Bad science

16 The Media’s MMR Hoax

The MRSA swab scandals were a simple, circumscribed, collective hoax. MMR is something much bigger: it is the prototypical health scare, by which all others must be judged and understood. It has every ingredient, every canard, every sleight of hand, and every aspect of venal incompetence and hysteria, systemic and individual. Even now, it is with great trepidation that I even dare to mention it by name, for two very simple reasons.
Firstly, at the quietest hint of a discussion on the subject, an army of campaigners and columnists will still, even in 2008, hammer on editors’ doors demanding the right to a lengthy, misleading and emotive response in the name of ‘balance’. Their demands are always, without exception, accommodated.
But there is a second issue, which is less important than it seems at first: Andrew Wakefield, the doctor who many imagine to be at the centre of the story, is currently in front of the GMC on charges of professional misconduct, and between me finishing and you reading this book, the judgement will probably be out.
I have no idea what that judgement will be, and being honest, although I suppose I’m glad they look into things like this in general, cases like his are two a penny at the GMC. I have no great interest in whether one individual’s work was ethically dubious: the responsibility for the MMR scare cannot be laid at the door of a single man, however much the media may now be trying to argue that it should.
The blame lies instead with the hundreds of journalists, columnists, editors and executives who drove this story cynically, irrationally, and wilfully onto the front pages for nine solid years. As we will see, they overextrapolated from one study into absurdity, while studiously ignoring all reassuring data, and all subsequent refutations. They quoted ‘experts’ as authorities instead of explaining the science, they ignored the historical context, they set idiots to cover the facts, they pitched emotive stories from parents against bland academics (who they smeared), and most bizarrely of all, in some cases they simply made stuff up.
Now they claim that the original 1998 Wakefield research has been ‘debunked’ (it was never anything compelling in the first place), and you will be able to watch this year as they try to pin the whole scare onto one man. I’m a doctor too, and I don’t imagine for one moment that I could stand up and create a nine-year-long news story on a whim. It is because of the media’s blindness—and their unwillingness to accept their responsibility—that they will continue to commit the same crimes in the future. There is nothing you can do about that, so it might be worth paying attention now.
To remind ourselves, here is the story of MMR as it appeared in the British news media from 1998 onwards:
Autism is becoming more common, although nobody knows why.
A doctor called Andrew Wakefield has done scientific research showing a link between the MMR triple jab and autism.
Since then, more scientific research has been done confirming this link.
There is evidence that single jabs might be safer, but government doctors and those in the pay of the pharmaceutical industry have simply rubbished these claims.
Tony Blair probably didn’t give his young son the vaccine.
Measles isn’t so bad.
And vaccination didn’t prevent it very well anyway.
I think that’s pretty fair. The central claim for each of these bullet points was either misleading or downright untrue, as we will see.
Vaccine scares in context
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, and how poorly they propagate themselves in different soils. The MMR and autism scare, for example, is practically non-existent outside Britain, even in Europe and America. But throughout the 1990s France was in the grip of a scare that hepatitis B vaccine caused multiple sclerosis (it wouldn’t surprise me if I was the first person to tell you that).
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. And in the 1970s—since the past is another country too—there was a widespread concern in the UK, driven again by a single doctor, that whooping-cough vaccine was causing neurological damage.
Looking even further back, there was a strong anti-smallpox-vaccine movement in Leicester well into the 1930s, despite its demonstrable benefits, and in fact anti-inoculation sentiment goes right back to its origins: when James Jurin studied inoculation against smallpox (finding that it was associated with a lower death rate than the natural disease), his newfangled numbers and statistical ideas were treated with enormous suspicion. Indeed, smallpox inoculation remained illegal in France until 1769.*
≡ Disdain for statistics in healthcare research wasn’t unusual at the time: Ignaz Semmelweis noticed in 1847 that patients were dying much more frequently on the obstetrics ward run by the medical students than on the one run by the midwifery students (this was in the days when students did all the legwork in hospitals). He was pretty sure that this was because the medical students were carrying something nasty from the corpses in the dissection room, so he instituted proper handwashing practices with chlorinated lime, and did some figures on the benefits. The death rates fell, but in an era of medicine that championed ‘theory’ over real-world empirical evidence, he was basically ignored, until Louis Pasteur came along and confirmed the germ theory. Semmelweis died alone in an asylum. You’ve heard of Pasteur.

Even when Edward Jenner introduced the much safer vaccination for protecting people against smallpox at the turn of the nineteenth century, he was strongly opposed by the London cognoscenti.
And in an article from Scientific American in 1888 you can find the very same arguments which modern antivaccination campaigners continue to use today:
The success of the anti-vaccinationists has been aptly shown by the results in Zurich, Switzerland, where for a number of years, until 1883, a compulsory vaccination law obtained, and smallpox was wholly prevented—not a single case occurred in 1882. This result was seized upon the following year by the anti-vaccinationists and used against the necessity for any such law, and it seems they had sufficient influence to cause its repeal. The death returns for that year (1883) showed that for every 1,000 deaths two were caused by smallpox; In 1884 there were three; in 1885, 17, and in the first quarter of 1886, 85.
Meanwhile, WHO’s highly successful global polio eradication programme was on target to have eradicated this murderous disease from the face of the earth by now—a fate which has already befallen the smallpox virus, excepting a few glass vials—until local imams from a small province called Kano in northern Nigeria claimed that the vaccine was part of a US plot to spread AIDS and infertility in the Islamic world, and organised a boycott which rapidly spread to five other states in the country. This was followed by a large outbreak of polio in Nigeria and surrounding countries, and tragically even further afield. There have now been outbreaks in Yemen and Indonesia, causing lifelong paralysis in children, and laboratory analysis of the genetic code has shown that these outbreaks were caused by the same strain of the polio virus, exported from Kano.
After all, as any trendy MMR-dodging north-London middle–class humanities-graduate couple with children would agree, just because vaccination has almost eradicated polio—a debilitating disease which as recently as 1988 was endemic in 125 countries—that doesn’t necessarily mean it’s a good thing.
The diversity and isolation of these anti-vaccination panics helps to illustrate 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, or polio, is dangerous in one country, it should be equally dangerous everywhere on the planet; 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.
Andrew Wakefield and his Lancet paper
In February 1998 a group of researchers and doctors led by a surgeon called Andrew Wakefield from the Royal Free Hospital in London published a research paper in the Lancet which by now stands as one of the most misunderstood and misreported papers in the history of academia. In some respects it did itself no favours: it is badly written, and has no clear statement of its hypothesis, or indeed of its conclusions (you can read it free online if you like). It has since been partially retracted.
The paper described twelve children who had bowel problems and behavioural problems (mosdy autism), and mentioned that the parents or doctors of eight of these children believed that their child’s problems had started within a few days of them being given the MMR vaccine. It also reported various blood tests, and tests on tissue samples taken from the children. The results of these were sometimes abnormal, but varied between children.
12 children, consecutively referred to the department of paediatric gastroenterology with a history of a pervasive developmental disorder with loss of acquired skills and intestinal symptoms (diarrhoea, abdominal pain, bloating and food intolerance), were investigated.
…In eight children, the onset of behavioural problems had been linked, either by the parents or by the child’s physician, with measles, mumps, and rubella vaccination…In these eight children the average interval from exposure to first behavioural symptoms was 6.3 days (range 1-14).
What can this kind of paper tell you about a link between something as common as MMR, and something as common as autism? Basically nothing, either way. It was a collection of twelve clinical anecdotes, a type of paper called a ‘case series’—and a case series, by design, wouldn’t demonstrate such a relationship between an exposure and an outcome with any force. It did not take some children who were given MMR and some children who weren’t, and then compare the rates of autism between the two groups (this would have been a ‘cohort study’). It did not take some children with autism, and some children without autism, and then compare the rates of vaccination between the two groups (this would have been a ‘case-control study’).
Could anything else explain the apparent connection between MMR, bowel problems and autism in these eight children? Firstly, although they sound like rare things to come together, this was a specialist centre in a teaching hospital, and the children had only been referred there because they had bowel problems and behavioural problems (the circumstances of these referrals are currently being examined by the GMC, as we will see).
Out of an entire nation of millions of inhabitants, if some children with a combination of fairly common things (vaccination, autism, bowel problems) all come together in one place which is already acting as beacon for such a combination, as this clinic was, we should not naturally be impressed. You will remember from the discussion of the unfortunate Dutch nurse Lucia de Berk (and indeed from reading news reports about lottery winners) that unlikely combinations of events will always happen, somewhere, to some people, entirely by chance. Drawing a target around them after the fact tells us nothing at all.
All stories about treatment and risk will start with modest clinical hunches like these anecdotes; but hunches, with nothing to back them up, are not generally newsworthy. At the publication of this paper, a press conference was held at the Royal Free Hospital, and to the visible surprise of many other clinicians and academics present, Andrew Wakefield announced that he thought it would be prudent to use single vaccines instead of the MMR triple vaccine. Nobody should have been surprised: a video news release had already been issued by the hospital, in which Wakefield made the same call.
We are all entitled to our clinical hunches, as individuals, but there was nothing in either this study of twelve children, or any other published research, to suggest that giving single vaccines would be safer. As it happens, there are good grounds for believing that giving vaccines separately might be more harmful: they need six visits to the GP, and six unpleasant jabs, which makes four more appointments to miss. Maybe you’re ill, maybe you’re on holiday, maybe you move house, maybe you lose track of which ones you’ve had, maybe you can’t see the point of rubella for boys, or mumps for girls, or maybe you’re a working single mum with two kids and no time.
Also, of course, the children spend much more time vulnerable to infection, especially if you wait a year between jabs, as Wakefield has recommended, out of the blue. Ironically, although most of the causes of autism remain unclear, one of the few well-characterised single causes is rubella infection itself, while the child is in the womb.
The story behind the paper
Some fairly worrying questions have been raised since then. We won’t cover them in detail, because I don’t find ad hominem stories very interesting to write about, and because I don’t want that aspect of the story—rather than the research evidence—to be the reason why you come to your own conclusion about the risks of MMR and autism. There are things which came out in 2004, however, which cannot fairly be ignored, including allegations of multiple conflicts of interest, undeclared sources of bias in the recruitment of subjects for the paper, undisclosed negative findings, and problems with the ethical clearance for the tests. These were largely uncovered by a tenacious investigative journalist from the Sunday Times called Brian Deer, and they now form part of the allegations being investigated by the GMC.
For example, it is investigating whether Wakefield failed to disclose to the editor of the Lancet his involvement in a patent relating to a new vaccine; more worrying are the concerns about where the twelve children in the 1998 Royal Free study came from. While in the paper it is stated that they were sequential referrals to a clinic, in fact Wakefield was already being paid ￡50,000 of legal aid money by a firm of solicitors to investigate children whose parents were preparing a case against MMR, and the GMC is further investigating where the patients in the study came from, because it seems that many of Wakefield’s referrals had come to him specifically as someone who could show a link between MMR and autism, whether formally or informally, and was working on a legal case. This is the beacon problem once more, and under these circumstances, the fact that only eight of the twelve children’s parents or physicians believed the problems were caused by MMR would be unimpressive, if anything.
Of the twelve children in the paper, eleven sued drug companies (the one that didn’t was American), and ten of them already had legal aid to sue over MMR before the 1998 paper was published. Wakefield himself eventually received ￡435,643 plus expenses from the legal aid fund for his role in the case against MMR.
Various intrusive clinical investigations—such as lumbar punctures and colonoscopies—were carried out on the children, and these required ethics committee clearance. The Ethics Committee had been assured that they were all clinically indicated, which is to say, in the interests of the children’s own clinical care: the GMC is now examining whether they were contrary to the clinical interests of the children, and performed simply for research.
Lumbar puncture involves putting a needle into the centre of the spine to tap off some spinal fluid, and colonoscopy involves putting a flexible camera and light through the anus, up the rectum and into the bowel on a long lube. Neither is without risk, and indeed one of the children being investigated as part of an extension of the MMR research project was seriously harmed during colonoscopy, and was rushed to intensive care at Great Ormond Street Hospital after his bowel was punctured in twelve places. He suffered multiple organ failure, including kidney and liver problems, and neurological injuries, and received ￡482,300 in compensation. These things happen, nobody is to blame, and I am merely illustrating the reasons to be cautious about doing investigations.
Meanwhile, in 1997 a young PhD student called Nick Chad-wick was starting his research career in Andrew Wakefield’s lab, using PCR technology (used as part of DNA fingerprinting) to look for traces of measles strain genetic material in the bowels of these twelve children, because this was a central feature of Wakefield’s theory. In 2004 Chadwick gave an interview to Channel 4’s Dispatches, and in 2007 he gave evidence at a US case on vaccines, stating that there was no measles RNA to be found in these samples. But this important finding, which conflicted with his charismatic supervisor’s theory, was not published.
I could go on.
Nobody knew about any of this in 1998. In any case, it’s not relevant, because the greatest tragedy of the media’s MMR hoax is that it was brought to an end by these issues being made public, when it should have been terminated by a cautious and balanced appraisal of the evidence at the time. Now, you will see news reporters—including the BBC—saying stupid things like ‘The research has since been debunked.’ Wrong. The research never justified the media’s ludicrous over-interpretation. If they had paid attention, the scare would never have even started.
The press coverage begins
What’s most striking about the MMR scare—and this is often forgotten—is that it didn’t actually begin in 1998. The Guardian and the Independent covered the press conference on their front pages, but the Sun ignored it entirely, and the Daily Mail, international journal of health scares, buried their piece on it in the middle of the paper. Coverage of the story was generally written by specialist health and science journalists, and they were often fairly capable of balancing the risks and evidence. The story was pretty soft.
In 2001 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. In March he published new laboratory work with Japanese researchers (‘the Kawashima paper’), using PCR data to show measles virus in the white blood cells of children with bowel problems and autism. This was essentially the opposite of the findings from Nick Chadwick in Wakefield’s own labs. Chadwick’s work remained unmentioned (and there has since been a paper published showing how the Kawashima paper produced a false positive, although the media completely ignored this development, and Wakefield seems to have withdrawn his support for the study).
Things began to deteriorate. The anti-vaccination campaigners began to roll their formidable and coordinated publicity machine into action against a rather chaotic shambles of independent doctors from various different uncoordinated agencies. Emotive anecdotes from distressed parents were pitted against old duffers in corduroy, with no media training, talking about scientific data. If you ever wanted to see evidence against the existence of a sinister medical conspiracy, you need look no further than the shower of avoidant doctors and academics, and their piecemeal engagement with the media during this time. The Royal College of General Practitioners not only failed to speak clearly on the evidence, it also managed—heroically—to dig up some anti-MMR GPs to offer to journalists when they rang in asking for quotes.
The story began to gain momentum, perhaps bound up in the wider desire of some newspapers and personalities simply to attack the government and the health service. A stance on MMR became part of many newspapers’ editorial policies, and that stance was often bound up with rumours about senior managerial figures with family members who had been affected by autism. It was the perfect story, with a single 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? Because nestling in the background was this extraordinary new diagnosis, a disease that struck down young boys and seemed to have come out of the blue, without explanation.
Autism
We still don’t know what causes autism. A history of psychiatric problems in the family, early birth, problems at birth, and breech presentation are all risk factors, but pretty modest ones, which means they’re interesting from a research perspective, but none of them explains the condition in a particular person. This is often the case with risk factors. Boys are affected more than girls, and the incidence of autism continues to rise, in part because of improved diagnosis—people who were previously given labels like ‘mentally subnormal’ or ‘schizophrenia’ were now receiving a diagnosis of ‘autism’—but also possibly because of other factors which are still not understood. Into this vacuum of uncertainty, the MMR story appeared.
There was also something strangely attractive about autism as an idea to journalists and other commentators. Among other things, it’s a disorder of language, which might touch a particular chord with writers; but it’s also philosophically enjoyable to think about, because the flaws in social reasoning which are exhibited by people with autism give us an excuse to talk and think about our social norms and conventions. Books about autism and the autistic outlook on the world have become bestsellers. Here are some wise words for us all from Luke Jackson, a thirteen-year-old with Asperger’s syndrome, who has written a book of advice for teenagers with the condition (Freaks, Geeks and Asperger Syndrome). This is from the section on dating:
If the person asks something like ‘Does my bum look fat?’ or even ‘I am not sure I like this dress’ then that is called ‘fishing for compliments’. These are very hard things to understand, but I am told that instead of being completely honest and saying that yes their bum does look fat, it is politer to answer with something like ‘Don’t be daft, you look great.’ You are not lying, simply evading an awkward question and complimenting them at the same time. Be economical with the truth!
Asperger’s syndrome, or autistic spectrum disorder, is being applied to an increasingly large number of people, and children or adults who might previously have been considered ‘quirky’ now frequently have their personality medicalised with suggestions that they have ‘traits of Asperger’s’. Its growth as a pseudo-diagnostic category has taken on similar proportions to ‘mild dyslexia’—you will have your own views on whether this process is helpful—and its widespread use has allowed us all to feel that we can participate in the wonder and mystery of autism, each with a personal connection to the MMR scare.
Except of course, in most cases, genuine autism is a pervasive developmental disorder, and most people with autism don’t write quirky books about their odd take on the world which reveal so much to us about our conventions and social mores in a charmingly plain and unselfconscious narrative style. Similarly, most people with autism do not have the telegenic single skills which the media have so enjoyed talking up in their crass documentaries, like being really amazing at mental arithmetic, or playing the piano to concert standard while staring confusedly into the middle distance.
That these are the sort of things most people think of when the word ‘autism’ pops into their head is testament to the mythologisation and paradoxical ‘popularity’ of the diagnosis. Mike Fitzpatrick, a GP with a son who has autism, says that there are two questions on the subject which will make him want to slap you. One is:’ Do you think it was caused by MMR?’ The other is: ‘Does he have any special skills?’
Leo Blair
But the biggest public health disaster of all 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. Most other politicians have been happy to clarify whether their children have had the vaccine, but you can imagine how people might believe the Blairs were the kind of family not to have their children immunised, especially with everyone talking about ‘herd immunity’, and the worry that they might be immunising their child, and placing it at risk, in order that the rest of the population should be safer.
Concerns were particularly raised by the ubiquity of Cherie Blair’s closest friend and aide. Carole Caplin was a New Age guru, a ‘life coach’ and a ‘people person’, although her boyfriend, Peter Foster, was a convicted fraudster. Foster helped arrange the Blairs’ property deals, and he also says that they took Leo to a New Age healer, Jack Temple, who offered crystal dowsing, homoeopathy, herbalism and neolithic-circle healing in his back garden.
I’m not sure how much credence to give to Foster’s claims myself, but the impact on the MMR scare is that they were widely reported at the time. We were told that the Prime Minister of the United Kingdom agreed to Temple waving a crystal pendulum over his son to protect him (and therefore his classmates, of course) from measles, mumps and rubella; and that Tony let Cherie give Temple some of his own hair and nail clippings, which Temple preserved in jars of alcohol. He said he only needed to swing his pendulum over the jar to know if their owner was healthy or ill.
Some things are certainly true. Using this crystal dowsing pendulum, Temple did claim that he could harness energy from heavenly bodies. He sold remedies with names like ‘Volcanic Memory’, ‘Rancid Butter’, ‘Monkey Sticks’, ‘Banana Stem’ and, my own personal favourite, ‘Sphincter’. He was also a very well-connected man. Jerry Hall endorsed him. The Duchess of York wrote the introduction to his book The Healer: The Extraordinary Healing Methods of Jack Temple (it’s a hoot). He told the Daily Mail that babies who are breastfed from the moment of birth acquire natural immunity against all diseases, and he even sold a homoeopathic alternative to the MMR jab.
‘I tell all my patients who are pregnant that when the baby is born they must put it on the breast until there is no longer a pulse in the umbilical cord. It usually takes about 30 minutes. By doing this they transfer the mother’s immune system to the baby, who will then have a fully-functioning immune system and will not need vaccines.’…Mr Temple refused to confirm yesterday whether he advised Mrs Blair not to have her baby Leo vaccinated. But he said: ‘If women follow my advice their children will not need the MMR injection, end of story.’*
Daily Mail, 26 December 2001
≡ Here is Jack on cramp: ‘For years many people have suffered with cramp. By dowsing, I discovered that this is due to the fact that the body is not absorbing the element ‘scandium’ which is linked to and controls the absorption of magnesium phosphate.’ And on general health complaints: ‘Based on my expertise in dowsing, I noted that many of my patients were suffering from severe deficiencies of carbon in their systems. The ease in which people these days suffer hairline fractures and broken bones is glaringly apparent to the eyes that are trained to see.’

Cherie Blair was also a regular visitor to Carole’s mum, Sylvia Caplin, a spiritual guru. ‘There was a particularly active period in the summer when Sylvia was channelling for Cherie over two or three times a week, with almost daily contact between them,’ the Mail reported. ‘There were times when Cherie’s faxes ran to 10 pages.’ Sylvia, along with many if not most alternative therapists, was viciously anti-MMR (over half of all the homeopaths approached in one survey grandly advised against the vaccine). The Daily Telegraph reported:
We move on to what is potentially a very political subject: the MMR vaccine. The Blairs publicly endorsed it, then caused a minor furore by refusing to say whether their baby, Leo, had been inoculated. Sylvia [Caplin] doesn’t hesitate: ‘I’m against it,’ she says. ‘I’m appalled at so much being given to little children. The thing about these drugs is the toxic substance they put the vaccines in—for a tiny child, the MMR is a ridiculous thing to do. ‘It has definitely caused autism. All the denials that come from the old school of medicine are open to question because logic and common sense must tell you that there’s some toxic substance in it. Do you not think that’s going to have an effect on a tiny child? Would you allow it? No—too much, too soon, in the wrong formula.’
It was also reported—doubtless as part of a cheap smear—that Cherie Blair and Carole Caplin encouraged the Prime Minister to have Sylvia ‘douse and consult The Light, believed by Sylvia to be a higher being or God, by use of her pendulum’ to decide if it was safe to go to war in Iraq. And while we’re on the subject, in December 2001 The Times described the Blairs’ holiday in Temazcal, Mexico, where they rubbed fruits and mud over each other’s bodies inside a large pyramid on the beach, then screamed while going through a New Age rebirthing ritual. Then they made a wish for world peace.
I’m not saying I buy all of this. I’m just saying, this is what people were thinking about when the Blairs refused to publicly clarify the issue of whether they had given their child the MMR vaccine as all hell broke loose around it. This is not a hunch. Thirty-two per cent of all the stories written that year about MMR mentioned whether Leo Blair had had the vaccine or not (even Andrew Wakefield was only mentioned in 25 per cent), and it was one of the most well-recalled facts about the story in population surveys. The public, quite understandably, were taking Leo Blair’s treatment as a yardstick of the Prime Minister’s confidence in the vaccine, and few could understand why it should be a secret, if it wasn’t an issue.
The Blairs, meanwhile, cited their child’s right to privacy, which they felt was more important than an emerging public health crisis. It’s striking that Cherie Blair has now decided, in marketing her lucrative autobiography, to waive that principle which was so vital at the time, and has written at length in her heavily promoted book not just about the precise bonk that conceived Leo, but also about whether he had the jab (she says yes, but she seems to obfuscate on whether it was single vaccines, and indeed on the question of when he had it: frankly, I give up on these people).
For all that it may seem trite and voyeuristic to you, this event was central to the coverage of MMR. 2002 was the year of Leo Blair, the year of Wakefield’s departure from the Royal Free, and it was the peak of the media coverage, by a very long margin.


What was in these stories?
The MMR scare has created a small cottage industry of media analysis, so there is a fair amount known about the coverage. In 2003 the Economic and Social Research Council (ESRC) 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. Ten per cent of all science stories were about MMR, and MMR was also by far the most likely to generate letters to the press (so people were clearly engaging with the issue); by far the most likely science topic to be written about in opinion or editorial pieces; and it generated the longest stories. MMR was the biggest, most heavily covered science story for years.
Pieces on GM food, or cloning, stood a good chance of being written by specialist science reporters, but for stories on MMR these reporters were largely sidelined, and 80 per cent of the coverage of the biggest science story of the year was by general-ist reporters. Suddenly we were getting comment and advice on complex matters of immunology and epidemiology from people who would more usually have been telling us about a funny thing that happened with the au pair on the way to a dinner party. Nigella Lawson, Libby Purves, Suzanne Moore, Lynda Lee-Potter and Carol Vorderman, to name only a few, all wrote about their ill-informed concerns on MMR, blowing hard on their toy trumpets. The anti-MMR lobby, meanwhile, developed a reputation for targeting generalist journalists wherever possible, feeding them stories, and actively avoiding health or science correspondents.
This is a pattern which has been seen before. If there is one thing which has adversely affected communication between scientists, journalists and the public, it is the fact that science journalists simply do not cover major science news stories. From drinking with science journalists, I know that much of the time, nobody even runs these major stories by them for a quick check.
Again, I’m not speaking in generalities here. During the crucial two days after the GM ‘Frankenstein foods’ story broke in February 1999, not a single one of the news articles, opinion pieces or editorials on the subject was written by a science journalist. A science correspondent would have told his or her editor that when someone presents their scientific findings about GM potatoes causing cancer in rats, as Arpad Pusztai did, on ITV’s World in Action rather than in an academic journal, then there’s something fishy going on. Pusztai’s experiment was finally published a year later—after a long period when nobody could comment on it, because nobody knew what he’d actually done—and when all was revealed in a proper publication, his experimental results did not contain information to justify the media’s scare.
This sidelining of specialist correspondents when science becomes front-page news, and the fact that they are not even used as a resource during these periods, has predictable consequences. 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, they 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. Journalists—and many campaigners—think that this is what it means to critically appraise a scientific argument, and seem rather proud of themselves when they do it.
The scientific content of stories—the actual experimental evidence—is brushed over and replaced with didactic statements from authority figures on either side of the debate, which contributes to a pervasive sense that scientific advice is somehow arbitrary, and predicated upon a social role—the ‘expert’—rather than on transparent and readily understandable empirical evidence. Worse than this, other elements are brought into the foreground: political issues, Tony Blair’s refusal to say whether his baby had received the vaccine, mythical narratives, a lionised ‘maverick’ scientist, and emotive appeals from parents.
A reasonable member of the public, primed with such a compelling battery of human narrative, would be perfectly entitled to regard any expert who claimed MMR was safe as thoughtless and dismissive, especially if that claim came without any apparent supporting evidence.
The story was also compelling because, like GM food, the MMR story seemed to fit a fairly simple moral template, and one which I myself would subscribe to: big corporations are often dodgy, and politicians are not to be trusted. But it matters whether your political and moral hunches are carried in the right vehicle. Speaking only for myself, I am very wary of drug companies, not because I think all medicine is bad, but because I know they have hidden unflattering data, and because I have seen their promotional material misrepresent science. I also happen to be very wary of GM food—but not because of any inherent flaws in the technology, and not because I think it is uniquely dangerous. Somewhere between splicing in genes for products that will treat haemophilia at one end, and releasing genes for antibiotic resistance into the wild at the other, lies a sensible middle path for the regulation of GM, but there’s nothing desperately remarkable or uniquely dangerous about it as a technology.
Despite all that, I remain extremely wary of GM for reasons that have nothing to do with the science, simply because it has created a dangerous power shift in agriculture, and ‘terminator seeds’, which die at the end of the season, are a way to increase farmers’ dependency, both nationally and in the developing world, while placing the global food supply in the hands of multinational corporations. If you really want to dig deeper, Monsanto is also very simply an unpleasant company (it made Agent Orange during the Vietnam War, for example).
Witnessing the blind, seething, thoughtless campaigns against MMR and GM—which minor the infantile train of thought that ‘homeopathy works because the Vioxx side-effects were covered up by Merck’—it’s easy to experience a pervasive sense of lost political opportunities, that somehow all of our valuable indignation about development issues, the role of big money in our society, and frank corporate malpractice, is being diverted away from anywhere it could be valid and useful, and into puerile, mythical fantasies. It strikes me that if you genuinely care about big business, the environment and health, then you’re wasting your time with jokers like Pusztai and Wakefield.
Science coverage is further crippled, of course, by the fact that the subject can be quite difficult to understand. This in itself can seem like an insult to intelligent people, like journalists, who fancy themselves as able to understand most things, but there has also been an acceleration in complexity in recent times. Fifty years ago you could sketch out a full explanation of how an AM radio worked on the back of a napkin, using basic school-level knowledge of science, and build a crystal set in a classroom which was essentially the same as the one in your car. When your parents were young they could fix their own car, and understand the science behind most of the everyday technology they encountered, but this is no longer the case. Even a geek today would struggle to give an explanation of how his mobile phone works, because technology has become more difficult to understand and explain, and everyday gadgets have taken on a ‘black box’ complexity that can feel sinister, as well as intellectually undermining. The seeds were sown.
But we should return to the point. If there was little science, then what did appear in all these long stories on MMR? Going back to the 2002 data from the ESRC, only a quarter mentioned Andrew Wakefield, which seems odd, considering he was the cornerstone of the story. This created the erroneous impression that there was a large body of medical opinion which was suspicious of MMR, rather than just one ‘maverick’. Less than a third of broadsheet reports referred to the overwhelming evidence that MMR is safe, and only 11 per cent mentioned that it is regarded as safe in the ninety other countries in which it is used.
It was rare to find much discussion of the evidence at all, as it was considered too complicated, and when doctors tried to explain it they were frequently shouted down, or worse still, their explanations were condensed into bland statements that ‘science had shown’ there was nothing to worry about. This uninformative dismissal was pitted against the emotive concerns of distressed parents.
As 2002 wore on, things got really strange. Some newspapers, such as the Daily Mail and the Daily Telegraph, made MMR the focus of a massive political campaign, and the beatification of Wakefield reached a kind of fever pitch. Lorraine Fraser had an exclusive interview with him in the Telegraph in which he was described as ‘a champion of patients who feel their fears have been ignored’. She wrote a dozen similar articles over the next year (and her reward came when she was named British Press Awards Health Writer of the Year 2002, a gong I do not myself expect to receive).
Justine Picardie did a lavish photo feature on Wakefield, his house and his family for the Telegraph Saturday magazine. Andy is, she tells us, ‘a handsome, glossy-haired hero to families of autistic children’. How are the family? ‘A likeable, lively family, the kind you would be happy to have as friends, pitted against mysterious forces who have planted bugging devices and have stolen patients’ records in ‘apparently inexplicable’ burglaries.’ She fantasises—and I absolutely promise you I’m not making this up—about a Hollywood depiction of Wakefield’s heroic struggle, with Russell Crowe playing the lead ‘opposite Julia Roberts as a feisty single mother fighting for justice for her child’.
The evidence on MMR
So what is the evidence on the safety of MMR?
There are a number of ways to approach the evidence on the safety of a given intervention, depending on how much attention you have to give. The simplest approach is to pick an arbitrary authority figure: a doctor, perhaps, although this seems not to be appealing (in surveys people say they trust doctors the most, and journalists the least: this shows the flaw in that kind of survey).
You could take another, larger authority at face value, if there is one that suits you. The Institute of Medicine, the Royal Colleges, the NHS, and more, all came out in support of MMR, but this was apparently not sufficient to convince. You could offer information: an NHS website at mmrthefacts.nhs.uk started with the phrase ‘MMR is safe’ (literally), and allowed the reader to drill down to the detail of individual studies.*
≡ Whether you buy the DoH phrase ‘MMR is safe’ depends on what you decide you mean by ‘safe’. Is flying safe? Is your washing machine safe? What are you sitting on? Is that safe? You can obsess over the idea that philosophically nothing can ever be shown to be 100 per cent safe—and many will—but you would be arguing about a fairly meaningless and uncommon definition of the word.

But that too did little to stem the tide. Once a scare is running, perhaps every refutation can seem like an admission of guilt, drawing attention to the scare.
The Cochrane Collaboration is as blemishless as they come, and it has done a systematic review of the literature on MMR, concluding that there was no evidence that it is unsafe (although it didn’t appear until 2005). This reviewed the data the media had systematically ignored: what was in it?
If we are to maintain the moral high ground, there are a few things we need to understand about evidence. Firstly, there is no single golden study which proves that MMR is safe (although the evidence to say it is dangerous was exceptionally poor). There is, for example, no randomised controlled trial. We are presented instead with a huge morass of data, from a number of different studies, all of which are flawed in their own idiosyncratic ways for reasons of cost, competence and so on. A common problem with applying old data to new questions is that these papers and datasets might have a lot of useful information, which was collected very competently to answer the questions which the researchers were interested in at the time, but which isn’t perfect for your needs. It’s just, perhaps, pretty good.
Smeeth et al., for example, did something called a ‘case-control’ study, using the GP Research Database. This is a common type of study, where you take a bunch of people with the condition you’re looking at (‘autism’), and a bunch of people without it, then look to see if there is any difference in how much each group was exposed to the thing you think might be causing the condition (‘MMR’).
If you care who paid for the study—and I hope you’ve become a bit more sophisticated than that by now—it was funded by the Medical Research Council. They found around 1,300 people with autism, and then got some ‘controls’: random people who did not have autism, but with the same age, sex, and general practice. Then they looked to see if vaccination was any more common in the people with autism, or the controls, and found no difference between the two groups. The same researchers also did a systematic review of similar studies in the United States and Scandinavia, and again, pooling the data, found no link between MMR and autism.
There is a practical problem with this kind of research, of course, which I would hope you might spot: most people do get the MMR vaccine, so the individuals you’re measuring who didn’t get the vaccine might be unusual in other ways—perhaps their parents have refused the vaccine for ideological or cultural reasons, or the child has a pre-existing physical health problem—and those factors might themselves be related to autism. There’s little you can do in terms of study design about this potential ‘confounding variable’, because as we said, you’re not likely to do a randomised controlled trial in which you randomly don’t give children vaccines: you just throw the result into the pot with the rest of the information, in order to reach your verdict. As it happens, Smeeth et al. went to great lengths to make sure their controls were representative. If you like, you can read the paper and decide if you agree.
So ‘Smeeth’ was a ‘case-control study’, where you compare groups which had the outcome or not, and look at how common the exposure was in each group. In Denmark, Madsen et al. did the opposite kind of study, called a ‘cohort study’: you compare groups which had the exposure or not, in order to see whether there is any variation in the outcome. In this specific case, then, you take two groups of people, who either had MMR or didn’t, and then check later to see if the rate of autism is any different between the two groups.
This study was big—very big—and included all the children born in Denmark between January 1991 and December 1998. In Denmark there is a system of unique personal identification numbers, linked to vaccination registers and information about the diagnosis of autism, which made it possible to chase up almost all the children in the study. This was a pretty impressive achievement, since there were 440,655 children who were vaccinated, and 96,648 who were unvaccinated. No difference was found between vaccinated and unvaccinated children, in the rates of autism or autistic spectrum disorders, and no association between development of autism and age at vaccination.
Anti-MMR campaigners have responded to this work by saying that only a small number of children are harmed by the vaccine, which seems to be inconsistent with their claims that MMR is responsible for a massive upswing in diagnoses of autism. In any case, if a vaccine caused an adverse reaction in a very small number of people, that would be no surprise—it would be no different from any other medical intervention (or, arguably, any human activity), and there would be, surely, no story.
As with all studies, there are problems with this huge study. The follow-up of diagnostic records ends one year (31 December 1999) after the last day of admission to the cohort: so, because autism comes on after the age of one year, the children born later in the cohort would be unlikely to have shown up with autism by the end of the follow-up period. But this is nagged up in the study, and you can decide whether you think it undermines its overall findings. I don’t think it’s much of a problem. That’s my verdict, and I think you might agree that it’s not a particularly foolish one. It did run from January 1991, after all.
This is the kind of evidence you will find in the Cochrane review, which found, very simply, that ‘existing evidence on the safety and effectiveness of MMR vaccine supports current policies of mass immunisation aimed at global measles eradication in order to reduce morbidity and mortality associated with mumps and rubella’.
It also contained multiple criticisms of the evidence it reviewed, which, bizarrely, has been seized upon by various commentators to claim that there was some kind of stitch-up. The review was heading towards a conclusion that MMR was risky, they say, if you read the content, but then, out of nowhere, it produced a reassuring conclusion, doubtless because of hidden political pressure.
The Daily Mail’s Melanie Phillips, a leading light of the anti-vaccination movement, was outraged by what she thought she had found: ‘It said that no fewer than nine of the most celebrated studies that have been used against [Andrew Wakefield] were unreliable in the way they were constructed.’ Of course it did. I’m amazed it wasn’t more. Cochrane reviews are intended to criticise papers.
Scientific ‘evidence’ in the media
But the newspapers in 2002 had more than just worried parents. There was a smattering of science to keep things going: you will remember computer-generated imagery of viruses and gut walls, perhaps, and stories about laboratory findings. Why have I not mentioned those?
For one thing, these important scientific findings were being reported in newspapers and magazines, and at meetings, in fact anywhere except proper academic journals where they could be read and carefully appraised. In May, for example, Wakefield ‘exclusively revealed’ that ‘more than 95 per cent of those who had the virus in their gut had MMR as their only documented exposure to measles’. He doesn’t appear to have revealed this in a peer-reviewed academic journal, but in a weekend colour supplement.
Other people started popping up all over the place, claiming to have made some great finding, but never publishing their research in proper, peer-reviewed academic journals. A pharmacist in Sunderland called Mr Paul Shattock was reported on the Today programme, and in several national newspapers, to have identified a distinct subgroup of children with autism resulting from MMR. Mr Shattock is very active on anti-immunisation websites, but he still doesn’t seem to have got round to publishing this important work years later, even though the Medical Research Council suggested in 2002 that he should ‘publish his research and come forward to the MRC with positive proposals’.
Meanwhile Dr Arthur Krigsman, paediatric gastrointestinal consultant working in the New York area, was telling hearings in Washington that he had made all kinds of interesting findings in the bowels of autistic children, using endoscopes. This was lavishly reported in the media. Here is the Daily Telegraph:
Scientists in America have reported the first independent corroboration of the research findings of Dr Andrew Wakefield. Dr Krigsman’s discovery is significant because it independently supports Dr Wakefield’s conclusion that a previously unidentified and devastating combination of bowel and brain disease is afflicting young children—a claim that the Department of Health has dismissed as ‘bad science’.
To the best of my knowledge—and I’m pretty good at searching for this stuff- Krigsman’s new scientific research findings which corroborate Andrew Wakefield’s have never been published in an academic journal: certainly there is no trace of them on Pubmed, the index of nearly all medical academic articles.
In case the reason why this is important has not sunk in, let me explain again. If you visit the premises of the Royal Society in London, you’ll see its motto proudly on display: ‘Nullius in verba ‘—‘On the word of no one’. What I like to imagine this refers to, in my geeky way, is the importance of publishing proper scientific papers if you want people to pay attention to your work. Dr Arthur Krigsman has been claiming for years now that he has found evidence linking MMR to autism and bowel disease. Since he hasn’t published his findings, he can claim them until he’s blue in the face, because until we can see exactly what he did, we can’t see what flaws there may be in his methods. 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.
Krigsman and others’ failures to publish in peer-reviewed academic journals weren’t isolated incidents. In fact it’s still going on, years later. In 2006, exactly the same thing was happening again. ‘US Scientists Back Autism Link to MMR’, squealed the Telegraph. ‘Scientists Fear MMR Link to Autism’, roared the Mail. ‘US Study Supports Claims of MMR Link to Autism’, croaked The Times a day later.
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 track record of announcing research that never subsequently appears in an academic journal. In fact, astonishingly, four years later, it was Dr Arthur Krigsman again. The story this time was different: he had found genetic material (RNA) from vaccine-strain measles virus in some gut samples from children with autism and bowel problems. If true, this would fit with 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 USA offering eccentric treatments for developmental disorders.
The Telegraph went on to explain that Krigsman’s most recent unpublished claim was replicating similar work from 1998 by Dr Andrew Wakefield, and from 2002 by Professor John O’Leary. This was, to say the least, a mis-statement. There is no work from 1998 by Wakefield which fits the Telegraph’s claim—at least not in PubMed that I can find. I suspect the newspaper was confused about the infamous Lancet paper on MMR, which by 2004 had already been partially retracted.
There are, however, two papers suggesting that traces of genetic material from the measles virus have been found in children. They have received a mountain of media coverage over half a decade, and yet the media have remained studiously silent on the published evidence suggesting that they were false positives, as we will now see.
One is from Kawashima et al. in 2002, also featuring Wakefield as an author, in which it is claimed that genetic material from measles vaccine was found in blood cells. Doubt is cast on this both by attempts to replicate it, showing where the false positives probably appeared, and by the testimony of Nick Chadwick, the PhD student whose work we described above. Even Andrew Wakefield himself no longer relies on this paper.
The other is O’Leary’s paper from 2002, also featuring Wakefield as an author, which produced evidence of measles RNA in tissue samples from children. Futher experiments, again, have illustrated where the false positives seem to have arisen, and in 2004, when Professor Stephen Bustin was examining the evidence for the legal aid case, he explained how he established to his satisfaction—during a visit to the O’Leary lab—that these were false positives due to contamination and inadequate experimental methods. He has shown, firstly, that there were no ‘controls’ to check for false positives (contamination is a huge risk when you are looking for minuscule traces of genetic material, so you generally run ‘blank’ samples to make sure they do come out blank); he found calibration problems with the machines; problems with log books; and worse. He expanded on this at enormous length in a US court case on autism and vaccines in 2006. You can read his detailed explanation in full online. To my astonishment not one journalist in the UK has ever bothered to report it.
Both of these papers claiming to show a link received blanket media coverage at the time, as did Krigsman’s claims.
What they didn’t tell you
In the May 2006 issue of the Journal of Medical Virology there was a very similar study to the one described by Krigsman, only this one had actually been published, by Afzal et al. It looked for measles RNA in children with regressive autism after MMR vaccination, much like the unpublished Krigsman study, and it used tools so powerful they could detect measles RNA down to single-figure copy numbers. It found no evidence of the magic vaccine-strain measles RNA to implicate MMR. Perhaps because of that unfrightening result, the study was loudly ignored by the press.
Because it has been published in full, I can read it, and pick holes in it, and I am more than happy to do so: because science is about critiquing openly published data and methodologies, rather than press-released chimeras, and in the real world all studies have some flaws, to a greater or lesser extent. Often they are practical ones: here, for example, the researchers couldn’t get hold of the tissue they ideally would have used, because they could not get ethics committee approval for intrusive procedures like lumbar punctures and gut biopsies on children (Wakefield did manage to obtain such samples, but he is, we should remember, currently going through a GMC professional conduct hearing over the issue).
Surely they could have borrowed some existing samples, from children said to be damaged by vaccines? You’d have thought so. They report in the paper that they tried to ask anti-MMR researchers—if that’s not an unfair term—whether they could borrow some of their tissue samples to work on. They were ignored.*
≡ ‘The groups of investigators that either had access to original autism specimens or investigated them later for measles virus detection were invited to take part in the study but failed to respond. Similarly, it was not possible to obtain clinical specimens of autism cases from these investigators for independent investigations.’

Afzal et al. was not reported in the media, anywhere at all, except by me, in my column.
This is not an isolated case. Another major paper was published in the leading academic journal Pediatrics a few months later—to complete media silence—again suggesting very strongly that the earlier results from Kawashima and O’Leary were in error, and false positives. D’Souza et al. replicated the earlier experiments very closely, and in some respects more carefully: most importantly, it traced out the possible routes by which a false positive could have occurred, and made some astonishing findings.
False positives are common in PCR, because it works by using enzymes to replicate RNA, so you start with a small amount in your sample, which is then ‘amplified up’, copied over and over again, until you have enough to measure and work with. Beginning with a single molecule of genetic material, PCR can generate 100 billion similar molecules in an afternoon. Because of this, the PCR process is exquisitely sensitive to contamination—as numerous innocent people languishing in jail could tell you—so you have to be very careful, and clean up as you go.
As well as raising concerns about contamination, D’Souza also found that the O’Leary method might have accidentally amplified the wrong bits of RNA.
Let’s be clear: this is absolutely not about criticising individual researchers. Techniques move on, results are sometimes not replicable, and not all double-checking is practical (although Bustin’s testimony is that standards in the O’Leary lab were problematic). But what is striking is that the media rabidly picked up on the original frightening data, and then completely ignored the new reassuring data. This study by D’Souza, like Afzal before it, was unanimously ignored by the media. It was covered, by my count, in: my column; one Reuters piece which was picked up by nobody; and one post on the lead researcher’s boyfriend’s blog (where he talked about how proud he was of his girlfriend). Nowhere else.*
≡ In 2008, just as this chapter was being put to bed, some journalists deigned—miraculously—to cover a PCR experiment with a negative finding. It was misreported as the definitive refutation of the entire MMR-autism hypothesis. This was a childish overstatement, and that doesn’t help anyone either. I am not hard to please.

You could say, very reasonably, that this is all very much par for the course: newspapers report the news, and it’s not very interesting if a piece of research comes out saying something is safe. But I would argue—perhaps sanctimoniously—that the media have a special responsibility in this case, because they themselves demanded ‘more research’, and moreover because at the very same time that they were ignoring properly conducted and fully published negative findings, they were talking up scary findings from an unpublished study by Krigsman, a man with a track record of making scary claims which remain unpublished.
MMR is not an isolated case in this regard. You might remember the scare stories about mercury fillings from the past two decades: they come around every few years, usually accompanied by a personal anecdote in which fatigue, dizziness and headaches are all vanquished following the removal of the fillings by one visionary dentist. Traditionally these stories conclude with a suggestion that the dental establishment may well be covering up the truth about mercury, and a demand for more research into its safety.
The first large-scale randomised control trials on the safety of mercury fillings were published recently, and if you were waiting to see these hotly anticipated results, personally demanded by journalists on innumerable newspapers, you’d be out of luck, because they were reported nowhere. Nowhere. A study of more than 1,000 children, where some were given mercury fillings and some mercury-free fillings, measuring kidney function and neurodevelopmental outcomes like memory, coordination, nerve conduction, IQ and so on over several years. It was a well-conducted study. There were no significant differences between the two groups. That’s worth knowing about if you’ve ever been scared by the media’s reports on mercury fillings—and by God, you’d have been scared.
Panorama featured a particularly chilling documentary in 1994 called The Poison in Your Mouth. It opened with dramatic footage of men in full protective gear rolling barrels of mercury around. I’m not giving you the definitive last word on mercury here. But I think we can safely assume there is no Panorama documentary in the pipeline covering the startling new research data suggesting that mercury fillings may not be harmful after all. In some respects this is just one more illustration of how unreliable intuition can be in assessing risks like those presented with a vaccine: not only is it a flawed strategy for this kind of numerical assessment, on outcomes which are too rare for one person to collect meaningful data on them in their personal journey through life; but the information you are fed by the media about the wider population is ludicrously, outrageously, criminally crooked. So at the end of all this, what has the British news media establishment achieved?
Old diseases return
It’s hardly surprising that the MMR vaccination rate has fallen from 92 per cent in 1996 to 73 per cent today. In some parts of London it’s down to 60 per cent, and figures from 2004-05 showed that in Westminster only 38 per cent of children had both jabs by the age of five.*
≡ Not 11.7 per cent as claimed in the Telegraph and the Daily Mail in February and June 2006.

It is difficult to imagine what could be driving this, if not a brilliantly successful and well-coordinated media anti-MMR campaign, which pitched emotion and hysteria against scientific evidence. Because people listen to journalists: this has been demonstrated repeatedly, and not just with the kinds of stories in this book.
A 2005 study in the Medical Journal of Australia looked at mammogram bookings, and found that during the peak media coverage of Kylie Minogue’s breast cancer, bookings rose by 40 per cent. The increase among previously unscreened women in the forty-to-sixty-nine-year age group was 101 per cent. These surges were unprecedented. And I’m not cherry-picking: a systematic review from the Cochrane Collaboration found five studies looking at the use of specific health interventions before and after media coverage of specific stories, and each found that favourable publicity was associated with greater use, and unfavourable coverage with lower use.
It’s not just the public: medical practice is influenced by the media too, and so are academics. A mischievous paper from the New England Journal of Medicine in 1991 showed that if a study was covered by the New York Times, it was significantly more likely to be cited by other academic papers. Having come this far, you are probably unpicking this study already. Was coverage in the New York Times just a surrogate marker for the importance of the research? History provided the researchers with a control group to compare their results against: for three months, large parts of the paper went on strike, and while the journalists did produce an ‘edition of record’, this newspaper was never actually printed. They wrote stories about academic research, using the same criteria to judge importance that they always had, but the research they wrote about in articles which never saw the light of day saw no increase in citations.
People read newspapers. Despite everything we think we know, their contents seep in, we believe them to be true, and we act upon them, which makes it all the more tragic that their contents are so routinely flawed. Am I extrapolating unfairly from the extreme examples in this book? Perhaps not. In 2008 Gary Schwitzer, an ex-journalist who now works on quantitative studies of the media, published an analysis of five hundred health articles covering treatments from mainstream newspapers in the US. Only 35 per cent of stories were rated satisfactory for whether the journalist had ‘discussed the study methodology and the quality of the evidence’ (because in the media, as we have seen repeatedly in this book, science is about absolute truth statements from arbitrary authority figures in white coats, rather than clear descriptions of studies, and the reasons why people draw conclusions from them). Only 28 per cent adequately covered benefits, and only 33 per cent adequately covered harms. Articles routinely failed to give any useful quantitative information in absolute terms, preferring unhelpful eye-catchers like ‘50 per cent higher’ instead.
In fact there have been systematic quantitative surveys of the accuracy of health coverage in Canada, Australia and America—I’m trying to get one off the ground in the UK—and the results have been universally unimpressive. It seems to me that the state of health coverage in the UK could well be a serious public health issue.
Meanwhile, the incidence of two of the three diseases covered by MMR is now increasing very impressively. We have the highest number of measles cases in England and Wales since current surveillance methods began in 1995, with cases occurring mostly in children who had not been adequately vaccinated: 971 confirmed cases were reported in 2007 (mostly associated with prolonged outbreaks in travelling and religious communities, where vaccine uptake has been historically low), after 740 cases in 2006 (and the first death since 1992). Seventy-three per cent of cases were in the South–East, and most of those were in London.
Mumps began rising again in 1999, after many years of cases in only double figures: by 2005 the United Kingdom had a mumps epidemic, with around 5,000 notifications in January alone.
A lot of people who campaign against vaccines like to pretend that they don’t do much good, and that the diseases they protect against were never very serious anyway. I don’t want to force anyone to have their child vaccinated, but equally I don’t think anyone is helped by misleading information. By contrast with the unlikely event of autism being associated with MMR, the risks from measles, though small, are real and quantifiable. The Peckham Report on immunisation policy, published shortly after the introduction of the MMR vaccine, surveyed the recent experience of measles in Western countries and estimated that for every 1,000 cases notified, there would be 0.2 deaths, ten hospital admissions, ten neurological complications and forty respiratory complications. These estimates have been borne out in recent minor epidemics in the Netherlands (1999: 2,300 cases in a community philosophically opposed to vaccination, three deaths), Ireland (2000: 1,200 cases, three deaths) and Italy (2002: three deaths). It’s worth noting that plenty of these deaths were in previously healthy children, in developed countries, with good healthcare systems.
Though mumps is rarely fatal, it’s an unpleasant disease with unpleasant complications (including meningitis, pancreatitis and sterility). Congenital rubella syndrome has become increasingly rare since the introduction of MMR, but causes profound disabilities including deafness, autism, blindness and mental handicap, resulting from damage to the foetus during early pregnancy.
The other thing you will hear a lot is that vaccines don’t make much difference anyway, because all the advances in health and life expectancy have been due to improvements in public health for a wide range of other reasons. As someone with a particular interest in epidemiology and public health, I find this suggestion flattering; and there is absolutely no doubt that deaths from measles began to fall over the whole of the past century for all kinds of reasons, many of them social and political as well as medical: better nutrition, better access to good medical care, antibiotics, less crowded living conditions, improved sanitation, and so on.
Life expectancy in general has soared over the past century, and it’s easy to forget just how phenomenal this change has been. In 1901, males born in the UK could expect to live to forty-five, and females to forty-nine. By 2004, life expectancy at birth had risen to seventy-seven for men, and eighty-one for women (although of course much of the change is due to reductions in infant mortality).


So we are living longer, and vaccines are clearly not the only reason why. No single change is the reason why. Measles incidence dropped hugely over the preceding century, but you would have to work fairly hard to persuade yourself that vaccines had no impact on that. Here, for example, is a graph showing the reported incidence of measles from 1950 to 2000 in the United States.


For those who think that single vaccines for the components of MMR are a good idea, you’ll notice that these have been around since the 1970s, but that a concerted programme of vaccination—and the concerted programme of giving all three vaccinations in one go as MMR—is fairly clearly associated in time with a further (and actually rather definitive) drop in the rate of measles cases.


The same is true for mumps:


While we’re thinking about mumps, let’s not forget our epidemic in 2005, a resurgence of a disease many young doctors would struggle even to recognise. Here is a graph of mumps cases from the BMJ article that analysed the outbreak:


Almost all confirmed cases during this outbreak were in people aged fifteen to twenty-four, and only 3.3 per cent had received the full two doses of MMR vaccine. Why did it affect these people? Because of a global vaccine shortage in the early 1990s. Mumps is not a harmless disease. I’ve no desire to scare anyone—and as I said, your beliefs and decisions about vaccines are your business; I’m only interested in how you came to be so incredibly misled—but before the introduction of MMR, mumps was the commonest cause of viral meningitis, and one of the leading causes of hearing loss in children. Lumbar puncture studies show that around half of all mumps infections involve the central nervous system. Mumps orchitis is common, exquisitely painful, and occurs in 20 per cent of adult men with mumps: around half will experience testicular atrophy, normally in only one testicle, but 15 to 30 per cent of patients with mumps orchitis will have it in both testicles, and of these, 13 per cent will have reduced fertility.
I’m not just spelling this out for the benefit of the lay reader: by the time of the outbreak in 2005, young doctors needed to be reminded of the symptoms and signs of mumps, because it had been such an uncommon disease during their training and clinical experience. People had forgotten what these diseases looked like, and in that regard vaccines are a victim of their own success—as we saw in our earlier quote from Scientific American in 1888, five generations ago (see page 276).
Whenever we take a child to be vaccinated, we’re aware that we are striking a balance between benefit and harm, as with any medical intervention. I don’t think vaccination is all that important: even if mumps orchitis, infertility, deafness, death and the rest are no fun, the sky wouldn’t fall in without MMR. But taken on their own, lots of other individual risk factors aren’t very important either, and that’s no reason to abandon all hope of trying to do something simple, sensible and proportionate about them, gradually increasing the health of the nation, along with all the other stuff you can do to the same end.
It’s also a question of consistency. At the risk of initiating mass panic, I feel duty bound to point out that if MMR still scares you, then so should everything in medicine, and indeed many of the everyday lifestyle risk exposures you encounter: because there are a huge number of things which are far less well researched, with a far lower level of certainty about their safety. The question would still remain of why you were so focused on MMR. If you wanted to do something constructive about this problem, instead of running a single-issue campaign about MMR you might, perhaps, use your energies more usefully. You could start a campaign for constant automated vigilance of the entirety of the NHS health records dataset for any adverse outcomes associated with any intervention, for example, and I’d be tempted to join you on the barricades.
But in many respects this isn’t about risk management, or vigilance: it’s about culture, human stories, and everyday human harms. Just as autism is a peculiarly fascinating condition to journalists, and indeed to all of us, vaccination is similarly inviting as a focus for our concerns: it’s a universal programme, in conflict with modern ideas of ‘individualised care’; it’s bound up with government; it involves needles going into children; and it offers the opportunity to blame someone, or something, for a dreadful tragedy.
Just as the causes of these scares have been more emotional than anything else, so too has much of the harm. Parents of children with autism have been racked with guilt, doubt and endless self-recrimination over the thought that they themselves are responsible for inflicting harm upon their own child. This distress has been demonstrated in countless studies: but so close to the end, I don’t want to introduce any more research papers.
There is one quote that I find—although she would perhaps complain about my using it—both moving and upsetting. It’s from Karen Prosser, who featured with her autistic son Ryan in the Andrew Wakefield video news release from the Royal Free Hospital in 1998. ‘Any mother who has a child wants it to be normal,’ she says. ‘To then find out your child might be genetically autistic is tragic. To find out that it was caused by a vaccine, that you agreed to have done…is just devastating.’




AND ANOTHER THING

I could go on. As I write this in May 2008, the media are still pushing a celebrity-endorsed ‘miracle cure’ (and I quote) for dyslexia, invented by a millionaire paint entrepreneur, despite the abysmal evidence to support it, and despite customers being at risk of simply losing their money anyway, because the company seems to be going into administration; the newspapers are filled with an amazing story about a finger that ‘grew back’ through the use of special sciencey ‘pixie dust’ (I quote again), although the claim has been around for three years, unpublished in any academic journal, and severed fingertips grow back by themselves anyway; more ‘hidden data’ scandals are exposed from the vaults of big pharma every month; quacks and cranks continue to parade themselves on television quoting fantastical studies to universal approbation; and there will always be new scares, because they sell so very well, and they make journalists feel alive.
To anyone who feels their ideas have been challenged by this book, or who has been made angry by it—to the people who feature in it, I suppose—I would say this: You win. You really do. I would hope there might be room for you to reconsider, to change your stance in the light of what might be new information (as I will happily do, if there is ever an opportunity to update this book). But you will not need to, because, as we both know, you collectively have almost full-spectrum dominance: your own slots in every newspaper and magazine in Britain, and front-page coverage for your scare stories. You affect outsider swagger, bizarrely, from the sofas of daytime television. Your ideas—bogus though they may be—have immense superficial plausibility, they can be expressed rapidly, they are endlessly repeated, and they are believed by enough people for you to make very comfortable livings, and to have enormous cultural influence. You win.
It’s not the spectacular individual stories that are the problem, so much as the constant daily grind of stupid little ones. This will not end, and so I will now abuse my position by telling you, very briefly, exactly what I think is wrong, and some of what can be done to fix it.
The process of obtaining and interpreting evidence isn’t taught in schools, nor are the basics of evidence-based medicine and epidemiology, yet these are obviously the scientific issues which are most on people’s minds. This is not idle speculation. You will remember that this book began by noticing that there has never been an exhibit on evidence-based medicine in London’s Science Museum.
A five-decade survey of post-war science coverage in the UK by the same institution shows—and this is officially the last piece of data in the book—that in the 1950s science reporting was about engineering and inventions, but by the 1990s everything had changed. Science coverage now tends to come from the world of medicine, and the stories are of what will kill you, or save you. Perhaps it is narcissism, or fear, but the science of health is important to people, and at the very time when we need it the most, our ability to think around the issue is being energetically distorted by the media, corporate lobbies and, frankly, cranks.
Without anybody noticing, bullshit has become an extremely important public health issue, and for reasons that go far beyond the obvious hysteria around immediate harms: the odd measles tragedy, or a homeopath’s unnecessary malaria case. Doctors today are keen—as it said in our medical school notes—to work ‘collaboratively with the patient towards an optimum health outcome’. They discuss evidence with their patients, so that they can make their own decisions about treatments.
I don’t generally talk or write about being a doctor—it’s mawkish and tedious, and I’ve no desire to preach from authority—but working in the NHS you meet patients from every conceivable walk of life, in huge numbers, discussing some of the most important issues in their lives. This has consistently taught me one thing: people aren’t stupid. Anybody can understand anything, as long as it is clearly explained—but more than that, if they are sufficiently interested. What determines an audience’s understanding is not so much scientific knowledge, but motivation: patients who are ill, with an important decision to make about treatment, can be very motivated indeed.
But journalists and miracle-cure merchants sabotage this process of shared decision-making, diligently, brick by brick, making lengthy and bogus criticisms of the process of systematic review (because they don’t like the findings of just one), extrapolating from lab-dish data, misrepresenting the sense and value of trials, carefully and collectively undermining the nation’s understanding of the very notion of what it means for there to be evidence for an activity. In this regard they are, to my mind, guilty of an unforgivable crime.
You’ll notice, I hope, that I’m more interested in the cultural impact of nonsense—the medicalisation of everyday life, the undermining of sense—and in general I blame systems more than particular people. While I do go through the background of some individuals, this is largely to illustrate the extent to which they have been misrepresented by the media, who are so desperate to present their favoured authority figures as somehow mainstream. I am not surprised that there are individual entrepreneurs, but I am unimpressed that the media carry their assertions as true. I am not surprised that there are people with odd ideas about medicine, or that they sell those ideas. But I am spectacularly, supremely, incandescently unimpressed when a university starts to offer BSc science courses in them. I do not blame individual journalists (for the most part), but I do blame whole systems of editors, and the people who buy newspapers with values they profess to despise. Specifically, I do not blame Andrew Wakefield for the MMR scare (although he’s done things I hope I would not), and I find it—let’s be very clear once again—spectacularly distasteful that the media are now revving up to hold him singly responsible for their own crimes, in regard to that debacle.
Similarly, while I could reel out a few stories of alternative therapists’ customers who’ve died unnecessarily, it seems to me that people who choose to see alternative therapists (except for nutrition therapists, who have worked very hard to confuse the public and to brand themselves as conventional evidence-based practitioners) make that choice with their eyes open, or at least only half closed. To me this is not a situation of businessmen exploiting the vulnerable, but is rather, as I seem to keep saying, a bit more complicated than that. We love this stuff, and we love it for some fascinating reasons, which we could ideally spend a lot more time thinking and talking about.
Economists and doctors talk about ‘opportunity costs’, the things you could have done, but didn’t, because you were distracted by doing something less useful. To my mind, the greatest harm posed by the avalanche of nonsense we have seen in this book is best conceived of as the opportunity cost of bullshit’.
We have somehow become collectively obsessed with these absurd, thinly evidenced individual tinkerings in diet, distracting us from simple healthy eating advice; but more than that, as we saw, distracting us from the other important lifestyle risk factors for ill health which cannot be sold, or commodified.
Doctors, similarly, have been captivated by the commercial success of alternative therapists. They could learn from the best of the research into the placebo effect, and the meaning response in healing, and apply that to everyday clinical practice, augmenting treatments which are in themselves also effective: but instead, there is a fashion among huge numbers of them to indulge childish fantasies about magic pills, massages or needles. That is not forward-looking, or inclusive, and it does nothing about the untherapeutic nature of rushed consultations in decaying buildings. It also requires, frequently, that you lie to patients. ‘The true cost of something,’ as the Economist says, ‘is what you give up to get it.’
On a larger scale, many people are angry about the evils of the pharmaceutical industry, and nervous about the role of profit in healthcare; but these are formless and uncalibrated intuitions, so the valuable political energy that comes from this outrage is funnelled—wasted—through infantile issues like the miraculous properties of vitamin pills, or the evils of MMR. Just because big pharma can behave badly, that does not mean that sugar pills work better than placebo, nor does it mean that MMR causes autism. Whatever the wealthy pill peddlers try to tell you, with their brand-building conspiracy theories, big pharma isn’t afraid of the food supplement pill industry, it is the food supplement pill industry. Similarly, big pharma isn’t frightened for its profits because popular opinion turned against MMR: if they have any sense, these companies are relieved that the public is obsessed with MMR, and is thus distracted from the other far more complex and real issues connected with the pharmaceutical business and its inadequate regulation.
To engage meaningfully in a political process of managing the evils of big pharma, we need to understand a little about the business of evidence: only then can we understand why transparency is so important in pharmaceutical research, for example, or the details of how it can be made to work, or concoct new and imaginative solutions.
But the greatest opportunity cost comes, of course, in the media, which has failed science so spectacularly, getting stuff wrong, and dumbing down. No amount of training will ever improve the wildly inaccurate stories, because newspapers already have specialist health and science correspondents who understand science. Editors will always—cynically—sideline those people, and give stupid stories to generalists, for the simple reason that they want stupid stories. Science is beyond their intellectual horizon, so they assume you can just make it up anyway. In an era when mainstream media is in fear for its life, their claims to act as effective gatekeepers to information are somewhat undermined by the content of pretty much every column or blog entry I’ve ever written.
To academics, and scientists of all shades, I would say this: you cannot ever possibly prevent newspapers from printing nonsense, but you can add your own sense into the mix. Email the features desk, ring the health desk (you can find the switchboard number on the letters page of any newspaper), and offer them a piece on something interesting from your field. They’ll turn you down. Try again. You can also toe the line by not writing stupid press releases (there are extensive guidelines for communicating with the media online), by being clear about what’s speculation in your discussions, by presenting risk data as ‘natural frequencies’, and so on. If you feel your work—or even your field—has been misrepresented, then complain: write to the editor, the journalist, the letters page, the readers’ editor, the PCC; put out a press release explaining why the story was stupid, get your press office to harrass the paper or TV station, use your title (it’s embarrassing how easy they are to impress), and offer to write them something yourself.
The greatest problem of all is dumbing down. Everything in the media is robbed of any scientific meat, in a desperate bid to seduce an imaginary mass who aren’t interested. And why should they be? Meanwhile the nerds, the people who studied biochemistry but who now work in middle management at Woolworths, are neglected, unstimulated, abandoned. There are intelligent people out there who want to be pushed, to keep their knowledge and passion for science alive, and neglecting them comes at a serious cost to society. Institutions have failed in this regard. The indulgent and well-financed ‘public engagement with science’ community has been worse than useless, because it too is obsessed with taking the message to everyone, rarely offering stimulating content to the people who are already interested.
Now you don’t need these people. Start a blog. Not everyone will care, but some will, and they will find your work. Unmediated access to niche expertise is the future, and you know, science isn’t hard—academics around the world explain hugely complicated ideas to ignorant eighteen-year-olds every September—it just requires motivation. I give you the CERN podcast, the Science in the City mp3 lecture series, blogs from profs, open access academic journal articles from PLOS, online video archives of popular lectures, the free editions of the Royal Statistical Society’s magazine Significance, and many more, all out there, waiting for you to join them. There’s no money in it, but you knew that when you started on this path. You will do it because you know that knowledge is beautiful, and because if only a hundred people share your passion, that is enough.




FURTHER READING AND ACKNOWLEDGEMENTS

I have done my absolute best to keep these references to a minimum, as this is supposed to be an entertaining book, not a scholarly text. More useful than references, I would hope, are the many extra materials available on www.badscience.net, including recommended reading, videos, a rolling ticker of interesting news stories, updated references, activities for schoolchildren, a discussion forum, everything I’ve ever written (except this book, of course), advice on activism, links to science communication guidelines for journalists and academics, and much more. I will always try to add to it as time passes. There are some books which really stand out as genuinely excellent, and I am going to use my last ink to send you their way. Your time will not bo wasted on them.
Testing Treatments by Imogen Evans, Hazel Thornton and Iain Chalmers is a book on evidence-based medicine specifically written for a lay audience by two academics and a patient. It is also free to download online from www.jameslindlibrary.org. How to Read a Paper by Professor Greenhalgh is the standard medical textbook on critically appraising academic journal articles. It’s readable, short, and it would be a best-seller if it wasn’t unnecessarily overpriced.
Irrationality by Stuart Sutherland makes a great partner with How We Know What Isn’t So by Thomas Gilovich, as both cover different aspects of social science and psychology research into irrational behaviour, while Reckoning with Risk by Gerd Gigerenzer comes at the same problems from a more mathematical perspective.
Meaning, Medicine and the ‘Placebo Effect’ by Daniel Moerman is excellent, and you should not be put off by the fact that it is published under an academic imprint.
There are now endless blogs by like-minded people which have sprung from nowhere over the past few years, to my enormous delight, onto my computer screen. They often cover science news better than the mainstream media, and the feeds of some of the most entertaining fellow-travellers are aggregated at the website badscienceblogs.net. I enjoy disagreeing with many of them—viciously—on a great many things.
And lastly, the most important references of all are to the people by whom I have been taught, nudged, reared, influenced, challenged, supervised, contradicted, supported, and most importantly entertained. They are (missing too many, and in very little order): Emily Wilson, Ian Sample, James Randerson, Alok Jha, Mary Byrne, Mike Burke, Ian Katz, Mitzi Angel, Robert Lacey, Chris Elliott, Rachel Buchanan, Alan Rusbridger, Pat Kavanagh, the inspirational badscience bloggers, everyone who has ever sent me a tip about a story on [email protected], Iain Chalmers, Lome Denny, Simon Wessely, Caroline Richmond, John Stein, Jim Hopkins, David Colquhoun, Catherine Collins, Matthew Hotopf, John Moriarty, Alex Lomas, Andy Lewis, Trisha Greenhalgh, Gimpy, shpalman, Holfordwatch, Positive Internet, Jon, Liz Parratt, Patrick Matthews, Ian Brown, Mike Jay, Louise Burton, John King, Cicely Marston, Steve Rolles, Hettie, Mark Pilkington, Ginge Tulloch, Mattfiew Tait, Cathy Flower, my mum, my dad, Reg, Josh, Raph, Allie, and the fabulous Amanda Palmer.
EOF