Friday, March 31, 2006

A measly response

I started this post on Wednesday but, having had a very pleasant and slightly surreal time in Glasgow (meeting an old friend whom I have not seen in almost 12 years), I have returned to the post...

Doctor Crippen has a post up about measles. Like him, I too had all of the childhood diseases—my parents deliberately exposed me to the infected—although the one that I remember, partly because my parents were so keen for me to get it as a child*, was chickenpox. I would, in any case, endorse his urgings to get your children immunised.

However, though I lay some claim to significant knowledge of microbiology, I am not a doctor (or even a nurse quacktitioner); thus, inevitably, it is the political points that Crippen raises that interest me, for they are—purely in passing, you understand—contradictory.
Remember BSE? Remember all the dishonesty, the platitudes, and the patronising, dissembling lies from the government? Remember the appalling John Selwyn Gummer, as reported by the BBC, inserting tainted meat into his daughter?

Readers over the last few days will be aware that I went off on one about BSE the other day. Indeed, I do remember BSE; I remember how thousands were going to die within ten years, how we were all doomed.

It did not happen. 161 people in Britain have contracted what is amusingly called vCJD (amusing because it killed "younger people" than CJD. Including a man of 46. Not so very young, methinks). The point is that there was massive hysteria over CJD, the British beef industry was all but destroyed and for what? Despite the recent scare stories, I do not believe that CJD is a threat, significant or otherwise. Apart from anything else, scientists do not know what the infection vector is. They do not really know whether "prions" are symptomatic or causative (or possibly both). They have also never explained why, if BSE could transfer to humans, why scrapie (the sheep equivalent) could not.

However, what the good doctor is trying to say, I think, is that the cover-ups and vacillations by the politicians (possibly) led to the deaths of 161 British people. The government did nothing until the last minute. With the BSE crisis, there were concerns, however misplaced, over the safety of British beef: the government (eventually) acted on those concerns but was excoriated, rightly, for not doing so before.

Contrast this with the measles epidemic. Now, there were concerns over the MMR jab; if you are a regular Private Eye, you may well still have concerns over the jab. When there is a concern over the safety of such a medicine, then it should be withdrawn. Dr Crippen maintains that the government should have put money into its own research report: this would have been sensible. However, as the good doctor must surely realise, a report such as this cannot be knocked up overnight. To counter effectively the Wakefield report (and a larger study with a similar conclusion to Wakefield's in the US), the research would have to studied people over the course of a number of years.

Many people were unwilling to put their children at risk of what they perceived to be the greater danger; that of their child possibly developing autism through having the jabs, hence the shortfall. There was an alternative: single jabs.

The government failed to approve these, and actually threatened to prosecute doctors who gave them. This was a stupid move and an unfogiveable failing, leading to a significant drop in the number of people immunising their children. When I pointed this out to Dr Crippen in his comments, one of his commenters replied thusly.
single jabs were never a sensible option. it would have re-inforced the idea that one of the vaccines was dangerous and should be avoided. The whole vaccs programme would have gone belly-up as everyone had a pick'n'mix of vaccs. 6 jabs instead of 2, most of the population would end up short of one or more vaccs.

The point is that the vaccine may indeed have been dangerous. No one was to know at the time that Wakefield had it wrong. The fact is that many of the chidren with autism that he studied had signs of the attenuated measles virus in their guts; he postulated a connection. I repeat: some fairly credible research showed that the MMR jab may have been dangerous.

In which case, surely the sensible thing would have been to withdraw it—until it was proven safe‐and make the alternative available? As it is, people didn't bother vaccinating at all, which is surely a worse scenario; at least Dr Crippen seems to think so, and I would tend to agree.

The government arsed the whole thing up by doing nothing, or actively threatening those who wished to provide the alternative. Some doctors risked prosecution in order to ensure that children had at least some form of protection against the disease. So, now, as Dr Crippen points out, we have a meases epidemic starting in Doncaster.

Another criminally stupid, life-wasting load of inaction from our lords and masters; their record on disease is not good. Coupled with the appalling slaughter of livestock during the Foot and Mouth Crisis**, this is just another fucking cock-up from NuLabour.

Why won't these people just fuck off and die...?

UPDATE: Given bookdrunk's comment below, perhaps I should clarify. Let's assume that the government knew that MMR was safe; this did not affect the fact that some people decided against using that form of innoculation on their children. Given this emtirely predictable response why, then, did the government specifically ban the single jabs? Surely some protection is better than none?

UPDATE: A warm welcome to readers of House Of Dumb, who also sums up my point quite neatly...

* Chickenpox is caused by the Human Herpes Virus Type 3. Chickenpox is particularly dangerous for adults, since it can far more frequently lead to shingles, which is a reappearance of the chickenpox virus.

Like other forms of herpes, notably genital herpes and oral herpes ("cold sores"), the chickenpox virus can never be completely eliminated from the body. This is because the herpes virus "hides" in the central nervous system, although the immune system is usually able to suppress any reoccurance.

Part of the reason that viruses are able to hide in the CNS is that, when the central nervous system has stopped growing, the entire system is flooded with enzymes that inhibit, or rather almost totally shut down, any growth within or around the system. This is a significant reason why people with broken backs and necks are not able to recover to any significant degree: because the CNS tissues are prevented from regrowing by the enzymes present in the spinal fluid.

** My uncle is a Foot and Mouth Disease specialist at Britain's main animal disease research centre, the Purbright Centre. They should have been consulted over FMD which was foolish anyway, since my uncle had written a paper for Purbright, in the early 90s, predicting that the so-called "Asian strain" FMD would hit Britain within the next 10 years.

The government refused to consult Purbright, instead hiring an expert in human disease epidemiolgy which led directly to the mass slaughter of millions of animals which were illegal, both in the fact that animals that had not come into contact with the disease were slaughtered and, in many cases, the way in which the killings were carried out. The government realised this and slipped a retrospective law allowing the cull through the last parliament.

The lying, cheating scum.

16 comments:

BD said...

In which case, surely the sensible thing would have been to withdraw it—until it was proven safe‐and make the alternative available?

I suspect - or rather hope - that a balanced decision had to be made between the alleged health cost of keeping a vaccination that might cause problems in circulation, versus the known consequences to public health of withdrawing a vaccine that seems in the majority of cases to have a track-record of being effective and safe.

So while some people did withdraw from the vaccination programme of their free will, it did less damage than having everyone stop - not least because of how hard it would be to get people to trust a new alternative after admitting the old one was dangerous. In short, I'm not sure withdrawal was necessarily the most pragmatic 'sensible' option for public health as a whole - certainly not until more was known. That doesn't stop it from being horrible for the family whose child apparently develops autism as a consequence of vaccination.

Of course, as I say, I hope that's the reasoning - though I suspect the interests of public health may have been swallowed by a rather less healthy political pragmatism: will this lose me an election?

Panlane said...

What is important to note - leaving aside what is the incredibly dubious evidence for the problems with MMR and the overwhelming evidence in favour of it - is that an individual's protection from infectious disease is not simply dependent on having been vaccinated but also by others having been. Not all vaccines take, indeed the failure rate in childhood vaccinations tends between 5-15%. Furthermore, some people cannot be vaccinated for various reasons. Thus the personal choice of some not to vaccinate is not a decision that only impacts upon themselves, it influences the probability of infecting others and maintaining sustainable disease populations. Personal choice and social cost is not a simple thing in these instances.

The NHS has always been geared to evidential-based medicine (Thank Christ!). The evidence did not and does not support Wakefield's case and thus the NHS was under no obligations to provide alternatives to the MMR. The private sector on the other hand can offer whatever the panicking fruitcakes prefer.

Devil's Kitchen said...

Panlane,

The problem is that they couldn't be sure that MMR was not implicated in the onset of autism. Given what you say about endemic illnesses in populations, surely it would have been even more sensible to allow a single jab?

If someone said, "I'm worried about MMR; is there an alternative" then the correct response should have been, "I am sure that MMR is safe, but we can administer single jabs. You will need to come in 6 times rather than twice, but if that is what you want, then fine."

As it is, we now have a large number of children completely open to infection which might not only damage them but also, as you point out, lead to higher endemic levels of disease within the total population (which given the high potential mutation rate for retroviruses such as measles might also lead to more virulent or resistant strains too).

DK

dearieme said...

I never supposed for a moment that Dr Wakefield might have been right - until Tonito began his dissembling/lying/prevaricating on the subject. Golly he pollutes everything he touches.

Panlane said...

I understand the point you are making, the problem is that by saying we offer single jabs for those who are worried a number of things follow.

First, these are increased costs due to three times as much staff time plus additional vaccination costs. For a publicly-funded health service these costs are non-negligable and will impact upon healthcare in other sectors.

Second, more people will not be vaccinated due to missed appointments and lower efficacy with a single jab approach. You could argue that given the choice of MMR and no vaccinations some people opted for no vaccinations. However, I would dispute that these people actually understood the issues sufficiently and probably came away skeptical of vaccinations as a whole (the movement against them having been a constant precence since their development).

Third, part of the founding ethos of the NHS is that practice of care will follow the evidence rather than public whim. If the NHS offers seperate jabs as a publicly-funded alternative, it in essence endorses that approach. Moreover, it endorses the shakey science (a classic case of file-drawer syndrome) behind the desire to avoid MMR. This is not following the evidence. For a majority of the public the NHS and the media are their only sources of medical science. The media stoked a frenzy for their own dubious interests, the job then fell on the NHS to crush it, not pander to it.

I agree that the government did not handle it well. Government never handles anything well, only in varying degrees of incompetence.

The compromise approach I'd have recommended would have been for the NHS to offer the single vaccinations at their costs (including time) minus the MMR costs. That way, no net loss to the service would have occured, all would have a choice, though with optional stupidity tax, and it would include a statement of NHS medical opinion by one being free, the other not.

Anonymous said...

I'm with DK on the criminal irresponsibility of this government.

I have my doubts about Wakefield, but the hatchet job attacks on him tend to make me sympathetic.

There is however another possibility that hasn't been properly investigated, namely the use of mercury preservatives in vaccines.

They've now been banned, and they were banned for a reason. Meanwhile, children have been injected with mercury compounds designed to keep the vaccines "fresh", and which also have possible side effects...

We have 3 children, all have been vaccinated. The eldest has Asperger's Syndrome, an Autistic Spectrum Disorder. We believe it to be natural, (and my wife loves to compare Alex's behaviour with my own), but we made damn sure our youngest 2 children were vaccinated relatively late, and WITHOUT the jabs containing the mercury preservative.

Measles, etc. is dangerous, but there's no harm in avoiding risks, especially when there's a possibility your children may have greater susceptibility!

Devil's Kitchen said...

David,

Yes, I have read about the mercury preservatives in a number of sources. It's interesting, since mercury attacks the nervous system in really very low concentrations (my A Level Biology experimental project was an investigation into the toxic properties of various heavy metals and mercury was way out front).

DK

Anonymous said...

Hell preserve up all, DK, what a load of bollocks. You started off discussing MMR. MMR has never, ever, not even once contained mercury. Nor have single measles, mumps or rubella vaccines, nor the old oral polio. These are all live virus vaccines, and putting preservatives in them would kill off the live viruses, which sort of spoils the point. There was thiomersal (mercury based preservative) in the old diptheria, tetanus and pertussis vaccines, but not enough to cause brain damage except in the mind of the anti-vac loons.
You said further up that if we couldn't be sure there was no risk from the vaccine it should be withdrawn. Bollocks again. We can't be sure the vaccine doesn't cause Tapanuli Fever and the Black Formosa Corruption, but we have no evidence that it does. We do know that if we stop vaccinating against measles we will again have epidemic measles, just like the good old days. That means a half to one million cases per year. Proportionately, very few of those will die but it soon adds up.

ttfn

Anonymous coward, gp and angry drunk liberal.

Martin said...

DK,

No government can be trusted in matters of public health.

The vCJD 'crisis ' appears to have a similar impact on you as the HIV 'crisis' of the '80's had on me.

If medical truth is to be established, don't mix votes and viruses.

And I'm sorry for any unvaccinated wee one, because they're now more likely than ever to come into contact with diseases which had previously been radiacted here, such as TB.

Devil's Kitchen said...

Hell preserve up all, DK, what a load of bollocks. You started off discussing MMR. MMR has never, ever, not even once contained mercury

Did I mention mercury being in MMR vaccines? Did David? No.

DK

Panlane said...

No but in keeping with all healthscare rhetoric two distinct issues are flowing into each other because neither stands strong on its own. What is frustrating about this, more than its utter predictability, is that each one somehow ends up reinforcing the fears of the other, despite in this case both scares being over nothing. Perhaps this is because both Mecury (Thimerosal) and MMR were both bogusly dubbed to cause autism (http://www.quackwatch.org/03HealthPromotion/immu/thimerosal.html). Basically if someone claims something simple causes autism, keep a salt cellar handy.

Anonymous said...

Did I mention mercury being in MMR vaccines? Did David? No.

And the title of your original post was...?

In response to Dr Crippen's article about...?

ttfn

ac, gp & adl

Devil's Kitchen said...

Anon,

I do think that comments are allowed to expand beyond the remit of the original post. That's part of the fun of discussion isn't it? We can start talking about MMR and then move on to vaccines in general, no?

DK

Devil's Kitchen said...

Panlane,

Interesting article on thimerosal. Being a science bod., could you explain this action?

Thimerosal has been used as preservative in biologics and vaccines since the 1930s because it prevents bacterial and fungal contamination, particularly in multidose containers.

Just interested as to why it stops microbial proliferation.

As a matter of interest, the 1mg mercury, that they cite as the old daily dose, was more than enough to severely inhibit the action of the enzymes (one being galactase, as I recall) that I was poisioning in my lab project (referred to above). However, I accept that this was an in vitro test using molar solutions of mercury oxide, and were not in a live subject.

I just enjoyed poisoning things...

DK

Panlane said...

Ha ha, the point is that the problem with both mercury and MMR as a vehicle for autism is that they had a mechanism that seems plausible but isn't actually accurate. If we judge healthcare by what might be rather by what is, we find ourselves utterly constrained in our ability to do anything.

I can't actually comment on the levels of mercury that would suppress contamination, certainly you're right in saying it is horribly toxic, but that doesn't mean the levels that would kill bacteria or suppress the action of galactose in vitro and the levels that would cause permenant neurological damage to humans are one and the same. Not that you are, of course.

The problem with this whole debate, and I do enjoy it by the way, is that relatively intelligent and informed people, such as many of the blogsphere, have it about a specific issue whilst in the background we have knowledge of how science works and the value its progress (e.g. vaccinations) has wrought. Unfortunately, what filters down to the moronic mass that surrounds us is that there is simply massive doubt about the safety of vaccinations. That is why these topics have to be handled so carefully and it fucks me off something chronic.

Anonymous said...

@ DK
I do think that comments are allowed to expand beyond the remit of the original post. That's part of the fun of discussion isn't it?

There is no harm in a little topic drift, and it is, after all, your blog. Equally, there is no harm in pointing out that drift, especially as it drifted to vaccines (unspecified) rather than vaccines (but obviously not live ones so not including MMR).

@ panlane

That is why these topics have to be handled so carefully and it fucks me off something chronic.


Amen, Brother, amen.

ttfn

ac, gp & adl

The very model of a modern scientific man

Your humble Devil was thoroughly amused by Neil Ferguson's fall from grace, and is very pleased to have found the time to outline Fergus...