Archive for September, 2009

A few weeks ago, I apologized for the appalling lack of blogging and promised all 2.4 readers I would have a few juicy posts coming up in the next few weeks…

I lied.

Well, not so much lied as failed to act on my promise, and will probably continue to do so, at least until late November.
For you see, I’m now in my 1st week of my 5th term of 5th year – meaning I have around 9 weeks to re-learn and remember every tidbit of information I have come across this year – from the core material in the lectures, to the spot quizzes from overly zealous vascular surgeons pressing me for information about the most recent double-blinded, randomized control trial published in the Australian Journal of Unnecessary Pedantics studying the pharmacological treatment of Inflated Head Syndrome [Surgical registrar Type I].

[Incidentally, the study found no statistical difference in outcome between pharmacological treatment and a brick to the head, P < 0.01]

Anyways, with the impossible amount of study I am yet to do, I have found myself losing patience with everyone around me. It seems, there aren’t enough hours in the day and I have been getting increasingly annoyed with people who insist on wasting my precious time. So, when my (lovely, helpful) registrar suggested my colleague and I do *extra* psychiatric on-call evenings, all kinds of hideous profanities started going off in my head (and some in the ensuring conversation I had with my colleague). 5th year, it seems, has transformed me from an incurable optimist into a raving nihilist, so much so that my conversations with my husband have flipped from:
Keags: We should do X, Y and Z.
Phoeb: frolicking into the sunset Sounds like fun, I’m so excited! Yay!

Keags: We should do X, Y and Z.
Phoeb: Deadpan You haven’t considered the variables, A, B and C. Logistically, that’s never going to work. Seriously, we may even end up dead. We probably will. Do you want us to die?

Well, there’s always my chocolate and coffee shoppee… which, is as doomed as my medical career thanks to the GFC, as my fellow medico Joel so kindly pointed out.

But, I’ll end on a good note. Thankfully there is one thing (or rather, person) I trust will get me through the next 9 weeks. You might have heard of him. He’s your friendly, neighbourhood Lord and saviour, Jesus Christ, who works for the good of those who love him, who have been called according to his purpose (Rom 8:28).

Psalm 19
For the director of music. A psalm of David.
1 The heavens declare the glory of God;
the skies proclaim the work of his hands.

2 Day after day they pour forth speech;
night after night they display knowledge.

3 There is no speech or language
where their voice is not heard. [a]

4 Their voice [b] goes out into all the earth,
their words to the ends of the world.
In the heavens he has pitched a tent for the sun,

5 which is like a bridegroom coming forth from his pavilion,
like a champion rejoicing to run his course.

6 It rises at one end of the heavens
and makes its circuit to the other;
nothing is hidden from its heat.

7 The law of the LORD is perfect,
reviving the soul.
The statutes of the LORD are trustworthy,
making wise the simple.

8 The precepts of the LORD are right,
giving joy to the heart.
The commands of the LORD are radiant,
giving light to the eyes.

9 The fear of the LORD is pure,
enduring forever.
The ordinances of the LORD are sure
and altogether righteous.

10 They are more precious than gold,
than much pure gold;
they are sweeter than honey,
than honey from the comb.

11 By them is your servant warned;
in keeping them there is great reward.

12 Who can discern his errors?
Forgive my hidden faults.

13 Keep your servant also from willful sins;
may they not rule over me.
Then will I be blameless,
innocent of great transgression.

14 May the words of my mouth and the meditation of my heart
be pleasing in your sight,
O LORD, my Rock and my Redeemer.


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The *not so* Great Debate

There really has been a terrible paucity of blogging around here lately. For that I apologise. 5th year medicine really isn’t conducive to blogging…or socializing… or sleeping…

Anyways, I’ve got some juicy posts lined up for the next few weeks. I’ve already started one about my ongoing debate with my vegetarian colleague about the antics of PETA, or as I’ve dubbed them, People for the Endless Taunting of Agriculturalists.

But something else really got up my proverbial goat this weekend. I turned on the Today Show and came across a segment entitled the ‘Immunisation debate.’

I’m sorry, what? There’s no debate.

Debate implies a robust argument between equally informed groups with valid pros and cons on each side. There isn’t. It’s a case of the entirety of peer-reviewed medical research in every respected scientific journal versus a few voodoo conspiracy theorists in a shed somewhere.

But don’t take my word for it.

The whole immunization fuss relates to an article published in the lancet in 1998, an ecological study that suggested a causal link between the MMR vaccine and autistic spectrum disorders (ASD)1. This article presented 12 cases of developmental delay associated with gastrointestinal symptoms and developmental regression, many of which were reported soon after the MMR vaccine was given. The article has since been widely criticized due to its poor study design and methodological flaws – not to mention allegations of fraudulent results and the authors’ previously undisclosed links to autism litigators – which has lead to allegations of professional misconduct, for which 3 of the authors, Wakefield, Walker-Smith and Murch are currently under investigation.

There is overwhelming evidence from subsequent studies that do not support the theory of a link between MMR and developmental disorders2,3. The supposed ‘link’ between ASD and MMR arises from nothing more than the fact the MMR vaccine is given at 12 months of age, which is around the time when children are demonstrating more social behaviours – thus it is around this time that deficits in social functioning (such as in ASD) are becoming more apparent.

The real tragedy for Australian children, is when their uninformed parents decide to forgo immunizing their children. The results of such a turnaround have been disastrous. Pertussis (Whooping Cough) vaccinations are on the decline in Australia, and consequently incidence rates have been increasing resulting in 3 deaths in young children this year4. And, there were similar deaths in the UK as a result of the autism-MMR fiasco in the late 1990s. In an immensely affluent country with a free childhood vaccination program, a highly educated populace and easy access to medical services, this is quite simply, a highly preventable tragedy. The naivety of this generation of Australian parents to the effects of vaccine preventable diseases, it seems, has been both a blessing and a curse. Sadly, it may be that until parents see their 6 month old on CPAP in ICU for pertussis-induced respiratory failure, or a moribund child unable to speak, breathe or swallow due to H. Influenzae epiglottitis they won’t understand the tragic consequences of having an unvaccinated child. It’s irresponsible, it’s costly, it’s heartbreaking and utterly preventable. No child in Australia should have to pay for such foolishness.

1. Wakefield AJ, Murch S. et. al. Ileal lymphoid nodular hyperplasia, nonspecific colitis and regressive developmental disorder in children. Lancet 351, 637-641 (1998)

2. Wilson K, Mills E, Association of autistic spectrum disorder and the measles, mumps, and rubella Vaccine: A systematic review of current epidemiological evidence. Arch Pediatr Adolesc Med. 2003;157:628-634.

3. Briese T, Buie T, et al. Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study. 2008. PLoS ONE 3(9): e3140.

4. Ask me about the time Mad got Pertussis due to the short sighted decision of a misinformed physician, and I’ll show you the effects of a vaccine-preventable disease.

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