There’s a telling moment at the end of Don Imus’ interview with Andrew Wakefield, the gastroenterologist who has been barred by the UK General Medical Council from practicing medicine. Wakefield had just spent seven minutes explaining that he is the victim of a huge witch hunt and conspiracy by vested interests who can’t handle the truth about vaccines. Imus, unencumbered by facts and research, played along, eager to put another fluff celebrity interview in the can. Then this exchange:
Imus: If everything you say is true, if these are the facts, it doesn’t make any sense what happened to you.
Wakefield: That’s just the way the system deals with dissent and (unintelligible).
Imus: If you were a complete total whack job making all these wild charges, I could understand.
I think Imus is onto something. If Wakefield was telling the truth, then the GMC’s verdict against him makes no sense. But Wakefield wasn’t telling the truth, ergo what happened to him does make sense, ergo Wakefield is a complete and total whack job.
Let’s go to the tape:
Wakefield’s fact-challenged defense, which he also made during an interview with Matt Lauer two weeks ago, stands on two very shaky legs. First, he claims that the results of the discredited 1998 “measles in the gut” study have been replicated in five studies. His second point is that the US government has been conceding cases of vaccine-induced autism since 1991. Both claims are demonstrably false.
Wakefield identified the five studies for Imus:
This has been a common contention that nobody else has been able to replicate our findings, the key finding in The Lancet, which is bowel disease, has been replicated in five different countries. In Italy by Dr. Balzola, in Venezuela by Dr. Gonzales, in the US by Dr. Krigsman, and by Dr. Chen and Dr. Galiotsatos in Canada. It has been replicated around the world. The notion that it has not is false and a deception on the American public.
Sullivan at LBRB takes us through the five “studies”. Wakefield’s Balzola citation could refer either to a case study of a single adult autistic with an inflamed bowel, or an unpublished report of a meeting that took place five years ago. Neither constitutes independent, peer-reviewed replication of Wakefield’s finding of “autistic enterocolitis.”
The Gonzales study did not replicate Wakefield’s 1998 findings, although it did report a higher incidence of gastrointestinal problems in the autistic group.
The research for the Krigsman paper was performed at Thoughtful House, the alternative health clinic that Wakefield started in Austin, Texas, and was published in Autism Insights, an online journal that has been publishing for less than one year. If Imus had spent 15 minutes researching the story, he could have asked Wakefield how an article published in a journal he edits qualifies as independent confirmation. In fact the editorial board is packed with Wakefield cronies. Mike Stanton at Action for Autism rightly suspects the purpose of Autism Insights is to “publish paper papers by biomed supporters that cannot find a reputable journal that will publish them. This would make it no better than the bogus journals that Elsevier set up to publish infomercials for drug companies posing as bona fide research.”
The Chen study, published last winter, is a case study of two autistic children and a “rare association between autism and colitis”. The authors conclude:
This report suggests the possibility of either impaired intestinal barrier function or an aberrant immune system that predisposes autistic children to sensitization to environmental antigens. Large controlled studies are needed to examine this hypothesis.
To call this paper a replication of anything is more than a stretch. It’s desperate.
The Galiatsatos paper is a case report of two autistic adults with gastrointestinal problems, where the authors’ conclusion calls for “more investigations”. This is hardly the same as a replication of Wakefield’s original finding. Autism does not prevent GI problems, so it is not surprising that some adult autistics have GI problems.
Wakefield’s studies are weak tea compared to the studies that failed to replicate his findings. They include the 2008 Hornig study which faithfully reproduced Wakefield’s famous Lancet study, going as far as to use his original lab, and concluded his results most likely resulted from shoddy lab work. Also, to Chen et. al., (2004) who found no link between autism, MMR and the measles virus.
Wakefield’s second line of defense, that the US government has secretly been admitting a link between vaccines and autism is so ludicrous that only a doddering buffoon, i.e. Don Imus, would fail to catch on. It would be remarkable if none of the 2,100 cases awarded in vaccine court involved a child with autism. Given a known prevalence of 1:100, we can expect 21 cases where the plaintiff had an autism diagnosis. According to research by Kathleen Seidel at Neurodiversity, there are nine.
Wakefield’s accusation is so specious that even David Kirby won’t pursue it. Last year, the Generation Rescue pitchman wrote on the famously credulous Huffington Post:
And, more than 1,300 vaccine court cases were already paid out for encephalopathy and seizure disorders. We will soon learn how many of those children also have an ASD, though I can confirm now that it appears to be far, far higher than the 1-in-150 rate reported by CDC.
We’re still waiting for that follow up.
Wakefield’s deviations from the truth were not limited to junk science and historical revisionism. He also told Imus, with a straight face, that it is not unethical to act without ethical approval, where such approval is clearly required:
The essence of medical practice, Don, is fully informed consent. (Drawing blood from children at a birthday party) did not have ethical approval, and that was naive on my part. That does not make it unethical.
If there is a lesson in l’affaire Wakefield, it’s that matters of science are best discussed in scientific forums, where critical thinking matters more than glib replies. When a brave maverick doctor chooses the klieg lights of easy fame over the harsher light of free inquiry, he loses not only the respect of his peers, but any legitimate claim to be taken seriously. Wakefield’s long fall from London’s Royal Free Hospital has many stops along the way, and they reflect, in descending order, how far the mighty can fall. Imus in the Morning is just one more station before Mr. Wakefield’s final transformation into a complete and total whack job.