Nicholas (nwhyte) wrote,

October Books 9) MMR: Science & Fiction: Exploring the Vaccine Crisis

9) MMR: Science & Fiction: Exploring the Vaccine Crisis, by Richard Horton

Got this at the recommendation of thette, and it's obviously on a subject in which I have a personal interest. Richard Horton (at least, this Richard Horton) is the editor of the Lancet, which published the 1998 study by Andrew Wakefield linking autism with the MMR vaccine. No other credible evidence has been found for the link, and Wakefield's failure to disclose his personal conflicts of interest caused Horton and the Lancet to retract the relevant research in 2004 (Wakefield remains defiant).

Horton presents the book as "something of a personal exorcism"; he attempts to use the MMR affair as a lens through which to examine justice, truth and the public perception of science. I don't think he completely succeeds, and it was rather ambitious of him to try in 170 pages knocked off in four months. He has a couple of policy recommendations for diverting and channeling public discourse around health research into safer channels, which I think are wholly unrealistic. He calls for science to develop its public image, and to engage more professionally with journalists, and here I think he is on surer ground: indeed, dealing with the media and the public ought to be a basic point of training for any researcher today (though I think Horton is monstrously unfair in casually discounting the contributions of Robert Winston and - for once I shall be positive about him - Richard Dawkins).

He has a fascinating chapter on the extent of state funding for research on autism in the USA. A few weeks ago, Anne and I were gripped by The Stackhouse Filibuster, the 2001 West Wing episode where a senator forces Congress and the President to approve the creation of "five centers of excellence in universities around the country to help scientists coordinate their research, three special units for autism epidemiology at the CDC, and a centralized facility for gene and brain banking" - I was astonished to discover from Horton's book that this is more or less what was actually legislated in the Children's Health Act in 2000; though I guess in real life less heavy-handed methods were used to get the bill passed. Apparently autism research in the UK is way underfunded by comparison, and I would not be astonished to find that the rest of Europe is in the same place. I would have to say that, as far as we can tell anecdotally, Belgium's care provisions for children with autism and their families are way ahead of Britain's.

Pulling back the focus a bit, I was interested by Horton's more philosophical discussion of how truth is established, and struck by the contrast with my own field of work, which is also the subject of academic research but where the truths that matter operationally, in terms of deciding what political decisions are made, are determined not by academe but by professionals elsewhere. Science doesn't seem to recognise a distinction between practitioners and policy-makers, or at least the dynamic is wholly different. If I ever take some time off to look further into the concept of epistemic communities, this is a contrast that will bear further investigation.

I was, however, disappointed by Horton's reluctance to make the obvious moral judgements about Wakefield, or to defend his own unwillingness to do so. His book concludes:
Wakefield was guilty of naïveté, of relying on flawed intuition, of equating instinct with evidence, and of allowing his beliefs to drive a series of public statements that cracked the foundation stone of one of Britain's most important programmes for protecting the health of its children. For some people, these were irresponsible acts which could never be forgiven. For others, myself included, they threw into sharp relief more systematic failings of a medical and public health system that was and remains poorly designed to meet the needs of today's more questioning, sceptical and inquiring public.
I've blogged about Wakefield before; I find it impossible not to form a negative judgement of him, for all the reasons Horton lists in the first sentence quoted above, combined with the fact that he has expressed no contrition except for the inconvenience he caused his fellow researchers. I could go on, but the subject makes me too angry.
Tags: bookblog 2007, life: autism, people: andrew wakefield

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