Part 11 (1/2)

Perhaps yes, when they visited Malyszewicz's laboratory, which had none of the accreditation which you would expect for any normal lab. On just one occasion the government's Inspector of Microbiology was permitted to inspect it. The report from this visit describes the Chemsol laboratory as 'a freestanding, single storey wooden building, approximately 6m x 2 x 2m in the back garden'. It was a garden shed. They go on to describe 'benching of a good household quality (not to microbiology laboratory standards'). It was a garden shed with kitchen fittings. in the back garden'. It was a garden shed. They go on to describe 'benching of a good household quality (not to microbiology laboratory standards'). It was a garden shed with kitchen fittings.

And we should also mention in pa.s.sing that Malyszewicz had a commercial interest: 'Worried about MRSA? The perfect gift for a friend or relative in hospital. Show them how much you care for their health by giving a Combact Antimicrobial Hospital Pack. Making sure they come out fighting fit.' It turned out that most of Chemsol's money came from selling disinfectants for MRSA, often with bizarre promotional material.

How did the papers respond to the concerns, raised by senior microbiologists all over the country, that this man was providing bogus results? In July 2004, two days after Malyszewicz allowed these two real microbiologists in to examine his garden shed, the Sunday Mirror Sunday Mirror wrote a long, vitriolic piece about them: 'Health Secretary John Reid was accused last night of trying to gag Britain's leading expert on the killer bug MRSA.' Britain's leading expert who has no microbiology qualifications, runs his operation from a shed in the garden, misp.r.o.nounces the names of common bacteria, and demonstrably doesn't understand the most basic aspects of microbiology. 'Dr Chris Malyszewicz has pioneered a new method of testing for levels of MRSA and other bacteria,' it went on. 'They asked me a lot of questions about my procedures and academic background,' said Dr Malyszewicz. 'It was an outrageous attempt to discredit and silence him,' said Tony Field, chairman of the national MRSA support group, who inevitably regarded Dr Malyszewicz as a hero, as did many who had suffered at the hands of this bacterium. wrote a long, vitriolic piece about them: 'Health Secretary John Reid was accused last night of trying to gag Britain's leading expert on the killer bug MRSA.' Britain's leading expert who has no microbiology qualifications, runs his operation from a shed in the garden, misp.r.o.nounces the names of common bacteria, and demonstrably doesn't understand the most basic aspects of microbiology. 'Dr Chris Malyszewicz has pioneered a new method of testing for levels of MRSA and other bacteria,' it went on. 'They asked me a lot of questions about my procedures and academic background,' said Dr Malyszewicz. 'It was an outrageous attempt to discredit and silence him,' said Tony Field, chairman of the national MRSA support group, who inevitably regarded Dr Malyszewicz as a hero, as did many who had suffered at the hands of this bacterium.

The accompanying editorial in the Sunday Mirror Sunday Mirror heroically managed to knit three all-time cla.s.sic bogus science stories together, into one stirring eulogy: heroically managed to knit three all-time cla.s.sic bogus science stories together, into one stirring eulogy: Whistle-blowers appear to bring out the very worst in this Government. Whistle-blowers appear to bring out the very worst in this Government. NO WAY TO TREAT A DEDICATED DOCTOR NO WAY TO TREAT A DEDICATED DOCTOR First, Frankenstein foods expert Arpad Puzstai felt Labour's wrath when he dared to raise the alarm over genetically-modified crops. Then Dr Andrew Wakefield suffered the same fate when he suggested a link between the single-jab MMR vaccine and autism. Now it's the turn of Dr Chris Malyszewicz, who has publicly exposed alarmingly high rates of the killer bug MRSA in NHS hospitals. First, Frankenstein foods expert Arpad Puzstai felt Labour's wrath when he dared to raise the alarm over genetically-modified crops. Then Dr Andrew Wakefield suffered the same fate when he suggested a link between the single-jab MMR vaccine and autism. Now it's the turn of Dr Chris Malyszewicz, who has publicly exposed alarmingly high rates of the killer bug MRSA in NHS hospitals. Dr Chris Malyszewicz should get a medal for his work. Instead he tells the Dr Chris Malyszewicz should get a medal for his work. Instead he tells the Sunday Mirror Sunday Mirror how Health Secretary John Reid sent two senior advisers to his home to 'silence him'. how Health Secretary John Reid sent two senior advisers to his home to 'silence him'.

The Sunday Mirror Sunday Mirror was not alone. When the was not alone. When the Evening Standard Evening Standard published an article based on Malyszewicz's results ('Killer Bugs Widespread in Horrifying Hospital Study'), two senior consultant microbiologists from UCH, Dr Geoff Ridgway and Dr Peter Wilson, wrote to the paper pointing out the problems with Malyszewicz's methods. The published an article based on Malyszewicz's results ('Killer Bugs Widespread in Horrifying Hospital Study'), two senior consultant microbiologists from UCH, Dr Geoff Ridgway and Dr Peter Wilson, wrote to the paper pointing out the problems with Malyszewicz's methods. The Evening Standard Evening Standard didn't bother to reply. didn't bother to reply.

Two months later it ran another story using Malyszewicz's bogus results. That time Dr Vanya Gant, another UCH consultant microbiologist, wrote to the paper. This time the Standard Standard did deign to reply: did deign to reply: We stand by the accuracy and integrity of our articles. The research was carried out by a competent person using current testing media. Chris Malyszewicz...is a fully trained microbiologist with eighteen years' experience...We believe the test media used...were sufficient to detecl the presence of pathogenic type MRSA. We stand by the accuracy and integrity of our articles. The research was carried out by a competent person using current testing media. Chris Malyszewicz...is a fully trained microbiologist with eighteen years' experience...We believe the test media used...were sufficient to detecl the presence of pathogenic type MRSA.

What you are seeing here is a tabloid journalist telling a department of world-cla.s.s research microbiologists that they are mistaken about microbiology. This is an excellent example of a phenomenon described in one of my favourite psychology papers: 'Unskilled and Unaware of It: How Difficulties in Recognizing One's Own Incompetence Lead to Inflated Self-a.s.sessments', by Justin Kruger and David Dunning. They noted that people who are incompetent suffer a dual burden: not only are they incompetent, but they may also be too incompetent to a.s.say their own incompetence, because the skills which underlie an ability to make make a correct judgement are the same as the skills required to a correct judgement are the same as the skills required to recognise recognise a correct judgement. a correct judgement.

As has been noted, surveys repeatedly show that a majority of us consider ourselves to be above average at various skills, including leaders.h.i.+p, getting on with other people, and expressing ourselves. More than that, previous studies had already found that unskilled readers are less able to rate their own text comprehension, bad drivers are poor at predicting their own performance on a reaction-time test, poorly performing students are worse at predicting test performance, and most chillingly, socially incompetent boys are essentially unaware of their repeated faux pas faux pas.

Perceived logical reasoning ability and test performance as a function of actual test performance Kruger and Dunning brought this evidence together, but also did a series of new experiments themselves, looking at skills in domains like humour and logical reasoning. Their findings were twofold: people who performed particularly poorly relative to their peers were unaware of their own incompetence; but more than that, they were also less able to recognize competence in others in others, because this, too, relied on 'meta-cognition', or knowledge about the skill.

That was a pop-psych distraction. There is also a second, more general point to be made here. Journalists frequently flatter themselves with the fantasy that they are unveiling vast conspiracies, that the entire medical establishment has joined hands to suppress an awful truth. In reality I would guess that the 150,000 doctors in the UK could barely agree on second-line management of hypertension, but no matter: this fantasy was the structure of the MMR story, and the MRSA swab story, and many others, but it was a similar grandiosity that drove many of the earlier examples in this book where a journalist concluded that they knew best, including 'cocaine use doubles in the playground'.

Frequendy, journalists will cite 'thalidomide' as if this was investigative journalism's greatest triumph in medicine, where they bravely exposed the risks of the drug in the face of medical indifference: it comes up almost every time I lecture on the media's crimes in science, and that is why I will explain the story in some detail here, because in reality-sadly, really-this finest hour never occurred.

In 1957, a baby was born with no ears to the wife of an employee at Grunenthal, the German drug company. He had taken their new anti-nausea drug home for his wife to try while she was pregnant, a full year before it went on the market: this is an ill.u.s.tration both of how slapdash things were, and of how difficult it is to spot a pattern from a single event.

The drug went to market, and between 1958 and 1962 around 10,000 children were born with severe malformations, all around the world, caused by this same drug, thalidomide. Because there was no central monitoring of malformations or adverse reactions, this pattern was missed. An Australian obstetrician called William McBride first raised the alarm in a medical journal, publis.h.i.+ng a letter in the Lancet Lancet in December 1961. He ran a large obstetric unit, seeing a large number of cases, and he was rightly regarded as a hero-receiving a CBE-but it's sobering to think that he was only in such a good position to spot the pattern because he had prescribed so much of the drug, without knowing its risks, to his patients.* in December 1961. He ran a large obstetric unit, seeing a large number of cases, and he was rightly regarded as a hero-receiving a CBE-but it's sobering to think that he was only in such a good position to spot the pattern because he had prescribed so much of the drug, without knowing its risks, to his patients.*

- Many years later William McBride turned out to be guilty, in an unfortunate twist, of research fraud, falsifying data, and he was struck off the medical register in 1993, although he was later reinstated. - Many years later William McBride turned out to be guilty, in an unfortunate twist, of research fraud, falsifying data, and he was struck off the medical register in 1993, although he was later reinstated.

By the time his letter was published, a German paediatrician had noted a similar pattern, and the results of his study had been described in a German Sunday newspaper a few weeks earlier.

Almost immediately afterwards, the drug was taken off the market, and pharmacovigilance began in earnest, with notification schemes set up around the world, however imperfect you may find them to be. If you ever suspect that you've experienced an adverse drug reaction, as a member of the public, I would regard it as your duty to fill out a yellow card form online at yellowcard.mhra.gov.uk yellowcard.mhra.gov.uk: anyone can do so. These reports can be collated and monitored as an early warning sign, and are a part of the imperfect, pragmatic monitoring system for picking up problems with medications.

No journalists were or are involved in this process. In fact Philip Knightley-a G.o.d of investigative journalism from the Sunday Times Sunday Times' legendary Insight team, and the man most a.s.sociated with heroic coverage on thalidomide-specifically writes in his autobiography about his shame over not covering the thalidomide story sooner. They covered the political issue of compensation, rather well (it's more the oeuvre oeuvre of journalists after all) but even that was done very late in the day, due to heinous legal threats from Grunenthal throughout the late 1960 of journalists after all) but even that was done very late in the day, due to heinous legal threats from Grunenthal throughout the late 1960s and early 1970 and early 1970s.

Medical journalists, despite what they may try to tell you, most certainly did not reveal the dangers of thalidomide: and in many respects it's difficult to picture a world in which the characters who produce bogus MRSA hoax stories could somehow be meaningfully engaged in monitoring and administering drug safety, ably a.s.sisted, perhaps, by 'leading experts' from their garden sheds.

What the MRSA episode reveals to me, alongside a gut-wrenching and cavalier grandiosity, is the very same parody that we saw in our earlier review of nonsense science stories: humanities graduates in the media, perhaps feeling intellectually offended by how hard they find the science, conclude that it must simply be arbitrary, made up nonsense, to everyone. You can pick a result from anywhere you like, and if it suits your agenda, then that's that: n.o.body can take it away from you with their clever words, because it's all just game-playing, it just depends on who you ask, none of it really means anything, you don't understand the long words, and therefore, crucially, probably, neither do the scientists neither do the scientists.

Epilogue Although he was a very pleasant man, from my first telephone conversation with Chris Malyszewicz it was immediately clear that he lacked the basic background knowledge necessary to hold even a rudimentary discussion about microbiology. Patronising as it may sound, I feel a genuine sympathy for him, almost as a Walter Mitty figure. He claimed to have consulted for 'Cosworth-Technology, Boeing Aircraft, British Airways, Britannia Airways, Monarch Airways, Birmingham European Airways'. After BA and Boeing, neither of which had any record of any dealings with him, I gave up contacting these organisations. He would send elliptical comments in response to detailed criticisms of his 'a.n.a.lytic techniques', such as they were.

Dear Ben, Dear Ben, As a quote: As a quote: 'I am surprised, but knowing what I know am not and knowing what I mean'. 'I am surprised, but knowing what I know am not and knowing what I mean'. Thanks, Chris Thanks, Chris I have strong feelings on this story: I do not blame Chris. I am certain that the true nature of his expertise would have been clear to anybody who spoke with him, regardless of background knowledge, and in my view it is the media that should have known better, with their huge offices, chains of command and responsibility, codes of conduct and editorial policies: not one man, in a shed in his back garden, surrounded by kitchen fittings and laboratory equipment he barely understood, bought on bank loans he was struggling to repay, in a small conurbation just outside Northampton.

Chris wasn't happy with what I wrote about him, and what was said about him after the story was exposed. We spent some time on the telephone, with him upset and me feeling, in all honesty, quite guilty. He felt that what was happening to him was unfair. He explained that he had never sought to be an expert on MRSA, but after the first story the journalists simply kept coming back, and everything s...o...b..lled. He may have made some mistakes, but he only wanted to help.

Chris Malyszewicz died in a car accident after losing control of his vehicle near Northampton shortly after the MRSA stories were exposed. He was heavily in debt.

16 The Media's MMR Hoax

The MRSA swab scandals were a simple, circ.u.mscribed, collective hoax. MMR is something much bigger: it is the prototypical health scare, by which all others must be judged and understood. It has every ingredient, every canard, every sleight of hand, and every aspect of venal incompetence and hysteria, systemic and individual. Even now, it is with great trepidation that I even dare to mention it by name, for two very simple reasons.

Firstly, at the quietest hint of a discussion on the subject, an army of campaigners and columnists will still, even in 2008, hammer on editors' doors demanding the right to a lengthy, misleading and emotive response in the name of 'balance'. Their demands are always, without exception, accommodated.

But there is a second issue, which is less important than it seems at first: Andrew Wakefield, the doctor who many imagine to be at the centre of the story, is currently in front of the GMC on charges of professional misconduct, and between me finis.h.i.+ng and you reading this book, the judgement will probably be out.

I have no idea what that judgement will be, and being honest, although I suppose I'm glad they look into things like this in general, cases like his are two a penny at the GMC. I have no great interest in whether one individual's work was ethically dubious: the responsibility for the MMR scare cannot be laid at the door of a single man, however much the media may now be trying to argue that it should.

The blame lies instead with the hundreds of journalists, columnists, editors and executives who drove this story cynically, irrationally, and wilfully onto the front pages for nine solid years. As we will see, they overextrapolated from one study into absurdity, while studiously ignoring all rea.s.suring data, and all subsequent refutations. They quoted 'experts' as authorities instead of explaining the science, they ignored the historical context, they set idiots to cover the facts, they pitched emotive stories from parents against bland academics (who they smeared), and most bizarrely of all, in some cases they simply made stuff up.

Now they claim that the original 1998 Wakefield research has been 'debunked' (it was never anything compelling in the first place), and you will be able to watch this year as they try to pin the whole scare onto one man. I'm a doctor too, and I don't imagine for one moment that I could stand up and create a nine-year-long news story on a whim. It is because of the media's blindness-and their unwillingness to accept their responsibility-that they will continue to commit the same crimes in the future. There is nothing you can do about that, so it might be worth paying attention now.

To remind ourselves, here is the story of MMR as it appeared in the British news media from 1998 onwards: - Autism is becoming more common, although n.o.body knows why.

- A doctor called Andrew Wakefield has done scientific research showing a link between the MMR triple jab and autism.

- Since then, more scientific research has been done confirming this link.

- There is evidence that single jabs might be safer, but government doctors and those in the pay of the pharmaceutical industry have simply rubbished these claims.

- Tony Blair probably didn't give his young son the vaccine.

- Measles isn't so bad.

- And vaccination didn't prevent it very well anyway.

I think that's pretty fair. The central claim for each of these bullet points was either misleading or downright untrue, as we will see.

Vaccine scares in context Before we begin, it's worth taking a moment to look at vaccine scares around the world, because I'm always struck by how circ.u.mscribed these panics are, and how poorly they propagate themselves in different soils. The MMR and autism scare, for example, is practically non-existent outside Britain, even in Europe and America. But throughout the 1990s France was in the grip of a scare that hepat.i.tis B vaccine caused multiple sclerosis (it wouldn't surprise me if I was the first person to tell you that). France was in the grip of a scare that hepat.i.tis B vaccine caused multiple sclerosis (it wouldn't surprise me if I was the first person to tell you that).

In the US, the major vaccine fear has been around the use of a preservative called thiomersal, although somehow this hasn't caught on here, even though that same preservative was used in Britain. And in the 1970s-since the past is another country too-there was a widespread concern in the UK, driven again by a single doctor, that whooping-cough vaccine was causing neurological damage.

Looking even further back, there was a strong anti-smallpox-vaccine movement in Leicester well into the 1930s, despite its demonstrable benefits, and in fact anti-inoculation sentiment goes right back to its origins: when James Jurin studied inoculation against smallpox (finding that it was a.s.sociated with a lower death rate than the natural disease), his newfangled numbers and statistical ideas were treated with enormous suspicion. Indeed, smallpox inoculation remained illegal in France until 1769.*

- Disdain for statistics in healthcare research wasn't unusual at the time: Ignaz Semmelweis noticed in 1847 that patients were dying much more frequently on the obstetrics ward run by the medical students than on the one run by the midwifery students (this was in the days when students did all the legwork in hospitals). He was pretty sure that this was because the medical students were carrying something nasty from the corpses in the dissection room, so he inst.i.tuted proper handwas.h.i.+ng practices with chlorinated lime, and did some figures on the benefits. The death rates fell, but in an era of medicine that championed 'theory' over real-world empirical evidence, he was basically ignored, until Louis Pasteur came along and confirmed the germ theory. Semmelweis died alone in an asylum. You've heard of Pasteur. - Disdain for statistics in healthcare research wasn't unusual at the time: Ignaz Semmelweis noticed in 1847 that patients were dying much more frequently on the obstetrics ward run by the medical students than on the one run by the midwifery students (this was in the days when students did all the legwork in hospitals). He was pretty sure that this was because the medical students were carrying something nasty from the corpses in the dissection room, so he inst.i.tuted proper handwas.h.i.+ng practices with chlorinated lime, and did some figures on the benefits. The death rates fell, but in an era of medicine that championed 'theory' over real-world empirical evidence, he was basically ignored, until Louis Pasteur came along and confirmed the germ theory. Semmelweis died alone in an asylum. You've heard of Pasteur.

Even when Edward Jenner introduced the much safer vaccination for protecting people against smallpox at the turn of the nineteenth century, he was strongly opposed by the London cognoscenti.

And in an article from Scientific American Scientific American in 1888 you can find the very same arguments which modern antivaccination campaigners continue to use today: in 1888 you can find the very same arguments which modern antivaccination campaigners continue to use today: The success of the anti-vaccinationists has been aptly shown by the results in Zurich, Switzerland, where for a number of years, until 1883, a compulsory vaccination law obtained, and smallpox was wholly prevented-not a single case occurred in 1882. This result was seized upon the following year by the anti-vaccinationists and used against the necessity for any such law, and it seems they had sufficient influence to cause its repeal. The death returns for that year (1883) showed that for every 1,000 deaths two were caused by smallpox; In 1884 there were three; in 1885, 17, and in the first quarter of 1886, 85. The success of the anti-vaccinationists has been aptly shown by the results in Zurich, Switzerland, where for a number of years, until 1883, a compulsory vaccination law obtained, and smallpox was wholly prevented-not a single case occurred in 1882. This result was seized upon the following year by the anti-vaccinationists and used against the necessity for any such law, and it seems they had sufficient influence to cause its repeal. The death returns for that year (1883) showed that for every 1,000 deaths two were caused by smallpox; In 1884 there were three; in 1885, 17, and in the first quarter of 1886, 85.

Meanwhile, WHO's highly successful global polio eradication programme was on target to have eradicated this murderous disease from the face of the earth by now-a fate which has already befallen the smallpox virus, excepting a few gla.s.s vials-until local imams from a small province called Kano in northern Nigeria claimed that the vaccine was part of a US plot to spread AIDS and infertility in the Islamic world, and organised a boycott which rapidly spread to five other states in the country. This was followed by a large outbreak of polio in Nigeria and surrounding countries, and tragically even further afield. There have now been outbreaks in Yemen and Indonesia, causing lifelong paralysis in children, and laboratory a.n.a.lysis of the genetic code has shown that these outbreaks were caused by the same strain of the polio virus, exported from Kano.

After all, as any trendy MMR-dodging north-London middlecla.s.s humanities-graduate couple with children would agree, just because vaccination has almost eradicated polio-a debilitating disease which as recently as 1988 was endemic in 125 countries-that doesn't necessarily mean it's a good thing.

The diversity and isolation of these anti-vaccination panics helps to ill.u.s.trate the way in which they reflect local political and social concerns more than a genuine appraisal of the risk data: because if the vaccine for hepat.i.tis B, or MMR, or polio, is dangerous in one country, it should be equally dangerous everywhere on the planet; and if those concerns were genuinely grounded in the evidence, especially in an age of the rapid propagation of information, you would expect the concerns to be expressed by journalists everywhere. They're not.

Andrew Wakefield and his Lancet Lancet paper paper In February 1998 a group of researchers and doctors led by a surgeon called Andrew Wakefield from the Royal Free Hospital in London published a research paper in the Lancet Lancet which by now stands as one of the most misunderstood and misreported papers in the history of academia. In some respects it did itself no favours: it is badly written, and has no clear statement of its hypothesis, or indeed of its conclusions (you can read it free online if you like). It has since been partially retracted. which by now stands as one of the most misunderstood and misreported papers in the history of academia. In some respects it did itself no favours: it is badly written, and has no clear statement of its hypothesis, or indeed of its conclusions (you can read it free online if you like). It has since been partially retracted.