Sunday, July 15, 2007

Another Day of Shame for UK Media on Topic of MMR and Autism

Faustus and the Devil Meet
It's St. Swithin's Day. According to folklore in the UK, if it rains today then it will rain for the next 40 days. It is a little known fact (in fact, known nowhere outside the confines of my imagination) that last Sunday was St. Maximilian Kolbe and Blessed Titus Brandsma Day: once The Observer had published those notorious pieces, it guaranteed abysmal coverage of the issue for the next 100 days.

The Observer publishes some of the many letters that they received, including one apiece from Prof. Baron-Cohen and Prof. Bustin. Baron-Cohen:
[Your] article linked MMR and autism.

The research does not...

The best estimate of the prevalence of autism is the 1 per cent figure published in the Lancet in 2006.

My view is that any apparent rise is likely to be driven by better recognition, greater awareness, growth in services, a widening of the definition of autism and a shift towards viewing it as a spectrum rather than a categorical condition.
Bustin (see Fitzpatrick for a summary of Bustin's devastating testimony):
Remarkably, there is no reference in your story to the fact that on 11 June the first of 4,800 cases in autism proceedings came to trial at the United States Court of Federal Claims in Washington. These are designed to establish whether or not autism can be caused by MMR. For the first time, a succession of highly respected researchers in epidemiology, genetics, virology, molecular biology and other medical and scientific disciplines - the 'medical and scientific establishment' of the Observer article - provided detailed evidence of why, in their opinion, there is no medical or scientific basis for any claim linking the MMR vaccine with autism.
You might have thought that the interventions from these two luminaries might have made it into the Readers' Editor response to the letters and the result of his investigations into the story. The short piece is riddled with self-exoneration. The Head of News says:
'I believe it was legitimate to include the thoughts of two of the authors of the study. We didn't conflate the two issues; the issues are already conflated.

'We worked hard to give a non-incendiary, balanced view. I believe we had to give the readers all the information we had. After all, they would ask, "Could MMR be a factor?"
Sins of omission and commission abound. They seem unrepentant about publishing the inflammatory 1 in 58 figure but grudgingly acknowledge that perhaps they might have included the other figures that were less disturbing and more inline with current estimates (I know, amongst many much-needed corrections, they didn't touch the issue of it being a tool that may generate a 50% rate of false positives which may be acceptable if it has good specificity). It doesn't seem to disturb them that their conclusions are at considerable variance with the contents of of a report about that screening tool (pdf) from Baron-Cohen's research centre (HT to correspondent who sent me this link). The concluding sentiment and sentence are breathtaking for their complete lack of any awareness of the issues that fuelled the strong response of so many readers plus the introduction of a novel definition of accurate.
And the central point, in my view, is that the leaked story of the apparent rise in the prevalence of autism was a perfectly legitimate and accurate story in its own right, which did not need the introduction of the MMR theory.
Oh misery me! Omnes plecum plangite! However, if the Guardian/Observer offered a completely inadequate apologia pro ephermeris sua (HT Kristina Chew) then The Independent is just vox stulti. They offer yet more publicity for the Fletcher family who are caught up in an MMR action against the UK Government (also recently featured in the Daily Mail) and are stalwart supporters of Dr Andrew Wakefield. That is probably understandable and gives the sort of dramatic colour that newspapers favour. It is the coverage of the 'factual information' that is peculiarly irritating.
"There is now overwhelming evidence that MMR does not cause autism," says the DoH in its official guidance and almost every medic and scientist in the country agrees, at least in public. Tomorrow, the one doctor who has been prepared to challenge this universal wisdom will appear before a disciplinary hearing which may lead to his being struck off.

It is nine years since Dr Andrew Wakefield raised doubts about MMR, suggesting it may be linked to bowel disease and – by extension – autism. His paper in The Lancet medical journal – and the media firestorm that followed – triggered one of the great public-health scares of modern times. Who should parents believe? The experts and officials who insisted Dr Wakefield was scaremongering? Or the lone doctor who said the needle might destroy their baby's chance of a healthy life?
The sympathies of the writer seem to surface in the juxtaposition of the acknowledgement that MMR uptake declined with some claims that don't make sense as written (could be bad editing):
Alarmed health experts have warned many times that a deadly measles epidemic may follow. It never has and relentless government information campaigns have slowly regained the trust of some parents. And questions have been asked about Dr Wakefield's methods and his motives. Critics say he is a peddler of bad medicine and hope that the fears he has raised will now be killed off once and for all.
It look like the writer claims that health experts indulged in shroud waving but they have the money to fund information campaigns so some parents trust them because their opinion has been bought; there is no possibility that the parents have been reassured by some decent science arguments? The "peddler of bad medicine" is not a useful way of describing all of the issues involved and I haven't seen any criticisms expressed in that way. By the by, from the paucity of information about Profs Walker-Smith and Murch, either they are keeping a strategically low profile or they lack the money to hire Wakefield's remarkably effective PR team.

Just in case there hasn't been enough dis-information based on the leaked report and that infamous 1 in 58 estimate, The Independent thinks that we need to see it being inappropriately quoted yet again.
The number of autistic children is far higher than previously thought, it emerged last week. One child in 58 may have a related condition, believe researchers at Cambridge University. The previously accepted figure was one in 100. Professor Simon Baron Cohen of the Autism Research Centre, whose team discovered the high rate, does not believe it is due to the jab. "Evidence does not support the idea that the MMR causes autism," he says. The causes are a mystery, but many believe the neurological condition is genetic and the rise in cases is a result of better and wider diagnosis.
No, no, no. The 1 in 58 does not supplant the 1 in 100 estimate but Baron-Cohen doesn't get to rebut that in situ here which just makes this coverage even worse. It looks as if his reference to "the rise in cases" is tacitly accepting the 1 in 58.

The remainder of the piece is just as irritating.
"If Wakefield is struck off," says John Fletcher, "it will discourage any doctor from asking questions about the safety of vaccines and it will leave the policy making to the government and the pharmaceutical industry. Parents who complain will be disregarded, and the research on better treatment for these children will stop. That is unthinkable."
Unlikely. Wakefield, Walker-Smith and Murch are not embroiled in GMC Hearings because they questioned vaccine safety but because of assorted charges relating to serious ethical irregularities and dishonesty. There are many research projects on the topic of improving education and quality of life for children with autistic spectrum disorders.
Government arguments for MMR have always been based on civic responsibility: the jab is the best way to protect society. Yes, there is a "very, very small risk" of some kind of reaction, as one expert put it last week, but that is the case with all vaccines. However, parents act primarily on behalf of their child, not society. For those who visualise a doctor hovering over their baby with a needle, the words "very, very small" can sound like a whisper, and the word "risk" like a warning shout.
MMR: The Facts does make a hidden reference to civic responsibility but it is 1 point in a list of 10 that does include benefits for the individual child (albeit this could be a better list). The fact that we are all given to irrational fears is not a terribly good reason for acting in accordance with them. I think that it is a tad disingenuous of The Independent to affect ignorance that they and other MSM have disseminated so much information that it feeds this irrationality. A few months ago, Orac was discussing Wakefield's financial benefits from involvement in the MMR litigation in the UK. There is a remarkable comment from a parent in the UK:
...deciding to go with MMR, and taking my son to be vaccinated was still one of the most terrifying things I have ever done. I think there is little that is more horrifying to a parent than the idea that your own actions could directly and irreperably harm your child. I am a rational individual, and a strong proponent of the scientific method, and all that I had read on this subject could still not completely eradicate that fear.
The preponderance of coverage of vaccination issues has resulted in some parents feeling that a routine medical procedure is "terrifying" and the MSM (amongst others) shares responsibility for that.

I'll mention the Mail on Sunday farrago of pseudoscience, pseudoepidemiology and, well, generally, pseuds but I refuse to discuss its version of The truth about MMR because I will lose my will to live. I do recommend: Dr Michael Fitzpatrick MMR and Autism: what parents need to know; Arthur Allen Vaccine; Dr Paul Offit The Cutter Incident: How America's First Polio Vaccine Led to the Growing Vaccine Crisis; for an easy web reference, I like the Science Museum's straightforward coverage in the MMR Files although it could stand some updating.

The belief in a link between MMR-vaccines-mercury-autism has cultish overtones. Most religions have an act of contrition. UK media collectively need to make an act of contrition and perform an act of reparation. The latter, of course, should take the form of some informed coverage. I would nominate Ben Goldacre (who is uncharacteristically/ominously quiet at present) but then what would somebody who is medically qualified and known for promoting the public understanding of science (awards and everything) have to add to this discussion? In the absence of such reparations, I would be grateful for suggestions for penances that are rather more colourful and a touch mediaeval. After all, we needn't be superstitious about events on St. Maximilian Kolbe and Blessed Titus Brandsma Day.

Thanks to Wellcome for use of this open access image.

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Blogger Jon said...

re. developing treatments for and/or ways to support people with autistic spectrum disorders - I'd argue that the anti-vaccination movement have done a lot of damage. There are links between this movement ('Evidence of Harm', etc.) and those advocating unjustified and/or dangerous autism 'treatments' like secretin, chelation and autism (ironically, often using pharmaceutical products to do this).

The very last thing that's needed is more poor quality 'research' into daft autism 'treatments'.

6:25 pm  
Blogger kristina said...

Perhaps it might be better to refer to these papers as vox stultissimi!

7:40 pm  
Blogger Shinga said...

I would like to think that they are stultissimi, Kristina but I fear that more is to come and greater depths are to be plumbed during the estimated 3 months of these hearings!

9:12 pm  
Blogger Shinga said...

Absolutely, Jon. The corollary of "something must be done" is not "Oh here, this sounds OK because it's more important to be seen to doing something than to concern onself with the scientific plausibility">

9:13 pm  
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