In an article and editorial published online, a leading medical journal, BMJ, has taken aim at a competitor, The Lancet, by singling out a controversial paper that falsely linked a vaccine to increased risk of autism.
The object of BMJ's scorn is a 1998 paper by Andrew Wakefield, MBBS, and colleagues that implied a link between the measles-mumps-rubella vaccine and autism. Wakefield, according to the BMJ, was guilty of fraud.
"The Wakefield fraud had sat in plain view for six years before serious challenge. Journals, the BMJ included, had fretted over epidemiology and viral studies without giving pause to the remarkable, now fully-retracted, fundamentals," wrote journalist Brian Deer in a blog posted alongside the editorial and full report on the BMJ website.
The BMJ report is the latest installment from Deer, who had previously uncovered discrepancies between the published report and records of the 12 children described in the 1998 paper, published in The Lancet.
For the new article, Deer obtained more of the original records -- many of which were made public last year in a U.K. General Medical Council proceeding that stripped Wakefield of his British medical license -- and interviewed the children's parents.
Deer reported that many of the Lancet paper's descriptions of the children's conditions before and after vaccination were at enormous variance from the children's medical records -- so much so, according to Deer, that Wakefield must have committed research fraud.
For example, the Lancet paper indicated that 11 of the 12 children had "nonspecific colitis," but Deer's investigation found that only three had such symptoms.
More damningly, Wakefield and colleagues said eight of the children began showing autism-like or gastrointestinal symptoms within days of vaccination, whereas the records indicated that was true of no more than two. For the others, symptoms either had already been recorded prior to vaccination, or were not noted until months had elapsed, Deer indicated.
The Lancet formally retracted the 1998 paper last year, nearly a year after Deer published a series of articles in the Times of London that accused Wakefield of falsifying data, though it stopped short of calling the paper fraudulent.
In an editorial accompanying Deer's latest investigation, BMJ editor Fiona Godlee, MB, BChir, BSc, was not so diplomatic.
Godlee blasted Wakefield for "alter[ing] numerous facts about the patients' medical histories in order to support his claim to have identified a new syndrome" and insisted that incompetence could not account for the discrepancies.
"A great deal of thought and effort must have gone into drafting the paper to achieve the results he wanted: the discrepancies all led in one direction; misreporting was gross," Godlee wrote.
She also had harsh words for Wakefield's co-authors, even though most had previously repudiated the paper and the General Medical Council found that Wakefield alone had written the paper submitted to The Lancet.
"They all failed in their duties as authors," Godlee argued, suggesting that co-authors "have to check the source data of studies more thoroughly than many do at present."
Godlee said nothing about the responsibility of journals, including BMJ, that regularly published articles by Wakefield and colleagues in addition to the notorious 1998 Lancet paper.
But in a sidebar "blog" article also appearing on the BMJ website, Deer noted that they too deserve blame.
"Did the scientific community ever really believe that 12 families had turned up consecutively at one hospital, with no reputation for developmental disorders, and make the same highly specific allegations -- with a time-link of just days -- and that there was not something fishy going on?" Deer asked.
He likened the episode to the Britain's Piltdown Man fraud, in which a phony skeleton constructed of modern human and ape bones was officially accepted for decades as an ancient "missing link" until the deception was revealed in 1953.
Many in the scientific community looked the other way despite misgivings about the skeleton, Deer wrote, because they were reluctant to suggest openly that "a gentleman could not be trusted."
Asked about the public health implications of the Wakefield paper, Bill Schaffner, MD, who chairs the department of preventive medicine at Vanderbilt University in Nashville, told ABC News/MedPage Today, "Andrew Wakefield has done inestimable damage to the public health both in the U.S. and Europe. Bad enough when his work was thought to be a combination of inept science and misguided hucksterism -- now there are allegations of premeditated fraud! "
In an e-mail, Greg Poland, MD, of the Mayo Clinic, who is also editor-in chief at the journal Vaccine, wrote that the so-called vaccine hypothesis put forth by Wakefield "has hurt individuals, families, communities, and the broader public health. Children whose parents made fear-based decisions based on these claims have died, and these families are forever damaged and broken."
And Robert Jacobson, MD, chair of pediatrics at the Mayo Clinic in Rochester, Minn., blamed Wakefield for "worldwide drops in vaccination rates as well as a number of outbreaks of mumps and measles that centered in the British Isles but were felt the world over. In fact, the 2006 Iowan mumps epidemic and the 2009 New York mumps epidemic can both be traced to the British mumps virus that circulated as a result of loss of confidence in vaccination with MMR due to Wakefield."
Steve Lauer, MD, of the University of Kansas in Kansas City, had more blame to lay at Wakefield's feet: the ongoing pertussis epidemic in California.
Lauer told ABC News/MedPage Today that the increase in pertussis deaths in California is "another example of completely preventable deaths linked to the decline in vaccination rates. Study after study in numerous countries involving hundreds of thousands of children have never shown any link between autism and any vaccination. That Dr. Wakefield's lies have led to increased illness and deaths among innocent infants and children is a social and medical disaster."
The damage inflicted by the Wakefield papers can be measured not only in disease and death, but also in time and anxiety, said Leonard Rappaport, MD, of Children's Hospital in Boston, who wrote in an e-mail that it was "impossible to quantify the amount of time wasted in pediatric practice discussing why we believe that the MMR does not cause autism and that children should be immunized. Second, the heartbreak and worry for parents of children with autism who have secretly believed in the quiet of the night that they were responsible for their child having an autism spectrum disorder and the anxiety of parents approaching immunization time with so much false information and fear flying around them is impossible to comprehend."