#158 – Brian Deer: A tale of scientific fraud—exposing Andrew Wakefield and the origin of the belief that vaccines cause autism

Brian Deer is an award-winning investigative journalist best known for his coverage of the pharmaceutical industry. In this episode, he and Peter discuss the content of his book, The Doctor Who Fooled the World: Science, Deception, and the War on Vaccines, which exposes the complex and disturbing story behind the infamous 1998 Lancet paper by Andrew Wakefield linking the MMR vaccine and autism. Brian explains how doctors led by Wakefield, a lawyer, and an anti-vaccination parents’ group worked together on a study to validate their preconceived belief that the MMR vaccine caused autism. He reveals what happened behind the scenes as the study was carried out, explains problems in the lab, and discusses inconsistencies in the analysis.  In the end, this is a story that serves as a cautionary tale about the consequences of science driven by an agenda rather than by a spirit of open inquiry.

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We discuss:

• How Andrew Wakefield’s flawed approach to scientific research led to the belief that vaccines cause autism (3:25);
• The importance of following the scientific method, and how Wakefield twisted the science to link measles virus to Crohn’s disease (14:15);
• The backstory behind Andrew Wakefield’s infamous 1998 Lancet paper linking the MMR vaccine and autism (26:45);
• The many flaws and disturbing aspects of Wakefield’s study: suffering children and failure to do strain-specific sequencing (45:15);
• The epicenter of fraud: Bogus PCR testing furthering the belief that measles virus from the MMR vaccine caused autism (1:00:00);
• Additional issues that contaminated the study results (1:22:15);
• Discovering the misrepresented medical records for the kids involved in the study leading to the retraction of the Lancet paper and Wakefield losing his license (1:31:00);
• The resurgence of the anti-vaccination movement, Brian’s motivation to write the book, and parting thoughts (1:36:45); and
• More.

How Andrew Wakefield’s flawed approach to scientific research led to the belief that vaccines cause autism [3:25]

• This is not just a discussion about vaccines but also about fraud in science
• Vaccines can be a polarizing issue, but it’s important to get to the bottom of the story
• Peter reached out to Brian after reading his book, The Doctor Who Fooled the World: Science, Deception, and the War on Vaccines, twice

“I believe too many people enjoy the convenience of opinion without the inconvenience of thought.” —Peter Attia

Andrew Wakefield

• To understand the origin of the belief that    c, one must understand the work of Andrew Wakefield 
  • Peter urges listeners to read Brian’s book in addition to the podcast
  • In some countries many people believe that autism is likely or probably caused by vaccines
    • And it’s not an uncommon belief in US
    • Though Brian says not so much in the UK anymore
  • Idea that vaccines might cause autism became prominent in early 1990s
  • Before Brian’s book, Peter assumed Andrew Wakefield was “a misguided and not particularly competent physician,” but now he realizes that it goes well beyond that
• Brian wanted to follow the arc of Wakefield’s development and planned to give him the benefit of the doubt in his early years
  • Wakefield went to Canada and started training in surgery in late 1980s, but despite a long-term goal to be a surgeon for unknown reasons he “moved very quickly” away from surgery into research 
  • Brian didn’t find the story of a good guy who was misguided but rather of a guy who became obsessed with an idea that he strangely latched onto and refused to let go
• In Toronto where he trained, they were investigating bowel transplants to treat Crohn’s disease (“an appalling, ulcerating, blistering, burning” bowel disease of unknown origin)
  • Theory was that it was an allergic reaction inside the gut, but Wakefield wondered if it could instead be a disease of the gut blood supply caused by an infectious agent
  • This was the late 1980s when AIDS and infectious agents were in the news
• Wakefield got a job in London at a “third rate” hospital, Royal Free in Hampstead North London
  • Was still on payroll of Wellcome Trust, which today is a great health-related charity that has enhanced the UK’s coronavirus response, but then was the grant-branching arm of a pharmaceutical company
  • Wakefield knew the funding would eventually go to the med school and wanted to use funding for his Crohn’s idea while he could
• Wakefield went through a two-volume encyclopedia of viruses called Fields Virology and saw that acute measles can be found in the intestines, so he decided to focus on measles
  • In Crohn’s disease, get little ulcers in the gut
  • In measles, see Koplik’s spots
  • So he concluded that measles was the cause of Crohn’s disease
  • However, during infection, measles is found everywhere in the body, not just the gut
  • But Wakefield decided to “prove” that measles caused Crohn’s disease
• Wakefield had a surgeon’s mindset rather than a researcher’s mentality

“In science, courage isn’t about proving yourself right, it’s in your efforts to prove yourself wrong. . .to try and refute your own hypothesis.” —Brian Deer

• In science you must start with a hypothesis and then collect data about it in a way that tries to disprove it
  • Wakefield never did second step; never doubted or questioned his ideas
  • This is “an extraordinary flaw of character,” especially in a scientist

The importance of following the scientific method, and how Wakefield twisted the science to link measles virus to Crohn’s disease [14:15]

• Peter says Wakefield’s approach reminds him Richard Feynman saying something like “the first principle in science is not to fool yourself”
  • Even the word “proof” is loaded in science
  • You look at a body of experiments and ascertain which way the evidence points
• Peter says it’s not just surgeons but doctors in general who don’t get a lot of training in the scientific method
  • Those who do research get it
  • but not so much in med school generally, where you learn a bit of the history and science and a lot of facts but not really about the scientific method
• Scientific method: generate a hypothesis, figure out what the right questions are, design experiments to test it, look critically for all the ways you could be fooled
  • Peter says it’s hard to learn without good mentoring in a lab
  • Brian says medicine is like a European learning Chinese – you don’t question what you’re taught, you just learn it 
• Wakefield’s favorite word was “consistent”: this particular finding or data point was consistent with his hypothesis
  • But consistent means nothing: could say orbit of Mercury is consistent with inflammatory bowel disease (IBD), or consistent with Peter and Brian talking
  • Peter says it’s similar to saying “associated with,” which means nothing
  • Being “consistent” doesn’t prove the hypothesis
  • Wakefield “never stopped to question at any stage, or to carry out any experiment, or research, or anything that would conflict with that commitment to the idea that measles virus was the cause of Crohn’s disease”
• Wakefield used immunohistochemistry, a microscopic staining technique
  • Take tissue sample, use antibodies to stain it in a certain way, then look under a microscope
  • Will change color if sample has antigen you stained for
• Polymerase chain reaction (PCR) technique: when this technique was used, could not find measles in Wakefield’s study samples
  • Wakefield said PCR wasn’t sensitive enough, which made the American undergraduate students Brian told this story to laugh
  • Doesn’t make sense to suggest you could find something under a microscope that you cannot find at a molecular level

{end of show notes preview}

Brian Deer

Brian Deer is an award-winning investigative journalist for the London-based The Sunday Times who focuses on medicine, particularly the pharmaceutical industry, and social issues; topics he has covered include the withdrawn Merck painkiller Vioxx, an ill-fated drug trial of an experimental monoclonal antibody, and false claims about a link between the MMR vaccine and autism.  The author of The Doctor Who Fooled the World: Science, Deception, and the War on Vaccines, Deer won a British Press Award in 1999 and 2011 and the annual HealthWatch award in 2011.  He is a graduate of the University of Warwick.

Website: briandeer.com

Twitter: @deerbrian