Focus on Alternative and Complementary Therapies
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Focus Alternat Complement Ther©2005 Pharmaceutical Press
Focus Altern Complement Ther 2005; 10: 98–100
FACT readers are well aware of the current popularity of CAM. What is far less well known is the fact that the CAM boom significantly impacts on immunisation practice. This focus article aims to highlight this issue.
Immunisation is, of course, a highly controversial topic. Many CAM proponents are supporters of the ‘anti-vaccination movement’. The measles, mumps and rubella (MMR) immunisation programme, for example, has been of recent concern among professionals, parents and the general public. New figures from the Health Protection Agency show that 3504 suspected mumps cases were reported in the first 3 weeks of January 2005, up from 248 over the same period in 2004.1 Anti-vaccination groups and campaigns are gaining support, particularly in the USA and Western Europe.2 Some homoeopaths, chiropractors and naturopaths are expressing their views against immunisation.3,4
In many countries (e.g. Germany and the UK), homoeopathy is practised by physicians and ‘lay-homoeopaths’ in parallel. The training of the latter group is highly variable. In several countries (e.g. the UK), no mandatory training exists at all. Some (particularly non-physician) homoeopaths advise their patients against immunisation, even though the official policy of their professional body does not support this behaviour.
When all homoeopaths listed in the telephone directory of Sydney, Australia, were questioned about their attitude regarding immunisation, 83% did not recommend this procedure.5 A larger, representative study was carried out in Austria,6 where all 230 registered homoeopaths received a postal questionnaire, which was returned by 117. Only 28% of these rated immunisation as an important preventive measure. A further survey of all 45 homoeopaths within our local area of the UK7 yielded a response rate of 51%. Seven of the 10 physician homoeopaths but none of the 13 lay homoeopaths recommended immunisation. In a survey of 77 homoeopaths in which CAM practitioners were asked about MMR immunisation for a baby, none advised in favour of the immunisation and 40% openly advised against it.8 Forty-two homoeopaths working in Massachusetts (USA) were asked about their attitude towards immunisation in general. Thirty-five per cent of them actively recommended childhood immunisation while 9% opposed it.9 A sizeable German survey (n = 300) involved medically qualified homoeopathic (HP) and non-homoeopathic physicians (NHP). They were asked about their attitude towards 17 different vaccines.10 The responding NHPs did not generally refuse immunisations but rather viewed them in a specific hierarchy. ‘Classical’ vaccines were applied but vaccines against childhood diseases were used less frequently by HPs.
The chair and vice-chair of the UK Society of Homeopaths recently declared that their society does not encourage their members to advise patients against vaccination.11 They also claimed that there is much anecdotal and scientific evidence to support the arguments both for and against immunisation.
Some homoeopaths advocate individual ‘homoeopathic immunisation’, i.e. high dilutions of infectious agents administered orally. There is no evidence to show that this method is effective.12 Two cases have been reported where patients followed their homoeopath’s advice and administered ‘homoeopathic immunisation’ against malaria before travelling in an epidemic area.13,14 The patients promptly contracted malaria and one14 subsequently suffered multiple organ failure.
The older chiropractic literature contains strong negative statements on immunisation, repeatedly stressing that it is hazardous and ineffective.e.g. 15,16 Facts are sometimes distorted, e.g. ‘smallpox vaccination was stopped in the USA and Britain because it was realised that the vaccinated suffered the worst effects of the disease.’17 The risks of immunisation are occasionally exaggerated: ‘The dangers of vaccination to the young child are profound … in some cases, the vaccine acts non-specifically to increase a child’s pre-existing chronic disease tendency.’18 Other sources state that immunisation is useless and harmful: ‘Immunisation programmes continue on the premise of prevention’ but ‘it cannot be said that the … programme has been proven successful … and the complication rates for the vaccines continue to claim the lives of children via disability and/or death.’19
A US survey aimed at identifying chiropractors’ attitudes towards immunisation.20 A random sample (1%) of all US chiropractors were provided with a choice of policy statements. Subsequently, participants completed a standard questionnaire. One third of the sample agreed with the statement that there is no scientific proof that immunisation prevents disease, that it causes more disease than it prevents and that contracting an infectious disease is safer than immunisation. Another survey included 150 licensed chiropractors from Boston (USA).21 Thirty per cent of them reported actively recommending immunisation and 7% advised their clients against immunisation. In our own survey, 22 chiropractors were included, of whom 6% recommended MMR vaccination and 19% advised against it.8
When, in 1981, all naturopaths in the State of Washington, USA, were interviewed, ‘many’ (no data provided) were opposed to routine immunisation because they felt the procedure was unnatural, unnecessary and ‘elitist’.22 More recently, 23 naturopaths working in Massachusetts (USA) were asked about their attitude towards immunisation.9 Twenty per cent recommended and 7% openly discouraged childhood immunisation. A recent survey of students of naturopathic medicine in Canada (n = 312) assessed their attitudes towards paediatric immunisation. Only 12.8% of the respondents advised in favour of full vaccination.23 In April 2001, one of the authors (EE) was invited to give a lecture to the annual conference of the British Naturopathic Association. A show of hands by the approximately 100 delegates attending this conference revealed that roughly twice as many naturopaths were against immunisation as were in favour of it.
This evidence collectively suggests that some homoeopaths, chiropractors and naturopaths have a negative attitude towards immunisation and advise their clients accordingly. Patients consulting such practitioners might follow such advice and may be harmed as a result.e.g. 13,14 One survey from 1995 suggested that seeing a homoeopath is the most prevalent reason for non-compliance with immunisation in the UK.24 With the rising popularity of CAM this could amount to a major threat to public health. Clinicians should know about this opposition and target effective measures against it. A rational debate about immunisation and the issues that arise from it would be a good start.
