Bioterrorism and compulsory vaccination
http://www.100md.com
《英国医生杂志》
EDITOR—Jefferson discussed some of the major flaws of the study by Brachman et al with respect to policies making certain vaccines compulsory in the US military.1 2 Additional shortcomings of the study by Brachman et al have been described in fuller detail elsewhere.3-5 For example, the often reported rate of 92.5% effectiveness for the anthrax vaccine sounds impressive but should be considered against the actual results in which 99.7% (378/379) of vaccinated workers avoided anthrax infection compared with 96.4% (399/414) of placebo workers. Thus the vaccine protected only an additional 3.3% of workers compared with no treatment.
Moreover, officials from the Department of Defense continue to ignore criticism of the 2002 Institute of Medicine report on the anthrax vaccine.w1 w2 At least three major studies in England, Canada, and the United States had found problems with the anthrax or other vaccines among military veterans.w1 The report mentioned on page 93 some of those studies but seems to have dismissed them largely because they were based on self reports or cross sectional data.w2 Yet, the same report hails the millennium cohort study, based largely on self report, as an important asset for studying the long term safety of the anthrax vaccine, even though relatively little information has been asked about anthrax vaccination in that study.
Furthermore, the RAND Corporation's report on immunisations as a factor in Gulf war illness had been due out in 2002w1 but as of early October 2004 had not yet been published. It is not clear why, other than for political reasons, it would take so long for the defense department to approve the release of a scientific text on vaccines and Gulf war illness, especially when it was being published by extraordinarily capable and distinguished scientists affiliated with the RAND Corporation. Perhaps the best approach to vaccine education is not to be found in pretending that certain scientific results are irrelevant merely because they do not fit the desired paradigms, political or otherwise. Given such considerations and uncertainties, until better evidence is available, I agree with Jefferson—the choice of whether to be vaccinated or not should be left to the individual.
Walter R Schumm, professor
School of Family Studies and Human Services, Kansas State University, Justin Hall, 1700 Anderson Avenue, Manhattan, KS 66506-1403, USA Schumm@humec.ksu.edu
Competing interests: WRS at age 60 (2011) will be in receipt of retired pay from the US Department of Defense for his 30 years of service in the US Army Reserve and Army National Guard (1972-2002). WRS provided expert testimony on behalf of the plaintiffs in the case of John Doe # 1 et al v Donald Rumsfeld et al (US District Court for the District of Columbia, Civil Action No 03-707) as did Dr Winkenwerder and Colonel Grabenstein on behalf of the defendants.
Additional references w1 and w2 are on bmj.com
References
Brachman PS, Gold H, Plotkin SA, Fekety FR, Werrin M, Ingraham NR. Field evaluation of a human anthrax vaccine. Am J Public Health 1962;52: 632-5.
Jefferson T. Bioterrorism and compulsory vaccination: better vaccines are needed if vaccination is to be made compulsory. BMJ 2004;329: 524-5.
Schumm WR, Brenneman RL, Arieli B, Mayo-Theus S, Muhammad J. A statistical reanalysis of Brachman et al's 1962 study of a human anthrax vaccine. Medical Veritas 2004;1: 171-8.
Schumm WR. Bioterrorism and compulsory vaccination revisited: Arguments for current vaccines based on inadequate support for older vaccines. bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/329/7465/524#76147 (accessed 6 Oct 2004).
Schumm WR, Brenneman RL. How "adequate and well-controlled" was the "clinical trial" of a human anthrax vaccine, 1955-1959? Medical Veritas 2004;1: 166-70.
Moreover, officials from the Department of Defense continue to ignore criticism of the 2002 Institute of Medicine report on the anthrax vaccine.w1 w2 At least three major studies in England, Canada, and the United States had found problems with the anthrax or other vaccines among military veterans.w1 The report mentioned on page 93 some of those studies but seems to have dismissed them largely because they were based on self reports or cross sectional data.w2 Yet, the same report hails the millennium cohort study, based largely on self report, as an important asset for studying the long term safety of the anthrax vaccine, even though relatively little information has been asked about anthrax vaccination in that study.
Furthermore, the RAND Corporation's report on immunisations as a factor in Gulf war illness had been due out in 2002w1 but as of early October 2004 had not yet been published. It is not clear why, other than for political reasons, it would take so long for the defense department to approve the release of a scientific text on vaccines and Gulf war illness, especially when it was being published by extraordinarily capable and distinguished scientists affiliated with the RAND Corporation. Perhaps the best approach to vaccine education is not to be found in pretending that certain scientific results are irrelevant merely because they do not fit the desired paradigms, political or otherwise. Given such considerations and uncertainties, until better evidence is available, I agree with Jefferson—the choice of whether to be vaccinated or not should be left to the individual.
Walter R Schumm, professor
School of Family Studies and Human Services, Kansas State University, Justin Hall, 1700 Anderson Avenue, Manhattan, KS 66506-1403, USA Schumm@humec.ksu.edu
Competing interests: WRS at age 60 (2011) will be in receipt of retired pay from the US Department of Defense for his 30 years of service in the US Army Reserve and Army National Guard (1972-2002). WRS provided expert testimony on behalf of the plaintiffs in the case of John Doe # 1 et al v Donald Rumsfeld et al (US District Court for the District of Columbia, Civil Action No 03-707) as did Dr Winkenwerder and Colonel Grabenstein on behalf of the defendants.
Additional references w1 and w2 are on bmj.com
References
Brachman PS, Gold H, Plotkin SA, Fekety FR, Werrin M, Ingraham NR. Field evaluation of a human anthrax vaccine. Am J Public Health 1962;52: 632-5.
Jefferson T. Bioterrorism and compulsory vaccination: better vaccines are needed if vaccination is to be made compulsory. BMJ 2004;329: 524-5.
Schumm WR, Brenneman RL, Arieli B, Mayo-Theus S, Muhammad J. A statistical reanalysis of Brachman et al's 1962 study of a human anthrax vaccine. Medical Veritas 2004;1: 171-8.
Schumm WR. Bioterrorism and compulsory vaccination revisited: Arguments for current vaccines based on inadequate support for older vaccines. bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/329/7465/524#76147 (accessed 6 Oct 2004).
Schumm WR, Brenneman RL. How "adequate and well-controlled" was the "clinical trial" of a human anthrax vaccine, 1955-1959? Medical Veritas 2004;1: 166-70.