As flu season progresses and caseloads increase (epidemically), a reminder from a 2012 NYT story:
Last month, in a step tantamount to heresy in the public health world, scientists at the Center for Infectious Disease Research and Policy at the University of Minnesota released a report saying that influenza vaccinations provide only modest protection for healthy young and middle-age adults, and little if any protection for those 65 and older, who are most likely to succumb to the illness or its complications.
You will find the post from which I draw the quote noteworthy.
After reviewing, I reminded myself how mentally idle we sometimes become. We administer vaccines by rote, every cold season. And why? Because they work and we see the order pre-populated on the screen each time we open the CPOE menu (right?).
Call me cynical, but the descriptor “oversell” does come to mind, and I do not think I am judging inhospitably.
Additionally, I always enjoy when authors of papers and blog posts mix things up in comment sections. Concerning the NYT piece, I found the two responses by the same Univ. of Minnesota chief investigator enlightening. They are worth reading in full.
After completing, you may reconsider what you think you know, and what you actually do.
Some food for thought as you click the boxes, draw your syringes, and work your Rx pads the next few weeks. I also wonder about vaccination strategy. If the vaccine has minimal effect on the young and sickest elderly, in a shortage situation, should the vectors–the rest of us–receive priority in the hopes of maximizing herd immunity. Not the visceral approach we would undertake, but one option I draw from the study findings.
Moreover, relate the above-mentioned box clicking to policy. We entrenched the vaccine core measure into routine. Regulation can automate behavior, sometimes diverting resources from other deeds. We focus on influenza–with yes, all the resulting positive externalities–but would the ROI be greater if similar efforts produced an advanced directive endeavor of similar stature. Opportunity cost is a bedrock policy principle, and do not mistake the status quo for correctness. We usually do until we read and educate ourselves, but data does not surface easily.
Seriously, stay healthy and well, and may your ER volume tread lightly.
“The single principle of medicine is that you don’t force people to take medicine,” she said.
Huh? What about TB?
Rhode Island’s regulation, enacted in December, may be the toughest and is being challenged in court by a health workers union. The rule allows exemptions for religious or medical reasons, but requires unvaccinated workers in contact with patients to wear face masks during flu season. Employees who refuse the masks can be fined $100 and may face a complaint or reprimand for unprofessional conduct that could result in losing their professional license.
Some Rhode Island hospitals post signs announcing that workers wearing masks have not received flu shots. Opponents say the masks violate their health privacy.
Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education.
Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates.
Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University.
He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.