At what point does causation become culpability, ignorance malice, or recklessness murder? In 1919 in the case of Schenk v United States, US Supreme Court justice Oliver Wendell Holmes opined that the right to free speech did not extend to falsely shouting “fire” in a crowded theatre, as such speech served no purpose other than to cause a panic and result in injury to others. Clearly, free speech does not absolve us of a duty to watch what we say.
At time of writing there is an outbreak of measles in Wales. So far there have been thousands, with only one fatality (in fairness, the fatality rate for measles is miniscule). In the past fifteen years, the West has seen an increase in the incidence of measles, resulting in a couple of dozen deaths. Small stuff in the greater scheme of things, but each of those deaths represents a tragedy to someone. A double tragedy, because those deaths were preventable. Nobody should be dying of measles in the Western World any more than they should be dying of smallpox or polio. A vaccine has been in existence since the 1960s, and is administered freely in most countries. In addition, it also prevents mumps and rubella (German measles). A simple product, but one which has saved millions of lives since its creation. And a product which, thanks to some cynical scientific fabrication coupled with a sensationalist media ever ready to jump on any controversy, real or imagined, that anything up to a fifth of the population will not allow their children to have it.
Medical myths abound. There have been cases taken (unsuccessfully) against the Irish government to stop putting flourine in drinking water, on the grounds of any number of supposed consequences. By way of some anecdotal evidence (this is not a scientific article, so I can get away with it), in 2009 and 2010 a large volume of stickers appeared on Dublin lampposts warning that swine flu jabs were made from (I kid thee not) embalming fluid and crushed foetuses. However, the MMR/Autism hoax is one of the few that found its way beyond those sections of the community who wear tinfoil hats to prevent mind control messages being beamed into their heads. This is due to the fact that, unlike the claims outlined above, the MMR hoax was propagated by a real doctor, with a research paper published in a reputable journal with a dozen listed coauthors.
Andrew Wakefield was an unremarkable individual prior to 1998. The son of two medical professionals, it is perhaps unsurprising that he followed both of them into medicine. He published a number of papers, none of which ever broke out of the rarified circles of medical researchers. He became something of an authority on Crohn’s Disease, but beyond that, few would have guessed what would follow. Curiously, in 1996, he linked the above condition with MMR, though that has never been proven. In any case, it was only a prelude to the main event
The story goes something like this. In 1998 Wakefield, along with a dozen coauthors, published an article in respected medical journal The Lancet. Amidst much hedging, it alleged, based on reports from parents of children with autism, that there may have been a link between the condition and the MMR vaccine. This, however was not the central tenet. Had that been propagated as the main point, The Lancet would most likely have declined to publish. The central point was a link between autism and bowel disorders, on which Wakefield, given his earlier work with Crohn’s Disease, was a respected figure. He even proposed a new name for the condition, autistic enterocolitis. So far, so uncontroversial.
However, to coincide with the publication of the paper, a press conference was held in the Royal Free Hospital in London. Here the link between MMR and autism was first proposed to the press. A minor media circus ensued, in which all the potential scientific biases of the article (tiny sample size, reliance on self-reporting, possible use of loaded questions, etc) were ignored. Even the main thrust of the article was set aside in favour of a speculative claim by one of the authors who, as will be explained later, had rather darker motives for making that claim than were known at the time. Wakefield suggested that the MMR jab be suspended and replaced with three separate jabs.
The story did not begin to gain real traction till the early 2000s, when Wakefield published a number of articles explicitly claiming a link between MMR, autism and bowel conditions, as well as attacking its effectiveness as a vaccine against measles. This time, the fallout was anything but minor. What followed was a major drop in vaccination rates coupled with masses of uninformed speculation in the British media, backed by anecdotal evidence as to the supposed horrors of MMR. British Prime Minister Tony Blair caused a minor political ruckus by claiming the vaccine was safe while at the same time refusing to comment on whether his son Leo had received it.
Two things happened after this. The first was that measles and mumps, which had been sitting on the verge of eradication in Britain for years, began to make an unwelcome reappearance. Given how infectious measles is, a vaccination rate of over 90% is required to achieve so-called “herd immunity” a point where there simply aren’t enough potential carriers for the disease to spread effectively. The second was the complete collapse in the credibility of Wakefield and his hypothesis.
In 2004 it emerged that, prior to the publication of The Lancet paper, Wakefield had received sizeable payments (initially thought to be £50,000, then found to be over £400,000) from solicitors attempting to build a case against MMR. This explained both his earlier attempts to link Crohn’s Disease with the vaccine and his focus on the side issue of MMR in The Lancet article and the ensuing press conference. Thanks to the research of Sunday Times journalist Brian Deer, Wakefield’s financial interests in bringing down MMR were coming to light. Apart from the litigation money, it also emerged that he had filed a patent on an alternative method of administering the vaccine, as well as for diagnostic kits for his fictional disease of autistics enterocolitis. By attacking MMR, Wakefield hoped to clear the field for his invention, potentially netting him millions.
Following these revelations, most of the coauthors repudiated the 1998 paper’s conclusion. The paper itself has since been revealed to be largely fabricated, with results changed to suit Wakefield’s conclusion. Nobody has since been able to duplicate the results outlined in 1998 and The Lancet has subsequently retracted it in full. In addition, Wakefield has had to pay substantial compensation to some of his research subjects. Following a five-year investigation, in 2011 Andrew Wakefield was struck off the medical register and banned from practicing in the UK.
From a scientific point of view, the issue is now closed. The link between autism and MMR has been thoroughly discredited, as has been the individual who propagated it. The problem is that this is quite simply insufficient. Vaccination rates for MMR have never fully recovered. Significant trust issues exist among the general public. And Wakefield is still propounding his chicanery, beyond the reach of the General Medical Council. At the moment he operates out of Texas, where a number of well-backed organisations continue to spread this dangerous misinformation. There is no doubt that, struck off or not, Andrew Wakefield has profited hugely from attacking MMR.
Wakefield has long since resorted to the traditional defences used by quacks. His opponents are shills of Big Pharma, which has striven to hide the truth. Brian Deer, a journalist in good repute, is a “hitman” brought in by Big Pharma to “take him down”. In Wakefield’s world, he should be venerated as a hero who stood up to this amorphous evil, rather than decried as a fraud.
A huge amount of the blame for this scandal lies with the mass media. From the start, in 1998, they bought Wakefield’s hypothesis hook, line and sinker. In 2002, when the controversy was in full swing, far more columns in the British media went on stories critical of MMR rather than any attempt to look at the story in a balanced manner. A huge amount of effort was expended trying to determine whether Leo Blair had received the vaccine, as if the Prime Minister had damaging information about MMR that was not available to the general public (It subsequently emerged that Leo had, in fact, received the MMR jab).
In America, a huge amount of publicity was given to the story by daytime TV luminary Oprah Winfrey. Swimsuit model, jobbing actress, and definite non-doctor Jenny McCarthy went further, claiming MMR had given her son autism. Subsequently she ascribed his cure to chelation therapy, another discredited idea.
Nor can any of the coauthors of the 1998 paper be absolved of guilt. None of them jumped ship on Wakefield until it became clear that said ship was sinking. These were individuals who were comfortable with sitting on the sidelines until it became apparent which way the tide was turning, and who then made the decision to retract their interpretation.
However, the bulk of the blame still lies with Andrew Wakefield. He was the one who generated the false data that the 1998 paper was based on. He was the one who used that paper to discredit MMR for personal gain, and he is the one who continues to propound this theory for profit.
Scientific fraud is nothing new, as Paul Kammerer, Hwang Woo-Suk, or generations of alchemists throughout history demonstrate. Nor are medical panics. The tragedy of the MMR scandal was how both came together in such a damaging way. Andrew Wakefield would never have gained this level of attention but for the fact that he was a doctor in good standing. Despite such outliers as the Daily Mail and Express, the British media has a reasonably responsible attitude when it comes to medical reporting, and quacks, tricksters and mountebanks rarely get any airtime. It was the fact that this was a genuine doctor who fabricated the data that made it credible, as Wakefield knew it would.
To this day Wakefield has shown no remorse over his fraud, or the consequences. He has profited enormously from the debacle, at the cost of thousands of victims of measles, mumps and rubella who should never have been vulnerable to those conditions. Even today, despite its scientific bankruptcy, the MMR/autism link is still believed by a significant portion of the general population, and as a result, there are still deaths from preventable diseases.
The tragedy is that Andrew Wakefield will never face justice for his crimes. The causational chain linking the deaths of measles victims back to his discreditation of MMR is simply too weak. Too many actors, including The Lancet, the coauthors, the mass media and above all parents who made a decision not to vaccinate stand between Wakefield and the consequences of his actions. His crimes are inchoate, and not covered by any existing laws.
Certain countries have scientific fraud laws on the books, and others have found ways to bring fraudsters to book. Hwang Woo-Suk was incarcerated for embezzlement of state money used for his fraud. Clearly a stronger standard needs to be adopted. Exactly how it would be done is unclear. Perhaps an extension of current fraud laws to cover scientific falsifications for profit could be enacted, though enforcement would be, to put it mildly, a tricky matter. But something must be done. Already, dozens of deaths can be attributed to Andrew Wakefield’s fraud, and that number can only go in one direction.
Had he actually physically killed a child, Andrew Wakefield would now be spending the rest of his life in prison. The fact that children have died as a result of claims he has made may absolve him from criminal culpability, but it does not absolve him from responsibility. Freedom of speech does not extend to shouting “fire” in a crowded theatre, especially if one is a firefighter. The law may never catch up with Wakefield, but it should make sure nobody else gets away with what he did.