Blogging is spontaneous. I did not know I would be writing on this subject when I arose from bed this morning. Two things coalesced however, and they just fit. Inside joke interlude: sorry Leslie, the other post will have to wait.
The first was a dynamite podcast a friend recommended. If you enjoy 60 Minutes or investigative journalism, this one is for you. Most of us are aware of the recent attention The Lancet received for publishing a case series in 1998 on the MMR vaccine and its supposed association with autism.
It was the opening salvo in the anti-vaccine crusade–and yes, I am showing my true colors–that led to more needless suffering and public health setbacks than anything I can recall in recent memory. Celebrities, whose names I will not cite out of disgust, whose scientific backgrounds are as narrow as a China is wide, have propagated lies and conspiracy theories and harmed many. Their suppositions have been thoroughly debunked however, but sadly, their movement persists and thrives.
The journalist, who uncovered the fraudulent activities of the UK physician at the center of the scam, Dr. Andrew Wakefield, persevered for close to a decade to obtain the truth, often risking his career. Brian Deer, the reporter, makes Mike Wallace look like a pussycat, and he so much admits it.
Listen to his account as he slowly eviscerates Wakefield’s canard bit by bit. It becomes apparent this effort required tenacity beyond the usual journalistic effort, and it was true grit and a belief in aiding society that kept him centered. A great listen, and there is more here than a story; it is instructive on the limits of science, and serves as a warning to physicians that there is nothing absolute, even in a top tier journal. How The Lancet and many others mucked this up is beyond me. You will ask yourself the same question.
The second relates to the new vaccine guidelines published in Annals of Internal Medicine last week. It functions as a good companion piece to the podcast. Why? Again, it is a reminder that we are serving the public in good stead and our role as educators is paramount. I always tell patients, “If it is good enough for me and my family,” and it is, “in my best professional opinion, it is for you as well.”
A few points:
1. We are undervaccinating adults at risk for shingles. Given the Medicare Part B and D cross signaling, and the prohibitive cost of maintaining stocks of this vaccine in private offices, as well as its known efficacy and underuse, it is not unreasonable to consider this as a potential hospital-based intervention. With meaningful use/HIT integration on the horizon, or at least until CMS corrects the payment and administration imbalances, it is a quality intervention to consider when discussing process issues in your institutions.
2. The over administration of the pneumococcal vaccine (“when in doubt, give it”), may lead to desensitization and decreased efficacy. Many of us continue to “play to the measures” in attempting to meet national goals, but one dose after age 65 is adequate. Additional shots may not benefit patients, and in fact, may be harming them.
3. While I am somewhat in doubt over the benefit of the pneumococcal vaccine in immunocompetent older adults (despite a mixed, but trending positive literature for the flu vaccine), I am convinced we are promoting good public health by vaccinating hospital workers and ancillary staff for influenza. Current receptivity levels are disgraceful, and the excuses I hear from nurses, residents, docs, and other health literate individuals is simply astounding. Everyone gets the shot.
4. Adults are a reservoir for pertussis. We rarely succumb to it, but the kids we transmit it to certainly do. The pediatricians reading this, particularly those in California, witnessed firsthand what happens when vaccination rates wane. Bottom line, this is not a childhood only vaccination!
Hope this helps and enjoy the podcast.
BONUS: Incidentally, NYC is a pedestrian city, ideal for personal listening devices and podcasting. Those who live in rural areas and are use to automobiles would see that the “disconnected e-citizen” is alive and well on the streets of my city. You can walk for miles here.
Below is a picture of 2nd Avenue, my street, in all its splendor (the arrow points to my building). Notice the construction: your tax dollars at work and our equivalent of Boston’s Big Dig. The Second Avenue subway is under construction, and it has uniformly wrecked our lives–both audibly and visually. 2016 is a long ways away….