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Vaccination controversies
Harold Lambert Physician
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You're proposing to do something to a normal, your normal child so maybe he'll get measles, maybe he won't, you know. It's actually, a lot of the public controversies of- about this don't recognise that. I'm not saying you should yield to that naturally and don't immunise people but I'm saying it's very difficult because I'm obviously strongly in favour of immunisation. What about measles? Is, is- Well, measles, the main complication was pneumonia and the other big complication, which people trivialise is otitis media, which as you know often leads to deafness and is itself a painful and miserable thing and then about one in a thousand got encephalitis which was sometimes m- so, I mean, one in a thousand doesn't sound much but if everyone gets measles it's a lot of people. So, you know, when the disease was common that's a substantial thing to contend with, which I've seen a number of times. And, and the, the modern, con- controversies with the MMR vaccine and such like, has that, did that make you gnash your teeth or- Well, it does a bit because a lot of it is really nonsensical really at an intellectual level but it's not nonsensical emotionally. And it's extraordinarily difficult- one of the bits of research we did on pertussis, a chap called Ian Johnston who's now a chest physician in Nottingham, was really a very, very detailed epidemiological study of, I think it was about 170 children or something with about- with two controls for each child and in order to not to confound for the social background it was done in schools so, roughly speaking, people in the same school in Merton, would be more or less the same social class and the same family structures. And he did enormously detailed lung function studies on children known to have had pertussis at various times before with their controls. And the answer really was in British children in that time, which would have been, I suppose, the seventies or eighties, eighties, there wasn't evidence of lung damage following pertussis. Now, there are two snags about that. First of all, poor countries as opposed to here; and the other thing is a rare consequence and, as I said before, we used to do chest surgery on children who'd had, who had bronchiectasis and said to have had it following pertussis and if you said would that exclude- it was a good study, I'd stand by every word of it, I think it was just actually a very good study. I mean, it was in combination with Ross Anderson, you know, the professor of epidemiology and, and, and Alan was a very careful chap. It was really good. But if you said- oh does that exclude the possibility of a patient getting bronchiectasis, maybe one in a thousand cases? Well, no, it doesn't because you can't do that sort of- the work is too big. So, I think, I think most of the- I was on the joint committee of vaccination for many years, the main pontificating body about this, and I think it was a jolly good committee which did very good work and I think the public health relationships of the people concerned, not on the committee but in the Department of Health and the Public Health Service, with- was about as honest and straightforward as you could make them within the limits of mutual understanding. I really would defend them, what they did, not because I was personally involved with that aspect but I think it was valid. But at the end of the day there's this thing we were saying. At the end of the day you've got: A- doing something to your normal child, which he might not get or might not get badly and the other thing is, you know, rare, what about rare things. Do you think one in a thousand children might get this. Actually, as you know, it's extraordinarily difficult to say that. You can't really. So, you can't really totally, honestly answer people about that. And also quantification of risk is such a difficult thing to take on board, isn't it? Very hard. And I won't go into the modern Wakefield thing but the, the old pertussis one, which I knew more about and was on various studies and committees about trying to work it out, it really was this classical epidemiological thing. They saw children in Great Ormond Street with bad neurological conditions and some of them said they'd had pertussis and the mother said it followed the vaccine. Well, you know how faulty that can be, without any evil intent. All our memories are faulty and if something terrible happens- we, we had one child, I remember, who was- the mother told me that she was wheeling the pushchair on the way to have the pertussis vaccine, the triple vaccine, and the child had a fit. Well, now, if it had it an hour later wouldn't you yourself and I would, I'd say I know it's not epidimial but I truly believe that was caused by the vaccine and that's what epidemiology partly is about, isn't it really. It's extremely hard. I think it's really, you really do want a cause for things. It's funny that people call witchcraft irrational. I mean, it's not irrational at all. It's, you know, you want to know a cause for something and you look for it. So, anyway, that, the answer, the actual scientific answer to the pertussis brain damage answer is if it happens at all it's so rare that you can't measure it. Now that still wouldn't comfort a parent worried about it but that's, that's the true answer. Yes. Yes. Yes. It might be like one in 300,000 or something. Yes. Yes. Yes. And it must be some form of comfort to, to blame the government or the, or the scientists. Oh yes, absolutely. One gets contamination, that contamination happens. It's dirty vaccine really. I mean, as you know what it is, the toxoids of diphtheria and tetanus are, are toxoids, they're pretty clean things and if you think of the millions of people who've had those, nobody's said they're causing harm. It's quite remarkable actually but the pertussis before the acellular pertussis vaccine, which as you know is coming in more and more, it was killed pertussis bugs. I mean, disgusting really when you think about it. All those antigens, which you don't need, might harm you. I mean, when you think about it, it's horrible. It just works. And the early measles vaccine was pretty grim, wasn't it? Well, yes, and some were rejected because of that but the later ones, they did cause some unwanted effects, which were mainly really essentially mild measles but there was, again, controversy about that- things about that.

British doctor Harold Lambert (1926-2017) spent his career tackling infectious diseases, helping in the development of pyrazinamide as an effective treatment for tuberculosis. He also published work on the rational use of antibiotics and was a trustee and medical advisor for the Meningitis Research Foundation.

Listeners: Roger Higgs

Roger Higgs was an inner city GP for 30 years in south London, UK, and is Emeritus Professor of General Practice at Kings College London, where he set up the department.

He gained scholarships in classics at Cambridge but changed to medicine after a period of voluntary work in Kenya in 1962. He was Harold Lambert's registrar for 18 months in the early 1970s, the most influential and exciting episode in his hospital training. He set up his own practice in 1975. He helped to establish medical ethics as a practical and academic subject through teaching, writing and broadcasting, and jointly set up the 'Journal of Medical Ethics' in 1975.

His other work included studies in whole person assessment and narrative in general practice and development work in primary medical care: innovations here included intermediate care centres, primary care assessment in accident and emergency departments, teaching internal medicine in general practice and establishing counselling services in medicine.

He was made MBE in 1987 for this development work and now combines bioethics governance, teaching and writing with an arts based retirement.

Tags: measles, pneumonia, deafness, encephalitis, immunisation, pertussis, chest surgery, vaccine

Duration: 7 minutes, 25 seconds

Date story recorded: October 2004

Date story went live: 24 January 2008