Reporting of MMR evidence in professional publications: 1988-2007

Abstract

Objective:To examine how journals and magazines disseminate research evidence and guidance on best practice to health professionals by aligning commentaries on measles, mumps, and rubella vaccine (MMR) evidence in journals with key events in the MMR controversy.Design:Content analysis.Data sources:Comment articles in six commonly read UK publications.Main outcome measures:Number of comment pieces by publication, year and article type; trends in the focus, tone and inclusion of recommendations on MMR.Results:860 articles met the inclusion criteria (BMJ n = 104, Community Practitioner n = 45, Health Visitor n = 24, Practice Nurse n = 61, Nursing Standard n = 61 and Pulse n = 565). Of these 860 comment pieces, 264 made some reference to evidence endorsing the safety of MMR. Around one in 10 were rated as negative (10.9%, n = 29) or neutral (11.3%, n = 30) in relation to MMR safety, and nearly a quarter (22.7%, n = 60) were rated as mixed. Following the publication of Wakefield et al’s 1998 paper there was a period of neutrality. In 2000, despite growing public concerns and widespread media coverage, fewer than 20 comment pieces were published. Less than a quarter of comment pieces (n = 196, 22.7%) included recommendations.Conclusion:While a period of neutrality may reflect a professional response to uncertainty by holding back until consensus emerges, it may also represent a missed opportunity to promote evidence-based practice.

Editors should not be propagandists

“…I do not accept the conclusion of Hilton et al 2 that “some journals and magazines appeared to stand back and wait for consensus to develop”. Rather, I believe they were waiting to hear the evidence; and of course there was little to hear for some years, partly because the whole MMR/autism association was then and is now a “straw man”—impossible to knock down as he is hardly real in the first place.…”

“…In this month’s journal, a group of social and public health scientists examine the response to the paper by several journals likely to be read by those responsible for providing advice to individual families regarding immunisation 2. They conclude that the journals “missed opportunities to accurately inform practitioners about the evidence” and seemingly preferred to “stand back and wait for consensus to develop”.…”

“…Hilton et al 2 note that the magazines and journals they surveyed expressed uncertainty about the evidence and published ambiguous messages about safety “though there was little scientific disagreement that MMR was safe ….” That is true, but the corollary is that those journals should have promoted MMR on the basis of that lack of disagreement—but, as Lett pointed out, “evidence based on authority or testimony is inadequate”. As editor of ADC during part of the period covered by the survey, I would have been reluctant to publish an encomium of MMR simply based on consensus—even though as a practising paediatrician I was part of that consensus.…”

Childhood vaccinations and autism, 1998-2010: Expert domains in formal information exchanges

“…Hilton, et. al (2009), in a analysis of six commonly read health professional publications in the UK, found that coverage of the possible MMR‐autism link evidenced a period of neutrality immediately following the initial controversial 1998 study. While this approach may represent an understandable hesitancy in waiting for a consensus to develop, authors suggest health professionals may be missing an opportunity to “promote evidence based practice” early in a controversy (Goodyear‐Smith et al, 2007).…”

“…(2007) analyze media produced between 2001 and 2003 from 400 different national publications in New Zealand to find an overall "positive trend toward reduction in alarmist antiimmunization messages" (p. 759) and advocate a proactive educational role for health professionals when dealing with the media. Hilton, et. al (2009), in a analysis of six commonly read health professional publications in the UK, found that coverage of the possible MMR-autism link evidenced a period of neutrality immediately following the initial controversial 1998 study.…”