This is an extract from my new book “Bad Science“, in the Guardian today. It’s out on Monday: my recommendation is that you buy it, and give it to someone who disagrees with you.
Saturday August 30 2008
Dr Andrew Wakefield is in front of the General Medical Council on charges of serious professional misconduct, his paper on 12 children with autism and bowel problems is described as “debunked” – although it never supported the conclusions ascribed to it – and journalists have convinced themselves that his £435,643 fee from legal aid proves that his research was flawed.
I will now defend the heretic Dr Andrew Wakefield.
The media are fingering the wrong man, and they know who should really take the blame: in MMR, journalists and editors have constructed their greatest hoax to date, and finally demonstrated that they can pose a serious risk to public health. But there are also many unexpected twists to learn from: the health journalists themselves were not at fault, the scale of the bias in the coverage was greater than anybody realised at the time, Leo Blair was a bigger player than Wakefield, and it all happened much later than you think.
Before we begin, it’s worth taking a moment to look at vaccine scares around the world, because I’m always struck by how circumscribed these panics are. The MMR and autism scare, for example, is practically non-existent outside Britain. But throughout the 1990s France was in the grip of a scare that hepatitis B vaccine caused multiple sclerosis.
In the US, the major vaccine fear has been around the use of a preservative called thiomersal, although somehow this hasn’t caught on here, even though that same preservative was used in Britain. In the 1970s there was a widespread concern in the UK, driven again by a single doctor, that whooping-cough vaccine was causing neurological damage.
What the diversity of these anti-vaccination panics helps to illustrate is the way in which they reflect local political and social concerns more than a genuine appraisal of the risk data, because if the vaccine for hepatitis B, or MMR, is dangerous in one country, it should be equally dangerous everywhere; and if those concerns were genuinely grounded in the evidence, especially in an age of the rapid propagation of information, you would expect the concerns to be expressed by journalists everywhere. They’re not.
In 1998 Wakefield published his paper in the Lancet. It’s surprising to see, if you go back to the original clippings, that the study and the press conference were actually covered in a fairly metered fashion, and also quite sparsely. The Guardian and the Independent reported the story on their front pages, but the Sun ignored it entirely, and the Daily Mail – home of the health scare, and now well known as vigorous campaigners against vaccination – buried their first MMR piece unobtrusively in the middle of the paper. There were only 122 articles mentioning the subject at all, in all publications, that whole year.
This was not unreasonable. The study itself was fairly trivial, a “case series report” of 12 people – essentially a collection of 12 clinical anecdotes – and such a study would only really be interesting and informative if it described a rare possible cause of a rare outcome. If everyone who went into space came back with an extra finger, say, then that would be worth noting. For things as common as MMR and autism, finding 12 people with both is entirely unspectacular.
But things were going to get much worse, and for some very interesting reasons. In 2001 and 2002 the scare began to gain momentum. Wakefield published a review paper in an obscure journal, questioning the safety of the immunisation programme, although with no new evidence. He published two papers on laboratory work using PCR (a technique used in genetic fingerprinting) which claimed to show measles virus in tissue samples from children with bowel problems and autism. These received blanket media coverage.
The coverage rapidly began to deteriorate, in ways which now feel familiar and predictable. Emotive anecdotes from distressed parents were pitted against old men in corduroy with no media training. The Royal College of General Practitioners press office not only failed to speak clearly on the evidence, it also managed to dig up anti-MMR GPs for journalists who rang in asking for quotes. Newspapers and celebrities began to use the vaccine as an opportunity to attack the government and the health service, and of course it was the perfect story, with a charismatic maverick fighting against the system, a Galileo-like figure. There were elements of risk, of awful personal tragedy, and of course, the question of blame: whose fault was autism?
But the biggest public health disaster of all – which everyone misses – was a sweet little baby called Leo. In December 2001 the Blairs were asked if their infant son had been given the MMR vaccine, and refused to answer, on the grounds that this would invade their child’s right to privacy. This stance was not entirely unreasonable, but its validity was somewhat undermined by Cherie Blair when she chose to reveal Leo’s vaccination history, in the process of promoting her autobiography, and also described the specific act of sexual intercourse which conceived him.
And while most other politicians were happy to clarify whether their children had had the vaccine, you could see how people might believe the Blairs were the kind of family not to have their children immunised: essentially, they had surrounded themselves with health cranks. There was Cherie Blair’s closest friend and aide, Carole Caplin, a new age guru and “life coach”. Cherie was reported to visit Carole’s mum, Sylvia Caplin, a spiritual guru who was viciously anti-MMR (“for a tiny child, the MMR is a ridiculous thing to do. It has definitely caused autism,” she told the Mail). They were also prominently associated with a new age healer called Jack Temple, who offered crystal dowsing, homeopathy, neolithic-circle healing in his suburban back garden, and some special breastfeeding technique which he reckoned made vaccines unnecessary.
Whatever you believe about the Blairs’ relationships, this is what the nation was thinking about when they refused to clarify whether they had given their child the MMR vaccine.
The MMR scare has created a small cottage industry of media analysis. In 2003 the Economic and Social Research Council published a paper on the media’s role in the public understanding of science, which sampled all the major science media stories from January to September 2002, the peak of the scare. It found 32% of all the stories written in that period about MMR mentioned Leo Blair, and Wakefield was only mentioned in 25%: Leo Blair was a bigger figure in this story than Wakefield.
And this was not a passing trivial moment in a 10-year-long story. 2002 was in fact the peak of the media coverage, by a very long margin. In 1998 there were only 122 articles on MMR. In 2002 there were 1,257 (from here). MMR was the biggest science story that year, the most likely science topic to be written about in opinion or editorial pieces, it produced the longest stories of any science subject, and was also by far the most likely to generate letters to the press, so people were clearly engaging with the issue. MMR was the biggest and most heavily covered science story for years.
It was also covered extremely badly, and largely by amateurs. Less than a third of broadsheet reports in 2002 referred to the overwhelming evidence that MMR is safe, and only 11% mentioned that it is regarded as safe in the 90 other countries in which it is used.
While stories on GM food, or cloning, stood a good chance of being written by specialist science reporters, with stories on MMR their knowledge was deliberately sidelined, and 80% of the coverage was by generalist reporters. Suddenly we were getting comment and advice on complex matters of immunology and epidemiology from Nigella Lawson, Libby Purves, Suzanne Moore and Carol Vorderman, to name only a few. The anti-MMR lobby, meanwhile, developed a reputation for targeting generalist journalists, feeding them stories, and actively avoiding health or science correspondents.
Journalists are used to listening with a critical ear to briefings from press officers, politicians, PR executives, salespeople, lobbyists, celebrities and gossip-mongers, and they generally display a healthy natural scepticism: but in the case of science, generalists don’t have the skills to critically appraise a piece of scientific evidence on its merits. At best, the evidence of these “experts” will only be examined in terms of who they are as people, or perhaps who they have worked for. In the case of MMR, this meant researchers were simply subjected to elaborate smear campaigns.
The actual scientific content of stories was brushed over and replaced with didactic statements from authority figures on either side of the debate, which contributed to a pervasive sense that scientific advice is somehow arbitrary, and predicated upon a social role – the “expert” – rather than on empirical evidence.
Any member of the public would have had very good reason to believe that MMR caused autism, because the media distorted the scientific evidence, reporting selectively on the evidence suggesting that MMR was risky, and repeatedly ignoring the evidence to the contrary. In the case of the PCR data, the genetic fingerprinting information on whether vaccine-strain measles virus could be found in tissue samples of children with autism and bowel problems, this bias was, until a few months ago, quite simply absolute. You will remember from earlier that Wakefield co-authored two scientific papers – known as the “Kawashima paper” and the “O’Leary paper” – claiming to have found such evidence, and received blanket media coverage for them. But you may never even have heard of the papers showing these to be probable false positives.
In the Journal of Medical Virology
May March 2006 there was a paper by Afzal et al, looking for measles RNA in children with regressive autism after MMR vaccination, using tools so powerful they could detect measles RNA down to single-figure copy numbers. It found no evidence of the vaccine-strain measles RNA to implicate MMR. Nobody wrote about this study, anywhere, in the British media (except for me in my column).
This was not an isolated case. Another major paper was published in the leading academic journal Pediatrics a few months later, replicating the earlier experiments very closely, and in some respects more carefully, also tracing out the possible routes by which a false positive could have occurred. For this paper by D’Souza et al, like the Afzal paper before it, the media were united in their silence. It was covered, by my count, in only two places: my column, and a Reuters news agency report. Nowhere else (although there was a post on the lead researcher’s boyfriend’s blog where he talked about how proud he was of his girlfriend). [EDITED to disambiguate]
Journalists like to call for “more research”: here it was, and it was ignored. Did the media neglect to cover these stories because they were bored of the story? Clearly not. Because in 2006, at exactly the same time as they were unanimously refusing even to mention these studies, they were covering an identical claim, using identical experimental methodology: “US scientists back autism link to MMR” said the Telegraph. “Scientists fear MMR link to autism” squealed the Mail.
What was this frightening new data? These scare stories were based on a poster presentation, at a conference yet to occur, on research not yet completed, by a man with a well-documented track record of announcing research that never subsequently appears in an academic journal. This time Dr Arthur Krigsman was claiming he had found genetic material from vaccine-strain measles virus in some gut samples from children with autism and bowel problems. If true, this would have bolstered Wakefield’s theory, which by 2006 was lying in tatters. We might also mention that Wakefield and Krigsman are doctors together at Thoughtful House, a private autism clinic in the US.
Two years after making these claims, the study remains unpublished.
Nobody can read what Krigsman did in his experiment, what he measured, or replicate it. Should anyone be surprised by this? No. Krigsman was claiming in 2002 that he had performed colonoscopy studies on children with autism and found evidence of harm from MMR, to universal jubilation in the media, and this work remains entirely unpublished as well. Until we can see exactly what he did, we can’t see whether there may be flaws in his methods, as there are in all scientific papers, to a greater or lesser extent: maybe he didn’t select the subjects properly, maybe he measured the wrong things. If he doesn’t write it up formally, we can never know, because that is what scientists do: write papers, and pull them apart to see if their findings are robust.
Through reporting as shamelessly biased as this, British journalists have done their job extremely well. People make health decisions based on what they read in the newspapers, and MMR uptake has plummeted from 92% to 73%: there can be no doubt that the appalling state of health reporting is now a serious public health issue. We have already seen a mumps epidemic in 2005, and measles cases are at their highest levels for a decade. But these are not the most chilling consequences of their hoax, because the media are now queueing up to blame one man, Wakefield, for their own crimes.
It is madness to imagine that one single man can create a 10-year scare story. It is also dangerous to imply – even in passing – that academics should be policed not to speak their minds, no matter how poorly evidenced their claims. Individuals like Wakefield must be free to have bad ideas. The media created the MMR hoax, and they maintained it diligently for 10 years. Their failure to recognise that fact demonstrates that they have learned nothing, and until they do, journalists and editors will continue to perpetrate the very same crimes, repeatedly, with increasingly grave consequences.
· This is an edited extract from Bad Science by Ben Goldacre, published by Fourth Estate on September 1 at £12.99. To order a copy for £10.99 with free p&p, call 0870 836 0875 or visit guardianbookshop.co.uk
Or if you prefer you can buy it off Amazon