On Vaccines and Knowledge

I was recently discussing vaccine recommendations with a parent and it went something like this:

Me: “I see she hasn’t had any vaccines. Can we get some started today?”

Parent: “We don’t like the ingredients in the vaccines.”

Me: “Which ingredients?”

Parent: “Mercury.”

Me: “Okay that’s fine because there is no mercury in any of the immunizations we would recommend giving today.”

Parent: “Well we don’t believe in vaccines.”

I found this confusing. Vaccines aren’t something to “believe in.” I am still not sure what that even means. I wouldn’t tell my mechanic that I believe or don’t believe in rotating my tires. I may ask pros and cons, how much it costs, etc. to learn more about it and help me make an informed decision, but it is not a matter of faith.

Maybe I am just turning into a grumpy old man but it seems that as a society we are losing the ability to differentiate between what we know and what we believe. When the evidence showed that the nasal flu vaccine was not effective, we didn’t cling to some kind of belief in it and keep giving it anyway. We stopped using it. It was the same when the initial Rotavirus vaccine showed a small, but real, increase in the incidence of an intestinal blockage known as intussusception. We stopped giving it.

There is nothing wrong with believing things. There are things that I believe but cannot prove but I am up front with folks about what I believe to be true and what I know to be true and the difference between the two.

But when one equates believing something with knowing something, it shuts down all discussion and opportunity to learn something new. I have learned a lot of new things through the years by listening to different perspectives and being open to new evidence. If I had not been willing to consider that what I believed was not true, I would have missed out on a lot of interesting, important, exciting, life-giving knowledge. Of course, I have also learned some things along the way that I wish I didn’t know, although knowing them makes me a better person.

So believe what you believe, but be open to the possibility that you may be wrong and willing to change your mind if that is where the evidence leads.

The Importance of Meeting Different Types of People

I think one of the most important things we can do to help ourselves and our children grow is to meet and talk to people whose lives and experiences are different from our own.

I recently had the opportunity to travel to Zambia with two of our children. I have been to Zambia before in my work with a small non-profit organization of which I am a part. But each trip resets my perspective, at least temporarily.

Seeing folks with basic medical needs which have not been addressed for years, sometimes for reasons as basic as not having access to transportation, is frustrating. Using a toilet which is basically a hole in the ground inside of a small structure made of mud bricks while children playing just outside are visible through the cracks is humbling. Seeing a plate of dead mice awaiting preparation to be eaten while making a house call to see someone who is in too much pain to make it to our makeshift clinic is sobering. Hearing about the woman who died in childbirth and the child who drowned in an open well the week before we got there is depressing.

On the flip side, seeing folks who have made economic progress with the small opportunities they had is exciting. And teenagers who walk several kilometers to school each day or live in a mud house but take every educational opportunity they get are inspiring. And it was comforting that the Muslim owner of the bush camp we visited, knowing that we had already sliced our spare tire on a rock so no longer had a back-up, volunteered to come and rescue our vehicle full of Christians if we had not made it back to the paved road in three hours.

Not everyone has the opportunity to go to Africa. But there are plenty of people all around us who have different life experiences which we can learn from. This happens for me on a daily basis in my office in the heart of the Shenandoah Valley. We can all learn by seeking out folks who are different from us and hearing their stories. Maybe they have a different type of job or are of a different race or religious or ethnic background.

Hearing the stories of others helps take our focus off ourselves and our problems and helps us understand why others do what they do. As one of the kids said after we got back home, “I feel bad complaining about anything now.” Exactly.

 

A Gift I Received From My Parents

There is an old joke that politicians enjoy using against opponents from the other party: “He was born on third base but he thinks he hit a triple.”

I don’t know exactly where on the base paths I was born, but I know my parents worked hard to make sure my siblings and I were born further along than they were.

My parents started their now 59 years of marriage with virtually nothing financially. My father was expected to contribute all his earnings to his family until age 21 so he had nothing to start his own family with. He worked evenings and weekends while attending college while my mother typed term papers for other students for 10 cents a page on a manual typewriter while watching their two young children, my older sister and brother.

They transferred the importance of work along to us as well. We were expected to help with chores around the house. While I may have grumbled at the time, I now have fond memories of Saturdays spent cutting firewood with my father and brother and of shelling peas in the evening while watching Monday Night Baseball. When I was a child, both of my parents worked full-time away from home so we had a dish-washing schedule through the week so my mother didn’t have to do that as well after a day at work and then making dinner. Those times often turned into a lot of fun as I dried dishes while my father or one of my older siblings washed them. I especially enjoyed when I found something that wasn’t clean enough and handed it back to be re-washed.

As I grew older, my father would sometimes take me to help with jobs on the weekend – reroofing a house, putting up some siding, etc. And I eventually worked for him in the summers. I still get a little surge of pride driving by projects I helped on 30 or 35 years ago. Conversations in our car often go something like this:

Me: “I put that roof on one summer.”

Backseat: “Yes Dad, we know.”

Me: “I helped Grandpa dig the footers for that house.”

Backseat: “Yes Dad, we know.”

My first summer job was when I was thirteen. For 50 cents an hour, I worked in a lawn and garden, scraped and painted a long board fence, and did odd jobs around a farm. A week or so into my tenure there, my boss called me in to speak to him. I wasn’t sure why he wanted to talk to me but I was a little nervous. He said, “Kurtis, when you need something from the shed, you don’t need to run to the shed to get it and then run back to where you are working.” I just thought that is how one worked because that is what my father did. Who knew? At the end of the summer, he gave me a $50 bonus.

These lessons growing up have served me well. I have messed up in a variety of ways through the years but I don’t recall ever being accused of a lack of effort.

I haven’t always done a good job modelling this for my own children. In retrospect, when a soccer game on the screened-in porch left the screens torn and dangling, I should have tried to fix it with them helping. It would have been a good lesson in how it is easier to destroy things than it is to repair them. I think that lesson extends well beyond porches to relationships, people, institutions, and a host of other things. Instead, I just got angry and made other arrangements to have it fixed.

When you are tired and overwhelmed, it is often easier to just do things yourself than to get help from an eight-year-old who will make cleaning out the garage take twice as long. I am sure there are times my “help” slowed my parents down. But helping them is how I learned to work. And that is one of the many ways my parents got me off to a good start running the bases.

A Few Thoughts on Our Healthcare System

I entered medical school in the fall of 1989 and have been intimately involved in the United States' healthcare system in one way or another ever since. And the financial part of it still makes no sense to me so I cannot imagine how confusing and frustrating it must be for folks who do not interact with the system on a daily basis.

In our family, we have two persons with the same diagnosis which has required treatment since early infancy to prevent permanent brain damage. The variations in how this has been covered or not covered through the years seem mostly like an exercise in randomness, even though we have always been fortunate enough to have insurance. There have been times when their treatment was completely covered and free to us. At most other times, it has not been covered and we have often paid more than $10,000 a year for the same treatment.

We recently had a situation in which these two people with the exact same diagnosis and the exact same insurance were prescribed the exact same thing. For one of them, it was considered a covered service by our insurance and cost $27 per month. For the other, it was denied by insurance and the same amount was going to cost more than $1400 per month from the same supplier. After many phone calls and letters by our healthcare providers, the insurance company agreed that it was a covered service for both of them.

The second confusing piece of this is that the insurance company does not actually pay the supplier anything for the prescription. Because it is a covered service, we get the contract price of $27 and the rest of the cost is written off by the supplier. So why are they willing to accept $27 if we have insurance but would charge us $1400 if we didn’t?

We never know from one year to the next whether we are going to get prescriptions filled cheaply or need to pay thousands of dollars for them.

I once participated in a General Assembly committee hearing in Richmond addressing the issue of insurance coverage for treatments for genetic metabolic disorders. After I had spoken, an executive of an insurance company stood at the lectern and assured everyone that his company provided coverage for treatment for a certain disorder. Since we had coverage through his company at the time and were being denied coverage for the disorder in question, I knew this was not true. I do not think he was intentionally lying. I think he just didn’t know. But since the hearing rules said that once a person spoke they were not permitted to speak again, I could not point out this inaccuracy.

I think the helplessness I felt as I sat in my seat in that hearing room probably is shared by many folks as they encounter the illogical behemoth that is the American medical system.

 

 

Some Thoughts on Picky Eaters

Many children are picky eaters, especially in the toddler and preschool years. This is a frequent concern I hear from parents. Often it comes in the form of “Johnny won’t eat anything but chicken nuggets.” Some parents give the child what he wants, fearing that if they don’t, he just won’t end up eating enough. The problem with that approach is that if he knows he can hold out for the nuggets, he is not likely to try other things but will just wait until he gets what he wants.

My advice is usually not to worry too much about it and don’t turn it into a battle. Making the child sit at the table until he cleans his plate never seems to work and just upsets everyone involved. I suggest presenting him with healthy foods and then letting him choose to eat it or not, but not giving him an alternative meal or snack if he turns his nose up at dinner. The response to this is often “But he’s got to eat something!”

Yes, he does, and he will. When he gets hungry enough, he will eat. The key is being comfortable with allowing a child to miss a few meals along the way if necessary. We have a genetic, metabolic condition in our family which has severely limited the food options for several family members. But even with limited options, they always ate enough of what was available to them (and chicken nuggets were not an option). In almost twenty years of practice, I can only think of a couple of otherwise healthy children who refused to eat enough to maintain normal weight gain and growth.

Some children truly have feeding issues that make it difficult for them to eat certain foods. This can be a physical problem with their anatomy or inability to handle certain textures, anxiety, developmental disorders such as autism, or isolated eating disorders. In those cases, referral to feeding specialists can be helpful.

But for most children, I think simply presenting them with healthy options and then letting them decide whether to eat or not is a good option. At some point, when they get hungry enough, they will eat.

Why I Admire My Dog

Sometimes I wish people, myself included, were more like my dog. We got Wags at the SPCA when she was a puppy. She is now 14 or 15 years old and doesn’t move very fast and can’t see or hear very well. But she is the sweetest mammal on the planet.

Sometimes she wanders away from home and we need to go find her. When we do find her, she always trots towards us with her tail wagging, like maybe she was looking for us. The one time she didn’t come right to me, I knew something was wrong even though I couldn’t see her very well in the dark woods with my flashlight. It turned out that a large flap of skin had been torn from her underside and was dangling on the ground. As I carried her back home, she didn’t protest in any way but just nuzzled her nose up under my chin.

Recently as I was letting them in for the night, our other rambunctious beagle just ran into her and knocked her flat on her side. She didn’t make any fuss but just got back up and trotted in with her tail wagging. When she tries to sniff the cat and gets hissed and swiped at, she just turns around and walks away as if nothing happened. When she doesn’t want to go outside and I make her, she doesn’t resist.

When we get home, she trots out to greet us, tail wagging (at least if she is close enough to hear us drive up which needs to be pretty close). She gracefully endures the constant unwanted attention of our other dog.

I think if there was a canine version of “the fruit of the spirit,” she would be the poster child for it. So today I am going to endeavor to be like Wags – no barking or growling at others, lots of tail-wagging, and just getting back up and continuing on if I get knocked down.

Doctors Are People Too

In case anyone wondered, physicians are actual people. We are subject to the usual foibles of humanity – pride, selfishness, impatience, anxiety, fatigue, and our own personal biases to name a few. Hopefully these tendencies are mitigated by professional standards, a desire to help people, and the pursuit of objective evidence.

There was a time in my career when I was working far too hard. I was perpetually exhausted and it wasn’t unusual for me to walk into a room to examine a child and have the mother say “Dr. Sauder, are you OK?” One night I was making hospital rounds after a long day in the office and the grandmother of one of my patients said to me, “Dr. Sauder, you look like you could use a hug.” We must have been an odd sight; an older African American woman and a younger (at the time) white doctor embracing on the pediatric ward late at night. I am sure she never realized how much that buoyed my spirits.

Doctors, being human, make mistakes. Interestingly, I have found that people have often been more forgiving of my actual mistakes than my perceived mistakes. And as with most things in life, circumstances are often not exactly as they appear on the surface. There have been times that I have heard things in public about physicians or events that I knew weren’t true but I could not correct them because I would have needed to compromise a patient’s confidentiality to do so.

Clearly the days of regarding a doctor’s word as gospel truth are long gone, as they should be. We have years of training and experience in our chosen field and are dedicated to doing the best we can for our patients. But we are also human. And it is important for us and for our patients to remember that.