Vaccines: A Friend's Reply

Here are some comments I found somehow in my spam from a respected friend and medical intern.  These comments are in regard to my post on Vaccines which brought up some areas of debate.  I unfortunately didn't see them earlier and thought it would be fair for me to share without any alterations, edits, or reply. I respect his position and hope this encourages an open forum -


As mentioned before, I believe your intentions are honest and your desire to provide health advice pure, even if we disagree on several points. You are correct to believe that there has been and continues to be a link between medical training and pharm companies, but I think this relationship is much smaller and less profound than you believe it to be. During my first two years of school, anyone lecturing on pharmacology had to disclose any conflicts of interest. At all national and international meetings where new research and treatments are presented, presenters and authors disclose any conflicts of interest as a matter of routine. Failing to disclose this information or fraudulently denying ties to the pharm companies carries serious consequences and will essentially ruin the career of anyone who does it. As a whole, the medical community is sensitive to this issue because there have been problems in the past, and many changes have been made and regulations put in place to control these problems. (You'll often hear doctors complain they don't even get free pens anymore) Several years ago I read about a Harvard medical student who called out his professor because he failed to disclose his ties to the industry and gave biased lectures. Harvard has since changed policies to keep this from happening again. (Surprisingly, most medical schools already had these policies in place, way to lead the way Harvard) I'm not naive enough to believe there won't ever be problems again at any medical school, and I actually believe some industry money is a good thing provided it is closely monitored and drives innovation and new research. Any education I've received regarding drugs during medical school has been couched in terms of safety, efficacy, pharmacokinetics and mechanism of action. Occasionally the price of the drug is brought into the discussion, but only in terms of trying to save the patient money with an equally efficacious and safe generic. I honestly can plead ignorance as to who manufactures almost any of the drugs I've come in contact with during medical school.

Regarding diabetes, diet and exercise, or "lifestyle modification" is always the first step undertaken when treating a patient with diabetes and exists in many official standard of care algorithms used by physicians. I have witnessed this first hand while working in a family practice clinic last year. (This clinic even had a diabetes nutritionist on staff to help educate people with a new diagnosis or anyone who needed further help) As you very well know, not everyone actually modifies their lifestyles, and short of going to their homes and forcing them spit out their sprinkled donuts, there's not much else we can do for people who don't have the desire to change. I'm glad I'll have more than just a hammer in my tool belt when I encounter those patients. When diet and exercise fails, I'll have a wide variety of pharmacological tools to employ, and can actually tailor my therapies in accordance to various co-morbid conditions a particular patient might have. It is true that for patients whose HbA1c levels are off the charts, we will start some drugs right away, but we do try some some prevention before reaction in this instance. For a humorous account about why medicine does tend to be more reactive than proactive, read this link. http://www.pandabearmd.com/2007/04/25/pie-will-out/ a small taste: Most education, like most preaching, is ineffectual. The parson can talk himself blue in the face but the bars will still be open and the fancy women will have no shortage of customers because unless people have some strong personal motivation for change, a motivation which cannot be accessed by the usual uninspired preacher or government scold, they will continue to indulge their immediate gratification at the expense of of some unknowable future punishment. Late at night, when the motivational speakers have gone home and the skinny lady from the university has stopped trying to extract impossible promises, the siren call of the pecan pie in the refrigerator is irresistible. Pie will out. This simple yet seductive desert will trump our best efforts. When you’re three hundred pounds hoping to lose the fleshy equivalent of a couple of sixth graders, the smooth seduction of caramelized Karo syrup and the smokey crunch of jumbo pecans offers immediate gratification with which no nebulous promise of low blood pressure can hope to compete. It was my mistake to bring up the autism link as you did not, and I didn't mean to imply that you did. I should have stated instead that one can't dismiss any and all research showing benefit from vaccines because one believes they are funded by pharm companies. As we both acknowledge, the bias goes both ways. I think we will have part ways about our positions on the flu vaccine. To be clear, your stance in one of opinion and not logic. (Although I whole heartedly admire and acknowledge that your stance on the matter is a rather ballsy one) To believe as you do, that "it is impossible to have any valid vaccine to prevent the flu" is to believe that legions of employees from the CDC, World Health Organization and pharmaceutical companies, as well as countless pediatricians and physicians, most of whom are rather well educated folks who routinely get the flu vaccine themselves, are motivated not by compassion but by greed, and are all in on some massive conspiracy aimed at getting unsuspecting victims to fork up 20 bucks once a year to get thimerosol injections. It is also to believe that all the research supporting the use of the influenza vaccine is written by dishonest people willing to not only gamble their professional credibility, but are willing to inject even their own children to keep the charade alive, year after year. I can't possibly believe that, but I respect the level of conviction needed to.