>> WELL, GOOD MORNING. CAN YOU HEAR ME? GOOD MORNING. ARE YOU ALL THERE? OKAY. I'M ROGER GLASS, DIRECTOR OF THE FOGARTY INTERNATIONAL CENTER HERE AT NIH AND IT GIVES ME REALLY A GREAT DELIGHT AND PLEASURE TO HAVE FIONA GODLEE BACK TO VISIT US ON THE NIH CAMPUS. WELCOME. FIONA WAS LAST HERE AS YOU CAN SEE IN THIS PICTURE IN 2007 WHEN WE HAD A SPECIAL ISSUE OF JOURNALS AROUND THE WORLD, COUNCIL SCIENCE EDITORS ON THE GLOBAL THEME OF POVERTY AND HUMAN DEVELOPMENT AND SHE WAS ONE OF THE JUDGES FOR GLOBAL REVIEW OF BEST PAPERS ON GLOBAL HEALTH IN THAT ISSUE. AND WE HAD A SYMPOSIUM ON CAMPUS. SHE'S ALSO BEEN INVOLVED WITH US IN A PROGRAM TO TRAIN EDITORS IN THE DEVELOPING WORLD TO BRING THE EDITORIAL QUALITY OF LOCAL JOURNALS UP TO AN INTERNATIONAL STANDARD. SO SHE'S AN OLD FRIEND OF NIH AND WE'RE DELIGHTED TO HAVE HER BACK. FIONA HAS BEEN THE EDITOR OF THE BMJ SINCE 2005, SHE QUALIFIED AS A PHYSICIAN IN THE UK AND IN 1985 IN CAMBRIDGE AND LONDON AND IS A FELLOW OF THE RURAL COLLEGE OF PHYSICIANS. SHE WENT AS A YOUNG PHYSICIAN TO INTERN AT THE BMJ FOR A YEAR, FOUND THAT SHE LIKED IT, AND ENDED UP REMAINING FOR -- GOING BACK SERIES OF DIFFERENT POSITIONS AND WHEN SHE TOOK THE TOP POSITION IN 2005 THE ISSUE THAT SHE WILL ADDRESS TODAY IS ONE THAT ABSOLUTELY CAPTIVATED MY ATTENTION AND I THINK THE ATTENTION OF THE WORLD IN THE MEDICAL COMMUNITY. LESSONS FROM THE MMR SCARE. I WORKED ON RODO VIRUS FOR MUCH OF MY CA REEMPLET I WAS NEVER INTERESTED IN ADVERSE EVENTS UNTIL THE FIRST RODO VIRUS VACCINE WAS CRIPPLED BY INTERSU SEPTION AND THAT WAS FILED BY ALL KINDS OF EVENTS BUT ONE OF THE GRATE FUELS FOR THAT FIRE OF ANTI-VACCINE ACTIVITY WAS AN ARTICLE BY ANDREW WAKEFIELD IN THE LANSETT IN 1998. LINKING MMR TO AUTISM. THAT HAS REALLY IN A PRESTIGIOUS JOURNAL A MAJOR ASSOCIATION IN A WORLD TERRIBLY CONCERNED WITH AUTISM AND WITH VACCINES. AND FOR YEARS WE HAVE LIVED WITH THIS SPECTOR OF THIS ACTIVITY, THIS PUBLICATION AS FUEL FOR THE FIRE. IN JANUARY OF THIS YEAR, I READ AND I COULD NOT PUT DOWN THE THREE ISSUES OF THE BMJ THAT COVERED AN INVESTIGATION BY BRIAN DEER OF THIS EVENT AND THE EDITORIAL BY DR. GODLEE ON HOW IT ALL CAME TO PASS. MUCH OF THE WORK OF BRIAN DEER, A JOURNALIST WAS IN THE BRITISH PRESS BUT IT NEVER REALLY MADE IT INTO THE MEDICAL LITERATURE. SO I NEVER REALLY APPRECIATED THE EXTENT OF THIS UNTIL IT WAS PUBLISHED IN THE BMJ IN THESE THREE PUBLICATIONS. I WOULD SAY IT WAS A PAGE TURNER FOR ME, IT OPENED MY EYES TO AN AREA OF MEDICAL FRAUD THAT I NEVER THOUGHT ABOUT. IN SCIENCE WE THINK VERY HARD ABOUT SCIENTIFIC EVIDENCE AND ITS QUALITY AND VALIDITY. WE NEVER THINK ABOUT THE QUALITY OF THE DATA ITSELF. AND I THINK THAT'S WHAT WAS BEHIND THIS. IN SOME WAYS IT MAYBE EMBARRASSED THAT I'M SO OBJECTIVE ON THINKING ABOUT CRITICAL ISSUES IN SCIENCE, NOT SO OBJECTIVE ABOUT OR TRUSTING THAT THE EVIDENCE IS PROPERLY COLLECTED AND MANAGED. SO WITH THIS BACKGROUND, FIONA TO HER CREDIT BROUGHT THESE ISSUES TO LIGHT IN THE BMJ, IT'S A PAGE TURNER, IF YOU HAVEN'T READ IT. AND IT'S MADE THE WORLD THINK MORE CAREFULLY ABOUT THE VALUE OF CRITICAL THINKING AND AD VER EVENTS AND MEDICAL INVESTIGATIONS. SO FIONA, WELCOME AND THANK YOU FOR OPENING OUR EYES. I KNOW IT'S BEEN A TRYING AND INTERESTING WORLD FOR YOU. WE'RE LOOKING FORWARD TO HEARING YOUR PERSPECTIVE. WELCOME DR. FIONA GODLEE. >> THANK YOU VERY MUCH. [APPLAUSE] >> THANK YOU VERY MUCH, ROGER. IT'S A REAL PLEASURE TO BE HERE, A REAL HONOR AS WELL. ROGER AND I -- HE SAID THAT HE BEGAN HIS WORK A MILE DEEP AND AN INCH WIDE IN TERMS OF FOCUSING ON RODO VIRUS IN BANGLADESH BUT NOW HIS LIFE IS AN INCH DEEP AND A MILE WIDE AT FOGARTY, IT'S A GOOD WAY OF DESCRIBING A MEDICAL EDITOR'S LIFE. AN INCH DEEP, A MILE WIDE, COVERING A HOST OF FAS GNATTING ISSUES WHICH IS WHY THE JOB IS A WONDERFUL ONE TO DO. BUT SO OFTEN SOMETHING COMES UP WHERE YOU'RE COMPELLED OR DRAWN OR DRAGGED OR WILLINGLY OR UNWILLINGLY INTO AN ISSUE THAT YOU BECOME COMPLETELY ABSORBED IN AND YOU HAVE TO GO A MILE DEEP IN ORDER THE UNDERSTAND IT. THIS IS CERTAINLY THE CASE WITH MMR. I WONDER IF YOU CAN REMEMBER WHERE YOU WERE THE 28th OF FEBRUARY, 1998. IT MAY NOT BE YOUR JFK MOMENT BUT IT MAY HAVE BEEN SOMETHING THAT WE CAN RECOGNIZE CHANGING SOME ELEMENTS OF SCIENCE AND HEALTHCARE AND OUR UNDERSTANDING OF HOW THE SCIENTIFIC PROCESS WORKS. I DON'T REMEMBER THE DAYS EXACTLY BUT I REMEMBER THE TIME AND I REMEMBER BEING AROUND AS THESE EVENTS UNFOLDED. I JUST GOT MARRIED AND PRINCESS DIANA DIED, THOSE TWO EVENTS CLOSELY LINKED. WE WERE SIMILAR AGE. I WAS WORKING WITH A TEAM OF PEOPLE TO CREATE A THING WHICH HAS BECOME CLINICAL EVIDENCE WHICH IS A COMPENDIUM OF MEDICAL EVIDENCE. WE'RE ABSORBED IN THE EVIDENCE-BASED CRITICAL APPRAISAL AGENDA. I WAS A -- BECOMING I SUPPOSE TO BE AN EXPERT IN EVIDENCE BASED MEDICINE SO I WAS INTERESTED IN WHAT WAS BEING TALKED ABOUT WHEN THIS PAPER WAS PUBLISHED. THE PAPER REPORTED 1 CHILDREN, REFERRED TO A PEDIATRIC GASTROENTEROLOGY CLINIC IN LONDON WITH BOWL SYMPTOMS AND LOSS LOSS OF AQAIRED SKILLS. -- ACQUIRES SKILLS. 11 OUT OF 12 HAD EVIDENCE ACCORDING TO PAPER OF INFLAMMATORY REACTION IN THEIR BOWEL. PARENTS WERE ASKED WHETHER THEY SUSPECTED A LINK WITH MMR AND 8 OF THE PARENTS FAMILIES SAID THAT ONSET OF DEVELOPMENT DELAY OCCURRED WITHIN TWO WEEKS OF MMR VACCINE AND IN THREE CHILDREN THE ONSET WAS WITHIN 48 HOURS AS REPORTED IN THE PAPER. THE PAPER SAYS WE DID NOT PROVE ASSOCIATION BETWEEN MMR VACCINE AND THE SYNDROME DESCRIBED BUT AS MANY OF YOU KNOW AT THE PRESS CONFERENCE WHEN THE PAIRP WAS PUBLISHED, ANDREW WAKEFIELD SAID THERE WAS SUFFICIENT FOUGHT DO YOU THINK IN MY OWN MIND FOR CASE TO BE MADE THAT THE VACCINES BE GIVEN INDIVIDUALLY AT ONE YEAR INTERVALS. I REMEMBER THINKING WHAT IS GOING ON HERE, WHY IS HE SAYING THAT? WHY ARE PEOPLE LISTENING BASED ON WHAT IS BEING PUBLISHED? THE MEDIA RESPONSE WAS INITIALLY SOBERING IN THE UK. I DON'T KNOW ABOUT IN AMERICA. THERE WAS A LOT OF EMPHASIS ON THE LACK OF EVIDENCE FOR LINK AND PRIET EYE WHICH IS A KIND OF SATIRECAL MAGAZINE, OUT OF NATIONAL BAD SCIENCE WEEK BASED ON THIS PUBLICATION. BUT BY 2002 THINGED CHANGED. AND THE PRESS IN THE UK HAD REALLY PARTS OF PRESS BECOME EXTREMELY INTERESTED IN LOOKING AT CONTROL AND LOOKING FOR THE TRUTH AND PRIVATE EYE ALSO CHANGED ITS TUNE AND RAN A 32 PAGE JOURNALISTIC EXPOSE OF THE WHOLE MMR VACCINE REALLY IN SUPPORT OF WAKEFIELD SAYING HE WAS REALLY PUSHING FORWARD IMPORTANT THINGS AND THERE HADN'T BEEN ENOUGH RESEARCH INTO THE SAFETY OF MMR. SO THERE WE GO. THINGS MOVED ON. I HAD MY FIRST CHILD. I REMEMBER THE DECISION TO GIVE HIM AN MMR VACCINE. HOW DO I GO BACK? BACK. BACK. BACK. AND MY HUSBAND WAS HORRIFIED WHEN I HAD A GLIMPSE OF PAUSE WHEN THE DECISION WAS TO BE MADE. WE ALL KNOW THE EVIDENCE BUT WHEN IT COMES TO THE EMOTIONAL SIDE YOU DO QUESTION THESE THINGS AND I RECOGNIZE MANY, MANY FAMILIES AROUND THE UK IN PARTICULAR BUT AROUND THE WORLD WERE MAKING THAT DECISION AND IT WASN'T EASY, HAVING FAMILIAR WITH THE EVIDENCE. AND CONFIDENCE WAS ERODED. MMR VACCINATION RATES IN THE UK PLUM METED TO A LOW OF 80% IN 2003 AND IN 2008 MEAS LES ENDEMIC WAS DECLARED IN ENGLAND AND WAILS FOR THE FIRST TIME IN 14 YEARS, MEASLES. A NUMBER DID DIE THOUGH NUMBERS WERE SMALL. AT THAT STAGE THERE WAS STILL FEW DEATHS THANKFULLY. THIS ALL HAPPENED DESPITE VERY HARSH CRITICISM OF THE PAPER AND I THINK WHAT'S INTERESTING HERE IS THAT UNLIKE A PREVIOUS VACCINE SCARE, THE DTP CARE IN THE '70s AND '80s DURING WHICH THE MEDICAL PROFESSION WAS DIVIDED AND DOCTORS AND SCIENTISTS FELT EVIDENCE OF A LINK. IN THIS CASE THE MEDICAL PROFESSION IN THE UK AND PERHAPS GLOBALLY WAS VERY UNITED IN ITS STRENGTH STANDING FIRM ON THE EVIDENCE SAYING THERE WASN'T AN EVIDENCE OF A LINK. BUT THEIR VOICE WAS STRANGELY MUTED AND IN IN INEFFECTIVE AGAINST THIS KIND OF MEDIA ONSLAUGHT. AS FOR THE JOURNALS, VERY INTERESTING TO LOOK AT WHAT THE JOURNALS DID. THE LANSETT ITSELF RATHER APPALLED, I CAN'T SPEAK FOR THEM BUT I IMAGINE IT WOULD HAVE MUST HAVE BEEN A HORRIBLE TIME FOR EDITORS OF THE LANSETT. AND THEY PUBLISHED A LOT OF STUFF THAT COUNTER ACTED THE WEIGHT OF THE PAPER AND PROVIDED EVIDENCE OF THERE NOT BEING A LINK. AND THE BMJ II PUBLISHED A NUMBER OF PAPERS AND THERE WAS EVIDENCE IN SWEDEN FROM FINLAND, ENGLAND, A NUMBER OF STUDIES. REALLY I WON'T GO THROUGH THEM, SURE MANY OF YOU ARE FAMILIAR. I SHOW YOU THIS BECAUSE IT HAS A PICTURE IN THE BMJ. THIS IS BY 2001. SO OVER THAT PERIOD OF TIME BETWEEN 1998 AND 2001, A LOT OF EVIDENCE WAS BEING REPORTED WHICH SHOWED THAT, AS FAR AS YOU CAN PROVE A NEGATIVE THAT THERE WAS NO LINK. THIS SHOWS NO CORRELATION BETWEEN MMR VACCINATION AND RISK OF AUTISM OVER TIME SO JUST A TIME SERIES. BUT IT WAS ONE OF MANY PIECES OF EVIDENCE WHICH REALLY BEGAN TO -- WITHIN THE SCIENTIFIC COMMUNITY, CONFIRM THAT BELIEF THAT THERE REALLY WAS NO RISK. THE YEAR THE PAPER WAS PUBLISHED ANDREW WAKEFIELD WAS SACKED OF THE ROLE. I WASN'T AWARE AT TIME AND BECAME AWARE MORE RECENTLY. IT WAS DONE QUIETLY, I THINK THE PEOPLE WERE KEEN THAT HE NOT BE THERE AND A DEAL WAS MADE AND HE DEPARTED. BUT AS I UNDERSTAND IT NOW THE REASON FOR THAT DEPARTURE WAS THAT HE HAD DECLINED, REFUSED CONSISTENTLY REFUSED TO ATTEMPT TO REPEAT THE STUDY THAT WAS PUBLISHED IN THE FUND IN A GIVEN TIME AND HE REFUSED TO DO IT AND DE FACTO. IN 2004 NEWS EMERGED OF SOME ALLEGATIONS ABOUT THE PAPER OF WHICH YOU'LL BE FAMILIAR WITH. PUBLISHED IN THE SUNDAY TIMES BY BRIAN DEER, AN INVESTIGATIVE JOURNALIST WORKING FOR THE SUNDAY TIMES WHO UNEARTHED EVIDENCE THAT WAKEFIELD WAS PAID BY A LAWYER TO FIND A LINK BETWEEN THE MMR VACCINE AND SYNDROME. AND RECRUITMENT OF THE STUDY HE ALLEGED WAS RIGGED. HE THOUGHT IT WAS EXTRAORDINARY THESE CHILDREN SHOULD ALL PRESENT IN A CONSECUTIVE SERIES SO-CALLED WITH THESE SERIES OF THIS KIND OF SYNDROME THAT SEEMED TO BE BEING DESCRIBED. SO THE INSTITUTION LOOKED INTO IT, AS WE GATHERED. AND CLEARED WAKEFIELD OF ALL BUT ONE ALLEGATION, THE CONFLICT OF INTEREST PAYMENT BY THE LAWYER AND STATEMENTS WERE PUBLISHED IN THE LANSETT AND TO THE PRESS AND A FEW WEEKS LATER THIS IS A STATEMENT FROM THE MEDICAL SCHOOL HUMPHREY HODGESON, VICE DEAN SAYING HE WAS COMPETENT IT WAS ALL FINE, NOTHING TO WORRY ABOUT. AND THESE STATEMENTS ARE STILL HAVE NOT YET -- HAVE NOT BEEN RETRACT FROM THE LANSETT WEBSITE SO THAT LEFT THE STUDY THERE WAS A RETRACTION A FEW WEEKS LATER OF THE INTERPRETATION OF THE STUDY. SO THE IDEA THAT THERE HAD BEEN AN IMPLICATION OF A LINK WITH THE MMR VACCINE WAS RETRACTED, IT WAS A PARTIAL RETRACTION BUT THAT LEFT A STUDY ITSELF, THE INFORMATION, THE DATA, THE PATIENT DATA, THE SUMMARIES, OF ALL THE PATIENT INFORMATION STILL STANDING. THAT WAS IN 2004. THE SCARE CONTINUED. I THINK IT'S FAIR TO SAY IT WAS FROM THE PERIOD ON FROM 2004 ONWARD THAT THE IMPACT OF THE VACCINE SCARE SPREAD OUTSIDE THE UK TO LARGELY A UK EVENT UNTIL THEN. AND CERTAINLY IN THE UK, WE HAD ONGOING CONCERN ABOUT VACCINATION RATES FALLING DESPITE EFFORTS FROM THE GOVERNMENT TO REASSURE PEOPLE. MEANWHILE, WAKEFIELD HIMSELF MOVED TO THE U.S. TO CONTINUE HIS WORK AND THE UK'S GENERAL MEDICAL COUNCIL IN RESPONSE TO THE BRIAN DEER INVESTIGATION EMBARKED ON WHAT TURNED OUT ITS LONGEST EVER HEARING OF 217 DAYS IN ALL FROM JULY 2007 TO MAY MAY 2010. AT THE END OF THE HEARING, THEY CONCLUDED THAT ALL OF BRIAN DEER'S ORIGINAL ALLEGATIONS WERE PROVEN AND AGAINST THE CRIMINAL STANDARD OF PROOF THEY FOUND WAKEFIELD GUILTY OF FOUR COUNTS OF DISHONESTY AND ACTS OF CRUELTY AND DISREGARD FOR THE VULNERABLE CHILDREN IN HIS CARE. SO ALMOST EXACTLY 12 YEARS AFTER THE PAPER WAS PUBLISHED, THE LANSETT RETRACTED THE PAPER IN FEBRUARY 2010. THIS IS WHERE THE BMJ COMES IN BECAUSE IN SYSTEM WAYS BMJ IS A KIND OF LIKE THE OTHER, LIKE A BYSTANDER ON THIS, I SPOKE TO JEFF RAVEN THE OTHER DAY OF THE NEW ENGLAND JOURNAL, THEY HAVE A POLICY THAT IT DOESN'T COMMENT ON THINGS PUBLISHED IN OTHER JOURNALS. WHICH I THINK WITH INTERESTING. THIS ISN'T IT SETS THE NEW ENGLAND JOURNAL TO BECOME A UNIVERSE UNTO ITSELF, PUBLISH IN OUR JOURNAL AND PEOPLE CAN COMMENT ON WHAT WE PUBLISH BUT WE'RE NOT INTERESTED IN WHAT'S GOING ON ELSEWHERE. I THINK THAT'S AN ODD APPROACH AND I SAID THAT TO JEFF. BECAUSE THIS IS STUFF THAT IS IMPORTANT AND WE CAN'T IGNORE IT. AND OTHER JOURNALS I THINK DO HAVE A RESPONSIBILITY TO REFLECT ON WHAT IS GOING ON IN THEIR COLLEAGUES' WORK. IT IS A DIFFICULT RELATIONSHIP, IT'S A DIFFICULT SITUATION BECAUSE WE ARE COLLEGIAL AS THE RESEARCH IS COLLEGIAL, THE JOURNALS ARE COLLEGIAL, WE LIKE IT LIKE THAT BUT I CAN'T ALWAYS BE LIKE THAT I'M AFRAID. SO I ASKED BRIAN DEER, I WAS CONFUSED. I SAID WELL, HOW COME THE GMVC HAVE FOUND THAT ALL THESE THINGS ARE PROVEN WHEN THE INVESTIGATION THAT THE LANSETT AND THE WORLD UNDERTOOK AT THE TIME IN 2004 WHEN THE ALLEGATIONS FIRST CAME TO LIGHT FOUND THEM NOT PROVEN AND DID THEY HAVE THE SAME INFORMATION AND HOW COME -- AND BRIAN SAID THERE WAS NO INVESTIGATION. AND BY THE WAY, THE ARTICLE IS A FRAUD. BY THE WAY, WAKEFIELD WAS IN IT TO MAKE A LARGE AMOUNT OF MONEY. AND I WAS COP SMACKED. I WAS SUBSEQUENTLY MADE AWARE THAT A LOT OF THIS INFORMATION WAS IN THE PUBLIC DOMAIN, ON BRIAN DEAR'S WEBSITE, HE WAS UNDER A VERY THOROUGH JOB OF RECORDING HIS INVESTIGATION AS HE'S GONE ALONG. I CERTAINLY WASN'T AWARE OF THIS. AND I EXPECT OTHER PEOPLE WEREN'T AWARE. SO AS I SAY, IT SEEMED IMPORTANT. SO WE ASKED BRIAN DEER TO WRITE THREE ARTICLES FOR US. THE FIRST ONE WAS ON THE SCIENTIFIC FRAUD, THE SECOND ON THE MONEY, AND THE THIRD ON THE THE NON-INVESTIGATION. HE ALSO HAD PREVIOUSLY WRITTEN EARLIER ON IN THE MIDDLE OF 2010 AN ARTICLE RELATING TO THE GASTRO INTESTINAL PATHOLOGY OF THE 12 CHILDREN AND THE WAY IN WHICH THE PATHOLOGICAL REPORT HAD BEEN ADAPTED, ADOPTED, ALTERED IN ORDER TO GIVE THE IMPRESSION OF A SYNDROME. NOW, AS YOU CAN IMAGINE, A HUGE AMOUNT OF WORK IS BEING COMPRESSED TO THESE FOUR ARTICLES. BRIAN DEER'S WORK MAINLY HIS LIFE'S WORK YOU COULD ARGUE. BUT ALSO TO BMJ'S AND WE COULD SAY ON TOP OF THE SEVEN YEARS OF VAIX UNDERWRITING WHICH IS AN ENORMOUS PIECE OF OF WORK THERE WAS INTENSE DISCUSSIONS WITHIN THE BMJ WHETHER WE SHOULD DO IT AT ALL. AS I HAVE SAID, IT FELT RATHER AWKWARD AND A HASTE OF WASTE, IS IT RIGHT WE SHOULD BE GOING INTO INVESTIGATIVE JOURNALISM? I THINK IT IS RIGHT BUT THERE ARE PEOPLE WHO DON'T THINK IT IS THE RIGHT THING TO DO WHO THINK IT'S NOT THE JOB OF THE MEDICAL JOURNAL. THEN IN ADDITION TO THAT DISCUSSION THERE WAS THE FACTUAL CHECKING, THE LEGAL CHECKING AND PEER REVIEW WHICH TOOK MONTHS. WHAT THESE ARTICLES SAID IN BRIEF, IF YOU READ THEM I APOLOGIZE FOR TELLING YOU THINGIOUS KNOW, BUT IT IS IMPORTANT. WHAT THEY SAID IN BRIEF WAS WAKEFIELD HAD BEEN HIRED BY A LAWYER, WITH THE LAWYER IN 1996, TWO YEARS BEFORE THE LANSETT PAPER WAS PUBLISHED. HE APPLIED FOR A GRANT FROM THE LEGAL SAID BOARD IN THE UK. IN THAT GRANT APPLICATION THEY STATED THAT THERE WAS A NEW SYNDROME LINKED TO MMR VACCINE AND THEY WOULD UNDERTAKE RESEARCH TO CONFIRM THIS. THAT WAS IN 1996. THE ARTICLE ALSO SAID BY VARIOUS MEANS WAKEFIELD PRE-SELECTED THE CHILDREN IN ORDER THEY MIGHT HAVE THE THREE NECESSARY ELEMENTS OF THE SYNDROME AND THE LINK WITH MMR. IN ORDER THAT THE LAWSUIT WOULD SUCCEED AND IN ORDER THAT HE WOULD HAVE I THINK -- THERE WAS A LOT OF PERSONAL AMBITION TO DO WELL OBVIOUSLY. HEZ THREE THINGS WERE INFLAMMATORY BOWEL PROBLEMS, REGRESSIVE PROBLEMS AND THE PARTIAL CLAIM THE MMR WAS THE UNDERLYING CAUSE. WHAT THESE ARTICLES ALSO SAY IS THAT WHEN THOSE THREE THINGS DIDN'T COME UP TRUMP FROM THE 12 CHILDREN INCLUDED AN SUBSEQUENT SERIES OF CHILDREN, ANDREW WAKEFIELD ALTERED THE DATA TO MAKE THOSE THREE ELEMENTS EMERGE. THE ARTICLE SAY IT IS SOURCE OF FUNDING FOR THE RESEARCH AND THE FACT OF SUBSTANTIAL DIRECT PAYMENTS TO WAKEFIELD HIMSELF, HE RECEIVED $435,000 PLUS EXPENSES OVER THE PERIOD OF TIME WHEN HE WAS IN THIS LAWYER'S EMPLOY OR NOT EMPLOY BUT RELATIONSHIP WITH. THESE FUNDING SOURCES AND PAYMENTS WERE NOT DECLARED IN THE PAPER. ALSO SAY THAT WICKFIELD DID NOT HAVE ETHICS APPROVAL FOR THE BATTERY OF INVASIVE TESTS INFLICTED WHICH WERE NOT CLINICALLY INDICATED OR IN THE CHILDREN'S BEST INTEREST. NONE OF THE PARENTS COMPLAINED AGAINST ANDREW WAKEFIELD. THEY WANTED -- THEY WERE EAGER THAT HE SHOULD HELP TO INVESTIGATE THEIR CHILDREN. SO THESE -- THIS IS NOT A COMPLAINT AGAINST -- THE PARENTS HAVE NO COMPLAINT BUT THE CHILDREN THEMSELVESES ARE VULNERABLE AND IS THERE IS A QUESTION ABOUT WHAT IS THE RIGHT APPROACH TO EBB ENSURING INVESTIGATIONS ARE CLINICALLY APPROPRIATE TO THE CHILDREN REGARDLESS PERHAPS OF THE PARENTS' WISHES. AND THEY ALSO SAY THESE ARTICLES THAT WAKEFIELD HAD ELABORATE SECRET BUSINESS SCHEMES TO EXPLOIT THE MMR SCARE COMMERCIALLY THROUGH DIAGNOSTIC PRODUCTS AND A SINGLE MEASLES VACCINE 8 MONTHS BEFORE THE ARTICLE WAS PUBLISHED AND THIS REPRESENTED A SERIOUS CONFLICT OF INTEREST. OBVIOUSLY A LOT OF THE -- AS I SAY, COMPRESSED INFORMATION IN THESE LANSETT ARTICLES, WE HAVE STRUGGLED TO FIND WAYS BRIAN DEER AND BMJ TO MAKE THEM AS READABLE AND AS APPROPRIATE AS POSSIBLE. A LOT OF DATA BEHIND THEM ARE IN EXTRA SHEETS. IN SUMMARY THERE'S A BOX ON THE FIRST PAPER THAT SUMMARIZES THE EVIDENCE AROUND THE FALSIFICATION OF THE DATA. THE OFFICE OF RESEARCH INTEGRITY, I DON'T KNOW IF YOU KNOW, HAS A DEFINITION OF FRAUD WHICH CONSISTS OF PLAGIARISM, FALSIFICATION AND FABRICATION. THE END OF THIS DISCUSSION WITH BRIAN DEER WE WERE CLEAR THIS WAS A CASE OF FALSIFICATION OF DATA AS OPPOSED TO FABRICATION AND DID CONSTITUTE SCIENTIFIC FRAUD. SO WHAT THE IN SUMMARY WHAT THE DATA MANIPULATION AND SUPPRESSION AND FALSIFICATION CONSISTED OF, WAS THAT THOUGH THREE OF THE NINE CHILDREN -- THREE OF NINE CHILDREN REPORTED REGRESSIVE SYNDROME BUT DID NOT HAVE AUTISM DIAGNOSED AND ONE CHILD HAD REGRESSIVE AUTISM. THE PAPER CLAIMED ALL 12 CHILDREN AND FIVE DOCUMENTED PR EXISTING CONCERN. SOME EXPERIENCEND BEHAVIORAL WITHIN DAYS OF THE MMR BUT THE RECORD STARTING AFTER VACCINATION. HITS PATHOLOGY RESULTS, INFLAMMATORY CELL POPULATION CHANGED AFTER MEDICAL SCHOOL SO-CALLED RESEARCH REVIEW TO NON-SPECIFIC COLITIS. AND THE PAM OF 8 CHILDREN BLAMING MMR BUT 11 FAMILIES MADE THE INVESTIGATION, THIS IS AN INTERESTING POINT. AND THE EXCLUSION OF THREE ALLEGATIONS, ALL GIVING TIME ONSET OF PROBLEMS IN MONTHS RATHER THAN WEEKS. HELP TO CREATE THE APPEARANCE OF A 14-DAY TEMPORAL LINK. 'S A FASCINATING POINT. FINALLY AS SAID, PARENTS WERE RECRUITED THROUGH ANTI-MMR CAMPAIGN AND THE STUDIED DIWAS COMMISSIONED AND FUNDED FOR PLANNED IDENTIFICATION. ALSO THE PAPERS -- TABLES IN THE PAPER WHICH COMES FROM OTHERS AVAILABLE IN MORE DEPTH AND WITH A VERY EXTENSIVE REFERENCING FROM BRIAN DEER. REALLY WHAT IT SHOWS IS THE 12 CHILDREN COMPARING THE FEATURES DESCRIBED IN THE LANSETT ARTICLE WITH THOSE AVAILABLE THROUGH THE CHILD'S RECORDS. AS YOU'LL SEE AT THE BOTTOM HERE THE LANSETT ARTICLE SUGGESTS THAT NINE OF 12 HAD REGRESSIVE AUTISM WHEN REVIEW OF THE RECORDS SEEMS TO SUGGEST THAT IT'S 6 OUT OF 12. LANSETT SUGGESTED 11 OUT OF 12 HAD NON-SPECIFIC COLITIS BUT THE RECORD SUGGESTED 3 OUT OF 12. IN TERMS OF SOANT OF SYMPTOMS IN RELATION TO MMR VACCINE, 8 OUT OF 12 SAID HAPPENED WITHIN DAYS BUT IN FACT WHEN BRIAN INTERVIEWED PATIENTS AND LOOKED AT RECORDS IT GETS DOWN TO ABOUT 2 OUT OF 12. WHEN YOU LOOK AT WHETHER ALL FEATURES WERE EXISTING IN THE 12 CHILDREN FROM -- WE HAVE 6 OUT OF 12 IN ALL THE LANSETT PAPER AND NONE OUT OF 12 IN REALITY. GOING BACK TO THE FASCINATING TO ME POINT ABOUT THE TIME INTERVAL AND, OR SORRY, THE BLAMING OF THE MMR VACCINE, THE FACT THAT 11 OUT OF 12 PARENTS DID BLAME THE VACCINE IS NO SURPRISE, THESE PARENT VERSUS COME FROM VACCINE CAMPAIGN ANTI-VACCINE CAMPAIGNS AND SEVERAL WERE KNOWN TO EACH OTHER AND REFERRED ON BY EACH OTHER TO SEE ANDREW WAKEFIELD BUT OBVIOUSLY AN OBVIOUS THING FOR PEER REVIEWER TO SPOT THE 11 OUT OF 12 BLAMING, THE TOO GOOD TO BE TRUE SIGNALS WHICH START FLAIRING. IN ADDITION TO WHICH, ACTUALLY ALTHOUGH THE 11 OF 12 FAMILIES BLAMED THE VACCINE, SEVERAL WERE QUITE EXTENSIVE INTERVALS. , SIX MONTHS OR SOMETHING AFTER THE VACCINE OR YEARS IN SOME CASES. SO BY CUTTING OUT SOME OF THESE PEOPLE THE LINK WAS TIGHTER IN TERMS OF TIME. AND A VERSION OF PAPER SIX MONTHS BEFORE PUBLICATION HAVE NINE OUT OF 11 WITH A MAXIMUM TIME INTERVAL OF 56 DAYS BETWEEN MMR AND SYMPTOMS. AND THE FINAL ARTICLE HAD 8 OUT OF 11 SO ONE MORE DROPPED WITH A MAXIMUM INTERVAL OF 14 DAYS, MEANTIME WAS REDUCED FROM 14 DAYS TO 6.3 DAYS IN THE FINAL ARTICLE. SO YOU CAN DOCUMENT SUCCESSION VERSION OF THE ART BRINGING THAT TIME LINK DOWN TO THE LINK THAT WAS NEEDED FOR ILLEGALLY COMPEL -- A LEGALLY COMPELLING CASE WHICH WOULD BE A MAXIMUM OF 14 DAYS AND IN THIS CASE AN AVERAGE OF 6.3 DAYS. MAY ASK AN OBVIOUS QUESTION. WHY ARE WE SHOCKED BY THIS? SPEAKING FOR MYSELF IT'S AN OBVIOUS BREACH OF TRUST AND SCIENCE EXISTS ON TRUST. AND WE ENGAGE IN SCIENCE, VARIOUS CAPACITIES TO TRY TO IMPROVE THE LOT OF MAN KIND AND FELLOW BEINGS ON THIS EARTH YOU MIGHT SAY. AND THE IMPACT OF THIS BREACH OF TRUST ON PUBLIC HEALTH ON PEOPLE WITH AUTISM AND THEIR FAMILIES AN ON SCIENCE AS A WHOLE IS BEING CONSIDERABLE. WE DONE WANT TO BELIEVE THAT THIS KIND OF THING CAN HAPPEN BECAUSE IT MAKES LIFE COMPLEX AND IT GOES AGAINST A LOT OF OUR NATURAL TENDENCIES. THE QUOTE I QUOTED IN THE EDITORIAL FROM BUD ROMAN, WHO USED TO BE EDITOR OF THE NEW ENGLAND JOURNAL WHOA HAD TO DEAL WITH A NUMBER OF SCIENTIFIC FRAUDS DURING HIS TIME, SINCE SCIENCE IS THE QUESTIONING AND SKEPTICAL OF ACTIVITIES AND THE MOST TRUSTING. IT'S SKEPTICAL ABOUT THE POSSIBILITY OF ERROR BUT TOTALLY TRUSTING ABOUT THE POSSIBILITY OF FRAUD. I THINK THAT SAYS A LOT ABOUT WHAT WAS GOING ON HERE. THAT THE DATA FROM 2004 STOOD AND PEOPLE WERE ABLE TO CONTINUE TO BELIEVE THE DATA THEMSELVESES WERE TRUE IN THIS PAPER BECAUSE THE IDEA THEY MIGHT BE FRAUDULENT HADN'T OCCURRED TO PEOPLE. NOW, A LOT IS BEING MADE BY THE BMJ AND BY OTHERS OF THE FACT THAT IT WAS SOMEONE OUTSIDE SCIENCE OUTSIDE THE SCIENTIFIC COMMUNITY WHO DID THINK ABOUT THE POSSIBILITY OF FRAUD. WITHOUT THAT PERSON AND TYPE OF THINKING WE WOULDN'T BE IN THE POSITION WE ARE TODAY. I THINK IT'S INTERESTING TO US TO UNDERSTAND HOW THE CASE UNFOLDED AND HOW BRIAN DEER'S INVOLVEMENT CAME ABOUT. BRIAN IS AN EXPERIENCED MEDICAL INVESTIGATIVE JOURNALIST PUT ON TO THE MMR CASE BY EDITOR AT THE SUNDAY TIMES. DEER I THINK BRIAN DEER THOUGHT IT WOULD BE A ONE-OFF INVESTIGATION. HE HAD DONE VACCINES ALREADY, AND WANTED TO MOVE TO OTHER THINGS BUT HE WEPT ON AND DID THIS. HE PREVIOUSLY INVESTIGATED THE DTP VACCINE SCARE. BECAUSE OF THAT, VARIOUS ASPECTS OF THE LANSETT PAPER RANGE BELLS WITH HIM AND MADE HIM IMMEDIATELY SUSPICIOUS. IT WAS I THINK A LOT OF PEOPLE AGREED IMMEDIATELY ON PUBLICATION OF LANSETT, POOR SCIENCE BUT TO BRIAN'S MIND THERE WERE THINGS TOO GOOD TO BE TRUE, THAT SIGNAL THAT MADE ONE THINK WHAT'S GOING ON HERE. ALMOST ALL THESE CHILDREN WHO ARE REFERRED APPARENTLY AS CONSECUTIVE CASES WITH BOWEL PROBLEMS ENDED UP HAVING ALMOST IDENTICAL OR SIMILAR VERY SIMILAR HISTOLOGICAL CHANGES IN THEIR BOWEL. AND THE HIGH PROPORTION OF PARENTS BLAMING THE VACCINE WAS A BIT OF A SIGNAL AND THIS NEAT MAXIMUM 14 DAYS TIME LINK, INTERESTING THE DTP VACCINE WAS LINKED WITH A SIMILAR THING. I THINK THAT MADE BRIAN THINK THIS IS -- THIS SOUNDS -- GIVEN THE FACT THE VACCINES WORK IN DIFFERENT WAYS THIS DOESN'T SEEM TO MAKE SENSE. SO HE UNCOVERED THE LINK WITH THE LAWYER AND THE ANTI-VACCINE CAMPAIGN GROUP AND FOUND NONE OF THE FAMILIES WERE FROM LONDON DESPITE THE ROLE HAD NO REPUTATION IN THIS AREA AT THE TIME. THROUGH THE FREEDOM OF INFORMATION ACT INTRODUCED IN 2000 IN THE UK HE TRACKED DOWN ETHICS COMMITTEE REPORTS AND OTHERS THAT SHOWED THE LAN SETS 12 CHILDREN HAD BEEN INVESTIGATED UNDER COVER OF A DIFFERENT STUDY SO NO ETHICAL APPROVAL OF THE STUDY REPORTED IN THE LANSETT. THEN WHEN HIS FINDINGS WERE PUBLISHED IN THE SUNDAY TIMES AND WAS A TELEVISION DOCUMENTARY MADE, ANDREW WAKEFIELD DECIDED TO SUE HIM. THAT COULD HAVE BEEN ANDREW'S BIG MISTAKE BECAUSE IT MEANT THAT BRIAN DEER WAS GIVEN ACCESS BY LEGAL PROCESS TO ANDREW WAKEFIELD'S DOCUMENTS. NOW, HE COULDN'T USE THEM EXCEPT IN THE CONTEXT OF THE LEGAL CASE. HE COULDN'T USE THEM EXCEPT TO DEFEND HIMSELF. WHEN THE GMC TOOK THE CASE FORWARD AND REQUISITIONED THE CHILDREN'S NOTES ALL THAT INFORMATION WAS PLACED IN PUBLIC DOMAIN, A LOT WAS PLACED IN PUBLIC DOMAIN. BRIAN DEER WAS UNABLE TO USE THE HE HAD TO DRAW THIS TO EVERYONE'S ATTENTION. SO IF YOU BACK TO HOW WAS HE EXPOSED, FOUR THINGS SEVERAL HE COULDN'T HAVE PREDICTEDCH ONE, A SKILLED INVESTIGATIVE JOURNALIST WAS PUT ON THE CASE, THIS TURNED OUT TO BE THE MOST EXTENSIVE MEDICAL INVESTIGATIVE JOURNALISM EVENT EVER. THE SECOND WAS THE FREEDOM OF INFORMATION ACT HAD COME IN IN 2000. THIS CHANGED A LOT OF THINGS FOR A LOT OF PEOPLE AND MADE INVESTIGATIVE JOURNALISM IN THE UK POSSIBLE IN A WAY LONG BEEN POSSIBLE IN THE US. THE THIRD WAS WAKEFIELD'S DECISION TO SUE BRIAN DEER, WHICH FORCED BRIAN TO KEEP DIGGING IN HIS OWN DEFENSE. I THINK OTHERWISE HE MIGHT WELL HAVE BEEN HAPPY TO WALK AWAY. I DON'T KNOW, YOU HAVE TO ASK HIM T. FOURTH THING WAS THE GMC DECISION TO TAKE UP THE CASE WHICH PUT THE INFORMATION INCLUDING 11 OF 12 CHILDREN'S MEDICAL NOTES, MEDICAL INFORMATION, INTO THE PUBLIC DOMAIN. BUT ONE STILL HAS TO ASK THE QUESTION, WHY DID IT TAKE SO LONG? OTHER RECENT SCIENTIFIC FRAUDS HAVE BEEN MUCH MORE QUICKLY UNCOVERED. ANOTHER LANSETT PAPER BY JOHN (INAUDIBLE) A CANCER RESEARCHER IN OSLO, HIS INSTITUTION PUBLISHED THE RESULTS WITHIN MONTHS OF THE WHISTLE BEING BLOWN. SCOTT REUBEN IS AN ANESTHESIOLOGIST AT BAY STATE MEDICAL CENTER IN SPRINGFIELD, MASSACHUSETTS, HE RECENTLY COMPLETED SIX MONTHS IN JAIL FOR HEALTHCARE FRAUD, TEN PAPERS RETRACTED AND A NUMBER OF OTHERS ARE UNDER INVESTIGATION. THEY STATE WERE ALERTED BY INTERNAL REVIEW AND COMPLETED ITS INQUIRY IN ABOUT A YEAR. IN OCTOBER LAST YEAR ANOTHER FRAUD HIT ANESTHESIOLOGY AFTER ONE PAPER BY THIS -- WAS RETRACKED. 200 OTHER BUSINESS THE SAME RESEARCH ARE CURRENTLY BEING INVESTIGATED. IT TOOK A YEAR FROM PUBLICATION TO RETRACTION AND DISMISSAL OF BOTH FROM HIS CLINICAL POST. A MONTHS AND ABOUT A YEAR IN THE OTHER TWO CASES INSTEAD OF 12 YEARS OR 13 IN WAKEFIELD'S CASE. I WANTED TO SEE IF ANYTHING ELSE STRIKES YOU HERE, ANY LADIES IN THE ROOM? THIS IS A JUSTIFICATION FOR MORE WOMEN IN RESEARCH. THAT'S WHAT I SAY. [LAUGHTER] >> I CAN'T -- I MUST ALSO SAY ONE OTHER REASON THAT I THINK IT TOOK TIME IS WE WERE FALSELY REASSURED. IN 2004 WHEN BRIAN DEER TOOK ALLEGATIONS TO THE LANSETT AND THE LANSETT LOOKED AT THEM, THEY DIDN'T DO AN INVESTIGATION AS WE WERE TOLD THEY HAD DONE. THEY DID WHAT I THINK ONE COULD SAY WAS A SCRAMBLE REALLY, TO BRUSH THIS UNDER THE CARPET AND PROTECT REPUTATIONS. I THINK THAT IS SOMETHING WHICH WE REALLY DO HAVE TO -- KNOWLEDGE HAPPENED -- ACKNOWLEDGE HAPPENED AND MAKE SURE IT DOESN'T HAPPEN AGAIN. SO THE ARTICLES WERE PUBLISHED IN THE BMJ AND WE WERE AWARE IT MIGHT SEEM LIKE AN OLD STORY BUT I HAVE TO SAY WE WEREN'T SURPRISED BY THE ALMOST COMPLETE LACK OF ANY INTEREST IN THE UK, I THINK IT WAS ABOUT A PARAGRAPH IN THE TELEGRAPH. JUST NOTHING, THE PRESS DIDN'T TAKE IT UP, THE TELEVISION MEDIA DIDN'T TAKE IT UP. THIS COMPARED WITH A REAL STORM I THINK FROM SPEAKING FROM ACROSS THE ATLANTIC, A STORM OF INTEREST IN AMERICA. WE HAD CNN ON TO IT, WE HAD AN EDITORIAL IN THE NEW YORK TIMES AND WALL STREET JOURNAL, UNPRECEDENTED I THINK IT'S FAIR TO SAY FOR THE BMJ. BUT ALSO RUSSIA, WE HAD AL JAZZEERA, COVERAGE RIGHT ACROSS EUROPE AND STRAIL I CAN'T RECOLLECT IT WAS A GLOBAL PHENOMENON EXCEPT FOR THE UK. RATHER STRANGE. IN THE AFTER MATH THERE WAS LOTS OF ONLINE COMMENTS, MOSTLY HOSTILE TO THE ARTICLE AS YOU WOULD EXPECT AND MANY CLAIMING TO HAVE FOUND HOLES IN BRIAN DEER'S INVESTIGATION. THIS IS ONE OF MY FAVORITES. BMJ ADMITS FRAUD CLAIM HAS NO BASIS IN FACT, THERE WE GO. SO FAR WE'RE AWARE ONE SPELLING MISTAKE IN A REFERENCE AND ONE ERROR IN A WEB TABLE IN THE WHOLE OF BRIAN DEER'S FOUR ARTICLES IN THE BM JRK. MANY OF THE BACK -- MANY OF THE JEPTS HAVE ACCUSED BRIAN DEER OF CONFLICT OF INTEREST UNDECLARED WHICH IS NOT TRUE, I'M ENTIRELY CONFIDENT OF THAT. THE BMJ WE WERE ALSO ACCUSED OF CONFLICT OF INTEREST, IN THAT CASE IT WAS AN APPROPRIATE CHALLENGE. WE HAVEN'T THOUGHT TO DECLARE, I WAS AT FALL HERE, WE HADN'T THOUGHT TO DECLARE THE FACT THAT WE RECEIVE FUNDS FROM TWO PHARMACEUTICAL COMPANIES WHICH PRODUCE MMR VACCINE. MERCK AND GSK. THOUGH THAT MONEY COMES INTO THE BMJ PUBLISHING GROUP, THE BMJ SITS WITHIN A PUBLISHING GROUP AND THE PUBLISHING GROUP HAS A NUMBER OF COMMERCIAL RELATIONSHIPS WITH VARIOUS PEOPLE INCLUDING PHARMACEUTICAL COMPANIES AND ONE IS MERCK AND ONE IS GSK. THESE ARE ALL PROPER IN TERMS OF CURRENT STANDARDS OF THE DAY, VERY, VERY STRONG EDITORIAL DISTINCTION, NO INFLUENCE ON EDITORIAL CONTENT OR THINGS THAT MAKE ME PERSONALLY FEEL COMFORTABLE WITH THOSE RELATIONSHIPS BUT RIGHT TO QUESTION THEM AND WE PUBLISHED A CORRECTION NOT TO BRIAN DEER'S ARTICLE Z BECAUSE THEY WEREN'T CONFLICTS OF INTEREST TO HIM BUT MY ARTICLES, THE EDITORIALS I HAD WRITTEN. IT SAYS WE SHOULD HAVE DECLARED ADVERTISING SPONSORSHIP REVENUE SPECIFICALLY MERCK AND GSK, MANUFACTURE, MMR VACCINE N LONGER RESPONSE, I COULDN'T RESIST AND PERHAPS I SHOULD HAVE EXPLAINED MYSELF WHICH WE DO WHEN WE CHALLENGE FOR NOT DECLARING THEIR CONFLICT OF INTEREST AND I'M SCOFFING AND SAYING GOODNESS, YOU SHOULD HAVE DECLARED. ANYWAY, THE EXPLANATION WAS I IT SIMPLY DIDN'T OCCUR TO ME ON THREE FRONTS. ONE THE ARTICLES WERE NOT PRO VACCINE, THEY WERE ANTI-FRAUD. THE SECOND WAS THAT THESE RELATIONSHIPS ARE NOT WITHIN THE BMJ ITSELF BUT WITHIN THE PUBLISHING GROUP. WE'RE IN THIS -- THAT'S THE DISTINCTION THAT MAY NOT BE OBVIOUS TO PEOPLE BUT IT IS OBVIOUS TO ME. THIRD WHICH I DIDN'T SAY AT THE TIME BECAUSE IT THOUGHT IT MIC MAKE ME LOOK STUPID, I DIDN'T KNOW MMR WAS MANUFACTURED BY GSK OR MERCK. I DIDN'T KNOW THAT. SO AGAIN, IGNORANCE BUT IT SHOWS YOU HOW WE CAN BE CALLED OUT AND THAT'S FAIR ENOUGH. THE OTHER CHALLENGES HAVE BEEN ABOUT THE FACT THAT REPORTEDLY THERE ARE MANY PEOPLE WHO REFULLY KATEED ANDREW WAKEFEEL'S WORK. I'M AFTER AN EXTENSIVE SEARCH TALKING TO MANY PEOPLE UNAWARE OF ANY PEER-REVIEWED RESEARCH ARTICLE REPLICATED ANDREW WAKEFIELD'S WORK AND GIVEN THE TIME AVAILABLE I WON'T PRESENT THOSE TO YOU BUT I HAVE A GOOD FILE OF ARTICLES AT MY DESK WHICH ALL WITHOUT EXCEPTION ARE ABSTRACTS OR LETTERS AND THERE'S NO SUCCESSFUL PEER REVIEW PUBLICATION THAT HAS MANAGED TO REPLICATE WAKEFEEL'S WORK. INDEED THERE ARE A FEW PEOPLE WHO TRIED TO REPLICATE THE WORK AND FAILED TO DO SO. THERE'S ALSO -- THOSE HAVE BEEN PUBLISHED YOU MIGHT ARGUE THOSE WHO ARE PART OF THE CONSPIRACY THEORY IN FAVOR OF ANDREW WAKEFIELD WOULD SAY THIS IS THE ACADEMIC ESTABLISHMENT. GATHERING ROUND AND ROADING PEOPLE BACK BUT I'M NOT AT ALL CONCERNED THAT IS THE CASE. WE HAVE NO LEGAL CHALLENGE FROM ANDREW. NO PRESS COMPLAINTS. H'S BEEN GIVEN AMPLE TIME TO ADMIT OVER THE LONG PERIOD OF TIME THAT BRIAN DEER IS INVESTIGATING HIM. AN ERROR OR TO APOLOGIZE BUT HE'S DECLINED TO DO THAT. HE DECLINED AN OFFER FOR RIGHT OF REPLY IN THE BMJ BUT DECIDED TO TAKE PART IN AN EXTENSIVE PROGRAM ON BBC, A RADIO PROGRAM WHICH THE URL IS HERE AND YOU CAN LISTEN TO, IT DOES A GOOD JOB TRYING TO PIN HIM DOWN, BUT IN PARTICULAR SO CONCERNED ABOUT THE WELFARE OF THE CHILDREN, WHICH MAYBE THE CASE, HE SHOULD DO SOME PROPER RESEARCH. THAT SEEMS TO BE THE NUMBER OF THIS BUT IT'S WORTH A LISTEN AND RICHARD HEART ALSO TOOK PART IN THAT PROGRAM THOUGH HE'S DECLINED TO RESPOND TO THE BMJ. UNIVERSITY COLLEGE LONDON, RESPONSIBLE FOR THE ROYAL FREE HOSPITAL RESPONDED AND WILL NOW UNDERTAKE A FULL INVESTIGATION AND I GATHER THAT'S UNDERWAY AND LOOK FORWARD THE HEARING WHAT THAT COMES UP WITH. QUESTION IS WILL IT CHANGE ANYTHING? PARENTS ARE CHANGING BUT IT'S A SLOW BUSINESS. VACCINATION RATES STILL STRUGGLE. AS YOU KNOW IN EUROPE WE HAD A RECENT OUTBREAK OF MEASLES AND THERE'S REPEATED OUTBREAK OF MUMPS AND OBVIOUSLY AS THE COHORT OF BOYS COMING THROUGH WHO HAVEN'T HAD MUMPS VACCINATION AND ALL KIND OF INFERTILITY AND RISKS WE NEED TO KEEP AN EYE OUT FOR. AS FOR THE MEDIA, I THINK THERE HAS BEEN A SLIGHT CHANGE. MAYBE THE UK MEDIA SILENCED IN RESPONSE TO THESE ARTICLES WAS ASSESSED IN A SENSE OF AWARENESS OF THEIR OWN CONTRIBUTION, PRIVATE EYE, THE SATIRECAL MAGAZINE, A MEA CULPA, A THOUGHTFUL APOLOGY FOR THEIR PREVIOUS SPECIAL ISSUE. SO THIS MAY HAVE CHANGED THEIR VIEWS, I'M NOT SURE. IT MAY END UP BEING A TRIGGER FOR ACTION ON SCIENTIFIC MISCONDUCT IN THE UK. WE ARE BEHIND AMERICA. WE HAVE NO OFFICE OF RESEARCH INTEGRITY AND WE HAVE A BODY WHICH WAS SET UP BUT HAVE NO TEETH AND NOW HAVE NO MONEY. SO THAT'S NOT GOING TO BE MUCH USE I'M AFRAID. BUT THERE'S A RECENT PARLIAMENTARY SELECT COMMITTEE WHICH SAID THAT THE UK NEEDS TO HAVE A BODY THAT WILL TACKLE ALLEGATIONS OF MISCONDUCT. SO I'M HOPEFUL THAT THAT MAY COME TO SOMETHING. LOOKING BACK, WHY THE MESSAGE DIDN'T GET ACROSS, THERE'S A HHS OF REASONS ONE LOOKS TO. THINKING ABOUT EARLY DAYS OF THE SCARE, WHY THE GOVERNMENT DIDN'T MAKE A BETTER CASE IN THE UK TO CONTAIN THINGS. ONE HAS TO SAY NEGATIVE STUDIES ARE NOT NEWS. IN THE PLACE OF THIS SINGLE 12 CHILDREN CASE SERIES WHICH SEEM TO SUGGEST SOMETHING POSITIVE BUT DREADFUL. NEGATIVE STUDIES STRONGLY CONFIRM SOMETHING NEGATIVE BUT POSITIVE -- SORRY NEGATIVE BUT GOOD FOR HEALTH ARE NOT SUCH IMPORTANT NEWS. IT'S ALSO I THINK FAIR TO SAY VERY COMPLEX STORY. THIS IS ONE NEWSPAPER'S ATTEMPT TO EXPLAIN IT. WHY YOU MIGHT FLEE FROM THAT AND GO INTO SOMETHING MORE ENJOYABLE. SOUND BYTES ONE WAY TO DO IT BUT THAT DOESN'T REFLECT THE COMPLEXITY OF THE ISSUES. YOU HAVE YOU HAVE AN ELOQUENT ENTHUSIAST IN ANDREW WAKEFIELD. HE'S COMPELLING AND BELIEVABLE AND A INARTICULATE AND DISTRACTED SET OF OFFICIALS TRYING TO TELL PEOPLE THIS WASN'T THE CASE. AA LOAN CRUSADER AGAINST THE ESTABLISHMENT IS A COMPELLING IDEA. THE THIGH POTSIS KEPT CHANGING, -- HYPOTHESIS WAS CHANGING, WAS IT CO-ANTIBIOTICS, INFECTION, BEFORE DUG OR AFTER PREGNANCY, THE NEED TO BE A STRONG TIME LINK AND DISCUSSION ABOUT WHAT THE UNDERLYING MECHANISM MIGHT BE. THERE WAS ALSO PRE-EXISTING DISTRUST IN THE GOVERNMENT IN THE UK BECAUSE OF OUR BSE SPONGI FOARNL ACCEPT LOVETHY AND THE -- ENENCEPHALOPATHY AND THERE WAS AN EPISODE OF TO ANY BLARE REFUSING TO TELL WHETHER HE HAD HAD HIS BABIES VACCINATED OR NOT. SO THERE WERE A NUMBER OF ISSUES GOING ON IN THE UK. THE OTHER THING IS THE ROLE OF THE MEDIA IN THEIR ATTEMPT TO BE BALANCED WHEN YOU GET AN ISSUE LIKE THIS. WHAT THEY WOULD DO HAVE WAKE FIELD AGAINST THE WHOLE OF THE ESTABLISHMENT AND EQUAL AIR TIME BECAUSE THIS WAS A BALANCED DISCUSSION. THAT WENT ON FOR QUITE A LONG TIME. WE PUBLISHED A GOOD PAPER IN THE BMJ IN 2003 WHICH FOUND ONLY 23% OF PEOPLE WERE AWARE THAT THE BULK OF THE EVIDENCE FAVORED THE VACCINE. AND 53% BELIEVED THERE WAS EQUAL EVIDENCE ON BOTH SIDES. REALLY THE RESULT BECAUSE OF THIS HEAD TO HEAD APPROACH THAT THE MEDIA ADOPTED. THESE ALSO CONCLUDE RESEARCH QUESTIONING THE SAFETY OF SOMETHING WIDELY USED APPROACHED WITH CAUTION, AND LEGAL DEFINITION OF IMPARRIALITY CANNOT BE APPLIED SIMPLISTICALLY TO THIS QUESTION. THERE COMES A MOMENT WHEN THE MEDIA NEEDS TO SAY THIS IS WHERE THE BULK OFd8 THE EVIDENCE LIES AND REALLY STOP GIVING SO MUCH AIR TIME TO THE OTHER SIDE. I THINK IT'S FAIR TO SAY THAT IN THE U.S. LOOKING AT YOUR VACCINE SCARE, YOU HAVE BEEN IN THE FULL-BLOWN ERA OF THE INTERNET, IT'S AN ENTIRELY DIFFERENT STORY, ONE PROBLEM IF YOU LOOK AT MMR VACCINE THROUGH GOOGLE THE FIRST THINGS THAT COME UP ARE ALL THE CONCERN WEBSITES SAYING THERE IS A LINK. AND YOU HAVE GOT I HAVE FORGOTTEN HIS NAME, CARRIE, HIS WIFE. JIM CAREY'S WIFE WHO IS A TERRIFIC CAM PAPER AN SPEAKER. SO YOU HAVE -- CAMPAIGNER AND SPEAKER. AND THE INTERNET MAKES IT EXTREMELY DIFFICULT BATTLE TO WIN. I THINK WE NEED INVESTIGATIVE JOURNALISM AND WE NEED IT IN HEALTHCARE AS MUCH AS ANY OTHER FIELD OF ENDEAVOR. THIS IS A QUOTE FROM ONE OF MY PREDECESSORS, HUE KLEG WHO SAID A SUBJECT THAT NEEDS REFORM SHOULD BE KEPT BEFORE THE PUBLIC UNTIL IT DEMANDS REFORM THAT'S ONE THING INVESTIGATIVE JOURNALISM CAN DO, UNCOVER ISSUES, THAT ARE OTHERWISE HARD TO REACH. AND PUT THEM INTO THE PUBLIC AND MAKE THEM AWARE OF THEM. FRAUD HAPPENED AND WE CAN'T PRETEND IT DOESN'T AND WE HAVE A RANGE OF REASONS FOR NOT WANTING TO INVESTIGATE PROPERLY, INCLUDING PROTECTING THEIR REPUTATIONS. THE GENERAL MEDICAL COUNCIL DID AN AMAZING JOB BUT IT'S NOT THE RIGHT PLACE FOR THIS INVESTIGATION, 217 DAYS, 6 MILLION POUNDS, IT MAKES NO SENSE. IN THE UK WE NEED OFFICE OF RESEARCH INTEGRITY AND ONE BETTER THAN THE AMERICAN ONES, WE NEED PROPERLY FUNDED, PUBLICLY FUNDED RESEARCH, THE OFFICE OF RESEARCH INTEGRITY BUT ALL RESEARCH, WHETHER WE'LL GET THAT IN THIS CURRENT CLIMATE, NOT SURE BUT THAT'S WHAT WE PUSH FOR. INSTITUTIONS NEED TRAINING HOW TO DO THESE INVESTIGATIONS AND THEY NEED TO UNDERSTAND THEIR OWN CONFLICT OF INTEREST AND WHAT AN INDEPENDENT INVESTIGATION LOOKS LIKE. WE NEED DEFENSE FOR WHISTLE BLOWERS, ANYONE WHO LISTENS TO THIS TALK WHO IS IN SUPPORT OF ANDREW WILL SAY HE IS A WHISTLE BLOWER, HE NEEDS DEFENSE. AND YOU MIGHT SAY THAT THE HYPOTHESIS THAT A VACCINE CAUSES HARM IS ABSOLUTELY A REASONABLE HYPOTHESIS TO INVESTIGATE. I WOULD AGREE WITH THAT. ABSOLUTELY. WE HAVE TO PUT GOOD SCIENCE TO THAT KIND OF HYPOTHESIS. THAT'S NOT WHAT HAPPENED IN THIS CASE. WE NEED RESEARCH INTO THE CAUSES OF AUTISM, ONE OF THE REALLY SAD THINGS ABOUT WHAT HAD HAPPENED IS THERE'S BEEN A DISTRACTION, A DIVERSION OF ATTENTION IN FUNDS AND ENERGY AND EMOTION AWAY FROM FINDING MORE ABOUT THE CAUSE OF AWETISM AND PROVIDING FAMILIES AN PEOPLE WITH AUTISM BETTER MANAGEMENT AND CARE AND SUPPORT. I'M AWARE OF THIS STUDY THAT'S UNDERWAY, THE NATIONAL CHILDREN'S STUDY, WHICH IS GOING TO LOOK AT CHILDREN FROM BOTH FROM BEFORE BIRTH UNTIL 21 YEARS, WHICH OBVIOUSLY IS IS A LONG TIME COMING BUT IT MAY HELP, ONE PROMISING EXAMPLE OF WHAT WE MAY FIND SOME ANSWERS. NEARLY FINISHED. BUT GOING TUCK ABOUT THE WHAT COULD HAVE BEEN DONE TO PREVENT THIS. WE COULD HAVE HAD MORE VIGILANT OVERSIGHT OF BIOETHICS COMMITTEES AND BY THE INSTITUTION INVOLVED WHILE THIS WAS GOING ON. PEOPLE WERE COMPLACENT AND CARRIED ALONG BY WAKEFEEL'S PERSONALITY AND ENTHUSIASM. AND THERE WASN'T ENOUGH OVERSIGHT OR CHECKING. WE NEED CO-AUTHORS TO DO THEIR JOB HERE. ALL CO-AUTHORS I IMAGINE IN THIS ROOM. WHAT DOES IT MEAN TO BE A GOOD CO-AUTHOR IN? YOU HAVE TO CHECK THE SOURCE DATA OR IN YOUR STATEMENT OF CO-AUTHORSHIP YOU NEED TO SAY THESE ARE THE BITS I CAN TAKE RESPONSIBILITY FOR. I DIDN'T LOOK AT THESE BITS, I DIDN'T HAVE EXPERTISE HERE, THIS IS THE ONLY I CAN VOUCH FOR. IN THIS CASE THE CO-AUTHORS DID NOT FULFILL THEIR RESPONSIBILITIES. THERE'S NO ALLEGATION OF MISCONDUCT AGAINST THEM APART FROM THE OTHER TWO WHO WERE ARRAIGNED WITH ANDREW WAKEFIELD BUT THEY DIDN'T FULFILL THEIR RESPONSIBILITIES. WE NEED BETTER PEER REVIEW. THAT WOULD HAVE HELPED IN THIS CASE. AND IN THE -- BUT IN THE END IF SCIENTISTS LIED TO EDITORS WE ARE VULNERABLE. THERE'S LITTLE THAT WE CAN DO ABOUT THAT. WE CAN SUSPECT IT, INVESTIGATE IT BUT IF WE DON'T SUSPECT IN THE FIRST PLACE, WE ARE VULNERABLE. THEN WHEN ALLEGATIONS ARE MADE WE NEED PROPER TIME INDEPENDENT INVESTIGATION AND STRONGER PENALTIES FOR THOSE WHO COMMIT FRAUD. ANDREW WAKEFIELD SUFFERED, HE'S LOST HIS JOB, HAD TO MOVE TO ANOTHER COUNTRY, HE HAS LOST HIS REPUTATION. BUT MY QUESTION IS WHY IS SCIENTIFIC FRAUD NOT A CRIMINAL ACT? THAT'S A QUESTION FOR DISCUSSION. SEEMS TO ME THAT THE DAMAGE DONE BY THIS SCIENTIFIC FRAUD IS EXPENSIVE AND COULD EASILY BE CONSIDERED I THINK RESEARCH -- NO DOUBT RESEARCH IS A HUMAN ENTERPRISE VULNERABLE TO THE USUAL FLAWS OF HUMAN NATURE. WE HAVE TO HAVE TRUST BUT WE CAN'T BE COMPLAI SEN OR NAIVE. WE HAVE THE APPLY SKEPTICAL OPTIMISM TO EVERYTHING WE SEE. THERE'S A QUOTE FROM ALBERT EINSTEIN. I GATHER IT'S AT THE NATIONAL ACADEMY OF SCIENCES IN WASHINGTON D.C. T RIGHT TO SEARCH FOR TRUTH IMPLIES ALSO A DUTY. ONE MUST NOT CONCEAL ANY PART OF WHAT ONE HAS RECOGNIZED TO BE THE TRUTH. AND I THINK WE SCENIC A VERY DETERMINED EFFORT TO CONCEAL PART OF WHAT WERE REVEALED BY THE RESEARCH. I HAVE JUST TO THIS AUDIENCE WANT TO ADD AN ADDITIONAL CHALLENGE BECAUSE YOU'RE INTERESTED IN VACCINES, INTERESTED IN GLOBAL HEALTH. I DO THINK THAT WE NEED BETTER RESEARCH INTO VACCINE SAFETY. TOM JEFFERSON IS SOMEONE I WORKED WITH ON A NUMBER OF PROJECTS INCLUDING A BOOK ON PEER REVIEW AND HE'S WRITTEN A GOOD BOOK, SURE YOU'RE WARE OF IT FLAWS IN CURRENT VACCINE SAFETY RESEARCH. MOST IS GOVERNMENT FUNDED, MOST HE SAYS IN A SYSTEMATIC REVIEW PUBLISHED IN VACCINE IN 2003, MOST HE SAYS IS OF POOhlu– QUALITY. WE HAVE TO DO A BETTER JOB OF MAKING SURE THAT VACCINE RESEARCH IS FOLLOWED AND PEOPLE CAN TRUST IT. AND I THINK THAT WOULD PERHAPS BE A CHALLENGE FOR THIS AUDIENCE. THANK YOU VERY MUCH, INDEED. [APPLAUSE] >> THAT WAS A LONELY EXPOSE OF WHAT YOU HAVE DONE, COURAGEOUS ON YOUR PART. LET'S OPEN FOR QUESTIONS. DON LINDEBURG JOINS ME AFTER I STARTED BUT HE'S MY CO-HOST TODAY. I MIGHT ASK HIM FOR THE FIRST QUESTION. >> CONGRATULATIONS ON THE WONDERFUL WORK YOU HAVE DONE. NICE JOB REPORTING. I WANT TO ASK AN UNDERHANDED QUESTION. >> CAN YOU HEAR IN THE BACK? >> AN UNDERHANDED QUESTION. A MANUSCRIPT, SAY THE SAME ONE, CAME TO YOU AND IT HAD ONE OF THOSE FOOT NOTES THAT SAID BY THE WAY, I HAVE RECEIVED DEFINITELY A KNOWLEDGE OF POUNDS FROM SOMEBODY WHO WANTS -- HAS AN AX TO GRIND, WHAT WOULD BE THE -- WHAT SHOULD THE EDITOR IN CHIEF DO? >> WHAT IS INTERESTING, THE BMJ HAS PUBLISHED A PIECE. I DON'T KNOW THE DATE WHICH LOOKED AT CONTAMINATION OF DRINKING WATER IN CORNWALLCH THAT WAS LINKED THE LEGAL ACTION AMONK THE PEOPLE WHO WITH -- AND THAT WAS STATED IN THE ARTICLE. SO IT'S NOT INEVITABLE THAT THIS WOULD MEAN ONE WOULDN'T PUBLISH THE PIECE. I THINK RICH SAID IN HE HAD KNOWN IN 2004 -- IF HE HAD KNOWN IN 1998 WHAT HE DISCOVERED IN 2004 HE WOULDN'T S HAVE PUBLISHED THE ARTICLE. WHAT IT MAY HAVE DONE IS CAUSED PEOPLE TO HAVE A DEEPER LOOK AT HOW THE CHILDREN HAVE BEEN RECRUITED. THIS I THINK IN THIS CASE WAS THE FLAG WHICH WOULD MAKE YOU THINK OKAY, WHICH CHILDREN HAS LEGAL ACTION, HOW WERE TRAY RECRUITED, AND THAT SERIES OF INQUIRY MIGHT HAVE FOLLOWED SO IT'S INEVITABLY MEANS YOU WOULDN'T PUBLISH BUT IT DOES RAISE A LOAD OF ADDITIONAL QUESTIONS. >> HARD TO FOLLOW UP THOUGH, ISN'T IT? THE TWO COMPANIES YOU SITE HAVE BOTH MEN FOUND GUILTY IF YOU WILL IN THE PUBLIC EYE OF CONCEALING DATA, NOT REPORTING GOOD RESULTS AN CONCEALING THE BAD RESULTS ALSO IN A CASE OF CHILDREN, I WOULD THINK THAT WOULD BE A CRIMINAL ACT BUT NO ONE SEEMS TO AGREE. >> I WOULD AGREE. IT'S A CRIMINAL ACT. >> COME TO THE MICROPHONE AND INTRODUCE YOURSELF IF YOU WILL. >> WHAT ARE THE CHALLENGES IN LOOKING AT THE CRIMINAL (INAUDIBLE) STANDARD OF PROOF. >> RIGHT NOW FOR RESEARCH MISCONDUCT IT'S ADMINISTRATIVE ISSUE, DEMONSTRATING PROOF. ONE CHALLENGE IS TO ENSURE THAT YOU GET FINDINGS THAT EVERYONE CAN AGREE ON AND RELEASE AND THAT YOU DON'T SCWEL FACT FINDING. THE OTHER ELEMENT IS IN OUR COUNTRY FRAUD HAS FOUR ELEMENTS IN THIS DEFINITION. TWO ARE DIFFICULT TO APPLY TO. SCIENTIFIC. PEOPLE BELIEVE THE RESULTS, FOR EXAMPLE, ENACTED ON THOSE BELIEFS IS ONE OF THOSE ELEMENTS. >> THANK YOU VERY MUCH. I GATHER IN THE UK IT ISN'T A SIMPLE THING, THIS SUGGESTS IT MIGHT BECOME A CRIMINAL ISSUE IS NOT SOMETHING TO SAY RIDICULOUS, COULDN'T POSSIBLY HAPPEN. WHEN PUBLIC FUNDS HAVE BEEN MISAPPROPRIATED THAT'S AN EASIER ISSUE. I THINK WE JUST HAVE TO HAVE A BROADER VIEW OF WHAT WE MEAN BY PUBLISH FUNDS, PUBLIC ATTENTION, PUBLIC EFFORT, THE PUBLIC. I THINK THE PUBLIC INTEREST MIGHT WELL BE SERVED IF WE CAN GET THE DEFINITION TIGHT ENOUGH, IF WE CAN ESCALATE, THIS WOULD BE ONE IN MY MIND WHICH HAD SUFFICIENT IMPACT ON PUBLIC HEALTH, THAT MAYBE THE WAY. BUT I'M NOT A LAWYER. AND SURE ANY LAWYER LISTENING TO THIS WILL THINK IT I'M NAIVE TO SUGGEST IT. MORE MONEY FOR THEM. WHO KNOWS. >> I'M (INAUDIBLE) FROM THE FOGARTY INTERNATIONAL CENTER. YOU SAID THAT SCIENTIFIC FRAUD MAYBE SHOULD BE A CRIMINAL OFFENSE AND IT'S NOT NOW. THOUGH IT WOULD BE HARD TO SORT OUT WHO TO PROS SCIEWT THAT. I KNOW -- I WAS WONDERING IF SOME OF THE E YOU SAID THERE WAS MEASLES EPIDEMIC THAT PROBABLY WOULDN'T HAVE HAPPENED IF PEOPLE WERE FULLY VACCINATED. A MALL PERCENTAGE OF CHILDREN DIED. I WOULDN'T BE SURPRISED IF THERE WAS A CLASS ACTION SUIT THAT AS TH WAS NOT VACCINATION SO THE CHILDREN DIED. AND THAT WOULD BE I THINK A VIABLE CRIMINAL SUIT BECAUSE THERE ARE SIMILAR THINGS THAT ARE PROPAGATED AGAINST DRUG COMPANIES THAT CONCEAL INFORMATION. VERY GOOD POINT. >> I'LL RAISE THAT WITH THE LAWYER. >> INTRODUCE YOURSELF. >> I'M JACOB CROSBY WITH GW SCHOOL OF PUBLIC HEALTH AND HEALTH SERVICES. I WANT TO -- YOU MADE A NUMBER OF STATEMENTS HERE REGARDING ANDREW WAKEFIELD WHO IS NOT HERE TO DEFEND HIMSELF AGAINST THEM BUT THERE ARE A COUPLE OF PROBLEMS THAT I SAW WITH HIS CLAIMS OF HE CLAIMED THREE CHILDREN WEREN'T AUTISTIC BECAUSE THEY HAVE ASBERGERS SYNDROME, 6, 7 AND 12 BUT THAT'S A FORM OF AUTISM. HE SAID THE BOWEL RESULTS WERE FRAUDULENT BECAUSE THEY DON'T MATCH WITH THE ROUTINE PATHOLOGY RESULT WHICH IS IS ONLY THE FIRST STEP IN A TERTIARY DIAGNOSTIC PROCESS. THE END RESULT FROM THE ROUTINE PATHOLOGIST'S REPORT WHO IS NOT ACCUSED OF FRAUD TO MY KNOWLEDGE, MATCHES WHAT WAS IN THE PAPER AND FURTHERMORE, ALL FIVE CHILDREN 506 CHILDREN HE CLAIMED DID NOT REDEGREES OR HAVE SOME SORT OF DETERIORATION AFTER THE MMR VACCINE, THOSE FIVE CHILDREN WERE ALL DEVELOPMENTALLY NORMAL EXCEPT FOR ONE KID WHO HAD DEVELOPMENTAL PROBLEMS DUE TO UNRELATED PRE-EXISTING CONDITION. AND THEY ALL FACE DEVELOPMENTAL REGRESSION AFTER THE VACCINE. SO I'M CURIOUS BECAUSE I'M CURIOUS WHY YOU'RE TALKING ABOUT THERE NEEDS TO BE OVERSIGHT IN FRAUD, BUT IT SEEMS LIKE BRIAN DEER HERE COMMITTED FRAUD. >> A LOT OF THE THINGS YOU'RE ITEMIZING HAVE BEEN RAISED ON VARIOUS WEB COMMENTS AND BRIAN RESPONDED TO THEM. I CAN GIVE YOU MY RESULTS. >> NO HE HASN'T. >> I THINK YOU'LL FIND HE HAS. THE THREE CHILDREN WITH ASBERGER'S SYNDROME HE MAKE IT IS POINT THE PAPER IS REGRESSIVE DEVELOPMENTAL DELAY SO THESE CHILDREN WERE BEING PRESENTED AS PEOPLE WITH REGRESSIVE AUTISM. >> RIGHT. THEY DID HAVE -- THEY REGRESSED. CHILDREN 6 AND 7 THEY DID HAVE SEIZURES BEFORE MMR VACCINE T PAPER IS ONLY TALKING ABOUT THEIR DEVELOPMENTAL PROGRESS WHICH REGRESSED. >> I'LL BE HAPPY TO TALK ABOUT THAT CASE, WE CAN DISCUSS THAT AFTER. >> FINE. I'M JUST SAYING -- >> BRIEFLY ABOUT THE PATHOLOGY, WHAT'S IMPORTANT TO RECOGNIZE IS WHAT WAS IMPORTANT IN THE METHODOLOGY OF THE PAPER, WAS A PLANNED PROTOCOL APPROACH WITH THESE FOUR PATHOLOGISTS, THAT WASN'T IN FACT THE CASE, WHAT HAPPENED WAS THE PATHOLOGY SLIDES FOUND ALMOST NO EVIDENCE. >> THAT WAS ROUTINE PATHOLOGISTS, THAT WAS -- THERE WAS AN EXPERT IN THAT FIELD. THAT'S WHEN THEY FOUND EVIDENCE. >> IT WAS NOT REPORTED IN THAT WAY. >> YES, IT DID. >> LET'S MOVE ON AND WE CAN CONTINUE AFTERWARDS. I WAS GOING TO ASK BRUCE GELLON HEAD OF THE NATIONAL VACCINE OFFICE TO COMMENT ON THE CONSEQUENCES OF THE WAKEFIELD PAPER AND THE VMJ RESPONSES, BRUCE, IF YOU WILL. >> THANK YOU FOR COMING. WHAT I FIND FASCINATING ABOUT THIS FIELD VACCINE CRISES IS HOW THEY PLAY OUT IN DIFFERENT WAYS AN PLACES AND WHY MMR WAS MORE YOUR PROBLEM THAN OURS, AEROSOL IS MORE OURS THAN YOURS. THE FRENCH HAD AN ISSUE WITH HEPATITIS AND MULTIPLE SCLEROSIS. WONDER IF YOU HAVE ANY THOUGHTS ABOUT WHY THESE THINGS PICK UP IN THE WAY THEY DO. AND IF THEY'RE THINGS WE CAN LEARN ABOUT SOME OF THESE ROOT CAUSES. I THINK THE PROBLEM WE HAVE AND YOU HINTED IN YOUR DISCUSSION, THE SCIENCE TAKE AS LONG TIME TO CATCH UP WITH THE ALLEGATION. AND WE HAVE PUBLIC PER SEMGS TO DEAL WITH. WONDER IF YOU HAVE ANY THOUGHTS HOW TO SHORTEN THE TIME. THE QUESTION I WANTED TO ASK YOU WAS PART OF YOUR DISCUSSION WAS TALKING ABOUT INVESTIGATIVE JOURNALISM WITHIN THE CONTEXT OF MEDICAL JOURNALISM. I'M NOT AWARE HOW BIG A FIELD THAT IS, YOU'VE RIN IN OTHER ASPECTS AS WELL. SOME OF THE CRITICISMS OF WHO'S HANDLING OF THE PANDEMIC AND I WOULD LIKE TO HEAR MORE ABOUT WHERE YOU SEE THIS FIELD GOING AND HOW YOU DECIDE WHICH THINGS TO GO AFTER OR NOT. THANK YOU. >> VERY GOOD. THANK YOU VERY MUCH. SO THE DIFFERENCE -- DIFFERENT WAYS VACCINE SCARES EMERGE ACROSS DIFFERENT PARTS OF THE WORLD IS VERY INTERESTING. I'M NOT AN EXPERT BUT IT IS A CULTURAL PHENOMENON FUELED BY DIFFERENT INTEREST GROUPS IN DIFFERENT PARTS OF THE WORLD. IN THE U.S., AS YOU SAY THE DIFFERENT APPROACH IN FRANCE AN EUROPE. IT'S A FASCINATING ANTHROPOLOGICAL STUDY. IF WE WANT TO DO A BETTER JOB INTRODUCING IN AN EVIDENCE BASED WAY AND BRINGING THE PUBLIC AWE LONG WITH THE NEED TO VACCINATE, THOSE ARE THINGS WE NEED TO INVESTIGATE MORE THOROUGHLY. AS TO HOW TO REDUCE THE TIME, I MEAN, I GAVE SOME THOUGHTS ON THAT, HOW WE CAN MAKE SURE THIS DOESN'T HAPPEN AGAIN AND HOW THE IMPACT IS OF ANY SUCH FUTURE FRAUD OR SCANDAL IS REDUCED. I THINK IT'S A COMBINATION OF FACTORS BUT A BIG PART IS EDUCATING THE PUBLIC. WE NEED THE PUBLIC ON OUR SIDE. WE NEED TO BE FRANK AND CLEAR AND OPEN WITH THE PUBLIC. ANY SIGN THAT GOVERNMENT OR INDUSTRY OR MEDICINE IS FAILING TO BE OPEN, ABSOLUTELY QUITE RIGHTLY FUELS CONCERNS OF A HIDDEN AGENDA HERE. SO GREAT ADVOCATE FOR TRANSPARENCY. I THINK THE DRUG INDUSTRY HAS A GREAT DEAL MORE TO DO ON THIS GOVERNMENT LIKEWISE MEDICINE GENERALLY AND THE MEDICAL PROFESSION MUST LAY ITSELF OPEN AND BRING THE PUBLIC ALONG WITH THESE KINDS OF THINGS. A FINAL THING I SUPPOSE IS ALSO AN ISSUE ABOUT INVESTIGATIVE JOURNALISM. IT IS A RISK. SPEAKING PURELY AS EDITOR OF A JOURNAL, IT'S A RISK BECAUSE IT MAKES PEOPLE BELIEVE THE JOURNAL IS NOT SCIENTIFIC OR LESS INTERESTED IN SCIENCE, WE PUT EFFORT INTO OUR SCIENCE IN ORDER TO BALANCE WHAT MIGHT BE SEEN AS A DIFFERENT TYPE -- IS SEEING THE TYPE OF MATERIAL WITHIN THE JOURNAL. WE'RE DEVELOPING, LEARNING AS WE GO. TRYING TO ESTABLISH CODES OF CONDUCT, MAKE SURE THAT WE DO THIS IN A WAY TO BE ENTIRELY CONFIDENT. WE HAVE EXTENSIVE FACT CHECKING AND LEGAL CHECKING, WE HAVE EXTENSIVE PEER REVIEW SO WE DO QUITE A LOT OF WORK WITH THIS TYPE OF JOURNALISM THAT WE DON'T WITH OUR STRAIGHT NEWS REPORTING. I THINK IT'S A FIELD THAT HAS A LOT OF SCOPE BUT I DON'T THINK IT CAN ACT ALONE, IT HAS TO GO ALONGSIDE SCIENCE AND EPIDEMIOLOGY. YOU MENTIONED THE WHO WORK THAT WE DID. IT WAS VERY MUCH DONE IN CONJUNCTION WITH CLINICAL EPIDEMIOLOGISTS WITH LOOKING AT THE CONCERNS AROUND TAMI FLU AND WHAT THE EVIDENCE REALLY SHOW, NOT THE EVIDENCE THAT WE HAVE BEEN PRESENTED WITH BUT WHAT THE EVIDENCE THAT'S SLOWLY EMERGING AS THE DRUG INDUSTRY IS FORCED TO DECLARE MORE INFORMATION SO A TERRIFIC JOB I THINK FOR CLINICAL EPIDEMIOLOGISTS WITH EXPERTISE TO WORK ALONGSIDE INVESTIGATIVE JOURNALISTS TO PRESENT TO THE PUBLIC A THOROUGH AND ACCURATE PICTURE OF WHAT'S GOING ON. >> GOOD MORNING, MY NAME IS MARCUS, I'M A A MEDICAL STUDENT FROM THE UNITED KINGDOM ACTUALLY. I THINK ONE THING THAT REALLY STRIKES ME ABOUT THIS CASE IS EVERYONE IS TAUGHT ABOUT HOW IT'S LIKE YOU NEED TO HAVE MEDICAL INVESTIGATIVE JOURNALISM UP AND RUNNING, MAKE SURE EVERYONE IS CERTAIN OF THE FACTS BEFORE YOU PUBLICIZE IT BUT I THINK ONES WE STARTED TALKING ABOUT LIKE THE ELEMENT OF SCIENTIFIC COMMUNICATION AND HOW EXACTLY WE PRESENT THESE FINDINGS TO THE PUBLIC, INDEED EVEN BEFORE WE ARRIVE AT A CERTAIN CONCLUSION, HOW CAN WE ACTUALLY TELL THE PUBLIC SORT OF LIKE LOOK, WE DON'T ACTUALLY QUITE KNOW WHERE EXACTLY WE'RE GOING WITH THIS BUT IT'S LIKE PREMATURE TO JUMP TO CONCLUSIONS THAT SAY FOR EXAMPLE AN MMR VACCINE HAS SUCH ADVERSE EFFECT LIKE AND THEREFORE IS UNWISE FOR YOU AS PUBLIC TO NOT TO ACT ON THESE CONCLUSIONS AND NOT HAVE YOUR KIDS TAKE THE VACCINE. I THINK IT'S ESPECIALLY RELEVANT IN THIS CASE. TWO POINTS STRIKE ME. FIRSTLY BECAUSE YOU MENTION THE WHOLE IDEA OF ONE MAN TOPPLING THE ENTIRE INSTITUTION, IT'S CLEARLY I THINK DR. WAKEFIELD WAS LIKE VERY SKILLED IN THIS ASPECT OF COMMUNICATION, HE WAS ABLE TO SELL A LIE TO EVERYONE ELSE AN EVERYONE ELSE WAS NOT SKILLED, WAS NOT ABLE TO DEFEND THAT LIE. OR REFUTE THAT LIE. AND SECONDLY, EVERYONE IS ALSO TALKING A LOT ABOUT THIS IDEA OF THE INTERNET AND HOW EVERYONE'S ACTUALLY CAUGHT -- AT LEAST THE FRAUDSTERS HAVE USED THAT AS AN ENGINE OF DISSEMINATION BUT YET US AS A SCIENTIFIC COMMUNITY HAS BEEN SO SLOW TO CATCH UP AND THEREFORE WE'RE SUFFERING. THEREFORE I WAS JUST WONDERING IF YOU COULD COMMENT A LITTLE BIT ABOUT THAT. THANK YOU VERY MUCH. >> THANK YOU VERY MUCH. I AGREE WITH YOU ENTIRELY. THAT IS AN ENORMOUS CHALLENGE. WHERE YOU HAVE GOT A VERY COMMITTED JUSTIFIABLY COMMITTED IN MANY CASES PEOPLE WITH AUTISTIC CHILDREN AN PEOPLE WITH AUTISM THEMSELVES WITHOUT ADEQUATE ANSWERS, WITHOUT PEOPLE COMMUNICATING IN A HELPFUL WAY WHAT'S GOING ON, AN WITHOUT ENOUGH SUPPORT AND ADVICE ON WHAT THE CAUSES MIGHT BE. YOU'RE GOING TO GET A COMMITTED GROUP OF PEOPLE, THEY'RE CONSTANTLY ABLE TO POST AN DISCUSS AND PUT PEOPLE ON THE INTERNET. THE ROUTINE OFFICIAL USE OF INTERNET DOESN'T COMPETE IN ANY WAY WITH THAT, THE SCALE AND THE PASSION OF IT. AND THE LIFE-LONG COMMITMENT TO IT IF YOU LIKE. SO I DON'T KNOW WHAT THE ANSWER IS. YOU'RE RIGHT ANDREW WAKEFIELD IS A GOOD COMMUNICATOR AND I THINK THAT WHEN YOU PUT HIM UP AGAINST OFFICIALS WITH LESS SKILL IN THAT WAY, THEY APPEAR FLAT-FOOTED. YOU CAN SEE THAT ALL THROUGH THE EARLY 2000s IN THE UK. I THINK YOUR CNN COMMENTATORS DID A GOOD JOB CALLING HIM INTO ACCOUNT AND THE BBC ACCOUNT DID ALSO A VERY GOOD JOB OF CALLING INTO COUNT. BUT HE'S A CLEVER MAN AND I THINK COMBINED WITH THE DEVOTION OF HIS FOLLOWER, IF YOU LIKE, THAT IS A TERRIFIC CHALLENGE. MORE BROADLY THINKING ABOUT VACCINES AND DOING THE RIGHT JOB FOR GLOBAL HEALTH, THERE'S ABSOLUTE LAY COMMUNICATIONS ISSUE. WE NEED TO BE MUCH MORE SOPHISTICATED AND YIEWL USE ALL THE TOOLS THAT ARE AT OUR DISPOSAL. SOCIAL NETWORKING, MEDIA COMMUNICATIONS SKILLS, ALL OF THOSE. >> OKAY. ANY OTHER QUESTION? LAST QUESTION? >> I WAS CURIOUS APPARENTLY DR. WAKEFIELD WAS HIRED BY AN ATTORNEY RELATED TO SYSTEM SORT OF CASE. DO YOU KNOW WHAT HAPPENED WITH THAT CASE? >> IT WAS THROWN OUT. 1500 FAMILIES, LEGAL AID WENT FORWARD AND IT WAS THROWN OUT. I'M AFRAID I CAN'T TELL YOU EXACTLY. IT WOULD BE IN THE -- I DON'T KNOW, LATE '90s. IT WAS QUITE PREMTORALLY THROWN OUT. ALSO CASES IN THE U.S. WHERE U.S. COURTS HAVE BEEN ASKED TO LOOK AT SIMILAR CASES AND HAVE THROWN THEM OUT. >> ON BEHALF OF ALL OF US AT NIH, LET ME THANK YOU FOR THE LOVELY PRESENTATION. THE EXPOSE AND PUBLICATIONS, IT CERTAINLY HAS HAD REPERCUSSIONS ON THIS SIDE OF THE ATLANTIC AS YOU MENTIONED. YOU'LL BE GOING ON TO CDC TOMORROW TO SPEAK ABOUT THE SAME ISSUES. SO WE WELCOME YOU HERE AND THANK YOU, VERY MUCH FOR JOINING US. >> THANK YOU VERY MUCH. 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