Next Wednesday significant parts of the NHS will be taking industrial action. I am supposedly working to rule, with a “ban on non-essential paperwork, e-mail exchanges, attendance at meetings and telephone calls.” The industrial action is being organised by my union Unite, which in a recent ballot obtained a mandate from the membership for this action (76% for, 23% against), and a mandate for strike action later (53% for, 45% against). When the ballot was taken the credit crunch was already well established, and in part that probably influenced the membership - angry with a below inflation pay deal. Following the ballot Unite’s position was made clear:

Unite’s National Officer for Health, David Fleming said: ‘The stand that our members have taken against the derisory three-year pay deal imposed by ministers has been vindicated.’

David Fleming said: ‘Our members were appalled and angry at the 7.99% three-year pay deal imposed by the government in the spring. Inflation has now broken through the 5% barrier and their household bills are increasing on an almost daily basis.’

‘They were also upset that the government undermined the independence of the Pay Review Body by imposing its own settlement.’

The latter point is a matter of principle, which has not changed. However, treasury’s forecasts are suggesting an annual inflation rate averaging 0.5 per cent next year.The government may not have thought they were being generous at the time, but 7.99% over three years is looking like a good deal in the current economic circumstances. This is not the 1970s, we are not struggling with 25% inflation rates.

People are losing their jobs. Companies with inherent weaknesses, masked until the hard times, with large amounts of employees are looking very shaky. We have people warning that deflation is impending. There is a concern about the level of government debt (although read this piece for a more sober analysis of those “record” debt levels). So, exactly how much support are NHS employees complaining about a 7.99% pay rise over the next three years going to get? Not much I suspect. Would you honk your horn?

Given the current situation, then rather than asking for solidarity from the public over our pay rise, would the union not be better advised to accept it is now a reasonably good deal (even if it wasn’t offered as such at the time) and act in solidarity with the country as a whole? I’d be interested to see if the result would be the same if the membership was balloted now.

Tactically, the action doesn’t even make political sense given the ties between Labour and the unions. Is it really the best time for a union to be creating disruption? Or have I got the purpose of the unions wrong? Do they actually exist to inflict wounds on left wing governments struggling with economic crises?

You’d think they’d learnt nothing from the last time they ushered in the Conservatives.

The Independent recently published an article in which a father explained why his daughters would not be given the HPV vaccine. David Salisbury has written in to correct the article.

I was sad to see the article, “My girls won’t have the cancer jab” (16 November): to use its own words, the article was unnecessary, reckless and ridiculous. The back-of-the-envelope economic analysis was nave. The UK model shows the NICE criteria were passed at a range of prices, including the list price used. Government contract prices can be significantly lower.

The safety concerns raised come from an anti-vaccine website. Analyses show no significant increased risks of serious adverse events; it is irresponsible to raise such concerns when there are no grounds to do so. Presentations on the safety of Gardasil cover 20 million doses under passive surveillance and more than 375,000 doses under active surveillance. And to refer to “a healthy immune system that hasn’t been challenged by too many vaccinations” to prevent cervical cancer is just nonsense.

The safety concerns the father cites appear to come from Judical Watch, which appears to think it has uncovered horrifying evidence of harm from HPV vaccine by examining reports of suspected adverse reactions filed with the CDC in the US. One of the problems of transparency in drug safety is that people with little understanding of the nature of drug safety data can either innocently, or deliberately because of an idealogical opposition to vaccines, create the impression of a safety problem when none exists. More on this later, but it is worth noting that a British non-tabloid newspaper, which ironically was handing out guides to science earlier this year, is allowing seepage of anti-vaccine material into its pages.

Recently the BBC reported on a concern about the use of single vaccines:

UK researchers have raised concerns over the monitoring of the safety of single measles and rubella vaccines.

It comes after an unexpectedly high number of cases of anaphylactic shock after single vaccines given at private clinics in south west England.

Although the figures are likely to be an anomaly, poor data on vaccines given at private clinics is preventing proper scrutiny, they warn.

I am a supporter of the use of the combined measles, mumps and rubella (MMR) vaccine. I support its use for two reasons, neither of which involve concerns about the safety of single vaccines.

1. The use of single vaccines leads to gaps in the vaccination schedule, exposes the child to more discomfort, and potentially can lead to a failure to vaccinate at all. It should be remembered that before MMR thousands of children suffered measles.

2. Providing single vaccines against the scientific evidence would be exploited as a tacit admission that there was a risk of autism attached to MMR vaccine by UK anti-vaccinators. It would undermine confidence in MMR vaccine, and the media would publish extremely confusing news stories about MMR vaccine. Wakefield’s hypothesis never explained why single vaccines might be “safer” in this regard.  Anti-vaccinators would then move on to attacking single vaccines, winning by increments.

The latter point is a perhaps less of a concern. Despite some calls from politicians for the provision of single vaccines in the past, the autism-MMR vaccine hypothesis is now so discredited that I don’t think there is any possibility of caving in to the demands of a few isolated cranks. In addition, a rising awareness of the damage done to herd immunity in the UK, and outbreaks of measles, make the public health case for the combined vaccine even more compelling. So why don’t I admit a loud Whoopee about this news? MMR vaccine has less chance of causing anaphylaxis. Or does it?

The authors of the new study, which the BBC report is based upon, cite a UK national incidence of anaphylaxis for MMR vaccine as 1.4 cases per 100,000 doses from a paper by Peng et al in Arch Intern Med from 2004 [PDF]. That study is a GPRD (General Practice Research Database) study, which uses medical data from a large number of GPs (currently 450) and their patients (currently 13 million). While the GPRD has a good reputation, in terms of quality of data, even Peng et al state that “we cannot rule out the possibility that some cases of anaphylaxis may not have been recorded in the GP computer record, particularly those that occurred in hospital.” Anaphylaxis in the community may not have been recorded in patient’s notes in all cases. If a child suffered anaphylaxis in a surgery acute treatment of the child would have been a priority; the child later being admitted to a hospital where the coding would happen in a totally different system. In addition, the average of 1.4 cases per 100,000 is based on 2 cases of anaphylaxis after 143,000 administered doses of MMR vaccine. Only a small amount of cases which avoided coding would move the average up considerably.

The paper by Erlewyn-Lajueunesse et al that the BBC report is based upon used what appear to have been 4 spontaneous reports of anaphylaxis submitted to the authors in their locality, with data obtained from the MHRA on the number of imported MMR vaccine obtained nationally during the period. They argue that the incidence of anaphylaxis they found (18.9 cases per 100,000 for measles and 22.4 per 100,000 for rubella) was probably an under-estimate, since presumably more cases of anaphylaxis occurred elsewhere they were unaware of. This is probably a fair assumption. However, there are perhaps other biases at work. Perhaps the reporters were also the suppliers of the single vaccines, and are partly motivated by what they perceive as a danger of MMR vaccine. If so, they may have been more keen to report reactions to other vaccines. Alternatively, the reporters could have been those treating the anaphylaxis and may have felt strongly that side effects to the unlicensed single vaccines should be reported. So reporting rates in both studies may have been totally different in nature. It is hard to make any firm decisions on the limited data we have.

It is therefore not sensible to compare the two incidences, and to come to the conclusion that single vaccines are more prone to anaphylaxis. To be fair the authors make this point themselves at the BBC:

“We can’t think of any reason why it [anaphylaxis] would be higher for single vaccines and it’s probably an anomaly.

“The issue is that people go for these vaccines because they are uncertain about how safe the MMR is but we know how safe the MMR is because we have lots of data.”

He added that the Healthcare Commission should insist private clinics are subject to the same standards of vaccine data reporting as is expected of the NHS.

“They are more than likely safe but the issue it raises is about how that is monitored.”

Seeking to scare parents into using the combined jab on the basis of the evidence about anaphylaxis isn’t quite as dubious as the Wakefield-inspired scare story over MMR vaccine, but it is in the same ball park. David Elliman’s comments are also sensible:

Immunisation expert Dr David Elliman, a community paediatrician at Great Ormond Street Hospital also said there was “no logical reason” why the rates of anaphylaxis should be so high with the single vaccines.

“The important message is not about the rate but the fact that it does occur and this idea that the single vaccines for some magical reason are safer is nonsense.”

Avast me hearties! Shiver me timbers! There is news that rain may be linked to autism:

Research published today suggests that regular rainfall may help trigger autism in children, USA TODAY’s Rita Rubin reports.

“If you look at the autism literature now, they’re much more open to an environmental trigger,” says lead author Michael Waldman, a Cornell University economist who says his son was diagnosed with an autism spectrum disorder at age 3 but has recovered and is now a normal third-grader.

He and his team studied children in California, Oregon and Washington state. They speculate that rain might act as a trigger in genetically susceptible children by carrying pollutants or by forcing indoor activity that leads to increased TV-watching, decreased vitamin D levels or increased exposure to household chemicals.

Ahoy!

Remember global warming is linked to falling numbers of pirates. Which means that Somalia is the leading country in the fight against climate change.

There is no “epidemic of autism” in the first place. Arrr!

UPDATE: The BBC cover the rainfall linked to autism study. They didn’t cover the far more important Hornig study which dismissed the link between MMR vaccine and autism.

Obama has been elected and has delivered his victory speech. This means that science in the US will hopefully become less politicised. Christopher Hitchens noted a few days ago that the Republican party:

has placed within reach of the Oval Office a woman who is a religious fanatic and a proud, boastful ignoramus. Those who despise science and learning are not anti-elitist. They are morally and intellectually slothful people who are secretly envious of the educated and the cultured. And those who prate of spiritual warfare and demons are not just “people of faith” but theocratic bullies. On Nov. 4, anyone who cares for the Constitution has a clear duty to repudiate this wickedness and stupidity.

Thankfully, Obama’s victory has put a stop to that. McCain had appeared to have bought into the quackery associated with the vaccine-autism hypothesis. If he’d won, extremist anti-vaccine lobby groups could have influenced vaccine policy.

One of the most amusing aspects of the US Presidential race in the UK, has been watching Melanie Phillips. Phillips is no slouch in the war on science. She helped undermine confidence in MMR vaccine with ignorant and irresponsible reporting, and has fundamental misunderstandings about science. She also believes atheism is the cause of the current economic crisis. No, really.

Over the past few weeks she has become increasingly hysterical about an Obama win. On Monday she was worrying about supposed links with the Nation of Islam, prior to that she posted material suggesting an Obama victory would give jihadists “access to US National security”, and she has painted Obama as the biggest threat to the free world:

Over the past seven years, the media has created the Big Lie that America is the biggest rogue state in the world, with Israel its proxy. Now it is ensuring that a man [Obama] who will act on that very premise to crush America and destroy Israel will be placed in the White House to do so. It is not just that the west’s Big Media can no longer be trusted. It has become the most important weapon in the arsenal of the enemies of the free world.

She hasn’t posted any material since Monday. Perhaps she is already holed up in a bunker in Montana with a militia, ready to fight off the cryto-communist jihadist one-world government threat of the Obama Presidency?