Health knowledge made personal
Join this community!
› Share page:
Go
Search posts:

The lack of substance in Andrew Wakefield’s supporters’ arguments

Posted Nov 11 2011 3:34am

Andrew Wakefield , the man who brought us the MMR scare, is back in the news. In a relatively small way. Earlier this year, Mr. Wakefield was in the news in a big way when the BMJ called him out for research fraud . At the time, Mr. Wakefield was enjoying the hospitality of wealthy patrons in a Jamaican resort, under the auspices of a “ vaccine safety conference “. Also attending the conference were a team from the (aside, I am getting more and more leery of groups that put “national” into their name). Why is this important? Because instead of responding to the BMJ article directly, Mr. Wakefield provided material to one of members of the Whistleblowers Center so he could reply. The letter , by David Lewis, attempts to address one of the many issues involved with Mr. Wakefield’s research. It does not do this well, to be frank.

One problem with discussing Andrew Wakefield’s work is that there is just so much wrong that one can easily lose the forest for the trees. The big picture gets lost going over count after count of dishonesty and unethical behavior.

When analyzing Mr. Lewis’ argument, there are again many problems to discuss. Once again, it is easy to lose the story for the details. Allow me to address a few.

First, the argument is a classic strawman. Mr. Lewis posits that it is reasonable for Mr. Wakefield to have reported nonspecific colitis in his 1998 Lancet article, therefore no intentional misinterpretation was committed. To bolster this argument, he provided the BMJ with the original scoring sheets used by the pathologist who reported on the samples. Writes Mr. Lewis:

As a research microbiologist involved with the collection and examination of colonic biopsy samples, I do not believe that Dr. Wakefield intentionally misinterpreted the grading sheets as evidence of “non-specific colitis.” Dhillon indicated “non-specific” in a box associated, in some cases, with other forms of colitis. In addition, if Anthony’s grading sheets are similar to ones he completed for the Lancet article, they suggest that he diagnosed “colitis” in a number of the children.

As though, even if accurate, this would exonerate Mr. Wakefield. As the BMJ point out, in not one , but two pieces by specialists (gastroenterologist and pathologist), these grading sheets do not support the claims made in the 1998 Lancet article.

If you don’t have time to read those short articles, here’s the title of one: “We came to an overwhelming and uniform opinion that these reports do not show colitis”. Pretty clear.

And, yet, one can already see the battle lines being drawn and the talking points distributed. Before, people ignored the facts and instead tried to frame this as a personal battle: “Brian Deer, journalist, vs. Andrew Wakefield, Doctor.” Just a quick tweak and we have “David Lewis, expert who knows colonic biopsy analysis vs. Brian Deer, mere journalist.” This is, of course, more convincing that “Opinion of soil scientist vs. a pathologist and a gastroenterologist .” And, of course, easier than tackling the facts.

Let’s consider some facts, then. The first sentence of the (now retracted) 1998 Lancet paper: “We investigated a consecutive series of children with chronic enterocolitis and regressive developmental disorder. ”

“Consecutive series” was, at best, misleading given the facts of how the children were referred to the Royal Free. A fact not addressed in any way by Mr. Lewis.

“Chronic enterocolitis”. Note, “enterocolitis”. Not “non-specific colitis”. Let’s break this down. “ -itis ” means inflammation. Colitis “refers to an inflammation of the colon and is often used to describe an inflammation of the large intestine (colon, caecum and rectum).”

All fine so far. But, “ enterocolitis “? The word actually used in the first sentence of the Lancet? The word used in the condition Mr. Wakefield coined for the condition he proposed, “ autistic enterocolitis “? Enterocolitis is “an inflammation of the colon and small intestine.” And small intestine.

You can check the scores on grading sheets in the table Mr. Deer provided on his website. These include links to the scanned sheets themselves. For example, the sheets for Child 1 .

The sheets and the table are arranged in a specific order: top down. From the highest point reached in the colonoscopy on down to the rectum (the exit of the large intestine).

Why point this out? Because you will notice from the table that for two of the eleven children reported (child one and twelve), there are no data for the duodenum (start of the small intestine) or the ileum (as noted in the Lancet article). Those reports start at the Caecum (the start of the large intestine) or lower. For some of the other children (child four , seven and nine ), there are data, and they are listed as “normal”. The Lancet reports them as having lymphoid nodular hyperplasia. Child two has some notation, but again is checked “normal” by Dr. Dhillon. Likewise child 5 and child 6 .

Which begs the question: how can you diagnose “enterocolitis”, inflammation of the large and small intestine, without data from the small intestine, or when the data you do have is normal? For 8 out of the 11 children, by my count.

Answer: you can’t. Hence the switch from “enterocolitis” to “non-specific colitis” in Mr. Lewis’ letter to the BMJ. In that letter, the term “enterocolitis” only appears in his citation of a Brian Deer article.

So, back to the first sentence of the Lancet article and ask, what is accurate? Let’s include the points made by Mr. Deer that not all these children demonstrated regression, and there wasn’t a single developmental disorder. So, with thanks to a reader who pointed this out: “We investigated a consecutive series of children with chronic enterocolitis and regressive developmental disorder(s).

or,

“We investigated children with developmental disorder(s)”

Not really very exciting.

While I have fallen into the trap I described at the outset, losing the forest for the trees, allow me to discuss one last piece of the way people are attempting to frame the way Mr. Wakefield wrote his paper. Instead of being an active researcher, it seems he is considered to be merely the man who collected the data and typed the manuscript. Mr. Lewis wrote, “I do not believe that Dr. Wakefield intentionally misinterpreted the grading sheets as evidence of “non-specific colitis.” ”

As though the entire process of diagnosing children with enterocolitis involved looking at Mr. Dhillon’s grading sheets. Once again, what did the Lancet article say? Under “Histology”:

Formalin-fixed biopsy samples of ileum and colon were assessed and reported by a pathologist (SED). Five ileocolonic biopsy series from age-matched and site-matched controls whose reports showed histologically normal mucosa were obtained for comparison. All tissues were assessed by three other clinical and experimental pathologists (APD, AA, AJW).

AJW refers to Andrew J. Wakefield. So, did he just accept the diagnoses from others, as we are being asked to believe now, or did he assess tissues, as he wrote in the Lancet in 1998? Seems an important point to downplay, as Mr. Lewis is not attempting.

To bring this to a close, a press release has been issued in support of Andrew Wakefield. Mr. Lewis is quoted:

“There was no fraud committed by Dr. Wakefield. The crux of the matter in Wakefield’s case, so far as research fraud is concerned, is whether Wakefield fabricated the diagnosis of non-specific colitis for 11 of the 12 Lancet children as claimed in Table 1. Drs. Paul Dhillon’s and Andrew Anthony’s grading sheets clearly show that Wakefield did not fabricate the diagnoses of non-specific colitis reported in the Lancet article.”

Well, no. Nonspecific colitis is not the “crux of the matter” at all. Mr. Lewis is referred to Mr. Deer’s article, and the discussion of regressive autism and when symptoms appeared. Facts which were not reported accurately in the Lancet.

And there’s that whole first sentence not being accurate at all thing…let’s not even get started on the concluding sentence:

We have identified a chronic enterocolitis in children that may be related to neuropsychiatric dysfunction. In most cases, onset of symptoms was after measles, mumps, and rubella immunisation. Further investigations are needed to examine this syndrome and its possible relation to this vaccine.

  1. Brian Deer:
    Wakefield tried very much the same manouver earlier this year over GP records. The argument then went that we relied on GP records for our reports, he never saw the GP records, therefore he couldn't have committed fraud. At its core, this argument was a deceit (of a logical form he uses a great deal). Apart from a tiny amount of signposting, like one or two ages, such information we used from GP records was the GPs noting phone calls and suchlike from Wakefield, soliciting individual children by name (extraordinary conduct in itself). He certainly knew about that, and it went to the heart of his fraudulent account of how the children came to be at the hospital, and the concealment of this, which the GMC panel found proven against a criminal standard of sureness. The key mismatches we identified last January (and also previously in a Sunday Times report) were from Royal Free hospital records, including letters to Wakefield himself, not GP records. We (and our lawyers) would know that someone couldn't have intent with regard to information they were unaware of, so we relied on what he must have known. Wakefield knew this, but, because he has nowhere else to seek refuge, he and his acolytes took up this claim about GP records, so as to suggest that he wasn't dishonest. That was material about the first claim in the Lancet paper - regarding a purported temporal link between MMR and autism, which the BMJ's editors judged to be fraudulent. Now we turn to the other claim in the paper, the purported discovery of a new inflammatory bowel disease. Using this guy Lewis, who was essentially bought by the anti-vaccine lobby in much the same way that the drug industry buys up doctors and scientists (foreign travel and luxury accommodation), Wakefield advances the same kind of deception. Through Lewis, he places the lie that our reports alleged that the fraud lay in pathology (when, since we didn't have the reports now disclosed we could hardly have divined the intent involving their use), then he says (following his discovery that we have had the forms assessed) that these are ambiguous, and that therefore there was no fraud. Previously, he claimed that Dhillon diagnosed non-specific colitis with these forms. But when we pointed out that, if this was true, then Dhillon also diagnosed colitis in the ileum and duodenum (which is impossible), he changed tack. We also pointed out that in one child (8), Dhillon scored straight zeros for inflammation in two biopsies, but still ticked "non-specific". Thus the Wakefield campaign, perhaps learning a little about the bowel, changes its stance. As I say, this is his style. And it has been for many years. It's interesting to see the anti-vaxxers claiming that he never said that MMR caused autism and suggesting that falsehoods in his work were the result of incompetence, not dishonesty. This is a new tack. However, in all the excitement, people may have forgotten that four counts of dishonesty over his research were found proven by the GMC panel. This means that Wakefield (who I understand has been stripped of his fellowship of Royal College of Surgeons) will never publish in a credible biomedical journal again. Finally, if he and his former Royal Free colleagues really cared about the children, they would have published the finding of severe constipation, and dedicated themselves to trying to investigate this very prevalent and distressing problem. Nobody of any credibility has ever suggested that many children with developmental issues don't have GI issues. That has been written about since the 1930s.
  2. Sullivan:
    "...they would have published the finding of severe constipation, and dedicated themselves to trying to investigate this very prevalent and distressing problem." I am reminded that in one case elevated lead levels were detected in one of the Lancet 12. It was noted but not treated.
  3. Science Mom:
    As a research microbiologist involved with the collection and examination of colonic biopsy samples,
    Yes, what expertise does an environmental microbiologist have with histopathology? Also, Dr. Lewis makes it sound as though he is performing medical procedures. Again, this is just another back-door attempt by Wakefield to exonerate himself because he doesn't have the goods to initiate any action against Mr. Deer and the BMJ. Does he even know that he is only preaching to the choir and no one else believes his bollocks?
  4. _Arthur:
    Am I correct that _none_ of the kids were treated by the Royal Free, and there was no follow-up in any case ? That would be at odds with the claim that the kids were severely sick. Or maybe that's the way medecine works in the UK, I can't say.
  5. Sullivan:
    _Arthur, Some children were treated. Some with anti inflammatory drugs. One with Mr. Wakefield's transfer factor experimental drug (without ethical approval)

Write a quick comment


Post a comment
Write a comment:

Related Searches