Prevention

By Dr. Jim Ferguson

No, this essay is not about how our leaders are failing in their primary duty which is to protect the citizens of the United States. We all know what must be done to prevent terrorism, but there is not the will to do so in Washington. Israel understands that their neighbors are trying to kill them and as a result controls its borders, profiles and does extreme vetting. Until we do so, main street will remain under siege.

The focus of this week’s essay is preventive measures in medicine, especially annual examinations and vaccinations. You might be surprised to learn that there are no scientific studies which show that annual physical examinations are beneficial. Perhaps this is because it would be almost impossible to design a study with thousands of patients matched for medical conditions and stratified in groups to try and measure a difference between more medical care or less. And who would fund such a study which might require decades? I used to try and explain this to patients, but it so challenged preconceived notions that I gave up.

There are measurable scientific benefits from checking blood pressure, cholesterol and glucose. And there are intangible benefits from  reestablishing the relationship between you and your doctor, but in my opinion a lot of things done these days are not cost effective or relationship building.

This is the time of year when flu shots are recommended. While flu vaccinations are not a perfect preventive measure, there is good science which shows that flu shots prevent or lessen the severity of influenza. This viral infection is especially dangerous for older folks, children and people with damaged immune systems or in pregnancy. The Spanish influenza epidemic after WWI killed more people than were killed on all the battlefields of Europe.

When I was growing up I remember the Hong Kong and the Asian Flu outbreaks. It has been decades since we’ve had similar outbreaks, and we’re long overdue. An otherwise healthy adult will probably survive influenza infection, but it’s a miserable ordeal. I once had a patient who described his bout of flu. He said, “Doc, I know I had the flu because I felt so bad I was afraid I wouldn’t die.”

Flu shots do not prevent the common cold which is caused by dozens of other viruses. The common cold is associated with chills, malaise and low grade temperature, as well as nasal congestion and cough. Influenza often causes a sudden chill and fever of 101° or more, headache and muscle aches so severe you’d swear someone had beaten you with a stick. People feel so bad that they find it even difficult to get out of bed, a term referred to as prostrate – not prostate! And the post flu fatigue can last for weeks.

Vaccinations work by challenging the immune system to make specific cells (white blood cells called T lymphocytes) which can quickly identify influenza virus or other bacterial proteins. Then, if a person comes in contact with the Real McCoy, the immune system revs up quickly to counter the invading agent. The problem with influenza virus is that it constantly changes its surface proteins and each year you have to get vaccinated against the predicted strain. Experts study the mutating influenza virus in Asian aquatic fowl to formulate the annual flu vaccine.

Another useful vaccination is the so-called pneumonia shot. The original Pneumovax contains the surface proteins found on twenty-three strains of the common and lethal pneumococcal bacteria. There is now another pneumococcal vaccine which has a narrower spectrum, but is more immunogenic. The current recommendation is to use both vaccines in older people perhaps a year apart. I followed my doctor’s recommendations and have had both pneumococcal vaccinations. I also received the higher dose flu vaccine because I’m no longer a “spring chicken” and it is known that a person’s immune system wains with aging and may require a bigger stimulus to respond.

There are many other vaccines that are best used in certain defined situations. Examples are haemophilus influenzae and meningococcus vaccines. You should discuss these with your doctor. I have never treated a patient with tetanus or diphtheria. I suspect this is because these bacterial scourges have been largely eliminated in America because we protect our children with vaccinations. In recent years I’ve been using the modified tetanus and diphtheria booster which also contains a pertussis component.

Some of you may remember whooping cough, but I’ve never seen a case of this dreaded illness. At one time it was a common malady, but became less so with vaccinations we give our children. And there was a component of “herd immunity” from remote infections before there were vaccinations against this bacterial pathogen. Unfortunately there’s been a resurgence of whooping cough, an illness which produces such paroxysms of cough that people crack ribs and “whoop” as they gasp breath.

There are more vaccinations which one should especially consider under travel situations. You might find interesting to learn that there’s a branch of internal medicine which deals with travel considerations. This is called Emporiatrics. If you’re going to live in Southeast Asia then it might be reasonable to vaccinate yourself against hepatitis B infection. And if you’re traveling in the Middle East or Central or South America you might consider hepatitis A or typhoid vaccination. Unfortunately, at this time there are not any vaccinations for dengue, malaria, zinka or a host of other maladies. The CDC has an excellent website that you can consult and discuss with your doctor before you travel.

Too often we take health for granted, and many are not aware of the intricacies of the immune system or how vaccinations modify our defenses. Like so many other things, we are too often unaware of wondrous mechanisms at work.

I ended last week’s essay with a quote from the Psalmist (118:24). This wisdom is profound and true. I’ll end this week’s essay with a quote from the Master who said, “ To whom much is given much is expected” (Luke 12:36). We are required to do our best and to do our duty with the talents and knowledge we are given. So, get your vaccinations because an ounce of prevention is worth more than a pound of cure!

 

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