Autism is a brain disorder that can result in behavioural problems. In 1998, Dr Andrew Wakefield published a report in a medical journal. Dr Wakefield and his colleagues had carried out tests on twelve autistic children. Dr Wakefield and his colleagues claimed to have found a possible link between the MMR vaccine and autism. Dr Wakefield wrote that the parents of eight of the twelve children blamed the MMR vaccine for autism. He said that symptoms of autism had started within days of vaccination. Some newspapers used parts of the report in scare stories about the MMR vaccine. As a result, many parents refused to have their children vaccinated. Dr Wakefield's research was being funded through solicitors for the twelve children. The lawyers wanted evidence to use against vaccine manufacturers.
 
Use information from the passage on the opposite page to answer these questions.

 (i) Was Dr Wakefield's report based on reliable scientific evidence?
   Explain the reasons for your answer.

 (ii) Might Dr Wakefield's report have been biased?
  Give the reason for your answer.

Let us pause there in order to reflect upon the question. While several quanta removed from the implications of the Reich’s insidious mathematics test, the coercive subtext is the same. It was set, apparently, by teachers trained in science. It was set for children whose futures depend upon providing answers that will allow them to pass the exam, i.e., by expressing views consistent with those of the State. It is intended to embed opinion.

First, I will deconstruct the passage that the students are given to read.

Autism is a brain disorder that can result in behavioural problems.

Actually, rather than being a brain disorder, autism is a disorder that affects the brain.  A growing body of published evidence indicates that for many children, autism is a systemic disorder affecting the immune system, the intestine, and various metabolic processes such as those responsible for detoxification. Similarly, Sydenham’s chorea and Pediatric Autoimmune Neurological Disorder Associated with Streptococcus (PANDAS) are systemic disorders associated with adverse neurologic and behavioral consequences following streptococcal infections of, for example, the tonsils rather than the brains of susceptible children. 

In 1998, Dr Andrew Wakefield published a report in a medical journal. Dr Wakefield and his colleagues had carried out tests on twelve autistic children.

I, and twelve other well-respected physicians and scientists, published the report that described the results of clinical tests carried out on twelve sick children who were admitted to the Royal Free Hospital under the care of a senior pediatric gastroenterologist for investigation of their clinical symptoms. An apparently novel inflammatory bowel disease was discovered and has since been confirmed in five different countries.  The paper was a case-series (rather than an analytic study, e.g., a case-control study); this was clearly stated in the paper. It is a typical and well-established mode of presenting medical cases with similar features. It is a hypothesis-generating study that is a precursor to analytic studies in which inclusion of controls is appropriate.

Dr Wakefield and his colleagues claimed to have found a possible link between the MMR vaccine and autism.

We specifically stated in the paper that the findings did not prove an association – let alone a causal association – between MMR vaccine and the syndrome that was described.

Dr Wakefield wrote that the parents of eight of the twelve children blamed the MMR vaccine for autism.

Appropriately and accurately, we reported the parental histories of developmental regression following MMR vaccination in eight of the twelve children. No one would have suggested censoring, for example, parental reports of natural chickenpox if this is what had preceded their child’s regression.

He said that symptoms of autism had started within days of vaccination. 

We did not say this; we provided an account of the parental reports of the “onset of first behavioral symptoms,” which had often started within days of receiving the MMR vaccine.

Some newspapers used parts of the report in scare stories about the MMR vaccine. As a result, many parents refused to have their children vaccinated.

This is misleading and without any evidential basis. Asked what vaccination strategy I would recommend, I suggested in 1998 (and now) a return to single-spaced vaccines. This recommendation was based upon extensive research by me into the safety studies of measles-containing vaccines, compiled into a report that was several hundred pages long. The conclusions of this report with respect to the inadequacy of MMR vaccine safety studies have since been endorsed by the gold-standard scientific review by the Cochrane collaboration.  However, while a fall in uptake of MMR was reported following our publication, figures for the reciprocal uptake in single vaccines were not. I have contacted private UK clinics providing single vaccines and I am informed that they have administered tens, if not hundreds, of thousands of doses, none of which are documented in the official statistics. Bizarrely, when the demand for single vaccines was at its highest, the UK government revoked the license for importation of single vaccines in August 1998, six months after I had made my recommendation. Parents with genuine safety concerns about MMR were denied a choice of how to protect their children: the UK government had decided to put protection of policy before protection of children. Beyond this point, vaccine uptake may genuinely have fallen, for which the government with its “our-way-or-no-way” policy must take responsibility.

Dr Wakefield's research was being funded through solicitors for the twelve children. The lawyers wanted evidence to use against vaccine manufacturers.

This is false. The allegation that The Lancet paper was funded by the Legal Aid Board (LAB) through lawyers looking to sue vaccine manufacturers was made by a freelance journalist who simply got it wrong and whose claims have now been discredited by the evidence. Not one single cent of LAB funding was spent on The Lancet report. In fact the funding for the LAB study (a separate viral detection study) was not even available to be spent until nine months after the children in The Lancet study had been investigated, their results analyzed, and the paper written and submitted to The Lancet for possible publication. These are matters of fact.

In other words, the students’ required reading is substantially false or misleading. And yet in order to gain marks, the students, whatever their understanding of the true state of affairs, are required to endorse the errors of their examiners or fail on the question. The examiners provide a breakdown of their marking scheme:

Answer (i) Was Dr Wakefield's report based on reliable scientific evidence?

A. No (any two from sample size small [only twelve], conclusion based on hearsay from parents, only eight parents linked autism to MMR, no control used (two marks) 

First, the question is confusing. A report provides facts, its conclusions (if any) are based upon evidence. The options given for a correct answer completely fail to understand the nature of a case series (such as Kanner’s original description of autism in eleven children), which is essentially an uncontrolled report of the children’s history backed up, where available in our case, by contemporaneous developmental records and GP reports, and clinical findings including a detailed analysis of the children’s diseased intestinal tissues.

Answer (b)(ii) (yes) being paid by parents / lawyers (one mark) 

As stated above The Lancet 1998 paper was not funded in any way by Lawyers. And rewarding the answer that I was being paid by ‘parents’ is extraordinary; it not only bears no resemblance to the truth, but it finds no mention in the paragraph upon which the examiners base their question.

Finally, to part (a) of the exam question: “can we explain how MMR vaccine protects children from these diseases.” A simple answer - one pleasing to the examiners - would be: by the induction of specific, life-long antibody and cellular immunity that produces high herd immunity and interrupts chains of virus transmission. While this may get a good mark, it would be false. In truth, there is much that is not known about vaccine-induced immunity. The legacy of mumps vaccination – a policy forced on reluctant Public Health systems in the US and UK, essentially through commercial pressures – has simply made mumps a more dangerous disease. Mumps is a trivial disease in children but substantially more dangerous in adolescents and adults. The vaccine does not protect enough children, and what protection it does confer, does not last - even with boosters. The effect has been to leave pubertal and post-pubertal individuals susceptible to mumps and its complications. Measles vaccine comes considerably closer to the examiner’s preferred answer, although waning immunity is also a problem that may not be overcome by booster doses, a practice that has yet to be studied adequately for safety. The long-term consequence of waning immunity at the population level is an issue of genuine concern.

I would score precisely zero for my response. But what of those who face the question in the future or who have already taken the test? The examining board was sent a series of searching questions by a journalist about this issue. Immediately, the exam paper was taken down from the website. What happens now? Will the students who have already answered the question pass if their answers conform to the dictate of the public health apparatchiks, or will they fail because their answers are wrong? And the science graduates who set the question – on what did they base their position? From their response to the journalist’s questions, the answer would appear to be, the integrity of the Sunday Times – so much for due scientific process. Where does that leave the prospects for tomorrow’s medical science? Consider the recent revelation during the course of Vioxx class action hearings: the publishing house Elsevier (owner of The Lancet and over 500 other medical and scientific titles) created six fake journals that were dressed up to look like scientific journals, funded by Merck without any disclosure, and strongly favorable to Merck in their content.  And Merck itself, a company whose suggested corporate policy on Vioxx apparently included “seeking out [dissenting doctors] and destroying them where they live.”  Parents of the world’s remaining neurotypical children might wish to consider this when discussing career choices.

‘Corporate government’ is heavily invested in propaganda, many of the techniques of which are a legacy of the Third Reich. It is difficult to believe that it was not influential in setting the UK school’s biology curriculum. For their efforts, Julius Streicher,  the Reich’s apothecary of young Aryan mind poisoning, would have given the GCSE examiners and whoever was pulling their strings  no more than a six out of ten and a “see me after class.” Streicher was tried and sentenced to death at Nuremberg. Who knows where he might otherwise have ended up?

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, pursuing a career in gastrointestinal surgery with a particular interest in inflammatory bowel disease. He qualified as Fellow of the Royal College of Surgeons in 1985, and in 1996 was awarded a Wellcome Trust Traveling Fellowship to study small-intestine transplantation in Toronto, Canada. He co-founded The Thoughtful House Center for Children in Austin, Texas. You can read his full bio at the Thoughtful House website HERE.