Archive for 29th April 2009

VACCINATION

The technique of vaccination was discovered in England in the late 18th century by Sir Edward Jenner, who noticed that the dangerous disease, smallpox, did riot affect milkmaids, who were exposed to a similar disease in cows, known as cowpox. Jenner used material from cow-pox sores to immunise patients against smallpox.

Vaccines are made from viruses and bacteria which have been killed or weakened by heat or chemical treatment but are still able to provoke an immune response which causes the production of antibodies to that disease. Sometimes live organisms which are non-virulent to human beings, such as cowpox, are used as vaccines.

During pregnancy most live vaccines are not permitted, since the live organisms can cross the placenta, causing abnormalities in the foetus. Smallpox, rubella, hepatitis B and yellow fever vaccines all contain live organisms, as does the Sabin vaccine against poliomyelitis. None of these are suitable for pregnant women. However the Salk vaccine against poliomyelitis and vaccines against hepatitis A and B, cholera and typhoid fever are all permissible.

The subject of vaccination is controversial. Some children have serious reactions to vaccines. However a great deal of serious disease has been prevented by vaccination. As a result of world-wide vaccinations against smallpox, the virus has become almost extinct. Among the diseases for which vaccines are available are diphtheria, tetanus, whooping cough, poliomyelitis, measles, rubella, tuberculosis, hepatitis A and B, cholera, typhoid, paratyphoid and yellow fever. Many of these vaccines are available free of charge, especially for children. It is recommended that children be vaccinated against polio at two months and begin a series of three ‘shots’ to immunise them against diphtheria, tetanus and whooping cough. Unfortunately the whooping cough vaccine can cause serious side effects in about one in 100,000 cases. In Britain, where concern about these side effects prompted many people not to have their children vaccinated, major whooping cough epidemics resulted and a number of children died or suffered serious brain damage. It would be wise to consult a doctor if you are worried about the effects of such vaccination. One should also remember that the side effects of vaccination are generally less dangerous than the disease itself.

When travelling to foreign countries where certain diseases are common, doctors often advise patients to be vaccinated a number of days before their departure to allow time for the immune system to produce the necessary antibodies.

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DEPRESSION IS A SERIOUS ILLNESS THAT SHOULD BE TREATED BY A DOCTOR

Depression can certainly be an extremely serious and, in some cases, even a fatal condition. But the symptoms of depression range in severity from severe cases to milder instances of feeling stressed and overwhelmed or lacking in energy and enthusiasm. In this regard, depression is like many medical problems, for example headaches, which can range from tension headaches to the intense throbbing pain of migraine or the pressure headaches that may signal the presence of a brain tumour. While tension headaches can be treated simply with painkillers, the more severe headaches need the help of a neurologist. Just as you might not consider going to a doctor if you suffered from mild tension headaches, so you might not feel the need to get medical help for mild symptoms of depression or stress.

Regardless of what one believes the ideal course of action in dealing with depression to be, a simple inspection of the numbers will indicate that it is impossible for all people with depressive symptoms to be taken care of by doctors. According to one estimate, 17.6 million people in the US alone suffer from major depression. There are approximately 38,000 psychiatrists and 17,000 GPs in the US. If all the depressed people were evenly divided among these providers, that would mean approximately 320 depressed patients for each doctor. Such numbers would pose an overwhelming case load for a practitioner, who would also be expected to care for patients with other types of disorders as well. In addition, patients with major depression constitute only a fraction of individuals with depressive symptoms. According to one widely respected population study, more than one in five adults complained of depressive symptoms in the month before they were surveyed. Many of these were regarded as suffering from what is known as subsyndromal depression, a less marked form of the condition but one that is nevertheless responsible for considerable misery and suffering. Clearly it is unrealistic to imagine that all of these people could be properly taken care of by the mainstream medical establishment and the evidence bears this out.

In a recent consensus statement in the authoritative Journal of the American Medical Association, a group of leading researchers pointedly observed:

In the Epidemiological Catchment Area study, a nationwide community survey of psychiatric illness that was conducted around 1980, approximately one third of people suffering from a major depressive disorder sought no treatment for it. Of those who sought treatment, few received adequate treatment. In fact, only about one in 10 of those suffering from depression received adequate treatment.

R Hirschfeld and colleagues,

Journal of the American Medical Association, 1997

These same authors reviewed the psychiatric histories of people who entered various depression research studies even more recently than the 1980 study mentioned above, during the years when the SSRIs became very popular. Even so, the researchers concluded:

The lack of any prior anti-depressant treatment of patients is striking, ranging from 67 per cent to 48 per cent, who despite being ill for a median of … 20 years never received any anti-depressant medication. The range of patients who received adequate treatment is also sobering: from a low of 5 per cent to a high of 27 per cent.

Experts in public health have pondered the reasons why people have not received treatment for their depressive symptoms. In some cases, medical personnel may fail to make the correct diagnosis or to treat the problem adequately. In other instances, the depressed person may not recognize the problem, may be embarrassed to seek help for it, may feel afraid of going to a psychiatrist or deterred by the stigma associated with the diagnosis.

Whatever the reasons for the failure of mainstream medicine to take adequate care of depression in a large proportion of affected individuals, there is general agreement that depression is common, exacts a serious toll on the lives of those who suffer from it, is underdiagnosed and undertreated, and that there is a great deal of room for improvement in the situation.

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