I don't like to get vaccines. Even as a doctor, I look away and take a deep breath. I don't like pain, even if it's quick. But every year I make sure I get a flu shot.
So I understand that parents don't like getting their kids vaccinated. But refusing a measles, mumps and rubella (MMR) vaccine is clearly dangerous for many reasons -- the health of one's child and others.
The recent measles outbreaks due to un-inoculated children are troubling not only because of the potential unnecessary deaths that can result, but also because of the massive research fraud and falsification involved. Unfortunately many anti-vaccine parents mistakenly think that the scientific jury is out -- that some research suggested that vaccines cause autism, and that the theory is merely "not yet proven," that the question remains.
In reality, there are no lingering questions, and it is important to recognize that deviousness was involved in the mere suggestion of a link. Not only was there never any evidence to support the notion that the vaccination caused autism, the research that supposedly supported this link was in fact wholly fabricated. Unfortunately, the facts of this fraud get forgotten. Discussions occasionally mention that the research has been "discredited," but that description is in fact a massive understatement.
In 1998, a British surgeon, Dr. Andrew Wakefield, published a paper in The Lancet with 12 co-authors, reporting that the measles, mumps and rubella (MMR) vaccine was associated with "regressive autism" and colitis in 12 children. The paper ignited and propelled anti-vaccine campaigns throughout the world.
A journalist, Brian Deer, began investigating these children's medical records and found that the paper's data were largely fabricated. Of the 11 children reported as having colitis, only three did, according to the medical records. Wakefield claimed that all 12 children were "previously normal," while in fact five had developmental problems before receiving the vaccine. Of the nine with regressive autism, three had no autism at all. Of the eight children who reportedly developed symptoms only days after receiving the vaccine -- which would be important in convincing a court that the vaccine was to blame -- six took much longer, and for two it is not clear. While Wakefield claimed six of the 12 children had all three features -- autism, colitis, and development of symptoms days after the vaccination, in fact, none of them did.
It turns out that in 1994, a British-based anti-vaccine group, JABS, claimed that the MMR vaccine causes brain damage and other problems, and hired a lawyer, Richard Barr, who then retained Wakefield, a surgeon. Barr began sending Wakefield patients from the group, and paid Wakefield over $700,000. Most of the children's parents were associated with the anti-vaccine group -- hardly an unbiased group.
After Deer's investigation, Wakefield at first claimed innocence, saying that the other authors had written the final paper. In fact, he had written the paper, and the other authors had signed on.
The General Medical Council began an investigation, lasting 217 days, and concluded that Wakefield had falsified the research. The Lancet later retracted the paper, but only 12 years after publishing it.
While some conservative politicians argue that MMR refusal is an individual's right, the notion that the vaccine is somehow medically dangerous still lurks, fueling their beliefs. Indeed, Michelle Bachmann, when running for president in 2012, claimed that vaccines caused mental retardation. Various online patient groups still support Wakefield and proclaim his innocence.
Some patient advocacy groups and well-meaning individuals can readily embrace scientific lies and mistruths. Patients and their family members as well as subjects and physicians must thus be careful and vigilant.
This case has several broader implications as well, underscoring the dangers not merely of "bad science" but also of scientific fraud. Larger questions remain of how we should each -- whether as doctors, scientists, or patients -- assess the science that we read.
We expect scientists to act ethically, but sometimes we need to watch what they do. Most scientists try to act as ethically as possible, but alas, they are only human, and a certain proportion -- small, but present -- cheat. In fact, the rates of scientific journal retractions are increasing. The percent of scientific articles retracted because of fraud has risen 10 times in the past 40 years -- in part because of relative decreases in the NIH budget, heightening pressures to "publish or perish." Countless papers contain errors or fraud that remain undetected.
The case underscores, too, critical lessons for medical journals, medical centers, physicians and patients -- reminding scientists of the need to police themselves vigilantly. Alas, our oversight systems are weak. Wakefield's fraud was discovered by a journalist, not a scientist. When questions arose in 2004, the hospital where he worked said the research had undergone appropriate ethical review. The Lancet, in retracting the paper, wrote that several elements were "incorrect -- in particular," the paper's claim that children were "conservatively referred" and that the study was approved by a local ethics committee were false. The journal did not comment on the far more extensive fabrication of the data itself.
Scientific literacy also needs to be increased in this country. Many patients scour the Internet for journal articles but need to be careful about what they read.
Despite the pain of needle pricks, we need to get shots -- and read claims about science carefully. Even if we may not like it. The dangers of doing otherwise could be deadly.
Update Feb. 9, 2015: This post previously implied that deaths have resulted from lack of measles vaccination. Such deaths may occur in the future.