You can’t go wrong with the evidence

As I think of moving on to the next thing in my career as an epidemiologist and into public health policy, I have been thinking of what kinds of challenges I’ll face when I make the leap. If you know me, you know that I absolutely cannot stand politics and politicians. I hate that they are willing to say — or do — anything and everything so long as they stay in power. They’ll lie, cheat, and steal, and then deny that they did even in the face of convincing evidence against them.

See, in their silly little minds, they think that they are being “Mavericks” or “Win-at-all-costs Winner” by systematically doing things that are very “questionable” in order to retain their elected position. And it’s not just the elected politicians, either. I’ve met plenty of non-elected people in power who will also go to great lengths to stay in power. They will go along with a horrible plan, even one that they know is horrible, and then not criticize that plan once it is agreed that it was horrible.

So one of my weaknesses in going into public health policy will be my willingness to admit when I’ve made a mistake and the sense of urgency I feel in correcting it. Now, some of you may think that I’m just blowing my own horn by saying that I am self-aware enough to admit my own mistakes — the kind of attribute reserved for historical figures. But I really am not. If anything, admitting my own mistakes has gotten me in trouble when I’ve uncovered mistakes made by me when others would have never found them.

The one big thing I hate to carry around is guilt. I really don’t like it. Ask Pedro. She can detect the slightest hint of guilt on me and make me confess to anything that I’ve done. So it’s going to be hard to be in politics when I am prone to admitting my own mistake. Although, to be honest, I have no interest in being a politician. I’ll just be working with them. But some of them are going to be my bosses, and anything I say or do will be interpreted in light of the day’s politics. This is going to lead to conflict and frustration.

Then again, you can’t go wrong if you have all the science and all the evidence on your side. Even if you make a huge mistake, as long as you did what you did with all the available information and evidence on your side, you really should be in the clear. I’m no mind reader, no fortuneteller. So, if I base the things I will do in public health policy on stuff that has been proven to work, then I should be okay.

Still, I’m sure I’ll find a way to get in trouble.

Advertisements

We, Pharma Shills

There is a particularly petulant internet troll cruising some pro-science and pro-vaccine blogs and websites who has done two things to really scare the crap out of me. Number one, he once wrote that what is bad for public health is good for him. Number two, he keeps accusing people who work in public health of just being paid-off or even outright employees of pharmaceutical companies. “Epi Ren” once took him to task over his comment about public health. So let’s look at his conspiracy theory that public health workers are in the pockets of “Big Pharma”.
To believe that conspiracy, you first have to believe that vaccines are profitable to pharmaceutical companies. See, the cost of the vaccine schedule ranges from free (when subsidized by the government or a charitable organization – or pharmaceutical companies themselves) to a few hundred dollars. For that amount of money, you get to be protected from diseases that will cost thousands if not hundreds of thousands of dollars to treat. For example, hepatitis B is a chronic infection that may even end up costing you your liver. Do you know how much a transplant goes for? Not only that, but how much is the immune-suppressive therapy to keep you from rejecting the organ?
That cost is much more than vaccines.
So, to believe the conspiracy, we have to believe that pharmaceutical companies do not want to make money from drugs for transplant patients, antibiotics for meningitis and other bacterial infections, antivirals for influenza or rotavirus, or supportive drugs for those on life support or in assisted/nursing care. No, no, no… No, they want to make money from vaccines that prevent all of those things.
Check out this awesome webpage explaining the costs of treating vaccine-preventable diseases from my friend Todd W: http://antiantivax.flurf.net/costs
Alright, so let’s say that vaccines are somehow profitable to pharmaceutical companies. How much money do they pay out to their “employees” to push vaccines on the population? To answer that question, we would first have to see who is involved in this conspiracy. I’m only going to cover the United States for this exercise. Alright, so there are 50 states and several territories in the United States. Let’s look at the States.
In every State, there are three branches of government. To pass a bill requiring immunizations, all three branches of government have to agree to the bill – or at least two of three if the legislature can override an executive veto. So “Big Pharma” has to have a majority of legislators at the state level, the executive, and a majority of the courts in their pockets. How much do they charge? How much money would you take to pass a bill that “pushes” vaccines to people only for the profits of the drug companies? Me? I wouldn’t settle for anything less than a cool million dollars, or two, or three… I’m a greedy bastard, yes, but it would mean the end of my political career if this is ever found out. I’d want to have a nice, comfortable parachute for a soft landing into an island in the pacific.
But it doesn’t stop there. You’d have to pay-off some of the politicians’ staff members. I mean, the politicians don’t do their jobs all by themselves, do they? They have secretaries, assistants, go-fers. All of them would have to be paid off lest they run to their blogs or to wikileaks with information on the conspiracy. Would they settle for less than their bosses? Maybe, but I wouldn’t trust human nature that much.
Alright, so that takes care of the decision-makers, what about the implementers? In every State, there is a Department of Health headed by a Health Secretary. Then you have their deputies, their deputies’ assistants, the State Epidemiologist, the epidemiologists, their assistants, the community health nurses, their assistants, and every other person involved in telling the public about the vaccines and giving them to the community. Not only that, but then you have to pay-off all the people at the local level who will actually, physically give the vaccine to the people.
Does the conspiracy go that deep?
Maybe not, but those people at the “bottom” of any State’s public health system are not stupid. They read – get this – scientific papers and know about the benefits and risks of vaccines. They would be able to smell a rat – and bullshit – and say something about it. At least some of those people would need to be paid off. So multiply all that times the number of local health departments in the country and then times the number of States in the Union, and you begin to see the huge investment “Big Pharma” must be making in promoting “the lie” that are vaccines, according to anti-vaccine groups and people.
Ah, but a good conspiracy would not stop there, would it? Big Pharma would have to pay an overwhelming majority of healthcare providers (MDs, DOs, PAs, NPs, Nurses) and allied health professionals (Medical Technicians, Respiratory Therapists), and basically everyone else who has seen the evidence of vaccines and promotes them.
So how much money would go into that? And would it be covered by the few hundred bucks per person in the United States? Of course not.
Then again, like good conspiracy nuts, they will say that you only need to have a few key people in your pocket and fool the rest of the people. That is also a stretch. You’d need to fool all of the scientifically-inclined people in the world. You’d have to fool doctors at all levels who agree that vaccines are quite the public health intervention. You would also have to fool law enforcement and those over-eager prosecutors. You’d even have to fool investigative journalists who are always looking for some juicy story to sell. What better story than “VACCINES DON’T WORK, ACTUALLY DEADLY”?
Seriously. Tell me.
But that will not stop the anti-vaccine groups from playing what is called the “Pharma Shill” gambit, where they accuse everyone and anyone of being an “employee” of the pharmaceutical industry if they should happen to support vaccines. In “The Poxes”, you will read over and over again how this accusation is used to place doubt in the hearts of many people looking for answers about what happened in the first chapter. See, it’s been my experience that anti-vaccine people will rabidly attack first during a time of crisis. Just ask the parents of that child in Australia who died from whooping cough. Not only did they have to deal with the death of their child, but they also had to deal with harassment from an anti-vaccine person who wanted them to claim the child did not die from pertussis.
In their universe, there is more than enough money to pay everyone off, except them. Also, vaccine-preventable diseases do not kill anyone. In real life, and in “The Poxes”, they do kill, and maim, and bring the world to its knees.