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Pox Parties: Half-Truths, Anecdotes, And Fear

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There has been much abuzz about “pox parties” – the practice of parents getting a bunch of unvaccinated kids together with an infected one (pick one, really, though chicken pox is the focus of the recent article in Time) in the hope that their little sweethearts become ill and therefore “naturally” immune to the disease. This deliberate infection involves things as seemingly innocent as breathing the same air as the infected to the stomach-turning sharing of bodily fluids (Saliva lemonade, anyone?). To compound the issue, it seems that parents aren’t always taking into account how the viruses are transmitted, and end up trying oral transmission to  transmit a disease that is transmitted through the air. And yes, the whole thing is as stupid as it seems.

Given that the people partaking in these events have likely not vaccinated their children against anything else, these parties could be a source point for multiple highly contagious infections. Most of us have had chicken pox as children and don’t remember it fondly – now imagine having chicken pox with mumps, mono, and maybe a little hepatitis A to top it off. It is also easy to forget in Western luxury that these innocuous childhood illnesses are actually lethal. Just measles? Well, one death per 3000 measles infections might not seem like much, until you consider the fact that in 2008, 164,000 people died of the measles worldwide - approximately the same number of civilians that have died in the entire length of the current Iraq war. That’s an annual number, and it’s gone down by almost 80% over 10 years. How? The World Health Organization has implemented vaccination programs in the developing world. They increased the global vaccination rates from an average of 73% uptake to 81% uptake. And that was without any participation in the program by India. And it saves 569,000 lives annually.

Let me say that again. The measles vaccine is currently saving 569,000 lives per year in comparison to 2000.

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But that’s measles! We’re talking about plain old chickenpox, how bad can it be? Well, barring shingles (a disease more typical of adults, extraordinarily painful and the cause of the majority of the deaths due to the Varicella-Zoster virus that also causes chicken pox), childhood chickenpox is not fun either. One in ten unvaccinated kids who get chicken pox will have serious enough symptoms to warrant a doctor visit. By deliberately infecting your unvaccinated kid, you’re signing up for 2 weeks of fever, a more severe pox rash, and dehydration. But worse than that, you’re signing up for that 1 in 10 lottery shot at secondary bacterial infections of the skin, the underlying tissues, the lungs, the bone, the joints, or the blood (you might know it better as sepsis). And hey, if that doesn’t scare you, the virus itself can turn nasty and cause pneumonia, or best of all, encephalitis, where the virus is infecting the brain. And once that’s all done, anyone who has ever had chicken pox has a lifetime potential of the virus spontaneously reactivating and turning into shingles. Just 20 years ago, before there was a chicken pox vaccine, about 50 kids and 50 adults would die of the Varicella-Zoster virus annually in the US.  Now personally, I’m of the opinion that any preventable death is an unnecessary one. If you know your kid will be exposed to chicken pox and you can prevent them from getting sick, why wouldn’t you?

Of course, the topic is not nearly as simple as this. In some respects, I understand the mentality of parents sending their children to pox parties. They legitimately are trying to do what they think is best for their kids. And they think that abstaining from nasty unnatural vaccines made by big corporations and getting their kids “natural” immunity is the best thing for them. The problem is that they’re making these decisions based on bad information.

But I’m getting ahead of myself. Let’s get to the underlying issue here: is vaccinating a choice that parents should make? Or are we, as suggested in Vaccine Epidemic, a book published earlier this year, merely the pawns of government coercion and biased science? As much as I love a good conspiracy theory, spoiler alert: no, so seriously, please vaccinate your kids.

Habakus and Holland dramatically assert “vaccination choice is a fundamental human right,” not as the first sentence in their book, but the first chapter’s title. You can’t miss it. Autonomy, the idea that we have the right to choose what is best for ourselves, is a fundamental human right, they argue, and therefore the right to choose whether we vaccinate is also a fundamental human right. And, although I find their shock tactics distasteful, I can’t argue with them. I agree that lining up the entire population of the world and giving them a shot in the arm without ever telling them what or why or obtaining their permission would be morally wrong.

But that exact same argument can be used to utterly defeat their position.

Allow me to explain. Autonomy hinges on two words that most people have heard but few truly understand: informed consent. It’s the idea not just that you agree, but that you grasp the entirety of the situation, its consequences, the different options you can choose, the risks of the scenario with actual context for what those risks mean, as well as a complete understanding of the benefits. Informed consent ensures everybody is on the same page and knows where things are heading and why. It’s something that is rather unique to medicine – typically when you sit down in a restaurant, your server doesn’t inform you that there is a 1 in 2,000 chance that your food has come into direct contact with rats or that it’s possible but unlikely that you could be fatally wounded by a falling serving tray over the course of your meal, or that, if you wanted, you could put off your meal to another time when you were more hungry.

Would you like to see our dessert menu?

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You see, to have informed consent, it’s not just enough to consent. It’s not just enough to say okay, I want to deliberately infect my kid with chicken pox so that he develops natural immunity, and I want to avoid vaccines because I’ve heard there’s nasty preservatives in them. Informed consent requires a thorough examination of the issue, with some concrete data. Do these parents know how the immune system works? If they did, they’d know that vaccines work the exact same way that being infected does, only in a much less dangerous way because the virus is either dead or had the stuff that made it infectious removed. Do they understand the real-world implications of not vaccinating? That if everyone chose not to vaccinate, these diseases would run rampant, killing the most vulnerable people in our society – their children, their aging parents? Do they know that vaccines are the only way to eradicate an illness entirely, that if everyone was vaccinated, we could make diseases like measles and polio disappear from the surface of the planet? Do they know that this can happen even if the vaccine is not 100% effective? Do they know that doing things nature’s way means astronomical mortality rates of infants and young children due to infectious disease?

More importantly, do they know that “natural” is big business, just like the pharmaceutical companies they so dread are? Do they know that the Canadian supplement & functional food industry alone brings in in shy of $3 billion annually. Do they realize that alternative medicine practitioners have financial incentive to encourage people to use their services too? Do they know that this whole vaccine-thimerosal-autism thing has been debunked from here to last decade, to the point where it is utterly redundant and tiresome to read the medical literature on it? (Seriously, the titles of these papers have not changed over the last 5 years. It is a field going absolutely nowhere because people will not let this thing die. If Jenny McCarthy would stop asking where the studies are, maybe these poor grad students could get on with their lives and research something that hasn’t been done to death.)And you know what, I get it. Denialism is one of the more interesting aspects of human psychology. Vaccine denialism has all the interesting bits. There’s all sorts of potential for conspiracy theories, from the dull profiteering to the much more intriguing mind control and brain washing. They can cherry pick out the confirmatory studies like nobody’s business, usually bizarre studies published in obscure journals written by people who have no business doing science (like lawyers, for example). They have tons of false experts, from the laywer-turned epidemiologists who have no idea how to interpret scientific data, to the Playboy bunnies. They move the goalpost constantly – with every negative study, there’s a further “well what about this?” and the ubiquitous “long-term effects” question, which makes no sense given that the autism/vaccine link is supposed to be in early development, and that vaccines have been around for a few generations now with no apparent ill effects, and in fact quite the contrary. There’s the feelings of a lack of control, of scary things people don’t understand, of blame for random circumstance. There’s the cognitive biases towards things happening together causing each other. They also spend so much time attacking vaccines that most people forget that they have little to replace them. Potentially lethal pox parties? No thanks.

Eat up, kids!

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If you’re choosing not to vaccinate for rubella, are you prepared to have a child with major birth defects? Because in a world without the MMR vaccine, if you get sick with rubella around the time you get pregnant or at any point during the first trimester, you’re looking at about a coin toss for deafness, cataracts, and/or heart defects at birth, plus mental deficiencies and a host of other effects as they develop. 50-50. Or, you could play it safe to avoid the never-been-demonstrated-to-be-a-real-association vaccine-autism thing.

So is vaccination choice a fundamental human right? Sure, if you’ve got a flair for the dramatic and a book deal. However, the anti-vaxers need to realize that by spreading their half-truths, anecdotes and fear, they are denying parents the ability to make that choice. Informed consent is about information and its real world application, and I think most people would willingly choose to be a part of a world where we can prevent over half a million deaths in a single year with a single vaccine at the price of a bit of a sore arm.

*This blog post was originally published at Skeptic North*


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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

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“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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