Tuesday, January 11, 2011

The BMJ and Brian Deer

In case you haven't heard, ex-doctor Wakefield now stands acused of being a fraud by the British medical journal BMJ.  In a scathing article and accompanying editorial, the journal says, in no uncertain terms, that Wakefield not only acted unethically but also intentionally fabricated data in his now infamous study -
Deer unearthed clear evidence of falsification. He found that not one of the 12 cases reported in the 1998 Lancet paper was free of misrepresentation or undisclosed alteration, and that in no single case could the medical records be fully reconciled with the descriptions, diagnoses, or histories published in the journal. 
Who perpetrated this fraud? There is no doubt that it was Wakefield. Is it possible that he was wrong, but not dishonest: that he was so incompetent that he was unable to fairly describe the project, or to report even one of the 12 children’s cases accurately? No. A great deal of thought and effort must have gone into drafting the paper to achieve the results he wanted: the discrepancies all led in one direction; misreporting was gross.
These are extremely serious charges for the editor of a prestigious medical journal to be making.  If Wakefield's career wasn't already in the toilet, it would certainly be put in jeopardy by this.  So I would expect that, given the extremely serious nature of the charges, the journal would have rock solid data to back up its allegations.  You don't accuse someone of intentionally manipulating data without being sure that you are correct.  And you don't do it using an editorial in a major journal without being very, very sure.

Or at least I thought that was would be the case.  But after reading the editorial and the article, I have my doubts.  As far as I can tell, none of the charges are anything new nor is there any new substance behind the allegations.  So I really have to wonder what the point of the whole thing is.

I am not defending Wakefield here (I repeat - I am not defending Wakefield) but I have to say that that this looks like just yet another attack on Wakefield by Brian Deer.  Brian Deer has been making these charges for years now and I strongly suspect that if there was enough evidence to make the fraud accusations stick that it would have been brought up at the GMC hearing.  I am sure the GMC would have loved to say that Wakefield committed fraud in addition to acting dishonestly and irresponsibly.

Which brings me to my real question - why did the BMJ pay Brian Deer to write yet another attack on Wakefield?

I could see a journal like the BMJ publishing a review written by researchers or doctors but I don't understand bringing in a journalist to write the piece - especially Brian Deer.  He is not what you would call an unbiased party.  Published papers are supposed to be unbiased, factual affairs - not the same sort of sensationalism that you would find in the Sunday paper.  But if you read the article it looks like something you would see in the newspaper, attempts at footnoting notwithstanding.

As a side note, I have to wonder if this is the first time that the BMJ has published a "peer-reviewed" article, like this one is supposed to be, that cited newspaper articles as an authority.  Articles which were also written by Brian Deer, I might add.  Since the newspaper articles were used to support the claims of the article, were the referenced articles peer reviewed as well?  And how exactly does citing your own newspaper article work?  As you can see, I said the exact same thing over there, and my peer, the editor, agreed with me, therefore it must be true....

One of the other things that really bothers me about this article is that Brian Deer appears to have the medical records of the children from the Wakefield study (he basically said as much last year).  It is one thing for him to have these records - presumably without the consent of the children's parents - that fact alone is bad enough (and possibly illegal, at least in the US).  It is something altogether different if those records were used to publish an article in the BMJ without the proper consent.  That would be a major problem for the journal as well - especially if the journal itself was the one that commissioned and paid for the article.

Which brings me to the next problem, the matter of payment.  Brian Deer said to CNN that he was paid to write this article -
On CNN's "American Morning" Thursday, Deer did not deny he was paid by the BMJ. "I was commissioned by BMJ to write the piece," he said. "That's what journalists do."
And yet, if you look in the competing interests section from the article it makes no mention of this fact -
Competing interests: The author has completed the unified competing interest form at www.icmje.org/coi_disclosure.pdf (available on request from him) and declares no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years
He claims to have not received any support from any organization for the article.  I would consider being paid for writing the article a form of support.  The only hint that in either the editorial or the article that Deer might have been paid is under the competing interest section of the article where it says -
Provenance and peer review: Commissioned; externally peer reviewed.
But that one word is a poor substitute for a real disclaimer.  If Brian Deer was paid to write these articles then he should have disclosed that fact appropriately.  His failure to do so is especially ironic considering that the failing to disclose relevant financial information was one of Wakefield's sins.

As I said above, I really have to wonder why these articles were written.  All of these things about Wakfield have been said before - mostly by Brian Deer - and there is nothing new here except the forum.  I don't believe in conspiracy theories but I can't that I can think of any reason why this newspaper article was publish in the BMJ.  It just doesn't make any sense.


  1. I'm guessing from your perplexity, you are not British.

    We're still struggling to get the vaccination rates back up, and in some parts of London, the battle appears to be being lost.

    The man's considered an absolute public health menace. Typhoid Mary for the 21st century.

    It's time to put away the DBPCT and peer review and lynch the muppet.

    (It's a bonding thing)

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  3. Socrates, are you saying that dishonest accusations, improperly documented, based on illegally obtained private medical records is the right way to deal with parental distrust of authority?

    Somehow I doubt that this approach will reassure parents who have doubts about the honesty of the government, the doctors and the pharmaceutical companies.

    But to each his own...

  4. There appears to be nothing questionable going on with Deer's access to the records. He openly says how he got access (and I'm glad he did get access):

    "It was not merely medically confidential, it was also legally protected: a double screen against public scrutiny. But responding to my first MMR reports, in the Sunday Times in February 2004, the GMC decided to investigate the cases and requisitioned the children’s records.

    The regulator’s main focus was whether the research was ethical. Mine was whether it was true. So as a five member disciplinary panel trawled through the records, with five Queen’s counsel and three defendant doctors, I compared them with what was published in the journal...

    ..when the details were dissected before the GMC panel, multiple discrepancies emerged."

  5. I did read that part, I am just not sure that I completely buy it. As Brian Deer said almost a year ago -

    "I know the names and family backgrounds of all 12 of the children enrolled in the study, including the child enrolled from the United States. I don't believe that Dr Yazbak has a family relationship with any of them."


    And he wrote an article containing details about the medical histories of the children a year before that.


    I didn't line up all of the timelines from the most recent article with the GMC hearings - where he claims to have gotten the details - with the stories that he has published, but I think there is sufficient reason to believe that he has access to some confidential information.

  6. Deer had the names and private info about the children up on his website in early 2006.


  7. Minority,

    I can't believe that Deer actually published the names of minors om his web site. And, as you say, he at least had (and again published) the dates that they were admitted to a hospital.

    I wonder were he got that information, it certainly wasn't the GMC hearings.

    I think my opinion of Deer just went down another notch.

  8. Just as a note, if you look at a current post on LBRB, it seems to agree that Deer had access to the medical records outside of the GMC -

    "It was during this period that Mr. Deer became more convinced that the Lancet article “could not be rationally explained”. Since the information was clinically confidential information at the time, Mr. Deer could not take the information into the public domain. This changed with the GMC hearings and, especially the hearing transcript hearings"


  9. I challenge anyone who hates Wakefield like some kind of comic book villain to check if they know the answers to these questions:

    Wakefield's legal money (the reason the paper got pulled) was donated to which paper?

    What are the tests that should be performed on people with chronic gut conditions?

    Is the current MMR the same one that was being used when Wakefeild's case study came out?
    O.K. that answer was too easy - how about why was that first MMR vaccine replaced with a more expensive one - or more importantly why was it not replaced sooner.

    How can you say subsequent studies - when you are no longer studying the same thing?

    For what misdemeanour did Wakefield lose his licence - even though he had full parental consent. And in what universe does that deserve being struck off for?

    In what universe does calling for more testing constitute a sin? If I'd had more information I might have continued vaccinating my kids on a limited schedule. As it was - one bad reaction - and no data - and I just stopped for ages - they still only have dip tet. And I have never regretted that decision. But my heart almost stopped when a boy who walked a year before was in a wheelchair - and I asked him why. MeNZB vaccine.

    And all the pro vaccinators are going to say that's just unlucky, there's a cost/benefit to everything. Which is my point, and Wakefield's point, and the SCIENTIFIC point, let's actually do the studies and find out so that we can make properly informed decisions because right now the Sharks are in the paddling pool - and they either killed a wicked old man or a lifeguard - take your pick.

  10. The seeming over concern (by those alleging conflict of interest) about a law suit against the government (instead of the vaccine manufacturer as Dr. Wakefield had assumed) well before any law suit was going forward only makes sense in the context that they had knowledge of the Urabe vaccine deal and the liability the government had taken on to make it possible to use the vaccine and were already assuming the government would be the one in trouble. It's not hard to understand that this whole thing has been about protecting the interests of the vaccine makers and the "government" personnel (i.e., corporate bought and paid for public servants) who allowed this deal to go through. As they say, follow the money.
    I'm not going to assume Dr. Wakefield is correct (that's for research to determine) but something about this whole situation really stinks. This should have been settled as an academic debate; not with a journalistic "hit man" who didn't argue any real science, used language not appropriate to a medical journal to bias the reader, turned a fairly conventional business deal from a possible scientific discovery into a conspiracy, etc.
    BTW, I'm not anti-vaccine but I do have concerns about their safety, the lack of research done on the potential long term effects of vaccines, the lack of study regarding how vaccine affects those with compromised immune systems (I had a very bad reaction to a hepatitis B vaccine that worsened a pre-existing condition; no one ever tells you that you could potentially have problems if your immune system is already compromised) and regards autism, the poor level of evidence that many studies purporting to falsify the vaccine/autism link put forward to refute any connections (i.e., correlative epidemiological studies which only look at possible temporally related, direct reactions to vaccines and do not give credence alternative possibilities such as the theory that micro-glial damage and immune damage could be accumulating with multiple vaccines and and the initial symptoms of autism may not always coincide with a specific vaccination; they really should be doing much more than correlative studies in an effort to disprove the vaccine/autism hypothesis.)

    For more about the overall context of what is going on with science in the UK, see below:

    "Keep Scientists in Cages" http://lecanardnoir.posterous.com/keep-scientists-in-cages-the-new-wonderful-qu

    "New Labour, the market state, and the end of welfare" http://www.lwbooks.co.uk/journals/articles/rutherford07.html

    P.S., I find it fascinating that all of these people accusing Dr. Wakefield of having conflicts of interest are all somehow connected to GSK. If Dr. Wakefield was planning on producing a vaccine (and as I stated above, that would be par for the course and expected; not some conspiracy theory) then one has to wonder if that vaccine might be competition for the GSK vaccine? If that's the case, then couldn't it actually be argued that the real conflict of interest is in how GSK and loyal vested parties are trying squash a competitor and not just someone they consider to be wrong? A much smaller and less powerful competitor than GSK and the large number of people in positions of power that are supporting the vaccine manufacturer? He would have been insane not to patent the research (as all do with research such as this or the researcher risks getting scooped) and the idea that the patent provides “proof” is at the level of an asinine conspiracy theorist.

    Carry on!

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  15. Looking at the BMJ article:
    I noticed that the guy who started the proceedings, Mark Pepys, has received large amounts of funding from Glaxo Smith Kline; the company making the vaccine implicated (with excessive meningitis cases and the possible autism connection.)
    I also noticed that there are many, many unsupported and un-documented statements by Brian Deer that appear speculative at best.
    I also noticed that much of the language Deer uses is inflammatory and rhetorical; words such as "scheme" regarding the company “Carmel” that was planned (when at best it can be said that what happened with the foundation of this company so as to possibly produce a safer vaccine--i.e., looking to profit from your discovery--is what every research doctor does nowadays; for this NOT to have happened would be unusual; especially in the UK. In fact, I would guess that he would have been pushed or even required by his parent organization--Royal Free--to develop profitable outcomes from the research. If anyone thinks this set up is unusual then you really don't have a clue about current medical research practices. There is a reason that the CDC has been getting into trouble for having way too many cozy relationships to industry and many individual researchers are getting large grants from drug and vaccine manufacturers.) Language is important and the words used to describe something can completely alter the context of a discussion and influence how people think about what they are reading. The kinds of statements and language that Deer uses are not appropriate for a scientific debate.
    I also noticed the unusual step of publishing a journalistic article to refute a medical science finding instead of an academic article by research peers with specific evidence.
    I also notice that much of what Deer writes about is in essence nit-picking (especially when it comes to patient histories which are often dependent on patient/guardian memories and can vary or there can be discrepancies that occur with multiple authors and researchers.)
    I also notice that there is a climate in Britain in which the New Labour government has privatized a massive portion of their public services and is taking massive donations from very wealthy people in return for influence. Can you imagine having an insurance company like UNUM Provident (which CA state Insurance Commisioner John Garimendi referred to as an "outlaw company") and other comparable organizations taking over social security and disability public policy in the UK and completely redefining the meaning of what is mean to be sick or disabled so that they can push large numbers of people into the workforce, many of whom actually are far too disabled to work, using assessments inappropriate for many disabilities (and private companies get to profit from potentially ruining people's healths and, unlike government agencies and personnel who have no direct financial stake in what occurs with a disabled patient, they will have all the incentive to game the system.) That is exactly what they have done in the UK. Seems crazy but it's true and there is a great deal of documentation to support this.

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  17. Socrates,
    So you are laying the blame at Wakefield's feet? Have you thought that perhaps instead of doing absolutely nothing for years and just hoping that the issue would "go away", the government of the UK could have bothered to try to replicate the research in a timely manner so that the confusion regarding safety could have been avoided and there would not have been an affect on rates of vaccination? Wakefield found a potential link between autism and a vaccine and called for further research that would establish the case one way or the other; this was not done. It's up the the government to take up the issue if it's a potential public health issue instead of doing nothing for years, and not replicating the finding, and then attacking a researcher without basis (still without study replication.)

  18. Synapse - I absolutely agree.

    viva la science - ask the questions and then find the answers.