Sticking it to the Man

29 Nov

Over the past month I’ve had a TB test, a blood workup, a flu shot, and a combination tetanus/whooping cough shot. I’ve never been particularly afraid of needles, but that’s a lot of jabbing. As a kid it seemed every time I went to the doctor I ended up getting a shot of some kind. Now doctors are more inclined to write prescriptions.  However, when we lived near Orlando, we saw a physician, who became to be known to us as  “The Shot Doctor”. When you went to see him,  no matter what was wrong with you, you could always count on getting some sort of injection. He had all these wooden boxes, packed with skinny glass hypodermic needles. You would walk into his office and before you knew it,  one of them would be stuck in your rear.  “You’ve got a cold, you need a shot”. “Headaches? A shot will clear that right up.”  “Flat feet? Drop your pants.”

 My recent needle marathon  took place because I had been dodging  doctor  appointments. I had the blood workup, the day before my doctor’s appointment (only about seven months late),  but  I lucked out because they didn’t have the results ready  for my appointment. So instead of the lecture,  I got a nice phone call from a  nurse instead.

I got a flu shot because I knew the doctor was going to ask me about it. Besides seasonal influenza  is  a major  public health hazard.  Influenza in America typically results in about  200,000 hospitalizations  and  36,000  fatalities annually. Generally, the  flu season in Indiana  starts around mid-fall, peaks in January,  and  runs through the spring.

According to a study  from New York’s  Mount Sinai Medical College,  the flu  is more  common in   winter  months  because  the  virus is more stable and   airborne longer when the weather  is cold,  dry, and the humidity is lower,  as it is in winter.   By studying guinea pigs, exposed to the virus,  the researchers found that influenza  transmission  was greatest  at 41o degrees and decreased as  the temperature rose, stopping completely at 86o

Also the shorter winter days with less sunshine, result in a decrease in the natural production of vitamin D,  a substance important for immunity.  Also in the winter months, due to bad weather children often   come into closer contact with each other,  resulting in more opportunities to spread the virus, at school and home.

Of course, the best way to avoid  the flu is the vaccine. Last year  the U.S. Centers for Disease Control and Prevention (CDC), issued a new  recommendation, that said everyone over the age of 6 months should be inoculated. Exceptions are  people  who have reacted badly to the  vaccine in the past, people  with an egg allergy, and those who have previously contracted Guillain-Barré syndrome after getting the shot. It’s best to get your vaccination  early, because it takes almost 2 weeks to develop immunity.

In the 2010-2012 flu season, the CDC, estimated that over 120 million Americans  received flu shots. That number however, only represents 49 % of children and 41%  of adults— meaning that more than  half of Americans went unprotected. There are  several  reasons that  American  refuse flu vaccinations.

It’s been estimated that at least 10% of American adults   have a significant phobia of needles and injections  (technically termed  trypanophobia). The actual number is probably much greater since people with severe symptoms simply avoid medical treatment.This common phobia prevents a large number of American from getting an annual flu   vaccination.

Needle  phobia  was officially recognized in 1994,   when it  was included as a diagnosis in the fourth edition of  the American Psychiatric  Association’s  Diagnostic and Statistical Manual, (DSM-IV). Writing in the Journal of Family Practice, James G. Hamilton, suggests that needle phobia  is genetic and has an evolutionary  basis. He believes that our ancestors,  who were able to avoid  all  sorts of punctures or stab wounds  had  a significantly greater chance of survival.  Hamilton also found that   80% of patients with needle phobia reported  the  same fear in a close relative. 

For people who  suffer from needle phobia there are many treatments and alternatives that can be effective.  The alternate use of nasal sprays or jet injectors which use air pressure rather than  hypodermic needles is often suggested. Fast acting anti-anxiety medications, the dental anesthetic  nitrous oxide, topical anesthetics at the site of the needle stick and beta blockers have been found  useful for people who faint. Laying down, with the legs elevated, often helps prevent  loss of consciousness in people prone to faint and it usually helps if patients  are instructed to breathe deeply and slowly. For  more severe cases, various psychological approaches such as psychotherapy, cognitive therapy, hypnosis,  and muscle relaxation training have been found helpful.

 A growing group of parents  refuse flu shots for their children  because they believe that it   causes autism.  According to Jeff Dimond, a public affairs specialist at the CDC,  This belief  is usually based on an early, but  generally  discredited  study,  that linked a vaccine preservative  to autism. Although the association was never proven, the  substance  in question  was removed from  all  childhood vaccines and most  flu shots. Celebrity activists,   like   Jenny McCarthy,  who claimed her son’s autism was caused by a  childhood vaccination, have given this issue  a  lot of public traction. Despite the assertions of the CDC and  scientific experts,  one  study showed that over 24% of parents still give credence to McCarthy’s views on  vaccinations.   

Some people are frightened because they   believe  you can catch the flu  from the vaccination.   This comes from the belief that   vaccinations still  give you a mild case of the disease,  so you can build up your  immunity. Dimond says that  you are only exposed to the dead virus, which cannot cause the disease.

            Other refusers think that   flu shots are not all that effective. The CDC reports that flu shots are typically  between 70% and 90%  effective at preventing influenza. However, a recent study at the University of Minnesota found that the shots were about 59% effective, somewhat  less than the  CDC claim. While the study had no conclusions regarding the elderly,  they did find that the vaccine was 83%  effective for young children. There is also some evidence that even in  people who  get sick with influenza, the vaccination reduces severity and the chance of complications.  

 Finally some folks  simply believe  that you should always leave well enough alone.  A few day ago I was talking to a reasonable and intelligent professional, who told me that he never gets flu shots, even though they are free where he works and would only take a few minutes.    He didn’t have any strong beliefs,   a needle phobia, or any other logical reason. He just felt that since he never had the flu, why take a chance on unsetting the applecart.  I have to admit before my doctor convinced me, I felt exactly the same way. This line of thinking is based on the  pessimistic  philosophy  that if any   can go  wrong,  it  probably will,  so  why tempt fate. The only counter to  this line of thinking is  that the consequence of  contracting influenza is likely to do  much more harm,  than the vaccination ever could.  Social responsibility is another  cogent argument for vaccinations.  By having the shot you are also protecting other people you come in contact with, especially those who have weaker immune systems, like young children and the elderly. Think of it as your doctor avoidance program, one shot and you’re home free.


Originally in the News Tribune of Southern Indiana


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