This doctor has something very important she wants every uncertain parent to know about vaccinations.
I cradle my six-week-old baby girl in my arms. She is all chubby cheeks and dimples, a small pink bundle of delight. She smiles and stretches contentedly, blissfully unaware of the rude shock ahead of her.
Three years ago, almost to the day, it was another six-week old baby in my arms. Let’s call him Henry.
I was working in the Emergency Department of a large children’s hospital. Henry’s parents had noticed a blocked nose and cough a few days prior, and he’d been bluish in the face after coughing episodes. He seemed to be tiring easily when breastfeeding, and he was unsettled and cranky, most unusual for him. He’d had less than half his usual number of wet nappies, and he had a low-grade fever on arrival to the Department.
His five-year-old brother (we’ll call him Tom) was well apart from a runny nose. Tom was fully immunised, as were his parents and grandparents. Tiny Henry was admitted to hospital with pertussis, better known as whooping cough, and went on to spend the next fortnight in hospital, including a week-long intensive care stay. He survived. As we were tragically reminded once again just last week, not all those young babies with whooping cough are so lucky.
I have never met a doctor who doesn’t vaccinate their children. I have never met a nurse who doesn’t vaccinate their children. I’ve never met a medical student who doesn’t vaccinate their children.
So why aren’t we getting our message across to some members of our community who still refuse to vaccinate?
One thing my profession hasn’t always done well is communicate effectively with our patients. We are getting much, much better; communication is a core component of every modern medical school curriculum. But not so long ago, it was common for doctors to make the decisions on behalf of the patients. And let’s face it; we don’t have a perfect record of always getting it right.
But one thing we do well these days is apply principles of evidence-based medicine. That is, practice medicine in accordance with the best-available scientific evidence.
Critical appraisal of the scientific literature is not just typing a query into Google. It is not just looking at the results of studies. It is looking at who has performed these studies, how they were designed, how the subjects were recruited, how the analysis of results was performed. What the biases were, whether the conclusions drawn are appropriate, real, or whether the investigators have fudged their results. Unfortunately it is not easy to analyse studies and scientific data. In fact, it can actually take years to learn how to do it properly. Furthermore, we know all too well that studies can be falsified, biased, and incorrect. Investigators can be unscrupulous.
There is no better example of this than Andrew Wakefield’s fraudulent research linking autism and the measles, mumps and rubella (MMR) vaccination, as published by The Lancet in 1998. This has been thoroughly debunked, formally retracted by The Lancet (in 2004), and Mr Wakefield has been stripped of his medical license. Yet his scurrilous legacy remains.