Respectful Insolence

Barbara Loe Fisher versus the flu vaccine

Around about this time last year, the nation, nay, the world, was in the throes of a frenzy about the H1N1 influenza pandemic. It was also fertile ground for skeptical blogging for two reasons. First, it was a major health-related story. Second, the mass vaccination campaigns for H1N1 that governments thew together hurriedly was a magnet for quacks, cranks, and loons of the anti-vaccine variety. Truly, the craziness came fast and furious, with each new day bringing a new atrocity against science and reason. Indeed, even one of my favorite magazines, The Atlantic, wasn’t immune, as demonstrated by a truly execrable attack on the H1N1 vaccine that was so bad that, as a subscriber for over 25 years, I canceled my subscription.

Fortunately, this year doesn’t seem to be nearly as bad. Yet.

The reasons for the much less heated response to the beginning of the 2010-2011 flu season should be fairly obvious. For one thing, there has been ample time to produce the vaccine and incorporate H1N1 antigens in it, along with other predicted strains of influenza virus that will be circulating. For another thing, there is much less of a sense of urgency. Even though H1N1 tended to affect the young more severely than the old, the predictions of a 1918-like pandemic that would kill millions did not come to pass, although the severity of its attack did strain resources at some hospitals. Even so, we weathered H1N1 and have a better idea what to expect this year. A lot of what was so scary last year is that we didn’t know for sure what to expect. Unfortunately, because we were fortunate and the pandemic didn’t kill as many people as was feared, anti-vaccine loons have proclaimed all the precautions and the mass vaccination programs undertaken as unnecessary wastes of resources or, in the crazier circles, a massive plot by big pharma to increase its bottom line. Truly, I do not envy public health officials. They’re damned if they do and damned if they don’t. They mount a massive public health effort to prevent a pandemic and get blamed for overreacting when the pandemic isn’t as bad as feared. You can be absolutely certain that, had the pandemic turned out to be as bad as feared and public health officials not reacted, they would have been blamed for not doing enough.

None of this means that there isn’t plenty of anti-vaccine crazy to go around this year. It’s just that it’s more a run-of-the-mill anti-vaccine crazy compared to last season. In a way, that’s kind of a relief. It was tiring to deal with post after post by the anti-vaccine movement about the flu. Still, this year, there is a new trend in flu vaccination programs, and that’s an increasing trend towards hospitals requiring that their staff be vaccinated against seasonal flu. Indeed, that is the case at the cancer center where I work, as I mentioned a couple of days ago. Basically, at our cancer center, anyone involved with patient contact, from physicians to nurses to aides to receptionists, is required to be vaccinated against the seasonal flu. Anyone can refuse, but refusal carries a price. Anyone who refuses will be required to wear a mask during any time they are in patient care areas or otherwise anyplace where they might interact with patients. To me this seemed a reasonable compromise between the health care imperative that leads us to protect not just ourselves but our patients and personal freedom. The only thing I would have added to it is to require anyone refusing the vaccine to wear gloves as well.

Naturally, requiring health care professionals to do what they should do anyway out of duty to themselves and their patients does not sit well with certain people. People like the Grande Dame of the antivaccine movement, Barbara Loe Fisher, for example. The other day, she posted a very telling screed (along with video, of course) entitled Forcing Flu Shots on Health Care Workers: Who Is Next? It’s also crossposted on BLF’s blog, Vaccine Awakening. Not surprisingly, BLF’s piece of obvious co-opting of libertarian (dare I say, even, Tea Party-ish?) impulses in the service of her anti-vaccine agenda was rapidly picked up by the anti-vaccine crank blog Age of Autism.

BLF (not BFF, at least not mine):

60 percent of all U.S. health care professionals don’t want to get an annual flu shot,2 which matches the number of Americans, who choose not to get a flu shot, even in pandemic years.3, 4 Surveys reveal that health care providers know that influenza vaccine can cause nasty, unexpected side effects for some people, like paralysis5 and convulsions.6

But that has not stopped medical organizations from launching a national crusade to force everyone employed in a “healthcare setting” to get a flu shot every year, whether they have direct contact with patients or not.7, 8 That’s right. Not just doctors and nurses, but every single person who has anything to do with the health care facility, including students, volunteers, and contract workers. An exception could be made if the doctors in charge approve a “medical exemption” to vaccination, which, today, is about as hard to get as a job.

It is not a pretty sight to watch doctors acting more like thugs than healers. When doctors threaten people with financial ruin for refusing to shut up and salute smartly, there is something wrong.

Let’s get one thing straight before I go on. I can understand the libertarian argument that no one should be forced to undergo vaccination. The “health freedom” argument is deceptively appealing. It ignores one thing, however. Taking care of patients is not just any job. A health care worker would be perfectly free not to protect himself against seasonal influenza were it not for the fact that his decision affects more than just himself. It affects potentially every patient he comes in contact with. Consequently, it is not at all unreasonable to require as a condition of working in a hospital during the flu season that such health care workers be vaccinated against the seasonal flu. As described in a recent article in Infection Control Today, high levels of vaccination against seasonal flu are a patient safety imperative. Similarly, if you work in a pediatric hospital, you should be vaccinated against pertussis. In fact, it’s incredibly depressing that these points even have to be brought up. Anyone who doesn’t accept even the tiny risk of being vaccinated to protect himself and his patients shouldn’t be taking care of patients during flu season.

Of course, to BLF, this reasonable requirement that health care workers be vaccinated against the seasonal is the first step on the road to creeping health fascism:

We are next in line because when doctors trade in their white coats for military uniforms, going after their own is just the first step on the road to going after the rest of us. If this latest power grab is allowed to set precedent in America, the only question in the future will be: how many vaccines will we be forced to take or lose our jobs, our health insurance, our right to enter a hospital, or receive medical care, or get on a plane, or check into a hotel if we can’t prove we have gotten vaccinated?

You might be puzzled by the reference to doctors trading their white coats in for military uniforms. The explanation for that allusion is simple. The Centers for Disease Control and Prevention (CDC), the government agency that produces vaccine recommendations and is responsible for public health, is part of the Public Health Service (PHS). The PHS was formerly the Marine Hospital Service, and due to the military origin of the PHS there is a branch of the PHS known as the U.S. Public Health Service Commissioned Corps (PHSCC), which is led by Surgeon General, who holds the grade of a three-star vice admiral while in office. Indeed, the PHSCC is one of the seven uniformed services of the U.S. and allocates its officers to all seven uniformed services depending on their health and/or medical needs. It also sends its officers to help in response to national disasters, such as 9/11, when 1,000 PHSCC officers were dispatched to New York in the wake of the World Trade Center terrorist attacks. Similarly, they were sent to New Orleans in the aftermath of Hurricane Katrina. These days, the PHS and PHSCC are in the Department of Health and Human Services and the Surgeon General reports to the Assistant Secretary for Health in the Office of the Secretary. In other words, the military background and the fact that some 6,500 members of the PHSCC are commissioned officers mean to BLF that the physicians in the PHSCC have “traded their white coats for military uniforms.” And those PSHCC officers working at the CDC must be budding Mengeles, if BLF is to be believed.

Yes, that’s all that BLF is referring to, as far as I can tell. She’s basically saying that, because there are a lot of PHSCC officers working at the CDC, that has led to incipient health fascism in the CDC, leading to mandatory vaccine orders. She might as well slur all military physicians (and I have known a lot of military physicians in my day) as being a threat to freedom, because that is what she is in effect doing. She’s implying that by simply putting on the military uniform a physician suddenly becomes a threat to health freedom. The next part of BLF’s little tirade is a classic slipperly slope logical fallacy. Basically, she predicts all sorts of horrible abuses of freedom, such as requiring vaccines to receive medical care or get on a plane (?), as inevitable consequences of current efforts to require health care workers to be vaccinated. As most people who use and abuse the slippery slope fallacy do, BLF does this without, oh, you know, actually connecting the dots and showing you how requiring health care workers to be vaccinated will inevitably push us down the slippery slope to all these violations of freedom for all Americans. She simply expects you to believe that they are the inevitable consequence of mandatory vaccination programs for health care workers.

The next segment of BLF’s little rant is truly amusing, or it would be if it weren’t such a pernicious little piece of propaganda. Basically, she traces all the things she hates about mass vaccination programs back to a Supreme Court decision in 1905 that upheld the power of states to require smallpox vaccination. The result of this decision, according to BLF, was an “evangelistic crusade” on the part of public health officials to “smack down all microorganisms associated with infectious disease by calling on 300 million Americans to be injected with multiple vaccines from day of birth to year of death.” This is, of course, a very silly claim, given that, even with our current vaccine schedule, we still only vaccinate against a fraction of infectious diseases that we could potentially vaccinate against. BLF’s claim also makes me ask: Which are public health officials? Religious zealots or fascistic military officers demanding submission to vaccination?

The rest of BLF’s rant is quite instructive. First, she parrots yet again the same old anti-vaccine trope that it’s all a big pharma plot to sell vaccines that is behind the drive to vaccinate health care workers, complete with references to big pharma profits and its desire to expand its market. Then, in order to demonstrate to the world that she is a philospher, maaaan, BLF blames vaccine mandates on utilitarianism. From there, it’s just a hop, skip, and a jump to raising the specter of eugenics and U.S. eugenics laws that shame our nation to this day. She even goes Godwin because, of course, what else can you do once you link the object of your hatred to eugenics by hook or by crook? It is, after all, the nuclear option:

The cruel reality of what can happen to individuals when utilitarianism is used to prop up public health policy was brought home in 1927, when US Supreme Court Justice Oliver Wendall Holmes used the Jacobsen vs. Massachusetts decision to facilitate the forced sterilization of a young woman. At the age of seven months, Carrie Buck was judged to be mentally retarded like her mother. So Holmes gave the green light to the state of Virginia to employ a eugenics solution advocated by medical doctors and scientists and sterilize Carrie for the greater good of society.

Justice Holmes said flatly and prophetically, “The principle that sustains compulsory vaccination is broad enough to cover cutting the fallopian tubes.”

It is no surprise that Hitler and the Nazis were big fans of Oliver Wendall Holmes. By the way, it turned out that Carrie was not mentally retarded after all.

Because requiring health care workers to be vaccinated clearly leads to eugenics, which clearly leads straight to Hitler. Actually, one could argue that requiring health care workers to be vaccinated against the seasonal flu flows more from the ethical rquirement that health care professionals put the needs of their patients to the forefront, except that by vaccinating their workers hospitals are in fact helping their workers and their patients. That BLF would go to such lengths to liken mandatory vaccinations for health care workers to eugenics and Nazi-ism tells you all you need to know about her views on vaccines. She’s not “pro-freedom.” She’s anti-vaccine.

She then goes on to prove it even more. Wrapping her anti-vaccine rhetoric in the familiar “health freedom” cloak because it’s so appealing to Americans given our nation’s history of valuing freedom and rebelling against infringements on our freedom, BLF goes on a tear:

Why are we letting fellow citizens with M.D. or Ph.D. written after their names to tell us what kinds of risks to take with our lives or the lives of our children? Why do we continue to put doctors and scientists on a pedestal in America and fail to put boundaries on the power they too often wield with callous disregard for the informed consent ethic, civil liberties and individual human life?

Uh, Barbara, we’re not. It’s not doctors who have the power here, by the way. It’s our elected officials. If anything, physicians have been wielding less and less power as time has gone on. There are more and more constraints on what we can do, and, more importantly, more and more restraints on what we can do for research, the latter of which is, for the most part, a good thing. Not that that stops our good buddy BLF:

It is unscientific, irresponsible and a gross waste of health care dollars, especially in these hard economic times, for doctors and scientists in positions of authority to conduct an uncontrolled national medical experiment on the American people by threatening societal sanctions for those who refuse to get a flu shot every year. Firing health care workers, already hit by unemployment, for simply exercising their human right to informed consent to medical risk taking, is unnecessary and unethical.

Ah yes! Look at the framing! To BLF, it’s not vaccinating health care workers in order to protect them and their patients from a disease that can cause at the very least suffering and a loss of work and at the most death, particularly in patients. Oh, no. It’s an “uncontrolled national medical experiment.” Well, calling it an experiment does not make it an experiment. There may be unknowns about influenza and the flu vaccine, but there is enough known to justify vaccinating health care workers. By labeling such programs as an “experiment,” BLF can demonize them without actually having to argue the science. By invoking hard economic times, she can both play on the sympathy we all have for the unemployed and invoke frugality, all while decrying authoritarianism.

I’ll give BLF credit. It’s excellent propaganda.

Will it work? Who knows? My guess is: Probably not. The tide seems to be moving towards more support for requiring that health care workers be vaccinated. Indeed, this example at Virginia Mason Medical Center of how very high rates of vaccine uptake (98%) can be achieved with a combination of understanding barriers to vaccination and then addressing them in an educational, non-threatening way using a comprehensive program of education and information. Most health care workers want to do the right thing, but even they are not immune to the misinformation that the anti-vaccine movement (i.e., groups like BLF’s) promotes. Fortunately, education can work. However, education is work. It takes a lot of effort and planning to make this sort of program work. Fortunately, Virginia Mason Medical Center showed us the way. Unfortunately, know-nothings like BLF continue to stand in the way.

ADDENDUM: Right on queue, the stupid flows fast and furious in the comments section of AoA’s post linking to BLF’s anti-vaccine screed.

Some samples follow.

1. Judith: “The flu shot will not prevent the flu. Proper diet, adequate Vit D, Vit C, adequate rest, regular exercise along with proper hand washing, and common sense will!”

Uh, no, Judith. You may think yourself to be Superwoman who can make yourself invulnerable to the flu virus if you just eat the right foods, do the right exercises, and live the right lifestyle (making it, of course, your fault if you get the flu, which is the usual subtext of the exaggeration of the benefits of such interventions), but the influenza virus may well have other ideas.

2. patrons99: “Offit’s views are positively frightening. He is a totally conflicted PharmaWhore. There is nothing quasi about it. I hold him accountable for my vaccine-injured siblings. The harm that he has personally wrought upon society is incalculable.”

Because in the minds of anti-vaccine loons like patrons99, trying to protect children against harmful diseases and combat misinformation that is used to decrease vaccination rates does incalculable harm to the anti-vaccine cause.

3. Shiny Happy Person: “This is quasi-fascist bullsh$t and should not be tolerated by any free republic, regardless of anyone’s stance on any particular vaccine(s).”

Because institutions requiring their workers not to endanger patients is clearly incipient fascism.

4. patrons99 (again): “‘Just authoritarian bullying.’ I hope that’s all it is. It’s authoritarian bullying, at the very least. To me, mandated jabs and denial of INFORMED CONSENT, is the single biggest issue in public health today. This is the front line in the conflict over global vaccine policy which I refer to as ‘vaccine madness.’ The immediacy of the issue will not go away. It’s reached a crisis. It was completely out of control, last year, with the pandemic flu fraud and hysteria of 2009. This year is shaping-up to be even worse. At its base, is the issue of God-given natural rights, freedom of religion, imminent risk of injury, and clear and present danger of government-mandated inoculations. The PharmaWhores handiwork is VERY evident in this year’s flu campaign.”

Of course, by “informed consent,” anti-vaccine activists mean that they want people to be informed of “risks” that are not, “risks” that haven’t been demonstrated through science, “risks” that they can use to frighten people into not vaccinated.

Comments

  1. #1 Lawrence
    October 8, 2010

    Isn’t the physicians’ creed – Do No Harm?

    If a doctor or nurse knowingly comes into their place of work, to care for patients, with symptoms of the flu – isn’t that an ethical violation?

    Since doctors and nurses should know that it can take days to fully manifest the symptoms of the flu, isn’t it also an ethical violation not to take the necessary precautions against potentially spreading the disease to vulnerable patients?

    I don’t get the general lack of understanding here – since doctors and nurses are also highly likely to treat infectious individuals (given the number of people who get the flu and either rush to the ER or their doctor), don’t they want to be protected?

    Again, I just don’t get the attitude of these people.

  2. #2 Antaeus Feldspar
    October 8, 2010

    This is particularly true about

    (And that’s where the sentence stopped. How does it finish?)

  3. #3 Matthew Cline
    October 8, 2010

    Holy crap! How did Th1Th2 (from the comments in this post) learn about immunology? By putting an immunology textbook into a food blender and then reading the results? Gah, that was painful to read.

  4. #4 Todd W.
    October 8, 2010

    When she mentions doctors trading their white coats for military uniforms, I thought she was trying to link the issue to Nazi Germany, not the PHSCC.

    BLF also creates a straw man and false dichotomy. She argues that the policies are “get vaccinated or you’re out”. In reality, it seems that the policies are “get vaccinated or wear masks and take other precautions to protect our patients”. I could see someone rightfully getting canned if they refuse both.

  5. #5 Todd W.
    October 8, 2010

    Left a comment over at her blog calling her out on her claim that health care workers are getting fired solely for refusing the vaccine. Let’s see if she let’s it through moderation.

  6. #6 Lycanthrope
    October 8, 2010

    Why do I seem to enjoy starting my day with depressing stories like this?…

  7. #7 Dangerous Bacon
    October 8, 2010

    How Loe can she go?

    Actually, BLF has the germ of a an actual point hidden within the ranting and Godwinization of her article, as referenced by Orac:

    “Taking care of patients is not just any job. A health care worker would be perfectly free not to protect himself against seasonal influenza were it not for the fact that his decision affects more than just himself. It affects potentially every patient he comes in contact with. “

    I think what BLF especially fears is that the concept of responsibility for protecting those around us is spreading. If more people including non-health care workers start to think about the consequences of spreading serious infectious diseases to the vulnerable (i.e. children, the elderly and immunosuppressed) and get vaccinated to be socially responsible, her mission of spreading antivax propaganda will get much harder.

    Wonder what Jay Gordon will do when hospital(s) where he’s on staff start requiring annual flu vaccination? Will he find a religious out by declaring membership in the Church of the Anti-Needle?

  8. #8 opony
    October 8, 2010

    People let’s remember about different people in countries like this. Let’s stop the war!

  9. #9 René Najera
    October 8, 2010

    What really cracks me up is the uproar over the “rushed to development” of the H1N1 vaccine last year. Yet, not a single peep in the media about this season’s strains being new. Last year, we had Brisbane H3N2 and type B strains. This year, we have Perth H3N2 and type B strains (and California H1N1). Guess what? The strains genetically drifted.
    I tried explaining this, but people still are being idiots.

  10. #10 Paul Browne
    October 8, 2010

    Dangerous Bacon is right, what anti-vaxers fear is that vaccination against searsonal flu and other infectious diseases that may harm patients is becoming more usual, even popular, among health professionals. They know that health professionals are considered to be role-models by many people, at least where health issues are concerned.

    Why else would cranks go to such efforts to highlight the medical credentials of their members (even if not relevant to the issue at hand) and often use doctorates in subjects unrelated to healthcare shen being interviewed.

  11. #11 Ruth
    October 8, 2010

    And next they will fire any surgeon who operates without washing their hands. And why waste money sterilizing scalpels. A free people will not cower before mere germs.
    Give me liberty or give me death from vaccine preventable disease!

  12. #12 Matthew Cline
    October 8, 2010

    @Dangerous Bacon:

    Actually, BLF has the germ of a an actual point

    *ba-dum-ching!*

  13. #13 AMW
    October 8, 2010

    My favorite part is the “fellow citizens with an MD or PhD written after their names” bit. Those people are just regular Joes, right? It’s not like they actually know anything or have any special training in medicine or science. No, they just scribbled a couple of letters after their name and voila! They think they can tell us what to do!

  14. #14 FreeSpeaker
    October 8, 2010

    Dangerous Bacon highlights a good point. Requiring that health care workers be vaccinated is the equivalent of setting up a localized herd immunity within the health care system. For any anti-vaxxer to support requirements that health care workers be vaccincated is akin to them agreeing that 1) herd immunity is real (many deny it) and 2) the proper and socially responsible thing to do.

  15. #15 Elf Sternberg
    October 8, 2010

    Well, I got my thimerosol dose yesterday. Doesn’t seem to have done me any harm. We’ll see if it wards off the flu this year. Some years, it feels more like a fetish, like taking Emergen-C or whatever that stuff is, for all the good it does me.

  16. #16 triskelethecat
    October 8, 2010

    @Matthew Cline: ANYTHING Th1Th2 has to say is painful. She is so off the wall, I find it hard to read her. (I usually just skip her comments and read the responses to her idiocy. I tried a few times to engage with her but had to quit…I don’t think in crazy)

    My employer gave out free flu shots yesterday. I didn’t go only because I have an appointment with my pcp for flu and any catchup vaccines I need next week. But a lot of people from my department went.

    (Side note: one of my coworkers, a fairly young woman, broke out with shingles on Tuesday so she is home on acyclovir at the moment and those who haven’t had chicken pox or don’t remember it are a bit anxious. I recommended shingles vaccines to those of the right age – not that they are at risk of catching it from coworker, but that they should get the vaccine, especially – as in 1 case – if you’ve had shingles before you are more prone to get it again)

    MI Dawn

  17. #17 Squillo
    October 8, 2010

    It’s pretty rich for BLF to invoke eugenics as a logical consequence of mandatory vaccination. Actually, anti-vaccinationism has a germ of eugenics in it (pun intended.)

    According to many anti-vaxers, those with strong immune systems (presumably supported by homeopathic nostrums or whatever) will weather flu, measles, pertussis etc. just fine. Only the immunologically weak will suffer complications or death.

  18. #18 Scott
    October 8, 2010

    @ AMW:

    What, you don’t realize that getting an MD or PhD actually makes the recipient stupider and less able to judge such things than the average woman-on-the-street?

    *remove tongue from cheek*

    Anti-intellectualism really ticks me off.

  19. #19 Denice Walter
    October 8, 2010

    Eugenics? Well, she’s late to the (tea**) party! Seems that the misreading and misunderstanding of a recent statement by Bill Gates tempts our prolific woo-meisters into crying, “Eugenics! 1.”Bill Gates says that Vaccination Can Help Reduce World Population”; Mike Adams,NaturalNews; 10/1/10 2.” Death by Vaccination: the Bill Gates Foundation and the New Eugenics” Richard Gale and Gary Null;9/22/10.**(probably herbal, organic, weak tea)

  20. #20 Todd W.
    October 8, 2010

    @Denice Walter

    Good god! They’re still harping on about the Gates misquote? That is sooooo old!

  21. #21 Denice Walter
    October 8, 2010

    “98% …vaccine uptake” due to “education” at Virginia _Mason_ Medical Center…. doesn’t *that* explain it all!

  22. #22 Scott
    October 8, 2010

    @ Denice:

    OMG, you’re right! Heck, I bet they’ve even got lights, and therefore ILLUMINATION there. And we all know what THAT means!

  23. #23 Todd W.
    October 8, 2010

    @Ruth

    And next they will fire any surgeon who operates without washing their hands. And why waste money sterilizing scalpels. A free people will not cower before mere germs.

    Give me liberty or give me death from vaccine preventable disease!

    We have a contender for winner of the thread!

  24. #24 Militant Agnostic
    October 8, 2010

    triskelethecat/MI Dawn

    I recommended shingles vaccines to those of the right age

    What is the “right age”? I have had chickenpox, so I am wondering if I am at that age yet.

  25. #25 Paul
    October 8, 2010

    Next thing you know they’ll be insisting that surgeons wash their hands before surgery, putting themselves at risk of dry skin and chapping.

  26. #26 Paul
    October 8, 2010

    Always embarrassing when a comment expressing the same idea appears after you hit ‘post’. Still, great minds etc…

  27. #27 Karl Withakay
    October 8, 2010

    There’s a pronounced, anti-intellectual disdain for doctors and other intellectuals in BLFs writing:

    >>>”It is not a pretty sight to watch doctors acting more like thugs than healers.”

    >>>”We are next in line because when doctors trade in their white coats for military uniforms…”

    >>>”Why are we letting fellow citizens with M.D. or Ph.D. written after their names to tell us what kinds of risks to take with our lives or the lives of our children? Why do we continue to put doctors and scientists on a pedestal in America…”

    I don’t know about anybody else, but my flu shot was not administered by an MD.

    If big pharma really want to increase their profits without caring whether they do anything useful (and if vaccines really don’t work anyway), they should switch all vaccines to homeopathic preparations and invent a patented method of dilution and succession to protect their interests.

    >>>”It is no surprise that Hitler and the Nazis were big fans of Oliver Wendall Holmes”

    Was there a Hitler founded Nazi fan club for OWH that my history books failed to mention?

  28. #28 triskelethecat
    October 8, 2010

    @Militant Agnostic: CDC recommendations are that those 60 yrs and older (whether you had chicken pox or not) should get the shingles vaccine because those are the ages that were studied for vaccine effectiveness, and the age group that makes up about 1/2 of the cases of shingles in the US. However, their website also says that the risk of shingles starts to rise around age 50 and more studies are needed to determine whether they will decrease the recommended age.

    Under 60,the varicella vaccine is recommended if you have had not had chicken pox.

    MI Dawn

  29. #29 muteKi
    October 8, 2010

    Just going to comment on #3 in the addendum there.

    I am entirely in favor of government regulation and oversight of most industries. I’d rather have a little more government control than have cause to suspect that my favorite restaurant would fail a health inspection, for example.

  30. #30 Justin Swayne
    October 8, 2010

    Is lamentable that they go on still existing this kind of situations, where the health care does not have importance, where the harassment and the abuse dominates, and this is because people him accepts, all that must denounce one.

    Justin Swayne
    Findyourdrug

  31. #31 Dan Weber
    October 8, 2010

    As a believer in health freedom (and someone who has taken some shit on this blog for that), I have absolutely no problem requiring people who work in public hospitals to vaccinate. People who drive on public roads shouldn’t be drunk, either.

    Since we’ve linked back to the old article about the Atlantic, though, I’ll ask the question I asked last time: we haven’t seen spikes in flu deaths in years that there have been supply problems. We are measuring noisy data so I realize that could be lost, but is that the only response to that point?

  32. #32 Todd W.
    October 8, 2010

    Upon reading BLF’s tirade a second time, I noticed a couple more things. First, as support for her claim that hospitals are firing people, she links to a video from Dr. Offit talking about last year’s policy. No evidence is given that that policy is in effect this year.

    She also uses CHOP’s policy to imply that hospitals in general are instituting the same policy (i.e., vaccinate or be fired).

    I also did a little bit of digging and found that Ms. Loe Fisher also made another factual error. She states that only medical exemptions from the doctor in charge are allowed, yet in presentation given to DHHS, philosophical exemptions are also allowed (not sure when the presentation was, though – no date on it). The presentation about CHOP’s policy does not specify that the doctor in charge is required to sign off on any exemptions, either.

    BLF – Full of Lose.

  33. #33 Dave
    October 8, 2010

    I can understand the libertarian argument that no one should be forced to undergo vaccination.

    I would have thought that the libertarian argument would be to allow employers to make whatever demands they feel appropriate upon their employees, and the market would decide what works best. Afterall, it isnt the government mandating this, but the hosbitals themselves.

  34. #34 rob
    October 8, 2010

    we all know what will happen one doctors go down the slippery slope of forced vaccination. soon it will forced organ donation!!11!!1!1!

    i recommend you all dispose of your liver donation cards* right away!!1!!!!!!!!111

    *umm…it’s a bit graphic. a bit.

  35. #35 Scott
    October 8, 2010

    @ Dave:

    For a real libertarian, yes. But for most who claim the title, what it really means is “any restrictions I disagree with are bad”, regardless of who placed said restrictions.

  36. #36 george
    October 8, 2010

    My body my choice, regardless of profession. Why are you so scared if you get the vaccine yourself and think it works? Stop pushing your drugs on us! Just because it is legal doesn’t mean it is safe nor effective.

  37. #37 Karl Withakay
    October 8, 2010

    @Dave #32, that sure fits in with what I have heard from libertarians regarding smoking in restaurants and other public places, both for patrons and employees- that the owner should be allowed to set whatever policy they want free of regulation and patrons and employees can go elsewhere if they don’t like it.

  38. #38 rob
    October 8, 2010

    BLF is exactly right.

    just yesterday, i was on the corner and i was just like staring at the traffic thinking about everything, but then again i was thinking about nothing. a middle aged man next to me was coughing, and looked like he had a mild fever and chills.

    next thing i know five young doctors pull up in a pimped out lexus, jump out and cap the guys ass. with vaccinations!

    drive by vaccination! what’s the world coming to?

  39. #39 Dangerous Bacon
    October 8, 2010

    “My body my choice, regardless of profession.”

    And if you’re a health care worker who ignores patient safety, you have an absolute right to be unemployed.

  40. #40 Militant Agnostic
    October 8, 2010

    george@35
    It isn’t just your body your choice if you are working with immune compromised patients. Try reading the post before jerking your knee. I would hope that great medical ignorance expressed in your comment means you don’t work in a hospital or other medical setting.

  41. #41 Orac
    October 8, 2010

    My body my choice, regardless of profession.

    Sure, but your choice has consequences. You don’t have the “right” to a job in health care if you aren’t willing to take precautions against being a potential danger to the patients with whom you come in contact. In fact, those running a health care institution have not only the right but the duty to tell you that if you choose not to take such minimal precautions, you are also choosing not to be employed there anymore.

  42. #42 Todd W.
    October 8, 2010

    My body my choice, regardless of profession.

    If you choose to inject narcotics into your body or to drink alcohol to intoxication, that is grounds for termination from most jobs because it tends to affect job performance and, depending on the profession, can put others at risk. Personal liberty does not always trump other factors.

  43. #43 Sid Offit
    October 8, 2010

    Basically, she predicts all sorts of horrible abuses of freedom, such as requiring vaccines to receive medical care or get on a plane (?), as inevitable consequences of current efforts to require health care workers to be vaccinated.

    Or go to public or private school. Seems like her predictive ability is rather strong.

  44. #44 Karl Withakay
    October 8, 2010

    “My body my choice, regardless of profession.”

    Remember that the next time you go to a restaurant and you wonder whether the staff that handles your food washes their hands after using the restroom.

  45. #45 Dave
    October 8, 2010

    Or go to public or private school. Seems like her predictive ability is rather strong.

    Only if BLF, like Merlin, lives backwards in time. Vaccination requirements for schools are nearly two centuries old now.

  46. #46 Sid Offit
    October 8, 2010

    The libertarian would say if you want to work in a bar then accept breathing in 2nd hand smoke. If enough quality employees decided it wasn’t for them, their pay would rise or ownership would decide to voluntarily make their establishment smoke free. If enough patrons found 2nd hand smoke offensive that would also drive smoke free bars and clubs. My current thinking is to be congruent with the aforementioned scenario one would have to accept that a private institution such as a hospital has the right to make vaccination a requirement of employment.

  47. #47 Chris
    October 8, 2010

    Sid:

    Or go to public or private school.

    Like the public charter school in San Diego:

    The 7-year-old goes to the San Diego Cooperative Charter School in Linda Vista. The child set off a chain reaction that has infected two siblings, one of whom was a fellow charter student, and at least one classmate.

    private school was closed:

    Classes were canceled at the 300-student East Bay Waldorf School at 3800 Clark Road because a number of kindergartners and their teachers have come down with the contagious lung infection, authorities said.

    I think a prediction that outbreaks of pertussis, measles and other vaccine preventable diseases often occur more often in private school or public schools with lax vaccine requirements is more certain than predictions by BLF.

  48. #48 jre
    October 8, 2010

    Barbara Loe Fisher’s slippery slope argument is wrong, but Oliver Wendell Holmes really did say that compulsory sterilization is OK because compulsory vaccination is OK. More than eighty years later, his opinion still shocks the conscience:

    It would be strange if it could not call upon those who already sap the strength of the State for these lesser sacrifices, often not felt to be such by those concerned, in order to prevent our being swamped with incompetence. It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes. Jacobson v. Massachusetts, 197 U.S. 11 , 25 S. Ct. 358, 3 Ann. Cas. 765. Three generations of imbeciles are enough. [274 U.S. 200, 208]

    Holmes saw Carrie Buck’s sacrifice as trivial when compared to the public good. We should not make excuses, but the idea that the “feeble-minded” had no rights was a terrifyingly common view in 1927. Today, it is clear that the analogy to vaccination is bogus. Holmes was wrong — not just in the larger moral issue, but in whether Jacobson supported his argument. It did not. Barbara Loe Fisher should be ashamed to harness Holmes’ eugenics in the service of her crusade, but that would be a lot to hope for.

  49. #49 augustine
    October 8, 2010

    [Orac: Sure, but your choice has consequences. You don't have the "right" to a job in health care if you aren't willing to take precautions against being a potential danger to the patients with whom you come in contact.]

    Says who? You? No one has a “right” to any employment for that matter. Neither does an employer have a right to impose unwanted and possibly dangerous medical procedures.

    In fact, those running a health care institution have not only the right but the duty to tell you that if you choose not to take such minimal precautions, you are also choosing not to be employed there anymore.

    Minimal precautions? I like how you spin coerced invasive needle puncture into “minimal precautions”

    I would like to see 60% (amount of employees who do NOT get the flu vaccine) walk out on your hospital or cancer center and see how your tune changes. You’ll change your bullying tactics and compromise your so called principles at that point.

    The ONLY reason this healthcare worker vaccine propaganda is being initiated is because of such a low uptake by health care employess. It looks bad on the agenda when your own workers want take a vaccine that you’re selling. It will be easier to sell the lie to the public if you can say “see little Heath healthcare worker gets his shot. So should you” at the same time not telling the public that you forced it on him.

    If you want to talk about rights and coercing individuals, (which is sickening by so called professionals) the hospital(employer) and the pharmaceutical company should pay for any side effects AND FAILURE to prevent illness. That would only be fair and reasonable for such a fascist policy that tells it’s citizens to “do it for the herd” or will ruin your financial ability to sustain your family. “We control you.”

    Why don’t we ask all healthcare workers to make sure they take their “once daily” antibiotic before they come to work. Oh sure, some of their health will be jeopardized permanently or only temporarily, but it will only be a minority and you can always say the party line “The benefit outweighs the risk.”

    BTW BLF would send Orac packing his lunch in a debate on this issue. He might know how to swindle grant (tax) money for his own personal financial gain but politics is not his forte. Or maybe it is.

  50. #50 augustine
    October 8, 2010

    [Remember that the next time you go to a restaurant and you wonder whether the staff that handles your food washes their hands after using the restroom.]

    That would be reasonable if washing your hands could cause you to go into a convulsive febrile seizure or have permanent paralysis. But it turns out that washing your hands is pretty innocuous. So the analogy is a false one. It is 100% safe to wash your hands.

    As has been said here many time vaccine are not 100% safe or 100% effective. They appear to not know how safe just “not 100%” safe. They appear to not know how effective just not “100% effective”.
    It could be anywhere from 0%-99%. Who knows? Save me your false quantitative arrogantly assertive replies. You don’t know and that’s the bottom line.

  51. #51 Chris
    October 8, 2010

    Why don’t we ask all healthcare workers to make sure they take their “once daily” antibiotic before they come to work. Oh sure, some of their health will be jeopardized permanently or only temporarily, but it will only be a minority and you can always say the party line “The benefit outweighs the risk.”

    Because it is a supremely stupid idea. And most health care employees are more intelligent than you, so you will not find 60% walking out to protest vaccine requirements.

  52. #52 Chemmomo
    October 8, 2010

    Just curious – what do BLF and other antivaxers think about the requirements for lab workers who handle human tissue products being vaccinated against hepatitis?

    Is it irrelevant because that vaccination is only protecting the worker in question (and close contacts) rather than the public at large? Or are they just unaware of those requirements? Sid, care to weigh in?

  53. #53 KoryO
    October 8, 2010

    I’ve been to Tea Parties. I’ve seen some wackaloon stuff, but never any anti-vax protesters. Of course, YMMV wherever you are.

    I just don’t understand how someone IN HEALTH CARE could be so willfully ignorant. But then again, my sis in law had an emergency c-section after a failed homebirth, and one of her L&D RN’s was a wackaloon homebirth fanatic like she is, so….go figure.

  54. #54 Orac
    October 8, 2010

    Why don’t we ask all healthcare workers to make sure they take their “once daily” antibiotic before they come to work. Oh sure, some of their health will be jeopardized permanently or only temporarily, but it will only be a minority and you can always say the party line “The benefit outweighs the risk.”

    Because that’s an idiotic idea. Taking antibiotics without a valid medical indication would not only be harmful to the worker, but would make sure that workers all become incubators for antibiotic-resistant organisms that would then be shed into the hospital environment. Hospitals have a bad enough problem with resistant organisms; to breed more would make a bad situation worse.

  55. #55 Todd W.
    October 8, 2010

    Oh, augie…

    I would like to see 60% (amount of employees who do NOT get the flu vaccine) walk out on your hospital or cancer center and see how your tune changes. You’ll change your bullying tactics and compromise your so called principles at that point.

    If I were a sadist, I would like to see that, too, and see how the public reacts to the sudden burden on the health system and the massively increased wait times for service.

    But, I’m not. I wouldn’t wish that situation even on you, augie.

    It looks bad on the agenda when your own workers want take a vaccine that you’re selling.

    Know what’s even worse? When patients come into the hospital without influenza and contract it while there. Even worse is when they die as a result. If you bothered to look into Dr. Offit’s account of the policy at CHOP, you would find that such concerns are a major reason the policy was instituted. But then, you probably would think that that explanation is nothing but a cover, more propaganda. If you do think that, then perhaps you could pony up some evidence that such is the case.

    Why don’t we ask all healthcare workers to make sure they take their “once daily” antibiotic before they come to work. Oh sure, some of their health will be jeopardized permanently or only temporarily, but it will only be a minority and you can always say the party line “The benefit outweighs the risk.”

    Wow. What a crappy example you picked, augie. We wouldn’t ask health care workers to take a daily antibiotic because the benefits do not outweigh the risk. Rather, the risks heavily outweigh the benefits, since using antibiotics in the absence of a bacterial infection is known to breed antibiotic-resistant bacteria.

    Personally, I think CHOP should have offered employees the option of wearing appropriate protective gear as an alternative to being vaccinated (such as Orac mentions is available at his institution). However, in the absence of the actual document spelling out the policy, I can’t be certain that such an option was not available.

  56. #56 Todd W.
    October 8, 2010

    @augie

    [Remember that the next time you go to a restaurant and you wonder whether the staff that handles your food washes their hands after using the restroom.]

    That would be reasonable if washing your hands could cause you to go into a convulsive febrile seizure or have permanent paralysis. But it turns out that washing your hands is pretty innocuous. So the analogy is a false one. It is 100% safe to wash your hands.

    Analogy slam fail. Washing hands is not 100% safe. There is the risk for an allergic reaction. Further, over-washing one’s hands can lead to chapping and cracked skin, which is more prone to infection.

  57. #57 augustine
    October 8, 2010

    [chris: And most health care employees are more intelligent than you, so you will not find 60% walking out to protest vaccine requirements.]

    Because they know they don’t have to. The hospital administration and the Dr. Offit’s of the hospital will cave in because they could not afford the financial loss and burden put on the other staff. If they wanted to get the vaccine they would’ve gotten it. The numbers are pretty consistent. ONly 40% vaccinate for the flu. Forcing them is the way to improve on that statistic for propaganda purposes.

    Otherwise if it happens we would expect to see a large drop in influenza numbers at the hospital. Won’t happen.

  58. #58 Karl Withakay
    October 8, 2010

    Let’s just keep our goal posts clear here. We have the opposition such as augustine arguing at least two different points here.

    One is that they contend vaccines are neither safe nor effective.

    The second is they oppose the right of an employer, such as a hospital, to impose certain requirements (such as vaccination) upon their employees (such as those who will be around immunocompromised individuals).

    If they are correct on point one, there is no reason to move to point 2. If point one is invalid, however, then point 2 gets relegate to the same status as the question of whether hospital staff can be required to wash their hands.

    What we are likely dealing with here is zealous anti-vaccinationists hiding behind the smoke screen of libertarian principles.

  59. #59 Karl Withakay
    October 8, 2010

    What augustine fails to comprehend is that not getting a vaccine is also not 100% safe.

    It is, in fact, less safe than getting the vaccine. You are more at risk if you do not get the vaccine. That’s the whole point of vaccination: the benefits outweigh the minimal risks.

  60. #60 Lawrence
    October 8, 2010

    Not to get too far off topic, but Augie mentioned washing hands as not being “effective.” I seem to recall a massive decrease in the maternal mortality rate when doctors started washing their hands before assisting in the birth of children.

    So, not washing your hands can kill in certain circumstances.

  61. #61 Calli Arcale
    October 8, 2010

    It is entirely reasonable for hospitals to require that enough of their staff be vaccinated to achieve herd immunity — and I could even see requiring vaccination, period, for people in certain very high-risk areas such as the ICU. (People unable to be vaccinated for whatever reason would be transferred to a different part of the hospital. That’s congruent with how employers are supposed to accommodate disabilities or religious restrictions.)

    Every employer has the right to require that the employees are protected for their safety, and for the safety of the patients/customers/visitors/etc. Veterinary clinics can require their staff be vaccinated against rabies (primarily for protection of the staff). The military can require the troops be vaccinated against smallpox (primarily to discourage enemies from weaponizing smallpox, sort of like building missile defense to discourage use of ICBMs). The ADA and laws against religious discrimination mean they must make reasonable accommodations if people cannot be vaccinated or if it violates their religious beliefs.

    This is in no way comparable to eugenics. This is not a mass vaccination program. This is employers requiring a minimum standard of their employees, and it’s not even one of the really big examples. For years, vets have required their lab techs to get vaccinated against rabies, which is entirely for their own protection, not the patients’, and is a rather riskier vaccine than the flu shot.

    It’s reasonable. As long as reasonable accommodations are made for those who can’t do it, employers can require just about anything of their employees. Draconian Internet monitoring? Perfectly legal, and even reasonable — it’s the company’s bandwidth, after all. Off-the-job behavior? Yep, may be a fireable offense, depending on the circumstances and the job. Submit to a background check? Conform to cumbersome rules for working in a cleanroom facility? Be willing to provide a urine sample at any time, with refusal being a fireable offense? Heck, in the US, the standard is at-will employment, so unless you’re in a union, you can pretty much be fired because they don’t like your shirt. And there are jobs which contain a much bigger element of risk than healthcare. Look at linemen. They submit to a hell of a lot more risk than a doctor rolling up his sleeve to get a flu shot. They follow carefully devised procedures when working with energized high-tension power lines, but even tiny mistakes can be lethal.

    Barbara Loe Fisher is nuts. But then, we all knew that.

  62. #62 augustine
    October 8, 2010

    [karl: What augustine fails to comprehend is that not getting a vaccine is also not 100% safe.]

    No, I don’t fail to comprehend that.

    [It is, in fact, less safe than getting the vaccine.]

    You have gotten caught up in that amorphous blob of a concept called the “herd”. What you fail to understand is that you can not definitively make a statement of safety for any single individual. If you can then please tell the pharmaceutical companies and health officials. They desperately need your help to save the vaccine program and citizen victims of medical vaccines.

  63. #63 W. Kevin Vicklund
    October 8, 2010

    Washing hands is not 100% safe. There is the risk for an allergic reaction.

    For example, me. Hell, just getting my hands wet can lead to a nasty rash, since I also have aquagenic pruritis. Life is interesting when your body’s immune system freaks out.

    But I’m just an anecdote. Wash your damn hands!

  64. #64 Tsu Dho Nimh
    October 8, 2010

    In other words, the military background and the fact that some 6,500 members of the PHSCC are commissioned officers mean to BLF that the physicians in the PHSCC have “traded their white coats for military uniforms.”

    She better not watch the weather reports, or go to the beach … NOAA has uniform-wearing, jack-booted geeks in ships, helicopters and airplanes.
    http://www.noaacorps.noaa.gov/

  65. #65 Sid Offit
    October 8, 2010

    @Che

    Sid, care to weigh in?

    A private institution should be allowed to set policy for it’s employees. As a consequence hepatitis shots are OK by me. As would the abolition of government protections/interferences such as the ADA, minimum wage, pregnancy leave and anti-discrimination laws.

  66. #66 Dangerous Bacon
    October 8, 2010

    augie: ” I like how you spin coerced invasive needle puncture into “minimal precautions”

    Ooo, “coerced invasive needle puncture”. Could it be that our augie suffers from belonephobia (fear of needles)? This is the basis of some antivaxers’ vehement dislike of shots, and I suspect it’s underrecognized.

    Medscape’s article on belonephobia (linking available only to subscribers, sorry) notes that sufferers from belonephobia may be able to tolerate injections when the syringes are decorated in a reassuring manner, i.e. with “butterflies, flowers, fish and smiley faces”.

    augie, have you asked your doctor about this? It might help.*

    *note: I am not making fun of belonephobiacs in general, just those who draw on this phobic reaction to power their antivax activities.

  67. #67 LW
    October 8, 2010

    Augustine, you are not truly anonymous to Orac, and you can be sued for libel. Think about that next time you choose to accuse him of “swindl[ing] grant (tax) money for his own personal financial gain”.

  68. #68 gaiainc
    October 8, 2010

    When I started med school I had to prove immunity to measles, rubella, and Hep b or get vaccinated. For residency and the two jobs I’ve held since I’ve had to prove immunity to those three diseases plus varicella. Not proving immunity or not being to give a reason why I couldn’t receive the vaccines meant there were aspects of my job that I couldn’t do or a strong possibility that I wouldn’t be hired. Don’t hear the anti-vax people complaining about that.

    Augie, way to go on hyperbole. Yes, immunizations are not 100% safe. Neither is driving your car. Bottom line I do know that immunizations are safer than driving in my car (less than 5000 claims submitted tobthe Vaccine Court since inception versus over 35,000 motor vehicles fatalities in the US alone in 2008). If I will assume the risk of driving, not accepting the risk of an immunization makes no sense.

  69. #69 MikeMa
    October 8, 2010

    Augie has finally recovered from his week-long incoherent rambling to make some really bold comments like:

    Minimal precautions? I like how you spin coerced invasive needle puncture into “minimal precautions”

    Sounds like Augie has a real needle phobia. Makes a shot sound like bathing in nuclear waste. FSM forbid Augie has any kids. How will he deal with the near-daily cuts, scrapes and punctures of childhood?

  70. #70 dean
    October 8, 2010

    As would the abolition of government protections/interferences such as the ADA, minimum wage, pregnancy leave and anti-discrimination laws.

    Because to sid if you can’t make fun and discriminate against people with disabilities, fire women who dare to get pregnant, and keep people of the wrong color away from you, there is no freedom.

    just when you think he can’t get any lower on the scum scale, he does.

  71. #71 MikeMa
    October 8, 2010

    Ah, Dangerous Bacon got in there with his belonephobia comment while I was spell checking or something. Great new word that! Thanks.

  72. #72 dedicated lurker
    October 8, 2010

    I used to have a severe case of belonephobia, to the point that for a week before a TD vaccine I stopped eating and threw up every day.

    And even then I knew getting the vaccine was beneficial; I was just irrationally afraid.

  73. #73 garry
    October 8, 2010

    every time i use a restaurant men’s room, there’s a sign saying “employees must wash hands”. same principle.

  74. #74 Old Rockin' Dave
    October 8, 2010

    Plain old brass tacks: My wife is an RN who works in a bone marrow transplant unit, which in simple terms means that for part of the time they’re in the hospital, her patients do not have an immune system to speak of. She would never want to endanger her patients by bringing in any communicable disease, and her hospital would not let her anyway. It makes no sense to me that anyone who works in such a place would insist that they have a right to refuse vaccination.
    Nor does the BMTU make a difference. I am generally pretty robust, but last year surgery that I had went wrong and I came close to death. I spent a week in ICU that I don’t remember. I am grateful that nobody around me gave me influenza the day I went into the OR.
    If you are willing, in spite of the evidence, to endanger the people you come into contact with, then you have no right to go among people, any people, not just people at increased risk.

  75. #75 Matthew Cline
    October 8, 2010

    @augustine:

    1) You say that the motivation for this is propaganda. How do you rule out “prevent patients from getting the flu from workers” as a motive?

    2) What is the motive behind the propaganda? Is it merely vaccine manufacturers trying to increase their profits, or is it something deeper?

  76. #76 Seb30
    October 8, 2010

    @ Matthew

    I can guess Augustine’s answer to number 1.
    “Because vaccines are useless (and/or do more harm than good)”

    It’s the underlying opinion behind all of his/her posts.
    Our position is based on the opinion (sustained by evidence) that vaccines, in the right circumstances, do more good than harm.
    But anything we can say makes no sense to him/her, because to him/her, vaccines are useless. So, of course, the only conclusion is that we are liars and criminals.

    Augustine, after your baseless, fact-free rant at 48, don’t come around asking for evidence. If you believe that Orac – or any scientist – is getting personally richer by obtaining federal grants for his job, I would like to you to provide some proof of it.
    Or do you mean you are against government-subsided research?

  77. #77 Harbo
    October 8, 2010

    Do libertarians stop at traffic lights?

  78. #78 Chris
    October 8, 2010

    Matthew Cline:

    Holy crap! How did Th1Th2 (from the comments in this post) learn about immunology? By putting an immunology textbook into a food blender and then reading the results? Gah, that was painful to read.

    I believe Th1Th2 is a computer program. A troll version of the Automatic Computer Science Paper Generator. That kind of goes with your observation of the use of the immunology textbook.

  79. #79 Composer99
    October 8, 2010

    I see that augustine is up to his usual standards of honesty and integrity.

  80. #80 J N
    October 8, 2010

    Before criticising true libertarians, one should probably read what, for example, Reason magazine has to say on the subject of ‘vaccination’. It’s certainly not what you’d expect if you thought coverage would be as uninformed and paranoid as that in The Nation, for example. Certainly, there’s some criticism of government-run vaccination programs- where they are justified by the high costs of vaccines driven by insane liability insurance costs (due to what could be seen as failure to reform tort laws)- but the benefits of vaccination and the danger of the antivax movement and its trial lawyer Dark Lords are dealt with in a reasonable manner.

  81. #81 J N
    October 8, 2010

    @ harbo 75: Do you think one should be able to slowly roll though a red at 3am after stopping, looking in all directions and seeing no oncoming traffic, without worrying about receiving a revenue generation camera ticket a couple of weeks later? If so, you might be a traffic light libertarian.

  82. #82 Harbo
    October 8, 2010

    Oh JN @79 You wacky funnster! What are you going to do with the 37 seconds of extra freedom you have attained by “carefully” running the late night red.
    Don’t take too long or you’ll blow your new found freedom.

    I suggest you look up “metaphor” and “irony”.

  83. #83 Chris
    October 9, 2010

    J N, the intersection three blocks away has cameras. You’ll get caught.

    Before the cameras, there were accidents even at night… plus more than once a light running car came close to hitting me as I crossed the street (yeah, I sometimes actually walk to the grocery store half a block past the intersection, my favorite were the color blind and/or libertarians who thought a blinking yellow left turn arrow is the equivalent to a green arrow).

  84. #84 Epidemiologist
    October 9, 2010

    Just wanted to clarify, as a USPHS Commissioned Corps officer working for CDC, a couple of things. The Corps is basically a federal health professional employment system, with officers working at the Indian Health Service, FDA, NIH, CDC, Office of the Surgeon General, Coast Guard, Bureau of Prisons, ICE detention facilities, and scattered other agencies (even the National Park Service). Some do clinical work, others epidemiology, research, or policy work. There are PhDs, MDs, RNs, environmental health officers, mental health people, dentists, etc.

    We don’t actually supply officers to the military except the Coast Guard, since the military medical system has plenty of staff. A lot of people leave the military medical system and come to the Corps to stay in until they “retire” after 20 years and come back as civil servants.

    We are an obscure agency, often mistaken for Navy officers because of the khaki uniform, which alludes to the early Naval Hospital history of the Corps. Unfortunately under Bush the Corps became more quasi-military, requiring daily uniform wear (used to be weekly), saluting, and other trappings. This alienated a lot of officers and contributes to their problems retaining people, especially doctors. I only joined in order to get better paid while in training in the Epidemic Intelligence Service at CDC, but will leave the Corps after that.

  85. #85 The Gregarious Misanthrope
    October 9, 2010

    @Epidemiologist

    “requiring daily uniform wear (used to be weekly), saluting, and other trappings.”

    Yeah, the Air Force Reserve went through similar militarization. If I wanted to wear a damn hat, I would have stayed active!

    All jokes aside, one provision of the Health Care Bill was to increase the size of your corps. It was astonishing how many ignoramuses thought it was Obama building his own private army. Yeesh.

    @MikeMa

    A fear of needles would be the least disturbing part of the dank, dark makeup of augie’s squiggly little mind.

  86. #86 MadScientist
    October 9, 2010

    There are places around the planet where anyone in a medical facility from the janitors on up to the surgeons and administrators must receive certain vaccines or they simply will not be allowed to work; the only exceptions made are where vaccines are contraindicated for an individual. Unfortunately there are still far too many places where the policy is “we recommend it but it’s not required”. That seems almost as bad as making all the hand washing and scrubbing optional.

    As for the uniformed civilian positions like the Surgeon General, I suspect such offices originated because of the actual work exposure of such people (they’ve traveled a lot and dealt with strange cases all over the place) and the fact that they are independent and not in the pocket of any corporation. My father served in the USAF Medical Services Corps and the level of service and the attitude of the majority of USAF MSC personnel simply put most civilian hospitals to shame (even though the military hospitals are not necessarily the best equipped). The same goes for the Medical Corps of the US Navy. I’m quite comfortable with appointments from the actual medics corps of the armed services. If a person were appointed from outside the armed services I’d want to make sure we were getting one of the best in some field – for example Dr. Paul Offit who has a broad range of experience from clinical practice and medical research (and someone who happens to be very much pro-vaccination, as every competent medical officer is).

  87. #87 David N. Brown
    October 9, 2010

    I think the biggest problem with BLF’s argument is that she seems to overlook the people with the most power and most to lose in these situations: Hospital administrators. For better or (often) worse, they are cautious and canny about things that could get them sued, and having a doctor or other staff infect a patient with a preventable disease would be right up there.

    Also, if all will bear with a shameless plug, reading this made me think of the “Quarantine Station” chapter from my most popular book, “Walking Dead”. Just for setting the stage, I tried to lay out logically the consequences of an untreatable, highly contagious disease, let loose in the setting of a military-controlled refugee camp. To me, this is about aas disturbing as any of the supernatural antics that follow.

  88. #88 J N
    October 9, 2010

    @Harbo: Not waste time. But hey, it’s all worthwhile if you get to feel good about following the rules? @Chris: Yeah, and I’m sure you were observing all possibly applicable rules regarding jaywalking. But hey, no camera systems to enforce that, yet.

  89. #89 Matthew Cline
    October 9, 2010

    @Epidemiologist:

    Unfortunately under Bush the Corps became more quasi-military, requiring daily uniform wear (used to be weekly), saluting, and other trappings.

    What was the point of the administration doing that?

  90. #90 Matthew Cline
    October 9, 2010

    @augustine:

    What you fail to understand is that you can not definitively make a statement of safety for any single individual.

    So, if I’m understanding you correctly: risk is something that only applies to groups, not individuals, and hence “safe” meaning “low risk” doesn’t apply to individuals. For an individual, saying “with this vaccines, there’s a 1 in X chance of [blah] happening” is nonsensical, since for any individual either there will be no adverse reactions, in which case it’s 100% safe for that individual, or there will be an adverse reaction, in which case it’s 0% safe for that individual.

  91. #91 Chris
    October 9, 2010

    J N:

    Yeah, and I’m sure you were observing all possibly applicable rules regarding jaywalking.

    Um, yeah… jaywalking on that intersection is pretty much an act of idiocy, and possibly suicide. What is your point?

    Oh, wait. You don’t have one.

  92. #92 Dangerous Bacon
    October 9, 2010

    Here’s a hospital policy that will have antivaxers fuming.

    “Nationwide Children’s Hospital (in Columbus, Ohio) is continuing last year’s policy of withholding raises for those employees who refuse the (influenza) vaccine. Last year, that policy (which exempts those who have a medical or religious reason) helped them get about 97 percent of employees vaccinated with the H1N1 and seasonal vaccines, said Dr. Dennis Cunningham, physician director for epidemiology and infection control.

    “You have to have some teeth in the policy,” he said.

    “We have many children in the hospital who are immunocompromised … if we give the flu to those patients, they have the potential to become seriously ill.”

    Top reasons for health-care workers avoiding the vaccine include a fear of needles, the belief that the vaccine will make them sick and the belief that they never get sick and don’t need the vaccine, Cunningham said.”

    It’s…it’s health fascism, that’s what it is! Using sick kids as an excuse, how loe can you get.

  93. #93 Antaeus Feldspar
    October 9, 2010

    As has been said here many time vaccine are not 100% safe or 100% effective. They appear to not know how safe just “not 100%” safe. They appear to not know how effective just not “100% effective”.
    It could be anywhere from 0%-99%. Who knows?

    People who actually understand statistics do. That group, of course, does not include Boring Auger, whose grasp of the subject is so poor he claims that a weatherman who assesses an 80% probability of rain is “100% wrong” if it doesn’t end up raining. (I guess if the weatherman says there’s a 80% chance of rain and a 20% chance of sun, he winds up both 100% right and 100% wrong no matter what the weather does!)

  94. #94 augustine
    October 9, 2010

    [anteus fedlspar: People who actually understand statistics do.]

    Oh are you saying you’re the one? Ok.

    What is my chance of dying from influenza? (don’t bother with your “vaccines aren’t just about death gambit, although death is the main sales point)

    If I take the influenza vaccine what are my chances of not getting influenza symptoms? If I don’t take the influenza vaccine what are my chances of not expressing clinical influenza symptoms?

    What are my absolute chances of having a serious or chronic adverse side effect to the vaccines?

    [feldspar: attempts to arrogantly assert confidence with a bluff answer...]

    But wait you don’t even know my age. Is the risk the same for all age groups?

    But wait you don’t know my medical history. Do I have a mitochondrial disorder? Have I reacted negatively to vaccines before?

    Do you know my health status? My nutritional status? My family health history. Do you know if I take medication?

    Do you know my socioeconomic status? My gender? My race? My stress levels? How many people live in my house? Do you know if I have children? Do they go to school or daycare?

    How many people around me are vaccinated? How many people are vaccinated but not protected. How many people have natural immunity around me?

    How virulent is the strain this year compared to last year? will it kill EXCATLY 36,0000 people yet again year after year? How many people get pneumonia that is not related the vaccine strain influenza? (because that would be the only ones the vaccine could theoretically protect)

    You see, you nor anyone in the world can filter out the variables. No matter how arrogantly you throw out false numbers to confuse people or deceive yourself, the answer is you just don’t know.

    And you could say, “oh that is why you need to see your doctor, to find out if the flu shot is right for you.LOL.”

    But when my grocer asks me if I would like to buy a flu shot with my groceries I somehow doubt he’s know the risks and perceived benefits. Or when I see drive through flu clinics I doubt they are making those calculations on the spot.

    But perhaps that is the way to end this mess. Have flu shots go over the counter. If they are as safe as science blogs say they are then they should be take home novelties. Surely they are safer than tylenol and aspirin.

    This way the doctors who sell the vaccine will be emotionally removed when the failure of the vaccine shows up to their offices. Maybe then they’ll be ready to accept the fact that vaccines often fail and vaccine can cause damage. Maybe then they won’t deny that they(or their ideology) actually caused the damage that they see instead of deny. They’ll still be able to blame the patient.

  95. #95 Broken Link
    October 10, 2010

    Slightly off-topic, but anti-vaxers have been busy putting nasty tags on Paul Offit’s books on Amazon.

    To avoid the spam trap, his forthcoming book is linked on my name. Once there you can also add tags to Autism’s False Profits.

    Please go on over and provide some scientific balance.

  96. #96 triskelethecat
    October 10, 2010

    Damn. Won’t let me put another review of AFP (BYW, Broken Link, it’s Autism’s False Prophets not Profits…unless you are a AOA fan). I did add tags though.

  97. #97 Broken Link
    October 10, 2010

    @94 Heh! Posting too early for me to be able to spell.

    (not an AoA fan, but maybe reading them too much ;)

  98. #98 Chris
    October 10, 2010

    Dawn, you can always make comments on other reviews.

  99. #99 Antaeus Feldspar
    October 10, 2010

    All Boring Auger’s wordy rant at 93 is just another invocation of the Nirvana fallacy. “Either you know exactly, down to the eighteenth decimal point, what my chances are of getting influenza with and without the vaccine, or you don’t know anything!

    The truth is that it’s simply Augustine who doesn’t understand probability or statistics — as mentioned before, he once claimed that a weatherman who estimated an 80% chance of rain was “100% wrong” if it did not in fact rain. Do we see a pattern here? Augustine wants everyone to believe that everyone else is “100% wrong” and 100% in the dark because that’s the only way he can pretend his nonsense is on equal footing.

  100. #100 augustine
    October 10, 2010

    [ Anteus: All Boring Auger's wordy rant at 93 is just another invocation of the Nirvana fallacy.]

    I see. So you don’t have a real answer to my questions or do you not think those factors are relevant to risk?

    [The truth is that it's simply Augustine who doesn't understand probability or statistics ]

    The TRUTH is you just don’t know what the real risk is. And you know it. That pisses you off doesn’t it?

  101. #101 Kristen
    October 10, 2010

    Wow, I am gone for a few weeks and Augustine gets even more incoherent. I didn’t know it was possible.

    I added tags to Dr. Offit’s books. I didn’t know he had written another, I can’t wait to read it. It is really handy that I just discovered ibooks (ironically the reason I have been absent).

    I’ll admit I have never had a flu shot. I will be getting my first on the 25th. I don’t think anyone likes needles, but I’ll happily get my shot to protect myself and others (just like Orac, I hope mine contains lots and lots of mercury :).

  102. #102 Matthew Cline
    October 10, 2010

    @augustine, a repeat of my questions:

    1) You say that the motivation for this is propaganda. How do you rule out “prevent patients from getting the flu from workers” as a motive?

    2) What is the motive behind the propaganda? Is it merely vaccine manufacturers trying to increase their profits, or is it something deeper?

  103. #103 Seb30
    October 10, 2010

    @ Augustine 93, 99

    Go ask an epidemiologist. He (or she) does this variable filtering for a living (unlike most of us here) and will have an answer to all your questions in 93.
    And yes, a number of the factors you pointed may be relevant to risk. Again, a specialist in flu epidemiology will have all the numbers by age, vaccination status, race, whatever.
    If there is one around on this blog, I’ll defer to his/her expertise. Yes, I have the weakness to trust people who have been trained to and are paid to assess health concerns, to do their job correctly. That is, unless I get evidence that my trust is misplaced. Do you have any such evidence?

    Well, an epidemiologist will be unable to tell you if you are going to catch the flu this year, or suffer an adverse event from the flu vaccine. But he certainly can give you a range of probabilities, in function of your medical file.
    So yes, statisticians know the risk of getting the flu etc.

    Just by curiosity, do you have a car insurance? Because you don’t know either if your car is going to be stolen or damaged this year. But again, if you ask your insurer nicely, I’m sure he can give you some interesting statistics, in function of your car brand, where you live, etc. You know, collecting and filtering variables.

  104. #104 Calli Arcale
    October 10, 2010

    But perhaps that is the way to end this mess. Have flu shots go over the counter. If they are as safe as science blogs say they are then they should be take home novelties. Surely they are safer than tylenol and aspirin.

    This way the doctors who sell the vaccine will be emotionally removed when the failure of the vaccine shows up to their offices.

    Actually, they are definitely safer than Tylenol. And perhaps you are not aware of this, but vaccines actually do not generally require a doctor’s prescription — they are behind-the-counter. (However, only a licensed medical professional — used to be an RN, but nowdays it’s usually an LPN — is generally allowed to administer them. While in theory a pharmacist could sell you a preloaded syringe and let you inject yourself, few pharmacists want to be known to the local recreational drug user community as a source of hypodermic needles.)

    My local grocery store, which has a pharmacist but not a clinic, is selling flu shots. No doctors involved. And I’ve never bought a flu shot from a doctor. From a clinic, yes, but not from a doctor. In fact, if I get a flu shot at my regular clinic, I won’t even see a doctor. There’s no point. It’ll be administered by a nurse, during a five-minute appointment window. (They’re very efficient at this clinic.)

  105. #105 DR
    October 10, 2010

    There are 3 Cochrane reviews on influenza vaccination published this year that are worth reading. If you’re not familiar with Cochrane Reviews, you can read more about them at http://www.cochrane.org/cochrane-reviews. These reviews are generally thought of as the highest quality, most rigorous reviews of the medical literature, and the reviews are developed free of any commercial funding.

    The first Cochrane review, Influenza Vaccination for Healthcare Workers Who Work with the Elderly, is most applicable to the SHEA position statement. SHEA’s position on the utility of vaccinating HCWs to prevent influenza transmission to patients is based on 4 studies in long-term care facilities (LTCFs). And of note, those 4 studies are part of the Cochrane review, which comes to the following conclusion: “We conclude there is no evidence that vaccinating HCWs prevents influenza in elderly residents in LTCFs.”

    Another recent Cochrane review evaluated the utility of influenza vaccination of healthy adults, which presumably represents the majority of HCWs. The authors concluded: “Influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission.”

    The last Cochrane review is least applicable to our current discussion, but interesting nonetheless. In reviewing the effect of influenza vaccine for the elderly, the authors conclude “The available evidence is of poor quality and provides no guidance regarding the safety, efficacy or effectiveness of influenza vaccines for people aged 65 years or older.”

    So given the lack of rigorous evidence supporting the utility of vaccinating HCWs to prevent transmission to patients, I find it astonishing that the Society of Hospital Epidemiologists would adopt such a position. I certainly would have no problem with a position statement that strongly encourages vaccination, but to recommend that HCWs be fired for noncompliance with vaccination is over the top and undermines SHEA’s credibility. The level of compliance with any intervention to improve the quality or safety of patient care must be correlated to the strength of the evidence, and in this case, the evidence for a mandate is lacking.

  106. #106 Antaeus Feldspar
    October 10, 2010

    I see. So you don’t have a real answer to my questions or do you not think those factors are relevant to risk?

    When you claim that no one has any idea of the risk because it’s way too crazy-difficult to calculate, I do have a real answer. “You’re full of bullshit” is a real answer, and it’s completely correct.

  107. #107 augustine
    October 10, 2010

    [Anteus felspar: "You're full of bullshit" is a real answer, and it's completely correct.]

    Nice. I guess it really does piss you off that you don’t know the answer. How very “scientific” of you.

  108. #108 augustine
    October 10, 2010

    [Seb30: Go ask an epidemiologist. He (or she) does this variable filtering for a living ]

    Don’t mind if I do.

    http://www.bmj.com/content/333/7574/912.full

    Summary points

    “Public policy worldwide recommends the use of inactivated influenza vaccines to prevent seasonal outbreaks

    Because viral circulation and antigenic match vary each year and non-randomised studies predominate, systematic reviews of large datasets from several decades provide the best information on vaccine performance

    Evidence from systematic reviews shows that inactivated vaccines have little or no effect on the effects measured

    Most studies are of poor methodological quality and the impact of confounders is high

    Little comparative evidence exists on the safety of these vaccines

    Reasons for the current gap between policy and evidence are unclear, but given the huge resources involved, a re-evaluation should be urgently undertaken”

    http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-3Y21V0N-1&_user=10&_coverDate=01%2F06%2F2000&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1492484799&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=e5f2e47499729fa2fb31ac81360e1d67&searchtype=a

    “Conclusions: If assessed from the point of view of effectiveness and efficiency, vaccines are undoubtedly the best preventive means for clinical influenza in healthy adults. However, when safety and quality of life considerations are included, parenteral vaccines have such low effectiveness and high incidence of trivial local adverse effects that the trade-off is unfavourable. This is so even when the incidence of influenza is high and adverse effect quality of life preferences are rated low. We reached similar conclusions for antivirals and NIs even at high influenza incidence levels. On current evidence we conclude in healthy adults aged 14–60 the most cost-effective option is not to take any action.”

    “Vaccine effectiveness in reducing clinical influenza cases (i.e. without virological confirmation) was lower, with efficacies of 13 and 24% respectively. Use of the vaccine significantly reduced time off work, but only by 0.4 days (95%CI: 0.1–0.8 days). Analysis of vaccines matching the circulating strain gave higher estimates of efficacy, whilst inclusion of all other vaccines reduced the efficacy”

    ——————

    And that still doesn’t take into consideration mine or any individual risk.

  109. #109 JakeS
    October 10, 2010

    Do you think one should be able to slowly roll though a red at 3am after stopping, looking in all directions and seeing no oncoming traffic, without worrying about receiving a revenue generation camera ticket a couple of weeks later?

    No. Of course not.

    You seem to be labouring under the delusion that it is a bad thing for car traffic violations to be indirect taxation of drivers. It is not.

    There are precisely five sound reasons to drive a car:

    1) You are a cripple, from disease, disability or old age.

    2) You are hauling bulky goods on short and/or irregular trips (for long and regular trips, use a railway).

    3) You have children too small to move under their own power.

    4) You live so far out in the boonies that there is no useful mass transit infrastructure.

    5) Your vehicle is part of a mass transit system or an emergency response service.

    If you are driving a motorised vehicle for any other reason, you are wasting valuable urban space, polluting our air and killing people for no good reason. You should therefore be taxed until you stop doing it. Whether this tax takes the form of speeding tickets, parking fees or gasoline taxes is a fairly minor distinction.

    - Jake

  110. #110 Chemmomo
    October 11, 2010

    augustine,
    why’d you leave out the last line of the methods section of the abstract: “The economic results show that in healthy adults, inactivated vaccines appear the best buy.” ?

    I’m not planning on buying the full article, so I can’t comment on Augustine’s summary points. I think it’s worth noting that one of the authors is T. Jefferson (of The Atlantic fame), and that it was published back in 2000.

    Not being your health care provider, augustine, I can’t comment on your individual risk. I can comment on my own, however. I’ll take the risks of “trivial local adverse effects” over the risks full-blown flu. I’m not sure (particularly since I don’t have access to the whole article) why the authors conclude that “the trade-off is unfavorable” when the adverse effects are trivial.

  111. #111 John
    October 11, 2010

    Jake5, are you serious with that post? Who on earth do you think you are to tell people whether they have the right to drive or not?

    How about people enjoying driving, is that not reason enough to do it? I’m absolutely certain that you enjoy doing things that add to the traffic on the roads, so it is rank hypocrisy of you to live an existence that requires goods to be trucked in by road, yet sit there and try to deny others the pleasure or convenience that driving brings.

  112. #112 Scott
    October 11, 2010

    @ JakeS:

    Or, mass transit would take several times as long to get anywhere. Which is very often true even when the local mass transit is generally good, depending on precisely where you are and where you are going.

    For that matter, the degree of “bulkiness” needed to make non-car transport impractical is not very great. Groceries for a family, for instance.

    You betray a great deal of ignorance of how people actually live.

  113. #113 Pablo
    October 11, 2010

    You betray a great deal of ignorance of how people actually live.

    In fact, how people live betrays the ignorance of his comments. Where it is feasible and more effective to use public transportation, in fact, many people do. But in order to make that work, public transportation has to be as/more effective as driving.

    Count the number of people on the subway in NYC and you can see that to a large extent it is – there.

  114. #114 Chris
    October 11, 2010

    I think the driving bit came by comparing the requirements for health care workers to not spread influenza where they work to the mandates required to obey traffic signals.

    So it is getting a bit off topic. Though perhaps it would be worth noting that on public transport you are required to pay, to not jump out the windows, ride on the roof… or harass the driver.

  115. #115 JakeS
    October 11, 2010

    Jake5, are you serious with that post? Who on earth do you think you are to tell people whether they have the right to drive or not?

    Driving is not a right, it is a privilege. We do not permit ordinary citizens to ride around in a major city on horseback – why should car drivers have more rights than horseback riders?

    How about people enjoying driving, is that not reason enough to do it?

    No. Some people enjoy painting over road signs, thereby confusing people and wasting their time. Some people enjoy bringing cars into cities for no good technical reason, thereby wasting people’s time. If you enjoy driving, do it in the countryside where won’t be wasting other people’s time.

    I’m absolutely certain that you enjoy doing things that add to the traffic on the roads, so it is rank hypocrisy of you to live an existence that requires goods to be trucked in by road,

    Very few goods have to be trucked very far by road. Most overland transportation tasks can be perfectly well performed by rail with only the distance from rail terminus to end-user being handled by truck. Having them trucked by car is a political choice, not an industrial necessity – and I didn’t vote for it.

    None of which speaks to the practicality of personal automobiles.

    Or, mass transit would take several times as long to get anywhere.

    Then your county, municipality and/or state is doing it wrong. Well-run mass transit takes, for the vast majority of trips, either less or not much more time than going by car – and everybody going by mass transit will, in reasonably densely populated areas, take much less time than everybody going by car. But there’s a free-rider problem, because part of the time loss in going by car is imposed on your fellow citizens by virtue of cars slowing other traffic more than mass transit.

    Which is very often true even when the local mass transit is generally good, depending on precisely where you are and where you are going.

    For the vast majority of trips, it is not the case given a well-planned and well-run public transit system. If every trip you make happens to be in that small minority, sure, a car is justified. But if it is only really necessary for a small minority of your trips, which is the usual case, then there is no reason not to dispense with the car and go by taxi on those occasional trips.

    For that matter, the degree of “bulkiness” needed to make non-car transport impractical is not very great. Groceries for a family, for instance.

    Will fit easily in a bike trailer. If your grocery shopping is not within biking range, then somebody screwed up the city planning for your neighbourhood.

    You betray a great deal of ignorance of how people actually live.

    Uh, no. The suburbanites who insist on bringing their cars into city centres for no good reason display a great deal of arrogance in presuming that city-dwellers should just have to live with the imposition.

    In fact, how people live betrays the ignorance of his comments. Where it is feasible and more effective to use public transportation, in fact, many people do. But in order to make that work, public transportation has to be as/more effective as driving.

    Given proper city planning, it almost always is more effective in the aggregate. Since each individual driver is able to off-load part of the inefficiency of driving on his fellow citizens, the market equilibrium always becomes sub-optimal. Hence the need for sovereign intervention.

    And if you have enough cars on the streets, throwing out most of the cars becomes a prerequisite for making busses and light rail work – a bus gets just as much stuck in a traffic jam as a personal automobile. Throw out half the cars and replace the capacity with busses, and everybody will get to their destination faster. Add the capacity in busses before you throw out the cars and you just add to the gridlock.

    And that’s just the congestion aspect. There’s also the whole pollution thing, the whole killing a hundred times more people annually than terrorist attacks thing, and the whole being a horridly uneconomical way to use energy thing.

    Fortunately, Peak Oil is going to solve the problem for us in a couple of decades. Whether the mass transit solutions will have adequate capacity to cope with all the former drivers who decide that driving really isn’t more important than eating will depend on how much the auto-über-alles lobby succeeds in hampering sane city planning and transport policies.

    - Jake

  116. #116 Chris
    October 11, 2010

    Yes, I agree that the public transport in our city is good, but wretched in the county. Especially compared to what we experienced in Denmark.

    But still, like the rules governing that health care workers should be vaccinated to avoid getting patients even sicker, there are rules on every public transport system (like not jumping on the back, hanging on to ride the tram, bus or train).

    Any other discussion is getting quite off topic.

  117. #117 Scott
    October 11, 2010

    Then your county, municipality and/or state is doing it wrong. Well-run mass transit takes, for the vast majority of trips, either less or not much more time than going by car – and everybody going by mass transit will, in reasonably densely populated areas, take much less time than everybody going by car. But there’s a free-rider problem, because part of the time loss in going by car is imposed on your fellow citizens by virtue of cars slowing other traffic more than mass transit.

    For the vast majority of trips, it is not the case given a well-planned and well-run public transit system. If every trip you make happens to be in that small minority, sure, a car is justified. But if it is only really necessary for a small minority of your trips, which is the usual case, then there is no reason not to dispense with the car and go by taxi on those occasional trips.

    ROTFLOL. The sort of system you’re suggesting here would be, for any sort of sizable metropolis, utterly impossible to implement. It’s simply not a credible option to have a reasonably direct bus route between every two points within, say, 10 miles (a VERY small radius by most standards).

    Will fit easily in a bike trailer. If your grocery shopping is not within biking range, then somebody screwed up the city planning for your neighbourhood.

    Um, no. No, it won’t. Not without a completely impractical frequency of trips.

    And that’s not even getting into the fact that, of my six most recent addresses, three were well beyond bike radius and for two you would’ve been taking your life into your hands to try, given the roads involved. Whether you call that “screwed up” or not has exactly zero meaning, given that it is the reality.

    Sure, if the overwhelming majority of the world’s cities had been designed completely differently from the ground up, the kind of setup you’re suggesting would be practical. The rest of us, however, have to live in the real world.

  118. #118 Chris
    October 11, 2010

    Bike transport also works best in places with limited hills. I live in a city where the 4th Ave. entrance to the city hall is on the first floor, and the 5th Ave. entrance is on the fifth floor. It is always exciting when a car (or bus) loses its brakes.

    And like a health care working getting vaccinated to protect the patient, cyclists need to follow certain rules. These rules include wearing a helmet, having reflectors and lights in the dark, staying off of sidewalks and off several major motorways (like the freeway in the urban area).

  119. #119 JakeS
    October 11, 2010

    It’s simply not a credible option to have a reasonably direct bus route between every two points within, say, 10 miles

    Which is, of course, why you don’t do it that way. You have a grid of arterial lines and ring lines. That way, you will have only one or two changeovers per trip. And then you make the service frequent enough that you don’t lose more than a minute or two per changeover.

    Perfectly doable. Berlin does it. Göteborg does it. Paris does it, albeit with poorer suburban connections than the two former. Moskva and New York are reputed to do it, but I haven’t personally verified.

    Um, no. No, it won’t. Not without a completely impractical frequency of trips.

    You clearly use the wrong bike trailer – they go up to a cubic meter in size, y’know ;-)

    Ride the bike to a transit hub on the far side of your grocery store of choice in the morning and do your grocery shopping on the way home in the afternoon. Perfectly doable, even fairly far out in the suburbs, if your suburbs are properly planned.

    Sure, if the overwhelming majority of the world’s cities had been designed completely differently from the ground up, the kind of setup you’re suggesting would be practical. The rest of us, however, have to live in the real world.

    The overwhelming majority of cities in the world have not been designed for cars from the ground up – cars adaptations are a retrofit. Even for those who were designed under an auto-über-alles paradigm, it’s perfectly possible to de-sprawl without knocking them down and starting over. Start with the zoning laws to permit mixed residential and commercial properties, then do infill, and stop subsidising sprawl. Presto, the sprawl will go away over a decade or two, at the outside. Keep subsidising sprawl and keep insane zoning laws in place, and the sprawl will stay, of course. Until you hit a series of oil shocks – then it’ll go away regardless of your policy preference.

    - Jake

  120. #120 Scott
    October 11, 2010

    Which is, of course, why you don’t do it that way. You have a grid of arterial lines and ring lines. That way, you will have only one or two changeovers per trip. And then you make the service frequent enough that you don’t lose more than a minute or two per changeover.

    That’s the system used around here (Boston). It still takes at least four times as long as driving. I mention direct routes because then it would at least only be twice as long.

    And that’s entirely leaving aside the fact that most cities don’t even have public transport anywhere near as good as it is around here. Real world, remember?

    You clearly use the wrong bike trailer – they go up to a cubic meter in size, y’know

    I said FAMILY. A cubic meter doesn’t begin to come close to cutting it, again without a completely impractical trip frequency.

    Even for those who were designed under an auto-über-alles paradigm, it’s perfectly possible to de-sprawl without knocking them down and starting over…

    As I said, some of us have to live in the real world.

  121. #121 JakeS
    October 11, 2010

    That’s the system used around here (Boston). It still takes at least four times as long as driving.

    Then there’s something deeply wrong with the trip frequencies or the route layout. It simply shouldn’t be possible for a car to outperform an integrated subway/light rail/bus system by a factor of two (nevermind four) in an urban environment. I’ve never seen that happen in Europe, at least not in any city with a half-decent rail system.

    I said FAMILY. A cubic meter doesn’t begin to come close to cutting it, again without a completely impractical trip frequency.

    Two persons doing grocery shopping on their way home from the train station two or three times per week. That’s four to six cubic meters of food per week. What kind of pets are you maintaining on that sort of grocery budget? A pack of Grizzly bears?

    For that matter, as long as you’re within a ten to fifteen minute walk, two adults can do grocery shopping for a four-person household with their hands, feet and a couple of cloth bags. Been there, done that, didn’t starve to death.

    Even for those who were designed under an auto-über-alles paradigm, it’s perfectly possible to de-sprawl without knocking them down and starting over…

    As I said, some of us have to live in the real world.

    I’m all for living in the real world.

    Living in the real world implies, however, living on a real-world energy budget, something that is impossible with an auto über alles transportation infrastructure.

    - Jake

  122. #122 Chris
    October 11, 2010

    JakeS, your shopping hints have to do with Barbara Loe Fisher’s rant how?

  123. #123 Mephistopheles O'Brien
    October 11, 2010

    It still takes at least four times as long as driving.

    Back when I lived in the Boston area, it occasionally was faster to walk 2 or 3 miles than ride a bus. And just try to catch the T at 3 AM. On more than one trip the closest subway stop to my destination was more than 4 miles away – and I never saw a bus. So a car would have been handy at times. Not worth the hassle of parking it usually, but handy.

  124. #124 Vicki
    October 11, 2010

    JakeS–

    I have been commuting by subway since I was 11 years old (except for a few years at college, when I lived on campus and walked). And my reaction was to start explaining why what you’re saying was often impractical.

    When someone like me, who has never owned a car, and has arranged her life so she can get around by mass transit, reads your comments and thinks that you are being impractical, thoughtless, and judgmental, you’re doing it wrong. You may have some good policy ideas, but as propaganda or advocacy your comments on this thread are counter-productive.

  125. #125 Julian Frost
    October 12, 2010
    I said FAMILY. A cubic meter doesn’t begin to come close to cutting it, again without a completely impractical trip frequency.

    Two persons doing grocery shopping on their way home from the train station two or three times per week. That’s four to six cubic meters of food per week.

    Six trips a week to do grocery shopping? That IS a completely impractical trip frequency you nitwit!

  126. #126 Ender
    October 12, 2010

    @Vicki – I am also someone who has only ever used public transport (apart from trips arranged and driven by other people) and when someone like me thinks that you are being judgemental, thoughtless and counter-productive, you’re doing it wrong.

    Does that work? Can all of us who’ve never driven a car just simply declare someone irrelevant without addressing any of their points or doing anything except toot her own horn?

    Sweet.

  127. #127 Kristen
    October 12, 2010

    Two persons doing grocery shopping on their way home from the train station two or three times per week. That’s four to six cubic meters of food per week. What kind of pets are you maintaining on that sort of grocery budget? A pack of Grizzly bears?

    Um, you are an arrogant asshat. I have four children and (officially as of yesterday) two are on the autistic spectrum. I go to work when my husband gets home and I get off work at generally midnight or later. I am supposed to, at that hour, go to the grocery on a bike three times a week? Or perhaps, I should ride a bike to the grocery along the roadways with children who don’t understand about danger?

    In most places in America, the urban planners didn’t allow for physically powered transportation. Nobody wants to see this changed more than me, but disparaging everyone (save your five excuses) when you don’t even know what it is like to live in a country that doesn’t give a damn about clean air or exercise is simply asinine.

    I am reminded of a proverb:

    Before criticizing a man, walk a mile in his shoes.

  128. #128 Chris
    October 12, 2010

    (while I am annoyed at JakeS for going so far off topic, I think it would be fun to see him go to work for our regional transportation agency — I would love to see how he deals with our terrain that includes roads from sea level to 1000 meters, the various counties/cities where “compromise” translates into “don’t wanna decide” leadership stagnation, and the shopping mall magnate who continually blocks mass transit system attempts through lawsuits and a cry to build more freeways — due to, caution this will be on topic, similar political beliefs to Barbara Loe Fisher)

  129. #129 augustine
    October 12, 2010

    [Chris: (while I am annoyed at JakeS for going so far off topic, ...]

    Yet you just…can’t….seem…to…not…argue. “Must…argue…anyway.” Even if it’s off topic you still have to be right. It’s noted that you must also “cap end” any old thread argument also.
    ” Have…to…have…last….word. ”

    This seems to be a trait with many SBMers.

    “Can’t let lurkers think we are weak or have no answer. Must frame argument in the shape of victory.”

  130. #130 Scott
    October 12, 2010

    Then there’s something deeply wrong with the trip frequencies or the route layout. It simply shouldn’t be possible for a car to outperform an integrated subway/light rail/bus system by a factor of two (nevermind four) in an urban environment. I’ve never seen that happen in Europe, at least not in any city with a half-decent rail system.

    Oh, so now you’re insisting that it include subway and light rail everywhere. Yeah, the money for that really exists (again, real world). If we’re going to be the least bit practical, the bulk of it has to be buses. Which means that they’re just as affected by traffic, have to make frequent stops, AND are necessarily taking a less direct route for the overwhelming majority of trips. It’s impressive that a factor of two is even doable.

    Two persons doing grocery shopping on their way home from the train station two or three times per week. That’s four to six cubic meters of food per week. What kind of pets are you maintaining on that sort of grocery budget? A pack of Grizzly bears?

    Oh yeah, two people three times a week is SO practical. One person twice a week is pushing it.

    Living in the real world implies, however, living on a real-world energy budget, something that is impossible with an auto über alles transportation infrastructure.

    Less than ideal, certainly. But functional. Which the alternatives are not.

    It appears that your fundamental claim is that in the long run things will have to change. There’s a certain amount of truth to that (though don’t underestimate the potential for clever people to figure out ways to keep things going), but it doesn’t even begin to vaguely justify your blanket condemnation of everyone who has to drive in the real world today.

    “If the world were to profoundly change in ways X, Y, and Z then nobody would have to do this, therefore anybody who does have to today is an idiot and a murderer!”

  131. #131 Vicki
    October 12, 2010

    Ender–

    I’m not claiming that my background means I can dismiss his policy suggestions. What I’m saying is that when his posts make someone who is living the kind of life he advocates think “come on, that’s not reasonable, what about people who can’t spare that much time, or aren’t entirely physically healthy, or whose live in the suburbs?” he’s unlikely to convince anyone who isn’t already on his side.

    When someone tells me she doesn’t ride the bus because she doesn’t feel safe at the relevant bus stop at night, I can reasonably express sympathy that a bus commute isn’t practical for her, or suggest ways to change the route (if I know the area) or otherwise increase her safety. Or I might agree that this is unfortunate, but suggest that the bus would still be useful for some trips, even if she has to drive to and from work. “You shouldn’t care whether you’re attacked while you wait for the bus” would not be a useful answer. (The comment about the unsafe bus stop is from a conversation elsenet, last night and this morning.)

    If you build it, they will come: my local transit system increased bus ridership by something like 50% in 12 months by providing free bus-to-subway transfers. A lot of people liked the idea of not walking that half or three-quarters mile, they just didn’t like it enough to pay a second fare. And when the MTA saw how popular it was, they added more crosstown buses. (This was before the current recession.) You won’t get that result by criticizing people for not taking the bus, and running very few or very expensive buses.

  132. #132 al
    November 14, 2010

    vaccines are not sterilized ,they are supposed to be clean biologic substances. the culturing of attenuated viruses on foreign animal tissues is a risky thing . foreign animan DNAs and extraneous viruses have proved to be disasterous . these things can cause all kinds of host specific cancers and immunodysregulations . now just think about the advant of AIDS and the mass vaccination programs . the time line is certainly suspicious . i believe we are certainly being lied to and the public must resist the technology ,as it can amount to so much genetic manipulation.wake up man the 4th reicht is here among us . do your research !!

  133. #133 Chris
    November 14, 2010

    Oh, look it is a new fact free Necromancer, demanding we do our research when they don’t reference any. Al, argument by assertion is a an automatic fail.

    Some basic rules before commenting on a blog or forum:

    1) If you find an article through Google, before commenting go to the first page and see what is under discussion. There may be more a recent relevant thread for your comment.

    2) Get to know the place, lurk for a while.

    3) Become familiar with the writing style, especially in how issues are discussed.

    4) Try to proof read your comments (okay, we don’t all do that).

    5) If you think you want to bring a subject up to the participants’ attention, please use the search box on the upper left side of this page to see if it has been discussed before.

    6) If you get an error when posting a comment, before posting again… open another window to see if it was actually posted.

  134. #134 novalox
    November 14, 2010

    @132

    Great, Godwin’s law has been invoked….

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