Monday, January 23, 2012

Anti-vaxxers challenge younger docs' clinical skills

It's not often I see a good article in the lay press on health and medicine. This one from the Chicago Tribune is an exception. It goes like this: Many childhood diseases, thanks to vaccines, disappeared from the scene. A generation of doctors went through training without seeing a single case. They “learned” about these diseases once in med school from lectures and textbooks but never encountered a patient. They enter practice not thinking about these diseases and have no real sense of what they look like. Enter the anti-vaccine movement. Now these diseases, until recently of mainly historical interest to today's doctors, are re-emerging. And today's doctors are unprepared.

Not only that, according to the article, survey data presented at IDSA recently suggested that younger docs are not as attuned to the importance of vaccines as their older colleagues.

According to one expert quoted in the article:

"During medical training, you can learn as much as you want about these diseases from textbooks, but unless you see a child struggling to breathe from whooping cough or brain damaged from bacterial meningitis, the feeling of how bad these diseases can be is not visceral," he said.

Aside from the lack of a visceral appreciation of these diseases a rising influence of quackery in medical education (quackademic medicine) along with a growing cynical distrust among medical students toward the pharmaceutical industry may have contributed to the shift.

As an aside, one form of the meningitis referenced above is Haemophilus influenzae type b (Hib). For a somewhat visceral view of that story see this article.

Measles is prominent among the re-emerging childhood diseases that are challenging today's doctors. Few docs in practice today have ever seen a case. I have never seen a case in my career. My defense against missing the diagnosis is to know when to think of it: in any patient with a rash, fever and a really bad cold. Background here.

More about the missed diagnosis of measles from the article:

Last summer, one of the largest outbreaks occurred in Indiana when 14 people came down with measles after an unvaccinated person returned from a yearlong trip to Indonesia. It was initially misdiagnosed as the mosquito-borne tropical disease dengue fever, and it took 17 days to figure out it was the measles, said Angela Cierzniewski, the Indiana state epidemiologist. By then, more than 800 people had been exposed.

And this concerning whooping cough:

Studies show that 20 percent of adults with a cough that lasts more than two weeks actually are suffering from whooping cough, which is often misdiagnosed as bronchitis or asthma.

It's a combination of nasty anti-vaccine quackery and ignorance of the seriousness of childhood diseases that has led to reduced vaccination rates and their re-emergence.


lynni said...

My son is a young doctor who is very pro-vaccine and has seen too much for his young years. He watched his 20 year old brother (when he was 19) fight 26 days against meningococcal meningitis. Saw the gangrene take away my son's arms and legs, saw the DICU, the loss of kidney function, 10 hours of grand mal seizures. He learned the hard way about the importance of vaccinations. I hope it doesn't take young doctors to lose somebody close, to see what happens when someone isn't vaccinated.

Michael Kirsch, M.D. said...

The vaccine-autism link has been scientifically skewered, but it still lives. I'm glad we have a special 'vaccine court' to adjudicate these emotional claims and allegations that have no scientific support. Always looking for a victim...