The Doctor Who Fooled the World Page 8

  Margaret and I talked at her kitchen table, where I tried to visualize events. Between us lay a transcript of her evidence to a Dublin court, and a little blue magnetic-tape microcassette voice recorder that spared me the distraction of making notes.

  “So, where did you phone the doctor from?” I asked after maybe thirty minutes, in the hope of reconstructing the awful night of which she spoke.

  Margaret got up, and fumbled at the stove. Tape off. Then on when she returned. “Well,” she said. “There was a neighbor whose phone I sometimes used.”

  That made sense. Phones were scarce. The incident occurred in the year of the first moon landing, in a poor fishing village called Kinsale.

  “So, is that what you did?” I pressed, keen for color.

  Margaret got up again, moved back to the stove, and paused before responding. “No.”

  Again, I waited. Tape off. Tape on. “So, what, you used a phone box?”

  “Yes.”

  It was no big deal. Or so it felt at the time. But when I got back to London, and replayed the tape, my chin sank and my eyebrows rose. Why mention the neighbor if she used a pay phone? Why the walkabout, delay, and terse responses? Surely the night when her child’s life was wrecked was indelibly etched on her mind?

  And that’s what would set me on my path to Wakefield. A week after my trip to Ireland, I ordered the transcript of Best v. Wellcome—and a big box of spiral-bound binders arrived, reporting every day of a thirty-five-day trial that, I thought, was riddled with anomalies. There were medical records contradicting Margaret’s account, for instance, and she’d even taken her son for a second DTP, despite the apparent reaction.

  “I am not suggesting for a moment that Mrs. Best is telling lies,” Wellcome’s leading counsel, Henry Hickey, had told the presiding judge in June 1989. “What I am saying is her recall is wrong, and that the events of which she talks occurred six weeks to two months after the time she thinks they did.”

  Who could say, so many years later? But the judge wasn’t easily persuaded. “I think it goes further,” replied Justice Liam Hamilton, president of Ireland’s High Court, sitting among benches nearly as creaky as Stuart-Smith’s. “I am satisfied, if her account isn’t accurate, she is lying.”

  The drug company, however, maintained its stance—and this was where the case got interesting. Although the boy’s doctor had made all kinds of notes (“snuffles,” “eczema,” “chesty,” and so forth), he wrote nothing about seizures, which, on Margaret’s evidence, were occurring up to twenty times a day.

  Hickey insisted that the mother was “confused,” and he persevered with his argument. “People can convince themselves of the truth of events in retrospect,” he said. “We see it every day of the week in road traffic accidents.”

  But that submission only helped to seal Wellcome’s fate, allowing the Supreme Court of Ireland to have a say. Margaret’s story was so intricate—recounting daily seizures and visits to the doctor—it deduced that, if her account wasn’t true, she must be lying. Therefore, given the company’s position that she wasn’t lying, then logically, she was telling the truth.

  “They could have kept their mouths shut,” Margaret tells me later, of a victory celebrated in a minor media festival. “If they’d said nothing and just conducted their defense, and didn’t open their mouths about whether they thought I was lying, or whether I was telling the truth, or whether I was confused—it didn’t matter a damn—if they had said nothing they might have been better off.”

  There, I confess, was my Guinness Moment. I thought: Could she? Would she? Why not? Here was an icon of much that I valued. She was a working-class mother. She left school at twelve. And she’d defeated a drug company. Fantastic.

  But when I gave it more thought, the clichés dissolved. She hadn’t earned her triumph in a bubble. It mattered to other families, facing choices over shots, trying to balance the benefits and risks. Besides, I was journalist. I wasn’t a campaigner. I believed that in truth lay freedom.

  So, I dug a little further. Well, a year’s work further. And I discovered the story—real people, specific facts—behind that difference of opinion between a High Court judge and a Sunday newspaper reporter.

  Incredibly, that story began with a doctor: a doctor at a London hospital. He published a research paper in a medical journal that was pounced on by TV and newspapers. It was a case series of children who, within fourteen days of a three-in-one-shot, were said to have suffered a neurological injury. An epidemic of fear circled the globe.

  But this doctor wasn’t Wakefield. His name was John Wilson, a consultant pediatric neurologist. The hospital was the Hospital for Sick Children, at Great Ormond Street, London: one of the world’s top pediatric centers. It was three and a half miles south of the Royal Free, Hampstead. The journal was the midrank Archives of Disease in Childhood. And the media alarm was launched on a show called This Week—when Britain had only three TV channels.

  I ordered the video and watched it many times.

  “Are you satisfied that there is a link between the whooping cough vaccine and brain damage?” Wilson was asked, in April 1974, by This Week’s reporter, who wore a big-collared pink shirt, chunky spectacles, and sideburns trimmed to his jawbone.

  “I personally am,” the neurologist replied. “Because now I’ve seen too many children in whom there has been a very close association between a severe illness—with fits, unconsciousness, often focal neurological signs—and inoculation.”

  “What do you mean? You’ve seen a lot?”

  “Well, in my time here, the last eight and a half years,” he recalled of his tenure at Great Ormond Street, “I personally have seen somewhere in the region of eighty patients.”

  Wilson was a contemporary of Wakefield’s father, Graham, and like him, was a god among gods. He wore his black hair oiled, flashed cuff links from dark suits, and spoke in the meticulous, languid tones of a less-than-passionate Christian bishop.

  He’d gotten interested in immunization early in his career, before the then dreaded smallpox was vanquished. England blazed the trail in beating that disease, dating back to the late eighteenth century, when a physician, Edward Jenner, invented “variolation”: credited as the first true vaccine. And catching the tail end, in the 1960s, Wilson had a sideline with personal injury lawyers, assisting claims of damage from the shots.

  He published his DTP paper in January 1974, three months before starring on This Week. That was twenty-four years before Wakefield’s twelve-child study, when, with two trainees—a German, Marcia Kulenkampff, and a Brazilian, José Salomão Schwartzman—Wilson authored four pages in the Archives.

  “Between January 1961 and December 1972 approximately 50 children have been seen at the Hospital for Sick Children, London, because of neurological illness thought to be due to DPT inoculation,” Wilson explained in the text. “There were 36 children in whom there was adequate data on the timing, and only those neurological illnesses occurring up to 14 days after DPT inoculation were included.”

  Wilson had gotten his two juniors to trawl the hospital’s vaults for children’s records implicating the vaccine. Then he used the two-week timeframe, which he picked himself, to segregate vaccine victims. “It was a very naive study,” says Schwartzman, more than forty years later, when I visit with him in São Paulo, Brazil.

  Before the TV broadcast, 79 percent of England’s kids got DTP. But by 1978, after newspapers joined the furor, the figure had slumped to 31 percent.

  Litigation followed. As I probed the history, I found reports of massive lawsuits, in Canada, the United States, and two test cases in London—both presided over by the cello-playing Stuart-Smith. And it was from those that I learned a few lessons in life that later would help in peeling the rancid onion from which the Wakefield story tumbled out.

  The first English DTP case concerned a developmentally challenged boy by
the name of Johnnie Kinnear. According to the evidence of his mother, Susan, he suffered “five or six” seizures on the night of his shot. Then more, every day, after that. But, despite doctor appointments for a string of minor ailments, the boy’s medical records revealed nothing serious being raised for the next five months.

  She lied.

  The scene was tragic. Susan snarled at the court, like a lioness defending her cub. “You see, you are trying to confuse me now. You are trying to confuse me.”

  But they weren’t.

  Stuart-Smith ruled that she “was not telling the truth,” and it was Johnnie’s own lawyers who pulled the plug. “Anybody who was in court and heard the relevant witnesses,” his counsel addressed the judge, in May 1986, “and saw the discrepancies between their accounts and the medical records, can be left in no doubt that his prospects are effectively nil.”

  Then came the second test, involving Susan Loveday, a developmentally challenged girl. This time, however, the parents weren’t allowed to give evidence (for fear of a second collapse, with huge costs and delay), unless the science alone favored their claim. Most notably, the trial analyzed a landmark British study, which reported the “attributable risk” of permanent brain damage from DTP as 1 in 310,000 shots.

  That research (named the National Childhood Encephalopathy Study) ran for three years, included two million doses of DTP, and was the most definitive such inquiry anywhere. Its top line would be quoted in product data sheets and by doctors all over the world.

  But when the judge went to work, he found the calculation ultimately rested on just seven key patients. So, overruling objections from the researchers responsible, he ordered the records of the seven to be produced and went through them, child by child. One had Reye’s syndrome, which isn’t caused by vaccines. Three were afflicted by viral conditions. And the files on the remainder showed their outcomes were “normal”: cutting the attributable risk to nil.

  Stuart-Smith galloped on, looking at more kids’ cases, and concluded that even the saddest accounts weren’t necessarily dependable.

  Case 1473: The parents’ account is inconsistent with a previous account given by them.

  Case 1509: Onset of symptoms was in the previous October; it was changed to an onset of less than 24 hours on the basis of the parents’ account given many months later.

  Case 1215: The parents’ claim, as recorded in the documents, that the child was normal before vaccination, is plainly incorrect.

  He also found what looked like fraud. It’s hard to think what else could explain it. Two different printouts were discovered of tests of children’s skills, showing that scores inexplicably changed. Although they referred to the same patients, and the same examinations, the more recent results were erratically lower, dumbing down certain borderline patients.

  “Bizarre,” said the judge, “because it is difficult to see how the same data can give rise to different scores.”

  It was Wilson, however, who came off worst, along with his study claiming three dozen victims. Stuart-Smith reviewed them all. The neurologist admitted that in eight there was no link between the vaccine and illness. In fifteen, he accepted there was a reasonable alternative cause. He only stood his ground on twelve. And of this remaining third, a mere three were instances in which enough information was available to understand the circumstances, and even a role in those couldn’t be proved.

  Surprisingly, some kids on whom Wilson reported suffered their first symptoms before vaccination. But the most striking in his series was a pair of identical twin girls who weren’t only diagnosed with a genetic condition, but—despite their function in triggering a twentieth-century health panic—never received DTP.

  Unforgettable. My investigation bore fruit in almost seven thousand words, across six elegant pages of the Sunday Times Magazine. It taught me that, when it comes to vaccine victims, you can’t simply believe either parents or doctors. And, after mastering arcane topics that I’d never need again (from the “mouse weight gain test” to the “tenets of Arlwyn Griffith”), it also taught me that vaccines as a field of inquiry was too difficult to be tackled on a whim.

  So that was on my mind—literally, right then—when on Friday, February 27, 1998, I picked up The Guardian in a doctor’s living room and read its page 1 from Hampstead. I was still on the road over DTP when Wakefield hit the news with MMR.

  “You should investigate that,” the doctor suggested as I left.

  “No way.” I laughed. “Not a chance.”

  EIGHT

  First Contact

  So where did it begin? Really begin. Was it the phone call from Ms. Two, as Wakefield would say, introducing him to the story of his sentinel case? Was it the formation of JABS by Newsnight’s woman in scarlet, as she sought allies to help her sue for compensation? Or had it started decades before, at Great Ormond Street, with a different doctor and a different three-in-one?

  I’ll peel the rancid onion, so you don’t have to, for what headlines would later shout:

  THE TRUTH

  At the start there was a phone call. But it wasn’t to Wakefield. It was from him to a British civil servant. This was a man by the name of David Salisbury, forty-six, the government’s top official on vaccines. He was a beige kind of character, never prone to indiscretion, and a pediatrician who once worked under the neurologist John Wilson: an experience that shaped his life.

  He’d been there, on the wards, during the whooping cough crisis, greeting blue-light transfers to Great Ormond Street and its specialist kid-size ventilators. He saw babies cough for their lives as they were carried from ambulances, parents crying, nurses scurrying, and patient histories that didn’t end well. He saw congenital rubella syndrome, which can lead to brain damage, deafness, blindness, and heart disease in babies. He saw the horrors of SSPE.

  Subacute sclerosing panencephalitis: caused by measles virus attacking the brain long after initial infection. It usually began with mild memory loss, then falls, fits, coma, and a vegetative state, with death after one to three years. He even traveled with Wilson to break the news to parents of a young boy given the diagnosis.

  “I’ll always remember John explaining to them, very gently and sensitively,” Salisbury tells me on the phone one evening, “how their child was going to die.”

  At the time of Wakefield’s call, Salisbury worked at Friar’s House: an anodyne oblong office building at the Elephant and Castle, a run-down neighborhood surrounding a complex traffic system a little more than a mile south of the River Thames. Here was a cluster of government outposts—pensions, welfare, social services—and few staff got better than Salisbury’s office, room 388, overlooking a parking lot.

  This was two and a half years before Ms. Two phoned Wakefield, and two months, to the day, before Jackie Fletcher’s son, Robert, was vaccinated, as she said on Newsnight. It was Wednesday, September 23, 1992, when, from outside Salisbury’s office, his secretary buzzed with a call that would herald the beginning.

  At the time, Salisbury’s big project was rolling out a new vaccine: against Haemophilus influenzae type b. He was chasing supplies with pharmaceutical companies, catching snags in transportation by Department of Health contractors, and fielding endless inquiries from physicians.

  “I’ve got a Dr. Andrew Wakefield. Royal Free medical school. Something about MMR.”

  More MMR. Salisbury was getting a lot on that, due to news of a safety issue. Only a week last Monday, Kenneth Calman, the chief medical officer, had written to every doctor in England and Wales, announcing that two brands of the vaccine were being dropped. One was called Plusarix, from the British company SmithKline Beecham. The other was Immravax from France’s Pasteur-Merieux. This would leave only one—Merck’s M-M-R II—if supplies from the United States were sustained.

  The reason was simple, Calman explained in his letter. Crudely, the mumps component was running too hot, sporadica
lly breaking through to cause illness. Like measles and rubella, mumps was included in the triple shot as a modified “live” virus. And the strain in the two products, called Urabe AM9, was sometimes causing symptoms of the disease it should prevent, presenting usually as a mild meningitis—inflammation of the lining of the brain.

  Canada and Japan had already acted. But British government laboratories had now calibrated the risk: at 1 in 11,000 injections. “This rate,” however, Calman’s letter stressed, was “appreciably lower” than from natural infection.

  For nine days, Salisbury had monitored press coverage, delivered each morning to his desk. The Times was first, with 140 words on Tuesday, September 15. Coverage was low-key, and since the brands were withdrawn, public concern over the issue was minimal.

  Salisbury had never heard of the doctor without patients. And when his secretary flipped a button to connect him with the caller, and a broad-chested voice introduced itself, the civil servant was initially perplexed. As Wakefield would experience two and a half years later when Ms. Two got through to his place of work, Salisbury wondered over the reason for the contact.

  In the light of what followed, it would be unwise for a journalist to rely on one party’s recollection. So I’m indebted to Wakefield, who summarized the conversation in a two-page follow-up letter. At the time, he was waiting for publication of his J Med Virol paper on the virology of Crohn’s disease. This was where he’d reported finding measles virus and his team photographed what he’d seen.

  “So I’m thinking,” Salisbury tells me, “why do we need to take this seriously? We have a very good vaccine program. We have no measles.”

  But in the phone call that day, Wakefield was blunt, citing J Med Virol as his credential. While acknowledging that the paper was nothing to do with vaccines (or, for that matter, mumps, or the brain), he explained his purpose: he wanted a meeting. And, more, he wanted money.