fellowship

Measly

One of the first patients I met in medical school was a 10-year-old boy with SSPE, a not-so-rare and always-fatal complication of measles infection. He was blind, deaf, severely encephalopathic, and spastic. It was a peds GI clinic, so I guess he had some GI issues too, but the thing I remember most about him was his father lifting him out of his wheelchair and carrying him across the room to the exam table. His head flopped as Dad laid him down; he had scissoring clonus at both legs.

 

He was the first neurologically devastated person I’d met, and it was shocking. I was pretty naive, I guess — I was a first-year medical student, 22 years old, still wet behind the ears. In the decade since, I’ve taken care of a lot of people in various stages of coma, but that kid stands out to me. That kid, more than anything else — more than the science, even — convinced me that vaccines were essential.

 

So when I heard that SSPE is on the rise (previously thought to be 1:10k cases, but with vaccination rates falling, appears to be more like 1:600) and that Europe is facing a massive measles outbreak that’s left 17 children dead in Romania alone, I’m struggling a bit with the appropriate response. Yes, sympathy for the families of those kids — no parent should ever, ever have to bury their child. But I can’t quite silence the little part of me that wants to say, “What did you think was going to happen? You withhold a lifesaving preventative measure from your child; therefore they die. Do you make sure your kid wears their seatbelt? Brush their teeth? So why don’t you vaccinate?”

I’m a big believer in the patient’s right to bodily autonomy, but I think we’ve lost sight of the fact that the patient here is the child. I can’t think of anything that strips your bodily autonomy faster than complications of a vaccine-preventable disease.

[Please, no anti-vax arguments in the comments. I’ve heard them. They are wrong. And if there is a God, there will be a special circle of Hell for Andrew bloody Wakefield, who is directly and personally responsible for this current iteration of the anti-vaxxers. Preferably involving torture by the souls of the children he has killed.]
Advertisements

2 thoughts on “Measly

  1. Thank you for this. I have many friends who won’t vaccinate their children. Some of them had their first babies in the ’90s when Wakefield’s paper was first published, so I understand that they had heard there was a problem with the vaccine and wanted to spare their children. No doctor back then ever said (at least not loud enough or often enough to be heard), “IF he is right, then let’s look at the risks. Here are the odds of having problems if he’s right, versus the odds of having complications from the disease if he’s wrong.” The response instead was the paternalistic, “Do what I tell you to because I’m the doctor,” which is the wrong response when dealing with people who are willing to do research and make up their minds based on facts. Sadly, facts are not presented to counter what they’ve already heard. That problem has just gotten worse since then.

    I was hopeful when I found the Science-Based-Medicine site, but discovered that he just scoffs at anti-vaxers and ridicules them instead of providing scientific facts to counter the anti-vax claims. Ridiculing people is not the way to change their minds. I know it would be time consuming, but in the long run it could save time and thousands of lives if someone would put together a comprehensive response to the various anti-vax arguments. I’d do it myself, but I don’t know all the science.

    1. Definitely mocking parents is inappropriate and won’t change anyone’s mind. But there are lots of resources aimed at various levels of scientific literacy, explaining why vaccines work and why the schedule is the way it is. A quick google search turns up this article which is from 2010 but still accurate and is quite comprehensive. The CDC also offers a quick word on the subject, and the AAP has always been very vocal about protecting children and babies. I know these resources weren’t available, or not so easily available, in the late 1990s, but vaccination rates are falling and children are dying, even as physicians and public health groups are working harder to reach out and explain the science.

      I spent my med school summer working on health policy, including vaccine advocacy, and in my experience, many anti-vaxxers have an idée fixe about vaccination. I hear parents express skepticism of the doctor/the science, but they do not carry that same healthy skepticism over to anti-vax claims. Instead, I see a lot of near-hero worship of a fraud and and a Playboy bunny (whose son, by the way, does not have autism; he has Landau-Kleffner Syndrome, a rare autoimmune epileptic aphasia). I am sure that most parents are not like that, but because the hardcore anti-vax crowd are very vocal and often media-savvy, theirs is the voice that gets heard.

      I have pediatrician and family practice friends who are trying to decide whether to require vaccines as a condition of care, in order to protect the other children in the waiting room who may be too young or too sick to be vaccinated. (This is a major problem in certain areas of Manhattan, for instance.) On the other hand, that would be denying care to a child who needs it, and totally antithetical to what being a physician is about.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s