Talk:MMR vaccine

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[edit] Archived talk page

Very long talk page, mostly over a year old. No activity for two months, so I archived it. Editors here may be interested in the activity going on at vaccine controversy, which is an ugly merge from that page and anti-vaccinationist. Cool Hand Luke 03:02, 24 July 2007 (UTC)

[edit] Exercising caution

I've again removed the suggestion that Wakefield's recommendation was to "exercise caution" (http://en.wikipedia.org/w/index.php?title=MMR_vaccine&diff=152536053&oldid=152529761). His recommendation speaks for itself; describing it as "exercising caution" is an attempt to insert a leading phrase and POV. It implies that giving the vaccines in combination is somehow incautious, when in fact there is quite a bit of evidence that giving them in combination is safe, and none that it's harmful. MastCell Talk 20:10, 20 August 2007 (UTC)

[edit] Article no longer conforms to NPOV

Recent edits to this article by one editor have biased it strongly towards the minority opinion that the MMR vaccine is unsafe. The consensus medical opinion should be documented fairly; there is good reason that it is the consensus. Here are some problems with the recent changes:

  • An old opinion poll of UK health professionals is being cited as if it were supporting claims that there is serious doubt in the medical community about the safety and effectiveness of the MMR vaccine. But the poll apparently asked whether the government could "prove there was no link between MMR and autism and bowel disease". You cannot prove a negative, so the simplest explanation is that those polled were just saying that. Furthermore, these poll results date back to when the Wakefield paper had not yet been thoroughly discredited. These poll results do not belong in a scientific article on MMR.

This one is for starters; more later. Eubulides 14:32, 29 August 2007 (UTC)

Concepts like "safe" or "unsafe" in this context do not seem scientific or even rational to me in this context, and create a false dichotomy lumping all concerns together. I'd say the issue here is risks vs. benefits. If the "consensus medical opinion" is that the benefits outweigh the risks, it shouldn't be that hard to find reference to state organizations, persons and publications claiming that benefits outweigh the risks. However, I understand Cochrane is very highly respected part of the medical community, and it's saying the studies on safety are largely inadequate. If Cochrane is one example of things which shouldn't be mentioned, but added claims from a very involved player in the controversy like Horton is OK, I don't see how that would be going towards NPOV. Your criticisms on the poll about proving a negative as well as the time of the poll are valid, I'll see whether there were better questions in the poll. --Jkpjkp 15:09, 29 August 2007 (UTC)
It is not an encyclopedia editor's job to opine about the philosophy of "safe". Just report the current medical consensus, and report it fairly. The first sentence of the "Author's conclusions" section in the Cochrane report is "Existing evidence on the safety and effectiveness of MMR vaccine supports current policies of mass immunisation aimed at global measles eradication in order to reduce morbidity and mortality associated with mups and rubella." If you read the entire report, it's quite clear that the medical consensus is that the benefits of MMR outweigh the costs. The authors of the report do request higher-quality studies, but existing studies are enough to support the conclusion that the MMR vaccine is safe and effective. It is completely misleading to ignore the main conclusion of the report while citing its request for more information, with the implication that there isn't enough evidence to justify MMR. That is not at all the current consensus. Eubulides 15:57, 29 August 2007 (UTC)
Would 2003 be current enough? "A third of HPs wouldn't advise giving MMR to a child with a close family history of autism." [1] --Jkpjkp 15:18, 29 August 2007 (UTC)
First, 2003 is not current enough, as the definitive studies refuting Wakefield's claim did not come out until the 2004/2005 time frame. Second, that is a completely misleading summary of that NHS report. That report says only a tiny fraction of HPs (1–3%) thought MMR can cause autism. The question about advising parents with children with a close family history of autism is more a question about public perception than it is about whether MMR actually causes autism. Eubulides 15:57, 29 August 2007 (UTC)
You misrepresent what the convroversy is about in the medical community - it's _not_ that some say "we know MMR causes autism" (as I understand it, even Wakefield himself has never said that) and some say "we know MMR does not cause autism". Well, some do say something like "we know MMR does not cause autism" but that appears to be not supported by the evidence (see e.g. the part of the Cochrane quote about largely inadequate studies). The article shouldn't say "according to the science, MMR does not cause autism", as that's not supported with the facts. Someone quoted the Cochrane summary here on the talk page - that seemed like an excellent summary of the situation, that's a much better thing to put to the page to say something to the effect of "there's lots of evidence about MMR benefits and no evidence that it causes MMR" like the writing of the personally involved Horton. --Jkpjkp 05:45, 30 August 2007 (UTC)
I am not misrepresenting what the controversy is about. Wakefield's controversial claim is that there is a real risk that MMR vaccine causes autism. That is why Wakefield advised against the MMR vaccine in his press conference in 1998. The overwhelming consensus of the medical community is that Wakefield is wrong, and that there is no scientific evidence of any real risk. The article does not say "according to the science, MMR does not cause autism". There's nothing wrong with quoting Horton, either. It's not like he's alone in his opinion: his opinion is the consensus one. Eubulides 02:27, 31 August 2007 (UTC)

Here are some more points.

  • An extended quote from the Cochrane library is given, saying that evidence for MMR should be stronger. This completely mischaracterizes the Cochrane report, whose main result says exposure to MMR is unlikely to be associated with autism. The main result should be given prominence; the desire for more evidence is secondary.
  • Text saying that the medical consensus is that the vaccine is safe is surrounded be weasel words casting aspersions on the author of the Lancet paper in question. Just say what the medical consensus is: don't attack the messenger.
  • MMR vaccine #Urabe Mumps strain encephalitis contains duplicative text about an older vaccine that gives undue weight to this section. It contains breathless wording like "Britain's Telegraph newspaper reported on-line in March, 2007 on revelations from an FOIA request" and "Published medical reports" that are peacock terms designed to puff up one side of the dispute. It also contains an implied attack on the Thatcher government that is out of place in a medical article. The main question here ought to be about the cost/benefit ratio of substituting the newer, more expensive vaccine for the older one, on safety grounds. The article doesn't even raise this question, much less address it.
  • MMR vaccine #Report claiming a possible link between MMR and autism is completely out of whack. The scientific and medical consensus is that the Wakefield et al. report was incorrect (as evidenced by 10 of his 12 collaborators retracting the interpretation of an association between MMR and autism). And yet this section gives just one short phrase to the medical consensus; the entire rest of the section attacks the MMR vaccine. Most of the section should be given to the consensus medical opinion; this is a medical article, not an article about the controversy.

This stuff belongs in MMR vaccine controversy, if it belongs anywhere. It does not belong here. Eubulides 15:26, 29 August 2007 (UTC)

I have to agree that a) the Cochrane quote needs to be better contextualized. See the summary, in which the authors emphasize the risks of measles, mumps, and rubella, the safety of the vaccine, the lack of "credible evidence" associating it with autism, and its demonstrated effectiveness. Secondly, if we're spinning off an MMR-controversy fork, then there needs to be a much shorter summary of the controversy here. The effectiveness of the vaccine in preventing a heavy burden of disease, disability, and death and saving billions of dollars in health-care costs is mentioned in one brief (though very well-referenced) paragraph, while the "controversy" is expounded upon at length and with some fairly dubious sourcing, which seems to violate WP:WEIGHT - particularly in the presence of an existing content fork already covering the controversy. MastCell Talk 15:40, 29 August 2007 (UTC)
Some of the critisms regarding recent edits seem quite a bit off-base. First, the article size was a bit bigger before the first edit by me around a week ago than it was after the last edit by me before this commend. Second, the space the MMR controversy takes is down from 15 lines to 6 lines on my screen. Third, I disagree with the assertion that the MMR vaccine controversy article spun off from Vaccine controversy article (which was getting very big and was giving undue weight to MMR controversy) is a WP:POVFORK. As for Horton as a reference on what "consensus medical opinion" is - couldn't a reference be found which is not a party to the controversy? --Jkpjkp 16:10, 29 August 2007 (UTC)
It's not a question of total size, it's a question of weight within the article. An article can easily be edited to take a particular viewpoint without changing its size. The MMR controversy wording in MMR vaccine #Autism is heavily biased in favor of the minority viewpoint that MMR causes autism: only a small fraction of that section covers the consensus medical opinion that these concerns are unjustified, and the vast majority of that section attempts to justify the concerns. Any reference giving the consensus medical opinion on the subject is by definition a party to the controversy, so insisting on a reference to someone who is "not a party to the controversy" is the same as insisting on exclusion of consensus medical opinion. MMR vaccine #Autism is in real trouble right now: it is in no way an unbiased presentation of the work. And the other points I raised above remain unaddressed. Eubulides 04:25, 30 August 2007 (UTC)
There's a big difference between being a key figure personally involved (like Horton, who approved the original article for publication) plus having written a book on it, and having expressed an opinion on the controversy. --Jkpjkp 05:45, 30 August 2007 (UTC)
Again, there's nothing wrong with quoting the consensus opinion. Eubulides 02:27, 31 August 2007 (UTC)
I agree with Eubulides and MastCell; medical consensus needs to be faily represented. SandyGeorgia (Talk) 01:05, 30 August 2007 (UTC)

I have rewritten the affected sections to bring the article back to the mainstream point of view (while representing dissenting opinions as fairly as I can) and so have removed the NPOV template. Eubulides 21:58, 3 September 2007 (UTC)

[edit] moving 'Urabe Mumps strain encephalitis' to MMR vaccine controversy

Maybe it would be reasonable to move Urabe Mumps strain encephalitis to MMR vaccine controversy after all, as it's somewhat brit-centric and the publicity there is connected to the media frenzy surrounding the possible MMR-autism connection. May this this would ease the "undue weight" -concerns presented above? --Jkpjkp 07:46, 30 August 2007 (UTC)

[edit] the Cochrane meta-study

Quoted from above: An extended quote from the Cochrane library is given, saying that evidence for MMR should be stronger.' Sorry, but that's not at all what the Cochrane publication's review is saying. In "Main results", it says "We could not identify studies assessing the effectiveness of MMR that fulfilled our inclusion criteria". In other words, not a single study could be found which studied the effectiveness of the vaccine and fulfilled Cochrane's inclusion criteria. To put in another way, according to this Cochcrane review, there are no studies to vouch for the efficiency of the vaccine. Furthermore, the quote given is the whole text of "Author's conclusions", so it clearly isn't "out of context" or a mischaracterization of the report. A second quote from above: This completely mischaracterizes the Cochrane report, whose main result says exposure to MMR is unlikely to be associated with autism. Well, I don't agree with the claim of mischaracterization, but I agree that the unlikeliness of the connection according to Cochrane should be in the article. I added that to the Autism section. --Jkpjkp 08:02, 30 August 2007 (UTC)

I'm sorry, but you've clearly gone out of your way to take the Cochrane conclusions out of context. You quote: "We could not identify studies assessing the effectiveness of MMR that fulfilled our inclusion criteria". Odd you end that quote with a period, since that's only part of the full sentence. The full sentence reads: "We could not identify studies assessing the effectiveness of MMR that fulfilled our inclusion criteria even though the impact of mass immunisation on the elimination of the diseases has been largely demonstrated." I've emphasized the portion of the sentence which you left out without so much as an ellipsis. In the plain-text summary, the authors also wrote: "No field studies of the vaccine's effectiveness were found but the impact of mass immunisation on the elimination of the diseases has been demonstrated worldwide." So yes, you're taking the Cochrane findings out of context. MastCell Talk 16:18, 30 August 2007 (UTC)
I did not end the quote with a period; the period was after the second quote mark, ending the main sentence I wrote. I also included the other part of the sentence in the article "even though the impact of mass immunisation on the elimination of the diseases has been largely demonstrated." I now added quote marks to make it more clear what was said. To me, the whole sentence seems contradictory and puzzling - if no studies on effectiveness were found to fulfill the inclusion criteria, what do the authors base their opinion on the effect of mass immunisation? I understood the sentence so that they believe the impact has been demonstrated in some other way than the in the studies they reviewed. It seems like the second part of the sentence is not based on the research reviewed but something. What else, remains unclear. Maybe you can shed some light on this? --Jkpjkp 17:23, 30 August 2007 (UTC)
Cochrane is extremely meticulous (some would say fetishistic) about high-quality medical evidence - as satirized in this BMJ article. Some practices in medicine are supported by such iron-clad prospective evidence; other practices are so well-established (and so clearly useful) that they have never been subjected to the kind of trials that Cochrane would ideally like to see. As with parachutes in the above citation, some things are clearly effective but have never been subjected to strict high-quality trials. The Cochrane quote indicates that MMR vaccination falls into this category. MastCell Talk 18:11, 30 August 2007 (UTC)
In other words, we seem to agree that the second part of the sentence is not based on the research under review. Or, as authors of the Jpands 2006 article [2] put it, "this is not science. It is not based on any evidence presented, but supports often repeated official government statements." Anyway, is there a problem here - I don't think there's a big problem with how the passage reads now in the article (with both parts quoted), do you think there's a problem? --Jkpjkp 18:41, 30 August 2007 (UTC)
The 2006 Jpands article [3] has some quite interesting claims and observations on the Cochrane paper and the economy and conflict of interest policies of Cochrane, and possible influence by the British government on the issue. Also the quotes of what Tom Jefferson of Cochrane Vaccine department has said do seem to give support to the issue that not all in the mainstream medical community seem to believe that research on the safety and efficiency is sufficient. --Jkpjkp 18:37, 30 August 2007 (UTC)

[edit] consensus / overwhelming medical opinion

On the talk page, in several occasions, it's claimed that The consensus medical opinion or the medical consensus is poorly represented in the article. The article mentions in the overwhelming medical opinion in one place. If there's a medical consensus on something, it shouldn't be that hard to reference it. Without reference, claims of the medical consensus are original research, and not verifiable. If there's been a consensus meeting somewhere with the resulting consensus statement that the risks of using single vaccines increases the risk of infection and should be avoided, it shouldn't be that hard to provide a refence for that. If there's been a consensus meeting with the outcome that the benefits of the MMR vaccine are well researched and far outweigh the risks, a reference to that meeting and the statement should be put in. --Jkpjkp 08:22, 30 August 2007 (UTC)

Claims of consensus are always a bit hard to reference to everyone's satisfaction; but yesterday I was going to add a list of medical and scientific organizations supportive of childhood vaccination (hint: it's all of them). I had collected references from the CDC, WHO, NIH, AAP, AMA, British NHS, and Institute of Medicine, among others, but I ended up not adding them because of the rapid pace of editing. But I'll work these sources in; I prefer that sort of referencing rather than "overwhelming medical consensus" claims anyway. MastCell Talk 16:14, 30 August 2007 (UTC)
That sounds good. --Jkpjkp 18:59, 30 August 2007 (UTC)

Sources (collecting them here first):

... more to come. MastCell Talk 17:46, 31 August 2007 (UTC)

[edit] Inconsistency between text and graphics

The line: "In the United States, the booster began in the mid 1990s. It is widely used around the world; since introduction of its earliest versions in the 1970s" does not square with the graph, that shows vaccine introduced circa 1962. —Preceding unsigned comment added by 38edward (talk • contribs) 17:22, 22 February 2008 (UTC)

Thanks, I added a mention that the vaccine (not the booster) was first licenced in 1963. Eubulides (talk) 17:33, 22 February 2008 (UTC)


[edit] Aborted Fetus Cell Lines and Virus Strain

This is a key point for religious and principled people. Need at least some clear reference. 71.31.121.191 (talk) 04:41, 16 May 2008 (UTC)