I had been wondering why the anti-vaccine crank blog Age of Autism had been gearing up the slime machine against Brian Deer lately. For example, former UPI reporter turned vaccine/autism cran Dan Olmsted has been attacking the BMJ. As you recall, the BMGpublished Brian Deer’s latest revelations earlier this year when he quite pithily and correctly referred to the now infamous (not to mention fraudulent and consequently retracted) 1998 Lancet case series published by vaccine/autism quack and crank Andrew Wakefield “Piltdown medicine.” Particularly curious are the more recent articles, which try to cast doubt on Deer’s reporting about Child 11, in essence calling Brian Deer a liar when he reported that Child 11′s symptoms of autism developed before he got the MMR vaccine, hitting that theme a week ago and then again earlier this week. I had been curious why Olmsted had resurrected his putrid yellow journalism directed at Brian Deer, after not having added to the series (An Elaborate Fraud) since part 6 in August.
Now I know. It’s a preemptive strike.
Just yesterday, the BMJ published another followup article by Deer entitled Pathology reports solve “new bowel disease” riddle that further elaborate on the the real “elaborate fraud,” namely Andrew Wakefield’s fraudulent research that ignited a scare about the MMR vaccine as a cause of regressive autism. It is a scare that has not yet abated, even nearly 14 years after the publication. It was a scare based on the claim by Wakefield that he had identified a new syndrome, which he later dubbed “autistic enterocolitis” in a followup paper in the American Journal of Gastroenterology. This syndrome, Wakefield suggested, was associated with vaccination with the MMR vaccine, and The Lancet paper, which linked autism and “autistic enterocolitis” with the MMR served as the basis of Wakefield’s later claims that the MMR vaccine was a cause of regressive autism. Thirteen years and multiple studies later, no investigator not somehow associated with either Wakefield and/or the anti-vaccine movement has been able to replicate his work. Indeed, an explicit attempt to replicate Wakefield’s work failed utterly. After all that time, there remains no persuasive evidence that such a syndrome as “autistic enterocolitis” even exists. Indeed, Deer found in his investigation that the vast majority of specimens that the gut was normal but only after a re-review by Wakefield’s team were they described as abnormal.
In any case, this alleged new syndrome depended on the finding of “colitis” in ileal biopsy specimens from autistic children in Wakefield’s original case series. In his book Callous Disregard, Wakefield claimed that he “played no part in the diagnostic process at all” and:
It was decided that, in order to standardize the analysis of the biopsies, the senior pathologist with the most experience in intestinal disease, Dr. Paul Dhillon, should review all biopsies from autistic children. In turn, Dhillon decided that pathology should be graded on a reporting form designed by him to document the presence and severity of microscopic damage. Thereafter, a regular review of biopsies took place involving Drs. Dhillon and Anthony, a trainee pathologist. I was also in attendance. Dhillon’s diagnosis formed the basis for what was reported in The Lancet.
Unfortunately, as Sullivan notes, these statements have been difficult to verify, and the original pathology slides made from biopsy samples taken from the original children studied in Wakefield’s case series are missing, which obviously makes it impossible to go back and look at the specimens and see whether expert pathologists agree with Wakefield’s team or not. This does make me wonder what happened to the original pathology blocks used to make the slides. If those still existed, it would be possible to cut and stain more sections. In fact, it makes me wonder how all of these specimens, slides, blocks, and all, could go missing. Be that as it may, it’s also interesting that Dr. Dhillon’s original scoring sheets were also missing.
Deer got ahold of the original scoring sheets, as he describes here:
Between 1988 and 2001, Wakefield was an academic researcher at the Royal Free medical school in Hampstead, north London, from which his five page paper was published. “Researchers at the Royal Free Hospital School of Medicine may have discovered a new syndrome in children involving a new inflammatory bowel disease and autism,” the school announced to promote the paper, which the Lancet retracted last year.
But the data–passed to us by David Lewis, a self employed American environmental microbiologist working with Wakefield–tell a different story, kept hidden for nearly 14 years.
The funny thing is that Lewis forwarded these reports to the BMJ because he thought they exonerated Wakefield, probably leading Wakefield now to wonder, “With friends like these, who needs enemies?”
What Deer got ahold of where Dhillon’s histology scoring sheets for 62 intestinal biopsy specimens from 11 of 12 of the Lancet children, and it turns out that Dhillon’s reports actually showed nothing particularly unusual. Deer reproduces some of the grading sheets in his article and on his website. For example, here’s the scoring sheet for Child #1 and for Child #2. It turns out that Dhillon did not find frank enterocolitis in any of the children, and in fact, quite the contrary to what was reported in The Lancet paper, what is recorded in these reports is far more consistent with normal intestinal mucosal than with any significant enterocolitis:
But Dhillon’s reports produced results that pathologists, gastroenterologists, and a gastrointestinal immunologist to whom we have shown them say are overwhelmingly normal and might be found in almost anybody’s gut.
“Most of this stuff is so close to normal that you’ve really got to question whether there is really anything there,” said Henry Appelman, professor of surgical pathology at the University of Michigan and a specialist in gastrointestinal disease. “These are the kind of things that we in our practise here would ignore completely.”
By way of background, remember that these specimens were nearly all read as normal by consultant histopathologist Susan Davies, who also challenged claims of “colitis” in a draft of the original Lancet paper withdrew her objections in favor of Dhillon’s analysis. However, as Deer reports:
But it now emerges that, although expressed as scores rather than narratives, Dhillon’s findings were largely consistent with Davies’s. “Everyone thinks I am crazy even asking them,” said King’s gastroenterologist Bjarnason, after discussing the scorings with other specialists. “All but one of the children is normal in their eyes. There is no enteritis and no colitis, simple as that.”
There was at least one other major problem, and that’s what was left out of the reports that might have put even the mild changes noted in the intestinal biopsies. What was left out was a history of severe constipation. For example, one of the patients endured failure to pass the endoscope because there was still fecal matter in the cecum, even after a full bowel prep. This is very important because pathologists, if they knew about this, would think less of even the mild changes observed, mild inflammation and lymphoid follicles, are common in biopsies of patients with severe constipation.
In a second article in the same issue of BMJ entitled MMR fraud needs parliamentary inquiry, says BMJ, as new information puts spotlight on Wakefield’s co-authors, BMJ editor-in-chief Dr Fiona Godlee goes one further than Brian Deer in that she asserts that at least six other papers by Wakefield besides the Lancet paper require “independent investigation.” She sent a letter to Andrew Miller MP arguing that Parliament must investigate University College of London, where the research was carried out, unless UCL immediately starts an independent inquiry:
“If UCL does not immediately initiate an externally-led review of its role in the vaccine scare, we believe that parliament should do it,” concludes Godlee. “After the effort and time it has taken to crack the secrets of the MMR scare, and the enormous harm it has caused to public health, it would compound the scandal not to heed the warnings from this catastrophic example of wrongdoing.”
Amusingly, Lewis, stung that his attempt to exonerate Wakefield by supplying the pathology scoring sheets to the BMJ has backfired so spectacularly and actually made the Wakefield team look even worse, is mounting a counterattack by writing a letter to the BMJ. Basically, his argument boils down to trying to claim that Wakefield was just “reporting what he was told” and had nothing to do with shaping the analysis of the bowel samples. In other words, Lewis is arguing that Dhillon and Wakefield were incompetent, although that’s not what he calls it. However, that’s not what the General Medical Council found after two years to investigate the matter. It concluded that there was fraud involved.
Hilariously, Lewis discusses learning of Deer’s stories earlier this year while at a “vaccine safety conference” with Wakefield. It’s hard not to note that if you say you’re at a “vaccine safety conference” with Wakefield, it was in actuality an anti-vaccine conference, and the conference to which Lewis refers is the infamous conference in Jamaica held earlier this year. There, Wakefield shared the bill with other anti-vaccine cranks such as Dr. Russell Blaylock (who is an all purpose medical crank and, like many all purpose medical cranks, anti-vaccine), Dr. Shiv Chopra (who is anti-vaccine to the core), and Dr. Richard Deth, Raymond Obamsawin, among others. Here’s a hint: While trying to defend and anti-vaccine crank like Wakefield, don’t bring attention to the fact that he’s an anti-vaccine crank by mentioning his having attended an anti-vaccine conference. Come to think of it, don’t mention your having attended the conference as well.
In the end, Deer’s latest findings are evolutionary, not revolutionary. It’s not clear why Lewis so wanted to exonerate Wakefield and clear his name that he was willing to persuade Wakefield to let him provide Dhillon’s scoring sheets to the BMJ, but I’m grateful that he was so clueless that he did so. In the absence of the original pathology specimens and the ability to get other pathologists to evaluate them, Lewis inadvertently provided the next best thing to help confirm once again the utter incompetence and fraud that is Wakefield.