Review of Hear the Silence
http://www.100md.com
《英国医生杂志》
EDITOR—Much of the confusion about measles, mumps, and rubella vaccination and autism is caused by the conflation of two questions into one. This is exemplified in the responses from parents with affected children to the reviews of Hear the Silence1-4 and a little in the response from the editor of the Lancet.5
As things stand, anyone who has doubts on giving their child measles, mumps, and rubella (MMR) vaccine should have the same doubts on giving their child measles vaccine alone, as a single vaccine. Parents who fear MMR are generally willing to give single measles vaccine because they know that any risk of that vaccine is outweighed by the risk of measles, a condition that makes children much sicker than modern parents find tolerable even when it is uncomplicated, and that kills or maims them when it is complicated.
Presumably the risk parents tolerate on behalf of their child includes the tenuous, speculative risk of autism after the single vaccine. If they are willing to give single measles vaccine then they can only be unwilling to give MMR if they believe that there is some evidence suggesting a difference in late side effects between measles vaccine in MMR and measles vaccine alone, and there is absolutely no such evidence.
This is why almost no public health and child health doctors view the single vaccines alternative as the middle ground, the compromise area. A programme attempting six separate single virus injections per child (on top of all the other immunisations) could only harm attempts at population herd immunity, as well as causing pain and increasing fear in individual children.
Ed Cooper, locum consultant community paediatrician
Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH edcooper@doctors.org.uk
Competing interests: None declared.
References
Elliman D, Bedford H. Hear the Silence. BMJ 2003;327: 1411. (13 December.)
Fitzpatrick M. Hear the Silence. BMJ 2003;327: 1411. (13 December.)
Electronic responses. Hear the Silence. bmj.com 2003. bmj.bmjjournals.com/cgi/content/full/327/7428/1411-a#responses (accessed 18 Dec 2003).
Electronic responses. Hear the Silence. bmj.com 2003. bmj.bmjjournals.com/cgi/content/full/327/7428/1411#responses (accessed 18 Dec 2003).
Horton R. Another view. bmj.com 2003. bmj.bmjjournals.com/cgi/eletters/327/7428/1411-a#43238 (accessed 18 Dec 2003).
As things stand, anyone who has doubts on giving their child measles, mumps, and rubella (MMR) vaccine should have the same doubts on giving their child measles vaccine alone, as a single vaccine. Parents who fear MMR are generally willing to give single measles vaccine because they know that any risk of that vaccine is outweighed by the risk of measles, a condition that makes children much sicker than modern parents find tolerable even when it is uncomplicated, and that kills or maims them when it is complicated.
Presumably the risk parents tolerate on behalf of their child includes the tenuous, speculative risk of autism after the single vaccine. If they are willing to give single measles vaccine then they can only be unwilling to give MMR if they believe that there is some evidence suggesting a difference in late side effects between measles vaccine in MMR and measles vaccine alone, and there is absolutely no such evidence.
This is why almost no public health and child health doctors view the single vaccines alternative as the middle ground, the compromise area. A programme attempting six separate single virus injections per child (on top of all the other immunisations) could only harm attempts at population herd immunity, as well as causing pain and increasing fear in individual children.
Ed Cooper, locum consultant community paediatrician
Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH edcooper@doctors.org.uk
Competing interests: None declared.
References
Elliman D, Bedford H. Hear the Silence. BMJ 2003;327: 1411. (13 December.)
Fitzpatrick M. Hear the Silence. BMJ 2003;327: 1411. (13 December.)
Electronic responses. Hear the Silence. bmj.com 2003. bmj.bmjjournals.com/cgi/content/full/327/7428/1411-a#responses (accessed 18 Dec 2003).
Electronic responses. Hear the Silence. bmj.com 2003. bmj.bmjjournals.com/cgi/content/full/327/7428/1411#responses (accessed 18 Dec 2003).
Horton R. Another view. bmj.com 2003. bmj.bmjjournals.com/cgi/eletters/327/7428/1411-a#43238 (accessed 18 Dec 2003).