RICHARD HORTON has, one suspects, rather more enemies than friends. The editor of
The Lancet dismisses the Government’s efforts to manage public health scares as “ham-fisted” and accuses it of playing Russian roulette with children’s health. The Prime Minister, Horton rules, made a “grave misjudgment” in not disclosing whether his son Leo had the MMR jab. He condemns the pharmaceutical industry for turning science into “McScience ”, with companies buying up research departments and churning out improperly tested drugs that, on the whole, contribute little to public health. The stench of the profit motive can be smelt everywhere, with industry executives breathing down editors’ necks to get their dubious research published and, when that fails, operating sinister campaigns to destabilise opponents.
But Horton has become best known, notorious even, for his role in the MMR affair, which began six years ago when he published research by Dr Andrew Wakefield, of the Royal Free Hospital in London. Dr Wakefield’s paper described a new type of inflammatory bowel disease in a group of children with developmental disorders and speculated, without causal proof, that bowel disorders and autism could be linked to the measles, mumps and rubella (MMR) vaccine administered routinely to pre-school children.
It furnished Horton, 42, with yet more foes, not least public health officials, who saw parental confidence in vaccination crash. When it emerged that Dr Wakefield had received legal funding to establish grounds for a possible lawsuit against vaccine manufacturers — a conflict of interest — the paper was partially retracted.
With so much ire around, you would expect Horton, who has dissected the MMR affair in a new book, MMR: Science and Fiction, to be thoroughly unpleasant. One of those abrasive, cocksure doctors who scares the bedjackets off cowering patients, with an uncrushable backbone of self-belief hardened by his appointment as the Lancet’s custodian at just 33. Instead, when I arrive at his home in North London, I find a tall, quiet, rather academic-looking family man, who later seems touchingly baffled at how to deal with his 3-year-old daughter Isobel when she presses her face against the glass doors that have been closed for our meeting.
The book, Horton is keen to emphasise, is more than just a postmortem examination of the MMR saga. It deals with why the scare happened and how future ones can be prevented. He does not berate parents for shying away from vaccination. Instead, the medical profession, journal editors, the Government and the media must shoulder the blame. “You can’t hold a gun to parents’ heads and say ‘You must get your children vaccinated’,” says Horton. They need to be persuaded by rational argument but instead, he says, public debates descend into “vilification, censorship and punishing people who say things against the grain”.
That the lessons from MMR have not been learnt is obvious to him, given the recent anxiety created by news of a five-in-one inoculation for babies. The information leaked out before a public announcement, again stoking parental suspicions. Horton rolls his eyes: “The Government made a serious error of judgment thinking that it could release the information to doctors ahead of the public. If you try to tell people privately, secretly, it will always leak out. It was clearly ham-fisted. We had two or three days of extreme headlines; the (Government) message that came back was that you will put your child at mortal risk if you don’t get the existing vaccine. So you counter one scare with another scare. If there was one thing that came out of MMR, it was that you don’t play Russian roulette with your children.”
Since public trust in Government has evaporated, Horton wants to see the creation of a new body, a National Agency for Science and Health (Nash), that can evaluate scientific studies and provide impartial guidance. He denies that Nash would represent a politicisation of science; such accusations have dogged the Food Standards Agency, whose independence is tainted by a perceived subservience to Government.
Instead, Horton argues, it would take the politics out of science and health policymaking: “Every health reform we’ve had since the inception of the NHS has been driven by ideology, whereas if we’d tested them properly, we would have learnt a huge amount about how to run a health service. That’s the politicisation of science. We have systems for evaluating drugs but no system for evaluating policies. How mad is that?”
Another reason to establish Nash is the ever-powerful pharmaceutical industry, with its massive marketing might. “If you look at the way that research has been influenced by industry — and how some scientists have been bought — you have to regard it is a serious threat,” he says.
He recalls one Lancet colleague being telephoned by a drug company and harangued over queries that had arisen during the peer-review process: “My colleague was told ‘Why are you raising all these difficult questions? Don’t you know we’re going to buy an enormous number of reprints?’ That is an unjustified, clearly damaging, intervention in the peer-review process. The implication was that the paper would be withdrawn and there would be loss of revenue (to The Lancet). This is not uncommon.
“When we published criticism of one drug the company went ballistic. One of its board members rang me in a rage that we had published this and asked what the hell I was doing as it had come out in the week of their third-quarter results.” Horton says the company was offered the right of reply prior to publication but, for some reason, had not taken up the offer.
The matter did not end there: “Then there’s this behind-the-scenes threat that somehow you’ve behaved inappropriately. So, for example, one senior member of the company wrote to a senior member of our publishing group to complain about us — complain about me, I suspect, although I never saw the letter — and you see how this insidious process goes on to try to undermine you.”
More importantly for the public, the malign influence of Big Pharma means that drugs are not as well tested as they should be: “Drugs are licensed on the basis of small clinical trials, and while we are fairly sure of their efficacy, we are very uncertain about their safety.”
