Countering misinformation and its effects

I turned 50 years old this year, I am demographically located at the tail end of the Boomer generation.  One of the many things I have enjoyed because I was born in the second half of the 20th century is that infectious diseases have not played a large role in my life. They played an even smaller role in my son’s, and I’m confident – and excited – that the threat to life and health from infectious disease will be even smaller in the life of my two year old granddaughter.

I may die tomorrow in a car accident or some freak random act of violence, but I know I will not die next week from smallpox, a threat my parents faced for the first thirty years of their lives.

Philly.com has a wonderful piece this morning by Rachel Sobel [a medical professional of unclear type].

Scrubbing In: It’s swine flu we should fear, not the vaccine that saves us [Excerpts]

Rachel Sobel

[snip] I’m talking about what’s become a culture of fear around getting the shots. More than a third of parents don’t want their kids vaccinated for swine flu, according to a recent Associated Press-GfK poll. Many fear that vaccines do more harm than good. This comes up a lot with the scientifically discredited link between vaccines and autism-related developmental disorders. There’s also the conventional wisdom that a flu shot can “make you sick.”

The vaccine-autism controversy has mostly run its course. Celebrities such as playmate Jenny McCarthy and actress Amanda Peet argued about whether to vaccinate kids. Peet called McCarthy and the other vaccine-phobic parents “parasites” for relying on the immunity of others to hold off measles, small pox, polio, and other now-rare diseases.

I am not that rabid, but the science at least is clear. “If you decide not to vaccinate your child, you put your child at risk. Your child could catch a disease that is dangerous or deadly,” says the American Academy of Pediatrics.

It has been a long time since the hospital wards were filled with kids on iron-lung machines suffering from polio. And it’s been almost a century since a worldwide flu killed more than 20 million people. That’s probably why some people have not been getting the message about the importance of vaccines.

Last year, the Centers for Disease Control and Prevention counted 131 cases of measles in the first half of the year, more than double what it had been for the preceding year. More than 90 percent of those cases were in unvaccinated children or those with unknown vaccination status. And half of those did not get vaccines because of “philosophical or religious beliefs.”

[snip] Sometimes concerns about vaccines are just plain irrational, even among doctors. Last year one of our residents, who is a particularly astute clinician, opted not to get the flu shot. He boasted that he had never gotten the flu shot and had never gotten sick. Why would he get it now?

We all joked about his overconfidence. Then the next week he got really sick and had to miss work, though he claims it wasn’t the flu. I asked him whether he will get the seasonal flu shot this year. “Probably.” And the H1N1 vaccine? “Potentially,” he said. “We’ll see.”

Vaccines are modern miracles. The last naturally occurring case of small pox was in 1977 in Somalia. Polio is still out there, with several public health groups working toward eradication.

Some time ago I came to believe that having so many people unaware of what it really means to live with the threat of deadly infectious diseases as part of the very fabric of day-to-day life leaves them bereft of a “healthy respect” for that threat – pardon the clumsy pun.  It has been over thirty years since our last influenza pandemic, and that one was also mild.

Additionally, a portion of our population has “never had the flu”, real influenza, the kind that puts you abed for several days wishing you would just ahead and die already.  These people have no conception of what “a case of the flu” feels like – if they did I don’t think they would be quite so cavalier about becoming infected.  I’ve had “the flu”.  I had a pretty nasty bout of influenza in 1978.  I have all the respect one could have for “the flu” because of that infection.

The Wall Street Journal offers us this today:

Swine Flu Is Severe for Some, Studies Show

[Excerpts]

A girl receives the H1N1 nasal mist vaccine at Wake County Human Services in Raleigh, N.C., on Friday.

Only a small portion of those who develop swine flu become severely ill. As of Aug. 22, 278 people had been admitted to ICUs in Canada, about 3.9% of total reported cases for that period, according to the Canadian study.

Swine flu is mild for most people, but some become so gravely ill that they require sophisticated techniques, equipment, and aggressive treatment in intensive-care units to survive, according to three new studies.

“This is the most severely ill that we’ve ever seen people,” said Anand Kumar, lead author of one of the studies and ICU attending physician for the Winnipeg Regional Health Authority in Canada. “There’s almost two diseases. Patients are either mildly ill or critically ill and require aggressive ICU care. There isn’t that much of a middle ground.”

Some of the patients Dr. Kumar and his colleagues saw were so sick they had to be saved with a technology similar to one used for patients undergoing heart bypass.

The studies of critically ill patients in Canada, Mexico, Australia and New Zealand, published online Monday in the Journal of the American Medical Association, suggest that intensive-care units could be stretched as a second wave of H1N1 swine flu builds in Northern Hemisphere countries such as the U.S.

American public-health and hospital officials have expressed concern that the country’s intensive-care facilities may not be up to accommodating the swell of patients they could potentially end up with in large-scale outbreaks.

[snip] In Canada, Australia and New Zealand, doctors turned to an advanced technology similar to one used for cardiovascular surgery when prolonged mechanical ventilation and other therapies proved not to be enough for some H1N1 patients. “Extracorporeal membrane oxygenation,” or ECMO, acts as a lung machine, circulating a patient’s blood through a system that adds oxygen. The severely ill patients’ lungs were so filled with fluid they couldn’t get oxygen to their blood.

[snip] Only a small portion of those who develop swine flu become severely ill. As of Aug. 22, 278 people had been admitted to ICUs in Canada, about 3.9% of total reported cases for that period, according to the Canadian study.

How does one communicate risk when many do not have an existing frame of reference within which to “internalize” that risk?  There’s an entire specialty devoted to the psychology of it: Risk Communications. I’m not expert in it, I’m not even good at it most of the time, but I’ve been doing this long enough to have been continually frustrated by the difficulty of the task.

An excerpt from the New York Times today is yet another attempt to debunk the misinformation campaign of the anit-vaccine lobby.  Please follow the link for the entire offering,

Nothing to Fear but the Flu Itself

By PAUL A. OFFIT

Philadelphia

[excerpts]

PUBLIC health officials are now battling not only a fast-spreading influenza virus but also unfounded fears about the vaccine that can prevent it.

Since April, more than a million Americans have caught H1N1 flu, more than 10,000 have been hospitalized, and about 1,000 have died, including 76 children. And it’s only the beginning of October. Yet, in a new survey, 41 percent of adults said they will not get vaccinated.

The good news is that for the first time in more than 50 years we’ve made a vaccine against a pandemic strain of influenza before the onset of winter, when lower temperatures and humidity allow the virus to spread more easily. Distributing this vaccine to those who need it most — pregnant women, health care workers, children older than six months and people with compromised immunity — will be difficult enough. But the task is made harder by the various myths, spread on TV talk shows and Web sites, suggesting that Americans have more to fear from the vaccine than from the deadly disease it prevents. Here are some of those myths, and why they’re wrong….

[snip]

New myths will inevitably arise as some of the millions of people who are inoculated against H1N1 flu suffer unrelated illnesses. Health officials will keep a close eye out for any real problems. One can only hope that the American public will understand that subsequence isn’t necessarily consequence, and not be scared away from a vaccine that can save lives.

Paul A. Offit, the chief of the infectious diseases division of the Children’s Hospital of Philadelphia, is the author of “Autism’s False Prophets: Bad Science, Risky Medicine and the Search for a Cure.”

I left out Dr. Offit’s debunking because this post is already too long and those who have a genuine interest in seeking the truth will follow the link to read the entire piece. Those who are not interested in learning the truth would not benefit even if I copied Dr. Offit’s OpEd in its entirety.

It is extremely difficult to dissuade people from what they believe, even when what they believe is wrong. We are “emotionally invested” in those things we believe. For the most part, what we believe has a limited impact on our lives, and an even smaller likely impact on those around us. If we are parents of minor children what we believe about influenza in general, pandemic influenza while one is occurring, and vaccines [generally and the pandemic vaccine] has impact on our children.

I would also posit that when it comes to pandemic influenza and its protective vaccine it has an impact on our wallets, or at least some wallets. Importantly to me: My wallet is one of those wallets impacted.

The health insurance premiums I pay and my husband pays [separately insured with two different health insurance companies] are based on what “plan costs” were the previous year. The more plan participants use their health insurance the greater our premiums. The higher the cost of those services the greater the overall plan expenses are.

The company I work for has a statistically probable likelihood of having several plan participants [whether primary or dependent] suffering an H1N1-2009 infection severe enough to require in hospital intensive care. Even one of these cases [above and beyond the plan's normal experiences with intensive care incidents] will affect my health care premium when we renew our policies next fall. If the plan suffers ten infections requiring ICU care my premium will be severely impacted. That’s real money out of my wallet.

Those on publicly funded healthcare plans, Medicare and Medicade, impact the tax dollars the federal government helps itself to out of my pay check. That’s real money out of my wallet.

Those who receive no cost [to them] health care at the local public hospital because they have no health insurance impact my local taxes, my state taxes, and my federal taxes. That’s real money out of my wallet.
So, in the end, what people believe about the threat of pandemic influenza, the statistical likely severe cases, small though the percentage is, and all those who are going to refuse to be protected by the pandemic vaccine does impact me — personally– because it impacts my wallet.

Some people have no choice, or no choice right now.  I can’t yet receive the H1N1-2009 vaccine because I’m pretty far back in the line of who gets it when.  If I become severely ill and require ICU care the impact I have on my health care plan’s costs will be at no fault of mine, up until the time I am allowed to receive my vaccine.  Once I am able to receive and choose not to be vaccinated, then I am willfully telling all of my fellow plan participants that I don’t give a spit about how my actions impact their wallets.