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Webwatch
June 2009
As has been written in The Platelet before, the Association tries very hard to present information and guidance based on the best available evidence. Simply believing something is effective or useful is not enough, there must be a clear consensus based on evidence.
The trouble with the internet is that much medical information available is published by those who "believe" even though a large amount of evidence to the contrary is available. One example stems from the idea that Autism is caused or linked to the MMR vaccination. In 1998, Andrew Wakefield and others claimed such a link in The Lancet, but subsequent attempts to reproduce their results have failed. Dr Wakefield still believes there is such a link, he named it as autistic enterocolitis.
Why I find this subject interesting and directly linked to ITP and its treatment, is the persistence of false ideas in the face of overwhelming evidence to the contrary. Why ideas persist and why some people stick to their beliefs is not only a real puzzle, it is a significant danger.
The MMR fiasco has caused an important drop in MMR and hence measles immunisation. Cases of measles, a serious disease, have increased dramatically. The Health Protection Agency on www.hpa.org.uk has a great deal to say on the subject, put measles in their search box as the resulting links are far too long to reproduce here. An old NHS website at www.mmrthefacts.nhs.uk gives a banner saying that it is no longer updated, but it still contains some interesting links once you click the "close message" window. The newer NHS webpage about MMR is at www.immunisation.nhs.uk/Vaccines/MMR.
Brian Deer has a page at briandeer.com/solved/solved.htm, the main narrative is on briandeer.com/mmr/lancet-summary.htm, also linked from the main page. On these pages are links to a Times headline that says "Hidden records show MMR truth" on www.timesonline.co.uk/tol/life_and_style/health/article5683643.ece
Andrew Wakefield is now Executive Director of an organisation called Thoughtful House, their website is at www.thoughtfulhouse.org. It is interesting to spend a few moments browsing the site. You will find that they say "Despite continued media misrepresentations on his work, he and his research collaborators continue to focus on evidence-based medicine." Described as the Executive Director, the site says Dr. Wakefield is "an academic gastroenterologist from London. He is world-renowned for his research, and for his discovery of autistic enterocolitis." In their Press Release of February 2005 (www.thoughtfulhouse.org/pressrelease.htm) they say "Japanese study is the strongest evidence yet for a link between MMR and autism" yet just a few lines further down they say "They predict that, if MMR causes autism, stopping MMR should result in a subsequent decline in incidence. This was not seen." Two opposing views in the same document. Very odd.
Believers often cling to one "expert" or report then sit back and ignore the rest. Sadly, some people still cling to the idea that MMR risks their child's health. They ignore the greater risk of an epidemic. If most but not all people in a population are immunised against a disease, the disease fails to gain a hold. It affects a low proportion and does not pose a risk of epidemic. Should the immunisation fall below a critical level, things go bad. An infectious disease is endemic when roughly one sufferer infects one other, the numbers affected do not increase. A disease gives rise to an epidemic when one person infects more that one other, i.e. the rate of infection rises exponentially. If the rate of infection is low, a population has a "herd immunity", i.e. it is difficult for a virus or infecting agent to infect a sufficient number. If such a herd immunity is strong, the disease dies out. The great risk of the failure of some parents to have their children immunised with MMR is a change in the herd immunity, potentially large numbers of people will suffer from a small change in the numbers immunised. In plain words, some will die as a result of not using MMR.
en.wikipedia.org/wiki/Herd_immunity and en.wikipedia.org/wiki/Mathematical_modelling_in_epidemiology#When_a_mass_vaccination_programme_cannot_exceed_the_herd_immunity (sorry for the huge links!)
A light-hearted example of a believer is one Charles K. Johnson. Writing
in his newsletter, he claimed that the famous Wright brothers said: "Science
theory held us up for years. When we threw out all science, started from
experiment and experience, then we invented the airplane." By the
way, airplanes all fly level on this Plane earth." Johnson clung
to this idea and that "scientists consist of the same old gang of
witch doctors, sorcerers, tellers of tales". He quotes respected
people, the Wright brothers, takes their quote as fact then looks no further.
In his eyes, there is no need as his belief is solid. Mr. Johnson was,
from 1971, president of the Flat Earth Society. en.wikipedia.org/wiki/Flat_Earth_Society
Happy Surfing.
Howard