The modern miracle

October 1, 2010

Here's the story of one full-time pediatrician with 20 years' experience. Over the years, she's witnessed many changes in the practice of medicine, including the virtual elimination of some diseases.

I am a full-time pediatrician with 20 years' experience. I went to one of the best medical schools in the country, Baylor College of Medicine in Houston, and then on to an extraordinary institution, Children's Hospital National Medical Center (CHNMC), to do my residency in pediatrics. I graduated in 1990 and since then have been working as a full-time pediatrician in the suburbs of Washington, DC.

Over my career, I have seen many changes in the practice of medicine, including the virtual elimination of diseases such as Haemophilus influenzae type B (Hib) disease and Streptococcus pneumoniae through the introduction of vaccines against them.

I would like to tell you what goes through my mind as I fold my hands and look across my desk at the parents.

I remember my days as a resident at CHNMC, when we had wards of children with H influenzae disease. We always had between 1 and 5 children at any time with sepsis, pneumonia, or meningitis because of H influenzae. I remember the worried looks of their parents. The children were admitted through the emergency department (ED), and we did a rapid septic workup.

I knew we had the antibiotics that could treat them. But I also knew that about 8% of them would be left with permanent hearing loss and that about 8% of them would not make it. I sat up at night with their parents worrying about them and praying for them.

I remember a mother I saw in the ED with her child with S pneumoniae septic shock. He was a 6-year-old boy who she said was fine in the morning. By noon, he had a fever and was not feeling well. The school called her to pick him up. He went to his pediatrician and was sent to the ED for a septic workup because he was becoming increasingly lethargic.

By the time I saw him at 6 PM, he was in our code room in full septic shock. The intensive care unit (ICU) team was intubating him. His mother kept saying throughout the ordeal, "But he was just fine this morning! What happened to him? What should I have done? What could I have done?"

The answer was, nothing. There was no vaccine yet to prevent it. There was nothing she could have done. He was transported to the ICU and remained there with full ICU support for the next 3 days. Finally, he recovered and had no long-term medical problems. He was one of the lucky ones.

Then there was the mother I saw in my first year in private practice. She brought in her 18-month-old little girl who had cerebral palsy and was mentally handicapped. She was fed through a gastrostomy tube. I spoke with the mom and read through the child's chart. She had been a normal, healthy, thriving infant until she was 12 months of age. She then became infected with S pneumoniae. The bacterium turned this normal, healthy child into a child with complex medical problems and a dim future. A few months later, she died of aspiration pneumonia.

Can you imagine what this mother would have done to prevent this for her child? The answer is, Anything. Anything at all.

I spoke with my mother-in-law about my confusion with the rising resistance by some people toward immunization and the emergence of anti-immunization groups.

She reminded me of polio in the 1950s. The community was virtually paralyzed with the fear of contracting the disease. Almost everyone knew of a family in his or her community or school who had contracted polio.

She blessed the day that mass immunization for polio started. Everyone lined up and waited for hours to be among the first to be immunized. This resulted in the virtual elimination of polio and the fear that accompanied it.

Twenty years have passed since my residency days and that first child I had in my practice with cerebral palsy because of S pneumoniae. The Hib vaccine given at 2 years was dropped to a vaccine given at 2 months in 1990. This virtually eliminated Hib disease.

Then in 1999, the S pneumoniae vaccine became available for the 2-month-old. My daughter was 9 months old at the time. I had her vaccinated as soon as it arrived in my office.

I too will do anything to prevent these diseases from affecting my children. I have spent my professional career on a campaign to vaccinate children. With every dose I give, I see the faces of those parents fighting for the lives of their children appear before my eyes.

I could not prevent the disease for those children, but I can prevent it for my patients now.

After these memories have cleared, I turn my attention back to the parents sitting before me to address their concerns about vaccines.

I have a plethora of brochures from the American Academy of Pediatrics and the Centers for Disease Control and Prevention addressing some of the more common concerns of parents regarding vaccines.

I have news articles discussing recent court cases dismissing the charges that vaccines or thimerasol cause autism.

I also present the parents with the retraction of the Lancet article written by Dr Wakefield in 1998 touting a relationship between the MMR vaccine and autism. His research was found to be fraudulent, and he suffered the subsequent retraction of his medical license.

I hand this information to the parents and refer them to additional Web sites for further information and discussion.

I see from the looks on many of their faces, however, that I have not succeeded in dispelling their fears. I know why. They have not seen what I have seen. They have not known a mother who lost a child or has a child disabled because of disease.

I fear that if vaccination rates fall further, creating gaps of unimmunized populations again, these parents will come to know what I have known. I ask then, what sense does that make? And who in the end is it that suffers?

I can answer that. It will be the children.