The doctor who triggered an international health scare over the safety of the measles, mumps and rubella (MMR) vaccine will take the stand at the General Medical Council today in an attempt to save his professional reputation.
Ten years after Andrew Wakefield's paper linking the MMR vaccine with bowel disease and autism appeared in The Lancet, he will defend the research, which is said to have done more damage than anything published in a scientific journal in living memory. Scores of parents who are convinced that the vaccine caused autism in their children will demonstrate in support of Dr Wakefield outside the GMC's headquarters in London, where the case is being heard, as they did when the hearing opened last July. They claim he is the victim of a witch-hunt by the Government and the pharmaceutical industry, who have conspired to cover up the harm the MMR jab has caused.
Along with two of his former colleagues, Professors Simon Murch and John Walker-Smith, Dr Wakefield, 51, is accused of abusing his position as a doctor and of failing to obtain the necessary ethical approval for his research on children, or of going beyond it or of not being qualified to carry out the procedures he undertook. If found guilty of serious professional misconduct, all three doctors face being struck off the medical register. They deny the accusations.
The charges, though narrowly focused on the ethics of the research rather than the disputed link between MMR and autism, have revived the decade-old row which has pitched parents against the medical establishment and led to a collapse in immunisation levels nationwide.
Vaccination rates with MMR stood at 91 per cent in 1997-98, before The Lancet published Dr Wakefield's findings. In the ensuing scare, vaccination rates slipped to 80 per cent in 2003-4 and lower still, to 60 per cent, in parts of London.
Although the rates have since recovered to 85 per cent, hundreds of thousands of children remain unprotected from the diseases and cases of measles have soared.
Almost 1,000 people were infected with the illness last year – the highest figure since records began in 1995. The illness causes fever which can lead to serious complications. Cases of mumps have also risen sharply.
The five-member GMC panel, who are each being paid £310 a day, have spent three months listening to the prosecution case. Today, they begin hearing the case for the defence. A further three months of hearings are scheduled, involving scores of lawyers, medical experts and witnesses in what is likely to be one of the most expensive misconduct cases ever heard by the GMC, which is responsible for regulating doctors and ensuring good medical practice. There is speculation that a judgment could be delayed until 2009.
The 92-page list of allegations took more than an hour to read out. A key charge is that when Dr Wakefield submitted his research paper to The Lancet, he failed to declare he was a paid adviser to solicitors acting for parents who believed their children were harmed by MMR and had accepted £55,000 from the Legal Aid Board for research to support their legal action.
It was this disclosure that led The Lancet to announce a partial retraction of the paper in 2004 in what the editor, Richard Horton, declared was a "fatal conflict of interest". Dr Horton said the had he known about it at the time, he would never have published the paper.
Yet Dr Wakefield had admitted receiving the legal aid payments in a letter published in The Lancet in May 1998, three months after his research appeared, and he is expected to argue that the journal knew this before publication. He had also patented a single measles vaccine in 1997.
Other medical editors have pointed out that most authors of research papers have some conflict of interest. While normal practice is to declare it at the end of the paper, the degree of conflict that would render a paper unpublishable is undefined. But it is the damage done to public confidence in vaccination that is the most serious legacy of Dr Wakefield's work.
Since The Lancet printed his paper in February 1998, a series of epidemiological studies has failed to find any evidence of a link between MMR and autism. This has failed to satisfy parents, predominantly middle-class and well-educated, who have refused to allow their children to be immunised or demanded single vaccines, as Dr Wakefield recommended.
One of the greatest puzzles of the saga is what has sustained this level of mistrust in the medical authorities. Unlike most scientific controversies which flare up and die away, this one has simmered for a decade – and is now to be fired up again by the GMC case.
Dr Wakefield is said to be unrepentant about his research and remains convinced that some children are vulnerable to damage by the MMR vaccine. His supporters claim that independent studies from different countries have confirmed his findings – but clinical investigation of individual cases which could provide the proof has been blocked in the UK.
Dr Wakefield's career in Britain ended in 2001, when he lost his job at the Royal Free Hospital in London, where he carried out his research. Ostracised by the medical community, he moved to America with his wife and four children and now works at Thoughtful House, a centre for children with developmental problems in Austin, Texas.
The risk is that the GMC case against Dr Wakefield will reinforce the view that there is a conspiracy by the Government, drugs companies and the medical establishment to promote the MMR vaccine and discredit a doctor whose only sin was to raise questions about its safety. If found guilty, he will become a martyr to the cause – a lone voice struggling to defend the interests of desperate parents and their damaged children. If he is exonerated, it will add fuel to the anti-MMR campaign. Either way, it looks as if parents and children will be the losers.
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