Barbara Loe Fisher versus the flu vaccine

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

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

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

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

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

BLF (not BFF, at least not mine):

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Some samples follow.

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

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

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

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

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

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

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

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