transparency

This is a rant that ID doc Mark Crislip posts every year in vaccine season.

This is the rant on the original Medscape site, where you have to login to see it but it’s free and they don’t spam you or anything:

http://boards.medscape.com/forums?128@659.kq28abHJzWk@.2a0e4709!comment=1

For those who don’t want to login, I am taking the words at the bottom of the post literally and passing this essay on. I know you are mostly not healthcare providers, but much of it does apply to the rest of us anyway.

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This essay is, I would like to clarify, directed at healthcare providers, not patients. Healthcare providers have no excuse to avoid the flu vaccine: they have access to the world’s medical knowledge and should be able to rise above superstition and ignorance.  Yes, I too am a Dumb Ass, but for different reasons.

I give you, slightly rewritten for 2011, a Budget of Dumb Asses.

I wonder if you are one of those Dumb Asses who do not get the flu shot each year? Yes. Dumb Ass. Big D, big A. You may be allergic to the vaccine (most are not when tested), you may have had Guillain-Barre, in which case I will cut you some slack. But if you don’t have those conditions and you work in healthcare and you don’t get a vaccine for one of the following reasons, you are a Dumb Ass.

1. The vaccine gives me the flu. Dumb Ass. It is a killed vaccine. It cannot give you the influenza. It is impossible to get flu from the influenza vaccine.

2. I never get the flu, so I don’t need the vaccine. Irresponsible Dumb Ass. I have never had a head on collision, but I wear my seat belt. And you probably don’t use a condom either. So far you have been lucky, and you are a potential winner of a Darwin Award, although since you don’t use a condom, you are unfortunately still in the gene pool.

3. Only old people get the flu. Selfish Dumb Ass. Influenza can infect anyone, and the groups who are more likely to die of influenza are the very young, the pregnant, and the elderly. Often those most at risk for dying from influenza are those least able, due to age or underlying diseases, to respond to the vaccine. You can help prevent your old, sickly Grandmother or your newborn daughter from getting influenza by getting the vaccine, so you do not get flu and pass it one to her. Flu, by the way, is highly contagious, with 20% to 50% of contacts with an index case getting the flu.  However, Granny may be sitting on a fortune that will come to you, and killing her off with the flu is a great way to get her out of the way and never be caught.  That would make a good episode of CSI.

4. I can prevent influenza or treat it by taking echinacea, vitamin C, oscillococcinum or Airborne. Gullible Dumb Ass cubed then squared. None of these concoctions has any efficacy what so ever against influenza. And if you think oscillococcinum has any efficacy, I would like you to invest in a perpetual motion machine I have invented.  None of the above either prevent or treat influenza. And you can’t “boost” your immune system either. Anyone who suggests otherwise wants you money, not to improve your health.

5. Flu isn’t all that bad of a disease. Underestimating Dumb Ass. Part of the problem with the term flu is that it is used both as a generic term for damn near any viral illness with a fever and is also used for a severe viral pneumonia. Medical people are just as inaccurate about using the term as the general public. The influenza virus directly and indirectly kills 20,000 people  (depending on the circulating strain and year) and leads to the hospitalization of 200,000 in the US each year. Influenza is a nasty lung illness. And what is stomach ‘flu’? No such thing.

6. I am not at risk for flu. Denying Dumb Ass. If you breathe, you are risk for influenza. Here are the groups of people who should not get the flu vaccine (outside of people with severe adverse reactions to the vaccine): Former President Clinton, who evidently doesn’t inhale. Michele Bachmann. Wait, that’s the HPV vaccine.  And people who want to be safe from zombies. If you don’t get the vaccine you do not have to worry about the zombie apocalypse, because zombies eat brains.

7. The vaccine is worse than the disease. Dumb Ass AND a wimp. What a combination. Your mother must be proud. Unless you think a sore deltoid for a day is too high a price to pay to prevent two weeks of high fevers, severe muscles aches, and intractable cough.

8. I had the vaccine last year, so I do not need it this year. Uneducated Dumb Ass. Each year new strains of influenza circulate across the world. Last year’s vaccine at best provides only partial protection. Every year you need a new shot.

9. The vaccine costs too much. Cheap Dumb Ass. The vaccine costs less than a funeral, less than Tamiflu, and less than a week in the hospital.

10.  I received the vaccine and I got the flu anyway. Inexact Dumb Ass. The vaccine is not perfect and you may have indeed had the flu.  More likely you called one of the many respiratory viruses (viri?) people get each year the flu.  Remember there are hundreds of potential causes of a respiratory infection circulating, the vaccine only covers influenza, the virus most likely to kill you and yours.

11. I don’t believe in the flu vaccine. Superstitious, premodern, magical thinking Dumb Ass. What is there to believe in?  Belief is what you do when there is no data. Probably don’t believe in gravity or germ theory either. Everyone, I suppose, has to believe in something, and I believe I will have a beer.

12. I will wait until I have symptoms and stay home. Dangerous Dumb Ass.  Despite often coming to work ill, especially second year residents, about 1 in 5 cases of influenza are subclinical, hospitalized patients are more susceptible to acquiring influenza from HCW’s than the general population,  and 27% of nosocomial acquired H1N1 died. And you wil never realize that you were the one responsible for killing that patient by passing on the flu.

13. The flu vaccine is not safe and has not been evaluated for safety.  Computer illiterate Dumb Ass.  There are 1342 references on the PubMeds on safety of the flu vaccine, and the vaccine causes only short term, mild reactions.  All health care requires weighing the risks of an intervention against the benefits. For the flu vaccine all the data suggests huge benefit for negligible risk. And as a HCW, it could be argued that we have a moral responsibility to maximize the safety of our patients.

14. The government puts tracking nanobots in the vaccine as well as RFID chips as part of the mark of the beast, and the vaccine doesn’t work since it is part of a big government sponsored conspiracy to keep Americans ill, fill hospital beds, line the pockets of big pharma and inject the American sheeple with exotic new infections in an attempt to control population growth and help usher in a New World Order. Well, that excuse is at least reasonable. Paranoid Dumb Ass.

So get the vaccine.  And pass this essay on to someone else.  The life you may save may be your own. Or be a Dumb Ass.

And if you and yours are admitted to the hospital or visit a HCW during the flu season, ask if your provider has had the vaccine. If not, ask for a new provider.  Who wants their health care provided by a Dumb Ass?