| briandeer.com | MMR: THE LANCET FIASCO

Richard Horton glorifies Wakefield with no regrets over discredited MMR paper

This page is research from an investigation by Brian Deer for The Sunday Times of London and the UK's Channel 4 Television into a campaign linking the MMR children's vaccine with autism. | Go to part I: The Lancet scandal | Go to part II: The Wakefield factor

In a book, five years after he published a now-discredited paper by Andrew Wakefield, Lancet editor Richard Horton, explains why he was glad he did it. In this extract, he asks: "Creating the conditions for a resurgence of measles is bad medicine. Or is it?"

But I do not regret publishing the original Wakefield paper. Progress in medicine depends on the free expression of new ideas. In science, it was only this commitment to free expression that shook free the tight grip of religion on the way human beings understood their world. Sometimes the ideas proposed will be unpalatable. Nobody wanted to believe the existence of the first few cases of AIDS in the early 1980s. Nobody wanted to believe that bovine spongiform encephalopathy (BSE) would somehow jump species to cause variant Creutzfeldt-Jakob disease among humans. In that instance, it was the suppression of concerns about this possibility that led to massive public fear and anger when the first cases were confirmed. Whenever new ideas are reported, they must be subsequently tested to check their reproducibility and validity. Verification is the right test of new thinking, not censorship. Debate since publication of the Wakefield paper has established that his work opened up an important new field of science - the relation between the brain and the intestine in the etiology of autism.

There was also an unpleasant whiff or arrogance in this whole debate. Can the public not be trusted with a controversial hypothesis? Must people be protected from information judged too sensitive for their consumption by a scientific elite? The view that the public cannot interpret uncertainty indicates an old-fashioned paternalism at work. But one could argue that believing in unfettered open debate, while intellectually credible (that is, the public is entitled to know as much as possible), ignores the brutal realities of the disease. The fall in rates of MMR vaccination after publication of the Wakefield paper was striking, In the UK, MMR vaccine coverage in children over two years of age was above 90 percent in the pre-Wakefield era. One year later, rates had fallen to 87.6 percent, a small but significant drop. The rate had dropped still further, to 83.8 percent, by July 2002. Measles outbreaks occurred in poorly protected communities. Creating the conditions for a resurgence of measles is bad medicine. Or is it? Good medicine, by this definition, means forcing families to immunize their children with the MMR vaccine. Fortunately, we do not yet live in a police state where public health doctors dictate what we can do (exercise and eat fruit) and what we cannot (smoke and eat burgers), even if their advice is wise and reasonable. If one of the results of freedom of choice is an adverse outcome for the public’s health, that is a regrettable but necessary consequence of our democracy. The responsibility rests with public health experts to educate and to persuade with understanding and compassion - not to berate with anger and frustration. And medical journals are not instruments of the public healthy service. Medical journals are simply highly specialized newspapers. We publish what is new and newsworthy in medicine and we do our best to publish work that is true. But only time, sometimes a long time, will tell if we have chosen well...

I worked at the Royal Free from 1988 to 1990 and met him on many occasions. He is a committed, engaging, and charismatic clinician and scientist. He asks big questions about diseases - what are their ultimate causes? - and his ambition often brings quick and impressive results. But his findings sometimes have limited staying power, and are overturned or substantially modified by less iconoclastic colleagues. His reputation unfairly in tatters, Wakefield resigned from the Royal Free Hospital, realizing that he had no future there and that he would be virtually unemployable in the work that he wanted to do anywhere else in the UK. There were rumours, not denied, that he was put under pressure by university authorities to leave. His colleagues, once so eager to pursue their careers on his coattails, mostly abandoned him...

The MMR vaccine paper was published not because peer review indicated that the findings were true - peer review can never prove truth, only indicate acceptability to a few experts, as was indeed the case with Wakefield’s findings - but because the issue raised was so important for public health and so in need of urgent verification that not to publish with appropriate caveats would, in my view, have been an outrageous act of censorship.

Richard Horton, Second Opinion, Granta Books, 2003

Go to our MMR index | home |