Horton Analogy madness
Richard Horton Waffles on Lancet's Wakefield Retraction
by Sally Beck
The Lancet has officially retracted a study which sparked a health scare over the MMR vaccine. The leading British medical journal said that it accepts that claims made by Dr. Andrew Wakefield and two fellow researchers were 'false.'
This came after the General Medical Council (GMC) found the three doctors had been 'dishonest' and 'irresponsible' and had subjected children to invasive procedures that were not warranted.
Richard Horton, editor of The Lancet was quick to dismiss Wakefield who he once told he had the 'utmost respect for.'
In one newspaper he said of the Wakefield study: "It was utterly clear, without any ambiguity at all, that the statements in the paper were utterly false. I feel I was deceived."
This is in stark contrast to comments Horton made earlier in an interview with me for The Observer newspaper, and in a written email to an epidemiologist seeking clarification on whether the science in the Wakefield study held up. Horton was quick to confirm that the science in the paper, which looked at whether 12 autistic children also suffered bowel disease, was good.
He reiterated his statement in his evidence to the GMC, "There was no question in my mind that subject to external peer review and editor debate, we should publish this work," he said. "The description of what seemed to be a new syndrome and its relations to possible environmental triggers was original and would certainly have interested our readers."
The paper was peer reviewed and duly published back in early 1998. The researchers included a line stating that eight of the parents felt the MMR vaccine had played a part in their children's decline. Horton knew this was controversial but published anyway. He said: "We felt it was important not to censor the information. We had censored information regarding BSE (Bovine spongiform encephalopathy, known as mad cow disease) and CJD( Creutzfeldt-Jakob disease, the human form of BSE). We knew there was a risk that BSE could be transferred from cows to humans, but at the time we thought the risk was small so we didn't include the information. It was a big mistake and we should have published it."
At the time of our interview in 2006, Horton seemed very confused in his thinking, especially when it came to the validity of the parents' concerns. He agreed that it was parents who first linked taking the drug Thalidomide to subsequent deformities in their children, but insisted you couldn't compare MMR and Thalidomide because Thalidomide was taken by the mother during the first trimester and the MMR was injected into babies. And although both drugs entered a child's system, albeit different routes, in the case of the MMR any perceived subsequent effect was invalid.
He agreed that researchers should ask parents for their views on what might have caused the children's problems, but then insisted that the information not be given credibility. "The fact that the parents reported that (the children had been fine before receiving the MMR) means nothing," he insisted. "Because proof of cause and effect doesn't come from what you or I might say about a temporal link between an event and a possible risk factor.
"It's like saying that I was born under the star sign Capricorn and in the year that I was born there was some terrible human disaster. Does that somehow mean that my birth was linked to the human disaster? No of course it doesn't"
The analogy was a tough one to figure out but he went on. He said the only way to determine if the MMR was to blame was through epidemiological studies, not by examining children who may have been suffering an adverse drug reaction. To prove his point he gave another unfathomable analogy. "Examining the children is not going to prove whether MMR causes bowel disease or not. Finding the measles virus in their guts does not prove anything.
"It's like saying I have coins in my pocket and I have a cold. Finding the coins in my pocket at the same time I've got a cold, doesn't prove the coins caused my cold..."
So if we understand Mr. Horton correctly, his advice is that if you think your child has had a severe adverse reaction to their vaccine, don't bother to investigate because even if vaccine strain measles virus is found in their gut, this is a totally insignificant fact. "Examining the children has really no part to play in understanding cause and effect here," he said. "It often takes 10 years to prove cause and effect by accumulating a large body of evidence. A very important component in any body of evidence is epidemiological."
That may be true, but is it really advisable to abandon research into physiological changes in children? Surely that wouldn't be very scientific. Or maybe the fear is that scientists will discover that the MMR has a lot to answer for.