This week, Dr. Andrew Wakefield's now infamous study linking the MMR vaccine to autism was finally retracted by the prestigious Lancet medical journal. The move came days after medical officials in the United Kingdom found the doctor guilty of multiple ethics violations. For doctors, this is a victory -- but a bittersweet one.
As a pediatrician, I grapple daily with what Wakefield wrought: parents who are twisted in knots -- to the point of tears -- about whether to immunize their child. In the 12 years since the publication of Wakefield's study, 10 of his fellow co-authors have denounced him, and an unremitting series of revelations have exposed just how corrupt his motives and methods were. Most important, multiple studies verified there is no link between the MMR (or any other) vaccine and autism. Meanwhile, infectious diseases once confined to medical history have broken out in our communities. To say the retraction is criminally overdue is an understatement.
Further, even as Wakefield's research is expunged from the scientific record, what he spawned -- a well-funded, vocal, even rabid movement -- will remain. Without him, poster girl Jenny McCarthy would have been abandoned in the MTV archives instead of smugly crowing to Time magazine, "I do believe sadly it's going to take some diseases coming back to realize that we need to change and develop vaccines that are safe. If the vaccine companies are not listening to us, it's their f___ing fault that the diseases are coming back. They're making a product that's s___ ." And anti-vaccine darling David Kirby would split his time between running a P.R. firm and writing pithy articles about art and aircraft instead of turning speculation and rumor into a Kennedy-esque vaccine-autism conspiracy theory. Finally, Wakefield himself stands to be completely unaffected by both the U.K. medical community (which could revoke his license to practice there) and the Lancet's decision. He long ago settled here in the U.S. and successfully peddles his views through his Thoughtful House autism center in Texas.
Still, while the media busily finger-wagged, blogged and tweeted about the damnation of Andrew Wakefield, I wondered whether it considered its own complicity in the whole sordid affair.
The anti-vaccine hysteria, after all, began like so many other big stories: with a press conference. That's where Andrew Wakefield first staked his claim that the MMR vaccine caused autism, according to Paul Offit's book, "Autism's False Prophets." Wakefield wasn't flanked by doctors or hospital officials but by P.R. folks he had hired himself. "One case of [autism] is too many," he said. "It's a moral issue for me, and I can't support the continued use of [the MMR vaccine] until this issue has been resolved."
The problem, of course, is that a news conference loads a gun that the media usually pulls the trigger on: Headlines like "Ban Three-in-One Jab, Doctors Urge" started rolling off the presses. While measles made a tragic resurgence, few reporters attempted to scrutinize Wakefield or his audacious claim. (Even Salon has its own history of bad reporting on the topic, in a controversial and inaccurate 2005 piece by Robert F. Kennedy Jr.)
Former CNN reporter Gary Schwitzer is a University of Minnesota professor whose expertise is healthcare and the media, and he sees complicated issues in their intersection. "I tell my students to look for stories that are counterintuitive, because they can make good news," he told me. But if reporters don't care about the underlying science, and don't have the tools to dissect and question it, "it can be very easy to get excited about hazards and scares" that lack a credible basis.
Then there's the pressure to report something, anything to make your bosses happy. Schwitzer told me about a story he covered for CNN in the 1980s, when Utah doctors first tried to implant an artificial heart in a patient. He recalled how the doctors would have hourly news conferences updating the patient's condition. In it, they mostly recited mundane facts, like the amount of urine the patient was producing. But Schwitzer had to get on camera almost hourly and update viewers with something, whatever it might be.
Frankly, progress in science and medicine occurs much more slowly than the news cycle can tolerate. "Science," says Schwitzer, "is like a slow winding stream. It has ebbs and flows, and twists and changes in its path that, if you don't follow, can fool you. But too many reporters, unfortunately, like to dip their toe in the water, run back and report about it without following that river to where it leads."
Rather than dig for details, many reporters rely on "balance" instead. My favorite comment about this comes from, of all people, Arianna Huffington. Sometimes, she says, there simply aren't two sides to a story. Evolution, for instance. Or global warming. And given the weight of scientific, legal and ethical evidence against anti-vaccinationists, you'd think Huffington would heed her own rhetoric. Yet there was her Web site, with stories turning Wakefield into a martyr and twisting innuendo into medical fact. And it's not just HuffPo -- CNN, in a report on Wakefield, added "balance" to its coverage by featuring Kim Stagliano, the co-founder of anti-vaccine group Age of Autism.
But it's unfair to hold the mainstream media completely responsible for its behavior. The Lancet, one of the world's most well-known medical publications, played an enormous role here, showing us how medical journals are at risk for their own kinds of malpractice. Offit's "False Prophets" details how Richard Horton, then the journal's editor in chief, seemed enamored of the notion of publishing something muckraking. As Offit writes, "By ignoring the criticisms of several reviewers, the warnings of an accompanying editorial, Wakefield's history of holding press conferences, a British press primed for controversy, and a public distrustful of pubic health officials, Richard Horton allowed the public to question the safety of a vaccine based on flimsy, irreproducible data. The loss of the public trust that followed was entirely predictable."
Gary Schwitzer points out that, like magazines, newspapers and the Web, medical journals have business interests as well. For example, major journals regularly publish their own news releases. "They don't carry everything, just the sexier items." Those items, he believes, are probably not chosen by a committee of peer reviewers, but rather by employees whose goal is to increase the visibility, prestige, advertising and reprint revenue of their publication. Also, the very fact that these releases come from a medical journal lead reporters to believe "it's etched in stone on a mountaintop." Reporters latch on, using the old standby "according to a study in the [fill in title of journal]" to lend credibility to their shocking story. The problem, of course, is that nobody bothers to check the credibility of the study in the first place.
Still, despite it all, there is room for a little hope between the media and medicine. The inflection point in the history of the Andrew Wakefield Affair came because one individual wouldn't stop asking questions, raising doubts and digging deeper. His name is Brian Deer, an investigative reporter for the Times of London. It was his research and reporting that exposed Wakefield's malfeasance. When Deer first confronted Richard Horton and the Lancet editors with what he had discovered back in 2004, even Horton -- stubbornly defensive even now about his decision to publish Wakefield's study -- gasped. "The allegations made by Deer, as I saw them were devastating," he recalled.
Deer's reputation and hard work got a big pop-culture boost on this side of the pond as well. It was his reporting that inspired Keith Olbermann to declare Andrew Wakefield the "Worst Person in the World" on his show a year ago .
But the next day, Olbermann, like some preying mantis eating its own, turned around and anointed Brian Deer as one of the worst persons in the world for having an alleged conflict of interest in the Wakefield investigation himself. He did not, as it turns out; the allegation proved false, but not before anti-vaccine bullies at HuffPo and the Age of Autism trumpeted it on the Web. It was hard to believe Olbermann hadn't been pressured by them.
Bittersweet, indeed.
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