By Marika Sboros

The strategies that critics use to persuade the public that doctors like Prof Tim Noakes are “anti-vaxx” are becoming transparent. Also transparent is likely their real target: Noakes’s promotion of low-carb, high-fat (LCHF) to treat and prevent serious disease.

One strategy appears to be to bring up the MMR (measles, mumps and rubella) vaccine. They do so whenever the opportunity arises – and even when it doesn’t.

Another is to link Noakes’s views to that of a “discredited, disgraced” doctor. That’s a reference, of course, to Dr Andrew Wakefield, the UK gastroenterologist who lost his licence to practice medicine in that country.

Wakefield co-authored a study series the Lancet published in 1998. It showed an associational link between gastrointestinal disease, autism and MMR vaccines. The journal eventually retracted the study. And in the fallout, the British regulatory body, the GMC (General Medical Council), stripped Wakefield of his licence to practise medicine.

Many continue to report, wrongly, that Wakefield lost his licence because he fraudulently claimed that the MMR vaccine causes autism. Yet the Lancet study does not make that claim. Instead, Wakefield’s sole claim in that study was an associational (thus, not causal) link between the MMR vaccine n a single combination and the subsequent development of autism. And that was in a small case series of affected children.

Wakefield’s take-home message was not that parents shouldn’t vaccinate their children. He suggested that children should not receive the vaccine as a single all-in-one combination. Instead, they should receive the individual vaccines on three separate occasions.

Dr Andrew Wakefield

Many doctors globally who are demonstrably not “anti-vaxx”, Noakes among them, say that makes sense.

Anyone reading the case against Wakefield with an unjaundiced eye can see that the GMC acted against him on the basis of allegations of undeclared conflicts of interest. These included financial conflicts connected to his MMR research and other instances of ethical misconduct.

They can also see that Wakefield was only one of 12 co-authors of the study who also came under scrutiny for undeclared COIs.

And that the GMC chose to prosecute him alone. (Editor’s note: My error! A reader pointed out that this is icorrect. The GMC also struck Prof John Walker-Smith off the roll. He went to court and the GMC had to reinstate him. See Murray Braithwaite comment below.)

As well, anyone watching the movie, Vaxxed,  with the same unjaundiced eye will see that there really are “two tales” about him.

Wakefield directed the movie. In one tale, he is “a charlatan, an unethical researcher and a huckster”. And the British medical registry rightly “erased” him from medical practice.

In the other, Wakefield is “a brilliant and courageous scientist, a compassionate physician” whose patients still adore and respect him. It turns out that there’s a good case to be made that Wakefield is ” a champion for families with autism and vaccine injury”.

Why Wakefield?

So why, when Noakes raises the issue of possible suppression of data in medical research, do his critics bring up Wakefield? And the MMR vaccine? And why do they claim that he believes that the vaccine causes autism when he hasn’t said that?

Noakes has said that much of the evidence linking vaccination to autism is associational and thus cannot prove causation. That is not the same as saying vaccines cause autism.

But then you would know that if you were a scientist, as Noakes is – and as many of his doctor critics are not.

And as discussed in Part 1 of this two-part series, Noakes’s first tweet in August 2014 wasn’t about vaccines. Instead, it was about bad science. His critics leapt on it anyway and spawned the “anti-vaxx” campaign against him. (Click here for Noakes’s full response.)

The tweet was about allegedly suppressed data at the US Centre for Disease Control and Prevention (CDC). The data reportedly shows a significantly increased autism rate in African-American children given the MMR vaccine as a single combined vaccine before three years of age.

But Noakes wasn’t tweeting that as possible proof that the vaccine causes autism. On the topic, he says that the cause of autism is “clearly multifactorial”. And “perhaps the most important overlooked factor is nutrition, both of the mother and the child”.

Real target

Diets too high in carbohydrates, missing essential fats and perhaps too low in vitamin B12, may be factors, he says.

Therein very likely lies the real target of spurious anti-vaxx claims against Noakes and others.

On the Medical Brief website, Cape Town paediatrician Alastair McAlpine once again attacks Noakes as anti-vaxx.  McAlpine continues his years-long campaign against Noakes on Twitter. His friend, UCT commerce faculty junior “ethics” lecturer Jacques Rousseau, joins him regularly.

Predictably, McAlpine makes the “pro-vaxx” case for vaccine efficacy and safety.

He cites World Health Organisation (WHO) estimates that diphtheria, pertussis, tetanus and measles vaccines save 2-3 million lives annually. He also cites the Global Vaccine Alliance estimates based on the schedule of paediatric vaccines. Given to a hypothetical cohort of 4 million children born in 2009, it will prevent “approximately 20 million illnesses and 42,000 deaths over that cohort’s life time”.

McAlpine misses the point completely. No one of any scientific credibility – least of all Noakes–  is saying that vaccines haven’t ever done a good job of saving lives. Those brave enough to put their heads above this scientific parapet simply say we shouldn’t ignore evidence on health risks.

The authors of a Cochrane report in 2012 are a good example of that open-mindedness.

They accept that measles, mumps and rubella are “very dangerous infectious diseases which cause severe morbidity, disability and death in low-income countries”. They say that vaccination with one dose of MMR vaccine is “at least 95% effective in preventing clinical measles among preschool children”.

However, they conclude that the design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are “largely inadequate”.  They also say it’s not possible to separate evidence of adverse events after MMR immunisation from “its role in preventing the target diseases”.

Vaccine ‘injury’

In other words, it’s all very well saving lives from one health problem only to precipitate another. And doctors who ignore the latter do so at their patients’ peril.

Some doctors say that it is no longer possible to claim with a straight face that there are no health risks associated with vaccines. Or that there are no documented cases of massive compensation from the US government for children suffering vaccine “injury”.

That’s in the wake of the National Childhood Vaccine Injury Act (NCVIA) that the US Congress passed in 1986. It was designed to protect manufacturers of certain vaccines. Under the NCVIA,  those claiming a vaccine injury from a covered vaccine cannot sue a vaccine manufacturer without first filing a claim with the US Court of Federal Claims.

The most famous first-ever case is still that of Hannah Poling.  Hannah will likely receive more than $20 million over her lifetime for vaccine-induced autism. There is ongoing debate about whether that will be exception or precedent-setting, as Sheryl Attkisson notes in a Time magazine 2008 report.

There’s “no denying” that Hannah’s case puts “a chink — a question mark — in what had been an unqualified defense of vaccine safety with regard to autism”, another Time magazine report said.

That report notes circumstances that make Hannah’s case “a bit unusual”. “For one thing, she received an unusually large number of vaccines in 2000 .” That was when the organic mercurial compound, thimerosal, was still in use.

And clearly, such cases are rare. But they raise the question why the US government settled the Poling case out of court? And why are the materials of the case “sealed” from outside scrutiny?

The establishment response to new evidence in the recent 2018 finding is also worrying.

Aluminium guilty?

The UK researchers show that a group of children with autism had “some of the highest values for aluminium in human brain tissue yet recorded”. Thus, say the authors: “..one has to question why, for example, the aluminium content of the occipital lobe of a 15-year-old boy (with autism) would be 8.74 (11.59) μg/g dry wt.?”

They conclude that their findings “could implicate aluminium in the aetiology of autism spectrum disorder”. Not surprisingly, the study attracted vociferous criticism.

On its own, the presence of aluminium in the brains of autistic people in a laboratory does not automatically say anything about vaccines. And there are many other sources of environmental exposures to aluminium.

However, the study authors say that the most likely source “may be multiple vaccinations”. They are unlikely to have plucked that idea out of thin air.

Prof Christopher Exley

The venomous attacks on one of the study’s authors, Keele University bioinorganic chemistry Prof Christopher Exley are probably no surprise.

But scientists such as Exley and Noakes are simply interested in promoting high-quality science. They see a need for evidence that could answer complex questions. Among these questions is the potential link between certain forms of vaccination and autism.

One problem, says Noakes, is that the pharmaceutical industry did a very good job of “duping the world on the question of what causes heart disease”.

Therefore, we perhaps need to be careful in accepting everything the industry promotes as “the incontestable truth”.

The industry is also “heavily conflicted”, he says, “because it benefits financially from our actions based on the medical and scientific myths that it carefully cultivates”.

Who are the real ‘patient killers’?

Another strategy in contentious scientific debates is an emotive tactic. It’s the claim that any doctor who goes against orthodoxy is “killing patients”.

Dr Malcolm Kendrick

That really riles Scottish GP Dr Malcolm Kendrick. By no stretch of even the most fevered, fertile imagination could anyone accuse Kendrick of being anti-vaxx. In a letter to the BMJ in 2008, Kendrick notes that at the time of  Wakefield’s study,  the Lancet did not request authors to disclose conflicts of interest.

“So Dr Wakefield broke no rules,” Kendrick writes.

There’s perhaps a more pertinent issue, he says. A huge number of researchers, and those who write clinical guidelines, are far more “conflicted” than Andrew Wakefield ever was, is or probably could ever be.

Kendrick also looks at Oxford University’s “most eminent statin expert”, Prof Rory Collins. Collins took great exception to a Cochrane Collaboration paper criticising the benefit of statins in low-risk and primary prevention patients. He called the paper  “far more dangerous than … Wakefield’s Lancet paper”.

Wakefield’s example is familiar to all, Kendrick writes. “He stands accused of causing the deaths of thousands of children.”

Less well-known, he says, is Dr Peter Gøtzsche, a Danish physician, professor and head of the Nordic Cochrane Collaboration and long a critic of breast cancer screening. Gøtzsche is author of Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare.

He is “regularly accused of killing thousands of women”, Kendrick says.

Noakes and schoolyard bullies

Critics, particularly cardiologists, have regularly attacked Noakes for “criminal views” (on statins). They have suggested that he will end up killing people.

Kendrick speaks directly to Collins and others who make similar claims: “Hey guys, engage in scientific debate or shut up. Accusing people of killing patients is a terrible and horrible insult… It is the tactic of the playground bully. Yes, I mean you.”

Like Noakes, Kendrick is a big fan of debate in science. He says that it is essential.

“You would hope it were the very lifeblood of progress,” he writes. One would also hope that researchers could disagree with each other in frank and open debate, Kendrick says.

It has become increasingly obvious to him that if you criticise the experts in medical research you can expect “a very rough ride indeed. You certainly risk being stomped into silence.”

Other experts say that doctors, scientists and parents across the globe remain concerned about “a startling lack of actual science that proves (vaccines’) safety”.

They risk doctors like McAlpine and others trying to “stomp them into silence”. Luckily for patients, some stand their ground against would-be stompers.

They say that a good place to start when looking for evidence of risk with all medicines is with the drug company’s own leaflets. The companies are, after all, legally obliged to be honest about side effects.

The HPV (human papillomavirus) vaccine, Gardasil, is an interesting case study here. HPV has the dubious distinction of being the most common STI (sexually transmitted infection).

Once you get HPV, that’s it. You have it for life. There’s no cure. That makes prevention so much better.

Gardasil problems

The US regulatory body, the Food and Drug Administration (FDA) approved Gardasil in 2008.The original Gardasil side effects that Merck declared were virtually non-existent.  On its website, the CDC declares that the HPV vaccine is “very safe” and effective at preventing HPV. It says that the most common side effects are mild and many people have no side effects.

The Japanese government also approved Gardasil but withdrew approval in 2013. The government cited concerns from the public about adverse effects.

Merck has since had to add a slew of side effects that patients reported. Among these is a small but increased risk of Guillain-Barré syndrome as shown in a US 2011 study. A 2017 study by Public Health England researchers refuted the link but concerns continue.

Japanese research in 2016 revealed two cases of acute disseminated encephalomyelitis (ADE) following Gardasil vaccination. ADE is as nasty and serious as it sounds. Doctors define it as an “immune-mediated inflammatory demyelinating condition”. It predominately affects the white matter of the brain and spinal cord.

The NIH website defines it as “a brief but widespread attack of inflammation in the brain and spinal cord that damages myelin. Myelin is the protective covering of nerve fibres.” IT also says that ADE  “often follows viral or bacterial infections, or less often, vaccination for measles, mumps, or rubella (MMR)”.

So far, the evidence does show that serious outcomes after vaccination may be very rare. However, that’s cold comfort to victims and their families. And some doctors are rightly concerned that when you vaccinate more than a million children in each school year every year, as in the UK, some lives will be ruined forever.

Price of ‘injury’

You just have to read the harrowing story of paralysed dancer Chloe Leanne Brooks to know how the devastation of those affected.

Chloe Leanne Brookes

And concerns remain about vaccines and auto-immune diseases. A 2009 Israeli study is by researchers at the Centre for Autoimmune Diseases at Sheba Medical Centre in Tel-Hashomer. It looked at the link between 10 cases of systemic lupus erythematosus related to the hepatitis B vaccine.

Their conclusion: The potential association should alert physicians to its “possible long latency period and unique presentations”. It should also encourage physicians to  “report and analyse these cases”.

An Italian study in 2006 looked at sudden infant death syndrome (SIDS) shortly after hexavalent vaccination. (Those are vaccinations against diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenza type B and hepatitis B. Not all in one go, of course, at least one would hope not.)

The study followed investigations by the European Agency for the Evaluation of Medical Products into a possible link between hexavalent vaccines and some deaths.

Their conclusion: Doctors should investigate any case of sudden unexpected death occurring perinatally and in infancy, especially soon after vaccination. Such cases should “always undergo a full necropsy study” according to their guidelines.

The list of small associational studies suggesting risks goes on – and on and on. And there’s the matter of official data in the US on payouts. These have totalled nearly $4 billion in vaccine compensation cases.

Angel and devil doctors

Yet critics of Noakes act as if asking questions about vaccines is a dangerous business. Or an area into which foolish, “bad”, devilish doctors rush and “good” doctors, like angels, fear to tread.

But “good” (ie pro-vaxx) doctors, McAlpine among them, appear to want to shut down debate. Whether they do so by default or design, and on behalf of vested interests is not always clear.

In 2009 in Australia, doctors and others launched a “citizens’ campaign” to silence public criticism of vaccination. It involved “an extraordinary variety of techniques to denigrate, harass and censor public vaccine critics”. So says Australian social science professor Brian Martin.

The campaign was unlike anything in other scientific controversies, Martin says. It involved everything from “alleging beliefs in conspiracy theories to rewriting Wikipedia entries”.

Martin is an emeritus professor at the University of Wollongong, Australia, and vice president of Whistleblowers Australia. He is the author of 17 books and hundreds of articles on dissent, scientific controversies, non-violence, democracy, education and other topics.

His latest book is Vaccination Panic in Australia, available free for download. In it, Martin analyses the 2009 campaign from the free speech viewpoint.

He describes techniques used in attacks against doctors who dare to talk about health risks of vaccines.

Martin assesses different ways of defending and offers wider perspectives for understanding the struggle.

Free speech issue

His book is not just readers who interested in the vaccination debate, he says. It is for those who “care about free speech and citizen participation in decision-making”. He says that pro-vaxxers have created “direct censorship”, which he documents in his book.

Martin agrees that depending on the context, calling someone anti-vaxx can be defamatory.  It is an attempt to “stigmatise a person by putting them in a stigmatised category”, he says.

One factor stoking the scientific flames is that the vaccine debate includes children’s health.

“Children are seen as innocent, so anything that threatens them is seen as bad,” he says. “Strangely, both sides in the debate are concerned about children’s health. They just have different views about the best way to protect it.”

And because partisans in the vaccination debate denigrate those on the “other side” this discourages open discussion. It also hinders free speech.

“Many people are reluctant to express their views because of the possibility of coming under attack,” Martin says.