Most people have heard of Andrew Wakefield, the doctor from the Royal Free Hospital in London whose research on children with bowel disease and autism triggered the MMR scare.
Fewer will know of Richard Horton, the editor of The Lancet, which published the infamous paper in 1998. For six years Horton has been in the eye of the storm as the controversy has raged around him. Now he has published a book, MMR: Science and Fiction, containing his reflections on these troubling events.
It is a gripping read. Having endured a storm of criticism over his decision to publish the paper in 1998 (many held it was flawed from the start), Horton suffered the embarrassment of being forced into a retraction in February this year after new information came to light.
It emerged that Wakefield had been paid by the Legal Aid Board to conduct a pilot study on behalf of parents of allegedly MMR vaccine-damaged children, which he had not disclosed to his co-researchers. This created a conflict of interest that could have influenced his results. Horton describes his emotions as he was besieged by journalists for a comment on the retraction. "I felt a coil of suppressed frustration unwinding within me, having been pressed into a position of extraordinary tension during the preceding six years."
Critics will say his relief reflected the fact that he had been let off the hook. The MMR paper had arguably done more damage than anything published in a scientific journal in living memory. In TV interviews, Horton said that Wakefield's work was "fatally flawed" and if he had known then what he knew now, he would never have published it. His own three-year-old-daughter, he added, had had MMR.
But although highly critical of Wakefield, Horton was even more disturbed by the way he was pilloried. One senior protagonist in the affair declared his intention to "rub out" Wakefield and another, sipping red wine, boasted he was "drinking his blood".
Horton says the affair reveals a society "unable to come to terms with dissent", and calls it a "crisis of rationality" in which we have lost the ability to resolve disputes reasonably. And the GP and author Michael Fitzpatrick expressed the puzzlement of many when he observed that the really surprising feature of the scare was not how it started, but how it was sustained for so long in the face of overwhelming evidence that it was unfounded.
"Intelligent people chose to reject mainstream science and listen to far less authoritative sources," he said. Why? And what can be done to tackle future scares?
Horton's answer is to establish a National Association of Science and Health that would arbitrate in scientific disputes. "Only an independent body such as this would provide the trustworthy space to debate and judge conflicting evidence concerning mobile phones, water fluoridation, GM foods, animal experimentation, BSE and CJD, Sars, stem-cell research, global warming, nuclear power, public health preparations for weapons of mass destruction, animal to human transplants, gene therapy and the links between cancer, radon and housing design."
Reading that list, you see the force of his call for some institution that could offer an authoritative judgement. The Institute of Medicine in the US fulfils something like this role. It has an eminent membership and wields huge influence. There is no UK equivalent. But when Horton put his proposal to the chief medical and scientific officers, there was little enthusiasm. The Government wanted to cut quangos, not create them, he was told.
So future scares look likely to be fought, as before, in the press, on the airwaves and in the doctor's surgery. It does not seem a satisfactory way to settle matters of life and death.Reuse content