Reviews

MMR: the onslaught continues

   The controversy surrounding the measles, mumps, and rubella (MMR) vaccine continues to smoulder and every now and then someone stokes the fire. This time it is "top Mail writer" Melanie Phillips in a much hyped series of three articles in the Daily Mail under the banner "MMR: the truth" (11, 12, and 13 March).

Despite a three month globe-trotting investigation, Phillips, a seasoned polemicist, presents nothing new; she simply follows the usual pattern of conspiracy theory. For example, she claims that Professor John O'Leary, a pathologist at Trinity College Dublin, was gagged after announcing that the measles virus he had found in the guts of children with autism was the same strain as that used in the MMR vaccine. And she refers to more "potentially explosive" about-to-be-published research from gastroenterologist Andrew Wakefield"the doctor at the heart of the MMR furore"which it is claimed will show that he is right and that the rest of the world is wrong.

Phillips' articles, billed as a "major new series," follow the special MMR theme issue published last year by the satirical magazine Private Eye, which also appeared to have taken on board unthinkingly all that Andrew Wakefield has said, and lacked any scientific underpinning (BMJ 2002;324:1224)[Free Full Text].

In a similar fashion to the Private Eye "exposé," Phillips consistently describes the experts in the "anti-MMR camp" in glowing terms, such as "eminent," "renowned," and "foremost." However, she is less liberal with her superlatives in describing the "pro-MMR" experts.

She describes Wakefield as an outcast and an enemy (of the scientific community and the government), who believes himself to be on the brink of vindication. Unfortunately, appealing to the public through a writer like Melanie Phillips, rather than by subjecting his findings to the usual scientific peer review process, will only cause further anxiety and concern for parents and do nothing to win the hearts and minds of the scientists.

Phillips makes much of the conflicting interests of various experts. She rightly points out that vaccine manufacturers have employed some "pro-MMR experts" as advisers or have funded them in their research. But surely it is reassuring to know that the companies seek advice from people who know what they are talking about? Authors in most mainstream journals, including the BMJ, are required to declare any potential conflicting interests; if they sit on government committees discussing vaccines, they do not take part in discussions that may conflict with these interests.

However, Phillips does not point out that Andrew Wakefield and other players are acting for the parents in an upcoming court case over MMR and so could be said to have vested interests. Just as we ought not to ascribe venal motives to the parents of autistic children who would stand to receive compensation if their lawsuit succeeds, so we should not accuse researchers of bias because vaccine manufacturers fund their research. If everyone with an "interest" were to be removed from the debate there would be no one left with any knowledge of the subject.

View larger version (121K): [in this window] [in a new window]   "MMR: the truth" presents nothing new

Phillips rubbishes epidemiological studies, even though such studies have been the tools used in many major medical discoveries, such as the link between smoking and lung cancer. The reviews she quotes have quite correctly concluded that the evidence does not support a link between autism and MMR, but it can never rule out the possibility that the occasional case is associated with the vaccine. Phillips interprets this as distortion, which demonstrates her lack of understanding of one of the fundamental tenets of epidemiological researchthat one can never totally prove a negative. However, she refers to an "epidemic of autism." If there is one, then epidemiological studies should have no problem in picking up a major factor in its causation.

In place of epidemiological studies, Phillips calls for clinical studies, involving talking to parents and examining individual children. Why this should be better is unclear and reveals a lack of understanding that one always has to compare affected children with those who are unaffected. Without this, there can be no useful progress and, more likely, there is a serious risk of drawing the wrong conclusions, as was the case with the whooping cough vaccine.

The Daily Mail's series of articles will serve only to worry parents further. Researchers, and those who report their work, must consider the effect that anything they say may have, especially when it comes to the health of children. This responsibility should not be taken lightly.

Footnotes

Both authors have received funding from vaccine manufacturers as well as other sources to attend educational meetings and conduct research.

Another review of the Mail articles can be found at www.spiked-online.com/Articles/00000006DCD6.htm

Institute of Child Health, London

David Elliman, consultant in community child health. 

St George's Hospital, London