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LETTERS: Steve Iliffe and Jill Manthorpe Communicating risk: Patients often have complex understanding of risk BMJ 2003; 327: 1403-b [Full text]

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Doctors must not ignore evidence when communicating risk to patients

B. Ronan O'Driscoll   (14 December 2003)

Doctors must not ignore evidence when communicating risk to patients 14 December 2003
B. Ronan O'Driscoll, Consultant Physician Hope Hospital, Salford M6 8HD Send response to journal: Re: Doctors must not ignore evidence when communicating risk to patients	Dr Steve Iliffe and Professor Jill Manthorpe have ignored well established evidence concerning the risk of serious illness in un- vaccinated children. They imply that doctors should accept (or even encourage) the belief of some patients that MMR vaccine may pose a risk of an outcome with a profound impact (autism) "whereas mumps, measles and rubella will have a low impact, despite being increasingly likely". There is no proof that any child has ever developed autism as a result of MMR vaccination but there were 3 deaths in the Dublin measles outbreak in 2000 and 3 deaths in the 1999-2000 measles outbreak in the Netherlands. Most doctors and most patients would not describe death from measles as a "low impact event" and the same is true of encephalitis, deafness or congenital rubella syndrome. It is estimated that MMR vacciation in France prevents about 300 deaths, 1,700 cases of encephalitis and 86 rubella infections during pregnancy per year (Reference 1). Dr Iliffe and Professor Manthorpe are entitled to their non-evidence- based "common sense" belief that "the immune system (if well brought up) will respond flexibly to challenge, without need for potentially hazardous immunization". This "common sense" view may "resonate with conventional wisdom" but it could put many children at risk of death or disability. It is hoped that Dr Iliffe does not impose his potentially harmful belief on his patients or on his medical students. The authors have asked for alternative common sense suggestions. How about telling parents the simple truth that mumps, measles and rubella are preventible infections which can cause death and disability but MMR vaccination is very safe. Dr Ronan O'Driscoll References. 1. Reinert P, Soubeyrand B, Gauchoux R. 35-year measles, mumps, rubella vaccination assessment in France. Arch Pediatr. 2003 Nov;10:948- 54. Competing interests: None declared