1/22/2011

Spin Spin Spin: Now it was Crohn's Disease and the MMR that Wakefield was all about

The apparent new talking point orders for Wakefield supporters are to insist that the 1998 retracted Lancet article was not about autism being caused by the MMR (he never said that!) and to focus not on the autism diagnosis (not the quote below that says in "some children") but on the  MMR and Crohn's.  Except that the kids didn't have Crohn's.

AoA has posted this bit of clever spin from Mothering:

"Mothering Editor and Publisher Peggy O'Mara interviews Dr. Andrew Wakefield; coauthor of a 1998 study that suggested a link between Crohn's Disease and the Measles Mumps Rubella (MMR) vaccine in some children. He has been accused of incorrectly linking the MMR vaccine with autism. In this special interview, Wakefield discusses the current controversy surrounding his research."

Mothering then actually links to the retracted Lancet paper. That's ballsy. Stripped of his medical license, erased from the registry, with several journal articles retracted, with solid accusations of fraudulent, dishonest behavior, Wakefield is out there continuing to self-justify. Now it's not about the autism and autistic enterocolitis he discovered ("
We have identified a chronic enterocolitis in children that may be related to neuropsychiatric dysfunction. In most cases, onset of symptoms was after measles, mumps, and rubella immunisation. Further investigations are needed to examine this syndrome and its possible relation to this vaccine."), it's the MMR and the Crohn's he discovered. But he didn't and it's curious that anyone would buy this spin.  

Before Wakefield happened on autistic kids as his way to sainthood, he focused on Crohn's and whether persistent measles virus might be responsible, so some of the references (19 and 20 below) are to his own work.

From the retracted Lancet paper:

We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described. Virological studies are underway that may help to resolve this issue.
If there is a causal link between measles, mumps, and rubella vaccine and this syndrome, a rising incidence might be anticipated after the introduction of this vaccine in the UK in 1988. Published evidence is inadequate to show whether there is a change in incidence22 or a link with measles, mumps, and rubella vaccine.23" (bolding mine)

Mentions of Crohn's in the retracted article are as follows:

"
Four cases showed the "red halo" sign around swollen caecal lymphoid follicles, an early endoscopic feature of Crohn's disease.3" But the children were not diagnosed with Crohn's.


"Measles virus 18,19 and measles vaccination 20 have both been implicated as risk factors for Crohn's disease and persistent measles vaccine-strain virus infection has been found in children with autoimmune hepatitis. 21" (19 and 20 are Wakefield's past research into measles virus and Crohn's disease, a connection that has not been replicated --see Seagroatt, 2005)

"Urinary methylmalonic-acid excretion is increased in disorders such as Crohn's disease, in which cobalamin excreted in bile is not reabsorbed." 

Those are the three mentions of Crohn's in the case series, and this last quote occurs in the second to last paragraph. No patients were diagnosed with Crohn's disease.

In the Fitness to Practice Panel Hearing, Crohn's in these children is dealt with.

On page 12, under Wakefield:

"b. On 1 August 1995 Child 2 attended an outpatient consultation with Professor Walker-Smith at St Bartholomew’s Hospital following  which Professor Walker-Smith concluded that there was no evidence of Crohn’s disease or chronic inflammatory bowel disease and he did not arrange to see Child 2 again,  
Admitted and found proved" (my bolding)

On page 13, still under Wakefield:

"In May 1996, after you had further contact with Mrs 2 regarding Child 2’s condition and subsequent discussions with Professor Walker-Smith, Child 2 was re-assessed by him on 21 June 1996.  Professor Walker-Smith recorded in the notes: “Arrange admission with Dr Wakefield.” After that out-patient consultation, Professor Walker-Smith wrote to Dr Cartmel (Child 2’s GP) (letter dated 28 June 1996) in which he states: “I think Crohn’s disease is 
unlikely. Dr Wakefield has the view that there may be some kind of other inflammation which may be a relevant factor in Child 2’s illness and we now have a programme for investigating children who have autism and a possible reaction to immunisation”. The Panel has concluded, on the basis of the medical records, that the programme of investigations that Child 2 underwent was for research purposes and for which there was no Ethics Committee approval." (my bolding)

Page 19:

"In addition to the reasons set out at 13. a., the Panel has taken into account the letter dated 16 May 1996 from Professor Walker-Smith to the paediatric neurologist which states: 'I am actually passing on [your] letter to my colleague Dr Andy Wakefield, who is the inspiration of our work linking MMR, autistic behaviour and Crohn’s disease and I am asking him to write to you to fill you in on our proposed study…'"

Except the Lancet article didn't find that these twelve children had Crohn's. In fact, it would seem that it disproved Wakefield's hypothesis, since they were not diagnosed with Crohn's.

Page 49:

"b. The invention which was the subject of the patent, and of which you were one of the inventors, related to a new vaccine for the elimination of MMR and measles virus and to a pharmaceutical or therapeutic composition for the treatment of IBD (Inflammatory Bowel Disease); particularly Crohn’s Disease and Ulcerative Colitis and regressive behavioural disease (RBD);       Admitted and found proved" (my bolding) And note this was done before the Lancet publication, "On or before 5 June 1997."

Page 58, under Walker-Smith:

"c. On 1 August 1995 Child 2 attended an outpatient consultation with you at St Bartholomew’s Hospital following which you concluded that there was no evidence of Crohn’s disease or chronic inflammatory bowel disease, Admitted and found proved" (my bolding)

Page 59, under Walker-Smith:

"h. On 28 June 1996 you wrote to Dr Cartmel stating that,  i. Crohn's disease was unlikely but Dr Wakefield’s view was that there might be some kind of other inflammation of relevance 
to Child 2’s illness, Admitted and found proved" (my bolding)

Page 61, under Walker-Smith:

"You wrote to Child 2’s GP on 28 June 1996, stating “I think Crohn’s disease is unlikely" (my bolding).

Page 69, referring to the letter quoted above on page 19.

And under Murch, page 115, again back to child 2:

"had seen Child 2 previously at St Bartholomew’s Hospital in August 1995 when he concluded that there was no evidence of Crohn’s disease or chronic inflammatory bowel disease,  
Admitted and found proved" (my bolding)

I don't know how Wakefield plans to pull off arguing that now the Lancet case series wasn't about a novel form of autistic enterocolitis as he has for years. ANDI lists Wakefield's subsequent articles where he promotes his idea of "a novel form of enteropathy in autistic children."

There is even a Wiki page devoted to autistic enterocolitis, which points out that Wakefield coined the term. ACN Online has a page devoted to autistic entercolitis and Balzola et al.'s work. Left Brain Right Brain points out that Balzola's published piece is a case study of one.


It seems fairly clear that although Wakefield hoped to show that MMR and Crohn's were also linked in autistic children that his case series did not bear this out and he had to settle for calling these gastrointestinal issues that he termed at the time "chronic enterocolitis." Not Crohn's. 


Additional References:

Seagroatt, V. (2005). MMR vaccine and Crohn's disease: ecological study of hospital admissions in England, 1991 to 2002. BMJ: British Medical Journal, 330(7500), 1120-1121. Retrieved from EBSCOhost.

3 comments:

sharon said...

Wakefield epitomises the saying, never let the facts get in the way of a good story.

Sirenity said...

Wow Kim, very nice breakdown. I have been a bit dismayed by all the posts and news articles with that line about Wakefield supposedly having NEVER meant for anyone to think it was about autism...
Guess his supporters hope that if they can get that line out there in enough of the www world then it will become true.

Catherina said...

Very nice take down, Kim. Very poor performance of sMothering to give Wakefield such a platform.