Falsehood flies, and truth comes limping after, so that when men come to be undeceived, it is too late; the jest is over and the tale hath had its effect: like a man, who hath thought of a good repartee when the discourse is changed, or the company parted; or like a physician, who hath found out an infallible medicine, after the patient is dead.
—Jonathan Swift, 1710
If a single event can be said to be the trigger for the modern anti-vaccine movement, it is the publication in 1998 of “Ileal-Lymphoid-Nodular Hyperplasia, Non-specific Colitis, and Pervasive Developmental Disorder in Children,” a research journal article in the Lancet. The primary author of this study was Andrew Wakefield. The paper claimed that there was a link between the MMR vaccine offered in England at that time and the development of a new kind of autistic regression, where otherwise healthy children started to regress in development. Later investigation showed that other scientists were unable to replicate Wakefield’s results, and the investigative journalist Brian Deer showed that the paper was a significant case of scientific fraud. The paper was retracted in 2010.1 Following this retraction Wakefield was eventually investigated and lost his license to practice medicine. He then traveled to the United States, where he has since started a variety of ventures that have taken advantage of his status as a martyr to the anti-vaccine movement. Despite these events, the media coverage of the paper played a pivotal role in setting off a major vaccine scare and a belief in a vaccine-autism link that lingers to this day.
The paper reported the cases of twelve children who had developed normally until they began losing skills and language, and developed diarrhea and abdominal pain.2 A series of assessments were performed on the children. They were tested for abnormal neurological conditions, using techniques such as MRI and EEG, and their guts were examined endoscopically and by biopsy of the mucosa. They were also tested for coeliac disease and infections with bacteria, such as salmonella. Their urinary methylmalonic-acid levels were observed to be high, an indicator of having a vitamin B12 deficiency. Endoscopic images of their gastrointestinal tracts showed early indicators of Crohn’s disease, as well as follicular hyperplasia, which can be symptomatic of a number of disorders. The children’s histories also showed that their parent’s recalled vaccinating them with the MMR vaccine just before the onset of their symptoms.
The Lancet paper concludes by speculating as to possible causes for the reported medical findings. One hypothesis for the cause of autism-like symptoms was an excess of opioids caused by the breakdown of certain dietary proteins into peptides, which are then absorbed in excess and interact with the nervous system. The paper drew a link between the MMR vaccine and such symptoms, noting that the first symptoms of autism appear within a few weeks of vaccination, but came short of specifying a causative relationship.
Although the Lancet published this article, in the same issue, they published a critical commentary.3 The commentary acknowledged that no vaccine is perfectly safe and continued on to address the specific points made in the paper. Because vaccines are administered to many millions of people, an adverse event that occurs in even one-tenth of 1 percent of recipients would be unacceptable. Yet the mechanisms that were in place to discover and identify those events had not identified any adverse event linked to the development of autism. The commentary pointed out that in order to infer a causative relationship between vaccination and an adverse event, questions of adverse events must be addressed in a very specific way.
Just two weeks before, the British Medical Journal had published an editorial, reviewing how adverse media could negatively impact vaccine coverage and noting that earlier reports linking MMR to inflammatory bowel disease had not stood up to scientific inquiry, but had already had negative effects. The editorial referenced a 1993 Danish television station that had aired anti-vaccination programming, leading to the lowest coverage rate yet.4 These papers in the BMJ and Lancet suggest that a number of people were aware of the impending publication of the Lancet paper and were unhappy with the editorial decision.
Although a report like the one that the Lancet had published could potentially point in new directions for research, or provide such prior probability to look for a connection in data between vaccination and bowel disease, it did not on its own do the kind of large statistical test that would be necessary to say such an effect really existed in the population. Indeed, although the number of measles cases reported had declined significantly due to the widespread vaccination of millions of children, among those many millions, no reports had been recorded of bowel disease or behavioral problems developing post-vaccination.
The symptoms reported in the Lancet article were not unique or particularly rare, and they had existed before the introduction of the MMR vaccine. One explanation for the parents in the study associating the onset of symptoms with MMR vaccination is recall bias. Recall bias occurs when asking someone to retrospectively report events; it makes it difficult for people to accurately recall when the onset of symptoms began.5 Asking someone “When did the symptoms start?” will always lead to less accurate answers than will asking them to record symptoms as they appear.
Additionally, the proposed mechanism of association: vaccination causing irritable bowel syndrome that then caused autism did not match the order of events in the reported cases. The patients had noticed the development of behavioral symptoms before that of bowel symptoms. The Lancet commentary pointed out that many developmental disorders appear in the first years of life, which is the same time period when most vaccinations occur. Assuming a causative effect simply from proximity in time invites making false associations.
Vaccine-safety concerns such as that reported by Wakefield and colleagues may snowball into societal tragedies when the media and the public confuse association with causality and shun immunisation.6
In the same issue, the Lancet published a research letter examining samples from patients with Crohn’s disease and ulcerative colitis, forms of inflammatory bowel disease. If measles was the cause of inflammation in these diseases, it would be expected that genetic material from measles could be detected in these samples. No such association was shown.7
To scientists reading this issue of the Lancet, the inclusion of this commentary and this research letter sent a clear message. Although the journal had gone ahead with the publication of the early report suggesting a link between the development of autism and vaccination, the editors were skeptical of the conclusions. Indeed, three meetings were held to determine if the journal should go ahead with publishing the study. As written, the study appeared to have been conducted properly, and the appropriate methods and protocols appeared to have been followed. The results, if true, were important enough to warrant publication. The usual tests for publication are validity of the methods used and importance to the field.
However, as the commentary and research letter showed, the results seemed incongruous with respect to the existing literature, and even potentially dangerous. The editors were aware of the vaccine fears that had been rekindled in the 1970s by the report in the British Medical Journal suggesting a link between the DPT and neurological deficits in thirty-six children,8 as they had published a history of it the previous month, in January 1998,9 detailing how the airing of “Vaccine Roulette” had led to public health concerns in the United States and eventually to worldwide pertussis outbreaks.
The publication of this history just before that of the 1998 Lancet paper was, if not deliberate, then eerily prescient. The editors faced a hard choice but decided to go ahead with publication, but not to include the paper in their normal press release. Although the journal chose not to publicize the paper, the Royal Free Hospital, Wakefield’s employer, did choose to directly address the media in a press conference to be held before the paper’s publication. Five doctors, each with different views on the paper, were called into a panel. All five rehearsed and agreed that until further research could be done, MMR vaccinations should continue. This agreement fell apart during the conference, with Andrew Wakefield advocating individual vaccines in annual intervals and others disagreeing vehemently.10 Stating that MMR was dangerous far exceeded what even Wakefield’s paper concluded. Although Wakefield suggested that the combined MMR vaccine was dangerous and that individual vaccines would be safer, none were available on the market at that time, an absence that effectively told parents not to vaccinate.
One more case of this is too many. … It’s a moral issue for me and I can’t support the continued use of these three vaccines given in combination until this issue has been resolved.11
The damage had been done. In the press the next day, alarming headlines suggested that the Lancet article should provoke immediate action. The front page of the Guardian reported, “Alert over Child Jabs.” In the following years, MMR immunization fell from 91.5 percent of children by the age of two to a low of only 79 percent in 2004.12 Alarm about a claimed link between vaccinations and autism took on a life of its own in subsequent years. It led to a series of congressional hearings covered on widely watched news programs,13 decreases in vaccination rates, and a number of sick children. Some of this anti-vaccine panic may have arisen even in the absence of this paper, but Wakefield and others who followed provided a scientific veneer to holding anti-vaccine beliefs, creating an alternate narrative for those who wanted to believe that a conspiracy of ill-behaved humans was responsible for autism, rather than the intentionless actions of many genes interacting with unpredictable elements in the environment.
Over the course of several years, it became clear that the Lancet article had been produced under irregular circumstances. In 2004 the investigative journalist Brian Deer published a piece in the Sunday Times revealing that in August 1996 Wakefield had secured up to £55,000 (roughly $210,000 today) to investigate a possible link between MMR and autism in ten children by the Legal Aid Board. A month later he sent a letter to the government’s chief medical officer urging against the MMR vaccine. Four to five of the children in the study published in the Lancet were covered in Wakefield’s contract to look for a link between autism and MMR.
Scientific journals provide an opportunity to declare conflicts of interest, which are often minor. Doing occasional consulting work for a company whose drug is tested in a study is one such conflict that may be reported and is considered by editors when deciding to accept or reject an article. Wakefield did not declare his conflict—that he had been paid, in effect, to draw a link between the MMR vaccine and autism in order to justify legal proceedings. This clear conflict of interest was not disclosed to the public or to coauthors of the manuscript.14 The editor who had approved the article stated that had he known about the conflict, he would not have approved publication.
Wakefield admitted that children had been included in the study because he had been paid to help them make a legal case. Following Deer’s investigative journalism, the Royal Free Hospital, University College medical school, and the Royal Free Hampstead NHS Trust released a statement: had they known about the conflict of interest, they would have advised reporting it.15 Ten of the paper’s twelve authors later issued a “Retraction of an Interpretation” statement, wherein they stated, “We wish to make it clear that in this paper no causal link was established between MMR vaccine and autism as the data were insufficient.”16 Wakefield filed a libel suit against Deer, which was soon dropped. A solicitor, Richard Barr, had been pursuing cases related to injuries that parents believed were caused by vaccination. Barr had used an organization called Justice, Awareness, and Basic Support (JABS)17 to approach and pay Wakefield to research a proposed link between MMR and autism. Over time Wakefield would be paid £435,643 (just above $1 million today adjusted for inflation) plus expenses.18 JABS members were involved in a lawsuit against the three companies that manufactured the MMR vaccine.19 Wakefield had already tried to show a link between MMR and intestinal inflammation, so it made sense to approach him to look for a link between MMR and another disorder.
Although the journalistic world had been quick to respond to the 1998 paper by promoting and amplifying its findings, the scientific world responded more slowly and measuredly. In March 1998 the Lancet published a rebuttal to the Wakefield paper,20 pointing out that developmental delays are noticed slowly over time, not immediately or all at once; that the selection of patients was not blinded; that the study did not have controls;21 that researchers were not blinded;22 and that if symptoms were first observed soon after vaccination, this was not enough to make an inference that vaccination was the cause of symptoms.
The same month, the British Medical Journal published an editorial with similar conclusions.23 Although hundreds of thousands of children were vaccinated annually, there was no epidemiological reason to associate MMR with autism. The World Health Organization had reviewed the biological and epidemiological plausibility of such an association,24 finding that there was little evidence to implicate measles as a cause of inflammatory bowel disease and that “current scientific data do not permit a causal link to be drawn between the measles virus and [chronic inflammatory bowel disease].” Indeed, a number of studies attempted to look at the question of whether the measles virus used in MMR vaccination was a causative factor in inflammatory bowel disease.25 These had failed to confirm this hypothesis.26
In June 1999 the Lancet published a study of 498 cases of autism.27 Notably the presence of autism as diagnosed by the International Classification of Diseases was used as a criterion for inclusion in the study, and not whether a participant’s parents had paid the investigators to help build a legal case. The investigators found that there was no association between the time of vaccination and the onset of symptoms of autism, a finding that dealt a blow to Wakefield’s MMR-vaccination hypothesis.
Studies continued to look for the proposed link. Compared to nonregressing children, autistic children who appeared to have regressed did not have symptoms appear at a different time, and inflammatory bowel disease did not appear to be more frequent in these children.28 The diagnosis of autism increased from 1988 to 1999, by seven times, but the vaccination rate had remained relatively stable at about 95 percent.29
A retrospective study of over 500,000 children found no increased risk of developing autism symptoms in the months following vaccination and no link between children with autism and hospitalizations for inflammatory bowel disease.30 Incidence of bowel symptoms and incidence of developmental regression did not change from before the time that the MMR vaccine was introduced to after.31 A case-control study of hundreds of autistic and non-autistic children calculated the odds ratio that increasing exposure to vaccine components increased the risk of autism. An odds ratio = 1 indicates that exposure does not influence the odds of the outcome. An odds ratio > 1 indicates that exposure is associated with a higher risk of outcome, and an odds ratio < 1 indicates that exposure is associated with a lower risk of outcome.32 The odds ratio was 0.999 for exposure up to three months, 0.999 for exposure up to seven months, and 0.999 for exposure up to two years,33 indicating that there was no relationship between vaccine exposure and diagnosis with autism. A 2014 meta-analysis studied the combined outcomes of available high-quality studies and found no relationship between vaccination and autism, vaccination and autism spectrum disorder, autism and MMR, autism and thimerosal, and autism and mercury.34
Dozens of studies have been conducted looking for a link between MMR and autism, with multiple methodologies employed and many more participants than Wakefield’s study, and all have reached the same conclusion: there is no link between the MMR vaccine and the development of autism, the development of inflammatory bowel disease, or the development of a new subtype of autism characterized by developmental regression.
The quantity and quality of this scientific body of work is impossible to ignore in an honest inquiry conducted by someone with scientific training. Did the media cover the findings of the scientists studying these questions as breathlessly and with as much excitement as it did Wakefield’s? It did not. In 2002 the BBC aired an episode of Panorama titled “How Safe Is MMR?” The Sun and the Daily Mail argued for individual vaccines for measles, mumps, and rubella,35 a practice that can increase the period during which children are vulnerable to infection. Many news outlets attempted to provide ”balance” when discussing vaccination;36 however, although balance is a journalistic virtue when reporting on disputes, adding balance to a scientific question often elevates an extreme minority position, such as Wakefield’s, to a disproportionate position of false equivalence. This is frequently called false balance.
Celebrities began to weigh in. Jenny McCarthy first declared her son to be a “crystal child,” in 2006, then later, autistic. It is unclear whether her son was ever medically diagnosed with autism. She appeared on The Oprah Winfrey Show, Larry King Live, and Frontline claiming that vaccines can cause autism. In 2008 she was awarded the James Randi Educational Foundation’s Pigasus Award37 for contributions to pseudoscience. Jenna Elfman appeared at a rally against California’s law (SB-277) tightening rules on vaccine exemptions, on the basis that it infringed on parental rights. Jim Carrey wrote an editorial for the Huffington Post, suggesting a link between vaccines and autism.38 Alicia Silverstone wrote a parenting book that opposed giving childhood vaccinations (as well as using diapers and eating meat and dairy while pregnant).39 Kirstie Alley tweeted against SB-277, and a variety of other celebrities issued anti-vaccine tweets, including Selma Blair, game show host and former real estate developer Donald Trump, Erin Brockovich, and Bill Maher.40
Shortly after McCarthy went on a press tour to promote her book, ABC aired the first episode of Eli Stone, featuring a corporate lawyer who suffers from hallucinations and decides to “fight for the little guy,” by taking on a pharmaceutical company on behalf of a parent who believes a fictionalized version of the vaccine-preservative thimerosal had caused her child’s autism.41 The episode was protested by a number of professional groups, including the American Academy of Pediatrics; however, it was aired regardless with a warning that the company portrayed was fictional.42
Of course, celebrities often gain their fame for reasons other than their ability to evaluate and interpret evidence. Skills at acting, playing sports, or making media appearances are not the same as such skills as evaluating scientific evidence and making choices based on the best available data. Having platforms able to reach large numbers of people places celebrities in a position of potential influence, as advertisers and film marketers have long recognized. However, despite numerous celebrities having spoken against SB-277, which affected a state with a large portion of the entertainment industry, it passed and was signed into law.
Both journalists and scientists search for the truth. So why did the press coverage feature a relatively weak finding in Wakefield’s paper but largely fail to report the broader state of scientific research, both contemporaneous to that of the paper and in the years that followed? In short, an important purpose of journalism is to report on what is new. Wakefield’s study suggesting that the MMR vaccine is not safe was new. Continued reporting that the scientific status quo remained the status quo is not new or particularly exciting.
Journalists fill very different social roles than those of scientists, and the press serves different roles than those of scientific institutions.43 Scientists and research institutions have motivations for communicating with the public that only partly overlap with those of journalists. From a scientist’s perspective, the function of media ought to be to disseminate scientific results accurately and in proportion to the strength of the evidence they have produced. A public health researcher is motivated by the desire to see vaccination rates improve and fewer people suffer from death and disease. Journalists, on the other hand, work to avoid the appearance of working for a “special interest.” The news media aim to entertain; warn of dangers and failures; and report, explain, or comment on events. Preventing disease is not one of these goals.
These journalistic virtues make sense when considering, as an example, a journalist reporting on a corporation that is dumping wastewater used to cool a reactor into a river. The public has an interest in knowing that the change in temperature of the river water is killing fish and causing other environmental damage, so the journalist works diligently to ascertain what happened without reporting the corporation’s statement that the waste water is safe, absent their own fact-checking and interpretation.
Likewise, when interviewing scientists and institutional leaders, journalists see scientists, as well as business leaders and politicians, as parties with individual interests, as potentially biased holders of power. Scientists have their own set of social functions and intellectual virtues. Science develops new and life-saving technologies, new weapons, and new tools. It helps us to understand the world we live in; the living things that occupy it; our own behavior; and our biological, physical and chemical origins.
Journalists also work on a deadline. Although scientists are motivated to publish, the pace of scientific research often rewards patience and getting things right. A single scientific publication might represent several years’ worth of work and may take several rounds of peer review, new experiments, and revision before it is accepted into a reputable journal. Although desiring to only present factual information, a journalist with a deadline to deliver a story before the publication of a newspaper or the airing of television program may simply not have enough time to “get it right” because they interviewed the wrong people, missed important features, or were not able to follow up on sources. Long-form investigative journalism, such as Deer’s investigation of Wakefield’s conflicts of interest, can slowly fill these gaps.
Science often falls for the so-called file-drawer effect, wherein negative results are unreported and have a harder time getting published.44 This causes problems in its own right, increasing the risk of reported false positives and resulting in studies repeated by various groups because the negative results of prior groups aren’t available. News media tend to emphasize negative stories or use negative frames when reporting stories.45 Humans are also apt to see studies that find health risks as more trustworthy than those that show low or no risk.46 As a result, news is biased toward reporting negative stories, those that portray institutions or individuals as villains, and those that present opportunities for the media to serve its role as a watchdog. This can in turn lead to greater availability of information suggesting risk, which may in turn increase a person’s perception of the likelihood of a dangerous event taking place.47 Since the news is, by definition, new, stories that upend the status quo will naturally be more appealing to report than those that reinforce it.
Science journalism can’t be said to be uniformly bad. The quality of scientific news falls on a spectrum.48 Some venues provide very accurate coverage that is novel and reflects the scientific consensus. Other outlets, often with wider reach, spread misinformation.
One recent philosophical approach to epistemology (the study of knowledge) may help to bridge the divide between science and the news media. Virtue epistemology frames the pursuit of knowledge not by a codified set of fixed techniques and mechanisms but by drawing an analogy to moral virtues. A scientist holds such epistemic virtues as doing hypothesis-driven research, keeping meticulous notes, and maintaining clean glassware. A journalist may hold such virtues as balance, following up on sources, and cross validation of results. By understanding the journalistic virtues, and how journalists conceive of their role in society, scientists may be better able to navigate situations where they must interact with journalists in order to tell scientific stories and spread accurate public health information.
Journalists should be aware that scientific ways of knowing fall outside of the approaches they’re used to employing for getting to the truth. In science, those stories that upend the status quo are often the least interesting because they’re most likely to be false. In science, individual opinions hold little weight, and individual interviews can be next to useless for determining facts. Rarely do issues have “two sides” of equal scientific merit that deserve equal representation. Credentials alone mean little. Those representing themselves as scientists or physicians may well have doctorates, but they may also be speaking well outside their areas of expertise. The story of the little guy going up against an evil corporation may make for a compelling (and well-worn) narrative, but often the little guy is working with bad science. Scientists often speak very carefully using precise and qualified language—for the reason that care must be taken to accurately portray their views. Patronizing “simplification” of scientists’ communication often simply leads to confusion as statements that made sense in context become weaker, more easily assailable, or flat wrong.
Brian Deer continued to investigate Wakefield’s paper. He tracked down parents of children involved in the study who provided medical records contradicting what had been reported.49 The General Medical Council (GMC) spent 217 days evaluating the Wakefield case (its longest-ever disciplinary hearing) and in January 2010 found Wakefield to have committed misconduct related to his paper.50 Young children had undergone invasive procedures such as endoscopies and lumbar puncture; however, these procedures had not been reviewed by the appropriate ethics panel. In February 2010 the Lancet retracted the 1998 paper. In March 2010 the GMC removed Wakefield from the medical register.
Moreover, many of the specific claims made in the paper began to fall apart. Many of the children documented in the paper had been diagnosed not with regressive autism but with Asperger’s syndrome, or with nothing at all. Some of the children, who had been believed to be “previously normal,” had previously documented developmental delays or abnormalities. Deer showed that all the children in the study in some way had their case histories altered or misrepresented to fit the paper’s narrative.
In another report, Deer revealed that Wakefield had filed a patent in 1995 for a method of detecting Crohn’s disease from measles virus in “bowel tissue, bowel products, or body fluids.”51 The application had suggested that the service could be the basis for a profitable company. Richard Barr, the lawyer who had paid Wakefield, directly stated that he had paid for the Lancet research. After the press conference, Wakefield held a meeting with a venture capitalist about launching “Immunospecifics Biotechnologies Ltd.” The company was to market a stand-alone measles vaccine. In 2001 Wakefield was presented with a letter expressing concerns that the business he was launching had a business plan based on yet-undemonstrated research and that this caused a conflict of interest with his work at the Royal Free Hospital. An offer was made to Wakefield to replicate the results of his Lancet study with more children, but he failed to do so. He was paid severance and lost his job at the hospital.
Wakefield has publicly denied any wrongdoing and refused to retract his initial paper. An interview for this book was requested through his assistant; however, Wakefield never responded. In various interviews he has asserted a conspiracy as the cause of negative interpretations of his work. Deer’s interpretation, and the interpretation of most scientists, was that Wakefield had performed scientific misconduct.52 He had received payment to produce plausibility in the scientific literature to help a lawsuit move forward and to market his own alternative measles vaccine. He hid this when conducting the study, violated ethics rules in examining the children, and misrepresented their patient histories and diagnoses. This case of research misconduct also throws his other publications into question.
In the years after Wakefield’s separation from the Royal Free Hospital, he eventually moved to the United States. In 2004, in Austin, Texas, he helped found the Thoughtful House Center for Children, where he was said to be in charge of research53 and was executive director, earning about $250,000 a year.54 He eventually resigned in 2010, around the time of his GMC hearings. In 2011 the institution’s name was changed to the Johnson Center for Child Health and Development. Wakefield then started a charity, the Strategic Autism Initiative (SAI). As of 2012 about 58 percent of the money SAI had taken in went to salaries, with the majority going to Wakefield.55 In 2012 more was spent on salaries than was taken in. By 2013 SAI took in only $50,498 and ran a deficit of $97,514 according to tax forms. Also in 2010 Wakefield registered a company called the Autism File Global, amended in 2011 to the Autism Media Channel.
In 2010 Wakefield gave a talk to Somali-Americans in Minnesota incorrectly claiming that autism does not exist in Somalia.56 In 2017 this community would be the center of the largest measles outbreak in Minnesota in recent memory.
In 2013, representing the Autism Media Channel, Wakefield pitched a “reality” television program about an “Autism Team” that diagnoses children with “autism-associated enterocolitis” and then cures the children.57 Autism-associated enterocolitis is a term invented by Wakefield and not a recognized disease. The Autism Media Channel’s YouTube channel has been dormant for several years; its Facebook group has not been updated since February 2017; and its website was no longer loading as of the time of writing.
In 2016 Wakefield directed the Autism Media Channel–produced documentary film Vaxxed: From Cover-up to Catastrophe. The film was initially accepted into the Tribeca Film Festival but was eventually withdrawn.58 The withdrawal followed actor Robert De Niro’s reviewing the film with scientists and deciding that it would not contribute to the public health discussion surrounding vaccines. The media coverage surrounding this withdrawal perhaps boosted the profile of a film that is mired in conspiratorial beliefs regarding cover-ups and hidden information.
1. Retraction is a fairly rare move and does not occur simply when a paper has been shown to be wrong, and it should not occur, for political reasons. According to the Committee on Publication Ethics, a retraction should only occur when editors have “clear evidence that the findings are unreliable, either as a result of misconduct, or honest error,” that the findings have been previously published, that the paper constitutes plagiarism, or that the paper reports unethical research. Retraction is intended as a means of correcting the literature when a grievous error occurs. Almost always the retracted paper remains available, but the reasons for retraction are specified. Discussion of the paper itself should be preceded with the knowledge that the scientific community and editors of the Lancet found the paper to meet these strict requirements for retraction. See COPE, “COPE’s Retraction Guidelines,” publicationethics.org/newsevents/cope%E2%80%99s-retraction-guidelines. (Accessed November 13, 2019.)
2. The Editors of the Lancet, “Retraction—Ileal-Lymphoid-Nodular Hyperplasia, Non-specific Colitis, and Pervasive Developmental Disorder in Children,” Lancet 375 (2010): 445.
3. A. J. Wakefield, S. H. Murch, A. Anthony, J. Linnell, D. M. Casson, M. Malik, et al., “Ileal-Lymphoid-Nodular Hyperplasia, Non-specific Colitis, and Pervasive Developmental Disorder in Children,” Lancet 351 (1998): 637–641.
4. N. Begg, M. Ramsay, J. White, and Z. Bozoky, “Media Dents Confidence in MMR Vaccine,” BMJ 316 (1998): 561.
5. S. S. Coughlin, “Recall Bias in Epidemiologic Studies,” Journal of Clinical Epidemiology 43 (1990): 87–91.
6. Robert T. Chen and Frank DeStefano, “Vaccine Adverse Events: Causal or Coincidental?” Lancet 51, no. 9103 (1998): 611–612.
7. M. A. Afzal, P. D. Minor, J. Begley, M. L. Bentley, E. Armitage, S. Ghosh, et al., “Absence of Measles-Virus Genome in Inflammatory Bowel Disease,” Lancet 351 (1998): 646–647.
8. M. Kulenkampff, J. S. Schwartzman, and J. Wilson, “Neurological Complications of Pertussis Inoculation,” Archives of Disease in Childhood 49 (1974): 46–49.
9. E. J. Gangarosa, A. M. Galazka, C. R. Wolfe, L. M. Phillips, R. E. Gangarosa, E. Miller, et al., “Impact of Anti-Vaccine Movements on Pertussis Control: The Untold Story,” Lancet 351 (1998): 356–361.
10. J. Laurance, “I Was There When Wakefield Dropped His Bombshell,” Independent, January 29, 2010, www.independent.co.uk/life-style/health-and-families/health-news/i-was-there-when-wakefield-dropped-his-bombshell-1882548.html.
11. Andrew Wakefield, quoted in B. Deer, “Focus—MMR: The Truth behind the Crisis,” Sunday Times, February 22, 2004, briandeer.com/mmr/lancet-deer-2.htm.
12. D. Batty, “The Doctor Who Sparked the MMR Vaccination Debate,” Guardian, March 27, 2008, www.theguardian.com/uk/2008/mar/27/health.healthandwellbeing.
13. Institute of Medicine (US) Immunization Safety Review Committee, Immunization Safety Review: Vaccines and Autism (Washington, DC: National Academies Press, 2010).
14. B. Deer, “Focus—MMR: The Truth behind the Crisis.”
15. H. Hodgson, “A Statement by the Royal Free and University College Medical School and the Royal Free Hampstead NHS Trust,” Lancet (2004): 824.
16. S. H. Murch, A. Anthony, D. H. Casson, M. Malik, M. Berelowitz, A. P. Dhillon, et al., “Retraction of an Interpretation,” Lancet 363 (2004): 750.
17. Jab is slang for “vaccination” in the UK.
18. B. Deer, “Secrets of the MMR Scare: How the Vaccine Crisis Was Meant to Make Money,” BMJ 342 (2011): c5258.
19. P. A. Offit, Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure (New York: Columbia University Press, 2010).
20. J. W. Lee, B. Melgaard, C. J. Clements, M. Kane, E. K. Mulholland, and J. M. Olivé, “Autism, Inflammatory Bowel Disease, and MMR Vaccine,” Lancet 351 (1998): 905; author’s reply, 908–909.
21. A control in this case would be a group of children who had received the MMR vaccine but did not display symptoms of developmental regression.
22. In this context, “blinded” does not mean that the researchers ought to have had their eyes gouged out. It is a technique used in scientific studies to reduce bias effects by, for example, making sure that researchers do not know whether they’re examining endoscope images from children with developmental delays or controls.
23. A. Nicoll, D. Elliman, and E. Ross, “MMR Vaccination and Autism, 1998,” BMJ 316 (1998): 715–716.
24. World Health Organization, Expanded Programme on Immunization (EPI), “Association between Measles Infection and the Occurrence of Chronic Inflammatory Bowel Disease,” Weekly Epidemiological Record 73 (1998): 33–39.
25. J. Metcalf, “Is Measles Infection Associated with Crohn’s Disease?,” BMJ 316 (1998): 166.
26. Science cannot prove a hypothesis to be wrong; it can only fail to confirm it.
27. B. Taylor, E. Miller, C. P. Farrington, M. C. Petropoulos, I. Favot-Mayaud, J. Li, et al., “Autism and Measles, Mumps, and Rubella Vaccine: No Epidemiological Evidence for a Causal Association,” Lancet 353 (1999): 2026–2029.
28. E. Fombonne and S. Chakrabarti, “No Evidence for a New Variant of Measles-Mumps-Rubella–Induced Autism,” Pediatrics 108 (2001): E58.
29. J. A. Kaye, M. del Mar Melero-Montes, and H. Jick, “Mumps, Measles, and Rubella Vaccine and the Incidence of Autism Recorded by General Practitioners: A Time-Trend Analysis,” BMJ 322 (2001): 460–463.
30. A. Mäkelä, J. P. Nuorti, and H. Peltola, “Neurologic Disorders after Measles-Mumps-Rubella Vaccination,” Pediatrics 110 (2002): 957–963.
31. B. Taylor, E. Miller, R. Lingam, N. Andrews, A. Simmons, and J. Stowe, “Measles, Mumps, and Rubella Vaccination and Bowel Problems or Developmental Regression in Children with Autism: Population Study,” BMJ 324 (2002): 393–396.
32. M. Szumilas, “Explaining Odds Ratios,” Journal of the Canadian Academy of Child and Adolescent Psychiatry 19 (2010): 227–229.
33. F. DeStefano, C. S. Price, and E. S. Weintraub, “Increasing Exposure to Antibody-Stimulating Proteins and Polysaccharides in Vaccines Is Not Associated with Risk of Autism,” Journal of Pediatrics 163 (2013): 561–567.
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