Here’s a letter I wrote to The Sherbrooke Record in response to an article equating Dr. Andrew Wakefield, the man who started the MMR vaccine-autism controversy, and Dr. Ignaz Semmelweis who discovered in the 19th century a way to reduce puerperal fever among women giving birth but whose results were ignored . The article concluded that the Wakefield and Semmelweis story were the same, that both both were wrongfully ignored leading to needless deaths or cases of autism. If you read my response, you’ll see why that’s way off the mark.

When you write about entertainment, the only people who’s well-being you might affect is actors and musicians. When you write about health, you have to be really sure about what you say because people can take you at face value. Bad health advice doesn’t just cost people the $15 it cost them to see a bad movie, it can cost them their health–or worse, their children’s health.

Last week The Sherbrooke Record ran a mostly well-researched and written account of the research of Dr. Ignaz Semmelweis who discovered in the 19th century that by having doctors wash their hands between delivering babies they could reduce maternal mortality from puerpural fever from 20% to 1%. The problem was that Semmelweis’ research came before Louis Pasteur’s discovery of germ theory and therefore didn’t fit with the theories of the day. Despite the fact that Semmelweis’ research saved many lives, the practice was ridiculed and forgotten. If the article ended there, it would have left the reader enlightened.

Instead, Semmelweis’ story was tied to Dr. Andrew Wakefield, whose research misconduct lost him his medical license in the United Kingdom and the man to blame for the popularization of the idea that the measles, mumps and rubella (MMR) vaccine causes autism. There are two reason why it’s no longer reasonable to believe, much less propagate the idea, that the MMR vaccine causes autism.

The first has to do with Wakefield’s research itself. Despite the fact that it was published in The Lancet, the New York Times of the medical research world, so many flaws have been in found in how the research was conducted–most notably data falsification and conducting risky procedures on the 12 children who participated without ethical approval–that the paper has now been retracted. Through the work of journalist Brian Deer and the legal proceedings surrounding Wakefield, it has been revealed that the medical records and, perhaps most importantly, the stories told by the parents of the children involved in the study do not match the data published in the paper. The medical records and parents’ stories do not in any way support the theory that the MMR vaccine causes autism. For more, read Deer’s recent feature, “How the Case Against the MMR Vaccine was Fixed,” in the British Medical Journal.

Further condemning Wakefield was the fact that he failed to disclose that he had received over $600,000 from a lawyer who represented parents who wished to sue the vaccine makers. In the words of The Lancet’s editor Richard Horton, “There were fatal conflicts of interest in this paper. If we had known [about them], it would have been rejected.” When the other authors of paper were informed of this, 10 of 13 of them withdrew their support of the paper.

But even if, for some reason, you don’t believe the hospital records, the parents of the children involved or the United Kingdom legal system. Even if you think an undisclosed $600,000 isn’t a conflict of interest coming from people looking for a specific result. Even if you think Wakefield’s research was entirely on the up and up–there’s a problem. Wakefield’s study is what medical researhers call a case-series. Basically a study with no controls that simply describes a series of cases. Case-series are never meant to prove hypotheses. At best they can suggest a hypothesis to be tested with a larger scale observational study or randomized control trial. Both in the UK and the US, case-series rank very low in terms of quality of evidence.

This is where Wakefield’s story diverges from Semmelweis’ story. Where Semmelweis’ results were wrongfully ignored and forgotten, medical researchers did the right thing in response to Wakefield’s study by conducting many large-scale observation studies to see if the rate of autism was higher among children receiving the MMR vaccine than among those who didn’t receive it. The results indicated that there is no connection between the MMR vaccine and autism. A review of all the evidence available after Wakefield’s study said, “Low risk of
bias evidence did not support a causal association with Crohn’s disease, ulcerative colitis or autism.” In other words, well-designed and conducted studies revealed no evidence that the MMR vaccine causes autism.

Upon closer inspection, Semmelweis’ and Wakefield’s stories couldn’t be more different. Had the scientists of the day listened to Semmelweis or at least tested his theory further, many women who needlessly died could have been saved. On the other hand, many children whose parents believed Wakefield and refused vaccination had their health needlessly jeopardized. Wakefield is the furthest thing from a hero.