Editor's Choice

We need to put the evidence to work

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b5236 (Published 03 December 2009) Cite this as: BMJ 2009;339:b5236

Re: Evidence is not the only factor...

Harry Hall raises an important issue. The primitive nature of the
reaction to swine flu was attacked in no uncertain terms by Marc Girard on
the English language service of French television recently [1]:

"In the mediaeval age, when there was an epidemic, people burned
Jews. That was a way of doing something."

Girard also discovered seven unexplained deaths in GSK's trials for
Pandemrix vaccine in a trial group of 2000 people [2].

The issue is further complicated by the ambitions of the vaccine
industry [3,4,5,6,7] and the poor evidence for the effectiveness of flu
vaccine in general [3,8,9].

Further, I note the evidence of the Cochrane review of MMR [10] where
the authors sifted through 5,000 studies, reviewed 31 in detail,
concluding:

"The design and reporting of safety outcomes in MMR vaccine studies,
both pre- and post-marketing, are largely inadequate."

but also:

"We were disappointed by our inability to identify effectiveness
studies with population or clinical outcomes."

and as a final more general comment:

"More attention needs to be paid to safety outcomes in vaccine
studies both pre and post marketing."

In view of all this the dictatorial status recently granted the UK
Joint Committee on Vaccination and Immunology [11, 12], and the lack of
transparency or accountability for its decision making process is
disturbing and unwarranted. We have a policy where the solid evidence for
effectivess and safety has been jettisoned in favour of ideology, and the
hegemony of an industry. The costs are barely beginning to be counted.

[1] Face Off, 'Swine flu: how safe is the vaccine?' France 24, 20
November 2009, http://www.france24.com/en/20091120-face-off-swine-flu-how-
safe-is-the-vaccine

[2] European Medical Agency, CHMP Assessment Report for Pandemrix
Vaccine, Doc Ref : EMEA/CHMP/619109/2009, Lodon 24 September 2009, p.57,
http://www.emea.europa.eu/humandocs/PDFs/EPAR/pandemrix/Pandemrix-H-832-PU
-17-AR.pdf

[3] Interview with epidemiologist Tom Jefferson, "A whole industry is
waiting for a pandemic", Der Spiegel 21 July 2009,
http://www.spiegel.de/international/world/0,1518,637119,00.html

[4] PriceWaterhouseCoopers, 'Pharma 2020: the vision"
http://www.pwc.com/gx/en/pharma-life-sciences/pharma-2020/pharma-2020-
vision-path.jhtml

[5] 'New Pharmaceuticals research report from Business Insights', PR-
Inside 7 November 2009, http://www.pr-inside.com/new-pharmaceuticals-
research-report-from-r1570390.htm

[6] 'New Report Forecasts More Than Doubling of Vaccine Sales by
2013', Reuters 11 June 2009, http://www.reuters.com/article/idUS199518+11-
Jun-2009+MW20090611

[7] Anna Lewcock, 'Kids' vaccine market set to quadruple',
DrugResearcher.Com 20 November 2007,
http://www.drugresearcher.com/Research-management/Kids-vaccine-market-set-
to-quadruple

[8] Peter Doshi, 'Are US flu death figures more PR than science?',
BMJ 10 December 2005, http://www.bmj.com/cgi/content/full/331/7529/1412

[9] Tom Jefferson, 'Influenza vaccination: policy versus evidence'
BMJ, 28 Octovber 2006, http://www.bmj.com/cgi/content/full/333/7574/912

[10]
Vittorio Demicheli, Tom Jefferson, Alessandro Rivetti, Deirdre Price,
'International Review:
Vaccines for measles, mumps and rubella in children', The Cochrane Library
http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004407/fr...

[11] Laura Donelly,'Scientists to be given power to decide on
vaccinations', Sunday Telegraph 7 March 2009,
http://www.telegraph.co.uk/health/healthnews/4953256/Scientists-to-be-
given-power-to-decide-on-vaccinations.html

[12] Lucy Johnston,' Jab makers linked to vaccine programm', Sunday
Expres 8 March 2009, http://www.express.co.uk/posts/view/88216/Jab-makers-
linked-to-vaccine-programme

Competing interests:
autistic son

Competing interests: No competing interests

08 December 2009
John Stone
Contributing editor: Age of Autism
London N22