The doctor without patients: Brian Deer, The Doctor who Fooled the World
Deer, Brian. 2020. The Doctor Who Fooled the World: Science, Deception, and the War on Vaccines. Johns Hopkins University Press. https://www.press.jhu.edu/books/title/12139/doctor-who-fooled-world.
Brian Deer’s The Doctor Who Fooled the World: Science, Deception, and the War on Vaccines (Johns Hopkins University Press, 2020) recounts the story of Andrew Wakefield, a gastroenterologist from the Royal Free Hospital in London, who, in 1998, published a (since retracted) paper in The Lancet (Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children) that argued that gastrointestinal disease was linked (a) to “developmental regression” in “previously normal” children and (b) to a specific “environmental trigger,” namely the measles, mumps, and rubella (MMR) vaccine.
Now, before we go any further, it is crucial (for reasons that will become clear) to note that this paper has not only been retracted: its claims have been debunked, and the lead author was struck from the medical registry in the U.K. for fraudulent and unethical practice in the preparation of this paper. He misrepresented the nature of his sample, the nature (and even the existence) of the gastrointestinal disease, the timing of the “environmental triggers” the authors claimed were responsible, and the very strong financial competing interest the lead author had in the results he produced.
In other words, there was no positive value to any part of the work. According to Deer, the subjects were not recruited in the way the paper claimed (instead of a random sample, they were self-selected by parents who were suspicious of vaccines); the stated relationship between time of vaccination and onset of autism was incorrect in several cases (sometimes the actual onset was much later than reported; sometimes it actually preceded vaccination; in some cases the children were not autistic at all); and the study was not set up to test whether there was a connection, but rather to show that there was one, in preparation for a lawsuit (funding was provided via the lawyer leading the case).
This is not a matter of scientific interpretation or “teaching the conflict”: the “Wakefield paper” was not a study in any meaningful sense of the word.
It was no more a genuine scientific paper than the Sokal hoax was a genuine piece of research in the social sciences and humanities — except that where the goal of the Sokal paper was to expose what the author thought were lax standards in those fields, the goal of the Wakefield paper appears to have been enrichment and fame for its author.
This is not the place to rehearse all the issues with the research and its impact on public health — indeed, doing just that is what Deer’s book is partially about.
But we can summarise by saying that the impact was devastating. Wakefield’s fraud undid a generation’s worth of public-health work focused on the eradication of avoidable diseases such as measles, and it led more or less directly to the anti-vax, anti-public health protests we saw towards the end of the pandemic.
Given that Canada has recently lost its status as free of endemic measles (there is a large outbreak in southern Alberta right now, in the fall and winter of 2025), and that the anti-vax, anti-public health anger kicked up by Wakefield’s paper has led to things such as the breaking up of Alberta Health and laws preventing health officials from taking necessary steps to prevent the spread of the next pathogen, we are still feeling the impact of Wakefield’s fraud.
Leaving the actual results aside, then, Deer’s book was interesting to me for three main reasons:
- It clearly shows how Wakefield was enabled in large part because of research “accountability” exercises such as the Research Excellence Framework (REF);
- It shows the danger of an absolutist approach to academic freedom;
- It reveals, once again, the existence of an infrastructure that supports disgraced academics and others who, having run into professional trouble for their positions, end up doubling down in a well-paid public sphere supported by wealthy patrons and crowdfunding.
When Ockham’s razor just doesn’t make the cut
The impact of the REF is seen in the very fact that Wakefield’s study was carried out and his paper published.
According to Deer, the Royal Free, as a second-rate research hospital, needed the impact Wakefield’s work promised to bring. While (again according to Deer) higher-ups in the administration had their suspicions about his work, they were led to put these aside — or convince themselves there was nothing to be concerned about — because of the promise it seemed to offer for success in the assessment exercise:
Six pages in the number two general medical journal. Wakefield walked on water. Publishing was the first of two metrics of his performance, and The Lancet could transform a career. More important to the Royal Free’s dean and managers (and shaping their behavior in what was to come) was its potential for their profile and accounts. At the time, the medical school competed in a national “Research Assessment Exercise.” Using a scale, mainly based on success in high-impact journals, activities at institutions of higher education were ranked in steps from 5 down to 1, to decide the share-out of hundreds of millions in government grants. University College London, three miles south, was assessed with straight 5s in two vital areas. The Hampstead school: 2 and 3.
Those pages on Crohn’s were therefore money in the bank.
But Wakefield needed to name that virus.
Fraudulent papers, of course, are an exceptional result of this pressure to perform.
But as we demonstrated in our paper Excellence R Us, this focus on metrics rather than science does have a more broadly deleterious impact on quality: papers in “top” journals (such as The Lancet and Nature) tend to be retracted more often, age less well (the strength of their effects tends to fall faster over time than in lesser-ranked journals), and so on — in part because these journals privilege spectacular results over merely pedestrian ones.
Researchers therefore have every incentive to read their results as strongly as possible rather than conservatively.
Not all of this is fraud (and even when results are cooked, very few papers will be as more-or-less completely fabricated as Wakefield’s).
But tying research money to spectacular results and “high-impact” publications necessarily creates a perverse incentive structure.
It certainly does not encourage the pessimistic, minimalist interpretation of results that good scientific work requires, and it encourages the kind of hucksterism that Wakefield apparently excelled at — and that his deans were glad to see.
Absolute academic freedom corrupts absolutely
The second thing Deer’s book shows is that an absolutist approach to academic freedom is also dangerous for research quality.
This is a much larger topic that I am currently working on.
But I have long thought of Wakefield’s case as an exemplum of when it makes sense to curb the protection of academic freedom.
Most debates focus on the social sciences and humanities (can an academic deny the Holocaust, or minimise residential schools? Can one call what is happening in Palestine a genocide? How rude can one be on Twitter?).
But scientists, too, are protected by the concept — indeed, Galileo is usually cited as a classic example of why academic freedom is necessary.
Wakefield has always seemed to me to be an excellent counterexample to the claim that there should never be any constraints on academic freedom at a university.
Given that his work was essentially fabricated, profoundly incorrect, and has undermined one of the greatest achievements of modern public health — killing and harming thousands, if not hundreds of thousands — it seems reasonable to agree that a university would not be wrong to deny him a platform for further dissemination of that work.
What I did not know before reading Deer was that Wakefield actually used academic freedom to try to prevent his fraud from being uncovered.
By this point, the Royal Free had been incorporated into the much stronger King’s College London medical school.
As part of an attempt to resolve what had become an embarrassment, the Provost offered to pay for what appears to have been a replication study — that is, internal funding was offered to allow Wakefield to demonstrate that his earlier work was correct.
KCL is a world-class university, and at such institutions the rules and practices around internal funding differ somewhat.
Still, Provosts generally do not use internal funds to support major research projects: the expectation is that researchers will bring in external funding, which is precisely why Wakefield’s original administrators turned a blind eye.
According to Deer, however, Wakefield ultimately refused the replication funding on the grounds that being required to replicate his work infringed his academic freedom.
As Deer notes,
I admit I found Wakefield incapable of embarrassment. To me, he’d got no conscience. But his response to the university’s requests to do his job and prove claims that, by now, were terrorizing a generation went beyond such errors (or whatever they were) into a blank refusal to answer the question with the gold-standard study — claiming this would infringe his “academic freedom.”
Months passed.
Then came a last straw: a blunt confirmation, in September 2000, that he wouldn’t mount the project he’d agreed to.
He wrote to Llewellyn Smith:
It is the unanimous decision of my collaborators and co-workers that it is only appropriate that we define our research objectives, we enact the studies as appropriately reviewed and approved, and we decide as and when we deem the work suitable for submission for peer review.
I can understand the principle behind this in an academic setting: academics generally do not do research-for-hire, and agreeing to conduct an experiment because the Provost tells you to is a violation of that norm with potentially serious repercussions elsewhere.
A Provost who can compel replication under public pressure can also tell you to stop working in gender studies for similar reasons.
But there is another way to understand this episode.
Wakefield’s results were already being discredited.
By offering funding (but, crucially, not being able to require its acceptance), the Provost was arguably doing the right thing.
If Wakefield had been operating in good faith, he had a duty to accept the opportunity to demonstrate that his results were not fraudulent.
My main critique of the setup would be that we should not fund foxes to demonstrate that they are responsible guardians of henhouses: it would have been better to fund an independent replication by someone else.
“You like me. You really, really like me” — on the existence of an aftermarket for disgraced academics
The final striking feature of Deer’s book is that it provides yet another example of what I will call an aftermarket for disgraced academics: a funding and support infrastructure for those whose work violates the standards of the academic community but remains popular with wealthy patrons.
We have seen many recent examples — Jordan Peterson and Lindsay Shepherd, to name two in Canada.
The pattern is familiar: Academic X says something widely condemned, suffers career damage or exclusion, and then ends up both more radicalised and far better off financially through support networks funded by wealthy donors or, more recently, small-dollar crowdfunding platforms such as Patreon.
In this respect, Wakefield was something of a pioneer.
He was taken up by what we would now describe as the “MAHA” (Make America Healthy Again) crowd, represented in the current U.S. government by Health Secretary Robert Kennedy Jr.
As a result, Wakefield became relatively wealthy (for an academic) and even more aggressively anti-vaccine and anti-public health.
Some of this reflects the long-standing relationship between academics and the wealthy — or, as Anand Giridharadas recently put it in an article on the relationship between academics such as Larry Summers and Jeffrey Epstein,
The smart need money; the rich want to seem smart; the staid seek adjacency to what Mr. Summers called “life among the lucrative and louche”; and Mr. Epstein needed to wash his name using blue-chip people who could be forgiving about infractions against the less powerful.
Of course, this is not true of all modern academics.
The rise of the modern university as a middle-class employer means that most academics do not need to curry favour with the rich to do basic work. They get the money they need to do their research from funding agencies (or if not, do work that doesn’t require more than can be funded from their salaries), and they understand their jobs at the university as essentially work for pay: they might think they are well-paid or poorly paid, but they don’t think of their work as being independent of (or worth expontentially more than) their monthly salary.
But Giridharadas’s observation does seem to be true of a subset academics — those who are either famous (the Pinkers and Summerses assembled by Epstein) or infamous (the Petersons and Wakefields who are adopted by pressure groups and patron networks). For these, the symbolic value of their fame rapidly becomes much more than even a top Harvard salary or a large grant from the (pre-Trump) NIH can possibly match — as celebrities, they are simply no longer middle class, despite their paycheques. And so they end up reentering the prestige and patronage economy that existed in academia before its institutionalisation and modernisation (say after the Civil War in the U.S., and the 1950s and 1960s in Canada, and the 1960s and 1970s in the U.K.
The road to hell…
In the case of the infamous, something I have always found fascinating is how fast this movement into the patronage economy is and how impactful it appears to be on their thought and positions.
Jordan Peterson was originally a psychology professor who objected to using preferred pronouns.
Lindsay Shepherd was a graduate student who showed a Jordan Peterson video in a way her supervisors thought inappropriate (and handled disastrously).
Frances Widdowson held contrarian views about Truth and Reconciliation in Canada.
Wakefield, meanwhile, appears to have wanted to make a quick fortune and international reputation by following in the footsteps of Barry Marshall and Robin Warren, who showed that stomach ulcers are caused by the bacterium Helicobacter pylori rather than stress, by claiming that something — almost anything — was caused by the measles virus.
What happened in each case, however, was not retreat but doubling down. That is to say, having run into resistance, they seem to very quickly discover a patronage economy that is willing to take them on, and, as a result, rapidly become fully engaged with positions that originally represented only a part of their original approach, in many cases — and I think Deer shows this particularly well in the case of Wakefield — becoming almost parodies of their original selves.
