Health

Why are antivaccinationists so at home with Libertarianism?

That’s the question Orac asked last month at Respectful Insolence. It’s kind of an odd question, since the main piece of evidence he discusses is Ronald Bailey’s pro-vaccination article at Reason Magazine, one of the flagship publishers of libertarian thought. Here’s the main point of Bailey’s argument:

People who refuse vaccination for themselves and their children are free-riding off herd immunity. Anti-vaccination folks are taking advantage of the fact that most people around them have chosen the minimal risk of vaccination, thus acting as a firewall protecting them from disease. But if enough refuse, the firewall comes down and other people get hurt.

Oliver Wendell Holmes articulated a good libertarian principle when he said, “The right to swing my fist ends where the other man’s nose begins.” Holmes’ observation is particularly salient in the case of whooping cough shots.

To borrow Holmes’ metaphor, people who refuse vaccination are asserting that they have a right to “swing” their microbes at other people. There is no principled libertarian case for their free-riding refusal to take responsibility for their own microbes.

Orac’s evidence of libertarian anti-vax leanings is in the response at Police State USA, and a bunch of Facebook comments about Bailey’s article. Orac quotes a few of the dumber comments:

Explain how not getting a vaccination yourself puts someone else at risk. If you get sick and they are vaccinated then they won’t get sick because they a vaccinated against it right? Oh, vaccinations don’t actually protect against getting sick?!? Then why do we get them.

Herd Immunity is more Bullshit from Big Pharma with NO logic behind it!

That’s certainly uninformed anti-vaccination nonsense, but all it proves is that libertarianism is not totally free of anti-vax goofballs. Neither are the Democrats or Republicans. A few idiotic comments hardly make the case that libertarianism is a good home for anti-vaxers.

In fact, far from shunning vaccines, libertarians have complained that the government-controlled vaccine market often experiences shortages, a problem rarely seen with more commercial medications that trade in a freer market. And when Reason Magazine published their “45 Enemies of Freedom” edition, they picked anti-vax nutjob Jenny McCarthy as #28, saying that “hundreds of thousands of fearful parents have needlessly endangered the health and lives of their children.”

Orac also objects to this comment, without realizing it’s substantially different:

How about “I DON’T WANT TO!”? That’s about as libertarian as it gets. There is no such thing as a positive obligation in libertarian philosophy and that includes an obligation to be vaccinated.

From the libertarian viewpoint, there’s a world of difference between saying “X is a good thing” and saying “the government should force people to do X,” and that’s true whether X is getting vaccinated, wearing motorcycle helmets, or drinking smaller beverage portions. The government does not enforce its rules with a gentle hand, and even the most trivial infractions are ultimately enforced by men with guns who will drag you off in shackles, lock you in a cage, and take your stuff.

Ronald Bailey’s article is actually part of a Reason debate with Dr. Jeffrey Singer over vaccination policy. Neither debater questions the general efficacy of vaccines, both reject the autism danger, and both debaters think getting vaccinated is a good idea. Those are not the questions being debated. The libertarian issue in question is whether the government should force people to get vaccinated.

Questioning the appropriateness of forcing medical treatments on people against their consent is not some kind of crazy fringe concern. One of the cornerstones of medical ethics is that all treatments require the informed consent of the patient. If a patient refuses even lifesaving treatments, doctors will generally respect that decision.

There are exceptions, of course, but the issue is complex, confusing, and worthy of careful thought. In most cases it’s also highly controversial, such as the requirements in some states that women seeking abortions receive a medically unnecessary trans-vaginal ultrasound, which involves placing a probe into the woman’s vagina. There’s also a long history of school systems pressuring parents into putting their children on psychoactive drugs, ostensibly for the child’s benefit, but apparently also as a tool for classroom management.

I’ve written about doctors who perform invasive procedures on patients in the name of the war on drugs, and this country has a disgraceful history of involuntary sterilization of people with undesirable attributes, the Tuskegee syphilis experiments, and of course the Nazi atrocities that led to some firm rules about informed consent which have informed medical ethics all over the western world. Generally speaking, this is not good company to be in, and I think that before implementing plans to forcibly vaccinate people we should give careful consideration to alternatives such as education.

It’s one thing to believe — as Ronald Bailey and Orac both apparently do — that the utilitarian social benefits of vaccination outweigh the violation of self-ownership and personal dignity that forced vaccinations would necessarily entail. But it’s disingenuous to lump this libertarian objection in with the generic anti-vax crowd that denies the effectiveness and safety of vaccination.

No here’s a dumb story from Portland, Oregon:

When an apparently drunk man peed in a Mount Tabor reservoir around 1:30am last night, he set off an unprecedented chain reaction.

A security officer who had been watching the man and his four friends drinking from the reservoir guard tower alerted police, then called on the water bureau to take the reservoir offline. Using a new $23 million remote control system, just installed in April, the bureau immediately shut off the pipes leading from the reservoir. The guard and a police officer confronted the men and got their information, including the alleged 21-year-old pee-er.

Then, the water bureau made the call to dump the entire 7.2 million gallons of water in the reservoir, at a cost of over $35,000. That’s one expensive trip to the bathroom.

On top of that, the city is working with the district attorney to consider pressing charges against the pee-er, perhaps to help recoup some of the cost. Water Bureau administrator David Shaff isn’t sure what the charge would be exactly, “Well, I just dumped 8 million gallons, there’s maybe a ‘theft’ in there somewhere… He has some idea that he’s made a mistake, but he has no idea how big.”

[Emphasis in the original.]

His mistake wasn’t as big as the one the Water Bureau just made by dumping all that water. Maybe I’m missing something but doesn’t the Water Bureau clean the water? Not to mention that when you dilute a bladder’s worth of urine with seven million gallons of clean water, for all practical purposes the resulting water is still urine-free. Especially since urine itself is mostly water.

Also, urine is normally sterile, so the only risk is from bacteria if the guy had an infection that could get into the urine stream. Another story indicates that he was out that night with four other people. I haven’t done the math, but my guess is that those people face a greater health risk than the population of Portland because they probably touched a guy who had just peed without washing his hands.

My wife is out of surgery and resting in her room at the hospital. All went very well. The surgeon was able to do the whole procedure using the robot, which means they made only a few small holes, so she’s expected to bounce back pretty quickly.

I’m at home for a few minutes to check on Dozer the cat. He seems to be getting a bit better. He’s still weak, but I don’t think he’s in pain. He’s been feeding himself, and he gets up and walks around a bit. If this keeps up, I’ll probably take him back to the vet to try to figure out how best to care for him.

My wife and I are now both really glad we didn’t agree to let the emergency vet euthanize him. I think the lesson here is that we should keep in mind that an emergency vet is for emergencies. As soon as they told us there was no immediate emergency, we should have just left and taken him to the regular vet the next day.

And yes, I’m a little less angry at the world.

As all computer geeks know, it’s very difficult to wipe out a virus, and I mean eradicating it completely from the world. The fight against real-world viruses, the kind that attack humans and animals, is much, much more difficult. Viruses have evolved into the most abundant type of biological entity on the planet.

The idea of eradicating one sounds like an impossible dream, yet scientists managed to do just that with the smallpox virus, and have repeated the feat a second time now with the rinderpest virus. Rinderpest, a virus that killed almost all of the cattle on the African continent, was eliminated through a combination of creating an easy to use detection kit and making the vaccine widely available.
OK, so it’s not the same kind of story as the elimination of smallpox, but it’s big news just the same. Smallpox killed almost half a billion people in the 20th century alone before the smallpox vaccine managed to wipe the virus from the planet by 1979. The rinderpest virus killed most of the cattle in Africa, so wiping it out has had a significant impact on the food source for many of the world’s poorest people.
The point is that this seemingly impossible feat has been accomplished for a second time in human history thanks to vaccines and science-based medicine. There are a lot of quacks out there who are misleading the public about vaccines for nothing but personal gain, and they are managing to convince far too many people who should know better that vaccines are dangerous and ineffective.
While vaccines do have known side effects for a tiny percentage of people, the scare mongering about them has cause a reduction in vaccine usage around the world (only in the “educated” wealthy parts, ironically) and the increase of human viruses that were once on the verge of being wiped out themselves. It’s amazing that modern, educated people would allow Jenny McCarthy to guide them on medical decisions based upon scary stories spread by snake-oil salesmen looking to make a quick buck from worried people.
Modern vaccines are extraordinarily safe and effective. If you haven’t already done so, get your flu vaccines for this year. If you have an infant, keep their vaccine schedule up-to-date.  Vaccines are never 100% effective, yet by making sure that nearly everyone is vaccinated scientists are able to do the impossible and wipe viruses (we can use the plural form of that word now!) from the planet.

All of this political correctness is making me ill.

Now we have to refer to the flu pandemic as H1N1 so we don’t offend the pig farmers, the National Pork Board, or God forbid the pigs.The hell with that. 

From now on, I’m calling it FFKAS or the “Flu Formerly Known as Swine”.

It all started when my 88-year-old father’s home care nurse came to visit and noticed that his left foot looked infected. He has diabetes—meaning an infection in an extremeity could be serious—so she got some kind of medi-car service to take him to the emergency room at the local V.A. hospital. The ER there operates as a walk-in clinic during the day.

The doctor took a look at his foot, did some tests, and declared it infected. He wanted to admit my father to the hospital for a few days, but after my father’s experience last time, he didn’t like the idea. The doctor agreed instead to send him home with a huge dose of antibiotics—the V.A. pharmacist told me he’d never seen a dose that large before—provided we promised to come back on Wednesday for a followup.

Everything was fine when I took my dad for the followup visit, but I noticed that he was more worn out by the trip than usual.

The next day, Thursday, my father fell down in his room, slamming his back against the bedframe. He said he had gotten light-headed. My mother called for paramedics, and they decided to take him to the emergency room. Since he’s already a patient at the V.A. hospital, they agreed to take him there.

The ER did X-rays, and all kinds of tests. His back was fine, other than a nasty bruise (he’s on blood thinners, so all bruises are nasty) but they decided to admit him for observation, and maybe also to complete the course of antibiotics.

While he was there, they also discovered a problem with his lungs which they have been treating. His bedroom will get a new piece of medical equipment when he goes home.

If he ever goes home.

The title of this post, “nosocomial,” means “hospital caused,” as in “hospital caused disease.” This is a concept that has become an important part of my dad’s life, and therefore of my life.

My father is old and has arthritic knees, so walking has been difficult. With support, such as a walker, he manages to get up and around the apartment, going to the bathroom, adjusting the fan in his room, and coming into the living room to watch television with my mother.

During the first two weeks of my father’s stay in the hospital, they kept him resting in bed, with no physical activity at all. I don’t know much about medical care, so maybe a full bed rest was necessary, but the cost has been high: With so little activity, my father’s legs lost whatever conditioning they had, and he was unable to walk, even with assistance or a walker.

The hospital’s next step was to move him to a rehab ward and give him physical therapy every day. I’m sure that was the right thing to do, but it wouldn’t have been necessary if they had given him some exercise earlier in the process.

Rehab took about a month to get him back to where he was when he was first admitted. However, trapped in a dull, boring, and poorly-lit hospital room for days on end, my father began to show signs of delerium. His short-term memory went bad, he had a hard time expressing himself, he became obsessed with features of his environment, and he lost the ability to think about and explain his needs to the staff or to me. I know my father’s 88 years old, and his mind hasn’t been at its sharpest for a while now, but this was a sudden, steep, and frightening decline in his mental state.

His doctors assured me that they had checked for every possible physiological malady that could cause such an acute change in his behavior, and there was nothing. By process of elimination, it had to be caused by the environment of the hospital. They say that part of the problem is the unfamiliar environment, so I’ve been making the drive to see him every day for several weeks to try to help him improve. It may be working, because he’s returning slowly to his old self.

Late last week, the doctors started telling me they were planning to discharge him on Sunday, so my family started gearing up for it: Buying supplies, fixing up his room, putting his portable oxygen tank in the car.

Then on Saturday, they told us his white blood cell count was a little high. They thought it could be a reaction to some of his medication, but they were taking blood and urine samples anyway.

Sunday morning, his doctor told us he turned out to have a urinary tract infection, so they wanted to keep him in the hospital while they fought it.

On Monday, they apparently identified the infection as some sort of multi-drug resistant organism, so they isolated my father in a private room. I have to wear gloves and a gown whenever I see him, and I wash my hands thoroughly afterwards.

Again, I’m no doctor, but I do know a little about science. Organisms don’t appear spontaneously. Bacteria can only come from other bacteria of the same type. Since my dad didn’t have this infection when he moved to the rehab ward, he must have acquired it when he got there. Since even now he can’t walk without effort, I don’t think he was wandering around and visiting other patients.

No, someone gave him this infection. Either they were carrying it themselves, or they transfered it from another patient. Either way, it’s a breakdown in infection control: Somebody didn’t wash their hands, or they didn’t wipe down an instrument between patients. Hospitals are notorious for this kind of problem. Even before this, his ward had ongoing outbreaks of MRSA and VRE.

To summarize, my father comes in with a foot infection, gets dizzy from antibiotics and falls, is hospitalized for that, loses his ability to walk during the bed rest, has to get therapy to walk again, then catches an infection, for which he needs intravenous antibiotics.

All of this may well be unavoidable given the current state of medical care, but at this rate they will spend more effort—and he will spend more time—dealing with the maladies caused by his hospital stay than with the medical problems he had when he came in.

When I took my father to the hospital two days ago, he was feeling really bad. He even threw up after getting in the car. While he was in the emergency room getting tests, I drove to a nearby do-it-yourself car wash to clean out the car.

I wore latex gloves to avoid catching what he had, but apparently I wasn’t careful enough. Now I’m puking and crapping and running a fever of 101.6°F.

My father’s diagnosis was gastroenteritis, so I figure I’ve got the same thing. If this were an episode of House, that would be misdirection, and I’d really have some rare and dangerous condition that mimics gastroenteritis in its early stages before the more disturbing symptoms start.

My father is 45 years older than me, so they gave him IV liquids and a big dose of Cipro and admitted him to the hospital for a few days.

Me, I’m going to ride it out at home.

Blech.

There was no blogging yesterday because my father got sick and I had to take him to the hospital. It’s apparently nothing too serious, but because of his age and other conditions, they want to keep him for a couple of days.

All I know about hospitals I know from House. The real thing is just as annoying as on TV, but much, much slower. Everything seems to happen at a glacial pace. That’s probably a good thing, since they save the speed for emergencies, but it’s frustrating and tiring.

The worst part is that it’s so hard to understand what’s going on. In my little world of computer programming, photography, and blogging, I understand in considerable detail how things work or how to make them work. Even when it comes to things I don’t usually do myself, such as auto repair, I understand what it is that I want out of the process—”make that noise stop”—but at a hospital, I don’t even understand what they’re trying to do most of the time. It’s an uncomfortable lack of control or input.

I know a lot of people (you know who you are) who will be happy to hear this:

More than a decade’s use of mobile phones does not increase the risk of brain cancer, according to one of the largest studies yet conducted into the link.

The latest study published in the US Journal of the National Cancer Institute, is a follow up to a study in 2001. It extends to an average of eight and a half years the period during which mobile users were monitored, with a maximum of 21 years.

(Hat tip: Hit & Run)

In a previous post I linked to a short note about the early days of the AIDS epidemic.

It’s well-written, but I’d like to address a side issue that rubs me the wrong way. The author touches on it in her opening sentence:

At a time when the mere threat of avian flu or SARS can set off a coast-to-coast panic—and prompt the federal government to draw up contingency plans and stockpile medicines—it’s hard to imagine that the national response to the emergence of AIDS ranged from indifference to hostility.

This is an echo of a certain resentful tone that I’ve noticed before when people affected by AIDS discuss the public health response to other diseases. One of the commenters makes it a little clearer:

So interesting that you point that out, everyone so worried about chickens. No one cared when so many of my friends were dying each in there own individual horrible way.

Obviously, I’m not condoning indifference and outright hostility against AIDS victims. The public health system responded poorly to the early days of the AIDS epidemic. One of the things that struck me while reading Randy Shilts’s riveting And the Band Played On is the way public health officials uttered a depressing progression of statements about the emerging crisis:

  • It’s not a priority because only 5 people have died.
  • It’s not a priority because only 20 people have died.
  • It’s not a priority because only 100 people have died.
  • It’s not a priority because only 1000 people have died.

Of course, the best time to try to stop an infectious disease is before it infects a whole lot of people. It’s as if these policy makers didn’t understand the implications of the word contagious.

Actually, I think there’s a grain of truth to that. I’m pretty sure that much of the foot-dragging in the early years was due to routine bureaucratic inertia. The kinds of people that climb to the tops of government agencies by winning budget battles and currying favor with political power brokers are not necessarily the kinds of people you want in charge when something terrible happens. We had another reminder of this when hurricane Katrina struck New Orleans.

Still, I have to believe that a big part of the problem responding to AIDS was due to dislike for the types of people the disease was infecting. When people affected by AIDS get angry about that, I can’t begrudge them their feelings. The have every right to be angry and to act on that anger.

What does bother me, however, is the attitude of resentment towards the response to bird flu. The injustice here is the weak response to AIDS, not the strong response to bird flu.

[Clarification: I’m pretty sure the author of the original article doesn’t really want bird flu to receive an ineffective response. I didn’t mean to imply otherwise.]

I’ll start with the hyperbole in the comment and just point out that the big panic today is not about the birds, of course, but about the people that will get sick and die if the disease spreads to humans.

The flu we hear about every year hits most people as sniffles, coughing, fever, and soreness. But for a portion of the population—newborn babies and the elderly—influenza is a deadly disease that kills about 35,000 Americans every year. Worldwide, the annual death toll is around a quarter million. It’s the equivalent of the Indian Ocean tsunami of 2004 happening every year.

There are several active flu strains evolving from year to year, so every year we get hit by something a little different. In some years, the death toll rises to half a million. In a few years, it rises much higher.

If you asked any influenza epidemiologist about his worst-case scenario, he’d probably say it’s a repeat of the Spanish Flu pandemic of 1918. Nobody is sure how many people died, but the lowest number I’ve found is 25 million, and nobody would be surprised if it really killed twice that many.

This brings us to the reason everyone is so upset about bird flu. It’s genetically very similar to the Spanish flu. And based on the 100 or so human cases so far, the resemblance doesn’t end with DNA. Bird flu has killed 40% of the people who’ve caught it.

[Update: According to Bird Flu Breaking News there have been 229 cases of bird flu in humans, 130 of them fatal. That’s a 57% mortality rate.]

In a typical flu season, about 10% of the people in the United States come down with the flu. If the bird flu spreads to humans and follows the same infection pattern, it could kill 12 million people in this country alone.

Of course, that figure is a statistical fiction. Bird flu in humans is a rarity, so we are unlikely to have much natural immunity. The infection rate could be much higher than 10%. Then again, bird flu is presumably rare in humans due to some biological barriers. If those barriers hold, the infection rate in humans could remain tiny until the disease burns out in the avian population. Nobody knows how these factors will balance out.

Even if bird flu hits us hard, we really can’t extrapolate what will happen based on our annual experiences with flu because we can do things to fight bird flu that we would never do to fight seasonal flu. We can cancel sporting events and musical performances and movies. We can close the schools for a few months. We can shut down non-essential businesses and restrict travel. We’ve seen influenza before, and we have some pretty good ideas what to do about it.

And that’s the biggest reason you can’t compare bird flu to AIDS: We know all about bird flu, but AIDS was something new and mysterious.

We didn’t know what virus caused it, or even if it was a virus. It wasn’t even clear that it was an infectious agent. Some doctors thought it might be a side effect of some new kind of club drug. That sounds strange now, knowing what we know, but at the time everyone knew of drugs that could compromise the immune system, but no one had ever heard of a virus with that ability.

And the kind of virus it was, a retrovirus, had only been identified as a class a few years earlier. The first AIDS cases presented with mysterious diseases. It took a while to figure out that these were opportunistic diseases, and that the main problem was with the patients’ immune systems. Equipment for doing T-cell counts had only just started to become available.

It’s been 25 years since AIDS was discovered. Descriptions of influenza have been found that date back 2500 years. It’s an old enemy that we have learned how to fight.

I imagine that someday, eventually, AIDS will be an old enemy too. There will be ever-improving treatments for those infected, and a vaccine to protect those who aren’t. AIDS will become just another once-deadly disease being held in check by medical science.

And maybe someday epidemiologists in Africa will spot a dangerous new strain of HIV emerging among the simian population and crossing over to humans. And maybe this strain will be just different enough from the known strains that our vaccines and treatments might not work as well as we’re used to. That’s pretty much what’s going on with bird flu right now. Let’s hope that any such new strain of HIV is handled like bird flu and not like AIDS was handled the first time it emerged.

Alexandra Billings has a moving account of the early days of the AIDS pandemic here in America:

At a time when the mere threat of avian flu or SARS can set off a coast-to-coast panic–and prompt the federal government to draw up contingency plans and stockpile medicines–it’s hard to imagine that the national response to the emergence of AIDS ranged from indifference to hostility. … People with the disease were routinely evicted from their homes, fired from jobs and denied health insurance. Gays were demonized by the extreme right wing: Reagan adviser Pat Buchanan editorialized in 1983, “The poor homosexuals–they have declared war against nature, and now nature is exacting an awful retribution.” In much of the rest of the culture, AIDS was simply treated as the punch line to a tasteless joke: “I just heard the Statue of Liberty has AIDS,” Bob Hope quipped during the rededication ceremony of the statue in 1986. “Nobody knows if she got it from the mouth of the Hudson or the Staten Island Fairy.” Across the river in Manhattan, a generation of young adults was attending more funerals than weddings.

I almost died. I was in the hospital and my doctor told me to call my parents and arrange the funeral. Chrisanne did just that. We were arranging my funeral as I lay in my hospital bed with my blue checkered gown wetting myself and sweating so bad they were changing my beddings three times a night. I was 35 years old. I had already been infected since the late eighties. The tip of the disease. I lived long enough, stayed away from the hospital just long enough to watch every single one of my friends waste away to ash. I had seen more death before I was 40 than anyone in my family.

Read the whole thing.

Here’s an unusual way to demonize fast food:

In the battle against childhood obesity, well-intentioned government policies that encourage healthy eating face a daunting challenge from the proliferation of fast-food establishments right outside the schoolhouse door, a new Chicago-based study shows.

The median distance from any Chicago school to the nearest fast-food restaurant is about a third of a mile—a walk of little more than 5 minutes for an adult—according to the study by Boston researchers, published today in the American Journal of Public Health.

Almost 80 percent of public and private schools in Chicago had at least one fast-food restaurant within about a half mile, exposing children to “poor-quality food environments in their school neighborhoods,” according to the researchers from Children’s Hospital Boston and the Harvard School of Public Health.

The study found 79 fast-food restaurant chains clustered around some 1,300 Chicago schools. McDonald’s restaurants made up 16 percent of the 613 fast-food sites, followed by Subway, Dunkin’ Donuts, KFC, Burger King, and other chains.

The article makes it sounds like fast food restaurants are predators stalking the little children.

Well, why not?

The cheerleaders for the nanny state have demonized booze, cigarettes, and firearms by spreading fear about the effects on “the children.” People have been joking for years that fast food would be next. I guess so…