For two countries that share a common heritage and -- mostly -- a common language, the differences between the United States and Britain can be striking. We drive on different sides of the road; Americans call injections shots, the Brits call them jabs.
And in the debate over whether those jabs can cause autism, the focus in the United States has mostly been on a mercury preservative, while across the Atlantic the issue is the MMR -- the measles, mumps and rubella vaccine.
Now the MMR debate has caught fire again in Britain, despite thoroughgoing efforts by the government and health authorities to stamp it out. The question becomes: Will MMR now face more scrutiny in "the states"?
"A former British government medical officer responsible for deciding whether medicines are safe has accused the government of 'utterly inexplicable complacency' over the MMR triple vaccine for children," the Daily Mail reported last week.
The official, Dr. Peter Fletcher, was chief scientific officer at the Department of Health -- not a minor post. He became an expert witness for parents' lawyers, which of course creates a competing interest that needs to be factored in. But Fletcher said his new role gave him access to documents that deeply concerned him.
"There are very powerful people in positions of great authority in Britain and elsewhere who have staked their reputations and careers on the safety of MMR and they are willing to do almost anything to protect themselves," he said.
Strong stuff, but not strong enough to shake the certainty of British health officials that the three-in-one live virus shot and every other routine immunization is safe, effective -- and essential in its present form.
"Britain's leading child health experts united this weekend to reassure parents that the use of multiple vaccines for children was safe, calling claims to the contrary 'irresponsible'", the Observer reported on Sunday.
"The only previous connection drawn between multiple vaccines and illness was in 1996 when autism was blamed on immunisation for mumps, measles and rubella (MMR). The link was refuted by all subsequent studies."
In true Fleet Street fashion, the Observer took a swipe at the competition as well as the contrary viewpoint.
"Groups like the anti-vaccine campaign Jabs, backed by several tabloid newspapers, argued that (more vaccines) would put too much strain on children's immune systems. They said previous combinations of vaccines had triggered serious side-effects in children. The claim was flatly rejected by scientists."
Well, apparently not by all scientists, considering Fletcher's comments.
There is a lot of history -- one might say, histrionics -- in Britain over the MMR, including the departure of the man who first proposed a possible link in 1998, Dr. Andrew Wakefield. He decamped to the United States, where he and doctors concerned he may be on to something persist -- at considerable professional risk -- in studying the issue.
The U.S. Centers for Disease Control and Prevention recommended in 1999 that vaccine manufacturers phase out thimerosal, the mercury-based preservative that was in several childhood vaccines. By now, most routine childhood immunizations are reported to be thimerosal-free -- with the exception of the flu shot, which the CDC recommends for all pregnant women and for children 6 to 23 months old.
We've already questioned the logic of leaving thimerosal in flu shots -- even though it can be made without it, and a small supply of that formulation is available. But at least you could say: In response to public fears whether reasonable or not, the public health authorities took action.
Not so on the MMR, on either side of the Atlantic. Wakefield made what seemed like a relatively modest proposal, to separate the three components and space out the immunizations. After all, separate shots are available, and the measles vaccine was originally given that way.
Nothing doing. "Wouldn't it be better for children to have the vaccines separately?" asks a Q&A fact sheet from Health Scotland.
"No," the agency replies to itself. "Giving the vaccines separately would leave children exposed to measles or mumps or rubella for longer. These can be serious or even fatal diseases. It has been said that giving the three vaccines together overloads children's immune systems. This is not the case.
"Children's immune systems make excellent responses, naturally protecting them against these diseases. No country in the world recommends MMR be given as three separate vaccines. The World Health Organization advises against using separate vaccines because they would leave children at risk for no benefit."
Let's hope the authorities are right about the MMR. If they're not, the failure to take this relatively simple step will be hard to justify. If it turns out the MMR causes autism, said former chief scientific officer Fletcher, "the refusal by governments to evaluate the risks properly will make this one of the greatest scandals in medical history."
And not just in Great Britain.