One of the strangest parts of the story of Dr. Wakefield’s research is the birthday party where blood was drawn from his child’s friends who were given five pounds each.
Dateline NBC included this in their recent story, A Dose of Controversy. Here are two clips from that show, spliced together:
The first thing that struck me was the explanation of the money. If I understand Dr. Wakefield correctly, he didn’t “pay” the children, they were “rewarded” at the end of the party. That makes it a different situation “in ethical terms”.
I’d like to have one of the kids at the party explain the ethical differences, as I am confused.
I guess if the kids gave the blood of their own free will, and only later the were “rewarded”…they didn’t know they would get money…in that case the money wasn’t an incentive or a coercion? Is that what is being said?
If so,I am further confused by this quote attributed to Dr. Wakefield:
Again for those who’ve heard the story, you can put your hands over and you can take time out here, but this is again my son’s birthday party, 32 healthy controls. And you line them up – with parental informed consent, of course. They all get paid £5, which doesn’t translate into many dollars I’m afraid.
So, were they were paid? I thought we just heard that they were “rewarded”, which is different in an ethical sense.
And, what about that “at the end of the party” statement? Again, a quote attributed to Dr. Wakefield:
“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. 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.
Is it important that the children were rewarded at the end of the party? My guess is that makes it less of a coercion. But, that little girl got her money right away, didn’t she?
I guess if she was the last child to have blood drawn, and this was the end of the party, this could fit in with Dr. Wakefield’s description of “end of the party.” Possible, I guess, but that is not how I saw this playing out when I first read that quote.
Sorry to switch back on you, but I am still trying to reconcile “reward” vs payment. Consider this statement attributed to Dr. Wakefield:
“And (NAME) burst into tears. Ruined his birthday party. But people said to me, Andrew, look, you know, you can’t do this, people, children won’t come back to you. [laughter]. I said you’re wrong, I said: ‘Listen, we live in a market economy. Next year they’ll want ten pounds!'”
I am having trouble figuring out how to reconcile “rewards” with “a market economy” and the children wanting a higher amount the next time.
I gather that at least part of the problem Dr. Wakefield is facing is that blood is not bought or sold in the UK (at least, there is a statement to this effect on Brian Deer’s website). As a U.S. citizen, I am used to the idea that blood is bought and sold. Paying people for blood is still a bit strange to me, but not unheard of. But from my perspective, I would have greater respect for Dr. Wakefield if he had just said (assuming it is true) that he had made a mistake.
Just in case Dr. Wakefield’s comments in print seem a bit too surreal to be true, Here is a video with a bit more of Dr. Wakefield discussing the birthday party:
note–I made a number of clarifications after this post was published.
Left Brain Right Brain 
Hi Kev
I agree Dr Wakefield made a mistake and I believe everyone realises that.
He will get disciplined for this.
But what is the big deal?
Teachers with no medical experience, routinely drew blood often I imagine with inadequate equipment in biology class.
A practice later abandoned in schools.
No way do I think it is possible for Dr Wakefield to cause harm with his credentials.
It is a mistake.
But he did and still does important work on finding causes for autism. Just because this goes against Government and industry policies is no reason to conduct a campaign to search and destroy him beginning more than 5 years after this incident.
A person who dies from a vaccine has no legal recourse (relatives) after 3 years.
When asked about a conspiracy to imprison the entire British Cabinet the then Prime Minister said that was ten years ago and is history.
It appears minor misdemeanours create feuds that may like terrorism continue for the next thousand years perhaps?
Mad as a Hatter I call it.
john fryer-
the practice of taking blood in schools was indeed banned in the 1980’s- but this was done by fingerprick- not venopuncture. It was also something that was performed on sixth-form (16+) students- not small children.
It is also highly unethical to take blood blood outside of a clinical protocol. As a scientist who had a very good understanding of the clinical regulations and the Declaration of Helsinki he would have completely understood this and realised what he was doing. In 2006 the GCP regulations were made into law, If he did this again in the UK it would be an offence punishable by large fines, or even a prison sentence.
This is not a minor misdemeanour- this is a serious breach of ethics that quite rightly being punished.
The rest of your comment is just conspiracy drivel- the government does not need to campaign to saerch and destroy him- he has managed to do that by creating a mass panic based on lies, deceit and the harming of children for personal profit.
Then, of course, there was his presentation: where he had everyone in hysterical laughter over children crying, fainting and vomiting; and where, as the BMJ later noted of his evidence, he later said that he was lying about this.
So, in addition to the abuse of children, we have Wakefield lying to a group of parents, who appeared to find the experience deeply satisfying.
All in all, very revealing.
@john fryer, Wakefield has not identified a single cause of autism, not one. What he did was not only grotesque but in such obvious violation of ethics regarding study subjects and approval that there is simply no excuse for what he did. Furthermore, who are these parents that would consent to such a thing at a child’s birthday party?
Science Mom,
to add to your statement. Last I looked, Dr. Wakefield hadn’t had a published paper since 2007. Even with that, his papers are basically defending his positions from 10 years ago and not novel.
And, from what the stats tell us, we’re probably approaching the time (if it hasn’t already happened) when we see an autistic child severely injured at Thoughtful House, and when Wakefield, Krigsman, and all the fancy people on their board, get sued to their shorts when the parents’ lawyers find out that constipation is not an indication for colonoscopy.
I think the birthday party tells us a lot, and will return to haunt Wakefield for a long time to come.
If half of what Brian Deer has reported is true, the birthday party story will be analogous to getting a ticket for wreckless driving after leaving a crime scene.
Dr. Wakefield’s story seems to have changed about the birthday party. I’ve noted that in the post above (see how easy that is?)
There were other statements from Dr. Wakefield on the Dateline episode that are worth exploring. I’ll explore one more tomorrow.
Wakefield was joking in those quotes. It was a stupid clip NBC showed, if they had to show that they should have shown Brian Deer outside the GMC yapping at parents of children with regressive autism and inflammatory bowel disease that their kids don’t really have inflammatory bowel disease.
Jake Crosby,
I’ve noted that in the post above now. To repeat myself–see how easy it is to make a correction?
It’s sort of difficult position one is in when one has as his defense that he was joking about a breach of medical ethics.
Did the person who drew blood at the birthday party testify at the GMC to back him up, or are we left with merely two stories from Dr. Wakefield?
It’s not a difficult position at all, unless joking is a breach of medical ethics, too. If it is I don’t see why Britain doesn’t just have a thought police.
And since the burden of proof is on the prosecution, has the person who had taken the blood, or anyone else involved at the birthday party for that matter, given testimony that contradicted those of the defendants?
I don’t believe that anyone else from that event has spoken. Does the GMC have the power to subpoena someone to talk? Somehow, I’d think Dr. Wakefield would be pushing his friends to testify on his behalf.
Take him at his (current) word. It appears to this reader that he didn’t even know what the medical ethics of the situation were.
I missed the part in the MIND talk where Dr. Wakefield says, “Of course you all know, this is a joke”. Best case scenario for Dr. Wakefield, he lied at the MIND institute lecture. That’s the best case.
Check in tomorrow. I’m interested in your views on that post.
Jake,
You miss the point, so adamant are you in your need to defend Wakefield. Either he did draw the blood, which is unethical, or he lied and joked about it, which goes to his character and integrity or potential lack thereof.
Kwombles,
I think Jake Crosby is also missing out on the bigger picture: this is pretty much the least of Dr. Wakfield’s worries.
If I were in Dr. Wakefield’s situation, rather than say, “Well, you have the burden of proof” I would be saying, “here’s a great example of why you can take me at my word”. That would help a lot with the other, much more serious, charges.
But, what do I know. I’ve never published a discredited study and been called before the GMC.
Symball,
I do think we often get lost in the “did he pay/did he not pay” question. I don’t really understand the ethics of this–it is just strange to me. Very strange.
Aside from the ethics issues, it speaks to a very amateur approach to research. Dr. Wakefield wasn’t the first person to draw blood for a research project (to put it mildly).
Dr. Wakefield presents this in the interview presents it as though there weren’t established methods in place to obtain blood samples for research.
One of the biggest questions in Dr. Wakefield’s research was whether he was operating outside of protocol. In specific, was he collecting research samples from the children under the guise of treatment?
Even taking Dr. Wakefield at his current word on the birthday story, this demonstrates that he was doing research outside of a defined protocol.
I think it is worth considering what the charges are in relation to the birthday party:
The renumeration is only 1 of three parts of the charge for this event.
It’s not a difficult position at all, unless joking is a breach of medical ethics, too.
Ah, yes. This is a favorite tactic of apologists for Scientology, too – when confronted by iron-clad evidence that one of their idols has said or done something shockingly stupid/reprehensible, they purport to believe that the person was “only joking”.
‘Birthday Parties’ Wakefield style, definitely takes on new meaning. While the rest of us are providing the old bouncy castle, majician, and balloon sculpted animals, they lay on a phlebotonist dressed up as a clown (or was it a clown dressed up as a phlebotonist).(before I’m corrected on this, I’d better point out that I’m joking). To say that the entire business is bizarre is a serious understatement from the outset, when a family hosting a childrens birthday party think it appropriate to ask their guests to provide a sample of blood,to the parents of those children consenting to the procedure in that environment, to the giving and receiving of rewards for the said samples and the entire process later being used by the host, in poor taste and total lack of insight and sensitivity, to generate cheap laughs in his lecture where the attendees rather than share in the horror expressed by most on hearing of the birthday party antics, roll around in laughter.
Setting aside the horror and disbelief this episode generates within most of us, there is a far greater issue regarding the ethics and procedural correctness of taking samples from healthy volunteer subjects for the purposes of research at a birthday party.Although the Wakefield party entertainment is entirely unnaceptable creating sheer disbelief in many of us, if not totally unethical, the practice of obtaining control samples from healthy child volunteers for research is by no means unique.
The use of “Buddy controls” whereby healthy volunteer children matched in sex and age to that of litigant children were asked to supply blood and urine samples was also advocated by the solicitors representing the children in the MMR litigation. Letters were sent out by Alexander Harris, one of the group of solicitors representing the chldren in the MMR litigation to parents in 2002 requesting that we source a “buddy friend” for our children who were “not diagnosed with any developmental delay” and who had had the MMR vaccine, from other family members or neighbours for the purposes of providing samples of blood and urine. I understand from parents who did manage to get neighbours kids etc to participate, that a nurse called at their homes to obtain the samples.There is no suggestion that this coincided with any birthday parties but there remains the question of whether or not these children were given “rewards” for supplying samples of their urine and blood or if this was exclusive to the Wakefield party attendees. Were this to be the case, given the sheer number of litigants with “buddies”, the expenditure could have been quite considerable for the Legal Services Commission who funded the litigation and whose agreement would have been necessary upfront for the proposed expediture . As a result of the many posts on this topic, I’m now questioning where was the Ethics Committee approval for the taking of samples from healthy “Buddy Controls” in their own homes, advocated by the solicitors for the purpose of furthering research to support the MMR Litigation. Can anyone help or advise me on this matter?
Sully- I agree it is very strange, as a PI on the study he knew what performing this procedure on the kids would involve, and even worse he would know that any data generated could never be published. As for joking about what he had done.
Abuse of children in this way- you cannot have legal consent from the parent if the consent form has not gone through the ethics committee, should be a criminal offence, however the parents would have to complain before this could be looked into.
For a start: yes joking about something can be a breach of ethics, it depends what you’re joking about and who to. Example: Joking to a chronically ill patient that they don’t have to worry about Christmas anymore would be seen as offensive and quite likely to damage the therapeutic relationship and trust of the patient, and would likely be seen as a breach of many of paragraphs 21 to 32 of the Good Medical Practice (GMC 2006) guidance.
So yes, joking (inappropriately or offensively) can be a breach of medical ethics. It’s unlikely to be escalated beyond the local level, and unlikely to result in caution or dismissal, but it’s still a potential breach of ethics.
Anyway, convenience sampling is a widely used smapling method, yet it is usually only seen as appropriate if all the pertinent data can be collected, that is, if the method chosen poses little risk of not picking up on data that should have been included in the analysis. As Wakefield appears to have only the say-so of the parents that the children had no neurological or gustatory problems, the utility of conveniance or ‘buddy’ sampling may be methodolically unsound, even before we consider that it may have been extra-protocol, unlikely to have passed the board, and potentially medically unethical.
Jake Crosby,
You avoid the fact that Dr. Wakefield lied on Dateline. He chastises Brian Deer for having “a little knowledge” and says that the patent was for a treatment only. The patent was not for a treatment only. It also was a patent for a preventative vaccine.
Whether he has made this lie in the past isn’t really the point.
Do you have a statement from Richard Horton on that, or are you basing this on what Dr. Wakefield as asserted?
Dr. Horton has stated:
that doesn’t sound like “So not even the editor of The Lancet found it to be a sufficient enough conflict of interest to publish” at all.
What the joking presentations about the party really offer, methinks, is an insight into Wakefield. It looks like the “Saint Andy” one-man show, pure and simple – it is all about him. The love and approval from the audience of his groupies is the validation.
I doubt that any sense of how such a performance (the speech, not the party) might come over as rather inappropriate in a medical/ethical context would get a look-in ranked against that.
This chimes with the prevailing view of Wakefield in science as a glory-hunter and corner-cutter who was not going to let inconvenient data (or lack of it) get in the way of his determination to be famous.
Some of the comments on here are brilliant, Sullivan especially hits the nail on the head.
I am a final year medical student, I have taken blood from numerous patients as part of my training. In an appropriate setting, for the right clinical reasons and with the patient’s consent. The idea of taking blood at a birthday party from children is just completely absurd. The money thing makes it even more so. Don’t even get me started on Wakefield’s comments after that.
Doctors do things in a patient’s best interests within the bounds of an ethical framework. He stepped so far over the line that I don’t think he even has a clue where it is. This is not how research should be carried out and it really concerns me that certain posters on here think that is an acceptible thing to do!
Make no mistake. A doctor who hosted a children’s party with the intent to obtain blood from the guests would be found guilty of serious professional misconduct.
The GMC’s charges:
The Birthday Party
‘42. a. On a date unknown prior to 20 March 1999 at your son’s birthday party you,
i. took blood from a group of children to use for research purposes,
ii. paid those children who gave blood £5 each for doing so,
b. On 20 March 1999 you gave a presentation to the
MIND Institute, in California, USA in the course of which you,
Admitted and found proved to the words ‘California, USA’
i. described the incident referred to in 42.a. above in humorous terms,
ii. expressed an intention to obtain research samples in similar circumstances in the future;
‘43. a. Your conduct as set out in paragraph 42.a. above was unethical in that,
i. you did not have ethics committee approval for your actions,
ii. you took blood from children in an inappropriate social setting,
iii. you offered financial inducement to children in order to obtain blood samples,
iv. you showed a callous disregard for the distress and pain that you knew or ought to have known the children involved might suffer,
v. in the circumstances you abused your position of trust as a medical practitioner,
b. Your conduct set out in paragraph 42.b. was such as to bring the medical profession into disrepute;’
If anyone is left in any doubt as to the unethical practice of drawing blood from a group children attending a birthday party for the purposes of furthering research, they can read up on the subject of medical research which involves children in this paper.
“Guidelines for the ethical conduct of medical research involving children” (Royal college of Paediatrics and Child Health : ethics Advisory Committee) Arch Dis Child 2000; 82:177-182,
where it is said ” We believe that research in which children are submitted to more than minimal risk with only slight, uncertain or no benefit to themselves deserves serious ethical consideration. The most common example of such research involves blood sampling”