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

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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?

 

 

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Ebola vs Measles: Personal Stories and Statistics

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Personal stories tend to grab readers much more quickly and effectively than statistics. Unfortunately, that phenomena is what is driving the current trend among affluent, educated parents declining to vaccinate their children and the subsequent measles outbreak in southern California. Parents hear a personal story about a child who was diagnosed with autism after receiving a vaccine or they read about it on the internet. Exempting your child from vaccination in many states has become as simple as filling out a conscientious objector statement for school. Personal stories score headlines when politicians make unsupported comments concerning vaccines. Sen Rand Paul recently spoke out saying,  ” I have heard of many tragic cases of walking, talking normal children who wound up with profound mental disorders after vaccines.”  Or Michelle Bachmann in 2011, ” She told me that her little daughter took that vaccine (gardasil), that injection and she suffered from mental retardation thereafter.”  It may be coincidental, but both Paul and Bachmann were competing for the Republican nomination for President at the time of their comments.

This is my personal story. Gavin (pictured above) is the 13 month old son of one of my co-workers. At 8 months he was diagnosed with a very advanced case of Wilm’s or cancer of the kidney. He has spent the past 6 months undergoing chemotherapy and multiple surgeries and is currently cancer free. Because Gavin is still immune compromised due to his recent chemo, he has not had his first vaccination for measles (MMR) and is at risk of contracting the disease if he is exposed. Because he is immune compromised, a measles infection can become fatal rather than a nuisance illness.

The family routine has started to normalize and both of his parents are back to work full-time. This means that Gavin has returned to his daycare center, but also that he is among children that may not be vaccinated due to their parent’s personal objections. Unvaccinated children are the children who become sick during a measles outbreak. The early symptoms of measles are similar to a bad cold – fever, runny nose, sneezing, and a sore throat. Measles, however, is much more easily transmitted than the common cold. The virus can live on surfaces and in the air for up to 2 hours and is spread through coughing and sneezing.  Measles is so contagious that 90% of people who are not immune will become infected when in close contact with an infected person (CDC statement). I would bet that the number is closer to 100% in a daycare center given the amount of coughing, sneezing and drooling that occurs.

And this is the statistics part of my story. In a previous post, I referred to the 2015 Gates Annual Letter detailing the work that they hope to accomplish in the developing world in the next 15 years. Since 1990 they have been able to cut the rate of death in children before age five in half, from 10% to 5%. Immunizations have played a major role in that decline, both in protecting individual children from disease and in decreasing the overall prevalence of disease in the general population. If we could move a vaccine denier and their children to a developing world country, they may be better able to see the benefits of vaccines from the eyes of mothers in that country, who fear that their children have a 1 in 20 chance of dying from pneumonia or diarrhea. Vaccines against these illnesses are currently being developed with financial help from the Gates Foundation.

Finally, let me compare the measles outbreak/vaccine debate to the Ebola outbreak.  Over 100 people were infected in California with measles, whereas there were less than 10 people in the US infected with Ebola and only 2 contracted the disease in this country.  Mass hysteria, both in the private sector and in the healthcare system, ensued with Ebola. Sales of protective gear on the internet soared, hospitals and clinics created policies and education regarding Ebola, immigrants from Africa were stigmatized, to name just a few.  And what mass hysteria have we seen since there have been 10 times as many people infected with measles, a disease which is 100 times more contagious than Ebola?  The majority of the comments from politicians have centered around individual parental rights to vaccinate or not vaccinate their children, not speaking out for what is important for the country as a whole. Compare this to the brave citizens of Liberia who are volunteering to be the first recipients of the newly developed Ebola vaccine. We have no long term data about the possible side effects of the vaccine or how effective it might be. However, these men and women have seen the brutal effects of Ebola in their country and are willing to sacrifice personal safety for a better future for their country. Would American citizens be as Brave?

Dear Pregnant Patient

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With all of the news recently about the measles outbreak in California, I have seen many news articles and blog posts referring to the parents of unvaccinated children and their contribution to the epidemic. As an obstetrician, when a pregnant patient informs me that she is not planning on vaccinating her unborn child, I can refer this discussion to her family practice or pediatrician. Maternal vaccinations during pregnancy is a topic I need to discuss with each of my patients. This can be one of the most frustrating conversations that I have each day, as there is good evidence to support the benefits but an enormous amount of unsupported evidence on the internet. This topic and others repeatedly arise in my daily work, so I have decided to address the most common in a letter.

 

Dear Pregnant Patient,

As part of my training to become an obstetric MD, I have spent 4 years in college, 4 years in medical school and 4 years in specialty training. I am required to perform ongoing medical education each year and also read journals to keep as up to date as possible. What I don’t read are articles on the internet that are not supported by medical fact. Just because you have found an article via Dr Google to support your position, doesn’t mean that I need to agree with it.  Please read below as it will save you an inordinate amount of time searching the internet.

1. The fact that you are seeing me for an ob visit is a reminder that you are pregnant.  I  would not prescribe a medication that would cause harm to your baby. So if I inform you that you need a medication, don’t ask “Will that medicine hurt my baby?”

2. Pitocin is a medication that has reduced maternal deaths from hemorrhage in the developed world by 70%. It is much more effective when given prior to a hemorrhage (prophylactic) than once a hemorrhage has occurred. Similar to wearing a seatbelt, everyone needs to wear one because you can’t always predict who will be in a car crash or have a hemorrhage.

3. If I discuss your weight and recommended weight gain during pregnancy, I am not trying to be judgmental. I am attempting to improve the health outcome of both you and your unborn child. Obesity and excessive weight gain are associated with preterm delivery, diabetes, hypertension and increased risk of operative delivery.

4. I try to stay on time as much as possible with my office schedule, but sometimes need to attend to a patient in labor. If your appointment is delayed because of this, please remember that you will be a labor patient soon.

5. Vaccines during pregnancy are meant to protect you from getting ill as well as protecting the health of your unborn child. During the first year of life and before infants are vaccinated, they are susceptible to illnesses from the caretakers in their life. Your hurry to get out of the office today or the pain you may experience from a shot are not reasons to decline vaccination.

6. An ultrasound assessment of you baby is usually done at 5 months of pregnancy to rule out major problems with the pregnancy. At this time we can usually determine the sex of the baby. We will not order the ultrasound earlier so you can fit the “Reveal Party” into your social calendar.  We will not repeat the ultrasound just to be sure the baby is a boy or girl. If you can’t bond with your child because you’re not sure if it is a boy or girl, there are bigger problems.

7. All obstetricians have the same birth plan for their patients – Healthy Mom, Healthy Baby. We will honor any of your birth plans as long as it doesn’t conflict with our birth plan. And remember how much experience we have had and how many births that you have attended.

8. Childbirth is painful – I think it started with that passage in the bible about Eve eating an apple. If you don’t want pain meds, we won’t force them on you. If you do get pain meds, realize that it may not work 100% of the time. You don’t get a medal if you decline pain meds and it is not any one persons’ fault if your pain medication doesn’t work as well as you expected.

9. We are always available after office hours for emergency calls. Calling at 2 am to ask if you can take a Tylenol or at 5 am to report on a mild pain that has been present for 3 days is not an emergency.

10. The Family Birth Center has a limit on the amount of people who can be present during the delivery of your child. Family does not refer to your sister’s boyfriend’s cousin – especially when they can’t remember your last name when looking for your room.

11. If you are unable to be “skin to skin” with your infant immediately after birth, you and your child will still have a chance at being well bonded. I think most of us are bonded with our mothers and we were whisked off for a bath and to be bundled up before being able to see our mother’s face a few hours later. My youngest daughter was 25 months old when she first saw my face and heard my voice and she knows just as well as her sibs whom to ask for money or a car ride.

I love being part of a woman’s pregnancy and birth.  Hopefully my Birth Plan coincides with yours.