Vaccination and morality

Who has the moral high ground in the vaccination wars?

My initial response is that I do, “I” meaning the medical and public health fields—those of us who prevent disease, disability, and death.

But it’s much more complicated. Many anti-vaccine activists are “true believers”. They really believe that vaccines do more harm than good. But, without getting all Godwin, being a true believer doesn’t insulate one from moral responsibility.
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The APS should have known better

Those reading Deltoid’s coverage of the APS fiasco are probably up to date on this issue, but I feel like we need to discuss the APS failure in more detail. For those unaware of the latest in global warming denialist nonsense, the American Physical Society made the foolish mistake of entertaining global warming denialists by giving Christopher Monckton space in their newsletter to “challenge” global warming. As Lambert demonstrates in his post, the factual and calculation errors are a joke, but the strategy error is demonstrated by the fact that every global warming crank from tobacco apologist Steven Milloy to creationist William Dembski at UD is now celebrating the supposed end of a consensus on climate.

Milloy leads with a story that “APS ENDS CONSENSUS MYTH!” and all the other cranks with no regard for disreputable sources have happily followed suit. Creationists like Dembski, happy to promote any conspiracy theory about “mainstream” science that they think oppresses cranks like him cheerfully joins in. This is despite the fact that the APS has not changed it’s position on global warming, the article itself is a joke, and it is not even in the peer-reviewed literature. Monckton is crying foul because he thinks that a piece in a newsletter represents peer review. How embarrassing is it for them that because the piece was subjected by a review by an editor that he thinks this is peer review? Do we really have to explain what peer-review actually is to these people? Are they so ignorant? Clearly the answer is yes.

Peer review means that your paper is shared with experts in the field and they are allowed to challenge statements made in the paper and the author has to rebut or provide more data to address their concerns. Peer review is not having a single editor look over the paper for egregious errors; if this were actually a peer-reviewed publication, such a review would represent a massive failure of the review system to have a publication with only an editor reading over the paper. For those that haven’t been through the process, peer-review is usually grueling, must involve more than just an editor looking over the paper – often several leading researchers in a field – and usually requires an author to address substantive challenges to their argument. Monckton’s stunning ignorance of the process is telling.

That being said the bigger failure here is that of the APS not realizing they were dealing with a den of snakes when they opened up any publication to the likes of Monckton. Never mind that Monckton’s paper is about as big a challenge to the theory of anthropomorphic climate change as a poodle wearing boxing gloves is to Mike Tyson; as has been said before, denialists aren’t interested in debate, they are only interested in the appearance of debate. This non-peer-reviewed publication in a newsletter is being touted by cranks all over the internet as proof that global warming is being debated in the halls of academia because it is under the auspices of the APS. When the APS clarifies, correctly, that this is not an example of peer-reviewed publication, they get attacked by Milloy and others as stifling debate and caving to the global warming conspiracy.

To sum up. Monckton has published tripe that is clearly nonsense, is not peer-reviewed, and in no way has APS changed it’s position on global warming. The lesson is that when dealing with crooks, the truth doesn’t matter, and they will twist the truth to serve their purposes if you give them an opening. The APS has failed to realize that these people are not honest brokers in a debate. There are few clearer examples of this phenomenon than this blatant prevarication by the likes of Monckton, Milloy and others promoting this “end to consensus” or cover-up by the APS. This is not debate, this is denialism, and APS has learned the difference the hard way.

Where did we go wrong? Framing vaccination

I’ve had a bit of writer’s block lately, but I’ve learned to take my own advice and just wait it out. And so I did. Then, today, I read Orac’s piece on framing the vaccine problem. It set my mind a-whirring, so I’ve put the coffee on, and I’m setting fingers to keyboard.

I don’t care about the whole “framing science” thing. The systematic evaluation of science communication is too far outside my field. I am stuck being a “empiric framer.”

(Jargon alert! Outside of the blogosphere, my communications are basically one-on-one, doctor and patient. My framing is the equivalent of a RCT n=1 trial—I get a chance to intervene with a single subject and evaluate the response, but I don’t get the chance to study larger sample sizes and do statistical analyses of my work. End jargon)

The vaccine problem is currently an n=1 problem. Individual medical professionals work hard every day to educate individual patients. Decades ago, we didn’t need to convince anyone to get vaccinated—the need was so blindingly obvious that people lined up for their shots and prayed there would be enough to go around. Everyone saw polio, saw measles, saw people becoming disabled or dying from infectious diseases. Everyone watched as our public health improved with the wide-spread administration of vaccines. And now we are the victims of our own success—people don’t fear vaccine-preventable diseases because they no longer know them.
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The stupid continues at Channel 7

Right now, I’m looking out my window to see the spreading pall of burning stupid rising over Channel 7’s tower in Southfield. And the stupid isn’t just for Steve Wilson anymore. What reporter Carolyn Clifford lacks in adiposity, she easily makes up for in credulity. Her “investigative report” tonight on the HPV vaccine Gardasil is another example of embarrassingly bad health reporting.

A few preliminaries:

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Uh oh…not again

Tonight on WXYZ Channel 7 in Detroit, the station that brought us the irresponsible health reporting of Steve Wilson, there will be a report on the HPV vaccine Gardasil. Given this station’s recent history, I’m not very optimistic.

The Gardasil issue has been a unique crank-magnet. It has attracted a an interesting mix of religious zealots, antivax cultists, consumer advocates, and conspiracy theorists. It’s even got Oprah! It’s also damned interesting science.

Stay tuned.

The economy, denialism, and perception

How bad is the economy?

Really fucking bad. My patients are losing their jobs, the restaurants are empty, businesses are shuttered, houses empty.

Really, really fucking bad.

What does the government have to say about it? Not so bad. Chill.

There are some good reasons for this. As the recent Indymac debacle shows, a statement from a politician can destroy a bank (although, to be fair, the bank was a dead man walking before Schumer’s letter came out).

So, when our leaders continue to downplay the economic disaster in this country, are they being denialists, or responsible public servants?
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No right answers

I take care of my own patients in the hospital. I say that because it is not a given for internists. For a number of reasons, many having to do with time management and money, most internists utilize hospitalists, internal medicine docs who specialize in the care of hospitalized patients.

Taking care of patients in the hospital presents some unique challenges. First, they are very, very ill. You have to be pretty sick to get into a hospital these days. You must be willing to be available 24 hours a day, 7 days a week. And you have to be able to deal with some rather intractable problems.

My SciBling DrugMonkey had an interesting post about dealing with hospital patients who have addictions. This is a common, daily problem for me and other docs who see hospitalized patients.

The most common substance is tobacco, followed by alcohol, followed by “other” (pot, heroin, prescription opiates, methamphetamine, cocaine, etc.).
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Medical Education—service vs. education

Teaching new doctors is an interesting process. Much has been done over the last ten years to improve the way we teach new doctors. Medical residents still work very hard, but there are strict rules on work hours and other “service” duties that can interfere with education and safety.

One of the issues that often comes up in running a residency program is the problem of “service” vs. “education”. Per the accrediting body that does these things:

The learning objectives of the program must not be compromised by excessive reliance on residents to fulfill service obligations.

Along with details such as work hours limitations, this is one of the more important guiding principles for residencies. This can be a real problem on certain very busy medical services, such as an intensive care unit.

Residency is work; there is no getting around that. But in exchange for this work, residents expect to receive teaching, feedback, and respect. There are operational measures of these parameters used in evaluating residency programs.

When residents aren’t treated with respect, aren’t given proper feedback, and aren’t taught, it frankly pisses me off. These young doctors are counting on us to mitigate their fears and build their confidence. They are counting on us to impart the practical knowledge that they will use to save lives. There is very little justification for using a resident as your personal scut-monkey, and even less for yelling, degrading, or otherwise humiliating them. That’s not how you make good doctors.