"All that is necessary for the triumph of evil is for good men to do nothing" Edmund Burke, 18th century Philospher.

"A long habit of not thinking a thing wrong gives it a superficial appearance of it being right." Thomas Paine

"The welfare of humanity is always the alibi of tyrants." Albert Camus

"Choice is the essence of ethics: if there were no choice there would be no ethics, no good, no evil; good and evil have meaning only insofar as man is free to choose." Margaret Thatcher, March 14, 1977

“It is difficult to get a man to understand something, when his salary depends on his not understanding it.” ― Upton Sinclair

Explaining the Cause

I am a practicing obstetrician who is a strong supporter of patients rights to informed consent and refusal. I believe a patient has the right to choose her own path given true and not skewed informed consent. Following that tenet, just as a woman should be able to choose to have an elective c/section she should be able to choose not to have one, as well. The American system of hospital based obstetric practice has been eroding those choices for women for quite some time. Due to concerns of economics, expediency and fears of litigation women are being coerced to make choices that may not be in their best interest.

I have had a long relationship collaborating with midwives and find the midwifery model of care to be evidenced based and successful. I was well trained at Cedars-Sinai Medical Center in the mid 80's to perform breech deliveries, twin deliveries, operative vaginal deliveries and VBACs, and despite evidence supporting their continued value, hospitals are "banning" these options. Organized medicine is also doing its best to restrict the availability of access to midwives.

Home birthing is not for everyone but informed choice is. Medical ethics dictates that doctors have a responsibility and a fiduciary duty to their patients to provide true, not skewed, informed consent and to respect patient autonomy in decision making. Countries with the best outcomes in birthing have collaboration between doctors and midwives. This is not what has been happening in the hospitals of America. Its time for a change and the return of common sense.

The midwifery model of care supports pregnancy as a normal function of the female body and gives a legitimate and reasonable alternative to the over-medicalized model of birth that dominates our culture. Through this blog I hope to do my part to illuminate what is wrong with our maternity care system and what is right with it. I do not expect all to agree and that is OK. We must all understand that given honest data it is not always reasonable to expect two people to come to the same conclusion. Our differences should be respected.

Wednesday, August 14, 2013

Revisiting The Vaccine Question

The to vaccinate or not to vaccinate controversy is far from ended despite a recent statement from the CDC based on an Institute of Medicine (IOM) review that concludes, "the evidence favors rejection of a causal relationship between thimerosal–containing vaccines and autism". I have seen this statement repeated in many recent news items including one in USA Today yesterday. (That just doesn't sound right....USA Today yesterday). I do not profess to have any expertise on this subject other than what I hear and read. Which means I am as confused as you are since the truth does not seem as black and white as the IOM would have us believe. I also, do not think there is any conspiratorial process going on between big Pharma and big Government.

So, when asked my opinion recently by a client I was happy to be able to refer them to Jennifer Margulis' new book, "The Business of Baby". Its subtitle talks of what doctors won't tell you and what companies try to sell you and how to determine what's truthful. She presents an extremely well researched and referenced discussion without a personal agenda. Vaccines have performed miracles in the 20th Century, eradicating polio and small pox and minimizing risks from a variety of illnesses from mumps to measles to tetanus. When I traveled to endemic areas I did not hesitate to get vaccinated for yellow fever.

But, as will all aspects of life and, as I have related to pregnancy, there is nothing that is risk free. In my career I have seen a case of Guillain-Barre Syndrome related to a routine vaccine. We know that if the threat of a small pox epidemic from bioterrorism were ever to occur that the vaccine would save millions of lives but a few people would have an allergic reaction and die. Because of our ridiculously litigious American society this predictable and medically acceptable risk would result in lawsuits and has scared so many small pox vaccine manufacturers that only one company remains. Not having the capability of having this vaccine mass produced could be devastating. But I digress.

Whether to vaccinate or not is a personal decision that each of us has to make for ourselves and our children. What I can say is that in healthy women I see no reason to give universal hepatitis B vaccine to a newborn as is the policy in many hospitals. Always ask about this one. It makes absolutely no sense in families who are not active hepatitis B carriers. And almost every pregnant woman is routinely screened for this. Measles, mumps, Rubella, chicken pox and such options as Guardasil for HPV and the flu shot are never mandatory so do your own research as to the pros and cons. (One article out of Japan has shown that high doses of daily Vitamin D has been more effective against the flu than vaccination. Reminder: This study does not end that debate, either.)

I will end this blog with one last example of the rigidity of the academic-medical model taught to most pediatricians. A story related to me by one of my current pregnant clients and one that I hope most pediatricians would abhor. While searching the area for a supportive pediatrician she asked his position on routine vaccination. He stated that he recommended the standard vaccine regimen but that he would still accept her baby into his practice if she chose not to. This sounded most reasonable until he added that if she chose not to vaccinate her baby that he and his associates would only be available for her phone calls during business hours. He would not care for her baby after hours and on weekends should her baby become ill! Seriously, that is what she was told and I believe her. Off to the emergency room with you! As I think about it I am still shaking my head. How does a person say something like that? Does it not seem a bit unethical to that physician? It would be much more honorable to suggest she go elsewhere. I guess this is the new ethics and there is no vaccine against it. Caveat Emptor!

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