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Visit or invasion?

It is encouraging to read about vaccines making their way successfully through the early stages of testing. I have been tracking some of the discussion about the SARS-CoV-2 virus in some of the scientific literature. But have to confess that while I can follow the flow of the academic arguments, I find that details ain't sticking in my memory.

I will hardly be alone in having to defer to people with decades of training and experience. However, I have at other stages of my life, seen people benefit from inoculation or vaccination.

More critically, I knew of a family where the parents decided not to allow either of the Salk or Sabin vaccinations against polio to be administered to any of their children. All three caught polio. Although long term there seems to have been no effects, there were many years of misery for the children concerned.

Albert Sabin and Jonas Salk share the glory of all but eradicating polio. But their vaccinations were radically different. Sabin's arrived first to market and was a "dead" virus injected to create immunity. Salk's live-virus oral vaccine shortly followed it.

I think I had the jab. But I certainly remember that a box of sugar cubes became part of the contents of my father's medical bag. Salk's oral vaccine was dripped onto sugar and (almost) every kid took it without question. The small number of dissenters got theirs on a small piece of bread.

I understand that Sabin's jab was considered superior, docs love the needle?, but the ease of administration of a sugar cube won out.

We may be, if we are fortunate, about to see a repeat of the polio vaccine battle. A number of successful vaccines which create the desired antibody creation using a variety of different routes. If successful, that will be good, because a minority for whom a particular vaccine is not appropriate, may have another option.

For the NHS, having a choice of vaccines, if of equal efficacy, should keep the price down as companies compete to get their variant into service.

So for politicians, the challenge will be to avoid dropping options from support when they still look viable. Because in the rush to head off the spread of this virus, the temptation to look for short-cuts is always there.

The traditional "Dr Finlay" approach to community medicine had much to commend it even if a good portion of its success depended on the character of the personal rather than clinical support provided by a trusted local GP. The range of interventions available to them when I was a youngster in the 1940s and 50s was extremely limited by comparison with today.

I remember the excitement of new vaccines and new antibiotics. On one occasion, I had an attack of impetigo, a highly infectious skin condition, which affected my upper lip. This disease killed almost no one and went away of its own accord in about ten days. But I remember my father's excitement at the almost magical effect of Aureomycin, a member of a new class of antibiotics called tetracyclines. Their "trick" was to inhibit the multiplication of bacteria rather than as penicillin which directly attacked them.

As an ointment, it was perfect for my impetigo. It's "magic" effect was, of course, magnified by its using gold as one of its constituents. Hence the "Aureo" prefix. Or so I remember from dinner table discussions. The fact that it was an expensive remedy only seemed to magnify its powers.

Those were simpler days. There wasn't much evidence that GPs spent time extending their skills and knowledge. In today's much more complex world, with a vastly wider range of pharmacological options available, a much greater understanding of the adverse side effects, and the need to consider the interactions of multiple medicines prescribed for more than a single condition in a patient, it's so much more complex.

There was really only one publication that came into the household that gained much consideration. That was MIMS - The Monthly Index of Medical Specialities. It was simply a list of the drugs available for prescription. There were three alphabetical indexes, by drug name, by British Pharmacopoeia name, by disease or condition. And it little bit of commentary at the start about this month's amendments. I suspect this was the only thing father read to keep up to date with what was changing in the medical world. I very rarely saw either the British Medical Journal or the Lancet in his hand. We kids read Pulse, a freebie newspaper for GPs.

MIMS was of some use to the rest of the family too. On a daily basis, packets would be delivered by the postie from drug companies. These samples got slung into a big chest of drawers against the idea that they might prove useful at some future date. Their value seemed to be mostly for self-medication by my siblings and me.

If we thought we were unwell or experiencing a treatable condition, we would consult MIMS. And then rummage around to see if there was a sample that matched our problem. If yes, it was upstairs to consult father. Generally, we would say something like, "Double dose to start and then TID?" (TID - Ter in Die, three times a day - father still prescribed in Latin for names and Greek symbols for quantities). After a brief examination of the medicine, not the patient, he would peer over his specs and generally respond with, "Won't do you any harm".

Today we have central bodies to advise doctors on prescribing. And active monitoring of outcomes.

Choosing from multiple vaccines, as seems not unlikely, will be yet another decision the docs will have to make. But at least there are likely to be solutions available.

I wrote earlier in my diary about our failure to find a vaccine to control the virus clan that causes the common cold even after decades of research. And hung my pessimism about the prospects for a successful SARS-CoV-2 vaccine out to view.

Perhaps today's a day when I should crank up my optimism a notch or two. Although my autumn flu etcetera jabs may require more arms to be punctured in future years. I suspect we shall need at least an annual kick up the rear for our immune systems to continue to be safe from this rotten bug.

As if my cup cannot be already filled up by my pharma-led lifting of mood, my political world will experience a boost today as well.

Boris Johnson is here to help the Independence campaign by reminding us that "London knows best".

Seems he may be visiting the military, as I predicted to my spouse a few days ago, on a visit to Moray.

But then maybe not as he has not done the courtesy of telling the Scottish Government anything about his plans for the day.

Business as usual.


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