Life expectancy in general has soared over the past century, and it’s easy to forget just how phenomenal this change has been. In 1901, males born in the UK could expect to live to forty-five, and females to forty-nine. By 2004, life expectancy at birth had risen to seventy-seven for men, and eighty-one for women (although of course much of the change is due to reductions in infant mortality).
So we are living longer, and vaccines are clearly not the only reason why. No single change is the reason why. Measles incidence dropped hugely over the preceding century, but you would have to work fairly hard to persuade yourself that vaccines had no impact on that. Here, for example, is a graph showing the reported incidence of measles from 1950 to 2000 in the United States.
For those who think that single vaccines for the components of MMR are a good idea, you’ll notice that these have been around since the 1970s, but that a concerted programme of vaccination – and the concerted programme of giving all three vaccinations in one go as MMR – is fairly clearly associated in time with a further (and actually rather definitive) drop in the rate of measles cases.
The same is true for mumps:
While we’re thinking about mumps, let’s not forget our epidemic in 2005, a resurgence of a disease many young doctors would struggle even to recognise. Here is a graph of mumps cases from the
Almost all confirmed cases during this outbreak were in people aged fifteen to twenty-four, and only 3.3 per cent had received the full two doses of MMR vaccine. Why did it affect these people? Because of a global vaccine shortage in the early 1990s.
Mumps is not a harmless disease. I’ve no desire to scare anyone – and as I said, your beliefs and decisions about vaccines are your business; I’m only interested in how you came to be so incredibly misled – but before the introduction of MMR, mumps was the commonest cause of viral meningitis, and one of the leading causes of hearing loss in children. Lumbar puncture studies show that around half of all mumps infections involve the central nervous system. Mumps orchitis is common, exquisitely painful, and occurs in 20 per cent of adult men with mumps: around half will experience testicular atrophy, normally in only one testicle, but 15 to 30 per cent of patients with mumps orchitis will have it in both testicles, and of these, 13 per cent will have reduced fertility.
I’m not just spelling this out for the benefit of the lay reader: by the time of the outbreak in 2005, young doctors needed to be reminded of the symptoms and signs of mumps, because it had been such an uncommon disease during their training and clinical experience. People had forgotten what these diseases looked like, and in that regard vaccines are a victim of their own success – as we saw in our earlier quote from
Whenever we take a child to be vaccinated, we’re aware that we are striking a balance between benefit and harm, as with any medical intervention. I don’t think vaccination is all that important: even if mumps orchitis, infertility, deafness, death and the rest are no fun, the sky wouldn’t fall in without MMR. But taken on their own, lots of other individual risk factors aren’t very important either, and that’s no reason to abandon all hope of trying to do something simple, sensible and proportionate about them, gradually increasing the health of the nation, along with all the other stuff you can do to the same end.
It’s also a question of consistency. At the risk of initiating mass panic, I feel duty bound to point out that if MMR still scares you, then so should everything in medicine, and indeed many of the everyday lifestyle risk exposures you encounter: because there are a huge number of things which are far less well researched, with a far lower level of certainty about their safety. The question would still remain of why you were so focused on MMR. If you wanted to do something constructive about this problem, instead of running a single-issue campaign about MMR you might, perhaps, use your energies more usefully. You could start a campaign for constant automated vigilance of the entirety of the NHS health records dataset for any adverse outcomes associated with any intervention, for example, and I’d be tempted to join you on the barricades.
But in many respects this isn’t about risk management, or vigilance: it’s about culture, human stories, and everyday human harms. Just as autism is a peculiarly fascinating condition to journalists, and indeed to all of us, vaccination is similarly inviting as a focus for our concerns: it’s a universal programme, in conflict with modern ideas of ‘individualised care’; it’s bound up with government; it involves needles going into children; and it offers the opportunity to blame someone, or something, for a dreadful tragedy.
Just as the causes of these scares have been more emotional than anything else, so too has much of the harm. Parents of children with autism have been racked with guilt, doubt and endless self-recrimination over the thought that they themselves are responsible for inflicting harm upon their own child. This distress has been demonstrated in countless studies: but so close to the end, I don’t want to introduce any more research papers.
There is one quote that I find – although she would perhaps complain about my using it – both moving and upsetting. It’s from Karen Prosser, who featured with her autistic son Ryan in the Andrew Wakefield video news release from the Royal Free Hospital in 1998. ‘Any mother who has a child wants it to be normal,’ she says. ‘To then find out your child might be genetically autistic is tragic. To find out that it was caused by a vaccine, that you agreed to have done … is just devastating.’
Disdain for statistics in healthcare research wasn’t unusual at the time: Ignaz Semmelweis noticed in 1847 that patients were dying much more frequently on the obstetrics ward run by the medical students than on the one run by the midwifery students (this was in the days when students did all the legwork in hospitals). He was pretty sure that this was because the medical students were carrying something nasty from the corpses in the dissection room, so he instituted proper handwashing practices with chlorinated lime, and did some figures on the benefits. The death rates fell, but in an era of medicine that championed ‘theory’ over real-world empirical evidence, he was basically ignored, until Louis Pasteur came along and confirmed the germ theory. Semmelweis died alone in an asylum. You’ve heard of Pasteur.
Here is Jack on cramp: ‘For years many people have suffered with cramp. By dowsing, I discovered that this is due to the fact that the body is not absorbing the element “scandium” which is linked to and controls the absorption of magnesium phosphate.’ And on general health complaints: ‘Based on my expertise in dowsing, I noted that many of my patients were suffering from severe deficiencies of carbon in their systems. The ease in which people these days suffer hairline fractures and broken bones is glaringly apparent to the eyes that are trained to see.’
Whether you buy the DoH phrase ‘MMR is safe’ depends on what you decide you mean by ‘safe’. Is flying safe? Is your washing machine safe? What are you sitting on? Is that safe? You can obsess over the idea that philosophically nothing can ever be shown to be 100 per cent safe – and many will – but you would be arguing about a fairly meaningless and uncommon definition of the word.
‘The groups of investigators that either had access to original autism specimens or investigated them later for measles virus detection were invited to take part in the study but failed to respond. Similarly, it was not possible to obtain clinical specimens of autism cases from these investigators for independent investigations.’
In 2008, just as this chapter was being put to bed, some journalists deigned – miraculously – to cover a PCR experiment with a negative finding. It was misreported as the definitive refutation of the entire MMR–autism hypothesis. This was a childish overstatement, and that doesn’t help anyone either. I am not hard to please.
Not 11.7 per cent as claimed in the
AND ANOTHER THING
I could go on. As I write this in May 2008, the media are still pushing a celebrity-endorsed ‘miracle cure’ (and I quote) for dyslexia, invented by a millionaire paint entrepreneur, despite the abysmal evidence to support it, and despite customers being at risk of simply losing their money anyway, because the company seems to be going into
