Some dates worth remembering:
1862: Louis Pasteur discovers the eponymous process of pasteurization (based on work done by Lazzaro Spallanzani 100 years earlier), first used in beer and wine, but most importantly in milk. As the process is gradually introduced (the first US state required it in 1947, the federal government for interstate commerce in 1973). It took a while, but with its introduction the frequency of serious and often life-threatening infections coming from unpasteurized (= “raw”) milk, including streptococcus, typhoid, typhus, and TB, among others, dramatically decreased. Health was improved.
2024: The US President-elect, Donald Trump, announces that he will nominate Robert F. Kennedy, Jr., who advocates the drinking of unpasteurized milk, to the cabinet post of Secretary of Health and Human Services.
1952: During the last major polio epidemic in the US, a friend comes to visit our family on a Saturday to see my new baby sister. On Monday, she comes down with polio and spends the rest of her life in a wheelchair. My parents are worried about their children having been infected, more about the greater risk to 3-year-old me than the baby, as polio in infants was uncommon. I do not get clinical polio (see * below) and soon thereafter receive both the Salk (injection) and later the Sabin (oral) polio vaccines. During this decade I also come down with clinical cases of measles, mumps, German measles (rubella), and chicken pox. The last was quite unpleasant, but I didn’t die and had no significant after-effects. The vaccine against measles (and mumps and rubella) were released in 1963. The rates of these diseases, especially measles which caused the most deaths, plummet. Most measles outbreaks since have been in populations in which people did not immunize their children, notably in 2019 among Hasidic Jews in Brooklyn.
As a young doctor at a public hospital in the 1970s, one of the common and feared infections we saw in the pediatric emergency room was that caused by the bacteria Hemophilus influenza b (not the same as the virus influenza). It commonly caused ear infections, but also very serious meningitis, and, most scary to us, epiglottitis, in which the epiglottis, the piece of tissue in your throat that prevents you from breathing in food, swells very large very fast and can completely cut off a child’s breathing unless a breathing tube can be placed in time (and it is difficult with the swelling). In 1985, the vaccine against H flu b was introduced, and these infections and deaths almost disappeared. Varicella (chicken pox) vaccine was not released until 1995, and the rate of those infected (and then later infected with shingles, a resurgence of the same virus, known as Varicella-Zoster) plummeted. Before the vaccine was released, about 4 million cases of chicken pox, with over 10,000 hospitalizations and 100 deaths, occurred (mostly among children) annually in the US.
2024: The US President-elect, Donald Trump, announces that he will nominate Robert F. Kennedy, Jr., who believes all vaccines are bad and should be avoided, to the cabinet post of Secretary of Health and Human Services.
The difference between individual and public health is important, and bears repeating. For the individual, getting a disease (infectious or not) is 0% or 100%. If something happens to “one in a million” people it is very rare (including serious reactions to vaccines, which do not, incidentally, include autism) but if you are the one, it is 100% for you. On the other hand, if something affects 99% of people, but you are in the 1%, you are lucky. Public health looks at trying to prevent (or contain, if they are infectious) diseases by looking at the impact of disease, or preventive measure (e.g., vaccines, pasteurization) on the population**. Pointing to individual exceptions (“my grandfather drank a quart of whisky and smoked two packs of cigarettes a day and lived to be 100”, or “we drank raw milk all the time and we’re healthy”) does not change that unless an subgroup that is not susceptible can be identified (e.g., biological males do not get cervical cancer – although they still should be immunized against HPV as they can transmit it). Some things may decrease the risk; those drinking raw milk direct from the cow on their farm are at lower risk of infections than those who consume it after it has been shipped and had days, or longer, to become infected. Folks who are skeptical of modern medicine often emphasize “prevention”, but this is not a magic incantation. Vaccines are one of the few things we have that actually prevent serious disease. Also avoiding foods that have a significant likelihood of being infected – tainted meat, shellfish, water infected with sewage (water remains the largest cause of death, through infant diarrhea; the main reason commercial campaigns to replace safe breastfeeding with formula that needs to be rehydrated are terrible), or raw milk.
Human progress is not unidirectional. There are often steps backwards, motivated by misinformation, financial gain, fantasies, (some people’s interpretation of) religious beliefs, political gain, and others. The appointment and confirmation of Kennedy would be a big step backward. The implementation of the policies he advocates will take us back more than a century.
There is a – very important – place for evidence and truth.
*Even though poliovirus infects almost everyone exposed who is susceptible, not everyone who is infected with poliovirus gets clinical polio; it is about 10%. Measles, on the other hand, also infects almost 100% of susceptible people, and virtually everyone infected gets clinical disease.
**It is worth noting that even the practice of one-on-one clinical medicine is based on applied epidemiology, the science of studying disease in populations. Why we may suspect a certain condition in a person with certain symptoms is because, in a population of people who are similar and who have these symptoms, these are the common causes. Same for treatments: we don’t say “well, the last person I saw with diabetes responded well to insulin, but you’re a different person, so let’s try digitalis.”
2 comments:
Generally our health care system is based on science, facts and documentation which we use for the prevention and treatment of potential insults to our health. In contrast, our incoming political system seems to be guided more by whim. The results are predictable. We would expect a threat to health care and a negative impact on our government since decisions are not being made on the basis of facts, but rather we are receiving the dysfunctions that we would expect when prioritizing whim over well documented government improvement that stems from the study of political science.
How would that apply today? What should we expect when individuals uneducated in political science assume control of health care, again without being educated in the basics of the health sciences? Terrible outcomes can be anticipated. On the other hand, if those well educated in the health sciences but with very little knowledge of political science based on not much more than whims assumed control of the government, we can anticipate a dysfunctional government (except possibly in public health if the health sector were to introduce an improved form of Medicare and provide that for everyone).
Moral? Let’s let the competent in health care run the health care system and the competent in public policy run the government. We didn’t do the latter this time, but we can learn from facts and documentation and get it right the next time around (after introducing an education in policy on how to finance health care that would produce health justice for all).
posted for Dennis Bier, MD:
Of all the things in medicine don’t work, or worse, it is simply inconceivable that physicians have to defend vaccinations. Presumably one reason that RFK Jr. is still around to spread around his ignorance is that RFK Sr. got him vaccinated as a child.
And, by the way, below is a brief “history of medicine” taken from a book (cited) that I am now reading which you too might enjoy:
“An instructive way of viewing the history of medical therapeutics is to categorise it schematically in three periods:
Period 1 was the time when virtually all medical treatments were worse than a placebo.
Period 2 was an epoch when treatments emerged that were equal to a placebo.
Period 3 is the present, where we have finally developed treatments that are effective beyond placebo.”
from Bizarre Medical Ideas: ... and the Strange Men Who Invented Them by Edzard Ernst
I would then add
Period 4, the time when formal evidence-based methods unfortunately reaffirmed that many treatments were, in fact, no better than or even worse than, placebo.
And even Period 5: When anti-science advocates on the evidence-free side of the looking glass declare: “History be Damned! Full Speed backwards.”
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