Ethics: February 2009 Archives

The diethylene-glycol-containing "My Pikin Baby Teething Formula" has now killed 84 infants in Nigeria, according to Reuters. A report in November had placed the number of related deaths at 25. Many of those affected to date, 111 total (including the dead), are children between 2 months and 7 years of age.

A nationwide recall has recovered more than 400 bottles of the product, and the Nigerian government has shut down the responsible company, Barewa Pharmaceuticals, in Lagos. Reuters also indicates that "a number of people involved in distributing [the product] have been arrested."

The AP writes that DEG entered the product when a Barewa official attempted to purchase propylene glycol, a "normal" ingredient in teething formula, from an unregistered chemical dealer on the slum fringes of Lagos. Historically DEG has been a cheap (and very toxic) substitute for glycerin in consumer products. The active ingredient in My Pikin is reported as paracetamol, aka acetaminophen.

Death due to the consumption of DEG is almost universally due to renal shutdown. For a list of previous incidents of DEG-contaminated consumer products, go here, and read ongoing posts about the 1937 Elixir Sulfanilamide disaster in the United States at this blog.

Photo of My Pikin Baby Teething Formula from Vanguard.

In a final act, Rod Blagojevich, the crazy ex-governor of Illinois, approved an increase in the state's Medicaid reimbursement rates to pediatricians who provide critical care services. Today's Chicago Tribune, which has the story (or at least some of it), reports that the governor's last-minute decision did not need a legislative nod. The percentage increase in Medicaid reimbursement was evidently not revealed by state officials.

Among the many charges in the federal complaint against Blagojevich—which led to his bizarre and unprecedented impeachment—is the allegation that he tried to squeeze the CEO of Children's Memorial Hospital in Chicago, Patrick Magoon, for a $50,000 contribution last November. In exchange, the governor would approve $8 million in state funds, as urged by a pediatric healthcare initiative, We Care for Illinois Kids, a coalition that promotes increased reimbursement rates for specialized pediatric care.

The coalition supports Illinois HB5331, which stipulates that physician fee rates for the All Kids Insurance Program (the state's Medicaid program for children) must increase to competitive levels. Currently pediatric specialists in Illinois received only 33 cents for every dollar spent on Medicaid patients, one of the lowest Medicaid reimbursement rates in the country. The Children's Hospital of Chicago is the state's largest provider of inpatient, outpatient, and physician Medicaid services.

Despite Blago's final attempt to increase pediatric Medicaid funding, which is to be reviewed by the current governor—the bland but, god willing, semi-ethical Pat Quinn—the funds are "nowhere near" enough, according to an involved lawmaker who was cited by the Trib.

In yet another effort to refute the shifting arguments of those who maintain that vaccines cause autism, CHOP physicians Jeffrey Gerber and Paul Offit take on the latest rant of "too many, too soon," in the February 15 issue of Clinical Infectious Diseases.

This most recently developed theory of antivaccinationists proposes that simultaneous administration of multiple vaccines somehow affects (overwhelms, weakens, etc) a child's immune system, which in turn leads to some sort of neurologic effect that triggers autism. The big problem with this theory, as Gerber and Offit rightly note, is that there is no evidence that autism is an immune-mediated (or specifically autoimmune-mediated) disease.

Their counterarguments, with respect to vaccines:

• They do not overwhelm or weaken even a new infant's immune system—which, although immature, can generate "a vast array of protective responses."
• The total immunologic load of currently recommended vaccines (14) is actually much less than that of recommended vaccines administered in 1980 (7)—all thanks to advances in protein chemistry and DNA technology.
• Vaccines actually represent a tiny fraction of the immunologic challenges (eg, all those environmental antigens running around) that a child typically encounters.
• Vaccines don't "weaken" the immune system, as evidenced by the equivalent susceptibility to infections* among vaccinated and unvaccinated children.
• Last, there are no clinical data** to support the idea that spreading out or reducing the number of childhood vaccinations reduces the incidence of autism.

* Non-vaccine preventable.

** And for good reason, because such a study would be unethical.

The number of Zimbabweans affected by the country's ongoing cholera epidemic has nearly doubled since early January. The latest report from the World Health Organization indicates that more than 60,000 people have been infected and more than 3100 have died since August of last year. WHO forecasts that the epidemic will continue to escalate, affecting surrounding countries as well as Zimbabwe, unless "drastic action is taken by all players in this crisis."

At present, WHO urges the following measures to stifle the spread of disease:

• Improve awareness of cholera prevention and treatment, particularly among residents in remote sections of the country.
• Increase the availability of oral rehydration salts and chlorine tablets within communities to enable a rapid response.
• Mobilize financial resources to pay Zimbabwe's healthcare workers, many of whom cannot pay for basic needs like transportation to work. WHO concludes, "This vacuum in availability of national health staff is a prime factor in the increasing number of cholera sufferers dying."
• Increase public access to nongovernmental organizations, like Médecins Sans Frontieres (aka Doctors Without Borders), which fill the current void in national services.
• Strengthen the "multisectoral" response of the United Nations, nongovernmental groups, donors, and the Zimbabwe government.

WHO's Assistant Director-General for the group's Health Action Crises Cluster, Dr. Eric Larouche advised, "Political differences need to be put aside, economic barriers overcome, health services in the country's periphery strengthened and community awareness to respond enhanced to save many more people from dying due to a disease that can be readily prevented and treated." Although the case fatality rate of Zimbabwe's epidemic has decreased slightly, reports WHO, it remains higher than 5%,* and the death rate at the community level is approximately 3 times higher than that in health facilities.

* The "acceptable" death rate is less than 1%. 

Map showing spread of cholera in Zimbabwe as of December 8, 2008, from Wikipedia.