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

Abstract

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.

Very civilising …

Polio is a dreadful disease that modern medicine has largely overcome.

The majority of infections are mild or even asymptomatic but about one in a thousand are quickly fatal and about one in a hundred result in muscle weakness or paralysis.

Depictions of people with withered limbs and young people walking with canes suggest that polio has been with us for thousands of years but prior to the 20th century, polio infections were rarely seen in children under six months, most cases occurring between six months and four years of age. Poor sanitation resulted in a constant exposure to the virus, producing a degree of natural immunity. In developed countries during the late 19th and early 20th centuries better sewage disposal and clean water supplies radically changed the picture. Small localized polio epidemics began to appear in Europe and the United States around 1900 becoming widespread through North America, Australia, and New Zealand in the next 50 years.

By 1950 the peak age incidence of paralytic poliomyelitis in the United States had shifted from infants to children aged five to nine years, when the risk of death and paralysis are higher; about one-third of the cases were reported in persons over 15 years of age.The United States experienced its worst ever outbreak in 1952.  Of nearly 58,000 cases reported that year 3,145 died and 21,269 were left with mild to disabling paralysis.

Vaccination programs have turned the tide against this cruel waste of young people’s potential. New cases are now few, there are, however, quite a few disabled survivors.

There are now just three countries acting as a reservoir of reinfection – Pakistan, Afghanistan and Nigeria. The vaccine is cheap, the effort to distribute it has been well funded and well coordinated.

Gunmen shot dead five female health workers who were immunizing children against polio on Tuesday, causing the Pakistani government to suspend vaccinations in two cities and dealing a fresh setback to an eradication campaign dogged by Taliban resistance …

There have been similar events in Afghanistan and Nigeria.