by Brian Deer
But there was a whack-a-mole quality to Wakefield’s explanation. The children’s records revealed that, were his claimed criterion applied to all twelve, more parental claims would disappear. Ms. Four, for example, had gotten the idea about MMR and autism three and a half years after her son received his shot, inspired by a newspaper clipping.
So that was one case down. On Wakefield’s professed formula, the paper was wrong already. “[He] did not have any initial reaction, and was not ill at the time,” Ms. Four explained to lawyers in October 1998. She later sent me a Xerox of the clipping.
And hers wasn’t the only child tabulated among the eight who didn’t appear to meet the claimed criterion. Child One’s local doctor wrote to Walker-Smith, describing MMR as the parents’ “most recent concern” about their three-year-old son, who was vaccinated twenty-eight months before. And after interviewing Ms. Six in October 1996, the Australian professor wrote to Wakefield, saying that she’d only “relatively recently associated the change of behaviour” with a shot given to the boy three years before.
“In this child,” Walker-Smith told the General Medical Council hearing, “although the mother did not associate the MMR with what went on, the mother became quite convinced latterly that MMR played an important role.”
So was that three of the eight that, on Wakefield’s claimed criterion, should have been omitted? Yes. Then there was Child Three. “Recently his mother has been told by Social Services that it is likely that the MMR might have caused the problem,” the professor wrote to the local doctor who referred the boy, nearly five years after the shot was given, noting that Ms. Three “had been in touch with the organisation JABS.”
And then there was Child Two, Wakefield’s founding inspiration, whose mother seemed to surface everywhere. The first mention from the records of her raising any issue with professionals about MMR had flopped from the binders three weeks into the hearing, when her family doctor slumped into the witness chair in front of me and acknowledged a note he made in the boy’s medical records, thirteen years before.
Nil obvious Re MMR story
He wrote that on Wednesday, November 2, 1994, when Ms. Two came to see him at his office. Her son had been vaccinated five years earlier. And on that day of her visit (five months ahead of the Newsnight broadcast), a half-page story had appeared in The Guardian newspaper, featuring JABS, Jackie Fletcher, and talk of compensation. It was headlined:
Painful choice of risks
Had Ms. Two read the story, from which there was nil obvious to the doctor? Did somebody tell her? Who can say? But it appeared that Wakefield’s link between the shot and behavioral problems rested on shifting sands. His eight figure should have been more: declaring all parents who made the complaint at the hospital. Or it should have been less: based on thorough checks of the records. Either way, Lancet readers were misled.
That whack-a-mole phenomenon cropped up a lot. For example, over the three: the two brothers, plus one other (whose mother went to Wakefield on advice from the brothers’ mother), who hadn’t been diagnosed with “autism.” Why were they listed in the paper’s Table 2 as among nine of the twelve expressly stated to have been given a “behavioural diagnosis” of “autism”?
In his monster affidavit, Wakefield’s answer to that argued that he didn’t mean “autism” like he used it everywhere else: in his New Orleans conference abstract, which I raised at my meeting with The Lancet’s editors; addressing parents at a meeting in Sacramento; in his report to the Legal Aid Board; at Burton’s congressional hearing; on the Thoughtful House website; in documents for the lawsuit against Channel 4 and me. Or even as he explained in his book.
Instead, he said, “autism” was used in The Lancet in a “generic sense,” and as “a generic term,” which, he said, was “appropriate” for a “disorder on a spectrum.”
In circumstances where the terms: “Asperger’s,” “autism syndrome,” “autistic,” “likely Asperger’s,” and “autistic spectrum disorder” are used, the label of the generic term “autism” is appropriate in the description.
But why would any medical professional think such a thing? It wasn’t that Table 2 was too cramped to squeeze the words in. And the table contradicted his explanation. He’d used spectrum terms in it: “Disintegrative disorder?” as a possibility for Child Four, and “Autistic spectrum disorder” for Child Nine.
There was nothing “generic” about a diagnosis of “autism.” Right, wrong, relevant, or irrelevant, the diagnosis was the diagnosis. Period. It was a considered form of words, which both parents and professionals often set great store by. And if his aim was really as he said, why would he want to change the specific to the generic, the concrete to the vague—deliberately disclosing less information (and less accurate information) to the journal’s editors, peer reviewers, and readers? Why substitute the opinions of a lab worker and former trainee gut surgeon, who’d never examined the patients, and whose employment contract forbade clinical care, for the judgments of specialist pediatricians?
The clues, I thought, were in his paper and patents: where he claimed all twelve kids were “previously normal” and suffered a “regressive developmental disorder” (and “severe developmental regression”). Reporting the true diagnoses would contradict both. Pediatricians would spot that in seconds. If his motive wasn’t to create the appearance of regressive autism—to go with enterocolitis to conjure his “syndrome”—why change the clinicians’ words to his own?
He didn’t explain that, but those changes also made a difference on Lord Justice Stuart-Smith’s checklist. And after Ms. Two had told me, at the start of my investigation, that her son’s head-banging began “about six months” after the shot (and, therefore, not within two weeks, as specified in the paper), I discovered more alterations impacting on the checklist in the critical temporal link.
Soon after my first story, I made a discovery that I never wrote up at the time. I obtained the early version of the Lancet paper, circulated in the medical school in August 1997: six months before the final publication. It made great PowerPoints: I created pretty pie charts to illustrate remarkable alterations. In these, the summer version of what would be unveiled in the Atrium, for instance, the number of kids whose parents fingered MMR wasn’t eight. Nor was it eleven, as fished from the binders.
It was nine. Three out of four.
So, the figure started at eleven, when the parents spoke to doctors between September 1996 and February 1997, fell to nine by the following August, by which time Wakefield had allegedly invoked his exclusion criterion, and then to eight by January 1998, when the paper was ready to print.
And, yet—get this—with that ninth case counted, a striking phenomenon was evident. The additional boy’s mother volunteered a two-month link and yet the combined figure in that early, summer, version still involved fourteen days.
Fourteen days: the figure picked by John Wilson for his 1974 paper that triggered the DTP alarm. Fourteen days: the time frame in Wakefield’s paper, twenty-four years later (and three and a half miles north), doing the same with MMR. Fourteen days: the link cited by the Arizona mother, Theresa Cedillo, before she halved the time to onset to seven days. And now revealed from those binders, the “2 weeks” as volunteered by Ms. Two at Hampstead for when her son’s head-banging began.
But the fourteen days in the summer version was different. It wasn’t the claimed maximum time between shot and symptom. In the summer version, that was fifty-six days. The maximum wasn’t two weeks, but two months.
Rather, with nine complaints included in the math, fourteen days was the average time to onset.
One child was then dropped—the outlier eliminated—and the average became the upper range. Eight of twelve. Fourteen days maximum.
Average = 6.3.
This was complex, tricky stuff. Tough to get your head around. But serious malfeasance may lurk in complexity. Ask anybody w
orking on Wall Street.
Infectious agents, I assume, know little of fortnights. So, could that switch from two months to two weeks maximum, and the survival of two weeks as first the average, then the range, be just a coincidence, or what?
I sometimes wondered whether somebody whispered, “No, Andy, I meant fourteen days max.”
But that was just me. And when I struggled with the detail, PowerPoint was my friend for presentation. The summer version also showed that, upon Wakefield’s revision, bowel disease had skyrocketed among the children (who hadn’t returned to the Royal Free to be scoped again) as the data were progressively changed. I could even use my pointer to make a pie chart movie, illustrating how the cases rose: from about three, to eight, to eleven.
Neat as it was, though, it was nothing compared with the power of human testimony.
A promising source was the Californian, Mr. Eleven, who’d dashed from Hampstead with a pot on his knees. I meet with him twice: the first time in London when he’d come to watch the annual tennis tournament at Wimbledon. He was staying at a hotel near Sloane Square, Chelsea, with Ms. Eleven, Child Eleven, and the boy’s brother.
Seated in the lobby, I show the father Wakefield’s paper, which he’d never seen or heard of before. I tell him that his son was eleventh in the tables, but give no further details (or mention that I’d read the boy’s poorly redacted report) until I obtain his reaction cold.
According to Table 2, labeled “Neuropsychiatric diagnosis,” “1 week” elapsed between Child Eleven’s MMR and his first behavioral symptom. But looking at the table, the father objects. First, he says, he’d been told that his son was the thirteenth seen (I also spoke with a mother who says her son was the eleventh). Then when I assure him that my information is accurate on this question, he denies the one-week link. “That’s not right,” he says, pointing at the journal, open in front of us. “That’s not true,” he adds.
His son received the shot at fourteen months. And medical records, quoted in the poorly redacted report, gave two versions of when his development ceased to be what Royal Free pediatricians called “normal.” One said thirteen months—which was before vaccination—and the other, itemizing the “initial behavioural abnormality,” said:
18 months: slowed speech patterns; Repetitive hand movements
So that was four months after the shot.
The father had given Wakefield that time frame, four months, even before he brought his boy to London. “The onset of his autistic like behaviors,” Mr. Eleven wrote from his home in January 1997, “began around 18 months.”
Where the “1 week” came from, Wakefield couldn’t explain. “It is not possible at this point to say exactly what the symptoms were,” he said in his affidavit, filed in Texas. He continued:
I can say, however, that some behavioral symptom was reported to have occurred in a one week period or the statement would not have been made.
The father saw these things differently, however. After digesting the paper back home in California, he emails me a request that spoke his mind. “Please let me know if Andrew W has his doctor’s license revoked.” And later he’s more specific in his opinion:
If my son really is Patient 11, then the Lancet article is simply an outright fabrication.
His was the only family not enrolled in Barr’s lawsuit. The British parents—guided by Ms. Two and Ms. Six—weren’t so easy to deal with. Although my investigation began after Barr’s lawsuit collapsed, confused families were encouraged to blame me. But when Ms. Four broke ranks, made contact, and produced documents, another crack in the paper yawned.
She gave me everything, from diary notes reporting Wakefield leading ward rounds (“Dr Wakefield & team of 5 came in to explain things”), to an email from his wife, Carmel, asking Ms. Four to phone her as the GMC made inquiries (“I am sorry to trouble you but i am trying to help andy”). But what really made the difference to evidencing the truth was, again, a fatal disparity.
Child Four (“most compelling”) was given special prominence, with text in a column, as well as an entry in Table 2. The summer version of the paper said that, following vaccination, his “mother described a dramatic deterioration in behaviour starting four weeks later.” And this account was backed in the binders.
Yet in the published version, the link had tightened. Now the text said the first symptom was “the day after” the triple shot, and Table 2 reported (squaring the timing with fourteen days):
Dramatic deterioration in behaviour immediately after MMR
Nothing read from the binders supported that claim. And Ms. Four insists that it’s untrue. Not only did she not make any link at the time of her son’s immunization but, even before the hearing on Euston Road had begun, she’d written to Wakefield’s lawyers (in an email she later gives me) telling them that his paper was wrong.
“I did not say [my son’s] behaviour dramatically changed immediately after MMR,” she informed them. “I said within weeks.”
She had wanted to come to London to give evidence at the hearing: not least on the horrors of her son’s time on Malcolm Ward. But after Wakefield’s lawyers took a written statement of what she would say, she learned that she wasn’t required.
“My concern is the paper and what happened at the hospital,” she emails me, adding:
I know that paper is not right and fraudulent. I can see that from what was written about [my son].
TWENTY-SIX
Cry Smear
For all but three of the 217 days of the General Medical Council hearing, nothing outside 350 Euston Road betrayed the mammoth inquiry within. From Mondays to Fridays, the street scene was the same: a six-lane divided highway of blue-black asphalt, where westbound vehicles picked up speed—surging from the ramp of a cut-and-cover underpass—while those heading eastbound crawled toward traffic lights in a haze of hydrocarbon exhaust.
But on the other three days, there was a little extra interest. On the north side of this slice of London’s official inner ring road, police erected steel barriers around revolving glass doors, and maybe fifty, or sixty, people—mostly middle-aged women—clustered with hand-painted placards.
We’re With Wakefield
Dr Wakefield Cares
Stop Hiding Vaccine Damage
The first such gathering was on day one of the hearing: when, at the rectangle of tables on the building’s third floor, ninety-three pages of charges were read aloud by a tag team of GMC staff. But it was another—the first day on which Wakefield gave evidence—that I’ll always remember most vividly. For that was the occasion when I made a mistake, which taught me so much about anti-vaccine campaigners that, as they exported their hero’s crusade to the world, forearmed me.
Never again.
My fail was epic—if, looking back, understandable. That world was changing so fast. Just two weeks before my first story about Wakefield, a couple of Harvard University students launched a website called Facebook. When he threatened the little newspaper, the Cambridge Evening News, the inaugural YouTube video had been up for two months. And when a court order allowed me to read the Lancet kids’ records, the first Twitter post was sixty-three days old.
That velocity of change would take time to absorb. Although I started in journalism on mechanical typewriters, I thought I was an early adopter. I trailblazed on the internet in July 1990 and had published a website since June 2000. But the sum of the parts of the great transformation hadn’t upgraded my biology. In particular, I hadn’t guessed how it would all come together when every last shoulder bag and pair of long pants came packing a video camera.
My mistake went like this. As I passed through the protest, I paused to speak to a man holding a placard:
Witch Hunt
His name was David Thrower: brown beard, fifty-seven, a public transport planner from the north of England, who in Richard Barr’s lawsuit had sued SmithKline Beecha
m on behalf of his autistic son, Oliver.
Thrower was the author of what he called “A Briefing Note,” avidly circulated by vaccine campaigners, republished as a download by Lenny Schafer in Sacramento, and cited from Canada to New Zealand. It was the most detailed document that I’d ever see that argued MMR caused autism.
I’d received a copy from Ms. Six, four years before, and was struck by its autistic quality. Thrower’s “note,” at that time, ran to 159 pages, with an “Executive Summary,” an index, appendix, sections 1 to 130 (in Parts A to M), all crammed with excerpts, and interpretations of research.
But, more memorable to me than its systematization, was its title:
MMR and Acquired Autism (Autistic Enterocolitis)
It seemed to me that Thrower didn’t know what that meant: that this man, who played guru to parents seeking answers, hadn’t even the courtesy toward those who trusted him to at least get his first sentence right. By the time I saw him on Euston Road, moreover, his note had swollen to 427 pages, with a new, longer title—which told me that he still didn’t get it.
MMR Vaccine, Thimerosal and Regressive or Late Onset Autism (“Autistic Enterocolitis”)
So, with an entirely legitimate journalistic purpose, I ask him, “What’s ‘autistic enterocolitis’?”
Thrower is surrounded by placard-wielding protesters, and he repeats my question, half-shouting above the traffic. “What’s ‘autistic enterocolitis’? Well, we don’t know, do we?”
Well, yes we do. “We know what Wakefield says it is,” I reply. “What does Wakefield say it is?”
“We’d be here all day if I said what Wakefield says it is.”