On Vaccinations and Vacuums

Oh, to go back to the days of medical research done in a vacuum.

Years ago medical scientists were free to generate hypotheses, plan clever experiments, test complicated theorems, and develop scientific theses without having politically-driven, ideological critics lurking over their shoulders to make sure the results align with the beliefs of a select group of squeaky wheels.

The case in point is last month’s revelation that the original research linking vaccinations to autism was all fabricated.  In 1998, Dr. Andrew Wakefield and 12 others published a study in The Lancet that launched a cottage industry of activists aiming to eradicate the evils of routine childhood vaccinations.  A year ago The Lancet retracted the decade-old study and now new evidence shows that Dr. Wakefield actually falsified data to generate his conclusions.  To make matters worse, it turns out Dr. Wakefield (whose position at a Texas health center was terminated after he paid kids at his son’s birthday party 7 bucks each to provide blood specimens for his research—talk about party favors) was slipped three-quarters of a million dollars to serve as an expert witness in a lawsuit against the manufacturer of vaccines at the very moment he managed to produce the critical data linking routine MMR vaccination to the development of autism.

The fallout from this whole affair was resurgence in measles cases among children of parents who refused to allow vaccination, presumably in a belief that their children would fall victim to illnesses such as autism.  One particular outbreak, in San Diego in 2008, sickened 12 children and cost the state $176,000 to contain and treat.

While I obviously take issue with any scientist knowingly falsifying data to further a personal agenda, I can’t find fault with concerned parents who earnestly believe their children might be harmed by a vaccine about which an institution as esteemed as The Lancet had raised concerns.  I do, however, look critically at people—especially professionals—who continue to perpetuate discounted theories long after a preponderance of data has conclusively proved them wrong.

You can’t really find many issues as controversial as vaccinations and autism, but despite the uproar of this supposed linkage the scientific community has gone to great lengths to prove beyond any reasonable doubt that such a linkage doesn’t exist.  With the debunking of Dr. Wakefield’s original claims, the last shred of evidence vanishes—at this point there are no data whatsoever showing that childhood immunization can lead to autism.  Yet despite this there remains a strong undercurrent of support among laypeople and pseudo-professionals championing the purported association.

So, what good is the research if it doesn’t change the beliefs of the public?  It seems as if the millions spent on investigating these claims have resulted in no perceptible change in public attitude about the safety of vaccination—it’s the tree falling in the woods with no one around to hear.  We still have those who would prefer we return to the pre-vaccine days when measles was a common illness from which 500 people died and which hospitalized 50,000 every year.

This is what I mean when I say that I sometimes wish our research could progress in a public relations vacuum.  I’ve already lamented this in a previous post on the hundreds of publications proving that cholesterol medications are safe when used appropriately.  Even after over a hundred thousand volunteers were safely studied, we still can’t convince some patients (and some healthcare professionals, for that matter) that the benefits of statin medications outweigh the risks.

The problem is not just the vocal few who hold to a flat earth long after a round one has been decidedly proven.  The real dilemma is that such debate continues to dominate dialogue among people who make policy decisions and who decide where research funds are allocated.

As I extol the benefits of research done without the voyeurism of the opinionated public I need to remind myself of the hazards of science pursued at the opposite end of the spectrum.   Medical curiosity without the checks and balances of ethical oversight has brought us some of the most scandalous and sorrowful stories of the last century.  The “Public Health Service Syphilis Study” that ran unchecked from 1932 to 1972 and victimized the poor sharecroppers of Tuskegee, Alabama in the name of research is one such blemish on the history of science in a vacuum.  In this study, patients with syphilis were identified and followed for years to observe the natural course of the disease, all the while not being informed of their diagnosis or offered treatment despite the presence of a cure in the form of penicillin.

Between the vaccination scandal and the syphilis tragedy there has to be a middle ground where research can be conducted with the final judgment rendered only by the outcome of solid evidence.  As a yardstick I hold up the example of another research trial I’ve previously elaborated on: The Cardiac Arrhythmia Suppression Trial (CAST) of 1989.  At the time, patients coming into hospitals with heart attacks were routinely administered newly developed drugs to suppressed ventricular rhythm abnormalities that seemed to be the most common cause of death in the first few days of the illness.  When a few clinicians suggested putting this approach under an objective microscope by organizing a randomized, placebo-controlled trial, critics scoffed at the idea of purposefully withholding a therapy that was widely believed to be lifesaving.  To the surprise of nearly everyone, the CAST results turned popular opinion on its head when the researchers found that the drugs meant to stabilize cardiac rhythm were in fact triggering more malignant arrhythmias and leading to higher death rates rather than better outcomes.

While I believe many lessons can be learned from this story, I think the most illusory is how the medical community accepted the possibility of a new paradigm, embraced this new line of thinking, and simply moved on—even those who most vehemently opposed the possibility of such an outcome accepted the new data without allowing the issue to fester in the fringes.  Wouldn’t it be something if the public as a whole had the ability to do the same when solid scientific evidence points in a direction that may not favor popular sentiment?

Until then I’m afraid that much of medical research, when invested in hot-button topics like immunizations, will remain like the tree falling in the deserted forest and we’ll continue to chase disproven theories with our time, attention, and money.