Stick With The Needle

Dr. Andrew Wakefield is an entrepreneur. In 1987 he patented a measles vaccine that faced a major impediment to success; the existing combination mumps, measles and rubella (MMR) vaccine dominated the market. So in 1988 Wakefield, with research support from equally entrepreneurial personal injury lawyers, published an article in the prestigious medical journal The Lancet that suggested that the MMR vaccine might be responsible for autism in young children. The problem was that Wakefield made up the data; there were only twelve children in the study (several of whom were offspring of litigious parents searching for confirmation of their suspicions of the vaccine), and the invasive procedures performed on the children were never cleared by an ethics board. Following a sensational news conference announcing Wakefield’s results, many concerned and frightened parents refused to vaccinate their children, exposing them to serious disease. Other researchers were unable to replicate Wakefield’s finding and no other scientists could find evidence that the vaccines were in any way linked to autism. Nevertheless, U.K. vaccination rates plunged below the levels necessary to contain the diseases and measles, a disease once on its way to eradication, reappeared and some children died. Resistance to vaccination spread to the U.S. and other countries and soon they too were reporting outbreaks of measles.

In 2004, due largely to the work of journalist Brian Deer (http://briandeer.com/solved/bmj-enterocolitis.htm), the fraudulent nature of the work, and the enormous sums paid Wakefield to support the litigation were widely publicized. Thereupon 10 of the original 13 co-authors redacted their names from the Lancet article. Prime Minister Tony Blair also spoke out for the efficacy of vaccination. Incredibly, The Lancet’s editor, Dr. Richard Horton, while conceding some irregularities and concerns, refused to retract the article. Publicity about Deer’s 2004 findings led to a rebound in vaccination rates but many parents remained fearful. Deer continued his research, unearthing, among many disturbing things, that about $780 thousand dollars paid to Wakefield came from The Legal Services Commission a publicly funded agency intended to help poor people gain access to legal aid that was hijacked by anti-vaccine activists to underwrite phony research and testimony. After losing his position at the Royal Free Hospital in 2001 Wakefield absconded to the U.S. and Florida’s International Child Resource Development Center, purveyors of dubious autism testing and treatment products, and was soon appointed to a $280,000 position at the oddly named Thoughtful House in Austin, Texas. Dr. Horton and The Lancet continued to defend the original article but a competing publication, The British Medical Journal, published and endorsed Deer’s findings. Finally in 2010, 12 years after the fraud, a British medical panel found that Wakefield’s work was dishonest, unethical, and displayed a “profound callousness” to the suffering of children affected by his work. The only double-blind factor in the fraud, The Lancet, finally retracted the article in 2010.

This is a story about a meme, those gene-like messages that biologist Richard Dawkins defined to explain the propogation and persitence of ideas. Memes, like viruses, are typically very simple creatures that rely on hijacking their hosts’ resources to reproduce and proliferate. The “vaccines cause autism” meme is short, memorable, and easily transmitted. Once a population is infected it is very hard to extinguish a bad meme. Many memes are not antigens in the sense of automatically stimulating our intellectual immune system. Treatment and removal of bad memes usually requires sustained action, either preventive inoculation in the form of expertise or exposure to compelling new information. Unfortunately, while the meme linking the vaccine to autism spread rapidly and widely, the meme refuting the fraud has moved relatively slowly and encountered stiff resistance from the original meme’s dupes and dupesters. Some believers have even threatened the people who exposed the fraud and others have sued to discourage efforts to discredit the false story. Wakefield’s fraud is but an example, although a dangerous one, of the proliferation of false or corrupt memes; in many cases made through the Internet. We call some of them “urban myths” or “legends” and everyone occasionally receives a few in their email.

Why do so many succeed in entering and lodging in the popular mind? To paraphrase the Irish philosopher Edmund Burke, “All that is necessary for the triumph of ignorance is that good men learn nothing.” The promotion of gratuitous self-esteem, the postmodern notion that facts are mutable social constructs, and increasingly common exposure to diluted forms of higher education supports spread of ignorance. As biologist Peter Medawar has observed, many people are educated well beyond their capacity for critical thinking.

Take Jenny McCarthy, former Playboy model, college drop-out, actress in a slew of tacky shows and movies, including being typecast in The Stupids, and a curiously influential autism activist who has helped spread and defend the “vaccines cause autism” meme. Let us grant Ms. McCarthy that having an autistic child, as she does, is a serious blow but it is no excuse for imperiling the children of impressionable and equally ignorant parents by discouraging vaccinations. Ms. McCarthy has remained steadfast in her support of Dr. Wakefield and, like others in the anti-vaccine industry, has sought to launch a new meme that Brian Deer is part of a drug company conspiracy to protect their investment in dangerous vaccines and other drugs.

What have we learned from this sorry episode? The story of the MMR vaccine meme is instructive in a number of ways. Robert Goldberg, author of Tabloid Medicine, How the Internet is Being Used to Hijack Medical Science for Fear and Profit, applies the findings of behavioral economists, Daniel Kahneman and Amos Tversky, that we are not very good at evaluating risks, particularly long term risks. I think that is a very useful insight that explains our vulnerability to fraudsters but we need also to look more broadly to the systems and institutions we create that facilitate the fraudsters.

• A fair number of memes are intentionally generated by self-interested people, lawyers in this case and many others, but they often find channels among self-promoting celebrities, gullible journalists, and guilt-addled citizens. Activists are continually looking for new targets.
• Corroborating experts can always be found, Wakefield in this case, but highly credentialed people have profited in many dubious frauds upon the public. Courts have been extraordinarily lax in testing and policing credentials.
• Tax-supported programs intended to provide legal support to poor and uneducated people (such as The Legal Services Commission in the U.K. or poverty law programs in the U.S.) are vulnerable to hijacking by self-interested parties, often lawyers. Whatever their initial mission, they exist to challenge the establishment and to sue, and so they do. These groups face no market discipline and measure success in suits and claims filed.
• Corrupt memes, such as the Rosenbergs’ innocence, the U.S. government’s advance knowledge of Pearl Harbor, and the MMR vaccine hoax, often spawn vested interests that promote their distribution and resist their eradication – often for years. These people can be vicious in defense of their franchise to exploit their ignorant supporters. Tevi Troy, a former deputy secretary of HHS, reports in a recent Weekly Standard book review that Dr. Paul Offit, a legitimate vaccine expert, has been repeatedly harassed and sued, called a terrorist, prostitute, and devil. No one seems to have used similar tactics with Ms. McCarthy.
• Official and media bodies are often slow to respond and often ineffective in battling false memes. Independent efforts such as Brian Deer, are often more effective but face the threats mentioned above as well as the institutional agendas of seemingly reputable actors. The Lancet, under Dr. Horton, protected the seed meme for twelve years, in part for Horton’s left-wing political agenda which included prostituting the once-great journal with articles of extravagantly biased estimates of Iraq war casualties intended to erode support for the campaign.

The story of vaccines tells us a lot about the public system of health regulation and reminds us that incentives matter. Why we are surprised when initially well-intentioned institutions support the efforts of evil people is another issue.

Posted by Bob

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