The Doctor Who Fooled the World Page 9

  If I could split screens, like an early Quentin Tarantino movie, now would be the moment to do it. Because Wakefield wasn’t the only player to spot an opportunity in the government’s repudiation of the brands.

  Another was a lawyer. This was Richard Barr, who would later be featured in the Sunday Times Magazine, and whose name would appear in the clipping on the notice board that led to Ms. Four’s suspicions.

  Dark-haired with wide-set eyes and flattened rural vowels, Barr might have passed for a piano tuner, a carpet salesman, or the landlord of a real-ale pub. Then aged forty-two, his main claim to fame was coauthorship of a book: Which? Way to Buy, Sell and Move House. And before that November, when the Urabe brands were discontinued, his career was less than downtown.

  “A jobbing solicitor,” he describes his work at that time, when we meet, nearly twelve years later. “Magistrates court in the morning, conveyancing at lunchtime, probate in the afternoon.”

  He practiced in King’s Lynn, near the Norfolk coast, almost halfway up the east side of England. But, like “royal” in Royal Free, “king” in King’s Lynn wasn’t a pledge of anything classy. The town (population forty thousand) had largely turned its back on a medieval heritage, and since the 1960s had been blighted by lax planning, the lack of a university to brighten its evenings, and a doggedly white monoculture.

  Nevertheless, Barr longed for what most lawyers long for. And, apart from that, he’d an abiding ambition. He wanted to bring a trial to the Royal Courts of Justice, the nation’s cathedral of disputes. His father was a lawyer, his mother a doctor, so all came together in him wanting more than most things to get a pharmaceutical class action going.

  After the first Times report, he moved like a greyhound. He was talking to journalists within hours. Eight years before, by the kind of luck you make yourself, he’d carried out the conveyancing for a commercial caterer named Angela Lancaster, who bought a four-bedroom bungalow near the Sandringham Estate, one of the Queen’s many properties, ten miles northeast of King’s Lynn.

  The purchase was one-off, of no great value. But then, one day, his client reappeared. In May 1990—two and a half years before the brand withdrawals—Lancaster’s son, Richard, aged thirteen, came down with mumps meningitis. At an exclusive private school, he’d been lined up with his friends, and vaccinated with MMR.

  “It was horrendous,” Angela remembers of the acute phase in the hospital, where her son was stretchered with headaches, light sensitivity, fever, vomiting, a stiff neck, and lethargy. “They were taking his temperature every ten minutes.”

  She asked Barr about the prospects of suing the doctor. She’d heard from another mother that general practitioners earned bonus payments for meeting immunization targets. So, the way she saw it, the one who came to the school had profited from a risky procedure.

  For Barr, step one was to claim legal aid: taxpayer cash to fund representation for people who can’t afford to pay. In the British system, minors were always eligible, so Barr completed a green form for step two: an expert’s report and a statement from the mother on what happened to her son and when. The case looked promising, and the government’s Legal Aid Board would pay the lawyer’s bill, win or lose.

  But, after five weeks in a darkened room, the boy completely recovered. He’d not lost income. He’d no dependents. And, if anything, his mother had gained the impression that Urabe might have done him some good.

  “It probably transformed my son,” she tells me, laughing at the idea that maybe a touch of inflammation may have sharpened his mental focus. “He just read computer magazines. And, at the age of thirteen, he basically said he wanted to work for NASA, and at the age of twenty-three, he turned them down.”

  Fast forward to the brand withdrawals of November 1992—Barr remembered the Lancaster’s case. When Angela got home at around four o’clock on the Tuesday afternoon of the Times report, she found messages from the lawyer asking for permission to give out her phone number to reporters. Her son’s story was now news: a perfect anecdote to make the most of the government’s action.

  The mother tells me she spoke with the midmarket Daily Mail, but the journalist missed a deadline to file. Faring better was the upmarket broadsheet Independent, whose medical editor, Celia Hall, was a veteran of the DTP scare. She hammered out not one but two reports that evening. Barr had connections with both.

  One tie was oblique, possibly a coincidence in a country with a population then of 58 million. Hall interviewed a family doctor in a village near Wisbech, thirteen miles from King’s Lynn. Wisbech was a town where Barr’s firm had a branch, and where his father had long practiced as a solicitor.

  Hall’s first story was headlined across three columns of page 2, “Children received vaccine despite meningitis link,” and rested on criticism from the family doctor of a lack of speed by the Department of Health.

  One GP accused the department of choosing administrative neatness over maximum safety. “They wanted the MMR II supplies to be in place before they told us,” Dr David Bevan, of Outwell, near Wisbech, Cambridgeshire, said.

  Not exactly the most trenchant objection, or source, to warrant a national news story. Especially when the doctor also acknowledged, as he did, that the Urabe brands were better than nothing. But, having scored a half page of controversy over vaccines, Hall did the business for Barr.

  “ ‘Horrific’ experience leads some to take legal action,” ran the headline of the Independent’s second story, underneath. The only case identified was the long-abandoned Lancasters’, with four paragraphs on how Angela had planned to sue. Then came a sentence with the rasp of scratched backs:

  But their solicitor, Richard Barr, of King’s Lynn, a specialist in compensation cases, is representing another family, from the North of England whose five-year-old son was left profoundly deaf after meningitis following MMR vaccination.

  Barr . . . a specialist in compensation cases? Hall, it appeared, was a prophet. For then, as it was, in the early 1990s (before every Indian restaurant had its menu on the web), getting named in a newspaper was the bait of choice for lawyers fishing for clients.

  And so it would be that the otherwise unmemorable solicitor emerged from the undergrowth of his chosen profession to win a contract from the legal board to represent families hoping to sue over MMR. It was a contract that would blossom over the next twelve years, as he and Wakefield nurtured a crisis over the vaccine that one day would be felt everywhere.

  The lawyer and the doctor had yet to meet. But by the time of the phone call to the civil servant, Salisbury, it seemed that Wakefield’s big idea had evolved. Now it wasn’t measles virus. It was measles vaccine virus. And while this had “not been addressed” in J Med Virol, he warned “this will be the first question that is raised.”

  In his third-floor office, Salisbury sensed a dog whistle. He’d seen the downside of such speculations before. He remembered the wards during Wilson’s DTP scare, the retching babies, the SSPE, the telling parents how their child would die.

  “My concern,” Wakefield told him, “is that although measles, and in particular the vaccine, may ultimately have no association with Crohn’s disease whatsoever, what will be picked up by the press is the apparent association between the increasing incidence of disease and the vaccine.”

  Picked up by the press? Why should that be? The caller’s insinuation hit the spot.

  Wakefield’s career had taken a different path to Salisbury’s. Patients were never high on the agenda. “Therefore I think it would be imperative for us to meet in the near future and discuss the way forward,” the voice insisted, as minuted by letter. “However, adequate funding is crucial to this research programme and this is an issue which must be discussed when we meet.”

  More than a decade passes before I speak with Salisbury. But he remembers that conversation like yesterday. “Even his very first phone call rang alarm bells,” he tells me
, admitting that he’s paraphrasing what he took to be a shakedown. “The tone, the sort of blackmailing, bullying, ‘You will want to take notice of this. You will want this. There might be consequences.’ ”

  NINE

  The Deal

  Richard Barr was born where medicine met the law and the United States met the United Kingdom. His mother, Marjorie, was a pathologist from Scottsbluff, Nebraska, who met his father, David, a British solicitor, amid the wreckage of Nazi Germany. It should thus come as no surprise that long before their son’s coup over the MMR brand withdrawals, he yearned for one of those epic, crusading, may-we-approach-the-bench class actions in which, at last, big business comes unstuck.

  According to another lawyer—who tells me she checked records—Barr first contacted Wakefield in about October 1995. That was three years after the brand withdrawals, six months after Newsnight’s bowel-brain conflation, nine months before the first of the twelve children was scoped at the Royal Free, and more than two years before the Lancet paper was unveiled. It would begin a collaboration that was to echo down the years to haunt parents not even born. Two months later, the two men shared their “shot in the dark” triumph in the Sunday Times Magazine, where they appeared alongside Jackie Fletcher. And, by January 1996, Barr was claiming seventy cases of alleged injuries from vaccines containing measles virus, and hundreds more “in the pipeline,” he said.

  Although never revealed until I expose it years later, in the first of the revelations to tumble from my inquiries, they were already hand-in-glove. “As you may have read in the Sunday Times,” Barr wrote that January, in the fourth of a string of campaigning “newsletters” mailed out by post to clients and contacts, “Dr Andrew Wakefield has published some very disturbing material which indicates a clear link between the measles element of the vaccine and Crohn’s disease.”

  Well, no it didn’t. There was never a “clear link.” But the newsletter (rescued for me by Angela Lancaster, the mother who helped Barr get his name in the press) listed what he said were “signs to look for.” These included weight loss, diarrhea, “unexplained low level fever,” mouth ulcers, and aching joints. “If your child has suffered some or all of these symptoms,” he requested, “could you please contact us and it may be appropriate to put you in touch with Dr Wakefield.”

  Here were activities that would remain unknown to almost everyone who would gather in the Atrium. Not only Fletcher, but also Barr, sent Wakefield clients and contacts: talking up symptoms so vague, or common, that practically any parent might wonder if their child was suffering from an appalling inflammatory bowel disease and so benefit from referral to the hospital.

  Two weeks after the mailshot, Barr took a train and sped south through the winter green of England. No more would he rely on representing shoplifters, scratching out house deeds over a ploughman’s sandwich, or reading wills to the happily bereaved. After two hours to London, and a ten-minute taxi ride, he’d be ensconced in a magnificent Georgian brownstone to confer with Queen’s Counsel (a senior trial attorney), and the charismatic Royal Free doctor.

  At Barr’s side that day was his assistant, Kirsten Limb. Five years later, they would marry. With straight brown hair, sometimes worn waist-length, she was ten years younger than the man she accompanied, to whom she’d originally come as a client. Her daughter, Bryony, had suffered severe brain damage in a medical accident, over which Limb had hoped to sue.

  To his MMR clients, Barr advertised Limb as his “Scientific and Medical Investigator,” “scientific expert,” or more often simply “Scientist.” As the Independent reported, with no mention of Wakefield:

  Mr Barr, who refused to let his children be vaccinated, said their research was being helped by having an in-house scientist working on the cases.

  But Limb wasn’t quite the scientist that some parents might have expected. According to her first husband, Robin Limb, they met at university, each graduating with a bachelor of science degree in agriculture. And I obtain their curriculum: it wasn’t quite farming. Then they worked at an experimental sugar beet farm, on flat landscapes, east of Cambridge.

  The main man that Barr and Limb traveled to meet that day was Augustus Ullstein, forty-nine. He was a jovial, blue-eyed, relatively new Queen’s Counsel, specializing in personal injury, clinical negligence, and product liability disputes. “A genuine gentleman who is prepared to go the extra mile,” he would be praised in a consumer guide.

  He didn’t come cheap. But, then, did they ever? By the time he finished over vaccines, years later, Ullstein would be reported in a document I obtain to have cost the taxpayer £360,000 (about £595,000 or US $744,000 at the time I write this).

  Wakefield would be there: Barr’s then only expert, so thin was any evidence against the shots. There wasn’t even agreement on the scope of the injuries that MMR was supposed to inflict. Although Limb would claw together a mountain of paper, there were no convincing data (except concerning the withdrawn brands issue), and the overwhelming consensus in medicine, if not agriculture, was that the product’s safety profile was good.

  The doctor’s assignment from Barr was to disrupt that consensus: in a deal so secret, especially its timing, that even many years after I reveal it, to public anger, Wakefield would deny when it really began. The way he told it was that the children came to Hampstead as purely in need of the bowel unit’s care, and only after was he asked to help lawyers.

  “Now let’s be very clear,” he’d say, for instance, to the NBC network’s correspondent Matt Lauer, in a Dateline show focused on my reports. “They were admitted to the Royal Free for investigation of their symptoms. Nothing to do with research. Nothing to do with class action. Nothing to do with vaccines.”

  And with regard to his relationship with the Norfolk solicitor, he’d tell a conference in Brussels, Belgium, “When the children were approached by a lawyer, I was asked—and this is after they had been seen at the Royal Free Hospital—I was asked if I would help as a medical expert in determining whether there was a legal case against the manufacturers of the vaccine.”

  In fact, he agreed to work for Barr before, at, or within days of meeting Ullstein—when not one child had crossed the Royal Free’s threshold for the project that would make it into The Lancet.

  “Thank you for your kind comments following our meeting with Counsel last week,” Wakefield wrote to the solicitor, confirming their relationship, on Monday, February 19, 1996: six weeks before the first of the twelve kids attended an outpatient clinic in a first floor suite at the hospital. “I would be happy to act as an expert witness on behalf of your clients for £150 per hour plus expenses” (about £248 or US $310 at the time I write this).

  That would be another thing that he would say over the years: that he’d just been an expert, and how “many, many, many doctors, during the course of their work, act as medical experts.”

  But he wasn’t just an expert. Experts gave opinions, helped courts with science, and represented fields of medicine for litigants. His role was unprecedented: commissioned, as he would be, to create the evidence against the shot.

  Hundreds of phone calls would pass between the solicitor and the doctor. Crates of records would be trucked back and forth. And an assistant from Barr’s firm, named Adele Coates, would be seconded to work from a cramped garage office, beside Wakefield’s Taylor Avenue home.

  Together they fashioned what Wakefield predicted would be “the biggest medical litigation case in history.”

  It started small: first with what Barr called a “detailed scheme” from Ullstein—which they borrowed from the DTP lawsuits. At the end of the second trial, in the name of Susan Loveday (before I volunteered my “everybody knows” opinion), Lord Justice Stuart-Smith had set out a checklist of the kinds of evidence that would be needed to convince a court that a vaccine caused an injury.

  The judge’s first heading was, “A distinct and specific clinical syndrome.”<
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  Next, “A specific pathology.”

  Third, what he called a “temporal association” between the time of vaccination and symptoms.

  Fourth, “Plausible mechanisms” (or “Biological mechanisms”).

  Fifth, of least significance, “Animal experimentation.”

  And finally, “Epidemiological evidence.”

  Wakefield would attempt to create all of these (bar the animals) while employed in his deal with Barr. The Royal Free was to become a litigation factory, processing at least one hundred children that I can prove (whose parents were listed in a court register I obtain), and numbered by other sources at more than twice that. With pediatric gastroenterology allocated four slots a week in the endoscopy suite, that was the equivalent of full capacity—receiving no other patients from John Walker-Smith’s unit—for possibly much longer than a year.

  But first, Barr asked Wakefield to design a study, covering both clinical evidence (symptoms, signs, histories, and suchlike) and scientific, or laboratory-type, tests. Then, five months after the meeting with Ullstein—but still before any of the kids were seen for scoping—they asked the Legal Aid Board to pay for it.

  If I didn’t have the documents, I wouldn’t believe the manifesto they submitted that summer. But in a three-page “Proposed Protocol and Costing Proposals,” plus a seventeen-page “Proposed Clinical and Scientific Study,” they set out plans for the grueling regime the children would undergo, giving the names of eight staff who would later appear on the Lancet paper, an itemized estimate of how much would be charged to the board, and the purported upshot (you might think surprisingly): a test for vaccine damage.

  “The children will come into the Paediatric Gastroenterology Ward under the care of Professor John Walker-Smith,” Wakefield specified in the submissions. “Costs for four nights stay for the child and their parent plus colonoscopy will be £1,750.”

  Naming as his “coordinating investigator–molecular studies” the young scientist Nick Chadwick, who would be waiting at the endoscopy suite to freeze tissues in nitrogen, the documents offered (at £500 a pop) “strain-specific” sequencing of measles virus: meaning reading its genetic code to discover where it came from—a vaccine, nature, or a lab.