to think it's not terribly helpful to keep referring to parents who haven't MMR'd as "whack jobs"...

[MsGillis]

..or morons, or unfit parents, or up there with people who drink and drive?

I appreciate that people have very strong feelings around the subject, but I think that we need to understand that there are a significant number of parents who didn't/haven't vaccinated, not because they are crystal waving nutjobs, but because they are actually scared shitless and paralysed into indecision?

Surely there are ways and means to communicate information, and arrogantly shouting about how one person is right and anyone who disagrees is all kinds of nobhead is not going to be conducive in opening up reasonable dialogue?

Limited understanding of evidence based medicine (not helped by the medias piss poor interpretations of it).

sorry that was meant to be one post

Someone (sorry, it was a while back & I've forgotten) wrote that nhs policy is based on 'evidence'.
Yep, and cost. At times 'the best' treatments or meds are not offered as first line tx (or at all) due to cost. I love the NHS, but policy is complex and it is an oversimplification that policy = best practice.

Is there some sort of problem with basing policy on both evidence and cost?

If it was cost alone then that would be cause for concern. But cost PLUS evidence doesn't mean something dire is afoot.

the data saintly has posted has mostly been about a hypothesis that vaccines cause autism

Only in your head.

I haven't said anything of the sort or linked to anything of the sort.

To repeat. I have said
(1) MMR is safe for the majority of children
(2) MMR has not caused the rise in autism rates
(3) some subgroups of autism have mitochondrial and/or immune disorders - it is not yet clear exactly what this means for the individuals concerned

(4) some researchers (who have been linked to & who are experts in autism) have said that given the type of dysfunctions being uncovered that for this subgroup for the moment it may be wiser to space vaccinations out.

No hypothesis of any sort at all.

Please stick to what I actually say. And I ask you again - imagine you had a severely autistic child, and children with red flags for immune and/or mito dysfunction. Who would you listen to? Experts in autism & the immune system or people who don't even seem to realise it isn't one condition. Or can you really not imagine being in such a situation?

Mathanxiety, no, it is not necessarily a problem if the med/treatment deemed to be 'good enough' (that which has a decent evidence base & cost) suits you.
But my point of view it is worth recognising nhs policy does not necessarily represent the 'best' treatment. And so some people need approaches that are not in line with policy.

Raspberry. I understand your frustration. I'd also like to take this opportunity to wave at saintly & give her a double thumbs up.

Nowhere in the world can medical treatment happen without some sort of a nod to cost. That is reality. The result, which is also reality, is that for most people, what is administered by way of medical treatment works just fine -- it is in fact the best treatment available and administered in the best way. Nobody in the medical field is ever going to claim that it is a perfect system. But for the vast majority of people medical treatment does the trick. It is good enough.

"This thread is about the suggestion that mmr causes autism"

No, it is not. I don't see "autism" mentioned in the thread title, nor in the OP.

Nobody in the medical field is ever going to claim that it is a perfect system. But for the vast majority of people medical treatment does the trick. It is good enough.

Yes, that's fine, but why can't we have an exception made for those relative few for whom it's not good enough? This is what we keep coming back to, and each time we get the response 'there's no link between autism and MMR', which doesn't really address the question.

Some cite cost grounds, but if only a relatively small percentage are involved it wouldn't be too costly, would it?

"But for the vast majority of people medical treatment does the trick. It is good enough"

This sounds a lot like the "I'm alright Jack" attitude WhenSheWas accused me of earlier in the thread.

Why aren't you protesting against this, WhenSheWas?

Where is the test that will show what individuals should get something different from the normal schedule? Where is the evidence to use when designing that test?

It's not a bit 'I'm alright Jack' to say that for the vast majority medical science in its current incarnation does the trick. It's a statement of fact. Until there is a factual basis to design a test that will isolate individuals who need something other than what is currently offered then people who choose not to vaccinate are doing so on the basis of a hunch. And in doing so they are putting people known to be immunocompromised at risk.

Your "I'm alright Jack" isn't in mentioning the obvious, that vaccines are fine for the vast majority. It is in then going on to say that this is "good enough".

I agree with Cote & LaVolcan. I didn't say it should be a 'perfect' system, that is near impossible. At the moment though it is fair to say, isn't it, that the current nhs approach is not best for everyone. It makes sense to me that (some) people want to think about policy carefully, as none of us can expect that govt policy is going to be best for our individual circumstances.

Single vaccines are less safe than MMR because they leave children vulnerable to disease for longer.

But not as long as having no vaccine at all, which is the choice we currently have if we don't want MMR. Sorry I have yet to be convinced that bringing back singles wouldn't be a good thing in the long run.

Argh so many posts. Dd only went to sleep an hour ago. Going to have a quick read up on what I've missed.

Could I just clarify what people are concerned the MMR will do to their child which the single jabs don't carry a risk of too?
Cheers.

"Mathanxiety, no, it is not necessarily a problem if the med/treatment deemed to be 'good enough' (that which has a decent evidence base & cost) suits you.
But my point of view it is worth recognising nhs policy does not necessarily represent the 'best' treatment. And so some people need approaches that are not in line with policy."

Cote, my 'good enough' was an echo of Spink's. Further in response, the NHS policy is not an isolated one. Some countries go further by way of policy and mandate vaccinations before school entry.

The only acceptable medical policy is one that has a 'decent' evidence base with cost as a secondary factor (because clearly it would be cheaper not to bother vaccinating at all). A decent evidence base is in fact what policy is founded on. By the nature of policy, it aims to produce the best possible outcome for the most people. As long as there is such a thing as policy there will be a few individuals whose cases do not have a positive outcome. And to say 'that is life'/'that's policy for you' isn't cold or 'I'm alright Jack'. There but for the grace of god go I. But until there is evidence that the policy that exists right now is what is causing the damage that individual parents complain of the current policy will remain and should remain, because it must be evidence based.

The policy that exists right now is 'good enough' because it is evidence based, it provides the intended result for the vast majority of people treated. Those are two of the major requirements of any medical/vaccination policy.

It actually is probably 'best for everyone', Spink, because as long as there is a high enough level of vaccination to provide herd immunity children who are not vaccinated will probably not become infected. When a scare such as the Wakefield induced MMR/autism panic happens and vax levels drop below the level needed for herd immunity then you end up with epidemics and as seen in Wales deaths, especially in older patients.

The policy that exists right now is 'good enough' because it is evidence based, it provides the intended result for the vast majority of people treated.

Good enough for the majority maybe. This still ducks the question about what to do for those who don't belong to the vast majority.

One solution could, for example, be to have the child's specialist certify that single vaccines would be preferable and have them made available on the NHS on a named basis. I don't think that option is available, but would be happy to be corrected if that were the case.

This would discourage those who just didn't fancy the MMR but would go along with a measles jab.

"The policy that exists right now is 'good enough' because it is evidence based, it provides the intended result for the vast majority of people treated."

And what about the small minority? Are you comfortable with the collateral damage?

mathanxiety - we don't know if there have been any deaths yet in Wales. The evidence was inconclusive. It's gone very quiet on that front, but that may just because it's the weekend and the labs are shut.

No one has answered my question about how herd immunity is possible if the vaccine wanes...