“In postmodern medicine, risks and adverse effects will receive a much higher priority”1

To users, adverse effects of healthcare interventions are made up of a perception of exposure to risk, its consequences and the way that information on these is communicated. The story of measles mumps and rubella (MMR) vaccine is a good example of this contemporary paradigm.

In 1998 Wakefield and colleagues described a series of cases of 12 children aged 3 to10 years affected by chronic enterocolitis and regressive developmental disorder.2 Nine of the 12 children had received MMR vaccine within the previous month. Wakefield and colleagues postulated a possible association of these entities with MMR vaccination.2 This work followed an earlier study by Miyamoto et al3 and Ekbomet al 4 who suggested MMR vaccination as a possible risk factor for Crohn's disease. The subsequent onset of autism, the authors suggested, could be attributable to disorders of absorption or breakdown of gut derived peptides, or both, leading to a disruption of normal neuroregulation and brain development.

Since the publication of the Wakefield study on 28 February 1998 public concern fuelled by extensive media coverage, caused a steady decline in MMR coverage in parts of the United Kingdom, with a subsequent …