Vaccination …

Currently a warm topic in Oz because Bill Gates has just endorsed the practice and because of recent legislation in NSW.

I heard a discussion on your ABC recently of the great good that vaccination can do. Talk back radio being what it is, a nicely spoken gentleman called in to disagree. The thrust of his argument was that the gold standard investigation is a double blind cross over trial, since this hadn’t been done for vaccination the practise should be abandoned. He was a polite version of the terrorists in Pakistan who are shooting the health workers who are getting close to eradicating the scourge of polio.

I doubt he is reading but I am sure he would be interested in this paper by Smith and Pell in the British Medical Journal BMJ 2003; 327


Objectives To determine whether parachutes are effective in preventing major trauma related to gravitational challenge.

Design Systematic review of randomised controlled trials.

Data sources: Medline, Web of Science, Embase, and the Cochrane Library databases; appropriate internet sites and citation lists.

Study selection: Studies showing the effects of using a parachute during free fall.

Main outcome measure Death or major trauma, defined as an injury severity score > 15.

Results We were unable to identify any randomised controlled trials of parachute intervention.

Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.

Indeed, with his profound interest in the wellbeing of our community he might even volunteer for the study.