*Note: I feel I should clarify that the word "madness" in the title refers to a comment made by Meryl Dorey.
Meryl Dorey, from the
Australian Vaccination Network (AVN) has posted two lengthy articles telling the tale of a woman who delivered her own baby at home but had to go to hospital the next day with related complications. Since this is the AVN, you can guess that, once the medical profession becomes involved, the story turns dark and we soon find ourselves on a journey of unimaginable bureaucracy, lies, heavy-handedness, unnecessary tests and pharmaceutical madness.
I have no reason to doubt the basic details of
the article [
update: That article has now been password protected for some reason but a copy is available here] but we must keep in mind that this is a second-hand account of a story initially told by someone who had found herself in exceptionally difficult and seemingly disturbing circumstances - so some of the details may be a little murky, though I don't doubt the woman's anguish even if the story is only partly correct. My main interest, however, is with Dorey's approach to medical facts, statistics and assumptions.
For the sake of brevity I'm not going to re-paste much of the article here. In short, the woman gave birth at home and the next day, after she and her baby had been taken to hospital, her baby had a fever and was subjected to tests and procedures, including a lumbar puncture, against the mother's will. Reading it, I was disturbed that doctors would be sticking a needle into a newborn's spine if the only concern was a raised temperature. Surely there must be something she's not telling us? Remember, I'm not a doctor - (
neither is Meryl Dorey).
The doctors' refusal to submit to the mother's wishes forms the basis of Dorey's retelling of her story. Dorey is miffed, to say the least, that trained doctors would take action against the wishes of someone "using their brain" (
yes, she still considers that a scientific qualification).
In the comments section, "Tom" points out that it appears the doctors acted in accordance with standard practice based on a risk of sepsis (
I assume from his comments that Tom is a doctor or healthcare worker of some kind). Dorey responds (
my bolding)...
Thank you for replying Tom. I have to say, I am appalled! The risk of a lumbar puncture has GOT to be greater then the risk that a fever – with no other symptoms – could be sepsis. This is madness, plain and simple...
As an aside, it's worth noting that despite writing almost 3400 words in the article, most of them condemning the medical profession and various government departments, Dorey never mentions sepsis once. The first mention of it on the page was in Tom's first comment where he succinctly explains, in a 27-word sentence, why it is medically negligent for a doctor not to act quickly. I'll leave that with you.
Now, back to Dorey's comment. Whilst she lists some possible complications of lumbar puncture in the article, most of which are "rare", "very rare", "extremely rare", or otherwise inconsequential, Dorey doesn't supply any data on the relative risks of either lumbar puncture or sepsis misdiagnosis. So, is it madness? Is it plain, or simple? I didn't know so I had a look around and it appears Tom is right and Dorey is, not surprisingly perhaps, wrong. First to Wikipedia...
The problem for doctors, as Tom mentioned in his comment, is that
neonatal sepsis can present with nothing more than a fever...
It is difficult to clinically exclude sepsis in newborns less than 90 days old that have fever (defined as a temperature > 38°C (100.4°F).
These doctors were dealing with a baby just 24 hours old and suffering high temperature and who was delivered at home in unknown conditions by a mother who'd suffered heavy blood loss after failing to deliver the placenta. One imagines these doctors had some reasons to be concerned but, ignoring all the other factors, were they right to act so quickly, against the mother's wishes, when the baby only had a fever?
Dorey says
"when doctors become the only ones whose opinion matters ... we have turned a corner into anarchy (
"dictionary for Ms Dorey please!").
But why would doctors make a snap decision? Here's a few stats on the
mortality rate of neonatal sepsis (
my bolding).
A prospective study was carried out to determine the predictors of outcome in neonates with sepsis admitted to neonatal care unit at Basrah Maternity and Children Hospital over six months (from the first of November 2004 till the end of April 2005). One-hundred twenty neonates were studied, sepsis was confirmed by clinical and laboratory measures. Seventy four (61.7%) neonates were males and 46 (38.3%) were females. Thirty three (27.5%) were preterm and 87 (72.5%) were full term. Sixty seven (55.8%) neonates were still alive during period of hospitalization and discharged home, while fifty three (44.2%) neonates died. Early onset sepsis was detected in 35(29.2%) neonates while late onset sepsis was detected in 85(70.8%) neonates, however, the mortality rate was higher in early onset sepsis (62.9%) compared to late onset sepsis (36.5%).
So, almost 63% of neonates with early onset sepsis died. Almost
two out of three of them died!
Now recall that neonatal sepsis can present with nothing more than a fever. Note too that, in his comment, Tom makes the point that an infected baby probably won't survive 24 hours without treatment. The
WHO says that
"The chances of survival are slim for newborns with a serious infection, whether hospitalized or in the community."
Did the doctors take the right action? Again, a bit of Googling says they followed protocol. From
MedlinePlus Medical Encyclopedia (
my bolding)...
Babies in the hospital and those younger than 4 weeks old are started on antibiotics before lab results are back. (Lab results may take 24-72 hours.) This practice has saved many lives.
So far, Tom appears to be on the money. The doctors acted correctly in the best interests of the baby, albeit against the wishes of the mother. But what about the lumbar puncture that had me concerned? From MedlinePlus again...
A lumbar puncture (spinal tap) will be done to examine the cerebrospinal fluid for bacteria.
Bingo! That's why I don't offer medical advice and why my "feeling icky" about a procedure does not make that procedure invalid or unwarranted. Meryl Dorey's personal opinions and doubts carry similar weight where real medicine is concerned.
Argument from incredulity is a logical fallacy.
So, facts we have at our disposal after 15-30 minutes of looking for information...
- a newborn presented with a high temperature
- high temperature can indicate sepsis
- early onset sepsis can be fatal in 63% of cases
- doctors acted quickly to deal with possible sepsis
- they took blood samples and performed lumbar puncture
- they administered antibiotics as per accepted protocol
There are other aspects to the story which would require independent verification to even begin to hold an opinion on. I have no intention of commenting on them but the
medical decisions of the doctors look to be correct to a layman like me.
I'll leave you with some choice comments from Meryl in her comments section...
I would have thought that here in Australia, we were past this sort of mediaeval treatment of women and babies.
Hmmm, because antibiotics and evidence-based protocols are mediaeval? I wonder what she thinks of homeopathy?!?!
Until it is known that there is a bacterial infection present, the indiscriminate use of such invasive procedures should have been left up to the mother. If there had been any ramifications afterwards, it was the mother who would face them and she was willing to take that chance.
She was
willing to take the chance that her baby might not have had sepsis - with a 63% mortality rate? Did she even know the risks? If I'm
"willing to take the chance" that my nappy-wearing baby will bounce safely if I drop it on its backside, should I be allowed to take that chance? (
I saw something along these lines in a video in high school, some 30 years ago, so I do have evidence)
The right to risk letting your child die when evidence suggests a possibly-life-saving alternative is a whole different discussion to whether these doctors acted correctly. We've seen this issue raised before with homeopathically-inclined parents who let their own
baby die of eczema rather than use evidence-based medical help and others who preferred their
cancer-stricken child be wrapped in mud rather than try chemotherapy. From America we've seen similar stories of parents who prayed while their child died from a treatable disease and others who ran from authorities wanting to save their child's life with chemotherapy.
I wonder if Dorey thinks there is anything the government should prevent parents from doing, regardless of the risks to their children's lives? Is every parent always right, as long as they claim to use their brain? For the record, I think Dorey, with her constant conspiratorial battle against rules, regulations and reality, is the one advocating
anarchy.
Now, we have a baby who may have ongoing gut and immune system issues because of this and who could possibly have been made a paraplegic or killed because of the lumbar puncture that the mother did not want.
The risk of ignoring possible sepsis was high -
one quarter of the world's 4 million neonatal deaths are from sepsis. There was no time to "wait and see" since deaths often occur before the lab results are in. The risks of the complications Dorey prefers to highlight were, as usual, minimal.
This isn't Lotto but if it was, Dorey's preferred strategy seems to have been selected to minimise the chances of winning.
Once again we have a case of Dorey effectively arguing that "seat belts are bad because some people die whilst wearing them" yet refusing to acknowledge the life-saving statistics that counter such an argument. I'm finding it increasingly difficult to trust anything on the AVN websites. I wouldn't be making medical decisions based on Meryl Dorey's "feelings".
NOTE: Like Dorey, I'm neither a doctor nor a scientist.
