February 8, 2015

Why do so many people deny science?  This is the question of the hour.

I became a mother in early 2004, when murmurings of vaccines and autism were getting loud, but before they were definitively refuted.  My father survived a long bout with polio in the 1950s, and I grew up on tales of its brutality and longevity.   My personal history easily leads me to favor vaccination.

About a year ago a friend of mine took her child in for a check-up.  She was wary of the messages going around and simply asked the pediatrician for more information before the shots were administered.  She received a lecture and was derided like a naughty kindergartner for asking the question.

She wanted information and reassurance.  New parents, by the way, need a lot of that.  And for the dumbest reasons you could imagine because we are exhausted, sleep deprived, and overwhelmed.

I have no sympathy for the likes of celebrities who abuse their vast access to uneducated masses by spreading ideas they are not qualified to present, especially when they profit from doing so.  But I am concerned over new parents not having a safe place to voice their fears and talk through them (no matter how stupid they may seem today).

In the vitriol spewing from either side, are new or uncertain parents going to get the support they need?  The bedrock of critical thinking is inquisitiveness, an inherently imperfect practice.  The only stupid question really is the one not asked.

Whenever we as a society gather a group together, string them up, and label them the enemy, I can’t help but be suspicious.  Are we sure the criminals are so different from us?  Are we missing important parts of the picture by laying the blame so squarely at the feet of one group?

We want to identify the enemy and annihilate her.  But denial of science is a more vast landscape than today’s dialogue frames.  While those who refuse to vaccinate are extreme, their failure to recognize flawed thinking and its consequences are far from unique.  As we vilify science deniers in the media, our list of criminals may be too narrow.

Consider the slow beginnings of anesthesia, first used in human medical operation in 1846.  Methods had been tested with that goal in mind for more than 300 years, and the general chemicals and protocol used in that first surgery had been around for over 40 years.  The medical community resisted for so long this practice we now consider indispensable.

“…anesthesia itself was hardly new in the 19th century, but that a moral objection prevented its use. Why? Because pain was considered an integral and necessary part of life, and the removal of pain was the work of either a charlatan or a Satan…”

Could you imagine such an innovative technique sitting on the shelf unused for four decades?  Fortunately we know the benefits of reducing patient suffering.   We even sedate or anesthetize for routine invasions whether the discomfort is pain or just anxiety.

But there have been holdouts to this line of thinking among some caregivers.  It is well documented that Mother Theresa withheld pain medication from suffering patients because she believed pain was God’s Will.  And what did we do?  We set her on the path to sainthood.  Her name is synonymous with selflessness, and the pedestal we have her on is high.

Only a year after that first anesthetized medical procedure a clinician succeeded in proving how vital hand washing is to the quality of patient care during child delivery.  But the overwhelming evidence had a rocky path to the light of day.  (See On Washing Hands, by Atul Gawande.)

“…the Viennese obstetrician Ignac Semmelweis famously deduced that, by not washing their hands consistently or well enough, doctors were themselves to blame for childbed fever. Childbed fever, also known as puerperal fever, was the leading cause of maternal death in childbirth in the era before antibiotics (and before the recognition that germs are the agents of infectious disease).  It is a bacterial infection — most commonly caused by Streptococcus, the same bacteria that causes strep throat — that ascends through the vagina to the uterus after childbirth. Out of three thousand mothers who delivered babies at the hospital where Semmelweis worked, six hundred or more died of the disease each year — a horrifying 20 percent maternal death rate. Of mothers delivering at home, only 1 percent died. Semmelweis concluded that doctors themselves were carrying the disease between patients, and he mandated that every doctor and nurse on his ward scrub with a nail brush and chlorine between patients. The puerperal death rate immediately fell to 1 percent — incontrovertible proof, it would seem, that he was right. Yet elsewhere, doctors’ practices did not change.  Some colleagues were even offended by his claims; it was impossible to them that doctors could be killing their patients. Far from being hailed, Semmelweis was ultimately dismissed from his job.

Semmelweis’s story has come down to us as Exhibit A in the case for the obstinacy and blindness of physicians. But the story was more complicated. The trouble was partly that nineteenth-century physicians faced multiple, seemingly equally powerful explanations for puerperal fever. There was, for example, a strong belief that miasmas of the air in hospitals were the cause. And Semmelweis strangely refused to either publish an explanation of the logic behind his theory or prove it with a convincing experiment in animals. Instead, he took the calls for proof as a personal insult and attacked his detractors viciously.”

But despite all that ego and personal dysfunction, the lesson was learned.  Handwashing is a cornerstone of surgical practice.

“But such enthusiastic devotion to hand hygiene does not exist outside the operating room. And again and again in discussions about quality and safety and the terrible infections that can ensue, one issue continues to bedevil the patient-doctor relationship yet defies all reason: why don’t doctors wash their hands more?

Over the last 30 years, despite countless efforts at change, poor hand hygiene has continued to contribute to the high rates of infections acquired in hospitals, clinics and other health care settings.  According to the World Health Organization, these infections affect as many as 1.7 million patients in the United States each year, racking up an annual cost of $6.5 billion and contributing to more than 90,000 deaths annually.”

Christopher Hitchens, the journalist who published the story about Mother Theresa I mention above, died of one of the illnesses we fear most.  Cancer.  Well, actually, he was battling cancer.  But he died of pneumonia caused by a hospital infection, as his wife was quick to point out in several interviews.  We spend billions of dollars fighting this disease, and still can’t comply with the simplest and least expensive strategy in favor of surviving it.

Science denial is a symptom of the worst part of our humanity – our incessant notion that our judgment is enough, our priorities are right, and we are not the problem.  Our god complex.  We then systematically scramble evidence to the contrary in our brains to give us a worldview palatable to our psyches.  Then we point the finger at someone else.

When Gawande refers to his hospital and details its compliance statistics, he is referring to Brigham & Women’s in Boston, staffed by Harvard physicians and one of the finest hospitals in the world.

“With the (alcohol) gel finally in wide use, the compliance rates for proper hand hygiene improved substantially: from around 40 percent to 70 percent. But — and this is the troubling finding — hospital infection rates did not drop one iota. Our 70 percent compliance just wasn’t good enough. If 30 percent of the time people didn’t wash their hands, that still left plenty of opportunity to keep transmitting infections. Indeed, the rates of resistant Staphylococcus and Enterococcus infections continued to rise. Yokoe receives the daily tabulations. I checked with her one day not long ago, and sixty-three of our seven hundred hospital patients were colonized or infected with MRSA (the shorthand for methicillin-resistant Staphylococcus aureus) and another twenty-two had acquired VRE (vancomycin-resistant Enterococcus) — unfortunately, typical rates of infection for American hospitals.”

Quality public health is not simply a battle with a small community of nutjobs.  It is a complex system that needs us to fight against the foolishness in us all.

As I watched the polarization over immunization grow, I asked other parents what they thought.   One friend reminded me that her son has had a suppressed immune system most of his life to help him battle an ongoing medical condition.  I had forgotten, because he is a healthy and vibrant kid now.  His immune system can’t tolerate a live vaccine, and many of the conditions we avoid through vaccination could kill him.  He doesn’t have the luxury of immunization.  Parents who choose not to vaccinate do so because they don’t believe their own child is at risk.  Well, this kid is.

So I asked her, what do you do?

She makes sure the school nurse knows her son’s face and his story.  She gets to know the other parents and sometimes which kids haven’t been immunized.  She tells them her son’s story.  She encourages her school community to tell her if they get so much as a whiff of concerning symptoms.

“I build relationships,” she told me.  She knows firsthand that some minds simply will not be swayed, and that their ignorance could deliver her worst fear to her doorstep.

New vaccines will come, thankfully.  Despite the amazing advancement of pharmaceuticals, there is no perfect science.  If a new vaccine starts to show evidence of unacceptable risk, I worry we will be so weary of this issue, and so defensive on behalf of vaccines as a category, that even the most pro-science among us will be unable to consider it.

We can never be too certain we know the answer.  I don’t share the sentiment that Big Pharma is evil, but pharmaceutical companies don’t have a pristine track record either.  Not because they are evil, but because companies are made up of human beings.

As you shake your head at the idiots of the world, take the time to make sure your own vaccinations are up to date.  And when you are or someone you care about is being treated in a health care facility, make damn sure your caregivers wash their hands.