In a 17/3/08 e-mail to his mailing list, Prof Patrick Holford of Teesside University discusses Wakefield’s work and the possible role of the gut in autism.
Wakefield’s hypothesis can be summarised as follows:
[A] subset of children…develop[e] a particular form of developmental regression following previously normal development, in combination with a novel form of inflammatory bowel disease…Exposure [to the MMR vaccine] leads to long-term infection with measles virus within key sites, including the intestine, where it is associated with lymphoid hyperplasia and acute and chronic mucosal inflammation.
It sounds like a plausible hypothesis, but it’s wrong. One would expect a professor carrying out research in this field to know this – but we will recap the evidence, in case Prof Holford might have missed some of it. This idea of a ‘novel form of inflammatory bowel disease’ is – as a scientist writing on Left Brain Right Brain argues – an example of how one can manufacture a disease (which then creates a market for treatments). The evidence for such a disease was never good:
In a forensic dissection of the key paper by Wakefield and colleagues in the Am J Gastroenterology in 2000 (Am J Gastroenterol. 2000 95:2285-95), MacDonald and Domizio clearly showed that the so-called enterocolitis was due to Wakefield incorrectly deeming enlarged lymphoid follicles in the gut as pathological abnormalities, and that he had also created new and unsubstantiated pathological abnormalities to give the impression of gut pathology.
A particular problem is that Wakefield claimed that
a tissue section from the gut of an autistic child was abnormal if it contained a lymphoid follicle. However when the gut biopsies were taken at colonoscopy from autistic children, lymphoid follicles were specifically targeted for sampling because they wanted to look for measles in these tissues. So it is obvious that all will have pathology if one uses this invented criteria.
Things look even more suspicious when one notes that
MacDonald was also an expert witness last year in the Hazelhurst versus HHS case in the USA. In his testimony MacDonald re-iterated in some depth the extent of Wakefield’s rogue and junk science, going back all the way to his identification of measles virus in Crohn’s disease using reagents which were not specific for measles virus. However he picked up yet another deception in the Am J Gastro paper. Much of the paper deals with the alleged lymphoid hyperplasia in the ileum of autistic children, graded by Wakefield on a score 0-3, with 0 being no follicles and 3 allegedly an undefined “severe” lymphoid hyperplasia. To illustrate the colonoscopic appearances of grades 0-3, a panel of photographs purportedly showing the different grades is included as Figure 1 of the paper. The date and time each photograph was taken is reproduced in figure. The image of alleged grade 0 ileal lymphoid hyperplasia (ILH) was taken on the same day and only 1 minute 54 seconds before the image of alleged grade 3 ILH. It is impossible to remove a colonoscope from 1 child and scope another child, reaching the ileum in 1 minute 54 seconds. Therefore the grade 0 and grade 3 images were taken from the same child; the grade 0 image most probably from the caecum ( the part of the colon just after the ileum) and the grade 3 image from the terminal ileum.
Of course, autistic children do have bowel problems – and no-one is saying that they should be denied treatment for such problems. However, constructing these problems as a novel disease is a different matter: as the scientist blogging on Left Brain Right Brain notes
Throughout this saga, Wakefield has traded on the fact that autistic children do have real gut problems. However instead of attributing these problems in the majority of children to a combination of chronic and severe constipation, fecal impaction, unusual diet, diarrhea, bloating, parasites, gas etc, he had to find a new disease!
This finding of new diseases is a favourite big pharma tactic – once you have manufactured a disease, you can then sell ‘treatments’ for it. Coincidentally, Wakefield now offers dubious autism treatments at the Thoughtful House clinic in America. Holford recommends that those with autism supplement omega 3 fats and “Nutrients for a healthy gut”, and happens to have a commercial interest in selling these products.
No wonder that Holford will be outside Andrew Wakefield’s GMC hearing – where Wakefield is accused, based on strong evidence, of unethical research on vulnerable children – at a protest in support of Wakefield. Manufactured new diseases are a great thing for a whole manner of people – especially for those in big pharma and big CAM, with shiny new treatments to sell – but not, by and large, for those ‘diagnosed’ with and ‘treated’ for these new maladies.