Health: Not immune to how research can hurt

Jeremy Laurance talks to the man at the centre of the controversy over the MMR vaccine

"IF I AM wrong I will be a bad person because I will have raised this spectre. But I have to address the questions my patients put to me. My duty is to investigate their stories."

Dr Andrew Wakefield is a man under pressure. Last week he published research indicating a possible link between the MMR vaccination against measles, mumps and rubella and inflammatory bowel disease and autism. It is a finding that will have chimed with parents' deepest fears about the safety of exposing babies' developing immune systems to potentially toxic drugs. But it also threatens to destabilise carefully nurtured vaccination programmes which are acknowledged to have saved millions of lives worldwide. That is a heavy responsibility, as Dr Wakefield knows. "I have thought about this every night for the last ten years. My children say `Why do you do what you do, Daddy?' and I do not know what to say to them. It is a moral issue for me."

His story begins in Canada in the late 1980s, where he had been working as a transplant surgeon. He became dissatisfied with chopping out pieces of diseased bowel and wanted to know what triggered the disease process in the first place. One freezing night, drinking a pint of Guinness in a bar, he had an inspiration. What if inflammatory bowel disease was not a bowel disease at all, caused by bacteria in the gut, but a vascular disease caused by damage to the blood supply to the gut wall?

He returned to England "in something of a crisis" and set to work at the Royal Free Hospital, north London, to test his hypothesis. With his close colleague, Professor Roy Pounder, who has stood by him throughout their decade-long association, he demonstrated that the blood supply was indeed broken down by an insidious destructive process. They published the first of a series of papers in The Lancet in 1989, although their theory remains controversial.

The next question was what caused the blood vessels to break down. At the time there was a lot of interest in viruses in blood vessels. "I sat down with two volumes of a virology textbook and worked through it. I got to measles virus and it described how it gets into the gut, causing ulcers and inflammation. You could have been reading an account of Crohn's disease [inflammatory bowel disorder]. It was very exciting."

That was in 1990 and the pair started looking for measles virus in bowel tissue taken from patients with Crohn's disease. They have been looking ever since.

In a paper in 1994 they claimed to have found it and said Crohn's disease was three times more common in people who had had measles vaccination. That study triggered a new rush of parents to Dr Wakefield's clinic claiming their children had developed symptoms of autism and bowel disorders shortly after MMR vaccination. The result was last week's paper.

Morality and science make uneasy bedfellows. When Dr Wakefield speaks of morality he refers to his duty to his patients. "We get these parents ringing up every day. They say `My child has autism and bowel problems and we believe they are linked'. You have to do something for them. These are the people to whom we are answerable."

He admits this makes life difficult for public-health doctors whose corresponding duty is to care for populations, but it can't be helped. His patients come first.

Dr Wakefield, a reader in experimental gastro-enterology, is not a crank. His research has been published in The Lancet, after being submitted to expert peer review. He has 12 co-authors on his latest paper and is regularly invited to speak at international meetings on gastro-enterology.

Yet he has been vilified and his research has been attacked as flawed and inadequate. Even The Lancet was nervous about it, commissioning a highly sceptical commentary and deliberately omitting it from its usual press release "to avoid being alarmist," according to a spokeswoman.

The Government moved swiftly to reassure parents, while the research team, from the Royal Free Hospital, emphasised that they remained in favour of immunisation.

One of Dr Wakefield's co-authors confided last week that he would prefer to work on the link between bowel disease and autism and leave aside the emotive question of the link with MMR for the sake of a quieter life.

That remark drew a stinging response from Dr Wakefield. "If they are uncomfortable they should look for a quieter life elsewhere. I can't do that."

The history of scientific advance is littered with individuals who held out against major political and commercial interests. Think of smoking and cancer. But they are hugely outnumbered by those who believed they were on to something and whose hypotheses later died. Indeed, the British Medical Journal declared Dr Wakefield's hypothesis dead in a an editorial published only six weeks ago.

If he is right about MMR, governments worldwide will have to rethink their vaccination policies, manufacturers will face a raft of compensation claims and hundreds of patients who have harboured suspicions about the safety of vaccinating young babies will feel vindicated.

If he is wrong, the consequences could be still more serious if vaccination rates fall and measles cases start to rise.

Have you tried new the Independent Digital Edition apps?
ebooks
ebookA delicious collection of 50 meaty main courses
Life and Style
ebookNow available in paperback
  • Get to the point
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating
and  

By clicking 'Search' you
are agreeing to our
Terms of Use.

ES Rentals

    iJobs Job Widget
    iJobs General

    SThree: Trainee Recruitment Consultant - Dublin (based in London)

    £20000 - £25000 per annum + commission: SThree: Real Staffing's Pharmaceutical...

    SThree: Trainee Recruitment Consultant

    £18000 - £25000 per annum + Commission: SThree: Are you great at building rela...

    SThree: Trainee Recruitment Consultant - Swiss Banking and Finance

    £20000 - £25000 per annum + Uncapped commission: SThree: Can you speak German,...

    Ashdown Group: Marketing Executive - 6 month FTC - Central London

    £25000 - £30000 per annum + benefits: Ashdown Group: An exciting opportunity f...

    Day In a Page

    Fishing for votes with Nigel Farage: The Ukip leader shows how he can work an audience as he casts his line to the disaffected of Grimsby

    Fishing is on Nigel Farage's mind

    Ukip leader casts a line to the disaffected
    Who is bombing whom in the Middle East? It's amazing they don't all hit each other

    Who is bombing whom in the Middle East?

    Robert Fisk untangles the countries and factions
    China's influence on fashion: At the top of the game both creatively and commercially

    China's influence on fashion

    At the top of the game both creatively and commercially
    Lord O’Donnell: Former cabinet secretary on the election and life away from the levers of power

    The man known as GOD has a reputation for getting the job done

    Lord O'Donnell's three principles of rule
    Rainbow shades: It's all bright on the night

    Rainbow shades

    It's all bright on the night
    'It was first time I had ever tasted chocolate. I kept a piece, and when Amsterdam was liberated, I gave it to the first Allied soldier I saw'

    Bread from heaven

    Dutch survivors thank RAF for World War II drop that saved millions
    Britain will be 'run for the wealthy and powerful' if Tories retain power - Labour

    How 'the Axe' helped Labour

    UK will be 'run for the wealthy and powerful' if Tories retain power
    Rare and exclusive video shows the horrific price paid by activists for challenging the rule of jihadist extremists in Syria

    The price to be paid for challenging the rule of extremists

    A revolution now 'consuming its own children'
    Welcome to the world of Megagames

    Welcome to the world of Megagames

    300 players take part in Watch the Skies! board game in London
    'Nymphomaniac' actress reveals what it was really like to star in one of the most explicit films ever

    Charlotte Gainsbourg on 'Nymphomaniac'

    Starring in one of the most explicit films ever
    Robert Fisk in Abu Dhabi: The Emirates' out-of-sight migrant workers helping to build the dream projects of its rulers

    Robert Fisk in Abu Dhabi

    The Emirates' out-of-sight migrant workers helping to build the dream projects of its rulers
    Vince Cable interview: Charging fees for employment tribunals was 'a very bad move'

    Vince Cable exclusive interview

    Charging fees for employment tribunals was 'a very bad move'
    Iwan Rheon interview: Game of Thrones star returns to his Welsh roots to record debut album

    Iwan Rheon is returning to his Welsh roots

    Rheon is best known for his role as the Bastard of Bolton. It's gruelling playing a sadistic torturer, he tells Craig McLean, but it hasn't stopped him recording an album of Welsh psychedelia
    Morne Hardenberg interview: Cameraman for BBC's upcoming show Shark on filming the ocean's most dangerous predator

    It's time for my close-up

    Meet the man who films great whites for a living
    Increasing numbers of homeless people in America keep their mobile phones on the streets

    Homeless people keep mobile phones

    A homeless person with a smartphone is a common sight in the US. And that's creating a network where the 'hobo' community can share information - and fight stigma - like never before