Comment: Research is all about error. Either learn how to interpret data yourself, or trust those who can do it for you
Ben Goldacre
Wednesday November 2, 2005
The Guardian
Whatever you have been told, science is not about certainty. And this creates problems for those health professionals who are charged with interpreting and relating data to the general public. We are expected to refute wholesale misunderstandings, in a popular forum, to people who may well be intelligent but who know nothing of evidence-based medicine, in soundbite format.
Health scares are like toothpaste: they’re easy to squeeze out, but very difficult to get back in the tube. On Monday, for example, Melanie Phillips of the Daily Mail wrote yet another attack on the MMR vaccine. She suggested that the journalists who trusted the new Cochrane review, which shows that MMR is probably safe and not linked to autism, were lazy stooges who took the press release at face value.
The problem is that Phillips seems to misunderstand basic epidemiology. She cites “research data” of highly dubious status and misrepresents what data there is. Her response is a microcosm of the problems that can arise when journalists engage with science.
The Cochrane Collaboration is an independent, international non-profit organisation that produces systematic reviews of the literature, written by and for scientists who understand critical appraisal. It would be a happier world if journalists who write about health issues were also au fait with the intricacies of evidence-based medicine, and were trained to read academic papers. But because the majority of them can’t, the report is converted into a more easily digested press release for journalists.
This creates its own problems. Science is all about the error bar, a graphic representation of the uncertainties in the data. I look forward to the day when every politician’s speech has an error bar next to it, fluctuating in response to the margin of certainty around their claims.
This is how science works: you do a piece of research, you get some results and you write them up, in full, so that everyone can see what you’ve done, replicate it and critique it. You say: here are our results, they are this statistically accurate (error bar), and on the basis of this finding, and many other findings from other labs (which are clearly referenced) we come to the following verdict on a particular hypothesis.
The process is transparent, but relies on people being able to critically appraise a paper, pull apart its methodology, understand the statistics, in order to come to their own verdict. It follows that all scientific papers are flawed, to a greater or lesser extent, and each in its own unique way, because of the different ways of working around the practical problems of doing research: imperfect follow-up, imperfect measurements and so on. Scientists all know that.
A Cochrane review is a systematic review of the literature, which critiques each paper it encounters in exactly this manner. So the press release for this particular Cochrane review said, overall, that this overview of the evidence suggests that MMR is pretty safe.
But Phillips has read the full report, and is outraged by what she thinks she’s found: “It said that no fewer than nine of the most celebrated studies that have been used against [Andrew Wakefield, who first claimed in 1998 that there was a link between the vaccine and autism] were unreliable in the way they were constructed”. Of course it did. Cochrane reviews are intended to criticise papers.
She seems surprised that the report doesn’t walk the reader through the reasons why Wakefield’s speculative 12-subject case-series report is less worrying when considered alongside the many large epidemiological surveys of up to half a million people that the Cochrane review focuses on. But the reasons are clear to anyone who understands biomedical research.
Phillips presents material as experimental scientific research when it has never been published in a peer-reviewed academic journal and is not indexed in PubMed, the standard search tool for finding medical academic papers.
One piece of scientific research she refers to has been published only in the in-house magazine of a rightwing US pressure group well known for polemics on homosexuality, abortion and vaccines. She says “autistic enterocolitis” is a “disease” and a “new syndrome” that has been “replicated in studies around the world”. As a rough guide, the phrase “autistic enterocolitis” appears in only five PubMed-indexed academic papers, one by Wakefield and four others mostly doubting its status.
What’s more, she seems to misunderstand basic epidemiology. Large population surveys have greater power to detect a small increase in a given condition. Apparently not for Phillips: “Only a very small proportion are said to have been badly affected … ” she says.”But population-wide studies are considered too large and insensitive to pick up small numbers such as this.”
It is self-evident to anybody who understands biomedical research, and if you don’t get it then you have only two choices: you can either learn to interpret data yourself and come to your own informed conclusions; or you decide who to trust. Choose wisely.
· Ben Goldacre is a doctor and writes the Bad Science column in the Guardian bad.science@guardian.co.uk
Comments below, personal anecdotes will be deleted as people get easily upset by the subsequent responses, childish personal attacks on anyone will be deleted unless they are funny. If your post is more than one thousand words long you are officially a loser.
Michael P said,
November 10, 2005 at 11:36 am
This is not the Guardian. As for the content…
www.badscience.net/?page_id=7
Hmmm, maybe something should be added about the “misuse” and “overuse” of “”.
quizzical said,
November 10, 2005 at 12:35 pm
I can rephrase it:
Presumably the Guardian think that printing Melanie Phillips on MMR shows how “heated†and “close†the “debate†on the “controversial†MMR vaccine is.
They should be ashamed of themselves.
Stuart said,
November 10, 2005 at 1:28 pm
Interesting to note that even Private Eye is distancing itself from the anti-MMR campaign. Of course they claim that they never said that MMR caused autism etc., but they did act as apologist for Wakefield and did a proper job of trashing anyone who dared point out that there was no evidence of a link.
As I recall, after the Sunday Times printed Brian Deer’s piece on Wakefield’s alleged conflicts of interest they published a long diatribe by Heather Mills about how several pro-MMR scientists were compromised by links to drug companies (how many biomed researchers don’t?). The after the C4 Dispatches programme she went for Deer himself.
Now apparently they never believed in it or something. Anyway it’s all pretty weaselly stuff from an otherwise commendably cynical organ.
Richard Lindley said,
November 10, 2005 at 3:46 pm
With respect to the JPANDS article – the methodology seems sound at first glance (although I am not qualified to comment on the RT PCR primers) – but there seems to be a couple of big problems:
1. Why were there only 3 controls?
This is surely an important finding in the 3 selected cases, but why was this study set up as a pseudo case-control? I would have been much more impressed if the study had looked at 30 or 300 “normal” controls and found no evidence of MV in CSF or bowel. Note that they seem to acknowledge the results wouldn’t be worth testing for significance….
2. Why only “normal” controls?
Alternative hypothesis: MV causes bowel inflammation without autism(which is coincidental and only occurred as Wakefield is involved in this study and litigious parents came to him): we need to see results from children with bowel disease and no autism
This paper is therefore fit to be filed under “looks intersting, go away and do more work”
I therefore feel this answers the second question:
Why publish your paper in a non-PubMed/Index Medicus journal with no impact factor if you are a serious researcher?
I suspect it is because peer reviewers in more respected journals would have rejected the paper (see above). Of course, I would say that as I am part of the vast worldwide conspiracy paid for by Big Pharma and the Illuminati that is secretly denying anti-MMR research a proper outlet….
Kev said,
November 10, 2005 at 4:12 pm
Kevin,
said: The judge made his decision based on a number of reasons, you have chosen to highlight one of them, and imply a motive which is not proven
If you have read the ruling in full you will have seen Justice Eady said:
“It thus appears that the Claimant wishes to use the existence of the libel proceedings for public relations purposes, and to deter other critics, while at the same time isolating himself from the “downside†of such litigation, in having to answer a substantial defence of justification.”
Please also note how Justice Eady refers to ‘The Claimant’ who’s hands control remains, not his lawyers who are instructed.
Melanie Phillips notwithstanding, its the Andrew Wakefields, Jeff Bradstreets and Hugh Fundbergs of this world who have done serious damage to autism research.
Kevin Mannerings said,
November 10, 2005 at 4:43 pm
Richard, it is good that you are discussing the science in this, BUT
>>Why publish your paper in a non-PubMed/Index Medicus journal with no impact >>factor if you are a serious researcher?
MP says that the JPANDS applied for pubmed indexing some time ago, and when Pubmed get around to it, it will be indexed there. I have no reason to doubt this, do you?
I would not in the main with points of 2 and 3, not least because I don’t have the specialist knowlege to evaluate the research. It would be the task of good science journalists to seek out the experts and give us a balanced view.
You write:
“I suspect it is because peer reviewers in more respected journals would have rejected the paper (see above). Of course, I would say that as I am part of the vast worldwide conspiracy paid for by Big Pharma and the Illuminati that is secretly denying anti-MMR research a proper outlet…. ”
Can you provide any evidence about the standards of peer review applied by JPANDS ? If you can, please do share it, if not, you get points for irrationality. Suspicion is not enough. Science, and rational thought, is based on fact. And no, I wouldn’t dream of applying the Mandy Rice Davies “he would say that, wouldn’t he” line. I am quite open to argument about the quality of JPANDS, but it has to be solid, not irrelevant guff about abortion, gay rights, and vaccines. it seems like an unusual organisation founded during WW2. The campain it has led against mercury in vaccines must have been a pain in the butt for both industry and government, but interestingly, mercury is being phased out, and the WHO has endorsed this. It is over the top to see them as a medical version of the John Birch Society, what we need is a qualified history of their politics and origins.
RS said,
November 10, 2005 at 4:48 pm
Richard, what I think is even more worrying, and evidence that the paper is fundamentally flawed, is that they selected subjects they already knew had tested positive for measles virus in the gut: “All three children had concomitant onset of gastrointestinal (GI) symptoms and had already had MV genomic RNA detected in
biopsies of ileal lymphoid nodular hyperplasia (LNH).” So what do their findings tell us? If we take it at face value it says that in three subjects with autism and gastrointestinal symptoms, who tested positive for measles virus in the gut (and were presumably selected for this reason), that these three subjects also showed measles virus in CSF. Whether the controls did or didn’t show measles virus in CSF seems pretty irrelevant here. Therefore it is not even the hideously underpowered case-control study it purports to be. Just saying something is a control does not make it so.
The problem is that people like Melanie Phillips are unable (or in her case, quite probably unwilling) to recognise the different strengths of entirely uncontrolled case reports like this one and Wakefield’s Lancet paper, and large-scale epidemiological or case-control studies.
Ray said,
November 10, 2005 at 7:35 pm
“but interestingly, mercury is being phased out”
Interestingly, Procter & Gamble phased out the moon-and-stars logo that was alleged to be a Satanic symbol. Doesn’t mean it was Satanic, just that discontinuing it was easier than ongoing hassle from those who mistakenly thought it was.
aphasia said,
November 11, 2005 at 1:05 am
How about the following Bill Hicks quote for a T-shirt:
“Have you ever noticed that
most creationists look very unevolved”
Kevin Mannerings said,
November 11, 2005 at 12:09 pm
Ray (109) That is a fair point, but as there is a lot of litigation about this going on stateside, it is not reasonable to expect that the motives will be put on display by those being sued.
I have an open mind on the question, but one argument went a long way with me: it is claimed that the mercury levels do not reach dangerous levels because the mercury is spread throughout the body and rapidly excreted. This is the same argument that was used by those ‘scientists’ who used to assure us that there is NO EVIDENCE THAT SMOKING CAUSES CANCER. That is an assumption, possibly an assumption too far.
Stephen said,
November 11, 2005 at 3:52 pm
Kevin
Your last point about smoking and cancer is a weird incongruous tangent.
The pertinent point in regards to this discussion is to remember that the link between smoking and cancer was most convincingly demonstrated by a large epidemiological study (of GPs I believe)– not a laboratory or clinical study.
RS said,
November 11, 2005 at 7:15 pm
“First, this totally ignores the various research papers* — which have been published in a range of distinguished journals — to which I referred in my article, along with the American Institute of Medicine, also all but totally ignored….*Some papers endorsing or replicating the Wakefield research:”
So let us just quickly skim the abstracts of these papers to see if these papers truly replicate or support Wakefield’s work:
“1) Evaluation of an association between gastrointestinal symptoms and cytokine production against common dietary proteins in children with autism spectrum disorders;
Harumi Jyonouchi MD, Lee Geng PhD, Agnes Ruby BS, Chitra Reddy MD and Barbie Zimmerman-Bier, MD
Journal of Pediatrics, May 2005, p 610”
Young children with autism spectrum disorders and gastrointestinal symptoms produced more tumor necrosis factor-alpha (TNF-alpha)/interleukin-12 (IL-12) than control subjects, when provoked with cow’s milk protein and its components.
“2) Dysregulated Innate Immune Responses in Young Children with Autism Spectrum Disorders: Their Relationship to Gastrointestinal Symptoms
and Dietary Intervention;
Harumi Jyonouchi Lee Geng Agnes Ruby Barbie Zimmerman-Bier Department of Pediatrics, New Jersey Medical School, UMDNJ, Newark, N.J. , USA
Neuropsychobiology 2005;51:77–85”
Pretty similar to the last one, TNF-alpha levels produced with endotoxin and cow’s milk protein.
“3) Some aspects about the clinical and pathogenetic characteristics of the presumed persistent measles infections: SSPE and MINE;
Paul Richard Dyken, Institute for Research in Childhood Neurodegenerative Diseases, Mobile, Alabama, U.S.A.
Journal of Pediatric Neurology 2004; 2(3): 121-124”
This is an editorial (so I actually skimmed the whole thing) discussing parallels between Subacute Sclerosing PanEncephalitis (SSPE) and what he calls MINE (Measles Induced Neuroautistic Encephalopathy), which is essentially Wakefield’s autistic enterocolitis. The author was involved in the class action of the parents and the article is actually describing the supposed syndrome, and refers only to the original 12 Wakefield patients. The author claims that “In each patient, regardless of type, measles virus genes were found in the tissues studied, such as blood, gut and spinal fluid. In those with enough antigen identified, the genes were found to arise from the vaccine-related live-attenuated measles virus and not from the usual wild measles virus which is associated with measles exanthema.”, he does not give a reference for this. While the paper may be called supportive of Wakefield, it is not a scientific study, it is an opinion piece.
“4) Spontaneous Mucosal Lymphocyte Cytokine Profiles in Children
with Autism and Gastrointestinal Symptoms: Mucosal Immune
Activation and Reduced Counter Regulatory Interleukin-10
Paul Ashwood, Andrew Anthony, Franco Torrente and Andrew Wakefield
Journal of Clinical Immunology, Vol. 24, No. 6, November 2004 ( C_ 2004)”
Duodenal and colonic biopsies were obtained from 21 ASD children, and 65 developmentally normal paediatric controls, of which 38 had signs of histological inflammation. Basically ASD children had more inflammatory markers than non-inflamed controls, but not more than inflamed controls. I don’t think I have access to this journal, but obviously it would be interesting to know how and why they got the biopsies of the ASD children (i.e. did they already have an inflammatory bowel complaint or not).
“5) Panenteric IBD-Like Disease in a Patient with Regressive Autism Shown for the First Time by the Wireless Capsule Enteroscopy: Another Piece in the Jigsaw of this Gut-Brain Syndrome?
Federico Balzola , Valeria Barbon , Alessandro Repici , Mario Rizzetto , Daniela Clauser , Marina Gandione , Anna Sapino.
American Journal of Gastroenterology, April 2005”
This is a letter to the editor, it reports as single case of a 28yr old male with regressive autism that had aenemia, apparently due to some kind of bowel inflammation. Um, that’s it.
“6) Gastrointestinal abnormalities in children with
autistic disorder
Karoly Horvath, MD, PhD, John C. Papadimitriou, MD, PhD, Anna Rabsztyn, Cinthia Drachenberg, MD.
Journal of Pediatrics, Vol 125, no 5”
Thirty-six children with autistic disorder and GI symptoms underwent upper gastrointestinal endoscopy with biopsies, intestinal and pancreatic enzyme analyses, and bacterial and fungal cultures. Histologic examination in these 36 children revealed grade I or II reflux esophagitis in 25 (69.4%), chronic gastritis in 15, and chronic duodenitis in 24.
“7) Autistic disorder and gastrointestinal disease
Karoly Horvath, MD, PhD, and Jay A. Perman, MD
Pediatrics 2002, 14:583–587”
This reference is wrong, I think she means Curr Opin Pediatr. 2002 Oct;14(5):583-7. It appears to be a review or editorial, i don’t have access – here’s the abstract:
“Autistic disorder is a pervasive developmental disorder manifested in the first 3 years of life by dysfunction in social interaction and communication. Many efforts have been made to explore the biologic basis of this disorder, but the etiology remains unknown. Recent publications describing upper gastrointestinal abnormalities and ileocolitis have focused attention on gastrointestinal function and morphology in these children. High prevalence of histologic abnormalities in the esophagus, stomach, small intestine and colon, and dysfunction of liver conjugation capacity and intestinal permeability were reported. Three surveys conducted in the United States described high prevalence of gastrointestinal symptoms in children with autistic disorder. Treatment of the digestive problems may have positive effects on their behavior.”
Ari said,
November 11, 2005 at 7:32 pm
And let’s not forget that the National Academies Institute of Medicine do not in fact come out against vaccines. They say: “the evidence favors rejection of a causal relationship at the population level between MMR vaccine and autistic spectrum disordersâ€
RS said,
November 11, 2005 at 7:40 pm
So what do we have then? Two scientific studies (#1,2) that looked at sensitivity to food in autistic patients with gastrintestinal symptoms, and suggesting some kind of inflammatory response to challenge. The only mention of Wakefield is a reference to study #4 in the first paper, no mention is made of measles, and MMR is only mentioned in passing in the second paper. These appear to add no credibility to Wakefield’s MMR hypothesis.
We have an editorial by someone involved in the MMR-autism class action, adding no new evidence to the table (#3). We have a scientific study by Wakefield and colleagues that might suggest greater inflammatory markers in autistic patients than patients without GI symptoms – but it isn’t clear at this point how many of the autistic patients did actually have GI symptoms [anyone got access to this paper?] (#4). I can’t see at present how this supports the MMR-autism link.
We have a single case of an autistic man with IBS (#5), which adds precisely nothing to the MMR-autism debate. Evidence that autistic patients with GI symptoms mostly have non-intestinal problems (#6), which would seem inconsistent with Wakefield’s original hypothesis, but is certainly not evidence for it. Finally a wrongly referenced review article which appears to have high prevalence of gastrointestinal symptoms in children with autistic disorder as its main point (#7), which isn’t adding anything to the question of whether MMR and autism are linked.
No wonder Melanie Phillips isn’t convinced by those pesky epidemiological studies.
RS said,
November 11, 2005 at 8:13 pm
Shit, are these the studies she meant when she said:
“He claims that Wakefield’s term “autistic enterocolitis” has appeared in no other studies that have endorsed it. But Wakefield’s core finding of a unique gut-brain disease has been replicated in peer-reviewed papers in the Journal of Paediatric Neurology, Neuropsychobiology, the Journal of Paediatrics, the Journal of Clinical Immunology and the American Journal of Gastroenterology.”
In that case I have discovered my own unique lung-brain disease, ‘schizotuberculosis’, on the basis that a considerable proportion of people with schizophrenia also have lung disease, and I’ve already narrowed down the cause to M. tuberculosis. Nobel prize please.
CaptainT said,
November 12, 2005 at 11:54 am
Great article on this from Spiked yesterday, worth following the link to the original because there you can follow the links in the references (dontcha love teh internets):
www.spiked-online.com/articles/0000000CAE57.htm
11 November 2005
The death agony of the anti-MMR campaign
Even after a Cochrane review found ‘no credible evidence’ of a link between MMR and autism, sections of the British media just won’t let it lie.
by Dr Michael Fitzpatrick
A recent Cochrane systematic review concluded that there was ‘no credible evidence’ of a link between the measles, mumps and rubella vaccine (MMR) and either inflammatory bowel disease or autism (1). The virtually unanimous verdict of the media was that this review, following a series of studies coming to the same conclusion, meant that the scare launched by Andrew Wakefield’s now notorious Lancet paper in 1998 was finally over. Not quite.
The publication of the Cochrane review provoked demands that the Daily Mail and Private Eye acknowledge their past mistakes and apologise for their role in promoting the MMR-autism scare. Instead the Mail published a feature by leading columnist Melanie Phillips insisting that claims that MMR was safe were ‘a load of old baloney’ (2). Phillips proclaimed that, far from having received the ‘all-clear’, the ‘MMR scandal’ was ‘getting worse’. When Guardian science writer Ben Goldacre observed that Phillips seemed ‘to misunderstand basic epidemiology’ (3), she accused him of ‘smear and evasion’ (4). The hapless Eye stumbled between pleading that it had always been pro-immunisation and insisting that Wakefield had been unjustly ‘completely vilified’ for claiming a link between MMR and autism (though neither he nor anybody else has substantiated this since it was first suggested, nearly 10 years ago) (5).
Phillips’ defiant articles and the Eye’s apologia for Wakefield stand as symbols of the woeful role of the media in the course of the MMR controversy. It is true that the MMR-autism scare did not start in the press. Both a reputable London teaching hospital and a prestigious medical journal failed to protect the public from junk science. Yet, once Wakefield decided to go public with his anti-MMR campaign, the media played a major part in promoting the scare. Phillips’ response to the Cochrane study follows the familiar themes of numerous anti-MMR articles over the years, including several by Phillips herself.
In her response to Goldacre, Phillips objects to his charge that she is scientifically illiterate: ‘this argument has been used to tell parents that the evidence of their own eyes is not true.’ But this statement eloquently confirms Goldacre’s point. Scientists have been contradicting the evidence of people’s senses – and of common sense – ever since Galileo advanced the heretical, and counterintuitive, view that the Earth revolved around the sun (could he not see with his own eyes that the sun rose in the east and set in the west?) (6). Parents who cite the evidence of their own eyes that their children became autistic after receiving the MMR vaccine are in the grip of one of the oldest of commonsensical fallacies – that association proves causation. Even though parents may cling passionately to the belief that MMR caused their children’s autism, it is the responsibility of scientists to tell them that intensive scientific research in a number of disciplines indicates that the evidence of their own eyes is not true. While acknowledging the provisional character of all scientific truth and the difficulties in determining it, the Cochrane review concludes that the truth about MMR is that it does not cause autism (though it does protect children against three potentially serious diseases).
It is important that scientists do not shirk the onerous responsibility of telling parents the truth about the MMR-autism link, because the costs of denying this truth are high. The false belief in the MMR-autism link has led thousands of families of autistic children into a doomed quest for compensation from vaccine manufactures and has caused thousands more parents to feel anger, anxiety and guilt over giving their children the vaccine. The scare has led to a significant decline in vaccine uptake that may yet lead to new epidemics of measles and other diseases. For a scientist to promote the notion of a link between MMR and autism for which he cannot produce compelling evidence is socially irresponsible. It is also irresponsible for journalists to endorse the anti-MMR campaign without critically examining the claims of its promoters and providing an accurate account of the overwhelming weight of scientific evidence against the autism link.
Goldacre rightly points out that Phillips misunderstands the nature of a systematic review. She misinterprets any criticism of studies of MMR safety, or any expression of uncertainty about their conclusions, as a vindication of Wakefield’s case. She echoes the mantra of anti-MMR campaigners that epidemiological methods are not suitable to discover an association between MMR and autism, when this is precisely the point of such methods. Epidemiology has successfully identified a link between MMR and the skin rash resulting from a sharp fall in blood platelets (thrombocytopenic purpura), a (generally benign) condition much rarer (around 20 cases a year in Britain) than the so-called epidemic of autism attributed to MMR.
Indeed, this is why Wakefield explicitly invited epidemiological studies in his Lancet paper – only to repudiate this approach when one study after another failed to support his hypothesis. Having started out blaming MMR for causing an epidemic of autism, campaigners are now reduced to the absurd claim that it causes a number of cases too small to measure by epidemiological methods.
Wakefield is depicted as a heroic victim, yet he uses his lawyers to bully critics
Phillips endorses Wakefield’s claims. She insists that his discovery of ‘autistic enterocolitis’ has been replicated around the world and that ‘vaccine-strain’ measles virus has been found in cerebrospinal fluid (CSF) samples from autistic children, though she fails to mention that these few studies have been carried out by Wakefield or his collaborators and are universally dismissed by reputable authorities. Phillips takes exception to Goldacre’s characterisation of the Journal of American Physicians and Surgeons, which has published several articles by Wakefield and his supporters, as the ‘magazine of a right-wing US pressure group well known for polemics on homosexuality, abortion and vaccines’. But Goldacre’s description is accurate. Until two years ago the journal was known as the Medical Sentinel, when it was relaunched declaring a continuing ‘commitment to publishing scholarly articles in defense of the practice of private medicine’ (7). Recent issues include features entitled ‘Illegal aliens and American medicine’ (Spring 2005) and ‘Homosexuality: some neglected considerations’ (Fall 2005), which make the Daily Mail appear positively liberal.
Echoing Wakefield, both the Daily Mail and Private Eye have repeatedly quoted claims that measles virus has been discovered in bowel and CSF samples obtained (by invasive investigations of dubious clinical value and ethical propriety) from autistic children. The key authorities are Professor John O’Leary from Dublin and Dr Jeffrey Bradstreet from Florida. O’Leary published two papers in 2002 which Wakefield immediately claimed supported his theory, a claim explicitly rejected by O’Leary who insisted that his work ‘in no way establishes any link between the MMR vaccine and autism’ (8). The failure of O’Leary’s subsequent investigations of children whose parents were pursuing compensation to come up with reliable evidence of measles infection was the key factor in the collapse of the litigation. After receiving very substantial legal aid fees for these studies, it seems that O’Leary has now abandoned this field.
Dr Bradstreet has variously presented himself as a paediatrician, a Christian family physician, a professor of neuroscience and as an expert/lecturer on autism. He was formerly a radio talk show host and an evangelical preacher: according to the website of his Good News Doctor Foundation, the multi-talented Bradstreet has also conducted ‘vast research’ into the Bible, which has given him a ‘clear grasp’ of Scripture (9). His centre in Melbourne, Florida was exposed in Brian Deer’s Channel 4 Dispatches documentary in November 2004 as the source of a range of quack remedies for children with developmental disorders, including Bradstreet’s personal product, ‘Sea Buddies Concentrate’, advertised as a ‘high potency formula with five ingredients that help support healthy focus and concentration in children’. While Wakefield, Phillips and Private Eye may have faith in Bradstreet, the rest of the world awaits independent replication of his results.
It is extraordinary that, after nearly a decade of Wakefield’s empty promises that he would prove his critics wrong, sections of the British press appear to be still captivated by his self-professed status as a maverick and crusader against the establishment. His posture of martyrdom and victimhood seems to have a particular appeal for Phillips. The price of this mutual self-indulgence is borne by the real victims of the MMR-autism fiasco – parents of autistic children and parents facing decisions about immunisation.
With a few notable exceptions – such as Brian Deer, whose work for The Sunday Times and Channel 4 helped to discredit Wakefield’s Lancet paper – British journalists have a poor record on MMR and, indeed, on autism. It is good news that Deer and Channel 4 have won a high court ruling against Wakefield’s attempt to delay the hearing of his libel claim against them (10). Mr Justice Eady took particular exception to what he described as Wakefield’s wish to ‘use the existence of the libel proceedings for public relations purposes, and to deter other critics’. Wakefield has also tried to silence the Liberal Democrat MP Evan Harris and has sought to restrict the Department of Health from ‘supplying the public with such information as it thought appropriate’ by providing a link to Deer’s website. Eady objected to Wakefield using libel proceedings as ‘a tool for stifling further criticism or debate’ over an important public issue and insisted that the case should go ahead in the near future. Wakefield may be depicted in the Mail and the Eye as a heroic victim, but he does not hesitate to use his lawyers to bully critics.
While journalists have lionised Wakefield (who is now in private practice in Texas), real scandals – such as the recent death of an autistic boy from Britain undergoing mercury chelation therapy in the USA, or the inadequacy of respite services revealed by the conviction of a 67-year-old mother for killing her adult autistic son when she could no longer cope with his violent behaviour – have largely been ignored (11). If children die from measles, the MMR scandal may indeed get worse.
Dr Michael Fitzpatrick is a GP and author of MMR and Autism: What Parents Need to Know (buy this book from Amazon (UK) or Amazon (USA)). An edited version of this article, Why can’t the Daily Mail eat humble pie over MMR?, appears in this week’s British Medical Journal.
(1) Demichelli V, Jefferson T, Rivetti A, Price D, ‘Vaccines for measles, mumps and rubella in children’, The Cochrane Database of Systematic Reviews 2005, issue 4, 19 October 2005
(2) MMR: the unanswered questions, Melanie Phillips, Daily Mail, 31 October 2005
(3) The MMR sceptic who just doesn’t understand science, Ben Goldacre, Guardian, 2 November 2005
(4) The case against me boils down to smear and evasion, Melanie Phillips, Guardian, 8 November 2005
(5) ‘The lessons of Cochrane’, Private Eye 1145, 11-24 November 2005
(6) The Unnatural Nature of Science, Lewis Wolpert, Faber, 1992
(7) Journal of American Physicians and Surgeons
(8) MMR and Autism: What Parents Need to Know, Michael Fitzpatrick, Routledge, 2004, p127-8
(9) Good News Doctor Foundation
(10) Judgment, Hon Justice Eady, Royal Courts of Justice, 4 November 2005. Also see High Court judge criticises Andrew Wakefield for trying to silence his critics, Clare Dyer, British Medical Journal, 12 November 2005
(11) When quackery kills, by Dr Michael Fitzpatrick
Ray said,
November 12, 2005 at 1:18 pm
Good stuff. Did anyone of these studies consider the possibility of autism causing gastrointestinal symptoms for other reasons? For example, many autism sufferers live on limited idiosyncratic diets.
tc said,
November 12, 2005 at 11:17 pm
I think the Daily mail put her up to this. She’s probably kicking herself for not sticking to a subject where refutations are harder to come by. Immigration, terrorism, or baiting a religious minorty perhaps?
CaptainT said,
November 13, 2005 at 1:48 am
So did the Guardian “put her up to it” as well? Actually I guess in a way they probably did.
Anthony said,
November 13, 2005 at 8:03 am
Readers may be interested in this: MMR: A pictorial guide to the reporting of science in The Daily Express
Mark said,
November 13, 2005 at 1:01 pm
I would like to add my congratulations to Ben for his column and this website. I have a an additional small point. From the headlines and much of the discussion you would think that the Cochrane report was primarily about MMR and autism. However, I believe that only 6 out of the 31 studies assessed in the Cochrane report relate to autism. In fact the majority of the studies took place well before 1998.
This makes Melanie’s statement:
“it said that no fewer than nine of the most celebrated studies that have been used against him were unreliable in the way they were constructedâ€
look very strange and suggests that she didn’t even read the paper properly – much less understand the science.
Am I right – or are some of these studies more closely related to Wakefield’s work than it appears?
Cheers
Stu said,
November 13, 2005 at 6:33 pm
A Mel P-esque piece in The Onion: www.theonion.com/content/node/42384
MikeTheGoat said,
November 14, 2005 at 8:24 am
Looks like she’s not just getting science offensively wrong at the moment….
www.guardian.co.uk/france/story/0,,1641463,00.html
MC said,
November 14, 2005 at 11:07 am
This could be an interesting evening…
www.mmrthequestions.com/
Hillingdon Autistic Care and Support
present
AN EVENING WITH DR. ANDREW WAKEFIELD
Dr Wakefield will present an update on the gastrointestinal association with developmental disorders and regressive autism in particular. He will discuss the role of environmental factors in the cause of developmental disorders and examine the claims for and against a role for childhood vaccines in this process. Dr Wakefield will also describe the work in progress at Thoughtful House, a new centre for the care of children with developmental disorders in Austin, Texas.
Wednesday 23rd November 2005
7.30pm entry for 8.00pm start
L .C. Theatre F
Brunel University
Kingston Lane
Hillingdon
UB8 3PH
£15 per ticket
Anthony Cox said,
November 16, 2005 at 10:50 am
Is he touring? The parallels with George Galloway grow.
Dean Morrison said,
November 16, 2005 at 1:29 pm
I’ve just nominated Melanie Phillips to:
www.crank.net
“Cranks, Crackpots and Loons on the net” –
I hope she gets in…..
Penta_Water_UK said,
December 4, 2005 at 12:02 pm
T-Shirt idea!
How about:
“Why worry about MMR?
Colour Nation has a relitivistic heavy ion collider out the back!…
Tell your friends.”
Only you will need very long slieved t-shirts or very small print…or both!
Commonplace Book » Britain’s top Stupid Intellectual said,
December 20, 2005 at 12:24 am
[…] Instead of actually making an effort to understand the evidence presented to her in very simple (yes, patronising) language, Phillips instead attacked Goldacre and science generally, and complained that Goldacre had said she was stupid. Unfortunately if one says stupid things one must allow that other people may call you stupid as a result. […]
Jeff Took said,
January 1, 2006 at 6:47 pm
The real action is still in brian deer’s investigation. Its fascinating:
briandeer.com/mmr/lancet-summary.htm
Mark said,
February 11, 2006 at 11:01 am
You may have noticed that Melanie and The Mail on Sunday are back on the MMR theme.
www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=376203&in_page_id=1774&in_a_source=
Does anyone more about Dr. Peter Fletcher?
Mick James said,
February 27, 2006 at 12:10 pm
“There are very powerful people in positions of great authority in Britain and elsewhere who have staked their reputations and careers on the safety of MMR and they are willing to do almost anything to protect themselves.”
This is unfortunately where the debate ends and veers off into conspiracy theory. Once you accept that powerful vested interests will do “almost anything” then you will see any contrary finding as the result of bribery, fakery and worse.
sciencefan said,
May 20, 2006 at 9:14 pm
I’ve just checked out the Badscience shop and find what I consider to be a disturbingly ‘unscientific’ statement on every item, e.g. “MMR is safe …tell your friend/parent etc “.
Is the statement “MMR is safe” actually true?
I’d have thought that it needed at least some form of qualification, along the lines of e.g.” MMR is safe (in at least 99.99% of cases – so your child should be OK)” or “MMR is safe (usually)” or “MMR is generally regarded as safe ” or perhaps even “MMR is pretty damn safe (but not in all cases)”.
Perhaps these (more accurate?) slogans would interfer with the bold, stark design of the T-shirts, mugs etc and reduced their impact somewhat, but surely in the interests of Goodscience … 😉
Conservative la-la land: the top seven fictions swollowed by the right « Frank Owen’s Paintbrush said,
September 2, 2009 at 6:05 pm
[…] The MMR-Autism link. An odd one I’ll admit, but it’s been a pervasive debate in the Daily Mail for donkey’s years. Why it is such a right-wing hobby horse I have no idea; I’m tempted to say that their sheer hatred of the MMR-autism link sceptics it implies a worrying mistrust of all scientists and the norms of scientific methodology. Melanie Phillips loves to froth at the mouth about it; As the ever-brilliant Ben Goldacre points out, most of what she says is absolute bobbins. […]
Apathy Sketchpad » Blog Archive » If Science Cannot Do Without Nutt… said,
November 4, 2009 at 2:04 am
[…] Phillips’ views on science are almost uniformly opposed to reality. Take, for example her butchering of the Cochrane report on MMR or her support for ‘intelligent design’. Incidentally, Nutt’s speech cites the […]
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Vaccinations != Autism | Obfuscated Reality said,
July 14, 2011 at 3:35 am
[…] Goldacre (a real doctor, unlike that quack Wakefield) www.badscience.net/2005/11/comment-the-mmr-sceptic-who-just-doesnt-understand-science/ www.badscience.net/2006/06/mmr-is-back/ […]