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Reviews TV

The Third Degree. MMR: Can You Decide?

BMJ 2003; 327 doi: http://dx.doi.org/10.1136/bmj.327.7415.628 (Published 11 September 2003) Cite this as: BMJ 2003;327:628
  1. Abi Berger (aberger{at}bmj.com)
  1. BMJ

    BBC Three, 11 September, 9 pm

    Rating: Embedded Image

    I have a confession to make. I am entirely in favour of the MMR (measles, mumps, and rubella) vaccination, and actively support its use. I am for all vaccination programmes, because I believe in protecting our communities, and I have seen at first hand what happens in countries that do not enjoy the privileges that we have in the United Kingdom.



    Embedded Image

    Decision time over MMR

    Credit: BBC THREE

    That said, I find it quite tough being a general practitioner—getting caught in the middle between caring for individual patients while still defending the “masses.” And I find parents who happily support the general notion that our children should be vaccinated, yet withhold their own cherubs from doing their bit towards herd immunity, utterly selfish.

    So I was looking forward to watching this programme about how parents decide whether or not to have their children vaccinated. I was hoping that it might reveal some original insights into what it is to hold conflicting views and how these conflicts are converted into decisions. Four “undecided” parents—two mothers and two fathers—with children of vaccinable age came together to listen to experts giving “evidence” about the MMR vaccine.

    But early in the programme—which was broadcast on a BBC digital channel aimed at the 16-35 age group—it became clear that the two mothers had clearly made up their minds before the proceedings had begun. They were simply assimilating the strands of the arguments that best fitted their preconceived ideas. They were not going to choose the MMR vaccine, whatever “evidence” was placed before them. The two fathers admitted that they were more inclined than their wives towards having their children vaccinated, but ultimately both men deferred to their wives to make the final decision. This was a television programme not about decision making, but about stereotyping.

    The experts included three doctors. There was a GP who was positive about MMR, and believed that there was no connection between his son's autism and the vaccine. The parents wrote him off as interesting but biased because obviously he stood to make money from achieving vaccination targets. There was a doctor who privately administered separate vaccines. His services were also viewed with a degree of scepticism.

    The only doctor who articulated an argument in favour of the MMR vaccine and who could not be easily discounted on the grounds of financial reward was a paediatrician. He explained that science, and even a limited understanding of immunology, could not account for the speed with which some children had apparently acquired the regressive symptoms of autism after being vaccinated. The human immune system did not function in this way. Developing severe neurological symptoms just two hours after being vaccinated was scientific proof that it could not be the vaccine that was causing the problem.

    The four parents threw science out of the window in favour of gut responses and emotional decisions. For a split second the two fathers wavered. The science was presented simplistically, and compellingly. But sadly, it was not sufficient to persuade any of them. Both men agreed that they were beginning to be swayed, but neither was prepared to cross their wives.

    Ultimately, it seems to me that the real issue is about science, and the fact that many people in Britain do not trust scientific explanations. But it is also an issue about understanding risk. Many millions of children around the world have been safely vaccinated with MMR and only a tiny number of those have subsequently been diagnosed as having autism. Most people appreciate that the risk of being diagnosed as having autism is small, and the vast majority do not make a connection between autism and MMR. But some people do, and it is this significant minority in the UK that is threatening the safety of all our children by refusing MMR. For some inexplicable reason, the original Lancet study that triggered these people's fears—poorly conducted as it was and involving just 12 children—is more compelling to them than the mountains of subsequent data that have consistently failed to replicate the original findings (Lancet 1998; 351: 637-41).

    This programme failed to inspire me. The questions were dull and the arguments had all been heard before. The programme makers made no effort to discuss the concept of risk. I'm suffering from MMR fatigue. People will believe what they want to believe, and sadly, in the United Kingdom at least, we seem to have become a nation of people that trusts science only when it's convenient to do so.

    Items reviewed are rated on a 4 star scale (4=excellent)