On January 28, 2010, the morning the panel’s ruling was to be issued, Wakefield appeared outside the GMC’s headquarters wearing a dark gray suit, crisp white shirt, and bright red tie. He was accompanied by his wife, whose long blond hair was accented by a knee-length black leather coat and tall black leather boots. While a small coterie of his supporters disrupted the council’s actual meeting by shouting “Bastards!” and “Bullshit!” at the panel’s members, Wakefield remained on the street outside, where he kissed despondent mothers and hugged autistic children. At one point, the crowd, which was speckled with signs reading, “Guilty of helping damaged kids” and “We’re WITH Wakefield—Crucified for helping sick kids with autism,” broke into spontaneous chants of “For he’s a jolly good fellow.”
Ever since 2004, when the fruits of Brian Deer’s investigative reporting began appearing in The Times (London), Wakefield and his allies had steadfastly insisted that the actual issue at hand was not anything as pedestrian as medical ethics or conflicts of interest—it was the suppression of a doctor trying to help families who were being ignored by a pitiless establishment. “My only concern was for the clinical well-being of this child,” Wakefield told the press one morning before testifying about his treatment of a research subject. “It was my duty as a physician and a human being to respond to the plight of this mother.”
Despite his lofty rhetoric, Wakefield failed to call on even a single parent to give evidence in his defense. When Rochelle Poulter, a fervent supporter of Wakefield’s whose son, Matthew, had been identified as “Child 12” in the pages of The Lancet, did take the stand, it was the prosecution, not Wakefield’s lawyers, who had requested her presence. Matthew’s health problems had begun in 1994, when he began soiling himself multiple times every day. Two years later, when Matthew was five, he was diagnosed as being on the autism spectrum. Poulter and her husband were just coming to grips with this new reality when Poulter ran into an acquaintance at a mother-and-toddler play group. “[She] asked me if he had received his MMR jab, because she’d heard there might be a link with autism and bowel disorders,” Poulter said. Despite the fact that Matthew’s first MMR shot had been administered more than a year and a half before his gastrointestinal problems had started and almost four years before he was diagnosed with a developmental disorder, when Poulter heard about Wakefield’s theory, “The pieces fell into place. I cried.”
Soon thereafter, Poulter contacted Wakefield’s research team at the Royal Free Hospital. Even though a slew of preliminary tests showed that Matthew had little or no signs of an ongoing GI disorder—Wakefield himself acknowledged that while Matthew had some “features of autism,” he had “rather minimal gastrointestinal symptoms”—Wakefield included the boy in his study. On the afternoon Matthew was admitted to the hospital, a physician making rounds wrote on Matthew’s chart that he was “not to have MRI or LP [lumbar puncture].” Nevertheless, over a four-day period, Matthew was subjected to “a colonoscopy, a barium meal and follow-through, an MRI scan of his brain, a lumbar puncture . . . an EEG and other neurophysiological tests, and a variety of blood and urine tests.” Despite an employment contract that explicitly prohibited his involvement in the clinical management of patients’ care, Wakefield signed the hospital request forms for a number of these procedures.
When the GMC ruled that Wakefield’s actions had been “contrary to the clinical interests of Child 12,” Rochelle Poulter was aghast. “I insisted that the hearing be informed that I was completely happy with the treatment my son had received and that I did not have any complaint against any of the doctors,” she wrote in a testimonial of her support. “To this day I do not really know why I was asked to attend and give evidence.” Her confusion was typical of the willful incomprehension of Wakefield’s supporters: As long as they had no grievance with Wakefield’s methods, they felt that any ethical violations he had committed in the course of treating their children should be ignored.
The final GMC report had none of the narrative drama or barely sublimated moral outrage of the Special Masters’ decisions in the Omnibus trials. (A typical passage read, “At all material times you were, a) A UK registered medical practitioner, Admitted and found proved b) Employed by the Royal Free Hospital School of Medicine. . . . Admitted and found proved c) An Honorary Consultant in Experimental Gastroenterology at the Royal Free Hospital; Admitted and found proved.”) The formal language did not diminish the record of callous opportunism chronicled in its pages. It wasn’t only that Wakefield had been working with Richard Barr, the lawyer representing families who believed their children had been injured by vaccines—he’d also been “dishonest,” “misleading,” and “in breach of your duty” when he accepted £50,000 from the U.K.’s Legal Aid Board to do work that had already been financed by the National Health Service. It wasn’t only that his claim that the children he had written about in The Lancet had been “consecutively [i.e. randomly] referred” was “dishonest,” “irresponsible,” and “resulted in a misleading description of the patient population in the Lancet paper”—he’d also subjected children who “did not meet the criteria for either autism or disintegrative disorder” to invasive and dangerous medical procedures. It wasn’t only that he had precipitated a worldwide vaccine scare whose repercussions were still being felt—he’d also positioned himself to profit on the panic by developing an oral measles vaccine that would be produced and distributed by a company he and the father of one of his test subjects had been in the process of founding.
Finally, there were the events that took place at Wakefield’s son’s birthday party, where he’d not only “caused blood to be taken from a group of children for research purposes” and “paid those children who gave blood £5 for doing so”—he’d also “described the incident referred to above in humorous terms,” and “expressed an intention to obtain research samples in similar circumstances in the future.” “You showed a callous disregard for the distress and pain that you knew or ought to have known the children involved might suffer,” the panel wrote in its conclusion. “In the circumstances you abused your position of trust as a medical practitioner [and] your conduct . . . was such as to bring the medical profession into disrepute.”
The GMC report didn’t contain any surprises—Brian Deer had already chronicled most of the particulars in even greater detail—but for the first time it appeared as though some of Wakefield’s stalwart defenders had had enough: On February 17, Jane Johnson, who’d gone from being Thoughtful House’s main financial backer to the co–managing director of its board, released a terse statement announcing that Wakefield had resigned. (The following day, Arthur Krigsman said he was leaving Thoughtful House as well.) When I asked Johnson why after all these years and all the red flags Wakefield was only now making his exit, she said the GMC decision had put him at greater risk of hurting the clinic “in terms of the local medical community with whom we’re trying to build bridges, with the Texas Medical Board. . . . Being associated with Andy is a lightning rod for negative attention.”
A couple of months after his departure from the treatment center he’d helped to launch, I called Wakefield at his home in Austin. It was our fifth conversation over the course of the previous year, and in that time, his countenance had become noticeably less cocksure. Our first interview had taken place the previous April, during an ARI/DAN! conference at the Renaissance Waverly Hotel in Atlanta. Wakefield was wearing sun-bleached cowboy boots and weathered jeans, and his blue-and-white-striped Oxford shirt was unbuttoned far enough to show off his deeply tanned chest. Throughout the hour I spent with him that morning, the only time his right leg stopped jackknifing was when admirers came over to introduce themselves. When I visited him at Thoughtful House four months later, he was noticeably more self-conscious; after I sat in on a brief staff meeting, he asked if we could conduct the remainder of our interview in a sandwich shop down the road as opposed to his windowless basement office. Now he just seemed dazed. He maintained his defiance—“Their case
was pathetic. . . . It was impossible to work out quite how they had the gall to get away with it”—but I got the impression that he was talking more to himself than to me.
When the conversation turned to his plans for the future, Wakefield said he was putting the finishing touches on a book titled Callous Disregard, which, in a manner reminiscent of David Kirby’s Evidence of Harm, took a quote from the ruling against him and flipped it on its head. “Basically it’s about why this [research] was closed down and why we have been treated the way we have—because the government is trying to cover up the fact that it introduced an unsafe MMR vaccine,” he said. “I haven’t been able to speak about it because of the legal proceedings, and now I’ve decided, To hell with that, and I’ve written a book on it.”
Before we hung up I asked Wakefield if I could read a prepublication copy of his manuscript, which was scheduled to go on sale that May. Of course, he replied—in fact, he said, he was keen on sending me a copy. “You might want to read it and decide whether it has a market in Israel, to see if anyone wants to find out what went wrong and why it went wrong,” he said. “You may want to decide if it’s worth translating into Hebrew.” It was one of the few times in my life I have been stunned into silence. The only context in which Wakefield had ever known me was as a reporter writing about a controversy that he’d help to start; in fact, on several occasions he’d stressed that he was limited in what he could share with me because he needed to marshal material for his memoir-cum-exposé. We’d never once had a conversation about our personal lives, never mind our religious backgrounds. (As it happens, I am Jewish. I do not, however, speak Hebrew.) I awkwardly tried to change the subject. Then, just as we were getting off the phone, he reminded me to stay in touch regarding “getting involved with the translation.” “Certainly your English is very good, so that’s not a problem,” he said. “But you may be too busy to do it—or you might have some recommendations.”
On Monday, May 24, 2010, Andrew Wakefield’s name was officially struck off of the U.K.’s medical register, which left him without a job or the ability to practice his chosen profession. Later that week, he received a standing ovation at the AutismOne conference in Chicago, where he also headlined a rally, gave two presentations, took part in an Age of Autism panel, posed for pictures with Bob Sears, and held a book signing. Wakefield might have been a lightning rod for negative attention from state medical boards and public health agencies, but it appeared as if his support among his core followers was as strong as ever. As Jay Gordon wrote in a blog post on his Web site, “I spent Saturday at an incredible conference in Chicago. Any thoughts I ever had about wavering in my support of Andrew Wakefield have dissolved. Jay.”
In the years since the conversation with my friend that launched this project, there’s been a dramatic rise in the number of communities where vaccination rates have fallen below the 90 to 95 percent threshold needed to maintain herd immunity. An overwhelming percentage of those are left-leaning, well-educated enclaves demographically similar to the neighborhood in which I live. The city that’s gotten the most attention as of late is Ashland, Oregon, which is home to a nationally renowned Shakespeare festival and the Ashland Independent Film Festival and has a vaccine exemption rate of around 30 percent, which is the highest in the country. Just north of San Francisco, Marin County, which has the fifth-highest average-per-capita income in the United States, has an exemption rate more than three times that of the rest of California. A recent Los Angeles Times investigation identified two hundred Southern California schools where outbreaks are more likely “in large part because of parents choosing not to immunize. . . . Most are schools in affluent areas.” One of those schools is the Ocean Charter School in Del Rey, California, where an entire century’s worth of medical advances have effectively been reversed: Since the 2007–2008 school year, between 40 and 60 percent of incoming kindergarteners have been exempted from vaccines. Administrators told the Times those figures were no surprise, because the school’s “nontraditional curriculum” attracted “well-educated parents who tend to be skeptical of mainstream beliefs.” “They question traditional knowledge,” the school’s assistant director said, “and feel empowered to make their own decisions for their families, not deferring to traditional wisdom.”
The situation is much the same throughout the rest of the country. Between 2005 and 2010, the rates of unvaccinated children doubled in New York and Connecticut and rose by 800 percent in New Jersey. Meg Fisher, the head of the AAP’s section on infectious diseases, said she almost never came across parents who asked for exemptions when her practice was located in inner-city Philadelphia. Now that she works in the suburbs of New Jersey, she encounters them all the time.
The consequences of these trends are as tragic as they are predictable. In 2009, six unvaccinated children in southeastern Pennsylvania were infected with Hib, a disease that was assumed to have been eliminated in the United States twenty years ago. Two of them died. In May 2010, a mumps outbreak that began the previous summer, when an eleven-year-old unvaccinated boy from Brooklyn was infected during a trip to England, was tracked all the way to Los Angeles. In October, the California Department of Public Health announced that a statewide whooping cough epidemic had already caused more than 5,500 infections, which put the state on pace to record the highest number of cases since 1950, when the pertussis vaccine was just entering widespread use. By that point, nine children had already died. Eight of them were infected when they were less than two months old, which is the age at which infants are scheduled to receive their first dose of the DPT vaccine.
It’s tempting to place the blame for this state of affairs squarely on the shoulders of people like Andrew Wakefield; after all, it would be hard to think up a character more sinister than someone who pays children for their blood. But that’s the easy way out: Wakefield might have provided the spark, and any number of other charlatans and hucksters might have fanned the flames, but it’s the media that provided—and continues to provide—the fuel for this particular fire. In February 2010, a month after the GMC issued its ruling and a year after the dual-causation Omnibus decisions were handed down, a columnist for The Boston Globe wrote about how she was worried that vaccinating her son could lead to “the moment he’d slip away. . . . For every scientific study that rejects a link [between vaccines and autism], there’s a heartbreaking, unprovable, irrefutable anecdotal story that says otherwise.” Four months later, the Globe used the occasion of Wakefield’s loss of his medical license to run another column on the issue of autism and vaccines. The main subject of that piece was Wakefield ally Richard Deth, an “undeterred” Northeastern University professor of pharmacology who “believes in the possibilities of outside-the-mainstream therapies and research” and is “intrigued by the use of special diets and supplements” to treat autism. Deth’s conclusions, the columnist wrote, “didn’t seem very controversial.”
She was right. Deth’s conclusions aren’t controversial: virtually everyone else in his field agrees that they’re wrong. This is not information that requires a lot of research to uncover. Deth’s testimony as an expert witness in one of the Omnibus cases prompted George Hastings to write, in his ruling in the Cedillo trial, a nine-page, point-by-point summary of the various deficiencies of Deth’s theories. Hastings concluded his analysis by writing, “There were also a number of other specific points concerning which Dr. Deth’s presentation was again shown to be erroneous, too numerous to detail here.”
The type of journalism that relies on the reporter’s notion of what does or doesn’t “seem” correct or controversial is self-indulgent and irresponsible. It gives credence to the belief that we can intuit our way through all the various decisions we need to make in our lives and it validates the notion that our feelings are a more reliable barometer of reality than the facts.
Make no mistake: the repercussions of this outlook extend far beyond this specific issue. According to NASA’s Goddard Institute for Space Studies, 2005 w
as the hottest year ever recorded; 1998, 2002, 2003, 2006, 2007, and 2009 are tied for second. (As of October 15, 2010 is on pace to take over the top spot.) During that time, the percentage of the population that said global warming is not a problem has doubled. Over the past several years, a number of states have either introduced or passed laws mandating that students be tutored in misinformation: In February 2010, both houses of the Kentucky legislature began considering a “science education and intellectual freedom” bill that “encourages” teachers to promote “critical thinking skills” about the “advantages and disadvantages of scientific theories . . . including but not limited to the study of evolution, the origins of life, global warming, and human cloning.” Louisiana has already passed a nearly identical law, and in 2009, the Texas Board of Education passed a curriculum that requires schools to teach “all sides” of evolution and the “strengths and weaknesses” of global warming.
Just as I was finishing my research for this book, my wife gave birth to our first child. Like hundreds of thousands of new parents around the world, vaccines scare me—but when I sneak into my son’s room at night to watch him sleep, I don’t worry that the day he gets his MMR shot will be the day he “slips away.” Instead, I worry that he might be one of those children for whom a given vaccine isn’t effective, or that he’ll come into contact with someone infected with Hib or measles or whooping cough before he’s old enough to have gotten all his shots. I worry that he’ll end up in a pediatric ICU because some parent decided the Internet was more trustworthy than the AMA and the AAP.
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