Idiocy has consequences — the risks of risk reduction

An article yesterday in the Wall Street Journal by an MD who was a deputy commissioner at the FDA offered 3 reasons why the flu vaccine is in such short supply. One of the three is totally unnecessary. The government decided to require the vaccine to be produced in single dose syringes. The usual technique is to place the vaccine in large vials, distribute them, and then have the locals remove each dose by a separate (and disposable) syringe. It’s obviously more laborious to put 100 doses in 100 syringes, than into one vial. It also takes a lot longer. Hence, one source of delay. Even though 40, 000,000 doses of flu vaccine were ordered last spring at the first inkling of trouble, they are nowhere in sight (we were supposed to have them by November).

What was the rationale for requiring single dose syringes? Multidose vials hang around a lot longer, and the risk of contamination is greater so more preservatives must be used per dose, one such being thiomersal. Basically the government knuckled under to the unfortunate parents of autistic children who believe that their child’s autism was caused by the mercury in thiomersal. There is excellent epidemiologic evidence that it doesn’t. Similar theories of other vaccines causing autism have been proposed and shot down. See [ Nature vol. 427 p. 765 ’04 ] for the sordid details of one example.

The flu is certainly out there (as it is every fall) and one local grade school has 22% of the kids out sick. Now assume (1) the H1N1 flu will become more virulent (it certainly doesn’t have to become any more infectious), (2) the vaccine offers some degree of protection against it. Both assumptions are reasonable (but arguable). Assuming them true, this means that people (and so far in the epidemic this means children) will die because they didn’t get the vaccine in time. Idiocy has consequences.

An even more sordid example of the risks of risk reduction is the following [ Nature vol. 354 p. 255 ’91 ]. An amazing article places the blame for the cholera epidemic sweeping South America starting in Peru on a misguided application of an Environmental Protection Agency study implicating water chlorination as a cause of cancer. During the 80’s Peruvian officials, citing the EPA study, stopped chlorinating many of the wells in Lima. However, others say that the decision might have been based on economics than data.

It’s comforting to know that the 3,516 who have died so far have been spared a long bout with cancer.

I can’t find the exact quote, but H. L. Mencken when writing about prohibition said something to the effect that “the humble swineherd will put us all into his pen.”

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  • luysii  On November 5, 2009 at 5:23 pm

    Hopefully the H1N1 virus hasn’t become more virulent on its summer trip to the Southern Hemisphere. It certainly hasn’t become any less infectious. The State Department of Health yesterday announced two shipments of 100 vaccine doses each to a local community. Unfortunately the absentee rate in the public schools of that community is around 20% (vs. the usual for 3 – 7% at this time of year). The same community is also home to a branch of the State University with over 20,000 students.

    The delay in getting the vaccine out and the current problems with its distribution will likely be the Hurricane Katrina of the new administration. Unlike Katrina, this problem was well known well over 6 months in advance. A previously healthy 12 year old girl with no known underlying disease died last week in a community 100 miles away. We can console her parents with the thought that she has been spared autism, and that the government was doing the best it could.

  • luysii  On November 12, 2009 at 7:46 pm

    Today the Dr. Schuchat of the CDC announced that there have been 4000 deaths due to the H1N1, of which 540 have been in children. I’ve written them to ask how many of these unfortunates had received the vaccine, and how many had underlying conditions (cystic fibrosis, muscular dystrophy, leukemia) which would make them more susceptible to any infection. Clearly only those dying since the first doses of the vaccine became available could be considered avoidable. If most of them received the vaccine, this will give us a handle on its efficacy.

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