Tag Archives: Public health

Prevention: vaccines as public health superstars

Prevention: n. the act of keeping from happening, holding back or hindering

An ounce of prevention is worth a pound of cure.

I’m working on an article for a health magazine on vaccinations for children.

If you don’t have little kids you may not be aware that vaccinations have become a focus of parental angst since a (now-debunked) 1998 study of 8 autistic children by Andrew Wakefield in the UK, which claimed that the measles-mumps-rubella vaccine could cause autism.  Turns out that the doctor was a shill for the kids’ families who were seeking financial settlements. And last week several cases trying to link autism to vaccines were thrown out of court.  (Newsweek‘s Sharon Begley just did an excellent feature on the history and current state of the vaccination kerfuffle – Anatomy of a Scare….)

Wakefield’s British medical license was revoked, but the damage was done. Parents with autistic children had found themselves a scapegoat in the vaccine, and parents of healthy infants began to question the whole concept of vaccination.

  • There were so many shots: “Why when I was a kid,” they said, “we just had the DPT and polio vaccines….”
  • Is this an evil collaboration between Big Government [the CDC] and Big Pharma to get more money from us?
  • Had the vaccines been properly tested – separately and in combination? Was it safe to give babies so many shots at one time?
  • What are all these diseases anyway? Why should we worry?

To make matters worse, the media picked up the controversy and rumors spread like wildfire on the Internet. Celebrities ignorant of science and the scientific method ranted on TV. Some parents decided to forego vaccinating their kids;  some (thanks to a misleading and poorly researched book on vaccinations by the Dr. Robert Sears) decided to formulate alternative vaccination schedules for their babies – delaying some and dropping others.

I interviewed several pediatricians, family practice physicians, and epidemiologists for the article and they all were disturbed by the level of public misunderstanding and the potential repercussions of fewer kids being vaccinated.

“The problem,” said one pediatrician, “is that many of these vaccines have been around long enough and have been so dramatically successful that today’s young parents are unaware of how devastating these diseases can be. In my travels to less developed parts of the world I’ve seen kids struggle for their very lives or die from them.”

Another pediatrician told me that parents always fear for possible health threats to their babies. “Without the actual diseases themselves to fear, they are now focused on vaccine side-effects. Instead they should be worried that many of these childhood diseases are just a plane flight away. Or an unimmunized buddy at daycare away.”

According to the Children’s Hospital of Philadelphia’s Vaccine Education Center:

Before the vaccines we use today parents in the US could expect every year:

  • Polio would paralyze 10,000 children
  • Rubella (german measles) would cause birth defects and mental retardation in as many as 20,000 newborns.
  • Measles would infect about 4 million children, killing 3,000 and causing severe brain damage in many others.
  • Diptheria would be one of the most common causes of death in school-aged children
  • A bacterium called Haemophilus influenzae typ b (Hib) would cause meningitis in 15,000 children, leaving many with permanent brain damage
  • Pertussis (whooping cough) would kill thousands of infants.

Additionally, the recent rotavirus vaccine protects the against an intestinal infection that’s still one of the  leading killers of the very young around the globe.

The other issue big on young parents’ minds is the timing of vaccinations – so many so close together. But that is how they have been studied, said the docs I spoke to – the current vaccination schedules have proven effectiveness and safety, and alternative schedules have not.

I could go on and on, but this is just a blog post.  If you’d like more information check out the CDC website.

Update 4/23/09: Jim Carrey wrote an outrageous post at Huffington Post yesterday – another celebrity rant by someone who doesn’t understand science. I’m not linking to it, but I will link to Skeptic Dad at Science-Based Parenting, who rebuts in detail the Carrey post. Nice job.

Pro-Life? How do you respond?

Pro-life: n. code word for (usually) Christian conservatives meaning that you oppose abortion.

Mike Huckabee called me the other night. Well, Mike, the former gov of Arkansas, former fattie, former presidential candidate and current talk show host (of course… what better way to stay in the public eye in preparation for his next run) didn’t actually call me in person; his robot did.

“Hi,” said his computer voice, “this is Governor Mike Huckabee – I want to ask you a couple of questions… Did you vote in the last election?”

Since I always want to hear what Republicans are currently spinning, and because it’s true, I said yes.

“Do you consider yourself pro-life?” Huckabee’s voice asked.

Now this stumped me for a minute, because I’m “pro” lots of things. I mean who wouldn’t be pro “LIFE”? It’s better than the alternative, as Woody Allen once said.

Framing the anti-abortion movement as being “pro-life” was a stroke of linguistic genius because the most natural oppositional phrases are “pro-death”, “anti-life” or “pro-abortion” – all of which sound bad, even though none of them are accurate descriptions of those who believe women have the right to choose whether to carry an unwanted pregnancy to term or not.

Planned Parenthood used to have a brilliant slogan: “Every child a wanted child.”  It conveys the heart of the matter: a woman should be able to control her own fertility because who knows better her ability to bear, love and raise that child? No child should have to bear the burden of being born to someone who doesn’t want him. God knows, in this world a kid has a hard enough time getting the love, support, health care and education he deserves being raised by parents who wanted him. Unfortunately every community around the world has growing populations of homeless men, women and children who lacked that nurturance.

Anyway, back to Mike and me.

He took my stammering for a YES and plunged on with the true purpose of his call – to pass along the scary lie that Obama’s top priority was to pass a law to make it possible for anyone to perform an abortion on any woman anywhere anytime.  Now, if I had known Mike was going to call with such a load of codswallop, I’d have figured out how to record the call so I could quote him exactly and could parse the statement phrase by phrase…

The message was paid for by Americans United for Life, but I believe he’s done various versions of the message for other pro-life groups as well.  They are nothing if not well organized and well-funded.

I totally deplore fear-mongering as a persuasion technique – and the Right specializes in it – that and reducing the issue to its most simplistic even if the truth must be twisted or ignored to get there.  Those of us on the left have a greater interest in facts , even if they’re messy and complex to communicate.

So back to “pro-life”.

Our standard catch phrase response is “pro-choice”, which, though truthful,  lacks the emotional impact of “pro-life.”  We are certainly not “pro-abortion”; we’d much prefer the pregnancy be avoided thru the use of contraceptives. But contraception can fail and women do get raped.

Some of us believe we could call the pro-lifers “pro-fetus, anti-child,” because once the child is born conservative ideology says taxpayers shouldn’t have to support “welfare mothers” who can’t make ends meet raising kids alone.

We could also call them the “forced pregnancy” squad.

My own definition of pro-life means we respect the mother’s right to choose to give life or not. And if she does, we as a society are there to help her succeed as a parent and to help her child grow up to be a healthy, responsible, educated and contributing member of society.

Palin Pregnancy: poster child for “abstinence only”?

For awhile rumors flew that the Palin’s fifth child was actually their 17-year-old daughter Bristol’s. But now we learn that Bristol is five months pregnant herself, which lays the first story to rest, but brings up another:

Abstinence only.

It worked so well for Bristol. So now there will be a shot gun wedding. The family will be lauded for their support of their wayward daughter and for accepting the new challenges “God” has brought into their lives.

Those who like their women pregnant and barefoot will applaud this whole charade. Meanwhile those who believe public policy should give women control over their own bodies just suffered another blow.

Maybe Bristol’s marriage will work out. Occasionally the high school flame is good for life. Mostly not though. And many kids who become pregnant because they were “abstinent” have no family support or understanding.

Here’s another question: do we want a vice-president who’s in the middle of two family dramas – rearing a baby with Down Syndrome, and dealing with a pregnant teen?  Just getting up to speed on foreign policy should be filling Palin’s every waking hour from now till she loses the election.

Poison Pill for Planned Parenthood from the Bush administration

The Bush administration has it out for women (and the environment and the poor and our civil rights and our servicemen and and and and…). Their latest attack on the rights of women to have access to reproductive health care just came down (from the Washington Post):

The Bush administration yesterday announced plans to implement a controversial regulation designed to protect doctors, nurses and other health-care workers who object to abortion from being forced to deliver services that violate their personal beliefs.

The rule empowers federal health officials to pull funding from more than 584,000 hospitals, clinics, health plans, doctors’ offices and other entities if they do not accommodate employees who refuse to participate in care they find objectionable on personal, moral or religious grounds.

“People should not be forced to say or do things they believe are morally wrong,” Health and Human Services Secretary Mike Leavitt said. “Health-care workers should not be forced to provide services that violate their own conscience.”

The proposed regulation, which could go into effect after a 30-day comment period*, was welcomed by conservative groups, abortion opponents and others as necessary to safeguard workers from being fired, disciplined or penalized in other ways. Women’s health advocates, family planning advocates, abortion rights activists and others, however, condemned the regulation, saying it could create sweeping obstacles to a variety of health services, including abortion, family planning, end-of-life care and possibly a wide range of scientific research.

What this means – if the public doesn’t make a big enough fuss – is that pharmacists, doctors, nurses and others don’t have to provide birth control pills, Plan B emergency contraception and other forms of contraception if they think it’s wrong, and explicitly allows workers to withhold information about such services and refuse to refer patients elsewhere.

Planned Parenthood is fighting this ruling and urges people to contact their congressperson, the Dept of HHS, newspapers, etc.  And of course Planned Parenthood will accept your contributions to their action fund so they can fight it.

I can imagine a time when a vegetarian grocery checker will refuse to check you out if there’s meat in your cart, a teacher will refuse to teach your child because he’s Muslim, a fundamentalist waiter will refuse to serve a couple because they’re gay…   What is WITH these people????

*The 30-day comment period means YOU – speak up!  Here’s the Dept of Health and Human Services comment site.  (No matter that it appears the comments are about the website; this is where you comment).

Pills as panacea, paying pushers?

Panacea: a remedy for all ailments or difficulties, from the Greek

In the paper today was an article about the major decline in the past ten years of patients visiting shrinks for talk therapy. Instead they are being prescribed pills for whatever bothers them.

Why this change? Because the insurance industry pays for pills – with just enough talk that the shrink can decide whether the pink or green or yellow pill would be best.

This is fine if your problem is biochemical. Some are. But if you’re struggling with your temper, your spouse, issues left over from a painful childhood, existential desire for meaning, etc etc etc (you name it, stuff bothers us) a pill will not do the trick.

Once more we’re prescribing bandaids, where a “get to the root of it approach” (public health philosophy) might well be more appropriate. We are so stuck on the instant bottom line!!

Or worse: could it be that Big Pharma has bought and paid for our docs?? Certainly they pay for the research. They pay docs to speak on behalf of their meds. And they shower them with free samples…

Pill Pusher  by Paul Noth, New Yorker 7/14/08

Pill Pusher by Paul Noth, New Yorker 7/14/08

Prevention: public health’s mission

Prevent: to keep from happening by some prior action, avert, thwart

Public: of, concerning or affecting the community or the people.

I mounted my public health pulpit yesterday, perhaps having a presentiment that prevention would be a topic on the NPR program, “Splendid Table.” Host Lynne Rossetto Kasper’s guest was a guy who calls himself ChefMD, internist John La Puma.

He was saying what those of us in public health have been saying for decades: what you eat has a profound effect on your health, but those in the medical (bandaid) profession don’t know anything about nutrition.

All I can say is, “well, duh!!!!”

The majority of cardiovascular diseases, diabetes and many cancers are caused by what we are eating that we shouldn’t, or not eating that we should. And yet, according to Dr. La Puma, of the 116 US medical schools, 68 still don’t require any classes in nutrition.

Of those that do, only a teeny fraction of course hours are devoted to it – like 4 out of 3,000.

Most docs, when confronted with an overweight patient, hand them a brochure and maybe refer them to a dietitian. Wouldn’t it be great instead if pediatric and prenatal clinics offered nutrition and cooking classes BEFORE their patients got fat???

Is this not a no-brainer??

Public Health: a parable and two pickles

Two women are washing their laundry by the river. One looks up and sees a basket floating by, and in the basket is a baby! She wades in and pulls the basket to shore.

She’s cuddling the infant when another basket floats by with a baby in it. She wades in and grabs that one too. Then there’s another and another.

She calls to her companion to help, but instead of jumping into the water, the other woman is running upstream along the riverbank.  “Where are you going??? the wading woman yells. “We’ve got to save these babies.”

“I know,” yells back the second woman. “I’m going upstream to find out who’s putting the babies in the water. And I’m going to stop them.”

This story illustrates two very different approaches to solving a serious problem: the bandaid model (symptom relief for individuals), and the public health model (community-wide prevention strategies).

Our current medical system is still primarily based on the bandaid model. Folks get sick or hurt and the doctor fixes them. Take diabetes (please). Diabetes until recently was something that happened to you and then the doctor patched you up with insulin. And while it’s true that some folks have a genetic predisposition to diabetes, it turns out that today’s epidemic is a result of our eating too much (crap) and exercising too little – on a grand scale.

I came around to a public health perspective many years ago through my own personal experience of trying to lose weight. I tried about as many diets as there were weeks in the year, and failed at every one of them. It gradually dawned on me that specific diet programs (eat this, don’t eat that) were bandaids that covered up deeper issues – that only more awareness, an attitude shift and behavioral changes could fix, once and for all. Once I resolved those issues and changed my behavior the need for a special diet disappeared, as did the excess weight.

This got me thinking about how much trouble you could avoid if you could prevent the overeating in the first place. For example, working with kids before they developed bad eating habits, educating their parents about nutrition, improving school lunches and PE programs, and then going back even further in the chain to the suppliers of our food. (I was a few decades ahead of the curve here!).

Instead of trying to help individuals lose weight after they’d gained it, giving them insulin after they got diabetes or statins when their cholesterol was too high (bandaids), where could you shove a stick into the cogs of the machine to effect the greatest preventive benefit to a whole bunch of people?

These questions led me back to school for a masters in Public Health. Ever since, I’ve been the woman running upstream to find out where the babies are coming from.

The public health perspective asks foundational questions: Where does the problem begin? How could we prevent it from occurring in the first place? Here are a small sample of profoundly important measures that have come out of those questions: safe drinking water; sewage treatment systems; vaccinations (small pox, polio, measles, pertussis, hepatitis, etc etc), mosquito abatement projects (malaria), occupational safety regulations, food inspection programs, pre-natal care for women, family planning education programs….

Of course many of our public health problems are not caused by pathogens like polio or cholera. They are caused by money-making enterprises whose products turn out to be toxic. Tobacco. Asbestos. Certain medications like estrogen-replacement therapy. Foods made with trans fats. Leaded gas and paint.

Or they’re a result of toxic by-products of the manufacturing process:  nuclear waste, coal-fouled air, water fouled by all manner of manufacturing processes as well as grazing animals, and so on.

Business hates being told how to conduct itself and rarely ceases a practice unless under threat of penalties and lawsuits. This means the public’s safety is often at the mercy of our elected officials, many of whom (Republicans esp. under this disastrous Bush administration) do not have a public health perspective. For them it’s about the bottom line AND about getting re-elected.

Even Democrats, who are more sympathetic to prevention and regulation, need money to get re-elected. Unfortunately the very toxic industries that need regulating are often the biggest campaign contributors.

That’s the first pickle.

The second pickle is that public health campaigns are long-term investments. What we must pay out today to prevent a future epidemic or catastrophe seems like a huge chunk of change when the payoff could be decades in the future. Often we can’t begin to grasp what the catastrophe might be like that we’re paying to prevent.

When Al Gore suggests an investment of $5 trillion for us to make a switch to 100% renewable energy sources in ten years we balk. But when inaction may cost us the very survival of humans on earth: well, that’s a profoundly ponderous public health pickle.