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The very best of intentions

MagazineJanuary 1996 (Vol. 6 Issue 10)The very best of intentions

The old chestnut about the path to hell being paved by good intentions keeps coming to mind whenever we think about modern medicine

The old chestnut about the path to hell being paved by good intentions keeps coming to mind whenever we think about modern medicine.

Its practitioners are not evil people. They endeavour to do good and to protect us from the indiscriminate dark forces of illness and disease, as they view disease to be.

This desire is compelling and natural, especially when we see children suffering. We want to feel that we have it in our power to either prevent disease or to ease the suffering rapidly.

So imagine the exasperation of families and doctors in Sweden where there has been an almost continual epidemic of whooping cough since the 1970s.

Sweden is one of the few countries in the world to have the courage and morality to withdraw its whole-cell pertussis (whooping cough) vaccine, which it did in 1979.

It did so because health officials considered the adverse reactions to the vaccine to be unacceptably high, and because the vaccine failed to offer proper protection. Whooping cough epidemics were occurring throughout the 1970s, even when 90 per cent of Sweden's children were being vaccinated. In short, the risks were outdistancing the benefits.

Drug manufacturers were unable to produce a vaccine that could offer both safety and protection to the satisfaction of the Swedish health officials.

But in the 16 years since the withdrawal of the pertussis vaccine, the desire to come up with a solution has become overwhelming. A new piece of research, from Goteburg University in Sweden, has been welcomed with open arms by anyone who cares in Sweden. The research has concluded that there is both a safe and effective vaccine for Sweden's children after all.

Researchers carried out a scientific, double-blind placebo study into a new acellular pertussis vaccine, which is considered safer because the pertussis toxin has been made inactive by hydrogen peroxide. They gave a course of three inoculations to one group of some 1,700 infants, and a "placebo" a diphtheria and tetanus vaccine to another group of similar size.

The researchers concluded that the new pertussis vaccine is "safe", but away from the headlines, buried deep in the research, the true picture emerges. Two of the infants suffered febrile convulsions within 48 hours, one child died, four children had bacterial infections and five others developed malignant diseases. This is in addition to the hundreds that suffered the usual 48-hour soreness and sweating.

And, continued the headlines, it also provides "substantial protection". The small print reveals the true protective power of the vaccine to be just 55 per cent once the children had been given the second shot.

So, one death and 11 serious reactions later, we have a vaccine offering a 50-50 chance of protection.

The desire to find an answer, to find a place of safety against the dark forces of illness, is understandable; it is also very human.

But it is not science. Worse, it is dangerous.

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