Heart vs Head
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BL Fisher Note:
The reason that the vaccine safety issue will not go away, including the
debate about the relative safety of the MMR vaccine, is that the real life
experience of the people with vaccine risks is quite different from what
doctors are telling them about vaccine risks. When the people watch their
own children or a friend's child regress before their eyes and become
chronically ill or disabled after vaccination, it doesn't matter what those
with an M.D. or Ph.D. written after their names say.
The empirical evidence is for the head to judge, just as love is a matter
for the heart to judge. Combine the two, the head and the heart, and there
are not enough lies, money or power on earth that will convince the people
that what they know is true is not true.
http://commentisfree.guardian.co.uk/richard_horton/2006/04/the_sadness_of_mmr.html
Guardian Unlimited, UK
Heart vs head
Richard Horton
April 24, 2006 03:19 PM
It's hard to imagine that anything useful could still be written about the
MMR vaccine. Too much has probably been said already, most of it either
wilful nonsense or wild speculation. So I hesitate. And especially because
it was I who was responsible for publishing - to the eternal damnation of
many of my medical and public-health colleagues - Andrew Wakefield's 1998
paper that fuelled a smouldering underground movement against the vaccine. A
campaign that we now know was partly linked to efforts to win a legal claim
against vaccine manufacturers.
But this week I have been thinking about the words of a mother who wrote an
incredibly moving piece in The Times in which she described how she "felt
like a criminal" and under suspicion. Why? Simply because she was trying to
do what she thought best for her daughter and son. Sarah Ebner described how
she knew that Wakefield's work had been discredited. She knew that she
needed to get her children vaccinated against measles. She was not stupid.
And yet she felt condemned for her wish to seek single vaccines for her
daughter.
She was made to feel uncaring and irresponsible - a bad or even mad parent.
But she had to balance her head with her heart, and her heart won. She urged
the government to show humility. To give parents the choice between MMR and
single vaccines.
We have been having this debate for eight years now. It all seems so futile.
But it has come into focus once again because the population's immunity
against measles has fallen to such a degree that outbreaks are occurring in
unvaccinated communities, putting the children in those communities at great
risk of complications of measles infection. So what should parents and the
government do?
Perhaps the first thing to say is that this issue is not going away anytime
soon. Many of those involved in this tragedy have already given written
evidence in the run up to a hearing at the General Medical Council in which
Wakefield and two of his former colleagues will be pursued for serious
professional misconduct. The date of this hearing has not been set.
But when Wakefield walks into the GMC, he will have a national stage that
has been denied him ever since he used a press conference to call for the
provision of single vaccines. The outcome of the GMC's proceedings could be
lose-lose for the Department of Health. For Wakefield's supporters, he will
either be vindicated as a hero or go down as a martyr to his cause. But the
issue of the MMR vaccine's safety should not be about the reputation of one
man. It should be about evidence and the confidence we have in our
public-health system. The GMC hearing is not designed to address these
matters.
If outbreaks of measles continue and if the present measles immunisation
rate of 81% does not rise faster to a safer level of around 95%, the
Government will surely have to do something different. But the simplistic
dichotomy of single versus triple vaccines is not the choice we have to
make, at least not immediately.
What needs to take place - and amazingly still has not taken place - is an
independently led public discussion about the MMR vaccine. If such a
discussion was to take place, with a genuine effort to put past rancour to
one side, perhaps we might come closer to healing the very bloody schism
that has divided families and doctors for almost a decade. A scientific and
public health truth and reconciliation commission - no blame, no suspicion,
but just a committed effort to reach a reasoned conclusion.
I want to be clear. My view is that the evidence shows MMR vaccine to be
safe. We should have absolute confidence in our national programme of
vaccination. But I want to be able to make that case not only on a blog or
in the pages of the Daily Mail, but also in a quasi-judicial setting where I
can be held to account for my judgement. And where I can hold others to
account for their views too.
If parents could see that a fair debate had taken place - true procedural
justice - then perhaps they would be better equipped to do what was best not
only for their children but also, since that is the way herd immunity works,
for the children of their equally vulnerable neighbours.
Thanks to measles vaccines, global measles deaths fell by 40% between 1999
and 2003. This success depended on a remarkable alliance between parents and
public-health workers. In Britain, that kind of virtuous alliance seems to
have broken down. We all share a responsibility for restoring that trust in
one another. We have, it seems, all failed Sarah Ebner.
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