Over the last several centuries, science has advanced by leaps and bounds. Just in the last 200 years, our understanding of the structure of atoms has improved dramatically. At first, many scientists thought that they were the smallest constituents of matter (atomic literally means irreducible or unsplittable). Then electrons were discovered and scientists modeled atoms as a pudding, with electron "plums" in it. It was not long before they were able to discover that the distribution of charge within an atom does not support that model, and next atoms were modeled as electrons orbiting the nucleus. Again though, this model was frustrated by quantum physics, and our current model has an atomic nucleus surrounded by an "electron cloud" that is not actually an orbital, but a probability space within which the electrons are most likely to be located. No one believes in the plum pudding model anymore, and while diagrams often represent atoms using the orbital model, no one in serious science actually believes in that model either. As old science has been disproved, scientists have moved on to more proven and supported science. This is true in all fields except for one.
In medicine, we still have this theory that diseases are caused by mysterious miasms. Many people believe that burning a certain fungus on or near the skin (yes, this does often cause painful burns) can cure diseases. There is a whole discipline of medicine that believes that pressure or pin pricks on the skin can cure anything. There is even a discipline that believes merely imagining a disease leaving the body will make it actually do so. I thought medical science was past all of this. I thought that we established more than a century ago that most diseases were caused by viruses or bacteria, which can and have been observed under microscopes and in cultures, not some mystical, undetectable magic "miasms." I thought that we invented medicines and medical practices to fight these infections, instead of using shamanistic practices without any record of verifiable success. In short, I thought that medical science had advanced the same way classical physics has. It turns out I was very wrong.
Homeopathy is a medical discipline that believes disease is caused by miasms. Despite the fact that the existence of viruses, bacteria, and other pathogens, not to mention proven explanations for the causes of other non-pathogenic diseases, like cancer, has been well proven, plenty of people still believe in these totally undetectable magical disease causing things called miasms. And worse, they pay real money for water or alcohol preparations that at one time might possibly have had a few molecules of some "medicine" in it, before it was diluted out to the point that modern science has proven that most homeopathic "drugs" don't even have a single molecule of the original, supposedly curative substance in them. (Which is actually a good thing, given that many of them are potent poisons in high enough concentration to have any effect at all.) The only thing homeopathy is actually successful in is the placebo effect and convincing seriously sick patients to forgo life saving treatments long enough that they die from preventable causes.
Most other forms of "alternative medicine" are more believable than homeopathy, but most of them also have a host of evidence against them. For instance, Traditional Chinese Medicine, including acupuncture and moxibustion (that thing about burning the fungus) have potentially believable biological explanations for their claims. Acupuncture is supposed to stimulate nerves in ways that aid the immune system (though, the original explanations involving the flow of life energy are a rather less supported by biology). The problem is that it does not actually work. This is not a matter of modern medicine attacking it to reduce competition. Plenty of research, including many clinical trials, has shown that getting stuck with needles in special life energy or nerve points is no more effective than water or saline injections with a hypodermic needle in the normal places injections are given. (It does turn out that getting injected is actually one of the most powerful placebos, but that does not justify the prices of Traditional Chinese Medicine.) Still, many people choose to believe in these practices, despite the fact that they have repeatedly been disproved. As with homeopathy, aside from the placebo effect, Traditional Chinese Medicine does little more than convince people to die by forgoing proven life saving medical treatment.
Even treatments like Chiropractic have questionable claims, though, Chiropractic has some proven benefits for spinal health, and it has been proven to relieve muscle pain associated with spinal misalignment. There is not significant evidence that Chiropractic can cure cancer, but there do seem to be some health benefits from it, though those may largely be related to the fact that pain relief tends to relieve harmful stress.
Altogether, we almost live in a highly scientifically enlightened age. The big exception is the field of medicine, where a lot of people seem to take the most important part of science, their own health, for granted, and treat it as something of so little value that they will ignore all of the warnings and choose to be guinea pigs for already disproved treatments. I suppose this could be regarded as natural selection against poor judgment, but I think the government bears some of the blame as well. Alternative medicine is the only medical discipline where the burden is to disprove, instead of to prove. In modern medicine, there are strict government requirements on proving that a medication or procedure is reasonably safe before it can be administered to the general public. In alternative medicine, largely anything is permitted so long as it is not proven ineffective or harmful under extremely rigorous trials (about the same rigor required of modern medicine to prove its claims, which no one is willing to fund for alternative medicine), and the burden of proof lies on no one in particular, making it very difficult to prosecute and shut down all the quacks and charlatans. I am not opposed to finding new medical treatments, especially ones that might cause consternation in the modern medical community (they need to get stirred up about things once in a while, and some serious competition would do the medical industry a world of good), but it is beyond absurd to place strict restrictions on safety and evidence of claims on the only scientifically based medical community without doing the same for all of the medical disciplines that are not backed by science. I mean, allowing faith healing is one thing, but allowing practices that have been proven harmful or potentially harmful is another altogether.
Showing posts with label medicine. Show all posts
Showing posts with label medicine. Show all posts
19 May 2015
05 January 2015
Misuse of Technology
Within the last few years, some of the most potentially useful technology for medical use has gained wide popularity, especially among teens. E-Cigarettes have become more popular than traditional cigarettes among teens in the U.S. These high tech cigarette replacements vaporize water containing nicotine and sometimes flavorings or aromas, for inhalation. They are safer than traditional cigarettes which also contain tobacco tar, toluene, and other dangerous substances, but there is no evidence that e-cigarettes are any less addictive than traditional tobacco. This is a shameful and stigmatizing use of a technology that could be very valuable in modern medicine.
Many types of medication have been found to be more potent and effective when inhaled as a vapor. Several anti-histamines are commonly administered as a nasal spray to take advantage of the ability of mucous membranes to absorb medications quickly. Inhaled medications (steroid vapors, for instance) are an essential part of long term asthma treatment. In theory, many other kinds of medications could benefit from a vapor delivery system. The problem now, however, is that every e-cigarette will be assumed to be charged with nicotine. The most valuable uses of these devices will stigmatize patients, and they will like be banned from schools and similar public places, regardless of their medical value. A track record of this has already been established in a few instances where insulin was banned in certain public schools, because the hypodermic needles used in administering the life sustaining drug are the same as needles used in administering heroin. E-Cigarettes are likely to share the same fate, only this time, the medical industry as a whole may choose to avoid the use of this incredibly valuable technology, because its first public use was to administer nicotine.
E-Cigarettes are some awesome technology, and they could easily be the realization of futuristic drug administration, for completely legitimate pharmaceuticals. They could make a number of vapor born drugs that are currently difficult to administer easier and cheaper to use. E-Cigarettes might even use useful as an alternative means of administering certain vaccines. These devices should be the next medical break through. Vapor administration of legitimate pharmaceuticals could be easier and safer than current means, and we should be taking advantage of this technology for something good.
Many types of medication have been found to be more potent and effective when inhaled as a vapor. Several anti-histamines are commonly administered as a nasal spray to take advantage of the ability of mucous membranes to absorb medications quickly. Inhaled medications (steroid vapors, for instance) are an essential part of long term asthma treatment. In theory, many other kinds of medications could benefit from a vapor delivery system. The problem now, however, is that every e-cigarette will be assumed to be charged with nicotine. The most valuable uses of these devices will stigmatize patients, and they will like be banned from schools and similar public places, regardless of their medical value. A track record of this has already been established in a few instances where insulin was banned in certain public schools, because the hypodermic needles used in administering the life sustaining drug are the same as needles used in administering heroin. E-Cigarettes are likely to share the same fate, only this time, the medical industry as a whole may choose to avoid the use of this incredibly valuable technology, because its first public use was to administer nicotine.
E-Cigarettes are some awesome technology, and they could easily be the realization of futuristic drug administration, for completely legitimate pharmaceuticals. They could make a number of vapor born drugs that are currently difficult to administer easier and cheaper to use. E-Cigarettes might even use useful as an alternative means of administering certain vaccines. These devices should be the next medical break through. Vapor administration of legitimate pharmaceuticals could be easier and safer than current means, and we should be taking advantage of this technology for something good.
20 October 2014
Discrimination Against the Poor - Part 1
I want to share a little bit of back story before I start the actual article. We just had our 5th child. It was a natural birth at a local hospital. Our first birth was a water birth in a birthing center, and we went home three hours after the birth. Our other three were all natural in-hospital births, where the hospital required us to stay for 24 hours for observation after the birth, and my wife was sick of this. We made a birth plan specifying that we wanted to leave 12 hours after the birth, and while we forgot it at home, we made our plans very clear to the hospital staff. Our nurse, our midwife, and the pediatrician all accepted our decision, though some of them did not agree with it. The nurse, however, informed the billing person for the hospital, who came in and informed my wife that if we left against medical advice (the hospital's 24 hour policy required the pediatrician to write the discharge for the baby as "against medical advice" if we left before 24 hours), Medicaid would not pay for the services provided for the baby, and we would have to pay out of pocket. The midwife had told us something different, so I went home and did some research, while my wife tried to contact Medicaid by phone. Eventually, she reached Medicaid who told her that they had no such policy and could only find a reference stating that if we brought the baby back before the 24 hours were up, we might be charged for services for the new visit that did not qualify as medically necessary. Before that, however, my research at home revealed a rats nests around the billing lady's claim. First, her claim was completely and absolutely false. Second, most hospitals tell their patients this lie (though, hospital staff rarely knows the truth to begin with) and not just those insured through Medicaid. I found three research papers from three different studies about this problem. None of them found any insurers in the US with such a policy. Anyhow, we left about 13 hours after the birth, and we informed the nurse that the claims were false and asked her to forward that on to the billing lady (the baby had no issues within those last 11 hours, though, the hospital staff had already determined she was perfectly healthy and the probability of problems was extremely low).
It should be obvious that poor people in the US face regular discrimination. It is awfully hard to get hired for a job, even a really poor job, without nice clothing to wear to the interview (in fact, at least one US charity loans suits to poor job applicants to wear to interviews). Many Medicaid, Food Stamp, and WIC office employees treat clients as inferiors. Often, schools in poorer areas of towns and cities get sub-par teachers, while the other schools get the more skilled ones. Middle and upper class people often look down on poor people and treat them as inferiors, and sometimes poor people even treat each other more poorly than those with more wealth. Many Americans assume poor people are lazy. This problem is so prevalent that comments from the few people that really are freeloading on government welfare often reflect badly on anyone who is receiving government welfare for any reason. There is one place where this discrimination against the poor is especially repugnant, not to mention of questionable legality.
Most hospital employees in the US will tell patients that if they leave before their treatment is complete (known as leaving "against medical advice" or AMA), their insurance will not pay for it. Because most patients leaving AMA are Medicaid patients, and because more wealthy patients can afford the costs better, this affects poor people far more than anyone else. At least three studies have been done on this subject in the last three years, and none of these studies have found any insurance provider in the US with such a policy (some insurers actually laughed at the researchers for even asking). Medicaid also has no such policy. Now, in most cases, the hospital employees are not deliberately lying (though, hospitals do stand to benefit from patients staying "for observation" longer than is strictly necessary). This is a common misconception among hospital employees, and it is presumably perpetuated as interns are taught this lie by regular employees. This problem is not just bad for patients, it is also bad for insurers and potentially very bad for hospitals.
Because this problem affects primarily the poor, it is a clear case of discrimination against the poor. As such, it is rather appalling. It is also dangerous and perhaps even illegal. This may be one reason that medical costs in the US are so high. The biggest reasons people leave a hospital AMA are poor treatment or lack of additional time after treatment is complete. Often, Medicaid patients have long waits to see a doctor, when their conditions are not critical. Eventually, they get fed up with waiting, and they sometimes leave against medical advice. The second, and more nefarious problem is when a patient has completed treatment, but the hospital either wants to observe the patient for an extra day or more, or the patient has to wait a long time for the doctor to do a final review and sign discharge papers. In both cases, the hospital may charge more money to Medicaid, another insurer, or the patient, for the longer stay. In the second case, however, it is possible that the long waits are actually deliberate abuse of the system, designed to allow the hospital to charge more for the visit by keeping the patient there longer. Either way, forcing patients to wait so long that they consider leaving without getting full treatment is dangerous to the health of the patient. Telling the patient that insurance will not pay if they leave early, however, may be more dangerous to the hospital than the patient.
Most hospitals require patients to sign a release before leaving AMA, to reduce liability for any problems that might have been prevented had the patient received full treatment. Patients leaving AMA is considered a big problem in the US right now, especially among Medicaid patients (males patients are also more likely to do this). Concerned hospital workers may be tempted to lie to patients to convince them to stay and complete treatment. This carries two very dangerous consequences. If found out, these lies will cause patients to distrust doctors, and this is already a big enough problem in the US; we really do not need to add to it. Lying to patients may cause them to look for alternatives to normal medical treatment that might be dangerous or at least allow serious conditions to go untreated. This is not in the best interest of the patients, and as such, it qualifies as a violation of the oath taken by nearly all medical practitioners in the US to avoid harming patients. The second consequence is worse, at least for the hospital. Medical patients have legally protected rights in the US, and one of those rights is to refuse treatment. Any medical patient in the US may choose to leave a hospital at any time, without legal penalty, and if the hospital attempts to hold them against their will, the hospital is breaking the law. This is a very serious offense. Lying to a patient to manipulate them into forgoing this right, when they would otherwise have chosen to exercise it is a violation of this right. Telling a patient that there will be severe financial penalties (for people on Medicaid, nearly any hospital bill is severe) is essentially forcing the patient to make a choice under duress. Decisions made under duress are not legally binding. If the patient has informed a hospital employee of an intent to leave AMA, and the hospital uses this lie to convince the patient to stay, the patient's original decision is still in force (because the overriding decision was made under duress), and by keeping the patient, the hospital is both holding the patient against his or her will (this is illegal by itself) as well as violating the rights of the patient.
There are several better ways to treat this kind of situation. First, financial employees in hospitals should determine policy for specific insurance providers before any employee is allowed to suggest to a patient that penalties might exist. Since most insurance companies have no such penalties, there is no point discussing them without asking the companies first. Second, instead of trying to scare patients to stay by lying to them, it should be far more effective to inform them of the actual medical consequences of leaving AMA. Even Medicaid patients are not stupid. If they still want to leave, fully informed of the potential consequences, then it is their legal right to do so. At that point, they have chosen to own the consequences, and nobody has any right to force them to stay.
This problem is dangerous to both patients and hospitals. Employees need to be educated properly so that they do not inadvertently do or say things that could get the hospital in trouble. Violations of patient rights can incur heavy fines, and multiple instances can get hospitals shut down. Given how prevalent this problem is in the US, there have probably been enough of this kind of patient rights violations at most US hospitals to get them shut down. Further, this kind of discrimination against the poor needs to stop. Most poor people may not have the research skills to ever discover the lie they have been fed, but this does not absolve hospital employees of their responsibility to treat patients well and honestly. If nothing else, more care should be taken to treat the poor fairly and legally, because they have a disadvantage.
Following are the studies on this problem:
The University of Chicago Medicine
http://www.uchospitals.edu/news/2012/20120203-billing.html
PubMed.gov, Journal of General Internal Medicine
http://www.ncbi.nlm.nih.gov/pubmed/22331399
Annals of Emergency Medicine, An International Journal
http://www.annemergmed.com/article/S0196-0644%2809%2901798-3/fulltext
It should be obvious that poor people in the US face regular discrimination. It is awfully hard to get hired for a job, even a really poor job, without nice clothing to wear to the interview (in fact, at least one US charity loans suits to poor job applicants to wear to interviews). Many Medicaid, Food Stamp, and WIC office employees treat clients as inferiors. Often, schools in poorer areas of towns and cities get sub-par teachers, while the other schools get the more skilled ones. Middle and upper class people often look down on poor people and treat them as inferiors, and sometimes poor people even treat each other more poorly than those with more wealth. Many Americans assume poor people are lazy. This problem is so prevalent that comments from the few people that really are freeloading on government welfare often reflect badly on anyone who is receiving government welfare for any reason. There is one place where this discrimination against the poor is especially repugnant, not to mention of questionable legality.
Most hospital employees in the US will tell patients that if they leave before their treatment is complete (known as leaving "against medical advice" or AMA), their insurance will not pay for it. Because most patients leaving AMA are Medicaid patients, and because more wealthy patients can afford the costs better, this affects poor people far more than anyone else. At least three studies have been done on this subject in the last three years, and none of these studies have found any insurance provider in the US with such a policy (some insurers actually laughed at the researchers for even asking). Medicaid also has no such policy. Now, in most cases, the hospital employees are not deliberately lying (though, hospitals do stand to benefit from patients staying "for observation" longer than is strictly necessary). This is a common misconception among hospital employees, and it is presumably perpetuated as interns are taught this lie by regular employees. This problem is not just bad for patients, it is also bad for insurers and potentially very bad for hospitals.
Because this problem affects primarily the poor, it is a clear case of discrimination against the poor. As such, it is rather appalling. It is also dangerous and perhaps even illegal. This may be one reason that medical costs in the US are so high. The biggest reasons people leave a hospital AMA are poor treatment or lack of additional time after treatment is complete. Often, Medicaid patients have long waits to see a doctor, when their conditions are not critical. Eventually, they get fed up with waiting, and they sometimes leave against medical advice. The second, and more nefarious problem is when a patient has completed treatment, but the hospital either wants to observe the patient for an extra day or more, or the patient has to wait a long time for the doctor to do a final review and sign discharge papers. In both cases, the hospital may charge more money to Medicaid, another insurer, or the patient, for the longer stay. In the second case, however, it is possible that the long waits are actually deliberate abuse of the system, designed to allow the hospital to charge more for the visit by keeping the patient there longer. Either way, forcing patients to wait so long that they consider leaving without getting full treatment is dangerous to the health of the patient. Telling the patient that insurance will not pay if they leave early, however, may be more dangerous to the hospital than the patient.
Most hospitals require patients to sign a release before leaving AMA, to reduce liability for any problems that might have been prevented had the patient received full treatment. Patients leaving AMA is considered a big problem in the US right now, especially among Medicaid patients (males patients are also more likely to do this). Concerned hospital workers may be tempted to lie to patients to convince them to stay and complete treatment. This carries two very dangerous consequences. If found out, these lies will cause patients to distrust doctors, and this is already a big enough problem in the US; we really do not need to add to it. Lying to patients may cause them to look for alternatives to normal medical treatment that might be dangerous or at least allow serious conditions to go untreated. This is not in the best interest of the patients, and as such, it qualifies as a violation of the oath taken by nearly all medical practitioners in the US to avoid harming patients. The second consequence is worse, at least for the hospital. Medical patients have legally protected rights in the US, and one of those rights is to refuse treatment. Any medical patient in the US may choose to leave a hospital at any time, without legal penalty, and if the hospital attempts to hold them against their will, the hospital is breaking the law. This is a very serious offense. Lying to a patient to manipulate them into forgoing this right, when they would otherwise have chosen to exercise it is a violation of this right. Telling a patient that there will be severe financial penalties (for people on Medicaid, nearly any hospital bill is severe) is essentially forcing the patient to make a choice under duress. Decisions made under duress are not legally binding. If the patient has informed a hospital employee of an intent to leave AMA, and the hospital uses this lie to convince the patient to stay, the patient's original decision is still in force (because the overriding decision was made under duress), and by keeping the patient, the hospital is both holding the patient against his or her will (this is illegal by itself) as well as violating the rights of the patient.
There are several better ways to treat this kind of situation. First, financial employees in hospitals should determine policy for specific insurance providers before any employee is allowed to suggest to a patient that penalties might exist. Since most insurance companies have no such penalties, there is no point discussing them without asking the companies first. Second, instead of trying to scare patients to stay by lying to them, it should be far more effective to inform them of the actual medical consequences of leaving AMA. Even Medicaid patients are not stupid. If they still want to leave, fully informed of the potential consequences, then it is their legal right to do so. At that point, they have chosen to own the consequences, and nobody has any right to force them to stay.
This problem is dangerous to both patients and hospitals. Employees need to be educated properly so that they do not inadvertently do or say things that could get the hospital in trouble. Violations of patient rights can incur heavy fines, and multiple instances can get hospitals shut down. Given how prevalent this problem is in the US, there have probably been enough of this kind of patient rights violations at most US hospitals to get them shut down. Further, this kind of discrimination against the poor needs to stop. Most poor people may not have the research skills to ever discover the lie they have been fed, but this does not absolve hospital employees of their responsibility to treat patients well and honestly. If nothing else, more care should be taken to treat the poor fairly and legally, because they have a disadvantage.
Following are the studies on this problem:
The University of Chicago Medicine
http://www.uchospitals.edu/news/2012/20120203-billing.html
PubMed.gov, Journal of General Internal Medicine
http://www.ncbi.nlm.nih.gov/pubmed/22331399
Annals of Emergency Medicine, An International Journal
http://www.annemergmed.com/article/S0196-0644%2809%2901798-3/fulltext
19 August 2014
Vaccine and Vitamin K Refusal
I just read this article from Scientific American. While I have great respect for the magazine, I find the author somewhat lacking. In fact, I have found a great deal lacking in nearly every author promoting the medical industry and attacking skeptics of modern medicine. Now, I am not saying that the medical industry is wrong, but it is at fault in a large degree for the various movements opposing vaccination and other things like vitamin K shots or eye drops for newborns.
The primary problem is not the media and movements encouraging parents to avoid potentially life saving treatments for their children. The problem is general mistrust of doctors, which has been caused by their own poor behavior. My wife is a doula (a professional labor coach and educator). We have chosen to forgo both the vitamin K shots and the eye drops that hospitals typically give all newborns. Our first child was born in a birthing center, where we were educated on all of the risks involved with both sides. Further, we did some research of our own. We found that the risk of complications is extremely low without the treatments. Contrary to the article, both treatments do indeed carry risks, however they are also extremely low. Based on our knowledge, we chose not to allow the midwives to administer either of the treatments. Similarly, we have been very selective about vaccinations. Now, let me first assure you that we do not believe the claims (which have been proven false) that vaccines cause autism. This is a bunch of crock spread by celebrities that have no medical education. Our first reason to limit vaccination is that many vaccines contain small amounts of latex, and my wife and at least one of our children has shown a sensitivity to latex. Latex allergies can quickly become life threatening with repeated exposure, so we chose to limit vaccinations to limit latex exposure. We have had our children vaccinated for a few things. These are diseases that either have a high probability of fatality or permanent injury or that cannot be cured once contracted. While I have seen no empirical data on this, I have observed that people who get every single vaccine and thus rarely get sick tend to fare less well when they do get sick, while people who avoid common vaccines that are mostly just for convenience (the flu vaccine for most people) tend to get over nearly anything fairly quickly. So, why would anyone choose to forgo even vaccines for higher risk diseases?
As a doula, by wife is present when her patients give birth. This typically occurs in a hospital. Additionally, we have had several of our children born in hospitals. My wife has had multiple experiences where doctors or nurses administer treatments without informing or consulting the patient. In many cases, these treatments have not been strictly necessary and were administered either for the convenience of the patient or for the convenience of the medical professional. I am also aware of instances where a doctor has recommended an unnecessary, high risk treatment to a patient for personal convenience. In one case, the doctor used scare tactics to convince the patient to agree to a cesearan section because the birth was taking too long and was going to cut into a birthday party the doctor wanted to attend. In one case where my wife was present, the doctor and nurses completely ignored a list of documented requests from the patient without any medical reason for doing so. In this last case, the patient is now showing symptoms of post traumatic stress disorder related to pregnancy and hospitals. This is why people refuse vaccinations and other treatments for their children. After an experience where your human rights are blatantly violated by medical professionals, it becomes very natural to distrust the medical industry in general.
The problem is not those who spread lies about potential side effects of vaccinations or other treatments. The problem is the doctors that mistreat patients and breed mistrust. Sadly, the most common place this occurs is in hospitals. Private practices and family doctors tend to be much better at informing patients about treatments, with one small exception (I'll get to this). In hospitals, it is very common for nurses and doctors to treat patients without ever discussing the treatment with the patient. With births, doctors will frequently tell the patient a treatment will be administered without any concern for the desires of the patient (unnecessary C-sections and inductions are a very major problem in the US, and typically the mother is never even offered a choice). This is wrong, and to most people it is clearly a violation of human rights. It really should come as no surprise that many parents are willing to trust unknowns over the people who have violated them and lied to them.
Now I want to look at the one exception. Vaccinations always carry risks. In fact, any time the skin is pierced with something, there is a risk of infection. Modern sanitation practices have reduced this risk to almost nothing, but it does exist. There is also a risk that any given patient is allergic to something in a vaccine. Again, this is typically very small. Most pre-drawn vaccines contain latex, and the rubber stopper on vaccine containers that are not pre-drawn frequently contain latex. For those with a threshold allergy to latex (this is the kind of allergy that becomes more severe with each exposure), even this small exposure to latex can be life threatening. Even if it is not, it can cause the next reaction to be more severe. Overall though, for most people the risk of complications from vaccination is extremely small. In fact, the risks are so small that beyond asking about allergies first, I do not see any reason why doctors should be forced to discuss them in detail.
On the other hand though, there is the risk of serious complications from catching the disease that the vaccination would have prevented. For instance, the flu almost never kills. When it does, it is almost exclusively very young children and extremely old people. On occasion, it kills someone else who has a severely compromised immune system. Outside of these easily identifiable groups, the flu is merely a brief and slightly painful inconvenience. Chicken pox is even less severe than the flu (though it does carry the risk of getting shingles later in life, which rarely kills but is extremely painful). Getting these trivial diseases does little more than cause inconvenience, but they can ultimately strengthen the immune system (something like exercise strengthens muscles). Now, these two diseases are trivial, but fairly common. That is not true of the rest of the diseases that we typically vaccinate against. Most vaccines provide immunity for diseases that less than a percent of a percent of the population will ever be exposed to. Further, many of these diseases, while they can be severe, are no longer as deadly as they were when we did not know how to treat them. The chance of serious complications, when combined with the extremely low chance of exposure, may even start to approach the potential risk caused just by getting the vaccine in the first place. This is what doctors do not tell you. Most vaccinations will never even matter and may even increase the overall risk of harm.
How can we deal with this? First, I think that doctors should be required by law to discuss both potential negative and positive consequences of any treatment with the patient or guardian before administering any treatment (except in serious emergency cases where there is not time, in which case the discussion should take place after the emergency situation is over). Until this happens though, parents and patients will have to figure out how to deal with these things on their own. I would suggest asking you doctor a lot of questions. You can legally refuse any treatment (the doctor may ask you to sign a wavier though). This means that you can tell the doctor that you will not permit treatment until you are fully informed of all potential risks involved. You can also search the internet, but make sure you find sources from both sides of any debate, otherwise you will only get half of the knowledge you need to make an informed decision (also, learn to distinguish reputable sources from random people running their mouths; in medicine, celebrities are not reputable sources). Look for numbers. If you find something saying that some treatment increases the chances of some horrible outcome by 50%, try to find what it is 50% of. If the chances are 1 in 1 million, that means they are only 1.5 in one million with the treatment. Relatively, that 50% increase seems large, but the actual probability is still extremely low.
There is one other thing doctors will rarely tell you. Most vaccinations now are given to improve "herd immunity." What this means is, the chance that your child will get the measles, even without the vaccination, is almost non-existent. Your child will probably not benefit at all from it, in fact. Many vaccines target diseases that are almost extinct (at least in the 1st world). The goal of the vaccinations is to keep the disease isolated or even to eliminate it, not to benefit the individual getting the vaccine. This is called herd immunity, because it benefits the group (or "herd") as a whole, but it almost never benefits the individual. In other words, there is almost no individual risk of getting the disease to balance the negative risks associated with getting the vaccine. Now, in case you are feeling disgust that doctors would value the well being of the abstract herd over the well being of your child, you should know that this herd immunity gained from widespread vaccination is what eliminated small pox. It was so effective that we no longer vaccinate for small pox because the risk is almost literally zero. Now, with that in mind, feel free to form your own opinions.
Here is our solution to the problem. My wife and I avoid vaccinations for trivial diseases like chicken pox or the flu. If there was an extremely severe strain of the flu going around (and a vaccine was made available quickly enough; for the flu, they usually are not), then we might consider getting our children vaccinated. Otherwise, we do not consider the risk, though small, worth the minor convenience. We also opted out of many of the vaccinations for extremely uncommon diseases with very low risk of permanent harm. We did, however, get our children vaccinated for one of the hepatitis versions that is difficult or impossible to cure once contracted. One reason is that we are occasionally exposed to people who have recently come from a country where that disease is more common; the other is that a serious disease that cannot be cured is probably worth getting vaccinated for, even if it is pretty rare in the US. The hepatitis vaccination happens to be commonly administered in combination with a few other vaccinations, so we decided to get the combo, because the difference in risk between the single and the combo is negligible (if existent at all).
Our solution to the vitamin K and eye drops was to opt out. Our reasoning is this: Most complications requiring vitamin K occur in the hospital. Other complications are extremely rare (and at least one is genetic, and neither of us has any family history of it). The eye drops are designed to more or less sanitize the eyes after birth, in case some dangerous bacteria got into the eyes. This is also extremely rare. At the time, the eye drops were made of some silver compound that happens to be toxic to humans as well. There has been no research showing the silver drops to be safe for humans, so we decided the risk was higher than the benefits and opted out. (Note that most hospitals are now using a different compound for this. I do not know anything about the safety record of the new compound.) Anyhow, we have opted out of these two things with all four of our children, without any issues.
Now, all of this is personal choice. I do not want to convince you to vaccinate or to avoid vaccination. Similarly, I am not trying to encourage or discourage trusting doctors. Not all doctors are as negligent as those you frequently hear about. I want two things to come out of this article. First, I want regular people to know that they do not have to let doctors bully them. You never have to accept treatment you do not want. You can ask about the risks of a treatment, and you can refuse it if you are not willing to take the risk (this is even true of "mandatory" things, like the IV our local hospital requires for birthing mothers). You also have the ability to learn for yourself and to keep yourself well informed (most hospitals offer free WiFi; bring your tablet, smart phone, or laptop, but make sure you find reputable sources of information). Second, I really would like to see doctors be held more accountable. An honest mistake or impossible situation can happen where the doctor may not be entirely responsible, but cases where the doctor makes a judgment call without any concern for the desire or well being of the patient should never be permitted. No person should be practicing medicine who is willing to subject a patient to unnecessary surgery to get to a party on time, and a patient who comes away from the hospital with post traumatic stress disorder due to poor treatment from the nurses and doctors should be compensated very well for the suffering (not to mention be compensated for treatment for the PTSD). If accountability were higher, fewer doctors would mistreat patients, people would trust doctors more, and scare tactics and lies designed to trick people into avoiding beneficial treatments would be far less effective.
The primary problem is not the media and movements encouraging parents to avoid potentially life saving treatments for their children. The problem is general mistrust of doctors, which has been caused by their own poor behavior. My wife is a doula (a professional labor coach and educator). We have chosen to forgo both the vitamin K shots and the eye drops that hospitals typically give all newborns. Our first child was born in a birthing center, where we were educated on all of the risks involved with both sides. Further, we did some research of our own. We found that the risk of complications is extremely low without the treatments. Contrary to the article, both treatments do indeed carry risks, however they are also extremely low. Based on our knowledge, we chose not to allow the midwives to administer either of the treatments. Similarly, we have been very selective about vaccinations. Now, let me first assure you that we do not believe the claims (which have been proven false) that vaccines cause autism. This is a bunch of crock spread by celebrities that have no medical education. Our first reason to limit vaccination is that many vaccines contain small amounts of latex, and my wife and at least one of our children has shown a sensitivity to latex. Latex allergies can quickly become life threatening with repeated exposure, so we chose to limit vaccinations to limit latex exposure. We have had our children vaccinated for a few things. These are diseases that either have a high probability of fatality or permanent injury or that cannot be cured once contracted. While I have seen no empirical data on this, I have observed that people who get every single vaccine and thus rarely get sick tend to fare less well when they do get sick, while people who avoid common vaccines that are mostly just for convenience (the flu vaccine for most people) tend to get over nearly anything fairly quickly. So, why would anyone choose to forgo even vaccines for higher risk diseases?
As a doula, by wife is present when her patients give birth. This typically occurs in a hospital. Additionally, we have had several of our children born in hospitals. My wife has had multiple experiences where doctors or nurses administer treatments without informing or consulting the patient. In many cases, these treatments have not been strictly necessary and were administered either for the convenience of the patient or for the convenience of the medical professional. I am also aware of instances where a doctor has recommended an unnecessary, high risk treatment to a patient for personal convenience. In one case, the doctor used scare tactics to convince the patient to agree to a cesearan section because the birth was taking too long and was going to cut into a birthday party the doctor wanted to attend. In one case where my wife was present, the doctor and nurses completely ignored a list of documented requests from the patient without any medical reason for doing so. In this last case, the patient is now showing symptoms of post traumatic stress disorder related to pregnancy and hospitals. This is why people refuse vaccinations and other treatments for their children. After an experience where your human rights are blatantly violated by medical professionals, it becomes very natural to distrust the medical industry in general.
The problem is not those who spread lies about potential side effects of vaccinations or other treatments. The problem is the doctors that mistreat patients and breed mistrust. Sadly, the most common place this occurs is in hospitals. Private practices and family doctors tend to be much better at informing patients about treatments, with one small exception (I'll get to this). In hospitals, it is very common for nurses and doctors to treat patients without ever discussing the treatment with the patient. With births, doctors will frequently tell the patient a treatment will be administered without any concern for the desires of the patient (unnecessary C-sections and inductions are a very major problem in the US, and typically the mother is never even offered a choice). This is wrong, and to most people it is clearly a violation of human rights. It really should come as no surprise that many parents are willing to trust unknowns over the people who have violated them and lied to them.
Now I want to look at the one exception. Vaccinations always carry risks. In fact, any time the skin is pierced with something, there is a risk of infection. Modern sanitation practices have reduced this risk to almost nothing, but it does exist. There is also a risk that any given patient is allergic to something in a vaccine. Again, this is typically very small. Most pre-drawn vaccines contain latex, and the rubber stopper on vaccine containers that are not pre-drawn frequently contain latex. For those with a threshold allergy to latex (this is the kind of allergy that becomes more severe with each exposure), even this small exposure to latex can be life threatening. Even if it is not, it can cause the next reaction to be more severe. Overall though, for most people the risk of complications from vaccination is extremely small. In fact, the risks are so small that beyond asking about allergies first, I do not see any reason why doctors should be forced to discuss them in detail.
On the other hand though, there is the risk of serious complications from catching the disease that the vaccination would have prevented. For instance, the flu almost never kills. When it does, it is almost exclusively very young children and extremely old people. On occasion, it kills someone else who has a severely compromised immune system. Outside of these easily identifiable groups, the flu is merely a brief and slightly painful inconvenience. Chicken pox is even less severe than the flu (though it does carry the risk of getting shingles later in life, which rarely kills but is extremely painful). Getting these trivial diseases does little more than cause inconvenience, but they can ultimately strengthen the immune system (something like exercise strengthens muscles). Now, these two diseases are trivial, but fairly common. That is not true of the rest of the diseases that we typically vaccinate against. Most vaccines provide immunity for diseases that less than a percent of a percent of the population will ever be exposed to. Further, many of these diseases, while they can be severe, are no longer as deadly as they were when we did not know how to treat them. The chance of serious complications, when combined with the extremely low chance of exposure, may even start to approach the potential risk caused just by getting the vaccine in the first place. This is what doctors do not tell you. Most vaccinations will never even matter and may even increase the overall risk of harm.
How can we deal with this? First, I think that doctors should be required by law to discuss both potential negative and positive consequences of any treatment with the patient or guardian before administering any treatment (except in serious emergency cases where there is not time, in which case the discussion should take place after the emergency situation is over). Until this happens though, parents and patients will have to figure out how to deal with these things on their own. I would suggest asking you doctor a lot of questions. You can legally refuse any treatment (the doctor may ask you to sign a wavier though). This means that you can tell the doctor that you will not permit treatment until you are fully informed of all potential risks involved. You can also search the internet, but make sure you find sources from both sides of any debate, otherwise you will only get half of the knowledge you need to make an informed decision (also, learn to distinguish reputable sources from random people running their mouths; in medicine, celebrities are not reputable sources). Look for numbers. If you find something saying that some treatment increases the chances of some horrible outcome by 50%, try to find what it is 50% of. If the chances are 1 in 1 million, that means they are only 1.5 in one million with the treatment. Relatively, that 50% increase seems large, but the actual probability is still extremely low.
There is one other thing doctors will rarely tell you. Most vaccinations now are given to improve "herd immunity." What this means is, the chance that your child will get the measles, even without the vaccination, is almost non-existent. Your child will probably not benefit at all from it, in fact. Many vaccines target diseases that are almost extinct (at least in the 1st world). The goal of the vaccinations is to keep the disease isolated or even to eliminate it, not to benefit the individual getting the vaccine. This is called herd immunity, because it benefits the group (or "herd") as a whole, but it almost never benefits the individual. In other words, there is almost no individual risk of getting the disease to balance the negative risks associated with getting the vaccine. Now, in case you are feeling disgust that doctors would value the well being of the abstract herd over the well being of your child, you should know that this herd immunity gained from widespread vaccination is what eliminated small pox. It was so effective that we no longer vaccinate for small pox because the risk is almost literally zero. Now, with that in mind, feel free to form your own opinions.
Here is our solution to the problem. My wife and I avoid vaccinations for trivial diseases like chicken pox or the flu. If there was an extremely severe strain of the flu going around (and a vaccine was made available quickly enough; for the flu, they usually are not), then we might consider getting our children vaccinated. Otherwise, we do not consider the risk, though small, worth the minor convenience. We also opted out of many of the vaccinations for extremely uncommon diseases with very low risk of permanent harm. We did, however, get our children vaccinated for one of the hepatitis versions that is difficult or impossible to cure once contracted. One reason is that we are occasionally exposed to people who have recently come from a country where that disease is more common; the other is that a serious disease that cannot be cured is probably worth getting vaccinated for, even if it is pretty rare in the US. The hepatitis vaccination happens to be commonly administered in combination with a few other vaccinations, so we decided to get the combo, because the difference in risk between the single and the combo is negligible (if existent at all).
Our solution to the vitamin K and eye drops was to opt out. Our reasoning is this: Most complications requiring vitamin K occur in the hospital. Other complications are extremely rare (and at least one is genetic, and neither of us has any family history of it). The eye drops are designed to more or less sanitize the eyes after birth, in case some dangerous bacteria got into the eyes. This is also extremely rare. At the time, the eye drops were made of some silver compound that happens to be toxic to humans as well. There has been no research showing the silver drops to be safe for humans, so we decided the risk was higher than the benefits and opted out. (Note that most hospitals are now using a different compound for this. I do not know anything about the safety record of the new compound.) Anyhow, we have opted out of these two things with all four of our children, without any issues.
Now, all of this is personal choice. I do not want to convince you to vaccinate or to avoid vaccination. Similarly, I am not trying to encourage or discourage trusting doctors. Not all doctors are as negligent as those you frequently hear about. I want two things to come out of this article. First, I want regular people to know that they do not have to let doctors bully them. You never have to accept treatment you do not want. You can ask about the risks of a treatment, and you can refuse it if you are not willing to take the risk (this is even true of "mandatory" things, like the IV our local hospital requires for birthing mothers). You also have the ability to learn for yourself and to keep yourself well informed (most hospitals offer free WiFi; bring your tablet, smart phone, or laptop, but make sure you find reputable sources of information). Second, I really would like to see doctors be held more accountable. An honest mistake or impossible situation can happen where the doctor may not be entirely responsible, but cases where the doctor makes a judgment call without any concern for the desire or well being of the patient should never be permitted. No person should be practicing medicine who is willing to subject a patient to unnecessary surgery to get to a party on time, and a patient who comes away from the hospital with post traumatic stress disorder due to poor treatment from the nurses and doctors should be compensated very well for the suffering (not to mention be compensated for treatment for the PTSD). If accountability were higher, fewer doctors would mistreat patients, people would trust doctors more, and scare tactics and lies designed to trick people into avoiding beneficial treatments would be far less effective.
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