Opinionista Nathan Geffen 28 August 2014

Tim Noakes and the responsibility of experts

One of the major medical advances of the last few decades has been the two-dose vaccine for children against measles, mumps and rubella. A responsible doctor or public health expert would not do anything to jeopardise public confidence in the vaccine. Yet this is exactly what UCT's Professor Tim Noakes did this past weekend.

The measles vaccine is a vital part of public health.

The World Health Organisation (WHO) estimates that before the vaccine became widely available in the 1980s, measles killed over 2.5 million people per year. By 2012 this had dropped to a bit more than 120,000 deaths per year. This was in large part because of the vaccine.

You have to treat these statistics cautiously. Estimating the number of people throughout the world who die of a particular disease every year is a difficult, uncertain exercise even with today’s sophisticated technologies to aid data collection. This is even more the case for historical data. But the WHO estimates are reliable enough to show that the measles vaccine has saved, and continues to save, many lives.

In 2009, the health department claimed that 99% of South African children received the measles vaccine, but the WHO and UNICEF estimated this was only 65%. Although the data is flawed measles vaccination coverage in South Africa has improved. Most children receive both doses, but there are substantial differences in coverage across districts, and problems with supply. This is probably why there are still occasional measles outbreaks, such as in 2009 and 2010 when 18,000 cases were reported. Nevertheless, measles has become a much smaller problem over the last few decades because of vaccination.

In 1998 Andrew Wakefield, a British surgeon, was the first author of a research paper published in a leading medical journal, The Lancet, which purported to show that there was a link between the measles, mumps and rubella (MMR) vaccine and autism.

Wakefield became the leader of a movement against the MMR vaccine. Opponents of the MMR vaccine included celebrity actors such as Jenny McCarthy and Jim Carrey.

But not only was Wakefield’s paper “fatally flawed both scientifically and ethically”, it was also, explains the British Medical Journal, “an elaborate fraud”. Wakefield was found guilty of several counts of dishonesty in 2010 by the General British Medical Council and barred from practising medicine. Since the Wakefield paper, large well-conducted studies have not been able to find evidence of a link between vaccines and autism. It is highly unlikely there is any link between the MMR vaccination and autism.

Wakefield’s name is becoming synonymous with dishonesty in science. He’s not someone a reputable scientist would wish to be associated with. Yet at the weekend, Noakes tweeted to his 46,000 followers on Twitter: “Dishonest science. Proven link between autism and early immunisation covered up?” The tweet contained links to two videos (here and here), one of them featuring Wakefield, which claim that the United States Centers for Disease Control (CDC) is covering up a link between autism and immunisation.

You’d have to be living on Mars not to know that Noakes has been proposing that many people would benefit from switching to a low-carbohydrate high-fat diet. His book, Real Meal Revolution, is a bestseller. Sensational media headlines followed his recent visit to Parliament, where he reportedly told MPs South Africa “was sitting on a ‘time bomb’ if diabetes and obesity were not addressed.” That’s a somewhat misleading statement, but beyond the scope of this article.

The debate about whether it is healthier to eat more fat or carbohydrates is not high on GroundUp’s priority list. So we’ve ignored Noakes until now. But his flirtation with the anti-vaccination movement can’t be ignored. Here is an academic with a considerable public voice and masses of supporters spreading a dangerous claim.

The claims made in the videos have been debunked by David Gorski on the website sciencebasedmedicine.org. There is no evidence of a CDC cover-up, nor any evidence that the MMR vaccine causes autism.

By reading Gorski’s superb article you’ll find out there’s a troubling racial angle to the conspiracy theory too. The anti-vaccination proponents are claiming that what is being covered up is a statistical association between the MMR vaccine and autism in black children. This is nonsense; no such association has been found. But should this bad idea gain traction in the United States, where African Americans are already disadvantaged when it comes to health-care, or in South Africa where black people have historically been harder hit by measles, the consequences could be dire.

Noakes was challenged on Twitter. Stephen Ballot asked, “Prof, please tell me straight if you think there is a link between [the MMR vaccine] and autism.” Noakes responded, “have no opinion. Focus of video was on wilful distortion of science and importance of whistleblowers. How did you miss it?” To which UCT philosopher Jacques Rousseau, who has challenged the way Noakes has wildly presented many of his claims, wittily responded, “but the video wilfully distorted the evidence to make that point. How did you miss it?”

After recommending that his followers watch videos that cast suspicion on the MMR vaccine, it is disingenuous for Noakes to say he has no opinion. But even if we take him at his word, Noakes is a doctor who is outspoken on matters of public health. He has been awarded UCT’s highest degree. For a person of his qualifications, stature and popularity to claim indifference on the benefit of getting the MMR vaccine is analogous to Stephen Hawking claiming he has no opinion on whether the earth orbits the sun.

Noakes’ dietary advice is highly controversial, but even if he turns out to be right about the fat versus carbohydrates debate, the measles vaccine is a greater contribution to public health and the increase in human life-expectancy than his entire life’s work by a very long way. To spread doubt about the vaccine as he has done is not merely arrogant, it is irresponsible. DM

Nathan Geffen used to work for the Treatment Action Campaign. He is currently the editor of GroundUp.

Minor edits and one important correction were made to this article after publication. In the South African public sector, children are vaccinated against measles. The combination vaccine for mumps and rubella is available in the private sector only. The original version didn’t reflect this nuance. Thanks to Disqus user Donne for pointing this out. Some public sector paediatricians are however pushing for the introduction of the combination vaccine with mumps and rubella because these diseases also cause morbidity in South Africa.



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