February 25, 2010
By Kate Johnson
In the loud noise that echoed worldwide after the Lancet’s stunning retraction of Andrew Wakefield’s controversial paper on the autism/MMR vaccine link, there was an equally stunning whisper from the journal’s editor Dr. Richard Horton, that is still bouncing around disagreeably in my head.
In a nutshell, it was a cloaked threat to the public’s right to know.
“The lesson we’ve learned is that anything we publish will be picked up and used. It certainly made us much more risk-averse, much more conservative,” he told National Public Radio.
“We now try to be even more cautious about the kinds of work we publish, recognizing that you cannot have a closed discussion in the scientific community about anything today. Everything is accessible to everybody, at any time.”
Yes, he acknowledged the journal’s mistake in publishing the fraudulent paper. In fact, he called it a “system failure”. “We failed, I think the media failed, I think government failed, I think the scientific community failed,” he said.
But then he dropped the “too much information” bomb.
“We used to think that we could publish speculative research which advanced interesting new ideas which may be wrong, but which were important to provoke debate and discussion. We don’t think that now,” he said. “What we don’t seem able to do is we don’t seem able to have a rational conversation in a public space about difficult, controversial issues, without people drawing a conclusion which could be very, very adverse.”
Bob Garfield, the interviewer then laid it in his lap: “is this a case where these conversations would have been better confined to the medical community that somehow the public should not be participating in these things because we simply don’t have the wherewithal to evaluate them?”
Dr. Richard Horton: “I think that [LAUGHS] although that’s a nice thought, the problem is that that’s just impossible today. The 19th century days where you could sit in the salon at the Royal Society and have a private conversation amongst your fellows, it just doesn’t exist anymore. So I think, yeah, too much information in this particular case is a bad thing, which seems to go against every kind of democratic principle that we believe in. But in the case of science, it seems to be true.”
I can’t get my head around this comment, many versions of which have no doubt been bandied about amongst “the fellows” at the Royal Society, what?
The suggestion that medical debates should take place behind closed doors is a deeply troubling notion, especially coming from the editor of a medical journal.
The media admittedly has had a field day with the autism/vaccine story, but isn’t that an essential part of public debate? Certainly there are bad journalists – just as there are bad scientists. But in the end, wasn’t it actually a journalist who first exposed Dr. Wakefield’s fraud?
As a medical journalist I am biased, but I think I am also correct in saying that journalists play a useful – maybe even essential – role in advancing the public’s understanding of issues and controversies in medicine. True, bad journalism does damage (so does bad science) – but you can’t tar us all with the same brush.
Unfortunately, many researchers and physicians do.
Take Dr. Val Jones’ recent Science Based Medicine blog: Why You Can’t Depend On The Press For Science Reporting.
Yes, she has a nightmare story to tell. I don’t blame her for being mad. But then she slam dunks all mainstream media:
“My take home message from the experience is that blogs like Science Based Medicine seem to offer the only guarantee of unedited rational thought on matters of health and medicine. Thank goodness we’re no longer beholden to mainstream media for all our health news and commentary. It is a shame that most consumers get their news from TV and other outlets that don’t seem to maintain a journalistic quality filter.
This is why our work here is so important… because without scientists and healthcare professionals providing a counterpoint to the endless onslaught of superficial and misleading information, our patients won’t stand a chance of discerning the truth. We need more critical thinkers to join the cause, and I hope that more of us will step up to the plate and contribute to outlets like SBM or Better Health. Waiting for reporters to include us in the discourse could take a very long time..”
So, what is a curious, committed journalist to do? Is the answer to communication break-down really to shut the door on us? Isn’t there a constructive compromise?
A commentary in this week’s Journal of the American Medical Association offers one.
Writing about selective academic reporting in the field of deep brain stimulation (DBS), psychiatrists Dr. Thomas E. Schlaepfer (Johns Hopkins University and University Hospital, Bonn, Germany) and Dr. Joseph J. Fins (Weill Medical College of Cornell University, New York) point out that “balanced publishing of results—both pro and con—is particularly critical because scientific articles concerning DBS attract prominent media coverage. Public and patient understanding of the risks and benefits of DBS is strongly shaped by media accounts.”
In other words, the delivery of accurate medical information to the public relies on the collaboration of scientists and journalists.
Shutting the media out of medical debate will only serve to deepen the public’s misunderstanding of complex issues. Rather than closing their doors, medical researchers should open them wider to allow journalists the access and understanding they need to tell their stories well.
In the wise words of Dr Schlaepfer and Dr. Fins:
“While science and a democratic society thrive on the open exchange of ideas and a free press, those who are privileged to produce, assess, disseminate, or report new knowledge have a responsibility to place scientific work into proper context. Without a nod to censorship, investigators, journal editors, and journalists should try to help their readership understand the significance of published work. This effort cannot be done when authors engage in selective submissions of their work, editors fail to ask about contrary data, and journalists hype whatever outcome they have been given. In the Nichomacean Ethics, Aristotle wrote of the greater responsibilities of those with superior knowledge to act morally and make good choices precisely because they knew better. Those entrusted with the creation and dissemination of new knowledge should aspire to Aristotle’s phronesis. This is a lesson that transcends the DBS example and is pertinent more generally for science and society.”
Kate Johnson's Medical Musings 
Great post Kate. I totally agree with your disquiet about Richard Horton’s comments. Science absolutely should be debated out in the open, and if a paper is going to be controversial that’s not a reason not to publish it.
However, I think you may underestimate just how much of a problem the media can be in all this. Over here in the UK, there were some absolutely disgraceful stories about MMR and autism in the mainstream press from journalists who really should have known better. I can absolutely see where Dr Horton is coming from in thinking that keeping such stories away from the public eye can avoid all the misinformation.
But I also think he’s wrong. Just because journalists frequently misinterpret science isn’t a reason to keep science out of the public domain. It’s a reason for the good science journalists to make their voices heard more loudly over all the bad science journalists who want to misinterpret things.
Sadly, however, I don’t think that’s a battle that’s being won.
Oh, and I totally agree with you that scientists have a part to play as well. They could do a much better job than most do currently about communicating their results. But remember it’s hard for them to communicate directly to the public without journalists acting as intermediaries.