Ep. 24 Dr. Bich-May Nguyen - Public Health in Houston: Vaccinations
Dr. Bich-May Nguyen 0:00
***radio effect on voice*** I mean, I think it's like any, other when you are trying to have a conversation with people about something that you may not agree about, then facts and science don't always, they're not always persuasive. And so for some people, it's much more helpful to kind of talk about stories and anecdotes, right. Because that seems to be more memorable. But for every person who worries about how safe these vaccines are, I can, I share those stories that I have of the patients I have taken care of who have not been vaccinated.
Rob Icsezen 0:40
What's up Houston! Welcome to H-Town Progressive, Houston's impenetrable fortress of progressive thought! I'm your host Rob Icsezen!
Measles! Diphtheria! Polio! Rubella! Mumps! Smallpox! Tuberculosis! Whooping Cough! Oh, my! These are all diseases of varying degrees of severity and contagiousness, and one of the things that they all have in common is that you almost definitely have never had any of them. You might not have even heard of some of them outside of references in books and literature. And well, that's a very good thing, because they're all pretty nasty and even fatal in some cases. But not that long ago, they were a very real threat and the day to day lives of pretty much everyone. And that looming threat has largely been eradicated because of one wonderful development of modern medical science: vaccines. You don't have to be a scientist to understand that before vaccinations, certain diseases were ubiquitous. And now with vaccinations, those diseases have either been eradicated, as with smallpox, or have been made very rare, as with measles. The results are undeniable. That's why, I've been vaccinated, and you've also probably been vaccinated, in each case, because our government has required that we be vaccinated. Communicable disease is a public health problem, which is to say that the solution is found in the collective action of the population. One person getting vaccinated doesn't solve the problem. We all or at least most of us need to do it for it to be effective. And our society has understood this for some time and done a pretty good job of addressing it through appropriate vaccination policy. But recently, we've seen the rise of the anti-vaxxers, people who refuse to comply with public vaccination policy by not vaccinating themselves and/or their children. And well, as a result, not surprisingly, we've seen outbreaks of preventable diseases like the measles popping up all over the place from California to right here in Texas. And these anti-vaxxers justify their position often by appealing to religion, where they are entitled to exemption from certain public policy in many states, Texas being one of them. They also appeal to junk science, usually peddled by those who have something to gain from it, whether it be industry or celebrity. It looks very similar to the arguments made by those who deny that climate change and global warming are happening and caused by humans. And it's frankly maddening, because these are problems with solutions. We have the tools, people, we just need to use them! There's a lot of stuff in the world, that's hard to understand. And it's mostly okay that we don't understand most of it. But sometimes, particularly in the case of these big problems with solutions that require collective action, we need to be better at accepting the underlying logic and science of the matter, even if we don't understand every aspect of it. But don't take my word for it, I'm just some damn lawyer! No, you should listen to those who have spent their careers working on this stuff like our guest today.
Dr. Bich-May Nguyen (http://www.bichmaynguyen.com/) is on the Family Medicine Residency faculty at the memorial Family Medicine Residency Program in Sugarland, Texas where she is also the research director (https://www.memorialfammed.org/faculty.asp). Her research interests include students specialty choice, workforce diversity and health policy. Dr. Nguyen earned her MD in the Underserved Track from Baylor College of Medicine (https://www.bcm.edu/education/schools/medical-school/md-program/curriculum/pathways/care-of-the-underserved-pathway), an MPH with a concentration in health policy from the Harvard T. Chan School of Public Health (https://www.hsph.harvard.edu/), and completed her residency training in Family Medicine at Boston University (https://www.bu.edu/familymed/residency/).
It's my honor to welcome to the show today, Dr. Bich-May Nguyen! Dr. Nguyen, welcome to H-Town Progressive.
Dr. Bich-May Nguyen 4:25
Thank you so much for having me.
Rob Icsezen 4:27
I'm really excited to have you on, our topic today, we're talking about public health. We're hoping to cover a lot of topics within public health, but today we're talking specifically about vaccinations.
Dr. Bich-May Nguyen 4:34
I love talking about vaccinations!
Rob Icsezen 4:36
Right. I mean, and and all you have to do is listen to NPR, open a newspaper, vaccinations are in the news these days. And that's, that's somewhat troubling. And so but but let's talk a little bit about where they come from, and their role in public health if you want to get us started.
Dr. Bich-May Nguyen 4:54
Sure. So when you look at the list of the top 10, top 20 public health achievements from the 20th century, vaccines are number one. They have done so much to improve our quality of life and our life expectancy. You know, people used to die much younger from these communicable diseases, that now we have vaccines that can help prevent them. So it's really scary now that a lot of people have been hesitant or questioning about how safe they are, or whatever their concerns are about vaccines, that now we're seeing these diseases that we hadn't seen in 50 years or more, they've kind of popped back into...
Rob Icsezen 5:36
Yeah, well, and you know, one thing about what you just said, being one of the top 10 to 20 achieve-, medical achievements of the 20th century, that's a pretty prestigious list to be on! I mean, we're talking about antibiotics, we're talking about all kinds of stuff that has prevented, has extended life expectancy. I mean, it's there's so much on that list of medical achievements in the 20th century. But, but people these days are not trusting of vaccinations. What do you think that comes from?
Dr. Bich-May Nguyen 6:11
So it's kind of hard to say, because I think that in, kind of any society, there's going to be some minority of people who may be kind of question, you know, popular wisdom, conventional science. And I think there's always been that kind of current. But in, I think it was, there's a paper that was published in The Lancet many years ago. And it was by Andrew Wakefield, and it was a case series of 12 patients that allegedly developed autism as a result of the MMR vaccine. And, really, the, the paper was so questionable, there's so many issues with the way that paper was done. I mean, it was funded by a law firm that was trying to bring forth a case against an MMR vaccine manufacturer. A lot of the children, some of the children didn't even have autism, they never were diagnosed with it. Other children, there was such a gap in between the symptoms, and, you know, when they got their vaccine, that there really was no time relationship between when they got the vaccine and when they developed- a lot of them had some symptoms before they even got the vaccines. So, the paper ended up getting retracted by The Lancet, which is a big deal. (*** for more on the MMR Vaccine see: http://immunize.org/talking-about-vaccines/mmr.asp ***) But that and and that doctor, who was the first author who published on it, he actually lost his medical license, he can't practice medicine anymore.
Rob Icsezen 7:37
Dr. Bich-May Nguyen 7:38
Yeah. But he still, he has followers. He goes and talks to people and he kind of spreads these ideas and they cause a lot of danger.
Rob Icsezen 7:46
So he's peddling snake oil right now as we speak. Well, okay, let's pause for just a second. MMR: measles, mumps, rubella. Vaccinations aside, what are those glorious things? Can you explain to us what they are and how they've affected humanity?
Dr. Bich-May Nguyen 8:00
Yeah, so these are very infectious, very contagious diseases. Measles is especially scary, because if someone has that infection, and they go into a public space, and they cough, there are droplets that can linger in the air for hours afterwards. And so if someone else comes into that room and inhales that, they can get sick very quickly, even though that person may, you know, the original person who was sick already left hours ago.
Rob Icsezen 8:28
So it's not just like you, you don't have to just be next to a person. They just cough into the air and leave the room, and even some time later, you can walk into that room and be exposed to the measles contagion?
Dr. Bich-May Nguyen 8:42
That's why there was a case, situation recently where I think was like a Portland Trail Blazers game, and someone who was infected with measles went to a game and there were thousands of people in that auditorium, who could be at risk for getting it. And I think it takes about 21 days for the symptom, to kind of pop up and, you know, for, it has an incubation period of about 21 days, so it can linger for a little bit before someone shows that they have symptoms. So it takes a little while before they realize it.
Rob Icsezen 9:10
And when you get it, it can be fatal, right? I mean, it's...
Dr. Bich-May Nguyen 9:13
Yeah, so that's the danger. So some of the complications that can happen are pneumonia. So it's a bacterial infection of your lungs. And that doesn't seem that bad, maybe for an adult, but for a child who has a weaker immune system, that can be really dangerous. For someone... Yes, for an elderly person or someone who has a disease, that are, is on some medication that make their immune system weaker, it will make them more vulnerable to getting ill or suffering from that consequence. So pneumonia is really, can be a consequence. Another complication can be encephalitis. So it's a infection of the brain tissue [inaudible] can be very dangerous and cause swelling. There's a flight attendant who flew between Israel and New York recently who is currently in a coma in an intensive care unit in Tel Aviv.
Rob Icsezen 10:03
Because of measles?
Dr. Bich-May Nguyen 10:04
From measles. Yeah. They're not totally sure where the flight attendant caught it. But right now they're saying... Yeah, the last I heard... It was a newspaper article like last week or something.
Rob Icsezen 10:14
And so measles, I mean, this is in the news a lot lately. We've had outbreaks all over the country. There's, there's, if you look in the newspaper any given week, we're talking about measles in 2019. That seems to be a problem!
Dr. Bich-May Nguyen 10:26
Yeah. I mean, we basically considered it eradicated in 2000. But because of the vaccine hesitancy, people questioning, there are enough people who have not gotten vaccinated at this point, where it's allowed the infection an opportunity to find a group and run through it.
Rob Icsezen 10:26
What about mumps?
Dr. Bich-May Nguyen 10:26
Mumps. So that one is, it, so again, it's some kind of, it's an infection, it can be very contagious. And most commonly, I think you think about it, where it causes like a swelling of your, one of your parotid glands, like in your face. So you see people, old style cartoons, where people are wearing that little bandage wrapped around their head [laughing], to kind of help, you know, keep the swelling from from really hurting. In teenage boys it can cause swelling in a testicle.
Rob Icsezen 10:42
That's a great example, that the wrapping the thing around the head in cartoons because, because people would have looked at that. Children, back in old cartoons would have looked at that and said, Oh, yeah, I've seen that around. That's normal. That's a thing that people know. You show my kids that today, they'll be like, Papa, why is why is that kid wearing that?
Dr. Bich-May Nguyen 11:18
Right! Yeah, I don't think I understood it.
Rob Icsezen 11:36
Right? I would, I wouldn't either! I would, we'd have to explain that to them. And I wouldn't be able to explain it, my parents would, or my grandparents would be able to explain that. But now that people are questioning the vaccinations that prevent these illnesses. I mean, these things have been coming back. And I want to go through all three of these so Rubella, I, what's Rubella?
Dr. Bich-May Nguyen 11:58
So, So again, so this is kind of hard, because it's not necessarily something I've ever seen before, right? So I learned about these in textbooks, I read about them. The things I can definitely say, with Rubella, that I have seen, is if women get Rubella while they're pregnant, it can cause a lot of harm to the fetus. And so the babies are born and they end up with this, like blueberry muffin rash, where you can see these little blue spots all over. And it can really, depending on what point in their pregnancy, they contract it, it can really impact different organ development, especially with the brain developing intellectual disability, deafness, a lot of stuff. I mean, I have I have a few patients I take care of now who they have, they were born and their mothers had contracted the infections while they were in the womb in the uterus. And they are, you know, they have cognitive issues, they have some intellectual disability, they have some deafness, they're mute, they're not able to take care of themselves. So they live in group homes and other people help take care of them. I mean, it can cause a lot of problems, lifelong... aside from just death.
Rob Icsezen 13:12
Right! so when I say fatal, that's only part of it.
Dr. Bich-May Nguyen 13:15
Right. Rare, rare complication, I think.
Rob Icsezen 13:19
And it's undeniably nasty, I mean, this is stuff that's nasty, that that nobody would want. And we have actually a way to handle it. I mean, that's what the vaccinations are. And so you brought up, so MMR, the reason we put those together is that any parent now knows or should know that, that the MMR vaccine is something that your kid, kids get at an early age, and it prevents, you know, protects your children and the public as a whole, because they're highly contagious from measles, mumps, and rubella. And these things are put together. And you mentioned at the outset, there's this paper that came out that said, "Oh, be careful. This might be connected to autism." But the scientific basis of that was never established, the doctor who published this paper, had to retract the paper. And basically, there's not basically, there's literally nobody within the scientific medical community who support... well, you're... I'll stop there, I'm talking a lot. This is where you can tell me!
Dr. Bich-May Nguyen 14:23
No! So it's really hard! I think when this president took office, he set up some kind of vaccine committee to kind of do more scientific research into the safety of this. And, you know, there was a public hearing, I think, with the former head of the CDC. And when people ask, you know, are vaccine safe? Some of us kind of pause for a second and kind of look like, Are you serious? Is this a serious question here, because the science is just so certain on this. We have years of data, so many different studies that show that these things, vaccines overall are very safe. You know, in order to get vaccines approved, you know, they have to go through rigorous testing, just like any drug, any medication, you know, the Food and Drug Administration and the CDC do have studies showing, you know, studying, how effective are these medications, are these vaccines, can they work. And once they have it working in a small group, they kind of expand out the number of people that they tested in, they start with adults first, they test on a few hundred, a few thousand people. And then once they approve it for general use, then there is monitoring afterwards. So there are vaccine safety reporting sites that, you know, if there is a complication, a side effect that pops up, then the doctor, the patient, the nurses can report that. So I mean, I've been practicing now, I've been in medicine, for over 15 years. I have, you know, been involved with many, many vaccinations and I have had one side effect from a vaccine that I've reported. It was very clear, you know, I had I had asked this patient about when her last tetanus vaccine was. She didn't know, we gave it to her, and then within a week, she had developed some swelling just at the sight of where we had given it to her. And, and that was it. And that was when I said, no, we need to report this, this needs to go so that someone can help keep track and figure out this was safe, you know, and if there's any problems with this, we need to know.
Rob Icsezen 16:26
And I think there are two very important points in what you've just said, which is one: vaccinations, no vaccination, to my knowledge, you can correct me if I'm wrong here is 100% effective. But they're very, very effective, meaning nienty-some percent or whatever, 99. I don't know what it might be. And that's a good thing unequivocally. But when you have the, the the exception come out, when someone does have a side effect of some kind, it gets blown out of proportion. It's used as sort of an anecdotal counter argument. But there's a there's an analytical reasoning problem with that. It's like it's sort of have the counter example to a statement that doesn't say "all of all of this is effective at one time." It's a counter example to something that says "Yeah, sometimes there are counter examples." Perfectly consistent with the idea of vaccinations that every now and then you might have someone with a reaction that is not anticipated. The severity of it, of course, is something we need to talk about. But data needs to support to support that.
Dr. Bich-May Nguyen 17:27
Yeah, I mean, I think it's like any other, when you are trying to have a conversation with people about something that you may not agree about, then facts and science don't always, they're not always persuasive. And so for some people, it's much more helpful to kind of talk about stories and anecdotes, right, because that seems to be more memorable. So yeah, I can definitely, like, for every person who worries about how safe these vaccines are I can, I share those stories that I have of the patients, I've taken care of who have not been vaccinated or develop these congenital infections while they were fetuses. Other patients, you know, I have a patient I take care of who contracted polio when she was one. And so that really caused her some mental disability. And she is deaf as a result of that. I mean, other you know, you can think of like president FDR, who had polio too and hid it from the public and he had to get around in a wheelchair. I mean, and people don't even remember, like, all these really old photos you can see in encyclopedias and stuff of people who had to breathe on iron lungs, right! That was polio.
Rob Icsezen 18:35
Dr. Bich-May Nguyen 18:36
Right. And polio, like this infection caused you to have trouble breathing, like, all the muscles become very slack, and you can't control them very well. So people are hooked up to iron lungs to help them breathe. And there's definitely been a few stories in the past, in the past few years about how because we've basically eradicated polio, at least in the US, not around the world, we don't have any of these iron lungs anymore. And there's some people we still need them and they still need maintenance and upkeep. And it's, it's very hard to get the equipment, repair it, or even have people who know how to fix these machines.
Rob Icsezen 19:08
Yeah, yeah, so if we have an outbreak of an eradicated disease, we don't have the infrastructure to address that. Or we don't have, it's not set in place. It's it's we've we've kind of, we don't, do we vaccinate for polio anymore? I don't think or do we?
Dr. Bich-May Nguyen 19:23
Yeah yeah, it's one the childhood vaccines.
Rob Icsezen 19:25
Ah, is it, okay! All right. Yeah, like smallpox, though. We don't, do we vaccinate for smallpox?
Dr. Bich-May Nguyen 19:30
Not routinely, I can't remember if we do that, maybe in the military, or there might be some stockpile in the military. Definitely, and thinking about, you know, there are vaccines for children. So we think about, you know, there's a bunch of vaccines, we give kids the first four to six years of life. And then after that, we kind of start moving into some of the adolescent vaccines that we can get like tetanus every 10 years, HPV, meningitis.
Rob Icsezen 19:57
HPV is a controversial one.
Dr. Bich-May Nguyen 19:59
It has been. It is, that's true. That's true. We've gotten and definitely, you know, when something is first new first approved, you know, of course, I am skeptical. I'm thinking okay, how safe is this? Do we have long term data, do we really need to be doing this? But we have, you know, this vaccine's been available now for about a decade. And we've demonstrated that when we vaccinate people, children, adolescents, with the HPV vaccine, we're decreasing a lot of different type of cancers later on down their life.
Rob Icsezen 20:32
But people are upset because it's human papillomavirus, which is an STD, and they're they're upset that their, you know, 10 year old 11 year old is getting vaccinated against something that's sexually transmitted.
Dr. Bich-May Nguyen 20:43
Rob Icsezen 20:44
In theory, I think that that might be the argument, but...
Dr. Bich-May Nguyen 20:48
No, I think it is. I think that's the concern, I guess, people parents are afraid to think about their children becoming sexually active.
Rob Icsezen 20:54
Dr. Bich-May Nguyen 20:55
And it's definitely something that again, we, we just want to keep them protected, help them stay healthy, and well, so we try to get it to them before they become exposed to any of those. Which, you know, HPV is transmitted through intimate contact. So it's, it's just one thing. And I think even recently, there's recommendations to expand the age that that vaccine has indicated for. So I think we've been recommending up until about 26 years old, but I think some groups are starting to recommend it up to 44 years old.
Rob Icsezen 21:32
Okay, oh wow.
Dr. Bich-May Nguyen 21:33
So we'll see how that kind of plays out.
Rob Icsezen 21:35
So there are two points here, or the second point from before that I was I was kind of leading towards is that vaccines evolve like any science, they evolve over time. I think vaccine, vaccines will get improved over time. But I'm curious in hearing... I'm not advocating, I would never advocate that we just trust everything that's put in front of us. We need to rigorously engage and question all policy that's put in front of us and scientific reasoning as well. But you can't just do it on an ad hoc basis. You need to employ analytical reasoning, logic, the tools of science that we have out there. But you know, given that, sure, we should we should question at least on a presumptive basis, the science, but the presumption then, once you look into it a little bit, you see that the science is justified... and and but but, maybe you can tell us a little bit about what the FDA, what does the CDC, what do they what do they do, these these governmental institutions that are there to help protect us, to help do some of the legwork for that analytical reasoning, we we should employ to question policies and things like that are out there?
Dr. Bich-May Nguyen 22:48
I mean, I think it's, what they do is they're there to safeguard and protect public health. So again, I mean, the process of getting a vaccine approved is very similar to the process of how a medication is approved. And, you know, there's continuing research. Really, I mean, I guess until it's really established, I mean, I don't even know if they, if the NIH, or if the NIH is even funding a lot of vaccine research, because we already know that they work. So that's why, you know, when the president started this new commission on vaccine safety, a lot of public health researchers thought: We shouldn't even be doing that! We shouldn't be wasting public dollars on something that is so well understood already! That we should, we could really use it in, use that money in some other way, in a more valuable way. I think that with, you know, again, with the programs to get approval to make sure something is safe, continuing surveillance of how these medicines are, these medicines and vaccines are working... I mean, and like you said, there are changes, I can think, in the past couple of years, there's been a new shingles vaccine that's been developed. And it's actually more effective than the older one we have. So in thinking about, you know, we moved from adolescent vaccines, there are also adult vaccines you can get, right. So all adults continue to need a tetanus booster every 10 years. And then once you hit around 50-60 years old, there's a shingles vaccine that's available. So the old one was called Zostavax, and it was about 50-60% effective in preventing a shingles outbreak, preventing the pain that can come along with the outbreak. That pain can linger for about a year afterwards and can be very uncomfortable. So now this new vaccine's been approved by the FDA in the past year or so, it's two shots, it's given about two to six months apart. And it's about 97% effective. If you get it in your 50s, it's about, it drops off a little bit about 95% effective if you get it in your 60s and about 93% effective if you get it in your 70s. But it's been so much more effective, that you know now we're recommending just get that one don't even get the older Zostavax version, get the new Shingrix version. Because it's just more effective. And you know, shingles doesn't sound like that big of a deal. But I think if you talk to someone who's actually gotten shingles, you know, and we can, a lot of us can get it because it's from the chicken pox virus, it kind of lives in your system for the rest of your life, it never goes away. And then under some some times of stress, something happens, then it can cause this rash on your body. The ratio in itself doesn't seem like that big of a deal, but it can cause a lot of pain. I have a friend who got it in her early 40s. And she said it took her out for a few months. And she was very active. She's running marathons, she does yoga, aerial yoga, and she was, yeah, she felt it was very debilitating. And the, what's worse is that if it breaks out in a certain part of your body, it can be a little more dangerous. If it breaks out around your eyes or your brain tissue it can cause encephalitis, then again, that would be a more dangerous complication.
Rob Icsezen 26:01
Well and a lot of, I myself, and I'm sure a lot of people have family members who've gotten shingles. It's pretty common out there, and especially for elderly people.
Dr. Bich-May Nguyen 26:10
Rob Icsezen 26:10
It's It's wonderful to know that we have a new version of the vaccine that maybe I won't get it! [laughing]
Dr. Bich-May Nguyen 26:15
Rob Icsezen 26:16
Fantastic! I'm excited about that! Well, what about the flu? Because the flu vaccine is important. I always get it. My family and I get it. But it's it's it's one of the lower effectiveness vaccines, I believe, at least this year was because my whole family got vaccinated and half of us got the flu. [laughing] But again, people will use that example, as an argument against all vaccines.
Dr. Bich-May Nguyen 26:20
Rob Icsezen 26:24
"Oh, look, I had the vaccine and we got the flu. So therefore, the HPV vaccine, we shouldn't take!" or whatever, any list, measles, whatever it might be. So, we need to dispel that notion! Yeah, right?
Dr. Bich-May Nguyen 26:59
Yeah. So that, the flu is probably the one I probably end up talking about the most with patients, because a new version comes out every year. And the way it kind of works is that around springtime around now, you know, these researchers have to anticipate for next fall, which strains of the flu are going to be the most dominant ones. And that's how, that's what we need to prepare our vaccines. Now, it involves growing them in eggs. So it takes time.
Rob Icsezen 27:27
Dr. Bich-May Nguyen 27:27
Yeah, it's very time intensive, you have to be very careful. So they're preparing flu vaccines now for next season. And again, they try to estimate the best way they can based on patterns and the year and the weather, a lot of different factors. And so they guess, they guess which ones are gonna be the most dominant, and they create the strain, the flu vaccine based on those, to attack those strains. So unfortunately, we have, we do recommend that you have to get a new vaccine every fall, and hopefully that will carry you through and protect you for the whole flu season. Even if you end up getting the flu, I think it's going to be a lot less intense...
Rob Icsezen 28:10
That's a great point!
Dr. Bich-May Nguyen 28:13
Yeah, than if you didn't get the flu. I mean, I've had patients who told me, you know, a grandma came in and she said, you know, "I got the flu and my husband got the flu. He got his vaccine, so he got better within a few days. But for me, it took a couple of weeks." So she brought in her grandkids to get, to all get vaccinated. So I've definitely seen some of us, you know, some of us health professionals, you know, we get our flu vaccine every year. I've gotten the flu shot every single year, I've never had the flu, so I have no idea what it's really like! [laughing]
Rob Icsezen 28:40
Knock on wood! [laughing] Although the knocking on the wood has nothing to do with the results, to be clear! Get the vaccine! Stop knocking on wood! [laughing]
Dr. Bich-May Nguyen 28:49
[laughing] Yeah, it works really well! I mean, one of our residents this year, got the flu shot, and then he got the flu and he was still working. [laughing] He looked really sick! So I thought he should go home, but he was still working!
Rob Icsezen 29:01
Well, and that, I have an anecdote as well. I mean, like I said, my family, we all got vaccine, got vaccinated. That's my four kids, my wife, myself, also my parents., Half of us got the flu.
Dr. Bich-May Nguyen 29:10
Rob Icsezen 29:10
But! It was not particularly intense, for least those... my dad got it and he's in his 90s, and he went to the hospital. It's very serious for people who are elderly, but, and we just dropped like dominos. But! You know, my youngest daughter got it, and she, it was like a two day idea.
Dr. Bich-May Nguyen 29:30
Rob Icsezen 29:30
And she was okay afterwards.
Dr. Bich-May Nguyen 29:32
That's how well they can work. I mean, last year, I think 2017, 2018, the flu was so bad that year that I think almost, I think 180 children died, from the flu, in America, from from the flu virus. So it's it's not a completely benign, you know, it's not just a cold or something. It can be very serious, it can cause, you've had experience in your family, people can get complications, they get admitted to the hospital, they get secondary infections, like pneumonia, bacterial infection of the lungs, because the flu is a virus. And there have been some very serious flus in the past. I always think of the Great Pandemic of 1918, it was around the beginning of World War I. And it killed millions of young healthy men in the military around that time. A million, literally millions of people died.
Rob Icsezen 30:26
The stories of fighting people in the trenches in World War I in those conditions and how disease spread is just shocking. It's astonishing.
Dr. Bich-May Nguyen 30:36
Right, and if you think about now, like how easy it is for people to travel around the world, you know, things can spread even more quickly now, so...
Rob Icsezen 30:45
And so the stuff I've been reading is that measles today, the very highly communicative disease that we talked about at the beginning here, has been showing up in communities that are, you know, particularly, maybe their religion tells them not to take on vaccines, and they're also kind of insular, like the Amish community, I think in Pennsylvania has had some particularly serious outbreaks. You know, that sort of thing. But it's not just in these insular communities. Like I said one person, there was a guy who was on a train from Detroit to New York or something like that, that came out recently in the news, that caused a whole bunch of spreading of the disease.
Dr. Bich-May Nguyen 31:26
Yeah, there's such a there's such a mix in the communities that end up not getting vaccinated. I mean, I think it's certainly some of the insular communities, very tight knit, maybe don't really meet, talk to a lot of outsiders. There was a Somali immigrant community in, I think, Minneapolis last year, one of the Wakefield, Andrew Wakefield, the doctor who published that retracted Lancet paper about the MMR vaccine causing autism, like he and his disciples spoke at, with this Somali refugee community, and you know...
Rob Icsezen 32:00
Dr. Bich-May Nguyen 32:00
...convinced them not to get vaccinated, and then the measles came through that group. And then in Brooklyn, it's been primarily an Orthodox Jewish group. That's been very questioning, you know, and not very sure how safe it is. There have been some, yeah, some misinformation kind of spread through that. But then there's been other groups where, you know, most people who are vaccine hesitant or vaccine deniers they're, white, not Jewish, well educated with means...
Rob Icsezen 32:32
and that's a good point, because one of the things we were talking about before recording is that this is not necessarily a progressive issue. There are folks who would call themselves progressive, who are anti-vaxxers, as they, as we say, in the media, I suppose. And that's, that's a problem. I think, I think that idea on the Left comes from a sort of distrust of concentrations of power, which I get, I'm all about distrusting concentrations of power! [laughing] But doctors, health professionals saying, hey, vaccines work, and here's why. And the risks, there are some risks, but we need to be eyes open about them. This sort of the balancing of all of the factors, obviously says, as a matter of public health, we should do vaccines. That is different from a cigarette company hiding the effects of cigarettes over time because it, you know, it's profitable to them. But I think that that's, at least on the Left, I think that there's sort of a similarity, or at least that there's a, there's a, people are seeing similarities between those two things. Do you think that that's kind of maybe where it's coming from?
Dr. Bich-May Nguyen 33:49
I mean, I think the way the healthcare system in America is so frustrating that I can see why people mistrust it. Just with how people have problems with insurance coverage, surprise bills... Yeah, I can see why people are just so questioning of it. I think what's important is to really just make sure that you have a doctor that you trust, and try to talk to them about it. There are definitely doctors offices that maybe decide, you know, what, if these kids are not willing to get vaccines, we don't want to have them, we don't want to come, we don't want to have them coming to our office and then putting our other children at risk or other patients at risk, who may have weaker immune systems and are not able to be vaccinated. But I would be concerned about the families who are not vaccinating, and just disappearing and not coming back into the medical establishment. So I think it's just really important to try to have a primary care doctor that you trust, that you can talk to about this guy stuff. There's certainly other issues with experiments, government run experiments in the past that have treated people poorly. And so I can understand, you know, stemming from research in Tuskegee, with syphilis, reproductive health, you know, testing patients in Guatemala, or Puerto Rico for different, you know, contraceptive methods, different gynecological surgeries, that there's definitely problems that the medical establishment has in earning and regaining trust with patients. And I think that's why, you know, people have, they're so frustrated with how, you know, primary care offices can work, how inconvenient the hours can be, how they have to come in, and they wait. And then it takes a long time. And the doctors are just looking at their computers and not really talking to them. That, you know, they end up turning to the internet and reading things about how maybe we should be taking all the supplements that Dr. Oz recommends, or sticking, you know, Jade eggs and our vaginas like [inaudible] recommends, you know [laughing]
Rob Icsezen 36:03
[laughing] Never do an image search on Google for any disease ever!!!
Dr. Bich-May Nguyen 36:05
[laughing] It's tough. So I don't, you know, there are a few, yeah I'll recommend websites like www.immunize.org. If you have question about vaccines, it's a really good science based site with lots of stories and facts and information about what these diseases can cause, stories of families that have gone through, you know, when their loved one became ill with an infection, and what happened. I think that's kind of promising, because, you know, some of these kids that have grown up in these anti-vax families, now they're old enough that they've been able to get on the internet. They've done research on their own, and now they want the vaccine. You know, so there's an 18 year old kid, I think, who testified before Congress about a month or two ago.
Rob Icsezen 36:49
Dr. Bich-May Nguyen 36:49
Yeah, I can't remember what state he was from but he's in a state where, he is not... so there are a lot, I think there are only 17 states that allow minors to get vaccinated without their parents' permission. So he wasn't in one of those states. So when he turned 18, he had been doing, you know, his mama told them all the stuff, he started doing his own research. And, you know, they asked him, well, what sites did you go to? And he said, Oh, like the CDC, like, like these government sites, these science based sites. And he said, Yeah, I thought that the vaccines, pretty, seem pretty safe, and I asked my mom if I could get vaccinated, and she said, No, so as soon as he turned 18, he got the vaccines on his own.
Rob Icsezen 37:25
Wow! Well, and that's... Good for that kid, by the way! Thankfully, he survived. But... [laughing]
Dr. Bich-May Nguyen 37:33
Rob Icsezen 37:33
But you make, I think your point is really, really a good one: that trust in the system, which is the fundamental problem, I think, when you're talking about questioning concentrations of power, you're talking about trust. You think that motives are, are somewhere where they shouldn't be. So trust in your personal physician is probably the single most effective way to eradicate this problem. And so, so that relationship has been eroded, I think, the way we do healthcare here. And so that's perhaps something we should try to focus more on, you know.
Dr. Bich-May Nguyen 38:10
I think so, I mean there's definitely policies, like some states have passed policies to decrease the number of non-medical exemptions that people could, get, to not get vaccinated. So that's what happened in California after they had a huge measles outbreak at Disneyland. A pediatrician who served in the state legislature led the passage of a bill that that did that. (https://www.latimes.com/local/california/la-me-ln-vaccine-bill-20190326-story.html) What they found is that they've definitely forced more people to get vaccines. They also have reporting. So you can see, you know, which, what the vaccination rate at different elementary schools are. So you can kind of see like how safe those schools are, if they've reached that threshold to prevent outbreaks from happening. Right, you have to have, you have to hit a certain percentage in order to try to protect the people who cannot get vaccinated.
Rob Icsezen 38:57
And for anyone without kids, I mean, you have to submit you're vaccination records to your school, at least in Texas in HISD, my kids like we have to give it to them every year. And and I mean, we've done that, but I assume if you don't have them, then you have to take, claim an exemption of some kind, you know.
Dr. Bich-May Nguyen 39:15
I think there's definitely, I mean, there's definitely some policies with the state legislature this year in Texas, where they're trying to... weaken...
Rob Icsezen 39:20
They are trying to relax it, yes. Going in the opposite direction, shocker! In Texas we're going the opposite direction. It's one of those fights we need to, we need to really focus on.
Dr. Bich-May Nguyen 39:28
Yeah, I mean, I think some people feel like it's a personal liberty issue. And it's a freedom to parent how I want to parent. I mean, I think definitely people who kind of fall on the more progressive side of the aisle, they would agree that it's great to try to help protect everybody, right, protect the whole community to try to... again, reaching that critical threshold, getting a certain percentage of everybody vaccinated so that outbreaks don't occur. For people who kind of fall on the more conserve aisle with the personal liberty and freedom, I'm still trying to figure out what the best way to kind of talk to them about that...
Rob Icsezen 40:01
Yeah, yeah. I mean, that, and those arguments, you're right, no one's... well, people on the Left typically aren't going to make the personal liberty argument, they're going to make the trust in powers arguments, or distrust in power argument. But on the Right, it's the same kind of argument that you make in a lot of different spheres, you know, that, that, okay, you can kind of live in your bubble, but then you don't get any of these other cool things like roads and [laughing], you know, like, like, like food that you can, that you can buy at a grocery store and trust, you know, things, little things like that, that kind of, people take for granted.
Dr. Bich-May Nguyen 40:36
Yeah, I've talked to one of my colleagues who, she's, you know, a family physician who is board certified in complementary alternative medicine, integrative medicine. And so she ends up attracting a lot of patients, families who may be vaccine hesitant, anti-vax. And it's not a consistent, you know, I don't want any, you know, healthcare formal thing. It's, I don't want vaccines, but I still want the antibiotics when, when I need them.
Rob Icsezen 41:05
Got it. [laughing]
Dr. Bich-May Nguyen 41:06
So that's interesting to me. [laughing]
Rob Icsezen 41:07
Yeah, well, it is that sort of connection from, you know, antibiotics work in a day. But the vaccine is the sort of thing that you don't see, and then someone tells you it's working, and yeah, sure, maybe it is or I'm just, you know, very, I'm a very strong person! So, it's not the vaccine! [laughing]
Dr. Bich-May Nguyen 41:19
Yeah! I mean, there's there's antivirals for flu, that really, if you look at the research, it's it's not as effective as you think it is. So the flu vaccine was much better for you than the anti viral.
Rob Icsezen 41:30
Dr. Bich-May Nguyen 41:31
Rob Icsezen 41:32
Well, Dr. Nguyen, thank you so much for walking us through that. I think that hopefully this will, this will at least shed some light on what's going on in our public health sphere. I hope! [laughing]
Dr. Bich-May Nguyen 41:43
Sure! Love to come back!
Rob Icsezen 41:44
All right, thank you very much.
Dr. Bich-May Nguyen 41:45
Rob Icsezen 41:46
Next week, we're going to continue in the realm of public health as we shift our discussion to the tragic but also preventable problem of gun violence with ER doctor Dr. Cedric Dark. Hope you'll join us.
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