H1N1

Does the flu vaccine cause miscarriages?

oracknows — Thu, 14 Sep 2017 06:50:50 +0000

Does the flu vaccine cause miscarriages?

The reason there wasn't a post yesterday is simple. The night before, I was feeling a bit under the weather. As a result, I went to bed early, neglecting my blogly responsibilities. As I result, I missed the release of a whopper of a study that normally would have been all over like...well...choose your metaphor. On the other hand, the one day delay isn't necessarily all bad because it lets me see the reaction of cranks to this study, the better to apply some not-so-Respectful Insolence to it. The crankiest of these cranks, of course, is Mike Adams, a grifter deep in the thrall of any form of pseudoscience that he can sell to burnish his brand and keep the rubes buying and who knows how to whip his minions into a fine frothy head of anti-pharma conspiracy mongering. In actuality, though, I was a little bit disappointed, as Adams was almost restrained, at least by his usual crazed standards:

A CDC-funded medical study being published by the medical journal Vaccine has confirmed a shocking link between flu shots and spontaneous abortions in pregnant women. The study was rejected by two previous medical journals before Vaccine agreed to publish it, further underscoring the tendency for medical journals to censor any science that doesn’t agree with their pro-vaccine narratives.
“A study published today in Vaccine suggests a strong association between receiving repeated doses of the seasonal influenza vaccine and miscarriage,” writes CIDRAP, the Center for Infectious Disease Research and Policy.

“A puzzling study of U.S. pregnancies found that women who had miscarriages between 2010 and 2012 were more likely to have had back-to-back annual flu shots that included protection against swine flu,” reports Medical Xpress, a pro-vaccine news site that promotes vaccine industry interests. Notice that the opening paragraph of their study assumed the study couldn’t possibly be true. It’s “puzzling” that mercury in flu shots could cause spontaneous abortions, you see, because these people have no understanding of biochemistry and the laws of cause and effect.

Actually, as has been documented so many times before, it is Mike Adams who has no understanding of biochemistry—or any other science—other than what it takes for him to portray himself to his gullible followers as a "real scientist." As for the "laws of cause and effect," whenever someone says something like that in reference to an epidemiological study, I know he's really, really clueless, because if there's anything that's very difficult to do in an epidemiological study with reliability it's determining cause-and-effect. That's why the cardinal rule of epidemiology is that correlation does not equal causation. It might, but usually it doesn't, and it usually takes a whole lot more than just one study with a correlation to start to suggest causation. This is particularly true when a study like the one Adams is gloating about is such an outlier, which this study most definitely is, as you will see. It's also an exercise in data dredging that illustrates the danger of small numbers in studies like this.

Let's go to the study itself. I can't help but note that Frank DeStefano of the CDC is a co-author. DeStefano, as you might recall, is one of those CDC investigators that antivax conspiracy theorists like those who made the propaganda film VAXXED portray as one of the main villains in the "CDC whistleblower" conspiracy theory. Also, several of the authors receive pharma money for research support. Nicola Klein, for instance, receives research support from GlaxoSmithKline, Sanofi Pasteur, Pfizer, Merck, MedImmune, Novartis, and Protein Science, while Allison Naleway receives funding from GlaxoSmithKline, MedImmune, and Pfizer. Others receive support from MedImmune and Novavax. So basically, this was a study funded by the CDC and carried out by CDC scientists and scientists receiving significant pharma funding. I just couldn't resist pointing that out. I know, I know, antivaxers will claim that the findings were so compelling that not even the CDC and pharma shills could hide them, but it would amuse me to point these things out to antivaxers.

Yet, here we see Del Bigtree, producer of VAXXED, gleefully citing J.B. Handley gloating over this study:

Tough breaking news for @ChelseaClinton @DrPanMD @doritmi FLU SHOT linked to MISCARRIAGE! #endvaxinjury https://t.co/6JwjnsAviY

— Del Bigtree (@delbigtree) September 13, 2017

I wonder if he knows that DeStefano is a co-author. He probably doesn't care, because DeStefano, like any scientist, can be a hero or a villain depending solely upon whether he produces information or studies that agrees with the antivaccine narrative that the flu vaccine is not just useless but dangerous. Be that as it may, the article above is a typical bit of Handley's Dunning-Krugger arrogance of ignorance, even more full of hyperbole and nonsense than the usual Mike Adams' endeavors in that area. Indeed, Handley even uses the argumentum ad package insert gambit. (Whenever I see that gambit used by an antivaxer, my estimation of his cluelessness goes up several notches, which for Handley is really saying something.) In any case, you can get a feel for how much the authors of this study are stretching to find a correlation—any correlation—between influenza vaccines and miscarriages that they're looking at combinations of vaccines by their brief justification for the study:

Since 2004, the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) and other organizations have recommended routine influenza vaccination for pregnant women regardless of gestational age [1,2]. Influenza in pregnancy can cause serious, life-threatening illness in both the mother and fetus, as demonstrated during the 2009 pandemic [3,4]. Numerous studies of influenza vaccine during pregnancy have not identified serious safety concerns [5–12], but relatively few investigations have evaluated vaccination in the first trimester, a period when the embryo is highly vulnerable to teratogens and other factors [5,13]. A case-control study conducted by the Vaccine Safety Datalink (VSD) demonstrated that influenza vaccination during early pregnancy in the 2005–06 and 2006–07 influenza seasons was not associated with spontaneous abortion (SAB) [14].

The emergence of a pandemic influenza virus, A/California/ 7/2009 (H1N1)pdm09 (pH1N1), led to rapid development and widespread use of vaccines containing pH1N1 antigens. Several studies have evaluated the safety of vaccines containing pH1N1 in pregnancy, but few have focused on outcomes in early pregnancy [15–19]. Using a design and protocol similar to the previous study [14], we conducted a case-control study to determine if receipt of influenza vaccine containing pH1N1 was associated with SAB.

Notice the eight studies cited (references 5-12) that failed to find significant safety issues with the vaccine in pregnancy, and a study (reference 14) using VSD data failed to find an association between flu vaccination with spontaneous abortion. That's actually a lot of data for the safety of the flu vaccine during pregnancy, which makes me wonder what the justification for yet another study looking for an association between influenza vaccination and miscarriages. If I were a funding agency and received a grant application to do a study like this with text above in the "Background and Significance" or the "Impact" section, my first reaction would be: Why on earth would we fund this? It's all been done before, many, many times. Yet the CDC funded this study. So much for antivax claims about the CDC not being concerned about vaccine safety and not being willing to look for adverse reactions due to vaccines.

I also find it rather odd that the authors would say that few studies have been done looking for a correlation between vaccination against influenza, when in fact there have been a lot, many well-designed, and they've pretty much all been negative. Whenever you see a study that finds something a lot different from the bulk of the studies that have been done before, the first question to be asked is: Are the results of the current study so robust that they indicate a hole in the existing data addressing the question asked that we should begin to question the cumulative results of all the studies that have gone before? Keep that question in mind as I continue.

Also consider the bias that exists in journals to publish novel findings. As this news report points out, this is the "first study to identify a potential link between miscarriage and the flu vaccine." That's almost certainly the reason that it was published. Adams, in his haste to portray as a conspiracy to silence, inadvertently tells me something. That this paper was rejected by two previous journals is not surprising to me. What is surprising is that Vaccine ultimately accepted it. Of course, how Adams would know that this paper was submitted elsewhere and rejected, I don't know, which is why I have my doubts about Adams' claims.

So what about the study itself? First, it's a case-control study. Basically, that means that the authors found a cohort of women who had miscarriages (the cases) and compared them to a cohort of women who didn't have miscarriages but instead delivered full term infants or had stillbirths during the study period (the controls). The authors chose two flu seasons (2010 to 2012) and asked if women who had miscarriages were more likely to have been vaccinated for influenza within 28 days prior to miscarriage, as well as for different time periods before miscarriage.

The most critical aspect of any case control study if, of course, the matching of cases to controls. The idea is to match them as closely as possible on all relevant factors other than the condition under investigation (in this case, miscarriage). Not uncommonly, investigators will do a 2:1 match, controls to cases, in order to make the comparison more robust. It's not mandatory, and Donohue et al chose not to do this. In this study, cases had SAB and controls had live births or stillbirths and were matched on site, date of last menstrual period, and age. I also note that the database they used was the Vaccine Safety Datalink (VSD). As I like to say, the VSD is an excellent rebuke to antivaxers who claim that doctors don't care about vaccine safety. It's a database designed to document adverse events associated with vaccination, and it's a huge database. I've discussed it before on more than one occasion.

So what did the study find? Here's a summary of the cases analyzed:

if you look at the tables in the paper, the first thing you will notice is that the adjusted odds ratios (aORs) for miscarriage as a function of having received the flu vaccine are nearly all around 1.0 or not statistically different from 1.0. Obviously, there are exceptions. Basically, the study found that, if a woman had consecutively received a flu vaccine containing the 2009 H1N1 virus the season before and had the flu vaccine in one of the two seasons studied, the aOR in the 1–28 days was 7.7 (95% CI 2.2–27.3). Otherwise, the aOR was 1.3 (95% CI 0.7–2.7) among women not vaccinated in the previous season; i.e., not statistically significant from 1.0, meaning no detectable difference in miscarriage rates compared to women who had not been vaccinated. This effect was noted in both seasons.

Now here's where you should be skeptical.

This study has several important limitations. First, the most striking findings relate to the association between SAB and IIV [inactivated influenza vaccine] in women who previously received pH1N1-containing vaccine. This interaction effect was not an a priori hypothesis; the results were generated in a post hoc analysis with small numbers of women in the various subgroups. Although the interaction was observed in each of the two seasons studied, the point estimates were substantially larger (though not statistically different) in the first season for reasons that are unclear. Second, although most cases had an ultrasound, assignment of a precise date of SAB was challenging. With guidance from an obstetrician we integrated different types of information from the medical record (e.g., ultrasound results, clinical and laboratory findings, provider notes) to estimate the timing of the SAB. Estimation of SAB dates was independent of vaccination status so any error should bias the results toward the null (i.e., non-differential misclassification). Third, we studied only women who had clinically confirmed SAB; the proportion of women with clinically unrecognized pregnancy loss is uncertain but may be substantial [50,51]. Our results could be biased if women who sought care for SAB were more likely to be vaccinated in the 28-day exposure window.

So what we're looking at is an association, nothing more. It's an association with a lot of caveats, too. Basically, having found nothing more than one association with an aOR of 2.0 for the 1-28 day window of exposure to the influenza vaccine before miscarriage that was barely statistically significant (95% confidence interval: 1.1-3.6), the authors did a post hoc analysis looking for other associations. (Never mind that the "association" they found was eminently unimpressive given the size of the confidence intervals.) "Post hoc" means that they did additional analyses not originally specified. Basically investigators don't usually do post hoc analyses if there is a robust association in their data. They do it when they fail to find an association or only find an unimpressive association that is not robust. Also, post hoc analyses are prone to type 1 errors, which means finding a statistically significant "association" where there is none; i.e., finding a false positive. When the numbers in the subgroup are so small and the study is observational (i.e., retrospective), that tendency is even stronger. Then there was the issue that the cases and controls were not as comparable as one would like in a case control study. For example, cases were significantly older than controls and more likely to be African-American, to have a history of 2 spontaneous abortions, and to have smoked during pregnancy. The authors did some correcting for age and history of spontaneous abortions, but it's questionable to me whether it was adequate.

Basically, the authors did what we refer to as a subgroup analysis, in this case the subgroup being women who had received H1N1 vaccination the season before they received the flu vaccination in the seasons examined? That clearly wasn't a primary hypothesis being tested. Rather, it was a hypothesis the authors clearly came up with while doing the study. One wonders if this analysis was prespecified or whether the protocol was changed midway through. I only ask that because antivaxers went wild over claims by the "CDC whistleblower" that the Atlanta MMR study changed its protocol part way through the study, but, here, where the analysis seems to suggest such an "adjustment" during the study (although it is certainly possible that the H1N1 analysis was prespecified in the original protocol, given the choice of the 2010-11 and 2011-12 flu seasons), we hear...silence. Whatever the case, there clearly was post hoc analysis strongly resembling p-hacking going on here, in which the investigators, having failed to find much, started looking at other potential associations. Certainly, it smells that way.

Speculations about the protocol aside, the investigators found what they found, namely an aOR of 7.7 for cases versus controls for exposure to the H1N1 vaccine the year before plus the flu vaccine within 1-28 days before their miscarriages. This was based on some very small numbers, though, namely 14 miscarriages and 4 controls. In other words, this is almost certainly a statistical fluke, given that it was only found for women who had received H1N1 the season before and had received the flu vaccine within 28 days of their miscarriage, and that the association was not observed for pretty much any other time window or combination. When considering such a result, one also has to consider biological mechanism and plausibility, and it is just not very plausible from a biological or immunological standpoint that this combination of flu vaccines—and only this combination—given only during a specific time window will cause miscarriages. Like Dr. Gregory Poland, the editor of Vaccine, I don't believe these findings, either.

I particularly don't believe them in light of what we already know, based on studies Tara Haelle summarized the data with respect to flu vaccines and miscarriages, stillbirths, and birth defects in 2014, using mainly studies published during the prior two years, and the results were very consistent and overwhelming: There was no association between vaccination for influenza and adverse fetal outcomes. Just for yucks, I did some PubMed searches myself for more recent studies, and found basically the same thing, but instead of listing those studies, I'll just refer you to a recent large meta-analysis that found that the risk of stillbirth was actually lower in women vaccinated against influenza and no difference in the risk of spontaneous abortion. In other words, this new study is an outlier. It's such an outlier, that scientists are correct to be very skeptical of its results. Heck, even the authors are skeptical of its results. Unfortunately, they're not so skeptical that they don't resist making the call for "more research." They'll probably get the funding for that "more research," and then when the inevitable negative study is finally published, no one will remember it. They'll all remember this study, and, of course, the antivaccine movement will be flogging it for years to come.

oracknows Thu, 09/14/2017 - 02:50

Tags

Antivaccine nonsense

Clinical trials

medicine

case control study

Just as the H1N1 conspiracy theory machine did in 2009, the Ebola conspiracy theory machine goes into overdrive

oracknows — Thu, 16 Oct 2014 04:46:19 +0000

Just as the H1N1 conspiracy theory machine did in 2009, the Ebola conspiracy theory machine goes into overdrive

Does anyone remember the H1N1 influenza pandemic? As hard as it is to believe, that was five years ago. One thing I remember about the whole thing is just how crazy both the antivaccine movement and conspiracy theorists (but I repeat myself) went over the public health campaigns to vaccinate people against H1N1. It was truly an eye-opener, surpassing even what I expected based on my then five year experience dealing with such cranks. Besides the usual antivaccine paranoia that demonized the vaccine as, alternately, ineffective, full of “toxins,” a mass depopulation plot, and many other equally ridiculous fever dream nonsense, there was the quackery. One I remember quite well was the one where it was claimed that baking soda would cure H1N1. Then there was one of the usual suspects, colloidal silver, being sold as a treatment for H1N1. Then who could forget the story of Desiree Jennings, the young woman who claimed to have developed dystonia from the H1N1 vaccine? Truly, pandemics bring out the crazy, particularly the conspiracy theories, such as the one claiming that the H1N1 pandemic was a socialist plot by President Obama to poison Wall Street executives, which was truly weapons-grade conspiracy mongering stupidity. Oh, wait. That was a joke. It’s so hard to tell sometimes with these things.

Yes, pandemics and epidemics do bring out the worst in people, as far as critical thinking goes. This time around, five years later, it’s Ebola virus disease. To the average person, Ebola is way more scary than H1N1, even though H1N1, given its mode of transmission, had the potential to infect and potentially kill far more people. Now that cases of Ebola virus disease have been reported in the US, the panic has been cranked up to 10 in certain quarters, even though the risk of an epidemic in the US comparable to what is happening in west Africa is minimal. We’ve seen quackery, too, such as homeopaths seriously claiming that they can treat Ebola and quacks advocating high dose vitamin C to “cure” Ebola. The über-quack Mike Adams is selling a “natural biopreparedness” kit to combat Ebola and pandemics, while the FDA is hard-pressed to track down all the quacks, such as hawkers of “essential oils,” who—of course!—also think that their wares can cure Ebola.

Now, given how afraid everyone is of Ebola, not entirely without some justification (it is a horrible disease, after all, and it is spread by contact with blood and bodily fluids), you’d think that everyone could get behind a vaccine against the disease. Given that Ebola is a virus and a successful antiviral treatment tends to be considerably more difficult to develop than a successful antibiotic, a vaccine likely represents the best hope for bringing the current epidemic under control with as little loss of life as possible. Certainly if such a vaccine were to be developed, as it likely will be relatively soon (at least in terms of drug or vaccine development time), given the urgency now that wasn’t there before), you’d think that a vaccine would be welcomed with open arms. And when it comes to most people, at least not antivaccine loons, you’d be right. However...take a look at this video by Barbara Loe Fisher, Grande Dame of the antivaccine movement and founder of the Orwellian-named National Vaccine Information Center (NVIC):

First, we have a highly cherry-picked timeline designed to make the US and CDC look as incompetent as possible, as Fisher asks a series of "Why?" questions, some semi-reasonable, some pure fear mongering. Then comes the kicker. Near the end of the video, Fisher asks (at the 9:00 mark or so):

And why are experimental Ebola vaccines being fast tracked into human trials and promoted as the final solution rather than ramping up testing and production of the experimental ZPap drug that has already saved the lives of several Ebola-infected Americans?

Hmmm. I wonder what this "ZPapp" drug is. I've never heard of it. I wonder if Fisher means ZMapp. Barbara, Barbara, Barbara. How are we supposed take you the least bit seriously if you can't even get the name of the main experimental drug currently being tested against Ebola right? Then there's Fisher's choice of words to describe experimental vaccines: Final solution. One wonders if she could be more obvious in her biases against vaccines. Freudian slip much, Barbara? In any case, contrary to what Fisher claims it isn't clear whether ZMapp actually did save the lives of those Americans who survived Ebola. It might have. It might not have. We need more data and a clinical trial to tell if ZMapp is as effective as we all hope it is. It might have been that those patients would have recovered anyway with supportive care alone. Indeed, at least one patient that I've read about received the drug but died anyway. As for "ramping up production," it's not as though it's as easy as just turning a switch. This drug is a humanized monoclonal antibody (like Avastin and Herceptin, for instance). Making such drugs is difficult, expensive, and can't easily just be "ramped up" instantly.

Of course, to Fisher, this emphasis on fast tracking an Ebola vaccine can only mean one thing:

A logical conclusion is that some people in industry, the government, and the World Health Organization did not want the Ebola outbreak to be confined to several nations in Africa because that would fail to create a lucrative global market for mandated use of fast tracked Ebola vaccines by every one of the seven billion human beings living on this planet. Will there be an Ebola outbreak in America? Ask the CDC, WHO, DOD, NIH, and Congress. Learn more about Ebola and Ebola vaccines at NVIC.org. It's your health, your family, your choice.

Notice how it never occurs to Fisher that the best way to stop an outbreak of an infectious disease is through prevention (i.e., a vaccine, in addition to other public health measures designed to slow the spread of the disease). This is particularly true when the disease in question is a viral disease for which an effective drug is difficult to make. In any case, this is a common theme through the latest crop of Ebola conspiracy theories coming from antivaccine loons like Fisher: The claim, implication, or insinuation that the government either created or at least sustained (and took advantage of) the current Ebola outbreak in order to create a market for vaccines for its pharma overlords, although some variants, as we will see, postulate that the reason for starting and sustaining the epidemic is to create a lucrative market for ZMapp, whose early development was—of course!—funded in part by the U.S. Department of Defense.

Fisher is not alone in promoting paranoid conspiracy theories. All over Twitter and other social media, there are exchanges like this:

@KaiHolloway I cant see any other agenda for the Ebola Feargasm on M$M...fuck I hope im wrong..

— Paul Schmidt (@psc96180_pablo) October 15, 2014

The replies were equally unhinged:

@psc96180_pablo me too brother, but we have seen it coming... as a human being we are entitled to defend our selves. this is fkn bollox!

— no one special (@KaiHolloway) October 15, 2014

That’s right. According to antivaccinationists, the real reason for the Ebola “feargasm” is to promote a toxic mass vaccination program because...well, just because apparently the government wants to poison us in order to...well, I must confess that I really can’t follow the “logic” of this particular conspiracy theory, such as it is. Such is the nature of the conspiracy theories springing up among antivaccinationists about the latest Ebola outbreak. Why would the government want to kill thousands, possibly hundreds of thousands if the epidemic gets out of control in Africa. They honestly seem to think that the epidemic is a pretext for mass vaccination, rather than proposals for vaccines flowing from the understandable desire of public health officials in the US, Africa, and the rest of the world to stop mass suffering and death. Not surprisingly, the paranoia and conspiracy theories are eerily similar to the ones that sprang up five years ago in response to the H1N1 pandemic and the mass vaccination programs instituted by the US and other nations to try to forestall its worst effects.

In fact, the conspiracy theories get even loonier than that. Remember the whole “CDC whistleblower” conspiracy theory? It broke on a waiting online world like a massive fart only less than two months ago, back in August. It began when biochemical engineer turned “vaccine expert,” epidemiologist, and, of course, mercury militia member published a truly awful “re-analysis” of a decade-old study (DeStefano et al) that failed to find a correlation between age at MMR vaccination and risk of autism in a case control study. Basically, his “re-analysis” proved Andrew Wakefield wrong in that it found no increased risk of autism attributable to MMR vaccination in all but a very small subgroup in the study, African-American boys, and the numbers for that group were so suspect that virtually everyone with any knowledge of statistics, epidemiology, or experimental design highly doubted they were anything other than an anomaly. Unfortunately, it did spark a ridiculous campaign on the part of the antivaccine fringe, who saw this as “smoking gun proof” of their central conspiracy theory that the CDC covered up The Truth that vaccines cause autism, because, it turns out, a CDC psychologist named William Thompson, who was a co-author on DeStefano et al, had been feeding Brian Hooker information out of some sort of misguided “guilt” over a decade-old scientific disagreement over how to analyze the data that he lost. Naturally, there was no evidence presented that the CDC did anything wrong other than the cherry-picked and highly edited quots and snippets of text from Thompson provided by Andrew Wakefield and Brian Hooker, the latter of whom had recorded Thompson without his knowledge for months, but that didn’t stop the antivaccine movement from going full mental jacket over this affair.

So, now that they’ve failed to get any traction on the “CDC whistleblower” issue in the mainstream press other than a smackdown by MSNBC's Ronan Farrow, who made one of the “thinking moms” named Lisa Goes look even more clueless than usual, angering the “media editor” of the antivaccine crank blog Age of Autism. How do antivaccinationists explain their failure to get any significant news attention in the mainstream media, despite a whole lot of trying? My explanation is that most reporters know cranks as cranky as this when they see them and, probably more importantly, that Andrew Wakefield is so disgraced and so toxic that his involvement in the story basically killed any opportunity antivaccinationists might have had to get a bottom feeding “mainstream media” outlet to take them seriously. One antivaccinationists’ explanation is that, obviously, Ebola’s the result of a plot to keep the mainstream media from reporting on the “CDC whistleblower” affair:

How is it we suddenly have an Ebola “outbreak” and it is coming to the USA too?
The Ebola outbreak is quite a coincidence – senior CDC scientist Dr Thompson has been talking with Dr Hooker for 10 months about the CDC knowing the MMR vaccine causes autism. The Ebola “problem” was introduced gently to the US public earlier in the year.

Now we have an Ebola “outbreak” in the west just when Hooker’s paper has been published and the admissions about the CDC knowing the MMR vaccine causes Autism issue are breaking news which the mainstream media refuse to report.

And today’s news of a “vaccine” will of course be certain to ensure editors will publish nothing about MMR vaccine causing autism.

Of course to test a new vaccine and a new drug one needs a clinical trial. But people tend not to get Ebola – it has been pretty quiet for a very long time – until now.

And suddenly they ship the sick people off to the USA with all the attendant risks of spreading the disease instead of treating them where they got sick.
Seems a gift for WHO and the CDC but who wrapped it and how long ago?

Because, obviously, the CDC and US government are so nefarious and clever that they foresaw many months ago that in August the whole “CDC whistleblower” thing would blow up, which is why they got an Ebola epidemic in Africa going with enough lead time so that the number of fatalities would be percolating along at the same time, timing it even more ingeniously so that the fear of the disease would be reaching a fever pitch right around the same time those poor, intrepid antivaccinationists were trying to get the attention of the media. Damn, I wish our government functioned so efficiently and with such purpose! Obviously, it doesn’t. But it’s still a hell of a conspiracy theory. Well, not really.

That doesn’t stop the “Vaccine Information Network” from asking Ebola: yet another fake pandemic set up to poison us with drugs and vaccines? The cranks at the VIN do realize that usually when the title of an article is in the form of a question, the answer to that question is, “No,” don’t they? Apparently not, because clearly Jon Rappaport (remember him?) believes that it is. And guess what? He even likens it to H1N1 in this interview:

Q: What is the major psychological factor at work here?
A: Above all else, it is people making an automatic connection between their own frightening image of Ebola and the statement, “So-and-so is sick.”

Q: “Sick” doesn’t automatically = Ebola?
A: That’s right, even when an authority says some person is sick and in the hospital and has Ebola.

Q: Is the Ebola epidemic a fraud, in the same way that Swine Flu was a fraud?
A: In the summer of 2009, the CDC stopped counting cases of Swine Flu in the US.

Q: Why?
A: Because lab tests on samples taken from likely and diagnosed Swine Flu cases showed no presence of the Swine Flu virus or any other kind of flu virus.

Q: So the CDC was caught with its pants down.
A: Around its ankles. It was claiming tens of thousands of Americans had Swine Flu, when that wasn’t the case at all. So why should we believe them now, when they say, “The patient was tested and he has Ebola.” The CDC is Fraud Central.

Q: Where is the fraud now, when it comes to counting Ebola cases and labeling people with the Ebola diagnosis?
A: The diagnostic tests being run on patients—the antibody and PCR tests are most frequently used—are utterly unreliable and useless.

Q: Therefore, many, many people could be labeled “Ebola,” when that is not the case at all?
A: Correct.

Q: But people are sick and dying.
A: People are always sick and dying. You can find them anywhere you look. That doesn’t mean they’re Ebola cases.

Q: In other words, medical authorities can place a kind of theoretical grid over sick and dying people and reinterpret them as “Ebola.”
A: Exactly. The map can be drawn in any number of ways.

Got that? Back in 2009, apparently, it wasn’t H1N1 that was sickening people, and now in 2014 it’s not Ebola that’s killing people in West Africa and infected a handful of people in the US. What is the cause? According to Rappaport, it’s not the virus. Basically, it’s protein-calorie malnutrition, hunger, starvation, extreme poverty, contaminated water supplies, overall lack of basic sanitation, a decade of horrific war, toxic medical drugs, prior toxic vaccine campaigns, and the like that cause destruction of immune systems, leading to:

Then, any germ that sweeps through the population, a germ that would ordinarily be defeated, instead kills many people. Why? Because the immune system is too weak to respond. With healthy and strong immune systems, the germs would have no significant effect.

This is, of course, utter BS. Rappaport, as usual, argues by assertion and doesn’t know what he’s talking about. It’s amazing how constant the forms of infectious disease denialism are. Just like HIV/AIDS denialism blamed “lifestyle” and immune compromise due to drugs, anal sex, and “lifestyle,” claiming that AIDS is not caused by HIV, Ebola virus denialism claim that what is being diagnosed as Ebola is in fact not due to Ebola but to “toxins,” malnutrition, and, of course, vaccines. Of course. Yes, to Rappaport, the whole thing is a plot to drive demand for products made by big pharma, such as vaccines. Naturally, as with all good disease conspiracies, Rappaport drives it with claims that the case numbers are being "manipulated," labeling the Ebola outbreak as a "hoax," claims that the tests are "unreliable" (they're not; while it’s true that early in the course of symptomatic Ebola infection the disease resembles a lot of other viral diseases, there are a number of sensitive and accurate diagnostic tests, including PCR, ELISA, and, ultimately, virus isolation); and claims from the inventor of PCR, Kary Mullis, from whom Rappaport cites a 1996 quote claiming that "quantitative PCR is an oxymoron." It's not; I've been doing highly accurate quantitative real time PCR in my lab for 14 years now, and it's a routine technique in molecular biology labs. In 1996, reliable quantitative PCR hadn't been perfected yet, but today it's a routine, every day test.

Of course, it’s not just the CDC, at least not according to Yoichi Shimatsu, but it’s apparently the UN, too. Yep, according to the Shimatsu, Ebola outbreaks coincided with vaccination campaigns by World Health Organization (WHO) and the UN children’s agency UNICEF. To others, however, the Ebola outbreak is not so much a plot to enrich big pharma but rather US-sponsored bioterror. At least, so sayeth someone calling himself Prof. Jason Kissner. Kissner, it turns out, is a criminologist and a birther, but with a twist. While he accepts that President Obama was born in Hawaii, but claims that he holds dual citizenship as an Indonesian. In fact, Kissner is all over the conspiracy sites, and his arguments about Ebola are no more coherent than his arguments about the President’s birth certificate. He also thinks that the "the racial 'dialogue we've been hectored about for several decades is in reality no "dialogue" at all; it is a monologue imposed by the powerful in order to decimate the values and individuality of the powerless." After worrying about whether the virus responsible for the current outbreak might have gone airborne, he goes on to invent a conspiracy theory in which the current outbreak is due to a bioengineered variant of Ebola that’s more contagious than previous strains. He bases this almost entirely on an article in the New England Journal of Medicine from April about the emergence of the Zaire strain of Ebola in Guinea, which notes that the Guinea strain in West Africa is distinct:

According to the initial epidemiologic investigation, the suspected first case of the outbreak was a 2-year-old child who died in Meliandou in Guéckédou prefecture on December 6, 2013 (Figure 2). A second investigation confirmed the origin of the outbreak in Meliandou but revealed a somewhat different timing of the early events (including the death of Patient S1 at the end of December and the deaths of Patients S2, S3, and S4 in January). Patient S14, a health care worker from Guéckédou with suspected disease, seems to have triggered the spread of the virus to Macenta, Nzérékoré, and Kissidougou in February 2014. As the virus spread, 13 of the confirmed cases could be linked to four clusters: the Baladou district of Guéckédou, the Farako district of Guéckédou, Macenta, and Kissidougou. Eventually, all clusters were linked with several deaths in the villages of Meliandou and Dawa between December 2013 and March 2014.

In a nutshell, both The Shimatsu conspiracy theory and Kissner’s conspiracy theory rely on an appeal to incredulity. Just because Kissner and Shiamatsu can't believe that Ebola could remain dormant for years and then reemerge to cause this outbreak, to them something else must be going on. For instance, Shimatsu writes:

The mystery at the heart of the ebola outbreak is how the 1995 Zaire (ZEBOV) strain, which originated in Central Africa some 4,000 km to the east in Congolese (Zairean) provinces of Central Africa, managed to suddenly resurface now a decade later in Guinea, West Africa.

Kissner’s contribution to this argument from incredulity is that he can’t believe that the distinct strain of Ebola could have arisen naturally and then found its way from Zaire all the way to West Africa without human intervention. I bet you can guess what that intervention is:

And, we seem to have a single introduction of the Guinea (West African) Ebola variant into the human population. Thus, we seem not to have, for example, something along the lines of multiple bites of humans by supposedly Guinea variant Ebola infected fruit bats.

Finally, the Western Africa Ebola outbreak does not appear to be traceable to Central Africa or anywhere else, and so we still do not know how Ebola got to West Africa.

To Kissner, this of course means that it must have been US bioterrorism that introduced this “new” Ebola strain into the human population in Guinea in order to...what? Why? To Kissner, it’s all about the experimental Ebola drug ZMapp, which was only identified as a potential Ebola drug candidate in January 2014:

Does “ZMapp was first identified as a drug candidate in January 2014” mean that ZMappwas designed from the ground up, pretty much when the outbreak began, with the specific purpose of treating the Guinea Ebola variant (see above for timing of the outbreak)? Or, does it mean that ZMapp was repurposed in some way to grapple with the Guinea variant? Or does it perhaps mean something else entirely?

That “something else entirely” to Kissner is that the makers of ZMapp knew about the new Guinea variant and designed ZMapp to combat it. Apparently Kissner has never heard of crossreactivity of antibodies. Or perhaps he has but just doesn’t believe it:

Perhaps Mapp had been in the process of designing ZMapp so that it could successfully attack already extant Ebola variants, and whatever properties made it effective against those already extant variants also transferred to the novel Guinea variant?

Maybe.

But if that is so, ZMapp should prove successful against variants of Ebola other than the Guinea variant. Will it?

If it doesn’t prove successful against variants of Ebola other than the Guinea variant, I do not see how one can logically avoid the conclusion that the West African rooted, Guinea variant of Ebola amounts to U.S. government linked bioterror.

Unless, of course, one is willing to invoke what amounts to a miraculous stroke of luck consisting in the design of a solution that successfully attacks something that’s never been seen before and was not anticipated—even though the solution fails against related versions of the same problem.

In closing, please note that the U.S. act of bioterror explanation economically accounts for all three U.S. lies discussed in the article. It explains why the U.S. government is lying about the airborne status of Ebola, why the U.S. government/MSM hybrid is in no hurry to disclose the geographical and virological novelties of the Guinea variant, and, finally, why the U.S. government, out of one side of its mouth, wants to act like its “miracle experimental drug” had to be pried out of its greedy and comprehensive regulatory hands.

That’s one hell of a plot, isn’t it? Of course, ZMapp has been under development at least since 2012 and the antibody cocktail against Ebola virus used went through at least three distinct iterations, its latest composition having been arrived at in early 2014 based on testing in rhesus macaque primates. I suppose that means that those nefarious Department of Defense funders who helped fund the drug and Leaf Biopharmaceutical Inc., the company currently developing ZMapp, must have planned even further ahead than even Kissner could know. Or maybe there’s just good crossreactivity of this antibody cocktail to multiple strains of Ebola.

Shimatsu disagrees. Although his logical fallacy is also an appeal to personal incredulity, unlike Kissner, he thinks it’s all due to the UN vaccine programs:

The reason for suspecting a vaccine campaign rather than an individual carrier is due to the fact that the ebola contagion did not start at a single geographic center and then spread outward along the roads. Instead. simultaneous outbreaks of multiple cases occurred in widely separated parts of rural Guinea, indicating a highly organized effort to infect residents in different locations in the same time-frame.

But how and why? Shimatsu has a ready answer:

Repeated dosages of potent toxins on populations with poor health, which no public-health agency in the Western world dares attempt inside its own borders, can have harmful side effects, especially on children. The casualties of vaccination have gone unreported by the media and buried under official cover-ups. Even worse, vaccine programs could well have been used to conceal human testing of antibodies that originated in biological warfare labs for the purpose of mass murder of entire nations.

Yes, according to Shimatsu, the MSF, UNICEF, WHO, CDC, NIH, USAMRIID and, as Shimatsu puts it, the “rest of the alphabet soup of the hypocritical oafs of pharmaco-witchcraft” are all just that evil.

Throughout history, infectious disease has brought out the best and worst in humanity. The best, like Doctors Without Borders, go selflessly straight into the hearts of epidemics in order to treat the ill, try to prevent further spread of the disease, and alleviate suffering wherever they can. The worst, like antivaccinationists and conspiracy theorists like Kissner and Shimatsu, try to deny the cause of the disease in favor of conspiracy theories that demonize the very organizations trying to help its victims and companies trying to make vaccines to prevent it and drugs to treat it.

oracknows Thu, 10/16/2014 - 00:46

Categories

Medicine

.....holy crap.

There's waaay to much herp in their derp. I don't think there's enough tinfoil to cover that amount of B.S.

That BLF can't get ZMAPP right doesn't surprise me, nor do the usual quack calls for Vitamin C, colloidal silver, etc as curealls... but I can't fathom that level of pure, unadulterated paranoia.

65% of America is now suffering from contagion Fear-bola.

Kissner: "And, we seem to have a single introduction of the Guinea (West African) Ebola variant into the human population. Thus, we seem not to have, for example, something along the lines of multiple bites of humans by supposedly Guinea variant Ebola infected fruit bats."

Shimatsu: "the ebola contagion did not start at a single geographic center and then spread outward along the roads. Instead. simultaneous outbreaks of multiple cases occurred in widely separated parts of rural Guinea"

It seems like this is a question of fact. Either there was a single initial case or there were multiple initial cases. But I suppose conspiracy theorists needn't bother with facts.

Isn't there some way to warn readers that they're about to scroll past an image of Barbara Loe Fisher?

The sudden nausea could be incapacitating.

Not quite a conspiracy-theory "story", but to ad to the mix, there's an op-ed at the New York Times this morning worried that bioterrorists could--using the publicly available genome--synthesize smallpox virus de novo: http://www.nytimes.com/2014/10/16/opinion/resurrecting-smallpox-easier-…

At some point, hopefully not in my lifetime, there is going to be a serious pandemic. If we are able to develop an effective vaccine in time it will be a case of evolution in action for the vaccine deniers. Of course, if there is no vaccine, it will still be evolution in action, but only those with a naturally occurring immunity will win the evolutionary lottery.

@MI - it is only a matter of time. There have been a series of troubling outbreaks in Asia and Australia that show diseases beginning to make the jump from animals to humans....luckily, these outbreaks (mostly linked to Bats) have been limited in scope, but also with very high mortality rates.

Unfortunately, these conspiracy nuts will never be satisfied or understand even basic biology, epidemiology or all of the other research into this area of disease emergence and spread.

People don't seem to realize that HIV emerged in just the past 50 years and has killed more than 40 million people.....and the next pandemic disease could be right around the corner.

Perhaps dreaming** up conspiracy theories about Ebola will distract anti-vaxxers away from new studies like this:

K.Chawarska et al at Yale Medical School found that 20% of younger siblings of children diagnosed with autism would be diagnosed themselves as well by age 3. 57% exhibit symptoms by 18 months whilst others appear to be relatively asymptomatic. The study looked at communication, social indicators and repetition. A small percent displayed eye contact but had other symptoms. Thus different combinations emerge at different ages.

And can account for the tales we read from sources like the usually suspected ones. Also there may be a pool of un/ under vaccinated younger siblings with autism. ( see Stagliano and possibly Jameson)

** and dreaming is free.

Yes, it is striking that many conspiracy theories require either an extremely specific degree of foresight, or access to a time machine, on the part of the alleged perpetrators.

Ebola has been known since the 1970s, and its close relative Marburg since the 1960s, although both were probably around a few decades before that. (Relative to Lawrence's point about HIV, I understand its origins have recently been traced back to the 1920s, although the disease it causes was not identified until the early 1980s.) What was different about this Ebola outbreak compared to earlier outbreaks is that this one managed to reach a major population center, and spread from there. But it can be dealt with, as Nigeria and Senegal are demonstrating. Is the US health system at least as good as what Nigeria and Senegal have? I'd like to think so--we do have more resources available--but that idea will be put to the test here. Notably, the three known cases so far of people contracting Ebola outside Africa have been the two in Texas, where ideological opposition to government spending is exceptionally strong, and one in Spain, where cuts imposed due to austerity measures resulting from the 2008 financial crisis have arguably reduced their ability to deal with viral infections like Ebola. These policies may well prove penny-wise, pound-foolish.

If anybody is starting to feel a little queasy/nervous everytime a family member or aquaintance pops by with some yummy Cracker Barrel left overs, or maybe just a little pendantic for the hell of it, then they might encourage their kids to do this preparation as an elected chemistry lab exersize...

Two teams of chemists are now burnishing silver’s status. They have independently developed methods to make robust silver nanoparticles on a large scale — and have worked out what makes them stable.

Bigioni’s recipe mixes one of the cheapest silver salts — silver nitrate — with other inexpensive reagents in water and ethanol. The simple, reliable method gives yields higher than 95%, ... “It’s very different from any other nanoparticle synthesis I’ve ever encountered,” says Bigioni. “This is something a high-school student could do.” The procedure is described this week in Nature.

Bigioni and Zheng's procedures made only particles with 44 metal atoms, no more or less ... it would also make the properties and quality of the particles much more predictable, easing the path to regulatory approval for any biomedical uses of the particles, such as delivering antibiotic silver atoms to a microbe.

http://nature.com/news/easy-route-to-stable-silver-nanoparticles-1.13681

http://www.nature.com/nature/journal/v501/n7467/full/nature12523.html

Besides, a toddler's security blanket doesn't usually cause any harm or make him turn blue unless he eats enough of it or it's rayon/dacron/nylon and he played muslim terrorist with it a little too tight for too long.

@Eric - prior to the current outbreak, researchers in Africa have been tracking the spread of Ebola through the primate population - primarily gorillas, where it has been devastating & cut a wide swath through the regional groups....it was only a matter of time before Ebola got a foothold in a larger human population (i.e. moved from rural to urban centers) - not to mention the fallout of all of the other diseases that are now basically untreated because of the resources all being dedicated to Ebola control and containment right now.

Again, the anti-vax cranks and conspiracy nuts will look at any and all available evidence only through their own "conspiracy-colored glasses" and never really believe that this is anything more than a man-made outbreak or that governments are actively encouraging the spread for some nefarious (though usually unstated) purpose.

As to the current challenges we are facing here - in the treatment of Ebola patients in our own hospitals - this is really the first time the vast majority of our medical professionals have had direct contact with a pathogen like this. I would expect, even in ideal circumstances, that mistakes will be made or whatever protocols are issued might not cover all situations that the nurses / doctors are faced with.

The CDC & local hospitals need to do a better job - but given the circumstances they aren't doing too badly either.

"How is it we suddenly have an Ebola “outbreak” and it is coming to the USA too?
The Ebola outbreak is quite a coincidence – senior CDC scientist Dr Thompson has been talking with Dr Hooker for 10 months about the CDC knowing the MMR vaccine causes autism. The Ebola “problem” was introduced gently to the US public earlier in the year."

The Ebola "problem" has been going on a lot longer than that, but the US media couldn't be bothered as long as it seemed like it was just gonna do the usual thing of wiping out a few African villages. I don't think antivaxxers are generally racist, but thigns like this certainly reveal just how little interest they genuinely have in events beyond the borders of the US.

@Calli - they are firm believers in "First World Problems" as opposed to caring about what happens to kids in Africa or Asia....unless, of course, they can blame whatever is going on, on vaccines - then they care (sort of).

Although I'm not a medical person, I know about Ebola and Marburg for well over 20 years via general news reports and through education relevant to employment concerning hiv+ people because of the origins/ emergence of all of these viruses.

On the vaccine front, a group called Children of God for Life has gotten huffy because of "fast tracking" of Ebola vaccine that is using "aborted fetal cells."

For those interested in learning more about Ebola & other emerging diseases, I would recommend:

http://www.amazon.com/Spillover-Animal-Infections-Human-Pandemic/dp/148…

Pretty scary, but informative reading...less sensationalized than the Hot Zone was & goes deeper in the facts.

Hey Orac, pretty sure you are a national treasure.

Don't forget what commenters at Natural News "know" is true: If you get the Ebola vaccine, you will get Ebola!

Rappaport (and Adams et al): "With healthy and strong immune systems, the germs would have no significant effect. " My knee-jerk reaction is always: Prove it. Get yourselves over to the hospital and help take care of the Ebola patients.

@lsm - if they are so sure of their "immunity" and ability to fight off disease, then they are doing a public disservice by not volunteering to take care of those who are sick.....

It's deeply offensive that anyone would think that "they" would engineer a pandemic, killing thousands of people and leaving thousands of children as orphans, in order to "cover up" any sort of bureaucratic scandal. There are a hundred things wrong with the current Ebola outbreak and the international response and lack of preparedness for it, but vaccine cover up ain't one of them.

@Tim

The problem with impregnanted textiles - the release of the NPs during washing - and they do get released - which leaves the antibacterial/antimicrobial properties of the blanket in question after the first wash (and will release the NPs to the aquatic environment).

Also, there is limited data to support ingestion of silver for its antibacterial/antimicrobial properties. There's also a lack of data for the excretion of AgNPs from the body.

We know that the size of the NP is inversely proportional to its uptake - meaning the smaller particles are taken up more efficiently. They are small enough to be taken up into the body's cells by simple diffusion, and also by active transport (in place of Na+ cations).

Once the NPs enter the cell, they produce ROS which normally leads to apoptosis. There's evidence of uptake in the liver, kidneys, heart, lungs and brain. Nanosilver also gives a positive modified AMES test, and is toxic to germ cell lines.

Darwy,

The test serves as a quick and convenient assay to estimate the carcinogenic potential of a compound because standard carcinogen assays on mice and rats are time-consuming (taking two to three years to complete) and expensive. However, false-positives and false-negatives are known.

http://en.wikipedia.org/wiki/Ames_test

If the 'blue man group' starts developing tumors I'd still probably suspect Corexit-tainted army {more than two} things first...

It is too much to hope that the vaccines would be highly efficient and allow us enough leeway in regards to herd immunity to accommodate all those uncomfortable with taking it.

False positives and false-negatives are known for a number of tests.

Given that there's positive modified AMES test, mouse micronucleus (MN) assay, Pig-a assay and Comet assay, cytochalasin B-blocked micronucleus assay, all which indicate genotixicity...

I think there's enough evidence there that ingesting nanosilver is a bad idea.

Thus, we seem not to have, for example, something along the lines of multiple bites of humans by supposedly Guinea variant Ebola infected fruit bats.

I'm pretty sure that attacks by flying frugivores could have just been ruled out a priori.

The Rowan Farrow piece was interesting. I am disheartened by the dusting off of the "vaccines debate" meme (or to keep it current, '#vaccinesdebate'), though.

The mystery at the heart of the ebola outbreak is how the 1995 Zaire (ZEBOV) strain, which originated in Central Africa some 4,000 km to the east in Congolese (Zairean) provinces of Central Africa, managed to suddenly resurface now a decade later in Guinea, West Africa.

Yah, that's a stumper, Shimatsu.

Oh, wait.

Denice @15: There is even a book on the subject, The Hot Zone, which was aimed at a popular audience and published in the early 1990s (or maybe as early as 1989--I don't have my copy handy). I bought my copy at a secondhand bookstore in either 1995 or 1996, and have read it at least twice. So that information has been available to civilians for more than 20 years.

The point of The Hot Zone is that this is not the first time we have seen Ebola infections in the United States. The book is centered on an outbreak that occurred in an imported monkey warehouse in Reston, VA, in the late 1980s. The Reston variant of Ebola was believed at the time to have been capable of airborne propagation, though I understand this conclusion is now disputed. One or two human employees at this warehouse actually became infected with Ebola Reston. Luckily for everyone involved, the mutations which distinguish the Reston strain from the other two strains of Ebola that were known at the time rendered the Reston strain incapable of causing anything worse than a cold in humans, though it was fatal to all of the monkeys involved.

The variant responsible for the current outbreak is, unfortunately, "real" Ebola and not Reston. But it's not even true that the two nurses in Dallas were the first to contract Ebola in the United States.

The variant responsible for the current outbreak is, unfortunately, “real” Ebola and not Reston. But it’s not even true that the two nurses in Dallas were the first to contract Ebola in the United States.

For all intents and purposes, it is true. Reston virus (from the Philippines) is in the genus, but it's not EBOV.

@AllieP #21: re "they" coordinate--

All that, of course, assumes massively more competence in a group of highly disparate organizations' ability to coordinate things than even approaches reality. The US military has come a long ways in interoperability amongst the services and even with some NGOs, but they at least have the major incentive and opportunity to practice. Even still there are multiple areas to screw that sort of thing up in the most mundane of matters like comms, terminology, and the like. And these are groups with similar structures and are English speaking...the complexity is boggling even at the level of things like tsunami relief! Conspiracy indeed. It's a combo of Murphy's law on steroids plus "the best laid plans of mice and men" all tumbled together with a bunch of other cats and dogs. It's ludicrous, it is--couldn't happen even if "they" wanted it to.

Take 4 minutes and hear what Shep Smith of Fox News said yesterday http://mashable.com/2014/10/15/fox-news-shep-smith-ebola/ . And read the following as well: The tag #FactsNotFear is being used by many media sites to promote this fact filled article. http://www.cdc.gov/vhf/ebola/pdf/infographic.pdf Ebola: #FactsNotFear http://on.wkyc.com/1xQ3cOj How quickly Ebola spreads compared to other diseases http://wapo.st/ebola-spread via Post Graphics

Yeah I work in PH and it has been non-stop Ebola panic and fighting to get some kind of guidelines out all week. I do find it personally offensive when some of these nuts make the case that essentially the entire field of PH is complicit in murdering/maiming small children. The depth of the conspiracy theories is shocking and to whoever upthread (sorry but I am headed out door and don't want to look) a nod towards your comment about a time machine. Either a breathtaking number of people have to be 'in on it' or the government has access to a true precognitive (and if that was the case why don't they just get the PowerBall numbers and retire rich) or a time machine. The fear surrounding this illness makes it difficult to have reason penetrate the shell. Hopefully TX will have its act together and we won't have any more cases.

After careful thought, if something happened and - LO! - there were an approved Ebola vaccine available tomorrow, I would not sign up for it. Of course, it probably wouldn't be available to me since I don't live in an area where Ebola is endemic, I am not planning to travel to such an area, and I don't work in a field where I am likely to come into contact with someone who is sick with Ebola. My expectation would be that at first the supplies would be reserved for the people in those 3 categories.

After that, we'd see.

LW -

Either there was a single initial case or there were multiple initial cases.

But what if it's quantum?

This is a test - I tried posting with the phrase "it depends on whether the wave function has collapsed" and the message vanished mysteriously (much like my door knocker). I thought this was a better punch line than "quantum".

from one of Colorado's newly registered not-a-doctor's, "ummm...ebola is a VIRUS! Why aren't hospitals willing to use a well-proven anti-viral just because it is a vitamin and not a drug??? The is plenty of research out there about IVC being used to cure polio in the 1940's...very frustrating when there is an obvious treatment that gets ignored because it is not a new expensive drug…ugggh!"

This video was posted on a thread over on Mothering.com called "Ebola hoax busted"

https://www.youtube.com/watch?v=1ZonCVRQ-2s#t=397

They seem to think this is pretty convincing evidence.

And the latest news picture that shows a man with a clip board not in any kind of protective gear helping transport one of the nurses to an airplane is also considered further evidence that this whole this is a scam and hoax by the anti-vaccine nuts on Mothering.

@Tim #11,

Treasure it:
http://www.youtube.com/watch?v=Wb_m9-3bI1U

No wave functions terminate on the brains of anti-vaxxers.

If we're going Quantum, Mephistopheles O'Brien (and I'd rather not right now), then --

Road construction ahead...Get in both lanes

matters like comms, terminology, and the like. ...

Well said, brewandferment #31. Of course, I read it as 'commas' and thought you a grammar nazi what can't see the meaning for the words... but only for a few cycles *grins*

Pictorial proof that the Mainstream Medea is poisoning you:
http://upload.wikimedia.org/wikipedia/commons/3/3f/Medea-Sandys.jpg

^^ I'm sure the dude in that picture did not have breast cancer... he's a liar....

Kiiri -- me too. Some idiot posted a Facebook rumor this morning that we had an active Ebola case in our jurisdiction and we spent nearly the entire day doing rumor control.

The only silver lining to this cloud is that I racked up five hours of overtime.

This video was posted on a thread over on Mothering.com called “Ebola hoax busted”

This one's good:

"Once upon a time (no wait, that is pretty much every day) a skeptic site says something vile - like, I don't know, 'anti-vaxxers masturbate over dead babies.' That, for the record, is an actual quote."

The only other relevant time that G—le has heard about this is from the same commenter. Even better, though, is that Beckybird actually links to the "We've Got to Save 'Dr.' Megan by Posting All of Her Personal Information" mother ship, Jimstonefreelance.

^ Dammit. There are two links in there.

@Narad,

What is the “We’ve Got to Save ‘Dr.’ Megan by Posting All of Her Personal Information” link you're talking about?

Blimey. The amount of contortion these conspiracy peeps get themselves into is worthy of a Cirque du Soleil act.

What is the “We’ve Got to Save ‘Dr.’ Megan by Posting All of Her Personal Information” link you’re talking about?

If you insist. The budgetcamerareview-dot-com thread has been scrubbed (cf. this), but it unfolds here. The Jim Stone cranks come to the fore some 20+ pages in.

Narad, thanks for the links. I'll have to take a look another day when I have time.

It couldn't be a real Ebola conspiracy without Dr. Rima Laibow. The FDA, the FTC and CBS TV News are is looking for Rima and she is unavailable:

http://newyork.cbslocal.com/2014/10/10/experts-scammers-are-exploiting-…

This is apt

http://www.newyorker.com/humor/borowitz-report/fear-ebola-outbreak-make…

Speaking of the New Yorker, is it just me, or is outdenting block quotations a new low in their collection of dopey affectations?

You know there's panic and conspiracy theories abounding in the US when they make the goddamned news in another country.

I was treated to about 20 minutes of discussion in the local news here about the widespread panic, etc in the US. Then they discussed one of the Doctors without Borders who was currently in isolation in a negative pressure room at the hospital about 10 minutes from me, with Ebola like symptoms.

(He tested negative)

Just when we thought it couldn't get any sillier, they throw this into the mix:http://www.mtlblog.com/2014/10/smoking-marijuana-can-protect-you-from-e…

I would love to see a critique if anyone has one, and more than that would love to see the guy behind this go fight Ebola in Africa armed only with a bag of nails and a donkey laden with shatter, or whatever it is they're smoking this week?

Annie, if you're looking for the tl;dr version of the 'Saving "Dr." Megan' affair, it's encapsulated here.

I was talking to someone only last night whose daughter's best friend is antivax and also thinks ebola is a conspiracy. The depressing part is they have a young baby and they're traveling to Nigeria soon. While the odds of getting ebola are probably very slight, there are other diseases like yellow fever, typhoid etc. which are far more common. This aggressive stupidity and willful endangerment of their child really angers me.

@Adam: And have these people checked entry requirements for the country or countries they plan to visit? Most tropical countries require proof of vaccination against yellow fever for travelers coming via countries where yellow fever is endemic, and some require it of all travelers. The only exceptions are people who can document, with a doctor's note (translated into the local language if necessary), a medical contraindication to the vaccine.

Many of these countries have recent experience with vaccine preventable diseases, so the sort of anti-vax stuff we see in the US and Europe will not carry any weight in most of the Third World.

Our former governor and Libertarian candidate for president, now medical marijuana businessman, suggested its use again.

But, he backed off from claiming it is a cure.

http://krqe.com/2014/10/14/former-governor-comments-on-ebola-and-mariju…

I just saw a segment on Ebola scare nonsense on the Rachel Maddow Show: Republican representatives and Fox News reporters are worried about terrorists with Ebola crossing the country's porous borders. A URL squatter is trying to sell 'ebola.com' to the highest bidder, starting at 6 figures. You can get 'protective' yellow garments from $99 (and up) at ebolasuits.com. Gizmodo ran a story on "6 Fake Ebola Cures Being Peddled Online" with Rima Laiblow's Nano Silver in the #1 spot.

The screen behind Maddow shows Laiblow, then cuts to Rand Paul. This has all been an intro to Maddow taking down Paul for a recent speech in which he claimed Ebola is "incredibly contagious" and could be contracted by talking to someone at a cocktail party, and in which he accused the White House and CDC of covering up the true danger of the virus.

This guy is the leading contender for the Republican Presidential nomination in 2016.

You should watch the clip, as Maddow is in high form, but here's the summation for those who want a quick take:

After Maddow notes that the AP report of Paul's speech indicated his "comments directly conflict with statements from world health authorities who have dealt with Ebola outbreaks since 1976" she goes on to discuss the fact that his 'board certification' in Opthalmalogy comes not from the actual Opthalmalogy Board, but from an 'organization' he founded with himself as president and his wife and father-in-law as officers.

[with dripping sarcasm] Trust Rand Paul when it comes to things like Ebola. Don't trust 'them'! Don't trust the authorities. Trust him. He's a doctor! Kind of.[end sarcasm]
...There's a real need right now for us to have a sober national dialogue. We are having some of that, but we are also having people trying to cash in on it, and people using their positions of authority not to contribute meaningfully to the dialogue, but instead to recklessly make stuff up. Making stuff up hoping it might freak people out more than they already are, even though what he's saying is sourced entirely from deep files and research he surely maintains on the subject at his homemade doctor group that he and his wife founded in a P.O. Box at a UPS Store down the block in Kentucky. Literally. It's one thing to try to profit off people dying from a deadly disease, it's another to exploit people's fears to try to profit off pretending to address those fears -- it is whole nother thing entirely to be in a position of authority and to stoke your own authority on the issue, while stoking fears, while seeking to profit from those fears, while you have no idea what you're talking about, but people think you might.

Man, I glanced at the AoA comments. When Cia Parker is the voice of reason, you've got a serious infestation of crazy on your hands.

See my comment about Rima Laibow here:

http://scienceblogs.com/insolence/2014/10/16/just-like-for-h1n1-the-ebo…

Rima is married to Bert Stubblevine and they qualify for this encyclopedia entry:

http://americanloons.blogspot.com/2013/01/378-albert-stubblebine-rima-l…

Man, I glanced at the AoA comments. When Cia Parker is the voice of reason, you’ve got a serious infestation of crazy on your hands.

It gets worse. The poster Serious Investigative Reporting needed has bought hook, line and sinker 5 6 different conspiracy theories in one post.

Which AoA post are you guys referring to?

I'd love to see this.

Which AoA post are you guys referring to?

I’d love to see this.

No you don't

Don't say I didn't warn you. The stupid it burns.

1,400,000 Googlehits for "ebola" + "zionist".

Oh Please. Spare me any more comments from CIA Parker, who is a known pathological liar, who blames her child's ASD diagnoses on the snap diagnosis she made about her newborn's encephalitic cry....yet never took her baby immediately to a hospital emergency room for a neurological examination.

She's already informed us that (if you can believe anything she states) that she herself has an ASD diagnosis, has multiple family members who have varying degrees of developmental disabilities including ASDs and severe intellectual impairments, has a gene mutation commonly found to cause ASDS, was old (44 years of age) when she delivered her only child, never went to genetic counseling before conception, had an emergency C-section due to fetal distress (a true knot in her child's umbilical cord)...and yet...in spite of these facts....her infant survived.

Parker claims that a Td booster given to her in college, caused her own MS...which was diagnosed more than ten years after receipt of the that Td booster, which prevents her from holding down a full time job. Yet, there she is posting hundreds of comments around the clock, spreading her lies, when she goes on her all-too-frequent commenting sprees...while she neglects her teen age special needs child.

Parker is still convinced that peanut products/peanut oils were used in the manufacture of vaccines licensed in the United States....in spite of the many citations that have been provided to her, but multiple sources, she uses homeopathic "medicine" on herself and her hapless child and wants her child to contract "natural measles".

There is something or many things radically wrong with this woman and her thinking processes as well as her delusional thoughts she clings to; my guess is that she has a personality disorder (narcissistic type), which is common as dirt within the general population and which is a danger to her child, who is defenseless against the onslaught of Parker's dangerous "belief system".

P.S. she has been banned from multiple science blog, including the Shot of Prevention blog, because she resorts to using hundreds of sock puppets....yes she's that desperate to be heard.

BTW, Parker doesn't dare come to RI to posts comments, because I and a number of the RI regulars, are well aware of her stunts and the delusions that are her make believe world.

No you don’t

Oh, c'mon:

"I'm thinking Liberia likely has strategic and/or resource value that some want to use the U.S. military to obtain/secure."

It reminds me of this bit of sharp thinking:

"According to Think Progress [heh], this number represents 'nearly two-thirds of AFRICOM’s 4,800 assigned personnel' who will coordinate with civilian organizations to distribute supplies and construct up to 17 treatment centers."

In other news, 3000 represents nearly two-thirds of 4800 unrelated anything, such as AFRICOM's assigned personnel. I could swear that the first version of this that I saw insinuated that it was really about tactical information gathering (for when the U.S. comes to reclaim the property usurped by the American Colonization Society, or something), but it's hardly worth the effort to excavate.

Has this bit of dot-connecting been covered?

Sooooooooo.... as far back as 2004, geogie porgie set up the "Ebola" play. Nice eh? Spread the info around my friends!

From the Annals of Self-Parody: Alex Jones starts a White House petition for a general strike to get the White House to reverse its policy on West African flights.

^ Or his chief lackey, none other than Hipster Patrick McGoohan.

Back at AoA there is a new bidder to replace Jake in the 6, 66 or 666 degrees of separation identification.

A quick google search shows Klains' wife Monica is a lawyer for National Geographic.

Ah ha. That explains everything.

Ah ha. That explains everything.

This is a nice touch:

"One minute I'm afraid we live under the fourth Reich, and the next, the USSA (maybe it's both) and not enough are concerned enough, but I guess we could have gotten an IACC-like committee instead."

Yah. THE CHAIR IS AGAINST THE WALL.

https://www.youtube.com/watch?v=-WcrYUdzjFc

Or his chief lackey, none other than Hipster Patrick McGoohan.

That's weird. I have fond memories of running down that beach* aged about 15, though I wasn't chased by a huge balloon, resulting in a mixture of relief and disappointment..

* It's Portmeirion in Wales, which is worth a visit for Prisoner fans, and/or odd architecture aficionados, if you happen to be in the area.

the White House to reverse its policy on West African flights

Does the Executive branch have powers to arbitrarily curtail commerce in that way? My impression was that the Commerce clause makes it a Congressional responsibility.

Does the Executive branch have powers to arbitrarily curtail commerce in that way? My impression was that the Commerce clause makes it a Congressional responsibility.

The FAA is within the executive branch, and Congress has granted it rulemaking authority. I'm not going to investigate the details of its powers just now, but I'm guessing that they're broad enough.

Thanks.

The folks over at AoA are going into overdrive today building a new "enemies" list - those individuals who they want to line up for any experimental Ebola vaccine.....

And poor Jake, looks like he's finally managed to alienate what few allies he had left (re: his most recent post about Hooker praising Wakefield).....

As near as I can tell, Jake hasn't yet alienated Papa Doc and Baby (not) Doc Geier, and the White Rose loon. Also maybe not the Barry commenter. I figure that his list of 'not enemies' has to be getting very short these days.

A quick question, Lawrence - are all the comments at Jake's place moderated? After all the comments you've made, do you have to wait to see your post come up, or is it more or less automatic? The traffic there seems very 'bursty', almost as if Jake approves everything. On the other hand, he doesn't seem to be filtering out people who seem to very much disagree with him. I guess this would make him an honest nutter.

@Johnny - Jake does "moderate" all posts, though he's admitted that he's only deleted very few (I believe a couple of John Best's posts were too much, even for Jake).

I still get "in moderation" every time I write, so yes - he approves them when he gets to them.

Looks like Jake has crossed the "woo-bicon" when it comes to both Hooker & Wakefield....I doubt either one of them will ever cooperate (or converse) with him again after this most recent fiasco.

His list of "friends" must be incredibly short at this point.

Lawrence, you and the 'other guy' ( & diverse SB folk) should be congratulated for your appearances and ability to tolerate great loads of nonsense, conspiracy peddling and obfuscation.
Jake is really and truly a piece of work.

@Denise - he is certainly well & truly "off the reservation."

Swine flu was a total hoax though.

@John - it was a real disease & people got sick....how exactly is that a "hoax?"

Swine flu was a total hoax though.

It was? I want the time I spent sick in bed back.

Always with this colloidal silver/nano silver bullshit!!!

At very best it is a fairly weak anti-microbial. You gain surface area by grinding it in to so called 'nano particles' but there is no evidence at all to show this increases its effectiveness. And certainly not against ebolavirus!

It is one of those intellectual exercises where it sounds like it SHOULD work, if you discount the sliding scale of everything else that is going on in the body. I think that may be one of the primary problems that scammers do not understand; how the fact the response to a dose is not linear but - sometimes HUGELY - negatively exponential.

Hey Nigeria is now declared Ebola free and they don't have a vaccine. They just made everyone stay at home. I suppose the CDC can't market that, bad for shareholders.

Last year there wasn't a pandemic, all the MD's I know were told to stop testing after a few weeks of the bullshit reporting because most of the tests were negative for H1n1 or whatever you want to call it.

How come the CDC has a patent on the Ebola virus? Conspiracies don't exist David, it's all about marketing and the confidence ask Gok Wan.

Hey Nigeria is now declared Ebola free and they don’t have a vaccine. They just made everyone stay at home. I suppose the CDC can’t market that, bad for shareholders.

Note that Goofus' sneering assumes that every nation on Earth has a strong government which gets enough cooperation from its citizenry that it can apply "hey, everybody, stay home" as a public health measure.

If you admit that there are places like Liberia and Sierra Leone where there just isn't the infrastructure to make such a strategy successful as the only way to fight a disease, then it becomes obvious that we do need to have a vaccine in our arsenal if we're going to bring the disease under control worldwide.

As for the CDC's "patents on Ebola", which cover only one strain, the simplest explanation is that our patent system is really messed up. In a sane world, the last thing you'd have to worry about, if you were a scientist trying to cure a disease as nasty as Ebola, would be some psychopath saying "Haha, I have a patent on the idea of an Ebola vaccine! You can't go ahead and find that cure unless you pay to use my patent!!" But while we have a patent system which allows people to make ridiculously overbroad patent claims, and presumes the validity of any issued patent, it makes perfect sense to take out patents simply to make sure others won't interfere with you. Are "defensive patents" yet another aspect of the world that Goofus is completely unaware of, just like Liberia's troubled history?

Do you think that model would work in an industrialized first world country - to make 'everyone' stay at home? I personally would first of all not worry too much agout it anyway as I don't plan to exchange fluids with an ebola patient. Secondly, when a vaccine does becomes available I will happily have that toxic stew of nanontechnology and mercury injected in to my arm. At which point I would revel in all the bodily fluids I wanted. Problem solved.

As for the CDC's 'patent on ebolavirus'... Come on chum... They have it in order to PREVENT biotech companies from issuing hostile, gouging patents of their own that would stifle innovation and narrow the field of research. The CDC in comparison allows anyone who wants to seriously study the virus to do so without worrying about licensing fees or infringing the rights of a rival company.

But you know this already.

Damn - beat me to it Antaeus!!! Nicely said though, nicely said.

How come the CDC has a patent on the Ebola virus?

Apparently, because you're too stupid to even understand the patent, which doesn't cover EBOV in the first place and is, in any event, void as to the natural sequences.

Johnny not Hill: "Hey Nigeria is now declared Ebola free and they don’t have a vaccine. They just made everyone stay at home. I suppose the CDC can’t market that, bad for shareholders."

The reason was that there was exactly one index case: a person who entered with Ebola from a neighboring African country. Most of the people he infected were the medical persons who treated him, and who worked very hard to keep him in the hospital so he would not infect others.

One particular doctor was quick in discovering that the patient she was treating had Ebola, and she unfortunately died:
http://www.bbc.com/news/world-africa-29696011

The reason was that there was exactly one index case: a person who entered with Ebola from a neighboring African country.

Well, I wouldn't describe Nigeria as neighboring Liberia, but Lagos and Port Harcourt are different kettles of fish from Meliandou.

Oh, look, Phildo had yummy in his tummy over Lew Rockwell just a few days ago. Anyway,

Last year there wasn’t a pandemic, all the MD’s I know were told to stop testing after a few weeks of the bullshіt reporting because most of the tests were negative for H1n1 or whatever you want to call it.

This is a pretty severe step down from Borges' Nueva refutación del tiempo.

Yes, Narad. Sorry about the "neighboring" bit. I am a bit sleep deprived and could not mentally conjure up a map of Africa. The guy did fly there, and apparently Liberia accused the hospital of kidnapping him because they refused to let him leave.

Ok, what about the story published by Liberia's leading newspaper which accused the United States military of developing Ebola (and HIV) and named names pertaining to the government and military agencies involved? Why do Africans distrust the Red Cross and other 'aid' orgs and NGO's enough to attack them even murder them? I have no answers just questions. There's so much BS to sift through from every direction as usual. This certainly isn't being lost on the opportunistic politicians who won't let a good tragedy go to waste.

I thought it was HUGE to see that Liberian news article accusing our military. It warrants investigation.

I suppose the author of this above debunking also believes that humans are always benevolent, especially those humans in positions of power. They would NEVER conspire against anyone in the name of personal gain now would they? Pharmaceutical companies only have our best interests in mind, ALWAYS, same with all government personnel, agencies and so forth. In fact, most humans want to do the right thing by each other, and the planet. People cannot be bought or be deceptive, the only people who are critical thinkers are those people who do not believe that other humans conspire against other humans.

Right, LOL?

I suppose the author of this above debunking also believes that humans are always benevolent, especially those humans in positions of power. They would NEVER conspire against anyone in the name of personal gain now would they? Pharmaceutical companies only have our best interests in mind, ALWAYS, same with all government personnel, agencies and so forth. In fact, most humans want to do the right thing by each other, and the planet. People cannot be bought or be deceptive, the only people who are critical thinkers are those people who do not believe that other humans conspire against other humans.

All you've demonstrated with your "supposing" is your own logical failings. There are more options in the world between "my conspiracy theory is true" and "all humans in the world are benevolent"; you've done nothing by knocking down that strawman except torpedo your own credibility. And in a nation with the terrible history of dictatorial and corrupt governments that Liberia has, there are certainly other explanations for "someone believes a conspiracy theory" other than "that conspiracy theory is true".

I have no answers just questions.

How about coming back when you do have answers?

Ok, what about the story published by Liberia’s leading newspaper which accused the United States military of developing Ebola (and HIV) and named names pertaining to the government and military agencies involved?

What about it? Are the statements in the story substantiated? Was it a news story or an opinion piece? What is the reputation for honesty for that paper (honest question, as I don't know)?

Why do Africans distrust the Red Cross and other ‘aid’ orgs and NGO’s enough to attack them even murder them?

Often it's because the people who are doing the murder are various forms of criminal, rebel, or pirate. Sometimes it is because they have been grossly misinformed. The vast majority of Africans do not murder representatives from aid agencies; if you have evidence that this mistrust and muder is widespread, please share.

There’s so much BS to sift through from every direction as usual.

I was going to comment on this, but ...

This certainly isn’t being lost on the opportunistic politicians who won’t let a good tragedy go to waste.

Possibly so, I see no reason why various people won't try to use this for their own perceived best advantage. But then, people use traffic accidents and shark attacks for the same purpose, so there you go.

The actual article in question is quite entertaining. The author's citations include barmy dentist Len Horowitz, a science fiction novel, and equally barmy Jon Rappaport. He claims, without a shred of evidence, that Tekmira, a Canadian pharmaceutical company, has been "injecting and infusing healthy humans with the deadly Ebola virus".

There's a good take-down of the article here.

Wow, when even a site as interesting as breitbart.com says you're wacko...

Re: distrust

One thing I left off is that certain African people have reason to distrust some foreigners, given the history of colonialism. That said, I'm still looking for evidence that there is a general distrust of aid workers who work for NGOs.

'I'm just asking questions...'

Original.

On the subject of conspiracy theorists, I have just been reading "The Flaxborough Crab". In one scene, the loveable grifter Lucinda Teatime is writing a bulletin to send to the customers of her Herbal Virility scam:

Miss Teatime withdrew the sheet from the machine and carefully read it through. From time to time she nodded to herself. Plenty of capital letters. Excellent. Devotion to upper case, she had noticed, was one of the more consistent characteristics of Life Force enthusiasts.

http://www.telegraphindia.com/1120116/jsp/frontpage/story_15011108.jsp#…

Never mind the girls who are being harmed by the HPV vaccine. Your kid is ok one minute- they get a vaccine and the next day they are dead. But hey, it WASNT the vaccine!

Never mind all those parents who have claimed that their kids were fine before vaccines but were hurt, or worse dead immediately after vaccinations.

It happens. Do deny that people are harmed by vaccines is irresponsible.

If it happens to happen to you, you are screwed. You'll just be collateral damage. Like the kids in India who developed polio from the vaccine.

How would you like your life to be reasoned away as justifiable collateral damage?

Do you people just see in black and white? Assumptions have been made about my first post here. Can we not ask questions without you pulling out the tinfoil hats? Frankly, you anti conspiracy people come across as equally irrational and zealous as the people who are full throttle against vaccines.

I think it is very healthy to question what is going into our bodies, whether it's food, medicine or information we could be talking about. It makes more sense to me for people to be protective and empowered over their own bodies minds and lives rather than to blindly allow ANYONE or any institution all access. Doctors and other health professionals enjoy a certain power and authority which I often find to be arrogant- it is as if they believe they are entitled to this access without being questioned. I wish more health professionals honored their patients as being the highest authority over their bodies.

We aren't 'trained' to be empowered now are we? How many humans even know what's inside their own bodies or how their organs function to begin with? Let alone how to prevent diseases and problems? To nurture prevention would be to nurture empowerment.

This is not exactly a world that nurtures empowerment and awareness now is it? Please don't argue that it is. I've lived here long enough to see the writing on the wall.

Never mind the girls who are being harmed by the HPV vaccine. Your kid is ok one minute- they get a vaccine and the next day they are dead. But hey, it WASNT the vaccine!
Never mind all those parents who have claimed that their kids were fine before vaccines but were hurt, or worse dead immediately after vaccinations.

Sounds like you are making definite claims, and all the flimflam about "just asking questions" is the usual disingenuous bullsh1t.

"Never mind all those parents who have claimed that their kids were fine before vaccines but were hurt, or worse dead immediately after vaccinations."

http://www.voicesforvaccines.org/vaccine-injury-stories-the-sacred-cows…

When vaccines cause harm....no big deal unless you're one of the lucky ones who develop polio

You're really not very good at that "comparative risk" thing, are you? Here, let me help:

"Until [the] early 1990s India was hyperendemic for polio, with an average of 500 to 1000 children getting paralysed daily."

I am happy to let the Indian politicians and health experts work out their own relative risk calculations and decide on their own vaccination policies. It really is not my business.
If Eyes-open person thinks they are Doing It Wrong, perhaps he or she should go and argue with them.

Eyes wide open,
From the article you linked to:

the very vaccine it is using to fight polio is causing more polio paralysis than the wild poliovirus.

That's because the wild polio virus has been eradicated in India, and even a very small number is greater than zero. There were 5 recorded cases of vaccine derived paralytic polio in the whole of India in 2013. This is a measure of the vaccine's success, and means it's time to move to the IPV, if someone can scrape the cash together.

Would you prefer India to go back to the good old days of 1978 when almost 1% of children surveyed in Lucknow suffered from paralytic polio? Or do you have some other alternative?

Minor correction - that Lucknow study was carried out in 1972-4 and published in 1978.

This is a measure of the vaccine’s success, and means it’s time to move to the IPV, if someone can scrape the cash together.

I'd say "start to move," with a mixed IPV/OPV schedule. Continued sewage surveillance is going to be essential.

Uh-oh. Big Rubber is in on it.

In other Ebola news, the Dachelbot cements the fact that AoA is really asshurt over its stealing their "thunder" with "Lawrence Solomon A Voice of Ebola Reason [sic]."

How many humans even know what’s inside their own bodies or how their organs function to begin with?

As a matter of fact, not many.
There are actually quite a number of erroneous ideas floating around.
There is a reason why biologists and physicians take 2-5 years, full time, to learn about human physiology and related fields. It's complicated (see kidney's function - very simple in its concept, deviously intricate in its operation), there are plenty of small details which no-one but a specialist in the field really needs to know (do you know the name of all proteins involved in blood clotting?) and it's gross (who wants to learn about bodily fluids?).

That is not to say a layman shouldn't try to learn about it. On the contrary, I agree that knowledge is power.
But.

If you look inside the archives, our host and most regulars here are perfectly willing to answer specific questions about biology and other matters - with citations you could look up.
But when the same question has been asked 20 times already and the questioner is ignoring our efforts to communicate and obviously just want to profess its beliefs... It's a bit dishonest, isn't it? Excuse us if we are not very welcoming of another JAQ guy.

Which brings me to:

I wish more health professionals honored their patients as being the highest authority over their bodies.

If you are stating that you should have the final decision about what should be going into your body, I would agree with that, within limits (you don't get a similar free pass for your dependents).
If you wish healthcare people would spend more time talking to their patients and explaining what's going on, you are not alone in this. The majority of healthcare specialists may join you on this.
If you are saying that systematically, on all medical matters, you know more about your body than someone who specializes into human medicine... Now, who is arrogant, here?

I enjoy this site....all MUST read a factual book that gives all the crap about virus/vaccines....research in America...and the corrupted "science" still continues today....ie...follow the dollar....the two factual books are..."Mary"s Monkey>>>and "The Hot Zone"...Read Mary's Monkey very carefully and understand the time frame....jet it all forward to todays medical events (and the last 40 years)...IS THERE A PURE VACCINE???WHAT VIRUS S HAVE NOT BEEN REMOVED....PRAY FOR PLANET EARTH...

" But while we have a patent system which allows people to make ridiculously overbroad patent claims, and presumes the validity of any issued patent, it makes perfect sense to take out patents simply to make sure others won’t interfere with you." Anus feldspar

Hey, I thought the world of science was coming together with some kind of humanitarian gesture, so I get it, the idea is to say " I have patented the disease so you can't fix it only me?" or have I got that wrong?

"There are more options in the world between “my conspiracy theory is true” " Anus rock

Well I suppose all vaccines save lives is a good conspiracy too, I mean that's some wazzed up believe system you got there. Most medics can't even recognise someone whose healthy let alone make a proper diagnosis. So how many people dying in the Ebola zone are actually 'tested' confirmed cases? Don't want to upset that patent do we?

I see MyNewOrleans.com describes Dr Mary's Monkey as "required reading for conspiracy lovers".

http://www.myneworleans.com/New-Orleans-Magazine/July-2007/Dr-Marys-mon…

What other books would you add to that list, Wayne?

Now that "wayne smith" has graced the audience with Haslam's boneheaded conspiracy theory, it seems just as well to note that John Fryer Chemist has managed to connect Ebola to some sort of conspiracy to give the electron an integral charge.

Just for reference purposes, a friend linked to this article.
http://www.livescience.com/48386-deadliest-viruses-on-earth.html

Johnny, etc: "Well I suppose all vaccines save lives is a good conspiracy too, I mean that’s some wazzed up believe system you got there"

Why would that be a conspiracy? Why is it better to get measles than prevent it?

"So how many people dying in the Ebola zone are actually ‘tested’ confirmed cases?"

Why don't you just fly over to one of those areas and help them out. You are obviously much smarter than any of those silly people who went to medical school.

Ok, I'm not reading every comment. But I will say this...your useage of the title "conspiracy theorists" amuses me. Did it ever once occur to you to see where the term originated, by whom, and why? People don't always except what they're told like good little sheep. Some of us question things. Your example of H1N1 shows your lack of knowledge because its been clinically and scientifically proven that the levels of mercury in the vaccine have caused (at that time) young or unborn children (now) to have delayed learning complications ranging from mild to ADHD to Autism. My son was 2 months before birth when I was forced by job to take the vaccine. The nurse even warned me of the potential harm even then! Swine flu was a hoax...not nonexistent, but a way to force inject people and cause paranoia. Was I paranoid? Nope. Am I paranoid about Ebola? Nope. But I'll not receive any vaccines. Why should I? I'm more likely to die of pneumonia than Ebola. But here is my "why" question...perhaps with your "vast" knowledge you can explain it. Ebola was discovered in 1977. New strains since, 5total I believe? But Zaire is not what his strain of 2014 is. The makeup of the viral strands differ, by approximately 25%. Mutated strain of Zaire? Maybe. But remember, there is not just one patent held by the US. Google "Ebola virus patent" and you'll find four pages of different patents and descriptions and which country researched a discovery (UN, China, and Canada, as well as US Dept of Defense). Why? If the reasoning were in fact valid that their research was to find vaccines and antibiotics, why after multiple experiments and playing around with these strains is there NOTHING!? That's 37 years, in case you need help adding. I find it extremely hard to comprehend how in 37 years, the CDC has nothing but stockpiles of test tubes loaded with multiple variants of Ebola, and know nothing.

@Phoenix - perhaps because Ebola, despite its high mortality rate, has not infected that many people compared to most other diseases...which means that is isn't a high-priority disease that gets lots and lots of resources (attention, yes, resources, no).

Just like a true conspiracy theorist - your upset that no vaccine is available & you'd also be upset if a vaccine was available....you get to be pissed both ways.

@Phoenix:

its been clinically and scientifically proven that the levels of mercury in the vaccine have caused (at that time) young or unborn children (now) to have delayed learning complications ranging from mild to ADHD to Autism.

Citation DEFINITELY needed.

Swine flu was a hoax…not nonexistent, but a way to force inject people and cause paranoia. Was I paranoid? Nope.

You sound pretty paranoid to me.

Why? If the reasoning were in fact valid that their research was to find vaccines and antibiotics, why after multiple experiments and playing around with these strains is there NOTHING!? That’s 37 years, in case you need help adding. I find it extremely hard to comprehend how in 37 years, the CDC has nothing but stockpiles of test tubes loaded with multiple variants of Ebola, and know nothing.

It's harder than it looks to create a vaccine. That's why.

Phoenix: there's a corollary to Darwin's Law that says as soon as you use the words "sheep" or "sheeple" in a post you are laughed out of court.

Your example of H1N1 shows your lack of knowledge because its been clinically and scientifically proven that the levels of mercury in the vaccine have caused (at that time) young or unborn children (now) to have delayed learning complications ranging from mild to ADHD to Autism.

Please provide citations for or links to the peer-reviewed journal articles where this scientific and clinical proofmay be found, so we can examine it ourselves.

I’m more likely to die of pneumonia than Ebola.

Absolutely true, but that says nothing about the safety or efficacy of vaccination--in fact, being vaccinated against infectious diseases which can result in your developing pnuemonia (influenza, measles, etc.), will significantly reduce the likelihood you'll die from itnuemonia.

If the reasoning were in fact valid that their research was to find vaccines and antibiotics, why after multiple experiments and playing around with these strains is there NOTHING!?

Because developing a safe and effective vaccine isn't a trivial exercise with a guarantee of short term success. If it were, we'd not only have had rotavirus and human pappiloma virus vaccines far earlier than we did but we wouldn't still be pursuing an effective HIV vaccine. Note taht HIV afects far greater numbers of people worldwide and far greater resources have been allocated to developing a vaccine for HIV, so clearly the inherent difficulty of developing a safe and effective vaccine isn't something that can be addressed just by throwing money and personel at it.

Phoenix: "Swine flu was a hoax…not nonexistent, but a way to force inject people and cause paranoia. Was I paranoid?"

That's an interesting one - vaccines are devised to deliberately induce antivax paranoia. I'm gonna have to contact Merck to alert them to this self-defeating paradigm.

"People don’t always except what they’re told like good little sheep. Some of us question things."

And some keep right on "questioning" even after getting answers that debunk their claims. Maybe Just Asking Questions is a vaccine-induced disease too.

"Ok, I’m not reading every comment."

Good, it's very risky to do that; you might learn something.

But I will say this…your useage of the title “conspiracy theorists” amuses me. Did it ever once occur to you to see where the term originated, by whom, and why?

These questions would have been more helpful if Phoenix had been willing to answer them. Where did the term originate then? Who originated it? Don't leave us in suspense like an inconclusive X-Files episode!

If #138 is in fact a parody of the everything-is-a-lie skepticredulity that permeates the Interweb, then well done Phoenix!

Did CDC ban those airline blankets?

cmonforton — Tue, 28 Jun 2011 07:34:56 +0000

Did CDC ban those airline blankets?

Within 15 minutes of my 6:00 am flight from Austin to Baltimore, I knew it was going to be a long, COLD, 3-hour trip. I'd already turned off the overhhad vents to stop the frigid air from blowing on me, and contorted myself into a ball on my seat trying to stay warm. As I visualized myself lounging in the hot sun, my light slumber was interrupted by a "DING!" coming from some seat ahead of me. Two rows up, a passenger had depressed the flight attendant call button to summon the Southwest Airlines crew member.

"May I get a blanket?" the woman passenger asked.

Like me, she must have felt the airplane was doubling as a meat locker.

" No, we don't have blankets anymore. The CDC made us get rid of them."

I opened one eye to get a glimpse of the person who made that curious remark. It was indeed one of the flight attendants. Unfortunately, she has the story wrong.

During the 2009-2010 influenza season when infectious disease specialists were particularly concerned about the possiblity of an H1N1 pandemic, the Centers for Disease Control and Prevention (CDC) issued "Interim Guidance for Management of Influenza-Like Illness aboard Commercial Aircraft." The document offered a variety of recommendations for controlling the spread of the virus---from discouraging fever-ridden passengers from boarding airplanes, encouraging passengers with symptoms to wear a face mask and dispose of used tissues in a plastic bag, to frequent handwashing and providing sick leave for airline crew----but the word "blanket" doesn't appear anywhere in the document.

The decision to remove the airplane blankets was Southwest Airline's call. A company spokesperson said in June 2009:

"We recently removed blankets and pillows from the aircraft in the last month or so, when the concerns about the swine flu came up. We took them out thinking we would replace them."

The Houston Chronicle's Shannon Buggs reported that the blankets and pillows never made it back into the planes' overhead bins.

"Southwest's accountants are enjoying extra cash on the balance sheet. The savings partly come from quicker cleanups of cabins that allow for faster turnarounds between flights. Plus, linens add weight to the aircraft. Their removal lightens planes' loads, which translates into slightly increased fuel efficiencies. Spread out over the entire fleet, those incremental fuel savings add up."

Buggs indicated that the flight attendants' also supported the change, with their union's spokesperson commenting:

"Those blankets have frequent-flier miles on them, to say the least. A lot of us wear gloves to handle the blankets and pillows because we notice quite a few stains on them."

On my flight, the crew member's response "CDC made us get rid of the blankets" may have simply been misinformed. Or it could be the tendency by some to blame a supposed government regulation when they have to bear news that may not be well received. As I wrote in a post last week, I've heard business owners and others invoked a "that's against OSHA regulations" in situations where there is no such OSHA rule. I guess they think it will be better tolerated than saying "our company has a policy against that."

In the case of the airline blankets, what about:

"we thought those blankets were unsanitary so we don't keep them onboard any more."

For me, the lesson is simple: throw a sweater in my carry-on bag.

cmonforton Tue, 06/28/2011 - 03:34

Tags

Environmental health

infectious diseases

Public Health - General

As someone who takes a sweater almost everywhere, I have a suggestion. Do not put the sweater in your carry-on where it will take up space unless you have room. Instead carry it. Since it is clothing instead of a personal item, it does not incur the limits on carry-ons.

This suggestion also applies to coats. Unless you are checking bags and paying the price to check bags, save the space in your carry-on.

In these days when you better carry everything in the hand baggage, you should put on as much clothes as possible. You can take them off in the plane. I even have a vest with lots of pockets where I can carry all small but heavy little things (like my Moskva 2 camera, which is a pocketable 6x9 thingy, Soviet-made, and almost 60 years old, but still kicks ass). I spent the last New Year on a two week trip to the Dominican Republic, and managed to do it without check-in luggage.

So far the only place where the trick didn't work was in Tonga. All passengers were put on scales with their carry-on baggages, and those exceeding the total weight limit had to pay extra. You will understand the airline company's policy, when you see an average Tongan...

It sounds like something from talk radio or perhaps a rumor that started with the staffers who listen to right wing yakkers. Not unusual. As for Southwest, they seem to live up to their hype in Texas, but not elsewhere.

I always wear my coat on the plane, even through Sky Harbor when it's 150Â° on the tarmac. No sense in taking-up valuble luggage space for it.

Of course, the weight of all those coats and sweaters would tend to wipe out the incremental fuel savings gained by getting rid of those lightweight blankets and pillows.

Blaming the federal gov't is a tried and true tactic. Like the "OSHA fee" that so many dentists charge for every patient visit, and that patients undoubtedly think goes to OSHA.

Inside the Outbreaks

mpendergrast — Mon, 21 Jun 2010 11:03:59 +0000

Inside the Outbreaks

Mark Pendergrast writes: To kick off this book club discussion of Inside the Outbreaks, I thought I would explain briefly how I came to write the book and then suggest some possible topics for discussion.

The origin of the book goes back to an email I got in 2004 from my old high school and college friend, Andy Vernon, who wrote that I should consider writing the history of the EIS. I emailed back to say that I was honored, but what was the EIS? I had never heard of it. I knew Andy worked on tuberculosis at the CDC, but I didn't know that he had been a state-based EIS officer from 1978 to 1980 in Oklahoma.

When he explained that EIS stood for the Epidemic Intelligence Service, I was intrigued. Was there really an outfit with a name like that? As I learned more, I realized that I had the opportunity to write the first history of an organization that has had a profound impact on the way public health is practiced not only here in the United States, but across the globe.

This book took me nearly twice as long as any previous book, even though it covers a shorter time period than my other histories. (For info on all my books, see www.markpendergrast.com.) I could not have survived on the advance from the publisher, so I am extremely grateful to the CDC Foundation and the Josiah Macy, Jr. Foundation for the grants that made the book possible.

The project took so long because it involved so many characters and investigations, making it a challenge to write. I considered organizing it by disease or theme, with a chapter each on polio, cholera, chronic diseases, environmental health, or violence, for instance. But such an approach would have meant jumping around in time, and readers would have lost the historical context. Instead, I wrote the book chronologically, from Alexander Langmuir's creation of the EIS in 1951 to the present. That meant that most chapters contain a smorgasbord of investigations.

Thus, for example, Chapter 5, "New Discoveries and Mysteries in the Early Sixties," begins with the 1961 hepatitis A outbreaks traced to oysters in Pascagoula, Mississippi, and to clams in Raritan Bay, New Jersey, and then to intentional urination in potato salad at the officers' mess at Cecil Field Naval Air Station in Jacksonville, Florida. Then it shifts to hepatitis B traced to blood transfusions as well as to a New Jersey osteopath-psychiatrist who put IV drips into depressed patients to deliver tranquilizers, vitamins, and "energizers," cross-contaminating with hepatitis B by reusing the same tubing. Then the chapter jumps to salmonellosis due to raw eggs in cake mixes, which led back to chickenfeed made from contaminated fishmeal. Then I wrote about Salmonella hospital infections traced to nutritional drinks made with raw eggs. Onward from there to a remote Bolivian village to retrieve a particularly virulent plague bacillus for the Fort Detrick biological warfare scientists, followed by an apparent outbreak of lethal encephalitis among Guatemalan Mayans that stemmed from mercury fungicide on wheat seeds that the starving Indians had eaten. From there to leukemia clusters in Niles, Illinois, cholera in the Philippines, Reye syndrome in North Carolina, and finally, a section focusing on Alexander Langmuir in his prime. And that's all just one chapter!

Despite the book's disparate contents, there are narrative threads that weave throughout the book, some of which I will introduce here.

Alexander Langmuir himself provides one such thread. The founder of the Epidemic Intelligence Service was a visionary leader who put his personal stamp on the institution. "We'll get EIS officers on an epidemic as fast as we can," he said. "Throw them overboard. See if they can swim, and if they can't, throw them a life ring, pull them out and throw them in again."

The rituals and institutions that Langmuir established have proven to be remarkably hardy. The annual April conference is a case in point, a wonderful springtime introduction to Atlanta for new EIS recruits who can marvel at the amazing presentations - talk about a smorgasbord! - while being wooed and assessed (and simultaneously wooing and assessing) in this EIS version of a fraternity/sorority rush. They then return to Atlanta in the sweltering July heat for intense training, during which EIS officers make friends that often last a lifetime.

Diseases provide other narrative threads. Polio, for instance, is a major focus from the beginning, when EIS officers studied possible fly transmission, then put the EIS on the map during the 1955 Cutter Incident, when virulent live virus survived in some polio vaccines, thus paralyzing some recipients. I wrote about the 1962 decision to switch from the Salk killed injected vaccine to the Sabin oral live attenuated polio vaccine, the subsequent surveillance that revealed how children and their parents sometimes contracted polio as a result of the oral vaccine, the eventual decision to switch back to the killed vaccine in the United States, and the current pursuit of polio eradication that is tantalizingly close to success but is still frustratingly difficult.

Similarly, readers can follow threads throughout the book about malaria, Reye syndrome, Salmonella, diarrhea, smallpox, natural disasters, refugees and war, psychosomatic illnesses, problematical alternative medicines, E. coli O157:H7 and other foodborne pathogens, injuries, AIDS, Ebola, and many other health problems.

Another thread traces the evolution of more complex epidemiological methods, from simple description epi and cohort studies to case control studies, random sampling, and multivariate analysis.

Another is the impact of politics and global events on EIS investigations, from the Cold War fear of biological warfare that helped create the Epidemic Intelligence Service, to the Reagan administration's shameful neglect of AIDS, to the Bush and now Obama years. And on another level, there are the politics of the CDC and the Public Health Service. For years the CDC flew under most governmental radar, hiding out in Atlanta, but that ended with Legionnaire's disease and the national vaccination campaign against the swine flu epidemic that failed to materialize in 1976, which I covered in a chapter called "The Year of Living Dangerously." That year also introduced Ebola and Legionnaires' disease.

Unsolved mysteries provide another thread. EIS officers don't always break every case, at least not right away.

Yet another theme is the growing diversity of EIS officers. In the 1950s, most were white male physicians. Today over half are women, around a third are members of minority/ethnic groups, and a substantial number of officers arrive from other countries. Many are non-physicians.
Another thread in the book is how businesses sometimes put profits ahead of public health, as in the case of Reye syndrome and the aspirin industry or toxic shock syndrome and Procter & Gamble, which made the Rely tampon.

Other themes that thread throughout the book are: increasing microbial drug resistance to antibiotics, emerging infections, and the broadening EIS/CDC involvement in chronic diseases and behavioral factors such as smoking, drinking, suicide, and violence - and now looking at the public health impact of climate change.

Another theme that emerges throughout the book is that a disproportionate number of health problems afflict the underprivileged, the poor, the oppressed.

Yet another thread is the lesson that individuals, with their own particular interests and personalities, can make such a difference. There are many instances in which curious EIS officers or alums took on a problem and just wouldn't let it go.

In summary, let me quote from the book's epilogue, "The EIS Legacy," about the nature and importance of the EIS:

EIS alum Patrick Moore observed: "Most EIS recruits are not run-of-the-mill people. They aren't doing it to make lots of money. We really felt we were putting ourselves at risk, selflessly facing down bad diseases to help other people."

In the early years, most physicians joined the EIS to avoid the draft, but many remained in public health once they realized that they could have such a powerful impact on thousands of lives. That same realization occurred to latter-day officers such as Scott Harper, who observed: "Working as an EIS officer in public health was exciting, important, and satisfying. Whether investigating an outbreak or writing policy for vaccines, I had the opportunity to affect many more people's lives than a clinician seeing 30 people a day." Kay Kreiss recalled thinking, "This is the best job I'm ever going to have, with infinite backup and no administrative responsibility."

Scott Holmberg added: "Being dropped into an outbreak, given the authority to investigate it and do the detective work, then apply that knowledge to curbing the current outbreak and preventing future ones - there's no better work in the world. Wherever you go, everybody wants the same two things - peace and prosperity. It doesn't matter whether their lips are stretched and they are dyed blue, or whether they sit in front of a computer. They are worried about family, friends, tribe, nation."

I then went on to provide a quick summary of illustrious EIS alums and how they have influenced public health. I also wrote about EIS clones, the Field Epidemiology Training Programs around the world. And I concluded the book with these two paragraphs:

In 1951, Alexander Langmuir seized a Cold War opportunity to fund a small training program for young epidemiologists who would keep an eye out for biological warfare while responding promptly to unintentional epidemics. Today these EIS officers are the world's premier front-line disease detectives.

For an obscure government program, the Epidemic Intelligence Service has produced remarkable results. Perhaps it has done so in part by remaining relatively small, nimble, and flexible. One of the lessons of the EIS history is the impact that one person can have. Put creative, intelligent, well-trained, motivated individuals into the right environment, and the outcome can save lives and lead to vital careers. EIS officers and alums have had an impact far beyond their original numbers. Today, with global public health bedeviled by substantial threats, the life-saving work performed around the world by these shoeleather epidemiologists is more essential than ever. The EIS program and its offspring have, in short, influenced and defined how field epidemiology and public health are practiced on our planet.

So there's a somewhat scattered introduction to this book club discussion of Inside the Outbreaks. I look forward to hearing from readers and I anticipate an interesting, fruitful exchange.

Here is the only photo someone took of me in a village in Niger when I was following EIS officers there:

mpendergrast Mon, 06/21/2010 - 07:03

Tags

abortion surveillance

Anaconda Copper Mining Company

Behavioral Risk Factor Surveillance System

Centers for Disease Control and Prevention

cerebrovascular disease

choking game

cholera

chronic fatigue syndrome

congenital hypothyroidism

Council of State and Territorial Epidemiologists

Crater Lake National Park

Creutzfeldt-Jakob disease

cruise ship outbreaks

e. coli O157; hemolytic uremic syndrome

Epidemic Intelligence Service

Field Epidemiology Training Program

Guillain-Barre syndrome

Haemophilus aegyptius

insecticide-treated bednets

intestinal worms

ischaemic heart disease

IUDs

Jack in the Box hamburgers

Legionnaires' disease

lymphocytic choriomeningitis

meningococcal meningitis

mercury poisoning

MMWR

molecular fingerprint

monkeypox

multiple drug resistant tuberculosis

multivariate analysis

mumps

Mushrooms

Navajo flu

Neisseria meningitidis

nosocomial infections

nurse homicides

nutrition surveillance

obesity

oral rehydration

PAHO

Pan American Health Organization

physician-assisted suicide

sick building syndrome

Spanish toxic oil syndrome

spina bifida

St. Louis encephalitis

staphylococcus

strep

streptococcus

Streptococcus pyogenes

sudden infant death syndrome

suicide

swine flu

syndromic surveillance

World Health Organization

In which the school newspaper's article on H1N1 vaccination angries up my blood.

jstemwedel — Fri, 29 Jan 2010 15:13:25 +0000

In which the school newspaper's article on H1N1 vaccination angries up my blood.

This, our first week of classes of the Spring semester, also marked the return of regular publication of the daily student newspaper. Since I'm not behind on grading yet (huzzah for the first week of classes!), I picked up yesterday's copy and read one of the front-page articles on my way to my office.

And dagnabbit if that article didn't angry up my blood.

The trouble is, I'm having a hard time figuring out where properly to direct that anger.

The article, which appeared below the fold, was titled "U.S. Health Secretary urges vaccinations". It drew from a January 26, 2010 conference call between U.S. Secretary of Health and Human Services Kathleen Sebelius and college newspapers about the novel H1N1 flu virus, the prospects for an uptick in novel H1N1 flu in January, the availability of vaccine, and the vulnerability of younger people to this virus. (The article cited Sebelius's claim that people in the 18- to 24-year-old group who get this flu are six times more likely to be hospitalized than those in other age groups.)

Later in the article, there was some discussion of how the government is trying to use social media to get the word out about flu, vaccines, and ways not to infect your coworkers and classmates.

All of this seemed pretty reasonable, and pretty standard, to me.

But midway through the article, the author of the piece did this thing that I can only assume journalism programs are teaching staff writers on student newspapers to do. He asked students on campus for their views on the novel H1N1 flu and vaccines against it:

[Name redacted], a junior nutritional science major, said she doesn't believe H1N1 is any different from seasonal flu.

"I think it's just like any other flu going around," she said. "You just have to be ready."

[Name redacted] said she doesn't plan on getting vaccinated.

"I am never going to get vaccinated," [name redacted] said. "I'm against it."

She said she is preventing herself from getting sick by eating nutritious foods to help boost her immunity, exercising, getting of rest and washing her hands before eating.

Sophomore chemistry major [name redacted] said he also doesn't plan on getting vaccinated, as he isn't worried about becoming infected with swine flu.

"I feel as though it's not going to affect my life," he said. "I feel I will not get it."

[Name redacted] said he wasn't doing much to prevent getting sick.

"I'm not doing anything in particular," he said. "I try to stay healthy in general, but other than that, absolutely nothing."

Senior nursing major [name redacted] said he was vaccinated to protect himself.

"I found out that the school was offering it for students, and so I thought it would be a great idea to get vaccinated," he said.

(Note that the students interviewed for the linked story are identified by name in that story. I've decided to redact their names here in case they were misquoted, and because even if they weren't, I'm not comfortable taking them to task here in a way that gives their names lingering negative Google-juice. I'm committed to the idea that people, and especially college students, are capable of learning.)

The junior majoring in nutritional science was the proximate cause of my first facepalm.

I'd be curious to know on what basis she's claiming that the novel H1N1 is no different from seasonal flu. The fact that you could contract both (and that there are distinct vaccines for the two) would seem to argue for their non-identicality. Plus, the disproportionate rate of hospitalizations of the traditional "college aged" cohort with the novel H1N1 flu but not the seasonal flu seems like it might point to a relevant difference.

Also, I find it interesting (and perplexing) that her strategy for "being ready" for either flu does not involve vaccination (which she's "against" for reasons not detailed in the article). Rather, she plans to "boost her immunity" with healthy foods, exercise, rest, and hand washing.

Don't get me wrong here. I would be thrilled if all the students at our university ate lots of nutritious foods, got plenty of rest and exercise, and were scrupulous hand washers. But these steps do not render the body immune to viruses to which it is naÃ¯ve. I do rather wonder whether this nutritional science major believes "immunity boosting" foods like lemon juice and garlic obviate the need for antiretroviral drugs in the treatment of HIV.

The sophomore chemistry major interviewed here made me sad (as a former member of Team Chemistry), but I reckon he's probably just coming from a young person's place of presumptive invulnerability. I'm sure he doesn't believe he'll get the flu, and thus sees no point in getting the vaccine. If he lives long enough, he'll probably amass some data that suggests that our expectations and our actual outcomes are not always in agreement.

I'm not at all surprised that the senior nursing major interviewed for the article chose to get vaccinated. Entrance to our nursing program is extremely competitive, and the students in that program are extremely smart. No doubt the coursework for a nursing degree includes some discussion of the biology of the immune system, and viruses, and vaccines.

Now, as I mentioned above, I'm torn over where I should place my anger here.

On the one hand, I'm kind of angry at the way what seems to be a standard journalistic convention (at least in the universe of daily student newspapers on college campuses) juxtaposes presumably reliable information from experts with whatever a student wandering across the reporter's path might happen to opine. The expert says X. The student says Y. And no analysis whatsoever of the gap between X and Y, or what it might mean that a student holds Y regardless of the expert opinion that X.

Journalists, what is the point of this juxtaposition? Especially in an article like this, which is not about, say, the difficulty of adding classes, or a proposed student fee increase?

Sure, I can do my own analysis -- maybe anticipating that I may have more contagious students to interact with this term than I would have hoped (although I've had my vaccines for novel H1N1 and seasonal flu, so I'm not planning to free-ride on the rest of the herd).

But, I'm a wee bit concerned that the major field of the non-vaccinating student quoted at most length in the article may make her appear to the other students reading this story as if she is drawing on relevant expertise, too.

And honestly, if students are reading this article and thinking, "Well, someone majoring in nutritional science said, right there in the paper, that eating healthy foods, and exercising, and getting enough rest, will keep you from getting the flu, and that the vaccine is bad," that's pretty dangerous.

Admittedly, a student relying that heavily on an article in the school paper could do better at seeking reliable sources of information. But there's not a hint in the reporting of the story that the view articulated by the nutritional science might not be credible. Arguably, identifying her major suggests that there is a certain range of topics on which she could be regarded as more credible than students majoring in other fields -- the powers of a nutritious diet, presumably, falling within that range.

So is the problem here a stupid journalistic convention? A staff writer who didn't go the extra mile to provide some analysis, or to put the presumptive expertise of an interviewee in perspective? An interviewee who was speaking with authority she didn't have the knowledge base to back up?

Or could it be that they are actually teaching nutritional science majors here that foods have the power to render humans immune to influenza?

jstemwedel Fri, 01/29/2010 - 10:13

Tags

Teaching and Learning

I think part of the blasÃ© attitude may be in part because many of us know a couple of people who had flu at the peak of the H1N1 scare and found out from the hospital that it was an H1N1 strain, and it wasn't that bad. So even though there is much less exposure to H1N1 in the population, making it more dangerous, many of us have a sense that it isn't worse than common strains of flu on account of some sample cases.

I have to admit to confusion about the vaccine myself. All last semester, the message was that the vaccine was for high-risk people - and folks of my age (50s) didn't fall into any of those high-risk groups specified. So I reconciled myself to not getting vaccinated. Now there seems to be a message that everyone should get it. When did the recommendations change, and why?

The bit about vox-pops in the middle of this awesome clips (http://blogs.journalism.co.uk/editors/2010/01/28/charlie-brooker-on-how…) seems relevant to this discussion.

Well, H1N1 and this year's seasonal flu are different. But they're basically the same bug phylogentically, just not immunologically (although viruses are classified in bizarro ways). It's a little bit like Plasmodium swapping out var genes ("falciparum and the amazing technicolor dreamcoat" of many colors).

But... yeah. Facepalm indeed. Letter to the editor?

Pat, I think the change might be because of availability. Until recently (if I understand correctly), there wasn't a lot of the vaccine around. (I know the pharmacies around here only got it a month or so ago.) So they were trying to restrict vaccination to those most at risk. Now there is more vaccine, so they're encouraging more people to get it--which would have been the original message had there been more to go around at the beginning.

MGS @1, I'd have been thrilled to see some exploration or analysis of not just students' attitudes, but what sorts of things are behind them (e.g., experience of friends, difficulty dealing with probabilistic claims, etc.). That probably would have been enough to mitigate my facepalm.

pat @2, last month when my health care provider was running a flu vaccine clinic, it was for ages 2 to 49. If folks with the vaccine in your area are now welcoming all ages, I'm guessing that's because they feel like they have adequate supplies to vaccinate everyone seeking vaccine, rather than staring with the age range most likely to be naÃ¯ve to the virus.

Ed @3, that video is simultaneously awesome and scary as hell.

We had one of the worst outbreaks worldwide last year in my home state of Victoria, Australia (3,000+ confirmed cases and 26 deaths) yet we still have a low rate of vaccination against H1N1. I think part of the reason is that the illness is being down-sold by both the media and the health authorities. The federal government's health website says:
"Despite some deaths in Victoria, the vast majority of cases of Human Swine Flu continue to be mild. Most people are still recovering without any medical treatment. However for people with chronic medical conditions, influenza can be severe. This is evidenced every year in Australia, where roughly 2,500 people die from seasonal flu annually."
http://humanswineflu.health.vic.gov.au/

Anecdotal stories are statistically meaningless but emotionally powerful. Everyone seems to know or know of at least one person who had swine flu, recovered, and is fine. The cumulative effect of the government telling us not to panic, the media downplaying any actual deaths, and personal "experience" has led many people to conclude the vaccine is unnecessary for them.

Just addressing the journalism question: this isn't new, of course, and it bothers me as well. It seems to be based on a perception (at least) that readers/viewers want to see what the entity-on-the-street has to say. About anything. Whether or not EotS's opinion has any real value or relevance.

I'm reminded of a time, years ago, when the ultra-local news on cable (yes, that's what they call themselves: "ultra-local") did some item about the search for Saddam Hussein that was going on at the time, and they stuck the microphone in front of motorists stopped at a main intersection in town. They asked them, "Do you think Saddam Hussein is still alive?"

WTF?, said I. He's alive, or he isn't; what on Earth does it matter what these people in suburban New York think?

Sigh.

In the continuing vein of discussing this issue through the medium of British comedy: http://www.youtube.com/watch?v=OQnd5ilKx2Y

"You may not know anything about the issue but I bet you RECKON something..."

I'm struck by the fact that the student journalist apparently made no attempt to get comments or opinions from faculty in departments that might be presumed knowledgeable on the subject -- e.g. nursing faculty.

I'm also horrified at the implied new meaning of the word "mediating" by the nutrition science student in the very last sentence of the story.

What you can do about the Flu. First, don;t take those dangerous vaccines, next get treated if you do happen to get the flu. See a doctor. Out side of the doctor here are some things that will alos help:

Vitamin A

A powerful antioxidant and immune booster.

Vitamin C

Strengthens the immune system by increasing the number and quality of white blood cells.

Colloidal Silver

Good for viral infections, promotes healing.

Garlic

Has antiviral and antibacterial properties.

L-Lysine

Aids in combating viral infections and preventing outbreaks of cold sores in and around the mouth. Do not take L-Lysine longer than six months at a time!

Zinc

Zinc supports immune function and may have antiviral effects.

NAC

Thins mucus and aids in preventing respiratory disease.

Maitake/Shiitake/ Reishi

Helps boost immunity and fight viral infection.

Elderberry

Has antiviral properties and reduces flu symptoms.

Olive Leaf Extract

Enhances immune function and fights all types of infection including the flu virus.

Recommendations

Do not take Iron supplements while a fever exists. Sleep and rest as much as possible and drink plenty of fluids.

Other Products

LifeSource 4 Life All natural Antibiotic
Botanic Choice Homeopathic Cold & Flu Formula
Heel FluPlus
Ecological Formulas Monolaurin
NSI Cold & Flu Relief Formula

Instead of buy supplements, I'll have my immune system make anti-bodies by getting the vaccine so I can carry on with my life. It's more cost effective.

"# You Might Be a Redneck If... : On Becoming a Domestic and Laboratory Goddess (this site)"

Someone is actually still PAYING to promote this racist garbage???? Who is paying - Isis? Or SB?

Ahh, I love the smell of woo in the morning. Colloidal silver? As a topical antiseptic, yeah, there is some benefit. Ingested - nope, it's been tested. I think Science-Based Medicine had this, and so did the Skeptics Guide to the Universe. Anyone want to bet how many of those supplements have actually been tested (double-blind placebo controlled) and been found to have real effects? Considering that the "homeopathic" (ie sugar or water, no active ingredients) remedy is being put forth....I'd say, not very likely.

It's depressing seeing how much misinformation and general ignorance about medicine (along with biology and chemistry) there is.

Dr. Freeride- my best guess- and it is only a guess, mind- is that the 2-49 is *not* the age range most susceptible. Rather it is the age range that can get the intranasal live attenuated vaccine safely. In my area, at least, the intranasal was available sooner. But of course, all the people I'm worried about aren't in that age range (well, I was worried about bringing it home to them, so I got it, but yeah).

Dr. Free Ride bust free riders! BLAMMO!

I love how people act like it is just the same as the seasonal flu. This is why we had a Summer flu season as big as each of the last two years', a Fall flu season 3-4 times as big, and we're waiting for the uptick on the Winter season (end of February is the usual peak). Wake up people!

http://www.cdc.gov/flu/weekly/

My husband blew off annual suggestions that he get a flu shot... until the year he actually got the flu. Now, he's quite happy to get a flu shot every year. :-)

(An asthmatic, I get whatever immunization I can; trips to the ER for an inability to breathe are scary and expensive.)

Out side of the doctor here are some things that will alos help:

Inside of a doctor, you can probably rely on the MD's immune system, since they are overwhelmingly likely to have taken the vaccine.

Why write:
"Entrance to our nursing program is extremely competitive, and the students in that program are extremely smart."?

To me it sounds like you are setting "extremely smart" students in one program against less smart in other programs and then equaling smart with choosing vaccination.

Unfortunately, I saw several people die of swine flu & complications (so far) this season. The saddest case was the 19 yr old freshman from University for Smart Kids. Heartbreaking. The problem *is* misinformation. Media presenting a buffet version of the truth doesn't help, but neither does 12 years of teaching children to be uncritical, compliant, bubble-filling, relativistic, task-doers who lack the ability to make a sound, rational judgment entirely.

#11 Something tells me you're not a real doctor, but just play one on the internets.

Your school needs to fire the entire nutritional science faculty. They are turning out incompetent graduates (unless a whole lot of learning goes on in year 4).

I can see why a journalist might want to include the opinions of the "general public". It might convey the concept of what people are saying despite the fact without actually saying hey this is what people are saying.

And to address the ignorant perspective of some college students... it's probably just the ignorant perspective of some college students. It can be hard to overcome long held ideas about things (vaccines, mental illness etc.) especially if you are being taught the facts. That is most likely why the nursing student was vaccinated. As a new nurse, I would never have gotten vaccinated against the flu before but not that it is basically unethical to not get vaccinated when you work with sick people. You could pass it on or bring it home. When you come into daily contact with folks with H1N1 on a daily basis and watch some of them die, you just take it more seriously.

I feel you though. I don't think I could work with college students at this point in my life...

I'm just curious--are most of the staffers for your school newspaper actually journalism majors? Not that being an undergraduate student in something means you should already be good at it, but you could at least set the bar a bit higher. At my undergraduate institution, though, almost no one on the newspaper staff was actually a journalism student. Most of them were (weirdly) engineers.

Either way, this is certainly disappointing on both ends: the writer of the article should have addressed the disparity between expert advice and student opinions, and college students should be much better informed about current events and science than they appear to be from this admittedly small sample.

"Don't get me wrong here. I would be thrilled if all the students at our university ate lots of nutritious foods, got plenty of rest and exercise, and were scrupulous hand washers. But these steps do not render the body immune to viruses to which it is naÃ¯ve."
Your above quote would lead me to assume that you naively believe that a vaccination would render the body immune to viruses. If so you are making a claim that even the vaccine manufacturers would not dare state.
Taking alternative healthy precautions is wise, risk free, and of benefit to the entire community.
To borrow a quote from another blog on this site.
"You do need to be extremely careful about medical claims though; there are people out there who might have something valuable to sell but rather than sell it honestly they'll make claims which simply are not true. Far more common are people with something of almost no value to sell and who make insinuations that their product is valuable. If you see any article which mentions "epidemiological studies" you can safely dismiss it as nonsense; first of all such studies only suggest a correlation - to which any decent scientists will shrug and say "so what?" Epidemiological studies are also used almost extensively for 'data mining' to support false assertions; the technique seems to be: (1) get a lot of worthless data, (2) ignore most of that worthless data to find a few bits that you can use to con the unwary into believing your claims."
I suggest you do further research into the real facts and statistics before you join the CDC/WHO choir.

Meanwhile, I keep getting those who claim there is "no proof" that vaccines work at all.

They don't even have to get a license to spout off like that.

The Bush War on Education is taking its toll. Science illiteracy, and what would pass as plain insanity among informed people, becomes more common.

Tragic H1N1 death of University of North Carolina freshman: get your vaccine now

terrasig — Thu, 17 Dec 2009 11:02:24 +0000

Tragic H1N1 death of University of North Carolina freshman: get your vaccine now

If you think that the H1N1 pandemic is slowing down and have grown complacent with vaccination now that vaccines are more widely available, please learn something from last night's tragic loss of local college student from Rhode Island, Lillian Chason:

A University of North Carolina at Chapel Hill student, who friends said was battling complications from the H1N1 virus, died Wednesday evening, according to UNC Hospitals and a Facebook post made by her father.

Freshman Lillian Chason had been in critical condition at UNC Hospitals for weeks. Friends told WRAL News on Tuesday that she started feeling bad before Thanksgiving and went into the hospital on Nov. 20.

"I'm sorry to have to tell everyone that Lillian died this afternoon at 5:20 PM," her father, Eric Chason, wrote on Facebook Wednesday. "As you all know, she put up an incredible fight and if there was anyway she could have overcome this disease, she would have."

I don't know anything about this case other than what is appearing in the local and Rhode Island media and what appears on the Facebook page. However, it appears that Ms. Chason had no underlying pulmonary disease or other health issues.

This is the kind of death we have been worrying about with H1N1: one that strikes the very healthy, young adult population.

Ms. Chason had the best quality of care at one of the top US academic medical centers. I suspect that the UNC Health Care team is distraught and felt helpless in the face of the complication of H1N1 that they could not overcome even with the best medical tools.

Ironically, today's paper has an article by Sarah Avery entitled, "H1N1 shots arrive as demand dies down."

So, young and healthy US readers of ScienceBlogs, more H1N1 vaccine has become available around the country so that those at "the back of the line" can now receive theirs. Lauren Neergaard at AP reports that 100 millions doses are estimated to be available by the week's end.

The vaccine is, of course, not 100% effective but the loss of Lillian Chason should remind us that any shot you have at reducing risk is worth it.

As a father of a young girl, my heart aches for the Chason family.

If you are so inclined, you may register your condolences with the family here.

terrasig Thu, 12/17/2009 - 06:02

Tags

I get mine on Saturday.

The increasing apathy is unfortunate. A recent flu clinic in Minneapolis expected to dispense 4500 doses but only dispensed 2000. I doubt (based on anecdotal evidence) the rates of immunization will reach "herd immunity" levels. Sadly, there may be more deaths of healthy individuals.

To be completely honest, there has never been a year where herd immunity has been achieved for influenza.

Chuck- True, but seasonal flu has never been given the attention H1N1 has. This does bring up an interesting question that may not have an easy answer: at what point does herd immunity become a "reliable" factor? Can this even be quantified? Is 90% good enough, 99%? I presume statistical studies have been done, but I'm sure the results vary with different viruses. Sorry, I'm typing (thinking) out loud. Maybe someone has some insights.

Yea spread the FEAR. The media and outlets like this do more harm than good.

Radford University (Radford, Virginia) held a flu clinic for its students, offering both H1N1 and seasonal flu shots at nominal cost. My daughter attends New River Community College (Dublin, Virginia), but she was allowed to come in and get an H1N1 shot at the Radford flu clinic. Thank you, Radford University! (New River Community College later offered its students free doses of the nasally-administered H1N1 vaccine. Bravo to them as well.)

Non-trad senior here ... and I got mine free through campus as a priority before I go into clinical rotation for spring semester. The seasonal shot is required for clinicals, and I got the pandemic shot because I know how to read the CDC's weekly FluView!

I'm just sorry it takes the death a vibrant-looking young lady to wake some folks up ... there are still kids on campus who are certain they have nothing to worry about because "it's just the flu."

DC just got vaccine for general population use. Luckily, I can get one at work with relatively little hassle. I wonder how long the line will be.

Yeah, it's pretty sad. I spent a few weeks at our pathology department and saw the messed up effects of H1N1 on healthy lungs. Not a pleasant sight.

Wow that's so sad. I got my shot two days ago and the slightly sore arm is worth the peace of mind. It's too bad people are so afraid of the vaccine, there's so much bad info out there. My pregnant sister (she had the baby yesterday) didn't get it because she had heard all this vague information about squalene and mercury, that seems to be the case with most people I talked to. Cases like Desiree Jennings got so much publicity, yet it seems like the H1N1 deaths are brushed off. Nobody has died from the vaccine, but people around me just say "oh it's like any other flu, no need for the vaccine". They think if they get it they'll end up walking backwards, but they don't bother to consider the way more obvious risk of not getting it.

Oops...that last sentence should start "They think if they get the vaccine..."

just to clarify...

So very sad and no words can express what this family is going through.
My 23 yr old daughter was only able to find the nasal spray vaccine and I have read conflicting reports on its efficacy, which trouble me. I have even wondered if she should go ahead now and get the shot in addition to the nasal spray vaccine, now that it's so available. However, as a lay person, I don't know if that would be a safe thing to do. Any info or comments on this?

chemgeek,

The 2008 influenza season is the last one that I have information for.

Stratifying both Census and CDC information, 30% of the total population received the seasonal influenza vaccine. That yearâs vaccine was a poor match for the most prevalent strains, so the effectiveness was estimated by the CDC to be 40%. That means that only 12% of the population would not be vectors of further infection that could be attributable to the vaccine.

@Margaret: it would be safe, just not really necessary.

Sad, sad stuff.

I received the H1N1 shot last Sunday when it became available in my area.

A friend of mine died from complications of the H1N1 flu after seventeen days in the ICU. She didn't have any underlying medical conditions. She was the ripe old age of thirty two.

Huxley narrowly escapes The Swine Flu

gregladen — Fri, 04 Dec 2009 17:34:09 +0000

Huxley narrowly escapes The Swine Flu

We brought Huxley in for his first doctor visit yesterday. Everything was fine. But since we were going to a clinic with an urgent care unit, I expected to see a lot of people with the flu in the waiting room. There is always a lot of messing around in the waiting room, with a two stage sign in process, a need to show ID, sign stuff, etc. etc. and then there would be a wait in the waiting room breathing in H1N1 kooties. My plan was to keep Huxley, who was in the nifty car seat-stroller thingie and well bundled against the elements, in the entrance way of the building or even in the parking lot while Amanda did what we were already told would be extended paperwork attendant to a first visit. Then, I would await Amanda's signal through the clinic's window when it was time to go into an exam room.

But that is not how it worked out at all.

I once worked, briefly, with a guy who kept big cats. My interest was research related, and his was in using the cats in movies and commercials, and in following the Ren-Fest circuit. He had one lion in particular that you may know. If you've seen the Dreyfus commercial with the lion, that's him. He also did some work for MGM, so some recent depictions of the MGM lion are the same cat.

At the Ren Fest, people, especially kids, could get their picture taken with the lion. The photograph would show you sitting right next to the lion's head, with your arm around the beast, lion staring more or less into the camera.

Even though this particular lion was very accustom to humans and relatively docile, there was always a chance that he could turn his head and nom-nom-nom the customer. So here's how it was done to avoid that:

1) The lion had a collar, not visible under the mane. This collar was attached to a short chain affixed to the platform on which the lion and customer would sit. So, the lion could not move very far, but could still turn his head to the left to nom-nom-nom if he was so inclined.

2) The customer would be accompanied to the lion by the lion's owner, who would be standing behind the customer like in a Tango, with his left hand on the customer's left arm, and right arm on the customer's right wrist, extending the customer's arm well out to the side. The only way you would move towards the lion would be if the lion's owner moved you there, and he would the place your arm around the lion's mane and duck to the side. Since the mane was bushy and the camera in close, the lion's owner would not be visible in the picture, but if he saw anything even a little funny he'd pull the customer away in an instant, and now and then, cancel the next few pictures and take the lion out back for a little calming down. It was key to keep the customer back behind a certain plane behind the lion's face. Thus the tight grip and total control over the customer's location.

3) A big scary guy would be standing immediately on the other side of the lion with a stick ready to jam the stick into the lion's mouth. Not that he looked like he was going to do that. He just looked like a medieval guy in medieval cloths with a cane. But he was there to put the stick (the cane) into the lion's mouth if needed.

4) The guy taking the picture was constantly talking to the lion, keeping his attention.

So, the first person in line would be brought quickly to the lion, before anyone ... the customer, the lion, any nervous parental onlookers ... even knew what was happening, the customer would be planted on the lion, the photo snapped, the customer pulled away from the lion and escorted off in the other direction by a helper while the lion's owner grabbed the next customer. In and out, in and out, in and out. No time for the lion to bite the child.

So, we got to the clinic and the H1N1 virus was the lion, the receptionist was the lion's owner, a pediatrics nurse was the big guy with the stick, and so on, as we were escorted instantly past about 25 very sick looking people (including several obviously viral children) instead of showing ID, filling out paperwork, etc. We were escorted quickly and directly into The Elmo Room, where we filled out the paper work, got weighed (well, they weighed Huxley), got seen by the doctor, filled out some more paper work... and were then hustled out of the building past all the plague ridden pheasants, I mean, sick clinic customers, and out into the parking lot.

Phew .... close call....

gregladen Fri, 12/04/2009 - 12:34

Tags

H1N1 Novel Swine Flu

H1N1

Huxley Laden

Nice analogy! I really enjoyed the lion tale (har har) I always wondered about how that was done.
The clinic experience reminded me of my own experience at a flu ridden clinic a couple weeks ago when I went in to get my ribs checked out. While I was standing at the counter signing in (the entrance door behind me) the receptionist suddenly cut off from speaking, eyes wide, jumped up ran out the door beside her and yelled to the man behind me to 'GET IT THAT ROOM' (while pointing down the hallway). She continued to shuffle him off while stating in high tones that 'These people are all SICK out here, Go go!'. Turns out he had a baby with him.
My first thought was 'I'm not sick...... it's just my ribs ... can't I go in there too? *mewl*'

Nice story, very dramatic.
I imagine Huxley being secreted past the evil germs while the theme song from Mission Impossible is playing in the background.

That's the original theme song, btw, where the time signature for the whole piece is in 5/4.

Listen to original version (below), and tell me if it's fitting.

http://www.youtube.com/watch?v=k55NuWQCh78

It was Huxley's namesake's early encounters with circus cnidarians that would lead to his later scientific interests.

You got me. For 3/4 of the post I'm thinking, "What, no well-baby room?!" I keep forgetting that this is your first time doing this.

Bravo to the hospital for the hustle, though. Glad to hear that they are still taking this thing seriously. Too many have brushed it aside or think it's all over with.

I keep forgetting that this is your first time doing this.

Well, it isn't my first time, but my older kid is 14, and the new models are a bit different. What's a "well baby room"? You must be from Canadia or something.. sounds socialistic.

Aww. Dodged the first bullet. Only a jillion left till the parents can breathe comfortably. In about 18 - 30 years... (Bet there are times you wish you could still run interference for the 14-year-old...)

I've been on the other side of this. Had to take my toddler in (forget why, now) when he obviously had chicken pox. Was told over the phone to drive to the back door of the clinic and bang on it till someone came to let us in, so as to avoid the waiting room. To do so, had to squeeze car down an alley with dumpsters surrounded by broken glass. Made it, got child seen by doctor, got let out back door, drove a couple of blocks...& discovered I now had a very flat tire. Along with, of course, a sick, cranky kid. Oh, and did I mention that, in accordance with the First Law of Sick Babies, this was on a Sunday, and we were way the hell downtown where the only after-hours ped clinic was located?

Didn't think I should try to jack up car with tot inside...didn't think I could hold him & jack car at same time...Not the kind of neighborhood you want to spend a lot of time in...(Happy ending--able to call white knight in form of husband...)

* * *

Wow, really something the way you worked that lion story in! :D

* First Law of Sick Babies: Always during the weekend.
* Second Law oSB: They start showing symptoms friday afternoon, but it doesn't look too serious. It does once your regular doctor's office is closed and the only option left is the emergency room.
* Third Law oSB: Once you get there, symptoms will have subsided and the doctor looks at you as if he's mentally looking up MÃ¼nchhausen by Proxy and wondering whether he should report you.

"...past all the plague ridden pheasants..."

I'm just wondering why you chose a peds office with sick birds in the waiting room. Does it have a vet side business to help make ends meet?

Because I thought it was funny?

When I was going through my six week bought with H1N1 (including pneumonia), I was treated well, effectively, and at a distance (Geisinger is a wonderful non-profit regional system). Those exhibiting any flu-like symptoms were asked to come in a side door where we were met by a nurse with face masks and hand-sanitizer. Only then could we go and check in. And, except for having my throat examined (some lesions due to the hacking), my mask stayed on and they gave me a little bottle of sanitizer and asked me to keep using it while I was there. I did.

The pediatrics area has a well-child play area (separated physically from the sick kids). They also had a glassed-in area for those with flu symptoms. A third area handled sick by not piggy children.

It is nice to see that the health care professionals take this stuff seriously but don't panic. They did have plans in place to deal with such eventualities.

Glad to hear the little one is good.

Your adventures with Huxley are a treat--how did you work in that lion? How they handle it safely is fascinating.

The contagion issue hasn't come up for me, but most of my doctors and clinics have only one waiting room. My family doctor has a small one but there's never more than one other person in it. My local multi-doctor clinic has a large waiting room on each floor for a group of family doctors (GPs). I don't know how they handle contagious illnesses: they might send them to a different floor or tuck them into a particular office or just give them a mask, but I go there only for Saturdays, Sundays, and after hours or for lab tests, so I don't know. However, the floor plans in both places are at least thirty years old.

The clinic has one set of patient records, at least for all the GPs and the labs. So you have a regular doctor, but you can make an appointment with another doctor or just walk in and see the on-call doctor. Usually about three doctors are holding office hours and one of them is there to see walk-ins. You just show your provincial health-insurance card at Reception. If you get decent state health insurance, look for a setup like that. It's very convenient because you can always see a doctor if they're open and they can refer you to a specialist with a private office in the same building.

There are labs in the building, so if you need a blood test, an X-ray image, or an ultrasound scan, they send you downstairs; and you return to the clinic in a few days when the results are in. Of course you don't have to go to the same lab: any lab will do your tests and send the results to the doctor who prescribed them.

This week, in Toronto, the free clinics set up by the provincial health agency started giving both flu vaccines. I've had the Mexican swine-flu inoculation. (I'm getting the seasonal one next Friday at work, where the employer has arranged for a service to come in as a convenience for employees.) But if anyone hasn't had either, he or she can get one in each arm. I hear that 2/3 of the Canadian population has been vaccinated. No one that I know of has died of vaccination, but about 350 have died of swine flu.

I don't think well baby/kid rooms are a particularly new model. When I was a young child (I'm 29 now) my pediatrician actually had two waiting rooms; the reception area was central and there were separate doors on either side of the lobby. One was for sick kids, the other for well. It worked beautifully and until I had kids myself I had no idea that it wasn't standard everywhere (still not sure why it isn't, actually).

How many people does it take to make a baby really sick?

gregladen — Tue, 03 Nov 2009 10:06:31 +0000

How many people does it take to make a baby really sick?

We have an interesting conundrum. Our offspring (______) is due on November 20th. This places the likely date of birth just prior to Thanksgiving. This causes many people to get very excited because they get to see and play with the new baby. I wonder how mad at me all those people are going to get when they find out I might not let that happen?

I'm not entirely sure what we are going to do postpartum. I'm quite interested in advice, so please do make your suggestions below. I'd especially like the advice of the MD's and Public Health Scientists in the vicinity. Or anyone with relevant experience.

The reason advice is needed is two-fold. First, although I've raised a child before, I've not had charge of an infant during a pandemic. Second, few other people have either, and the nature of advice, common knowledge and practice about things in general and health related issues in particular is not usually rational, in my opinion.

We've already decided to skip the usual Huge Thanksgiving Get Together for the simple reason that there will be thirty or forty people there, and it simply does not make sense to wander into a crowded house full of people with a new baby during a flu pandemic.

An alternative has been suggested. This is a smaller, more limited Thanksgiving dinner with just a few family members, and that's all. But there are three problems with this emerging, at least in my mind: 1) At least two people who will be there have rather proudly declared (and I love you guys, but you are way off on this one ...) that they don't do vaccines. They are not denialists, they just think the vaccines will make them sick. And of the other people who might visit I'm not sure who or who else might have the vaccine; 2) There will be at least one, possibly two, other vulnerable individuals who will also be at the get-together, so this may not be a good idea for them either. (Though they are older than what seems to be a high-risk cutoff for Novel A/H1N1 Swine Flu, and by that time will have been vaccinated.); and 3) I'm not sure that spending five hours in a house with one person who is sending out flu infectoids is much different than spending five hours in a larger house, more densely crowded, with, maybe, a dozen people sending out the infectoids. In fact, the way social events like this work, it is quite possible that the expected number of people woud grow rather than shrink. Will it be eight people? Ten? Fourteen? All these numbers are less than 30 (the best guess for the main Thanksgiving event) but I'm not sure if I care about that difference. Yes, I understand that exposure for longer periods and to more infectious sources should be more highly correlated with actual infection across many instances, statistically, so the probabilities are different. But ...

We are talking about my baby. If I had a hundred babies, I might not mind so much if two or three of them died of the flu. But with just one .... I'm not so sure that aggregate values and probabilities are of any great interest to me. My baby does not get to be several thousand dots on a graph only a few of which will get sick. He is allowed to be only one dot.

My current plan is to monitor the situation, and consider a visit that falls short of staying around for hours and having dinner, but would allow the people to see the child and visa versa. Although the unvaccinated will be wearing those scary masks and everyone will be washing their hands every few minutes.

As I suggested above, there is likely to be a certain amount of irrationality in a decision making process like this one. I'm not sure what will emerge in this particular case, but for the more general circumstance of family meeting baby vs. limiting exposure to baby, here's a few items that come to mind:

First, if you read the "how to not screw up your baby" literature, you'll see a common question addressed: When is it "safe" or advisable to "take your baby out" after it is born? The answer in this literature strongly implies that new parents are often too shy about going out with baby. It is perfectly OK to cart around a properly swaddled new-born. Just don't let sick people touch it, and be smart about what you are doing. In fact, you will see comments in this expert advice literature such as "It is probably healthier to get your baby ... and yourself! ... out of the house early and reasonably often! Don't be a hermit." and so on.

And of course, that is all true. But, this advice addresses a question other than: "When is it safe to bring my baby into contact with other people who may have the Pandemic Flu?"

And, the advice does not specifically mention my baby. Here, we are talking about my baby. If I had a hundred babies, I might not mind so much if two or three of them died of the flu because I took them out because some FAQ on taking care of new borns told me to. But with just one .... I'm not so sure....

A second feature of this sort of discussion is the necessity and importance of the family visit, of the "coming out" of the new born for all to meet and stuff. Obviously, this is a very important thing to do, but it is possible that the importance of everyone getting to meet and greet the new baby is not quite as great as the baby surviving his first several weeks of life, despite one's desire to avoid social awkwardness of any kind.

Let me be quite stark about this: Cousin Jeeter may feel great about meeting the new baby now, but how is Jeeter going to feel if the next day he suddenly comes down with the flu, and two weeks later finds out that he probably gave the flu to his infant cousin, who has died, and no, Jeeter is not invited to the funeral. I understand that dead baby comments are in bad taste and there will be people mad at me for making the stark link between this decision and that outcome.

Tough. We are talking about my baby. If I had a hundred babies, I might not mind so much if two or three of them died of the flu. But with just one .... I'm not so sure that someone's sensitivity to facing the stark reality that this flu ... this pandemic flu we are having now ... appears to be potentially deadly to anyone under 18 years of age is of any great interest to me. Yes, the chances that an infant will die from the flu are low. A week or two in the NICU should take care of him, and organ damage caused by such a major infection early in life won't matter for ... decades, if at all. But we are talking about my baby, so I might be a little picky about this.

A third fallacy that is of great importance is that if everyone washes their hands, there won't be any problem. While it is good to wash hands a lot to reduce flu transmission, this only reduces transmission to some extent. The flu is transmitted very nicely by flying through the air. Even if an infected person coughs into his or her sleeve, the air that comes out of the person's mouth has a zillion tiny saliva spaceships each occupied by thousands of eager flu viruses, which blow around the sleeve and into the air. Those tiny, microscopic droplets float around in the air for many minutes, possibly hours. They are then breathed in by other people in the room. They can also land on surfaces such as ... candy in a candy dish, the rims of drinking glasses, the nipple of a baby's bottle, the cat, or on someone's hair.

Yes, a really good way to get the flu is if an infected person coughs slimy stuff into his hand, and shakes your hand thus putting the slimy stuff on your palm, then you wipe your nose with the palm of your hand or maybe you lick your palm or something. But for the most part, the way flu actually gets from one person to another is when there are two people in a room, one is infected and the other not, and they both breath for a while, with the infected person coughing or sneezing now and then.

Am I exaggerating the air borne infectious nature of this flu? Maybe, maybe not. Conditions vary, the flu varies, it is all a game of complex interconnected probabilities, so there is certainly a calculable probability of infection via direct hand to hand (to mouth) contact vs. airborne only.

But we are talking about my baby. If I had a hundred babies, I might not mind so much if two or three of them died of the flu transmitted via the air. But with just one .... I'm not so sure that aggregate values and probabilities are of any great interest to me.

I feel very lucky that all the close and more distant family members in our case will be totally understanding and supportive of whatever decisions we make (though everyone really should get vaccinated). The problem is, what exactly should that decision be?

So, what are you doing for Thanksgiving? What do you think we should we do?

gregladen Tue, 11/03/2009 - 05:06

Tags

Well, speaking as a complete and utter non-expert in any relevant field, skipping the big Thanksgiving dinner seems like a no-brainer to me. Unless evidence is presented that such family gatherings do not, in reality, increase the risk of transmission among infants, it seems that given the nature of the flu it is extremely likely that there is a noticeable increase in risk.

When the kid is 6 months old, you can get them flu shots. Until then, while we have pandemic flu floating around, it just seems to me a no-brainer that the small but palpable risk is quite enough to make some small sacrifices. There will be other Thanksgiving dinners, after all.

I doubt that the little one will appreciate Thanksgiving, coming to it a few days after birth. I should think that a happy second Thanksgiving is a better idea, and keep him home to make sure that he gets one. Whether the adults are disappointed at not seeing him would count as zero with me. But then I'm just a cranky old woman who nearly didn't survive a couple of flu pandemics in my youth.

It is a clear no-go. Risk/reward. Sorry to the relies, try Skype if you want a visit.

Anybody who gives you grief about this is thinking about themselves, not the baby. Fuck 'em.

I say you make it mandatory to get vaccinated to see the baby. It's for everyone's best interest.
This phrase: "They are not denialists, they just think the vaccines will make them sick. " does not compute, assuming they don't get anaphylaxis type reactions to egg or something.

My Dad and I were speculating about it. There's a good chance he's already had H1N1 (went to the Dr. and got tamiflu, but without a PCR who really knows...). He and my mother got sick just before they came out to help me with the newborn. I was worried about it, but the fevers had passed and they were feeling better and so on. I got a respiratory illness right after I gave birth. Amanda will probably get sick before baby _____. Assuming she's breastfeeding, that might not be such a bad thing. Most of the breastfeeding mommies I've talked to have said that babies tend to get a lighter version of some of the things they got, but tended not to get everything (at least, pre-daycare they didn't, and with the exception of ear infections for some kids). Probably mommy getting the antibodies first is good. Obviously, if she's vaccinated and breastfeeding, the odds are probably much better baby ____ will be safe, though I have no quantitative data.
So, anyway, my dad was speculating about it. He said "I was wondering if I should get vaccinated" (keeping in mind he may have already had it) and I said "well that depends, do you want baby to come home for Christmas?"
I've been getting seasonal flu vaccines for years, because I'd feel crummy if I went from work (at a medical center), drove the 12+ hour drive home and got all stressed and susceptible, and infected my older parents (who smoke and have respiratory issues, and yeah I've nagged at them to stop and yeah it'll never happen). If I do it for them, they can do it for baby.

Also, it was -23 degrees F below zero the day I was born. A very cold winter. My mom was a hermit and it was ok. OTOH, I imagine I would have gone completely nuts (moreso than as it was). See how Amanda feels when you get to that point.

Also, what little science I know suggests that the flu is one of the best for airborne dispersal. Seasonal flu spaceships love winter weather (one of the reasons they've speculated seasonal flu is so seasonal). I bet it hasn't been done for H1N1, but you're probably a smidge better in uncommonly humid weather (if droplets get too heavy I think the spaceships sink).

I'm no expert in anything other than telling people what to do, so I'll stick with that. Don't go. ONE person is enough to get your baby sick. Even if everyone's vaccinated, there are those for whom the vaccine won't work or who got it too late and don't realize they are sick, or feel like they might be sick but come anyway because "it's not that bad."
No. Just tell people you "don't think you'll be up to it" what with the new baby and all, and then don't go. And put up quarantine tape around your house.

My son was born 6 weeks premie, and was quite fragile for his first few months. I wouldn't let anyone near him who seemed to have a cold or hadn't been fully vaccinated for his first 3 months, or so. It mildly offended some people, but tough! this was *my baby* we were talking about.

Take lots of pictures and pass those around, not the baby.

I would also tell everyone, no matter who they are:

"if you are/were recently sick, do not come".
"If you were with someone recently who is/was recently sick, do not come".

No exceptions.

I agree with everyone else, don't do it. There will be time to have big dinners after the newborn phase. Also, you and Amanda are going to be tired. And, you will also be nervous about handing him off to all those germ carriers, or even having the germ carriers in his air space. Even if they don't have the flu, per se, who knows what else they could be breathing into his tiny, fragile, still developing lungs. This is what the internet is for. Send out pictures/announcements and tell your relations you're having a fine time getting to know your son, and they can just wait.

I'm kind of imagining that your wife will be a bit too tired for a large gathering, too. Personally, I'd skip the whole holiday.

Obviously I'm not a medical expert but I would go with a lot of the other commentators - virtual quarantine for Thanksgiving. Coming so soon after the baby's due date I just don't think it's a good time to be exposed.

The problem, as I see it, is not that a child is more likely to get sick at say 7 days rather than 7 months or 7 years. It's that if the child does get sick then the small size of a new born :

a) Gives the child that much less margin to fight off the infection.

b) Limits the options that medical staff have, should hospitalization be necessary.

My recommendation:

Enjoy Thanksgiving with just the three of you, plus a chicken. It's the only way to control the situation.

I think you made a serious flaw in strategy here. You are saying:

âHere, we are talking about my baby. If I had a hundred babies, I might not mind so much if two or three of them died of the fluâ

You should have said:

âHere, we are talking about my baby. If I had a hundred babies I would still hate to lose even a single one to the flu.â

You have just greatly reduced your chances of ever having a hundred babies. No self-respecting woman is going to choose a man who wonât care if her baby dies of the flu so long as he has plenty of extra ones.

Let me go on record here, that no matter how many babies I have, hundreds or even thousands, I would mind very much losing even a single one, and would take great pains to try and ensure that does not happen.

As the parent of a preemie born in March, do whatever makes you comfortable. If you are really worried about the baby getting sick (and it's a rational concern) then don't go and ignore all the people whose feelings will get hurt. (And they will be hurt, trust me on this one. Been there, done that, painted the spare bedroom 8 months ago.)

We have friends whose baby was born two weeks ago, also premature. And the grandparents are deeply insulted that our friends want to have a bris that's just family.

I mean, how *dare* the parents of a *premature infant* be concerned about pandemic flu???? Don't they know that the rights of adults to sneeze and cough on a preemie are paramount???

Idiots.

daedalus2u- This is going to sound horrible, but if I had 1000 babies, I wouldn't mind losing a few. I don't have 1000 nipples here.

daedalus2u = K-strategist

becca = r-strategist

Clearly, you have to put your baby's health first. I have no idea why people go on the "baby tour" shortly after a kid's birth -- though I wonder if maybe it's to confer onto the baby the sicknesses that are floating around in your population, to build immunity. Something like the "we kiss to pass immunity" hypothesis. Hmm.

Congratulations by the way! A while back I read an article about how expecting parents (both mom and dad) experienced increased levels of oxytocin, which leads to the OCD like behavior (like getting up in the middle of the night to see if child is breathing) which is protective and natural for new parents. (Sorry, I looked for the link, but can't find it).

Why? IMO it's because baby's and toddler's have an amazing ability to get sick and into trouble and you need OCD like symptoms to give them the minimal amount of safety (at least until preschool). (Maybe that's just my kids, though).

When I was younger, it was pretty much assumed that parents were not going to take newborns out into public (malls, parties, etc) If you wanted to see the baby, you called ahead to visit (in couples or small groups), you brought food and you expected the parents to be exhausted and you didn't hold the baby unless offered. Things seem different now, but my children were both adopted as toddlers, so I don't know.

I would not plan to have people over for the holidays. That is too much work and you can't control the situation. If you do want to make an appearance, make plans to attend someone elses small holiday gathering and make it clear you may not attend if you, child or mom aren't feeling up to it. If you decide to attend and you don't feel comfortable with someone holding the baby leave the baby in the carrier (if you have a sling or front carrier, you have even more control)and tell people "I just got him settled, I want to let him rest for a bit or we think she might be coming down with something, etc" If people are being too pushy, wrap it up and go home.

One phrase I found helpful. "The doctor says I shouldn't or should..." People find it very hard to fault a parent for listening to their pediatricians orders and they don't seem to take it as personally. I'm sure you can find a doctor who will tell you whatever you want if you don't feel like fibbing.

Personally (I may be horrifying many), I don't go in for the extreme version of anti-germ ultra cleanliness that some mom's are into these days (fabric protector's and sanitizer for every shopping cart). I think that it's good for kids to catch the occasional bug and eat the oreo that fell on the floor 30 seconds ago.

BUT this opinion does not apply to newborn and infants. Colds and flu are much riskier for them (I think. Once again don't have personal experience).

Best of Luck and Congrats again!

I remember reading advice somewhere to not have any meet-the-baby parties until this blows over (or possibly until the baby has had a flu shot). I don't know where I read it, though.

My sister-in-law just delivered her baby yesterday (Evi Sophie). I usually use the car to go to work, but this week I'm in training and commute by public transport. As a result, I'm not going there to look at my niece until I've had at least a couple of days in 'quarantine'.

I understand it's going to be hard on your family and friends, so you should try to make it up to them with lots of pictures and other promises. But keep as many of them as possible away from your son. If possible, don't put a message in the card itself, but use a separate insert. That way, you won't be reminded of the pandemic every time you see the card.

Perhaps you can get a doctor (family doctor, gynaecologist, obstetrician) to write up something for you, to act as a scapegoat so you cab be 'just the messenger.

Yes, I do find the one hundred babies comments and dead baby comments quite disturbing. Please stop it. You will give me nightmares. And you are killing my (mental image of a) sweet little baby face buzz.

Congratulations on your impending arrival. I suggest you offer the carrot of a baby blog (maybe make it private, password protected if you prefer) and keep it up to date so people have something to see what is happening. My family is all overseas so I've been babyblogging for nearly 2 years. Mainly for the grandparents at this stage, I think!

I agree with most of what has been said. You could also point out that the newborn stage is the least interesting stage to observe a baby in. Since there isn't much action, it's pretty well captured on film.

Your baby will be more interesting to observe when he is older. He also will be more interested in people later. You wll be more desperate for adult conversation and a pair of arms to park the baby in later.

This seems like a win-win situation. I'm not sure where everyone got the idea that the baby must be viewed immediately by everyone the parents know/ are related to.

Don't know what your wife's preferences are, but I was not eager to bring my baby into any sort of gathering during those first few weeks. This was not out of any rational calculation, but simply because I craved the quiet bonding with my newborn. When I did go out, it was without child. Both of my children were born in the middle of the winter, which gave me a great excuse to hide away with them.

How many? One.

The question is, "which one?" At which point you're doing statistics, and as I recall you can do those yourself.

HOWEVER stacking the deck is a Good Thing. Flu vaccination is Highly Recommended for pregnant women. What's better, they can provide passive immunity to infants both in utero and via lactation. Short of moving to a cave, this seems like an option worth considering.

I'm taking for granted that, since you plan to be in regular contact with Slightly Laden, you are yourself getting the shot (and as a caregiver you qualify as a priority.)

Okay, you DID ask for advice from healthcare folks -- my family's like the medical mafia, our dinner conversation is not for the squeamish, and I have kids who were both born during flu seasons . . . so here is the solicited advice.

You wrote: "Although the unvaccinated will be wearing those scary masks and everyone will be washing their hands every few minutes."

EVERYBODY needs to wear the scary mask (hey, they can draw a smiley face on the front, right? After everybody washes hands and the Sharpie is sprayed with Lysol, of course). Really the baby shouldn't be around a lot of people, but don't piss off the grandparents. ;-)

With a baby that young, you won't be having much of a Thanksgiving any way. Frankly y'all will probably be way too sleep-deprived to have or attend parties around the holidays any way.

Masks for everyone, and make sure everybody washes their hands, washes their hands, washes their hands for a loooong time with lots of soap and water and fresh towels. And spray doorknobs, phones, flush handles, faucets etc with disinfectant often.

If people get miffed, they'll have to get over it. You can always laugh it off as the anxiety of a new parent . . . as you hand them their mask and ask them to wash their hands vigorously.

Baby can socialize more broadly after he/she gets his/her own immunizations. And for FSM's sake, do not take the baby to the mall or in public places before baby gets those vaccinations. (Drives me crazy when I see brand new babies out in densely packed public spaces like that.)

Good luck, and I hope there's a follow-up post on how it goes. I'm sure new parents will appreciate hearing about that. Congrats!!

I can weigh in one this one with confidence as both a PICU and NICU nurse with many years of experience (having started when birds were still dinosaurs!). No, you should NOT take your newborn infant to a family gathering at this time. Not only are you risking other family members making your infant ill, you are risking making your older child ill, who may then pass it on to his beloved brother! Little children are bug factories with immature immune systems and can pass along 'gifts' while still appearing healthy themselves. As well as seasonal flu and the unwelcome H1N1, there is also the specter of RSV. While RSV can look like a mild cold in an adult,it can be devastating to an infant. I've cared for infants on ECMO from RSV (rare, but it happens). Ask your pediatrician about it.If the family is pissed off..tell them doctor's orders!

In all seriousness don't do it. Stay at home and rest. Maybe accept a basket of food if it is dropped off outside and the person dropping it off leaves before the door is opened. You can use the flu excuse, but stress reduction is the main goal.

Going through birth is an extreme stress. It needs to be recovered from even if the adverse effects are not immediately apparent. I think that physiology has evolved for women to hide how they feel just after giving birth, even from themselves (that makes hiding it from everyone else that much easier).

What any kind of stress does is reduce the rate of recovery. The early postpartum period is a time when a lot of things happen which are not fully understood. Postpartum depression and even psychosis are not uncommon and are going to be made worse (maybe even much worse) by any kind of stress.

Another way to perhaps get out of it is to ask if anyone has any good recipes for placenta. That you want to bring a "special" treat to the Thanksgiving meal.

daedalus2u wrote: "I think that physiology has evolved for women to hide how they feel just after giving birth, even from themselves (that makes hiding it from everyone else that much easier)."

Ay de mi. I must be incredibly unevolved then. I was sore, sleep-deprived and crabby. And this was not a secret from anyone, either.

However, Breyer's chocolate ice cream seemed to ease my stress significantly, as did the children's father taking childcare shifts.

I'm just sayin'.

This Breyer's chocolate ice cream thing is silly, and I happen to know it will simply not work for my wife at all.

Bryer's mint. That works.

Your wife should get vaccinated. Then, if the kid breastfeeds, her antibodies will protect him in the coming months.
I don't think that by Thanksgiving enough of the population will have been vaccinated and had time to mount a response for it to be safe for your kid to be around many people in November. I don't know how it is where you are, but in WI very few people have gotten the H1N1 vaccine and the school children will not be vaccinated until late November. Assume 7-9 days for the antibody response to come up. I think you're looking at Dec at the earliest assuming everybody gets vaccinated.

It seems to be that you are chosing between staying in the house with no visitors vs. going to a dinner with five or ten people, whereby you go before dinner and leave before food, or after dinner for a visit.

I would go for the second choice just to get out of the house but go early in the day so the virus carriers have not yet had a chance to spit on every single thing.

We have very few vaccines here. My wife is vaccinated for H1N1. They used up all the vaccine on the preggos, which is good, but the rest of us are starting to get jealous.

- As gwen pointed out, it's not just baby getting directly infected, but indirectly through family members.
- The more people the more fomite.
- I believe Revere covered a report early in the outbreak of (I think) an infected tour group where the interpersonal contacts were traced in great detail, and hinted at a strong aerosol component over a moderate distance.
- Even if people around were vaccinated, would it have taken, and had loong enough for them to develop an immune response? I don't know what vaccine availability situation is for you, but I don't see myself as even having the possibility of being vaccinated before Thanksgiving.

- Downside: Baby won't be able to be vaccinated for some time, and the flu season will, probably, only get worse.

@ Greg,

Well, we are at least agreed that Breyer's ice cream is the critical element here (aside of course from co-parenting).

I am not sure if her preference for mint over chocolate means that she is more or less evolved than I am. No doubt that would have the potential to spark off furious scientific debate, if there were any ice cream left.

Stay home for thanksgiving. Alone. Post videos of _____. EVERYONE WHO MATTERS WILL UNDERSTAND!. According to our ID docs at Regions, this virus is especially dangerous to children and young adults because it is causing a heightened immune/inflamatory response, which is typically strongest in the young and healthy. That's why the older and elderly are not being sickened so severly; their immune responses are weaker. It is the body's own chemical immune/inflamatory modulators that are doing the damage; the stronger the immune response, the worse the illness. That said, new babies do not have strong reactive immune systems, but they do have tiny tiny airways, and ANY inflamation is dangerous. BTW, many of us OTD people have lived thru a pandemic, called Polio. Nobody went anywhere with kids. I suspect you may be feeling bad about missing out on a wonderful opportunity to present your new baby to lots of important people in your life, and of course, why wouldn't you? Just not worth the worry, or worse. In my opinion. Hope everything continues to go well for you guys.

Tell them to google '4th trimester'. It's not just for your baby, but your baby's parents' sanity.

One of my happiest memories is of the look on the face of my elder daughter (then aged two and a half) when we let her hold her sister, then aged a bit less than one day. The look was of awe, joy and shear wonderment. Try not to deprive yourself of such moments.

Some years later when said elder daughter produced her daughter the hospital rules said only Mum, Dad and hospital staff could touch baby. I can understand that even though it meant doting grandparents had to wait until the child was at home. However, I will be disappointed if my granddaughter doesn't get a chance to hold her sibling the way her mother did.

When said granddaughter was about four months old, her mother found out there was a whooping cough epidemic in Sydney and said we couldn't see the granddaughter until we were immunised. (I had had whooping cough as a chiled and assumed I was immune, but apparently that is not the case.) However, there was no problem, just turn up at the doctor's, say, `I have a grandchild' and get it for free. (Similarly for the swine flu immunisation, there's no shortage here and it's free.)

Anne, I don't think you are less evolved than anyone else, you must have been in incredibly bad shape for you to only be "sore, sleep-deprived and crabby" and to feel safe enough to be able to share that with everyone around you. Hiding when you are in bad shape is SOP for most people and organisms. My ex hid what kind of shape she was in. It was only years later that she told me âshe almost diedâ.

Ice cream is good, it contains xanthine oxidoreductase which can reduce nitrate to nitrite to NO. More NO in the postpartum period is a good thing (within limits). Get lots of lettuce too (contains nitrate). A high NO and low stress status pre-infection will tend to reduce the severity of the cytokine storm (NO inhibits NFkB).

I heard on NPR this a.m. that young kids are not showing sufficient antibodies at 10 days and 21 days post H1N1 vaccination, so they will probably need TWO vaccinations, whereas pregnant women are fine with one.

I'd go for no more than a few people around the baby regularly for the first 8 weeks. Normally I'd say 6 weeks but with this pandemic it makes sense to expand it.

And I LOVE the idea of telling unvaccinated folks (unless they are allergic to eggs) that they can't hold or breath on the baby. We have GOT to start cracking down on all this anti-vaccine nuttiness.

If I had a newborn now, I'd have a big sign on my door saying, "No entry to anyone who has not had the H1N1 vaccine. No exceptions. Thanks for understanding." And stick to it.

I agree with the 'quarantine the baby and take lots of pictures to share' theme. However, don't forget the possibility the baby may not be ready to come out until after the holiday. So you may get to go after all.

First, many congratulations.

Second, screw the flu - think of Amanda. Assuming that young (insert name here) arrives on time, by November 25th Amanda will have been out of the hospital for only 2 maybe 3, days. She'll be smack in the middle of her hormonal letdown, tired, probably cranky, and probably not up to having crowds invading her personal space.

Third, back to the flu - keep away from anyone who even might be sick for at least two weeks after the birth. Chances are little (insert name here) would be fine, but that's not a lottery you want to buy a ticket in.

Best wishes

Lee Harrison

(PS - don't worry about pissing off grandparents. If they are ill, make them keep away - they'll do it gladly and be every bit as happily gooey when they get better and finally get to see the evolutionary fruit of their respective ancestral loins.)

Just as an aside, with all the talk of staying at home and away from people, anyone staying at home without visitors for weeks, possibly months, with a baby will go insane. All that miraculousness and wonder only goes so far.

Schedule things so the primary caregiver can go out and hang with friends, go to the mall, gym, whatever. Even better if you can get someone to watch baby occasionally during nap to nip out together for lunch a walk or something.

Even without hormone shifts the change from being out working with people to being home and isolated can be very depressing.

You're due the 20th. Thanksgiving is, in the States, on the 26th (if I'm not mistaken). The average primip goes 8 days overdue, which means you may very well still be expecting for the grand event. Your wife should get vaccinated now if she isn't already, because pregnant women in their 3rd trimester are at 5x greater risk of hospitalization with H1N1. This risk continues to one month post-partum (because your immune system doesn't snap back like an elastic with the birth of the baby, obviously).

So, if you're still pregnant and you don't have to travel far, and she's been vaccinated at least 10 days prior, go to the dinner.

If you've had the baby and you're less than two weeks post-partum, DO NOT GO. I'd say this even if there wasn't a pandemic. This is not only for the baby's health but for that of your wife. Women often think they should get right back into normal activities after giving birth, and many of those that do, get sick. She's still at risk for post-partum hemmorhage in that period, is likely to be seriously sleep-deprived (you, too -- baby won't have figured out days and nights yet) and you both will still be adjusting to this new life of yours. You're going to be exhausted. Breastfeeding starts around 4 days post-partum and then she'll be at risk for mastitis (which happens more often when women are tired and trying to do too much). Mastitis looks exactly like the flu, FYI.

So... even if you both feel great, take it easy. Rest. Enjoy your baby-moon. :) Your wife will have just gone through a tremendous physical ordeal, pandemic or no. You're all at greater risk for H1N1, and anyone who badmouths you for cloistering your family at home for a bit is definitely not worth listening to.

Heather: The average primip goes 8 days overdue, which means you may very well still be expecting for the grand event.

We are hoping for later for a number of reasons, but on Thursday the midwife noted that Amanda is quite effaced and said with some certainty "You will deliver before your due date"... so, well, whatever.

Regarding vaccinationfor H1N1 ... Amanda got that.

Two weeks seems to be emerging as a cutoff point.

I've seen mastitis, and I've seen women die from it.

Several caveats here, firat don't take medical advice off the internet. There are regional differences in swine flu distribution and the circumstances around your baby can make very large differences in care. Second caveat is I am only a medical student so my knowledge is much more academic then experianced. Really ask your pediatrician about what would be best. However, as mentioned new born babies aquire the mother's antibodies. She should be vaccinated which protects against aquiring the disease, but also makes the illness much less severe. So the odds of a dead baby are low very low. I would be much more worried about an unvaccinated toddler or even child at such a gathering. Likewise and this is in agreement with the above we tend to worry about the exotic low risk crcumstances then the familar much more likely outcomes. Post-partum depression should be much more of a concern then swine flu. If the two of you would like to see a few people during Thanksgiving then that should be fine just take care of each other, and do whatever you can to help her through a difficult stressful but amazing time. Congratulations

I agree with the folks who say screw the flu angle, just don't go because both of you are going to be exhausted. It's entirely true (you will be: the delivery is just the beginning, and babies don't know from clocks) and it sidesteps all people who will want to show what good hygiene they are capable of.

You will have to continue to deal with this through many more months, even after flu season. Get used to saying with a smile, "Nice of you to stop by to see the baby, hand soap and towels are by the sink." Be prepared to repeat it, too.

Congratulations on the pending new arrival.

How about setting up a baby cam at home and a monitor in the main gather room where family can go and watch him/her and a donate button so folks can oogle the dear one from a safe distance and help start his/her college fund at the same time?

My vote. Do not take your newborn to a family gathering mere days after birth. Not only for baby's sake, but for mommy's as well. Trust me, sitting and yakking for hours is NOT going to be something she is really up for yet.

Skip the celebration until next year.

Even when H1N1 is not factored in, anyone who won't give a pass to a woman who went through childbirth the week before a huge family celebration is a jerk.

Congrats!
I recommend the chinese approach
keep the baby I side and away from everyone for 4 weeks

I agree with MS2 "Post-partum depression should be much more of a concern then swine flu" so skip thanksgiving, but don't let swine flu fears trap Amanda inside and alone.

I'm thinking, gee, wouldn't it be wonderful if someone were to announce they don't want flu carriers at the Turkey Day fest, and so I'd have a perfect excuse to stay home, eat my own turkey, send felicitations to everyone and avoid the crush. You might be more popular than you imagine if you put limits on who can visit . . .

But you ask:

What do you think we should we do?

Isn't it obvious? You say you'd be less concerned if you had a hundred babies. You need to acquire 99 more kids by Thanksgiving.

My wife & I have an almost-5-month-old little girl, who's probably the most adorable baby on the planet at the moment, sleeping against my chest in the carrying sling while I type this. Which is to say, I know where you're coming from with the "just one" mantra....

Even before the pandemic fired up, we kept her generally away from the public; very few visitors, and (even in France, where normally there's a lot more kissing) neighbors and friends have been increasingly careful about protecting her from possible exposure to anything nasty. We get out of the house all the time (at a bare minimum, she comes with me to walk the dog); we just don't usually go near people.

We had planned a grand voyage this month to go see her three grandparents who can't travel to visit us -- two in Malaysia and one in the US -- plus other loved ones in both places. We were a bit hesitant about the plan to begin with; the pandemic pushed the idea off the cliff (the airports... the long hours in closed airplanes... and the assholes who just *have* to travel even though it's blazingly obvious they're coming down with something horribly contagious).

So, are family members sad we aren't coming? Sure, but everyone has encouraged us to stay home -- and we're doing what we can to bridge the distance with live video, videos online, and lots of photos and phone calls.

That's better than just a short visit, anyway -- they are getting to see her change and grow, not just the one possibly-cranky moment when they happened to be physically there.

If anyone does object, just be sympathetic and drop some magic phrases like "pandemic", "possibly fatal", "undeveloped immune system" and "our pediatrician was pretty emphatic about it".

I'll echo the advice to breastfeed, as well, though it can certainly be a PITA to get started. My wife & I both came down with an unpleasant cold one after the other about a month after the birth (due to lack of sleep, etc...) and the baby never showed signs of it at all, despite being inundated by our germs; my understanding is the breastfeeding was the main protection as work there.

I'm not sure where the "two weeks" thing came from in other comments; our pediatrician basically just told us at our last visit (@ 4 months) that if we were bottle-feeding we didn't have to sterilize it anymore. Right now is about when I'd normally be putting her into gradually more contact with the public; we're just putting it off a bit until after the flu gets under control.

Good luck and courage!

How many people does it take: Just ONE person in the early stages of flu ... the virus shedding but not yet feeling bad stage is all it takes.

I vote for staying home and having a quiet moment of bonding with the infant and re-bonding with your wife.

Before our firstborn was born, we read somewhere a suggestion that said something like 'Make sure you get the first two weeks to yourselves to get used to being a family - things will be difficult enough without entertaining every man and his dog'. How true that was. We had *no idea* how physically exhausting the first few weeks, (months actually) could be. But guess what? My wonderful inlaws took exception to our right to decide what to do with our own lives and our baby and effectively cut us off. In week two, when I called the inlaws specifically to invite them up, my sister-in-law was "too busy". They've been too busy now for 16 (sixteen) years. So I can best repeat the sound advice given by 'Stephanie Z' at #4 :
"Anybody who gives you grief about this is thinking about themselves, not the baby. Fuck 'em."
but ... caveat, the repercussions could last them a long, long time. And no, I don't miss them.
Bob

Even if H1N1 weren't going around, I wouldn't bring a < 1 week baby to a big family gathering. For lots of reasons. One is the infectious disease issue (and it's not like H1N1 influenza is the only thing going around). But there's also the fact that the kid will get absolutely nothing out of it, is too young to interact in any meaningful way with what to him/her are just a bunch of total strangers, and will likely not even have a good feeding routine established yet anyway. What's more, *you* will likely be far too exhausted to appreciate the party, given that your baby will not yet be sleeping through the night and indeed will still be adjusting to the very concepts of "day" and "night". Even if the party is completely sterile, it'd be tough to enjoy more than a brief visit with a brand new baby.

One month, then they get to where they'll sleep through the party and it's fun. But at least with my two babies, those first two weeks were rough. It was hard just to make *myself* presentable, to say nothing of the baby. ;-)

Isn't it obvious? You say you'd be less concerned if you had a hundred babies. You need to acquire 99 more kids by Thanksgiving.

Ladies and gentlemen, we have a winner!

Sounds like a great plot for a movie too. Kids would be difficult, though. How about dogs? Dalmatians, perhaps?

Newborns are boring. They just sleep and bide their time, waiting for other people to sleep so they can scream.

Get a doll. No-one will be able to tell the difference. It's win-win.

Errr, get a doll for the family to coo over, I mean. Not get rid of the real kid. You need to keep that one, obviously. They get better over time.

At 6 weeks (s)he may start to smile. It will be all that saves the critter's life, in my experience. Evolution knows that this is the point that woods, wolves, and the appeasement of the old gods are thoughts entering a parent's mind.

Hi, Greg. Just to chime in from a medical (nurse-midwife) point of view: Stay home and rest. We used to try to encourage our patients to be "Princess" for a week, if not two, depending on family help. That meant they ate, slept, breastfed and relaxed. Someone else did the cooking, cleaning and laundry. Mom and baby get a good start on breastfeeding, mom stays rested so she stays healthy, and dad gets to enjoy the happiness of a rested and calm mom and baby.

H1N1 aside, you just don't need the extra company. I had a baby in mid October and STILL had trouble dealing with Thanksgiving company. Make them wait till next Thanksgiving.

In my family, coming out for a baby generally seems to occur at about six months, and rather than being a big gathering, it takes more the form of a trip where the parents go and visit all the other relatives and grandmothers, great aunties and experienced aunties take care of the baby while they get a good night's sleep on the couch. Works for everyone and you can avoid risks on a case-by-case basis.

In no way should you and your newborn be expected to show. Every person is a potential infection vector for your baby. H1N1 and flu viruses can both be life threatening for your baby at its age. The best thing you can do for it is have your wife get both flu and H1N1 vaccinations shortly after she has recovered from the pregnancy, and then BREASTFEED the baby so he/she can pick up the anti-bodies from the milk. There are plenty of studies out there that show breastfeeding your kid reduces their chance of being sick for the first 6 months.

Also I forgot to comment that you and your wife should not go yourselves as well. Weeks 1-2 you should consider your wife as "recovering". Also for each person you come in contact with, you become a potential disease carrier for your child. I don't mean to put a barrier between you and society (that's just silly), but you should become more aware of who around you is sick. You can not protect your baby from everything, but you can make the smart plays when it comes to intervening between you and your baby. Hand sanitizer is a must this winter.

I also like the idea of telling the unvaccinated to stay away. One of the consequences of that decision (assuming they aren't allergic or otherwise unable to get it, of course) is that they knowingly put others at risk.

And one of the consequences of putting other people at risk is that they aren't as nice to you as you might like them to be.

Leni (and other who have said similar things): Yes, absolutely. In our case, relatives once informed of the situation immediately became pro-vaccine. However, THEY RAN OUT OF VACCINE!!!!11!!

So, what do we do now????

Enjoy a quiet holiday? It'll be the last one for a long time.

Stay home, get rest, e-mail 'em baby pictures, insist that the paediatrician said to be cautious. You'll be exhausted.

I also second breastfeeding if possible: it might be a little hard to get started, but its wonderful to have milk warm and ready without even getting out of bed or scrubbing bottles afterwards. Your contribution can be to get out of bed and bring the baby to mother.

The La Leche League has experienced mothers who will share advice and experiences with new mothers and help them to breastfeed successfully.

One of the best things for new mothers is to have someone else take over for a few hours so they can sleep or take care of themselves; also to be taken out for a drive or walk and to see some adult faces.

Best of luck to you all!

Oh, yeah. Flu particles can become airborne just from someone talking.

I am and have been quite the germaphobe for years. I have raised 5 children and all healthy to date. When my first was born, she's 23 now. I can still rememeber the day I took her home and had only three relatives at the house and they were poking and prodding my child. I started balling and asked them to go home. I spent countless hours a day cleaning and washing my hands until they were raw. I did lighten up by the time my youngest was born (she's almost 11 now). At that time there was not an flu pandemic happening.(I guess I was a bit extreme)

I think that we can't help if we are unfortunate to fall ill to H1N1, but we can do everything possible to minimize the risks. I certainly would have no problem letting people know that I wasn't comfortable with company. I think, if it is, so incredibly important that they come over, than I would mandate visitation only to those who have been vaccinated or had a confirmed case of H1N1 and had at least 3 weeks to have developed immunity to it. I would also limit the numbers to those you feel it is important for your newborn to eventually build a life long relationship with. Upon entering your home I would ask them to wear a mask and wash and sanitize their hands. I would not allow them to hold the baby, just look at it. This seems extreme I know, but I think better to have the child around to have and hold later then to lose that incredible apportunity. When children go through the oral fixation phase and start crawling around on the floor, that is indicative that thier bodies are ready to start building immunity to all kinds of viruses and infections. Until that day comes, keep your child safe, you have an obligation to do that as a parent and being afraid of an uncomfortable situation that might hurt the feelings of others is really thier problem not yours.

On another note, I have a friend who just had a baby. She actually went to the hospital two weeks before she was due because she thought she might have H1N1. Turned out she didn't have it, but she ended up needing an emergency C-section for another reason and had a healthy baby boy. During that time it was our (Canadian) Thanksgiving and of course the whole family was excited to see that new baby. She and the baby were quarantined until the test results came back negative and the family just had to accept that and they did. There was a baby shower planned for the 14th of November and I just talked to her today and she informed me that the shower has been cancelled because it just isn't worth the risk. I stand behind her decision 100%.

Good luck to you in dealing with the situation. On Thanksgiving you and your husband and newborn should be thankful all by yourselves, have a great dinner.

Do NOT under any circumstances go!! In fact, plan on skipping Xmas and New Years. Our baby was in the hospital for four days at 2 months old with RSV. Google it, it's not fun by any means and us scary as hell for mom. A child under three months with any fever is basically instantly rushed to the hospital because they have NO immune system with which to fight off anything. We didn't take our baby out or anything, but drew the short straw in that my husband who rides the train probably brought it home with him. It was horrible and I caution any parents who have winter babies to make like bears and hibernate. It's sooooo not worth watching the nurses come in every two hours to use the suction hose attached to the wall to suck the snot out of your baby so he can breath. No no no no no!! STAY HOME!!!

How do we know how bad the Swine Flu is so far?

gregladen — Sat, 31 Oct 2009 10:02:53 +0000

How do we know how bad the Swine Flu is so far?

I spent about 45 minutes yesterday in the local HMO clinic. They had turned the main waiting room into a Pandemic Novel A/H1N1 Swine (nee Mexican) Influenza quarantine area, and I could feel the flu viruses poking at my skin looking for a way in the whole time I was there.

Amanda, who is 8.3 months pregnant, started getting symptoms of the flu two days ago. As a high school teacher in a school being affected in a state being affected (as most are) she is at high risk for this. She was one of the first people around here to get the vaccine, just a couple of days ago, but it takes about 10 days to take full effect, so it was recommended that she go on Tamiflu for a while.

Tamiflu seems to not work very well against the current (or should I say expected) seasonal flu, but it appears that the Pandemic Swine Flu has virtually no resistance to it. And it normally works fast. Within 24 hours Amanda's symptoms disappeared. There are three possible explanations for that:

Utter chance;
Tamiflu did it's thing; or
The Tamiflu pill was actually a sugar pill with an especially strong Placebo effect.

Today, Amanda and many many other teachers from across the country are meeting at the national Science Teachers Association. So any mixing up and spreading of the flu that the students have not yet accomplished will be compensated for by the teachers exchanging the virus today and over the weekend. But Amanda has her Tamiflu and the vaccine, so she should be fine. I may ask her to take some extra placebo tonight with dinner.

In the next iteration of a pandemic, we should be providing vaccine for free at conferences and conventions. (Maybe we're doing that now.... anybody know?)

There are three things you should read on the internet this morning about the flu, vaccines, and related issues:

1) Swine flu: How bad was the first wave?

This is by Revere, and it covers a paper just published in expedited form, OpenAccess, so you can read it yourself. I'll have a few comments to make about this paper below, but the best summary of its results is Revere's post at Effect Measure.

Then there are these two items by Orac and and James Hrynyshyn, respectively, on related issues: 2) The anti-vaccine movement strikes back using misogyny and 3) The link between the climate denial and anti-vaccine crowds

OK, now, about this flu paper. My comments are restricted to two aspects of the method used in this paper, and all I really want to do is add a little to your comfort level in relation to these methods. These are methods commonly used in my own fields of research (including archaeology) and that I've thought a bit about and taught in various classes, and I've found that people, once they start to learn about them, get all freaked out and refuse to believe that they are of any use. The methods are, to adopt terminology for this post that may not be reflected perfectly in the paper at hand, extrapolation and resampling.

Resampling first. Bootstrapping is also known, depending on its implementation, as Monte Carlo Simulation, Resampling, or just Simulation. There are other terms as well. It is probably best to consider them all under the heading "Resampling."

To really understand the value of resampling, it is best to start with a concept of the inadequacy of normal parametric statistics. What the heck does that mean? At the risk of oversimplifying.... Let's say you have calculated two averages and you want to find out if it is statistically OK for you to say that they are different ... that they are averages of different populations, instead of two numbers that look different but only for random reasons. So you take the averages, the difference between them, and some kind of estimate of the variation in the population(s) you think you are sampling, and the number of samples you took to get the average.

If the two numbers are farther apart, you can have more confidence that they are different. If the amount of variation in the actual populations you are sampling is low, then you can have more confidence that they are different. If the number of samples you've taken is greater, you can have greater confidence that they are different.

Standard statistical methods evaluate this information ... difference between means, variation in the population, and size of your sample(s), to give you a couple of numbers you can use to determine if it is statistically valid to say that the numbers are different.

But, there is a problem with this. In order for out of the box statistical methods to be used to do this, there has to be a number of assumptions made about the underlying distributions of the population(s) you are looking at. For instance, it is common to assume that these populations are "normally distributed" (like a bell curve) or that they follow some other standard, well studied distribution. So, you plug the numbers you have ... the means or the difference between them, the info on variance, and the sample size ... and those parameters are evaluated by magic statistical formulas built into computer programs in relation to some pre-existing model using distributions and statistics derived from earlier study with those distributions.

Often that works well because the previously studied distributions, and the relationships between the numbers and the distributions and stuff tends to be the same time after time. If you are studying the behavior of a roulette wheel, the frequency over time of raindrops falling into a bucket, people getting the flu, Russian soldiers getting killed by their horses, the distribution of stars in the sky, and so on, you may be able to use research on the distributions and statistical measures (and their interactions) carefully carried out on one or two of these phenomena to develop shortcuts to apply in the other situations.

And that is the crux of what I want to say: Standard statistical tests (the z-test, the t-test, the F-test, chi-square statistics, etc. etc.) whether they be "parametric" or "non-parametric" are all shortcuts.

The reason these shortcuts exist is because it is impossible to take thousands or tens of thousands of data points, analyze them to determine the nature of the distributions they represent, then use those discovered empirically based situationally dependent distributions to calculate test statistics and confidence intervals and stuff.

Unless, of course, we had a machine to do this! If only we had a machine into which we could put all the data, and then this machine would do calculations on the data!

Yes, folks, with modern computers it is quite straight forward to replace the old fashioned shortcuts with a brute force, direct analysis of actual data which produces (using proper methods and theory) much much better statistics than before.

I want to re-explain this two more ways keeping in mind that I'm still oversimplifying.

1) Here is the actual sequence of events one would like to do in statistical analysis.

a) Formulate a hypothesis about some numbers.

b) Fully analyze the distributional context of those numbers ... are the populations they come from uniformly distributed? skewed? unary (only one possible number can be obtained no matter how often you sample it)? distributed like a bell curve?

c) Calculate the parameters of the actual distribution linked to the actual numbers you are using.

d) Calculate the actual probability related to your hypothesis, such as "the probability that these two numbers I say are different are actually drawn form the same population and only look different because of the nature of the distributions I analyzed in step 'b' is ..."

Here's what really happens in traditional statistical analysis:

a) Some guy, like two hundred years ago, gets interested in numbers and creates idealized distributions of things and figures out that there are some interesting relationships between and among them.

b) Some other guys, over the next couple of centuries, do the same thing with a bunch of other phenomena and come up with a handful of additional relationship types. Having no computers for any of this, that was hard.

c) Meanwhile, people figure out how to take this handful of distribution sets and use then to estimate what may or may not be going on with a particular data set. But each time one must worry about the degree to which one's own data matches the original distribution on which a certain test statistic is based. Over time, people forget what the original distributions even were, and begin to fetishize them. For instance, the degree to which one's data behave just like Russian Army horses' tendency to kick soldiers to death becomes a matter of great angst and consternation, especially in graduate school.

d) Individual researchers learn which other researchers to emulate, and then they just do what they do and hope nothing goes wrong. The important thing is the p-value anyway.

Here is how resampling works:

a) All of the above is compressed into a single analysis of your actual data.

The distributional behavior of your data is determined by taking repeated random samples of the data (with replacement). Perhaps you will do this at several sample sizes. The result tells you how badly wrong your hypothesis can be ... and if the answer is "not to bad" then your good. (This is all done with numbers, of course.)

2) For my second parable, imagine that you are in a situation that has nothing to do with statistics but requires you to make a decision. It is complex. The situation is unique although is falls into a known category of situations. So, you go to an experienced expert in this kind of situatoi and you describe only the basic outline, leaving out all details, and ask the expert what she would normally do in this situation.

The expert replies "Well, I don't know the details, but generally, in this situation, I'd punt (or whatever)."

Alternatively, you are facing the same situation. So you get the expert (from above) and bring them to wherever it is you are working on this. The expert gets to see the exact situation you are in, and how your situation differs from the typical situation. Based on all the information, she draws a very different conclusion than above because there are particulars that matter.

"Don't punt (or whatever)."

Which would you prefer? The first scenario is your data in a t-test. The second scenario is your data bootstrapped.

The second analytical techniques talked about in the paper covered by Revere is extrapolation. Obviously, extrapolation is dangerous and scary. Which would you feel more comfortable with:

1) Estimate the percentage of people who are sick in the hospital with a possible flu who require IV fluids in a particular hosptical in United States. You are given given data on number of people who walk into a hospital with flu-like symptoms, and the number of these people who get IV's, for five one week periods distributed evenly across the flu season in ten randomly chosen hospitals plus the one you are charged to calculate this number for. In other words, you are having a statistician's wet dream.

2) Estimate the number of people who have the flu in the United states for a given flu season based on the number of IV's doled out to patients in ten randomly chosen hospitals. You are now having a statistician's nightmare.

Or, consider this somewhat cleaner comparison:

You must dig a hole into which will be placed the the concrete base for a gate you hope to have in a fence you are installing in your yard.

1) All of the fence posts are in place, and you are told to put the gate post half way between two of the posts.

2) None of the fence posts are in place, and you are told to measure a line that is 47.5 feet from the NW corner of your house at bearing 312 degrees. You are not quite sure what is meant by "corner" of your house because your foundation has a vertical jog in it, and the original measurement may have been from the siding and not the foundation. Your compass sucks. You are not sure if this is 312 degrees off magnetic north or true north. You don't have a tape measure that long. And so on.

Taking numbers that are fairly good numbers and dividing them up, looking within their ranges, breaking them into bits, is interpolation, and that can be done fairly accurately. Extending numbers outward long 'distances' (sometimes real distances, sometimes time, sometimes frequencies, etc.) involves a lot more uncertainty. That is what you see in the flu paper. The authors use appropriate techniques, and you will see that the range of numbers they conclude in answer to the question proposed in the title of the paper is quite large ... that is because it is extrapolation that they are using, but these numbers are well confirmed by a kind of resampling.

How well all this works depends, as usual, on the question you are asking. One time I needed to find out if a particular house was made of brick vs. timber. The remote farm house had been torn down and most of the debris seemed to be dumped in the cellar hole. There were a lot of bricks, but there would have been one or two chimneys in a frame house. Also, a frame house could be "nogged" which is where clunkers and seconds (low quality bricks) are used to fill in between the timbers. Or, it oculd have been a brick house.

So, I did two things. Using the foundation size and what was known for houses at the time, I estimated how many bricks would be used for the following:

A two story brick house
A one story brick house
A two story nogged house
A one story nogged house
A two story house with a brick chimney
A one story house with a brick chimney

Separately, I weighed all the bricks we dug up in several holes, and extrapolated that number to estimate how many bricks would likely be found if we dug up the whole property. I came up with a number closest to choice 5: One chimney on one story frame house.

I did not need to know the actual number of bricks. What I needed to know was which of the plausible alternatives the estimate of brick quantity matched most closely. For the flu, it may be enough at this time to know if the Swine Flu is like the seasonal flu, not nearly as bad, much worse, etc.

Confidence can be increased in extrapolation with confirming evidence. In the case of the farm house, I counted the number of brick faces that were heavily charred (from being inside the chimney) and found that this number relative to uncharred faces was a very high. This suggests a fireplace. I noted that the bricks were mostly in one area of the foundation like maybe there was a chimney there. That suggests the chimney idea is more likely than the other ideas. And, I noted that most houses built in Saugerties NY in the 1870s were one story unnogged timber with brick chimneys. Had I started with that last observation and drew conclusions I might be guilty of confirmation bias. But instead, I ended with it, and got reasonable confirmation.

The first estimate was truly unworthy .... I could have been way far off with the brick count for a lot of reasons, and I had to make a lot of assumptions (we had not dug very many holes!). But the ratio of burned surfaces was an independent confirmation, and the conclusion was not unexpected. So, I was able to argue against confirmation bias (finding what we expected) and put this house down in the data base as yet another timber framed farm house.

Extrapolation is dangerous. Ask any Marine artillery forward observer you may happen to know, because it is what they do, but they do it with bombs and a misplaced bomb may fall right on him or herself, or a nearby baby food factory, or some other thing you don't want to drop a bomb on. But with strong empirical background, experience, good theory, and independent confirmation it works. Or at least, it is often the best we can do and our best is good enough.

Reed, C, Angulo, F., Swerdow, D, Lipsitch, M, Meltzer, M, Jeernigan, F., & Harvard School of Public Health (2009). Estimates of the Prevalence of Pandemic (H1N1) 2009, United States, April-July 2009
Emerging Infectiou Diseases, 15 (11)

gregladen Sat, 10/31/2009 - 06:02

Tags

this post made me giddy
in all the meanings of the word.

thanks.

It was an interesting essay. BTW, have you read Christine Soares' "Pandemic Payoff" in the November Scientific American. She has a few things to say on why the epidemic has been so mild and focused on the young.

The scary part is that my SO didn't get his flu shot (they're still doing high-risk population segments) before kiting off to compete in a large-scale event in the U.S. Sp I'm glad to hear that Tamiflu seems to be effective on the U.S. variety of Mexican swine flu. Amanda was wise to hit the Tamiflu early because this flu is very harsh on women in late pregnancy, with their reduced lung capacity.

Prussian soldiers...

I am also giddy from reading parts of this. Perhaps the author nwould do well to get some of those bladders full of nitrous oxide and give a speech in the park?

"Bootstrapping is also known, depending on its implementation, as Monte Carlo Simulation, Resampling, or just Simulation."

Bootstrapping IS a resampling method, but simulation to me implies that new data is generated - e.g. you come up with a model for your data and then generate a bunch of data on your computer and compare the distribution of test statistics on that simulated data to the test statistics on your actual data. Some people may call bootstrapping "simulation," but that makes me cringe. I guess I just like words to have more precise meanings.

Why is the swine flu vaccine so late? Who are you to ask such a question?

ddobbs — Mon, 26 Oct 2009 07:43:23 +0000

Why is the swine flu vaccine so late? Who are you to ask such a question?

In a disturbing post at ScienceInsider, Jon Cohen and Martin Enserink explain why the swine flu vaccine is running so late. Or at least they try to explain why it's so late. For while all the suppliers are running into problems, we're not allowed to know what they are.

The delays are substantial and critical. They leave us naked as the flu spreads through the country. The flu has now killed 1000 people, over 100 of them children. Even as this happens, the delivery dates keep moving back and the delivery amounts keep shrinking. As recently as a month ago, the CDC was telling us that we'd have 40 million doses by the end of this month. Last week, they were saying 30 million doses. Now they're saying 16 million doses and not making any promises beyond that.

The U.S. contracted with five companies to supply vaccine. Only one, MedImmune -- the company supplying the adjuvanted FluMist product -- has come close to its promised delivery schedule. But because we're so leery of adjuvanted product, we ordered only 12.8 million doses from MedImmune. The other four companies, meanwhile, are all running badly behind. Why? When ScienceInsider pressed Nicole Lurie, the assistant secretary for preparedness and response at HHS, for answers, she essentially she couldn't say.

For proprietary reasons, Lurie would not name the delay issues at each manufacturer, but said "one company was just really overoptimistic" in its delivery predictions to HHS. Initially, all of the makers of inactivated vaccine had trouble with the "potency assay" used to ensure that 15 micrograms of influenza antigens are present in each dose. Once that was corrected, said Lurie, this company lost 20% to 35% of its antigen during the "recalibration." Unfortunately, said Lurie, the company did not notify HHS of the problem. "They thought they were going to compensate by getting their yield up but they never let us know," she said. "When we learned of problem, it was over and there was nothing we could do, which is too bad because we could have helped."
After Columbus Day on 12 October, HHS learned about delays at two of the other companies. One had a new production line to fill doses of vaccine into individual syringes. "Getting up the new production lines with prefilled syringes was really slow," Lurie said. The third company had "major production problems" that Lurie said she could not describe in detail for proprietary reasons. Basically they had difficulty making "acceptable" vaccine that did not contain an immune booster called an adjuvant, which is used in several countries but not the United States.

The final company wanted to supply its own country with vaccine before shipping product to the United States, which Lurie said would begin next week. She did not identify the company, but Australia's CSL earlier said it would supply its country before exporting the product.

Given the drug industry's recent problems with what one might generously call overpromising (and with what Lurie here even more generously calls "overoptimism"), this is troubling. We contracted with four companies, and each of the four was apparently either overoptimistic or misleading in its delivery predictions. The CDC apparently found them convincing -- and was apparently left blind to the delays until the companies revealed them at a very late hour. The CDC now tells us simultaneously that no one could have foreseen the problems, for they came (at four different companies) from a perfect storm, or four perfect storms -- and that these perfect storms are all to be expected, because this is vaccines, and vaccines are slow and glitchy.

If they have so much experience making the product [asked ScienceInsider], why so many snafus with the pandemic vaccine? "Almost every flu season, something goes wrong," said Lurie, emphasizing that she was referring to manufacturing, not safety.

I don't think the CDC is conniving here. But it appears it has let itself be misled by an industry that has a remarkably well-known record of misleading. It remains unexplained how this industry enjoys so strong a presumption of goodwill and integrity that even in a supply issue so directly vital to public health, we're not allowed to know more about what slowing things down. I like industrial secrets as much as the next person. Doubtless these companies must keep certain hard-won information under wraps. But it would seem that when tens of millions of doses of vaccine are weeks late, leaving a country exposed to a fairly dangerous virus, we might get something more specific than that one company was overoptimistic and another had trouble filling syringes.

In a way, this is to be expected, for most people in virology and public health recognize that our conventional mode of making vaccines is outmoded and is no match for pandemic viruses. A six-month production schedule -- six months when everything goes well -- is no match for a virus that can go global in weeks.

So one big question is whether this shortfall -- which would be catastrophic if this flu did its ugliest job on even, say, 5 percent more of the infected -- will inspire a serious move toward other strategies. Nonadjuvanted vaccines, for instance, can get to more people sort of quickly, and other vaccines in development, such as those built by via cell culture or modeling or with virus-like particles, can be made much more quickly. But how vigorously will we pursue these? There's a risk that simply because this flu is so far not killing vast numbers of people, the existing complacency about the threat of pandemics will couple with the antipathy or apathy about vaccines to leave the current inadequate system in place.. "Well, that wasn't so bad, even though the vaccines were late. The strategy worked." Combine that with the veil of proprietary secrecy over the production delays, and you get a formula not for better vaccines, but for simply trying the same strategy next time.

In short, if we care so little about the delays, and about vaccines in general, to accept that these delays were simply a bad-luck "perfect storm" (even while being to-be-expected), then we're less likely to put in place something much better for next time. The conventional egg-based vaccine approach isn't working for flu. It's too slow, too glitchy -- and apparently not terribly accountable. We've spent a lot of money and invested a lot of hope in vaccines that are getting here too late. If this holds up and is not seen as a major failure needing correction, we're missing what at this point appears to be a learning opportunity that is vital but relatively inexpensive -- if, that is, you can call thousands of deaths inexpensive.

ddobbs Mon, 10/26/2009 - 03:43

Tags

medicine

Pharma

public health

Viruses, flu, & immunology

I don't believe for one minute that the problems these companies were experiencing had anything to do with "proprietary" processes - this is simply their way of covering up manufacturing screw-ups (just as governments like to cover mistakes with "classified top secret" labels).

I also don't believe that there was nothing the CDC could have done to prevent this. While I have not researched this, I would be surprised if the CDC did not have the power the require prompt disclosure of manufacturing shortfalls or delays - for example: requiring the companies to disclose the results of their potency surveys. If the CDC does not currently have such power, they should certainly write it into the next set of similar contracts.

The whole thing sounds like a classic case of the regulator getting much too comfortable with the regulated.

I completely believe the causes of these delays are proprietary in nature; these companies will patent anything they possibly can, and with good reason. They need those secrets to make money.
What I don't understand is how they could possibly be "overoptimistic." Biological samples are notoriously finicky. Anybody who knows what they're doing should be pessimistic almost to a fault. If I'm doing lab work that tells me I'm going to get 80% return of a sample, I just assume I'm getting 50% back at most and count myself lucky if I get even that. That these companies did not operate under the same assumptions is astounding to me.

I'm dubious of the whole thing. CDC has admitted (by use of the Freedom of Information Act) that their numbers are skewed after CBS did an investigative report showing that they have overestimated the number of H1N1 cases substantially. Many people who have been told since July that they had "probable" Swine Flu did not have it- or any other flu. CDC forced states to STOP testing for Swine Flu in July. So, people who have previously believed that they had H1N1 and that they had immunity are now being told to get a vaccine anyway. A vaccine which can cause rare but serious complications such as Guilliane Barr. And which is- by the way- in short supply. What is the real story here?

Do you think we are going to start seeing adjuvant in use? Would this be a possible outcome of the "state of emergency" thingie? And wouldn't that be a good thing?

"A vaccine which can cause rare but serious complications such as Guilliane Barr." I am calling bullshit here. Please provide more information before making these assertions. Yes, that syndrome was once associated with a bad batch of vaccinations though it hasn't since. At present the chances of acquiring it "naturally" from the flu are larger then acquiring it from being vaccinated. Something anti-vax folks always forget to mention. As always if you have a history of adverse events after getting vaccinated take them seriously and talk to your doctor. Though for the rest of us the vaccine provides unambiguously solid gains and protects us and the people we love while the 'serious complications' are only a nebulous and unsupported assertion.

Back to point. I do agree that a for profit vaccination industry isn't a very good system to ensure the necessary supply. At best market forces just don't have a strong enough predictive power to induce the necessary preparation ahead of time, and at worst can result in hoarding and extortion. Likewise, if we have a particularly mild flu season that is an unambiguously good thing. Unless, you are the ones making vaccines and millions of doses go unused. We need to make the vaccine creation process much more concerned about public health and less interested profits.

"Only one, MedImmune -- the company supplying the adjuvanted FluMist product -- has come close to its promised delivery schedule."

I'm 99.99% certain FluMist does not contain an adjuvant.

"Basically they had difficulty making "acceptable" vaccine that did not contain an immune booster called an adjuvant, which is used in several countries but not the United States."

Why on earth would not adding an adjuvant be a cause for 'difficulty'?

Greg - I personally don't think we will see adjuvants used at any point with the novel H1N1 vaccine for a number of reasons. First, I'd assume Alum would be the only viable option at this point since using any other adjuvant would require numerous lengthy safety tests - and the 'pandemic' may well be attenuate by the time these studies are completed. Reformulating the already manufacture vaccine would undoubtedly add time and $. Formulating upcoming vaccine with adjuvant seems viable (and logical), yet I'd still be surprised if this happens. After listening to a joint CDC/DHHS conference, I got the feeling these organizations understand the public's irrational nonacceptance of adjuvant use. The fear that even fewer people may be willing to receive the vaccine if it contains an adjuvant seemed to be a major deterrent.

1. My bad on the FluMist: You are right, there's no adjuvant in it. It's built around a weakened rather than the killed virus used in the shots built by the other four companies, and so is not eligible for quite as many users, which is one reason the CDC ordered only some of those. Plus I understand the CDC (and some others) are generally leery of inhaled vaccines, though there is quite a range of opinion on that. I may be overlooking or forgetting other reasons for using/not using the Flumist-like product.

As to a possible switch to adjuvanted vaccines:

1. I certainly don't think we'll see adjuvanted vaccines used for H!N! in the U.S. this year, and probably not in the next couple years. Several reasons: The adjuvanted doses this year are already spoken for by other countries; you can't just take the existing nonadjuvanted doses on order and jigger them with adjuvants, for that occurs way upstream in the process; and the CDC and FDA are both leery of adjuvanted vaccines because of political and social resistance, even aside from safety concerns. I wrote about this aversion to adjuvanted vaccines in my Slate piece a few weeks back, at http://www.slate.com/id/2228700/. I don't think the debate is changed much as yet.

Thanks for writing, all.

David, thanks for the clarification and the link to your Slate article - a very nice piece indeed. Keep up the good work!

-C

I am still terrified that we are going to get to the front of the line and they are going to say, "So sorry, we just gave the last dose to the people in front of you" :)

I was actually surfing looking for conversation about the politicization of hin1 when I found your post. Really interesting read, but scary. Thanks.

In Canada, Arepanrix(TM) H1Ni has been approved:

* Split virion (to provideH1N1 antigen)

* Inactivated: viruses are killed and partially dismantled, washed, and purified.

* Adjuvanted with AS03 and an oil-water emulsion

* AS03 contains DL-alpha-tocopherol (Vitamin E), squalene (a normal biological fat), and polysorbate 80 (anti-oxidant?)

It does contain a small amount of thiomersal. It was cultured on eggs so those allergic to eggs must avoid it.

The adjuvant has been used in other flu vaccines and enables us to make the vaccine we have protect four times as many people.

It's not approved for babies under 6 months; they depend on antibodies in breast milk, staying away from crowds, and others who have been vaccinated so as not to get sick around them.

Children 6 months to 9 years are supposed to have two half-doses 21 days or more apart. However, children over six may need only one.

Free vaccination has begun for vulnerable groups. (DAMN that universal medicare!)

Ever since the Clinton Administration federalized flu vaccine, the delivery of vaccine has drifted later into the flu season. You would think that the Obama Administration would be more concerned that this experiment in federalized medicine not turn into a "Katrina" response -- too little too late -- in the year of his health initiative. If it is the companies who have failed under their federal contract -- and from what I can tell they have not -- why has the federal response not been as swift and direct as, say, the reaction to Fox News coverage.

I certainly don't think we'll see adjuvanted vaccines used for H!N! in the U.S. this year, and probably not in the next couple years. Several reasons: The adjuvanted doses this year are already spoken for by other countries; you can't just take the existing nonadjuvanted doses on order and jigger them with adjuvants, for that occurs way upstream in the process; and the CDC and FDA are both leery of adjuvanted vaccines because of political and social resistance, even aside from safety concerns.

I may be overlooking or forgetting other reasons for using/not using the Flumist-like product.