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Monday, September 10, 2007

Post#3 Who to Believe?

"The irony of the Information Age is that it has given new respectability to uninformed opinion."
Veteran reporter John Lawton speaking to the American
Association of Broadcast Journalists, 1995

As a pediatrician, I try to log in a respectable amount of hours in a noble attempt to keep up with the latest research concerning new treatment modalities, changes in immunization guidelines and patterns in endemic outbreaks of particular germs. Not only do I find articles concerning such topics intriguing, I feel an innate sense of duty to my patient population to stay well-informed. After all, parents spend their hard-earned money and valuable time to seek out my advice whenever they have a question that concerns their child.

Overall, the internet has, for the most part, made my job as an educator easier. Many parents log in their due diligence on various topics prior to their visit, maximizing the value of our conversation. Furthermore, the internet acts as an external screening tool for parents wishing to validate the advice they receive from me; generally, the informDation found on the web is quite reliable and I not only condone this, I encourage it. I will often end a patient visit by writing down my presumptive diagnosis and suggest that the parents read more about their child's condition at home in order to fully understand the natural history of what is to transpire. It is a luxury that my father (a retired pediatrician) did not have.

However, it is not unusual in the course of a busy workday to stumble upon what I deem "disinformation". Most of the time, it is simply loving, however misguided advice/warnings from a grandmother or aunt. The bulk of this "disinformation" comes in the form of old wives' tales that have been passed down from generation to generation, e.g. "not wearing socks will make a baby sick" or "green mucus needs antibiotics". For the sake of brevity, I will refrain from discoursing on why these adages are not scientifically accurate.

Suffice it to say, they are not true. However, neither statement is overtly precarious. Of course, should we start to treat (or continue in some cases) every green runny nose with antibiotics (most of which are viral in origin and thus do not require them), it would contribute significantly to the current surge in antibiotic resistant bacteria. However, case to case, it is hard to argue that a single misdirected prescription of Zithromax can be qualified as hazardous.

Other issues are more frustrating and ominous in nature. Of particular consequence is the issue of immunizations. This is often a touchy subject, which can at times evolve into an insurmountable divide between a family and their pediatrician. It is clear that in their short history in the world, vaccines have had their share of misgivings. Specific examples range from Rotashield-related cases of intussusception (a dangerous condition where your bowel involutes) to seizures related to whole-cell pertussis (whooping cough) vaccine. Both products have now been replaced with safer next-generation immunizations which have fared better in terms of safety profile.

Even with these setbacks, the overall safety profile for immunizations as a whole has been tremendously innocuous. What's more, the overall benefit to humanity is as Mastercard so aptly states: "priceless".

Per the CDC 2006:
"Vaccination is among the most significant public health success stories of all time. However, like any pharmaceutical product, no vaccine is completely safe or completely effective. While almost all known vaccine adverse events are minor and self-limited, some vaccines have been associated with very rare but serious health effects."

Even the CDC readily acknowledges serious side effects amongst the many success stories vaccines have enjoyed. In fact, if you pick up a copy of the regularly updated Bible of vaccines, Epidemiology and Prevention of Vaccine-Preventable Disease, it is refreshingly transparent about past side effects associated with particular immunizations.

The largest current scare to sweep the globe links autism to either the MMR vaccine (Measles, Mumps, Rubella) or thimerosal (a preservative which is currently being phased out in order to increase public confidence in vaccines). The initial stir begin following a 1998 Lancet article in which lead author Andrew Wakefield and colleagues posited a link between the MMR vaccine and autism.

Multiple studies by respectable scientific organizations have since been unable to validate any type of statistical correlation between either the MMR vaccine or thimerosal and autism. In fact, the Lancet journal (as well as 10 of the original 13 authors) itself has renounced the article that it originally published in 1998. Currently, Dr. Wakefield is facing multiple charges of medical ethical misconduct in the U.K. As for thimerosal - Denmark, a country that abandoned thimerosal as a preservative in 1991, actually saw an increase in autism beginning several years later.

Ultimately, I have no problem with a mother or father concerned about the possible deleterious effects of immunizations. Often, these parents are educated individuals who are well-informed and have nothing but the safety of their child in mind. Certainly no one can fault them for this. Furthermore, they have a reason to be antsy about vaccines. There has been some checkered success with certain immunizations in the past.

However, there has to be a filter through which a family decides who and what to believe. Often it is their pediatrician, who hopefully has gained their trust through a history of smart decision making and thoughtful care. And while there are internet sites galore which still tout the harm of MMR as a risk factor for autism, many of these sites rest the foundation of their case on an article which has since been widely discredited. Unfortunately in some cases, the newer data, rather than discrediting Dr. Wakefield, has conversely made him a martyr for parents not wanting to vaccinate their children.

At some point, these same parents hopefully will wonder why the vast majority of pediatricians continue to vaccinate their own children with the MMR vaccine. After all, if anyone has studied immunizations up close and personal, it is a pediatrician. Our education bound with the Hippocratic Oath hopefully qualifies our profession to make judicious decisions for each patient of ours. And like any loving parent, we do what we think is best for our own children. We just happen to have chosen a profession which equips us to be a little more discerning about what we come across on the world wide web. Hopefully, with well placed effort and knowledge we can do our part to keep informed opinion respectable in the era of the Information Age.

1 comment:

nhokkanen said...

Look more closely at the skewed Denmark autism statistics.