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Required Immunizations

Dragging this topic into the appropriate forum!!

To bring everyone up to speed:

1) Lots of places are starting to require H1N1 vaccines as well as standard flu shots.
2) When in crowded/confined spaces is this appropriate?
3) Is taking a cue from history justification for these actions?

The menengitis Vx isn't even required now (well, at least it wasn't when I entered college in 2004), but, nope, I do not think it should ever be required.

Is the individual always more important than the community? Most certainly not. I never stated that, either. But I do believe that a person has a right to do what they want with their body, and I think denying that right on any scale is wrong.

Nope, like I said, I know nothing about the "anti-Vx movement", I've just never been fond of them and since I have had the choice I have always refused them. I would/will be very sad to see my right to this gone.

Am I anti-western medicine? No, another thing I never said.. I believe my words were "not huge on". I believe that it serves a purpose, most certainly a large one for our society as a whole, but I am more interested in preventing myself from having anything too serious than "curing" whatever it is that I have. I also believe that most complementary and alternative medicine is bullshit.. so we agree :)

The meningitis vaccine is not required anymore!?  Ugh.  I am... saddened.

OK.  I'm going to draw some lines then... so the individual is not more important than the community.  However, the individual's right to choose not to be vaccinated is more important than conferring herd immunity on a population... and preventing an excessive cost from being placed on the health system that the community has to pay for (in the case of Medicare/Medicaid/S-Chip/future universal health plan).  Did I get it right?

That's the issue I was referencing before... not the issue of socioeconomic forces pushing people into obesity.  That in itself is fraught with danger, because it removes agency from the individual and furthers the cycle.  It's really multi-modal with biologic/genetic, socioeconomic, and psychological factors.

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The meningitis vaccination requirement varies between schools, I didn't have it required, nor did my sister, but I do know several still do.

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can I just point out we all die at one point or another?

And the way inwhich someone dies is, to some extent, their choice? If I die because I decide not to get a vaccine then so be it. If I was stuffing handfuls of bad food into my face and had a heart attack or a stroke. I would probably deserve it. If I get lung cancer because I was a smoker, thats my fault. Also, getting really bad flu symptoms that turn into something else and say I cough up blood, if I'm stupid enough not to go to a doctor and die because of it.

You know what, that was probably my fault! I think people need to worry a little more about educating people on the truth about h1n1 and not the hype you get from the media frenzy. And to me, however you look at it, requiring someone to put something in their bodies that they don't want their is WRONG. Reguardless of it being "safe" or not. There are some people out there who cannot get vaccines. I am one of them, they make me extremely sick. The last time I was "highly suggested" to get a vaccine, I got it and almost died from it. Its my choice if I want to or not, not someone else who doesn't know my body like I do.

And if it comes down to the right to be a citizen and required to get it done, well ship me to another country then, I hear Europe and Canada are nice. And hell I speak some spanish so mexico and spain would be okay too!

Now you may say "you're missing the point" and you know to you maybe I am but I think we should all just agree to disagree on certain things.

My ranting is done now  :)>>>

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Some vaccines in particular are less about benefiting the individual than benefitting the immunocompromised people in the community. It is an individual's choice if they want to take the risk of getting polio, the flu, or tetanus (well... except with polio; that's your parents' choice), but if you choose not to get any vaccines, you can be a healthy carrier and pass them onto people who will not survive an infection.

Generally, not everyone in a community needs to be vaccinated for that community to remain free of that disease. The general figure is 70% vaccination for protection (but it depends on the disease), so if some people don't get vaccines (either by choice or medical necessity), not really a big deal. But if everyone were afraid of vaccines/a particular vaccine and no one got it... well, the benefit of getting the vaccine would eventually become clear.

I think it's irresponsible for someone in the healthcare field to refuse certain vaccines, only because you can so easily and directly pass disease onto patients. Nosocomial disease is already so high, the least we can do is get vaccinated and wash our hands.

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Some vaccines in particular are less about benefiting the individual than benefitting the immunocompromised people in the community. It is an individual's choice if they want to take the risk of getting polio, the flu, or tetanus (well... except with polio; that's your parents' choice), but if you choose not to get any vaccines, you can be a healthy carrier and pass them onto people who will not survive an infection.

This.

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not really part of the debate, but relevant to the immunisation thang......I was very shocked at work (in a large acute hospital) when I heard that our infectious diseases / antibiotic pharmacist was not getting the H1N1 vaccine and more so that she was recommending that other pharmacists at work don't get it either!
Working on an acute admissions unit, exposed to all types of patients I got the vaccine and she asked me why I felt I needed to. Hmmm.

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not really part of the debate, but relevant to the immunisation thang......I was very shocked at work (in a large acute hospital) when I heard that our infectious diseases / antibiotic pharmacist was not getting the H1N1 vaccine and more so that she was recommending that other pharmacists at work don't get it either!
Working on an acute admissions unit, exposed to all types of patients I got the vaccine and she asked me why I felt I needed to. Hmmm.

That's very unfortunate.  Pharmacists are great with the drugs.  Surprise.  That's what they do.

However, pharmacists are not trained in pathophysiology... or physiology... or microbiology/infectious disease.

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can I just point out we all die at one point or another?

And the way inwhich someone dies is, to some extent, their choice? If I die because I decide not to get a vaccine then so be it. If I was stuffing handfuls of bad food into my face and had a heart attack or a stroke. I would probably deserve it. If I get lung cancer because I was a smoker, thats my fault. Also, getting really bad flu symptoms that turn into something else and say I cough up blood, if I'm stupid enough not to go to a doctor and die because of it.

You know what, that was probably my fault! I think people need to worry a little more about educating people on the truth about h1n1 and not the hype you get from the media frenzy. And to me, however you look at it, requiring someone to put something in their bodies that they don't want their is WRONG. Reguardless of it being "safe" or not. There are some people out there who cannot get vaccines. I am one of them, they make me extremely sick. The last time I was "highly suggested" to get a vaccine, I got it and almost died from it. Its my choice if I want to or not, not someone else who doesn't know my body like I do.

And if it comes down to the right to be a citizen and required to get it done, well ship me to another country then, I hear Europe and Canada are nice. And hell I speak some spanish so mexico and spain would be okay too!

Now you may say "you're missing the point" and you know to you maybe I am but I think we should all just agree to disagree on certain things.

My ranting is done now  :)>>>

Most people disagree with you... including most who support universal healthcare.  The idea of universal healthcare is that you should be able to do whatever you want to your body and still have the ability to see a physician or surgeon to fix you up.

For me. I don't think people understand the risks they're taking.  I can't tell you how many people roll into the hospital with their COPD and 20 pack year habit of cigarettes.  Or... the people who stop buying their meds in order to buy crack cocaine.  Guess what.  They still get sick and present to the emergency department, and the hospital usually has to take the hit, because they oddly enough don't qualify for Medicaid or the cost is so huge that Medicaid's puny reimbursement can barely dent the million dollar work up for crushing chest pain in the left 5th dermatome + 10 out of 10 headache + focal neurological deficits.

There's a little thing called EMTALA.  If someone sick presents to the emergency department, the physicians in the ED have to stabilize the patient independent of insurance status.  People know this.  Dialysis is expensive in some places.  In fact, some people have figured out that flying to the US and presenting to the emergency department with a K of 7 is an easy and cheap way of getting the dialysis they need.

Do you have an undocumented egg allergy?

Move to Canada?  Stuff White People Like #75:
http://stuffwhitepeoplelike.com/2008/02/24/75-threatening-to-move-to-canada/

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not really part of the debate, but relevant to the immunisation thang......I was very shocked at work (in a large acute hospital) when I heard that our infectious diseases / antibiotic pharmacist was not getting the H1N1 vaccine and more so that she was recommending that other pharmacists at work don't get it either!
Working on an acute admissions unit, exposed to all types of patients I got the vaccine and she asked me why I felt I needed to. Hmmm.

That's very unfortunate.  Pharmacists are great with the drugs.  Surprise.  That's what they do.

However, pharmacists are not trained in pathophysiology... or physiology... or microbiology/infectious disease.

ummm, ID pharmacist - very well trained in micro/ID. Many of our ID doctors has said that she probably knows more about microbiology than they do.  And yes we do get basic training in physiology and pathophysiology otherwise we can't understand how the drugs work completely.

Anyways, back to the original topic......

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not really part of the debate, but relevant to the immunisation thang......I was very shocked at work (in a large acute hospital) when I heard that our infectious diseases / antibiotic pharmacist was not getting the H1N1 vaccine and more so that she was recommending that other pharmacists at work don't get it either!
Working on an acute admissions unit, exposed to all types of patients I got the vaccine and she asked me why I felt I needed to. Hmmm.

That's very unfortunate.  Pharmacists are great with the drugs.  Surprise.  That's what they do.

However, pharmacists are not trained in pathophysiology... or physiology... or microbiology/infectious disease.

ummm, ID pharmacist - very well trained in micro/ID. Many of our ID doctors has said that she probably knows more about microbiology than they do.  And yes we do get basic training in physiology and pathophysiology otherwise we can't understand how the drugs work completely.

Anyways, back to the original topic......

I stand corrected.  Then it's actually terrible that this pharmacist is not getting vaccinated.

"Basic training" in physiology and pathophysiology is different from being "trained" in it.  I have "basic training" in psychiatric medicine.  I'm not "trained" in it.

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faylinameir, I think your "survival of the smartest, let the stupid ones die off" mentality is really twisted and disturbing.  If anything, one of the functions of government is to ESPECIALLY protect people who lack common sense or who have some block that prevents them from making good decisions (lack of knowledge or resources).  That's why we have seatbelt laws and helmet laws.  The notion that people should be punished for lack of education, or even lack of common sense (which is another form of lacking education) is really, really sad to me.  If anything, they need guidance and assistance the most.

Second, if vaccines make you deathly ill, obviously you would not be required to get one.  No one is going to force you a vaccine that would kill you!  Be realistic.

If Jane Doe decides she's not going to get the vaccine, and she carries the virus and passes it to me, and I have a compromised immune system and die, then Jane Doe is determining how I die.  This is in direct contradiction with what you are saying, fay.

My school required the meningitis vaccine.  I'm glad! Meningitis is serious and not something to mess around with.  

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faylinameir, I think your "survival of the smartest, let the stupid ones die off" mentality is really twisted and disturbing.  If anything, one of the functions of government is to ESPECIALLY protect people who lack common sense or who have some block that prevents them from making good decisions (lack of knowledge or resources).  That's why we have seatbelt laws and helmet laws.  The notion that people should be punished for lack of education, or even lack of common sense (which is another form of lacking education) is really, really sad to me.  If anything, they need guidance and assistance the most.

Second, if vaccines make you deathly ill, obviously you would not be required to get one.  No one is going to force you a vaccine that would kill you!  Be realistic.

If Jane Doe decides she's not going to get the vaccine, and she carries the virus and passes it to me, and I have a compromised immune system and die, then Jane Doe is determining how I die.  This is in direct contradiction with what you are saying, fay.

My school required the meningitis vaccine.  I'm glad! Meningitis is serious and not something to mess around with.  

I don't fully agree with this but, I agree about liberty.
The state should be there in a liberal democracy for the people, for every person. Protecting their legal rights, whatever they may be, which should be based upon what society see's fit in a way that doesn't discriminate against people. There should be no minorities at risk because they're a minority in a liberal society.

This goes down to an individual.

Education should be for all. And in people should have the ability to be in education unless they're in a mental state the stops them from being able to benefit from that. Not always a clear line, but my Grandfather's lost it completely, altzimers? or one of the ones similar to that. To put him in education would be absurd.

I believe there should be an opt in universal health care. I think per person the US spends either the most or close to the most on health care? Yet it's ranked very low in comparison to most of the developed world.

More-over I also believe people should be able to do what they want with their body's.

The reason universal healthcare can work is because if you go into a GP here, you don't get charged, you can check symptoms early, you can stop things in the early stages, which is almost always cheaper.

If someone decides they don't want the injections then that should be there decision. If they get it, and you get it from them, depending on the circumstances I wouldn't necessarily hold them accountable. If they knowingly had it and locked you in a room with them then yes, I would hold them accountable for killing you. Aside from obvious motive there's also no way you can avoid that.
On the other hand if it's because they've passed you on the street, not only is it hard to tell if it really was them or someone else that's given it to you, but also *I'd argue it was your decision to take the risk to go out.

With regards to punishment I take what I've read from Bentham about it. People should only be punished to stop them from harming someone or something directly. Rehabilitation should always be looked into.

Anyway, that's some basic views of mine. I bet most will disagree with *.

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Well, I'm not interested in living in a society where the only recourse for not getting a hideous communicable disease is to quarantine myself.  In that case I would argue that the government has failed.  There are options which prevent this.

To add on to what fay said--I think smoking is an apt analogy.  Johnny has a right to smoke 10 packs a day until he dies.  BUT, I have a right NOT experience his second hand smoke.  This is exactly parallel.  Johnny has a right to inject himself with H1N1 and die.  He doesn't have a right to go around putting other people at risk.  Putting yourself at risk for H1N1 can't really be done without putting others at risk, by its very nature.

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Well, I'm not interested in living in a society where the only recourse for not getting a hideous communicable disease is to quarantine myself.  In that case I would argue that the government has failed.  There are options which prevent this.

To add on to what fay said--I think smoking is an apt analogy.  Johnny has a right to smoke 10 packs a day until he dies.  BUT, I have a right NOT experience his second hand smoke.  This is exactly parallel.  Johnny has a right to inject himself with H1N1 and die.  He doesn't have a right to go around putting other people at risk.  Putting yourself at risk for H1N1 can't really be done without putting others at risk, by its very nature.

So then the individual must have his or her liberties taken away by the state for the sake of society.

Let us say that Jonny has a fear of needles, believing that he's more likely to get certain diseases from using needles.
He is however forced by the state, despite his objections, to receive an injection to stop him from getting swine flu. This results in Jonny getting aids. Should Jonny really have had to put his preferences and rights over his own body aside for the state?

Now let us say that 51% of the population do want to have the injection, bu out of that only half of them can (about 25% of the population). Should the 49% when they eventually can be forced to get the injection?

What about if we inverse that, should due to the 2% difference anything really change? I mean 2% is a low figure.

Should we have in cases of individuals rights of their body what they can or can't do with their body forced upon them by the opinion and preference of others?

What about if we take it to abortion, let us say that 51% of America believes that abortion is wrong because the unborn baby is alive. Where life begins is of course a complex issue, but lets just take it for granted that these 51% have thought things well fairly well, and it is a difference in moral thinking, not in logic, that has lead to this opinion. Should the women of the 49% not be allowed to have abortions?

Whilst the 51% aren't at risk from it, what about them advocating the babies interests to remain living. In the same way many of us do with animal rights.

I feel I should also state that personally I'm pro choice.

In a similar situation if the view isn't well thought out and the 51% actually believe that by you having an abortion you will heighten the whole countries chances of going to hell (for whatever reason they don't believe God judges individuals but societies as a whole), should be allowed to dictate to you what you do or don't do to your own body?

Going back to my original point, where can we draw the line? If it is more likely that I will get a certain disease by not getting an injection. But at the same time that there is a 1/3 chance that I will have a bad, potentially fatal reaction, to the injection, would that be acceptable to force upon me?
Where statistically do you draw the line.
Note: I’ve not said the particular injection is good or bad in the main case, this one is hypothetical, but perhaps that I have a fear of needles. This is therefore particularly different in where the fear of risk lies. However at the same time there is clearly an issue of individual rights pitted against society as a whole.

Sorry if this post isn't as coherent as you would like, there's a problem with the browser meaning that everytime I type the text box jumps up and down.

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If someone is getting AIDS in the process of getting a flu vaccine, we have bigger problems.  
If there is a 33% chance of severe adverse effects from a vaccine, we have bigger problems.

And brevity works wonders.  I can barely digests your posts because the length is so disproportionate to the content.  You have maybe three main points there but you wrote 11 paragraphs.  Oy.

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If someone is getting AIDS in the process of getting a flu vaccine, we have bigger problems.  
If there is a 33% chance of severe adverse effects from a vaccine, we have bigger problems.

And brevity works wonders.  I can barely digests your posts because the length is so disproportionate to the content.  You have maybe three main points there but you wrote 11 paragraphs.  Oy.

You're having trouble reading and understanding about 650 words written in basic and simple words?
Like hell.

I'm talking about hypothetical situations relating individual rights to this social problem.
To jsut say "we have a bigger problem" misses the point.

And 3 points with how I came to think of them, or apply them, so on so forth, in less than 900 words (300 each) is fair enough to write.
I haven't written  masses.
Either reply to what I put up, make conversation, or make another point. don't just winge, it stops debate.

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Well if you want to choose to communicate ineffectively, go ahead.  Individual rights and all.  But this isn't a college philosophy class.  No need to write a term paper.  We're writing for a different purpose here.

Your posts aren't difficult to comprehend, they're just not pleasant to read.  

I'll expand because I guess that wasn't clear:  No one is getting AIDS from vaccines.  1/3 of vaccinated people aren't dying from vaccines.  If that were the case, then this discussion would hardly be pressing or appropriate, because there would be larger problems to solve regarding vaccines.  We do not have these problems.  You are trying to make a case using theoretical scenarios.  I think that is a poor debate strategy.  I'm interested in the implications for society NOW, not some fictional society that you made up.

Is that crystal clear?

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Well if you want to choose to communicate ineffectively, go ahead.  Individual rights and all.  But this isn't a college philosophy class.  No need to write a term paper.  We're writing for a different purpose here.

Your posts aren't difficult to comprehend, they're just not pleasant to read.  

I'll expand because I guess that wasn't clear:  No one is getting AIDS from vaccines.  1/3 of vaccinated people aren't dying from vaccines.  If that were the case, then this discussion would hardly be pressing or appropriate, because there would be larger problems to solve regarding vaccines.  We do not have these problems.  You are trying to make a case using theoretical scenarios.  I think that is a poor debate strategy.  I'm interested in the implications for society NOW, not some fictional society that you made up.

Is that crystal clear?

But the issues I'm raising are that there can be conerns for the individual that society as a whole my no care about. And that is why I posed this hypothetical situations. Because if you're going to say we should force the individual to do x or y, where do we draw the line, where do we give power and authoity to the individual over their own body. Philosophy does come into this unsprisingly. The issues I've raised directly effect whether or not people should be forced to take the immunizations.

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Well, I'm not interested in living in a society where the only recourse for not getting a hideous communicable disease is to quarantine myself.  In that case I would argue that the government has failed.  There are options which prevent this.

To add on to what fay said--I think smoking is an apt analogy.  Johnny has a right to smoke 10 packs a day until he dies.  BUT, I have a right NOT experience his second hand smoke.  This is exactly parallel.  Johnny has a right to inject himself with H1N1 and die.  He doesn't have a right to go around putting other people at risk.  Putting yourself at risk for H1N1 can't really be done without putting others at risk, by its very nature.

So then the individual must have his or her liberties taken away by the state for the sake of society.

Let us say that Jonny has a fear of needles, believing that he's more likely to get certain diseases from using needles.
He is however forced by the state, despite his objections, to receive an injection to stop him from getting swine flu. This results in Jonny getting aids. Should Jonny really have had to put his preferences and rights over his own body aside for the state?

Now let us say that 51% of the population do want to have the injection, bu out of that only half of them can (about 25% of the population). Should the 49% when they eventually can be forced to get the injection?

What about if we inverse that, should due to the 2% difference anything really change? I mean 2% is a low figure.

Should we have in cases of individuals rights of their body what they can or can't do with their body forced upon them by the opinion and preference of others?

What about if we take it to abortion, let us say that 51% of America believes that abortion is wrong because the unborn baby is alive. Where life begins is of course a complex issue, but lets just take it for granted that these 51% have thought things well fairly well, and it is a difference in moral thinking, not in logic, that has lead to this opinion. Should the women of the 49% not be allowed to have abortions?

Whilst the 51% aren't at risk from it, what about them advocating the babies interests to remain living. In the same way many of us do with animal rights.

I feel I should also state that personally I'm pro choice.

In a similar situation if the view isn't well thought out and the 51% actually believe that by you having an abortion you will heighten the whole countries chances of going to hell (for whatever reason they don't believe God judges individuals but societies as a whole), should be allowed to dictate to you what you do or don't do to your own body?

Going back to my original point, where can we draw the line? If it is more likely that I will get a certain disease by not getting an injection. But at the same time that there is a 1/3 chance that I will have a bad, potentially fatal reaction, to the injection, would that be acceptable to force upon me?
Where statistically do you draw the line.
Note: I’ve not said the particular injection is good or bad in the main case, this one is hypothetical, but perhaps that I have a fear of needles. This is therefore particularly different in where the fear of risk lies. However at the same time there is clearly an issue of individual rights pitted against society as a whole.

Sorry if this post isn't as coherent as you would like, there's a problem with the browser meaning that everytime I type the text box jumps up and down.

It's always the case in communities that individual rights must be weighed against the greater good.  Why do we have taxes?  A welfare state?  Why do we have a progressive tax, which some people argue penalizes success?  It's because individuals have to hold up their share of society.

You're talking about a very big issue in medicine: can people really make informed decisions about their health without knowing anything about it?  The pendulum has swung away from the physician as patriarch/matriarch model and towards patient-centered care.  Is that necessarily a good thing?  Very few patients actually truly understand their diseases (80% Left Main occlusion, Cushing's disease... these words mean nothing to the lay public) and the very idea of informed consent is probably a myth.  Regarding that, do you really think mass public health decisions should be made by referendum?  That would be disastrous.  That's why it's not done.

Side note: a person gets HIV from an exposure (very unlikely in an area with disposable needles) not AIDS.  A person only gets AIDS after the CD4 count drops below 200 or gets an AIDS-defining illness.

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sunbeam, I'm not interested in where we draw the line.  If present conditions appear to encroach on that hypothetical line, then we should re-evaluate.  Right now the conditions are pretty stable--if anything, they are moving the opposite direction from what you suggested.  Sanitation and vaccines are better and better all the time.  I understand the analogy, but we aren't building a society from scratch where we have to worry about those scenarios.  

I'm not saying your theoretical analysis isn't academically valid, I just think it has no applicability or use to us.

Also, we live in a finite, real world, and lines ARE drawn.  When engineers build structures, they include a certain safety factor which quantifies that there is X% chance that the structure will fail.  That factor is arbitrary, to a great extent.  We wouldn't abandon the entire structure because there is some minute chance that it will fail and people will die.  Likewise, we don't abandon vaccines because there is some minute chance that people will die.  The real world has finite, arbitrary cutoffs.  It has to.  We can move the cutoff points as things improve, but they will always exist. 

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