Monday, July 09, 2007

Wakefield and Why The Edith Piaf Routine Is Baseless: Part 1

When Andrew Wakefield went through his deeply-affecting Edith Piaf routine for Denis Campbell of the Observer, did his voice suddenly take on husky gallic overtones in contrast to "the deep green polo shirt, chinos and outdoor jacket" that seem to have so impressed Campbell and made him come over all descriptive? Edit update, July 9: Wakefield has a history of insisting that he should be interviewed by journalists who know little about MMR or medicine (Brian Deer postcript).

It seems as if moral probity oozed from Wakefield as he recounted his touching story of the prophet who is without honour in his own country. The story was obviously so affecting that Campbell neglected to research some basics.
Journalists asked about the authors' main claim to have discovered, in a study of 12 children, a new form of inflammatory bowel disease, which they linked to the MMR vaccine. The doctors outlined their theory that in some children the combination vaccine damaged the immune system because they could not cope with simultaneously receiving a tiny dose of three separate diseases, leaving them susceptible to illness.
Campbell could have consulted many sources on this issue or gone straight to Brian Deer for the inside story (no pun intended) on the gut issue. He might have looked at the official investigation in the immune question: Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System?. He could have done that and then he would never have written as if these issues were still worthy of further consideration.

What about that scary-sounding ileal-lymphoid-nodular hyperplasia that so impresses and intimidated these hardened journalists? Wasn't this a new, terrifying, malign finding that must mean something? Well, no. It turns out that the swelling of the glands, near the end of the small intestine and close to the appendix is a generally benign finding in children that has been known about for some time. It has nothing to do with inflammatory bowel disease and is not, of itself, an inflammatory bowel disease.

But what about the autistic enterocolitis? Patrick Holford (amongst others) is concerned about the chronic inflammation that scourged the large and small intestines of the children in Wakefield's studies. He still refers to autistic enterocolitis in his books and articles; especially those promoting the need for a restrictive diet that should be supervised by one of his nutritional therapists who will also recommend a gut-healing programme and extensive supplementation. He also emphasises that the children have inflammation arising from infection because he is a staunch advocate of anti-fungal medications for children with these compromised guts.

Patrick Holford and others who recommend elimination diets (amongst other modalities) for children with autism cleave to their belief in this chronic inflammation despite the fact that Wakefield's colleagues have withdrawn their support for his research and retracted the publication that articulated this claim. Patrick Holford still promotes this idea although one of Wakefield's collaborators and co-authors, Walker-Smith, has admitted that most of the children did not show signs of inflammation and that there were no unusual findings in the children's colons.

If you're not queasy about that sort of thing, do go and look at the illustrations and photographic plates on Brian Deer's site; you will learn a lot about the appearance of normal and inflamed bowel tissue.

You will also learn enough to be confident that the researchers had not discovered a "new inflammatory bowel disease" or anything else that could be linked to the MMR vaccine.

Whatever various characters in this drama claim to have thought then, there have been several investigations into the claim that vaccines overwhelm the immune system of young children. One notable report is: Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System?. In summary, we learn that matters are not quite as those researchers (mainly Wakefied) thought at that time:
  • Newborns commonly encounter a host of challenges to their immune system at the same time
  • Newborns are capable of generating protective immune responses to bacteria and viruses, as well as vaccines, from the moment of birth. This capability is necessary for them to meet the tremendous number of environmental challenges they will encounter in the first few hours and days of life.
One of the authors, Dr Paul Offit explained some findings about the remarkable robustness of newborns:
Babies emerge from the relatively sterile environment of the womb into a world teeming with bacteria, viruses and other microorganisms, and their immune systems are designed to stand up to these challenges from the start. Newborns have billions of immunologic cells that are capable of responding to millions of different microorganisms. By quickly making an immune response to bacteria that live on the surface of their intestines, for example, babies are able to keep those bacteria from invading their bloodstream and causing serious disease.
He went on to further explain that research indicates that young infants are fully capable of generating protective immune responses to multiple vaccines given simultaneously.
Our analysis shows that infants have the theoretical capacity to respond to about 10,000 vaccines at once. Currently, the most vaccines that children receive at one time is five. Using this estimate, we could predict that even if all 11 of the routinely recommended vaccinations were given to infants at one time, only about .01 percent of the immune system would be used.
Offit also reveals that improvements in vaccine development mean that today's infants receive fewer substances in vaccines that stimulate an immune response than they did 40 or 100 years ago. The nett effect of this is that although there has been a substantial increase in the number of routine
childhood vaccines over the past several decades, children receive fewer antigens.
Parents who are concerned about the growing number of vaccinations recommended for their children may take comfort in knowing that children are actually exposed to fewer antigens-- proteins that stimulate an immune response -- in the vaccines they receive today than in the past. Vaccine formulations have been refined and simplified over the years. Although we currently give children more vaccines than in the past, the actual number of antigens they receive has declined significantly. Whereas previously one vaccine, smallpox, contained about 200 antigens, now the 11 routinely recommended childhood vaccines
contain fewer than 130 antigens combined.
Now, granted those issues, is it unfair to expect researchers to keep quiet if they suspect flaws in matters that affect safety? No-of course it isn't. But it does behove those researchers to be absolutely sure of their ground. And, at the time of the Lancet publication, Wakefield knew that people in his own lab. had serious misgivings about some of the claims in the paper.

Dr Nick Chadwick started to work as a graduate student in Dr Wakefield's lab in the Royal Free Hospital in 1994. The lab started to focus on testing samples and tissue from autistic patients in 1996. Chadwick was responsible for processing the materials and looking for measles RNA. He reported that there were never any confirmed findings of measles RNA. The only positives that were obtained were rapidly shown to be false positives and he reported this to Wakefield.

Chadwick's testimony to the Autism Omnibus hearings (pdf) was devastating.
pg 10
Q [Y]ou personally tested while you were in Dr. Wakefield's lab gut biopsy material, CFS, PBMCs?

A Yes, that's right.

Q And all the results were either negative, or if they were positive it always turned out that they were false positives?

A Yes, that's correct.

Q Did you inform Dr. Wakefield of the negative results?

A Yes. Yes.
Chadwick further reported that Wakefield had decided that it would be useful to send samples to Dr Kawashima's lab because he was also working on the detection of measles virus using another methodology. Chadwick discovered that there were serious and significant reporting errors from Kawashima's lab and that, yet again, the only positive results were subsequently shown to be false positives. He had concerns about contamination. He informed Wakefield of the problem with the Kawashima results. Chadwick's results also returned negative results, with every positive being subsequently shown to be a false positive.
pg 12
Q [D]uring your time on your Ph.D. research in Dr. Wakefield's lab you only obtained nine positive PCR results for measles. Every time you did that you sequenced them.

A That's correct, yes. We sent it off to a sequencing lab to be sequenced, and the data that came back showed that they were all false positive results.

Q Every positive result you got was a false positive?

A Yes...

[pg 12 cont. to pg 14]
Q [Y]ou state that you had reservations about the immunohistochemistry done to detect measles virus, specifically the use of an antibody from Porton Down?

A Yes, that's right. The antibody seemed to cross-react.
Experiments we did in the lab seemed to show that the antibody cross-reacted with bacterial proteins, which I think is an artifact of how the antibody was made, and that led us or led me to think that it may have been cross-reacting with bacteria in the gut of patients rather than measles virus.

Q Now, that would lead to contamination?

A Well, it would lead to a false positive result. Say for instance if the antibody was binding to something in the guts of these patients, it may well have been a bacteria rather than the measles virus.

Q Okay. Producing the false positives in those?

A Yes, that's correct.

Q You also state in your affidavit that you believe Dr Wakefield was aware of all your negative results when he submitted his paper "Ileal Lymphonodular Hyperplasia, Nonspecific Colitis and Pervasive Developmental Disorder," which was published in 1998 to the Lancet.

A Yes, that's correct.

Q You were working at the lab at that time, and you had actually published some articles with Dr. Wakefield on other subjects, hadn't you?

A Yes. Yes.

Q Why isn't your name on the paper I just referenced?

A Well, my name isn't on that because none of my data went into that paper.
There was a manuscript which did use some PCR data I think from Dr. Kawashima's lab, and I asked for my name to be taken off anything that was related to PCR data because I wasn't comfortable with the quality of the data.
It is a remarkably serious step to request that your name is taken off a paper and should not be used in reference to data. The significance of this would be apparent to any researcher, scientist or journalist.

So, Campbell might have done some background checking but he would then have discovered that there was no scary "new inflammatory bowel disease" and that the concerns about overwhelming the immune system of healthy infants and children were unfounded, and that Wakefield knew that there was no foundation for the "potential link between gut disorders, autism and MMR vaccination" that he had received Legal Aid money to investigate. All of this information is public domain. Why did Campbell not present it in the Wakefield as Edith Piaf piece?
Wakefield told The Observer that he has no regrets for saying what he did in 1998 nor for continuing to seek to prove his view of MMR as the likeliest explanation for the rise in cases of autism in Britain.
Brian Deer has suggested that some of these claims are worthy of an investigation by the Press Complaints Commission; I would like to think that the PCC would treat this matter seriously. I would also like them to give a stern talking-to to whomever was responsible for signing-off on these pieces from the Observer and whoever told Denis Campbell that his science/medical material was accurate.

Blog reactions:
Ben Goldacre of Bad Science: Try Me, Sh*thead - the strange case of Carol Stott, Wakefield and the Observer
Dr Crippen of NHS Blog Doctor: Andrew Wakefield, MMR, Autism and the GMC
Tony Hatfield of Retired Ramblings: What the Observer's MMR Piece Didn't Tell You!
Tim Worstall: Crap Reporting in the Observer
Anthony Cox: New Autism Fears, A Man in Denial and MMR Memes in Newspapers
Mike Stanton: Cry Shame on Wakefield and MMR
Kristina Chew of Autism Vox: 1 in 58
Ms Clark of Autism Diva: Embattled Andy Wakefield Speaks and Wakefield and Walker-Smith: Dishonest and Irresponsible
Russell Brown of Public Address: Bad journalism, old stories
Patrick Holford and Andrew Wakefield

Related posts or relevant reading

Dr Michael Fitzpatrick on Stephen Bustin's devastating testimony and why there is nothing in the MMR-autism theory
Brian Deer for a very readable summary of The MMR-autism scare and Wakefield's role in it.
Brian Deer on Prof. John Walker-Smith and his involvement in experimentation on children with autism symptoms and his statement relating to the revelations about the Lancet paper.
Brian Deer on Prof Simon Murch and his involvement with the studies and his defence of the Wakefield research. Brian Deer has performed a thorough analysis of the differences between that statement and the claims made in the Lancet paper
Daily Telegraph on Prof Murch and his statement that there is no link between MMR and autism
Brian Deer has made available an easy-to-read format of the cross-examination of Dr. Arthur Krigsman in the Cedillo case of the Autism Omnibus.
Andrew Wakefield, Chronology and "Bad Science"
Patrick Holford and Dr Andrew Wakefield's Discredited Findings: Part 1 and Part 2
Wakefield's Latest Tent Mission on the Doctrine of Autism
Kevin Leitch on Andrew Wakefield and the death of the MMR debacle
Patrick Holford, MMR and What Passes for Hard Evidence
Mike Stanton on Patrick Holford and his unusual views on vaccination, MMR and autism
Patrick Holford Claims Remarkable Benefits for Homeopathic Vaccinations
Holford Watch: Holford believes Secretin is "Worth considering" as an autism treatment; however, there is no evidence that this treatment is effective and
Holford is sceptical about off-label prescribing, but thinks that secretin for autism is "Worth considering"

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Anonymous L. Powell said...

I am a mother of 8 children, and 13 grandchildren, as well as 1 great grandchild. I tell my children when their babies are born to keep them away from any shots for at least 6 months, and only allow one shot to be administered at a time, to be sure the doctors take care not to multiply several shots into one. We do not live in some third world country, and live relativly clean lives, with great attention to where and with who our babys are when they are young and more vunerable. I do not believe the science behind the over kill that is given to this matter today, the medical community, in my opinion is not to be trusted, and do NOT have todays children best interest in mind.. this over kill is not healthy or safe. I trust my instincts over todays so called science., What was good enough for my first children is good enough for todays.

11:20 am  
Blogger Shinga said...

Just to be clear, you trust the science that has given you good housing, clean water, excellent sewage systems and the infrastructure that means that those of us in the West are priviliged to live safe lives. You have possibly trusted medical science by proxy for antibiotics involving family members' surgery etc. but you don't trust the medical community and believe that they do not have children's best interest in mind.

I'm glad that your kith and kin is so healthy. Do you allow any room for the possiblity that they are the beneficiaries of the herd immunity that is conferred by other people vaccinating their children according to schedule?

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Anonymous anxiety disorder said...

I'm glad that your kith and kin is so healthy. Do you allow any room for the possiblity that they are the beneficiaries of the herd immunity that is conferred by other people vaccinating their children according to schedule?

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