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I disagree with Fiona Godlee that the case against Wakefield should be dropped. Her stated editorial position has always been that of an ardent MMR advocate. It seems that by proxy and belief therefore, Wakefield has been inconclusively and irrefutably proven wrong in the eyes of the whole medical profession?

The reason why the case against Wakefield should proceed is that if the pro-vaccine medical literature on MMR is not also flawed, the proponents of MMR have a wonderful platform from which to convince the public that everything since 1998, said by Wakefield is a load of rubbish. Either side should be prepared to put up or shut up, not suggest that cancelling the case is a good idea, because not prosecuting will deprive Wakefield supporters of airtime.

The basis of scientific accuracy and resultant public choice, should be robust debate, not "no debate and maybe the problems will go away."

Fiona Godlee also says that Wakefield's work served as a reminder about flawed medical research, and "as if to prove [that]point" she rolls out Tom Jefferson's article showing lack of evidence of usefulness of the flu vaccine.

Again here, I believe she is wrong. The medical evidence about the uselessness of the influenza vaccines dates from the 60's when the USA DBS (Division of Biologics Standards, now the FDA) attempted to silence their vaccine tester, Dr Anthony J Morris, who for years found that the flu vaccine was consistently useless before he was "shifted sideways".

More recently, a couple of years ago, when Simonsen et al likewise found the same thing,

http://www.fic.nih.gov/news/inthenews/SimonsenArchives.pdf

using data from the point where Dr Morris was shifted sideways to 2004, they were later forced to recant, and pay penance by saying "...but if we vaccinate all the children then Granny won't get it." That didn't go down so well with parents, so it seems that last week, the backroom boys pulled the ultimate emotional blackmail on mothers, on the basis of one supposed study to say

http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=412187&in_page_id=1&in_page_id=1&expand=true#StartComments

... that pregnant and lactating women should receive the flu vaccine on the basis that it might prevent a two-fold increase in childhood cancer.

No mention that such a position is based on the erroneous assumption that the vaccine works in the first place. What does it take for the medical profession to drop something that has been pretty much useless since it first hit the market 50 plus years ago...? If Health Departments and governments can't see sense with the flu vaccine, is it any wonder that MMR's halo will be relentlessly protected, no matter what?

I believe the time has come, not to say who may speak, who may not; which case should go forward or which should not; but to root out flawed research, hypocrisy, inflated egos, and lack of transparency and accountability in the medical profession, politicians and medical journals.

If all that is done, then when fall-out has finished, the average person on the street might have a chance to see what the real issues are without the current, constant obfuscation by point-scoring.

 

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It appears Ms Godlee in resisting the temptation to shy away from controversy has shied away from any responsibility to public health or the doctors she supports.

It is important to publish papers such as the Tom Jeffersons(1) paper but to do so in an appropriate way. To do so in the middle of a vaccination campaign risks leaving individuals unprotected. The rise in measles she describes in her first paragraph should have been her warning.

Does she see her role as helping to improve health and helping her readership to do that? or something else? The BMJ certainly achieved something- the headlines “Those flu jabs could be a waste of time, says expert’”– Telegraph (2)

“Flu vaccines 'not worth the bother' says expert” Mail(3)

Was there any consideration for the General Practitioners who are still completing their flu vaccinations and now face questions of its efficacy without time to assess the article? Or even the people who may decide not to have their vaccination having read these headlines? And what of the consequences?

Jeffersons paper supports the Joint Committee on Vaccination and Immunisation (JCVI) policy decisions(2). It shows a decrease in influenza in healthy adults and elderly and a decrease in deaths in the elderly but she makes no reference to this.

The vaccine is safe and effective but the BMJ has helped to promote the opposite message at the most sensitive time.

(1)Jefferson T., Influenza Vaccine: policy versus evidence BMJ 2006;33: 912-5 (2) Telegraph 27/10/06 (3) Mail 27/10/06 (2)CMOs letter, June 2006, Department of Health

Competing interests: None declared

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5 years ago I asked my GP what the facts were about the pros and cons of ‘flu vaccination, and I was referred to the propaganda hand outs from the Department of Health. These were long on assertion and short on facts. Perhaps unwisely I embarked on a literature search and running correspondence with various civil service mandarins (including Sir Liam Donaldson) with the limited ambition of getting data on what actual tests- of efficacy and safety- were done on current vaccines and with what results. After much evasive action and stalling I was informed that such information was confidential. The Lancet (2001:357:2141) published my scepticism about the extra ordinary claims being made for the ability of ‘flu vaccine to prevent not only the ‘flu but death as well, whatever the cause. Since then there have been a few papers expressing concern about the inconclusive nature of the evidence for its efficacy (1,2). On the other hand, there have been repeated exhortations to the public to “protect themselves.” The enormous expense of this futile exercise doesn’t seem to register- partly, I fear, because of payment inducements offered to GPs. They, perhaps, may claim they believed the recommendations of the DH and carried out the vaccination programs in good faith. This “only carrying out orders” excuse is of doubtful validity. There can be no excuse for the harmful public health decisions and refusal to come clean about what precisely were the reasons for their them. It is too much to hope for repentance and reversal, however. The Faustean contract exemplified in the structure of the Medicines and healthcare products regulatory agency will see to that.

1.van der Wouden et al, Respiratory Medicine (2005) 99,1341-1349. 2. Simonsen L et al, Arch Int Med (2005) 165, 265-272

Competing interests: None declared
 

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Over the past few decades the practice of Medicine has moved from a basis of personal experience and understanding of the disease process and its treatment, towards the application of authorized protocols and guidelines. The body of Medical knowledge is now so great that this has many advantages. Nevertheless, we do recognize the importance of in-depth understanding, both in applying guidelines sensibly, and managing uncommon conditions for which rigorous evidence-based recommendations are not available.

Tom Jefferson's article raises concern about the situation in which an inadequate evidence base has become canonised into established guidelines, Government policy and incentivised practice. It takes a bold man indeed to challenge this set of Emperor's clothes.

Perhaps we need a forum within which such nagging concerns can be raised by lesser mortals in order to build up a sufficient groundswell of opinion to challenge the court tailors.
Competing interests: None declared
 

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