Wednesday, February 03, 2010

THE MMR/Autism article withdrawn from the Lancet

The announcement is terse:

Retraction—Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children

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[1] are incorrect, contrary to the findings of an earlier investigation.[2] 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.


[1] Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998; 351: 637-641. [with live links]

[2] Hodgson H. A statement by The Royal Free and University College Medical School and The Royal Free Hampstead NHS Trust. Lancet 2004; 363: 824. [with live links]

What it means has been unpacked a bit by many news outlets. I’m archiving here those of the WSJ and the NYT.

First, the New York Times article (live links have been stripped; sign up for the NYT to follow their links).

February 3, 2010
Journal Retracts 1998 Paper Linking Autism to Vaccines

A prominent British medical journal on Tuesday retracted a 1998 research paper that set off a sharp decline in vaccinations in Britain after the paper’s lead author suggested that vaccines could cause autism.

The retraction by The Lancet is part of a reassessment that has lasted for years of the scientific methods and financial conflicts of Dr. Andrew Wakefield, who contended that his research showed that the combined measles, mumps and rubella vaccine may be unsafe.

But the retraction may do little to tarnish Dr. Wakefield’s reputation among parents’ groups in the United States. Despite a wealth of scientific studies that have failed to find any link between vaccines and autism, the parents fervently believe that their children’s mental problems resulted from vaccinations.

Tom Skinner, a spokesman for the Centers for Disease Control and Prevention, called the retraction of Dr. Wakefield’s study “significant.”

“It builds on the overwhelming body of research by the world’s leading scientists that concludes there is no link between M.M.R. vaccine and autism,” Mr. Skinner wrote in an e-mail message.

A British medical panel concluded last week that Dr. Wakefield had been dishonest, violated basic research ethics rules and showed a “callous disregard” for the suffering of children involved in his research. Dr. Richard Horton, editor in chief of The Lancet, said that until that decision, he had no proof that Dr. Wakefield’s 1998 paper was deceptive.

“That was a damning indictment of Andrew Wakefield and his research,” Dr. Horton said.

With that decision, Dr. Horton said he could retract the 1998 paper. Dr. Wakefield could not be reached for comment.

Jim Moody, a director of SafeMinds, a parents’ group that advances the notion the vaccines cause autism, said the retraction would strengthen Dr. Wakefield’s credibility with many parents.

“Attacking scientists and attacking doctors is dangerous,” he said. “This is about suppressing research, and it will fuel the controversy by bringing it all up again.”

Dr. Wakefield is part of a small but fervent group of doctors who discourage vaccinations because of a seeming link with autism.

Dr. Wakefield’s paper reported on his examinations of 12 children with chronic intestinal disorders who had a history of normal development followed by severe mental regressions. He speculated that the combined measles, mumps and rubella vaccine may have caused some sort of chronic intestinal measles infection that in turn damaged the children’s brains. He suggested that the combined vaccine should be split into three separate shots and given over a longer period of time.

But an investigation by a British journalist found financial and scientific conflicts that Dr. Wakefield did not reveal in his paper. For instance, part of the costs of Dr. Wakefield’s research were paid by lawyers for parents seeking to sue vaccine makers for damages. Dr. Wakefield was also found to have patented in 1997 a measles vaccine that would succeed if the combined vaccine were withdrawn or discredited.

After years of investigation, the General Medical Council in Britain concluded that Dr. Wakefield had subjected 11 children to invasive tests like lumbar punctures and colonoscopies that they did not need and for which he did not receive ethical approval.

After Dr. Wakefield’s study, vaccination rates plunged in Britain and the number of measles cases soared.

In the United States, anti-vaccine groups have advanced other theories since then to explain why they think vaccines cause autism. For years, they blamed thimerosal, a vaccine preservative containing mercury. Because of concerns over the preservative, vaccine makers in 2001 largely eliminated thimerosal from routinely administered childhood vaccines.

But this change has had no apparent impact on childhood autism rates. Anti-vaccine groups now suggest that a significant number of children have a cellular disorder whose effects are set off by vaccinations.

With each new theory, parents’ groups have called for research to explore possible links between vaccination and autism. Study after study has failed to show any link, and prominent scientific agencies have concluded that scarce research dollars should be spent investigating other possible causes of autism.
Now, the Wall Street Journal article (live links have been stripped; sign up for the WSJ to follow their links).

FEBRUARY 3, 2010
The Lancet's Vaccine Retraction
A medical journal's role in the autism scare.

The British medical journal The Lancet yesterday offered a mea culpa of sorts for its role in launching a global vaccine scare. Its regrets come about 12 years too late.

The journal finally issued a full retraction of a study it ran in 1998 linking measles-mumps-rubella vaccines to autism. The paper, with Dr. Andrew Wakefield as lead author, sent British parents fleeing from inoculations and fed U.S. alarm over preservatives in vaccines.

Even in 1998, overwhelming scientific evidence showed vaccines to be safe. Yet the press-savvy Dr. Wakefield had been getting headlines for his research, and the Lancet's publication fed the controversy by giving him an aura of respectability.

Evidence of vaccine safety continued to build, but the Lancet stuck to its story through 2004, when it was revealed that Dr. Wakefield had been paid to conduct his study on children who were clients of a lawyer ginning up a lawsuit. Even then the journal offered only a partial retraction, saying it had been correct to "raise new ideas."

Meanwhile, Britain's child vaccination rates had plummeted to below 70% in some areas, down from more than 90% in the mid-1990s. The country has since suffered waves of measles outbreaks. In 1998 England and Wales had 56 cases; by 2008 the number was 1,370. In 2006, the first British child died of measles in more than a decade.

The Lancet decision came after the General Medical Council—Britain's medical regulator—ruled last week that Dr. Wakefield had acted "dishonestly and irresponsibly." The panel confirmed years of allegations that he had been untruthful about his patients and funding and had shown a "callous disregard" for the children—subjecting them to invasive and unnecessary procedures. Only with the GMC now considering whether to strip Dr. Wakefield of his license has the Lancet finally said it "fully retract[s] this paper from the published record."

The Lancet episode shows how even reputable publications can become conduits for junk science when political causes run hot. Especially amid the scandal over politically motivated climate science, the public needs professional journals to be scrupulous about their standards and honest about the science.


St. Elizabeth of Cayce said...

I think it's safe to say that our child will receive the benefit of immunization against infectious diseases. First, passive from her Mommy, then active since Mommy cannot gestate forever.

St. Elizabeth of Cayce said...

The Onion also weighs in.