Book Review: The Doctor Who Fooled the World

Corruption pays, myth stays; civilizational blaze?

Wakefield won. When Brian Deer, the journalist who exposed his fraud, wrapped up his book-length account of disgraced doctor’s rise and fall five years ago, Wakefield was “rich, famous, and [lived] with a sex goddess’ ” (Brian Deer’s The Doctor Who Fooled the World: Andrew Wakefield’s war on vaccines, Scribe Publications, 2020, p. 366).

The good news: Elle MacPherson’s spokesperson later confirmed that she and Wakefield broke up around the time of the book’s publication.

The bad news: Reports of a “science police” have been greatly exaggerated. And so no one is coming to march scientific frauds like Wakefield off to jail. Thus, he remains unrepentant and at large. His victims — desperate parents he has conned; marginal subgroups that he targets and actively endangers — celebrate him. He enriches himself like the classic snake-oil salesman by selling his confidence in his lies, the infamous and unambiguous mastermind of the original MMR vaccine-autism fraud that has contributed to six-figure child measles deaths in recent years, when double-digit such deaths were feasible.

If bad science could incur the death penalty, he would need the Atticus Finch of fraud. But he has, it seems, the same in the eyes of the law as he has in the eyes of MacPherson: he’s not a wanted man. Who cares?

Maybe the parents of the two schoolchildren who died of measles in an ongoing West Texas outbreak — one of 10 U.S. outbreaks so far this year. A safe and effective vaccine is available to prevent transmission, decrease disease severity, and prevent disability and deaths which are particularly likely in infected children under the age of five. The vaccine is estimated to have saved over 60 million lives worldwide since 2000. But vaccine hesitancy has lowered uptake since Wakefield’s fraud convinced a minority of parents that the combination measles, mumps, rubella (MMR) vaccine had caused or could cause autism. This is especially tragic, because infants and immunocompromised people depend for their protection on herd immunity, requiring in this case that about 95% of the population be vaccinated, because measles is very infectious — one unvaccinated person can infect nine out of ten of their unvaccinated contacts.

Quick Sum

There’s a summary here, but Deer’s book is worth reading for its in-depth look at how one prominent fraudster got Bikked, lost his UK medical license (struck off the register), and lived to tell his own, demonstrably false side of the story.

Wakefield’s original motive seems to have been money: he was paid handsomely by a private attorney looking to file a class action lawsuit relating to MMR-autism claims, which he then designed research to support without disclosing conflicts of interest. That research was not just methodologically bad (e.g., confirmatory evidence-seeking), but also demonstrably fraudulent (e.g., misrepresenting the patients’ medical histories and findings).

It also put developmentally disabled children through painful, invasive tests in the course of an in-patient hospital stay, none of which was medically indicated for their symptoms or benefited them. And it did that without IRB knowledge or approval, but “those tests had been agreed on by a firm of lawyers before a single child was admitted” (p. 255). Meanwhile, Wakefield had filed for patents for two singleton (separate) measles vaccines, as opposed to the combination MMR shot. He was a man with a plan to make a lot of money proving his theory that the MMR vaccine caused autism. (It doesn’t.)

Highlights

Particularly chilling: Wakefield’s original victims, the twelve autistic children in his retracted Lancet article that first advanced the MMR-autism lie, “were rendered unconscious, scored, and tested for evidence of measles virus in their guts” (p. 52). They had no symptoms that warranted this invasive, painful medical treatment.

Particularly stupid: Wakefield kept arguing that his findings of microscopic-level stains were superior to the “surely vastly more sensitive” molecular methods that consistently returned blanks, or false negatives, as he called them. “Indeed, when [Deer has] presented [Wakefield’s] proposition, talking to biology undergraduates, they laugh. They think it’s a joke” (p. 112).

Particularly corrupt: In a public hearing that resulted in the relevant patient medical files being read into the public record (revealing the depth of the fraud), retracted Lancet paper co-author S.H. Murch told lawyers for Britain’s GMC (General Medical Council) reinvestigating Deer’s early findings that co-authors S.E. Davies and A.P. Dhillon led the debate over the children’s biopsies. They “must have known their specialty’s consensus” that the reported findings “were frequent, normal findings in healthy guts, and shouldn’t be reported as colitis” (p. 266). In other words, “The pathologists found no pathology” (p. 259). But no one took issue with Wakefield’s calling it that, because “yes please, they’d have a paper with their names on it in The Lancet, the world’s number two general medical journal” (p. 267).

Particularly brave: The mother of one of the Lancet article patients contacted Deer because she knew what Wakefield et al did to her son at the hospital was wrong, and that the paper was fraudulent as it concerned his medical record (p. 282).

Particularly dogged: Deer staying on Wakefield. “But,” as he writes, “once he’d begun suing and sliming to cover his tracks, I’d no choice but to stay on his trail” (p. 362).

More dogged still: Wakefield staying on vulnerable communities — Somali-American immigrants, Orthodox Jews — to put out his message that measles vaccination would harm instead of helping them. “In his sights were neighborhoods where immunization rates were low, and he wanted to keep them that way. Vaccines, he now preached, were ‘neither safe, nor effective,’ and the historic decline in deaths and sickness from measles, was ‘nothing to do with vaccination’ ” (p. 363).

Takeaway

Individual level: Deer caught a blatant fraudster red-handed. And, even still, Wakefield thrived and continued endangering children worldwide.

System level: Wakefield and his colleagues responded to perverse incentives to do bad science, and those incentives still haven’t changed to meaningfully punish scientists whose misdeeds results in serious harms or even large numbers of deaths. Human societies seem to be, as ever, terrifically bad at solving collective action problems through the means we have ostensibly designed for that purpose — politics.

Next: Peter Gøtzsche’s Vaccines: Truth, Lies, and Controversy, and the requisite marginalization of the whistleblower. Wakefield plays Gøtzsche on TV, pretending to be an anti-establishment firebrand who’s persecuted for threatening the corrupt status quo. Apparently, not enough people can tell the authentic from the imitation. Enough being the requisite 95%…