On Medical and Science Ethics: The MMR Vaccine Fiasco

There is a reason why I am a student of a science heavily focused on public health.  Human population health is important to me.  In my view, a healthy society is a productive one, and a healthy environment with accurate science is the most conducive to human health.  Therefore, in the quest for knowledge about health, the issue of scientific and medical ethics is near and dear to my heart.

There are a multitude of ethical quandaries that the average scientist wades through during their career.  If your data aren't as nice looking as you'd hoped, the standard deviations a bit further from how you expected them to be, you might be tempted to alter results a little bit to make it fit your expectations.  If you're doing a study on human or animal subjects, you might be tempted to take short cuts for the sake of reducing cost/energy/work.  If your study is paid for by an interest group, you might feel pressured to ensure your data fits the expectations of your financial backers.  It would seem as though these are all obvious, black-and-white, cut-and-dry issues.  Clearly, you think, I will just report the data as they are.  I will run the experiment in the best way with the best statistics I can afford.  If the interest groups don't like the results, well that is the risk of science.  Unfortunately, not everyone is able to overcome their personal interests or those of their financiers.   Even more unfortunately, these ethical mistakes can have huge implications on public health.

The MMR vaccine is a combination vaccine protecting the body against the mumps, measles, and rubella.  These three diseases used to be common afflictions, but they could be quite dangerous, and if left unchecked for too long, or if the body doesn't respond to medications, can lead to permanent injury or death. They are also quite infectious, and it used to be that almost every single child would get at least one of the three diseases in their lives.  The MMR vaccine was developed to protect children from these illnesses.  However, some anecdotal evidence suggested that the MMR vaccine was administered to some children who immediately started showing signs of autism, a developmental abnormality that leads to varying degrees of behavioral disorders.

Andrew Wakefield was a medical researcher who conducted a study based on these claims and suggested that within days after vaccination with MMR the 12 children in his study had developed symptoms of autism and gastrointestinal issues.  These results were recorded and published in a 1998 Lancet article entitled "Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children."  The publishing of this article subsequently led to a drop in vaccination rates and a surge in childhood disease rates.
In 2003, a British journalist named Brian Deer launched an investigation into this research and discovered that Dr. Wakefield's findings were not what they seemed.   Dr. Wakefield had received money from a law firm wishing to pursue a lawsuit against the vaccine companies, but he had not listed this as a potential conflict of interest in the publishing process of his paper.  He also had not disclosed that the 12 anonymous children participating in his study were very carefully selected by anti-MMR campaign groups to provide specific evidence.  Anyone who has ever taken a statistics class knows that the key to statistical relevance and true scientific research is that your samples must be as random as possible.  Another key is that your sample size must be as large as possible.  12 subjects that were hand-picked for the cause is not a good scientific approach to the problem.  Small studies should make way for larger studies, and subsequent research inquiries with larger sample sizes were never able to replicate the results that Dr. Wakefield published.

The study was since retracted but the damage is far-reaching.  Many parents are still hesitant to vaccinate their children because of the fear of regressive autism.  Some of my cousins refuse to vaccinate their children, fabricating exclusions based on religion in order to allow their children into public schools where vaccinations are required.  I even have friends who have not vaccinated their children because they fear the "jury is out" when it comes to whether vaccines cause autism.  For me the biggest issue is that with all the blame placed on the MMR vaccine causing autism, the true roots of the disorders are not actively being sought and the issue will indefinitely persist.  It is an injustice to the very nature of science and public health.

This example of unethical scientific conduct is far reaching and extreme, but even smaller issues may have unintended consequences, and the risk to public health is not worth a paper being published when the methods and financial backers are not fully disclosed.