MMR and the Daily Mail
Last Sunday (the 5th of February) The Mail on Sunday revived its long-running campaign supporting the position that the MMR (Measles, Mumps, Rubella) combined vaccine potentially causes children to develop autism. This was quickly followed by an article from Melanie Phillips, in The Daily Mail Tuesday 7th with the title MMR : the facade cracks.
The gist of the story is that while the vast majority of medical opinion rejects the proposed link between MMR and autism, Dr. Peter Fletcher, a former Chief Scientific Officer who was responsible for assessing the safety of vaccines in the late 70's, has now stated that he is not convinced the vaccine is safe.
This is a very interesting story from the point of view of science communication but I have some trouble taking a detached view because the story itself is so misleading and potentially harmful.
As a quick reminder - the link between MMR and autism was first proposed by Dr. Andrew Wakefield in an article in the Lancet in 1998. Since then Wakefield and the article have been comprehensively discredited by the medical community. A good summary is to be found at http://www.mmrthefacts.nhs.uk/library/research.php. However, the The Daily Mail has never recognised this and continues to claim the vaccine is potentially unsafe and that the government is at fault for not providing the alternative of three single vaccines. The result has been a significant drop in the vaccination rate and lengthy and expensive law suits from parents of children with autism.
I am not a doctor and neither is Melanie Philips. So, like most of the population, we have to rely other experts to guide us as to whether there is a risk. However, a statement from one expert who retired nearly 30 years ago is hardly an overwhelming breakthrough in the anti-MMR case. No doubt Dr. Fletcher is extremely well-qualified and deserves to be listened to, but he is not a new recruit to the Wakefield cause. He has been wheeled out to back up the anti-MMR case from time to time over the last 5 years (for example this story from 2001) and the vast majority of medical opinion remains unimpressed.
Clearly autism is a very emotional subject, especially for the parents involved, and feelings also run high in those who write about it. But it is worth remembering a few simple background facts which are not in dispute.
1) There is no evidence that any children become autistic through MMR, but if there are any it is a very small number. In fact Melanie Philips herself stresses this in trying to explain why a large study will not detect the relationship (she seems not to understand that the larger the study the smaller the correlation that it can detect - but we will let this pass).
2) The alternative of taking each of the three vaccines independently is available privately. The issue is whether this alternative should be provided by the NHS at the tax-payer's expense.
3) There is no more (or less) evidence for the safety of the single vaccine approach than MMR. There is just an unsubstantiated hypothesis that in a very few cases the use of multiple vaccinations simultaneously may in some way overwhelm the immune system. However, there is a clear and undisputed risk to the child if it receives no vaccine.
4) MMR is used worldwide and many other governments have assessed its safety and have found no evidence of a risk of autism.
It is also important to understand that Melanie Philips herself does not always take too much care when investigating her sources. In the article she mentions the Cochrane report - a metastudy of the MMR vaccination. She wrote about this when it first came out and Ben Goldacre in The Guardian rapidly exposed her failure to understand it. I also had a brief exchange of e-mails with her which confirmed her failure to fully understand the paper. For example, she said "On the contrary, it said that no fewer than nine of the most celebrated studies that have been used against him were unreliable in the way they were constructed." On inspection of the paper it turns out that only one of these nine studies is at all related to Wakefield's work and the majority were published before 1998! (The papers looked at other sideeffects of the MMR vaccine such as short term inflammation and nausea). It seems she had skimmed the paper for useful quotes without taking the time to properly understand what had been written.
A quick Google reveals that none of the other major newspapers ran the Peter Fletcher story last week. It seems the only other places where it appeared were some special interest web-sites that used The Daily Mail as their source. Unfortunately The Mail is a widely read national paper with considerable influence. It is right that scientific orthodoxy should be challenged by journalism. But in turn, the journalists should take some responsibility for the effects of what they publish and ensure they have the technical competence to understand the orthodox case.
The gist of the story is that while the vast majority of medical opinion rejects the proposed link between MMR and autism, Dr. Peter Fletcher, a former Chief Scientific Officer who was responsible for assessing the safety of vaccines in the late 70's, has now stated that he is not convinced the vaccine is safe.
This is a very interesting story from the point of view of science communication but I have some trouble taking a detached view because the story itself is so misleading and potentially harmful.
As a quick reminder - the link between MMR and autism was first proposed by Dr. Andrew Wakefield in an article in the Lancet in 1998. Since then Wakefield and the article have been comprehensively discredited by the medical community. A good summary is to be found at http://www.mmrthefacts.nhs.uk/library/research.php. However, the The Daily Mail has never recognised this and continues to claim the vaccine is potentially unsafe and that the government is at fault for not providing the alternative of three single vaccines. The result has been a significant drop in the vaccination rate and lengthy and expensive law suits from parents of children with autism.
I am not a doctor and neither is Melanie Philips. So, like most of the population, we have to rely other experts to guide us as to whether there is a risk. However, a statement from one expert who retired nearly 30 years ago is hardly an overwhelming breakthrough in the anti-MMR case. No doubt Dr. Fletcher is extremely well-qualified and deserves to be listened to, but he is not a new recruit to the Wakefield cause. He has been wheeled out to back up the anti-MMR case from time to time over the last 5 years (for example this story from 2001) and the vast majority of medical opinion remains unimpressed.
Clearly autism is a very emotional subject, especially for the parents involved, and feelings also run high in those who write about it. But it is worth remembering a few simple background facts which are not in dispute.
1) There is no evidence that any children become autistic through MMR, but if there are any it is a very small number. In fact Melanie Philips herself stresses this in trying to explain why a large study will not detect the relationship (she seems not to understand that the larger the study the smaller the correlation that it can detect - but we will let this pass).
2) The alternative of taking each of the three vaccines independently is available privately. The issue is whether this alternative should be provided by the NHS at the tax-payer's expense.
3) There is no more (or less) evidence for the safety of the single vaccine approach than MMR. There is just an unsubstantiated hypothesis that in a very few cases the use of multiple vaccinations simultaneously may in some way overwhelm the immune system. However, there is a clear and undisputed risk to the child if it receives no vaccine.
4) MMR is used worldwide and many other governments have assessed its safety and have found no evidence of a risk of autism.
It is also important to understand that Melanie Philips herself does not always take too much care when investigating her sources. In the article she mentions the Cochrane report - a metastudy of the MMR vaccination. She wrote about this when it first came out and Ben Goldacre in The Guardian rapidly exposed her failure to understand it. I also had a brief exchange of e-mails with her which confirmed her failure to fully understand the paper. For example, she said "On the contrary, it said that no fewer than nine of the most celebrated studies that have been used against him were unreliable in the way they were constructed." On inspection of the paper it turns out that only one of these nine studies is at all related to Wakefield's work and the majority were published before 1998! (The papers looked at other sideeffects of the MMR vaccine such as short term inflammation and nausea). It seems she had skimmed the paper for useful quotes without taking the time to properly understand what had been written.
A quick Google reveals that none of the other major newspapers ran the Peter Fletcher story last week. It seems the only other places where it appeared were some special interest web-sites that used The Daily Mail as their source. Unfortunately The Mail is a widely read national paper with considerable influence. It is right that scientific orthodoxy should be challenged by journalism. But in turn, the journalists should take some responsibility for the effects of what they publish and ensure they have the technical competence to understand the orthodox case.
posted by Mark Frank at 9:17 am
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