Are we really still talking about Wakefield's autism con?

We seem to be living in the age of the con. In a time when facts, well, they don't seem to matter very much, do they? We've moved beyond Stephen Colbert's "truthiness" to outright lies masquerading as the truth. And I am not even talking about Donald Trump.

Last weekend Andrew Wakefield, the disgraced former British physician, brought his shameful film Vaxxed to Philadelphia, where it is now screening at the Ritz Five. The film tries to resuscitate the unsupported belief that autism is caused by vaccination, specifically the measles, mumps, rubella vaccine (MMR). Study after study after study has shown this to be an outright false claim.

It finds an audience among parents who believe their children suddenly developed autism, and who are not helped by the medical profession's past insistence–just as misplaced as the vaccine hypothesis–that cold mothering was to blame. "We don't know what causes it" is not easy to hear.

Theater owners have a Constitutional right to screen whatever nonsense they like. But, as reminder to those searching for answers about the causes of autism, and for those who care about the public's health, Wakefield is not the truth teller that he claims to be.

Let's review the evidence.

1) Wakefield was banned from practicing medicine in Great Britain following a 2010 "Fitness to Practise Panel Hearing" by Britain's General Medical Council. It found that Wakefield had acted "dishonestly and irresponsibly" in conducting his infamous 1998 Lancet study, in which he first claimed the association between the MMR vaccine and autism. That study was retracted by the Lancet in 2010. According to the medical council, Wakefield conducted invasive tests, including colonoscopies and lumbar punctures, that were not approved by his institution's ethical review board and were against his research subject's best interests. In addition, Wakefield had paid children for blood samples that were drawn at his own son's birthday party (there's an idea for a party favor). The chair of the panel investigating Wakefield concluded that the research was conducted with "callous disregard for the distress and pain the children might suffer." Finally, the panel concluded that Wakefield did not disclose a clear conflict of interest—he was a paid advisor to lawyers representing parents who believed their children had been harmed by the MMR vaccine.

2) In 2011, investigative journalist Brian Deer published a scathing summary of Wakefield's unethical actions in the British Medical Journal. The flaws (to put it kindly) in Wakefield's Lancet study weren't simply about poorly conducted research. Instead, as Fiona Godlee, the editor-in-chief of BMJ told CNN in 2011, "It's one thing to have a bad study, full of error, and for the authors then to admit that they made errors. But in this case, we have a very different picture of what seems to be a deliberate attempt to create an impression that there was a link by falsifying the data."According to BMJ, "Wakefield altered numerous facts about the patients' medical histories in order to support his claim to have identified a new syndrome," and that "not one of the 12 cases reported in the 1998 Lancet paper was free of misrepresentation or undisclosed alteration, and that in no single case could the medical records be fully reconciled with the descriptions, diagnoses, or histories published in the journal." Finally, the BMJ report also found that Wakefield received 435,000 British pounds for his work with lawyers representing parents who believed that their children had been injured by MMR vaccine. A clear conflict of interest.

3) Evidence suggests that in the years since Wakefield's claims about the relationship between autism and MMR vaccine, skepticism of vaccination has grown. For God's sake, we are still talking about this!!! And while vaccine coverage remains robust nationally, there are pockets of vaccine resistance where we have seen significant drops in immunization coverage for kids. That means outbreaks of vaccine-preventable disease like measles because of spread among unvaccinated children. The 2014 Disneyland measles outbreak, for example, was due to MMR vaccination rates as low as 50% in some communities. While we can't directly blame the Lancetstudy for this, a 2008 paper found that "there was a significant increase in selective MMR nonreceipt that was temporally associated with the publication of the original scientific literature."

As I've written in these pages before, parents who accept the various vaccine hypotheses about autism are, after all, just parents looking for answers, sometimes desperately, for them and their loved ones. Nonetheless, it doesn't offer an excuse to follow the fraud offered by Wakefield that puts the public's health at risk. A statement published last year by the Autism Self Advocacy Network, a group that "seeks to advance the principles of the disability rights movement with regard to autism," frames the issue powerfully:

While no link exists between autism and vaccines, of greater concern is the willingness of those who promote this theory to suggest that exposing children to deadly diseases would be a better outcome than an autistic child. Vaccinations do not cause autism – but the use of autism as a means of scaring parents from safeguarding their children from life-threatening illness demonstrates the depths of prejudice and fear that still surrounds our disability. Autism is not caused by vaccines – and Autistic Americans deserve better than a political rhetoric that suggests that we would be better off dead than disabled.

Michael Yudell has published on the ethics of how autism risk is communicated (here and here) and is currently writing a book on the history of the condition.

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