Tuesday, October 29, 2013

Mandatory flu shots just plain wrong for hospital staff and visitors - flawed science, high cost, low efficacy, intrusion into personal health

Soon, BC hospital staff and visitors must either get vaccinated for the flu or wear a mask at all times. And that's just plain wrong.

Flu shots are ineffective 41% of the time, on average
Bill Tieleman’s 24 Hours Vancouver / The Tyee column

Tuesday October 29, 2013
By Bill Tieleman
We simply don't have good evidence that vaccination of healthcare personnel prevents influenza transmission to patients."
When flu season starts, mandatory flu shots or wearing a mask will be required not only for hospital and care home staff in British Columbia, but visitors as well.
And that's just wrong.
Wrong on the science. Wrong on the approach to healthcare workers, including doctors and nurses. Wrong for the intrusion into people's personal choices about their own health. And wrong on the hundreds of millions of dollars spent by both governments and individuals on vaccinations that fail at least 41 per cent of the time, perhaps more.
But starting around December, neither visitors nor workers will have a choice -- you will take the shot or wear a mask if you are in a hospital or care home.
Visitors who refuse could be blocked from entering -- but workers could be fired, after an arbitrator rejected healthcare unions' objections last week.
"We're expanding our policy to visitors," B.C. provincial health officer Dr. Perry Kendall told media last week, saying everyone visiting hospitals or long-term care facilities should either have had a flu shot or wear a mask.
London, Ontario hospitals will enforce the same choice and others will likely follow, according to that province's health promotion agency.
But the science behind both flu shots and masks is simply nowhere near good enough to make such a draconian decisions on our rights.
Flawed flu studies
Start with the fact that most studies on flu shots are flawed, according to the Center for Infectious Disease Research and Policy at the University of Minnesota.
"Applying very strict criteria to filter out potential bias and confounding, a U.S. research team sifted more than 5,000 studies and found only 31 that they felt provided reliable evidence about the efficacy and effectiveness of flu vaccines. The findings were published online today by Lancet Infectious Diseases," it found.
One of Canada's most prominent infectious disease specialists agrees.
Dr. Michael Gardam argued in the Canadian Medical Association Journal that flu vaccine is only modestly effective and making shots mandatory could lose in court.
"Any sort of policy decision where you're going to make a vaccine mandatory is going to be an uphill battle, right? It's going to be a real fight. And so you have to decide if you're going to make that fight, is this vaccine worth it to make that fight? And I personally don't think it is," said Gardam, head of infection control at Toronto's University Health Network. Gardam himself is in favour of the vaccine and gets a flu shot.
Professor Nick Kelley, who is also pro-vaccine, points out that new analysis of past studies shows that the flu shot is no cure-all for healthcare workers.
"We really don't have a good grip on the epidemiology of influenza in the healthcare setting," Kelley said.
Kelley added that even if hospitals achieved 100 per cent vaccination rates for staff, there would still be a 41 per cent failure rate for the flu shot, leaving patients vulnerable to infection from sick workers.
Vaccination no fail-safe solution: US union
In B.C., the Health Sciences Association, the Hospital Employees Union and the BC Nurses Union all oppose mandatory flu shots for members, while still supporting voluntary immunization.
"Crucially, there is simply no evidence to support the assertion that vaccination of healthcare workers will prevent the transmission of influenza to patients," Lindsay Lyster, the HSA lawyer who argued the arbitration for the unions, told CBC Radio.
National Nurses United, the largest U.S. organization of nurses, also opposes mandatory flu shots.
"Nurses, joined by many physician organizations and researchers, reject the notion that vaccination is a fail-safe solution to prevent the spread of the flu virus," said co-president Karen Higgins. "We oppose forced vaccinations or the related mandate that those who decline the shots must wear masks or risk losing their jobs."
Higgins said the science simply doesn't support it.
"A 2005 National Institute of Allergy and Infectious Diseases study over 20 years found no correlation between increased vaccine use and a decrease in deaths," Higgins argued.
Professor Nick Kelly summed it up succinctly on Twitter last week: "Overstating the data on flu vaccines is shooting ourselves in the foot... reduces the need for innovation & confuses public."
Let sick workers stay home
National Nurses United promotes a better solution to preventing flu: make sure all workers can take sick time when they need it.
The organization cites a American Journal of Public Health study in 2011 that estimated that lack of sick time helped spread five million cases of illness during the 2009 swine flu outbreak in the U.S.
In the U.S., private healthcare companies would rather vaccinate than grant sick time or take additional preventive measures to reduce the spread of disease.
"Too many hospitals whose mantra is profits, not patient safety, favour forced vaccinations while cutting nursing or housekeeping staff, and denying paid sick leave," Higgins said.
The alternative to a flu shot -- wearing a mask at work in a hospital or during a visit -- is also of dubious medical value.
"Very little information is available about the effectiveness of face masks and respirators in controlling the spread of pandemic influenza in community settings," a U.S. government document reported.
For many healthcare workers, wearing a mask all day is irritating and gets in the way of developing an interactive relationship with their patients.
There are obvious occasions where a mask is required, as well as other protective gear and precautions.
But a blanket policy seems more designed to force workers to get a flu shot and punish those who refuse. It will also cause patients and co-workers to potentially shun those who wear masks while feeling falsely secure with workers who don't.
There are clear alternatives short of demanding healthcare workers be forced to have a flu shot or be fired. The famed Mayo Clinic's policy is that staff who don't want to take a flu shot must sign a statement that explains why. It has a 90 per cent vaccination rate.
Immense expense
Lastly, flu shots are an immense expense for both governments and individuals.
The cost of flu vaccines in Canada alone is likely more than $100 million, according to Dr. Danuta Skowronski of the B.C. Centre for Disease Control.
Those at particular risk, such as the elderly or those with chronic illnesses, can get a free flu shot, as can healthcare workers -- but for others it can cost between $20 to $30 per person. That adds up to a lot of revenue for drug companies.
Dubious scientific evidence, heavy-handed government intervention, high costs for low results, healthcare professionals' opposition and an intrusion on personal freedom all add up to one conclusion: "mandatory flu shots or else" is just plain wrong.


Tuesday, October 22, 2013

Latest in Conservative Rejections of Science: Ban on Prescription Heroin by Health Minister Rona Ambrose

Treatment proven to help hardcore addicts shunned by our evidence-averse Tory government.

Bill Tieleman’s 24 Hours Vancouver / The Tyee column
Doctor-prescribed heroin
Tuesday October 22, 2013
By Bill Tieleman
"I think it's ethically quite dubious to withhold access to a scientifically proven treatment." 
The science supporting doctor-prescribed heroin for severe addicts is strong, including extensive medical reports from six countries in tests involving over 1,500 patients.
But for the federal Conservative government, ideology will always be grounds to reject science, research, evidence and experts.
The latest example? Health Canada recently approved a pilot research program in Vancouver involving just 16 hardcore heroin addicts who haven't yet found help through either methadone treatment or residential rehabilitation. For the study, medicinal heroin was to be prescribed and safely administered by doctors.
The goals: improve addicts' health, reduce criminal activity, cut harm from street drugs, and potentially give them a chance to eventually kick heroin.
But once the approval came to light, Conservative Health Minister Rona Ambrose flew off the handle and said no way, attacking her own ministry by news release.
"Our policy is to take heroin out of the hands of addicts, not to put it into their arms," Ambrose fumed.
That was swiftly followed the next morning by a fundraising email to Conservative Party donors, claiming Health Canada had broken "the wishes of our elected government."
And a petition appeared on a Conservative website urging signatures to "Stop giving heroin to addicts."
Can you spell opportunistic politics?

Controversial, but clearly effective
Last week's throne speech kept up the anti-science, we-know-better-than-doctors-and scientists drumbeat.
"Our government will... close loopholes that allow for the feeding of addiction under the guise of treatment," the speech read.
176-page European report 
But rigorous medical research clearly shows the troubled Tories are simply wrong.
Hardcore addicts can be helped by prescription heroin, a 176-page scientific report on the results of pilot studies in six countries involving 1,500 patients says.
Issued by the European Monitoring Centre for Drugs and Drug Addiction, the report admits that doctors prescribing heroin to severely addicted patients can at first seem "counterintuitive" and "controversial" but the results are clear.
"Internationally, a number of experimental projects using robust research designs have been beginning to suggest that for some of those failing to respond to other approaches, the use of diamorphine as a substitution medicine may be an effective way forward," it says.
"This is not simply a case of giving heroin to heroin addicts. Rather, studies have looked at the use of heroin as part of a highly regulated treatment regime, targeting a particularly difficult-to-treat group of patients," it continues.
Mixing poppies with politics
But science be darned -- that's the view of right-wing strategists like Rod Love, a federal Conservative supporter and political consultant who was ex-Alberta premier Ralph Klein's right-hand man.
I debated Love and National Post columnist Barbara Kay on CBC Radio's The 180 with host Jim Brown and the results were eye-opening.
Here's one exchange, after I pointed out that just 16 addicts had received Health Canada approval for prescription heroin before Ambrose vetoed it and that the European studies results were scientifically solid:
Rod Love: "What the minister said clearly was that so it's only 16 -- it is inconsistent with the government's anti-drug policy in her opinion and she makes the decisions in this respect, not some report from Europe with..."
Bill Tieleman: "Doctors and scientists?"
Rod Love: "Yeah."
Bill Tieleman: "We don't want doctors and scientists telling this government what to do. They don't listen to scientists anyway, Rod, we've already proved that over and over on the environment!"
Barbara Kay: "I think that when you introduce these 'It's only for a very tiny group of people' -- it's the same thing that they said with euthanasia -- it's only for a very tiny group of people. Now in Belgium they're like, you know, euthanizing 14 year olds for depression.
"I think this is a slippery slope and the ideology behind it is the wish to legalize hard drugs. This is a gateway opening towards that."
Bill Tieleman: "If your values trump my science, I don't want to see that, I don't think that's correct... if the science proves and the doctors say it's working, we should listen to them and not to ministers doing it for political reasons."
Fortunately, others are taking on Ambrose's kneejerk approach.
BC Liberal Health Minister Terry Lake: "We're reluctant to close the door on innovation and creativity when it comes to tackling these very challenging problems. We have to think out of the box sometimes… I know that the thought of using heroin as a treatment is scary for people, but I think we have to take the emotions out of it and let science inform the discussion.
Respected Vancouver medical doctor and author Gabor Mate in an open letter to Ambrose: "In the absence of medically provided heroin in a safe environment, such unfortunate individuals will continue to seek illegal sources of drugs, potentially impure, and inject them under frequently unsafe circumstances. The resulting illness, overdose, and deaths are surely not outcomes you would desire."
And B.C.'s provincial health officer Dr. Perry Kendall: "This is an accepted treatment practice in several advanced countries in the world. And I think it's ethically quite dubious to withhold access to a scientifically proven treatment."
Of course, the Conservatives aren't objecting to another drug created with the same opium poppies that heroin comes from. Prescription morphine is used widely for the effective treatment of chronic or temporary pain by hundreds of thousands of Canadians without any Conservative objections.
In fact, one in six Canadians over 15 years of age used some form of opioid pain reliever in the previous 12 months, according to a 2011 Health Canada survey.
Which all goes to show how poppies and politics don't mix.
Prescribing heroin for heroin addicts may seem counterintuitive, but using science-based evidence should not be -- even for this Conservative government.


Thursday, October 17, 2013

Why Tom Mulcair Should Toast Provincial NDP Failures to Win in Nova Scotia & British Columbia

The 'paradox of provincial power' means federal NDP MPs' 2015 seats just got a lot safer.  
The late Jack Layton and Tom Mulcair, Vancouver, 2007 - Bill Tieleman photo
Bill Tieleman’s 24 Hours Vancouver / The Tyee column

Tuesday October 15, 2013

By Bill Tieleman

"How wonderful that we have met with a paradox. Now we have some hope of making progress."
While New Democrats cry in their beer in Nova Scotia after last week's stunningly disastrous election fall from power to third place, and in British Columbia after blowing a "sure thing" election, federal NDP leader Tom Mulcair might want to drink champagne.
That's because despite the loss of party allies, the NDP nationally almost always suffers in provinces run by NDP governments.
Indeed, the paradox of provincial power means Mulcair's NDP Members of Parliament in B.C. and Nova Scotia just saw their seats get a lot safer in the 2015 federal election.
The evidence? Look back to the watershed 1988 federal election in B.C., fought over the Free Trade Agreement with the United States brought in by Conservative Prime Minister Brian Mulroney.
The NDP in B.C. took 19 of the province's then 32 seats, leaving the Conservatives with 12 and the Liberals just one.
But in 1991, the BC NDP took power provincially under Mike Harcourt and the federal NDP went into a steep decline. The 1993 federal election saw the NDP devastated in B.C., dropping from 19 seats to just two, after two years of the Harcourt administration.
The next federal election in 1997 came with then-NDP premier Glen Clark in power for a year -- with the national party claiming just three seats in B.C.
The 2000 federal vote occurred with unpopular ex-NDP premier Ujjal Dosanjh polling in the low 20 per cent range -- and only two NDP MPs were elected.
But once the BC NDP was demolished provincially in 2001, federal fortunes quickly improved. The federal NDP took five seats in 2004, doubled to 10 in 2006, nine in 2008 and won 12 in the 2011 election.
The same paradoxical pattern plagued the federal NDP when the revered Dave Barrett led the provincial NDP to form B.C.'s first social democratic government in 1972.
The federal NDP went from winning seven of 23 seats in 1968 despite new prime minister Pierre Trudeau's popularity and 11 seats in B.C. in the 1972 national vote to just two seats in 1974.
That fall from grace came as Barrett's government implemented sweeping and at the time often unpopular changes, such as introducing public auto insurance and the Agricultural Land Reserve. They survived but the NDP government didn't.
With Barrett vanquished by Social Credit premier Bill Bennett, the federal NDP bounced back to collect eight seats in the 1979 election.
Dexter's fall
If B.C. is any example, the federal NDP in Nova Scotia would have been similarly disadvantaged by the unpopular provincial government led by NDP premier Darrell Dexter that was trounced Oct. 8, dropping from 31 seats to just seven and into third party status after only one four-year term.
It's also worth looking at the contrast between Dexter and outgoing BC NDP leader Adrian Dix.
Dexter was an affable, TV-friendly leader who seemed destined to win a second term in 2011, riding high in the polls and with a huge $25-billion federal contract to build new warships announced that would bring thousands of jobs to Nova Scotia.
But Dexter broke an NDP promise not to raise taxes, hiking the Harmonized Sales Tax by two per cent in 2010 to Canada's highest rate to deal with an inherited deficit and increasing power rates.
And after it was revealed after the shipyard deal that Nova Scotia was providing Irving Shipbuilding with a $260-million potentially forgivable loan to upgrade its facilities, the good news turned to bad for Dexter.
Add in an MLA expense scandal that began before he took office along with other local issues and presto -- no more NDP government. Embarrassingly, it marked the first time in 130 years that a government was defeated after just one term.
A fickle electorate
While Sun News political commentator Warren Kinsella, a diehard Liberal, makes the outlandish claim that the Nova Scotia election results were Tom Mulcair's fault and "wouldn't have happened if [Jack] Layton was still federal leader," the reality is that the NDP government committed political suicide unaided by the national party.
Veteran pollster Mario Canseco of Insights West also doubts Kinsella's analysis.
"I don't agree with Warren. There's been a tendency from Tories and Grits to deify Layton in an effort to make Mulcair seem weak," he said via email. "I don't think there's much anyone could have done about Dexter."
Kinsella is hardly neutral on Mulcair, calling him variously "a disgrace," "unfit to be prime minister," and "gutless."
"Mulcair can remain a more attractive option without carrying any burden from the provincial defeats," Canseco says. "B.C. shows that the federal party chose wisely by not selecting Brian Topp as leader, and aside from looking at Nova Scotia as a historic failed re-election, I see it more as a sign of a fickle electorate who have sent their government to third place twice in a row-- the Progressive Conservatives in 2009 and now the NDP in 2013."
Too moderate?
Other commentators like Tom Walkom of the Toronto Star more interestingly point to the moderate approach favoured by Dexter and proposed by Dix -- "Change for the better. One practical step at a time" -- to argue that left-wing voters were disillusioned and unenthusiastically stayed home, leading to both NDP defeats.
It's an arguable case, particularly in Nova Scotia after four years of NDP governing, but one which has to be tempered with the reality that Dix, who I supported, pledged from his leadership campaign on to raise corporate taxes, reinstitute a capital tax on financial institutions, oppose the Enbridge Northern Gateway pipeline and address social inequality. None of those positions were ever described as moderate either by the BC Liberals or business.
The Manitoba NDP experience is also telling. The provincial party is enjoying its fourth consecutive term, proving it has the campaign smarts, staying power and governing ability to succeed like the NDP previously in Saskatchewan, whereas B.C., Ontario and Nova Scotia have mostly failed.
But the federal NDP's fortunes during those four terms in Manitoba have been less than stellar, though not as roller coaster as B.C.'s. Manitoba has elected between one and four NDP MPs of its current 14 seats during the provincial party's tenure, first under Gary Doer starting in 1999 and then Greg Selinger in 2009, both regarded as moderates.
Regardless of the moderation debate -- and it's a critical one for the NDP -- what is unequivocal is that the federal NDP may have dodged two bullets in 2015's election by seeing its provincial wings in B.C. and Nova Scotia relegated to opposition, not government.