BMJ Blasts Lancet Role in MMR-Autism Scare

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BMJ Blasts Lancet Role in MMR-Autism Scare

By Gever, Senior Editor, MedPage TodayPublished: January 18, 2011

In the final installment of a three-part investigation of the scandal surrounding Wakefield, MBBS, BMJ took aim squarely at rival journal The Lancet, which published Wakefield's now-retracted 1998 paper that started the MMR-autism scare.

British journalist Deer wrote in BMJ that when he brought a sheaf of evidence to Lancet editors in 2004 indicating that Wakefield had fudged data in the 1998 paper, the journal conducted only a perfunctory investigation before issuing a statement backing the paper's substance.

Moreover, Deer said, The Lancet treated him as if he were the wrongdoer. It was only after he published additional findings in the Sunday Times of London, and they were corroborated in lengthy hearings before Great Britain's General Medical Council (GMC) in 2009 and 2010, that the journal fully retracted the paper.

"Were it not for the GMC case ... the fraud by which Wakefield concocted fear of MMR would forever have been denied and covered up," Deer contended.

But Lancet editors, in an unsigned statement in response to queries from MedPage Today, said they had acted responsibly and as quickly as they could.

The statement noted that less than three weeks after Deer visited the journal's office in February 2004, The Lancet published a partial retraction signed by 10 of Wakefield's 12 co-authors, specifically repudiating any connection between measles-mumps-rubella vaccine and the autism-like behavioral syndrome reported in the paper.

In addition, the editors pointed to the subsequent research articles and editorials the journal published that refuted links between childhood vaccines and autism. "At no point did we actively defend Wakefield's public statements about the link between MMR and autism," they wrote.

The statement also alleged that Deer's new report contains "many errors" but did not identify or attempt to refute them. "We do not believe it is useful to turn the clock backward," the editors wrote.

They added that the journal had given proper credit to Deer when it published the partial retraction in March 2004. Editor Horton wrote a commentary at the time that "cited Mr. Deer's investigation as the spark leading to the retraction," the statement said.

"At each stage we acted as soon as we had the evidence to do so," the editors wrote.

But Deer suggested otherwise in the new report published online on Tuesday.

Drawing on documents and testimony by Horton and others at the GMC hearing, Deer described a furious two-day effort to "bury" his accusations against Wakefield after he brought them to The Lancet.

He said he had given them five thick file folders of papers showing numerous discrepancies between the published report and other records and had gone over them with Horton and other editors for five hours.

Immediately following the meeting with Deer, Horton met with Wakefield and his two top collaborators, according to Deer. That meeting was followed by another with Wakefield, one of his co-authors, and an official at the Royal Free Hospital, where the children in the case study were seen.

At the meetings, Wakefield and the other authors insisted that the paper was accurate. But neither Horton nor the hospital official examined the records themselves nor asked anyone other than the authors to do so, Deer wrote.

In essence, Deer contended, Horton and the Royal Free simply accepted Wakefield's word.

Knowing that Deer's story would appear shortly in the Sunday Times, they turned their attention to defusing the expected media firestorm, according to Deer.

Wakefield and his co-authors, the Royal Free Hospital, and The Lancet all issued statements timed to beat Deer's story -- just two days after his presentation at the journal office. The gist was that the hospital had investigated Deer's allegations and determined that Wakefield had failed to disclose a conflict of interest -- a relationship with an attorney -- but that otherwise there was no deception or ethical problem with the research.

Moreover, Deer claimed, even before his meeting at the The Lancet office had ended, the journal shut him out.

"I expected guidance and at least a quote," he wrote. "I thought Horton would say that an investigation was required, and I assumed this might take some time. ... But Horton would say nothing. He left the room to meet the authors and released the statements without speaking to me again."

An editorial by three ethicists at Seattle Children's Hospital accompanied Deer's new report, lamenting the difficulty in enforcing ethical standards in medical research.

"Perhaps we need to focus less on the people involved and more on the defects within the biomedical research enterprise that permit such egregious misconduct," wrote J. Opel, MD, and colleagues, noting a long string of misconduct cases preceding Wakefield's.

They suggested such cases should be regarded as "adverse events," which, in turn, should prompt as much scrutiny as clinical adverse events in an ordinary medical study.

Such an approach is valuable because investigations of clinical adverse events typically focus on systems of care rather than on individuals, in part because such events usually do result from systemic failure, not individual incompetence or malfeasance, Opel and colleagues suggested.

"Deer's articles reveal the urgent need to understand why there was a failure of multiple systems within the research enterprise," they wrote.

They also noted that cultural factors clearly play a role in muting the research establishment's interest in exposing misconduct, and not only in the Wakefield case.

"Even the most elaborate strategies, procedures, and interventions designed to prevent future research adverse events will be unsuccessful unless problematic aspects of culture and unwritten customs are explored, understood, and tackled," Opel and colleagues wrote.

> > > > > > >> > > > > > >> > > > > > >> > > > > > >> > > > > > > << I did not mention religion.>>> > > > > > >> > > > > > >> > > > > > > ** My only reason for saying anything at all was that the> CCHR> > issue> > > > > was raised in response to Jim's comment. I felt it was> irrelevant.> > I> > > > > went on to share my views on the Wakefield issue to indicate> that> > some> > > > > of us without CCHR affiliations had opinions similar to Jim's.> > > > > > >> > > > > > >> > > > > > >> > > > > > > << Please also consider, that where I live we do not, as a> > rule, use> > > > > ploys> > > > > > >> to extract knee jerk reactions. We tend to be direct and> > factual.>>> > > > > > >> > > > > > > ** I referred to the pro-drug movement as using ploys. I did> > not> > > > > mean to suggest that anything in your comment was designed to> > elicit> > > > > anything at all from readers. I'm sorry for any unclarity on> this.> > > > > > >> > > > > > >> > > > > > >> > > > > > > << However if I may move into the instinctive for a moment,> > then I> > > > > must> > > > > > >> properly consider Wakefields patents for alternative> > vaccines, & ask> > > > > > >> myself what was he doing placing endoscopes & taking spinal> > taps> > > > > from 5> > > > > > >> out of the 12 children, who it has been established, were> > > > > > >> developmentally delayed before they had MMR> > > > > > >>> > > > > > >> If a pharma co carried out trials in this manner there> would> > be an> > > > > > >> outcry round here & rightly so. Therefore the establishments> > > > > reaction to> > > > > > >> Wakefield must also be seen within the context of> Wakefield's> > > > > actions & > > > > > > >> not solely as a kneejerck reaction to protect it's MMR> > product.> > > > > > >>> > > > > > >> Please also remember that the 12 children were the> offspring> > of the> > > > > > >> clients of a classaction lawyer> > > > > > >>> > > > > > >> Returning to the rational then all that I am asking is that> > someone> > > > > show> > > > > > >> me where Wakefield's science established MMR causes Autism> > > > > > >>> > > > > > >> >>> > > > > > >> > > > > > > ** I'm conflicted, . I know how far the power base in> > this> > > > > world will go to protect the cash cows that have made them rich.> > How do> > > > > we know THEY aren't going for the knee jerk reaction of the> public> > with> > > > > the story of the "deception" put upon people by Wakefield?> > > > > > >> > > > > > >> > > > > > > I'm just going to have to wait and see if I feel any clearer> > on this> > > > > in time to come. Right now, I'm not so sure this isn't one huge> > set-up.> > > > > > >> > > > > > > Take care, . I hope you understand I bear no ill will> > > > > whatsoever.> > > > > > >> > > > > > >> > > > > > > Regards,> > > > > > > > > > > > > >> > > > > > >> > > > > > >> > > > > > >> > > > > > >> > > > > > >> > > > > > > ------------------------------------> > > > > > >> > > > > > >