The casual callousness of alternative medicine

In the Independent on Sunday this week (10/08/08) there was a letter from a naturopath called Pat Rattigan. He makes the claim, whilst dismissing the need for vaccination against measles, that:

"There are no cases in recorded medical history of any child, in reasonable health to begin with and with properly managed treatment, being harmed by measles."

I'm not going to examine whether this is true or not, I'm mainly concerned with what it says about the mindset of those who deny the need for and usefulness of measles vaccinations. He is not denying that children die from measles, he is pointing out that it is mainly (he claims only) those children who are most vulnerable who will die from or develop other problems from measles. Is it just me, or is that a chilling statement? To me his statement sounds like 'Well my child is healthy, and coped with a measles infection ok, so screw those kids too  poorly to have a robust immune response.'  This is in other words, survival of the fittest. This is a foundation stone for evolutionary theory, but it's no way to run a modern compassionate society where we protect those who are vulnerable. Maybe you think I'm over-reacting, but put yourself in the shoes of a parent with a chronically ill child reading that sentence.

There is no doubt that measles vaccination has lead to a massive reduction in the number of people contracting measles and also dying of measles.  One of the consequences of a high percentage of children being vaccinated is that a condition called 'herd immunity' develops. This basically means that even if measles is caught by a few people it never becomes epidemic, thus protecting almost all people, including those most vulnerable. I ought to point out here that vulnerable adults can also die from measles.

Not convinced? Here's a graph I prepared from information sourced from the health protection agency. I have plotted together the figures for Measles Notifications and Deaths and the measles vaccination coverage. Because the figures for measles notifications are so much higher than those for deaths they are plotted on the right. The other data is plotted on the left.

I think this data disproves several of the anti-vaxers favourite theories, such as the only improvement in measles being down to improvements in hygiene - there may have been a big improvement when proper sewerage etc. was installed in towns, but the big drop here happens in the 80's, when vaccination rates were soaring. I don't think there was a massive difference in public hygiene from the beginning of the 80's to the end, do you? But as you can see there was a big difference in vaccination rates.

And just as an aside, because it's a whole big blog post on its own, there is no link between MMR and autism. Just in case that was worrying you.

Edited following comment from Gina.

Chiropractors get cross

On the face of it chiropractic is one of the most plausible alternative therapies. Practitioners are regulated by act of parliament, there is even actual evidence that it is more effective than placebo (something which escapes homeopathy and most other alternative therapies). So why has the New Zealand Chiropractors' Association threatened the NZ Medical Journal with legal action?

I think this needs some background. Chiropractic is not based on science, in fact it is based on a rather bizarre set of ideas, principal amongst which is that you can cure many if indeed not all ailments by manipulating the spine. They have some proper evidence that it is more than just placebo - but only for back pain (and possibly headaches, but the evidence is equivocal for that). It isn't really surprising that manipulating the spine could have an effect on back pain. The bad news for chiropractics is that there is no evidence of it working for anything else, and even for back pain it is no more effective than conventional treatment. For these reasons chiropractors are not allowed to call themselves Doctor, at least where this implies they are a medical doctor.

This is law, by the way, at least in the UK and NZ. It appears that a lot of chiropractors in NZ are ignoring this law. The NZ Medical Journal published this article (and another) exposing and excoriating the illegal practice, and the NZ Chiropractors promptly sent a nasty letter. This has been published and rebuffed(pdf) by the esteemed organ with the brilliant soundbite: "let's hear your evidence not your legal muscle".

Could you ask for anything more inspiring to prompt a first blog post?