A paediatrician who needs to be spanked. Do it for the children.

I have often blogged about the fact of my incidental motherhood. Recently one of my skeptic-spawn has come down with what I am convinced is a bout of giardiasis, sans diarrhea. We just spent christmas in my childhood home in the tropics where the little blobby parasites in question are endemic, and it has been going around the local paediatric population. The only problem is, my dear little infected sproglet doesn't have diarrhea, just all the upper abdominal symptoms, and the local general practice population here in more temperate climes seem pig-ignorant of what a protozoan hoe-down actually looks like clinically. I tried to explain to them that giardiasis often present without diarrhea. Then in desperation I even explained that many other children my kid had been playing with have presented with the tell-tale diarrhea (actually, the way it was relayed to me was that a certain child "vomited mayonnaise out of his arse".)

The fact that some people only get upper abdominal symptoms with giardia infection isn't exactly new, I have a prehistoric parisitology textbook from the 1950s that even makes note of it, and that matches my own clinical and personal experience. After doing a rather puzzled internet search, I uncovered an amazing thing: There is something like 30 giardia fact sheets from around the world that have exactly, and I mean verbatim, the same true, but clinically misleading information on them. The CDC and the New South Wales health department among them. Whereas my ancient parisitology textbook was written by a boffin who based his information purely on what he saw himself down a microscope and in the people who he presumably chased for stool samples.

We are becoming a profession of gullible rubes. Its so easy to go and google something that nobody stops to think about what they actually see in front of them. Or what that crotchety old GP spent fifty years seeing in front of him, and then told you about. I'll admit tropical medicine is my schtick, I wouldn't know a chillblain if I found one on my arse, but I found it disturbing that if you got all of the GPs together that I have had to see in the last week, you would probably get one knowledgable doctor in the aggregate.

So I'm sitting here nursing a good head of hate for other peoples' willfull ignorance, when all of a sudden I come across a JAMA article called "Cimate Change Puts Children In Jeopardy" by Rebecca Voelker. Yawn. Whatever. Heard it all before. I must have been feeling masochistic, though, 'cause I kept reading. Mostly it was all the same tired old crap about how children are going to be hurt most by climate because they are the future. Or the future was going to hurt them because of the climate. Something like that. Then I see this:

When pediatrician Aaron Bernstein, MD, sees young patients with Lyme disease at Children’s Hospital Boston, in Massachusetts, his advice to parents often goes beyond the obvious of protecting their children against infectious ticks with insect repellant, long pants, and long sleeves on trips to the woods.

I think I knew where this was going, and I didn't like it. I had to read all the way to the end of the article, past the bit where they recommend saving the children by replacing wholesome incandescent bulbs with toxic mercury bombs, to get the second bit of the Lyme disease story.

Back in Boston, Bernstein makes an effort to give his patients’ parents a quick rundown on how such vectorborne illnesses as Lyme disease that make their children sick are linked with climate change and its influence on ecosystems.

Oh. Sweet. Lord. Of. Crap. Fire this man immediately. IMMEDIATELY!!!!! At the very least make him do some remedial undergraduate pre-med biology classes. Or medical ethics. Or maybe we could explain to HIM, with his kids present, how his children are all doomed and its all his fault.

How does he even vaguely think this is going to help the parents of a child who has FRICKIN' LYME DISEASE?!!! This man obviously cares about his patients above and beyond the call of duty, does he also espouse paediatric bubble-wrapping? Microchipping? (Actually, I have considered microchipping my children, but thats different.)

OK. Breathe, Paua. Breathe. Think of a happy place. You're on a beach somewhere. A polynesian David Thewlis has just shown up with a jug of mojitos...

Its going to be alright...

I'm a hippy and I vaccinate

There are alot of diseases out there that are distinctly un-freakin'-funny. One that is particularly not-cute is whooping cough. Australia has been weathering one of the worst whooping cough epidemics on record. Theres something like 24,000 cases now and counting.

Whooping cough epidemic reignites immunisation debate

It is the feeling amongst the profession (but you'll have to wait on the epidemiologists to back me up in a few months time when they inevitably publish on this) that the massive number of cases has been due to less than optimal vaccination of children.

Of the kids born in 2003, around 80% were fully immunised by the age of 5. Thats pretty crap.

Some of the hardest hit areas such as far north Queensland and northern New South Wales have some of the lowest immunisation rates in the country. There goes herd immunity out the window. (Whereby, if most people are immunised, you don't have a reservoir of disease in the community and so those who aren't or can't be immunised aren't exposed.)

Not every kid should be immunised, there are medically relevant reasons for this, thats why we depend on herd immunity to keep them safe.

I have many friends who didn't immunise their kids, and sorry to say this, but I wouldn't call many of them true conscientious objectors. If challenged they couldn't really give you a good reason why they chose not to vaccinate, beyond the fact that everyone's not vaccinating and it seemed like a good idea at the time. (I have two friends who have good reasons - one has a child who is anaphylactically allergic to everything and the paediatrician scared her by saying if they vaccinated they would have to a have a resusc team on standby, and the other had a son who went into convulsions after having the old (OLD!) whooping cough vaccine. This last friend had two subsequent babies and was too scared to have them vaccinated after the first bad experience. This is a real shame, because the old pertussis (whooping cough) vaccine was a live-attenuated vaccine and adverse reaction were more common with that (but still statistically low), and the vaccine used now has an exceedingly low rate of adverse reactions because its acellular. However, the other 20-odd un-vaccinated kids running around in my kids peer groups do not have such a good excuse. And, yes. They all got whooping cough.

Unfortunately, there are many people out there who will tell you how terrible immunisation is, how dangerous. Trust me, there are much worse things that can happen than your kid crying for 5 minutes.

When I had my first child, a family friend helpfully dropped off a bunch of information on why I shouldn't vaccinate. It was kind of akin to the misinformation being spouted by the Australian Vaccination Network, who should be tied up and beaten with a rubber hose just for co-opting that official sounding name, amongst other things. They are also freaking people out that not only will vaccinations do insidiously evil things to their children, but that the government is going to force compulsory vaccinations on them. Oh, puh-lease. If compulsory vaccinations were a viable option we wouldn't have the whooping cough epidemic, now would we?

(If only they knew that the government-medical complex is going to enforce compulsory vaccinations on them so they can secretly microchip them in the process, mwah ha ha ha - Ed.)

Anyway, all kidding aside. I just had a look at their no-vaccination blog, and they are also telling everyone that H1N1 was fine and dandy and a storm in a teacup. As someone who was completely floored with pig-pox, I'm choosing to take this entirely personally (it really was swine flu, too. I got swabbed and everything and now the infectious diseases lab keeps stalking me to take part in some study). I swear to freakin' god that if we had had the H1N1 outbreak in an era before modern pharmaceuticals and medical interventions, it might have been getting towards Spanish Flu badness. We put pregnant women on bypass in induced comas because they were so sick with it. BYPASS! Thats an order of sickness way above and beyond "go home and take two paracetamols".

Note to self - people to hate:

- Doctors for the environment.
- Matt Damon.

And now:

- The Australian Vaccination Network.

Whether the weather: Climate schmimate

A few months ago, one of my kids (let's call him "Thing no. 3") decided to go all croup-y and respiratory distressed, thus necessitating a post-midnight trip to the local party-hard-capital-of-the-Universe, the Emergency Department.
Naturally, once the adrenalin and cortisol levels brought on by an exciting trip to the hospital had kicked in, and we were in the nice, warm, climate controlled hospital environment, Thing 3 immediately category 5-ed himself, which was both a relief and slightly embarassing. For those of you who haven't had to do any emergency triage lately, category 5 is the "running around yelling "wheeee"" category, as opposed to the "arriving dead - crap, we'd better do something about it right now" category 1 at the opposite end of the scale.
While Thing 3 ran around the paeds waiting room entertaining the other, distinctly un-sick looking kids, I had ample time to catch up on my television infommercials and think thoughts of health and climate.

Viral croup has long been recognised as cropping up in epidemics during the winter months, and often is most acute at night-time when children's bedrooms are colder. This is such accepted epidemiology that most guidelines and textbooks don't even bother referencing these factoids (but if you're really keen you can lit search it yourself if you don't believe me - or alternatively, Listen To Your Mother. She knows.) However, I would probably stop short of saying that Thing 3 got struck by the climate. He had a higher likelihood of getting croup because of the climate, but was probably more likely a victim of the weather. If he had the same viral infection on a warmer evening, he might not have gone all dramatically Sarah Bernhardt on me in the middle of the night.

There seems to be a bit of mis-use or mis-appropriation of the word climate in health care. Climate is a valid determinant of health but is not often a causative factor of mortality. Weather is much more likely to off you, but when can you blame weather and when can you blame climate? Climate is an average across a period of time or across a geographic span across time. Weather is what is happening right now in a given spot. So if you get caught out in a blizzard, I would probably say you got killed by the weather. Sure, you probably lived in a cold climate to have blizzards (or were spectactularly unlucky and should be written up in Fortean Times), but I would probably say the weather got you. If you got cataracts or skin cancer and lived in Australia, I would say that climate could be a part of what caused it (that and probably being caucasian), but skin cancer and cataracts are generally cumulative processes that occur over time, just like "climate". You couldn't definitively pick the one sunny day that did it, you can just extrapolate a bit from statistics.

Given that labelling "climate" as an actual directly causative factor of mortality (when you really mean "weather") is a bit on the fuzzy side, one would think that attributing deaths to "climate change" is plunging logic deep into hazy land. Pardon me my cynicism, but one suspects that the overall fuzziness of the association might be the point of the exercise. It often doesn't occur to anyone to question it, "wait...you said what, now? Exactly how do you figure this?"

Contrary to much popular belief, its actually pretty bad for your health to live in a colder climate. Sure, you get wa-ay more exciting parasites in the tropics, but much of the warm latitudes mortality can be attributable to the fact that that is where many of the world's poor people live. (Should I include Florida in that? I'm not sure...)

For instance, if you were worried about keeling over from heart disease, and hey, who isn't - ischaemic heart disease and cardiovascular disease are the top two causes of mortality in Australia, you are more likely to do so in winter. This could be for a variety of reasons, and the fact that spikes in overall mortality in developed nations in winter correlate with influenza rates is either part of the problem or at least doesn't help much.

Last year, the American Heart Association published a paper called "The "Sunshine Deficit" and Cardiovascular Disease", which neatly summarised some of the more recent research and thinking in this area. They noted that:

Vitamin D deficiency links to cardiovascular disease can be found in a number of studies demonstrating a 30% to 50% higher cardiovascular morbidity and mortality associated with reduced sun exposure caused by changes in season or latitude. Conversely, the lowest rates of heart disease are found in the sun-drenched Mediterranean coast and in southern versus northern European countries. Cardiac death has been reported to be the highest during winter months.

It would seem that these days you can blame Vitamin D deficiency for almost everything, and much of this began as a process of inquiry into why morbidity and mortality could be epidemiological correlated with latitude, season and weather. There is lots of fascinating biochemistry (if you're into that sort of thing) about the role of Vitamin D being discovered as a result, and we may get bored with the Vitamin D hypothesis in the future or figure out it's a bit more complicated than we thought. Be this as it may, the statistical relationship between morbidity, mortality and temperate climes still remains, regardless of the present explanation de jour.

So back up off of blaming everything on global "warming", or worse yet, climate "change", unless you can tell me explicitly in 150 words or less why you should be allowed to use the word "climate" as a causative factor for mortality in the first case. Then we can argue the "change" bit later...

Think of the little children...

As a climate denier, I find it hard to find time between my usual skeptic activities of reputedly drowning live puppies and raping your grandma. However, when I do get a free moment, I am also a parent.

A 2007 survey of 600 Australian children between the ages of 10-14 years old discovered that:

"...44% are nervous about the future impact of climate change."

I wonder how those kiddies would poll now, after such advertising campaigns as the recent UK Government climate change ad? This advert told a heartwarming, cautionary tale about a cute cartoon puppy who drowns because the little kid's parents are bastards and don't want to pay extra on their energy bills. Although arguably not as disturbing as kiddy classics like "Blue Beard" and "Little Red Riding Hood" (which features cross-dressing, violence and an underage love interest), its still not really prime-time viewing.

The advertising campaign has attracted 350 complaints so far (and counting), and is being investigated by the Advertising Standards Authority.

According to an article in The Times:

Ministers sanctioned the campaign because of concern that scepticism about climate change was making it harder to introduce carbon-reducing policies such as higher energy bills.

The same article mentions that a study by The Department of Energy and Climate Change found that:

When asked how they would react if they knew climate change were going to have a serious effect on their children’s lives, 74 per cent said that they would be willing to change their lifestyle. Fifteen per cent said that they would not make any changes.

Ulterior motives, much.