A = LETTER 1 B = LETTER 2 C = LETTER 3 D = LETTER 4 Which letter defends the safety of the vaccination programme claims that fears about the vaccine were based on unreliable evidence believes that intellectual freedom is threatened by mistakes made by science and society emphasizes the difficulties in dealing with health scares makes a comparison of Iraqi civilian deaths and MMR says that Melanie Phillip is confused about epidemiology and clinical results points out that scientists would become less credible if they do not base their conclusion on enough evidence suggests that readers search the journal mentioned in the debate by using Google suggests that a neutral organization be established for mediation of scientific controversies accuses Melanie Phillips of misrepresenting the truth 1. ______ 2. ______ 3. ______ 4. ______ 5. ______ 6. ______ 7. ______ 8. ______ 9. ______ 10. ______ A LETTER 1 When a vaccine, drug or therapy is marketed as "safe", it is done so on the basis or formally controlled, large-scale, usually blind investigations by qualified professionals. The fact that "a small proportion of parents found that after vaccination their children developed bowel problems, an allergic reaction to various foods and a halt to their behavioural development that produced the symptoms of autism" does not render an entire vaccination programme unsafe any more than it suggests a causal relationship between administration of the vaccine and onset of symptoms. Anybody with even the most basic grasp of scientific principles can understand this. The MMR vaccine in its current form was approved following the same extensive testing as any other clinical prophylaxis. For Melanie Phillips to suggest that the "government and [the] medical establishment ... have behaved recklessly and spinelessly" in the aftermath of Wakefield’s so-called research is itself an irresponsible misrepresentation of the truth, which contributes to the unnecessary confusion in the general public domain. B LETTER 2 The difficult relationships between science, medicine and public policy are well illustrated by your reports on Iraqi mortality (The media are minimising US and British war crimes in Iraq, November 8) and MMR (The case against me boils down to smear and evasion, November 8). The triggers for these controversies were research papers published in the Lancet. In a lost age, these studies would have been privately discussed in academic circles, their conclusions confirmed, refined or refuted. This environment of intellectual freedom has served science and society well for 400 years. But such freedoms are now under threat from errors made by both science and society. The mistake scientists have made -- and 1 include myself in this criticism -- is to blur their roles as independent investigators and public advocates. It is entirely right that scientists and doctors play a prominent part in social and political debate. But we lose credibility, justifiably, when we go beyond the evidence. Here, the comparison between Iraq and MMR is instructive. On Iraq, the authors of the Lancet report used their results to call for the genuine uncertainty over civilian deaths to be clarified urgently by drawing on further data that only government could provide -- indeed, which government had a duty to provide under the Geneva conventions. This was responsible advocacy in the face of scientific uncertainty. By contrast, Andrew Wakefield used a press conference to subvert the conclusions of his Lancet study by casting doubt on the safety of the MMR vaccine, a doubt that the research paper specifically denied. One could argue that neither study should have seen the light of day. This would be a capitulation to those who would prefer censorship to serious public discussion about controversial ideas. While it is impossible to turn the clock back to a time when science was hidden from the public sphere, there is a need to find better ways to conduct complex debates openly and accountably. An independent body to provide a neutral public space to mediate, investigate and make recommendations about scientific and health controversies, akin to the Food Standards Agency, deserves serious consideration. C LETTER 3 It is a microcosm of the difficulties in dealing with health scares that I can write 850 words on an anti-MMR diatribe by Melanie Phillips, generate 900 words of letters in return as well as an article by Phillips -- all reinforcing her original misconceptions, and raising some new ones. For every unit of energy you put in, you get twice as much back, and so you can never win. She is still amazed that a critical review of the scientific literature on MMR is critical of some of the literature it reviewed and she still thinks this is evidence of guilt or cover-up in the conclusions of the report. I criticised her for claiming that: "Wakefield’s discovery of autistic enterocolitis as a completely new syndrome has now been replicated in studies around the world as a new and so far unexplained disease in patients with autism." Her response is to provide references to various speculative research findings on the bowels of people with autism. Such studies exist but few would claim that such early work constitutes wide replication of the discovery of a "new disease". I also encourage any readers who are interested in what Phillips considers to be an appropriate source for ground-breaking, peer-reviewed scientific research to look up the Journal of American Physicians and Surgeons on Google and read about this strange esoteric political organisation for themselves. Having said all that, Melanie Phillips of the Daily Mail has misrepresented and attacked me personally: and so whatever the future may bring, I can die a rounded and happy human being. D LETTER 4 Melanie Phillip’s rebuttal of Ben Goldacre’s criticisms bears out his main points. She claims that the Cochrane report does not say that the fears about the vaccine were based on unreliable evidence. Yes it does. You need go no further than the abstract to read "no credible evidence of an involvement of MMR with either autism or Crohn’s disease was found’. She goes on to say that epidemiology cannot establish a causal association, and that Goldacre is confusing epidemiology and clinical results. No, the confusion is hers. Epidemiology can produce overwhelming evidence for a causal connection. What it cannot produce is information about the mechanism of that connection. It is worth adding that clinical studies do not necessarily produce information about the causal mechanism.