Andrew Wakefield
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Andrew Wakefield (born 1956 in the United Kingdom) is a Canadian trained surgeon, best known as the lead author of a controversial 1998 research study, published in the Lancet, which reported bowel symptoms in a selected sample of twelve children with autistic spectrum disorders and other disabilities, and alleged a possible connection with MMR vaccination [1]. Citing safety concerns, in a press conference held in conjunction with the release of the report Dr. Wakefield recommended separating the components of the injections by at least a year. The recommendation, along with widespread media coverage of Wakefield's claims was responsible for a slump in immunisation rates in the UK. [2]. The conclusion in the Lancet report, of the possible connection to vaccination, was subsequently retracted by ten of the paper's thirteen authors. [3]
Following the controversy, in March 2004 the GMC announced it was launching an inquiry into allegations of serious scientific misconduct against Dr Wakefield and two former colleagues [4]. It centred on claims that autistic children admitted to the hospital were subjected to "unnecessary and invasive", tests, and the basis for the claim of a possible link between MMR and autism. However, some of the children's parents are understood to have staunchly defended the doctors' actions, praising them as the first to take their concerns seriously. By June 2006, the GMC had not yet filed charges against Wakefield, but it was expected that formal hearings in the case would begin in 2007 [5].
Wakefield has since claimed in several journals, including the Journal of Clinical Immunology, to have discovered a new disease, unlike other childhood intestinal disorders. However, no other group has confirmed this claim. Since arriving in the United States in the wake of the MMR controversies, over which he is accused of scientific misconduct, Wakefield has continued his research at the Thoughtful House, a centre for autistic children in Texas.[6]
In May 2006 one of Wakefield's colleagues from Thoughtful House presented some preliminary research in Montreal, Canada, that he said supported Wakefield's findings with what was described as fresh evidence of the presence of the vaccine strain of the measles virus in the guts of autistic children [7]. Dr Stephen Walker, of the Wake Forest University School of Medicine, North Carolina, however, warned against making any such connection [8]
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[edit] Early career
Dr. Andy Wakefield, MB BS FRCS FRCPath, is an academic gastroenterologist. He graduated in Medicine from St. Mary’s Hospital, part of the University of London, in 1981, and pursued a career in gastrointestinal surgery, pursuing an interest in inflammatory bowel disease (such as Crohn's disease and ulcerative colitis). He became a Fellow of the Royal College of Surgeons in 1985, and in 1996 he was awarded a Wellcome Trust Traveling Fellowship to study animal small intestinal transplantation in Toronto, Canada.
Discoveries made during his time in Canada led him to pursue the scientific investigation of inflammatory bowel disease. In 1998, he and his colleagues at the Royal Free Hospital reported what he claimed to be a novel inflammatory bowel disease in children with developmental disorders such as autism; which he later called autistic enterocolitis. He left the Royal Free School of Medicine in 2001, after refusing financial support from his employer, University College London, to verify his hypothesis in a large cohort of children. He is involved in scientific collaborations in the U.S and Europe. The main focus of Dr. Wakefield’s research is an investigation of the immunologic, metabolic, and pathologic changes occurring in inflammatory bowel diseases such as autistic enterocolitis, links between intestinal disease and neurologic injury in children, and the potential relationship of these conditions to environmental causes, such as childhood vaccines.
During the course of his work on childhood developmental disorders, Dr. Wakefield said he became increasingly convinced of the need for a research-oriented, integrated bio-medical and educational approach to these disorders in order to translate clinical benefits for affected children into measurable developmental progress; this is the driving aim of Thoughtful House. Dr. Wakefield has published 132 original scientific articles, book chapters and invited scientific commentaries and was awarded the Fellowship of the Royal College of Pathologists in 2001. He is medical advisor to the United Kingdom charity, Visceral, and sits on the board of the U.S. charity, Medical Interventions for Autism.
In 1995, while conducting research into Crohn's disease, he was approached by Rosemary Kessick, the parent of an autistic child seeking help with her son's bowel problems [9]. Kessick ran a group, Allergy Induced Autism [10], focused on the effects of diet of autistic children's behavior. Wakefield subsequently began the controversial Lancet study that ultimately included 12 children, including Kessick's son.
He is currently the Executive Director of Thoughtful House Center for Children (www.thoughtfulhouse.org).
[edit] The MMR controversy
In February 1998 a paper[1] written by Wakefield and 12 other doctors about 12 autistic spectrum children was published in the Lancet. Although in the paper the authors stressed no causal connection had been proven, Wakefield called for suspension of the triple MMR vaccine at a press conference and in a video news release issued by the hospital. [11]
He said, "If you give three viruses together, three live viruses, then you potentially increase the risk of an adverse event occurring, particularly when one of those viruses influences the immune system in the way that measles does." He suggested parents should opt for single jabs against measles, mumps and rubella, separated by gaps of one year.
The paper described what its authors suggested was a possible new syndrome, raising the possibility of a link between a novel form of bowel disease, autism, and the MMR vaccine. In prefacing the study's findings, the authors noted parents of eight of the twelve children reported the onset of behavioral problems within two weeks of MMR vaccination. In the published Lancet summary, the authors wrote, "We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers." These possible triggers were reported to be MMR in eight cases, and measles infection in one. The paper was instantly controversial, leading to widespread publicity in the UK and the convening of a special panel of the UK's Medical Research Council the following month.[12]
Publicity for Wakefield's warnings caused a drop in the number of children receiving MMR, as had been predicted in a letter to the government by Wakefield's chief at the hospital.[13] The controversy escalated as the UK government declined to introduce single-jab alternatives (which would have required licenced products to become available), based on the contention most closely associated with Dr David Salisbury, Deputy Chief Medical Officer, that the risk of prolonging the period before children were immunised against all three diseases was greater than any credible risk of harm from combining them. Single vaccines, spaced a year apart, clearly expose children to greater risk of infection, as well as additional distress and expense,and no evidence had been produced upon which to adopt such a policy.
In November 2001 Wakefield become a fellow of the Royal College of Pathologists in recognition of his research publications.
In December 2001, Wakefield resigned from the Royal Free Hospital, saying, "I have been asked to go because my research results are unpopular." The medical school said that he had left "by mutual agreement." In February, 2002, Wakefield stated, "What precipitated this crisis was the removal of the single vaccine, the removal of choice, and that is what has caused the furor - because the doctors, the gurus, are treating the public as though they are some kind of moronic mass who cannot make an informed decision for themselves."[14]
[edit] Aftermath of initial controversy
Wakefield has continued conducting clinical research in the US, joining American researcher Dr. Jeff Bradstreet to conduct further studies on the possible relationship between the MMR vaccine and autism.
Meanwhile, many parents with autistic children have come forward to tell of children who appeared to be developing normally, until shortly after administration of MMR but whose children's development regressed, with many reported to also have digestive problems and food intolerances. Some parents have criticized Wakefield's warnings about the potential adverse effects of the MMR, contending they were made to feel guilty for having had their child vaccinated. Wakefield's medical critics say the temporal association between vaccination and the appearance of developmental disorders is inevitable, rather than demonstrating causation, since autism is commonly first revealed early in the second year of life, when MMR vaccination is routine.
The "novel bowel syndrome" claimed by Wakefield has also been criticised, since the key symptom had been recognised for many years as a common finding in children without developmental disorders [15]
[edit] Controversy resurfaces
In February of 2004, controversy resurfaced when Wakefield was accused of a conflict of interest. The London Sunday Times reported that some of the parents of the 12 children in the Lancet study were recruited via a UK attorney preparing a lawsuit against MMR manufacturers, and that the Royal Free Hospital had received £55,000 from the UK's Legal Aid Board (now the Legal Services Commission) to pay for the research. [16] Previously, in October 2003, the board had cut off public funding for the litigation against MMR manufacturers[17]. Following an investigation of The Sunday Times allegations by the UK General Medical Council, Wakefield was charged with serious professional misconduct, including dishonesty, due to be heard by a disciplinary board in 2007 [18]
[edit] Retraction of an interpretation
Twenty-four hours before the Sunday Times report, the Lancet responded to the investigation in a public statement, describing Wakefield's research as "fatally flawed," an allegation he has denied.[19] The Lancet's editor said he would not have published the study if he had known of the legal involvement in the research.
Ten of Wakefield's 12 co-authors of the Lancet paper later published a "retraction of an interpretation."[20] The 'retraction' stated, "We wish to make it clear that in this paper no causal link was established between (the) vaccine and autism, as the data were insufficient. However the possibility of such a link was raised, and consequent events have had major implications for public health. In view of this, we consider now is the appropriate time that we should together formally retract the interpretation placed upon these findings in the paper, according to precedent."[21]
In November 2004, the UK's Channel 4 Television broadcast a one-hour investigation by reporter Brian Deer, which alleged that before the Lancet paper was published, Wakefield had filed a patent application [22] for a single measles vaccine, and that his laboratory had failed to find measles virus in the children.[23] In November 2005, the scope of the allegations facing Wakefield, which he denies, were set out in a High Court judgment [24].
In June, 2005 the BBC program Horizon reported on an unpublished study examining blood samples from a group of 100 autistic children and 200 children without autism. They report finding 99% of the samples contained no trace of the measles virus, and the samples that did contain the virus were just as likely to be from non-autistic children. The study's authors found no evidence of any link between MMR and autism.[25] The BBC program also included interviews with Harvard pediatric gastroenterologist Dr. Timothy Buie, who stated that he did not believe any new bowel syndrome had been found in autistic children, and leading autism expert Lorna Wing, who said that she had seen no change in the presentation of developmental disorders in recent years.
The Institutes of Medicine (IOM) [26], along with the CDC, NIH, and Food and Drug Administration (and their British counterparts) continue to deny that any link has been found between vaccines and autism. While a number of epidemiological studies have concluded there is no evidence of any link between MMR and autism or bowel disease, Wakefield contends some of the data supports his thesis.[27]
In the aftermath of the Wakefield affair, data suggests that UK vaccination rates have begun to rise [28]
[edit] See also
[edit] References
- ^ Wakefield A; Murch S, Anthony A, Linnell J, Casson D, Malik M, Berelowitz M, Dhillon A, Thomson M, Harvey P, Valentine A, Davies S, Walker-Smith J (February 28 1998). Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children pp. 637-641. The Lancet - Vol. 351, Issue 9103. Archived from the original on 1998-02-02. Retrieved on 2006-07-01.
[edit] External links
- ThoughtfulHouse.org - 'Thoughtful House Center for Children' (Wakefield's current affiliation)
- BBC Profile: Dr Andrew Wakefield
- BBC MMR doctor 'to face GMC charges' 12 June 2006
- About.com - 'Killing the Messenger: Dr. Andrew Wakefield Fired', Floyd Tilton, About.com (December 5, 2001)
- BMJJournals.com - 'High Court judge criticises Andrew Wakefield for trying to silence his critics', British Medical Journal (November 12, 2005)
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- BMJJournals.com - 'MMR: Science and Fiction. Exploring the Vaccine Crisis; MMR and Autism: What Parents Need to Know' (book review) BMJ
- BrianDeer.com - 'Andrew Wakefield and Channel 4 & Ors' (November 4, 2005)
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- BrianDeer.com - 'Wakefield's reply to Lancet's retraction says legal contract was for viral study' (April 17, 2004)
- Brian Deer.com - 'the Lancet scandal: Following a Sunday Times investigation by Brian Deer, researchers at Britain's Royal Free Hospital retracted claims that had caused a worldwide scare by linking the MMR vaccine with autism'
- Karger.com - 'Abnormal Measles-Mumps-Rubella Antibodies and CNS Autoimmunity in Children with Autism', Vijendra K. Singh, Sheren X. Lin, Elizabeth Newell, Courtney Nelson, Journal of Biomedical Science, Vol 9, No 4, 2002
- MelaniePhillips.com - 'The smearing of Andrew Wakefield', Melanie Phillips (February 23, 2004)
- Mercola.com - Response to NEJM Autism MMR Study, Dr. Andrew Wakefield
- MMRTheFacts.nhs.uk - 'MMR The Facts' (UK National Health Service)
- NCCN.net - 'MMR Vaccine' (Nevada County Community Network)
- ProLiberty.com - 'More studies link MMR vaccine to autism', The Idaho Observer
- RedFlagsWeekly.com - 'Japanese study is the strongest evidence yet for a link between MMR and autism' (opinion), Andrew J. Wakefield, FRCS, FRCPath, Carol M. Stott, PhD
- SNHS.com - 'Anti-vaccine activists get jabbed', Michael Fumento (March 11, 2004)
- Yahoo.com - 'Wakefield, Needleman; Putting Sound Science on Trial; Is History Repeating Itself? Unfounded "Scientific Misconduct" Charges Against Wakefield Aren't a First for Compromised Science' (press release), National Autism Association (June 15, 2006)
