For a broader class of publications, which include scientific journals, see Academic journal.

Cover of the first issue of Nature, 4 November 1869.

In academic publishing, a scientific journal is a periodical publication intended to further the progress of science, usually by reporting new research. There are thousands of scientific journals in publication, and many more have been published at various points in the past (see list of scientific journals). Most journals are highly specialized, although some of the oldest journals such as Nature publish articles and scientific papers across a wide range of scientific fields. Scientific journals contain articles that have been peer reviewed, in an attempt to ensure that articles meet the journal's standards of quality, and scientific validity. Although scientific journals are superficially similar to professional magazines, they are actually quite different. Issues of a scientific journal are rarely read casually, as one would read a magazine. The publication of the results of research is an essential part of the scientific method. If they are describing experiments or calculations, they must supply enough details that an independent researcher could repeat the experiment or calculation to verify the results. Each such journal article becomes part of the permanent scientific record.

The history of scientific journals dates from 1665, when the French Journal des sçavans and the English Philosophical Transactions of the Royal Society first began systematically publishing research results. Over a thousand, mostly ephemeral, were founded in the 18th century, and the number has increased rapidly after that.^[1]

Articles in scientific journals can be used in research and higher education. Some classes are partially devoted to the explication of classic articles, and seminar classes can consist of the presentation by each student of a classic or current paper. In a scientific research group or academic department it is usual for the content of current scientific journals to be discussed in journal clubs.

The standards that a journal uses to determine publication can vary widely. Some journals, such as Nature, Science, PNAS, and Physical Review Letters, have a reputation of publishing articles that mark a fundamental breakthrough in their respective fields. In many fields, an informal hierarchy of scientific journals exists; the most prestigious journal in a field tends to be the most selective in terms of the articles it will select for publication, and will also have the highest impact factor. It is also common for journals to have a regional focus, specializing in publishing papers from a particular country or other geographic region, like African Invertebrates.

Articles tend to be highly technical, representing the latest theoretical research and experimental results in the field of science covered by the journal. They are often incomprehensible to anyone except for researchers in the field and advanced students. In some subjects this is inevitable given the nature of the content. Usually, rigorous rules of scientific writing are enforced by the editors; however, these rules may vary from journal to journal, especially between journals from different publishers.

Types of articles[link]

Cover of the first volume of the Philosophical Transactions of the Royal Society, the first journal in the world exclusively devoted to science

There are several types of journal articles; the exact terminology and definitions vary by field and specific journal, but often include:

• Letters (also called communications, and not to be confused with letters to the editor) are short descriptions of important current research findings that are usually fast-tracked for immediate publication because they are considered urgent.
• Research notes are short descriptions of current research findings that are considered less urgent or important than Letters.
• Articles are usually between five and twenty pages and are complete descriptions of current original research findings, but there are considerable variations between scientific fields and journals – 80-page articles are not rare in mathematics or theoretical computer science.
• Supplemental articles contain a large volume of tabular data that is the result of current research and may be dozens or hundreds of pages with mostly numerical data. Some journals now only publish this data electronically on the internet.
• Review articles do not cover original research but rather accumulate the results of many different articles on a particular topic into a coherent narrative about the state of the art in that field. Review articles provide information about the topic and also provide journal references to the original research. Reviews may be entirely narrative, or may provide quantitative summary estimates resulting from the application of meta-analytical methods.

The formats of journal articles vary, but many follow the general IMRAD scheme recommended by the International Committee of Medical Journal Editors (ICMJE). Such articles begin with an abstract, which is a one-to-four-paragraph summary of the paper. The introduction describes the background for the research including a discussion of similar research. The materials and methods or experimental section provides specific details of how the research was conducted. The results and discussion section describes the outcome and implications of the research, and the conclusion section places the research in context and describes avenues for further exploration.

In addition to the above, some scientific journals such as Science will include a news section where scientific developments (often involving political issues) are described. These articles are often written by science journalists and not by scientists. In addition, some journals will include an editorial section and a section for letters to the editor. While these are articles published within a journal, in general they are not regarded as scientific journal articles because they have not been peer-reviewed.

Electronic publishing[link]

Electronic publishing is a new area of information dissemination. One definition of electronic publishing is in the context of the scientific journal. It is the presentation of scholarly scientific results in only an electronic (non-paper) form. This is from its first write-up, or creation, to its publication or dissemination. The electronic scientific journal is specifically designed to be presented on the internet. It is defined as not being previously printed material adapted, or re-tooled, and then delivered electronically.^[2][3]

Electronical publishing will exist alongside paper publishing, because printed paper publishing is not expected to disappear in the future. Output to a screen is important for browsing and searching but is not well adapted for extensive reading. Paper copies of selected information will definitely be required. Therefore the article has to be transmitted electronically to the reader's local printer. Formats suitable both for reading on paper, and for manipulation by the reader's computer will need to be integrated.^[2][3]

Electronic counterparts of established print journals already promote and deliver rapid dissemination of peer reviewed and edited, "published" articles. Other journals, whether spin-offs of established print journals, or created as electronic only, have come into existence promoting the rapid dissemination capability, and availability, on the Internet. In tandem with this is the speeding up of peer review, copyediting, page makeup, and other steps in the process to support rapid dissemination.^{[citation needed]}

Other improvements, benefits and unique values of electronically publishing the scientific journal are lower cost, and availability to more people, especially scientists from non-developed countries. Hence, research results from more developed nations are becoming more accessible to scientists from non-developed countries.^[2]

Moreover, electronic publishing of scientific journals has been accomplished without compromising the standards of the refereed, peer review process.^[2][3]

One form is the online equivalent of the conventional paper journal. By 2006, almost all scientific journals have, while retaining their peer-review process, established electronic versions; a number have moved entirely to electronic publication. In similar manner, most academic libraries buy the electronic version, and purchase a paper copy only for the most important or most-used titles.

There is usually a delay of several months after an article is written before it is published in a journal, making paper journals not an ideal format for announcing the latest research. Many journals now publish the final papers in their electronic version as soon as they are ready, without waiting for the assembly of a complete issue, as is necessary with paper. In many fields in which even greater speed is wanted, such as physics, the role of the journal at disseminating the latest research has largely been replaced by preprint databases such as arXiv.org. Almost all such articles are eventually published in traditional journals, which still provide an important role in quality control, archiving papers, and establishing scientific credit.

Cost[link]

Many scientists and librarians have long protested the cost of journals, especially as they see these payments going to large for-profit publishing houses. To allow their researchers online access to journals, many universities purchase site licenses, permitting access from anywhere in the university, and, with appropriate authorization, by university-affiliated users at home or elsewhere. These may be quite expensive, sometimes much more than the cost for a print subscription, although this reflects the number of people who will be using the license; a print subscription is the cost for one person to receive the journal, whereas a site-license can let thousands of people access it.

Publications by scholarly societies, also known as not-for-profit-publishers (NFP), usually cost less than commercial publishers, but the prices of their scientific journals are still usually several thousand dollars a year. In general, this money is used to fund the activities of the scientific societies that run such journals, or is invested in providing further scholarly resources for scientists; thus, the money remains in and benefits the scientific sphere.

Despite the transition to electronic publishing, the serials crisis persists.^[4]

Concerns about cost and open access have led to the creation of free-access journals such as the Public Library of Science (PLoS) family and partly open or reduced-cost journals such as the Journal of High Energy Physics. However, professional editors still have to be paid, and PLoS still relies heavily on donations from foundations to cover the majority of its operating costs; smaller journals do not often have access to such resources.

An article titled "Online or Invisible?" ^[5] has used statistical arguments to show that electronic publishing online, and to some extent open access, both provide wider dissemination and increase the average number of citations an article receives. Lawrence postulates that papers that are easier to access are used more often and therefore cited more often.

Copyright[link]

Traditionally, the author of an article was required to transfer the copyright to the journal publisher. Publishers claimed this was necessary in order to protect author's rights, and to coordinate permissions for reprints or other use. However, many authors, especially those active in the open access movement, found this unsatisfactory,^[6] and have used their influence to effect a gradual move towards a license to publish instead. Under such a system, the publisher has permission to edit, print, and distribute the article commercially, but the author(s) retain the other rights themselves.

Even if they retain the copyright to an article, most journals allow certain rights to their authors. These rights usually include the ability to reuse parts of the paper in the author's future work, and allow him to distribute a limited number of copies. In the print format, such copies are called reprints; in the electronic format, they are called postprints. Some publishers, for example the American Physical Society, also grant the author the right to post and update the article on the author's or employer's website and on free e-print servers, to grant permission to others to use or reuse figures, and even to reprint the article as long as no fee is charged.^[7] The rise of open access journals, in which the author retains the copyright but must pay a publication charge, such as the Public Library of Science family of journals, is another recent response to copyright concerns.

See also[link]

• List of scientific journals
• Academic authorship
• Academic conference
• Academic journal
• Citation index
• Open access journal
• Scientific writing

References[link]

External links[link]

• Shaping Written Knowledge: The Genre and Activity of the Experimental Article in Science (online book) by Charles Bazerman
• 'Free at Last: The Future of Peer-Reviewed Journals' by Stevan Harnad
• Bibliography of Findings on the Open Access Impact Advantage
• Links to the world's electronic journals
• Electronic publishing in science: changes and risks by Otto Kinne
• The scientific communication life-cycle model by Bo-Christer Björk
• The cost of publishing in a scientific journal, some examples and recommended reading from OpenWetWare life scientists' wiki

Andrew Jeremy Wakefield (born 1957) is a British former surgeon and medical researcher, known as an advocate for the discredited claim that there is a link between the measles, mumps and rubella (MMR) vaccine, autism and bowel disease, and for his fraudulent 1998 research paper in support of that claim.^[1]

Four years after the publication of the paper, other researchers' results had still failed to reproduce Wakefield's findings or confirm his hypothesis of a relation between childhood gastrointestinal disorders and autism.^[2] A 2004 investigation by Sunday Times reporter Brian Deer identified undisclosed financial conflicts of interest on Wakefield's part,^[3] and most of his coauthors then withdrew their support for the study's interpretations.^[4] The British General Medical Council (GMC) conducted an inquiry into allegations of misconduct against Wakefield and two former colleagues.^[5] The investigation centred on Deer's numerous findings, including one that autistic children were subjected to unnecessary invasive medical procedures,^[6] such as colonoscopy and lumbar puncture, and that Wakefield acted without the required ethical approval from an institutional review board.

On 28 January 2010, a five-member statutory tribunal of the GMC found three dozen charges proved, including four counts of dishonesty and 12 counts involving the abuse of developmentally challenged children.^[7] The panel ruled that Wakefield had "failed in his duties as a responsible consultant", acted both against the interests of his patients, and "dishonestly and irresponsibly" in his published research.^[8][9][10] The Lancet immediately and fully retracted his 1998 publication on the basis of the GMC’s findings, noting that elements of the manuscript had been falsified.^[11] Wakefield was struck off the Medical Register in May 2010, with a statement identifying dishonest falsification in the Lancet research,^[12] and is barred from practising medicine in the UK.^[13]

In January 2011, an editorial accompanying an article by Brian Deer in BMJ identified Wakefield's work as an "elaborate fraud".^[1][14][15] In a follow-up article,^[16] Deer said that Wakefield had planned to launch a venture on the back of an MMR vaccination scare that would profit from new medical tests and "litigation driven testing".^[17] Wakefield's study and public recommendations against the use of the combined MMR vaccine were linked to a steep decline in vaccination rates in the United Kingdom and a corresponding rise in measles cases, resulting in serious illness and fatalities.^[18][19][20] Wakefield has continued to defend his research and conclusions, saying there was no fraud, hoax or profit motive.^[21][22]

Personal life and career[link]

Wakefield was born in 1957;^[23][24] his father was a neurologist and his mother was a general practitioner.^[25] After leaving the independent King Edward's School, Bath,^[26] Wakefield studied medicine at St Mary's Hospital Medical School^[25] (now Imperial College School of Medicine), fully qualifying in 1981. He became a fellow of the Royal College of Surgeons in 1985.^[24] At the University of Toronto (U of T) from 1986 to 1989, he was part of a team that studied tissue rejection problems with small intestine transplantation, using animal models.^[27][28] He continued his studies of small intestine transplantation under a Wellcome Trust traveling fellowship at U of T in Canada.^[24]

Back in the UK, he worked on the liver transplant programme at the Royal Free Hospital in London.^[24] In 1995, while conducting research into Crohn's disease, he was approached by Rosemary Kessick, the parent of an autistic child, who was seeking help with her son's bowel problems and autism; Kessick ran a group called Allergy Induced Autism.^[29] In 1996, Wakefield turned his attention to researching the connection between the MMR vaccine and autism.^[24] At the time of his MMR research study, Wakefield was senior lecturer and honorary consultant in experimental gastroenterology at the Royal Free Hospital School of Medicine (from 2008 UCL Medical School). He resigned in 2001,^[30] by "mutual agreement and was made a fellow of the Royal College of Pathologists",^[31] and moved to the US in 2001^[32] or 2004,^[31] both dates according to 'The Times'. One report noted he was asked to leave Royal Free Hospital in 2004 after he did not fulfill a request to duplicate the findings in his controversial Lancet paper.^[33]

Wakefield subsequently helped establish and served as the executive director of Thoughtful House Center for Children, a center for the study of autism in Austin, Texas where, according to The Times he "continued to promote the theory of a link between the MMR vaccine and autism, despite admitting it was 'not proved'."^[31] He resigned from Thoughtful House in February 2010, after the British General Medical Council found that he had been "dishonest and irresponsible" in conducting his earlier autism research in England.^[27][34] The Times reported in May 2010 that he was a medical advisor for Visceral, a UK charity that "researches bowel disease and developmental disorders".^[31]

Wakefield is no longer licensed in the UK as a physician,^[13] and is not licensed in the US.^[35] As of January 2011, he lives in the US where he has a following including celebrities like Jenny McCarthy^[36] who wrote the foreword for Wakefield's autobiography, Callous Disregard, and believes her son's autism is due to vaccines.^[20] According to Deer, as of 2011, he lives near Austin with his wife, Carmel, and four children.^[27]

In 2011, Wakefield was at the top of the list of the worst doctors of 2011 in Medscape's list of "Physicians of the Year: Best and Worst".^[37] In January 2012, TIME Magazine named Wakefield in a list of "Great Science Frauds".^[38]

MMR controversy[link]

On 28 February 1998, a paper written by Wakefield and twelve other authors about twelve autistic children was published in The Lancet.^[39] In it, the authors claimed to have identified a new syndrome which they called autistic enterocolitis, raising the possibility of a link between a novel form of bowel disease, autism, and the MMR vaccine. In the study's "findings", the authors noted that the parents of eight of the twelve children linked what were described as "behavioural symptoms" with MMR, and in its "results" reported that the onset of these symptoms began within two weeks of MMR vaccination.^[39] In the published Lancet summary, known as the "interpretation", the authors wrote:

"We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers."^[39]

These possible triggers were reported to be MMR in eight cases, and measles infection in one. The paper was instantly controversial, leading to widespread publicity in the UK and the convening of a special panel of the UK's Medical Research Council the following month.^[40] One study done based in Japan found that there was no causal relationship between the MMR vaccine and autism in groups of children given the triple MMR vaccine and children who received individual measles, mumps and rubella vaccinations. The MMR was replaced with individual vaccinations in 1993.^[41]

Although the paper said that no causal connection had been proven, and before it was published, Wakefield made statements at a press conference and in a video news release issued by the hospital, calling for suspension of the triple MMR vaccine until more research could be done.^[42] The press conference was later criticized as 'science by press conference'.^[43] According to BBC News, it was this press conference, rather than the Lancet paper, that fueled the MMR vaccination scare.^[44] According to the BBC, "He told journalists it was a 'moral issue' and he could no longer support the continued use of the three-in-one jab for measles, mumps and rubella. 'Urgent further research is needed to determine whether MMR may give rise to this complication in a small number of people,' Dr Wakefield said at the time."^[44] He said, "If you give three viruses together, three live viruses, then you potentially increase the risk of an adverse event occurring, particularly when one of those viruses influences the immune system in the way that measles does."^[42] He suggested parents should opt for single jabs against measles, mumps and rubella, separated by gaps of one year.

In December 2001, Wakefield resigned from the Royal Free Hospital, saying, "I have been asked to go because my research results are unpopular."^[30] The medical school said that he had left "by mutual agreement." In February 2002, Wakefield stated, "What precipitated this crisis was the removal of the single vaccine, the removal of choice, and that is what has caused the furore – because the doctors, the gurus, are treating the public as though they are some kind of moronic mass who cannot make an informed decision for themselves."^[45]

Aftermath of initial controversy[link]

Wakefield continued conducting clinical research in the US after leaving the Royal Free Hospital in December 2001. He joined a controversial American researcher, Jeffrey Bradstreet, at the International Child Development Resource Center, to conduct further studies on the possible relationship between the MMR vaccine and autism.^[46]

In 2004, Wakefield started work at the Thoughtful House research center in Austin, Texas.^[47] Wakefield served as Executive Director of Thoughtful House until February 2010, when he resigned in the wake of findings against him by the British General Medical Council.^[34][48]

In February 2004, controversy resurfaced when Wakefield was accused of a conflict of interest. The Sunday Times reported that some of the parents of the 12 children in the Lancet study were recruited via a UK lawyer preparing a lawsuit against MMR manufacturers, and that the Royal Free Hospital had received £55,000 from the UK's Legal Aid Board (now the Legal Services Commission) to pay for the research.^[49] Previously, in October 2003, the board had cut off public funding for the litigation against MMR manufacturers.^[50] Following an investigation of The Sunday Times allegations by the UK General Medical Council, Wakefield was charged with serious professional misconduct, including dishonesty.^[51] In December 2006, the Sunday Times further reported that in addition to the money they gave the Royal Free Hospital, the lawyers responsible for the MMR lawsuit had paid Wakefield personally more than £400,000, which he had not previously disclosed.^[52]

Twenty-four hours before the 2004 Sunday Times report, The Lancet responded to the investigation in a public statement, describing Wakefield's research as "fatally flawed". The Lancet's editor said he believed the paper would have been rejected as biased if the peer reviewers had been aware of Wakefield's conflict of interest.^[53] Ten of Wakefield's twelve co-authors of the Lancet paper later published a retraction of an interpretation:^[54] The section of the paper retracted read as follows:

"Interpretation. We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers."

The retraction stated:^[54]

"We wish to make it clear that in this paper no causal link was established between (the) vaccine and autism, as the data were insufficient. However the possibility of such a link was raised, and consequent events have had major implications for public health. In view of this, we consider now is the appropriate time that we should together formally retract the interpretation placed upon these findings in the paper, according to precedent."^[55]

Wakefield v Channel 4 and others[link]

In November 2004, Channel 4 broadcast a one-hour Dispatches investigation by reporter Brian Deer; the Toronto Star said Deer had "produced documentary evidence that Wakefield applied for a patent on a single-jab measles vaccine before his campaign against the MMR vaccine, raising questions about his motives".^[27][56]

In addition to Wakefield's unpublished initial patent submission,^[56] Deer released a copy of the published patent application.^[57] At page 1, the first paragraph of this stated:

"The present invention relates to a new vaccine/immunisation for the prevention and/or prophylaxis against measles virus infection and to a pharmaceutical or therapeutic composition for the treatment of IBD (Inflammatory Bowel Disease); particularly Crohn's Disease and Ulcerative Colitis and regressive behavioural disease (RBD) (also referred to as "Pervasive Developmental Disorder)."

Before describing the research in Wakefield's 1998 Lancet paper, at the same page this patent explicitly states that the MMR vaccine causes autism:

"It has now also been shown that use of the MMR vaccine (which is taken to include live attentuated measles vaccine virus, measles virus, mumps vaccine virus and rubella vaccine virus, and wild strains of the aforementioned viruses) results in ileal lymphoid nodular hyperplasia, chronic colitis and pervasive developmental disorder including autism (RBD), in some infants."

According to Deer, a letter from Wakefield's lawyers to him dated 31 Jan 2005 said: "Dr Wakefield did not plan a rival vaccine."^[56]

In the Dispatches programme, Deer also revealed that Nicholas Chadwick, a researcher working under Wakefield's supervision in the Royal Free medical school, had failed to find measles virus in the children reported on in The Lancet.^[58]

In January 2005, Wakefield initiated libel proceedings against Channel 4, the independent production company Twenty Twenty and Brian Deer. At the same time, Wakefield issued libel proceedings against The Sunday Times, and against Deer personally over his website briandeer.com.^[59] Within weeks of issuing his claims, however, Wakefield sought to have the action frozen until after the conclusion of General Medical Council proceedings against him. Fighting back, Channel 4 and Deer obtained a High Court order compelling Wakefield to continue with his action, or discontinue it. After a hearing in court on 27 and 28 October 2005, Mr Justice David Eady ruled against a Stay of proceedings, stating:

"It thus appears that the Claimant wishes to use the existence of the libel proceedings for public relations purposes, and to deter other critics, while at the same time isolating himself from the “downside” of such litigation, in having to answer a substantial defence of justification."

He also said in his judgment:

"I am quite satisfied, therefore, that the Claimant wished to extract whatever advantage he could from the existence of the proceedings while not wishing to progress them or to give the Defendants an opportunity of meeting the claims."^[60]

The judgment identified Channel 4's "very lengthy extracts" regarding Wakefield, where Deer's allegations are that he had:^[60]

i) Spread fear that the MMR vaccine might lead to autism, even though he knew that his own laboratory had carried out tests whose results dramatically contradicted his claims in that the measles virus had not been found in a single one of the children concerned in his study and he knew or ought to have known that there was absolutely no basis at all for his belief that the MMR should be broken up into single vaccines.

(ii) In spreading such fear, acted dishonestly and for mercenary motives in that, although he improperly failed to disclose the fact, he planned a rival vaccine and products (such as a diagnostic kit based on his theory) that could have made his fortune.

(iii) Gravely abused the children under his care by unethically carrying out extensive invasive procedures (on occasions requiring three people to hold a child down), thereby driving nurses to leave and causing his medical colleagues serious concern and unhappiness.

(iv) Improperly and/or dishonestly failed to disclose to his colleagues and to the public at large that his research on autistic children had begun with a contract with solicitors which were trying to sue the manufacturers of the MMR vaccine.

(v) Improperly and/or dishonestly lent his reputation to the International Child Development Resource Centre which promoted to very vulnerable parents expensive products for whose efficacy (as he knew or should have known) there was no scientific evidence.

In addition the Justice Eady's ruling states that "...the views or conclusions of the GMC disciplinary body would not, so far as I can tell, be relevant or admissible...", that Channel 4's allegations "...go to undermine fundamentally the Claimant's professional integrity and honesty..." and that "It cannot seriously be suggested that priority should be given to GMC proceedings for the resolution of issues...".

Other proceedings continued for two years, but in December 2006, Deer reported figures obtained from the Legal Services Commission showing that it had paid £435,643 in undisclosed fees to Wakefield for him to build a case against the MMR vaccine,^[61] payments which The Sunday Times reported had begun two years before the Lancet paper.^[52]

Within days of Deer's report, Wakefield dropped all his libel actions^[62] and was required to pay all the defendants' legal costs.^[63][64]

Other concerns[link]

Other concerns regarding Wakefield were that an extension of his project caused life-threatening complications in one child, who received substantial compensation in an out-of-court settlement.^[65] Wakefield's data were also questioned;^[19] a former graduate student, who appeared in Deer's programme, later testified that Wakefield ignored laboratory data which conflicted with his hypothesis. An independent investigation of a collaborating laboratory questioned the accuracy of the data underpinning Wakefield's claims.^[66]

In June 2005, the BBC programme Horizon reported on an unnamed and unpublished study of blood samples from a group of 100 autistic children and 200 children without autism. They reported finding 99% of the samples contained no trace of the measles virus, and the samples that did contain the virus were just as likely to be from non-autistic children, i.e. only three samples contained the measles virus, one from an autistic child and two from a neuro-typical child. The study's authors found no evidence of any link between MMR and autism.^[67]

The Institute of Medicine (IOM) of the United States National Academy of Sciences,^[68] along with the CDC^[69] and the UK National Health Service,^[70] have found no link between vaccines and autism. Reviews in the medical literature have also found no link between the MMR vaccine and autism or with bowel disease, which Wakefield called "autistic enterocolitis."^[71][72][73]

General Medical Council hearings[link]

Between July 2007 and May 2010, a 217-day "fitness to practise" hearing of the UK General Medical Council examined charges of professional misconduct against Wakefield and two colleagues involved in the Lancet paper.^[74][75] The charges included that he:

• "Was being paid to conduct the study by solicitors representing parents who believed their children had been harmed by MMR".^[74]
• Ordered investigations "without the requisite paediatric qualifications" including colonoscopies, colon biopsies and lumbar punctures ("spinal taps") on his research subjects without the approval of his department's ethics board and contrary to the children's clinical interests,^[74] when these diagnostic tests were not indicated by the children's symptoms or medical history.
• "Act[ed] 'dishonestly and irresponsibly' in failing to disclose ... how patients were recruited for the study".^[74]
• "Conduct[ed] the study on a basis which was not approved by the hospital's ethics committee."^[74]
• Purchased blood samples – for £5 each – from children present at his son's birthday party, which Wakefield joked about in a later presentation.^[74]

Wakefield denied the charges;^[76] on 28 January 2010, the GMC ruled against Wakefield on all issues, stating that he had "failed in his duties as a responsible consultant",^[8] acted against the interests of his patients,^[8] and "dishonestly and irresponsibly" in his controversial research.^[9] On 24 May 2010 he was struck off the United Kingdom medical register. It was the harshest sanction that the GMC could impose, and effectively ended his career as a doctor. In announcing the ruling, the GMC said that Wakefield had "brought the medical profession into disrepute," and no sanction short of erasing his name from the register was appropriate for the "serious and wide-ranging findings" of misconduct.^[13][77] Co-author John Walker-Smith was also struck off the medical register, while junior author Simon Murch was cleared.^[13][78][79] On the same day, Wakefield's autobiography, Callous Disregard was published. It argued that he had been unfairly treated by the medical and scientific establishment.^[80] John Walker-Smith appealed the decision and won.^[81][82]

Fraud and conflict of interest allegations[link]

In February 2009, The Sunday Times reported that a further investigation by the newspaper had revealed that Wakefield "changed and misreported results in his research, creating the appearance of a possible link with autism",^[83] citing evidence obtained by the newspaper from medical records and interviews with witnesses, and supported by evidence presented to the GMC.

In April 2010, Deer expanded on laboratory aspects of his findings in a report in the BMJ, recounting how normal clinical histopathology results (obtained from the Royal Free hospital) had been subjected to wholesale changes, from normal to abnormal, in the medical school and published in The Lancet.^[84] On 2 January 2011, Deer provided two tables comparing the data on the twelve children, showing the original hospital data and the data with the wholesale changes as used in the 1998 Lancet article.^[85]

On 5 January 2011, BMJ published an article by Brian Deer entitled "How the case against the MMR vaccine was fixed".^[86] Deer, funded by The Sunday Times of London and Channel 4 television network, said that, based on examination of the medical records of the 12 children in the original study, his research had found:^[86]

"The Lancet paper was a case series of 12 child patients; it reported a proposed “new syndrome” of enterocolitis and regressive autism and associated this with MMR as an “apparent precipitating event.” But in fact:

"Three of nine children reported with regressive autism did not have autism diagnosed at all. Only one child clearly had regressive autism;

"Despite the paper claiming that all 12 children were “previously normal,” five had documented pre-existing developmental concerns;

"Some children were reported to have experienced first behavioural symptoms within days of MMR, but the records documented these as starting some months after vaccination;

"In nine cases, unremarkable colonic histopathology results—noting no or minimal fluctuations in inflammatory cell populations—were changed after a medical school “research review” to “non-specific colitis”;

"The parents of eight children were reported as blaming MMR, but 11 families made this allegation at the hospital. The exclusion of three allegations — all giving times to onset of problems in months — helped to create the appearance of a 14 day temporal link;

"Patients were recruited through anti-MMR campaigners, and the study was commissioned and funded for planned litigation."^[86]

In an accompanying editorial, BMJ editors said:

Clear evidence of falsification of data should now close the door on this damaging vaccine scare ... Who perpetrated this fraud? There is no doubt that it was Wakefield. Is it possible that he was wrong, but not dishonest: that he was so incompetent that he was unable to fairly describe the project, or to report even one of the 12 children's cases accurately? No. A great deal of thought and effort must have gone into drafting the paper to achieve the results he wanted: the discrepancies all led in one direction; misreporting was gross. Moreover, although the scale of the GMC's 217 day hearing precluded additional charges focused directly on the fraud, the panel found him guilty of dishonesty concerning the study's admissions criteria, its funding by the Legal Aid Board, and his statements about it afterwards.^[1]

In a BMJ follow-up article on 11 January 2011,^[16] Deer said that based upon documents he obtained under Freedom of information legislation,^[87] Wakefield—in partnership with the father of one of the boys in the study—had planned to launch a venture on the back of an MMR vaccination scare that would profit from new medical tests and "litigation driven testing".^[17][56] The Washington Post reported that Deer said that Wakefield predicted he "could make more than $43 million a year from diagnostic kits" for the new condition, autistic enterocolitis.^[87] According to Deer's report in BMJ, the ventures, Immunospecifics Biotechnologies Ltd and Carmel Healthcare Ltd—named after Wakefield’s wife—failed after Wakefield's superiors at University College London's medical school gave him a two-page letter that said:

"We remain concerned about a possible serious conflict of interest between your academic employment by UCL, and your involvement with Carmel ... This concern arose originally because the company's business plan appears to depend on premature, scientifically unjustified publication of results, which do not conform to the rigorous academic and scientific standards that are generally expected."^[16]

WebMD reported on Deer's BMJ report, saying that the $43 million predicted yearly profits would come from marketing kits for "diagnosing patients with autism" and that "the initial market for the diagnostic will be litigation-driven testing of patients with AE [autistic enterocolitis, an unproven condition concocted by Wakefield] from both the UK and the US".^[88] According to WebMD, the BMJ article also claimed that Carmel Healthcare Ltd would succeed in marketing products and developing a replacement vaccine if "public confidence in the MMR vaccine was damaged".^[88]

Journal retractions[link]

On 2 February 2010, The Lancet formally retracted Wakefield's 1998 paper.^[89][90] The retraction states that "the claims in the original paper that children were 'consecutively referred' and that investigations were 'approved' by the local ethics committee have been proven to be false".^[11]

The following day the editor of a specialist journal, Neurotoxicology, withdrew another Wakefield paper that was in press. The article, which concerned research on monkeys, had already been published online and sought to implicate vaccines in autism.^[91]

In May 2010, The American Journal of Gastroenterology retracted a paper of Wakefield's that used data from the 12 patients of the Lancet article.^[92]

On 5 January 2011, BMJ editors recommended that Wakefield's other publications should be scrutinized and retracted if need be.^[36]

Wakefield response[link]

As of January 2011, Wakefield has continued to maintain his innocence. He said:

"I want to make one thing crystal clear for the record – my research and the serious medical problems found in those children were not a hoax and there was no fraud whatsoever. Nor did I seek to profit from our findings. ... despite media reports to the contrary, the results of my research have been duplicated in five other countries ... I continue to fully support more independent research to determine if environmental triggers, including vaccines, are causing autism and other developmental problems. ... Since the Lancet paper, I have lost my job, my career and my country. To claim that my motivation was profit is patently untrue. I will not be deterred – this issue is far too important."^[21]

According to BMJ, he says "he never claimed that the children had regressive autism, nor that he said they were previously normal. He never misreported or changed any findings in the study, and never patented a measles vaccine. None of the children were [attorney] Barr's clients before referral to the hospital, and he never received huge payments from the lawyer. There were no conflicts of interest. He is the victim of a conspiracy. He never linked autism with MMR."^[86]

In an internet radio interview, Wakefield said the BMJ series "was utter nonsense" and denied "that he used the cases of the 12 children in his study to promote his business venture".^[17] Although Deer is funded by The Sunday Times and Channel 4, he has filed financial disclosure forms and denies receiving any funding from the pharmaceutical industry, who Wakefield says is paying him.^[17] According to CNN, Wakefield said the patent he held was for "an 'over-the-counter nutritional supplement' that boosts the immune system".^[17] WebMD reported that Wakefield said he was the victim of "a ruthless, pragmatic attempt to crush any attempt to investigate valid vaccine safety concerns".^[88]

Wakefield claims that Deer is a "hit man who was brought in to take [him] down" and that other scientists have simply taken Deer at his word. While on Anderson Cooper 360°, claiming he had not read the BMJ articles yet, he denied their validity and denied that Deer had interviewed the families of the children in the study. He also urged viewers to read his book, Callous Disregard, which he claimed would explain why he was being targeted, to which Anderson Cooper replied: "But, sir, if you're lying, then your book is also a lie. If your study is a lie, your book is a lie."^[93]

Wakefield would later imply that there is a conspiracy by public health officials and pharmaceutical companies to discredit him, including suggesting they pay bloggers to post rumors about him on websites or that they artificially inflated reports of deaths from measles.^[33]

Deer counter response[link]

Deer responded to Wakefield's charge by challenging Wakefield to sue him for libel:

If it is true that Andrew Wakefield is not guilty as charged, he has the remedy of bringing a libel action against myself, the Sunday Times of London, against the medical journal here, and he would be the richest man in America.^[94]

He also noted that Wakefield has previously sued him and lost.^[60][94] In January 2012 Wakefield filed a defamation lawsuit in Texas state court against Deer, Fiona Godlee and the BMJ for false accusations of fraud, seeking a jury trial in Travis County. The lawsuit said Wakefield is a resident of Austin.^[95][96] The suit cited the "Texas Long-Arm Statute" as justification for the venue. The journal said that it stood by the writings and would "defend the claim vigorously."^[97][98]

On 5 April 2011, Deer was named the UK's specialist journalist of the year in the British Press Awards, organised by the Society of Editors. The judges said that his investigation of Wakefield was a "tremendous righting of a wrong".^[99]

Epidemics and effects[link]

Physicians, medical journals, and editors^{[100][101][102][103][104]} have made statements tying Wakefield's fraudulent actions to various epidemics and deaths.^[105] Michael J. Smith, a professor of pediatrics at the University of Louisville, an "infectious diseases expert who has studied the autism controversy's effect on immunization rates", said, "Clearly, the results of this [Wakefield] study have had repercussions."^[106][107]

The Associated Press said:

"Immunization rates in Britain dropped from 92 percent to 73 percent, and were as low as 50 percent in some parts of London. The effect was not nearly as dramatic in the United States, but researchers have estimated that as many as 125,000 US children born in the late 1990s did not get the MMR vaccine because of the Wakefield splash."^[106]

ABC News Channel WWAY3 said:

"Since Dr. Andrew Wakefield's study was released in 1998, many parents have been convinced the measles, mumps and rubella vaccine could lead to autism. But that study may have done more harm than good. According to the Centers for Disease Control and Prevention, in the United States, more cases of measles were reported in 2008 than any year since 1997. More than 90 percent of those infected had not been vaccinated, or their vaccination status was not known."^[105]

Paul Hébert, editor-in-chief of the Canadian Medical Association Journal (CMAJ) said:

"There has been a huge impact from the Wakefield fiasco ... This spawned a whole anti-vaccine movement. Great Britain has seen measles outbreaks. It probably resulted in a lot of deaths."^[27]

A profile in a New York Times Magazine article noted:

"Andrew Wakefield has become one of the most reviled doctors of his generation, blamed directly and indirectly, depending on the accuser, for irresponsibly starting a panic with tragic repercussions: vaccination rates so low that childhood diseases once all but eradicated here — whooping cough and measles, among them — have re-emerged, endangering young lives."^[33]

Journalist Brian Deer called for criminal charges to be brought against Wakefield.^[94]

Despite the allegations of misconduct and fraud, Wakefield continues to rely on the monetary and emotional support of fans who continue to support him. J. B. Handley of the autism and anti-vaccine advocacy group Generation Rescue noted, "To our community, Andrew Wakefield is Nelson Mandela and Jesus Christ rolled up into one."^[33]

On April 1, 2011, the James Randi Educational Foundation awarded Wakefield the Pigasus Award for "refusal to face reality".^[108]

A 2011 journal article described the vaccine-autism connection as "the most damaging medical hoax of the last 100 years".^[109]

Selected publications[link]

Books

Journals

See also[link]

• List of vaccine topics

References[link]

External links[link]

• Deer, B. (2011). "The Lancet's two days to bury bad news". BMJ 342: c7001. DOI:10.1136/bmj.c7001. PMID 21245118. http://www.bmj.com/content/342/bmj.c7001. 
• Opel, D. J.; Diekema, D. S.; Marcuse, E. K. (2011). "Assuring research integrity in the wake of Wakefield". BMJ 342: d2. DOI:10.1136/bmj.d2. PMID 21245120. http://www.bmj.com/content/342/bmj.d2. 
• Alaszewski, A. (2011). "How campaigners and the media push bad science". BMJ 342: d236. DOI:10.1136/bmj.d236. http://www.bmj.com/content/342/bmj.d236. 
• Godlee, F. (2011). "Institutional and editorial misconduct in the MMR scare". BMJ 342: d378. DOI:10.1136/bmj.d378. http://www.bmj.com/content/342/bmj.d378. 
• "The Vaccine War" – PBS FRONTLINE documentary, 27 April 2010
• "Lessons from the MMR Scare" by Fiona Godlee, presentation September 6, 2011 at the Fogarty International Center, National Institutes of Health

• Recorded webcast of "Lessons from the MMR scare" on the NIH VideoCasting site. Runtime: 01:06:51