Monday, February 8, 2010

Wakey, Wakey!

This is slightly stale news, but I haven't really had time to blog on it: The Lancet, the prestigious British Medical Journal that originally published Andrew Wakefield's shall we say, problematic study purportedly linking vaccines to autism, has retracted it [PDF]. I think this is a long time in coming, though I understand why it took so long. Retraction of a peer-reviewed paper is actually a big deal and very uncommon, even for fairly bad papers. Even prestigious journals don't retract papers just because someone turned out to be wrong, or there was a critical error in an experiment that was undertaken in good faith. In these cases it's more typical for the scientists themselves to retract the paper. Usually there has to be very serious issues.

The Big Sin in Wakefield's case wasn't simply being wrong, but in failing to disclose his associations and potential conflicts of interest and not respecting the rights of his research subjects. Reading Autism's False Prophets by Paul Offit, it's actually very clear that Wakefield's research was highly questionable if only because he was working for trial lawyers involved in tort cases against vaccine manufacturers aiming for a class-action lawsuit. For people who argue that pharmaceutical companies have a vested interest in denying vaccine danger, I would like them to consider (however briefly) that Wakefield has had a vested interest in connecting vaccines to some form of disease. This, in addition to the fact that he himself patented a stand-alone measles vaccine, all the while encouraging people not to use the multi-valent vaccine for Measles-Mumps-Rubella (MMR). I should also point out that by contrast, Dr. Offit makes no bones about admitting he works on vaccines himself- a level of disclosure significantly greater than that of Wakefield.

Measles vaccines being grown in chicken eggs. (Photo courtesy of the WHO)

When pharmacuetical companies do research, we know their agenda and scientists can stand back and consider potential biases. The FDA and other government agencies also get involved in monitoring the research and making sure that scientific rigor is being applied. While the FDA has had its debacles, and in all fairness the system is flawed- there is at least some level of openness about the research being done and acknowledgement of who pays the piper, so to speak. With Wakefield, he deliberately withheld his conflicts of interest from the journal, which would have called for increased scrutiny of his research had he done so. That the Lancet published it in the first place was a case of the journal doing it's due diligence with data that seemed plausible from what seemed to be a responsible unconflicted party on the subject. The Lancet would have been manifestly derelict in its duty to inform the medical and scientific communities had it not published such a paper. When it's discovered that the data was bad, the research subjects were mistreated, and that there were significant conflicts of interest- why should the paper stand?

Yet the predictable response of the anti-vaccination movement is talk of "censorship". I remember a day when censorship meant that saying certain things got you imprisoned or killed. In fact, I believe they still do this in some countries and that the people who die speaking freely might have an objection to that characterization. That a publication refuses to publish your drivel isn't censorship- it's discretion. Discretion is an important part of the peer-review process: That people qualified in the field and who understand the state of the science decide its value to others in the community of researchers.

I'm very comfortable calling the anti-vaccination movement anti-science denialists. I'm less comfortable doing that with say- global warming deniers (though I still call them deniers). In the case of people against the idea of anthropogenic global warming, there are those among them who look at the data and come off with at least superficially plausible differing interpretations. Anti-vaccinationists offer no mechanisms of action, do not consider the importance of harm-reduction (even if vaccines did cause autism, the likelihood is so small that vaccination is still worth the risk relative to the risk of infectious disease), they are unmoved by further studies that cannot detect the connection or replicate Wakefield's results, and this is the kicker: IGNORE OTHER POSSIBLE CAUSES FOR AUTISM.

This last one kills me. Dollars that went to confirm Wakefield's results and determine the nature of the purported autism-vaccine link were dollars wasted. That money was money that never went to finding cures or treatments for autism that never worked. People who donated to various anti-vaccine movements have deprived numerous researchers and scientists of funds urgently needed to help those with autism, and if this does turn out to be completely genetic, screening technologies for it. Meanwhile the resulting scare resulted in deaths and disfigurement of numerous children who were not vaccinated because their parents were either misguided or willfully obstinate. People die when you disseminate medical information that happens to be false. When you spread information you know to be wrong- that's simply unconscionable. I sincerely hope Mr. Wakefield finds his mattress small help in falling asleep tonight.

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