MMR: OH DEER OH DEER

Private Eye 26 Nov, 2004

THE makers of Channel 4's MMR: What They Never Told You in the Dispatches strand should perhaps have thought twice before engaging journalist Brian Deer to present a hatchet job on Dr Andrew Wakefield.

According to Deer, Dr Wakefield, the gastro-enterologist at the centre of the MMR controversy, was little more than a snake oil salesman who led a Royal Free medical school conspiracy to discredit the MMR triple vaccine and make money from a vaccine it was developing itself.

Deer also claimed that when Wakefield voiced his concerns about the triple jab, he had already tested for and failed to find measles in the autistic and gut-diseased children he was treating; and moreover that those children were abused in the name of his flawed research. There were plenty of other allegations thrown into the mix but those are the main ones and certainly the ones over which m'learned friends are currently rubbing their hands.

What Deer failed to point out is that until Wakefield voiced concerns over MMR, he was a high flyer at the forefront of advances in understanding and treating inflammatory bowel diseases. Yet Deer made no mention of Wakefield's previous career or credentials; no mention of the science which preceded the controversial 1998 paper which Deer claims started the MMR scare; no mention of the research since (including that which has found measles virus in the guts, spinal fluid and in one case the brain of an autistic child). Nor was there any acknowledgment that the controversial paper in question - only partially retracted last year - did indeed identify a new disease process in these children's guts.

Deer's personalised documentary follows his allegations earlier this year in the Sunday Times that when Dr Wakefield's paper was published, he had not yet declared that he had been become an expert adviser to the children in the UK litigation against the vaccine manufacturers. Although the issue of a conflict of interest was actually raised in the Lancet six years ago, its resurfacing in the Sunday Times has led to Dr Wakefield and two others from the Royal Free research team now defending the charges in an unprecedented hearing before the general medical council.            

Deer's most recent demonisation of Wakefield and his theory was based on the fact that nine months before publication of the 1998 paper, Wakefield and the Royal Free sought to patent a treatment, called Transfer Factor, with a spin-off vaccine and that this had been kept secret until now. The team at the Royal Free were indeed at one stage intending to carry out a treatment trial of a method of boosting immune response to measles virus using cell lymphokines, part of the body's defence mechanism.

In the event this was never pursued by the Royal Free: there was no trial, no treatment, and  no vaccine. A patent was, however, granted in 1999. But contrary to Deer's suggestion, Wakefield did declare it. The Eye has seen a letter he wrote to the Lancet in 1999 informing the editor of the patent. The Lancet decided not to mention it. The patent is also mentioned on at least three subsequent research papers.

Wakefield voiced general concerns about the combined measles vaccines as early as 1992, many years before the Royal Free patent application was filed in 1997.

Perhaps the most disingenuous part of Deer's programme was that viewers may have been left with the impression that not only was there no reason to believe measles virus present in the Royal Free children's gut at the time the paper was published, but that that is still the case today.

This is untrue on both counts - unless one of the world's leading pathologists, Professor John O'Leary, chair of pathology at Trinity College, Dublin, is seriously in error. Before publication of the 1998 paper, researchers had already found measles virus protein in the gut tissue, although not the virus itself. Further, at the site of the inflammation in the gut there were clusters of cells j that are typically seen in chronic virus infection.

On the programme, both of Wakefield's former collaborators told Brian Deer that if the measles virus was there they would have found it. But at the time they shared Wakefield's concerns that the method and equipment (now obsolete) used to detect the virus DNA was not sensitive enough. They put their names to the negative finding research paper which Wakefield himself insisted was published even though it went against his own hypothesis. It concluded: "These results show that either measles virus DNA was not present in the samples or was present below the sensitivity limits known to have been achieved."

And so it proved to be. Shortly afterwards the samples were sent to Prof O'Leary. Using state-of-the-art viral detection methods and equipment, he found measles virus in the guts of children with autism. It has since been found in the spinal fluid and brain. That work does not prove a link with autism, but it should at least raise alarms.

The response has always been that the O'Leary tests have not been replicated; but then other methods have always been used. Only now in the US are researchers seeking to properly replicate the work in what both sides of the debate are looking to as a definitive study. Prof Ian Lipkin, of Columbia University, NY, who is leading the research, is internationally renowned for his work in immunology and viruses.

Deer's allegation that Wakefield "abused" the Royal Free children by subjecting them to invasive procedures might have carried more weight if it had come from parents. But they consented to their children's treatments as part of the ongoing clinical investigation. Those children were being treated for appalling and painful gut disease - many had impacted bowels or persistent diarrhoea. Doctors at the Royal Free were diagnosing and treating, and in many cases alleviating, symptoms. They were not merely using the children for research.

Deer focused exclusively on Wakefield's past and did not consider any of the other relevant science. For example, in the week of his Channel 4 attack, a team from the John Hopkins University School of Medicine in Baltimore, looking at brain tissue of autistic patients, found chronic inflammation triggered by an abnormal immune response. Although it was a small study of 11 autistic people who had died, they also found similarly high levels of inflammatory cytokines (messengers that run between cells) in the spinal fluid from six autistic children. The researchers found an immune reaction similar to that found in dementia associated with HIV virus.

These sort of studies suggest Dr Wakefield is not the lone lunatic that Deer would have us believe. Despite allegations to the contrary, Private Eye is not anti-vaccine and has never said Dr Wakefield hypothesis is right. We have merely maintained that his work deserves proper investigation and that single jabs, used long before MMR, should be made available as a precautionary measure to keep up herd immunity. That proper investigation is finally taking place in the US; but until Prof Lipkin and others report, the jury is still out.

Interestingly, in Lancet editor Richard Norton's book on the MMR controversy, he disclosed how "one of the protagonists in the affair had said openly and publicly that his intention was to 'rub out' Wakefield". The "protagonist" in question? Step forward Brian Deer.