http://bmj.com/cgi/content/full/323/7324/1304#resp3
Should decision on vaccination be best for
you or us?
Although
I agree with Majeed that Dr Peter Mansfield's referral to the General Medical
Council seems inappropriate, this may prompt more debate around the
important issue of whether it is reasonable to legislate for the
rights of the community over the rights of the individual as regards
vaccination for measles, mumps, and rubella.1
The argument seems to be that we know that combined measles, mumps, and
rubella vaccine is safe and effective (anyone who takes the time to
assess the extensive literature should be able to persuade
themselves of this fact) and that single vaccines may reduce
adherence to the full course and show no advantage. The community
therefore loses out as a result of an individual's decision, by a
reduction in herd immunity and an increased chance of an epidemic.
The Department of Health therefore thinks that single vaccines
should not be offered on the NHS, and there is now a question as to
whether this is defensible medical practice.
Other individual choices (such as aspirin or warfarin in stroke prevention)
are allowed as these are not seen to affect the community directly,
although they might result in a notable burden for those caring for
the increased numbers of people with strokes that this would create.
The Department of Health banks on the fact that more people would take up
the option of receiving single vaccines if they were available than
would refuse all vaccinations if the former were not available.
Although this may seem sensible from a public health and community
perspective, it is sometimes difficult to communicate the lack of
individual choice in this matter in the consulting room. Shouldn't
we, in this age of "patient centred" medicine, trust
patients to make decisions for their own children? This would mean
the cost of a potential epidemic with each media scare, but give
parents the freedom, responsibility, and ownership of such a decision.
Alex Manning
Burwell Surgery, Burwell, Cambridgeshire CB5 0AE alex.sam@virgin.net
|
1. |
Majeed A. Referral of Dr Peter Mansfield to the GMC. BMJ
2001; 323: 356 |
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.