212 British Homceopathic Journal

The Immunizat ion Decision. A Guide for Parents. Randall Neustaedter. Berkeley, California 1990, North Atlantic Books, ISBN 1-55643-071-X, s Pp. 114.

The author rejects the standard view on the advis- ability of immunization. His book is really written to support parents who already share this opin- ion. It has 2 stated goals: 'to give information about the (relevant) diseases, the vaccines and their side-effects'; and 'to give support to those parents who choose not to immunize according to the recommended schedule'.

He certainly succeeds in the latter respect. The book is well written, and free enough from tech- nical jargon for the average intelligent reader to follow without difficulty. The main points are repeated in clear numbered boxes at each sec- tion's end. He does indeed give referenced statis- tics on the incidence of each disease, the efficacy and side effects of its vaccine. These naturally draw chiefly on North American literature, since that is where Dr Neustaedter lives.

Time was when the patient attended the doctor for advice, and was content to accept what he/she was given. Now, ironically, at a time when such advice is more safely supported by scientific evi- dence than it ever was in the past, patients are increasingly asserting their own rights to discuss and decide each issue. This trend is probably more apparent in the USA than it is here. Such assertiveness is assumed, and by implication encouraged, in this book.

There are clearly times when such discussion is valuable, and situations in which a joint decision is appropriate. There are others ('you have acute appendicitis and need urgent surgery') where it is quite inappropriate. Where does the immuniz- ation issue fall on this scale? One problem is that parents are likely to be swayed by whichever argument is better presented. A little knowledge is still a dangerous commodity.

It is only with more knowledge that one can see through the maze of information and assess its real worth. I found myself wanting to argue with the author on almost every page, not, on the whole, because I doubted the facts, but the man- ner of their presentation. For example: Polio Summary, point 1: 'No wild cases of polio have occurred in the United States since 1979'. Point 2: 'The vaccines have questionable effectiveness.' In a recent British study Joce et al. report that all 21 confirmed cases notified in England and Wales between 1985-91 were either vaccine-related or imported from Asia or Africa. ~ The risk from the

first dose (where it is greatest) of oral vaccine is 1.46 per million. The British author describes it as 'one of the safest and most effective vaccines in use today'. In the sense that no vaccine is entirely effective there has to be some truth in Neustaed- ter's second point. Put in context, however, I con- sider it a misleading, if not mischievous misrepresentation of the true position. Unfortu- nately, this kind of half truth recurs throughout his book.

On whooping cough Neustaedter's argument is one-sided. Firstly, he is incorrect in stating that UK children no longer receive the vaccine. This is surprising, as most of his factual statements are referenced accurately. He reports 'several thou- sand' cases and 4-11 deaths per year (presumably USA, but not stated). Then in his summary he says that the incidence is now low. He does not refer to the UK situation of the recent past in which a serious drop in vaccination levels led to a sharp increase in the disease, with its attendant morbidity and mortality. He does discuss the difficulty we face in determining the exact inci- dence of permanent damage following pertussis vaccination. Although he quotes the official con- clusions, such as an unproven association with sudden infant death syndrome, he repeats the conclusion that pertussis immunization is danger- ous. He quotes Coulter's assertion, that all man- ner of learning defects and behaviour problems may be due to the vaccine] Immunization is one of many features of modern life, and it is wrong and irresponsible to blame just one of them when the statistical backing for the assertion is lacking.

He quotes my own article on treating whooping cough homoeopathically accurately, including the disclaimer that the number of cases was too small to draw conclusions, but in his summary asserts a positive result from homceopathic treatment as though it were firmly proven. 3 He also mentions antibiotics and passive vaccine as effective treat- ments, which they are not, in terms of preventing complications. He suggests that the higher reported incidence of disease here, in Sweden and Japan might be due to inflated figures because 'every lingering cough is reported as per- tussis.' My own findings, when I tried to use notifi- cations as a control, were that they almost certainly underrepresented the case, as a sub- stantial proportion of GPs notify hardly anything at all.4 The view is supported by Fleming (RCGP Research Institute, personal communication).

Mendelsohn is quoted as having criticized the paucity of placebo-controlled or longitudinal studies of vaccinated v. unvaccinated groups. 5

Volume 81, Number 4, October 1992 213

There is indeed a case for expecting such studies on new vaccines. One might defend the omission by pointing to ethical difficulties, and the enor- mous expense involved in mounting a study in which so few positive cases are expected. In the context of this book I object to the subtle insin- uation that the medical profession is irresponsi- ble, or does not really know what it is doing, Such a suggestion will readily be assimilated by those already inclined to such a view.

Neustaedter may well be correct in counselling caution in the introduction of new vaccines such as Haemophilus influenzae b (Hib) meningitis, where so far the efficacy is poor and the side effect profile high. ~'

Would I recommend this book to patients? Normally I am in favour of adult, responsible behaviour. Perhaps I am being paternalistic, but in this instance, with young parents in a vulner- able position, I think, on balance, that they are better served by firm, well-informed, authorita- tive advice, and that that advice is that the currently recommended vaccines are worth- while. So, no, I would not.

I do believe, however, that as the incidence of disease in the wild drops, as it has done for polio, there will come a time when the dangers of vac- cination exceed those of not doing so, and that we will have to change the current policy of some vac- cinations, as we have done already for smallpox.

J O H N E N G L I S H

References 1 Joce et al. Paralytic poliomyelitis in England and Wales,

1985-91. BrMedJ305: 6845. 2 Coulter HL. TheAssaultontheAmericanehild: Vaccination,

So~opathy and Criminality. Berkeley, California. North Atlantic Books. 1990.

3 EnglishJM. SymptomsandTreatmentofWhoopingCough, 1980-82. Br Horn J 1987; 76.

4 English JUM, Pertussin 3(~-preventive for whooping cough? A pilot study. BrHom J 1987; 76.

5 Mendelsohn R. The truth about immunizations. The People's Doctor April 1987.

6 MMWR (Morbidity and Mortality Weekly Report), Preven- tion of Haemophilus influenzae type b disease. 1988; 37.

Proceedings of the 1991 Professional Case Confer- ence. International Foundation for Homceo- pathy, Seattle, USA. ISBN 0-8403-7208-6. Pp. 302. Price not stated.

This is the third year that the International Foun- dation for Homceopathy has published the pro- ceedings of its Case Conference meeting. I have not seen the proceedings from 1989 but enjoyed

reading the proceedings from 1990, and it encour- aged me when trying to facilitate a Case Confer- ence meeting for the Faculty. A Case Conference can provide an excellent forum for experienced homoeopaths to learn from each other and to gen- erate new educational material for those studying homeeopathy for the first time. In the right format it provides discussion of clinical management including comparison of drug pictures, case analysis and follow-up strategies. It is not primar- ily a meeting where homceopathy is statistically validated, nor where supervision is offered, nor when help in prescribing is required. It presents cases where the medicine has clearly acted according to hom(eopathic principles with a ben- eficial result observed over a significant period.

In the 1991 Case Conference several series of cases were presented including discussion of 'sev- eral cases in a whooping cough epidemic' (Jeff Baker) 'Three cases of hemorrhagic uterine fibroids' (Laurie Dack), 'Three cases of epilepsy' (Paul Herscu) and 'A series of Apis cases' (Roger Morrison). These presentations all provided many insights into how experienced prescribers evaluate and prioritize cases, and give clear rationales for the selected treatment.

For me the proceedings come alive when a case is presented as it is here, with clear weighting of symptoms and comments on patients' behaviour and demenour in a fashion that allows you to assess the case as if you were in the consulting room. This is followed by perceptive discussion amongst the audience. At times there is a feeling that further discussion would enhance the value of the cases, and make more use of the experience of the audience. When minor or unusual drugs are presented they are often supported with other observations and clinical cases, both from the presenter and from the floor. Four such cases in this book were on 'Myasthenia gravis' (Lewis Klein), a case from Jonathan Shaw (to name the medicines discussed would spoil your entertain- ment), 'A case of persistent pruritus with atopic xeroderma, plus a case of recurrent depression' (Carl Robinson) and 'Chronic fatigue syndrome' (Nancy Herrick).

There was an interesting discussion on 'Pelvic disorders coming on after grief' (Linda Johnson), relating the onset of illness to emotional aetiolog- ical agents which is so common in practice.

The Proceedings are much more than just a souvenir copy for participants of the Conference. They are a well-presented collection of cases allowing hom0eopathic observations and eluci- dating principles from experienced prescribers in