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Taking a new view on the current MMR/Media debate from a social science perspective

February 11th, 2009

Dr Petra

Over the last few days the case of Ben Goldacre and LBC has spread across the net.

In case you’ve forgotten, here’s the story in a nutshell:.

First of all…
In January LBC radio presenter Jeni Barnett had a phone-in on MMR as part of her regular afternoon programme. It featured Jeni endorsing misleading views on MMR and discrediting health professionals who tried to educate her listeners.

Next…
Ben Goldacre heard about the programme, was upset about the inaccurate views given, and posted a clip of the show focusing on the MMR debate. LBC threatened to sue him. Ben had to remove the clip.

Following that…
Several bloggers posted chunks of the larger clip on their sites along with transcripts of the show.

In the middle of this…
Brian Deer reported in The Times that Andrew Wakefield had fabricated data used in his paper on MMR previously published in The Lancet

At the same time…
Jeni Barnett wrote a couple of blogs defending her position, one stating she had a right to her views as a mother (although acknowledging she perhaps should have researched the area a bit more thorougly before going on air), the other attacking what she called ‘bad scientists’. Folk commented on her blog, mostly disagreeing with her position.

Suddenly…
Barnett removed comments. After that her blog entries were taken down. Bloggers found the cache of these discussions and posted them on the net.

Meanwhile…
Bloggers took pot shots at Barrett, Wakefield, homeopaths, anti-vaccine campaigners, and parents who don’t get their kids vaccinated, while promoting evidence based medicine, randomised control trials and the scientific method. In contrast anti-vaccine and alternative medicine forums buzzed with hatred against Goldacre and Deer; and raised questions about research, parent choice, and the influence of drug companies. And media folk started saying ‘well why did they punish Brand and Ross for swearing but misleading on health seems to be okay?’

And then…
David Aaronovitch at The Times lambasted LBC, recommended counter legal action and backed Ben. Actor Stephen Fry urged his fans to support to Ben. MP Paul Flynn threw his hat into the ring, criticising LBC; while Lib Dem Health and Science shadow ministers Norman Lamb and Evan Harris have tabled an Early Day Motion to Parliament to get the house to show it supports MMR.

And all the while more and more and more bloggers covered the tale.

Rather than just reading my summary, why not read Ben’s update here.

Things are moving on apace and if you’re following any science/media blogs you can’t avoid this story and debates it has generated. In fact, it’s transformed into a great piece of action research.

And that’s the reason why I think we now need to up our game further and apply good health research approaches to this story so we focus on transparency, critical thinking and reflexive practice.

Here’s how (and why) we might do this.

The debate thus far has featured a lot of input from bloggers with a natural science/medicine background. It’s time more social scientists contributed. For example, the Jeni Barnett phone in on MMR has been transcribed and appears in audio form (links to both available in Ben’s recent blog linked above). Those skilled in qualitative analysis could at this time provide some much-needed input to how the discussion went, what devices were used to convey particular messages, what issues were covered, and where interruptions and disagreements took place.

Why would this conversation analysis be useful? Well, many with an interest in MMR would like to try and debate the issue or explain more about why parents should opt to have their children vaccinated. However, they know many who oppose vaccinations use particular rhetorical techniques they find hard to counter – not because they don’t know what to advise on MMR but because opposition can be leftfield and tricky to anticipate and respond to. So having detailed textual analysis would highlight particular patterns in conversations on MMR which may allow for clearer discussion in the future.

If you work in health/social science you could use these transcripts as part of a teaching exercise in how we frame debates on MMR. Or you could encourage your students to follow all the wider discussions on this story to see how it developed, what issues were covered, and how different bloggers and writers approached the story (this would also be helpful for those of you teaching journalism and media studies).

Posting transcripts is a great way of archiving discussions and ensuring they can’t be deleted and can be examined independently. But I’d argue as a social scientist this is only part of the work we need to be doing. Simply to leave the transcripts as they are is equivalent to leaving numerical data as raw data. So anyone who can do qualitative analysis should at this point be sharing their skills to further interrogate the materials a few helpful bloggers have very kindly transcribed.

Borrowing from a qualitative approach, we could also do with some reflexivity here. We need to examine our motives for blogging and be mindful about our overall purpose in discussing this case. We need to read what we’ve written and reflect on our messages. Where we’ve been using the story to crow about stupid parents, or construct a radio presenter as a middle-aged-old-bat then we may want to reflect on why we’ve done that and what we believe it will achieve. We’ve been rightly harsh on Jeni Barnett for passing off opinion as fact, but we need to consider if in places we’ve done this too and reflect on what circumstances led us to take that approach.

Which leads me on to transparency. As bloggers are picking up this story it’s taking on something of a life of it’s own, and the best blogs have been careful to document completely the discussions as they find them. That means linking to blogs, sharing papers about the MMR debate, and also to sources of advice and support for a lay audience. Given that so many parents and politicians are anxious about MMR it would be helpful if, when they found blogs or websites tackling this issue, that any discussions were clearly signposted and all discussions endorsing MMR contained somewhere a link to a source of advice for those worried about the health needs of their children.

This topic area is an emotive one for many reasons. We must never lose sight of the reason we’re fighting this battle. It’s because we want to keep children healthy, we don’t want children to suffer or die. Those working in healthcare will have seen this first hand. But because many of us are so emotionally invested in this area we need to consider how that translates into the messages we give and how we convey ideas.

Parents often complain they don’t know who to trust about MMR and are skeptical of scientists. If we speak in terms a lay audience cannot follow, or appear intent on beating down anyone who doesn’t sign up to evidence based medicine we are going to lose the fight to those who oppose MMR. Those who speak in a language of care, parent support, and opposition to bad medicine, arrogant scientists, corrupt politicians and the pharmaceutical industry.

As one of her devices to get her audience to support her view Jeni Barnett used the ‘I’m speaking as a mother’ phrase. Her critics acknowledged she could speak as a mother, but not if she turned opinion into fact or used her platform to misdirect other mothers’ listening. Some bloggers went further by sneering at Barnett for using a phrase they saw as foolish.

But we can occupy different subject positions in how we think about and talk about issues that are important to us. Let me give you an example. This whole blog so far has been me speaking as a social scientist. I’m now going to speak to you as a mother.

I gave my son the MMR because I wanted to protect him from disease and protect other children. I had no concerns about doing this because I’m a mam who also works in healthcare. I knew why the triple vaccine was used, what the side effects could be, and what ‘herd immunity’ meant.

But my friends with new babies weren’t so lucky. They were all smart women, but didn’t have a background in healthcare. Like me they’d all been confused by conflicting advice from health visitors, several of us had planned for a birth experience that never materialised, most got their health information from the media. Unlike me they didn’t have access to scientific journals, an understanding of healthcare evidence, or a GP colleague at the end of the phone if ever I had a question. They were understandably anxious about whether to vaccinate or not. Where could they go for help?

Are we all certain, as we blog, women like my friends could feel able to approach us or listen to what we have to say? What aspects of our writing are accessible and persuasive? Are there any parts of what we’re writing or advocating that might make people stop listening?

As scientists, bloggers, healthcare staff or whatever position we occupy in promoting MMR and tackling misinformation about it we have to remember that at the heart of this whole sorry saga are parents who are desperate to do the best for their children and still building their confidence as parents. Believe me (and I speak very much as a mum here) it doesn’t take an awful lot to knock that confidence.

Parents aren’t making the choice not to give the vaccine because they are stupid, uncaring, selfish child abusers. They are choosing not to vaccinate because they want to keep their baby safe. People like Jeni Barnett are dangerous because they play on this. And we can also be dangerous if we speak in ways that distance us from the very people we want to reach.

I’ve heard a lot in the last week from bloggers talking about activism. I would endorse that. But perhaps in a more practical way than has been suggested so far (hey, I’ve told you I’m a mum and a scientist, what did you expect?!). It’s fine blogging about MMR, it’s fine debating it on forums, it’s fine shouting out about bad journalism and misunderstanding science. But who are we talking to?

If you’re someone who reads blogs and forums on science and healthcare you’ve probably heard this story. Is it being heard outside of this sphere? We need to question if these are the only places to have our discussions. How much more good could we do if we moved information and advice on MMR to blogs, websites, magazines and forums for parents? I don’t have the skills or qualifications to do this, but those people who do could use this recent case to flag up the issue. Perhaps we might ask nurse Yasmin who argued the case with Jeni Barnett to do that?

Here’s where we could bring in a final piece of good health research practice – we could ask people to ask us their questions, listen carefully, and use those worries to form the basis of the advice we offer.

This story is about so many issues. On the surface it’s about poor media practice and bad health advice. But the resulting activity provides us with a rich seam of data and an opportunity for critical reflection that should, if we accept the challenge, inform our practice, improve our skills as communicators, and make it that much more likely that we can promote MMR effectively.

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