BMJ  2005;331:1148 (12 November), doi:10.1136/bmj.331.7525.1148

reviews

Press

Why can't the Daily Mail eat humble pie over MMR?

The recent publication of a Cochrane systematic review concluding that there is "no credible evidence" of a link between the measles, mumps, and rubella (MMR) vaccine and either inflammatory bowel disease or autism provoked demands that the British tabloid newspaper the Daily Mail apologise for its role in promoting the MMR-autism scare (http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004407/frame.html). Instead, on 31 October, the paper published a feature by leading columnist Melanie Phillips insisting that claims that MMR was safe were "a load of old baloney" (www.melaniephillips.com). Phillips proclaimed that, far from having received the "all-clear," the "MMR scandal" was "getting worse."

The otherwise unanimous verdict of the media was that the Cochrane review—following a series of studies coming to the same conclusion—confirmed that the scare launched following the now notorious Andrew Wakefield Lancet paper in 1998 was finally over ( Lancet 1998;351: 637[CrossRef][ISI][Medline]). Phillips's defiant article stands as a symbol of the woe-ful role of the media in the course of the MMR controversy.

It is true that the MMR-autism scare did not start in the press. Both a reputable London teaching hospital and a prestigious medical journal allowed the scare to start. Yet, once Wakefield decided to go public with his anti-MMR campaign, the media played a major part in promoting the scare. Phillips's response to the Cochrane study follows the familiar themes of numerous anti-MMR articles over the years, including several by Phillips herself.

Phillips's article is scientifically flawed. She seems to misunderstand the nature of a systematic review and to misinterpret any criticism of studies of MMR safety, or any expression of uncertainty about their conclusions, as a vindication of Wakefield's case. She echoes the mantra of anti-MMR campaigners that epidemiological methods are not suitable to discover an association between MMR and autism, when this is precisely the point of such methods. Indeed, this is why Wakefield explicitly invited epidemiological studies in his Lancet paper—only to repudiate this approach when one study after another failed to support his hypothesis.

In endorsing Wakefield's claims, Phillips ignores the overwhelming weight of scientific evidence to the contrary. She insists that his discovery of "autistic enterocolitis" has been replicated around the world and that "vaccine-strain" measles virus has been found in cerebrospinal fluid samples from autistic children, though she fails to mention that these few studies have been carried out by Wakefield or his collaborators and are universally dismissed by reputable authorities.

Two days after publication of her Daily Mail article, Phillips was criticised by doctor and columnist Ben Goldacre, in a piece in the Guardian newspaper. This week (8 November) the Guardian gave Phillips a right of reply, in which she defended the stance of her Mail article.

Phillips appears to be captivated by Wakefield's self professed status as a maverick and crusader against the establishment. His posture of martyrdom and victimhood seems to have a particular appeal for Phillips, whose polemical style provokes much animosity. The price of this self indulgence (Phillips is one of Britain's best paid journalists) is borne by the real victims of the MMR-autism fiasco. These are parents anxiously facing decisions about immunisation and parents of children with autism who carry an unwarranted burden of guilt over having had their children immunised.

Phillips is one of many journalists (by no means confined to the tabloids) who have endorsed the anti-MMR campaign. They have provided a voice for middle class anxieties about environmental threats and for the distrust of established sources of authority in science, medicine, and politics that have led some parents to reject MMR. Some journalists, writing as celebrity parents, have followed the principles of the "journalism of attachment" popularised in recent military conflicts. This requires a high level of emotional engagement but no specialist knowledge of the subject (specialist medical and scientific correspondents have generally rejected the MMR-autism link). Although autism has become fashionable in the media, a condition characterised by difficulties of communication remains uniquely terrifying to those who live by the word. For a profession renowned for its sociability, children for whom language and friendship are problematic are a source of potent fears.

British journalists have a poor record on MMR and, indeed, on autism

With a few notable exceptions—such as Brian Deer, whose work for the Sunday Times and Channel Four helped to discredit Wakefield's Lancet paper—British journalists have a poor record on MMR and, indeed, on autism. While certain journalists have lionised Wakefield, real scandals—such as the recent death of an autistic boy from Britain undergoing mercury chelation therapy in the United States, or the inadequacy of respite services revealed by the conviction of a 67 year old mother for killing her adult autistic son when she could no longer cope with his violent behaviour—have largely been ignored (www.spiked-online.com). If children die from measles, the MMR scandal may indeed get worse.

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London fitz{at}easynet.co.uk

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Competing interest: MF is the author of MMR and Autism: What Parents Need to Know (Routledge, 2004).

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