Wakefield on NBC Dateline

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September 1st, 2009 · 26 Comments · Critical thinking, Narrative

If disgraced UK gastroenterologist Andrew Wakefield is displeased by his recent star turn on NBC Dateline, he only has himself to blame. After all, Wakefield asked for it. Literally.

Last Winter, Dr. Nancy Snyderman told Matt Lauer on the Today Show that Wakefield is “a fraud”. She also had sharp words for Wakefield in April’s Stanford Medicine when she wrote:

(Wakefield) believed virus from the MMR vaccine traveled from the arm to the intestines, causing inflammation there, which led harmful proteins to enter the bloodstream and the brain, causing neurological impairment. He didn’t let the fact that he hadn’t identified these proteins stand in his way (and neither did the journal). The hypothesis became conventional wisdom and 10 years later we are cleaning up after the damage.

Wakefield’s lawyers, ANB has learned, contacted NBC News, and alternately threatened legal action and demanded that the network air their client’s side of the story. The network complied.

It’s not the first time that a bluff has backfired on Wakefield.

In 2004 he welcomed, even insisted, that the General Medical Council launch in investigation into his professional conduct. When the GMC followed through, Wakefield fled to the US.

That same year Wakefield sued UK’s Channel 4 for libel over reporter Brian Deer’s investigation. That led to a judge approving a motion for discovery that forced Wakefield to release more damning documents to Channel 4 and Brian Deer, further assisting the GMC’s inquiry. Wakefield later dropped his suit and paid Channel 4′s legal expenses.

So what was Waker’s thinking when he demanded a sit-down interview with Matt Lauer, parts of which were packaged as “A Dose of Controversy” and aired to the nation Sunday night? The episode was produced by Amy Schmitz, who is Snyderman’s full-time producer. Schmitz formerly produced for Dr. Tim Johnson at ABC, another evidence-based health advocate who sees through vaccine charlatans.

Lauer’s report, though tepid at times, and confusing at others, should be welcomed by the public health community and pro-vaccine advocates. Fortunately, Lauer listened to Deer, and also Dr. Paul Offit, another leading Wakefield critic. Both men wasted no time getting to the point.

“This thing stank from the first day it appeared,” said Deer, who went on to explain Wakefield’s conflict of interests with a law firm that was suing makers of the MMR vaccines.

“I think (Wakefield) has done a tremendous amount of harm, and it’s amazing to me that he doesn’t accept the responsibility for that harm,” said Offit.

NBCWakers

Curiously, Lauer stumbled throughout the piece, seemingly oblivious to the target rich environment that Wakefield had led him to. At one point, Wakefield asked Deer “In your opinion, how much did Wakefield’s lawyers pay him to perform the study?” The answer, $750,000, is not an opinion – it’s a matter of public record. Lauer also asked Deer “In your opinion, was Wakefield developing his own vaccine (in 1998)?” Wakefield admitted to Lauer that he was working on a vaccine, but that it was only to treat people already infected. That was a lie: claim 2 of Wakefield’s patent clearly states says it can be used as prophylaxis against measles. Lauer either didn’t know, or didn’t care.

Wakefield played the brave maverick doctor, and maintained that he was concerned by UK press coverage of his Lancet study. He said he didn’t know if vaccines cause autism, and he cited the precautionary principle – putting the interests of children first – as justification for breaking up the MMR series into individual shots.

The report’s low point came in the person of Dr. Bernadine Healy, who buttressed Wakefield’s claim that “other doctors” are backing his unsubstantiated and ludicrous claims. But Healy spoke in generalities and platitudes, and avoided concrete statements. She spoke of a “small subset” of children who might be hurt by vaccines that aren’t picked up of the large population studies. Does this mean she doubts the “autism epidemic” canard? Hard to say. As Sullivan at LBRB puts it:

Some will hear that and think, “children with autism, that’s the small subset” and the “take away” message will be, “she supports the idea of vaccines causing an epidemic of autism”. It’s possible that “small subset” means a small subset of autistics. In other words, she might be accepting the data that show vaccines haven’t caused an epidemic of autism. It’s possible that “small subset” is the very small subset of people who are injured by vaccines, some of whom are autistic and some of whom are not. In which case, what she said isn’t controversial at all.

We just can’t tell what she meant from what she said.

The report also suffers from the inclusion of Warrior Mothers, whom Lauer describes as “emotionally involved, desperate for answers”. But emotional, desperate parents function as human shields for the quack practitioners performing procedures of little value for large sums of money. We are introduced to the Kasemodels of Minnesota, who traveled with their autistic son to the Lourdes Shrine of Big Autism, Wakefield’s Thoughful House, where we watch the boy being sedated for an endoscopy. The procedure will cost the Kasemodels $4,500, to look for a disease that doesn’t exist. We hear the results – mild inflammation, but no evidence it is caused by vaccines. Our voyeuristic impulses fully sated, Lauer moves on. That’s a shame. With so many dots to connect, from rigged test results to preventable disease outbreaks to a growing quack cure industry, all we get is a cheap diagnosis, rather than Snyderman’s verdict from last winter – “This guy is a fraud”.

Update:

RangelMD chimes in:

Even though he “confronted” Dr. Wakefield with several of the accusations of fraud and conflict of interest that are now well known in association with this case, Mr. Lauer appeared to be more than content with Dr. Wakefield’s minimalist denials and stonewalling. The entire interview can be summed up thus:

Mr. Lauer: “What do you say to those who accuse you being a fraud?”

Dr. Wakefield: “I’m not a fraud.”

Mr. Lauer: “Well, OK then.”

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26 responses so far ↓

1 Sullivan // Sep 1, 2009 at 10:11 am

The answer, $750,000, is not an opinion – it’s a matter of public record

Technically, it is an opinion that Dr. Wakefield was paid this amount.

It is an opinion since we can’t rule out whether Dr. Wakefield was paid more.

I feel confident that Mr. Deer would have found and reported other payments, though.

Dr. Wakefield made some amazing statements. His take on paying kids money at a birthday party for a blood draw was stunning–it wasn’t a payment, it was a reward.

Yeah, that settled the issue.
2 Clay // Sep 1, 2009 at 12:28 pm

As a journalist, it seems that Matt Lauer is just another “haircut”. He really should educate himself on issues before taking them on. Failure to do so is just being irresponsible. Dr. Snyderman pulled him up short recently, on the subject of vaccines. He should have learned his lesson.
3 Anthony's Dad // Sep 1, 2009 at 4:14 pm

Yeah, I remember that. Lauer said at the end of an interview with her, something like “And the controversy continues.” And she shot back, “No, there IS no controversy.” She wouldn’t let him get away with ending it like that. Awesome.
4 Harold L Doherty // Sep 1, 2009 at 11:01 pm

Your opinion that Dr Wakefield is disgraced is interesting. Did the GMC investigation launched in 2004 determine that he was guilty of professional misconduct? If so can you provide a link?

Thanks.
5 autblog // Sep 2, 2009 at 6:17 am

Harold, why are you assuming that personal and professional disgrace only comes with a guilty verdict?
6 Benjamin Wyatt // Sep 2, 2009 at 10:04 pm

I’m still new to this whole vaccine debate so I’m not taking sides one way or the other. However having done a brief search of Dr. Snyderman, I don’t see why I should care one way or the other what she thinks about vaccines and autism.
7 autblog // Sep 3, 2009 at 11:14 am

Nor should you. What’s important is the evidence.
8 Randy E // Sep 6, 2009 at 5:15 pm

What a horribly skewed and biased post.

Given that Healy is a former director of the NIH, she has some bona fides. Your glib remark about a small subset of children reveals your obvious lack of understanding of statistics.

The Simpsonwood transcripts also bolster the reasonable doubt regarding vaccinations. One participant, upon hearing the evidence regarding thimerosol, stated that he wouldn’t want his grandson to be injected with it.

Offit is a coinventor of a vaccination. That alone disqualifies him as an unbiased source. The original critic of Wakefield was also found to have a serious conflict of interest.

Disregarding the conflict of interest of the critics and of the supporting evidence undermines the credibility of this post and of this website as a whole.

Quack.
9 Concerned Parent // Sep 7, 2009 at 7:22 pm

It looks to me like this website is funded by the pharmaceuticals. In that case, of course vaccines couldn’t possibly have contributed to autism. In fact, there is no possible way any environmental factor could have contributed. Why have cases gone from 1/10,000 in the ’80′s to 1/150 today, with much of the rise coincident with the increasing number of vaccines given, and with evidence that many children were given doses of thimerosal from their vaccines that exceeded that safe EPA guidelines for mercury exposure, and coincident with the introduction of 80,000 mostly untested chemicals into the environment???? Why, it’s obvious that medical professionals just diagnose it better. I guess their colleagues prior to the ’90′s just weren’t that competent, because they must have missed 59/60 cases of autism. Hmmmm. No mystery here. Perhaps the chemical manufacturers also contribute to this site.
10 autblog // Sep 7, 2009 at 9:06 pm

Why have cases gone from 1/10,000 in the ’80’s to 1/150 today,

CP, you should do your own homework, and stop cribbing notes off Generation Rescue. There was no “autism spectrum” in the 1980s – just autistic disorder. The prevalence for AD was estimated at about 5:10.000 back then, using the very restrictive criteria of DSM-III. So you’re comparing apples to oranges.

Nobody is disputing that environmental factors may contribute the autism. In 2007, the AAP said:

“…the expression of the autism gene(s) may be influenced by environmental factors. Although currently under investigation, these factors may represent a “second-hit” phenomenon that primarily occurs during fetal brain development. That is, environmental factors may modulate already existing genetic factors responsible for the manifestation of ASDs in individual children.”
11 Randy E // Sep 8, 2009 at 8:04 pm

Cal released a study in January that ruled out a change of diagnosis as the cause of incidence rate increase (talk about doing your homework).

Regarding the rate increase and genetics, there is no way the skyrocketing rates is a genetic epidemic. That simply does not happen. There is most certainly some “modulation” occuring.
12 autblog // Sep 9, 2009 at 7:10 am

You’re talking about the UC Davis study on cumulative incidence of autism in California, aka Hertz-Picciotto paper (HP). It concluded that autism prevalence continues to increase in CA., age of diagnosis changes increase incidence by 12%, inclusion of milder cases increases incidence by 56%, so the increase is not fully accounted for by these two factors. That’s all it said. It didn’t blame environmental causes, as the UC-Davis press release claimed. HP also failed to take diagnostic substitution in account.

But HP’s biggest shortcoming is that it used administrative data to make conclusions about increase in prevalence – something the CDDS even warns against on its website.

How do you define “skyrocketing rates”? Please use actual numbers and dates.
13 Randy E // Sep 9, 2009 at 7:53 pm

I’ll rephrase my original reply to you “apples to oranges” claim. You have no evidence of this and the Cal Study concludes this:

“Whether the observed increase in prevalence in part reflects a true increase in incidence or is totally an artifact of improved recognition and detection combined with a broadening of the diagnostic definition remains to be clarified. However, these data clearly demonstrate that autism is much more common than previously believed.”

In terms of skyrocketing rates, look for yourself.

http://thewip.net/contributors/herzlin_lineplot.jpg

Ask any school districts in your area about their increased need for sped teachers with a skill set that includes working with autism.

Feel free to post opposing rates, numbers, dates, etc.
14 autblog // Sep 10, 2009 at 8:52 am

Ranting is for people who don’t have facts on their side. ; -)

Those who argue for an autism epidemic are fond of saying “it’s not just change of diagnostic criteria.” I totally agree. Nobody seriously suggests that it’s just changes in DSM criteria. Rising case rates are attributable to other factors as well: diagnostic substitution, increased public awareness, and an increase in services, to name a few.

The fact is, we have no good data to conclude one way or the other. But we can say for certain that Generation Rescue’s claim that rates have risen from 1:10,000 in 1983 to 1:150 today is deliberately misleading. First, I’ve never seen a population study from 1983 which shows 1:10,000. Lotter (1966) found 4.5:10,000. That’s the earliest study, and Lotter was looking for a specific subset of children with Kanner’s autism. Today’s DSM is far less restrictive in defining autistic disorder.

The Thoughtful House chart uses IDEA data. IDEA rates for all disabilities during the same period is flat. This is evidence for diagnostic substitution. If you have an alternative explanation, please share.

An amended version of the Individuals with
Disabilities Education Act (IDEA), passed by Congress in 1991, required schools to count children with disabilities, which is why Thoughtful House’s chart starts in 1992. But these numbers are not based on medical diagnoses of autism, or on carefully drawn population studies, so researchers who rely on “administrative-based estimates,” will arrive at misleading conclusions about autism’s prevalence. California’s DDS warns about the limitations of administrative data on its website.

The most reliable estimates of ASD rates come from “population-based estimates,” such as the one Lotter did in 1966. Eric Fombonne analyzed about 40 such studies conducted between 1966 and 2007 (IIRC), and found no evidence for a true rise in prevalence. However, to be fair, nobody has found evidence that rules out such a rise, either.

Hope this clears things up.
15 Joseph // Sep 10, 2009 at 8:54 am

@Randy E: No one disputes that the number of children labeled with autism has skyrocketed. This is *not* the same as saying that the number of autistic children has skyrocketed. A lot of people seem to confuse these two statements.

In fact, the total number of children in special education has not increased, so why would there be a need for more special education teachers, beyond what would be expected from population growth?
16 anonymous // Sep 10, 2009 at 2:13 pm

Google is your friend. Reliable info showing that special education and level of need has increased and is steadily increasing.

Data shows that before the census for Autism spectrum ratio is that if you combine non autistic labeled adults who were diagnosed with some sort of mental retardation or mental dysfunction combined, do not add up to total Autism diagnosis, today and it is steadily increasing.

Smelling smoke has been something we’ve been smelling for a long time, now.

So, ignoring the fire by using selective information and ridiculing those who see the fire is not going to make the vaccine Autism issue go away.
17 Randy E // Sep 10, 2009 at 9:58 pm

Joseph, the Cal study did not find that a change in diagnosis was the only related factor in the increase in incidence.

The number of of young people diagnosed with austism has most certainly risen and I’ve shared data to support this. The rate incidence of other special ed categories has been steady while autism rates have increased.

Feel free to share some supporting evidence for your position.
18 Randy E // Sep 10, 2009 at 9:59 pm

Given that dianosis has not been shown to be the factor in the increase, the actual number of kids has increased.
19 Joseph // Sep 11, 2009 at 5:24 am

Joseph, the Cal study did not find that a change in diagnosis was the only related factor in the increase in incidence.

I assume you’re referring to the UC Davis / MIND study. That study did not really quantify “change of diagnosis” (diagnostic substitution) at all. It only looked at age at diagnosis, changes in criteria, and inclusion of “milder” cases. It finds that these factors might explain a 4.26-fold increase in CalDDS, whereas they expected to explain a 6.85-fold rise. It’s not clear why they think this difference is statistically significant. The paper doesn’t say.

The paper admits they did not account for certain factors that ought to be significant, such as awareness. Hence the paper’s tempered conclusion.

The paper had many very serious problems. I listed them at the end of this post:

http://autismnaturalvariation.blogspot.com/2009/01/age-of-diagnosis-analysis-is-also-wrong.html

BTW, it’s not as easy to quantify diagnostic substitution in the CalDDS database, as it would be in IDEA. That’s simply because in IDEA there’s a “primary disability” category, whereas in CalDDS a “client” has multiple categories simultaneously. So you shouldn’t expect there to be a decrease in mental retardation classifications, for example, as they are based on assessments of IQ.
20 Mike Stanton // Sep 12, 2009 at 10:32 am

Over on LBRB Sullivan has posted about a study by King and Bearman analysing the California data for diagnostic substitution in which:

“it is estimated that 26.4% (95% CI 16.25–36.48) of the increased autism caseload in California is uniquely associated with diagnostic change through a single pathway—individuals previously diagnosed with MR.”

Taken together with the results of the UC Davis / MIND study which Joseph mentioned above this would seem to seriously undermine attempts to use the Californian data to support the idea of an autism epidemic.
21 Joseph // Sep 14, 2009 at 11:56 am

It needs to be noted that the majority of autistic children in CalDDS have been assessed as having *no* mental retardation. There’s no reason to think these same children would’ve been assessed as having mental retardation in the past. (When the child is untestable, they have a category called “unknown MR.”) So it’s not surprising that diagnostic substitution from MR (without autism) would only account for a faction of the increase in CalDDS. The rest is probably due to awareness and increased service provision for kids who don’t have cognitive impairment per se.
22 Sullivan // Sep 14, 2009 at 4:50 pm

“He said he didn’t know if vaccines cause autism”

Odd, he says it quite clearly in his patent.
23 Sullivan // Sep 14, 2009 at 4:53 pm

Given that Healy is a former director of the NIH, she has some bona fides. Your glib remark about a small subset of children reveals your obvious lack of understanding of statistics.

You may want to stick to what she says, rather than her “bona fides”.

Dr. Healy was a member of TAASC, an organization paid by Tobacco company interests to deny the dangers of second hand tobacco smoke.

They also denied global warming, but, as a medical doctor, that may not be Dr. Healy’s domain at TAASC.

Dr. Healy actually says very little. Much of what she said in the past was incorrect (such as her assertions against the IOM).
24 Sullivan // Sep 14, 2009 at 4:55 pm

The rate incidence of other special ed categories has been steady while autism rates have increased.

Dr. Shattuck has a paper that states the opposite.

Also, if you want to argue from CDDS data, that is a different dataset entirely. In the CDDS data, it is very clear that the number in the MR category has gone down markedly as autism has gone up.
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