The Doctor Who Fooled the World Page 2

  The ex-doctor without patients was back.

  BIG IDEAS

  ONE

  The Guinness Moment

  In some imaginary universe, he might be revered as Professor Sir Andrew Wakefield. Two decades before his invitation to Trump’s ball, the destination that he felt beckoned, like a big bony finger, wasn’t Washington, DC, or anywhere in America, but a concert hall in downtown Stockholm. Dressed like Fred Astaire, in white tie and tails, his dream, people said, was to collect a gold medal from the hands of the King of the Swedes.

  “You’d hear them in the canteen,” a former colleague of his tells me. “They’d be talking about the Nobel Prize.”

  But to that, or any, universe, the gateway was the same: the portal to all his possibilities. It stood then—and stands now—on Beacon Hill: high above the city of Bath, in the county of Somerset, ninety minutes by train west of London. Here you’ll find the entrance to his childhood home, and the exit to all roads he will travel.

  It’s no picket gate. This isn’t Tom Sawyer. I’d guess the frame weighs more than a ton. Embracing two ten-foot Doric columns and matching pilasters, with an ornately carved frieze across a multilayered architrave, it resembles the entrance to a Victorian mausoleum, or a side door to the Colosseum of Rome. It speaks of wealth, class, authority, and entitlement. In uppercase, the lintel is lettered:

  HEATHFIELD

  The “Heath” in question was James Heath, an entrepreneur, who patented his own “Bath chair.” This was a delicate hand-pushed, or horse-drawn, minicarriage, with a folding hood or sedan-like enclosure. Profits paid for a house (although it’s said he never lived here) on a rugged escarpment of fossil-rich moraine, with slopes to match the best of San Francisco’s. It looked out, and looks out, across the Avon River valley to a pale yellow city, built in oolitic limestone, that’s today a United Nations site of world heritage.

  The six-bedroom stone residence—an “Italianate villa”—was completed in 1848. Beneath its blue slate roof and tall, tall chimney stacks were two floors of high-ceilinged, big-windowed, family rooms, and below them, a half floor, dug into the moraine, once quartered by parlor maids and cooks. These two societies were linked by hidden networks of wires, connected at one end to metal levers on fireplaces, and at the other to jangling bells. By the mid-twentieth century, these contraptions had rusted. But you could never forget they were there.

  During the 1960s and 1970s, the Wakefield family—two adults and five children—lived here, by all accounts happily. As a home it was mayhem, with a swing hanging from a doorframe and the tap-tap of dog paws on parquet. But amid the rough and tumble, the mother, Bridget Matthews, later remembers her second son—the future crusader—as an island of calm and compliance.

  “He was the least troublesome of my children; he’s a conformist really,” she tells me, in tones that betray a struggle to explain this. “When he was a child, if you shouted at him, and said, ‘Your room’s untidy,’ he’d look at you and say, ‘I’m sorry, Mum.’ But he would never, like the others, say, ‘Oh, I haven’t got time to clean it up,’ or this, that, and the other. And it took the wind out of your sails.”

  Both parents were doctors—as were Bridget’s father and grandfather—which made Andrew a fourth-generation medic. And if such a fine pedigree didn’t guarantee greatness, it at least validated the ambition. In England’s stubborn class culture, he would reside above stairs: granted permissions to pull life’s levers, and exemptions from answering its bells.

  Role model number one was his father, Graham Wakefield, a patrician and physically imposing neurologist who rose to the National Health Service’s top rank—consultant—at the Royal United Hospitals across the valley. He’d trained in brain doctoring before the advent of scanning, and some thought this lent his character an inclination to certainty before all of the facts were in. Without computerized tomography or magnetic resonance imaging, his formative diagnoses were rooted less in medical science than observation, interrogation, and guesswork.

  Consultant neurologists were gods among gods. Ward rounds were stately processions. “He would quiz you very precisely,” a former junior doctor recalls. “But it was never to humiliate, or embarrass. He took time to explain. Every patient would be another chance to teach. ‘What does this mean?’ ‘At what level is the lesion?’ ‘What do you think is the cause?’ ”

  Graham was a busy clinician but briefly dabbled in research, including a study published in The Lancet. In October 1969, he was the second of three authors of a three-pager on vitamin B12 and the neurological complications of diabetes. It included tables reporting on eight Royal United patients, plus a stop-press “addendum” of four late cases. Home-delivered, it would have dropped onto the Heathfield doormat when young Andy was aged thirteen.

  Bridget d’Estouteville Matthews (also styled “Mrs. Wakefield”) was yin to her husband’s yang. She was a firm family physician, or “general practitioner,” with a no-nonsense manner and a strong sense of mischief, who met Graham when they were students at St. Mary’s Medical School in the Paddington district of west London. She had nerves of titanium and knew a thing about grit, having been evacuated to New Mexico during World War II, sailing with her three sisters, at the age of ten, to return four years later on a troop ship.

  “She has no fear of anything, a determined chin, a strong will and piratical temperament,” her father, Edward Matthews, warned her wartime hosts, in advance of his children crossing the ocean. “She has a streak of cruelty in her which she uses to cover her sensitivities and can devise the most malignant remarks with which to crush opponents.”

  But it wasn’t only his parents in whose image Wakefield grew. A yet taller tree towered over Heathfield. His grandfather Edward (“call me Ted”) became a psychiatrist at the Royal United and retained a room at the house for consultations. He also trained at St. Mary’s (like his father before him), and as his son-in-law matured as a doctor of the brain, Edward flourished as a man of the mind.

  His big project was a two hundred–page book for boys titled Sex, Love and Society. Published in 1959, when he’d just turned sixty, it professed to be “an attempt to discover the basic patterns of the mind.” But that mind, for the most part, was his own. As the Swinging Sixties loomed, he used his pages to campaign: against copulation before marriage, prostitution, homosexuality, and the “increasing aggressiveness” of women.

  “It was Helen of Troy’s face which launched a thousand ships,” he explained in a topical passage, trawling Greek myth, “not the violence of her tongue, or the strength of her biceps.” And his book, dedicated to grandsons Andrew, Charles, and Richard, was an antidote to idle pleasures. “The boy who masturbates is always fed up and tired,” he warned. “If you feel that you must masturbate in spite of your good intentions, get on with it and get it over with as quickly as possible.”

  Young Andy was nearly three when such nuggets were handed down. What heed he later paid isn’t clear. Andrew Jeremy Wakefield was born on Monday, September 3, 1956, at the Canadian Red Cross Memorial Hospital, near Taplow, Berkshire—forty miles west of London. Built on land donated by the Astor family of New York, and paid for by the Ottawa government, it was a North American contribution to Britain’s titanic struggles during the First and Second World Wars.

  At the time of his birth, his parents were junior doctors and had already started a family with a son. They shared a Gloucestershire cottage, before relocating to Bath: to eventually pass through Heathfield’s mighty gateway, when a period of serenity began.

  Education was local: King Edward’s School, Bath, an exclusive independent, founded in 1552, where Andy showed no special smartness. Indeed, his mother confides that to follow her family into medicine at St. Mary’s, he sat his final school tests twice. “I won’t say he excelled in his exams,” she tells me. “He actually had to re-do.”

  But one signature quality that surfaced at King Edward�
�s was a natural “charisma” that people would speak of, and which equipped him for what was to come. With a remarkable ability to win the hearts of others, it first manifested most dramatically in sport. “When he got to secondary school, he was captain of rugby really,” Bridget remembers. “And then,” she appends, “head boy.”

  The story was the same on his admission to St. Mary’s: academically unmemorable but socially brilliant, again showcased as captain of rugby football. He led the team and took a featured position, in the coveted number “8” shirt. Other players had titles—say, “prop” or “fly-half”—but “Wakers,” as he was dubbed, occupied the only role designated simply by a number. This was a marauding forward, in the heart of hostilities, needing huge raw strength, fitness, agility, and the fearlessness to smack into an enemy.

  “He’s a typical Mary’s man,” snarls the crusty old author of the rugby club’s history, when I phone for the lowdown on the player. “Read Lord Moran’s book.”

  “Oh, right. What’s it called?”

  “The Anatomy of Courage.”

  “I see.”

  Courage Wakefield had. And courage he would need: to survive two weekends in the “8 man” position, let alone two decades trashing vaccines. But courage that’s powered with the fuel of ambition can hurl a character into the path of worldly winds. Success or failure. Praise or blame. Fame or disrepute. Pleasure or pain. A life may blow this way, or that.

  His career Plan A was professor of surgery. “If in doubt, cut it out” and all that. Here was medicine’s most self-regarding branch, still clinging in England to a quaint medieval custom of distinguishing surgeons from mere “Dr.” physicians with the prenominal “Mr.” or “Miss.” They’d nurtured this snobbery since their days of blood and gore when, should you need any part of your body removed, your loved ones took you to the barber.

  “Andrew always wanted to be a surgeon,” his mother tells me. “Even as a little boy he used to sew patches on his trousers, and they were always beautifully sewn on. And he always wanted to be a surgeon. He never said he wanted to do anything else.”

  He would crave that professorship. And had he stuck with surgery, I can’t conceive he wouldn’t have gotten one. But when he watched the craft closely, as first a student, and then a junior doctor, even the most heroic of slashing and stitching lacked something he knew his life needed. Resecting intestine would make a difference to patients. But his dreams were bigger than that.

  The fracture with a timeline featuring scalpels and clamps didn’t come until he was thirty years old. After graduating St. Mary’s in 1981, he finished a string of training jobs, mostly around London, and then turned up in Canada on a two-year fellowship at the Toronto General Hospital.

  At the time, “the General’s” top surgeons were buzzing. Its big beasts were racing for a first. They aimed to beat rivals to a whole-bowel transplant, the most heroic item left on their bucket list. Wakefield, however, sloped off into lab work—a switch that his mother calls “just the way things went”—which offered prospects of achievement beyond swapping organs: not merely for the patient, but the world.

  He was the seventh of eight authors on his first journal article, about poisoning from mercury batteries. And the next saw him fourth of seven sharing credit for a study of immunity issues in rats. “He did a lot of very good research,” Zane Cohen, professor of surgery, told the Toronto Star, years later. “He is definitely not a corrupt individual.”

  But then—and this was back in 1987—the legacy of Heathfield kicked in. For reference, I’ll call this his “Guinness Moment,” when the worldly winds first howled at his door. He only talked of it once publicly, as far as I’m aware: in an interview with a London journalist named Jeremy Laurance, with whom I once briefly shared an office.

  The location of the moment was a bar in downtown Toronto, on a freezing winter night. Wakefield was sitting, it was said, with a pint of Ireland’s favorite black beverage, when—alone, and missing his young wife, Carmel—he had the first in a string of life-defining ideas, from which the rest of this story unfolds.

  At the time, the Holy Grail of gastroenterology lay in the field of inflammatory bowel disease. Classically, there were two—ulcerative colitis and Crohn’s disease—of which the latter would become his main target. Named after the sharp elbows of one Burrill B. Crohn, and first systematically described in the 1930s, it could sometimes get so bad that it ate through the GI tract. And yet scientists couldn’t agree on the cause. Most thought it started as an autoimmune reaction, perhaps triggered by bacteria or food.

  But an ocean away from home, and facing a creamy Guinness froth, Wakefield experienced an epiphany. “What if inflammatory bowel disease was not a bowel disease at all,” Laurance captured the thought-line from this vital moment, “but a vascular disease, caused by damage to the blood supply?”

  That’s bigger than you think. In fact, it’s epic. And in Canada, Wakefield went further. He hypothesized that the ultimate culprit was a virus, causing inflammation and cell death in blood vessels. It was a brave speculation that would shape his life. But, if right—and especially if he could name that bug—then the white tie and tails might be his.

  A virus? Why not? This was the 1980s. This was the age of AIDS. Although trying to link mystery illnesses with proposed infectious agents had stymied visionary doctors and scientists for centuries, whoever stepped to the plate and proved the cause of Crohn’s disease would deserve some of life’s gold medals.

  It wasn’t even that Crohn’s affected huge numbers of people; estimates said less than six per one hundred thousand in any one year. Rather, its fascination lay in the riddles of a foe that had defeated some of the bravest and brightest. It was geographically more prevalent in the north than the south; commoner in cities than in rural areas; more frequent among cigarette smokers; often ran in families; and, most enticingly, likelier to be found in those whose first home was plumbed with a hot water tap.

  Now came courage. At the end of his fellowship, he forsook the scalpel forever. And in its place he was issued a lab researcher’s coat at one of the least regarded medical schools in London. Embedded within the fabric of a hospital—the Royal Free—it would be there that, for the next thirteen troubled years, he would seek to fulfill a promise to himself on that icy Toronto night.

  Looking back, on the face of it, he had much on his side. There was the double helping of confidence, and the personal charisma to build teams and run with the ball. Medical science is a mix of inspiration and collaboration, most productive when its leaders show courage. He had all of that behind him—plus a calm determination to prove that his ideas were right.

  But courage in science isn’t proving yourself right. It’s in your efforts to prove yourself wrong. And there Bridget’s son had an issue with himself that would scar more lives than his own.

  TWO

  It Must Be Measles

  The Royal Free hospital and medical school, Hampstead, squatted on the slopes of one of London’s biggest hills, four miles north of Trafalgar Square. Squeezed between eighteenth-century townhouse terraces, nineteenth-century brick-and-mortar churches, and with views across the meadows and woodlands of Hampstead Heath, it brooded over the neighborhood like a concrete castle, in fourteen stories of modernist brutalism, seen from the air as an irregular cross.

  Like USS Enterprise, “Royal Free” was a nameplate that had moved from ship to ship. Unveiled at a different location in the 1830s, “Royal” was the gift of a young Queen Victoria, and “Free” a recognition of its no-cost treatments, one hundred years before the National Health Service. For much of its early life, it was the capital’s only institution that trained female doctors, with what was the London School of Medicine for Women.

  But in the late 1980s—when Wakefield joined the staff—this wasn’t any center of excellence. The medical school was nearly bankrupt, according to its dean, and the hospital (which
leased it one quarter of the building) was admired for its liver unit, and little else.

  Wakefield arrived here in November 1988. He was then thirty-two years old. In that year, the world saw George H. W. Bush elected to succeed Ronald Reagan in the White House. Hollywood brought forward its first portrait of autism in an Oscar-winning movie, Rain Man. Just months into the future, a Brit—Tim Berners-Lee—would invent the World Wide Web.

  Two years before his arrival, Wakefield married Carmel. That’s Carmel Philomena O’Donovan: a diet-conscious, blonde-haired Zelda to his Scott, whom he met when they were students at St. Mary’s. Like him, she wasn’t wedded to caring for patients, and quickly switched to a desk job with the Medical Defence Union, which shielded doctors against their mistakes. “She seems like the kind of person you want to take into a knife fight,” one admirer assessed her charms.

  At the time, the couple lived with their first baby, James Wyatt Wakefield, in a flat-fronted, two-story, mid-terrace house, near a tidal stretch of London’s River Thames in the west side district of Barnes Bridge. This was eight miles by train from the new father’s place of work, and the journey gave him hours to ponder his mission: to find the undiscovered culprit for Crohn’s.

  These were exciting times in his chosen field. Although the inflammatory bowel diseases weren’t yielding many secrets, further up the GI tract, in the stomach and duodenum (the uppermost part of the small intestine), two Australians were rocking the specialty. At the Royal Perth Hospital, Robin Warren, a pathologist, and Barry Marshall, a clinician, were publishing claims about a spiral-shaped bacterium (eventually named Helicobacter pylori), which they argued wasn’t merely the main cause of peptic ulcers but could be cured with cheap antibiotics.

  They were right and would later share the Nobel Prize. But at the time, they were as popular with the medical establishment as a hair in an after-dinner brandy. Any general practitioner would have told you that ulcers were caused by excess stomach acid, stress, bad diet, smoking, drinking, or the legacy of awkward genes. They would then prescribe you a fistful of antacid tablets that, if you took indefinitely, might relieve your symptoms and bring a smile to the manufacturers’ share price.