Vol 57: DeceMBeR • DéceMBRe 2011
|Canadian Family Physician•Le Médecin de famille canadien
Top of the list
Nicholas PimlottMD CCFP, SCIENTIFIC EDITOR Let me tell you the secret that has led me to my goal. My
strength lies solely in my tenacity.
Medical publishing remains a slow and fraught process, as has been so well documented by for- mer editor of the British Medical Journal (BMJ) Richard Smith.1 Canadian Family Physician is prone to all of the ailments of the bigger journals like the BMJ. So, as I write this December editorial it is World Polio Day, October 24th. A thoughtful and stirring op-ed piece in The Globe and Mail newspaper by former Canadian Prime Minister Paul Martin reminds us that polio remains a serious and life-threatening disease in countries such as India, Pakistan, and Afghanistan, among many others. He also rallies us in the worldwide fight against polio:
Now is our chance to finally eliminate polio so no child ever has to suffer from this disease again. If we are successful, it would be a historic achievement.
Finishing the job would make polio only the second disease, after smallpox, to be eliminated.2
Ever since the discovery of vaccination there has been an antivaccine movement.3 Since the publication of a now-discredited4,5 study of the link between childhood autism and the measles-mumps-rubella (MMR) vaccine in the Lancet in 1998,6 vaccination has come under a shadow, with many parents and adult patients cautious to the point of refusing vaccinations. The claims made by Wakefield and colleagues led to decreased use of MMR vaccine in Britain, Ireland, the United States, and other countries. Subsequently Ireland, for example, experi- enced measles outbreaks in which there were more than 300 cases, 100 hospitalizations, and 3 deaths.3
To celebrate the launch of the new BMJ in 2007, read- ers of the journal nominated 70 medical milestones since the journal was first published in 1840. A panel of editors and expert advisors narrowed the list down to a final 15, then invited champions to write about each one.7
As Professor Michael Worboys has argued, in terms of number of lives saved since its discovery, it is hard to beat vaccination.7 Since Edward Jenner’s famous 18th-century observation that milkmaids who had suffered from cowpox (vaccinia) were thereafter immune to its deadly relative, smallpox, and his subsequent testing and promotion of inoculation with small amounts of vaccinia pustules to pre- vent smallpox, it is impossible to quantify the lives saved.
Although Jenner’s seemingly miraculous discovery saved many thousands from deadly smallpox, it was a
“one off,” and it was not until Louis Pasteur’s work to develop a vaccine against rabies almost a century later that the promise that vaccination offered in eradicating seemingly untreatable disease began to be fulfilled.8
It is hard for those born since the 1960s to recall the serious and often fatal childhood infectious diseases that have been rendered rare by the vaccines that we now take for granted—diphtheria (1923), whooping cough (1926), measles (1963), rubella (1969), MMR (1969), and, of course, polio (1958 and 1961)7—but Mr Martin himself reminds us:
I’m committed to this fight against polio because I know its effects firsthand, as did my father before me.
When I was 8, polio paralyzed my throat. My par- ents feared the worst as they rushed me to hospital.
During those years, most children who survived polio became permanently paralyzed or ended up in an iron lung. But I became one of the fortunate ones and fully recovered after a long spell in the polio ward at the Hôtel-Dieu Hospital in Windsor [Ontario].2
Vaccines hold great promise in eradicating many of the diseases that currently afflict us—malaria and schistosomiasis, HIV and severe acute respiratory syn- drome, cancer and autoimmune disorders—as well as the diseases of the future.7 So it is timely that in this month’s issue of Canadian Family Physician Dr Vivien Brown (page 1377) reminds us that, while family physi- cians are dedicated to delivering preventive care to their patients, the most effective type of prevention—vaccina- tion—is literally at the bottom of the list9 on the preven- tive care reminder tool used by family physicians across the country.10 As the world works to finally eradicate polio, let us not take for granted the most powerful tools for prevention that we have to offer here at home.
competing interests None declared References
1. Smith R. The trouble with medical journals. London, UK: Royal Society of Medicine Press; 2006.
2. Martin P. We are on the cusp of ending polio. The Globe and Mail 2011 Oct 24.
Available from: www.theglobeandmail.com/news/opinions/opinion/we-are-on- the-cusp-of-ending-polio/article2209941. Accessed 2011 Oct 24.
3. Poland GA, Jacobson RM. The age-old struggle against the anti-vaccinationists. N Engl J Med 2011;364(2):97-9.
4. Madsen KM, Hviid A, Vestergard M, Schendel D, Wohlfart J, Thorsen P, et al. A popu- lation-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med 2002;347(19):1477-82.
5. DeStefano F, Thompson WW. MMR vaccine and autism: an update on the scientific evidence. Expert Rev Vaccines 2004;3(1):19-22.
6. Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, et al. Ileal- lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disor- der in children. Lancet 1998;351(9103):637-41. Retraction in: Lancet 2010;357(9713):445.
7. Worboys M. Vaccines: conquering untreatable diseases. BMJ 2007;334:(Suppl 1):s19.
8. Godlee F. Milestones on the long road to knowledge. BMJ 2007;334:(Suppl 1):s2-3.
9. Brown V. Immunization. Last on the list. Can Fam Physician 2011;57:1377-8 (Eng), 1379-81 (Fr).
10. Iglar K, Katyal S, Matthew R, Dubey R. Complete health checkup for adults: update on the Preventive Care Checklist Form©. Can Fam Physician 2008;54:84-8.
Cet article se trouve aussi en français à la page 1376.