A Public Health Stranger in the Land of Medical Care
Monday, November 2, 2009
I cannot recount the number of times in the past few weeks friends, relatives, students, and strangers have asked me whether they should get the H1N1 vaccine.
Some are concerned about the side effects or wonder whether the vaccine has been tested. Parents are worried for their young children. They are concerned about the claims of links between vaccines and autism even if they know that there has never been a credible study demonstrating it. Some of my students say that the flu sucks, but it isn’t bad enough to get a vaccine. They ask: Is it effective? Will the vaccine make me sick?
Let me be clear: I am neither a physician nor a scientist. On the other hand, many don’t seem to trust physicians or scientists who claim the benefits of the vaccine with near unanimity even while some admit that we really will not know how effective the vaccine is until H1N1 has run its course. So when people ask for vaccine advice (or any medical advice for that matter), I hesitate to tell them what I think. I can only tell them what I would do.
I would vaccinate. And I will vaccinate after they cover all those who are most at risk. Why, you might ask. There are two major reasons for vaccinating. One is self-interest. Who wants to be sick? Second, I don’t want to infect anyone else.
Most of us don’t think of the second reason, especially in the U.S.A. In many parts of Asia, for example, the culture of community responsibility is embedded (admittedly, it is also mandated in some places). Living in Singapore in 2003, residents would wear masks if they had symptoms to prevent the spread of infection. And that was BEFORE the SARS epidemic.
Luckily, I am a generally healthy 50+ year old. Thus, I am low on the priority list for the H1N1 vaccine. But when I am called, I will be vaccinated. I hate being sick, but I also don’t want to infect pregnant women, young children, or anyone else who might be at higher risk than I.
For anyone who is wavering, think of it as giving a gift to those around you who will NOT be infected because you vaccinated.
Sunday, September 20, 2009
I don’t need to know if you are sick. Or do I? How about if you have a contagious illness? Perhaps H1N1?
Fortunately, the latest pandemic has not been as fatal as we had feared. While tragedy has struck some families, the death rate is about the same as or less than seasonal flu. Most of those who have perished had prior illnesses or conditions that left them susceptible to opportunistic infections like H1N1.
In the Ithaca community, tragedy struck a Cornell senior who became the third college student to die from H1N1 in the US. We do not know if any prior conditions contributed to his death. Yet, headlines in the Cornell Daily Sun this week read:
Hospital Says It Has Not Discussed Whether Any Underlying Condition Contributed to H1N1 Death
The laws are clear: patient privacy is secure and protected. Only the patient or the family has the right to grant access to health information. Even when the climate of fear permeates the community, our culture and laws value and protect the individual right to privacy. For that we should be thankful. For now.
What about the next epidemic? When the extent of the disease is more widespread, the fatality rates are higher, and underlying conditions are an obvious risk factor? What can we learn from the current epidemic? Shall we do anything different? Dare say, shall we suspend the laws and culture of privacy, for example? They do that in many other parts of the world in order to protect the public's health.
Do I need to know if you are sick? Or did you have an underlying condition, or not? Is the greater responsibility to protect the community or the individual right to privacy?
Stay tuned. The next epidemic is…..
Meanwhile, here is my highly recommended reading for this subject: The Last Town on Earth by Thomas Mullen; a novel about the morality issues of isolation, quarantine, and fear surrounding the deadly 1918 flu pandemic.