To Jab Or Not To Jab?

I think Shannon Brownlee is on a crusade to convince me never to see a doctor again.  And she's doing a good job!  Today, she has a pretty interesting article in the Atlantic questioning whether flu vaccines actually have any effect at all:

Study after study has found that people who get a flu shot in the fall are about half as likely to die that winter — from any cause — as people who do not....Yet in the view of several vaccine skeptics, this claim is suspicious on its face.....When researchers from the National Institute of Allergy and Infectious Diseases included all deaths from illnesses that flu aggravates, like lung disease or chronic heart failure, they found that flu accounts for, at most, 10 percent of winter deaths among the elderly. So how could flu vaccine possibly reduce total deaths by half? Tom Jefferson, a physician based in Rome and the head of the Vaccines Field at the Cochrane Collaboration, a highly respected international network of researchers who appraise medical evidence, says: “For a vaccine to reduce mortality by 50 percent and up to 90 percent in some studies means it has to prevent deaths not just from influenza, but also from falls, fires, heart disease, strokes, and car accidents. That’s not a vaccine, that’s a miracle.”

....The history of flu vaccination suggests other reasons to doubt claims that it dramatically reduces mortality. In 2004, for example, vaccine production fell behind, causing a 40 percent drop in immunization rates. Yet mortality did not rise. In addition, vaccine “mismatches” occurred in 1968 and 1997: in both years, the vaccine that had been produced in the summer protected against one set of viruses, but come winter, a different set was circulating. In effect, nobody was vaccinated. Yet death rates from all causes, including flu and the various illnesses it can exacerbate, did not budge.

So why do people who are vaccinated get less sick?  Skeptics say it's because people who get the vaccine are healthier in the first place.  In fact, it's called the "healthy user effect" (catchy!), and a researcher named Lisa Jackson did a study a few years ago showing that people who got vaccinated during flu season were also much less likely to die even outside flu season.  They really do seem to be a healthier group in the first place.

So what to do?  I've never gotten a flu vaccine before, and to the best of my knowledge I've never had the flu either.  I was thinking of finally caving in this year and getting one, but now I'm not so sure.  I don't suppose it does any harm, but I don't generally accept that as a good reason for doing anything else, so I'm not sure why I'd find it persuasive in the case of flu vaccines either.

In any case, apparently there's wide agreement even among skeptics that the vaccine is effective in children, and that immunizing healthcare workers and some others is a good idea in order to prevent the spread of flu.  For the rest of us, I guess it depends on who you believe.  Either way, though, Sumit Majumdar, a physician and researcher at the University of Alberta, offers this advice: “There’s no worse place to go than the hospital during flu season.  But we don’t tell people this.”  Now he has.

UPDATE: After reading through the comments, I realize that my writing here was sloppy.  Apologies.  So just to be clear: Brownlee's article questions whether the flu vaccine reduces flu deaths, not whether it works at all.  If you want to reduce your chance of getting the flu and feeling crappy for a couple of weeks, get the shot.  It might or might not have much effect on your risk of dying, but it does lower your risk of getting sick.

The Bush administration Environmental Protection Agency actually reached the conclusion back in 2008 that climate change was a threat to humans. They just decided not to let anyone know about it.

The Bush administration kept the document declaring that carbon dioxide pollution endangers public welfare under wraps, but the Obama EPA released it to E&E yesterday. The response to the Supreme Court's ruling in Massachusetts v. EPA is marked "Deliberative, Do Not Distribute." Excerpts were released last year, so it was widely known that the report had concluded that climate change was a problem. But now the actual document is available to the public.

"The Administrator proposes to find that the air pollution of elevated levels of greenhouse gas (GHG) concentrations may reasonably be anticipated to endanger public welfare," the document reads.

The document makes it clear that the Bush EPA's environmental experts concluded in their draft that greenhouse gases pose a threat to human welfare and should therefore be regulated, and the finding was approved by Administrator Stephen Johnson. But the White House Office of Management and Budget would not sign off on the document, and even went so far as to refuse to open the email containing the finding so that they would not have to acknowledge it publicly. If they had acknowledged the finding, they would have been compelled by law to move forward on regulations, which the Bush administration strongly opposed. Instead, they left the finding to the Obama team, which reached a similar conclusion in April.

A congressional investigation last year concluded that the White House changed course on the endangerment finding after hearing from the office of Vice President Dick Cheney, the Office of Management and Budget, the Transportation Department, and Exxon Mobil Corp., among others.

The 29-page document makes it clear that administration officials were well aware of the threats of climate change, including changes to precipitation patterns, sea-level rise, the melting of glaciers, and ecosystem disruptions.

Chutzpah Watch

Via Dan Drezner, I see that the Saudis have an intriguing proposal:

Saudi Arabia is trying to enlist other oil-producing countries to support a provocative idea: if wealthy countries reduce their oil consumption to combat global warming, they should pay compensation to oil producers.

That's obviously not too likely to happen, but someone help me out here.  My recollection is that one of the roadblocks to raising gasoline taxes back in the Carter/Reagan era was Saudi opposition.  They figured it would reduce oil consumption and therefore reduce both oil prices and oil revenue.  So this is basically the same position they've held for 30 years or so.

Is this true?  My memory is vague on this.  But I could swear that this is more of the same old same old, just updated for the 21st century.

A $720 million whistleblower lawsuit against Lockheed Martin and Northrop Grumman, two of America's biggests military contractors, can move forward, a US District judge has ruled.  Michael DeKort, the whistleblowing former Lockheed engineer, says the companies wasted taxpayer dollars and didn't fulfil the terms of their contracts under the Coast Guard's $26 billion Deepwater modernization program. The Deepwater program has a history of problems—eight ships that were supposed to be modernized ended up structurally unsound, for example—but the government has yet to recover the money it paid the contractors for what DeKort (and government reports) said was shoddy work. DeKort is aiming to change that by bringing his suit under the False Claims Act, which allows citizens to sue to recover government money and keep some of the winnings for themselves. A trial date is set for November 2010.

The judge gave the defendants until the end of the day on Wednesday to file any new motion to dismiss DeKort's case.

It is still nearly a week before the follow-up to Freakonomics—the award-winning pop economics tome by journalist Stephen Dubner and University of Chicago economics professor Steven Levitt—hits the shelves. Yet already the book is generating controversy. A chapter on climate change—a new subject for the authors—has attracted the ire of Joe Romm, an outspoken expert on the subject. But with the provocative title SuperFreakonomics: Global Cooling, Patriotic Prostitutes and Why Suicide Bombers Should Buy Life Insurance, perhaps that's what the authors intended.

The chapter on climate is titled "What do Al Gore and Mount Pinatubo have in common?". The author's answer to this quixotic question is that both Gore and Mt. Pinatubo present solutions to global warming—but that Mt. Pinatubo's are better. Dubner and Levitt conclude that Gore-style proposals to cap carbon emissions are ineffective and prohibitively costly. But they see the 1991 eruption of Mount Pinatubo—a volcano in the Philippines that spewed 20 million tons of sulfur dioxide into the stratosphere, lowering average global temperatures by half a Celsius degree for two years—as an example of the best way to combat climate change. The authors don't advocate blowing up more volcanoes to avert a climate catastrophe, but rather geoengineering a similar result. The concept of geoengineering—a low cost but high-risk remedy to climate change—is highly controversial. And a closer reading of the chapter prompts a number of questions about the scientific evidence the authors cite to make their case.

Elmo takes time to hug some children during the morning performance of the Sesame Workshop's Talk, Listen, Connect initiative show in U.S. Army Garrison Stuttgart, Oct. 2. The Sesame Street characters address the topic of deployment and discuss healthy ways that military children can deal with them. More than 1,650 children, parents and teachers attended the two performances. (Photo by Brittany Carlson via army.mil.)

Need To Read: October 14, 2009

Today's must-reads:

Get more stuff like this: Follow me on twitter! David Corn, Mother Jones' DC bureau chief, also tweets, as does MoJo blogger Kate Sheppard. So do my colleagues Daniel Schulman and Rachel Morris and our editors-in-chief, Clara Jeffery and Monika Bauerlein. Follow them, too! (The magazine's main account is @motherjones.)

The Karzai Problem

I'm not usually especially smitten with Tom Friedman's musings on war and nation building, but he's on the right page here:

I understand the huge stakes in stabilizing Afghanistan and Pakistan. Gen. Stanley McChrystal, our top commander there who is asking for thousands more troops, is not wrong when he says a lot of bad things would flow from losing Afghanistan to the Taliban. But I keep asking myself: How do we succeed with such a tainted government as our partner?

....I am not sure Washington fully understands just how much the Taliban-led insurgency is increasingly an insurrection against the behavior of the Karzai government — not against the religion or civilization of its international partners. And too many Afghan people now blame us for installing and maintaining this government.

....We have been way too polite, and too worried about looking like a colonial power, in dealing with Karzai. I would not add a single soldier there before this guy, if he does win the presidency, takes visible steps to clean up his government in ways that would be respected by the Afghan people.

If Karzai says no, then there is only one answer: “You’re on your own, pal. Have a nice life with the Taliban. We can’t and will not put more American blood and treasure behind a government that behaves like a Mafia family. If you don’t think we will leave — watch this.” (Cue the helicopters.)

If Obama and McChrystal can come up with a truly plausible plan for stabilizing Afghanistan, I think I could gulp hard and support it.  But the absolute bare minimum requirement for such a plan is a national government that's largely supported by the population.  Like Friedman says, it doesn't have to be Switzerland, but it has to be good enough.  Without that, Afghanistan really is Vietnam 2.0.

Yo, Chamber of Commerce, You Speakin' For Me?

Leaders of some of the largest urban chambers of commerce are distancing themselves from the US Chamber in the wake of recent controversies over its inflated membership numbers, undemocratic structure, and right-wing policy positions. In recent interviews, they strongly disagreed with the national group's positions on health care and climate change and disputed its implicit claim to speak for their members.


"They don’t represent me," says Mark Jaffe, CEO of the Greater New York Chamber of Commerce, which is a dues-paying member of the national group.  He added that the Chamber's "parochial interests"—large corporations that control its self-appointed board of directors—"are well represented."


Jaffe also scoffed at the US Chamber's oft-repeated claim to "represent 3 million businesses of all sizes, sectors, and regions." Yesterday Mother Jones questioned the number, which appears to be based on the idea that the Chamber "represents" the members of the New York Chamber and similar local groups. That number of members would comprise more than half of the 5.7 million employers in the United States. "They are playing games" with their numbers, Jaffe said. "They don’t have half the businesses in America as registered, dues-paying members."


The New York Chamber has no plans to leave the national Chamber (its annual membership dues are only $1000 per year), yet neither is Jaffe happy with the group. "We get involved in some of their activities," like working to modernize airports, he said, "but we don’t agree with all of their principles either, like their position on health care. You have to be selfish, blind, or stupid not to want everybody to be required to have health care."


Jaffe’s objections to the US Chamber’s policies were echoed by Rob Black, vice-president of public policy for the San Francisco Chamber of Commerce. "We take a fundamentally different approach than the US Chamber," he said, adding that while the national Chamber opposes the Waxman-Markey climate bill, "we support a market-driven cap-and-trade system. It’s good for business, but it’s also a good way to try to spur innovation and new technologies."

Make Mine Unleaded

Speaking of books, here's a passage from Mark Kleiman's When Brute Force Fails that I've been meaning to blog for a while:

Given the decrease in lead exposure among children since the 1980s and the estimated effects of lead on crime, reduced lead exposure could easily explain a very large proportion — certainly more than half — of the crime decrease of the 1994-2004 period.  A careful statistical study relating local changes in lead exposure to local crime rates estimates the fraction of the crime decline due to lead reduction as greater than 90%.

Mark's book is focused on a particular strategy for reducing crime, so this topic gets only a couple of pages in a chapter on miscellaneous methods of crime control.  But surely it deserves more?1  If it's really true that lead reduction was responsible for most of the post-1990 decrease in crime, and if changing demographics played a role as well, doesn't that mean that everything else probably had almost no effect at all?  Broken windows, open-air drug markets, three-strikes laws, CompStat, bulging prison populations, etc. etc. — all of them together couldn't have had more than a minuscule impact if lead and demographics explain almost everything.

I don't really have a lot to say about this, actually.  Mainly I just wanted to highlight this passage because it's pretty interesting.  It seems a little discouraging, though, if it's really true that all our best efforts to reduce crime over the past couple of decades have had a collective impact only barely different from zero.

On the other hand, it certainly means that federal spending to eliminate lead from houses ought to be a no-brainer.  It would cost about $30 billion, but as Mark says, it would probably save us at least $30 billion per year in reduced crime.  The fact that Congress didn't allocate this money long ago makes you wonder if maybe the Capitol building could use a lead abatement program of its own.2

1Of course it deserves more.  So here's a bit more.

2The stimulus bill included $100 million for lead abatement, which is fine.  But considering just how effective lead reduction is on all sorts of policy levels, it's sort of a crime that they couldn't manage to dig up a little more than that out of an $800 billion total.