Brian Deer on Andrew Wakefield: Pathology reports solve “new bowel disease” riddle

10 Nov

Today the British Medical Journal (BMJ) released a four articles on Andrew Wakefield and his research efforts at the Royal Free Hospital. To sum up the four articles in a single sentence (from Fiona Godlee of the BMJ): “Previously unpublished histopathology grading sheets apparently completed by Amar Dhillon, the senior pathologist on the paper, remove any remaining credibility from the claim that the Royal Free doctors had discovered a new inflammatory bowel disease associated with MMR”

For those who may wish a bit of background, earlier this year, the BMJ had a series of articles on Mr. Wakefield’s research:

Secrets of the MMR scare: how the case against the MMR vaccine was fixed (Feature by Brian Deer)

Secrets of the MMR scare How the vaccine crisis was meant to make money (Feature by Brian Deer)

The Lancet’s two days to bury bad news (Feature by Brian Deer)

and

Wakefield’s article linking MMR vaccine and autism was fraudulent (editorial by Fiona Godlee of the BMJ)

These articles came after Mr. Deer was able to review the transcripts of Mr. Wakefield’s “Fitness to Practice” hearings held before the General Medical Council (GMC).

Mr. Wakefield’s work focused on gastrointestinal disease. He went so far as to claim to have found a new syndrome, which he coined autistic enterocolitis. 13 years later, there is still no proof such a condition actually exists. When evidence came forward that the discussion of the children in the Lancet did not match the clinical records, Mr. Wakefield claimed that ““Dr Dhillon’s diagnosis formed the basis for what was reported in the Lancet,” and “I played no part in the diagnostic process at all.” Unfortunately it has been difficult to verify these statements. For one, the slides made from the samples taken from the children in the Lancet study are apparently missing, so direct comparison of what was reported in the paper to what was actually found in the children was difficult. Also, Dr. Dhillon’s analyses were not available. Until now. The scoresheets used by Amar Dhillon, the pathologist coauthor on the 1998 Lancet article, were recently made available to the BMJ. These form the basis for the articles published today.

In his new BMJ article, Pathology reports solve “new bowel disease” riddle, Mr. Deer discusses the pathology reports. He compiled a table based on these reports (for example, the report from Child 1). If I can summarize Mr. Deer’s discussion: what is striking about these reports is that they are not striking. Dr. Dhillon used his own score method to rank the disease found in the specimens. In most cases, these were “normal” or “mild”.

Mr. Deer shared the reports with a number of professionals for comment. Including Dr. Henry Appleman:

“Most of this stuff is so close to normal that you’ve really got to question whether there is really anything there,” said Henry Appelman, professor of surgical pathology at the University of Michigan and a specialist in gastrointestinal disease. “These are the kind of things that we in our practise here would ignore completely.”

And Ingvar Bjarnason:

“Everyone thinks I am crazy even asking them,” said King’s gastroenterologist Bjarnason, after discussing the scorings with other specialists. “All but one of the children is normal in their eyes. There is no enteritis and no colitis, simple as that.”

While the reports were not striking, there is indication of inflammation. Mr. Deer argues that a key point was left out of the Lancet article, the presence of constipation in many of the children, which would have put the inflammation signs into better perspective for the readers:

No less controversial, the authors omitted from the paper the children’s principal gastroenterological problem. “Almost all” had “severe” constipation.(30) The GMC panel heard, for example, that after bowel preparation by nasogastric tube, the first patient, who had mild caecal cryptitis, endured two attempted ileocolonoscopies that failed because of faeces in the caecum, with “scope trauma” noted on the second.

This omission of constipation was no small matter. It went to the heart of how the paper would be read. Specialists told me that both mild inflammation and prominent lymphoid follicles may be expected to be associated with this sign.

(30) Murch S, Thomson M, Walker-Smith JA. Authors’ reply. Lancet 1998;351:908.

Mr. Deer, of course, is not a medical professional. But, we do not have to rely solely on Mr. Deer’s report. The BMJ has two companion pieces by medical professionals.

In Commentary: I see no convincing evidence of “enterocolitis,” “colitis,” or a “unique disease process”, Karel Geboes, Professor Doctor, Department of Pathology Univ Hospital KUleuven reports:

In general, the data are rather similar to the reports of the Royal Free hospital pathology service, which I reviewed for the BMJ last year.(7) Although minor abnormalities are noted in a minority of patients, I see no convincing evidence of “enterocolitis,” “colitis,” or a “unique disease process” being present in all patients. The Wakefield et al paper is obviously problematic and its wording does not reflect the data shown in the grading sheets.

(7) Deer B. Wakefield’s “autistic enterocolitis” under the microscope. BMJ 2010;340:c1127.

In Commentary: We came to an overwhelming and uniform opinion that these reports do not show colitis, Dr. Ingvar Bjarnason, professor of digestive diseases, consultant physician and gastroenterologist at King’s College, London, writes:

The hospital pathology service found the histopathology to be normal,(3) and, except in the case of the child mentioned above, the grading sheets also note normal findings. The fact that these scores were interpreted as abnormal raises, in my opinion, questions for the authors of Wakefield et al to answer, and particularly for the consultant histopathologists.

From the histological and endoscopic reports, there are no grounds to believe that any new inflammatory bowel disease may have been discovered, or any possible “unique disease process” observed, as reported by Wakefield et al. Nothing can be said about the aetiology of any minor irritations noted, and nothing can be inferred regarding treatment.

(3) Deer B. Wakefield’s “autistic enterocolitis” under the microscope. BMJ 2010;340:c1127.

In Institutional research misconduct, Failings over the MMR scare may need parliamentary inquiry, BMJ editor Fiona Godlee discusses how there is no sign that the Royal Free Hospital (University College London) has begun the expected inquiry into the misconduct which occurred there in the 1990’s:

It is now more than 18 months since the UK’s General Medical Council found Andrew Wakefield guilty of dishonesty and other serious professional misconduct(1) ; and it is nearly a year since the BMJ concluded that his now retracted Lancet paper linking the measles, mumps, and rubella (MMR) vaccine with autism and bowel disease was an “elaborate fraud.”(2) (3) At that time, January 2011, we called on Wakefield’s former employer, University College London (UCL), to establish an inquiry into the scandal. Ten months on, no inquiry has been announced.

Ironically, these data were made available to the BMJ with the intent of exhonerating Mr. Wakefield.

In 1997, Dhillon was asked to reassess intestinal biopsy specimens taken from children enrolled in Wakefield’s research after the hospital’s histopathology service, under consultant and fellow coauthor Susan Davies, reported most of the children’s biopsies to be normal. His 62 A4 grading sheets were sent to the BMJ by c, a self employed environmental microbiologist. Lewis says he was given them by Wakefield after they met at a vaccine safety conference in January. In his accompanying letter, Lewis concludes that a non-expert pathologist such as Wakefield could have thought they showed that the children had non-specific colitis.

Ms. Godlee is being kind, in my opinion, using the title the self-styled “vaccine safety” conference chose. This was the same conference in Jamaica which was discussed here at Left Brain/Right Brain recently.

It strikes me as rather odd that Mr. Wakefield did not provide these documents to the BMJ directly. Perhaps in a response to the articles published earlier this year. What advantage he gained in providing them through a proxy is unclear.

When he was found guilty of misconduct by the GMC, Mr. Wakefield vowed that he would not go away. So far, this appears true. However, his arguments are getting weaker as time goes on. In this case, they seem to have outright backfired. Writes Ms. Godlee:

The grading sheets are certainly interesting, but not for the reasons Lewis (or, it may be assumed, Wakefield, in giving them to him) intended. We sent them to two independent reviewers and supplied the data for comment to two further senior gastroenterologists. We also showed them to Brian Deer, the investigative journalist who over the past eight years has uncovered the secrets behind the MMR scare and who arguably knows more about this case than anyone apart from Wakefield. Our expert reviewers are in no doubt that Dhillon’s findings—like Davies’s before him—are almost all normal, or as near to normal that the changes they reported were likely to be physiological.(6) (7) In an accompanying feature article, Deer explains what they add to our knowledge of the Wakefield saga.(8)

(6) Geboes K. Commentary: I see no convincing evidence of “enterocolitis,” “colitis,” or a “unique disease process.” BMJ 2011;343:d6985.
(7) Bjarnason I. Commentary: We came to an overwhelming and uniform opinion that these reports do not show colitis. BMJ 2011;343:d6979.
(8) Deer B. Pathology reports solve “new bowel disease” riddle. BMJ 2011;343:d6823.

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11 Responses to “Brian Deer on Andrew Wakefield: Pathology reports solve “new bowel disease” riddle”

  1. MikeMa November 10, 2011 at 19:03 #

    Closes door on Wakers and his fraud nicely. No way for the rat to escape. Wakefield’s fraud inspired more danger to children and the immunocompromised than anyone else I know about. Sickness and death are at his feet and should be on his conscience.

  2. Brian Deer November 11, 2011 at 00:34 #

    In some ways the most amazing thing in the whole flurry at present is how the anti-vaxxers were able to buy this guy Lewis. They just lay on a drug-industry-style seminar in Jamaica, offered out a few freebies in in comes this guy panting for Wakefield.

    I feel sorry for Lewis really. He has spent what should have been the best days of his career caught up in some almost entirely incomprehensible dispute with the EPA, and I think it’s done something pretty bad to him.

    I’ll publish some of the documentation in the next few days if he persists in his nonsense. Meanwhile, this is the brief story

    http://www.bmj.com/rapid-response/2011/11/10/re-how-case-against-mmr-vaccine-was-fixed

    • Sullivan November 11, 2011 at 10:38 #

      If true to form, John Stone should pop in shortly with a ton of questions, followed shortly thereafter with complaints all over the internet that Brian Deer doesn’t respond to those questions (the implication being that Mr. Deer has something to hide).

      Not that this has become routine or anything.

  3. Science Mom November 11, 2011 at 02:16 #

    But a General Medical Council (GMC) panel considering the Wakefield case heard from Davies, now at Addenbrooke’s Hospital, Cambridge, that after challenging claims of “colitis” in the draft, she withdrew her objections in deference to a “research review” by Dhillon.14 In light of that, some of the authors met and agreed that the paper, already intended for submission to the high impact journal, was accurate and, despite the omission of Davies’s normal findings, she was credited with authorship.

    “It should be appreciated that the term ‘colitis’ covers a range of changes,” she said last year, defending her decision, “from minimal, self-limiting and non-specific, to extensive, severe and characteristic; such [that] it is difficult to select a point from within a spectrum for a single definition.”15

    I find this excerpt largely disturbing. What happened in this meeting that Davies recanted her findings? I also find Dhillon’s claim that he didn’t keep a copy of his score sheets to be a load of bollocks. First rule of science-document EVERYTHING and keep copies.

    I’m glad to see the BMJ fervently holding all those involved accountable but I see that two key figures are missing…Richard Horton and Richard Barr. I’d like to think that Wakefield rues the day that he gave David Lewis Dr. Dhillon’s score sheets to present to the BMJ as evidence of his innocence but he’ll just slither his way out as usual.

  4. Chris November 11, 2011 at 02:32 #

    A press release I found:
    http://www.cnbc.com/id/45247589

    I’m not sure if Dr. Lewis even understands.

  5. Science Mom November 11, 2011 at 02:58 #

    Chris, you should read his (Lewis’) BMJ and Nature letters. I think the man has caught “Wakefield Fever”. Leave it to Wakers to find a new angle to keep himself in the spotlight and try to cast doubt on Deer’s investigation.

  6. Chris November 11, 2011 at 03:46 #

    Oh, I did read the BMJ letter. Nature linked to it, I did not know he had a letter in Nature. I have my suspicions on how he got sucked into Wakefield’s field of influence.

    And so does Emily Willingham. She has written about it, included links to all of the BMJ papers, which are now out from behind the paywall:
    http://biologyfiles.fieldofscience.com/2011/11/oh-what-tangled-web-we-weave.html

  7. Visitor November 11, 2011 at 07:06 #

    BMJ letter from Brian Deer v interesting

    MMR and human waste disposal
    Thu, 11/10/2011 – 00:37

    For many years, David Lewis has been locked in dispute over his sewage sludge research with the US Environmental Protection Agency, from which he was terminated.[1] He has been represented by the Washington employment lawyers Kohn Kohn & Colapinto, which operates what it calls the “National Whistleblowers Center”, whistleblowers.org, a domain registered to one Stephen Kohn. It should not be confused with whistleblower.org, the influential not-for-profit Government Accountability Project.

    In January, Lewis and Kohn were guests of anti-vaccine campaigners at the 2,000 acre Tryall Club villa resort in Montego Bay, Jamaica, where struck-off former surgeon Andrew Wakefield headlined the cabaret. An autism website reports that travel costs and hospitality at the five star holidayspot were paid for by the promoters.[2]

    You couldn’t make this stuff up, but pursuant to his high season Caribbean trip, Lewis concluded that Wakefield in addition to himself had been “targeted for retribution” by sinister commercial and/or government interests.[3] In a bid to evidence this fascinating proposition, and perhaps find consolation en passant over his sludge research grievance, Lewis got from Wakefield some gut histology proformas.

    My BMJ reports of January 2011 [4] made little of sewage or histology, but it may be recalled that in 1998 Wakefield alleged that (a) MMR apparently precipitated autism in 8 of 12 children within days of vaccination; and (b) 11 of the 12 had “colitis”. He announced “a unique disease process”, and fostered lucrative legal claims that a “new variant IBD” made the gut wall leaky, causing autism. [5]

    The forms [6] were devised by a pathologist, who doesn’t mention “colitis” – much less anything “unique”, “new variant” or “leaky”. He sees almost entirely unremarkable, likely protective, non-specific changes in what has been called the “state of controlled inflammation”[7] in healthy gut mucosa.

    God only knows how this helps Wakefield. Previously (a), and now (b), above have been exposed as false. As for “whistleblower”, please watch the most disgusting performance I’ve ever seen by a doctor.[8]

    But I’m grateful for the forms, which further illuminate how the appearance of a link between MMR and autism was manufactured in an elaborate fraud.[9][10]

    References

    [1] Lewis D. A summary of court records in civil actions filed by David L Lewis Ph.D, RA McElmurray III and G William Boyce. Land application of processed sewage sludge (biosolids) 1997-2011. Hallman & Wingate attorneys, 28 September 2011. http://www.hallmanwingate.com/the-gatekeepers

    [2] Sullivan. The 2011 “Vaccine safety conference” in Jamaica. Leftbrain/Rightbrain. October 6 2011.

    [3] Lewis D. Research misconduct project. Text archived, June 2 2011.

    [4] Deer B. Secrets of the MMR scare. BMJ 2011; 342:c5347, 342:c5258, 342:c7001.

    [5] Deer B. Pathology reports solve “new bowel disease” riddle. BMJ 2011; 343:d6823.

    [6] Deer B. Tabulation of pathology proformas behind “new inflammatory bowel disease” claims. http://briandeer.com/solved/dhillon/tabulation.pdf

    [7] Fiocchi C. The normal intestinal mucosa: a state of ‘controlled inflammation’. In Targan SR, Shanahan F, Karp LC (eds). Inflammatory Bowel Disease: From Bench to Bedside (2nd ed), Kluwer Academic Publishers, 2003.

    [8] Deer B. MMR whistleblower threatened and betrayed. http://briandeer.com/solved/whistleblower-betrayed.htm

    [9] Godlee F, Smith J, Marcovitch H. Wakefield’s article linking MMR vaccine and autism was fraudulent. (editorial) BMJ 2011; 342:c7452

    [10] The New York Times. Autism Fraud. (editorial). 13 January 2011.

Trackbacks/Pingbacks

  1. Latest Irritable Bowel Disease Types News | Irritable Bowel Disease Symptoms - November 10, 2011

    […] process” observed, as reported by Wakefield et al. Nothing can be said about … Read more on Left Brain/Right Brain This entry was written by admin, posted on November 10, 2011 at 12:58 am, and filed under […]

  2. Sadly, measles cases may be what it takes » Black Triangle - November 19, 2011

    […] years since I first blogged on MMR vaccine here, and it is still ongoing. The recent news that the “new bowel disease” discovered by Wakefield was a fantasy, isn’t that much of a surprise. I’d been told as much a few years ago, but the mistake […]

  3. Brian Deer strikes again: More evidence of the worthlessness of Andrew Wakefield’s “research” « iluvimunisasi -"Love Them, Protect Them, Immunize Them" - December 20, 2011

    […] as Sullivan notes, these statements have been difficult to verify, and the original pathology slides made from […]

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