MMR and the media - a historical perspective - News & Features
31 December 2013
Looking back at 2013, one can’t ignore a story that began in February in South Wales and continued throughout the year; the UK has experienced its largest outbreak of measles for nearly 20 years. A public health campaign was begun to roll out the measles, mumps and rubella triple vaccine (MMR) to an area where negative media reports in the late nineties and early noughties pushed vaccine uptake well below the required level for herd immunity. In the following piece, which was originally published in the December edition of Microbiologist, John Illman, a health and medical journalist who has worked as a reporter and editor for many of the UK’s big national papers, discusses the anatomy of the MMR media debacle.
The measles, mumps and rubella triple vaccine (MMR) was introduced in the UK in 1988. In 1998, a report in The Lancet suggested that it might cause autism. MMR has been in the headlines ever since, generating complaints about inaccurate, sensational and naive media reporting. Such controversy discourages scientists and clinicians from working with reporters. This article suggests, among other things, that this may be counterproductive.
The paper published in The Lancet concerned 12 children with bowel and behavioural problems. At a press conference called by the Royal Free Hospital, London, the lead author, Dr Andrew Wakefield, surprised colleagues by advocating single vaccines instead of MMR. The paper did not propose this, but the conference was outside peer review. No one should have been surprised – the single vaccine message had already been distributed in a video news release.
The study was very small, but The Lancet was a leading international journal, the Royal Free was a leading teaching hospital and such press conferences were not everyday occurrences. Media interest was thus legitimate, but only The Guardian, The Independent and the Daily Mail reported the study, with heavy emphasis on Government advice to disregard Wakefield.
Supported by various newspapers, including the Daily Mail, Wakefield subsequently raised further questions about MMR. In 2001, Prime Minister Tony Blair precipitated extensive media coverage by refusing to confirm if his baby son Leo had been vaccinated. He insisted that this was a private matter, only to generate speculation that he did not trust his own Health Secretary’s advice. (It later emerged that Leo had been vaccinated.) In 1998−9, 88% of children had been immunized against measles, mumps and rubella. By 2003−4, coverage had fallen to 80% and to 61% in some London areas. In 2004, a Medical Research Council supported study concluded that there was no evidence linking MMR to autism.
In 2010, the General Medical Council struck Wakefield off the Medical Register for serious professional misconduct over his research methods. Ironically perhaps, it was the tenacity and persistence of a journalist, Brian Deer, who uncovered Wakefield’s extensive conflicts of interest and unethical research practice. Deer’s work in The Sunday Times led to the retraction of the 1998 Lancet report.
In 2013, the Department of Health launched a national catch-up vaccination campaign in response to a rise in measles cases and an epidemic in Swansea. This was mostly attributed to unprotected 10−16 year olds who were not vaccinated in the late 1990s and early 2000s.
The cultural context
The media is alleged to create health scares in order to provoke panic and banner headlines. There is sometimes some truth in these accusations, but the head-on collision between two of the biggest drivers in contemporary life – science and the preoccupation with risk – has created what the sociologist Frank Furedi calls a culture of fear. Previous generations did not ask: should we eat beef? Do mobile phones cause brain cancer? Does living near high-voltage power lines cause cancer? Should we take aspirin to avoid heart attacks? Should we vaccinate our children?
The media did not create this culture, but it does fuel it. However, the media is primarily reactive, not proactive. A study of medical journals in Scandinavia and the UK between 1967 and 1991 found a highly significant increase in the use of the term ‘risk’. During the first five years the number of ‘risk’ articles published was about 1,000 – for the last five years there were over 80,000. The media should and did reflect this trend.
During the same period, the relationship between doctors and patients changed, and people became increasingly interested in their health. Again, this was not because of the media, but because of the impact of consumerism; self-help groups; the women’s liberation movement, which campaigned against the medicalization of everyday life; and the HIV/AIDS lobby, which provided a template for thousands of advocacy groups for patients with diseases ranging from depression to breast cancer.
How has science, the biggest ever driver of change, changed? Ironically, researchers are still encouraged, as they were half a century ago, to remain at the bench and let their publications talk for them. However, the MMR story is one of many examples exploding the myth that evidence speaks for itself. This may be especially true of vaccination, which has been controversial ever since Edward Jenner’s pioneering work against smallpox in the early 1800s.
Research suggests that scientists and healthcare professionals assume that the public will make the right healthcare choices if they are provided with information; this seems logical, but imagine the following scenario. Jane is a young mother who, ironically, because of the success of vaccination, has never seen a case of measles and knows nothing about herd immunity. After reading a harrowing account about a seven-year-old who developed autism after MMR, she cancels her child’s vaccination appointment.
Story telling: statistics vs case histories
Should such emotionally charged stories be published? I believe so because vaccination is not risk-free. There were 24 Government awards to vaccine-damaged children totalling more than £2 million in the 10 years to 2013/14 (Press statement to John Illman from the Department for Work and Pensions, September 2013). However, context is everything. Critics complain that the media has highlighted the plight of the tiny minority of vaccine-damaged children without stressing the benefits of vaccination to millions of others; the dangers of measles, mumps and rubella; and the risks of single vaccines which leave children unprotected for longer and involve several clinic visits. Yet, to quote one example, the £3 million campaign launched by the Government in 2001, the year of the Leo Blair controversy, to allay parents’ fears was widely reported.
So what went wrong? Scientists, I believe, over-estimate the power of statistics in mass communication. Research into what persuaded people to give to charity showed that the better statistically informed the potential donors were, the less money they gave. People who read a short emotional appeal about an African child at risk from hunger gave more than twice as much as those who just saw raw statistics about threats to millions of Africans. Thus, the facelessness of statistics, one of the great strengths in science, can be an abject failure in mass communication.
This presents a unique challenge in the MMR story. A media case history about a child who has been successfully vaccinated would be profoundly dull – the child would be one of millions. Conversely, a story about a “vaccine-damaged” child may be extremely powerful by virtue of being different.
If case histories carry more weight than statistics, why not adopt more of a storytelling approach, combining case histories with statistics? Storytelling is an integral part of every culture. From a very young age we listen to and tell stories. Medical stories are encapsulated in case histories in both medical education and medical journalism. Stories help us – in a way that statistics cannot – to define ourselves and to compare ourselves with others, giving us a sense of perspective about our place in the scheme of things.
No one recognized this better than the late children’s author Roald Dahl who declared: “It really is almost a crime to allow your child to go unimmunized” (as quoted here). Dahl knew the power of this sound bite. His message was reinforced by the death of his own daughter from measles at the age of seven before a vaccine became available. Hers is one of many powerful case histories.
Media case histories have their critics. For example, Professor Raymond Tallis complains about “the curse of the media anecdote” and the habit of giving appealing individuals, with their moving stories, at least as much credence coverage as unappealing data; and of preferring faces to graphs and vox-pops to statistics. The anecdote may be an imperfect tool, but communication via p-values and confidence intervals resonate with only a small minority. The real problem is not so much the anecdote, as its misuse. The challenge is in achieving balance – easier said than done.
Journalists are trained to present both sides of the story in the interest of objectivity and impartiality. This “balance” can work well in a political story in which a Government minister and an opposition spokesperson have equal time or space. It may not work so well in science stories in which two opposite viewpoints are presented as if they are equal.
In Health, Risk and News: The MMR Vaccine and the Media, Tammy Boyce complains that what is missing from much of the coverage is any sense of the weight of scientific evidence, which is firmly stacked on the side of the safety of the MMR vaccine. When examining balance, she adds, it is not just a matter of counting which side appeared more often. Balance is also influenced by the way journalists use scientific evidence. Boyce argues that by selecting equal numbers of scientists for and against MMR, journalists suggest that scientists and healthcare professionals overall are split on the issue when, in reality, the vast majority support MMR. Mark Henderson’s The Geek Manifesto: Why Science Matters, a must-read for any mass communication student, also highlights this legitimate concern.
How does a journalist achieve “balance”? The answer in MMR may seem to be clear, but I have been puzzling over this question for more than 30 years. The most difficult thing to do as a journalist is to present the evidence appropriately, especially in science which is inherently controversial. It is easy enough to report what you are told, but this is rarely enough. Evidence needs to be interpreted and spoken for, and it shifts and changes according to who is doing the interpreting.
Working with the media – or not?
In his widely acclaimed Bad Science, Dr Ben Goldacre criticizes the media for poor reporting, especially over MMR. Much of what he says is true, but such attacks discourage scientists and clinicians from working with the media. Avoiding media questions for fear that they may exacerbate public alarm may open up the ground to commercial interests who exploit fear for profit; and to pressure groups who disseminate misleading information. Saying “no” to a media interview request may mean your view will go unrepresented or be misinterpreted as meaning you have something to hide.
For example, in 2003, Channel Five broadcast a hagiographic drama about Wakefield, followed by a studio debate with the man himself. Many experts on public health, paediatrics, autism and vaccination refused to take part. This principled, but misguided, stand robbed viewers of the authority of those who were best able to challenge Wakefield before a huge audience.
Criticism of the media over its reporting in MMR is justified, but healthcare professionals and scientists need to recognize that if they do not accept opportunities to represent their views, they may be misrepresented or go unheard.
John Illman Communications specializes in media and presentation skills training. A former Editor of GP, he has also worked as medical correspondent on the Daily Mail and Health Editor on The Guardian. His sixth book, “Handling the media: communication skills for healthcare professionals”, is due out early in 2014.
You can hear John discussing some of the issues surrounding MMR in the media with SfAM's Nancy Mendoza in a recent edition of Micropod.