Koplik's Spots

UPFRONT

EDITORIAL Koplik’s spots Stephen Hancocks OBE Editor-in-Chief

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here are certain facts that most of us remains below the 95% coverage required informed professional debate to ensure that we remember from our undergraduate to confer herd immunity. Te Chief Medical all know what is the most up-to-date medical days that are almost time-honoured Ofcer for England Professor Dame Sally information. While the balance between the Tin their rarity and yet cherished for their Davies recently blamed the situation on the greater good of society as a whole and human erudition. Familiarity with the very rare spreading of social media fake news, adding rights is ever a difcult one, in the UK we have Gorlin’s syndrome is one and knowledge of that parents who believe the lies circulated a track record of making sensible decisions. Koplik’s spots is another. Tese latter, oral online by anti-vaccine campaigners ‘are Compulsory car seat belt wearing attracted lesions are considered pathognomonic for absolutely wrong’, and urged them to ignore the similar complaints of infringing individual measles, occur a few days before the skin rash naysayers. freedom of choice (to be allowed to be cata- appears and thankfully are not ofen seen Tis was followed by Health Secretary Matt pulted through your own windscreen). A ban anymore in the UK due to efective vaccina- Hancock calling a meeting with representatives on smoking in public was also thought initially tion administered as the Measles, Mumps, of some of the social media companies to ask by politicians to be too controversial but was Rubella (MMR) combined vaccine. them to limit and restrict ‘anti-vaxx’ groups then rapidly implemented when it became clear However, sadly, measles is on the rise once spreading their messages; as the companies that the public will was behind it. So, is it time again, most noticeably in the USA but also in had done previously for self-harm images. As a to email social media giants and start a conver- the UK and other countries around the world. result, Facebook has announced that it will no sation about restricting those who oppose the According to WHO, cases have continued to climb into this year with preliminary global ‘Where is the cut off point for free speech data showing a rise of 300% in the frst three months of 2019, compared to the same period versus the public good, and who decides in 2018. Tis follows consecutive increases this?’ over the past two years. Te main reason seems to be a lack of uptake of the vaccine, the blame for which has been laid by some at the feet of social media. Controversy had surrounded the MMR vaccine as in 1998 Te Lancet carried the longer allow advertisements that include misin- universally recognised, safe and efective public results of a small-scale study that claimed formation about vaccines. It will also diminish health measure of water fuoridation? a link between the vaccine and autism and the reach of groups and pages that spread Te ‘fake news’ vaccine story has prompted colitis in children. anti-vaccine misinformation by reducing their no less than the initiator of the term, President Over successive years allegations that ranking in search results and on the News Feed, Trump, to urge all Americans to ‘get the shot’. the study data had been falsifed lead to the removing them from autofll suggestions in the An important message from a quarter and a complete retraction of the paper by Te Lancet search bar, and from recommendation features country arguably not always strong on public and the General Medical Council erasing the such as ‘Groups You Should Join’. health interventions. For those who may be lead author from the Medical Register for being Tis seems wholly reasonable given the seeing more Koplik’s spots in the immediate guilty of serious professional misconduct, importance of the disease and its potential future there is one additional and slightly unnecessarily invasive tests on children and consequences, which can include death. But ironic piece of dinner-party trivia to add to multiple, undeclared conficts of interest. While what of other vexatious anti-public health the repertoire. Dr Koplik (1858–1927), who the scientifc consensus is that there is no causal groups and messages? Should they have their frst described the eponymous markers, was link between the MMR vaccine and autism this activities curtailed on social media too? What a physician in New York and in recent days did not prevent the public’s confdence in the about the anti-fuoridationists? Te anti-amal- that same city has passed legislation to ban vaccine being seriously shaken and vaccination gam lobby? Where is the cut of point for free parents from declining MMR vaccination for rates fell. Having improved somewhat in the speech versus the public good, and who decides their children on religious and other grounds. meantime to 87% of children in England this? Te bedrock, as always, is the importance Biology works in mysterious ways.  receiving both necessary doses, the level of good science, appropriate peer review and DOI: 10.1038/s41415-019-0465-6