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Re: Re: Re: Re: Re: Re: Re: My goodness - someone else feels as I do! (John Stone)
 

Under normal conditions, healthy children do not die from or become disabled from the complications of measles and if they do, questions should be asked about their management.

Before I am overwhelmed by people quoting from the Department of Health Handbook ‘Immunisation against Infectious Diseases’ where it states in paragraph 22.1.5,

“Before 1988 (when the MMR was introduced) more than half the acute measles deaths occurred in previously healthy children who had not been immunised,”

they should first check the source for this statement - ‘Deaths from measles in England and Wales, 1970-83’ (in the bibliography of the Department of Health handbook it omits ‘1970-83’ from the title), Miller CL BMJ 1985;443-4,(1). The definition of ‘healthy’ is somewhat less than straight forward. It is stated in this study that almost half of the people who died from measles between 1970-83 (270) had a ‘pre-existing condition.’ “The ‘pre-existing conditions’’ in the 126 previously abnormal individuals included:

Cerebral palsy (24), mental retardation (20), Down’s syndrome (19), various congenital abnormalities (22), Immune deficiency or Immunosuppression (9), Lymphatic leukaemia (19)....”In those with pre- existing conditions most were grossly physically or mentally abnormal or both.” (ref 2)

I think that most people, medically qualified or otherwise, would agree that there is probably a gradient between these individuals and healthy ones, yet the rest are quoted by the Department of Health Handbook as being ‘healthy.’

Most importantly, the author states:

“no attempt was made to establish vaccination history.”

This is pretty amazing really – to go to the bother of trawling through all that data and not record such a crucial price of information – we are supposed to be scientists after all.

So we do not know how many of the people who died in the study were vaccinated or not but we do know that over 70% of cases of measles in outbreaks may be vaccinated (3). So if measles vaccination is not saving the lives of ‘healthy’ children, how can it possibly hope to save the lives of those with ‘pre-existing conditions’ as those with poor immunity produce less antibodies in response to vaccination anyway

To clarify this matter I wrote to Dr David Salisbury, Principle Medical Officer, Immunisation and Infectious Diseases Group at the Department of Health and one of the editors of the book (also the person to whom professional queries were to be directed). I wrote to him in March of 1999. My questions were:

1) Where was the additional information from 1984-88 obtained (the paper only covered up to 1983)? and

2) As the paper stated that, ‘no attempt was made to establish vaccination history,’ where the information on vaccination status was obtained?

He did not acknowledge or reply to this letter, nor to the two further letters that I sent to him in June and July 1999. I also left messages with his secretary on numerous occasions to no avail. In October of 1999 I wrote to Alan Milburn, then Secretary of State for Health, complaining about the lack of response from Dr Salisbury and asking Mr Milburn to furnish this information for me. This letter was not acknowledged or replied to. However, a letter that I sent to Mr Milburn regarding another matter was acknowledged by return of post and answered within the usual time (so it was nothing personal!).

The inability to supply the requested information leads me to give little weight to this widely quoted statement in the Immunisation against Infectious Diseases Handbook and also increases some of the serious doubts I have about some of the other statements made in this and other publications by the Department of Health.

Then we have to ask how the children with measles who died were managed.

Standard medical advice is to suppress all fevers with Calpol (paracetamol) or Ibuprofen. This is not very helpful when fever is a useful response to infection with a virus or bacterium and runs contrary to the body’s natural attempts to throw out toxins and right itself. In addition, Calpol is metabolised in the liver. The liver is a major component of our immune system and is generally much better occupied in carrying out its immune functions during an illness than blocking itself up detoxifying Calpol.

Parents no longer seem to be given common sense advice about how to look after a child with an infection – put them to bed, open the window, avoid dairy products, plenty of fluids, don’t feed unless hungry and then only easy to digest food in small amounts and more rest.

We are all told that symptoms are the problem and must be gotten rid of. But children only get infectious diseases – whether vaccinatable or non vaccinatable when they need to learn what to do with their immune system or when they need a ‘clean out’ – to put it unscientifically – before taking a developmental leap.

If you look carefully at children after they have been supportively nursed through an infectious disease, you will always see them do something new, depending upon their age and circumstances. An infant may produce a tooth; a toddler who kept banging into things will walk confidently; a six-year old who is not reading will suddenly start to read. It is rather like a snake that has to crack off the old skin before it can grow, children go through these crises before they can move on to the next step. I have often seen children with endless snot or lots of warts have both of these cleared by a healthy bout of chicken pox.

Such infectious diseases do not improve the population, in the harsh Darwinian view of things, by killing off the weak and leaving only the strong ones to reproduce; they actually give each individual child the opportunity to strengthen their own individual immune system and make the best of what they have.

However, we as a society are not set up to allow the timely unfolding of such events. We teach people to fear all symptoms and expect their immediate removal. In the UK more than 50% of mothers with children under five work away from home, so are not there when their children need to be nursed. So they give them the calpol plus or minus the non-indicated (for viral infections) antibiotics and/or antihistamines (to dry up that cough) so that they can send them back to school/ nursery/ childminder so they can get back to the office where time off to care for sick children is not viewed so sympathetically as time off to take the car to the garage, not to mention the intense pressure that parents are put under by schools to have their children there every day to keep up their attendance figures in order for the school not to be penalised by the government.

Is it any wonder that so many children with measles end up in hospital – the last place they should be with their lowered cell mediated immunity, and that some of them die – and here I am talking about well nourished children who live in houses and have clean water supplies – not starving children in developing countries who are suffering from malnutrition, live in inadequate, poorly ventilated housing and drink sewage - where measles or infectious diarrhoea is the last straw that breaks the camel’s back.

And so I reiterate, under normal conditions, if healthy children do die from or become disabled from the complications of measles, questions should be asked about their management.

References:

(1) Immunisation against infectious diseases HMSO London 1996 para 22.1.5, p126

(2) Miller CL, Deaths from measles in England and Wales, 1970-83,BMJ 1985;290:443-4

(3) Hutchins S, Markowitz L, Atkinson W, Swint E, Hadler S, Measles outbreaks in the United States 1987 through 1990 Padiatr Infect Dis J 1996;15:31-8

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Re: Re: Response to Donegan
 

“Almost half of the people who died from measles between 1970-83 (270) had a ‘pre-existing condition’.”this is the message of the paper by CL Miller (1), the one that the Immunisation Handbook (Department of Health 1996) uses as the source for it’s claim that, “Before 1988 (when the MMR was introduced) more than half the acute measles deaths occurred in previously healthy children who had not been immunised,” (2)

CL Miller adds that: ”In those with pre- existing conditions most were grossly physically or mentally abnormal or both.” I am not suggesting that it does not matter if those with ‘pre-existing conditions’ die from measles. I am contesting the Immunisation Handbook’s claim that,

“Before 1988 (when the MMR was introduced) more than half the acute measles deaths occurred in previously healthy children who had not been immunised,”

Dr Flegg says that ‘it would have been useful to know’ – the vaccination history.

Useful – it is crucial if we do not know the vaccination history then we don’t know whether the measles vaccination is helping or not – if we don’t know whether children who have complications or die of measles are vaccinated or not, how can we know whether there is any point in vaccinating against measles in the first place?

I can also imagine it would be insensitive and inappropriate to question parents on their dead child’s vaccination status – especially if their children had been vaccinated – it might certainly make the parents question the effectiveness of that vaccination.

But why would it be necessary to ask the parents – are there not such things as medical records? Or is it a complete waste of my time that I write down notes every time I speak to a patient if these are not able to be used in the future for such data gathering. The investigators had access to the notes. Would it not be Dr Flegg’s standard practice to ask whether a patient admitted with a vaccinatable disease had been vaccinated against that disease?

Dr Flegg says: “The fact that over half the deaths occurred in apparently “healthy” people should sound alarm bells about the potential severity of the measles and not be dismissed lightly, as Donegan seems to do.” Dr Flegg has seems to have missed the point that these children may very well be not ‘healthy’ at all – just not actually, “grossly physically or mentally abnormal or both.” (not my words – those of CL Miller) and that the Department of Heath’s statement that “half the acute measles deaths occurred in previously healthy children who had not been immunised,” is just an attempt to scare parents into vaccinating their children – often against their better judgement.

Dr Flegg says that advice such as “open the window, avoid dairy products” etc. is unlikely to have any impact whatsoever on the development of complications. Has he ever tried giving such advice, or doing it himself? – If he hasn’t, how would he know? It is certainly the case in my experience but I am afraid that I cannot produce studies in medical journals to quote from because nobody does such studies – these interventions are too simple, straight forward and free.

Dr Flegg says: “I find efforts to shift the blame for these deaths on someone’s failure to “open a window” (when the infection is likely to have been prevented in the first place through vaccination) rather saddening.” – I find it saddening that we don’t know how many of these deaths would have been prevented by vaccination, because we don’t know whether they were vaccinated or not – if vaccination were safe and effective – I would be all for it.

Dr Flegg then quotes papers regarding outbreaks of measles in vaccinated and unvaccinated individuals, claiming that vaccination is ‘protective’ because less people who are vaccinated get measles than those who do not get measles. If there were no vaccination, most people would get measles. What is wrong with getting measles? – it is a normal part of childhood development. It is certainly not great fun to be hot with sticky eyes, a rash and maybe a cough for as long as two weeks – and it certainly is hard work to nurse someone who is ill with the measles – or any childhood illness, whether there is a vaccine for it or not – but most parents make many sacrifices for their children – it is part of being a parent and life is not without it’s trials, at any age. I am sure that all of the parents with vaccine damaged children would gladly nurse their children through such an illness many times over, rather than have them suffer the living death to which they are now condemned.

But the main point of even having a vaccine is surely to try to stop death and disability.

As for the issue of herd immunity (which is supposed to protect those who are unable to be vaccinated with live vaccines) and the 95% levels that are supposed to be necessary eradicate measles, this figure is based on no more science than that 60% levels didn’t do it, nor 70%, nor 80%, nor 90% and when we get to 95% levels and measles is still circulating (it will be causing deaths in small babies by then, whose vaccinated mothers did not pass over good quality, long lasting, antibodies to natural measles) we will be told that 99% levels are needed – as well as more booster doses, based on nothing more than guess work – whoops, I mean ‘mathematical projections’ like the ones Dr Flegg quotes to tell us how many complications of measles have been avoided in countries who vaccinate against it, and to predict that so-called epidemic that was used as an excuse to vaccinate seven million school children with Measles-Rubella vaccine in 1994 – causing , I think, 577 acknowledged severe reactions (cup looking pretty empty there)

If cars performed as reliably as vaccines, no-one would buy them.

“This is not the first time Donegan has been caught out by her misrepresentation of the true facts”, says Dr Flegg. He should read Hilary Butler’s ‘How accurate are the statistics anyway?’ (4th February 2005, above) regarding ‘true facts’.

I do not get caught out by misrepresentation of the true facts, rather my conclusions based on the methods and results of studies are often different to those of the authors.

The CONCLUSIONS of the authors, drawn from their results in their studies are often not the same as mine because I carefully sift through the method and the results section and form my own conclusions. This course of action was recently supported in the BMJ (6th Nov 04) as being the correct was to read a scientific paper. Indeed in: Users' guide to detecting misleading claims in clinical research reports M Montori et al specifically advise readers of scientific papers to: “Read methods and results only?” And the reason.. “The discussion section of research reports often offers inferences that differ from those a dispassionate reader would draw from the methods and results.” (3)

Doctors read scientific papers very poorly, they are often very unselective in what they believe, due to time pressure and from not realising that there is a need.

(1) Immunisation against infectious diseases HMSO London 1996 para 22.1.5, p126 [2002 version NZ--whale editor]

(2) Miller CL, Deaths from measles in England and Wales, 1970-83,BMJ 1985;290:443-4

(3) M Montori et al (BMJ 2004;329:1093-1096

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Re: Dr David Salisbury caught out but nevertheless bats on
 

Peter Flegg gleefully accuses Jayne Donegan of misrepresenting the facts about measles and measles vaccination.

From the facts of Dr Donegan’s response, it would seem that David Salisbury, Principle Medical Officer at the Department of Health missed the opportunity in 1999 to put her straight on the facts, on the facts as Dr Flegg thinks he knows them. Surely, it is Dr Salisbury who has been caught out and not the unfairly maligned Dr Donegan. Surely, it is time Dr Salisbury did a catch up and came clean about vaccine safety and efficacy and the true presentation of facts. Alleged misrepresentation of the facts can lead to allegations of ‘serious professional misconduct’ and even worse - and Flegg surely knows this.

PS. Am I the only one who found incomprehensible the last paragraph of Flegg’s ‘Response to Donegan’?