Wednesday, 23 September 2009

Lest we forget

“Respect your elders.” It’s a phrase that just about every living person would have heard at some point during their childhood. The sentiment being that those who are older than us have more experience in the ways of the world and that their advice and opinions have a deeper grounding than us and our peers. In many cultures, this is taken further. Stories of our ancestors and forefathers are passed down from generation to generation with the hope that the young will gain knowledge from those that have gone before.

It seems to me that the modern way in different. We don’t respect our fathers, we don’t respect their experiences, and we don’t respect their knowledge. We don’t overthrow them or castigate them. We simply forget them.

I can point to the Credit Crunch of 2007 and the ensuing worldwide recession as a prime example. It’s not as if recessions or market bubbles are a new phenomenon. It’s not as if the factors leading up to a recession are deeply buried secrets. All the documents, all the policies and legislation from the 1920s and even 1980s are all fully out in the open in the public domain. We could all have read all about it if we wanted to – but we didn’t. We didn’t know the history, we didn’t care about the history, we believed that “That was all yonks ago, things have changed now and that disaster couldn’t possibly happen in the modern era.”

We were wrong. It could happen again and it did happen again.

But that what we modern westerners do, we think often about the present and sometimes about the future, but never about the past. Our fathers have always been dead to us. We simply forget them.

It’s happening again. As you sit reading these words, we are in the midst of a global influenza pandemic. Again, 'flu pandemics are not a new thing. We’ve been through them before. Our fathers died in bygone pandemics and those who survived documented what happened so that future generations could learn. We know how pandemics behave and what’s great about 2009 is that we don’t have to go rummaging around old musty libraries to find out. The information is at our fingertips, merely microseconds away. It’s not even in the dim and distant past. There are thousands of people alive today who lived through the last pandemic.

The pandemic hits in the summertime with a large increase in the number of cases. Attempts to halt the spread of the disease fail for a multitude of reasons but at the height of summer, the number of people with the illness falls as people go off on holiday. When they and their children return in the autumn, the disease comes back with a vengeance killing more and more as autumn rolls into winter. Can you guess what’s happening with the swine flu pandemic now autumn is here and schools have resumed?

I guess that human flu has been around as long as humanity itself and in some ways it’s surprising that in this day and age we have remarkably few weapons at our disposal to fight it. Unlike their antibiotic cousins, anti-viral agents such as oseltamivir (Tamiflu) and zanamivir (Relenza) are actually pretty ineffective at treating the flu so, if we get the disease we pretty much have to rely on our own immune systems to fight the disease. History tells us that for a lot of us, our own immune system won’t be up to the task.

So what can we do about it?

As far as I can see, our medical and political leaders are doing what they can. Trust me, I’m no apologist for Liam Donaldson or Gordon Brown but they have at least tried to get the handwashing message out and the antivirals to the right people. More importantly, they have done the best they can to keep the worried well from swamping GP and hospital services. They’ve tried not to panic the population as a whole but, as I say there’s no decent treatment for flu and there’s not much we can actually do for people with flu apart from try and support them as best we can. It seems to me that our best hope of avoiding the deaths that we’ve seen in previous pandemics lies with a swine flu vaccine.

And yet… and yet…

Speaking to my colleagues, it seems that for a variety of reasons, many won’t be taking the vaccine. Polls among the profession show a similar story. We’ve had UK medical blogger Dr Crippen writing in the national press that the vaccination programme is a load of codswallop and that he certainly won’t be having it. There seems to be an ingrained resistance to this simple public health measure and it seems churlish for us doctors as a profession to expect other people to have the vaccine if we won’t have it ourselves.

Personally, I believe that when the first nurse or junior doctor dies from this disease, it will change the attitude of many of my peers, but it’s a shame that it will actually take the death of a colleague for people to start to pay attention to what the past has told us.

But, like I say, this is the modern way. We only think about the present and we forget the lessons that our fathers try to teach us.


6969 said...

From a GP

I was a swine flu vaccine sceptic but having looked at the data, I've decided I'll be vaccinating myself and my kids. An alarming trend occurs with these pandemic - with seasonal flu the age/death graph is decidedly 'U'shaped with the very young and very old being hit. The time to death is also generally in the order of 6-10 days and is mostly due to secondary infection. In the pandemics, the age/death graph takes on a 'w' shape with a peak in the 35-45 year old group. The other alarming detail is that these deaths occur normally within 3-4 days ie they result from the primary infection and its acute sequelae - normally ARDS/renal failure. Tamiflu has been shown to reduce deaths (marginally) from secondary infection but has made NO impact on deaths from primary infection (though admittedly, since Tamiflu's introduction, there have been thankfully few of these).

This then leads to the conclusion - why are we not including those in the middle peak of the 'w' in the forthcoming vaccination campaign?

Flu is self-limiting said...

What if a junior doctor or nurse die of the vaccine? What then?

... and I am quoting from history here Dr, for this did happen before in the 70s in the USA and the vaccine was immediately withdrawn because of people developing a nasty neurological disease which was 'proven' to be a direct result of the vaccination!

Swine Flu has so far proven to be a mild illness, why chance it?! Where is the evidence to support the need for a vaccine, let alone mas vaccination?!

6969 said...

True Gillain-Barre was a problem with the 1976 swine flu vaccine - it is actually a recognised risk with the seasonal flu vaccine (but a small one). The vaccine in 1976 was made is a rather different way than the one made now - indeed the swine flu vaccine has been made in the same way the seasonal vaccine is made. It should also be noted that H1N1 strains are included in the seasonal vaccine. for some further details - (yes it's wikipedia, but this time it's pretty accurate)

doc joe said...

To be honest, I have worked in laboratories for some big pharmaceutical companies, I wouldn't trust them with my lunch, let alone a fast-tracked vaccine that could play russian roulette with my life.

Dr Michael Anderson said...

6969 - thank you for putting to bed some misconceptions about the vaccine.

doc joe and FISL - you can look up the data yourself, more people have died in the last 30 HOURS from swine flu than have in the last 30 YEARS from any complications of the flu vaccine. I know which risk I'd rather take...

fayaz said...

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