MMR: Science & Fiction

by Richard Horton

The publication of Andrew Wakefield's work in The Lancet in 1998 inadvertently triggered a collapse of public confidence in the MMR vaccine. Six years into this health crisis, a key and much disputed part of the report was retracted. Now The Lancet's editor, Dr Richard Horton, considers the implications of this affair. Horton is an advocate of the MMR (his own child has had the triple vaccine) and here he gives an insider's account of the events surrounding this controversy. He reviews the history of the MMR vaccine and the claims about its safety, discussing why we consistently fail to debate controversial science rationally. He analyses the malign influence of financial conflicts of interest in medical research today and looks at what might be done to improve our present understanding of autism. He examines prospects for completely eradicating measles from the world, a disease which kills 700 000 children each year. Finally, he considers how a damaging episode such as this might be prevented in the future - a message that politicians, public health officials, scientists, and the media need to engage with if we are to protect the health of those unable to speak for themselves - our children. The royalties from this book will be donated to charities representing autism and child health.

160 pages, Paperback

First published September 30, 2004

Reviews

[Nicholas Whyte]

http://nhw.livejournal.com/950854.html[return][return]Richard Horton is the editor of the Lancet, which published the 1998 study by Andrew Wakefield linking autism with the MMR vaccine. No other credible evidence has been found for the link, and Wakefield's failure to disclose his personal conflicts of interest caused Horton and the Lancet to retract the relevant research in 2004 (Wakefield remains defiant).[return][return]Horton presents the book as "something of a personal exorcism"; he attempts to use the MMR affair as a lens through which to examine justice, truth and the public perception of science. I don't think he completely succeeds, and it was rather ambitious of him to try in 170 pages knocked off in four months. He has a couple of policy recommendations for diverting and channeling public discourse around health research into safer channels, which I think are wholly unrealistic. He calls for science to develop its public image, and to engage more professionally with journalists, and here I think he is on surer ground: indeed, dealing with the media and the public ought to be a basic point of training for any researcher today (though I think Horton is monstrously unfair in casually discounting the contributions of Robert Winston and Richard Dawkins).[return][return]He has a fascinating chapter on the extent of state funding for research on autism in the USA. A few weeks ago, Anne and I were gripped by The Stackhouse Filibuster, the 2001 West Wing episode where a senator forces Congress and the President to approve the creation of "five centers of excellence in universities around the country to help scientists coordinate their research, three special units for autism epidemiology at the CDC, and a centralized facility for gene and brain banking" - I was astonished to discover from Horton's book that this is more or less what was actually legislated in the Children's Health Act in 2000; though I guess in real life less heavy-handed methods were used to get the bill passed. Apparently autism research in the UK is way underfunded by comparison, and I would not be astonished to find that the rest of Europe is in the same place. I would have to say that, as far as we can tell anecdotally, Belgium's care provisions for children with autism and their families are way ahead of Britain's.[return][return]Pulling back the focus a bit, I was interested by Horton's more philosophical discussion of how truth is established, and struck by the contrast with my own field of work, which is also the subject of academic research but where the truths that matter operationally, in terms of deciding what political decisions are made, are determined not by academe but by professionals elsewhere. Science doesn't seem to recognise a distinction between practitioners and policy-makers, or at least the dynamic is wholly different. If I ever take some time off to look further into the concept of epistemic communities, this is a contrast that will bear further investigation.[return][return]I was, however, disappointed by Horton's reluctance to make the obvious moral judgements about Wakefield, or to defend his own unwillingness to do so. His book concludes:[return][return]"Wakefield was guilty of na