The Man is now so worried about the decline in take-up of the MMR (Measles-Mumps-Rubella) vaccine that some clinicians are suggesting they be made compulsory – that no child should be admitted to school unless they’ve had the vaccination. Such is the level of desperation in clinical circles about the threat posed by the spread of these diseases. A little perspective might be in order.
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I, Editor by Henry Gee
This is the Nature Network and therefore Terribly Extremely Very Serious foothold for Nature Senior Editor Henry Gee. If you want fun and games, visit http://cromercrox.blogspot.com/
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Should The MMR Vaccination Be Compulsory?
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- Wednesday, 03 Jun e 2009 - 09:51 UTC
That such a step – refusing school to those who don’t toe the line – is completely unworkable should be apparent from the most cursory examination. Parents who refuse to immunize their children would simply take their children out of school, and/or claim violations of their Human Rights, and even use such a draconian provision to say that scientists, unable to offer evidence that MMR has no link to autism/bowel disorder/feeling slightly lame every other week (half-day closing Wednesdays)/(delete as applicable) only illustrates that there is (of course!) a cover-up.
Part of the problem is that today’s parents might not themselves be old enough to remember a world with these diseases. Back the far-off days of the 1960s and 1970s, the scare stories were about polio, diphtheria and whooping cough (pertussis), and there was just the same skepticism from parents following well-publicized cases of children ‘damaged’ by vaccination.
Rubella was rife. Back then we called it ‘German Measles’, but hey, Love Thy Neighbour was still a hit show on TV. As a childhood disease, rubella itself was mild, and children would pass through it and acquire a natural immunity almost without knowing it. Parents whose children came down with it would throw a party for all the neighbourhood kids, ensuring that everyone would get it and so become immunized. The reason? Although mild in childhood, rubella could cause serious defects in children whose mothers had contracted it while pregnant. That was the reason we liked to spread it around when we were still too young to know about such things.
Measles was – and is – much more serious. You’d only normally catch it once, but it could be a killer. Me, being me, caught it twice: the second time pneumonia joined in, and I had to take both of them to an isolation hospital.
Mumps, the famous nutcracker, I never got, and I hope I never will.
Roll the
bathwaterplanariantape of time forward to Chateau Gee, when Gee Minor (she of the Unicycling Girrafes) was at kindergarten. She had the first MMR jab (of two). At around the same time she was beginning to show symptoms of being somewhere on the autism spectrum. For several months she was convinced that she was some kind of man-eating archaeopteryx and would unerringly attack old ladies in the street, problems which made shopping, or indeed going out of the house, somewhatentertainingproblematic.Gee Minor was born less than a month after the publication in The Lancet of the now-notorious Wakefield paper in which a link between MMR vaccination and autism had been mooted. Our lives as novice parents were overshadowed by the atmosphere of worry and concern. The story was in the news, and here we had a child who’d been injected with the stuff and was showing signs of being Upney (i.e. one stop short of Barking). Yes, as informed parents, we knew that the Wakefield study was pitifully weak (I mean to say, N=12 and that’s epidemiology?) but we were parents and felt we should take every precaution. We were also concerned that the government of Mr Bliar, the World Famous Middle-East Peace Envoy, refused to countenance the availability on the NHS of separate vaccines for these diseases – and there was some concern that the MMR vaccine, for some children, might be too hard to take. Heavens, I even remember colleagues at Nature, who know a thing or two, expressing the same worry. After all, I remembered measles as a serious disease – and now we were being asked to shoot up our kids with it, and two other diseases as well?
That’s when we took Gee Minor for separate measles jabs at a private clinic in Elstree ran by a Dr Pugh. We were in the middle of the course when the story broke in the Mail on Sunday of allegations that his doctors were injecting children – including ours – with ineffective vaccines, or even just saline. That was a weekend I’d rather forget. In due course, Dr Pugh was found guilty of snake-oilery, and Gee Minor had the top-up MMR booster. She also now has a Statement of Special Educational Need following a formal diagnosis of Asperger’s Syndrome. Now, I am fairly convinced that there’s no link between MMR and the autism spectrum, but I still ask myself why the government didn’t make separate vaccinations available on the NHS to those that wanted it – short-circuiting a snake-oil market only too keen to exploit the fears of parents.
If you were a parent of a child who showed signs of surreality after her first jab, and were living through the years of the MMR scare, ask yourself, what would you do? Bonus marks will be given for honesty, and deducted for broomhandle-up-the-arse self-righteous pomposity. After all, science is forever skirting the borders of the unknown, and even if Wakefield’s paper was flat-out wrong in its sampling, design and so on, one had, as a parent, to weigh up the risks – acknowledging that we were dealing with a threat of unknown magnitude.
I think there’s a lesson here for us journal editors, too. If you are going to publish a paper that’s likely to attract controversy, make sure, before you begin, that it’s a decent paper.
Last updated: Wednesday, 03 Jun 2009 - 09:51 UTC
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Comments
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We were very worried at the time, and what really pissed me off was the Government’s ‘we know best, shut up and eat your greens’ attitude. So we insisted on separate jabs (on the NHS) for Rachel. By the time it came to Sophie we realized that the ‘link’ was indeed ‘missing’, so she had the triple.
Yeah. It was a difficult time.
Is there any evidence that getting a vaccine with three different antigens instead of one is “harder to take”? It was my understanding that our immune systems are bombarded by many multiples of different antigens all the time, and that this is what it was designed to do. Interested to know of any papers to the contrary.
I’ve had a google and a PubMed (hey, if ‘google’ can be a verb, so can ‘PubMed’) and the only evidence I’ve found so far suggests that combined vaccines are just as immunogenic as individual ones.
Henry, I had to learn so much so very quickly when my son was having to have his jabs – mandatory in Colorado, although parents can sign a release (always wondered how ‘mandatory’ this can be then). Even as a scientist – but not being familiar with the topic at all (call me oblivious) – it took some work to wade through the forest of information out there and separate the loonies from the real stuff. All the while, all you just want is to do the best thing for your child, and definitely not harm them.
So I can totally understand your worries at the time!
And thanks for reminding me that I have to make an appointment for the booster.
My daughter is (almost exactly) one year older than Henry’s. I well remember sitting down with PubMed and pulling all the studies that I could lay my hands on (there really weren’t many) then attempting a calculation of risk for both having the jab and not having the jab. The data was woeful so a lot of finger in the air guessing was involved. The result was that I calculated that the risk of autism from MMR (assuming Wakefield and co were right and hadn’t cherry picked or simply faked their results) was near enough the same as the risk of serious brain damage/death from being left unprotected from measles.
In the end she had the MMR vaccination but the deciding factor was less my calculations than the fact that we were living in an area of London whose parent seemed highly likely to not get their children immunized. I’ve thus got every sympathy for James Randerson of the Guardian whose 11-month old daughter contracted measles last month.
Obviously this idea of banning the unvaccinated from school can at its most charitable be described as ridiculous. I wonder though whether schools should be obliged to find out and publish the overall level of vaccination in their pupils. More useful when choosing a school than the percentage of pupils on free school meals.
Chris: in Colorado, the school/daycare actually keeps a copy of the children’s vaccination records on file, but – as far as I am aware – they don’t give out that information to anyone (maybe the State?).
Would it actually be legal to ban children from schools? I mean, on the one hand, the government
abuses childrenforces children to be educated, but on the other threatens to exclude them.You could home-school, but that’s a choice, it’s not something you should have to do.
Back to Jenny’s question, there seems be evidence that a combined vaccine is more effective, as you’re already jolting the immune system into action.
what really pissed me off was the Government’s ‘we know best, shut up and eat your greens’ attitude
Indeed: and as you say, it’s all a matter of choice. My problem with the government on this issue (I shall leave out the very many others) was that their insistence that they were right jibed with that of scientists, who were, in those Dawkinsian times, inclined to do very much the same thing, taking account of the valid concerns of the informed public only inasmuch as they might be patronized. It would have been so much easier had the government made separate vaccinations available, irrespective of scientific ‘advice’.
A deeper problem with this authoritarian attitude is, as I am sure I have said before, the presumption on the part of scientists that they have access to The Truth, when any scientific decision is based on a calculation of risk. At the time, this was undermined by the fact that Mr Blair was rather less than open about whether his youngest son had had the MMR.
@Jenny – the point is that having the vaccines separately, over time, would spread out the shock to the system of having the combined jab. I know too little of immunology to know whether this makes sense, but I would counter that immunologists are as ignorant of this as I am.
The argument I’ve heard about separate vaccines is that it’s more likely that one will be missed: there are 3 times as many appointments to make.
[separate vaccines] would spread out the shock to the system of having the combined jab.
Citation needed. Is there a ‘shock’? And — more crucially — is that a bad thing?
I know too little of immunology to know whether this makes sense, but I would counter that immunologists are as ignorant of this as I am.
To add to Bob’s point – which is backed by the available experience, e.g. from Japan, see discussion in the comments thread here – there is also the extended unprotected interlude with separate shots (since you need six vaccinations in all, at intervals) during which you could get the vaccine-preventable diseases. Plus there is a small but finite risk of local infection with vaccination. Also a small but finite risk of adverse reaction, partly because rare reactions can occur to other components than the antigen(s).
The real numbers are actually overwhelmingly in favour of vaccination, but are not as easy to find as they ought to be. A good place for real numbers is in this British Medical Journal comments thread. Look especially for the posts by Infectious Diseases consultant Peter Flegg, who you can see trying to explain the numbers (rather patiently) to several of the anti-vaccine gang from JABS.
Also a good source of info about where to find some of the background science is this article by Paul Offit, who has also published on the “overloading the immune system” idea that you hear from a lot of the anti-MMR types.
And anyone who has had to comfort a screaming baby over vaccinations will be in favour of reducing the number…
When we first got to Sydney we had to produce the girls’ vaccination records to prove they were up to date. The govt-funded schools [in NSW at least] are allowed to refuse entry if the children haven’t had both their MMR jabs. Whether they would have done is another question.
Oh, Kate – you just reminded me: I had to produce my vaccination records when I had to go through the fun immigration process in the US! And because I had measles and rubella as a child (I had a certificate that showed my rubella immunity level, this was tested at school when I was a teenager), but not mumps, I had to get the MMR shot. (Mind you, I don’t know whether they would have kicked me out if I had refused?) So I’m doubly good now. Right?
@ Austin, Richard, all – I stand corrected. Just shows that when the chips are down and we’re talking about one’s own children, it’s hard to tell the difference between science and folklore – especially when there’s bad science out there that fuels the folklore.
Henry, I think that’s the take-home message of the whole debacle. If even intelligent, reasonably-educated people get into a muddle then what hope is there for the rest of us?
It further underscores the need for good scientific communication, and being able to discuss this sort of thing in public (without fear of being sued!)
We never considered not getting Rachel immunized we just weren’t happy with the triple. What on earth possessed The Powers That Be to withdraw the single vaccines from the NHS? (snake-oil excluded obviously) would the take-up rate be higher if parents still had the option?
A lot of the problem is that both sides take the same attitude, which is one of ‘respect my authority!’ (just come over here and say that – Ed.). The scientists always claim victory because they (claim to) use and evidence-based approach, whereas the forces of ant-science don’t. That strategy is, however, flawed, for precisely the reasons we’ve stated – if regular joes like me can’t tell the difference, we’re on our own. More seriously, reswpect for science as opposed to authority is undermined, and one voice seems just as valid as another. It’s no good the Royal Society (or whoever) weighing in, because shouting more loudly only makes the problem worse.
What scientists should bear in mind here is that such debates aren’t so much about evidence as attitude. If scientists were a bit more humble, and admit freely that they don’t have some hotline to Truth, but doing their best to quantify risk – and then say in everyday terms how great those risks are – they will stand a greater chance of coming over as reasonable people rather than a speciali-interest group with an axe to grind. Especially – and this is the important part – they say to the public that the final decision on what to do rests with them. It’s theirs, their choice, and in a mature society people can’t tell people what to do.
It comes down to numbers in the end. No matter how complicated your rig, how fancy your modelling, everything comes down in the end to a P value, after which you are on your own.
@ Kate – sorry, our comments crossed.
We never considered not getting Rachel immunized we just weren’t happy with the triple
We were in much the same position as you.
What on earth possessed The Powers That Be to withdraw the single vaccines from the NHS?
Money, I expect. They managed it OK in Germany.
would the take-up rate be higher if parents still had the option?
Impossible to say, but I suspect ‘yes’. The government failed to understand a lesson from business which is ‘give the public what it wants’. There is a story (possibly apocryphal) about Alan Sugar at Amstrad. His marketing team said people felt better about computers if there were cooling fans in the back. The tech guys said that there was no need for cooling fans, as the computers dissipated heat OK without them. Sugar went with the marketing guys. People bought lots of hs computers, cooling fans and all. Because that’s what they wanted.
I suspect there must be quite a few scientists who had vaccination-age kids around the time of the Wakefield press conf who paid to have the single vaccines – I certainly know one or two.
One of the points that always gets rehearsed in the Bad Science arena when MMR gets discussed is that the public health / vaccine / epidemiology / paeds GI / virology people took Wakefield’s work, and the issue of MMR safety, very seriously. There was tons more work done post-Wakefield to test out whether any aspect of his hypothesis had any validity, and it all came back “no”, from population epidemiology, to post-MMR surveillance, to lab studies showing exactly how the false-positives in his later PCR-for-measles-on-gut-samples had arisen. The more recent suggestions from Brian Deer that the initial data had been massaged or even “cooked” (see here and here) just offered a possible (or plausible, depending on your point of view) explanation for how the observations could have come out that way in the first place.
Anyway, the scientific and medical community really did respond by going back and looking again, very hard. Unfortunately, this message has never really got across to the public – or rather, the “MMR scary” meme is so widely distributed out there in the wild that it is seemingly impossible to eradicate. The blame for that, I personally think, lies with government bungling at the start, especially in terms of presentation of things like risk, and dire mainstream media reporting then and since – and also to the fact that the whole scare plays to parents’ darkest fears.
Plus we should also not forget little Leo Blair and his parents, whose “has he, hasn’t he” saga clearly crystallized the “the Govt is concealing things from you” view for many people.
For anyone interested in the social science take on how people arrive at a view on things like MMR, there is an interesting published study here.
I know it’s cruel and ungentlemanly to point out tyops, but the forces of ant-science is special.
So…a weird question: was the MMR triple shot new when the study came out?
Because, I’ve had it (it’s on my immunization record, which I had to show when I worked in a hospital here in TO) and I did not get any shots after I left elementary school (in 1990). I can check the date on which I got the shot when I get home.
Not really.
The vaccine debate (MMR:autism) is one which will not go away for a long time, even in light of numerous epidemiological studies failing to show any such correlation. What is really interesting here is that as scientists who understand the importance of vaccinations, we are reverting to our “gut feelings” when it comes to our own wee uns. Once you’re hear a scare story, to believe anything to the contrary is difficult.
The MMR:autism controversy is interesting on so many levels in that it reflects a wider issue of how we can communicate and combat gut feelings with good science-based medicine. There is a really interesting article in PLoS Biology this month which I recommend reading on how the MMR/autism situation led to a loss in public faith in the medical community and how we can readdress this issue.
I, (sorry for the self promotion here) recently blogged about this issue where as long as we’ve had vaccines there’s been opposition. The whole stick it to the “Man” issue being a strong one as Henry points out. I think we tend to forgot how thorough the science is behind vaccinations and their importance. It’s easy to be glib about serious infectious diseases today which we never see, due to the success of the vaccination program.
There is an excellent post today by Steven Novella (“Should vaccines be compulsory?”) on this issue here . An interesting point made is that education of the effectiveness of vaccines etc is not working in changing peoples opinions on whether to or not vaccinate. Instead we need to re-emphasize what will happen when we don’t vaccinate; outbreaks of serious infectious diseases like we are seeing now in the UK.
_If you were a parent of a child who showed signs of surreality after her first jab, and were living through the years of the MMR scare, ask yourself, what would you do? _
Bonus points for honesty, you say? I wouldn’t have worried about it, and I didn’t when our kids (now 8 and 6, for timing calibration of the above statements) were vaccinated. Possibly, that I work on Autism (although I didn’t at the time) may be contributing to some rosy hindsight here.
Henry’s comments about Rubella interested me, as I heard someone say something almost identical about Chickenpox recently (i.e., getting all the neighbourhood kids together so everyone got it all at once and was done with it). I’d never heard of this approach. Of course, there’s now a commonly available Chickenpox vaccine, which wasn’t around when I was young. Lots of other things seem to have sprouted vaccines in the interim, as well – Meningitis jumps to mind.
Oh, and the incidence of Autism Spectrum Disorders is increasing, I believe… in other words, diagnosis is getting more inclusive, or more accurate, or both. I imagine this is positively correlated with the increased use of MMR vaccines, with increases in global temperature, and with increases in the number of Hare Krishnas in Brazil, among other things.
Eva, I got the MMR when I was a kid (early Seventies). I think it’s basically the same – 3 attenuated viruses. It’s worth pointing out I actually contracted mumps despite this!
@Jenny – the point is that having the vaccines separately, over time, would spread out the shock to the system of having the combined jab.
Yes, like Richard, I question that this is a ‘shock’. I think not encountering antigens would be a shock to our system – like filling up your petrol tank with water instead of fuel. Three antigens vs one antigen in the same adjuvant – I can’t see how that would make a difference to how the body would react, generally, to a jab. Of course I’m not sure, which is why I was wondering what’s known. I took hefty immuno courses in grad school but things change a lot in that field.
For Henry – here is one of the medical blogs I read articulating a view somewhat in line with yours.
I’m 100% with Barry on the dismal phenomenon of Celebrity Idiot-Science. The space that Jim Carrey and his logically-challenged paramour Jenny McCarthy get to spout utter nonsense about vaccines across the US Media is truly depressing. It has not been quite as bad in the UK for vaccination, though there was the Juliet Stephenson “Hear the silence” TV play about MMR, a few years back (and follow-up “debate”, which was worse than the play), and the dire Jenny Barnett /LBC radio show earlier this year. Another more surreal example was the sight, about this time last year, of various suspiciously well-preserved celebs being wheeled out to extol the virtues of useless “anti-ageing” antioxidant vitamin supplements. This was after a Cochrane Collaboration review indicated that they were worse than useless.
Sometimes the only possible response to all this seems to be to resort to juvenile humour. As the line goes “you have to laugh, or else…”
@ Austin – thanks for your sage contribution. Not that anyone else’s isn’t sage. Oh bother. I think I’ll rearrange
the deckchairs on the Titanicthe cabinet. Or phone Simon Cowell. Bother.One of the points that always gets rehearsed in the Bad Science arena when MMR gets discussed is that the public health / vaccine / epidemiology / paeds GI / virology people took Wakefield’s work, and the issue of MMR safety, very seriously
Of course they did – they’d have been very irresponsible if they hadn’t. But a great deal of fuss and bother could have been saved if that paper hadn’t been published in the first place. I should be somewhat reticent in case I’m sued, but one might imagine (not that I’m doing any such thing, mind) – imagine, speaking entirely hypothetically, a scenario in which the publication of that paper might be seen, if perhaps only after the fact, as just the teensiest bit exploitative, to get as many headlines as possible. Just my opinion. Which is mine. It’s bad enough doing that with a M****** L***, but at least in that case one is not playing with peoples’ lives.
Plus we should also not forget little Leo Blair and his parents, whose “has he, hasn’t he” saga clearly crystallized the “the Govt is concealing things from you” view for many people.
Quite.
@ Richard: I know it’s cruel and ungentlemanly to point out tyops, but the forces of ant-science is special.
Glad to see someone’s on the ball. Demon, I adjure thee. Or words to that effect.
@ Barry – thanks very much for those really useful links.
The whole stick it to the “Man” issue being a strong one as Henry points out. I think we tend to forgot how thorough the science is behind vaccinations and their importance. It’s easy to be glib about serious infectious diseases today which we never see, due to the success of the vaccination program
MMR came after a whole lot of other acronyms, such as HIV and BSE, not to mention Foot and Mouth and so on and so forth, in which a climate was created in which the public mistrusted scientists almost by instinct. And, yes, the ‘glib’ was part of my point: when I was a child, children in Britain died of things like diphtheria, and now that’s no more than a very high-scoring word in Scrabble™. One thinks of TB, seen as a disease of past centuries, but on the rise because of glibness – and the continued problem of Subscriber Trunk Dialling among the young and promiscuous.
@ Richard W – I hadn’t heard of the chickenpox party. Interesting. And yes, we should gear ourselves up for another round of irrationality. Any vaccine against any form of meningitis is a must (I know people seriously disabled by it). And as a parent of daughters, I am Girding My Loins, if that’s the phrase … What’s that? It is? Oh, good. Well, as I was saying, Girding My Loins for a battle about the vaccination against cervical cancer. Mrs Gee’s mother died of it, you see, but I expect that there’ll be some Dark Forces of Ant Science out and about saying that it only promotes Subscriber Trunk Dialling.
Henry – I confess I’d forgotten about HPV vaccination, even though it has been the focus of a very visible PR campaign in these parts (originating within the Ontario Public Service, of all places – good for them). But Youngest Wintle is a bit young for us to be thinking of that just yet.
Goodness, you lot are busy this evening. Youc an stop later, as it’s the series finale of Desperate Housewives, which I, for one, am not going to miss.
@ Richard W: Oh, and the incidence of Autism Spectrum Disorders is increasing, I believe… in other words, diagnosis is getting more inclusive, or more accurate, or both.
@ Jenny – I’m sure you’re right. Time was when I would say that immunology was, to me, as intelligible as Medieval Bulgarian. But then I met someone who was actually a specialist in Medieval Bulgarian.
@ Austin – why is it that people believe that anything said by someone rich or famous for non-scientific reasons is suddenly an authority, already? Beats me.
I think it’s a combination of inclusivity of diagnosis, plus a greater trend to put labels on things by service providers who need to prioritize resources. In the old days I’m sure Gee Minor would just be seen as a geek. Either that, or just about everyone I know who’s a scientist, present company excepted, of course, is on the autism spectrum.
@ Austin – In the UK, you didnt need a Jenny as you had the whole Leo Blair furore which is detailed here by Ben Goldacre. Although once Carol Vorderman came out about MMR, that must have been it.
@Henry – regarding the Wakefield study, although most of the the authors have retracted themselves from the study, the paper itself has not per se been retracted. As an Editor, what is your take on this?
Call me boring but:
I have no problem whatsoever with the MMR triple being triple. I also have no problem with the DTT being triple, though I found that harder to “put my babies in for” as they get those shots far younger than the MMR.
The advantages of getting it all out of the way at once, logisitcally in terms of trips to the surgery and less needles for the child, together with no evidence for any negative effect, are to me wholly persusasive.
The other question, that of whether the vaccine should be compulsory. I think yes. Measles, for example, was virtually eradicated in this country before the irresponsible scares about MMR began. Now, its back.
I have had measles, mumps and “german measles” (rubella) as I was a child before the vaccines. They are all horrid for a child (especially) to endure. I did have a rubella jab in fact, when a young(ish) adult because the strain of german measles I had when a child wasn’t the rubella strain, and I was advised to have the vaccination before trying to get pregnant. I was very impressed by this rare example of preventative medicine on the British NHS and wish there was more of it, if only to protect the babies and children in our society.
PS And I fail to see any relevance of what Tony and Cherie Blair decided. People can surely make up their own minds – after all, they don’t do what politicians say in many other instances, so why would anyone care what one of them decided to do in an “out of scope” mode. Let them get on with
ruiningrunning the country, and let adults in the population be adults, thinking for themselves.@Barry – regarding the Wakefield study, although most of the the authors have retracted themselves from the study, the paper itself has not per se been retracted. As an Editor, what is your take on this?
There is no shame in having made a mistake. The literature is full of studies that turned out to be wrong, because they couldn’t be replicated, or perhaps didn’t have the right design and so on, or have just been superseded by better data. All one can do is the best with the information you have at the time. What worries me is when papers which are substandard get through on the criterion of newsworthiness, when the editor and perhaps the referees suspect that the papers are not all they are cracked up to be. Of course, it isn’t a perfect world, and often one publishes papers which you know could be better, but one tries to be honest and not … well … cynical. I don’t know what went on in the run-up to the publication of the Wakefield paper, but as even a quick glance shows the smallness of the sample sizes , one can only wonder why the editor or the referees didn’t tell the researchers to go away and do a better job. But then again, just my opinion.
@Maxine – Whilst I agree that most people ignore the words of politicians, when they are not doing something, then that can arise greater suspicion. In this case when the leader of the country is in doubt of following public policy, then thus just confirms fears that they are “in” on the information. As much as it was their own personal business, it didn’t help the situation.
But then I met someone who was actually a specialist in Medieval Bulgarian.
I once met someone who was a specialist in Portuguese Medieval history. He was Canadian. And a Rhodes scholar.
I have no idea what he’s doing now, mind, nor what his opinion is on the MMR vaccine.
Maxine, I think the success of the Labour government tells us that people don’t make up their own minds. Baa-aa.
@ Austin – In the UK, you didnt need a Jenny
I say Austin, how ungallant of you.
What a great post and thread – I haven’t much to add but wanted to pick out a couple of things.
I would argue for making the MMR jab compulsory on ‘greater good’ grounds. There are many instances in which we sacrifice some of our liberties for this principle. The 30 mph speed limit is compulsory, for example, and for good reason.
But the wider question of how you get good scientific information out to the public is more interesting. The MMR debacle shows how difficult it can be. Clearly there were many factors at work (bad science, an untrustworthy government, ill-informed celebs), but I take Henry’s point above that the tendency of some scientists to presume that they alone have “access to The Truth” is also part of the problem. It is perhaps difficult to avoid the temptation of arrogant over-statement when confronted by some of the wilder idiocies of alt. med. practitioners. But many people are taken in by this and the scientific community needs to find effective ways to get the case for evidence-based risk-assessment across (Step 1 – a pithier slogan!). And to (re)-establish an authorative voice. This was a question that I was grappling with (albeit a tad clumsily) in that post but one that is probably worth returning to.
I think one could make jabs compulsory without tying it to education like that.
I disagree with compulsion, for this implies that one has lost the argument and so must force compulsion through threat of sanction. This is not a battle won by the
FecesForces of Ant Science, but by Science shooting itself in the foot through arrogance and poor communication.@Henry – So in essence it again boils down to science being communicated
properly; neither under- over over-stated. A familiar story?
Its nothing to do with those ants…
@Henry – how about ‘compulsory within the framework of a democratic society’ (one in which scientific issues can be debated without recourse to the law-courts). That is, after all, how we are supposed to make up the rules that help us to live together.
I really had meant to do lots and lots of research about the MMR, even though I was inclined to think the autism business came from the “aspartame will give you migraines and cancer and make you look like Don Knotts” people. When the Small Girl was about eight months old, though, she had some sort of rash, and we took her to the ER. At the same time, a #@!!#*#& non-vaccinating family with a measles-ridden kid also decided to visit the ER, and the johnny-on-the-spot nursing staff failed to isolate him. Result: They bundled us into a room and wouldn’t tell us for most of an hour why. Didn’t until they found me roaming halls and demanding to know whut up when we were supposed to be in isolation. When I found out, I nearly busted several people’s worth of veins, and SG had her first MMR that evening. No computer in the room and no way to find out whether there was any point to the vaccine after exposure. So I told the dealer “Hit me” and on we went.
She didn’t get measles; she’s better equipped with the social module than I am; she did get the other shots in due time. The only one I’ve balked at is chicken pox, because we don’t know how long-lived the immunity is from the shot, there’s no knowing what vaccine cost and delivery will be like in 30 years, and varicella when you’re older really, really sucks. I’d rather she get it for real as a kid. When I said so at the clinic, nurses descended on me telling me that 21st-c varicella has fangs and pimples and will turn your child into a gourd. So I said all right, give her the first one; she’ll still be able to catch it if it’s around, but likely have an attenuated case. If she hasn’t caught it by the end of first grade we’ll do the other shot or play catch-up. Problem is that all the other kids have been vaccinated, so there aren’t any poxy kids for her to play with, so I suspect she’ll get the shot.
Locally MMR is compulsory for school attendance unless you can claim religious exemption, and people who’re that much into God tend not to send their kids to public schools anyway. As I’ve watched it play out at the hippie daycare, the anti-vaxing moms mostly cave and do get the children vaccinated for public school. I’m guessing that’s how it goes most other places, too. You need a whole alternativey community in place to support resistance to school rules — functioning & affordable alternative schools, financial ability to homeschool, etc.
Exactly the same argument could be used against drink-driving laws.
If MMR isn’t made compulsory, then some parents will say “well they’re not saying our children have have to have it, so we’ll play it safe, and not have more injections”. If enough take that attitude, we could get below the threshold for herd immunity. As a matter of social policy, if this is what would make a difference, I think it would be irresponsible of a government not to insist on vaccination.
I guess the problem is pone of signals and trust. People tend not to trust the government, so if it stands up and says vaccination is compulsory, it won’t be believed. But if your doctor say you must vaccinate, you have more trust so you’ll follow the advice. So, perhaps the government needs to make vaccination compulsory, but let the medical services take charge of the publicity and implementation.
@ Stephen: I would argue for making the MMR jab compulsory on ‘greater good’ grounds. There are many instances in which we sacrifice some of our liberties for this principle. The 30 mph speed limit is compulsory, for example, and for good reason.
In general, the steps we take to curtail our own liberties for the greater good are only successful if they are generally agreed to be necessary, by all involved. In other words, they have to be consensual. In which case, comparing urban speed limits with MMR uptake might not be such a good example. In the case of speeding, there is a consensus that
wearing crocsdriving too fast in a built-up area endangers lives. It stands to reason, and anyone can understand it – it’s not something that has to be communicated by ‘experts’. For MMR, on the other hand, all we have to go on is advice from The Gummint and their Scientists who Tell Us What’s Good For Us without properly explaining why. And when there appears to be Bad Science mixed up with Good Science, people are understandably cautious.how about ‘compulsory within the framework of a democratic society’ (one in which scientific issues can be debated without recourse to the law-courts). That is, after all, how we are supposed to make up the rules that help us to live together.
Well, maybe, but in this case our Elected Dictatorship told us what was good for us and ignored any dissent, while the Elected Dictator was very secretive about whether his own family followed advice from his own Gummint.
@Bob – no, drink-driving is different. Again, everyone agrees that drink-driving is wrong and dangerous. This is not the case for MMR vaccination. Some people think MMR is fine, some think it’s not … while the rest of us don’t know, but tend to give in to it eventually through force of circumstance, as Amy did, or indeed the Gees.
@Bob, Stephen and Barry – yes, it comes down to science communication. People feel so helpless. Bob’s point about getting the info straight from your doctor is a good one, because your doctor is some with whom one can have a one-to-one relationship. You can sit in a room with him or her and ask questions. Again, it’s all down to authority. Scientists have given themselves the authority without the rest of us being clear how or why, and when they are assailed by the Dark Forces of Ant Science, scientists tend to close ranks and shout more loudly. To the general public, this means that there’s no easy way of telling the difference between Good Science and Bad Science (this is where the blogosphere has found a useful niche … but then the authority question is bumped along further – do you trust the blogger’s agenda?) … and also creates the right conditions for people to accuse scientists of a cover-up.
I think that scientists need to be more aware of the fact that the public view of scientists (speaking only as an observer of such things) is more nuanced and conflicted than you might think.
People tend to think of scientists as wizards, and to paraphrase Tolkien, one should not meddle in the affairs of wizards, for they are subtle and quick to anger.
On the one hand, they are ‘boffins’ — demiurges, casting runes and formulating magic potions that have all kinds of benefits which, if we are sufficiently complaisant, they might choose to shower upon us rather like manna from heaven. They might have disagreements with other wizards, but us ordinary folk can’t be expected to understand such things, except to wonder whether, if wizards disagree so much among themselves, and so heatedly, then their communications with us might be compromised – for how is one to know which wizard to believe? This leaves the way open for all kinds of fake wizards to pop up – dealers of snake oil and various complementary therapies, many of whom adopt what seem to be approved wizardly trappings – diplomas, letters after their name, membership of seeming learned associations, arcabe scholarly journals written in wizardly gobbledegook. (For any lawyers watching, chiropractors are OK, OK?). So, if one is allowed to choose which wizard to believe (because, when one can’t understand what’s going on, you have no other choice but what ‘feels right’), you might as well take Extract of Unicycling Girrafe as anything prescribed by a Proper Doctor.
If the real wizards then start shouting that the alternative wizards are indeed fake, and backing up their claims on what seems to be no more than a self-conferred authority, the public’s reaction is ‘well, they would say that, wouldn’t they?‘. That’s why compulsion in the case of MMR wouldn’t work – the real wizards have regressed to a kind of laager where they put the wagons in a circle and shoot outwards. The public, unable to understand what they’re on about, much less to comprehend the nature of the disagreements they have, and unable to tell the difference between scientists and charlatans, will revolt – being shrewd (even if not intellectually knoweldgeable), they wille xpect fould play.
It might take some time for scientists to regain that trust. The first step is to speak softly. The second is to adopt some degree of humility before the evidence. Charlatans will say their remedy is 100% effective – scientists should get away from that mode of communication as fast and as far as they can. They should be open and frank about the real nature of risk and be able to communicate that effectively.
An excellent analysis.
Thank you. The cheque is in the post.
Henry, I think you’re being unfairly dismissive of Stephen & Bob’s analogies. And if the general public is so incompetent at following scientific arguments, then we need good analogies to illustrate our points.
11 PEOPLE ARE KILLED BY DRINK DRIVERS ON UK ROADS EVERY WEEK
Clearly, some of the people involved don’t generally agree that these regulations are necessary. This number is an enormous underestimation of the actual number of people who actually drive after drinking more than permissible by law. These are just the ones involved in fatal collisions. Some still think it’s fine to drink and drive – after all, they can handle the booze, others don’t think it’s so fine.
I could try to estimate how many people don’t believe that 30mph (or other) speed limits are applicable to them – after all, they’re good enough drivers and always in control of their car…, but hopefully the first example serves to illustrate.
I think both of these cases show that not everybody really agrees that the current laws we are constrained by need apply to them, even when their unlawful behaviour can have disastrous consequences for others. When it comes to legislating for vaccination programmes, it’s likely to be very hard to make it work, but Bob’s point about
Douglas Hurdherd immunity needs to be used to base any guidelines on.Human rights were mentioned above – but I wonder how the counter-argument can be invoked here. Smoking has been banned in indoor public spaces in Scotland, on health grounds – to reduce the incidence of workers’ health issues related to passive smoking. I’m not sure what other official reasons in the many other European nations/countries where it’s been banned (e.g., in Spain, it seems to be based on, ummmm, well, no-one seems to know, and it’s almost entirely optional anyway).
If we’re worried about these sort of health issues in public areas and willing to legislate for it, why not with other health issues? Schools represent an excellent mixing ground for infectious diseases, which can then rapidly spread through the rest of the community. Measles, mumps and rubella are all very dangerous diseases, for at least some part of the population. Being inoculated for all three at one time is an incredibly effective method for controlling all three diseases.
I don’t have any kids, but I’ve followed the autism-MMR non-link debate since Wakefield kicked it off in 19981. If I have kids, I will have no hesitation in dragging them down for a triple-in-one jab, unless solid research is published showing a causative link between the MMR vaccination and autism between now and then. There is no evidence from any of the many other countries that use a single MMR jab of any link to autism. Unfortunately, the media jumped on the scandal generated by the original (now discredited) paper.
Unfortunately, media hype is much louder and more memorable than sound governmental or medical advice.
1 I hereby and therefore award myself a tasty chunk of authority points. The paper is Wakefield et al (1998) The Lancet you can find a copy here
Mike – your argument makes sense. It’s just that I don’t agree with it.
Unfortunately, media hype is much louder and more memorable than sound governmental or medical advice.
Why?
I’ve said my opinion on MMR and hold to it, but those who responded to my Tony Blair comment or who think he should have led the way by revealing Leo’s vaccination status, I wonder if Mr B had converted to Roman Catholicism while PM and not after, would you have followed suit? Out of scope, in both cases, in my opinion.
Maxine – the two events are simply not comparable. The government flatly (and high-handedly) refused to make separate jabs available on the NHS, as a matter of policy, and Mr Blair was less than forthcoming about whether he followed his own policy in this case. Blair’s religious conversion is quite different for two reasons.
First – it was very public.
Second – as far as I know, it was not government policy to insist that people belong to this religion or that.
Again, it’s all down to authority. Scientists have given themselves the authority without the rest of us being clear how or why, and when they are assailed by the Dark Forces of Ant Science, scientists tend to close ranks and shout more loudly. To the general public, this means that there’s no easy way of telling the difference between Good Science and Bad Science
This sounds exactly right to me until we get to the last sentence. I don’t think the general public is equipped to tell the difference even if it’s laid out in the kindest, friendliest, most unassuming way possible. The GP is not interested in sorting out the arguments and coming to a view which admits of complexity. A small segment of the GP, yes. But most, no, and the segment interested may not even be a terribly influential one.
I suspect that the only way to push compliance will be with a full-bore propaganda campaign re-educating the public in realities of those ancient diseases. I think you’re right, Henry, about people’s having forgotten what measles and mumps are, and about our being accustomed to No Major Problems that maim or kill. In other words, the other balance pan is empty.
I do happen to know something about measles, having been one of those morbid children who likes reading about Plagues and Diseases of Long Ago. Which is why, in the moment, I said “needle stick” even though I was aware it might’ve been dangerous for a child that young & that it might’ve been useless (or possibly counterproductive) just after exposure, and even though the two residents trying to propagandize/reassure me were entirely unconvincing in their authority. I had some idea what the consequences might’ve been if she’d gotten measles. If there’s a propaganda campaign, will there still be people who refuse, certainly. But I suspect you’d win over a good 70-80% of those who’d otherwise think they were smart by avoiding the vax, and the remainder would look like nuts.
In other words, you guys are being too nice and attempting to reason where reason finds no quarter. You need to appeal somewhere around the brainstem.
@Amy: Hmmmm ….. you might be right. Perhaps the government ought to have come up with a seriously grisly commercial showing how people became seriously disabled or died from measles (maybe they did – anyone know of one?). Certainly, the government information commercials shown on British TV, warning people of the dangers of (say) smoking, excessive speeding and drink-driving are pretty near the knuckle. But such a visceral approach wouldn’t have answered the question of why we needed all three diseases in one jab.
Now, one could say that I’d raised no objections to the triple diphteria, tetanus, polio vaccine I was given as a kid, and which are administered to all children these days without a qualm. And you’d be right. Perhaps it’s simply a generational thing.
Thinking about all this, everything comes back to the Wakefield study, and what the world would have been like had it not been published…
I beg to disagree, Henry.
There was no reason for the NHS to offer separate, single jabs, and there is reason to offer the triple – because, for example, of likely drop-off in take-up if spread over time and subjecting a child to several painful injections instead of one.
(My analogy was to the DTP, mistyped as DTT, in my first comment in this thread – which is given to babies younger than the age MMR is offered).
Mr and Mrs Blair’s medical decisions about their child, or their religious beliefs, are irrelevant to anyone but themselves. I don’t think Mr Blair (or anyone) should have been, in effect, bullied into disclosing a personal piece of information he did not wish to disclose.
Maxine wrote:
“Mr and Mrs Blair’s medical decisions about their child, or their religious beliefs, are irrelevant to anyone but themselves. I don’t think Mr Blair (or anyone) should have been, in effect, bullied into disclosing a personal piece of information he did not wish to disclose.”
Well, I agree with the principle, Maxine, but under the circumstances I think the decision was disastrous. The GenPub simply drew its own conclusion, which was that Leo Blair had probably had separate jabs and that therefore (i) Govt policy was hypocrisy and (ii) “they know something they’re not telling us”.
Subsequent coded statements, long before Cherie B’s autobiography, made clear that baby Leo B had actually had the MMR shot. For instance, in Jan 2002 TB told Jimmy Young on Radio 2:
‘We certainly wouldn’t ask anybody or say or advise people to have this vaccine if we thought it was the wrong thing for our child. Now, I hope people understand what I’m saying there, but I’m not going to get into the situation of answering a whole lot of details about what treatments Leo has.’
Personally I think TB should have just said “of course he’s had the jab” as part of the above speech. Standing on the point of principle (“no info on private family matters”) was, in this case, not worth the massive collateral damage to public confidence in the vaccine. Given the circumstances, I don’t think a one-line statement – rather than the lawyerly phrasing above – would have compromised the family privacy too much, or even the privacy principle.
From what we read in the Cherie autobiography, family privacy did sometimes get overridden by political need. With MMR, it didn’t – but for me that was a mistake. I would love to know if the Blairs still feel it was the right decision.
@Maxine: what Austin said, and, more generally, what I have been saying all along, which is that there are times when the public should be given what it wants, rather than what some ‘authority’ tells it it needs. This might be one such case. Now, consider, had the NHS offered separate vaccines back then, how many fewer cases of measles might there be now?
Further, whereas the likes of thee and me can have some claim to privacy, this is less tenable for public figures such as Mr Blair, especially if he chooses to air some private matters but not others.
When I moved to the US in 98 to attend grad school I had to produce my vaccination record. Obviously I couldn’t, having been a toddler and not under my own autonomous control when they ere done. So I had to have my MMR shot again.
I know why babies cry.
It really hurt! It’s a wossname…an IGg innit? Feels like the nurse is injecting a half fluid Oz of jelly into your arm…
You wuss, Brooks. Before I went to do fieldwork in Kenya I was vaccinated against typhoid, cholera, rabies, yellow fever, hepatitis A, B, C, D, E, F, K and N (probably twice), Waltham Forest Virus, Horn-Swooped Bongo Spotted Fever and Water On The Knees.
Ahh a pox upon you Gee, I had a swathe of jabs before
getting too stoned to go tomed school. I worked for the NHS for years as a Nurse Auxiliary and had all the jabs, boosters, shots and stuff. I think the worst was cholera (maybe?), like the MMR it’s an immunoglobulin shot, so it goes in like liquid concrete and just seems to sit there.I remember one shot, not what it was for, a Hep booster maybe, and the bloody nurse hit my humerus with the tip of the needle. Not humorous. Not even slightly.
May you grow two heads and your skin fall off in blue scaly lumps, Brooks. Just kidding, honest. Yes, I remember having the cholera jab in one arm and the typhoid in the other, both at once, simultaneously, together and at the same time. I made the mistake of going straight from the surgery to work. My arms would have done credit to Pop-Eye but I felt like I had already died and had been run over by the No. 9 to Kensington High Street.
I had a flu shot last fall. It hurt much more than the previous year’s, i.e. almost not at all. They use a 1200-gauge needle or something; I’m always afraid it’s going to break off in my
rock hardmanlytonedflabby arm muscle.On the other hand, the good old TB skin test, where they inject a nasty bubble of something
barelyinactivated under your skin, kind of grosses me out. Not had to have one of those for lo, these many years, fortunately.Babies, all of you. For years I had to go to allergists’ and get injected with teeny tiny amounts of
poisonselfdestructo fluidvarious allergens and then sit in the waiting room while my armsfell offswelled up, just in case Istopped breathingstopped breathing while all this was going on. I was then given a pat on the rear and told to go play but call if I stopped breathing.I don’t keep my childhood immunizations
stapled to mehandy, either, so I also had to have the MMR when I started grad school. I don’t remember it being particularly painful, though. Maybe I couldn’t feel it with my arm all swole up and me not breathing, though.Gone a bit quiet on this one – for anyone still reading, the Observer has an extended comment piece by Catherine Bennett today on pretty much exactly this issue.
A quick dip into the comments after her piece will show you just the kind of maniacs that the topic tends to bring out whenever in turns up in a newspaper forum.
I’ve stopped contributing because I’ve said what I think but been stamped on. I do still think that there was and is no reason for 3 separate vaccines, etc, but have taken my bruised toes elsewhere;-)
No, Maxine, keep your bruised toes here! I agree with you. The more sticks there are, the better the odds you’ll miss some, either because you can’t get to the doctor, or you’ve forgotten, or (stateside) there’s no insurance and the vaccine might be free but the visit isn’t, or you can’t face the prospect of terrifying the child that many more times.
I do understand the reasons for ordering a la carte, but if I were running public health, I’d do a 3-in-1, too.
I’ve stopped contributing because I’ve said what I think but been stamped on.
No, Maxine. Your comments have been read, considered and digested. If other people disagree with you and give reasons for doing so (which I have) then that’s their right.
I’ve stopped contributing because I’ve said what I think but been stamped on.
No, Maxine. Your comments have been read, considered and digested. If other people disagree with you and give reasons for doing so (which I have) then that’s their right.
OOOh, on both feet, Henry ! ;-)
Urrr, what was your response to my
farty drivelsuccinct summaryOh yeah:
It’s flattering that some of what I say makes sense, but possibly more so that you didn’t come up with any reasons for disagreeing.
Yours, helpfully pointing out the bleeding obvious,
etc.
Why should he have to? It’s his blog.
(hm, this is what happens when I am away from the computer for a week and miss NN updates…)
I would think that the main reason for wanting a triple shot is to reduce the trips to the GP (risk of missing one or more appointments) since there are a lot of shots to be had before the age of 5 in a child. With a triple one, the amount of adjuvant can usually be reduced compared to the “three times one shot” in order to get a response.
That said, I wonder if the MMR that there was such a discussion about was the one aluminum adjuvant? It has been shown to have different effects and vary a bit in different concentrations. If nothing else, the vaccine development are looking very heavily into finding newer adjuvants….
On the personal level, very hypothetical since I don’t have children of my own, I would probably vaccinate against measles and some of the others since I find it very important to keep the herd immunity. As someone suggested, it would be an important factor for me at least, what level of immunity the children in a school had when choosing schools. One can argue, as some parents do, that “we don’t have measles in our countries” but since people travel quite much nowadays that is simply not true. Plenty of families go to places where measles is a common disease and soon enough I fear that we will see outbreaks of that disease in small children exposed.
….but I am a sort of doom and gloom woman when it comes to infectious diseases ^^
..on the compulsory issue. I dislike some compulsory things, this is where I would like it to be visual what can happen if you aren’t vaccinated – i.e. show what measles really look like and how many children who die of it every year. On the top 5 killers….. but if it comes to it – I think that MMR might be on the list of the vaccines that could be compulsory simply because the cost of having measles roam freely in a country is quite devastating. If we are there yet? hm, not sure. It depends on how much more attention is brought to the more un-sciencey studies and peoples’ beliefs…
@Mike – If you direct your eyes two comments above your own self-confessed farty drivel, you’ll see I gave an exhaustive analysis of why I think the case of MMR vaccination is different from drink-driving or speeding. I saw no reason for spelling these reasons out again. So, you have your view, and I disagree with it. I disagree with it because it is self-evidently wrong.
@Richard – thank you.
@Åsa – compulsion is a blunt instrument, because it assumes that those being compelled are too stupid for one to waste time explaining things to them. That, in my view, is a very patronizing attitude and doesn’t help the spread of knowledge and scientific literacy. Consensus is better, reached by persuasion, because everyone involved will understand the arguments and will be more supportive.
Henry: I agree on that when things turn compulsory it tends not to be as explained “why” or even given more thoughts. However, I would really like some more information that explains more on exactly how dangerous it is with some of these diseases since at least half of the parents I have talked to seem to underestimate how deadly some of these diseases are…. I would be happier if I thought they were choosing between real disease and complications and vaccines…
You’ve made a good argument for education, but not compulsion.
Henry
I don’t know how your stamina is for reading endless drivel, but if you want an example of why some people despair of trying “reasoned explanation” in respect of MMR and other vaccinations, you could probably have no better example than the discussion following this article by Catherine Bennett in the Observer.
I don’t favour compulsion on things like vaccination – at least, not starting from where we are starting from in the UK – but educating people out of their deeply held suspicions and misconceptions is going to be one hell of a job. And as long as the mass media is full of people who find printing and re-printing eye-catching scares to be a good way of generating circulation, the scientists (reality-ists?) will always be playing catch-up (and banging their heads on the desk).
PS There is an interesting article discussing some of this over at PloS Biology.
Austin – I finally got round to reading that article in the Observer, and once one gets below the snide, superior and patronizing tone one (sadly) expects from any paper from the Guardian stable, one sees all the points I’ve been making here.
I don’t favour compulsion on things like vaccination … but educating people out of their deeply held suspicions and misconceptions is going to be one hell of a job
Yes, quite. And there’ll always be fringe loonies who won’t have vaccinations, not ever (I was educated at a Rudolf Steiner school so have seen such lunacy at first hand).
However, I am surprised that if the government cares so much, it hasn’t put out TV and banner ads on the perils of not having vaccinations done, educating the populace through fear. The Govt is the single biggest client of advertising, and has done some very hard-hitting adverts about smoking and road safety lately. So why not MMR?
At root, however, is the fact that the Wakefield study was published by The Lancet, in other words, a respected journal of scientific and medical research. I have not seen a mea culpa from that source – at least, not one that adds up to a hill of bean – for the lives lost, the unnecessary cases of measles, and the damage done to scientific credibility more generally.
There is a mea culpa, if you define their full account of the adjudication as such, in the Lancet in 2004. See here for details. (Free to read but you have to register.)
Also, in the same issue of the Lancet in which Wakefield et al published their study in 1998, which incidentally did not claim a causal connection, there was a statement (I believe by the referees, but if not, by two invited specialists) stating how the study was flawed. This is here, but subscription only.
Thanks for that link, Maxine. It is indeed what I thought it was, and therefore not amounting to a hill of beans.
Yes, I find it interesting that the UK pro-MMR vaccination ad campaigns are so anaemic, Henry.
For comparison, you can see some of the harder-hitting ones from one German state in a blog post here.
Re. the Wakefield Lancet paper, anti-vax types often insist loudly that “it has never been retracted or refuted”. I have spent many a fruitless hour on the blogs trying to explain that that isn’t what happens with lousy science – rather, further work tests out the methods, predictions, hypotheses, and they are found mistaken, inaccurate, or inadequate. But the original (fatally flawed in this particular case, as we now know) paper will just sit there in the literature as a monument to the necessarily imperfect nature of science and its practitioners.
OOOH, Austin, cutting!
The Lancet has its own policies on which I will not comment (conflict of interest). However, for Nature journals, we do have a corrections policy. When an error is found in a paper, we publish a correction and annotate the online PDF, which is thus annotated for ever more in the A&I (abstracting and indexing) literature, eg pubmed et al. On the rare occasions when we retract a paper, the PDF is watermarked RETRACTED in red letters.
I can’t speak for other publishers, but I feel Nature journals are exemplary in this regard.
Well of course they’re exemplary, Maxine. They’ve got you.
Was that cutting? Really? That was me trying to be relatively restrained…
Actually, I quite like “cutting”. Sounds much classier than “snide”.
Answering to just the title of topic, I can say the only one thing. MMR vaccination MUST be compulsory (and FREE). It is not such question, which can be the subject of freedom of choice.
So – it is strange discussion…
Sorry… Maybe I don’t understand something, eh?… Let colleagues correct me if it is so. However, I’ll say..
Children are being ill and dying
!! YOUR children!
NOT my children, because my country has compulsory MMR vaccination and we have lowest number of disease cases in the world. Your children are ill, but you dare to waste time here in idle discussions instead of real measures.
Well. All of us had these diseases in our childhood. It was usual thing. For example, there is a record in my medical cart – “measles, chicken pox”. But vaccine didn’t exist in our childhood. However now it exist. Why do you allow idiots to interfere in vaccination question and to harm your children?
Is it democracy? Rather it is levity…
I apologize.
Svetlana
In Western democracies it is almost universally regarded as unacceptable to compel vaccination. The “back door” route to compulsion is to refuse school admission to kids without vaccinations, largely on the grounds of the safety of the other children, and especially of any who might be unvaccinated on medical grounds. However, even then there are various exemptions from vaccination. For instance in the US, where the schools-require-vaccination policy is common, objections on religious grounds are widely allowed.
Thank you, Austin.
But it is a repeat. Yes, I said about the same.
But it is necessary to ask question at last: is such situation right?
It is bad. And it must be changed. Children must not be hostages of stupidity and backwardness of their parents.
There would be a tremendous outcry at any attempt to make vaccination (or any other treatment) compulsory, as it would be seen to contravene autonomy and basic democratic freedoms.
Obviously circumstances DO arise where doctors feel that a child patient’s best interests are not being served by parents’ actions (e.g. if the parents insist they do not want conventional treatment for their 2 yr old’s eminently treatable childhood leukaemia because they believe in alternative medicine, or if an HIV-positive mother insists she does not want her baby HIV-tested because she doesn’t believe HIV causes AIDS). However, even in such relatively clear-cut cases the health authority would have to go to court to substitute their judgement for that of the parents.
As I understand it the judgement by both doctors and courts hinges on “benefits vs harms”. With vaccination I would think it is an even trickier one in law because the benefits and harms are in large part collective rather than individual.
I find it pretty much impossible to imagine a court in England would ever rule to enforce vaccination on a child against the parents’ wishes. It would be viewed as infringing the individual’s autonomy, and also potentially harming the child and the family psychologically – while the benefit to the child would be seen as small, compared to the examples I have given above.
I find it pretty much impossible to imagine a court in England would ever rule to enforce vaccination on a child against the parents’ wishes.
I imagine that ‘pretty much’ has become ‘certainly’ since the adoption of modern human rights legislation in the UK. Whether that’s a good thing or a bad is a matter for another discussion.
“Modern human rights”? Indeed?
OK! Show me, please, in modern human rights where it is written that parents have a right to harm their children and that parents can’t be punished for bad attitude to children. Look at this, e.g. :
http://www.dcscience.net/?p=1661
Or do you think that England observes the human rights, but Australia doesn’t?
Modern human rights defend the right of children and don’t allow absolute and non-reasonable power of parents.
Sorry, but one must not pass off the local English laws/traditions/customs as a human rights.
“yes”
Indeed?
Hmm… It is sad that you insist.
I remind – we talk about CHILDREN.
Are you against children and their rights?
Is anyone else getting the irony here?
Deep Sigh
@Svetlana – if you read my comment above more carefully, you’ll see that I noted explicitly that this post was not the place for a discussion of the rights and wrongs of human-rights legislation. All I said was that any attempt to enforce compulsion on parents might be met with challenges under that legislation. That’s all.
For what it’s worth, I think compulsion is the mark of a totalitarian society. What works best in our context is persuasion, and as Austin and I discussed above, it’s odd that the government hasn’t promoted MMR vaccination in the same hard-hitting way that it has promoted cessation of smoking or road safety. If they did, you’d see TV adds featuring children disabled by measles because their neighbours were selfish and didn’t vaccinate their children.
I see your comment above, Henry. And it is really odd, that you don’t consider your society as totalitarian, when your government forbids smoking or (worse!) when your monarchy uses its power for promotion of quackery:
http://www.dcscience.net/?p=1466
However, all of you start to cry about totalitarism, when one starts to talk about defence of children.
Indeed, it is very strange.
OK. I stop my participation in the discussion.
Maybe you will succeed in the overcoming of infections, not using “totalitarian” measures and merely persuading your people in necessity of vaccination … Maybe. Though I doubt.
In any case – good luck.
And health to your children.
Thank goodness for that.
Thank you, Richard, for making my first century.
I am, as ever, your humble servant.
I reared this thread once again, and I see that I can not be voiceless.
Any talks about non-effectiveness and harm of MMR vaccination are idle and even silly. If it was so, huge countries with compulsory vaccination such as USA and Russia couldn’t overcome epidemics of diseases in question. However, they have overcame these epidemics.
As for autism (as well as child dyslexia), it is (in most cases) wire-drawn, silly diagnosis, invented by philoprogenitive anxious parents and mercenary doctors for lazy spoiled children.
Sorry. IMHO.
As for autism … it is (in most cases) wire-drawn, silly diagnosis, invented by philoprogenitive anxious parents and mercenary doctors for lazy spoiled children
I was going to ignore this, but I can’t. This is simply rubbish. Obviously, Svetlana, you don’t have a child on the autsm spectrum.
Heavens! And hell!!
I was the same child MYSELF, Henry! But thankfully I grew in USSR and went to good soviet school, where nobody and never labeled children by idiotic spoof diagnoses!
Happily this tradition continues in Russia – some of my friends were the same in their childhood and their children are the same now; and nobody consider it as diagnosis, all the more so – as “disability”! Good, healthy children… Above-average in some things.
As for my own children, if I survive yet in my life and dare to have my own children, then they will be the same. I am simply “doomed” to have children such as myself. And I would be enormously happy to have such children.
Certainly I rushed into extremes, when I called your child “usual child”. I am sorry, Henry. Certainly she is precocious child with higher level of intellectual development than her contemporaries. And even if she is “usual child” then only from view-point of the same type of people (you, me, our colleagues). But main thing – she is HEALTHY child. This diagnosis – Asperger syndrome – is invented by stupid mediocrities, who hates and fears talented people and their children. Don’t believe them. As for other types of autism, dyslexia and other nonsense, it is a bad paedagogy and bad paediatrics/psychology. It is necessary to change the system of education of teachers, doctors and child psychologists, but not to stamp children by silly diagnosis.
Yes, your child is healthy. But why is she so extraordinary? It is not surprising. Because her dad is scientist. Is her logic/lexics strange? No wonder! It is YOUR logic and YOUR lexics. Moreover, she doesn’t simply imitate/parrot you. It is her own “immanent” behaviour, as we can see from your stories. Yes, she is adapted to scientific environment already now, because she is living in it. People in this forum said rightly about all this story. However noone said only one key word “healthy”. Of course, these children are more labile, that other, because any highly-developed being, any complicated equipment, any valuable work of art is more labile than something rough and simple. But these children are healthy.
I apologize for extreme emotions in my comment (again!). But some stupid things goad me into fury ;) Let these “doctors” and “psychologists” make the diagnosis “oligophrenia” to themselves and cure themselves of it!
PS. By the way, do you really think that it is illogical name for snake “Cabbage”? Not at all. Snake exuviates like a cabbage. Besides, this snake is probably too thick for normal snake :) And if she/he is thin actually, it is friendly joke for favourite snake (sort of “hi, old chap!” for young lad). :) Iron logic!
In brief, all is OK.
This correspondence is now closed – Ed.