Friday, 25 November 2011


Am I the only one who thinks the British Medical Journal's call for an independent inquiry into University College London's role in the Andrew Wakefield MMR saga is a bit OTT? Perhaps I am and you will all put me right on this, but until you do I’m leaning towards thinking it feels wrong.

Before I explain why, let me say two things. Firstly, I love Brian Deer. He is the personification of a kind of investigative reporting that inspired me to study journalism, a kind of journalism that is almost nonexistent in science today as most reporters struggle to file 3 or 4 news stories a day and to escape the dreaded diary. Secondly, no-one, with the exception of maybe Brian Deer and Andrew Wakefield, talks about the MMR scare more than I do. You cannot tell the story of the SMC without talking about MMR. I never do a speech without talking about it, or debate the issue of science in the media without referring to it. It is the seminal example of how potent a media scare story can be and of the lessons we must learn.

But do we really need to pursue one of our finest science universities for a small part they played in a now discredited paper published 13 years ago?

It was Deer’s continuing revelations about the extent of Andrew Wakefield’s scientific "fraud" that prompted the BMJ to call on UCL to set up an independent inquiry earlier this year. Ten months on and with no action from UCL the BMJ has now referred the matter to the House of Commons Select Committee on Science and Technology stating, "if UCL does not immediately initiate an externally led review of its role in the vaccine scare, we believe that parliament should do it."

Let me explain why I’m uncomfortable with this.

I cannot see what is to be gained from yet another expensive and lengthy inquiry into what went wrong on MMR. No story can have been more scrutinised than the story of MMR. Brian Deer has done brilliant work, shining a light into every aspect of this complex issue and picking over the detritus of an ever murkier story. And Deer’s work prompted others to do the same. The SMC’s handy media-friendly Timeline on MMR gives dates for all the various actions resulting from multiple investigations: the date that the Lancet partially retracted the paper (2004), then when they fully retracted the paper (2010), when the GMC announced their inquiry (2007) and 3 years later when they found Wakefield guilty of serious professional misconduct in May 2010 and struck him off the medical register.

It is also seems especially harsh on UCL. At the time the Lancet paper was published in 1998, the Royal Free Medical School was not even part of UCL. Most of Wakefield’s fellow authors have retired and moved on. As is the way with universities these days there have been many reorganisations since then and almost all the approval processes for research are unrecognizable compared with those in 1998. As a result of the GMC ruling on Wakefield last year, UCL has already initiated a review of its research governance, which is ongoing. The current Provost Malcolm Grant has been the head of UCL since 2003, five years after the Lancet article was published, and is generally considered by his own scientists to be doing great things for science at a very challenging time for universities.

The BMJ makes the point that it would compound the original scandal if we did not heed the warnings from this wrongdoing. I could not agree more. But are we really unable to learn those lessons without another major inquiry?

As it happens I think things have already changed because of MMR – especially in the media. I have been in rooms when editors admitted they called it wrong on MMR and claimed that they defer to their specialist science and health reporters more because of the fallout from that story. It’s also the case that one of the reasons MMR comes up so often in every discussion about science in the media is that there are no more recent examples with quite the same wide-reaching impact. The fact that a scare story that broke 13 years ago is still being discussed suggests that to some extent, all of us are doing things differently. I would certainly like to think that the presence of the SMC now means that the scientific community engages more effectively and more swiftly when extraordinary claims are made on weak evidence.

There were other positive spin-offs which few people mention, like the way a much-neglected condition came to the fore. In 1998, autism was common but badly neglected by doctors and the research community. It isn't now. Talking to vaccine scientists, I gather that they have also learned much that is helpful from this episode that has global value. After all MMR wasn't and isn't the only vaccine that people worry about, however irrationally.

However, while many things have changed for the better, there is still some way to go. While Brian Deer and the BMJ have recently focused on the scientific misconduct in this sorry story, there were many angles to this controversy. Of most interest to me was the way that a weak scientific study, combined with the statements that Wakefield made at a press conference which went way beyond the paper, were seized on by a media hungry for a scare story. Sadly this is still a lethal combination that sees far too many scare stories hitting the headlines. And here’s the thing: the medical journals themselves are a critical part of this chain. A high percentage of the scare stories we see each week come from the key 5-10 medical journals. Many are genuinely alarming and are covered in a balanced and accurate way. Others are sensationalized by reporters or sub editors. But some are studies with significant weaknesses that are not always highlighted as much as they could be by the journal press releases or by the authors announcing the results. We know this because several times a week the SMC issues third party reaction to these studies which attempt to put them into context and spell out the limitations. A quick glance at these comments will show that the phrase 'extraordinary claims need extraordinary evidence' is a message that should be applied to journals as much as to journalists. Everyone involved in publicising scientific research has the responsibility to get it right.

I agree we should continue to talk about MMR – it remains the most recent and dramatic example of how poor science and bad reporting can cost lives. But I think the time for the 'blame game' may be over. When Baby P died some people got so carried away with wanting to punish social workers that they lost sight of the fact that Baby P was killed by his mother and her boyfriend. Hardly anyone involved in the MMR saga emerges smelling of roses, but in the end the person most responsible has been identified and punished appropriately. Instead of now focusing on UCL I think it’s time to concentrate our efforts on improving the way we all communicate science to the public, ensuring something like this never happens again.


Paul Nuki said...

Not at all sure you are right here, Fiona. The story of the MMR scare is as much to do with how the medical and research fraternity aided and abetted Wakefield as it is about Wakefield himself. If UCL and it ethics committee had done its job properly it would never have happened. Same for the Lancet and its process of peer review. Indeed if the GMC had applied a standard of proof to the case on a par with a criminal court (rather than several hurdles above that) it would have struck off Wakefield months after Brian’s Sunday Times investigation was published – instead of some five or six years later. The BMJ is right to say the system needs properly looking at. It may be convenient for the medical and research community to pretend it was “just one rogue doctor”. But it is not the truth.

Michael Fitzpatrick said...

No, Fiona, you are not the only one.

I agree that the pursuit of Wakefield and co-authors, peer-reviewers, editors and everybody else involved in the MMR-autism scare has reached the point where a spirit of sanctimoniousness and vindictiveness exceeds a commitment to rigour and justice. At the time of the GMC inquiry, I noted an element of bad faith in the prosecution of Wakefield by authorities who had largely remained silent during the years when the anti-MMR campaign had a major impact.

I doubt if many papers could withstand the scrutiny that has, alas late in the day, been devoted to that Lancet paper. No doubt many studies supporting currently fashionable medical crusades against obesity, passive smoking and binge drinking could also be shown to be based on junk science and dodgy statistics (and perhaps also to have authors with conflicts of interest). This seems a cause more worthy of further inquiry – or perhaps of Brian Deer-style investigative journalism.