The Doctor Who Fooled the World Read online

  The location for the event was what the hospital called the Atrium, on Level 1, near the building’s main entrance. Fifty feet by one hundred, with no natural light, it rose a mere twenty feet to a white neon ridge that a moth wouldn’t mistake for the sky. A blond oblong of hardwood, three-quarters of the floor, was edged with seven pillars and surrounded by carpet, like the ballroom of a midpriced hotel.

  By ten o’clock, reporters, producers, and camerapeople were gathered on ranks of hard-backed chairs. They faced a blue-clothed table, where the platform party was to sit, and a wooden lectern, where Zuckerman would stand. The Times, The Guardian, the Daily Telegraph and The Independent were there. So were the Mail on Sunday, The Express, and Practice Nurse. There was Channel 4, Channel 5, the BBC, and Sky News. There was the Press Association and Reuters wire services. Pulse sent two people; The Lancet three. Team Wakefield totaled nearly a dozen.

  During the months that had passed since its first submission to the journal, the paper had significantly changed. There was the addition of an author—a consultant pathologist named Susan Davies—taking the total now credited to thirteen. And, after discussions, a new title had been devised: placing in journalists’ hands and scattering on chairs five double-columned pages under a two-line gothic heading:

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

  Hardly any non-doctor could unravel that mouthful, and even many who could wouldn’t get it. But the paper’s conclusions, in a section headed “Interpretation,” were plain enough for all to grasp.

  We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers.

  The text made clear that nothing was proved. But those triggers—described as the “apparent precipitating events”—practically phoned themselves into the news.

  As a facing pair, on the second and third pages, were two three-inch-deep tables, each across both columns, itemizing apparent facts about the children. The patients were anonymized, numbered 1 to 12: the eleven boys and one girl, described as aged three to nine. None were diagnosed with Crohn’s.

  Table 1 was complex. Even seasoned medical journalists would struggle to decode its terms. In three columns, set against the patients’ numbers, were strings of “abnormal laboratory tests” plus “endoscopic” and “histological” findings. Nearly every line contained the same arcane phrases. Almost all included “chronic non-specific colitis”—inflammatory disease of the large intestine—and “ileal lymphoid hyperplasia,” the ugly swollen glands in the small intestine.

  Table 2 was simple. It was as easy to read as a big fat sign screaming, “DANGER.” This page-wide rectangle was labeled “Neuropsychiatric diagnosis,” with the first column headed “Behavioural diagnosis” and the second “Exposure identified by parents or doctor.” Below these were listed the reported diagnosis for each of the children, and the apparent precipitating event:

  Autism . . . Autism . . . Autism . . . Autism . . .

  MMR . . . MMR . . . MMR . . . MMR . . .

  People got what this paper was about.

  Nine of the diagnoses were reported to be “Autism” (although one, Child Four’s, was given as “Autism? Disintegrative disorder?”).

  In eight cases, the “exposure” was “MMR.”

  Turning back to page 1, an opening “Summary” gave the first of the paper’s “Findings”—apparently based on what parents, such as Ms. Two and Ms. Four, told John Walker-Smith and his team.

  Onset of behavioural symptoms was associated, by the parents, with measles, mumps and rubella vaccination in eight of the 12 children.

  Eight of twelve? That’s two out of three. So . . . two out of three families of children with autism blamed it on MMR.

  More startling information lay at the foot of the next page: reporting a terrifying sudden onset of the problems. The “first behavioural symptoms” (also described as “behavioural features” and “behavioural changes”) were said to follow the shot within days.

  In these eight children the average interval from exposure to first behavioural symptoms was 6.3 days (range 1–14).

  So, up to fourteen days to onset—two weeks, maximum—the very figure that was given by Ms. Two to the hospital’s doctors for when her son’s head-banging began. The shortest times, meanwhile, were a mere “24 h” and “immediately” after MMR.

  Last came the wordiest section, headed “Discussion.” Among other things, this hypothesized mechanisms of damage, including vitamin B12 issues and “opioid excess,” both raised by Ms. Two in her phone call. And, at the end, unusually, was a stop-press “Addendum”—just like there had been in the 1969 paper by Wakefield’s neurologist father, Graham. Forty more patients had been “assessed,” it said, with thirty-nine having what it called “the syndrome.”

  At the blue-clothed table, four speakers took their seats: Wakefield (who, it transpired, had alone written the paper), Pounder (who wasn’t listed among its authors), Simon Murch (listed as second author), and a smooth-domed child psychiatrist, Mark Berelowitz (credited as the seventh of thirteen).

  Presiding from the lectern, to their left, facing the press, Zuckerman strove to reassure. “Hundreds of millions of doses of these vaccines have been given worldwide,” he declared. “They’ve been shown to be absolutely safe.”

  But if Zuckerman presided, Wakefield commanded. He was the reason why everybody came. Wearing a soft-shouldered black suit, white shirt, and patterned tie, he spoke into the glare of television lighting, every inch the honest doctor and surefooted guide on a perilous frontier of science.

  “The association—the temporal association—between MMR and autism was initially made in the United States,” he said. “We have confirmed that temporal link in our small cohort.”

  As he spoke, dozens of hands around the Atrium twitched. Reporters scribbled quotes. Producers logged sound bites. The press officer, Hutchinson, took minutes.

  Selection criteria: 1, Normal development; 2, behavioral regression; 3, bowel symptoms.

  Average time 6.3 days, 1–14 days range.

  Lymphoid nodular hyperplasia and chronic colitis.

  Four times the paper referred to a “syndrome,” said to be a constellation of bowel and brain issues. “This particular syndrome that we are describing is very new,” Wakefield explained from his chair at the front. “It appears that it may have come into being beyond 1988, when MMR first originated.”

  The dean fought back with measles statistics. During the previous year in Romania, he said, there were twenty thousand cases, and thirteen children died.

  But Wakefield heaved such background aside and called for the triple shot to be suspended. “It’s a moral issue for me,” he announced. “And I can’t support the continued use of these three vaccines, given in combination, until this issue has been resolved.”

  Those words alone would have been enough—even billed as the opinions of one doctor. But sitting to Wakefield’s right, sometimes adjusting the microphone, Pounder endorsed the message.

  The professor’s visual tell was a curious kind of gaze, with the hoods of his eyes curved like crescent moons, which he projected on the assembly like a bird. “Now, my feeling about vaccination goes more along with Andrew Wakefield,” he said. “It does seem that this unique combination of having three viruses in the same day may be an unnatural, unusual, event.”

  That should do it. And that day, it did. After months of planning, Wakefield, Pounder, and a minor medical school shouted “bomb” in a crowded place.

  Independent Television News hit the note that night:

  Questions were raised today about the safety of the combined mumps, measles, and rubella vaccine . . .

  Channel 4:

  New research showing a
possible link with a bowel disease which could lead to autism . . .

  Channel 5:

  Claims there could be a link between a common childhood vaccine and autism . . .

  Trucks and trains hauled the story through the night, pounded onto paper for news vendors and mailboxes. And, the next morning, the nation woke to coverage such as the Guardian’s. It ran three reports, kicking off on page 1.

  A MEDICAL study suggests today that there could be a link between the measles, mumps and rubella vaccine (MMR) given to children in their second year of life and inflammatory bowel disease and autism.

  Dr Andrew Wakefield and colleagues at the Royal Free Hospital in Hampstead, London, report in the Lancet that children referred to them with signs of autism and gut problems had a hitherto unknown bowel syndrome and that treating it alleviated some of the symptoms of autism.

  They also found that the behavioural changes in the children which are typical of autism, such as forgetting the basic language they had just learned, began within days of their MMR vaccination.

  Naysayers squawked like Hitchcock ravens. The study was too small. Twelve children meant nothing. There were no control subjects (without autism, or MMR) to check if the “syndrome” was unique. Parents were susceptible to “recall bias.” The pathology wasn’t evaluated blind.

  The Lancet, too, would come under fire. Surely, it was irresponsible to raise doubts without proof. And to publish on just twelve children? But like three years before, with the question-marked paper, the journal had covered itself. Two scientists from the US Centers for Disease Control and Prevention—including an epidemiologist, Frank DeStefano—had been invited to contribute a twelve-hundred-word rebuttal, dumping on Wakefield’s work.

  “A first dose of MMR vaccine is given to about 600,000 children every year in the UK, most during the second year of life, the time when autism first becomes manifest,” they noted. “Not surprisingly, therefore, some cases will follow MMR.”

  But these were public health doctors preaching to the choir. The national congregation wasn’t listening. If it was true there was a hospital where, in the space of a few months, a string of parents surfaced in a bowel clinic’s caseload saying their child got the MMR and showed behavioral symptoms within days, then surely that needed explaining? Maybe elsewhere, at hospitals throughout the world, less vigilant doctors had missed the first snapshot of a hidden epidemic of injury.

  And twelve not enough? No controls? What? The naysayers should have known better. Crohn’s disease was first systematically reported, in 1932, on gut specimens from just fourteen patients. Autism was classically described, in 1943, in a mere eleven children. And what became known as AIDS was initially published, in 1981, on five gay men in Los Angeles. Should those observations have passed without comment, for fear of triggering alarm?

  Nothing was written in the paper, or said in the Atrium, about the role of Jackie Fletcher and JABS. Or that the children had been brought to take part in research and weren’t merely routine referrals. I’d discover all that, to trigger uproar, years later. But, if the study’s subjects and findings were as they appeared to be, then surely they were worth a few pages of The Lancet.

  If they were as they appeared.

  SECRET SCHEMES

  SEVEN

  Everybody Knows

  I’m pretty sure I cried when I discovered vaccination. Well, whoever knew a baby that didn’t? And the hypodermic syringe that punctured my skin, at a clinic on Raglan Street in Kentish Town, north London, was scary enough to hold up a bank. Here was a reusable glass barrel, practically as thick as an oboe, a nickel-plated brass plunger, with sufficient suction to clear drains, and a beveled steel needle (heat sterilized between stabbings) that my mother might have paired to knit sweaters.

  Memory plays tricks. But that was then the standard kit: ten years after World War II. Thirteen years more, and my mother was dead of breast cancer, leaving me a portable typewriter, a judgmental disposition, and a folder of paperwork (birth certificate, school reports . . . ), including records of my immunizations. The first was a shot against the diphtheria bacterium, which, according to a four-inch by three-inch green card, I was given on Wednesday, May 4, 1955. I was fifteen months and twelve days old.

  From that you can age me. And I’m now much older: so old, I confess, that when I joined the Sunday Times, the paper was set in lead. As a smartass twenty-something in black suede winklepickers, I’d begun in the 1980s on the business section, as a rewrite man and “stone sub” editor, sweating over slugs of back-to-front type that were locked into a flat steel tombstone (called a “forme”) to be pushed away on wheels by the printers.

  What set me on collision with Andrew Wakefield, however, were just sixteen published words. At the time I wrote them, I was the paper’s social affairs correspondent and had recently run a campaign to get an act of Parliament giving new rights to people with disabilities. On the day in question—Friday, April 1, 1988—I held forth in a thousand-word opinion column sideswiping a vaccine controversy. This was over a shot against Bordetella pertussis, the bug that caused whooping cough, that, for most of the 1970s and 1980s, was thought (by doctors, as well as many parents) to sometimes, if only rarely, cause brain damage.

  A generation later, this saga was forgotten, superseded by anxiety over MMR. But only two days before I wrote the piece in question, a judge, sitting in the magnificent gothic palace of London’s Royal Courts of Justice, near the River Thames embankment, had issued a landmark ruling. After a sixty-three-day hearing, with evidence and experts from all over the world, Lord Justice (Sir Murray) Stuart-Smith, a sixty-year-old father of three boys and three girls, had read aloud to a breathless, creaking courtroom, a fourteen-chapter 273-page opinion, largely bringing the controversy to an end.

  His answer was no. On the balance of probabilities, the pertussis shot didn’t do the harm that many people thought. “I was ready to believe that this belief was well founded,” read the former cavalry officer, whose hobbies included shooting and playing the cello. “But over the weeks that I have listened to, and examined, the evidence and arguments, I have become more and more doubtful.”

  I didn’t agree. And, two and a half miles east, near the Tower of London, I set aside his lordship’s opinion. That Friday, I’d conducted my own inquiry, swiveling in my chair in the Sunday Times newsroom, snapping rubber bands, and riffling manila folders stuffed with yellowing newsprint clippings. The evidence was overwhelming—even a Sunday Times campaign later accorded its own logo: “The Vaccine Victims.”

  Vaccine victims win round 1 in fight for compensation

  Whooping cough vaccine risks concealed, say victims’ parents

  Whooping cough: the facts parents have not been told

  Bundles of the stuff. Beyond a doubt. A “special investigation” by our medical correspondent had even concluded that the risks from vaccination were greater than from pertussis itself. “The government is presenting its case with misleading figures,” he found. Experts’ opinions were “concealed.”

  The picture wasn’t simple as I flicked through the clippings. As parents became alarmed, vaccination rates slumped. On one measure, notifications of whooping cough jumped from 8,500 to 25,000 a year. And, in just one of many outbreaks, near the end of the 1970s, three dozen kids coughed themselves to death, with another seventeen left brain damaged.

  Vaccinations decline “may lead to epidemic”

  32,463 hit by whooping cough after vaccine scare

  Four children die of whooping cough

  Great stuff for newspapers: two scares for the price of one. And the concern that lurked behind my sixteen words was merely to point out that the struggling families of brain-impaired children needed help, whatever the cause of their issues. “When need outweighs blame” was the headline I was given, with a twenty-two-word “standfirst,” as we called them:

  After a “vaccine-
damage” ruling last week, children will not get help. BRIAN DEER says all disabled people should have equal rights.

  I still think that, but the piece was hardly memorable—apart from the sixteen words. From the court of Her Majesty’s Press I decreed for printing, 1.2 million times:

  Everybody knows there is a rare association between the whooping cough vaccine and severe brain damage.

  In those happy days before universal email, nobody wrote in to complain. But I think my statement put down a marker among some to certify a particular interest. And, a few years later, I got a call from a woman in Ireland, who was then the queen of vaccine campaigners.

  Her name was Margaret Best. She lived near the city of Cork, in Ireland’s ceaselessly rainswept south. She’d famously won a huge financial settlement—£2.75 million, plus her lawyer’s bills—from the Wellcome Foundation drug company (which coincidentally funded Wakefield’s early career) over her neurologically challenged son, Kenneth. In September 1969—when Margaret was twenty-two, and her son four months—she’d taken him for immunization against the whooping cough bug, combined, as it was, with those against tetanus and diphtheria, in a three-in-one DTP, or DPT.

  Within hours, she said later, she phoned the local doctor after Kenneth suffered a terrifying seizure. “His face got very red and his eyes turned in to the right,” she said. “Both his arms came up to his chest, and it was as if his whole body was stiff.”

  In November 1996, she invited me to go see her. She was forty-seven years old: short, energetic, with tight black curls, and a rolled-up-sleeves kind of manner. Separated from her husband, Ken, she lived with a boyfriend, Christy, in a freshly built house with electric gates, gravel drive, barking dogs, and furniture that looked like it was bought at one department store in a matter of an hour or two.

  Kenneth, twenty-seven, occupied an annex. He didn’t speak, but sometimes screamed. His greatest pleasure was to blend balls of knitting wool into big soft bundles of color.