by Brian Deer
And for an eight-year-old girl, 280 miles northeast:
Mum taking her to Dr Wakefield, Royal Free Hospital for CT scans/gut biopsies. ?Crohn’s—will need ref letter—Dr W to phone me. Funded through legal aid.
Then there were the referral letters, sent to Wakefield or Walker-Smith. They also made clear what was happening.
This 7¾ year autistic child’s parents have been in contact with Dr Wakefield and have asked me to refer him.
[This little girl’s] mother has been to see me and said you need a referral letter from me in order to accept [her] into your investigation programme.
Thank you for asking to see this young boy.
Who in that room would know how it worked? Probably not even Montgomery. This choreography of referral, like the money from Barr, would have revealed a secret purpose behind the twelve-child paper: to pressure the legal board to fund a lawsuit.
Wakefield shook off his pursuer. Easy peasy. Then, a few weeks later, did it again. A Lancet reader, a doctor named Andrew Rouse, wrote in about a Barr fact sheet, which he’d found posted online by a little group called the Society for the Autistically Handicapped, which I never heard of before or since. Rouse was concerned about possible litigation bias and that this wasn’t addressed in the paper.
Again, Wakefield saw him off, deflecting the suggestion. “No conflict of interest exists,” he wrote to The Lancet, hurling a fist of blinding dust at his pursuer. “AJW had never heard of the Society for the Autistically Handicapped and no fact sheet has been provided for them to distribute.”
To that, he added a line that one day he’d claim was evidence of his innocence and honesty:
Only one author (AJW) has agreed to help evaluate a small number of these children on behalf of the Legal Aid Board.
He would say this covered it: that he’d disclosed the position. And he threatened to sue The Lancet after it condemned his conflict, when I revealed it in the Sunday Times. But the journal hit back: that he’d framed his admission in the present tense—“has agreed”—three months after the event in the Atrium. That made his “help” appear to follow the paper, when it had started two years before.
Ferguson did her best. But she didn’t stand a chance. She was schooled in doctorly discourse. To take on Wakefield, specific facts needed nailing: data, documents, proof. And, after hearing his reply—laying on her shoulders the guilt he should have felt—she meekly backed away. He was safe.
“I apologize,” she said, as if she’d behaved badly. “I wasn’t suggesting any impropriety.”
Yet, she’d come so close to the heart of his strategy. The “finding” in the paper, linking autism with the vaccine, wasn’t any kind of finding at all. It was the crucial component of his research’s methods; not a discovery, but his means of execution. Parents’ concern over vaccine damage was why they came to the hospital: some traveling hundreds (in one case, thousands) of miles. It was a preplanned inclusion criterion.
But moments after the apology, and barely seconds before the day’s concluding tea break, his mask briefly slipped, and he evidenced the nature of a mind made up, unchanged since his first big idea. Turning from Ferguson to address the gathering, he made remarks that, to a scientist, were so revealing of character that, of all the day’s discussions, it will be the moment that Pattison, presiding from the chair, recalls twenty years later, when I phone him.
“I have a different perspective, clearly, to most people in this room,” Wakefield told them, as the event drew toward its close. “And it comes from, I expect, with actually having looked down the microscope, looked down the electron microscope, and seen these things, and done the work. And I stand by that absolutely. I still feel there is a link between measles virus and chronic intestinal inflammation in these situations. Now my job is to go away and try and convince you of that.”
Then he added, “And that’s what I’ll do.”
THIRTEEN
Turn of the Century
Doom-mongers forecast the end of the world. In the final twelve months of the twentieth century, talk was rife of a computer bug, “Y2K,” which, at the stroke of midnight to welcome the year 2000, might make bank deposits vanish, aircraft plummet, and launch war between the United States and Russia. It was said that old programs clocking dates in double digits might run out of numbers, and go berserk.
At the Royal Free, however, the closing year of the second millennium kicked off looking sweet for Wakefield. By January 1999, his office had moved up eight floors to the tenth, lightening his life with luscious views across London. His mailbox was stuffed with referrals and queries, meaning plenty more kids to be scoped. And his once-parallel schemes in litigation, science, and business ventures converged like one of those night sky alignments of Jupiter, Venus, and Mars.
First up: his secret contract with the lawyer Richard Barr to produce evidence for the government’s Legal Aid Board. Asking for its money two and a half years previously, he’d promised results with molecular amplification, “strain-specific” sequencing of measles virus, and Nick Chadwick as his coordinating investigator. But all that yielded nothing, so now, on Tuesday, January 26, 1999, he filed a report on the pilot study based on his staining tests.
Nobody cared. He could have filed his lunch. What would the board know of proteins and nucleotides? The storm created through The Lancet guaranteed that Barr’s lawsuit would be funded by the taxpayer. Four national newspapers now backed the crusade. Some eighteen hundred families swelled Barr’s contact lists. And the first “writs,” as they were called, against vaccine manufacturers, had been stamped in red at the Royal Courts of Justice.
Wakefield’s report to the board was a secret dossier claiming his discovery of the new gut-brain “syndrome,” which he predicted before the first child was scoped. That ticked the box for Lord Justice Stuart-Smith’s checklist item 1: a “specific clinical syndrome.” And here, too, was a candidate for Wakefield’s disease: a specific pathology (checklist item 2), which he named “autistic enterocolitis.”
“Both those affected children funded by Legal Aid and, subsequently, a larger group of similarly affected children who were referred independently by their General Practitioners, have been investigated,” he submitted, through Barr.
The conclusion of this report is that in some children there is a strong likelihood of a causal relationship between measles virus and possibly some other component of the MMR vaccine and the new syndrome.
The bowel story was the same as he told it in The Lancet. The colitis and swollen glands—the ileal lymphoid hyperplasia—were a “consistent pattern of intestinal pathology,” he told the board, that was “consistent” with the cause being a virus. But his “temporal link” (checklist item 3) had notably undergone evolution. Reporting not on twelve kids but now more than forty, that association had weakened from the fourteen-day maximum before behavioral symptoms to four weeks, on average, after the shot.
I think Barr must have watched that evolution too. He knew the importance of the timings. Before the paper’s publication—even before the kids were scoped—the lawyer, with his wife-to-be and scientist, Kirsten Limb, had advised on the temporal link. For the board to cover the costs of parents hoping to sue, the pair stressed that it needed to be told of a “clear reaction,” and a “close link up in time,” preferably in a “number of days.”
That didn’t mean the couple told their clients what to say, only what needed to be said. “Let’s get this straight,” Barr insists, during my early inquiries, before he refuses further comment. “My role is to do the best for my clients. It always has been, and always will be. Clients came to me and told me what was happening to their children.”
True. But in an outpouring of fact sheets and newsletters, the couple did a great deal of telling. Perhaps no wonder, with Limb believing that her daughter was a victim of medical negligence. Or maybe they were impassioned for a cause, or bil
lings. Either way, they didn’t merely brand doctors wrong, but implied that they were dishonest.
We are concerned that risks associated with the actual illnesses may have been exaggerated, perhaps to frighten people into having their children vaccinated.
And:
Even in the face of quite an obvious link between the vaccine and the injury, doctors are dismissive and say the cause was anything but the vaccine.
And:
We are troubled that there seems to be a certain amount of massaging of the figures.
Slippery suggestions. And fantastic advice for parents with broken hearts. In the decades to come, such poisonous acorns would mature into a dark ideology. Little was more potent in building a campaign than opponents branded fools and liars.
“She was very full of herself,” one mother in the lawsuit tells me of Limb. “She talks for Britain, seldom letting up, and was full of the conspiracy stuff.”
“I’ve got to be really honest with you, Brian,” claims a former colleague of the pair, who helped to prepare the class action for court. “Going to work for them was like having to dunk my arm in a pot of boiling oil.”
Barr and Limb told clients that Wakefield was a “paediatric gastroenterologist,” which he wasn’t; claimed that those who “in any way challenge” the safety of vaccines were “publicly discredited,” which they weren’t; and even admitted that they aimed to “raise a question-mark” over the “rationale” for immunization.
“Needless to say, both Kirsten and I are satisfied that the link between the vaccines and the injury to our individual clients is not a fanciful one, but one of direct causation,” Barr had declared in a newsletter, even before the meeting with Augustus Ullstein two years before the Lancet paper.
At public expense, they’d made up their minds, and had no mind to keep it to themselves.
One angle, which they plied their clients with for years, insinuated profession-wide shenanigans. Comparing lay medical books created for family use, they noted that in the days before vaccines were available, doctors downplayed measles, mumps, and rubella, telling parents they were usually mild. But in a marvelous contrast—spread across seven pages—fact sheets revealed that, after vaccines were licensed, “perception of the illnesses” apparently changed. Now doctors “inexplicably” stressed the risks.
“Something curious has happened to the ‘official’ perception of the childhood illnesses,” they informed their clients, many of whom weren’t sophisticated people. “They have all officially become more serious since vaccines were introduced.”
With arguments that smart and a surge in client numbers, Barr and Limb moved to a bigger firm, with offices in London, with maybe less room to maneuver. But parents were free to tell it how they saw it—with Ms. Two, as usual, in the lead. “CYNICAL ATTEMPT TO DISGUISE THE TRUTH,” she shouted in a statement from her group, Allergy-Induced Autism, over a government-funded research paper. “SCANDALOUS PUBLIC DUPE.”
Ms. Two was a gem, a one-in-a-million. She delivered like a midwife on speed. In March 1999, she organized a conference, with Wakefield the star, drawing nearly four hundred, including the Australian professor, to the National Motorcycle Museum. And, all but incredibly, it was she who’d first suggested the mechanism of damage, the Stuart-Smith checklist item 4. She’d raised it in her phone call after the Newsnight broadcast, and it would survive to the end of Barr’s lawsuit.
Her mechanism went back to the “opioid” idea that even made it into the Lancet paper. It was borrowed from an Estonian psychobiologist, Jaak Panksepp, who injected morphine into lab rats and guinea pigs. Then he watched them sink into stupor or go crazy. In a two-and-a-half-page paper published in July 1979, he hypothesized that “opioid peptides” (most notably found in wheat and dairy products) led to what he called “opioid excess.” Moved over to children, this caused an “emotional disturbance”—which is what he believed autism to be.
“Think morphine or heroin and you’ll get the basic drift,” Ms. Two popularized this idea.
How many loaves of bread it might take to get wasted wasn’t part of any Wakefield equation. But he seized on this mechanism—what I call the “stoned rodent model of childhood autism”—soon after he heard it from the mother. In his Lancet paper, he gave it two hundred words, with more in his secret report to the legal board.
“A coherent explanation for a link between the gut, persistent measles virus infection, autoimmunity and autism, is embodied in the ‘opioid excess’ hypothesis,” he told the board. “The hypothesis proposes that early in life, opioid peptides—principally in ß-caesomorphine and ß-gliadorphin—derived from dietary casein and gliadin [a gluten component] respectively, enter the circulation through a damaged or leaky gut.”
So, here was how MMR was meant to cause autism. Persistent measles virus led to bowel inflammation. Then an “excess” of peptides from food escaped into the bloodstream, traveled to the brain, and caused damage. As Ms. Two would file in court papers for her son:
The presence of measles vaccine virus in the tissues of the gut causes immune dysregulation and/or autoimmune reactions which lead to the development of inflammatory bowel disease, which in turn initiates a biochemical cascade resulting in an excess of opiate peptides in the circulation damaging the brain so as to cause autism.
Speculative, yes. But it was referenced to an -ologist, a psychobiologist. And 1999 was a year of new ideas about immunization impacting the brain. In July, there was concern in the United States when the US Public Health Service and the American Academy of Pediatrics called for the retirement of a mercury-based preservative, thimerosal, then contained in many vaccines, in case of possible neurodevelopmental effects.
Thimerosal had been used for some seventy years to protect multidose vaccine vials from bacteria. The plan to phase it out echoed Britain’s brand withdrawals—and triggered a similar reaction. When the government made a move to tighten vaccine safety, lawyers pounced, campaign groups formed, and a class action lawsuit was raised.
The “live virus” MMR never contained thimerosal. Yet here was power to Wakefield’s elbow. At the time, however, his mind was still on measles and, after servicing Barr’s lawsuit at hourly rates of pay, and poring over the stoned rodent model picked up from Ms. Two, his third priority for that good-looking year was business—a.k.a. making money.
His biotechnology company, Immunospecifics, was still in talks with the medical school, which by now had been swallowed by University College London—a blue-chip institution with more than sixteen thousand students, and seven thousand staff, in countless buildings. It was this that now owned his patent claims—for the tests, treatments, and single measles vaccines—which, although he lodged without his employer’s permission, he devised while on its payroll.
And more news bubbled on the business front: another company was good to go. With his venture capital partners, Robert Sleat and Alex Korda, as well as Roy Pounder, the professor of gastroenterology, he was readying a scheme for a more ambitious enterprise, which they named Carmel Healthcare. It was to focus, first, on selling diagnostic kits based on the detection of measles virus.
I obtain the draft prospectus, the pitch to investors, stamped “Private and Confidential.” It was brave.
Carmel has positioned itself, uniquely, to be part of the solution to what is going to be one of the major healthcare problems of the new millennium.
Carmel is a new biotechnology venture specialising in the development and commercialisation of measles specific clinical diagnostics.
In all the years of my investigation, I never worked out why finding measles virus would diagnose anything but measles. But the plan was to launch the venture—on Monday, January 17, in the new year, 2000—before Wakefield spoke at a conference. In advance of the event, he’d be media-coached, ready to sound an even louder alarm than two years earlier in the Atrium.
His team, he p
lanned to say, had used molecular methods to find “unequivocal” evidence of vaccine-derived measles in the guts of autistic children. Ms. Two would be with him to give the parents’ view, and the results, he would say, were to be published in Nature: one of the two top science journals in the world.
He saw this moment as a turning point—and a new feedback loop to himself. The London lawsuit, which rested on his advice, wasn’t merely to pay him through fees agreed with Barr, but was to create the launch pad for Carmel. Citing “the UK Legal Aid Board” as a founding customer, its thirty-five-page prospectus argued that “autistic enterocolitis,” shortened “AE,” had the potential to make a fortune.
It is estimated that the initial market for the diagnostic will be litigation driven testing of patients with AE from both the UK and the USA. It is estimated that by year 3, income from this testing could be about £3,300,000 rising to about £28,000,000. [About £48 million or US $59 million at the time I write.]
This was no charity venture. A big chunk would be his. Having created the evidence that lay behind the scare, with his secret legal deal, and his hold on the media, his share of the stock was to be 37 percent. Sleat, the father of a child among the twelve, would get the next slice—22.2 percent—with Korda, 18 percent; Pounder, 11.7 percent; and a fifth owner 11.1 percent. Wakefield would also bag a £30,000-a-year consultancy, with corresponding arrangements for the others.
Here was final victory over the naysayers. And, win or lose, the company would pay him. The only minor remaining challenge was to oil a squeaky wheel: a newly arrived head of medicine at Hampstead. It was one of those situations that, as often over the years, would call upon his charm, and charisma.
The new head, Mark Pepys, started work on October 1, 1999, settling into a new center at the rear of the building built expressly to house his team. Aged fifty-five, he was a slim-framed South African–born high achiever: professor of immunology, Cambridge double first, and a fellow of the Royal Society (the world’s most elitist club of science, with a past president named Sir Isaac Newton). He was the school’s biggest catch since 1959, when Sheila Sherlock, a liver specialist, arrived to become Britain’s first female professor of medicine.