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The Lancet retracts Andrew Wakefield’s article

In 1998 Andrew Wakefield and 11 other co-authors published a study with the unremarkable title: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Such a title would hardly grab a science journalist’s attention, but the small study sparked widespread hysteria about a possible connection between the mumps-measles-rubella (MMR) vaccine and autism spectrum disorder (ASD).

The study itself has not stood the test of time. The results could not be replicated by other labs. A decade of subsequent research has sufficiently cleared the MMR vaccine of any connection to ASD. The lab used to search for measles virus in the guts of the study subjects has been shown to have used flawed techniques, resulting in false positives (from the Autism Omnibus testimony, and here is a quick summary). There does not appear to be any association between autism and a GI disorder.

But it’s OK to be wrong in science. There is no expectation that every potential finding will turn out to be true – in fact it is expected that most new finding will eventually be found to be false. That’s the nature of investigating the unknown. No harm no foul.

Andrew Wakefield, however, was apparently guilty of more than just getting it wrong, or even of being a sloppy scientist. He has been the subject of an ethics investigation by the General Medical Council who recently concluded that:

The General Medical Council ruled he had acted “dishonestly and irresponsibly” in doing his research.

David Gorski has the full report on the GMC ruling, which I will not repeat.

What is also at issue, however, is the integrity of the published peer-reviewed medical research. Again – there is not the expectation that peer-reviewed research will always get the answer right. In fact, the published research stands as an important record of error – the blind alleys, red herrings, false correlations, and erroneous conclusions that are part of the history of science.

However, error should not include scientific fraud, or science that is thoroughly misrepresented. One aspect of the transparency demanded by science, and increasingly an issue, is disclosure of potential conflicts of interest. This is the issue that first got Wakefield in hot water with the Lancet – the journal that published his original research. Wakefield was being paid as an expert by lawyers who were suing over alleged vaccine injury. In fact some of the children in the study were the children of parents who were suing. This is a massive conflict of interest.

When this came to light the Lancet responded by contacting the co-authors of the article and essentially asking them if they still stand by the results of the study. Ten of the original 12 authors of the study retracted their support for the study and its interpretation. In 2004 the Lancet published a retraction. However, it was only a partial retraction, and the study remained as part of the published literature.

In the wake of the GMC ruling, however, the Lancet has once again reviewed the study and concluded that there is now sufficient evidence of wrongdoing on Wakefield’s part to print a full retraction. Here is the entire text of the article:

Following the judgment of the UK General Medical Council’s Fitness to Practise Panel on Jan 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al are incorrect, contrary to the findings of an earlier investigation. In particular, the claims in the original paper that children were “consecutively referred” and that investigations were “approved” by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record.

This should be the final nail in the coffin of this controversial and harmful study. Coming 12 years after the original paper, after just about every element of the research and its findings have been refuted, the Lancet retraction almost seems unecessary. But it is necessary and important. As the retraction indicates – it removes this dubious research from the published record.

While we can all celebrate this move, I also believe it highlights the need for scientific journals to have a lower threshold in retracting published studies that are found to be fraudulent, or are so flawed either ethically or scientifically that they should never have been published in the first place.

The process of editorial and peer-review is not perfect, and given the number of papers that are published there is no way to keep dubious, even fraudulent, research from slipping past the goalies. But peer-review does not stop when a paper is published – in fact that is when it begins in earnest. So it is common for serious problems with a paper to be discovered only after they are published. When this happens, the journal editors should be willing to admit error and correct their mistakes.

An example of the importance of correcting the published record is the Cha/Wirth/Lobo study conducted at Columbia University and published in the Journal of Reproductive Medicine in 2001. The study alleged to find that intercessory Christian prayer doubled the success of in-vitro fertilization. However, Rogerio Lobo, presented as the lead author, later acknowledged that he had nothing to do with the conduction of the study. His name was removed from the authors list in 2004.

But much worse than that, Daniel Wirth, who is not an MD and is not affiliated with Columbia University and who seems to be most responsible for the study results, was indicted by a federal grand jury and pleaded guilty to conspiracy to commit fraud. (See this excellent article by Bruce Flamm for all the details.) Essentially this study was conducted by a paranormal researcher with the resume of a con-artist.

And yet, the Journal of Reproductive Medicine has refused to admit error and retract the paper. It remains listed on PubMed, without any hint that the study has been seriously called into question.

They have published a clarification by the third author, Kwang Cha, who is digging in and defending the paper, writing:

This deliberate design constraint made it impossible for Mr. Wirth to have played any role in manipulating or altering the data.

I find it very difficult to believe that manipulation was “impossible.” I think Dr. Cha overestimates the ability to protect against deliberate fraud, and underestimates the cleverness of those who choose to commit fraud. Cha would have us believe that it is more likely he proved the efficacy of a miraculous intervention than that someone guilty of fraud may have committed fraud.

While this study has been scientifically discredited, it remains part of the published record and continues to be cited by supporters of the efficacy of prayer.

Conclusion

I applaud the Lancet for finally retracting the Wakefield study and removing it from the published record. It should not, however, have taken this long.

Posted in: Science and Medicine

Leave a Comment (29) ↓

29 thoughts on “The Lancet retracts Andrew Wakefield’s article

  1. BigHeathenMike says:

    It’s great that the Lancet retracted this study, but we all know that this study will always be in the pile with “tornados through junkyards”, “why are there still monkeys”, and “Evan is my science…my mommy instinct is more important”.

    Though we’ve got the evidence on our side, the scientific upper hand, it’s worthwhile remembering that it’s not enough to have a great hand, you also have to know who you’re playing against, how to play the cards you have, and when.

    Great as always, Steve.

  2. jimpurdy says:

    From my long-ago days as a news reporter with UPI (United Press International), I still remember our instructions:

    “Get It First, But First Get It Right.”

    In a wire service, intense competition means that every second counts in breaking a news story.

    If news reporters under that kind of intense pressure can check their facts, there is no excuse for sloppy fact-checking by medical journals with months to check their facts.

    Especially since people die when medical journals get it wrong.

    The 50 Best Health Blogs

  3. Scottynuke says:

    Unfortunately I’m sure plenty of anti-vaccs have PDFs of the article stored away somewhere, and they’ll post them with absolutely no compunctions about ignoring the retraction. *SIGH*

  4. windriven says:

    BigHeathenMike hit the nail squarely noting: “it’s not enough to have a great hand, you also have to know who you’re playing against, how to play the cards you have, and when.”

    I would add that you also have to have someone to play the cards. The peripatetic freakshow of autism cranks has a well-oiled mechanism for driving their point of view in the mainstream media. We, on the other hand, have some fine and articulate scientists who will happily answer questions if a reporter happens to ask them.

  5. Grinch says:

    As if, on que, the antivaxxer waco’s come out with no evidence to present just to say something. Case-in-point; Age of Autism:
    “Dr. Andrew Wakefield is one of the most vilified medical practitioners of recent times, and now he carries the extremely rare dishonor of a retraction in The Lancet, on the paper he coauthored in 1998 suggesting a potential link between autism, bowel disease and Measles-Mumps-Rubella (MMR) vaccine.

    I believe that the public lynching and shaming of Dr. Wakefield is unwarranted and overwrought, and that history will ultimately judge who was right and who was wrong about proposing a possible association between vaccination and regressive autistic spectrum disorder (ASD).

    Wakefield’s critics can condemn, retract, decry and de-license all they want, but that does nothing to stop or alter the march of science, which has come a long way over the past 12 years, and especially in the last year or two. The evidence that autism is increasing at alarming rates, and that some thing (or things) in our environment is wreaking havoc on a vulnerable one-percent of all US children is now so irrefutable that, finally, the federal government is climbing aboard the environmental research bandwagon – way late, but better than never…”

    http://www.ageofautism.com/2010/02/david-kirby-the-lancet-retraction-changes-nothing.html

  6. provaxmom says:

    Their steadfastness in this belief is absolutely amazing……..just amazing. Today on our local news, they reported the story and then of course, they had to interview a non-vaxer. So they chose the PA person or leader of NAA. Her statement was something about “decision was politically motivated.” What was politically motivated was waiting this long to retract a study that was clearly known to be flawed YEARS ago.

  7. sj says:

    CBC-TV lead their national newscast with this story last night. And they made it clear that the anti-vaxers were wrong. Not a single one of them was interviewed, but plenty of sensible infectious disease specialists were and they took pains to point out the effect of the decrease in vaccination rate on the increase in preventable disease and death. Kudos to the CBC for not taking the “both sides” approach in this matter.

  8. Zoe237 says:

    I was going to say, why the heck did it take them 12 years?

    Apparently a better editorial process is needed at top journals.

  9. Fredeliot2 says:

    Dr. Offut did a great job on TV this morning explaining the significance of the finding. Unfortunately they wasted some time with Wakefield denying everything and I’m sure Dr. Offut had a lot more he could have said about the lawyers and patent conflicts of interest.

  10. provaxmom says:

    Can you tell me what network? Google/Bing are not helpful. All that keeps coming up is some link about “Paul Offit Vindicated…” Blech, groan and sigh……..I was unaware that Dr. Offit needed vindication.

  11. Chris says:

    JimPurdy:

    “Get It First, But First Get It Right.”

    Ah, that explains why Dan Olmsted is no longer working for UPI.

  12. antipodean says:

    A paper so bad and so damaging it has now been retracted TWICE.

    I don’t know if that’s ever happened before.

  13. squirrelelite says:

    Well, that was the right subject, but it didn’t include Dr Offit. (I was having trouble getting the video to play on my other computer.)

    This is a CBS interview with Dr Offit.

    http://www.tv.com/video/vYD_j9gUF8aM_ZxAdGQYSAMBg14EPS4_/whos-to-blame?o=cbs

  14. mxh says:

    @Zoe “Apparently a better editorial process is needed at top journals.”

    That and a better way to limit political/financial pressure to publish a paper. The bigger journals are certainly guilty of publishing pretty crappy studies only because the results make a nice headline, while rejecting great studies because the title isn’t sexy enough.

  15. sohare says:

    The title of Kirby’s article over at HuffPo pretty much sums it up the antivax position. “The Lancet Retraction Changes Nothing”.

  16. David Gorski says:

    Of course it doesn’t. We never thought it would, at least not for die hard antivaxers. However, for others, it might let them know just how bad Wakefield’s “science” was and is.

  17. Susan says:

    Kudos to you and David Gorski for calling Wakefield out a while ago. In June I commented on the autism – vaccine controversy and the role that Oprah had in promoting it (http://bit.ly/cL700, http://bit.ly/cSDR0F). Thanks for the update about The Lancet’s retraction. It is inexcusable that it took 12 years to retract a paper which has caused so much harm by casting doubt over the MMR vaccine. (Time Magazine also has an article which states that Wakefield may lose his license to practice http://bit.ly/9J5xyr )

  18. jguidotti says:

    Guys, a retraction does not make Dr Wakefield wrong. The fight to demonstrate the earth was not flat took years and much worse than retractions for politcal more than sicentific purposes does not have a much meaning as you might think. Peer reviewed is peer reviewed. What about all the other research papers…what about the body of evidence? These publications have no credibility in my view and I believe in “vaccinating the herd”

    We are so screwed up, we humans, we rarely get things correct in the immeediate or near term…rarely.

    We are a sad species….

    I like modern….but these peoiple who know…are in the know….do us all a dis service on btoh sidea!!

  19. David Gorski says:

    Guys, a retraction does not make Dr Wakefield wrong.

    That’s true. The retraction doesn’t make Wakefield wrong. It’s Wakefield’s incompetent, trial lawyer-purchased, probably fraudulent science that makes him wrong, coupled with the loads of data from other researchers that do not support his hypothesis. The retraction is simply a long overdue acknowledgment of that wrongness.

  20. Harriet Hall says:

    What makes Wakefield wrong is that his results could not be replicated and there is now a large body of data contradicting his hypotheses.

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