Truth and Health Consequences
SCOTT C. RATZAN
Most of us reading this Journal are engaged with improving
the health of the public through a variety of interventions. In our
quest, the ethical base to do no harm and advance with scientific integrity
and humanistic values are implicit. Nonetheless, in 2004, modern day
communication media—whether it be medical journals (e.g., the Lancet),
the popular press (e.g., USA Today) or interactive media—straddle
the ethical fence where fact and fiction blur in the instantaneous and
repetitive 24/7 news environment.
In issues relating to health and security, such communication
faux pas have great consequence. One of the best—and most unfortunate—example
– relates to the Measles, Mumps, and Rubella (MMR) vaccine (Clements
and Ratzan, 2003). As autism is usually diagnosed during the toddler
years, when children receive many childhood vaccinations, some believe
that the causes of autism are vaccine related. In 1998 researchers from
the Royal Free Hospital and School of Medicine London published a study,
linking autism to the MMR vaccine. Andrew Wakefield, lead author of
this study, reported that two-thirds of 12 cases studied demonstrated
an ‘‘association’’ of the onset of behavioral symptoms
with MMR vaccination, spent nearly 6 years on a public campaign proclaiming
this hypothesis as fact. This led to a diminution of MMR vaccination
in the United Kingdom, as well as continued distrust of advances related
to therapeutic interventions in children. Thousands of parents with
children with behavioral symptoms continue to look for
causation, often turning to immunization as the agent.
Given such media coverage and need for the ‘‘truth,’’
a panel of experts was convened by the US Institute of Medicine in 2001.
The expert committee rejected the contention that vaccination with MMR
caused autism, on the basis of overall data at a population level. The
panel did, however, encourage additional studies to assess the possibility
that a few children might be at increased risk. The studies ensued and
doubt continued.
In 2004, the London Sunday Times ran a front-page story
uncovering Dr. Wakefield’s motivation and proclaiming that the
Legal Aid Board in the U.K. paid Dr. Wakefield £55,000 ($102,690)
to investigate children who were allegedly vaccine-damaged for a possible
legal action by their parents. Dr. Wakefield’s research study never
disclosed the conflict of interest. The subsequent Times article was
widely followed up in print and broadcast media.
Following this recent disclosure, ten of the 13 authors
of the original study, which raised the possibility of a link between
the MMR vaccine and autism, ‘‘retracted’’ this interpretation
of the data.
The Lancet editor Richard Horton also became a purveyor
of the hypothesis. He shed light on his role ‘‘as the father
of a three year old who has had the MMR, I regret hugely the adverse
impact this paper has had.’’ But he added: ‘‘Professionally,
I don’t regret it. The Lancet must raise new ideas.’’
Yet he also suggested that, with the benefit
of hindsight, the Lancet would not have published the paper due to ‘‘fatal
conflicts of interest ...that would have strongly affected the peer
reviewers about the credibility of this work and in my judgment it would
have been rejected.’’
This pursuit of ‘‘new ideas’’ translates
into to annual NHS immunization statistics for England showing that
by March 2003 only 82 of children aged two years had been vaccinated
with the MMR vaccine.
The consequences of ethical lapses are often unquantifiable.
Public confidence, trust, and integrity that relate to people, journals,
and/or brands do not fit easily into studies or reports, nor does the
future decision-making of a public consuming divergent health messages.
Additionally most of the education and training of scientists and researchers
have emphasized the hard sciences as the foundation of clinical knowledge
and research. The current educational and reward system also places
great pressure to produce papers in peer-reviewed journals.
Perhaps it not only is time to review the processes of
how MMR and other recent events occurred so that we can reduce the possibility
of similar events happening in the future, but it may be time to think
of ways to institutionalize ‘‘ethical training’’
for critical thinking and discriminating among values. A virtuous goal
may be to add ethical issues in health communication to standardized
curriculums for medicine, public health, journalism, communication,
public relations, and related public ‘‘media literacy’’
programs. Of course, it would be ambitious to think that this alone
could translate into incorporation of this ideal into standard media
practice and consumption. Yet, without any changes in our systems and
mindset, we can only wait to see not if faulty premises and unethical
behavior beget public confidence and health, but how frequent and how
great the consequences may be.
With scientific advances, medical breakthroughs, and information
sharing advancing at a 24/7 pace, the goal of diffusing sound ethical
throughout society relating to health is of utmost importance.
References
Clements, C.J. & Ratzan, S.C. (2003). Misled and confused?
Telling the public about MMR vaccine safety. Measles, mumps, and rubella.
Journal of Medical Ethics, 29(1), 22–6.
Wakefield, A.J., Murch, S.H., Anthony, A. et al. (1998).
Ileal-lymphoid-nodular hyperplasia, non-specific colitis and pervasive
developmental disorder in children. Lancet, 351, 637–41.
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Scott C. Ratzan MD, MPA is Editor-in-Chief of the Journal of Health
Communication: International Perspectives.
