The jab that can stop cancer – Dispatches

July 22, 2008

The thought of any family member dying of cancer is always emotive, and all the more so if you think you might have been able to do something to prevent the disease from wreaking havoc. In the Channel 4 current affairs series Dispatches, journalist Jane Moore considered the forthcoming campaign to treat all 12 year old girls in the UK with a vaccine that can prevent cervical cancer.

This sounds on the face of it like an excellent idea and Moore is not an immunisation skeptic, indeed she paid privately for her older daughter to have the jab, and fully expects her younger daughter to have the injection in the fullness of time. She does, however, raise a number of interesting arguments that show that the decisions about whether or not the UK should be entering into such a full-scale vaccination programme is rather more complicated. The main issues are: (1) is the vaccine safe?; (2) is the vaccine effective?; (3) will the vaccine offer false security?; (4) will it lead to greater promiscuity?; and (5) does this represent good use of NHS resources? Let’s take each of these in turn. Read the rest of this entry »

MMR: our children, our choice? – Panorama

January 23, 2008

In 2002, the BBC’s Panorama series included an edition entitled MMR: Every Parent’s Choice which investigated the origins of the controversy over measles, mumps and rubella (MMR) vaccination in the UK. In particular, the programme focussed on the role of Dr Andrew Wakefield and his, now refuted, claims concerning the link between the use of ‘triple-jab’ MMR vaccine and childhood autism and bowel disease. Although the public controversy surrounding this vaccination has now largely been settled, MMR uptake still remains below the level required to ensure population (or ‘herd’) immunity (see MMR uptake still short of target, BBC News, September 28th 2007 or watch video Warning over low MMR uptake, BBC News). The 2006-07 NHS immunisation statistics in England for example report it to be 85% by the age of two (NHS Immunisation Statistics, England, 2006-07), a figure which highlights that even today, 10 years after the controversy first ignited, immunisation rates have not yet returned to their previous levels of over 90% (NHS Immunisation Statistics, England, 1997-8).


MMR controversy makes the Telegraph headlines on February 27th 1998 (from Panorama, BBC2, February 3rd 2002, 22.15)

The MMR controversy also remains a particularly rich source of material for discussing the ethical issues implicit in mass vaccination programmes. The MMR: Every Parent’s Choice episode of Panorama is a good example of this as it explicitly explores key issues, including:

  • the tension between the rights of individual parents to choose whether or not to have their children vaccinated and the aims and objectives of state endorsed vaccination policy
  • the factors influencing parents decision-making about vaccination, and variable influence of health professionals, the media, and science in shaping these
  • the proper role for doctors as both scientific and social actors

Read the rest of this entry »

Making of Modern Medicine

May 10, 2007

In a 30-part radio series (15 mins per episode), Andrew Cunningham from Cambridge University offered a fascinating insight into the history of modern medicine.  The series was first transmitted on BBC Radio 4 over a six-week period in February and March 2007 (see here for episode guide). I only managed to catch the final two episodes, The Crippler and Transplant, but both contained fascinating bioethical conundrums. 

The Crippler tells the story of polio, and more specifically, the development of vaccine against the virus.  Ethical dilemmas included whether to use a killed virus or a live-attenuated virus (in fact both were developed) and suitable timing to swap from animal testing to human testing of the vaccine.  There was a genuine risk that these early vaccines might have inadvertently led to infection with an active or reactivated form of the virus, so who to include in the human trials was also an issue.  The decision made in 1950s America was to innoculate the residents of a home for mentally handicapped children!  As subsequent history shows, the vaccine turned out to be effective and mass innoculation programmes followed.

Transplant begins with Christiaan Barnard’s pioneering work on heart transplantation in 1967-68 (see BBC News report at time of his death in Sept 2001 – requires realplayer).  Cunningham asks to what extent those early pioneering operations can be considered successful in a medical sense (as opposed to proof or principle about surgical techniques, for example) and to what extent present day success in transplantation is, in fact, dependent upon breakthroughs in immunosuppresive drugs made in the late 1970s.  He raises questions about the overall place of transplantation in modern medicine – it absorbs a large slice of the resources available to medicine, it captures the public imagination, but for all of that involves a very small percentage of patients.

The final episode closes with some more general reflections on the ethical and social implications of medicines increasing adoption of science and technology.  These include the shift from focusing on the individual and their personal symptoms, to emphasising the disease, with the patient reduced to the role of someone who has the disease.  Cunningham talks about medicine as an arena in which the division between rich and poor has been broken down – disease A is the same whatever our bank balance. Personally, I think that this is rather an oversimplification; our likelihood of being struck down by certain illnesses is definitely not evenly distributed across classes, and our subsequent ability to garner resources to challenge the disease is also proportional to our income.

Other bioethical conclusions are rather less controversial.  The programme highlights the increasing reliance on machines in medicine (there is a nice poem written by an unnamed dialysis patient which echoes the marriage vows, beginning “do you take this machine, in sickness and in health…”).   Transplant technology has also prompted a re-evaluation of what it means to be an individual in an age where we have exchangeable internal organs, and a change in the definition of death, from a focus on heartbeat pre-1968, to brain death or indication of irreversible coma.      

Sadly, as a joint Open University production, the Making of Modern Medicine series is not covered by the Educational Recording Act and as such copies cannot be purchased from the BUFVC (OU programmes require a separate licence).  The BBC has, however, released it as a Radio Collection for personal use.  It seems like the sort of series that is highly likely to be re-broadcast at a later stage, so it may be worth setting up a TRILT alert so that you can catch it when repeated.