For the sake of others: looking after ourselves and others, and the MMR controversy
No man is an island entire of itself; every man is a piece of the continent, a part of the main; if a clod be washed away by the sea, Europe is the less… any man's death diminishes me, because I am involved in mankind.
And therefore never send to know for whom the bell tolls; it tolls for thee.
Devotions upon Emergent Occasions: John Donne
When we consider our own health and well-being, should we be thinking of our family and friends at the same time? How does our own health affect those around us, those who care for us, who love us, and who look after us? Conversely, how much does it hurt us, when a loved one is ill? How often have you heard a parent say that they would gladly suffer their child’s illness, to spare the child the suffering?
When I was working, I particularly enjoyed the company of one colleague, a psychiatrist as it happens, who, when treating a patient, was fond of saying that he was doing so not solely for the patient’s benefit, but for the benefit of the people around that patient. Mental illness is difficult to live with, whether depression or psychosis, and presents a considerable burden on family and friends. Indeed, friends can fade away when illness arises. And not just in mental illness; I have another friend who was afflicted by a facially-disfiguring malignancy, and who, during the process of having plastic surgery to reconstruct his face, found that people who were once friends purposefully avoided contact with him.
The mumps, measles and rubella (MMR) vaccination story is instructive in this regard. Dr Andrew Wakefield published work in 1998 evidently proving that MMR was associated with the development of autism and bowel disease. Other researchers were unable to reproduce his results in subsequent studies; a statutory tribunal of the GMC concluded that Wakefield had "failed in his duties as a responsible consultant,” acted against the interests of his patients, and behaved "dishonestly and irresponsibly" in his research. Wakefield was erased from the medical register on 21st December 2010 after a Fitness to Practise panel hearing and now lives abroad, effectively in exile.
There were people, intrinsically suspicious of the whole concept of vaccination, who were only too willing to believe Wakefield’s work. As a result there was a precipitous decline in the uptake of the MMR vaccine and a large number of children contracted measles. Some died.
A word about measles. This is a dreadful disease. There is no treatment. Although often mild and self-limiting it is not just another childhood illness. As a junior doctor I learned to diagnose it, and to distinguish it from German measles; my own, excellent (but younger) GP has never seen a case. Measles caused 2.6 million deaths worldwide every year prior to MMR. Deaths that occur are usually in the under 5 age group. It can cause a fatal pneumonia; it can cause inflammation of the brain, which is also usually fatal. In some cases, brain damage ensues after a delay of several years – so, when the child has recovered, it may develop fits and mental deterioration, a condition known as subacute sclerosing panencephalitis, which is universally fatal – though mercifully very rare now in the UK. It is the most infectious of all viruses; exposure of a non-immune individual to the virus always results in infection. If you wanted to create a really nasty, easily spread biological weapon, you would start with measles. It is entirely possible that certain agencies have done so. Imagine Ebola RNA inside the measles particle – no, don’t.
Wakefield continues to protest his innocence. Once again, when I was a junior doctor I worked for a time at the same hospital as one of Wakefield’s co-researchers. I remember this man as being utterly convinced that he had stumbled upon the most significant discoveries of his generation, and that MMR was hugely damaging. There was nothing about him that suggested conspiracy or deception; this man was convinced, utterly. It is now widely accepted that he was mistaken and that a great deal of human suffering arose from his shared, mistaken, convictions. The British Medical Journal did not extend any such consideration to Wakefield, as I had been inclined to do for my colleague: “Who perpetrated this fraud? There is no doubt that it was Wakefield. Is it possible that he was wrong, but not dishonest: that he was so incompetent that he was unable to fairly describe the project, or to report even one of the 12 children’s cases accurately? No”. BMJ 2011;342:c7452
There is something called “Herd Immunity”. Viruses exist solely for their own benefit; their sole purpose is to propagate. The presence of certain bacteria is productive, even beneficial – in the gut, for example, aiding the breakdown of food; viruses by contrast are pure evil. Where a large number of individuals in a population – let’s call the population a primary school class - share immunity to an infectious condition, that condition finds it difficult to jump from child to child and continue its existence. Thus, even if a few children in the class are not immunised against measles, the presence of a larger number of children who cannot have measles, and therefore cannot spread it, confers an immunity to the class as a whole. This is “Herd Immunity”.
However, if the number of susceptible children in the class exceeds a certain number, herd immunity fails, and the disease runs rampant.
My friend from the first paragraph had his patients’ family and friends in mind when he treated his patients’ mental illness; by relieving their depression, he improved the lives of the people around them. When we refuse vaccination, we not only expose our own children to potentially lethal illnesses, but we increase the risk to other children, too. For the sake of others. We should pay attention to our own health, beyond mental health, beyond vaccination, not just for our sake, but for the sake of people around us.
The author is a retired Consultant in Anaesthesia and Intensive Care. These are his views.
And therefore never send to know for whom the bell tolls; it tolls for thee.
Devotions upon Emergent Occasions: John Donne
When we consider our own health and well-being, should we be thinking of our family and friends at the same time? How does our own health affect those around us, those who care for us, who love us, and who look after us? Conversely, how much does it hurt us, when a loved one is ill? How often have you heard a parent say that they would gladly suffer their child’s illness, to spare the child the suffering?
When I was working, I particularly enjoyed the company of one colleague, a psychiatrist as it happens, who, when treating a patient, was fond of saying that he was doing so not solely for the patient’s benefit, but for the benefit of the people around that patient. Mental illness is difficult to live with, whether depression or psychosis, and presents a considerable burden on family and friends. Indeed, friends can fade away when illness arises. And not just in mental illness; I have another friend who was afflicted by a facially-disfiguring malignancy, and who, during the process of having plastic surgery to reconstruct his face, found that people who were once friends purposefully avoided contact with him.
The mumps, measles and rubella (MMR) vaccination story is instructive in this regard. Dr Andrew Wakefield published work in 1998 evidently proving that MMR was associated with the development of autism and bowel disease. Other researchers were unable to reproduce his results in subsequent studies; a statutory tribunal of the GMC concluded that Wakefield had "failed in his duties as a responsible consultant,” acted against the interests of his patients, and behaved "dishonestly and irresponsibly" in his research. Wakefield was erased from the medical register on 21st December 2010 after a Fitness to Practise panel hearing and now lives abroad, effectively in exile.
There were people, intrinsically suspicious of the whole concept of vaccination, who were only too willing to believe Wakefield’s work. As a result there was a precipitous decline in the uptake of the MMR vaccine and a large number of children contracted measles. Some died.
A word about measles. This is a dreadful disease. There is no treatment. Although often mild and self-limiting it is not just another childhood illness. As a junior doctor I learned to diagnose it, and to distinguish it from German measles; my own, excellent (but younger) GP has never seen a case. Measles caused 2.6 million deaths worldwide every year prior to MMR. Deaths that occur are usually in the under 5 age group. It can cause a fatal pneumonia; it can cause inflammation of the brain, which is also usually fatal. In some cases, brain damage ensues after a delay of several years – so, when the child has recovered, it may develop fits and mental deterioration, a condition known as subacute sclerosing panencephalitis, which is universally fatal – though mercifully very rare now in the UK. It is the most infectious of all viruses; exposure of a non-immune individual to the virus always results in infection. If you wanted to create a really nasty, easily spread biological weapon, you would start with measles. It is entirely possible that certain agencies have done so. Imagine Ebola RNA inside the measles particle – no, don’t.
Wakefield continues to protest his innocence. Once again, when I was a junior doctor I worked for a time at the same hospital as one of Wakefield’s co-researchers. I remember this man as being utterly convinced that he had stumbled upon the most significant discoveries of his generation, and that MMR was hugely damaging. There was nothing about him that suggested conspiracy or deception; this man was convinced, utterly. It is now widely accepted that he was mistaken and that a great deal of human suffering arose from his shared, mistaken, convictions. The British Medical Journal did not extend any such consideration to Wakefield, as I had been inclined to do for my colleague: “Who perpetrated this fraud? There is no doubt that it was Wakefield. Is it possible that he was wrong, but not dishonest: that he was so incompetent that he was unable to fairly describe the project, or to report even one of the 12 children’s cases accurately? No”. BMJ 2011;342:c7452
There is something called “Herd Immunity”. Viruses exist solely for their own benefit; their sole purpose is to propagate. The presence of certain bacteria is productive, even beneficial – in the gut, for example, aiding the breakdown of food; viruses by contrast are pure evil. Where a large number of individuals in a population – let’s call the population a primary school class - share immunity to an infectious condition, that condition finds it difficult to jump from child to child and continue its existence. Thus, even if a few children in the class are not immunised against measles, the presence of a larger number of children who cannot have measles, and therefore cannot spread it, confers an immunity to the class as a whole. This is “Herd Immunity”.
However, if the number of susceptible children in the class exceeds a certain number, herd immunity fails, and the disease runs rampant.
My friend from the first paragraph had his patients’ family and friends in mind when he treated his patients’ mental illness; by relieving their depression, he improved the lives of the people around them. When we refuse vaccination, we not only expose our own children to potentially lethal illnesses, but we increase the risk to other children, too. For the sake of others. We should pay attention to our own health, beyond mental health, beyond vaccination, not just for our sake, but for the sake of people around us.
The author is a retired Consultant in Anaesthesia and Intensive Care. These are his views.
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