reBOOKS • CD ROMSviews • ART • WEBSITES • MEDIA • PERSONAL VIEWS • SOUNDINGS ful role of the media in the course of the of guilt over having had their children MMR controversy. immunised. It is true that the MMR-autism scare did Phillips is one of many journalists (by not start in the press. Both a reputable Lon- no means confined to the tabloids) who don teaching hospital and a prestigious have endorsed the anti-MMR campaign. medical journal allowed the scare to start. They have provided a voice for middle class Yet, once Wakefield decided to go public anxieties about environmental threats and Why can’t the Daily with his anti-MMR campaign, the media for the distrust of established sources of played a major part in promoting the scare. authority in science, medicine, and politics Mail eat humble pie Phillips’s response to the Cochrane study that have led some parents to reject MMR. follows the familiar themes of numerous Some journalists, writing as celebrity par- over MMR? anti-MMR articles over the years, including ents, have followed the principles of the several by Phillips herself. “journalism of attachment” popularised in recent military conflicts. This requires a he recent publication of a Cochrane Phillips’s article is scientifically flawed. high level of emotional engagement but no systematic review concluding that She seems to misunderstand the nature of a specialist knowledge of the subject (special- there is “no credible evidence” of a systematic review and to misinterpret any T criticism of studies of MMR safety, or any ist medical and scientific correspondents link between the measles, mumps, and have generally rejected the MMR-autism rubella (MMR) vaccine and either inflamma- expression of uncertainty about their link). Although autism has become fashion- tory bowel disease or autism provoked conclusions, as a vindication of Wakefield’s able in the media, a condition characterised demands that the British tabloid newspaper case. She echoes the mantra of anti-MMR by difficulties of communication remains the Daily Mail apologise for its role in campaigners that epidemiological methods uniquely terrifying to those who live by the promoting the MMR-autism scare (http:// are not suitable to discover an association word. For a profession renowned for its www.mrw.interscience.wiley.com/cochrane/ between MMR and autism, when this is pre- sociability, children for whom language and clsysrev/articles/CD004407/frame.html). cisely the point of such methods. Indeed, friendship are problematic are a source of Instead, on 31 October, the paper published this is why Wakefield explicitly invited potent fears. a feature by leading columnist Melanie Phil- epidemiological studies in his Lancet lips insisting that claims that MMR was safe paper—only to repudiate this approach were “a load of old baloney” (www.melanie- when one study after another failed to sup- British journalists have a phillips.com). Phillips proclaimed that, far port his hypothesis. from having received the “all-clear,” the In endorsing Wakefield’s claims, Phillips poor record on MMR and, “MMR scandal” was “getting worse.” ignores the overwhelming weight of scien- indeed, on autism The otherwise unanimous verdict of the tific evidence to the contrary. She insists that media was that the Cochrane review— his discovery of “autistic enterocolitis” has With a few notable exceptions—such as following a series of studies coming to the been replicated around the world and that Brian Deer, whose work for the Sunday same conclusion—confirmed that the scare “vaccine-strain” measles virus has been Times and Channel Four helped to discredit launched following the now notorious found in cerebrospinal fluid samples from Wakefield’s Lancet paper—British journalists Andrew Wakefield Lancet paper in 1998 was autistic children, though she fails to have a poor record on MMR and, indeed, finally over (Lancet 1998;351: 637). Phillips’s mention that these few studies have been on autism. While certain journalists have defiant article stands as a symbol of the woe- carried out by Wakefield or his collabora- lionised Wakefield, real scandals—such as tors and are universally dismissed by the recent death of an autistic boy from reputable authorities. Britain undergoing mercury chelation Two days after publication of her Daily therapy in the United States, or the Mail article, Phillips was criticised by doctor inadequacy of respite services revealed by and columnist Ben Goldacre, in a piece in the conviction of a 67 year old mother the Guardian newspaper. This week (8 for killing her adult autistic son when she November) the Guardian gave Phillips a could no longer cope with his violent right of reply, in which she defended the behaviour—have largely been ignored stance of her Mail article. (www.spiked-online.com). If children die Phillips appears to be captivated by from measles, the MMR scandal may indeed Wakefield’s self professed status as a maver- get worse. ick and crusader against the establishment. His posture of martyrdom and victimhood Michael Fitzpatrick general practitioner, London seems to have a particular appeal for [email protected] Phillips, whose polemical style provokes much animosity. The price of this self Competing interest: MF is the author of MMR indulgence (Phillips is one of Britain’s best and Autism: What Parents Need to Know paid journalists) is borne by the real victims (Routledge, 2004). of the MMR-autism fiasco. These are parents anxiously facing decisions about Items reviewed are rated on a 4 star scale immunisation and parents of children with (4=excellent) autism who carry an unwarranted burden 1148 BMJ VOLUME 331 12 NOVEMBER 2005 bmj.com reviews people working at the community level to take on poverty and global health. Less publi- cised, a group of international health leaders met at Yale University as part of the Oxford Health Alliance to increase global attention to the epidemics of chronic diseases such as diabetes, cardiovascular disease, and cancer. The US Public These events put sharp focus on the need for strong collective action, and they pointed out Broadcasting System in clear terms that we have the historical and Time Magazine knowledge and the economic means to make an immediate difference in these global take on global health problems. The PBS series, narrated by Hollywood A week of events including the television actor Brad Pitt, began with in-depth coverage series RX for Survival: A Global Health of the current polio campaign, focusing on Challenge, broadcast on PBS from 1 to 3 the last remaining pockets of resistance and November and available on VHS and DVD the last residual cases of acute flaccid www.pbs.org/wgbh/rxforsurvival/index.html paralysis. David Heymann, WHO polio campaign director, remarked that as a result Rating: ★★★ of the most sweeping public health campaign in history, we might soon see the last cases of ith the discovery of penicillin in polio. In 1977, after thousands of years of the 1940s, scientists were confi- human suffering, we saw the last case of small- dent that “humanity had finally W pox in Somalia, eliminated using ring vacci- provides cheap transportation for medical won” in the war with microbes. Infectious care and medicines, delivers health care to the diseases that had devastated the globe for nation and creative surveillance to isolate cases and prevent spread. But these two most remote places in Africa. In west Africa, centuries were in abeyance by the 1970s, ivermectin is distributed as a cooperative and most people in developed countries did eradication campaigns are different, and the story behind them, told by smallpox warriors effort between Merck, the World Bank, the not fear the old scourges of smallpox, Carter Center in Atlanta, and others to halt cholera, plague, malaria, and tuberculosis. D A Henderson and William Foege, revealed what has to be done to eradicate polio. One river blindness in its tracks. In Botswana and Since then, however, the world has been Uganda, the pan-African disaster of HIV/ shocked by the rise of new plagues such as must overcome not only huge logistic problems, but also political and religious AIDS has been slowed through good medical HIV/AIDS and SARS (severe acute respira- practice and increased financing. tory syndrome), haemorrhagic fevers arising resistance and misguided complacency. In Nigeria, rumours that Western coun- Without such interventions, life expect- from Ebola and Marburg viruses, and the ancy can be expected to go down, and the threat of avian influenza. But many old tries included sterilising chemicals in the polio vaccine caused resistance to the costs of inaction will overwhelm economies plagues still devastate developing countries, and health systems. Already, 80% of all hos- destabilising the global community and campaign, and polio then spread to other sub-Saharan African countries; in India, pital admissions in sub-Saharan Africa are unnecessarily killing millions. In response, for AIDS related illness. The money is avail- rock stars, developmental economists, bil- devout Muslims preferred to trust in god rather than Western-sponsored campaigns to able, prevention and treatment options are lionaire entrepreneurs, and even occasional well established, and now commitment, governments now recognise the need for protect their children; in affluent US commu- nities, well off mothers refuse vaccines funding, science, and human resources can commitment to global health. make a difference. Last week the US Public Broadcasting because of potential harm to their individual Although the series referred to the System (PBS) put out a six-part series entitled children. All of these resistant cases are epidemic of obesity as an emerging global Rx for Survival, dedicated to explaining the targeted as part of a collective enterprise health threat in both affluent and emerging historical successes and new challenges in requiring cooperation and commitment to economies, it made no mention of the infectious disease control.