Andrew Wakefield

Dr Andrew Wakefield was a researcher who suggested that the measles, mumps and rubella (MMR) combined vaccine might be linked to an increased risk of autism and bowel disorders. In 1998 Wakefield and eleven others published a peer reviewed paper in the Lancet which consisted of a case review of 12 children sequentially referred to the gastroenterology unit of London's Royal Free Hospital, where Wakefield was a reader in experimental gastroenterology. The paper said the children had "a history of normal development followed by loss of acquired skills, including language, together with diarrhoea and abdominal pain."

The paper said: "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." While the paper noted some parents' views that those environmental triggers included the MMR vaccine, the paper itself did not claim a causal link. This is consistent with the nature of epidemiological research, which does not identify cause-and-effect but only points to associations or correlations.

Wakefield commented to the media (i.e. not in the paper itself) that the children's behaviour changed drastically shortly after they received the MMR jab. He said: "This is a genuinely new syndrome and urgent further research is needed to determine whether MMR may give rise to this complication in a small number of people."

Wakefield theorised that the combination of the three virus strains contained in MMR may overload the body's immune system and cause the bowel disorder to develop.

The publicity following the paper's publication resulted in a dramatic fall in public uptake of the MMR vaccine.

GMC hearing

In January 2010, the results of a three-year investigation by the General Medical Council into the fitness to practise of Wakefield and two other doctors from the MMR research team, Professor Simon Murch and Professor John Walker-Smith, were announced: Wakefield and Walker-Smith had been found guilty of professional misconduct and were struck off the doctors' list. Murch was found not guilty.

The Lancet, the journal that published Wakefield and colleagues' paper, retracted it on 2 February 2010.

The GMC report on the hearing (GMC, Fitness to Practise Panel Hearing, 28 January 2010) can be read here. The following factors emerge from the report:

• Serious symptoms of bowel dysfunction and autism were suffered by children that featured in Wakefield et al's case review, and these were linked by parents and in some cases by GPs and consultants (ie not just Wakefield and the other two doctors on trial) to the MMR vaccine
• A whole team of doctors and consultants - not just Wakefield and the other two doctors on trial - were caring for and deciding on the investigations to be performed on the children and on their treatment
• The invasive procedures (colonosocopy and lumbar punctures) that Wakefield was accused of causing to be done on the children were standard investigations performed at the hospital on children suffering serious bowel symptoms and/or suspected meningitis. It also becomes clear that Wakefield was not in charge of deciding on or carrying out these procedures, which were done by consultants whose speciality they were.

What is frustrating about the GMC report for any member of the public who wants to read both sides of the story is that while all the allegations against the doctors are published fully, with the GMC verdict on each allegation (e.g. "proven" or "not proven"), the doctors' defences do not appear.

Conflicts of interest

• Professor Denis McDevitt, who was originally proposed by the GMC as chair of its GMC fitness to practice investigation into Wakefield and colleagues, was himself a member of a 1988 government safety panel which approved Pluserix MMR vaccine as safe for vaccine manufacturer Smith Kline & French Laboratories (later GlaxoSmithKline). This was revealed in previously secret government minutes that were disclosed by the MMR litigation brought by parents of alleged MMR-damaged children. Also, at the time that the panel approved the vaccine, McDevitt was being paid as a research fellow by MMR vaccine manufacturer, Smith Kline & French Laboratories.

The government minutes that reveal these facts are also interesting from the point of view of the adverse reactions reported to the early version of the MMR vaccine, using the subsequently discontinued Urabe strain of mumps virus. The reactions included convulsions, neurological complications, meningitis, and encephalitis. One member of the panel raised concerns about "the potential infectivity of the mumps component of MMR to susceptible contacts", though he was "assured" that it was "not transmissible".

According to an article by Martin Walker on the Age of Autism vaccine damage information site, McDevitt was dropped as proposed chair of the GMC fitness to practice hearing into the three doctors when campaigners revealed these conflicts of interest. The chair subsequently chosen by the GMC was Dr Surendra Kumar.

• Dr Surendra Kumar chaired the GMC fitness to practice hearing into the three Royal Free doctors. He read out the verdict of the General Medical Council (GMC) panel, which condemned the doctors as “dishonest”, “irresponsible”, and as acting “contrary to the clinical interests of this child”. In 2003 Kumar disclosed a shareholding in GlaxoSmithKline. He still had shares in GSK in 2004. GSK was a defendant in litigation brought by parents of alleged MMR-damaged children under the legal aid scheme, litigation in which the parents employed Wakefield as an expert witness.
• Dr Andrew Wakefield was accused of a conflict of interest in that he was employed by the group of parents who sued vaccine manufacturers for alleged vaccine damage of their children. Dr Richard Horton, then editor of The Lancet, told the GMC that he had been unaware of this alleged conflict of interest on the part of Wakefield at the time he published Wakefield's MMR paper in The Lancet, though Wakefield told the GMC he had declared it. A discussion of this incident by John Stone, a supporter of the vaccine-damage advocacy group JABS, based on contributions to the BMJ Rapid Responses forum, is here.

Andrew Wakefield was legally correct in stating that there was no conflict of interest in this respect. In defending herself against a parallel allegation of conflict of interest made in Private Eye (19 March 2004), Professor Elizabeth Miller, head of the Health Protection Agency's Immunisation Department and expert witness for the vaccine producers - presumably with the best legal advice - wrote:

there can be no conflict of interest when acting as an expert for the courts, because the duty to the courts overrides any other obligation, including to the person from whom the expert receives the instruction or by whom they are paid.

This legal view was also given by barrister Robert Hantusch in a letter to the Times of 24 February 2004:

But the courts do not consider that the engagement of someone to act as an expert witness in litigation has the effect that that person is then biased. Indeed, if this were the legal position, no paid professional could ever at any time give evidence to a court.

• Wakefield was also accused of a conflict of interest in that he had filed a patent in 1997 as a co-inventor of an alternative vaccine against MMR, and a pharmaceutical composition for treating inflammatory bowel disease.

See also:

• Crispin Davis
• Nigel Davis
• MMR