Charismatic Doctor at Vortex of Vaccine Dispute

Experts Argue Over Findings, but Specialist Sees Possible MMR Link to Autism

LONDON -- The first lesson a doctor needs to learn, says Andrew Wakefield, is to listen to his patients. And so when Rosemary Kessick brought in her son William in 1996, Wakefield listened carefully.

She described how William had deteriorated at age 15 months from a healthy developing toddler into a withdrawn, incommunicative child who screamed throughout the night, and how his bowels seemed on fire with constant diarrhea and pain. All of this had started, she said, within days after William received the MMR -- an injection known here as the "triple jab," designed to vaccinate youngsters against measles, mumps and rubella.

In the end Wakefield, a specialist in intestinal disease, did more than just listen. Working with colleagues, he came up with the hypothesis that William and other victims were suffering from a unique form of intestinal disorder related to their autism that might have been triggered by the MMR. He also claimed that the vaccine might be one reason for the soaring rates of autism in the developed world over the past two decades.

Public health officials insist he is wrong. While Wakefield continues publishing reports supporting his theory, study after study has failed to find a link between autism and MMR, and large numbers of doctors question his work.

But many parents have rallied to his side; vaccination rates in Britain have fallen steeply, and measles rates have begun to climb. Feeling hounded from his job in Britain, Wakefield is finding a new and receptive audience in the United States, where for now, at least, MMR vaccination rates remain stable. For parents and for much of the media, he has become a familiar archetype: the courageous lone crusader for truth and justice up against an uncaring, faceless medical establishment and a greedy pharmaceutical industry.

Now his credibility has taken another blow, from a Sunday Times newspaper report that Wakefield failed to disclose that his work had been supported by funds from a group of parents filing a lawsuit against the vaccine companies. Wakefield has vehemently denied any conflict of interest, but the editor of the Lancet, a distinguished medical journal, now says he would not have published Wakefield's groundbreaking 1998 report had he known about the funding.

Ten of the 13 physicians involved in the original report have withdrawn their support, and the cabinet secretary in charge of Britain's national health service has called for an investigation.

The Wakefield story is about public health and risk and the abiding mistrust that many people hold toward government officials, especially when it comes to issues of health and safety. It is also about how the media can transform complex matters of public policy into simple narratives with heroes and villains. And it is about one charismatic doctor who contends he holds the key to unlocking a medical mystery and that many of his colleagues are either too craven or too frightened to seek the truth.

A Study Is Launched

Tall, square-jawed and soft-spoken, Wakefield, now 47, was once a golden boy in the medical world. He trained at St. Mary's Hospital in London as a gastrointestinal surgeon, then spent several years doing research in Toronto, where he helped develop a novel theory on the causes of intestinal disease. By the early 1990s he was back in London, directing the inflammatory bowel disease study group at the Royal Free Hospital, one of Britain's premier teaching and research facilities.

Richard Horton, a former colleague who now edits the Lancet, once described him as "committed, engaging and charismatic. He asks big questions about diseases, and his ambition often brings quick and impressive results."

By the time Kessick came to see Wakefield with her son William, he had already begun to theorize about a link between the rising numbers of children with Crohn's disease, an inflammatory intestinal disorder, and the introduction of the MMR vaccine a few years earlier. William's case, Wakefield says, helped convince him that there could be a connection between the vaccine and autism as well.

Frustrated to the point of rage by what she saw as a general lack of understanding in the medical profession, Kessick had schooled herself in the disorder. She discovered that autism comes in many shapes and sizes, but its most general characteristic is profound isolation -- an autism sufferer cannot communicate with or understand others. Some children seem to suffer from autism at birth, while in others it develops in the first few years of life.

Kessick also learned that autism rates were rapidly rising -- although there is no agreement on exactly how fast or why. Many experts argue that improved diagnosis and deeper awareness among professionals have led to more accurate and earlier identification of the problem. Others contend that the absolute number of cases is rising, not just medicine's ability to find them. In their view, something in the environment must be to blame.

Based upon William's nightmarish decline, Kessick was certain that the MMR vaccine was at least one of the environmental factors. Most of the doctors she saw dismissed her as an obsessed and guilt-stricken mother looking for an answer to an unsolvable mystery. "Most of them were like, 'Oh, don't worry your little head about the MMR,' " she recalled.