At lot of medicine is about what we think we understand to be true. We use the best available evidence, if there is evidence available, to help patients make decisions about their care and to manage disease to the best of our ability. (I previously posted on this idea of evidence based medicine.) I think most of life works this way. Our minds compile what we think is the best available evidence to make decisions. Like when I go to the grocery store. Which package of strawberries seems to be the brightest, which milk carton expires latest, what granola bars my kids will eat this month.
But there are some things that we don’t have much evidence for. Sometimes this is because we don’t have much experience or research with the problem. Take, for example, the Zika virus. Although the Zika virus has been around for some time, we have very little experience and research with the virus when it comes to adverse pregnancy outcomes such as microcephaly, miscarriage, and other complications in pregnancy. You see, what was first noticed was an association. A large number of women who had been exposed to the virus or were known to have the infection had babies born with microcephaly, or underdevelopment of the brain. Does association mean causation? No way. So scientists from the CDC and other organizations began to explore how these two things were related. For many other infections a pregnant woman might be exposed to doctors can give a significant amount of information to their patients about the risk to your baby depending on when you are exposed and other laboratory findings. But for Zika we don’t know that information. We have limited data that would say about 1/3 of pregnant women infected with Zika will have some kind of adverse pregnancy outcome.
So what do we do? Well, the CDC says if you’re pregnant just never go outside. (I can hear you laughing all my pregnant ladies.) We tell our patients to use insect repellent with DEET, to avoid travel to Zika infected areas while pregnant or for at least 6 months prior to attempting pregnancy and don’t have sex with men who have been exposed to Zika or have travelled to Zika infected areas if you are pregnant. We have no vaccine; we have no treatment. But, hopefully soon, we will. Researchers will continue to work on how the virus is transmitted, why certain women’s infants are affected, and how to prevent or treat Zika before it becomes an even bigger health concern.
The other issue I’d like to address today that we don’t know much about is gun violence. Oh yes, I went there. You see the CDC has had a self imposed ban on gun violence research since 1996 when its funding was threatened. It has been more than 4 years since Sandy Hook and only a week since the Orlando night club shooting. Two large bills to fund gun violence research have failed to pass. Is there some research out there on gun violence? Sure. But consider this: if you do a PubMed search on Gun violence you will find about 1500 scientific articles or editorials on the topic. If you do the same search on autism, you will find over 34,000 articles on the topic. Is autism research important? Absolutely. Should we have the opportunity to publish over 30,000 more papers on gun violence? Absolutely. Because I can’t tell you if more guns or less guns or safer guns or more training or anything will keep men women and children from being gunned down by individuals hell bent on destroying the world around them but unless we try and find out what we can do we are powerless to do anything. It’s like telling pregnant women not to go outside or just avoid travel to Zika areas…sometimes you need to go outside and Zika might just come to your area. And then you need to know what best to do for yourself and your family. You need to know what you don’t know.
So, on this Father’s day, I am thankful for a father who loved to hunt but always made us feel safe and secure when we went with him. For a father in law who loves to travel and has been generous to take us with them. And for a husband who loves his daughters, and everyone else around him for that matter, enough to work hard to bring more peace to the world on a weekly basis.
(photo credit to @jonmsutton on twitter)