Intended for healthcare professionals

Rapid response to:

Feature Secrets of the MMR scare

The Lancet’s two days to bury bad news

BMJ 2011; 342 doi: (Published 18 January 2011) Cite this as: BMJ 2011;342:c7001

Rapid Response:

The BMJ’s version of events lacks diversity

Brian Deer, The Sunday Times and Channel Four's Dispatches should be
congratulated. The current BMJ editor is right to say that medicine needs
more investigative journalism, and to highlight the need for wider
vaccination against measles.

But several problems remain. The neutral observer might well ask how
the “good” investigative journalism of Mr Deer is to be reliably
distinguished from the "bad" of the Daily Mail, The Daily Telegraph and
Private Eye. Is it really just the detail, the lengths to which Mr Deer
went? I am not convinced that if Melanie Phillips (say) had spent the same
amount of time on the story, she would have ended up believing Andrew
Wakefield to have been fraudulent, or even deliberately dishonest.

Mr Deer himself seems to recognise the limits of his three BMJ
pieces. In a Press Gazette interview last year he indicated that there is
no real distinction between scientific journals, newspapers and magazines.
He stated in a Guardian Blog (12th January 2011) that the BMJ was part of
an "insidious cartel". What difference does it make, then, that his first
BMJ piece was "peer reviewed" by the usual anonymous process? Perhaps it
would have been more consistent of him to decline it.

The Lancet's Richard Horton is alleged to have acted from entirely
"medical establishment" motives. But in my view there are two significant
flaws in the Deer/BMJ account. First, it distorts and minimises the
history of the "autistic enterocolitis" construct, which developed from a
decade or more of speculative but "peer reviewed" research, and not merely
Wakefield's undisclosed legal action.

Second, it ignores the whole context in which the worldwide anti-
vaccinationist movement has grown. The British Medical Journal and the
Lancet have both played an important role in the current debate, following
Vioxx and other cases, about "industry" conflicts of interest and the
right balances between openness, promotional claims, and business

However, the BMJ has gone much further, even at the height of the MMR
scare in the UK, in promoting scepticism about the "inappropriate
domination of the Western view of mental health", a process in which
"doctors and the pharmaceutical industry" irresponsibly push both "Western
cultural ideas" and "a rapid growth in the numbers of children diagnosed
with conditions such as attention deficit hyperactivity disorder and
autism" (Timimi, BMJ, 2005).

Two days after Brian Deer's second article, a Blog piece entitled
"How to stop the medical arms race" by a former BMJ editor revealingly set
out the default position of the journal (Smith, BMJ, 13th January 2011):
selectively publish evidence that "technology" and "doctors" lead to worse outcomes,
not better. That Richard Smith's Blog piece was typically urbane and self-
deprecating might suggest that here, not in the Lancet, lie the really
established views.

The BMJ has also published many opinion pieces by the "No Free Lunch"
campaigner Des Spence which go further. For example: "big pharma use[s]
political lobbying to pervert the course of medical justice" (11th March
2009), and "A medicated childhood is blunt, defies reason, and is just bad
medicine." (21st July 2010).

Taken together, when some parents, journalists and politicians read
these opinions, in the light of their own experience of the indifference
by the "medical establishment" to neurodevelopmental disorders, it is not
very surprising that they prefer a different version of events: Andrew
Wakefield's continued fight against a vaccine industry which scored a
temporary victory during the fitness to practise panel's 45 days of
deliberating in secret (to use Brian Deer's preferred term, rather than
the GMC's euphemistic "in camera"). Today, searching the GMC site for
"Wakefield transcript" still turns up no results, despite the Editor's
claim two weeks ago that it had been published.

Finally, that an eminent "evidence-based medicine" expert such as
Trisha Greenhalgh inflames the situation further by repeating a comparison
of the MMR sceptics with "flat-earthers" (rapid response, 18th January),
only shows how remote the BMJ is perceived to be from the concerns of
ordinary patients, and the "front-line" staff who do not have the luxury
of engaging with non-MMR-sceptic families only.

If medical journals are really just newspapers with mystique, perhaps
it follows that a way out might be for medicine to become an honest trade
rather than a dodgy "profession". No doubt the size of the financial
transaction between the BMJ and Brian Deer was small; and it remains open
whether the journal's new policy of commercially encouraging "good"
investigative journalism at the expense of "bad", will have the desired
result in respect of the larger dragons of commercialised medicine, which
the BMJ appears to see as its destiny to slay.

Competing interests: I have consulted to The Priory Group within the last three years.

04 February 2011
Neil MacFarlane
Independent Consultant in Adult Developmental Psychiatry
17 Wimpole Street, London