9.10.2009

Incurable Optimism

Above: Michael J. Fox on the cover of his latest book, Always Looking Up.

"Simple things can change the world -
be the difference you want to see in the world."
Sam Malek, Extreme Makeover: Home Edition

Optimism has definitely been my "cuppa tea." To me, its quite an interesting concept: How can people who face battles where the odds are against them possibly see a light at the end of the tunnel. I think that strong optimists are goal makers who love to think of the extreme, and perhaps the impossible. Some people term these ideas "blue sky." (I love thinking of it this way: Without blue sky ideas, how can one possibly enjoy the sunshine?)

(One of my fellow med students has given me the nickname Mr. Sunshine, by the way.)

I finished Always Looking Up, by Michael J. Fox a few weeks ago. I loved the subtitle he threw on the book: The adventures of an Incurable Optimist. The obvious meaning first strikes: his optimism is shadowed by a lack of a cure for his condition of Parkinson's. However, I can see him meaning optimism has become such a stronghold of his life, he just can't let go of it. I think Mr. Fox does a great job of showing how it gets him through life and through his foundation and the values he advocates (not only through his public life but through his family).

It got me to think,there have been times I haven't felt a strong sense of optimism surrounding me during my medical school career. And for an optimist like myself, negativity is like kryptonite. I can recall examples: seeing motivations for studying simply driven by potential failure, healthcare agendas in congress seeming more like battlefights to avoid the worst, and even today's doctors simply saying that they either joined a specialty simply for the "lifestyle" or complain about the profession becoming a defensive one, saying our job is basically to avoid being sued.

No, it's not bad to assume the worst or to be realistic. It becomes a problem when one gets infatuated with negative ideas.

Even in the light of those ideas, I still believe medicine is about optimism. I could ask myself: Why should we take care of people, even if the odds are bad? Because, there's hope that person can continue to live life potentially to do something great. I believe that everyone has a right to go on and do something amazing, for themselves (e.g. go explore a place one has never been to before) or even society.

A quick example of the latter: Mom's been on a roll getting me to watch TV. This time it was Extreme Makeover: Home Edition. Sam Malek is a coffeeshop owner in the metro area of St. Louis, Missouri. However, Sam Malek is not your average Starbucks owner. According to Sam, a man who was born premature with cerebral palsy (an umbrella term to describe conditions where damage has occurred in brain areas that affect movement and posture), he was thrown right into a trash can. Today, he goes around with the aid of crutches, but never complains and clearly loves his life. He wanted to give others like him an opportunity he always wanted. He started up a coffeeshop called More Than Coffee, dedicated to employing those who have crutches, wheelchairs or other disabilities who might not find a job elsewhere. His idea was spurned by his philosophy, as quoted above (I love that quote). You know, had nobody taken care of him, I don't think he would have ended up taking that idea to do something that I deem amazing.

And perhaps, I've strolled across another reason why I love medicine. I see it as a field where the work we do teaches (or at least should teach) people about hope and optimism. Through our amazing job, we can teach others to be amazing in their own way too.

9.07.2009

Proof Positive?

Above: Dr. Andrew Wakefield surrounded by supporters, found via Google Images.

VACCINES?
FRIEND OR FOE?

My mom always calls me down from upper deck (my term for the second floor of our house) to watch television programs. Sometimes, I don't really care (e.g. America's Got Talent results shows), but when my mom mentioned the words "autism" and "Dateline" put together, I said to myself, "This 'oughta be good." Next thing, I'm flying down the stairs and next to my mom I plopped myself in front of the television. The show: "Dateline: A Dose of Controversy" on NBC.

The story was behind Dr. Andrew Wakefield, formerly a researcher in Britain, now a head of an autism intitute in the Americas called "Thoughtful House." Reporting by Matt Lauer of NBC centered around the growing trend of people stopping vaccinating their children, due to a believed link between autism (a brain developmental disorder that hinders social interactions with others) and the MMR vaccine (a combination vaccine against the Measles, Mumps, and Rubella viruses), an idea being pursued by Dr. Wakefield. It was soon encouraged that patients start taking vaccinations in separate form (one shot for measles, another for mumps, and another for rubella). In the wake of his research, published in The Lancet (a reknowned British Medical Journal, similar to our New England Journal of Medicine), a slew of controversy over motivation for the research arose as families started demanding the single vaccines (creating a shortage of supply) instead of the combination vaccine.

The program also presented the pro-vaccination side of the story, featuring Dr. Paul Offit, a renowned researcher in Pediatrics in the United States, co-credited with the creation of the Rotavirus vaccine, saying that vaccines are not associated with autism and are very safe. In his 2008 book, Autism's False Prophets, he talks about the misinformation going on in the This point of view is shared among many doctors, autism researchers, and medical journals, according to the New York Times. However, in pop culture, Jenny McCarthy, along with Jim Carrey, a Hollywood-led grass roots effort has been going strong, raising questions about the true safety of vaccines. At Autism conferences, Wakefield gathers great support from parents who believe that their kids have autism.

Since the report now over a week ago, a lot of parents and advocates on the Autism Web Newspaper The Age of Autism have spoken out for their support of Dr. Wakefield, and Dr. Wakefield has released a statement saying that Matt Lauer's report on NBC had left out critical facts, such as Dr. Paul Offit's connections and associations with vaccine makers, and crediting research that has supported Dr. Wakefield's findings (Just like other mass media, bias was definitely present in this report towards the pro-vaccination point of view).

For a medial student like me, it makes me wonder, 1) Where did the distrust in medical science begin? and 2) How can we earn the trust in these people again?

That is... especially when our empirical research shows differently from what others believe. Disagreements in empirical research and in the information being conveyed to the public could take away from the giant strides that vaccines have made in fighting diseases. Outbreaks of diseases we thought we have had a control over are coming around in areas that are not being well vaccinated. If this trend grows, these outbreaks may grow.

I wish I had the answers to the questions I proposed in this entry, but at least this debate has a lot of ethical food for thought for both us clinicians and patients in today's world.

Sources: Dateline NBC, Thoughtful House and The Age of Autism.