A Tragic Loss that Teaches No Lessons

A Tragic Loss that Teaches No Lessons

Recently we were all shocked an upset to hear that a young 7 year old girl died, apparently from an infection.

This is a tragedy.  A life cut short for a reason that is profoundly unsettling, frightening.

I do not yet have sufficient details to discuss exactly what happened.  The public information available is limited to the fact that a particular germ was identified from tests on the girl.  That germ is a commonly circulating bacteria, Streptococcus pneumoniae, that is known to cause infections, but these days it is extremely rare to hear that this germ could prove fatal in an otherwise healthy 7 year old.  

Given the limited information available, can we offer any advice or learn anything from this tragedy?

Not too much, but here are some items that can be offered:

SOME ITEMS

• The germ Streptococcus pneumoniae is also called the pneumococcus, and is a common cause of very common and minor infections such as skin infections (impetigo), ear infections, as well as more serious infections like blood infections (bacteremia, sepsis), bacterial pneumonia (not the mild and common walking or viral pneumonias), and bacterial meningitis.
• Streptococcus pneumoniae, or the pneumoccocus, is not the germ that causes strep throat.  That germ is related, but far different, and is called Streptococcus pyogenes.  This means that no one with strep throat is contagious for Streptococcus pneumoniae, or the pneumoccocus.
• Thankfully, infections with bacteria, including those like Streptococcus pneumoniae, or the pneumoccocus, are almost always not contagious.  There are some minor exceptions, typically limited to minor infections on the surface of the body that cause no real hazard or harm, like impetigo, bacterial pink eye, and strep throat.  But any bacterial infection inside the body, like an ear infection, bacterial pneumonia, etc., tends not to be contagious.  Think about the rare cases of bacterial meningitis, usually only one person in a family or school comes down with it, a particularly large outbreak may reach only 3 cases.  
• This is wildly different than how viruses behave.  One cold virus can sweep across literally millions of people before it is done spreading.  Bacteria simply do not act this way.  This means the child with the tragic infection likely posed no risk to those she had occassional contact with.
• Streptococcus pneumoniae, or the pneumoccocus, is around.  Most people have the germ on them sometime in their life.  The real story of bacterial infection is that these infecting bacteria come and go across our lives, and only cause infection rarely.  Consider the fact that each of us is coated with bacteria all our lives, even now, but only get infections of our skin very occasionally.   So a bacterial infection is not so much about "catching a disease," as much as a bacteria finding its rare opportunity to get inside the body and grow.  This is another way of saying that serious bacterial infections do not tend whip through groups of people, but rather, reflect something complex about that one bacteria managing to find its way into that one person.
• Streptococcus pneumoniae, or the pneumoccocus, also turns out to one of several bacteria that we can immunize against.  You may recognize the name of the relevant vaccine, derived from the name of this germ- it is the pneumococcal vaccine.  It goes by various names, pneumococcal vaccine, prevnar, PCV.  It comes in dozens of forms.  The first generation of the vaccine protected against 7 forms, and the current one we use protects against 13.  In both instances the 7 and 13 forms are the ones that most commonly cause serious infection.  The use of these vaccines has made serious infection from Streptococcus pneumoniae, or the pneumoccocus, much rarer, but sadly, not extinct.  Use of this vaccine across the United States has also, nicely, sharply reduced the number of ear infections and complications from ear infections as well.
•  Finally, we really do not know the full story of what happened to this very unfortunate 7 year old girl, and in our experience, the details of a situation make all the difference in understanding it.   And so, we hesitate to draw any lessons from this tragedy.  

LESSONS FROM THIS TRAGEDY

• The primary lesson to take is that there is no lesson.  As noted above, this situation likely reflects very individual circumstances.  Circumstances that are, actually, not contagious, and that are very likely very reflective of details pertinent only to that particular instance of connection between that germ and the specific person.  Such very individual circumstances do not generalize, and hence there are few lessons to be learned in this tragedy.
• Some lessons that should not be learned:
• All people get colds, fevers, runny noses, congestion, and coughs.  The fact that this girl had these symptoms does not mean that others with these symptoms are at risk.  If you have a cold, and seem to be comfortable and acting normally, you have a cold, nothing more.
• There is no deadly epidemic about to break out.  These tragedies are always limited to very small numbers of people, usually one.  Never has such an infection whipped across a large population in recent history.
• There is no point to running to get an antibiotic just because this one case took place.  The same approach to deciding how worried to be still is in place- if you are comfortable, in no serious pain, able to achieve normal alertness, have no serious trouble breathing, you are safe.  If you have a stiff neck, cannot breathe, cannot wake up normally, have serious pain, then, of course, you should seek medical advice.

Bottom Line

A terrible loss has struck our community, our hearts are with the family that has suffered an inexplicable and terrible loss.

The events that caused this loss are not fully known, but the germ implicated and the infection that took place pose no or very little threat to any one else in the community.  This was a quite unusual event, very, very likely not to recur.

This means that despite this tragedy, families should manage their illnesses as they always have, specifically:

If you or your child has symptoms of a mild viral illness, namely, fever, cough, runny nose, feeling lousy, not eating well, not sleeping well, you should make yourself comfortable, and know that this tragedy has no implications for you and should have no impact on how you care for your mild viral illness.

And, of course, if symptoms of more serious disease appear, specifically having serious pain, or serious trouble breathing, difficulty achieving alertness, stiff neck, or a fever reaching 106 or higher, then call immediately for medical attention.

Advanced Pediatrics stands by ready to help if you have any questions, and certainly if you need help knowing if an illness is mild or more serious.

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

ProLoquo2Go- A Breakthrough Approach to Augmented Communication

ProLoquo2Go:

A Breakthrough Approach to Augmented Communication

Thanks to a parent in the practice, I would like to bring to your attention a new approach to help children who have trouble speaking, ProLoquo2Go  (http://www.proloquo2go.com/). 

This is an intervention designed for children with special health care needs that include a serious impairment in the ability to talk, but who retain the ability to construct thoughts.  Children in this situation often experience very painful frustration:  they have many thoughts and feelings to share, but physically are blocked from communicating them.  Sign language helps those who have sufficient hand function to do so, but many children in this situation also have limited hand function as well.

For many years, developers have been seeking devices that will allow a person to indicate their ideas by tapping a button or series of buttons.  Once tapped, the button will communicate to the listener what the person would like to say.  For example, one button might communicate the thought, "I am hungry," or another that says, "Yes," or, "No."

Typically devices that allow this approach to communication have been very expensive to obtain, often costing many thousands of dollars.

This is where ProLoquo2Go comes in.  It transforms your iPhone, iPod Touch, or iPad into such an augmentated communication device for $150-250!

Families that have used ProLoquo2Go have stated that it makes a real difference.

So if you have a child with such a special need, or know of someone who does, I do recommend that you take a look at ProLoquo2Go and see if it might help. 

Many thanks to the parent who brought this to my attention,

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Constant Contact: Why it doesn't matter if you are contagious

Constant Contact:  

Why it doesn't matter if you are contagious

With very rare exceptions, it does not matter at all if you or your child is contagious with an illness.

This is because we are all very heavily exposed to the viruses that cause nearly all the illnesses that circulate in a community, namely colds, flus, and stomach flus.

This is not the message we are usually taught by schools and by our parents.  

We have all been raised to think that it is only common courtesy to stay away from friends when ill for fear of "giving them" our cold or flu or stomach flu.  Everyone has complained at some time or another about the child who returns to school or co-worker who returns to the office while sick, and upset that they might gives us or our child their illness.

So how can it makes sense to say it does not matter if you are contagious?

The reason lies in the superabundance of viruses in the air and their extraordinary ability to jump from person to person.

Virus Stats
Let's start with the numbers:

• Every single human being gets viral infections, and loads of them.   
• The average is 8 every year from birth through the elderly years, and every year in between.
• With colds, people fill the air with their virus with every breath for about 3 weeks, that means every person is pumping virus into the air about 24 weeks every year.
• With some stomach flus, the viruses can be spread by a person for a whole year after the illness.
• For mono the virus can be spread easily for a year after the illness.
• Given that just for colds the average person is pumping virus into the year nearly half of every year, it is hard to imagine just how much virus fills the air of a major city.
• Put it all together, and with every breath, we breathe in about 1 billion live viruses, every breath!

How well do Viruses Get Around?

Now, how about how well viruses move around?

Viruses turn out to be little packets of genetic material, either DNA or RNA.  They are wrapped in proteins that hold the key to entry in a cell.  Once in a cell, the viral DNA/RNA activates the cell to make more virus.

That's it, that's what viruses do.

Viruses have been doing this for about 3 billion years.  Humans have only existed for about 100,000 years.  So viruses have been jumping from cell to cell 10,000 times longer than humanity has even existed.

The point is, they are very, very good at getting around and spreading.  

We are all soaking in virus- contagion is essentially irrelevant

So if you or your child has a viral illness, it turns out to not matter at all if they are contagious, because everyone, including their family and friends, is so heavily exposed to viruses with every breath, that they will be heavily exposed to virus whether you or your child are with them or not.

When a well person wonders if someone with a cold or flu might make them ill is very much like a group of people playing in the ocean wondering if a new person, who happens to be wet, can play with them for fear the new person can make them wet.

Exceptions to the Rule

What rare situations demand isolation for contagious persons?

The main such situation is if someone has a weakened immune system and is actually isolated from other people.  For example, someone critically ill in a hospital, or some people undergoing intense chemotherapy, or a recent organ transplant recipient.  Most of people in this situation are avoiding contact with nearly everyone, and are fairly isolated, so a visit from someone who is contagious could make a difference.

Bottom Line

• Viruses surround us, we breath in a billion with every breath
• People are contagious after a viral illness for weeks or months
• So, with the rare exception of a person who is critically ill, it makes little sense to remain fully isolated if you are contagious for a virus.
• Schools and families need to reconsider their traditional approach to limiting the spread of viruses, such policies have a nearly 100% failure rate and so should no longer be used.
• If you have a viral cold or flu, stay home if you feel sick, but do not remain isolated just to avoid the spread, the virus has already spread.

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

When a Hoax has Real Roots

When a Hoax has Real Roots

Dr. Andrew Wakefield is a British doctor who had to flee England to avoid charges relating to his authorship to one of the cruelest, and most effective hoaxes in recent history.

For a number of years, Advanced Pediatrics has been presenting facts that demonstrate that Dr. Wakefield's hoax was indeed not true.  Recently, the Sunday Times of London concluded an investigation, being published in the British Medical Journal, that provides definitive proof that Dr. Wakefield's initial paper was, in their words, "an elaborate fraud."

What was Dr. Wakfield's big lie, who did he fool, and what harm did he cause?

The Lie

Dr. Wakefield's lie was that he had proof that the MMR vaccine caused autism.  How was it a lie?  He published a paper that presented 12 cases of children becoming autistic after getting the MMR.  It turns out that nearly half of these children had abnormal development evident before they ever got the MMR, and the allegation that any of the children developed autism in relation to the shot was, simply put, fabricated.

Dr. Wakefield's paper had 13 authors, 10 have retracted their claims, and several have faced charges in British courts.  When charges were brought, Dr. Wakefield fled to the US.

Who Was Fooled

Millions of people.  Sadly, a handful of celebrities joined the bandwagon and whipped up a frenzy that covered the hoax in a persuasive cloak of credibility.  Leading this phenomenon was the actor Jenny McCarthy, but Ms. McCarthy was hardly alone.  Even today, despite the ignominous exposure of Dr. Wakefield's hoax, millions of Americans still believe his discredited claims.

Who Was Harmed

Infants and young children.  Enough families were taken in by the hoax, deciding not to immunize their children, that a pool of susceptibility grew to allow epidemics of measles.  In California in 2010, at least 5 infants died from measles infections that would have never occurred without Dr. Wakefield's actions.

Lessons Learned

1. The first lesson to be learned is that hoaxes still happen.
2. Just as importantly, the claim that immunizations cause autism turns out to truly be a hoax.
3. One lesson I do not take from Dr. Wakefield's dishonesty is to drop a deep skepticism of pharmaceutical industry marketing.

The Real Roots of the Hoax

Around the same time that Dr. Wakefield was being exposed, an important article in Vanity Fair (January, 2011), documented that roughly 200,000 people actually die from the use of prescription medications, used as prescribed, each year in the United States.  The article details a growing trend towards testing new drugs overseas, outside of the regulatory glare of American rules for testing drug safety and efficacy.  One drug profiled, Avandia, became the world's number one oral drug for diabetes, and caused over 80,000 unnecessary heart attacks before being taken off the market.  These are powerful and deeply disturbing numbers and trends.

The point is that the public has a very keen and accurate sense that something has gone terribly wrong with the way drugs are developed and promoted.  A sense of trust has been broken, and I support that perception.  The US pharmaceutical industry has retained tremendous integrity in their manufacturing, a bottle of penicillin can still be absolutely trusted to contain penicillin.  But when it comes to marketing, the integrity has been shattered.

In an era in which trust in the safety and promised efficacy of medications has been put into question, Dr. Wakefield's allegation that immunizations turn out to cause autism fell on very fertile ground.

Bottom Line

• The distrust of claims of safety and efficacy for drugs is profound and based on real experience.
• Immunizations do not cause autism, Dr. Wakefield's bold assertion that they do has been fully discredited.
• Advanced Pediatrics will continue to work hard to maintain an objective view of the drug industry, with these key policies maintained:
• Drug companies will continue to be barred from offering any items to the office, and also will continue to not be allowed to physically enter the premises.
• Medical literature reviews will continue to be used to determine if a new drug actually works and what its actual side effects are.
• Advice to families will continue to be based on the most objective information Advanced Pediatrics can bring to our discussions.

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.