BMJ, UCL & MMR: OTT?

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.

Why we need the best journalism on public health stories

My favourite bit of Sunday is when I finally get to sneak away to a quiet corner of our house and settle down to read my Observer. Last week however it ended up being the unsettling bit of my weekend. When I saw the headline I had to check that I hadn't picked up the Mail on Sunday by mistake – but there it was under the Observer masthead: "New health fears over big surge in autism. Questions over triple jab for children". This front page splash linking a rise in autism with the joint Measles, Mumps and Rubella (MMR) vaccine coincided with a two page exclusive interview on the inside pages with Dr Andrew Wakefield, architect of the MMR scare, who is due before the General Medical Council (GMC) Fitness to Practise Panel this week to face charges of misconduct in relation to his research on MMR.

"This had better be good", I thought as I hungrily devoured the piece.

The article was based on a leak of unpublished research into the rising levels of autism. The top line was that as many as one in 58 children may have some form of the condition - much higher than the current highest estimate of one in 100.

You would think that was already a shocking enough story – but then in paragraph three the reason for the headline becomes clear. Apparently two of the seven researchers privately believe that the rise may be connected to the MMR vaccine. The claim is elaborated on in the fourth paragraph where the two researchers are named as Dr Carol Stott and Dr Fiona Scott. Though the paper made it clear that Professor Simon Baron-Cohen, leader of the research group and one of Europe's most respected autism experts, does not accept the link, alarmingly almost ten years after Andrew Wakefield sparked off a frenzied debate over a link between MMR and autism, the Observer's front page was suggesting that there is still a serious dispute amongst leading experts as to whether he was right. Predictably several papers repeated the MMR allegations the next day and countless columnists, including James Le Fanu and Peter Hitchins have cited the Observer piece as evidence that the MMR autism row is still alive and well.

One of the challenges for the Science Media Centre (SMC) was what to do about it. We were set up in the wake of media furores over issues like MMR and we know that poor journalism on public health is our territory. However we also know that the SMC philosophy (the media will 'do' science better when scientists 'do' media better) was a reaction against the culture of complaint within science which often saw top scientists complaining privately about coverage rather than pro-actively engaging with the story.

With this in mind, the SMC reacted to the article primarily by coordinating a joint media statement by 14 institutions involved with child health and vaccination to back the safety of the jab which we issued to coincide with the GMC hearing. However I did also send a note to Denis Campbell, the journalist who wrote the article and a friendly contact of ours, to make sure he knew that the SMC was unable to defend the piece to the angry scientists who were contacting us. The result was an invitation to meet with him, the readers' editor and a variety of other Observer news editors at their offices. So, with two leading MMR experts at my side, I went to highlight the concerns.

One of the main points that I made at that meeting was my belief that in science reporting the rule of thumb should be that the more outrageous the claim the more the need for the best standards of journalism – a rule which is often interpreted in exactly the opposite way by journalists hungry for a sensational scoop. I then argued that I would take this rule even further in this peculiarly sensitive and important public health issue. The claim that MMR may cause autism, made by Dr Andrew Wakefield in 1998, produced one of the biggest rows in public health for decades and millions of pounds of public money have been spent on scientific studies researching the evidence for a link. Not a single reputable study has found any and just last year the SMC coordinated a joint appeal from many of those involved in child health that the media now draw a line under this row unless and until it has compelling new evidence. Many autism experts have echoed this call and issued their own plea for resources to move from the obsession with MMR to investigating the many other possible causes - including genetics, environmental factors and so on.

Given this context, I would argue that the bar for evidence in any newspaper splashing on a link between MMR and autism needs to be much higher than for other stories. In my view the Observer really needed to have produced stunning evidence of a link between MMR and autism to justify re-running this particular scare story.

Stunning evidence it wasn’t. The two researchers cited are experts in autism but not in MMR and the study they were involved with was nothing to do with MMR. In fact it had nothing whatsoever to do with what causes autism at all - it simply looked into prevalence of autism. As such, the authors private views on MMR are neither significant in terms of public health or in any way relevant to the Observer's story. In fact I'm tempted to say that their private views as to what causes autism are no more significant than my mum's view - something on which it seems Dr Fiona Scott agrees: when contacted the following day by the Telegraph she was not prepared to repeat any private views in public and instead voiced her support for MMR and her decision to get her daughter vaccinated.

One of the news editors pointed out that that any article reporting a dramatic rise in autism would prompt readers to turn to the question of MMR. I accept that but the way to answer those readers' questions is with an accurate summary of the balance of evidence against any link. Instead, any Observer reader whose mind turned to the question "is MMR to blame?" was provided with the answer that two out of seven experts believe it is and one believes it is not - a reckless distortion of the real balance of views within the scientific community.

Ironically, if this piece had appeared in certain other campaigning papers, no would one would even bothered complaining. The fact that it was in the Observer, which has a reputation for excellent science and health coverage, made it worth challenging. The fact that senior editors invited us in and the acknowledgement by the readers' editor Stephen Pritchard the following week that the MMR allegations should not have been included in the autism story reassure me that the Observer have seriously reflected on the scientific community's concerns and their responsibilities as journalists - that should be welcomed.