Tuesday, June 8, 2010

Little Ones and Lobotomy

The Incident

Two weeks ago, our two-year-old daughter ran into a table and smacked her head.  She hit it pretty hard, and this resulted in a painful headache.  We decided a medical professional should look at the injury to make sure it was properly cared for, so we took the girls and drove to a medical clinic.  (If you haven't heard about this yet and are starting to freak out, don't.  Everything is just fine; but please keep reading.)

Before going any further, I should explain that I have a pretty radical philosophy when it comes to medical treatments.  I believe the following:

1) A medical treatment must not be performed unless it provides a benefit.
2) If a medical treatment has risks associated with it, it must not be performed unless the benefits are greater than the risks.

These are very simple and reasonable standards, but I have found that many parents as well as many medical professionals do not follow them.  As my daughter's father, I believe it is my duty to ensure, to the best of my ability, that any medical treatment performed on her meets these criteria.  That belief was put to the test during this incident.

On the way to the clinic, I knew we were going to be facing a difficult decision.  You see, in cases such as this, it is a standard medical procedure to perform a lobotomy on the part of the brain that is causing the pain.  This is done to prevent the pain from causing larger problems later on.  In fact, most children of this age have already had that part of the brain severed as a precaution.  Knowing that this is a controversial issue (many medical professionals are against this practice), my wife and I had previously done some independent research on the risks and benefits of this particular procedure.  The results of our research led us to refuse the procedure for our children up until this point.

We got to the clinic, checked in with a nurse, and waited for a doctor to show up.  While we were waiting, I decided to call our daughters' pediatrician.  I am not a medical professional, and I had come to trust his expert medical opinion.  Even though I had done my own research, I wanted to confirm with him that a lobotomy was not necessary in this particular case.  Indeed, he told me that as our daughter's pediatrician, and with the information I gave him, he did not see a need for the lobotomy.  He also confirmed that it is a standard procedure in cases such as this, and that I was correct to assume that the doctors at this clinic would recommend the procedure.  He did not actually make a recommendation, but told us that it was perfectly fine for us to decide which course of action to take.

A doctor came and looked at our daughter.  As I expected, she asked us why we had not allowed her to have a lobotomy until now.  I answered simply and clearly, "Statistical analysis."  Looking slightly surprised, she went on to explain that she would recommend we have the lobotomy done.

I should add that, during my research, I discovered that these procedures usually include severing multiple parts of the brain at once, in order to kill many birds with one stone.  Therefore, I asked the doctor, "Will you only operate on the portion directly related to this injury?"  She clearly answered in the affirmative, which surprised me a little.  I told her that we would have to discuss it.  We had time to think about it because our daughter's wound needed some cleaning and an X-ray to ensure no bone was damaged, which they were going to do soon.

That doctor left.  A few minutes later, another doctor came in and introduced herself as the supervisory doctor of the clinic.  She told us a little more about the lobotomy.  She also added that many of "those studies" about medical procedures are flawed because they do not take into account collective immunity.  For example, polio (which she mentioned specifically) does not spread much anymore because much of the population has been immunized against it.  This makes the virus seem less dangerous than it would be if the immunization had never been created.

If you're asking yourself what the spread of viruses has to do with a non-contagious headache resulting from an injury, congratulations!  You are more intelligent than the supervisory doctor of a medical clinic.  I'm.  Not.  Kidding.

Anyway, I was not about to get into an argument with the very people that were trying to help our daughter who needed medical treatment.  Therefore, I simply told her that we wanted to wait until our visit to the pediatrician in a few days before making a decision about the lobotomy.  Our daughter was given a temporary treatment for the pain that would last until then, so an immediate decision was not necessary.  The doctor didn't seem satisfied, but she left anyway.

A while later, a nurse came in to clean the wound.  She asked my wife, "Is it okay with your religion if I use this cleaning solution on her?"  Not once did we make any reference to religions or belief systems, but by now the entirety of the clinic staff probably thought they had a bunch of extremist nut jobs on their hands.  As I said, I clearly cited statistical analysis as my justification for questioning the medical treatment.

Later on, one of the nurses told us that our pediatrician was on the phone.  Obviously, the supervisory genius of the facility couldn't accept the fact that any self-respecting doctor would allow some religious whackos to deny medical treatment for a child in favor of simply praying that God will magically heal the injury.  I'm assuming she tried to talk some sense into him and insisted that he convince us to get the lobotomy done.

When I picked up the phone, he repeated that we were free to make whatever decision we were comfortable with.  He also added this juicy tidbit: if the operation were performed at this clinic it would actually affect other parts of the brain, not just the one relating to the current injury.  Oh, really?  While this confirmed what I had learned in my own research, it was contradictory to what the first doctor told me when I asked her about it in no uncertain terms.

At this point, we just wanted to get out of the clinic.  The doctors were very reluctant to let us go without making a decision regarding the lobotomy.  (How is one to make an informed decision without time to gather information?)  I told them that I knew we were going against the standard procedure, but I insisted that we take it up with our pediatrician.

Eventually, they let us go.  Our one-year-old suffered little more than boredom.  Our injured two-year-old was a real trooper - the only time she got really frightened was during the X-ray, but it was quick and I was able to sort of hold her while wearing protection.  At my request, she said, "Thank you." to the clinic staff on the way out, which was really cute.  They gave her a toy to keep, too.

If you suspect that parts of this story are made up, you would be correct.  A similar event did occur, but I changed the injury and treatment in order to make a point.  The same logic still applies to the actual injury and the treatment that was actually offered.

The Soapbox

You may have wondered why anyone in their right mind would perform a lobotomy just to eliminate the silly prospect of serious complications resulting from headache pain.  The chances of such a thing happening must be almost non-existent!  And obviously, a lobotomy has serious risks associated with it.

If someone tried to tell you that most doctors agreed this standard procedure was actually beneficial, wouldn't you ask to see some statistical data to back up that claim?  If they told you that the procedure had been thoroughly tested, wouldn't you demand to see the evidence that the benefits outweigh the risks?  If this was really tested, the results should surely be available to the public, right?  Yet parents, medical "professionals," and others often fail to ask such simple questions.

In many cases, it is hard or impossible to find statistical justification for controversial medical practices.  You can read about how difficult it was for me to investigate this particular treatment here.  If the treatment is as good as many claim it is, why is it so difficult to gather this data?

Again, justification must meet these criteria:

1) A medical treatment must not be performed unless it provides a benefit.
2) If a medical treatment has risks associated with it, it must not be performed unless the benefits are greater than the risks.

There are no exceptions.

I don't care about looking up some hippie's website and finding that all vaccinations are evil because they give everybody autism.  The onus is not on me to prove that the treatment is too risky; it is on the medical community to prove that the treatment is justified.  If such justification cannot be produced, you can bet I'll exercise my right to refuse treatment for my children.

Just ask why.  Ask for justification.  It's not a complicated request.

If you don't, shame on you.  Especially if you are responsible for the medical care of another.

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