“Don’t let the world around you squeeze you into its own mould, but let God re-mould your minds from within...”
Romans 12:2

Fleas, the good, the bad and the very ugly

Hilary Butler - Saturday, October 25, 2008

Ever wondered about paediatricians who blog? This is one time where it would be of educational value to read all the embedded links. The full implications of some types of medical "practice" might not sink in, unless you do.

Once upon a time, when I was still on Mothering, a mother told her story of her child who had seizures after her first DPT (whole cell vaccine) and who died aged 8 and a half.  ( See about page 4 – 5 of this thread.) A member of Mothering told the story to a paediatrician called Robert P Lindeman, who had plenty to say about people who don’t vaccinate. He wrote a now defunct blog post under the name Dr Flea, which can still be read here .  He referred to people who used alternative medicine as "alties".   One of the his many blogdom colleagues who also participates in “alties” excoriation, Dr David Gorski, ( Orac ), naturally leapt to Lindeman’s defence.  This is par for the course, when it comes to any altie, "woo" or vaccination issue.

Suddenly, one day, "Dr Flea" disappeared.  Some years before, he had failed to diagnose a child with Type 1 diabetes, who died a few months later, and Lindeman was taken to court for malpractice. He made the stupid mistake of blogging during the case, venting what he thought about the parents, the case, the lawyers, the court and the “dozing” jurors.  The day after the prosecution lawyer pulled him up about this in court, he settled the case. Another blogger detailed Dr Lindeman’s thoughts about being a doctor, blogging and the case.  More recently, other complaints have surfaced about this paediatrician’s ability to miss serious illnesses, (which is something they can all do ) and the debate about him goes on at Mothering.

But here’s the interesting point about Dr Robert P Lindeman, and his practice website. He has some very interesting, and enlightened numbers on it, like this one on fever.  He’s way ahead of the average garbage on this topic, though in defiance of all logic, he still prescribed acetaminophen and ibuprofen!  But at least he has the idea that fever is good. This article called, “viruses that dare not speak their names”  has a very important statement on it, which all parents should memorize. It goes like this:

The most important thing that parents need to know about their kids is that they are essentially healthy human beings who recover completely from virtually every acute illness that nature and daycare centers can throw at them. Parents struggling to keep straight names and numbers of particular viruses are less likely to remember this simple, reassuring fact.

And this commentary on paediatric training is worth noting:

Only recently have pediatric training programs begun to teach primary care in any depth. As a result, pediatricians emerge from training programs well-prepared to care for sick children, and less-well prepared to care for healthy children. This type of training gives a young pediatrician a much skewed perspective on the health of children. It wasn’t until I began practicing in the communities that I discovered that the overwhelming majority of children are, in fact, quite healthy!

The ‘Sick’ Model

It follows naturally that pediatricians should regard children as essentially sick people. After all, pediatricians get the bulk of their training caring for sick children. This model of the child as ‘sick’ person doesn’t work well in primary care. Pediatricians are trained to find and treat disease, not to manage wellness. As the saying goes ‘when you have a hammer, the whole world looks like a nail’. Pediatricians are trained to wield highly-specialized hammers. They are over-equipped to practice well-child care.

And there never was a truer blog than one of his which said this: 

Were it not for ear infections, most of us fleas in primary care would be out of a job. To be more precise, were it not for fear of ear infections, most of us fleas in primary care would be out of a job.

Just yesterday Flea paid a house call to an 8-month old who had been pulling at her ears (she was teething). What if instead, the girl had had a non-infected-looking effusion? Some (many?) fleas would have handed the parents a script for Amoxicillin (some fleas would have handed them a script for Azithromycin, but that is a matter for another day!) Why? This is a perfectly happy, peppy kid who pulls at her ears! What would happen, if we left fluid in her middle ear space for while? Would she go deaf? Would she become language delayed? For the last 40 years or so, most of fleadom, in fact most of the world, believed something dire would come to pass if this child were not antibiosed.

And so it was until Jack Paradise and colleagues at Children's Hospital of Pittsburgh began asking if middle ear effusions were really as big a deal as all that. As early as 1981, Paradise began evaluating the literature on middle ear effusions. He found that the data... well... there wasn't much, and the existing data sucked.

Fifteen years ago, Paradise and colleagues began following a group of kids from Pittsburgh from birth to age 12. Many of these kids got ear infections and had fluid behind their ears. Paradise et al. wanted to know if the ear fluid prevented these kids from acquiring speech and learning correctly.

That study is now ended. Here's the verdict: There appears to be no association between early ear infections and later impairments of speech, language, and cognitive development.

So is that it? Do we pack up our otoscopes and go into real estate?

Not so fast. Science and culture tend to run on different schedules. Even in the presence of the definitive study on the subject, Flea figures his colleagues will continue poking holes in tympanic membranes for a long time to come. What's more (and here's where Flea's colleagues threaten to beat him with blunt objects), ear infections pay the bills. Consciously or unconsciously, fleas will continue to take good care of our hot little bête noire. After all, she's been good to us.

No doubt parents in the rest of the world, will be kept thoroughly in the dark about that nasty piece of truth. 

And perhaps even this is edifying in a hypocritical sort of way:

Flea will acknowledge that obesity is a (you'll pardon the expression) a big problem. But no problem was ever solved through an initiative that enjoins us to do anything for the sake of doing something.

For the record, Flea's got no problem with making money. He'd like to make lots and lots of it. We draw the line at being told how to practice medicine without evidence-basis, for the sole purpose that someone else can make a buck.

I bet you though, that in spite of the fact that evidence based medicine shows that the flu vaccine doesn’t work in the elderly, and doesn’t do much for kids either, he’ll still believe that it does. And in spite of evidence based medicine showing that the 23-valent pneumococcal vaccine is a load of tripe, the fact that it’s just been recommended for all smokers will nullify the evidence based facts. And in spite of the fact that the whooping cough vaccine has major issues, he will still continue to give that vaccine too.  Like some racehorses, some doctors can only function with blinkers on.

An article on his website is worth reading when it comes to the differences in clinical practice in 1904, and 2004.  Whereas in 1904, a baby whose teething gums weren’t cut open by the doctor was likely to “die”… in 2004, treating ear infections with antibiotics, now replaces the lunacy of 1904.

But here is where I really start to gag. This man is a paediatrician and says this?

The truth is that a normal infant is born with a fully-functional, multi-pronged, ready and able immune system. It does not need to be primed or tested. It can be neither weakened nor overwhelmed by newborn vaccinations. It is capable of fighting off viral infections. It does not need to be "boosted" by anything.

Really. Seems a medical student's thesis could teach him a thing or four.

By such logic as "babies have a fully functional multi-pronged, ready and able immune system", then wouldn't you think that babies could cope with disease like adults do, and wouldn't be at increased risk of diseases?  Perhaps they don't even need all those vaccines?!!   After nearly fainting, you sort of wonder how it is that he then hasn’t computed that were this actually so, babies wouldn't need the number of vaccines recommended.   And surely, shouldn't the vaccines be given as a much smaller dose than..., or even equal antigen numbers to those given to an adult? Why is it then, that baby vaccines often contain greater quantities of antigen than adult formulations, if the immune system capacity is the same?

The statement above masses of research, paediatric immunology texts, and published graphs showing age-incremental-maturation of all of the immunoglobulin classes.  It defies information on how breastmilk is a key catalyst in triggering the gene expression required to develop, tune up and orchestrate the maturing of an immature immune system.  Does he not know that bottle fed babies have much higher rates of acute and chronic diseases right into old age, because they miss out on this crucial breastmilk "tune-up", as well as other "protection" which only breast milk can give?  No "tune up" would be required, if a baby was born with a immune system which was functioning effectively in every part of the body from birth. 

As a paediatrician, wouldn’t you think that Dr Lindeman would also know about the dangers to a baby of a raft of drugs during the gradual process of progressive myelination of the baby’s brain? Until that process is complete, a child is at high risk from the resultant “breaches” in the immune system. There is so much more that could be said on this, but it would take at least one book, if not more.

And there is this comment on his website, too which couldn’t be further from the truth either:

Most people don’t know about the enormous hurdles a vaccine manufacturer must jump to get a vaccine approved. After approval, vaccines are very closely monitored. If strange, unexpected side effects begin to appear, the vaccine is quickly pulled from the market. Vaccines are not only safe they are effective.

He clearly hasn't read any of the congressional hearings about at least 32 dangerous useless vaccines sold for decades at great profit to the companies, but no gain for the public. Nor has he really looked hard at protocols of current vaccine trials, and post marketting surveillance. Again, at least one book could be written about this misinformation!

But...much of what else he had to say is true, and in some ways, inspiring.

For all his faults some of his views appear to be more forward looking than those of many doctors in this country.

And that’s the danger for parents, because when someone comes across as reasonable about some things, how does a parent separate out the good stuff, from his inaccurate statements about a baby’s immune system and vaccines?

When it comes to those points, Lindeman loses the plot, and that’s a pretty serious plot to lose, because those assumptions might lead to serious undiagnosed health issues.

As a blogger, Dr “Flea” had many interesting things to say. His arrogance, and uber-confidence meant that he said stuff that medical wimps and PC people would never think of saying.  He believed implicitly in everything he had to say, the good, the bad and the very bad. Perhaps that was his blogdom downfall.

Parents need to know ALL the thoughts of any paediatrician they consult for an opinion about their baby or child, because while that paediatrician may seem brilliant ~ even very forward thinking perhaps, ...  it’s the blinkered dogma that might bite YOU, when it comes to the crunch.

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