revere | October 27, 2009On Saturday we posted our take on The Atlantic magazine article by Shannon Brownlee and Jeanne Lenzer. It's a major story in the November issue, a banner across the top of the cover page reading: Swine flu: Does the vaccine really work? We tried to ignore it. People kept asking us to comment on it, but we didn't want to get entangled in vaccine controversies. As Orac warned me, it's a game of Whac-A-Mole. But we got fed up and posted our global response, not a point by point refutation, since that wasn't what the issue was. Our main point was that it was a straw man argument built around the…
revere | October 26, 2009CDC is again warning parents not to send your children to a swine flu party. The idea is to provide them with immunity, like used to be done with chickenpox parties. It's pretty hard to believe this is a live issue and CDC admits it doesn't have evidence that any have actually occurred. When it came up in the spring, during the first wave of H1N1, we and all other flu experts said it was a very bad idea, but at least one could understand the reasoning then. Since there was no vaccine and the worry was that swine flu might come back in the fall in altered and worse form during flu season, it…
revere | October 25, 2009Al Franken may have made his name as a comedian on Saturday Night Live, but as a Senator (D-MN) he's a force to reckon with. In this clip from hearings this week he nails a witness from the right wing Hudson Institute pimping for the health care industry. Her claim? That health care reform would lead to more bankruptcies. He makes his point and thanks the witness, but she tries to score with a question of her own. Bad move. It turns out Franken knows the answer:
Smart, serious, prepared. Live from Washington, DC. It's not Saturday Night Live!
Addendum, 1 pm EST: Just had to take my son-in-…
revere | October 25, 2009R. Crumb has an illustrated version of the Book of Genesis out in graphic novel format. It's gotten rave reviews from both the skeptic and non-skeptic sides of the house. Consider this, from Greta Christina at Alternet:
Crumb's Genesis emphasizes biblical accuracy -- he's a non-believer, but he has a deep respect for the book's historical and cultural importance. So he created this graphic novel as a straight, word- for- word illustration job.
And so, when it came to illustrating the freakier and more unsettling aspects of the narrative, he pulled no punches. The multiple marriages, the…
revere | October 24, 2009I keep getting asked about the Atlantic Magazine article, Does the Vaccine Matter? by Shannon Brownlee and Jeanne Lenzer, two reporters whose particular bias is that we as a nation are "over treated." As a generalization that's probably true, and finding examples isn't hard. Unfortunately by taking as their main example flu vaccine during a pandemic, they have not only picked the wrong example but created more confusion at a time when there's already too much.
Here's the gist:
Vaccination is central to the government’s plan for preventing deaths from swine flu. The CDC has recommended that…
revere | October 23, 2009While we don't yet know with certainty the relative contributions of the three most likely modes of transmission for influenza (large droplets, small aerosols of viral laden material that remain suspended in the air for hours or days, inanimate objects like door knobs or desk tops), it is certain that if you are in the path of a cough or sneeze or even vigorous talking from someone actively shedding flu virus you are at risk. When it comes to delivering big time viral loads, nothing quite beats a vigorous cough or sneeze.
Take a look:
Of course it may not be so easy to "just stay home." The…
revere | October 22, 2009A reader (h/t MVD) sent me this link to a "CBS News Exclusive," Study Of State Results Finds H1N1 Not As Prevalent As Feared. As far as I can see the main aim was to raise CBS News's profile and gain readership. That's what news organizations do. We hope they do it by good journalism. I think this is an example where the reporters just didn't have enough knowledge of what they were reporting and put the wrong spin on it.
The central claim is that CDC stopped testing for swine flu hastily and without advance notice to the states:
If you've been diagnosed "probable" or "presumed" 2009 H1N1 or…
revere | October 21, 2009We've gotten the question here fairly frequently: If antivirals (Tamiflu, Relenza) for swine flu work best when given early but shouldn't be given to people who aren't really that sick, how do you balance waiting for them to get sick and have the drugs not work well with giving it when you don't need to? There is no absolutely right answer to this difficult question. Early in the pandemic antivirals were being given prophylactically to stop spread, then they were being given only when a diagnosis of swine flu was confirmed. Then only to the sickest patients. We're all on a learning curve. The…
revere | October 20, 2009When swine flu appeared, the pork producers were keen to say there was no connection or relationship between pigs and swine flu (even though the virus's genetic segments were all of swine origin). They didn't want anyone to call it swine flu, giving rise to the celebrated naming controversy. But then we started seeing pigs infected with human pandemic swine flu, both in the lab and in pig herds. It's likely the pigs got it from us, although which direction things went in isn't completely clear. But originally the virus made the jump from pigs to humans, probably sometime in late 2008 or…
revere | October 19, 2009Monday morning, start of week three of the official flu season (which began October 4). CDC's scientific spokeswoman on the flu, Dr. Anne Schuchat has said we are seeing "unprecedented" flu activity for this time of year, including an unusual toll in the pediatric age group. What does "unprecedented" mean? It's not very specific on what precedents are included, but if we confine ourselves to the three years before this one, we can get a good idea of just how unusual this flu season is. This week CDC unveiled a new graphic for their Emerging Infections Program (EIP) (I liked the old one better…
revere | October 18, 2009We've been traveling again (and offline), so we'll limit this to a few comments to put recent news into the context of things we talked about here recently (an excellent up-to-date status report can be found by DemFromCT at DailyKos). A good article by Rob Stein of the Washington Post highlighted some of the increasing anxiety of clinicians as flu season ramps up with pandemic swine flu in the northern hemisphere. Stein's article is quite long, but I have snipped a few things from it:
Although why a minority of patients become so sick remains a mystery, new research indicates that H1N1 is…
revere | October 18, 2009I will be the first to concede that religion can be extremely interesting (although not to me). My general rule of thumb is that virtually any topic is interesting once you really get into it, and religion is no exception. One can study it from within its own logic and set of doctrines (theology or Talmudic scholarship), from outside (anthropology) or through many other lenses (political, economic, etc.).
The same is true about special topics in the subject of religion, like God or gods or The Gods or however you want to express it. Now there's a quick and easy way to get into the subject:…
revere | October 17, 2009The vaccine problem as seen from a different angle:
The Daily Show With Jon Stewart
Mon - Thurs 11p / 10c
Doubt Break '09
www.thedailyshow.com
Daily Show Full Episodes
Political Humor
Ron Paul Interview
revere | October 17, 2009We hate to write posts like this. The Reveres lost a friend and the battle against HIV/AIDS lost a Field Commander this week when Steve Lagakos, his wife Regina and his mother were killed in a horrific head on collision on their way back from his summer home in New Hampshire, where they celebrated his mother's 94th birthday. The driver of the oncoming car was also killed. Four lives gone in an instant.
Steve was one of the world's premier biostatisticians and we had known him for 20 years, since his early days at the Harvard School of Public Health where he and his mentor, Marvin Zelen,…
revere | October 16, 2009Via Crof's blog (invaluable, as always) I learned of the decision of Massachusetts state health officials to vaccinate state prisoners before the rest of the population:
Prison officials warn that inmates could quickly spread the flu if not inoculated -- particularly those in high-risk groups such as AIDS patients.
Middlesex Sheriff James DiPaola told the Boston Herald that prisons were the perfect flu "breeding ground."
DiPaola dealt with riots in a Cambridge jail when rumors of swine flu spread there. (AP)
State legislators are already complaining that there are other, more vulnerable…
revere | October 15, 2009I've been asked a number of times why I am bothering to get both flu vaccines this year (the seasonal flu trivalent vaccine and the swine flu vaccine when it is my turn). I am in the older age group (last in line for swine flu vaccine) and it is my group that is hit the least hard from the swine flu virus. But there are a lot of us and we're still being hit. I don't know if I will be one of the unlucky few in my age group who draws the short straw or not, and I'd rather get vaccinated with an acceptably safe vaccine than take a chance in winding up having a machine breathe for me or not…
revere | October 14, 2009I don't fly as much as I used to but I still fly too often for my likes and when the cart comes around for the free beverages it's either orange juice "with no ice" or a bloody mary mix "with no ice." I rarely drink water, but if I did, I would never drink the water out of a pitcher, as offered to me a couple of weeks ago on Air Canada. From a bottle, maybe, but since bottled water isn't as well regulated as tap water, I usually don't partake. I know a fair amount about public drinking water, but one day I was seated on a plane next to somebody who knew a lot about airplanes and he said he'd…
revere | October 13, 2009The online publication of three papers and a commentary yesterday in the Journal of the American Medical Association (JAMA; free access, links at bottom of post) provides some further data on what demand for critical care resources might be from the current swine flu pandemic. One paper reports on the Mexican experience, where mortality seemed unusually high but where access to services may have made the outcome worse. The papers from Canada are perhaps most pertinent to what might be experienced in the US and Europe. It appears that in terms of demand for ICU beds, the first wave from last…
revere | October 12, 2009I agree with one thing that Paul JJ Payack, president and chief word analyst of The Global Language Monitor says:
“At this point it is becoming increasingly difficult to engage in any form of public dialogue without offending someone’s sensitivities, whether right, left or center.” (Paul Payack, Global Language Monitor site)
Well, not complete agreement. I'm not offended by what he says. I just think it's dumb.
Although I had never heard of Mr. Payack's site, apparently he has taken it upon himself to compile, for the last six years, a list of what he deems the ten most politically incorrect…
revere | October 11, 2009If you are hesitating to be vaccinated for swine flu this year, perhaps this post will help you make up your mind. If it does, I hope it pushes you to get vaccinated, but whatever persuasion we attempt here will only be from a recital of what we know of the epidemiology of this pandemic. Because it is the different epidemiology that is the main feature, not the clinical characteristics or the virulence of the virus. So far this looks pretty much like a standard influenza A virus -- except for the epidemiology. Since I'm an epidemiologist, you might expect me to think this is important, and I…