The Toronto Star has come under intense fire from Canada’s public health community for its investigation last week into Gardasil, the HPV vaccine given to teenaged girls across Canada to prevent cancer.

The investigation, published on the Star’s front page with a large banner headline — “A wonder drug’s dark side” — told you that “Hundreds of thousands of teen girls have safely taken Gardasil … But a Star investigation has found that since 2008 at least 60 Canadians experienced debilitating illness after inoculation. Patients and parents say the incidents point to the full disclosure of risks.”

That alarmist information is not the full story.

What you need to know and understand fully is the fact that there is no scientific medical evidence of any “dark side” of this vaccine. The Gardasil vaccine has been tested by highly credible national and global public health agencies and the scientific evidence overwhelmingly concludes that it is safe and effective.

That was made quite clear in an Opinion page article published in the Star this week. That article was written and endorsed by 65 Canadian specialists in infectious diseases, public health or related sciences.

The only — and very rare — serious side effects of HPV vaccines that scientific studies point to are allergic reactions. Continuing studies of databases of adverse effects “have not found any evidence of any other serious side effects,” the experts said in their article.

That opinion article was submitted to rebut the Star’s Gardasil investigation and provide important and necessary perspective to our readers. The Star did the right thing in publishing the health specialists’ article. I believe it presents the established scientific facts on Gardasil, making clear the vaccine’s value in preventing cervical and other cancers.

The experts who endorsed the article and the public health community throughout North America have weighed in vigorously, expressing strong concern that the Star’s investigation was alarmist in the face of the established science. I agree.

These critics rightly charge that in giving disproportionate and dramatic play to the heartbreaking stories of young women who suspect their illnesses are linked to having received the vaccine — and, indeed, either they or their doctors have reported those illnesses to a public database that collects individuals’ reports of adverse vaccine reactions — the proven scientific evidence of the vaccine’s safety was not made clear enough to readers.

In matters of public health, the science of vaccine safety is significant. Penny Park, executive director of the Science Media Centre of Canada , a non-profit organization set up to encourage excellence in media coverage of science issues, told me that this is of great importance in medical stories that have an impact on personal and public health.

“Especially in medical stories, journalists must be held to the highest standards,” she said. “The impact of misinformation is far too grave, not only for our own personal health, but for decisions on public policy.”

While journalists certainly have every right to investigate the medical, pharmaceutical and public health establishments – and indeed, should — the standards of excellence and responsibility expected in any journalism that pertains to health and medicine demands that the evidence-based science be given proper weight over the emotional stories of individuals that science labels “anecdotal evidence.”

The widespread criticism of the Star’s story expressed by those within the medical, scientific and public health communities is fair and valid. The many experts who have come forward to explain fully the science of this vaccine’s safety are highly credible. I believe they have spoken up out of genuine concern that the Star has fallen short of evidence-based standards of reporting on public health. They fear the Star investigation could cause harm if young women and their parents don’t fully understand the robust evidence of the vaccine’s safety and thus, avoid the vaccine.

The Star now understands and takes seriously the concerns and criticism. As publisher John Cruickshank said in responding publicly on CBC Radio’s As it Happens this week, “We failed in this case. We let down. And it was in the management in the story at the top. I take responsibility and we will focus on doing better in the future.”

It’s too bad there isn’t a vaccination to prevent journalistic misstep. I suspect we’d all line up for that shot about now. The fallout here has been devastating for the newsroom. As editor Michael Cooke rightly points out, “the Star has a long history of important investigative reporting on possible safety issues of the drugs we use and the pharmaceutical industry that produces them. The piece on the HPV vaccine Gardasil was done as part of that stream of coverage.”

To be fair, in the Gardasil investigation, reporters David Bruser and Jesse McLean absolutely do not conclude or state that the vaccine caused any of the suspected side effects the young women talk about. The article was written carefully to try to impart to readers the message that there was no conclusive evidence.

And, if you read the article carefully, you will see that it states explicitly the fact that “there is no conclusive evidence showing the vaccine caused a death or illness.” It explains that in all of the cases discussed in the article, it is the opinion of a patient or her doctor that a drug has caused a side-effect. As well, the story tells you that comprehensive clinical trials and other data “show the vaccine’s well-studied safety and efficacy.”

It includes the voice of Dr. Jennifer Blake, president of the Society of Obstetricians and Gynaecologists of Canada, who said, “I’m extremely comfortable that this is a safe vaccine.” It reports that hundreds of thousands of girls in Canada have safely taken Gardasil.

But the proven and stated fact of the vaccine’s safety was seemingly lost to too many. I think that’s largely due to the dramatic front-page presentation with its large headline heralding the vaccine’s “dark side” and subheadline telling you that 60 Canadians experienced debilitating illness after inoculation.

That subhead doesn’t inform you that there is no science-based evidence whatsoever that the vaccine caused those debilitating illnesses. The captions accompanying the photos of four girls contained none of the above context the story took care to include.

The main photo caption accompanying a large photo of a mother sitting in her deceased daughter’s bedroom and stating, “Linda Morin found her 14-year-old daughter Annabelle dead in the bathtub shortly after she received her second injection of the HPV vaccine Gardasil” is alarmist in the face of the fact that there is no scientific evidence to prove the vaccine caused her daughter’s death.

The reports of these young women’s illnesses come from a public database of adverse vaccine effects. The Star’s investigations editor, Kevin Donovan, has said publicly he believes this is valid information and the investigation gave voice to women who believe their debilitating illnesses were caused by the vaccine.

But, as public health experts have made clear to me in dozens of emails this week, by the standards of evidence-based science and science reporting, such stories are considered “anecdotal evidence” only. These reports in no way prove the vaccine caused harm. To allay fear, that important context needed to be proclaimed much more boldly in the article and its presentation.

The reporters told me from the outset that “the story is neither anti-vaccine nor pro-vaccine.”

“As with many of our other articles published as part of our ongoing investigation into drug safety, this one is mainly about transparency. In this case, transparency for girls and their parents so that they get all of the available risk and benefit information,” the reporters stated last week.

That’s a valid intent but unfortunately I don’t think that’s what came through to a great many readers — hence the intense public outcry. On first reading the story and particularly on viewing the dramatic video that includes a mother who believes her daughter’s death may be linked to the vaccine, even I felt an immediate pang of alarm over having allowed my own daughter to receive the vaccine — and relief that she experienced no ill effects.

In its overall presentation, the Star provided mixed messages. It needed to make crystal clear in big bold type the fact that the scientific evidence has concluded the vaccine is safe and that there is no evidence at all to indicate that the ill effects the young women reported to the vaccine effects database were caused by the vaccine.

Ongoing scientific studies of databases of adverse effects done by credible organizations have all concluded the HPV vaccine is safe and effective. The World Health Organization says so. So do the Centers for Disease Control and Prevention, the Public Health Agency of Canada and Canada’s National Advisory Committee on Immunization. The Canadian Cancer Society also agrees.

The public outcry over this investigation is not surprising given that the Star chose to publish it in the same week that a measles outbreak made news across North America and public health officials have expressed concerns about parents who refuse to get their children vaccinated against the highly contagious disease because of fears that the vaccine causes autism.

Evidence-based medicine has discredited any factual basis for that fear. Still, it persists, driven by “anti-vaxxers” who focus on emotional, non-scientific, anecdotal evidence from parents who believe their child’s autism was caused by the measles vaccine. Public health officials have battled for many years to create public understanding of the childhood vaccine’s safety by stressing the importance of scientific evidence over individual and anecdotal suspicions of harm that cannot be proven by science.

The Star’s editor, Michael Cooke, now understands these concerns and takes full responsibility for the newsroom’s missteps here.

“I apologize to our readers and to the people in the medical community, and especially to those who believe our story could be used to fuel the anti-vaccine movement,” he said. “There was a bad story-management combination approved by me: a foreboding headline, undue emphasis on the front page and terrible timing.

“There is a current and intense debate over immunization that has raged since the latest measles outbreak and I did not put the proper framework around the story. More should have been done to acknowledge the fraught framework in which the story was published.”

I agree with that and would go further. In looking at all of this, I have to wonder why the Star published this at all — especially at this sensitive time in public health. If there is no proof that any of the young women’s illnesses, or the 60 adverse reactions in the database, were caused by the vaccine, then what is the story?

In coming days, I expect there will be much discussion in the newsroom about what has been learned here. One thing made clear to me this week is the fact that if anyone in the newsroom had consulted with any one of the Star’s excellent health and medical reporters, they could have explained the inherent land mines in not giving greater weight to scientific evidence in a story of such importance to public health.

The Star fell short in not giving its readers public health information in a manner that meets the standards of responsibility expected in evidence-based science journalism.

In matters of life, death and public health, the science matters.

publiced@thestar.ca