I Want The Drug Of Choice

A retired teacher recently presented with nontender quarter sized minimally red blotch on her leg. She told of recent treatment for a skin infection at an ED. She had no drainage to culture so was treated empirically with a cephalosporin, the infection rapidly diminishing but she soon stopped the med due to GI side effects leaving this minimal lesion. A few days later she came to my office, seeking further treatment.

Mrs. Surfer:I want linezolid for this. The Internet says it is The Drug Of Choice for skin infections.

Dr. Dall: It's used for severe, dangerous infections with possibly resistant staph. We try to hold it in reserve so we don't breed resistance.

Mrs. Surfer: I want the best medicine, it is what is recommended.

Dr. Dall: I'm not going to give it to you. Your infection is minor, non-threatening, and responded to an ordinary antibiotic and is essentially gone. You don't need a horrendously expensive IV medicine.

Mrs. Surfer:I want the best medicine, I don't care about the cost. I can pay for it if my insurance does not.

Dr. Dall: I'm not going to give it to you, I reserve it for specific circumstances.

Mrs. Surfer:Could you give me IV penicillin then? I won't take anything oral.

MMR Derangement Syndrome

BMJ published the first article in a series documenting how Andrew Wakefield falsified data to publish a purported link between the MMR vaccine and autism. Please read the article and commentary  in full (and future installments as they are published).

A summary from the BMJ article:

How the link was fixed

The Lancet paper was a case series of 12 child patients; it reported a proposed “new syndrome” of enterocolitis and regressive autism and associated this with MMR as an “apparent precipitating event.” But in fact:

Three of nine children reported with regressive autism did not have autism diagnosed at all. Only one child clearly had regressive autism

Despite the paper claiming that all 12 children were “previously normal,” five had documented pre-existing developmental concerns

Some children were reported to have experienced first behavioural symptoms within days of MMR, but the records documented these as starting some months after vaccination

In nine cases, unremarkable colonic histopathology results—noting no or minimal fluctuations in inflammatory cell populations—were changed after a medical school “research review” to “non-specific colitis”

The parents of eight children were reported as blaming MMR, but 11 families made this allegation at the hospital. The exclusion of three allegations—all giving times to onset of problems in months—helped to create the appearance of a 14 day temporal link

Patients were recruited through anti-MMR campaigners, and the study was commissioned and funded for planned litigation

The original paper fueled anti-immunization sentiment, and contributed to decreasing immunization rates and increasing infection rates across the Western world. Although the original paper was retracted last year by the Lancet, and Wakefield was stripped of clinical privileges in Britain, he remains a star of anti-immunization groups.

For his fraud, Wakefield gained fame and filthy lucre (including over $600000 from the legal firm). He remains unindicted, free to peddle his ideas here in the US.

The rest of us have paid a heavy price for these lies, in distrust and alienation between parents and doctors. In millions spent trying to disprove a fantasy. In children with preventable illness and untimely death.