Battle for the Planet of the Monkey Pox
September 16, 2011
A couple of weeks ago now, my family went to see an enjoyable, and thought provoking movie, the Rise of The Planet of the Apes. In case you're not familiar with the story, or the original franchise from the 1970s which inspired it, it is the cautionary tale of a laboratory chimpanzee who accidentally develops human-level intelligence when genetically modified in an attempt to find a cure for Alzheimer's disease. In Hollywood fashion, the sympathetic lab apes unite, and escape from their greedy human captors.Last week in the in the Milwaukee Journal Sentinel, I read with interest how the Milwaukee County Zoo has made available to some of its Great Apes, the iPad. Of course they are not allowed to handle the tablets (I wouldn't even let a human child to do that), but they are allowed to reach through the bars and manipulate it with their fingers. It was not long before people began comparing these experiments with those which produced intelligent apes in the movie. Most of these comparisons were done humorously, but a more serious American fear is revealed in Rise of the Planet of the Apes. Namely, it reveals our fear of unencumbered science-- more specifically the proliferation of vaccination.
In the movie, things go wrong when well-meaning scientists manipulate a virus to genetically alter the apes. In essence, they attempt to create a vaccine to cure human dementia. Last week Texas Governor Rick Perry was lambasted by Michele Bachmann for his executive order to require girls to receive the HPV vaccination, to protect against a major cause of cervical cancer and genital warts. Later she went even further to suggest that the vaccination could could cause mental retardation. This week we were warned by the City of Milwaukee Health Commissioner, Beven Baker, that at least 2 confirmed cases of measles, a disease preventable by vaccination, have appeared in Milwaukee.
Governor Perry's defense was that parents have a means to refuse the required vaccination, and indeed, I do have some patients who philosophically refuse vaccinations in general, and a greater number who specifically decline that HPV vaccination. And why? Much of it is based on anecdotal, and inaccurate information, such as Ms. Bachmann's claim that the vaccine could cause mental retardation. Some of it frankly is a libertarian rejection of being told to do anything by the government. And some of it is the result of a genuine mistrust of the science, especially when the science is tainted by Big Pharma trying to maximize profits. The latter concern has some legitimacy. It personally irritates me every year when private vaccine manufacturers fail to produce enough flu vaccine, or fail to distribute it effectively, because of their emphasis on profitability; when the local Walgreen has plenty of vaccination, and the doctor's office has none. Likewise, it concerns me when I see pharma expanding the market for the HPV vaccine to include boys, when the long term data supporting this is lacking, and the medical justification is questionable. But Ms. Bachmann's accusations against Governor Perry go a step further-- she makes the accusation that it was political contributions to Rick Perry's campaign that influenced his decision.
Let it be known, vaccination has been a boon to improved public health. Few of us can remember the ravages of the polio epidemic, or have even ever seen a case of Small Pox. Yes, we can credit that to the result of years of compulsory vaccination policies. But Small Pox is a far cry from genital warts. Inconvenient as it is, we must make sure that our health policies are based in reasonable science, not just high tech solutions in search of a justification. In fairness, no one is requiring boys to get HPV vaccinations, but there is an industry motivated push for providers to push parents to vaccinate their sons, as well as their daughters. However, as we push vaccinations for diseases of lifestyle, such as genital warts, we dilute the importance of the truly life saving ones.
That being said, I'm not sure if I want to castigate Ms. Buchmann, or applaud her... Or both.
Kevin Izard, MD
It's Enough to Drive You Crazy
August 18, 2011The Milwaukee Journal Sentinel did a series a while back highlighting the difficulties with the mental health care system. Another story has appeared this week discussing the slow progress in mental health reform. People might be surprised at how much psychiatry is actually part of the day to day functionings of a primary care practice. Patients often see their primary care provider for physical manifestations of what are actually psycho-social-spiritual problems.
Yesterday I had a conversation with a patient who saw me last month because she couldn't stop crying. She works for a non profit organization, and so her job does not offer health insurance. This means that she had to pay out of pocket for the office visit and any medication that I wanted to subsequently prescribe her. She was not suicidal at the time, but she did have a history of major depression and suicide attempts in the past, and so I started her on antidepressant medication samples that I had in the office, took her off from work for 2 weeks, and referred her to the Psychiatric Crisis Center, at the Milwaukee County Mental Health Complex. Despite the myriad of problems with the Mental Health Complex, it serves an essential role in the delivery of health care in southeastern Wisconsin. This is probably the ONLY place a person get psychiatric care for free. And given the nature of mental illness, many of its sufferers tend to be disproportionately poor and uninsured.
After the second attempt, it appears that my patient was finally able to see someone. She was not hospitalized (at the disappointment of her family), but she was given some referrals to some therapist that she might see. The reason for the call yesterday? Well, her student loan deferment program will not accept depression as a reason to postpone repayment of her student loans. Because she is not currently working, she cannot pay her bills, thus adding to her already stressed out and depressed state. I could not honestly report any other medical reason that she was not able to work. I will do the best I can to try to find some other means for her to get by. Of course, the irony of the whole thing is that I will likely never be paid for the office visit, or any of the subsequent time that I will spend writing letters, filling out paperwork, etc. Such is the nature of what we do.
Kevin Izard, MD
