Archive for May, 2015

A confession about immunizations

May 3, 2015

It may be hard to believe, but I have never seen a case of chicken pox as a physician.  Yes, even after seven years I have not seen a single case.  Of course I have read about it – I have even experienced it when I was in second grade but I have never diagnosed it.  

I think this remarkable fact illustrates the effectiveness of immunizations. I thought about their effectiveness as a pertussis outbreak engulfed our county this winter.  Pertussis immunization is highly effective however it does wane some with time. Due to the high number of persons who are nonvaccinated, several population areas are below the herd immunity threshold.  As a consequence the new immunization recommendation is that persons in area of outbreak be immunized again and all persons have a one time booster. 

This winter the Wall Street Journal had a powerful visual reminder of the power of immunization:


Doctor…What’s my risk?

May 2, 2015

For the most part, humans are a poor judge when it comes to estimating statistically small risk.  One example chance of death in an airplane vs car.  When you get behind the wheel of a car, you are more likely to die in a car crash than when you board a plane.

Similarly in medicine we have the same problem.  Last week in my office, a patient came in to address her weight.  There are certain drugs that are FDA approved to address weight loss and so we discussed the risks and the benefits of each one.  Towards the end of our conversation I scrolled through her medical file and notice that the patient smoked about 1/2 pack of cigarettes a day.  I causally asked if she had thought about quitting.  It didn’t occur to the patient that her continued smoking carried a far greater risk of death than her weight.

Robert Wood Johnson Health Foundation established a new tool this year to help visualize health problems  

I will include some of these graphs in future articles