The pre-Columbian peoples in the Americas had a number of diseases that
were not found in the Old World--yaws, Chagas', Posada's, valley fever.
Yes, they quickly succumbed to measles and small pox, to which they had
no immunity. But earlier the Europeans had died en masse from plague, the
black death, new at the time to them. Now we have seen danger from SARS,
contained through contemporary knowledge. It could have been a pandemic
had the virus passed from animals to humans earlier, although slowed by
the means of travel available. Now, despite medical advances, we face the
possibility of a flu pandemic from a mutated virus. Novel pathogens can
be a problem wherever they occur. On the other hand, wherever endemic
diseases occur, populations manage to cope. The classic example is
resistance to malaria by thalassemia or sickle cell. But living
conditions among the desert tribes of northern Mexico and southwestern US
seem to have produced a tendency to diabetes. What is beneficial under
some conditions can be devastating under others.
On Tue, 15 Nov 2005 22:20:41 -0600 Mervin Bitikofer <email@example.com>
Isn't there some pretty good research now showing that Native Americans
were a pretty healthy bunch over here until the filthy and disease ridden
Europeans came over with their army of microorganisms that ended up doing
their dirty work for them? The Europeans probably had merciless immune
systems necessitated by survival in cities of open sewage compared with a
relative healthy and lazy set of immune systems in their native isolation
on this side of the puddle. Don't get me wrong -- I still wash my hands
like mother taught me, and I'm glad doctors do the same now. But I still
have to wonder how much of a long term favor we really are doing our
civilization when we aspire to make everything as sterile and disease
free as possible. And yet -- what else could we possibly want?
jack syme wrote:
I was serious about my question about what were appropriate topics for
this forum. I did not imply that what Glenn posted was not appropriate,
I was asking what is or is not.
Michael Roberts suggested medical ethics. I chair our hospital ethics
committee so I am always looking into some ethical issue or another. But
I had never thought to bring up the issues here, I never really thought
they were appropriate. I could bring these issues up from time to time
now that I think about it.
So, to give this a whirl, this is what we discussed at our last hospital
ethics committee meeting. Admittedly, there are other medical ethical
issues that would be more appropriate for this forum, this is just the
most recent issue we were dealing with.
Many pediatricians say they would not continue care for families who
More than one-third of pediatricians say they would dismiss a family from
their practice for refusing all vaccinations, according to a study in the
October issue of the Archives of Pediatrics & Adolescent Medicine, one of
the JAMA/Archives journals.
The rate of unvaccinated children has risen significantly since 1995,
according to background information in the article. While most parents
continue to believe that vaccination is important, a large number express
concern about vaccine safety. Although most parents depend on their
pediatrician's advice and counsel in their decision to vaccinate their
children, when a parent refuses one or all vaccines the relationship
between parent and pediatrician may be weakened. Some pediatricians may
choose to end their participation in the care of children whose parents
refuse vaccinations, the authors suggest.
Erin A. Flanagan-Klygis, M.D., of Rush Medical College, Chicago, and
colleagues surveyed pediatricians who provide routine vaccinations in a
primary care setting. The survey included questions on the pediatrician's
experience and type of practice; a question asking the pediatrician to
rate the importance of the seven most common vaccines; and a set of
questions about parental vaccine refusal and the pediatrician's response,
including reasons for dismissing a family from the pediatrician's
Of the 302 pediatricians completing the survey, 85 percent (256) reported
encountering a family refusal of at least one vaccine during the previous
12 months, the researchers report. Fifty-four percent (162) of
pediatricians reported encountering a parent who refused all vaccines.
Pediatricians reported that parental reasons for both partial and full
refusal of vaccines were similar. The most common reasons were safety
concerns, concern at giving multiple vaccines at once, philosophical
reasons and religious beliefs.
"In the case of parents refusing specific vaccines, 82 (28 percent) said
that they would ask the family to seek care elsewhere; for refusal of all
vaccines, 116 (39 percent) of pediatricians said they would refer the
family," the authors write. The most important factors for pediatricians
in the decision to dismiss families who refuse vaccines were lack of
shared goals and lack of trust. There were no significant differences
between pediatricians who would dismiss families for vaccine refusal and
those who would not with respect to age, sex, number of years in practice
or number of patients seen per week.
"Does the practice of family dismissal, in fact, promote or undermine
immunization for particular children or children as a group?" the authors
write. "Might family dismissal generally damage relationships between
pediatricians and families such that parents become less likely to seek
or successfully obtain other needed primary preventive services or care
for acute or chronic illness? Given the changing climate of confidence in
childhood vaccination, future research should address these and other
potential implications of practice dismissal in the face of parental
vaccine refusal. The answers obtained may provide insight into the
influence physician behavior has on the health and welfare of children
and communities for many years to come."
Received on Wed Nov 16 13:25:52 2005
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