Saturday, January 15, 2011

An Assessment of the Wakefield Affair, part 1

Some of you may have seen my post on Jenny McCarty’s Huffington Post article and are probably curious why I changed my opinion of Dr. Wakefield. What particular piece of information changed my mind? Well, that is a tough question to answer. I can’t point to one particular thing because the only thing I can go on is the evidence provided.

When I started looking at this, I had to use what information that was available. Admittedly, I am missing one particular piece of information from Dr. Wakefield, and that is his book. I haven’t had the time, or the money, to read this book as of now. Am I going to read it? Yes, I will. But, from what I’ve been able to gather, it is really only a rehash of his defense against Deer’s allegations. To not read Wakefield’s book and look at it with the same objective light as I’ve tried to look at everything else concerning this would be intellectually dishonest.

My evaluation looked at Brian Deer’s BMJ articles, his website, Andrew Wakefield’s defense and those websites that defended him, and finally the GMC transcripts. The transcripts were the most time consuming aspect of this case because it was over 6 million words, and I will admit that some of the things mentioned in there I didn’t completely understand. Maybe it was the language used (I’m only bilingual; I speak American, Texan and a tiny bit of Coon-ass). I’ve spent the past week, both day and night, reading, pondering, evaluating, weighing, and thinking. Sometimes, all night, just laying in bed thinking about it (which is why some of my posts on Jenny’s Huffpo article are so rife with spelling and grammar errors…I’m usually much better about things like that)

I’m not going to lie to you; I’m having a really hard time writing this. I put a little bit down, then have to step away and really think about what I need to say next. Some of my trepidation is knowing that my admission has disappointed many people I consider friends. Some of it is mental exhaustion. Some of it is self evaluation. Some of it is the realization that I don’t really have to try to convince anyone of turning against Andrew Wakefield; I only have to tell you what convinced me.

So, let me start with my thought process. You can see a little of it one of my older posts, which I will leave up. I realized that I had an emotional investment in this issue, and that to truly, objectively, evaluate the evidence, I needed to somehow detach myself from my personal investment and actually LOOK at what was being written. In this case, I tried to evaluate it with the following in mind: Deer was biased against Wakefield; Wakefield was biased for himself; and the GMC is supposed to be an unbiased 3rd party (which, I am quite sure, will be argued against…but for the sake of argument, assume that they are unbiased). This was NOT easy, so bear with me.

Over the next few days (maybe longer considering how long it’s taking me to write this), I will discuss specific items pertaining to the Wakefield affair. This will include several items from each of the above mentioned locations. I will evaluate and weigh each of these items and explain why I think the argument is weak or strong.

What jumped out at me first was the accusation that Brian Deer brought against Wakefield as to a potential motive for the 1998 Lancet paper. Essentially, Deer says that Wakefield manufactured the Lancet paper in order to scare the British parents into taking the separate M M and R vaccines, then he would market his own Transfer Factor as a potential rival for these vaccines. This, to me, was Deer’s weakest argument (and thereby Wakefield’s strongest). Yes, the application for the patent does say that it was a vaccine. However, Wakefield’s defense claims that it wasn’t meant as a rival vaccine because it was mainly to be used as a treatment for Inflammatory Bowel Disease and as a potential prophylaxis for immune-compromised patients (bottom of page one, and top of page 2). I am willing to give Wakefield the benefit of the doubt on this one, because Wakefield’s statement concerning this is corroborated by evidence. However, since Wakefield did not disclose this information when releasing the Lancet article, and in the subsequent media announcement, this is a blatant Conflict of Interest. That is bad, even if you defend Wakefield. This calls his Lancet article into serious question, even before you start looking at the science. The GMC hearings say this:

f. A proposal, dated 4 March 1998 and drafted by Mr 10, was submitted to the Royal Free Hospital School of Medicine in relation to the proposed company,
Admitted and found proved

I realized that I started in the middle, so I had to go all the way back to early 1996, when Deer alleges that Wakefield was approached by Richard Barr. To me, this is one of Deer’s strongest arguments. Barr admits to soliciting Dr. Wakefield in order to provide him with several patients for an then unheard of condition that Barr claims was linked to MMR. Over the course of the research into the ‘98 Lancet article, Wakefield received about $750 thousand dollars (plus expenses) for his work. This was also undisclosed. Not only bad, but REALLY bad. Wakefield’s defense is to claim that he was using this money to pay for a second study that he was doing, though never released. But, even if you believe Wakefield, the fact that he did not disclose this information is a serious COI. The GMC hearings say this:

a. In 1996 you were involved in advising Richard Barr, a solicitor
acting for persons alleged to have suffered harm caused by the
administration of the MMR vaccine, as to the research that would be
required to establish that the vaccine was causing injury,
Admitted and found proved

b. Mr Barr had the benefit of public funding from the Legal Aid
Board in relation to the pursuit of litigation against manufacturers of the
MMR vaccine (“the MMR litigation”),
Admitted and found proved

Ok. I think that’s enough for now. I am going to open up the comments to everyone, even those not normally allowed to comment. I have a stipulation, however. Keep it civil, guys. If the comments get out of hand, you will get one warning. If they continue to get out of hand, I will delete the comment. On the 3rd strike, you will no longer be able to comment.

Tomorrow (maybe) I will continue with my evaluation.

66 comments:

  1. For those of use who don't want to browse through the 3,000+ comments on the McCarthy post, maybe you could just reiterate what your opinion of Wakefield is now?

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  2. Craig, this was a case series report, not a formal scientific study. Wakefield explains this in his book Callous Disregard in chapter one. The Deer charge is way over the top. Deer is not a scientist. It is very discouraging to see such a witch-hunt in our 21st century.

    The actual GMC conclusion (not a scientific conclusion) was a breach of ethics regarding the procedures on the children. So read the joint statement by the majority of the parents of these children. (which this forum has ignored). http://www.youtube.com/watch?v=DHrgYxqcU0w&feature=player_embedded

    Read the Huffpost article here http://www.huffingtonpost.com/jay-gordon/emthe-lancetem-retracted_b_447341.html

    And read the AoA article here http://www.ageofautism.com/2011/01/autism-advocacy-organizations-and-parent-groups-support-dr-andrew-wakefield.html#more

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  3. Sorry, MJ. here it is:

    "Well, after spending the past few days reading over everything I could concerning Andrew Wakefield, the GMC, the TF patent applicatio­n, and Brian Deer, I have no choice to come to the conclusion that Wakefield is fraudulent in his research. The evidence to this is pretty damning, and I cannot deny it. It is clear that he had COI's, and I can certainly say that this could have motivated him to do what he did. Do I believe all the charges leveled against him? No. Some of the things Wakefield has said in his own defense line up with the evidence. But yes, I have to agree that Brian Deer's thorough investigat­ion is pretty damned rock solid.

    This was not easy to write (I'll probably have a post on my blog concerning this in the next few days). I defended his research in hopes that it could offer clues to my son's condition. Even if you try to paint him in the most favorable light, and think that he had the best interests of children in mind, it still does not excuse faking research, and this both angers and saddens me. It angers me that I defended him (I'm mad at myself, mostly), and it saddens me that it will prevent children like my son, who have had real and verifiable reactions to one or more vaccines, will probably not ever be investigat­ed or helped by medical science.

    But, as a reasonable person, I can no longer defend Dr. Wakefield."

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  4. sdtech, I realize that it was a report. However, when written and published in a major scientific journal, disclosing COI's is pretty relevant.

    I agree that the GMC ignored the parents. However, the GMC was really only looking at the fitness to practice of Wakefield. They were looking at his ethical practices, and found them wanting. The parents would not have been able to add anything relevant to the hearings because the hearings were focusing on the scientific aspect of Wakefield's report.

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  5. First, you are an excellent advocate for your son.

    Second, Dr. Wakefield would respect your advocacy and opinion.

    Third, having met him and listened to his presentation on possible causes of autism and other disorders, there is a clear sense of this man's commitment ot children and to science. He seems to give every bit of his best efforts to helping children.

    Fourth: Post your email address and I will mail my copy of his book.

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  6. Oh, and everyone, please write your reasons for supporting him or opposing him. I want this to be an open discussion, and any evidence that you can supply to support your view is relevant here. If any of you have evidence that may change my mind, please present it. I will admit that I may have missed something, so I want to have everything I can concerning this.

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  7. sdtech, thank you. That really means a lot.

    And I appreciate the offer of Wakefield's book. My email address is willoughby.craiga@gmail.com

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  8. It is admirable to change your beliefs, to make them more true, in the face of the desire not to, and it is courageous to do so against the disappointment of your friends, and to the approval of your enemies. I would hope that many people praise you for your strength of character, here and at HuffPo.

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  9. "To see what is in front of one's nose needs a constant struggle."

    - George Orwell

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  10. Thanks for posting that.

    If everything Deer said is true then you are right - Wakefield would not look so good. I might still argue that he was merely overzealous and pushed far past what his evidence supported rather than deliberately committing fraud, but that comes down to motivation rather than actual evidence.

    The problem I run into is taking Deer at his word. Based on things that I have seen him say and the tone of what he writes, I don't think his motivations are pure. He comes across as a glory hound - a particularly narcissistic one at that. He has also said some inflammatory things about children with disabilities and their parents.

    As a result, I don't like the guy nor do I trust him to stick to the truth. And since much of his material isn't publicly available, it is hard to evaluate just how honest he is being.

    So at the end of the day I am torn. I don't know how much of Wakefield's research was done in good faith nor do I know how much of Deer's reporting was done in bad faith. I don't think Wakefield purposely set out to commit fraud for his own profit but I do have some questions about how his research was done. I tend to think that either his data was wrong at best or that he was overzealous at worst.

    Regardless, I respect the fact that you have the intellectual integrity to say that you have changed your mind. There are many, many people in the autism world who stubbornly stick to their stated beliefs even when presented with clear evidence that they are wrong.

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  11. Thanks, St Thomas.

    MJ,
    Excellent commentary. I, too, do not like Deer. I and would agree that he has a grudge against Wakefield completely. Also, much of what he has said has turned my stomach and made me dislike the man even more. You are right; not everything has been made public. However, I am going off of as much information as I have, and I have to objectively evaluate that information as best as I can. The fact is, Deer's data about Wakefield's dishonesty in regards to the case series has been verified by independant sources. Wakefield's account has not. And no matter how much I dislike Deer, and how much I want Wakefield's research to be true, I have to go with what is verifiable. And, I hate so much that I have to do that.

    I cannot fight for something or someone I don't believe in.

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  12. Wow, you read the whole transcipt. Deer sent me Dr.Peggs testimony which, while not as clear as it could be, shows the ethics rules for research were basically from a 1990 UK Dept. of Health publication and depended on the intent of the doctor --which trashed Wakefield's invented rule.

    But I still don't have a link to the transcripts. Please email it to me at wawa10101@gmail.com

    Thanks

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  13. Here is a statement yesterday by Dr. Wakefield at
    http://www.ageofautism.com/2011/01/breaking-news-statement-from-dr-andrew-wakefield-no-fraud-no-hoax-no-profit-motive.html

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  14. I admire your willingness to think critically and change your mind. I pray that one day soon there will be an accepted cause or causes for autism that will bring about a cure instead of just something to blame it on.

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  15. Just to clarify Craig. You've just changed your mind about Wakefield, not about the GI/Autism relationship or the Autism/Vaccine correlation.

    Is that correct?

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  16. Of the theories that vaccines cause autism, blaming measles vaccine virus (only when part of MMR, but not just as a monovalent virus) isn't one that makes a lot of sense.

    For one thing, what happens to the brain if measles virus reaches it is well-known. The results can be fatal or devastating, but they aren't autism. Professor Rima's testimony at the OAP made that clear. It isn't surprising that this is well-known becaused measles was a public health issue into the 1960s in rich countries and is still a public health issue in poor countries.

    Another issue is timing. Measles vaccine is given in 'rich countries' no earlier that 12 months. The evidence is that autism seems to be a result of events occuring early. So if one ends up blaming a vaccine or ingredient, it makes more sense to blame a vaccine or ingredient given early.

    So why the MMR theory. Wakefield was a GI academic who was looking for something to blame measles virus on. He was still trying to blame measles for Crohn's and published a paper in 2005 on the topic. What went wrong, aside from the epidemiology, was that his testing resulted in false positives because his lab tools weren't accurate enough. The other side was a group of parents organized by a lawyer looking for scientific backing for the MMR lawsuit.

    ASD have higher rates of GI problems, but not higher rates of IBD.

    I don't believe vaccines cause autism, but if you were going to blame anything linked to vaccines, picking measles virus wouldn't be a first choice.

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  17. Hi Craig, I read your comment on HuffPo and was admittedly gobsmacked. At the risk of sounding patronising, I congratulate you for examining the sources and coming to the conclusion that you have. I know it wasn't easy, but it was honest.

    @ MJ, I suspect that Mr. Deer is rather egotistical and his demeanour rubs people the wrong way. But at the end of the day, would you rather be given verified, factual evidence by a 'glory hound' or shovelled a load of bollocks by a smarmy, charismatic charlatan?

    Craig again, Wakefield absolutely intended his single vaccine to be a replacement for MMR. In his patent, look at pp. 1, line 22 - pp. 2, line 2; pp. 2, lines 10 - 14. It is clear that Wakefield meant for this to be for pre-prophylaxis for measles, as well as a 'treatment' for 'persistent measles virus'.

    This is a new journey for you and undoubtedly a process that will leave you sleepless and angry, but you will be fine and I know that there are, at least a couple of people, that you can commiserate with.

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  18. Science Mom,

    At the end of the day, I would rather have open and transparent access to data so that I can decide for myself if the data supports the assertions being made. Failing that, I would like a neutral and unbiased party to provide an accurate assessment of both the evidence for and against rather than just evidence against.

    But when I can't have either - as in this case - I am forced to make a judgement based on the character of the person making the statements. Based on what I know of him, I think it is highly likely that Deer would exaggerate or cherry pick the facts that fit his case.

    P.S. You think Wakefield is charismatic ?

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  19. Craig,

    Kudos to you for the difficult task of reading through all of that material, and for the even more difficult task of changing your mind. That's gotta be tough.

    I, too, think that Deer comes off as a rather arrogant, egotistical jerk at times, and that that can taint how one interprets what he writes. At the end of the day, though, what matters are the facts. And frankly, they don't look good for Wakefield.

    At any rate, I just wanted to commend you for having the courage and tenacity to challenge your prior beliefs. The journey is far from over, and it will be a difficult road, but there are many who will support you along the way. I wrote a little bit about what the feelings must be like over at Silenced by Age of Autism. I wish you the best on the journey ahead, and if you need someone to talk to, you have quite a few who will listen.

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  20. @MJ

    Wakefield is incredibly charismatic. He is a very smooth individual, with a calm, cool demeanor. When he speaks, it is with conviction and lacking any note of doubt. Yes, he is a very charismatic person.

    Because of that charm, I bridle when I hear him say something that is not supported (or even contradicted) by the evidence.

    Out of respect for Craig, I'll leave it at that.

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  21. At the end of the day, I would rather have open and transparent access to data so that I can decide for myself if the data supports the assertions being made. Failing that, I would like a neutral and unbiased party to provide an accurate assessment of both the evidence for and against rather than just evidence against.

    Well you are in luck for Mr. Deer has put out an offer to Craig for his information on RI: http://scienceblogs.com/insolence/2011/01/the_race_to_flee_andrew_wakefield.php#c3123006

    As for the unbiased source, of course that is crucial, which is why his information is in BMJ and has been vetted thoroughly. The UK has rather onerous libel laws so you can bet it has been fact-checked to extremes. There is also the GMC, all of their transcripts are available so you can read them for yourself as Craig did.

    I personally don't find Wakefield charismatic, but I do know others find him so and often find themselves defending him based upon that characteristic rather than the actuality of him.

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  22. @Craig: Just read Orac's post and I have to say I admire your willingness to review your beliefs and make changes based on facts. It's a hard thing to do, to admit one is wrong (believe me, I know what you are going through) and one loses friends when you decide against their beliefs. But know that you will find a lot of support from those of us who respect that science is self-correcting and eventually the truth is known.

    I am not a Christian any longer, but even so, this statement holds true: You shall know the truth and the truth shall make you free.

    MI Dawn

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  23. Science Mom,

    So, Deer is offering to share a child's medical records with a complete stranger and you think this is a good thing? Because those are the only sources that would be able to show a clear history one way or the other. Although, as I recently said elsewhere, it is very easy for a child to have multiple distinct medical records and these records won't always agree.

    (Yes, I realize that I am being a little bit hypocritical here calling for open access and then criticizing Deer for offering access. I just have a problem with anyone sharing a child's medical history without the appropriate consent).

    As for the thorough vetting done by the BMJ, you will have to forgive me. I find it hard to take a "peer-reviewed" paper seriously when it cites newspaper articles as an authority. I also find it a little discouraging that the BMJ paid Deer to write the article. Journals should not have an agenda.

    The article may have well been fact checked to prevent libel, but I think we both know that science should be about presenting an unbiased view - not a biased but factually accurate one.

    Regardless, we are really saying the same thing here (which might be a first). I just don't happen to like Deer.

    As a side note, are the GMC transcripts freely available? Since Sheldon was requesting a copy of them above I assumed that they were not available on-line anywhere, but I could be wrong.

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  24. Stand by for other anti-vaxers to vilify Craig. It probably won't even been a week till he gets accused of being a "Big Pharma shill" or having "Sold out".

    Interesting how the scientific disproofs of Wakefield's work didn't convince him, but the revelations about Wakefield's character as a fraud, did.

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  25. @MJ

    "So, Deer is offering to share a child's medical records with a complete stranger and you think this is a good thing?"

    Here's Brian Deer's comment over at Respectful Insolence:

    "I know nothing of Craig, but if he is a genuine person seeking information, I may be able to answer any difficult questions he has about my investigation. I've always been willing to give up time, and even to supply documents, to those with a reasonable attitude, whatever their ultimate opinions are.

    I have no material secrets, no conflicts of interest, nothing I am ashamed of. But if he wants anything, he needs to be fairly quick as I have other things to get on with next week."


    He did not specify what kind of documents, so your umbrage at Deer is unjustified.

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  26. Todd W. -

    Since most of Deer's recent accusations of fraud are based on discrepancies between the Lancet and the children's medical records, your point is just a little silly.

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  27. Dear Craig,

    Just read your comment at Respectful Insolence.

    I just wanted to say, first: I admire your courage for standing up & saying "I have changed my mind." Second: for doing so in a social circle that can be quite vitriolic to those who disagree with them.

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  28. @ MJ, the children's identities have been redacted and they were also used in the GMC fitness to practise hearing.

    The article may have well been fact checked to prevent libel, but I think we both know that science should be about presenting an unbiased view - not a biased but factually accurate one.

    I'm afraid you are making very little sense here. Mr. Deer's investigation, was not of a scientific nature, as one would develop a study design. So, if it has been fact-checked and validated by numerous parties and published, then you either rely upon that or you don't. If it can withstand the scrutiny of a libel suit (or even a PCC complaint), then what exactly are you trying to argue?

    KWombles just posted this for the full transcript: it's not available online; it has to be requested, paid for and mailed to you. See http://www.gmc-uk.org/publications/right_to_know/publications_scheme.asp.

    You don't have to like Deer, you simply need to accept his information as credible or not based solely upon the provenance and reliability of it. I think too many people become accepted as authorities because of their appearance or charisma. And that is a dangerous road to go down, in my opinion.

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  29. @MJ

    You could say that theory is simply a polite word for bias. Bias is an important *part* of science - it provides critical review of conflicting biases. Evidence is the way that one bias hopefully achieves acceptance over another. The scientific method is not perfect (just check out any text on the philosophy of science). It simply the most effective and accurate way we have come up with to answer questions.

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  30. Craig, read Orac's piece and your comment. Considering your opinion of one another, it was remarkably civil on both side.

    @MJ
    Craig's road to Damascus involved reading the GMC transcripts. I want a copy, by the way.

    Deer has made clear that his legally acquired information in the articles comes from the GMC transcripts.

    So fact-checking by the BMJ external reviewers was time consuming but pretty obvious. They simply checked the information against the GMC transcripts.

    So it doesn't matter whether Brian Deer is a kind, modest man or a jounalist schooled in the ways of London papers (rougher than elsewhere) or a mean, rotten man who has been out to get Wakefield. Because the BMJ backed him up. Also consider this. Wakefield and cronies have the transcripts as well. But we don't hear very specific criticisms.

    For example, I don't hear Wakefield denying that there was a referral letter for child 8 sent to hima and using the word in the BMJ article.

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  31. Science Mom,

    We could go around and around on this forever. Basically it comes down to the fact that I don't trust Deer, I don't think the story belonged in a journal, nor do I like the fact that the journal paid for the story to be written. Journals should not have an agenda nor should they pay for articles that fit their agenda, that is a very slippery slope.

    It doesn't matter whether it can withstand a libel suit or not (the PCC deferred to the judgement of the GMC and didn't come to its own conclusion). The standard of proof for science isn't whether or not it can survive a libel claim.

    And, as I said above, I accept the fact that the Lancet study was flawed. I do not necessarily accept the fact that Wakefield set out to commit fraud and the reason is that I don't trust Deer. I could very easily see him pushing the boundaries of what is true and what isn't to spin a better story.


    @ Gary -
    No, a theory is not a bias. The two are very different.

    @Sheldon -

    Honestly, I don't believe Deer when he said that all of his information is legally obtained. In 2006 he published the names of all of the children in the study as well as details about when they were admitted to the Royal Free Hospital. I believe that was done before the GMC hearing even started, so where did that information come from?

    Let me repeat that last part - he published the names of children and some details about their medical case history. I am going to go out on a limb and say that he didn't have the parent's consent to do so.

    Does any parent here feel comfortable with that?

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  32. @MJ

    You haven't dealt with many scientists have you?

    Joking aside, scientists are as biased as anyone else (they are people after all) - especially when it comes to their own pet theories. A large portion of the scientific process is intended to filter that bias through the sieve of evidence. Evidence and its reliability is the critical ingredient to scientific acceptance and bias has nothing to do with it one way or the other.

    To be blunt - I was making the point that bias is an integral part of science and that your understanding of the scientific method is lacking. Your statement about biased but factual vs unbiased is patently ridiculous and completely wrong - I was trying to point that out politely.

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  33. Gary, if I a dollar for every time someone tried to tell me I was "completely wrong", I would be a very rich man.

    Of course people - scientists included - have biases, that is normal. However, the scientific method was created with the explicit goal of minimizing those biases. The whole point is to base theories, hypotheses, and conclusions on evidence, not a preconceived notion of what is true or not.

    A scientist who only talked about the evidence that agreed with their bias and ignored the rest would not be much of a scientist. Although they might pass a "fact-check" if they stick closely to the facts that fit their bias.

    That is (or should be) the difference between science and journalism. Journalism should be factually accurate but doesn't necessarily have to tell both sides of the story while science should always consider all available evidence and then show why the evidence favors one conclusion or the other.

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  34. @MJ

    Theories pretty much always start out as bias by definition. It is rare that new facts come to light and change current understanding (although it has happened...). Much more commonly someone has a theory (bias perhaps...) about how current understanding is wrong and they go looking for the evidence to prove it. Einstein is a classic example; general relativity (1915) had to wait until 1919 before the first evidence was actually found and acknowledged as evidence for GR (although in retrospect there were experiments performed as early as 1899 which provided evidence - no one realized at the time).

    The scientific method does *not* try to minimize bias. It attempts to filter it out through the process of collecting and publishing evidence and having that evidence collection process being repeatable so that your skeptics can repeat the experiment for themselves. This process *requires* bias to work effectively. You should go hang out at a scientific conference some time and listen to the Q&A at the end of the presentation of a new paper. BD is a pussycat by comparison.

    Your "unbiased" preference is suspiciously like a restatement of the practice of false equivalence that is so prevalent in the US media. Each side of an argument does *not* necessarily have equal weight - especially when you consider the available evidence as the meter stick for evaluating the argument. Brian Deer is biased against Andrew Wakefield because he thinks that Andrew Wakefield is full of crap. Nowhere does it say that he has to be unbiased about it. What he does have to do however is present evidence to back his bias up if we are going to take him seriously - note: I did not say agree with him. This *is* just as important to a journalist as to a scientist.

    Unfortunately there is this weird idea that journalists should be "fair" and present both sides of an argument in spite of any evidence. Frankly I think that is crap and that the primary attribute I look for in a journalist is skepticism - of everything. Andrew Wakefield's con is prime evidence of why this should be the case.

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  35. Gary, what does the word "bias" mean to you?

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  36. @MJ

    This definition from dictionary.com works:

    a particular tendency or inclination, esp. one that prevents unprejudiced consideration of a question; prejudice.

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  37. Kapitano,

    So far, the response has not been nearly as bad as you think. Most people have been very understanding, if somewhat disappointed. They mainly want to know what changed my mind.

    Sheldon,

    I only have the transcripts in hard copy, which I obtained through a friend of mine. You can request a copy through this site:

    http://www.gmc-uk.org/publications/right_to_know/contact_us.asp

    Everyone, I want to thank you for the continued words of encouragement, and for the civil tones of your posts. Please, feel free to continue the discussion, and I promise to have part 2 out tomorrow or Wednesday. I've been under the weather weekend, so I took a day off of work to rest. Hopefully tomorrow I will feel well enough to post my further thoughts.

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  38. @liz,

    Who villified Craig? I have yet to see one villifying comment.

    Sounds more like a stereotype to me.

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  39. @sheldon,

    "Of the theories that vaccines cause autism, blaming measles vaccine virus (only when part of MMR, but not just as a monovalent virus) isn't one that makes a lot of sense."

    That's a little odd Sheldon, given the one of the most well documented cases of Autism following adverse vaccine reaction involved MMR and measles infection. It certainly didn't support Wakefield's original hypothesis about leaky gut, but it certainly provided a lot of insight into how any live virus vaccine could trigger vaccine reaction followed by Autism.

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  40. @science mom,

    "@ MJ, I suspect that Mr. Deer is rather egotistical and his demeanour rubs people the wrong way. But at the end of the day, would you rather be given verified, factual evidence by a 'glory hound' or shovelled a load of bollocks by a smarmy, charismatic charlatan?"

    It's interesting how different people react to the personalities here. I hear what you're saying, but I don't feel the same way, not that either of our reactions is wrong mind you.

    I side with MJ on this one. Unfortunately I am not blessed with access to the GMC transcripts at this time.

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  41. @kapitano

    Where? Who? It's already been a couple of days and I have yet to see villification...

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  42. I just wanted to add my praise for your open-minded approach to this issue, and voice my understanding of how hard and how admirable your search for the truth is.

    I come from a background in teaching both law and philosophy - two disciplines where you learn and are expected to strongly argue for a point of view. One of the most important things I've tried to teach my students is to drop their preconceptions on an issue and just for a bit, fully and unreservedly take seriously and accept what an opponent is saying. It is the best position from within which to identify boths truths and errors in other people's reasoning. It is also a fabulously important way in which to broaden your horizons and can even strengthen your previously existing view-point.

    Even if you find, after all the evidence, that you hold the view you started out with anyway, you will have engaged in a valuable mental exercise which will enrich your understanding and ability to argue for what you believe / know.

    In other words, good on you :)

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  43. @science mom,

    Let me elaborate on my position right now. There are 2 main items that currently hold me in my current position:
    1) The GMC findings were different than Brian Deer. Why? I actually look forward to what Deer has to say this week about the medical community closing ranks. I anticipate that should be very interesting. Perhaps he can explain away this point. Unfortunately, I don't actually have the transcripts to make my own judgement. Have you read the transcripts?

    2) Brian was very selective in his quotations. Rarely if ever, did he quote more than 2 words and almost never in context. Part of his BMJ writeup was a stretch (the part about fabricating/changing the GI results) and was part of the protocol as outlined in detail by co-author Dr. Davies both in the trial and in the GMC. His embellishment and misleading commentary just makes me wonder, what other facts/quotes did he embellish.

    My last issue isn't so much against Brian Deer, but against one of the arguments I see over and over supporting the BMJ articles.
    3) How does one peer review a story? Brian's articles are written like a story. They are not a scientific study. What exactly is Peer-review when it comes to story telling? As we all know peer-review does NOT ensure accuracy, does not ensure bias free opinion and does not ensure correctness. So please, let's just drop that dumb argument.

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  44. @gary,

    "You could say that theory is simply a polite word for bias. Bias is an important *part* of science - it provides critical review of conflicting biases."

    No, you might say that, but that is not an official position at all. In my own field, I will often propose 3 alternate theories to explain a particular phenomenon, and then will set out to test and determine which is the explanation. Those theories are NOT biases at all. They are alternate plausible explanations for something.

    In fact, the scientific method is specifically designed to eliminate bias from the study process.

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  45. @Schwartz

    The point that I am trying to make is that the scientific method attempts to remove bias from the results. All scientists have a point of view on unanswered (or answered, for that matter) questions and more often than not those opinions are driven by preconceptions and bias. Your three theories are not the only ones possible - they are just the ones that you like. In real real world science has as much politics involved as anything else. The big difference is with science is that it tries to compensate for that in it's results.

    My original point about Brian Deer was that his bias (or lack thereof if you want to argue that) is not relevant to the analysis of his results and the evidence supporting them. Bias in science happens and in some cases is good because it can produce determined people that challenge the status quo. That is key to any

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  46. @gary,

    "our three theories are not the only ones possible - they are just the ones that you like."

    Not at all, they are the ones I've deduced to be the most plausible. It has absolutely nothing to do with like.

    "In real real world science has as much politics involved as anything else. "

    I agree with that entirely. But you are actually discussing the institution and "common" practice of science, not the definition of science itself.

    "My original point about Brian Deer was that his bias (or lack thereof if you want to argue that) is not relevant to the analysis of his results and the evidence supporting them."

    Understanding the bias of the author is entirely relevant when we don't have the ability to examine the data ourselves. Given that his article wasn't "science", but more of a legal argument, bias applies all the more. He does not provide a lot of references, and he quotes without providing context.

    If everything he presented was open for us to examine the evidence ourselves, then I agree with your proposition: The topic of bias is not relevant. However, that is certainly not the case here, and in medicine, is rarely the case.

    "Bias in science happens and in some cases is good because it can produce determined people that challenge the status quo."

    No, bias in the politics of science can lead to good or bad things. Bias in scientific study is not good but it could and usually does lead to misleading results.

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  47. I am a little late to the party but I wanted to say it takes a lot of courage to do what you just did.

    I am a mother of an ASD son and daughter. It is hard to know what is good information and what is not but we are all linked in the desire to do what is right for our children.

    The fact that you were willing to write this piece is a testament to your honesty and integrity. Andrew Wakefield doesn't deserve the admiration of parents, he has only earned our contempt and dismissal.

    I admire you, sir. And wish you all the best.

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  48. @Schwartz

    "Not at all, they are the ones I've deduced to be the most plausible. It has absolutely nothing to do with like. "

    Like, plausible - from my perspective of your science there is no difference. That you find them plausible is redundant from my point of view - obviously you think your argument is plausible; why would you have pursued it otherwise? You come to any argument with your own preconceptions and bias (as do I) whether conscious or unconscious. This influences the theories you chose to investigate.

    Bias does happen in all parts of the scientific process - whether with intent or not - how can anything else be true? Thankfully the science is reported provides us with a framework that allows us to have a good shot at judging correctness.

    I happen to find the evidence that Deer presented on AW's fraud to be pretty compelling. Which just goes to show that interpreting evidence is also not the cut and dried process we would like it to be. But then if we all agreed there would be no interesting discussions to be had anywhere...

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  49. Hi Craig,

    It takes a lot of courage to change tacks like this, particularly on such an emotional issue. I found you from Orac's post like many others, so I just wanted to offer my encouragement to keep looking at this with as much honesty and integrity as this post shows.

    We can choose to disagree on whether autism and vaccines are connected and still respect each others' points of view. Having seen some of your other posts about AoA's villifying of folks, I am pretty sure you feel the same way.

    Anyway--good luck as you get deeper into this. I have the feeling you'll discover, as many people leaving cults do, that the true believers out there who cannot be persuaded by the facts will turn on you, but I hope maybe JB and Jenny and gang are a bit more civilized and open-minded than they appear.

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  50. @gary,

    "Like, plausible - from my perspective of your science there is no difference..."

    Ok, I can accept that is your perspective, but I don't agree, nor do I believe that any generally accepted definitions see it as such. "Like" implies a personal motive.

    Experiential bias which most certainly exists all the time, and is what I believe you are trying to describe, has little to do with personal motives. It has everything to do with plausibility assessments or assumptions based on experience.

    However, that is a form of evidence based reasoning (not necessarily right) which is very different from the bias originating from unscientific motives such as "like" or personal desires. Those are fundamentally different which is why it is entirely relevant to differentiate between them.

    I don't accept the idea that you can broad brush experiential bias with personal motives into the same bucket and dismiss them all as equal. Almost every profession recognizes the difference which is why we have conflict of interest guidelines tracked independently of expertise (which is at the root, what you describe as experiential bias). They are almost universally treated differently.

    "I happen to find the evidence that Deer presented on AW's fraud to be pretty compelling. Which just goes to show that interpreting evidence is also not the cut and dried process we would like it to be. But then if we all agreed there would be no interesting discussions to be had anywhere..."

    On this point, I agree completely.

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  51. @Schultz

    I don't think that we are as far apart as it seems. For me, it is all about frame of reference. I cannot tell if a researcher's bias is personally motivated or not. It makes no sense to try as my own personal bias comes into play which becomes a very slippery slope. I think that I am objective, but have been proven to have unconsciously been a victim of my own prejudices too many times to play that game. That leaves us with doing the best we can and focussing on the evidence in relation to the conclusions as the basis of any analysis.

    Is BD biased or just passionately right? I don't know. I don't know the man. So, look at the evidence. That is where I have been trying to get to.

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  52. We could go around and around on this forever. Basically it comes down to the fact that I don't trust Deer, I don't think the story belonged in a journal, nor do I like the fact that the journal paid for the story to be written. Journals should not have an agenda nor should they pay for articles that fit their agenda, that is a very slippery slope.

    @ MJ, sorry it took me so long to respond. Yes, we can go round and round but in the end, it doesn't matter whether you or I or the BMJ or anyone trusts Brian Deer. Because you can review his sources (a daunting task but available) for yourself and make your determination. I'm rather chagrined that those who should be doing what Craig has done, are not and simply retreating to the comfort of their previous beliefs by not making any effort to go to the source and pretending that by slamming Deer, nothing he writes can be true.

    It is not unusual at all for a medical/scientific journal to commission an article. It is a bit unusual to commission one from a journalist, but that, in and of itself, is not suspect. The story is about one of the biggest medical ethics/frauds perpetrated in the last decades. Brian Deer is intimately involved with that investigation so it makes sense that he would write it. The BMJ editorial staff vetted/reviewed his work, perhaps even more so than most submitted studies because of the implications. Sorry, but it seems as though you are making excuses for not confronting the evidence. Because let's face it, if it appeared in the National Enquirer, would we even be having this conversation?

    It doesn't matter whether it can withstand a libel suit or not (the PCC deferred to the judgement of the GMC and didn't come to its own conclusion). The standard of proof for science isn't whether or not it can survive a libel claim.

    It absolutely matters that the BMJ features can withstand a PCC complaint, or worse, a libel suit (nothing is barring Wakefield from doing that, particularly now). Because this was NOT a scientific study, but rather a report of individuals and institutions involved with scientific and medical fraud.

    And, as I said above, I accept the fact that the Lancet study was flawed. I do not necessarily accept the fact that Wakefield set out to commit fraud and the reason is that I don't trust Deer. I could very easily see him pushing the boundaries of what is true and what isn't to spin a better story.

    OK, did Dr. Nicholas Chadwick lie under oath during the OAP and in a scientific publication (with Wakefield as a co-author) in which Chadwick did not find measles vaccine virus in the Lancet samples, but rather contamination? And notified Wakefield of those results prior to the Lancet publication submission? You see it isn't just Deer and again, you don't have to trust Deer, you just have to read what he has read.

    Honestly, I don't believe Deer when he said that all of his information is legally obtained. In 2006 he published the names of all of the children in the study as well as details about when they were admitted to the Royal Free Hospital. I believe that was done before the GMC hearing even started, so where did that information come from?

    Let me repeat that last part - he published the names of children and some details about their medical case history. I am going to go out on a limb and say that he didn't have the parent's consent to do so.


    Could you provide a source for this MJ? As far as I know, nothing of the kind happened and the parents (most or all) did self-identify themselves at some point. They did have a suit against GSK you know. So the timeline of your accusation is very important.

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  53. Science Mom,

    You are right that I could go to the time, effort, and expense of requesting the transcripts from the GMC hearing and reading them all. However, I don't believe that the information that is the most relevant to Deer's accusations - the children's medical records - are in there. Bits and pieces of them perhaps, but not the entire thing.

    However, even if I did that, I am not sure it would make me shift from simply discounting Wakefield's research to believing that he intentionally and maliciously committed fraud. Fraud implies a specific intent and I don't know whether that the material would or would not be able to tell me that.

    Regardless, it is unlikely that my level of trust for Deer would change since he was not a major part of the hearings. Every single fact in his articles could be technically true and I still wouldn't trust him for reasons that (I think) I went into above.

    As for what Deer knew about the children and how he learned about it, consider the following.

    As of about Nov 29, 2004 Deer had a page up on his site that contained the names of the children from the Lancet study as well as the dates that they were admitted to the RFH

    http://web.archive.org/web/20041129090953/briandeer.com/wakefield/lancet-kids.htm

    The children's last names were added to the site sometime between Sept 2005 and Feb 2006 -

    http://web.archive.org/web/20060216121432/briandeer.com/wakefield/lancet-kids.htm

    Both of these dates predate the GMC hearings.

    Then there is a recent quote on LBRB -

    http://leftbrainrightbrain.co.uk/2011/01/dowsing-for-data/

    "It was during this period that Mr. Deer became more convinced that the Lancet article “could not be rationally explained”. Since the information was clinically confidential information at the time, Mr. Deer could not take the information into the public domain. This changed with the GMC hearings and, especially the hearing transcript hearings"

    If that statement is accurate (I haven't verified it) that means that Deer did have access to the records before the GMC as well.

    And then there is Deer's statement last year that he had "the names and family backgrounds of all 12 children enrolled in the study" -

    http://autismjabberwocky.blogspot.com/2010/03/brian-deer-doesnt-respect-privacy-of.html

    I don't have access to the GMC transcripts, but I doubt that they contained the family history of the children from the study.

    So I think it is clear that Deer had sources for the children's records other than the hearings. What I don't know is if he obtained the information from the parent's lawsuits against the vaccine makers, from Wakefield's suit against him, or from some other source. It may be possible that if you looked at every detail that Deer ever published that you would be able to tie it back to a public piece of information but I tend to doubt it.

    But at the end of the day, I don't really have the time or inclination to spend that much time on this one issue. Especially considering that the whole thing is rather moot. Wakefield's research tying together GI problems, a persistent measles virus, and autism has been found to be flawed and was withdrawn.

    However, that is not the same thing as saying that children with autism don't have GI problems or that vaccines have nothing to do with autism. Two of my daughters have GI problems that made the symptoms of their autism worse until they were addressed. I also have questions about whether vaccines contributed to a regression that they had and made their autism worse than it would have been otherwise. And before you start slinging the "anti-vaccine" phrase around, go look my most recent post were I went into the history and specific reasons for my doubts.

    (continued...)

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  54. (continued...)

    As for whether Chadwick lied, distorted, or otherwise misrepresented the truth, I don't know. I do know that the the admission of testimony and materials from the UK court system was dubious at best. As the circuit court who reviewed the matter said, if the vaccine court was a normal court then the admission of these materials and testimony would have been improper.

    So before I would be willing to comment on Chadwick et al I would want to hear the evidence from the "other side" - evidence that was not presented because it could not be obtained.

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  55. @Gary,

    Let's talk about my two main questions regarding the evidence then:

    1) Have you read the response to Deer's accusation from Dr. Davies in the BMJ? It addresses the only real case for scientific fabrication quite adequately -- namely the heart of the study which was the GI diagnostics.

    2) Why did the GMC make no finding of fraud (i.e. requiring malicious intent, or fabrication of data) when they extensively reviewed exactly the same evidence?

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  56. @sciencemom,

    "The story is about one of the biggest medical ethics/frauds perpetrated in the last decades."

    Huh? That is a huge embellishment -- the kind that I think Brian Deer engages in.

    The fabrication of medical journals paid for by pharmaceuticals exposed in a REAL trial has almost certainly cost governments and people millions of dollars in funds spent on unnecessary drugs.

    The withholding of data around VIOXX, Redux/Pondimin, Trayslol, has resulted in literally tens of thousands of premature DEATH and over 100,000 cases of REAL damage. Can't forget Avandia either.

    Then of course, how could we forget the case of Dr. Reuben who's research set the medical guidelines on Anesthesiology for the last decade. It turns out his research was all fraudulent. That was at least 21 peer-reviewed articles in very reputable journals over a period of 12 years, all fraudulent. That is easily the biggest proven case of medical fraud in the last few decades.

    All of these cases were quite real, and directly resulting in the deaths and damage to many thousands of people. Trumped up statements about deaths resulting from Wakefield are not only hypothetical, but quite different and empty when you drill into a real discussion.

    It is statements like yours thrown into a mix of real arguments that severely detract from any attempt to hold a logical discussion of actual evidence. Embellishments such as this, just raise the level of rhetoric and make me question whether you are here to have an honest discussion or not.

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  57. "OK, did Dr. Nicholas Chadwick lie under oath during the OAP and in a scientific publication (with Wakefield as a co-author) in which Chadwick did not find measles vaccine virus in the Lancet samples, but rather contamination? And notified Wakefield of those results prior to the Lancet publication submission? You see it isn't just Deer and again, you don't have to trust Deer, you just have to read what he has read."

    @sciencemom,

    You are shifting the goalpost and raising a Red Herring here. Chadwick had nothing to do with the lancet 12 study at all? Why do you bring him into the picture. Wakefield et al 1998 didn't publish or discuss any PCR tests in the early report.

    Chadwick was never cross examined by Wakefield and his defense team, and most interestingly, never called by the GMC as a witness to any allegation of fraud.

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  58. @sciencemom,

    "Could you provide a source for this MJ? As far as I know, nothing of the kind happened and the parents (most or all) did self-identify themselves at some point. They did have a suit against GSK you know. So the timeline of your accusation is very important."

    Brian Deer's defense team did not receive legal access to the GMC records until a legal ruling in November 2006. In that ruling, they only received access for the purposes of that lawsuit. As noted by MJ, the names of the patients were published as early as February that year, and most certainly, a public posting of their names had nothing to do with the legal libel cases against Deer.

    The parents of the patients did not all self identify prior to February 2006.

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  59. @sciencemom,

    "I'm rather chagrined that those who should be doing what Craig has done, are not and simply retreating to the comfort of their previous beliefs by not making any effort to go to the source and pretending that by slamming Deer, nothing he writes can be true."

    A few quick questions:

    1) Did you read the transcripts?
    2) Did you read Wakefield's book?
    3) Did you read the original study?
    4) Did you read the BMJ rapid responses from this year and last year?
    5) Did you read the Uhlmann studies?

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  60. Schwartz, let us assume that Brian Deer had improper or illegal access to medical records before the judges order in 2006. How does that effect the accuracy of the GMC decision or the BMJ articles. All of which were based on medical records that Wakefield had since 2006.

    I look forward to your creativity.

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  61. Re Chadwick -- nice evasion.
    The GMC decided the allegation against Wakefield they were interested in.They left out Chadwick. Chadwick was deposed for the Wakefield lawsuit. Chadwick testified in the OAP. Its funny, but I haven't read a criticism of Chadwick by Wakefield. Chadwick tested all the samples for the kids, including the 12.

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  62. Sheldon,

    "Schwartz, let us assume that Brian Deer had improper or illegal access to medical records before the judges order in 2006. How does that effect the accuracy of the GMC decision or the BMJ articles. All of which were based on medical records that Wakefield had since 2006."

    It doesn't and I never stated otherwise. What is does address is hypocrisy, because if Brian Deer did in fact gain illegal access to the records -- probably a criminal offense -- then we have a serious breach of medical and journalistic ethics.

    "I look forward to your creativity."

    I assume this was sarcastic. This does not imply you came here with the intent of having an honest discussion of the evidence.

    I've stated very clearly what my two evidentiary issues are, and no one has chosen to address them yet here or elsewhere. Do you care to engage in honest discussion and attempt an answer?

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  63. @Sheldon

    I was not evasive at all. Please follow the logic of the conversation carefully:

    1) MJ states: "And, as I said above, I accept the fact that the Lancet study was flawed. I do not necessarily accept the fact that Wakefield set out to commit fraud and the reason is that I don't trust Deer."

    OK, let's review the context:
    We are talking about the lancet 12 study and the BMJ article about that study. Brian Deer wrote the BMJ article and references the GMC hearing which discussed that particular study.

    Science Mom in her response has implied the following:
    a)"OK, did Dr. Nicholas Chadwick lie under oath..."
    This implies that Chadwick testified in the GMC hearing. That is factually incorrect.

    b) "And notified Wakefield of those results prior to the Lancet publication submission? " -- this implies Chadwick produced data prior to the lancet 12 study publication.

    Chadwick was not involved in the lancet 12 study. The lancet 12 study did not involve measles virus detection. Therefore this argument is completely irrelevant and erroneous.

    c) "You see it isn't just Deer and again, you don't have to trust Deer, you just have to read what he has read."
    This implies that Deer used Chadwick's information when writing his piece. Deer does NOT reference Chadwick in his articles, nor does Chadwick even come into play because Brian Deer knows very well that the lancet 12 study did not involve any lab tests of measles virus.

    Given that Chadwick's testimony has absolutely nothing to do with Brian Deer's article, or the lancet 12 study, OR the GMC hearing, raising his testimony as an argument supporting Brian Deer's article is either trying to shift the goalpost (to include events OUTSIDE of Brian Deer's articles and the GMC hearing) or just a plain RED HERRING since it is unrelated to both Brian's paper and the discussion at hand.

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  64. "The GMC decided the allegation against Wakefield they were interested in.They left out Chadwick. "

    The GMC was interesting in professional conduct. Scientific fraud is definitely in the domain of professional conduct. I can only conclude that if Chadwick's testimony provided evidence to support fraud then it would have been included.

    "Chadwick was deposed for the Wakefield lawsuit."
    There was more than one Wakefield lawsuit. Which one are you referring to?

    "Chadwick testified in the OAP."
    Yes, and Wakefield had nothing to do with that hearing. He had no representation there, so there was no opportunity to contest the allegations.

    "Its funny, but I haven't read a criticism of Chadwick by Wakefield. "
    Sheldon, when a lawsuit it settled and everyone agrees to keep all the proceedings confidential, I would absolutely expect that you would not read any criticism of Chadwick by Wakefield. Doing so might very well be in contempt of court.

    "Chadwick tested all the samples for the kids, including the 12."
    That may be true, but it had absolutely no bearing on 1) The study in question 2) The Allegations of Fraud leveled by Brain Deer or 3) The GMC hearing.

    So again, this piece of information is a red herring to this discussion.

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  65. @sheldon,

    Brain Deer's legal access to the children's records is important, because if we are to disbelieve the GMC, we are completely reliant on Brian Deer's personal assessment and opinion, which means a character assessment is completely justified. It would be pretty ironic to have someone accusing another of a breach in professional ethics, while engaging in the same thing themselves.

    It is not lost on many people that all parties involved here had serious conflicts of interest. It makes the opinions all the more difficult to judge all around.

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  66. http://www.vaccinesafetyfirst.com/pdf/BRIAN%20DEER%20IS%20THE%20LIAR%20.pdf

    http://www.vaccinesafetyfirst.com/pdf/Evidence%20of%20Professor%20Walker-Smith.pdf

    http://www.vaccinesafetyfirst.com/pdf/BMJ%20MUST%20RETRACT.pdf

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