Update – BMJ Wakefield series continues, fingers pointed at Lancet and Royal Free

By Grant Jacobs 24/01/2011 2

A pointer to further articles by Brian Deer and others, highlighting an excellent comment by a reader of Respectful Insolence and brief thoughts.

The British Medical Journal–better known by it’s acronym, BMJ–continues to offer articles by Brian Deer on the long-running Wakefield saga, accompanied by several opinion pieces and editorials.

In particular Deer’s latest article points fingers at the Royal Free Hospital Medical School and the editorial board of Lancet as Harvey Marcovitch, Associate Editor at BMJ, relates with an edge of understated British humour:

Experience of cases reported to the Committee on Publication Ethics, a body founded by medical journal editors, leads to a conclusion that universities and other funding bodies differ in their response to reports from suspicious editors, reviewers, or readers. Some investigate, some retreat into a Trappist silence, and others are adept at carpet sweeping. Brian Deer’s report in the BMJ this week implies no shortage of shagpile in the Royal Free Hospital Medical School and the Lancet office.7

The articles at BMJ include (all open-access and linked to full-text web page):

Brian Deer’s latest feature (18th Jan):

Secrets of the MMR scare: The Lancet’s two days to bury bad news

An editorial (18th Jan):

Assuring research integrity in the wake of Wakefield (Opal et al.)

A Views & Reviews article (18th Jan):

Personal View : How campaigners and the media push bad science

And more commentary on 19th Jan:

Institutional and editorial misconduct in the MMR scare (by BMJ editor Fiona Godlee)

MMR and scientific fraud: Is research safe in their hands? (by BMJ associate editor Harvey Marcovitch)

While this story may have fallen from main-stream media attention, articles and comments continue on-line. Well-known blogger ‘Orac’, at Respectful Insolence continues to weigh in. (Despite strongly supporting Deer’s investigation into the Wakefield case, Orac differs in opinion with Deer on a few matters outside of Wakefield’s work itself, including ’Deer’s attack on Drs. Offit, Goldacre, and Fitzpatrick’.)

Rather than extensively quote or paraphrase these articles, I encourage interested readers to read the originals. I would like, though, to suggest that some of the commentary following Orac’s article is worth reading. In particular, this response by ‘Prometheus’ to Brian Deer’s hopefully innocent misunderstanding of another commenter’s remark deserves attention and I quote it below in full:

Elizabeth Reid (#17) comments:

“It doesn’t really matter from a scientific perspective that Wakefield was fraudulent rather than just wrong.”

to which Brian Deer (#18) retorts:

“Why would somebody shrug off research fraud? Why would somebody say that Wakefield’s ability to place fraudulent findings on a matter of child health into the Lancet, and keep it there for six years in the face of all the public and professional scrutiny that it received, “doesn’t really matter from a scientific perspective”?”

As I see it, there are two “non-overlapping magisteria” here: one is the realm of scientific validity or “truth”, if you like; the other is the realm of ethics.

In terms of validity or “truth”, Wakefield’s 1998 Lancet paper was known to be invalid (i.e. attempts to replicate his findings failed to show what he claimed) long before his data were shown to be fraudulent. His pathetic attempts to “vindicate” his research by claiming conspiracy and corruption on the part of his critics were laughed off by the “scientific community” because that’s exactly the wrong way to deal with scientific criticism. To many of us, his claims of persecution only showed that he had no faith in his results and was trying to “save face”.

As Mr. Deer pointed out in his articles, Dr. Wakefield was offered the time and resources to replicate his findings in a larger group of subjects, but he declined to do so. Had this been more widely known, it would have immediately raised suspicion of fraud in the “scientific community”. He was refusing to do what he should do to defend his findings and – as we only later found out – was not able to plead a lack of time or resources to do it. This would have been (and is) highly suggestive of conscious fraud.

In the ethical realm, I believe that any scientist would be appalled that Dr. Wakefield (or any scientist) deliberately falsified data. I can’t believe there would be a single exception. The only reason that science “works” is because we implicitly trust that researchers won’t commit fraud. We expect them to be wrong on occasion, but we expect that the errors and misinterpretations of data will be honest mistakes, not deliberate attempts to deceive. Being wrong doesn’t end a scientific career (unless you’re usually wrong), but a single act of fraud will bring a scientific career – even a long and productive one – to an immediate end.

Although I cannot speak for anyone but myself, I think that it’s probable that most scientists – at least, those who knew anything about Andy Wakefield prior to last week – considered Wakefield’s research a “dead issue” (and dead wrong) long ago. Thus, the recent revelations of fraud only serve to explain why his conclusions were wrong.

From a purely scientific perspective – from the perspective of increasing human knowledge about how the Universe works – Andy Wakefield’s work was dead long before we knew it was fraudulent. It isn’t any less scientifically relevant today than it was last year, since the “relevance scale” only goes down to zero.


Posted by: PrometheusJanuary 20, 2011 2:46 PM

Orac writes in response ’you nailed it better than I could think of a way to do.’

I’m highlighting this comment as it says well something raised in an earlier thread on my own blog by Alison: ’The whole study was flawed even before the evidence of outright fraud came to light.’ It’s worth to remember the fraud allegations are in addition the scientific conclusions, that they are separable things.

What the fraud revelations may do is get the anti-vaccine promoters to move on. The science community can handle the research issues, but the advocacy groups may need different motivations. (I like to think of Prometheus’ two magisteria here, with ethical issues being one few would want to bear, whatever their view on medical science.)

Some advocacy groups and their members are prone to rejecting scientific explanations–that’s part of what causes them to hold the views they do–but it’s perhaps harder to them to continue to support work that has been shown to be fraudulent.

Deer’s latest article, with it’s focus on the hospital and editorial boards, will raise more discussion on what academics, perhaps journal editors in particular, can do to prevent fraud.

It is a vexed question, as it is not something peer-reviewed is aimed at tackling. Peer review considers what data is presented to be presented in good faith. It doesn’t start by considering that the data might be ‘cooked’. My initial reactions were to be a bit of a pessimist and say that fraud is likely to always be caught well in arrears of the actual events, a few cases excepted.

Having read Opal and colleagues’ editorial Assuring research integrity in the wake of Wakefield I’m inclined to think that their thoughts might point that way. They offer examples of fraud being dealt with promptly, raising the question of why this was not true of Wakefield’s work. Their examples suggest a need for the open involvement (i.e. not sweeping things under carpets, shagpile or otherwise) of the institutions the research is conducted at and their staff.

It’s easy to dismiss this as an isolated incident–fraud with the sort of impact Wakefield’s work has had is rare–but more modest cases must occur and with these in mind it’s perhaps worth institutions taking note – ?

Other articles on Code for life:

Fact or fallacy, a survey of immunisation statements in the print media

Wakefield autism studies slammed as fraud by BMJ

Seeking science-y reading?

Book review – The Poisoner’s Handbook

In good health or not? — ’natural health’ advertising in newspapers, magazines

Book sales, frumpy readers, and mental rotation of book titles

2 Responses to “Update – BMJ Wakefield series continues, fingers pointed at Lancet and Royal Free”

  • This might be a good moment to post the BMJ’s response to the charlatan Wakefield’s various statements put round to those he looks to for his future income and lifestyle. Some people may not have seen this response.

    “Since we published the first of three articles by Brian Deer on the secrets of the MMR scare [1] and a linked editorial [2] on 5 January 2011, the BMJ has been the subject of an orchestrated campaign of emails. In response to questions raised in these emails, we make the following statement.

    “The BMJ stands by the article and the editorial. The article, which was subjected to peer review and editorial checking, was based on enquiries carried out over some seven years, involving, among other things, interviews with parents of children enrolled in Andrew Wakefield’s research. Four such parents are quoted in the article. As made clear in the article, the core data on which the findings were based were evidenced, except in the case of one child, by the transcript of a General Medical Council fitness to practise hearing which sat between July 2007 and May 2010.

    “In many of the emails we have been sent, it is suggested that Andrew Wakefield did not have access to GP records and therefore could not be responsible for discrepancies between those records and what was published in the Lancet in February 1998. The case we presented against Andrew Wakefield that the 1998 Lancet paper was intended to mislead is not critically reliant on GP records. It is primarily based on Royal Free hospital records, including histories taken by clinicians, and letters and other documents received at the Royal Free from GPs and consultants.

    “We draw attention to the finding of the fitness to practise panel, on which we are entitled to rely, that “the project reported in the Lancet paper was established with the purpose to investigate a postulated new syndrome and yet the Lancet paper did not describe this fact at all. Because you [Wakefield] drafted and wrote the final version of the paper, and omitted correct information about the purpose of the study or the patient population, the panel is satisfied that your conduct was irresponsible and dishonest.”

    “Contrary to other suggestions contained in the emails, we made no allegation of dishonesty against Andrew Wakefield’s co-authors, or indeed against anybody else. As the GMC panel heard, it was Andrew Wakefield who wrote the Lancet paper, using data which he anonymised, with little oversight by other authors. We confirm that under the uniform requirements for manuscripts submitted to biomedical journals all authors should be in a position to speak to data, but the evidence is that in this case they were not.

    “We are aware of recent claims made by Andrew Wakefield that “new documents have come to light” purportedly confirming his claims in the Lancet. The material he cites was presented to the GMC panel two and a half years ago. Andrew Wakefield was last year erased from the medical register and he has chosen not to appeal that decision. As indicated, the very many charges proven against him include dishonesty in his research.

    “We are unaware of any peer reviewed paper replicating Andrew Wakefield’s research or confirming his claims to have identified a new syndrome of regressive autism and inflammatory bowel disease associated with MMR vaccination. With respect to gastrointestinal issues, we draw attention to an authoritative consensus statement published last year by experienced specialists in this field [3] and particularly to statement 4: “The existence of a gastrointestinal disturbance specific to persons with ASDs (eg ‘autistic enterocolitis’) has not been established.”

    “Fiona Godlee, Editor in Chief, BMJ

    1. Deer B. How the case against the MMR vaccine was fixed. BMJ 2011; 342:c5347 doi: 10.1136/bmj.c5347
    2. Godlee F, Smith J, Marcovitch H. Wakefield’s article linking MMR vaccine and autism was fraudulent. BMJ 342:doi:10.1136/bmj.c7452
    3. Buie P, Campbell DB, Fuchs GJ, et al. Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: a consensus statement. Pediatrics 2010;125;S1-S18.”

  • Thanks for dropping that in Brian. I was thinking over the weekend that I ought to look for updates or follow-ons from your series, but never found time, so it’s good to have this. (I’m a bit swamped with work.)

    I noticed an interview of Wakefield by NaturalNews on YouTube too. (Haven’t had time to watch it, though. I think I have the details right!) Hopefully “Orac” will have seen to that. For those not familiar with him – look for the ‘Respectful Insolence’ blog.

    I can imagine the ’email campaign’ the BMC refer to will in part be the doing of the likes of Age of Autism. It’s the sort of thing that they seem to consider “activism”.

    Just stepping back for a moment, I find it a shame a small number of advocacy groups choose to campaign for scientific/medical for the disease they have concern about on the basis of championing a person, rather than research into the disease as a whole. It’s a wrong-headed approach, even if the science done by the person happens(ed) to be good.

    (It’s also one reason I was a bit taken aback by the some CFS research advocates championing Judy Mikovits.)

    Those into logical criticism would say it suffers from the appeal to authority fallacy, but on a more practical level it leaves these groups in an intractable position if their chosen “leader” is proved to be unsound.

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