BMJ  2005;330:1335 (4 June), doi:10.1136/bmj.330.7503.1335

reviews

TV

Horizon: Does the MMR Jab Cause Autism?

BBC 2, 29 May at 9 pm

Rating:

Oh no. Surely the MMR (measles, mumps, rubella) vaccine story has been hammered to death. Why is the BBC now picking through the remains of yesterday's news? At our baby clinic on Tuesday afternoons we still have concerned mums and dads, but most are happy to go along with our advice. Like most doctors, I have trotted out my own unsystematic interpretation of guidance from experts, government departments, and advice leaflets. But, I should confess, there was still a tiny voice in the back of my mind wondering if there might still be a grain of truth in the story about a suggested link between autism and MMR.

Depending on the day, I watch programmes about MMR with a varying balance of natural cynicism and scientific acceptance. The BBC is usually fair and well researched, so I tried to watch this programme with an open mind. The Horizon verdict: there was nothing in the MMR and autism story and many children have suffered unnecessarily from the outcome of the widespread publicity. The programme makers presented both sides in a balanced and relatively unemotional manner.

This was difficult, because MMR is such an emotive subject and we all naturally sympathise with distraught parents searching for the cause of their children's autism. Autism is an incredibly difficult condition for a family to cope with and I cannot blame any parent convinced that Andrew Wakefield—the gastroenterologist who first mooted the link between autism and MMR—had the answer. After all, we have precious few other explanations. It is such a shame that what appears to have begun as a genuine hypothesis got lost in the media hype, and scientific debate became such a public battlefield.

As a doctor, I found the endless shots of needles, syringes, and childhood injections in Horizon's foray into this battlefield a little offputting, and I am sure parents found it difficult too. Our epidemiology colleagues, often pictured as a rather dull and worthy lot, would have enjoyed their portrayal as the good guys, the cavalry coming over the mountain armed with conclusive evidence. There were also some damning indictments of anecdotal medicine: soundbites used by the anti-MMR lobby that would make any scientist cringe—"forget epidemiology, look at the children" or "I don't have time for statistics when I see a sick child." But many parents might have found such arguments seductive. The programme quoted unpublished evidence to support its stance, and it could also have been criticised for this.

Television is about a good story, however, with lots of twists and turns, and this programme was no exception. It began with moving pictures of an autistic boy called James. It ended with this patient's father, himself a general practitioner, forth-right in his support of MMR, and with Simon Murch, one of the co-authors of Andrew Wakefield's original Lancet paper ( Lancet 1998;351: 637[CrossRef][ISI][Medline]), changing his mind about the purported MMR-autism link.

I am still not sure why the programme makers waited until now to do the story. The world has moved on and there are more topical medical controversies. Also, parents' attitudes have changed. It is a long way from Northern Ireland to South Devon and we don't have many happy hippies in sandals and flowing print skirts in our city practice, but my patients are genetically programmed to be suspicious of government. Interestingly, however, attitudes to immunisation have altered in the past few months. What has made the difference is a recent epidemic of mumps. A fascinating natural experiment has left the older generation immune, the younger children mostly immunised, but those in their early 20s with neither natural nor evoked immunity. And so mumps has been raging through our young adults. Now we have queues for immunisations, and the patients are chasing us, not the other way around. Recently I also saw a case of measles.

We have come full circle now, and immunisation rates are creeping back up. But it is neither scientific papers nor medical journals that have made the biggest and most lasting impression. It is witnessing the suffering of others, and our emotional response to illness. Mums and dads are more likely to have their children immunised if they see what happens when others are ill.

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Belfast domhnall.macauley{at}ntworld.com

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