The British GP who broke the rules on the contentious MMR vaccine explains
his predicament
[By Margarette Driscoll in the UK Sunday Times.]
http://www.sunday-times.co.uk/news/pages/sti/2001/08/12/stirevnws01011.html
Aug 12, 2001
Dr Peter Mansfield is a maverick. He believes that too much of modern
medicine is about doling out drugs and too little is about helping people to
become healthy and stay that way.
Having spent years building up a successful practice in rural
Lincolnshire, he resigned as a general practitioner in the mid-1990s. Since
then he has hovered around the fringe of conventional medicine, running an
advice service promulgating his ideas about hygiene, good food and the
efficacy of vitamin supplements and cold baths.
There are few minor ailments, he believes, which cannot be avoided by
eating properly and taking plenty of exercise interspersed with periods of
rest, or cannot be warded off by more of the same (but with more rest). In
his days as a GP, his prescribing rates were about 40% lower than those of
his colleagues. Some of his ideas seem new agey, but he insists that he is a
conventional doctor.
"Most people don't want medicines and don't ask for them as long as
you give them a decent hearing," he says. "The trouble is that GPs are so
bombarded by drug companies that they haven't got room in their heads for
the old- fashioned stuff."
Now Mansfield, 58, has been catapulted back into the centre of the
conventional arena - and in the most alarming way. He has been called to
account by the General Medical Council (GMC) for injecting infants with
measles, mumps and rubella vaccines separately, rather than using the 3-in-1
single MMR shot that the government recommends.
The triple vaccine has aroused unease in many parents who suspect that
it may be linked to autism. Mansfield is one of a number of GPs who have
begun to import the single vaccines in small quantities (they are no longer
made in Britain) to satisfy the demands of parents who have turned their
backs on government-approved MMR.
Mansfield was already arranging single vaccines for members of his
advice service, Good HealthKeeping, when he was approached by Desumo, an
independent health company wanting to set up vaccination clinics in
Worcester. As soon as the first clinic took place in May, Brian McCloskey,
director of public health for Worcester, complained to the GMC.
It has come down on Mansfield like a ton of bricks, charging its
interim orders committee with investigating the case. The committee can
suspend a doctor from the medical register or restrict his practice
immediately, pending an inquiry rather than awaiting its outcome, a power
designed to stop doctors such as Harold Shipman in their tracks.
It seems somewhat out of proportion to the alleged crime, given that
Mansfield is actually vaccinating children who would not otherwise have the
jabs at all. But vaccination has become an overheated debate and he is
accused of "putting children at risk" by being "at variance with normal
clinical practice".
The government sets great store by its vaccination programme, which
has been an overwhelming success. More than 500m doses of MMR have been
administered in more than 90 countries since the early 1970s. Childhood
diseases such as measles and mumps are almost unheard of in Britain now, but
to maintain that situation (what is called "herd immunity") a critical mass
of the population must be immunised; some 95%, for instance, is needed to
prevent measles spreading.
The uptake on measles is down to 88% and experts are predicting a
measles epidemic. But little of real value is being done to bolster public
confidence. A £3m advertising campaign earlier this year backfired with
parents accusing the government of crude propaganda (a lion was seen
prowling beside a baby's cot to illustrate the dangers of childhood
disease).
The European Union has just started a £2.5m review of the possible
adverse effects of the triple vaccine, but the results will not be known for
three years and worries about the vaccine have been swirling around for the
past 10 years.
"The question for the Department of Health is whether it can persuade
people away from single vaccines. A lot of parents won't go for the triple
and if there's no alternative, they'll go for nothing," says Virginia
Bovell, co-founder of Pace, a group of parents of autistic children. "The
sort of parents who've bothered to do the research and seek out someone like
Mansfield won't be browbeaten. They want to be thoroughly convinced."
Research by Dr Andrew Wakefield, a gastroenterologist at the Royal
Free hospital, north London, first suggested a link between the triple
vaccine and autism. His research has been widely discredited - other
researchers using more sensitive measures have not been able to replicate
it - but some parents insist that their children began to regress almost
from the moment the triple vaccine was administered. About 500 are now
preparing a case for compensation.
More worries have been raised about the use of mercury as a
preservative in the DTP vaccine, which protects against diphtheria, tetanus
and whooping cough. Mansfield believes that injecting three viruses into the
body at once is probably not a good idea - "you are opening a Pandora's box
without any idea of what will fly out" - but he is essentially agnostic. "If
they think I was campaigning against MMR they've got the wrong bloke," he
says. "A doctor should have concern for the individual circumstances of the
child.
"It was a deficit in the vaccination coverage that got us going on
this in the first place. As things stand these children are unprotected and
we are giving them the best protection we can. We're meeting the real
situation of real people who have dissented. I can't see we've done anything
wrong."
In some countries vaccination is compulsory. Here, in theory at least,
there is a choice. But the government seems to be giving out mixed messages.
On the one hand we are encouraged to take responsibility for our own
health - give up smoking, take exercise, eat three egg-sized potatoes a
day - yet when parents try to discuss legitimate concerns and exercise
choice over vaccination they are given a blunt option of taking what the
government prescribes or nothing.
The fact that GPs are given bonus payments for fulfilling MMR
vaccination targets (although they are hardly spectacular: £910 a year for a
70% take-up, £2,730 for 90%) also adds to parents' doubts. "Some say their
GP is abrupt and they come out like naughty schoolchildren with their hands
slapped," says Ann Coote of Jabs, a support group for parents of
vaccine-damaged children. "Most GPs want a good relationship with their
patients but their hands are tied." Last week's edition of Doctor, the GPs'
journal, said about one in four GPs believes that single vaccines should be
licensed.
Like the advertising campaign, the heavy-handed attempt to squash
Mansfield's clinic seems to have had the opposite of the desired effect.
There were 50 new inquiries in a single day last week and yesterday his
clinic was taking place as usual. "I don't want to seem to be cocking a
snook at the GMC, but I have commitments to patients," he says.
The people who have come to the clinic, who are generally worried
because there is autism in the family or because their child reacted badly
to a previous vaccination, have made enormous efforts.
One family travelled from Caithness in the Highlands, another from
Cornwall. Even a round trip from the home counties can mean several hours of
driving - and the journey must be made three times.
There is no evidence that giving vaccines singly is any safer or
"better" for the child. Indeed, the government says it is more risky because
several weeks have to elapse between each jab during which the child is
unprotected to the other diseases.
However, a significant minority of parents still have to be persuaded:
the sight of a well-meaning doctor being hauled before the GMC will not add
to their confidence.
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