Vaccines, Shoddy Research and Jabberwocky

Alice_Liddell_2

 

Alice Liddell. Photograph by Charles Dodson (aka Lewis Carroll)

The Jabberwocky

‘Twas brillig, and the slithy toves
Did gyre and gimble in the wabe;
All mimsy were the borogoves,
And the mome raths outgrabe.

“Beware the Jabberwock, my son!
The jaws that bite, the claws that catch!
Beware the Jubjub bird, and shun
The frumious Bandersnatch!”

He took his vorpal sword in hand:
Long time the manxome foe he sought—
So rested he by the Tumtum tree,
And stood awhile in thought.

And as in uffish thought he stood,
The Jabberwock, with eyes of flame,
Came whiffling through the tulgey wood,
And burbled as it came!

One, two! One, two! and through and through
The vorpal blade went snicker-snack!
He left it dead, and with its head
He went galumphing back.

“And hast thou slain the Jabberwock?
Come to my arms, my beamish boy!
O frabjous day! Callooh! Callay!”
He chortled in his joy.

‘Twas brillig, and the slithy toves
Did gyre and gimble in the wabe;
All mimsy were the borogoves,
And the mome raths outgrabe.

‘Through the Looking Glass and What Alice Found There’ by Lewis Carroll.

This is one of the best known poems of doggerel in the English language, and there is a nice description with definitions of many of the words in the Wikipedia article. It was highlighted in a lecture I gave about six years ago on research fraud in medicine.

What on earth has the Jabberwocky to do with research fraud, or for that matter, Alice Liddell? It’s a bit of a story.

Shoddy Research

Years ago, in one of the most celebrated examples of misleading research, Andrew Wakefield published a paper in the Lancet entitled “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children”, Volume 351, Number 9103, February 1998, which purported to draw a connection between vaccines and autism. If you look now, you will find that the Lancet has the word “Retracted” displayed prominently across the page after what was one of the longest hearings ever of the General Medical Council (doctor’s judicial organization) of the UK. The panel ultimately wrote the following paragraph in their report:

The Panel considers that Dr Wakefield’s conduct in relation to the facts found falls seriously short of the relevant standards and that suspension would not be sufficient or appropriate against a background of several aggravating factors and in the absence of any mitigating submissions made on his behalf. Dr Wakefield’s continued lack of insight as to his misconduct serve only to satisfy the Panel that suspension is not sufficient and that his actions are incompatible with his continued registration as a medical practitioner.

Accordingly the Panel has determined that Dr Wakefield’s name should be erased from the medical register (meaning he lost his license to practice medicine).

Reduced Compliance with Vaccination Program

Unfortunately, by this time, May 24, 2010, a lot of the damage had been done, and the number of children in the UK (vaccination compliance in two year olds dropped over 10% between 1996 and 2004 in England) and around the world receiving vaccines of any kind, dropped, exposing a lot of children to unnecessary illness and death. To this day you can still hear people citing this article. But the entire Lancet article is called into question by the behavior of it’s leading author, as indicated by the verdict of the GMC hearing:

The results of the research project were written up as an early report in the Lancet in February 1998. Dr Wakefield as a senior author undertook the drafting of the Lancet paper and wrote its final version. The reporting in that paper of a temporal link between gastrointestinal disease, developmental regression and the MMR vaccination had major public health implications and Dr Wakefield admitted that he knew it would attract intense public and media interest. The potential implications were therefore clear to him, as demonstrated in his correspondence with the Chief Medical Officer of Health and reports which had already appeared in the medical press. In the circumstances, Dr Wakefield had a clear and compelling duty to ensure that the factual information contained in the paper was true and accurate and he failed in this duty.

Wakefield’s co-workers disavowed the article, withdrawing their authorship, and saved their privilege of practicing medicine, although one other co-author was erased from the medical register (de-licenced) because of the part he played.

The damage to the world in terms of trust of the profession in general and vaccines in particular, was profound, and I have little doubt that many children lost their lives as a result of failing to obtain vaccinations for an extended period following the publication of this paper. To this day you can easily find people who think MMR vaccines cause autism.

Shoddy or Fraudulent Publications

Those not in the medical field will be shocked to hear that in the ‘good old days,’ becoming an author of a paper was overly easy, and the rules around what was required of authors extremely lax. I know on several examples I was listed as an author without ever knowing. Indeed, I just this week discovered I was a co-author on an abstract which to the best of my recollection I had never seen (fortunately a good summary, once a colleague of mine and I found it). This was common.

Not so any more, thank heaven.

Strict rules are outlined in ‘Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication’ Updated April 2010. Publication Ethics: Sponsorship, Authorship, and Accountability International Committee of Medical Journal Editors. Responsibilities of all co-authors in any medical paper are laid out, and peer reviewed journals now generally abide strictly to these rules. Repercussions for fraudulent reporting can be severe, as they should be, for the results can be tragic.

OK, so vaccines took a bad rap from a badly conceived and implemented bit of research. What’s that got to do with the Jabberwocky?

The Slaying of Jabberwocky

Charles Dodson (aka Lewis Carroll) was a lecturer at Christ Church, Oxford. He befriended the family of the Dean, Henry Liddell. One of the children was Alice, in the picture above taken by Dodson (although sources are quick to point out that a parent was always in attendance). Concerns of over Dodson’s attentiveness and attraction to the children are in the literature surrounding Dodson, and it is hard to imagine there may not have been rumors of pedophilia. Nevertheless, all accounts I have seen suggest Dodson’s friendship with the family was innocent, but a ‘break’ in this family friendship may have been the result of gossip, it has been suggested.

Dodson has been questioned on the meaning of the word ‘Jabberwocky,’ and as referenced in the Wikipedia article above, Dodson himself described it as the ‘result of much excited and voluble discussion.’

Reminiscent of the ‘Music Man,’ of the women who gather to nit and to gossip:

Pick a little, talk a little, pick a little, talk a little/Pick, pick, pick, talk a lot, pick a little more.

Gossip. Or, the results of gossip, more specifically. Put another way, Jabberwocky is ‘the unexpected consequences of relying on unsupported assertions.’

Poorly conducted medical research, fraudulent research, misinterpreted research, can all lead to mistakes and faulty conclusions. So too can gossip. And I am reminded of Christopher Hitchens beautiful but always angry statement, in reference to other large areas of unsupported assertions, ‘that which can be asserted without evidence can also be dismissed without evidence.’

The results of gossip, the conclusions from unsupported assertions, those repercussions of faulty logic and research–this is all Jabberwock.

And when you think about it, charitably, poor old Dodson may have simply been very fond of children he would never have himself, perhaps especially Alice above (ultimately to become Alice in Wonderland), only to have that relationship cut off because of some possible malicious gossip…well…you can certainly see why he would have reveled in slaying the Jabberwocky, can’t you.

Slaying the Jabberwocky: Ridding the world of the consequences of accepting unsupported assertions.

Oh frabjous day!

 

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