Who Says Dishonesty Doesn’t Pay?

January 28, 2010 in Medical Ethics by RangelMD

Dr. Andrew Wakefield, formally of the United Kingdom and gastroenterologist by trade, was found guilty by the NHS General Medical Council of beingĀ  “dishonest, irresponsible and showed callous disregard for the distress and pain of children” over his role in a 1998 study which suggested the possibility of a link between the childhood Measles-Mumps-Rubela vaccine (MMR) and autism. Though this study was extremely small (12 children) and highly speculative and preliminary it never-the-less caused the medical equivalent of mass panic in the UK and a substantial drop in MMR vaccination rates (the nadir was in 2003) closely followed by the predictable rise in measles cases.

Wakefield’s study has itself become a case study in how ulterior motives, conflicts of interest, deception, and greed can contaminate a study. It turned out that Wakefield had initiated his small study with autistic children who’s parents were considering suing the makers of the MMR vaccine and paid him for the study, a financial arrangement that he withheld from Lancet prior to publication. Wakefield also applied for a patent for a “safer” single injection measles vaccine during this time and advocated for the use of this alternative even thought it is more risky. The Medical Council also criticized Wakefield for his conduct in having his study subjects undergo painful and invasive colonoscopies and lumbar punctures for questionable indications and paying children at his son’s birthday party to get blood samples from “normal controls.”

The General Medical Council didn’t address the results of the study but numerous and much larger and better designed studies have failed to find any such connection (pathophysiological, epidemiological, or any other causal link) between MMR vaccinations and rates of or risk of autism. Ten of the 13 authors of the 1998 study have disassociated themselves from the study and the Lancet retracted the study in 2004.

For 99.99% of researchers, accusations of professional misconduct, the retraction of your study by a major scientific journal, and the surfacing of serious conflicts of interest would have been more than enough to destroy a career. But not if you are Andrew Wakefield who has remained defiant in the face of overwhelming criticism and even more supportive of his alternative theory of a gastric-MMR-autism connection despite overwhelming scientific evidence to the contrary. And it has not hurt that he has built up a mass of cult-like followers who believe his every word and pay thousands of dollars for physicians at “Thoughtful House” to diagnose and “treat” autism.

Wakefield started Thoughtful House after losing his job with the NHS in the UK in 2001 and moving to Austin Texas. He pays himself $270,000 a year as executive director and research chief of Thoughtful House even though he is not licensed to practice medicine in Texas (or elsewhere in the US) and despite the fact that he still can’t show a definitive connection between gastroenterological pathology and autism or between vaccinations and autism or proof of cure or treatment of autism with special diets.

Dr. Wakefield’s take-home message is this. If you are going to conduct research using questionable methods with financial conflicts of interest and then steadfastly stand by your results in the face of massive scientific evidence to the contrary, make sure that you do your research in the field of a non-fatal neuro-psychiatric disorder that has no proven cause, cure or treatment and in which the diagnoses of and thus the results of any potential treatment are not easily clinically measurable and which has an almost endless supply of parents who are desperate for any hope of a treatment, no matter how small or unlikely.

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