Raryn

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How many doctors do you know who refused vaccination against influenza?

http://www.nytimes.com/2010/04/14/opinion/14wed3.html?ref=opinion
They emailed us last week that our overall student bodies vaccination rate was 80% for seasonal flu and 82% for H1N1 last year. On the low end. (That only counts the students who got vaccinated at the med school or at our main hospital, so anyone who had it done somewhere else like at the VA is in addition to that).

I had both done.
 

RxnMan

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I asked for extra squalene with my H1N1 shot.
 

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I never got H1N1. It wasn't because I refused it. I just kept putting it off and time flew by. If I were doing rotations there'd be no way I'd miss it though. I got the seasonal flu because my school got a ton and then practiced on each other.
 

Ashers

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We were required to get both by our program. People who didn't get them by certain dates were reminded by the chiefs to get them. I got them as soon as I could since I was on wards for a large part of that season.
 

sonofva

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i didn't get my H1N1 intentionally...by the time they had enough vaccines out and i had access to them, i had already been in direct contact with at least 20 patients with confirmed H1N1...i figured i had the antibodies built up and any benefit i would get from the vaccine would be outweighed by potential risks.
 

Mr hawkings

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i didn't get my H1N1 intentionally...by the time they had enough vaccines out and i had access to them, i had already been in direct contact with at least 20 patients with confirmed H1N1...i figured i had the antibodies built up and any benefit i would get from the vaccine would be outweighed by potential risks.
Its not so much to protect you as it is to protect other patients you might come into contact with who may not have your stong immune system.

So at any point in time, you could theoretically have tranfered the infection from one of those 20 patient to someone who was in for something else without you ever getting more than a light case of the sniffles. During that period of time it took you to build an immunity, you could have infected several patients.
The probability of that is probably higher with the regular flu than H1N1 though
 

donkeyboy

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i didn't get my H1N1 intentionally...by the time they had enough vaccines out and i had access to them, i had already been in direct contact with at least 20 patients with confirmed H1N1...i figured i had the antibodies built up and any benefit i would get from the vaccine would be outweighed by potential risks.
what potential risks? and just because you've been around people with H1N1 doesn't mean you have built up sufficient Abs. I've been around tons of people with TB, doesn't mean I have TB or have built up Abs.
 

RxnMan

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i didn't get my H1N1 intentionally...by the time they had enough vaccines out and i had access to them, i had already been in direct contact with at least 20 patients with confirmed H1N1...i figured i had the antibodies built up and any benefit i would get from the vaccine would be outweighed by potential risks.
You should probably read this:



via Information is Beautiful
 

Impromptu

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Fortunately, I had already had both seasonal flu and swine flu by the time the vaccines came out in October. But, to avoid the annoying reminders, I got the both vaccines anyway right when they came out.
 

QuizzicalApe

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I got both. It was required by my school, with priority going to folks on rotations. I was eager to not accidentally kill anyone by being a walking plague bomb.
 

justdoit31

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Got both but at my school they had a shortage of both... ended up that students who weren't in the clinic a majority of the time didn't have the opportunity to get theirs til January- I got both from my general physician over xmas break.
 

Dwindlin

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I didn't get either one. No good particular reason for not doing it though.
 

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This was the first year our school required seasonal vaccination. Also, both sites I applied to for away rotations in the fall required proof of both seasonal and H1N1 vaccination. So just something for people to keep in mind if they're going into their 3rd year.
 

URHere

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I got the annual flu vaccine, but not H1N1.

I actually had H1N1 before the vaccine was availble (along with most of my classmates). A few months later, my school comes out with a vaccine requirement but won't accept a verified exposure as a reason for exemption. All of the vaccine clinics were held at times when I had to be at my research lab, and I ended up signing a form saying that I would wear a mask in clinic upon request just so I wouldn't have to deal with the giant administrative clusterf**k that was the vaccination process.
 

kappa09

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I got both. My school made it surprisingly easy, convenient, and FREE to get them (they held 2-3 days worth of vaccination clinics for each), so I had no reason not to.
 

OnDemond

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I got the seasonal only. I'm a first year - not too much exposure. Besides, please excuse me but I'm of the opinion that there was too much artificial hype around the H1N1. The death rates from seasonal influenza were higher than H1N1's. I know quite a few people in teens/mid-twenties who contracted H1N1, and honestly, it wasn't the worst in the world, putting the scare aside.
 

Mr hawkings

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I got the seasonal only. I'm a first year - not too much exposure. Besides, please excuse me but I'm of the opinion that there was too much artificial hype around the H1N1. The death rates from seasonal influenza were higher than H1N1's. I know quite a few people in teens/mid-twenties who contracted H1N1, and honestly, it wasn't the worst in the world, putting the scare aside.
Could it be that the lower death rates could be indirectly because of the "hype" that drove a vaccination campaign?
If you look at the #infected vs deaths in other countries, i would not be suprised if the rate was actually higher.

Also, when substantial numbers of working age people cant work because of illness, it can have an adverse effect on the country even if they end up recovering. Thats why if you look at Homeland security's list of potential terrotist biological agents, a large number of them are agents that dont kill you but make you sick.
 

RxnMan

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I got the seasonal only. I'm a first year - not too much exposure. Besides, please excuse me but I'm of the opinion that there was too much artificial hype around the H1N1. The death rates from seasonal influenza were higher than H1N1's. I know quite a few people in teens/mid-twenties who contracted H1N1, and honestly, it wasn't the worst in the world, putting the scare aside.
Two points:

1) By your reasoning, we shouldn't be treating cancer, because MIs and strokes kill more people every year in the US. :rolleyes:

The seasonal flu causes around 36,000 deaths/year. H1N1 caused an additional 12,000 deaths in 2009-2010. When you have an increase of 33% in deaths, we should get worried. Despite your "experience", young people and pregnant women were disproportionately affected. The fact that it wasn't bad in retrospect does not mean our response was inappropriate. Rather, it is a modern miracle that the US was able to respond as well as it did.

2) Plural of anecdotes is not data, and a few of the most dangerous words in medicine are "In my experience...". The others being, of course, "Hold my beer and watch me do this!"
 
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Thats why if you look at Homeland security's list of potential terrotist biological agents, a large number of them are agents that dont kill you but make you sick.
Homeland security doesn't practice evidence based policing, or the agency wouldn't even exist. Their motives are suspect, because as a new and expensive federal agency during a time when the federal government is broke, they have to prove their worth any way they can. Thus, it is in their best interest to shout TEH TERRORISTS every opportunity they can. (a side note : this was why the FBI focuses on kidnapped children above nearly any other crime, because of the obvious P.R. benefits to the agency if they make a recovery. The problem for Homeland Security is that headline grabbing terrorists are so incredibly rare, so they have to do what they can to keep the public afraid during the meantime.)
 
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Could it be that the lower death rates could be indirectly because of the "hype" that drove a vaccination campaign?
If you look at the #infected vs deaths in other countries, i would not be suprised if the rate was actually higher.


Also, when substantial numbers of working age people cant work because of illness, it can have an adverse effect on the country even if they end up recovering. Thats why if you look at Homeland security's list of potential terrotist biological agents, a large number of them are agents that dont kill you but make you sick.
I agree. And it's not artificial hype if you're the one who's on the dying end of it. When I was on ICU, I saw 3 people die after contracting novel influenza despite IV zanamivir. Not pretty.
 

engineeredout

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Considering the guy who sits next to me in class caught H1N1, along with about 20 other people, I'm pretty glad I was vaccinated.
 

sumstorm

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we weren't 'required' to get it, but we are required to work with swine, poultry, etc to complete the year, and the animal hospitals banned folks without it. Unfortunatly, the vaccine didn't come out till after several students came down with it. Several have scarring. that seems a little serious to me, when we are talking about healty adults. Others had confirmed cases, but very little in the way of symptoms, but still had to stay out of classes.
 

Orbo

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You should probably read this:



via Information is Beautiful

All I'm seeing is a horrible effectiveness for the vaccine. I love it when people say they got the vaccine and all of a sudden there's no way they'll get H1N1. Or when school policy says if you refuse to get vaccinated you gotta wear an N95 mask instead. It's 30-40% effective, folks. Just like the regular seasonal vaccine, it's not even close to a magic bullet that the CDC and your school administration would like you to believe.
 

45408

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I got it before they had a vaccine (small chance I didn't actually have it), so I didn't really focus on getting it until I had a baby. His pediatrician wanted me to get both flu vaccines, so I did.
 

RxnMan

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All I'm seeing is a horrible effectiveness for the vaccine...
Then that's a pretty narrow and selective view.

My point is that sonvova's argument of "potential risks" was baseless. The most common side effect is that you'd be sore. The only major risk was a 1:1,000,000 chance. One would have to be pretty selfish to be so blase about passing on a serious communicable disease to sick people.

...Just like the regular seasonal vaccine, it's not even close to a magic bullet that the CDC and your school administration would like you to believe.
Perfection fallacy. I guess since nothing in medicine is 100% effective and risk-free, doctors shouldn't do anything at all. There's absolutely no benefit to making a dent in disease. :rolleyes:
 

vasca

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All I'm seeing is a horrible effectiveness for the vaccine. I love it when people say they got the vaccine and all of a sudden there's no way they'll get H1N1. Or when school policy says if you refuse to get vaccinated you gotta wear an N95 mask instead. It's 30-40% effective, folks. Just like the regular seasonal vaccine, it's not even close to a magic bullet that the CDC and your school administration would like you to believe.
My boyfriend (an IM attending) told me the exact same thing. You can still get it, but the risk of the infection turning into ARDS is very low.

I never got vaccinated and I lived through all of it being close to infected patients (many of them who died) and never got sick. I did get vaccinated against the seasonal flu though. By the time my hospital got the H1N1 vaccine, I was on antibiotics for something else and couldn't take it and right then went on vacations. By the time I came back there were no more vaccines left and people told me I was screwed.

They have plenty of vaccine in my village for children and pregnant women, but none for healthcare workers. Hilarious. Looks like I'll never get vaccinated. My village doesn't even have H1N1 anyways despite having a lot of chickens everywhere. It's more likely I'll get sick from brucelosis, malaria, hemorragic dengue, rickettsiosis, tetanus and many other assorted rare diseases. Heck, I could get stung by a scorpion which are one of the deadliest in the world at bed at night.

I think I'll be fine without the vaccine. :luck:
 

Orbo

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Then that's a pretty narrow and selective view.

My point is that sonvova's argument of "potential risks" was baseless. The most common side effect is that you'd be sore. The only major risk was a 1:1,000,000 chance. One would have to be pretty selfish to be so blase about passing on a serious communicable disease to sick people.

Perfection fallacy. I guess since nothing in medicine is 100% effective and risk-free, doctors shouldn't do anything at all. There's absolutely no benefit to making a dent in disease. :rolleyes:

Fallacy my ass. There's a difference between something that's 99% effective (i.e. Hep B, polio) and something that's 30% effective. What if the vaccine were 10% effective, would you still force that down everyone's throats? What about 0.1%? Just like everything, you weigh the cost-to-benefit analysis. The vaccine, believe it or not, doesn't come free. I take severe issue to making something that's 30% effective MANDATORY like my institution does. The resources and time spent trying to get this marginal benefit is better off spent improving some other aspect of health care. :rolleyes::rolleyes:
 

RxnMan

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Fallacy my ass...
Nope, you pretty much nailed the definition.

...Just like everything, you weigh the cost-to-benefit analysis...
Exactly. You put your life in greater danger when you drive to the supermarket than by getting vaccinated. But you don't go hungry. So what about this is doesn't make sense?

...I take severe issue to making something that's 30% effective MANDATORY like my institution does...
Be sure to mention this to your attending when you see your first Whipple, or radiation and chemo for SCLC, or when they order a sed rate on a undifferentiated patient.

But as you said, in a world of limited resources if I had to pick a couple of groups to get a vaccine, I'd pick the group that's most likely to get sick (old, immune-suppressed), and the group that's most likely to spread the disease (That's us).

Nobody forced you to become a doctor. But since you and I chose to be doctors, and we will be coming in contact with a large number of sick people, we should probably take steps to make sure our patients don't get worse. My school makes us take the Hippocratic oath on the first day of class, and there's a line in there about "First, do no harm..."
 

Orbo

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Remind me again, at what percent effectiveness do you draw the line between worth it and not worth it? Some how I missed your answer to that question...



And just an aside, I'm totally not seeing the relevance between my argument against yearly mandatory low effectiveness vaccination and the procedures/treatments you listed for already sick patients? I mean, it's just so irrelevant that I'm left scratching my head on what point exactly you were trying to make.
 

Orbo

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Oh yes, enlightened one. Clearly by bringing up random examples of procedures one would do on a patient absolutely and unequivocally demolishes my claim that mandatory application of a low-effectiveness vaccine might not be as necessary as the CDC would like you to believe. I mean, how could I not see that? It's so obvious that I'm just surrendering when I question the relevancy of his oh-so-awesomely powerful retort.
 

RxnMan

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Remind me again, at what percent effectiveness do you draw the line between worth it and not worth it? Some how I missed your answer to that question...
Don't change the subject. You've yet to give a reason why you'd avoid a nearly trivial intervention that will protect you and your patients from of death and disability, especially when it's a well-known part of your chosen profession.

...And just an aside, I'm totally not seeing the relevance between my argument against yearly mandatory low effectiveness vaccination and the procedures/treatments you listed for already sick patients? I mean, it's just so irrelevant that I'm left scratching my head on what point exactly you were trying to make.
Then you need to study more.
 

Orbo

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Don't change the subject. You've yet to give a reason why you'd avoid a nearly trivial intervention that will protect you and your patients from of death and disability, especially when it's a well-known part of your chosen profession.
Nope, not changing the subject. Answer the question. It's entirely relevant. The point is that there is some minimum effectiveness below which it is no longer worth it to vaccinate every HC worker yearly. That number is above 30% for me, but apparently below 30% for you. The only difference is how you justify below 30% vs. how I justify above 30%. That is the crux of the argument, not this side-track about being a doctor and the hippocratic oath.


Then you need to study more.
Incorrect. I'm fully aware that the treatments you listed are controversial. That's the point you're trying to make. I'm saying it's irrelevant. Try harder.
 

Raryn

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Nope, not changing the subject. Answer the question. It's entirely relevant. The point is that there is some minimum effectiveness below which it is no longer worth it to vaccinate every HC worker yearly. That number is above 30% for me, but apparently below 30% for you. The only difference is how you justify below 30% vs. how I justify above 30%. That is the crux of the argument, not this side-track about being a doctor and the hippocratic oath.


Incorrect. I'm fully aware that the treatments you listed are controversial. That's the point you're trying to make. I'm saying it's irrelevant. Try harder.
If everyone got vaccinated and 30% of the population became fully immune to H1N1 (not to mention the sizable fraction that would gain at least some resistance), you would reduce the number of H1N1 cases by *far* more than 30%. You would be protecting all those people, plus anyone they might have infected as well.

Hell, a study done on a bunch of communities in Canada found that by just vaccinating all of the children in the town, not even the adults, the TOTAL flu rate for the whole population went down 61%.
 

RxnMan

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...That is the crux of the argument, not this side-track about being a doctor and the hippocratic oath...I'm saying it's irrelevant. Try harder.
It's the crux of your argument, which is based on a false premise, further compounded through a combination of shifting goal posts, fact illiteracy, misunderstanding of basic mathematics and risk, and a willful ignorance of the tenets of your chosen profession at the expense of your patients. These are things a first year medical student would know. But wait, I have heard this type of argument before...



From here.
 

Orbo

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If everyone got vaccinated and 30% of the population became fully immune to H1N1 (not to mention the sizable fraction that would gain at least some resistance), you would reduce the number of H1N1 cases by *far* more than 30%. You would be protecting all those people, plus anyone they might have infected as well.

Hell, a study done on a bunch of communities in Canada found that by just vaccinating all of the children in the town, not even the adults, the TOTAL flu rate for the whole population went down 61%.
Decent argument. Can you link me the study or give the title/author?


It's the crux of your argument, which is based on a false premise, further compounded through a combination of shifting goal posts, fact illiteracy, misunderstanding of basic mathematics and risk, and a willful ignorance of the tenets of your chosen profession at the expense of your patients. These are things a first year medical student would know. But wait, I have heard this type of argument before...



From here.
All the same can be said right back to you. Good day, sir.
 

RxnMan

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Raryn

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