AstroNutrition Health & Fitness Blog

Norman recently posted about the news that ministers would be reviewing whether PSA testing was sensible on the basis of a study reported in the media, with a further update by a reader here. His link takes you to an article by Sarah Boseley in the Guardian. Unlike some other papers, she at least notes the down side of screening:

the trial also threw up the very real risks of being wrongly identified as at risk and having unnecessary and potentiually damaging treatment. A total of 5,990 prostate cancers were detected in the screening group and 4,307 in the control group.

The rate of overdiagnosis – defined as diagnosis in men who would not have clinical symptoms during their lifetime – was as high as 50% among those who were screened.

Ben Goldacre, in The Guardian, takes the media to task for their poor, and selective, reporting in this case.

all around the world, people were saying something completely different, on the same day, about the very same academic publication: Prostate Cancer Screening May Not Reduce Deaths said the Washington Post. Studies cast doubt on leading prostate cancer test said USA Today. PSA testing may not save your life, after all said Scientific American. Prostate cancer blood test does little to decrease death rate said the Sydney Morning Herald. And so on.

Why would the American and the Australian journalists say something completely different to the British ones, about the very same evidence?

Firstly, our journalists were simply confused. Not a single newspaper managed to clearly explain the risks and benefits of screening in the trial they were writing about. It’s very simple: the study took over 160,000 men between the ages of 55 and 69 and randomly assigned them either to get PSA screening, or to be left alone. The differences were marginal. Yes, there were 20% fewer deaths in the screening group. What does that mean in terms of real people, in real numbers you can understand, not percentages?
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But it gets worse. British journalists also deliberately ignored one whole half of the research, and I’ll confess I’ve slightly lost my sense of humour over this. There were in fact two large studies on PSA testing published in the New England Journal on the 18th of March 2009, not one. They were both published on the same day, in the same journal, they are side by side on the same contents page. British journalists discussed only one of them: the one that said PSA screening does reduce deaths.

The study they ignored was huge too: it took over 75,000 men and randomly assigned them to either a screening programme, or no screening. It found no difference in death rates between the two groups at all, and in case you think it was a close thing, in fact, there was a non-significant trend towards more deaths in the screening group. Not one UK newspaper mentioned this trial.

Ben’s case against the media, and argument that a group of dispersed experts and commentators on the internet can counter and compete with such misinformation, is persuasive. However, while I think informed citzen and scientific comment on blogs and other electronic media can act as Policeman and a corrective check on the media, I’m not convinced such groups are currently as powerful, in terms of engaging with the public more generally, as a front page headline in the media.

Jeremy Laurence draws attention to the news that Prof David Salisbury, Director of Immunisation at the Department of Health, has decided to sue the One Click Group - the group who used homophobic attacks on Brian Deer.

I fear this episode is symptomatic of a wider problem. The fault, if Salisbury has one, is not in what he says but how he says it. The tone in a recent Radio 4 ‘Today’ interview, as measles cases hit a new high, was hectoring, with a note of irritation. “I think it’s irrational [refusing the vaccine]. I think it’s putting children’s lives at risk. I can see no shred of benefit,” he said. Is he becoming exasperated? That would not be surprising, but this is not the way to reassure parents anxious about their children’s safety

Whatever the pros and cons of David Salisbury’s legal action against the One Click Group, it should be noted that the Independent cannot be trusted as experts on what is reassuring to parents. In the past few days they have run three stories on vaccines that are on a par with the worst of the Daily Mail’s scaremongering over MMR vaccine. The first one was a front page story on Meningitis C vaccine, which I criticised in this post. The second story was a follow-up to the original Meningitis C vaccine story. I wrote a letter to The Independent about this story - which was not published.

Dear Editor,

The Independentreported on the 27th of February 2009 that doctors in the UK had been asked to trace all babies who had been injected with a meningitis C vaccine, which was also called a ‘tainted jab’. In fact, there is no evidence that any meningitis C vaccine distributed in the UK was contaminated with Staphylococcus aureus; it passed all normal sterility testing. Additionally, there appears to be no evidence that the Department of Health has asked doctors to trace any children, for the very good reason that there is no evidence of any safety risk to UK children. Could The Independent confirm whether this claim is true or just an excuse to provide an exciting headline? Ten years of media misreporting of the MMR-autism hoax, with its detrimental effect on public health, has apparently not been enough to make journalists reflect on their propensity to scaremonger when it comes to vaccine safety.

I have not received any information back from the The Independent to verify their claim that children were being traced.

Whatever the failings of the Department of Health over the years in communicating with the public, they are dwarfed by the huge tottering pile of deliberate misinformation thrown out by the media, with no regard to public safety, over the years.

The third story from The Independent concerning vaccines I will cover later today.

The Telegraph reports:

From next month, the health secretary will lose his power to rule which jabs should form part of a national programmes to immunise children against a host of diseases.

Instead, a change in the law will mean recommendations from Government scientists on vaccinations must automatically be followed.

Critics accused the Government of “passing the buck” over contentious decisions to an unelected committee which was answerable to no-one.

But public health experts said an attempt to “depoliticise” decisions about the health of millions could help to restore public confidence in a national programme which has been badly damaged by concerns over the safety of the MMR vaccine.

Under the new law, all decisions taken by the Joint Committee on Vaccination and Immunisation [JCVI], backed with evidence showing the jabs are cost-effective, must automatically be authorised by the secretary of state for health.

This is a welcome step. Parallels can be made with NICE and the independence of the Bank of England - although both of those are not without controversy.

NICE was created, in part, because of politicians becoming over involved in NHS decision-making about the rationing of drugs. Frank Dobson’s guidance restricting the supply of sildenafil (Viagra) on the NHS was deemed illegal. NICE was created to make evidence-based judgements about the cost effectiveness and suitability of drug treatments on the NHS. Despite some political interference, it has largely prevented politicians getting involved in deciding which drugs the NHS will supply. However, even NICE can have problems with politicians:

Many members of parliament are ready to espouse popular causes such as supporting patients with cancer or crippling diseases. Tabling questions in parliament is an effective way to do this. The House of Commons question book lists 84 questions on trastuzumab, 56 on donepezil, and 188 on interferon beta, but only two on ciprofloxacin, and none on penicillin or prednisolone.

Politicians are susceptable to lobby groups, such as patient groups who can be overly influenced by the pharmaceutical industry. They are open to emotive Daily Mail campaigns. They are influenced by anecdote, and perhaps understandably open to persuasion by their constituents. In short, they are not best placed to make long-term decisions based on the best available information.

The same pressures can exist in vaccination policy. The leading anti-vaccine pressure group, JABS, routinely uses the media to push discredited pseudo scientific views on vaccines - such as the hoax hypothesis that MMR vaccine causes autism. They can also provide emotive cases for journalists.

Ahh, you might say, but no-one would take these people seriously? Well, they might. We were fortunate that the UK government did not cave into political pressure on the issue of MMR vaccine in the early 2000s. At the height of the MMR vaccine scare, it was far from clear that it was in the short-term self-interest of the Labour government to comply with scientific advice. Allowing the supply of single vaccines on the NHS, as requested by Wakefield, would have been less effective and sent a terrible message to the anti-vaccine movement (vindication and permission to move on to criticising single vaccines) and parents (admission of a danger when none existed). In the long term, caving in to such pressures would obviously have made the government look extremely foolish, but at the time newspapers were full of material about the so-called risk.

And there were politicians of both the left and right who did cave in. Liam Fox, himself a doctor, would have. So would Ken Livingstone. Placing vaccination policy outside of the hands of politicians is a welcome step.

JABS are not pleased with this new development.

Pressure group Jabs, a support group for families who believe their children have been damaged by vaccines, said the change was “undemocratic”, expressing concern that a body which was “answerable to no-one” would have the final authority.

Campaign founder Jackie Fletcher said: “The committee is a voluntary advisory body made up of medical professionals which includes members with potential conflicts of interest, because of direct and indirect links with vaccine manufacturers.”

She expressed fears that the move would allow the Government to go further in extending the national vaccination programme, or making its use compulsory, by using the excuse that it is only following the orders of its advisers.

Some brief comments about JABS concerns.

They are concerned that this is undemocratic and that the group is “answerable to no-one”. However, it is unlikely that we are heading into a technocracy. Parts 9 and 12 of the Code of Practice for the JCVI state:

9. The Secretaries of State are accountable to Parliament for the performance of the JCVI and for ensuring that it continues to observe the highest standards of propriety including impartiality, integrity and objectivity in the execution of its role and responsibilities.
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12. Appointments to the JCVI are the prerogative of the Secretaries of State; they are normally of four years duration. Appointments may, however, be terminated, without compensation, in the event of unsatisfactory attendance at meetings or conduct which renders the member unfit to remain in office, or at the discretion of the Secretaries of State.

Are these aspects of the code changing.

Secondly JABS note the potential for conflicts of interest. As people with a vested interest in promoting vaccine safety scares, who have been involved in legal actions over alleged harms from vaccines, this criticism is perhaps attenuated somewhat. However, a risk of conflicts of interest does exist. However, the Code of Practice for the JCVI does note members need to follow the Nolan principles. Additionally, there is a balance to be made between the “purity” of the committee and the need to have experts on vaccines - who due to the very nature of products involved are likely to have some involved with manufacturers.

Thirdly, JABS suggest that this decision to take ministers out of the decision making process is just a scam for ministers to extend vaccination, or make it compulsory. This contradicts their first position, that it removes ministers from the process, but does neatly illustrate the conspiratorial nature of their organisation. That vaccination policy is even further away from their dangerous influence is extremely good news.

One of the public health successes of recent years, has been the vaccination campaign for meningitis C. Here is a graph of laboratory confirmed cases of serogroup C disease for England and Wales between 1998-99 to 2007-08.

Last April I noted here that there are around 500 people alive now, who would not have been if the vaccine had not been extensively administered, and pointed out some of the misreporting by the media of reported vaccine reactions at the time of its launch. Today, The Independent ran with a front page headline “Questions over vaccine safety”, which is both alarmist and vague enough to create general fear about vaccines.

The story claims:

21,000 doses of meningitis C vaccine have been withdrawn GP clinics because they may have been contaminated by a bacteria.

That the MHRA only issued an “emergency recall” after being contacted by The Independent.

The shadow health secretary, Andrew Lansley, said: “This is very disturbing news. We will be looking to the Government to give the fullest possible account of what’s happened.” Another Conservative health spokesman, Mike Penning, said “Parents take vaccines to make their children safe, not put them at risk. They will want answers as to why it took so long to withdraw the vaccine. The Government has got to come clean about its decision-making and when the Secretary of State was told what happened. We could need an independent inquiry to establish the facts.”

Another piece in The Independent about the meningitis C vaccine contains the highly emotive views of a mum, pictured with her child who did not suffer any adverse reactions after meningitis C vaccine. The piece includes the dangers of meningitis C infection, and does note the recall is precautionary, but it still comes across as a vaccine scare story.

The Independent points out that another vaccine scare might undermine parental confidence in vaccines, but that does stop them irresponsibly plastering this story on their frontpage?

Well, no it doesn’t.

So should it have been on the front page? As a pharmacist working at the MHRA notes:

Dr Ged Lee, from the MHRA, stressed that the move was a precautionary one and that none of the samples that had come to the UK had been contaminated.

He said: “The batch that was contaminated I can reassure you was not distributed into the UK and I can also reassure parents that the product that has been used in the UK has passed all the necessary quality standards and is perfectly safe.”

The contaminated batch was actually a batch undergoing separate testing to see to examine whether the sample would remain secure under different air pressures during air transport. At the end of its journey it was found to be contaminated with staphylococcus aureus bacteria, which could have been due to the seals expanding on the containers used. All the batches of meningitis C vaccine distributed in the UK underwent the normal testing process with no problems. They are being withdrawn on an entirely precautionary basis. The Guardian reports concisely and sensibly, that the contaminated vaccine never even entered the UK. There is no harm known to have been done to any individuals. This is minor story at best.

I’m fairly skeptical of claim made by The Independent that they have forced the hand of the MHRA in taking action on this issue. The time scale of the action, given the highly precautionary nature of the action, seems sensible and in-line with previous MHRA action on other products. Calls for a public inquiry for tardiness are an over-reaction and regrettably give the impression there has been a failure to maintain patient safety. It may well be seen as an another useful opportunity for the opposition to paint the government as dysfunctional and incompetent, but politicians should think before they raise the temperature on vaccine safety issues. The past ten years have demonstrated how vaccines can be rapidly undermined by media reporting; it would be better if politicians didn’t throw petrol on minor fires.

There are NHS resources which combat such stories relatively rapidly, and the MHRA have pointed out the fact that the nature of this non-story:

There is currently no evidence of any risk to UK children, and there have been no reports of any infections following vaccination.

The two batches sent to the UK passed all the normal tests, including a sterility test, to ensure the safety, quality and effectiveness of the product before leaving the manufacturing site in Italy and travelling by road to the UK.

The Independent has not covered itself in glory by running the story so prominently.

Here’s the motion:

That this House expresses its support for the use of the combined MMR vaccine; notes with concern the re-emergence of measles and the loss of life and long-term health problems which will afflict children as a result of the decline in the vaccination rate which followed Dr Andrew Wakefield’s now discredited research paper suggesting a link between MMR vaccine and autism; expresses its disappointment that ill-informed comments by presenters such as Jeni Barnett on her LBC radio show will continue to cause unfounded anxieties for many parents and are likely to result in some parents choosing not to vaccinate their children; recognises the right of Jeni Barnett as a parent to make her own judgement about vaccinations for her own children but implores her and others in the media to act more responsibly when making comments in the public domain; and further expresses its hope that in the future reporting the issue of MMR will be less sensationalist and more evidence-based.

Here’s the performance of the main parties at the moment in terms of percentage of MPs who have supported the EDM (number of seats held by each party):

Conservatives: 2%
Labour: 10%%
Liberal Democrats: 38%

Well done Liberal Democrats. Shame on the Conservatives and Labour, especially the Conservatives given they introduced MMR vaccine.