Your liberty to swing your fist ends just where my nose begins.
– John B. Finch, 1882
Each season brings its signature challenges to the ER. In the now past summer it was trauma; blood and gore, alcohol and profanity, violence and death. Goodbye summer.
Now in the fall and winter the challenge is fever; the elderly with their fevered delirium, death ever hovering, keeping vigil with their worried spouses of fifty or sixty years. Kids with their sudden raging, spiking fevers and their worried parents. Interns and residents and nurses, their immune systems worn down with overwork and overexposure trying to tough out one more shift, wearing surgical masks to contain their feverish contagion.
Fever is especially a challenge during the fall. Flu season is just in the offing. Until flu is firmly here every adult with fever in the ED is a potentially deadly case of sepsis. Once the flu arrives in full our guard can go down a little; there is no way, and no need, to hospitalize all the adults we will see with fevers. Kids, of course, get high fevers in response to virtually every minor viral infection and we are more adept at sorting through the deadly fevers and the normal febrile events of childhood.
“Flu” is an encompassing term for multiple different illnesses and is not synonymous with influenza. True influenza is caused by several different strains of the influenza A and B viruses. Over 200 other unrelated viruses and some bacteria can cause “influenza like illnesses” (ILI’s in doctors’ parlance). During the height of flu season only ten per cent of ILI’s are caused by influenza A or B, the disease the flu shot protects against.
Still this ten percent or so is a big number nationwide and causes significant illness and even death, and so I still strongly recommend yearly flu vaccinations beginning now. I also agree with the CDC that most children over the age of six months should get vaccinated yearly against the flu. Last year 146 children died of influenza.
I mention this every year around this time in my column, usually as an aside because I assumed that the safety and efficacy of vaccines have been accepted by the American public. Certainly the science has been long settled. Vaccines prevent illness and death. Period. Vaccines do not cause autism. Period.
Now comes Donald Trump, the current front runner for the Republican presidential nomination, to declare on national TV during the second televised Republican debate that vaccines cause autism. He even had a dramatic but undocumented vignette of a child who recently got vaccinated. Well, I’ll let him tell it…
“And we’ve had so many instances. People that work for me. Just the other day—two years old, two and a half years old, the child, a beautiful child, went to have the vaccine, and came back, and a week later got a tremendous fever, got very, very sick, now is autistic.”
Aside from the fact that the timeline here is so fractured, this doesn’t bother me too much. Intellectually Donald Trump is probably the equivalent of a Playboy Bunny, like Jenny McCarthy, the other prominent anti-vaccine celebrity. Surely no one takes medical advice from the Donald.
No, what does bother me is the response of the two doctors also in the debate, Rand Paul and Ben Carson. Carson, a retired neurosurgeon was asked if Donald Trump should stop saying vaccines cause autism. Yes, he should stop saying it; please Ben Carson, just tell him to stop saying it.
Instead, Carson offered a tepid refutation of the vaccine and autism link which quickly morphed into a confusing sort conspiracy theory.
“This was something that was spread widely 15 or 20 years ago,” he said of the supposed vaccine-autism connection, “and it has not been adequately, you know, revealed to the public what’s actually going on.”
Then he veered off into pure baloney.
“Vaccines are very important, certain ones, the ones that would prevent death or crippling. There are others, a multitude of vaccines that don’t fit in that category, and there should be some discretion in those cases.”
I have no idea what he is talking about here. Every one of the 12 childhood vaccines recommended by the CDC demonstrably saves lives. And finally he closes with this whopper:
“But it is true that we are probably giving way too many in too short a period of time. And a lot of pediatricians now recognize that, and, I think, are cutting down on the number and the proximity in which those are done, and I think that’s appropriate.”
No responsible pediatrician believes that, and the American Academy of Pediatrics firmly rebuts it in its policy statements supporting the CDC vaccination schedule completely. Cutting down the number and proximity of childhood vaccines puts children’s lives at risk.
I watched this pandering trainwreck of medical nonsense from a prominent physician in open mouthed fascination. I was waiting for the other physician in the debate, Rand Paul, to grab the brake handle and bring this careening runaway train to a halt. Of course, I was disappointed.
“I’m all for vaccines, but I’m also for freedom,” Rand Paul said, conflating two unrelated issues in a classic non sequitur. “Even if the science doesn’t say bunching them up is a problem, I ought to have the right to say I want to spread them out.”
Except the science doesn’t say spreading them out provides the same efficacy as “bunching them up.” Spreading them out will cost some children their lives. Not just the children of those parents but others in the community too young to get vaccinated or with weakened immune systems. That is a strange type of right to wish for.
Fortunately, Rand Paul’s stance was completely denounced by a prominent physician/presidential candidate.
“Although I strongly believe in individual rights and the rights of parents to raise their children as they see fit, I also recognize that public health and public safety are extremely important in our society. Certain communicable diseases have been largely eradicated by immunization policies in this country and we should not allow those diseases to return by foregoing safe immunization programs, for philosophical, religious or other reasons when we have the means to eradicate them.”
That was Ben Carson back in February.