The Big Lie

How one doctor’s medical fraud launched today’s deadly anti-vax movement

By Kurt Eichenwald

Originals

Copyright © 2021 by Kurt Eichenwald

All rights reserved

Cover design by Catherine Casalino

ISBN: 9781094412849

First e-book edition: April 2021

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Author’s Note

This story is based on interviews I conducted with scores of people involved in the events it recounts, as well as on thousands of pages of documents, including court records, sworn statements, hearing transcripts, official witness interviews, and transcripts from 148 days of testimony over two and a half years before Britain’s General Medical Council. Other materials include personal letters, emails, memos, financial records and contracts, telephone logs, business plans, meeting minutes, video and audio recordings, medical reports and presentations, travel documents, scientific analyses and research papers, and an array of books, articles, and news broadcasts.

Every history builds on the work of others, and this is no exception. This story could never have been told without the tenacity of Brian Deer, the British reporter who exposed Andrew Wakefield’s chicanery. Without Deer’s reporting dating back to 2004, there is a strong chance that Wakefield’s deceits would have remained undiscovered, and his fraud would be wreaking far more global damage than it already has. Because of his dedication to truth, Deer has endured almost two decades of personal and professional attacks by members of the anti-vax movement. Anyone recounting this tale owes him a debt of gratitude.

Most of my interviews were conducted on condition of anonymity. However, I have chosen not to identify most sources who went on the record. This is because I have found that, in an investigative story, indicating those who agreed to speak on the record makes it easier to deduce the identities of those who did not.

Dialogue and the events described were reconstructed with the help of participants or witnesses to the conversations, documents that describe them, recordings of the words, or articles from reporters who heard the statements that are quoted. Because of the various means used to reconstruct dialogue, readers should not assume that a given speaker was my source for their statements. In a few instances, secondary sources had been informed of conversations with a participant; if the secondary source agreed on what was said, or the comments were corroborated by documents, the dialogue was used. Material reconstructed by this method never amounted to more than one sentence in a given scene and was never incriminating.

To weave together the narrative of the rise and collapse of Andrew Wakefield, I assembled a pyramid of credibility for the hundreds of sources I used. At the top were video, audio, and transcripts of the events described. Next were contemporaneous records: letters, emails, business plans. Following that were sworn statements, testimony, and interviews provided in official proceedings. Given the length of time that has passed, I compared some sources’ memories of dialogue with statements they made decades earlier. In those instances, I often quoted back to a source comments they had made to other reporters; if the source stood behind those words from many years before, I used them.

Of course, I am not claiming that the dialogue in these pages is a perfect transcript of incidents that occurred thirty years ago—that would be a feat of journalism beyond any reporter’s powers. It does, however, represent the best recollections of those events and conversations, supported by voluminous documentary records. Over the years, I have found that this approach more accurately reflects reality than mere paraphrase can. Indeed, I have often had sources summarize conversations for me, then asked them to go back and attempt to reconstruct the dialogue. When pushed to dig into memories—or when aided by documents placed before them—they frequently concluded that their summary recollections were incomplete or even incorrect compared with the dialogue they reconstructed.

In some cases, I was unable to determine the precise date when an event occurred. In those instances, I present the scene at the point in the narrative that is most consistent with the information contained in the relevant documents and interviews. Lacking certainty about the exact date, I have omitted it.

Finally, a note about science. I am not an expert on vaccines, developmental disorders, or any other medical or scientific field. However, from the time I first engaged in science reporting in 1999, the brilliant researchers I’ve interviewed have taught me what goes into strong medical studies and described the dangerous shortcuts taken by the careless or unconcerned. Researchers cannot take their interpretations a single step beyond what the data shows without sacrificing their credibility.

And that, perhaps, is the most shocking thing about Wakefield’s work: His published research did not prove what he implied (and later said) it did. His study never showed a causal link between the MMR vaccine and autism. Reporters did a disservice to the world by allowing Wakefield to spin nonsense at media appearances without carefully reading his study and disclosing that it offered no data-driven scientific support for his claims. Indeed, his small, inconclusive study would likely have passed unnoticed if the media had reported what the research actually found, and hadn’t allowed the lead scientist to publicly lie with impunity.

The Big Lie

Prologue

A Fateful Press Conference

INSIDE THE ROYAL FREE HOSPITAL, in London, scores of reporters, physicians, and hangers-on packed the Atrium conference room, waiting for a press briefing to begin. At the front, a table draped in blue cloth held microphones for the five medical specialists who, in a few minutes, would deliver what would prove to be a historic—and dangerous—announcement.

It was February 1998. As the crowd settled down, journalists reviewed the embargoed press release they had received the previous day revealing the news: A Royal Free study may have discovered a link between autism in children and a gastrointestinal disorder. Near the end of the official statement, a sentence noted that symptoms of the disorder sometimes emerged after a child had received the triple vaccine for measles, mumps, and rubella—known as the MMR—and suggested that more research into a possible link should be conducted.

The five scientists entered the room and took their seats. They had agreed beforehand to sidestep any broad pronouncements about vaccines, given that the study, involving just twelve children, had established no causal relationship between the vaccine, the disorder, and autism. In fact, any link bordered on little more than anecdote—barely enough to justify further inquiry. The researchers decided to discuss only the gastrointestinal condition and autism; if journalists raised questions about the MMR shot, the doctors would simply affirm the effectiveness of the lifesaving vaccine.

Then things took a jarring turn. A journalist asked the dean of Royal Free, Arie Zuckerman, whether parents should continue immunizing their children. Zuckerman threw the question down the table to Andrew Wakefield, the tall, boyishly handsome lead researcher. Zuckerman waited to hear Wakefield sing the praises of vaccination, as he had agreed to do, and to declare to the reporters that even his own children had been immunized.

Instead, Wakefield blindsided his colleagues. “I believe there are sufficient anxieties for a case to be made to administer the three vaccines separately,” he intoned. “I do not think that the long-term safety trials of MMR are sufficient for giving the three vaccines together.”

Wakefield’s words floored Zuckerman. Not only had he broken their agreement, but he was giving recommendations unsupported by their study or by any other research. No data, no hypothesis—nothing suggested that the MMR should be abandoned for separate inoculations. Wakefield, a gastroenterologist with no expertise in immunizations, was making a recommendation that none of them had even considered.

Worse, separate vaccines had been replaced by the MMR and were far more difficult to obtain. By slamming the triple shot in favor of largely unavailable individual vaccines, Wakefield could be interpreted as suggesting that parents cease inoculating their children entirely for three deadly diseases.

These irresponsible claims could not go unchallenged, Zuckerman decided. He interrupted his colleague’s reckless assertions and passed the question to Simon Murch, a pediatric gastroenterologist who—unlike Wakefield—worked with children.

“I have full confidence in the MMR vaccine,” Murch said. If this new study caused an unnecessary scare and led to cutbacks in immunizations, he added, measles cases would surely go up.

This wasn’t enough. Zuckerman jumped to his feet and pounded a lectern. “Measles is the eighth most common cause of death in the world today, and 250 million doses of MMR have been given in Western Europe,” he said sharply. “The MMR campaign has been shown to be safe and effective.”

It was too late. In the weeks and months that followed, Wakefield’s comments, amplified by the media megaphone, set off a global panic about the purported dangers of the MMR vaccine. Wakefield would stoke this fear for years, delivering lectures and speaking to any reporters who would listen to his theories, whipping up public opposition to a preventive measure that had saved millions of lives.

Epidemiologists, virologists, and other infectious-disease specialists argued against this unqualified doctor as they produced comprehensive research refuting his claims, but to little success. For a public already deeply suspicious of drug companies and their relationships with doctors and government officials, Wakefield’s assertion of a connection between the MMR and autism validated misguided beliefs and transformed a once unknown researcher into a superstar. He was lauded in speeches, at conventions, and even in a fictionalized television movie that portrayed him as a hero fighting for children while staving off dark forces in the pharmaceutical industry and the medical establishment.

The result? Measles, an often fatal disease that was on the verge of disappearing from the planet, has returned as a global threat, setting off epidemics and killing children in developing and industrialized countries alike.

Years passed before the ugly truth emerged: It was all a fraud. Wakefield had engaged in transgressions of audacious proportions by fudging and misreporting data, while lying to colleagues not only about his own conflicts of interest but about the families whose children figured in his research. A British medical council found his actions “irresponsible and dishonest” and stripped him of his license. Wakefield’s career crashed, his reputation in tatters.

Why did he do it? Popular belief presumes Wakefield’s motivation was a thirst for riches and fame, but the truth is more complex. He was a man obsessed, driven by a pet theory and furious that colleagues and the government refused to confer the acclaim he believed his work deserved. Combined with a temperament that relentlessly adopted viewpoints contradicted by evidence, this made him that most dangerous of deceivers: a man with unyielding faith in a falsehood. At bottom, however, was a basic fact that had little to do with malfeasance or psychological eccentricity: Wakefield, quite simply, was an utterly incompetent researcher.

“He didn’t really understand the basic science that he thought he was doing,” says Nicholas Chadwick, a researcher who conducted sophisticated molecular analysis in Wakefield’s lab for years. “The scientists thought of him as a laughingstock; they had no respect. But the [doctors] were quite in awe of him … When you have someone in charge who doesn’t know how science should work, things can get quite dangerous.”

Yet medical researchers who suspected something improper in Wakefield’s study largely remained silent, doubting their own doubts about his integrity, committing their faith to a review system not designed to catch fraud, and frightened about leveling the most serious charge possible against a scientist only to be proved wrong. Meanwhile, Wakefield kept himself in the limelight by spewing nonsense to journalists hungry for scoops and politicians eager for headlines.

The account of Wakefield’s deceptions is no mere sordid history lesson from the archives of research. Despite his exposure as a fraud willing to lie about his expertise and findings—or, more accurately, because of that exposure—Wakefield transformed himself into a champion of truth for the gullible. He left England for the United States, where he is lauded by those who oppose vaccines, known as anti-vaxxers, as one of the few health experts who can be trusted. Through the support of his acolytes, Wakefield’s public success grew far beyond what he could have imagined in his days toiling in medical school labs. He became wealthy through speaking engagements and lived in million-dollar homes. He mingled with celebrities associated with the anti-vax movement, including the former supermodel Elle Macpherson, who is now his girlfriend. Not surprisingly, he also caught the attention of Donald Trump. During a Republican presidential debate in 2015, Trump repeated Wakefield’s claim that vaccines cause autism, and he continued to make that claim throughout his campaign. Shortly before the 2016 election, Wakefield was granted an audience with Trump, whose vaccines-cause-autism rhetoric became an established part of his repertoire of lies.

What began at that 1998 press briefing as a misrepresentation of a small research study has ballooned into a myth with global consequences. After his career as a scientist collapsed, Wakefield expanded his lies until they bore no resemblance even to the false claims he’d made decades before. He moved from condemning the MMR to condemning vaccines in general, and lately has gone even further by attacking an array of critical public-health measures.

“Wakefield clearly ignited” the modern anti-vax movement, says Peter J. Hotez, co-director of the Center for Vaccine Development at Texas Children’s Hospital. “It started off with his MMR claims and evolved into sort of this whack-a-mole game, with new false claims about vaccines raised as the others are knocked down.”

Worse, much of the anti-vax movement has become aligned with far-right-wing groups, infusing long-held conspiracy theories and misinformation campaigns with political rage. That has made it far more difficult to combat COVID disinformation.

“Anti-vaxxers ramped up in 2015 when they aligned with right-wing political extremism,” says Hotez. “Then these political anti-vaxxers glommed onto masks and social distancing, becoming a full-on anti-science group.”

It is perhaps unsurprising, then, that Wakefield has gained prominence during the pandemic, claiming that COVID is not serious and that fighting it has only caused harm. At an online conference of anti-vaxxers last spring, Wakefield declared that the pandemic has led to “a destruction of the economy, a destruction of people and families, and unprecedented violations of health freedom. And it’s all based upon a fallacy.” By spring 2021, the COVID-19 death toll in the United States had surpassed 550,000.

This is why it’s so important to understand the full extent of Andrew Wakefield’s fraud. His story is not some remnant of the past; he continues to spread lies, to people who don’t know his history, don’t understand what he proved and what he didn’t, and don’t recognize that he could well be the most dangerous charlatan to emerge in modern medicine.

Attempts to interview Wakefield failed. One of his spokespeople, Jamie Coker-Robinson, said in an email that Wakefield typically does not do interviews with mainstream publications unless the articles will be “fair and balanced” about vaccines. When told that the information in this article would rely on peer-reviewed science, she replied that Wakefield’s problem with such stories “is that the ‘science’ used in articles such as yours to ‘debunk’ his claims as well as the smear campaign carried on shortly after his paper was published is often bought and paid for by the pharmaceutical industry and is not accurate.” After two more exchanges, Coker-Robertson stopped responding.

This story is based on scientific studies and researcher notes, business records and other internal documents, court filings, affidavits, sworn testimony, and emails, as well as interviews with British officials, lawyers, and others directly involved in the events they describe. The picture that emerges portrays the terrifying ease with which dishonest science and conflicts of interest can upend the world, and the desperate need for systems that hold compromised and incompetent researchers accountable.

“He has done incalculable damage, and he should have that on his conscience for the rest of his life,” says David Salisbury, a former director of immunization for the British government who had run-ins with Wakefield for years. “At a relatively early stage, I thought he was looking down the barrel of many years of unemployment. Actually, I was wrong. He reinvented himself instead. And now he’s rich.”

1

Ambition

ON A SUMMER DAY in 1982 in London’s Regent’s Park, thirty musicians from a British infantry regiment played selections from the musical Oliver! A crowd filled the area in front of the Victorian bandstand by the shore of a boating lake, eating lunch or relaxing on the grass as they enjoyed the first of a season of annual lunchtime concerts.

Unseen beneath the bandstand’s floorboards, a long-delay timer from a VCR ticked down until, at 12:55, it hit zero. In a nanosecond, an electric pulse flowed to a military-grade detonator inside fifteen pounds of nitroglycerine-laced gelatin.

The force of the explosion lifted the musicians off the floor. Bodies and body parts were flung everywhere. Six of the soldiers died instantly; a seventh was severely wounded and would later die. At least eight civilians suffered injuries.

Two miles away, Andrew Wakefield, a young intern at St. Mary’s Hospital, jerked his head at the sound of the explosion. He was outside, hurrying to get a sandwich, but lunch would have to wait. He knew the blast he’d heard was a bomb. Almost immediately, medical personnel dashed about, scrambling toward emergency vehicles. Wakefield climbed into the back of an ambulance that roared to the bandstand in less than five minutes.

They arrived to a scene of chaos. The bandstand was a wreckage, with bodies, charred limbs, and crushed chairs scattered across the grass. Wakefield barreled out of the ambulance but soon discovered that the seriously wounded had already been rushed to another nearby hospital, leaving only those with minor injuries. He wandered about, unable to help the victims, little more than a spectator.

“I felt an overwhelming sense of futility and failure,” he wrote of the experience. “My medical training had counted for nothing.”

The episode—later determined to be a terror attack launched by the Provisional Irish Republican Army in two London parks that day—transformed Wakefield. In the years that followed, he would tell family, friends, and supporters that he often relived that day whenever he stood on the sidelines of something, powerless to be of any help. He would never let that happen again. If patients needed him, he would do whatever was necessary, a conviction he believed was an important developmental step in his lifelong calling.

That Wakefield had pursued medicine would come as no surprise to those who knew him growing up in Bath, in southern England. The child of a neurologist and a general practitioner, Wakefield was often referred to as “the doctors’ son.” Even at a young age, the soft-spoken boy projected an air of calm charisma. That, combined with an intense faith in whatever he believed to be true—his family compared him to his grandfather, also a doctor, whose confidence in his own opinions was unshakable—made Wakefield a formidable and persuasive advocate for his convictions.

His gentle assuredness and good looks helped him move easily through life, succeeding even when he wasn’t the smartest or most talented. He set his sights early on becoming a surgeon, a goal that was known not just to his family but also to his classmates at King Edward’s, an exclusive private school.

Wakefield moved from Bath to study medicine at St. Mary’s, where he began his residency in 1981. In 1985, he married Carmel O’Donovan, a fellow St. Mary’s student, who would remain a steadfast advocate for decades. The following year, the Wellcome Trust, a research-based charity, awarded him a fellowship, and he moved to Toronto to study small-intestine transplantation. After two years, Wakefield returned home to join a liver-transplant program at Royal Free, an internationally renowned teaching hospital.

Slowly, he developed a reputation as a researcher, publishing studies from data he collected from surgical procedures and related treatments while working in Toronto and London. But a single observation changed the direction of his career: similarities between the rejection of a transplant graft and the appearance of Crohn’s disease, a chronic inflammatory syndrome of the gastrointestinal tract. Perhaps, he thought, Crohn’s was a vascular disease triggered by a viral infection. The idea was potentially transformative for the diagnosis and treatment of gastrointestinal illnesses like Crohn’s.

As Wakefield and his gastroenterology group embarked on pioneering research, excitement crackled among the tenth-floor medical staff at Royal Free. Wakefield and his boss, Roy Pounder, might well be on the verge of producing studies that could invigorate the long-moribund research work of the hospital’s Academic Department of Medicine.

Royal Free desperately needed this reputation boost. The school’s research efforts had become ho-hum, its reputation as a leader in medical science long faded. It still rested on the laurels of Dame Sheila Sherlock, the first female professor at the medical school and perhaps the twentieth century’s most revered contributor to the study of the liver. But after she stepped down as chief of medicine, more than a decade earlier, the spotlight of research fame had dimmed at Royal Free. The dull, crowded concrete building had become a metaphor for the institution: unimaginative, lumbering, unremarkable.

Radiating charisma, enthusiasm, and ambition, Wakefield was a shock to the system at Royal Free. This new idea of gastrointestinal inflammation as a vascular disease caused by a virus was a source of pride among the academic staff. For the layperson, it might seem remote, worthy of a shrug, but in the world of medicine, the theory, if true, was the stuff of Nobel Prizes.

“Wakefield brought a sudden sense of excitement to the department,” says Richard Horton, who worked in the liver unit at Royal Free in the early 1990s and is now editor in chief of The Lancet, the medical journal. “The department felt alive again.”

IN THE SEARCH FOR a viral villain at work in the gastrointestinal mystery, Wakefield alighted on a single suspect: measles. Not the so-called wild measles virus—the kind people pick up interacting with others infected with the disease. Instead, Wakefield believed that the measles virus causing inflammation of the intestines could be the live, weakened version injected during immunization. Though Wakefield had no professional expertise in either immunology or measles, he became unwavering in his certainty about a link between vaccination and Crohn’s disease.

At the time, measles was a hot topic. Use of a single measles vaccine began in Britain in the late 1960s, but vaccination rates remained relatively low. Then, in 1988, MMR immunization was introduced for babies aged thirteen to fifteen months, with a catch-up program for preschool children. Within a short time, Britain had managed to attain a 90 percent vaccination rate. But controversy exploded in September 1992 when the UK Department of Health withdrew two MMR vaccines following reports of a possible link to a rare but mild form of meningitis. Before the week was out, parents had filed a flurry of legal claims that the vaccine had injured their children.

Twelve days after the government announcement, Wakefield sent a letter to David Salisbury, a pediatric vaccine expert and the head of immunization at the health department. He wrote that incidence of Crohn’s was growing—something other experts attributed to increased consumption of carbohydrates, expanded diagnostic parameters, and other issues—and that this increase had, to a certain degree, coincided with growing use of measles vaccines. He had no evidence that suggested a causal relationship, only a general sense that there was a correlation.

“My concern is that although measles, and in particular the vaccine, may ultimately have no association with Crohn’s disease whatsoever,” he wrote, “what will be picked up by the press is the apparent association between the increasing incidence of disease and the vaccine.” Wakefield urged that they meet to hash out a public response, and asserted the need for the health department to fund his research.

The letter left Salisbury confused. First, the health department didn’t provide money for that kind of biomedical research; that was up to Britain’s Medical Research Council. But more important, Wakefield’s tone seemed overwrought; he appeared to be convinced that there would be an outcry about a hypothesis the public wasn’t even aware of. Salisbury knew that measles had been blamed for causing plenty of other conditions, and that those theories had been proved wrong. Wakefield’s certainty of a link between MMR and Crohn’s seemed to be based on little more than speculation—not on data.

“It was like a religion to him, and he was determined to prove it whatever way he could,” Salisbury says. “And if the evidence was inconvenient, he would simply ignore it.”

A cheery man whose appearance and demeanor reflected British social graces, Salisbury trained as a pediatrician in the early 1970s at Oxford and at the Hospital for Sick Children, in London. Even before joining the health department, he gained an international reputation as an expert in pediatric infectious disease and immunization. He worked extensively with the World Health Organization on its global vaccine programs against smallpox, polio, measles, and other deadly diseases. For his significant contributions to global public health, Salisbury was often rumored to be a candidate for royal honors, and in 2001 he would be named a Companion of the Order of the Bath, one step below knighthood.

Given his work and stature, Salisbury was unlikely to spend much time nursing concerns about vaccines from a gastroenterologist with no background in pediatrics. Still, Salisbury treated Wakefield with courtesy. In November 1992, he sent Wakefield a short response saying that the research sounded interesting and he would try to arrange a meeting.

No meeting followed. Annoyed at being virtually ignored, Wakefield sent another missive six months later, this time to the health department’s director of research.

“Some months ago I wrote to Dr. Salisbury of the Department of Health requesting an urgent meeting and he has so far failed to respond in a very positive manner,” Wakefield wrote. “This is not something that is going to go away, and it is going to cause considerable embarrassment if no action is taken at this stage.”

Again, no government alarm bells, and little but passing interest in Wakefield’s work. He had recently published a study in the Journal of Medical Virology claiming that small areas of inflammation had damaged tissue in the guts of Crohn’s patients and that measles virus had turned up there. The foundation of Wakefield’s theory as described in his letters to the health department—that increased immunization was causing an increase in Crohn’s—made no appearance.

The study was almost statistically meaningless, involving nine Crohn’s patients. The controls for comparing results from diseased patients with those of healthy ones were virtually nonexistent: noninflamed tissue from two people. While it attracted some publicity, the study went largely unnoticed by the public.

But Wakefield was not so easily brushed aside.

MAHATMA GANDHI WAS perhaps the most famous opponent of vaccines in the early twentieth century. Smallpox, he insisted, was not an infectious disease, but something caused by problems in the bowels. To ward off the illness with a vaccine, which came from calf’s blood containing the cowpox virus, was deemed by him to be barbaric and an affront to God.

As was the case with most anti-vaxxers who preceded and followed him, Gandhi’s convictions stemmed from scientific ignorance. Since at least the eighteenth century, opponents had invoked “liberty” and “rights” as reasons they should not be compelled to be vaccinated—an argument that, while defensible on some levels, ignores the rights of others to be protected from infection. Intensifying the dispute were problems that arose in the early days of polio vaccines, including a 1955 manufacturing error that resulted in hundreds of new cases of the disease. Anti-vaxxers accused scientists and drug companies of immorality, claiming that greed was behind the push for immunization.

Making it worse was the scientific ignorance of the news media. Frequently, clinical reports included statistically insignificant data purely as observational information for other physicians; too often, that information was then presented by the general press as important or potentially conclusive. For example, a 1974 study by a group of British scientists theorized that severe neurological problems that developed in a group of thirty-six boys and girls were linked to the triple vaccine for diphtheria, tetanus, and pertussis, known as the DTP (DPT in the United States). The findings ultimately proved to be incorrect, but not before panic had been set off.

Hyperbole and misrepresentation in the press worsened public alarm. In 1982, the local NBC affiliate in Washington, D.C., broadcast a television report called DPT: Vaccine Roulette that played an enormous role in spreading misinformation about the vaccine. Excerpts were also shown on the Today show. Faced with arguments based on anecdotal evidence that the DPT caused neurological damage, parents frightened of the triple vaccine flooded pediatricians’ offices with calls. Medical professionals were outraged. The story’s “distortion and total lack of balance of scientific fact” had caused “extraordinary anguish and perhaps irreparable harm to the health and welfare of the nation’s children,” wrote the American Academy of Pediatrics in a letter to NBC’s president.

But science is complicated and slow, while fear is simple and fast. The DPT story spurred a group of parents to form an organization called Dissatisfied Parents Together. One of those parents, along with a doctor, published a book in 1985 called DPT: A Shot in the Dark, which claimed that the vaccine caused autism. In the early 1990s, the group changed its name to the National Vaccine Information Center; it has since raised millions of dollars in funding and been criticized as a purveyor of anti-vax disinformation.

The trend of the media using unqualified sources for information about vaccines took a turn for the worse when celebrities began portraying themselves as experts. In 1990, Lisa Bonet, an actress on The Cosby Show, condemned vaccines during an appearance on the nationally broadcast Phil Donahue Show. Vaccines “introduce these alien microorganisms into our children’s blood,” she said, suggesting that vaccines might be responsible for causing asthma, cancer, multiple sclerosis, and sudden infant death syndrome. “It’s very scary and it’s very serious,” Bonet said. “That’s why I didn’t do it. You know, we have to think twice. Why are our kids getting these diseases?”

With those words, Bonet—a high school graduate who attended an actor’s studio—reached millions more parents than epidemiologists and infectious-disease experts ever would.

“This topic touches on some intense ideas—childhood illness, the idea of parental rights over children, the idea of government intervention in our health,” says Jonathan Berman, an assistant professor of science at the New York Institute of Technology and the author of Anti-Vaxxers: How to Challenge a Misinformed Movement. “It sets off a lot of people’s emotional triggers, particularly in those who don’t have the training or critical tools to think about what they are hearing.”

EACH DAY, NICHOLAS CHADWICK grew more troubled. An assistant of Wakefield’s, Chadwick found that the more he took part in his boss’s research, the more rattled he became. The work seemed sloppy, even irrational.

Chadwick had joined Wakefield’s team after graduating from Durham University in 1993 with a degree in biochemistry. Around that time, he had read a newspaper article about Wakefield’s Crohn’s work and was intrigued. He contacted Wakefield, who agreed to meet. Wakefield was impressed with Chadwick and hired him as a lab technician. Chadwick began in late 1993, but only a few months would pass before his concerns emerged.

“I was very enthusiastic about the research to begin with,” he says, “but began to have doubts as time went on.”

He frequently found himself perplexed by his boss’s instructions. While he considered the idea that a virus might cause vascular issues that led to Crohn’s to be an interesting theory, Chadwick considered it bizarre that Wakefield focused solely on the measles virus as the potential biological offender.

Chadwick attempted to repeat the findings from Wakefield’s study linking the virus to Crohn’s, but he could never confirm the data. Moreover, the tests used by Wakefield to locate measles viruses were weak; nobody in the lab believed they produced reliable findings. Chadwick applied a more advanced technique and again tried to duplicate Wakefield’s results. Still nothing.

The young technician approached Wakefield to inform him of the news: None of the sample tissues contained measles viruses. His boss thanked him, and essentially ignored him.

“Whenever I showed [the data] to him and tried to explain what it meant, there was a look in his face that really showed me he didn’t want to talk about it,” Chadwick says. “He didn’t want to come to terms with anything that disagreed with his theory. It was a complete denial.”

Even as Chadwick labored without success to prove a link between measles and Crohn’s, the health department was rushing to avert a measles epidemic. Two independent studies had just concluded that measles cases were rising among unvaccinated older children, and that as many as 150,000 people were at risk of infection. The first cases emerged in Scotland; at just one hospital, 138 teenagers were admitted with the disease. At the same time, rubella was spreading among adolescents. Facing a public health crisis, the government launched a mass immunization drive to administer booster shots to children aged five to sixteen, starting in November 1994. The vaccination would be the MR, used for measles and rubella.

Just weeks before the new campaign was set to begin, Wakefield shot another letter to Salisbury. Again he groused that the government was not giving his work the attention it deserved.

“I fear we face a potential catastrophe in the form of an epidemic of Crohn’s disease” from the planned immunization campaign, Wakefield wrote. “I do not believe the government can continue to ignore our work any longer and the time has come to resource this work appropriately.”

This time, Wakefield’s table banging had the desired effect, and health department officials set his long-sought meeting for January 10, 1995. But there would not be simple acquiescence to Wakefield’s theories. Salisbury invited other prominent researchers of Crohn’s; when Wakefield argued that the disease was caused by the measles vaccine, one of the experts said that, no, a bacterial parasite was the culprit. No one had sufficient data to argue that one particular theory was correct and the others wrong. The meeting ended with the group agreeing that more research on Crohn’s was necessary, and Salisbury suggested that Wakefield seek funding from the Medical Research Council.

Annoyed, Wakefield dashed off another letter, this time to Jeremy Metters, the department’s deputy chief medical officer. Once again, Wakefield complained that no one was taking his research on Crohn’s and measles seriously.

Metters passed the latest Wakefield missive to Salisbury, who responded. The informal meeting was never intended to be decisive for changing government immunization policy. “The department, in its public health role, has to consider the effects of research results that may call in question established policies, such as routine childhood immunisation,” he wrote. “And this makes it all the more important that any results that call this into question have to be rigorously tested in the scientific arena.”

Salisbury wouldn’t say so in his letter, but he was baffled by Wakefield’s obsession. It seemed as though Wakefield wanted the entire immunization program in Britain to screech to a halt because of his one little study. Science didn’t work that way.

Soon after, Wakefield sent another letter to Salisbury, this one containing a copy of a paper he had co-authored, scheduled for publication in The Lancet. In the letter, Wakefield expressed concern that this new study could set off a public panic once it was published.

“Would you let me know if the department intends to set up a ‘helpline’ and if so, what the number will be,” Wakefield wrote. “We can then communicate this to patients and relatives.”

A help line? What was this man talking about? The health department set up help lines to provide British citizens with information about major health crises such as epidemics.

“This was really unusual,” Salisbury says of Wakefield’s request. “We were somewhat concerned. We really had not actually come across circumstances the same as this when forthcoming publication of a piece of work was being viewed in such a light that we would need to set up a help line.”

Salisbury reviewed the Wakefield paper. He wasn’t even the lead author, but the third. And overall, it was pretty unremarkable. The researchers had obtained answers to questionnaires about gastrointestinal problems from 3,545 people who had been part of a 1964 clinical trial on measles immunization. A control group of 11,407 people who had been part of a child development study beginning in 1958 answered the same questionnaire. The results: Of the 3,545 immunized, fourteen developed Crohn’s. Not 14 percent—fourteen people, or 0.004 percent. Similarly small numbers emerged for other gastrointestinal problems. The study even acknowledged that, while the research showed a statistical correlation of sorts between immunization and Crohn’s, there was nothing to establish a causal relationship.

That was it? Salisbury discussed Wakefield’s latest missive with other staff in the health department, and they were equally bewildered. Why was this researcher pushing so hard?

The answer might lie with the patent office. About the same time he sent Salisbury his most recent letter, Wakefield quietly filed a patent application, dated March 28, 1995, claiming that he had proven Crohn’s was caused by the measles virus and that he had developed a technique to find the offending microbe. This “invention,” as he called it in the application, could be used not only in the manufacture of medicine to treat Crohn’s, but also as the basis of treatments for measles.

If his theories proved true, and if the patent was granted, Wakefield could make millions.

2

Test Subjects

ROYAL FREE SPONSORED a press briefing on the day the Lancet study appeared. Reporters turned up; some wrote articles. But Wakefield’s predictions proved wildly overblown: no nationwide panic, no deluge of calls to the health department. Even his fellow researchers played down the study. If a causal connection did exist between immunization and Crohn’s, the risk of illness remained “extremely small,” one of the study’s other authors told a reporter.

But the news stories raised Wakefield’s public profile, and a parent reached out to him. On May 19, 1995, Wakefield’s office phone rang. The caller introduced herself as Rosemary Kessick. “I’m the mother of an autistic child …,” she began.

“I don’t know anything about autism,” Wakefield said. “I’m a gastroenterologist.”

Kessick said she knew that. “But I have a theory.”

Kessick had no medical training. She had worked as a business manager before retiring to devote herself full-time to caring for her child, William. Still, as she spun her complex medical notion, Wakefield listened without interruption.

Beginning when he was two, Kessick told Wakefield, her son had developed recurring bowel problems. That was about the same time that he showed his first symptoms of autism. When the bowel problems were bad, his behavioral problems were bad, and when his bowels were calm, so was William. “So, based on my own observations, I believe that the gut itself is the start point for my child’s neurological problems,” she said.

Wakefield periodically asked for more details about William’s story. He was intrigued and wanted William to undergo some tests. The conversation seemed to be reaching its end, but Kessick had something more to say.

“By the way,” she said, “I think the MMR has something to do with this, because that’s when my son changed.”

A pause. “Go on,” Wakefield said.

She wasn’t the only one with this belief, Kessick said. Other parents she knew also thought their children’s chronic bowel problems and autism may have been triggered by the MMR vaccine. But no matter how many times she explained the idea to her son’s doctors, they did little more than pat her on the head and send her on her way. Wakefield was the first who seemed interested.

Kessick expounded her complex theory. The bowel problems caused by the MMR decreased vitamin B12 absorption, she said, and that deficiency could cause neurological problems, which perhaps led to autism.

This belief in a cascade of physical reactions to the MMR contained enormous amounts of unproven science. Wakefield knew the research was strong that Crohn’s patients suffered from malabsorption of B12, but even on that point Kessick’s theory had flaws. The most common reason for B12 malabsorption in Crohn’s patients was linked to intestinal surgery for the disease, which often entailed removal of a portion of the small intestine. Had any of these children undergone intestinal surgery? If so, wouldn’t those who’d had a portion of their small intestine removed have the highest incidence of autism? If not, what was the connection between their gastroenterological disease and the drop in B12?

Good science required each of those questions to be answered independently, which is why research takes years to reach the kinds of conclusions that can drive diagnostic and treatment decisions. Declaring belief in an overarching theory that encompassed so many different disciplines—infectious disease and vaccines, biochemistry, gastroenterology, endocrinology, pediatrics, neurology, developmental psychology—would be reckless.

While a responsible study of Kessick’s idea would be a massive undertaking, Wakefield believed it merited immediate attention. The fact that there were other parents who believed a connection existed between the MMR vaccine, gut disease, and autism meant that there was a pool of potential research subjects.

Wakefield urged Kessick to take her son to a pediatric gastroenterologist he knew named John Walker-Smith. Walker-Smith saw the boy in August 1995. After completing his examination, he wrote an update to the boy’s psychiatrist, David Wozencroft. The bottom line: Walker-Smith was unsure of any basis for the speculations about the cause of William’s health problems.

“I am left somewhat confused as to what the evidence is of B12 deficiency,” Walker-Smith wrote. “On examination there is no evidence of Crohn’s disease which concerned the mother, in view of the possible association between measles and Crohn’s disease.” In fact, Walker-Smith related, there was no evidence of inflammatory bowel disease of any kind. Nonetheless, he was intrigued by Wakefield’s claims and accepted his invitation to work on a study of possible links between the MMR, Crohn’s, and autism.

Walker-Smith, who had known Wakefield for years, appeared to be the perfect choice to partner on this study. Tailored and neat, with half-rim glasses and wavy, receding hair, he looked like a physician straight out of central casting. Like Wakefield, Walker-Smith had been raised in a family immersed in medicine—his grandfather, his father, and uncles on both sides were physicians and surgeons. Born and raised in and around Sydney, he was brought on hospital rounds by his father from age six; he always believed there was a tacit understanding among his relatives that he would go into what was effectively the family business. He also had extensive exposure to medical treatment, a consequence of childhood illness. He experienced intense attacks of vomiting between the ages of seven and ten. Then, when he was fourteen, he fell through a plate-glass window. The accident lacerated his left wrist and severed a nerve, leaving him with a weakened arm and hand. The chance of becoming a surgeon like his father disappeared that day, but he could still be a physician.

In 1973, after establishing a strong reputation in Switzerland and Sydney, he joined a hospital program in London, where he established one of the country’s most prestigious training programs for pediatric gastroenterology. He served as editor of the premier medical journal in his field while also working as a clinician, researcher, educator, and writer.

In terms of professional respect, Walker-Smith was well out of Wakefield’s league.

Walker-Smith first encountered Wakefield in 1989, while working at St. Bartholomew’s Hospital—better known as Bart’s. By then, Wakefield was at Royal Free. Walker-Smith admired his colleague’s research and was particularly impressed with Wakefield’s paper, published that year, linking blood vessel inflammation to Crohn’s. In 1994, he invited Wakefield to speak at Bart’s annual postgraduate course on pediatric gastroenterology, where Wakefield told the assembled doctors that he had succeeded in associating increased rates of Crohn’s with use of the measles vaccine—something that, in fact, his research had never done.

Walker-Smith soon learned that officials at Britain’s health department—particularly David Salisbury—considered Wakefield to be a zealot pushing bad science about the MMR. Salisbury telephoned Walker-Smith shortly after Wakefield’s presentation at Bart’s to discuss the man’s work and his relentless communications to the government attacking vaccines.

“I told John Walker-Smith to be very careful with his involvement with Wakefield,” Salisbury says. Instead, Walker-Smith told Salisbury of his admiration for Wakefield and dismissed Salisbury’s warning as the result of a squabble between two headstrong scientists.

Once Walker-Smith joined Wakefield on the study, the two men worked to recruit colleagues. Soon, a thirteen-person team was ready to go—ten gastroenterologists, a radiologist, a neurologist, and a psychiatrist. The neurologist, who would be examining autistic children, worked with adults and had no experience treating developmental disorders in children. The psychiatrist did not consider himself an expert on autism. None had any expertise in immunization or infectious disease.

WAKEFIELD SAT AT HIS COMPUTER in October 1995, typing out the protocol for the tests that needed to be run on the autistic children in his study. The procedures—many of which could leave the child screaming in terror—were clothed in the benign verbiage of medical jargon: ileocolonoscopy, lumbar puncture, MRI, EEG. All uncomfortable, several invasive.

He titled his protocol “A New Paediatric Syndrome: Enteritis and Disintegrative Disorder Following Measles/Rubella Vaccination.” The inquiry would test the hypothesis that, for some kids, the vaccine caused infection and inflammation of the small intestine, followed by malabsorption of vitamin B12, which in turn led to damage to the brain.

At this point, Wakefield had nothing backing up his hypothesis other than the speculations of Rosemary Kessick. Each sequential step of her theory had been adopted by Wakefield as worthy of study, the only scientific support even vaguely underpinning it being his own work suggesting a link between Crohn’s and the measles virus—a correlation that his lab researcher hadn’t succeeded in confirming.

But there was a serious problem with the proposal: Wakefield repeatedly wrote that he was researching something that he was not. He wrote that the study would focus on the MR, the measles-rubella vaccine; never once did he say a word about the MMR. He only discussed disintegrative disorder—also known as Heller’s syndrome—which is not the same as autism. Disintegrative disorder is far worse, and far rarer, than autism as it was then defined. (In 2013, autism, Heller’s, Asperger’s syndrome, and a range of other conditions were joined under the term “autism spectrum disorder.”) Research requires specificity in the protocols to ensure that, once results are available, unethical scientists don’t start revising the area of inquiry to conform to data results. Wakefield would never revise or adjust his protocol, but he also never studied the purported relationship between MR and disintegrative disorder that he said was the topic of his research.

Worse, the protocol Wakefield was proposing would be a nightmare for the hospital’s ethics committee. The rules covering ethical testing of young children set numerous hurdles, and clearing them would be difficult. Performing a barrage of invasive tests on children whose age and developmental circumstances left them incapable of granting consent would be particularly challenging. Parents could not volunteer their children; instead, a referral had to come from an independent medical professional already involved in the child’s care. Any tests—even blood tests—could be performed only as part of the child’s normal clinical treatment. Wakefield’s plan to use child test subjects could well be impossible.

A solution would arrive in just three months, from a most unlikely source.

MEDICINE AND LAW had long been central to Richard Barr’s life. His grandfather was a judge, his father and brother both lawyers. His mother, an American from Nebraska, worked as the town doctor in Elm, Cambridgeshire, a tiny village of a few thousand residents where Barr’s family had lived since the end of World War II.

Barr ultimately blended the two specialties. He began his work at a law firm then known as Dawbarn, Barr & Knowles, handling workaday legal cases. But in the 1980s his career turned to medicine and health after a woman arrived at his office claiming to have suffered damages from an anti-inflammatory medication. He brought suit against the manufacturer for a group of clients, and while they received only limited compensation, Barr developed a reputation as a personal injury lawyer, often in mass-claim medical cases. He represented clients who believed that their health had been impaired by a pesticide ingredient, and veterans who claimed that they had been damaged by medicines they received during the 1990 Gulf War.

Then came the MMR case.

In 1994, parents from a newly formed group called JABS—Justice, Awareness, and Basic Support—decided to sue MMR makers, asserting that the vaccine caused an array of health issues. Rosemary Kessick was a member. They applied to Britain’s Legal Aid Board, a government body that covered litigation costs for those who could not afford them, and were approved for financing. Barr signed on as their lawyer.

Barr moved into Wakefield’s orbit not long after, as a result of an article he read in Britain’s Sunday Times Magazine titled “A Shot in the Dark,” about the purported dangers of multi-shot vaccines used to prevent measles. The article featured a photograph of Wakefield, who was quoted extensively, expounding his theories linking measles and Crohn’s. Barr knew about Wakefield from some of the parents he represented in the MMR case, and decided they could potentially establish a mutually beneficial relationship. He asked his wife and assistant, Kirsten Limb, to telephone Wakefield and set up a meeting.

Days later, the three got together at Wakefield’s office.

“We’re seeing clients and potential clients who have developed Crohn’s disease,” Barr said. But they weren’t just interested in Crohn’s. They were also investigating potential links to autism, as well as multiple sclerosis, diabetes, juvenile arthritis, and a range of other conditions.

Barr came to the point. “Would you be prepared to act as an expert in litigation?”

Wakefield agreed to consider the offer and, a couple of weeks later, contacted Barr to accept. He agreed to prepare a report on vaccine safety—something he was unqualified to do—and examine bowel tissues of the children with Crohn’s for evidence of measles virus.

“Acting as an expert, what would your professional fee be?” Barr asked. Wakefield consulted with a colleague and came up with a price: £150 an hour.

Barr was delighted. He announced the good news in the February 1996 issue of a newsletter he mailed to clients to keep them up to date on the case. “As you may have read in the Sunday Times of 17 December 1995, Dr. Andrew Wakefield has published some very disturbing material which indicates a clear link between the measles element of the vaccine and Crohn’s disease,” Barr wrote. “He has deeply depressing views about the effects of vaccines on the nation’s children.”

Wakefield, Barr wrote, was anxious to arrange for tests of the children whose parents were part of the planned lawsuit. He wanted to see anyone who had been vaccinated with either the MR or MMR vaccine who showed signs of bowel or digestive problems. “If your child has suffered some or all of these symptoms,” he wrote, “could you please contact us, and it may be appropriate to put you in touch with Dr. Wakefield.”

The clients with the theory, the lawyer with the case, and the scientist eager to prove himself right about the MMR were all now working together.

THE STUDY PROTOCOL prepared by Wakefield had yet to be reviewed by the ethics committee at Royal Free. None of the other doctors who would participate in the study had seen it, either.

But soon after he agreed to work with Dawbarns, as the firm was now known, Wakefield gave a copy of the protocol to Barr. At the lawyer’s request, Wakefield also put together a budget proposal for his research, in the hope that the Legal Aid Board would fund it. On May 21, 1996, Barr mailed both the proposal and Wakefield’s study protocol to a lawyer at the board, letting her know that a scientific breakthrough might be in the offing.

“There does at last seem to be an increasing acknowledgement among the medical profession that these vaccines actually are causing damage,” Barr wrote. Wakefield “is actually quite astonished at the evidence that he is uncovering and feels that objective tests may well establish conclusively that the measles vaccine is causing a wide range of these injuries.”

In his proposal, Wakefield asked for £57,000, a number he chose almost at random; he did not consult the other researchers on the costs of their work. He misspelled the name of one of them, Mark Berelowitz, from the Royal Free Department of Child Psychiatry. And he wrote that Berelowitz would assess developmental changes in children with autism—diagnostic efforts, the psychiatrist would later state, he had no training to perform.

While Wakefield hammered out his financial arrangements with Barr and the Legal Aid Board, Walker-Smith was hard at work searching for potential subjects to include in their study.

He had begun in April, when he examined a child who exhibited some autistic behavior and appeared to experience bowel problems, and whose parents were convinced that the MMR was the cause of both. Yet Walker-Smith found no evidence of bowel inflammation or any serious gut problem. While the child sometimes became constipated, Walker-Smith learned that this had been an issue months before he received the MMR vaccination. Still, Wakefield cautioned Walker-Smith not to dismiss the child as unsuitable for study—there might be subtle, unrecognized intestinal inflammation. So Walker-Smith prepared the case for the next step.

In June, Walker-Smith gave a medical workup to another child at a Royal Free outpatient clinic, this one with diagnosed autism. The boy’s general practitioner had referred the parents to him because they feared that his developmental problems had been caused by the MMR. But the referral contained no mention of any gastrointestinal problem—Walker-Smith’s area of practice. On examination, he found no evidence of any bowel disease, but he kept the boy on his list for further study.

Two days later, William Kessick, Rosemary Kessick’s autistic son, returned to see Walker-Smith. Ten months earlier, he had found no evidence in William of inflammatory bowel disease. The same was true now. Yet again, Wakefield recommended keeping the boy for future examination, contending that there could be undetected bowel disease that made him a good candidate for research.

This “maybe there’s a problem the medical exams didn’t find” standard led Walker-Smith to refer each of these three children for tests in the weeks and months that followed. According to their records, they were admitted to the hospital for “investigation of the possible association between gastrointestinal disease/autism/measles.” They received general anesthesia, colonoscopies, spinal taps, vitamin B12 injections with dye, and a range of other tests, none of which would have been performed as part of their standard clinical care.

The research had begun. Yet neither Wakefield nor Walker-Smith had sought approval from Royal Free’s ethics committee. The doctors were performing undisclosed medical research on children, with no oversight.

BRITAIN’S 1994 VACCINATION CAMPAIGN for measles and rubella had been an enormous success. Despite Wakefield’s warnings to the health department that the mass second-dose immunizations would lead to a catastrophic outbreak of Crohn’s, that didn’t happen. Participation had been over 90 percent, and test results showed that the number of children aged five to sixteen who were unprotected from measles or rubella dropped to 2.1 percent. Those results led British officials to launch a permanent immunization campaign, with children receiving a second MMR dose before attending kindergarten. Government officials felt confident that if they remained vigilant, these infectious diseases could be eradicated in Britain.

The news infuriated Wakefield. He had just published another study in The Lancet, this one analyzing twenty-five thousand birth records from 1940 through 1949. Of those births, four women had been infected with measles while pregnant. Of those four, three of the children developed Crohn’s disease. Though the study offered nothing that connected immunizations to Crohn’s—the measles vaccine didn’t even exist in the 1940s—Wakefield believed it helped prove his theory.

He wrote the health department again in September 1996 but decided not to waste any more time with David Salisbury. Instead, he addressed his letter to Sir Kenneth Calman, the department’s chief medical officer.

“You will have seen our recent paper in The Lancet which provides what many consider to be compelling evidence of a causal association between measles and Crohn’s disease following exposure in utero,” Wakefield began. “No doubt your experts will be able to reassure you on this particular issue.”

The supposed experts were compromised, he continued, torn by conflicts of interest, blinded by ambition. “Their scientific and professional standing and credibility is inextricably linked to the success of measles vaccination,” he wrote. The papers they published that seemed to disprove Wakefield’s work were simply wrong! “This is a superficial and naive perspective that reflects a profound lack of understanding of … the risk factors for persistent infection and delayed disease that are associated with measles virus infection.”

While department officials relied on other studies in their belief that vaccines were largely safe, that research was not credible, Wakefield continued.

“The expert evidence that you have received has been deficient, and far from independent,” he wrote. “If and when the dam bursts it will be you and your department that is standing in the way.”

There was no doubt what the government should do, Wakefield concluded. “Do not revaccinate.”

Calman shared the letter with Salisbury, who read it with a sense of alarm. There was so much wrong here. Wakefield used meaningless data and patched together information in a way that made little sense to implicate the measles vaccine in the occurrence of Crohn’s disease. Other scientists were publishing far better epidemiological studies than Wakefield’s that disproved his belief. But rather than address this like a true scientist, Wakefield’s argument—They’re stupid, I’m not—was more suited to the playground than to scientific discourse.

On top of everything else, Wakefield seemed to have an uninformed view of how communication in a professional setting worked. He refused to write to Salisbury directly and had insulted him in his letter, apparently unaware that Calman would immediately consult his chief of vaccinations about Wakefield’s claims.

“This was a very strange letter,” Salisbury says. “The zeal that Dr. Wakefield expressed for us not to revaccinate children was not supported by any evidence of harm that might come to those children, but if we had followed this, we would have left children at risk of harm.”

Salisbury helped Calman draft a reply to Wakefield. The letter thanked Wakefield for expressing his concerns and assured him that the revaccination program had been carefully deliberated by an independent advisory group.

The letter went off to Wakefield, but Salisbury anticipated that they would hear from him again.

Meanwhile, the Legal Aid Board granted preliminary approval to fund Wakefield’s research, which would include twelve test subjects. Wakefield sent another letter, this time to Barr at the Dawbarns law firm, asking that an initial sum of £25,000 be sent to him, the check made out to the Royal Free Hospital School of Medicine. In his correspondence with the board, Barr assured the agency that Wakefield’s results would be amazing.

“They have already started testing some of the children,” he wrote, “and so far, every single child tested has come out positive with positive staining for measles virus in the inflamed areas.”

NO MEASLES viruses. None.

Wakefield’s lab technician, Nicholas Chadwick, finished examining tissue from an autistic child and, as always, found nothing. Tests from this latest study produced results that were no different from all the others he’d gotten, dating back three years.

Chadwick was responsible for the entire process. He stood alongside the doctors in the Royal Free endoscopy suite as they sedated the children, slid tubes up their rectums to scrape tissue from their guts, and injected needles into their backs to suck out spinal fluid. He then personally carried the material to the lab, where he processed the tissue to extract the children’s RNA, a molecule that is the primary messenger in the manufacture of proteins. The existence of measles in the tissue would be proven by finding evidence of the virus’s RNA in the RNA of the child; none ever turned up.

A few samples came back positive, but they turned out to involve tissue contaminated with the measles strain that Wakefield kept in the lab. It was as if Chadwick had tested vegetable soup for sodium after someone had accidentally dropped a salt shaker into the pot.

Chadwick approached Wakefield time and again, letting him know that the tests weren’t backing up his theory. His boss never seemed bothered, but eventually Wakefield commissioned a researcher from Tokyo, Hisashi Kawashima, to test his tissue samples. Chadwick prepared them for shipping. He put samples into test tubes, making sure to arrange proper controls in order to prevent bias: Some of the tissue did not come from test subjects; some came from test subjects and was divided into separate tubes, with only Chadwick knowing which tubes held material from the same subject. Since tissue from the same person would have the same infection, a proper test would turn up the same result in the duplicate tubes.

Success—or so Kawashima thought. His lab reported finding measles virus in some of the tissues. He sent the information to Chadwick, who checked the controls. But the doubles didn’t match; Kawashima had found the virus in one of the tissues but not in its duplicate. Kawashima also reported finding the virus in some of the control samples—tissue that wasn’t taken from autistic children.

Once again, the discovery of measles virus in the tissues was a lab error. Chadwick ran more tests based on Kawashima’s work and found that, again, the virus that was detected was the result of contamination.

Yet again, Chadwick told Wakefield of his discovery, assuring him that there were no measles viruses in any of the autistic children’s gut tissue. Wakefield thanked him, then informed Barr that his research was proving his theory correct.

CHILDREN WHO SHOW symptoms of severe autism need significant support and, when they grow up, are typically incapable of living alone. Many are unable to speak and either are unaware of or simply do not engage with people around them. While movies and television shows often correctly portray autistic people as having extremely high IQs and unusual cognitive abilities, these are exceptional cases. More often there is self-injury involved, particularly head banging, and aggressive behaviors such as kicking and biting. But autism isn’t a disease that tends to be immediately apparent at birth; instead, children can undergo perfectly normal development for two years or longer before suddenly regressing into silence, hypersensitivity, and reduced cognitive function. The rapid change, the sense of their child slipping away, exacerbates parents’ anguish. Frightened and often guilt-ridden, stunned at the inexplicable transformation they’ve witnessed, they seek out answers for what happened.

All of this places particularly strong ethical demands on autism researchers: They are testing the children of parents who are desperate. Parents were eager to join Wakefield’s study, even absent the involvement of an ethics committee, and without the preliminary data providing any reason to believe the hypothesis might be correct. If drug companies had caused these children’s suffering, perhaps their parents could obtain a large enough settlement to ensure they were provided for. It was easy to believe that Wakefield’s research not only might lead to protecting others, but would also alleviate parents’ restless nights as they fretted about their children’s well-being, especially after they were gone.

Plus, Wakefield had touched upon widely held and powerful emotional convictions: that pharmaceutical companies conspired with governments to make money by ignoring potential drug risks, and that vaccines in particular were dangerous. The British withdrawal of two brands of the MMR vaccine in 1992 because of possible links to a mild form of meningitis should have been seen as proof of the safeguards that existed in the public health system; instead it fueled conspiracy theories about an array of health conditions totally unrelated to immunization.

In their desperation, parents relied on Wakefield to take care, to avoid giving them false hope, and to conduct his research according to the best scientific practices.

They trusted him.

3

Conflicts of Interest

IT WAS MONTHS INTO the study before Wakefield submitted his testing protocol to the Royal Free ethics committee. At first the proposal was rejected on the grounds that children could not be subjected to these invasive tests just for research; such procedures could be performed only as part of their normal clinical care.

Meetings and letters about the committee’s verdict followed. Both Walker-Smith and Wakefield assured committee members that the children in the study would be receiving the tests as part of their standard treatment. In fact, they said, Walker-Smith had already tested five such children. What they didn’t say was that the tests showed no evidence of bowel disease.

Another point: There was a term in the standard application requiring Wakefield to disclose his personal financial interest in the study, particularly any payments he may have received. There were also requirements in the ethics rules that prohibited parents of the test subjects from having a financial interest. Wakefield replied that funding for the research would come from a Royal Free research grant. He made no mention of the Legal Aid Board or his involvement in the Dawbarns lawsuit.

Still, one issue remained. The ethics committee could not approve inclusion in the study of the five children already tested. That data had been collected before the ethics review; after-the-fact approval was forbidden. The committee would approve the protocols, but on the condition that no data obtained from the five children be used. Wakefield and Walker-Smith agreed to abide by the requirement.

But they didn’t. The five remained in the study, and represented almost half of the test subjects.

At about this same time, in another wing of Royal Free, the hospital’s grant administrator, Dave Wilson, received a letter from Wakefield. Wilson was experienced with funding notifications from hospital scientists, but this one from Wakefield—as well as the £25,000 check the doctor had attached—was unique. The payment wasn’t from an individual donor or medical foundation but from the Legal Aid Board, which Wilson knew was an organization that funded litigation. Why, Wilson wondered, was the board giving money to Wakefield? He soon figured out that the payment was somehow connected to the Dawbarns law firm. That raised more questions.

The Legal Aid Board did not “just hand over money like that,” Wilson wrote to his boss, Cengiz Tarhan, Royal Free’s deputy finance officer. “Is a third party involved? Was funding channeled through Dawbarns the solicitors?” And the implicit question: If the money was being directed by Dawbarns, what was Wakefield up to?

Tarhan agreed—these were questions that needed to be answered. He decided to hold off on distributing the money to Wakefield. Soon after he was told of the decision, Wakefield ran into Tarhan at the hospital. Annoyed, he told Tarhan to just send the check back to the Legal Aid Board. He would find another way to get it cashed.

It wasn’t until one month later, on January 30, 1997, that Wakefield’s closest colleague, Walker-Smith, learned about Wakefield’s connection to the Legal Aid Board and Dawbarns; Wakefield dropped the bombshell during a project meeting. Walker-Smith tried to keep calm, but he could not understand how Wakefield had agreed to this. He left the meeting, telling Wakefield he needed the weekend to think about the situation, leaving open the possibility that he would depart from the study entirely.

Once again, Wakefield decided to send a letter to make his argument. The future of the children in their study was bleak, he wrote to Walker-Smith. Society did not take care of them properly. What if the parents died, leaving their disabled children alone in a hostile world? If they had no money, who would look out for them?

“Vaccination is designed to protect the majority and it does so at the expense of a minority of individuals who suffer adverse consequences,” he wrote. “If [autism] is caused by MMR vaccination, then these children are the few unfortunates that have been sacrificed to protect the majority … An inescapable moral imperative is the principal reason that I have decided to become involved in helping these children pursue their claims.”

If his words were to be believed, Wakefield did not simply view the MMR-autism link as a hypothesis to be tested; he was on a mission. Philosophically, he was laying out a moral objection to vaccinations. He was presenting his study as all that stood between these sick children and a bleak future.

Wakefield’s involvement in the litigation created an enormous conflict, and his letter showed that he had lost all objectivity. On these grounds, any researcher of Walker-Smith’s stature would conclude that the study needed to be shut down. He sat at his desk and drafted a response.

“It is clear that the legal involvement by nearly all the parents will have an effect on the study as they have a vested interest,” he wrote. “Never before in my career have I been confronted by litigant parents of research work in progress. I think this makes our work difficult, especially in publication and presentation.”

He would not testify in the lawsuit, nor would he aid the lawyers in any way. Nonetheless, Walker-Smith decided to continue with the research.

ANDREW WAKEFIELD SMILED warmly as a group of doctors stepped into a conference room at Royal Free in the winter of 1997. “Gentlemen, welcome,” he beamed. “I’m so glad you could come.”

The immunization experts extended their hands, introducing themselves to Wakefield and the medical school professors in attendance. The doctors were from the Joint Committee on Vaccination, a group of independent specialists who advised the government on immunization policy. Also in attendance was David Salisbury.

When Wakefield issued the invitation to the advisory group, its chairman, David Hull, urged anyone who could to attend the meeting. As Hull understood it, Wakefield believed there was a potential link between MMR and variants of an inflammatory bowel disease that had wider health impacts. Certainly, Hull told his colleagues, this was something they needed to consider in developing future recommendations for vaccination policy.

Everyone took their seats, and Wakefield launched into his presentation. He projected a series of photos of cells on laboratory slides.

“Now,” Wakefield said, “we are currently investigating and testing many children with autism who …”

Hull snapped to attention. Testing autistic children? Wakefield had not mentioned this before. Hull looked closely at the slides Wakefield was showing. They were cells scraped from patients’ guts. They could have been obtained only through invasive procedures like a colonoscopy. Hull could not imagine any clinical reason why “many” children with autism would be subjected to such an intense test. No, he decided, he must have misunderstood.

But as Wakefield continued, Hull realized that his initial impression had been correct. Wakefield was subjecting these children to extreme procedures. He glanced around the room. The dean and other professors were there. Since the research would have been approved by the ethics committee, he figured there must be additional details that led them to approve such a study.

What those details might be, Hull could not imagine.

In the days that followed, Hull couldn’t shake the feeling that something very wrong was taking place in Wakefield’s lab. Then came confirmation.

As chairman of the vaccine advisory group, Hull often received copies of immunization-related documents filed with a House of Commons committee on child health services. Included in a recent batch were records sent by Dawbarns, which apparently was preparing a lawsuit claiming that negligence by vaccine makers had harmed children. Hull settled in to read through the records. Then his eyes widened.

Dawbarns was “working with Mr. Wakefield of the Royal Free Hospital London. He is investigating [Crohn’s],” one of the documents read.

Hull was stunned. Wakefield was working with a law firm? Hull dug through the records, looking to discover more about a Dawbarns connection. His mouth almost dropped when he saw the word: autism. Dawbarns was claiming vaccines could cause autism. Wakefield was testing autistic children. And he was working with Dawbarns. The ethics board at Royal Free could not have known this when they approved Wakefield’s study, Hull thought.

Hull contacted Arie Zuckerman, the dean of Royal Free. This was the first time Zuckerman had heard anything about this research. He told Hull that he was alarmed that Wakefield’s investigation of measles and intestinal disease had been extended to include children with autism, and also by the fact that lawyers were somehow involved. He thanked Hull for the information and promised to look into the matter.

THE ELEVATOR DOORS OPENED, and Mark Berelowitz stepped into the broad corridor on the sixth floor of the Royal Free Hospital. The child psychiatrist walked through Malcolm Ward and headed into a patient’s room. A small boy of about four lay asleep in the bed, his father nearby.

It was February 18, 1997. This was something of a normal day for Berelowitz, but with a twist. He worked as a liaison with various departments at the hospital, including the gastroenterology group. Children would often shift from relatively good health to severe inflammatory bowel disease, and it could be psychologically shocking for both them and their families. The gastroenterologists would meet with the psychology group every Thursday morning, so Berelowitz knew those doctors well, including Wakefield. He was now a co-researcher in Wakefield’s study, examining patients who might make good subjects. The dozing child in front of him was the latest candidate.

Berelowitz introduced himself to the father, Robert Sleat. He explained that he was a child psychiatrist working with Wakefield and Walker-Smith. Sleat knew about the study and had agreed to have his son evaluated.

“Can you tell me about your son?” Berelowitz asked. “What are the issues you see in his present state?”

“He doesn’t talk,” Sleat replied. “And he isn’t potty-trained.”

“What is his demeanor? How would you describe that?”

“He’s friendly and affectionate.”

A few more questions and a fuller picture emerged. The boy recognized his parents and sought them out at home. He loved to cuddle.

“Then, when he was about fifteen months old, he just disappeared,” Sleat said.

“Had he been vaccinated by then?”

“Yes, about three months earlier.”

Berelowitz scribbled that down. “Did anything else happen around the time he, as you put it, ‘disappeared’?”

“He was sick with a fever,” Sleat replied. “He had a rash, vomiting, and he barely woke up for three days. We took him to his GP, and he was diagnosed with German measles.”

“Was he sick before or after he seemed to disappear?”

“Before,” Sleat replied. “After he was sick, he avoided eye contact and wouldn’t let anyone touch him. He slept badly, and he became sort of obsessive about some things.”

“Did he still play? Was he still affectionate with you?”

“No, he stopped playing with toys, and he lost interest in us and everything else except for videos.”

“Have things changed at all since then?”

“Oh, yes. He has dramatically improved over the last six months.”

Berelowitz asked a question about autism.

“Please,” Sleat said. “If you see my wife, don’t mention autism. She hates that word, and she’s convinced he has disintegrative disease.”

“A disintegrative disease has a much worse prognosis than autism,” Berelowitz said.

Sleat looked surprised. “I didn’t know that.”

“Where have you been hearing about this?”

“Oh, we’ve been speaking a lot with Rosemary Kessick from one of the autism groups,” Sleat said. “I believe her son William is already in this study.”

Strange. Such a small number of people in the study, and two of them knew each other. Berelowitz decided not to pursue it. And he had missed one more hint that something odd was going on: Parents with children in the study were saying “disintegrative disease.” Berelowitz didn’t know, but that was what Wakefield claimed in his research protocol to be studying, not the more common and usually less severe cases of autism.

Berelowitz wrapped up the discussion and left. From what Sleat described, his son had become affectionate again in the past six months—unlikely for a child with an autism-related disorder. Instead, he probably had brain swelling as a secondary consequence of contracting German measles, also known as rubella. That would also explain why he got better. As for the bowel and bladder problems, the boy was quite young. He might simply have resisted toilet training. Time would tell.

The child was likely not autistic, probably had no ongoing intestinal problems, and had been infected with a virus, perhaps rubella. He was not an appropriate candidate for the study, Berelowitz concluded. He decided to write to Walker-Smith and Wakefield to let them know.

Berelowitz sent the letter two days later, informing his fellow researchers that the boy did not meet the requirements for the study. His letter was ignored, and the boy was designated as Child 10. Only Wakefield knew the real names of the subjects. Berelowitz, who never saw the child again, would discover years later that the boy he deemed an inappropriate subject had been included, under an alias, in the study he co-authored.

THE LEGAL AID MONEY directed to Wakefield had yet to be deposited anywhere. Barr’s law firm would never consider sending direct payments to the researcher, as the government required someplace independent for the money to go.

Why not a charity? The best organization to contact, Wakefield decided, was the Royal Free Hampstead NHS Trust, an independent entity set up by the National Health System, which could hold charitable funds in special trustee accounts. If he could persuade officials there to deposit the money from Dawbarns into an account and distribute it to his team, the problem of the uncashed check would be solved.

In his pitch to the trust’s finance department, Wakefield wrote that he was working on a study that was providing groundbreaking evidence of the causes of autism. He claimed, falsely, that his incomplete, unproven results “have elevated the Royal Free Hospital to great heights in the world of autism research.”

In late June 1997, Wakefield met with the chief executive of the Hampstead NHS Trust, Martin Else. One of Else’s biggest concerns, he told Wakefield, was that this money from the Legal Aid Board might create a conflict of interest for the doctor. That could lead to conscious or implied pressure for Wakefield to come up with particular results for the benefit of the lawsuit and its plaintiffs. If true, someone could sue the trust or even the National Health Service. Wakefield assured him that no conflict existed. Fine, Else said. Send it in writing.

Wakefield dispatched his assurances. “Further to our conversation the other day,” he wrote, “I am writing to confirm that there is no conflict of interest in relation to the Legal Aid funding for our clinical study of children with autism and intestinal inflammation.”

The initial £25,000 that came through Dawbarns was deposited into account 106 at the trust, for distribution at Wakefield’s request. He never informed anyone at the trust that the majority of his test subjects were plaintiffs in the case.

4

Business Plans

DOWN A COBBLED PASSAGEWAY, just a few doors from the local pub, Wakefield’s lawyer sat in his office, writing his client’s latest patent application. Recently, Wakefield had contacted the lawyer, Peter Stebbing, telling him about his latest idea: a technique that would replace the triple-dose MMR with a new single-dose vaccine unlike any on the market.

Stebbing had taken notes as Wakefield excitedly laid out the details. The lawyer didn’t need to understand all the technicalities; his job was to conduct legal research and prepare the paperwork. Wakefield’s main co-applicant was a man named Hugh Fudenberg, an American immunologist who shared his unproven belief that the MMR caused autism. Another co-applicant was Royal Free Hospital.

The case Wakefield made for this single-dose vaccine seemed compelling. The MMR, Wakefield wrote, “has been shown to be instrumental in development of Crohn’s Disease and other forms of [intestinal bowel disease] … and particularly has been instrumental in a substantial increase in Crohn’s Disease in children.” No surprise. Stebbing knew about this theory from Wakefield’s 1995 patent application, still languishing in the government patent office.

Then came the new part. Apparently, Wakefield had linked the MMR to autism and other related conditions, which he referred to collectively as regressive behavioral disease, or RBD. “It has now also been shown that use of the MMR vaccine … [results in] pervasive developmental disorder including autism (RBD) in some infants,” he wrote. “I have now discovered a combined vaccine/therapeutic agent which is not only most probably safer to administer to children and others by way of vaccination/immunization, but which also can be used to treat [inflammatory bowel disease] whether as a complete cure or to alleviate symptoms.”

This miracle drug, Wakefield wrote, was “transfer factor.” Substituting a single dose for the MMR, Wakefield’s writing implied, could solve the problem of vaccines leading to autism and Crohn’s.

Stebbing could not have known it, but the claim Wakefield made was based on falsehoods, omissions, and bad science. Transfer factor—a chemical made from the blood or spleen cells of a person or animal that has developed immunity to a certain disease—had been around for decades, but it was very controversial among immunologists who studied it. No controlled trials had been performed on its use; in fact, almost all the information about transfer factor was anecdotal. Plus, the studies Wakefield cited related to its safety were irrelevant: All of them pertained to transfer factor derived from humans. He and Fudenberg hoped to produce their own concoction: First, inject mice with measles, extract and process the rodents’ white blood cells, inject that into pregnant goats, and then milk them after they give birth. Take that product, turn it into a milk-based capsule, call it transfer factor, and give it to human children. No research had ever been conducted to suggest this process would do anything at all.

As for Fudenberg, Wakefield had neglected to mention some things. Two years before, the South Carolina medical board had suspended Fudenberg’s medical license as a result of the doctor’s “engaging in dishonorable, unethical, or unprofessional conduct” by obtaining narcotics from a member of his office staff and using them, and also writing prescriptions for someone who was not a patient. He had only recently had his license reinstated, but he was prohibited from writing prescriptions. Fudenberg also believed, without evidence, that flu vaccines caused Alzheimer’s disease.

As for Royal Free being a co-applicant, the hospital knew nothing about it. Wakefield had told no one at the hospital that he was putting its name on his patent application. While it might increase the chance of the patent being granted, the rights could revert to Wakefield if the hospital later refused ownership.

Topping it off, the application was simply sloppy. It misspelled Fudenberg’s name as “Fundenburg.” And the phrase Wakefield used for autism—regressive behavioral disease—was not a clinical term; no expert in the field would have understood what Wakefield was trying to say. His incompetence and lack of qualifications where autism was concerned appeared to be so fundamental that he didn’t even know the correct terminology.

SINCE THE TIME that his son was included in the study as Child 10, Robert Sleat had remained in frequent contact with Wakefield. The two were feeling each other out about going into business together. Wakefield told Sleat the news about his patent application for a single-dose immunization. Wakefield repeated his poorly researched beliefs about transfer factor, boasting that it had no serious side effects and could be used not only to prevent measles but also to treat inflammatory bowel conditions. Sleat, who had a business background and was well versed in the pharmaceutical industry, was intrigued that Wakefield had filed for a patent for this supposed miracle drug.

As Wakefield and Sleat discussed transfer factor, Child 10’s mother, Sally, grew increasingly desperate about her son. On June 20, 1997, she contacted one of the nurses working on the study, telling her that the boy’s behavior was deteriorating rapidly. Wakefield had informed Sally that he wanted to treat the boy either with a transfusion of a blood serum known as IVIG or perhaps with transfer factor. She asked the nurse if she knew whether Wakefield had decided which medication he wanted to use.

Ten days later, Sally telephoned Walker-Smith, still distressed about her son’s condition. The child’s sociability had degenerated, he struggled more with eye contact—everything had worsened. She told Walker-Smith that Wakefield had found measles virus in the boy’s intestines, so there must be some sort of viral flare-up. And what about those treatments Wakefield had discussed, IVIG and transfer factor? Wakefield also told her that he’d be testing the gut tissue for rubella virus, the cause of German measles, which the boy had already been diagnosed with. Had those results come back yet?

Walker-Smith was incensed that Wakefield was doling out advice to a distraught mother. Wakefield was a researcher, ethically bound to avoid any involvement in the boy’s treatment. As the child’s clinician, that was Walker-Smith’s job. He wasn’t knowledgeable about transfer factor, but he would never recommend using IVIG to treat the boy. And what was Wakefield doing telling Sally about a rubella test? This was the first time Walker-Smith had heard anything about rubella in this research.

The discussions with Walker-Smith produced no results, so on July 11 Sally sought out Wakefield again. Would he, she asked, proceed with treating her son with this new medication, this transfer factor?

With Child 10’s condition continuing to slide, Wakefield wondered if the time had come to prepare him for an injection. He discussed the idea with Walker-Smith, who was concerned that Child 10 was showing regression and that Wakefield had reported finding measles in the boy’s intestine. Walker-Smith, wanting to know more, obtained research about transfer factor. He found the scientific papers quite persuasive. Walker-Smith was particularly impressed by a study on the use of transfer factor in AIDS patients; it struck him as providing strong evidence that the drug was safe. He did not know that the studies involved a different form of transfer factor, not Fudenberg’s mouse-blood-goat- milk formula.

Wakefield contacted Fudenberg, asking him to send some of his homemade transfer factor to London. Then, on July 25, he and Walker-Smith contacted Wendy Spicer, manager of the Royal Free medication dispensary, where they would have to store the drugs before giving them to Child 10.

In a letter to Spicer written by Wakefield and signed by both men, they explained that the mother of one of their patients had approached them, practically begging that they provide transfer factor treatment to her child. While they had no idea if it would work, they had been in contact with an American doctor who said he’d had success using it to treat a child with autism.

The letter was a black hole of omission. Neither man mentioned that Child 10 had not been diagnosed with autism, nor had they seen the treatment records from the supposed use of transfer factor in the American child. They did not say that the doctor they were citing had only recently had his medical license reinstated. Worse, Child 10 could not in any way be considered their patient for his developmental problems. Two gastroenterologists—one not even a pediatrician—should not be treating his supposed autism.

They told Spicer that they would be dropping off the transfer factor at the dispensary, where they’d come and get it when needed.

“We are prepared to take full responsibility for the outcome of this treatment,” they wrote.

DAYS LATER, panic and outrage raced through the Royal Free Hospital. What had Andrew Wakefield done?

Louise McKee, a reporter from the British magazine Pulse, had called the hospital’s press office, asking surprising questions about Wakefield’s unpublished work investigating alleged connections between the MMR and autism, about government suppression of information on the dangers of vaccines, and about planned meetings between Wakefield and Tessa Jowell, Britain’s recently appointed minister for public health. The hospital had been caught unaware, flummoxed by how the reporter had learned any of this. No researcher with even the flimsiest knowledge of basic ethics would discuss potential conclusions from incomplete research with the media. It was a colossal blunder in judgment.

The press officer alerted hospital administrators, who in turn tried to contact Wakefield; he was on vacation, unreachable. But the calls kept coming. The reporter contacted a mother with two children in Wakefield’s study. The mother telephoned other doctors at Royal Free, demanding to know who had violated confidentiality in apparent contravention of British law.

Some of Royal Free’s questions were answered by the August 2, 1997, issue of Pulse. Copies of the magazine rocketed among researchers, administrators, and professors, as well as vaccination and autism experts in the health department, including David Salisbury. He studied the article in disbelief.

Titled “New MMR Studies Revive Crohn’s and Autism Fears,” the article read as if it had been dictated by Wakefield himself:

Pressure on the government to order a full review of alleged links between MMR immunization and a range of serious illnesses grew this week with the emergence of fresh research evidence. The Department of Health has so far rejected suggestions of a link between MMR and MR vaccines and a rising incidence of Crohn’s disease and autism in children.

Salisbury sighed and kept reading. The article referenced five unpublished studies showing a connection between MMR and either autism or Crohn’s. Then Salisbury saw the name he expected. Wakefield, author of the studies, was quoted uncritically, spewing his interpretations of the studies and suggesting that government officials were trying to silence him:

Dr. Andrew Wakefield, reader in medicine at the Royal Free Hospital in London, said the studies were designed to enable evidence to be looked at from several angles—“a bit like fitting together the pieces of a jigsaw” … [Wakefield] first published research on the topic in The Lancet two years ago. At the time, his findings were dismissed by department officials as flawed … He said criticism of his previous findings by the Chief Medical Officer and other government officials showed a lack of understanding.

Further down, Salisbury read that his boss was scheduled to get together with Wakefield soon, something he knew was not true: “Pulse has learned that Public Health Minister Tessa Jowell has set a date for a meeting next month to hear results from five new studies set to be published within the next six months.”

This was bad. The article was not in some obscure academic journal; lots of general practitioners kept Pulse in their waiting rooms. Parents would read this nonsense and likely become fearful that vaccinations would harm their children. Few if any would note that Wakefield’s studies were incomplete and had not been peer-reviewed.

At Royal Free, doctors raged about Wakefield’s recklessness. One professor at a meeting of pediatricians fumed that they would be besieged by parents worried about immunizations. For any of them with autistic patients, it would be a thousand times worse.

The group agreed to contact Roy Pounder, who had hired Wakefield years before and was now a mentor for him. He was stunned to hear that his protégé had broken ethical rules, tarnished the hospital’s reputation, raised false hopes of untold numbers of parents of autistic children, and openly disdained his colleagues.

On learning that Wakefield was out of town, Pounder called Walker-Smith. No one could find Wakefield, Pounder said, and the Pulse article was proving to be a catastrophe. Unnerved, Walker-Smith asked Pounder to fax him a copy.

He was dumbstruck. That Wakefield was working with a law firm was bad enough; now he was blabbing to the media about unpublished data. This was horrendous. Since he couldn’t reach Wakefield immediately, Walker-Smith decided to send him a letter.

“I could hardly believe what I read,” he wrote. “How can you talk about the papers to be published when they have not appeared in press? Why did you give such an interview at this delicate time when we are so close to publishing?”

Wakefield’s behavior could well undermine the entire study. Two other researchers on the project, Walker-Smith wrote, “are both very upset and concerned that our professional reputation as collaborators is in jeopardy … This whole crisis has really soured relationships all round.”

When his vacation ended, Wakefield returned to a hospital in chaos. He assured everyone that he hadn’t intended for this to happen. A member of Parliament contacted by Wakefield had given the heads-up to the Pulse reporter. When he heard from the reporter, Wakefield said, he thought he was speaking off the record. All a mistake, he assured his colleagues. Wouldn’t happen again.

ON AUGUST 8, 1997, the directors of Freemedic, Royal Free’s investment arm, gathered for one of their periodic meetings. Freemedic had been established a few years earlier by Cengiz Tarhan, the hospital’s deputy finance officer, to back companies launched by its researchers. The strategy was for Freemedic to put seed capital into ideas that stood the best chance not only of bringing money to the hospital but also of producing medical innovations that would benefit society.

On this day, the directors had gathered to consider a new proposal from Andrew Wakefield. Tarhan was aware of Wakefield’s unconventional approach to fundraising, having recently refused his request to deposit the Legal Aid Board money into a hospital account. Now Wakefield had come to Freemedic in search of £200,000 to set up a company to produce transfer factor.

Wakefield’s application was bizarre. He had informed Freemedic’s directors that he’d recently submitted a patent request naming Royal Free as a co-applicant, yet the hospital never would have allowed that without express authorization. Additionally, the science described by Wakefield was complex and had led Tarhan to forward the application to various hospital colleagues as well as to outside consultants, to help determine whether it had any commercial merit.

The feedback was discouraging. On reviewing Wakefield’s proposal, Arie Zuckerman, the dean of Royal Free Medical School, contacted Tarhan with an insistent message: Do not invest in this. Zuckerman explained that he had a lot of experience with transfer factor and its use in infections, and Wakefield was providing assurances about its use that were not scientifically sound. Worse, Wakefield’s proclamations that the MMR had been incontrovertibly linked to Crohn’s disease were false. Wakefield had never proven a connection between the vaccine and any intestinal disease; his studies merely suggested a link. And even that theory was weak.

“The case for an association between measles and Crohn’s disease is highly controversial, and is yet to be confirmed independently,” Zuckerman told Tarhan.

The outside consultants also gave it a thumbs-down. The transfer factor formula Wakefield wanted to use was a soup of ingredients, without any of the active components that would provide viral immunity identified or described. It was as if Wakefield wanted money for a new rocket fuel but failed to give any information about how—or even if—the fuel burned.

Freemedic decided to pass on the proposal.

STEAMER TRAYS LOADED with hot food beckoned faculty to the cloth-covered banquet bar. Nearby, academics and administrators from Royal Free sat at wooden tables and on overstuffed couches as they munched their meals in the senior common room, the intellectual hub of the medical school.

Cengiz Tarhan was enjoying a midday break when Wakefield spotted him from across the room. He sauntered over, eager to discuss his business ideas for transfer factor.

Tarhan was unerringly polite. But he made it clear that the directors had ruled out investing. Wakefield pitched a few suggestions, as if there were some magic words he could say that would change the situation.

“He was quite determined,” says one official involved in the decision. “Andy did not want to take no for an answer.”

“I’m sorry, Dr. Wakefield,” Tarhan said. “We’ve had a number of meetings about financially supporting your work, but we’ve decided that, in part because of the controversy surrounding it, Freemedic cannot allocate funds for this.”

“What controversy?”

“Well, there has been some concern about the idea, since some of your positions about the measles virus and Crohn’s are not widely accepted.”

“A lot of the criticism has been based on incorrect interpretations.”

“Be that as it may,” Tarhan said, “this is the decision we made. However, this does not mean your work has to end. I might suggest you look into obtaining grants from independent organizations or perhaps from venture capital funds.”

Wakefield hesitated. “Unfortunately, there are money problems right now,” he said. “We’re running out of cash. If we don’t get some sort of capital infusion, we could lose the patent and the whole project would be jeopardized.”

There had to be some way the medical school could work with him on this, Wakefield pleaded. If there was just a little investment to ameliorate the current cash shortage, the project could continue. This could benefit many patients and the hospital itself.

Tarhan considered Wakefield’s request. Perhaps something could be done, some financial maneuverings to keep Wakefield afloat as he worked on his idea a little longer.

“I’ll see what we can do,” Tarhan said.

Over the next week, he consulted with other members of the finance department and came up with a solution. If Wakefield found a way to cover half the costs through July 1998, Royal Free would cover the other half out of general funds. If he persuaded outside groups such as pharmaceutical companies to put in some money, Tarhan thought, his proposal to match those funds should keep the transfer factor project going.

5

Peer Review

HANDSOME GEORGIAN HOUSES wrapped an opulent garden square in London’s West End. Once the fashionable residences of dukes and lords, the buildings had long since been converted to office space. Richard Horton strolled past lush trees to number 42 Bedford Square, the headquarters of The Lancet, the internationally renowned medical journal.

Horton, editor in chief of the publication, considered the neighborhood delightfully posh, and the office was kitty-corner from the onetime home of Thomas Wakley, the surgeon who had founded The Lancet more than 150 years before. A stone’s throw away was the London School of Hygiene and Tropical Medicine, where he and his editors could fetch a cup of coffee during a demanding workday.

Inside the cramped first-floor offices, Horton found the usual tumult as a harried group of editors buzzed about. Their workload was almost unfathomable; as one of the oldest and best-known medical journals, The Lancet attracted researchers from around the globe who aspired to see their papers published in its pages. Some ten thousand manuscript submissions arrived by mail at Bedford Square every year, and Horton’s team of twelve editors read every one to decide which papers to pursue further.

This day in November 1997 would be an interesting one—Thursdays always were. Papers that arrived weeks before had already received an initial review, and those that hadn’t been rejected had also been read by outside specialists. Any that cleared that second hurdle would be discussed at the Thursday editorial meeting, when the editors asked questions, discussed changes, and generally poked and prodded each manuscript to determine whether it was worthy of The Lancet.

During the meeting that afternoon, the editors turned to paper number 11096, which had been reviewed by John Bignall, a general practitioner who had joined the editorial staff three years before. This was a submission from researchers at Royal Free, where Horton himself had once worked; the lead author was Andrew Wakefield.

Ah, Wakefield. Horton knew the name well. They’d had little contact at Royal Free, where they worked at opposite ends of the tenth floor. But he was familiar with Wakefield’s vibrancy, charisma, and ambition. He brought energy to the department. Horton had published other Wakefield studies and was delighted to hear that he had submitted a new one. Wakefield shook things up.

“This is about a new GI syndrome in children,” Bignall began.

The editors pored over the submission. There were two papers, one describing the syndrome and parents’ recollections of the time that had elapsed between their child’s vaccination and the onset of behavioral symptoms. The second paper described Wakefield’s attempts to isolate the component of the MMR that caused the gastrointestinal issue. The outside peer reviewers had rejected the second paper as unworthy of publication. The editorial team agreed.

As for the other paper, the reviewers delivered a mixed response: They were intrigued by the theory that an intestinal problem may have led to a developmental condition—but the rest of it, not so much. The parents of eight of the twelve study subjects believed there was a connection between their children receiving the MMR and the appearance of behavioral symptoms. These claims didn’t carry any weight. It was always a risky bet to ask untrained people to recall medical events from months or years before. Merely asking the question could cloud memories and lead to false answers.

Bignall had marked the paper ER—for “early reports”—which readers of The Lancet knew were presentations of preliminary results subject to subsequent analysis. The editors agreed: The potential gastrointestinal link to developmental conditions was the paper’s central thrust. The parental testimony was incidental, a side note of little scientific importance. If Wakefield wanted to keep it in the article, he must give as much context as possible, explaining that the parental testimony was purely speculative and that the study did not show an actual link between the MMR and either the gut syndrome or autism. He must highlight the importance of vaccination and why people should continue to provide standard immunization to children.

That struck everyone as a good strategy. The editors’ questions and concerns would be sent to Wakefield and his colleagues, and either they would agree to address them or the paper would be rejected.

After receiving feedback from The Lancet, the study authors met to discuss revisions. As they reviewed the draft, Walker-Smith noticed a sentence that Wakefield had added.

“Investigations were approved by the Ethical Practices Committee of the Royal Free …”

Well, that wasn’t correct. The committee had approved the research protocol but made clear that five of the children could not be included in the study, and insisted that any invasive tests—lumbar punctures, colonoscopies, blood work—had to be performed solely as part of the children’s normal medical care. Undoubtedly, if Wakefield had even suggested that these painful and extensive tests would be performed simply for research, the committee would have rejected the study outright.

“There’s a problem here,” Walker-Smith said. He pointed out the sentence and explained why it was wrong.

“Okay, well, I’ll sort it out,” Wakefield replied. “I am discussing it with The Lancet.”

The meeting broke up and everyone went on their way.

EVERYTHING WAS LOOKING UP for Wakefield by December 1997. He felt sure that, with a few fixes, his study would appear in The Lancet and make a global smash. And he may have found a way to get the transfer factor business going: Robert Sleat, the father of Child 10.

With a background in business and ties to the pharmaceutical industry, Sleat had the knowledge and contacts that Wakefield’s enterprise needed. He could connect Wakefield with manufacturers who could produce the tests Wakefield described in his first patent application, those that detected the presence of intestinal measles virus. Then Sleat could raise money for clinical trials to test Fudenberg’s transfer factor formula, the supposed single-injection alternative to the MMR. Once the research was done, he could help set up another manufacturing and product-distribution system for the drug.

Sleat ran some analyses and concluded that Wakefield’s test to find intestinal measles viruses could bring in £4 million per year in the United Kingdom alone. And once they were ready to go with transfer factor, even greater riches awaited. But to undertake these projects, they needed to raise £2 million.

Wakefield felt certain they would have enough money soon—from both outside investors and Royal Free. Meanwhile, he decided, it was time to test Fudenberg’s formula. Child 10 would be administered transfer factor starting immediately. No documentation would appear in the boy’s medical records about his cognitive state at this time or whether his parents knew that the Fudenberg drug was experimental. Nor is it known whether Wakefield had asked for hospital approval to administer the drug or if he had improperly done it himself. Whatever the circumstances, in December 1997, Child 10 began receiving a concoction invented by an American barred from writing prescriptions.

Wakefield had crossed into dangerous territory: He was conducting an unapproved experiment on a developmentally disabled child, using a drug that could someday make him rich.

WAKEFIELD AND HIS COLLEAGUES made the revisions requested by the Lancet editors, and the article was scheduled for February 1998. The Royal Free media office announced a press briefing to coincide with publication.

Arie Zuckerman, the Royal Free dean, had seen Wakefield engage in too much irresponsible behavior when dealing with the media over the past two years, so he stipulated that some of Wakefield’s co-authors be at the briefing. The group would impose rules: Speculation and the spinning of theories was prohibited. All five doctors agreed—Wakefield included—that the briefing would be restricted solely to their findings on intestinal changes in the bowels of twelve children with developmental disabilities. Nothing else.

The day before the briefing, Simon Murch, a pediatric gastroenterologist and one of the study’s co-authors, received an early copy of The Lancet containing the research paper. Wakefield had promised to circulate each draft to the group, but this was the first version of the article Murch had seen since November.

Murch felt a bit anxious about the upcoming press briefing and was focused on how best to present the paper to reporters. He barely noticed the sentence “Investigations were approved by the Ethical Practices Committee of the Royal Free.”

It was that same false statement, the one pointed out by Walker-Smith months before, that Wakefield had promised would be deleted.

At Dawbarns law firm, Richard Barr also thumbed through an early copy of The Lancet.

He read the list of potential conflicts for the researchers on the study. He had expected to see something about Dawbarns or the Legal Aid Board. But there was nothing.

Well, not his decision. Wakefield certainly knew what he was doing.

6

Media Frenzy

THE NEXT DAY, February 26, the researchers assembled at Royal Free’s Atrium conference room. In no time, Wakefield went rogue, ignoring his commitment to limit his comments solely to what the study showed. “With the debate over MMR that has started,” he told the reporters, “I cannot support the continued use of the three vaccines given together. We need to know what the role of gut inflammation is in autism.”

The answer for now, he said, was to stop using the MMR. “My concerns are that one more case of this is too many, and that we put children at no greater risk if we dissociated those vaccines into three.”

It got worse from there. Wakefield attacked vaccine safety, said that the MMR had not undergone proper testing, and suggested that national health efforts could suffer if his advice was not heeded. “The vaccine policy in this country depends on trust,” he said. “I fear there may in the future be a breach of this trust and that may adversely affect vaccination policy.”

Horrified, Zuckerman broke in and turned the discussion over to Simon Murch, who, equally flabbergasted, delivered a statement of support for the MMR.

What does this man have against the health department and the vaccine experts? Murch wondered to himself. Urging the government to ditch triple-dose immunization and spreading vague theories attacking vaccine-safety studies could produce disastrous consequences.

And what about Wakefield’s own children? His eldest three—two boys and a girl—were old enough to have received their vaccines. But the Wakefields had an infant son at home. Would Wakefield’s zealotry lead him to withhold a vaccine?

The researchers tried to turn the discussion to the primary findings—that twelve children with developmental disorders had been diagnosed with intestinal problems—but it was too late.

The briefing ended, and the reporters dashed to Wakefield. Mark Berelowitz, the child psychiatrist on the study, spotted a writer he knew from a medical journal. He approached the man.

“The real story is all the rest of us,” Berelowitz said, meaning the other scientists’ focus on the findings about this new gastrointestinal syndrome they’d studied.

The journalist shook his head. “No, Mark, it is not,” he replied.

He turned his back on Berelowitz and headed off to interview Wakefield.

WHAT BERELOWITZ and his colleagues didn’t know was that the Royal Free media office had distributed a video press kit to reporters before the briefing. No hospital administrators had been asked to review it, and not even Zuckerman knew that the press office had abandoned the standard practice of producing videos in-house and instead had turned the work over to a private company. The tape was no calm recitation of scientific findings; it played more like a segment from a tabloid news program.

Early in the recording, the video displayed a syringe with a needle dripping liquid, then cut to a little girl crying as vaccine was injected into her arm. Later, a parent declared that the MMR had caused her son’s autism. Then Wakefield appeared, repeating his false warnings about the triple vaccine. “Giving the measles vaccine on its own reduces the risk of this particular syndrome developing,” he said. Literally no valid science—including his own—provided any justification for such a statement. But that was the message reporters heard.

After the briefing, Zuckerman hurried to his office, where he found a partial script of the video. For the first time, he realized that the material prepared for the press was chock-full of misleading and false information. And it was too late to retract it.

That night, word of the purported findings of Wakefield’s study exploded on local news broadcasts in London.

“New research showing a possible link with a bowel disease that could lead to autism” (Jon Snow, Channel 4 News).

“Claims there could be a link between common childhood vaccines and autism” (Rob Butler, 5 News).

“Questions were raised today about safety of the combined mumps-measles-rubella vaccine” (John Suchet, News at Ten).

The uproar continued the next morning. “Ban Three-in-One Jab, Urge Doctors,” read The Daily Mail. “Alert Over Child Jabs,” blared the front page of The Guardian. The broadcasts featured Wakefield from the video news release, and newspaper articles quoted him from the briefing. In each case the message was the same: The MMR poses potential threats; three individual vaccines would be safer.

This was worse than his colleagues had feared. Murch, Walker-Smith, and another one of the co-authors, Michael Thomson, decided to act. Perhaps issuing their own press release would help curtail the frenzy that Wakefield’s misinformation had set off. But they couldn’t attack Wakefield directly, nor could they say he was wrong; they couldn’t prove a negative. Maybe the theory was true, maybe not. No one knew, including Wakefield. He was using exclamation points when question marks were needed.

The three men immediately took a crack at composing a release. The first paragraph was about what the study actually showed, reading, “For the first time it describes significant bowel inflammation in children with autism and related disorders.”

They wrestled with the second paragraph. “The MMR Could Hurt Your Child!” is a much sexier headline than “More Study Needed,” so they knew the truth would be less appealing to the media than alarmist speculation. Still, they tried: “As to the possible risk of MMR, we support present public health policy concerning MMR. However, it is important that evidence be collected as soon as possible to establish whether there is any role for MMR as a cause of bowel inflammation found in children with autism.”

The men took the release to Royal Free’s chief press officer. She reviewed it, then told them that Royal Free was preparing its statement, which went out the next business day. It read much like the draft composed by the three doctors.

The media ignored it.

ON THE MORNING of March 3, 1998, Wakefield escorted two men to the offices of the hospital’s finance department. Cengiz Tarhan stood to greet the visitors. Handshakes all around, and then into a conference room for Wakefield’s latest pitch about his planned transfer factor business. Once everyone was seated, Wakefield gestured to his two guests. He introduced the first, Alex Korda, as the nephew of a famous Hungarian-born film director who ran his own venture capital fund in London. The second, Robert Sleat, had worked with him on this project for some time. Their new company, he said, would be called Immunospecifics Biotechnologies, with Korda serving as chairman and Sleat as chief executive. Wakefield didn’t mention that Sleat was the father of a boy in his autism study, nor that the child had been given experimental doses of transfer factor.

Tarhan asked a few garden-variety questions. “If it’s not too much trouble,” he then said, “could both of you send me background papers on yourselves?”

“Yes, we’ll get that prepared,” Wakefield said. He had already sent two references for Korda and promised he would provide some for Sleat as well.

Korda spoke next, explaining that he had a wide-ranging background with startup companies in the biotechnology field. “I’ve discussed this proposal quite extensively with Dr. Wakefield, and I’m prepared to raise funds for this company,” he said.

The company would raise half the money for early testing, with the other half coming, as promised, from Royal Free. After that, about £2 million would be required for full development of the transfer factor. The market for its product, Wakefield said, was about £4 million in Great Britain alone. He proposed that Royal Free surrender the intellectual property from his research, which normally would be owned by the hospital, in exchange for a financial relationship with Immunospecifics.

“Put together a business plan,” Tarhan said. “I’ll review it and consult with my colleagues to see where we go from there.”

THE NEXT DAY in northwest Wiltshire, England, a public health official named Andrew Rouse sat at his computer searching the internet. Rouse regularly read medical journals like The Lancet, and given the explosion of publicity about the Wakefield paper and its potential impact on vaccination rates, Rouse decided to conduct some online sleuthing.

A major issue bothered him about the Lancet article: It revealed nothing of how the twelve children in the study had been selected—critical information other scientists needed to assess the integrity of the research. Did the children join through standard doctor referrals? Or through self-referrals by parents who already believed the MMR had caused their children’s autism? The distinction was critical. If the parents made the decision, that could have introduced bias into the selection of study participants, as well as parental recall bias on the timing between vaccination and the emergence of symptoms of autism.

On a website for a group called the Society for the Autistically Handicapped, Rouse discovered a fact sheet from a British law firm called Dawbarns. The document was dated May 15, 1997—ten months before the Lancet article. As he scanned the forty-eight-page document, his concerns grew.

On page 27: “We are working with Dr. Andrew Wakefield of the Royal Free Hospital London. He is investigating this condition.”

Page 44: “Inflammatory Bowel Disease and Autism. If your child has developed persistent stomach problems (including pains, constipation or diarrhea) following the vaccination, ask us for a fact sheet from Dr. Wakefield.”

Pages 47–48: “If you believe your child has been damaged: we propose to seek proper compensation in the courts … We will also help with applications to the Vaccine Damage Tribunal.”

The interconnections—Wakefield, Dawbarns, parents of autistic children, lawsuits—were disturbing enough. But the ideas espoused in the document linking vaccines to bowel disease and autism closely matched Wakefield’s research described in The Lancet. Could the children in the study, Rouse wondered, have been connected to this organization and its law firm? Would the possibility of lawsuits lead to recall bias from parents who wanted to believe the MMR caused autism? If this suspicious relationship between Dawbarns and Wakefield involved the research subjects as well, the study was junk.

The Lancet editors needed to know, Rouse decided. He opened a blank document on his computer and wrote at the top, in extra-large type: “Vaccine adverse events: Litigation bias might exist.”

After explaining his online search, Rouse quoted from the fact sheet he had found on the Society for the Autistically Handicapped website. He chose his words carefully. “It would appear likely, therefore, that some of the children investigated by Wakefield came to his attention because of the activities of the Society,” he wrote. “Information gained from parents referred in this way would undoubtedly suffer from recall bias.”

He finished his letter by stating, “If some of the children were referred (directly or indirectly) because of the Societies [sic] activities it is unfortunate that Wakefield did not declare his interest in the Society.”

Rouse wasn’t alone in his criticism. The medical community’s backlash against The Lancet for publishing the Wakefield paper was swift and brutal. Other researchers bemoaned that such a flimsy piece of work—only twelve families, all of them self-reporting symptoms?—had been put forward in a way that could cripple public health initiatives. This was preliminary, meager data, potentially meaningless, and now the pressure was on governments and pediatricians around the world to prove Wakefield wrong.

The World Health Organization proclaimed that the Wakefield paper “failed at every level to make a causal connection” between the MMR vaccine and autism, and that the decision to publish such claptrap was “tragic.” Some criticism was personal, directly attacking Horton, the editor in chief, for what public health officials considered a disastrous failure in judgment.

“I think you will bear a heavy responsibility for acting against the public health interest which you usually aim to promote,” one colleague wrote to Horton. “Moreover, you will only increase the anguish of the parents of the sick children with whom all doctors will sympathize.”

Some prominent critics challenged Horton quietly. A longtime member of the Joint Committee on Vaccination and Immunization—an independent advisory group for the government—sent a letter to the attention of the chairman of The Lancet’s editorial board, slamming Horton for failing to address the damage that had been done to national immunization efforts. The paper, the writer said, should never have been published. The Lancet has no editorial board chairman, so the letter was delivered directly to Horton.

The most pointed public critique of Horton was written by Simon Fradd, a senior figure within the British Medical Association, and published in the newspaper Doctor. Horton’s motivation for publishing something so reckless, Fradd suggested, was purely self-interest. “The process of peer-review in accepting this paper for publication in a high-profile medical magazine needs examining,” he wrote.

In some ways, Horton found the outrage amusing. What did they expect, that he would only publish boring papers? Sure, he could have taken a more hands-on approach with the press briefing and media releases. But he had never considered that to be his responsibility. And the arrogance being exhibited by all these experts, Horton thought: Did they believe it was up to the scientific elite to decide whether to present controversial hypotheses to the public? Absurd.

At around that time, Rouse’s letter arrived at the Lancet offices. Horton glanced over it. Just more criticism. He instructed an editor to send it to Wakefield for a response.

BUNDLED UP in his coat against the brisk morning weather, Wakefield walked toward the six-pillared portico of the Royal College of Surgeons on March 23, 1998. Inside, he found his way to the meeting hall, where he had been called to discuss his paper in The Lancet with members of the Medical Research Council, a government body that financed medical studies.

Dozens of researchers and physicians who worked with the council had gathered to question Wakefield. Thirteen other officials—including two of Wakefield’s sometimes nemeses, Arie Zuckerman and David Salisbury—joined the meeting as observers.

George Radda, chairman of the council, stood to open the discussion. “Good morning and welcome to this meeting,” Rada began. “I would like to thank all of you for attending, many of you coming at very short notice, which reflects the seriousness and the importance of the business and the topic today.”

The council members asked a spate of questions about the underlying science related to the gastrointestinal issues described in Wakefield’s study. The panel expanded its inquiry, asking Wakefield about the children’s immunological status and the potential involvement of vitamin B12.

Then they turned to the primary issue at hand: these declarations about links between autism and the MMR. A member named Roy Anderson took the floor. The average age for children receiving the MMR was about two, Anderson said. “So, if you chose children at random of that age, then in essence most of them would have been in a very close proximity to the point of their immunization. I am just wondering, in the analysis there of an association, whether you corrected for age and the average age of vaccination?”

“What we are reporting is merely the story as it was reported to us,” Wakefield replied. “We have not corrected for anything. I have merely told you the story as it was told to us by the parents. And the parents had made the association with MMR.”

But his work was not finished, he continued. Since the Lancet study, his team had investigated more children. “And still more are on the waiting list,” he said. All told, he had about five hundred children ready to be part of his research.

But where had the children come from? Anne Ferguson, former director of the Department of Medicine at the University of Edinburgh, broached the question.

“I am going to be forthright, since it looks as if nobody else is going to raise the issue of bias in generating this serious of a case,” Ferguson began.

Ferguson’s depiction of events was startlingly on point: In the mid-1990s, Wakefield and his colleagues became concerned about the measles vaccine, while at almost the same time, an anti-vaccine group called JABS formed that had the same concern.

“And then … there was a lot of publicity on the telly and newspapers and on the internet suggesting that if someone had a child with autism and bowel symptoms, that this [research study] was the center in the world to find out about it,” Ferguson said. “Is that not correct? Is that not how these 500 cases have come along?”

The question was direct, and critical to understanding whether the study had any validity at all. Wakefield’s theory seemed to be built on the stories of parents with an extreme bias. Ferguson’s question was the first time the issue had been put to Wakefield with no wiggle room. An honest researcher would tell the truth.

Wakefield lied.

“Thank you for being forthright,” he began. “I imagine you are suggesting we are a sort of dumping ground for disaffected parents. No, we are not. And indeed, these parents came to us de nouveau without any connection through any other organization … All patients that we have reviewed so far have come to us through their general practitioners or pediatricians by the standard route.”

In fact, parents had been connected to him by JABS, from Dawbarns, or both. With his evasive and dishonest answer, Wakefield successfully hid his own conflicts, as well as those of the parents pursuing vaccine litigation.

Ferguson could not have known she was being deceived. Wakefield’s answer described an acceptable situation. Scientists have faith in the peer-review system and share a conviction that fraud in the field is extraordinarily rare. That, coupled with a fear of making false accusations of deception about a colleague, often explains how dishonest schemes fail to be detected by other researchers.

“The accusation of fraud is so serious that it cannot be made lightly,” Wolfgang Stroebe, a social psychologist at Utrecht University, in the Netherlands, wrote in a 2012 paper. “Even if one suspects that the work of a colleague is fraudulent, one needs unambiguous proof for this suspicion: the well-known ‘smoking gun.’ ”

Not surprisingly, after hearing Wakefield’s explanation, Ferguson felt embarrassed, for she knew that her question could be taken as an accusation that he had been hiding something about how his subjects had been found.

“I apologize,” Ferguson said. “I wasn’t suggesting any impropriety. It was really the interest in the subject.”

Wakefield smiled. No problem.

7

“No Evidence”

A FAX MACHINE in Wakefield’s office hummed to life, and a two-page document scrolled into the tray. Editors at The Lancet had been sending Wakefield copies of letters they received in response to the autism paper, many of them sharply critical. This new one, though, from some public health official who signed his letter “A. Rouse,” was the only letter suggesting that Wakefield might have a conflict of interest, and that the parents interviewed in the study might have been blinded in their recollections by the prospect of winning money in a lawsuit.

Wakefield was not about to let this pass without comment. He sat at his computer and typed. He had never heard of the Society for the Autistically Handicapped, he wrote, nor had he provided them a fact sheet to distribute. The children had been enrolled solely through referrals from their personal physicians. “No conflict of interest exists,” he said decisively.

Wakefield’s response was a marvel of obfuscation and misdirection. He denied having heard of the society that published the Dawbarns document on its website but said nothing about Dawbarns itself. He didn’t disclose his use of the Legal Aid money to fund his research. He hid the fact that parents from JABS—represented by Dawbarns—were asking their physicians for referrals to his study. And he sidestepped Rouse’s concern about litigation bias by lying again, this time saying that no conflicts existed.

After completing his reply, he faxed it to The Lancet. Richard Horton reviewed it.

No problems, he thought. He told his team to edit the Rouse letter and the Wakefield response and get them into the next issue. The editors removed all the quotes from the Dawbarns fact sheet that Rouse had highlighted. Wakefield’s mollifying statement seemed quite reasonable as a reply to the letter as edited, but not to the letter Rouse had written.

ROUSE FLIPPED OPEN the latest issue of The Lancet in early May. He had been informed a few weeks earlier by one of the editors that they would be printing his letter.

There. He found it. And was dumbfounded.

The Lancet editors had removed all of the quotes from the Dawbarns fact sheet that he had highlighted. The edited-down version made it appear as if this was just some unimportant bit of commentary.

He read through Wakefield’s response. His answers were vague, ignoring the most troubling questions. Without the fact sheet quotes, Wakefield’s soothing words might allay the concerns of any reader who did not know what had been cut; his reply seemed quite reasonable to the letter as published, but not to the letter that had been written.

Well, Rouse told himself, he had done his best. He had warned The Lancet that danger might lie ahead. They took no action. There was nothing else Rouse could do.

“I AM VERY, very much concerned.”

Zuckerman eyed John Walker-Smith evenly as he spoke. It was July 1998, months after publication of the Lancet article, and colleagues were still contacting Zuckerman to express ethical worries. Something wasn’t right, and no one had gotten a clear answer from Wakefield. To resolve the matter, Zuckerman had asked to meet with Walker-Smith, Simon Murch, another researcher, and the Royal Free medical director.

Zuckerman explained that he had received questions from people he respected, including members of the Medical Research Council, who’d walked away from their March meeting with Wakefield more troubled than when they arrived. Wakefield’s plans to test hundreds of children with autism—how could that be proper? There was no independent confirmation that the twelve subjects in Wakefield’s study suffered from long-term bowel disorders, yet he wanted to push hundreds more through hospitalization, sedation, lumbar punctures, bowel biopsies, MRIs, and radiography?

“I assure you,” Walker-Smith said, “these investigations have only been undertaken as indicated by clinical need.”

“Well,” Zuckerman said, “I’m not a pediatrician, so I’m not in a position to judge clinical need. But there still is a significant ethical issue here.”

Wakefield, Zuckerman explained, had refused to seek confirmation of his findings from an independent laboratory. Beginning when Wakefield first said that he’d found measles in the guts of people with Crohn’s, Zuckerman had urged him to send his biopsies elsewhere and have his findings corroborated. That was standard for ethical medical research; Wakefield wouldn’t do it.

Zuckerman had asked Wakefield’s boss, Roy Pounder, to compel him to obtain independent confirmation. No success. He asked a member of the National Institute for Biological Standards and Control whether he would be willing to examine the tissue. The man said yes, wrote to Wakefield asking for the material, and was ignored. Finally, Zuckerman ordered Wakefield to provide tissue samples to Bill Bellini of the Centers for Disease Control and Prevention in the United States for independent confirmation. Wakefield said he would. Bellini later wrote Zuckerman, asking why Wakefield had failed to send the samples.

This was indeed a major ethical lapse, Zuckerman said. Worse was that many reputable scientists—including some from Royal Free—had tried to duplicate Wakefield’s findings with different biopsies but were unable to do so. There was no confirmed evidence of an association between the MMR and inflammatory bowel disease.

“I believe, since these are your patients,” Zuckerman said to Walker-Smith, “that it is up to you to instruct Dr. Wakefield to send these biopsies.” And he needed to do it through the CDC or another lab that participated in global quality-assurance programs.

This would not be a problem, Walker-Smith said. He would persuade Wakefield to send the tissue samples for confirmation.

Wakefield never did.

WAKEFIELD’S PLANS were sputtering for his transfer factor company, Immunospecifics. Royal Free backed away from any potential investment role, at the recommendation of experts. The same problems still remained: Wakefield had not proved the science. And his team seemed to be making little progress in raising their half of the money.

But Wakefield and Sleat were far from giving up. Sleat knew of a professor in Dublin named John O’Leary whose developments in molecular technology might attract investors. Perhaps they could partner with him.

Wakefield met with O’Leary, a balding, cherubic man with a thick Irish accent and an air of great confidence. The two men found that they had a lot in common: endlessly self-confident, immersed in the biological sciences, and eager to earn their own place as businessmen capitalizing on their research. Quickly, they decided to work together.

Wakefield changed the name of Immunospecifics, registering it in Ireland as Carmel Healthcare. He divvied up the ownership. Sleat, the father of Child 10, received just over 22 percent, while Alex Korda, the venture capitalist, got 18. Wakefield’s boss, Pounder, was playing a role in the company, too; he and O’Leary received about 11 percent each. Wakefield got 37 percent.

O’Leary incorporated his own company, called Unigenetics, with Wakefield as a director. Wakefield then helped Unigenetics join the Dawbarns case, and the company obtained £800,000 in funding through the Legal Aid Board. From then on, all tests for measles in the tissue of Wakefield’s subjects would be conducted by O’Leary and his staff.

The dreams were big for these men planning to make money from litigation and fears that the MMR vaccine caused bowel disorders and autism. They put together documents calling for a public relations campaign targeting “parent groups and lawyers representing affected individuals” and “major pharmaceutical companies.”

While trying to raise funds, they put together a prospectus that laid out the strategy in more detail. “Once the work of Professor O’Leary and Dr. Wakefield is published, either late in 1999 or early in 2000, which will provide unequivocal evidence for the presence of the vaccine derived measles virus in biopsy samples, the public and political pressure for a thorough, wide ranging investigation into the etiology of the bowel conditions will be overwhelming,” the prospectus said. “As a consequence of the public political and legal pressures brought to bear, the demand for a diagnostic able to discriminate between wild type and vaccine derived measles strains will be enormous.”

The strategy seemed ironclad. Legal Aid would pay for the research, financing Wakefield and O’Leary. The test results—which Wakefield promised in writing would prove that the vaccine caused bowel disorders in autistic children—would drive publicity. The media outrage would create pressure on governments worldwide for tests and treatments to head off the intestinal and developmental disorders from vaccines. And Wakefield, along with his business partners, would be rich, famous, and celebrated as pioneers in the global war on autism.

It would be the victory that Wakefield had longed for all his life.

MEANWHILE, THE MEDIA STORM over the Lancet article continued into the new year. Mark Berelowitz, the child psychiatrist on the study, watched helplessly as the media played up stories about the “controversy,” with no one, it seemed, having actually read the study’s conclusions.

Berelowitz had taken pride in being careful, demanding clarifications and revisions to the paper to make sure readers knew it did not establish a link between the MMR and autism. But from the day of the press briefing, when Wakefield hijacked the discussion, the study’s exact words were lost amid the provocative sound bites that he offered in abundance.

Berelowitz decided to call some of the reporters and editors who’d gotten it wrong. First, he phoned a reporter at a British paper who had written a long article that misrepresented the research.

“Have you read the paper?” Berelowitz asked.

“No.”

“Can I read this paragraph to you?” Berelowitz said. “ ‘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.’ ”

“Thank you,” the reporter said. “I did not realize it said that.”

“Would you like me to send you a copy of the paper?”

“Yes.”

But no matter the number of calls he made, no matter how many times he explained that what the media portrayed was not what the paper said, nothing changed. And sometimes journalists flat out told him they didn’t care about getting it wrong.

In a call to the health editor of one newspaper, Berelowitz pointed out that a recent article had misquoted the study.

The editor checked the study. “Ah, yes, you’re right.”

A small victory. “Are you going to withdraw that little piece?” Berelowitz asked.

“What’s the point?” the editor replied.

ON MAY 20, 1999, Wakefield stood before a crowd gathered in Sacramento, California, to hear him speak about vaccines and autism. He had begun spreading the word about his work, traveling around the world giving talks and setting up meetings with drug companies like Johnson & Johnson and SmithKline Beecham. On this day, he was speaking at the MIND Institute, a research center recently formed with UC Davis to study developmental disorders. Some parents who had helped fund the center, including a powerful former state politician, were convinced that autism was at least partially attributable to vaccines, making Wakefield virtually a hero for them.

Wakefield updated the group on his research, retelling an anecdote that had become a crowd-pleaser in his talks. He and his colleagues, he said, had hunted for measles, mumps, and rubella viruses in the blood of twenty-two children with autism and bowel problems, then compared the results with blood obtained from thirty-two healthy children. One of the more difficult things for pediatric researchers is ethically obtaining the blood of healthy children, because it entails discomfort. But as Wakefield told it, he obtained the samples easily.

“Again, for those who’ve heard the story, you can put your hands over [your ears] and you can take [a] time-out here, but this is again my son’s birthday party, thirty-two healthy controls,” he said. “And you line them up—with parental informed consent, of course. They all get paid five pounds, which doesn’t translate into many dollars, I’m afraid. But they put their arms out and they have the blood taken. All entirely voluntary.”

The crowd laughed.

“And when we did this at that party,” Wakefield continued, “two children fainted, one threw up over his mother …”

Again laughter.

“One child, who’s my son’s best friend, Ollie, he put his arm out, very bold, had the tourniquet put on, and then went very pale and sort of … ‘Wait till next year,’ ” Wakefield said. “He was nine at the time, and his four-year-old sister came up, stuck her arm out, had the blood taken, took her five pounds, and went off.”

Another child cried. “Ruined his birthday party,” Wakefield continued. “But people said to me, ‘Andrew, look, you know, you can’t do this, people, children won’t come back to you.’ I said, ‘You’re wrong.’ I said: ‘Listen, we live in a market economy. Next year they’ll want ten pounds!’ ”

A video camera recorded Wakefield’s words; officials at the MIND Institute hoped to distribute the tape to parents and scientists who missed the talk. Instead, years later, the video would serve as evidence of Wakefield’s disregard for medical ethics.

BRENT TAYLOR’S ANGER at Wakefield was widely known throughout the medical school at Royal Free. Head of its community child-health department, Taylor considered Wakefield to be a press-hungry showboat who pushed conclusions from his studies that greatly exceeded what the research showed. Taylor had seen enough sick children over the years to know that Wakefield’s data-free assault on vaccines could lead to illness or even death. Taylor had played a role in Zuckerman’s demand that Wakefield send his biopsies out for independent confirmation, instructions Wakefield continued to ignore.

Ultimately, Taylor had made a decision: If Wakefield rebuffed every effort to confirm his findings, he would use other science to do it for him. He formed a team that included an immunization specialist, pediatricians, and a statistician. They collected data from 498 children on the autism spectrum and compared the timing of the onset of their symptoms with that of their MMR vaccination. As a control, they studied data from autistic children who hadn’t received the MMR. The appearance of autism symptoms in the children was steady, with no sudden step-up after the MMR. The age of diagnosis was no different for children who had been vaccinated than for those who hadn’t. The timing of developmental problems did not cluster around the months after vaccination.

Taylor and his colleagues wrote up their findings, clearly stating that this research was in direct response to the Wakefield study. He submitted the paper to The Lancet, which agreed to publish.

The paper appeared in June 1999, without any of the could be, maybe not, no real evidence language of the Wakefield paper. Instead, Taylor wrote a firm conclusion: “Our analyses do not support a causal association between MMR vaccine and autism. If such an association occurs, it is so rare that it could not be identified in this large regional sample.”

The paper infuriated Wakefield, who banged out a response for publication in the journal.

“Hypothesis testing and presentation of the outcome—either positive or negative—is a fundamental part of the scientific process,” Wakefield wrote. “Brent Taylor and colleagues have ignored the rules. They are inappropriately didactic in their conclusions, despite the weakness of their method and the contradictions in their data.”

He ranted about how they had ignored the catch-up campaign of 1994, when the health department urged MMR booster shots for children aged five to sixteen. Relevant to nothing, he falsely slammed the program as “untested policy” in terms of safety. Worst of all, it was a lie—the Taylor study did include data from the catch-up campaign.

In stark and insulting words, Wakefield raged that Taylor and his team had dishonestly used data to prove, rather than test, a hypothesis and ignored data that didn’t support their beliefs.

“The full story,” he wrote ominously, “has yet to unfold.”

MARK PEPYS, named in October 1999 as the new head of medicine at Royal Free, had no patience for Wakefield. He considered the man almost a charlatan and had told medical school officials he would not transfer there so long as Wakefield was on staff. But after arriving, he found that Wakefield not only remained but had been promoted.

Well, fine. But Pepys would not indulge Wakefield’s ego. Pepys had heard all about Wakefield’s business ventures based on his meager, unproven study; he and his partner Sleat had been hitting up Royal Free again to work with Carmel Healthcare, and Pepys knew that the school once again had said it would have no involvement. But Pepys wanted to go further—to kill Wakefield’s business exploits altogether, while also forcing him to stop his media performances and to confirm his research. Royal Free had merged with the larger medical school of University College London the previous year, and this enterprise did not need the danger of the controversy that followed Wakefield’s publicity.

In December, Pepys arranged for the school’s provost, Chris Llewellyn-Smith, to meet with Wakefield at the central campus of the medical school. The men confronted Wakefield about Carmel, about his willingness to stake his financial well-being on unproven claims. He needed to focus, they said. The parents scared of the MMR, or fearful for the well-being of their autistic children, deserved answers. Stay out of the public eye, forget the business dealings, confirm your findings. The school would support him, even give him the patents he wanted, if he completed his research.

And to make sure there was no confusion about what had been said, Llewellyn-Smith wrote a letter to Wakefield spelling out their criticisms and demands.

“We remain concerned about a possible serious conflict of interest between your academic employment by UCL, and your involvement with Carmel,” the letter read. “This concern arose originally because the company’s business plan appears to depend on premature, scientifically unjustified publication of results, which do not conform to the rigorous academic and scientific standards that are generally expected … Good scientific practice now demands that you and others seek to confirm or refute, reliably and above all reproducibly, the possible causal relationship between MMR vaccination and autism/‘autistic enterocolitis’/inflammatory bowel disease that you have postulated.”

The meeting ended amicably, and Wakefield headed back to the Royal Free campus. Pepys didn’t believe that Wakefield would follow through on their demands.

“Pepys knew straightaway that this science could not be credible, but he certainly gave Wakefield every opportunity to prove him wrong,” one doctor who worked with Pepys says. “But Wakefield wouldn’t take the opportunities to validate his work.”

Although Wakefield had agreed to Llewellyn-Smith’s terms, three months passed in which he presented no research plans, confirmation testing, or anything at all. It seemed Wakefield was ignoring the conditions he had accepted.

Llewellyn-Smith wrote Wakefield again in March 2000, recounting the commitments he needed to meet. He wanted a progress report on Wakefield’s research, and reminded him to make no public statements until he had completed more study and confirmed his results.

But Wakefield had no intention of abiding by that requirement.

AT 10:37 ON THE MORNING of April 6, 2000, Congressman Dan Burton banged a gavel twice, silencing the crowd in Room 2154 of the Rayburn House Office Building, in Washington, D.C. For two years, the controversy surrounding the Wakefield study had intensified, feeding on decades of anti-vaccine disinformation, despite other research that repeatedly debunked the theory of a link between the MMR and autism. The belief appealed to desperate relatives of autistic children—including Burton himself, whose grandson was developmentally disabled. Now, at Burton’s behest, a congressional hearing was opening to delve into Wakefield’s work, granting the imprimatur of American politics to a false idea that had already led to a drop in vaccination rates in the UK.

Burton, an Indiana Republican, opened the hearing by recounting the anguish among his staff as they recited letters from parents of autistic children. “I do not have to read a letter to experience the kind of heartbreak that is in these letters,” Burton said, referring to his grandson Christian. He had been a healthy baby, and his pediatrician had guessed he would grow to be almost seven feet tall.

“We anticipated having him support the family by being an NBA star,” Burton continued. “Unfortunately, after receiving nine shots in one day, the MMR and the DTaP shot and the hepatitis B, within a very short period of time, he quit speaking, ran around banging his head against the wall, screaming, hollering, waving his hands, and became a totally different child. We found out that he was autistic. He was born healthy. He was beautiful and tall. He was outgoing and talkative. He enjoyed company and going places. Then he had those shots, and our lives and his life changed.”

In the audience sat Wakefield, nattily dressed in a dark suit with a dark shirt. Near him, a group of pediatricians and researchers almost winced; this whole hearing was a setup. The chairman was personally invested in an outcome. Like so many relatives of so many severely autistic children, he understandably wanted someone to blame for his grandson’s transformation. A number of experts on vaccines, infectious diseases, and developmental disorders had been blocked from testifying. They were reduced to submitting written statements pleading with Congress to consider the evidence dispassionately rather than accepting anecdotal testimony as gospel. They knew that no one wanted to believe that having a child with severe autism was just luck of the draw. That was the insidious danger of Wakefield’s theory: It created an enemy—government in league with drug companies—that could be held accountable for what was most likely the outcome of a genetic lottery.

After introducing some of the witnesses who would be testifying, Burton turned the floor over to Representative Henry Waxman, a California Democrat who was already deeply concerned about the possibility of misinformation being propagated by the hearing.

“We do know some things about autism. We know there is a genetic component to autism,” Waxman said. “We know that autism most likely develops very early during fetal development. We also know that parents are not to blame for autism. We have come a long way from the time when fathers and mothers were led to believe that they had done something to cause their children’s autism, leaving them with needless and destructive guilt. But I also understand that this hearing was called to consider a theory that certain vaccines cause autism. From my discussions with medical experts, scientists, and the autism community, it is clear that this is only a theory. As the American Medical Association concluded recently, ‘Scientific data does not support a causal association between vaccination and autism.’ ”

Waxman looked toward a group of parents invited to testify. “We need to do everything we can to give these parents here and other parents around the country answers,” he said. “In medicine, the best answers come from research that can withstand the rigors of the scientific method.”

Burton introduced the first round of witnesses: the parents of children with severe autism. For more than an hour, they recounted the difficulties of raising a child with this disability. Some directly tied the onset of their children’s symptoms to the MMR, while one parent—a doctor—urged caution because of the dearth of evidence linking the two.

That moment of reason slipped away when Burton thanked the panel of parents. “I just want to say to the four of you who have experienced this change right after the MMR,” he began, “I and my daughter experienced exactly the same things that you did, and I believe what you are saying, and we are going to pursue that as diligently as possible, because I cannot believe that it is just a coincidence.”

As the parents gathered their things, Wakefield approached the witness table. With him was John O’Leary, whom he had failed to disclose as his business partner in Carmel Healthcare, and on whose company board Wakefield served as a director.

Wakefield’s presentation was dry, more appropriate to a scientific conference than a congressional hearing, complete with tissue slides and research terms that likely few if any of the politicians understood. Then he made an unexpected announcement: “We have now investigated over 150 children, and the results that I am going to describe are pertinent to all those children bar about four.”

The words stunned other scientists in the room who already considered Wakefield’s work hyped and demonstrably false. Now he was trotting out, on national television, raw data that had not been subjected to peer review.

Worse, he threw out only fragments of the information, not enough for the scientists to interpret; he spent much of his time refuting studies that contradicted his theory.

Then it was O’Leary’s turn. He followed Wakefield’s lead, speaking in scientific jargon that left the nonexperts scratching their heads. He explained that he had examined biopsy tissue Wakefield had provided from the intestines of autistic children who had received the MMR. His testing, O’Leary said, found that twenty-four of the twenty-five children were positive for measles virus, compared with just one out of fifteen control patients. He explained nothing about these protocols, and none of the scientists could assess whether this new work was groundbreaking or worthless.

But O’Leary left the audience with a clear message. “I am here to say Wakefield’s hypothesis is correct.”

Case closed. The scientists who were preparing to dispute Wakefield’s study had been blindsided: They could not trot out guesses about what this data with the undescribed “protocols” and “controls” meant, even though O’Leary had done just that.

The next people to speak were doctors peddling cures for autism, several of whom climbed on the MMR bandwagon to advance their own treatments. One pediatrician said that the MMR caused a depletion of vitamin A, which then led to autism, and that the condition could be treated with cod liver oil. Another pushed antifungals. A biologist suggested steroids, along with total blood removal and replacement. And an osteopath proclaimed that autism could be cured by manually “decompressing” children’s heads.

After that group came a series of experts on infectious disease or autism, and biologists who worked with the Centers for Disease Control and Prevention or the National Institutes of Health, or were published researchers with extensive credentials. All joined in a unified message: There was no link between the MMR and autism.

Coleen Boyle, chief of the CDC’s developmental disabilities branch: “CDC believes that the current scientific evidence does not support the hypothesis that MMR or any combination of vaccines cause the development of autism.”

Paul Offit, a professor of immunologic and infectious diseases at the Children’s Hospital of Philadelphia and a member of the advisory committee on immunization practices to the CDC: “No evidence exists which proves this association.”

Brent Taylor of Royal Free, whose published work had disproved Wakefield’s theories: “The belief that MMR is the cause of autism is a false hope … There is no evidence that measles or measles vaccine play any part in inflammatory bowel disease.”

Following these doctors’ testimony, Burton began his interrogation.

“Dr. Offit,” said Burton, “you talk about collaboration, I guess, with the Merck Pharmaceutical Company?”

Yes, Offit replied. He had worked with Merck on a rotavirus vaccine for eight years, and also gave talks about vaccines funded by drug companies and universities.

“So they pay for your expenses and that sort of thing?” Burton asked, resting his chin on his hand.

“They have an interest in educating physicians about vaccines, and it is good that they do, because physicians need to be educated about vaccines.”

“And they produce the MMR vaccine, don’t they?”

“Yes, they do, yes.”

Burton pointed at Offit to dismiss him. “Thank you.”

He turned to Taylor.

“Dr. Taylor,” Burton said, reading from notes on his desk. “In your Lancet paper, you omitted to mention the Catch-Up Campaign [in Britain] … Yet you appear to have included these Catch-Up children in your analysis of the step-up hypothesis. Do you consider that to be methodol … metholog … methodol—excuse me. It’s a tough word to say. Do you think that is a correct analysis?”

Taylor remained expressionless. He doubted Burton understood his own question. It had probably come directly from Wakefield.

“That statement isn’t true, Mr. Chairman,” Taylor replied. “We did include the children involved in the Catch-Up Campaign in our analysis, as is clearly stated.”

He shot a glance at Wakefield. “To suggest otherwise—and I suspect the suggestion comes from Mr. Wakefield—is malicious.”

Burton engaged in a back-and-forth argument on specific elements of the study with Taylor, spouting nonsense that showed he had not read Taylor’s paper. Then Burton took the conversation in a surprising direction.

“We have an epidemiologist in the audience.” He glanced around the crowd. “Where is he? Would you mind coming up? I would like to have you sworn in.”

The hearing descended into chaos as Walter Spitzer, a professor of epidemiology at McGill University, in Montreal, approached the witness table. Waxman invoked a point of order, fuming that the rules required that the committee be given at least twenty-four hours’ notice of a witness so the members could review that person’s credentials.

“Suddenly, we have a witness being called forward,” Waxman said. “We have all of these people testifying, and we have now a witness coming up—I do not know who he is.”

Burton waved away the objection, saying the rules allowed him to suspend the requirements in “unusual circumstances.” He gave no explanation for why Spitzer’s testimony qualified for an exemption.

“Mr. Chairman, if I might be heard … ,” Waxman began.

Burton interrupted. “No.”

Waxman gave up on his point of order, but he didn’t leave it there. “For a witness to be brought out of the audience because the witnesses before you did not give you testimony that fit with your preconceived theory seems to me to turn a congressional hearing more into a circus than a genuine fact-finding opportunity,” he said.

Burton reiterated that he was proceeding with the witness. The audience in the hearing room burst into applause.

The testimony was short. Burton asked Spitzer to comment on the allegation of statistical manipulation in Taylor’s study. While Taylor had said that his study included children from the Catch-Up Campaign, Spitzer replied, those numbers were not segregated so that others could examine them. There needed to be an international panel to review all of Taylor’s data. Spitzer said nothing about Wakefield’s study, which contained no data showing a link between the MMR and autism. Burton thanked the doctor, then prepared to move on.

This is not true. Taylor broke in. “Mr. Chairman, can I comment on that?”

Congressman John Tierney spoke. “I would like to hear what Mr. Taylor has to say in response to that. I think it would be educational.”

“I have no objection to him responding,” Burton replied. “But I have some more questions of Dr. Wakefield.”

With that, Burton invited Wakefield to return to the witness table. “Dr. Wakefield, would you clarify the difference of opinion that you have from [Taylor]?”

Wakefield began spinning a series of objections and accusations that were so sloppy, they made no sense to the experts. First, he claimed that data had been withheld from the Taylor study. Then he said it had been improperly included. Burton went back to Taylor for a response.

“It does seem slightly surprising that at one moment we are accused of excluding them, and therefore that upsets the results, and now we are accused of including them, and that upsets the results,” Taylor began.

He leaned into the microphone. The most important point, he said, was this: “Individual children did not develop symptoms of autism within various defined periods after they received the MMR vaccine.”

Waxman spoke. “I am troubled by this hearing,” he said. “This hearing was called and structured to establish a point of view, and it is the point of view of the chairman. The chairman believes a particular point of view, and that is the connection between autism and vaccinations.”

The hearing had essentially been rigged, Waxman was suggesting.

“I think hearings like this have a real danger, because if you sensationalize the idea that there is a connection between immunization and autism, immunization rates will drop,” he continued. “That is what happened in Great Britain after Dr. Wakefield published his first study. Immunizations dropped. Autism rates did not drop, but measles rates increased.”

Waxman’s voice became laced with frustration. “This can cause brain retardation and death. We know we can prevent that. Why should we then scare people about immunizations until we know the facts? I fear that what we have in this hearing is a sensationalization by the chairman in order to get all these cameras to report to the American people that there is this connection because he believes it, and many other people believe it, and therefore a lot of others who watch this will think, I will not immunize my children.”

Burton ignored Waxman, instead demanding copies of the data from all the studies mentioned at the hearing. He then looked at Wakefield.

“Who funded your study, Dr. Wakefield?” he asked.

“We did,” he replied. “We have a small charitable contribution, but …”

“A charitable organization did,” Burton replied, glancing over at Taylor. “I see.”

DESPITE ROYAL FREE’S demand for an outside review of Wakefield’s work, no independent investigator would ever check the tissue slides from the autism study. Wakefield saw to that. And he would tolerate no further interference from the medical school. No more listening to orders for confirmation of his findings. No more accepting demands that he conduct further comprehensive research with the involvement of the medical school. None of it.

Instead, he threw down the gauntlet. “It is clear that academic freedom is essential, and cannot be traded,” he wrote to the school provost, Llewellyn-Smith. “It is the unanimous decision of my collaborators and co-workers that it is only appropriate that we define our research objectives, we enact the studies as appropriately reviewed and approved, and we decide as and when we deem the work suitable for submission for peer review.”

And as for not speaking publicly without completing his research? That was off the table, too. Besides, he had already taped his biggest interview yet.

8

Spin vs. Science

ED BRADLEY, a correspondent with 60 Minutes, appeared onscreen next to an image of a large hypodermic needle dripping liquid.

“The vaccine known as MMR—actually three vaccines in a single dose—has all but eradicated those diseases in the United States,” Bradley intoned. “But now the MMR vaccine is at the center of a controversy about whether or not, in some children, it causes autism.”

It was November 12, seven months after the congressional hearing, and the question “Do vaccines cause autism?” was about to be presented to millions of television viewers in the United States.

Cut to a child on a porch, introduced by Bradley as Nicholas Wildman. The boy, Bradley said, “appeared perfectly normal until just after his first birthday, when he received the MMR vaccination.”

Bradley interviewed the boy’s parents, who described his symptoms. “And you’re certain of why,” said Bradley.

“Because of the MMR vaccine,” the boy’s mother said. Nicholas threw food on the floor.

A physician appeared onscreen. “There is absolutely no scientific evidence of any relationship between measles-mumps-rubella vaccine and infantile autism,” he said. Bradley introduced the doctor as Sam Katz, a professor at Duke University.

“So why,” Bradley asked, “would parents blame the vaccine if there’s no evidence to support that?”

“Because,” Katz replied, “there is a very articulate gentleman from the United Kingdom who claims that he has shown a relationship.”

Cut to Wakefield looking into a microscope. “My concern comes from, initially, the story that the parents tell,” he said. All of the stories fit a pattern: healthy child, vaccination, development of symptoms of autism.

On it went, with scientists saying there was no evidence of a link, Wakefield implying there was, and parents insisting that MMR had crippled their children.

An image of The Lancet came onto the screen. Since the publication of Wakefield’s 1998 article, Bradley said in voice-over, 100,000 parents in Britain had chosen not to vaccinate their children.

David Salisbury appeared.

“What we expect is that we will start to see small [measles] outbreaks that will then just get bigger and bigger and bigger,” he said. “The estimate that we’ve come up with is 70,000 cases.”

“So, some will be hospitalized …,” Bradley began.

“Yes.”

“And some will likely die?”

Salisbury nodded. “That is correct.”

A key question: “Would you hold Dr. Wakefield responsible for this?”

“We have gone to international experts, and they say that his claims are not supported by the evidence he has produced,” Salisbury said. “Clearly, if we didn’t have the theories, we wouldn’t have the problem.”

Back to Wakefield.

“You have children?” Bradley asked.

“I have four children.”

“Knowing what you know now, would you give them the MMR vaccine?”

“No, I wouldn’t,” Wakefield replied.

“No?”

“I would almost certainly vaccinate them,” he said. “I would give them single measles, mumps, and rubella vaccines.”

In a voice-over, Bradley said, “That’s because Dr. Wakefield believes it is the combination of the three vaccines—measles, mumps, and rubella—in one shot that may cause some children to develop autism.”

Bradley apparently was unaware that there was literally nothing in the Wakefield research that supported breaking the vaccine in three. Individual vaccines weren’t even available in most countries anymore. With scientists on one side saying “no evidence,” parents with autistic children on the other saying the MMR was at fault, and Wakefield—a researcher with published papers—saying he would not vaccinate his own children with the MMR, lay viewers were left to conclude that vaccines could, in fact, be dangerous.

The momentum of misinformation was accelerating.

WAKEFIELD’S CAREER at Royal Free ended in late November 2001. Because of his refusal to seek independent confirmation of his findings and to stop his relentless self-promotion, he had become an embarrassment to the medical school. The hospital negotiated a settlement—some money, his intellectual property, and a statement clearing him of wrongdoing—and with that, he was gone.

As was expected among the higher-ups, Wakefield spoke to the British press in a matter of days.

“I have been asked to leave because my research results are unpopular,” he told The Telegraph. “I did not wish to leave, but I have agreed to stand down to take the political pressure off my colleagues and allow them to get on with the job of looking after the many sick children we have seen.”

His words to The Guardian portrayed the same message. “It was inevitable,” he said. “The issue is not about science. One is dealing with people’s belief systems. And that takes a great deal to change.”

Five months later, in April 2002, Wakefield dropped what seemed to be his biggest bombshell yet: He and his business partner O’Leary announced that they had developed comprehensive evidence linking the MMR and autism.

The details appeared in a new paper published by the journal Molecular Pathology, which claimed Wakefield and O’Leary had found measles virus fragments in the guts of the vast majority of the ninety-one autistic children tested. This was the pivotal evidence that litigants represented by Dawbarns and other law firms had hoped for and which could be the key to victory in their civil suit against the vaccine companies. With Wakefield’s forced resignation spun as part of a conspiracy, and now his study appearing to provide evidence linking vaccines to autism, a full-fledged public panic began.

By January 2003, Britain reported that the country’s MMR vaccination rate had dropped to just 79 percent, the lowest level since its vaccination program began fifteen years before. Parts of London were nearly half that. A major outbreak of measles had already struck Ireland. Two London children contracted measles after undergoing kidney transplants, which required them to take drugs to suppress their immune systems and decrease the chance of tissue rejection. The measles swelled their brains and caused irreparable damage.

Public health experts blamed the chaos on hysteria ginned up by Wakefield. But the real science, the better science, was ignored. Taylor’s study and a World Health Organization study from years before had demonstrated that there was no correlation between vaccination rates and autism. And in 2003, an examination of data on every child born in Denmark from 1991 through 1998 found no association between the timing of the MMR vaccine and autism. Those results were supported by other studies from Sweden, Finland, and France.

In the fall of 2003, Simon Murch, one of the co-authors on the 1998 study, issued an urgent request: Please ignore our study. “There is now unequivocal evidence that MMR is not a risk factor for autism,” he wrote in a letter published in The Lancet. “This statement is not spin or medical conspiracy but reflects an unprecedented volume of medical study on a worldwide basis.”

Like all the comprehensive research contradicting Wakefield’s assertions that preceded it, Murch’s statement was largely ignored outside the scientific community.

IN THE WORLD OF molecular science, few individuals were more respected than Stephen Bustin. With an ever-present, impish grin and a calm demeanor, Bustin worked as a senior academic at St. Bartholomew’s Hospital and the London School of Medicine. He was widely considered one of the world’s foremost experts in DNA and RNA analysis, which lay at the foundation of Wakefield’s research.

The Wakefield-O’Leary data published the previous year had been cited by the plaintiffs’ lawyers in the MMR litigation as the strongest proof that vaccines caused autism. The closer the case came to trial, the more the pressure grew for vaccine makers to gather details on this supposedly groundbreaking research. The companies needed to find someone of unquestioned integrity and professional repute to review Wakefield’s data.

In the summer of 2003, lawyers for the drug company GlaxoSmithKline contacted Bustin.

“Have you heard of the MMR trial?” one of the lawyers asked him.

Vaguely, Bustin replied.

“Would you be willing to examine some information?” the lawyer asked. There was the Wakefield-O’Leary paper from the year before, but they also wanted him to look through documentation they had received from O’Leary’s Unigenetics lab.

Bustin had never worked on litigation before, and he was not going to risk his reputation to serve as a hired gun. But the lawyer assured him that he would be a witness for the court, so his opinions would be independent of the interests on either side.

Before Bustin could get to work, in September 2003, Richard Barr’s vaccine lawsuit collapsed when the Legal Aid Board—now known as the Legal Services Commission—withdrew its support. The case had already racked up an estimated £15 million in fees and expenses, £10 million of which was paid by taxpayer money. Wakefield’s blithe exaggerations of what his research proved may have been the stuff of headlines, but when subjected to the rigors of science, they fell apart. With the evidence simply not there, the Legal Services Commission decided that the suit wasn’t worth pursuing.

Barr and other lawyers vowed to appeal. News reports on the dropped case mentioned nothing about Wakefield. He had succeeded in keeping his connection to the Dawbarns lawsuit hidden for six years. He could hardly be blamed if he had come to believe that, after all this time, no one would ever find out.

BRIAN DEER, a British investigative reporter, sat for lunch with his editor at The Sunday Times, ready to discuss ideas for his next project.

Over the years, Deer had developed a reputation as a journalistic bulldog. He was known for aggressively digging into medical topics, particularly a series of reports on the DTP vaccine, which had been the subject of international hysteria about possible safety problems in the 1970s and ’80s. He would have been a logical choice to write about Wakefield’s MMR-autism study five years before, but at the time he was deep into his research on another project.

Months later, intrigued by the ongoing controversy, Deer went to the British Library, in London, pulled the Lancet article, and photocopied it. What he read astonished him: A dozen families showed up at this single hospital, in roughly the same time frame, with children experiencing similar gastrointestinal complaints and, reportedly, their first symptoms of autism, all within fourteen days of getting the MMR.

Fourteen days. The number was familiar to Deer; it was the same amount of time between vaccination and symptoms reported in the 1973 study that set off the DTP panic. What was the chance that these two papers about two different vaccines would report the onset of symptoms in the same time frame? A fascinating question, but as before, he was busy with other work.

Now it was fall 2003, and over lunch, Deer’s editor urged him to come up with an in-depth project for the Focus section of the paper. After bouncing some ideas off each other, the editor said, What about MMR?

Sure, it had been five years since the Wakefield study, but the doctor was back in the news. A based-on-a-true-story TV movie had been made about Wakefield, and it was generating lots of publicity as the broadcast date approached. Prominent British actor Hugh Bonneville played Wakefield, and Juliet Stevenson—who had just gained renown for her role in the film Bend It Like Beckham—was cast as a semifictional mother fighting for her autistic child. The film made the Wakefield study worth revisiting.

Deer later attended an advance screening of the film, titled Hear the Silence. It was medical research transformed into a cliché thriller, with Wakefield’s character as the hard-charging hero. The only man willing to listen to a mother who believes vaccinations caused her son’s autism, the movie Wakefield tests and proves her theory. But anonymous forces turn on him, with secretive government officials and drug companies conspiring to take him down. His files are stolen, his phone lines tapped, and he hears heavy breathing from unseen villains making harassing calls to his home.

In the audience, Deer watched in silence. The film was so much claptrap—and dangerous at that. Something like this, targeted at a general audience, was sure to have an even more deleterious impact on vaccination rates. Any expert telling frightened parents that the movie was laughable fiction would be dismissed as part of the conspiracy.

The film ended and Deer headed out, his interest in the story growing.

A lot of the issues related to vaccines and autism would likely play out in a vaccine case that had been making its way through the High Court in London for years and was tentatively scheduled to finally go to trial in a few months. A little digging and Deer discovered that there was a litigation group called JABS involved, represented by a Richard Barr. He reached Jackie Fletcher, the group’s founder, who he learned blamed her son’s condition on the MMR. During their discussion, Fletcher casually mentioned that members of her organization had been part of Wakefield’s Lancet study.

Fletcher was so calm in revealing this that Deer felt certain she had no idea of her words’ import. He had never seen anything mentioned about a relationship between Wakefield and any litigants convinced that the MMR caused autism. If Wakefield pulled his subjects from a group of parents who already believed that, of course they would come to the study with bias.

Deer learned that Rosemary Kessick—who had first presented the theory about MMR and autism to Wakefield—was the mother of a boy in the Lancet article identified as Child 2. She agreed to meet with the reporter, and he traveled eighty miles from London for the interview.

The story she recounted was heartbreaking, but also disturbingly imprecise. She told Deer that her son William’s symptoms had emerged after he received his MMR vaccination at fifteen months.

“He screamed all night, and he started head-banging, which he had never done before,” she said.

“When did that begin, do you think?”

“That began after a couple of months, a few months afterward,” Kessick replied. “But it was still—it was convincing enough …”

Deer interrupted. “Sorry, I don’t want to be, like, massively persnickety, but was it a couple of months or a few months?”

“It was more like a few months, because he had this kind of, you know, slide down,” Kessick said. “He wasn’t right.”

“Not quicker than two months, but no longer than how many months?” Deer asked. “What are we talking about here?”

“From memory,” Kessick replied, “about six months, I think.”

None of this made sense. Wakefield’s study said that the first symptoms showed up in Child 2 just two weeks after he received the MMR vaccine, not six months. For a fifteen-month-old—the age when the Kessick boy was immunized—six months was practically half a lifetime.

Deer decided to seek an answer to the discrepancy from Wakefield’s primary co-author, John Walker-Smith. The reporter laid out the details of his meeting with Kessick and said that there was no case in the published study that matched the circumstances she described involving her child.

“That could be true,” Walker-Smith replied.

“So either what she is telling me is not accurate or the paper’s not accurate,” Deer said.

“Well, I really can’t comment,” Walker-Smith said. “You really touch on an area which I don’t think should be debated like this. And I think these parents are wrong to discuss such details, where you could be put in a position of having a lot of medical details and then try to match it with this, because it is a confidential matter.”

Britain had strict laws on medical confidentiality, so Walker-Smith’s concerns were understandable. But in this case, Deer thought, confidentiality might have been used to hide error, or worse.

IN DUBLIN, Stephen Bustin stared at a sign that read PLASMID ROOM. He and two colleagues had arrived at the Coombe Women’s Hospital to inspect the Unigenetics lab and try to confirm the data that scientists there had generated regarding Wakefield and O’Leary’s work. Though the Dawbarns case had been shut down and financing pulled, it still had the chance of being resuscitated on appeal. On top of that, there were cases being filed in the United States pushing the Wakefield theory, and O’Leary’s lab would undoubtedly be a central topic in that litigation as well.

Bustin and his colleagues had arrived at Unigenetics uncomfortable to begin with. The 2002 Molecular Pathology article citing Wakefield and O’Leary’s claims to have found measles virus in the bowels of autistic children had surprised them. Normally, such papers include the investigative procedures used in a study, as well as other significant details that allow the scientific community to evaluate the reliability of the results. But this paper contained none of that information. Plus, Unigenetics had rejected invitations to join a quality-control program run by an international group of laboratories, which would have provided independent assessment of its work.

The company seemed to have done everything it could to obstruct review of its findings on the Wakefield tissue samples. During the litigation, it had refused to turn over its underlying data until a change in Irish law required compliance with rulings made in English courts. Out of an abundance of caution, Bustin brought his own computer, on which he had previously loaded data that Unigenetics had sent him. He was relieved that he had taken the precaution when he found that the company computer—the only one there he could have used to analyze the work—was gone.

“They knew that I wanted to sit at their computer and look at the data,” Bustin says. “They didn’t count on me bringing my computer with me and looking at their data.”

Then there was the Plasmid Room, where thousands of types of bacteria were studied. It was right next to the lab where O’Leary’s DNA and RNA tests were run. Anyone handling plasmids could get the molecules in their hair, on their hands, on their clothes, and carry it from room to room. Even before entering O’Leary’s lab, Bustin suspected that they would find contamination of results.

After their inspection of the Unigenetics lab and a review of its data, Bustin and his colleagues prepared an initial report for the court hearing the vaccine case. With the case yet to go to trial, the report’s details could not be disclosed or even publicly discussed.

The following year, the last appeal to bring the vaccine case back to life would be tossed out. After almost a decade, the attempt to link autism to the MMR in court was dead—at least in Britain. But similar cases were appearing in other countries, including the United States.

Still, Bustin could say nothing about his report. For years he would wait, hoping that someday he’d be allowed to reveal what he’d discovered about Wakefield and Unigenetics. But until then, silence.

9

Counterpunches

IN THE COURSE of his reporting on Wakefield, Deer discovered the jaw-dropping secret: Wakefield had been paid £55,000 by the Legal Aid Commission to conduct the research that appeared in The Lancet. Nowhere in the paper had Wakefield disclosed this appalling conflict of interest, one that not only would have undermined his research but would have shown his rogue attacks on the MMR to be deeply suspect.

With that breakthrough, Deer contacted the Legal Aid Commission, which confirmed the payment. Deer then telephoned Richard Barr, the lawyer who recruited Wakefield for the case. The reporter recorded the interview.

“If Dr. Wakefield was part of drawing up that proposal to the Legal Services Commission to do these things,” Deer said, “the public would think, ‘Well, hang on a minute, this paper that appeared in The Lancet did not give any disclosure about the sources of its financing,’ and if people realized that this was done for the Legal Services Commission, they might interpret the paper quite differently.”

“Certainly, at the time there was, you know, there was no secret about it,” Barr replied. “We weren’t trying to sort of get an independent paper published under the carpet. I remember noting at the time that the funding acknowledgment wasn’t there, but it didn’t seem to be a big deal because it wasn’t a big deal in those days.”

Deer could scarcely believe Barr’s admissions: He had personally arranged for the Wakefield research to be financed by the government for a lawsuit. And regardless of Barr’s mistaken beliefs, Wakefield would have been obligated to disclose such a conflict to The Lancet’s editors and readers. Suddenly, the questions were: What did the editors of The Lancet know? And when?

He contacted The Lancet and arranged a meeting. On February 18, 2004, Deer stood in one of the journal’s conference rooms and laid out the findings of his investigation to Richard Horton, a handful of other editors, and a member of Parliament, Evan Harris, whom Deer had brought along as a witness.

The reporter had yet to speak with Wakefield. When Deer initially tried to reach him, he had been directed to a publicist. Eventually Wakefield agreed to be interviewed by the Times, but only if Deer himself wasn’t there. Everything about that odd demand screamed that Wakefield intended to mislead. None of Deer’s colleagues could be brought up to speed fast enough to know when Wakefield might be lying, but Deer and his editors decided that this option was better than nothing.

So while other Times journalists met with Wakefield, Deer spoke with The Lancet’s editors, letting them in on secrets that had been hidden from them for more than half a decade.

Despite Wakefield’s claim that his study protocols had been approved by the Royal Free ethics committee, Deer said, they had not. This was the sentence that Wakefield’s own colleagues had pointed out to him as false but that he still let appear in The Lancet. While the paper claimed that the study subjects had been found by independent, consecutive referrals from the children’s doctors, they had not. Wakefield and Walker-Smith had instead invited certain families to participate, creating issues of bias. Moreover, Deer had discovered some abstracts Wakefield had filed at gastroenterology conferences, and the information they revealed was even more shocking: Wakefield had data on eighteen additional kids, the majority of whose parents did not suggest a link between the MMR and the first autism symptoms; these children were excluded from the study. In other words, the incidence of parents connecting their children’s symptoms to the MMR dropped from 66 percent to just 12 percent when all test subjects were included.

Then Deer revealed the worst part: Wakefield’s research for the Lancet paper was financed in part by the Legal Aid Commission on behalf of parents suing vaccine makers. Some of the children in the lawsuit were Wakefield’s subjects. His study results had been passed to lawyers in the litigation before the Lancet paper was submitted for publication. And Wakefield had been paid £55,000 for the research.

Horton and the editors were speechless.

“I HAVE NO REGRETS.”

Wakefield, eyes red-rimmed after traveling back from the States, appeared haggard as he spoke those defiant words almost emotionlessly to Deer’s journalistic colleagues. They were meeting at the offices of the public relations firm where Wakefield’s publicist, Abel Hadden, worked. The interview took place at the same time as the meeting miles away at The Lancet.

Wakefield’s responses were a collection of obfuscations, rationalizations, and contradictions. He told the reporters “no conflict of interest exists” in his association with the Legal Aid Commission, then flipped to saying it was “a matter of opinion.”

“I believe that this paper was conducted in good faith,” Wakefield said. “There was no conflict of interest. Do we have any reasons [now] to change our opinion? No, but then again it’s a debate.”

How many of the children in the study were part of the litigation effort? “Four, perhaps five,” Wakefield replied. What was it? Four or five? “Let’s make it five.”

By then, many of Wakefield’s co-authors had been interviewed, and had reacted with dismay about his Legal Aid financing. But when the reporters asked if he had told his colleagues, Wakefield replied that he couldn’t recall.

What about the other children who had been part of the research but whose data had been excluded from the Lancet paper? That reduced the percentage of parents linking their children’s autism to the MMR. Didn’t that undermine his reported findings?

“You may be right,” Wakefield said. “I simply don’t know. It does seem that as we examined more numbers the percentage of parents who ascribed [the developmental problems of their children] to the vaccine fell away.”

The journalists asked Wakefield if he felt embarrassed by these disclosures or if he wanted to apologize. That set off a response that, almost more than any of his other answers, underscored his ignorance about a scientist’s responsibilities.

“Should we stop, should we go away, should we stop publishing because it is inconvenient?” he asked. “I’ve lost my job. I will never practice medicine in this country again. There is no upside to this.

“But if you come in to me and say, ‘This has happened to my child,’ what’s my job? What did I sign up to when I went into medicine? To look after your child … I’m here to address the concerns of the patient. There’s a high price to pay for that. But I’m prepared to pay it.”

Wakefield was wrong. He was not a clinician. As a researcher, his job was not to treat children. It was to remain objective, to collect data, to find results that could be extrapolated for all children and not just address the concerns of a small group. If he wanted to care for individual patients, he should have opened a medical practice. His waffling and prevarications revealed him as being incapable of meeting his professional obligations. If Wakefield truly believed what he was saying, if he really was preoccupied by thoughts of himself as healer, it went a long way to explaining his ease with violating ethics rules.

AFTER FIVE HOURS, Deer finished presenting his damning case against Wakefield. He hoped to leave with an on-the-record comment from Horton, but the editor declined.

“I cannot give you a quote for a newspaper article, because what you told me now triggers a set of responses for me which are really quite formal,” Horton said. “The first thing I need to do is go and talk to the authors who you are particularly pinpointing as at fault.”

Like something from a Keystone Cops movie, Horton told Deer that Wakefield would soon arrive in the building and asked him to stay in a conference room so the two would not encounter each other. After Wakefield arrived and headed to Horton’s office, Deer was sent on his way.

“IT SEEMS LIKE this whole affair is coming to a head,” Horton said.

He glanced around the circular table in the Lancet office where Wakefield, Walker-Smith, and Murch had joined him. An expressionless Wakefield stared past Horton. Frightened? Annoyed? Bored? Impossible to tell.

Not much time had passed since Deer wrapped up his presentation, and the anxious group of scientists had rushed to The Lancet to hash over the claims. Horton had retained copies of some of Deer’s documents and questioned the three men about what he had learned.

The most serious allegation, Horton said, was that the team had dodged the ethics committee for approval of their study. All three denied the claim stridently, and when they were joined by another co-author, Peter Harvey, he too insisted the accusation was a fairy tale.

But when Horton brought up the Legal Aid Board, Wakefield could not deny the accusation; Deer’s records were indisputable. Yes, he confirmed, the parents of some children who were part of that litigation knew of his involvement before they joined the study.

Wakefield then spun into an irrational explanation of his innocence and honorable intentions that he would cling to for years. Even though children from the lawsuit were in the study published in The Lancet, the Legal Aid Board had not paid for that research. There were, in fact, two studies: the one published in The Lancet and a second study that, despite the passage of eight years, had yet to be published.

Among the items that Deer had produced were newsletters to Barr’s clients providing updates on the case’s progress, and those troubled Horton greatly. They read as if litigation success was a foregone conclusion. Long before the Lancet paper, the newsletters crowed about how the preliminary research showed a link between the MMR and autism—a particularly problematic point, since that claim rested on literally nothing but the memories of a handful of carefully selected parents.

Horton watched the group of scientists. Murch’s jaw dropped in horror. Walker-Smith stressed that none of them knew anything about Wakefield’s conflicts. Meanwhile, Wakefield remained calm, repeatedly brushing away even the worst allegation as nonsense or insignificant.

After more discussion, the group constructed a strategy for attacking Deer’s case. Different members of the research team would write responses. Horton would meet with officials at Royal Free. There would be no independent inquiry; the researchers and the editor would investigate themselves.

PEOPLE WHO ANTICIPATE critical news articles about themselves or their institutions sometimes try to blunt the impact through a tactic called inoculation—putting their own spin on negative information and releasing it before the article is published. With Deer’s Times story days from appearing, the researchers and editors decided to inoculate themselves.

Horton, the researchers, and other academics met with Humphrey Hodgson, the vice dean at Royal Free, and described Deer’s claims. Then everyone received an assignment: Wakefield would write an explanation of his role in the litigation, while Walker-Smith and Murch would address different Deer charges.

The group hammered out a statement, which was an orgy of self-exoneration and minimization. Nothing improper had happened with the ethics committee, everything in the patient recruitment was on the up-and-up. There was the tricky problem of Wakefield being paid for working on litigation, but that was portrayed as a careless failure to disclose, not a conflict that undermined the study.

“This funding source should, we judge, have been disclosed to the editors of the journal,” the statement said. “We believe that our conflict of interest guidelines should have been triggered at the time for such a disclosure.”

The Lancet issued the statement on the afternoon of Friday, February 20—two days before Deer’s exposé would appear in the Times. This, Horton hoped, would tamp down the reaction to it.

Instead, the statement set off a media firestorm.

The BBC contacted Horton, who agreed to appear on an evening news broadcast. This time he was more forceful than he’d been in the statement.

“If we knew then what we know now, we certainly would not have published the part of the paper that related to the MMR,” he said, “although I do believe there was and remains validity to the connection between bowel disease and autism.”

With that, Horton jumped ahead of the science. Whether intentional or not, his words were horribly misleading. There was no finding in the Lancet paper of a link between bowel disease and autism. The article merely reported a clinical observation limited to twelve people. Calling it a “connection” rather than what it was—a claim by a doctor with questionable integrity, involving fewer children than would ride on a school bus—was another disservice to public health.

And Deer’s disclosures had yet to even be published.

“REVEALED: MMR Research Scandal.”

The words were splashed across the top of The Sunday Times’ front page on February 22, 2004. Inside the paper, a second article by Deer appeared, with the headline “MMR: The Truth Behind the Crisis.” The articles were a devastating assault on Wakefield, his colleagues, their study, and The Lancet. By the next morning, top officials in the British government appeared on morning news programs to lambaste Wakefield, his lousy science, and his part in setting off a global panic.

“There is absolutely no evidence to support this link between MMR and autism,” Prime Minister Tony Blair said in an appearance on ITV. “I hope, now that people see that the situation is somewhat different to what they were led to believe, they will have the triple jab.”

On the BBC radio program Today, the government’s top medical officer, Liam Donaldson, declared that he had always considered the autism-MMR paper to be bad research. Efforts to contact Wakefield had been difficult, Donaldson said, because the researcher refused to communicate directly, instead leaving the discussion with health officials to his publicist. “I don’t think that spin and science mix,” Donaldson said.

Wakefield tried his best to counterpunch. Evasive about his research for years, he now implied that he’d been a paragon of transparency about his work. “It has been proposed that my role in this matter should be investigated by the General Medical Council,” he said that same day. “I not only welcome this, I insist on it.”

With the storm of criticism raging throughout the medical world and in the media, Horton knew that The Lancet could not simply ignore it.

He contacted Simon Murch, and the two agreed to craft a statement to appear in the next issue. The best option, they thought: a statement that denounced the public’s understanding of the paper. The paper specifically stated that there was no data to justify a link between the MMR and autism. It was the media’s representation of the study that had caused the problem.

Murch spoke with his co-authors, convincing ten of the original thirteen to sign on to the statement. Wakefield refused, even when Horton contacted him with a personal entreaty. Wakefield was already furious with Horton, given the editor’s critical comments on the BBC. He wasn’t much interested in listening to his pitch.

By lunchtime on the day the journal would go to press, Horton still had no statement in his hands; apparently the co-authors were still debating the wording. With only a few hours until deadline, Horton telephoned Humphrey Hodgson, vice dean of the medical school.

“What do you need?” Hodgson asked.

A clear statement, Horton replied. And the word “retraction” in the headline.

“Okay,” Hodgson said.

About an hour later, the statement arrived. The three-paragraph “Retraction of Interpretation” said that the main thrust of the study was about intestinal problems in autistic children. “No causal link was established between MMR vaccine and autism as the data were insufficient,” it read. “However, the possibility of such a link was raised and consequent events have had major implications for public health. In view of this, we consider now is the appropriate time that we should together formally retract the interpretation placed upon these findings in the paper.”

The absence of Wakefield’s signature was too obvious to miss.

ONE DAY IN JANUARY 2006, Wakefield jumped into a taxi and sped across London to a courthouse. At the same moment, Deer sat at a table in his lawyer’s office reviewing medical files of children in the autism study, marking the first time anyone other than the researchers had seen them. And Wakefield was racing to stop him.

In the two years since Deer’s first articles about Wakefield appeared, what started off as a journalistic investigation had grown into an all-out war consuming the reporter, the scientist, and his growing number of acolytes. Shortly after publication, Deer had been invited to expand his investigation into a television news broadcast for Channel 4, and the results proved even more devastating than the Times stories. Deer revealed that Wakefield had filed patents for the kind of single vaccine he kept pushing after the Lancet article. The reporter disclosed letters from inside Royal Free challenging the ethics of Wakefield’s work. He found Nicholas Chadwick, the lab technician who had repeatedly informed the researcher that no measles virus was present in his samples. Deer traveled to the United States, where Wakefield now worked as research director for an organization peddling purported autism cures, and tracked him down at a convention. The reporter approached with a film crew, asking Wakefield to comment. Wakefield pushed the camera away and fled.

In response, and with great fanfare, Wakefield announced that he was filing libel lawsuits against The Sunday Times, Channel 4, and Brian Deer personally. Afterwards, he sued the Cambridge Evening News, a small newspaper with a readership of five thousand, over an article about threatening and abusive emails Deer had received from Wakefield’s supporters. Wakefield successfully browbeat the paper, which could not afford to defend itself, into publishing an apology saying that Wakefield had no conflict of interest in his work and had performed his research properly and ethically. Wakefield read the statement at a rally in Washington, D.C., for parents of children with autism, implying that he had been cleared of the allegations leveled by Deer.

It became evident that all of Wakefield’s lawsuits were like the one against the Cambridge Evening News—about public relations, not litigation. He sent a letter to a member of Parliament who had criticized him, pointing to the libel proceedings as a reason why no public statements should be made about what Deer’s reporting had revealed. He used the same argument against officials with the health department in an effort to stop the government from including criticism of his research on its website; they refused. Yet when it came to trying the libel case against Deer and the news organizations, Wakefield fought to delay the proceedings. He filed a claim form in March 2005 but failed to bring an actual lawsuit for more than four months—and then only under pressure from Justice David Eady, who was hearing the case. When Wakefield filed a motion to stay the litigation, Eady said no. Wakefield “wishes to use the proceedings for tactical or public relations advantage, without revealing that they have been put on the back burner,” Eady wrote.

The libel case chugged along, and then on November 1, 2006, Eady ordered Wakefield to turn over to the defendants—including Deer—unredacted medical records of children in the Lancet study. Meanwhile, Deer dropped another exclusive in The Sunday Times, revealing that Wakefield had indeed not been paid £55,000 by the Legal Aid Board. He had been paid £435,643, plus £3,910 in expenses. These numbers included everything—not just the money for the initial study, but also for reports, analysis, and other work he did for plaintiffs in the litigation. As shocking as that was, it paled in comparison with what Deer found in his review of the children’s medical records.

All of it had been a fraud. Not just a conflict of interest, not just ignored contradictory results. The information Deer read in the medical records did not line up with what Wakefield claimed in his study. The statement that parents saw the first symptoms of autism within fourteen days of their child’s vaccine was a lie. Some showed symptoms before the MMR; others many months later. The deeper he dug into the reports, the more astonished Deer became. This was sure to come out at trial, and Wakefield’s fraud would be fully exposed.

But Wakefield put a stop to that.

As Deer studied the records, Wakefield’s taxi arrived at the courthouse. He headed inside and filed notice that he was dropping the libel lawsuit. He agreed to pay all of the defendant’s legal fees. No explanation was given, although Deer had every reason to suspect he knew the answer: By withdrawing the lawsuit, Wakefield successfully blocked access to the children’s medical records, while the court’s rules required Deer to keep what he saw confidential.

10

Reckoning

STEPHEN BUSTIN walked past black wrought-iron gates into the red-brick United States Court of Federal Claims. It was June 20, 2007, a day he had eagerly awaited for three years: This was his chance to publicly reveal what he knew about the laboratory research conducted by Unigenetics for Wakefield.

Special hearings had been underway for five years in the United States, involving parents seeking a financial award from the National Vaccine Injury Compensation program for claims that the MMR had caused their children’s autism. Known as the Omnibus Autism Proceeding, they involved six test cases to determine whether Wakefield’s argument about a link between vaccines and autism was true. A favorable verdict for the parents in those six suits would allow for other families to bring similar claims.

Bustin had flown in from England to testify as an expert witness, one of the few who knew the truth about Wakefield’s claim to have found measles virus in tissue samples tested at Unigenetics.

Bustin was sworn in and took a seat. Alexis Babcock, a young trial attorney from the Justice Department, stepped forward. She asked for the usual information—name, education, professional background—before getting to the issue at hand.

“Now, moving on to Unigenetics specifically,” Babcock said. “As part of your prior work, have you had opportunities to examine the testing methods used by Dr. O’Leary while at Unigenetics?”

“Yes,” Bustin replied. “As part of the UK litigation, I was given access to all of the raw data.”

Bustin explained that, after examining the results cited in the 2002 article co-authored by Wakefield and O’Leary, he went to inspect Unigenetics. He discovered many problems: Samples were tested at inconsistent times and temperatures; essential controls were substandard; quality assessment was rare; equipment settings were unconventional. If Unigenetics tested a tissue sample twice and ended up with both positive and negative results, they reported it as a positive. And contaminants, such as from the Plasmid Room, were allowed near the laboratory equipment. Because of that, the results from his review of the Unigenetics data was unsurprising.

“Was Unigenetics ever accredited?” Babcock asked.

“No.”

“Could this be part of the reason some of these problems weren’t detected earlier?”

“Yes,” Bustin said. “I’m sure that is true.”

Efforts had been made to recruit Unigenetics into international quality-control programs, but the company refused to take part, Bustin said. “So there was never any independent quality assessment made of any of the work that was carried out by Unigenetics.”

After the data review, the inspection, and attempts to reproduce Unigenetics’ results, what had Bustin concluded about the lab’s claim to have found measles virus in the intestines of autistic children?

“I have very little doubt that what they are detecting is a DNA contaminant and not measles virus,” Bustin said. “I do not believe there is any measles virus in any of the cases they have looked at.”

His testimony ended after several hours. He returned to his hotel, packed, and headed to Dulles Airport for his return flight to Britain. Word of his testimony in the United States had already begun to spread among physicians and researchers in London. After almost a decade of listening to Wakefield spin his theories—and then supposedly proving them in his 2002 Molecular Pathology paper—Bustin had finally blown it all up.

“It has been incredibly frustrating,” Bustin told a medical journalist on his return to Britain. “For three years, we have been unable to reveal our findings. Now, based on the publicly available information, I want to get the message out about the O’Leary-Wakefield research. There’s nothing in it.”

“DR. WAKEFIELD, I have elevated my microphone. Can you hear me comfortably?”

Wakefield nodded almost imperceptibly to the woman standing at a podium before him. “Yes,” he said. “I can.”

It was April 11, 2008, and Wakefield was preparing to be cross-examined by Sally Smith, the lawyer serving in the role of prosecutor in hearings before a panel from Britain’s General Medical Council to determine whether Wakefield, Walker-Smith, and Murch should lose their medical licenses. For the fifty-seven days of testimony leading up to this moment, the panel had heard evidence from many witnesses—from Royal Free, Legal Aid, the health department, The Lancet, and more—who spelled out the details of Wakefield’s steamrolling of scientific standards and his obsession with proving a link between the MMR and multiple diseases.

Smith’s cross-examination came after days of questioning of Wakefield by his own lawyer. His self-defense could be summed up as “Everyone is wrong.”

In responding to Smith’s questions, Wakefield repeatedly twisted definitions of words into confusing concepts far afield of the normal rules of language. He argued about the meaning of “engaged,” “clinical responsibility,” “frequently,” “unique,” “stipulation,” and “involvement.” Sometimes when he wrote “clinical” in records, he said, he didn’t mean clinical. Just an error.

“There are a number of ambiguities and imperfections in the use of the English language in this correspondence,” Wakefield said about one letter used in evidence.

At one point, Smith displayed frustration when he claimed that a letter he had written to a Royal Free official that discussed “the study” referenced not one study but two, depending on which paragraph she cited. The recipient must have been fine with the letter, Wakefield said, since he never came back to him with concerns.

“May I suggest to you,” Smith said, “that the reason that he did not refer back to you is because he read that letter as any normal human being would read it, I suggest, namely that you are plainly referring to one and the same study throughout?”

“How he interpreted it I simply cannot say,” Wakefield replied.

The lawyer and the doctor sparred for days. The battle grew particularly intense over what constituted the requirements of the medical profession’s rules of ethics, with Wakefield often saying that he was his own barometer on what was right and wrong for a physician.

During closing arguments months later, Smith lambasted Wakefield for dishonesty in his testimony and adopting outrageous standards for himself on proper professional behavior.

“Individuals cannot simply be allowed to apply their own personal code of ethics,” she argued. “Underlying many of the allegations … there is a refusal to subject his own conduct to appropriate scrutiny, whether that is by an ethics committee or ultimately by the editor of the publication in which he seeks to publish his research, in this case The Lancet.”

She paused, eyes fixed on the panel. “It is our submission that Dr. Wakefield’s insistence on saying that he can decide ethical matters for himself by reference to his own personal standards underlies a number of the allegations against him.”

Smith cited Wakefield’s taking of children’s blood at a birthday party, which she argued violated fundamental ethics rules against inflicting pain or distress on healthy children purely for research. She returned repeatedly to Wakefield’s violation of disclosure rules through his failure to declare his financial interest and involvement in litigation to either the ethics committee or The Lancet.

“He apparently took the position that, so long as he is comfortable with his decided course of action, that was all that was ethically required of him as a doctor,” Smith said. “It is difficult to overstate the sheer arrogance of taking that position.”

But perhaps the most important element of the case was what Smith portrayed as the rigging of Wakefield’s MMR-autism study, which she said he had manipulated through his method of selecting which families participated. “The whole of science is based on the accuracy of that reporting and indeed the integrity of those who are doing the reporting,” she said. “In this case, you have not been hearing about minor inaccuracies. We say the paper that was ultimately published, the Lancet paper, was profoundly misleading.”

Wakefield and his co-authors presented a “striking … temporal link” recognized by a series of parents between injection of the MMR and the emergence of behavioral and gastrointestinal disorders in their children. “In truth,” Smith said, “that link was inevitably going to be made since, as was well known to Dr. Wakefield and Professor Walker-Smith, those who had the investigations had come to the Royal Free Hospital for those investigations on the very basis that their parents had made that link.”

And in the process, Wakefield subjected these disabled children to invasive, painful procedures for an outcome that was almost predetermined. “What he was doing was concerning himself with proving his research hypothesis,” Smith said. “And in pursuit of that aim, he did just what he pleased in respect of these children.”

ON JANUARY 28, 2010, the five members of the General Medical Council panel took their seats in the large, glass-paneled hearing room. The moment had finally arrived. After 148 days of hearings, followed by forty-five days of deliberation, the panel was ready to announce its decision. Surendra Kumar, the panel chair, was first to speak.

“Good afternoon to you all,” he said. “I am going to read a summary document. This is addressed to all the three doctors, but I do understand …”

Kumar glanced at the defendants’ table, his face registering surprise. Wakefield was nowhere to be seen. Kumar looked at Wakefield’s lawyer, Neil Sheldon, and asked what was going on.

“Sir, Dr. Wakefield is not here,” Sheldon said. “My understanding is he will not be attending this hearing. My instructions are, he is perfectly happy for you to continue.”

That he didn’t appear for a decision he considered illegitimate wasn’t surprising. And there was little doubt this ruling would condemn him. The evidence presented in the hearings was devastating, far worse than might have been predicted. Whatever the reason for his actions—arrogance, greed, a craving for fame, anger at being ignored, fanaticism—what the record proved was that his wrongdoing extended far beyond conflicts of interest. Instead, it revealed a man with little understanding of the purpose and standards of science, willing to lie and manipulate data to create the findings he desired.

Kumar dissected Wakefield’s research, laying out the fraud that Brian Deer saw years earlier when he reviewed the medical charts of the children in the study. He then recited the litany of other wrongdoing—the nondisclosure of the Legal Aid contract, his patents and business plans, drawing blood from children at the birthday party, and more. Then there was Wakefield’s role in administering transfer factor to Child 10 as an experiment, and his failure to write about it in medical notes or even to inform the child’s general practitioner that it had been given.

Perhaps most shocking was the panel’s conclusions based on its review of the medical condition of each child in the autism study. All medical research proposals include “inclusion criteria” for every subject in the study. Without identifying the topic of investigation through those requirements—fifteen-year-olds with untreated asthma, people over sixty with diagnosed Alzheimer’s, and so on—no study is valid. Scientists cannot reach scientific conclusions about certain conditions without establishing the type of person being examined. Wakefield listed his requirements in his original proposal, but then ignored them in the study. Of the twelve children in the research, eleven did not meet the inclusion criteria, the panel found. Some did not have “disintegrative disorder,” as Wakefield said they would. Others had no gastrointestinal symptoms. Wakefield’s proposal said he would include children immunized with the MR vaccine, not the MMR. But eight of them had been inoculated with the MMR—and that vaccine was what Wakefield publicly discussed in his press appearances. The study, even were it not laced with falsehoods and ethical violations, was meaningless. Almost all of the test subjects had a hodgepodge of conditions, and not the ones Wakefield had outlined in his proposal.

As Kumar spoke, anti-vaxxers in the audience jeered and booed. One yelled that the panel of experts were “bastards,” and shouted, “These doctors have not failed our children. You are outrageous.” Another bellowed, “This is a setup.”

Kumar wrapped up the reading of the panel’s findings. Based on those determinations, the panel suspended most of the hearings again to give its members time to debate which rules and standards Wakefield and Walker-Smith had violated and whether they should be punished.

The hearing participants and the audience headed outside, where Wakefield appeared amid cheers from placard-waving fans. “The allegations against me and against my colleagues are both unfounded and unjust,” he told the assembled supporters and reporters. “I invite anyone to examine the contents of these proceedings and come to their own conclusion.”

Five months of deliberation followed, during which the members considered the appropriate punishment. On May 24, 2010, they reconvened in the same room to deliver their final conclusion. Since the last hearing, Kumar told the crowd, the panel had weighed every element of Wakefield’s defense that might serve to mitigate their verdict. But the facts were just too overwhelming.

“Accordingly,” Kumar intoned, “the panel finds Dr. Wakefield guilty of serious professional misconduct.”

While suspension had been considered, Kumar said, Wakefield’s ethical transgressions and professional failures were too significant to warrant such minimal punishment. Instead, Wakefield would be removed from the medical register in Britain, prohibiting him from practicing as a doctor in that country again.

“It is the only sanction that is appropriate to protect patients and is in the wider public interest, including the maintenance of public trust and confidence in the profession, and is proportionate to the serious and wide-ranging findings made against him,” Kumar said.

He then proceeded to the final judgments of Wakefield’s two colleagues. Murch had been absolved of any improprieties, while Walker-Smith—who had previously been found, like Wakefield, to have violated numerous ethical rules for medical research—was also guilty of serious professional misconduct and would be struck from the medical register. (Walker-Smith went on to appeal this judgment, and it was reversed.)

The hearing ended, and Wakefield—who had attended this time—walked down the hall to the elevator. From the lobby, he stepped outside into a warm springtime sun. Crowds of supporters broke into applause, waving signs and banners with words like “GMC (General Medical Council) Used Fake Charges” and “One Jab Does Not Fit All.” Wakefield spoke to them for a moment, smiled, then headed away.

There would be no apology, no contrition, not a hint of remorse. In the aftermath of his scare campaign, vaccination rates had plummeted, children had contracted measles, and some had died. But Wakefield didn’t seem to notice, or care, so caught up was he in his self-righteousness.

“This is just ruthless pragmatism—how the system deals with doctors who step out of line,” he told The Guardian. “We as physicians responded to parental concerns as we should have done. We did exactly the right thing.”

In an interview with Matt Lauer on the Today show, he repeated his falsehoods.

“What [the General Medical Council verdict] does not detract from is the fact that there are millions of children out there suffering,” Wakefield said, “and the fact that the vaccines cause autism.”

11

Doubling Down

CROWDS STROLLED the deck of the Ruby Princess cruise ship as it prepared to sail along Mexico’s west coast in January 2016. Among the passengers on board was a group of about one hundred who had joined the trip for a special weeklong event: the first-ever Conspira-Sea Cruise. For a fee of $3,000, these travelers could discuss and debate UFOs, mind control, psychic vampirism, and other topics celebrated by the paranoid class as “alternative science.”

The group gathered in a conference center on Deck 6 for introductions to the featured seminar presenters scheduled for the cruise. One said that he had come back from the dead repeatedly, another that she personally knew Martians posing as politicians, and another that he knew secrets to help the attendees obtain vast riches.

And one was Andrew Wakefield.

“The story of my life,” Wakefield told the group, “is basically how to take a perfectly good career and flush it down the toilet.”

His self-assessment was right—he had fallen far since being struck from Britain’s medical registry. Now he was best known as an anti-vaxxer and speaker on the autism circuit, where he continued to spin stories about links between the MMR and the developmental disorder.

Following the General Medical Council’s findings, The Lancet finally retracted Wakefield’s paper in its entirety, a complete disavowal of the study that was far beyond its 2004 “Retraction of Interpretation.” While the repudiation of Wakefield’s paper was a significant black mark on the history of The Lancet, the respect Horton earned from decades of other work allowed him to emerge largely unscathed. As of early 2021, he remained editor in chief of the journal.

A flood of other research kept disproving any link between vaccines and autism. The Institute of Medicine, in the United States, published a comprehensive study in 2011, showing no connection between eight different vaccines and autism. The CDC published its own research in 2013 that showed the same results. When anti-vaxxers proclaimed that it was the preservatives in vaccines that caused autism, researchers rolled out nine more studies showing that the connection did not exist.

Yet despite it all, Wakefield remained a hero and an inspiration to the anti-vax crowd. They portrayed him as he saw himself—a man who fought for the truth, brought down by greedy and dishonest corporate interests. He hung out with famous anti-vaxxers like Robert Kennedy Jr. and Jenny McCarthy, the actress and vaccine skeptic. McCarthy even penned a foreword to Wakefield’s 2010 book about his theories and experiences.

“For hundreds of thousands of parents around the world, myself included,” McCarthy wrote, “Andy Wakefield is a symbol of strength and conviction that all parents of children with autism can use to fight for the truth.”

But to much of the rest of the world, Wakefield had become a punch line, a man who almost single-handedly set off measles outbreaks around the globe. On April 1, 2011, the James Randi Educational Foundation, a group dedicated to exposing fraud, awarded Wakefield the Pigasus Award for his “refusal to face reality.” Four days later, the British Press Awards named Brian Deer the “specialist journalist of the year,” describing his investigation of Wakefield as a “tremendous righting of a wrong.”

Wakefield’s participation in the Conspira-Sea Cruise, palling around with assorted oddballs, reflected his status in the world. He delivered his first talk aboard the ship shortly after a seminar on crop circles and before the nightly UFO watch.

As he stood in the Botticelli Dining Room, beneath a twinkling artificial night sky, Wakefield spoke to a rapt audience about the dangers of being a whistleblower—something he never was. Perhaps he believed his lies; perhaps he had entered a fantasy world of no return. Perhaps he just needed money. Whatever the reason, Wakefield’s arguments had descended into parody.

“Your bodies are owned by Big Pharma,” he said. “It’s turning into a science fiction movie.”

The role of the drug companies would bring about “the end of the United States of America,” Wakefield intoned. “This is a deliberate eugenics program. A deliberate population-control program.”

Wakefield finished speaking and the crowd broke into applause. He would be back for a panel debate the next day with other true believers about whether to blame autism on companies that manufactured vaccines or companies that grew genetically modified foods.

THE SCIENTIFIC WORLD was done with Wakefield. But Wakefield was not done undermining the work of real scientists. And after years as a failure, ridiculed as a joke, he rode his ill-gotten fame to new success.

The world had changed dramatically since the era when local television, books, and newspaper articles were the vehicles for spreading vaccine disinformation. By 2004, when Deer began exposing Wakefield’s fraud, social media had begun its rapid expansion. By the time Wakefield lost his medical license, in 2010, global use of social media had grown to more than one billion people on the top four sites—Facebook, YouTube, Myspace, and Twitter.

As Wakefield’s deception had proven for years, easily understood conspiracy theories travel faster than facts about complex science. With the explosion of social media, untold millions of ill-informed anti-vaxxers now had a megaphone with which they could spread lies.

Experts who knew the depth of Wakefield’s duplicity could only watch as the falsehoods continued to undermine public health efforts, a huge price to pay when even Wakefield’s foundational argument—that he had discovered measles virus in gut tissue—was a fantasy.

“There is absolutely no evidence they ever detected measles,” Bustin says. “They didn’t know what they were doing. They were technically inept. They got the results they wanted to get and ignored whatever contradicted their ideas.”

A key turning point for Wakefield came in 2015, when then-candidate Donald Trump endorsed the vaccines-cause-autism lie during a Republican presidential debate. “You take this little, beautiful baby and you pump—I mean, it looks just like it’s meant for a horse, not for a child,” Trump said, exaggerating the size of a vaccine syringe.

With a soon-to-be president recklessly repeating disproven theories, Wakefield’s anti-vax fame grew. Trump, faced with a backlash against his endorsement of quackery, doubled down, inviting Wakefield and a group of other anti-vaxxers to a meeting in 2016, not long before the election. Wakefield emerged from the meeting saying that Trump not only believed vaccines cause autism, but had promised to do something to address it if he were elected president. Epidemiologists grew anxious when Wakefield was invited to an inaugural ball but were relieved when, as proved to be his habit, Trump dropped the issue early in his administration, his attention drifting elsewhere.

That same year, with his fame growing, Wakefield abandoned his old life and started anew. Just after his wife of three decades, Carmel, filmed a strong defense of Wakefield for a documentary, he left his $1.5 million home in Austin, Texas, and took up with Elle Macpherson, the supermodel turned natural health advocate turned anti-vaxxer. He moved to Florida and filed for divorce.

About this same time, Wakefield visited a Somali community in Minnesota, where he pushed his crackpot theories. The community traditionally saw vaccination rates of 92 percent, among the highest in the United States. After Wakefield’s visit, that number dropped to 40 percent. A measles outbreak struck, infecting seventy-nine people, the vast majority of them children under ten. Twenty required hospitalization. It was the highest number of measles cases in Minnesota in decades, and exceeded the average annual number of cases in the entire country. Angry health officials laid the blame where it belonged: on Wakefield and his fellow zealots.

The trail of long-term damage left by Wakefield piled up. In 2019, British officials issued an urgent plea for vaccination. An outbreak emerged early that year, with more than a thousand measles cases and triple the number of mumps cases from the year before—almost eight hundred. But it was the age of the people infected that revealed Wakefield’s hand in the outbreak. An unusually large number of those who contracted measles and mumps were young adults, born amid the MMR panic set off by Wakefield two decades before. Now grown, those young people whose parents feared immunizing them because of Wakefield’s lies were paying the price.

Then came the COVID-19 pandemic. Despite having no scientific background in vaccines, despite his research being revealed as a fraud, Wakefield portrayed himself to his disciples as an expert on COVID and how to combat it. His message: The risks of COVID are insignificant, and vaccines to stop the spread are dangerous. Macpherson has joined him in this lie.

In May 2020, Wakefield was a featured speaker at an online event called the Health Freedom Summit, sponsored by two anti-vax activists. All across social media, this organization attacked Anthony Fauci as a fraud, pushed bogus “mask exemption” certificates for schoolchildren, and proclaimed that the government was planning false food shortages to force vaccine compliance. And they described Wakefield as a “true health expert.”

He did not disappoint the summit attendees. He declared that the virus was “no more deadly than seasonal flu” and that the death toll had been “greatly exaggerated.” The economic harm and sacrifices by people trying to contain the viral spread, Wakefield said, is “all based upon a fallacy.”

He said that government corruption and corporate greed have led to the conspiracy that COVID vaccines are beneficial. “One of the main tenets of mandatory vaccination has been fear, and never have we seen such fear exploited in the way we do now with the coronavirus infection,” he said.

Comparing his moral certainties to those of Nelson Mandela, Wakefield said, “Better to die as a free man than live as a slave. We have to fight to preserve [our] freedom because it will be surely stripped from us in a very short space of time if we don’t.”

Social media lit up with his claims that the pandemic was not serious, vaccines were dangerous, and those who knew this supposed truth were fighting for liberty. And he’s still at it. As recently as November 21, 2020, Wakefield was in North Carolina promoting an anti-vax propaganda film he made. He was introduced by his supermodel girlfriend, who spoke to him from a stage. “You made this film during COVID, and it’s interesting because it’s such beautiful, sacred timing when you watch the film, because it’s so pertinent and so relevant,” Macpherson said. “And for it to come in this divine time where vaccination and mandatory vaccination is on everybody’s lips.”

As months passed, as the COVID death toll climbed, as more infectious variants spread, as real scientists worked relentlessly to save millions, the Conspira-Sea Cruise star attraction kept spreading poisonous falsehoods. A recent video posted in a remote corner of the internet shows an interview with a smiling Wakefield—appearing in a sun-drenched room, dressed casually in a polo shirt—as he once again feigns expertise in a field for which he has no training, this time while attacking COVID vaccines manufactured by Moderna and Pfizer.

He babbles complex, science-y phrases that could persuade the untrained that he is an expert. But his statements are gobbledygook. He says that messenger RNA vaccines—like those made by Moderna and Pfizer—are genetic engineering. They are not. He claims problems could emerge years down the line from the RNA. Another falsehood: RNA degrades in the body in less than half a day. He insists huge problems have already emerged with the vaccine. A lie.

But like any good scaremonger, Wakefield issues catchy phrases to frighten people. “It’s rather like Jurassic Park …” and “The potential for this to go horribly wrong is enormous.”

Judging from the comments on the video, the falsehoods worked. “This is modern day gene-o-cide.” “Anybody saying they will not harm you is a liar.” “If it can go horribly wrong then it will. But not in me.” “Thank you Sir. It’s so rare to hear the truth anymore.” And, of course, “Dr. Wakefield is a good man.”

In another time, these ignorant ramblings of a charlatan would have been heard by only a handful of the tinfoil hat crowd; his words would harmlessly disappear as fast as they were spoken. In another time, Andrew Wakefield’s damage to global public health would have been contained. But not now. In a matter of weeks after the video interview was posted online, almost a quarter of a million people watched it—with many then shooting it out on Facebook, Twitter, and other social media, to be shared again and again.

Like the COVID-19 virus itself, Wakefield’s lies continue to spread, and could well be with us forever.

Primary Documents

Court Cases and Administrative Hearings

Cedillo v. Secretary of Health and Human Services, No. 98-916v, U.S. Court of Federal Claims. Declaration of Nicholas Chadwick, PhD, University of Manchester, May 25, 2007.

Cedillo, No. 98-916v. Testimony of Dr. Arthur Krisman, June 12, 2007.

Cedillo, No. 98-916v. Opening argument of Vincent Matonoski, U.S. Department of Justice, June 18, 2007.

Cedillo, No. 98-916v. Testimony of Stephen A. Bustin, June 20, 2007.

Cedillo, No. 98-916v. Testimony of Nicholas Chadwick, June 22, 2007.

Cedillo v. Secretary of Health and Human Services, No. 2010-5004, U.S. Court of Appeals for the Federal Circuit. Decision, August 27, 2010.

Fudenberg, Herman Hugh, MD (In the Matter of). Before the Board of the Medical Examiner, South Carolina Department of Labor, Licensing and Regulation. Agreement, March 27, 1995.

Fudenberg, Herman Hugh, MD (In the Matter of). Before the New York State Board for Professional Misconduct, Determination and Order (No. 96-237), October 4, 1996.

Gaiter v. Secretary of Health and Human Services, No. 17-1040v, U.S. Court of Federal Claims. Opinion, March 29, 2019.

Hazlehurst v. Secretary of Health and Human Services, No. 03-654v, U.S. Court of Federal Claims. Transcript: Examination of Thomas T. MacDonald, October 18, 2007.

Hazlehurst, No. 03-654v. Ruling on Petitioners’ Motion to Strike Certain Evidence, Dr. Stephen A. Bustin, February 12, 2009.

Hazlehurst, No. 03-654v. Decision, February 12, 2009.

Heads of Charge, Dr. Andrew Jeremy Wakefield. General Medical Council, no. 2733564, 2006.

Heads of Charge, Professor John Angus Walker-Smith. General Medical Council, no. 1700583, 2006.

Heads of Charge, Professor Simon Harry Murch, General Medical Council no. 2540201, 2006.

Hughes v. Secretary of Health and Human Services, No. 16-930V, U.S. Court of Federal Claims. Entitlement decision, January 4, 2021.

Mental Capacity Act 2005 and M (In the Matter of), No. 11822229, Court of Protection (UK). Judgment, August 11, 2014.

National Hockey League Players’ Concussion Injury Litigation, MDL No. 14-2551 (SRN/JSM), U.S. District Court for the District of Minnesota. Boston University CTE Center’s Response to the National Hockey League’s Supplemental Memorandum in Support of Its Motion to Compel Production of Documents, April 7, 2017.

Snyder v. Secretary of Health and Human Services, No. 1:01-vv-00162, U.S. Court of Federal Claims. Petition, March 22, 2001.

Snyder, no. 1:01-vv-00162. Notice of Filing of CV of Dr. Andrew J. Wakefield, January 21, 2004.

Wakefield, Dr. Andrew Jeremy, Professor John Angus Walker-Smith, and Professor Simon Harry Murch: Hearing Before Fitness to Practise Panel, General Medical Council (UK). Opening submissions of Sally Smith, QC, July 17–19, 2007.

Wakefield et al. Testimony of Dr. Trevor Hopkins, July 20, 2007.

Wakefield et al. Testimony of Dr. Bruce Baird Letham, July 23, 2007.

Wakefield et al. Testimony of Dr. Michael Stuart Pegg, July 25–26, 2007.

Wakefield et al. Testimony of Joanne Cowie, July 30, 2007.

Wakefield et al. Testimony of Dr. Mark Berelowitz, July 31–August 1, 2007.

Wakefield et al. Testimony of Professor Arie Jeremy Zuckerman, August 3 and 6, 2007.

Wakefield et al. Testimony of Dr. Richard Horton, August 6–8, 2007.

Wakefield et al. Testimony of Dr. David Hull, August 8, 2007.

Wakefield et al. Testimony of Peter Revell, August 14, 2007.

Wakefield et al. Testimony of Dr. David Salisbury, August 22–23, 2007.

Wakefield et al. Testimony of “Mrs. A.,” August 28, 2007.

Wakefield et al. Testimony of Cengiz Tarhan, September 3, 2007.

Wakefield et al. Testimony of Dr. Andrew Wakefield, March 27–May 6, 2008.

Wakefield et al. Closing submissions of Kieran Coonan, April 7–28, 2009.

Wakefield et al. Testimony of Dr. John Walker-Smith, July 16–August 27, 2008.

Wakefield et al. Testimony of Dr. Simon Murch, January 12–27, 2009.

Wakefield et al. Closing submissions of Sally Smith, March 16–31, 2009.

Wakefield et al. Closing submissions of Stephen Miller, June 8–23, 2009.

Wakefield et al. Closing submissions of Adrian Hopkins, July 6–8, 2009.

Wakefield et al. Summary of determination, January 28, 2010.

Wakefield et al. Submissions on Part II on behalf of the General Medical Council and Dr. Andrew Wakefield, April 7, 2010.

Wakefield et al. Reading of Heads of Charge, Admissions, July 16, 2007.

Wakefield et al. Determinations and decision on termination, May 24, 2010.

Wakefield v. British Medical Journal Publishing Group, No. D-1-GN-12-000003, District Court of Travis County, Texas. Defendants’ Brief in Support of Special Appearances, July 12, 2010.

Wakefield v. British Medical Journal Publishing, No. D-1-GN-12-000003. Plaintiff’s Original Petition, January 3, 2012.

Wakefield v. British Medical Journal Publishing, No. D-1-GN-12-000003. Declaration of Brian Deer in Support of Defendant’s Anti-SLAAP Motion to Dismiss, March 9, 2012.

Wakefield v. British Medical Journal Publishing, No. D-1-GN-12-000003. Deposition of Jane Smith, June 28, 2012.

Wakefield v. British Medical Journal Publishing, No. D-1-GN-12-000003. Second Affidavit of Andrew J. Wakefield, July 19, 2012.

Wakefield v. British Medical Journal Publishing, No. D-1-GN-12-000003. Amended Declaration of Brian Deer in Support of Defendant’s Anti-SLAAP Motion to Dismiss.

Wakefield v. British Medical Journal Publishing, No. D-1-GN-12-000003. Supplement to the Amended Declaration of Brian Deer, Replying to Plaintiff’s Response to Defendant’s Anti-SLAAP Motion to Dismiss, July 24, 2012.

Wakefield v. British Medical Journal Publishing Group, No. 03-12-00576-CV, Texas Court of Appeals. Appellees’ Brief, March 4, 2013.

Wakefield v. British Medical Journal Publishing, No. 03-12-00576-CV. Appellant’s Reply Brief, March 25, 2013.

Wakefield v. British Medical Journal Publishing, No. 03-12-00576-CV. Opinion, September 19, 2014.

Wakefield v. British Medical Journal Publishing Group, No. 14-0955, Texas Supreme Court. Response to Motion for Extension of Time to File Petition for Review, November 19, 2014.

Wakefield v. Channel Four Television Corporation, Twenty Twenty Productions LTD, and Brian Deer. High Court of Justice, Queen’s Bench Division, Neutral Citation No. (2005) EWHC 2410 (QB), No. HQ05X00900. Approved Judgment, January 11, 2006.

Wakefield v. Channel Four. Approved Judgment, November 29, 2006.

Walker-Smith v. General Medical Council, (2012) EWHC 503 (Admin). Judgment as Approved by the Court, July 3, 2012.

Sworn Statements

Horton, Dr. Richard. Sworn statement re: Rouse letter, contacts with Dawbarns, November 29, 2008.

Kirkpatrick, Dr. Charles H. Sworn statement re: Transfer Factor discussions with Wakefield, April 28, 2008.

Rouse, Dr. Andrew. Sworn statement re: Letter to The Lancet, April 17, 2008.

Letters and Personal Communications

Armstrong, Dr. Ernest Macalpine (“Mac”). Letter to Dr. Arie Zuckerman re: questions about Legal Aid support for research, October 15, 1996.

Barr, Richard. Letter to Joanne Cowie re: progress in research, Wakefield fee for preliminary report, November 22, 1996.

———. Letter to Patricia Simpson of Legal Aid Board re: Wakefield’s informal findings and request for extension of finances, May 21, 1996.

———. Letter to Patricia Simpson of Legal Aid Board re: Wakefield’s costing proposals, June 6, 1996.

———. Letter to Dr. Andrew Wakefield re: enclosure of £25,000 check, December 6, 1996.

Berelowitz, Dr. Mark. Letter to Dr. Simon Murch re: notes of examination of (Child 2), September 30, 1996.

———. Letter to Dr. John Walker-Smith re: notes of examination of (Child 10), February 20, 1997.

———. Letter to Dr. John Walker-Smith, copied to Dr. Andrew Wakefield, re: recommendation that autism paper stresses preliminary nature of findings, recommends title change, August 5, 1997.

Bishop, Ruth. Letter to Cengiz Tarhan re: recap of Immunospecifics business plan discussions, March 10, 1998.

Blatch, Bryan. Letter to Dr. Ernest Macalpine “Mac” Armstrong of British Medical Association re: follow-up to previous Armstrong letter to Zuckerman, February 24, 1997.

Calman, Dr. Kenneth. Letter to Andrew Wakefield re: request for evidence of a link between MMR and Crohn’s/autism, July 29, 1997.

Cooper, John, Chief Executive of Royal Free Hampstead NHS Trust. Letter to Andrew Wakefield offering him position as honorary consultant in experimental gastroenterology at Royal Free, January 21, 1994.

Cowie, Joanne. Letter to Richard Barr re: authorization of payment to Wakefield, November 4, 1996.

Deer, Brian. Letter to General Medical Council describing actions of Drs. Wakefield, Walker-Smith, and Murch, February 25, 2004.

———. Email to Abel Hadden, December 29, 2003.

———. Email to Abel Hadden, January 22, 2004.

Else, Martin Thomas. Letter to Dr. Andrew Wakefield re: Royal Hampstead NHS Trust special trustees’ agreement to fund 1996–98 salary of Rosslyn Sims for Wakefield’s MMR/autism research, September 17, 1996.

———. Letter to Dr. Andrew Wakefield re: establishment of fund within Special Trustees account for MMR research, June 30, 1997.

Hadden, Abel. Email to Brian Deer, January 8, 2004.

———. Email to Brian Deer, January 22, 2004.

Hooker, Brian, Andrew Wakefield, and James Moody. Letter to Dr. Harold W. Jaffe, MD, MA, Associate Director for Science Centers for Disease Control and Prevention and Dr. Don Wright, MD, MPH, Acting Director, ORI U.S. Department of Health and Human Services, October 14, 2014.

Hull, Dr. David. Letter to Dr. Arie Zuckerman re: JVCI Meeting with Wakefield and Pounder, February 26, 1997.

———. Letter to Professor Arie Zuckerman re: Ethics Committee approval of Wakefield study, July 9, 1998.

———. Letter to Professor Arie Zuckerman re: discomfort with misrepresentation in Lancet study statement on ethics committee approval, September 16, 1998.

Letham, Bruce Baird. Record of telephone conversation with Andrew Wakefield, “Re (Child 5), Dr. Wakefield, consultant gastroenterologist Royal Free rang and gave a v. lengthy and convincing case for (Child 5) to be referred to Professor John Walker-Smith,” September 30, 1996.

Llewellyn-Smith, Chris. Letter to Dr. Andrew Wakefield re: concerns about conflicts of interest, Carmel Business Plan, December 9, 1999.

———. Letter to Dr. Andrew Wakefield re: request for update on research progress, March 16, 2000.

Owens, Chris. Department of Health, “Letter to RadcliffesLeBrasseur,” July 25, 2005.

Pegg, Dr. Michael. Letter to Dr. John Walker-Smith re: Ethics Committee decision, December 19, 1996.

———. Letter to Professor Arie Zuckerman re: Wakefield, Dawbarns Solicitors, April 15, 1997.

Pounder, Dr. Roy. Letter to Dr. Kenneth Calman re: Pulse article, preliminary results of autism research, July 30, 1997.

RadcliffesLeBrasseur. “Letter to Mr. Murray Morse, Editor: Cambridge Evening News, Re: Mr. Andrew Wakefield,” June 29, 2005.

———. “Letter to Sophie Rawlings, The Medical Protection Society, The Department of Health, Re: Mr. Andrew Wakefield,” June 23, 2005.

Royal Free Hampstead NHS Trust. Letter to Andrew Wakefield offering a position as senior lecturer, December 10, 1992.

Rozencoft, Dr. David. Telephone call message from Rosemary Kessick, June 1995.

Salisbury, Dr. David. Letter to Andrew Wakefield re: willingness to arrange a meeting, November 4, 1992.

———. Letter to Andrew Wakefield re: Wakefield’s disappointment about January 1995 Department of Health meeting, March 3, 1995.

———. Letter to Andrew Wakefield re: Wakefield letter of February 18, denial that he insulted Wakefield, March 27, 1997.

———. Letter to Dr. John Walker-Smith re: shaky epidemiological case of measles/Crohn’s relationship, illogic of MMR/autism link, October 21, 1995.

Sawyer, Edwards and Butler (fundraising consultants). Letter to Drs. Roy Pounder and Andrew Wakefield re: priorities at Inflammatory Bowel Disease Study Group for 2007.

Singh, Dr. R. B. Letter to Andrew Wakefield re: procedures for research financing, June 18, 1993.

Stephenson, Andrew, Peter Carter-Ruck & Partners. Undated letter to Dr. Richard Horton, undated, sent by fax, February 27, 2004.

Tarhan, Cengiz. Letter to David Dutton et al. re: meeting with Wakefield et al. regarding Transfer Factor investment, March 4, 1998.

———. Letter to Professor Peter Revell seeking scientific advice on Wakefield proposal, August 8, 1997.

———. Letter to Dr. Peter Revell re: scientific advice for Freemedic, August 18, 1997.

———. Letter to Dr. Andrew Wakefield re: 50 percent cost-match proposal for Immunospecifics, October 20, 1997.

———. Letter to Dr. Andrew Wakefield re: assignment of patent applications, interest apportionment, June 25, 1998.

———. Memo to Professor Arie Zuckerman, May 1997.

Wakefield, Dr. Andrew. Letter to Richard Barr re: initial £25,000 payment, September 26, 1996.

———. Letter to Ruth Bishop at Royal Free Bursary re: Transfer Factor/patent strategy, June 24, 1997.

———. Letter to Dr. Kenneth Calman re: “Do Not Revaccinate,” September 7, 1996.

———. Letter to Martin Else re: assurance of no conflict of interest from Legal Aid funding, July 3, 1997.

———. Letter to Michael J. Peckham re: Crohn’s/Measles research, warning of government embarrassment, May 12, 1993.

———. Letter to Russ Phipps, assistant finance director, re: notification of check from Legal Aid, May 14, 1997.

———. Letter to David Salisbury re: concern about revaccination program, statement that government cannot ignore his research, October 4, 1994.

———. Letter to David Salisbury re: demands he confirm whether he insulted Wakefield to patient/reporter, February 18, 1997.

———. Letter to David Salisbury re: providing proof of upcoming article, question about helpline, April 14, 1995.

———. Letter to David Salisbury re: research on Crohn’s and measles virus, request to discuss funding, October 2, 1992.

———. Letter to MP Llewellyn-Smith re: offer to meet with the Minister of State in the Department of Health, July 14, 1997.

———. Letter to Cengiz Tarhan re: Legal Aid funding, September 25, 1996.

———. Letter to Cengiz Tarhan re: planned meeting with Wakefield, Alex Corda, et al. to discuss Transfer Factor investment, February 26, 1998.

———. Letter to Dr. John Walker-Smith et al. circulating version of paper for The Lancet, October 8, 1997.

———. Letter to Dr. Walker-Smith et al. re: discussing vaccines at the Royal Free press briefing, January 15, 1998.

———. Letter to Dr. Arie Zuckerman re: terms of Legal Aid agreement, March 24, 1997.

Walker-Smith, Dr. John. Letter to Dr. Richard Cartmel re: (Child 2), June 28, 1996.

———. Letter to Martin Else, Dr. Arie Zuckerman, et al. re: clinical need of study participants, July 24, 1998.

———. Letter to Dr. Trevor Hopkins re: (Child 10), November 11, 1996.

———. Letter to Dr. Michael Pegg, copied to Drs. Andrew Wakefield/Simon Murch, November 11, 1996.

———. Letter to Ajjegowda Lakshminarayana Shantha re: (Child 13), December 31, 1996.

———. Memo to Andrew Wakefield (copied to Simon Murch), February 20, 1997.

———. Letter to Professor Arie Zuckerman re: Hull letter of July 9, 1998, July 14, 1998.

Zuckerman, Dr. Arie. Letter to Dr. Ernest Macalpine “Mac” Armstrong of British Medical Association re: Legal Aid payment to Wakefield, October 11, 1996.

———. Letter to Dr. Michael Pegg re: Wakefield, Dawbarns Solicitors, April 14, 1997.

———. Letter to Cengiz Tarhan re: recommendation against Freemedic funding Transfer Factor proposal, September 15, 1997.

Zuckerman, Professor Arie. Letter to Dr. John Walker-Smith re: response to Hull letter, April 14, 1997.

Other Original Documents

Autism Trust USA. Announcement of Dr. Andrew Wakefield’s “cutting edge” program on the Autism Media Channel, undated.

Briefing of Chairman, Minutes of Department of Health meeting (UK) re: potential causes of Crohn’s, January 12, 1995.

Carmel Healthcare Ltd. Business plan. 1999.

Committee on Publication Ethics. “Code of Conduct and Best Practices Guidelines for Journal Editors,” March 11, 2012.

Cowie, Joanne. Notes of meeting with Wakefield, Barr, and Kirsten Limb of Dawbarns at Durham University, April 9, 1997.

Deer, Brian. Audio selection of interview with Richard Barr, January 14, 2004.

Divine Travels. “Sail the Magnificent Mexican Riviera and Awaken to the Truth That Sets Us Free During Our 7-Night Holistic ‘Conspira-Sea Cruise,’” marketing pamphlet, September 2, 2015.

Divine Travels. “Uncover the Mysteries of the Ancients as We Sail the Magnificent Mexican Riviera During Our 7-Night Conference at Sea Nov. 11 to 18, 2017,” pamphlet, undated.

Hear the Silence. Zenith Entertainment, December 15, 2003.

Immunospecifics Biotechnologies Ltd. Business plan (Draft), 1998.

Immunospecifics Ltd., Articles of Incorporation, Company Number 0371442, February 11, 1999.

Joint Committee on Vaccination and Immunisation (UK). Minutes of meeting on recommending the use of MMR in Britain to replace individual doses, November 7, 1986.

Leach, Melissa. “MMR Mobilisation: Citizens and Science in a British Vaccine Controversy.” IDS Working Paper 247, Institute of Development Studies, Brighton, United Kingdom, September 2005.

Legal Aid Board. “Authority to Do Contract Work, Contract Reference: MPA 94/2, Descriptions of MPA: Measles, Mumps and Rubella,” August 22, 1996.

Legal Services Commission. “MMR Experts’ Fees and Expenses as Allowed on Assessment of the Court,” undated.

MacDonald, Thomas T. “Expert Report of Professor Thomas T. MacDonald,” filed with U.S. Court of Federal Claims, North Carolina Superior Court, Hazlehurst v. Secretary of Health and Human Services, No. 03-654v.

Medical Research Council. “MRC Ad Hoc Meeting to Examine Evidence Relating Measles or Measles Vaccine to Chronic Gastrointestinal Inflammation,” report of the meeting held on January 23, 1998, at the Royal College of Surgeons.

Medical Research Council. Transcript of March 23, 1998, meeting with Dr. Andrew Wakefield.

“On Second Looking into the Case of Dr. Andrew J. Wakefield by William Long, MDiv, PhD, JD.” AutismOne 2016 Conference, Autism News and Views, January 26, 2010.

Miyajima, Miki. “Andrew Wakefield MMR Scandal.” Prezi, December 13, 2013.

“Profile: Dr Andrew Wakefield.” BBC.com, January 27, 2010.

Royal Free Hampstead NHS Trust. Ethical Practices Sub-Committee Protocol and Pro Forma. Responsible consultants: Professor John Walker Smith, Dr. Simon Much, Dr. A. J. Wakefield, June 8, 1996.

Royal Free Hospital School of Medicine. “New Research Links Autism and Bowel Disease,” press release, February 28, 1998.

Royal Free Hospital School of Medicine. Press statement on MMR Research, September 1, 1997.

Royal Free Hospital School of Medicine. Video press release, February 26, 1998.

Royal Free Video News Release on Wakefield study (captions), January 28, 1998.

Trinity Communications. “Professor John O’Leary Delivers His Inaugural Lecture as Chair of Pathology at TCD on Cancer: Genes, Proteins and Stemness,” May 18, 2007.

UK Department of Health Joint Subcommittee on Adverse Reactions to Vaccination and Immunization. Minutes of meeting, September 17, 1990.

Wakefield, Dr. Andrew. Transcript of statement offering to debate his critics om vaccines and autism and an incorrect/misleading history of MMR vaccines in Britain, April 2013.

Wakefield, Dr. Andrew. Receipt for £25,000 check, December 9, 1996.

Walker, Martin J. The General Medical Council’s Fitness to Practice Panel Hearing of Dr. Andrew Wakefield, Professor John Walker-Smith & Professor Simon Murch. Undated, unpublished manuscript.

Government and NGO Reports

Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine Preventable Diseases: Pink Book. Washington, DC: Public Health Foundation, 2012.

British Paediatric Association, Ethics Advisory Committee. “Guidelines for the Ethical Conduct of Medical Research Involving Children.” Bulletin of Medical Ethics, July-August 1992.

Global Advisory Committee on Vaccine Safety. “Global Advisory Committee on Vaccine Safety, November 29–30, 2006.” World Health Organization, Committee Report. Weekly Epidemiological Record, January 19, 2007.

Health Protection Agency (UK). “Measles Notifications and Deaths in England and Wales, 1940–2008.” London: Health Protection Agency, 2010.

Institute of Medicine. Immunization Safety Review: Vaccines and Autism. Washington, DC: National Academies Press, 2004.

National Academies of Sciences, Engineering, and Medicine. Fostering Integrity in Research, Appendix D: Detailed Case Histories. Washington, DC: National Academies Press, 2017.

Public Health England. “50 Years of Measles Vaccination in the UK.” Published online, October 15, 2018. https://www.publichealthengland.exposure.co/.

Public Health England. “Measles Deaths by Age Group: 1980 to 2017 (ONS Data).” Updated August 15, 2019. https://www.gov.uk/.

World Health Organization. “Mumps Virus Vaccines: WHO Position Paper.” Weekly Epidemiological Record, February 16, 2007.

Legislative Proceedings

Autism: Present Challenges, Future Needs—Why the Increased Rates? Hearings Before the U.S. House of Representatives Comm. on Government Reform, U.S. House of Representatives, 106th Cong. (April 6, 2000).

Vaccines Save Lives: What Is Driving Preventable Disease Outbreaks? Hearings Before the U.S. Senate Comm. on Health, Education, Labor, and Pensions, 116th Cong. (March 5, 2019) (Testimony of John Wiesman, Secretary of Health, Washington State Department of Health).

Patent and Trademark Documents

Royal Free Hospital School of Medicine; Andrew Wakefield, inventor. “Pharmaceutical Composition for Regressive Behavioral Disease.” UK Patent Office, application no. 9928642.9, filed June 4, 1998, granted November 7, 2001.

Wakefield, Andrew. “Diagnostic and Therapeutic System for Crohn’s Disease and Colitia Ulcerosa.” European Patent Office, patent no. EP0817864B1. Application no. EP0817864A, submitted March 22, 1996, granted June 12, 2002.

Wakefield, Andrew. “Regressive Behavioral Disorder Diagnosis.” United States Patent Office, patent no. US 6,534,259 B1. Application no. 09/445,388, submitted June 4, 1998, granted: March 18, 2003.

Wakefield, Andrew, signatory for Autism Media Channel. Trademark/Service Mark Amendment to Allege Use. Mark: “Autism Mothers TV.” Filed June 14, 2011.

Trademark/Service Mark Amendment to Allege Use. Mark: “Chiropractic’s Got Talent.” Filed February 2013.

Medical, Academic, and Scientific Journals

Afza, M. A. “Absence of Detectable Measles Virus Genome Sequence in Blood of Autistic Children Who Have Had Their MMR Vaccination During the Routine Childhood Immunization Schedule of UK.” Journal of Medical Virology, March 2006.

Bedford, Helen, et al. “Wakefield et al. Ileal-Lymphoid-Nodular Hyperplasia, Non-specific Colitis, and Pervasive Developmental Disorder in Children.” Letter to the editor. Lancet, March 21, 1998.

Bucci, Enrico M. “On Zombie Papers.” Cell Death & Disease, February 25, 2019.

Chen, Robert T., and Frank DeStefano. “Vaccine Adverse Events: Causal or Coincidental?” Lancet, February 28, 1998.

Challoner, Alan. “Does the MMR Jab Cause Autism?” Letter to the editor. BMJ, July 9, 2005.

Couzin, J. “Truth and Consequences.” Science, September 1, 2006.

D’Souza, Yasmin, et. al. “No Evidence of Persisting Measles Virus in Peripheral Blood Mononuclear Cells from Children with Autism Spectrum Disorder.” Pediatrics 188, no. 4 (October 2006).

Editors of the Lancet. “Retraction: Ileal-Lymphoid-Nodular Hyperplasia, Non-specific Colitis, and Pervasive Developmental Disorder in Children.” Lancet, February 2, 2010.

Dyer, Owen. “Andrew Wakefield Calls Trump ‘On Our Side’ over Vaccines After Meeting.” BMJ, December 5, 2016.

Fanelli, D. “How Many Scientists Fabricate and Falsify Data? A Systemic Review and Meta-Analysis of Survey Data.” PLoS One, May 29, 2009.

Fitzpatrick, Mike. “The End of the Road for the Campaign Against MMR.” British Journal of General Practice, August 1, 2007.

Fudenberg, H. H. “Transfer Factor: Past, Present and Future.” Annual Review of Pharmacology and Toxicology 29 (1989).

Godlee, Fiona, Jane Smith, and Harvey Marcovitch. “Wakefield’s Article Linking MMR Vaccine and Autism Was Fraudulent.” BMJ, January 6, 2011.

Godlee, Fiona. “Journal Responds to Email Barrage.” BMJ, February 7, 2011.

Harrison, Joel A. “Wrong About Vaccine Safety: A Review of Andrew Wakefield’s Callous Disregard.” Open Vaccine Journal 6 (2013).

Horton, Richard. “Autism, Inflammatory Bowel Disease, and MMR Vaccine.” Lancet, March 21, 1998.

Horton, Richard. “Offline: From Bedford Square to London Wall.” Lancet, July 4, 2015.

Horton, Richard, and David Sharp. “We’re Moving.” Lancet, November 13, 1999.

Horton, Richard. “The Crisis in Scientific Publishing.” Lancet, July 23, 2016.

Lyall, Joanna. “Editor in the Eye of the Storm.” BMJ, February 28, 2004.

MacDonald, T. T., and P. Domizio. “Autistic Enterocolitis: Is It a Histopathological Entity?” Histopathology 50, no. 3 (2007).

Madsen, Dr. Kreesten, et al. “A Population-Based Study of Measles, Mumps, and Rubella Vaccination and Autism.” New England Journal of Medicine, November 7, 2002.

Murch, Dr. Simon. “A Statement by Dr. Simon Murch.” Lancet, March 6, 2004.

Muscat, Mark. “Who Gets Measles in Europe?” Journal of Infectious Diseases 204, suppl. 1 (July 2011).

Opel, Douglas J. “Assuring Research Integrity in the Wake of Wakefield.” BMJ, January 18, 2011.

Pan, Richard J. “The Modern Plague of Antivaccine Extremists,” Annals of Allergy, Asthma & Immunology, 125 (2020).

Ramsay, M. E., et al. “Measles Vaccine: A 27-Year Follow-up.” Epidemiology & Infection 112, no. 2 (April 1994).

Ramsay, M. E. “Measles: The Legacy of Low Vaccine Coverage.” Archives of Disease in Childhood 98, no. 10 (July 2013).

Rouse, Dr. A. “Autism, Inflammatory Bowel Disease, and MMR Vaccine.” Letter to the editor. Lancet, May 2, 1998.

Sanna, Leonardo. “Tesi di Laurea in Semiotica dei Media e dei Consume: Appello Secondo.” 2016–2017.

Stroebe, Wolfgang, et al. “Scientific Misconduct and the Myth of Self-Correction in Science.” Perspectives on Psychological Science 7, no. 6 (November 2012).

Suelzer, Elizabeth, et al. “Assessment of Citations of the Retracted Article by Wakefield et al. with Fraudulent Claims of an Association Between Vaccination and Autism.” JAMA Network Open, November 15, 2019.

Taylor, B., et al. “Autism and Measles, Mumps, and Rubella Vaccine: No Epidemiological Evidence for a Causal Connection.” Lancet, June 12, 1999.

Thompson, Nicholas, et al. “Prognosis and Prognostic Factors in Inflammatory Bowel Disease.” Saudi Journal of Gastroenterology 1, no. 3 (September 1995).

Thompson, N. R., et al. “Is Measles Vaccination a Risk Factor in Inflammatory Bowel Disease?” Lancet, April 29, 1995.

Wager, Liz. “Wakefield: Should We Demand Public Access to Raw Data.” Influenza Update, BMJ, January 15, 2011.

Wakefield, Andrew. “Ileal Lymphoid Nodular Hyperplasia, Non-specific Colitis and Regressive Behavioural Disorder: A New Syndrome?” Journal of Pediatric Gastroenterology & Nutrition 25, supplement 1, abstract no. 30, 1997.

Wakefield, Andrew. Letter to the Editor. Lancet, June 24, 1999.

Wakefield, Andrew. “MMR Vaccination and Autism.” Lancet, September 11, 1999.

Wakefield, Andrew. “A Statement by Dr. Andrew Wakefield.” Lancet, March 6, 2004.

Wakefield, Andrew, and Scott M. Montgomery. “Measles, Mumps, Rubella Vaccine: Through a Glass, Darkly.” Adverse Drug Reactions and Toxicological Reviews, January 23, 2001.

Wakefield, Andrew, et al. “Enterocolitis in Children with Developmental Disorders.” American Journal of Gastroenterology 95, no 9 (September 2000).

Wakefield, Andrew, et al. “Evidence of Persistent Measles Virus Infection in Crohn’s Disease.” Journal of Medical Virology 39, no. 4 (April 1993).

Wakefield, Andrew, et al. “Genetics Versus Environment in Inflammatory Bowel Disease: Results of a British Twin Study.” BMJ, January 13, 1996.

Wakefield, Andrew, et al. “Granulomatous Vasculitis in Crohn’s Disease.” Gastroenterology 100 (May 1991).

Wakefield, Andrew, et al. “Ileal-Lymphoid-Nodular Hyperplasia, Non-specific Colitis, and Pervasive Developmental Disorder in Children.” Lancet, February 28, 1998.

Wakefield, Andrew, et al. “Thrombogenicity of Total Parental Nutrition Solutions: I. Effect on Induction of Monocyte/Microphage Procoagulant.” Gastroenterology 97, no. 5 (November 1989).

Wise, Jaqui. “Finnish Study Confirms Safety of MMR Vaccine.” BMJ, January 20, 2001.

Works by Brian Deer

Deer, Brian. “Revealed: MMR Research Scandal.” Sunday Times, February 22, 2004.

———. “Focus: MMR—The Truth Behind the Crisis.” Sunday Times, February 22, 2004.

———. “Key Ally of MMR Doctor Rejects Autism Link.” Sunday Times, March 7, 2004.

———. “Fresh Doubts Cast on MMR Study Data.” Sunday Times, April 29, 2004.

———. “MMR Scare Doctor Planned Rival Vaccine.” Sunday Times, November 14, 2004.

———. “MMR: What They Didn’t Tell You.” Dispatches, Channel 4 (UK), aired November 18, 2004.

———. “MMR Jab Scare Research Dealt a ‘Killer Blow.’” Sunday Times, March 6, 2005.

———. “Huge Sums Paid to Andrew Wakefield.” Sunday Times, December 31, 2006.

———. “Focus: Hidden Records Show MMR Truth.” Sunday Times, February 8, 2009.

———. “News Review: MMR Vaccine Scandal.” Sunday Times, January 24, 2010.

———. “Focus: ‘Callous, Unethical and Dishonest.’” Sunday Times, January 31, 2010.

———. “Wakefield’s ‘Autistic Enterocolitis’ Under the Microscope.” BMJ, April 17, 2010.

———. “Secrets of the MMR Scare: How the Case Against the MMR Vaccine Was Fixed.” BMJ, January 6, 2011.

———. “Secrets of the MMR Scare: How the Vaccine Crisis Was Meant to Make Money.” BMJ, January 11, 2011.

———. “The Lancet’s Two Days to Bury Bad News.” BMJ, January 18, 2011.

———. “Pathology Reports Solve ‘New Bowel Syndrome’ Riddle.” BMJ, November 9, 2011.

———. “Latest MMR ‘Dispute’ Is a Straw Man.” Nature, January 12, 2012.

Newspapers and Magazines

Adler, Erin. “Speaker Says Vaccines and Autism May Be Linked, a View Denied by Public Health Officials.” Minneapolis Star Tribune, May 2, 2017.

Aitkenhead, Decca. “Disgraced Doctor Andrew Wakefield’s New Life.” Weekend Australian Magazine, September 12, 2020.

Allday, Erin. “Anti-Vaccine Leader Tells Parents to Fight Immunization Bill.” San Francisco Chronicle, April 25, 2015.

“Bad Science Needs Good Scrutiny.” Editorial. Sunday Times, January 31, 2010.

Banks-Smith, Nancy. “MMR: What They Didn’t Tell You.” Guardian, November 21, 2004.

Bosley, Sarah. “How Disgraced Anti-Vaxxer Andrew Wakefield Was Embraced by Trump’s America.” Guardian, July 18, 2018.

Braunstein, G. D. “Andrew Wakefield’s Vaccination and Autism Study: Allegations of Fraud with Financial Motivations.” Huffington Post, May 3, 2012.

Christie, Bryan. “Measles Jab for 800,000 Scots Children.” Scotsman, September 30, 1994.

Consumer Health Digest, #11-10, May 1, 2011.

Dickey, Bronnen. “Climb Aboard, Ye Who Seek the Truth!” Popular Mechanics, August 17, 2016.

Dyer, Clare. “Doctor in MMR Controversy Drops Channel 4 Libel Action.” Guardian, January 6, 2007.

Fitzgerald, Michael. “The MMR-Autism Theory? There’s Nothing in It.” Spiked, July 4, 2007.

Frankel, Glenn. “Charismatic Doctor at Vortex of Vaccine Dispute.” Washington Post, July 11, 2004.

Fraser, Lorraine. “Parents Left Stunned as MMR Doctor Is Forced Out.” Telegraph, December 2, 2001.

Grinker, Roy Richard. “Science on Trial.” Wall Street Journal, June 30, 2007.

Harrison, Joel. “Andrew Wakefield Has Never Been ‘Exonerated’: Why Justice Mitting’s Decision in the John Walker-Smith Case Does Not Apply to Wakefield.” Expert Commentary Series, August 1, 2016.

Hilts, Donna. “TV Report on Vaccine Stirs Bitter Controversy,” Washington Post, April 28, 1982.

“How the MMR Scare Led to the Return of Measles.” Sunday Times, February 8, 2009.

Langdon-Down, Grania. “A Shot in the Dark.” Independent, November 27, 1996.

McKee, Louise. “MMR Assaults Immune System.” Pulse, August 2, 1997.

Meikle, James. “Claim That MMR Work Mixed Science and Spin.” Guardian, February 24, 2004.

Merian, Anna. “Here’s Robert F. Kennedy Jr. Explicitly Voicing His Support for Anti-Vax Godfather Andrew Wakefield.” Vice, October 15, 2019.

Midgley, Carol. “Vaccination: The Dilemma Now Facing Every Parent.” Daily Mail, September 16, 1992.

“The Ockhams 2018: The Rusty Razor Award for Pseudoscience and Bad Critical Thinking.” Skeptic, October 2018.

O’Regan, Eilish. “Mind & Body: Losing Weight? No Man Will Notice.” Irish Independent, May 8, 1995.

Paun, Carmen. “Trump Offers Vindication to Vaccine Skeptic Doctor.” Politico, February 9, 2017.

Phillips, Melanie. “This Baby Suffered Brain Damage and Epilepsy After the MMR Jab. So Why Did Doctors Ignore Warnings That It Might Be Unsafe? MMR: The Truth.” Daily Mail, March 12, 2003.

Revill, Jo. “Scientists’ Warning Prompts Fears over Measles Vaccine.” Evening Standard, February 26, 1998.

Ross, Emma. “Media Investigation Forces Retractions of Bogus Vaccine Research.” Associated Press, March 3, 2004.

Smith, Rebecca. “Andrew Wakefield—The Man Behind the MMR Controversy.” Telegraph, January 29, 2010.

Sun, Lena. “Senate Panel Warns of Dangers of Anti-Vaccine Movement.” Washington Post, March 5, 2019.

Sutcliffe, Thomas. “Last Night’s Television: A Drama Stricken Down by Jaundice; Hear the Silence; Five.” Independent, December 16, 2003.

Taylor, M. “Mothers Alarmed After TV MMR Drama.” Guardian, December 16, 2003.

Trueland, Jennifer. “Measles Jab Safe, Scientists Insist.” Scotsman, March 25, 1998.

Television

“Does the MMR Jab Cause Autism?” The Horizon, BBC, June 2005.

“Every Parent’s Choice.” Panorama, BBC, February 2, 2002.

“The MMR Vaccine: Controversy Surrounding British Study That Showed a Link Between Autism and the Vaccine for Measles, Mumps & Rubella.” Sixty Minutes, CBS, November 12, 2000.

“Was Vaccine-Autism Study a Fraud?” Anderson Cooper 360 Degrees, CNN, January 5, 2011.

Books

Barr, Richard. The Savage Poodle: Tales from Legal Practice. London: Ark Group, 2017.

Berman, Jonathan. Anti-Vaxxers: How to Challenge a Misinformed Movement. Cambridge, MA: MIT Press, 2020.

Broad, W. J., and N. Wade. Betrayers of the Truth. New York: Simon & Schuster, 1982.

Bustin, Stephen A. The PCR Revolution: Basic Technologies and Applications. Cambridge: Cambridge University Press, 2009.

———. “Why There Is No Link Between Measles Virus and Autism.” In Recent Advances in Autism Spectrum Disorders, Vol. I, edited by Michael Fitzgerald. IntechOpen, March 6, 2013.

Byrne, Andrew. Bedford Square: An Architectural Study. London: Athlone Press, 1990.

Boyce, Tammy. Health, Risk and News: The MMR Vaccine and the Media. New York: Peter Lang, 2007.

Fitzpatrick, Michael. MMR and Autism. London: Routledge, 2004.

Goodstein, D. On Fact and Fraud. Princeton, NJ: Princeton University Press, 2010.

Goldacre, Ben. Bad Science: Quacks, Hacks and Big Pharma Flacks. New York: Farrar, Straus & Giroux, 2008.

Horton, Richard. Second Opinion: Doctors, Disease and Decisions in Modern Medicine. London: Granta, 2003.

———. MMR Science & Fiction: Exploring a Vaccine Crisis. London: Granta, 2004.

Hotez, Peter. Vaccines Did Not Cause Rachel’s Autism: My Journey as a Vaccine Scientist, Pediatrician, and Autism Dad. Baltimore: Johns Hopkins University Press, 2018.

Offit, Paul. Autism’s False Prophets. New York: Columbia University Press, 2008.

———. Vaccinated: One Man’s Quest to Defeat the World’s Deadliest Diseases. New York: Harper Perennial, 2008.

———. Deadly Choices: How the Anti-Vaccine Movement Threatens Us All. New York: Basic Books, 2015.

Mnookin, Seth. The Panic Virus: A True Story of Medicine, Science, and Fear. New York: Simon & Schuster, 2011.

Specter, Michael. Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens Our Lives, Penguin Press, 2009.

Wakefield, Andrew. Callous Disregard: Autism and Vaccines—The Truth Behind a Tragedy. New York: Skyhorse, 2010.

Walker-Smith, John. Enduring Memories. Spennymoor, UK: Memoir Club, 2003.

About the Author

Photograph by Syvia Elzafon

Kurt Eichenwald is a New York Times bestselling author of five nonfiction books. His second, The Informant, was made into a movie starring Matt Damon and directed by Steven Soderbergh. In addition to his work as senior writer at Newsweek and contributing editor at Vanity Fair, Eichenwald spent two decades as a senior writer at The New York Times, where he was a two-time finalist for the Pulitzer Prize. He is a two-time winner of the George Polk Award, as well as a winner of the Payne Award for Ethics in Journalism.

About Scribd

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Table of Contents

Cover

Title Page

Copyright

Author’s Note

The Big Lie

Prologue

1: Ambition

2: Test Subjects

3: Conflicts of Interest

4: Business Plans

5: Peer Review

6: Media Frenzy

7: “No Evidence”

8: Spin vs. Science

9: Counterpunches

10: Reckoning

11: Doubling Down

Primary Documents

About the Author

About Scribd