Editorial: Dodgy science is bad medicine

It's a sad fact that the retraction this week of a controversial research paper on the effects of a common childhood vaccination will not have anything like the impact on public opinion of the paper's original publication.

Poet John Milton observed that "evil news rides post, while good news bates" and it's particularly true of medical alarm: fear penetrates the public consciousness more deeply than reassurance, and it latches on more firmly, too. We would sooner worry than believe that there is nothing to worry about.

In 1998, the British Medical Journal, the Lancet, published a paper by physician Andrew Wakefield and others that suggested a link between the measles, mumps and rubella (MMR) vaccine and autism in children.

The paper and Wakefield's subsequent statements that parents should beware of the vaccine led to a slump to below 80 per cent in vaccination levels in the UK and around the world - in New Zealand, compliance dropped to barely 70 per cent - as anxious parents withheld permission for their children to start or complete the two-dose course.

Predictably, cases of measles rose. Britain saw its first death from the disease for 14 years. Mumps reached epidemic levels in Britain in 2005.

The controversy would have been music to the ears of anti-vaccination campaigners, who work assiduously to foment a global distrust of the MMR vaccine in particular and vaccination in general. Wakefield was hailed as a hero fighting to prevent another thalidomide disaster. But his science was dodgy, his research unethical and his reporting dishonest.

The Lancet's online announcement that "we fully retract this paper from the published record" followed a finding by the General Medical Council, the statutory regulatory authority of doctors in the UK, that Wakefield had acted "dishonestly and irresponsibly" in reporting his research.

The evidence, of conflict of interest, data-fixing and ethical breaches, makes grim reading. But grimmer still are the effects of the needless anxiety his "findings" caused.

As Helen Petoussis-Harris, the director of research at the University of Auckland's Immunisation Advisory Centre, remarked: the "groundless controversy" had led to many preventable cases of disease internationally and in New Zealand.

That almost goes without saying. The widespread use of the MMR vaccine in the mid-1960s cut the incidence of measles by 90 per cent within two years in developed countries.

A similar result was achieved with rubella. These are not insignificant results - they translate into the saving of 5200 lives and 17,400 cases of brain damage in 20 years.

Spurning vaccine - and maligning the wisdom and motives of those who administer vaccination programmes - is, of course, a privilege of healthy middle-class Westerners.

In Africa and Southeast Asia, where measles remains a leading cause of vaccine-preventable childhood death, parents would love to have access to a vaccine to spurn.

The tragedy of Wakefield's dishonesty is that it lent strength to those who regard vaccination as a conspiracy between venal doctors and evil Big Pharma.

Reluctant though its opponents may be to accept it, the MMR vaccine is based on good science: it has been administered to more than half a billion children over more than a generation.

Minute numbers of adverse reactions, some serious, have been documented, studied and exhaustively reported by clinicians and researchers who, strange as it may seem, are as anxious as any parent to improve the efficacy of vaccines and cut the incidence of disease.

Wakefield's research reported on a dozen children and 10 of his 12 co-authors would eventually retract their support for the idea that there was a link between the vaccine and the symptoms.

Ben Goldacre, the English doctor who writes a weekly column in the Guardian called "Bad Science", blames the media for the damage done, saying that they gave undue prominence to Wakefield's findings and ignored dissenting voices.

"It would be nice," he writes, "if we could say the media had learned their lessons and recognised the importance of scientific evidence, rather than one bloke's hunch."

As a general observation about the nature of news, his remark has validity - though he may need to reconsider John Milton's words above.

But two other matters bear repeating. First, Wakefield was finally undone not by his peers but by the press - by the dogged work of an investigative journalist for the Sunday Times. A

nd his research was not "one bloke's hunch": it was a peer-reviewed academic paper by 13 authors published in one of the world's leading medical journals.

When the dust has cleared from this sorry affair, the editors of the Lancet will need to account to the world for having published such shoddy work in the first place.