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Simplifying Science

A Twist on Entitlement to Health Care: Every American as a Junior Physician

H1N1 Flu vaccine: dangerous or safe? Well if you listen to CDC, the Department of Health and Human Services, the American Academy of Pediatrics among others, it’s safe. And more than that, it’s necessary because it will save lives. But if you listen to some others, including a number of media figures—like Bill Maher—it’s not.

So who to believe? Isn’t the government in cahoots with the pharmaceutical industry, helping big pharma make a big buck at every turn? If so, then you certainly cannot trust them. Forget that these organizations are packed with scientists who have dedicated years of their lives to research in order to help protect and defend the quality of yours. Forget that in order to be a member of an advocacy organization like the AAP you need to have spent years in graduate school and specialty training learning how to care for children. Yes, it makes perfect sense that these doctors and scientists would work hard to snow the general public just so the CEO of a pharmaceutical company can get a bigger bonus this year. That makes lots of sense.

I understand the pessimism; it is reasonable that people question the integrity of the relationships between drug manufacturers and health care providers. But at this point, our healthy sense of skepticism has become infected: patients are willing to listen to—and in many cases take medical advice from—people with no training in medicine. Bill Maher is not the only self-proclaimed doctor out there, he’s just the one to make the biggest splash this week.

Everyone, it seems, is a junior diagnostician. If you go on any number of websites and type in your constellation of symptoms, you too can get a diagnosis. It is downright routine these days for patients to show up at the doctor’s office proclaiming they know what’s wrong with them and what prescription they need. Printed sheets off the Internet, proof in hand, patients know what’s best for them.

But let’s freeze for a moment here. We all saw “Lorenzo’s Oil” and know that there are cases out there that stump doctors, impassion patients, and result in medical victory only at the hands of dedicated—and often sick—individuals. That doesn’t mean that all of us need to rely upon ourselves to diagnose every illness. Physicians do—gasp—still have some utility in this world. If we all become junior physicians and trust only ourselves to figure out what is medically best, we throw out the baby with the bathwater. The next time your child has a fever of 104 degrees or you develop chest pain, you’re just going to look those symptoms up online?

Vaccines occupy an entirely different orbit in this debate because they are medicines that are given to healthy people (or are at least given preventively rather than therapeutically, whether or not the recipient is truly “healthy”). For this reason health care consumers feel even more entitled to take matters into their own hands. Okay doc, you can treat me when I am sick, but don’t try to force something onto me when I am well. Consumers of health care have become skeptical about vaccines for a number of reasons, but one has to do with their profit margins. Just to get the facts straight here, the H1N1 vaccine is free—doctors don’t stand to make any money by recommending it. So when people imply that doctors are just peddling the vaccine as a profit center, their facts are wrong.

To Mr. Maher and all of the other untrained champions of health and well-being, let me suggest that you spend a week or even just a day in a local hospital. Talk to the patients, learn about their illnesses. Find people with vaccine-preventable diseases like H1N1 (or pertussis or pneumococcal pneumonia)—and these people are in the hospital, I assure you—and ask them if they could do it over, would they have been immunized?

Doctors are legally liable for the advice they dispense; you are not. If I tell someone not to get a flu vaccine and they catch influenza, I assume several layers of culpability. The one you might point to is fiscal: the risk of a lawsuit. But the one consequence that makes me lose sleep at night, and the very one that you feel remarkably comfortable glossing over from the studio desk chair, has nothing to do with dollars. That consequence is that someone is no longer healthy. In discouraging a vaccine, I leave a patient vulnerable to an illness. If the patient gets that illness and suffers serious complications or dies from that illness, it is on my conscience. If you really weigh this side of the equation, how can you not feel an inkling of the same?

It is not my job to dictate whether patients get vaccines. All I can do is read every study I can get my hands on, weigh the risks and benefits, and then come to a conclusion. What patients do with that conclusion is their business. Not mine, and not yours either.