MMR: Science and fiction by Richard Horton, Granta, 拢7.99, ISBN 1862077649
MMR and Autism by Michael Fitzpatrick, Routledge, 拢14.99, ISBN 0415321794 Reviewed by Lorna Wing
A GREAT row began on 28 February 1998. On that day The Lancet published a paper by Andrew Wakefield and colleagues suggesting that there was a link between vaccination against measles, mumps and rubella (MMR) and autism. The link was mediated through 鈥渁utistic enterocolitis鈥�. Richard Horton, editor of The Lancet, explains in MMR why he originally accepted the paper and why he now feels he should have rejected it.
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Horton begins with the events following publication and the intensity of the emotion evoked on both sides of the debate. He examines the safety of the MMR vaccine and the rare complications that, unlike autism, have been proved to be due to the vaccination. He concludes that the available evidence shows the vaccine is very safe. The MMR controversy did, however, reveal the inadequacy of the way in which vaccines were evaluated for safety. Horton also considers the growing commercial support for science and the effect this could have in compromising objectivity.
In the chapter 鈥淎lone with autism鈥�, he makes clear the difficulties faced by parents and the problems they have in making sense of the MMR debate. Turning from autism to measles, Horton brings home the distressing complications, especially in developing countries, of this highly infectious illness. With vaccination, he points out, measles is preventable. This chapter should be compulsory reading for those who believe that measles is a mild illness and a lesser risk than the MMR vaccination.
Horton ends the book with a discussion of how the media present scientific controversies, and the corrosion of public trust in science, scientists and authorities in general. He suggests founding two new organisations for truly independent scrutiny of science and scientific controversies: a national agency for science and health, and a council for research integrity.
Horton uses the MMR problem as a starting point for a challenging discussion of the difficulties in enabling the lay public to evaluate scientific evidence, and the wider issues of scientific and political integrity.
In contrast, Michael Fitzpatrick鈥檚 book, MMR and Autism, concentrates mainly on the MMR story and gives, in detail, the available evidence, virtually all of which is against the theory of a link with autism. The two books complement each other very well.
On finishing Horton鈥檚 book, I was delighted to read that the royalties will be given to the Autism Intervention Research Trust, of which I am a trustee.