The MMR / Autism scare has spanned my career as a doctor, and, for all its damage, allowed me to learn a great deal. I have learned about vaccination, immunology, psychology and most of all communication all with reference to MMR. Here I will share my thoughts on the journey. This article is my ‘MMR and Me.’
When the possibility that the Measles, Mumps and Rubella vaccine might be responsible for causing autism was first announced I was an intern (in UK we were called House Officers). I had nothing to do with giving vaccines until Oct that year when I started a GP training scheme with 4 months as a GP Registrar in North London. All of a sudden it became very relevant.
I shat myself. We all did: all of us new GPs, and I suspect some of the more experienced ones too. We were told that the jury was still out on any direct vaccine-autism link, but surely the source could be trusted? The Royal Free Hospital was just up the road, a trusted establishment that we all had personal experience of. The Lancet, the journal that published the article, was one of the most respected in the country. We were all giving doses of MMR, and we really didn’t want to give anyone autism. Parents trusted us.
And so I read. I looked at the data on MMR and how it had reduced the rates of and deaths from disease, and I looked at its safety data. Then, with a big deep breath, I looked at THAT article. The study in question was conducted on 12 children, and concluded by speculating that its results showed a link between the vaccine and autism. Having written my fair share of journal reviews at medical school and sat in plenty of journal club meetings, I remember thinking how this would get poo-pooed by any consultant with a critical eye, and that it certainly did not, on its own, outweigh all the evidence in favour of MMR’s safety. Nevertheless, there it was in black and white in the Lancet. Research from the teaching hospital up the road, where my best mate’s brother went to medical school and whose Emergency Dept helped my sister when she ate all that medical cream when she was a toddler: MMR linked to Autism.
So I did what any self respecting junior doctor would do: I asked my trainer. He, as well as the GPs in charge of our weekly teaching sessions, and my next trainer (an inspirationally good communicator and GP from whom I learnt in 2001: the very height of the scare’s push from the UK media) all pointed me towards the opinions and position statements from professional bodies such as the UK college of GPs, which basically said what I wrote above – that 1 single study had suggested a link, but that there was a wealth of data pointing against this link and to the safety and effectiveness of the vaccine. And that was how I was taught to discuss the issue with parents.
The thing is, as I have realised over the past few years (since discussing it with another amazing communicator), the parents weren’t putting their trust in the Royal College of GPs, they were talking to me. The media was banging away at MMR causing autism, but the parents were asking me.
More than anything else, the MMR scare has taught me to own my opinions. I have my opinions about immunisation because I have worked them out for myself. Yes, they do agree with most of the current guidelines (although I now often recommend more vaccination than slow-to-change guidelines may), but they have been formed in my brain, as a result of my reading and my analysis. I have found that, since framing my vaccination advice in this way, it is better received, and conversations are far more respectful and constructive.
Guidelines are important. No doctor can analyse the publications for all issues, but for some issues it is vital that we own our opinions and explain why we personally recommend certain actions. Our patients trust us, and that is a responsibility not to be underestimated.