. As a result of this “urban legend”, many parents suffered from guilt because they blame themselves for letting the child be given the vaccine, and many children have developed mumps or measles (both of which can cause encephalitis and brain damage) and there have even been a few measles deaths because their parents are too afraid to let the children get the shot.

Yet the most recent story goes beyond misunderstanding science, because it suggests that outright fraud was committed for financial gain. Again, from the BMJ:

In a series of articles starting this week, and seven years after first looking into the MMR scare, journalist Brian Deer now shows the extent of Wakefield’s fraud and how it was perpetrated (doi:10.1136/bmj.c5347). Drawing on interviews, documents, and data made public at the GMC hearings, Deer shows how Wakefield altered numerous facts about the patients’ medical histories in order to support his claim to have identified a new syndrome; how his institution, the Royal Free Hospital and Medical School in London, supported him as he sought to exploit the ensuing MMR scare for financial gain; and how key players failed to investigate thoroughly in the public interest when Deer first raised his concerns.11

It was a deliberate scam or fraud, to make money.

Journalist Brian Deer has a summary of his findings in the BMJ or you can read them at his website, which summarizes the plot:

…the investigation discovered that, while Wakefield held himself out to be a dispassionate scientist,(yet) two years before the Lancet paper was published – and before any of the 12 children were even referred to the hospital – he had been hired to attack MMR by a lawyer, Richard Barr: a jobbing solicitor in the small eastern English town of King’s Lynn, who hoped to raise a speculative class action lawsuit against drug companies which manufactured the shot.

The physician involved rewrote the case histories of the children to make the evidence stronger, even claiming that their bowel biopsies were positive when they were actually normal. Several of the children had symptoms of developmental delay or problems before getting the vaccine, and others got the vaccine months before the problems started, but were reported to have problem within days of the vaccine:

In an exercise never before accomplished by a journalist, Deer was able to go behind the face of the 1998 paper, identify the subjects, and access original patient data. Penetrating veils of medical confidentiality, he discovered that the hospital’s clinicians and pathology service had found nothing to implicate MMR, but that Wakefield had repeatedly changed and misreported diagnoses, histories and descriptions of the children, which made it appear that the syndrome had been discovered.

The bad problem about all of this is that few ordinary folks realize that autism is a “syndrome”, not a single disease.

It has many causes: PKU or metabolic syndromes, Fragile X syndrome,  encephalopathy from eating lead paint, a child whose mom had Rubella while pregnant, encephalopathy from a virus or from the old DPT vaccine (we now use a newer version that doesn’t have the problem). Many children have a high fever before the symptoms develop, so we suspect a viral encephalitis, or maybe an ear infection that caused a high fever also caused meningitis that was not recognized but was treated by the antibiotic given to cure the ear infection. Neonatal sepsis or jaundice can cause autism too, especially in a premature child.

Alas, often we doctors can’t find the cause, so the parents blame each other, and divorce. They blamed the Obstetrician, resulting in skyrocketing malpractice insurance for physicians. They blamed the medicine for the ear infection. In the “good old days” the “cause” of high IQ autism was even blamed on “frigid mothering”.

So when the tabloids and conspiracy sites started to blame the vaccine, I got worried, but not surprised. Passing the blame onto someone else is one way to cope with this tragedy.

But the fraud in this case cannot be overlooked. Too many have suffered from the crime.

And the scientific community itself has to examine itself in how it does “peer review” before publishing papers.At least one paper compared it to the “piltdown man” scandal, where the “missing link” was found years later to be a hoax.

Maybe with this urban legend put to rest, there will be more energy and funding to find the various causes for Autism syndromes, and even find ways to treat these children.

As for MMR vaccine: Here is a story I bet you don’t know:

Joint News Release American Red Cross/CDC/UN Foundation/UNICEF/WHO

3 December 2009 | ATLANTA | Geneva | NEW YORK | WASHINGTON – The Measles Initiative announced today that measles deaths worldwide fell by 78% between 2000 and 2008, from an estimated 733 000 in 2000 to 164 000 in 2008.

Yes, measles kills. When I worked in Africa, I saw several children die from measles, and our hospital were involved in a major push to get our area of the country immunized. But such lives saved rarely make the headlines in the tabloids..

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Nancy Reyes is a retired physician living in the rural Philippines

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