Tuesday, March 25, 2008

Vaccines and health care, in general

I recently ventured back to Vox Popoli's blog, where an article/rant on the Evils of vaccines, which I knew would garner much fan-fare from his all-too-eager-to-please-the-master-Vox crowd, caught my attention.

Spoiled trust fund baby, Vox Popoli, rants a predictable conservative, religious diatribe on the evils of vaccinations.

In his typically hateful anti-female rhetoric, Popoli writes a response to Megan McArdle's article "More parents forgoing vaccinations." In her article, McArdle discusses the public health dangers that ride along with parents' refusals to vaccinate their children (which was based on a New York Times article about the same topic.

Popoli states at one point, in typical misinformed, unresearched fashion (in regards to McArdle):

"But your health isn't at risk if you've been vaccinated, right? What a loathsomely liberal fascist little cow! I truly don't know understand why Instapundit likes McArdle so much, she never writes anything even remotely intelligent and regularly coughs up hairballs of asininity like this. If the vaccine industry wasn't hiding so much information about the children being harmed by vaccines, if Congress wasn't indemnifying both the industry and the medical personnel who inject vaccines into non-consenting children, if millions of dollars weren't being paid out by VAERS, if there weren't very good medical reasons to avoid going along with the insane U.S. vaccination schedule, she still wouldn't have a point."

Note to Self #1: Self, if your "argument" isn't strong enough or backed up by any scientific sources, it is acceptable to call your opponent a "liberal fascist little cow" to try to prove your point.

Observe Popoli again doing this in Example #2:

"And there is no more evidence that vaccines are safe than there is that they cause autism, since the vaccine industry has resolutely resisted proper double-blind scientific studies into the safety of its products in favor of population surveys and metastudies of those surveys.

Don't get me wrong, vaccines aren't inherently bad. A limited and voluntary schedule of individual doses at a somewhat older age, spread out over time, is a perfectly reasonable program... in fact, that's how most adults over thirty today were vaccinated. But pumping infants full of toxins that have never been tested in combination with each other, 19 shots in the first six months, isn't just asking for trouble, it's demanding it."

I guess, once again, we should just take this Mensa member's word for it, regardless of the fact that he has no public health, medical, or scientific training or education. Or perhaps the fact that he is a man, and believes himself to be all-knowing, we should just take his word for it.

Bringing us to Note to Self #2: if your argument still isn't strong enough, it's acceptable to fall back on the trusty ole' "she's a woman, I'm a man, hear me roar" argument.

Anyway, the point of my article is not to debate the merits of vaccination programs. But, for the record, I think the benefits of requiring vaccinations for most vaccine-preventable diseases are in the best interests of public health. For libertarian-minded folks (as some of those who frequent Popoli's blog) this breaches their interest for society free from government control. A couple of them had decent points, for example a commenter named Bethyada:

"Beelzebub, I am very pro vaccination (though the US schedule sounds a little excessive). Yes the benefits for many (not necessarily all) vaccines are a group benefit. So what? You can't force law abiding citizens to place into their persons something just because you see the benefit.

Don't you see how draconian your position is? I would rather live with much more risk and less security and have my freedom. How much is life worth living as a slave to the well intentioned?

bethyada, do this because it is in your best interest even though you don't agree with me and it is best for the society.

You don't care for me other than how my cog best fits into your machine

(I agree to disagree based on my own knowledge of public health and vaccines, but I can see his/her point from a libertarian ideology)

I will not, however, engage in the debate with obsessed uber-parents who are extremely misinformed on the topic and convinced that their primary care providers and their vaccines caused the slightest imperfection to their precious, previously perfect little Lambs of God. And luckily, in my job (public health for adults), I never have to.

Observe many of the comments over at Popoli's blog:

"For the children who are affected negatively by vaccines, it is definitely not in their best interest to have been vaccinated.

Obviously, the State is willing to take the risk of sacrificing some individuals. As usual, the risk for the individual is catastophic, while the risk to the State is negligible."

zeno | 03.25.08 - 7:40 am | #

kids need to eat more dirt!
Rory | 03.25.08 - 7:22 am | #

I ate dirt when I was a toddler. I got sick every April and September.

...But it turns out that those months were the blooming seasons for the hedge in our backyard, to which I'm allergic. If my mom had paid a little more attention, I would have been VERY healthy.

Instead, my parents assumed that I was a "sickly child," and I got every shot known to man--which also made me sickly.
Mrs. Pilgrim | Homepage | 03.25.08 - 7:40 am | #

STDs are a real current public health crisis. Perhaps chastity belts for the unlicensed?

Should people who engage in medically risky behavior be in the public venues?

If Abagail Adams saw today in 1776, she wouldn't write about the lack of women's representation as a glaring omission, but as the blessing of God's providence.

Men too can be stupid, but most don't insist on parading it in public.
tz | 03.25.08 - 8:12 am | #

So what's the big deal with a few hundred or a few thousand kids being born autistic in a country of 300 million?

So what's the big deal about a few thousand people getting (fill in disease here) from not getting vaccinated?

So what's the big deal about a few thousand people (out of a country of 300 million) getting killed from being in Iraq?

Something about having to break a few eggs.....

And the "big deal" is that the incidence rate of autism has risen exponentially over the past 10-15 years, indicating a direct cause-effect relationship.
Inquiring Minds | 03.25.08 - 9:23 am | #

Well more droolie kids give them liberal douches more opportunity to show just how compassionate they is by having the police state stick a gun in my face and ask for some more "contributions" for "public health issues".
Michael Maier | 03.25.08 - 9:42 am | #

...At the "two week check-up" (check-up for whom, exactly?) that same doctor informed us that she had a batch of "shots" ready for our two-week-old child and intended to administer a battery of vaccinations. I politely refused. She politely refused to accept my refusal.

I got less polite. And so did she.

I said, "You told us that you would support our decisions on these matters. That's why we chose you as our pediatrician!"

To which she replied, "It is your choice. But I never said I would support your decision. If you refuse these mandatory vaccinations, I can no longer be your pediatrician."

I calmly said, "Please hand me my child." When the child was in my arms, I said, "You can no longer be our pediatrician. It has nothing to do with mandatory anything. It's because you're a liar and a shill."...

*end of comments*

It is sometimes frustrating to talk to people when it comes to their own health, and it is usually futile when it comes to talking to them about their children's health. The best we can do, as medical providers, is to give them current guidelines and practice current standards of care, and be up-to-date on the current research in our fields. But usually, people will follow where their prejudices lead. The mistrust and misunderstanding of the health care system and providers is so great in this country that it makes it difficult to establish a rapport between patients and providers.

I'm going to take a leap here and say that most health-care providers have a genuine interest in helping people be healthier and remain illness-free, or at least enhance quality of lives for their patients. Yet, those in private practices rely on money from insurance companies to turn a profit in their businesses, all while paying malpractice insurance with annual premiums that are sometimes in the six-figure range. In such a litigous society (especially one that makes it so easy to sue doctors and nurses for malpractice), they are bound by fears of losing their licenses, incomes, and means of support for themselves and their families.

Most medical practitioners maintain their practices under the current standards of care for their profession. If those standards (the CDC is the gold standard for immunizations, for example) are not met, then a patient may have a legal case against the provider for not following the currently accepted standard of care. The CDC's immunization schedule is the one that Vox Popoli and other, more adamant vaccine denialists disagree with. For medical providers this is often a no-win situation. Patients like the commenters on Popoli's blog are probably the same ones who would bitch and moan if there were a new epidemic of polio or measles and their children weren't vaccinated for them. They would probably then sue the medical providers for NOT mandating the vaccines.

I think further education is necessary. There are many, many misconceptions on the dangers of vaccines. (the autism/vaccine "link," expect an article on that topic later)

Doctors and nurse practitioners, while often accused of "playing God" in a negative way, are at the same time held up to those God-like expectations by their patients when they are sick. It is a double-standard that we have to accept. Patients expect their medical providers to know immediately what is wrong with them with often vague symptoms and tens of thousands of illnesses to choose from. If we get it wrong, they threaten a lawsuit, and at the very least, they leave the practice as patients.

From my perspective, the one thing I would ask from my patients, is to expect your medical provider to stay up-to-date on the latest professionally-accepted research and standards of care, and to remember that healthcare is a cooperative process. We will usually give you as many options as possible under the current standards of care. Most of us are no more trying to "play God," than we are genuinely concerned for your health, AND trying to avoid any potential lawsuits from an over-litigous society. Don't start your visit with your health-care provider on the defensive before you give them a fair chance. Don't go into the visit with a chip on your shoulder, because you will already alienate yourself from your provider, who would probably like to work WITH you to a better health outcome. While many aspects of health-care in the U.S. suck, don't take it out on your doctors and nurses. We are usually here to help.


Fannie said...

"From my perspective, ...remember that healthcare is a cooperative process. "

You mean people should take an active role in their own health and healthcare? You mean, people should take ownernship of their own ailments? You mean, it's not the fault of our medical providers that we are sick and it's not their fault if they can't immediately "cure" us?

What novel concepts!

Anyway, regarding the healthcare system. I think the "malpractice causes health care to be unaffordable" argument, while relevant, is often exaggerated. The larger problem is the one that you mention- our health care system is controlled by insurance companies who are controlled by profits. They aren't there to look after our health and ensure we get the best care, they are there to ensure that they make the largest profit they can- which usually means denying coverage, prescriptions, and procedures. This topic is entirely deserving of its own article, but our insurance system makes health care for all unrealistic, unaffordable, bureaucratic, and wasteful.

The malpractice piece is difficult. Providers should not be held up to the standard of perfection that they are. But, people should still be able to sue when doctors make stupid mistakes.

Oh, and well done with the Vox Day clusterfuck of ignorance and assholery. There's not really much more that is worth saying about him.

Jane Know said...

I agree that the insurance companies are largely to blame for the cost of healthcare in the U.S. Usually, the only way a doctor is going to get paid (unless funded through external things like grants from a non-profit, for example) is if the insurance companies cover the procedures they are performing in the office. It is getting harder and harder to get them to cover things that patients need. Yet on the other hand, insurance premiums have raised because our nation's health (due to things like sedentary lifestyles, obesity, heart disease, smoking, etc) has largely declined. People live longer now, but they live longer with chronic illnesses. And insurance fraud is not an entirely new concept either. "The People" aren't entirely innocent. Yet, if our govt spent billions more on healthcare funding for at the very least a broader, more affordable range of preventive health care services (paps, cancer screenings, cholesterol, diabetes tests), and decreased funding on things like private contractors for the war in Iraq and other federal defense wastes, we would be in a much better place right now.

John said...

I appreciate the dilemma that parents sometimes face.

Three times in my life I found myself in a situations where I did not agree with what health care professional recommended for my children and I had to take a stand and do what I thought was right over their objections.

But vaccinations are a whole different matter; the science is rock-solid; they work.

Jane Know said...

John, I agree. I have also been in situations where I haven't agreed with my own doctor. (like when my former PCP told me that lesbians don't need to get Pap smears). So I switched doctors to one more knowledgeable on LGBT health. Unfortunately, not everyone has the luxury of choosing multiple doctors (because of insurance restrictions or not having insurance at all). I would encourage everyone to stand up for what they believe is right, and to ask as many questions as possible so they know what is going on. Doctors (and all hospital workers) in particular are notorious for prescribing things and ordering tests without explaining to the patient or family what is going on. There is no excuse for that. Patients deserve to be treated like the human beings they are, and they deserve to know all of their options before anything is done. Because many patients aren't trained medical professionals doesn't mean they don't know their own bodies. It's easy to forget that at times.

Jane Know said...

On a side note, when I said "I would encourage everyone to stand up for what they believe is right," many things can then happen. A good provider would probably list all the options and explain why they are recommending the current treatment or procedure.

Like in the case of vaccine refusal, a doctor may choose to not be their healthcare provider anymore. But it sounds like there are doctors who will care for patients and parents who refuse vaccines. It's all about finding the right provider that fits your beliefs. I can respect differences in religions, practices, and beliefs, and make many accomodations for them, but when someone may be putting themselves or others in danger (according to all the research), I personally would not feel comfortable continuing on as that patient's provider.

John said...

I found myself in a ridiculous situation where the experts could not agree.

When my daughter was starting to walk, she was pigeon toed. My family thought this was serious, but my pediatrician was totally unconcerned. He examined her and observed that while sitting at rest, her hips, legs, knees and ankles were all normally aligned and concluded that she just liked to walk that way.

Then I was forced to change doctors because of change in insurance. My new pediatrician said that while her hips, legs ankles, and knees were fine, her feet were slightly malformed and recommended we exercise her feet by bending them at the arch. (We ignored that advice as he was the only one could see this malformation.)

But the family put the pressure on me and I reluctantly took her to a specialist who recommended that she wear braces to correct the problem. (He made his recommendation after so brief an examination, I know he had that planned in advance).

It just so happens that I have a cousin my age who had the same problem as a toddler, and she wore the braces, so I talked to my cousin's mother. She told me that those braces certainly did correct the pigeon toes, but now she is permanently knock-kneed.

The important thing is that I knew I was doing the right thing by ignoring the "problem" because all the doctors agreed on one thing. There was no malformation of the hips, knees, legs or ankles. As for the doctor who saw the malformed foot? Well, my daughter's feet look exactly like her mother's, and the work perfectly fine.

Jane Know said...

"But the family put the pressure on me and I reluctantly took her to a specialist who recommended that she wear braces to correct the problem. (He made his recommendation after so brief an examination, I know he had that planned in advance)."

I've noticed that a lot of doctors do this. They hear the chief complaint and already have the diagnosis before they get in the room to examine the patient or get more of a history.

I tend to not trust or go back to those providers.

My friend growing up had the same problem... she had to wear those braces, and is now knock-kneed, too. Many children are pigeon-toed when they are young (it's a normal, benign anatomical difference in children) and eventually grow out of it when the heads of their femurs rotate as they grow.

From http://www.uihealthcare.com/topics/bonesjointsmuscles/bone3447.html

"The most common cause of pigeon toes in girls over 2 years old is a hip that turns in causing the thigh bone to twist. When the thigh bone twists, the knees and toes point in. Children with a twisted thigh bone often sit with their legs crossed. The best way to treat this is to have the child sit in a chair with their legs uncrossed. Often this cannot be done until they are school age. This condition usually clears up by itself, but it may take 1 to 3 years for the thigh bone to straighten."

I take it she outgrew it? :-)

John said...

She outgrew it before she hit puberty.

I knew all along there was nothing to worry about.

Thanks for the link; too bad we didn't have the 'net back in those days.

vieve said...


You sound more and more like a public health practitioner:)

Maybe an MPH is in your future?

Jane Know said...

lol, maybe one day... after the APN in a year. :-)

rem said...

i have nothing smart to add, but i can say that jane is real good at giving shots and drawing blood. it like, doesn't even hurt...that's all i got so far...