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Tag Archives: Vaccinations

The Rash

The patient was a 17 year old female. She had a rash. The number of patients with rashes in the ED seems to be steadily increasing for some reason. According to the previous records, she was diagnosed with a yeast infection. Her primary care physician started her on Diflucan and on topical ketoconazole for good measure. Her rash became worse. It had now extended up her back. The patient’s mother called the patient’s primary care physician who recommended that she go to the emergency department. Hmmmm. Probably some type of contact dermatitis or perhaps a reaction to the topical medication, I thought as I walked into the room. The first thing I noticed was the patient’s motorized wheelchair. Braces for the patient’s arms were built into the wheelchair. Sitting on the bed, the patient appeared paralyzed. She was able to move her head to some degree. The patient’s arms were propped up on pillows. Her legs were somewhat contracted. She had difficulty speaking, so her mother provided me with most of the history. So the etiology for the rash changed a little bit based upon this initial presentation. Getting the history from the mother was easy. She was intelligent, articulate, and had tried OTC medications for the rash already. She had even consulted Dr. Google to see if she could determine what the cause of the rash was. “I thought it could be a reaction to the medication, so I stopped it. I’m not a doctor, though, but if it was a reaction to the Diflucan, wouldn’t the rash be all over her body?” Exactly. I got some more history. No other medical problems. No other medications. Then I asked about immunizations. The mother remained polite, but became very curt. “No, she doesn’t get immunizations any more. She hasn’t received them since she was 13. Thank you, though.” It was a curious response, so I asked “Do you mind if I ask you why?” She became teary-eyed. “My daughter wasn’t always like this,” she said. “She was a normal kid until she turned 13. On the basketball team. Played soccer. Then I decided to protect her by giving her the Gardasil vaccine. She developed weakness 4-5 days later. A week later she was on a ventilator. Two weeks after that she coded and almost died. She was in the ICU for over a month with a trach. This is what a vaccine did to her. So hopefully you can understand why we don’t vaccinate our children any more.” I nodded my head. After examining the rash and how she sat in her chair, it appeared that the rash pretty closely matched the back of her chair. Probably contact dermatitis of some sort. I told the mom that we could give her a short course of steroids, but that hopefully the rash would resolve if she could avoid contact with the back of the chair for a short while. The mother was very gracious and thanked me. I helped the patient’s sister and her mother get the patient back into her wheelchair. The patient smiled and slowly thanked me. I was so impressed with the entire family and their graciousness, but I couldn’t help being profoundly saddened by the visit. I advocate vaccination. But I have to admit that my confidence was a little shaken by this patient’s story. And I can’t say that I won’t think twice about letting my three daughters receive the Gardasil vaccine. Irrational? Maybe. I know that vaccines have help to largely eradicate many harmful communicable diseases. But however irrational the thought may be, the picture ...

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Vaccinate Now?

Flu season is late, but it is upon us. Is it only my experience, or does it seem to be the following: 1. Those patients and parents who most vehemently refuse influenza vaccines are the same ones who complain the loudest about their symptoms and their childrens’ symptoms when they actually come down with the flu. And I wish I had a dollar every time I hear someone say they don’t get vaccinated because “I get sick from the flu shots.” Since the virii in the shots are dead, getting sick from the flu shot is highly unlikely. But hey, enjoy your fever, headache, cough, and muscle aches for the next week or so. 2. Entirely too many people think that the “flu” is vomiting and diarrhea. It isn’t. The “stomach flu” is a misnomer. Symptoms of influenza are fever, cough, runny nose, sore throat, headaches, muscle aches, and fatigue. 3. People whose insurance does not cover Tamiflu demand amantadine even though amantadine doesn’t work on the circulating strains of influenza. In other words, people would rather take a free medication that doesn’t work at all rather than pay for something that could conceivably help them. And while I’m on an influenza rant, remember the 26 million treatment courses of Tamiflu that the US government stockpiled? Yeah. That’s all past its expiration date now. At about $100 per treatment course, that’s $2.6 billion that the government can now flush down the crapper. I’m sure that there was bulk pricing for the government’s stockpile, but even half that amount of money is a lot to be throwing away.  

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Are Vaccines Effective?

In one of my other posts, I cited an article showing that the incidence of pertussis in California has skyrocketed and at the same time the incidence of vaccine refusals in California has quadrupled over the past four years. Mama on a Budget raised a question as to whether the pertussis vaccine was effective, citing an investigation done by a California radio station which showed that 66% of people who contracted pertussis in California this year were fully immunized. I wanted to make a separate post so that I could post a graph that I scanned from a 2008 AMA article (click on the graph for a larger version if you can’t read the numbers). The graph below shows the incidence of disease before and after introduction of vaccines. In every instance, the incidence of disease post-vaccine decreased by between 80% and 99.9%. The incidence of death from several diseases decreased to zero. I realize that correlation does not equate to causation. I also admit the potential for the factual fallacy of post hoc ergo propter hoc. There is even the possibility that the data could be a government plot to classify pertussis infections by some other name to falsely increase vaccine effectiveness and to enrich the pharmaceutical companies that produce the vaccines. When vaccination occurs, incidence of every disease goes down. When larger numbers of citizens in California fail to get immunized (or possibly receive booster shots), incidence of preventable disease goes up. I think that the data make a pretty compelling argument that vaccines work and that vaccines save lives. I continue to think that those parents whose unvaccinated children die from a preventable disease should suffer some legal consequence.

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Why Healthy Young Adults Should Fear The Swine Flu

I’ve heard a lot of reasons why people don’t want to get influenza vaccinations. “I always get the flu after I get the shot” – injections are killed viruses containing only surface antigens and subvirons, so flu shots can’t cause infection. The intranasal sprays are weakened (“attenuated”) viruses which do have the potential to cause mild symptoms. Maaaybe you can say you got the flu from the spray – not from the shot. “Jenny McCarthy says that I’ll get autism from them” – don’t get me started. She also recommends doing routine “poop analysis” to check for “yeast, bacteria, or infections.” “The swine flu is a conspiracy by the government (see comment section) to increase pharmaceutical profits” – um … right … let me introduce you to Ms. McCarthy over here. “I never get the flu” – with up to 20% of the US population getting influenza each year, odds are against you. “I’m healthy. My body can handle the flu.” I heard someone use the last excuse recently and had to remind that person about a unique feature of the novel H1N1 virus (aka the “swine flu”). A disproportionate number of patients who died from H1N1 were young and relatively healthy. According to this Reuters article, 90 percent of the seriously ill victims in Mexico were less than 50 years old and most of those patients were previously healthy. In addition, 87% of those who died were aged 5 to 59 — compared to a usual average of 32% for seasonal flu. All of the patients who died had “multiple organ failure.” Here is another article from the Washington Post about increased H1N1 influenza deaths in young healthy victims. Why are young healthy patients the ones dying from H1N1? One theory is that the patients’ own immune systems are killing them. In younger children, the immune system hasn’t fully developed. In older patients, the immune system loses some of its effectiveness. The theory is that immune systems in young healthy people are “too good” and go out of control. Scientists call the theory “cytokine storm.” I”ll attempt a simple explanation of a cytokine storm, but realize that the process is more complicated than what I am trying to explain. When a virus infects the body, the body produces extra immune cells to combat the infection. Some immune cells attempt to kill the virus, others analyze the virus and produce antibodies. Some immune cells produce inflammatory chemicals called cytokines that serve several functions. Included in the function of cytokines is an inflammatory response – an increase in inflammation throughout the body. Normally, the body holds the inflammatory response in check – similar to the way that the thermostat in your home regulates the temperature. When the temperature in your house hits a certain set-point, the furnace shuts off. In a cytokine storm, the immune response is so intense that the feedback systems become overwhelmed. Cytokine production continues out of control and a generalized inflammatory response occurs in the body. Similar responses occur in anaphylactic shock and sepsis. Think of the difference between controlling a few bees buzzing around a picnic looking for food and a swarm of bees defending a hive. More information about cytokine storm can be found here and here. One study noted that gemfibrozil (Lopid) – a cholesterol medication – doubled survival rates in mice that had severe influenza infections. Apparently gemfibrozil has an inhibitory effect on inflammatory cytokine production. Not saying that every young healthy adult who gets swine flu is an automatic ICU admission. Death rates for H1N1 are low, but are still about 3 ...

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Legal Immunity

Last Friday, Secretary of Health and Human Services Kathleen Sebelius signed a document that provides vaccine makers immunity when they produce swine flu vaccine. Since vaccines are “well known” (wink, wink) to cause such physical maladies as autism … neurologic disorders, hyperactivity, learning disabilities, asthma, chronic fatigue syndrome, lupus, rheumatoid arthritis, multiple sclerosis, and seizure disorders, a federal law provides legal immunity for manufacturers that produce the vaccines. Instead of going through the court system, there is a fund called the Vaccine Injury Compensation Program that is set up to compensate those who have been injured by vaccines. Many vaccines have a low profit margin. In addition, most vaccines have only one or two manufacturers. If you were a vaccine manufacturer and knew that you could potentially spend tens or hundreds of millions of dollars defending and paying out on one class action lawsuit about a vaccine you produced, would you continue to make the vaccines? By immunizing manufacturers from liability for producing vaccines, the public policy argument is that the public benefits vaccines produce far outweigh the potential public detriment to the point that the government wants to encourage manufacturers to make vaccines. Several of the attorneys that frequent this blog have stated that legal immunity for physicians is the equivalent of a “license to kill” but they are also quick to defend legal immunity for judges in performance of their duties. So based on the above, I have two questions related to this immunity topic: [poll id=”2″] [poll id=”3″]

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Vaccinations Cure Cancer

According to the American Cancer Society, the cancer rate in the United States has shown a steady decline over the past 15 years, resulting in more than 650,000 lives saved. While the report suggests that “early detection practices” and “improvements in treatment” have attributed to decreases in death, I’ve noted a different trend. According to this position statement from the National Association of School Nurses, the number of recommended vaccines doubled between 1985 and 2000 and could triple in the next 20 years. Obviously the cancers are being caused by subclinical infectious processes that the vaccinations are now preventing. Direct evidence that increasing the number of vaccinations decreases the number of cancer deaths. Take that Jenny McCarthy. As a side note, why in creation would Oprah allow Dr. McCarthy to blog on her web site about analyzing poop to make sure that there are “no yeast, no bacteria, no infections”? The percentage of bacteria in an average stool is 30%. Heck, if we get rid of all the bacteria, we can just have the astronauts recycle all of their excrement. How novel.

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