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Peter Attia MD#158-Brian Deer: A tale of scientific fraud—Andrew Wakefield & the belief that vaccines cause autism
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CHAPTERS
- 0:02 – 5:15
Vaccines and autism belief, and Wakefield's early career
Peter Attia opens by asking how widespread the belief is that vaccines cause autism. Brian Deer explains that the idea arose in the late 1990s and describes his struggle to portray Andrew Wakefield sympathetically in the early part of the story. Wakefield trained as a surgeon, moved to research, and showed a fanatical fixation on proving an infectious agent caused a disease.
- •Surveys show many people hold the view that vaccines cause autism, more so in North America than the UK
- •The idea that vaccines cause autism arose in the late 1990s
- •Deer tried to give Wakefield the benefit of the doubt in his early years
- •Wakefield left surgery for research for reasons never fully explained
- •He showed an early obsession with proving a particular infectious agent caused a particular disease
- 5:15 – 11:48
Wakefield's pub "eureka" moment: measles virus and Crohn's disease
Deer recounts the story Wakefield told of conceiving his theory in a Toronto pub, wanting to find the cause of Crohn's disease. After moving to the Royal Free in London, he read about measles in a virology encyclopedia and concluded that measles virus caused Crohn's disease.
- •Wakefield wanted the cause of Crohn's disease rather than a career removing gut
- •He proposed an infectious agent affecting the blood supply to the gut, with AIDS as a backdrop
- •He read a paragraph on measles virus in the gut in Fields Virology
- •He equated Koplik spots with bowel lesions and declared measles the cause
- •Deer notes that acute measles can be found everywhere in the body, so the finding was unsurprising
- 11:48 – 19:50
Science means trying to prove yourself wrong
Attia and Deer discuss the scientific method, noting that courage in science means trying to refute your own hypothesis. They criticize Wakefield's reliance on the word "consistent" and his dismissal of contrary PCR results as insufficiently sensitive, even though he claimed to see the virus by immunohistochemistry.
- •Deer says courage in science lies in trying to prove yourself wrong, and Wakefield never doubted himself
- •Attia says medical school teaches facts, not the scientific method, which is learned in a lab
- •"Consistent" is a weak word that can link any two things
- •Wakefield claimed PCR wasn't sensitive enough, which made biology students laugh
- •Attia likens it to seeing the moon's details by eye but not through a telescope
- 19:50 – 27:51
Scientific reaction before 1998
Attia asks how the scientific community viewed Wakefield's measles work before 1998. Deer says it was a small specialist field. Some thought Wakefield incompetent, one professor thought his work fraudulent, and doctors were generally reluctant to conclude dishonesty rather than error.
- •The 1993 paper used immunohistochemistry, and a Japanese group's PCR work in 1995 could not replicate it
- •Gastroenterology is a small field where few people watched Wakefield closely
- •Some thought he used inappropriate controls, and Professor Tom McDonald believed the work was fraudulent
- •Professionals are reluctant to conclude someone is dishonest rather than wrong
- •The community moved on despite strong contrary evidence from multiple centers
- 27:51 – 45:33
From Crohn's disease to MMR and autism: the lawyer and the Legal Aid grant
Attia introduces the 1998 Lancet paper. Deer explains how criticism that Crohn's was rising as measles declined led Wakefield to blame vaccines. Solicitor Richard Barr, seeking an expert for a case against MMR, hired him, and together with campaigner Jackie Fletcher they got Legal Aid funding before any child had been investigated.
- •Wakefield extended his hypothesis to vaccines causing Crohn's disease
- •Richard Barr, a provincial solicitor, hired him in early 1996 at generous rates
- •Wakefield knew nothing about autism or vaccines
- •Autism was a newly emerging diagnostic category, which helped explain why it was chosen
- •Jackie Fletcher recruited clients through her group JABS
- •The June 1996 grant application promised a new syndrome before any child was seen
- 45:33 – 49:39
The 1998 Lancet paper and how the children were recruited
Deer describes the paper's prestige, the press conference and media blitz, and defends the case series as a legitimate form. He explains that he went behind the paper to the patients' records. The parents reported onset within 14 days of MMR, and Deer says the children were in fact pre-selected from families alleging vaccine injury.
- •The Lancet is described as the number two general medicine journal
- •A 12-child case series is not inherently improper, as Crohn's, autism and AIDS were first described that way
- •The paper said an ethics review board approved the work, which Deer says was a lie
- •Deer says a paper is not the study and he investigated the real patients and histories
- •The hospital promoted the findings with a press conference and extra phone lines
- 49:39 – 57:24
What the children endured at the Royal Free
Attia and Deer describe the invasive procedures the children underwent after traveling long distances. They also discuss the normal blood tests that did not justify colonoscopy, and why Wakefield wanted samples from the ileum to find measles virus.
- •The children were brought in on Sundays from places as far as Jersey and California
- •They underwent bowel prep, ileocolonoscopy, endoscopy, lumbar puncture, MRI, EEG and barium meals
- •Blood tests needed several people to hold the children down
- •Blood tests came back normal, yet the procedures went ahead
- •Wakefield sought measles virus in the ileum, where Crohn's is most characteristic
- 57:24 – 1:08:44
PCR failure and the missing strain-specific sequencing
Wakefield's own lab used PCR and found no measles virus, and he again said PCR wasn't sensitive enough. Deer and Attia explain that his grant application promised strain-specific sequencing, which distinguishes natural, laboratory and vaccine strains. Deer stresses that Wakefield was advancing a hypothesis, not testing it.
- •A PhD student prepared tissue for PCR and found no measles virus in the children
- •Wakefield had promised strain-specific PCR sequencing in his grant application
- •Sequencing could tell natural, laboratory and vaccine strains apart
- •Attia likens immunohistochemistry to seeing a person and PCR to fingerprinting them
- •The grant was authorized by a young lawyer with no scientific advice
- 1:08:44 – 1:20:05
A PCR primer: how amplification works
Before turning to O'Leary's lab, Deer and Attia explain how PCR works, covering polymerase, heating and cooling cycles, primers and probes, and the roughly 35-cycle limit. They discuss why it is sensitive, prone to contamination, and better at ruling infection out than in, drawing on coronavirus testing.
- •Taq polymerase, found in Yellowstone, copies DNA through repeated heat cycles
- •RNA viruses like measles first need conversion to cDNA
- •Primers and probes mark and detect the target, and a curve flattens around 35 cycles
- •Signals after 35 cycles are probably contamination or error
- •Clinical PCR is better at negative than positive predictive value, as seen with COVID testing
- 1:20:05 – 1:33:18
O'Leary's lab: no sequences and a manufactured belief
Deer says John O'Leary reported measles virus in about nine of ten children but never produced sequence data to show where it came from. The lawsuit collapsed without that data. Deer argues that the Wakefield and O'Leary papers together manufactured the belief that MMR causes autism, and that affected parents form the backbone of the anti-vaccine movement.
- •O'Leary, in a business arrangement with Wakefield, reported measles in nearly all the samples
- •No sequence data from the children was ever produced, despite his having a sequencer
- •The lawsuit consumed roughly $100 million and collapsed
- •The children were pre-selected from families alleging vaccine injury, which was not disclosed
- •The anti-vaccine infrastructure of parents later turned to the coronavirus
- 1:33:18 – 1:44:30
Formalin samples and altered PCR data
Attia asks about the formalin-fixed samples. Deer and Attia explain that formalin-fixed tissue should need more PCR cycles than frozen tissue, yet the defense expert found the same number of cycles for both. The expert, Steve Bustin, also found wells whose reported results appeared manually altered.
- •Formalin degrades nucleic acid, so fixed tissue should need more cycles than frozen
- •The pharmaceutical industry's PCR expert found equal cycle counts, implying contamination after fixing
- •The only explanation is that the virus did not come from the children
- •Bustin found wells reported as positive were submitted as empty, and empty wells reported positive
- •Attia and Deer compare the behavior to corporate fraud such as Enron and Volkswagen
- 1:44:30 – 1:50:28
Misrepresented medical records, retraction and lawsuits
Deer explains that records he read under a court order showed none of the 12 cases were accurately reported in the paper. Onset times, diagnoses and pathology findings were changed. A 217-day medical board hearing led to Wakefield losing his license and The Lancet retracting the paper.
- •Wakefield sued Deer and Channel 4, then abandoned the case while Deer read the records
- •Not one of the 12 children's cases was accurately reported in the paper
- •Developmental problems preceded vaccination in some, and onset was months later in others
- •Some children reported as autistic had no autism diagnosis, and normal pathology was described as bowel disease
- •The hearing lasted 217 days, Wakefield lost his license and the paper was retracted
- 1:50:28 – 2:04:24
Wakefield's return, the CDC whistleblower claim, and closing reflections
Deer touches on Wakefield's comeback and his false claim about a CDC whistleblower. He says Wakefield would never face a hard interview, then responds to a New England Journal of Medicine passage on anti-vaccinationists. Deer says the book is about how science can go wrong, and Attia ends on the harm to the children and parents.
- •Wakefield, written off after his ruin, returned with a false claim involving a CDC researcher
- •Deer says Wakefield would only speak to someone who won't ask difficult questions, and lies about his early lawsuit involvement
- •Deer agrees with the NEJM description but prefers to tell the story through real characters and facts
- •Deer's message is that if Wakefield could do this, others might be doing similar things in hospitals and laboratories
- •Attia calls the legacy of anxiety for parents the saddest outcome
