My Gifts from Korea and China

Gift

Since the adoption of our children 14 and 17 years ago, I have been told repeatedly how lucky my daughters are and that they are a gift to our family. The definition of a gift is something that is given freely. Although I am not exactly sure of the reasons their birth families chose not to raise them, I don’t think it was a choice that was freely made.  In Korea there is no social or familial support of unwed mothers and in China the pressure from the family is to produce a son to carry on the family name.  Circumstances prevented their mothers from making a free choice.

This week is Kamp Kimchee, a camp for Korean adoptees in northern MN, and a time when I get away from our hectic daily lives to  reflect on how adoption has changed our family and changed my perspectives. And this is when I hear from many of the older Korean adoptees that have been thinking about this from a personal viewpoint for much longer than I and that are brave enough to share their stories with adoptive parents. The reality is that in order for the gift of adoption to benefit my family, parents in another part of the world lost their child and our daughters lost a culture. Our fortune is built on others misfortune.

19989607_10211262377450128_8644538929775638933_n[1]

Lee and Whitney Frisk, Korean adult adoptees who are married and live in Tennessee, shared their stories with us this week and provided some insight into what our kids may face as they venture beyond their home nests. The gifts that were adorable Asian toddlers  will be seen as “not white” or foreign when they venture out into the world in young adulthood. Having been seen as Asian within a Caucasian family, they will now be viewed as Asian with a non-Asian sounding name. They will be repeatedly asked, “Where are you really from?”. They will need to look at the part of the country where they receive job offers to determine if they are brave enough to face discrimination on a daily basis. Living in a part of the southern US, they have seen a sharp rise in the amount of racism directed their way since the election. In this era of globalization, our children  will need to determine if they ever want to return to their home country and search for birth parents or learn more about their origins.

As a white parent with white privilege I can never fully understand how all of this will make my daughters feel. In the words of another adoptive parent, Martha Crawford, I am an invited guest to the adoptive experience and my job is to support, always love and accept who they become. Not that much different from a bio parent but with the possibility of another family a world away becoming part of our extended family if a birth family search is started and successful.

But the unexpected gift that no one told me about all those years ago when we attended our first adoption meeting is the wonderful friends we would make thru this experience. Our week at Kamp is when I get to reconnect with many of these friends from other parts of MN and share both joys and sorrows, laugh and cry together. Because only these special people understand the slight curves in the road that an adoption journey can bring. My daughters have allowed me the privilege to be a part of their cultures, share their fabulous food and art and only ask that I pay for a few melon bars at the end of each day.

19961193_10211262375490079_7306711313084181283_n[1]

 

Advertisements

Who is responsible for the Health Care Mess?

CRO_health_affordableCareAct_05-14[1]I as a physician am. You are. The President and Congress are. Pharmaceutical companies are. Or, as President Trump was heard to say, “Health Care is a lot more complicated than I thought”. As someone who has been in the midst of health care for 30+ years and who has also seen better health care for fewer dollars in other parts of the world, I would like to share my thoughts as to how we can talk common sense and come up with a better solution than either ObamaCare or TrumpCare.

We first have to discuss whether health care is a human right or a privilege. As the richest country in the world and one with the largest economy, I would argue from a moral standpoint that access to basic health care is a right. Luke 12:48 was quoted to me by a judge when our family appeared in court to formally adopt our Korean daughter. “From everyone who has been given much, much will be demanded; and from the one who has been entrusted with much, much more will be asked.” The judge understood that our family was blessed with talents, wealth and knowledge and asked that we use these instruments in the community for a greater good. The same should be held true for America – we benefit from living in a country with numerous natural resources, a democratic government and public school system. Using great minds in our country, we should be able to implement a basic health care system that is available to all of our citizens. If we have a finite amount of money to spend in the budget, where should health care fall in the priority list? Currently 55% of the US budget is spent on the military and only 6% on healthcare for all US citizens. Are we ok with spending money to defend our country beyond US soil while back home our own citizens die or become sick due to preventable illness?

discretionary_spending_pie,_2015_enacted_large[1]

Now that you are well into the quagmire of the ethics of Health Care, lets turn to the players in the system. The current system of paying hospitals and physicians is backwards. Spending my time in the office doing procedures is much more lucrative than counseling patients on improved lifestyle and performing preventative care. I can deliver a baby by cesarean in 30 minutes during daylight hours and be paid almost twice as much as compared to managing a women in labor for 24 hours, spending all night in the hospital and getting up for a 4 am vaginal delivery. Treating a woman with heavy menses with either birth control pills or a Mirena IUD only generates an office visit charge vs. performing a hysterectomy that takes an hour and increases my payment 10x.   The ACA made an attempt to fix this by implementing quality care standards (such as lowering the cesarean rate) that if met, increased your paycheck from the government. Unfortunately, the cost of implementing and reporting those standards was often more costly than the payback. Physicians are human just like every other American – some of us will strive to provide the most cost-effective care for our patients while others will look out for only their bottom line.

US senators are currently tying themselves in knots trying to come up with a Health Care plan that satisfies both conservatives (any government health care is too much) vs. moderates (expand benefits to the needs of their specific state). I find it ironic that conservative states such as Ohio and West Virginia want more federal money for the  opioid epidemic that has devastated their health care budget but yet these are some of the same states where the citizens and government officials are working to defund  Planned Parenthood. Having seen the astronomical costs both emotionally and economically when babies are born to drug addicted mothers, common sense would be to provide free or reduced cost birth control in those impoverished areas where opioid addition has taken hold. Each government representative is doing what is best for their state and citizens and not one of them has been willing to stand up and declare what is best for the country as a whole. If they really cared about America they would put aside political divides and approach this as adults, not toddlers trying to protect their pile of toys. Our President, as a former Democrat and now a Republican, should be working to bring these opposing sides together and Make American Great by being the champion of a health care policy for all Americans.

The price of prescription medications in this country are higher than anywhere in the world. And yet the pharmaceutical companies that develop and manufacture these same drugs are based in the US and use taxpayer dollars to fund the research and development of drugs. Drugs are sold to other developed nations for 30-40% less than what our own citizens are charged. These same countries have a universal health care system that negotiates drug prices with the manufactures, something the US lacks. The US lacks an impartial regulatory board that not only regulates the prices of drugs but also puts restrictions on the use of new and expensive medications. Regulation also needs to be instituted in regards to advertising of drugs, both to patients and to health care providers. When I started in practice 25 years ago, my clinic had a policy that drug reps weren’t allowed into physician offices to meet with us. We were also discouraged from receiving freebies such as dinner. At the time, I thought it was a bit overboard. Now I realize that this practice shaped my ability to fact check dubious claims made by well dressed pharm reps who were treating me to an expensive dinner. How is the average consumer able to decide between a generic inexpensive drug that has no public advertising and a drug that appears in a full-page color spread and is purported to drastically alter their life for the better?

obesity[1]

And finally the American people are to blame for the health care mess. We want to have our pick of the candy store (health care) without regard to price or outcome and we don’t want to be held accountable for our personal decisions that drive up the cost of the candy store. 35% of Americans are overweight and 10% are morbidly obese, contributing to the skyrocketing incidence of hypertension, diabetes, joint and low back pain, heart disease, sleep apnea and endometrial cancer. But we continue to sit on the couch and eat unhealthy diets, all while complaining about the price of medications to control our illnesses. I discussed this very subject with a mid 50 woman this week. She smokes 1/2 a pack of cigarettes a day and is taking 4 medications related to the health effects of her smoking. We discussed  priorities regarding her health and how she spends her money in addition to options to improve her overall health. She has knee pain and doesn’t feel that she can walk or exercise. She is worried about the health effects of pesticides on food, so limits herself to one fruit or vegetable a day. The perceived level of stress in her life limits her ability to quit smoking. She enjoys the sun so spends summer weekends laying outside and visits tanning booths in the winter. After twenty minutes of this, I gave up trying to motivate her. And I was paid the same amount for a preventative care visit whether I had started this discussion or not.

Yes, it is much more complicated than anyone imagined. But not impossible. We don’t need to recreate the wheel, as many first world countries, such as Australia and Canada, have health care systems that not only work but also cost much less and have better outcomes. I think whether you call yourself conservative or liberal, we can agree that a health care system that costs less with better outcomes is a winner for all Americans.

 

 

 

 

When Hate Brings About

hA15ODoL

This month has been difficult emotionally for many Americans, including myself. It started with the shooting in Washington DC of a congressman who was targeted for representing the Republican Party. On that same day, a shooter killed 3 workers at a UPS in San Francisco. With the acquittal of a police officer in the shooting of a black man stopped for a broken tail light, Minnesota was reminded that we have a long way to go when it comes to racial equality. It is easy to throw up our hands and believe that the world is becoming an increasingly nasty environment that will continue to sink lower in acts of hate and violence. But on the same day of the baseball shooting, I was invited to an event that reminded me that there can be a different path forward.

AW30Ramadan7

Friends from Tapestry, an interfaith women’s group that was originated in response to the bombings in Paris in late 2015 and the subsequent fear and hate of Muslims, invited me to an evening meal to break the fast of Ramadan. Each evening during the 30 days of Ramadan, a community of 250-300 Muslims gather at the local mosque to share a meal and prayers starting at sundown – that equates with 9 pm in June. The fasting starts at sunup, or 4 am, and involves abstaining from both water and food. Those that work outside the home may work a reduced schedule, but household chores never take a vacation. I think that most of us would have a difficult time following this schedule for one day, much less 30 days in a row. It is considered a time where self-control is practiced and submission to God is the focus.

As my husband and I entered the chaotic, noisy room where adults, teen and children were gathering to break the fast, it was obvious that we were outsiders both by our dress and skin color. While scanning the room for my friends, we were warmly greeted by complete strangers and welcomed to partake in both the meal and in the nightly prayers. A few chairs were set aside for us – my husband later went to the mens’ side of the room- and a bowl of dates was set on the table. Dates are the first food eaten to break the fast. Hearing the call to prayers, we followed everyone into the mosque worship space and observed as worshipers bowed and prostrated themselves on the floor in submission to God. Small children ran up and down the rows of bowed heads, snuggling beside parents or siblings when they finally came to rest on the floor. Then back into the larger room to share a delicious meal of middle eastern food cooked by a local restaurant. I had not eaten since noon and it was now 9:30 pm. Those around me who had been fasting since 4 am pushed me to the front of the line, insisting that their guest be the first to eat. I was humbled by their generosity and willingness to answer all of my questions and share their stories of practicing the Muslim faith within a predominately Christian culture.

What would be the reaction of your faith community if someone dressed in traditional middle eastern garb showed up for Christmas or Easter services at your house of worship? Would you escort them to a pew and sit beside them as you explained the nuances of your worship service? Would you introduce them to your friends and share conversation as well as coffee and doughnuts after the service. Would you share stories of your faith and ask them questions about their religion? Christianity is founded on love and acceptance. I think that most of us, myself included, have a long journey ahead to fully integrate this into our lives. And I think that other faiths or religions do a much better job than mainstream Christianity at welcoming outsiders.

The shooting of a congressman was carried out by one of our own “terrorists”.  He was not Muslim or of Middle Eastern descent. He was Caucasian, born in America and had easy access to multiple rounds of ammunition and a gun.  Just because I share his skin color,  place of birth and religion does not make me feel responsible for his behavior. But if this same deranged individual had been Muslim, we would have blamed the larger Muslim community and labeled this as a “terrorist act”.  Shouldn’t all hate crimes be labeled as terrorist since they are targeted against a specific group and randomly kill innocent victims simply because they are members of this group?

Muslims are my friends. They cook wonderful food, have interesting stories to tell and share a deep faith that I respect. I hope that they can understand that not all Caucasians fear them or hate their religion. What this world needs is for all of us to develop more empathy and rid ourselves of hate and fear of those who don’t look like us. Because often “others”  are more similar to us than different.

 

 

 

#Menstravaganza

MHD_fullcolor_clear

For those of you who have been following this blog over the past few years, you know that I am passionate about all things related to women’s health care. Considering that my job as an Ob/Gyn physician is intimately interwoven with this topic, it is only to be expected that my children are exposed to my opinions during conversations at home. They also hear about my experiences in Haiti and are often recruited to assist with the construction of reusable menstrual pad kits that are distributed to young Haitian girls to encourage them to remain in school after they start menstruation.

May 28th (5-28) is Menstrual Hygiene Day and is dedicated to creating awareness around an often taboo subject. The 5-28 has significance in that most women bleed for 5 days every 28 days. Although Western civilization has made great strides in the past few decades around menstrual health education, the stigma and embarrassment for young girls persists. My daughters and I were finishing a restaurant meal when we noticed that the girl leaving the table next to us had a large blood stain on the back of her dress. We looked at each other with horror while having a hurried discussion about whether it was less embarrassing to run after her and inform her of the stain vs. letting her find out herself. The decision was made as we heard the door of the restaurant close behind her and our chance was lost. Would we have wasted time in discussion if the bleeding had stained her clothes from a large cut on her leg? The blood is the same but the source so much different.

When my daughter informed me that she was combining both of the above experiences into one argumentative essay for her final AP Composition Essay, I had to smile and then pity the male teacher who was to be subjected to her strident opinions. This same teacher (late 30’s) admitted that he has never purchased feminine hygiene products for his wife and had no advice for sources of information to help support her argument that luxury taxes should be abolished on tampons and pads. Because of the work of humanitarian organizations such as WASH in developing world countries and women’s health advocates in this country, resources for information were plentiful.  I have included the first part of her essay below.

Luxurious Taxes

Toothpaste, sunscreen, chapstick, shampoo, condoms, viagra. All daily items, all exempt from taxes. Daily essential items that are categorized as a necessity and aren’t taxed. Items thought to be a luxury, however are taxed. Flowers, cell phones, nail polish, TVs, computers, and jewelry. They add pleasure to your life. Those items are bought by choice and personal interest. What defines whether an object is declared a necessity or a want? Does the gender of a buyer for an object affect the tax, non-tax ruling? Tampons are taxed, but females need them to tend to their monthly periods. Taxes should be removed on tampons in every state. They are looked upon too lightly and assumed to be more of a extravagance and less of need. They are the “pink tax”.

My mom is an OBGYN and she sees female patients on a daily basis that revolve around period defects. Patients are suffering from heavy streaming periods and other dysfunctions that are uncomforting. They have to change tampons more frequently than an average person. Changing tampons every hour is inconvenient and costly.  My mom works with women to try and assist them in feeling more comfortable with the unnatural feeling periods and other dysfunctions of being female and save them time and money from buying so many tampons. However seeing a doctor about menstrual issues becomes even more costly when trying to fix your awkward period malfunctions. Women are feeling embarrassed and uncomfortable.

Tampons. They are declared a luxurious item in thirty-eight states of the United States. On holidays, taxes are removed on some everyday items, however, tampons and pads are still taxed on those special occasions. Tampons are still looked upon as a non-essential item, as if they are used by choice. As if women choose to go out and buy a $7 box of wonderful cotton plugs. As if women choose to have periods every month for an average of thirty-six years of their life. As if women choose to spend close to $2,000 on such a “luxurious” item as a small cylindrical object made of cotton. As if women are being spoiled with an item to protect their blood from leaking out. What a treat.

Tampons aren’t flowers. People wouldn’t buy a box of tampons for their friend’s birthday. Tampons are a common piece of feminine hygiene that keep blood from spilling out uncontrollably and make periods a little less worse. Periods are a naturally occurring part of a female’s life that they can’t prevent, not to mention the berserk side effects of mood swings, cramps and cravings. Tampons and pads have to be used to prevent blood from pouring out and leaking everywhere, time after time after time.  Every second you feel uncomfortable blood shedding; every minute you’re hesitant of leaking; every hour you’re contemplating if you need to change tampons; every day you’re in fear of the current of your flow; every week you wonder when it will be done. Periods aren’t a choice. Tampons aren’t a choice. They are a need. Tampons are calculated to be needed for 456 periods, 38 years, and 2,280 days (2015, Kane) of a female’s life. Tampons are a female necessity.  

Although her grade for the entire essay was high, the one critique by her teacher is evidence that we still have some work to do in this country when it comes to education around menstrual health. He penned ” too graphic”.

MHDay_Onepager_v2

The work that needs to be done in developing world countries is even greater.  There is a growing awareness that less stigma around menstruation results in better lives for both boys and girls. Girls that stay in school beyond the age of menstruation because they have access to a private bathroom as well as menstrual pads, also have fewer children and are better able to secure a job to support their family because they have obtained a higher level of education. My involvement with the sewing center at Helping Haiti Work has reinforced what I have seen researched. The need for menstrual protection supplies in schools is recognized, but the thirst from teachers and students for education is even greater. Our Haitian seamstresses have been provided with women’s health training and given charts and pelvic models to use in their educational sessions. For $16 a day they will assist in the distribution of the reusable menstrual pad kits and provide 3-4 hours of education to teachers and students.

IMG_1501

My hope is that a future granddaughter will pen a similar essay to the one above for her ancient history class and use our current experiences as the beginning of the end when it concerns the menstruation taboo.

IMG_1509

 

 

What Moms really want/need for Mother’s Day

DSC_0009

Dear Baby Daddy,

This letter applies to anyone who has fathered a child, whether they be husband, boyfriend or estranged partner. If you aren’t aware, this Sunday is Mother’s Day. You should be honoring not only the woman who gave you life but also the woman who gave life to your children. And this honor thing should not be for just one day. It should be every day.

Being in the baby business for the past 25 years, I have been present at the start of hundreds of families. This is the moment that parenting starts and some guys do it better than others. Let me give you a few clues as to what is expected of you.

6828e4a49e8997872cafd89ff4dd790c

  1. Remember when this all started 9 months ago? You were there for the blessed event of conception and if you didn’t want to be a father, you should have voiced that opinion with the use of a condom. FYI – they are inexpensive, freely available and can be kept in your wallet for just such an occasion. History tells us about one immaculate conception and your partner hasn’t made history by being the second. This child is your responsibility for the remainder of your life, so stick around. And that means at the birth as well as the birthday parties. Responsibilities come in the form of monetary payments as well as emotional/physical support.
  2. Start practicing your involvement by coming to a few obstetric appointments. Hearing the heartbeat of the baby is a pretty cool trick that we doctors perform each visit. You can ask questions your partner may have forgotten. You CAN’T play video games on your phone during the entire visit – that makes you look like a child rather than a potential father.
  3. Set a good example at home with your diet and exercise habits. Eating a meal of McDonald’s on the couch while watching tv all evening doesn’t help your partner make nutritious food choices that will help her baby grow. Go for a walk and then help to cook a meal. You might even have a conversation about baby names that wouldn’t have happened in front of the tv. And if your partner is trying to give up smoking or drugs for the welfare of your child you are not allowed to offer her a cigarette, smoke in front of her or invite friends over for a night of illegal substance use.
  4. Support your partners decision to breast feed. Her breasts are not your property and will soon belong to your unborn child. Get over it!
  5. Pony up the money for a birthing class. When patients tell me they can’t afford the $80 fee, I wonder how they will afford to care for a child over the next 2 decades. I realize that you don’t need a birthing class in order to have a baby, but it makes the experience much less anxiety producing for both the mom and the doctor. Nobody would consider driving a car before taking driving lessons, but everyone thinks they are an “expert” at the birthing process because they watched someone else give birth.
  6. Your partner is in labor and you are with her at the hospital. These pointers will help you in how you are treated by the nurses and doctors. Your wife is our patient – not you. You will be required to get your own food and drink. If your partner is awake, you should be also. Sleeping on the couch in the room while your partner is trying to birth your child isn’t acceptable. Since the doctor and the nurse have been up all night helping to care for your partner, you have no excuse. And realize there will be a few sleep deprived nights ahead, so this is good practice.
  7. Labor hurts. Let me say this again; Labor hurts. Just because you and your partner decided that a natural childbirth without pain meds was a good idea last month doesn’t mean she can’t change her mind when she realizes that the horror stories she has heard are true and more. It’s her body and her decision – its your job to be supportive of her decision. Would you consider having your appendix removed without anesthesia to make it a more “natural” process? I didn’t think so.
  8. The baby has arrived and you are home. Now the hard work begins. Your partner has just pushed a volleyball out her vagina and she may be a bit sore. She is also experiencing 2 boulders sitting on her chest that leak copious amounts of milk at inopportune times. Your job is to take over the household responsibilities for at least a week. No sports on tv, no guy time, no video game marathons.
  9. For those men who are not living with the mother of their child, don’t feel that the above rules aren’t applicable to you. You are still on the hook for financial support and you should make sure that your visits aren’t disruptive but that you are helpful. Hold your child and become acquainted while mom takes a nap. Purchase a package of diapers as a gift. Offer to wash the dishes in the sink. See #1 – this is your child and your responsibility. Your parents (paternal grandparents of child) also should be holding you responsible. And if you think all this parenting work is too difficult – buy a lifelong supply of condoms.
  10.  You and your partner have made the mutual decision to stop producing more babies. She has birthed a few children as well as managed the birth control options to this point. Now it’s your turn. A vasectomy takes 10 minutes – that is the length of time for 2 contractions in a 12 hour labor – and is much less painful than one contraction. If your partner went thru childbirth without pain meds, you might want to consider a vasectomy without pain meds to make it more “natural”.  And finally, don’t forget the flowers this weekend.

PF_14_A614_SPR_MDAY_MINIMAL_VA0122_W1_SQ

Henrietta Lacks in Haiti – Tackling the epidemic of cervical cancer

aiti

For those of you who may not have heard of Henrietta Lacks, allow me to provide a short tutorial of her immortal importance after her death. Ms Lacks died of an aggressive form of cervical cancer in 1951 at the age of 31. During this same time, researchers at Johns Hopkins Hospital in Baltimore were attempting to grow tissue cultures from human cells. Most of these cell lines died within a few days, but the tissue obtained from Ms Lacks tumor reproduced at a high rate and could be kept alive to allow for further study. The cell line became known as HeLa and was instrumental in developing the polio vaccine 3 years later as well as other breakthroughs in medical science. We now understand that the reason that her cells reproduced so rapidly, and also why she suffered from such an aggressive form of cervical cancer at a young age, is that her cells were infected with a high risk strand of HPV (human papilloma virus) which caused uncontrolled growth of infected cells. This understanding has led to the Gardasil vaccine as well as more sophisticated HPV testing, both of which have the ability to eradicate cervical cancer from the globe.

Cervical cancer is becoming strikingly more important from a global health perspective for two reasons:  Maternal mortality has been reduced by almost 50% and HIV infected woman are living longer on retroviral medication. Unlike Henrietta Lacks, most women don’t die of cervical cancer until their 40’s to 50’s. Keeping more women alive in childbirth means that there will be a larger contingent of women susceptible to the effects of HPV. Women living with HIV, although appearing healthy when taking daily retroviral medication, have a depressed immune system and are more likely to develop cervical cancer when exposed to HPV.  Currently, 85% of world-wide deaths due to cervical cancer occur in the low and middle income countries.

During my 25 years of practice in the US I have encountered 4 cases of cervical cancer. Each of those cases occurred in a woman who had not had a pap smear or pelvic exam in more than 10 years. More than 50% of cases of cervical cancer in the US are not due to the inadequacy of screening but rather to the lack of screening. With the recent addition of HPV testing to pap smears, the accuracy of this test has improved even further. My   work in Haiti has revealed a much different picture. In 15 trips over the past 10 years, I have diagnosed 12 cases of cervical cancer, all of which were well advanced. By some accounts, Haiti has the highest incidence of cervical cancer in the world with 94 cases per 100,000 women. Cervical cancer is the leading cause of cancer death in Haitian women, with 1500 Haitians succumbing every year. It kills nearly as many women as all other cancers combined. This is in comparison to the US, where cervical cancer accounts for only 3% of female cancer deaths. Keep in mind that cervical cancer is one of the few cancers that we currently have the ability to not only prevent but also to treat pre-cancerous lesions before they progress to cancer. Cervical cancer can become a forgotten disease in 25 years.

IMG_4923

On the same evening that Henrietta Lacks premiered as an Oprah movie on HBO, I boarded a flight to Port au Prince, Haiti to participate in a conference addressing the need for a cervical cancer screening program in a country with low resources. Members of the Ministry of Health, Haitian ob/gyns and American aide groups came together to discuss and formulate a future plan. We discussed what works and what doesn’t work, the need for education in the community and how best to use limited resources to benefit the majority of women. Haiti sans Cervical Cancer has a tremendous amount of work to accomplish, but is stronger when everyone is pulling in the same direction.

IMG_4938

Partners in Health, known as Zamni Lasante in Haiti, is part of our coalition of Haitian organizations that has approached seemingly insurmountable world-wide public health challenges in the past. They were pioneers in improving tuberculosis treatment when multi-drug resistance to the disease became problematic and were instrumental in bringing HIV medications to poor people suffering from the disease. In both of those cases, the “experts” said it couldn’t be done but PIH proved them wrong. Cervical cancer is an equally deadly disease, killing mothers in the prime of their lives. The solution, however, is much less expensive – receiving 2 doses of the Gardasil vaccine as a young teenager and then a $10 HPV test every 5 years starting in your mid 20s until mid 50’s. By reducing the rate of maternal mortality by 50%, we have been successful keeping many more women alive during childbirth – now we need to tackle the disease that can kill these women later in life.

Fake News in Medicine – or how to get your medical degree from the internet

image1

A 22 year woman, pregnant for the first time, informed me at her obstetrics appointment this week that she had done “all of her research on the internet” and didn’t want any vaccines for herself or her infant because she is concerned about preservatives. I had a difficult time not asking her what preservative laden food she had eaten the day before. Another patient declined the tetanus/pertussis vaccine that is recommended at 7 months of pregnancy to provide passive immunity against whooping cough to an infant before they become fully vaccinated. This has become recommended due to periodic outbreaks of whooping cough among unvaccinated children. Her reason for declining the vaccine? “My friend told me it is a bad idea”. I spent an extra five minutes explaining why the vaccine is recommended, why contracting whooping cough as a young child can be serious and potentially deadly and that the vaccine has been proven safe in pregnancy. She continued to decline and on her way out the door informed the staff that Dr Jaeger told her that her baby might die.

In the past week in Minnesota there has been an outbreak of measles – 11 children have been affected, 10 of them were not immunized and many required hospitalization. Measles is one of the most contagious of human diseases and it is expected that more cases will be identified. Fortunately, it is very unlikely that any of these cases will be fatal as the children are otherwise healthy and were identified early in the course of the infection. All of these cases occurred in the Somali community, an immigrant population that can be distrustful of western medicine. They are a cohort that is seen as an easy target by the anti-vaccine movement, which spreads its false information via social networks and word of mouth. Studies have documented that Somali parents are more likely to believe that the MMR (measles, mumps, rubella) vaccine causes autism and are more likely to refuse the vaccine than non-Somali parents.

Fake news is defined as false information or propaganda published under the guise of being authentic news. History is replete with medical snake oil remedies to cure disease. But with the widespread acceptance of the internet as a source of information – true or not – the increase in fake medical news has skyrocketed. In an attempt to research what is best for their children, parents can be susceptible to the spread of this false information. Additionally, the anti-vaccine movement is being emboldened by the current Trump administration who has appointed Robert F Kennedy Jr to a task force that purports to investigate the safety of vaccines. Mr Kennedy holds no medical degree, has done no actual research and his intent is to push forward the anti-vaccine agenda with pseudoscience that is difficult for the average American to understand. But when he has the backing of the President of the US, he is given more credibility than he deserves.

Ironically, the anti-vaccine mindset is only possible because medical research and vaccines have almost totally eradicated communicable diseases from the developed world. My patient who declined the pertussis vaccine during pregnancy has never seen a child die of whopping cough, which occurred in 1 out of 5 children in the 1920’s.  As recently as 1980, 2.8 million deaths worldwide were attributed to measles. Global measles deaths have decreased by 79% since widespread immunizations have been implemented. Do we really want to be reminded of what it feels like when you lose a child to a preventable illness?