Geoff Watts looks at how an experts hypothesis became highly controversial

The time when medical journals were exclusively read by doctors is no longer. The press unearthed a public taste for the clever doings of their doctors. The hacks began to scan the learned journals in search of titbits.

The journals—most of them commercial enterprises as dependent on being read as the Sun or the Mirror—decided to help out by picking what they judged to be the best or most intriguing stuff and issuing press releases. In this way, much useful information is routinely disseminated. Research charities are able to flag up their work and raise more money. Many a consultant ego has been pleasantly tickled. Everyone is happy. So publicising medical journals has proved to be a Good Thing.

Alas, even the best Good Things have downsides, as one Essex neurologist has discovered. If Christopher Hawkes had published his short report in the Journal of Neurology, Neurosurgery and Psychiatry 50 years ago and not last month, he would have been OK. But nowadays a title like “Is multiple sclerosis a sexually transmitted infection?” is pretty much guaranteed to get your paper on the hot list. And for Hawkes, things have indeed become a little warmer than hed like.

Hawkes used a variety of published studies to erect a modest plinth of circumstantial evidence. Standing on his creation, he fulfilled the duty of all in this position: he suggested some testable hypotheses. The merits of his theory are, for the present purposes, neither here nor there.

The snag is that hes dealing not with disease transmission by uncontroversial routes such as eating or drinking or using other peoples combs and toothbrushes. Hes dealing with sex. “I propose,” he writes, “that multiple sclerosis is a sexually transmitted infection acquired principally during adolescence.” Sex, in other words, between kids who are not only young but possibly under age. And theres worse yet. “Some childhood multiple sclerosis,” he suggests, “might be spread through child abuse.”

The Multiple Sclerosis Societys response was an angry press statement pointing to the lack of “direct evidence of sexual transmission of an infective agent in MS.” Its comment was backed by the Cambridge professor of neurology, Alastair Compston, who described the paper as having “little if any scientific value.” The Institute of Neurology (to which Hawkes affiliates himself at the head of his paper) has also dissociated itself from his views, and denied that he has the right to claim such an affiliation.

The newspapers, for once, emerge more or less without blame. Most rely on quotes from the report and the society, and all that I have seen make use of the words “could” and “might” carefully.

So what is all this about? Its tempting to dismiss the affair as a bit of huffing and puffing brought on by a prudish refusal to face up to the fact that even nice respectable people sometimes catch sexually transmitted diseases. The difficulty, of course, lies in Hawkess brief reference to the possibility of child abuse.

It is easier in cases like this to say what shouldnt happen than what should. The Journal of Neurology, Neurosurgery and Psychiatry is a peer reviewed journal from the BMJ Publishing Group that can hardly refuse to publish views on the scientific basis of disease because they may distress certain people, or even imply that criminal acts have happened. Peer reviewers are certainly under an obligation to do their duty even more conscientiously than usual—but not to act as censors of the unpalatable; ditto the journals editor.

Nor should we try (against any possibility of success) to restore medical journals to their previous condition as closed communities of thought. The free circulation of ideas, however upsetting, is as essential to society as it is to science. And authors of new ideas should certainly not be attacked for having advanced them.

That said, it may be that a journal is not always the best place to do so. A closed meeting held as, say, part of an annual conference is one alternative. Such meetings raise spectres of their own. But interested professionals could debate the strengths and weaknesses of a controversial proposition in private and, if an idea is found wanting, dispose of it there and then, avoiding unnecessary upset.

Wider than normal peer review of this kind would be cumbersome, and hardly leakproof. But assuming (I hope) that no studentBMJ reader would defend intellectual censorship solely on the grounds of causing distress, the issue raised by the Hawkes case is less a matter of principle than of simple tact. Time and place are everything when swapping controversial opinions.