Vaccination against mumps, measles, and rubella: is there a case for deepening the debate?How safe is MMR vaccine?Validity of the evidenceDealing with uncertaintyGP's response

Primary careEthical debate Vaccination against mumps, measles, and rubella: is there a case for deepening the debate?Complex issues relating to ethics, values, and the nature of evidence lie behind the decision whether to give the MMR (mumps, measles, and rubella) vaccine.Tom Heller, a general practitioner, is uncomfortable with the evidence that the vaccine is safe.Together with Dick Heller, an epidemiologist, and Stephen Pattison, an ethicist, he explores some of the processes involved in doctors' decisions about whether to vaccinate. How safe is MMR vaccine?Tom Heller My duties as a general practitioner include immunising babies and small children against a range of common diseases.Recently, I have been increasingly uncomfortable when giving the combined mumps, measles, and rubella (MMR) vaccine.I find myself wondering if I would submit my own children for this immunisation if they were currently at that age.I find it difficult to be certain that the vaccine is as safe as the authorities say that it is.Somehow, the more strident the experts become, the less believable I seem to find them.The Department of Health website (http://193.32.28.83/mmrvac.htm)gives many references and internet links to the published studies that support its views, but it gives only one reference that raises the issue of a link between MMR vaccine and potential adverse reactions.The partial use of evidence that is apparent within official pronouncements is echoed by other experts.For example, Elliman and Bedford focus on possible problems with the research methods of people concerned about possible adverse effects of the MMR vaccine. 1 They do not mention potential problems with the research that concludes that the vaccines are safe.In addition, what are we to make of these and other researchers 2 who declare funding from drug manufacturers involved in manufacturing vaccines?Whether to vaccinate children can be a difficult decision