It's the story of the 1998 medical journal article which made a link between a common vaccine and autism.
In this episode, we'll be talking about the MMR vaccine and its success, Wakefield's fraudulent motives, and the enduring consequences of the MMR deception.
[00:00:05] Hello, hello hello, and welcome to English Learning for Curious Minds, by Leonardo English.
[00:00:11] The show where you can listen to fascinating stories, and learn weird and wonderful things about the world at the same time as improving your English.
[00:00:19] I'm Alastair Budge, and today we are going to be talking about perhaps the greatest fraud and deception in recent medical history.
[00:00:27] This is the story of the 1998 article in the medical journal The Lancet, which made a link between a common vaccine and autism, and how its effects continue to be felt around the world to this very day.
[00:00:43] We have a lot to deal with in this story, so let’s not waste a minute, and get right into it.
[00:00:51] Imesi-Ile is a small rural town in southern Nigeria.
[00:00:56] And in the middle of the 20th century, it was in trouble.
[00:01:01] Children were dropping like flies, with only one in two reaching their fifth birthday.
[00:01:08] There were all sorts of reasons for this, but the major one was a disease the villagers called “èèyi”.
[00:01:17] In English, the name is “measles”, but you might know it as “il morbillo”, “la rougeole”, “Masern”, or “sarampión”.
[00:01:27] It’s a disease that causes red spots to form, which then spread all over the body.
[00:01:34] It affects children more than adults, and compared to some other diseases it's not always particularly deadly.
[00:01:42] Now, the actual mortality rate from measles is both variable and debated, but it’s estimated to be anywhere between 0.2% under normal conditions in countries with good healthcare systems going up to 25% for children suffering from malnutrition.
[00:02:01] What is not debated, though, is that it is incredibly infectious, with the average person who has measles infecting somewhere between 12 and 18 other people, so even if it might not be the most dangerous and deadly of diseases, the fact that it is so contagious means that it spreads like wildfire.
[00:02:24] And in the town of Imesi-Ile, there seemed to be nothing that could be done to rid the children of the disease.
[00:02:33] That was, until 1960, when a British doctor who had been posted there suggested to trial a new and as of then untested type of vaccination.
[00:02:47] One small jab, a quick injection, and a child would be protected, with their probability of getting measles drastically reduced, and the probability of dying from it if they were unlucky enough to also get it also dramatically reduced.
[00:03:05] That was the theory at least.
[00:03:07] The British doctor really believed that it would work, so much so, in fact, that he included his own four children in the trial.
[00:03:17] Fortunately, it worked, and measles was stopped in its tracks.
[00:03:23] Soon the red spots vanished, and the children stopped dying.
[00:03:29] In fact, the village started to have a very different problem to deal with.
[00:03:34] The population started growing at 9% per year, and before long the community health service switched its focus from trying to stop children from dying to implementing a family planning programme, to encourage the families of Imesi-Ile to have fewer children to stop this explosion in the population.
[00:03:55] Shortly after this successful trial in Imesi-Ile, the vaccine was approved and adopted by countries all over the world.
[00:04:05] All of a sudden, just like in this Nigerian village, children stopped getting this disease, and measles deaths went off a cliff, the numbers reduced drastically.
[00:04:19] A disease that used to kill an estimated 2.6 million people every year now kills just over 100,000.
[00:04:30] And a decade after the introduction of the measles vaccine, an American microbiologist called Maurice Hilleman developed a three-in-one vaccine, which protects children not just against measles, but also against mumps and rubella.
[00:04:49] As you’ll know, mumps and rubella are different diseases, both less serious, but both posing significant health risks to children.
[00:04:59] And this new three-in-one MMR vaccine, which became available in 1971, was incredibly effective at protecting children from all three diseases.
[00:05:12] It was cheap, safe, easy to administer, and most importantly, it was very good at saving lives.
[00:05:22] Given all of this, it became very popular, a cornerstone in the public health policies of countries all over the world. And to put a number on it, since it was first released, it has been administered to an estimated 575 million children.
[00:05:42] I got it, almost every British child of my generation got it, and depending on how old you are, perhaps you got it too. But in February of 1998, the well-respected and going on 200-year-old medical journal, The Lancet, published a bombshell piece of research.
[00:06:07] The lead author was a British researcher called Andrew Wakefield, and in this paper he made the suggestion that there could be a link between this vaccine, the MMR vaccine, and the neurodevelopmental disorder, autism.
[00:06:25] In other words, Wakefield’s research suggested that a child given this MMR vaccine was more likely to develop autism than a child who wasn’t.
[00:06:37] As you might imagine, this was a huge revelation. The MMR vaccine had been in use since the early 1970s, and was given to practically every child in Britain to protect them against these three dangerous diseases.
[00:06:53] And it had been working wonderfully.
[00:06:56] Deaths from these three diseases had plummeted; people simply didn’t get them any more.
[00:07:03] But out came Wakefield’s research paper, which made the suggestion of a connection between these marvellous vaccines that had stopped these three diseases in their tracks and autism.
[00:07:17] Now, to briefly remind you of exactly what autism is, it is a complex developmental condition that affects how a person communicates and interacts with others. People with autism might find it harder to talk with other people, to understand social cues, and they might do the same things over and over.
[00:07:40] And before this paper, nobody really knew what caused autism.
[00:07:46] Was it genetic, was it environmental, was it something brought on during pregnancy, was it linked to certain plastics, foods, smoking or alcohol?
[00:07:58] Or, according to Andrew Wakefield, could it be caused by the MMR vaccine?
[00:08:05] Did this miracle vaccine, a vaccine that was saving millions of lives every year, did it turn children autistic?
[00:08:15] So, let’s take a look at exactly what Wakefield proposed, and how this connection was made.
[00:08:22] In the paper, Wakefield’s hypothesis was that the MMR vaccine caused inflammation of the intestines and harmful proteins to enter into the bloodstream. These proteins, so Wakefield hypothesised, were harmful to the brain, and could bring on autism.
[00:08:45] So, where did this come from, Wakefield must have got this idea from somewhere?
[00:08:51] After all, it was a scientific study published in a well-respected medical journal, and Wakefield was a trained and experienced doctor; this wasn’t some case of an eccentric amateur scientist doing an experiment in his garden shed and calling up the local newspaper to report on his discovery.
[00:09:12] Well, in the study, Wakefield focussed on a group of 12 children who all had some form of “developmental delay” and who had been sent to a London hospital with stomach problems.
[00:09:26] According to Wakefield, all of these children had developed stomach complaints shortly after getting their MMR jab, and had subsequently developed autism.
[00:09:38] There was a large press conference when the story was first published, with journalists from major newspapers and TV stations coming along to report on these scandalous revelations, or at least, scandalous suggestions.
[00:09:53] It was major news, all over the TV and on the front pages of major publications like The Guardian and The Independent.
[00:10:03] Clearly, it would be a huge revelation.
[00:10:07] The problem was, the entire research was at best flawed, full of mistakes and inconsistencies, and at worst, dishonest and fraudulent.
[00:10:21] Firstly, almost every child in Britain got this MMR vaccine at the time, with the first jab at around 12 months of age and the second jab at 3 years and 4 months.
[00:10:33] Millions of children had been getting it, but there was no evidence of an increase in autism in British children.
[00:10:43] Secondly, the causality in the paper was coincidental.
[00:10:48] The children in Wakefield’s paper were aged between 3 and 10, with an average age of 6.
[00:10:56] This is also the age range that children who have some form of autism tend to be diagnosed.
[00:11:03] So statistically speaking, it was very likely that a child who was diagnosed with autism would also have had the MMR vaccination, because everyone did, with their second jab coming shortly after their third birthday.
[00:11:20] Thirdly, Wakefield had suggested that the vaccine caused inflammation of the intestines, which then released damaging proteins that brought on autism. But it was later shown that these children had been diagnosed with autism before they had reported problems with their intestines.
[00:11:41] Clearly, the timing here is of the utmost importance.
[00:11:46] It’s like someone who says that wearing sunglasses made them go blind, let’s say. If they were blind before they put on the sunglasses, then it wasn’t the sunglasses.
[00:11:58] What’s more, the paper was based on case reports, reports about the children’s medical history, rather than hard data, so the evidence was weak at best.
[00:12:11] Now, you might be listening to this and thinking “well, perhaps a few mistakes were made, but I can’t imagine this happened on purpose”, but it’s here that we move more from the “flawed” analysis to the “fraudulent” one.
[00:12:29] In 2004, six years after the paper was published, it was revealed that Dr Andrew Wakefield had many conflicts of interests.
[00:12:41] At the same time as he was putting himself forward as merely a researcher, it turned out that he had been paid by a lawyer who was trying to launch a class action lawsuit against the MMR vaccine.
[00:12:56] And the 12 children had been cherry picked, they'd been specifically chosen, because Wakefield believed they were more likely to demonstrate a link between the vaccine and autism, they weren’t randomly selected; they were chosen because Wakefield had specifically set out to prove a point.
[00:13:17] What’s more, Wakefield had patented a rival vaccine to the MMR vaccine.
[00:13:24] In other words, he had a vested financial interest in making the MMR vaccine look like it was dangerous, because if he could discredit the three-in-one, he stood to make millions of pounds a year with his alternative vaccine.
[00:13:41] This was a huge conflict of interest, and a violation of the ethical code.
[00:13:49] The Lancet, the medical journal in which the report was published, partially retracted the article shortly after this revelation and said that it had been deceived by the doctor.
[00:14:01] In fact, Dr Wakefield was not a doctor for much longer.
[00:14:07] In 2010 he was struck off the British medical register, meaning that he can no longer practise medicine or call himself a doctor, so now he is just Mr Andrew Wakefield.
[00:14:21] Despite all of this, and the fact that he has been outed as a fraud, Andrew Wakefield has done a huge amount of damage to the credibility of the MMR vaccine.
[00:14:33] Trust in the MMR vaccine took a huge dip, dropping by 50%, as parents perfectly understandably were cautious about injecting their children with something that a paper in a reputable medical journal had once suggested could cause autism, even if that suggestion had now been retracted.
[00:14:54] For the absence of doubt, Wakefield’s claims have been completely debunked and discredited, there is no proven link between this vaccine and autism.
[00:15:06] But for there to be no proven link was not enough for some parents; there were calls for the British government to prove that the vaccine didn’t cause autism, which is of course almost impossible to do.
[00:15:20] You can prove that there is a link between two things, a cause and an effect, but proving that there is absolutely no link between two things is harder.
[00:15:32] In other words, the absence of evidence is not evidence of absence.
[00:15:39] And the fact that the seed of doubt had been placed was enough for the confidence in MMR vaccine to drop. People wanted certainty that it did not cause autism, but all that doctors were able to confidently say was that there was no evidence of any link between the two.
[00:15:59] The vaccination rate dropped. 89% of British children were fully vaccinated against measles in the year 2000, but this dropped to 81% in 2004, before climbing back gradually after Wakefield's paper was proved to be fraudulent.
[00:16:19] And despite the fact that Wakefield’s claims have been disproved by practically every major scientific journal since, he has continued to beat the drum of MMR scepticism, going from one anti-vax conference to another.
[00:16:33] And he is still a powerful force, especially in certain communities that have inherent distrust of modern science and medicine, not just in Britain, but all over the world.
[00:16:45] After the US government declared measles to be eliminated from the country in the year 2000, the numbers of cases have kept creeping up, with a record 1,274 cases in 2019.
[00:17:01] And globally, both measles cases and measles deaths continue to increase, with deaths topping 200,000 in 2019, a 50% increase from 2016.
[00:17:16] The ironic but tragic fact is that the cause of this is exactly the same as in the Nigerian rural village of Imesi-Ile in the 1950s, but it’s now for very different reasons.
[00:17:31] Back then, there was no vaccine, so the disease was spreading like wildfire, and killing children in their droves.
[00:17:41] Now there is a vaccine, a vaccine that the scientific community at large has very high levels of trust in, and has been successfully used on a large proportion of the planet, but parents are opting not to give it to their children.
[00:17:58] So, to conclude, the story of Andrew Wakefield and his MMR deception tells us many things, but perhaps most importantly it is a stark reminder of how fragile public trust is.
[00:18:13] When it comes to our health, and especially the health of our children, we can all be particularly cautious, sceptical even.
[00:18:21] In the case of this paper, it had tragic consequences.
[00:18:26] A single fraudulent study not only jeopardised decades of public health progress but also reignited diseases in communities that had long been free of them.
[00:18:38] The American author HG Wells once wrote, “human history becomes more and more a race between education and catastrophe”.
[00:18:48] As this story shows, progress in this race is much more fragile than we might like to admit.
[00:18:57] OK then, that is it for today's episode on The Great MMR Hoax.
[00:19:02] I hope it's been an interesting one, that you've learnt something new, and I hope not to be inundated with messages from supporters of Andrew Wakefield.
[00:19:10] But, as always, I would love to get this discussion started.
[00:19:14] Is there a strong anti-MMR and anti-vax movement in your country?
[00:19:18] How has this changed over time?
[00:19:21] Let’s get the conversation started, so the place for that is community.leonardoenglish.com.
[00:19:27] You've been listening to English Learning for Curious Minds, by Leonardo English.
[00:19:33] I'm Alastair Budge, you stay safe, and I'll catch you in the next episode.
[END OF EPISODE]
[00:00:05] Hello, hello hello, and welcome to English Learning for Curious Minds, by Leonardo English.
[00:00:11] The show where you can listen to fascinating stories, and learn weird and wonderful things about the world at the same time as improving your English.
[00:00:19] I'm Alastair Budge, and today we are going to be talking about perhaps the greatest fraud and deception in recent medical history.
[00:00:27] This is the story of the 1998 article in the medical journal The Lancet, which made a link between a common vaccine and autism, and how its effects continue to be felt around the world to this very day.
[00:00:43] We have a lot to deal with in this story, so let’s not waste a minute, and get right into it.
[00:00:51] Imesi-Ile is a small rural town in southern Nigeria.
[00:00:56] And in the middle of the 20th century, it was in trouble.
[00:01:01] Children were dropping like flies, with only one in two reaching their fifth birthday.
[00:01:08] There were all sorts of reasons for this, but the major one was a disease the villagers called “èèyi”.
[00:01:17] In English, the name is “measles”, but you might know it as “il morbillo”, “la rougeole”, “Masern”, or “sarampión”.
[00:01:27] It’s a disease that causes red spots to form, which then spread all over the body.
[00:01:34] It affects children more than adults, and compared to some other diseases it's not always particularly deadly.
[00:01:42] Now, the actual mortality rate from measles is both variable and debated, but it’s estimated to be anywhere between 0.2% under normal conditions in countries with good healthcare systems going up to 25% for children suffering from malnutrition.
[00:02:01] What is not debated, though, is that it is incredibly infectious, with the average person who has measles infecting somewhere between 12 and 18 other people, so even if it might not be the most dangerous and deadly of diseases, the fact that it is so contagious means that it spreads like wildfire.
[00:02:24] And in the town of Imesi-Ile, there seemed to be nothing that could be done to rid the children of the disease.
[00:02:33] That was, until 1960, when a British doctor who had been posted there suggested to trial a new and as of then untested type of vaccination.
[00:02:47] One small jab, a quick injection, and a child would be protected, with their probability of getting measles drastically reduced, and the probability of dying from it if they were unlucky enough to also get it also dramatically reduced.
[00:03:05] That was the theory at least.
[00:03:07] The British doctor really believed that it would work, so much so, in fact, that he included his own four children in the trial.
[00:03:17] Fortunately, it worked, and measles was stopped in its tracks.
[00:03:23] Soon the red spots vanished, and the children stopped dying.
[00:03:29] In fact, the village started to have a very different problem to deal with.
[00:03:34] The population started growing at 9% per year, and before long the community health service switched its focus from trying to stop children from dying to implementing a family planning programme, to encourage the families of Imesi-Ile to have fewer children to stop this explosion in the population.
[00:03:55] Shortly after this successful trial in Imesi-Ile, the vaccine was approved and adopted by countries all over the world.
[00:04:05] All of a sudden, just like in this Nigerian village, children stopped getting this disease, and measles deaths went off a cliff, the numbers reduced drastically.
[00:04:19] A disease that used to kill an estimated 2.6 million people every year now kills just over 100,000.
[00:04:30] And a decade after the introduction of the measles vaccine, an American microbiologist called Maurice Hilleman developed a three-in-one vaccine, which protects children not just against measles, but also against mumps and rubella.
[00:04:49] As you’ll know, mumps and rubella are different diseases, both less serious, but both posing significant health risks to children.
[00:04:59] And this new three-in-one MMR vaccine, which became available in 1971, was incredibly effective at protecting children from all three diseases.
[00:05:12] It was cheap, safe, easy to administer, and most importantly, it was very good at saving lives.
[00:05:22] Given all of this, it became very popular, a cornerstone in the public health policies of countries all over the world. And to put a number on it, since it was first released, it has been administered to an estimated 575 million children.
[00:05:42] I got it, almost every British child of my generation got it, and depending on how old you are, perhaps you got it too. But in February of 1998, the well-respected and going on 200-year-old medical journal, The Lancet, published a bombshell piece of research.
[00:06:07] The lead author was a British researcher called Andrew Wakefield, and in this paper he made the suggestion that there could be a link between this vaccine, the MMR vaccine, and the neurodevelopmental disorder, autism.
[00:06:25] In other words, Wakefield’s research suggested that a child given this MMR vaccine was more likely to develop autism than a child who wasn’t.
[00:06:37] As you might imagine, this was a huge revelation. The MMR vaccine had been in use since the early 1970s, and was given to practically every child in Britain to protect them against these three dangerous diseases.
[00:06:53] And it had been working wonderfully.
[00:06:56] Deaths from these three diseases had plummeted; people simply didn’t get them any more.
[00:07:03] But out came Wakefield’s research paper, which made the suggestion of a connection between these marvellous vaccines that had stopped these three diseases in their tracks and autism.
[00:07:17] Now, to briefly remind you of exactly what autism is, it is a complex developmental condition that affects how a person communicates and interacts with others. People with autism might find it harder to talk with other people, to understand social cues, and they might do the same things over and over.
[00:07:40] And before this paper, nobody really knew what caused autism.
[00:07:46] Was it genetic, was it environmental, was it something brought on during pregnancy, was it linked to certain plastics, foods, smoking or alcohol?
[00:07:58] Or, according to Andrew Wakefield, could it be caused by the MMR vaccine?
[00:08:05] Did this miracle vaccine, a vaccine that was saving millions of lives every year, did it turn children autistic?
[00:08:15] So, let’s take a look at exactly what Wakefield proposed, and how this connection was made.
[00:08:22] In the paper, Wakefield’s hypothesis was that the MMR vaccine caused inflammation of the intestines and harmful proteins to enter into the bloodstream. These proteins, so Wakefield hypothesised, were harmful to the brain, and could bring on autism.
[00:08:45] So, where did this come from, Wakefield must have got this idea from somewhere?
[00:08:51] After all, it was a scientific study published in a well-respected medical journal, and Wakefield was a trained and experienced doctor; this wasn’t some case of an eccentric amateur scientist doing an experiment in his garden shed and calling up the local newspaper to report on his discovery.
[00:09:12] Well, in the study, Wakefield focussed on a group of 12 children who all had some form of “developmental delay” and who had been sent to a London hospital with stomach problems.
[00:09:26] According to Wakefield, all of these children had developed stomach complaints shortly after getting their MMR jab, and had subsequently developed autism.
[00:09:38] There was a large press conference when the story was first published, with journalists from major newspapers and TV stations coming along to report on these scandalous revelations, or at least, scandalous suggestions.
[00:09:53] It was major news, all over the TV and on the front pages of major publications like The Guardian and The Independent.
[00:10:03] Clearly, it would be a huge revelation.
[00:10:07] The problem was, the entire research was at best flawed, full of mistakes and inconsistencies, and at worst, dishonest and fraudulent.
[00:10:21] Firstly, almost every child in Britain got this MMR vaccine at the time, with the first jab at around 12 months of age and the second jab at 3 years and 4 months.
[00:10:33] Millions of children had been getting it, but there was no evidence of an increase in autism in British children.
[00:10:43] Secondly, the causality in the paper was coincidental.
[00:10:48] The children in Wakefield’s paper were aged between 3 and 10, with an average age of 6.
[00:10:56] This is also the age range that children who have some form of autism tend to be diagnosed.
[00:11:03] So statistically speaking, it was very likely that a child who was diagnosed with autism would also have had the MMR vaccination, because everyone did, with their second jab coming shortly after their third birthday.
[00:11:20] Thirdly, Wakefield had suggested that the vaccine caused inflammation of the intestines, which then released damaging proteins that brought on autism. But it was later shown that these children had been diagnosed with autism before they had reported problems with their intestines.
[00:11:41] Clearly, the timing here is of the utmost importance.
[00:11:46] It’s like someone who says that wearing sunglasses made them go blind, let’s say. If they were blind before they put on the sunglasses, then it wasn’t the sunglasses.
[00:11:58] What’s more, the paper was based on case reports, reports about the children’s medical history, rather than hard data, so the evidence was weak at best.
[00:12:11] Now, you might be listening to this and thinking “well, perhaps a few mistakes were made, but I can’t imagine this happened on purpose”, but it’s here that we move more from the “flawed” analysis to the “fraudulent” one.
[00:12:29] In 2004, six years after the paper was published, it was revealed that Dr Andrew Wakefield had many conflicts of interests.
[00:12:41] At the same time as he was putting himself forward as merely a researcher, it turned out that he had been paid by a lawyer who was trying to launch a class action lawsuit against the MMR vaccine.
[00:12:56] And the 12 children had been cherry picked, they'd been specifically chosen, because Wakefield believed they were more likely to demonstrate a link between the vaccine and autism, they weren’t randomly selected; they were chosen because Wakefield had specifically set out to prove a point.
[00:13:17] What’s more, Wakefield had patented a rival vaccine to the MMR vaccine.
[00:13:24] In other words, he had a vested financial interest in making the MMR vaccine look like it was dangerous, because if he could discredit the three-in-one, he stood to make millions of pounds a year with his alternative vaccine.
[00:13:41] This was a huge conflict of interest, and a violation of the ethical code.
[00:13:49] The Lancet, the medical journal in which the report was published, partially retracted the article shortly after this revelation and said that it had been deceived by the doctor.
[00:14:01] In fact, Dr Wakefield was not a doctor for much longer.
[00:14:07] In 2010 he was struck off the British medical register, meaning that he can no longer practise medicine or call himself a doctor, so now he is just Mr Andrew Wakefield.
[00:14:21] Despite all of this, and the fact that he has been outed as a fraud, Andrew Wakefield has done a huge amount of damage to the credibility of the MMR vaccine.
[00:14:33] Trust in the MMR vaccine took a huge dip, dropping by 50%, as parents perfectly understandably were cautious about injecting their children with something that a paper in a reputable medical journal had once suggested could cause autism, even if that suggestion had now been retracted.
[00:14:54] For the absence of doubt, Wakefield’s claims have been completely debunked and discredited, there is no proven link between this vaccine and autism.
[00:15:06] But for there to be no proven link was not enough for some parents; there were calls for the British government to prove that the vaccine didn’t cause autism, which is of course almost impossible to do.
[00:15:20] You can prove that there is a link between two things, a cause and an effect, but proving that there is absolutely no link between two things is harder.
[00:15:32] In other words, the absence of evidence is not evidence of absence.
[00:15:39] And the fact that the seed of doubt had been placed was enough for the confidence in MMR vaccine to drop. People wanted certainty that it did not cause autism, but all that doctors were able to confidently say was that there was no evidence of any link between the two.
[00:15:59] The vaccination rate dropped. 89% of British children were fully vaccinated against measles in the year 2000, but this dropped to 81% in 2004, before climbing back gradually after Wakefield's paper was proved to be fraudulent.
[00:16:19] And despite the fact that Wakefield’s claims have been disproved by practically every major scientific journal since, he has continued to beat the drum of MMR scepticism, going from one anti-vax conference to another.
[00:16:33] And he is still a powerful force, especially in certain communities that have inherent distrust of modern science and medicine, not just in Britain, but all over the world.
[00:16:45] After the US government declared measles to be eliminated from the country in the year 2000, the numbers of cases have kept creeping up, with a record 1,274 cases in 2019.
[00:17:01] And globally, both measles cases and measles deaths continue to increase, with deaths topping 200,000 in 2019, a 50% increase from 2016.
[00:17:16] The ironic but tragic fact is that the cause of this is exactly the same as in the Nigerian rural village of Imesi-Ile in the 1950s, but it’s now for very different reasons.
[00:17:31] Back then, there was no vaccine, so the disease was spreading like wildfire, and killing children in their droves.
[00:17:41] Now there is a vaccine, a vaccine that the scientific community at large has very high levels of trust in, and has been successfully used on a large proportion of the planet, but parents are opting not to give it to their children.
[00:17:58] So, to conclude, the story of Andrew Wakefield and his MMR deception tells us many things, but perhaps most importantly it is a stark reminder of how fragile public trust is.
[00:18:13] When it comes to our health, and especially the health of our children, we can all be particularly cautious, sceptical even.
[00:18:21] In the case of this paper, it had tragic consequences.
[00:18:26] A single fraudulent study not only jeopardised decades of public health progress but also reignited diseases in communities that had long been free of them.
[00:18:38] The American author HG Wells once wrote, “human history becomes more and more a race between education and catastrophe”.
[00:18:48] As this story shows, progress in this race is much more fragile than we might like to admit.
[00:18:57] OK then, that is it for today's episode on The Great MMR Hoax.
[00:19:02] I hope it's been an interesting one, that you've learnt something new, and I hope not to be inundated with messages from supporters of Andrew Wakefield.
[00:19:10] But, as always, I would love to get this discussion started.
[00:19:14] Is there a strong anti-MMR and anti-vax movement in your country?
[00:19:18] How has this changed over time?
[00:19:21] Let’s get the conversation started, so the place for that is community.leonardoenglish.com.
[00:19:27] You've been listening to English Learning for Curious Minds, by Leonardo English.
[00:19:33] I'm Alastair Budge, you stay safe, and I'll catch you in the next episode.
[END OF EPISODE]
[00:00:05] Hello, hello hello, and welcome to English Learning for Curious Minds, by Leonardo English.
[00:00:11] The show where you can listen to fascinating stories, and learn weird and wonderful things about the world at the same time as improving your English.
[00:00:19] I'm Alastair Budge, and today we are going to be talking about perhaps the greatest fraud and deception in recent medical history.
[00:00:27] This is the story of the 1998 article in the medical journal The Lancet, which made a link between a common vaccine and autism, and how its effects continue to be felt around the world to this very day.
[00:00:43] We have a lot to deal with in this story, so let’s not waste a minute, and get right into it.
[00:00:51] Imesi-Ile is a small rural town in southern Nigeria.
[00:00:56] And in the middle of the 20th century, it was in trouble.
[00:01:01] Children were dropping like flies, with only one in two reaching their fifth birthday.
[00:01:08] There were all sorts of reasons for this, but the major one was a disease the villagers called “èèyi”.
[00:01:17] In English, the name is “measles”, but you might know it as “il morbillo”, “la rougeole”, “Masern”, or “sarampión”.
[00:01:27] It’s a disease that causes red spots to form, which then spread all over the body.
[00:01:34] It affects children more than adults, and compared to some other diseases it's not always particularly deadly.
[00:01:42] Now, the actual mortality rate from measles is both variable and debated, but it’s estimated to be anywhere between 0.2% under normal conditions in countries with good healthcare systems going up to 25% for children suffering from malnutrition.
[00:02:01] What is not debated, though, is that it is incredibly infectious, with the average person who has measles infecting somewhere between 12 and 18 other people, so even if it might not be the most dangerous and deadly of diseases, the fact that it is so contagious means that it spreads like wildfire.
[00:02:24] And in the town of Imesi-Ile, there seemed to be nothing that could be done to rid the children of the disease.
[00:02:33] That was, until 1960, when a British doctor who had been posted there suggested to trial a new and as of then untested type of vaccination.
[00:02:47] One small jab, a quick injection, and a child would be protected, with their probability of getting measles drastically reduced, and the probability of dying from it if they were unlucky enough to also get it also dramatically reduced.
[00:03:05] That was the theory at least.
[00:03:07] The British doctor really believed that it would work, so much so, in fact, that he included his own four children in the trial.
[00:03:17] Fortunately, it worked, and measles was stopped in its tracks.
[00:03:23] Soon the red spots vanished, and the children stopped dying.
[00:03:29] In fact, the village started to have a very different problem to deal with.
[00:03:34] The population started growing at 9% per year, and before long the community health service switched its focus from trying to stop children from dying to implementing a family planning programme, to encourage the families of Imesi-Ile to have fewer children to stop this explosion in the population.
[00:03:55] Shortly after this successful trial in Imesi-Ile, the vaccine was approved and adopted by countries all over the world.
[00:04:05] All of a sudden, just like in this Nigerian village, children stopped getting this disease, and measles deaths went off a cliff, the numbers reduced drastically.
[00:04:19] A disease that used to kill an estimated 2.6 million people every year now kills just over 100,000.
[00:04:30] And a decade after the introduction of the measles vaccine, an American microbiologist called Maurice Hilleman developed a three-in-one vaccine, which protects children not just against measles, but also against mumps and rubella.
[00:04:49] As you’ll know, mumps and rubella are different diseases, both less serious, but both posing significant health risks to children.
[00:04:59] And this new three-in-one MMR vaccine, which became available in 1971, was incredibly effective at protecting children from all three diseases.
[00:05:12] It was cheap, safe, easy to administer, and most importantly, it was very good at saving lives.
[00:05:22] Given all of this, it became very popular, a cornerstone in the public health policies of countries all over the world. And to put a number on it, since it was first released, it has been administered to an estimated 575 million children.
[00:05:42] I got it, almost every British child of my generation got it, and depending on how old you are, perhaps you got it too. But in February of 1998, the well-respected and going on 200-year-old medical journal, The Lancet, published a bombshell piece of research.
[00:06:07] The lead author was a British researcher called Andrew Wakefield, and in this paper he made the suggestion that there could be a link between this vaccine, the MMR vaccine, and the neurodevelopmental disorder, autism.
[00:06:25] In other words, Wakefield’s research suggested that a child given this MMR vaccine was more likely to develop autism than a child who wasn’t.
[00:06:37] As you might imagine, this was a huge revelation. The MMR vaccine had been in use since the early 1970s, and was given to practically every child in Britain to protect them against these three dangerous diseases.
[00:06:53] And it had been working wonderfully.
[00:06:56] Deaths from these three diseases had plummeted; people simply didn’t get them any more.
[00:07:03] But out came Wakefield’s research paper, which made the suggestion of a connection between these marvellous vaccines that had stopped these three diseases in their tracks and autism.
[00:07:17] Now, to briefly remind you of exactly what autism is, it is a complex developmental condition that affects how a person communicates and interacts with others. People with autism might find it harder to talk with other people, to understand social cues, and they might do the same things over and over.
[00:07:40] And before this paper, nobody really knew what caused autism.
[00:07:46] Was it genetic, was it environmental, was it something brought on during pregnancy, was it linked to certain plastics, foods, smoking or alcohol?
[00:07:58] Or, according to Andrew Wakefield, could it be caused by the MMR vaccine?
[00:08:05] Did this miracle vaccine, a vaccine that was saving millions of lives every year, did it turn children autistic?
[00:08:15] So, let’s take a look at exactly what Wakefield proposed, and how this connection was made.
[00:08:22] In the paper, Wakefield’s hypothesis was that the MMR vaccine caused inflammation of the intestines and harmful proteins to enter into the bloodstream. These proteins, so Wakefield hypothesised, were harmful to the brain, and could bring on autism.
[00:08:45] So, where did this come from, Wakefield must have got this idea from somewhere?
[00:08:51] After all, it was a scientific study published in a well-respected medical journal, and Wakefield was a trained and experienced doctor; this wasn’t some case of an eccentric amateur scientist doing an experiment in his garden shed and calling up the local newspaper to report on his discovery.
[00:09:12] Well, in the study, Wakefield focussed on a group of 12 children who all had some form of “developmental delay” and who had been sent to a London hospital with stomach problems.
[00:09:26] According to Wakefield, all of these children had developed stomach complaints shortly after getting their MMR jab, and had subsequently developed autism.
[00:09:38] There was a large press conference when the story was first published, with journalists from major newspapers and TV stations coming along to report on these scandalous revelations, or at least, scandalous suggestions.
[00:09:53] It was major news, all over the TV and on the front pages of major publications like The Guardian and The Independent.
[00:10:03] Clearly, it would be a huge revelation.
[00:10:07] The problem was, the entire research was at best flawed, full of mistakes and inconsistencies, and at worst, dishonest and fraudulent.
[00:10:21] Firstly, almost every child in Britain got this MMR vaccine at the time, with the first jab at around 12 months of age and the second jab at 3 years and 4 months.
[00:10:33] Millions of children had been getting it, but there was no evidence of an increase in autism in British children.
[00:10:43] Secondly, the causality in the paper was coincidental.
[00:10:48] The children in Wakefield’s paper were aged between 3 and 10, with an average age of 6.
[00:10:56] This is also the age range that children who have some form of autism tend to be diagnosed.
[00:11:03] So statistically speaking, it was very likely that a child who was diagnosed with autism would also have had the MMR vaccination, because everyone did, with their second jab coming shortly after their third birthday.
[00:11:20] Thirdly, Wakefield had suggested that the vaccine caused inflammation of the intestines, which then released damaging proteins that brought on autism. But it was later shown that these children had been diagnosed with autism before they had reported problems with their intestines.
[00:11:41] Clearly, the timing here is of the utmost importance.
[00:11:46] It’s like someone who says that wearing sunglasses made them go blind, let’s say. If they were blind before they put on the sunglasses, then it wasn’t the sunglasses.
[00:11:58] What’s more, the paper was based on case reports, reports about the children’s medical history, rather than hard data, so the evidence was weak at best.
[00:12:11] Now, you might be listening to this and thinking “well, perhaps a few mistakes were made, but I can’t imagine this happened on purpose”, but it’s here that we move more from the “flawed” analysis to the “fraudulent” one.
[00:12:29] In 2004, six years after the paper was published, it was revealed that Dr Andrew Wakefield had many conflicts of interests.
[00:12:41] At the same time as he was putting himself forward as merely a researcher, it turned out that he had been paid by a lawyer who was trying to launch a class action lawsuit against the MMR vaccine.
[00:12:56] And the 12 children had been cherry picked, they'd been specifically chosen, because Wakefield believed they were more likely to demonstrate a link between the vaccine and autism, they weren’t randomly selected; they were chosen because Wakefield had specifically set out to prove a point.
[00:13:17] What’s more, Wakefield had patented a rival vaccine to the MMR vaccine.
[00:13:24] In other words, he had a vested financial interest in making the MMR vaccine look like it was dangerous, because if he could discredit the three-in-one, he stood to make millions of pounds a year with his alternative vaccine.
[00:13:41] This was a huge conflict of interest, and a violation of the ethical code.
[00:13:49] The Lancet, the medical journal in which the report was published, partially retracted the article shortly after this revelation and said that it had been deceived by the doctor.
[00:14:01] In fact, Dr Wakefield was not a doctor for much longer.
[00:14:07] In 2010 he was struck off the British medical register, meaning that he can no longer practise medicine or call himself a doctor, so now he is just Mr Andrew Wakefield.
[00:14:21] Despite all of this, and the fact that he has been outed as a fraud, Andrew Wakefield has done a huge amount of damage to the credibility of the MMR vaccine.
[00:14:33] Trust in the MMR vaccine took a huge dip, dropping by 50%, as parents perfectly understandably were cautious about injecting their children with something that a paper in a reputable medical journal had once suggested could cause autism, even if that suggestion had now been retracted.
[00:14:54] For the absence of doubt, Wakefield’s claims have been completely debunked and discredited, there is no proven link between this vaccine and autism.
[00:15:06] But for there to be no proven link was not enough for some parents; there were calls for the British government to prove that the vaccine didn’t cause autism, which is of course almost impossible to do.
[00:15:20] You can prove that there is a link between two things, a cause and an effect, but proving that there is absolutely no link between two things is harder.
[00:15:32] In other words, the absence of evidence is not evidence of absence.
[00:15:39] And the fact that the seed of doubt had been placed was enough for the confidence in MMR vaccine to drop. People wanted certainty that it did not cause autism, but all that doctors were able to confidently say was that there was no evidence of any link between the two.
[00:15:59] The vaccination rate dropped. 89% of British children were fully vaccinated against measles in the year 2000, but this dropped to 81% in 2004, before climbing back gradually after Wakefield's paper was proved to be fraudulent.
[00:16:19] And despite the fact that Wakefield’s claims have been disproved by practically every major scientific journal since, he has continued to beat the drum of MMR scepticism, going from one anti-vax conference to another.
[00:16:33] And he is still a powerful force, especially in certain communities that have inherent distrust of modern science and medicine, not just in Britain, but all over the world.
[00:16:45] After the US government declared measles to be eliminated from the country in the year 2000, the numbers of cases have kept creeping up, with a record 1,274 cases in 2019.
[00:17:01] And globally, both measles cases and measles deaths continue to increase, with deaths topping 200,000 in 2019, a 50% increase from 2016.
[00:17:16] The ironic but tragic fact is that the cause of this is exactly the same as in the Nigerian rural village of Imesi-Ile in the 1950s, but it’s now for very different reasons.
[00:17:31] Back then, there was no vaccine, so the disease was spreading like wildfire, and killing children in their droves.
[00:17:41] Now there is a vaccine, a vaccine that the scientific community at large has very high levels of trust in, and has been successfully used on a large proportion of the planet, but parents are opting not to give it to their children.
[00:17:58] So, to conclude, the story of Andrew Wakefield and his MMR deception tells us many things, but perhaps most importantly it is a stark reminder of how fragile public trust is.
[00:18:13] When it comes to our health, and especially the health of our children, we can all be particularly cautious, sceptical even.
[00:18:21] In the case of this paper, it had tragic consequences.
[00:18:26] A single fraudulent study not only jeopardised decades of public health progress but also reignited diseases in communities that had long been free of them.
[00:18:38] The American author HG Wells once wrote, “human history becomes more and more a race between education and catastrophe”.
[00:18:48] As this story shows, progress in this race is much more fragile than we might like to admit.
[00:18:57] OK then, that is it for today's episode on The Great MMR Hoax.
[00:19:02] I hope it's been an interesting one, that you've learnt something new, and I hope not to be inundated with messages from supporters of Andrew Wakefield.
[00:19:10] But, as always, I would love to get this discussion started.
[00:19:14] Is there a strong anti-MMR and anti-vax movement in your country?
[00:19:18] How has this changed over time?
[00:19:21] Let’s get the conversation started, so the place for that is community.leonardoenglish.com.
[00:19:27] You've been listening to English Learning for Curious Minds, by Leonardo English.
[00:19:33] I'm Alastair Budge, you stay safe, and I'll catch you in the next episode.
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