Anti-MMR mania: diagnosis and cure
Once, the media fawned over anti-MMR crusaders; they were ‘handsome’, ‘glossy-haired’ and ‘brave’. Now it ridicules them as quacks. What explains journalists’ turn from inflaming anti-vaccine hysteria to embracing scientific evidence?
Andrew Wakefield, who launched the scare linking the measles, mumps and rubella (MMR) vaccine and autism a decade ago, has learnt to his cost the capriciousness of the celebrity culture of which he was once a beneficiary.
In June 2002 he was described as ‘a handsome, glossy-haired, charismatic hero to families of autistic children in this country and America’, in one of many fawning accounts (this one was in Britain’s Telegraph magazine). He was played as the ‘caring, listening doctor’ by Hugh Bonneville in the hagiographical TV docudrama Hear the Silence in December 2003. Yet by November 2004, Dr Wakefield was being pursued like a shady double-glazing salesman by investigative journalist Brian Deer in another TV programme, refusing to answer questions about alleged financial conflicts of interest and ethical violations in his research (the subject of continuing proceedings at the General Medical Council).
By the summer of 2007, Dr Wakefield found himself linked in the press to a settlement made by his former employer, the Royal Free Hospital, in relation to complications of a colonoscopy carried out by another doctor. He was also blamed for outbreaks of measles in 2006 and 2007, which were concentrated among Irish travellers and orthodox Jews, communities in which neither the mass media nor Dr Wakefield has much influence, and in which a low uptake of MMR long predates his notorious Lancet paper.
After briefly basking in the limelight, Wakefield is now cast into the gutter, scorned by those who once adored him. Once readily absolved by journalists of all responsibility for falling vaccine uptake, he now gets the blame for things over which he is not directly at fault.
That’s showbusiness – and the media is just as fickle in the way it treats its own. In 2002, Lorraine Fraser was garlanded as Health Reporter of the Year for her series of militantly anti-MMR articles in the Daily Telegraph. By the close of 2003, the climate had begun to change and the Guardian’s Ben Goldacre won the ‘best feature’ prize at the British Science Writers Awards for an article critical of Dr Wakefield and his anti-MMR campaign.
In the summer of 2007, Denis Campbell, newly promoted from the sports desk, wrote a routine anti-MMR feature for the Observer. This included all the familiar elements: the leak of an unpublished (and rapidly discredited) paper purporting to substantiate the anti-MMR case; the endorsement of a maverick scientist (soon revealed to be a close collaborator with Dr Wakefield and also on the expert witness payroll in the anti-MMR litigation); and a gushing interview with Dr Wakefield by a journalist with no relevant expertise or experience. Yet, whereas a few years earlier such a feature might have put this young journalist in with the chance of an award, now it provoked a storm of complaint, threatening not only his job but also that of his editor.
Now that the scare is receding into history and the rates of vaccine uptake are slowly recovering, it is a good time to reflect on the role of the media in the MMR debacle. Tammy Boyce, researcher in media studies at Cardiff University, has conducted an intensive study of media coverage of the MMR controversy, focusing on a six-month period in 2002, when the campaign for the triple vaccine to be made available in its separate components was at its height, supported by continuing claims of evidence linking MMR and autism (fiercely contested by supporters of the child immunisation programme).
For her new book Health, Risk and News: The MMR Vaccine and the Media, Boyce has examined the content of newspaper, radio and television reports, consulted national audience surveys, conducted focus groups and interviewed key sources and journalists. The result is a comprehensive appraisal of the media’s role in a controversy in which it has often been accused – particularly by doctors – of irresponsibly undermining confidence in the child immunisation programme.
Dr Boyce readily acknowledges that the media had a major impact and that it tended to favour the anti-MMR cause: ‘The media coverage told parents not only what to think, but also how to think about the MMR vaccine, that the vaccine might be unsafe and science and governments could not be trusted.’ She found that the repeated association of MMR with autism and the promotion of single vaccines as a solution ‘resonated with the audience’. Though most parents ‘worried about their MMR decision’, they ‘trusted health professionals, friends and family more than the media’ and opted for the vaccine. Some either modified their decision (delaying or going for single vaccines) while others decided not to vaccinate their children.
Dr Boyce asks a number of important questions, notably – why was media coverage so sympathetic to the campaigners against MMR? Why did those supporting MMR appear relatively ineffectual?
She shows how the journalistic commitment to balance, from telling both sides of the story, to presenting a controversy in terms of a contest between two positions of more or less equivalent substance, did not serve the public well over MMR. As she observes, this sort of ritualised balance is ‘not always the most effective or honest way of reporting a story’. Thus an objective account of the MMR controversy ‘would not have been balanced, because, in reality, the evidence was not balanced’. An objective account would have been obliged to indicate that, on the one hand, there was a vast amount of evidence confirming the safety and efficacy of the MMR vaccine, while on the other, there was much speculation, but very little evidence (and that highly contested), for the MMR-autism link. Dr Boyce found much ‘over-balancing’ of stories, giving the misleading impression of an equivalence of evidence, and creating ‘a charade of objectivity’. She also found ‘under-balancing’, where partisan journalists simply reported one side of the story.
There was a similar problem of balancing sources. Journalists and newspapers sympathetic to the Wakefield cause tended to quote anti-MMR scientists and health professionals, though these were a tiny minority, either exclusively or on equal terms to pro-MMR experts. Furthermore anti-MMR reporters often counterposed pro-MMR experts to parents who blamed MMR for making their children autistic, confusing expertise and experience, and elevating emotion over reason in their presentation of the debate.
Dr Wakefield and his supporters have often claimed that he is a victim of a conspiracy uniting the medical establishment, Big Pharma (the vaccine manufacturers) and the government. An irony that emerges from Dr Boyce’s study is that if there was any conspiracy over MMR, it was on the side of the anti-MMR campaign. Dr Wakefield collaborated with lawyers and parent campaigners, cultivated contacts with compliant (and scientifically naive) journalists and was advised by a leading PR firm. Meanwhile supporters of MMR, fragmented and lacking any coherent media strategy, were always in the position of reacting to the latest initiative from the Wakefield campaign. Medical authorities were inclined to leave matters to the Department of Health, but, put on the defensive in face of mounting public distrust and wary of further encouraging parental anxieties over MMR, government officials were inclined to keep a low profile.
The Royal College of General Practitioners had one official spokesman on immunisation matters, but also offered to put journalists in touch with the handful of anti-MMR GPs who were profitably engaged in selling single vaccines. It also advised journalists to contact their own GPs for information about MMR. This desultory response to a major threat to the child immunisation programme – one of the great achievements of public health and primary care in postwar Britain – was typical of the medical establishment.
In addition to its powerful friends in the media, the anti-MMR cause was supported by a number of parent-led groups, such as the anti-vaccination campaign JABS, Allergy Induced Autism, and prominent autism activists such as Paul Shattock and Jonathan Tommey. It also benefitted from celebrity endorsement by the likes of Nick Hornby and Juliet Stephenson. By contrast, as Dr Boyce notes, ‘there were no pro-MMR pressure groups’. Given the damage caused to families affected by autism by the spurious link with MMR – particularly to those drawn into the litigation – it was unfortunate that the National Autistic Society, the country’s leading autism organisation, played what Boyce characterises as a ‘fairly ambiguous’ role in the controversy. While maintaining an official line upholding the safety of MMR, the organisation’s press officer endorsed the anti-MMR campaign for single vaccines.
Dr Boyce shows how the politicisation of the MMR controversy in the wake of the BSE scandal had a major influence on media coverage. This was to the detriment of public discussion about science (not least because the MMR issue was rapidly passed over to reporters without any expertise in matters of science or health) and, ultimately, to the detriment of public health. There is much to be learned from the MMR story, by doctors and scientists, journalists and politicians, and also, Dr Boyce insists, by parents, who, though sceptical of professional authority, remain resistant to adopting the role of active consumer in matters of health which is being increasingly thrust upon them by government.
Dr Michael Fitzpatrick is author of MMR and Autism: What Parents Need to Know (buy this book from Amazon(UK)) and The Tyranny of Health: Doctors and the Regulation of Lifestyle (buy this book from Amazon(UK)).
Health, Risk and News: The MMR Vaccine and the Media, by Tammy Boyce is published by Peter Lang. (Buy this book from Amazon(UK).)
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