AFD Editorial Policies

 

Note: My apologies for this lengthy post in advance.

 

In response to several queries over the past few months as to why I do or don’t do specific things on this blog, I’ve decided to post my rationale for how I manage this blog.

 

Over five years, this blog (and blogger) have undergone a number of changes. Hopefully for the better - but that is for you, the reader - to judge. I’ve learned a great deal about infectious diseases of course, but perhaps even more about science blogging in general.

 

So today, if you’ll indulge me, an outline of the editorial policies I use when writing this blog, including  the sticky issue of`fair use’ of other people’s work.

 

These policies are specific to me, and and geared to address my personal strengths, sensitivities and foibles, and are not intended to be a guide for any other blogger but myself.

 

We each have our own style, strengths, and weaknesses. It would be a boring Internet indeed if we all wrote by the same rules.

 

# 5269

 

 

I have, admittedly, some fairly stringent self-imposed rules for writing this blog.  Since I serve as both author, and editor of AFD, they are the only safeguards I have to keep this 5-year endeavor from `jumping the shark’ (1).

 

Primarily, I try not to speculate, rant, or make this blog all about me. I also avoid, as much as possible, lifting more than a paragraph or two (with a link back) from any newspaper article.

 

Of course, from time-to-time, bits of these elements do sneak in. So it isn’t a complete ban.

 

But it is a goal.

 

And then there’s the tricky minefield of what to do with conflicting science, pseudoscience, politics and individual belief systems. 

 

 

A day doesn’t pass when I don’t find some idiotic news item, blog post, or nutty idea worthy of an acidic rant. The internet is, as they say, a target rich environment. And the strong, sometimes overwhelming temptation is to go after these nutbars with devilish delight.

But I’m pretty sure my small but erudite band of loyal readers don’t need me to tell them when some idea, or policy, is inane.

 

I’d be preaching to the choir. In the end, a rant would only serve to vent my own spleen.  So while I sometimes write them (it’s therapeutic!), I rarely post them.

 

Besides, if I succumbed to the temptation often, this blog would start to sound like a broken record. So I try to resist.

 

 

As far as personal speculation or bias goes, I work constantly to remove it from my writing.

 

Why?

 

Because no one should give a flip what cockamamie ideas this aging ex-paramedic might have on avian flu, virology, or any other subject for that matter.

 

When on rare occasions I do speculate, I try to clearly label it as such.  And I must feel I have at least some credible evidence to back it up.

 

Otherwise, it’s nothing more than biased dreck, and I know it.

 

My goal is to provide context and scientific evidence, not my opinion. I figure my readers are smart enough make up their own minds, without me insultingly trying to do it for them.

 

 

I also try to avoid assuming facts which are not yet in evidence.  Even if they seem `reasonable’, I side with caution.

 

Which is why, when we see suspected cases of H5N1 in Indonesia or Egypt, I don’t automatically assume them to be positive.

 

Or assume that negative results are always`false-negatives’.

 

When we see more than one infection in the same vicinity, and at the same time, I don’t instantly assume them to be the result of human-to-human transmission.

 

Yes, I know.

 

Someone else will likely be the first to declare that an outbreak has begun somewhere in the world. But since I know of no prize for being first to shout `Pandemic’ on the internet, I can live with that.

 

I’d rather be a day late and sure of the facts, than a day sooner and dead wrong.

 

Yes . . .you can always print a retraction, but Google never forgets. 

 

 

You’ve probably noticed I use colored text to segregate what I’m writing from excerpts or quotes by others (always in blue text).

 

Just another way to clarify who is saying what.

 

The subject of `fair use’ has come up a lot over the last year, and while I’ve always limited the amount of text I would lift from a news item (usually a linked headline, and a few paragraphs, followed by a second link), I’m taking even less today.

 

Over the past year I’ve tried to go with just the linked headline and no more than 1 or 2 paragraphs, along with my own summary of the news report.

 

Exceptions are generally press releases, state or official news releases, and of course, open access journal articles.

 

For other journal articles, I’ll give the citation, and some excerpts from the abstract, and then my own summary. 

 

Everything gets linked back to the source, of course.

 

My reasons are simple.

 

It’s no secret that newspapers, and journalists, are in financial trouble. And at least part of the problem is the wholesale `borrowing’ of their work, and reposting it all over the web.

 

I believe I can help them by enticing people to follow the link I provide and to read the original article with a well placed snippet or two, but I would be hurting them if I took much more than that.

 

I’ve too much respect for the talent and hard work of Maggie Fox, Helen Branswell, David Brown, Jason Gale, Lisa Schnirring, Robert Roos, David Dobbs, Maryn McKenna, and many others to ever want to scuttle their ships in order to pad my blog.

 

You’ll find that I use the very same standards when referring to another blogger’s work. And whenever I use a news item dug up by a newshound, I try to give them credit (note: I don’t use items unless linked to the original source), as well.

 

Now, I must confess that I have a personal bias when it comes to this blog.

 

I believe in promoting evidence based public health policies.

 

Unfortunately, sometimes scientific evidence is weak, anecdotal, or conflicting.  And as we all know, today’s `accepted truth’ has a bad habit of becoming tomorrow’s rejected fallacy.

 

Which is why you’ll sometimes find I write blogs like The Temporary Immunity Hypothesis and When Studies Collide (Revisited), that look at conflicting reputable scientific studies.  

 

When I do, I try not to take sides (at least not in print).

 

But when scientific evidence favoring one side is strong enough (notice I used the word `evidence’, not `proof’), I’ll side with the preponderance of evidence. Even though I know there is a chance it may be proven wrong later.

 

Why?  

 

Because the best we can do on any given day is to base our decisions on what the best evidence indicates right now, even if absolute proof is lacking.

 

As I’ve said before, if you want a guarantee. . . buy a Craftsman.

 

Which explains why I am pro-vaccination, even though I’m aware of the (minor) risks involved and the fact that they aren’t 100% effective.  And why I don’t use this blog to actively push unproven protective regimens, like Vitamin D (a frequent question, btw), even though there is some evidence that it may be effective.

 

(Personal admission: Being a `belt and suspenders’ type of guy, every flu season I use both).

 

 

Beyond that, I try not to attack anyone personally, even if I vehemently disagree with them (their ideas are always fair game, however). I also avoid dragging politics or religion into this blog like the plague, simply because I believe they polarize the audience, and distract from the science. 

 

I’ll leave that to others, better equipped and better suited, to joust with those windmills.

 

But most importantly, I try my very best not to sensationalize, or use unnecessary hyperbole when reporting on emerging threats. I believe that to do so is both irresponsible, and unprofessional.

 

And that, I think, harkens back to my years as a paramedic (yes, I’m violating the `about me’ rule here, but this whole blog post teeters on that precipice), where maintaining calm while in the midst of chaos was ingrained into us.

 

It’s why we walked (albeit briskly) at the scene of an emergency, never ran. And its how we `handled’ dealing with a dozen horrible events every day.

 

So if you detect the hint of a detached or dispassionate voice when I report on what are admittedly terrible events around the world, you now know why.  

 

There you have it.  The basic rationale I use when writing this blog.  These are my rules, for my blog, and are not meant to apply to anyone else.

 

I’ll post this on my sidebar, so that it remains available on the front page.

 

Hopefully it will have answered any questions you may have had, and now that I’ve written it down, will make it easier for me to stick to.

 

          *             *           *           *            *

 

(1)  `Jumping the Shark’ is an American idiom that goes back to the late 1970s.  It refers to an episode of the sitcom Happy Days, where Fonzie on water skis, jumps over a shark.  It was seen as a low point in the series, and a sign that the show was running out of good ideas, and on the decline.

To `jump the shark’ now means that something that was once great, has lost its way, and is on the downhill path.

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UK: 2010 Flu Vaccine Policy Debated

 

 

 

# 5182

 

 

With the UK on the cusp of what may turn into the first major flu epidemic in a decade, difficult questions are being raised about this year’s flu vaccination policies. 

 

The NHS provides free influenza vaccines to groups deemed to be at high risk from the virus, and this year that includes:

 

It is recommended you have a flu jab if you:

• are 65 or over
• are pregnant (see below)
• have a serious medical condition (see box)
• live in a residential or nursing home
• are the main carer for an elderly or disabled person whose welfare may be at risk if you fall ill
• are a healthcare or social care professional directly involved in patient care
• work with poultry (see below)

 

This is essentially a return to the pre-pandemic recommendations, based on the long standing determination that those over-65, and those with chronic health conditions, are most at risk from the influenza virus.

 

Children under the age of 5 were included (a carry over from last year’s pandemic) until The Independent Joint Committee on Vaccination and Immunisation dropped that recommendation last July.

 

Now . . .  with the HPA reporting (as of Dec. 24th) 460 people in intensive care, and 27 flu-related fatalities, this year’s vaccination policy has turned into a heated medical, scientific, and political debate.

 

The novel H1N1 virus – which since it emerged has shown a predilection for those under 65 – is once again the predominant strain of influenza in the UK (but not globally . . . go figure).

 

As a result, 89% of those in Intensive care units are under the age of 65.

 

There are now accusations being made in the media, and by some Shadow Ministers (members of Her Majesty's Loyal Opposition) that the exclusion of otherwise healthy under-5’s from the high-risk list was a cost cutting move, and ill advised.

 

It should be noted that by far, the most heavily impacted age group (based on ICU admissions) are those between the ages of 16-64 (79%).

 

Under-5’s made up about 6% of the total ICU admissions (n=26).

 

Details on how many of each group had pre-existing conditions, and would have been eligible for (or actually received) the jab, have not been made available.

 

 

Health Secretary Andrew Lansley is defending the decision, stating that their vaccination program was based based on age and risk factors and was continually under review.

 

 

This morning, a report from the BBC which includes statements by John Oxford, Professor of Virology at St Bartholomew’s and the Royal London Hospital, on our need to adapt to the changing threat from influenza.

 

 

28 December 2010 Last updated at 05:48 ET

Flu vaccine policy for children defended

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Study: Incoherent Public Health Laws And The Pandemic Response

 

 

 

 

# 4868

 

 

Few observers would deny that the world got off pretty easy with the pandemic of 2009.  As  bad as it was for some people, and as difficult as it was to manage in some regions, as pandemics go . . . novel H1N1 was relatively mild.

 

The next time, of course, we may not be so lucky.

Which is why it is imperative that we take lessons from the past 15 months, and use them to improve our response to the next global health threat.

 

We saw differing containment and mitigation responses around the world. 

 

In some regions, tough – some would say `draconian’ – measures were taken, particularly early in the outbreak. 

 

Other countries mounted a far less vigorous response.

 

These differing approaches give us an opportunity to see what worked, and what didn’t.   And reviews of that data are underway.

 

But should the next pandemic prove more severe, a more coordinated response may prove desirable. 

 

One of the major obstacles to such a coordinated response are the widely varying public health laws, regulations, infrastructures, and agencies around the world.

 

In an attempt to better understand these barriers, researchers have recently conducted a survey of the pandemic plans, policies, and public health laws of a number of European states. 

 

Representatives of 32 states were sent questionnaires, of which 23 responded. 

 

Austria, Belgium, Bulgaria, Croatia, Cyprus, Estonia, Finland, France, Germany, Hungary, Iceland, Ireland, Latvia, Lithuania, Malta, the Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Sweden and Turkey

 

We’ve an open access study appearing in BMC Public Health that calls these disparate approaches in the law and public policy `incoherent’, and cites them as a being  seriously problematic when dealing with a global health crisis.

 

Admittedly a bit data-heavy, and probably of greatest interest to  public health wonks, but this study is eye-opening just the same.

 

A few excerpts from the abstract.  Follow the link to read the study in its entirety.

 

Pandemic influenza control in Europe and the constraints resulting from incoherent public health laws

Robyn Martin, Alexandra Conseil , Abie Longstaff , Jimmy Kodo , Joachim Siegert , Anne-Marie Duguet , Paula Lobato de Faria , George Haringhuizen, Jaime Espin  and Richard Coker

BMC Public Health 2010, 10:532doi:10.1186/1471-2458-10-532

(EXCERPTS)

Methods

We undertook a survey of national public health laws across 32 European states using a questionnaire designed around a disease scenario based on pandemic influenza. Questionnaire results were reviewed in workshops, analysing how differences between national laws might support or hinder regional responses to pandemic influenza. Respondents examined the impact of national laws on the movements of information, goods, services and people across borders in a time of pandemic, the capacity for surveillance, case detection, case management and community control, the deployment of strategies of prevention, containment, mitigation and recovery and the identification of commonalities and disconnects across states.

Results

Results of this study show differences across Europe in the extent to which national pandemic policy and pandemic plans have been integrated with public health laws. We found significant differences in legislation and in the legitimacy of strategic plans. . States differ in the range and the nature of intervention measures authorized by law, the extent to which borders could be closed to movement of persons and goods during a pandemic, and access to healthcare of non-resident persons. Some states propose use of emergency powers that might potentially override human rights protections while other states propose to limit interventions to those authorized by public health laws.

Conclusion

These differences could create problems for European strategies if an evolving influenza pandemic results in more serious public health challenges or, indeed, if a novel disease other than influenza emerges with pandemic potential. There is insufficient understanding across Europe of the role and importance of law in pandemic planning. States need to build capacity in public health law to support disease prevention and control policies. Our research suggests that states would welcome further guidance from the EU on management of a pandemic, and guidance to assist in greater commonality of legal approaches across states.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

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A Hospital Is No Place For A Sick Person

 

 

# 3775

 

 

 

One of the more surprising things to come out of last week’s CIDRAP summit in Minneapolis was the group polling that indicated that Hospitals were among the least likely to make it easy for employees to stay home if they were sick.

 

Of course, I remember from my own days as a paramedic, that you had better be on death’s door before you could even consider calling in sick.   EMT’s and paramedics were a scarce resource, and since everyone was working at least a 56-hour-week . . .  trying to find someone to fill a shift was a major hassle.

 

So we worked with colds, with the flu, with aching backs, and Lord knows what else  . . . because the system required it.  And there were real (unwritten) punitive downsides to calling in sick. 

 

Of course, this was nearly 30 years ago.   One hopes that things have changed a bit in 3 decades.

 

But from what I heard at the CIDRAP Summit, and from what I hear nearly every week in emails and conversations with HCW’s (Health Care Workers), HR (Human Resources) departments in hospitals are very slow to make any changes to their policies, even in the face of a pandemic.

 

Of course, Hospitals will say they want sick employees to stay home . . . but their HR policies often run counter to that claim.

 

Sick leave for HCWs often comes out of an accrued PTO (Paid Time Off) account which combines vacation, holiday, and sick time off.  Workers accrue hours based on shifts worked, and their seniority.

 

Employees who haven’t sufficient hours `banked’ (or part-time workers who aren’t usually enrolled in PTO plans), must take unpaid leave if they fall ill.  

 

Those that do have banked time, must `burn’ vacation days even though they may have contracted the swine flu `in the line of duty’.

 

Either way, it is a decided disincentive to stay home if you are ill.

 

Live polling of the attendees at the CIDRAP conference indicated that industries other than Health Care, such as manufacturing, were more likely to give employees paid time off for the flu and for taking care of sick family members.  

 

Working sick is a bad idea in any workplace.

 

It exposes co-workers to the virus – who then can take it home to their families. It can also cause waves of absenteeism that can cripple a workplace.

 

But in the health care field, working sick can do much more damage. 

 

Infected HCWs can pass the virus on to their patients, who are often compromised and frail.   Sick HCWs are also impaired and more likely to make errors in judgment, which can endanger patients, and expose their facilities to liability. 

 

I’ve had HCWs tell me that when they try to call in sick they are sometimes urged to work `half a shift’, until a replacement can be found.   A reckless, but apparently common practice.

 

Many hospitals have `streamlined’ their operations to the point that they don’t have any `depth on the bench’.  There is also considerable peer pressure to work, even if you are sick, because if you don’t show up, someone else will have to do your job.

 

If any industry should be leading by example here, it should be the health care industry.

 

But the evidence suggests otherwise.

 

For more perspective – this time from a nurse with 30 years experience (Terri Polick) – I’d call your attention to this blog which appeared on the Nursingjobs.org website.   

 

Follow the link to read it in its entirety.  You’ll note, this was written BEFORE the pandemic virus emerged.

 

Presenteeism: Why Nurses Don’t Call Out Sick

 

February 27th, 2009  |  The Blog

It’s cold and flu season and many of my non-nursing friends are shocked when I tell them that hospitals have unwritten rules about nurses calling into work when they are sick. Sure, nurse recruiters tell new hirers that they can call in sick, but in reality, nothing could be farther from the truth. I’ve actually heard a nursing supervisor refuse to accept a nurse’s callout because there was no one that could take her place on the unit. There are consequences for calling in sick. Nurses that choose to take care of themselves when they are ill face the wrath of their employer when they return to work. Most nurses choose to work when they are sick. This scenario plays out everyday in hospitals and it’s called presenteeism.

(Continue . . .)

 

And yesterday, Crof over at Crofsblog posted an article – also on Presenteeism – which indicates that 1/3rd of American workers feel pressured to work when sick.

The curse of "presenteeism"

Via the Vancouver Sun, a good opinion piece by Craig McInnes on the unsanitary aspects of a good work ethic: H1N1: Those keeners may be the death of us. Excerpt:

A survey of American workers by the U.S. based National Foundation for Infectious Diseases a couple of years ago found that about a third of employees felt pressured to go to work despite being sick.

 

None of this bodes well for containing the spread of the H1N1 flu, which is now well-established in British Columbia. It may be that slackers and hypochondriacs are the heroes in the battle against this global pandemic. 

 

 

Whether it is due to punitive or restrictive corporate policies, financial necessity, peer pressure, or an overactive work ethic . . .  Health Care Workers are going to find themselves torn between doing the right thing and staying home when sick, and and caving into the myriad pressures and going in to work.

 

While there is no law or regulation to force them, hospitals have a moral duty . . .to their employees, to their patients, and to the community in which they operate . . . to make it easier for all employees (part time or full time) to take sick leave during this pandemic.

 

And if that isn’t enough justification, hospitals need to consider the liability angle as well.    Sick employees are more likely to make errors . . . and medical errors can be very costly.

 

While a liberal paid sick leave policy may cost some money in the short run, doing anything less is likely to end up being penny wise and pound foolish.

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