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What Does “Anti-Vaccine” Really Mean?

We write a lot about vaccines here at Science-Based Medicine. Indeed, as I write this, I note that there are 155 posts under the Vaccines category, with this post to make it 156. This is third only to Science and Medicine (which is such a vague, generic category that I’ve been seriously tempted to get rid of it, anyway) and Science and the Media.

There is no doubt that vaccines represent one of the most common topics that we cover here on SBM, and with good reason. That good reason is that, compared to virtually any other modality used in the world of SBM, vaccines are under the most persistent attack from a vocal group of people, who, either because they mistakenly believe that vaccines caused their children’s autism, because they don’t like being told what to do by The Man, because they think that “natural” is always better to the point of thinking that it’s better to get a vaccine-preventable disease in order to achieve immunity than to vaccinate against it, or because a combination of some or all of the above plus other reasons, are anti-vaccine.

“Anti-vaccine.” We regularly throw that word around here at SBM — and, most of the time, with good reason. Many skeptics and defenders of SBM also throw that word around, again with good reason most of the time. There really is a shocking amount of anti-vaccine sentiment out there. But what does “anti-vaccine” really mean? What is “anti-vaccine?” Who is “anti-vaccine?”

Given that this is my first post for SBM’s self-declared Vaccine Awareness Week, proposed to counter Barbara Loe Fisher’s National Vaccine Information Center’s and Joe Mercola’s proposal that November 1-6 be designated “Vaccine Awareness Week” for the purpose of posting all sorts of pseudoscience and misinformation about “vaccine injury” and how dangerous vaccines supposedly are, we decided to try to co-opt the concept for the purpose of countering the pseudoscience promoted by the anti-vaccine movement. Read more »

*This blog post was originally published at Science-Based Medicine*

More Unvaccinated Children Cause Public Health Fears To Increase

Dr. Robert Sears’ The Vaccine Book, is, as Dr. Rahul Parikh puts it, “a nightmare for pediatricians like me.”

In a piece from Salon, Dr. Parikh brings his issues to the author. The controversy of the book is the so-called “alternative vaccine schedule,” which, as vaccine developer Paul Offit puts it:

…is “misrepresentation of vaccine science” that “misinforms parents trying to make the right decision for their children” in the Journal of Pediatrics. And yet, as a pediatrician myself, I have seen an increasing number of caring, reasonable parents hold it up like a bible in my practice (and that of my colleagues).

This post, however,  isn’t about the vaccine controversy — I’ll leave you to read Dr. Parikh’s excellent piece for yourself.

What I found interesting was a passage discussing the public health fears stemming from an increasing number of unvaccinated children. Read more »

*This blog post was originally published at KevinMD.com*

Unscientific Medicine: What’s The Harm?

Any promoter of science-based medicine often faces the question: “What’s the harm?” What is the harm if people try treatment modalities that are not based upon good science, that are anecdotal, or provide only a placebo benefit? There are generally two premises to this question. The first is that most “alternative” placebo interventions are directly harmless. The second is that direct harm is the only type worth considering. Both of these premises are wrong.

The pages of Science Based Medicine (SBM) are filled with accounts of direct harm from unscientific treatments: Argyria from colloidal silver, death from chelation therapy, infection or other complications from acupuncture, burns from ear candleing, stroke from chiropractic neck manipulation — the list goes on. You can read anecdotal accounts of such harm on the website, whatstheharm.net.

Of course, as we often point out, harm and risk is only one end of the equation — one must also consider benefit. It is the risk-benefit ratio of an intervention that is important. But generally we are talking about interventions that lack any evidence for benefit, and therefore any risk of harm is arguably unacceptable. Read more »

*This blog post was originally published at Science-Based Medicine*

Responsible Vaccine Advocacy: How To Make A Difference

I lost a patient this season, an infant, to whooping cough (pertussis). After falling ill, he lived for nearly a month in the intensive care unit on a ventilator, three weeks of which was spent on a heart/lung bypass machine (ECMO) due to the extent of the damage to his lungs. But all our efforts were in vain. The most aggressive and advanced care medicine has to offer couldn’t save his life. The only thing that could have saved him would have been to prevent him from contracting pertussis in the first place.

He was unvaccinated, but that was because of his age. He was part of the population that is fully dependent on herd immunity for protection, and that is exquisitely prone to a life-threatening course once infected. This is a topic we’ve covered ad nauseum, and I’m not inclined to go into greater depth in this post. Suffice it to say his death is a failure at every level. We, both as medical professionals and as a society at large, need to do a better job of protecting our children from preventable diseases. Read more »

*This blog post was originally published at Science-Based Medicine*

Debunking Homeopathy, Cartoon Style

Here’s a wonderful cartoon primer by Darryl Cunningham on the fundamentals of homeopathic “medicine”:homeopathy
To see the entire 19-page cartoon strip, click here.

Well worth the read, especially for anyone who might be considering homeopathic treatment. This author also put together a nice explication of the Wakefield Autism Vaccine Fraud.

*This blog post was originally published at Movin' Meat*

Latest Interviews

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Latest Cartoon

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.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“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.

***

Click here for a musical take on over-testing.

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Eat To Save Your Life: Another Half-True Diet Book

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Unaccountable: A Book About The Underbelly Of Hospital Care

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