Immune to the facts

‘Public duped by media over MMR’ was the headline-grabbing claim emerging from a survey published on 19 May 2003 by the Economic and Social Research Council (1). On cue, the British press promoted yet another piece of junk science from the anti-MMR campaign.

According to research carried out at the Cardiff University School of Journalism, 53 per cent of those surveyed at the height of the media coverage of the MMR controversy in early 2002 believed that, because both sides of the debate received equal media coverage, there must be equal evidence for each. Though almost all scientific experts rejected the claim of a link between MMR and autism, only 23 per cent of those interviewed were aware that the bulk of evidence favoured supporters of the vaccine.

‘MMR raises risk of brain disorders say researchers’ proclaimed the Daily Mail on 20 May 2003. Yet another report undermining public confidence in MMR turned out to be based on a statistically flawed study using unreliable data. A similar study by the same authors, professional anti-immunisation campaigners Mark and David Geier, was condemned by the American Academy of Paediatrics for using data inappropriately and for containing ‘numerous conceptual and scientific flaws, omissions of fact, inaccuracies and misstatements’ (2).

Doctors and scientists often blame the media for provoking health scares and fears about new developments. In response, journalists point the finger at maverick medical and scientific authorities who have either sponsored or supported particular controversial viewpoints. It is true that the MMR-autism link was first proposed by a mainstream gastroenterologist (Dr Andrew Wakefield) working at a prominent teaching hospital (the Royal Free in North London) and published in an eminently respectable medical journal (The Lancet).

Though the media has played a secondary role in the unfolding of the MMR controversy, the Cardiff study and the reporting of the Geier study raise important questions about whether the story has been handled in a socially responsible – or journalistically rigorous – manner.

There have been two phases in the media treatment of the MMR-autism link. In the three years following the appearance of Dr Wakefield’s paper that first suggested the link in February 1998, the issue was largely the preserve of specialist health reporters in the broadsheet newspapers. They reported Dr Wakefield’s case against MMR and the mainstream response in a balanced way. The tone was sceptical towards Dr Wakefield and tended to affirm the benefits of the mass immunisation programme. After January 2001, MMR became a major political issue: Dr Wakefield questioned the safety of the national immunisation campaign, and the integrity of those running it, and the Chief Medical Officer launched a campaign of reassurance.

The demand for separate vaccines gathered momentum over the next 12 months, receiving a major boost in December 2001 when prime minister Tony Blair conspicuously evaded questions about whether his son Leo had received his MMR jab. Media coverage reached a peak in February 2002 when a BBC Panorama programme presented a broadly sympathetic account of Dr Wakefield’s case. (The research on which the Cardiff study is based was carried out in the first nine months of 2002.)

The responsibility for covering MMR passed from reporters with expertise in scientific and medical issues to general feature writers and political correspondents. While the broadsheets now adopted a more sympathetic line towards Dr Wakefield, the tabloids – especially those hostile to the government – now jumped on the anti-MMR bandwagon.

‘Shame on officials who say MMR is safe’ declared Lorraine Fraser in the Daily Telegraph on 21 January 2001, inaugurating a new phase of anti-MMR campaigning in the media. This article is largely based on an ‘exclusive interview’ with Dr Wakefield, who is described as ‘a champion of parents who feel that their fears have been ignored’. It provides an uncritical account of Dr Wakefield’s MMR-autism thesis and of his latest paper questioning whether MMR was adequately tested before its introduction in 1988.

The article also records Dr Wakefield’s diatribe against the Department of Health for failing to recognise his work and for refusing to acquiesce to his demand for separate vaccines. This piece set the tone for a series of anti-MMR articles by Fraser (around one every month over the next two years). These reveal a close contact with Dr Wakefield and his supporters and openly endorse the anti-MMR campaign.

The Telegraph‘s endorsement of the anti-MMR campaign was not limited to Fraser’s partisan articles. On 8 June 2002 its Saturday magazine carried a major feature by Justine Picardie, who describes Dr Wakefield as ‘a handsome, glossy-haired charismatic hero to families of autistic children in this country and America’. Clearly smitten, she fantasises about a Hollywood depiction of Dr Wakefield’s heroic struggle, with Russell Crowe playing the lead ‘opposite Julia Roberts as a feisty single mother fighting for justice for her child’.

(On 22 May 2003 it emerged that Picardie’s fantasy will shortly become reality, albeit on a more modest stage. Channel Five announced a rare foray into TV drama – a 90-minute special featuring Hugh Bonneville as Dr Wakefield and Juliet Stevenson as the heroic mother of an autistic child. Entitled Hear the Silence, the play is written by Tim Prager (creator of Two Thousand Acres of Sky). It is due to go into production in June. Hollywood will have to wait.)

The Cardiff study, carried out by Ian Hargreaves, Justin Lewis and Tammy Speers, provides a penetrating analysis of media coverage of the MMR controversy. Compared with reports of scientific issues such as climate change and genetic research, MMR was ‘most likely to be the main focus, it generated more op-eds, more letters and was given lengthier coverage on TV, radio and in the press’ (3).

The authors note the generally uncritical treatment of Dr Wakefield’s position, commenting that ‘the connection between the MMR vaccine and autism is a speculative claim made by Wakefield with questionable scientific data to support it’. Despite this, they continue, ‘Wakefield’s claims were not comprehensively or systematically challenged in media coverage’, with the result that ‘the weakness of empirical evidence in support of Wakefield’s claim was never fully aired’.

They also note that though there was no evidence that a single measles vaccination would be any safer than the MMR jab, the demand for separate vaccines was widely and unquestioningly taken up in the press. Though some journalists were satisfied merely to echo Dr Wakefield’s views, many did try to balance their reports by indicating that the bulk of evidence supported the safety of MMR. Yet, ‘attempts to balance claims about the risks of MMR jab tended merely to indicate that there were two competing bodies of evidence’.

Surveys conducted by the Cardiff team revealed that, between April and October 2002, the percentage of people aware of Leo Blair’s role in the story increased from 66 to 70 – ‘one of the highest percentages of correct answers in both surveys’. As the authors note, ‘for people confused about who to trust, this was an important indicator of the government’s faith in its own position. In a nutshell, was the government’s support for MMR deeply felt or merely tactical and strategic? Leo Blair might, therefore, be reasonably seen as a test of the government’s confidence in its own position’. The inescapable fact that Leo’s father failed this test was a serious blow to public confidence in MMR.

The media’s sympathetic treatment of Dr Wakefield and the growing endorsement of the demand for separate vaccines put the government and the health authorities on the defensive. As the Cardiff study authors note, the burden of proof was placed on the side of those defending MMR (who were increasingly faced with the absurd demand to prove a negative – that MMR does not cause autism). The difficulties of the medical authorities were compounded when their ‘dry generalisations’ were met with the rhetorical force of ’emotive and sympathetic’ parents who blamed MMR for making their children autistic.

In a telling table, the Cardiff report records that when parents appeared as sources in newspapers, 37 were anti-MMR, 7 pro-MMR; on TV, the balance was 10-3; on radio, 5-0. The authors comment that ‘the use of anecdotal evidence from a selective (and unrepresentative) group of parents might also be regarded as unhelpful for such an important matter of public policy’. They conclude pointedly that ‘these points matter’ because the media presentation of the MMR issue ‘appears to have led to a loss of confidence in the vaccine in Britain’, the potential public health consequences of which are ‘very serious indeed’.

The authors of the Cardiff study indicate that it was beyond their remit to account for the failure of journalists to question Dr Wakefield’s claims. However, they acknowledge that, in the climate created by the BSE/CJD scandal, journalists were more receptive to a self-proclaimed maverick: they ‘were unwilling to discount the possibility that he may be right’. Yet from the perspective of a school of journalism, it might be considered more alarming that so few journalists were prepared even to consider the possibility that Dr Wakefield was wrong. Indeed, so powerful had the anti-MMR consensus in the media become that Lorraine Fraser was hailed as the 2002 ‘health reporter of the year’ at the British press awards.

Why did the British media fall for Dr Wakefield? Perhaps in part it was the enduring appeal of what the American mathematician Norman Levitt calls the Galileo myth, ‘the idea of the lone noble genius whose insight transcends that of his hidebound age and who consequently faces scorn and persecution for his advocacy of unconventional truth’ (4).

As Levitt notes, ‘rarely has any cult hesitated to answer derision by resorting to this myth in some form’. Taking Dr Wakefield at his own estimation, the British press failed to realise that ‘while Galileo was a rebel, not all rebels – only a tiny fraction – are Galileos’. Though Galileo had some powerful sponsors, he could only have dreamed of the sort of backing that Dr Wakefield has received from the British press. Fortunately, he was able to substantiate his scientific claims – something Dr Wakefield has conspicuously failed to do in the five years since he first advanced his hypothesis.

Perhaps more significant is the fact that journalists are a key element of the professional middle-class social constituency that is at the centre of the refusal of MMR. Numerous journalists – as celebrity parents – have testified in their columns to their anxieties about MMR and, almost exclusively, to their sympathies with the anti-MMR campaign. The list includes Nigella Lawson (The Times), Allison Pearson (London Evening Standard), Libby Purves (The Times), Suzanne Moore (Mail on Sunday), Lynda Lee-Potter (Daily Mail).

For these columnists, writing about immunisation issues follows the principles of the ‘journalism of attachment’ popularised in recent military conflicts: it requires a high level of emotional engagement but no specialist knowledge of the subject. The basic qualification is having a child; a friend or relative with an autistic child is a bonus. All that is then required is a few words with Dr Wakefield and a flick through the cuttings file.

The recent journalistic fascination with autism may also have played a part in the media’s treatment of MMR. Though autism has become fashionable, a condition characterised by difficulties in communication remains uniquely terrifying to those who live by the word. For a profession renowned for its sociability, children for whom language and friendship are problematic are a source of potent fears.

It was not surprising that the Cardiff study attracted little substantial coverage in the British press this week (though its headline claims were cursorily reported). The latest study published by Mark and David Geier (5) claiming that MMR may be a factor in up to 15 percent of cases of autism and other neuro-developmental disorders was reported, first in the GP magazine Pulse on 19 May, then on the BBC News website on 19 May and in the Daily Mail on Tuesday 20 May. These reports followed an earlier account of the Geiers’ researches, by the veteran anti-immunisation reporter Rosie Waterhouse, in the Daily Telegraph on 7 April.

Mark Geier is a genetic counsellor in Maryland, USA; his son David is a graduate student who runs MedCon, a firm providing advice to families pursuing litigation claims over alleged vaccine injury. Though neither has any academic or professional expertise in any discipline relevant to immunisation, the Geiers feature prominently in the conferences and websites of autism parents and other anti-immunisation groups in the USA.

The paper reported in the Telegraph in April was published in the Journal of American Physicians and Surgeons (6). This sounds impressive, but turns out to be the recently relabelled Medical Sentinel, organ of the Association of American Physicians and Surgeons, a medical fundamentalist faction based in Tucson, Arizona, distinguished by its commitment to the practice of private medicine and its hostility to immunisation. The Geiers’ latest paper is published in International Pediatrics, another apparently impressive title; this one is the house journal of the Miami Children’s Hospital.

In response to the paper in the Journal of American Physicians and Surgeons, which focused on the alleged dangers of vaccines containing the mercury-based preservative thiomersal (known as thimerosal in the USA), the American Academy of Pediatrics published a detailed critique (7). The most important defect of this article – shared by the International Pediatrics article – is its reliance on data gathered by the Vaccine Adverse Event Reporting System (VAERS; this is analogous to the ‘yellow card’ reporting system in Britain).

This is a passive surveillance system that relies on professionals and parents reporting what they suspect may be adverse reactions to vaccines. Such reports may represent true adverse events, coincidences or mistakes: ‘inherent limits of VAERS include incomplete reporting, lack of verification of diagnoses, and lack of data on people who were immunised and did not report problems’. Such data are useful for flagging up possible problems and raising questions for further investigation; they can be legitimately used for ‘hypothesis generation’ but not for ‘hypothesis proving’.

In the judgement of the AAP, the Geiers ‘failed to acknowledge the inherent limitations of the VAERS database when drawing conclusions of adverse event associations contained in this report and in their other publications’. The AAP commentary includes a 15-point catalogue of further statistical flaws, errors and omissions in the JAPS paper.

One of the curiosities of the current controversy is that though parents on both sides of the Atlantic blame vaccines for causing their children’s autism, they blame different vaccines. In the USA, campaigners blame vaccines containing mercury-based preservatives (notably the combined diphtheria, tetanus, pertussis DTP vaccine), in the UK they blame MMR (which, because it includes live ‘attenuated’ viruses, cannot include mercury). Despite the fact that there is no scientific evidence in support of either theory – and a great deal against – these campaigns have continued to attract desperate and vulnerable parents, encouraged by the sort of junk science produced by the Geiers.

Though their main focus is thiomersal, the Geiers are sympathetic to Dr Wakefield and his anti-MMR campaign, which has attracted considerable support in the anti-immunisation fringe in the USA. It is thus fortuitous that their researches have led to the conclusion that ‘thimerosal contributed to about 75 per cent of cases of neurodevelopmental disorders, while MMR contributed to 15 per cent’.

Quite apart from the methodological errors in this research and the failure of intensive previous studies to confirm these adverse effects, the notion that 90 per cent of neurodevelopmental disorders can be attributed to immunisation is impossible to reconcile with the well-established genetic contribution to autism, not to mention Down’s syndrome, Fragile X, tuberous sclerosis and numerous other conditions. It is extraordinary that such self-evidently preposterous claims can be taken seriously by anybody.

The Geiers’ latest study plumbs new depths of absurdity. They compare the rates of adverse reactions following MMR (given at 15-18 months in the USA) with the rates of the same conditions reported after DTP (given at 2, 4 and 6 weeks). It is scarcely surprising to find higher rates of ‘gait disturbance’ in toddlers compared with infants in the first three months of life when infants are unable to walk and hence have no gait that might be disturbed. Nor is it surprising that there were more reports of autism and mental retardation among the older children: such conditions are generally not recognised until the second year of life – they are certainly not likely to be identified in babies.

Parents facing the decision about whether to give their children MMR – and parents of autistic children whose burden is now increased by (utterly unwarranted) fears that they may have made their children autistic by giving them MMR – have been ill-served by the media’s uncritical treatment of the anti-MMR campaign. All that is required to establish the credibility of the Geiers and their research is access to google.com. Yet it seems that the prejudice against MMR in sections of the British media is such that all critical and investigative instincts are in suspension.

Dr Michael Fitzpatrick is the author of MMR and Autism, Routledge, 2004 (buy this book from Amazon (UK) or Amazon (USA)); and The Tyranny of Health: Doctors and the Regulation of Lifestyle, Routledge, 2000 (buy this book from Amazon UK or Amazon USA). He is also a contributor to Alternative Medicine: Should We Swallow It? Hodder Murray, 2002 (buy this book from Amazon (UK) or Amazon (USA)).

Read on:

spiked-issue: MMR vaccine

(1) Ian Hargreaves, Justin Lewis, Tammy Speers, ‘Towards a better map: science,
the public and the media’, Economic and Social Research Council, 2003

(2) American Academy of Pediatrics, Study fails to show a connection between thimerosal and autism

(3) Ian Hargreaves, Justin Lewis, Tammy Speers, ‘Towards a better map: science,
the public and the media’, Economic and Social Research Council, 2003

(4) Norman Levitt, Prometheus Bedevilled: science and the contradictions of
contemporary culture, Rutgers, 1999

(5) Mark R Geier, David A Geier, ‘Pediatric MMR Vaccination Safety’,
International Pediatrics, 2003, 18 (2): 108-113

(6) Mark R Geier, David A Geier, ‘Thimerosal in childhood vaccines,
neurodevelopmental disorders and heart disease in the United States’,
Journal of American Physicians and Surgeons, 2003; 8: 6-11

(7) American Academy of Pediatrics, Study fails to show a connection between thimerosal and autism