Preventive Health Public Health Overrated

25 thoughts on “Preventive Health Public Health Overrated”

1. None of the points you list above is necessarily untrue, in and of themselves. The trick is, similar points can be made about any vaccine you want to try to demagogue out of existence, regardless of the actual weight of the data available.
   There is far more evidence out there than that 1,200-person study you keep citing, including the 190,000-person study conducted in the U.S. immediately after approval which showed NO side-effects statisticallly different from the unvaccinated background population in any of the age-groups studied. (Look it up yourself; I’m tired of doing your homework for you, Mr. Mensa.) Therefore, “unproven” is still a poor word choice, whatever your own (self-) exalted opinion.
   As for “a SINGLE WORD that would have been more accurate than ‘unproven’,” how about your pick of “unwanted,” “unneeded,” or “unnecessary?” Any one of those would have fit your point without being factually debateable, and honestly, I’d have personally agreed without question.
   And why the hissy fit over a single well-chosen word? Gone off our meds, have we?
   I think “hissy fit” more accurately describes your wild over-reaction to a really minor critique with a temper tantrum which would be the envy of any 2-year old if they could’ve seen/understood it. Perhaps your own self-esteem is low enough that finding even that small bone to pick was a deliberate frontal assault on your manhood in your eyes? Or maybe you just didn’t understand that it really was only a minor thing from my perspective. Personally, I find my reading comprehension skills are better when I’m not simultaneously attempting to parallel park. It’s just a thought, Heaven forbid I should tell a 2%-er how to do things.
   Since it’s clear to me now that you are far more interested in being right in your own mind than accepting (what started out as) a small note with no malice or slight intended, I will leave others to respond to your future comments and simply assume from now on that what you might have to say is not even worth the paper it’s printed on.
   (In case you’re still parking, that means “less than zero.” Because there’s no paper involved in posting comments to this site. Just trying to help.)

2. Hi Smokey,
   I evaluated a mixed bag article. My impressions are not completely dissimilar to the ones you mentioned. Here are a few salient and not-so-salient points from a washingtontimes.com piece:
   http://communities.washingtontimes.com/neighborhood/stress-and-health-dr-lind/2013/apr/10/us-court-pays-6-million-gardasil-victims/
   Headline: US court pays $6 million to Gardasil victims
   Comment: A court case is not necessarily the same thing as a scientific study. Some outcomes are sympathy verdicts that are not supported by the available evidence.
   Caveat: Naked statistics. No mention was made of the population size of Gardasil recipients that produced the deaths and apparent adverse effects. Would a control group of unvaccinated people of the same size, from a similar demographic, produce similar statistics?
   Red flag: “While it is not clear exactly what is causing so many adverse reactions, Gardasil does contain genetically engineered virus-like protein particles as well as aluminum, which can affect immune function.”
   Comment: Author Peter Lind appears to be suffering from anti-aluminium paranoia.
   Good point #1: “Further, according to the vaccine manufacturer product information insert, ‘Gardasil … not been evaluated for carcinogenicity or impairment of fertility.’” (2007 [227] p1986 )
   Comment: This point is germane. One of the rationales for the vaccine is that HPV can impair fertility in women. Does Gardasil decrease the risk of infertility, or does it increase that risk?
   Good point #2: In fact, Merck studied the Gardasil vaccine in fewer than 1,200 girls under 16 prior to it being released to the market under a fast-tracked road to licensure.
   Comment: Hey, Merck! Can you say, “small sample size?”
   Good point #3: According to the Annals of Medicine: “At present there are no significant data showing that either Gardasil or Cervarix (GlaxoSmithKline) can prevent any type of cervical cancer since the testing period employed was too short to evaluate long-term benefits of HPV vaccination.”
   Good point #4: HPV vaccines have been illegally administered to millions without informed consent, as the risks rarely disclosed.
   Good point #5: Over 90 percent of women infected with HPV clear the infection naturally within two years, at which point cervical cells go back to normal.
   Generic comment for the article as a whole: The author is a chiropractor. I suspect that most quackopractors have axes to grind.
   Now let’s backtrack a few steps. I used the word, “UNPROVEN,” to modify, “mass HPV vaccination at gunpoint.” By “unproven,” I meant: insuffficient info on risks and benefits.
   “Unproven” is more specific than “hallucinatory.” For most skilled readers, my meaning would have been clear from the context.
   Have you picked your daily quota of nits for the day? Now I’ll put the monkey on your back: Can you think of a SINGLE WORD that would have been more accurate than “unproven?”
   And why the hissy fit over a single well-chosen word? Gone off our meds, have we?

3. Oooooh Mensa. I bet you got a letter saying you qualified to pay to join “Who’s Who” as well. I hate to disappoint you, but you’re not the only one on this forum who’s qualified for Mensa’s little club. At least you didn’t fall for their scam and pay the $70. I’d have been more impressed if you’d said you could parallel park. I didn’t figure out how to do that well till I was 17. I was invited to pay to join Mensa when I was 8.

4. Interesting note, by raw numbers it could be implied that MMR vaccine is more dangerous.
   http://www.nvic.org/vaccines-and-diseases/Measles.aspx#Injuryv
   If the HPV vaccine works and were mandated it could prevent 6312 deaths per year in the US.
   http://www.kegel.com/hpv/deaths/
   So if the numbers are all that matters than it would seem, even taking the higher estimates of vaccine related death and adverse reactions, the vaccine would come out net positive with regards to mortality.
   Of course if you look at individual risk factors and choose to vaccinate or not accordingly a lot of risks could me mitigated, which is why I was against the mandate. But the obvious counter argument is that you can’t predict or control the behaviors of all children, especially with regards to sexual activity.
   I trust politicians to do what seems politically expedient, and I trust corporations to do what seems to be most profitable, but to dismiss all supporters of the mandate as being insincere or ill informed is not only unreasonable; it diminishes your ability to have a reasoned debate and make your side of the argument known.

5. And since you bring them up, let’s do talk about the deaths and other serious side effects listed in gruesome-yet-incomplete detail by the LifeSiteNews.com article for the apparent purpose of shocking the uninformed reader into agreement.
   The deaths et al. to which Mr. Baklinski refers come from a separate article by Judicial Watch, who printed an article listing their findings from a FOIA dredge of the FDA. From THAT article: “The total number of Gardasil-related deaths is 47 since the vaccine was approved in 2006.” But out of how many shots given to how many patients in that same timeframe? No data is given. “Overall, the FDA documented 6,723 ‘adverse events’ related to Gardasil in 2008, of which 1,061 were considered ‘serious,’ and 142 considered ‘life threatening.’” Same question? Same answer. (And who here really believes that those stats weren’t available in the same FOIA dredge? Talk about “misleading.”) Since I was missing a key set of variables needed to assess how common those reactions were, and thus had no way to judge how far those results may or may not have diverged from the Japanese results, I left those reports as “interesting but anecdotal” and made no mention of them in the footnote.
   I do not reject the reports as false by any means. There is simply no context by which to judge them. By way of comparison, I could say that more Americans died (forget the injured or disabled) on U.S. roads just last year than have been killed, injured OR captured during the entire so-called “War on Terror,” including the attacks on 9/11. I might be telling the truth (it’s actually very close… look it up!), but even so, wouldn’t you like to know how many vehicles, how many drivers, how many miles driven at what speeds, how many confounding factors (seat belts, alcohol, &c.) and so on were involved before you went about, exempli gratia, demanding a ban on motor vehicles?
   If you can provide the missing data in the FDA numbers, I’ll be happy to comment on them as I did the Sato report’s numbers; if Judicial Watch or Mr. Baklinski had done their due diligence, there’d be no need to hunt the data down in the first place. I suspect, however, that both were more interested in showing that harm was possible, a la your “100% safe” commentary, and thus didn’t consider the data important enough to find out, let alone print. This is a typical tactic of the MMR = autism crowd (and the anti-vaccine mob in general), and the dishonesty of it makes my skin crawl.
   Again, I must stress: ANY needless possibility of harm forced on those who are unwilling is patently unacceptable, and so again I agree with your earlier thought in re: Gov. Perry’s politcal maneuvering. But while they may be enough to support the idea that the HPV vaccine is “not 100% safe,” they are NOT enough to say that the vaccine in general is “unsafe” or “unproven.” Those terms require context… context which none of these articles provide.

6. Ok, first things first: just out of curiosity, the article you shared linked to both the study and the Judicial Watch article it cited throughout its main text; why wouldn’t you read those as well? Not checking out source material is a good way to lose credibility in a either a debate or a discussion. (I’m really not sure which we’re having anymore, thanks to the tone of your responses.)
   Second, I reject out of hand the accusation of being misleading for a number of reasons. To start with, you say I’m misleading and then admit that what I said might actually be correct… but you couldn’t be bothered to go find out. How does THAT work? Why would you not verify the substance of what I wrote first if you were going to make the accusation? As for substance, how is it misleading for me to say that Dr. Sato’s study showed over three million people got over 8 million shots and none of them died, when those were the actual results he published? Is it misleading to say “less than 2,000” when the actual number adverse reactions was 1,968? And just in principle, how is it misleading for me to fill in the gaps left by the author of the article you shared? Why would you not look to him first with your accusation, when he left his readers to fill in the blanks he left on their own? How is that even honest, let alone not misleading?
   If I’d wanted to be “truthful, but misleading,” I might have said something like “less than 400 had serious reactions,” cutting the number I actually wrote by 80% and thus misleading people as to the rate of adverse reaction (btw: actual number of “serious” reactions = 358). Instead it was Mr. Baklinski who thought it just fine to leave all of this information out of his article. At least he hot-linked the study, I’ll give him that — many outlets with an agenda won’t bother — but most people are intimidated by scientific writing and so most won’t even think to look, assuming that their favorite outlet for information is providing a reasonably unbiased assessment of said report. By contrast, the website hosting the study also has an obvious agenda, but at least they posted the complete results rather than simply cherry-picking the high points as Mr. Baklinski did. Apparently they actually believe the adage “The truth will set you free,” a charge which I cannot make of Mr. Baklinski due to lack of evidence.
   This is a textbook example of why I ALWAYS try to read the source material, a habit I humbly suggest you adopt as well. Also, save your fault-finding for after a good fact-checking. It tends to make for a more effective criticism, and improves one’s own credibility immeasurably.

7. Smokey | January 26, 2014 at 2:49 am | wrote:
   “With that out of the way, the one study to which your article links (http://sanevax.org/vaccine-manufacturers-documents-show-hpv-vaccines-may-induce-seizures/) indicates that while HPV does have a certain risk of side effects associated with administration (as do literally ALL vaccines, even placebos), those risks are generally slight: in this case, less than 2,000 total reactions out of 3.28 million vaccination subjects over an estimated 8.64 million doses, with no deaths reported.”
   Larry’s comment:
   No deaths reported, eh? Your characterization is in the technically truthful, but misleading category. I have not read Sato’s study, and the “no deaths reported” may very well be in there. However the article itself specifically mentions death.
   A side note about Physicianspeak: “Side effects” are fairly common, unpleasant, non-life-threatening reactions to a medication. ADVERSE EFFECTS are rarer, and these are the ones that can cause serious illness — or even kill you.
   Some physicians do not want their patients to know about the adverse effects. This is unfortunate, because when the adverse effects the fan, it never occurs to most patients to put 2 and 2 together. Anyway, physicians typically mention one or more of the common generic platitudes about side effects. Here are a few that may or may not apply to HPV vaccine:
   •Othostatic hypotension;
   •Certain sexual side effects;
   •May cause drowsiness;
   •Do not drive or operate heavy machinery;
   •May leave an ithchy rash, which will go away in a few days.
   Pardon the digression. From the article:
   “As evidence of serious adverse reactions to the drugs – such as seizures, blindness, paralysis, speech problems, pancreatitis, Guillain-Barré Syndrome, and death – began to mount, a national organization, the Nationwide Liaison Association of Cervical Cancer Vaccine Victims and Parents was formed to stop the distribution of the drugs to the children of unsuspecting families.”

8. Smokey | January 26, 2014 at 2:49 am | wrote:
   “With that out of the way, the one study to which your article links (http://sanevax.org/vaccine-manufacturers-documents-show-hpv-vaccines-may-induce-seizures/) indicates that while HPV does have a certain risk of side effects associated with administration (as do literally ALL vaccines, even placebos), those risks are generally slight: in this case, less than 2,000 total reactions out of 3.28 million vaccination subjects over an estimated 8.64 million doses, with no deaths reported.”
   Larry’s comment:
   No deaths reported, eh? Your characterization is in the technically truthful, but misleading category. I have not read Sato’s study, and the “no deaths reported” may very well be in there. However the article itself specifically mentions death.
   A side note about Physicianspeak: “Side effects” are fairly common, unpleasant, non-life-threatening reactions to a medication. ADVERSE EFFECTS are rarer, and these are the ones that can cause serious illness — or even kill you.
   Some physicians do not want their patients to know about the adverse effects. This is unfortunate, because when the adverse effects the fan, it never occurs to most patients to put 2 and 2 together. Anyway, physicians typically mention one or more of the common generic platitudes about side effects. Here are a few that may or may not apply to HPV vaccine:
   •Othostatic hypotension;
   •Certain sexual side effects;
   •May cause drowsiness;
   •Do not drive or operate heavy machinery;
   •May leave an ithchy rash, which will go away in a few days.
   Pardon the digression. From the article:
   “As evidence of serious adverse reactions to the drugs – such as seizures, blindness, paralysis, speech problems, pancreatitis, Guillain-Barré Syndrome, and death – began to mount, a national organization, the Nationwide Liaison Association of Cervical Cancer Vaccine Victims and Parents was formed to stop the distribution of the drugs to the children of unsuspecting families.”

9. * Footnote to the comment above:
   To be clear up front, I am still not arguing for enforced mass HPV vaccination, nor am I saying the HPV vaccine is “100% safe.” As you pointed out quite explicitly, Larry, there is no such thing and any risk needlessly enforced by the State is a needless risk suffered.
   With that out of the way, the one study to which your article links (http://sanevax.org/vaccine-manufacturers-documents-show-hpv-vaccines-may-induce-seizures/) indicates that while HPV does have a certain risk of side effects associated with administration (as do literally ALL vaccines, even placebos), those risks are generally slight: in this case, less than 2,000 total reactions out of 3.28 million vaccination subjects over an estimated 8.64 million doses, with no deaths reported. Thus, if anything may be considered ‘proven’, the vaccine’s safety seems at least as well demonstrated as its efficacy. I’ll leave a review of those studies for another time.
   One might also note the interesting focus of the title of the article previously offered: “Japan withdraws support of controversial HPV vaccine over safety concerns.” From the linked study it is clear that Japan never enforced or even supported mandatory mass vaccination; they now no longer actively advocate that young girls and women get the vaccine. IOW, the only thing they’ve stopped doing is advertising on behalf of the vaccine using public money. This decision remains in place pending a review of the reactions listed in the study.
   In fact, Japan has neither stopped vaccination against HPV, nor even discouraged health officials from providing the HPV vaccine, having instead stipulated that the vaccine remain available to those who wish to receive it. In addition, certain medical groups in Japan, including the Japan Pediatrics Association, have since argued for reinstatement of the official recommendation. These points are also made in Dr. Sato’s study.

10. Larry, as I re-read my comment (which you accurately quoted) I note that I nowhere used the term “100% safe,” nor even the term “100% effective,” so I’m not sure where your invective is coming from. It’s as though instead of saying that your terminology (to wit, “unproven mass medication”) “is an inaccurate categorization,” I instead said something like “it’s a completely false categorization,” or even “it’s a total, deliberate, fatuous lie.” I made no such comments, nor did I intend my critique of a single word choice as an invalidation of your argument (nor either of you as a person, as the heat of your invective seems to indicate).
    Specifically, I note that “unproven” in the context of your argument is unlikely to have been what you actually meant. One could invalidate the choice of wording easily by pointing out that vaccine has been tested repeatedly, and its efficacy and safety validated to a large degree as a result, though stating this does not imply any jump to the conclusion that it is “100% safe” — a term you tear down quite impressively for no apparent reason. In fact, your own commentary in several places admits to a certain efficacy, and refers to the risks presented by the vaccine as “few” (e.g.: “those few children who would have had adverse reactions,” emphasis mine), thus further undermining the use of the word. I simply highlighted the choice of wording as perhaps not what you actually intended to put across.
    If in fact you did intend “not-100% safe” or some other similar term when you wrote “unproven,” then I accept the exchange of terminology and thus withdraw my critique. Since it doesn’t materially affect your position that ANY unnecessary risk (no matter how minimal*) enforced at gun-point is unacceptable, and especially since I AGREED with that stance, it seems like a small thing to have generated such a big reaction.

11. Smokey | January 24, 2014 at 12:52 pm | wrote:
    “To assess the HPV vaccine as ‘unproven,’ now or at the time, is an inaccurate categorization.”
    To state the obvious: HPV vaccine exists and is commercially available. This means that there is at least SOME evidence for its efficacy. IOW, HPV vaccine is not in the same category as some BS folk remedy. However this does NOT mean that the evidence qualifies as a conversation-stopper.
    Another obvious point: Nothing in life is 100% safe for everyone under all circumstances — not even clean, 100% pure water. If you doubt that, I have a thought-experiment for you.
    Just after all of the ice has melted, parachute into the middle of Lake Michigan, with no equipment, and wearing only a Speedo. Psychic Larry predicts that you would not survive.
    If pure water is not 100% safe under all circumstances, then certainly we can say the same about HPV vaccine. If you’re a teenage female who wants to flirt with fulfillment, and if your ‘liberal’ parents approve, it would be wise to get expert advise from your physician and from your pharmacist about HPV vaccine. If it turns out that your medical situation is such that you are at high risk for adverse effects, then you would be well advised to steer clear of HPV vaccine (and to insist that your BF use a condom).
    Surprise, surprise! Some risks of HPV vaccine have already been indentified.
    Japan withdraws support of controversial HPV vaccine over safety concerns
    by Thaddeus Baklinski
    Wed Oct 16, 2013 14:01 EST
    http://www.lifesitenews.com/news/japan-withdraws-support-of-controversial-hpv-vaccine-over-safety-concerns
    Do you still think that “unproven” in its context is inaccurate? If yes, what would you substitute? How about, “pig in a poke?”

12. GH05T | January 24, 2014 at 11:53 am | wrote:
    “Is the phrase ‘I do not understand average minds like yours’ meant to be an insult? Are you implying that your mind is above average in some way?”
    How did you guess? Actually, I qualify for Mensa (the top 2% of IQs). However you can take cold comfort in the fact that my aptitude for parallel parking is in the average range.

13. Perhaps I’m suffering a bit of confirmation bias and observation bias in my research on the topic. I should say it seems to have been widely accepted in academic circles. The common man’s acceptance was probably the same as it is for any novel scientific idea of today; “interesting, but not my problem.” I haven’t come across reports of any large scale protests against it. Tacit acceptance can be just as bad. I see the issue as being similar to the height of CAGW fervor. Of course there were people that objected but they were publicly marginalized and dismissed. The phrase “religious leaders, and a few fringe scientists” was meant as an example of how they were characterized by the eugenicists rather than my own belief. Rereading it, I see I didn’t make that clear.
    Maybe I’m just being contentious, but I think the biggest advantage of CAGW over eugenics is that CAGW doesn’t require anyone to actually get their hands dirty. The sick and starving children are all in a different country where you don’t have to look them in the eye while you tell them what’s being done to them in the name of progress. Perhaps Hitler hid his deeds from the world for the same reasons. My biggest concern is that today, like then, the big turning of the tides moment won’t come until the horrors have become too large for the general public to ignore.

14. My quibbles with your point are also small.
    It is true that the concept was found throughout much of the scientific literature, and also true that a number of big names in the ivory towers of the day backed it whole-heartedly. However I’m not as sure that the idea was universally, or even widely accepted let alone supported as a principle upon which societies should routinely be manipulated or managed. Mostly, I think it was the “global climate change” of its day: lots of scary, fascinating implications and and applications, but not yet 100% accepted or validated (regardless of breathless claims to the contrary).
    It was certainly less widely accepted in politics, especially American politics, except among those of a certain political bent to begin with who may simply have been willing to point to “the academic consensus” as an excuse for implementation. However, as most of the elected theoretically represented their electorate, it’s not surprising that most of their public commentary seems muted, doubtful, or predjudicially dismissive of eugenics as a valid idea.
    Further, as tales of the implementation in Germany in the ’30s started to trickle into editorials and human interest stories, the general reaction from the American populace particularly seems to have been along the lines of “If that’s true, it’s a terrible thing. Still, there’s no way that can be true, is there?” Of note, the Nazi plan was still primarily one of demonization, sequestration and exploitation at that time, although targeted deaths and beatings did occur. Mass extermination was not implemented until later on. Even so, the snow job done on the world at those Summer Olympics was impressive; the lack of any visible evidence that Jews et al were being even significantly incovenienced went a long way towards relegating the trickle of contrary reports to the bin of “paid shills” and “conspiracy theorists.”
    Granted, since we are talking about past scientific and medical practices (with an eye towards the implementation of new/different practices in our own time), it may be more appropriate to consider the opinions of the geneticists and social scientists of that time to the exclusion of others, and so I concede that my refutation of the Holocaust as a salient example may not be as slam-dunk as originally presented. Still, to suggest that eugenics was popularly accepted as a standard best practice is less true, I think, than saying the same thing about the AGW/CAGW meme in our own time. The telling difference is that while logically both require death on a large scale, the scale of eugenics is generally larger and more specific in its selection at least initially, and also quite a bit more overt. This plus the “pro-environment” cover story may explain completely why AGW has gotten so much further into popular acceptance than eugenics ever did, at least in the US.

15. I only have one small exception to your points.
    “only the German Nazi Party, its supporters and its apologists ever condoned the Holocaust as being somehow scientifically valid, let alone socially acceptable.”
    I think it was the matters of scale and method that academia of the day objected to rather than a broad rejection of the scientific principles. Hitler got most of his ideas from public, mainstream scientists of the day. Eugenics was no small, cult philosophy, nor was it a brief pseudo-science fad. As early as 1911 the Carnegie Institute publicly endorsed the use of gas chambers for euthanatizing “imbeciles”. It was a global scientific movement. The Supreme Court upheld massive forced sterilizations based on the same scientific works that Hitler cited as his defense. Prior to the war many American politicians and academics praised the Nazi party for its progressivism with regard to sterilization and euthanasia. Some openly lamented that the USA was behind the times. After the war, even in light of the horrors of Nazi Germany, forced sterilization of the “feeble minded” and other undesirables continued in the united states with support of the scientific, academic, and medical communities. It would seem that many felt Hitler’s views were not so much unscientific as having gone too far.
    I feel this distinction is important because atrocities such as large scale unethical medical practice or genocide are easy to repudiate after the fact. The trick is knowing how to spot them before they happen. Madness is not always loud and raving. Sometimes it is charming, reasonable, and quite convincing.
    Eugenics was a socially progressive belief praised in the highest universities of several countries. It was based firmly on the cutting edge science of genetics. Vast quantities of literature were published in its favor, and politicians from school boards to presidents believed in it as though it were scientific fact. The known, indeed obvious, downsides were deemed acceptable in light of the greater good done for all humanity. The proponents of eugenics were famous scientists, respected professors, civil rights activist, and popular politicians. The only detractors were religious leaders, and a few fringe scientists who debated more about the effectiveness of specific polices than the basis of the science itself.
    It’s easy to point fingers and assign blame sitting where we are now, but can we really say with conviction what we would have believed had we been there at the time?

16. A few thoughts, if I might be heard “through the elegant yelling / of this compelling dispute:”
    1) To assess the HPV vaccine as “unproven,” now or at the time, is an inaccurate categorization. However the remainder of the discussion — specifically, the fact that only non-monagamous/serially monogamous, sexually active, non-barrier-protected women need consider its use in the first place — is generally correct. As such, any attempt enforce a choice upon not only those who do not wish it, but also those who do not have a REASON to get it, is of course unconscionable.
    2) That said, to say “Rick Perry’s motivation was purely political” seems accurate; I only question the target. If “Big Pharma’s” leadership is half as savvy as they are accused of being, they would have been shocked to see such a measure actually passed in a state as socially conservative as Texas. Lip service from the Governor is nice, but it doesn’t pad the bottom line, so I don’t think there was much gold to mine there.
    Keep in mind that Gov. Perry was at the time also a national figure (candidate for President), so his mother lode was more likely the so-called “women’s health” and “women’s rights” movements and their adherents — a far greater source of votes and media influence, and still a decent source of cash, even compared to the drug companies. Also remember that organizations such as NOW, Planned Parenthood and NARAL et al. were in full agreement with the good Governor’s proposal at the time. He even made a point of mentioning it on various national appearances, telling the country that (I speak facetiously) “Even a Republican like me can be pro women’s health, never mind if the people of Texas aren’t, exactly.” (Hmmm. Didn’t win the nomination, huh? Imagine that.) Finally, to this very day there exists a significant subset of GOP-ers that seem to think it is somehow possible to win points from that audience on a national level (everyone feel free to point at the nearest one and laugh), so this seems to me the more likely target for Gov. Perry’s ill-considered proposal.
    3) In all fairness, and meaning no insult, it appears to me as though the topic of the Holocaust is the best candidate so far for the title of “red herring” in the discussion. If you will, allow me to elaborate:
    The specific point under discussion as I understood it was lobotomy, a horrific practice now understood to be the next best thing to simply stabbing a poor sod in the eye with a spear. Today, we do indeed (rightfully) view this practice as “a gross human rights violation,” but objectively speaking this has neither always been the case, nor has it been the only such practice to have undergone a transformation in general perception from “generally accepted” to heinous criminal act.
    The strategic bombing of Japan during WWII is actually in one sense an utterly valid comparison. The point being made was that IF a given action was performed in all good faith by qualified people using procedures consistent with best practices, THEN no apology is necessary in the first place, let alone after the fact, even if that practice is later found not to be ideal, or even appropriate for the intended task. While lobotomy was the medical action originally considered, strategic bombing in WWII fits a similar profile in a military sense.
    In the case of the firebombing of Tokyo which was specifically mentioned, and in the case of strategic bombing in general by ALL parties in WWII, extensive studies have shown that the results were actually counter-productive to the acheivement of victory. Those studies not only found that mass bombings of civilian areas caused undue quantities of suffering among surviving populations, damage to infrastucture and resources, and loss of civilian life, but they also found that such campaigns actually prolonged the conflict, rather than shortening it, Hiroshima & Nagasaki being potent exceptions to the rule. Bombed populations typically had higher morale, greater work ethic and higher rates of productivity than ones who were not so attacked, a situation that typically changed only in the last 2-4 weeks prior to capture by opposing forces, by which point those areas were generally under the direct effects of ground- and sea-based combat.
    Counter-intuitive? You bet! But this is why precious little mass bombing of civilian centers is to be found in subsequent wars, to the point of being a non-existent practice as of the time of Desert Shield/Sword/Storm. It also explains the surge in development of so-called “precision weapons” which allow valuable, hardened targets to be struck effectively even in highly populated areas with minimal “collateral damage.” It may even have a role in explaining why strategic nuclear weapons are more commonly treated as weapons of politics, rather than weapons of the military or the battlefield.
    This conclusion, and the resulting change in military strategy, weaponry and tactics over time, closely parallels the eventual conclusion (however tortuously arrived at) regarding the ability of lobotomies to achieve their intended goals while doing as little accidental harm as possible. Broadly speaking, like the massive bombardments of Japan, the UK and Germany in WWII, lobotomies did not acheive any more than superficial success in alleviating symptoms, and the harm done collaterally was far worse than could be justified, especially as better treatments were already coming onto the scene by the time the technique was being “perfected.”
    To sum up, while today we may deplore and condemn an act of mass bombing by a national military (indeed, even an act of careless LIMITED bombing) as “a gross human rights violation,” such was standard practice during a time when it was hard not to see a country’s total population as just one more source of raw materiel for the war machine. To suggest that those who fought for the Allies back then (or those labeled as responsible-by-proxy today) should apologize for doing things the best way they knew how, at that time, with the best tools to hand, is of course — dare I say it — lunacy. The same principle follows generally those who advocated and performed lobotomies during the time when it, too, was an accepted best practice.
    However, this is why mentioning the Holocaust is precisely non-sequitur: only the German Nazi Party, its supporters and its apologists ever condoned the Holocaust as being somehow scientifically valid, let alone socially acceptable. The degree of effort put forth to hide the effort from the world during the Berlin Olympics shows the truth of the matter plainly: they knew even then that broad public knowledge of the effort would doom them to viscious global condemnation and reprisal.
    So the comparison of the Holocaust and its related atrocities to the practice of lobotomy ultimately fails: I know of no instance in modern times where genocide, ethnic cleansing or unprovoked military aggression are considered “generally accepted best practices” in either military OR medical doctrine.
    Whether the children should be held accountable for the sins of their fathers is a separate matter which I’ll leave to the rest of you to discuss.

17. Larry, I did not say that you personally were denigrating the heroes of WWII. What I said was, “I periodically hear people say that the USA should formally apologize for bombing Japan.” I’m sure you’ve heard those same sorts of people before and from what you’ve written I feel safe in assuming that you also are insulted by their insinuation.
    I put no words in your mouth. I merely drew a parallel between your assertion that the children of the “bad guys” should apologize and an assertion with which I knew you would disagree to point out that the premise is flawed when applied the other direction. On this point I think we will simply continue to disagree. I don’t feel that it is any more appropriate to ask the children and great grandchildren of Nazis to apologize than it is to expect the children of heroes to get credit for what their parents and grandparents did. If the bombing of Japan is a poor example, how about slavery or the slaughter of the indigenous tribes of the Americas? I’ve been told by some (not you) that I should feel guilt and responsibility about these things as well. I don’t feel any form of apology or reparations taken from people that did not commit the crime is appropriate or even meaningful. The German government responsible for the holocaust did not exist after the end of WWII. Therefore, no, I do not think there is any reason for the German government of today to be held responsible. You are correct that I do not deny the holocaust, but whether or not people that had no involvement should be held responsible for the holocaust is a completely different issue. I object to your statement that saying they shouldn’t is “making noise” like a holocaust denier. Bear in mind that the belief that guilt and social ills ran in family lines was a principle cause of the holocaust.
    I’ll concede that failure to pursue the proper education required to make an informed decision prior to foisting your ideas on to others is negligence, but I’ll point out that the movement to mandate the HPV vaccine failed. I agree that the leaders of most causes are in it for some form of personal gain, but they cannot succeed without sweeping up a large number of true believers to support them. Those people believed that the vaccine did no harm. After all of the garbage studies claiming other useful vaccines are bad for you, it makes a certain amount of sense to be incredulous about reports of harm that don’t seem to be supported by the independent studies, especially if opposition to the vaccine seems to be wrapped up with various religious beliefs like the pro-abstinence crowd.
    As for your statement “I do not know if the snark was directed at me personally, or if you were simply employing a diversionary tactic.” I directed no snark at you personally, and I don’t know what it is you think I am trying to divert your attention away from. My original post to you was to point out that 0.25% of all hospital visits is a large enough number to account for the seemingly large amount of anecdotal evidence. Everything else was merely my own opinions concerning your tangential discussion of whether medical ethics failures in history are indicative of a failing system today. You’re the one who made the leap from questionable medical practice to genocide and WWII. I merely followed your debate in that direction because I enjoy debate. Since you’ve brought up snark and impugned my motivations, tell me if this is insinuation “exists only in [my] own mind”. Is the phrase “I do not understand average minds like yours” meant to be an insult? Are you implying that your mind is above average in some way? At the risk of being accused of putting words in your mouth again, it would seem that snark, red herrings, feigned indignation, and putting words in other’s mouths are the tactics you are employing. Like a liar who assumes everyone else is dishonest, it seems the faults you find with me are merely a reflection of those you harbor yourself.
    Now THAT was snark.

18. GH05T | January 23, 2014 at 5:23 pm wrote:
    “I would point out that many of those fighting to have the vaccine declared a requirement did so out of the concern that it would be negligent not to vaccinate children. Their sin, if any, was in acting before all of the relevant data was in.”
    Sorry, I’ve gotta call BS on that one. There’s an old maxim: First do no harm. Sometimes it’s honored in the observance, and at other times it’s honored in the breach.
    IOW, do your bloody homework before foisting your speculative medical ideas on the general public. The mindless Precautionary Principle has no place in modern medical practice.
    Rick Perry’s motivation was purely political. If you subtract the spin, Perry’s proposal was nothing more than pandering to a corporate interest, the pharmaceutical industry. Perry doesn’t give a rat’s patootie about public health. He was willing to risk the health of those few children who would have had adverse reactions to this particular vaccine, in order to advance his political career. And Perry was willing to do it at gunpoint. He sure is brave with other people’s lives! What a creep!
    HPV vaccine has the potential to be beneficial for sexually active women whose partners do not use condoms. However there is a small risk, with precious little benefit, for those who do not throw caution to the wind when entering into relationships, and who are forced at gunpoint to have the vaccine.
    And what about religious people, like Orthodox Jews, who strongly believe in abstinence before marriage? They don’t need no stinkin’ HPV vaccine.
    And no, the biggest “sin” was unproven mass medication at gunpoint, while denying the right of informed consent to parents.
    GH05T also wrote:
    “I can’t agree with the premise that people should apologize for the action of their forbears.”
    Am I conclusion-jumping in assuming that you would apply the same moral principle to the German goobermint? If yes, then you’re suggesting that they were under no moral obligation to apologize for the 6 million Jews who were murdered during the Holocaust! You’re probably not a Holocaust Denier, but you sure make noises like one.
    BTW, your mention of the bombing of Japan was a red herring. In World War II, civilians account for approximately 90% of the deaths. In that war, the USA was under no moral obligation to play by Queensbury Rules.
    IMO, Truman’s decision to go ahead with the planned nuking of Hiroshima was the right thing to do. The fire-bombing of Tokyo was not having the desired effect. Hiroshima, together with the prompt unconditional surrender shortly after the follow-up nuking of Nagasaki, 3 days later, probably ended up saving lives, both civilian and military, in the long run.
    In WW2, we were not the war criminals. In the specific case of Hiroshima, our apology would be inappropriate.
    The “insinuation” — to which you feign moral indignation — exists only in your own mind. In the future, please refrain from putting words into the mouths of those with whom you disagree. That’s disingenuous — as well as being rude, crude, and socially unacceptable.
    However I must admit: I do not understand average minds like yours. I do not know if the snark was directed at me personally, or if you were simply employing a diversionary tactic, because you were running low on vacuous platitudes. Assuming that it’s the latter, I’d like to return to the main point that John was making in his blog post, but in my own words:
    Aside from proven proactive public health strategies — like basic sanitation, prenatal care, and certain childhood immunizations — there’s an awful lot of worthless flimflam out there. And it’s mislabeled as prevention. Given well-designed biomedical studies that are independently replicated, some of the speculative stuff may pan out in the fulness of time. But most of it will not.
    Perry’s proposed mass HPV vaccination at gunpoint is a good example of political baloney masquerading as public health. Shame on you, Rick Perry!

19. I also wrote “As advanced as we seem compared to the past, medicine is still a learning process.” I agree that modern medicine is no more on absolute footing than it was 50 or even 100 years ago. Belief that we know have all the answers is an all too common, and often costly mistake in all disciplines.
    You correctly assert that we don’t know what the benefits or detriments of enforced HPV vaccinations might have been. Only time will tell. I would point out that many of those fighting to have the vaccine declared a requirement did so out of the concern that it would be negligent not to vaccinate children. Their sin, if any, was in acting before all of the relevant data was in. Legally negligence is “a failure to exercise the care that a reasonably prudent person would exercise in like circumstances.” Most frequenters of this site seem to believe that denying your children vaccinations that have been approved and recommended counts as negligence.
    The same cautious approach that should be taken to early adoption of new practices should also apply to the abandonment of the old. Otherwise we risk going off half-cocked like those that wanted to force HPV vaccines, or those that wanted to abandon vaccines all together. In the interim some may be harmed through the actions or inactions of the cautious. Damned if you do; damned if you don’t. There is no perfect system.
    I can’t agree with the premise that people should apologize for the action of their forbears. I am not guilty of my father’s sins. I am not able to judge his actions against the context in which they were taken. I periodically hear people say that the USA should formally apologize for bombing Japan. I’m personally offended by the insinuation that my grandfathers and great uncles did anything wrong. It’s easy for people sitting comfortably at home in times of peace to smugly judge the actions and thoughts of people that lived decades ago in unique and extreme circumstance. I agree that it is important to learn from the past as we look to the future, but nothing positive comes from holding spiteful grudges against our ancestors. You cannot say with certainty how you would have felt had it been you in their place.

20. GH05T | January 23, 2014 at 3:46 am | wrote:
    “To judge doctors of the past by the standards of the present unfairly maligns people for doing the best they knew how.”
    Is that what I’m doing? Yes, American physicians no longer practice lobotomy. Thank goodness. Does this mean that we’ve learned ALL the truly big lessons of the past? Not really.
    Lobotomy –especially without informed consent — is a gross human rights violation. It was all the more egregious, coming as it did, on the heels of the monstrous medical ‘experiments’ of the Germans and Japanese during WW2.
    In terms of the independent thought required for the application of medical ethics, neurosurgeons during the Lobotomy Era — not to mention the Nobel Committee — could not think their way out of a paper bag. Has Modern Medicine repaired that blind spot? I don’t think so.
    Not many people know about the Lobotomy Nobel. Why not? Because that sad chapter of medical history has been conveniently swept under the carpet.
    On a much smaller scale, it’s comparable to the failure of ‘modern’ Turkey to accept responsibility for the Armenian Genocide during WW1. Even though all of the perps died a long time ago.
    The modern medical profession has belatedly embraced informed consent, which is a good thing. However that was a Minimalist adaptation to the lobotomy scandal. Modern medicine is just as susceptible to Groupthink as it was during the Lobotomy Era.
    A couple of years ago, Governor Perry of Texas wanted to vaccinate all public school children of a certain age group against HPV — by force if ‘necessary’ — whether they were sexually active or not. Would the benefits outweigh the risks? I do not know — and neither do you.
    Thought experiment: Would the majority of Texas physicians and nurses be willing to participate in such an unethical experiment? Of course, they would. And with the exception of John, most of those who would not have participated, would have looked the other way.
    For some odd reason, I’m reminded of the unethical EPA experiments on humans, without their informed consent. Can you say, “Old Boy Network?”
    Now it’s time for the Big Picture. Old saying: Those who fail to learn the [big] lessons of history are doomed to repeat them.

21. According to the CDC ( http://www.cdc.gov/nchs/fastats/hospital.htm ), if we add inpatient, outpatient, and emergency visits we get 265.6 million hospital visits per year. That means 0.25% is 664 thousand NPI per year. That’s still a lot of people as the anecdotal evidence suggests. We also have to consider that it takes a doctor to prove a doctor did something wrong. We can’t discount cronyism covering up for malpractice so the real numbers are likely higher. However, we also cannot ignore the emotional need to blame someone when things go wrong. Often the doctor is the most convenient target for a mourner that lacks understanding of the procedure performed.
    Regardless, the raw numbers show a medical system that is working well the vast majority of the time. That premise is supported by the trends in life expectancy and infant mortality. No system can ever achieve perfection. As advanced as we seem compared to the past, medicine is still a learning process. Standard practices will continue to improve over time as they have before. To judge doctors of the past by the standards of the present unfairly maligns people for doing the best they knew how.
    To define Negligent Patient Injury we must first define negligence. Doing something that is generally regarded by your peers as the best course of action available to you for the express purpose of attempting to help someone cannot be considered negligent even if it is ultimately harmful. The fact that some standard practices of today will inevitably be determined to have done more harm than good does not mean the doctors of today are negligent. Some people judge the healthcare system against utopian perfection where nothing ever goes wrong so they will always find fault and cry for reform no matter how well the system actually works.

22. John,
    Your essay makes the following point:
    “The only comprehensive U.S. hospital care patient safety studies
    over four decades show a rate of negligent patient injury less than
    0.25 percent.”
    Sorry, I cannot accept that statistic at face value. A friend of my late parents went into the hospital for a very routine operation. She left the operating room feet-first, because of gross negligence on the part of the anesthetist. There are a lot of avoidable hospital horrors out there. And their existence is common knowledge.
    During the early 1950s, lobotomies were in vogue, because of the 1949 ‘lobotomy Nobel’ that went to Egas Moniz. And thousands of lobotomies were performed, before they were replaced by improved psychiatric medications in the late 1950s.
    Our stumbling block may be the definition of “negligent patient injury.” (NPI) Do lobotomies qualify as NPI. Perhaps NPI is similar to “malpractice.” There’s a common-sense definition of malpractice, as well as a more technical definition, which includes the following two elements:
    1. actual damage
    2. NONSTANDARD practice.
    To a lawyer, a lobotomy in the early 1950s would not qualify as malpractice — no matter how harmful and how barbaric it was. No matter that informed consent was not possible in most cases. Why did lobotomy not ‘rise’ to the level of malpractice? Because stupid as it may seem today, lobotomy was a generally accepted type of medical ‘care’ at the time.
    There’s a lot of iatrogenic injury and death going on. But if it’s regarded as ‘standard’, and if it happens in a hospital, then perhaps it does not count as NPI?

23. I can say that neither I nor any of my nigh-impoverished neighbors went to the doctor if there was nothing wrong with us. I’m sure we all qualified for some form of Medicare, but if you aren’t sick or injured going to the doctor just isn’t a priority. Especially if it means time off of work or school.
    Even if the preventative methodologies worked, I don’t believe they’ll ever get from paper to real life. Poor diet and lack of exercise aren’t symptoms of ignorance. They’re part and parcel of the working class lifestyle. When a single parent works two jobs they don’t have time to cook decent meals and they don’t have the energy to go for a thirty minute run. You certainly don’t have time to sit in a waiting room for two hours just to be told you kid falls inside a few bell curves and that you should eat better and exercise even if the doctors were “free”.

24. John,
    Your essay at jpands.org is a thought-provoking piece, which I’m still digesting. That said, I have reservations about parts of it. I’ll get back with you about that later.
    I’m very much reminded of a conversation with the late Glenn Burress, the unacknowledged top economic policy forecaster of the 1970s. Glenn mentioned one aspect of Nixon’s propensity for Socialistic economic micromanagement.
    In a misguided attempt to control inflation, Nixon decreed that prices would not be allowed to increase beyond a fixed annual rate. However there was at least one fly in the ointment. Pharmaceutical prices had been increasing at a rate that was LESS than Nixon’s magic number.
    The drug company execs interpreted this part of Nixonomics as a wink and a nod, which gave them carte blanche to collude informally — in accordance with the “tit for tat” principle of Game Theory — to INCREASE pharmaceutical prices at a rate that was just below Nixon’s arbitrary ceiling.
    Talk about unintended consequences!

25. Good article, John. Is there any real data showing that any of these programs do anything other than distribute tax money?
    My guess is preventative medicine is nothing more than periodic visits to your doctor/clinic/county health dept, etc. How many people do not do this? It was something always done in my family. That didn’t stop the big ticket medical items from illness or injury.
    This sounds like a great way to pump some more money into select groups and into Obamacare. My congresscritter, Mr. Cantor, was all for it.