BMJ  2004;328:773 (27 March), doi:10.1136/bmj.328.7442.773

reviews

The Press

The new MMR?

Are the media stirring up a fresh autism scare?

On 15 March the Daily Mail reported that a scientist had made some disturbing claims about a common three-in-one childhood vaccine. In a nutshell, it could cause autism. Campaigners were demanding that the vaccine be phased out forthwith, and replaced by an available alternative. The government was resisting their demands, arguing that the alternative was less effective.

More on MMR (measles, mumps, rubella), you might be thinking. All a bit passé, surely. But no—the vaccine in this case is against diphtheria, tetanus, and pertussis (DTP) and the alleged link with autism is supposed to be mediated by thiomersal, the mercury-based material used as a preservative in the version of the vaccine commonly administered in Britain.

The Mail's article wasn't the first outing for this story and, apart from a few paragraphs two days later in the London Evening Standard, it made few waves. This time too it could just die. Or, for any of a score of reasons, it may yet stagger to its feet and, in the manner of the MMR fiasco before it, trample another destructive path through the fields of childhood vaccination policy.

Thiomersal, a sodium salt of ethyl-mercury, has been used for 60 years. In north America and much of Europe it has been abandoned, and the Department of Health says that this country will follow suit, though it may take some time. Unlike the single vaccines used instead of the triple MMR, an alternative to the thiomersal-containing DTP vaccine is apparently available through the NHS. But many people—including some general practitioners—are unaware of this. For the time being parents may be tempted to respond to this new perceived hazard in the way that many have to MMR: by not "risking" it.

The arguments for and against thiomersal are beyond the scope of this piece. The issue here is the part that journalists and campaigners play in driving these scares, and why.

Among the organisations protesting about thiomersal is the Glasgow-based Action Against Autism, a vocal opponent of MMR vaccination. Its chairman, Bill Welsh, told the Mail: "We want the government to explain why in the UK we are continuing to inject this known toxin into so many children's bodies."

Mindful of recent setbacks to the Wakefield hypothesis, cynics may suspect that Action Against Autism is now keen to hitch itself to a different anti-vaccination bandwagon. Not so. "Wakefield's case has not been blown apart," Mr Welsh insists. And, far from representing a change of tack, suspicions about thiomersal could be all-of-a-piece with the Wakefield theory. "We're looking at a cascade of events at the end of which the child becomes autistic. By giving mercury three times to a child under four months, you're giving three opportunities for damage to be done." And then a rhetorical question: "What happens when you inject three viruses into a child with very high toxin levels?"

So, for Action Against Autism, thiomersal is simply business as usual. But what of the Mail? Assuming the paper had no wish to launch a re-run of the MMR saga, I contacted the managing editor's office to ask what checks the paper had made with informed medical opinion in Britain about thiomersal, how it viewed the possibility of parents who had read the piece deciding not to vaccinate their children at all, and what responsibility it felt when reporting isolated or unproven views on potentially controversial medical issues. Despite a phone call, an email, and four more calls I received no replies.

While offering no apologies for the Mail's unresponsiveness, it does have to be accepted that reporting the exceptional rather than the commonplace is one of the elements of news journalism. Established vaccines only become a story when they are suspected of creating problems as well as solving them.

The MMR affair prompted a great deal of speculation about the role of the media in fuelling medical scares. It also threw up a revealing survey carried out by researchers at the Cardiff University School of Journalism, who reviewed 561 stories on MMR published during 2002 ( BMJ 2002;325: 603[Free Full Text]). While many of these stories featured the case for a causal link and the case against it, what didn't come across was the huge imbalance between the strengths of the two cases. The researchers said that the sheer frequency with which the alleged autism link was reported led many readers to conclude that doctors themselves must be having a real debate about it. And if there wasn't a debate, why was it so often reported?

As for thiomersal, the measure of the risk that it imposes—if any—remains unclear; nor do we yet know if it will be widely perceived as risky.

Meanwhile, American manufacturers are facing a multi-billion dollar lawsuit. The one certainty in all this is that drug companies' already much-diminished enthusiasm for developing new vaccines will not be boosted.

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Rapid Responses:

Read all Rapid Responses

No! The Old DPT

Alan Challoner MA (Phil) MChS
bmj.com, 26 Mar 2004 [Full text]

Geoff Watts just doesn't get it...

Hilary Butler
bmj.com, 27 Mar 2004 [Full text]

Re: No! The Old DPT

Raymond Gallup
bmj.com, 28 Mar 2004 [Full text]

What of the children?

Julie A Loch
bmj.com, 29 Mar 2004 [Full text]

The numbers say thimerosal causes autism

Andrew H. Cutler
bmj.com, 30 Mar 2004 [Full text]

Comment on Hilary Butler's reponse

Clair F Mills
bmj.com, 30 Mar 2004 [Full text]

Re: Comment on Hilary Butler's reponse

John Daniel Stone
bmj.com, 31 Mar 2004 [Full text]

Tapestry of Damage

Lisa C Blakemore-Brown
bmj.com, 31 Mar 2004 [Full text]

The drollness of "pot" thinking the kettle is black...

Hilary Butler
bmj.com, 31 Mar 2004 [Full text]

"THIOMERSAL FREE" VACCINES

Wolfgang M Maurer
bmj.com, 13 May 2004 [Full text]

Response to Hiliary Butler

Stephen Pearce
bmj.com, 14 May 2004 [Full text]

Re: Response to Hiliary Butler

John D Stone
bmj.com, 14 May 2004 [Full text]

Re: Re: Response to Hiliary Butler

Twyla I Gill, et al.
bmj.com, 15 May 2004 [Full text]

What i do know

Stephen Pearce
bmj.com, 15 May 2004 [Full text]

Re: Re: Re: Response to Hiliary Butler

John D Stone
bmj.com, 15 May 2004 [Full text]

Re: Re: Re: Re: Response to Hiliary Butler

Twyla I Gill
bmj.com, 16 May 2004 [Full text]

Re: Re: Re: Re: Response to Hiliary Butler: Jick & Kaye, Lingam et al and peer group review

John D Stone
bmj.com, 17 May 2004 [Full text]

Re: Twyla I. Gill's postings

E J Northey
bmj.com, 17 May 2004 [Full text]

Response to "Hiliary" Butler

H I L A R Y Butler
bmj.com, 17 May 2004 [Full text]

Re Twyla I Gill.

Hilary Butler
bmj.com, 17 May 2004 [Full text]

Where are they - the BCDSP and the DOH? We are owed an explanation.

John D Stone
bmj.com, 19 May 2004 [Full text]

Many routes to 'autism'

John P Heptonstall
bmj.com, 19 May 2004 [Full text]

Re: Many routes to 'autism' - the brief history of a government which simply couldn't care less

John D Stone
bmj.com, 20 May 2004 [Full text]

Re: Comment on Hilary Butler's reponse

Saadedine Tebbal
bmj.com, 1 Jun 2004 [Full text]

What of the children

Carol J
bmj.com, 31 May 2004 [Full text]

Problems with MMR

Mark A. Sircus O.M.D.
bmj.com, 4 Jun 2004 [Full text]

Failure of the medical profession to engage in debate

John D Stone
bmj.com, 13 Sep 2004 [Full text]

Re: Failure of the medical profession to engage in debate

Adam Jacobs
bmj.com, 13 Sep 2004 [Full text]

Re: Failure of the medical profession to engage in debate

Carol Johnston
bmj.com, 13 Sep 2004 [Full text]

Re: Adam Jacobs' response

John D Stone
bmj.com, 13 Sep 2004 [Full text]

Banana skins are slippery

Jenny L Robertson
bmj.com, 13 Sep 2004 [Full text]

Re: Re: Failure of the medical profession to engage in debate

Adam Jacobs
bmj.com, 13 Sep 2004 [Full text]

Re: Re: Re: Failure of the medical profession to engage in debate

Carol Johnston
bmj.com, 13 Sep 2004 [Full text]

Adam Jacobs has failed to address any of my four points

John D Stone
bmj.com, 13 Sep 2004 [Full text]

Re: Re: Failure of the medical profession to engage in debate

CA Johnson
bmj.com, 13 Sep 2004 [Full text]

Jacob Adams, Bananas, trust me, and goosechases.

Hilary Butler
bmj.com, 13 Sep 2004 [Full text]

Re: Re: Adam Jacobs' response

Saadedine Tebbal
bmj.com, 13 Sep 2004 [Full text]

Re: Failure of the medical profession to engage in debate

Carol Johnston
bmj.com, 13 Sep 2004 [Full text]

Re: Re: Adam Jacobs' response

Adam Jacobs
bmj.com, 13 Sep 2004 [Full text]

Re: Re: Re: Re: Failure of the medical profession to engage in debate

Adam Jacobs
bmj.com, 13 Sep 2004 [Full text]

Adam Jacobs' further response

John D Stone
bmj.com, 13 Sep 2004 [Full text]

Re: Adam Jacobs' further response

Adam Jacobs
bmj.com, 13 Sep 2004 [Full text]

WHO CARES ABOUT THE SAFETY OF OUR CHILDREN?

John D Stone
bmj.com, 13 Sep 2004 [Full text]

Thimerosal not Linked to Autism

SM Pearce
bmj.com, 9 Jul 2004 [Full text]

Re: Re: Adam Jacobs' further response

Lisa C Blakemore-Brown
bmj.com, 13 Sep 2004 [Full text]

Re: Thimerosal not Linked to Autism

John D Stone
bmj.com, 9 Jul 2004 [Full text]

Thiomersal, Autism and Big Bad Dr. Wakefield

Jamie S Robertson
bmj.com, 9 Jul 2004 [Full text]

Re: Thimerosal not Linked to Autism

Hilary Butler
bmj.com, 9 Jul 2004 [Full text]

Re: Thimerosal not Linked to Autism

Aasa H. Reidak
bmj.com, 9 Jul 2004 [Full text]

Education and the rise in ASD and ADHD

Lisa C Blakemore-Brown
bmj.com, 9 Jul 2004 [Full text]

The irresponsible madness of lacing vaccine with mercury

John D Stone
bmj.com, 9 Jul 2004 [Full text]

The Web of Official Truth

John D Stone
bmj.com, 13 Sep 2004 [Full text]

Re: The Web of Official Truth

Aasa H. Reidak
bmj.com, 13 Sep 2004 [Full text]

Re: The Web of Official Truth

eamonn clarke
bmj.com, 13 Sep 2004 [Full text]

Re: Re: The Web of Official Truth

John D Stone
bmj.com, 13 Sep 2004 [Full text]

Weaving the actual truth

Lisa C Blakemore-Brown
bmj.com, 13 Sep 2004 [Full text]

Sir Liam Donaldson and standards

John D Stone
bmj.com, 13 Sep 2004 [Full text]

Should this matter be referred to the GMC?

John D Stone
bmj.com, 9 Jul 2004 [Full text]

"Proof" or "truth"?

Jamie S Robertson
bmj.com, 13 Sep 2004 [Full text]

Re: "Proof" or "truth"?

Aasa H. Reidak
bmj.com, 13 Sep 2004 [Full text]

Re: Re: Re: The Web of Official Truth

eamonn clarke
bmj.com, 13 Sep 2004 [Full text]

The Web of Official Truth and Eamonn Clarke

John D Stone
bmj.com, 13 Sep 2004 [Full text]

Waiter et al

John D Stone
bmj.com, 9 Jul 2004 [Full text]

Re:: The Web of Official Truth

Carol Johnston
bmj.com, 13 Sep 2004 [Full text]

Re: The Web of Official Truth and Eamonn Clarke

eamonn clarke
bmj.com, 13 Sep 2004 [Full text]

Re: Re: The Web of Official Truth and Eamonn Clarke

John D Stone
bmj.com, 13 Sep 2004 [Full text]

Adverse reactions

John D Stone
bmj.com, 13 Sep 2004 [Full text]

From mmrthefacts website: Your questions answered...

John D Stone
bmj.com, 9 Jul 2004 [Full text]

Vaccinations and Mercury

Robert A. Da Prato
bmj.com, 9 Jul 2004 [Full text]

Reassuring parental anxiety

MC Feliciello
bmj.com, 13 Sep 2004 [Full text]

Re: From mmrthefacts website: Your questions answered...

Aasa H. Reidak
bmj.com, 9 Jul 2004 [Full text]

Prof. Lewis Wolpert: "But fraud does not occur".

John Stone
bmj.com, 9 Jul 2004 [Full text]

Prof. Wolpert: 'Malignant Sadness'

John Stone
bmj.com, 9 Jul 2004 [Full text]

Re: Vaccinations and Mercury--The Holy Grail

L. Travis Haws
bmj.com, 9 Jul 2004 [Full text]

Point of information

Sharon Davies
bmj.com, 8 Jul 2004 [Full text]

Re: Thimerosal not Linked to Autism

Peter Flegg
bmj.com, 10 Jul 2004 [Full text]

Re: Re: Thimerosal not Linked to Autism

John Stone
bmj.com, 13 Sep 2004 [Full text]

Re: Re: Re:Thimerosal not Linked to Autism

John Stone
bmj.com, 13 Sep 2004 [Full text]

Re: Re: Thimerosal not Linked to Autism

John Stone
bmj.com, 17 Jul 2004 [Full text]

Re: Re: Re: Thimerosal not Linked to Autism

Peter Flegg
bmj.com, 13 Sep 2004 [Full text]

Re: Re: Failure of the medical profession to engage in debate

Dr. Herbert H. Nehrlich
bmj.com, 14 Sep 2004 [Full text]

Whose side is Adam Jacobs really on?

John Stone
bmj.com, 15 Sep 2004 [Full text]

Re: Whose side is Adam Jacobs really on?

Adam Jacobs
bmj.com, 16 Sep 2004 [Full text]

Re: Re: Whose side is Adam Jacobs really on?

John Stone
bmj.com, 16 Sep 2004 [Full text]

Re: Re: Whose side is Adam Jacobs really on?

John Stone
bmj.com, 5 Oct 2004 [Full text]