Jewish World Review Jan. 10, 2003 / 7 Shevat, 5763

Drs. Michael A. Glueck & Robert J. Cihak

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Consumer Reports

A pox on the critics; diagnosis sour grapes | Although Al Quada candidly bangs the drums more rapidly with the threat of a bio-weapons attack against the United States and Israel; many public officials insist on sticking their heads in the sand one more time. Fortunately, not the President.

Last December, the Bush administration decided to proceed with national voluntary smallpox immunization - a policy We The Medicine Men had been advocating for some time.

Since then, the decision has drawn its share of criticism from the national public health community. Some seems to fit the predictable category of sour grapes, complaints that the usual experts - among them, experts Bill Clinton hired - were insufficiently "consulted." But some of the carping leads, albeit unintentionally, to an opportunity for the nation to take a hard look at our vaccination practices as a whole. And some reveals that, when you're dealing with bureaucracy, the rule is: First, protect thy turf.

In a December 29 Los Angeles Times commentary, Linda Rosenstock, MD, Dean of the UCLA School of Public Health and Director of the National Institute for Occupational Safety and Health in the Clinton administration, wrote, somewhat sourly:

"It may come as a surprise to some that we don't make health policy in this country based on portentous warnings from behind closed doors . . . Making such sweeping decisions as President Bush has done on smallpox vaccination -- keeping the public and experts in the dark -- is simply indefensible."

Actually, it's quite defensible. We medical and public health personnel are ill-equipped to make the vital trade-offs between public health, individual health, national security, economic productivity and military preparedness. We hold neither the authority nor the political power nor the expertise to make these determinations, and should not pretend to do so.

Further, beginning in medical school, physicians are inoculated with the dictum: "Never be the first to adopt the new medical treatments nor the last to toss the old aside." A wise-enough precept, no doubt, but problematical when faced with unprecedented perils. Preparedness requires that caution be leavened with informed, aggressive action and imagination.

Dr. Rosenstock then squeezes her grapes into sauce for a couple red herrings. She complains about "the implication that the risk now is sufficiently greater than it was before the Sept.11 attacks." If the risk was just as high (or greater) back when she and her boss held power, why was that information kept from us? Why was action not taken?

Finally, she extols the "established public health policy that once a clear public benefit exists, taking into account known risk -- as with routine childhood immunizations -- THEN the goal is universal coverage."

Whose goal? Yours, mine, or the bureaucracy's?

And that is the question that brings us to the larger issues.

Smallpox vaccination is VOLUNTARY, as it should be until an actual attack occurs or is imminent. People have the right to decline. But as individuals, there are times we aren't given the right to decline immunizations we DON'T want, sometimes for ourselves and most of the time for our children.

As Jane Orient, MD., Executive Director of the Association of American Physicians and Surgeons (AAPS) and Doctors for Disaster Preparedness (DDP) points out: "Children are routinely required to take vaccines against diseases much less serious than smallpox despite comparable side effects. Public health projections estimate the number of deaths associated with administration of 300 million does of the smallpox vaccine would be 350 deaths. And yet there were 440 deaths associated with only 20 million doses of hepatitis B vaccine as of 1998."

Finally, much of the public health community criticism reveals a certain bureaucratic defensiveness and intellectual rigidity. As Dr. George E. Hardy, executive director of the Association of State and Territorial health Officials, noted in a December 20 Los Angeles Times news article:

"As critical as it is that we be prepared to respond to a smallpox attack, it cannot come at the expense of other public health programs."

Whose programs? And since when have we had only one public health program? All states have their own policies.

"Tuberculosis, E. coli and measles are not taking a furlough," warned Patrick M. Libbey, executive director of the National Assn. of County and City Health Officials.

Of course not. Disease never has; it never will. But translate this statement from Dire Warning into Plain English, and in comes out: "Give us more of the taxpayers' money."

So what else is new?

We applaud the President for making a wise and courageous decision and sticking with it in spite of criticism by many (with eyes widely shut) in the public health community.

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Michael Arnold Glueck, M.D., is a multiple award winning writer who comments on medical- legal issues. Robert J. Cihak, M.D., is past president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists. Comment by clicking here.


01/03/03: If protesting is good for your health; then at least let's root for the home team
12/20/02: Obesidemic (obesity epidemic) or not?
12/20/02: Time for voluntary informed smallpox vaccinations
12/13/02: The real reason the state opposes homeschooling?
12/06/02: Conscience of a former conservative: Portrait of a political metamorphosis
11/27/02: Thanksgiving dinner hazard?
11/22/02: Time to think outside the box and inside the nucleus
11/15/02: The military should be protected from abusive environmental laws in times of war
11/11/02: Does Kyoto Treaty pose more harm than global warming?
10/31/02: Deep thoughts on Baseball, the World Series and Life: How about them Anaheim Angels?
10/23/02: "Pediatric rule" guinea pigs
10/23/02: Once the World Series ends, we need to create a Donnie Moore Day of Remembrance: Sports and mental health
10/18/02: Congress to senior patients: Do as we say not as we do for ourselves
10/11/02: Using pollution "scare labeling" to political advantage
10/04/02: The Great Asbestos Heist: Did Litigation and Junk Medical Science Helped Bring Down the World Trade Center?
09/27/02: The imminent rise of civic feminism: A far healthier national alternative in war and peace
09/20/02: A Ray A Day" to replace the daily apple?
09/13/02: Beware of celebrities hawking drugs
09/06/02: Avoid 9/11 overdose: Give blood to begin "September of Service," SOS
08/28/02: From Doubleday to strikeday: Baseball's collective anxiety attack
08/23/02: Should she or shouldn't she?: An alternative view on treating menopause with HRT
08/16/02: Cooking up defenses against germ warfare
08/02/02: Medicine, crime and canines
07/26/02: Lies, pathologic lies and the Palestinians
07/19/02: Medicare Drug Follies as in "now you see it, now you don't"
07/12/02: Anti-Profiling: A New Medically False Belief System
07/08/02: Don't procrastinate, vaccinate!
06/28/02: The scientific advances on the safe and effective deployment of DDT are being ignored, or denied. Why?
06/21/02: Sex and the system: In seeking healthcare men are different from women
06/14/02: The FDA, drug companies and life-saving drugs: Who's the fox and who's the hen now?
06/07/02: Medical Privacy Lost: A hippo on the healthcare back!
05/24/02: To clean up America's game: A (soggy) ground rule
05/10/02: Free speech is good medicine
05/03/02: Medicine's Vietnam
04/26/02: Attack on alternative medicine could lead to alternative lawsuits
04/12/02: Insure the 'crazies'?
04/09/02: No Time for Litmus Tests: In War We Need a Surgeon General and NIH, CDC, and FDA Directors
04/02/02: The scoop on soot: A dirty rotten shame?
03/22/02: Too many beautiful minds to waste: The first annual Caduceus Movie
03/15/02: Terror and transformation: Defense essential for health & state of mind
03/08/02: Diagnosis: Delusional
03/06/02: The great matzah famine
03/01/02: Is new Hippocratic Oath hypocritical?
02/15/02: Why the recent moaning about cloning?
02/08/02: Searching for Dr. Strangelove
01/15/02: Score one for the value of human life
01/04/02: Medical-legal-financial wake-up call
12/28/01: Who's afraid of a 'dirty bomb'?
12/21/01: End of medicine?
12/14/01: More heroes: Docs deserve a little credit after 9/11
11/16/01: Do we need 'Super Smallpox Saturdays'?
11/09/01: Why the post-9-11 health care debate will never be the same
11/01/01: Common sense good for our mental health
10/26/01: Your right to medical privacy --- even in terror time
10/12/01: Failed immigration policy ultimately bad for nation's mental health: Enemy within leads to epidemic of jumpy nerves
09/28/01: Can legal leopards change their spots: A treat instead of a trick
09/21/01: Civil defense again a civic duty
08/30/01: Shut down this government CAFE
08/23/01: School Bells or Jail Cells?
08/15/01: Time to take coaches to the woodshed
08/10/01: Blood, Guts & Glory: The Stem of the Stem Cell controversy

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