We Risk Losing Antibiotics

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approached-by-the-antibiotic-resistance

Antibiotic resistance  is according to our Chief Medical Officer, a far greater threat than the terrorist threat. It is already estimated to cause 5,000 deaths a year in Britain. No new classes of antibiotics have been developed for 25 years: the pharmaceutical industry has focused on more lucrative types of drug that are taken daily for years rather than antibiotics which because they are taken as a short course, are therefore less profitable. Dame Sally Davies, The Chief Medical Officer has warned that that resistance could ultimately make major operations and many treatments we take for granted too dangerous, and medicine will be forced back to the dark ages as effective antibiotics will not be available. She suggested last year that governments step in to help research funding. She is attending a conference in Berlin to address the global response to antibiotics resistance.

 

Infections [communicable diseases] used to be the commonest cause of death but now thanks to better sanitation, immunisations, and antibiotics they account for 7% of all deaths. The major causes of death in the UK are now what we call non communicable diseases such as heart attacks, cancers and strokes. [See my book Medical School Interviews The Knowledge p64] It would be appalling if antibiotics stopped working. As Dame Sally said ‘We won’t be able to do a lot of our cancer treatments or organ transplants’. People may die of a simple scratch again.

Why is antibiotic resistance increasing?

1. Over use of antibiotics by people. We do not need to use antibiotics for simple infections, many of which are viral and do not respond to antibiotics. If people do not take the full course or miss tablets it may allow resistant strains to grow by not completely killing all the bacteria. Although doctors in the UK are rightly criticised for over prescribing antibiotics they actually prescribe fewer than in most countries. It is also possible to buy antibiotics from pharmacies in most countries in the world without a prescription.

antibiotics and farmingimages

2. Overuse of antibiotics in farming. Animals actually consume more antibiotics than people. Infections are common in overcrowded dirty conditions so they are often given in small doses in feeds [this is cheaper than providing better conditions]. They are also used as growth promoters; if they are added to feeds they reduce the amount of bowel bacteria and animals put on more weight. In one study of Chinese pig farms Chinese and American scientists detected 149 unique resistance genes. The top 63 antibiotic-resistance genes were found in concentrations between 192 times and 28,000 times higher than “control” samples of manure or soil that were antibiotic-free. Salmonella, a bacterium found in poultry and infects humans who may eat undercooked chicken [barbecues are common culprits] has become increasingly resistant to antibiotics in this way.

3. Antibiotics are expensive to develop. There is not much incentive for drug firms to develop new antibiotics as they tend to be taken for just a few days while a new blood pressure pill may be taken continuously every day by a patient. Dame Sally said action was needed to overcome this “market failure” and stated that this should be taken up by the ‘Innovative Medicines Initiative’ – an EU funded body whose aim is to promote the development of new medicines. David Cameron had a similar discussion with G8 leaders [ the leaders of the richest 8 nations]
Leading microbiologists say that there are only a small number of ways of attacking bacterial cells and these are being exhausted. If we squander the antibiotics we have we will not necessarily have new antibiotics to take their place. There have not been any new antibiotic groups since the 1980s.

What can we do?
1. We should reserve antibiotics for serious infections. I often think of Tolstoy who said ‘Time and patience cures most things’- unfortunately many patients don’t have the time to be ill and certainly not the patience! MRSA[methicillin resistant staphylococcus] and clostridium difficile rates in hospital have decreased in hospital since better practices were introduced but unfortunately there has been a rise in E coli and other infections.We need to look very carefully at farming practices. Antibiotics should not be used to make up for shoddy, dirty farming practices.

antibiotic resistance staph
2. Value our ‘good bacteria’. About 90% of the cells in the human body are supposed to be bacteria. We have trillions of bugs living in our gut and on our skin. Most of these cause no harm and some are helpful. Their presence stops bad [pathogenic] bugs growing by depriving these pathogenic bacteria of space to grow. We know that over washing can lead to more rather than less skin infections and it is common after a course of antibiotics to get other infections such as thrush [a yeast infection which grows into the space that had been occupied by good bacteria now killed off by antibiotics.]
Many teenagers may be taking antibiotics for acne. These work against Propionibacterium acnes bacteria which cause inflammation in sebaceous glands of the skin leading to spots. Recent studies seem to show that those teenagers without acne still have Propionibacterium acnes but of a strain that does not cause inflammation. Perhaps in the future a treatment using this ‘good strain’ may become available. [J. Bacteriol. January 2012 vol. 194 no. 1 202-203]
Probiotics– These have been shown in some studies to be helpful in treating diarrhoea. They contain harmless bacteria like lactobacilli which are supposed to displace harmful bacteria. Studies have shown that taking capsules of ‘healthy faeces’ known as a ‘faecal transplant’ also helps certain types of diarrhoea by re-colonising the gut with normal healthy bacteria!poop_by_a_ufo_lost_in_flames-d5qoq873. Bacteriophages are viruses that infect bacteria. They have been used for over 90 years as an alternative to antibiotics particularly in Eastern Europe and the Soviet Union. They are usually very bacteria specific – only acting on one type of bacteria. There has has been increased interest in them because of antibiotic resistance and since 2006 several types have been licensed including one against MRSA! However they are still not in common use

bacteriophage

There must be a global, coordinated campaign. In some parts of the world antibiotic resistance is much greater. New Delhi Metallo-beta-lactamase-1 (NDM-1) is thought to have emerged in India where poor sanitation and antibiotic use have helped resistance to spread. This multi-resistant bacteria has been found in the Delhi drinking water but due to international travel, cases have been detected around the world including in the UK. Britain misuses antibiotics much less than many countries where they can be bought cheaply without prescriptions. Drug resistance cases of bubonic plague have also been discovered in Asia raising the spectra of recurrence of a disease that some estimate to have wiped out a third of the population of Europe.

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Personal Statements

UCAS logoPersonal Statements – you should have these ready to go off. I am re-blogging this to help you make those final touches.

Look up the the medical schools you want to apply to and list ‘key words and phrases’ that come up in their prospectus such as ‘appreciation of the human story’ ‘proven commitment’ and the ‘knowledge of the reality of becoming a doctor’  and bear these in mind when you write your personal statement.

My advice is to put everything you can think of down on paper at this point. You can edit and summarise and précis  everything later. It is important to get started.

  1. Introduction –Why you want to be a doctor. The hardest bit. Try to write something original but it is so hard to say something that is not a cliché as admissions staff see thousands of applications. Do not hyperbolise the virtues of doctors. Statements such as ‘Medicine is the only career that combines a love of science and caring for people’ are just not true and denigrate other professionals. Graduates should describe a “eureka” moment that made they decide that they wanted to medicine.
  1. Work experience – don’t list places or procedures. Remember they are most interested in what you learnt ‘from you experience not what you did. Medical schools say that they are looking for students with the ability to reflect and learn. Did you notice that doctors required any special qualities such as ‘courage’, ‘good communication skills’? Do you have these and are there any examples that prove that you have these? Perhaps mention the downsides of being a doctor  and why that does not put you off.  Remember doctors are dealing with human beings- it is no longer considered correct to refer to patients by their disease such as ‘the diabetic’ in bed 4 or the ‘asthmatic’ in bed 6 – it dehumanises them. Remember the ‘patient story’ is important. Referring to this shows empathy.
  1. Voluntary work; Again be brief about what you did and write mainly about what you learnt. It is probably good to mention a few of those ‘key qualities’ such as good communication skills, any leadership skills teamwork etc in this section as well as the next.
  1.  Extra curricular  activities.  Universities are looking for people who excel in  non academic fields in addition to getting good grades. What ever your passion or hobby always relate it back to how the skills you have learnt will help you in a medical career.

As in the previous paragraph mentioning how you demonstrated ‘competence skills’ such as teamwork, leadership skills, coping with stress or challenging behaviour, compassion and empathy.

They also want to know that you are sociable ‘well rounded’ person who knows how relax and ‘de-stress’. It is always an advantage if they think you may be able to contribute to University life eg the rowing team or drama society.

5. You may want to write about something you studied and enjoyed. It is not necessary to list every subject. Again focus on one or two points and avoiding listing. Perhaps mention books [or journals] you have read and why you found them interesting.

6. ‘Love of science’ it may be important particularly for Oxbridge entry to refer to    this. Say what it is about science that interests you – ‘scientific logic’ for example.

7. The Conclusion . Sum up and try to end with a flourish.

NEVER DISPLAY A HINT OF ARROGANCE BUT NEVER PUT YOURSELF DOWN!

Assisted Dying – Noel Conway loses his case.

Noel Conway.

Noel Conway, 67,  has motor neurone disease,  a condition that results in progressive  weakness of the muscles including respiratory muscles. He was a fit healthy man who used to enjoy a range of sports such as skiing however he now has virtually no movement and needs a ventilator to help him breathe. He argued that he wanted a doctor to be allowed to prescribe a lethal dose when his health deteriorates and does not want to be entombed in his body.

Noel skiing

Before his illness Noel Conway was a keen cyclist, skier and climber

Currently any doctor helping him to die would face up to 14 years in prison. He argued that the alternative would be pulling out his breathing apparatus which would lead to an uncomfortable and distressing death by suffocation. He said he could either bring about his own death while still physically able to do so, or await death with no control over how and when it came.

Assisted suicide is in the news a lot and is often the subject of ethical scenarios at medical school interviews.

Arguments against assisted suicide
1.‘Thou shalt not kill’ is one of the oldest moral commands. It has been a key part of medical ethics for centuries. The original Hippocratic oath states ‘I will give no deadly medicines to anyone if asked, nor suggest any such counsel.’ Many religious people contend that only God has the right to give or take life.
2. Those that are infirm may be pressurised to die or made to feel selfish or a burden if there was this option. Peter Saunders, from the Care Not Killing Alliance, said the decision was right “because of the concern that vulnerable people might be exploited or abused by those who have a financial or emotional interest”.
Slippery slope arguments. The ‘slippery slope’ argument holds that if assisted suicide was practised for people like Mr Conway then it would become acceptable to allow it for less clear cut cases and eventually you may end up with a situation as in Nazi Germany where those deemed to be defective were killed.
4. With good pain control and counselling, suffering will be minimised.

Arguments for assisted suicide:
1. The person’s right to autonomy, control over his or her life. According to polls most people in the UK feel that they should be able to have some control over when and how they die. In many philosophical traditions ‘egoistical suicide’ [death for one’s own reasons such as to avoid pain] is considered selfish and wrong. However the aim of ‘altruistic suicide’ which is carried out for the love of others or for the religion [eg Jesus praises a man who lays down his life for others [John 15;13] ] is more acceptable to most religions. It can be argued that someone who wishes to die in order not to be a burden is following the same principles.
2. Some, such as Debbie Purdy, who had multiple sclerosis, have argued that if her husband faced prosecution for helping her to commit suicide she would travel to Dignitas earlier while she could do so alone. However if the law permitted her to have help she would delay dying.
3. Even with the best palliative care [treatment of the dying] suffering and pain are common. Dr Ann McPherson, who set up the charity and website ‘Teenage Health Freak’ and supported a change in the law on assisted dying, died recently from pancreatic cancer. Her daughter wrote in the BMJ ‘our mum died slowly and in pain. …The law needs to change to allow terminally ill but mentally competent people the right to a more dignified death than my mum’.

Euthanasia
Active euthanasia is when death is brought about by an act – for example when a person is killed by being given a deliberate overdose of pain-killers.
Passive euthanasia is when death is brought about by an omission – i.e. when someone lets the person die. This can be by withdrawing or withholding treatment. Eg stopping a ventilator.
Active euthanasia is illegal while passive euthanasia is legal. ‘Thou shalt not kill but need’st not strive officiously to keep alive.’ [Arthur Clough 1850’]. It has been argued that often the moral difference between acts and omissions is tiny. The Catholic Church for example sees no difference between the two – ‘The act or omission which, of itself or by intention causes death in order to eliminate suffering constitutes a murder.’ [Catechism of the Catholic Church] NB In common language euthanasia is often used to mean active euthanasia.

What society thinks is usually reflected in the laws of a country. Assisted suicide is presently illegal but the view of the general population seems to be shifting with about three quarters of the population now reportedly backing assisted suicide. This is reflected by the lack of prosecutions of those helping loved ones go to Dignitas [the clinic offering assisted suicide in Switzerland].‘The law has a stern face but a kind heart’ is how Baroness Finlay described the present situation. However Lord Falconer has said:
‘No one has the stomach to enforce the current law, because it is inhumane and further provides no protection for the vulnerable. The threat [of prosecution] forces some people to die alone and earlier than otherwise for fear of what may happen to those who accompany them.’

The Director of Public Prosecutions was asked by Debbie Purdy a multiple sclerosis sufferer under what circumstances her husband would be not be prosecuted if he helped her travel to Dignitas. He produced a set of guidelines in 2009 in which he stated that the patient had to have shown that they had come to a ‘clear, settled and informed decision’ to commit suicide and that the loved one who aided them was entirely motivated by compassion.

Abortion should not be a crime.

assisted suicideAbortion is in the news again. The President of the Royal College of Obstetricians and Gynaecologists said that abortion should continue to be regulated and the 24 week upper limit retained but it should be decriminalised.

The Republic of Ireland has announced that voters will be asked to decide whether to change the Irish constitution under which abortion is only allowed if the life of the mother is in danger. The penalty for having an illegal abortion faces up to 14 years in jail. However thousands go abroad each year to obtain an abortion.The planned referendum could be held in May or June during or just before the planned papal visit to Ireland.

The Eighth Amendment of the Irish constitution, introduced in 1983, gives an equal right to life to a pregnant woman and an unborn child. This referendum is partly due to the death, four years ago Savita Halappanavar, an Irish dentist. The 31-year-old dentist was told that she was miscarrying, she asked for a medical termination a number of times of the nonviable foetus over a three day period, during which she was in severe pain. But her husband said these requests were denied because a foetal heartbeat was still present and they were told at one point: “This is a Catholic country.” Medical staff removed the dead foetus days later after the heartbeat stopped but Halappanavar died of septicaemia on 28 October 2013.

Northern Ireland has similar laws. Women are only allowed an abortion [termination of pregnancy] if there is a severe threat to their life.  Rape, incest and fatal foetal abnormalities are not circumstances in which they can be performed legally. This summer Parliament agreed to fund abortions for women in Northern Ireland coming to England but they still cannot have them in their own country.

The Abortion Act 1967 [UK but not Northern Ireland] makes abortion legal if one of the following criteria are agreed by 2 doctors.

[a] If the pregnancy has not  reached 24 weeks and there is  greater physical or mental risk of harm to the mother or her existing children and family by continuing the pregnancy.

[b]. At any stage if there is serious risk of permanent injury to the health of the mother

[c] that the continuance of the pregnancy would involve risk to the life of the pregnant woman.

[d]  At any stage if the foetus is likely to be born with severe physical or mental abnormalities.

Pregnancy and delivery are more dangerous than a termination so reason number one suggests that provided the pregnancy has not gone far there is effectively abortion on demand. However late terminations, beyond 12 weeks are rare. 90% are before 12 weeks in the UK.

Abortion is a very emotional subject. It is the only procedure that a doctor can opt out off. But the GMC advises that your personal beliefs should not affect your treatment of a patient. Even if you disagree with a patient who requests an abortion that patient should be treated with consideration and empathy. It may be reasonable to ask her to consider other options if she does not seem completely sure but that should not result in any significant delay. The patient should be quickly referred to a colleague who is willing to help her.

The major organs are formed by 12 weeks. The vast majority, 90% of abortions take place before 12 weeks in this country.  We think that the foetus may begin to feel pain at 20 weeks when the nervous system begins to mature.  When can they think, when does sentient life begin? Philosophers and ethicists and religious leaders have endlessly debated  when recognisably human life truly begins. The Pope and Catholic Church argue that even contraception is wrong because it prevents human life. The law in the UK argues that it is when independent life outside the uterus is possible. Medical science has advanced and many now argue that we should bring down the 24 week limit but the Royal College and BMA argue that while life outside the uterus is possible below 24 weeks babies born this young usually have  permanent disabilities.

Brave New World – what CRISPR- cas9 could do to humanity.

genetic engineering

 

Professor Doudna, a molecular biologist at Berkeley talked about her hopes and fears regarding the science she pioneered to the Times. In my nightmare she said ‘ I opened the door and the man turned out to be Adolf Hitler, but with the face of a pig   ‘I want to understand the uses and implications of this amazing technology you have developed.’ he said.’

Gene editing has become cheap and easy by CRISPR cas9 – an exciting  biological system for altering DNA. Prof Dupre of the Nuffield Council describes CRISPR cas9 as “satnav with scissors”, because it uses proteins to cut DNA at a precise, targeted location. Genome editing is the deliberate alteration of a selected DNA sequence in a living cell, A strand of DNA is cut at a specific point and then natural cellular repair mechanisms repair the broken strands.

There are 4,000 known inherited single gene conditions, such as cystic fibrosis. affecting about 1% of births worldwide. Genome editing leads to the possibility of such conditions being treated.In 2015 it was reported that a Chinese team of researchers had corrected disease-causing genetic mutations in non-viable embryos, so they were not allowed to develop. The UK’s Human Fertilisation and Embryology Authority (HFEA) also granted a licence in February 2016 to allow genome editing of embryos in the UK. British researchers led by Kathy Niakan at the Francis Crick Institute have begun removing individual genes from surplus IVF embryos that could not survive longer than the 14 limit allowed for experimentation to see what they do. Professor Doudna names Dr Niakan as one Time magazine’s 100 most influential people in the world.

This summer  two year old Layla was declared free of leukaemia. She was saved after researchers took ‘scissors’ to a donor’s immune cells, in June 2015 and added new genes that would help her fight the cancer that was seemingly unstoppable even in the face of maximum chemotherapy. Now Prof Doudna feels it is just a matter of time before IVF clinics start using it on a number of inherited conditions. There are 4,000 known inherited single gene conditions, such as cystic fibrosis. affecting about 1% of births worldwide. Genome editing leads to the possibility of such conditions being treated.

The possibilities are exciting but she describes it as opening up a ‘Pandora’s box’ of ethical dilemmas.

Positives;

Humans -Preventing and correcting inherited diseases  but this could lead to the slippery slope of designer babies.

-Designing stem cells to be used in medicine

-Fighting illnesses such as cancer in Layla

-Animals – Livestock selected to use less food and water and grow faster.

-Bringing back extinct species.

Plants –    Designing resistant crops  suitable for particular environments that can go        quickly and cheaply

Negatives – Designer babies, designer pets ‘Frankenpets’.

As with any advancement in technology,  such as nuclear energy, how the science is used will depend the intelligence and intrinsic values of humans in positions of power .  Hence I suppose Professor Doudna’s nightmare about Hitler.

 

 

 

Ethical Scenario -Whistleblowing.

whistleblowers-cartoon

The Whistleblower’s dilemma

 

You have a great job with a well known accountancy firm in the city. The accountancy firm sponsored your degree. You are working on the tax returns of an important client and you notice there are discrepancies in the accounts. You have brought them to the attention of your boss who tells you to ignore them and not to ever mention this matter again. What issues arise here?

Fraud occurring within an organisation is known as corporate fraud.  This involves deliberate dishonesty to deceive the public. This appears to be happening in this scenario. It may be helpful to see the scenario from all points of view:

The Company

Good companies should have a whistle-blowing policy. This allows employees to raise concerns about malpractice within the organisation which may be leading to loss of income or may lead to substantial fines if the company or company workers were found to be engaging in malpractice. It would work to the advantage of the employers in preventing employees engaging in external whistle-blowing which, if it happened, could undermine the credibility of the organisation. Action may pre-empt further abuses and lead to greater transparency within the organisation. PIDA [Public Interest Disclosure Act]-is an employment law act that protects workers from detrimental treatment or victimisation from their employer if, in the public interest, they blow the whistle on wrongdoing.

The Boss

It is very hard to approach your boss and effectively accuse them of dishonesty. Most whistle-blowers sacrifice their career and end up being slandered and victimised despite PIDA which [see above] is supposed to protect them. It would be best to make your concerns to him in writing [email] and avoid ‘discussions’ for which you will have no solid proof.

You – the new employee

You must report your concerns first to your boss and if you feel you have not got a satisfactory response you need to notify those further up the chain of command.

If this is also not successful then it should be reported to a third party such as The Serious Fraud Office. You could contact your Union if a member. Whistle-blowing can lead to alienation at work and termination from the job. Co-workers sometimes perceive whistle-blowing as “snitching” or as a betrayal of the organisation and its members. Four out of five workers end up being sacked or leaving [often with a gagging clause inserted in a termination agreement]   and only 1 in 5 whistle-blowing claims are apparently successful.

Society

The major ethical principle of Justice invokes fairness. Fraud is not fair. If as in this case someone is not paying their taxes as they should, then society loses out as there is less money for public services. It has been said that the economic crisis in Greece is partly due to the fact that so many, particularly the wealthy, avoid tax.

The diagram below is ‘the whistle-blower’s cross’. Being a whistleblower often leads to the hardships described in figure2

whistleblowers cross

 

Gene editing is here.

genetic engineering

Two year old Layla was declared free of leukaemia last week. She was saved after researchers took ‘scissors’ to a donor’s immune cells, in June 2015 and added new genes that would help her fight the cancer that was seemingly unstoppable even in the face of maximum chemotherapy.

layla richards

Last  week scientists in the USA started  gene editing in sperm, eggs and embryos to prevent inherited disorders such as cystic fibrosis and Huntingdons.

Gene editing has become cheap and easy by CRISPR – an exciting  biological system for altering DNA. Prof Dupre of the Nuffield Council describes CRISPR as “satnav with scissors”, because it uses proteins to cut DNA at a precise, targeted location.Genome editing is the deliberate alteration of a selected DNA sequence in a living cell, A strand of DNA is cut at a specific point and then natural cellular repair mechanisms repair the broken strands.

There are 4,000 known inherited single gene conditions, such as cystic fibrosis. affecting about 1% of births worldwide. Genome editing leads to the possibility of such conditions being treated.In 2015 it was reported that a Chinese team of researchers had corrected disease-causing genetic mutations in non-viable embryos, so they were not allowed to develop. The UK’s Human Fertilisation and Embryology Authority (HFEA) also granted a licence in February 2016 to allow genome editing of embryos in the UK.

There are obvious concerns, such as the potential risks of unintended consequences of changing DNA and the implications for future generations. There is the worry  of ‘designer babies’ where gene editing is used to produce attractive characteristics rather than treat serious conditions

The Nuffield Council said discussing ethical issues now would aid public understanding of the new technology. Scientists were taken aback by public opposition to GM foods and needed to take the public along with them this time.

There are a number of ethical issues but advances in genetics have created an unstoppable push to use such technologies in humans. Despite the UK parliament passing a law to allow manipulation of mitochondrial DNA to created 3 parent babies the US beat the UK and a baby boy containing genetic information from 3 parents was born last week. https://www.newscientist.com/article/2107219-exclusive-worlds-first-baby-born-with-new-3-parent-technique/.

Measles and a very sad, true story by Roald Dahl about his daughter’s death.

Measles is back in the news again. The disgraced doctor, Andrew Wakefield who was struck off for fabricating research and concealing payments,was back at a secretive showing of the new film ‘Vaxxed’.  This anti vaccine film by a conspiracy theorist alleges that the CDC [Centre of Disease Control in the US]and the  government suppressed information showing that the measles vaccine causes autism. Unfortunately measles which had been eradicated in the US is now on the rise as fearful parents refuse to allow their children to be vaccinated and they have the sympathy of a scientifically inept President.

Donals Trump tweeted

‘Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn’t feel good and changes – AUTISM. Many such cases!’

Donald Trump has also appointed Robert Kennedy Jr, a prominent vaccine conspiracy theorist, to chair a commission on “vaccination safety and scientific integrity”.

MEASLES: A dangerous illness by ROALD DAHL

roald dahl 1

Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything.

“Are you feeling all right?” I asked her.

“I feel all sleepy,” she said.

In an hour, she was unconscious. In twelve hours she was dead.

The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her.

That was twenty-four years ago in 1962, but even now, if a child with measles happens to develop the same deadly reaction from measles as Olivia did, there would still be nothing the doctors could do to help her.

On the other hand, there is today something that parents can do to make sure that this sort of tragedy does not happen to a child of theirs. They can insist that their child is immunised against measles. I was unable to do that for Olivia in 1962 because in those days a reliable measles vaccine had not been discovered. Today a good and safe vaccine is available to every family and all you have to do is to ask your doctor to administer it.

It is not yet generally accepted that measles can be a dangerous illness.

Believe me, it is. In my opinion parents who now refuse to have their children immunised are putting the lives of those children at risk.

In America, where measles immunisation is compulsory, measles like smallpox, has been virtually wiped out.

Here in Britain, because so many parents refuse, either out of obstinacy or ignorance or fear, to allow their children to be immunised, we still have a hundred thousand cases of measles every year.

Out of those, more than 10,000 will suffer side effects of one kind or another.

At least 10,000 will develop ear or chest infections.

About 20 will die.

LET THAT SINK IN.

Every year around 20 children will die in Britain from measles.

So what about the risks that your children will run from being immunised?

They are almost non-existent. Listen to this. In a district of around 300,000 people, there will be only one child every 250 years who will develop serious side effects from measles immunisation! That is about a million to one chance. I should think there would be more chance of your child choking to death on a chocolate bar than of becoming seriously ill from a measles immunisation.

So what on earth are you worrying about?

It really is almost a crime to allow your child to go unimmunised.

The ideal time to have it done is at 13 months, but it is never too late. All school-children who have not yet had a measles immunisation should beg their parents to arrange for them to have one as soon as possible.

Incidentally, I dedicated two of my books to Olivia, the first was James and the Giant Peach’. That was when she was still alive. The second was ‘The BFG’, dedicated to her memory after she had died from measles. You will see her name at the beginning of each of these books. And I know how happy she would be if only she could know that her death had helped to save a good deal of illness and death among other children

the-enormous-crocodile-by-roald-dahl