Herbal Medicine

The BMJ has published a study entitled: Factors associated with uptake of measles, mumps, and rubella vaccine (MMR) and use of single antigen vaccines in a contemporary UK cohort: prospective cohort study. Have a read of it all. The effects of the MMR vaccine-autism hoax are apparent. When looking at parents’ reasons for not immunising their child with the combined MMR vaccine (for children who were unimmunised and for those who received single antigen vaccines) they found:

Overall, 74.4% (71.3% to 77.0%, n=1110) of the parents made a “conscious decision” not to have their child immunised with MMR. Of all the reasons given by parents that fell into the “conscious decision” category, the most common were being too scared or thinking the vaccine was too dangerous (24.1%, 21.2% to 27.2%, n=277), not wanting to their child to receive MMR (18.6%, 16.1% to 21.3%, n=211), fears over possible links with autism (14.1%, 12.1% to 16.4%, n=168), and negative media attention (9.5%, 7.4% to 12.0%, n=105). Six per cent of parents (4.7% to 8.2%, n=65) of unimmunised children reported practical issues as the reason for their child not receiving MMR compared with only 0.1% (0.03% to 0.3%, n=3) of those whose children had received single antigen vaccines.

An accompanying editorial discusses the options for regaining herd immunity:

What can be done to reach the 95% or greater coverage with MMR needed to eliminate measles? Attitudes are key, because 14% of UK mothers in 2006 considered MMR a greater risk than the diseases it prevents, although this proportion had decreased from a peak of 24% in 2002. At the individual level, efforts to persuade parents with deep seated philosophical or religious objections to all vaccines are likely to be futile. The main focus should be on parents of partially immunised children, who fall into two broad groups—those who are socially or materially advantaged and those who are not. Strategies to tackle late or partial immunisation (or both) in disadvantaged populations should focus on improving access. Families who selectively refuse MMR, usually on the basis of safety concerns, are likely to have almost 95% coverage for other vaccines. Communication needs to consider the experience and context of the individual families. Pilot work with a detailed MMR decision aid for parents found that it has potential for influencing attitudes and knowledge. The aid details rates of measles and its complications and adverse events related to MMR vaccination. This balance is useful because some parents in the UK think of official information as biased and want information that is seen as “independent.” At the population level, initiatives such as linking parental financial incentives or entry to school or childcare facilities to completion of immunisation have improved overall immunisation coverage but require legislative action and societal support.

The fact that those who shun MMR vaccine because of the MMR vaccine-autism hoax are high users of other vaccines, provides us with some confidence that the anti-vaccination movement in the UK is still a relatively small group of obsessive cranks.

Mark Crislip provides a wonderful anecdote in his post about physician-pharma interactions:

After one of my intermittent outbursts against the involvement of big pharma in our conferences (I am the lone voice in this argument), the head of my hospital received an anonymous letter complaining about my behavior. The letter was ostensibly from a member of the hospital staff. Accompanying the letter were copies of emails I had sent to the ID docs in the city complaining about the influence of drug reps at our conferences. It turns out when you print a page from Windows sometimes it will also print the path on the hard drive to the file. At the bottom of the page you will see, as an example, C:/folder/folder/bchristi/file. Curiously, and I am sure it was a weird coincidence, the name of the folder was the same as the email address of a local drug rep, bchristi@company.com. Weird, huh, how the folder and the email had the same name? What are the odds of such a serendipitous event? Also of interest was a copy of a private email I had sent to one of our local ID docs. How that personal email ended up in the folder of the writer I still have yet to determine.

The President of my professional body has written to The Independent in favour of a legal obligation to publish all drug trials:

Sir: You report on a study from Hull University which questions the effectiveness of modern anti-depressants and raises important issues about the availability of data from drug trials (26 February).

The Royal Pharmaceutical Society of Great Britain (RPSGB) believes that drug companies should be under a legal obligation to publish all data relating to clinical trials, whether positive or negative. Only by doing this can full independent analyses take place which will help inform the decision-making process and improve patient safety.

The RPSGB is committed to making Britain the safest place in the world to receive medicines. We advise any patient who has been prescribed anti-depressants to continue taking their medicine. If patients have concerns, they should not stop taking the medicines but should seek the advice of a GP or pharmacist.

Hemant Patel

President, Royal Pharmaceutical Society of Great Britain, London SE1

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