In Defense of Pediatricians... (And a Few Words of Advice For Doctors and Other Public Health Types)

Allow me to share a few select comments from Twitter with you.

“You people are awful.”

“This is just sick,” wrote another.

“All this to enrich yourselves. DISGUSTING!!”

“You endanger KIDS LIVES for a $400,000 a year salary and a Lexus???”

Wow. What’s going on? What are these people talking about?

They’re taking me and my fellow pediatricians to task because of the perceived role pediatricians play in perpetuating the conspiracy that pediatricians, public health officials and greedy pharmaceutical companies encourage vaccinations in order to make money and are therefore willing to endanger the lives of children everywhere.

The anger toward pediatricians is real. How did things end up this way?

How did a medical specialty most people associate with sniffles and sore throats, reach the point where labels are thrown at us that are more commonly used to describe axe murderers and third world dictators?

Allow me to defend myself and my fellow pediatricians, most of whom are relatively reluctant to engage belligerent people on social media.

I do not have that problem.

In a way, I understand the anger. It makes sense to me.  I deal with parents every single day. These people are worried about the safety of their children. They’ve run across a very disturbing story on the internet and are worried by what they’re reading.

But these people do all seem to have one thing in common.

They seem to be operating with a mental image of doctors that got lodged in their brains about twenty- five years ago.  Or might they have acquired it by binge watching too many medical dramas on Netflix? (I prefer to blame Hollywood scriptwriters, whose portrayal of the glamorous lives doctors lead is equally detached from reality, however I will save that for another time.)

As for the idea that I’m living a life of luxury? I’ve heard this one enough times that the time has come to address it.

The financial windfall I am supposedly reaping by vaccinating the kiddos in my care? Let me break it down for you. For the last 15 years, I have been paid $6 per immunization by the various insurers. With the ushering in of “value-based care,” the reimbursement rate is up to a whopping $17-22 as of this year. This is the princely sum for which I am supposedly willing to sell out my principals and commit the crime of keeping a child healthy.

Let me point out one little detail many people may not be aware of. The vaccinations that people are getting so worked up about? Fifty years ago they were administered by physicians or nurses only. In recent years, thanks to structural and legislative changes in the healthcare system,  the vast majority of immunizations are being administered by medical assistants, pharmacists, and other healthcare workers, many of whom have completed a single 20-hour training course. Could playing it ‘fast and loose’ with vaccinations have something to do with some of the uptick in complication rates?

Hmmm.

 

Perhaps we should consult a statistician?

Here’s a study I’d like to see.  I’d like to see research that looks at the complication rates for vaccinations given by nonphysicians and compare them to the complication rates back in the days when pediatricians and nurses gave the immunizations.

I wouldn’t be surprised if the numbers tell a very interesting story.

Just ask Lou Ferrigno –otherwise known as “The Incredible Hulk”– about how he ended up in the hospital after receiving an immunization for pneumonia at his local pharmacy. His tweet said it all, “Went in for a pneumonia shot and landed up here [in the hospital] with fluid in my bicep.” He tells his followers that “it’s important you keep an eye on who’s giving the shot and make sure they not only swab the spot correctly but that you watch the needle come out of the package.”

The problem is that while pharmacists, medical assistants and health center employees are considered adequately qualified to roll up somebody’s shirt sleeve and jab a needle into their arm after a 20 hour crash course, they have little or no training to evaluate the health status of their patients. Many have never seen the patient before the day they walk through the door.

Which brings us back to those terrible stories on the Internet. 

It’s natural for parents to be upset. Especially when they raise their hands to ask questions and get shouted down by an angry mob. That’s because the stories they’re hearing sound plausible.  The vast majority of people who are being converted to the anti-vaxx camp are intelligent, rational people. Most are highly educated, and they are good parents. They are aware enough to search for scientific evidence to answer their questions after being dismissed by the CDC.

If you’re like me, you may have noticed that the conspiracy theories that are floating around keep gaining strength. These ideas incense public health officials and scientists, but it turns out that on social media, the more we try to suppress ideas we dislike, the more they spread.  At this point it’s become obvious that things aren’t getting better. They’re getting worse. Pretty soon, the entire system is going to break down.

And one day soon there may be a real epidemic. Not a flare up. Not a scare. A real epidemic that kills thousands of people and brings life as we know it in this country to a halt.

And I’ll tell you one thing. If it happens, it’s going to be our fault.

Yes, you read that correctly.

If you want to blame somebody for the vaccine crisis, blame the pediatricians. Why?

Because we know better. We let government bureaucrats and health insurance bean counters push us around, even though this puts the health and welfare of children at risk. We let others who are far less qualified than we are take the lead and take up the challenge of explaining the vaccine story to the world.

How did we let that happen? I’ll tell you what happened. We gave up.

We got sick and tired of beating our heads against a wall. Tired of explaining to public health officials that it’s a bad idea to tell people that vaccines just work. Period.  Tired of fighting with insurers and employers, who don’t see the value of paying twenty dollars more for a physician to administer immunizations directly. Tired of arguing with our government, which believes vaccinations are so ‘harmless’ that in 1993, U.S. Secretary of Health and Human Services Donna Shalala (currently serving in the US Congress) asked the American Pharmacists Association (APha) to help define the role of pharmacists in the national vaccine program for children.  They jumped at the opportunity when millions in revenue was at stake.

We’ve known since the beginning that vaccines have risk. All medicines have risks. They have trade offs and rewards. In an age when scientific information is widely available on the Internet, it makes absolutely no sense for public health officials and scientists to dodge the hard questions by telling people that “vaccines work”.

In a world where opinion is shaped through social media, a public health strategy based on trying to “educate people” by shoving “facts” in their face when the facts are in dispute is not going to work very well.  In reality, it may backfire and produce exactly the opposite result from the one you intended. And that is exactly what is happening here.

The people who are revolting and opting out of the vaccination system? They’re not going anywhere. They’re not going to be shamed into submission. They’re not going to sit back down and shut up. You can try to “educate them.” They’ll go out and get different books.  You can bar their kids from schools. They’ll build new schools.

It’s pretty clear that it’s time for a new approach.  We need to have a national conversation about the risks and benefits of vaccination. We need to respect the power of immunizations and their side effects.  And it’s time to take vaccinations out of the hands of people who know nothing about the risks involved and give them back to the physicians.

And lastly, it’s time for somebody to have a long hard talk with Big Pharma about the role they are playing here.  What data do they have? To quote one of Hollywood’s favorite conspiracy movies: What do they know and when did they first know it?

Many of the questions that are being raised by the people who are challenging the current system are fair.  Parents deserve answers to their questions and full disclosure. Then and only then, will the controversy subside and allow pediatricians to go back to the peace and quiet of their glamorous lives treating runny noses and all that other stuff.

In reality, physicians are the only group of healthcare professionals with the ability to turn the anti-immunization debacle on its head.  Pediatricians, especially, must reclaim the responsibility for talking openly and honestly with our patients about the risks, benefits, and alternatives of immunizations. After all, look at where relying on the CDC, WHO or even the US Government has gotten us?

Oh and one last thing? For the record.

$400,000 is a pipe dream and my Lexus is a minivan made by someone else.

Niran Al-Agba, MD is a pediatrician based in Washington State. She is an associate editor for The Deductible. Follow her on Twitter at @silverdalepeds

When Doctors Need Our Help: Do No Harm, A Film

In the United States, 400 physicians commit suicide annually – an average of one per day.  Physicians have the highest rate of suicide of any profession; almost double that of the general population.  While physician suicide has reached epidemic proportions, the general public is relatively unaware of this tragic phenomenon.  Robyn Simon has produced a documentary film, Do No Harm, to shed light on this taboo topic.  Common Spirit Health/Dignity Health/CHI/Fransciscan Hospital (formerly known as Harrison Memorial) is sponsoring a free screening of this movie in Kitsap County, scheduled for Friday March 22, 2019 at 6:00pm in the Bremerton High School Auditorium.  

“Do No Harm” chronicles the journey of two families – the Dietls and Mechams – which share common insurmountable challenges during medical training.  John and Michele Dietl lost their son Kevin to suicide 3 months before his graduation from medical school.  Feeling hopeless during his fourth year of residency, Hawkins Mecham, DO, tried to take his own life. 

Dr Mecham reached out to Dr. Pamela Wible, a friend and colleague who has focused her efforts on preventing physician suicide.  Dr. Wible connected Mecham with the Dietls.  John and Michelle were able to ask Mecham the questions that they could not ask their son and by sharing their story with Hawkins, he had more insight into those who are left behind after suicide. 

I was twelve years old when the first physician I knew in Kitsap County committed suicide. He was a colleague of my father’s in a local multispecialty physician group.  As a young girl, I went on occasional playdates with his children and attended birthday parties in their home. My father always described him as intelligent and kind.  At that age, I could not fathom the wear and tear this career has on the souls of all physicians.  

Physicians who die by suicide are struggling healers; they are mothers, fathers, sons, daughters, husbands, wives, colleagues, neighbors and friends.  As a community, we must embrace those who are struggling and erase the stigma associated with depression, anxiety and suicidality. Physicians are reticent to share their personal and professional struggles with others out of fear from being labeled as being weak.  This silence helps no one.

Like my esteemed colleagues, I have often felt overwhelmed by this challenging career, more so after the loss of my father and business partner eighteen months ago.  The heartfelt and valuable advice shared nearly twenty-five years ago by a local gastroenterologist – Dr. Pankaj Sharma – has helped me cope through it all. 

During my junior year in college, Dr. Sharma evaluated me for nonspecific abdominal pain with an upper endoscopy, a procedure where a thin scope with a light and camera at the tip is used to look inside the upper digestive tract, including the esophagus, stomach, and first part of the small intestine, known as the duodenum.  His evaluation yielded little in the way of a definitive medical condition. 

At my follow up appointment, a stack of Medical College Admission Test (MCAT) study books accompanied me, because I did not want to lose a moment preparing for this exam.  Dr. Sharma quickly realized my problem was more stress-related and shared some guidance: “The challenges you will face as a physician will be overwhelming.  You must find a way now to accept the crushing demands medicine places upon us. If you cannot, you will never survive a career as a doctor.” 

At nineteen, I did not fully grasp the significance of his words but after nearly two decades in this field, I know all-too-well how right Dr. Sharma was. Medicine is a science grounded in uncertainty; it is the weight of facing this ambiguity every day that exacts such a heavy toll.  When physicians cannot cope with such doubt, it can manifest as depression, anxiety, alcoholism, or even, suicide. 

The “Dr. Sharma talk” still resonates today.  Despite giving patients our best, sometimes the negative outcomes are beyond our control. Physicians must be careful not to lose themselves while helping others. Failure is a part of medicine because it is an inevitable part of life. Grieving, when necessary, is important; every physician is, first and foremost, a human being. 

Our nations healers --nurses, doctors and all of those working in healthcare -- are suffering, they need our support, appreciation, gratitude, and forgiveness.  Please know that when tucking our own children in at night, we are often thinking – and even dreaming – of yours.  Please join the community for a screening of this courageous film:  Do No Harm. Thank you to Common Spirit Health Hospital for bringing this film and filmmaker Robyn Simon to Kitsap County.

And I wish to thank Dr. Pankaj Sharma personally, for being the voice in my head whenever I struggle with the demands of a medical career.  I have followed your advice by exercising every day, enjoying close relationships with my patients, and writing openly about my frustrations working in a healthcare system that no longer makes sense.  Please know your work has made a world of difference.