Monday 17 March 2014

Surgery must be stopped!

A reader alerted me to this article in the newspaper The Times a few days ago, and I thought I would share it:
LONDON (Reuters): In a shocking announcement, the United States Department of Health and Human Services, the UK Department of Health, and the Canadian Ministry of Health have all agreed to suspend recommendations for laparoscopic cholecystectomy, a minimally-invasive removal of the gallbladder that is among the most common procedures performed worldwide.  US Secretary of Health and Human Services Kathleen Sebelius quoted the enormous number of patients seriously injured and killed by this procedure each year as the reason for withdrawing their recommendation, and she demanded more research into why so many people have this operation performed.

"In the United States alone," Ms. Sebelius reported to a joint session of congress last week, "there are approximately twenty million people living with gallstones.  There is only about a 20% chance of these patients developing gallstone pain over a 20 year period, yet 500-600,000 people still have their gallbladders surgically removed each year in the US.  Every one of those patients is at risk of hemorrhage, infection, bile duct injuries, blood clots, and even death."

Indeed, statistics show that up to 15% of patients undergoing laparoscopic cholecystectomy, which was only first done in 1985, are converted to the "open" technique, which is the old-fashioned procedure and involves a much larger incision, slicing across the abdominal muscles and causing much more pain and an increased risk of bleeding and wound problems.

In addition to bleeding and infection, up to 3 in 1000 patients undergoing this incredibly dangerous surgery will accidentally have their main bile duct accidentally torn, cut, or clipped, and these injuries are often not identified until days after the surgery.  Almost 1 in 500 have a hole punctured in their stomach, colon, or small intestine, and unbelievably the overall complication rate is as high as 1 in 20.  As many as 1 in 250 undergoing the procedure die due to complications, and if you happen to be lucky enough to survive, you have a 40% chance of developing bloating, abdominal pain, and indigestion, possibly permanently, after surgery.

"These injuries and deaths could all be prevented if people would just opt to live with their gallstone pain," Canadian Minister of Health Rona Ambrose told Reuters yesterday.  "Surgery just shouldn't be necessary.  I've heard a few anecdotes of people who read a story on Natural News and bought some kind of magic potion on Amazon or something which promises to flush the body of toxins and gallstones and other evil humours.  Surely this is a better option than letting sadistic surgeons cut you open and remove an organ.  These people were trained by barbers as recently as last century!  It's truly barbaric." 

UK Secretary of State for Health Jeremy Hunt went even further, stating "More investigation into the dangerous and lethal practice of surgery is needed.  We cannot in good conscience recommend anyone have this surgery, and possibly any surgery, until we can be sure that no one will ever again suffer a complication of any kind.  To my knowledge there has never been a double-blinded study done on gallstones, and until that is done we feel the practice should be stopped.
Sibelius, Ambrose, and Hunt all suggested trusting a random website which touts the healing power of cilantro and turmeric than some doctor who spent 20 years getting educated in the cutting-edge science of healing people.

Now for those of you whom have never read A Modest Proposal by Jonathan Swift, I suggest you click on the link and read it before you go any further.  I'll wait.  No seriously, go read it and I'll wait here.

All done?  Good.  The above Times article I just quoted is satire and entirely fabricated.  It never appeared in any newspaper, because I just wrote it.  However, the statistics I quoted are actually 100% true, and I presented them in a way to make the procedure seem as terrifying as possible.   

So why am I making it sound like my colleagues and I are butchers who routinely maim and kill innocent people?  Because I want to put myself out of business?  No, it's simply to illustrate a point.  People undergo surgery knowing that it is relatively safe, though not 100%.  The risks of surgery are small, but patients undergo it anyway, because the benefits far outweigh the risks.

"So what's the point, Doc?  What does this have to do with anything?"

My point is that many people these days are opting not to immunise themselves and their children against preventable diseases, even though vaccines are orders of magnitude safer than surgery.  There is a large (and growing) faction of anti-vaccinators who forgo vaccines against measles, hepatitis B, tetanus, the flu, and others, many of them potentially-fatal diseases, because there are infinitesimally small risks.

What these people fail to realise is that there are risks with everything.  There is a risk that your car will explode when you start it.  There's a risk a meteorite will fall on your head and kill you.  There's a risk that a sinkhole will swallow your house.  There's a risk a squirrel will maul your face in your sleep.  But that doesn't stop us from living our lives.  It does make me close my windows at night, though...fucking evil squirrels.

But this is just how absurd anti-vaccination zealots and their arguments against routine vaccinations are.  Vaccines are very safe, and this has been studied and documented over many decades.  But vaccines are also not 100% safe, and this has also been well documented over the same period.  Just like with surgery, a few people are injured, and a few people die.  But vaccines are far safer than surgery.  Of the millions upon millions of doses of vaccinations given per year, a handful of people are seriously adversely affected.  By far the most adverse reaction is pain at the site of injection, but headaches, malaise, and flu-like symptoms are also very common.  The serious reactions (including death) are fleetingly rare.

The anti-vax faction wants people to believe that these serious reactions are much more common than they are, making their stories sound as alarming and as terrifying as possible just as I did with my story about gallbladder surgery.  They are also desperate to link vaccines to everything from autism to diabetes to other auto-immune disorders.  But there is no conclusive evidence linking vaccines to any of these.  Stories and anecdotes abound ("I got the flu vaccine, and the next day a train crashed into my house!  It must have been the flu vaccine!"), and everyone seems to know someone who knows someone whose child developed autism 2.4 seconds after getting a vaccine.

The most telling aspect of anti-vax lunacy is how they claim that vaccines don't work.  They have graphs that show how the death rate of various diseases was already dropping before vaccines were introduced, so obviously vaccination is a hoax!  I mean, just look at these graphs and see for yourself!
"Oh my god!  Vaccines really haven't saved us!  It's all been a lie!"

Now wait a second and think.  Look at the dates on the graphs.  The advancement of medicine and antisepsis and supportive care were exploding in the early-to-mid 1900's, so of course the mortality rate would improve independent of vaccines.  What the anti-vax people don't want you to see is the trend of the actual incidence of the diseases:
As they say, a picture says a thousand words.  You can clearly see the normal annual fluctuations in incidence, but you can also clearly see how the rate dropped to near ZERO after the vaccines were introduced.  There is just no doubt that vaccines do exactly what they are supposed to do, and they have successfully eliminated (or nearly eliminated) many potentially-deadly illnesses, including polio and smallpox, which killed between 300 and 500 million people in the 20th century alone.

Despite this seemingly-overwhelming evidence, these groups of people, medical professionals included, continue to denounce vaccination programs, believing the minimal risks outweigh the concrete benefits.  These nurses and doctors are advising their patients not to immunise themselves and their children, recommending instead various foods, potions, herbs, and other hocus-pocus voodoo magic, which may all be perfectly healthful, but will protect you from polio exactly as much as a boot to the head will.  As the movement grows, outbreaks of these entirely preventable diseases are becoming more and more common

I would never be so duplicitous as to say that vaccines are 100% safe, because they are not.  But they are pretty damned close.  They are probably the second-most safe and effective preventative measure (next to soap) medicine has ever known.  Parents need to understand that there are risks, no matter how minuscule, before they come to a decision about immunising themselves and their children.  But they also need to understand how the benefits far outweigh those risks.

Now who is ready to have their gallbladder removed?  I have an opening next week.


  1. People can be so gullible. Too many want to live a risk-free life, and seem not to realize that it is impossible. I often wonder how these anti-vaxxers would react if polio or something like it would to make a reappearance. My parents grew up when polio was common, and when the polio vaccine was available, they dragged us to the school gymnasium to get vaccinated, no hand-wringing and worrying about the risk. What's worse, a small risk of a negative reaction to the vaccine, or a larger risk of contracting polio and ending up in an iron lung?

  2. The TV show Law and Order:SVU did an episode about anti-vaxers. If I remember correctly a mother who chose not to vaccinate her child led to the exposure and death of another child. I don't believe she was held accountable for this because the law was not up to date and she was found not guilty. Although the show is obviously fiction, the premise is still incredibly thought provoking. Personally, I was astounded and frustrated the anti-vaxer was not punished. Hopefully, a similar situation does not occur in real life due to the ignorance of others.

  3. BRAVO!!! Thank you Doc. Thank you.

  4. I'm all for vaccines! College in the States won't let you in unless you've had the proper vacs... And quite a few high schools are following that.

  5. Both my kids (now adults) were vaccinated at regular levels. The oldest, had to drop the P from the DTP he had a bad reaction. All the rest of his vaccinations were on time. Shoot to 6th grade, when we lived in a house that had toxic mold. His immune system was shot to hell, he had strep 4 times as well as undiagnosed mono. He started coughing, and coughing and coughing some more. It took a visit to the PCP's office for a breathing treatment when the allergist walked by and said how long has he had whooping cough. Nearly lost him. I think anti vaxers use bad science and listen to non science based people like Jenny McCarthy.

    What I want to know is why when I got my flu shot on a Tuesday, by Friday I was sicker than my dog?

    1. Coincidence. The flu shot contains only the dead virus, so it's impossible to get the flu from it. You may have picked up your virus when and where you got the shot. But it wasn't the shot itself.

  6. I think a lot of people insist "vaccines make [them] sick!" because they get a tender arm or the sniffles for a few days after a flu shot (I know suffering is relative so I won't call them spoiled, pampered whiners). But really, most people born after 1950-60 in the Western world have never experienced or seen one of the really severe, ugly, dangerous illnesses that vaccines have all but eradicated, and based on their limited and uninformed experience, legitimately believe the vax does more harm than good. I've tried to explain herd immunity and the technical aspect of how a vax stimulates the immune system, but stupid people are also usually stubborn - I don't even think their kid getting polio would change their minds.

    1. Does pneumonia count as a severe illness? 'Cause I've had that. And the Bubonic Plague still gets a few people here in California every year.

  7. Not being vaccinated is actually the perfect strategy if you can rely on everyone else being vaccinated. That way you eliminate the (very tiny) risk from the vaccine itself but will also not catch the disease because nobody else will have it and so they can't pass it on to you.

    Sadly everyone else is so selfish that they won't listen when I tell them that they need to get vaccinated so I don't have to!

    Needless to say our kids have had all of their vaccinations. Not only is it safer for them, it also prevents us from being the type of social parasite who relies on everyone else keeping the incidence down so that they avoid infection.

    1. The problem with that strategy is some vaccines are only given at a certain age (ie 12 months) or sometimes certain people need a booster dose to actually become immune. Meaning even if they plan to be a responsible citizen and be vaccinated, they are vulnerable for a short amount of time. Now imagine some jerk who chooses not to get their vaccine because they figure everyone else will, they get sick anyways, and then spread it to the poor innocent responsible people! Better for everyone to get vaccinated ;)
      What do I know though, I'm not a doctor! :P

    2. Yes - I hope you appreciated that I was not seriously advocating that as a strategy. It's fine in theory but in practice hopeless and highlights the fact that not getting vaccinated is a very selfish approach - it relies on others taking a risk that you won't take yourself. As I say, we had both of our kids vaccinated as early as we could.

  8. For a moment there I was worried I'd have to argue with doc about gall bladder surgeries . I thought he was about to call that article fake( well the #s) . I wouldn't like to argue with his awesomeness!
    I work as a PACU nurse and those gallbladder things made me laugh ! Actually tonight we had two galbladder have to go open and one with perf viscous . I was like hmm okay . But yes for the most part most surgeries turn out fine . My only issue with gallbladder surgery is the freaking surgeons drive around in the middle of the night trying to find people who want their gallbladder removed !

    I know it's true

  9. My high school won't admit you unless you've had proper vacs

  10. When my son had his first DPT, he developed a neurological reaction ("Crie de Chat;" or encephalitic cry) so we couldn't repeat it; he was fully immunized otherwise (this was before the DTaP shot was available). In 6th grade, there was an outbreak of pertussis (whooping cough) in his school; my son, an asthmatic, contracted it. IT WAS HORRIBLE. IT WAS LIFE-THREATENING. IT WAS THAT BAD FOR OVER A MONTH. He would coughcoughcoughcough, then his airway would spasm and he would be completely unable to breathe. For up to 70 seconds. Yes, I counted. My husband and I took turns going to work. We had to put him on home instruction. PS our daughter, fully immunized, did not catch it.

  11. I had laproscopic removal of my gall bladder and I would not have changed my mind, even seeing these statistics. I consider them to be fairly good considering there was a human being who was cutting into my body.

    I also have a son who is Autistic and one who is ADHD. I vaccinated them and would still do it again. Because vaccines did not make them this way. There is a very strong genetic trait in my family and a mild one on the other genetic side.

    I wish I had had a choice for chicken pox vaccine as a child as I ended up with a wicked case of shingles that left me with severe nerve damage for over two years.

    Everything has risks. Walking down the steps has risks.

  12. Thank you for this entry. I'll be sharing this far and wide. And by the way, I had my gall bladder removed, laparoscopically, in 2001. ;-) Die of infection or take the small risk inherent in any surgical procedure done... I chose surgery.

    Without giving my identity completely away I'll just add that the 2nd part of my email addy is if that rings any bells for you. Again, thank you for addressing this subject.

  13. I happen to agree that we remove gall bladders a little too freely. When I was 15 weeks pregnant I was having raging gallstone attacks and went to the ER. They were about to cut me then and there but I wanted to wait and speak to my doctor. After consulting with him and another specialist, I went on a strict fat free diet for the rest of my pregnancy and I have not had another gallbladder attack since (it's been two years). Surgery is never a matter to take lightly no matter how minor, especially during pregnancy, and as the (tongue in cheek) article rightly pointed out, cholecystectomy is hardly as minor as many people believe.

    1. I agree with you. Some surgeons operate a little too freely. I was going to have surgery to hopefully alleviate my acid reflux. My surgeon didn't tell me any alternatives such as losing weight to help instead of surgery. Actually, docbastard was the one who told me that I should try losing weight first before trying surgery.

  14. What amount of truth is there that vaccines do not protect you forever, thus leaving you vulnerable to those same diseases when you are older?

    1. Some, depending on the vaccine. This information is well-documented and easy to look up.

    2. I will look it up. It's an interesting subject.
      Would you still recommend to take up those vaccines if the danger is worse when we are adults? An honest question, not argumentative.

      Thank you for the swift reply.

    3. Yes, without question. The benefit of vaccines is orders of magnitudes greater than the potential risk.

  15. Vaccines are a great tool that should be used. That being said I hate getting the flu vaccine I get sick afterwards every time. I just attribute it to being imunecompromised (i don't think I spelled that right). But I still get the shot. I've gone through the flu 2009 was particularly bad and I don't want to be the one who didn't get the vaccination and be the carrier for other to sick.

    What I'm is get the vaccines done.


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