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The Spin Doctor
Scares and Flares in News Coverage


By Ivan Oransky

Posted August 23, 2000


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•  References
 
•  Endlinks

 

 

 

 

 

 

 
The coverage highlighted parents' fears and concerns.
 

 

 

 

 

 

 

 
A potential conflict of interest is that the authors were quoted as health experts.
 

 

 

 

 

 

 

 
If you believe the coverage, a child became autistic immediately after receiving an MMR vaccination.
 

 

 

 

 

 

 

 
Scores of similar blow-ups have occurred in the last two decades.
 

Although it's nice to know that medical stories can have an impact, that impact is not always beneficial, as a study published in the June issue of the Journal of Epidemiology and Public Health claimed [1]. A "protracted campaign" by the South Wales Evening Post throughout 1997consisting of 5 front-page stories, 3 opinion pieces, and at least 18 other articles on the supposed dangers of measles-mumps-rubella (MMR) vaccinations—reduced immunization rates by 13.6% in the paper's circulation area, and 2.4% in the rest of Wales.

Dr. Brendan Mason, co-author of the study, told the Spin Doctor that although he can't be sure that the Evening Post campaign caused the decrease, all the evidence points in that direction. For example, in the part of the country not covered by that paper, less of a decline occurred.

George Edwards, the South Wales Evening Post's editor, said the stories were not part of a "true campaign," and that his paper was only one of many writing on the issue. "Had it been a campaign we would have been encouraging parents not to trust the vaccination," Edwards said. "What we most certainly did do was highlight the fears and concerns of a number of parents based on their own experiences. They did not make these stories up, remember."

A storm has been brewing in Great Britain over the MMR vaccine since the publication of a Lancet study in 1998 by Dr. Andrew Wakefield, [2] claiming that MMR vaccinations caused gastrointestinal disorders and pervasive developmental disorder, a condition similar to autism, in 12 children. An accompanying editorial [3] by Drs. Robert Chen and Frank DeStefano of the US Centers for Disease Control and Prevention found a number of issues, such as selection bias, with the study, but British newspapers, hardly known to disdain sensationalism, were off and running. That issue of the journal was followed by the publication of another study in the Lancet in 1999 that found no association between MMR and autism [4], and another editorial by Chen and DeStefano [5]. The CDC's position is that there is no proven association between MMR vaccines and autism [6], and according to Ben Schwartz, of the CDC's National Immunization Program, there has been no decline in MMR vaccination rates in the US.

The implications of Mason's Journal of Epidemiology and Public Health study alarmed the Spin Doctor, who reviewed more than 30 newspaper articles sent to him by an editor at the South Wales Evening Post. Some were published after the ones studied by Mason, and there is no way to know whether the selection is representative, but several points emerged:

  • Mason and Peter Donnelly, his co-author, were frequently quoted, during the period they studied, by SWEP as health experts. That might have been worth mentioning in the study as a potential conflict of interest.

  • From a medical-journalism standpoint, the news coverage seemed fairly balanced. For example, on March 25, 1998, SWEP ran a profile of one couple who, after some soul-searching, had their child—smiling happily in the accompanying photo—immunized. Editor George Edwards told the Spin Doctor, "At all times the health authorities were given every chance to respond to claims and these responses were always published." According to the CDC's Schwartz, commenting generally because he did not review the SWEP coverage, "he said, she said" stories may look balanced, but mislead "because not all 'science' is equal."

  • In this case, the views of the anti-vaccine coalition, led by one Jackie Eckton of Port Talbot, Wales, were probably granted too much credence, and the insight into the science behind the Wakefield study was weak. The CDC's Schwartz: "If a reporter is going to present a story on vaccination and alleged adverse events, he/she needs to understand the issues well enough and be able to judge the quality of the research that serves as the basis of the allegation—and the response to it—in order to present a fair portrayal of the issue." One case report, for example, presented a child who appeared to become autistic immediately upon receiving an MMR vaccination, not a likely scenario. A story on July 6, 1998, led with, "Fears of a massive rise in measles cases in Swansea after the MMR jabs scare have proved unfounded," yet it was too soon—less than a year—after the "jabs scare" to have seen any rise in measles cases. However, on July 27, 2000, SWEP published a story duly reporting that a health official worried that an Irish measles outbreak, which has affected more than 1,200 children and is thought to be due to a similar decline in vaccinations, could be headed for South Wales.

  • The editorials cited by the study did not, for the most part, object to immunization completely. They instead called for separate "jabs" for measles, mumps, and rubella vaccines, spaced out over time. Unfortunately, as several of the paper's stories noted, such a vaccine is not available. British health authorities do not see the need to support its production, though at least one prominent official supports the three-pronged approach according to a July 29, 1998, story. According to the CDC's Schwartz, while three separate shots would provide the same protection against the three illnesses as a single shot, "it would result in delayed vaccination" and probably result in some children not being vaccinated against all three. Decreasing vaccine coverage would create much greater susceptibility."

  • The paper may have offered at least implicit support for the anti-vaccine parents group. On March 7, 1998, the paper published the phone numbers of that group's leaders, a practice that would have raised eyebrows among journalists in the US. Edwards: "The issue of the telephone number is a red herring. There are any number of newspaper practices in the USA which might raise eyebrows in Britain, but it is quite usual here to provide contact numbers as it is seen as a reader service."

Cochrane Vaccines Field Coordinator Dr. Tom Jefferson, who wrote an editorial accompanying the Mason study [7], told the Spin Doctor that scores of similar blow-ups over vaccination have occurred in the last two decades, citing recent scares over an association of hepatitis B with multiple sclerosis in France, and childhood vaccinations with type 2 diabetes in the US.

"We need a more mature debate," Brendan Mason told the Spin Doctor. "Doctors must communicate the certainties and uncertainties of the science that underpins medicine. Openness and transparency are essential."

Edwards suggested that the medical experts were pots calling the kettle black. "The reaction of the medical profession to evidence of damage to children was to claim coincidence," Edwards said. "We might as well say it was a coincidence that the take-up for MMR fell after we published our series of stories."

 

A study in contrasts

 

 

 

 

 

 

 
Angell has never been shy about airing the Journal's dirty laundry.
 

The naming in May of Dr. Jeffrey Drazen as the new editor of the New England Journal of Medicine was fraught with controversy. Critics were concerned that Drazen, an asthma researcher at the Brigham and Women's Hospital in Boston, has had strong ties to at least 21 pharmaceutical companies, according to USA Today [8]. That newspaper also reported that on one occasion Drazen made "false or misleading" statements about the value of a drug sold by a company that employed him as a consultant [9]. Drazen has said he will sever all drug company ties.

It was instructive to read, then, how Dr. Marcia Angell, his predecessor at the Journal, and Drazen handled the transfer of power. Angell, although sometimes late in airing the Journal's dirty laundry, has never been shy about doing so, whether it was on AIDS research in Africa [10], conflicts of interest (not unlike Drazen's) between "Drug Therapy" authors and the companies who produce their drugs [11, 12], or on the forced resignation of Angell's own predecessor, Dr. Jerome Kassirer [13], a situation that led to an examination of the relationship between the Journal and its owner, the Massachusetts Medical Society.

While not explicitly mentioning Drazen's commercial ties, Angell, in her "farewell" on June 29 [14], was quite emphatic that the Journal "has remained independent of any vested interests or considerations of commercialism, publicity, or expediency.... I have confidence," she continued, "that Dr. Drazen will continue this tradition."

The following week, Drazen made no references to his own conflicts of interest [15]. Instead, he reveled in the glory of the Journal's past, and offered his plans for the future—which sounded an awful lot like the status quo. The Spin Doctor thinks that given the agenda of the Journal's owners, who made it clear during their ouster of Kassirer that they plan to mass-market and dilute the Journal brand, Drazen did not want to give the impression that he was going to rock the boat.

 

Ivan Oransky, MD, is Editor of Praxis Post.

   


References

  1. Mason BW, Donnelly PD: Impact of a local newspaper campaign on the uptake of the measles mumps and rubella vaccine. J Epidemiol Community Health. 2000 Jun;54(6):473-74. [ PubMed abstract ]
  2. Wakefield AJ, Murch SH, Anthony A: Ileal-lymphoif-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998 Feb 28;351(9103):637-41 [ PubMed abstract ]
  3. Chen RT, DeStefano F: Vaccine adverse events: causal or coincidental? Lancet. 1998 Feb 28;351(9103):611-12. [ PubMed abstract ]
  4. Taylor B, Miller E, Farrington CP: Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet. 1999 Jun 12;353(9169):2026-029. [ PubMed abstract ]
  5. DeStefano F, Chen RT: Negative association between MMR and autism. Lancet. 1999 Jun 12;353(9169):1987-88. [ PubMed abstract ]
  6. Centers for Disease Control and Prevention: MMR vaccine and autism [press release online]. Accessed 2000 Aug 16: http://www.cdc.gov/nip/vacsafe/concerns/autism/autism-mmr.htm.
  7. Jefferson T: Real or perceived adverse effects of vaccines and the media—a tale of our times. J Epidemiol Community Health. 2000 Jun;54(6):402-3. [ PubMed abstract ]
  8. Cauchon D: Researchers' financial ties cause concern. USA Today. 2000 May 30. http://www.usatoday.com/life/health/drugs/lhdru127.htm
  9. Cauchon D: Editor overstated drug's safety, FDA says. USA Today. 2000 May 30. http://www.usatoday.com/life/health/drugs/lhdru126.htm
  10. Angell M: Investigators' responsibilities for human subjects in developing countries. N Engl J Med. 2000 Mar 30;342(13):967-9. [ PubMed abstract ]
  11. Angell M, Utiger RD, Wood AJ: Disclosure of authors' conflicts of interest: a follow-up. N Engl J Med. 2000 Feb 24;342(8):586-7. [ PubMed abstract ]
  12. Angell M, Wood A: Authors' conflicts of interest: A disclosure and editors reply. N Engl J Med. 1999 Nov 18;341(21).
  13. Angell M: The journal and its owner—resolving the crisis. N Engl J Med. 1999 Sep 2;341(10):752. [ PubMed abstract ]
  14. Angell M: A farewell. N Engl J Med. 2000 Jun 29;342(26):1989. [ PubMed abstract ]
  15. Drazen JM: Looking forward to serving you every week. N Engl J Med. 2000 Jul 6;343(1):57-8. [ PubMed abstract ]

 

   
     
 
Endlinks

The Immunization Action Coalition  This nonprofit organization offers a brief summary of immunization recommendations for adults as well as more detailed information, including translations into 22 languages of the Centers for Disease Control and Prevention's Vaccine Information Statements. http://www.immunize.org/catg.d/p2011b.htm

MMR and Autism  A discussion of the evidence linking the MMR vaccine to autism and alternatives to the MMR vaccine from the National Autistic Society. http://www.oneworld.org/autism_uk/faqs/qmmr.html

Institute for Vaccine Safety  Current news, updates, and discussions on many vaccines, including anthrax, hepatitis B, and MMR. http://www.vaccinesafety.edu/



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