Editor in the eye of a stormBMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7438.528 (Published 26 February 2004) Cite this as: BMJ 2004;328:528
Is the editor of a medical journal responsible for the way its contents are reported, and the quality of the ensuing debate, as well as the accuracy of the material itself? It is a question that Dr Richard Horton, editor of the Lancet, and one of the figures in the eye of this week's media storm over the MMR (measles, mumps, and rubella) vaccine, has answered unequivocally in the past.
In an essay entitled “Vaccine Myths”—included in his book Doctors, Diseases and Decisions in Modern Medicine, which was published last year (reviewed BMJ 2003;327: 399)—Dr Horton recounted the events that followed the Lancet's publication of Dr Andrew Wakefield's 1998 study that sparked the suggestion of a link between MMR and autism. He says: “Although I knew this paper would be controversial, I did not expect the level of vituperative attack and personal rebuke that followed. I was terribly and, looking back now, embarrassingly naive. I should have met with the Royal Free team before they held their press conference. I should have at least tried to persuade Andrew Wakefield not to recommend splitting the vaccine. [It was at the press conference that Wakefield said that parents should be given the choice of single vaccines, rather than just the MMR.]
“All in all, my attitude was far too laissez faire. If this is what critics meant—and still mean—by reckless, then I am guilty of that charge. I failed to do enough to manage the media reaction to this work. Until the Wakefield paper, I had not seen this media management role as one for a scientific medical journal editor. I now see it as one of my main responsibilities.”
Observers must wonder how that opinion has fared in the light of this week's events.
Last Friday BBC Online quoted Dr Horton saying that with hindsight the Lancet would not have published the paper. “There were fatal conflicts of interest in this paper. In my view, if we had known the conflict of interest Dr Wakefield had in this work I think that would have strongly affected the peer reviewers about the credibility of this work and in my judgment it would have been rejected.”
He also said: “As the father of a three year old who has had the MMR, I regret hugely the adverse impact this paper has had.” But he added: “Professionally, I don't regret it. The Lancet must raise new ideas.”
These statements followed a meeting at the London office of the public relations company Bell Pottinger on Wednesday, attended by the firm's executive Abel Hadden, Dr Wakefield, and three members of Sunday Times staff. The meeting was apparently to discuss material uncovered by Brian Deer, a freelance investigative journalist, working for the Sunday Times. Abel Hadden told the BMJ that he had arranged the meeting at which he was representing Visceral, a medical research charity for intestinal diseases, established in 2000, of which Andrew Wakefield is chief medical scientist.
“Professionally, I don't regret it”—Richard Horton
The allegations raised by Brian Deer's investigation—published in last weekend's Sunday Times and widely followed up in print and broadcast media—concerned the ethics of Wakefield's research study and claimed a failure to disclose a conflict of interest. It revealed that Wakefield was paid £55 000 ($102 690; €81 817) by the Legal Aid Board to investigate children who were allegedly vaccine-damaged for a possible legal action by their parents. A press statement from the Lancet, issued the Thursday before Deer's article was published and making no mention of the Sunday Times, expressed “regret” that this funding was not disclosed. The Lancet said it would “pursue a course of full disclosure and transparency” and publish a response to all the allegations.
In addition to the two page investigation by Brian Deer, the Sunday Times also carried an opinion piece by Dr Evan Harris, Liberal Democrat member of the Commons science and technology committee calling for an independent inquiry into the way the research was carried out. Dr Harris, a member of the BMA's ethics committee, said something similar to the Kennedy inquiry into the deaths of babies at Bristol Royal Infirmary was required.
The controversy over MMR has been one that has played out in the media all along; in the past week it has almost come to a head. However, instead of breaking down battle lines between some sections of the media and the Wakefield camp on the one hand, and the medical and scientific community and the government on the other, positions seem only to have become further entrenched. That most staunch defender of Dr Wakefield, the Daily Mail, claimed on Monday that he had been the victim of a smear campaign. By Tuesday the paper suggested that parents had been betrayed by the whole affair. Instead of Andrew Wakefield himself in the media firing line, it is the Lancet that has found itself under scrutiny. Perhaps it was in a bid to forestall this that the Lancet went public over the whole affair last week in advance of the Sunday Times story, thus angering Brian Deer.
On Tuesday Dr Horton told the BMJ that the UK needed an independent body to investigate the conduct of research. But he added that authors had a duty to reveal the context of their work and potential conflicts of interest. “The whole system depends on trust and honour,” he said.
And the duty of medical editors? “To report new thinking and make sure that the context is responsible.”