Thursday, February 5, 2015

Magic Seatbelts and Measles; and why I am truly upset.

A patient says that they were in a car accident once without a seatbelt. They got a few bruises, but it wasn't so bad. In fact, they have had friends who died because of seatbelts, because sometimes, seatbelts do that. They correctly point out that most accidents do not kill you even if you are not wearing a seatbelt. (This is true. In fact, I wouldn't be surprised if the chance of death from an accident without a seatbelt is less than 1 in a 1000.) And seatbelts make them uncomfortable, so they think seatbelts are a terrible idea. Even a conspiracy of Big Auto. (This is not just allegorical. People do say these things.)

What if there were a magic seatbelt? For only $2, you could wear that seatbelt twice and reduce your chance of dying in a car accident or ever even getting in a fender bender by 95% and would protect the drivers around you. What if, if everyone alive today did that, no one would ever get in a car accident or have to wear a seatbelt ever again? Who would be a seatbelt skeptic then?

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Measles kills 1 in a 1000 people who get the disease. Most people who get it have an uncomfortable illness that leaves no lasting damage. That's nice for them. But this most contagious disease on Earth can infect a lot of people, and that means that it kills a lot of people.

But there is a 'magic seatbelt.' For $2, a pair of doses of the vaccine reduces your chance of getting the measles by 95%. (It reduces your chance of dying of it by more, but I don't know that number.) Now, like a seatbelt, it can be uncomfortable, and, in a infinitesimal number of cases it kills. But, since there are no animal vectors of the disease, through herd immunity, it would possible to eliminate measles entirely, making the vaccine obsolete.

In 2013, AIDS killed 1.5 million people. In contrast, in 1980, before the vaccine was widely available, measles killed 2.6 million people, most of them children under 5. In 2013, when 84% of all children had received at least one dose of the measles vaccine before age 1, measles caused 145,700 deaths. Meanwhile, in the United States in the years just before the vaccine was introduced, there were about 450 deaths a year, but there were 48,000 hospitalizations and 4000 cases of encephalitis (brain inflammation) with high risk of permanent impairment.*

The fact that anyone would think to stand in the way of a vaccine that prevents millions of deaths each year is unfathomable. The fact that people believe that there could be an evil conspiracy to spread a vaccine that could cause its own obsolescence is amazing.

And I do take it personally when people who have not spent decades studying this sort of thing not only disagree, they publicly shout their opinion. Not only are they telling me that one of the most valuable tools of my calling is evil, they are telling me that my friends, colleagues, and I are fools or monsters. My pediatrician colleagues lose money administering vaccines that are undercompensated by insurance companies and overpriced by pharmaceutical companies.

So, yeah, I have a chip in my shoulder about this issue.

PS: Maybe the antivaccine movement is a conspiracy of Big Pharma. If the measles vaccine is used widely enough, they will never be able to sell it again. The smallpox vaccine was such a bust! If they keep this antivaccine thing going, they could rake in the profits forever! That's it!