Medicine Interview Hot Topics: MMR & Dr Andrew Wakefield
Dr Andrew Wakefield was a UK surgeon, who in 1998 published a case series in the Lancet, suggesting that the MMR (Measles Mumps and Rubella) vaccine could predispose children to behavioral regression and pervasive developmental disorder.
The case series received huge publicity, despite uncontrolled design and speculative conclusions. The MMR vaccination rate began to drop significantly in light of Wakefield’s results, with parents concerned about the risk of autism in their children after vaccination.
The Case Against Wakefield
After this, epidemiological studies were published that refuted Wakefield’s work. Ten of the 12 co-authors of the original paper would then go on to retract their previous interpretation of their data, saying that, ‘no causal link was established between MMR vaccine and autism as the data was insufficient.’ Additionally, the Lancet found that Wakefield had undeclared conflicting financial interests, having been funded by lawyers representing parents who were suing vaccine companies.
In 2010 the Lancet would completely retract the Wakefield paper, finding that several elements of the paper were incorrect, and holding Wakefield et al guilty of ethical violations and scientific misrepresentations.
Finally, the British Medical Journal would go on to publish a series of articles exposing that Wakefield and his team were guilty of deliberate fraud, having falsified facts and picked and chosen data that best suited their argument. It is believed that they did this for their own financial gain.
The GMC found that Wakefield had been dishonest, acting in his own best interests rather than those of his patients, and that he had, ‘failed in his duties as a responsible consultant.’ Three months after this, Wakefield was finally struck off the UK Medical Register and was barred from ever again practising medicine in the UK. A UK court ruled at this time that, ‘there is now no respectable body of opinion which supports [Dr. Wakefield's] hypothesis, that MMR vaccine and autism/enterocolitis are causally linked.’ Nonetheless, Wakefield continues to hold sway in the ‘anti-vaxxer’ movement - a movement he essentially created himself.
Talking points from the Wakefield saga
Breach of Trust
Wakefield’s paper and the subsequent years of climb downs over its claims show the ease with which the public may be led to believe something that isn’t, as far as science can see, true. Wakefield seized on the desires of a hugely vulnerable group of people - the desperate parents of autistic children and fed those desires with information that seemed plausible. He was after all a highly respected surgeon, in a good department at a London hospital.
We should reflect on the importance of peer-review, and of declaring bias or financial interests when conducting research. It would transpire much later that alongside working with lawyers taking on pharma companies, Wakefield had actually lodged a patent for a new vaccine against measles.
Ethics of Research
We should also consider the ethics of research, and of finding the right volunteers for research work. Wakefield used children with autism as his guinea pigs, subjecting them to invasive procedures that they had no need of. He would try out his vaccine on one child without telling their GP, and take blood from children at a birthday party for the sum of five pounds each. He failed to pay any attention to the high standards required of medical researchers.
Long Term Consequences
We now learn how hard it is to remove an idea like Wakefield’s from the public consciousness when it is embedded; despite refutals from the Lancet, BMJ, Medical Research Council and Health Protection Agency (to name just a few) many still believe Wakefield’s work, or have real fears and doubts about vaccines in general. He continues to feed off public doubt and fear in America, a far cry from his origins as a respected researcher.
Potential questions which may be asked in your interview
- Who was Andrew Wakefield?
- What is the MMR vaccine?
- What do you think about the anti-vaxxer movement?
- Should people be forced to have vaccines for common and deadly diseases?
- What does the Andrew Wakefield case tell us about research, or problems that may arise with research?
- Why was Andrew Wakefield struck off the medical register?
- What kind of conflict of interests might someone have that should prevent them from publishing a paper?
- How might you look for bias in a published paper?
How to answer questions on this topic
When answering questions on Wakefield or the MMR vaccine, you should show an awareness of research methodology and ethics in research. Scientific research should be undertaken without bias, research participants should be treated with the utmost respect according to current guidelines, and results should be truthfully and honestly conveyed, whether the result fits your hypothesis or not. Mention the importance of good research to evidence based medicine, one of the underpinnings of practice today.