MMR: Science and Fiction. Exploring a vaccine crisis
by Richard Horton, editor of The Lancet.

This is one of the more thought-provoking books I have read recently, and certainly the most compelling book on its subject.

Horton first gives some detailed background, from the perspective of an insider, about the “MMR crisis” that was ignited when his journal, The Lancet, published a paper in 1998 by Andrew Wakefield raising the possibility of a link between MMR and autism.

His conclusion on that controversy is that the possible autism link was a tentative preliminary suggestion, which has now been totally discredited. He argues that both the original paper and its subsequent (partial) retraction were blown out of all proportion by a media more interested in sensationalism than truth, reporting to a society that does not know how to reason about risk and has lost all trust in science. Notwithstanding serious errors of judgement that Wakefield committed, Horton has some sympathy for him, and in particular for the way that Wakefield has been unjustly vilified for his role in the MMR crisis. Horton also defends his own role, and that of The Lancet, in the affair, and examines both the case for the MMR vaccine and the need for further research into the causes and treatment of autism.

What is most interesting in Horton’s book is his analysis of the lessons to be learned from the whole sorry business.

He argues that science needs to change in order to regain the trust of the public. He points out the commercialisation of science, which undermines its independence and objectivity. He also points to the lack of any strong, independent or trusted public institutions to control scientific ethics, to investigate and debate scientific controversies or to improve communication between scientists and the public. He argues that the media too has lost its independence and objectivity as a result of commercialisation leading to a hunger for what is sensational and controversial over what is merely true.

There is also a fundamental disagreement, it seems, between science and the media about what it means to give a “balanced” account of a debate. The media, Horton says, consider that a balanced report must give equal time to each side of the debate. Science believes that a balanced account gives each side weight according to the strength of the evidence supporting that side. Of course, this can mean – as happened with MMR and autism – that science and media have radically different ideas about what amounts to a fair and balanced account of a controversy.

Horton argues strongly for two new public institutions. The Council for Research Integrity (CRI) would examine conflicts of interest or other ethical issues, and would work to ensure the integrity of scientific research. The National Agency for Science and Health (NASH) would be a forum, including both scientists and lay people, existing to investigate scientific controversy. NASH would, Horton suggests, provide both journalists and the public with the tools to understand and assess scientific issues such as vaccine risks.

It may be that Horton’s vision for NASH and the CRI is unrealistic – there certainly does not appear to be any political will to create such institutions. Nevertheless, his book is a telling account of the relationship between science, journalism and the public and it throws welcome light onto the MMR debate. His voice is clear and authoritative and I recommend his book.