Medical advances for the year ahead
One of the curious features of vaccine scares is their apparent national specificity. In Britain, we had the great MMR autism panic, in France multiple sclerosis has been linked to the hepatitis B vaccine, and in the US vaccines containing the mercurybased antiseptic thiomersal are the target of anti-vaccination campaigns. In Japan, the human papillomavirus (HPV) vaccination, given to teenage girls around the world over the past decade to prevent cervical cancer, has become controversial.
In response to a small number of parental complaints that the HPV vaccine had caused a wide range of adverse effects, including disabling neurological and neuropsychiatric reactions, in 2013 the Japanese government suspended the vaccine only a few months after its introduction.
On the basis of scientific evidence of dubious quality, researchers claimed to have identified “HPV vaccine-associated neuroimmunopathic syndrome (HANS)”. Campaigning parents posted videos of children claiming to be suffering from this syndrome on the internet and have launched a class action lawsuit claiming damages from the vaccine manufacturers.
Uptake of the vaccine has plummeted from 70 per cent to less than one per cent. In London last month, Dr Riko Muranaka of the Kyoto University medical school received the Maddox Prize for her work in challenging the campaign against the HPV vaccine in Japan. In press articles and television appearances, she has exposed the lack of scientific evidence for suspending the vaccine – as well as drawing attention to the likely consequences for women’s health. The Maddox Prize is awarded by the journal Nature, the Kohn Foundation and the charity Sense about Science to people who promote science and evidence on matters of public interest. Dr Muranaka has endured insults, litigation and attempts to undermine her professional status.
In her acceptance speech, Dr Muranaka spoke of the 100,000 wombs that would be removed in Japan if the suspension of the HPV vaccine continued for the 10 years that it is likely to take to resolve the lawsuit. The death rate is also likely to continue at around 3,000 a year. Meanwhile, in the UK, the HPV vaccine has been so successful that the number of smear tests recommended in a woman’s lifetime has been reduced from 12 to three.
When I met Dr Muranaka for tea the following day, she told me that she hoped that the publication of her book on the HPV controversy in Japan, which had been blocked by the campaign against her, could proceed. I hope she can also find a publisher in the UK who can rapidly produce an English translation.
Advance notice
With all the gloomy prognoses about winter pressures on NHS budgets, it is good to have something to look forward to in the new year. Here are a few medical advances that might yield some positive benefits for patients over the coming 12 months.
Monoclonal antibodies for migraine
I well recall the excitement over the “triptan” drugs that came into use for treating migraine in the Eighties. Many patients found them helpful, but they fell far short of being the wonder cure that some anticipated and had many unpleasant side-effects.
But now come the “mabs”, a group of monoclonal antibody drugs (such as erenumab and eptinezumab) which target calcitonin gene-related peptide (CGRP), a neurotransmitter that appears to play a key role in mediating the disabling symptoms of migraine. Early trials seem promising, confirming the efficacy of these drugs in preventing attacks, though concerns about adverse effects remain.
Gene therapies
Though unravelling the human genome turned out not to provide the key to all mysteries, it has offered clues for tackling some, even though relatively uncommon, conditions. Though much media attention has focused on the potential treatment for Huntington’s disease, this is likely to take a few more years to develop. Meanwhile, gene therapy for haemophilia appears to have reached a more promising stage and large-scale trials will be under way over the coming year.
Car park CAT scans
A pilot scheme offering CAT scans to smokers in supermarket car parks in Manchester detected 46 cases of lung cancer at – potentially treatable – early stages.
This scheme will be rolled out around the country over the next year, offering the prospect of early diagnosis of a condition which kills 35,000 people every year and is still commonly diagnosed at a late stage when the prognosis is likely to be very poor.
Flushable pregnancy test
According to the latest series of
The Crown, even Her Majesty in 1963 had to await laboratory confirmation that she was expecting Prince Edward. Next year, women will be able not only to discover they are pregnant at the earliest stages, but also to flush away the evidence, thus guaranteeing the privacy of this most intimate revelation.
Happy new year.
James Le Fanu is away