What I'm Reading Today

How Public Health Advocates are Trying to reach Non-Vaccinators

The approaches described in the article are interesting, because the situation was actually the opposite for me.  While pregnant with my first son, I was unsure whether to vaccinate.  One of the factors in arranging a meeting with his pediatrician was whether the practice would allow us to skip vaccinations or modify the schedule.  This practice allows that, and is the only one in our area that I found that did.  When I went to meet with the pediatrician, I asked him about vaccinations.  He calmly explained with facts, and offered articles as support, why vaccinations are safe and why the risk from not vaccinating is much greater than from vaccinating.  His approach made sense to us, and we choose to vaccinate our children.  When we go to our check-up appointments, the vaccinations are a part of the appointment.  That is, if we were non-vaccinators, we would have to actively deny the vaccination. 

With more understanding, I know why it is so important that my children, and all children who are able to be vaccinated, are.  I still agree with the practice's approach of allowing non-vaccinated children, because those children, whose parents are making a bad decision, should also have a right to health care.  I wish our provider didn't have to be the one to provide it, because I did worry before my children were vaccinated, but I felt the quality of care we receive there was excellent, so I did not change providers.

Public Health Concern: Conspiracy Theories

A survey getting some press today indicated that half of all Americans believe in health-related consipiracy theories.  This survey was conducted by political science professor Eric Oliver at the University of Chicago, and published in JAMA. 

Some of the conspiracy theories include:

• Vaccines cause autism
• Cell phones cause cancer
• The FDA is deliberately preventing access to natural cancer cures
• The use of GMOs in food is a program designed to shrink the world population

This, to me, represents a very difficult challenge in public health. I believe that, in buying into these myths, people believe they are being responsible and thinking critically.  It is hard, though, to refute the "evidence" that people have access to: they saw it on the internet, and therefore it must be true.  This is tough to refute not because it is true, but because what people believe is true often has little to do with what actually is. 

To give examples of concrete issues with these views, if a patient believes that there is a natural food out there that will cure him of cancer, and meanwhile refuses to accept chemotherapy, there will be a real consequence to that person and his family. Unfortunately, that consequence could come too late for it to be useful as a learning experience to that patient.  I have not heard of a situation in which this is happening en masse, however.  The anti-vaccine mamas, however, are, as a group, taking a path that not only puts their own babies at risk, but those children and adults who are not able to be vaccinated.
In a more abstract sense, would trying to change these views by any means lead your patient to distrust you, and do more damage to the situation than good?  I feel this is extremely likely, and this secondary danger may be even more dangerous than the first situation.  It certainly depends on the patient. 

20140207 Current Events

http://www.medscape.com/viewarticle/820234?src=rss#3 Mandatory Flu Vaccinations for Nurses

This article on medscape tells about a pregnant nurse who was fired for refusing the flu vaccine.  I find this situation to be very interesting.  I really want to side with the nurse.  I want to be able to say that I believe that should have been her option.  I want to say this because, in other cases, I myself would like the right to refuse a vaccination if I feel that it is not safe.

However, this is the flu vaccine.  I myself have never received it, but I do get it for my children every year, and when I begin nursing school, I will begin taking the shot.  I simply do not take it because I have never had the flu and I do not currently work with an at-risk population.  Since my children's immune systems are immature, I feel incumbent to vaccinate them.  Because the flu is so contagious, I do believe that anyone working in a hospital, long term care facility, or, really, anywhere where there is a concentration of people (such as a school) should receive the vaccination if they do not have a solid reason not to.

This nurse was pregnant, and she feared that the vaccination could put her baby at risk.  Her anxiety over this was so great that she was able to get a physician's note saying that the stress from worrying about this was putting her baby at risk.  However, this just is not fact-based.  While no group of pregnant women is assembled as part of a study of effects on pregnancies before the vaccine is released, data from after the vaccine is released shows that receiving the vaccine may actually lead to lower incidence of pre-term birth.

In an age of evidence-based practice, do we want a nurse who won't use the evidence?

And then, I do see her side.  How do we know what is true?  But anecdotal stories of things going awry are hard to critically examine, since they don't really give us enough information to prove causality.  In some cases, it is less clear. With a disease so easily spread as the flu, I just don't think there is enough evidence against the vaccine. Could her employer have given her some tasks away from patients until after she had the baby, or after flu season? It is possible, but would that be her job? I am all for being flexible, and I think employers should be flexible. But I can also see how they wouldn't want her in the building, and also that there might not be another job suited to her with minimum patient contact. It could truly be a dangerous precedent.

http://www.recorder.com/news/townbytown/shelburne/10549654-95/letter-nursing-shifts

letter to the editor regarding nurse demands in a strike; nurses being overworked; quality of care

This is a letter to a paper editor, spurred by a patient's observations about nurse scheduling and overtime, as well as an impending strike. The patient appreciates the competence demonstrated by her nurses and expresses dismay at the focus on profit rather than patient outcomes.