Issue 16 / 9 May 2011

EVER wondered what happened to Andrew Wakefield, the discredited doctor whose claims of a link between the MMR vaccine and autism led to a slump in immunisation rates around the world?

Well, he’s alive and well and still winning over audiences in Texas, according to this story in the New York Times magazine.

Journalist Susan Dominus paints a picture of self-deception, grandiosity and paranoia, of a once respected doctor who has gone so far out on a scientific limb that he can no longer afford to consider the possibility he might have been wrong.

It’s an impressive insight into the man and the power he continues to wield over his followers, many of them parents of children with autism who are desperate for answers.

But writing about vaccination is a fraught business, as every health reporter knows.

Journalists have come to expect attacks from those at the nuttier fringes of the anti-vaccine movement, but Dominus’ article provoked a wave of online criticism from supporters of immunisation too.

Hackles were raised by the headline’s description of Wakefield as an “autism guru” — unfortunate perhaps, but hardly Dominus’s fault since journalists don’t write their own headlines and often don’t even see the headlines until they are published.

In a thought-provoking critique, science journalist Paul Raeburn argued that the article should never have been written because the sympathetic portrayal of Wakefield would prompt some parents to refuse vaccination, leading to deaths and suffering in children.

At first, I wondered if Raeburn and I had read the same story since I thought Wakefield came across as having all the appeal of a snake oil salesman, but it’s true the article might have had a different impact on readers who knew less of the background.

Still, is it right to suggest we should not discuss some topics at all for fear of unintended consequences in less informed readers?

Dr Sue Ieraci argued in MJA InSight recently that supporters of immunisation need to avoid making extreme claims of their own and be open about efficacy and risks.

I think the same applies when it comes to writing about a character like Wakefield.

Yes, there’s a risk that such articles give him and his misguided views more oxygen, but we’d be foolish to think the whole thing will just go away if we ignore it.

Like it or not, Wakefield and his ilk have a following and the internet will always provide fertile ground for the spread of their scare-mongering.

That’s a battle that won’t go away, but good journalism, along with reasoned argument from medical experts, are among the weapons available to help us to keep fighting it.

Jane McCredie is a Sydney-based science and medicine writer.

Posted 9 May 2011

8 thoughts on “Jane McCredie: Fighting off medical ignorance

  1. Ronald Brett McCoy says:

    Thought provoking and well written assessment. That’s an interesting point about the (non) relationship of the journalist to the headline – one that I’m sure many people do not understand, and it has very important implications. Great point!

  2. Richard Middleton says:

    Let us not forget that this is the United States, where about 70% of all polled believe in angels, most know the names of all five Simpsons but few know the full wording of their Constitution!
    Unfortunately, poor educational standards leading to widespread ignorance provide fertile ground for shills to spread this sort of dangerous misinformation amongst the truly vulnerable and desperate.
    Are there not grounds for criminal charges against such people, if it is clear that their gospel can lead to reversals of public health programs and demonstrable harm?

  3. Donald says:

    Perhaps a good critical review of Wakefield’s scientific response to the media onslaught published in his new book “Callous Disregard” available through and posted on Amazon would go some way to understanding what he really said. I wonder how many journalists read the original Lancet publication let alone its conclusion?

  4. Rob Loblay says:

    Good one Jane!
    As a follower of the Wakefield saga since the original Lancet paper was first published, and having been involved in quite a bit of research into diet & GI symptoms in autistic children, I found Susan Dominus’ article an excellent and highly nuanced portrayal of this complex and multifaceted issue.
    By contrast, I thought Paul Raeburn’s criticisms were quite wide of the mark. If Dominus’ article had appeared in some sensationalist tabloid newspaper, the readers of which only look at the headline and first paragraph, it could arguably have left them with an overly sympathetic impression of Wakefield and his spurious vaccination concerns. However, having lived in NY and subscribed to the NYT for many years, I can vouch for the fact that its readers are much more discerning than Raeburn credits; they are more likely to have read the full article and to come away seeing Wakefield as well-meaning and self-deluded, but a snake oil salesman nonetheless.
    Whether or not readers of the NYT article decide to have their children vaccinated will be determined more by their prior beliefs than anything they read in the article. To her great credit, Dominus has avoided the common journalistic error of presenting both sides of a ‘debate’ as though they had equal merit in the misguided pursuit of ‘balance’.

  5. JennyH says:

    Medical publishing is split on the causes of autism. Some recent papers support gastrointestinal problems as a possible cause; some claim there could not possibly be a connection. Most of the comment here has been on one side. There is more to it! Here is a reference anyone can find via a PubMed search:
    “The strong correlation of gastrointestinal symptoms with autism severity indicates that children with more severe autism are likely to have more severe gastrointestinal symptoms and vice versa. It is possible that autism symptoms are exacerbated or even partially due to the underlying gastrointestinal problems.” Adams JB, Johansen LJ, Powell LD, Quig D, Rubin RA. “Gastrointestinal flora and gastrointestinal status in children with autism — comparisons to typical children and correlation with autism severity”. BMC Gastroenterol. 2011 Mar 16;11(1):22.
    Andrew Wakefield is not on his own. Maybe he was right, maybe he was wrong. We don’t have much unbiased information to go on. But maybe we have so blindly accepted the denigration of Wakefield that we can no longer consider the possibility that he, and others, might be right.
    So, what are the side effects for MMR vaccine? MIMS Manual lists gastrointestinal disorder, gastroenteritis, stomatitis, ahpthous stomatitis, colitis and encephalitis. That is what the vaccine manufacturers list as related, though possibly rare, occurrences. These are causes for concern. If current publishing and official reports are any indication, the jury is still out on whether “untreated gastrointestinal problems could be behind some of autism’s symptoms” or not.

  6. TS says:

    Perhaps Jenny H can give examples of untreated gastrointestinal disorders which lead to irreversible central nervous system dysfunction in the developing brain and a plausible explanation as to how the two may be connected. The authors of the study quoted issued a caution at the end saying that more carefully designed studies are needed .

  7. Anonymous says:

    The phrase “autism guru” in the heading of the article in the New York Times is indeed unfortunate. It is my understanding that newspaper headlines are generally written by sub-editors and not by the authors of the article. The headlines are often written to be provocative and grab people’s attention regardless of whether they accurately reflect the contents of the article. The Melbourne “Age” is planning to out-source sub-editing, which is likely to make this problem even worse.

  8. Rob Loblay says:

    @ JennyH. Thank you for drawing my attention to this interesting article about gastrointestinal problems in children with autism. It interested me for two reasons. The first was the overlooking of a major set of confounding factors that should have been obvious to anyone who has done research in this field, i.e. those relating to DIET. It is very common for children with autism to have extremely fussy eating habits related to the smell, taste, and even the colour of foods, and often their diets are quite bizarre. On top of this many families of autistic children exclude all wheat and dairy products in the belief that these foods might have a causal role in autism, based on some rather dodgy publications on urinary excretion of casomorphins and glutomorphins the results of which have been widely publicised over the past decade by support groups and via the internet. The worse the autistic behaviour, the more desperate the parents are, and the more things they dabble around with. Autistic children are also more often given probiotics for GI symptoms and antibiotics for these and other problems. In these circumstances it is hardly surprising to find a higher than usual prevalence of gastrointestinal symptoms and changes in gut flora in autistic children; nor is it surprising that these changes would correlate with the severity of the autism. Experience shows that appropriate dietary adjustment can improve GI symptoms, irritability and related behavioural disturbances in autistic children, but it does not fix the autism…. The second thing that was interesting about the article was its authorship. The first three authors are from the ‘School for Engineering of Matter, Transport, and Energy’ (Arizona State University) – a most unlikely centre of expertise in research on autism, gastroenterology and/or microbiology. It may be relevant to note that it’s quite common for the fathers of autistic children to be engineers, IT professionals, mathematicians, etc, and they often exhibit Asperger traits themselves… So sorry, Jenny, the article does NOT support a causal relationship between GI symptoms and autism, medical publishing is NOT “split” on the causes of autism, and Andrew Wakefield IS “on his own”!

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