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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.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

134 replies on “Barbara Loe Fisher versus the flu vaccine”

Isn’t the physicians’ creed – Do No Harm?

If a doctor or nurse knowingly comes into their place of work, to care for patients, with symptoms of the flu – isn’t that an ethical violation?

Since doctors and nurses should know that it can take days to fully manifest the symptoms of the flu, isn’t it also an ethical violation not to take the necessary precautions against potentially spreading the disease to vulnerable patients?

I don’t get the general lack of understanding here – since doctors and nurses are also highly likely to treat infectious individuals (given the number of people who get the flu and either rush to the ER or their doctor), don’t they want to be protected?

Again, I just don’t get the attitude of these people.

This is particularly true about

(And that’s where the sentence stopped. How does it finish?)

Holy crap! How did Th1Th2 (from the comments in this post) learn about immunology? By putting an immunology textbook into a food blender and then reading the results? Gah, that was painful to read.

When she mentions doctors trading their white coats for military uniforms, I thought she was trying to link the issue to Nazi Germany, not the PHSCC.

BLF also creates a straw man and false dichotomy. She argues that the policies are “get vaccinated or you’re out”. In reality, it seems that the policies are “get vaccinated or wear masks and take other precautions to protect our patients”. I could see someone rightfully getting canned if they refuse both.

Left a comment over at her blog calling her out on her claim that health care workers are getting fired solely for refusing the vaccine. Let’s see if she let’s it through moderation.

Why do I seem to enjoy starting my day with depressing stories like this?…

How Loe can she go?

Actually, BLF has the germ of a an actual point hidden within the ranting and Godwinization of her article, as referenced by Orac:

“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. “

I think what BLF especially fears is that the concept of responsibility for protecting those around us is spreading. If more people including non-health care workers start to think about the consequences of spreading serious infectious diseases to the vulnerable (i.e. children, the elderly and immunosuppressed) and get vaccinated to be socially responsible, her mission of spreading antivax propaganda will get much harder.

Wonder what Jay Gordon will do when hospital(s) where he’s on staff start requiring annual flu vaccination? Will he find a religious out by declaring membership in the Church of the Anti-Needle?

Dangerous Bacon is right, what anti-vaxers fear is that vaccination against searsonal flu and other infectious diseases that may harm patients is becoming more usual, even popular, among health professionals. They know that health professionals are considered to be role-models by many people, at least where health issues are concerned.

Why else would cranks go to such efforts to highlight the medical credentials of their members (even if not relevant to the issue at hand) and often use doctorates in subjects unrelated to healthcare shen being interviewed.

And next they will fire any surgeon who operates without washing their hands. And why waste money sterilizing scalpels. A free people will not cower before mere germs.
Give me liberty or give me death from vaccine preventable disease!

My favorite part is the “fellow citizens with an MD or PhD written after their names” bit. Those people are just regular Joes, right? It’s not like they actually know anything or have any special training in medicine or science. No, they just scribbled a couple of letters after their name and voila! They think they can tell us what to do!

Dangerous Bacon highlights a good point. Requiring that health care workers be vaccinated is the equivalent of setting up a localized herd immunity within the health care system. For any anti-vaxxer to support requirements that health care workers be vaccincated is akin to them agreeing that 1) herd immunity is real (many deny it) and 2) the proper and socially responsible thing to do.

Well, I got my thimerosol dose yesterday. Doesn’t seem to have done me any harm. We’ll see if it wards off the flu this year. Some years, it feels more like a fetish, like taking Emergen-C or whatever that stuff is, for all the good it does me.

@Matthew Cline: ANYTHING Th1Th2 has to say is painful. She is so off the wall, I find it hard to read her. (I usually just skip her comments and read the responses to her idiocy. I tried a few times to engage with her but had to quit…I don’t think in crazy)

My employer gave out free flu shots yesterday. I didn’t go only because I have an appointment with my pcp for flu and any catchup vaccines I need next week. But a lot of people from my department went.

(Side note: one of my coworkers, a fairly young woman, broke out with shingles on Tuesday so she is home on acyclovir at the moment and those who haven’t had chicken pox or don’t remember it are a bit anxious. I recommended shingles vaccines to those of the right age – not that they are at risk of catching it from coworker, but that they should get the vaccine, especially – as in 1 case – if you’ve had shingles before you are more prone to get it again)

MI Dawn

It’s pretty rich for BLF to invoke eugenics as a logical consequence of mandatory vaccination. Actually, anti-vaccinationism has a germ of eugenics in it (pun intended.)

According to many anti-vaxers, those with strong immune systems (presumably supported by homeopathic nostrums or whatever) will weather flu, measles, pertussis etc. just fine. Only the immunologically weak will suffer complications or death.

@ AMW:

What, you don’t realize that getting an MD or PhD actually makes the recipient stupider and less able to judge such things than the average woman-on-the-street?

*remove tongue from cheek*

Anti-intellectualism really ticks me off.

Eugenics? Well, she’s late to the (tea**) party! Seems that the misreading and misunderstanding of a recent statement by Bill Gates tempts our prolific woo-meisters into crying, “Eugenics! 1.”Bill Gates says that Vaccination Can Help Reduce World Population”; Mike Adams,NaturalNews; 10/1/10 2.” Death by Vaccination: the Bill Gates Foundation and the New Eugenics” Richard Gale and Gary Null;9/22/10.**(probably herbal, organic, weak tea)

“98% …vaccine uptake” due to “education” at Virginia _Mason_ Medical Center…. doesn’t *that* explain it all!

@ Denice:

OMG, you’re right! Heck, I bet they’ve even got lights, and therefore ILLUMINATION there. And we all know what THAT means!

@Ruth

And next they will fire any surgeon who operates without washing their hands. And why waste money sterilizing scalpels. A free people will not cower before mere germs.

Give me liberty or give me death from vaccine preventable disease!

We have a contender for winner of the thread!

triskelethecat/MI Dawn

I recommended shingles vaccines to those of the right age

What is the “right age”? I have had chickenpox, so I am wondering if I am at that age yet.

Next thing you know they’ll be insisting that surgeons wash their hands before surgery, putting themselves at risk of dry skin and chapping.

Always embarrassing when a comment expressing the same idea appears after you hit ‘post’. Still, great minds etc…

There’s a pronounced, anti-intellectual disdain for doctors and other intellectuals in BLFs writing:

>>>”It is not a pretty sight to watch doctors acting more like thugs than healers.”

>>>”We are next in line because when doctors trade in their white coats for military uniforms…”

>>>”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…”

I don’t know about anybody else, but my flu shot was not administered by an MD.

If big pharma really want to increase their profits without caring whether they do anything useful (and if vaccines really don’t work anyway), they should switch all vaccines to homeopathic preparations and invent a patented method of dilution and succession to protect their interests.

>>>”It is no surprise that Hitler and the Nazis were big fans of Oliver Wendall Holmes”

Was there a Hitler founded Nazi fan club for OWH that my history books failed to mention?

@Militant Agnostic: CDC recommendations are that those 60 yrs and older (whether you had chicken pox or not) should get the shingles vaccine because those are the ages that were studied for vaccine effectiveness, and the age group that makes up about 1/2 of the cases of shingles in the US. However, their website also says that the risk of shingles starts to rise around age 50 and more studies are needed to determine whether they will decrease the recommended age.

Under 60,the varicella vaccine is recommended if you have had not had chicken pox.

MI Dawn

Just going to comment on #3 in the addendum there.

I am entirely in favor of government regulation and oversight of most industries. I’d rather have a little more government control than have cause to suspect that my favorite restaurant would fail a health inspection, for example.

Is lamentable that they go on still existing this kind of situations, where the health care does not have importance, where the harassment and the abuse dominates, and this is because people him accepts, all that must denounce one.

Justin Swayne
Findyourdrug

As a believer in health freedom (and someone who has taken some shit on this blog for that), I have absolutely no problem requiring people who work in public hospitals to vaccinate. People who drive on public roads shouldn’t be drunk, either.

Since we’ve linked back to the old article about the Atlantic, though, I’ll ask the question I asked last time: we haven’t seen spikes in flu deaths in years that there have been supply problems. We are measuring noisy data so I realize that could be lost, but is that the only response to that point?

Upon reading BLF’s tirade a second time, I noticed a couple more things. First, as support for her claim that hospitals are firing people, she links to a video from Dr. Offit talking about last year’s policy. No evidence is given that that policy is in effect this year.

She also uses CHOP’s policy to imply that hospitals in general are instituting the same policy (i.e., vaccinate or be fired).

I also did a little bit of digging and found that Ms. Loe Fisher also made another factual error. She states that only medical exemptions from the doctor in charge are allowed, yet in presentation given to DHHS, philosophical exemptions are also allowed (not sure when the presentation was, though – no date on it). The presentation about CHOP’s policy does not specify that the doctor in charge is required to sign off on any exemptions, either.

BLF – Full of Lose.

I can understand the libertarian argument that no one should be forced to undergo vaccination.

I would have thought that the libertarian argument would be to allow employers to make whatever demands they feel appropriate upon their employees, and the market would decide what works best. Afterall, it isnt the government mandating this, but the hosbitals themselves.

we all know what will happen one doctors go down the slippery slope of forced vaccination. soon it will forced organ donation!!11!!1!1!

i recommend you all dispose of your liver donation cards* right away!!1!!!!!!!!111

*umm…it’s a bit graphic. a bit.

@ Dave:

For a real libertarian, yes. But for most who claim the title, what it really means is “any restrictions I disagree with are bad”, regardless of who placed said restrictions.

My body my choice, regardless of profession. Why are you so scared if you get the vaccine yourself and think it works? Stop pushing your drugs on us! Just because it is legal doesn’t mean it is safe nor effective.

@Dave #32, that sure fits in with what I have heard from libertarians regarding smoking in restaurants and other public places, both for patrons and employees- that the owner should be allowed to set whatever policy they want free of regulation and patrons and employees can go elsewhere if they don’t like it.

BLF is exactly right.

just yesterday, i was on the corner and i was just like staring at the traffic thinking about everything, but then again i was thinking about nothing. a middle aged man next to me was coughing, and looked like he had a mild fever and chills.

next thing i know five young doctors pull up in a pimped out lexus, jump out and cap the guys ass. with vaccinations!

drive by vaccination! what’s the world coming to?

“My body my choice, regardless of profession.”

And if you’re a health care worker who ignores patient safety, you have an absolute right to be unemployed.

[email protected]
It isn’t just your body your choice if you are working with immune compromised patients. Try reading the post before jerking your knee. I would hope that great medical ignorance expressed in your comment means you don’t work in a hospital or other medical setting.

My body my choice, regardless of profession.

Sure, but your choice has consequences. You don’t have the “right” to a job in health care if you aren’t willing to take precautions against being a potential danger to the patients with whom you come in contact. In fact, those running a health care institution have not only the right but the duty to tell you that if you choose not to take such minimal precautions, you are also choosing not to be employed there anymore.

My body my choice, regardless of profession.

If you choose to inject narcotics into your body or to drink alcohol to intoxication, that is grounds for termination from most jobs because it tends to affect job performance and, depending on the profession, can put others at risk. Personal liberty does not always trump other factors.

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.

Or go to public or private school. Seems like her predictive ability is rather strong.

“My body my choice, regardless of profession.”

Remember that the next time you go to a restaurant and you wonder whether the staff that handles your food washes their hands after using the restroom.

Or go to public or private school. Seems like her predictive ability is rather strong.

Only if BLF, like Merlin, lives backwards in time. Vaccination requirements for schools are nearly two centuries old now.

The libertarian would say if you want to work in a bar then accept breathing in 2nd hand smoke. If enough quality employees decided it wasn’t for them, their pay would rise or ownership would decide to voluntarily make their establishment smoke free. If enough patrons found 2nd hand smoke offensive that would also drive smoke free bars and clubs. My current thinking is to be congruent with the aforementioned scenario one would have to accept that a private institution such as a hospital has the right to make vaccination a requirement of employment.

Sid:

Or go to public or private school.

Like the public charter school in San Diego:

The 7-year-old goes to the San Diego Cooperative Charter School in Linda Vista. The child set off a chain reaction that has infected two siblings, one of whom was a fellow charter student, and at least one classmate.

private school was closed:

Classes were canceled at the 300-student East Bay Waldorf School at 3800 Clark Road because a number of kindergartners and their teachers have come down with the contagious lung infection, authorities said.

I think a prediction that outbreaks of pertussis, measles and other vaccine preventable diseases often occur more often in private school or public schools with lax vaccine requirements is more certain than predictions by BLF.

Barbara Loe Fisher’s slippery slope argument is wrong, but Oliver Wendell Holmes really did say that compulsory sterilization is OK because compulsory vaccination is OK. More than eighty years later, his opinion still shocks the conscience:

It would be strange if it could not call upon those who already sap the strength of the State for these lesser sacrifices, often not felt to be such by those concerned, in order to prevent our being swamped with incompetence. It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes. Jacobson v. Massachusetts, 197 U.S. 11 , 25 S. Ct. 358, 3 Ann. Cas. 765. Three generations of imbeciles are enough. [274 U.S. 200, 208]

Holmes saw Carrie Buck’s sacrifice as trivial when compared to the public good. We should not make excuses, but the idea that the “feeble-minded” had no rights was a terrifyingly common view in 1927. Today, it is clear that the analogy to vaccination is bogus. Holmes was wrong — not just in the larger moral issue, but in whether Jacobson supported his argument. It did not. Barbara Loe Fisher should be ashamed to harness Holmes’ eugenics in the service of her crusade, but that would be a lot to hope for.

[Orac: Sure, but your choice has consequences. You don’t have the “right” to a job in health care if you aren’t willing to take precautions against being a potential danger to the patients with whom you come in contact.]

Says who? You? No one has a “right” to any employment for that matter. Neither does an employer have a right to impose unwanted and possibly dangerous medical procedures.

In fact, those running a health care institution have not only the right but the duty to tell you that if you choose not to take such minimal precautions, you are also choosing not to be employed there anymore.

Minimal precautions? I like how you spin coerced invasive needle puncture into “minimal precautions”

I would like to see 60% (amount of employees who do NOT get the flu vaccine) walk out on your hospital or cancer center and see how your tune changes. You’ll change your bullying tactics and compromise your so called principles at that point.

The ONLY reason this healthcare worker vaccine propaganda is being initiated is because of such a low uptake by health care employess. It looks bad on the agenda when your own workers want take a vaccine that you’re selling. It will be easier to sell the lie to the public if you can say “see little Heath healthcare worker gets his shot. So should you” at the same time not telling the public that you forced it on him.

If you want to talk about rights and coercing individuals, (which is sickening by so called professionals) the hospital(employer) and the pharmaceutical company should pay for any side effects AND FAILURE to prevent illness. That would only be fair and reasonable for such a fascist policy that tells it’s citizens to “do it for the herd” or will ruin your financial ability to sustain your family. “We control you.”

Why don’t we ask all healthcare workers to make sure they take their “once daily” antibiotic before they come to work. Oh sure, some of their health will be jeopardized permanently or only temporarily, but it will only be a minority and you can always say the party line “The benefit outweighs the risk.”

BTW BLF would send Orac packing his lunch in a debate on this issue. He might know how to swindle grant (tax) money for his own personal financial gain but politics is not his forte. Or maybe it is.

[Remember that the next time you go to a restaurant and you wonder whether the staff that handles your food washes their hands after using the restroom.]

That would be reasonable if washing your hands could cause you to go into a convulsive febrile seizure or have permanent paralysis. But it turns out that washing your hands is pretty innocuous. So the analogy is a false one. It is 100% safe to wash your hands.

As has been said here many time vaccine are not 100% safe or 100% effective. They appear to not know how safe just “not 100%” safe. They appear to not know how effective just not “100% effective”.
It could be anywhere from 0%-99%. Who knows? Save me your false quantitative arrogantly assertive replies. You don’t know and that’s the bottom line.

Why don’t we ask all healthcare workers to make sure they take their “once daily” antibiotic before they come to work. Oh sure, some of their health will be jeopardized permanently or only temporarily, but it will only be a minority and you can always say the party line “The benefit outweighs the risk.”

Because it is a supremely stupid idea. And most health care employees are more intelligent than you, so you will not find 60% walking out to protest vaccine requirements.

Just curious – what do BLF and other antivaxers think about the requirements for lab workers who handle human tissue products being vaccinated against hepatitis?

Is it irrelevant because that vaccination is only protecting the worker in question (and close contacts) rather than the public at large? Or are they just unaware of those requirements? Sid, care to weigh in?

I’ve been to Tea Parties. I’ve seen some wackaloon stuff, but never any anti-vax protesters. Of course, YMMV wherever you are.

I just don’t understand how someone IN HEALTH CARE could be so willfully ignorant. But then again, my sis in law had an emergency c-section after a failed homebirth, and one of her L&D RN’s was a wackaloon homebirth fanatic like she is, so….go figure.

Why don’t we ask all healthcare workers to make sure they take their “once daily” antibiotic before they come to work. Oh sure, some of their health will be jeopardized permanently or only temporarily, but it will only be a minority and you can always say the party line “The benefit outweighs the risk.”

Because that’s an idiotic idea. Taking antibiotics without a valid medical indication would not only be harmful to the worker, but would make sure that workers all become incubators for antibiotic-resistant organisms that would then be shed into the hospital environment. Hospitals have a bad enough problem with resistant organisms; to breed more would make a bad situation worse.

Oh, augie…

I would like to see 60% (amount of employees who do NOT get the flu vaccine) walk out on your hospital or cancer center and see how your tune changes. You’ll change your bullying tactics and compromise your so called principles at that point.

If I were a sadist, I would like to see that, too, and see how the public reacts to the sudden burden on the health system and the massively increased wait times for service.

But, I’m not. I wouldn’t wish that situation even on you, augie.

It looks bad on the agenda when your own workers want take a vaccine that you’re selling.

Know what’s even worse? When patients come into the hospital without influenza and contract it while there. Even worse is when they die as a result. If you bothered to look into Dr. Offit’s account of the policy at CHOP, you would find that such concerns are a major reason the policy was instituted. But then, you probably would think that that explanation is nothing but a cover, more propaganda. If you do think that, then perhaps you could pony up some evidence that such is the case.

Why don’t we ask all healthcare workers to make sure they take their “once daily” antibiotic before they come to work. Oh sure, some of their health will be jeopardized permanently or only temporarily, but it will only be a minority and you can always say the party line “The benefit outweighs the risk.”

Wow. What a crappy example you picked, augie. We wouldn’t ask health care workers to take a daily antibiotic because the benefits do not outweigh the risk. Rather, the risks heavily outweigh the benefits, since using antibiotics in the absence of a bacterial infection is known to breed antibiotic-resistant bacteria.

Personally, I think CHOP should have offered employees the option of wearing appropriate protective gear as an alternative to being vaccinated (such as Orac mentions is available at his institution). However, in the absence of the actual document spelling out the policy, I can’t be certain that such an option was not available.

@augie

[Remember that the next time you go to a restaurant and you wonder whether the staff that handles your food washes their hands after using the restroom.]

That would be reasonable if washing your hands could cause you to go into a convulsive febrile seizure or have permanent paralysis. But it turns out that washing your hands is pretty innocuous. So the analogy is a false one. It is 100% safe to wash your hands.

Analogy slam fail. Washing hands is not 100% safe. There is the risk for an allergic reaction. Further, over-washing one’s hands can lead to chapping and cracked skin, which is more prone to infection.

[chris: And most health care employees are more intelligent than you, so you will not find 60% walking out to protest vaccine requirements.]

Because they know they don’t have to. The hospital administration and the Dr. Offit’s of the hospital will cave in because they could not afford the financial loss and burden put on the other staff. If they wanted to get the vaccine they would’ve gotten it. The numbers are pretty consistent. ONly 40% vaccinate for the flu. Forcing them is the way to improve on that statistic for propaganda purposes.

Otherwise if it happens we would expect to see a large drop in influenza numbers at the hospital. Won’t happen.

Let’s just keep our goal posts clear here. We have the opposition such as augustine arguing at least two different points here.

One is that they contend vaccines are neither safe nor effective.

The second is they oppose the right of an employer, such as a hospital, to impose certain requirements (such as vaccination) upon their employees (such as those who will be around immunocompromised individuals).

If they are correct on point one, there is no reason to move to point 2. If point one is invalid, however, then point 2 gets relegate to the same status as the question of whether hospital staff can be required to wash their hands.

What we are likely dealing with here is zealous anti-vaccinationists hiding behind the smoke screen of libertarian principles.

What augustine fails to comprehend is that not getting a vaccine is also not 100% safe.

It is, in fact, less safe than getting the vaccine. You are more at risk if you do not get the vaccine. That’s the whole point of vaccination: the benefits outweigh the minimal risks.

Not to get too far off topic, but Augie mentioned washing hands as not being “effective.” I seem to recall a massive decrease in the maternal mortality rate when doctors started washing their hands before assisting in the birth of children.

So, not washing your hands can kill in certain circumstances.

It is entirely reasonable for hospitals to require that enough of their staff be vaccinated to achieve herd immunity — and I could even see requiring vaccination, period, for people in certain very high-risk areas such as the ICU. (People unable to be vaccinated for whatever reason would be transferred to a different part of the hospital. That’s congruent with how employers are supposed to accommodate disabilities or religious restrictions.)

Every employer has the right to require that the employees are protected for their safety, and for the safety of the patients/customers/visitors/etc. Veterinary clinics can require their staff be vaccinated against rabies (primarily for protection of the staff). The military can require the troops be vaccinated against smallpox (primarily to discourage enemies from weaponizing smallpox, sort of like building missile defense to discourage use of ICBMs). The ADA and laws against religious discrimination mean they must make reasonable accommodations if people cannot be vaccinated or if it violates their religious beliefs.

This is in no way comparable to eugenics. This is not a mass vaccination program. This is employers requiring a minimum standard of their employees, and it’s not even one of the really big examples. For years, vets have required their lab techs to get vaccinated against rabies, which is entirely for their own protection, not the patients’, and is a rather riskier vaccine than the flu shot.

It’s reasonable. As long as reasonable accommodations are made for those who can’t do it, employers can require just about anything of their employees. Draconian Internet monitoring? Perfectly legal, and even reasonable — it’s the company’s bandwidth, after all. Off-the-job behavior? Yep, may be a fireable offense, depending on the circumstances and the job. Submit to a background check? Conform to cumbersome rules for working in a cleanroom facility? Be willing to provide a urine sample at any time, with refusal being a fireable offense? Heck, in the US, the standard is at-will employment, so unless you’re in a union, you can pretty much be fired because they don’t like your shirt. And there are jobs which contain a much bigger element of risk than healthcare. Look at linemen. They submit to a hell of a lot more risk than a doctor rolling up his sleeve to get a flu shot. They follow carefully devised procedures when working with energized high-tension power lines, but even tiny mistakes can be lethal.

Barbara Loe Fisher is nuts. But then, we all knew that.

[karl: What augustine fails to comprehend is that not getting a vaccine is also not 100% safe.]

No, I don’t fail to comprehend that.

[It is, in fact, less safe than getting the vaccine.]

You have gotten caught up in that amorphous blob of a concept called the “herd”. What you fail to understand is that you can not definitively make a statement of safety for any single individual. If you can then please tell the pharmaceutical companies and health officials. They desperately need your help to save the vaccine program and citizen victims of medical vaccines.

Washing hands is not 100% safe. There is the risk for an allergic reaction.

For example, me. Hell, just getting my hands wet can lead to a nasty rash, since I also have aquagenic pruritis. Life is interesting when your body’s immune system freaks out.

But I’m just an anecdote. Wash your damn hands!

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.”

She better not watch the weather reports, or go to the beach … NOAA has uniform-wearing, jack-booted geeks in ships, helicopters and airplanes.
http://www.noaacorps.noaa.gov/

@Che

Sid, care to weigh in?

A private institution should be allowed to set policy for it’s employees. As a consequence hepatitis shots are OK by me. As would the abolition of government protections/interferences such as the ADA, minimum wage, pregnancy leave and anti-discrimination laws.

augie: ” I like how you spin coerced invasive needle puncture into “minimal precautions”

Ooo, “coerced invasive needle puncture”. Could it be that our augie suffers from belonephobia (fear of needles)? This is the basis of some antivaxers’ vehement dislike of shots, and I suspect it’s underrecognized.

Medscape’s article on belonephobia (linking available only to subscribers, sorry) notes that sufferers from belonephobia may be able to tolerate injections when the syringes are decorated in a reassuring manner, i.e. with “butterflies, flowers, fish and smiley faces”.

augie, have you asked your doctor about this? It might help.*

*note: I am not making fun of belonephobiacs in general, just those who draw on this phobic reaction to power their antivax activities.

Augustine, you are not truly anonymous to Orac, and you can be sued for libel. Think about that next time you choose to accuse him of “swindl[ing] grant (tax) money for his own personal financial gain”.

When I started med school I had to prove immunity to measles, rubella, and Hep b or get vaccinated. For residency and the two jobs I’ve held since I’ve had to prove immunity to those three diseases plus varicella. Not proving immunity or not being to give a reason why I couldn’t receive the vaccines meant there were aspects of my job that I couldn’t do or a strong possibility that I wouldn’t be hired. Don’t hear the anti-vax people complaining about that.

Augie, way to go on hyperbole. Yes, immunizations are not 100% safe. Neither is driving your car. Bottom line I do know that immunizations are safer than driving in my car (less than 5000 claims submitted tobthe Vaccine Court since inception versus over 35,000 motor vehicles fatalities in the US alone in 2008). If I will assume the risk of driving, not accepting the risk of an immunization makes no sense.

Augie has finally recovered from his week-long incoherent rambling to make some really bold comments like:

Minimal precautions? I like how you spin coerced invasive needle puncture into “minimal precautions”

Sounds like Augie has a real needle phobia. Makes a shot sound like bathing in nuclear waste. FSM forbid Augie has any kids. How will he deal with the near-daily cuts, scrapes and punctures of childhood?

As would the abolition of government protections/interferences such as the ADA, minimum wage, pregnancy leave and anti-discrimination laws.

Because to sid if you can’t make fun and discriminate against people with disabilities, fire women who dare to get pregnant, and keep people of the wrong color away from you, there is no freedom.

just when you think he can’t get any lower on the scum scale, he does.

Ah, Dangerous Bacon got in there with his belonephobia comment while I was spell checking or something. Great new word that! Thanks.

I used to have a severe case of belonephobia, to the point that for a week before a TD vaccine I stopped eating and threw up every day.

And even then I knew getting the vaccine was beneficial; I was just irrationally afraid.

every time i use a restaurant men’s room, there’s a sign saying “employees must wash hands”. same principle.

Plain old brass tacks: My wife is an RN who works in a bone marrow transplant unit, which in simple terms means that for part of the time they’re in the hospital, her patients do not have an immune system to speak of. She would never want to endanger her patients by bringing in any communicable disease, and her hospital would not let her anyway. It makes no sense to me that anyone who works in such a place would insist that they have a right to refuse vaccination.
Nor does the BMTU make a difference. I am generally pretty robust, but last year surgery that I had went wrong and I came close to death. I spent a week in ICU that I don’t remember. I am grateful that nobody around me gave me influenza the day I went into the OR.
If you are willing, in spite of the evidence, to endanger the people you come into contact with, then you have no right to go among people, any people, not just people at increased risk.

@augustine:

1) You say that the motivation for this is propaganda. How do you rule out “prevent patients from getting the flu from workers” as a motive?

2) What is the motive behind the propaganda? Is it merely vaccine manufacturers trying to increase their profits, or is it something deeper?

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