Friday, 29 January 2010

The Wakefield Experience And What Should Be Learnt From It

When I was completing the final course for my BSc (Hons) I decided to apply to study with the OU for an MSc. My acceptance was reliant on me getting my Bachelors degree, and having achieved it I had to decide what courses I would take for the MSc. I have always been interested in how science is presented to the public so this guided me towards the courses that I later chose to study.

The first course I took was called Science and the Public and was based on a series of fairly high-profile cases from the 1980s and 1990s. While studying these cases it became obvious to me at a fairly early stage that the media can be very undiscerning about what data they use to report a story. Not everyone can be a scientist, and not everyone can understand science, so it is very important that journalists who write stories about science should not only have a good knowledge of the subject but also be able to explain things in terms that any reasonably intelligent would be able to understand.

The final part of the course required the submission of a dissertation based on one of the stories that had formed the basis of the course. I chose to analyse the impact of newspaper reports about the MMR-autism link put forward by Dr Andrew Wakefield. I originally intended to look at all UK daily newspapers, but it soon became apparent that there was just too much to sift through so my dissertation proposal was refined so that I would look at what was written in three newspapers (including their Sunday versions). This still presented me with a lot of data to work my way through, but it was more manageable, and I decided that for key dates in the long-running saga that I would compare what was said in all UK newspapers for those dates.

It is as a result of this that I have had a more than cursory interest in the case before the General Medical Council, the results of the first stage of which were delivered yesterday. I should say at this point that I have absolutely no axe to grind. I do not have children, so I have never faced the dilemma of whether or not to allow them to be given the MMR vaccine. Nor am I a scientist, but I do have an analytical mind and analysis of data was a major part of my work when I was in employment.

The thing that struck me very early on in my study of the MMR-autism story, was that there really was no evidence that there was a link. The paper that was published in the Lancet did not mention a link, it was at the press conference that was called by the authors of the paper (a very unusual event for this sort of research paper) that the first mention of this link was made by Dr Wakefield. There can be no doubt that even at this early stage Wakefield was working to a hidden agenda which most of the other authors of the paper were not aware of.

My analysis of the reports in the newspapers at the time that this story of an MMR-autism link was running showed a great disparity in the quality of reporting. I had chosen the newspapers that I looked at based on their availability online, and by the type of their readership; those I looked at were the Times and Sunday Times, the Daily Mail and the Mail on Sunday, and the Sun and the News of the World. I hoped that this would give me a fairly representative sample of reporting on this subject.

Lots of tables were drawn up and entries made in them, there were word counts, there were lots of dates, there were details about the authors of the articles, there were references made to the qualifications of the writers of the articles and to the posts that they held at the paper. A lot of hours were spent gathering the data and then writing my analysis of it all. At the end of it all I was able to say that there was a significant difference in the quality of the reporting, the quantity of reporting, and the reliability of the information presented in the articles.

Throughout the time period that I was looking at it was interesting to note that the length of the article seemed to be related to the perceived interest that the article would attract in each of the papers. Those in the Sun and News of the World tended to be of few words and there was certainly no evidence of analysis of the data. In the Mail and the Mail on Sunday there were likely to be not only the actual report of whatever had occurred but also a long piece that in effect said that Andrew Wakefield was a saint and should be thanked by one and all for alerting us to the risk of one's offspring developing autism as a result of receiving the MMR vaccine, particularly if said piece was written by Melanie Phillips. The Times and Sunday Times tended to have measured pieces, which not only reported the facts but also regularly reported that no-one had been able to replicate the results that Dr Wakefield claimed to have produced. The one area where all of the papers seemed to produce very similar stories was the question of whether Leo Blair had or had not received the MMR vaccine.

Brian Deer was the reporter who eventually managed to investigate so deeply into the whole affair that he uncovered the evidence of unethical practices concerning how children were selected for the study, how Wakefield had received huge sums of money from the Legal Aid Board, and a multitude of other wrongdoings. If Deer had been writing in the US press he would have undoubtedly won a Pulitzer prize for his investigative reports.

There is no doubt that many of those mothers who decided that they would not allow their children to receive the MMR vaccine did so because they believed every word that reporters such as Melanie Phillips wrote. It is almost criminal that newspapers are allowed to print the kind of unsubstantiated drivel that she wrote on the MMR-autism link. She would regularly write about scientific evidence that did not actually exist, and never wrote about the evidence that did. It would not matter to reporters such as her how many studies were carried out showing that the link did not exist, in her mind Andrew Wakefield had shown that the link existed and that was it as far as she was concerned.

The fact that most of the charges against Drs Wakefield, Walker-Smith and Murch have been found to be proved, that unnecessary invasive tests were carried out on children, that much of the research that they carried out was unethical and irresponsible all show that there have to be serious concerns about their fitness to practice medicine. It now remains to be seen whether they will be struck off the medical register. But we should not forget that there have been many children, and some adults, who may have suffered as a result of Wakefield's irresponsible claims about the safety of the MMR vaccine and the subsequent drop in take-up of the vaccine. What does he say to the pregnant women who had miscarriages or gave birth to babies who were deaf because they came into contact with children suffering from German Measles? What does he say to the parents of the children who died or suffered serious complications because they got measles? Some of these children may not have been able to have the MMR vaccine because of serious medical conditions such as cancer.

One would hope that lessons have been learnt as a result of this long-running story. If such an event were to occur again, it should be hoped that the scientists would be very careful about what they said and that the evidence that they put forward have been achieved through properly conducted trials on a truly representative population sample rather than the 12 children that were in the original study. If such a thing were to arise again we should be able to expect that our politicians would be honest with us and not try to hide behind a sudden desire for privacy when they are keen to get whatever publicity they can at other times.

The problem is, that I know that this will not happen. We have already had another health scare in this country caused by someone who should have known better. This time it was swine flu and the villain of the piece was another doctor, Sir Liam Donaldson, the Government's Chief Medical Officer. His prognostications about the likely number of deaths that could be expected from what was only flu after all, was so far off what has actually occurred that he has become a laughing stock. However, he is not the first senior Government scientist to have made an announcement of massive death tolls that have not materialised. One has only to look back to the 1990s and the suggestion that there would be tens of thousands of cases of vCJD in the population as a result of BSE infected cows getting into the food chain, to see that it doesn't matter how many degrees you may have, or how may senior posts you may have occupied, or how much great work you have done, you can make a prediction that turns out to be so far wide of the mark that it will become the only thing that you are remembered for.


Jobbing Doctor said...

Excellent post.

Thank you.


Fuddled Medic said...

It is a shame that Melanie Phillips cannot be proesecuted for crimes against humanity or something similar. Thanks to her Measles, Mumps and Rubella are on the rise.

Take Rubella, it is now circulating at higher levels due to decreased uptake of the MMR Vaccine. Therefore pregnant women, who have not had the disease before can become carriers and pass it on to there unborn child. These children are then born deaf, blind and sometimes with deformed limbs, all due to congenital rubella.

This is the Daily Mails fault

Anyway, good choice of dissertation!

Alison said...

A very intriguing and well written post MSG, I had my first MMR vaccine almost 3 weeks ago in preparation for starting university in September (been gradually getting the vaccines updated) and since I only had one Rubella vaccine at the age of 13 it was recommended by my practice nurse to have the MMR at two doses. I didn’t hesitate, just as I didn’t hesitate about having the Swine Flu vaccine. MMR dose two will happen a week on Monday ;)

midwifemuse said...

Brilliant. I have to say that much of the media will go for eye-catching reporting with, seemingly, little regard for the true facts or the effect it will have.

Zarathustra said...

Last time I checked, Melanie Phillips had started taking an equally scientifically-literate, socially responsible approach to her analysis of climate change. They don't call her Mad Mel for nothing.

There was a very good article by Ben Goldacre in the Guardian on this subject, taking a similar view to MadSadGirl on the culpability of the media.