It is four years since the Lancet published work by the Inflammatory Bowel Disease Study Group from the Royal Free Hospital on a possible link between autism and bowel problems. In view of subsequent events it is sometimes hard to believe that the paper actually included the statement "We did not prove an association between measles, mumps and rubella vaccine and the syndrome described." (1)
Despite this, immediately following publication one of the members of the group, Andrew Wakefield, announced, "There is sufficient concern in my own mind for a case to be made for the vaccines to be given individually at not less than one year intervals."
At the time the British satirical magazine Private Eye ran an article entitled "National Bad Science Week." (2) The article was scathing about Wakefields suggestion, pointing out that "British taxpayers are now funding the damage limitation" and suggesting that "approval for Wakefield is to court flapdoodle." Since then, Private Eye has published articles on BCG and polio vaccines, but over the last year, the MMR vaccine has been the main focus of its interest. There has been a marked shift in the Eyes attitude to this vaccine since 1998, culminating in a special 32 page report on MMR published this month. The report, subtitled "The story so far: a comprehensive review of the MMR vaccination/autism controversy," has been put together by Private Eye journalist Heather Mills.
Often a source of mild amusement when sniping at petty bourgeois crooks and the establishment, on this occasion the Eye is more likely to trigger an attack of apoplexy. Perhaps not surprisingly the style is of a journalistic exposť rather than a well argued scientific treatise, with Andrew Wakefield held up as a crusader for truth, opposing the mighty drug companies and Department of Health. Private Eye seems to have used the kind of lay, anecdotal information that you might read in What Doctors Dont Tell You and the Informed Parent rather than what you might find in the BMJ or Lancet. Understandably, much space is given to the harrowing accounts of parents who believe that the triple vaccine caused their childs autism. However, the overwhelming evidence suggesting no link between the vaccine and autism and bowel problems is either not mentioned or dismissed out of hand, while that suggesting a link is given uncritical prominence.
For example, in telling the story of the evolution of Wakefields hypothesis the report fails to mention that at almost each stage independent researchers as well as the original investigators have been unable to replicate the findings. (3) (4) The scientists/researchers listed in the "Whos who in the MMR story" is nowhere near complete (but then to publish the names of all those who continue to support the vaccine would leave little space for anything else) and reflects the Eyes bias with seven of the nine doubting the safety of the vaccine. If one were to quantify the evidence for and against a link, the ratio would be in the other direction and considerably greater.
Even the photographs of those who believe MMR to be safe and effective show them to be unsmiling, in contrast with the smiling, benign expressions of the doubters.
Private Eye describes the study "Through a glass darkly," in which Wakefield and a colleague claimed that the vaccine had been inadequately researched before its introduction, as having "really rocked the medical establishment." (5) In fact it was published in an obscure journal, read by few clinicians, and was very poorly researched. The example of the failure to include such an important piece of research on vaccine safety as the twins study highlights the lack of scientific rigour in this research. (6) The effect of it was hardly an earthquake, but more that of an annoying gnat bite. However, it did mean that more time had to be wasted in countering the misleading publicity that it attracted.
The Eye report is dangerous in that it is likely to be read by people who are concerned about the safety of the vaccine. A doubting parent who reads this might be convinced there is a genuine problem and the absence of any proper references will prevent them from checking the many misleading statements. This is unfair on already frightened parents and could have a disastrous effect on the health of their children and the rest of the community. It is also cruel to the parents who feel guilty because they believe that their children are autistic because they chose for them to have the vaccine. What happened to journalistic responsibility?
consultant in community child health, St Georges Hospital, London
lecturer in child health, Institute of Child Health, London