Giving space to Andrew Wakefield on MMR isn't balance, it's lunacy

The Independent should not have run the discredited doctor's claims on its front page today, says Martin Robbins.

The photograph below is all that the majority of parents with young children will see of the Independent today, waiting in supermarket queues or flicking through magazine racks. The front page quotes a doctor – never mind that he was struck off in order to protect patients – saying he was right about the MMR-autism scare. And so the zombie controversy rises from the dead again.

There are three realities that need to be addressed here right at the start. First, the MMR vaccine is safe, many tens of millions of doses have been administered worldwide, the data show no link between MMR and autism. As with any medicine there are occasional side effects, in some cases these might be serious, but the benefits far outweigh the slight risks.

Second, single vaccines are less safe than MMR. They are less convenient, leading to poor uptake and more children being unprotected for longer; and they have had far less testing.  If the NHS were to start touting single vaccines as an alternative then not only would it have a negative impact on public health, it would be taken as evidence that the problem was real, potentially leading to a catastrophic loss of public confidence in vaccines (remember Tony Blair’s role in all of this).

Third, Andrew Wakefield is about as discredited as it is possible for a doctor to get. He was found to have ordered invasive investigations on children without either the qualifications or authority to do so. He conducted research on nine children without Ethics Committee approval. He mismanaged funds, and accepted tens of thousands of pounds from lawyers attempting to discredit the MMR vaccine, being found by the GMC to have intentionally misled the Legal Aid Board in the process.  He was not just dishonest, unprofessional and dangerous; his contempt for the rules and regulations that safeguard children in research projects was vile.

Wakefield’s research was unconvincing at the time and swiftly refuted, yet the ‘controversy’ over MMR has raged for years, fuelled almost entirely by credulous idiots in the media.

As Ben Goldacre wrote almost three years ago:

“The media repeatedly reported the concerns of this one man, generally without giving methodological details of the research, either because they found it too complicated, inexplicably, or because to do so would have undermined their story. As the years passed by, media coverage deteriorated further. Claims by researchers who never published scientific papers to back up their claims were reported in the newspapers as important new scientific breakthroughs while, at the same time, evidence showing no link between MMR and autism, reviewed academic journals, was simply ignored. This was cynical and unforgivable.”

And yet, three years after Wakefield was struck off and the Telegraph’s best journalist, Tom Chivers, wrote “so, farewell then, Dr Andrew Wakefield”, here we are again with Britain’s most dangerous doctor since Harold Shipman given pride of place on the Independent’s front page.

The villain, now firmly at the heart of America’s quack autism-cure industry, has come to gloat even as 60 measles-afflicted children are sent to hospital beds in Swansea.

What impression does the Independent website give of the MMR ‘controversy’?

On Twitter, the Independent's health writer Jeremy Laurance has spent the day demanding that critics read the whole piece. “Jeeezus!”, he responded to Ben Goldacre and others at one point, “U have NOT read the story.” What Laurance fails to understand is that few people ever do read the whole story. Any competent journalist understands that people tend to grab the information at the top, and don’t always stick around until the end of the piece. 

And besides, it’s not just the headline. Laurance’s article continues to put Wakefield’s point of view for a further 14 paragraphs, before giving over barely half that space to one contrary voice, addressing only a fraction of the points made. It would be a great example of the false balance inherent in ‘he-said, she-said’ reporting, except that it isn’t even balanced – Laurance provides a generous abundance of space for Wakefield to get his claims and conspiracy theories across, and appends a brief response from a real scientist at the end. 

The Independent’s deputy editor, Archie Bland, protests that ‘it’s not as if we give [Wakefield] unqualified airtime’. Well no, but few disclaimers – calling him ‘discredited’ for example - do not address this problem of giving Wakefield a big national platform in the first place.  As Dave Jones puts it, “why do the media give a lone, discredited voice in the darkness an equal platform as the whole body of scientific evidence? Is that balance?”

On top of this, Wakefield gets his own entire article, a further 12 paragraphs apparently copied verbatim from a days-old press release, linked to prominently on the Indie’s homepage. This isn’t health journalism, it’s simple, unadulterated PR.

Earlier, Ben Goldacre asked Laurance the following on Twitter: “How on earth can the Independent justify running 12 paragraphs today on MMR by Wakefield himself?” Laurance replied, “So what do u suggest? That we ignore him and let him go on spreading poison? Or answer him, point by point, as we have done?”

There’s a difference though, isn’t there, between ‘not ignoring’ someone, and putting their opinions on the front page of a national newspaper; just as there is a difference between answering somebody’s claims, and republishing them verbatim on page 5 of the same national newspaper.

Jeremy Laurance has a history of reacting badly to the idea that health and science journalists deserve scrutiny. What he doesn’t seem to grasp is that this is not an abstract public health debate between a few angry people on Twitter - he, and journalists like him, are putting the lives of real children at risk, their clumsy reporting stoking unwarranted fears about a safe vaccine.

Andrew Wakefield and supporters in 2010. Photo: Getty

Martin Robbins is a Berkshire-based researcher and science writer. He writes about science, pseudoscience and evidence-based politics. Follow him on Twitter as @mjrobbins.

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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear