11.6 Publishing controversial new ideas
Horton, R. (2004) ‘The lessons of MMR’, The Lancet, 363, 6 March 2004, pp 747–749 Elsevier. Copyright © 2004 Elsevier.
It seems obvious now that had we appreciated the full context in which the work reported in the 1998 Lancet paper by Wakefield and colleagues was done, publication would not have taken place in the way that it did. These are difficult judgments to make in hindsight. For example, our sensitivity to potential conflicts of interest is very much higher today than it was in 1998.17-19 What we will not do is to become profoundly conservative in our decision making about original ideas. A forum to raise new and sometimes unpopular thinking, even on the basis of what at first might appear flimsy evidence, is important20– and often vitally so for clinical medicine and public health.21 How we discuss this new thinking then becomes the central question to answer,22 not whether we should publish it or not.
Information that once could be confined to a small community of professionals is now open to wider distribution and comment – accurately or otherwise. No matter how many qualifying phrases or parallel reassuring editorials an editor might run, a new finding or a controversial claim is impossible to control. This places great responsibility on editors, scientists, and press and public-relations professionals to avoid encouraging anybody to go beyond the data or interpretations described in a paper. It is the job of journalists to tempt scientists to do otherwise. But we can all do better to adjust the volume of our message according to the validity of the information before us. Editors have a responsibility to be involved in all aspects of a paper's dissemination, whether in the pages of a medical journal or on the platform of a press conference.
Finally, what of the calls for a public inquiry into this entire affair? An inquiry would certainly provide an opportunity to investigate, once again, all the issues that have made this matter such a troubling one for so many. To that extent it would be welcome. But public inquiries are easy to demand, and less easily able to deliver on expectations. They can sometimes entrench division rather than relieve it. Would it not be better to create a more positive process that emphasises reconciliation, progress, and partnership? A collaborative consultation, perhaps, between equals: members of the autism lay community (including parents and possibly in conjunction with the Consumers’ Association, which has a strong interest in public information and, through the DTB, MMR23), clinicians responsible for the care of children with autism and related disorders, the MRC, and the Health Protection Agency. Call it, say, “MMR and autism: learning the lessons”. For there are, indeed, lessons to be learned.