Censorship is not the answer to health scares
The only way to challenge the pseudoscience of Andrew Wakefield and others is to have more debate, not less.
‘Serious thought should be given by the public as to whether the press can self-police their own conflict of selling their product and sensationalising poor science – and if not, recognised as such, and remedies put in place.’ (Gregory Poland, Ray Spier.)
‘Fear, misinformation, and innumerates: how the Wakefield paper, the press, and public advocacy groups damaged the public health.’ (Vaccine 28 (2010) 2361-2362.)
‘How could this have happened?’ asks a splenetic editorial reflection on the MMR-autism controversy in the current issue of Vaccine, the leading scientific journal in the field of immunisation. The authors - Gregory Poland of the Mayo Clinic and Ray Spier from the University of Surrey – proceed to blame everybody but the scientific authorities for the scare that was launched in a notorious (and now withdrawn) Lancet paper by the former Royal Free gastroenterology researcher Andrew Wakefield who was finally struck off the medical register this week on charges of serious professional misconduct.
They blame Wakefield (citing the General Medical Council verdict that he was ‘dishonest, misleading and irresponsible’), public health authorities (who ‘stumbled in responding poorly and immediately to the issue’), and the public (for being ‘innumerate’ and ‘uncritical’). In the tone of exasperated schoolteachers scolding truculent adolescents, the authors also attribute ‘significant and disproportionate blame’ to autism advocacy organisations and recommend a period of penitence: ‘deep self-reflection would be appropriate’.
The main target of editorial wrath is the media, which is judged to be unable to ‘balance reporting, risk communication and ethics’ and found guilty of ‘celebrity-based medicine’ and ‘sensational reporting’. A disingenuous assertion of support for the principle of freedom of speech is followed by the demand for apologies from the press for their failures over MMR and a commitment to more responsible reporting in the future, with the implicit threat of measures of censorship – ‘remedies put in place’ – should such responses not be forthcoming.
Professors Poland and Spier have nothing to say about the failures of scientific quality control that allowed the Wakefield research to proceed at a reputable British medical school and teaching hospital and to be accepted for publication in a prestigious medical journal. This is surprising as they are both eminent vaccine scientists and are, respectively, the current and former ‘editors in chief’ of Vaccine.
When, back in 1998, I showed Wakefield’s Lancet paper to a friend with some experience in medical research, his first question was ‘what can they mean when they say that the 12 children in the study were “consecutively referred” to the department of paediatric gastroenterology?’. It seems that none of the Lancet’s peer reviewers – or indeed any of the authorities subsequently assembled by the Medical Research Council to assess Wakefield’s claims – raised this basic question (or if they did, they did not energetically pursue it). Yet it was the pursuit of this question with forensic rigour by the investigative journalist Brian Deer from 2004 onwards that exposed the biased selection of cases and the associated conflicts of interest and deceptions that became the focus of the GMC inquiry.
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The notion that organisational methods of censorship and repression are the appropriate response to influential currents of pseudoscience has unfortunately become widely established. This is well illustrated by the recent controversy surrounding the journal Medical Hypotheses – published, like Vaccine and the Lancet, by Elsevier. Under its founding editor David Horrobin, and his successor Bruce Charlton, Medical Hypotheses has rejected the procedures of peer review now standard among academic journals in favour of a policy of selection by the editor, according to what he considers interesting, provocative, entertaining. The result is an eclectic mixture of science and pseudoscience, sense and nonsense.
For example, Medical Hypotheses has published articles suggesting that autism may be caused by iron, mercury, Vitamin D deficiency, electromagnetic fields, Lyme disease, the antibiotic Augmentin and improved childhood hygiene. I strongly suspect that these theories are as speculative and as insubstantial as the MMR-autism thesis, but this is no grounds for denying their authors a platform, particularly when it is clear that they have not been given the kite mark of peer review.
Medical Hypotheses and its editorial policy were safe – indeed the journal has flourished under Charlton’s editorship – until he published an article by Peter Duesberg, the notorious retrovirologist who rejects the theory that HIV is the cause of AIDS. This brought Charlton into conflict with one of the most powerful scientific advocacy lobbies, the AIDS establishment, which ranks second only to the climate-change crusade when it comes to trying to suppress its critics, who are stigmatised as ‘denialists’ of doctrinal orthodoxy.
After a brief standoff with Elsevier, when Charlton refused to back down on his editorial independence, he was sacked this month as editor of Medical Hypotheses. Now that those who call for a clampdown on scientists who express sceptical views about global warming or the scaremongering about AIDS seek to extend the label of ‘denialism’ to include those, like Wakefield, who ‘deny’ the consensus that childhood vaccines are safe and effective, the editors of Vaccine seem to want to restrict the expression of such views in the media.
Censorship is neither a legitimate nor an effective response to critical views, even – most of all – if such views popularise pseudoscientific ideas that are detrimental to public health. The only way to overcome the influence of anti-immunisation prejudices is through free and open debate. The lessons of the MMR-autism debacle are that we need rigorous peer review in mainstream scientific journals and that serious scientists and clinicians should challenge pseudoscience in the public realm, in open access journals like Medical Hypotheses, and in the wider media world of press and television. If the editors of Vaccine devoted more energy to regulating the conduct and publication of scientific research in their own speciality they would not need to issue pious homilies and thinly veiled threats to the popular press.
The Vaccine sermon concludes with a declaration: ‘One and only one principle should characterise all actions and discussions in this regard [questions about vaccine safety and efficacy] – truthfulness and credibility via full transparency that evokes the trust of the public must be the one and only goal.’
Apart from the apparent innumeracy of this statement, it is contradicted in practice by the growing popularity among scientists of the principle of ‘the good lie’. This is the notion that it is justifiable to be ‘economical with the truth’ or to ‘spin the facts’ in the service of what engaged scientists deem to be a higher cause (saving the planet from global warming, stopping the spread of HIV/AIDS, deterring people from smoking, promoting ‘healthy lifestyles’, and now preventing childhood illnesses through immunisation). The pervasive cynicism of ‘the good lie’ is a bigger threat to trust, and ultimately to public health and welfare, than the pseudoscience of Andrew Wakefield.
Dr Michael Fitzpatrick is the author of MMR and Autism: What Parents Need to Know (buy this book from Amazon(UK)) and Defeating Autism: A Damaging Delusion (buy this book from Amazon(UK)).
Gregory Poland, Ray Spier, ‘Fear, misinformation, and innumerates: how the Wakefield paper, the press, and public advocacy groups damaged the public health’, Vaccine 28 (2010) 2361-2362.
‘Don’t mention the d-word’, by Michael Fitzpatrick, New Scientist, 15 May 2010
Turning peer review into modern-day holy scripture, by Frank Furedi, 3 February 2010
Childish jibes are no substitute for serious debate, review of Kalichman, Denying Aids, spiked Review of Books, September 2009
Martin Enserink, ‘Elsevier to Editor: change controversial journal or resign’, New Scientist, 14 March 2010
Ann Mroz, ‘Decide it on science not silence’, THES, 6 May 2010
RIP Medical Hypotheses, Bruce Charlton blog, 11 May 2010