Monday, September 28, 2009

The Coincidence Factor

 

# 3777

 

I don’t usually tell `war stories’ in this blog  . . .  but today I’m going to make a brief exception because it illustrates a point that needs to be made.

 

Some years ago (okay, decades) my EMS partner and I were called to the scene of a suspected stroke.   We found an elderly gentleman sitting in an overstuffed chair in his living room, with at least a dozen distraught family members and neighbors standing vigil.

 

He was, according to the family, suddenly struck with one-sided paralysis and an inability to speak (aphasia).

 

I did what I always did when I approached a new patient.   I knelt down beside him, placed my hand on his bare arm (a great way to reassure a patient and to pick up `skin signs’ at the same time) and said, ”I’m a paramedic, and my partner and I are here to help you”.

 

Almost instantaneously, the gentleman’s paralysis and aphasia resolved.  Very quickly he was able to squeeze my hands, stand, and speak normally.

 

It was, by popular acclaim in the room, nothing less than a Miracle!

 

My partner and I tried (unsuccessfully) to explain that no miracle was involved, that the gentleman had suffered a T.I.A.  - a Transient Ischemic Attack – a temporary condition that mimics (and can be a precursor to) a stroke.

 

I’d preformed no miracle.  It was simply a coincidence.   A case of perfect timing on my part.

 

But no one was buying that explanation.

 

 

They’d seen it with their own eyes.  I `laid my hands’ on the gentleman, told him I `was here to help him’, and he was cured.

 

Case closed.

 

As my partner and I tried to convince the gentleman that he still needed to go to the hospital (why bother?  He was cured!), word of my miraculous powers quickly spread through the neighborhood.

 

Suddenly we were barraged by neighbors with medical problems wanting me to `put my hands on them’, to cure everything from deafness to hammertoes.   Pregnant women wanted me to touch their bellies.    For a time, I feared I’d be trampled.

 

We had a tough time extricating ourselves from the scene that night, and for weeks thereafter we got calls from that neighborhood requesting an ambulance, but only if that `nice young man with `the hands would come. 

 

 

If you are wondering what in blue blazes this has to do with an influenza pandemic, consider that millions of people are going to begin to receive pandemic vaccines next month.  

 

Many of those recipients are going to be `high risk’ individuals, with comorbid conditions. A certain number of them are going to have a medical event; a heart attack, a stroke, a miscarriage, a seizure, an asthma attack . . . something, in the days and weeks following their vaccination.  

 

Overwhelmingly, the odds are that the vaccine will play no part in their illness, but many people will link the two anyway.   They won’t see it for the coincidence it is.


Get a vaccine on Monday, and have a  miscarriage on Tuesday?  

 

It had to be the vaccine, right?


In the US, 2500 women miscarry each day.   Nearly 1 million women each year.    And that is without a pandemic vaccination program.    If we could vaccinate all of the pregnant women in the country today, tomorrow 2500 would still miscarry. 

 

And most would blame the vaccine.

 

Of course, there is no such thing as a completely benign drug.  And that includes flu vaccines.  

 

So doctors and scientists will be on the lookout for any signs that the pandemic vaccine is having adverse effects. But as they do, they must keep in mind the following statistics.

image

 

The much feared GBS (Guillain Barre Syndrome) afflicts more than 5,500 people each year.   If half the country takes the vaccine, then we could reasonably expect about 700 cases of GBS to develop in vaccine recipients within 90 days of their vaccination.

 

And that would have nothing to do with the vaccine.

 

The possibility exists, however, that this vaccine could produce adverse side effects.  And so it is important to monitor the number of cases of GBS, and miscarriages, and strokes among vaccine recipients so we could detect any changes in the pattern.

 

In July, I wrote a post called Flu Math where I compared the mortality rate of the much maligned 1976 swine flu vaccine with this H1N1 pandemic virus.  Even assuming a very low CFR (Case Fatality Ratio) for this virus, the odds overwhelmingly favor taking the vaccine.

 

But if you are uncomfortable with the idea of taking the vaccine, and would rather take your chances with the virus, I do understand. 

 

After all, despite knowing the odds, I still buy the occasional lottery ticket (Hope springs eternal).

 

I’m heartened to see that many of the mainstream press outlets are talking about these background rates of disease, and how we can’t automatically assume that adverse medical events are linked to getting the vaccine.  Hopefully those stories will continue to run as the vaccine is rolled out.

 

But I fully expect that some of the more `tabloid’ aspects of the media are going to try to link the vaccine to adverse medical events in order to draw viewers or sell papers.   

 

This is the scenario I wrote about in Public Health’s Biggest Pandemic Challenge, and what I worry about most with this vaccination program; that people will shun the vaccine because of undeserved bad publicity.

 

And should this vaccine should be shown to increase the incidence of  __________ (fill in the blank), that would still have to be put up against the costs of the virus.  

 

And right now, the swine flu virus is hospitalizing thousands of people each month here in the US, and killing hundreds.  Those numbers are only expected to climb.

 

Which makes my personal risk-reward analysis for taking the vaccine decidedly in favor of the jab.