I must admit, I never saw it coming.
At least, I never saw it coming this fast and this dramatically. After all, this is a saga that has been going on for twelve solid years now, and it’s an investigation that has been going on at least since 2004. Yes, I’m referring to that (possibly former) hero of the anti-vaccine movement, the man who is arguably the most responsible for suffering and death due to the resurgence of measles in the U.K. because of his role in frightening parents about the MMR vaccine.
I’m referring to the fall of Andrew Wakefield
Wakefield has shown an incredible ability to avoid the consequences of his actions, so much so that, as recently as the end of 2009, what has happened to him over the last month or so would have been almost unthinkable to me. No, I’m not referring to Wakefield’s having been found guilty by Britain’s General Medical Council of grossly unethical behavior with respect to his conduct while carrying out the “research” (and I use the term loosely) that resulted in his trial-lawyer funded, incompetent, and quite likely scientifically fraudulent 1998 Lancet paper. It was the study that launched the most recent (an possibly most virulent) iteration of the anti-vaccine movement, led to dramatically decreased MMR vaccination rates in the U.K., and launched a thousand quacks in the form of the “autism biomed” movement, which has in essence made autistic children the victims of unregulated and sometimes dangerous experimentation all in the name of trying to “cure” them of their autism. The price autistic children have paid for Wakefield’s pseudoscience is horrific enough, but the potential price that thousands of children, both autistic and neurotypical, are paying and will likely continue to pay in terms of suffering from vaccine-preventable diseases, will probably be even worse.
As I’ve pointed out before, I was quite happy when the British GMC told it like it is, so to speak, and found Wakefield guilty of research misconduct and in no uncertain terms called him “irresponsible and dishonest.” I was not surprised that the GMC had ruled against Wakefield; I was, however, surprised at the vehemence of the ruling and that it took three years after revelations by investigative journalist Brian Deer for the GMC to convene proceedings against Wakefield. Ironically, it was after those revelations, described in a Sunday Times investigative report and a TV news documentary on the U.K.’s Channel 4 entitled MMR: What They Didn’t Tell You, that Andrew Wakefield himself demanded the GMC investigation to “clear his name.” On February 23, 2004, the day after Brian Deer’s article Revealed: MMR research scandal that Andrew Wakefield himself was quoted as saying:
Serious allegations have been made against me in relation to the provision of clinical care for children with autism and bowel disease, and the reporting of their disease. It has been proposed that my role in this matter should be investigated by the GMC. I not only welcome this, I insist on it and I will be making contact with the GMC personally.
As I pointed out, the verdict of the GMC alone was not enough to bring about Andrew Wakefield’s fall. Indeed, I’d consider it, to use baseball parlance, strike one. Or, to mix metaphors as I am wont to do at times just for the heck of it, it could be viewed as the first piece of rock or ice to start falling from a mountainside, triggering more rocks to fall and ultimately leading to an avalanche that buried Wakefield. The second strike (or second rock, to continue my habit of mixing metaphors) occurred less than a week later, when the editors of The Lancet finally did the right thing. True, it took them six years after revelations of Wakefield’s conflicts of interest in the form of payments from trial lawyers and his having applied for a patent on a vaccine to compete with the MMR plus his research misconduct in the form of having performed medically unnecessary invasive procedures such as lumbar punctures and colonoscopies on autistic children were first brought to light by investigative journalist Brian Deer, but at least they finally did the right thing. They retracted Wakefield’s 1998 Lancet article from the scientific literature. That doesn’t even cover the revelations from nearly exactly a year ago, once again revealed by Brian Deer, that Wakefield was not only in the pocket of trial lawyers who wanted to sue vaccine manufacturers to the tune of £435,643 in fees, plus £3,910 expenses but he may well have committed scientific fraud in how he carried out his Lancet study.
From my perspective, the editors should have retracted Wakefield’s study back in 2004, when ten of the original thirteen authors retracted their support for the article and its interpretation. At the time, Andrew Wakefield and Peter Harvey refused to to retract. If the the editors had had any guts back then, they would have retracted the paper then and there. It would have been the right thing to do. After all, the editors all but admitted that Wakefield had violated The Lancet‘s rules on disclosure of conflicts of interest. Come to think of it, if Andrew Wakefield and Peter Harvey had had one iota of honor, they would have retracted the paper themselves, as honorable scientists do when serious flaws are brought to light. Not surprisingly, Wakefield did no such thing, because he is not an honorable man. Moreover, it should be noted that the involuntary retraction of a scientific paper by the editors of a journal is a very rare thing, particularly by a journal as high profile as The Lancet.
Wakefield’s dishonesty and lack of honor aside, up to this point, up to the two strikes against Wakefield, his supporters continued to rally around him. Two months earlier, the anti-vaccine National Vaccine Information Center (NVIC) had invited Wakefield to be its keynote speaker at its annual pseudoscientific conference, even going so far as to award him its Humanitarian Award. Then, in the weeks leading up to the expected GMC verdict at the end of January, the anti-vaccine propaganda blog Age of Autism ramped up its praise of Andrew Wakefield, even likening him to Galileo and the GMC to the Inquisition. As they say, to claim the mantle of Galileo, it isn’t enough to be “persecuted” for your views. You have to be right. Andrew Wakefield was anything but right. AoA also published a whole series of posts by John Stone and Martin Walker trying to discredit the GMC in advance of the expected ruling, along with pure idiocy published by Mark Blaxill. There was even a defense of “that paper” by Andrew Wakefield himself, plus a new “study” published in a new autism vanity journal claiming to have replicated Wakefield’s findings. Clearly, the crew at AoA was pulling out all the stops.
As I pointed out three weeks ago, the anti-vaccine movement continued to circle the wagons after the GMC ruling, but the defenses of Andrew Wakefield and attacks on his critics continued even after the Lancet retraction. The most bizarre of these came, courtesy of–who else?–Generation Rescue. In rapid succession, GR’s spokescelebrities Jenny McCarthy and Jim Carrey released a statement, soon followed by the founder of GR, J.B. Handley. The message? Well, here’s what Jenny and Jim said in a statement entitled, appropriately enough A Statement from Jenny McCarthy & Jim Carrey: Andrew Wakefield, Scientific Censorship, and Fourteen Monkeys (mirrored on the Generation Rescue website):
Dr. Andrew Wakefield is being discredited to prevent an historic study from being published that for the first time looks at vaccinated versus unvaccinated primates and compares health outcomes, with potentially devastating consequences for vaccine makers and public health officials.
It is our most sincere belief that Dr. Wakefield and parents of children with autism around the world are being subjected to a remarkable media campaign engineered by vaccine manufacturers reporting on the retraction of a paper published in The Lancet in 1998 by Dr. Wakefield and his colleagues.
But what was the study that the nefarious Vaccine Illuminati were going so far to squelch? Take a guess:
Behind the scenes, the pressure to keep the work of Dr. Wakefield and his colleagues from being published is immense, and growing every day. Medical journals take extreme risk of backlash in publishing any studies that question the safety of the vaccination program, no matter how well-designed and thorough the research might be. Neurotoxicology, a highly-respected medical journal, deserves great credit for courageously publishing the first phase of this vaccinated monkey study.
Yes, it’s the execrable unethical waste of primates to the cause of pseudoscience that I’ve blogged about twice before under the titles Monkey Business in Autism Research and Monkey Business in Autism Research, Part II. The excellent skeptical blogger Prometheus also deconstructed the study in A “Made for Court” Study? Read those posts if you want the gory details. Suffice it to say, that once again Wakefield was pushing bad, bad science, and, unfortunately, had managed to fool the hapless and apparently naive reviewers and editors at NeuroToxicology to publish the first part of his study. J.B. Handley added to this conspiracy theory vibe, apparently while trying to channel Cuba Gooding, Jr. and Tom Cruise in Jerry McGuire by repeating “Show me the monkeys!” eleven times in the course of his post. Even David Kirby launched his own bit of dissembling nonsense on that repository of all things quackery, The Huffington Post, in a post entitled The Lancet retraction changes nothing.
I thought so, too, David, at least in terms of the lionization of Andrew Wakefield by the anti-vaccine movement, but it turns out I may be wrong, as we shall see, but it took one more thing to change everything. But what was that one more thing, that strike three, that beginning of the real avalanche that buried poor Andy?
It happened one day after J.B. Handley’s “show me the monkeys” cry (or, at least, it was noticed one day later), making me think that Handley knew something was coming. That something arrived when NeuroToxicology withdrew Wakefield’s previously accepted “monkey business” paper. Not surprisingly, the lunatic fringe of the anti-vaccine movement viewed this as still more evidence that there was some sort of conspiracy theory against Wakefield. Topping off the conspiracy-fest, Ginger Taylor drew an elaborate chart of the nefarious forces in a post she called Anatomy of a witch hunt, leading a certain friend of this blog to ask, “But what about the Illuminati and David Icke’s reptilians?” While rational people could but shake their heads in disbelief, believers reacted to the charge of conspiracy theory correctly leveled against them by lamely claiming that the American Revolution started out as a conspiracy.
Meanwhile, the reaction of AoA was, surprisingly, much more subdued and delayed. So, surprisingly, was the reaction of the very same organizations that had so defended Wakefield, such as SafeMinds. Editorials defending Wakefield still showed up on AoA, and Mark Blaxill even managed to get a pro-Wakefield editorial published in USA TODAY, but they didn’t mention the withdrawal of Wakefield’s NeuroToxicology study. This presaged something I never would have expected. On Wednesday evening, a message appeared on the Yahoo! Thoughtful House Group:
Dr. Wakefield has resigned from Thoughtful House
The needs of the children we serve must always come first. All of us at Thoughtful House are grateful to Dr. Wakefield for the valuable work he has done here. We fully support his decision to leave Thoughtful House in order to make sure that the controversy surrounding the recent findings of the General Medical Council does not interfere with the important work that our dedicated team of clinicians and researchers is doing on behalf of children with autism and their families. All of us at Thoughtful House continue to fight every day for the recovery of children with developmental disorders. We will continue to do our very best to accomplish our mission by combining the most up-to-date treatments and important clinical research that will help to shape the understanding of these conditions that are affecting an ever-increasing number of children worldwide.
In 2007 alone, Thoughtful House saw 1,500 new patient requests — or about 60 percent of the center’s current total patient load — and almost a 50 percent increase in new patient requests in the last six months, says Anissa Ryland, director of operations. Thoughtful House’s funding, which comes largely from foundations and private donors, has also been rising steadily in the last two years. From 2005 to the end of 2007, the nonprofit saw a 48 percent increase in private donations and an 84 percent increase in donations from foundations and trusts, Ryland says. In the past two years, the nonprofit raked in $5.5 million in donations.
A number of celebrities and “prominent central Texans” are supporters of Thoughtful House. Former Dell Inc. executive Charlie Ball and his wife, Troylyn, are among the founders of Thoughtful House; their son has “struggled with physical and developmental problems.” The co-managing director of Thoughtful House’s board is Jane Johnson of New York, part of the family of the Johnson & Johnson health care products and services company. Johnson (who co-authored Jepson’s book, Changing the Course of Autism) and her husband, Chris, donated $1 million to lay the groundwork for Thoughtful House in 2004:
Naturally, I can’t resist suggesting that, given that a heiress of the Johnson family of the Johnson & Johnson pharmaceutical and health products company is a founding donor of Thoughtful House when it was established in 2004 and sits on its board of directors, that, by Jake Crosby’s logic on Age of Autism, Wakefield has clearly been a minion of big pharma at least since 2004. Given how often AoA fequently calls Dr. Paul Offit “Dr. PrOffit” and Robert F. Kennedy, Jr. calls him a “biostitute,” perhaps the science-based community should start calling Andrew Wakefield the same thing.
Now here was a bombshell. At first, I wasn’t even sure whether to believe it was true. After all, since its founding in 2004, Andrew Wakefield has been the face of Thoughtful House, and it was his fame that attracted patients. Few people have heard of Drs. Arthur Krigsman or Bryan Jepson, but everybody knows Wakefield, at least in the autism “biomed” circles. My guess at the time was that Wakefield’s notoriety due to the recent one-two punch of his having had an unfavorable ruling by the GMC followed by the retraction of his 1998 Lancet paper might have become a problem for Thoughtful House in that it might have brought unwanted attention from the Texas Medical Board and other local authorities. Add to that the retraction of the very last shred of Wakefield’s apparent (to anyone beside those who pay attention to his story) scientific credibility, his monkey study, and it’s possible that saner heads wanted Wakefield gone. It turns out that it was true. Wakefield was toast. On February 18, the day after the cryptic announcement appeared, Andrew Wakefield’s name disappeared from the list of Thoughtful House staff, as did his defense of his Lancet article published after the GMC ruling. On Friday, the news was confirmed by mainstream news sources. Then yesterday, Brian Deer reported:
Five days later [after the GMC ruling], the Lancet retracted Wakefield’s research. “It was utterly clear, without any ambiguity at all, that the statements in the paper were utterly false,” Dr Richard Horton, the journal’s editor, told The Guardian. “I feel I was deceived.”
The following day, Dr Joan Marie Cranmer, editor of the specialist journal Neurotoxicology, told her New York publisher that she would withdraw a new Wakefield paper, already released online, which also claimed to incriminate vaccines.
It’s understood that Cranmer “took another look at the paper” in the light of a GMC finding of research dishonesty, but a spokesman for the publisher, Elsevier, declined to comment. “It would be inappropriate to go into a lot of detail,” he said.
The Neurotoxicology decision is believed to have been the last straw at Thoughtful House, a centre founded in 2005 by the rich parents of developmentally-challenged children. The clinic was set up to enable Wakefield to continue activities which in October 2001 saw him fired from a London research position, and which eventually led to the GMC charges.
Within two days of Wakefield’s resignation, it was announced that Dr. Krigsman was also leaving Thoughtful House:
Re: Dr. Krigsman
Dr. Krigsman’s decision to relocate his clinical practice to a facility outside Thought House reflects his belief that the complexities inherent in a referral-based practice can be best addressed by his working independently. We will continue to refer patients for GI evaluations when appropriate, and we look forward to continuing to work with Dr. Krigsman on research projects. We are grateful to Dr. Krigsman for his dedication to Thoughtful House and for the work he does on behalf of the children we serve.
Just to be clear, this is official.
It looks as though a purge was under way at Thoughtful House, most likely instigated by Jane Johnson. Adding to the impression that Wakefield’s departure from Thoughtful House was not voluntary is this:
In further brief comment on the departure, Jane Johnson, a Thoughtful House board member and also executive director of the US Defeat Autism Now organisation of alternative practitioners, said that those who knew Wakefield “will not find it implausible” that he quit for the good of the centre.
Observers say that the doctor may now be the victim of a domino effect, which threatens to see him lose his fellowship of the UK’s Royal College of Pathologists, which he obtained in 2001 on the basis of a submission of his publications, and even potentially spark the collapse of a new celebrity-led American anti-vaccine movement.
So, in a period of time encompassing January 28, which is when the GMC decision was first announced, to February 17, which is when Wakefield was apparently forced to resign from his position at Thoughtful House, all the accumulated pseudoscience, dishonesty, conflicts of interest, and incompetent research finally caught up with Andrew Wakefield and reduced Thoughtful House from three practitioners of autism woo to just one. It was a breathtaking fall to those of us who have been following the case for years. So slimy and slick has Wakefield been that I had honestly thought that he could weather even the GMC ruling plus the Lancet and NeuroToxicology retractions. I was wrong. It was three strikes that sent Andy back to the dugout.
So what now?
Clearly, the retractions of Wakefield’s 1998 Lancet and his 2009 NeuroToxicology papers were the last nails in the coffin of whatever zombie of Wakefield’s scientific respectability remained to shamble about and eat the brains of hapless and unsuspecting journal editors. Those two developments guarantee that for the foreseeable future Wakefield will almost certainly not be able to fool a respectable journal into accepting one of his manuscripts again. He will thus be relegated to publishing in crank journals like JPANDS and Medical Veritas. The stream of seemingly respectable “research” would thus dry up and further compromise Thoughtful House’s ability to raise cash and attract patients not belonging to the anti-vaccine fringe–which is almost certainly why Wakefield had to go. In light of this development, I see a clinic in central America or someplace with similarly lax regulation of medical clinics in Wakefield’s future. Or maybe someplace as close as Tijuana. He could even still live in the U.S. and commute across the border.
Or maybe not. Autism pseudoscientists and quacks are nothing if not, as James Randi would put it, unsinkable rubber ducks. Wakefield is down, but I wouldn’t count him out–unfortunately. After several days of utter silence, Age of Autism’s very own Dan Olmsted published an interview with Wakefield in which Wakefield states that he will “move on to a new phase of leadership in the autism community” after leaving Thoughful House and going on the offensive to answer the GMC’s ruling. Never mind that it had been nearly four days after his resignation and two days since the mainstream press had started reporting on his departure. In that context, Wakefield’s announcement comes as anticlimactic at best.
The only question that I have remaining is this: Who would want Andy now? My top two guesses would be a position with either Generation Rescue or SafeMinds, the two premier organizations promoting autism pseudoscience these days. I fear we won’t have too long to wait for the answer promised us in his Age of Autism press release.