Total Impact: Wakefield edition

So it seems Andrew Wakefield is back in the news. As Phil Plait has described well, the man who has done more to undermine public health than any physician since Martini and Rodenwaldt has been given space in The Independent to accuse the British government of inadequate measles prevention. Because his rantings scared lots of parents off the MMR vaccine, and the NHS didn’t want to provide separate measles vaccines instead.

The pathological self-promoters you will have with you always, so there’s no real surprise there. But it got me to thinking about his future in British medical research. Because some denizens of less enlightened lands may not know how IMPACTFUL British research has become: The prime directive for state-sponsored research under the current government (though I think it started already under Labour) is “impact”, defined as

an effect on, change or benefit to the economy, society, culture, public policy or services, health, the environment or quality of life, beyond academia

because academia is just a province of Faerie, not an actual part of the society or economy. In addition to impact being a crucial part of every grant proposal, and the postmortem on every grant after it’s completed, this definition will guide 20% of the scoring on the Research Excellence Framework (REF) just now getting underway, replacing the Research Assessment Exercise (RAE) last conducted six years ago, because now instead of research being assessed, we agree that it’s all excellent but needs to be frameworked, or something.

So anyway, it’s noteworthy that BENEFIT is only one acceptable form of impact. Any change or effect gets you points for impact, rather in the way the bibliometric citation counting that prevails in many academic fields doesn’t distinguish between citations for your paper providing key insights that inspired follow-on research, and citations that point out yet another bone-headed mistake in the paper that has been confusing researchers and holding back the progress of the field.

What’s more, it’s not clear how anyone would evaluate whether those who benefit from the research are themselves providing a net benefit or harm to society. (Sorry, I mean, to the taxpayer. There’s no such thing as society.) Presumably no one will provide a support letter from bioterrorists, explaining how their headline-generating work would have been impossible without the groundbreaking research of Professor X, but someone like David Li could show evidence that his work formed the industry-wide basis for the multi-billion pound market in mortgage backed securities which (you may have heard) helped to crash the world economy. The fact that he might himself agree that his formula never should have been applied, that the bankers “misinterpreted and misused it“, and that “Very few people understand the essence of the model“, doesn’t detract from the benefit that derived to some people, at least in the short term, and even the worst recession in 75 years certainly counts as a “change in the economy”, demonstrating the IMPACT of the research.

With that in mind, I reveal the hitherto secret Wakefield Impact Case Study, titled “Royal Free Hospital School of Medicine characterisation of risk factors for Autism and Vaccination Policy”. We are confident that the massively impactful Wakefield will quickly be hired by a major research institution and showered with research grants.

Royal Free Hospital School of Medicine characterisation of risk factors for Autism and Vaccination Policy

Short summary of the case study

Research at Royal Free Hospital School of Medicine has transformed the study of autism, Crohn’s disease, and early childhood vaccination. The identification of the MMR vaccine as a key risk factor in the development of autism has led to the development and marketing of new dietary therapies, and has provoked a decisive shift in vaccination rates in the UK, across Europe, and in North America.

The impact has not been limited to academic audiences, but has found strong resonance in the popular press, and has inspired numerous citizens’ groups.

The conduct of the studies has, furthermore, been a crucial inspiration for changes in research ethics policies in universities and at leading journals, in the UK and abroad.

Underlying research

The impacts reported here flow from a combination of clinical examination of symptoms, endoscopy findings, and targeted biopsies on subjects asserted to be manifesting autistic symptoms, that were the first to identify the syndrome of autistic enterocolitis. The research was immediately reported on the front pages of major newspapers. Associated translational and social science research has also been undertaken during this period and up to the present. This addressed clinical and socio-ethical issues surrounding the involvement of solicitors in funding research, and new methodology for reporting experimental measurements that have conspired against a true theory. The research has inspired pioneering of novel methods (the so-called natalis or QL method) of paediatric hematological sampling.

Follow-up research worth millions of pounds has been conducted on a massive scale in Japan and Denmark, as well as the UK. A February 2012 metareview by the Cochrane Library found dozens of scientific studies deriving from this work, involving about 14,700,000 children in all.

This work established current UK clinical practice for fraught discussions of vaccine questions between GPs and parents.

References to the research

The research has been cited more than 200 times in peer-reviewed scientific papers, as well as thousands of times in the popular press throughout the world.

The contribution, impact, or benefit

Research at the Royal Free Hospital has transformed infectious disease medicine in the UK and abroad. The identification of the syndrome autistic entercolitis has impacted upon the diagnosis, clinical management and treatment of patients and families with these disorders. The legal and regulatory framework around autism and measles.

The research has contributed to a significant reformulation of vaccines worldwide. Levels of vaccination, particularly of the youngest children, have been substantially influenced. While exact numbers of jobs directly or indirectly created by the litigation and grass-roots campaigning inspired by this research are difficult to determine, independent commentators agree that it has “launched a cottage industry of activists aiming to eradicate the evils of routine childhood vaccinations”.

The research led to a patent application for a modified single-disease vaccine for prevention of measles.

£435,000 in outside support from Legal Services Commission based on potential litigation impact of the research.

JABS (Justice, Awareness, Basic Support) in the UK raised £15 million for litigation founded on this research.

The research has inspired and served as the foundation for the work of investigatory commissions of the Institute of Medicine (US), Centers for Disease Control (US), and the National Health Service (UK), as well as a special panel of the General Medical Council (UK).

Organisations who can corroborate claims of contribution, benefit and impact (named contacts can be provided):

National Vaccine Information Center

Talk About Curing Autism

National Health Service

Generation Rescue: “To our community, Andrew Wakefield is Nelson Mandela and Jesus Christ rolled up into one.”

Paul Hébert, editor in chief of the Canadian Medical Association Journal: “There has been a huge impact from the Wakefield fiasco … This spawned a whole anti-vaccine movement.”

Prizes based upon external assessment of this research and its impact: 

2011 Pigasus Award for Refusal to Face Reality of the James Randi Educational Foundation.

2012 Golden Duck Award from the Good Thinking Society.

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