I’m not sure how I missed the article, but one of my favorite New York Times bloggers wrote a piece in April titled “Are Med School Grads Prepared to Practice Medicine?” I applaud Dr Pauline Chen’s attempt to discuss the variability of medical education across the United States and the need for more uniform standards and testing, but the resounding answer to this question is obvious and is absolutely no. Reading the comments on this article (something I keep telling myself not to do but somehow cant avoid) would make you think that every young doctor out there is completely incompetent and therefore is not ready to practice medicine. My opinion might be unpopular, but I would argue that not being prepared to practice medicine out of medical school isn’t necessarily a bad thing.
I’ve often commented that medical school is the time for learning how to act like a doctor, while internship is for learning how to actually be a doctor. Part of the problem with preparing medical students to be physicians is that no amount of training can fully prepare you for internship. As one of the chief residents this year, it has become all to clear how “preparing students to be doctors” is almost an insurmountable challenge. Throughout their “clinical training”, third and fourth year students struggle with the tremendous amount of factual information they must learn in the chaotic environment of the hospital, while preparing for exams at the end of their rotations that are a test of knowledge rather than skill. Additionally, students are often observing residents and attendings interact with patients, and rather than being the lead are often at the bottom of the totem pole, a situation that makes acquiring clinical knowledge much more difficult. As it is, medical school still focuses on education for factual knowledge instead of clinical knowledge.
Interns are no different, and their learning curve is particularly steep. Surgical interns start out particularly handicapped – not only must they conquer the knowledge base of a medical doctor, but they must also acquire the skills necessary to be a young surgeon. But a solid knowledge base of medical facts does not ensure that a student will be prepared to be an intern; the critically important part of intern year is learning accurate clinical judgments. Learning that skill that takes variable amounts of time to acquire from resident to resident, and among attending physicians, some will always be better than others. Interns are also charged with taking care of far more patients than their student counterparts, and while the amount of responsibility students have varies across medical schools, interns are directly involved and responsible for patient care. Part of learning to be a physician is well… actually being a physician. If students came in fully prepared to practice, what would we need residency for?
I firmly believe that nothing can fully prepare you for the first time your pager goes off as an intern and an emergency in one of your patients awaits you on the other end of the line. But perhaps there is room to do better in training medical students.
I will undoubtedly get into trouble for this post. So be it.
October 1st marks the beginning of National Breast Cancer Awareness month, an annual international health campaign organized by major breast cancer charities every October to increase awareness of the disease and to raise funds for research into its cause, prevention, diagnosis, treatment and cure. Unless you’ve been living under a rock, you’ve undoubtedly seen pink colored products in mass quantities over the past few years. It seems like everyone “goes pink” for October.
I don’t want to trivialize breast cancer with the remainder of the post. As a physician and a surgeon, I recognize the critical importance of mammograms and the devastation that breast cancer causes to thousands of women each year. I also do not want to downplay the important work that is done by some breast cancer charities to support research toward ending breast cancer as well as screening and treatment. But before you go buying pink products this October, I want to add a word of caution to everyone out there, particularly women.
First, despite all the charity events, the “awareness”, and the funding, breast cancer is NOT the leading cause of death among women. As far as a woman’s individual health is concerned, a good diet, exercise, and avoiding smoking are far more important to prevent heart disease – which happens to be the overall leading cause of death for women. Avoiding smoking is doubly important because it’s highly associated with lung cancer, which happens to be the overall leading cause of cancer deaths among women.
Second, people should be aware of the term “pinkwashing” – the outrageous corporate practice of selling products linked to an increased risk of breast cancer while claiming to care about (and profiting from) breast cancer. I encourage everyone to visit the website for “Think Before You Pink“, because it highlights a lot of the hypocrisy in pink products. One of the more striking examples may be the NFL, which started “going pink” in October 2009 to support women and breast cancer. Given recent events surrounding the NFL and domestic violence, one might question how much the NFL really supports women. Of note, domestic violence affects more women annually than does breast cancer, and October also happens to be National Domestic Violence Awareness Month. Additionally, an analysis by Business Insider found that only 8% of the money spent on the plethora of pink gear sold by the NFL ended up going to research at the American Cancer Society, the supposed beneficiary of the league’s efforts. Since 2009, when pink first appeared on the field, the NFL has donated a grand total of $7 million towards the cause, while the league made $9 billion in revenue in 2012.
Third – be very critical of which charity you are supporting. Susan G Komen Foundation is one of the most widely recognized breast cancer charity, yet only 15% of its donations in 2011 went toward breast cancer research, with less going toward screening and only 5% toward treatment. For a charity that claims to be “for the cure”, spending nearly 43% of your donations on “public health awareness” seems a little suspect. I’m not claiming that others are any better, but just be aware of where your money is going. Donating directly to research institutions like Dana Farber or Memorial Sloan Kettering or to breast cancer survivor support groups might be more beneficial.
And finally, As the association Breast Cancer Awarness notes, pink ribbon products spread empty awareness – awareness that has failed to address and end the breast cancer epidemic. Pink ribbon trinkets on store shelves that promote “awareness” ultimately change nothing. We have more than enough awareness, but not nearly enough action that will make a significant difference to whether women get breast cancer or survive it. Awareness shouldn’t be the end goal; unfortunately, pink ribbon culture defuses anger about breast cancer and its devastating impact and distracts us from the meaningful actions that will achieve health justice.
If you walk around most hospitals, you’re likely to find a stethoscope hanging around the neck of a number of medical professionals. It’s probably safe to say that no other instrument has had such a lasting impact on medicine as the stethoscope, and no other single piece of equipment has come to symbolize “physician” quite like it.
The stethoscope first debuted in 1816 in France, when physician Rene-Theophile-Hyacinthe-Laennec rolled a piece of paper into a cylinder and pressed it to the chest of a sick patient. Almost 200 years later, the stethoscope is used by almost every medical provider and has changed minimally from its humble beginnings. In addition to symbolizing the profession of medicine, it has come to represent an intimate part of the physical exam – when is the last time your primary care physician didn’t listen to your heart and lungs?
But as Drs Soloman and Saldana point out in their article in the New England Journal of Medicine, ultrasound may prove to be the new stethoscope of health care. Over the past 50 years, ultrasonography has increasingly worked its way into different parts of medicine. Much like the stethoscope – the ultrasound is employed by a wide variety of physicians; long a standard tool in obstetrics and gynecology, ultrasound has become the most widely used and cost-effective imaging modality for cardiologist. ED physicians use ultrasound to perform basic abdominal, cardiac, and obstetric evaluations, and even surgeons use ultrasound during trauma scenarios. Ultrasound can be used to evaluate the heart, the blood supply, the uterus and ovaries, the liver and biliary systems, and the kidneys. Ultrasound has become the preferred imaging method for investigating intraabdominal pathology in children (such as appendicities) and pregnant women given the lack of radiation, as opposed to xrays and CT scans.
And much like most emerging technology, ultrasound machines have become smaller, more portable, and cheaper over time. I’ve even seen ultrasound apps for smartphones – perfect for use in the field or in developing countries with less medical infrastructure. It’s not too hard to imagine a future where instead of listening to the heart and lungs with a stethoscope, primary care physicians examine the heart with a portable, hand-held ultrasound machine – thus providing a more accurate picture of the patient’s cardiac function as well as a potential billing opportunity and source of income for primary care physicians.
Ultrasound’s advantages – low cost, no radiation, portability – are precisely why the technology has expanded so rapidly in medicine. Yet ultrasound has a few drawbacks to further implementation, the first of which is accurately interpreting the images (a drawback inherent in all imaging modalities). Inherent in in the first drawback is the other drawbacks – ultrasound is a skill that needs to be learned. Currently, ultrasound education occurs mostly during residency, where Emergency Medicine, OB/GYN, surgery and medicine residents learn to use ultrasound targeted toward their own specialties. Surgical residents are taught how to perform ultrasound exams in trauma scenarios and for certain procedures, while OB/GYN residents focus specifically on gynecologic and obstetric procedures. More detailed examination of the heart and vasculature often occurs during fellowship training in cardiology or vascular surgery. And ultrasound technology is extensively taught during residency training in radiology.
In order for ultrasound to become the “new stethoscope” and gain wider implementation, education in the proper use of ultrasonography must begin at the same point where physicians learn how to use a stethoscope – in medical school. Undergraduate medical education must routine incorporate training in ultrasound in order for the technology to become “point of care”. We cannot expect all of our physicians to be facile in using ultrasound if we don’t teach all of our “physicians in training” how to properly use the technology. As Soloman and Saldana point out, a generation of physicians will need to be trained to view ultrasound “technology as an extension of their senses, just as many generations have viewed the stethoscope. That development will require the medical education community to embrace and incorporate the technology throughout the curriculum.”
Hey, let me know when that vaginal disaster arrives.
That doesn’t narrow it down, isn’t that all women?
When we were growing up, our mothers often told us that we are what we eat. Well, it turns out that some of us are apparently eating cancer.
The Atlantic made my job incredibly easy when they posted an article yesterday about America’s poor health habits and the association with cancer. The article cites the American Association for Cancer Research’s new cancer progress report, which noted that roughly 50% of the 585,720 projected cancer deaths in the United States this year are related to preventable behaviors, with smoking being the biggest culprit. But poor diet and sedentary lifestyles accounted for nearly one third of preventable cancer deaths.
The good news? Smoking rates in the United States continue to decline, and smoking related cancers also seem to be on the decline. Obesity rates, however, continue to climb in the US – and their associated cancers are also increasing. Not to mention that smoking and obesity are synergistic – in combination, the two habits increase the risk for cancer.
This morning, CNN published a story surrounding the death of the hilarious Joan Rivers, who died at New York’s Mount Sinai Hospital on Thursday after undergoing elective throat surgery at Yorkville Endoscopy. Joan Rivers was laid to rest today with a star-studded funeral in New York City.
Though I have my own thoughts on the subject, we may never know what exactly led to Joan’s ultimate and unfortunate demise, as the medical examiner’s autopsy was “inconclusive”. But beyond the loss of a powerful and history making female celebrity, Joan’s death brings up two incredibly important points to me as a health care provider.
The first is that we as physicians, particularly those of us who perform procedures, have become the victims of our own success to a certain extent. We often remark that patients are undergoing a “routine” or “elective” procedure – I have often remarked that a patient is “just having a hernia repair”. But as the CNN article points out, calling a surgery “routine” or “elective” doesn’t mean it is simple or risk-free. Every procedure we do has risks, whether planned in advance (elective) or emergency surgery. Even the most mundane procedures carry risks.
A good friend of mine who also happens to be a resident physician posted the following on Facebook, and I couldn’t agree more. As a nation and as a medical profession, we’ve collectively done a terrible job at discussing end of life decisions and goals of care. Melissa Rivers should be commended for following her mother’s wishes.
Since every recent national tragedy results in us needing to have a national conversation (on guns, mental health, race), can we please take Joan Rivers’ death and have a national conversation on goals of care?
Many of us residents have dealt with hundreds of situations like Joan, and from what the news says (I was not involved in any way in Joan’s care), Joan lost her pulse, and CPR/ACLS kept her alive, but she never regained her mental status. Her goals were pretty clear, as she said them on national TV: if she couldn’t be functional (doing stand-up comedy, using her brain), she didn’t want to be kept alive. And it seems her daughter Melissa respected what Joan wanted, didn’t fight to keep her alive – trach’d and peg’d and living in a nursing home for months or longer in a chronically critically ill state with decubitus ulcers and line infections just because she couldn’t let go. They decided to no longer keep Joan’s body alive with life support, as it’s what Joan had said she wanted.
So please, talk to your parents and grandparents about what they want in case of tragedy. Have clear goals. Respect what your family would have wanted. Make a reasonable decision. *gets off soapbox*
It’s a little awkward when your first encounter with someone is pushing their butt back in.
Let’s say you live in New Jersey and find a better insurance plan across the river in New York. Sorry. You’re out of luck. But don’t worry, you’re told. Your state insurance regulators are doing their job, upholding standards and protecting your interests. Naturally, they can’t protect you in another state. So you pay more.
This makes little sense. You regularly cross the Hudson River for dinner on the town – and entrust your health to New York restaurant regulators. You drive through a tunnel and count on highway safety as regulated by New York’s Department of Motor Vehicles. But out-of-staters cannot buy insurance there. Ask yourself this: Who are those law protecting?
Jonathan Bush doesn’t directly say it, but clearly these laws are protecting insurance companies…
I’m currently reading Jonathan Bush’s new book Where Does It Hurt? and it definitely got me thinking about a lot of issues in health care. More on that to come for sure, but in the meantime a little story.
A few weeks ago, a good friend of mine had an allergic reaction to something he ate. He broke out in hives, and his face became swollen. Out of concern for his health, he visited the Emergency Department at a local community hospital. His story continues from here and highlights the failings of our health care system and questions why our system can’t and won’t perform better.
My friend spent four hours in the Emergency Department before he finally gave up and left. In the intervening four hours, he had to recount his full health history, his religious affiliation and his emergency contact information multiple times. (Anyone reading this is probably not surprised – having to recount your story multiple times is pretty much a standard when visiting a hospital.) An EKG was performed, he never actually saw a physician and the nurse assigned to take care of him was minimally present. He left without a prescription for prednisone.
After leaving the Emergency Department, he texted me in desperation asking for a prescription for prednisone. As a general rule, I don’t like writing random prescriptions for people who’s medical history I don’t actually know. My friend was desperate though because it was Sunday. His physician’s office was closed, the on call physician refused to help (a problem all in its own), and the local community health center was also closed. I finally convinced him to come to the Emergency Department at my hospital after promising to call down to the ED so his wait would be shorter and checking to see how busy things in the ED were. I’m thankful he had a good experience – though I imagine part of that was because I told colleagues in the ED that he would be showing up – but why should it be so hard? Why couldn’t the system take care of a non-life threatening medical problem on a weekend without requiring a trip to the Emergency Department?
Every aspect of my friend’s story illustrates yet another failing of the health care system. There are so many things wrong that it’s almost hard to know where to start. For example, the community hospital didn’t have access to my friend’s health records – something that likely would have decreased the number of questions he was asked in the Emergency Department. But the hospital and his primary care doctor do not share an electronic medical record, barring the hospital access to the most important information in his health history. The simple solution is a nationwide electronic medical record, so that any physician anywhere could access your health information when needed. More to come on that too.
The greater failing is that my friend couldn’t access health care outside of an Emergency Department on a weekend. But how many of us have had a non-life threatening medical event occur “after hours” and had to go to the Emergency Department to get care? You’re more likely to find a plumber or electrician available in the wee hours of the night than a physician. Health problems occur 24/7, so why has our system, and the American people, become comfortable with a medical profession that doesn’t provide 24 hour outpatient comprehensive care? When did we let the Emergency Department become the default?
In days long since gone, physicians saw their patients in their homes. Time, cost, and reimbursement concerns moved the physician visit out of the home and into a centralized office, and in the process physician hours changed. There has been some movement to change that; for medical practices to be certified as a Patient Centered Medical Home, “extended hour” appointments with “medical professionals” out of the normal work day are required – a regulation brought about by the Affordable Care Act. But that’s hardly enough incentive (and truthfully, being fully patient centered would mean going back into the home). Jonathan Bush comments in his book on the need for business outsiders to enter into the health care industry in order to change the status quo, create competition, and hopefully lower prices. These outsiders will begin by focusing on the medical system’s inefficiencies and finding ways to profit. Enter the pharmacy based clinic.
Pharmacy based clinics only came about because some smart entrepreneur or thinker at CVS and Walgreens saw an opportunity to profit off of the medical system’s inadequacies. They realized that people get sick all hours of the day, not just from 8am to 5pm, and that you can’t plan on getting sick and making an appointment. They realized that people would love having a convenient located option to get a flu shot or check for strep throat that didn’t require a doctor’s appointment, wait time, and price tag. People with chronic illnesses could easily stop at a “Minute Clinic” to have their blood pressure checked or their diabetes meds altered. After all – the pharmacy is five feet away. And CVS and Walgreens had the resources to overcome the health care system’s intense regulatory environment. Physicians initially derided these clinics as money-making opportunities headed by nurse practitioners and physician assistants with less training than physicians (with the undertone being worse quality), but we should take note. These clinics were born out of our failure as a profession to offer convenient, comprehensive service to the public.
If you argue that health care needs to change in slow incremental changes, then it’s only a matter of time before some other corporation keys into another growth opportunity in health care – and one that could have much wider reverberations and affect far more than just the physician’s office. If there’s any good news, it’s that the outsiders are slowly revolutionizing medicine, chipping away at the Berlin Wall that the status quo has for so long help up in their way. One day they will succeed in turning the industry upside down, and health care as we know it will be forever changed.
Earlier this month, well known surgeon Dr. Marty Makary wrote an opinion piece for the Wall Street Journal titled “A Minimally Invasive Approach to Health-Care Reform.” In the article, Dr. Makary touts the benefits of minimally invasive surgery as a cost-effective way of reducing health care costs in the United States. Complications following surgery cost roughly $25 billion annually, and Makary posits that minimally invasive surgery, with it’s lower overall complication rates, could save billions of dollars each year. He further notes that by avoiding larger incisions, patients spend less time in the hospital, have less pain, fewer infections, lower medication use during recovery, overall faster recovery, and lower risk of needing subsequent surgery.
However, Makary bemoans the fact that minimally invasive surgery is not the standard of care in hospitals across the United States. In fact, many patients are never even offered a minimally invasive approach. Furthermore, in a study conducted by Makary and colleagues at Johns Hopkins, they found little if any correlation between the use of minimally invasive procedures and the location, size or affiliation of a hospital. He correctly notes that the disparity likely comes from difference in culture between hospitals as well as the training of the surgeon, as some surgical training programs have heavier focuses on minimally invasive techniques. Makary continues to say that “standardizing minimally invasive and open technical training should be a priority for residency programs, rather than emphasizing on approach over the other.” He goes on to say that a hospital’s surgical outcomes should be transparent and available to prospective patients, and he even claims that a hospital’s rate of using minimally invasive surgery for specific operations should be considered a new quality measure. After all,
If there were a new medication that greatly reduced surgical infection rates, lowered pain medication use, and quickened recoveried, policy makers and health-care professionals nationwide would be asking one simple question: Why aren’t people getting it?
I agree with Dr Makary on many points in his article, but as he well knows, that question and the answers to it aren’t so simple. Dr Makary is correct with his contention that surgical training should be more standardized. Furthermore, publishing surgical outcomes and making those outcomes transparent to patients has been heavily argued for in the not so distant past – an idea that hospitals and physicians vehemently oppose and one that the Affordable Care Act is slowly trying to address through Medicare. And yes, minimally invasive techniques have an overall lower complication rate than open procedures, when performed by skilled surgeons.
But Dr Makary misses the mark on many levels, most importantly with regard to cost. First, minimally invasive techniques are more costly than open techniques; there is the added cost of specialized equipment, and in general, minimally invasive techniques take longer to perform, leading to higher operating room costs. Much of that added cost is recovered by the hospital with shorter lengths of stay and recovery times for patients undergoing minimally invasive techniques as compared to open procedures. But what Dr Makary fails to mention is that if we converted every open procedure currently being performed to a minimally invasive one (where feasible), we would certainly save money from less complications – but only if the number of procedures performed remained unchanged. Let me explain.
Minimally invasive techniques revolutionized medicine quite some time ago, with laparoscopic cholecystectomy (minimally invasive gallbladder surgery) being the best example. Prior to the introduction of laparoscopy, patients were forced to undergo painful open surgery which often necessitated hospitals days of 3-5 days or more, and the recovery time after leaving the hospitals was even longer. Open cholecystectomy was therefore reserved for patients with true emergencies; patients suffering from gallstones or biliary colic (occasional pain from the gallbladder) were told to change their dietary habits and take analgesics in order to avoid a painful operation and prolonged recovery period. Laparoscopic changed all of that by reducing risk, shortening hospitalizations, reducing pain, and decreasing recovery times. Proponents posited that despite the higher cost of performing laparoscopic cholecystectomy, the operation would greatly save money for hospitals and the health care system as patients no longer required hospitalization post procedure. They were right – but the number of gallbladder operations skyrocketed, as patients no longer wanted to deal with their gallstones and biliary colic. The result was that even though costs to hospitals decreased, overall health care costs increased due to the higher number of procedures performed. Minimally invasive approaches to nearly every other operation have likewise increased overall health care costs due to the higher number of procedures performed.
Finally, Dr Makary fails to mention that even though there may be a minimally invasive technique for a given procedure, not all operations are amenable to minimally invasive approaches. Partial colectomy (removal of a part of the colon) can be performed laparoscopically, but the minimally invasive technique is not always appropriate. And with regard to his prime example of appendectomy, the surgical literature still does not support that laparoscopic appendectomy is superior to the open technique.
There are many reasons to perform minimally invasive procedures, however, cost is not one of them. If Dr Makary’s intent is to improve the quality of care, then he’s right on the mark.
Rounding with the attendings is like a game of chess. The medical students are the sacrificial pawns that you send into battle first. The intern is like the knight and the mid-level resident is the bishop. But the main goal of everyone is to protect your queen…
… wait, I mean king!
When birthday cake is your last meal before coming to the hospital at age 84, that’s usually a sign from God.
Wait… so there are no gay rights in Louisiana?
vaccinate your kids. that’s all. Proof instead of misfearing
Originally posted on Violent metaphors:
In light of recent outbreaks of measles and other vaccine preventable illnesses, and the refusal of anti-vaccination advocates to acknowledge the problem, I thought it was past time for this post.
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It has been said that we fear that which we do not know and do not understand. But all too often, we engage in behavior known as “misfearing” – the term used to describe the human tendency to fear instinctively rather than factually. Misfearing is pervasive in our culture, and its consequences on our collective health are staggering.
In February, Dr Lisa Rosenbloom touched on the subject of misfearing with regards to women’s health in a perspective piece in the New England Journal of Medicine. A cardiologist by trade, Rosenbloom took an informal poll of her patients, asking them which health condition they thought was the number one killer of women. Many of her female patients accurately reported heart disease to be the leading cause of death for women. A fair number incorrectly said breast cancer. One of her patients, a woman with high blood pressure and high cholesterol, said “I know the right answer is heart disease, but I’m still going to say breast cancer.”
The truth is that heart disease takes the lives of more women each year than all types of cancer combined, that it is in many ways preventable, and that despite what many women believe, multivitamins and antioxidants do not reduce the risk. However, all the facts in the world cannot sway the opinion of a person who misfears, who determines their sense of risk based on not fact but feeling. Certainly, there is some amount of ignorance involved, some amount of misunderstanding from patients or a general lack of knowledge. I’m not implying that patients are not intelligent human beings, but rather physicians historically have done a particularly poor job of educating their patients. But with more and more information available to patients at their very fingertips in the nanosecond or two it takes to use Google on a smartphone, where has our collective misfearing come from?
For breast cancer, the availability of that information may be the very problem. As a society, we are constantly bombarded by health messages, and women in particular are assaulted by advertisements from groups like the Susan G. Komen Foundation, which seems to have trademarked the color pink. Women are constantly hearing about breast cancer and the importance of screening mammograms. Many physicians view a woman at age forty as beginning her “right of passage” by obtaining the first screening mammogram. There is no doubt that the message out there solidly directed at American women is to fear breast cancer, a message so pervasive that when the US Preventative Services Task Force recommended decreasing the frequency of mammography, there was a public outcry among doctors, women’s health experts, and women themselves. Rosenbloom goes on to discuss how pervasive the fear of breast cancer is in our culture, asking
Have pink ribbons and Races for the Cure so permeated our culture that the resulting female solidarity lends mammography a sacred status?
Rosenbloom goes on to create a greater argument surrounding misfearing, culture, and personal identity with breast cancer as her prime example, but misfearing is far more prevalent than only women’s health issues. Decades of research on risk perception have revealed the factors that feed our misfears, including those that are big, dramatic, memorable, or constantly on our minds. Misfearing is the reason that many of us horde guns to protect ourselves from random, senseless acts of violence that the media portrays as widespread, while we simultaneously fail to protect ourselves by buckling our seat belts. Similarly, misfearing is to blame for those who refuse to fly for fear that the plane may crash but do not realize they are far more likely to die in a car accident on the way to the local grocery store. We fear terrorists attacks and yet 15 percent of our population smokes regularly, misfearing our risks of heart disease, cancer, and stroke.
Perhaps the best example of misfearing comes from the controversy over autism and the belief that vaccines are to blame. The rising anti-vaccination movement has concluded that the dramatic increase in autism diagnoses is directly linked to childhood vaccines, citing evidence that is dubious at best and has been discredited by every respectable scientific and medical society. The same anti-vaxxer movement has been blamed for a rise in outbreaks of disease like measles and mumps, diseases that were considered eradicated in the recent past. How did this come to be? Simply put, diseases like measles and mumps have left our nation’s collective consciousness due to the incredible effectiveness of vaccines. Unlike our parents’ and grandparents’ generation, who grew up in a time when childhood disease like measles, mumps, and polio had devastating, if not deadly consequences, a new generation of parents has been immune to the highly contagious infectious diseases of our not so distant past and have instead come to fear autism’s devastating diagnosis. Despite the evidence that vaccines do not cause autism yet protect children from deadly diseases, parents continue to make the utterly baffling choice to refuse vaccines anyway. The culprit here? Misfearing – and it’s leading to a deadly public health threat.
Rosenbloom laments that there isn’t much we can do about misfearing. We can educate individuals to change the perception of their individual risk. We can craft laws and regulations based on fact rather than feeling. But while all the education and regulation in the world can sometimes nudge us toward behaviors that promote our health, they unfortunately cannot tell us what to believe. Before we can reduce our own risk, we have to believe it exists in the first place.
Ultimately, the health care we all get depends heavily on the caregivers we’ve got.