Anticipatory Silence

Wow.  I am flabbergasted and disappointed by what has happened in Florida and what is being advocated now in other parts of the country.  For those who may have missed it, Florida has passed a law that says that a pediatrician is not allowed to ask a parent if there are guns in the home.  This bill was a joint effort by the National Rifle Association and the Florida Medical Association.  Proponents of the bill apparently fear that the questions that physicians ask in the setting of a confidential medical visit will be used against them by the U.S. government at some point in the future.  Let me preface the rest of this discussion by saying that I support the second amendment and the right of Americans to bear arms.  My objection to the Florida law is its interference in the patient-doctor relationship.

Former Georgia congressman Bob Barr has written a blog post criticizing pediatricians for asking the question and proposes that pediatricians should concern themselves only with recognizing and treating illness, rather than preventing illness.  As a practicing pediatrician who politically falls on the spectrum between libertarian and conservative, I believe that the government should interfere with citizens' personal lives as little as possible.  I believe that law and order, the common defense, and the provision of public necessities, such as the highway system, should be the primary focus of our government.  I believe the Constitution, with its amendments, is one of the greatest achievements in human history.  I believe the Constitution should be respected by our congress and by our courts and that alterations to our constitution should only be made by the prescribed constitutional process and not through activist judges.

Bob Barr claims to be a libertarian, yet his support for this misguided Florida law reveals him to be a libertarian in name only.  A true libertarian would not advocate for the protection of one constitutional right (the Second Amendment) by unconstitutionally limiting another (the First Amendment).  A true libertarian would not support governmental interference in the doctor-patient relationship, but would recognize the importance of confidentiality in that relationship.  A true libertarian would say that what a physician discusses with his or her patients is none of the government's business.

Bob Barr makes a number of ridiculous statements in his blog on this issue, such as the assertion that you will see your pediatrician for an illness and be asked if you have a gun.  He also suggests that pediatricians ask children to snitch on their parents with regard to the presence of guns in the home.  If he had been to a pediatrician's office in the last 20 years, he would be aware that pediatricians are so busy making sure they cover all the things they are supposed to cover that they really aren't going to waste their time interrogating parents and their children about guns. Pediatricians may counsel about gun safety verbally or, more likely, in written format, because prevention of injury is part of what we do. We will also warn about the dangers of certain sleep positions, we will advise the use of helmets when biking or skating, and we will counsel about water safety. Apparently though, Barr also objects to any discussion of safety since he doesn't want pediatricians talking about pools either. For his blog on the topic, go here: http://blogs.ajc.com/bob-barr-blog/2011/05/02/“say-‘ahhh-’-does-daddy-have-a-gun

Barr further asserts that all pediatricians believe that no one should own a gun. He states "Apparently, the Hippocratic Oath taken by these pediatricians includes a footnote to ignore the Second Amendment guaranteeing Americans the right to own a firearm." Mr. Barr neglects to acknowledge that this legislation is an infringement to the First Amendment's guarantee of freedom of speech and also fails to recognize that pediatricians are not agents of the federal government (although I would love to be able to take advantage of the federal holiday schedule).

Leaving the fact that Barr's position on this issue reveals him to be just another politician who will say whatever he thinks will bring him popular support, let's move on to the question of whether a pediatrician should only be concerned with treating disease and not preventing it, as Barr asserts in his blog.  This logic, if applied to medicine in general, would be catastrophic.  Vaccines, probably the single greatest medical achievement in history, would not exist.  Countless multitudes of people would have already died or been permanently disabled just since the advent of the modern vaccine era in the last century if vaccines had not come to be.  Countless more would never have been born to begin with, since one or more of their parents would not have been able to conceive them.  You and I might not be around to even have this discussion.

According to the CDC: Before polio vaccine was available, 13,000 to 20,000 cases of paralytic polio were reported each year in the United States. Before measles immunization was available, nearly everyone in the U.S. got measles. An average of 450 measles-associated deaths were reported each year between 1953 and 1963. If vaccinations were stopped, each year about 2.7 million measles deaths worldwide could be expected. Before Hib vaccine, Hib meningitis once killed 600 children each year and left many survivors with deafness, seizures, or mental retardation. Since the introduction of conjugate Hib vaccine in December 1987, the incidence of Hib has declined by 98 percent. Prior to the licensing of the chickenpox vaccine in 1995, almost all persons in the United States had suffered from chickenpox by adulthood. Each year, the virus caused an estimated 4 million cases of chickenpox, 11,000 hospitalizations, and 100-150 deaths.

Besides the overwhelming success of vaccines, there are numerous other successes achieved by practicing preventive medicine and providing anticipatory guidance (anticipatory guidance is the practice of providing advice to parents to help avoid injury, illness, and other negative events that may compromise the health of children).  Since pediatricians began to recommend putting babies to sleep on their backs, cases of Sudden Infant Death Syndrome have declined by 60%-75%.  Since removal of lead from paint and gasoline, cases of true lead toxicity in the U.S. have decreased dramatically, except in certain limited geographical areas.

Preventive medicine is the cornerstone of pediatrics, particularly in the United States of America. It is far better to prevent illness and injury than to treat it once the damage has been done. Perhaps I should frame this in a way that a politician can understand: Is it better to do damage control once your extramarital affair has been discovered or never have the affair to begin with? Is it better to defend yourself before a grand jury regarding the funds that you misappropriated or is it better not to misappropriate the funds to begin with?

If you would rather that your state and federal governments not interfere with what you can say to your doctor and what your doctor can say to you, please let your representatives and senators know that this kind of intrusive legislation is not acceptable.  Our politicians need to know without a doubt that passing laws such as these will be detrimental to their careers.