Measles, vaccination and homeopaths

Measles is in the news again.  Just to provide a little context, the graph above shows the number of confirmed measles cases in England and Wales since 1996^*. The impact of insufficient vaccine coverage is easy to see. This year is looking like being a good year for measles; not so good for vulnerable members of the community. According to the BBC, “The Health Protection Agency [HPA] reported 334 cases compared with 33 in the similar period last year.”  In fact, this is rapidly approaching the total of 374 cases reported for the whole of 2010.  It seems that this is related to “an epidemic in France, where 7,000 cases have been reported since January – more than in the whole of 2010.”

The HPA are advising “Whether you stay here in the UK or travel abroad, it is crucial that individuals who may be at risk are fully immunised.” Although the coverage with the MMR vaccine is improving in the UK, it is “still far from the 95% uptake rate needed to stop the spread of the disease in the community.”^** One reason for this is the damage done by the media^*** uncritically promoting the views of the disgraced Andrew Wakefield^† and other vaccine scaremongers.

Measles and MMR: the risks

It’s easy to forget just how dangerous measles is.  Those of us who grew up in times where it was more common may tend to look back on measles as an inconvenient rite of passage.  Generally, this is because we may not have had direct personal experience of the serious consequences that can arise from a measles infection.  In the years since, vaccination brought diseases like measles under control and people have, thankfully, become even less familiar with the dangers.

Ignorant refusal

Jeni Barnett‘s recent deplorable on-air foray into the topic of vaccination and MMR has got me thinking about one of the most fundamental concepts in medical ethics: informed consent.

Back in 2005 Edzard Ernst discussed this in the context of the use of so-called complementary and alternative medicine (CAM). 

“The principle of informed consent means that patients need full information about a treatment before receiving it […] Informed consent, however, is more than just agreement, it’s also about information. According to the Department of Health, the data that healthcare professionals need to provide includes “information about the benefits and risks of the proposed treatment and alternative treatments”. [emphasis mine]

The Science Museum and MMR

I’ve not commented much on the MMR ‘controversy’ manufactured by Andrew Wakefield, his fellow travellers and the media: I’ve left it to better qualified commentators. 

To date, my only brief foray was on the topic of making decisions in the absence of certainty; a riposte to Dr John Briffa’s apparent instance on being able to be absolutely certain that the vaccine caused no harm before it could be endorsed. 

One of the sources I cited in the piece was the Science Museum’s generally excellent web pages, “The MMR Files“.  Recently bloggers Dr*T , JDC325 and Martin at “The Lay Scientist” pointed out that some of the science museum’s web content is distinctly dodgy.  In particular, it cites the vociferous, bizarre and downright dangerous anti-vaccination campaign group ‘JABS’. 

Living with uncertainty

I’ve been following a debate between various bloggers and Dr John Briffa about MMR and autism.  The good doctor seems to take the position that we are not in a position to know for sure that the MMR vaccine is safe, i.e. doesn’t cause autism.  This raises interesting questions about uncertainty, proof and evidence.

Of course, in science, there is generally room for doubt.  Particularly when we are dealing with complex interventions in complex systems (like vaccinating people), we are never in a position where we can be absolutely sure.  However, life needs to go on: we have to make the best decisions we can.

This raises important questions: how can we live with this kind of uncertainty?  How can we make the decisions that we need to when there are no guarantees?