PRACTICE!

I don’t understand!  What’s all the fuss about? People seems to be worried about the Covid vaccine immunization schedule.  One of the major complaints I hear frequently has to do with the number of shots required to get good immunity.  Would it surprise you if I told you that most of my vaccines started off as one shot/series and, in time, ended up as multiple shots or series of shots?

You probably don’t remember but your childhood vaccines were given on a schedule.  The DPT (diptheria, pertussis and tetanus) vaccine was given at 2, 4,6, and 18 months.  A booster was then given at 5 years of age and was supposed to confer permanent immunity.  Some years ago, the pertussis component began to fail, and a booster was added in high school. 

I “practiced” medicine for close to 40 years.  All physicians “practice” medicine!  Medical knowledge is constantly changing.  Research brings us new medicines and therapeutic interventions that offer the promise of improved performance over older treatments.  Physicians learn about and subsequently institute those new interventions and medications which promise to improve care without adding significant risk.  New treatments are followed closely once they are introduced to the public and, if problems are discovered, might be removed from the market (Vioxx) or their usage modified to account for added risk (Accutane).

Yep, as physicians, we practice with new meds and therapies; and we learn from using them.  Vioxx was an incredible pain reliever.  It was a non-steroidal, non-narcotic, anti-inflammatory medication that helped many of my patients.  It also supposedly caused significant heart disease and was subsequently removed from the market.  

Accutane is an excellent medication for the control of acne.  It causes birth defects and an assortment of other bothersome side-effects.  Due to these problems, its use has been restricted.  Women on Accutane are required to use at least two forms of birth control.  The last time I prescribed it, the patient was required to sign multiple legal documents acknowledging that he/she received and understood the informed consent documents provide to him/her.

My point is that, in both the above examples, physicians practiced with and learned from the use of new medications.  Yes, there are significant risks involved in practicing medicine.  There are also significant benefits that far outweigh the risks.  Many years ago, I was called to the ER to see a middle aged man who had been diagnosed as brain dead following a cardiac event.  I had read about a new device called an Artic Blanket and was elated to find that the ER had a brand-new Artic Blanket that had yet been used.  After discussing the diagnosis, we unwrapped the blanket, applied the new technology and said a few prayers.  Yes, this was a practice run which offered some hope.  The patient woke up the next day, went home and still is alive.

Practicing physicians should always share the risks and benefits of any treatment with you.  The process is called “informed consent.”  While I fervently believe in the process of informed consent, I hated doing it.  Why?  Informed consent often scares the patient out of doing the proposed procedure or taking my medications.  Everything carries risk!  When reviewing the risks of my upcoming DBS surgery, the surgeon discusses risks that include stroke, central nervous system infection and even death.  Without the surgery, my condition will continue to worsen.  With the surgery, my condition hopefully will improve for a while and the progression of PARKINSON’S be slowed.

Will the Covid vaccines prove to be as good as the Artic Blanket or as problematic as Vioxx.  Only time will tell.  The bulk of evidence today is strongly in favor of a 3 shot regimen and that is what Renee and I have done.

One last historical note.  Vioxx was so good at relieving pain that, despite the risk of heart disease, many of my patients would gladly buy it today, at any cost and despite any risk.

Here’s today’s joke: A man sends his wife to pick up his erectile dysfunction medication.

She gets back and they get undressed and get down to business.

The wife stops and says, “Our new pharmacist is a very nice Chinese man but talks too much politics; but don’t worry, I made sure your pills aren’t made in Russia.”

“Why would it matter if the Russians made my pills?” asked the husband.

The wife responded, Well, the pharmacist told me Russia was meddling in U.S erections.”