Helen Salisbury: Clutching at straws (and sticky tape)
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3724 (Published 30 September 2020) Cite this as: BMJ 2020;370:m3724Read our latest coverage of the coronavirus outbreak
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Dear Editor,
Helen Salisbury writes “ This weekend, practices around the country are pulling out the stops to run socially distanced flu vaccination clinics. “
A few months ago I suggested that Dr Salisbury explain how the Supreme Court’s Montgomery judgement can best be observed in busy flu vaccination clinics.(1)
My suggestion, which Dr Salisbury did not act upon, has become more pertinent this week.
Publication of the new GMC advice on ‘Decision making and consent’ (2) emphasises the importance of sharing all important information that patients might reasonably expect, and the respect that should be accorded to them if they make a decision that the doctor might not choose.
Careful reading of the advice suggests that in future the need to gain valid informed consent for any vaccination, will take much longer than the actual procedure.
An obvious clinical conundrum concerns the reasons for encouraging flu vaccination in the elderly. PHEngland, PHWales and the media regularly imply that older people who get flu are more prone to serious illness, and death, making vaccination a wise choice, they suggest.
The BMJ reported earlier this year that “ this recent well designed (albeit observational) study of the flu vaccine provides food for thought. The vast data set from 2000 to 2014 included 170 million episodes of care and 7.6 million deaths among 55-75 year olds in England and Wales. Over 65s were more likely to get a flu jab, but there was no evidence that it reduced hospitalisations or mortality in this older age group. Additional strategies may be needed to reduce the risk of flu, say the authors.
JAMA doi:10.1001/jama.2020.0442 “ (3)
It is surely inevitable that the findings of this study will need to be explained and discussed with every elderly candidate for flu vaccination in the UK ?
Does this happen ?
No one should be surprised by this worrisome scenario.
Many times in recent years it has been pointed out that the UK has a dysfunctional consent system for vaccination. (4)
No one has suggested otherwise.
Cunningham, Stone, and Doshi, (5,6,7 ) amongst others, have raised concerns about the policy and practice of flu vaccination. Those concerns have gone largely unanswered.
1 https://www.bmj.com/content/364/bmj.l108/rr-7
2 https://www.gmc-uk.org/
3 https://www.bmj.com/bmj/section-pdf/1022227?path=/bmj/368/8237/Education...
4 https://www.bmj.com/content/367/bmj.l6926/rr-7
5 https://www.bmj.com/content/367/bmj.l5995/rr-4
6 https://www.bmj.com/content/361/bmj.k2795/rr-6
7 https://www.bmj.com/content/346/bmj.f3037
Competing interests: No competing interests
Re: Helen Salisbury: Clutching at straws (and sticky tape)
Dear Editor
Noel Thomas is right [1]: we should also now expect doctors (and the government) to be open with the public about the safety and effectiveness profiles of any COVID-19 vaccine products. The government must be careful about the promotion or advertising of such products whether before [2] or after licensing. Given the government’s controversial handling of the COVID-19 crisis up until the present time it must now be seen to act transparently and support doctors appropriately, not least in meeting their legal obligations to the patient under the Montgomery ruling. Leaving doctors to flounder with contradictory professional demands is invidious. The government have already said that it means to uphold the principle of “informed consent” [3] but in order to do so it must not simply be a matter of the patient agreeing to receive the product, they also need be fully apprised of the risks and limitations of the product.
[1] Noel Thomas. ‘ Re: Helen Salisbury: Clutching at straws (and sticky tape)’, 2 October 2020, https://www.bmj.com/content/370/bmj.m3724/rr
[2] https://www.gov.uk/government/consultations/distributing-vaccines-and-tr...
[3] https://www.theyworkforyou.com/wrans/?id=2020-07-09.71891.h&s=c
Competing interests: AgeofAutism.com, an on-line daily journal, concerns itself with the potential environmental sources for the proliferation of autism, neurological impairment, immune dysfunction and chronic disease. I receive no payment as UK Editor