Ethical debate: Vaccination against mumps, measles, and rubella: is there a case for deepening the debate? How safe is MMR vaccine? Validity of the evidence Dealing with uncertainty GP's response

Abstract

Complex issues relating to ethics, values, and the nature of evidence lie behind the decision whether to give the MMR (mumps, measles, and rubella) vaccine. Tom Heller, a general practitioner, is uncomfortable with the evidence that the vaccine is safe. Together with Dick Heller, an epidemiologist, and Stephen Pattison, an ethicist, he explores some of the processes involved in doctors' decisions about whether to vaccinate.

No evidence for links between autism, MMR and measles virus

“…Though Urabe strain of mumps virus in MMR might increase the risk of aseptic meningitis (Miller et al 1993 ;Dourado et al 2000), it was replaced by the Jeryl-Lynn strain in the MMR vaccine in the UK in 1992 (Balraj & Miller, 1995). While the debates on the validity of published evidence (Edwardes & Baltzan, 2001;Heller, D. 2001;Heller, T. 2001 ;Yazbak, 2001;Fombonne & Cook, 2003) and MMR safety (Edwardes & Baltzan, 2001 ;Heller, T. 2001 ;Yazbak, 2001) continue, uncertainty still exists among health professionals and parents (Evans et al 2001;Petrovic et al 2001), adversely affecting vaccine uptake. Nonetheless, both vaccine coverage and vaccine safety are serious public health concerns.…”

Grappling with the grey evidence

“…However, sometimes support for a grey evidence issue develops at such momentum and is accompanied by such strength of feeling that clinicians face significant challenges when grappling with the consequences for their patients and their families. The literature over the last 10 years on the measles, mumps, and rubella (MMR) and autism debacle encapsulates these and charts how clinicians not only vacillate over wherein lies the truth, 1 but avoid public debate when this is potentially stifled by the strength of feeling engendered towards supporters of the vaccine 2,3 . In addition, work such as that which highlighted the absence of measles antigen in the peripheral leucocytes of children with autism immunized with MMR might only be published in the peer‐reviewed specialist journals and therefore not readily enter the public domain 4 .…”

Towards evidence-based marketing: the case of childhood obesity

“…recent experiences in the UK of childhood immunisation have shown just how damaging even a tiny number of dissenting voices can be (Heller et al, 2001, Wroe et al, 2005.…”