http://bmj.com/cgi/content/full/323/7309/356
BMJ 2001;323:356 ( 18 August )
Editorials
Referral of Dr Peter Mansfield to the GMC
Worcestershire Health Authority is wrong
What has happened in Worcestershire is that several hundred parents have
decided that they do not want their children to have the combined
MMR vaccine but still wish to have their children immunised and are
willing for them to have the single rubella, measles, and mumps
vaccines. Dr Mansfield is providing medical support to the charity
that has organised this immunisation programme. The health
authority's director of public health, Dr Brian McCloskey, was
quoted as saying that the reason for the referral to the GMC was
that Dr Mansfield "puts the health authority in a position that
a doctor is doing something clinically inappropriate in their area."2 I believe
that the decision to refer Dr Mansfield to the GMC was wrong for two
main reasons.
Firstly, if a child does not have the combined MMR vaccine he or she is
clearly better off having the single rubella, measles, and mumps
vaccines than no vaccine at all. Secondly, if patients make an
informed decision about their health care, or that of their
children, does the state have a right to interfere in that decision
when it does not fit with what the state perceives to be best
medical practice?
Doctors are faced daily with patients who decline what we consider to be the
most appropriate treatment for them. For example, in the case of a
75 year old man with atrial fibrillation and a history of
thromboembolic disease, evidence from randomised controlled trials
suggests that treatment with warfarin would reduce his risk of
having a thromboembolic stroke. Let us assume that, after discussion
about the risks and benefits of possible treatments, he declined to
be treated with warfarin because of the risk of haemorrhagic
complications but would be willing to take aspirin. If his general
practitioner went ahead and prescribed him aspirin (a "second
best" treatment) then, by Worcestershire Health Authority's
definition, the doctor would also be doing something that was
"clinically inappropriate." According to the health
authority's logic, this general practitioner should also be referred
to the GMC.
Doctors should supply patients with sufficient information to reach an
informed decision about their health care. After we have done this,
patients may sometimes not take the treatment that we consider to be
the most appropriate for them, but doctors should not be punished
when this happens. Health authorities and the Department of Health
are understandably worried about the fall in MMR uptake that has
occurred over the past few years. However, the way to address this
problem is not through the persecution of individual doctors but through
education campaigns to reassure the public that MMR vaccine is safe
and effective. Any remaining gaps in our knowledge about the risks
and benefits of MMR vaccine should be filled through the
government's current research programme. The fact that the
government does have a relatively large research programme in this
area suggests that there are still some issues about the safety of
the MMR vaccine that need to be clarified.3
One of the reasons Worcestershire Health Authority gave for referring Dr
Mansfield to the GMC was that there was no other method for
investigating private practitioners. But there are other steps the
health authority could have taken, both formal and informal, before
making a referral. Further, referral to the GMC will be a major
psychological and professional trauma for any doctor. Because the
GMC will inevitably give greater weight to a referral from a public
body than from an individual, health authorities should not make a
decision to refer a doctor to the GMC lightly. Many doctors will
feel that the referral of Dr Mansfield has been made because he is
doing something that is against the government's public health
policy. This will inevitably raise concerns among doctors that they
too may be referred to the GMC when they implement health policies
that contradict those of the government or of their local health
authority. The referral of Dr Mansfield sets a potentially dangerous
precedent. In defence of its action Worcestershire Health Authority
is likely to point out the complications of measles and rubella
infection, particularly among vulnerable groups such as pregnant
women. However, I do not accept that this is sufficient reason for
referral, as patients are placing themselves at increased risk of
complications whenever they do not accept the most clinically
appropriate treatment for themselves.
Worcestershire Health Authority is abusing its power in referring Dr
Mansfield to the GMC. It is important for doctors and patients to
take a stand on this issue, irrespective of whether they agree with
Dr Mansfield's opinions on the safety of the combined MMR vaccine.
Azeem Majeed
University College London, London WC1H 9EZ (amajeed@mwfree.net)
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1. |
Barratt H. MMR vaccine row raises questions of clinical
freedom. BMJ 2001; 323: 300 |
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2. |
Wilson C. Anger as MMR rebel faces GMC scrutiny. Doctor
2001 Aug 9:1. |
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3. |
Smeeth L, Hall AJ, Rodrigues LC, Huang X, Smith PG,
Fombonne E. Ecological studies cannot answer main question. BMJ 2001;
323: 163 |
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Rapid Response responses to
this article:
Read all Rapid Response
responses
clinically appropriate?
Brian F. Walker, medical director ,
Hong Kong
bmj.com, 16 Aug 2001 [Response]
I agree!
Peter Gray, GP Principal , Sittingbourne,
Kent
bmj.com, 17 Aug 2001 [Response]
ALL INFORMATION, DATA,
AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION
PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR
OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING
MEDICAL OR LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN
IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN
CONSULTATION WITH YOUR HEALTH CARE PROVIDER.