Medical Decisions

In the Bible, Proverbs 17 Verse 28 says: “Evan a fool who keeps silent is considered wise.” In 1907, Maurice Switzer updated that to read: “It is better to remain silent and be thought a fool than to open your mouth and remove all doubt.”

When I was a Hospital Commanding Officer, I relied on my Chief Nurse for nursing advice, on my Administrator for advice in that area, on my Chief Flight Surgeon for flight medicine advice and on the Base Dental Surgeon for dental advice. That was because I was sure that I didn’t know everything about everything.

Some of my fellow Commanders often took the attitude that becoming a Commander made them smarter than everyone else in the room regardless of the topic.

W. Edwards Deming was the father of Japanese product efficiency. When he went to Japan after World War II, the term “made in Japan” meant it was junk. By the 1970’s, cars, electronics and other items made in Japan were all of high quality. They got there by following his principles. Today, one of the top awards in the world for efficient companies is the Deming Award.

Deming’s principles focused on the average worker. He contended that the person doing the job every day, knows how to do it best. Executives often act like they know more than they really do. Deming referred to that as meddling.

We have recently seen an example of this in the United States. The MMR (measles-mumps-rubella) vaccine started to be used in 1971. It has now been in use for 54 years with no problems. Even though Dr Wakefield tried to question it with made up data trying to say it caused autism, he was caught and rightfully disgraced.

In 2003, it was combined with varicella (chickenpox) vaccine to create MMR-V. Studies have shown a small increase in febrile seizures with the combination. A febrile seizure is a seizure associated with a fever in small children. The varicella component caused a fever. There were statistically more seizures with the MMR-V than with the varicella vaccine alone.

While it was statistically more frequent, the actual numbers were small because they did not occur often. Febrile seizures are considered benign. Therefore, despite the small increase, MMR-V was continued.

The problem was that even though they are benign, it is traumatic for a parent to watch their child seize. One of my grandsons has febrile seizures. The first was emotionally traumatic. After that, it was more of a here we go again thing.

The best approach would be for parents and their physicians to discuss it and decide whether to give the MMR and varicella separate or not. Recently, the Federal government decided that it was not a decision for parents. They asked that we go back to separate MMR and varicella shots. There was really nothing wrong with that decision. It just no longer allowed parents to make the decision with their doctor.

However, Donald Trump then decided that we should also split up the MMR shot and give three separate vaccines. There were several issues with this.

The first is that we have been giving the vaccine for over 50 years without any difficulties. The second is that there are no single vaccines. They would have to be created. They would have to be studied to see if the side effects separately increased over the combined vaccine. There would be a lot of unnecessary money spent by the government.

The problem is that he thought being President makes him knowledgeable about everything including medicine. That is not the case. Anyone can make a mistake. Acknowledging that and building off of it for the next time is the goal.

That next time it might be wiser to say nothing at all. The Bible, Maurice Switzer and W. Edwards Deming would be proud of that approach.