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Speed of Thiomerosal Stumps

Supposedly a scientist, it is hard to keep up with evidence based life, let alone evidence based medicine.

The American Academy of Pediatrics (http://www.cispimmunize.org/IZSchedule.pdf) recommends a certain schedule of immunizations. Those recommendations are evidence based, right? So why am I having so much trouble figuring out why the Hep B series is recommended to all kids? As an adult I only need it because of I am a healthcare worker around needles. What about thiomerosal? What about autism? Recent reviews are reassuring on the later. In Acta Paediatrica, 2005 Jan;94(1):2-15, M. Rutter from the Institute of Psychiatry, Kings College, London, UK writes that “there is no support for the hypothesis for a role of either MMR or thimerosal in causation, but the evidence on the latter is more limited”.

But, my roles of parent and public health worker conflict when I read statements like that from A. Madi in Acta Acta microbiologica et immunologica Hungarica. 2005;52(1):95-103: “While specific recommendations were made to eliminate thimerosal from vaccines, consistent evidence is still lacking for an association of exposure and disease.” I don’t require proof that mercury is harmful to my baby to avoid it if there are other good reasons to do so.

Speaking of autism, or purported risks thereof, really enjoying the Nebula winning The Speed of Dark by Elizabeth Moon (http://www.sff.net/people/Elizabeth.Moon/). The author has an autistic daughter, and gives us an interesting protagonist who suffers from the same.

Anyway, put me down as a vaccine fan. Hib virtually eliminating H. flu meningitis in kids springs to mind in recent emergency medicine. I have never seen measles (Koplik’c spots? – http://www.whonamedit.com/doctor.cfm/1411.html). But I remember taking care of a young 20 something MVC trauma victim who had a solitary testicle. He explained that his mom chose not to give him the MMR, and then as a teenager he got mumps and necrosed a nut. An n=1 perhaps, but a memorable anecdote.

An international emergency medicine resident at Hopkins gave a talk about tetanus in India. There they have tetanus wards and patients with chronic tetanus. That’s nuts. BTW, I hear that forgetting to give tetanus in the ABEM oral boards is an automatic fail of the case.

Other studies are needed:

Prospective case-control study of kids raised on Dr. Sears’ attachment parenting vs. raised on a tight schedule with a crib and bottle with 25 follow-up measuring level of being a better, happier person.

Prospective case-control of pulling that dried black umbilical stump off vs. leaving it on (I wanted to show my wife it was okay to peel, but while conducting the literature review, it fell off.)



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