Yes, You Agreed To This

I waded into an argument last week after seeing what Ren wrote about fluoridation. A Doctor of Dental Surgery (DDS), who shall go unnamed because he’s a bit of a douche about stuff, decided to go on and on about how fluoridation of drinking water is an experiment on unwilling participants. Those participants, he claims, are the public, and the public never agreed to this according to him.

Number one, fluoride in drinking water is nowhere near a toxic level. It’s not even close. And there is little evidence that fluoride bioaccumualtes in humans. The human body is set up to deal with these things quite well. Unless your kidneys are completely in shambles, you’re going to be okay.

Number two, the people/public did agree to fluoridation of the water supply, even if they didn’t have a vote on it. In the United States, we elect people to make these decisions for us. Frankly, we would get nothing done if we had to hold an election every time some public health intervention needed to be made.

Essentially, we assented to have our elected leaders use the best available evidence and intervene on our behalf when a public health problem is identified. If we don’t like it, or if they do the wrong thing, then we vote them out… Or have a revolution or something.

Sorry, George.

This batshit insane rambling that vaccines or fluoride or vitamin K for newborns are all experimental is, well, insane. We took a vote, people. You lost. Live with it and go vote at the next election. Until then, drink up!

Who is to blame for all the measles?

There’s a massive outbreak of measles underway in China. It’s big, really big:

“In the first five months of 2014, China has reported nearly 36,000 cases of measles, well over the 27,646 cases reported for all of 2013 and almost six times the number reported in 2012.”

In a country with that many people (over 1.3 billion at last count), 36 thousand cases may not seem like a lot. It’s 0.003%, but remember that we don’t do math that way in epidemiology. We divide 36,000 by the number at risk, and the number at risk is indicated by the number who are not vaccinated or have lost their immunity due to disease (e.g. cancer) or treatment for a disease (e.g. cancer, again). That number, the number at risk, is pretty much uncertain because the public health infrastructure in China is, well, lacking.

But this post is not about China. It’s about the good ol’ US of A. We have a somewhat robust public health system that, in my humble opinion and when it comes to immunization, is probably up there with the best in the world. There is no child in this country that does not have access to immunizations. If you have a child in the most remote corners of this country, you can get them vaccinated at little to no cost, especially against the killers like whooping cough and measles. So why do we have measles making a comeback here in the US? Is it just the anti-vaccine crew that have done this to us? (Don’t be fooled, it is us, you and me, that will be affected if vaccine-preventable diseases make a comeback.)

Yes and no. I’ve been reading some blog posts by some very well-intentioned people, and they place all of the blame on vaccine refusers for the rise in measles that we are seeing. I read a lot of that hand-wringing in those posts. After all, anti-vaxxers are the natural enemy of vaccine supporters, right? It’s the Jenny McCarthys and Andrew Jeremy Wakefields and their followers who we must fight and fight some more, so why not blame them (and them alone) for the rise in measles, mumps, and whooping cough?

We can’t just blame them and them alone because this is a very complex issue. The federal and state governments also have some fault because they’ve made enforcing vaccination requirements a joke. There are states that allow parents to simply sign a form to let their unvaccinated disease incubators go to school. Other states allow religious exemptions though there are no actual religions that prohibit vaccination. (Maybe some of the newer, whackier religions?) And don’t get me started on the under-funding of public health overall. If I had to decide whether to enforce vaccine requirements or inspect foods, which would I do?

The educational system is also to blame because it has failed to give today’s parents the tools they need to discern between good and bad science. Very basic teachings in biology, chemistry, and math would allow people to tell that what they’re being told by anti-vaccine outfits are out-of-context facts at best and outright lies at worst. Biology would help them understand why “leaky gut,” viral shedding, and all the other things attributed to vaccines are crap science. Chemistry would help them understand why thiomersal is not “mercury” like anti-vaccine advocates would like you to think that it is. Math would help them understand things like odds ratios and relative risks.

Then there’s the media. Their continuing attempts at false balance by giving equal time to quacks when discussing vaccines confuses the unknowing, uneducated public. A hysterical anti-vaccine advocate who doesn’t let a medical doctor speak and just drones on and on about all the evil things that vaccines are believed to do is actually credible to some people. Some people want to believe, and when they see that credible news outlets invite anti-vaccine nuts, well, then their belief is confirmed.

I would love to just point the finger at outfits like NVIC and AoA and say that they’re to blame for all the measles. Heck, if it was only Andrew Jeremy Wakefield that did this to us, the solution would be simple. But the problem is huge and complex, and we pro-vaccine bloggers are not doing our audience any favors by just saying that it’s the anti-vaxxers and leaving it at that. After all, what kind of action can you take against someone with such closely-held beliefs? You can’t really change a person at that deep a level. But, if we realize that there are other causes that we can do something about, then we can, you know, do something.

Oh, and we’re a plane trip away from China and from a fresh pool of measles to land on us… That’s why I mentioned China. I almost forgot.

 

More real threats to public health

Let’s play a mental exercise. In this exercise you are a parent of a child. There is a virus out there that can give your child some nasty sores which can get infected with things like MRSA, a high fever, and make them feel like crap. Furthermore, because there are many people out there with compromised immune systems from things like HIV, treatment for auto-immune disease, or in treatment for cancer, you do not want that virus to be anywhere near them. It could be deadly to other people and cause your child to be sick. As a good parent, you want to protect your child and your community from this virus. So what do you do?

Do you immunize your child with a vaccine that has been shown to be safe and effective? The chances of a bad reaction from the vaccine are one-in-a-million, if that. Maybe there will be soreness at the site of the injection. Maybe, if your child is very young, he or she will be fuzzy and have a slight fever. Maybe. There won’t be any pustules, rashes, high fevers, or chance of death.

Or do you continue to propagate the virus with the flawed thinking that immunity this way is somehow “safe” or more “effective”? Do you do what this worthless excuse of a parent did:

No words.

No words.

That’s right. This parent went and got a lollipop from a person infected with chickenpox and gave them to their child. A lollipop that was licked by a sick child was given to a healthy child. Because THAT is safer than a vaccine?

It doesn’t stop there. The same group has other gems very openly displayed on their Facebook page:

chickenpox_mom3

Bullshit! The chickenpox vaccine is not given until 12 months of age. But truth has never been something these psychopaths can deal with.

chickenpox_mom2

chickenpox_mom

 

In case you missed it, these so-called parents knowingly and willingly expose their otherwise healthy children to an infectious agent that causes a disease capable of killing their children. But, you know, vaccines are the real evil in their world. I’d try to argue some sense with them, but this is the typical response you get from the anti-vaccine activists among them:

insult

Who can argue with reasoning like that?

If you picked the vaccine for our mental exercise, then you’re a reasonable and caring parent who looks after the health of their children. If you picked the infected lollipop, then you might as well hand over your children to people who will really care for them and step away before you kill them.

Your site preceptor chemically castrated children. Period.

If you don’t know the story of Dr. Geier and his son (heretofore referred to as “The Father and the Son”), you can read this excellent wrap-up of the history of these two. It boils down to this: They chemically castrated autistic children to “treat” those children’s autism. It’s really such a horrible thing that the state of Maryland’s medical board suspended the license of the father and filed charges against the son for practicing medicine without a license (making it look like he was a clinician). That was back in 2011. The date is important, and you’ll see why in a little bit.

When you go to school at the George Washington University School of Public Health, you are required to do a practicum (professional experience) at a site that is relevant to public health when you’re getting a master of public health (MPH) degree. A few friends of mine have gone there, and they did their practicums at DC DOH, at Maryland DOH, in Virginia, at hospitals, community clinics… Somewhere where they could learn about public health practice.

One particular individual, someone we refer to as “the kid”, did his practicum with – you guessed it – the Father and the Son. Well, okay, maybe just the Father, as the Father has been revealed to be the practicum site preceptor for the kid. A major university in the heart of the nations’ capital, one which has graduated some pretty great epidemiologists and public health practitioners, one that is up there in terms of public health research and practice, one that charges students a ton of money for a good quality education, approved a physician whose license was suspended in 2011 and revoked since to be the site preceptor for the kid.

Whether the kid knew that the Father and the Son were in hot water legally is up for discussion. One thing we know for sure, the kid knew what the Father and the Son were doing to autistic kids. He has blogged about it and defended it in different media. This is disturbing in many, many ways. Here we have an anti-vaccine, conspiracy theory-believing, public health professional (because he has the MPH, whether or not we like it) who knew what these guys were doing to autistic kids and still chose to do his “public health culminating experience” under the Father’s supervision.

To quote a friend, “WTF?”

I think somebody dropped the ball and did not do the kid a favor. The faculty at GWU should have reviewed the Father’s qualifications to be a site preceptor and not allowed the kid to do his culminating experience there. He should have gone to a place where actual public health is practiced, not what can be best described as “quackery”.

It is no surprise to me that the kid has been defending the work of the Father and Son.

Do you need to go to medical school?

I met a couple of kids who are in high school right now and are interested in a career in public health. They couldn’t be more different from each other in so many ways. Student A is White, lives in a big city, and goes to a public school. Student B is Asian, lives in the suburbs of that big city, and goes to a private school. Student A’s parents work at a local hospital. His mother is a nurse and his father is a radiology technician. Student B’s parents are both physicians at another hospital. I didn’t ask them, but I think they’re not poor, but it is clear that Student B’s lifestyle is a little more privileged.

Where these two differ is in their plan to get to a career in public health. Student A wants to go to a respectable college, get an undergrad in public health, then apply and go to medical school. Student B wants to go to a similar college, get an undergrad in microbiology, then a master’s in biomedical sciences, and then a PhD in public health. Student B wants to be more involved in research. Student A wants to be a physician so he can “be the boss” in a public health agency. It was that last part that gave me a chuckle. Continue reading

Go read my friend’s blog

What are you doing reading this? Go read Ren’s declaration of a new “forever war,” and his subsequent post about depression. Mental Health is something that we in public health don’t think about often, but it influences a lot of what we do. If a person is not of sound mind, how can we expect them to make the right health decisions for themselves and their community?

I do hope Ren keeps at it on the mental health aspects of public health. I’ll do the lifting with quackery and the anti-vax crowd. (Well, not just me. There are others. We are many.)

Operational Pause

Something really, really big just came up. I can’t tell you what it is, and you’ll probably never know that I’m about to do what I’m about to do. That’s how public health works. We do things in the background so that bad things don’t come to the forefront.

No worries. My “mission” this time is not at all like that of the hundreds of healthcare workers moving into Somalia right now to vaccinate children in that war-torn place. It certainly isn’t as dangerous as the vaccine workers that got shot and killed in Nigeria and Pakistan. And its not going to go down in the annals of history like the smallpox eradication campaign did and the polio eradication campaign surely will.

Maybe, if you’re good, I’ll post a picture when I get back. Maybe.

So find something else to do for a week, will you? (I suggest the reading list on the right side of this blog.)

Up, up and away…

I’m done with the kid, for now

It should be no secret to anyone reading this that I have a Master of Public Health (MPH) degree from an accredited univeristy. What is an MPH? It’s a professional degree in public health that accredits the person who earns it as someone who has done the readings, written the papers, and taken the exams to prove that he or she is trained to look after the public’s health.Some of us, the very idealistic among us, have taken a Public Health Oath:

“I will work to ensure that people have the chance to live full and productive lives, free from avoidable disease and disability and supported in their pursuit of physical, mental, and social well-being.

I will hold myself to the highest ethics, standards, values, and responsibilities as I move forward the science and practice of public health.

I will respect the rights, values, beliefs, and cultures of those individuals and communities with whom I work.

I will rely on evidence to support my decisions and actions, and translate that evidence into policies and programs that improve health for all.

I will add to the body of research and knowledge and share my discoveries freely.

I will continuously seek new information and be open to ideas that can better protect and promote the health of populations.

I will advance health literacy for all and seek equity and justice for vulnerable populations.

With this oath, I commit to the ideals and mission of public health.”

Unfortunately, not everyone who earns — or is looking to earn — an MPH degree agrees with this oath, let alone follows it. Continue reading

The many and the individuals

The thing about public health and public health workers is that we are not healthcare providers in the strictest sense. While some of us may be nurses, physicians, or physician assistants, most of us never even come into direct contact with the people we’re serving. Even those who do “treat” people, e.g. give a vaccine or administer post-exposure antibiotics, are not in charge of the continuing care of the individuals. On the one hand, we’re protecting the health of the people. On the other, it’s not entirely up to us.

This causes some friction, especially when a provider thinks that he or she should be the final arbiter of what to do with their patients. Take, for example, a certain pediatrician to the stars. This pediatrician has said over and over that his decades of experience in medicine and his gut feelings dictate his approach to immunizations. He believes that some vaccines undoubtedly cause bad things, and that vaccines should be spaced out as much as possible, if they are to be given at all.

For his individual patients, that’s fine. It’s really between he and his patients how he is to tend to their healthcare needs, so long as he practices a standard of care that is not negligent and does so in the best interest of his patients. However, for the population at large, this is not a good thing. It’s not good to erode herd immunity against things like measles or mumps. It’s not good under any circumstance.

There was once a kid in a very large university who came down with bacterial meningitis. He had been at a party and allegedly “hooked up” with several young women that night. We did our best to track down those contacts, and everyone else at the party. When we did, we notified them of a possible exposure to bacterial meningitis, and we advices them to go into their local health department to be given antibiotics or to go see the university’s health providers, or to go see their own physician. Well, there was one physician who saw one of the young ladies in question and refused to give her antibiotics. He said that she said that the case and her never really hooked up. They just sat on a bed in a room at the house where the party happened and talked, nothing more. So the physician took her word for it.

This triggered a huge discussion on what to do with her. Would we ask the physician at the local health department to give her the antibiotics anyway? Would we respect her physician’s decision, albeit a questionable decision? What to do?

In the end, the local health department staff reached out to her and explained to her the situation. She was told that she could be in danger if there was any chance that she and the case shared any spit, even incidentally, at the party. (He had fallen most ill about a day after that party, so he was very infectious when he went to it.) She opted not to chance it. Days later, her physician apparently complained about being overruled.

And that’s not the only example I’ve seen or heard of where private practice providers clash with public health practitioners and workers. It seems to be a constant struggle. I don’t see it as a bad thing, though. There must be an interest in providers to take care of their patients, even if jealously so. And the must be a willingness of public health workers to do their due diligence, even if that means stepping on the toes of private practitioners. All as long as we’re all doing it in the best interest of the patient.

So how do we deal with people who refuse vaccines even though they’re licensed healthcare providers who should know better? Or those who refuse to give vaccines and whose action, or inaction, may lead to an outbreak of a serious disease in the community?

I don’t know. It’s above my paygrade to figure out those things. But I have passed this discussion on to a friend who is about to enter a Doctor of Public Health program. I hope his education in that program covers these issues because we need answers. We need guidance. We need to figure out who supersedes whom when it comes to serious disagreements like vaccines, fluoridation, or even antibiotic use.

I’d like to say that evidence supersedes all personal or professional opinions, but the world doesn’t work that way, sadly. In this world, we need to deal with each other, work with each other, and do it all in the best interest of the public and their health.

Five things you need to know about the flu right now

Today, January 9, 2013, we are the peak of influenza activity in the United States. Places like Boston, Chicago, and North Dakota are seeing a surge in cases of influenza. The Centers for Disease Control and Prevention (CDC) is reporting that flu activity is widespread and intense in most of the nation.

WIDESPREAD!

INTENSE!

So here are five things you need to know about the flu right now:

1. The flu likes unvaccinated people. While there are some people who will get the flu eventhough they’re vaccinated, comparing apples to apples, people who are not vaccinated have a higher risk of getting the flu. There is an injectable vaccine and a nasal spray vaccine. The evidence seems to point to the spray being better for children and the injection being better for adults, while older adults need the high-dose vaccine. So get your flu vaccine, and get it each year. The flu likes to mutate, a lot. And, no, you can’t get the flu from a vaccine. If you do, you would be the first person in the world to do so, and scientists would like to talk to you.

2. The flu likes dirty people. The flu vaccine makes it harder for the virus to make you sick if it infects you. It doesn’t act as a magical barrier that keeps the virus off of you. To do that, you need to wash your hands, and wash them well. A simple rinse and go will not do. By washing your hands often, you minimize the chances of catching the flu from all the surfaces you touch during the day. When you touch a surface with the virus on it and then you touch your nose, mouth, or eyes, you have a good chance of getting infected. If you’re a food handler, you have a good chance of making a lot of other people sick if you don’t wash your hands well. That would be embarrassing.

3. The flu is deadly. Most of us will get through the flu just fine because most of us are otherwise healthy. We’ll feel bad for a few days and then recover with no lingering problems. This is not the case for people who have underlying medical conditions, and there are more of us with those underlying conditions out and about nowadays. What are those conditions? They include diabetes, pregnancy, asthma, cancer, heart conditions, lung conditions, even neurological conditions. This is why it is important for people who can be vaccinated to get vaccinated, and for everyone to wash their hands. Doing this protects people who are too weak or too sick to protect themselves. To date, according to CDC, there have been 18 deaths in children. That’s 18 too many, especially in an era where the flu is completely preventable with vaccination, hand hygiene, and social distancing.

4. The flu likes friendly people. Ever wonder why the flu is so active in the winter? One of the reasons is that people tend to pack into tight spaces in the winter. We do this almost automatically to get away from the cold weather. (The cold, dry air also helps the flu survive longer in the environment, so that’s a double whammy.) We pack ourselves into movie theaters, malls, schools, and at work, and we share the virus with everyone. So, if you are sick, stay away from crowds. If you want to increase your chances of not being sick, vaccinate, wash your hands, and stay away from crowds. (I don’t mean for you not to shop, but do it as off peak hours, online, or in places that are not too crowded.) If you must take the train in a crowded car, stay away from people who look ill and wash your hands as soon as you get to your destination.

5. The flu is inside you long before you know it. It takes between one to two days for you to feel the signs and symptoms of the flu once you’ve been infected. But here’s the kicker: You’re infectious one to two days before symptoms as well. That means that you can be completely healthy and be spreading the flu around. This is why quarantines generally fail when it comes to the flu if you base those quarantines on signs and symptoms. A perfectly healthy-looking person can make it through a checkpoint and be infectious. So, if you know you’ve been exposed, stay away from people who are susceptible to serious complications form the flu, complications like pneumonia and death.

Now that you’re armed with knowledge, you’ll be more likely to make it through the flu season, no colloidal silver or magic required. Good luck. I’ll see you on the other side.