Bad Science Part 11

Perhaps yes, when they visited Malyszewicz's laboratory, which had none of the accreditation which you would expect for any normal lab. On just one occasion the government's Inspector of Microbiology was permitted to inspect it. The report from this visit describes the Chemsol laboratory as 'a freestanding, single storey wooden building, approximately 6m x 2 x 2m in the back garden'. It was a garden shed. They go on to describe 'benching of a good household quality (not to microbiology laboratory standards'). It was a garden shed with kitchen fittings. in the back garden'. It was a garden shed. They go on to describe 'benching of a good household quality (not to microbiology laboratory standards'). It was a garden shed with kitchen fittings.

And we should also mention in pa.s.sing that Malyszewicz had a commercial interest: 'Worried about MRSA? The perfect gift for a friend or relative in hospital. Show them how much you care for their health by giving a Combact Antimicrobial Hospital Pack. Making sure they come out fighting fit.' It turned out that most of Chemsol's money came from selling disinfectants for MRSA, often with bizarre promotional material.

How did the papers respond to the concerns, raised by senior microbiologists all over the country, that this man was providing bogus results? In July 2004, two days after Malyszewicz allowed these two real microbiologists in to examine his garden shed, the Sunday Mirror Sunday Mirror wrote a long, vitriolic piece about them: 'Health Secretary John Reid was accused last night of trying to gag Britain's leading expert on the killer bug MRSA.' Britain's leading expert who has no microbiology qualifications, runs his operation from a shed in the garden, misp.r.o.nounces the names of common bacteria, and demonstrably doesn't understand the most basic aspects of microbiology. 'Dr Chris Malyszewicz has pioneered a new method of testing for levels of MRSA and other bacteria,' it went on. 'They asked me a lot of questions about my procedures and academic background,' said Dr Malyszewicz. 'It was an outrageous attempt to discredit and silence him,' said Tony Field, chairman of the national MRSA support group, who inevitably regarded Dr Malyszewicz as a hero, as did many who had suffered at the hands of this bacterium. wrote a long, vitriolic piece about them: 'Health Secretary John Reid was accused last night of trying to gag Britain's leading expert on the killer bug MRSA.' Britain's leading expert who has no microbiology qualifications, runs his operation from a shed in the garden, misp.r.o.nounces the names of common bacteria, and demonstrably doesn't understand the most basic aspects of microbiology. 'Dr Chris Malyszewicz has pioneered a new method of testing for levels of MRSA and other bacteria,' it went on. 'They asked me a lot of questions about my procedures and academic background,' said Dr Malyszewicz. 'It was an outrageous attempt to discredit and silence him,' said Tony Field, chairman of the national MRSA support group, who inevitably regarded Dr Malyszewicz as a hero, as did many who had suffered at the hands of this bacterium.

The accompanying editorial in the Sunday Mirror Sunday Mirror heroically managed to knit three all-time cla.s.sic bogus science stories together, into one stirring eulogy: heroically managed to knit three all-time cla.s.sic bogus science stories together, into one stirring eulogy: Whistle-blowers appear to bring out the very worst in this Government. Whistle-blowers appear to bring out the very worst in this Government. NO WAY TO TREAT A DEDICATED DOCTOR NO WAY TO TREAT A DEDICATED DOCTOR First, Frankenstein foods expert Arpad Puzstai felt Labour's wrath when he dared to raise the alarm over genetically-modified crops. Then Dr Andrew Wakefield suffered the same fate when he suggested a link between the single-jab MMR vaccine and autism. Now it's the turn of Dr Chris Malyszewicz, who has publicly exposed alarmingly high rates of the killer bug MRSA in NHS hospitals. First, Frankenstein foods expert Arpad Puzstai felt Labour's wrath when he dared to raise the alarm over genetically-modified crops. Then Dr Andrew Wakefield suffered the same fate when he suggested a link between the single-jab MMR vaccine and autism. Now it's the turn of Dr Chris Malyszewicz, who has publicly exposed alarmingly high rates of the killer bug MRSA in NHS hospitals. Dr Chris Malyszewicz should get a medal for his work. Instead he tells the Dr Chris Malyszewicz should get a medal for his work. Instead he tells the Sunday Mirror Sunday Mirror how Health Secretary John Reid sent two senior advisers to his home to 'silence him'. how Health Secretary John Reid sent two senior advisers to his home to 'silence him'.

The Sunday Mirror Sunday Mirror was not alone. When the was not alone. When the Evening Standard Evening Standard published an article based on Malyszewicz's results ('Killer Bugs Widespread in Horrifying Hospital Study'), two senior consultant microbiologists from UCH, Dr Geoff Ridgway and Dr Peter Wilson, wrote to the paper pointing out the problems with Malyszewicz's methods. The published an article based on Malyszewicz's results ('Killer Bugs Widespread in Horrifying Hospital Study'), two senior consultant microbiologists from UCH, Dr Geoff Ridgway and Dr Peter Wilson, wrote to the paper pointing out the problems with Malyszewicz's methods. The Evening Standard Evening Standard didn't bother to reply. didn't bother to reply.

Two months later it ran another story using Malyszewicz's bogus results. That time Dr Vanya Gant, another UCH consultant microbiologist, wrote to the paper. This time the Standard Standard did deign to reply: did deign to reply: We stand by the accuracy and integrity of our articles. The research was carried out by a competent person using current testing media. Chris Malyszewicz...is a fully trained microbiologist with eighteen years' experience...We believe the test media used...were sufficient to detecl the presence of pathogenic type MRSA. We stand by the accuracy and integrity of our articles. The research was carried out by a competent person using current testing media. Chris Malyszewicz...is a fully trained microbiologist with eighteen years' experience...We believe the test media used...were sufficient to detecl the presence of pathogenic type MRSA.

What you are seeing here is a tabloid journalist telling a department of world-cla.s.s research microbiologists that they are mistaken about microbiology. This is an excellent example of a phenomenon described in one of my favourite psychology papers: 'Unskilled and Unaware of It: How Difficulties in Recognizing One's Own Incompetence Lead to Inflated Self-a.s.sessments', by Justin Kruger and David Dunning. They noted that people who are incompetent suffer a dual burden: not only are they incompetent, but they may also be too incompetent to a.s.say their own incompetence, because the skills which underlie an ability to make make a correct judgement are the same as the skills required to a correct judgement are the same as the skills required to recognise recognise a correct judgement. a correct judgement.

As has been noted, surveys repeatedly show that a majority of us consider ourselves to be above average at various skills, including leadership, getting on with other people, and expressing ourselves. More than that, previous studies had already found that unskilled readers are less able to rate their own text comprehension, bad drivers are poor at predicting their own performance on a reaction-time test, poorly performing students are worse at predicting test performance, and most chillingly, socially incompetent boys are essentially unaware of their repeated faux pas faux pas.

Perceived logical reasoning ability and test performance as a function of actual test performance Kruger and Dunning brought this evidence together, but also did a series of new experiments themselves, looking at skills in domains like humour and logical reasoning. Their findings were twofold: people who performed particularly poorly relative to their peers were unaware of their own incompetence; but more than that, they were also less able to recognize competence in others in others, because this, too, relied on 'meta-cognition', or knowledge about the skill.

That was a pop-psych distraction. There is also a second, more general point to be made here. Journalists frequently flatter themselves with the fantasy that they are unveiling vast conspiracies, that the entire medical establishment has joined hands to suppress an awful truth. In reality I would guess that the 150,000 doctors in the UK could barely agree on second-line management of hypertension, but no matter: this fantasy was the structure of the MMR story, and the MRSA swab story, and many others, but it was a similar grandiosity that drove many of the earlier examples in this book where a journalist concluded that they knew best, including 'cocaine use doubles in the playground'.

Frequendy, journalists will cite 'thalidomide' as if this was investigative journalism's greatest triumph in medicine, where they bravely exposed the risks of the drug in the face of medical indifference: it comes up almost every time I lecture on the media's crimes in science, and that is why I will explain the story in some detail here, because in reality-sadly, really-this finest hour never occurred.

In 1957, a baby was born with no ears to the wife of an employee at Grunenthal, the German drug company. He had taken their new anti-nausea drug home for his wife to try while she was pregnant, a full year before it went on the market: this is an ill.u.s.tration both of how slapdash things were, and of how difficult it is to spot a pattern from a single event.

The drug went to market, and between 1958 and 1962 around 10,000 children were born with severe malformations, all around the world, caused by this same drug, thalidomide. Because there was no central monitoring of malformations or adverse reactions, this pattern was missed. An Australian obstetrician called William McBride first raised the alarm in a medical journal, publishing a letter in the Lancet Lancet in December 1961. He ran a large obstetric unit, seeing a large number of cases, and he was rightly regarded as a hero-receiving a CBE-but it's sobering to think that he was only in such a good position to spot the pattern because he had prescribed so much of the drug, without knowing its risks, to his patients.* in December 1961. He ran a large obstetric unit, seeing a large number of cases, and he was rightly regarded as a hero-receiving a CBE-but it's sobering to think that he was only in such a good position to spot the pattern because he had prescribed so much of the drug, without knowing its risks, to his patients.*

- Many years later William McBride turned out to be guilty, in an unfortunate twist, of research fraud, falsifying data, and he was struck off the medical register in 1993, although he was later reinstated. - Many years later William McBride turned out to be guilty, in an unfortunate twist, of research fraud, falsifying data, and he was struck off the medical register in 1993, although he was later reinstated.

By the time his letter was published, a German paediatrician had noted a similar pattern, and the results of his study had been described in a German Sunday newspaper a few weeks earlier.

Almost immediately afterwards, the drug was taken off the market, and pharmacovigilance began in earnest, with notification schemes set up around the world, however imperfect you may find them to be. If you ever suspect that you've experienced an adverse drug reaction, as a member of the public, I would regard it as your duty to fill out a yellow card form online at yellowcard.mhra.gov.uk yellowcard.mhra.gov.uk: anyone can do so. These reports can be collated and monitored as an early warning sign, and are a part of the imperfect, pragmatic monitoring system for picking up problems with medications.

No journalists were or are involved in this process. In fact Philip Knightley-a G.o.d of investigative journalism from the Sunday Times Sunday Times' legendary Insight team, and the man most a.s.sociated with heroic coverage on thalidomide-specifically writes in his autobiography about his shame over not covering the thalidomide story sooner. They covered the political issue of compensation, rather well (it's more the oeuvre oeuvre of journalists after all) but even that was done very late in the day, due to heinous legal threats from Grunenthal throughout the late 1960 of journalists after all) but even that was done very late in the day, due to heinous legal threats from Grunenthal throughout the late 1960s and early 1970 and early 1970s.

Medical journalists, despite what they may try to tell you, most certainly did not reveal the dangers of thalidomide: and in many respects it's difficult to picture a world in which the characters who produce bogus MRSA hoax stories could somehow be meaningfully engaged in monitoring and administering drug safety, ably a.s.sisted, perhaps, by 'leading experts' from their garden sheds.

What the MRSA episode reveals to me, alongside a gut-wrenching and cavalier grandiosity, is the very same parody that we saw in our earlier review of nonsense science stories: humanities graduates in the media, perhaps feeling intellectually offended by how hard they find the science, conclude that it must simply be arbitrary, made up nonsense, to everyone. You can pick a result from anywhere you like, and if it suits your agenda, then that's that: n.o.body can take it away from you with their clever words, because it's all just game-playing, it just depends on who you ask, none of it really means anything, you don't understand the long words, and therefore, crucially, probably, neither do the scientists neither do the scientists.

Epilogue Although he was a very pleasant man, from my first telephone conversation with Chris Malyszewicz it was immediately clear that he lacked the basic background knowledge necessary to hold even a rudimentary discussion about microbiology. Patronising as it may sound, I feel a genuine sympathy for him, almost as a Walter Mitty figure. He claimed to have consulted for 'Cosworth-Technology, Boeing Aircraft, British Airways, Britannia Airways, Monarch Airways, Birmingham European Airways'. After BA and Boeing, neither of which had any record of any dealings with him, I gave up contacting these organisations. He would send elliptical comments in response to detailed criticisms of his 'a.n.a.lytic techniques', such as they were.

Dear Ben, Dear Ben, As a quote: As a quote: 'I am surprised, but knowing what I know am not and knowing what I mean'. 'I am surprised, but knowing what I know am not and knowing what I mean'. Thanks, Chris Thanks, Chris I have strong feelings on this story: I do not blame Chris. I am certain that the true nature of his expertise would have been clear to anybody who spoke with him, regardless of background knowledge, and in my view it is the media that should have known better, with their huge offices, chains of command and responsibility, codes of conduct and editorial policies: not one man, in a shed in his back garden, surrounded by kitchen fittings and laboratory equipment he barely understood, bought on bank loans he was struggling to repay, in a small conurbation just outside Northampton.

Chris wasn't happy with what I wrote about him, and what was said about him after the story was exposed. We spent some time on the telephone, with him upset and me feeling, in all honesty, quite guilty. He felt that what was happening to him was unfair. He explained that he had never sought to be an expert on MRSA, but after the first story the journalists simply kept coming back, and everything s...o...b..lled. He may have made some mistakes, but he only wanted to help.

Chris Malyszewicz died in a car accident after losing control of his vehicle near Northampton shortly after the MRSA stories were exposed. He was heavily in debt.

16 The Media's MMR Hoax

The MRSA swab scandals were a simple, circ.u.mscribed, collective hoax. MMR is something much bigger: it is the prototypical health scare, by which all others must be judged and understood. It has every ingredient, every canard, every sleight of hand, and every aspect of venal incompetence and hysteria, systemic and individual. Even now, it is with great trepidation that I even dare to mention it by name, for two very simple reasons.

Firstly, at the quietest hint of a discussion on the subject, an army of campaigners and columnists will still, even in 2008, hammer on editors' doors demanding the right to a lengthy, misleading and emotive response in the name of 'balance'. Their demands are always, without exception, accommodated.

But there is a second issue, which is less important than it seems at first: Andrew Wakefield, the doctor who many imagine to be at the centre of the story, is currently in front of the GMC on charges of professional misconduct, and between me finishing and you reading this book, the judgement will probably be out.

I have no idea what that judgement will be, and being honest, although I suppose I'm glad they look into things like this in general, cases like his are two a penny at the GMC. I have no great interest in whether one individual's work was ethically dubious: the responsibility for the MMR scare cannot be laid at the door of a single man, however much the media may now be trying to argue that it should.

The blame lies instead with the hundreds of journalists, columnists, editors and executives who drove this story cynically, irrationally, and wilfully onto the front pages for nine solid years. As we will see, they overextrapolated from one study into absurdity, while studiously ignoring all rea.s.suring data, and all subsequent refutations. They quoted 'experts' as authorities instead of explaining the science, they ignored the historical context, they set idiots to cover the facts, they pitched emotive stories from parents against bland academics (who they smeared), and most bizarrely of all, in some cases they simply made stuff up.

Now they claim that the original 1998 Wakefield research has been 'debunked' (it was never anything compelling in the first place), and you will be able to watch this year as they try to pin the whole scare onto one man. I'm a doctor too, and I don't imagine for one moment that I could stand up and create a nine-year-long news story on a whim. It is because of the media's blindness-and their unwillingness to accept their responsibility-that they will continue to commit the same crimes in the future. There is nothing you can do about that, so it might be worth paying attention now.

To remind ourselves, here is the story of MMR as it appeared in the British news media from 1998 onwards: - Autism is becoming more common, although n.o.body knows why.

- A doctor called Andrew Wakefield has done scientific research showing a link between the MMR triple jab and autism.

- Since then, more scientific research has been done confirming this link.

- There is evidence that single jabs might be safer, but government doctors and those in the pay of the pharmaceutical industry have simply rubbished these claims.

- Tony Blair probably didn't give his young son the vaccine.

- Measles isn't so bad.

- And vaccination didn't prevent it very well anyway.

I think that's pretty fair. The central claim for each of these bullet points was either misleading or downright untrue, as we will see.

Vaccine scares in context Before we begin, it's worth taking a moment to look at vaccine scares around the world, because I'm always struck by how circ.u.mscribed these panics are, and how poorly they propagate themselves in different soils. The MMR and autism scare, for example, is practically non-existent outside Britain, even in Europe and America. But throughout the 1990s France was in the grip of a scare that hepat.i.tis B vaccine caused multiple sclerosis (it wouldn't surprise me if I was the first person to tell you that). France was in the grip of a scare that hepat.i.tis B vaccine caused multiple sclerosis (it wouldn't surprise me if I was the first person to tell you that).

In the US, the major vaccine fear has been around the use of a preservative called thiomersal, although somehow this hasn't caught on here, even though that same preservative was used in Britain. And in the 1970s-since the past is another country too-there was a widespread concern in the UK, driven again by a single doctor, that whooping-cough vaccine was causing neurological damage.

Looking even further back, there was a strong anti-smallpox-vaccine movement in Leicester well into the 1930s, despite its demonstrable benefits, and in fact anti-inoculation sentiment goes right back to its origins: when James Jurin studied inoculation against smallpox (finding that it was a.s.sociated with a lower death rate than the natural disease), his newfangled numbers and statistical ideas were treated with enormous suspicion. Indeed, smallpox inoculation remained illegal in France until 1769.*

- Disdain for statistics in healthcare research wasn't unusual at the time: Ignaz Semmelweis noticed in 1847 that patients were dying much more frequently on the obstetrics ward run by the medical students than on the one run by the midwifery students (this was in the days when students did all the legwork in hospitals). He was pretty sure that this was because the medical students were carrying something nasty from the corpses in the dissection room, so he inst.i.tuted proper handwashing practices with chlorinated lime, and did some figures on the benefits. The death rates fell, but in an era of medicine that championed 'theory' over real-world empirical evidence, he was basically ignored, until Louis Pasteur came along and confirmed the germ theory. Semmelweis died alone in an asylum. You've heard of Pasteur. - Disdain for statistics in healthcare research wasn't unusual at the time: Ignaz Semmelweis noticed in 1847 that patients were dying much more frequently on the obstetrics ward run by the medical students than on the one run by the midwifery students (this was in the days when students did all the legwork in hospitals). He was pretty sure that this was because the medical students were carrying something nasty from the corpses in the dissection room, so he inst.i.tuted proper handwashing practices with chlorinated lime, and did some figures on the benefits. The death rates fell, but in an era of medicine that championed 'theory' over real-world empirical evidence, he was basically ignored, until Louis Pasteur came along and confirmed the germ theory. Semmelweis died alone in an asylum. You've heard of Pasteur.

Even when Edward Jenner introduced the much safer vaccination for protecting people against smallpox at the turn of the nineteenth century, he was strongly opposed by the London cognoscenti.

And in an article from Scientific American Scientific American in 1888 you can find the very same arguments which modern antivaccination campaigners continue to use today: in 1888 you can find the very same arguments which modern antivaccination campaigners continue to use today: The success of the anti-vaccinationists has been aptly shown by the results in Zurich, Switzerland, where for a number of years, until 1883, a compulsory vaccination law obtained, and smallpox was wholly prevented-not a single case occurred in 1882. This result was seized upon the following year by the anti-vaccinationists and used against the necessity for any such law, and it seems they had sufficient influence to cause its repeal. The death returns for that year (1883) showed that for every 1,000 deaths two were caused by smallpox; In 1884 there were three; in 1885, 17, and in the first quarter of 1886, 85. The success of the anti-vaccinationists has been aptly shown by the results in Zurich, Switzerland, where for a number of years, until 1883, a compulsory vaccination law obtained, and smallpox was wholly prevented-not a single case occurred in 1882. This result was seized upon the following year by the anti-vaccinationists and used against the necessity for any such law, and it seems they had sufficient influence to cause its repeal. The death returns for that year (1883) showed that for every 1,000 deaths two were caused by smallpox; In 1884 there were three; in 1885, 17, and in the first quarter of 1886, 85.

Meanwhile, WHO's highly successful global polio eradication programme was on target to have eradicated this murderous disease from the face of the earth by now-a fate which has already befallen the smallpox virus, excepting a few gla.s.s vials-until local imams from a small province called Kano in northern Nigeria claimed that the vaccine was part of a US plot to spread AIDS and infertility in the Islamic world, and organised a boycott which rapidly spread to five other states in the country. This was followed by a large outbreak of polio in Nigeria and surrounding countries, and tragically even further afield. There have now been outbreaks in Yemen and Indonesia, causing lifelong paralysis in children, and laboratory a.n.a.lysis of the genetic code has shown that these outbreaks were caused by the same strain of the polio virus, exported from Kano.

After all, as any trendy MMR-dodging north-London middlecla.s.s humanities-graduate couple with children would agree, just because vaccination has almost eradicated polio-a debilitating disease which as recently as 1988 was endemic in 125 countries-that doesn't necessarily mean it's a good thing.

The diversity and isolation of these anti-vaccination panics helps to ill.u.s.trate the way in which they reflect local political and social concerns more than a genuine appraisal of the risk data: because if the vaccine for hepat.i.tis B, or MMR, or polio, is dangerous in one country, it should be equally dangerous everywhere on the planet; and if those concerns were genuinely grounded in the evidence, especially in an age of the rapid propagation of information, you would expect the concerns to be expressed by journalists everywhere. They're not.

Andrew Wakefield and his Lancet Lancet paper paper In February 1998 a group of researchers and doctors led by a surgeon called Andrew Wakefield from the Royal Free Hospital in London published a research paper in the Lancet Lancet which by now stands as one of the most misunderstood and misreported papers in the history of academia. In some respects it did itself no favours: it is badly written, and has no clear statement of its hypothesis, or indeed of its conclusions (you can read it free online if you like). It has since been partially retracted. which by now stands as one of the most misunderstood and misreported papers in the history of academia. In some respects it did itself no favours: it is badly written, and has no clear statement of its hypothesis, or indeed of its conclusions (you can read it free online if you like). It has since been partially retracted.

The paper described twelve children who had bowel problems and behavioural problems (mosdy autism), and mentioned that the parents or doctors of eight of these children believed that their child's problems had started within a few days of them being given the MMR vaccine. It also reported various blood tests, and tests on tissue samples taken from the children. The results of these were sometimes abnormal, but varied between children.

12 children, consecutively referred to the department of paediatric gastroenterology with a history of a pervasive developmental disorder with loss of acquired skills and intestinal symptoms (diarrhoea, abdominal pain, bloating and food intolerance), were investigated. 12 children, consecutively referred to the department of paediatric gastroenterology with a history of a pervasive developmental disorder with loss of acquired skills and intestinal symptoms (diarrhoea, abdominal pain, bloating and food intolerance), were investigated. ...In eight children, the onset of behavioural problems had been linked, either by the parents or by the child's physician, with measles, mumps, and rubella vaccination...In these eight children the average interval from exposure to first behavioural symptoms was 6.3 days (range 1-14). ...In eight children, the onset of behavioural problems had been linked, either by the parents or by the child's physician, with measles, mumps, and rubella vaccination...In these eight children the average interval from exposure to first behavioural symptoms was 6.3 days (range 1-14).

What can this kind of paper tell you about a link between something as common as MMR, and something as common as autism? Basically nothing, either way. It was a collection of twelve clinical anecdotes, a type of paper called a 'case series'-and a case series, by design, wouldn't demonstrate such a relationship between an exposure and an outcome with any force. It did not take some children who were given MMR and some children who weren't, and then compare the rates of autism between the two groups (this would have been a 'cohort study'). It did not take some children with autism, and some children without autism, and then compare the rates of vaccination between the two groups (this would have been a 'case-control study').

Could anything else explain the apparent connection between MMR, bowel problems and autism in these eight children? Firstly, although they sound like rare things to come together, this was a specialist centre in a teaching hospital, and the children had only been referred there because they had bowel problems and behavioural problems (the circ.u.mstances of these referrals are currently being examined by the GMC, as we will see).

Out of an entire nation of millions of inhabitants, if some children with a combination of fairly common things (vaccination, autism, bowel problems) all come together in one place which is already acting as beacon for such a combination already acting as beacon for such a combination, as this clinic was, we should not naturally be impressed. You will remember from the discussion of the unfortunate Dutch nurse Lucia de Berk (and indeed from reading news reports about lottery winners) that unlikely combinations of events will always happen, somewhere, to some people, entirely by chance. Drawing a target around them after the fact tells us nothing at all.

All stories about treatment and risk will start with modest clinical hunches like these anecdotes; but hunches, with nothing to back them up, are not generally newsworthy. At the publication of this paper, a press conference was held at the Royal Free Hospital, and to the visible surprise of many other clinicians and academics present, Andrew Wakefield announced that he thought it would be prudent to use single vaccines instead of the MMR triple vaccine. n.o.body should have been surprised: a video news release had already been issued by the hospital, in which Wakefield made the same call.

We are all ent.i.tled to our clinical hunches, as individuals, but there was nothing in either this study of twelve children, or any other published research, to suggest that giving single vaccines would be safer. As it happens, there are good grounds for believing that giving vaccines separately might be more harmful: they need six visits to the GP, and six unpleasant jabs, which makes four more appointments to miss. Maybe you're ill, maybe you're on holiday, maybe you move house, maybe you lose track of which ones you've had, maybe you can't see the point of rubella for boys, or mumps for girls, or maybe you're a working single mum with two kids and no time.

Also, of course, the children spend much more time vulnerable to infection, especially if you wait a year between jabs, as Wakefield has recommended, out of the blue. Ironically, although most of the causes of autism remain unclear, one of the few well-characterised single causes is rubella infection itself, while the child is in the womb.

The story behind the paper Some fairly worrying questions have been raised since then. We won't cover them in detail, because I don't find ad hominem ad hominem stories very interesting to write about, and because I don't want that aspect of the story-rather than the research evidence-to be the reason why you come to your own conclusion about the risks of MMR and autism. There are things which came out in 2004, however, which cannot fairly be ignored, including allegations of multiple conflicts of interest, undeclared sources of bias in the recruitment of subjects for the paper, undisclosed negative findings, and problems with the ethical clearance for the tests. These were largely uncovered by a tenacious investigative journalist from the stories very interesting to write about, and because I don't want that aspect of the story-rather than the research evidence-to be the reason why you come to your own conclusion about the risks of MMR and autism. There are things which came out in 2004, however, which cannot fairly be ignored, including allegations of multiple conflicts of interest, undeclared sources of bias in the recruitment of subjects for the paper, undisclosed negative findings, and problems with the ethical clearance for the tests. These were largely uncovered by a tenacious investigative journalist from the Sunday Times Sunday Times called Brian Deer, and they now form part of the allegations being investigated by the GMC. called Brian Deer, and they now form part of the allegations being investigated by the GMC.

For example, it is investigating whether Wakefield failed to disclose to the editor of the Lancet Lancet his involvement in a patent relating to a new vaccine; more worrying are the concerns about where the twelve children in the 1998 Royal Free study came from. While in the paper it is stated that they were sequential referrals to a clinic, in fact Wakefield was already being paid 50,000 of legal aid money by a firm of solicitors to investigate children whose parents were preparing a case against MMR, and the GMC is further investigating where the patients in the study came from, because it seems that many of Wakefield's referrals had come to him specifically as someone who could show a link between MMR and autism, whether formally or informally, and was working on a legal case. This is the beacon problem once more, and under these circ.u.mstances, the fact that his involvement in a patent relating to a new vaccine; more worrying are the concerns about where the twelve children in the 1998 Royal Free study came from. While in the paper it is stated that they were sequential referrals to a clinic, in fact Wakefield was already being paid 50,000 of legal aid money by a firm of solicitors to investigate children whose parents were preparing a case against MMR, and the GMC is further investigating where the patients in the study came from, because it seems that many of Wakefield's referrals had come to him specifically as someone who could show a link between MMR and autism, whether formally or informally, and was working on a legal case. This is the beacon problem once more, and under these circ.u.mstances, the fact that only only eight of the twelve children's parents or physicians believed the problems were caused by MMR would be unimpressive, if anything. eight of the twelve children's parents or physicians believed the problems were caused by MMR would be unimpressive, if anything.

Of the twelve children in the paper, eleven sued drug companies (the one that didn't was American), and ten of them already had legal aid to sue over MMR before the 1998 paper was published. Wakefield himself eventually received 435,643 plus expenses from the legal aid fund for his role in the case against MMR.

Various intrusive clinical investigations-such as lumbar punctures and colonoscopies-were carried out on the children, and these required ethics committee clearance. The Ethics Committee had been a.s.sured that they were all clinically indicated, which is to say, in the interests of the children's own clinical care: the GMC is now examining whether they were contrary to the clinical interests of the children, and performed simply for research.

Lumbar puncture involves putting a needle into the centre of the spine to tap off some spinal fluid, and colonoscopy involves putting a flexible camera and light through the a.n.u.s, up the r.e.c.t.u.m and into the bowel on a long lube. Neither is without risk, and indeed one of the children being investigated as part of an extension of the MMR research project was seriously harmed during colonoscopy, and was rushed to intensive care at Great Ormond Street Hospital after his bowel was punctured in twelve places. He suffered multiple organ failure, including kidney and liver problems, and neurological injuries, and received 482,300 in compensation. These things happen, n.o.body is to blame, and I am merely ill.u.s.trating the reasons to be cautious about doing investigations.

Meanwhile, in 1997 a young PhD student called Nick Chad-wick was starting his research career in Andrew Wakefield's lab, using PCR technology (used as part of DNA fingerprinting) to look for traces of measles strain genetic material in the bowels of these twelve children, because this was a central feature of Wakefield's theory. In 2004 Chadwick gave an interview to Channel 4's Dispatches Dispatches, and in 2007 he gave evidence at a US case on vaccines, stating that there was no measles RNA to be found in these samples. But this important finding, which conflicted with his charismatic supervisor's theory, was not published.

I could go on.

n.o.body knew about any of this in 1998. In any case, it's not relevant, because the greatest tragedy of the media's MMR hoax is that it was brought to an end by these issues being made public, when it should have been terminated by a cautious and balanced appraisal of the evidence at the time. Now, you will see news reporters-including the BBC-saying stupid things like 'The research has since been debunked.' Wrong. The research never justified the media's ludicrous over-interpretation. If they had paid attention, the scare would never have even started.

The press coverage begins What's most striking about the MMR scare-and this is often forgotten-is that it didn't actually begin in 1998. The Guardian Guardian and the and the Independent Independent covered the press conference on their front pages, but the covered the press conference on their front pages, but the Sun Sun ignored it entirely, and the ignored it entirely, and the Daily Mail Daily Mail, international journal of health scares, buried their piece on it in the middle of the paper. Coverage of the story was generally written by specialist health and science journalists, and they were often fairly capable of balancing the risks and evidence. The story was pretty soft.

In 2001 the scare began to gain momentum. Wakefield published a review paper in an obscure journal, questioning the safety of the immunisation programme, although with no new evidence. In March he published new laboratory work with j.a.panese researchers ('the Kawashima paper'), using PCR data to show measles virus in the white blood cells of children with bowel problems and autism. This was essentially the opposite of the findings from Nick Chadwick in Wakefield's own labs. Chadwick's work remained unmentioned (and there has since been a paper published showing how the Kawashima paper produced a false positive, although the media completely ignored this development, and Wakefield seems to have withdrawn his support for the study).

Things began to deteriorate. The anti-vaccination campaigners began to roll their formidable and coordinated publicity machine into action against a rather chaotic shambles of independent doctors from various different uncoordinated agencies. Emotive anecdotes from distressed parents were pitted against old duffers in corduroy, with no media training, talking about scientific data. If you ever wanted to see evidence against the existence of a sinister medical conspiracy, you need look no further than the shower of avoidant doctors and academics, and their piecemeal engagement with the media during this time. The Royal College of General Pract.i.tioners not only failed to speak clearly on the evidence, it also managed-heroically-to dig up some anti-MMR GPs to offer to journalists when they rang in asking for quotes.

The story began to gain momentum, perhaps bound up in the wider desire of some newspapers and personalities simply to attack the government and the health service. A stance on MMR became part of many newspapers' editorial policies, and that stance was often bound up with rumours about senior managerial figures with family members who had been affected by autism. It was the perfect story, with a single charismatic maverick fighting against the system, a Galileo-like figure; there were elements of risk, of awful personal tragedy, and of course, the question of blame. Whose fault was autism? Because nestling in the background was this extraordinary new diagnosis, a disease that struck down young boys and seemed to have come out of the blue, without explanation.

Autism We still don't know what causes autism. A history of psychiatric problems in the family, early birth, problems at birth, and breech presentation are all risk factors, but pretty modest ones, which means they're interesting from a research perspective, but none of them explains the condition in a particular person. This is often the case with risk factors. Boys are affected more than girls, and the incidence of autism continues to rise, in part because of improved diagnosis-people who were previously given labels like 'mentally subnormal' or 'schizophrenia' were now receiving a diagnosis of 'autism'-but also possibly because of other factors which are still not understood. Into this vacuum of uncertainty, the MMR story appeared.

There was also something strangely attractive about autism as an idea to journalists and other commentators. Among other things, it's a disorder of language, which might touch a particular chord with writers; but it's also philosophically enjoyable to think about, because the flaws in social reasoning which are exhibited by people with autism give us an excuse to talk and think about our social norms and conventions. Books about autism and the autistic outlook on the world have become bestsellers. Here are some wise words for us all from Luke Jackson, a thirteen-year-old with Asperger's syndrome, who has written a book of advice for teenagers with the condition (Freaks, Geeks and Asperger Syndrome). This is from the section on dating: If the person asks something like 'Does my b.u.m look fat?' or even 'I am not sure I like this dress' then that is called 'fishing for compliments'. These are very hard things to understand, but I am told that instead of being completely honest and saying that yes their b.u.m does look fat, it is politer to answer with something like 'Don't be daft, you look great.' You are not lying, simply evading an awkward question and complimenting them at the same time. Be economical with the truth! If the person asks something like 'Does my b.u.m look fat?' or even 'I am not sure I like this dress' then that is called 'fishing for compliments'. These are very hard things to understand, but I am told that instead of being completely honest and saying that yes their b.u.m does look fat, it is politer to answer with something like 'Don't be daft, you look great.' You are not lying, simply evading an awkward question and complimenting them at the same time. Be economical with the truth!

Asperger's syndrome, or autistic spectrum disorder, is being applied to an increasingly large number of people, and children or adults who might previously have been considered 'quirky' now frequently have their personality medicalised with suggestions that they have 'traits of Asperger's'. Its growth as a pseudo-diagnostic category has taken on similar proportions to 'mild dyslexia'-you will have your own views on whether this process is helpful-and its widespread use has allowed us all to feel that we can partic.i.p.ate in the wonder and mystery of autism, each with a personal connection to the MMR scare.

Except of course, in most cases, genuine autism is a pervasive developmental disorder, and most people with autism don't write quirky books about their odd take on the world which reveal so much to us about our conventions and social mores in a charmingly plain and unselfconscious narrative style. Similarly, most people with autism do not have the telegenic single skills which the media have so enjoyed talking up in their cra.s.s doc.u.mentaries, like being really amazing really amazing at mental arithmetic, or playing the piano to concert standard while staring confusedly into the middle distance. at mental arithmetic, or playing the piano to concert standard while staring confusedly into the middle distance.

That these are the sort of things most people think of when the word 'autism' pops into their head is testament to the mythologisation and paradoxical 'popularity' of the diagnosis. Mike Fitzpatrick, a GP with a son who has autism, says that there are two questions on the subject which will make him want to slap you. One is:' Do you think it was caused by MMR?' The other is: 'Does he have any special skills?'

Leo Blair But the biggest public health disaster of all was a sweet little baby called Leo. In December 2001 the Blairs were asked if their infant son had been given the MMR vaccine, and refused to answer. Most other politicians have been happy to clarify whether their children have had the vaccine, but you can imagine how people might believe the Blairs were the kind of family not to have their children immunised, especially with everyone talking about 'herd immunity', and the worry that they might be immunising their child, and placing it at risk, in order that the rest of the population should be safer.

Concerns were particularly raised by the ubiquity of Cherie Blair's closest friend and aide. Carole Caplin was a New Age guru, a 'life coach' and a 'people person', although her boyfriend, Peter Foster, was a convicted fraudster. Foster helped arrange the Blairs' property deals, and he also says that they took Leo to a New Age healer, Jack Temple, who offered crystal dowsing, h.o.m.oeopathy, herbalism and neolithic-circle healing in his back garden.

I'm not sure how much credence to give to Foster's claims myself, but the impact on the MMR scare is that they were widely reported at the time. We were told that the Prime Minister of the United Kingdom agreed to Temple waving a crystal pendulum over his son to protect him (and therefore his cla.s.smates, of course) from measles, mumps and rubella; and that Tony let Cherie give Temple some of his own hair and nail clippings, which Temple preserved in jars of alcohol. He said he only needed to swing his pendulum over the jar to know if their owner was healthy or ill.

Some things are certainly true. Using this crystal dowsing pendulum, Temple did claim that he could harness energy from heavenly bodies. He sold remedies with names like 'Volcanic Memory', 'Rancid b.u.t.ter', 'Monkey Sticks', 'Banana Stem' and, my own personal favourite, 'Sphincter'. He was also a very well-connected man. Jerry Hall endorsed him. The d.u.c.h.ess of York wrote the introduction to his book The Healer: The Extraordinary Healing Methods of Jack Temple The Healer: The Extraordinary Healing Methods of Jack Temple (it's a hoot). He told the (it's a hoot). He told the Daily Mail Daily Mail that babies who are breastfed from the moment of birth acquire natural immunity against all diseases, and he even sold a h.o.m.oeopathic alternative to the MMR jab. that babies who are breastfed from the moment of birth acquire natural immunity against all diseases, and he even sold a h.o.m.oeopathic alternative to the MMR jab.

'I tell all my patients who are pregnant that when the baby is born they must put it on the breast until there is no longer a pulse in the umbilical cord. It usually takes about 30 minutes. By doing this they transfer the mother's immune system to the baby, who will then have a fully-functioning immune system and will not need vaccines.'...Mr Temple refused to confirm yesterday whether he advised Mrs Blair not to have her baby Leo vaccinated. But he said: 'If women follow my advice their children will not need the MMR injection, end of story.'* 'I tell all my patients who are pregnant that when the baby is born they must put it on the breast until there is no longer a pulse in the umbilical cord. It usually takes about 30 minutes. By doing this they transfer the mother's immune system to the baby, who will then have a fully-functioning immune system and will not need vaccines.'...Mr Temple refused to confirm yesterday whether he advised Mrs Blair not to have her baby Leo vaccinated. But he said: 'If women follow my advice their children will not need the MMR injection, end of story.'* Daily Mail, Daily Mail, 26 December 2001 26 December 2001 - Here is Jack on cramp: 'For years many people have suffered with cramp. By dowsing, I discovered that this is due to the fact that the body is not absorbing the element 'scandium' which is linked to and controls the absorption of magnesium phosphate.' And on general health complaints: 'Based on my expertise in dowsing, I noted that many of my patients were suffering from severe deficiencies of carbon in their systems. The ease in which people these days suffer hairline fractures and broken bones is glaringly apparent to the eyes that are trained to see.' - Here is Jack on cramp: 'For years many people have suffered with cramp. By dowsing, I discovered that this is due to the fact that the body is not absorbing the element 'scandium' which is linked to and controls the absorption of magnesium phosphate.' And on general health complaints: 'Based on my expertise in dowsing, I noted that many of my patients were suffering from severe deficiencies of carbon in their systems. The ease in which people these days suffer hairline fractures and broken bones is glaringly apparent to the eyes that are trained to see.'

Cherie Blair was also a regular visitor to Carole's mum, Sylvia Caplin, a spiritual guru. 'There was a particularly active period in the summer when Sylvia was channelling for Cherie over two or three times a week, with almost daily contact between them,' the Mail Mail reported. 'There were times when Cherie's faxes ran to 10 pages.' Sylvia, along with many if not most alternative therapists, was viciously anti-MMR (over half of all the homeopaths approached in one survey grandly advised against the vaccine). The reported. 'There were times when Cherie's faxes ran to 10 pages.' Sylvia, along with many if not most alternative therapists, was viciously anti-MMR (over half of all the homeopaths approached in one survey grandly advised against the vaccine). The Daily Telegraph Daily Telegraph reported: reported: We move on to what is potentially a very political subject: the MMR vaccine. The Blairs publicly endorsed it, then caused a minor furore by refusing to say whether their baby, Leo, had been inoculated. Sylvia [Caplin] doesn't hesitate: 'I'm against it,' she says. 'I'm appalled at so much being given to little children. The thing about these drugs is the toxic substance they put the vaccines in-for a tiny child, the MMR is a ridiculous thing to do. 'It has definitely caused autism. All the denials that come from the old school of medicine are open to question because logic and common sense must tell you that there's some toxic substance in it. Do you not think that's going to have an effect on a tiny child? Would you allow it? No-too much, too soon, in the wrong formula.' We move on to what is potentially a very political subject: the MMR vaccine. The Blairs publicly endorsed it, then caused a minor furore by refusing to say whether their baby, Leo, had been inoculated. Sylvia [Caplin] doesn't hesitate: 'I'm against it,' she says. 'I'm appalled at so much being given to little children. The thing about these drugs is the toxic substance they put the vaccines in-for a tiny child, the MMR is a ridiculous thing to do. 'It has definitely caused autism. All the denials that come from the old school of medicine are open to question because logic and common sense must tell you that there's some toxic substance in it. Do you not think that's going to have an effect on a tiny child? Would you allow it? No-too much, too soon, in the wrong formula.'

It was also reported-doubtless as part of a cheap smear-that Cherie Blair and Carole Caplin encouraged the Prime Minister to have Sylvia 'douse and consult The Light, believed by Sylvia to be a higher being or G.o.d, by use of her pendulum' to decide if it was safe to go to war in Iraq. And while we're on the subject, in December 2001 The Times The Times described the Blairs' holiday in Temazcal, Mexico, where they rubbed fruits and mud over each other's bodies inside a large pyramid on the beach, then screamed while going through a New Age rebirthing ritual. Then they made a wish for world peace. described the Blairs' holiday in Temazcal, Mexico, where they rubbed fruits and mud over each other's bodies inside a large pyramid on the beach, then screamed while going through a New Age rebirthing ritual. Then they made a wish for world peace.

I'm not saying I buy all of this. I'm just saying, this is what people were thinking about when the Blairs refused to publicly clarify the issue of whether they had given their child the MMR vaccine as all h.e.l.l broke loose around it. This is not a hunch. Thirty-two per cent of all the stories written that year about MMR mentioned whether Leo Blair had had the vaccine or not (even Andrew Wakefield was only mentioned in 25 per cent), and it was one of the most well-recalled facts about the story in population surveys. The public, quite understandably, were taking Leo Blair's treatment as a yardstick of the Prime Minister's confidence in the vaccine, and few could understand why it should be a secret, if it wasn't an issue.

The Blairs, meanwhile, cited their child's right to privacy, which they felt was more important than an emerging public health crisis. It's striking that Cherie Blair has now decided, in marketing her lucrative autobiography, to waive that principle which was so vital at the time, and has written at length in her heavily promoted book not just about the precise bonk that conceived Leo, but also about whether he had the jab (she says yes, but she seems to obfuscate on whether it was single vaccines, and indeed on the question of when he had it: frankly, I give up on these people).

For all that it may seem trite and voyeuristic to you, this event was central to the coverage of MMR. 2002 was the year of Leo Blair, the year of Wakefield's departure from the Royal Free, and it was the peak of the media coverage, by a very long margin.

What was in these stories?

The MMR scare has created a small cottage industry of media a.n.a.lysis, so there is a fair amount known about the coverage. In 2003 the Economic and Social Research Council (ESRC) published a paper on the media's role in the public understanding of science, which sampled all the major science media stories from January to September 2002, the peak of the scare. Ten per cent of all science stories were about MMR, and MMR was also by far the most likely to generate letters to the press (so people were clearly engaging with the issue); by far the most likely science topic to be written about in opinion or editorial pieces; and it generated the longest stories. MMR was the biggest, most heavily covered science story for years.

Pieces on GM food, or cloning, stood a good chance of being written by specialist science reporters, but for stories on MMR these reporters were largely sidelined, and 80 per cent of the coverage of the biggest science story of the year was by general-ist reporters. Suddenly we were getting comment and advice on complex matters of immunology and epidemiology from people who would more usually have been telling us about a funny thing that happened with the au pair on the way to a dinner party. Nigella Lawson, Libby Purves, Suzanne Moore, Lynda Lee-Potter and Carol Vorderman, to name only a few, all wrote about their ill-informed concerns on MMR, blowing hard on their toy trumpets. The anti-MMR lobby, meanwhile, developed a reputation for targeting generalist journalists wherever possible, feeding them stories, and actively avoiding health or science correspondents.

This is a pattern which has been seen before. If there is one thing which has adversely affected communication between scientists, journalists and the public, it is the fact that science journalists simply do not cover major science news stories. From drinking with science journalists, I know that much of the time, n.o.body even runs these major stories by them for a quick check.

Again, I'm not speaking in generalities here. During the crucial two days after the GM 'Frankenstein foods' story broke in February 1999, not a single one not a single one of the news articles, opinion pieces or editorials on the subject was written by a science journalist. A science correspondent would have told his or her editor that when someone presents their scientific findings about GM potatoes causing cancer in rats, as Arpad Pusztai did, on ITV's of the news articles, opinion pieces or editorials on the subject was written by a science journalist. A science correspondent would have told his or her editor that when someone presents their scientific findings about GM potatoes causing cancer in rats, as Arpad Pusztai did, on ITV's World in Action World in Action rather than in an academic journal, then there's something fishy going on. Pusztai's experiment was finally published a year later-after a long period when n.o.body could comment on it, because n.o.body knew what he'd actually done-and when all was revealed in a proper publication, his experimental results did not contain information to justify the media's scare. rather than in an academic journal, then there's something fishy going on. Pusztai's experiment was finally published a year later-after a long period when n.o.body could comment on it, because n.o.body knew what he'd actually done-and when all was revealed in a proper publication, his experimental results did not contain information to justify the media's scare.

This sidelining of specialist correspondents when science becomes front-page news, and the fact that they are not even used as a resource during these periods, has predictable consequences. Journalists are used to listening with a critical ear to briefings from press officers, politicians, PR executives, salespeople, lobbyists, celebrities and gossip-mongers, and they generally display a healthy natural scepticism: but in the case of science, they don't have the skills to critically appraise a piece of scientific evidence on its merits. At best the evidence of these 'experts' will only be examined in terms of who they are as people, or perhaps who they have worked for. Journalists-and many campaigners-think that this is what it means to critically appraise a scientific argument, and seem rather proud of themselves when they do it.

The scientific content of stories-the actual experimental evidence-is brushed over and replaced with didactic statements from authority figures on either side of the debate, which contributes to a pervasive sense that scientific advice is somehow arbitrary, and predicated upon a social role-the 'expert'-rather than on transparent and readily understandable empirical evidence. Worse than this, other elements are brought into the foreground: political issues, Tony Blair's refusal to say whether his baby had received the vaccine, mythical narratives, a lionised 'maverick' scientist, and emotive appeals from parents.

A reasonable member of the public, primed with such a compelling battery of human narrative, would be perfectly ent.i.tled to regard any expert who claimed MMR was safe as thoughtless and dismissive, especially if that claim came without any apparent supporting evidence.

The story was also compelling because, like GM food, the MMR story seemed to fit a fairly simple moral template, and one which I myself would subscribe to: big corporations are often dodgy, and politicians are not to be trusted. But it matters whether your political and moral hunches are carried in the right vehicle. Speaking only for myself, I am very wary of drug companies, not because I think all medicine is bad, but because I know they have hidden unflattering data, and because I have seen their promotional material misrepresent science. I also happen to be very wary of GM food-but not because of any inherent flaws in the technology, and not because I think it is uniquely dangerous. Somewhere between splicing in genes for products that will treat haemophilia at one end, and releasing genes for antibiotic resistance into the wild at the other, lies a sensible middle path for the regulation of GM, but there's nothing desperately remarkable or uniquely dangerous about it as a technology.

Despite all that, I remain extremely wary of GM for reasons that have nothing to do with the science, simply because it has created a dangerous power shift in agriculture, and 'terminator seeds', which die at the end of the season, are a way to increase farmers' dependency, both nationally and in the developing world, while placing the global food supply in the hands of multinational corporations. If you really want to dig deeper, Monsanto is also very simply an unpleasant company (it made Agent Orange during the Vietnam War, for example).

Witnessing the blind, seething, thoughtless campaigns against MMR and GM-which minor the infantile train of thought that 'homeopathy works because the Vioxx side-effects were covered up by Merck'-it's easy to experience a pervasive sense of lost political opportunities, that somehow all of our valuable indignation about development issues, the role of big money in our society, and frank corporate malpractice, is being diverted away from anywhere it could be valid and useful, and into puerile, mythical fantasies. It strikes me that if you genuinely care about big business, the environment and health, then you're wasting your time with jokers like Pusztai and Wakefield.