(Fiona Morgan) Hello and welcome to the discussion segment for week three. This week, we’re talking about health research into treatments, how those treatments are tested. And I’m joined by two familiar faces, Andy Williams and Keren Williamson. So we’ve been talking about how treatments are tested. We’ve provided some questions that you can ask to decide whether you trust research or not. We’re not trying to over-complicate this. We’re just giving you some simple tools that will help you think about research when you’re looking at it. So we were talking. We’ve talked about treatments and how the basic standard treatment is that when you test it, you shouldn’t know that one treatment is better than another.
And I think you were saying that there were some concerns about that. Because people seem to think the new treatment. (Keren Williamson) Well, oftentimes when people are entered into trials, they hope that they will be offered the arm that gives them the new treatment, as opposed to the treatment that is the standard treatment. And sometimes it’s quite difficult to persuade them that the design of the trial is such that nobody would be disadvantaged, and that the new trial it is not– the new treatment– is not proven to be better than the treatment they would be offered normally.
And it’s how you can encourage people to look into the information that they’re given, so that they are reassured, and that they believe it, and what questions they can ask to help them to ensure that they are feeling confident that they’re not going to be disadvantaged in any way. (Fiona Morgan) Yes, because it’s fundamentally unethical to compare two treatments when you’ve already got significant evidence to show that one is much better than the other. What we looked at in our case study, Andy, was a case series. It was a small study looking at 12 children who had been vaccinated with the MMR vaccine. (Dr. Andy Williams) Yeah. Yeah.
And that’s a really good example to illustrate how important it is for members of the public to have a bit of an idea about what different forms of medical research can tell us, isn’t it? Yeah. And there’s nothing wrong with a case series like that, which is essentially what Ben Goldacre, the journalist, has called– and medical research– Ben Goldacre has called a collection of clinical anecdotes. It cannot tell us anything about cause and effect. It might raise interesting questions, which further, more detailed, different studies could check out. But it can’t prove, in this case, that the measles, mumps, and rubella vaccine causes something as common as autism. But the media coverage of this case was very interesting.
Because it showed us that sometimes a good story in the eyes of the media, a bit of a dust up between scientists and between interest groups in society, can lead to quite weak evidence being puffed up, being just taken up and run with by the media, not really to communicate the evidence very effectively, but more to promote further sales of that news product. There’s been further audience research in my field carried out which paints a really quite strong evidential picture that the news media coverage meant that fewer people vaccinated their children with the MMR vaccine, which led to lower vaccination rates for measles, mumps, and rubella, which really significantly affected herd immunity.
And whilst people do talk about the relatively few number of deaths this country, there have been measles deaths since the MMR scandal. And if you talk to people in Public Health Wales, Public Health England, who have to deal with these outbreaks of measles, and of mumps and rubella in cases, they call the people who suffered from these illnesses and conditions Wakefield’s children, you know. This is to do with the miscommunication of that very weak, evidentially weak, work on MMR in the late ’90s and early 2000s. (Fiona Morgan) Yes.
Now we have that one study which has never been replicated, the results of that have never been replicated against population studies in now well over a million children, which showed no causal link, and in fact show that although it’s not significant, that there is slightly less autism in vaccinated populations than there is a non-vaccinated populations. (Dr. Andy Williams) Yes. And we now have the evidence. And there was significant evidence at the time as well that Wakefield’s claims were pretty ropy really, not really very reliable. (Fiona Morgan) It’s really about the fact that when scientists talk, they are very nuanced. They’re very careful about how they express things, which carries with it less certainty.
And your emotional parent who says, I know this happened, carries a lot more weight in a weird kind of way, and a certain strange credibility that is no– that is not backed up by the evidence in this case. (Dr. Andy Williams) Yeah. The news media does not do uncertainty very well when it comes to science. Because you can’t fit– you can’t fit scientific uncertainty, you can’t fit all the caveats into the two minute broadcast lodge, or into the 300 word newspaper article, or online news article. It’s just– so the form of the news and what journalists look for militates against the nuanced communication of scientific uncertainty, which is, of course, one of the great strengths of science, isn’t it?
(Fiona Morgan) Yes. What can you take from it? A single study is unlikely to give you all the evidence you need, particularly if it’s as small as that, particularly if it’s a small case series, rather than a large study. We’re going to be looking at risk next week. And this is something that we will pick up in more detailed then, too. (Dr. Andy Williams) I’d say that one of the most important things that informed health consumers who read the mainstream news media can take from this is firstly, you can’t trust everything that the mainstream news media says about health. But that doesn’t mean that you should discount everything that the mainstream news media says about health.
There are certain things that you can do when looking at that coverage to insure yourself that this is based on rigorous research. Is it peer-reviewed? Is it published in a reputable journal? In which case, you know, in this case MMR, both of those things were true. Secondly, what are other scientists in the field saying about this? This is where the journalists really, really dropped the ball on the MMR case study. They paid too little attention to the consensus on the safety of all the risks associated with MMR.
And if it’s just one scientist or one small group of scientists, and that you’re not seeing much from anybody else in that field corroborating what they’re saying, that’s a big warning light, isn’t it, for you when deciding whether to make a decision that could affect you or your loved ones personally based on this information in the news media. (Fiona Morgan) And we do refer people to NHS Choices, Behind the Headlines. (Dr. Andy Williams) That’s an excellent, absolutely. (Fiona Morgan) Which covers those things. (Dr. Andy Williams) Always check out the myth busting websites that you’ve been giving people a link to.
Always check out the specialist science journalism that’s out there, in places like Nature and the BMJ, a lot of it online for free these days, like the New Scientist, if you’re really interested in these issues in more detail, or like the excellent range of science blogs which are out there, written often by science specialist journalists who really, really will go into the detail, will really, really go in more depth and hopefully rigorously test some of the claims which are more credulously accepted by the mainstream journalists, who just have less time and less knowledge on this issue. (Fiona Morgan) And Keren, you. (Keren Williamson) Yes.
I think one of the things for people who don’t quite understand perhaps the linguistics of medicine and science very well is look for key words. The gold standard we could say, is it a randomised control trial? If you look at that, that should give you a heads up that perhaps this is worth a second look. And then, yes, use the reputable sites, particularly those that are not for profit. So you can be reassured that there isn’t really always a hidden conflict of interest in there. (Fiona Morgan) Wonderful. Thank you very much.