Dr. Besser's Notebook: The Fallout of Fraud

Jan. 6, 2010— -- An investigation published in the British Medical Journal by Brian Deer lays out in detail a strong case that a paper published in 1998 by British surgeon Andrew Wakefield that purportedly demonstrated a link between the measles, mumps and rubella vaccine and autism was deliberate fraud.

Fraud! Not bad science, but rather a deliberate attempt to demonstrate the author's predetermined conclusion that vaccines cause autism.

Why in the world would anyone do that? According to the investigation, Wakefield was hired by a law firm that was suing vaccine manufacturers to provide scientific evidence that vaccines caused autism. Wakefield received roughly $750,000 for his efforts.

As a pediatrician, a public health practitioner and a parent, this report hits me at an emotional level. To have vaccine safety questioned because of a fraudulent study is almost unfathomable. I trained in pediatrics in the late 1980s and saw the devastating impact on children's lives of many diseases that are now preventable because of vaccines. I've worked around the globe and have watched children die from measles, meningitis, tetanus and other diseases that could have been prevented had there been access to vaccines. And I've seen outbreaks in this country because of parents losing faith in the safety of vaccines.

I can think of nothing we do in pediatrics that has had as much immediate proven benefit to children's health as getting them vaccinated fully and on time. Yet this study catalyzed the loss of trust some parents have in vaccines and, to some extent, in their doctors.

Who is to blame? Clearly Wakefield, but the blame shouldn't stop there. The co-authors had a responsibility to ensure that the information presented in the study was factual. The journal had a responsibility to more thoroughly review a paper presenting such a novel theory. The public health community should have taken the concerns more seriously and launched more intensive education efforts early on.

When it comes to vaccines, there is a paradox. When an infectious disease is rampant and people see it daily, vaccines are viewed with awe. The arrival of the polio vaccine in the 1960s was a great example. Parents no longer needed to fear that their children would become paralyzed by this "summer" disease. But when a disease like polio comes under control because of a vaccine against it, some parents question whether the vaccine is worth it.

Vaccine Coverage Down

We live in a very small world. As vaccine coverage here declines, we become more vulnerable to diseases resurging, but it is much harder for people to care and worry about a disease they do not see.

So what now? It's hoped this report can help to reassure new parents that vaccines do not cause autism. Study after study that tried to verify Wakefield's hypothesis found no connection between vaccines and autism. Scientifically, the issue has been laid to rest.

Convincing the general public of the safety of vaccines is a task that may fall to those experts who take up the cause in the popular media. Two newly released books offer a look at the rise of the anti-vaccine movement. Dr. Paul Offit, chief of the Section of Infectious Diseases at Children's Hospital in Philadelphia, analyzes the rise of vaccine fears in "Deadly Choices: How the Anti-Vaccine Movement Threatens Us All." And journalist Seth Mnookin explores the influence of Wakefield and other leaders of the anti-vaccine movement in "The Panic Virus: A True Story of Medicine, Science and Fear."

For parents who have autistic children and believe that vaccines were the cause, I don't think this investigation will change anything. Until science can unravel the causes of autism and how to cure or prevent it, it will be hard to change these beliefs. Thankfully, though, more dollars are being spent on autism research now than ever before. I hope answers will be forthcoming. The tragedy is that for so long, research was focused down the wrong path, stimulated in large part by a fear of vaccines that stemmed from a fraud.