A Response To Bill Maher’s Opposition to Vaccinations

Bill Maher has an entertaining show on H.B.O. and I often agree with him, but his ignorance of medical science rivals the ignorance exhibited by those on the right who deny evolution and climate change. I even noted recently that when he had former Senate Republican Leader Bill Frist on a recent show I wound up agreeing with Frist as opposed to Maher.

When right wingers deny evolution or climate change, many Republicans will join with them–especially if they are running for president. In contrast, many on the left condemn Maher’s ignorance of science just as strongly as we condemn the anti-scientific attitudes of the right. Michael Shermer, Editor of Skeptic magazine and a columnist for Scientific American has posted an open letter to Bill Maher at RichardDawkins.net:

Dear Bill,

Years ago you invited me to appear as a fellow skeptic several times on your ABC show Politically Incorrect, and I have ever since shared your skepticism on so many matters important to both of us: creationism and intelligent design, religious supernaturalism and New Age paranormal piffle, 9/11 “truthers”, Obama “birthers”, and all manner of conspiratorial codswallop. On these matters, and many others, you rightly deserved the Richard Dawkins Award from Atheist Alliance International.

However, I believe that when it comes to alternative medicine in general and vaccinations in particular you have fallen prey to the same cognitive biases and conspiratorial thinking that you have so astutely identified in others. In fact, the very principle of how vaccinations work is additional proof (as if we needed more) against the creationists that evolution happened and that natural selection is real: vaccinations work by tricking the body’s immune system into thinking that it has already had the disease for which the vaccination was given. Our immune system “adapts” to the invading pathogens and “evolves” to fight them, such that when it encounters a biologically similar pathogen (which itself may have evolved) it has in its armory the weapons needed to fight it. This is why many of us born in the 1950s and before may already have some immunity against the H1N1 flu because of its genetic similarity to earlier influenza viruses, and why many of those born after really should get vaccinated.

Vaccinations are not 100% effective, nor are they risk free. But the benefits far outweigh the risks, and when communities in the U.S. and the U.K. in recent years have foregone vaccinations in large numbers, herd immunity is lost and communicable diseases have come roaring back. This is yet another example of evolution at work, but in this case it is working against us. (See www.sciencebasedmedicine.org for numerous articles answering every one of the objections to vaccinations.)

Vaccination is one of science’s greatest discoveries. It is with considerable irony, then, that as a full-throated opponent of the nonsense that calls itself Intelligent Design, your anti-vaccination stance makes you something of an anti-evolutionist. Since you have been so vocal in your defense of the theory of evolution, I implore you to be consistent in your support of the theory across all domains and to please reconsider your position on vaccinations. It was not unreasonable to be a vaccination skeptic in the 1880s, which the co-discovered of natural selection—Alfred Russel Wallace—was, but we’ve learned a lot over the past century. Evolution explains why vaccinations work. Please stop denying evolution in this special case.

As well, Bill, your comments about not wanting to “trust the government” to inject us with a potentially deadly virus, along with many comments you have made about “big pharma” being in cahoots with the AMA and the CDC to keep us sick in the name of corporate profits is, in every way that matters, indistinguishable from 9/11 conspiracy mongering. Your brilliant line about how we know that the Bush administration did not orchestrate 9/11 (“because it worked”), applies here: the idea that dozens or hundreds pharmaceutical executives, AMA directors, CDC doctors, and corporate CEOs could pull off a conspiracy to keep us all sick in the name of money and power makes about as much sense as believing that Bush, Cheney, Rumsfeld, and their bureaucratic apparatchiks planted explosive devices in the World Trade Center and flew remote controlled planes into the buildings.

Finally, Bill, please consider the odd juxtaposition of your enthusiastic support for health care reform and government intervention into this aspect of our medical lives, with your skepticism that these same people—when it comes to vaccinations and disease prevention—suddenly lose their sense of morality along with their medical training. You excoriate the political right for not trusting the government with our health, and then in the next breath you inadvertently join their chorus when you denounce vaccinations, thereby adding fodder for their ideological cannons. Please remember that it’s the same people administrating both health care and vaccination programs.

One of the most remarkable features of science is that it often leads its practitioners to change their minds and to say “I was wrong.” Perhaps we don’t do it enough, as our own blinders and egos can get in the way, but it does happen, and it certainly happens a lot more in science than it does in religion or politics. I’ve done it. I used to be a global warming skeptic, but I reconsidered the evidence and announced in Scientific American that I was wrong. Please reconsider both the evidence for vaccinations, as well as the inconsistencies in your position, and think about doing one of the bravest and most honorable things any critical thinker can do, and that is to publicly state, “I changed my mind. I was wrong.”

White House Says Illegal Aliens Will Not Be Allowed To Purchase Insurance Through Exchanges

I understand the political pressures for Obama to make it clear that health care reform will not lead to spending tax payer’s money on illegal aliens, but this simply makes no sense. The White House now says that illegal aliens will not be able to purchase insurance through the new exchanges:

The White House on Friday said it would bar illegal immigrants from purchasing health coverage through a proposed insurance marketplace. But the administration also said that the federal government would continue to require hospitals to provide emergency treatment to illegal immigrants at taxpayer expense.

The question of how illegal immigrants would fare under a proposed overhaul of the health care system came into sharp focus on Wednesday during President Obama’s speech to Congress. Representative Joe Wilson, Republican of South Carolina, shouted “You lie!” when Mr. Obama insisted that his health care overhaul would not insure illegal immigrants.

And the Obama administration’s determination to show that immigrants will not benefit from the health system overhaul highlighted the extraordinary sensitivity to the issue at a time when lawmakers still remain divided over whether the government should pay to provide health coverage for all American citizens.

A White House spokesman, Reid Cherlin, said that the president’s proposals would bar illegal immigrants from purchasing private insurance through the new government marketplace, known as an exchange, and that verification of immigration status would be required for anyone seeking to purchase coverage.

Besides making no sense in principle to deny even illegal aliens the ability to purchase something with their own money, this might also have negative results for everyone else. Having more people, including illegal aliens, buying insurance increases the risk pool and would lower the cost. Not allowing illegal aliens to purchase insurance also increases the risk that they will require emergency room treatment at public expense. It would be advantageous for them to have medical coverage during future influenza epidemics to increase the chances they are vaccinated, potentially reducing spread of the disease.

This is an unnecessary way to demonstrate that Joe Wilson was wrong. Hopefully by the time the final legislation gets through Congress this idea will be forgotten.

WHO Declares Influenza Pandemic

The H1N1 influenza (Swine flu) has not received as much attention here lately as it turned out to be less lethal than suggested in initial reports, and the spread has diminished as influenza season ended in North America. That doesn’t mean it can be forgotten. The World Health Organization has now declared it to be a pandemic:

The swine flu (H1N1) virus first emerged in Mexico in April and has since spread to 74 countries.

Official reports say there have been nearly 30,000 cases globally and 141 deaths, with figures rising daily.

Hong Kong said it was closing all its nurseries and primary schools for two weeks following 12 school cases.

It is the first flu pandemic in 40 years – the last in 1968 killed about one million people.

However, the current pandemic seems to be moderate and causing mild illness in most people.

Most cases are occurring in young working age adults and a third to a half of complications are presenting in otherwise healthy people.

Dr Chan said: “We have evidence to suggest we are seeing the first pandemic of the 21st Century.

While there remains no reason for panic, there is the danger that the virus can evolve and potentially become more dangerous and could become a more serious problem in the United States when we get into the next flu season. I previously discussed the H1Ni influenza in posts including here.

Republicans Should Have No Fear Of Swine Flu


Good news for Republicans. Ignore all the stories about swine flu (H1N1 influenza). Don’t bother to wash your hands or avoid sick people. If there is no evolution, then you don’t have to fear a new strain of flu evolving to be able to spread from human to human.

For the 79% of the country who are not Republicans, or for those Republicans who do believe in evolution, here’s some information posted by the National Institute of Allergy and Infectious Disease of the NIH. Click on above diagram for a larger view.

H1N1 Influenza (Swine Flu) Information

Here’s some of the latest government posts for information on the H1N1 influenza (swine flu):


Schools, Colleges, Child Care

Employers & Employees


Health Professionals


More documents from the World Health Organization are available here.

A Pig By Any Other Name

The pork lobby has been upset about the way in which the latest influenza outbreak is being called swine flu. Some sources are giving in and are using the more scientific terminology of H1N1 flu instead. I noted that today the CDC is using H1N1 but still has Swine Flu in parentheses. They have defended the legitimacy of also calling it swine flu:

In a briefing Tuesday, Richard Besser, acting director of the federal Centers for Disease Control and Prevention in Atlanta, acknowledged that the agency’s use of the swine flu label was fueling the misconception that people could catch the new respiratory disease from food. “That’s not helpful to pork producers. That’s not helpful to people who eat pork,” Dr. Besser said. “And so we’re discussing: is there a better way to describe this that would not lead to inappropriate action on peoples’ part?”The flu that erupted in Mexico earlier this month is a big worry because it is transmitted between humans, who don’t have any immunity to the new strain. Medical authorities haven’t found any cases of people catching this new strain from contact with pigs or pork, nor has the new strain been detected in pigs.

Still, many scientists say the CDC is well within its rights to describe the disease as swine flu even though it seems to have mutated into a unique human virus. Flu viruses tend to be named after the first species in which they are discovered, and H1N1 was discovered in pigs decades ago.

Genetic sequencing of the new form of the H1N1 virus shows that it clearly had a long history in hogs before it made the leap into the human population and acquired its deadly new traits.

“The vast amount of material in it is in pigs,” said Michael T. Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy.

So far I don’t know that the pork industry has lost very much money because of any misconceptions about eating pork products. I’m far more worried about the affects of the pig scare in the 100 Acre Wood:


Pandemic Alert Level Raised To Phase 5

In follow-up of my earlier post on the swine flu, the World Health Organization has now raised the current level of influenza pandemic alert from phase 4 to phase 5. See the earlier post for background and further links to the definitions of the alert levels.

Why The Swine Flu Is A Big Deal

We tend to hear so many warnings from government and the media that there is a tendency towards skepticism among many people. In some cases this turns into outright denialism, such as with the number of conservatives who outright deny the scientific consensus on climate change. While comments here are hardly representative of the population at large, noting two different comments to the previous post (from different parts of the political spectrum) questioning the attention paid to swine flu I have decided to briefly explain why this story really is a big deal.

One commenter writes, “I remember the bird flu and the outbreaks of normal flu before and after, too. At certain times of the year, people get the flu. Is this really news anymore?” The potential of a pandemic is far more significant than a normal influenza outbreak. Infectious disease and pubic health experts have been concerned for years about the dangers of an influenza pandemic comparable to the 1918 pandemic which cost a tremendous number of lives worldwide. The current swine flu outbreak may or may not turn into a pandemic, but there is reasonable concern for the potential of this happening. The World Health Organization ranks the risk of pandemic on a scale of one to six, with six being a full-scale pandemic. Currently the swine flu outbreak is rated at four, but it looks like the WHO is getting close to moving this up to a five.

During a normal seasonal influenza outbreak there’s a tremendous number of people who are immunized against the expected influenza strains for that year. Even those who have not received the influenza vaccine are partially protected by herd immunity. Having less people in the community who are susceptible to the infection makes it harder to spread, reducing the risk for those who have not been vaccinated. In contrast to normal influenza outbreaks, we do not have large numbers of people immunized against the swine flu. (I have seen some speculation that those who have received influenza vaccines on a regular basis have received immunizations against a large number of influenza strains and might have some partial immunity, but we certainly cannot count on this).

One feature of this infection might also make it potentially more serious than other influenza epidemics. Many of the more serious cases have occurred among young adults, as opposed to among the higher risk individuals who often suffer the most in influenza outbreaks. There is speculation that the more serious consequences of this strain come not from the initial infection but from the response of one’s immune system. Paradoxically this might make young healthy people with strong immune systems the ones at greatest risk.

Another consequence of influenza is the development of secondary bacterial infections when people are weakened by the flu. Overuse of antibiotics has increased the risk of the selection of bacterial strains which are resistant to conventional antibiotics.

Our patterns of travel make it more difficult to control a potential pandemic. The ideal way to contain an epidemic is to identify the outbreak in its first location and contain it there. It is far too late for that. The amount of air traffic from Mexico and around the world has spread the virus around the world, with confirmed cases in seven countries, with this number expected to rise quickly. As of 11:00 a.m. today the Center for Disease Control reports ninety-one laboratory confirmed cases in the United States. These are in ten states (Arizona, California, Indiana, Kansas, Massachusetts, Michigan, Nevada, New York, Ohio, and Texas). The largest number of cases are in New York City (51). The first death has been reported in Texas.

There might be some tendency to see an increase to only ninety-one confirmed cases as trivial, but we have no idea how much this will increase. The incubation period is two to seven days, meaning that there can still be many people who will turn out to have the disease from contact which occurred even before news broke of this infection last Friday. The bigger question is how much it will spread in different communities.

At this point we do not know how severe an illness we will be seeing. Initial reports out of Mexico suggested that the virus might be more deadly than it now appears to be. Even when there were reports of over one hundred deaths it was difficult to interpret this as we had no accurate count of overall cases. It now appears that these reports were exaggerated, with the WHO officially reporting only seven deaths in Mexico.

The considerable amount of media attention might actually be helpful in reducing the risk of pandemic. Simple precautions such as washing hands (including use of products such as Purell when hand washing is not practical) can greatly reduce spread. Knowledge of the existence of the virus could increase the chances that those infected do remain at home and avoid contact with others. Besides taking prudent action to avoid infection, it would also be advisable to be prepared with supplies such as food in one’s home should there be a serious outbreak in one’s community. The more people avoid public places in case of such an outbreak, the more likely it will remain limited.

At this point we do not know how serious a problem there will be. It is important not to panic, but also not to write this off as a meaningless scare should this not turn out to be a serious problem this year. The same concerns which cause infections disease specialists to be concerned about the risk of a pandemic exist, and we can still face such problems in the future. It also must be kept in mind that we are at the end of the usual influenza season and we might stop seeing this strain as we stop seeing other types of flu this time of year. It remains possible that the swine flu will return during next year’s influenza season, but that would leave plenty of time to develop vaccinations.

Climate Change and Infection

In Guns, Germs and Steele, Jarod Diamond argued that European nations became dominant because of advantages of geography. As is obvious from the title, infections played a role. Diamond believes that Europeans weren’t as successful in colonizing tropical areas as areas in temperate climates because Europeans lacked immunity to tropical germs. His work came to mind when I read this report in The New York Times of an example of human activity which altered nature. Partially because of global warming, a village in Italy has had an outbreak of a virus previously only seen in the tropics:

Aided by global warming and globalization, Castiglione di Cervia has the dubious distinction of playing host to the first outbreak in modern Europe of a disease that had previously been seen only in the tropics.

“By the time we got back the name and surname of the virus, our outbreak was over,” said Dr. Rafaella Angelini, director of the regional public health department in Ravenna. “When they told us it was chikungunya, it was not a problem for Ravenna any more. But I thought: this is a big problem for Europe.”

The epidemic proved that tropical viruses are now able to spread in new areas, far north of their previous range. The tiger mosquito, which first arrived in Ravenna three years ago, is thriving across southern Europe and even in France and Switzerland.

And if chikungunya can spread to Castiglione — “a place not special in any way,” Dr. Angelini said — there is no reason why it cannot go to other Italian villages. There is no reason why dengue, an even more debilitating tropical disease, cannot as well.

“This is the first case of an epidemic of a tropical disease in a developed, European country,” said Dr. Roberto Bertollini, director of the World Health Organization’s Health and Environment program. “Climate change creates conditions that make it easier for this mosquito to survive and it opens the door to diseases that didn’t exist here previously. This is a real issue. Now, today. It is not something a crazy environmentalist is warning about.”

Climate change creates the potential for areas outside of the tropics to face new infectious diseases. At least, should we be faced with new infections in the United States, conservatives who do not believe in global warming should have nothing to worry about–just as conservatives who do not believe in evolution have no need to receive a new influenza vaccine each year as the flu virus evolves to become resistant to the previous year’s vaccine.

More Health Care Gibberish From John Edwards

I used to think that Edwards was simply a light weight seeking political power, or as Bob Shrum called him, “a Clinton who hadn’t read the books.” Considering how Edwards made a fortune convincing southern juries that birth defects were caused by medical malpractice, I thought he must have at least some cursory knowledge of health care. Of course there’s already something suspicious about someone who makes healthcare a cornerstone of his campaign but doesn’t know that Cuba has a government run health care system, especially as he asked this just a few days after recommending that people watch Sicko.

The more I hear from Edwards, the less it appears that he has any real understanding of the major issues of the day. The latest nonsensical statement from Edwards was that his health care system would not only encourage preventative care but make it mandatory. (Hat tip to Q and O).

Democratic presidential hopeful John Edwards said on Sunday that his universal health care proposal would require that Americans go to the doctor for preventive care.

“It requires that everybody be covered. It requires that everybody get preventive care,” he told a crowd sitting in lawn chairs in front of the Cedar County Courthouse. “If you are going to be in the system, you can’t choose not to go to the doctor for 20 years. You have to go in and be checked and make sure that you are OK.”

He noted, for example, that women would be required to have regular mammograms in an effort to find and treat “the first trace of problem.” Edwards and his wife, Elizabeth, announced earlier this year that her breast cancer had returned and spread.

Edwards said his mandatory health care plan would cover preventive, chronic and long-term health care. The plan would include mental health care as well as dental and vision coverage for all Americans.

I sure wonder how he plans to enforce this. Based upon the number of patients who refuse mammograms or other recommended screening studies, it may be a huge expense simply to enforce this. While I often find it frustrating to see so many patients make dumb decisions, freedom means being able to make your own dumb decisions as opposed to having government make personal decisions for you.

At present I have many patients refuse influenza vaccines every year. Should I force a patient to have one against their will I’d be charged with assault and battery. Under Edwards’ mandatory health care plan, would patients forcibly receive such vaccines? In some cases, such as mammograms, the value is well established. In many other cases there remains some controversy over what is best with different medical organizations having different recommendations. Even when the rational for a recommendation is established, this is something to be discussed by the patient and their physician, not a matter which applies without variation to every individual.

Hopefully the idea of dragging people in by force to have a influenza vaccine or mammogram is well beyond what Edwards proposes, but even less Draconian efforts could be counterproductive. Even if there were measures which penalized the non-compliant by increasing the out of pocket cost of care, or otherwise restricted care for those who fail to abide by recommendations for preventative care, this would be contrary to the real goal of making health care more affordable for all who desire health care services. If someone has not had mammograms do we then refuse to treat them should they later develop breast cancer? Unfortunately it is an unavoidable fact of life in health care that we often wind up treating people for things which might have been prevented.

The goal is to help enable people who desire coverage but are not able to under the current system, not to force people into a mandatory plan. I’ve long had reservations about Edwards based upon his poor record with regards to civil liberties as well as a Bush-like ignorance of the issues. A plan like this makes Edwards even more authoritarian than the current Republican Party.