Taking care of quite a few un-documented immigrants in my medical practice, I find that vaccination rates are typically pretty good, and parents are thoughtful enough to bring in their immunization cards (and their vaccine schedule is similar to ours, only we vaccinate for chickenpox and they vaccinate for tuberculosis). The Mexican immunization program in particular (at least according to the Houston Chronicle) does significantly better than the US one.

Among my commercially insured patients there's a mix of folks who are happier, angrier or ambivalent about changes in their coverage. For some folks things have gotten better (especially among the individually insured whose risk is now spread around) and for many worse, though worsening coverage with each passing year has been the rule.

Regrettably, the cost of insurance comes up frequently in my practice by necessity. Not just with figuring out which medicines an insurance company will reimburse for (down to needing to figure out if they prefer I prescribe capsules vs tablets of the sane medicine) but which procedures are reimbursable, which specialists they can see, how they get psychotherapy, if they can afford a followup visit with me, how their colonoscopy might get billed, or if their finances will be nuked to high heaven if they end up in the emergency department of hospital.

14 years ago in residency I did a rotation in Ireland and was amazed how much different practice was there (at least in rural County Clare) than what I'm used to in the US. Our copay here cost the same as the cost of their entire visit. The state paid for hospitalizations for everyone. Dr Gerry ran his entire practice on a 500 Euro piece of software with one nice lady in the front office and he got paid about the same as his US peers. He also had a nurse who handled much of the lady business. 16 year old girls were counseled on not imbibing more than two (imperial) pints a night.

Here, we need about 5 support people per primary physician to handle all the rules, paperwork, insurance reimbursement, claims and billing; and our computer system costs something on the order for $30,000 per doc per year all told. The Irish marveled at tales of how nuts our system is. Canadians (politely) make fun of it when we're at the same conferences. Seriously, WTF?

As a physician, the new system doesn't feel particularly more intrusive than what we had previously. What we do have is a lot of new patients who were previously uninsured. They don't seem angry about it; they seem happy (to a person, at least amongst the newly insured). And we can get to work preventing their modest problems from turning into gigantic, expensive once that got handled "for free" in the emergency department by spreading the cost of their uncompensated care around to everyone else.

Some of our previously insured patients seemed miffed because, just like before, medical care is expensive and the system is complicated. Some of them who used to blame the insurance companies now blame Obamacare.

I hope you'll (all) forgive me for furthering this part of the discussion, but in my line of work I continue to be mystified about how, say, sin brought about by mankind can result in two very nice, even very religiously adherent parents having a fetus who gets pretty severely bollixed (via isoalloimmunization as above, or the odd infection crossing the placenta, or a bit of chromosome scrambling) and dies before being born? (Or just about as bad, dies in their parents arms shortly after being born?)

My sincere apologies if you think I don't care about this question; it's one of several I care about very much and have great difficulty reconciling. The hospital chaplains' best explanations have amounted to, "Jesus said 'Suffer little children, and forbid them not, to come unto me., for such is the kingdom of heaven." Realizing that KJV usage has a different connotation for suffering, there's still a lot of suffering. I've never thought to say to one of these parents that this must be the result of sin. If you have a better explanation I could use to comfort the afflicted - afflicted, in this view, somehow by original sin which seems awfully distant - I'd love to hear it.

In the US, when you donate blood, you'll be tested for ABO/Rh, and some of the more "minor" blood antigens (minor insofar as they are less frequently implicated in transfusion reactions and pregnancy-related alloimmunization. Most pregnant women will get, in addition to ABO and Rh-D testing, tested with an antibody screen for sensitivity to antigens from other alleles on the Rh locus, Rh-C and Rh-E. The antibody screen also tests for anti-Kell (anti-K, typically the worst of the more minor antigens; we're taught "Kell kills"), anti-Duffy (Fy(a) and Fy(b)), and sometimes anti-Kidd antigens, and once in a while you'll see anti-P, anti MNS, and anti-Lewis, which typically cause little or no harm. (See this Medscape article for a few details.)

The deal is if you are (say) an Rh positive fetus in an Rh negative mom who was previously exposed to another fetus's D antigens (and D is often the culprit) you can get your blood cells nailed by mom's previously-formed anti-D antibodies. You get anemia, jaundice as well, and the potential various bad side effects therefrom (heart damage, brain damage, swelling all over[may not be safe for work]). Similar havoc ensues with anti-K. Preventive therapy with RhoGAM is available to prevent anti-D disease; it's a soup of anti-D antibodies that scavenge any fetal Rh-D positive blood cells that happen to find their way into mom's circulation. It's produced from pooled human blood plasma, though even most Jehovah's Witnesses (since a 1974 church opinion) and Jews (because there's an escape hatch in kashrut for saving human life) find it acceptable for treatment in order to prevent this fairly terrifying surprise G-d had in store for a few unlucky babies.

Sure, you can sit with my two young children since I boarded last on Southwest and no adjacent seats were available. Don't give candy to the girl, and if they fight threaten to take away the iPad.

I think you're probably right in a lot of cases, but what I think this proposal is getting at is that right now we have a single contraceptive implant on the market that needs to be swapped out every 3 years. And, swapping it out means numbing up the area (which smarts), making a 1 cm incision with an 11 blade and fishing around with mosquito clamps to get the Nexplanon out which is often encapsulated with connective tissue and it doesn't want to come out, then injecting another one in. What if it could be turned on and off according to whether the woman wanted to have kids or was abstinent for awhile, so then we can avoid excess poking and prodding and hormones? If we could make that secure, would it be worth it? The cost of the Nexplanon in the US isn't much related to its materials (perhaps $5) as to the research costs and insurance and pharmaceutical company marble toilets with gold handles ($700). Couldn't an electronic Nexplanon with extended duration reasonably be cost effective if we can avoid the excess minor surgery, physician visits, and unintended babies?

Strictly speaking, in the US, we're not paying people to have kids but paying for people who have already had kids to have baby food and clothing and medical care. Even in places where people don't get government support for their kids, they still have plenty of kids - as I think you may be alluding to in your second paragraph but I confess confusion about how reactionary undereducated dicks are particular to Pakastani folks and not, say, Kentuckians.

Government-supported access to contraception is likely highly cost effective - it makes not just intuitive sense, but studies seem to bear this out. Without all the bother of just letting teen moms and their homeless kids, you know, die in the streets and spread measles all around.

In the Unicef document I referenced, the definition given is: "DPT3 - Percentage of infants that received three doses of diphtheria, pertussis (whooping cough) and tetanus vaccine," 99% for Mexico in 2012, and 95% for the US, respectively. The way I'm reading that the Government funding of vaccines is simply the percentage of those given that were funded by the government, like the Vaccines for Children Program in the US (which funds Medicaid and uninsured vaccines), but that 95% percent of the vaccines (say, in the US) were given by VFC - it's closer to 50%. In any event, the WHO numbers you cited are from the same source - it's just that from 2012 to 2013, Mexico went from 99 to 86% DTP3 coverage, and the US from 96 to 94%. The overall trend from 2000 is still 94-96% for the US, whereas Mexico was 97-99% until 2013. I don't know what happened in 2013; I practice family medicine in the Pacific Northwest, in a clinic that serves a large immigrant population, and have gotten a fair amount of practice scrutinizing foreign pediatric immunization cards. I think you may have misread the data source explanations in the Unicef document. I can tell you that, in general, in my experience, my Mexican families think vaccines are a good way to protect their kids. My upper class white families tend to have considerably more skepticism.

You might look into the epidemiology of tuberculosis - where the US vaccination rate (of BCG vaccine for TB) is about 0, and it's on the standard schedule of vaccinations in Mexico. There's no particularly good vaccine for TB, but it's the US that has the whooping cough epidemic, not Mexico. See http://latimesblogs.latimes.co....

You can readily see that vaccination rates are higher in Mexico by checking out UN statistics here: http://www.unicef.org/infobyco... (and comparing to, say, http://www.unicef.org/infobyco...). In my experience as a medical professional vaccinating children, uptake rates remain about 100% in first through third generation Mexican and Central American immigrants, and lower in whites - especially, oddly, those of higher socioeconomic strata.

Tuberculosis tends to spread in crowded conditions and where treatment is not readily available - but treatment is different than vaccination. Mexico does routinely vaccinate against TB (with BCG vaccine, which sorta works); the US doesn't. Latent tuberculosis, for what it's worth, is about equally prevalent in migrant populations from Eastern Europe in my part of the world (Pacific Northwest United States), who tend to be legal immigrants. See http://ethnomed.org/clinical/t... for pretty graphs.

Mexican kids tend to have at least as high vaccination uptake as US kids. (I say this based on personal experience as a primary care physician taking care of a population with lots of Mexican immigrants who keep their vaccination cards, and based on data you can Google easily: http://www.vaccinationnews.org..., and http://www.unicef.org/infobyco... which shows Mexican DTP rates around 99%, compared to the United States, which is 93% by the third dose.)

So, I wouldn't look so strongly at Mexico, as I would at San Diego, which is the backyard of Dr Bob Sears and his Vaccine Book. He promulgates a non-evidence-based Alternative Schedule that more or less gives privileged white parents permission to be suspicious of the pro-science crowd. (See http://pediatrics.aappublicati... for cogent commentary on the same.)

With a panel of about 2000 patients, I've got more or less 0 vaccine refusers among my Mexican and Central American population, which correlates well with the Unicef data cited above.

Complications of measles depend on the setting - and though it's hard to surmise about your case in particular (you were "pretty sure" you had measles) the case fatality rate is up to 4-10% in developing countries (probably due to poor nutrition, but other folks at risk include being pregnant, old, or very young) due to brain inflammation or pneumonia. In developed countries the risk is lower, and we have nice expensive ICU's to care for people in - until we don't - in my city, we were running out of ICU beds for folks with influenza pneumonia this past year.

Cherry JD. Measles virus. In: Textbook of Pediatric Infectious Diseases, 6th ed, Feigin RD, Cherry JD, Demmler-Harrison GJ, et al (Eds), Saunders, Philadelphia 2009. p.2427.

Bernstein DI, Schiff GM. Measles. In: Infectious Diseases, Gorbach SL, Bartlett JG, Blacklow NR (Eds), WB Saunders, Philadelphia 1998. p.1296.

It's an interesting claim that apparently all cancer researchers feel there is so much money to be made in grants, they are careful to reject novel ideas that might lead to cure for cancer so they can securely remain on the gravy train. By interesting, I mean for what it reveals about how people think. Hanging around the parking lots of university-based research facilities did not yield a surfeit of expensive cars. And while a good argument can be made for the plodding progress of research despite all the pink ribbons, breast cancer mortality is in fact steadily decreasing - even for women with tumor that's spread to lymph nodes. From the same website, you'll see even more impressive progress in colon cancer mortality, lung, and prostate cancer, which rounds out the list of the most common fatal cancers.

In some sense, increasing cancer mortality likely results from people in industrialized nations being killed less often by other stuff (cars, emphysema, smallpox, contaminated water). And walking 10 km (on a regular basis) probably has significantly decreased cancer mortality, probably by changes in hormone balance and metabolism. Cancer research may not always be flashy, but they do seem to dig up useful stuff over time.

ECT gets a bad rap because it looks sadistic and no one quite knows how it works. On the other hand, it's effective - more effective than most other forms of depression treatment, and has the benefit of working when nothing else does. (Remission is severe depression is 70-90% with ECT vs 30% with a typical SSRI pill.) I've had patients who desperately wanted to be dead because each passing moment was filled with unbearable psychic pain, who after 3 treatments of ECT (with pulses lasting a few milliseconds) were smiling and chipper. (Albeit with some unpredictable holes in their memories.)

Moreover, contrary to One Flew Over the Cuckoo's Nest, modern treatment insists patients have voluntary, informed consent. This data isn't exactly hard to come by - Google ECT PubMed. In the US, unfortunately, ECT can be hard to come by, given attitudes such as that expressed by the parent poster, and I suspect reimbursement isn't that great (patients get general anesthesia for a few minutes, which isn't cheap, but US Medicare reimbursement for psychiatry is notoriously poor such that most psychiatrists don't take Medicare).