Rabid warnings

GPs are drowning in a cascade of public health alerts about everything from bat bites to 'calabash chalk'.

Dr Michael Fitzpatrick

Topics Politics

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According to an ‘urgent message’ faxed to every doctor in the country from deputy chief medical officer Dr Pat Troop, there is a ‘suspected case of rabies in Tayside, Scotland’.

Some readers of my column last week, on the scare over imported single mumps vaccines, may have been bemused by the reference to the command to ‘activate the cascade’ at the head of that urgent message. As the Scottish rabies case has provided the fourth occasion for activating the ‘public health link’ cascade in nearly as many weeks, I better explain how this waterfall works.

The idea is that ‘when information needs to reach health professionals quickly and there is not sufficient time to organise a hard-copy mailing’, the cascade is activated. A message is sent by fax from the Department of Health to directors of public health, hospital trusts, primary care trusts and similar bodies; they in turn forward the message to GPs, nurses, health visitors, pharmacists and other frontline health workers.

There are three categories of ‘public health link’ messages: immediate – ‘cascade within six hours’, urgent – ‘cascade within 24 hours’, and non-urgent – ‘cascade within 48 hours’. All four recent messages have been labelled ‘urgent’. So why have the public health authorities resorted so frequently to opening the floodgates of this NHS version of the information superhighway?

David McRae, a 56-year-old conservationist from Angus in Scotland, contracted European Bat Lyssavirus (EBL), a type of rabies found in several northern European countries. He is ‘known to have had prolonged close contact with bats over many years’ and has since died from his infection.

This is tragic for McRae’s family and friends, but is it a public health issue? The EBL that has been isolated from a few bats in Britain in recent years is less virulent than the common strain of rabies virus and has only very rarely infected humans. As Dr Troop’s fax states, ‘all available evidence indicates that the threat from these bats to the general public, or to pets or domestic animals, is extremely low’. Nor is there any danger of rabies being transmitted from one human to another.

So why activate the cascade? When I rang the Department of Health helpline, the story was that, because the Angus rabies case had been widely reported, people would turn up at their GPs’ surgeries worried that they might have got rabies. The rabies cascade message took the opportunity to advise on the appropriate safety precautions for people involved in bat conservation work. I wondered whether it might have been cheaper for Dr Troop to visit each batperson individually to pass on this message than to activate the cascade, but such a cost comparison was not available.

This week rabid bats, last week dodgy (even doggy) mumps vaccines; two weeks earlier the ‘urgent message’ was about a ‘cluster of wound botulism cases in injecting drug users’….

In the course of 2002, some 13 drug users have acquired serious infections with the notorious bacterium Clostridium botulinum. Britain’s infectious disease chief sombrely warned that ‘clinicians should suspect botulism in any patient with an ‘afebrile, descending, flaccid paralysis’. This sounds nasty – indeed it may present with ‘sudden respiratory paralysis, which may be fatal’.

Now as a humble GP, my diagnostic skills are rudimentary, but I think that if anybody showed up at the surgery with a descending, flaccid, paralysis (and a needle sticking out of their arm) I would spot that they were not very well and send them straight to hospital. If they had a fatal respiratory arrest, I could probably recognise that too, though I could do no more than summon the undertaker. Either way, I could manage without a cascade of useless information (such as the tips provided to drug users about how best to use their ‘works’).

Before botulism, it was a warning about the danger of lead in various ‘calabash chalk’ preparations used in West African communities as a remedy for morning sickness in pregnancy. The Food Standards Agency has found high concentrations of lead in traditional remedies on sale in ‘ethnic shops and markets’ in the form of ‘blocks, pellets and powders’.

Given the small size of the West African community in Britain and the tiny number of such shops and markets, it is difficult to believe that there is no more efficient method of dealing with this problem than sending a fax to every doctor in the country.

As a GP drowning in the public health cascade, I ask myself: what health benefit did these four most recent ‘urgent messages’ bring to my patients? Would they be any the worse if I were to throw out our fax machine and sever the ‘public health link’ with the Department of Health?

The public health cascade suggests that there are offices in high places full of people with time on their hands and money to burn. The government is so desperate to show its concern about issues of health that it is ready to stir up anxieties about non-existent threats like rabies or to promote scares for its own purposes, as in the case of the single mumps vaccine.

The cascade is not only an unconscionable waste of resources. It helps to bring the whole health service into disrepute. When there is a genuine cause for a public health alert, the boy who cried wolf may find that the fax machine has been turned off.

Dr Michael Fitzpatrick is the author of MMR and Autism, Routledge, 2004 (buy this book from Amazon (UK) or Amazon (USA)); and The Tyranny of Health: Doctors and the Regulation of Lifestyle, Routledge, 2000 (buy this book from Amazon UK or Amazon USA). He is also a contributor to Alternative Medicine: Should We Swallow It? Hodder Murray, 2002 (buy this book from Amazon (UK) or Amazon (USA)).

Read on:

Mumps vaccine: swollen concerns, by Dr Michael Fitzpatrick

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