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I recently had an interesting consultation with a family who had newly registered with me. They presented with their 3-week-old baby for a discussion about future immunisations. They had one older son aged 4 who had diabetes mellitus. The parents were mostly concerned about a possible causative link between vaccinations (particularly MMR) and IDDM. This was a tricky consultation because the parents were intelligent, informed, articulate and absolutely convinced that the MMR vaccine had caused their older son's diabetes. The parents clearly exhibited a number of important biases (anchoring, illusory correlation, causative and base-rate bias) that had coloured their thinking. I lacked the information and statistical tools to help them properly evaluate their options. The only information source available to me was the immunisation "Green Book" which was unhelpful in answering their specific concerns. My main success was to elicit the parents' concerns and agree referral to a paediatrician for further advice. I have tried to deal further with this (in an EBM way..) as follows... My main objective here is to ascertain if there was a causative link childhood immunisation (particularly MMR) or viral infection and juvenile onset diabetes mellitus. So I would be looking for evidence of a harm study linking these factors. My search question was: Does the routine immunisation of children with MMR vaccine increase the risk of those children developing juvenile onset diabetes mellitus? My search strategy would involve the following resources: 1. Medline 2. Bandolier site search 3. Cochrane Library (web search) 4. Internet Medline gave me only 2-3 interesting hits (via the BMJ website) & had no abstract on either article (one a letter from NZ & the other an article from Russia). I could get these from the library but that's 8 miles away. Bandloier, Cochrane & the internet provided nothing. I have used a variety of search phrases & strategies without success o the internet trying some general search engines & specific diabetes sites. I would appreciate comments on my strategy & any advice for other potentially useful information sources? +++++++++++++++++++++++++++++++++++++++++++++ + Dr Alan Hassey, [log in to unmask] + + The Fisher Medical Centre, Skipton + + GP Computer Adviser North Yorks HA + + RCGP Health Informatics Group & JCG + +++++++ PGP public key ID: 161BB451 +++++++++ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%