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Press
The controversy surrounding the measles, mumps, and rubella (MMR) vaccine continues to smoulder and every now and then someone stokes the fire. This time it is "top Mail writer" Melanie Phillips in a much hyped series of three articles in the Daily Mail under the banner "MMR: the truth" (11, 12, and 13 March).
Despite a three month globe-trotting investigation, Phillips, a seasoned
polemicist, presents nothing new; she simply follows the usual
pattern of conspiracy theory. For example, she claims that Professor
John O'Leary, a pathologist at Trinity College Dublin, was gagged
after announcing that the measles virus he had found in the guts of
children with autism was the same strain as that used in the MMR
vaccine. And she refers to more "potentially explosive"
about-to-be-published research from gastroenterologist Andrew
Wakefield
"the doctor at
the heart of the MMR furore"which
it is claimed will show that he is right and that the rest of
the world is wrong.
Phillips' articles, billed as a "major new series," follow the special MMR
theme issue published last year by the satirical magazine Private
Eye, which also appeared to have taken on board unthinkingly all
that Andrew Wakefield has said, and lacked any scientific
underpinning (BMJ 2002;324:1224)
In a similar fashion to the Private Eye "exposé," Phillips consistently describes the experts in the "anti-MMR camp" in glowing terms, such as "eminent," "renowned," and "foremost." However, she is less liberal with her superlatives in describing the "pro-MMR" experts.
She describes Wakefield as an outcast and an enemy (of the scientific community and the government), who believes himself to be on the brink of vindication. Unfortunately, appealing to the public through a writer like Melanie Phillips, rather than by subjecting his findings to the usual scientific peer review process, will only cause further anxiety and concern for parents and do nothing to win the hearts and minds of the scientists.
Phillips makes much of the conflicting interests of various experts. She rightly points out that vaccine manufacturers have employed some "pro-MMR experts" as advisers or have funded them in their research. But surely it is reassuring to know that the companies seek advice from people who know what they are talking about? Authors in most mainstream journals, including the BMJ, are required to declare any potential conflicting interests; if they sit on government committees discussing vaccines, they do not take part in discussions that may conflict with these interests.
However, Phillips does not point out that Andrew Wakefield and other players are acting for the parents in an upcoming court case over MMR and so could be said to have vested interests. Just as we ought not to ascribe venal motives to the parents of autistic children who would stand to receive compensation if their lawsuit succeeds, so we should not accuse researchers of bias because vaccine manufacturers fund their research. If everyone with an "interest" were to be removed from the debate there would be no one left with any knowledge of the subject.
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Phillips rubbishes epidemiological studies, even though such studies have
been the tools used in many major medical discoveries, such as the
link between smoking and lung cancer. The reviews she quotes have
quite correctly concluded that the evidence does not support a link
between autism and MMR, but it can never rule out the possibility
that the occasional case is associated with the vaccine. Phillips
interprets this as distortion, which demonstrates her lack of
understanding of one of the fundamental tenets of epidemiological
researchthat one can
never totally prove a negative. However, she refers to an "epidemic
of autism." If there is one, then epidemiological studies should have
no problem in picking up a major factor in its causation.
In place of epidemiological studies, Phillips calls for clinical studies, involving talking to parents and examining individual children. Why this should be better is unclear and reveals a lack of understanding that one always has to compare affected children with those who are unaffected. Without this, there can be no useful progress and, more likely, there is a serious risk of drawing the wrong conclusions, as was the case with the whooping cough vaccine.
The Daily Mail's series of articles will serve only to worry parents
further. Researchers, and those who report their work, must consider
the effect that anything they say may have, especially when it comes
to the health of children. This responsibility should not be taken
lightly.
Footnotes
Both authors have received funding from vaccine manufacturers as well as other sources to attend educational meetings and conduct research.
Another review of the Mail articles can be found at www.spiked-online.com/Articles/00000006DCD6.htm
Helen Bedford
Institute of Child Health, London
David Elliman
St George's Hospital, London
© 2003 BMJ
Publishing Group Ltd
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