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Helen Salisbury: Clutching at straws (and sticky tape)

BMJ 2020; 370 doi: (Published 30 September 2020) Cite this as: BMJ 2020;370:m3724

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Re: Helen Salisbury: Clutching at straws (and sticky tape)

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.


Competing interests: No competing interests

02 October 2020
Noel Thomas
retired / part time GP
Bronygarn, Maesteg, Wales, CF34 9AL